Fact sheet






Chicago , IL

Tuesday, April 26, 2005

Thank you, Matt and Kathleen, for that introduction. And thanks to the National Governors Association for inviting me to speak, and for supporting this very important conference.  It’s a real pleasure to be here, along with many of the CMS staff from around the country, as we take the next steps together to implement the Medicare law effectively.  This is a partnership conference. It’s a partnership within CMS, as the Medicare and Medicaid parts of our agency are working together to assist states. And I’d like to use this opportunity to announce that Jackie Garner, who has been doing a terrific job as the Regional Administrator here in the Chicago Regional Office, will be our Acting Deputy Director of our Center for Medicaid and State Operations.  One of her main tasks will be to work with all of you, and with our Medicaid and Medicare centers and our regions, on the smooth implementation of the new Medicare benefits.  It’s a partnership with the NGA and the other associations that support states and help us work together. And it’s a partnership with all of you.


That’s nothing new between the states and CMS – we’ve been working together on Medicaid and SCHIP and the quality assurance and quality improvement for health care providers, and on the uninsured, and on many other issues.  But working together is more important than ever before.  It’s important for making Medicaid sustainable – to provide better coverage and better care for lower-income and medically needy Americans at a more sustainable cost.  And it’s important as we bring Medicare benefits up to date.


And it’s an important for our future work together. By making this work – and we know it will present some challenges –  we can lay a foundation for further health care reforms that help states and help our beneficiaries.  And we know we can’t make it work well without you.  At the same time, many of your governors and many of you have told me that the current system has to change, and change now, for states to continue providing Medicaid services to people who need Medicaid.  In particular, you’ve told me that the Federal government needs to take more responsibility for Medicare beneficiaries who also depend on states to fill the large gaps that have emerged in Medicare benefits.  So for the sake of state programs, and for the sake of keeping coverage secure for Medicare beneficiaries, let’s keep building up that partnership.


I want to talk today about some of the main things we intend to accomplish through new Medicare benefits, including drug coverage, from the standpoint of the states and the beneficiaries.  First, the Medicare law intended for states to get significant savings, and we need to make sure that happens. Second, we need to transition dual-eligible beneficiaries to the comprehensive Medicare drug benefit. The comprehensive low-income benefit means access to all medically necessary drugs, generally for just a few dollars per prescription – and not just for the duals that most of you are covering now, but for millions more beneficiaries who only have limited Medicaid benefits like SLMB, QMB, and QI1. By working together, we will get secure and comprehensive drug coverage to millions more people who have Medicare and Medicaid.


Third, and a related point, is that we want to make applying for the extra, comprehensive help with drug costs as straightforward as possible for the millions of additional eligible beneficiaries who have limited means and no Medicaid coverage. The law requires states to support this process, and we have worked out some ways to help you do this as efficiently as possible. 


Fourth, we want to make sure that states are easily able to use their savings to “wrap around” the new Medicare coverage for their beneficiaries with higher incomes and assets, if the state wishes to do so. All the states that have state prescription assistance programs now will get substantial savings because they are no longer have to provide coverage entirely at their own expense, and they can use some of their savings to provide this wraparound coverage. But I also want to be clear that we will help any state that wishes to implement wraparound coverage for some of their residents. And a related point – we want to support states that want to help their beneficiaries get the most out of the Medicare coverage, through education and outreach programs.


Fifth, we need to make sure that states take advantage of all the savings the law intended. That includes savings on retiree coverage. In some cases, states need to take certain actions to get literally tens if not hundreds of millions in new subsidies from Medicare for their retiree plans.


And sixth and finally, we need to keep making progress toward providing better overall care for dual eligible beneficiaries, while reducing the costs other than drugs that states continue to face for the dual eligibles. This is one reason we are making available an unprecedented array of coordinated-care programs for frail and chronically ill dual eligible beneficiaries – programs that provide better outcomes and substantial additional benefits, meaning substantial additional savings for state Medicaid programs.


