October 2, 2003

Dear Conferee:

We are writing as members of the Consortium for Citizens with Disabilities (CCD), a Washington-based coalition of roughly 100 national disability organizations that advocates on behalf of the 54 million people with disabilities in the United States.  The establishment of a fair, affordable, and comprehensive Medicare prescription drug benefit for all Medicare beneficiaries, including the over 13 million people on Medicare that have a disability or chronic health condition, is one of our highest priorities.

As you work to reconcile the differences in the House and Senate Medicare prescription drug bills, H.R. 1 and S. 1, we urge you to ensure that all Medicare beneficiaries, including those who are covered under both Medicare and Medicaid (“dual eligibles”) receive a prescription drug benefit through Medicare. 

The Senate’s exclusion of a Medicare drug benefit for dual eligibles would likely harm the poorest and most vulnerable Medicare beneficiaries with disabilities and chronic health conditions.  Because Medicaid allows states to set their own eligibility and coverage standards, creating a patchwork effect with 50 plus different programs and drug benefits, Medicaid beneficiaries with disabilities of all ages lack the consistency that a national program like Medicare provides.

States are currently experiencing severe fiscal stress that is challenging their efforts to finance their Medicaid programs.  Because prescription drugs for dual eligibles cost states nearly $6 billion a year, the Senate provisions that exclude Medicare drug coverage for dual eligibles may lead states to reduce their Medicaid eligibility for persons with disabilities and chronic health conditions in order to shift the cost of drug coverage for these individuals onto Medicare.  This could have the unintended effect of making drug coverage for dual eligibles less, rather than more secure.  In the absence of wraparound Medicaid coverage, the Medicare drug benefit will be inadequate to meet the needs of many dually eligible individuals.  We are particularly troubled by the implications for Medicaid medically needy coverage, an optional coverage group taken up by 35 states and the District of Columbia.  Medically needy programs are a major source of Medicaid eligibility for people with disabilities.  If the Senate provision for excluding dual eligibles is retained, this creates an incentive for states to simply drop drug coverage for the medically needy, or eliminate medically needy coverage entirely.

We strongly urge you to adopt the House provision providing a Medicare drug benefit to all Medicare beneficiaries.  This is necessary to continue the existing practice for covering dual eligibles whereby Medicare is the primary payer and Medicaid supplements this coverage to meet the extensive needs of this population.  It is also necessary to deliver on the promise to modernize Medicare so that it can meet the needs of all of its beneficiaries.

Sincerely,

Advancing Independence

American Association of People with Disabilities

American Association on Health and Disability

American Association on Mental Retardation

American Congress of Community Supports and Employment Services

American Congress of Rehabilitation Medicine

American Medical Rehabilitation Providers Association

American Music Therapy Association

American Network of Community Options and Resources

Association of Academic Physiatrists

Association of Maternal and Child Health Programs

Association of University Centers on Disabilities

Bazelon Center for Mental Health Law

Brain Injury Association of America

Center on Disability Issues and the Health Professions

Disability Service Providers of America

Easter Seals

Eastern Paralyzed Veterans Association

Epilepsy Foundation

Family Voices

Helen Keller National Center

National Alliance for the Mentally Ill

National Association for the Advancement of Orthotics and Prosthetics

National Association of Councils on Developmental Disabilities

National Association of Disability Representatives, Inc.

National Association of Protection and Advocacy Systems

National Association of State Mental Health Program Directors

National Coalition on Deaf-Blindness

National Mental Health Association

National Multiple Sclerosis Society

National Organization on Disability

National Respite Coalition

NISH

Paralyzed Veterans of America

Spina Bifida Association of America

The Arc of the United States

Title II Community AIDS National Network

United Cerebral Palsy

Volunteers of America

World Institute on Disability