Medicare Changes Hurt Elderly and Mentally Ill

As a clinical social worker, I can’t tell you how frightened I am for mentally ill and elderly people across the country. Because of the changes in Medicare effective January 1, 2006, many elderly and severely mentally ill people are not getting their medications due to confusion over their benefits or inability to pay the new co-pays. The New York Times described the dire situation in Florida, where the state has not stepped in to supply people with their medications, as some other states have. From the article:

At Dayspring Village, in the northeast corner of Florida near Jacksonville, the 80 residents depend heavily on medications. They line up for their medicines three times a day. Members of the staff, standing at a counter, dispense the pills through a window that looks like the ticket booth at a movie theater.

Most of the residents are on Medicare, because they have disabilities, and Medicaid, because they have low incomes. Before Jan. 1, the state’s Medicaid program covered their drugs at no charge. Since then, the residents have been covered by a private insurance company under contract to Medicare.

For the first time, residents of Dayspring Village found this month that they were being charged co-payments for their drugs, typically $3 for each prescription. The residents take an average of eight or nine drugs, so the co-payments can take a large share of their cash allowance, which is $54 a month.

Even after the insurer agreed to relax “prior authorization” requirements for a month, it was charging high co-payments for some drugs – $52 apiece for Abilify, an anti-psychotic medicine, and Depakote, a mood stabilizer used in treating bipolar disorder.

Similarly, from The Detroit News:

While Medicaid offers top-rate prescription coverage that includes virtually every kind of psychiatric medication, Medicare coverage is more limited, they say.

And although federal guidelines direct insurers administering Medicare benefits to cover most psychiatric drugs, many plans have restrictions that did not exist under Medicaid, such as limits on how much a patient can take or how drugs can be mixed.

While insurers are supposed to cover most drugs, an analysis by the psychiatric society’s Gross found some psychiatric medications aren’t covered by some plans.

Gross also found that some plans regularly change their approved drug list, causing problems for people who picked their plans based on their specific medication needs.Then there’s the confusion among patients and pharmacists.

Many patients don’t know about, or don’t understand, the changes in their coverage. They may show up at a pharmacy believing they still have Medicaid, when in fact they’re covered by Medicare.

When that happens, it’s up to the pharmacists to determine what coverage the patient has. While druggists have spent months trying to understand the plan, some still aren’t clear about the Medicaid/Medicare issue, mental health advocates say.

Even pharmacists have had problems accessing information over the phone and through the Internet site that allows them to enroll people in a Medicare prescription plan. “Instead of just having to deal with, understand, learn the ins-and-outs of Medicaid in Michigan, you’ve got to look at dozens of private plans and learn what’s available and how it’s available,” said Mark Reinstein, president of the Mental Health Association of Michigan. “It’s a very daunting task for anyone, let alone someone who might have a mental health issue.”

And from The Providence Journal:

Elizabeth V. Earls, president of the Rhode Island Council of Community Mental Health Organizations, said that clients have been charged incorrect copayments, that pharmacists have been unable to access information about them, and that the federal government has deducted premiums from their Social Security checks, even though indigent people don’t have to pay premiums.

“In four to six weeks,” Earls predicted, “we’re going to see a huge surge in hospitalizations. . . . It is scary.”

At the South Shore Mental Health Center in Wakefield, Kathy Garlick, senior manager of the mobile treatment team, encountered a mentally ill man who just went two days without taking his heart medication.

“This is a man who had a heart attack a month ago,” Garlick said. “He went into the pharmacy on his own over the weekend.” Told he had to pay for the drugs, he replied that he didn’t have the money and walked out. The staff at the mental-health center learned about this yesterday. By the end of the day, they hadn’t figured out why he wasn’t in the system — but the pharmacy had agreed to provide a week’s worth of medication.

Garlick estimates that three-quarters of her clients have encountered difficulties getting their medications.

One was a woman who had received her Medicare drug card, and was actually in the system — but she needed preauthorization for her dosage of the antipsychotic drug Zyprexa. “I spent four hours on the phone,” Garlick said. “I kept track.” Eventually she obtained the necessary form, while the pharmacy gave the patient five days of drugs.

