For Professionals: Advocacy & Policy

California Low-Income Health Advocate Alert On Medicare Part D

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June 15, 2007

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More information on Medicare Part D, including past Alerts, can be found at www.cahealthadvocates.org/cmc/ and http://www.nsclc.org/areas/medicare-part-d.

State Update

California Co-pay Bill Stalls in Appropriations Committee

A California bill (SB 623 Wiggins) that would have provided Part D co-payment relief to California’s dual eligibles is dead for this legislative session. While the bill had passed through the Senate Health Committee, it was not able to make it through the Senate Appropriations committee. The bill was not taken “off suspense,” and therefore will not make it to the floor of the Senate to be voted on. As mentioned in prior Alerts, many individuals who are dually eligible for Medicare and Medi-Cal have been struggling to afford co-payments under the Medicare Part D prescription drug benefit. Those who cannot afford these co-pays often go without needed medications. Senate Bill 623 would have required the state to pay co-payments for dual eligible beneficiaries.

LIS Grace Periods Are Ending

As mentioned in the January Alert, many Part D plans in California offered a “grace period” in the early months of 2007 to beneficiaries who received the Low Income Subsidy in 2006, but did not qualify for it again in 2007. Through the “grace period,” plans continued to provide the benefits of the LIS to beneficiaries who no longer qualified. Many plans are now ending the grace period. Beneficiaries who did not re-qualify for the subsidy during the early months of 2007 are now receiving notices from the plans that they owe retroactive premiums and cost-sharing back to January 1, 2007.

The intention of the grace period was to allow beneficiaries time to reapply for the subsidy. Unfortunately, many beneficiaries, since they were still paying reduced co-pays, deductibles and premiums, never realized that they lost the subsidy and, therefore, needed to take action (e.g. reapply for the subsidy or switch to a less expensive plan). Providing notice now is not helpful to those beneficiaries who would like to switch plans since the Special Enrollment Period for beneficiaries losing their Low Income Subsidy has ended. Additionally, those who take action now to re-qualify for the subsidy will likely still be liable for retroactive premiums and cost-sharing. Eligibility determinations made by SSA are only prospective and Medi-Cal eligibility determinations are generally only retroactive three months.

Please share stories of clients who are in this situation with NSCLC ( ).

Medi-Cal & Medicare Managed Care and Part D

We have recently received a number of questions from advocates working with dual eligible beneficiaries who are enrolled in a Medi-Cal managed care plan. A dual eligible enrolled in a Medi-Cal managed care plan (as opposed to a Medicare managed care plan) will also be auto-enrolled into a stand alone Medicare Prescription Drug Plan (if s/he does not select a Part D plan on their own) since the Medi-Cal managed care plan will stop covering their medications as soon as they qualify for Medicare. This can create access problems when the Medi-Cal managed care plan pharmacies do not accept alternative forms of insurance (e.g. Kaiser pharmacies not accepting Humana prescription insurance).

The dual eligible can choose to retain the Medi-Cal Managed Care membership and the Medicare PDP membership and simply take prescriptions to pharmacies that do accept the Medicare PDP. Alternatively, dual eligibles who are happy with theie Medi-Cal managed care plan can inquire whether the sponsoring organization offers a Medicare managed care plan that includes prescription drug coverage. Many of the organizations that offer Medi-Cal managed care plans also offer Medicare Special Needs Plans that are capable of providing both Medi-Cal and Medicare benefits to a dual eligible (see Section IV, below, for information about a recent webcast on Special Needs Plans). It is always important to do a complete evaluation of a beneficiary’s needs, plan benefits and plan costs before changing plans.

In at least a few instances, dual eligible individuals who were already members of a Medicare managed care plan with drug benefits have been erroneously auto-enrolled by CMS into a new Medicare PDP. This erroneous auto-enrollment into a PDP causes involuntary disenrollment from the Medicare managed care plan. Beneficiaries must affirmatively contact the Medicare managed care plan in order to fix the erroneous disenrollment.

