Medicaid and BadgerCare co-pays temporarily suspended by DHS

Starting January 1, 2020, Medicaid and BadgerCare Plus members in Wisconsin won’t have to pay co-pays. The elimination of co-pays applies to all services covered by the programs, including doctor’s visits, prescriptions, and emergency care. The move aims to make healthcare more affordable and accessible to low-income individuals and families. Additionally, this change will benefit around one million people enrolled in Medicaid or BadgerCare Plus. This aligns with federal law, which prohibits the imposition of premiums and co-pays exceeding five percent of a member’s income. Also, the Wisconsin Department of Health Services (DHS) has initiated necessary system changes to ensure co-payments adhere to these regulations.

Members to Pay

Effective next year, the obligation of Medicaid and BadgerCare Plus members to pay co-pays for services obtained from providers registered under Medicaid shall be abolished. Hence, the policy change aims to support those with limited financial resources by improving access to healthcare services. Providers must ensure their systems are up-to-date and compliant with the recently implemented policy. This new rule results from the state’s efforts to increase access to affordable healthcare. Furthermore, the Centers for Medicare & Medicaid Services have sanctioned a temporary plan where DHS will not collect member co-pays. DHS will communicate to providers when they can resume collecting co-payments from members in 2020.

Temporary Suspension

Note: The temporary suspension of co-payments does not apply to members enrolled in SeniorCare or the Wisconsin Chronic Disease Program (WCDP). SeniorCare and WCDP members will continue to be charged co-pays.

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