To make these things happen – to improve benefits for dual eligibles, to provide higher quality care for seniors and people with disabilities, and to save money for states and deliver care more efficiently at the same time – to make these things happen, we need to partner together. This starts with working closely together to keep track of state savings to make sure you get savings as a result of the law, using the same kind of reliable data that you provide us today for all other aspects of determining Federal payments.


I want to be very clear about this.  Congress clearly intended for states to get significant savings as a result of the Medicare law.  I’ve been looking closely at our implementation of the program, and at the actual data we’ve received from states – the data from all of you that are validated and actually used on an ongoing basis for determining Federal matching payments –  and the data we have continues to show that every state will come out ahead. In fact, according to our latest estimates based on actual state data, states are estimated to save about $8 billion in the first five years of the program’s implementation alone (2006-2010).  But I also want to make sure we’re fully engaged to work together on this.  We’ve heard from some officials in certain states that they are concerned they might not be getting overall savings.  So, if you have any concerns, we need your help to make sure the savings come through.


We want to ensure that the phase-down contribution is accurate and fully reflects all appropriate state data, and that all other data related to state costs and benefits from the Medicare law are considered appropriately.  To support this process, CMS sent a letter to all Medicaid directors on March 28, 2005, asking them to provide data on the overall impact of MMA on their state.  We asked states to respond by April 8.  As of last week, 20 states had provided data to CMS.  We have been reviewing the submissions and have conducted follow up calls with all these states to discuss their data.  I want to thank the states that have already started working with us in this important effort, and I want to repeat:  If any of you have real concerns about savings, please send in the numbers you are looking at, and work with us to make sure we get it right, just as we always do to determine the right payments based on your spending.


And I want to include a couple of reminders as part of this effort. Remember that Medicaid savings come from several sources.  One is the fact that states are only expected to pay a fraction of the cost of their Medicaid dual-eligible beneficiaries, as projected forward from 2003. This fraction starts at 90 percent to build in, among other things, that some of you have been working with us to get your Medicaid drug costs down, for example through relying on PBMs to negotiate larger discounts just as the Medicare benefit will do. And it goes down to 75 percent over time, again to help make sure you come out ahead. Another source is that the law included additional DSH payments to states.  And as I’ll talk about more soon, there is a major new subsidy available to state retirement systems for continuing to provide prescription drug coverage to their retirees.  The letter we sent you a month ago includes a template that reflects all of these sources of savings, along with all the potential areas for additional state spending, to help us make sure that your state does realize savings. Now, many states are telling us they don’t need to go through these closer looks with us, because they expect savings. That’s great.  But if you’re concerned that your state won’t realize savings, come talk to us.  Bring any additional data you have, and we will work this out together.


Now I want to turn to the second big issue, the Medicaid dual-eligible transition.  As you know, we are in this situation because Medicare had fallen behind in covering essential elements of in modern medicine – behind on covering preventive care, behind on coordinated care that enables seniors and the disabled with chronic illnesses to prevent their complications, and behind on covering prescription drugs.  And all the states stepped in. Even though drug coverage is a so-called “optional” benefit under Medicaid, every single state acted to provide drug coverage for the most vulnerable of America ’s seniors.  And through your State Pharmacy Assistance Programs, you’ve provided coverage at your own expense to hundreds of thousands of seniors who needed help but were not needy enough to qualify for Medicaid.


Yet the growing costs for dual eligibles and for filling in the Medicare gaps are increasingly straining your budgets.    Prescription drug spending had been the fastest growing service category in the Medicaid program, as you have been paying for more use of more medicines that help Medicare keep costs down by avoiding expensive complications of diseases that drugs can now treat – for conditions ranging from diabetes to heart disease to lung disease and debilitating arthritis.  As you well know, States expect prescription drugs, accounting for drug rebate offsets, to grow by $2.4 billion, or 13%, between FY 2004 and FY 2005.  State Medicaid budgets need relief, and dual eligible beneficiaries need a lasting entitlement coordinated within Medicare for this essential part of modern medicine.


