Improving Copayment Tracking for Vermont Medicaid Members
The Department of Vermont Health Access (DVHA) is enhancing its copayment tracking system for Vermont Medicaid members. Starting April 1, 2023, a new system will ensure members are not charged more than 5% of their household income on copayments. Copayment policies remain unchanged, but the process will now be automated, with copays tracked in the Medicaid claims system. Members will receive notices when the cap is met or exceeded, ensuring fair cost-sharing practices. Providers will be informed of these changes and advised to check the Green Mountain Care Eligibility System for copay eligibility indicators. Overall, this update aims to streamline copay processes and improve transparency for all stakeholders involved.
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Presentation Transcript
5% Copayment Cap Department of Vermont Health Access March 2023
Whats happening? What s happening? The Department of Vermont Health Access (DVHA) is improving its system for tracking and charging copays for Vermont Medicaid members. The new system: 1. Ensures Vermont Medicaid members are not charged more than 5% of their household s total income on cost-sharing. 2. Streamlines copay information available to Vermont Medicaid-enrolled providers. This change is in accordance with federal regulations at 42 CFR 447.56(f). Copay policies are not changing under this new system. DVHA will implement this new system on April 1, 2023.
Whats changing? What s changing? Current Process: Manual, retrospective look back is conducted each quarter. Quarterly refund checks are sent to members who spent more than 5% of their income on copayments. New Process: Member copayments will be tracked in the Medicaid claims system. Copays will be applied to members eligibility households. Household copays will be automatically turned off within a calendar quarter if the 5% cap is met. The quarterly retrospective look back will remain in place in case some households pay more than their 5% cap. A refund check will be sent.
Whats the impact? What s the impact? How does this impact Vermont Medicaid members? Copayment policies are the same under this new system. Members will not be charged more than 5% of their household income on copays (or will get a refund the cap is exceeded). Copayment cap notices: The cap met notice says you've met your cap and will not have copays for the rest of the quarter. The refund notice says you've exceeded your cap and includes a check. How does this impact Vermont Medicaid-enrolled providers? The Green Mountain Care Eligibility System (EVS) will show a copay eligibility indicator that reflects whether Vermont Medicaid members should or should not be charged a copay based on the 5% cap. It is important for providers to continue to check EVS at the time of each visit to ensure copays are charged only when due. Providers will receive a letter informing them of the April 1, 2023, implementation date.
