You asked about the ConnPACE program, including (1) income guidelines and when they were last changed, (2) enrollment data, and (3) how many states have similar programs.

You also want some details on the new federal prescription drug program for seniors (Medicare Part D, now known as Medicare Rx).

SUMMARY

The state-funded Connecticut Pharmaceutical Assistance Contract to the Elderly and Disabled (ConnPACE) helps seniors and younger disabled adults pay for their prescription drugs. Current income limits are $ 21,400 if single, and $ 28,900 if part of a married couple; the limits are adjusted annually for inflation. The most recent significant increase occurred in 2002, from $ 15,100 and $ 18,100 for single and married applicants, respectively, to $ 20,000 and $ 27,100. The program had over 49,000 enrollees as of June 30, 2005. Of these, almost 42,000 were seniors over age 65 and over 7,600 were younger adults with disabilities. Twenty-two other states have similar programs.

The federal Medicare Part D program provides federal help, for the first time, in paying prescription drug costs for Medicare beneficiaries. Beneficiaries will be able to enroll in one of a number of Medicare-approved private prescription drug plans. Most will be eligible at least for “standard” coverage. Low-income beneficiaries and the Medicare-Medicaid dually eligible will receive extra federal help.

Connecticut legislation this summer and fall adjusts the state’s ConnPACE and Medicaid programs to conform to and address gaps in the federal law.

CONNPACE

The state-funded ConnPACE program pays for prescription drugs, insulin, and insulin syringes and needles for people age 65 and over. Participants must be state residents for at least six months and pay an annual $ 30 registration fee and a maximum co-payment of $ 16. 25 for each prescription. Additional program details and applications are available at: www. connpace. com

In 2005, the legislature made a number of changes in ConnPACE coverage to coordinate the state benefits with the upcoming federal Medicare Part D prescription program, which begins in January 2006. Basically, ConnPACE participants will have to enroll in a Medicare Part D plan in order to continue to be eligible for ConnPACE and will mostly have to follow the Part D plans’ requirements. ConnPACE copays will remain at no more than $ 16. 25 for drugs on a plan’s formulary and for drugs that are not considered Medicare Part D drugs. Plans will have federally required exception processes that beneficiaries can pursue to obtain coverage for drugs that are not on the formulary. Beneficiaries will also have an opportunity to receive state help in paying for medically necessary drugs that are Medicare Part D drugs but are not on their plan’s formulary (see below).

Income Limits

Applicants’ annual income caps are currently $ 21,400 if single, and $ 28,900 if part of a married couple. The most recent significant increase occurred in April 2002, as a result of 2001 legislation raising the limits from $ 15,100 and $ 18,100 for single and married applicants, respectively, to $ 20,000 and $ 27,100 (PA 01-2, June Special Session).

The limits have been, and continue to be, adjusted every year to reflect inflation adjustments in Social Security payments since January 1, 1998 (PA 97-2, June 18 Special Session).

Enrollees

ConnPACE had 49,396 enrollees as of June 30, 2005. Of these, 41,703 were seniors over age 65 and 7,693 were younger adults with disabilities, according to the ConnPACE Annual Report 2005 enclosed and available at: http: //www. connpace. com/pubs/SFY05Annual. pdf.

Similar Programs in Other States

Twenty three states (including Connecticut) and the U. S. Virgin Islands have state-funded programs that provide some level of prescription drug assistance to seniors who are not poor enough for Medicaid. The states are Alaska, California, Connecticut, Delaware, Illinois, Indiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, North Carolina, New Jersey, Nevada, New York, Rhode Island, South Carolina, Texas, Vermont, Washington, and Wisconsin. The structure of the programs varies considerably from state to state. The list and names of the state programs are available at: http: //63. 241. 27. 78/medicarereform/states/qual_spap_list. pdf

2006 FEDERAL MEDICARE PART D PRESCRIPTION PLANS AND STATE RESPONSE

Federal Part D allows Medicare beneficiaries to enroll in private prescription plans that must offer at least a specified “standard” benefit package. People with low incomes and assets and those eligible for both Medicare and Medicaid (the “dually eligible”) will receive extra federal help with deductibles, premiums, copays, and coverage. The plans only cover prescription drugs designated “Medicare Part D covered drugs,” and, to some extent, they can choose which of these they will put on their formularies. Federal law also requires each plan to establish an exception process, so people can appeal its nonpayment for drugs that are medically necessary for them but not on the formulary.

