Subject to subsections (g), (i), and (j), the State plan shall provide that in the case of individuals described in subparagraph (A) or (E)(i) of section 1396a(a)(10) of this title who are eligible under the plan-
The State plan shall provide that in the case of individuals other than those described in subparagraph (A) or (E) of section 1396a(a)(10) of this title who are eligible under the plan-
With respect to a qualified disabled and working individual described in section 1396d(s) of this title whose income (as determined under paragraph (3) of that section) exceeds 150 percent of the official poverty line referred to in that paragraph, the State plan of a State may provide for the charging of a premium (expressed as a percentage of the medicare cost-sharing described in section 1396d(p)(3)(A)(i) of this title provided with respect to the individual) according to a sliding scale under which such percentage increases from 0 percent to 100 percent, in reasonable increments (as determined by the Secretary), as the individual's income increases from 150 percent of such poverty line to 200 percent of such poverty line.
The State plan shall require that no provider participating under the State plan may deny care or services to an individual eligible for such care or services under the plan on account of such individual's inability to pay a deduction, cost sharing, or similar charge. The requirements of this subsection shall not extinguish the liability of the individual to whom the care or services were furnished for payment of the deduction, cost sharing, or similar charge.
No deduction, cost sharing, or similar charge may be imposed under any waiver authority of the Secretary, except as provided in subsections (a)(3) and (b)(3) and section 1396o-1 of this title, unless such waiver is for a demonstration project which the Secretary finds after public notice and opportunity for comment-
With respect to individuals provided medical assistance only under subclause (XV) or (XVI) of section 1396a(a)(10)(A)(ii) of this title-
In the case of any calendar year beginning after 2000, the dollar amount specified in paragraph (2) shall be increased in accordance with the provisions of section 415(i)(2)(A)(ii) of this title.
In applying this section and subsections (c) and (e) of section 1396o-1 of this title, with respect to cost sharing that is "nominal" in amount, the Secretary shall increase such "nominal" amounts for each year (beginning with 2006) by the annual percentage increase in the medical care component of the consumer price index for all urban consumers (U.S. city average) as rounded up in an appropriate manner.
No enrollment fee, premium, or similar charge, and no deduction, copayment, cost sharing, or similar charge shall be imposed against an Indian who is furnished an item or service directly by the Indian Health Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization or through referral under contract health services for which payment may be made under this subchapter.
Payment due under this subchapter to the Indian Health Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization, or a health care provider through referral under contract health services for the furnishing of an item or service to an Indian who is eligible for assistance under such subchapter, may not be reduced by the amount of any enrollment fee, premium, or similar charge, or any deduction, copayment, cost sharing, or similar charge that would be due from the Indian but for the operation of subparagraph (A).
Nothing in this subsection shall be construed as restricting the application of any other limitations on the imposition of premiums or cost sharing that may apply to an individual receiving medical assistance under this subchapter who is an Indian.
42 U.S.C. § 1396o
EDITORIAL NOTES
REFERENCES IN TEXTThe Internal Revenue Code of 1986, referred to in subsec. (g)(2), is classified generally to Title 26, Internal Revenue Code.
AMENDMENTS2022-Subsec. (a)(2)(G). Pub. L. 117-169, §11405(a)(2)(A)(i)(I), inserted a comma after "State plan". Subsec. (a)(2)(J). Pub. L. 117-169, §11405(a)(2)(A)(i)(II)-(IV), added subpar. (J).Subsec. (b)(2)(G). Pub. L. 117-169, §11405(a)(2)(A)(ii)(I), inserted a comma after "State plan". Subsec. (b)(2)(J). Pub. L. 117-169, §11405(a)(2)(A)(ii)(II)-(IV), added subpar. (J). 2021-Subsecs. (a)(2)(H), (I), (b)(2)(H), (I). Pub. L. 117-2 added subpars. (H) and (I). 2020-Subsecs. (a)(2)(F), (G), (b)(2)(F), (G). Pub. L. 116-127 added subpars. (F) and (G). 2010-Subsecs. (a)(2)(B), (b)(2)(B). Pub. L. 111-148 inserted ",and counseling and pharmacotherapy for cessation of tobacco use by pregnant women (as defined in section 1396d(bb) of this title) and covered outpatient drugs (as defined in subsection (k)(2) of section 1396r-8 of this title and including nonprescription drugs described in subsection (d)(2) of such section) that are prescribed for purposes of promoting, and when used to promote, tobacco cessation by pregnant women in accordance with the Guideline referred to in section 1396d(bb)(2)(A) of this title" after "complicate the pregnancy". 