Colorado set to eliminate most copays for Medicaid patients

Coloradans who rely on Medicaid — the public health insurance for the state’s lowest-income individuals and children — will no longer need to pay nearly all copays under changes passed by the General Assembly.

Patients would still need to cover copays for non-emergency emergency room visits. Currently, Health First Colorado, the state’s Medicaid program, charges copays of $10 per day for inpatient hospital services, $4 for outpatient hospital services, $2 for primary care and $1 per day for radiology services, such as non-dental X-rays.

The state would still pay providers for their services. In all, the department estimates the changes will eliminate copays for some 3.6 million services annually.

The Department of Health Care Policy and Financing cited several studies warning that copays “as little as $1 can lead to delayed care, pill-splitting, unfilled prescriptions, and more expensive utilization.”

“People struggle to afford the cost of health care, even when they have insurance,” state Rep. Emily Sirota, a Denver Democrat and sponsor of the bill to eliminate most cost pays and member of the budget-writing Joint Budget Committee, said. “We know that for many Coloradans, a copay of any size can be a deterrent to seek that care. We think this will be good for our Medicaid patients and for the providers who serve them.”

Nearly 1.8 million Coloradans are currently enrolled in Health First Colorado, according to the Department of Health Care Policy and Financing, which oversees the programs. A family of four generally qualifies for the program if their monthly income is less than $3,325. A single pregnant person generally qualifies if they make $3,219 or less per month.

Some Medicaid patients, including children, pregnant people, and members in nursing homes, never have copays. Some services, such as family planning and behavioral health services, do not have copays.

The copay bill and budget bill passed with bipartisan, but not unanimous, support in each chamber of the legislature. Gov. Jared Polis is expected to sign the legislation later this week. Medicaid changes still need federal approval before it goes into effect, likely in July.

Colorado would join 28 other states, plus Washington, D.C., in not charging Medicaid recipients for services. Jennifer Tolbert, associate director for the program on Medicaid and the uninsured for the Kaiser Family Foundation, said it’s hard to estimate how much more care people will use with the change, but called it “important” nonetheless.

“Copayments in Medicaid are obviously nominal, but what we do know from analyses is that costs can present a barrier to accessing needed care,” Tolbert said. People generally have a hard time determining when they need care, and for the poorest Americans, any barrier could prove dissuasive, she added.

In recommending the change to copays, the Joint Budget Committee noted optimism that it could lead to more use of preventative care and actually save money through better health outcomes — treating ailments before they escalate — but did not consider that in its fiscal analysis.

According to the nonpartisan partisan fiscal analysis, the proposal to eliminate most copayments, SB23-222, would cost about $7.3 million in each of the next two fiscal years, though the federal government would foot about $5.5 million of that cost.

State Sen. Barbara Kirkmeyer, a Brighton Republican and cosponsor of the bill, called it “a common sense approach to good government.” The proposal doesn’t break the state’s bank while increasing access for Medicaid patients and freeing up providers from the bureaucratic rigamarole, she said.

She acknowledged that copays can help keep “skin in the game” for patients, but was ultimately a small dollar amount that was more effort than it was worth.

“It actually causes issues for the providers through all the paperwork they have to fill out,” Kirkmeyer said. “So it actually ends up saving providers money, saving the people getting the services money, and it’s a great deal for everybody. So it just made perfect sense.”

State Rep. Matt Soper, a Delta Republican and member of the Delta Memorial Hospital board of directors, voted against the bill. He called Kirkmeyer’s assessment “probably an unfortunate truth” that collecting the fees is probably more hassle than it’s worth, and would have preferred to see a bill specifically addressing that.

Soper advocated for a “skin in the game” style approach both as a signal that these services aren’t free and to deter overuse of the health care system. Healthcare providers have finite time and resources to treat patients, and a person who abuses the system blocks out other patients, Soper said.

“(The changes) may mean the provider may get a little bit more from Medicaid, but in the long run, they’re probably going to get less because now that same person is going to overuse the system,” Soper said. “And they’re also going to deny access to care for other Coloradans because it will push other Coloradans further out on the schedule.”

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