Number of U.S. states with Medicaid/CHIP cost sharing requirements for children 2020

"States have flexibility to impose premiums and cost sharing in Medicaid, with the maximum allowable amounts varying by income and group. Medicaid enrollees, including children, pregnant women, parents and the adult expansion group, with incomes below 150% of the federal poverty level (FPL) may not be charged premiums without a waiver. Cost sharing generally is not allowed for children with incomes below 133% FPL. Medicaid enrollees with incomes above 150% FPL can be charged premiums and relatively higher cost sharing compared to those at lower incomes. Cost sharing cannot be charged for preventive services for children or emergency, family planning, and pregnancy-related services in Medicaid. Overall premium and cost sharing amounts for all family members enrolled in Medicaid may not exceed 5% of household income. States have somewhat greater flexibility to charge premiums and cost sharing for children covered by CHIP, although there remain federal limits on the amounts that can be charged, including the overall 5% of household income cap."