Kaiser officials recommend that advocates whose dual eligible clients are having “intractable or systemic” problems accessing their Kaiser drug benefits should call Joan Spiegler, 1-858-614-3921, a Medicare Compliance and Audit Specialist at the Kaiser San Diego Service Center.

Federal Update

Advocates Tell Congress: Make Medicare Work for Low-Income Beneficiaries

As mentioned in previous Alerts, Congress has stepped up scrutiny of CMS’ implementation of Medicare Part D and Medicare Savings Programs. Notably, recent hearings focused on the plight of low-income Medicare beneficiaries, especially those who lack adequate access to prescription drugs and other Medicare benefits.

On May 2, 2007, Senator Max Baucus convened the Senate Finance Committee to hear testimony from beneficiaries, providers and advocates about problems with the Medicare Part D program. A week later, the senators listened to officials from CMS, the Social Security Administration, and the Government Accountability Office (see “GAO Report Describes Medicare Prescription Drug Auto-Enrollment Time Lags; Faults CMS for Failing to Ensure Dual Eligibles are Reimbursed for Out-of-Pocket Costs” on page 10 for more details about the GAO’s recent investigation). Vicki Gottlich, an attorney for the Center for Medicare Advocacy, explained that the complexity of Part D made the program ripe for marketing abuses and affected “the ability of beneficiaries to understand the program, choose plans, pay premiums, benefit appropriately from the Low Income Subsidy, and utilize the exceptions and appeals process.” CMS official Abby Block later painted a far rosier picture, emphasizing that the majority of beneficiaries are satisfied and that the program is less expensive than projected.

On May 3, a House Ways and Means Subcommittee on Health hearing focused on Medicare Savings Programs (MSPs) (such as the Qualified Medicare Beneficiary (QMB) program), which help cover Medicare premiums and cost-sharing for low-income beneficiaries. Estimates suggest that only 40-60 % of eligible beneficiaries are participating in MSPs, leaving millions of needy individuals without assistance. The causes cited by witnesses included onerous application requirements, asset tests, and government’s failure to reach out effectively to beneficiaries, especially those with limited English proficiency. Because MSP enrollees automatically qualify for the Low Income Subsidy, under-enrollment in MSPs reduces access to affordable prescription drugs as well.

On May 22, California Health Advocates’ own David Lipschutz appeared before the House Ways and Means Subcommittee on Health to testify about problems beneficiaries experience with the sale of and access to care through Medicare Advantage Private Fee For Service (PFFS) Plans. David’s testimony focused on factors contributing to marketing misconduct, including the structure of PFFS plans, commissions paid to agents and the lack of adequate training and oversight of agents. In addition to examples of marketing misconduct, David’s testimony described how some PFFS plans continue to target dual eligibles, even though PFFS plans offer little, if any, additional benefits to duals, and many PFFS enrollees (including duals) find that their providers will not accept the terms and conditions of these plans. See: http://www.cahealthadvocates.org/….html

Testimony from the hearings is available online at http://finance.senate.gov/….htm and http://waysandmeans.house.gov/….

CMS Releases New Marketing and Enrollment Requirements for PFFS Plans

As reported in recent Issue Alerts, advocates in California and other states are continuing to encounter inappropriate marketing activities surrounding the sale of Part D and Medicare Advantage (MA) plans, particularly MA Private Fee-for-Service (PFFS) plans. Dual eligibles are being targeted to enroll in PFFS plans, which often results in them having to change doctors or try to disenroll from the plan in order to continue seeing their providers.

In response to concerns raised by advocates across the country, CMS recently created additional marketing and enrollment requirements for PFFS plans. These requirements are designed to ensure that beneficiaries understand the consequences of enrolling in a PFFS plan. New requirements include:

