Aspects of Need Addressed: Medical, Financial
Although Medicare Part D offered my disabled son a choice of 45 prescription drug providers, only one of these included in its formulary all the medications he is using or might need. But the one program requires payment of a monthly premium. Given my son's "extra help" status with Medicare, he has been entitled to have NJ Medicaid pick up all that Medicare does not pick up, such as premiums, co-pays, and payments beyond caps and in the Part D "doughnut hole".
So I got to wondering... Does NJ Medicaid cover those costs such as premiums that Medicare plans would require of my son?
I called the NJ Medical Hotline at 1-800-356-1561. As I worked myself through the recorded messages to the destination I wanted, I reflected on last night's vote in Washington for Obamacare, which would extreme Medicaid coverage to several million more people. Here was an initial test of the Medicaid system. How responsive would it be? How friendly? How effective? I went on hold at 2:54 pm.
Medicaid On The Phone
At 3:01 pm, a woman curtly answered. "Medicaid!" I asked where I might be directed to get the formulary of medications available from NJ Medicaid. "Well," the female voice responded, "I know that there are certain medications that Medicaid no longer pays for." Such as what, I asked. "Asthma. Medicaid no longer pays for asthma medication." Well, that is an issue for my son, since he has asthma. But that wasn't the purpose of my call. I repeated my question.'
"Where can I find the formulary of prescription medications offered by Medicaid?"
"Just a minute. Let me put you through to our pharmacist."
A Dr. Yablonksy came on the line. Dr. Yablonsky spoke with a distinct New York accent and a mildly aggressive tone.
"Speak up!" he said. "I can't hear you." I channeled my voice directly into the mouthpiece as repeated my question: does Medicaid have a printed formulary, and where can I find it?
"Medicaid has no formulary. A pharmacist will bill Medicaid directly."
We were not communicating too well, it seemed. So I tried to explain my son's ailments.
"Call Unisys, the fiscal agent for NJ Medicaid at 609 588 3397. Maybe they can answer your question. What kind of medications are we talking about here?" asked Dr. Yablonsky.
I mentioned the anti-psychotics like Geodon and benzodiazepines like Clonazepam (Klonopin).
"Benzodiazepines might require a prior authorization. The doctor would have to call first. Unisys gives the prior authorizations. Call Unisys."
Unisys On The Phone... Not.
So I called the number that Dr. Yablonsky gave me. A man named Jeff answered. I repeated my son's dilemma.
"No, Medicaid will not pay the premiums of Medicare Part D plans that require them. Only the "benchmark" plans require no premiums. And no Medicare Part D plan will cover benzos..."
This initial response sounded a little disjointed and not quite correct.
"Well," I countered, "we have actually found that one of the 45 suggested plans will cover his benzodiazepines. But that one, Aetna Rx Plus, requires a monthly premium. That's one of the reasons I am calling: to see if Medicaid helps a covered individual pay for such premiums."
"No, it doesn't," said Jeff. He paused. "Medicaid will cover benzodiazepines as a "wrap around".
Wrap around? "What's a wrap around?" I asked.
"It means that Medicaid pays."
I was still a little confused. I wondered whether I might be able to see something in print about all this. "Does Medicaid have a posted formulary somewhat, as do Medicare Part D prescription drug plans, right on Medicare's website?"
"Medicaid has no formulary", Jeff tersely replied. "If a drug is not covered by Medicare Part D, Medicaid usually doesn't pick up."
"Except for benzodiazepines, as you just said?" I asked cautiously. "Right. Except for the benzos. But prescriptions have to billed to Part D first."
Another pause.
"You know what?" Jeff said, "Talk to the SHIP counselor at the Local County Board of Social Services. They can help your son pick a Medicare Part D plan.
This seemed a strange suggestion from someone at Unisys whom Dr. Yablonsky had told me administers the NJ Medicaid program. "No, I'm not with Unisys," Jeff clarified. He was a pharmacist in the Division of Medical Assistance and Health Services, part of the New Jersey Department of Human Services.