Luckily here in Rhode Island, the Governor did the prudent thing and reinstated the old Medicaid system for people until the new system appears to be able to function properly. Other states like Florida and Michigan have not done that, resulting in even bigger problems for their elderly and mentally ill residents.

Something needs to be done. The government that created this new system needs to step up to the plate and amend it so that it can function, before innocent people are made to suffer further disastrous consequences.

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3 responses

  1. Sadly, the changes in the Medicare/Medicaid system—which have left countless of our most vulnerable citizens subject to a disruption of their medical care due to unaffordable added costs and confusion about what is covered and what is not and how to navigate the byzantine bureaucratic system that has spawned these changes—offer further proof (and how much do we need, at this point?) of how little the Bush administration truly cares about the poor, the elderly, the infirm, et al. Indeed, I believe that it can justifiably be said that Bush and his minions view many of us, here and abroad, as disposable. How else to explain what happened to the victims of Hurrican Katrina in New Orleans and along the Gulf Coast? How else to explain the continued rise in civilian and military casualties in the quagmire known as the War on Terror? What about the terror of those in this country who, in their time of greatest need, depend on the government to protect and serve them, only to find that they have literally and figuratively been left out in the cold and can expect to suffer or even die while our purported leaders smile sympathetically and offer glib reassurances at carefully orchestrated photo ops before they turn their backs and walk away? Such gross negligence and indifference deserves more than these scathing comments. It deserves indictments, prosecutions, impeachment. We need to hold those who have failed to uphold the law and their duties accountable for their actions. We need to do that NOW.

  2. You know, this is bordering on conspiracy-theory lunacy, but how else to explain this? It has been suggested that the bu$h admin has deliberately not taken all of the steps needed to make this plan work. The suggestion is that they want to demonstrate how ineffective the government is. The purpose is to prove St Ronnie Raygun’s adage that “government isn’t the solution; it’s the problem.” Once this has been amply demonstrated, the thinking goes, people will stop looking to the gov’t to solve their problems.

    Cynical? Absolutely. Both on their part and mine. Borderline whacko? You bet. Accurate? You look at the evidence and tell me. Think FEMA. Think EPA. Think Bureau of Mine Safety (not sure of the exact title). Think Provisional Coalition Authority, which ran the show in Iraq after our Mission was Accomplished. In all of these, bu$h has appointed either political hacks loyal to the Republican line or industry insiders (Mine Safety, EPA). In all cases, they have done an abysmal job.

    Now, it has been said that we should never ascribe to malevolence what can be explained by simple incompetence. So, is the bu$h admin a collection of knaves? or of fools? Which is worse? And remember, a lot of these clowns came from the corporate world. What does this say about the way corporations are run. Think about that the next time some wingnut extols the virtues of capitalism and the free market, how the best and the fittest survive, blah, blah, blah.

    Yes, the gov’t should step up and fix this mess, which is a mess of their own creation. Will they? Don’t hold your breath. This will be left to the states, who are already strapped for cash (despite that ‘booming’ economy we keep hearing about, but that we never actually experience), and who are not allowed to run deficits. The money will come from other programs; schools won’t be repaired, roads and bridges will deteriorate….

    Cynical? You tell me.

  3. A few more points:
    1. This issue is not getting nearly enough attention in the mainstream media, in my opinion.
    2. There is nary a peep from the conservative blogs about this unmitigated disaster in Republican policy and implementation. Hilzoy has a good post about this at Obsidian Wings: http://obsidianwings.blogs.com/obsidian_wings/2006/01/where_are_the_r.html
    3. One really sick thing about this is that people are forced to choose a plan and MUST stay on it for a year. But the plan can change which drugs it is covering anytime it wants. Thus, the unrectifiable uncertainty for people about which plan to choose. What if I choose plan #12 because it covers Lipitor but then plan #12 decides not to cover Lipitor anymore? I’m stuck footing the bill for an expensive drug for the rest of the year, or not taking it and risking major health problems. For more on this, you can read Michael Hiltzik in his piece in the LA Times: http://goldenstateblog.latimes.com/goldenstate/2006/01/golden_state_co_3.html

    4. Any politician or candidate who is ignoring this problem is not worthy of your vote. Indifference to this crisis on the part of our leaders is reprehensible.

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