§ 42-66.2-5 - Persons eligible.
SECTION 42-66.2-5
§ 42-66.2-5 Persons eligible. – (a) Persons eligible for assistance under the provisions of this chapterinclude any resident of the state who is at least sixty-five (65) years of ageor at least fifty-five (55) years of age and receiving social securitydisability benefits. State and consumer co-payment shares for these personsshall be determined as follows:
(1) For unmarried persons or married persons living separateand apart whose income for the calendar year immediately preceding the year inwhich assistance is sought is:
(i) Less than nineteen thousand three hundred forty-onedollars ($19,341) the state shall pay sixty percent (60%) of the cost of theprescriptions and the consumer shall pay forty percent (40%) of the cost of theprescriptions.
(ii) More than nineteen thousand three hundred forty-onedollars ($19,341) and less than, twenty-four thousand two hundred and eightydollars ($24,280) the state shall pay thirty percent (30%) of the cost of theprescriptions and the consumer shall pay seventy percent (70%) of the cost ofthe prescriptions; and
(iii) More than twenty-four thousand two hundred and eightydollars ($24,280) and less than forty-two thousand four hundred andninety-three dollars ($42,493), the state shall pay fifteen percent (15%) ofthe cost of prescriptions and the consumer shall pay eighty-five percent (85%)of the cost of prescriptions.
(2) For married persons whose income for the calendar yearimmediately preceding the year in which assistance is sought hereunder whencombined with any income of the person's spouse in the same year is:
(i) Twenty-four thousand one hundred and seventy-nine dollars($24,179) or less, the state shall pay sixty percent (60%) of the cost of theprescriptions and the consumer shall pay forty percent (40%) of the cost of theprescriptions;
(ii) More than twenty-four thousand one hundred andseventy-nine dollars ($24,179) and less than thirty thousand three hundred andfifty-two dollars ($30,352), the state shall pay thirty percent (30%) of thecost of the prescriptions and the consumer shall pay seventy percent (70%) ofthe cost of prescriptions; and
(iii) More than thirty thousand three hundred and fifty-twodollars ($30,352) and less than forty-eight thousand five hundred andsixty-three dollars ($48,563), the state shall pay fifteen percent (15%) of thecost of prescriptions and the consumer shall pay eighty-five percent (85%) ofthe cost of prescriptions.
(3) Eligibility may also be determined by using income datafor the ninety (90) days prior to application for benefits and projecting thatincome on an annual basis. The income levels shall not include those sums ofmoney expended for medical and pharmaceutical that exceed three percent (3%) ofthe applicant's annual income or three percent (3%) of the applicant'spreceding ninety (90) day income computed on an annual basis.
(4) For persons on social security disability benefits whoare: (i) unmarried or married and living separate and apart with income for thecalendar year immediately preceding the year in which assistance is sought thatis less than forty-two thousand four hundred and ninety-three dollars($42,493); or (ii) married with income that is less than forty-eight thousandfive hundred and sixty-three dollars ($48,563) the state shall pay fifteenpercent (15%) of the cost of prescriptions and the consumer shall payeighty-five percent (85%) of the cost.
(b) On July 1 of each year, the maximum amount of allowableincome for both unmarried and married residents set forth in subsection (a)shall be increased by a percentage equal to the percentage of the cost ofliving adjustment provided for social security recipients.
(c) No person whose prescription drug expenses are paid orreimbursable, either in whole or in part, by any other plan of assistance orinsurance is eligible for assistance under this section, until the person'sprescription drug coverage for a specific covered prescription medication isexhausted or the specific prescription medication is not covered by the planduring a benefit year, and as provided in subsection (d).
(d) The fact that some of a person's prescription drugexpenses are paid or reimbursable under the provisions of the federal Medicareprogram shall not disqualify that person, if he or she is otherwise eligible,to receive assistance under this chapter. In those cases, the state shall paythe eligible percentage of the cost of those prescriptions for qualified drugsfor which no payment or reimbursement is made by the federal government.
(e) Eligibility for receipt of any other benefit under anyother provisions of the Rhode Island general laws as a result of eligibilityfor the pharmaceutical assistance program authorized under this section shallbe limited to those persons whose income qualify them for a sixty percent (60%)state co-payment share of the cost of prescriptions.
(f) For all additional drugs, the consumer shall pay onehundred percent (100%) of the cost of prescriptions as set forth in §42-66.2-4.
(g) To promote coordination of benefits between thepharmaceutical assistance program created under this chapter and the MedicarePart D prescription drug program created in the federal Medicare PrescriptionDrug, Improvement and Modernization Act of 2003, RIPAE enrollees must apply forand enroll in the Medicare Part D prescription drug program.