Hunting Down The SHIP: Call to Mercer County Board Of Social Services
I called the Mercer County Board of Social Services. The recording identified the number as the screening line. To be screened, I was asked to leave a recording or go personally to the Trenton office. That wouldn't do. I then called another number offered by the recording, 989 4491, "to speak to your worker directly". I called it to speak to Mr. Holloway in Section F, who has helped my son before. His recorded voice answered and asked for me to leave a message. It also gave me another number "in case you need to speak to someone immediately". So I called that number. As it happened, Mr. Holloway answered that line! Good!
Again I described my son's situation.
"You have to speak to someone in Medical. That's a whole different department." What he meant by "Medical" was the Medicaid Department of the MCBOSS. [Note: All Medicaid cases in Mercer County, except for those on General Assistance (Welfare) or those like my son on SSI are handled by the 11 workers in this department. -Ed.] Mr. Holloway then transferred me.
"Medicaid. Mr. Fultini speaking". Another person. I began my explanation. Before I could finish, Mr. Fultini told me that I would have to speak to the Social Security Administration. I immediately countered to say that the matter is not about how my son got his Medicaid, but how Medicaid co-ordinates with Medicare. I explained that someone in the Medicaid pharmacy at Division of Medical Assistance (Jeff) said that I should speak to a SHIP counselor.
"What is a SHIP counselor?" I asked. "When they first came out with Part D," Mr. Fultini began, "they had some people helping the transition..."
"Who runs the SHIP counselors?" I asked.
"I'm not really sure," said Fultini. "I think it is another division of the State Let me find out. Sorry to put you on hold again." So the phone went quiet while he looked for the information.
He came back on the line. He gave me a number in Princeton, 609 924 2098 x14, someone sponsored by the NJ Department of Health and Senior Services. They are counselors for the general public to coordinate Medicare matters. "By the way," Mr. Fultini reported, "SHIP stands for State Health Insurance Assistance Program."
Call to SHIP
I then called the number Mr. Fultini gave me. "Family Guidance", a woman answered. It turns out that I had reached the Princeton office of Family Guidance, a private social services agency that had recently merged with the Family and Children Services. I asked to speak to the SHIP Counselor. "Oh, you need to speak to Wendy Polsen. She's not in today. She's at a seminar. Can you call back tomorrow?"
Well, we're still not finished. So many calls. So little progress. My God. Is this the future under Obamacare?
Although Medicare Part D offered my disabled son a choice of 45 prescription drug providers, only one of these included in its formulary all the medications he is using or might need. But the one program requires payment of a monthly premium. Given my son's "extra help" status with Medicare, he has been entitled to have NJ Medicaid pick up all that Medicare does not pick up, such as premiums, co-pays, and payments beyond caps and in the Part D "doughnut hole".
So I got to wondering... Does NJ Medicaid cover those costs such as premiums that Medicare plans would require of my son?
I called the NJ Medical Hotline at 1-800-356-1561. As I worked myself through the recorded messages to the destination I wanted, I reflected on last night's vote in Washington for Obamacare, which would extreme Medicaid coverage to several million more people. Here was an initial test of the Medicaid system. How responsive would it be? How friendly? How effective? I went on hold at 2:54 pm.
Medicaid On The Phone
At 3:01 pm, a woman curtly answered. "Medicaid!" I asked where I might be directed to get the formulary of medications available from NJ Medicaid. "Well," the female voice responded, "I know that there are certain medications that Medicaid no longer pays for." Such as what, I asked. "Asthma. Medicaid no longer pays for asthma medication." Well, that is an issue for my son, since he has asthma. But that wasn't the purpose of my call. I repeated my question.'
"Where can I find the formulary of prescription medications offered by Medicaid?"
"Just a minute. Let me put you through to our pharmacist."
A Dr. Yablonksy came on the line. Dr. Yablonsky spoke with a distinct New York accent and a mildly aggressive tone.
"Speak up!" he said. "I can't hear you." I channeled my voice directly into the mouthpiece as repeated my question: does Medicaid have a printed formulary, and where can I find it?
"Medicaid has no formulary. A pharmacist will bill Medicaid directly."
We were not communicating too well, it seemed. So I tried to explain my son's ailments.
"Call Unisys, the fiscal agent for NJ Medicaid at 609 588 3397. Maybe they can answer your question. What kind of medications are we talking about here?" asked Dr. Yablonsky.
I mentioned the anti-psychotics like Geodon and benzodiazepines like Clonazepam (Klonopin).
