January 2007 Newsletter
Volume 6, Number 3
Assistance with Medicare Part D Co-Pays Now Available
By Jean P. Hall, Ph.D., KU Evaluation Team, Principal Investigator
Kansas Medicaid has launched a new Medicare Part D Copayment
Assistance program effective January 1, 2007. The program is available
to people who have both Medicaid
and Medicare (dual eligibles). Under the new program, dual eligibles will only
be responsible for paying up to the Medicaid copayment for drugs, which is generally
$3.00 per prescription. Some Medicaid beneficiaries have no copayment obligation.
Under Medicare, the maximum copayment for dual eligibles has increased from $5.00
in 2006 to $5.35 in 2007.
In order to receive the assistance, beneficiaries need to show both their Medicare
and Medicaid cards when they fill a prescription and their pharmacy must
be a Medicaid provider. To find out more about the program, persons can contact
their local Working Healthy Benefits Specialist or call the Kansas Medical
Assistance Program Customer Service Center at 1-800-766-9012
Example of how the Copayment Assistance works:
Phillip is a Working Healthy participant and has a $3.00 Medicaid copayment.
His income is more than 100% of the federal poverty level. He fills a prescription
for a name-brand drug. If his Part D plan and his pharmacy are following the
copayment guidelines, he will have a copayment of $5.35. Medicare Part D Copayment
Assistance will pay the difference:$5.35 (Part D Copayment) - $3.00 (Medicaid
copayment made by Phillip) = $2.35 assistance paid by Kansas Medicaid
Other Important Part D Information
Although Part D has now been in effect for a year, people may not be aware
of some options they have under the program. Two of these options that apply
to Working Healthy enrollees and other dual eligibles include:
1. The ability to change Part D plans monthly. People may encounter problems
with their Part D plans such as the plan no longer covering a needed medication
or a local pharmacy not accepting the plan. People who are dually eligible
for Medicare and Medicaid have the option to change plans as frequently as
each month to ensure they can get the coverage that best meets their needs.
2. The ability to appeal a denial of a drug by a Part D plan. If a person’s
plan denies coverage of a particular medication, the individual can appeal
the plan’s decision. The denial may occur because the plan determines
the medication is not medically necessary, the drug dosage or form is not appropriate,
the doctor did not file a prior authorization, the drug is not on the plan
formulary, or for other reasons. Depending on the reason for the denial, several
levels and timelines for appeals exist under Part D.
For assistance with changing plans or appealing a drug denial, individuals
can contact Senior Health Insurance Counseling for Kansas (SHICK) at 1-800-860-5260
and on on-line at http://www.agingkansas.org/shick/shick_index.html or their
local Working Healthy Benefits Specialist by calling 1-800-449-1439.
Benefits Specialist Corner
This issue features Working Healthy Benefits
Specialist Terry Cronin from the Kansas City Service Center.
Terry joined the Working Healthy team in August 2006 after
working in EES. He is not new to the social services arena;
prior to his work for the State of Kansas, Terry worked in
various roles in the State of Missouri as well as several years
in Iowa working with at-risk youth and youth with psychiatric
disabilities. Terry enjoys spending time with his family -
especially his 9 month old granddaughter pictured with him
here - and is an ordained minister and active elder in his
church. Terry’s Working Healthy coverage area includes
the counties of Douglas, Johnson, Leavenworth and Wyandotte.
He can be reached by phone at (913) 279-7173 or by E-mail at
TCronin@srs.ks.gov.
Having been a Benefits Specialist for only a short time, I still have
a great deal to learn about the Working Healthy program and many other
aspects of my position. I do know enough however, to recognize the value
of this program to persons with disabilities who want to live productive
lives and be given the same opportunities as anyone else.
While working as a residence manager for a non-profit organization in Independence,
Missouri, I saw how being a person with a disability oftentimes means losing
the right to choose. I managed a 12 unit apartment building with 11 participants
and one full time staff. Our participants worked in sheltered workshops as
well as in competitive employment. We provided support for them in their transportation,
shopping, planning and preparing meals, and money management. The support was
designed to give them the ability to make choices and enrich their lives by
giving them the same opportunities as anyone else.
Well, almost. You see, if I don’t like my job, I can look for another
one or change positions when something else comes up. Earning more income is
a good thing for me and benefits my life. I can save money for vacations, retirement,
a new car, or just to have it when I want to use it for something. I have the
right and ability to make choices in my life. The choices I make may affect
me positively or negatively, but I still have them to make.
While working as the apartment manager, I had a wonderful full time staff person
who, as one of her many duties, helped plan great vacations for the participants.
They all worked together to choose where they would go and what it would cost.
