To waive COVID-19 copays, Medicaid must waive all co-pays: CMS
Skip to main content
MDHC_Logotype_white
Subscribe
  • My Account
  • Login
  • Subscribe
  • News
    • This Week's News
    • COVID-19
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • People
    • Regional News
    • Digital Edition
    • Healthcare construction primed to rebound faster than other sectors
      Drug executives: Big jump in vaccine supply is coming soon
      States rush to catch up on delayed vaccines, expand access
      Becerra supports access to care, provider funding during confirmation hearing
    • Drug executives: Big jump in vaccine supply is coming soon
      States rush to catch up on delayed vaccines, expand access
      White House promises vaccine help as states rush to catch up
      Michigan health aides to lose $2 raise without legislation
    • Dr. Imran Andrabi
      Q&A: ThedaCare CEO says lessons from COVID-19 will inform new approaches to population health management
      The Check Up: Dr. Imran Andrabi
      The Check Up: Dr. Imran Andrabi of ThedaCare
      Hospitals confront water shortages in winter storm aftermath
      beaumont-hospital-royal-oak_i_i_i.jpg
      Beaumont says nearly 2,000 second-shot vaccinations canceled due to vaccine shortage
    • Beyond the Byline: Insurers are betting on virtual-first plans as COVID-19 shifts care pathways
      Beyond the Byline: Insurers are betting on virtual-first plans as COVID-19 shifts care pathways - Transcript
      Health insurance execs' salaries grew faster than company revenue in 2020
      Five chronic conditions cost employers $2.5 billion over two years, study shows
    • States rush to catch up on delayed vaccines, expand access
      Becerra supports access to care, provider funding during confirmation hearing
      White House promises vaccine help as states rush to catch up
      Biden asks high court to drop two Trump-era Medicaid cases
    • deloitte GDP image chart graph going up
      Sponsored Content Provided By Deloitte
      Breaking the cost curve
      Modern Healthcare CEO Power Panel
      Providers focus on adding nurses, expanding outpatient care
      By the Numbers: Largest taxable not-for-profit bond issuances, 2021
      Dennis Dahlen
      Health systems aren't rushing to cut back on financial liquidity
    • man and woman looking at ipad wearing face masks stock image
      Sponsored Content Provided By Surescripts
      Improvements to benefits data can enhance ePrescribing and the patient experience
      Oscar Health's $1B IPO sets the stage for more health tech exits in 2021
      A map of the U.S. with images of the coronavirus.
      The digital divide becomes a new social determinant of health
      Google opens Rochester, Minn., office to be closer to Mayo Clinic
    • angela karpf headshot
      Sponsored Content Provided By B. Braun
      Making patient safety a policy priority
      Michigan Maze Woman-main_i.jpg
      State of confusion: Michigan's mental health system has many layers for those in need to navigate
      Next Up Podcast: Educating patients on the COVID-19 vaccine with Tanya Andreadis - Transcript
      Next Up Podcast: Educating patients on the COVID-19 vaccine with Tanya Andreadis
    • Michael Jordan, Novant team up to address health equity
      Former Ascension CEO, the first to lead the health system, passes away
      Biden's pick to head CMS would be first Black woman to hold post
      RAKESH SURI MD_i.jpg
      Cleveland Clinic creates president of international operations position
    • Midwest
    • Northeast
    • South
    • West
  • Insights
    • ACA 10 Years After
    • Best Practices
    • Special Reports
    • Innovations
    • The Affordable Care Act after 10 years
    • Dr. John Fischer
      Patient-reported outcomes tool for hernia surgery helps physicians improve care
      New care model helps primary-care practices treat obesity
      doctor with patient
      COVID-19 treatment protocol developed in the field helps patients recover
      Rachel Wyatt
      Project to curb pressure injuries in hospitals shows promise
    • What's next for on-demand telehealth companies?
      A map of the U.S. with images of the coronavirus.
      The digital divide becomes a new social determinant of health
      A CalOptima PACE vaccination clinic.
      Will COVID-19 be the catalyst for creating a more sustainable healthcare system?
      Ascension’s St. Mary’s Hospital Surgery Center at Towne Centre and Allegheny Health Network’s Bethel Park surgery center
      Hospitals see opportunity, risk in ambulatory surgery centers
    • Dr. Daniel Hall
      UPMC pilots machine learning, telehealth to inform patient transfers
      A woman being recorded using her inhaler on a smartphone.
      Digital check-ins, connected inhalers help control asthma
      A phone screen showing the question, "Mary we hope this information was helpful and we'd like to keep guiding you. Are you interested in knowing when it's your turn to receive the vaccine?"
      Chatbots, texting campaigns help manage influx of COVID vax questions
      A woman with a wearable sensor talking to her provider.
      Wearable sensors help diagnose heart rhythm problems in West Virginia
  • Transformation
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • What's next for on-demand telehealth companies?
      Rising prescription copays drop adherence, spike mortality, research shows
      Dr. John Fischer
      Patient-reported outcomes tool for hernia surgery helps physicians improve care
      Highmark Health inks six-year cloud, tech deal with Google
    • California hospitals prepare ethical protocol to prioritize lifesaving care
      Amazon, JPMorgan Chase, Berkshire Hathaway disband Haven
      Digital pathways poised to reshape healthcare continuum in 2021
      Healthcare was the hardest hit by supply shortages across all U.S. industries
    • Dr. Daniel Hall
      UPMC pilots machine learning, telehealth to inform patient transfers
      A woman being recorded using her inhaler on a smartphone.
