CMS Publishes Medicaid Cost Sharing Guidelines for 2013

By Wesley Prater

Section 1916 of the Social Security Act allows states to impose cost sharing and CMS recently published the Medicaid nominal cost sharing amounts allowed for Fiscal Year 2013.  These amounts can vary by income levels and are based on a  state’s payments for services.
Some groups (e.g., children and individuals in an institution) and some services (e.g., preventive services for kids, family planning, and emergency services) are generally protected from the imposition of cost sharing.  States are not allowed to impose cost sharing that exceeds 5 percent of family income under any circumstances.

While states are allowed to impose cost sharing, research shows that cost sharing can decrease enrollment in Medicaid and make it more challenging for low-income families to access care as many families in Medicaid can’t afford these payments. Spearheaded by budget constraints, we have seen a number of states asking CMS to allow for higher cost sharing, which will likely continue.

Thus, it will be important to monitor any potential changes to your state’s cost-sharing amounts and advocate to eliminate Medicaid cost sharing or at least keep them at minimal amounts.

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