BILL NUMBER: S355
SPONSOR: RIVERA
 
TITLE OF BILL:
An act to amend the elder law, in relation to program eligibility for
plans comparable to Medicare part D
 
PURPOSE OF BILL:
To allow individuals who have comparable coverage to a Medicare Part D
plan to also be eligible for EPIC if they otherwise qualify.
 
SUMMARY OF PROVISIONS:
Section 1 amends section 242 of the Elder Law, which sets forth the
eligibility criteria for the Elderly Pharmaceutical Insurance Coverage
(EPIC) Program, to clarify that a participant may be enrolled in a
public or private drug plan, aside from medicare Part D which has
successfully demonstrated to CMS that the coverage is as generous as, or
more generous than the defined standards coverage under the Medicare
Part D prescription drug benefit.
Section 2 of the bill provides an effective date.
 
EXISTING LAW:
Currently, to be eligible for EPIC a participant must be enrolled in a
Medicare Part D Plan.
 
JUSTIFICATION:
New York State established and funded the Elderly Pharmaceutical Insur-
ance Coverage (EPIC) Program in 1986 to assist seniors based on annual
income with the costs of prescription medications. Today, over 327,000
income-eligible seniors aged 65 and older receive assistance with
co-payments, the costs of excluded drugs, and/or plan premiums depending
on one's income. As the price of pharmaceutical drugs continues to rise
at unprecedented rates, EPIC has become even more important for many New
York seniors.
Unfortunately, some retirees are ineligible because their employers
opt-in to a federal program, which incentivizes them to offer comparable
coverage instead of the Medicare Part D plan. While the employer
receives a 28% Retiree Drug Subsidy (RDS) for creating a comparable drug
plan, in New York, the retirees who receive these comparable drug plans
are ineligible for EPIC. This legislation removes the barrier that
requires all participants to have a Medicare Part D plan and allows
those who have comparable coverage to be eligible for EPIC if they
otherwise meet the qualifications.
 
LEGISLATIVE HISTORY:
2023-24: S966 / A6518 Tapia
2021-22: 2535-A / No same as
2019-20: S6695 / A8654 Bronson
 
FISCAL IMPLICATIONS:
To be determined, but minimal as the number of EPIC-eligible retirees
with comparable coverage is small.
 
EFFECTIVE DATE:
This act shall take effect on the first day of April next succeeding the
date on which it shall have become law.