States can choose to impose limited enrollment fees, premiums, deductibles, coinsurance, and copayments for children and pregnant women enrolled in CHIP, generally limited to 5% of a family’s annual income. Cost sharing is prohibited for some services, like well-baby and well-child visits.

Medicaid Expansion Cost Sharing

States with Medicaid expansion programs must follow the Medicaid cost sharing rules.

Separate CHIP Program Cost Sharing

For families with incomes at or below 150% of the Federal poverty level (FPL), premiums cannot exceed the amount permitted in Medicaid.

For families with incomes above 150% of the FPL, state cost sharing requirements can’t exceed 5% of family income.