In 1996, Vermont Medicaid implemented an 1115 waiver entitled The Vermont Health Access Plan or VHAP. The waiver consisted of a five-year demonstration that introduced a statewide mandatory Medicaid managed care program. One unique component of the demonstration was a program to provide Medicaid prescription drug benefits to the State’s lower income Medicare beneficiaries. Medicare beneficiaries living in households with incomes up to 175 percent of the federal poverty level (FPL) are currently eligible for the full Medicaid outpatient pharmacy benefit. As part of the 1115 waiver, costs incurred under the VHAP Pharmacy program are eligible for federal matching dollars. Vermont’s pharmacy assistance programs provide a useful opportunity for assessing the impact of outpatient prescription drug benefits on the cost and use of drug and non-drug medical services among the elderly and disabled population. This study should also help inform the current national debate over outpatient prescription drug coverage for low- income Medicare beneficiaries at the federal or state levels. Some of the findings of this study include the following: 1) Nearly 16 percent of the 93,332 Medicare beneficiaries who resided in Vermont in 2000 received some form of outpatient prescription drug coverage through the state’s pharmacy assistance programs. 2) Of the 14,659 enrollees in 2000, 66 percent received full drug coverage under the 1115 waiver’s VHAP Pharmacy program for individuals with incomes up to 150 percent of federal poverty level (FPL). An additional 20 percent received coverage for maintenance prescriptions only under the 1115 waiver portion of the VScript program for individuals with incomes between 151 and 175 percent of FP. The remaining 14 percent received maintenance drug coverage through the VScript Expanded program for individuals with incomes between 176 and 225 percent of FPL with state-only dollars.
PIC ID: 7953
Agency Sponsor: CMS, Centers for Medicare and Medicaid Services
Federal Contact: Boben, Paul J., 410-786-6629
Performer: Research Triangle Institute, Research Triangle Park, NC