This is part of the most fundamental goal of the Medicare law:  moving Medicare from a program that focuses almost entirely on paying for the complications of diseases after they occur, to one that puts just as much emphasis on prevention.  This includes preventive benefits that for the first time match expert recommendations, as well as greater access to coordinated care for beneficiaries with chronic illnesses, through Medicare Advantage plans and new chronic care improvement programs in fee-for-service Medicare.  But the most important new preventive benefit to help our beneficiaries avoid disease complications is prescription drug coverage for every person with Medicare. We want to work with you to make sure that this transition is successful for our dual eligibles and that they do not lose a day of drug coverage.


To make this happen, we need to move quickly - we’re on track to deliver the drug benefit in about 8 months.   And while we’ve made a lot of progress together, there’s still much we need to do to build on that progress right away.


The transition for the dual eligibles needs to start now, not at the end of this year.  We are paying a lot of attention to comments and concerns and constructive input about making sure we have a smooth process for transitioning these dually eligible beneficiaries to Medicare on schedule, effectively, and with no gap in coverage. I know you all share this goal.


We are spending a lot of effort now to make this transition a smooth one. We’ve already worked with your state offices to identify the full dual eligibles, and we’ll start letting them know – in coordination with all of you – about the main points in the upcoming coverage changes during the summer.  


To ensure that they make a seamless transition, every dual eligible who has not chosen a Medicare prescription drug plan before January 1, 2006 will be automatically enrolled to make sure that they do not lose one day of drug coverage.  And we will let them and their plan know in early fall, in October, about the drug plan to which they’ve been assigned. As I’ll describe, this provides almost three months for implementing the transition for our dual-eligible beneficiaries.  And of course, any dual-eligible beneficiary can choose a different plan if they prefer before January 1. And, they can switch to a different plan any time after the coverage begins. 


Now, there’s been a lot of discussion about whether the Medicare plans will in fact provide access to the drugs that dual-eligible beneficiaries need, or if beneficiaries will face multiple sudden drug transitions. Based on the comments of advocacy groups, as well as best practices in drug plans for seniors and people with a disability that exist today – including some of your plans – we’ve worked to identify and require meaningful formularies, P&T processes, and exceptions and appeals processes for unusual circumstances in the drug benefit.


We issued a final guidance on formularies and drug coverage, laying out a process for comprehensive review and oversight to make sure that people with Medicare get the medically necessary drugs they need.  We’re implementing that process now, with multiple checks on each submitted formulary against commonly-used formularies, the drugs actually used by beneficiaries including dual eligibles, and broadly accepted practice guidelines, among other checks.  To give you an example, we have made clear that we expect plans to cover all or substantially all drugs for HIV/AIDS, mental illnesses, immunosuppression, and other diseases where a specific medication or combination of medication could be expected to make a real difference for a patient, and where transitions can be clinically difficult.  So just as the Federal Employees’ drug plans generally cover 25 or more antiretrovirals, we’ll have the same expectations for the Medicare plans.  And we’ve tightened and streamlined the process for getting exceptions to formularies and for appealing – and beneficiaries can get help from their doctor or a designated representative in the process.


We are also paying particular attention to the special needs of our dual-eligible beneficiaries who reside in nursing homes.  We are assuring that every approved plan provides the Medicare prescription drug benefit to every one of their enrollees, in every nursing home in every region.  As our guidance on long-term care pharmacy services made clear, this is a condition of participating in the program.  Additionally, that guidance established specific “any willing provider” conditions for long-term care pharmacies in terms of performance and service that will need to be fulfilled for nursing home enrollees.  These will address delivery, packaging, urgent access, and other needs so that there will be no change in drug safety and availability for this fragile population.  We have also issued a guidance requiring specific medication transition plans, based on current widely-used best practices, for example when state preferred drug lists change or when patients move among settings of care.  This is in addition to our formulary oversight and other aspects of our oversight to make sure that all beneficiaries get access to the medicines they need.


And we’ve also made clear that, while we don’t have the statutory authority to provide federal matching funds for duals’ Medicaid coverage after January 1, states can fill 90-day prescriptions in December and collect the usual Federal match, in effect extending the transition period even further.   Again, though, I want to emphasize that I think such transition extensions can be avoided by working with us and the drug plans to address any transition issues before the end of the year.


