Medicaid Rx Question/Confusion

[Rossat]

Randomly I come across Medicaid individuals aging into Medicare, and are still paying the Medicaid costs for their Rx's when I was under the impression those should be subject to Medicare's (PDP) cost.

Example (PA):
Client has Medicaid. Medicare begun 4/1 (A&B). Medicare reflects NO LIS, NO PDP coverage, NOT Full. IEP ends this month. Due to PA COVID extension, still has Medicaid but probably will lose it when extension ends; TBD. However, when I asked how much they are currently paying for their list of Medications, they gave the Medicaid Rates.

My question is ultimately: how is this possible? My understanding was once someone gets Medicare, Medicaid is secondary but Rx coverage stops with the exception of a handful of drug types.

Am I missing something here? I wish Medicare and Medicaid would make it very clear how they interact with one another during this transition period but it seems everyone is different.

 

[Todd King]

If they are dual eligible (Medicare + Medicaid), they will still pay Medicaid costs or the drugs.

 

[StephanieCJ]

If they are dual eligible (Medicare + Medicaid), they will still pay Medicaid costs or the drugs.

That must be state specific, because in Louisiana, once you have Medicare, you pay those co-pays even if you are dual eligible. The copays at that point depend on the level of extra help you qualify for.

 

[Todd King]

This might help....https://www.cms.gov/outreach-and-ed..._beneficiaries_dual_eligibles_at_a_glance.pdf

 

[StephanieCJ]

This might help....https://www.cms.gov/outreach-and-ed..._beneficiaries_dual_eligibles_at_a_glance.pdf

Interesting, that shows that Medicaid must cover the RX, but I've never seen it done. Most of the DSNP plans have $0 RX, but some still have co-pays and clients/prospects have paid them in that case. I wonder where the disconnect is happening.

 

[Rossat]

This might help....https://www.cms.gov/outreach-and-ed..._beneficiaries_dual_eligibles_at_a_glance.pdf

I'm not seeing in that document where it states that. It is stating Medicaid must cover prescription drugs, but that's not stating when an individual has both. Just simply: Medicaid programs must cover prescriptions.

Per the DHS site of PA it states: If you receive Medicare and get your prescription drugs through Medical Assistance (the ACCESS card), you will be required to enroll in a Part D plan.

AND

Medicaid will no longer cover most prescription drugs — Dual eligibles have to get their prescription drug coverage through Medicare Part D.