Medicaid Model Data Lab
Medicaid and CHIP Form Repository
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Medicaid Premiums and Cost Sharing PDF Forms

PDF Forms:

  • G1: Cost Sharing Requirements
  • G2a: Cost Sharing Amounts - Categorically Needy
  • G2b: Cost Sharing Amounts - Medically Needy
  • G2c: Cost Sharing Amounts - Targeting
  • G3: Cost Sharing Limitations