C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER D—STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) › PART 457—ALLOTMENTS AND GRANTS TO STATES › Subpart E—State Plan Requirements: Enrollee Financial Responsibilities

42 C.F.R. § 457.510

Premiums, enrollment fees, or similar fees: State plan requirements

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When a State imposes premiums, enrollment fees, or similar fees on enrollees, the State plan must describe—

(a) The amount of the premium, enrollment fee or similar fee imposed on enrollees;

(b) The time period for which the charge is imposed;

(c) The group or groups that are subject to the premiums, enrollment fees, or similar charges;

(d) The consequences for an enrollee or applicant who does not pay a charge, and the disenrollment protections adopted by the State in accordance with § 457.570; and

(e) The methodology used to ensure that total cost-sharing liability for a family does not exceed the cumulative cost-sharing maximum specified in § 457.560.

Notes of Decisions
Cited in 1 case (1 in the last 5 years), 2024–2024 · leading case: State of Florida v. Centers for Medicare & Medicaid Servs. (M.D. Fla. 2024).
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State of Florida v. Centers for Medicare & Medicaid Servs. (M.D. Fla. 2024). “§ 1397cc(e)(1)(A); 42 C.F.R. § 457.510 . States can also disenroll CHIP participants for nonpayment of premiums if the state provides sufficient notice and a grace period for late payments.”
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