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Out-of-Pocket Cost Exemptions

Population Groups Exempt from Out of Pocket Costs

  • Children under age 18 (or under age 19, 20, or 21 at the state's option) – states may impose alternative out of pocket costs on children under age 18 who are not covered under a mandatory categorically needy eligibility group or the Family Opportunity Act
  • Individuals living in an institution who are required to contribute all of their income (except a minimal amount required for personal needs) toward the cost of their care
  • Individuals receiving hospice care
  • American Indians and Alaska Natives who have ever received a service from the Indian Health Service, tribal health programs, or under contract health services referral
  • Women who are enrolled in Medicaid under the Breast and Cervical Cancer Treatment Program are exempted from alternative out of pocket costs only

Services Exempt from Out of Pocket Costs

  • Emergency services
  • Family planning services
  • Pregnancy-related services, including tobacco cessation (states may choose to exempt all services provided to pregnant women)
  • Preventive services for children