Update! Co-pays for Medallion 4 Services

November 01, 2018

The switch to Medallion 4 has caused more than a little confusion and concern about why suddenly there are co-pays for services such as TDT and Intensive In-home; here are some basic facts:

  • The co-pays are being charged for FAMIS MCO registrants only – but only by Aetna, Magellan and United Healthcare; the other three plans (Anthem, Optima and Virginia Premier) do not charge co-pays for FAMIS services for Intensive In-home and TDT services

  • FAMIS did not include co-pays when the services are Fee-for-Service (which they were until the individuals were recently rolled into Medallion 4)

  • FAMIS does allow for co-pays when services are provided through managed care (Medallion 4)

  • The statements received reflect that the co-pays are to be charged “for each visit” and are either $2 or $5 depending on the income of the family – the co-pay amount is reflected on the Card received from the MCO


Providers are obligated to “attempt” to collect the co-pay, but are not penalized if they can not do so.  Except, of course, in the loss of revenue!

We are talking with Medicaid about the issues that have been raised including:

  • Administrative burden which falls to the provider,

  • The obvious threat to the individual’s “access to needed services” if the per visit co-pay were to be charged for someone receiving services 5 days per week, and

  • The loss of revenue which will become a significant issues of service sustainability very quickly.


We expect more discussion and information from Medicaid in the next several weeks; please keep up to date as new issues arise and stay tuned for updates on the Monthly Member’s call.