Medicaid co-pay

Assembly Republican floor leader Pat Hickey is proposing co-pays for indigents under Medicaid, the federal health care program for low-income people administered by state governments.

Co-pays are a complicated device. The federal Deficit Reduction Act of 2006 authorized co–pays on Medicaid beneficiaries, but efforts to impose them must navigate some tricky shoals. When Arizona imposed them, they were struck down by a federal court because they were done by that state solely to keep the state budget balanced, not for “research or demonstration” purposes, as the law requires.

“The administrative record reveals that the purpose of Arizona’s waiver application was to save money,” the ruling read. “There is little, if any, evidence that the [Health and Human Services] secretary considered the [research/demonstration] factors … before granting Arizona’s waiver. Thus, the secretary’s decision was arbitrary and capricious.”

Hickey has said his purpose is to help keep the state budget in balance and also reduce emergency room use. That last factor is troubling, because it could discourage indigents from getting care early, exacerbating their conditions and subjecting the state to higher costs, and also make it vulnerable to lawsuits.

Utah has small co-pays for some purposes and is currently considering higher co-pays for smokers. Its policy on emergency rooms: “No co-pay when the ER is used properly/$6 co-pay for non emergency use of the ER.”