These services now require copays from Medicaid beneficiaries in Kentucky

Medicaid beneficiaries in Kentucky are now being charged copays for doctor visits and other services because of a new policy that took effect at the start of this year.

The policy, which began on Tuesday, requires a $3 copay for an office visit with a physician, physician’s assistant, advanced registered nurse practitioner, certified pediatric and family nurse practitioner, nurse midwife, or any behavioral health professional, according to the Kentucky Cabinet for Health and Family Services.

Other services for Medicaid beneficiaries that require a $3 copay include:

— Services from a chiropractor, dentist, optometrist or podiatrist.
— Physical, speech and occupational therapies.
— Laboratory, diagnostic or X-ray service.

When it comes to prescriptions, generic drugs carry a $1 copay, as do brand name drugs that are preferred over their generic equivalents. All other brand name drugs come with a $4 copay.

Additional services that come with copays include:

–Durable medical equipment: $4 copay.
— Outpatient hospital service: $4 copay.
— Outpatient surgery: $4 copay.
— Emergency room visit for a non-emergency service: $8 copay.
— Inpatient services, such as a hospital admission or a mental health or substance abuse admission: $50 copay.

What if I can’t afford the copay?

Under the new policy, providers cannot refuse services to Medicaid beneficiaries whose income is at or below 100 percent of the federal poverty level. But, if a beneficiary whose income is over the threshold does not pay the copay, it’s up to the provider to decide if services will be granted. Pregnant women and children cannot be refused services — no matter what.


Services exempt from copays include emergency services; preventative services such as screenings, checkups and patient counseling; and some family family services.

Certain Medicaid beneficiaries are exempt from being charged copays as well. They include children, pregnant women — for whom exemption lasts until 60 days after pregnancy ends — hospice care patients, and those who have reached their cost-sharing limit for the quarter.

Additional information 

For more information on the new policy, visit the Cabinet for Health and Family Services website. For frequently asked questions and a full list of services affected, click here.

You can find out more information about this story and others by following Chris Yu on Facebook and Twitter.

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