The Department of Social Services (DSS) recently updated administrative rules to remove the cost share requirement for Medicaid recipients. Prior to July 1, 2024, most Medicaid recipients were exempt from cost sharing. This included children under age 21, American Indians who have received services at Indian Health Services, individuals on hospice care, and individuals residing in a long-term care facility or receiving home and community-based services. In addition, many services were also exempt from cost sharing such as emergency services, family planning services, pregnancy-related services, laboratory services, radiology services, vaccines, vaccine administration, and services received from an individual care management provider.
Jacob Parsons, SDAHO’s Director of Advocacy and Reimbursement, testified at the July 23 Administrative Rules Hearing | (audio) in favor of the change. “This is an administrative burden on our providers and is a net negative on the healthcare system. It costs more to go through these processes than what they are collecting.” The change was approved unanimously by the Rules Review Committee and is in effect immediately.
For claims processed after July 1, 2024, or later, providers should no longer request or attempt to collect Medicaid cost sharing from recipients. Medicaid reimbursement will no longer deduct a cost share amount.
The following is key information for providers regarding claims processing dates:
- Pharmacy: Prescriptions filled on July 1, 2024, or later are not subject to a cost share.
- Dental: Dental claims processed for the July 1, 2024, payroll or as part of subsequent payrolls are not subject to cost sharing.
- Other Services: Claims processed directly by the Division of Medical Services for other services for the July 2, 2024, payroll or as part of subsequent payrolls are not subject to cost sharing.
Story shared by Keloland News (7/23/24) can be read here.
For more information, please see the DSS Medicaid Cost Share Update. If you have any questions, please contact Jacob Parsons.
