Health Politics

Health advocates say there are problems with Kentucky’s new Medicaid copays.

On January 1, the state began requiring copays from some enrollees for prescriptions and doctor visits. Enrollees making under 100 percent of the federal poverty limit are supposed to be exempt from the new rule. But during a regulatory meeting in Frankfort Monday, advocates said that some Medicaid recipients who should be exempt from the rule are being denied prescriptions and health services because they cannot pay.

Miranda Brown is the outreach coordinator at the Kentucky Equal Justice Center and helps people enroll in Medicaid. Brown said the new rule is confusing to providers. She said some enrollees who should be exempt are being told they have a copay.

“A Medicaid member was referred to me earlier this month in February. He’d been going without his Invega injection for two months,” Brown said.

“He was very anxious, he kept repeating his problem over and over. It turns out that Invega is an anti-psychotic and he needed it to help manage his bipolar [disorder]. And his pharmacy was trying to charge him $3 for the shot and he couldn’t pay.”

Bill Collins is a dentist from eastern Kentucky. Collins submitted written comments that were read at Monday’s hearing. Collins wrote that his office isn’t asking for copays from Medicaid patients because the system that tells doctors if a patient has a copay isn’t working. He said it would cost more money if his office incorrectly charged a patient and then had to refund the money. 

“Some of my peers have collected and then had to reimburse the patient,” Collins wrote. “This is not a simple task. Bookkeeping is initiated and costs are then on the provider. The $3 copay becomes a $5 to $10 return.”

Emily Beauregard, executive director of Kentucky Voices for Health, said there wasn’t enough training for providers before the new rule went into effect in January. She said the rollout has been confusing.

“It’s important to understand that in practice sometimes the safeguards that we write into policies aren’t always adhered to in practice,” Beauregard said. “And providers might not understand them, or their staff might not be aware or trained properly.”

While a basic outpatient doctor visit costs $3 for a person with Medicaid, other visits cost more. A visit to the emergency room for what the state deems a non-emergency costs $8; being admitted to the hospital or to an inpatient substance abuse/mental health facility costs $50.

Medicaid copays are part of sweeping state reforms approved by the federal government and are scheduled to be implemented in April. But Kentucky did not need approval from the federal government to require copays from Medicaid recipients.

The copays don’t apply to people who are pregnant, to children, or people in hospice. The state has until mid-March to respond to concerns about the copay regulation.

Lisa Gillespie is WFPL's Health and Innovation Reporter.