State flexibility
(1) In general
(1)In general#
Notwithstanding sections 1396 o and 1396a(a)(10)(B) of this title, but subject to paragraph (2), a State, at its option and through a State plan amendment, may impose premiums and cost sharing for any group of individuals (as specified by the State) and for any type of services (other than drugs for which cost sharing may be imposed under subsection (c) and non-emergency services furnished in a hospital emergency department for which cost sharing may be imposed under subsection (e)), and may vary such premiums and cost sharing among such groups or types, consistent with the limitations established under this section. Nothing in this section shall be construed as superseding (or preventing the application of) subsection (g), (i), (j), or (k) of section 1396 o of this title.
(2)Exemption for individuals with family income not exceeding 100 percent of the poverty line#
(A) In general Paragraph (1) and subsection (d) shall not apply, and sections 1396 o and 1396a(a)(10)(B) of this title shall continue to apply, in the case of an individual whose family income does not exceed 100 percent of the poverty line applicable to a family of the size involved.
(B) Limit on aggregate cost sharing To the extent cost sharing under subsections (c) and (e) or under section 1396 o of this title is imposed against individuals described in subparagraph (A), the limitation under subsection (b)(1)(B)(ii) on the total aggregate amount of cost sharing shall apply to such cost sharing for all individuals in a family described in subparagraph (A) in the same manner as such limitations apply to cost sharing and families described in subsection (b)(1)(B)(ii).
(2)(A)In general#
Paragraph (1) and subsection (d) shall not apply, and sections 1396 o and 1396a(a)(10)(B) of this title shall continue to apply, in the case of an individual whose family income does not exceed 100 percent of the poverty line applicable to a family of the size involved.
(2)(B)Limit on aggregate cost sharing#
To the extent cost sharing under subsections (c) and (e) or under section 1396 o of this title is imposed against individuals described in subparagraph (A), the limitation under subsection (b)(1)(B)(ii) on the total aggregate amount of cost sharing shall apply to such cost sharing for all individuals in a family described in subparagraph (A) in the same manner as such limitations apply to cost sharing and families described in subsection (b)(1)(B)(ii).
(3)Definitions#
In this section:
(A) Premium The term “premium” includes any enrollment fee or similar charge.
(B) Cost sharing The term “cost sharing” includes any deduction, copayment, or similar charge.
(3)(A)Premium#
The term “premium” includes any enrollment fee or similar charge.
(3)(B)Cost sharing#
The term “cost sharing” includes any deduction, copayment, or similar charge.