Physicians can begin collecting copays from Children’s Health Insurance Program (CHIP) members for COVID-19 vaccines, testing, and treatment starting Oct. 1.
Previously, the Texas Health and Human Services Commission (HHSC) waived copays for COVID-19 services provided to CHIP patients throughout the federal COVID-19 public health emergency. This waiver will end Sept. 30. The change will apply to all Texas health plans.
HHSC shared with Texas Medicine Today that it directed managed care organizations (MCOs) to notify CHIP patients of the change, and to issue guidance to physicians who treat CHIP patients about copay reinstatement, no later than Aug. 31.
CHIP patients pay copays for office visits, prescription drugs, non-emergency emergency room visits, and inpatient admissions. Copay amounts usually vary between $0 to $75 and are based on household income and service, per HHSC.
CHIP cost-sharing, which includes both the annual enrollment fee and copays, is capped at 5% of the family’s income. CHIP cost-sharing does not apply, at any income level, to:
- Well-baby and well-child services,
- Preventive services, including routine immunizations;
- Pregnancy-related services;
- Outpatient office visits or residential treatment services for mental health and substance use disorders; and.
For more information about billing and coding, visit TMA’s Billing, Coding, and Payment Resources page. To reach TMA payment staff, check out TMA’s comprehensive Physician Payment Resource Center.
Last Updated On
September 12, 2024
Originally Published On
September 12, 2024
Alisa Pierce
Reporter, Division of Communications and Marketing
(512) 370-1469