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Medicare Part D Can Hinder Ability to Spend Down to Medicaid

  • June 1st, 2007

Many states have programs allowing individuals above the Medicaid income thresholds to spend down excess income on health care costs and be eligible for Medicaid for a period of time. But those individuals with the Medicare prescription drug benefit -- Medicare Part D -- may experience some problems qualifying for Medicaid, including lapses in Medicaid coverage, according to a new issue paper from the Kaiser Commission on Medicaid and the Uninsured.

According to the paper, Medicare Part D recipients may not be able to spend down as quickly because they do not have large out-of-pocket drug expenses. This may cause them to have a lapse in Medicaid eligibility, which would impede their access to other health care services not provided by Medicare.

In addition, spend-down Medicare beneficiaries often do not attain Medicaid eligibility until late in the month and thus miss the cut-off for auto-enrollment into a Part D plan. While the federal Centers for Medicare and Medicaid Services has built in safeguards for individuals who experience a coverage gap, those safeguards do not specifically address spend-down beneficiaries.

To read the full paper, click here.

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Last Modified: 06/01/2007

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