SB 88 — ELDERLY-DISABLD-PROP TAX-DRUGS

*LRB09603141DRJ13158b* SB0088 96THEngrossed GENERALLRB096 ASSEMBLY03141 StateDRJ of13158 Illinoisb andAN 2010ACT SB0088concerning Introducedaging. 1/30/2009, by Sen.

Gary G.

Dahl SYNOPSIS AS INTRODUCED:

ILCS 25/4 from Ch.

67 1/2, par.

404 Amends the Senior Citizens and Disabled Persons Property Tax Relief and Pharmaceutical Assistance Act.

Provides that if a person files a claim the claim form that (i) he or she is a surviving spouse and (ii) his or her marital status is "single", then only his or her individual income for the applicable year shall be counted in determining his or her eligibility for a grant or pharmaceutical assistance.

Effective immediately.

LRB096 03141 DRJ 13158 b FISCAL NOTE ACT MAY APPLY A BILL FOR SB0088 LRB096 03141 DRJ 13158 b AN ACT concerning aging.

With SB0088 Engrossed - 2 - LRB096 03141 DRJ 13158 b respect to claims filed by individuals who will become 65 years old during the calendar year in which a claim is filed, the amount of any grant to which that household is entitled shall be an amount equal to 1/12 of the amount to which the claimant would otherwise be entitled as provided in this Section, multiplied by the number of months in which the claimant was 65 in the calendar year in which the claim is filed.

or (C) less than $36,740 for a household containing 3 SB0088 Engrossed - 3 - LRB096 03141 DRJ 13158 b or more persons.

IfFor grant year 2010 and each grant year thereafter, if a person files a claim for a grant under this Act and represents on the claim form that (i) he or she is a surviving spouse and (ii) his or her marital status is "single", then only his or her individual income for the applicable year shall be counted in determining his or her eligibility for a grant.

If household income in one or more months during a year includes cash assistance in excess of $55 per month from the Department of Healthcare and Family Services or the Department of Human Services (acting as successor to the Department of Public Aid under the Department of Human Services Act) which was determined under regulations of that Department on a measure of need that included an allowance for actual rent or property taxes paid by the SB0088 Engrossed - 4 - LRB096 03141 DRJ 13158 b recipient of that assistance, the amount of grant to which that SB0088 - 4 - LRB096 03141 DRJ 13158 b household is entitled, except as otherwise provided in subsection (a), shall be the product of (1) the maximum amount computed as specified in subsection (b) of this Section and (2) the ratio of the number of months in which household income did not include such cash assistance over $55 to the number twelve.

and, in the case of rent constituting property taxes accrued, shall SB0088 Engrossed - 5 - LRB096 03141 DRJ 13158 b the case of rent constituting property taxes accrued, shall prorate each month's rent payments to the residence actually occupied during that month.

(1) be (i) 65 years of age or older, or (ii) the surviving spouse of such a claimant, who at the time of death received or was entitled to receive benefits pursuant to this subsection, which surviving spouse will become 65 years of age within the 24 months immediately following the death of such claimant and which surviving spouse but for his or her age is otherwise qualified to receive benefits pursuant to this subsection, or (iii) disabled, and (2) be domiciled in this State at the time he or she files his or her claim, and (3) have a maximum household income of less than the income SB0088 Engrossed - 6 - LRB096 03141 DRJ 13158 b eligibility limitation, as defined in subsection (a-5).

In SB0088 - 6 - LRB096 03141 DRJ 13158 b addition, each eligible person must (1) obtain an identification card from the Department, (2) at the time the card is obtained, sign a statement assigning to the State of Illinois benefits which may be otherwise claimed under any private insurance plans, and (3) present the identification card to the dispensing pharmacist.

Whenever a generic equivalent for a covered prescription drug is available, the Department shall reimburse only for the reasonable costs of the generic equivalent, less the co-pay established in this Section, unless (i) the covered prescription drug contains one or more ingredients defined as a SB0088 Engrossed - 7 - LRB096 03141 DRJ 13158 b narrow therapeutic index drug at 21 CFR 320.33, (ii) the SB0088 - 7 - LRB096 03141 DRJ 13158 b prescriber indicates on the face of the prescription "brand medically necessary", and (iii) the prescriber specifies that a substitution is not permitted.

