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COMBINED MEDICAID 304-5 Out of Pocket Maximum Supersedes: CMA 304-5 (07/01/2016) Reference: SB 405 (MCA 17-7-502 and 27-2-205) and ARM 37.84.107 Overview: Medicaid households are required to pay copays and co-insurance. The amount paid out of pocket cannot exceed 5% of total countable household income. Once eligibility is determined and the 5% maximum out of pocket is calculated, it cannot be increased until the annual renewal, or when the client requests the amount be recalculated. Individuals receiving ACA Adult will have a 3% out of pocket maximum. Effective Date: January 01, 2018