Idaho Administrative Code
Title IDAPA 16 - Health and Welfare, Department of
Rule 16.03.18 - MEDICAID COST-SHARING
Section 16.03.18.050 - GENERAL COST-SHARING
Current through August 31, 2023
01. Cost-Sharing Maximum Amount. A family will be required to pay out of pocket costs not to exceed five percent (5%) of the family's anticipated gross monthly income unless an exception is made as provided in Subsection 050.02 of this rule. (3-15-22)
02. Exception to Cost-Sharing Maximum. A family will be required to pay cost-sharing amounts as provided in Sections 215 and 400 of these rules. These cost-sharing amounts may exceed the family's five percent (5%) of anticipated gross monthly income. (3-15-22)
03. Proof of Cost-Sharing Payment. If a participant believes that their cost-sharing exceeded the five percent (5%) cost-sharing of the family's anticipated gross monthly income, they must provide proof to the Department of the copay amounts that were paid. (3-15-22)
04. Excess Cost-Sharing. A family that establishes proof of payment for cost-sharing that exceeds the five percent (5%) of the family's anticipated gross monthly income will be reimbursed by the Department for the amount paid that exceeds the five percent (5%), except as provided in Subsection 050.02 of this rule. (3-15-22)
05. Cost-Sharing Suspended. A family that exceeds the five percent (5%) maximum amount for cost sharing will not be required to pay a cost-sharing portion for any family participant for the remainder of the calendar month in which proof of payment is established. (3-15-22)
