College of Human Environmental Science,
Department of Consumer and Family Economics,
University of Missouri Extension

Co-Payment Requirements

Consumers of Medicaid will now have required co-payments on almost all covered services and prescription drugs. These co-payments range from $0.50 to $3.00 per service. (Blind people, pregnant women and children are exempt from the co-payments.) Some services that will be subject to mandatory co-payments are:

All physician visits (not just those provided in an outpatient or hospital setting) including emergency room visits

• Inpatient hospital services
• Podiatry services
• Ambulatory surgical care
• Certified nurse practitioner services
• Lab tests and x-rays
• Non-emergency medical transportation
• Clinic services including services provided by federally qualified health centers and rural health centers.

Co-payments are not required for the following services, but they may be subject to co-payments:

• Dental services
• Drugs and medicines
• Optometric services
• Eye glasses
• Dentures
• Hearing aids
• Other services

Exemptions to Co-Payment Requirements

Co-payment requirements do not apply to:

• Recipients under 19 years of age
• Managed care enrollees
• People receiving Medicaid under a category of assistance for pregnant women or the blind
• Services to residents of a skilled nursing facility; intermediate care nursing home; residential care home; adult boarding home or psychiatric hospital
• Services to people who have both Medicare and Medicaid if Medicaid covers the service and provides payment
• Emergency or transfer inpatient hospital admissions
• Emergency services provided in a hospital outpatient clinic or emergency room to treat a life threatening condition
• Certain therapy services (physical therapy, chemotherapy, radiation therapy, psychotherapy, and chronic renal dialysis), except when provided as an inpatient hospital service
• Family planning services
• Services provided to pregnant women, directly related to the pregnancy or complications of the pregnancy
• Foster care recipients
• In-home/personal care services
• Hospice services
• Medically necessary services identified through an Early Periodic Screening, Diagnosis and Treatment screen (EPSDT)
• Mental health services
• Medicaid Waiver services

Under the new legislation, providers cannot refuse treatment to a patient due to inability to pay; however, the provider can deny “future services” if there is an outstanding debt from the unpaid co-payments (as long as this policy follows the provider’s normal business practice).