Medicaid co-payments to begin with New Year

(Plain Press, January 2006) This is the second of a series of articles on changes to health care programs.  This information is being provided by Community Partners for Affordable Accessible Health Care to help those affected understand and cope with the changes.

 Adults on Medicaid may soon find themselves being asked to make a co-payment when they receive certain health care services.  Last year as part of the Ohio state budget, the Ohio General Assembly passed rules stating that, effective Jan. 1, 2006, co-payments would be required for any adult on Medicaid receiving dental or visions services, obtaining non-generic prescriptions and making a non-emergency emergency room visit.

What does this really mean? This change means that, starting January 1, 2006:
- when an adult on Medicaid goes to a dentist or an eye-doctor, the adult will now be asked to pay $3 before being seen.
- when an adult on Medicaid is prescribed medication and either there is not a generic form or the adult does not want the generic form,  he or she will be asked to pay $3 before being  given the prescribed medication.
- when an adult on Medicaid visits the emergency room for what is determined to be a non-emergency, he or she will be asked to pay $3 before treatment is provided. For example, if an adult goes to the emergency room for an earache, the earache  will probably be determined not to be an emergency and the $3 co-payment will be requested.

Remember, this came about because of the last state budget, not the medical providers.  Dentists, eye doctors, pharmacists and hospitals must enforce it. So do not get mad at them, they do not have a choice.

The good news is that the new co-pay only applies to adults, so no child should be asked for a co-payment.  Most importantly, if you do not have or cannot pay the co-payment, you cannot be denied service. This means that the dentist or eye doctor must treat you, the pharmacist must give you your medication and the hospital emergency room must give you the care you need even if you cannot pay the co-payment.

You do still, however, owe them the money for the co-payment. It will be listed as a balance due on the account and the medical provider can send you bills or take collection action.  Further, if you still owe for the co-pays when you return for another visit, they can deny you service at that time because of your open and unpaid back balance.

We do not know how the various providers are going to implement this co-payment policy. Most are no happier than us about this. They do not get to keep the money, the amount of paper work is going to cost than more than they would get, and they are the ones who have to tell the patient about the co-payment.  

Remember, you cannot be refused care if you do not have the co-payment for the service requested.  SIMPLY state that you do not have the money and cannot make this co-pay.  YOU CAN BE REFUSED if you have a back balance owed of previous co-pays.  Practically speaking, we are hoping this will not happen.  If you are refused services for any reason relating to a co-payment, we want to know.  If you are treated rudely because of a co-payment, we want to know.  Matter of fact, we would like to know about any co-payment problem that occurs because of these new rules. You can call Tim at May Dugan (631-5800) or Amy at Merrick House (771-5070).


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