Concerned for the welfare of the state’s most vulnerable elderly and disabled residents, a Maine advocacy group has joined a federal lawsuit aimed at preserving people’s access to the medications they need while a complicated new federal drug program goes into effect.

The Maine chapter of the National Alliance for the Mentally Ill is concerned that some disadvantaged people will suffer potentially lethal problems because of confusion and delays during the initial enrollment period for the new Medicare prescription drug benefit. The enrollment period begins today and extends through May 15, 2006. Program benefits take effect Jan. 1, 2006.

About 46,000 Mainers are old or disabled enough to be covered by Medicare and poor enough to have their prescriptions paid by Medicaid, or MaineCare as the program is called here. As of Jan. 1, these so-called “dual-eligibles” will lose their MaineCare coverage and must be enrolled in a Medicare plan in order to get the drugs they need. Most already have been randomly assigned by the federal program to one of the many plans available, but advocates say problems are inevitable and potentially serious.

NAMI-Maine director Carol Carothers said Monday that without a procedural safety net of some sort, elderly, low-income Mainers with mental illness, mental retardation and other cognitive disabilities are likely to get into serious trouble when they make the forced switch from their current MaineCare prescription coverage to the more complicated Medicare program. Some may not be aware of the new requirement or may have slipped through the random assignment process, she said. Others may find themselves enrolled in plans that don’t cover the medications they need.

Carothers predicted that some seniors who fall through the bureaucratic cracks may simply stop taking the medications they need to control depression, anxiety and psychosis as well as other conditions.

“I expect it could be kind of a train wreck,” she said, adding that an extended enrollment deadline and extended federal funding of Medicaid’s prescription coverage would soften the transition.

The suit, filed Monday in federal District Court in New York, charges Secretary Michael Leavitt of the federal Department of Health and Human Services with failing to ensure a smooth switch-over for the country’s roughly 6.4 million dual-eligibles. The suit asks the court to direct Leavitt to ensure their continued access to medications while the complicated Medicare plan gets under way.

State-administered Medicaid programs now provide prescription coverage for dual-eligibles, and most recipients pay no out-of-pocket expenses. But beginning Jan. 1, they must be enrolled in one of the new Medicare drug plans in order to get the drugs they need. If the randomly assigned plan doesn’t provide good coverage for the drugs they take, enrollees may choose a different plan. But advocates say the complexity of the enrollment process is likely to discourage all but the sharpest elders.

Mike Hall, deputy commissioner of Health and Human Services in Maine, said Monday that the state will help people determine whether a randomly assigned plan is right for them and may even be able to transfer them into a more appropriate plan. Hall said it’s clear many people will have trouble comprehending their options and responsibilities under the new Medicare benefit.

While nearly everyone agrees the new benefit is hard to understand, NAMI-Maine and others bringing the lawsuit say dual-eligibles are especially likely to suffer “calamitous consequences” if they don’t get it right the first time.

Nationally, about 40 percent of all dual-eligibles suffer from some sort of mental illness or other cognitive impairment, according to the suit’s lead plaintiff, the New York City-based Medicare Rights Center. They also have higher rates of chronic illnesses such as diabetes, Alzheimer’s and cardiovascular illnesses.

In addition to their health problems, dual-eligibles face other challenges to successful enrollment in the Medicare program. Sixty-one percent do not have a high school diploma, 60 percent live below the federal poverty limit, and a significant percentage either speak no English at all or have limited English proficiency, according to the lawsuit.

Robert Hayes, former Maine resident and president of the New York-based consumer advocacy group Medicare Rights Center, said Monday that it’s inevitable that some dual-eligibles will be assigned to inappropriate Medicare plans or will otherwise get lost during the transition. That’s why it is important for the federal Center for Medicare and Medicaid Services to continue its funding of Medicaid prescription coverage until the transition is completed, he said.

“Say what you want about the drug benefit, but it should not be leaving folks worse off come January 1st,” he said. “This is a very grave situation for these folks all around the country – these are the poorest, weakest, oldest, frailest Americans.”

A spokeswoman from the Boston office of the regional Center for Medicare and Medicaid Services would not speak to the litigation directly, but emphasized that DHHS officials have worked closely with states to identify duel-eligibles and to prevent gaps in their prescription coverage. In addition, she said, pharmacists will work with customers to ensure they get the medicines they need and help them enroll in an appropriate plan.

Other parties joining the lawsuit were the New York Statewide Senior Action Council, the Coalition of Voluntary Mental Health Agencies Inc., United Senior Action of Indiana, Action Alliance of Senior Citizens of Greater Philadelphia, Massachusetts Senior Action Council and the Congress of California Seniors.

The lawsuit may be read online at www.medicarerights.org.