§ 242. Program eligibility.
1.Persons eligible for comprehensive\ncoverage under section two hundred forty-seven of this title shall\ninclude:\n (a) any unmarried resident who is at least sixty-five years of age and\nwhose income for the calendar year immediately preceding the effective\ndate of the annual coverage period beginning on or after January first,\ntwo thousand five, is less than or equal to twenty thousand dollars.\nAfter the initial determination of eligibility, each eligible individual\nmust be redetermined eligible at least every twenty-four months; and\n (b) any married resident who is at least sixty-five years of age and\nwhose income for the calendar year immediately preceding the effective\ndate of the annual coverage period when combined with the income in the\nsa
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§ 242. Program eligibility. 1. Persons eligible for comprehensive\ncoverage under section two hundred forty-seven of this title shall\ninclude:\n (a) any unmarried resident who is at least sixty-five years of age and\nwhose income for the calendar year immediately preceding the effective\ndate of the annual coverage period beginning on or after January first,\ntwo thousand five, is less than or equal to twenty thousand dollars.\nAfter the initial determination of eligibility, each eligible individual\nmust be redetermined eligible at least every twenty-four months; and\n (b) any married resident who is at least sixty-five years of age and\nwhose income for the calendar year immediately preceding the effective\ndate of the annual coverage period when combined with the income in the\nsame calendar year of such married person's spouse beginning on or after\nJanuary first, two thousand one, is less than or equal to twenty-six\nthousand dollars. After the initial determination of eligibility, each\neligible individual must be redetermined eligible at least every\ntwenty-four months.\n 2. Persons eligible for catastrophic coverage under section two\nhundred forty-eight of this title shall include:\n (a) any unmarried resident who is at least sixty-five years of age and\nwhose income for the calendar year immediately preceding the effective\ndate of the annual coverage period beginning on or after January first,\ntwo thousand one, is more than twenty thousand and less than or equal to\nseventy-five thousand dollars. After the initial determination of\neligibility, each eligible individual must be redetermined eligible at\nleast every twenty-four months; and\n (b) any married resident who is at least sixty-five years of age and\nwhose income for the calendar year immediately preceding the effective\ndate of the annual coverage period when combined with the income in the\nsame calendar year of such married person's spouse beginning on or after\nJanuary first, two thousand one, is more than twenty-six thousand\ndollars and less than or equal to one hundred thousand dollars. After\nthe initial determination of eligibility, each eligible individual must\nbe redetermined eligible at least every twenty-four months.\n 3. (a) Eligibility for assistance under this title shall not be\ngranted to any person who at the time an application is made is\nreceiving medical assistance under section three hundred sixty-six of\nthe social services law, or to any person receiving equivalent or better\ncoverage from any other public or private third party payment source or\ninsurance plan than those benefits provided for under this title.\n (b) An individual who is determined eligible for assistance under this\ntitle whose prescription costs are covered in part by any public or\nprivate plan may receive reduced assistance under this title. In such\ncases, benefits provided through this title shall be considered payments\nof last resort.\n (c) The participant registration fee charged to eligible program\nparticipants for comprehensive coverage pursuant to section two hundred\nforty-seven of this title shall be waived for the portion of the annual\ncoverage period that the participant is also enrolled as a full subsidy\nindividual in a prescription drug or MA-PD plan under part D of title\nXVIII of the federal social security act.\n (e) As a condition of eligibility for benefits under this title, if a\nprogram participant's income indicates that the participant could be\neligible for an income-related subsidy under section 1860D-14 of the\nfederal social security act by either applying for such subsidy or by\nenrolling in a medicare savings program as a qualified medicare\nbeneficiary (QMB), a specified low-income medicare beneficiary (SLMB),\nor a qualifying individual (QI), a program participant is required to\nprovide, and to authorize the elderly pharmaceutical insurance coverage\nprogram to obtain, any information or documentation required to\nestablish the participant's eligibility for such subsidy, and to\nauthorize the elderly pharmaceutical insurance coverage program to apply\non behalf of the participant for the subsidy or the medicare savings\nprogram. The elderly pharmaceutical insurance coverage program shall\nmake a reasonable effort to notify the program participant of his or her\nneed to provide any of the above required information. After a\nreasonable effort has been made to contact the participant, a\nparticipant shall be notified in writing that he or she has sixty days\nto provide such required information. If such information is not\nprovided within the sixty day period, the participant's coverage may be\nterminated.\n (f) As a condition of eligibility for benefits under this title, a\nprogram participant is required to be enrolled in Medicare part D and to\nmaintain such enrollment. For unmarried participants with individual\nannual income less than or equal to twenty-three thousand dollars and\nmarried participants with joint annual income less than or equal to\ntwenty-nine thousand dollars, the elderly pharmaceutical insurance\ncoverage program shall pay for the portion of the part D monthly premium\nthat is the responsibility of the participant. Such payment shall be\nlimited to the low-income benchmark premium amount established by the\nfederal centers for medicare and medicaid services and any other amount\nwhich such agency establishes under its de minimus premium policy.\n (h) The elderly pharmaceutical insurance coverage program is\nauthorized to represent program participants under this title with\nrespect to their Medicare part D coverage.\n (i) An individual who is determined to be eligible for assistance\nunder this article shall not become ineligible based upon income solely\nbecause of an increase in either a public or private pension or an\nincrease in social security benefits as provided under federal law where\nsuch increase does not exceed the consumer price index (all items United\nStates city average) for such year. This provision shall be limited to\none subsequent calendar year.\n 4. As a condition of eligibility for benefits under this title,\nparticipants must be enrolled in medicare part D and maintain such\nenrollment. For persons who meet the eligibility requirements to\nparticipate in the elderly pharmaceutical insurance coverage program,\nthe program will pay for a drug covered by the person's medicare part D\nplan or a drug in a medicare part D excluded drug class, as defined in\nsubdivision eight of section two hundred forty-one of this title,\nprovided that such drug is a covered drug, as defined in subdivision one\nof section two hundred forty-one of this title, and that the participant\ncomplies with the point of sale co-payment requirements set forth in\nsections two hundred forty-seven and two hundred forty-eight of this\ntitle. No payment shall be made for medicare part D plan deductibles.\n