42 CFR § 457.515 - Co-payments, coinsurance, deductibles, or similar cost-sharing charges: State plan requirements.

---
identifier: "/us/cfr/t42/s457.515"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 457.515 - Co-payments, coinsurance, deductibles, or similar cost-sharing charges: State plan requirements."
title_number: 42
title_name: "Public Health"
section_number: "457.515"
section_name: "Co-payments, coinsurance, deductibles, or similar cost-sharing charges: State plan requirements."
chapter_name: "CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES"
subchapter_number: "D"
subchapter_name: "STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs)"
part_number: "457"
part_name: "ALLOTMENTS AND GRANTS TO STATES"
positive_law: false
currency: "2026-04-05"
last_updated: "2026-04-05"
format_version: "1.1.0"
generator: "[email protected]"
authority: "42 U.S.C. 1302."
regulatory_source: "65 FR 33622, May 24, 2000, unless otherwise noted."
cfr_part: "457"
---


# 457.515 Co-payments, coinsurance, deductibles, or similar cost-sharing charges: State plan requirements.

To impose copayments, coinsurance, deductibles or similar charges on enrollees, the State plan must describe—

(a) The service for which the charge is imposed;

(b) The amount of the charge;

(c) The group or groups of enrollees that may be subject to the cost-sharing charge;

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

(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; and

(f) An assurance that enrollees will not be held liable for cost-sharing amounts for emergency services that are provided at a facility that does not participate in the enrollee's managed care network beyond the copayment amounts specified in the State plan for emergency services as defined in § 457.10.