Medicare Compliance & Reimbursement

High on states' wish list for Congress is legislation to shift Medicaid costs for beneficiaries who also are eligible for Medicare wholly to the federal government and away from states, National Governors Association Executive Director Ray Shep-pach told an April 8 forum on state health coverage sponsored by the David and Lucile Packard Foundation. "Hopefully there will be a Medicare drug bill passed this year" to accomplish that task. Medicare prescription-drug legislation developed by House Ways and Means Committee Chair Bill Thomas (R-CA) and passed last year by the House would phase in full federal responsibility for dual-eligibles' drug spending over ten years, and governors have pressed for passage of another such bill in 2003. "Our hope is that we can work with the Senate on a similar provision," said Sheppach. For his part, Thomas also seems to be hoping that the bill's promise to help strapped states will spur lawmakers to enact his Medicare legislation this year. In an April 9 statement, he touted a study released April 8 by the Commonwealth Fund that shows "how making Medicare, not Medicaid, the delivery program for prescription drugs to seniors could save states up to $6.8 billion annually and improve care to low-income beneficiaries. This would help states from having to make cuts to Medicaid."

The study, State Medicaid Prescription Drug Expenditures for Medicare-Medicaid Dual Eligibles, shows that state Medicaid programs vary widely in eligibility, benefit-structure, and cost-sharing rules, Thomas noted. According to the report, offering the benefit through Medicare instead would give "low-income beneficiaries ... improved access to prescription drugs in states where full Medicare coverage is now below 74 percent of poverty or where there are cost-sharing requirements or other limits on coverage," said Thomas. "In addition, low-income Medicare beneficiaries may be more likely to obtain prescription drug coverage if they can do so through Medicare" because "many believe Medicaid enrollment is burdensome or believe the program carries a stigma."