§ 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.

(i) An individual who is determined to be eligible for assistance
under this article shall not become ineligible based upon income solely
because of an increase in either a public or private pension or an
increase in social security benefits as provided under federal law where
such increase does not exceed the consumer price index (all items United
States city average) for such year. This provision shall be limited to
one subsequent calendar year.

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.