Despite letters to those dual beneficiaries saying they will "need to pay a small copayment for each prescription," Department of Human Services director Lillian Koller said the state moved quickly during the legislative session to set up a mechanism to cover those costs.

The letters went out to Hawai'i residents who receive benefits under both the Medicaid program, which is for the poor, and the Medicare program, which is primarily for those 65 and older. Medicare also covers some people with disabilities.

The change results from revisions to the Medicare system that will add prescription drug coverage for seniors in January.

People do not have to apply; the copayments will be automatically covered.

Koller said the copayments of $1 for a generic drug and $3 for a brand-name drug for all those people would add up to $2.5 million annually. If the money is needed the state will go in for an emergency appropriation next session, she said.

"They won't be paying anything out of their pocket for their copay," Koller said. "We were the first in the nation to pass this, the State Pharmacy Assistance Program. We saw what was happening and we jumped on it. We didn't want the most vulnerable of all of our Medicaid population — the disabled and elderly — to have any interruption in their 100-percent coverage in their drugs."

That message is still unclear to the people most affected, people such as Robert Wall, who received the notice in the mail and was already trying to figure out how to pay as much as $72 more for the 12 prescription drugs he takes as a bipolar diabetic with high blood pressure and cholesterol.

"Whether it's $12 or $36 or $72, it's the principle of the thing," says Wall, 49, who has been disabled since 1989 when he broke his back in a fall at work as a stagehand. "We're not the ones who are supposed to be taxed."

With a total income of $848 a month from a combination of Medicare and Medicaid subsidies, he said he lives on sandwiches, rides the bus and struggles to pay college tuition to retrain himself for another career.

Some Hawai'i residents also could be eligible for additional prescription drug benefits. Federal officials will be mailing out 99,000 letters to Hawai'i seniors over age 65 who they suspect also are eligible for additional help based on their low incomes.

The letters will be mailed through August and include applications for extra financial assistance, which could reduce premiums and copays.

"We want to get anybody who can possibly qualify," said Mary Rydell, Pacific area representative for the federal Centers for Medicare and Medicaid Services. "If they qualify then there's no premium and no co-payment."

To qualify for this extra assistance people need to have incomes that fall below 150 percent of the national poverty level.

In Hawai'i the poverty level is set at an annual income of $11,016 for a family of one, and $14,760 for a couple. The level of assets is $10,000 for a single and $20,000 for a couple.

There also is help for those who may be unfamiliar with how to fill out the application.

Anna Schwamlein, senior legislative representative for AARP encourages people to make applications for that additional aid. In a country with 40 million Medicare beneficiaries, that aid will make a difference for many, she said.

"If you think you might be eligible and you don't get a letter, call 1-800 Medicare," said Schwamlein.