Most nursing home residents on Medicaid are likely not being enrolled in the Medicare Part D prescription drug plan that best covers their medications, according to an analysis by the Long Term Care Pharmacy Alliance (LTCPA), an association of pharmacies that dispense drugs to long-term care facilities. The problem could be resolved if the nursing home residents were allowed to receive help from their caregivers, the LTCPA says. Such help is currently prohibited.
Low-income nursing home residents who fail to choose a Medicare Part D plan on their own are automatically assigned one by Medicare. In this randomized auto-enrollment selection, no attempt is made to match beneficiaries with the plan that best suits their needs, even though plans usually are available that will cover all or most of their medications.
Following up on its July 2006 policy analysis considering this issue, LTCPA used Medicare's online plan finder to compare how different plans covered ten drugs commonly prescribed to long-term care residents. The results demonstrated that the variability of access to these drugs between plans is significant. Often, two or more plans had few, if any, restrictions on all ten medications, while under other plans several drugs were unavailable or included restrictions.
The analysis concludes that under the auto-enrollment process, many nursing home residents eligible for both Medicaid and Medicare are at risk of being assigned to plans that are inadequate for their medical needs. To make matters worse, the federal government explicitly prohibits caregivers, the people who would know the medical needs of this frail and elderly population best, from choosing a plan for a beneficiary or from helping a beneficiary to choose the best plan. LTCPA urges the Centers for Medicare and Medicaid Services to allow caregivers to assist nursing home residents to choose the plan that is best suited to their particular medical needs.
ElderLawAnswers warned of these risks in a May 2005 investigative article (see 'Switch to Medicare Drug Coverage Poses Dire Risk for Nursing Home Residents, Experts Warn' ).
For the LTCPA policy analysis, 'State by State Formulary Variability in Medicare Prescription Drug Plans for Auto-Assigned Long-Term Care Residents,' click here.