What's happening
This bill removes Medicaid co-payment exemptions for individuals under 21 and pregnant women, expanding co-payments to nearly all services.
Why it matters
Lifting co-payment exemptions for children under 21 and pregnant women means these groups—often among the most financially vulnerable—will now face new out-of-pocket costs for Medicaid services, potentially impacting access to care.
By applying co-payments to nearly all Medicaid services (with the exception of diagnostic services), the bill could create financial barriers for low-income individuals who may already struggle to afford healthcare, possibly deterring them from seeking necessary treatments or prescriptions.
Granting the Health Commissioner broad authority to rapidly implement, adjust, or expand co-payment requirements and procedures could lead to swift and significant changes in how Medicaid recipients interact with the healthcare system, with limited legislative oversight or public input.
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Who cares
Medicaid recipients under 21 and pregnant recipients
The bill would remove their categorical co-payment exemptions, while retaining exemptions for family income below the federal poverty line and other specified circumstances.
Medicaid managed care enrollees
The bill would remove the exemption for services covered by managed care programs, subject to the remaining exemptions and federal requirements.
Pharmacies and Medicaid service providers
The bill would extend co-payments to all covered services except diagnostic services and require payment when services are rendered, subject to regulatory exceptions and federal limits.
New York State Department of Health
The commissioner would be authorized to issue rules, co-payment procedures, forms and instructions to implement the changes, including emergency regulations.
Headline styles
Expand Medicaid Co-Payments
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Referred to health
- Referred to health
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
2783
2019-2020 Regular Sessions
IN ASSEMBLY
January 25, 2019
Introduced by M. of A. SCHIMMINGER -- read once and referred to the Committee on Health
AN ACT to amend the social services law, in relation to medicaid co-payments for prescription drugs and other services
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Paragraph (b) of subdivision 6 of section 367-a of the social services law, as amended by section 15 of part B of chapter 57 of the laws of 2015, is amended to read as follows:
(b) Co-payments shall apply to all eligible persons for the services defined in paragraph (d) of this subdivision with the exception of:
(i) [individuals under twenty-one years of age;
(ii) pregnant women;
(iii)] individuals who are inpatients in a medical facility who have been required to spend all of their income for medical care, except their personal needs allowance or residents of community based residential facilities licensed by the office of mental health or the office of mental retardation and developmental disabilities who have been required to spend all of their income, except their personal needs allowance;
[(iv) individuals enrolled in health maintenance organizations or other entities which provide comprehensive health services, or other managed care programs for services covered by such programs, except that such persons, other than persons otherwise exempted from co-payments pursuant to subparagraphs (i), (ii), (iii) and (v) of this paragraph, and other than those persons enrolled in a managed long term care program, shall be subject to co-payments as described in subparagraph (v) of paragraph (d) of this subdivision;
(v)] (ii) individuals whose family income is less than one hundred percent of the federal poverty line, as defined in subparagraph four of paragraph (a) of subdivision one of section three hundred sixty-six of this title, for a family of the same size; and
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD03827-01-9
A. 2783 2
[(vi)] (iii) any other individuals required to be excluded by federal law or regulations.
§ 2. The opening paragraph of paragraph (d) of subdivision 6 of section 367-a of the social services law, as added by chapter 41 of the laws of 1992, is amended to read as follows:
Co-payments shall apply to [the following] all services covered by this title, except diagnostic services, and shall be pre-paid at the time when such services are rendered, subject to such exceptions for subcategories of these services as recognized by the commissioner of health in regulations, provided in accordance with section three hundred sixty-five-a of this [article] title and the regulations of the department, to the extent permitted by title XIX of the federal social security act:
§ 3. The commissioner of health is authorized to promulgate or adopt any rules or regulations necessary to implement the provisions of this act and any co-payments, procedures, forms, or instructions necessary for such implementation may be adopted and issued on or after the effective date of this act. Notwithstanding any inconsistent provision of the state administrative procedure act or any other provision of law, rule or regulation, the commissioner of health and the superintendent of financial services and any appropriate council are authorized to adopt or amend or promulgate on an emergency basis any regulation he or she or such council determines necessary to implement any provision of this act on its effective date.
§ 4. This act shall take effect immediately.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.