Colorado Gov. Jared Polis signed Senate Bill 222 on Thursday, eliminating Medicaid co-pays for pharmacy and certain healthcare services.
The Department of Health Care Policy and Financing (HCPF) said the elimination of co-pays will allow Health First Colorado members to put those savings toward other basic needs like rent or food.
“Saving Coloradans money on healthcare is a priority of the Polis-Primavera administration,” said Kim Bimestefer, executive director of HCPF. “This bill accomplishes that important goal, while also improving member health, increasing reimbursements to many of our healthcare providers, reducing provider administrative burden, and lowering healthcare costs over the long term.”
Studies have shown that the higher the cost-sharing, the worse the adherence to medication and healthcare utilization is, which can lead to worsening conditions and poor health outcomes.
Members of Health First Colorado, Colorado’s Medicaid program, will now have the following services completely covered without out-of-pocket costs:
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- Inpatient hospital services
- Outpatient hospital services
- Primary care physician and specialist services
- Laboratory services
- Radiology services
- Prescription drugs or services (refills)
- Rural health clinic visits
- Federally Qualified Healthcare Center visits
- Durable medical equipment/disposable supply services
- Optometrist visits
- Podiatrist visits
Pending federal approval, members should see the elimination of co-pays this July.
Previous policy authorized HCPF to lower the reimbursement to providers based on the expected co-pay amount collected for each claim. With the elimination of co-pays, the department said it will now be able to leverage additional federal funding for higher overall provider reimbursement.
The new law will allow HCPF to pay providers a higher amount and access additional federal funds to make up the difference, resulting in less administrative burden for providers to collect co-pays from members.
Colorado Access is the largest regional accountable entity in Colorado’s Medicaid program. Gretchen McGinnis, senior vice president of healthcare systems and accountable care at Colorado Access, told State of Reform that the removal of co-pays will facilitate the provision of care for its members.
“We know that financial obstacles can lead to Medicaid members delaying or avoiding care,” McGinnis said. “We are excited to see SB 222 signed into law, and applaud the governor and HCPF for championing the issue.”
Another bill awaiting the governor’s signature is HB 1183, which would require HCPF to grant an exception to step therapy for serious and complex medical conditions if the prescribing provider submits a prior authorization request.
HB 1183 is also expected to reduce the administrative burden for healthcare professionals under Medicaid, as well as lower costs and improve health outcomes for Health First Colorado members living with complex medical conditions.