A Parity Plan For Dual Eligibles: The Home and Community Services Copayment Equity Act of 2007

Source: Maribeth Bersani, Nursing Homes: Long Term Care Management, Vol. 56 no. 6, June 2007

Before January 2006 and the implementation of Medicare Part D, dual-eligible assisted living residents (those who receive Medicaid and Medicare benefits) were exempted from remitting co-payments for their prescription drugs. The exemption from co-payments was also applicable to individuals residing in skilled nursing homes, as well.

Under the new Medicare Part D program, however, dual-eligible residents in assisted living communities are not exempt from prescription drug co-payments. This has created a severe financial hardship for these residents who are already living on very low incomes. The only discretionary income most of these residents have is a Personal Needs Allowance (PNA)—frequently less than $60 per month. Residents use the PNA to pay for clothing, personal hygiene items, over-the-counter medications, and any other necessary items they need. To have to use this meager allowance to cover prescription drug co-pays is a true hardship.

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