For certain Medicaid services, the recipient is responsible for a set copayment or coinsurance that is to be paid directly to the provider
Copayment
A copayment is a predetermined amount of money, specified by Medicaid, that the recipient pays to a provider.
Coinsurance
A coinsurance is a percent of the Medicaid payment that the recipient pays to provider.
Medicare Crossovers
A dually-eligible Medicare and Medicaid recipient is required to pay Medicaid copayments and coinsurance, unless the recipient is otherwise exempt. The Medicaid copayment and coinsurance applies to services that will be billed first to Medicare and then crossover to Medicaid for payment of the Medicare deductibles and coinsurances.
SERVICES WITH COPAYMENTS FEES
• Each inpatient admission to a hospital $3.00
• Elective or scheduled admissions to the hospital outpatient
department or clinic visit, per day. (See below for the
coinsurance for emergency room services.) $3.00
• Rural health clinic or federally qualified health center visit, per
clinic, per day $3.00
• Physician services, per provider or group provider, per day $2.00
• Podiatrist services, per provider or group provider, per day $2.00
• Optometrist services, per provider or group provider, per day $2.00
• Nurse practitioner services, per provider or group provider, per day $2.00
• Registered Nurse First Assistant, per provider or group provider, per day $2.00
• Physician assistant services, per provider or group provider,per day $2.00
• Community mental health services, per provider, per day $2.00
• Home health services, per provider, per day $2.00
• Chiropractor services, per provider or group provider, per day $1.00
• Portable x-ray services, per provider, per day $1.00
• Independent laboratory services, per provider, per day $1.00
• Transportation services, each one-way trip $1.00
