Bill S6734-2013

Increases income eligibility levels in the EPIC program

Increases income eligibility levels in the EPIC program from $35,000 to $75,000 for unmarried residents and from $50,000 to $100,000 for married residents.

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  • Mar 4, 2014: REFERRED TO AGING

Memo

BILL NUMBER:S6734

TITLE OF BILL: An act to amend the elder law, in relation to eligibility levels in the elderly pharmaceutical insurance coverage program

PURPOSE OR GENERAL IDEA OF BILL:

Increases the income limits in the EPIC program to $75,000 for single and $100,000 for married couples. Also, excludes social security income from income threshold determinations.

SUMMARY OF SPECIFIC PROVISIONS:

Section 1: Subdivision 3 of section 241 of the elder law is amended to exclude social security income from income threshold determinations under the EPIC program.

Section 2: Subdivision 2 of section 242 of the elder law is amended to allow for the increase in the limits of income for the elderly covered under the EPIC program to $75,000 for individual enrollees and $100,000 for married enrollees.

Section 3 and 4: Amends section 248 of the elder law to reflect the increase in the limits of income for the elderly covered under the EPIC program to $75,000 for individual enrollees and $100,000 for married enrollees.

Section 5: Effective date.

JUSTIFICATION:

In 2012, prescription medication prices rose 3.6%, twice the 1.7% inflation rate.* Such an increase is extremely problematic considering the vast majority of seniors in New York are living on fixed incomes. New York seniors deserve relief from these rising prescription medication costs. The EPIC program can help combat these rising costs. However, currently, the eligibility requirements for EPIC are capped at $35,000 for an individual enrollee and $50,000 for married enrollees. These eligibility requirements can easily be expanded to assist even more New York seniors. This legislation will expand the income threshold to $75,000 for an individual enrollee and $100,000 for married enrollees and exclude social security income from the income calculations. This legislation is absolutely necessary to help senior citizens in New York afford their prescription medication during a time where prices are double the inflation rate.

PRIOR LEGISLATIVE HISTORY:

None

FISCAL IMPLICATIONS:

Based on a recent fiscal analysis prepared by the New York State Department of Health for the Independent Democratic Conference, this expansion will help cost $2.07 million in 2014-2015.

EFFECTIVE DATE:

Immediately.

* Dennis Cauchon, "Drug prices jump again while other health costs decline: The upward trend in the price of prescription drugs is in sharp contrast to other health costs," USA Today, February 2013, available at http://www.usatoday.com/story/news/nation/2013/02/13/ price-of-a-prescription-rising-again/1918099/(citing the Bureau of Economic Analysis).


