Provides for cost-of-living and marriage penalty adjustments to eligibility standards for the program for elderly pharmaceutical insurance coverage.
TITLE OF BILL: An act to amend the elder law, in relation to cost of living and marriage penalty adjustments to eligibility standards for the program for elderly pharmaceutical insurance coverage
PURPOSE OR GENERAL IDEA OF THE BILL: To eliminate the marriage penalty currently existing in the schedules for EPIC registration fees and personal covered drug expenditures (deductions).
SUMMARY OF PROVISIONS: The bill amends section 254 of the elder law (EPIC) by renumbering the current subsections 1 and 2 for cost of living adjustments as 1(a) and 1(b), and adding a new subsection 2. Marriage penalty adjustment, which directs the elderly pharmaceutical insurance coverage panel (consisting of the commissioners of the departments of education and health, the superintendent of insurance, and the directors of the state office for the aging and the division of the budget) to adjust registration fees as follows: first, joint income for a married couple is defined to mean income divided by two; and second, the panel is directed to set quarterly registration fees and deductibles for married couples at a level that is no greater than the fees and deductibles for individuals of comparable income.
JUSTIFICATION: Current EPIC schedules for registration fee and deductible assume that a married couple has greater resources than a single person, but with the rising costs of drugs, it is no longer true--if it ever was--that two can pay medical costs, when all other bills are accounted for, as cheaply as one. This legislation recognizes the important role played in the setting of fees and deductibles by the EPIC panel, and uses that mechanism to require adjustments.
The current fee and deductible schedule produce on average, fees for married that are 150%-200% more than fees for singles, and deductibles that, on average and where comparable, are 160% - 165% more than singles.
LEGISLATIVE HISTORY: 2009-2010 - S.2750 - Aging, Finance 2005-2006 - S.2971 - Aging, Finance 2007-2008 - S.118 - Aging, Finance
FISCAL IMPLICATIONS: To be determined.
EFFECTIVE DATE: April 1, after it becomes law.
STATE OF NEW YORK ________________________________________________________________________ 2172 2011-2012 Regular Sessions IN SENATE January 18, 2011 ___________Introduced by Sens. GOLDEN, BONACIC, DeFRANCISCO, HANNON, RANZENHOFER -- read twice and ordered printed, and when printed to be committed to the Committee on Aging AN ACT to amend the elder law, in relation to cost of living and marriage penalty adjustments to eligibility standards for the program for elderly pharmaceutical insurance coverage THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Section 254 of the elder law is amended to read as follows: S 254. ADJUSTMENTS. 1. Cost of living adjustment.
[1.](A) Within amounts appropriated, the panel shall adjust the program eligibility standards set forth in subdivision two of section two hundred forty-two of this title to account for increases in the cost of living. [2.](B) The panel shall further adjust individual and joint income categories set forth in subdivisions two and four of section two hundred forty-eight of this title to conform to the adjustments made pursuant to THIS subdivision [one of this section]. 2. MARRIAGE PENALTY ADJUSTMENT. THE PANEL SHALL FURTHER ADJUST INCOME, REGISTRATION FEES, DEDUCTIBLES, AND OTHER PROGRAM COMPONENTS TO ELIMINATE THE EPIC MARRIAGE PENALTY, AS FOLLOWS: (A) FOR PURPOSES OF SUBDIVISIONS TWO AND FOUR OF SECTIONS TWO HUNDRED FORTY-SEVEN AND TWO HUNDRED FORTY-EIGHT OF THIS TITLE, JOINT INCOME SHALL BE DEFINED AS INCOME, AS SUCH TERM IS DEFINED IN SECTION TWO HUNDRED FORTY-ONE OF THIS TITLE AND AS ADJUSTED PURSUANT TO SUBDIVISION ONE OF THIS ACTION, DIVIDED BY TWO. (B) THE QUARTERLY REGISTRATION FEE ESTABLISHED PURSUANT TO SECTION TWO HUNDRED FORTY-SEVEN OF THIS TITLE, AND THE LIMITS ON POINT OF SALE CO-PAYMENTS ESTABLISHED PURSUANT TO SUBDIVISION FOUR OF SUCH SECTION, AS SUCH ITEMS MAY BE OR HAVE BEEN ADJUSTED BY THE PANEL PURSUANT TO SUBDI- VISION ONE OF THIS SECTION AND OTHER SECTIONS OF THIS CHAPTER, FOR EACH MARRIED INDIVIDUAL PROGRAM PARTICIPANT SHALL BE SET AT A LEVEL THAT ISEXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD04202-01-1 S. 2172 2
NOT GREATER THAN THE QUARTERLY REGISTRATION FEE AND THE LIMIT ON POINT OF SALE CO-PAYMENTS FOR UNMARRIED INDIVIDUAL PROGRAM PARTICIPANTS WHOSE INCOME EQUALS JOINT INCOME AS DEFINED IN PARAGRAPH (A) OF THIS SUBDIVI- SION. (C) THE ANNUAL PERSONAL COVERED DRUG EXPENDITURES FOR EACH MARRIED INDIVIDUAL ELIGIBLE PROGRAM PARTICIPANT ESTABLISHED PURSUANT TO SECTION TWO HUNDRED FORTY-EIGHT OF THIS TITLE AS ADJUSTED BY THE PANEL PURSUANT TO SUBDIVISION ONE OF THIS SECTION AND OTHER SECTIONS OF THIS CHAPTER, SHALL BE SET BY THE PANEL AT A LEVEL WHICH IS NO GREATER THAN THE PERSONAL COVERED DRUG EXPENDITURES FOR UNMARRIED INDIVIDUAL ELIGIBLE PROGRAM PARTICIPANTS WHOSE INCOME, AS ADJUSTED PURSUANT TO SUBDIVISION ONE OF THIS SECTION, EQUALS JOINT INCOME AS ADJUSTED PURSUANT TO PARA- GRAPH (A) OF THIS SUBDIVISION. (D) THE LIMITS ON POINT OF SALE CO-PAYMENTS ESTABLISHED PURSUANT TO SUBDIVISION FOUR OF SECTIONS TWO HUNDRED FORTY-SEVEN AND TWO HUNDRED FORTY-EIGHT OF THIS TITLE, AS ADJUSTED BY THE PANEL PURSUANT TO SUBDIVI- SION ONE OF THIS SECTION AND OTHER SECTIONS OF THIS CHAPTER, FOR EACH MARRIED INDIVIDUAL PROGRAM PARTICIPANT SHALL BE SET AT A LEVEL THAT IS NO GREATER THAN THE LIMIT ON POINT OF SALE CO-PAYMENTS FOR UNMARRIED INDIVIDUAL PROGRAM PARTICIPANTS WHOSE INCOME EQUALS JOINT INCOME AS DEFINED IN PARAGRAPH (A) OF THIS SUBDIVISION. (E) THE PANEL SHALL MAKE THE ADJUSTMENTS REQUIRED BY THIS SUBDIVISION ON A FOUR-YEAR SCHEDULE WHICH IT SHALL ADOPT AFTER CONSULTATION WITH THE DIVISION OF THE BUDGET BEGINNING WITH THE FISCAL YEAR NEXT SUCCEEDING THE DATE ON WHICH THIS SUBDIVISION SHALL HAVE BECOME EFFECTIVE. S 2. This act shall take effect on the first of April next succeeding the date on which it shall have become a law.