  • Beginning in June 2007, PFFS plans must provide their CMS Regional Office Plan Manager with a schedule of all sales and marketing events they will conduct in the following month. Events hosted by both employed and contracted sales representatives must be included.
  • Plans must immediately cease using any materials or making any statements which imply that PFFS plans function as Medicare supplemental plans or using terms such as “Medicare Supplement Replacement.” Plans are permitted to say that the plan pays instead of Medicare.
  • Plans are required to prominently display new disclaimer language on all printed materials as soon as possible. The disclaimer language must be included in all sales presentations (both public presentations and private meetings with beneficiaries) immediately. The disclaimer states that PFFS plans work differently that a Medicare Supplement plan and says that providers who do not agree to the plan’s terms and conditions may deny care. Also, any plan statement that beneficiaries can see any provider must include the phrase, “…who agrees to accept our terms and conditions of payment.”
  • Plans must provide all enrollees with a complete description of plan rules, including information about provider participation in the plan. CMS has created a model two-sided leaflet for this purpose. One side of the leaflet contains information for the beneficiary. The other side has information for the provider. The leaflet is meant to be something beneficiaries can share with their providers. The leaflet must be included in all enrollment kits that are sent to prospective enrollees and must be available on the plan website. The leaflet must be put in place “as quickly as possible.”
  • Plans are required to conduct outbound education and verification calls to all beneficiaries requesting enrollment to ensure that they understand plan rules. Sales representatives must obtain a contact phone number when accepting an enrollment request from a beneficiary. The outbound calls must occur after – not during – the original sale. Outbound calls to beneficiaries who requested enrollment via a sales agent must not be made by those sale agents and the sales agents must not be present during the call. Plans are required to make three documented attempts to contact the beneficiary within 10 calendar days of receiving the request. Letters must follow an unsuccessful attempt to contact the beneficiary. All plans must have this process in place before they start marketing 2008 PFFS plans. CMS recommends, however, that plans implement these new requirements immediately. Model scripts and letters are provided by CMS.

CMS has also developed a number of “Best Practices” which it encourages plans to implement. Best practices include:

  • Using CMS created model language in sales presentations.
  • Participating in HEDIS and the Health Outcomes Survey (HOS) in 2008.
  • Developing a provider education plan to encourage providers to accept the plans’ terms and conditions. Plans are already required to have staff available to assist providers with questions.

All of the requirements and best practices are laid out in a memo to PFFS plans dated May 25, 2007. The memo and attachments are available at www.cms.hhs.gov/PrivateFeeforServicePlans/.

While these new requirements and best practices are a step in the right direction, many advocates are concerned that they do not address several ongoing marketing problems, including unscheduled presentations and sales at subsidized housing facilities, and language-appropriate plan correspondence and verification calls. Moreover, these new rules do not address what advocates believe is the root cause of much misconduct – the overpayments made to Medicare Advantage plans (including PFFS plans) and the commissions paid to agents which create incentives to steer people towards certain types of plans. If you encounter instances of potential marketing misconduct, we suggest that you report the case to CMS; for further information, and to share stories of potential marketing misconduct, please contact David Lipschutz at California Health Advocates at .

Retroactive Disenrollment

One of primary tools that advocates have to help Medicare beneficiaries “undo the damage” of marketing misconduct is the retroactive disenrollment process; however, many advocates report that they have encountered difficulty in obtaining relief for their clients through this process. Beneficiaries who have been wrongly enrolled in Medicare Advantage (MA) and stand-alone prescription drug plans (PDPs) – whether they are induced to sign up for private plans by agents or representatives who gave them false information about coverage or were enrolled in plans without their consent or knowledge – generally have a right to retroactively disenroll from private plans they did not want and enroll back into original Medicare or their previous plan. Under Medicare rules, CMS may grant a retroactive disenrollment from private plans where “there never was a legally valid enrollment” or when certain other events occur. See, e.g., 42 CFR §422.66(b)(5); 42 CFR §423.36(c); also see the Medicare Managed Care Manual (MMCM), Chapter 2, §60.5.

Many advocates assisting Medicare beneficiaries, though, report that the process of obtaining retroactive disenrollments on behalf of their clients can be cumbersome and time consuming. The Medicare Rights Center (MRC) and California Health Advocates recently wrote a letter to Health and Human Services Secretary Leavitt outlining concerns expressed by advocates and requesting resolution by CMS. The issues MRC and California Health Advocates raised include: the retroactive disenrollment process “remains opaque and ad hoc;” there is no timeline for CMS regional offices to issue decisions or guidelines for providing notice; there is no avenue of appeal of an adverse decision; and CMS regional offices and personnel vary extensively in their responsiveness to disenrollment requests. These problems are further exacerbated when CMS delegates the responsibility for processing retroactive enrollments to private plans themselves. MRC, CHA, and other advocacy organizations have requested that CMS take affirmative steps to resolve these issues.

