As part of an on-going public information partnership called SexSmarts, seventeen and the Kaiser Family Foundation conduct nationally representative surveys of teens 15 to 17 on issues related to their sexual health. The latest in the series examines their knowledge and attitudes about birth control and protection among adolescents. It covers a variety of issues related to contraception decision-making among adolescents, including how much they know about different methods and personal use among those who are sexually active.

Survey

Toplines

As part of an on-going public information partnership called SexSmarts, seventeen and the Kaiser Family Foundation conduct nationally representative surveys of teens 15 to 17 on issues related to their sexual health. The latest in the series examines their knowledge and attitudes about birth control and protection among adolescents. It covers a variety of issues related to contraception decision-making among adolescents, including how much they know about different methods and personal use among those who are sexually active.

Survey (.pdf)

The New Medicare Drug Benefit: Potential Effects of Pharmacy Management Tools on Access to Medications

This report describes the pharmacy benefit management tools that will be available to private plans administering the new Medicare drug benefit, including formularies, the definition of categories and classes, and cost sharing requirements. The authors conclude that substantial flexibility given to plans to design management tools could have significant implications for beneficiaries’ access to needed medications and out-of-pocket spending.

Issue Brief (.pdf)

The New Medicare Prescription Drug Law: Issues for Dual Eligibles with Disabilities and Serious Conditions

The new issue paper discusses the challenges the new Medicare drug program faces in meeting the needs of dual eligible individuals with disabilities, who tend to have extensive, complex and varying needs. The brief examines four key questions about how the new benefit will serve dual eligibles with disabilities and profiles some individuals from this population for whom prescription drugs are vital.

Issue Paper (.pdf)

Issues Surrounding the “Clawback” or State Contributions Towards Medicare Drug Coverage: A Conference Call Discussion

As part of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 signed into law last year, Congress included a financing provision that requires a monthly payment from each state to the Medicare program beginning in January 2006. MMA’s clawback provision will recapture most of the savings that states would realize when Medicare assumes prescription drug costs for dual eligibles.

The Kaiser Commission on Medicaid and the Uninsured and the National Association of State Medicaid Directors are sponsoring a conference call to discuss the clawback’s implications on states, the federal government, and low-income Medicare beneficiaries, as well as to answer questions.

The conference call-in number is (800) 353-6469. Password: KCMU. Please call a few minutes early to secure a line (let the phone ring) to get through to the call.

Agenda

Speaker Biographies

Formula for Determining Monthly State Clawback Payments

Barbara Edwards’ Presentation

Issue Brief – The “Clawback:” State Financing of Medicare Drug Coverage

Issue Brief – Medicaid Prescription Drug Spending and Use

This issue paper provides the latest data and trend analysis on Medicaid prescription drug spending and utilization. In 2002, Medicaid programs spent $30 billion for prescribed drugs.

Issue Paper (.pdf)

Policy Brief: U.S. Government Funding for Global HIV/AIDS Through FY 2005

To help understand U.S. budget trends and priorities for global HIV/AIDS, the Kaiser Family Foundation has prepared a new policy brief, “U.S. Government Funding for Global HIV/AIDS Through FY 2005.” It provides detailed data on funding through FY 2004, and for the FY 2005 budget request. FY 2004 marks the first year of funding for the President’s Emergency Plan for AIDS Relief (PEPFAR), a five-year $15 billion initiative to address HIV/AIDS, TB, and malaria in the developing world.

Policy Brief (.pdf)

This report examines the impact of Olmstead v. L.C. five years after the United States Supreme Court’s 1999 landmark decision. The analysis brings together new research with a synthesis of research undertaken over the past five years, to help policymakers and program administrators understand the meaning of the Americans with Disabilities Act for health programs in Olmstead’s aftermath.

Report (.pdf)

Related Olmstead Materials

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 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.