that the person for whom they care does not have to choose a different health plan. Several workshop participants* indicated that advocacy groups working with the families of beneficiaries who are cognitively impaired are advising them to wait before making a decision. Anxiety among the family members is very high because they bear the responsibility for making a critical decision for a loved one who clearly needs their assistance.

How does a person with cognitive impairment exercise Medicare beneficiaries' rights in the areas of enrollment, treatment, appeals, grievances, and disenrollment? The American Bar Association Commission on Legal Problems of the Elderly, the American Association of Retired Persons, and the Alzheimer's Association are working with HCFA to develop a set of rules governing decision making in managed care for people with cognitive impairments.

Current HCFA materials indicate that state laws in the area of decision making have precedence over federal regulations. States specify who is eligible to make a health care decision for a cognitively impaired person. However, only Florida's law includes selection of a health plan in the health care decision definition. The existing laws in 49 states do not cover health plan enrollment.