"Benzodiazepines might require a prior authorization. The doctor would have to call first. Unisys gives the prior authorizations. Call Unisys."
Unisys On The Phone... Not.
So I called the number that Dr. Yablonsky gave me. A man named Jeff answered. I repeated my son's dilemma.
"No, Medicaid will not pay the premiums of Medicare Part D plans that require them. Only the "benchmark" plans require no premiums. And no Medicare Part D plan will cover benzos..."
This initial response sounded a little disjointed and not quite correct.
"Well," I countered, "we have actually found that one of the 45 suggested plans will cover his benzodiazepines. But that one, Aetna Rx Plus, requires a monthly premium. That's one of the reasons I am calling: to see if Medicaid helps a covered individual pay for such premiums."
"No, it doesn't," said Jeff. He paused. "Medicaid will cover benzodiazepines as a "wrap around".
Wrap around? "What's a wrap around?" I asked.
"It means that Medicaid pays."
I was still a little confused. I wondered whether I might be able to see something in print about all this. "Does Medicaid have a posted formulary somewhat, as do Medicare Part D prescription drug plans, right on Medicare's website?"
"Medicaid has no formulary", Jeff tersely replied. "If a drug is not covered by Medicare Part D, Medicaid usually doesn't pick up."
"Except for benzodiazepines, as you just said?" I asked cautiously. "Right. Except for the benzos. But prescriptions have to billed to Part D first."
Another pause.
"You know what?" Jeff said, "Talk to the SHIP counselor at the Local County Board of Social Services. They can help your son pick a Medicare Part D plan.
This seemed a strange suggestion from someone at Unisys whom Dr. Yablonsky had told me administers the NJ Medicaid program. "No, I'm not with Unisys," Jeff clarified. He was a pharmacist in the Division of Medical Assistance and Health Services, part of the New Jersey Department of Human Services.
Hunting Down The SHIP: Call to Mercer County Board Of Social Services
I called the Mercer County Board of Social Services. The recording identified the number as the screening line. To be screened, I was asked to leave a recording or go personally to the Trenton office. That wouldn't do. I then called another number offered by the recording, 989 4491, "to speak to your worker directly". I called it to speak to Mr. Holloway in Section F, who has helped my son before. His recorded voice answered and asked for me to leave a message. It also gave me another number "in case you need to speak to someone immediately". So I called that number. As it happened, Mr. Holloway answered that line! Good!
Again I described my son's situation.
"You have to speak to someone in Medical. That's a whole different department." What he meant by "Medical" was the Medicaid Department of the MCBOSS. [Note: All Medicaid cases in Mercer County, except for those on General Assistance (Welfare) or those like my son on SSI are handled by the 11 workers in this department. -Ed.] Mr. Holloway then transferred me.
"Medicaid. Mr. Fultini speaking". Another person. I began my explanation. Before I could finish, Mr. Fultini told me that I would have to speak to the Social Security Administration. I immediately countered to say that the matter is not about how my son got his Medicaid, but how Medicaid co-ordinates with Medicare. I explained that someone in the Medicaid pharmacy at Division of Medical Assistance (Jeff) said that I should speak to a SHIP counselor.
"What is a SHIP counselor?" I asked. "When they first came out with Part D," Mr. Fultini began, "they had some people helping the transition..."
"Who runs the SHIP counselors?" I asked.
"I'm not really sure," said Fultini. "I think it is another division of the State Let me find out. Sorry to put you on hold again." So the phone went quiet while he looked for the information.
He came back on the line. He gave me a number in Princeton, 609 924 2098 x14, someone sponsored by the NJ Department of Health and Senior Services. They are counselors for the general public to coordinate Medicare matters. "By the way," Mr. Fultini reported, "SHIP stands for State Health Insurance Assistance Program."
Call to SHIP
I then called the number Mr. Fultini gave me. "Family Guidance", a woman answered. It turns out that I had reached the Princeton office of Family Guidance, a private social services agency that had recently merged with the Family and Children Services. I asked to speak to the SHIP Counselor. "Oh, you need to speak to Wendy Polsen. She's not in today. She's at a seminar. Can you call back tomorrow?"
Well, we're still not finished. So many calls. So little progress. My God. Is this the future under Obamacare?
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