Our staff would then help them all year long to save money each week and prepare
for their trips. Every year the participants planned, saved, and looked forward
to their vacation...just like anyone else.
Then one year, the regional center “reminded” our agency that Missouri
had set the resource limit for a single individual at $999.00. If a person
had more resources, they would lose their Medicaid coverage. If the agency
held the money in a separate account it could be considered fraud. So the participants
were now limited to where they could go or what they could do and their ability
to make a choice in this area of their lives was profoundly affected.
Missouri had a Medicaid Buy-in program for only a short while and chose not
to embrace this opportunity for their citizens with disabilities as Kansas
did with Working Healthy. Having worked with low resource limits and high spenddowns,
I can appreciate the benefits I see with Working Healthy: a program that allows
persons with disabilities to get closer to living their lives just like anyone
else; gives people the ability to have health insurance with a reasonable premium
instead of a costly spenddown and increased resource rules that allow people
to save money for things they want or need; and empowers people to make choices
to make or increase their income to better their lives...just like anyone else.
I am so happy to have the opportunity to be a part of this program and to work
with this team of dedicated individuals who want to make a difference in people’s
lives. - Terry Cronin, Benefits Specialist
Medicaid Infrastructure Grant
to Support the Employment of People with Disabilities
The Centers for Medicare and Medicaid Services (CMS) recently awarded Kansas
a four-year Medicaid Infrastructure Grant to promote the competitive employment
of Kansans with disabilities. Funding for the 2007 grant year is one million
dollars.
Grant funds will be used to create a comprehensive and coordinated state-wide
approach that supports individuals with disabilities who want to work, as well
as forming partnerships with Kansas businesses to encourage competitive, integrated
employment opportunities. The major objectives of this grant are to develop
a comprehensive employment system that:
• maximizes employment for Kansans with disabilities;
• increases the state’s labor force through the inclusion of people
with disabilities; and
• protects and enhances workers’ healthcare, other benefits, and
other necessary employment supports.
Working Healthy staff will be conducting a series of stakeholder meetings to
develop a more specific strategic plan for the grant. Input is needed from
people with disabilities, advocates and employers across the state. Please
contact Working Healthy at
1-800-449-1439 for more information.
Work Opportunities Reward Kansans (WORK): Personal
Assistance Services Coming Soon
The Working Healthy staff have been busy these last few months with the design
and planning for implementation of the WORK services benefit plan. A collaborative
group of advocates, services providers, SRS staff and consumers have been meeting
regularly to provide input and guidance in this process. The anticipated date
of implementation for WORK is now July 2007.
WORK services will include all of the state’s regular state plan services
plus personal assistance services for employed adults with developmental disabilities,
physical disabilities, and traumatic brain injuries who are eligible to enroll
in Working Healthy. The services will also include assessment, independent
living counseling, and assistive services.
As reported in the October 2006 issue, the new package of services has several
unique features. Personal assistance services will be offered using a “cash
model,” allowing participants to handle funds and purchase their services
directly. Participants also have the option to use a more traditional approach
to fiscal management and employ a fiscal agent to manage their funds. Moreover,
participants will also be given the flexibility to purchase services in an
alternative and cost-effective way, e.g., send laundry out rather than pay
an attendant to do the laundry.
These are just a few examples of the features available for workers with disabilities
wanting to utilize the WORK program for assistant services. For more information
or questions about WORK, please contact Working Healthy by calling 1-800-449-1439.
New Working Healthy Coverage Areas
In January, areas covered by Working Healthy Benefits Specialists changed in
order to accommodate the addition of a second Benefits Specialist in the
western half of the state. Seven Specialists still cover the state with the
newest member joining the team in the Greensburg SRS Service Center. Karen
Baessler is joining the Working Healthy team and will cover the Southwest
corner, including the counties of Barber, Clark, Comanche, Edwards, Finney,
Ford, Grant, Gray, Greeley, Hamilton, Hodgeman, Kearny, Kiowa, Lane, Meade,
Morton, Ness, Pratt, Scott, Seward, Stafford, Stanton, Stevens and Wichita.
Karen can be reached at (620) 723-3321 or GKSB@srs.ks.gov. For a map and
listing of coverage areas in the rest of the state and to find out who the
Benefits Specialist is in your area, go to the Working Healthy website www.workinghealthy.org
or call 1-800-449-1439.
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 the Kansas Health Policy Authority. 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 emailing: pixie@ku.edu
KU Research Team:
Jean Hall, Principal Investigator
Noelle Kurth, Project Coordinator and Editor
Michelle Crick, Graduate Research Assistant
Kansas Health Policy Authority:
Mary Ellen O'Brien Wright, Program Director
Nancy Scott, Benefits Specialist Team Leader