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State Medicaid Challenges: Implementing Medicare Part D

State Medicaid Challenges: Implementing Medicare Part D. Barbara Coulter Edwards Ohio Medicaid Director October 7, 2004. Impact on Dual Eligibles. Full-benefit duals, QIs, SLMBs, QMBs are deemed eligible for full low income subsidy

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State Medicaid Challenges: Implementing Medicare Part D

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  1. State Medicaid Challenges: Implementing Medicare Part D Barbara Coulter Edwards Ohio Medicaid Director October 7, 2004

  2. Impact on Dual Eligibles • Full-benefit duals, QIs, SLMBs, QMBs are deemed eligible for full low income subsidy • Full-benefit duals will be auto-enrolled (when, which plans?) • Adequacy of Part D formulary; non-Part D drugs – transition challenges • Impact on other utilization (nfs, disease mgmt)

  3. New Business Relationships Effective implementation of Part D for low income Medicare beneficiaries will require information sharing across multiple systems: • SSA and Medicare • SSA and Medicaid • Medicaid and Medicare (parts A, B,C and D!) • Medicaid and private plans • Medicaid and SPAPs • Medicaid and state insurance departments

  4. Information Technology IT systems changes will be required: Data sharing with other entities New reporting formats Low income subsidy eligibility determinations - Will states use SSA application and process? Challenges: HIPAA (continued!) Shared data systems Competing priorities

  5. Future Budgeting States are developing future budgets now, and we lack critical information: • “Clawback” payment amounts • ’03 base too high? • National inflation factors too high? • Enrollment impact on Medicaid - a “woodwork effect” for duals?

  6. Current Resources States need time, money, and people to accomplish the significant changes required by MMA. Reality for states: >Years of budget cuts. >No new funding for state share of costs. >Competing state priorities (control costs!). >Not enough time allowed by MMA.

  7. Will duals be harmed? • Medicaid Rx coverage stops 1-1-06, whether consumers, states, or PDPs are ready or not. • If states and PDPs aren’t ready, vulnerable consumers may be harmed. • Should CMS require states, PDPs to pass “readiness reviews” before implementing Part D?

  8. CMS State Issues Work Group • SSA Interaction (subsidy application and enrollment outreach) • Coordination of Benefits (transition for duals) • Notice Requirements • Data Coordination • “Clawback” Calculation (alternative ’03 reporting)

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