We will be working closely with all of you to implement this transition effectively, and to make sure our dual-eligible beneficiaries and their caregivers know about it well ahead of time.  But we are also planning for the cases where dual-eligible beneficiaries may not have been paying attention, and just show up at their pharmacy in January. As I’ll describe in a few minutes, we are working to provide this additional information by implementing electronic support systems that build on the electronic prescription processing systems already used by virtually every pharmacy in the country.  So if a beneficiary walks into a pharmacy in early January with no other identifying information besides their name and their Medicare ID number, the pharmacist will be able to use this system to tell the beneficiary about how to get their prescriptions.


The Medicare law provides a very broad drug benefit, including for example insulin supplies and smoking cessation treatments.  But it also allows state Medicaid programs to continue to provide a narrow set of drugs excluded from the Medicare drug benefit, like over-the-counter medicines and benzodiazepines, and still receive the Medicaid match from the Federal government.  We will soon release guidance to states about how to do this and continue to take advantage of our match, just as you do today.


As you know, it’s far more than the 6 million full dual eligibles who qualify for Medicare’s comprehensive low-income drug subsidy, with no premiums and no deductibles and continuous coverage, and with paying at most a few dollars per prescription.  Millions more low-income beneficiaries who have been struggling between the cost of drugs and the cost of other basic necessities also qualify for the comprehensive coverage. This includes beneficiaries with incomes up to 135 percent of poverty and limited assets – for couples, that’s around $18,000 in income and $23,000 in liquid assets.  And extra help on a sliding scale is available for beneficiaries with incomes up to 150 percent of poverty.  Altogether, that’s almost a third of our beneficiaries, and we intend to get help to as many of them as possible. 


You know how hard it can be to reach these beneficiaries: after many years, participation rates in SLMB, QMB and QI programs are still only around half of those eligible. And you know this is an important issue for states, since states as well as the Social Security Administration are required under the law to do eligibility determinations for the low-income subsidy.  To ensure our success, we’ve tried to learn from all of our experiences, and once again, we want to find a straightforward way to make this very important eligibility effort work well from the state standpoint and from the standpoint of our beneficiaries.  This is the third issue I want to discuss with you this morning: meeting our responsibilities to get low-income seniors enrolled in this free, comprehensive coverage.


To meet this requirement, we strongly encourage you to take advantage of the extensive work that SSA has already done based on the lessons from our previous experiences, by using SSA’s application and eligibility process.


One of those lessons that is: make the application process as automatic as possible. For beneficiaries that can be reliably identified as being eligible for the low-income subsidy, we’ll deem them eligible without any need to apply, and then we’ll make sure they get enrolled into Medicare drug coverage.  To do this, we need information from you on beneficiaries in your SLMB and QMB programs where you have reliable information that their income and liquid assets qualify them for the low-income drug assistance.  And for other beneficiaries who you think may be eligible but aren’t certain, we want to work with you to reach out to them and make sure they apply.


Another lesson is: start as early as possible, and work with as many local collaborators as possible.  So for the low-income beneficiaries who are eligible for the subsidy but that we can’t identify automatically, we’re starting the application process as early as possible – not next fall, but next month.  The Social Security Administration will begin mailing applications to potentially eligible beneficiaries in May. They’ve already gotten promising results from test mailings.  We are also working with SSA to support their community level outreach.   SSA is committed to be where the people are who want to apply for the subsidy.  They will work with community organizations to have staff at local events for seniors and people with disabilities to answer their questions and to take applications on the spot.  To further support this effort, we are also working with a broad array of community and advocacy organizations who are partnering with us in this outreach, and who are also screening for eligibility for other assistance programs.


Another lesson is: keep it as simple as possible. The application form was designed by the SSA with extensive input, involving multiple rounds of public comments, recommendations from experts who work with low income individuals, and focus-group testing with beneficiaries.  The form involves seven large-type pages, including one instruction page, one signature page, and one page for notices required by law.  In fact, there are four pages for the beneficiary to fill out with a total of 16 questions, and most of the individuals applying will only need to complete three of the four pages.  No attachments such as proof of income and assets are required. Four pages, 16 questions, for a comprehensive benefit worth over $4000 a year.


