Medicare Prescription Drug Subsidy Payments for Dually Eligible Beneficiaries in New Hampshire

摘要

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (the MMA) provides drug benefits for Medicare beneficiaries. As part of these benefits, Medicare subsidizes 100 percent of the prescription drug costs for full-benefit dual eligible beneficiaries (referred to in this report as dual beneficiaries). Dual beneficiaries are individuals who have Medicare coverage and are also eligible for Medicaid because they have either (1) limited income and resources or (2) high medical expenses that have caused them to spend down their income to Medicaid eligibility limits. In accordance with section 103 of the MMA, the 50 States and the District of Columbia are required to pay the Centers for Medicare & Medicaid Services (CMS) a monthly contribution, beginning in January 2006, to defray a portion of Medicare drug expenditures for dual beneficiaries. The States contributions will be phased down annually over 10 years as Medicare's responsibility for the subsidy increases. Pursuant to the MMA, each States contribution is determined in part by the number of dual beneficiaries in the State. To define this population, States are required to submit data to CMS for each month that a dual beneficiary is eligible for Medicaid. CMS uses these data both to calculate the States phased-down contributions and to deem beneficiaries eligible for the prescription drug benefit. CMS automatically enrolls beneficiaries who have been deemed eligible in a prescription drug plan (PDP) for an entire calendar year and pays the PDP a 100-percent prescription drug subsidy for these beneficiaries for the whole year.