The Joint Budget Committee last week denied a request by the Department of Health Care Policy and Financing to increase the co-payments charged to Medicaid enrollees for services. At the same time, the JBC approved increased co-payments for CHP+ services.Last year, the General Assembly passed SB 11-213 directing HCPF to change the CHP+ annual enrollment fee to a monthly premium for families with incomes above 205 percent of the federal poverty level (FPL). The aim was to foster personal responsibility in health care decisions for enrollees and to reduce state expenditures. But Governor Hickenlooper vetoed the bill, saying that the total monthly premium contributions would impede enrollment in the program.In response, HCPF proposed tripling the annual enrollment fees for CHP+ and increasing co-payments for Medicaid and CHP+ services. The increased enrollment fees for CHP+ were approved in the FY 2011-12 supplemental appropriations.Co-payments for Medicaid services are permitted for certain populations, primarily non-pregnant adults over 18 years. HCPF’s proposal would increase co-payments for services such as emergency and urgent care, inpatient and out-patient hospital services and routine office visits. For example, the co-payment for a routine office visit would increase from $2 a visit to $2.55 a visit. In practice, providers are responsible for collecting the co-payments. HCPF pays the practitioners the reimbursement amount less the expected co-payment. In the discussion, committee members said they were worried that providers might not be able to collect the co-payments from lower-income Medicaid enrollees and the end result would be reduced provider payments. JBC voted not to approve the increased Medicaid co-payments.The committee, however, gave its stamp of approval to the increased CHP+ co-payments. Currently, CHP+ clients with incomes above 100 percent FPL are charged co-payments on a sliding scale. The new plan called for increasing the CHP+ co-payments for non-office-based visits to encourage the use of appropriate medical services. Co-payments will be higher for inpatient and outpatient hospital services, emergency and urgent care, laboratory and X-ray services. For example, the co-payment for emergency and urgent care services would increase from $20 a visit to $50 for a family with income above 200% FPL.Not all committee members were satisfied with the decision. Although CHP+ enrollees have higher incomes than Medicaid enrollees, committee members expressed concern that the increased copayments will still end up as reductions in provider reimbursement. Several legislators lamented that CHP+ monthly premiums, like those in the vetoed SB 11-213, would have increased client financial participation without reducing providers payments. The measures were approved by a vote of 4-2 (Sen. Kent Lambert (R) and Rep. Jon Becker (R) were opposed). The higher co-pays will start July 1.The JBC earlier debated a package of payment reform initiatives from HCPF, the subject of last week’s blog. The committee will most likely take up that discussion Monday or Tuesday. The committee will make final decisions on all of the budget requests next week in preparation for the Long Bill, which will be introduced in the House the first week of April.