M E M O R A N D U M

IM-17  02/14/02  MEDICAID / MC+ COST SHARING


SUBJECT:
MEDICAID / MC+ COST SHARING
 
DISCUSSION:
Custodial parents converted to Medical Assistance for Families (MAF) eligibility effective January 1, 2002 were notified co-payments for services were no longer required.  The $10 provider visit co-pay for provider visits and $5 prescription co-pay are no longer required.  However, they are still responsible for pharmacy dispensing fees and other cost sharing requirements that apply to adult Medicaid/MC+ recipients.

Pharmacy dispensing fees apply to adult (age 19 and over) MC+/Medicaid recipients whether they are fee-for-service or enrolled with a health plan in managed care.  The dispensing fee can range from $.50 - $2.00 depending on the cost of the drug. 

Other cost-sharing requirements apply to adults (age 18 and over) Medicaid/MC+ recipients who are fee-for-service.  They do not apply to those MC+ recipients enrolled in a managed care plan. 

Other services that may require cost sharing are:

  • Eye care and glasses;
  • Hearing aids and testing;
  • Podiatry;
  • Dental;
  • Each hospital stay;
  • Hospital and doctor services in an outpatient clinic or emergency room.
There is no cost sharing for healthcare if the recipient is:
  • In foster care;
  • A Hospice recipient; or
  • In a nursing facility, state mental hospital, or a residential care facility.
There is no cost sharing amount if the health care is for:
  • An emergency;
  • Family planning;
  • Dialysis, radiation, physical therapy, chemotherapy, or counseling;
  • Pregnancy; or
  • Entering a hospital for an emergency or transferring to a new hospital.
Providers will advise the recipient if they need to pay any cost sharing when services are received.  Inquiries about services and fees should be referred to Recipient Services at 1-800-392-2161.
 
NECESSARY ACTION:
  • Review this memorandum with appropriate staff.
CSW
Distribution # 6
IM-16
[ 2002 Memorandums ]
 IM-18