Section E Co-payments

Family share co-payments

The family share co-payment is the amount of money that the client must pay you on the first day of attendance each month. The co-payment is based on the family’s income and family size. The family share co-payment is the total amount the family is expected to pay for all of their children that attend your facility; it is not a per child co-payment. DHS pays the rest of the family’s cost of care after the co-payment has been met. The monthly family share co-payment owed by the client will show on the Provider Web, and the POS machine.

Each day as children are checked into your facility, the POS machine will show the family share co-payment owed for the entire month. It will not change during the month unless the family’s worker makes a change on the case. In most cases, copayments will not increase during the 12 month eligibility period. However, copayments may increase when the 12 month eligibility period expires and the family’s eligibility is re-determined.

The amount of the co-payment you collect should never exceed the total cost of care. DHS payments equal the balance of the amount due for child care after the co-payment has been deducted. Sometimes, however, the co-payment itself will pay in full for the days the child attends. This can occur if the co-payment amount is fairly large and the family does not bring the children to your facility very often. In this circumstance, the family would only owe for the cost of the days the children attended. Look at the daily rate shown on the POS machine or on the Provider Web to determine how much the parent owes you. If the parent already paid the full family share co-payment, you must reimburse the difference. Of course, no EBT deposit from DHS will be made to you in these cases because the cost of the care is covered by the co-payment.

Co-payment Example

Marie’s co-payment is $40, which she pays to you at the first of the month. When Marie records attendance each day, it will show her co-payment of $40.

Marie only has one child, Jackson, who is authorized for a full-time daily rate of $15.

Jackson has attended your facility for 3 full-time days. Recorded attendance shows that Jackson has attended these 3 full-time days at your facility for a total of: $15 per day x 3 days= $45.

Marie has paid you her $40 co-payment. OKDHS subsidy payments will start with the difference of $45 – $40 = $5 for the 3rd day of attendance. All recorded days after that will be paid at the full OKDHS rate with subsidy payments.

Using more than one provider

Care may be approved when a child needs care at two different providers on different days of the week. For example, care is needed at one provider on weekdays, and at another on weekends. Siblings may also be approved to attend different providers when one child attends one facility and a sibling attends another one. When DHS authorizes care at two different providers, the worker assigns any co-payment owed by the client to the provider giving the most care for the family. If you are responsible for collecting the family share co-payment, it will show on the POS machine and on the Provider Web. If your POS machine or the Provider Web shows that a co-payment is owed but a client tells you that he or she should not owe you a co-payment, refer that client back to his/her worker for help. In some instances the co-payment is assigned to both providers in error. You should continue to collect a co-payment from the client until the error, if one was made, is corrected.

To verify if your facility should be collecting the co-payment, refer to the Provider Web https://www.okconnectecc.com/ecc/

You can view your facility authorizations from the main Provider Profile screen by clicking on Authorizations at the bottom:

Clicking a Person Name in the Authorizations Report list will open up the Current Authorizations for that specific person.

Clicking on Benefit# expands/collapses the authorization details for each authorization listed.

You will then look for the Co-pay Flag field:

A Y in the Co-pay flag field indicates Yes, the copay is due to your facility. An N in the Co-pay flag field indicates No, the copay is not due to your facility.

Changing providers in the middle of a month:

When a child changes to your facility from another provider, the POS machine will reflect the entire family share co-payment owed for the month even though all or most of the co-payment might have been applied at the other provider. You must look at your Totals Report on the POS machine for the month to see how much co-payment was withheld from your facility. You cannot determine exactly how much, if any, co-payment is owed until you receive the Totals Report for the first week the children start care with you. Prior to receiving payment for that payment week, you have the option of:

• requiring the client to pay the entire co-payment again until you know how much of that month’s co-payment was actually applied at your facility; or
• accepting a receipt from the client showing how much co-payment he or she paid to the first provider and waiting until the Totals Report confirms part of the co-payment is still owed before charging the client for that co-payment.

If you require the client to pay the entire co-payment, you must reimburse the client for the amount of co-payment that was not applied to your facility after receiving payment from DHS. If your Totals Report shows that a portion of the co-payment was applied to your facility, the client is responsible for paying you that amount. If the client paid the previous provider the entire co-payment owed for the month, that previous provider is responsible for returning the portion of the co-payment to the client that was not actually applied at his/her facility.

Payments paid by third parties:

In addition to these family share co-payments, sometimes the non-custodial parent or another third party such as an employer or other relative is paying a portion of the cost of care directly to you. The worker will send a notice to you and the client called a Client Notice of Action Taken, Form 08MP038E, to advise you how much money you should collect from this third party. In cases like these, DHS will begin paying for the month’s child care after the third party’s support amount and any co-payment owed by the family itself have been credited toward the cost of care. Again, it is your responsibility to collect the family share co-payment, just like you would from any of your other parents who owe you money. If the third party does not pay anything for the month or pays less than DHS staff estimated, DHS can make up the difference for you. Notify the client’s worker so he or she can adjust the amount owed and you can be reimbursed from DHS the money the third party never paid you. If the third party should begin to pay you more than DHS estimated, this needs to be reported to the client’s worker and the Finance Division EPS so that you don’t have an overpayment you will have to pay back to DHS.

In some instances the third party is only paying you a portion of the custodial parent’s family share co-payment. In this instance you are not sent a Client Notice of Action Taken, Form 08MP038E from the worker. If the third party does not pay you the amount he or she normally pays for a given month, you would collect the difference from the client not DHS.