Note that the Health Assistance Partnership (HAP) has resources relating to obtaining retroactive disenrollments on behalf of clients, including a tip sheet and sample letter at: http://www.hapnetwork.org/….html Please share stories of problems obtaining retroactive disenrollments with David Lipschutz at California Health Advocates ( ).

CMS Clarifies Retroactive Reimbursement Policy

As mentioned in the April Alert, CMS recently released an instructional memo to plans regarding reimbursing dual eligibles for coverage during a retroactive enrollment period. This process is particularly important for Medicare beneficiaries who later become eligible for Medicaid, and who currently experience a gap or delay in getting auto-enrolled in a prescription drug plan at the full Low Income Subsidy amount. Even though auto-enrollment and LIS eligibility are retroactive to the start of full benefit eligibility, beneficiaries may be forced to pay out-of-pocket until CMS’ systems get caught up (beneficiaries who cannot afford to wait for CMS’ systems to catch up should try to utilize the Point of Service option and/or the Best Available Data policy to secure medications at the appropriate subsidy level).

On May 25, 2007, CMS released a memo to plans clarifying reimbursement requirements. The new memo reminds Part D plans that they are responsible for reimbursing prescription drug costs that newly auto-enrolled members may have incurred during the period of retroactive eligibility. For 2007, CMS is requiring plans to provide a “special transition period” of up to seven months for which the plans must reimburse claims incurred while a beneficiary was retroactively dual eligible. When the special transition period applies, plans must reimburse charges paid by beneficiaries or third party payers for all Part D drugs, including non-formulary drugs and formulary drugs with prior authorization requirements. Outside of the seven month period, plans are only obligated to reimburse claims for formulary drugs. In both cases, if the retroactive dual eligibility period extends back into 2006, plans may not impose a 2007 cut-off for reimbursement claims.

The new memo is available at, www.nsclc.org/…. The earlier memo is available at, www.cms.hhs.gov/….pdf.

SSA Outreach to Low-Income Medicare Beneficiaries Encourages Enrollment in MSPs, LIS

In an effort to increase enrollment in programs that help pay for Medicare premiums, deductibles and cost-sharing, the Social Security Administration (SSA) will mail letters to 4.7 million Medicare beneficiaries with limited incomes. The letters will inform beneficiaries about the availability of Medicare Savings Programs (MSPs) and the Medicare Part D prescription drug benefit’s Low Income Subsidy (LIS), also known as “extra help.” Advocates should be prepared for beneficiaries seeking assistance in applying for these programs.

SSA will send out three different letters between May 16 and June 26, 2007:

  • Beneficiaries whose countable income appears to be too high for Medicare Savings Programs, but not too high for the LIS will receive a letter encouraging recipients to join a Medicare Part D plan and to sign up for “extra help,” i.e. the LIS.
  • Beneficiaries who already receive the LIS and whose countable income appears to be less than 135% of the federal poverty level, will receive a letter encouraging recipients to sign up for MSPs (these include the Qualified Medicare Beneficiary (QMB), Specific Low-Income Beneficiary (SLMB), and Qualifying Individual (QI) programs).
  • Beneficiaries whose countable income is less than 135% of the federal poverty level, but who are not currently enrolled in the LIS or MSPs, will receive a letter encouraging them to apply for MSPs and help with prescription drug costs.

A fourth letter will be mailed in late November 2007 to former disability insurance beneficiaries. These individuals will receive information about the Qualified Disabled and Working Individual (QDWI) program, which helps individuals who lost their free Medicare Part A because of work to buy into Part A.

Advocates should encourage beneficiaries to apply for the Low Income Subsidy through their state Medicaid office. Unlike the SSA, states are required to screen and enroll applicants for MSPs. In addition, individuals who qualify for MSP automatically receive LIS, but not vice versa.

