They will be bombarded with deadline notices and applications. They will be asked to choose from at least two prescription drug plans with different benefits, including different lists of drugs. And they will have three months to sort it out - a daunting proposition for anyone, let alone for a population that tends to rely on multiple drugs to stay alert and alive.
These choices also pose a nightmare for state health officials, who say they're not sure they have the staff to handle the extra paperwork and phone inquiries to help ensure wise choices by Utah's "dual eligibles" - people poor enough to qualify for Medicaid and old enough to qualify for Medicare.
On Thursday, Utah Medicaid Director Michael Diely warned lawmakers he will need an extra $4.8 million next year to cover hiring 20 new eligibility workers and other costs stemming from the Medicare Modernization Act.
"This is a complex transition that effects every bureau in my division," said Diely. "I've read the law and the regulations countless times and I still can't keep it all straight. That gives me a lot of pause."
Come January, prescription drug coverage will be available to all 240,000 Utahns on Medicare. They can enroll starting Nov. 15, and if they join by Dec. 31, their coverage will kick in by January.
But enrolling entails choosing between at least two plans, and information about them won't be available until October, after the federal government decides which private insurance companies win the bid to run them.
Helping dual eligibles make comparisons will require one-on-one help, said Diely, painting a "doom-and-gloom scenario" for lawmakers about the transition.
The state is working with 600 community activists to assist this vulnerable population, many of whom are in nursing homes or group homes for the mentally retarded or mentally ill.
Dual eligibles have been obtaining their prescriptions through Medicaid, which the state funds in part, rather than Medicare. And though it would seem that by transferring pharmaceutical costs to Medicare, Utah would save money, it's not that simple.
Offsetting the expected $1.4 million in savings are other administrative costs.
Whenever the federal government meddles with Medicare, more people rush to apply for Medicaid, which offers more comprehensive and affordable coverage, Diely said. This "woodwork effect" could result in 5,000 new Medicaid enrollees, he said. Also, as part of the modernization act, Social Security mailed out 19 million applications to Medicare beneficiaries who may be eligible for other low-income subsidies.
"We're looking at 100,000 Utahns who might qualify. That's scaring our eligibility staff quite a bit," Diely said.
Federal officials from the Centers for Medicare and Medicaid (CMS), also at Thursday's meeting, said they are doing all they can to avoid problems.
Poor and disabled dual eligibles will be automatically signed up in one of the new drug plans to prevent anyone from losing benefits, and they can switch plans before and after the Dec. 31 deadline.
The plans will cost more than Medicaid and cover a narrower list of drugs, but beneficiaries will have a chance to appeal any drug denials. The plans are required to cover drugs in six categories, such as chemotherapies, HIV-AIDS drugs and anti-psychotics.
But CMS regional administrator Alex Trujillo admitted, ''If there is a theme to this, it's 'Mission: Impossible.' " Trujillo added, ''Insurance companies and pharmacies have said, 'There is no way you can do this in such a short time frame.' But we don't have another option.''
His word of advice to the millions of Americans receiving applications for various benefits: "When in doubt, fill it out."
kstewart@sltrib.com
