NY Elder L § 242 (2021)
2021 New York Laws ELD - Elder Article 2 - Programs for the Elderly Title 3 - Program for Elderly Pharmaceutical Insurance Coverage 242 - Program Eligibility.

§  242.  Program  eligibility.   1. Persons eligible for comprehensive coverage under section two  hundred  forty-seven  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  five,  is  less than or equal to twenty thousand dollars. After the initial determination 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 less than or equal to twenty-six thousand dollars. After the initial determination of  eligibility,  each eligible  individual  must  be  redetermined  eligible  at  least  every twenty-four months.   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 seventy-five  thousand  dollars.  After  the  initial  determination  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 one hundred thousand dollars. After the initial determination of eligibility, each eligible individual  must be redetermined eligible at least every twenty-four months.   3.  (a)  Eligibility  for  assistance  under  this  title shall not be granted to any person  who  at  the  time  an  application  is  made  is receiving  medical  assistance  under section three hundred sixty-six of the social services law, or to any person receiving equivalent or better coverage from any other public or private third party payment source  or insurance plan than those benefits provided for under this title.  (b) An individual who is determined eligible for assistance under this title  whose  prescription  costs  are  covered in part by any public or private plan may receive reduced assistance under this  title.  In  such cases, benefits provided through this title shall be considered payments of last resort.  (c)  The  participant  registration  fee  charged  to eligible program participants for comprehensive coverage pursuant to section two  hundred forty-seven  of this title shall be waived for the portion of the annual coverage period that the participant is also enrolled as a full  subsidy individual  in  a  prescription drug or MA-PD plan under part D of title XVIII of the federal social security act.  (e) As a condition of eligibility for benefits under this title, if  a program  participant's  income  indicates  that the participant could be eligible for an income-related subsidy under  section  1860D-14  of  the federal  social  security  act by either applying for such subsidy or by enrolling  in  a  medicare  savings  program  as  a  qualified  medicare beneficiary  (QMB),  a specified low-income medicare beneficiary (SLMB), or a qualifying individual (QI), a program participant  is  required  to  provide,  and to authorize the elderly pharmaceutical insurance coverage program  to  obtain,  any  information  or  documentation  required   to establish  the  participant's  eligibility  for  such  subsidy,  and  to authorize the elderly pharmaceutical insurance coverage program to apply on  behalf  of  the  participant for the subsidy or the medicare savings program. The elderly pharmaceutical  insurance  coverage  program  shall make a reasonable effort to notify the program participant of his or her need  to  provide  any  of  the  above  required  information.  After  a reasonable  effort  has  been  made  to  contact  the   participant,   a participant  shall  be notified in writing that he or she has sixty days to provide  such  required  information.  If  such  information  is  not provided  within the sixty day period, the participant's coverage may be terminated.  (f) As a condition of eligibility for benefits  under  this  title,  a program participant is required to be enrolled in Medicare part D and to maintain  such  enrollment.  For  unmarried participants with individual annual income less than or equal to twenty-three  thousand  dollars  and married  participants  with  joint  annual  income less than or equal to twenty-nine  thousand  dollars,  the  elderly  pharmaceutical  insurance coverage program shall pay for the portion of the part D monthly premium that  is  the  responsibility  of the participant. Such payment shall be limited to the low-income benchmark premium amount  established  by  the federal  centers for medicare and medicaid services and any other amount which such agency establishes under its de minimus premium policy.  (h)  The  elderly  pharmaceutical  insurance   coverage   program   is authorized  to  represent  program  participants  under  this title with respect to their Medicare part D coverage.   4. As a condition  of  eligibility  for  benefits  under  this  title, participants  must  be  enrolled  in  medicare  part D and maintain such enrollment.  For  persons  who  meet  the  eligibility  requirements  to participate  in  the  elderly pharmaceutical insurance coverage program, the program will pay for a drug covered by the person's medicare part  D plan  or  a drug in a medicare part D excluded drug class, as defined in subdivision eight of  section  two  hundred  forty-one  of  this  title, provided that such drug is a covered drug, as defined in subdivision one of section two hundred forty-one of this title, and that the participant complies  with  the  point  of sale co-payment requirements set forth in sections two hundred forty-seven and two  hundred  forty-eight  of  this title. No payment shall be made for medicare part D plan deductibles.