K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured The Transition of Dual Eligibles to Medicare Drug Coverage: Implications for Beneficiaries and States Jocelyn Guyer Associate Director Kaiser Commission on Medicaid and the Uninsured Families USA Conference
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Medicaid and the Uninsured
The Transition of Dual Eligibles to Medicare Drug Coverage:
Implications for Beneficiaries and States
Kaiser Commission on Medicaid and the Uninsured
Families USA Conference
January 28 and 29th, 2005
*Community-residing individuals only.
SOURCE: KCMU estimates based on analysis of MCBS Cost & Use 2000.
“We have tens of thousands of people on Medicaid, in nursing homes, who will call their state legislator. It will be Medicaid that is blamed. State legislative leaders on both sides of the aisle have a firm interest in [a better transition plan].”
“The implementation for dual eligibles is going to be a disaster, given the short time to switch people over.”
“When you look at what we’re paying for the clawback, why should we have to pay 90 percent of what we spent and get something substantially less in value back [and] then have to wrap-around?”
“It is virtually impossible to plan. We don’t even know who we’re coordinating with.”
Monthly State Payment Plans
Per Capita Expenditures
State Match (S%)
Per capita Medicaid expenditures on prescription drugs covered under Part D for dual eligibles during 2003, trended forward
State share of Medicaid expenditures
Number of dual eligibles enrolled in a Medicare Part D plan in the month for which payment is made
Phase-down percentage for the year specified in the statute (e.g., 90% in 2006)Formula for Determining Monthly State Clawback Payments
SOURCE: Federal Register.