Medicare & Mental Health

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Until last month, low-income Medicare beneficiaries used Medicaid for prescription drugs. Now Medicare is supposed to pick up the tab for these people called dual-eligible beneficiaries. But, the transition’s been far from seamless.

“There are hundreds of stories…”

Carol Herrmann is Commissioner of the Alabama Medicaid Agency. Right now at least six states are using state dollars to cover those in need, but Herrmann says with 88,000 dual-eligible beneficiaries, Alabama can’t afford to do that.

“It would cost us 23 million state dollars to do this and we just do not have those resources.”

“Now with regard to these dual-eligible, we absolutely need to be listening to the Medicare state directors like Carol Herrmann.”

Republican Alabama Senator Jeff Sessions.

“We need to be hearing what they’re saying and if we need legislation to smooth out the rough spots I certainly would be supportive of that.”

Doctor Richard Powers directs the Alabama Department of Mental Health and Mental Retardation. He says the difficulties are compounding the troubles of Katrina victims.

“Listen, I saw about 15 people yesterday at the Wincreek evacuation point most of them are medicare/Medicaid I would say at least 1/3 of them had a problem when they went to the pharmacy.”

He says even if this problem is temporary it could have long term ramifications.

“The number one reason why people with mental illness relapse is because they quit taking their medication.”

Carol Leadbetter is a nurse with Alabama Mental Health Department.

“When you bring a client out of the darkness of life and give them a life where they can live and function and work and enjoy being alive, you don’t want to put them back in a cave or something or lock them up behind bars.”

She says the agency staff is tired and frustrated – having spent hours on the phone trying to sort out patient problems. Doctor Powers says people don’t like admitting they are mentally ill, and taking mental health drugs is a tacit acknowledgment of the problem.

“So every obstacle that you place in the way of medication compliance reduces the likelihood that that individual is going to continue to be compliant. These people are often time the least capable of dealing with these very intricate bureaucracies.”

Commissioner Herrmann says people warned of a systemic breakdown, but those running the new private plans didn’t pay attention.

“They didn’t have enough customer service reps…”

She says the federal Center for Medicare and Medicaid is working to improve the situation by increasing the number of customer service staff by 30-fold to handle the influx of complaints. But a spokesman for the National Mental Health Association says many of the new workers aren’t familiar with the complex details of each plan and end up giving out wrong information.

Sessions says with such a significant change in Medicare that he’s not surprised there are difficulties. The Senator stressed patience, saying it’ll take time to get the new system in place.

“But the net result is going to be for hundreds of thousands of Alabamians a tremendous burden is going to be lifted from their shoulders they’re going to be able to have drugs without having to give up on food or other necessities.”

But Commissioner Herrmann says what concerns her is the immediate problem.

“This’ll be two weeks where people have struggled to get their prescription drugs covered and we’re reaching a crisis point.”

Some doctors and nurses are using sample drugs or emergency funds to give patients medications they require, but they worry the supplies won’t last long.