Some Medicaid recipients will be charged copays for various medical services next year. | file art

More than 25 groups have signed a letter asking state officials to reconsider putting Medicaid copays in place for various services starting Jan. 1.

The Dec. 11 letter to Kentucky Medicaid Commissioner Carol Steckel argues that the copays, outlined on the Cabinet for Health and Family Services’ website, could have a negative impact on the health and well-being of Medicaid recipients and may have other negative repercussions.

“We just have a lot of research that shows how copays really limit people’s access to care, especially for the low-income population,” said Jason Dunn, a policy analyst with Kentucky Voices for Health, which signed the letter.

Also, he said, “the more they access services and the more copays they pay, that takes money away from other necessities like housing, utilities and food.”

The letter is signed by a wide range of groups, such as the American Heart Association, the Community Farm Alliance, the Kentucky Council of Churches and various health care providers, including the Shawnee Christian Healthcare Center and the Park DuValle Community Health Center.

“Having worked hand-in-hand with state agencies, providers, application assisters, legal aid programs, and others across the Commonwealth to get Kentucky covered, we have found that even modest financial barriers can mean the difference between having access to healthcare or going without,” the letter states.

Jason Dunn | Courtesy of Kentucky Voices for Health

Dunn elaborated about the potential impact on patients in an interview, saying: “If they think there’s a payment they can’t make, they may forgo care, or maybe they just don’t want to go to a provider and have a provider say, ‘OK, pay your copay,’ and then you have to say, ‘I don’t have the money.’ ”

Copays are fees that are charged at the time of service and are generally less than $10. Medical providers cannot refuse to see patients who are at or below the federal poverty level.

The fees will not apply for some things, including preventive services, such as check-ups and screenings, according to the state website. But nonexempt patients will have to pay for certain other office visits, specialty visits, physical therapy and X-rays. There’s also a charge for some hospital visits, including an $8 copay for going to the emergency room for a non-emergency service and $50 for inpatient services.

People who may be exempt include foster children, children enrolled in Medicaid, individuals receiving hospice care, pregnant women, and people who have reached their cost-share limit for the quarter, according to the website.

In the past, managed care organizations, such as Passport Health Plan, have been able to choose whether to charge co-pays. But under the new plan, eligible people will be required to pay copays, at least until the state’s Medicaid overhaul goes into effect next spring. Under that Section 1115 waiver, also known as the Kentucky HEALTH program, people would pay premiums or copays but not both, the state said at a recent forum.

The Dec. 11 letter notes that the Kaiser Family Foundation synthesized the results of numerous studies and found that premiums often create a barrier to coverage and that even modest copays create barriers to access to necessary health services for low-income populations.

“In short, the more vulnerable the population, the more harms faced by the required imposition of copayments,” the letter states. “This means people with disabling conditions, newly-arrived refugees, homeless individuals, and survivors of domestic and interpersonal violence attempting to make a new life, will be hit the hardest.”

The letter also says that state copay requirements have led to decreased prescription medication adherence in states like Mississippi.

The Cabinet had not responded to the letter as of Wednesday morning, according to Dunn. It also has not responded to an Insider Louisville request for comment.

The Community Farm Alliance, a statewide organization based in Berea, Ky., is among those hoping the state will have a change of heart on the copay issue.

“Access to affordable health care has always been a farm issue, and it is a priority for Community Farm Alliance members,” said Kelsey Voit, organizing director, via email.  “… Farming is a dangerous occupation, and with affordable healthcare, farmers have that important safety net to operate their small businesses and take care of their families. Mandatory copayments can create barriers to coverage.”

Darla Carter
Darla Carter is a hometown girl who recently joined the staff of Insider Louisville to mostly cover health. She previously served as a longtime health and fitness writer for The Courier-Journal, where she also worked for the Metro, Neighborhoods and Features departments. Prior to that, the award-winning journalist wrote for newspapers elsewhere in Kentucky and Tennessee, covering a range of topics, from education to courts. She's a graduate of Western Kentucky University, where she studied journalism and philosophy, and is the proud mom of two young children.