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Kentucky Medicaid Recipients To Start Paying For Doctor Visits This Week

Kentucky Hospital Association

Most Kentuckians with Medicaid insurance will have to pay a $3 copayment at the doctor starting this week. That’s because of a new state requirement that took effect Jan. 1.

The copays don’t apply to people who are pregnant, children, or people in hospice.

Health providers will ask for copays at each visit, but if a person making under 100 percent of the federal poverty limit doesn’t have the money for the copay, they won’t be turned away. People who make between 101 and 138 percent of the poverty limit could be turned away, or the provider could choose to cover the cost.

While a basic outpatient doctor’s visit will cost $3, other visits will cost more. For instance, a visit to the emergency room for what the state deems a non-emergency will cost $8. Being admitted to the hospital or to an inpatient substance abuse/mental health facility will cost $50.

Some services will have no copay, such as annual check-ups and other preventive care.

Medicaid copays are part of sweeping state reforms approved by the federal government and scheduled to be implemented in April. Changes include premiums for some and a requirement that some enrollees work, attend school or volunteer to keep coverage.

Kentucky did not need approval from the federal government to require copays from Medicaid recipients.

Lisa Gillespie is WFPL's Health and Innovation Reporter.