Elimination of co-pays reduces financial burden on members and families while improving overall reimbursement to providers
FOR IMMEDIATE RELEASE
April 20, 2023
Department of Health Care Policy & Financing
Denver, CO - Today, Gov. Jared Polis signed SB23-222 which will help eliminate Health First Colorado (Colorado’s Medicaid program) co-pays for most members for pharmacy and outpatient health care services.
While co-pays are common across health benefit programs, several studies have shown that cost sharing (such as co-pays) among Medicaid members can result in unintended consequences such as not scheduling or delaying needed health care visits, cutting pills in half or not filling prescriptions - all of which can lead to worsening health conditions and poor health outcomes, as well as increased use of the emergency room and higher overall health care costs. Examples include increased rates of uncontrolled high blood pressure and high cholesterol as well as reduced treatment for children with asthma. Additionally, research finds that cost sharing increases financial burdens for families, whereas the elimination of co-pays allows members to put those dollars toward other basic needs like rent or food.
“Saving Coloradans money on health care is a priority of the Polis-Primavera administration,” said Kim Bimestefer, executive director for the Department of Health Care Policy & Financing (HCPF). “This bill accomplishes that important goal, while also improving member health, increasing reimbursements to many of our health care providers, reducing provider administrative burden, and lowering health care costs over the long term.”
HCPF anticipates that as co-pays are eliminated, it will be able to leverage additional federal funding for higher overall provider reimbursement. Currently, the HCPF lowers the amount paid to providers based on the anticipated co-pay amount collected for each claim. By eliminating co-pays, HCPF would pay providers a higher amount and be able to draw down additional federal funds for the incremental difference. It would also result in less administrative burden for the providers to collect the co-pays from members. SB23-222 is a companion piece to HCPF’s FY 2023-24 R7 budget request to remove most co-payments for Health First Colorado members. A co-pay will still be charged for non-emergency care delivered in an emergency room.
Health First Colorado members will see most co-pays eliminated beginning in July 2023 pending federal approval. The list of services that will no longer have co-pays are:
- Inpatient hospital services
- Outpatient Hospital Services
- Optometrist Visits
- Podiatrist Visits
- Primary Care Physician and specialist services
- Rural Health Clinic Visits
- Federally Qualified Healthcare Center (FQHC) Visits
- DME/Disposable Supply Services
- Laboratory services
- Radiology services
- Dental X-rays already do not have a co-pay
- Prescription drugs or services (each prescription or refill)
HCPF will update providers, members and other stakeholders as the changes are made.
About the Colorado Department of Health Care Policy & Financing: The Department administers Health First Colorado (Colorado's Medicaid program), Child Health Plan Plus, and other programs for Coloradans who qualify. These health care programs now cover about one in four Coloradans. For more information about the Department, please visit hcpf.colorado.gov.