WV Medicaid to Start Charging Co-Pays in January

WV Medicaid to Start Charging Co-Pays in January

Beginning January 1, 2014, Medicaid recipients will be assigned co-pays for some medical services. A co-pay is the amount of money you will be expected to pay when receiving certain services.  The copays currently are broken into 3 tiers based on income with higher income members paying higher co-pays.

Co-pays are for services such as inpatient hospital stays, office visits, prescriptions not on the preferred list, non-emergency use of the Emergency Room at a hospital, and outpatient surgical services.

Each calendar quarter, members will have a maximum out of pocket (OOP) payment. The OOP is the most they can charge you in any given quarter for healthcare services.  If they charge you more than the amount listed please contact WVMMIS at 888-483-0797.   Please make sure you keep all receipts so you have proof of what you have paid each quarter.

  • Tier 1 maximum is $8 per quarter
  • Tier 2 maximum is $71 per quarter
  • Tier 3 maximum is $143 per quarter

January 1 – March 31, 2014
April 1 – June 30, 2014
July 1 – September 30, 2014
October 1 – December 31, 2014

There are some exemptions. If you fall under one of these you do NOT have to pay a co-pay.

  • Pregnant Women including pregnancy-related services up to 60 days post-partum;
  • Children under age 21;
  • Native American and Alaska natives;
  • Intermediate Care Facility or MR services;
  • Preventive services for children under age 18;
  • Provider-preventable services;
  • Individuals in Nursing Homes,
  • Receiving Hospice services,
  • Medicaid Waiver services, or covered through the Breast and Cervical Cancer Treatment Program;
  • Family Planning services and Emergency services.

Additional exemptions include diabetic testing supplies syringes and needles, BMS approved Home Infusion supplies and 3-day emergency supplies.


If you have any questions about these new co-pays or if you think you have been charged a co-pay that you should not have been charged contact WV Medicaid Member Services at 888-483-0797.






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