Medicaid Prescription Co-payment
States can limit prescription drug co-payments. Co-payment requirements can seriously restrict Medicaid patients’ access to prescription drugs; even a minimal out-of-pocket cost may be too expensive for low-income women and prevent them from buying the prescriptions they need. Indeed, in 2007, 36% of non-elderly women did not fill a prescription because of cost.1
Beginning in 2013, states will receive additional federal funding if their Medicaid program covers recommended preventive care without patient cost-sharing. Certain health services, including cancer screenings and smoking cessation treatments, may be covered without copayments for Medicaid enrollees in states that take up this option.
Does the state Medicaid program cover prescriptions without a patient co-payment?
States receive a "meets policy" when they provide Medicaid prescription coverage without requiring co-payments. States receive a "limited policy" when they require co-payments of two dollars or less. States receive a "harmful policy" when they require co-payments of more than two dollars.
| State | Strength of Policy | Change from 2007 |
|---|---|---|
| Alabama | Harmful Policy | Same |
| Alaska | Limited Policy | Same |
| Arizona | Meets Policy | Same |
| Arkansas | Harmful Policy | Same |
| California | Limited Policy | Same |
| Colorado | Harmful Policy | Same |
| Connecticut | Meets Policy | Same |
| Delaware | Harmful Policy | Same |
| District of Columbia | Limited Policy | Same |
| Florida | Meets Policy | Same |
| Georgia | Harmful Policy | Same |
| Hawaii | Meets Policy | Same |
| Idaho | Meets Policy | Same |
| Illinois | Harmful Policy | Same |
| Indiana | Harmful Policy | Same |
| Iowa | Harmful Policy | Same |
| Kansas | Harmful Policy | Same |
| Kentucky | Harmful Policy | Same |
| Louisiana | Harmful Policy | Same |
| Maine 2 | Harmful Policy | Worse |
| Maryland | Harmful Policy | Same |
| Massachusetts | Harmful Policy | Same |
| Michigan | Harmful Policy | Same |
| Minnesota | Harmful Policy | Same |
| Mississippi | Harmful Policy | Same |
| Missouri | Limited Policy | Better |
| Montana | Harmful Policy | Same |
| Nebraska | Limited Policy | Same |
| Nevada | Meets Policy | Same |
| New Hampshire | Limited Policy | Same |
| New Jersey | Meets Policy | Same |
| New Mexico | Harmful Policy | Worse |
| New York | Harmful Policy | Same |
| North Carolina | Harmful Policy | Same |
| North Dakota | Harmful Policy | Same |
| Ohio | Harmful Policy | Same |
| Oklahoma | Limited Policy | Same |
| Oregon | Harmful Policy | Same |
| Pennsylvania | Harmful Policy | Same |
| Rhode Island | Meets Policy | Same |
| South Carolina | Harmful Policy | Same |
| South Dakota | Harmful Policy | Same |
| Tennessee | Harmful Policy | Same |
| Texas | Meets Policy | Same |
| Utah | Harmful Policy | Same |
| Vermont | Harmful Policy | Same |
| Virginia | Harmful Policy | Same |
| Washington | Meets Policy | Same |
| West Virginia | Harmful Policy | Same |
| Wisconsin | Harmful Policy | Same |
| Wyoming | Harmful Policy | Same |
Data Source: Kaiser Family Foundation, Medicaid Benefits: Online Database, “Benefits by Service: Prescription Drugs: Copayment Required," available at http://medicaidbenefits.kff.org/service.jsp?gr=off&nt=on&so=0&tg=0&yr=4&..., accessed September 7, 2010.
Footnotes
1 Sheila D. Rustgi and others, The Commonwealth Fund, “Women at Risk: Why Many Women Are Foregoing Needed Care,” May 2009, available at http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief..., accessed August 27, 2010.
2 The Maine Medicaid program does not require copayments for mail-order prescription drugs.
