Increase in Copay Amounts for Medicaid Services On July 1, 2022, NC Medicaid copays will increase to $4. There are no changes to NC Health Choice copays.
In accordance with SECTION 9D.10.(a) of SL 2021-180, as passed by the North Carolina General Assembly, there will be an increase to existing Medicaid services that require copayments. Beginning July 1, 2022, copays for certain services that were previously eligible for $2 or $3 copays will now be a $4 copay. The change only applies to services and beneficiaries who previously were charged copays.
July 1, 2022 Copay Updates
- Standard Plans will be required to increase copayments to $4 for all services and populations where copayments are currently collected for Medicaid. Standard Plans should use the existing rules for this increase; however, the increase only applies to NC Medicaid and NOT NC Health Choice. The copayment increase must be made for services provided on or after July 1, 2022, per NCGA legislation.
- NC Medicaid copays are the same for all Medicaid beneficiaries, regardless of their enrollment in NC Medicaid Managed Care.
- Please see the public notice posted on June 3, 2022.
*There are NO Medicaid copays for the following people or services:
- Members under age 21
- Services related to pregnancy, childbirth and postpartum care - to include prenatal care
- Members receiving hospice care
- Federally recognized tribal members or members receiving services through Indian Health Service (IHS)
- North Carolina Breast and Cervical Cancer Control Program (NC BCCCP) beneficiaries
- Children in foster care
- People living in an institution who are receiving coverage for cost of care
- Behavioral health services
- Intellectual/developmental disability (I/DD) services
- Members enrolled in NC Innovations and NC TBI waiver programs
- Members enrolled in Community Alternatives Programs for Children (CAP/C) and Disabled Adults (CAP/DA)
- Members enrolled in Long-Term Support Services (LTSS)
- Family Planning Services
- Services covered by Medicare and Medicaid
A provider cannot refuse to provide services if a beneficiary cannot pay a copay at the time of service. If beneficiaries have any questions about Medicaid copays, they should call the NC Medicaid Contact Center (888-245-0179) or their Health Plan’s Member Services line.
* There are no NC Health Choice copays for federally recognized tribal members or people who receive IHS services.
NCTracks Contact Center: 800-688-6696