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Medicaid coverage of Medicare cost sharing
Act
by Jul 1, 2026
Effective date
Jul 1, 2026
Identified
Jul 1, 2026
Summary
BCBS Rhode Island clarifies that Medicaid must cover Medicare cost sharing (copays and coinsurance) for DSNP members on specific services including PCP visits (excluding annual physicals), X-ray-related medical services, specialist visits, and Part B DME supplies. Providers who are not approved Medicaid providers cannot bill members for these cost-sharing amounts and must submit claims to Medicaid instead.
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What to do
by Jul 1, 2026 · 6 steps
01Billing team must implement the following changes for all DSNP member claims.
02Update billing system to automatically route cost-sharing charges (copays/coinsurance) for PCP visits, specialist visits, X-ray-related services, and Part B DME supplies to Medicaid instead of the member.
03Verify practice's Medicaid provider status—if not approved, immediately stop all direct member billing for these cost-sharing amounts and establish Medicaid claim submission process.
04Train front desk and billing staff to inform DSNP members that they should not receive bills for copays or coinsurance on these covered services.
05Update claim submission workflows to ensure cost-sharing amounts are billed to Medicaid first.
06Reference the Medicare Cost Sharing by Medicaid Q&A and Scenarios documents (linked in policy) for denial reason codes and specific billing scenarios.
If missed: Failure to comply will result in compliance violations and potential member billing issues.
Original notice
Medicaid coverage of Medicare cost sharing
bcbsri.com · Always check the source before changing claims.
Related changes
See all Blue Cross Blue Shield of Rhode Island changes →Medicaid Coverage of Medicare Cost SharingHighEffective May 1, 2025 · Provider UpdateMedicaid coverage of Medicare cost sharingHighEffective Jul 1, 2025 · Provider UpdateMedicaid coverage of Medicare cost sharingHighEffective Jan 1, 2026 · Provider UpdateBrowse every Blue Cross Blue Shield of Rhode Island change in the policy list