441—22.3  (225D)  Cost-sharing requirements and graduated schedule of cost sharing.
	   22.3(1) An individual with a household income equal to or greater than 200 percent of the federal poverty level, up to a maximum of 500 percent of the federal poverty level, shall be subject to cost-sharing requirements. Cost sharing shall be implemented incrementally up to a maximum of 15 percent of the costs of the services provided through the program for an individual with a household income equal to 500 percent of the federal poverty level. The following is a chart of the cost-sharing requirements:
Family income as
a % of FPL	% of cost sharing
of service costs	Family income as
a % of FPL	% of cost sharing
of service costs	
200–209%	0.5%	350–359%	8.0%	
210–219%	1.0%	360–369%	8.5%	
220–229%	1.5%	370–379%	9.0%	
230–239%	2.0%	380–389%	9.5%	
240–249%	2.5%	390–399%	10.0%	
250–259%	3.0%	400–409%	10.5%	
260–269%	3.5%	410–419%	11.0%	
270–279%	4.0%	420–429%	11.5%	
280–289%	4.5%	430–439%	12.0%	
290–299%	5.0%	440–449%	12.5%	
300–309%	5.5%	450–459%	13.0%	
310–319%	6.0%	460–469%	13.5%	
320–329%	6.5%	470–479%	14.0%	
330–339%	7.0%	480–489%	14.5%	
340–349%	7.5%	490–500%	15.0%	
	   22.3(2) An individual may request an exemption from cost sharing due to financial hardship. To qualify for an exemption, an individual shall submit written documentation to the department that the individual or the individual’s family does not have the financial means to fulfill cost-sharing requirements.
	   22.3(3) Criteria to determine financial hardship include, but are not limited to, a change in income, change in employment of the parent or guardian, additional medical expenditures, other family members’ health conditions, or other conditions which may affect the ability to fulfill cost-sharing requirements. The department shall provide a written determination regarding eligibility for exemption from cost-sharing requirements. Eligibility for exemption from cost sharing expires at the end of the financial eligibility period.
[ ARC 1329C , IAB 2/19/14, effective 4/1/14;    ARC 2816C , IAB 11/23/16, effective 1/1/17]