Medicare prescription drug, improvement and modernization act of 2003 and its impact on dual eligibles (Medicare and Medi-Cal recipients) with disabilities


Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

5039.0: Wednesday, December 14, 2005 - 9:24 AM

Abstract #106379

Medicare prescription drug, improvement and modernization act of 2003 and its impact on dual eligibles (Medicare and Medi-Cal recipients) with disabilities

Katherine Hawksworth, BA, Amanda Cue, BS, Shawna Whitney, BA, and Sahru Keiser, BA. Department of Health Education, San Francisco State University, 1600 Holloway Ave, San Francisco, CA 94116, 925-370-9411, khawksworth@sbcglobal.net

Due to high prescription drug costs and complex medical needs paired with extremely low incomes, prescription drug coverage is a constant concern and a vital component in the lives of individuals receiving both Medicare and Medi-Cal benefits by reason of disability (Dual Eligibles). Effective January 1, 2006 the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) mandates that 900,000 Dual Eligibles in California will no longer be eligible for Medi-Cal prescription drug coverage. Instead, recipients will be randomly enrolled into private Medicare prescription drug plans, known as Medicare Part D, with unknown costs or restrictions on medications. Objective: To assess common characteristics of and services accessed by individuals with disabilities receiving both Medicare and Medi-Cal in two California communities. Methods: Thirteen key informant interviews in two California counties were conducted with a select group of service providers whom have as a part of their consumer base, Dual Eligibles (DE) with disabilities. Results: Providers themselves feel that DE with disabilities receive inconsistent, inaccurate and incomplete information, access and support for Medicare and Medi-Cal issues. Also, varying levels of knowledge exists among service providers regarding the potential impacts of the MMA on prescription drug coverage. Conclusion: On a local level, service providers must receive immediate information and training about the MMA and its potential impacts on DE with disabilities so as to proactively avoid an impending health care crisis. On a state level, the State Health Insurance Assistance Plan (SHIP) network should secure resources to provide information on the MMA.

Learning Objectives:

At the conclusion of the session, the participant (learner) in this session will be able to

1. Articulate the eligibility requirements to be dually eligible for Medicare and Medicaid.
2. Recognize the segment of the Medicare population who are dual eligibles by reason of a disability.
3. Define the structure of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) legislation and populations who are impacted by the changes.
4. Recognize the unique impacts of the MMA on dual eligibles with disabilities populations.
5. Identify interventions to reduce impacts of the MMA on dual eligibles with disabilities.
6. Define the Health Insurance Counseling and Advocacy Program (HICAP) model and identify the twenty-six California branch locations.
7. Identify challenges and opportunities faced by service providers in addressing the impacts of the MMA on dual eligible with disabilities populations.
8. Discuss the importance of health insurance coverage, prescription drug coverage and continuity of care for dual eligibles with disabilities.
9. Assess what is known about the dual eligible with disability population and areas that need to be further researched.

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation

Student Research in Disability

The 133rd Annual Meeting & Exposition (December 10-14, 2005) of APHA