A charge may not top $35 and the family total is capped at 5 percent of income
What the document says“in no case may a deduction, cost sharing, or similar charge imposed under the State plan with respect to care or an item or service furnished to a specified individual exceed $35.”
The section caps a charge for care, an item or a service at $35, with prescription drugs capped instead by the limits that would apply under section 1916A(c), and caps the total charges for everyone in a family at 5 percent of family income, applied quarterly or monthly as the State specifies. A State may let a provider require payment as a condition of care, and a provider may still reduce or waive it case by case.
What the document actually says“in no case may a deduction, cost sharing, or similar charge imposed under the State plan with respect to care or an item or service furnished to a specified individual exceed $35.”
No single charge may top $35. That covers care, an item or a service.
Prescription drugs follow a different cap. The family total may not top 5 percent of income. A provider may still waive a charge.
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