Charges for medical treatment, hospital stays and prescription drugs for the state’s poorest residents will rise – in some cases doubling – under new fees and co-payment increases set to take effect Feb. 1.
Hospitals, clinics and other medical providers were notified Tuesday of the changes, which will affect the approximately 175,000 state residents poor enough to qualify for the Colorado Indigent Care Program, known as CICP.
For some of the poorest Coloradans – those making between $3,829 and $5,933 a year – prescription drug co-payments will double, to $10.
The cost of a doctor’s office visit will rise to $35 from $27.
For higher wage earners who qualify for the program, such as a person earning $15,217 a year, the co-payment to see a doctor while admitted in a hospital will rise 17 percent, to $270.
In addition, the state has two new charges: emergency-room fees of $15 to $45 and a “specialty outpatient clinic co-payment” of $15 to $45. The fees are set based on a patient’s income and household size.
The state raised the charges because doctors, hospitals and clinics said they were losing money treating CICP patients, said Rhonda Bentz, spokeswoman for the state Department of Health Care Policy and Financing, which administers the program.
“We don’t want to harm the clients, but we want to make sure the providers get what they need to stay in the program,” Bentz said.
Co-payments for tests such as MRIs will, for the most part, remain the same – up to $600 for a single person making $17,706 a year.
“We’re talking about a staggering amount of money for poor people to have to pay, especially for specialty care like we do here,” said Cheryl Volmert, a social worker at the University of Colorado’s cancer center.
For a single person making $5,933 a year who goes to the cancer center, the clinic co-payment for a visit will go from $10 to $15. In addition, the patient now will be charged a new fee, the specialty outpatient clinic co-payment, of $25.
“So this ends up to be a $60 charge per visit for somebody making about $500 a month. They’re used to paying $10,” Volmert said.
Many of the 2,270 CICP patients whom the cancer center saw during the last fiscal year made two or even three visits a month for chemotherapy treatments, she said. The fees would apply for each visit.
In addition, if the patient needs prescription drugs, the cost will double to $10.
This is the first time since 1999 that co-payments have increased, said Bentz of the health care policy department.
Bentz said she had no estimate of how much additional money the fee increases would bring in.
She said the state did not consider increasing its reimbursements – which come from the state general fund – to hospitals and clinics.
“We’re at a point where getting more money from the state. … It’s not the easiest thing in the world to do,” Bentz said.
The CICP program reimburses hospitals, clinics, pharmacies and physicians for medical treatment provided to patients who are sick but cannot afford treatment. The state’s funding is matched by federal dollars.
In 2003-04, the most recent fiscal year for which the state had figures, the state payments totaled more than $150 million.
The Denver Health system, which sees more CICP patients than any other institution in the state, loses about 70 cents of every dollar it spends treating those patients, said Peg Burnette, chief financial officer for Denver Health.
In 2004-05, Denver Health’s clinics and hospital treated 31,000 patients who qualified for CICP assistance – and the health system’s loss on those patients was about $180 million, she said.
Burnette said Denver Health supported the co-payment increases, which she estimated would bring in an additional $300,000.
That is less than 2 percent of the $180 million loss in 2004-05.
“It’s a tiny amount,” Burnette said. “But that $300,000 helps pay for several positions. And as uncompensated care goes up and up, and we need additional help to care for these people, it is substantial.”
Staff writer Karen Augé can be reached at 303-820-1733 or kauge@denverpost.com.
