NOTICES
DEPARTMENT OF
PUBLIC WELFARE
Income Limits and Co-payments for the Subsidized Child Care Program
[41 Pa.B. 2172]
[Saturday, April 23, 2011]The purpose of this notice is to increase the income limits codified at 55 Pa. Code Chapter 3041, Appendix B (relating to co-payment chart family co-payment scale (based on the 2011 Federal Poverty Income Guidelines (FPIG)) under 55 Pa. Code § 3041.107(b) (relating to availability and use of the Federal Poverty Income Guidelines). This increase is effective May 2, 2011.
Section 3041.107(b) of 55 Pa. Code requires the Department of Public Welfare to update the copayment schedule in 55 Pa. Code Chapter 3041, Appendix B to reflect changes in the FPIGs. Effective May 2, 2011, the income guidelines for the subsidized child care program are increased due to increases in the FPIG. The copayment schedule is adjusted to reflect the increases. Chapter 3041, Appendix B of 55 Pa. Code also establishes the family copayment levels according to the family's computed annual income and lists the weekly family copayment based on the annual family income.
GARY D. ALEXANDER,
Acting SecretaryFiscal Note: 14-NOT-685. No fiscal impact; (8) recommends adoption.
CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE
(BASED ON THE 2011 FEDERAL POVERTY INCOME GUIDELINES)
Weekly Family Size: 1 Family Size: 2 Family Size: 3 Co-pay Annual Income Annual Income Annual Income $5.00 Less than:
$8,890 Less than:
$12,710 Less than:
$14,530 $10.00 $8,890.01 $10,890 $12,710.01 $14,710 $14,530.01 $16,530 $15.00 $10,890.01 $12,890 $14,710.01 $16,710 $16,530.01 $18,530 $20.00 $12,890.01 $14,890 $16,710.01 $18,710 $18,530.01 $20,530 $25.00 $14,890.01 $16,890 $18,710.01 $20,710 $20,530.01 $22,530 $30.00 $16,890.01 $18,890 $20,710.01 $22,710 $22,530.01 $24,530 $35.00 $18,890.01 $20,890 $22,710.01 $24,710 $24,530.01 $26,530 $40.00 $20,890.01 $22,890 $24,710.01 $26,710 $26,530.01 $28,530 $45.00 $22,890.01 $24,890 $26,710.01 $28,710 $28,530.01 $30,530 $50.00 $24,890.01 $25,592 $28,710.01 $30,710 $30,530.01 $32,530 $55.00 $30,710.01 $32,710 $32,530.01 $34,530 $60.00 $32,710.01 $34,569 $34,530.01 $36,530 $65.00 $36,530.01 $38,530 $70.00 $38,530.01 $40,530 $75.00 $40,530.01 $42,530 $80.00 $42,530.01 $43,546 200% FPIG $21,780 200% FPIG $29,420 200% FPIG $37,060
CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE
(BASED ON THE 2011 FEDERAL POVERTY INCOME GUIDELINES)
Weekly Family Size: 4 Family Size: 5 Family Size: 6 Co-pay Annual Income Annual Income Annual Income $5.00 Less than:
$16,350 Less than:
$18,170 Less than:
$19,990 $10.00 $16,350.01 $18,350 $18,170.01 $20,170 $19,990.01 $21,990 $15.00 $18,350.01 $20,350 $20,170.01 $22,170 $21,990.01 $23,990 $20.00 $20,350.01 $22,350 $22,170.01 $24,170 $23,990.01 $25,990 $25.00 $22,350.01 $24,350 $24,170.01 $26,170 $25,990.01 $27,990 $30.00 $24,350.01 $26,350 $26,170.01 $28,170 $27,990.01 $29,990 $35.00 $26,350.01 $28,350 $28,170.01 $30,170 $29,990.01 $31,990 $40.00 $28,350.01 $30,350 $30,170.01 $32,170 $31,990.01 $33,990 $45.00 $30,350.01 $32,350 $32,170.01 $34,170 $33,990.01 $35,990 $50.00 $32,350.01 $34,350 $34,170.01 $36,170 $35,990.01 $37,990 $55.00 $34,350.01 $36,350 $36,170.01 $38,170 $37,990.01 $39,990 $60.00 $36,350.01 $38,350 $38,170.01 $40,170 $39,990.01 $41,990 $65.00 $38,350.01 $40,350 $40,170.01 $42,170 $41,990.01 $43,990 $70.00 $40,350.01 $42,350 $42,170.01 $44,170 $43,990.01 $45,990 $75.00 $42,350.01 $44,350 $44,170.01 $46,170 $45,990.01 $47,990 $80.00 $44,350.01 $46,350 $46,170.01 $48,170 $47,990.01 $49,990 $85.00 $46,350.01 $48,350 $48,170.01 $50,170 $49,990.01 $51,990 $90.00 $48,350.01 $50,350 $50,170.01 $52,170 $51,990.01 $53,990 $95.00 $50,350.01 $52,350 $52,170.01 $54,170 $53,990.01 $55,990 $100.00 $52,350.01 $52,523 $54,170.01 $56,170 $55,990.01 $57,990 $105.00 $56,170.01 $58,170 $57,990.01 $59,990 $110.00 $58,170.01 $60,170 $59,990.01 $61,990 $115.00 $60,170.01 $61,500 $61,990.01 $63,990 $120.00 $63,990.01 $65,990 $125.00 $65,990.01 $67,990 $130.00 $67,990.01 $69,990 $135.00 $69,990.01 $70,477 200% FPIG $44,700 200% FPIG $52,340 200% FPIG $59,980
CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE
(BASED ON THE 2011 FEDERAL POVERTY INCOME GUIDELINES)
Weekly Family Size: 7 Family Size: 8 Family Size: 9 Co-pay Annual Income Annual Income Annual Income $5.00 Less than:
$21,810 Less than:
$23,630 Less than:
$25,450 $10.00 $21,810.01 $23,810 $23,630.01 $25,630 $25,450.01 $27,450 $15.00 $23,810.01 $25,810 $25,630.01 $27,630 $27,450.01 $29,450 $20.00 $25,810.01 $27,810 $27,630.01 $29,630 $29,450.01 $31,450 $25.00 $27,810.01 $29,810 $29,630.01 $31,630 $31,450.01 $33,450 $30.00 $29,810.01 $31,810 $31,630.01 $33,630 $33,450.01 $35,450 $35.00 $31,810.01 $33,810 $33,630.01 $35,630 $35,450.01 $37,450 $40.00 $33,810.01 $35,810 $35,630.01 $37,630 $37,450.01 $39,450 $45.00 $35,810.01 $37,810 $37,630.01 $39,630 $39,450.01 $41,450 $50.00 $37,810.01 $39,810 $39,630.01 $41,630 $41,450.01 $43,450 $55.00 $39,810.01 $41,810 $41,630.01 $43,630 $43,450.01 $45,450 $60.00 $41,810.01 $43,810 $43,630.01 $45,630 $45,450.01 $47,450 $65.00 $43,810.01 $45,810 $45,630.01 $47,630 $47,450.01 $49,450 $70.00 $45,810.01 $47,810 $47,630.01 $49,630 $49,450.01 $51,450 $75.00 $47,810.01 $49,810 $49,630.01 $51,630 $51,450.01 $53,450 $80.00 $49,810.01 $51,810 $51,630.01 $53,630 $53,450.01 $55,450 $85.00 $51,810.01 $53,810 $53,630.01 $55,630 $55,450.01 $57,450 $90.00 $53,810.01 $55,810 $55,630.01 $57,630 $57,450.01 $59,450 $95.00 $55,810.01 $57,810 $57,630.01 $59,630 $59,450.01 $61,450 $100.00 $57,810.01 $59,810 $59,630.01 $61,630 $61,450.01 $63,450 $105.00 $59,810.01 $61,810 $61,630.01 $63,630 $63,450.01 $65,450 $110.00 $61,810.01 $63,810 $63,630.01 $65,630 $65,450.01 $67,450 $115.00 $63,810.01 $65,810 $65,630.01 $67,630 $67,450.01 $69,450 $120.00 $65,810.01 $67,810 $67,630.01 $69,630 $69,450.01 $71,450 $125.00 $67,810.01 $69,810 $69,630.01 $71,630 $71,450.01 $73,450 $130.00 $69,810.01 $71,810 $71,630.01 $73,630 $73,450.01 $75,450 $135.00 $71,810.01 $73,810 $73,630.01 $75,630 $75,450.01 $77,450 $140.00 $73,810.01 $75,810 $75,630.01 $77,630 $77,450.01 $79,450 $145.00 $75,810.01 $77,810 $77,630.01 $79,630 $79,450.01 $81,450 $150.00 $77,810.01 $79,454 $79,630.01 $81,630 $81,450.01 $83,450 $155.00 $81,630.01 $83,630 $83,450.01 $85,450 $160.00 $83,630.01 $85,630 $85,450.01 $87,450 $165.00 $85,630.01 $87,630 $87,450.01 $89,450 $170.00 $87,630.01 $88,431 $89,450.01 $91,450 $175.00 $91,450.01 $93,450 $180.00 $93,450.01 $95,450 $185.00 $95,450.01 $97,408 200% FPIG $67,620 200% FPIG $75,260 200% FPIG $82,900
CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE
(BASED ON THE 2011 FEDERAL POVERTY INCOME GUIDELINES)
Weekly Family Size: 10 Family Size: 11 Family Size: 12 Co-pay Annual Income Annual Income Annual Income $5.00 Less than:
$27,270 Less than:
$29,090 Less than:
$30,910 $10.00 $27,270.01 $29,270 $29,090.01 $31,090 $30,910.01 $32,910 $15.00 $29,270.01 $31,270 $31,090.01 $33,090 $32,910.01 $34,910 $20.00 $31,270.01 $33,270 $33,090.01 $35,090 $34,910.01 $36,910 $25.00 $33,270.01 $35,270 $35,090.01 $37,090 $36,910.01 $38,910 $30.00 $35,270.01 $37,270 $37,090.01 $39,090 $38,910.01 $40,910 $35.00 $37,270.01 $39,270 $39,090.01 $41,090 $40,910.01 $42,910 $40.00 $39,270.01 $41,270 $41,090.01 $43,090 $42,910.01 $44,910 $45.00 $41,270.01 $43,270 $43,090.01 $45,090 $44,910.01 $46,910 $50.00 $43,270.01 $45,270 $45,090.01 $47,090 $46,910.01 $48,910 $55.00 $45,270.01 $47,270 $47,090.01 $49,090 $48,910.01 $50,910 $60.00 $47,270.01 $49,270 $49,090.01 $51,090 $50,910.01 $52,910 $65.00 $49,270.01 $51,270 $51,090.01 $53,090 $52,910.01 $54,910 $70.00 $51,270.01 $53,270 $53,090.01 $55,090 $54,910.01 $56,910 $75.00 $53,270.01 $55,270 $55,090.01 $57,090 $56,910.01 $58,910 $80.00 $55,270.01 $57,270 $57,090.01 $59,090 $58,910.01 $60,910 $85.00 $57,270.01 $59,270 $59,090.01 $61,090 $60,910.01 $62,910 $90.00 $59,270.01 $61,270 $61,090.01 $63,090 $62,910.01 $64,910 $95.00 $61,270.01 $63,270 $63,090.01 $65,090 $64,910.01 $66,910 $100.00 $63,270.01 $65,270 $65,090.01 $67,090 $66,910.01 $68,910 $105.00 $65,270.01 $67,270 $67,090.01 $69,090 $68,910.01 $70,910 $110.00 $67,270.01 $69,270 $69,090.01 $71,090 $70,910.01 $72,910 $115.00 $69,270.01 $71,270 $71,090.01 $73,090 $72,910.01 $74,910 $120.00 $71,270.01 $73,270 $73,090.01 $75,090 $74,910.01 $76,910 $125.00 $73,270.01 $75,270 $75,090.01 $77,090 $76,910.01 $78,910 $130.00 $75,270.01 $77,270 $77,090.01 $79,090 $78,910.01 $80,910 $135.00 $77,270.01 $79,270 $79,090.01 $81,090 $80,910.01 $82,910 $140.00 $79,270.01 $81,270 $81,090.01 $83,090 $82,910.01 $84,910 $145.00 $81,270.01 $83,270 $83,090.01 $85,090 $84,910.01 $86,910 $150.00 $83,270.01 $85,270 $85,090.01 $87,090 $86,910.01 $88,910 $155.00 $85,270.01 $87,270 $87,090.01 $89,090 $88,910.01 $90,910 $160.00 $87,270.01 $89,270 $89,090.01 $91,090 $90,910.01 $92,910 $165.00 $89,270.01 $91,270 $91,090.01 $93,090 $92,910.01 $94,910 $170.00 $91,270.01 $93,270 $93,090.01 $95,090 $94,910.01 $96,910 $175.00 $93,270.01 $95,270 $95,090.01 $97,090 $96,910.01 $98,910 $180.00 $95,270.01 $97,270 $97,090.01 $99,090 $98,910.01 $100,910 $185.00 $97,270.01 $99,270 $99,090.01 $101,090 $100,910.01 $102,910 $190.00 $99,270.01 $101,270 $101,090.01 $103,090 $102,910.01 $104,910 $195.00 $101,270.01 $103,270 $103,090.01 $105,090 $104,910.01 $106,910 $200.00 $103,270.01 $105,270 $105,090.01 $107,090 $106,910.01 $108,910 $205.00 $105,270.01 $106,385 $107,090.01 $109,090 $108,910.01 $110,910 $210.00 $109,090.01 $111,090 $110,910.01 $112,910 $215.00 $111,090.01 $113,090 $112,910.01 $114,910 $220.00 $113,090.01 $115,090 $114,910.01 $116,910 $225.00 $115,090.01 $115,362 $116,910.01 $118,910 $230.00 $118,910.01 $120,910 $235.00 $120,910.01 $122,910 $240.00 $122,910.01 $124,339 200% FPIG $90,540 200% FPIG $98,180 200% FPIG $105,820
CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE
(BASED ON THE 2011 FEDERAL POVERTY INCOME GUIDELINES)
Weekly Family Size: 13 Family Size: 14 Family Size: 15 Co-pay Annual Income Annual Income Annual Income $5.00 Less than:
$32,730 Less than:
$34,550 Less than:
$36,370 $10.00 $32,730.01 $34,730 $34,550.01 $36,550 $36,370.01 $38,370 $15.00 $34,730.01 $36,730 $36,550.01 $38,550 $38,370.01 $40,370 $20.00 $36,730.01 $38,730 $38,550.01 $40,550 $40,370.01 $42,370 $25.00 $38,730.01 $40,730 $40,550.01 $42,550 $42,370.01 $44,370 $30.00 $40,730.01 $42,730 $42,550.01 $44,550 $44,370.01 $46,370 $35.00 $42,730.01 $44,730 $44,550.01 $46,550 $46,370.01 $48,370 $40.00 $44,730.01 $46,730 $46,550.01 $48,550 $48,370.01 $50,370 $45.00 $46,730.01 $48,730 $48,550.01 $50,550 $50,370.01 $52,370 $50.00 $48,730.01 $50,730 $50,550.01 $52,550 $52,370.01 $54,370 $55.00 $50,730.01 $52,730 $52,550.01 $54,550 $54,370.01 $56,370 $60.00 $52,730.01 $54,730 $54,550.01 $56,550 $56,370.01 $58,370 $65.00 $54,730.01 $56,730 $56,550.01 $58,550 $58,370.01 $60,370 $70.00 $56,730.01 $58,730 $58,550.01 $60,550 $60,370.01 $62,370 $75.00 $58,730.01 $60,730 $60,550.01 $62,550 $62,370.01 $64,370 $80.00 $60,730.01 $62,730 $62,550.01 $64,550 $64,370.01 $66,370 $85.00 $62,730.01 $64,730 $64,550.01 $66,550 $66,370.01 $68,370 $90.00 $64,730.01 $66,730 $66,550.01 $68,550 $68,370.01 $70,370 $95.00 $66,730.01 $68,730 $68,550.01 $70,550 $70,370.01 $72,370 $100.00 $68,730.01 $70,730 $70,550.01 $72,550 $72,370.01 $74,370 $105.00 $70,730.01 $72,730 $72,550.01 $74,550 $74,370.01 $76,370 $110.00 $72,730.01 $74,730 $74,550.01 $76,550 $76,370.01 $78,370 $115.00 $74,730.01 $76,730 $76,550.01 $78,550 $78,370.01 $80,370 $120.00 $76,730.01 $78,730 $78,550.01 $80,550 $80,370.01 $82,370 $125.00 $78,730.01 $80,730 $80,550.01 $82,550 $82,370.01 $84,370 $130.00 $80,730.01 $82,730 $82,550.01 $84,550 $84,370.01 $86,370 $135.00 $82,730.01 $84,730 $84,550.01 $86,550 $86,370.01 $88,370 $140.00 $84,730.01 $86,730 $86,550.01 $88,550 $88,370.01 $90,370 $145.00 $86,730.01 $88,730 $88,550.01 $90,550 $90,370.01 $92,370 $150.00 $88,730.01 $90,730 $90,550.01 $92,550 $92,370.01 $94,370 $155.00 $90,730.01 $92,730 $92,550.01 $94,550 $94,370.01 $96,370 $160.00 $92,730.01 $94,730 $94,550.01 $96,550 $96,370.01 $98,370 $165.00 $94,730.01 $96,730 $96,550.01 $98,550 $98,370.01 $100,370 $170.00 $96,730.01 $98,730 $98,550.01 $100,550 $100,370.01 $102,370 $175.00 $98,730.01 $100,730 $100,550.01 $102,550 $102,370.01 $104,370 $180.00 $100,730.01 $102,730 $102,550.01 $104,550 $104,370.01 $106,370 $185.00 $102,730.01 $104,730 $104,550.01 $106,550 $106,370.01 $108,370 $190.00 $104,730.01 $106,730 $106,550.01 $108,550 $108,370.01 $110,370 $195.00 $106,730.01 $108,730 $108,550.01 $110,550 $110,370.01 $112,370 $200.00 $108,730.01 $110,730 $110,550.01 $112,550 $112,370.01 $114,370 $205.00 $110,730.01 $112,730 $112,550.01 $114,550 $114,370.01 $116,370 $210.00 $112,730.01 $114,730 $114,550.01 $116,550 $116,370.01 $118,370 $215.00 $114,730.01 $116,730 $116,550.01 $118,550 $118,370.01 $120,370 $220.00 $116,730.01 $118,730 $118,550.01 $120,550 $120,370.01 $122,370 $225.00 $118,730.01 $120,730 $120,550.01 $122,550 $122,370.01 $124,370 $230.00 $120,730.01 $122,730 $122,550.01 $124,550 $124,370.01 $126,370 $235.00 $122,730.01 $124,730 $124,550.01 $126,550 $126,370.01 $128,370 $240.00 $124,730.01 $126,730 $126,550.01 $128,550 $128,370.01 $130,370 $245.00 $126,730.01 $128,730 $128,550.01 $130,550 $130,370.01 $132,370 $250.00 $128,730.01 $130,730 $130,550.01 $132,550 $132,370.01 $134,370 $255.00 $130,730.01 $132,730 $132,550.01 $134,550 $134,370.01 $136,370 $260.00 $132,730.01 $133,316 $134,550.01 $136,550 $136,370.01 $138,370 $265.00 $136,550.01 $138,550 $138,370.01 $140,370 $270.00 $138,550.01 $140,550 $140,370.01 $142,370 $275.00 $140,550.01 $142,293 $142,370.01 $144,370 $280.00 $144,370.01 $146,370 $285.00 $146,370.01 $148,370 $290.00 $148,370.01 $150,370 $295.00 $150,370.01 $151,270 200% FPIG $113,460 200% FPIG $121,100 200% FPIG $128,740
CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE
(BASED ON THE 2011 FEDERAL POVERTY INCOME GUIDELINES)
Weekly Family Size: 16 Family Size: 17 Family Size: 18 Co-pay Annual Income Annual Income Annual Income $5.00 Less than:
$40,190 Less than:
$42,010 Less than:
$43,830 $10.00 $40,190.01 $42,190 $42,010.01 $44,010 $43,830.01 $45,830 $15.00 $42,190.01 $44,190 $44,010.01 $46,010 $45,830.01 $47,830 $20.00 $44,190.01 $46,190 $46,010.01 $48,010 $47,830.01 $49,830 $25.00 $46,190.01 $48,190 $48,010.01 $50,010 $49,830.01 $51,830 $30.00 $48,190.01 $50,190 $50,010.01 $52,010 $51,830.01 $53,830 $35.00 $50,190.01 $52,190 $52,010.01 $54,010 $53,830.01 $55,830 $40.00 $52,190.01 $54,190 $54,010.01 $56,010 $55,830.01 $57,830 $45.00 $54,190.01 $56,190 $56,010.01 $58,010 $57,830.01 $59,830 $50.00 $56,190.01 $58,190 $58,010.01 $60,010 $59,830.01 $61,830 $55.00 $58,190.01 $60,190 $60,010.01 $62,010 $61,830.01 $63,830 $60.00 $60,190.01 $62,190 $62,010.01 $64,010 $63,830.01 $65,830 $65.00 $62,190.01 $64,190 $64,010.01 $66,010 $65,830.01 $67,830 $70.00 $64,190.01 $66,190 $66,010.01 $68,010 $67,830.01 $69,830 $75.00 $66,190.01 $68,190 $68,010.01 $70,010 $69,830.01 $71,830 $80.00 $68,190.01 $70,190 $70,010.01 $72,010 $71,830.01 $73,830 $85.00 $70,190.01 $72,190 $72,010.01 $74,010 $73,830.01 $75,830 $90.00 $72,190.01 $74,190 $74,010.01 $76,010 $75,830.01 $77,830 $95.00 $74,190.01 $76,190 $76,010.01 $78,010 $77,830.01 $79,830 $100.00 $76,190.01 $78,190 $78,010.01 $80,010 $79,830.01 $81,830 $105.00 $78,190.01 $80,190 $80,010.01 $82,010 $81,830.01 $83,830 $110.00 $80,190.01 $82,190 $82,010.01 $84,010 $83,830.01 $85,830 $115.00 $82,190.01 $84,190 $84,010.01 $86,010 $85,830.01 $87,830 $120.00 $84,190.01 $86,190 $86,010.01 $88,010 $87,830.01 $89,830 $125.00 $86,190.01 $88,190 $88,010.01 $90,010 $89,830.01 $91,830 $130.00 $88,190.01 $90,190 $90,010.01 $92,010 $91,830.01 $93,830 $135.00 $90,190.01 $92,190 $92,010.01 $94,010 $93,830.01 $95,830 $140.00 $92,190.01 $94,190 $94,010.01 $96,010 $95,830.01 $97,830 $145.00 $94,190.01 $96,190 $96,010.01 $98,010 $97,830.01 $99,830 $150.00 $96,190.01 $98,190 $98,010.01 $100,010 $99,830.01 $101,830 $155.00 $98,190.01 $100,190 $100,010.01 $102,010 $101,830.01 $103,830 $160.00 $100,190.01 $102,190 $102,010.01 $104,010 $103,830.01 $105,830 $165.00 $102,190.01 $104,190 $104,010.01 $106,010 $105,830.01 $107,830 $170.00 $104,190.01 $106,190 $106,010.01 $108,010 $107,830.01 $109,830 $175.00 $106,190.01 $108,190 $108,010.01 $110,010 $109,830.01 $111,830 $180.00 $108,190.01 $110,190 $110,010.01 $112,010 $111,830.01 $113,830 $185.00 $110,190.01 $112,190 $112,010.01 $114,010 $113,830.01 $115,830 $190.00 $112,190.01 $114,190 $114,010.01 $116,010 $115,830.01 $117,830 $195.00 $114,190.01 $116,190 $116,010.01 $118,010 $117,830.01 $119,830 $200.00 $116,190.01 $118,190 $118,010.01 $120,010 $119,830.01 $121,830 $205.00 $118,190.01 $120,190 $120,010.01 $122,010 $121,830.01 $123,830 $210.00 $120,190.01 $122,190 $122,010.01 $124,010 $123,830.01 $125,830 $215.00 $122,190.01 $124,190 $124,010.01 $126,010 $125,830.01 $127,830 $220.00 $124,190.01 $126,190 $126,010.01 $128,010 $127,830.01 $129,830 $225.00 $126,190.01 $128,190 $128,010.01 $130,010 $129,830.01 $131,830 $230.00 $128,190.01 $130,190 $130,010.01 $132,010 $131,830.01 $133,830 $235.00 $130,190.01 $132,190 $132,010.01 $134,010 $133,830.01 $135,830 $240.00 $132,190.01 $134,190 $134,010.01 $136,010 $135,830.01 $137,830 $245.00 $134,190.01 $136,190 $136,010.01 $138,010 $137,830.01 $139,830 $250.00 $136,190.01 $138,190 $138,010.01 $140,010 $139,830.01 $141,830 $255.00 $138,190.01 $140,190 $140,010.01 $142,010 $141,830.01 $143,830 $260.00 $140,190.01 $142,190 $142,010.01 $144,010 $143,830.01 $145,830 $265.00 $142,190.01 $144,190 $144,010.01 $146,010 $145,830.01 $147,830 $270.00 $144,190.01 $146,190 $146,010.01 $148,010 $147,830.01 $149,830 $275.00 $146,190.01 $148,190 $148,010.01 $150,010 $149,830.01 $151,830 $280.00 $148,190.01 $150,190 $150,010.01 $152,010 $151,830.01 $153,830 $285.00 $150,190.01 $152,190 $152,010.01 $154,010 $153,830.01 $155,830 $290.00 $152,190.01 $154,190 $154,010.01 $156,010 $155,830.01 $157,830 $295.00 $154,190.01 $156,190 $156,010.01 $158,010 $157,830.01 $159,830 $300.00 $156,190.01 $158,190 $158,010.01 $160,010 $159,830.01 $161,830 $305.00 $158,190.01 $160,190 $160,010.01 $162,010 $161,830.01 $163,830 $310.00 $160,190.01 $160,247 $162,010.01 $164,010 $163,830.01 $165,830 $315.00 $164,010.01 $166,010 $165,830.01 $167,830 $320.00 $166,010.01 $168,010 $167,830.01 $169,830 $325.00 $168,010.01 $169,224 $169,830.01 $171,830 $330.00 $171,830.01 $173,830 $335.00 $173,830.01 $175,830 $340.00 $175,830.01 $177,830 $345.00 $177,830.01 $178,201 200% FPIG $136,380 200% FPIG $144,020 200% FPIG $151,660
CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE
(BASED ON THE 2011 FEDERAL POVERTY INCOME GUIDELINES)
Weekly Family Size: 19 Family Size: 20 Family Size: 21 Co-pay Annual Income Annual Income Annual Income $5.00 Less than:
$45,650 Less than:
$47,470 Less than:
$49,290 $10.00 $45,650.01 $47,650 $47,470.01 $49,470 $49,290.01 $51,290 $15.00 $47,650.01 $49,650 $49,470.01 $51,470 $51,290.01 $53,290 $20.00 $49,650.01 $51,650 $51,470.01 $53,470 $53,290.01 $55,290 $25.00 $51,650.01 $53,650 $53,470.01 $55,470 $55,290.01 $57,290 $30.00 $53,650.01 $55,650 $55,470.01 $57,470 $57,290.01 $59,290 $35.00 $55,650.01 $57,650 $57,470.01 $59,470 $59,290.01 $61,290 $40.00 $57,650.01 $59,650 $59,470.01 $61,470 $61,290.01 $63,290 $45.00 $59,650.01 $61,650 $61,470.01 $63,470 $63,290.01 $65,290 $50.00 $61,650.01 $63,650 $63,470.01 $65,470 $65,290.01 $67,290 $55.00 $63,650.01 $65,650 $65,470.01 $67,470 $67,290.01 $69,290 $60.00 $65,650.01 $67,650 $67,470.01 $69,470 $69,290.01 $71,290 $65.00 $67,650.01 $69,650 $69,470.01 $71,470 $71,290.01 $73,290 $70.00 $69,650.01 $71,650 $71,470.01 $73,470 $73,290.01 $75,290 $75.00 $71,650.01 $73,650 $73,470.01 $75,470 $75,290.01 $77,290 $80.00 $73,650.01 $75,650 $75,470.01 $77,470 $77,290.01 $79,290 $85.00 $75,650.01 $77,650 $77,470.01 $79,470 $79,290.01 $81,290 $90.00 $77,650.01 $79,650 $79,470.01 $81,470 $81,290.01 $83,290 $95.00 $79,650.01 $81,650 $81,470.01 $83,470 $83,290.01 $85,290 $100.00 $81,650.01 $83,650 $83,470.01 $85,470 $85,290.01 $87,290 $105.00 $83,650.01 $85,650 $85,470.01 $87,470 $87,290.01 $89,290 $110.00 $85,650.01 $87,650 $87,470.01 $89,470 $89,290.01 $91,290 $115.00 $87,650.01 $89,650 $89,470.01 $91,470 $91,290.01 $93,290 $120.00 $89,650.01 $91,650 $91,470.01 $93,470 $93,290.01 $95,290 $125.00 $91,650.01 $93,650 $93,470.01 $95,470 $95,290.01 $97,290 $130.00 $93,650.01 $95,650 $95,470.01 $97,470 $97,290.01 $99,290 $135.00 $95,650.01 $97,650 $97,470.01 $99,470 $99,290.01 $101,290 $140.00 $97,650.01 $99,650 $99,470.01 $101,470 $101,290.01 $103,290 $145.00 $99,650.01 $101,650 $101,470.01 $103,470 $103,290.01 $105,290 $150.00 $101,650.01 $103,650 $103,470.01 $105,470 $105,290.01 $107,290 $155.00 $103,650.01 $105,650 $105,470.01 $107,470 $107,290.01 $109,290 $160.00 $105,650.01 $107,650 $107,470.01 $109,470 $109,290.01 $111,290 $165.00 $107,650.01 $109,650 $109,470.01 $111,470 $111,290.01 $113,290 $170.00 $109,650.01 $111,650 $111,470.01 $113,470 $113,290.01 $115,290 $175.00 $111,650.01 $113,650 $113,470.01 $115,470 $115,290.01 $117,290 $180.00 $113,650.01 $115,650 $115,470.01 $117,470 $117,290.01 $119,290 $185.00 $115,650.01 $117,650 $117,470.01 $119,470 $119,290.01 $121,290 $190.00 $117,650.01 $119,650 $119,470.01 $121,470 $121,290.01 $123,290 $195.00 $119,650.01 $121,650 $121,470.01 $123,470 $123,290.01 $125,290 $200.00 $121,650.01 $123,650 $123,470.01 $125,470 $125,290.01 $127,290 $205.00 $123,650.01 $125,650 $125,470.01 $127,470 $127,290.01 $129,290 $210.00 $125,650.01 $127,650 $127,470.01 $129,470 $129,290.01 $131,290 $215.00 $127,650.01 $129,650 $129,470.01 $131,470 $131,290.01 $133,290 $220.00 $129,650.01 $131,650 $131,470.01 $133,470 $133,290.01 $135,290 $225.00 $131,650.01 $133,650 $133,470.01 $135,470 $135,290.01 $137,290 $230.00 $133,650.01 $135,650 $135,470.01 $137,470 $137,290.01 $139,290 $235.00 $135,650.01 $137,650 $137,470.01 $139,470 $139,290.01 $141,290 $240.00 $137,650.01 $139,650 $139,470.01 $141,470 $141,290.01 $143,290 $245.00 $139,650.01 $141,650 $141,470.01 $143,470 $143,290.01 $145,290 $250.00 $141,650.01 $143,650 $143,470.01 $145,470 $145,290.01 $147,290 $255.00 $143,650.01 $145,650 $145,470.01 $147,470 $147,290.01 $149,290 $260.00 $145,650.01 $147,650 $147,470.01 $149,470 $149,290.01 $151,290 $265.00 $147,650.01 $149,650 $149,470.01 $151,470 $151,290.01 $153,290 $270.00 $149,650.01 $151,650 $151,470.01 $153,470 $153,290.01 $155,290 $275.00 $151,650.01 $153,650 $153,470.01 $155,470 $155,290.01 $157,290 $280.00 $153,650.01 $155,650 $155,470.01 $157,470 $157,290.01 $159,290 $285.00 $155,650.01 $157,650 $157,470.01 $159,470 $159,290.01 $161,290 $290.00 $157,650.01 $159,650 $159,470.01 $161,470 $161,290.01 $163,290 $295.00 $159,650.01 $161,650 $161,470.01 $163,470 $163,290.01 $165,290 $300.00 $161,650.01 $163,650 $163,470.01 $165,470 $165,290.01 $167,290 $305.00 $163,650.01 $165,650 $165,470.01 $167,470 $167,290.01 $169,290 $310.00 $165,650.01 $167,650 $167,470.01 $169,470 $169,290.01 $171,290 $315.00 $167,650.01 $169,650 $169,470.01 $171,470 $171,290.01 $173,290 $320.00 $169,650.01 $171,650 $171,470.01 $173,470 $173,290.01 $175,290 $325.00 $171,650.01 $173,650 $173,470.01 $175,470 $175,290.01 $177,290 $330.00 $173,650.01 $175,650 $175,470.01 $177,470 $177,290.01 $179,290 $335.00 $175,650.01 $177,650 $177,470.01 $179,470 $179,290.01 $181,290 $340.00 $177,650.01 $179,650 $179,470.01 $181,470 $181,290.01 $183,290 $345.00 $179,650.01 $181,650 $181,470.01 $183,470 $183,290.01 $185,290 $350.00 $181,650.01 $183,650 $183,470.01 $185,470 $185,290.01 $187,290 $355.00 $183,650.01 $185,650 $185,470.01 $187,470 $187,290.01 $189,290 $360.00 $185,650.01 $187,178 $187,470.01 $189,470 $189,290.01 $191,290 $365.00 $189,470.01 $191,470 $191,290.01 $193,290 $370.00 $191,470.01 $193,470 $193,290.01 $195,290 $375.00 $193,470.01 $195,470 $195,290.01 $197,290 $380.00 $195,470.01 $196,155 $197,290.01 $199,290 $385.00 $199,290.01 $201,290 $390.00 $201,290.01 $203,290 $395.00 $203,290.01 $205,132 200% FPIG $159,300 200% FPIG $166,940 200% FPIG $174,580
[Pa.B. Doc. No. 11-694. Filed for public inspection April 22, 2011, 9:00 a.m.]
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