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Regular Medicaid Program

The Regular Medicaid program allows Medicaid clients to get services from any Provider that accepts Medicaid clients. There is no need to get referrals for care, but doctors are not required to take new patients either.

 

Clients in Regular Medicaid must pay the co-payment listed below when getting services, refer to 10 CCR 2505-10 Section 8.754:

 

SERVICE

CO-PAYMENT

Inpatient Hospital Services

$10.00 per covered day or 50% of the averaged allowable daily rate whichever is less.

 

Outpatient Hospital Services

$3.00 per visit

 

Practitioner Services

$2.00 per visit

 

Optometrist Visit

$2.00 per visit

 

Podiatrist Visit

$2.00 per visit

 

Psychiatric Services

$.50 per unit of service (1 unit = 15 minutes)

 

Community Mental Health Center Services

$2.00 per visit

 

Rural Health Clinic/ FQHC Services

$2.00 per date of service

 

Durable Medical Equipment (UB-outpatient and CO-1500 claims)

 

$1.00 per date of service

Laboratory (UB-outpatient and CO-1500 claims)

$1.00 per date of service

 

Radiological Services (UB-outpatient and CO-1500 claims)

 

$1.00 per date of service

Prescription Services (each prescription or refill)

Generic drugs - $1.00

Brand name drugs - $3.00

 

Some clients do not have to pay co-payments:

 

  • Clients who are ages 18 and under

  • Clients who are pregnant

  • Clients living in a nursing facility

     

What is a Co-payment?

 

A co-payment is a small amount of money that you pay for the cost of your medical care. Medicaid pays most of the cost of your care, but you may have to pay a small amount. Co-payments are different for different services.