CMS: California Medicaid can't charge copays

Tools

The Centers for Medicare & Medicaid Services on Monday blocked California's attempt to charge Medicaid participants with copays for certain services to help stem rising costs.

The copays would have included $3 to $5 for medications; $5 for physician, clinic and dental services; $50 for emergency room services; and $100 per day for hospital stays, up to a maximum of $200, the San Jose Mercury News reported. The Medi-Cal proposal, which Gov. Jerry Brown signed into law last March, also would have allowed providers to refuse care for Medicaid participants who didn't pay, reported Bloomberg.

As a participant in the state-federal joint Medicaid program, Medi-Cal needed CMS approval to move forward with the copays. However, CMS Acting Administrator Marilyn Tavenner said the agency was "unable to identify the legal and policy support" for California's request.

Under the Social Security Act, states must meet several tests, including "providing benefits to recipients of medical assistance which can reasonably be expected to be equivalent to the risks to the recipients," before charging copayments, according to the Sacramento Bee.

California plans to appeal the decision to U.S. Health & Human Services Secretary Kathleen Sebelius. "We think as a cost-saving measure this is a reasonable step, as opposed to achieving savings in the program through things like reduction of services," state Department of Finance spokesman H.D. Palmer told Bloomberg.

To learn more:
- see the San Jose Mercury News article
- read the Sacramento Bee article
- check out the Bloomberg article

Related Articles:
Ohio becomes Medicaid's first value-based purchaser

Blues plan enters Florida Medicaid market
Aetna, UnitedHealth dropped from state Medicaid program
Blues plans spend $170M to expand into Medicaid
Guest Commentary: Why the Medicaid payment model is shifting