February 17, 2010
California recently notified approximately 150 HIV/AIDS patients on Medi-Cal, the state Medicaid program, that on Feb. 28 it will stop paying private health insurance premiums through the Health Insurance Premium Payment program. The reason cited for dropping HIPP coverage is that the program clients are also eligible for Medicare.
HIPP covers commercial health insurance if this will save money for Medi-Cal, said Jeffrey Blackmon, spokesperson for California's Department of Health Care Services. Medicare began covering prescriptions through the Part D program in 2006, he said.
"Due to budget concerns, we have reviewed all of our programs for efficiencies," Blackmon said. "This came to our attention when commercial plans pointed out that they were not being utilized by the patient." Medicare Part B and D premiums, for doctor visits and prescription drugs, have already been paid through Medi-Cal. And all the HIPP beneficiaries had free Medicare Part A coverage for hospital visits.
"A beneficiary with [both] Medicare and Medi-Cal" would not face the 'donut hole' in Part D coverage," said Blackmon. "A lot of costs are being born by Medicare already and the commercial plans weren't being utilized in many cases."
"In general, if someone is covered by both Medi-Cal and Medicare, they do not have co-pays," Blackmon said. However, were someone enrolled in Medi-Cal to drop it, that person could be hit with co-pays, he acknowledged.
Lord Martine said he experienced "intense sticker-shock" when he went to pick up his prescriptions recently. Last year, Medicare Part D and private insurance covered everything but the occasional $3 co-pay, so he dropped Medi-Cal coverage. This year, he has a $5,000 deductible on prescriptions during the Medicare "donut hole." With no Medi-Cal coverage to fall back on, Martine's recent bill was $1,700. He has been unable to resolve the bill through Medicare or his private insurance.
Jane Gelfland, the director and attorney for Public Benefits Attorneys Inc., said her agency is working with about 15 people who are attempting to verify to officials that HIPP saves the state money, including for Medicare-eligible clients. The program requires a cost-savings ratio of 1:1, said Blackmon.