CHA Blog

Currently, Medicare Advantage (MA) beneficiaries with at least $4,000 worth of annual drug costs are eligible for pharmacy consultations at no cost. These consultations are provided to ensure: 1) people understand how to use their medication, and 2) the medication prescribed will not produce adverse side-effects with other medications the person may be taking.

In 2010, new guidelines from the Center for Medicare and Medicaid Services (CMS) will broaden the pharmacy consultation benefit to more MA beneficiaries. Health plans will be prohibited from restricting access to the benefit to members with a high number of chronic health conditions and medications, and the annual drug cost limit will be reduced from $4,000 to $3,000. Also, under the revised guidelines, MA plans will be required to review their member rolls on a quarterly basis to identify eligible members for the program. 

Pharmacists will be paid $50 by the health plans to review a beneficiary’s medications and make recommendations to their physician. Pharmacists will receive additional payments if they recommend a less-costly, therapeutic equivalent to the patient. This may be an important step, both in reducing health care costs and in improving people’s overall health as less medications reduce side effects and harmful interactions between medications.

For information on Medicare’s Part D drug coverage, see:

• Prescription Drugs – Medicare Part D

Beginning July 1, 2009, the state will end its adult Denti-Cal program — the state’s dental insurance program for its poorest residents. While many health advocates are still working to save this program, if it does end as scheduled, they predict it will create a painful hole in California’s health care safety net that could prove disastrous to fill later.

Statewide, the change will affect as many as 3 million adults, according to figures provided by the California HealthCare Foundation. This amounts to 15,000 to 20,000 adults in San Joaquin County alone, leaving these adults without dental benefits.

Many of these people may delay treatment because they cannot pay for it. Eventually, though, the treatment they will require will be more complex and expensive.

California is one of six states that offer this type of benefit to adults. The service will remain available to residents of nursing facilities.

The Denti-Cal program elimination was triggered recently when California failed to qualify for the full $10 billion federal stimulus package. It came up short by close to $1.8 billion, and several Medi-Cal optional benefits, including adult dental, chiropractic, incontinence creams and washes, acupuncture, audiology, optometry, podiatry, speech therapy and psychology services, were cut by the governor and the Legislature.

The loss of a safety net program for poor adults with dental needs is also bad news for California’s dental schools whose students receive training from working on patients, including many Denti-Cal recipients.

In addition, Denti-Cal is the primary payer source for many community health clinics, accounting for 50% to 80% of the payer source at a clinic, according to Carmela Castellano-Garcia, president and chief executive officer of the California Primary Care Association, which represents the state’s nonprofit community clinics and health centers that serve some of its poorest residents.

As a result of the state’s move, more poor people will likely begin searching for other organizations such as faith-based organizations or other privately funded community medical centers.

People in search of other dental resources can contact their local Area Agency on Aging (AAA) for a list of local programs. Some local Health Insurance Counseling and Advocacy Programs (HICAP) may also have a list of resources in their area. Click here for a list of offices statewide.

For more information on Medi-Cal programs for older adults and people with disabilities, see our website section:

• Medi-Cal (for people with Medicare)

Last Thursday, the California Assembly voted unanimously to pass a bill AB 23 that amends state law to allow workers at firms with fewer than 20 employees to qualify for the federal subsidy for COBRA coverage.

The legislation applies to the Cal-COBRA program, which facilitates coverage for workers laid off from firms with no more than 19 employees.  It also would require health plans to alert people to the availability of the subsidy.

Currently, the federal subsidy, which was enacted through the economic stimulus package, applies only to people eligible for COBRA who had worked for employers with 20 or more employees. If passed, under this new bill by Democratic Assemblyman Dave Jones, California workers laid off between Sept. 1, 2008, and Dec. 31, 2009, will be able to receive the 65% federal subsidy for up to 9 months to keep their private health insurance through the Cal-COBRA program.

The Assembly Appropriations Committee estimates that the bill will make 60,000 to 100,000 unemployed Californians and their families eligible for the federal subsidy, accounting for about $400 million from the stimulus package.

Now going to the Senate for consideration, the legislation will become effective immediately if passed.

For more information, see:

• Our website section on COBRA & CalCOBRA insurance
• Our article, Know Your Rights to COBRA? – Extended Healthcare Benefits for Terminated or Reduced Employment

We have 2 new Medicare podcasts available in English and Spanish, covering the topics of low-income assistance programs for Medicare beneficiaries and Medicare appeals. English and Spanish transcripts are also available for each.

All Medicare beneficiaries have the right to appeal a decision that denied them coverage or payment, yet not all beneficiaries are aware of these rights or know how to use them.

In addition, many people who qualify for low-income assistance to help pay for Medicare costs are unaware that these programs exist. The programs, such as Medi-Cal, the Medicare Savings Programs, and the Part D Low-Income Subsidy help cover people’s Medicare premiums, deductibles and copayment, therefore ensure people can afford and access their health care.

Podcasts are a simple and effective way to get this important information out and they make the information available especially to people with visual impairments, and those with low literacy levels. Beneficiaries, their families, caregivers and friends can listen together in English and/or Spanish and view the transcripts in both languages as well.