Federal Requirements and State Options: Premiums and Cost Sharing

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November 2017

Within federal parameters, states have the flexibility to charge certain Medicaid beneficiaries premiums, enrollment fees, or cost sharing for particular services. This fact sheet summarizes federal guidelines related to premiums and cost sharing, including which beneficiary populations may be subject to premiums and cost sharing, types of services for which they can be charged, caps on out-of-pocket spending, and consequences of non-payment. The fact sheet also discusses the specific parameters for states seeking waivers of the cost-sharing rules.

From: Federal Requirements and State Options: How states exercise flexibility under a Medicaid state plan

Publication Type: Fact Sheets

Tags: benefits, copayments, deductibles, income, premiums, waivers