In the event that 2 or more persons are eligible for any benefit under this Act, and are members of the same household, SB0088 Engrossed - 8 - LRB096 03141 DRJ 13158 b (1) each such person shall be entitled to participate in the SB0088 - 8 - LRB096 03141 DRJ 13158 b pharmaceutical assistance program, provided that he or she meets all other requirements imposed by this subsection and (2) each participating household member contributes the fee required for that person by the preceding paragraph for the purpose of obtaining an identification card.

and SB0088 Engrossed - 9 - LRB096 03141 DRJ 13158 b and (2) be domiciled in this State;

IfFor grant year 2010 and each grant year thereafter, if a person files a claim for pharmaceutical assistance and represents on the claim form that (i) he or she is a surviving spouse and (ii) his or her marital status is "single", then only his or her individual income for the applicable year shall be counted in determining his or her eligibility for assistance.

All individuals enrolled as of December 31, 2005, in the pharmaceutical assistance program operated pursuant to subsection (f) of this Section and all individuals enrolled as of December 31, 2005, in the SeniorCare Medicaid waiver program operated pursuant to Section 5-5.12a of the Illinois Public Aid SB0088 Engrossed - 10 - LRB096 03141 DRJ 13158 b Code shall be automatically enrolled in the program established by this subsection for the first year of operation without the SB0088 - 10 - LRB096 03141 DRJ 13158 b need for further application, except that they must apply for Medicare Part D and the Low Income Subsidy under Medicare Part D.

or (iii) age 65 or older, with incomes at or below 200% of the Federal Poverty Level and not eligible for SB0088 Engrossed - 11 - LRB096 03141 DRJ 13158 b federally funded means-tested benefits due to immigration status.

SB0088 - 11 - LRB096 03141 DRJ 13158 b (B) Eligibility Group 2 shall consist of beneficiaries otherwise described in Eligibility Group 1 but who are eligible for Medicare Part D coverage.

(E) On and after January 1, 2007, Eligibility Group 5 shall consist of beneficiaries who are otherwise described SB0088 Engrossed - 12 - LRB096 03141 DRJ 13158 b in Eligibility Groups 2 and 3 who have a diagnosis of HIV or AIDS.

SB0088 - 12 - LRB096 03141 DRJ 13158 b The program established under this subsection shall cover the cost of covered prescription drugs in excess of the beneficiary cost-sharing amounts set forth in this paragraph that are not covered by Medicare.

If the drug is included in the formulary of the Illinois AIDS Drug Assistance Program, individuals in Eligibility Group 5 shall continue to pay the SB0088 Engrossed - 13 - LRB096 03141 DRJ 13158 b co-payments set forth in this paragraph after the program established under this subsection and Medicare combined have SB0088 - 13 - LRB096 03141 DRJ 13158 b paid $1,750 in a year for covered prescription drugs.

(8) any prescription drug used in the treatment of lung disease SB0088 Engrossed - 14 - LRB096 03141 DRJ 13158 b and smoking-related illnesses;

and (10) any SB0088 - 14 - LRB096 03141 DRJ 13158 b prescription drug used in the treatment of multiple sclerosis.

and (2) those drugs included in the formulary of the Illinois AIDS SB0088 Engrossed - 15 - LRB096 03141 DRJ 13158 b Drug Assistance Program operated by the Illinois Department of Public Health that are also covered by the SB0088 - 15 - LRB096 03141 DRJ 13158 b Medicare Part D Prescription Drug Plan in which the beneficiary is enrolled.

A pharmacy may not charge a SB0088 Engrossed - 16 - LRB096 03141 DRJ 13158 b Medicare-enrolled beneficiary of the program established under this subsection more for a covered prescription drug than the SB0088 - 16 - LRB096 03141 DRJ 13158 b appropriate Medicare cost-sharing less any payment from or on behalf of the Department of Healthcare and Family Services.