CMS rejects California Medicaid co-pays

Federal health officials on Feb. 6 denied a request by California to charge a variety of copayments to most of its Medicaid enrollees.

The co-pays would have ranged from $3 for prescriptions filled at pharmacies to $100 for in-patient hospital stays. The say expected the co-pays to generate $600 billion beginning in October 2013, stated Norman Williams, spokesman for the California Dept. of Health Care Services, the state’s Medicaid agency.

But the say can’t implement the co-pays under a demonstration waiver, as it requested in December 2011, according to a letter from Centers for Medicare and Medicaid Services acting Administrator Marilyn Tavenner to California’s Medicaid agency. The co-pays are neither temporary nor targeted at a specific population, both of which are requirements in federal Medicaid law.

California is analyzing its options, including administratively appealing the federal decision, Williams said.

California Medical Assn. President James T. Hay, MD, applauded CMS’ decision. The co-pays would have unfairly burdened physicians, who are required by federal law and their own code of ethics to see patients in emergency departments regardless of their capability to pay, he said.

“These copayments would for all intents and purposes be uncollectable and would have made it even harder for [Medicaid] patients to gain access to the care and medication they need,” he said.

This is the second significant provision of the state’s budget that recently has been declared incompatible with existing law. A U.S. district court on Jan. 31 issued an injunction against a 10% Medicaid doctor fee cut that also was included in the state’s budget.

Many says charge co-pays for services provided to parents in Medicaid, according to a 50-state survey released in January by the Kaiser Family Foundation. For example, parents in Medicaid are subject to co-pays for nonemergency visits to emergency departments in 17 states. However, all but two of these says charge less than $10.

Parents in Medicaid face similar small co-pays for nonpreventive doctor visits in 23 says and for prescriptions in at least 39 states, according to the Kaiser report. Twenty-five says charge co-pays for in-patient hospital visits, ranging from 50 cents in Wisconsin to $220 in Utah.

Copyright 2012 American Medical Association. All rights reserved.

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Submited at Thursday, February 16th, 2012 at 11:00 pm on Uncategorized by jessica
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