Nebraska Medicaid Program

Provider Information

Client Copayments

The Nebraska Medicaid Program has established the following schedule of copayments for Medicaid services: Effective October 15, 2011 the updated services and copayments are:

Service

Amount of Co-Payment

Chiropractic Office Visits

$1 per visit

Dental Services
     Such as dentures, partials, and root canals
     (check with your dentist)

$3 per specified service

​Drugs (except birth control)
        Generic
           

​$2.00 per prescription
        ​Brand-name ​$3.00 per prescription
​Durable Medical Equipment ​$3.00 per specified service
Eyeglasses $2.00 for frames, lenses, or frames with lenses
Hearing Aids

$3.00 per hearing aid

​Inpatient Hospital ​$15.00 per admission
Mental Health/Substance Abuse

$2.00 per specified service

Optometric

$2 per visit office visit or eye exam

Outpatient Hospital Services
    This includes all services except laboratory,
     x-ray, and dialysis

$3.00 per visit

Physician Office Visits
     Except Family Practice, General Practice,
     Pediatricians, Internists, Nurse Practitioners,
     Nurse Midwives, and Physician Assistants

$2.00 per office visit

Podiatrists

$1.00 per office visit

​Therapy
Physical and Occupational (non-hospital based)
​$1.00 per office visit
Speech Therapy (non-hospital based)

$2.00 per office visit

If you are required to participate in the Managed Care Program, the only Copayment that you will be responsible for paying will be for Prescription and Mental Health/Substance Abuse services. If you are required to participate in the Managed Care Program, you will be notified in a separate letter on how to enroll.

Services Excluded from Copayment

The following services are excluded from the copayment requirement by federal regulations:

  • Emergency services provided in a hospital, clinic, office, or other facility that is equipped to provide the required care. An emergency is defined as the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity including severe pain that the absence of immediate medical attention could reasonably be expected to result in placing the patient's health in serious jeopardy; serious impairment to bodily functions; or serious dysfunction of any bodily organ or part.
  • Family planning services, supplies, and drugs (such as contraceptive pills, creams, lotions, etc.) provided to individuals of child-bearing age; and services provided by a health maintenance organization (HMO) to individuals enrolled in the HMO. Nebraska Health Connection Enrollment: Co-Payments are not required for clients enrolled in the Nebraska Health Connection (Nebraska's Medicaid Managed Care program) with either an HMO or the primary care case management network -- with the exception of prescription drugs.

Covered People

All Medicaid-eligible adults age 19 or older listed below are subject to the copayment requirement:

  • Adults eligible under the Aid to Dependent Children (ADC) program
  • Adults eligible under the Aid to the Aged, Blind, and Disabled (ABBD) Program
  • Adults eligible under the Refugee Resettlement Program (RRP)
  • Individuals who are receiving extended assistance for former DHHS System wards
  • Individuals age 19 and 20 eligible under the Ribicoff program

The client's Medicaid card will indicate whether he or she is subject to the copayment requirement. The provider may also verify the client's copayment status by contacting the Nebraska Medicaid Eligibility System (NMES).

Exempted People

The following individuals are exempted from the copayment requirement:

  • Individuals age 18 or younger; pregnant women through the immediate postpartum period (the immediate postpartum period begins on the last day of pregnancy and continues through the end of the month in which the 60-day period following termination of pregnancy ends)
  • Any individual who is an inpatient in a hospital, long term care facility (nursing facility or ICF/MR), or other medical institution if the individual is required, as a condition of receiving services in the institution, to spend all but a minimal amount of his/her income required for person needs for medical care costs
  • Individuals residing in alternate care, which is defined as domiciliaries, residential care facilities, centers for the developmentally disabled, and adult family homes
  • Individuals who are receiving waiver services provided under s 1915(c) waiver, such as the Community-Based Waiver for Adults with Mental Retardation or Related Conditions
  • The Home and Community-Based Model Waiver for Children with Mental Retardation and Their Families; or the Home and Community-Based Wavier for Aged Persons or Adults or Children with Disabilities
  • Individuals with excess income (over the course of the excess income cycle, both before and after the obligation is met)
  • Individuals who receive assistance under the State Disability Program (SDP)