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Alternative Premiums & Cost-Sharing Sections 6041 and 6042 of the DRA allow States to vary the premiums and cost-sharing that they charge to certain Medicaid recipients. No premiums are permitted for families with income above 100 percent and at/or below 150 percent of the Federal Poverty Limit (FPL). Cost-sharing up to 10 percent of the cost of services is permitted within this group. Above 150 percent of the FPL, premiums are permitted and cost-sharing up to 20 percent of the cost of services is allowed. No premiums or cost-sharing are permitted for families with incomes below 100 percent of the FPL. The DRA contains special rules on cost-sharing for prescription drugs and non-emergency care provided in emergency rooms (ER). In addition, States have the option to require payment of alternative premiums as a condition of eligibility and alternative cost-sharing as a condition of receipt of the service or drug, or cost-sharing for non-emergency services in the ER. The DRA provides that the aggregate premium and/or cost-sharing amounts must not exceed 5 percent of the family's income for all family members for the month or quarter period. As part of the ER provision, the DRA sets up a grant program that provides $50 million in funding for States to establish non-emergency alternative providers.
Page Last Modified: 02/22/2008 1:05:47 PM
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