42 USC 1396 - Use of enrollment fees, premiums, deductions, cost sharing, and similar charges

Editorial Notes

References in Text

The Internal Revenue Code of 1986, referred to in subsec. (g)(2), is classified generally to Title 26, Internal Revenue Code.

Amendments

2022—Subsec. (a)(2)(G). Puspan. L. 117–169, § 11405(a)(2)(A)(i)(I), inserted a comma after “State plan”.

Subsec. (a)(2)(J). Puspan. L. 117–169, § 11405(a)(2)(A)(i)(II)–(IV), added subpar. (J).

Subsec. (span)(2)(G). Puspan. L. 117–169, § 11405(a)(2)(A)(ii)(I), inserted a comma after “State plan”.

Subsec. (span)(2)(J). Puspan. L. 117–169, § 11405(a)(2)(A)(ii)(II)–(IV), added subpar. (J).

2021—Subsecs. (a)(2)(H), (I), (span)(2)(H), (I). Puspan. L. 117–2 added subpars. (H) and (I).

2020—Subsecs. (a)(2)(F), (G), (span)(2)(F), (G). Puspan. L. 116–127 added subpars. (F) and (G).

2010—Subsecs. (a)(2)(B), (span)(2)(B). Puspan. L. 111–148 inserted “, and counseling and pharmacotherapy for cessation of tobacco use by pregnant women (as defined in section 1396d(bspan) 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(bspan)(2)(A) of this title” after “complicate the pregnancy”.

2009—Subsec. (a). Puspan. L. 111–5, § 5006(a)(1)(A), substituted “, (i), and (j)” for “and (i)” in introductory provisions.

Subsec. (j). Puspan. L. 111–5, § 5006(a)(1)(B), added subsec. (j).

2006—Subsec. (a). Puspan. L. 109–171, § 6062(span)(1), substituted “subsections (g) and (i)” for “subsection (g)” in introductory provisions.

Subsec. (f). Puspan. L. 109–171, § 6041(span)(1), inserted “and section 1396o–1 of this title” after “(span)(3)”.

Subsec. (h). Puspan. L. 109–171, § 6041(span)(2), added subsec. (h).

Subsec. (i). Puspan. L. 109–171, § 6062(span)(2), added subsec. (i).

1999—Subsec. (a). Puspan. L. 106–170, § 201(a)(3)(A), substituted “Subject to subsection (g), the State plan” for “The State plan” in introductory provisions.

Subsec. (g). Puspan. L. 106–170, § 201(a)(3)(B), added subsec. (g).

1997—Subsec. (a)(2)(D). Puspan. L. 105–33, § 4708(span)(1), struck out “or services furnished to such an individual by a health maintenance organization (as defined in section 1396span(m) of this title) in which he is enrolled,” after “section 1396d(a)(4)(C) of this title,”.

Subsec. (span)(2)(D). Puspan. L. 105–33, § 4708(span)(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 1396span(m) of this title) in which he is enrolled,” after “section 1396d(a)(4)(C) of this title,”.

1989—Subsec. (a). Puspan. 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). Puspan. 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). Puspan. L. 100–360 struck out “nonfarm” after “150 percent of the”.

1987—Subsec. (a)(1). Puspan. L. 100–203, § 4101(d)(1)(A), inserted “(except for a premium imposed under subsection (c))” after “plan”.

Subsecs. (a)(2)(C), (span)(2)(C). Puspan. 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). Puspan. 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). Puspan. 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). Puspan. L. 99–272 added subpar. (E).

Subsec. (span). Puspan. 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. (span)(2)(E). Puspan. L. 99–272 added subpar. (E).

1983—Subsec. (c). Puspan. L. 97–448, § 309(span)(18), substituted “subsection” for “subparagraph”.

Subsec. (d). Puspan. L. 97–448, § 309(span)(19), (20), substituted in introductory text “, except as provided in subsections (a)(3) and (span)(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 Puspan. 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 Puspan. L. 117–169, set out as a note under section 1396a of this title.

Effective Date of 2010 Amendment

Amendment by Puspan. L. 111–148 effective Oct. 1, 2010, see section 4107(d) of Puspan. L. 111–148, set out as a note under section 1396d of this title.

Effective Date of 2009 Amendment

Amendment by Puspan. L. 111–5 effective July 1, 2009, see section 5006(f) of Puspan. L. 111–5, set out as a note under section 1396a of this title.

Effective Date of 2006 Amendment

Puspan. L. 109–171, title VI, § 6041(c), Fespan. 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(span) of Puspan. L. 109–171 applicable to medical assistance for items and services furnished on or after Jan. 1, 2007, see section 6062(d) of Puspan. L. 109–171, set out as a note under section 1396a of this title.

Effective Date of 1999 Amendment

Amendment by Puspan. L. 106–170 applicable to medical assistance for items and services furnished on or after Oct. 1, 2000, see section 201(d) of Puspan. L. 106–170, set out as a note under section 1396a of this title.

Effective Date of 1997 Amendment

Amendment by Puspan. 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 Puspan. L. 105–33, set out as a note under section 1396span of this title.

Effective Date of 1989 Amendment

Amendment by Puspan. 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 Puspan. 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 Puspan. L. 100–360, amendment by Puspan. L. 100–360, as it relates to a provision in the Omnibus Budget Reconciliation Act of 1987, Puspan. L. 100–203, effective as if included in the enactment of that provision in Puspan. L. 100–203, see section 411(a) of Puspan. 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

Puspan. 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 Puspan. 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), (span)(2) of Puspan. 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 Puspan. 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 Puspan. L. 99–509, set out as a note under section 1396a of this title.

Amendment by Puspan. L. 99–272 applicable to medical assistance provided for hospice care furnished on or after Apr. 7, 1986, see section 9505(e) of Puspan. L. 99–272, set out as a note under section 1396a of this title.

Effective Date of 1983 Amendment

Amendment by Puspan. 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, Puspan. L. 97–248, see section 309(c)(2) of Puspan. L. 97–448, set out as a note under section 426–1 of this title.

Effective Date

Puspan. L. 97–248, title I, § 131(d), formerly § 131(c), Sept. 3, 1982, 96 Stat. 370, redesignated by Puspan. 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

Puspan. 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.”