STATE NEWS- Copays no longer required for Mississippians on Medicaid


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[MM Curator Summary]: The state is dropping copays. Well for members anyway. Docs will get the copays from the state moving forward.


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Mississippians who are insured by Medicaid no longer have to make copayments for health care services, the state’s Division of Medicaid announced.

The policy change, which went into effect May 1, includes copays for prescription medications as well as hospital and doctor’s office visits.

The Medicaid division will keep paying providers for their services, including copays — the only change is that beneficiaries will no longer be responsible, according to communications officer Matt Westerfield.

Copays are a form of cost sharing in health insurance plans. Insurance companies pay a portion of the bill, while the patient is responsible for a certain out-of-pocket amount. 

Harold Miller, CEO of the Center for Healthcare Quality and Payment Reform, said copayments in Medicaid create problems for both policyholders and providers. 


Copays can discourage people from getting the care they need because they cannot afford it, which can snowball into a worse, even more expensive health care issue, “which means the Medicaid program would end up paying more overall,” Miller said. 

“For example, if an asthmatic child doesn’t get an inhaler because their parents can’t afford the copayment, they could end up in the hospital,” he said. “Sometimes people stretch out medications to reduce the number of refills, and that can cause problems.”

And then providers have to try and collect the copays.

“If the person can’t afford the copayment and the provider sees the patient anyway, the provider just gets paid less, and that can discourage physicians from taking on Medicaid patients,” Miller said. “In theory, the copayment discourages people from getting services they don’t need, but on balance, the problems they create by discouraging necessary care likely outweigh the advantages.”

In a month, Medicaid plans to submit a state plan amendment in pursuit of the change to the Centers for Medicare and Medicaid, which is required when a state plans to revise its policies. If approved, it will be retroactively effective to May 1. The amendment will be posted on the Medicaid agency’s website upon its submission. 

“We are always looking for opportunities to increase access to services while reducing administrative burdens on members and providers,” Westerfield said.


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