Cost Sharing

States may impose cost sharing for some children enrolled in Medicaid, within federal guidelines. Except for “mandatory children” a state may impose premiums for children, with some limitations based on family income. Co-payments are also allowed, with some restrictions for children with family incomes up to 150% of the federal poverty level. States cannot count money raised through premiums or cost sharing as state dollars for the purposes of meeting the federal matching requirements.

For more information see: The Deficit Reduction Act: A Review of Key Medicaid Provisions Affecting Children and Families.

Research has shown that premiums in Medicaid and SCHIP depress enrollment because of the financial burden they impose on families, potentially increasing the number of uninsured children. For more information see:

• Increasing Premiums and Cost Sharing in Medicaid and SCHIP: Recent State Experiences, Kaiser Commission on Medicaid and the Uninsured (May 2005).
• The Effect of Increased Cost Sharing in Medicaid: A Summary of Research Findings, Center on Budget and Policy Priorities (July 7, 2005).