Table I-B - State CHIP Maximum Out of Pocket

Effective Date: March 1, 2026

Previous Policy

Use this table to determine the out-of-pocket maximum (OOPM) base amount for State CHIP. The OOPM for State CHIP is 5% of the 200% poverty limit for the family, not the child. Copays, coinsurance, and deductibles are deducted from this amount during the plan year. Once the household has met the amount listed based on the household's size, they will no longer be required to pay the copays, coinsurance, and deductibles for the remainder of the plan year.

HOUSEHOLD SIZE ANNUAL INCOME LIMIT 200% FPL STATE CHIP OOPM AMOUNT 120% FPL 1 $31,920 $1,596 2 $43,280 $2,164 3 $54,640 $2,732 4 $66,000 $3,300 5 $77,360 $3,868 6 $88,720 $4,436 7 $100,080 $5,004 8 $111,440 $5,572 9 $122,800 $6,140 10 $134,160 $6,708

loading…

Table I-B - State CHIP Maximum Out of Pocket

Official source

Effective Date: March 1, 2026

Previous Policy

Use this table to determine the out-of-pocket maximum (OOPM) base amount for State CHIP. The OOPM for State CHIP is 5% of the 200% poverty limit for the family, not the child. Copays, coinsurance, and deductibles are deducted from this amount during the plan year. Once the household has met the amount listed based on the household's size, they will no longer be required to pay the copays, coinsurance, and deductibles for the remainder of the plan year.

HOUSEHOLD SIZE ANNUAL INCOME LIMIT 200% FPL STATE CHIP OOPM AMOUNT 120% FPL 1 $31,920 $1,596 2 $43,280 $2,164 3 $54,640 $2,732 4 $66,000 $3,300 5 $77,360 $3,868 6 $88,720 $4,436 7 $100,080 $5,004 8 $111,440 $5,572 9 $122,800 $6,140 10 $134,160 $6,708