For more information about the Low Income Subsidy, see NSCLC’s tool, “The Low Income Subsidy for Medicare Part D Enrollees: Summary of Regulations and Procedures,” available for free online at www.nsclc.org/…. California Health Advocates also has fact sheets on these and other issues available at: http://www.cahealthadvocates.org/facts/ as well as more consumer-oriented fact sheets at: http://www.calmedicare.org.

Sample copies of the SSA letters are available at: www.cms.hhs.gov/….

CMS Releases Proposed Regulations for Comment

CMS has released two new proposed regulations for public comment. One proposed regulation relates to CMS oversight of Medicare Advantage and Part D plans. This regulation addresses contract determinations relating to MA plans and PDPs, intermediate and civil monetary penalties that CMS may levy against plans, elements of MA plan and PDP compliance plans and Health and Human Services access to books and records of plan subsidiaries.

The other proposed regulation makes a variety of technical corrections to the final Part D regulations issued in January 2005. Topics of this proposed regulation include TrOOP calculation, plan-to-plan reconciliation and the late enrollment penalty.

Both regulations were published in the Federal Register on May 25, 2007. In order to be considered, comments on the proposed regulations must be received no later than 5 p.m. on July 24, 2007. For the full text of the regulations and instructions on commenting, see www.access.gpo.gov/….html. If you have concerns about the proposed regulations but do not wish to file your own separate comments, please contact Georgia Burke, .

Legislation Update

Several bills related to low income Part D beneficiaries are currently pending in Congress. These include:

  • S. 1102 (Bingaman): Part D Equity for Low-Income Seniors Act of 2007 (to improve and expand the Low Income Subsidy);
  • S. 1103 (Bingaman): Helping Fill the Medicare Rx Gap Act of 2007 (to change calculations of TrOOP);
  • S. 1107 (Smith): Home and Community Services Copayment Equity Act of 2007 (to eliminate co-payments for full benefit dual eligibles in assisted living facilities);
  • S. 1108 (Smith): Medicare Part D Outreach and Enrollment Enhancement Act of 2007 (to increase enrollment into the Low Income Subsidy);
  • H.R. 2056 (Courtney): Medicare Part D Improvement Act of 2007 (to change calculations of TrOOP and to improve and expand the Low Income Subsidy); and
  • H.R. 153 (Doggett): Prescription Coverage Now Act of 2007 (similar to S. 1102, to improve and expand the Low Income Subsidy).

For a more detailed description of each pending bill, please see http://www.nsclc.org/….

Litigation Update

As part of the ongoing Situ litigation, the National Senior Citizens Law Center and the Center for Medicare Advocacy have been deposing key officials from the Centers for Medicare and Medicaid Services. The depositions taken so far have highlighted the large disconnect that exists between the agency’s perception of the Medicare Part D “success” and advocates’ and low income clients’ actual experiences. A formal settlement conference with a magistrate judge is currently scheduled for the end of June.

For questions about the Situ litigation, contact Anna Rich, arich@nsclc.org, or Kevin Prindiville, kprindiville@nsclc.org. We particularly appreciate the support of some fabulous California advocates – thank you!!

New Reports

Commonwealth Fund Report Identifies Pitfalls of Part D for Low Income Beneficiaries, Recommends Improvements

A recently released report coauthored by NSCLC finds that low-income beneficiaries are not well-served by the Medicare Part D program as it is currently administered, and significant improvements are needed. Produced by the Commonwealth Fund and co-authored by NSCLC, Georgetown University’s Heath Policy Institute and the Center for Medicare Advocacy, “Improving Medicare Part D Programs for the Most Vulnerable Beneficiaries” reviews many systemic flaws in the administration of Medicare Part D and provides recommendations for improvement. The report is available at, www.nsclc.org/areas/medicare-part-d.

GAO Report Describes Medicare Prescription Drug Auto-Enrollment Time Lags; Faults CMS for Failing to Ensure Dual Eligibles are Reimbursed for Out-of-Pocket Costs

Significant time lags in the transfer of low income subsidy eligibility and enrollment information continue to haunt dual eligibles, according to a new report from the Government Accountability Office.