      Digital check-ins, connected inhalers help control asthma
      Humana partners with in-home provider for 24/7 care
      A phone screen showing the question, "Mary we hope this information was helpful and we'd like to keep guiding you. Are you interested in knowing when it's your turn to receive the vaccine?"
      Chatbots, texting campaigns help manage influx of COVID vax questions
    • Coordinated payment policies could speed transition to value, experts say
      CMMI's geographic direct contracting model needs an overhaul, experts say
      Hospitals fight UnitedHealthcare policies over lab test, specialty drug payments
      Cigna eliminates prior authorization for coronary CT scans
  • Data/Lists
    • Rankings/Lists
    • Interactive Databases
    • Data Points
    • Health Systems Financials
      Executive Compensation
      Physician Compensation
  • Op-Ed
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
    • Dr. Alan Kaplan
      The risks, rewards of taking organizations 'where they haven’t gone before'
      Wellstar CEO calls adapting for the pandemic her bold move
      Howard P. Kern
      Recognizing the value of telehealth in its infancy
      Dr. Stephen Markovich
      A bold move helped take him from family doctor to OhioHealth CEO
    • Dr. Stephen Markovich
      Making sure we're aligned along the path to achieving inclusion
      Barry Ostrowsky
      Ending racism is a journey taken together; the starting point must be now
      Laura Lee Hall and Gary Puckrein
      Increased flu vaccination has never been more important for communities of color
      John Daniels Jr.
      Health equity: Making the journey from buzzword to reality
    • In-person visitation must be part of the national COVID-19 response
      We've lost so much to the pandemic, but we've also made gains that will endure
      Medical groups key to meeting president's vaccine pledge
      We need a better social care referral loop, but it requires technology as well as the human touch
    • Letters: Eliminating bias in healthcare needs to be ‘deliberate and organic’
      Letters: Maybe dropping out of ACOs is a good thing for patients
      Letters: White House and Congress share blame for lack of national COVID strategy
      Letters: VA making strides to improve state veterans home inspections
    • Sponsored Content Provided By Optum
      How blockchain could ease frustration with the payment process
      Sponsored Content Provided By Optum
      Three steps to better data-sharing for payer and provider CIOs
      Sponsored Content Provided By Optum
      Reduce total cost of care: 6 reasons why providers and payers should tackle the challenge together
      Sponsored Content Provided By Optum
      Why CIOs went from back-office operators to mission-critical innovators
  • Awards
    • Award Programs
    • Nominate
    • Previous Award Programs
    • Other Award Programs
    • Best Places to Work in Healthcare Logo for Navigation
      Nominations Open - Best Places to Work in Healthcare
      Nominations Open - 50 Most Influential Clinical Executives
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Minorities in Healthcare
      • - Luminaries
      • - Top 25 Minority Leaders
      • - Minorities to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Excellence in Nursing Awards
    • Design Awards
    • Top 25 COOs in Healthcare
    • 100 Top Hospitals
    • ACHE Awards
  • Events
    • Conferences
    • Galas
    • Webinars
    • COVID-19 Event Tracker
    • podium march webinar logo lockup
      Sponsored Content Provided By Podium
      Webinar: Critical Touchpoints for Every Patient’s Journey — How Technology Plays an Important Role
      scp health logo lockup march 2021
      Sponsored Content Provided By SCP Health
      Webinar: COVID’s call to action — Reset for success in 2021
    • Women Leaders in Healthcare Conference
    • Social Determinants of Health Symposium
    • Healthcare Transformation Summit
    • Leadership Symposium
    • Virtual Briefings
      • - Hospital of the Future
      • - Mental Health
      • - Patient Safety & Quality
      • - Strategic Marketing
      • - Virtual Health
      • - Workplace of the Future
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Minority Leaders Gala
    • Top 25 Women Leaders Gala
  • Listen
    • Podcast - Next Up
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
    • Next Up Podcast: Educating patients on the COVID-19 vaccine with Tanya Andreadis
      Dr. Joseph Cacchione
      Next Up Podcast: Educating patients on the COVID-19 vaccine with Dr. Joseph Cacchione
      Dr. Karen DeSalvo
      Next Up Podcast: What to expect with telehealth and healthcare technology in the next four years
      Carter Dredge
      Next Up Podcast: Ready, set, innovate! Innovation and disruption in healthcare
    • Beyond the Byline: Insurers are betting on virtual-first plans as COVID-19 shifts care pathways
      Beyond the Byline: How residents' stories shape our coverage of the vaccination rollout in nursing homes
      Beyond the Byline: Regulators aim to boost value push with fraud and abuse law updates
      An older man wearing a mask receiving a vaccine.
      Beyond the Byline: Verifying information on the chaotic COVID-19 vaccine rollout
    • Outreach during COVID-19
      Leading intention promote diversity and inclusion
      Introducing Healthcare Insider Podcast
    • The Check Up: Dr. Imran Andrabi
      The Check Up: Dr. Imran Andrabi of ThedaCare
      The Check Up: Tanya Blackmon
      The Check Up: Tanya Blackmon of Novant Health
      The Check Up: Dr. Patrick Hwu
      The Check Up: Dr. Patrick Hwu of the Moffitt Cancer Center
      The Check Up: Suresh Gunasekaran
      The Check Up: Suresh Gunasekaran of the University of Iowa Hospitals & Clinics
    • ivana naeymi-rad one on one intelligent medical objects
      Video: Ivana Naeymi Rad of Intelligent Medical Objects
  • MORE +
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Medicaid
March 12, 2020 07:02 PM

