Legislature advances bill limiting copays for Medicaid

In a 28-9 vote, the Legislature gave first-round approval to a bill putting limitations on copays paid by Medicaid recipients.

Introduced and prioritized by Omaha Sen. John Fredrickson, the bill (LB929) allows Managed Care Organizations to cover copays for Medicaid recipients and sets limits on the cost-sharing measures authorized by Congress last year.

Managed Care Organizations, which include private insurance companies, contract with state agencies to deliver Medicaid benefits at a fixed cost.

"We still will have copay and cost sharing as required by federal law. With this, we would just go back to what we previously did as a department, which was to allow for MCOs to cover those costs, so they choose. This doesn't require MCOs to cover them," Fredrickson said.

In Nebraska, Medicaid discontinued copayments on May 1, 2024. Following a waiver period during the pandemic, Managed Care Organizations in the state restarted cost sharing on June 1, 2024, with copays typically ranging from $1 to $15 per service.

With the passage of President Donald Trump's One Big Beautiful Bill Act, states are now authorized to impose new Medicaid copayments of up to $35 per service for Medicaid expansion adults with incomes between 100% and 138% of the federal poverty line.

In Nebraska, 138% of the federal poverty level translates to roughly $21,600 per year for an individual and $44,556 for a family of four. At the federal poverty level, annual income is about $15,960 for an individual and $33,000 for a four-person household.