April 2006 Newsletter
Volume 5, Number 4
Comprehensive Employment Opportunities (CEO) Grant
By Mary Ellen O'Brien Wright, Working Health Program Director
The Centers for Medicare and Medicaid Services (CMS) will soon be soliciting proposals from states to continue to develop Medicaid infrastructure to support the employment of people with disabilities. The purpose of Comprehensive Employment Opportunities (CEO) grants is to maximize employment for people with disabilities, increase the state’s labor force through the inclusion of people with disabilities, and protect and enhance workers’ healthcare and other needed employment supports. CMS hopes that CEOs will increase the number of people with disabilities in competitive employment.
In order to achieve these objectives, states must involve a significant number
of employers, programs, services, and agencies. All will have to work in partnership,
with the common goal of supporting the individual with a disability who wants
to work. States receiving funding may use it to build comprehensive approaches
to removing employment barriers by forming linkages between Medicaid services
and other non-Medicaid programs. Such infrastructure development should continue
to support the goal of removing barriers to employment and create lasting improvements
by expanding the capacity of the state to support individuals with disabilities
who wish to work.
Kansas may be eligible to apply for one of these grants. Working Healthy staff
have been meeting with stakeholders to obtain input regarding what should be
included in the CEO application.
Employer Health Insurance and Working Healthy
If an employer offers health insurance to a Working Healthy participant, Medicaid
may be able to pay the employee’s share of the premium if doing so is considered
cost-effective. In those instances, Medicaid coverage through Working Healthy
acts as a “wraparound” service to cover medical services that the
private insurance does not. This program is known as the Health Insurance Premium
Payment System (HIPPS). You can learn more about HIPPS by contacting a Benefits
Specialist or your local SRS office. In addition, employers are allowed to pay
consumers’ Working Healthy premiums if they would like to do so as a benefit
for their employees. If you have questions about HIPPS or Working Healthy premium
payment by an employer, please contact the Benefits Specialist in your area
or call Working Healthy at 1-800-449-1439.
BENEFITS SPECIALIST CORNER
This issue features Working Healthy Benefits Specialist Steve Curtis from the
Topeka Service Center. Steve’s coverage area includes the counties of Atchison,
Brown, Doniphan, Jackson, Jefferson, and Shawnee. He can be reached by phone
at (785) 296-5816 or by E-mail at SXXC@srskansas.org.
HOW IS MEDICARE PART D AFFECTING WORKING HEALTHY ENROLLMENT?
One question that is being asked, and for which it may be too early to have
a definitive answer, is how Medicare Part D will affect Working Healthy enrollment?
As of this note, we have had about 80 days of Part D eligibility.
Based on enrollment figures from February, a couple of areas have had net losses,
but others have seen net gains in enrollment as compared to January. I had a
net loss of 2 consumers in February. However, I can only attribute one of these
drop offs directly to coverage under Part D and this individual chose to drop
Working Healthy only after discussing the effects with me. For many consumers
with premiums, being on Medicaid, even without the prescription drug coverage,
makes the premium cost effective.
It is a good idea for those who may be wondering whether to stay on Working
Healthy to discuss with the Benefits Specialists the effects of dropping Medicaid
coverage. I have discussed the effects of dropping coverage with several consumers
and they have chosen to continue with Working Healthy.
Reasons for retaining Working Healthy include coverage of benzodiazepines and
barbiturates under Medicaid that would otherwise not be covered by Medicare
Part D. For others, it is the combination of Medicaid as a secondary payer for
medical and hospital bills plus coverage of the Part B premium and Part D expenses
that continues to make Working Healthy a good choice. Another advantage to Medicaid
coverage under Working Healthy is the ability to switch Part D plans if the
need arises.
I am still meeting with folks who have questions about earnings and their effect
on benefits and I’m back to scheduling outreach for Working Healthy. Part
D has become another piece of the benefits puzzle that must be examined. As
new people come into the program, I’m checking to see if they have Medicare
coverage. If so, I then check to see if there is a record of enrollment into
Part D. If not, I try to contact the individual by phone and/or letter to ask
if they have enrolled in a Part D plan. If they have Medicare and haven’t
enrolled in Part D, I offer my assistance in finding 2 or 3 plans for them to
choose from and can help get them enrolled in the plan of their choice.
