Schizophrenics Anonymous New Brunswick

Aspect of Need Addressed: Social, Educational

In America, they say, there is a support group for everything. Clicking around the UMDNJ website this evening, I found that there is one specifically for individuals with schizophrenia, called, you guessed it, Schizophrenics Anonymous. It was founded in 1985 in Detroit by Joanne Verbanic. Today it is supported by the Schizophrenia and Related Disorders Alliance of America (SARDAA), which, among other things, offers a pretty good resource list. The organization has 150 groups in 31 states and a few other countries.

One of its local groups meets in New Brunswick at a facility apparently attached to the UMDNJ's University Behavioral Health program. The group bills itself as "a confidential SELF-HELP group for persons with schizophrenia or a schizophrenia-related disorder." It meets twice a month on the first and third Tuesdays of each month from 4:00 PM to 5:30 PM at The Self-Help Center - Lower Level, 96 Bayard Street, New Brunswick, NJ. For more information about this group, including a contact telephone number, see: http://ubhc.umdnj.edu/adult/Schizophrenics.htm

NJ Medicaid: Where To Find At Least Some Stuff

Aspect of Need: Medical, Financial

Just for the record...

The place to find more information about NJ Medicaid is at a nondescript website for the NJ Medicaid Management Information System, located here. But, being a very technical website principally for the use of Medicaid providers, when viewing it the common man would hardly know what it is.

The provisions of NJ Medicaid are found deep within the dense New Jersey Administrative Code. The NJAC can be found through the NJMMIS website which directs you to the New Jersey Division of Medical and Human Services site, which directs you to its Medicaid Eligibility and Services Manuals site, which directs you in turn to a Lexis-Nexis site in which, after you agree to terms, you can look at the long, dense, complicated NJ Administrative Code. For example, want to see what NJ Medicaid says about medications? Look up the "Pharmaceuticals Manual" in the NJAC, under Title 10, Chapter 51.

The list of Medicaid providers in NJ is now online here.

Changes in policies and regulations within NJ Medicaid are catalogued in its newsletter. See all the back newsletters here.

Touchdown! Enrollment Achieved

Aspect of Need Addressed: Medical, Financial

Done! Finally!

It was almost like filling out a complicated 1040 tax form. So went my disabled son's the enrollment in a new Medicare Part D prescription drug program. But now he is in a new plan, Medco's Medicare Prescription Plan--Value (PDP).

This process began in early February when my son received notice that his Part D plan provider, Fox Insurance, had been disqualified by Medicare. To meet his transitional needs, Medicare took him out of Fox and placed him in one of Medicare's own Part D plans administered by Humana. There was no apparent effect either on his status or coverage.

But Medicare instructed my son to decide, by April 30, whether to stay in the government plan into which Medicare switched him or decide anew on another private sector plan. For the past four weeks we have been trying to determine the linkages of his coverage in whatever plan between Medicare and Medicaid. We learned only yesterday, and confirmed again today, that NJ Medicaid will indeed cover payment for certain benzodiazepine medications that are excluded from the formularies of the six "bench mark" plans for which he as a "dual eligible" was eligible.

(A big shoutout, by the way, to Ms. Penali Patel, a pharmacist working in Unisys, the NJ Medicaid administrator, which whom I connected today. She was the first within the entire NJ Medicaid system who could crisply, confidently and completely answer all my questions!)

(Kudos also to Medicare's newly updated website. The graphics are better, and the navigability has improved. NJ Medicaid ought to follow suit.)

This was not an easy process by any means. But we got it done. In most cases I don't think psychiatrically disabled individuals would be able to manage this complicated process alone.

Bingo! (...I think...): The Answer!

Aspect of Need Addressed: Medical, Financial

The question is...

...when required to switch to a new Part D prescription drug plan, can my son maintain access to all the medications he needs within a plan that covers all their costs as to which he is entitled as a "dual eligible" disabled?

The answer is...

Yes... I think...

But the condition to the answer is...

...as long as NJ Medicare continues to pay for benzodiazepines even when they are not listed in Medicare's Part D formulary.

My quest sought to address two issues: access and cost. As to access, we had to assure that my son could get the medications he needed, without exception. As to cost, could we get the access he needs within one of the "benchmark" plans open to "dual eligibles" like my son?

My quest got off on the wrong track, due to my insufficient understanding. Eaerly on I got confused when misunderstanding that "dual eligibles" in New Jersey had only six plans from which to choose. I thought that dual eligibles were restricted only to these six plans. In fact, they can enter any of the 45 plans available in New Jersey. But they would have to pay those amounts above those payments made by NJ Medicaid.

After more research this afternoon, I finally found my answer. It came from a very knowledgeable call center worker at Medicare and from a very helpful local pharmacist at CVS in my home town.

From my Medicare call center friend, I was relieved to learn that my son's access to all his medications could be assured. Some plans may offer to cover such medications as Medicare will not, but charge a premium to cover their cost. (In fact, Aetna offers a very reasonable plan like this. Aetna's formulary includes all the benzodiazepines which my son had listed, but charged a moderate monthly premium of $7.29.)

I was also pleased to learn--not from NJ Medicaid (or from Mercer County Board of Social Services, the NJ SHIP Counselors, or Social Security's Trenton office, all of which I personally visited yesterday), but from my local pharmacist!--how NJ Medicaid really works. NJ Medicaid apparently pays for benzodiazepines as long as they are correctly prescribed and used, no matter what the restrictions in the formularies of the Medicare Part D providers who are the primary insurers. This means that, contrary to my worry, my son can enter a Part D plan in which his benzos are not in the formulary, knowing that NJ Medicare will cover them after payment is rejected by the primary insurer.

