November 06, 2024
Column

Part D safety net helps Maine seniors

Maine has a long tradition of being responsive to the prescription drug needs of its citizens. The Medicaid program in Maine, known as MaineCare, serves more than 270,000 low-income Maine people. The Drugs for the Elderly Program was created in 1978 to serve low-income elderly and disabled people that are not eligible for MaineCare.

When Congress passed the federal Medicare Modernization Act, which created the federal Medicare Part D program, I was encouraged that Medicare recipients would finally get a prescription drug benefit under the program. However, I was concerned with Part D’s complexity and how it would impact Maine seniors on our state programs, which had been working well for a generation.

With Medicare Part D, Maine is outlawed from continuing Medicaid coverage for people that are dually eligible for Medicaid and Medicare. Now seniors would need to choose from one of 16 drug plans, each with different drugs covered and costs.

There was potential for significant confusion. In response, the state took several precautions to ensure no senior would go without their prescriptions.

On Jan. 1, when Part D started, we opened a help desk fielding questions from pharmacies and seniors who were experiencing very real problems with Part D. During that first week, we received 15,000 calls and had 60 staff working the lines.

Because of Part D enrollment problems at the federal level, Maine was the first state in the country to create a “safety net” for Part D recipients. This ensured that Maine’s seniors would continue to get the drugs they need while complications were fixed at the federal level.

We have spent millions of dollars on this safety net, but gaps in coverage for Maine seniors were avoided. After much negotiation and hard work by all, especially our congressional delegation, the federal government agreed to pay us for this expenditure.

In addition, the state of Maine is helping Maine’s lowest-income seniors afford the costs of the Part D benefit. We are helping with premiums, deductibles, co-pays, and the “doughnut hole” – the point at which Part D does not cover any drug costs until a recipient’s out of pocket costs exceed a certain amount, often occurring between $1,200 and $2,500. The state is covering 80 percent of the costs recipients incur while in the doughnut hole.

We continue to receive more than 300 calls a day to our help desk. We know the support that we give is vital, particularly with the re-enrollment process for Medicare Part D starting this fall. As in the past, I am committed to providing necessary support and assistance to Maine’s seniors and disabled and to ensure they get the drugs they need.

Jude Walsh is special assistant to the Governor’s Office of Health Policy and Finance.


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