Because this SSA application will use the most extensively tested and most straightforward application form ever for a Federal means-tested program, and because it’s starting right away, we are strongly encouraging states to use it as well.  This is the least burdensome and most straightforward way to handle applications. SSA has mailed applications to the states, and we can help you if you need additional supplies.  We encourage you to work with us and reinforce our key, simple application messages for the low-income subsidy.  And the main one is:  starting next month, if you think you may be eligible, you can call Social Security, you can go online, you can get help at local events – but whatever you do, you should definitely apply through Social Security as soon as possible.  Again, this will minimize the burden and workload through your Medicaid offices.


This brings me to the fourth big issue. We know that many states want to provide more assistance and support for beneficiaries, even beyond this comprehensive new help for millions more low-income seniors.  This includes educational assistance in choosing a plan, as well as further financial help – since state contributions to the drug costs can count against the true out-of-pocket payment limit for beneficiaries who aren’t low-income. 


Now, we know that the choice-based approach to coverage in Medicare is not the way many state programs have worked.  But giving beneficiaries and their caregivers and family members the opportunity to choose the coverage they want, with our help, rather than just having to take one plan – well, that’s very important for making sure Medicare’s benefits continue to serve our beneficiaries effectively.  Never again do I want to see Medicare’s coverage falling decades behind the needs of our beneficiaries.  By partnering with beneficiaries and those who know them best, we can make sure that our coverage reflects their own preferences, and we can work with them to make sure the coverage gives them what they want and stays up to date.  Beneficiary choice means strong pressure for plans to offer quality benefits and the lowest possible costs – and that means a better deal.  That’s what has led a range of independent actuaries and analysts to conclude that the approach we are taking will result in the best prices and lowest drug costs nationwide for seniors – costs that are as low or lower than what Medicare could negotiate, and without the greater restrictions on access to medicines that could result.  For this Medicare drug coverage to succeed in getting the lowest costs for all seniors, we need all Medicare beneficiaries to have meaningful opportunities to get the coverage that’s best for them. 


That’s why we’ve provided written guidance to states on the educational activities that are permitted under the law. Briefly, what’s not allowed is steering by states in return for rebates or other financial considerations given to the states. These schemes raise costs for Medicare beneficiaries and taxpayers, because the drug rebates aren’t going to lower the drug prices and the premiums – which is where they need to go.  What is allowed and encouraged is advice and guidance to beneficiaries based on what matters for them – for example, advice about the formularies or the “insurance value” or other aspects of the coverage, advice about whether or not a beneficiary’s pharmacy is included – things that help beneficiaries get the best coverage for them at the lowest cost.  We strongly encourage states to provide such assistance, and we also encourage you to contact us soon so that we can implement it effectively together.  We’re already working with a number of states on such educational support, for example by making sure they get early access to information about the drug plan features in their states.


And as I said, states can provide additional financial help too, for beneficiaries with incomes and assets too high for the low-income subsidy.  The Medicare law allows qualified state prescription assistance programs (SPAPs) to “wrap around” the Medicare benefit to fill gaps in coverage, while still having the coverage count against an enrollees’ true out of pocket costs (TrOOP).  If you have an SPAP now, that means you can get the same or better coverage for all your current beneficiaries at a lower cost to the state.


To qualify, SPAPs must work with the drug plans in the state.  Now, we’ve been listening to your concerns about potential costs and burdens associated with actually making these wraparound payments to all the qualifying plans – we know this too is a change in business model for you. Consequently, we are establishing an electronic “TrOOP facilitator” system that uses existing electronic prescription processing systems, to provide for the timely exchange of information between all the drug plans and CMS and SPAPs, as well as other payers, to ensure that beneficiaries receive the full benefit of all available coverage when out-of-pocket costs are charged at the pharmacy, and to ensure that information essential for tracking TrOOP and is available to Medicare plans.  


