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5 Percent Copay Cap

Medicaid members have co-pays for medical services. There is a limit on how much a member may spend on co-pays. The limit is 5% of their household income in a quarter. DVHA reviews how much a member has paid for co-pays every quarter. The quarters are January-March, April-June, July-September, and October-December. If a member has met the 5% copay in the quarter, they will not have to pay a copay for the rest of the quarter. Copays will resume when the next quarter starts.

As of April 1, 2023, Vermont Medicaid will automatically track member copays and turn them off once members meet 5% of their household income.

Providers can check the VT Medicaid portal to see if the copay is waived. Click on "Transactions," then "Login." Once logged in, check under "Eligibility".

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