1. (1) Medicaid recipients are required to pay the designated copayment amount for the following services (including Medicare crossovers):

   1. (a) Physician office visits (including optometric)
   2. (b) Inpatient hospital admissions
   3. (c) Outpatient hospital visits
   4. (d) Rural health clinic visits
   5. (e) Durable medical equipment
   6. (f) Medical supplies
   7. (g) Pharmaceutical

2. (2) The copayment amount does not apply to services provided for the following:

   1. (a) Pregnancy
   2. (b) Recipients under 18 years of age
   3. (c) Family planning
   4. (d) Emergencies
   5. (e) Nursing Home Residents
   6. (f) Native Americans
3. (3) In addition to the exemptions in (2) above, each service has other specific exemptions. Please refer to the appropriate chapter for a complete list of the exemptions.
4. (4) A provider may not deny services to any eligible individual due to the individual's inability to pay the cost-sharing amount imposed.

Author: Kathy Hall, Deputy Commissioner, Program Administration

Statutory Authority: State Plan, Attachment 4.18-A; Title XIX, Social Security Act; 42 C.F.R. §§447.15, 447.50, 447.55.

History: Rule effective June 8, 1985. Amended: Filed January 19, 2011; effective February 23, 2011. Amended: Filed September 11, 2013; effective October 16, 2013.