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Florida Medicaid Copayments

Recipients are responsible for paying all applicable copayment and coinsurance amounts directly to the provider who furnished Florida Medicaid covered services.



Chiropractor services, per provider or group provider, per day


Community behavioral health services, per provider, per day


Home health services, per provider, per day


Hospital outpatient services, per visit


Federally qualified health center visit, per clinic, per day


Independent laboratory services, per provider, per day


Non-emergency transportation services, per each one-way trip


Nurse practitioner services, per provider or group provider, per day


Optometrist services, per provider or group provider, per day


Physician and physician assistant, per provider or group provider, per day


Podiatrist services, per provider or group provider, per day


Portable x-ray services, per provider, per day


Rural health clinic visit, per clinic, per day


Use of the hospital emergency department for non-emergency services

5% of the first $300.00 of the Florida Medicaid payment (maximum $15.00)


The following categories of recipients are not required to pay a copayment or coinsurance:

    • Individuals under the age of 21 years.
    • Pregnant women – for pregnancy-related services, including services for medical conditions that may complicate the pregnancy. This exemption includes the six week period following the end of the pregnancy.
    • Individuals receiving services in an inpatient hospital setting, long-term care facility, or other medical institution if, as a condition of receiving services in the institution, that individual is required to spend all of his or her income for medical care costs with the exception of the minimal amount required for personal needs.
    • Individuals who require emergency services after the sudden onset of a medical condition which, if left untreated, would place their health in serious jeopardy.
    • Individuals receiving services or supplies related to family planning.

Recipients Unable to Pay

Providers may not deny services to a recipient based solely on the recipient’s inability to pay a Florida Medicaid copayment or coinsurance amount. Providers may bill the recipient for the unpaid copayment or coinsurance amount.

Third-Party Coverage

Recipients who have third-party liability coverage (including recipients eligible for Medicare) are required to pay copayment or coinsurance amounts, unless:

    • The recipient is otherwise exempt.
    • The Medicare or third-party payment is equal to, or exceeds, the Florida Medicaid fee for the service. Providers must reimburse recipients who have paid a Florida Medicaid copayment when the Medicare or third-party liability payment is equal to or exceeds the Florida Medicaid fee for the service.


Fla. Admin. Code ยง59G-1.056

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