An Act to Clarify MaineCare Copayments
Maine Legislature, Session 131, LD 2153
Committee: Health and Human Services
Sponsors: ZAGER
Amends: 22 MRSA §3173-C

Legislative Document
No. 2153
H.P. 1377
House of Representatives, January 3, 2024
An Act to Clarify MaineCare Copayments
Submitted by the Department of Health and Human Services pursuant to Joint Rule 203.
Reference to the Committee on Health and Human Services suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative ZAGER of Portland.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  22 MRSA §3173-C, sub-§2, as amended by PL 2011, c. 458, §1 and 
affected by §4, is further amended to read:
2.  Prescription drug services.  Except as provided in this subsection and subsections 
and 4, a pharmacy shall charge a MaineCare member $3.00 for each drug prescription 
that is an approved MaineCare service.  The department shall adopt and follow procedures 
to ensure compliance with the requirements of 42 United States Code, Section 1396o‑1.  A 
pharmacy that has followed the procedures adopted by the department to ensure 
compliance with the requirements of 42 United States Code, Section 1396o‑1 may refuse 
to dispense the drug if the copayment is not paid.  Copayments must be capped at $30 per 
month per member. Total copayments must be capped per member per month at no more 
than the dollar amount equivalent to 10 times the copayment amount. If a member is 
prescribed a drug in a quantity specifically intended by the provider or pharmacist, for the 
recipient's health and welfare, to last less than one month, only one payment for that drug 
for that month is may be required.
Sec. 2.  22 MRSA §3173-C, sub-§3, ¶F, as amended by PL 2023, c. 405, Pt. A, 
§61, is repealed.
Sec. 3.  22 MRSA §3173-C, sub-§3, ¶G, as enacted by PL 1983, c. 240, is amended 
to read:
G.  Any other service or services required to be exempt under the provisions of the 
United States Social Security Act, Title XIX and successors to it.;
Sec. 4.  22 MRSA §3173-C, sub-§3, ¶H is enacted to read:
H.  Primary care services; and
Sec. 5.  22 MRSA §3173-C, sub-§3, ¶I is enacted to read:
I.  Community-based behavioral health services.
Sec. 6.  22 MRSA §3173-C, sub-§7, as amended by PL 2017, c. 407, Pt. A, §76, is 
further amended to read:
7.  Copayments.  Notwithstanding any other provision of law, the following 
copayments per service per day are imposed and reimbursements are reduced, or both, to 
the following levels: The department shall consider, in any reduction in reimbursement to 
providers or imposition of copayments, the need to maintain provider participation in the 
Medicaid program to the extent required by 42 United States Code, Section 
1396a(a)(30)(A) or any successor provision of law.
The department shall maintain copayments on the following services that are nominal in 
amount and that may contain exclusions per service category:
A.  Outpatient hospital services, $3;
B.  Home health services, $3;
C.  Durable medical equipment services, $3;
D.  Private duty nursing and personal care services, $5 per month;
E.  Ambulance services, $3;
F.  Physical therapy services, $2;
G.  Occupational therapy services, $2;
H.  Speech therapy services, $2;
I.  Podiatry services, $2;
J.  Psychologist services, $2;
K.  Chiropractic services, $2;
L.  Laboratory and x-ray services, $1;
M.  Optical services, $2;
N.  Optometric services, $3;
O.  Mental health clinic services, $2;
P.  Substance use disorder services, $2;
Q.  Hospital inpatient services, $3 per patient day; and
R.  Federally qualified health center services, $3 per patient day, effective July 1, 2004; 
and
S.  Rural health center services, $3 per patient day.
T.  Prescription drug services.
The department may adopt rules to adjust the copayments set forth in this subsection.  The 
rules may adjust amounts to ensure that copayments are deemed nominal in amount and 
may include monthly limits or exclusions per service category.  The need to maintain 
provider participation in the Medicaid program to the extent required by 42 United States 
Code, Section 1396a(a)(30)(A) or any successor provision of law must be considered in 
any reduction in reimbursement to providers or imposition of copayments.
Sec. 7.  22 MRSA §3173-C, sub-§8, as enacted by PL 2011, c. 458, §2 and affected 
by §4, is amended to read:
8.  Notification.  The department shall notify each MaineCare member who is subject 
to the copayment requirement in subsection 2 of the copayment requirements, any 
exemptions and limitations prior to coding the member's information for required 
copayments and shall notify the member again during annual recertification of eligibility. 
The department shall publish a list of all copayments and amounts by service category on 
the department's publicly accessible website.
SUMMARY
This bill amends the laws authorizing MaineCare member copayments. The bill 
removes references to certain service categories subject to copayments, prohibits 
copayments for community-based behavioral health and primary care services, clarifies the 
list of service categories subject to copayments and provides the Department of Health and 
Human Services authority to set copayment amounts.