TO: All Providers
RE: Co-Payment Changes for Medicaid Services
Effective for dates of service July 1, 2013, and thereafter, copayments for Medicaid covered services will be based on the federally approved maximum amounts shown below (including Medicare crossovers):
Services with Co-payments |
Co-payment Amounts |
Based on Medicaid’s Allowed Amount for the Services |
Office Visits (including visits to physicians, optometrists, nurse practitioners) |
$1.30 to $3.90 per office visit code |
$50.01 or more - $3.90
$25.01 - $50.00 - $2.60
$10.01 - $25.00 - $1.30 |
Federally Qualified Health Centers (FQHC) |
$3.90 per encounter |
|
Rural Health Clinic (RHC) |
$3.90 per encounter |
|
Inpatient Hospital |
$50.00 per admission |
|
Outpatient Hospital |
$3.90 per visit |
|
Ambulatory Surgical Centers |
$3.90 per visit |
|
Durable Medical Equipment |
$1.30 to $3.90 per item |
$50.01 or more - $3.90
$25.01 - $50.00 - $2.60
$10.01 - $25.00 - $1.30 |
Medical Supplies and Appliances |
$0.65 to $3.90 per item |
$50.01 or more - $3.90
$25.01 - $50.00 - $2.60
$10.01 - $25.00 - $1.30
$10.00 or less - $0.65 |
Prescription Drugs |
$0.65 to $3.90 per prescription |
$50.01 or more - $3.90
$25.01 - $50.00 - $2.60
$10.01 - $25.00 - $1.30
$10.00 or less - $0.65 |
Co-payment does not apply to services provided to/for:
· Pregnant women
· Nursing facility residents
· Recipients less than 18 years of age
· Native American Indians with an active user letter from Indian Health Services (IHS)
· Emergencies
· Family Planning
The provider may not deny services to any eligible Medicaid recipient because of the recipient’s inability to pay the cost-sharing (co-payment) amount imposed.