We have just learned (March 21) that those Medicare beneficiaries who become
Medicaid eligible and enroll in a Part D plan will have prescription drug coverage
retroactive to the month Medicaid begins. The details of this provision are
bit fuzzy at this point, but it may eliminate the coverage gaps some people
have experienced. -Steve Curtis, Working Healthy Benefits Specialist
A Note to Those Who Are Fully Dual Eligible
By Norman White, Working Healthy Benefits Specialist
You had Medicaid and got Medicare. You had Medicare and got Medicaid. You had neither and got both. You now have two cards - one red, white and blue Medicare card and one tan Medicaid card - that you can use. You are now fully dual eligible for Medicare and Medicaid.
When you have Medicaid - either through Working Healthy or you have met your
spenddown - and do not have Medicare, you can get your prescriptions through
your Medicaid card. When you get Medicare, you can no longer get your prescriptions
on your Medicaid card, except for some medications not covered by Medicare
.
If you already have Medicaid and get a notice that in three months your Medicare
starts, this is the time to learn about the Medicare prescription program (Medicare
Part D). So, you select a drug plan that covers all your medications. What if
the insurance company providing the drug plan says it does not have any information
indicating that you have Medicare. The information that you are Medicare Part
D eligible goes from Social Security to SRS to the Centers for Medicare and
Medicaid Services (CMS) to the Prescription Drug Plans (PDPs) at certain times
during the month. In between those times information that you are eligible may
not be available to your pharmacist or your drug plan.
If you are Medicare Part D eligible, have not yet chosen a drug plan and can
no longer get your medications with your Medicaid card, you can temporarily
get your medications through the Wellpoint program at the pharmacy. Wellpoint
provides a temporary way in which individuals can obtain prescriptions immediately.
Again, because of the time it takes the information to move through the system,
the pharmacy or the drug plan may not know you are dually eligible. By showing
the pharmacist both your Medicare and Medicaid cards, you should be able to
get your medications.
A couple of things to remember: 1) Keep your Medicaid and Medicare cards with
you when you go to the pharmacy so you can show them if needed; and 2) When
you have Medicaid and become Medicare Part D eligible, you will no longer be
able to get your medications through Medicaid.
If you have questions about the transition process contact either a Working Healthy Benefits Specialist in your area or your local SRS office.
Consumer Thoughts on Part D Assistance
In February and March, Working Healthy evaluation staff at KU conducted a telephone
survey to learn more about the experiences of dual eligibles transitioning from
Medicaid to Medicare Part D for drug coverage; 328 people enrolled in Working
Healthy responded. Among other topics, participants were asked about the information
they received about the transition to Medicare Part D from the Working Healthy
program. Eighty-one percent (n=258) of respondents found the letter sent to
them by Working Healthy to be helpful. Benefits Specialists also provided support
during the transition period by conducting workshops in communities across the
state and helping consumers one-on-one with questions and plan selection. Eighty-five
percent (n=85) of respondents found the workshops helpful, while 93% found that
working one-on-one with Benefits Specialists - either in person or on the phone
- to get more information and enroll in a plan to be helpful. Other findings
from this survey will soon be available.
This newsletter and other Working Healthy information can be found online at:
http://www.workinghealthy.org
Working Healthy is published quarterly by the University of Kansas CRL, Division
of Adult Studies and in cooperation with the Kansas Department of Social and
Rehabilitation Services.Additional copies and copies in alternate formats are
available upon request by writing the University of Kansas Division of Adult
Studies, Attn: Noelle, 1122 West Campus Rd. JRP Hall Rm. 517, Lawrence, KS 66045,
by phone (785) 864-7085, by email: pixie@ku.edu.
KU Research Team:
Jean Hall, Principal Investigator
Noelle Kurth, Project Coordinator and Editor
Michelle Crick, Graduate Research Assistant
Kansas Division of Health Policy & Finance:
Mary Ellen O'Brien Wright, Program Director
Nancy Scott, Benefits Specialist Team Leader