The Wisconsin Department of Health Services (DHS) is requesting comments on its SeniorCare program as part of its effort to get permission from the federal Center for Medicare & Medicaid Services (CMS) to extend the program through 2015. SeniorCare is a prescription drug assistance program for Wisconsin residents who are 65 years of age or older designed to help seniors with their prescription drug costs.

Background

On July 1, 2002, The State of Wisconsin received the necessary waiver approvals from the CMS to operate a portion of SeniorCare as a five-year demonstration project. Through its partnership with the federal government, the waiver extends Medicaid eligibility through Title XIX to cover prescription drugs as a necessary primary health care benefit.

The target population is seniors 65 years or older with income at or below 200 percent of the federal poverty level (FPL), which is $22,340 for an individual and $30,260 for a two-person family in 2012. Each month the SeniorCare waiver program serves about 60,000 seniors.

All SeniorCare participants pay an annual $30 enrollment fee and incur co-pays of just $5 for generic drugs or $15 for brand name drugs. Individuals or couples with incomes below 160 percent FPL have no other out-of-pocket costs. Those between 160 and 200 percent FPL pay the first $500 in prescription drug costs at the SeniorCare rate. Individuals with incomes above 200 percent but not greater than 240 percent FPL pay the first $850 in prescription drug costs. Individuals with income above 240 percent of the FPL must first meet their spend-down requirement, then satisfy an $850 annual deductible. There are no premiums, coinsurance and other out-of-pocket costs such as coverage gaps.

More than 1,300 pharmacies in the state are certified as SeniorCare providers.

Request for Extension

DHS is requesting a three year extension of the state SeniorCare prescription drug assistance program which would continue the program until December 31, 2015 instead of allowing it to expire on December 31, 2012. DHS’s proposal would maintain the existing SeniorCare program in its current form.

Request for Comments

CMS and DHS have agreed on a timeline to submit the waiver request to the federal government for approval by the end of August. Accordingly, all public comments must be received by DHS by July 16, 2012.

Comments will be accepted at public hearings, online, or via mail.

Public Hearing Schedule:

Stevens Point
June 28, 2012
10:00 a.m. to 12:00 noon
Portage County Annex
1462 Strongs Avenue
Stevens Point, WI

Waukesha
June 29, 2012
10:00 a.m. to 12:00 noon
State Office Building
141 NW Barstow, Room 151
Waukesha, WI

Hudson
July 13, 2012
10:00 a.m. to 12:00 noon
St. Croix County Government Center
1101 Carmichael Road, County Board Room
Hudson, WI 54016