2009-Subsec. (a). Pub. L. 111-5, §5006(a)(1)(A), substituted ",(i), and (j)" for "and (i)" in introductory provisions.Subsec. (j). Pub. L. 111-5, §5006(a)(1)(B), added subsec. (j).2006-Subsec. (a). Pub. L. 109-171, §6062(b)(1), substituted "subsections (g) and (i)" for "subsection (g)" in introductory provisions.Subsec. (f). Pub. L. 109-171, §6041(b)(1), inserted "and section 1396o-1 of this title" after "(b)(3)".Subsec. (h). Pub. L. 109-171, §6041(b)(2), added subsec. (h).Subsec. (i). Pub. L. 109-171, §6062(b)(2), added subsec. (i). 1999-Subsec. (a). Pub. L. 106-170, §201(a)(3)(A), substituted "Subject to subsection (g), the State plan" for "The State plan" in introductory provisions.Subsec. (g). Pub. L. 106-170, §201(a)(3)(B), added subsec. (g). 1997-Subsec. (a)(2)(D). Pub. L. 105-33, §4708(b)(1), struck out "or services furnished to such an individual by a health maintenance organization (as defined in section 1396b(m) of this title) in which he is enrolled," after "section 1396d(a)(4)(C) of this title,". Subsec. (b)(2)(D). Pub. L. 105-33, §4708(b)(2), struck out "or (at the option of the State) services furnished to such an individual by a health maintenance organization (as defined in section 1396b(m) of this title) in which he is enrolled," after "section 1396d(a)(4)(C) of this title,". 1989-Subsec. (a). Pub. L. 101-239, §6408(d)(3)(A), substituted "subparagraph (A) or (E)(i)" for "subparagraph (A) or (E)" in introductory provisions.Subsecs. (d) to (f). Pub. L. 101-239, §6408(d)(3)(B), (C), added subsec. (d) and redesignated former subsecs. (d) and (e) as (e) and (f), respectively. 1988-Subsec. (c)(1). Pub. L. 100-360 struck out "nonfarm" after "150 percent of the".1987-Subsec. (a)(1). Pub. L. 100-203, §4101(d)(1)(A), inserted "(except for a premium imposed under subsection (c))" after "plan".Subsecs. (a)(2)(C), (b)(2)(C). Pub. L. 100-203, §4211(h)(11), substituted "nursing facility, intermediate care facility for the mentally retarded" for "skilled nursing facility, intermediate care facility".Subsecs. (c) to (e). Pub. L. 100-203, §4101(d)(1)(B), (C), added subsec. (c) and redesignated former subsecs. (c) and (d) as (d) and (e), respectively. 1986-Subsec. (a). Pub. L. 99-509 substituted "subparagraph (A) or (E) of section 1396a(a)(10) of this title" for "section 1396a(a)(10)(A) of this title".Subsec. (a)(2)(E). Pub. L. 99-272 added subpar. (E).Subsec. (b). Pub. L. 99-509 substituted "subparagraph (A) or (E) of section 1396a(a)(10) of this title" for "section 1396a(a)(10)(A) of this title".Subsec. (b)(2)(E). Pub. L. 99-272 added subpar. (E).1983-Subsec. (c). Pub. L. 97-448, §309(b)(18), substituted "subsection" for "subparagraph". Subsec. (d). Pub. L. 97-448, §309(b)(19), (20), substituted in introductory text ",except as provided in subsections (a)(3) and (b)(3)" for "unless authorized under this section", and in cl. (5) substituted "is voluntary, or makes provision" for "in which participation is voluntary, or in which provision is made".
STATUTORY NOTES AND RELATED SUBSIDIARIES
EFFECTIVE DATE OF 2022 AMENDMENT Amendment by Pub. L. 117-169 effective on the 1st day of the 1st fiscal quarter that begins on or after the date that is 1 year after Aug. 16, 2022, and applicable to expenditures made under a State plan or waiver of such plan under title XIX of the Social Security Act or under a State child health plan or waiver of such plan under title XXI of such Act on or after such effective date, see section 11405(c) of Pub. L. 117-169 set out as a note under section 1396a of this title.
EFFECTIVE DATE OF 2010 AMENDMENT Amendment by Pub. L. 111-148 effective Oct. 1, 2010, see section 4107(d) of Pub. L. 111-148 set out as a note under section 1396d of this title.
EFFECTIVE DATE OF 2009 AMENDMENT Amendment by Pub. L. 111-5 effective July 1, 2009, see section 5006(f) of Pub. L. 111-5 set out as a note under section 1396a of this title.
EFFECTIVE DATE OF 2006 AMENDMENT Pub. L. 109-171, title VI, §6041(c), Feb. 8, 2006, 120 Stat. 85, provided that: "The amendments made by this section [enacting section 1396o-1 of this title and amending this section] shall apply to cost sharing imposed for items and services furnished on or after March 31, 2006." Amendment by section 6062(b) of Pub. L. 109-171 applicable to medical assistance for items and services furnished on or after Jan. 1, 2007, see section 6062(d) of Pub. L. 109-171 set out as a note under section 1396a of this title.
EFFECTIVE DATE OF 1999 AMENDMENT Amendment by Pub. L. 106-170 applicable to medical assistance for items and services furnished on or after Oct. 1, 2000, see section 201(d) of Pub. L. 106-170 set out as a note under section 1396a of this title.
