Certain individuals who are covered by Medicaid are required to share in the cost of Medicaid services. This is done in the form of copayments. A copayment is a fixed amount you pay for a covered health care services, usually when you receive the service.
Copayment amounts range from $1 to $15, depending on the service you receive. You will receive a written notice if you are responsible for copayments.
Your provider can advise you if you are responsible for copayment and the amount you must pay. You are required to pay the copayment directly to the provider at the time of service. If you believe the provider charged you incorrectly, you can appeal to Department of Health and Human Services (DHHS); however, you must continue to make copayments until DHHS determines whether the amounts are correct.
Individuals exempt from copayments include pregnant women, children 18 years of age or younger, persons in alternative care facilities, institutionalized individuals, Home and Community-Based Medicaid Waiver recipients, Native Americans who receive items and services furnished directly by a Native American health care provider or through referral from a Native American health care provider under contract health services, excess-income clients, and State Disability Program recipients. Please notify DHHS if you believe you qualify for one of these exceptions.
See below for a listing of current copayment amounts for various services:
$2 per office visit
A DOCTOR OR ANY OTHER HEALTH SERVICE PROVIDER WHO PARTICIPATES IN MEDICAID CANNOT REFUSE TO TREAT YOU BECAUSE YOU CANNOT AFFORD THE COPAYMENT AMOUNT AT THE TIME OF THE SERVICE. HOWEVER, YOU ARE STILL RESPONSIBLE TO PAY THE COPAYMENT. IF YOU DO NOT PAY THE COPAYMENT, THE PROVIDER MAY SEND YOU A BILL FOR THE AMOUNT YOU OWE.
Copayments are imposed pursuant to the Nebraska Revised Statute 68-912 and State Regulation at 471-NAC 3-008. If you file an appeal, you will not be granted a hearing solely to contest the rate of the Medicaid copayment. You may be granted a hearing if you believe you qualify for one of the exceptions listed above and DHHS did not grant you an exception.