1. (1) Medicaid recipients are required to pay, and physician providers are required to collect, the designated copayment amount on each physician visit. The copayment amount does not apply to services provided for the following:

   1. (a) Pregnancy
   2. (b) Nursing home residents
   3. (c) Inpatient hospital visits
   4. (d) Recipients under 18 years of age
   5. (e) Emergencies
   6. (f) Surgery fees
   7. (g) Physical therapy
   8. (h) Family planning
2. (2) A provider may not deny services to any eligible individual due to the individual's inability to pay the cost-sharing amount imposed.

Author: Desiree Nelson; Program Manager; Medical Support

Statutory Authority: Title XIX, Social Security Act; 42 C.F.R. §§447.50, 447.53, 447.55, et seq.; State Plan Attachment 4.18lA.

History: Rule effective June 8, 1985. Amended effective July 9, 1985; March 12, 1987. Amended: Filed December 7, 1994; effective January 12, 1995. Amended: Filed May 11, 2012; effective June 15, 2012.