ConnPACE and Medicare Part D

State legislation this year requires ConnPACE participants to (1) enroll in a Part D plan (enrollment can begin in November but benefits start in January); (2) disclose their income and assets to the Department of Social Services (DSS) to determine their eligibility for the extra federal help; and (3) appoint the DSS commissioner as their authorized representative to enroll them in a plan if they do not choose one in time and represent them in Part D appeals.

The legislation coordinates ConnPACE benefits with Part D so that participants do not pay more than ConnPACE’s $ 30 annual registration fee and $ 16. 25 per-prescription copayment for drugs that are (1) on their plan’s formulary or (2) not designated a Part D covered drug. ConnPACE participants may pay less than the $ 16. 25 copay if their federal copays are lower. DSS will pay ConnPACE participants’ Part D monthly premiums. It will cover drugs during the federal deductible period and the gap in the “standard” benefit. The standard benefit, after a $ 250 annual deductible, pays 75% of the drug costs up to $ 2,250 and then pays nothing (this is the gap) until total drug costs reach $ 5,100, after which it generally pays 95%.

DSS generally has no obligation for Part D covered drugs that are not on a plan’s formulary. But under a federal exception procedure, if the client or DSS appeals and wins, drugs not on the formulary could be treated and paid for as though they were on it.

In addition, the legislation establishes a “Medicare Part D Supplemental Needs Fund” to help Medicare Part D beneficiaries who are also ConnPACE participants or full benefit Medicare-Medicaid dually eligible and cannot pay for medically necessary non-formulary drugs, authorizes DSS to set conditions and procedures for this assistance, and transfers $ 5 million to the fund out of Medicaid appropriations for FY 06. It also gives ConnPACE recipients and applicants an opportunity to consult with the commissioner, or her designated agent, about Medicare Part D plan selection before choosing one and designates $ 1 million to provide additional resources for these services. Under the law, the DSS commissioner may to be the authorized representative of all ConnPACE applicants or recipients for purposes of enrolling them in a Medicare Part D plan (PA 05-280; PA 05-2, November 2 Special Session; PA 05-3, November 2 Special Session).

Medicare-Medicaid Dual Eligibles

Consistent with the federal law, Medicaid will no longer pay for Part D covered drugs for full benefit dual eligibles, even if they are not on the plan’s formulary. For drugs on a formulary, the federal Medicare copays for this group will generally be $ 1 to $ 5 depending on income and drug type. The state legislation requires DSS to pay these copayments for full benefit Medicare-Medicaid dual eligibles’ prescriptions under the new Part D plans. It also gives this group access to the new state “Medicare Part D Supplemental Needs Fund” for non-formulary medically necessary drugs. The legislation defines a “full benefit dually eligible Medicare Part D beneficiary” as a person who has coverage for Part D drugs and is eligible for full Medicaid benefits under any eligibility category (some eligibility groups receive limited Medicaid assistance only to pay their normal Medicare premiums, deductibles, and coinsurance). It also allows the DSS commissioner, to the extent permitted under federal law, to be the authorized representative for full benefit Medicare-Medicaid dually eligible people for purposes of enrolling them in a Medicare Part D plan (PA 05-280; PA 05-2, November 2 Special Session; PA 05-3, November 2 Special Session)

Under the federal law, this group does not have to pay premiums or deductibles and will not be subject to the coverage gap. Medicaid continues to cover their drugs that are not Part D covered drugs. Federal law had also already exempted dually eligible nursing home residents from the federal copays.

RESOURCES

The CHOICES health insurance counseling program is providing free individualized advice to Medicare beneficiaries trying to decide which prescription plan to choose. CHOICES can be reached at 1-800-994-9422. A number of CHOICES informational documents on Medicare Part D are available at http: //www. ctelderlyservices. state. ct. us/PubsFrm. htm

Additional information on Part D and ConnPACE can be found on the DSS website at: http: //www. ct. gov/dss/cwp/view. asp?Q=305744&A=2345.

The federal Center for Medicare and Medicaid Services has a toll-free number (1-800-MEDICARE -1-800-633-4227) and a website that provides basic information on the plans in all the states and a program that can find plans that cover a beneficiary’s specific drugs at www. medicare. gov.

Other resources include the National Conference of State Legislatures at: http: //www. ncsl. org/programs/health/MedicareRx. htm and the Center for Medicare Advocacy at: www. medicareadvocacy. org.

HN: ts