This system, which we are also using to track enrollment and eligibility, leverages existing pharmacy technologies to allow SPAPs to become “connected” to our COB and TrOOP facilitation processes.  This means that when an SPAP establishes itself as a payer or secondary payer, it may exchange eligibility information with our COB contractor and be part of the TrOOP facilitation process, just like any other payer that works with Medicare.  This is a key feature of implementing the drug benefit – Medicare isn’t paying for everything; to keep government costs down, we are working with employers and Medicare Advantage plans and charitable organizations and other existing sources of funding for drugs.  As this system is implemented, CMS and Medicare prescription drug plans will work with SPAPs to incorporate features to facilitate effective coordination of benefits between Medicare drug plans and SPAPs. This means you will be able to work with all the drug plans by working with only a single benefit coordinator – just as you work with a single plan or contractor today.


Now I want to turn to a couple of issues where there are clear opportunities for states to get additional savings, if you plan ahead and work with us.  The fifth issue is the major new subsidies to reduce state costs for retiree coverage. The Medicare law provides subsidies to employers that furnish qualified retiree drug coverage to Medicare beneficiaries, including the vast majority of states.  In some cases, the value of this retiree assistance can be worth close to $1000 per beneficiary – and that can amount to tens or hundreds of millions in savings for a state.  We’ve looked around the country, and while most states can get a lot of savings this way, they can’t always get it automatically. Many states have their retiree benefits set up in ways that can simply draw in the new federal subsidies as a new funding stream, reducing state costs without the need for any further state action. But some states may need to affirmatively adjust their contributions to retiree coverage funds to realize the intended savings.  We have staff here, and we will provide further technical support and direct assistance, to make sure that your state gets these savings.  And if this is outside your own area because it’s not Medicaid, we hope you’ll help us work with your budget officials and human resources officials to make sure this happens.  After all, this is new support for your own retirement coverage!


The sixth issue I’d like to discuss is a good one to end on:  we want to provide more opportunities for better coordination and continuity of care for the dual eligibles.  As I said earlier, prescription drugs are an important benefit for Medicare to take over, but they are only one part of the comprehensive approach we need to take to provide better care, with fewer unnecessary costs due to duplication and inefficiency and avoidable complications.  Coordination of care and disease management are proven approaches, in conjunction with drug coverage, to reduce the cost and improve the quality of the care we provide our dual eligible beneficiaries, who account for a large share of the costs of both Medicaid and Medicare, and who too often receive poor-quality care.  For example, we spend billions every year on hospitalizations for pressure ulcers and other infections or nutritional problems that could have been prevented. Frail and chronically ill dual eligible beneficiaries have the most to gain from continuity and coordination of care, and with the new Medicare law, we’re providing access to this coverage. 


You may already know that Medicare health plans are offering care coordination to prevent avoidable complications to more beneficiaries all over the country than ever before, as a result of the new law.  In 2005, well over 90 percent of Medicare beneficiaries will have access to Medicare Advantage plans, and these plans save beneficiaries an average of about $100 a month – $100 a month – on services Medicare doesn’t cover, through their lower copays and extra benefits.  Beneficiaries in fair or poor health save much more. That also means large savings for states whose dual eligible beneficiaries take advantage of these plans.  What you may not know is that the new funding for Medicare health plans is being concentrated on improving care for our beneficiaries who are frail and who have chronic illnesses, because we are moving rapidly to full “risk adjustment” of these payments for the first time ever.  That means the Medicare Advantage plans will have much stronger financial incentives to provide high-quality coordinated care for the beneficiaries who need it the most.


In particular, Medicare Advantage now includes “Special Needs” plans to our frail and high-cost beneficiaries, including those who are institutionalized or dually eligible or have chronic illnesses. These plans provide not only care coordination, but many extra benefits that substantially lower out-of-pocket costs and requirements for state copayments.  Already, this year, more than 40 plans are offering special needs plans in 2005.  Next year, I expect this number to triple.  We can tell you more about what these plans offer – for example, medication therapy management services to avoid the adverse interactions or contraindicated prescribing that occurs way too often among frail Medicare beneficiaries today, and care management services to prevent everything from pressure ulcers to heart failure complications.  These are proven approaches to improving quality while significantly lowering overall costs for chronically ill and frail Medicare beneficiaries, and they can be an important part of improving care and costs in Medicaid.