According to the GAO, it takes at least 35 days for a Medicare beneficiary who qualifies for Medicaid to be enrolled into a Part D plan in which the beneficiary can receive prescription drugs at subsidized rates. A Medicare beneficiary who is already enrolled in a Part D plan when becoming eligible for Medicaid must wait at least 26 days before evidence of subsidy eligibility will be shared with the beneficiary’s plan. These timeframes represent the best case scenario. Much longer delays are common. While low income beneficiaries wait for enrollment or subsidy information to be transferred to plans,they are forced either to pay high out-of-pocket costs for medications or simply to go without life sustaining medications.

CMS did design a contingency plan for beneficiaries who face enrollment delays. The GAO’s findings make clear, however, that this system, know as the Point of Service system or Wellpoint, has not been effective. Pharmacists have had difficulty using the system and the design of the system, which creates financial risk for pharmacists, disincentivizes widespread use.

The GAO also criticizes CMS for failing to inform beneficiaries of their right to request retroactive reimbursement for costs incurred during retroactive periods and failing to track plan compliance with this requirement. CMS pays plans to provide retroactive coverage to beneficiaries (roughly $100 million was provided to plans for this purpose in 2006). Given the complexity of the reimbursement process, it is likely that many dual eligibles have not been properly reimbursed. Of course, retroactive coverage provides little protection to those low income beneficiaries who could not afford to incur out-of-pocket costs during a coverage gap. While the number of un-reimbursed beneficiaries is high, there is likely an even larger number of dual eligibles who were forced, by the time lags, to go without medications.

The GAO report mentions steps CMS has taken to address systems issues, but expresses concern that CMS is not planning to conduct “end-to-end” testing of system changes. The report also discusses random auto-assignment and recommends that CMS follow the lead of states that have worked to tailor auto-enrollment to beneficiary prescription drug needs. The report can be viewed at, www.gao.gov/new.items/d07272.pdf.

Kaiser Study Explores Part D Experiences of Dual Eligibles in Three States

A new Kaiser report titled, “Perspectives on Medicare Part D and Dual Eligibles: Key Informant’s Views From Three States,” examines the effect of Part D on dual eligibles and the ways in which state action affects dual eligibles’ access to prescription drugs. The study was conducted during August and September of 2006 and surveyed individuals serving dual eligibles in Washington, Connecticut and Florida. Most of those who responded reported neutral or negative experiences in Part D. The report covers auto-enrollment, affordability, state assistance, formularies and utilization management, exceptions and appeals, and program complexity and offers “lessons learned” from each state. Randy Boyle and Kate McGarvey of the National Health Law Program co-authored the report with advocates from Northwest Health Law Advocates. The report is available at www.kff.org/medicaid/7639.cfm.

APA Study Shows Dual Eligible Patients Hurt During Transition to Medicare Part D

A recent study by members of the American Psychiatric Association show that for dual eligible individuals with psychiatric needs, the transition from Medicaid to Part D prescription drug coverage was very difficult, and at times hazardous to their health.

The study surveyed psychiatrists nationwide about their dual eligible patients’ ability to access psychiatric and other needed medications during the first four months of 2006, when their patients were moved from Medicaid to privatized Medicare drug coverage. Overall, more than 53% of dual eligible psychiatric patients had at least one problem getting access to needed drugs, and 27.3% of these patients experienced a significant, adverse clinical event as a result. 19.8% reported an emergency room visit; 21.7% reported an increase in suicidal ideation; and 11.0% were hospitalized due to disruption in access to medicines.

According to an accompanying editorial in American Journal of Psychiatry, the study raises larger policy questions about the Medicare Modernization Act of 2003, including whether the “complex array of for-profit and other prescription drug plans” guarantees a “chaotic and unregulatable system of access and utilization management, leading inevitably to decreased overall access and quality of care.”

The study is published in the May 2007 issue of the American Journal of Psychiatry; an abstract is available online at http://ajp.psychiatryonline.org/….

