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UPDATED: JANUARY 2012

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OTHER ELIGIBILITY REQUIREMENTS

CO-PAY

Description: Medicaid and Family Health Plus recipients age 21 or older may be asked to pay part of the cost of some medical care/items. This is called a Co-payment or Co-pay.

Policy: Health care providers may ask for a co-payment for certain services from Medicaid and Family Health Plus recipients age 21 or older. There is a maximum of $200.00 per Medicaid recipient per year for all co-payments. The co-payment year begins on April 1 each year and ends on March 31 of the following year. Once the maximum has been reached, no co-payments will be required until the new benefit year begins. There is no maximum for Family Health Plus recipients. There is no copayment for family planning treatment, services and supplies for individuals enrolled in Medicaid or Family Health Plus. There is no copayment for any treatment, services or supplies for individuals enrolled in an FPBP case. The provider cannot refuse to give medical services or goods because the recipient indicates that s/he is unable to pay the co-payment.

References: SSL Sect.

366

369ee

Dept. Reg.

360-7.12

Chapter 58 Laws of 2005

GISs

05 MA/026

05 MA/006

Interpretation: A Medicaid or Family Health Plus recipient age 21 or older may be asked to pay part of the cost of some medical care/items as identified below. Recipients in Managed Care plans are only required to pay prescription drug co-payments. The amounts for each are identified in REFERENCE CO-PAYMENT. (MRG)