The state is notifying all 211,000 participants in the Illinois Cares Rx program that they either will be paying more for their drugs beginning Sept. 1 or are being terminated from the program.
However, about 5,700 recipients have mistakenly been sent letters telling them they no longer qualify for the drug assistance program because they no longer meet income eligibility limits.
The Department of Healthcare and Family Services is in the process of sending that group new letters stating that they do, in fact, still qualify for the program.
“Based on their income data we had on file from their last application, they were over (the limit),” said DHFS spokesman Mike Claffey. “Subsequently, we got updated information. There is a group whose income has dropped and they remain eligible.”
The changes are the result of the new state budget, which cut funding for Illinois Cares Rx about in half, from $107 million to $53.7 million. Because of the reduction, the income maximum for participants was lowered, and co-payments for those who still qualify were increased.
Before the change, a single-person household could have income of up to $27,610 to qualify for the program. The maximum has dropped to $21,780. For a two-person household, the limit was lowered from $36,635 to $29,420.
“This is a voluntary, optional state program,” Claffey said. “Due to the nature of the state’s fiscal problems, we had to look across the board where we can to trim programs where we can. We are able to maintain significant help for more than 75 percent of the people in the program.”
DHFS expects 40,000 and 45,000 participants to lose their Illinois Cares Rx aid.
David Vinkler, associate director of AARP Illinois, said reduced funding is better than Gov. Pat Quinn’s original proposal to do away with the program entirely.
“We definitely wanted to see full funding (but) in the end we’re much gladder to see 160,000 people with the service than seeing them all gone,” Vinkler said.
Still, he said, “This definitely will cause major problems for seniors.
“This basically could drive people toward a nursing home placement,” Vinkler said. “If they go into a nursing home, then the state is paying $3,000 a month once they get onto Medicaid.”
Illinois Cares Rx is geared toward lower-income seniors, so Vinkler said it is likely that many of them will be Medicaid clients if they go into nursing homes.
“A lot of these programs were put in the budget to save the state money,” he said. “Cutting back on them now, you may see an immediate savings, but in the long run it may cost the state more money.”
Coburn said his agency is recommending that people who are terminated from Illinois Cares Rx should make sure the state has accurate income information for them. Second, since Illinois Cares Rx pays for Medicare Part D premiums, people losing their state coverage should check to see if less expensive Part D plans are available, he said.
He also recommended that people obtain 90-day supplies of medication before their coverage runs out and speak with their doctors about using less expensive generic drugs.
The agency also sent a fact sheet to counseling agencies on how to advise seniors who have questions about the changes.
Beth Monnat, a pharmaceutical assistance specialist for Senior Services of Central Illinois, said the agency has received only about 10 calls so far, but the letters went out only this week.
“We think there’s going to be a lot of people calling,” she said. “I think next week will be more of an indicator of what things will be.”
Monnat said the agency will make appointments for people to review their options.
“It’s going to be hard for some people,” she said.
Teri Johnson, benefits specialist for the Area Agency on Aging Lincolnland, said that agency also has received some calls from people wondering “how are they going to pay their prescriptions.”
She said that agency also is making appointments with people who want to discuss their options and can refer them to other places for help.
***
Four versions of letter
Four versions of the Illinois Cares Rx letter are being mailed, each tailored to the specific circumstances of the recipient. One version, for example, is being mailed to people still eligible for the program who have Medicare, while another goes to those who do not have Medicare.
Letters for those still eligible contain new co-payment amounts.
The letters also provide phone numbers for agencies and help lines where people can get information about the changes.
“People are going to be confused by these letters,” predicted John Coburn, senior attorney at Chicago-based Health and Disability Advocates. “One neighbor is going to get one that says they are terminated, another is going to get one that says their co-pays are going up.”
In fact, it is possible two people in the same household could get different letters, depending on whether they are on different prescription-drug payment plans.
Some retirees can continue to obtain drugs through their employers’ health plans. If they still qualify for Illinois Cares Rx, they receive $25 a month rebate checks through the program. That rebate is ending Sept. 1.
Income eligibility for Illinois Cares Rx
Current limit New limit
One person $27,610 $21,780
Two people $36,635 $29,420
Three or more $45,657 $37,060
——————–
Source: The State Journal Register - The Oldest Newspaper in Illinois