EFFECTIVE DATE OF 1997 AMENDMENT Amendment by Pub. L. 105-33 effective Aug. 5, 1997, and applicable to contracts entered into or renewed on or after Oct. 1, 1997, see section 4710 of Pub. L. 105-33 set out as a note under section 1396b of this title.
EFFECTIVE DATE OF 1989 AMENDMENT Amendment by Pub. L. 101-239 applicable, except as otherwise provided, to payments under this subchapter for calendar quarters beginning on or after July 1, 1990, without regard to whether or not final regulations have been promulgated by such date, see section 6408(d)(5) of Pub. L. 101-239 set out as a note under section 1396a of this title.
EFFECTIVE DATE OF 1988 AMENDMENT Except as specifically provided in section 411 of Pub. L. 100-360 amendment by Pub. L. 100-360 as it relates to a provision in the Omnibus Budget Reconciliation Act of 1987, Pub. L. 100-203 effective as if included in the enactment of that provision in Pub. L. 100-203, see section 411(a) of Pub. L. 100-360 set out as a Reference to OBRA; Effective Date note under section 106 of Title 1, General Provisions.
EFFECTIVE DATE OF 1987 AMENDMENT Pub. L. 100-203, title IV, §4101(d)(2), Dec. 22, 1987, 101 Stat. 1330-142, provided that: "The amendments made by paragraph (1) [amending this section] shall become effective on July 1, 1988."Amendment by section 4211(h)(11) of Pub. L. 100-203 applicable to nursing facility services furnished on or after Oct. 1, 1990, without regard to whether regulations implementing such amendment are promulgated by such date, except as otherwise specifically provided in section 1396r of this title, with transitional rule, see section 4214(a), (b)(2) of Pub. L. 100-203 as amended, set out as an Effective Date note under section 1396r of this title.
EFFECTIVE DATE OF 1986 AMENDMENT Amendment by Pub. L. 99-509 applicable to payments under this subchapter for calendar quarters beginning on or after July 1, 1987, without regard to whether or not final regulations to carry out such amendments have been promulgated by such date, see section 9403(h) of Pub. L. 99-509 set out as a note under section 1396a of this title.Amendment by Pub. L. 99-272 applicable to medical assistance provided for hospice care furnished on or after Apr. 7, 1986, see section 9505(e) of Pub. L. 99-272 set out as a note under section 1396a of this title.
EFFECTIVE DATE OF 1983 AMENDMENT Amendment by Pub. L. 97-448 effective as if originally included as a part of this section as this section was added by the Tax Equity and Fiscal Responsibility Act of 1982, Pub. L. 97-248, see section 309(c)(2) of Pub. L. 97-448 set out as a note under section 426-1 of this title.
EFFECTIVE DATE Pub. L. 97-248, title I, §131(d), formerly §131(c), Sept. 3, 1982, 96 Stat. 370, redesignated by Pub. L. 97-448, title III, §309(a)(8), Jan. 12, 1983, 96 Stat. 2408, provided that:"(1) Except as provided in paragraph (2), the amendments made by this section [enacting this section and amending section 1396a of this title] shall become effective on October 1, 1982. "(2) In the case of a State plan for medical assistance under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.] which the Secretary of Health and Human Services determines requires State legislation in order for the plan to meet the additional requirements imposed by the amendments made by this section, the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act [Sept. 3, 1982]."
APPLICABILITY OF 2020 AMENDMENT TO TERRITORIES Pub. L. 116-127, div. F, §6004(a)(2)(C), Mar. 18, 2020, 134 Stat. 205, provided that: "The amendments made [by] this paragraph [amending this section and section 1396o-1 of this title] shall apply with respect to a State plan of a territory in the same manner as a State plan of one of the 50 States."
- Secretary
- The term "Secretary" means the Secretary of Housing and Urban Development.1See References in Text note below.
- project
- The terms "federally assisted housing" and "project" mean-(A) a public housing project (as such term is defined in section 3(b) of the United States Housing Act of 1937 [42 U.S.C. 1437a(b)] );(B) housing for which project-based assistance is provided under section 8 of the United States Housing Act of 1937 [42 U.S.C. 1437f] ;(C) housing that is assisted under section 1701q of title 12;(D) housing that is assisted under section 1701q of title 12, as such section existed before November 28, 1990;(E) housing financed by a loan or mortgage insured under section 1715l(d)(3) of title 12 that bears interest at a rate determined under the proviso of section 1715l(d)(5) of title 12;(F) housing insured, assisted, or held by the Secretary or a State or State agency under section 1715z-1 of title 12;(G) housing constructed or substantially rehabilitated pursuant to assistance provided under section 8(b)(2) of the United States Housing Act of 1937 [42 U.S.C. 1437f(b)(2)], as in effect before October 1, 1983, that is assisted under a contract for assistance under such section; and(H) housing that is assisted under section 80131 of this title.