Bill S6417-2011

Establishes the medicaid prescription senior eligibility expansion program

Establishes the medicaid prescription senior eligibility expansion program in order to extend prescription drug coverage to qualified medicare beneficiaries and special low-income medicare beneficiaries.

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  • Feb 7, 2012: REFERRED TO HEALTH

Memo

BILL NUMBER:S6417

PURPOSE OR GENERAL IDEA OF BILL:

The purpose of this bill is to increase the access of pharmaceuticals, for needy senior citizens and the disabled by creating a Medicaid Rx Senior Eligibility Expansion Program, to be administered by the Department of Health.

SUMMARY OF SPECIFIC PROVISIONS:

Establishes a Medicaid prescription senior eligibility expansion program to be administered by the Department of Health. Requires all eligible participants to be: U.S. citizens or lawfully admitted aliensi state residents, at least 65 years old or be individuals between the ages of 19 and 64 who are otherwise eligible for benefits under Title (II) of the Social Security Acti meet the definition of a qualified Medicare beneficiary or specified low-income Medicare beneficiary as set forth in section (c); ineligible for and/or not receiving a prescription drug benefit through a Medicare supplemental policy or any other third party payer prescription benefit.

Individuals eligible for the Medicaid prescription senior eligibility expansion program shall be entitled to the Medicaid prescription drug coverage as provided to Medicaid recipients as set forth in title (XIX) of the Social Security act.

The Department of Health shall apply for a federal Medicare (1115) demonstration waiver from the federal Secretary of Health and Human Services. The department will also promulgate and adopt rules and regulations as are necessary. The department will also submit an annual report to the legislature beginning one year from the date of implementation of the program.

JUSTIFICATION:

Roughly, three out of ten Medicare enrollees have no coverage for pharmaceuticals. Furthermore, millions more senior citizens and disabled Medicare enrollees are under insured for prescription drugs. The bill would improve the access to prescription medicines for disabled and senior citizens, who are economically disadvantaged, the privilege of being entitled to Medicaid prescription drug coverage as set forth in the title (XIX) of the Social Security Act.

The federal (1115) Medicaid waiver, to extend prescription drug coverage to qualified Medicare beneficiaries and special low income Medicare beneficiaries, would provide meaningful access to prescription drugs for the state's poverty stricken and near poverty stricken population. The waiver will allow the state to benefit from well-established state-federal partnerships in Medicaid through access to federal matching fllllds in addition to state funds.

PRIOR LEGISLATIVE HISTORY:;

New Bill In senate.

FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:

To be determined.

EFFECTIVE DATE:

The act shall take effect immediately.


Text

STATE OF NEW YORK ________________________________________________________________________ 6417 IN SENATE February 7, 2012 ___________
Introduced by Sen. ADDABBO -- read twice and ordered printed, and when printed to be committed to the Committee on Health AN ACT in relation to increasing access to pharmaceuticals for needy seniors and the disabled through the expansion of eligibility for the medicaid program THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. This act shall be known and may be cited as the "medicaid prescription senior eligibility expansion program". S 2. Legislative findings and intent. The legislature finds and declares that states are looking for solutions to improve the access of needy seniors to prescription medicines. Nearly thirty percent of medi- care enrollees in the state have no coverage for pharmaceuticals, with nearly a quarter of such enrollees living below the federal poverty level. Furthermore, millions more elderly and disabled medicare enrol- lees are underinsured for prescription drugs. A federal 1115 medicaid waiver to extend prescription drug coverage to qualified medicare bene- ficiaries and special low-income medicare beneficiaries would provide meaningful access to prescription drugs for the state's poor and near- poor senior population. The legislature further finds that a federal 1115 medicaid waiver enables the state to benefit from the well estab- lished state-federal partnership in medicaid through access to federal matching funds in addition to state funds. S 3. Definitions. As used in this act: 1. "Department" means the department of health; 2. "Qualified medicare beneficiaries" means medicare beneficiaries with incomes equal to or below one hundred percent of the federal pover- ty level who are eligible for medicaid assistance for the Part A and Part B medicare premiums and for medicare deductibles and co-insurance requirements as set forth in section 1905(p)(1) of title XIX of the social security act; and 3. "Specified low-income medicare beneficiaries" means medicare bene- ficiaries who have incomes greater than one hundred percent of the federal poverty level and less than and equal to one hundred twenty
percent of the federal poverty level and meet the requirements set forth in section 1902(a)(10) (E)(iii) of title XIX of the social security act. S 4. Medicaid prescription senior eligibility expansion program. 1. There is hereby established a medicaid prescription senior eligibility expansion program. In order to become eligible for the program, an indi- vidual must meet the following requirements: a. be a United States citizen or a lawfully admitted alien; b. be a state resident; c. be at least sixty-five years of age or an individual between the ages of nineteen and sixty-four who is otherwise eligible for benefits under title II of the social security act; d. meet the definition of a qualified medicare beneficiary or a speci- fied low-income medicare beneficiary as set forth in section three of this act; and e. be ineligible for and/or not receiving a prescription drug benefit through a medicare supplemental policy or any other third party payer prescription benefit. 2. Individuals eligible for the medicaid prescription senior eligibil- ity expansion program shall be entitled to the medicaid prescription drug coverage as provided to medicaid recipients as set forth in title XIX of the social security act. S 5. Program administration. 1. The department shall administer the medicaid prescription senior eligibility expansion program. 2. The department shall apply for a federal medicare 1115 demon- stration waiver from the federal secretary of health and human services to expand medicaid eligibility for the purposes of prescription drug coverage to qualified medicare beneficiaries and specified low-income medicare beneficiaries under the medicaid prescription senior eligibil- ity expansion program. 3. The department shall promulgate and adopt rules and regulations as are necessary to implement the provisions of the medicaid prescription senior eligibility expansion program in a cost effective manner that are consistent with the purposes of such program. S 6. Annual report. The department shall submit an annual report to the legislature beginning one year from the date of implementation of the medicaid prescription senior eligibility expansion program. S 7. This act shall take effect immediately.

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