To waive COVID-19 copays, Medicaid must waive all co-pays: CMS

Harris Meyer
  • Tweet
  • Share
  • Share
  • Email
  • More
    Print
    Modern Healthcare Illustration / Getty Images

    To stay on top of the latest COVID-19 news as it relates to the industry, sign up for our daily newsletter here.

    State Medicaid programs can only waive copayments for coronavirus testing and treatment if they also suspend copayments for all services, unless they seek a time-consuming Section 1115 waiver, the CMS said Thursday in a new Medicaid guidance to the states on COVID-19.

    The agency released the 11-page frequently asked questions document following pressure from states and health plans for policy guidance on how they can deploy Medicaid and the Children's Health Insurance Program more effectively in addressing the pandemic.

    It discussed ways states can gain greater flexibility through waivers, eligibility and enrollment changes, telehealth, prescription refill rules, and eased healthcare workforce requirements.

    State Medicaid programs do not need federal approval to cover telehealth services in the same manner and at the same rate they pay for face-to-face services, the CMS said. In case of workforce shortages, states can expand the types of providers authorized to deliver services by filing a state plan amendment.

    "The Trump administration is actively working with governors to provide flexibility in Medicaid and CHIP programs, so states can respond effectively to this virus," said CMS Administrator Seema Verma in a news release.

    The agency said senior CMS leaders held a call last week with all state Medicaid agencies. On Wednesday, CMS officials met with leaders of Medicaid Health Plans of America, who asked the agency to establish consistency in how states and plans address the coronavirus outbreak.

    But observers felt the administration was slower in addressing Medicaid's response to the pandemic than in dealing with Medicare and commercial insurance issues. The administration has consistently sought to cut back Medicaid enrollment and spending.

    "What I'm hearing from my clients is there is a lot of policy coming out of the CMS related to Medicare and not enough on Medicaid," said Kinda Serafi, a partner at Manatt Health who consults with state Medicaid agencies. "The states are very eager for clarification on all these issues."

    The Trump administration has pushed commercial insurers and Medicare Advantage plans to quickly waive cost-sharing for COVID-19 testing, to encourage Americans who think they have been exposed or infected to get tested and thus slow the spread of the disease.

    But the CMS said state Medicaid programs would have to eliminate copays for all services if they want to reduce financial barriers to COVID-19 testing through a state plan amendment, which can be done quickly. If they aren't willing to erase all copays, they'd have to apply for a Section 1115 waiver, which can take months to get approved.

