Relates to eligibility levels in the elderly pharmaceutical insurance coverage program

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

To permit individuals with severe and permanent disabilities to participate in the EIPC program and raise the income eligibility for those currently in the EPIC program.

Summary of specific provisions

Section 1: Makes individuals who are eligible for or are receiving social security disability insurance (SSDI) eligible to participate in the EPIC program. Expands coverage for elderly individuals by providing coverage for those who are at least 65 years of age and whose income is less than fifty-thousand dollars annually for an unmarried person, and less than seventy-five thousand dollars annually for a married couple.

Section 2 Establishes deductibles based on income for unmarried individuals and married couples.

Section 3: Establishes co-payments based on income for unmarried individuals and married couples.

Section 4: Immediate effective date.

Justification

While EPIC is now limited to people age 65 and over, people with severe and permanent disabilities under this age have needs similar to New York's seniors. They, too, almost invariably live on fixed incomes and often have significant prescription drug needs. On aver age, disabled Medicare beneficiaries have lower incomes and much poorer physical, mental and functional levels than their elderly counterparts. Disabled beneficiaries are more than twice as likely to report being in fair or poor health than the elderly (59% vs. 23%) and are twice as likely to have trouble performing at least one "activity of daily living."

The combination of poor health status, high drug utilization and low income makes paying for prescription medications particularly burdensome for people with disabilities. A Kaiser Foundation national survey in December 2003 found that nine out often people with disabilities used at least one prescription medication on a regular basis. Almost a third of them (32%) identified cost as a barrier to obtaining necessary prescription drugs, more than the share who reported problems with any other medical benefit. Among the uninsured, 60 percent skipped doses, split pills, or did not fill a prescription due to cost. Not surprisingly, "improving prescription drug coverage" was named by 41 percent of respondents as the "most important disability-related issue for government to address."

The Part D drug benefit introduced in the Medicare program in 2006 does not adequately meet the needs of adults with disabilities. Some non-elderly adults with disabilities are not eligible for Part D because they are in the two-year waiting period for Medicare and those already receiving Medicare often find themselves in the Part D coverage gap or "donut hole" in the beginning of the calendar year due to their use of multiple costly medications.

While EPIC is one of New York's great success stories, its exclusion of people with disabilities must be corrected. At least 15 other states, including Massachusetts, New Jersey, and Connecticut, have implemented pharmacy assistance programs that cover non-elderly adults with disabilities. EPIC expansion would provide desperately needed coverage to many New Yorkers and help correct and equalize our patchwork health and prescription drug coverage system.

This legislation would also raise the income eligibility for those currently in the EPIC program as well as those who would become eligible as a result of this bill. This income eligibility expansion would allow thousands of seniors and people with disabilities to have access to the medications they desperately need to remain healthy.

Prior legislative history

This is a new bill

Fiscal implications

To be determined.

Effective date

Immediate effective date.