When the state recently mandated the collection of copays from certain Medicaid recipients, some providers worried about how their cash-strapped patients would be able to afford the charges.
“Obviously, people who live on an income that is that restricted have a difficult time paying for their rent, paying for their groceries, paying for their utilities,” said Ramona Johnson, president and chief executive of Bridgehaven Mental Health Services. “They don’t have extra income to pay copays.”
Johnson said she is tickled pink that the state has decided to, for now, drop these copays, which had been a source of confusion in recent weeks.
In a July 27 news release, the state Cabinet for Health and Family Services announced that “it has come to our attention that there has been inconsistent implementation of copays among MCOs,” which refers to managed care organizations such as Passport Health. “This has highlighted a need to suspend mandatory collection of copays.”
It’s unclear how long the suspension will be in effect, but the release says the state “will revisit how best to implement copays in the near future.”
Medicaid has been the focus of a lot of turmoil in recent weeks. The state cut some services, such as routine dental care for Medicaid expansion adults, and then announced that it would restore the coverage.
That occurred in the wake of a federal judge deciding to kick the state’s Section 1115 Medicaid waiver, also known as the Kentucky HEALTH program, back to the U.S. Department of Health and Human Service for further review. The ruling prevented the program from going into effect July 1.
“While the change to copayments was separate from Kentucky HEALTH, Kentucky HEALTH had two cost-sharing categories – a premium plan, and a copay plan” for people under 100 percent of the federal poverty level, the Cabinet’s news release notes. “The June 29th court ruling removed the premium category, which caused all members to fall into a copay plan, and not all MCOs were prepared to implement this change in the same manner.”
So “as of Thursday, we notified the MCOs that we were suspending enforcement of copayments, and as of Friday, we are withdrawing the regulation requiring mandatory collection of copayments,” according to the release from last week.
In the past, copays could be waived, but that was to change July 1, causing confusion because “we did not get instructions or much guidance at all, if any, on how to collect the copays,” Johnson said. “Everybody felt like they were operating in the dark; I think most providers felt that way.”
The new charge was a surprise to consumers, said Melissa Noyes Mather, a spokeswoman for the Family Health Centers, which had begun collecting copays for prescriptions but was awaiting guidance on assessing copays for other services.
Instead of paying what they were used to paying, patients were suddenly having to come up with a much different amount, Mather said.
“In talking with our staff, they said somewhere between $5 and $30 was kind of what they were seeing on the increase for patients who normally may have only paid a few dollars or nothing at all,” she said.
One of Bridgehaven’s concerns was patients being asked to pay copays for individual services in the same day or week.
“It was a situation that would be an extreme burden for consumers,” Johnson said.
For example, a person coming to Bridgehaven on a given day might receive three services, such as an individual therapy session, a group therapy session and a peer support service, so their copay would $9 for one day, or $27 if they came three days a week, she noted.
Beyond that, the person might need medical treatment. “They also might not be able to afford copays for their medications, which of course are essential to help them stay stable and to reach recovery,” she said.
At Family Health Services, Mather recalled a patient who typically paid $8 a month for her medication being surprised to find that she now owed $36 because of copays.
“Now you’ve got to figure out where to get (an additional) $28 every month,” Mather said. “… When you’re living at or below poverty, that’s a significant burden.”
The state’s news release notes that “providers who collect copays for fee-for-service Medicaid services should continue to collect copays in the same manner they have collected them to-date.” Cabinet spokesman Doug Hogan said the fee-for-service group includes anyone in Medicaid who is not a member of an MCO, such as a long-term care resident.
This story has been updated to include an explanation from the state about the fee for service and to correct the date of the July 27 press release.