COVID-19 Unwinding: Changes to Services

PDF Version

TO: All Providers

RE: COVID-19 Unwinding: Changes to Services

Per federal guidance, the phase down for funds related to the COVID-19 public health emergency (PHE) ends on September 30, 2024. Therefore, some flexibilities the Alabama Medicaid Agency (Medicaid) implemented due to the COVID-19 PHE will end at that time. Effective October 1, 2024:

• Pregnant adult recipients (ages 21 and older) will only be eligible for dental benefits during pregnant through the end of the month of 60 days postpartum when rendered by enrolled dental providers.
• At-Home over-the-counter (OTC) COVID-19 Diagnostic Tests from a pharmacy will no longer be covered. Medicaid recipients may still be tested for COVID-19 through a physician office or clinic.
• COVID-19 vaccine administration reimbursement will change from $40 to $8 per administration. This applies to pharmacy and non-pharmacy providers.
• COVID-19 vaccine counseling reimbursement will change from $31.70 to $13.00. This applies to pharmacy and non-pharmacy providers.
• All non-COVID vaccine administration reimbursement will change from $5 to $8 per administration. This applies to pharmacy and non-pharmacy providers.
• Copayments for Medicaid covered services will be reinstated. The amounts are based on the federally approved maximum amounts and are shown below (including Medicare crossovers):

ServiceswithCopayments	Copayment Amounts	Based on Medicaid's Allowed Amount for the Services
Office Visits (including visits to physicians, optometrists, nurse practitioners)	$0.65 to $3.90 per office visitcode	$50.01 or more - $3.90$25.01 - $50.00 - $2.60$10.01 - $25.00 - $1.30$10.00 or less - $0.65
Federally Qualified Health Centers (FQHC)	$3.90 perencounter
Rural Health Clinic (RHC)	$3.90 perencounter
Inpatient Hospital	$50.00 per admission
Outpatient Hospital	$3.90 per visit
Ambulatory Surgical Centers	$3.90 pervisit
Durable Medical Equipment/Medical Supplies and Appliances	$0.65 to $3.90 per line item	$50.01 or more - $3.90$25.01 - $50.00 - $2.60$10.01 - $25.00 - $1.30 $10.00 or less - $0.65
Prescription Drugs	$0.65 to $3.90 per prescription	$50.01 or more - $3.90$25.01 - $50.00 - $2.60$10.01 - $25.00 - $1.30$10.00 or less - $0.65

• Copayment does not apply to services provided to/for:
• Pregnant women
• Nursing facility residents
• Recipients less than 18 years of age
• Native American Indians with an active user letter from Indian Health Services (IHS)
• Emergencies
• Family Planning
• Vaccines and vaccine administration

A provider may not deny services to any eligible Medicaid recipient because of the recipient's inability to pay the cost-sharing (copayment) amount imposed.

Please continue to visit the Alabama Medicaid websitefor up-to-date information related to the 'unwinding' process. If you have questions, please contact the Provider Assistance Line at (800) 688-7989.

The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2024 American Medical Association and © 2024 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.

Public link

Please use the above public link if you want to share this noodl on another website.