New Federal Rule Allows States To Charge Medicaid Beneficiaries Premiums, Higher Copayments

From the Kaiser Family Foundation:

"A new federal rule allows states to charge Medicaid beneficiaries premiums and higher copayments for physicians' services, hospital care and prescriptions drugs, the New York Times reports. The rule, which was published on Tuesday in the Federal Register, implements a law (S 1932) signed by President Bush in 2006.

The rule allows states to implement a sliding scale for premiums and copays, the total of which cannot exceed 5% of a family's income. Under the new rule, states in certain cases can deny care or coverage to Medicaid beneficiaries who do not pay their premiums or their portion of the costs for particular items or services. For Medicaid beneficiaries with incomes at or below the federal poverty level, states can require copays of up to $3.40 for a physician visit or other services. That $3.40 maximum will be updated each year in accordance with medical inflation. For Medicaid beneficiaries with incomes between 100% and 150% of the poverty level, states can require beneficiaries to contribute up to 10% of what the state pays for a service. States can require beneficiaries with incomes above those levels to contribute up to 20% of what states pay for a service. The new rule allows states to use copays to encourage the use of preferred brand-name drugs and to discourage the use of emergency departments for primary care."

Full story: http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=55798