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Lawmakers consider raising health care co-payments for some on Medicaid

Last modified: 12/19/2015 12:34:47 AM
Lawmakers are poised to decide today whether to raise the cost of health care co-payments for a portion of the state’s Medicaid population.

The change would affect people covered by the health care program who make more than 100 percent of the federal poverty limit, roughly $11,700 for a single person, or $24,250 for a family of four.

The proposal calls for most co-payment costs to rise just slightly, but the co-pay for mental health and substance abuse inpatient services would more than double, from $50 to $125.

The Department of Health and Human Services raised co-pays so people eligible for the change maintain “personal responsibility for a portion of the cost of their health care coverage,” and pay for the portion of coverage that isn’t being subsidized by federal funds for 2016, according to a letter written by Commissioner Nick Toumpas to lawmakers. The measure is required to comply with federal rules and align Medicaid programs, said department spokesman Jake Leon in a statement.

The plan needs to be signed off from the Joint Legislative Fiscal Committee, made up of representatives and senators from both parties.

The cost changes would affect roughly one-third of the more than 40,000 residents enrolled in the state’s Medicaid expansion program and 5,500 people on traditional Medicaid, which covers pregnant women, low-income children and people with disabilities.

Co-payments would be capped at a quarterly limit of $147. Most co-pays, including those for primary care visits or rehabilitative occupational therapy, would be less than $10. But co-pays for behavioral health and hospital inpatient services would be $125.

As the state fights a substance abuse crisis, some say raising the costs for low-income people who need treatment isn’t a step in the right direction.

“I strongly oppose asking very low-income people and families to somehow pay even more money for basic health care, including needed substance abuse treatment,” said Concord Sen. Dan Feltes, a Democrat who is not on the committee. “It’s not only unfair, it’s impractical, as it will increase uncompensated care, which is a hidden tax on everyone.”

But others disagree and say the co-pays are not unreasonable, including those for substance abuse treatment.

“They are coming up with this money to support the habit,” said Sen. John Reagan, a Deerfield Republican. “So it’s not a burden for them to expend the same amount of money for a cure.”

(Allie Morris can be reached at 369-3307 or at amorris@cmonitor.com.)


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