Assemblywoman Clark: SFY 2012-13 Budget Restores Critical Funding to EPIC and Community Based Services for the Elderly

Funds to help elderly buy costly drugs are restored in upcoming state budget
March 30, 2012
A recent budget agreement for SFY 2012-13 has been reached that includes a partial restoration of New York’s Elderly Pharmaceutical Insurance Coverage (EPIC) and funding for community based services for seniors in the community.

“Many of our older residents are living longer and are increasingly more active, it is more important than ever that we have programs and services that help elderly New Yorkers remain independent and live with dignity,” said Assemblywoman Clark. “As in the past, the 2012-13 state budget reflects the Assembly Majority’s commitment to New York’s elderly population,” said Clark.

The budget provides $30.6 million to support the restoration of co-payment assistance that was eliminated on Jan. 1, 2012. This allows EPIC enrollees to pay no more than $20 as a co-pay when filling a prescription. Currently, seniors may have to make co-payments as high as 25 percent of the cost of the drug. “Seniors should not have to worry about being able to afford the medication they need to survive. The new policy will benefit hundreds of seniors in the 33rd Assembly district and more than 285,000 state residents who rely on EPIC,” according to Assemblywoman Clark

The Assembly was also able to restore drug co-payment assistance for the many seniors with very high prescription costs, more than $6,600 per year. These seniors are currently required to pay 5 percent of their drug costs, which can be a burden for individuals on a fixed income. The budget also caps co-payments for these seniors at $20. “EPIC helps low- and moderate-income seniors pay for medication costs that are not covered by Medicare. Seniors will see a savings in the new year when they once again pay between $3 and $20 for each prescription” said Clark.

Naturally Occurring Retirement Communities (NORC) and Neighborhood NORC Programs (NNORC)

NORCs and NNORCs are communities that were not originally built for seniors, but have evolved to have a significant proportion of residents 60 years or older. NORCs and NNORCs offer a broad range of social and health care services to support their residents. The state budget restores $458,000 in funding to the NORC and Neighborhood NORC programs.

Elderly Pharmaceutical Insurance Coverage Co-Payment Assistance (EPIC)

EPIC helps low and moderate income seniors pay for medication costs not covered by Medicare. The state budget restores $30.6 million in funding to EPIC for assistance with Medicare Part D co-payments. Starting in 2013 seniors will once again pay between $3 and $20 for each prescription.

Spousal Refusal

Spousal refusal provides critical support for many of seniors who are struggling with the cost health care. Without spousal refusal an elderly husband or wife would have to spend down their assets and income towards an ill spouse's care until they meet the Medicaid eligibility threshold. By maintaining spousal refusal, a husband or wife can avoid becoming impoverished in order for their spouse to receive the care they need. The state budget restores $34.3 million to maintain the right for spousal refusal in New York State.

Community Based Services

Expanded In-Home Services for the Elderly Program (EISEP) and Community Services for the Elderly Program (CSE) provide non-medical care for the elderly in their homes, including but not limited to: homemaking, housekeeping, chore services, home health services, adult day care, transportation, shopping assistance, and counseling services. The state budget provides $1.135 million for the EISEP and CSE programs to partially mitigate the reallocation of funds based on new Census data.