Coronavirus copay conundrum: State Medicaid programs can waive copayments but CMS doesn’t make it easy

Ilene MacDonald, Editorial Director | March 16, 2020

New Medicaid guidance reveals what states must do in response to the coronavirus outbreak.

The Centers for Medicare & Medicaid Services recently released answers to frequently asked questions about COVID-19 for state Medicaid and Children’s Health Insurance Program (CHIP) Agencies. 

The 11-page document explains what resources are available to assist states and territories in their response to the outbreak, as well as flexibilities for benefits, prior authorization, telehealth, prescription refills, and financial considerations.  

“We are especially mindful of our beneficiaries with underlying health conditions that make them more vulnerable. CMS is doing everything in its power to help states eliminate any barriers or delays in their care,” CMS Administrator Seema Verma said in an announcement.  

The guidance is the first set of FAQs to address questions and concerns raised by state Medicaid and CHIP agencies. Verma said CMS will address and answer more questions as they come in and will add them to the FAQs. 

How to waive copayments  

According to the guidance, states do have authority to waive copayments during a public health emergency. To stop charging copayments for particular items or Medicaid services, such as doctors or inpatient hospital services, the state can submit a state plan amendment (SPA).  

However, states cannot exempt individuals from copayments to only those affected by a particular diagnosis such as COVID-19. Rather, CMS says a copayment exemption under the state plan must apply to everyone who accesses a particular item or services.  

The other way to waive the copayments is to request a time-consuming Section 1115 authority to temporarily suspend copayments only for individuals who need treatment for the COVID-19 infection.  

States can stop charging copayments for particular items or services in CHIP through a CHIP disaster relief SPA.  

Modern Healthcare reports that New Jersey, New York, and Washington have already eliminated Medicaid copayments for COVID-19 testing. Medicaid copays generally range from $1 to $5 and could prevent low-income beneficiaries from getting tested, according to the publication. But some states may hesitate to eliminate the copayments if it means getting rid of co-payments for an entire program.  

https://www.risehealth.org/insights-articles/medicaid/coronavirus-copay-conundrum-state-medicaid-programs-can-waive-copayments-but-cms-doesn-t-make-it-easy/?utm_source=LinkedIn&utm_medium=social&utm_campaign=COVID-19