The “Clawback:” State Financing of Medicare Drug Coverage

Published: Jun 1, 2004

This issue paper describes the origins of the clawback, the formula by which each state’s clawback amount is calculated, and the clawback’s implications for states and for low-income Medicare beneficiaries.

Issue Paper (.pdf)

Additional Help with Rx Drug Costs For Low-Income People on Medicare

Published: Jun 1, 2004

Additional Help with Prescription Drug Costs For Low-Income People on Medicare (For 2007 Benefits and Cost-Sharing)

As of 2007, Medicare helps pay for outpatient prescription drugs. Medicare provides additional help with drug costs to beneficiaries who qualify based on low incomes and limited resources. The information below describes the different levels of assistance available to people who meet the eligibility requirements.

People on Medicare Who Also Have Full Medicaid Benefits (Dual Eligibles) pay:

  • No premium
  • No deductible
  • Copayments as follows:
    • Nursing home residents: No copayments
    • Individuals below poverty level: $1/generic; $3.10/brand name drug
    • Individuals above poverty level: $2.15 per generic; $5.35/brand name drug
  • No copayments after individual spends $3,850 out-of-pocket on their prescription drugs

People on Medicare with Incomes Below 135% of Poverty (about $13,000/individual; 17,000/couple) and Resources Below $6,120 per individual/$9,190 per couple pay:

  • No premium
  • No deductible
  • Copayments of $2.15/generic and $5.35/brand name drug
  • No copayments after individual spends $3,850 out-of-pocket on their prescription drugs

People on Medicare with Incomes Below 150% of Poverty (about $14,000/individual; $19,000/couple) and Resources Below $10,210 per individual/$20,410 per couple pay:

  • Sliding-scale premium
  • $53 deductible
  • 15% coinsurance up to $5,451 in total drug spending (= $3,850 out-of-pocket drug spending)
  • Copayments of $2.15/generic; $5.35/brand name drug after individual spends $3,850 out-of-pocket on their prescription drugs

NOTE: Resources are generally defined as assets that can be converted to cash within 20 days, such as stocks, bonds, checking, savings, and retirement accounts. A subsidy applicant’s principal home, car, and burial space do not count toward the resource limit. The resource limits can be slightly higher (an additional $1,500 per person) if individuals intend to use some savings for burial expenses.

Olmstead: I Did It

Published: Jun 1, 2004

This Kaiser Commission on Medicaid and the Uninsured video segment returns to the plaintiffs of the Olmstead case five years after the landmark U.S. Supreme Court decision. It reports on the impact of the decision for individuals with disabilities and some of the challenges that remain in the implementation of the court ruling.

California Health Care Chartbook: Key Data and Trends

Published: Jun 1, 2004

This chartbook provides California and U.S. data and trend analysis on a broad range of health system and financing indicators, including demographics and health status data, insurance coverage and the uninsured, employer health insurance premiums and offer rates, Medicaid and Medicare enrollment and spending, and health care industry trends.

Chartbook (.pdf)

Trends in Medicare Supplemental Insurance and Prescription Drug Benefits, 1996-2001Data Update

Published: May 31, 2004

Trends in Medicare Supplemental Insurance and Prescription Drug Benefits, 1996-2001 Data Update

This data update provides estimates of supplemental insurance and prescription drug coverage rates and trends between 1996 and 2001, which will help to provide important context for assessing future changes in supplemental insurance and drug coverage rates after provisions of the Medicare drug benefit take effect.

Report (.pdf)

New Report from Global HIV Prevention Working Group

Published: May 31, 2004

The Global HIV Prevention Working Group issued the first major report to examine global HIV prevention needs in a time of expanding treatment access, “HIV Prevention in the Era of Expanded Treatment Access.” The Global HIV Prevention Working Group is a panel of nearly 50 leading public health experts, clinicians, biomedical, and behavioral researchers, and people affected by HIV/AIDS, convened by the Bill & Melinda Gates Foundation and the Kaiser Family Foundation. This is the third report released by the Working Group.

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News Release (.pdf)

Summary (.pdf)

Full Report: HIV Prevention in Era of Expanded Treatment Access (.pdf)

Previous Global HIV Prevention Working Group Reports

Survey of Americans on HIV/AIDS – Part Two: HIV Testing Summary and Chartpack

Published: May 31, 2004

These survey findings of Americans’ views on HIV testing are part of Kaiser’s national “Survey of Americans on HIV/AIDS,” conducted in spring 2004. It explores such issues as how many adults report ever having been tested and talk to their doctor about HIV/AIDS, as well as misconceptions and stigma about HIV testing. The first part of the survey, on global HIV/AIDS, was released on June 2, 2004. The final portion of the survey will be released in August 2004.

Summary and Chartpack (.pdf)

Health Policy Challenges Affecting American Indians and Alaska Natives

Published: May 31, 2004
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CALL FOR PAPERS: Health Policy Challenges Affecting American Indians and Alaska Natives

The American Journal of Public Health (AJPH), in collaboration with the Henry J. Kaiser Family Foundation, is planning to publish a collection of papers on how the United States can more effectively meet the health care needs of American Indians and Alaska Natives (AIANs). The guest editors are soliciting contributions to the “Health Policy and Ethics” and “Research and Practice” sections of the AJPH. Research Articles (180 word structured abstract, 3500 word text, up to 4 tables/figures) and Analytic Essays (120 word unstructured abstract, 3500 word text, up to 4 tables/figures) for the department “Health Policy and Ethics” are encouraged that address the challenges or approaches to eliminating health care disparities (in access, quality, or financing of care) between AIANs and other population groups. All papers will undergo peer review by the AJPH editorial team, the guest editors, and a slate of referees, as per AJPH policy.

In order to be considered for inclusion in this series, papers must be submitted by September 1, 2004 through the online submission at http://submit.ajph.org. This website also provides Instructions for Authors, including specific guidelines for various types of papers. When submitting articles, please select “AIAN series” under the Theme Issue menu. Additional information concerning this series can be obtained by contacting AIAN_AJPHseries@kff.org

Marsha Lillie-Blanton, DrPH and Yvette Roubideaux, MD, MPH, Guest Editors

Poll Finding

Survey of Americans on HIV/AIDS – Part Two: HIV Testing Toplines

Published: May 31, 2004

These survey findings of Americans’ views on HIV testing are part of Kaiser’s national “Survey of Americans on HIV/AIDS,” conducted in spring 2004. It explores such issues as how many adults report ever having been tested and talk to their doctor about HIV/AIDS, as well as misconceptions and stigma about HIV testing. The first part of the survey, on global HIV/AIDS, was released on June 2, 2004. The final portion of the survey will be released in August 2004.

Survey Toplines (.pdf)

Poll Finding

Survey of Americans on HIV/AIDS – Part Two: HIV Testing

Published: May 31, 2004

These survey findings of Americans’ views on HIV testing are part of Kaiser’s national “Survey of Americans on HIV/AIDS,” conducted in spring 2004. It explores such issues as how many adults report ever having been tested and talk to their doctor about HIV/AIDS, as well as misconceptions and stigma about HIV testing. The first part of the survey, on global HIV/AIDS, was released on June 2, 2004. The final portion of the survey will be released in August 2004.

Summary and Chartpack

Toplines

Survey of Americans on HIV/AIDS – Part One: Global HIV/AIDS

Survey of Americans on HIV/AIDS – Part Three: Experiences and Opinions by Race/Ethnicity and Age