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From The Director - Together we can...
In June, the state Legislature will send its proposed fiscal year 2005 budget to the Governor. As we go to press, the Legislature’s budget is expected to propose that the Prescription Advantage Plan be funded at $110 million and that the Medicaid Home and Community-Based Waiver Program be expanded to allow the state to receive additional matching federal dollars. Elder Services supports both of these proposals.
The Prescription Advantage Plan is a state-funded insurance plan which enables elders and disabled persons to afford to purchase their prescription medications. The plan is available to elders age 65 or older regardless of income. Elders with lower incomes pay lower premiums, deductibles, and co-payments. For example, a single elder whose annual income is $16,883 or less, or a married couple whose income is $22,786 or less will pay no premiums or deductibles, and will have the lowest co-payments - $9 for a 30-day supply of level one Generic Drugs, $23 for level 2 Brand-Name Drugs, and $45 for level 3 Additional Brand Name Drugs. (These numbers are based on the rate schedule guide in effect for fiscal year 2004). There are many elders and disabled individuals residing in Berkshire County and throughout the Commonwealth who are unable to afford their prescribed medications and who desperately need the assistance the Prescription Advantage Plan provides. Unfortunately, individuals age 66 and older can only join the plan during an open enrollment period. During the last open enrollment period in September 2003, more than 11,000 individuals applied for enrollment into the plan. Although Berkshire County represents only 2% of the Commonwealth’s overall population, almost 7% of those applying for enrollment resided in the Berkshires. The Legislature’s proposed $110 million line item, which represents a $14 million increase over the $96 million the Governor proposed in his budget, would enable the state to have an open enrollment period during fiscal year 2005. This will give additional elders the opportunity to enroll in the plan so that they will be able to afford the medications they need.
The Medicaid Home and Community-Based Waiver Program is a federal-state program that expands the normal range of Medicaid long-term-care services considered "medically necessary", so that eligible elders may receive this higher level of service in a home or community-based setting if that is their preference. Currently, the Commonwealth receives matching federal dollars at the rate of fifty cents on the dollar for each individual the waiver program serves. The Legislature’s fiscal year 2005 budget is expected to propose that the income eligibility criteria for this program be expanded from $769 a month to $1,656 (the amount permitted under the federal guidelines), and that the asset test be expanded from $2,000 to $20,000. Many individuals who could be eligible for services under the expanded community-based waiver program are currently served by the state’s Enhanced Community Options Program, which is funded entirely by the state. It is expected that the expansion of the waiver program would be at no net cost to the state because it would enable the Commonwealth to receive additional matching federal dollars for each additional individual served, rather than bearing the entire cost alone as it does currently. Expansion would also give more elders the choice of receiving their services in a home or community-based setting.
The Governor’s response to the legislature’s proposed budget remains to be seen. Last year, he vetoed a number of line items relating to services for elders. The legislature ultimately overrode each of those vetoes. Stay tuned....
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