| This memorandum is being issued to clarify
a Medicaid recipient's responsibility for cost-sharing and copay amounts
for prescriptions and other Medicaid services. The requirements for
General Relief (GR) recipients are the same as those for all adult Medicaid
recipients. While a provider is required to charge the cost-sharing
and copay amounts, a provider may not deny or reduce services solely on
the basis of the recipients inability to pay at the time the service is
received.
This policy is in the Missouri
Medicaid Provider manual, which is furnished to each provider of Missouri
Medicaid services and can also be found on the Department of Social Services
website. The provider manual states in part:
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Recipients eligible to receive certain Missouri
Medicaid services are required to pay a small portion of the cost of the
services. This amount is referred to as cost sharing or copay.
The cost sharing or copay amount is paid by the recipient at the time services
are rendered. The provider must accept in full the amounts
paid by the state agency plus any cost sharing or copay amount required
of the recipient.
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Providers of service must charge and collect
the cost sharing and copay amount. Providers of service may not
deny or reduce services to persons otherwise eligible for benefits soley
on the basis of the recipient's inability to pay the fee when charged.
A recipient's inability to pay a required amount, as due and charged when
a service is delivered, shall in no way extinguish the recipient's liability
to pay the amount due.
As a basis for determining whether an individual
is able to pay the charge, the provider is permitted to accept, in the
absence of evidence to the contrary, the recipient's statement of inability
to pay at the time the charge is imposed. |