Section 71120 Cost Sharing Begins October 1, 2028, Implementation Watch
Issue
Medicaid financing and eligibility operationsTaking effect
Public Law 119-21, Section 71120 requires states to impose an amount greater than $0 on certain non-exempt care, items, or services selected by the state beginning October 1, 2028 for specified expansion adults above 100% FPL. The general ceiling is $35, with separate prescription-drug limits.
The new charge excludes protected services, primary care, mental health care, substance use disorder services, and services provided by FQHCs, CCBHCs, and RHCs. Those exclusions do not establish a universal patient quote or any provider-switching, visit, reimbursement, revenue, staffing, or financial outcome.
Key points
- The mandatory framework begins October 1, 2028 and applies to specified expansion adults above 100% FPL, not every Medicaid enrollee.
- $35 is a general ceiling, not a standard charge; prescription drugs follow separate limits and family cost sharing remains capped at 5% of income.
- Verify CMS guidance, the state plan or waiver, plan configuration, service, site, and date before changing workflows or patient communications.
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Part of
FQHC Talent. (2026, February 24). Section 71120 Cost Sharing Begins October 1, 2028, Implementation Watch. Source: U.S. Government Publishing Office. Retrieved October 6, 2026, from https://www.fqhctalent.com/intel/fqhc-copay-exemption