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Special coverage: Medicare

State will pay what Medicare missed

By the governor's order, Florida will pick up the tab for some medications that used to be covered by Medicaid.

By ANITA KUMAR and STEPHEN NOHLGREN
Published January 27, 2006

WASHINGTON - Florida will pay for prescription drugs for tens of thousands of poor elderly or disabled residents who have had problems getting medicine through the nation's embattled Medicare prescription drug plan.

Gov. Jeb Bush signed an executive order Thursday to immediately begin paying for drugs for roughly 100,000 people who used to get free drugs from the state through Medicaid but were switched to the new federal Medicare program Jan. 1.

"These are, in many cases, people who have complex medical needs that require prescription drugs for them to maintain their health, and based on the law they should not be coming out of pocket," Bush said Thursday during a visit to Washington.

The plan, which takes effect immediately, lasts until Feb. 15 but could be extended.

Bush's decision comes after weeks of confusion as pharmacists, the government and private insurance companies struggled to synchronize their computers so they could tell which plans were supposed to be serving this vulnerable Medicaid population.

Medicare officials have characterized these problems as temporary, the kind of snarls that might be expected of any huge new program. But that has been little solace to people who were supposed to pay $1 to $5 for their drugs but were told they owed hundreds of dollars because the computers couldn't verify their coverage.

Nationally, the problems have been so widespread that some states declared public health emergencies. More than 20 states already agreed to pay for the drugs, but Florida officials had refused, saying the problems were not severe or widespread.

In recent days, Bush was urged to act, including by state and federal lawmakers, the National Kidney Foundation of Florida and two Democrats running to replace him, Rep. Jim Davis and state Sen. Rod Smith.

Florida's decision came after federal officials announced this week they would reimburse states that bought medicine for "dually eligible" people - those entitled to both Medicaid and Medicare - who could not get help through the new Medicare drug benefit.

"It will take a short period of time to have the kinks worked out so it would make sense to have the states participate and they will reimburse us 100 percent," Bush said. "We've been trying to be of help."

The state Medicaid agency said $57-million would be available for the plan but only about $21-million was expected to be needed.

"After conferring with Gov. Bush, I have directed Florida Medicaid to ensure each of Florida's most vulnerable has the best access to the medications they depend on," said Alan Levine, secretary of the state Agency for Health Care Administration.

The state will pay for medications only when "dual eligible" coverage cannot be determined correctly. Medicaid clients also have found that they were assigned to plans that do not include some of their medications on plan formularies. Florida does not intend to cover the cost of those medications, Levine said.

In those cases, the Center for Medicare and Medicaid Services has ordered the plans to provide a 30-day emergency supply of drugs to Medicaid clients. In theory, that should give people time to appeal to the plans for special coverage, switch to a drug that is on the plan's formulary, or find a new drug plan.

Davis commended Bush but said he was "disappointed that it has taken Gov. Bush 26 days to take action."

Drug coverage for millions of seniors around the country who qualify for both their state Medicaid plan and the federal Medicare program was switched from state plans to Medicare at the first of the year.

Nationwide, 6.2-million low-income people receive both Medicare and Medicaid. About 400,000 are dually eligible in Florida, and Bush said about 100,000 or fewer have had problems.

"We have a very large dual eligible population," Bush said. "We have a large Medicare population. We have a large population of people eligible as well, so it's a serious issue."

Bush said he made the decision this week after speaking to state legislative leaders but did not want to wait for their approval to act.

A divided Congress reluctantly approved the drug plan pushed by President Bush in 2003.

Almost 42-million elderly or disabled people - no matter their income - will be eligible to enroll in one of dozens of programs offered by private companies that will be subsidized by the federal government.

Bush said he still supports the program.

"My guess is these issues are going to be worked out," he said. "It's a huge benefit to a large number of seniors."

Times researcher Angie Drobnic Holan contributed to this report.

[Last modified January 27, 2006, 07:00:44]