Lisa Wilson Disabled & Elderly Health Programs Group Center for Medicare & State Operations

1. Medicare Prescription Drug Coverage: Outreach to Dual-Eligibles, Partial Eligibles and Low Income Individuals Lisa Wilson Disabled & Elderly Health Programs Group Center for Medicare & State Operations Center for Medicare & Medicaid Services March 23, 2006

2. Ensuring Continuity of Coverage: Auto-Enrollment • Medicaid prescription drug coverage for full-benefit dual eligibles ended 12/31/005 • As of January 1, 2006, full-benefit dual eligibles were automatically enrolled in a prescription drug plan effective if they did not select a plan • Notices were sent informing duals of plan they would be autoenrolled in mid-October • NOTE: Full-benefit dual eligibles have a SEP so that they change plans any time

3. Going Forward:Auto-enrollment • Medicare 1st, Medicaid 2nd • Medicare/Medicaid same month • Date of autoenrollment: First day of the month of Medicaid eligibility or January 1, 2006, whichever is later • Medicaid 1st, Medicare 2nd • Date of autoenrollment: first day of Part D eligibility

4. Cycling on and offMedicaid • FBDEs who “cycle on and off” Medicaid • Considered a FBDE for the rest of the calendar year

5. Informing the BeneficiaryCMS • CMS sends notice that FBDE will be auto-enrolled in a given PDP on the auto-enrollment effective date unless s/he chooses another Part D plan

6. Informing the BeneficiaryPDPs • PDPs must send a notice confirming the auto-enrollment after receiving CMS confirmation of the enrollment • PDPs must provide the confirmation notice to new auto- and facilitated enrollees within seven (7) business days of receiving confirmation from CMS • PDPs must also send a modified version of the pre- and post-enrollment materials that must be provided to those who voluntarily enroll in a PDP. • Evidence of health insurance coverage • Costs • Effective date of coverage • How to obtain services prior to the receipt of an ID card (i.e.-confirmation letter) • Summary of Benefits

7. Auto-enrollment Notices – Timing of Events Mid-Late October • CMS mailed notices to beneficiaries auto-enrolled into PDPs • Start monthly auto-enrollments November – December • State Medicaid Agencies sent Notice of Action to full duals (that Medicaid coverage is ending for prescription drugs) December 31 • Last chance to change before auto-enrollment takes effect January 2006 Forward • Similar notifications ongoing

8. Facilitated Enrollment • The primary differences between facilitated and auto-enrollment are: • Populations involved • MSP-only, “SSI-only,” other low-income subsidy eligibles • When the process is first initiated • Effective date of facilitated enrollment • May 1, 2006 for first round of facilitated enrollment • Prospective: the first day of the second month after the beneficiary is included in a monthly facilitated enrollment run • Scope of the Special Enrollment Period • MSP-only & other LIS eligibles—make changes any time • “SSI-only”—make changes at the next available enrollment period

9. Facilitated Enrollment • Must have a chance to change Part D plans or affirmatively decline facilitated enrollment into Part D before the facilitated enrollment becomes effective. • Beneficiary choice always “trumps” facilitated enrollment • Notices similar those for autoenrollment will be sent by CMS and the plans

10. “Medicare Covers America”Campaign Strategy • Multi-level approach • National • Regional • State/local • SPAPs Multi-channel approach • Media • Direct mail • Grassroots outreach • Partnerships

11. Resources • Web Resources • Go to www.cms.hhs.gov/partnerships • Click on “Prescription Drug Information for Partners” • Click on “MMA Outreach Publications” • Medicare & You Handbook • Medicare Mobile Office Tour Visits

12. How to Help • 1-800-MEDICARE • Web Tools at www.medicare.gov • Prescription Drug Plan Finder • Formulary Finder • Landscape of Local Plans

13. Questions?