Cost-sharing and copayments reduce access to health care for low-income families who already struggle to make ends meet. In the debate to extend Medicaid to 250,000 adults, the idea of using some form of cost-sharing or copayment system has come up again and again. The federal government allows considerable state flexibility with implementing cost-sharing. However, a new report by Arkansas Advocates for Children and Families (AACF) says copayments can create barriers to access to care.

The report, "The Facts on Medicaid Copayments: Considerations for Arkansas," says copayments can also harm health care providers. Those providers lose out on income when Medicaid enrollees can't afford to pay their co-pays.

Anna Strong, health policy director at AACF, says incentivizing health care providers and patients to use cost-effective, preventive care can help improve outcomes and save money.

"There are better ways to lower costs while giving patients a stake in their health care," Strong says. "For example, structuring copays to encourage prevention and discourage unnecessary care can reduce costs and improve outcomes. We think those efforts will be more rewarding for Arkansans than imposing across-the-board copays that folks struggle to afford. People need access to health services, and providers should get paid for those services too."

Jo Lynne Varner, clinic administrator at Little Rock Pediatric Clinic, says the state needs a system that will make being a Medicaid provider more attractive.

"Shifting more of the cost to families will have the net result of cutting provider reimbursement," Varner says. "Many of those families cannot pay the copay, but providers are still obligated to provide services, knowing there is no mechanism for enforcement. Historically, medical bills are the last priority for families. In bankruptcy situations, healthcare providers rarely see any return."

Rich Huddleston, executive director of AACF, says as long as copayments are part of the debate over extending Medicaid services, there are some principles legislators should keep in mind.

"Consumers are not opposed to copayments as long as they're reasonable," Huddleston says. "We just need to make sure they don't restrict access to care. We also need to encourage preventive care and things like chronic disease management services. These programs encourage doctors and patients to work toward better outcomes that will lower Medicaid costs over the long term."

For more information and for a full list of recommendations, you can read the report here.