September 29, 2025
Copayments required for Pathways members effective October 1, 2025.
Effective October 1, 2025, Pathways members will be required to pay a copayment for certain services. Copayment amounts vary based upon the service. Please note, copayments for the Pathways program align with those of all other Medicaid classes of assistance, as reflected in the State’s Medicaid plan. If you cannot pay the copayment, you may still receive services. Copayments are not required for Pathways members under age 21. See below for copayment amounts.
| Service | Amount |
|---|---|
| Inpatient Hospitalization | $12.50 for entire stay |
| Outpatient Hospital Visit | $3.00 per visit |
| Non-Emergency Use of the Emergency Department | $3.00 |
| Primary Care | $0.00 |
| Specialist | $2.00 |
| Durable Medical Equipment | $3.00; $1.00 for rentals and supplies |
| Pharmacy | $10.00 or less: $0.50 $10.01 to $25.00: $1.00 $25.01 to $50.00: $2.00 $50.01 or more: $3.00 |