Getting to this conclusion has been exceedingly difficult and frustrating. Part of the problem was my misperception of a note in a yellow form letter from Medicare. But more of the problem is due to the very opaque NJ Medicaid system. Nowhere could I find a posted NJ Medicare formulary. Getting through to the NJ Medical Customer Center was also difficult. Even the helper behind the glass at the Social Security office became exasperated with NJ Medicaid. It was she who suggested that the best person for me to call about NJ Medicaid was... my local pharmacist!

To conclude, then, two questions:

1. Will Medicaid get better or worse with Obamacare?

2. How does a psychiatrically impaired individual navigate such a thing as changing Part D prescription drug plans on his own?

Medicaid Drug Coverage: Who Can Answer My Question?

Aspect of Need Addressed: Medical, Financial

I cannot get a definite answer. Will all the medications that my psychiatrically disabled son needs be covered under the new Part D plan he now must enter, since his previous Part D provider has been disqualified by Medicare?

About a month ago, Medicare canceled its contract with the Part D prescription drug contractor, Fox Insurance, which was covering my disabled son's medications. All the medications he needs were on Fox's formulary, so there was no need for concern. Now that Fox is no longer qualified to participate in Medicare, my son must change his Part D prescription drug plan provider.

Working through the Medicare website, he has learned that there are seven so-called "benchmark" Part D plans for which he is eligible. These "benchmark" plans are for those like my son who are on disability and need "extra help" paying for their medication coverage. Those needing extra help, also called "dual eligibles", are eligible for both Medicare AND Medicaid. Medicare pays for 80% of all costs, after certain deductibles. For dual eligibles, NJ Medicaid pays for the 20% co-pays.

Now that he must change his Part D plan, there arises an important issue. None of the seven benchmark plans include on their formularies all the medications he is taking or needs for his various psychiatrically related ailments. This causes me as his father some concern. A mentally ill individual must have access to his medications! What is to be done?

For four weeks I have been trying to find answers. Visits to the NJ SHIP Counselors, experts in Medicare but not Medicaid, have not been fruitful. Calls to the NJ Medical Customer Call Centers, which take the calls for Medicaid, have not been clarifying, either. I'm still nervous that my son might lose access to some of his medications.

Here's where I think we are at the moment...

1. Medicaid is a back up insurance plan for Medicare. In my son's case, whatever Medicare does not pay, Medicaid will.

2. Drug formularies are set by the Medicare Part D drug plan providers in accordance with Medicare, not Medicaid rules. In other words, drug formularies are driven by Medicare. There is apparently no special Medicaid drug formulary.

3. Medicaid does, however, sometimes pay for medications that Medicare will not cover. Such is true for certain benzodiazepines. Although they are effective medications for certain types of anxiety, the "benzos" are problematic because they are also addictive and sometimes abused. Medicare does not cover them. But Medicaid sometimes does, as long as they are correctly prescribed and controlled.

Stay tuned...

Ticket to Work: Ticket to Nowhere?

Aspect of Need Addressed: Occupational

A call came the other day for my disabled son. It was from a firm called MAXIMUS Ticket to Work, the agency contracted by the Social Security Administration to run its "Ticket to Work" program. Angela, a "Ticket Services Coordinator", had left a message for my son to call back.

The call was to see if my son had his Ticket to Work and whether he needed more assistance. When I called back on his behalf, a girl named Helen answered the phone. Helen clearly didn't know too much about the program. Most of her answers she read from a script. She frequently put me on hold to ask for more information from elsewhere. The outreach was appreciated, but not very effective.

In March, Angela had also called my son about Ticket to Work. At that time she sent him its list of "Employment Networks and State Vocational Rehabilitation Agencies which have agreed to serve your area". The list has the names of 64 agencies. Some of duplicates. All have an associated letter designation, A, B, and C. The As are those "in your local area". The Bs are those in your state. The Cs are national organizations that can serve the Ticket to Work ticket holder. But an inspection of the list shows that several firms designated "A" are not in our local area. Indeed, they are not even in our state. Among the As are firms in Racine, WI; Madison, WI; Brooklyn, NY.

As the father of a mentally disabled individual, I get quite annoyed with this kind of government inefficiency. Here's a massive program designed to help the disabled get back to work. Yet the administration of the program is complicated to say the least. A visit to the program's website, http://www.yourtickettowork.com/, will confirm this.

To get a feeling of what "Employment Networks" are and how they get to be part of the program, I clicked into the Employment Networks area. There I found a thicket of hard to interpret explanations and a blizzard of words. This program, I fear, is one of the large well-meaning but ineffectual programs that is wasting a ton of Federal money. It just does not seem well managed. It seems particularly difficult for a mentally ill loved one to navigate. My son's previous experience with this program to date has been sub par.

Big News! Feds Postpone 21% Price Cut For Medicare Doctors!

Aspect of Need Addressed: Medical

I received an update from the National Association of Social Workers today. It reports that President Obama has recently signed the "Continuing Extension Act of 2010." This new law, retroactive to April 1, extends through May 31 (only) the "zero percent update" of the Medicare Physician Fee Schedule. Without this legislation, the fees of Medicare providers would have been cut by21%!

This makes me nervous. The debate around the new health care recently passed talked a lot about some $500 million out of Medicare expenses. The 21% cut was factored into the economics of the bill. This increase immediately busts the cost savings that were predicted in the debate.

Everyone on Medicare, especially our disabled loved ones, should be alert to this issue. How are we to tackle the heavy costs of Medicare? Who can say?

This issue creates a conundrum for me. On the one hand, I am very worried about the out-of-control spending increases within the new health bill. On the other, I am very leery of price caps, and especially price cuts, being imposed on doctors. Too many doctors are already opting out of Medicare, feeling that Medicare's pricing and paperwork are not worth the candle.