As we take all of these steps to make Medicare better, especially for our seniors and people with a disability who have limited means and great needs, I need to ask you for a commitment as well. We need your partnership. We are working to be effective partners:  we’ve tried hard to listen to all the concerns and issues that you’ve brought up so far, and to work to address them.  As a result of all your constructive input, we are keeping on track with our tight schedule for bringing better coverage to Medicare and saving money for states at the same time. 


We understand that big changes like these are not easy, and we know the best way to make them succeed is to work closely together. Last year, we established a team of State, SSA, and CMS representatives, called the State Issues Workgroup that has helped us lay the foundation for addressing the key issues for states.  This year, we have added a State Pharmaceutical Assistance Program Workgroup that similarly helps bring SPAP-related issues forward for discussion between states, CMS and SSA.  These groups, plus input from many of you and our Technical Advisory Groups, helped us develop the guidances I've mentioned today, as well as other implementation, training, outreach, and educational materials.  Many of these materials will be discussed at this conference, they are available (and will be updated) on the “state” section of our Medicare drug benefit implementation website at, and they are being distributed on our MMA_States listserv which you can join if you haven’t already.  And we have and will be conducting further education and training activities for Medicaid officials, State legislators, and state health policy staff in the weeks ahead. 


To follow up on this meeting, we’re conducting webcast for state legislators on May 5 to further address issues and concerns.  Also, where possible, we will work with you to conduct video and onsite trainings on important issues that you identify.  We will continue to hold these meetings to help you address your concerns and to meet your needs so that the program can be a success – we just need to hear from you and your representatives at the NGA and other organizations about what you need. In particular, as we see effective approaches to address implementation issues in particular states, we want to increasingly use these opportunities to highlight the best practices.


In addition to the trainings, we have developed a number of materials such as the tool kit for state legislators to help you better understand the program, and to make sure you know the issues that need to be addressed and how. We’ve also got some “basic training” DVDs on the key features of the Medicare drug benefit.  As these materials are developed, they too will be placed on the CMS website. 


And we are establishing local networks of support across the nation.  Already, our regional offices are fully engaged to collaborate with local Social Security offices, Area Agencies on Aging, State Health Insurance Assistance Programs (we’ve doubled their funding), and other local partners as part of our national implementation effort – and that includes working closely with each state. 


We’re also engaging broad and diverse coalitions of non-government organizations like the Access to Benefits Coalition, the Medicare Today Coalition, NCOA, AARP, National Alliance for Hispanic Health and hundreds of local organizations to provide assistance for beneficiaries as well.  These collaborations are focusing right now on awareness about the upcoming drug benefit, and enrollment for seniors in the low-income subsidy. Later this year, they’ll switch to providing direct, grassroots experience to seniors and their family members and caregivers in getting the most out of the new drug coverage, when they start having an opportunity to enroll in November.


On the key state issues I’ve discussed today, we want to use this meeting both to continue our exchange of ideas about the best way to implement the law, but also to begin to move from guidances and discussions on key issues to actual, on-the-ground implementation all over the country.  In particular, we intend to set up implementation groups involving key CMS staff and the health plan association (AHIP) to help you work with the drug plans in your state on the specific transition issues for duals and for pharmacy assistance that you will face in the fall. If you are interested in such a “transition implementation” group in your state, we encourage you to let us know how we can best structure the group to support your transitions. 


This meeting, and the involvement of the NGA, is a critical step in our partnership to implement the Medicare law, to bring the maximum possible help to seniors and people with a disability who need it, while providing real savings to states. So let’s continue the discussions, let’s keep working together to get it right.  Let’s get it done. Thank you for coming and for working with us.  It’s a privilege to be part of Medicare at this exciting time, and a special privilege to be able to work with all of you, as we take these challenging, essential steps together to get better care and better health to the millions of Americans who need it now.