Elderly face unknowns in SenioRx plan

Wednesday, May 19, 2004

JEFFERSON CITY, Mo. -- Because the Missouri Legislature failed this year to pass a bill extending and revamping the state's prescription drug program, Missouri seniors next year may be signing up for benefits without knowing exactly what they're getting.

Legislation proposed this year by the Senate's Republican and Democrat leaders would have altered the program, known as SenioRx, to cover a gap in drug coverage once the federal Medicare prescription drug benefit begins in 2006.

Currently, the state SenioRx plan covers about 19,000 Missourians age 65 and older who have too much money to qualify for Medicaid but not enough to afford private prescription coverage.

Senate leaders, the governor and lieutenant governor all supported the legislation, which passed the Senate in early April. But the bill died without ever coming to a vote in the House, where some members didn't see any rush to act this year.

Missouri lawmakers created the SenioRx program in September 2001 and, if nothing is done, the program would expire in December 2005, said SenioRx director Laurie Hines.

Hines said she expects the legislature will act next year to continue the program, but she said their inaction now makes it tough when marketing the program to seniors over the next several months.

The program's annual re-enrollment period runs from January through February for a yearly coverage period that starts in July. Meanwhile, the legislative session runs from January through mid-May. That means seniors could be enrolling in a program next year that later gets changed by lawmakers.

And if the legislature passes something similar to this year's proposal -- to basically scrap the current program and instead use state money only to fill in the federal drug benefit gap -- then seniors could potentially have one benefit for six months of the state fiscal year and another for the rest of the year.

"It just is going to make it a little bit more of a challenge to go out and market a program and potentially change the rules of the game," Hines said.

Other questions also could arise, she said, such as whether current annual deductibles and enrollment fees must be changed if the program may only be around for half of a year.

Under the federal Medicare prescription benefit, senior citizens will pay a monthly premium plus the first $250 in annual prescription costs, and Medicare will cover 75 percent of the next $2,000. There will be no coverage for prescriptions totaling between $2,250 and $5,100. Medicare then will cover 95 percent of amounts higher than $5,100.

Under the failed Missouri legislation, the state would have covered 75 percent of drug costs in that $2,850 gap for seniors with incomes between 150 percent and 200 percent of the federal poverty level, which for 2004 would amount to $13,965 to $18,620 for an individual. The qualifying income would be adjusted according to the number of people in a household.

The legislative proposal also would have picked up drug coverage for those making less than $13,965 who fail a federal asset test and thus don't qualify for more generous Medicare drug benefits.

Several lawmakers and state officials expressed disappointment that the legislation failed this year.

"Missouri's most vulnerable seniors run the risk of losing the gap coverage they need to help with the high cost of prescription drugs," said Lt. Gov. Joe Maxwell, who leads the SenioRx Commission. "We will also lose critical time we would have had to help educate the seniors of this state on their options" when the Medicare drug benefit begins.

But others said the changes still can be passed next year, and by then lawmakers should have a better idea of how to line up the state program with the federal drug plan.

"We have plenty of time to tell seniors what to expect," said House Budget Committee chairman Carl Bearden, R-St. Charles. "If we pass it next year, they have a full six months or more to see what that impact is.

"This was very hastily drawn up," Bearden said about this year's legislation. "There are not any federal regulations put out on this yet. We would be trying to develop a plan to a federal program that doesn't really exist yet."

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