September 5, 2024

State of Alabama
Press Release: Medicaid

Reminder of Changes to Services on October 1, 2024 Related to COVID-19 Unwinding

PDF Version 

TO:   All Providers

RE:   Reminder of Changes to Services on October 1, 2024 Related to COVID-19 Unwinding

The following information was published in a Provider ALERT on July 2, 2024; however, the Alabama Medicaid Agency (Medicaid) is sending this information to providers again as a reminder of upcoming changes starting on October 1, 2024.

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 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 pregnancy and 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):

Services with Copayments

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 visit code

$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 per encounter

 

Rural Health Clinic (RHC)

$3.90 per encounter

 

Inpatient Hospital

$50.00 per admission

 

Outpatient Hospital

$3.90 per visit

 

Ambulatory Surgical Centers

$3.90 per visit

 

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 website for 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 © 2021 American Medical Association
and © 20
21 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.



  • For more information, visit http://medicaid.alabama.gov
  • For more state-wide press releases, click here