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Contact: Chris Black

Tel: 202 333 3853

An ALFA initiative to eliminate the prescription drug expense paid by poor seniors who live in assisted living communities was filed today on Capitol Hill.

Reps. Lloyd Doggett (D-25th TX) and Lincoln Diaz-Balart (R-21st FL) and twelve other House members are sponsoring HR 5604, the Medicare Part D Home and Community Services Copayment Equity Act of 2008. This bipartisan measure corrects an apparent oversight in the Medicare Part D Prescription Drug Program by exempting drug co-payments for residents in assisted living and other home and community-based settings who qualify for both Medicare and Medicaid. The measure treats these so-called dual-eligible recipients the same as Medicaid recipients in nursing homes.

“Seniors should not be punished for living independently,’’ said Rep. Doggett. “The high cost of medicine should not force seniors into expensive institutional care. This bill treats all seniors equally, regardless of where they live.’’

“It is simply wrong that any Medicaid recipient pay a financial penalty for living in an assisted living community,’’ said Richard Grimes, president of the ALFA. “We are grateful Members of Congress from both political parties recognize this inequity and are taking steps to correct it.’’

The legislation will provide financial relief to one million seniors, including 125,000 residents of assisted living communities, and cost an estimated $171 million annually, about one third of one percent of the estimated $52.2 billion in Medicare Part D spending this year.

Prescription drug co-payments range from $1 to $5 for each prescription. The typical assisted living resident takes eight to 10 different prescription drugs per month, the same as residents of nursing homes.  Medicaid recipients are allowed a limited personal needs allowance amounting to about $55 per month to pay for personal expenses for items ranging from clothing, shampoo and other toiletries, to telephone bills and postage stamps. Drug co-payments for many of these dual-eligible recipients met or exceeded the personal allowance leaving them with no money for shoes, personal hygiene items and other personal items and services. These residents were exempt from co-payments for prescription drugs prior to implementation of the Medicare Part D Prescription Drug program two years ago.

Assisted living providers have been using their own funds to subsidize these affected residents for more than two years. This expenditure cannot be sustained permanently.

Assisted living services cost about one half the amount of nursing homes. Medicaid saves between 50 percent to 66 percent for each resident cared for in an assisted living community instead of a nursing home. Because many Medicaid recipients do not necessarily need full time nursing care but do need some assistance in the activities of daily life, more than 40 states have sought Medicaid waivers for assisted living for their residents who qualify and choose assisted living.

Co-sponsors of the bill include: Allen, Tom (D-1st ME); Capito, Shelley Moore (R-2nd WV); Cohen, Stephen (D-9th TN); Diaz-Balart, Mario (R-25th FL); Kennedy, Patrick (R-1st RI); Matsui, Doris (D-5th CA); McCarthy, Carolyn (D-4th NY); McCollum, Betty (D-4th MN); Moran, James (D-8th VA); Platts, Todd (R-19th PA); Ramstad, Jim (R-3rd MN); Sánchez, Linda (D-39th CA).

Correcting this inequity is one of ALFA’s legislative priorities for 2008.

The Assisted Living Federation of America (ALFA, represents companies operating professionally managed assisted living communities for seniors.  ALFA advocates choice for seniors, quality of care, and accessibility and portability of long term care for all Americans.  ALFA’s efforts “raise the bar” for operational excellence among its member companies.  Among other options for long term care, assisted living is the fastest growing residential care option for seniors in the United States.  More than 36,000 communities care for more than one million seniors who need help in the activities of daily life to remain independent.

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