    "Having to eliminate co-payments for an entire program in order to eliminate co-payments just for COVID-19 may give some states pause," Serafi said.

    States that already have eliminated Medicaid copayments for COVID-19 testing include New Jersey, New York, and Washington. While copays in the Medicaid program are relatively small, ranging from $1 to $5, experts say they could discourage low-income people from getting tested for the coronavirus.

    Medical care can't be denied to Medicaid enrollees with incomes below 100% of the federal poverty level based on nonpayment of copays. But copays can be enforced against enrollees with incomes above that threshold.

    Some Medicaid health plans on their own are waiving copays related to COVID-19 testing and treatment, said Craig Kennedy, CEO of Medicaid Health Plans of America. "But this is an emergency," he added. "We would love it to be consistent for all 72 million Medicaid beneficiaries."

    Medicaid plans, state officials, and policy experts also sought CMS guidance on whether they could ease enrollment and re-enrollment processes to get and keep people covered in order to ensure they get testing and treatment as the pandemic advances. The CMS has tightened eligibility redetermination to enhance program integrity, reducing Medicaid enrollment by hundreds of thousands.

    In the new FAQ, the agency said states that have chosen to conduct eligibility redeterminations more frequently than once a year may submit a state plan amendment to extend the renewal period to one year.

    Some experts also have urged the CMS to do what it has done in past emergencies and approve fast-tracked waivers temporarily extending Medicaid coverage to people who are affected, as happened following Hurricane Katrina and other catastrophes.

    The new FAQ said states can choose to expand coverage by raising income eligibility standards for some populations through a state plan amendment, but that expansion could not be applied only to people affected by COVID-19. That's the process for permanently expanding Medicaid under the Affordable Care Act.

    Some observers predict that the coronavirus outbreak may prompt states that have not expanded Medicaid to reconsider if low-income people who lack health insurance start showing up in large numbers at healthcare facilities with virus exposure or actual infection.

    "I could see the combined forces of an economic downturn and the coronavirus causing states that haven't expanded to do so," said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation.

    But so far GOP opponents of expansion in North Carolina, Georgia, Kansas, and other states haven't budged. In North Carolina, GOP legislative leaders have been locked for months in a budget impasse with Democratic Gov. Roy Cooper over his push for expansion.

    "I don't believe there is any change in attitudes toward expansion because of the current state of the potential pandemic," said Rep. Donny Lambeth, a North Carolina Republican who supports expansion with a work requirement.

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    Biden asks high court to drop two Trump-era Medicaid cases
    Biden asks high court to drop two Trump-era Medicaid cases
    N.C. judge keeps in place Medicaid managed-care awards
    N.C. judge keeps in place Medicaid managed-care awards
    Sponsored Content
    Get Free Newsletters

    Sign up for free enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today

    The weekly magazine, websites, research and databases provide a powerful and all-encompassing industry presence. We help you make informed business decisions and lead your organizations to success.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS
    • Instagram

    Stay Connected

    Join the conversation with Modern Healthcare through our social media pages

    MDHC_Logotype_white
    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2021. Crain Communications, Inc. All Rights Reserved.
    • News
      • This Week's News
      • COVID-19
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition
    • Insights
      • ACA 10 Years After
      • Best Practices
      • Special Reports
      • Innovations
    • Transformation
      • Patients
      • Operations
      • Care Delivery
      • Payment
    • Data/Lists
      • Rankings/Lists
      • Interactive Databases
      • Data Points
    • Op-Ed
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Awards
      • Award Programs
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Minorities in Healthcare
          • - Luminaries
          • - Top 25 Minority Leaders
          • - Minorities to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Nominate
      • Previous Award Programs
        • Excellence in Nursing Awards
        • Design Awards
        • Top 25 COOs in Healthcare
      • Other Award Programs
        • 100 Top Hospitals
        • ACHE Awards
    • Events
      • Conferences
        • Women Leaders in Healthcare Conference
        • Social Determinants of Health Symposium
        • Healthcare Transformation Summit
        • Leadership Symposium
        • Virtual Briefings
          • - Hospital of the Future
          • - Mental Health
          • - Patient Safety & Quality
          • - Strategic Marketing
          • - Virtual Health
          • - Workplace of the Future
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Minority Leaders Gala
        • Top 25 Women Leaders Gala
      • Webinars
      • COVID-19 Event Tracker
    • Listen
      • Podcast - Next Up
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • MORE +
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing