Budget panel recommends smaller prescription copay hike after concerns about burden on Medicaid recipients

A legislative health budget subcommittee on Feb. 18 debated the governor's recommendation to raise prescription copays for people on Medicaid from $1 to $4 for one tier and from $3 to $8 for another.

The chair read the proposal, noting the change in the governor's recommended budget. "They're requesting that we increase that co pay from $1 to $4 and $3 to $8," the chair said. Several members pressed staff on whether federal rules required those exact amounts and on the financial impact of the change.

Committee members raised concern that the increases would impose a meaningful burden on low-income Vermonters, particularly those taking multiple medications. "Pharmacies call all the time, and she says, mom, they can't afford $3 now. They're never gonna be able to afford $8," the chair said, relaying testimony from a constituent.

Members also noted how state-collected copays interact with federal financing. "For every dollar we collect, we have to send 60¢ of that to the federal government," the chair said, arguing that much of any revenue increase would be shared with the federal government and might not translate to net state savings.

Faced with those concerns, the chair proposed that the committee recommend to appropriations a smaller increase—moving current copays from $1/$3 to $2/$4—rather than the governor's $4/$8. Speaker 2 seconded the request. The subcommittee conducted a hand-count straw poll; the chair recorded the result as "7 to 4" in favor of recommending the smaller increase. Members emphasized the vote was an internal, nonbinding recommendation for appropriations to consider.

Next steps: the committee will include the recommendation and its rationale in the ranked priorities submitted to the House appropriations committee for further consideration.