Policy Statement: Member Co-Payments and Provision of Services

Purpose

To outline the Department’s policy on the provision of services when a Health First Colorado (Colorado's Medicaid Program) member is unable to pay a required co-payment at the point of service.

Background

Concerns have been raised that some participating providers may be denying Health First Colorado members access to care because members are unable to pay the required co-payment.

Policy

Under the Department’s rules[1], a provider may not deny services because a Health First Colorado member is unable to make a co-payment at the time of service, though the client remains liable for the co-payment at a later date.

The Department encourages Health First Colorado provider to develop strategies for working with members who have trouble making co-payments. Providers are also permitted to waive collection of member co-payments.

Services to children under age 19, pregnant women, and members residing in institutional settings (e.g. mental health institutes, nursing facilities), as well as Behavioral Health Organization, family planning, and certain preventive services, are exempt from co-pays.

Additional information on co-payments can be found in the Colorado Code of Regulations (page 35).

Health First Colorado Provider Relations

Health First Colorado’s Provider Relations Unit was developed to ensure that Colorado Health First Colorado has an adequate and comprehensive network of quality providers that meet high standards for physical, behavioral, dental and long-term services.

For more information about the Provider Relations Unit or this policy, please contact:

Marceil Case, Provider Relations Manager
Marceil.Case@state.co.us or 303-866-3054


[1] 10 CCR 2505-10 8.754.6.B