Long Term Care Organizations Praise Representative Doggett's Effort To Eliminate Part D Co-Pays For Dual Eligibles In Assisted Living Residences

Main Category: Medicare / Medicaid / SCHIP
Article Date: 25 Mar 2008 - 6:00 PDT

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The National Center for Assisted Living (NCAL) and the American Health Care Association (AHCA) praised Representative Lloyd Doggett (D-TX) and his bipartisan co-sponsors, Tom Allen (D-ME), Stephen Cohen (D-TN), Shelley Moore Capito (R-WV), Lincoln Diaz-Balart (R-FL), Mario Diaz-Balart (R- FL), Patrick Kennedy (D-RI), Doris Matsui (D-CA), Carolyn McCarthy (D-NY), Betty McCollum (D-MN), James Moran (D-VA), Todd Platts (R-PA), Jim Ramstad (R-MN) and Linda Sanchez (D-CA) for their introduction of the Medicare Part D Home and Community Services Copayment Equity Act of 2008 (HR 5604). This legislation would provide dual eligibles - those covered by both Medicare and Medicaid - living in our nation's assisted living residences and other home and community-based settings (HCBS) the same co-pay coverage under Medicare Part D as those residing in nursing facilities.

"We applaud Representative Doggett's leadership and steadfast support on an issue that is critically important to assisted living's low-income, elderly and frail beneficiaries," said David Kyllo, Executive Director of NCAL. "Our residents require the same number of medications as nursing facility residents, yet this group of low-income assisted living residents is often unable to afford their co-payments and therefore denied access to these life-saving medicines."

"Seniors should not be punished for living independently," said Congressman Doggett. "This bill treats all seniors equally, regardless of where they live."

Dual eligible assisted living residents on average take eight to ten medications, and with Part D drug co-pays ranging from one to more than five dollars, their expenditures can quickly add up and exceed the resident's monthly personal allowance under Medicaid.

"Assisted living providers are concerned about the quality of life of their dual eligible residents," stated Bruce Yarwood, President and CEO of AHCA. "The passage of the Medicare Part D Home and Community Services Copayment Equity Act of 2008 (HR 5604) would ensure that residents receive their needed medications."

"A coalition of more than 35 national organizations representing consumers, geriatric care professionals, health care and long term care providers, pharmacists, and state officials stated their belief that remedying this gap in prescription coverage is based upon simple common sense," stated Kyllo. "NCAL shares that viewpoint and led this coalition to garner support on behalf of assisted living residents."

Analysis prepared for AHCA/NCAL by the Lewin Group revealed that by 2008, the HCBS dual eligible population will be larger than the number of dual eligible beneficiaries living in nursing facilities and other institutions.

However, though more states are opting to use Medicaid to cover assisted living services, a new federal government report shows that the Medicaid population in assisted living facilities declined somewhat from 2004 to 2007. A variety of federal and state policies could be playing a role in the decline, including the Part D co-pay requirement and Medicaid reimbursement rates and policies.

The American Health Care Association represents nearly 11,000 non-profit and proprietary facilities dedicated to continuous improvement in the delivery of professional and compassionate care provided daily by millions of caring employees to 1.5 million of our nation's frail, elderly and disabled citizens who live in nursing facilities, assisted living residences, subacute centers and homes for persons with mental retardation and developmental disabilities.

American Health Care Association

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