Cost-sharing

The State child health plan may not impose deductibles, coinsurance, or other cost sharing with respect to benefits for services within the categories of services described in subsection (c)(1)(D), in vitro diagnostic products described in subsection (c)(10) (and administration of such products), vaccines described in subsection (c)(12) (and the administration of such vaccines), services described in section 1396 o (a)(2)(G) of this title, vaccines described in section 1396 o (a)(2)(H) of this title administered during the period described in such section (and the administration of such vaccines), testing or treatments described in section 1396 o (a)(2)(I) of this title furnished during the period described in such section, or for pregnancy-related assistance.

(A) Children in families with income below 150 percent of poverty line In the case of a targeted low-income child whose family income is at or below 150 percent of the poverty line, the State child health plan may not impose— (i) an enrollment fee, premium, or similar charge that exceeds the maximum monthly charge permitted consistent with standards established to carry out section 1396 o (b)(1) of this title (with respect to individuals described in such section); and (ii) a deductible, cost sharing, or similar charge that exceeds an amount that is nominal (as determined consistent with regulations referred to in section 1396 o (a)(3) of this title, with such appropriate adjustment for inflation or other reasons as the Secretary determines to be reasonable).

(B) Other children For children not described in subparagraph (A), subject to paragraphs (1)(B) and (2), any premiums, deductibles, cost sharing or similar charges imposed under the State child health plan may be imposed on a sliding scale related to income, except that the total annual aggregate cost-sharing with respect to all targeted low-income children in a family under this subchapter may not exceed 5 percent of such family’s income for the year involved.

(C) Premium grace period The State child health plan— (i) shall afford individuals enrolled under the plan a grace period of at least 30 days from the beginning of a new coverage period to make premium payments before the individual’s coverage under the plan may be terminated; and (ii) shall provide to such an individual, not later than 7 days after the first day of such grace period, notice— (I) that failure to make a premium payment within the grace period will result in termination of coverage under the State child health plan; and (II) of the individual’s right to challenge the proposed termination pursuant to the applicable Federal regulations. For purposes of clause (i), the term “new coverage period” means the month immediately following the last month for which the premium has been paid.

Nothing in this subsection shall be construed as affecting the rules relating to the use of enrollment fees, premiums, deductions, cost sharing, and similar charges in the case of targeted low-income children who are provided child health assistance in the form of coverage under a medicaid program under section 1397aa(a)(2) of this title .