Center for Medicare Advocacy Report Outlines PFFS Legal Requirements

“Medicare Advantage Private Fee-for-Service (PFFS) Plans: A Primer for Advocates,” explores the legal requirements that PFFS plans must meet. The report explores requirements related to beneficiary liability, access to services, provider relationships and payment, balance billing, the provision of prescription drugs and more. The report can be viewed at, www.medicareadvocacy.org/MA_PFFSPrimerForAdvocates.pdf.

Information for Advocates

Announcements from CHA

California Health Advocates is pleased to announce that the following June 6, 2007 webcast is now available on our website at: http://www.cahealthadvocates.org/

“Medicare Advantage Special Needs Plans: A National and California Perspective” with presentations by Patricia Nemore of the Center for Medicare Advocacy, Inc., David Lipschutz of California Health Advocates, and Anna Rich of National Senior Citizens Law Center. This webcast was supported by the California Endowment.

Subscriptions/Workshops: To subscribe to California Health Advocates' bi-monthly electronic newsletter “CalMedicare Advocate” or to request information about our workshops for statewide organizations please email news@cahealthadvocates.org.

Announcements from NSCLC

NSCLC bids a fond farewell to Oakland office Directing Attorney Jeanne Finberg. Jeanne is leaving NSCLC to return to the Public Rights Division of the California Attorney General’s office to do tobacco litigation. Jeanne has directed the Oakland office since coming back to NSCLC in 2004. (Jeanne was also a staff attorney at NSCLC from 1988-1993 and from 2001-2003).

During her tenure Jeanne has been instrumental in establishing and funding the Oakland office and its important Medicare Part D advocacy. As a result of her efforts NSCLC has been at the forefront of advocating for protections for low-income Medicare Part D beneficiaries nationally and in California. Four Oakland office attorneys, Katharine Hsiao, Georgia Burke, Kevin Prindiville, and Anna Rich will continue the important work that Jeanne began. NSCLC heartily thanks Jeanne Finberg for her commitment, passion, hard work and extraordinary accomplishments.

California Health Advocates and NSCLC Thank the California Endowment

From the Fall of 2005 through this issue, the California Endowment has provided generous support for the California Part D Low Income Advocate Alerts. This has been just one of the many ways the Endowment has supported advocacy on behalf of low income Part D beneficiaries. We are grateful for their support and encouragement of our work.

Report Your Medicare Prescription Drug Stories!

In order to help to get changes at the state and federal levels, we need to hear about the problems your low income clients are facing. We know that your time as advocates is already stretched thin, but any time you can take to report client stories would be extremely helpful.

You can share stories, lodge complaints, ask questions and exchange ideas about
Medicare Part D on California Health Advocates' Medicare Part D Community Discussion page on their web site at: www.cahealthadvocates.org/partd/. The site is designed to benefit the Health Insurance Counseling and Advocacy Program (HICAP) network, health consumer assistance organizations, community–based agencies and other individuals who are assisting Medicare beneficiaries and their families with Part D related problems, issues or questions. Bob Rosenblatt, the site’s moderator and content developer, is a former Los Angeles Times Washington correspondent for over 26 years and currently, among other things, a columnist on health policy issues with the California HealthCare Foundation.

You can also use NSCLC’s updated “Client Story Form” to report problems your clients have faced. You can access the new form at www.nsclc.org/areas/medicare-part-d. This month NSCLC is especially interested in hearing about problems filing complaints with CMS. Thanks for sharing your stories and information.

More information about Medicare Part D is posted on www.calmedicare.org, and on the main page and California page of the NSCLC website, which you can view at www.nsclc.org/areas/medicare-part-d. We will continually post new training materials as this program develops. Other helpful websites:

For more information, e-mail California Health Advocates or NSCLC:

California Health Advocates

David Lipschutz

(213) 381-3670

National Senior Citizens Law Center

Jeanne Finberg

Katharine Hsiao

Georgia Burke

Kevin Prindiville

Anna Rich

# # #

This Alert is provided by California Health Advocates in partnership with National Senior Citizens Law Center with support from The California Endowment.

California Health Advocates: http://www.cahealthadvocates.org

National Senior Citizens Law Center: http://www.nsclc.org

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