Text

STATE OF NEW YORK ________________________________________________________________________ 6734 IN SENATE March 4, 2014 ___________
Introduced by Sens. VALESKY, AVELLA, CARLUCCI, KLEIN, SAVINO -- 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 eligibility levels in the elderly pharmaceutical insurance coverage program THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Subdivision 3 of section 241 of the elder law is amended to read as follows: 3. "Income" shall mean "household gross income" as defined in the real property tax circuit breaker credit program, pursuant to subparagraph (C) of paragraph one of subsection (e) of section six hundred six of the tax law, [but] EXCLUDING ANY PAYMENTS RECEIVED UNDER THE FEDERAL SOCIAL SECURITY ACT, AND only shall include the income of program applicants and spouses and shall exclude the income of other members of the house- hold. S 2. Subdivision 2 of section 242 of the elder law, as added by section 5 of part T of chapter 56 of the laws of 2012, is amended to read as follows: 2. Persons eligible for catastrophic coverage under section two hundred forty-eight of this title shall include: (a) any unmarried resident who is at least sixty-five years of age and whose income for the calendar year immediately preceding the effective date of the annual coverage period beginning on or after January first, two thousand one, is more than twenty thousand and less than or equal to [thirty-five] SEVENTY-FIVE thousand dollars. After the initial determi- nation of eligibility, each eligible individual must be redetermined eligible at least every twenty-four months; and (b) any married resident who is at least sixty-five years of age and whose income for the calendar year immediately preceding the effective date of the annual coverage period when combined with the income in the same calendar year of such married person's spouse beginning on or after January first, two thousand one, is more than twenty-six thousand dollars and less than or equal to [fifty] ONE HUNDRED thousand dollars.
After the initial determination of eligibility, each eligible individual must be redetermined eligible at least every twenty-four months. S 3. Paragraphs (a) and (b) of subdivision 2 of section 248 of the elder law, as added by section 17 of part T of chapter 56 of the laws of 2012, are amended to read as follows: (a) Annual personal covered drug expenditures for unmarried individual eligible program participants: individual income of $20,001 to [$21,000] $42,000 $530 individual income of [$21,001] $42,001 $550 to [$22,000] $44,000 individual income of [$22,001] $44,001 $580 to [$23,000] $46,000 individual income of [$23,001] $46,001 $720 to [$24,000] $48,000 individual income of [$24,001] $48,001 $750 to [$25,000] $50,000 individual income of [$25,001] $50,001 $780 to [$26,000] $52,000 individual income of [$26,001] $52,001 $810 to [$27,000] $54,000 individual income of [$27,001] $54,001 $840 to [$28,000] $56,000 individual income of [$28,001] $56,001 $870 to [$29,000] $58,000 individual income of [$29,001] $58,001 $900 to [$30,000] $60,000 individual income of [$30,001] $60,001 $930 to [$31,000] $62,000 individual income of [$31,001] $62,001 $960 to [$32,000] $64,000 individual income of [$32,001] $64,001 $1,160 to [$33,000] $66,000 individual income of [$33,001] $66,001 $1,190 to [$34,000] $68,000 individual income of [$34,001] $68,001 $1,230 to [$35,000] $75,000 (b) Annual personal covered drug expenditures for each married individual eligible program participant: joint income of $26,001 to [$27,000] $54,000 $650 joint income of [$27,001] $54,001 $675 to [$28,000] $56,000 joint income of [$28,001] $56,001 $700 to [$29,000] $58,000 joint income of [$29,001] $58,001 $725 to [$30,000] $60,000 joint income of [$30,001] $60,001 $900 to [$31,000] $62,000 joint income of [$31,001] $62,001 $930 to [$32,000] $64,000 joint income of [$32,001] $64,001 $960 to [$33,000] $66,000 joint income of [$33,001] $66,001 $990 to [$34,000] $68,000 joint income of [$34,001] $68,001 $1,020 to [$35,000] $70,000
joint income of [$35,001] $70,001 $1,050 to [$36,000] $72,000 joint income of [$36,001] $72,001 $1,080 to [$37,000] $74,000 joint income of [$37,001] $74,001 $1,110 to [$38,000] $76,000 joint income of [$38,001] $76,001 $1,140 to [$39,000] $78,000 joint income of [$39,001] $78,001 $1,170 to [$40,000] $80,000 joint income of [$40,001] $80,001 $1,200 to [$41,000] $82,000 joint income of [$41,001] $82,001 $1,230 to [$42,000] $84,000 joint income of [$42,001] $84,001 $1,260 to [$43,000] $86,000 joint income of [$43,001] $86,001 $1,290 to [$44,000] $88,000 joint income of [$44,001] $88,001 $1,320 to [$45,000] $90,000 joint income of [$45,001] $90,001 $1,575 to [$46,000] $92,000 joint income of [$46,001] $92,001 $1,610 to [$47,000] $94,000 joint income of [$47,001] $94,001 $1,645 to [$48,000] $96,000 joint income of [$48,001] $96,001 $1,680 to [$49,000] $98,000 joint income of [$49,001] $98,001 $1,715 to [$50,000] $100,000 S 4. Paragraphs (a) and (b) of subdivision 4 of section 248 of the elder law, as added by section 17 of part T of chapter 56 of the laws of 2012, are amended to read as follows: (a) Limits on co-payments by unmarried individual eligible program participants: individual income of $20,001 to [$21,000] $42,000 no more than $1,050 individual income of [$21,001] $42,001 to [$22,000] $44,000 no more than $1,100 individual income of [$22,001] $44,001 to [$23,000] $46,000 no more than $1,150 individual income of [$23,001] $46,001 to [$24,000] $48,000 no more than $1,200 individual income of [$24,001] $48,001 to [$25,000] $50,000 no more than $1,250 individual income of [$25,001] $50,001 to [$26,000] $52,000 no more than $1,300 individual income of [$26,001] $52,001 to [$27,000] $54,000 no more than $1,350 individual income of [$27,001] $54,001 to [$28,000] $56,000 no more than $1,400 individual income of [$28,001] $56,001 to [$29,000] $58,000 no more than $1,450 individual income of [$29,001] $58,001 to [$30,000] $60,000 no more than $1,500 individual income of [$30,001] $60,001
to [$31,000] $62,000 no more than $1,550 individual income of [$31,001] $62,001 to [$32,000] $64,000 no more than $1,600 individual income of [$32,001] $64,001 to [$33,000] $66,000 no more than $1,650 individual income of [$33,001] $66,001 to [$34,000] $68,000 no more than $1,700 individual income of [$34,001] $68,001 to [$35,000] $75,000 no more than $1,750 (b) Limits on co-payments by each married individual eligible program participant: joint income of $26,001 to [$27,000] $54,000 no more than $1,08 joint income of [$27,001] $54,001 to [$28,000] $56,000 no more than $1,120 joint income of [$28,001] $56,001 to [$29,000] $58,000 no more than $1,160 joint income of [$29,001] $58,001 to [$30,000] $60,000 no more than $1,200 joint income of [$30,001] $60,001 to [$31,000] $62,000 no more than $1,240 joint income of [$31,001] $62,001 to [$32,000] $64,000 no more than $1,280 joint income of [$32,001] $64,001 to [$33,000] $66,000 no more than $1,320 joint income of [$33,001] $66,001 to [$34,000] $68,000 no more than $1,360 joint income of [$34,001] $68,001 to [$35,000] $70,000 no more than $1,400 joint income of [$35,001] $70,001 to [$36,000] $72,000 no more than $1,440 joint income of [$36,001] $72,001 to [$37,000] $74,000 no more than $1,480 joint income of [$37,001] $74,001 to [$38,000] $76,000 no more than $1,520 joint income of [$38,001] $76,001 to [$39,000] $78,000 no more than $1,560 joint income of [$39,001] $78,001 to [$40,000] $80,000 no more than $1,600 joint income of [$40,001] $80,001 to [$41,000] $82,000 no more than $1,640 joint income of [$41,001] $82,001 to [$42,000] $84,000 no more than $1,680 joint income of [$42,001] $84,001 to [$43,000] $86,000 no more than $1,720 joint income of [$43,001] $86,001 to [$44,000] $88,000 no more than $1,760 joint income of [$44,001] $88,001 to [$45,000] $90,000 no more than $1,800 joint income of [$45,001] $90,001 to [$46,000] $92,000 no more than $1,840 joint income of [$46,001] $92,001 to [$47,000] $94,000 no more than $1,880 joint income of [$47,001] $94,001 to [$48,000] $96,000 no more than $1,920 joint income of [$48,001] $96,001
to [$49,000] $98,000 no more than $1,960 joint income of [$49,001] $98,001 to [$50,000] $100,000 no more than $2,000 S 5. This act shall take effect immediately.

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