The first wave of MassHealth co-pays will begin on February 1, 2004:

• Acute inpatient hospital: $3 per non-psychiatric stay, $36 maximum per enrollee per year ( $33 for calendar year 2004). This will not apply to admissions from long-term care facilities or rehab. hospitals and admissions from an emergency department.
• Non-emergency use of emergency department: $3 per visit, $36 maximum per enrollee per year ( $33 for calendar year 2004).
• Pharmacy prescriptions: $1 per generic prescription; $3 per brand name prescription; $200 maximum per enrollee per year ($184 for calendar year 2004). Does not apply to family planning supplies and services, inpatient medications, and emergency services.

Children, pregnant women, MassHealth Limited members, those in nursing facilities, chronic or rehab. hospitals or hospice programs are exempt from co-pays.

There is no co-payment for mental health and substance abuse-related services or emergency services.

DMA sent notices to members in January.

This is only the first wave of co-pays that may be instituted this year. Office visit co-pays do not currently exist, but may be announced at any time.

-Adapted from materials from Kim Simonian, MPH and MassHealth Eligibility Letter 119.