Issues in Developing Programs for Uninsured Children: A Resource Book for States. C. Procedures for Collecting Copayments

03/02/1998

Seven of the nine children's insurance programs collect copayments: California, Colorado, Florida, Massachusetts, New York, Pennsylvania, and Washington. All seven programs require contracted providers (i.e., physician's offices, hospitals, pharmacies) to administer the collection of copayments. In Colorado, however, providers are not required to collect copayments specified for services rendered, yet in order to promote patients' responsibility for their health care, they are encouraged to do so.

Table 14: Co-Payment Levels for the Nine State Plans

  CaliforniaKids Colorado Children's Basic Health Plan Florida Healthy Kids MA Children's Medical Security Plan* MinnesotaCare New York Child Health Plus Pennsylvania CHIP TennCare Washington Basic Health Plus
Office Visits

$5

$2

$3

$1-5

No copayments for children.

$2

 

No copayments.

No copayments.

Health Screenings  

$2

 

$1-5

$2

 
Outpatient Surgery          

$5

Outpatient Mental Health    

$5

   

$5

Emergency Room

$25

 

$25

   

$5

Ambulance Transport            
Hospital Admission            
Vision Care

$10

         
Eyeglasses    

$10

   

$5

Hearing Screenings and Aids          

$5

Prescriptions  

$2

$3

   

$5

Non-generic prescriptions

$10

$2

       
Dental

$10

       

$5

*Massachusetts has sliding scale copayments based on family income guidelines of $1, $3, or $5.