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PA Bulletin, Doc. No. 12-946

NOTICES

DEPARTMENT OF PUBLIC WELFARE

Income Limits and Co-payments for the Subsidized Child Care Program

[42 Pa.B. 2853]
[Saturday, May 19, 2012]

 This notice increases the income limits codified in 55 Pa. Code Chapter 3041, Appendix B (relating to co-payment chart family co-payment scale effective May 7, 2012 (based on the 2012 Federal Poverty Income Guidelines) under 55 Pa. Code § 3041.107(b) (relating to availability and use of the Federal Poverty Income Guidelines). This increase became effective May 7, 2012.

 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 Federal Poverty Income Guidelines (FPIG). Effective May 7, 2012, the income guidelines for the subsidized child care program are increased due to increases in the FPIG. Under section 408.3 of the Public Welfare Code (62 P. S. § 408.3), the copayment schedule is adjusted in incremental amounts 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, 
Secretary

Fiscal Note: 14-NOT-756. No fiscal impact; (8) recommends adoption.

CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE EFFECTIVE MAY 7, 2012
(BASED ON THE 2012 FEDERAL POVERTY INCOME GUIDELINES)

Weekly Family Size: 1Weekly Family Size: 2
Co-pay Annual Income Co-payAnnual Income
$5.00 Less than: $9,170 $5.00 Less than: $8,660
$10.00 $9,170.01 $11,170 $10.00 $8,660.01 $13,000
$15.00 $11,170.01 $13,170 $15.00 $13,000.01 $13,130
$20.00 $13,170.01 $15,170 $20.00 $13,130.01 $15,130
$25.00 $15,170.01 $17,170 $24.00 $15,130.01 $17,130
$30.00 $17,170.01 $19,170 $28.00 $17,130.01 $19,130
$35.00 $19,170.01 $21,170 $32.00 $19,130.01 $21,130
$40.00 $21,170.01 $23,170 $36.00 $21,130.01 $23,130
$45.00 $23,170.01 $25,170 $41.00 $23,130.01 $25,130
$50.00 $25,170.01 $26,250 $46.00 $25,130.01 $27,130
$51.00 $27,130.01 $29,130
$57.00 $29,130.01 $31,130
$63.00 $31,130.01 $33,130
$69.00 $33,130.01 $35,130
$74.00 $35,130.01 $35,556
200% FPIG $22,340 200% FPIG $30,260
Weekly Family Size: 3Weekly Family Size: 4
Co-pay Annual Income Co-payAnnual Income
$5.00 Less than: $8,660 $5.00 Less than: $8,660
$10.00 $8,660.01 $13,870 $10.00 $8,660.01 $14,730
$16.00 $13,870.01 $15,090 $17.00 $14,730.01 $17,050
$21.00 $15,090.01 $17,090 $23.00 $17,050.01 $19,050
$26.00 $17,090.01 $19,090 $27.00 $19,050.01 $21,050
$30.00 $19,090.01 $21,090 $32.00 $21,050.01 $23,050
$34.00 $21,090.01 $23,090 $36.00 $23,050.01 $25,050
$38.00 $23,090.01 $25,090 $40.00 $25,050.01 $27,050
$42.00 $25,090.01 $27,090 $44.00 $27,050.01 $29,050
$47.00 $27,090.01 $29,090 $48.00 $29,050.01 $31,050
$52.00 $29,090.01 $31,090 $52.00 $31,050.01 $33,050
$57.00 $31,090.01 $33,090 $57.00 $33,050.01 $35,050
$62.00 $33,090.01 $35,090 $62.00 $35,050.01 $37,050
$67.00 $35,090.01 $37,090 $67.00 $37,050.01 $39,050
$73.00 $37,090.01 $39,090 $72.00 $39,050.01 $41,050
$79.00 $39,090.01 $41,090 $77.00 $41,050.01 $43,050
$85.00 $41,090.01 $43,090 $82.00 $43,050.01 $45,050
$90.00 $43,090.01 $44,862 $87.00 $45,050.01 $47,050
$93.00 $47,050.01 $49,050
$99.00 $49,050.01 $51,050
$105.00 $51,050.01 $53,050
$111.00 $53,050.01 $54,168
200% FPIG $38,180 200% FPIG $46,100
Weekly Family Size: 5Weekly Family Size: 6
Co-pay Annual Income Co-payAnnual Income
$5.00 Less than: $8,660 $5.00 Less than: $8,660
$10.00 $8,660.01 $15,600 $10.00 $8,660.01 $16,470
$18.00 $15,600.01 $19,010 $19.00 $16,470.01 $20,970
$25.00 $19,010.01 $21,010 $27.00 $20,970.01 $22,970
$29.00 $21,010.01 $23,010 $31.00 $22,970.01 $24,970
$33.00 $23,010.01 $25,010 $35.00 $24,970.01 $26,970
$38.00 $25,010.01 $27,010 $39.00 $26,970.01 $28,970
$42.00 $27,010.01 $29,010 $44.00 $28,970.01 $30,970
$46.00 $29,010.01 $31,010 $48.00 $30,970.01 $32,970
$50.00 $31,010.01 $33,010 $52.00 $32,970.01 $34,970
$54.00 $33,010.01 $35,010 $56.00 $34,970.01 $36,970
$58.00 $35,010.01 $37,010 $60.00 $36,970.01 $38,970
$62.00 $37,010.01 $39,010 $64.00 $38,970.01 $40,970
$67.00 $39,010.01 $41,010 $68.00 $40,970.01 $42,970
$72.00 $41,010.01 $43,010 $73.00 $42,970.01 $44,970
$77.00 $43,010.01 $45,010 $78.00 $44,970.01 $46,970
$82.00 $45,010.01 $47,010 $83.00 $46,970.01 $48,970
$87.00 $47,010.01 $49,010 $88.00 $48,970.01 $50,970
$92.00 $49,010.01 $51,010 $93.00 $50,970.01 $52,970
$97.00 $51,010.01 $53,010 $98.00 $52,970.01 $54,970
$103.00 $53,010.01 $55,010 $103.00 $54,970.01 $56,970
$109.00 $55,010.01 $57,010 $108.00 $56,970.01 $58,970
$115.00 $57,010.01 $59,010 $113.00 $58,970.01 $60,970
$121.00 $59,010.01 $61,010 $119.00 $60,970.01 $62,970
$127.00 $61,010.01 $63,010 $125.00 $62,970.01 $64,970
$132.00 $63,010.01 $63,474 $131.00 $64,970.01 $66,970
$137.00 $66,970.01 $68,970
$143.00 $68,970.01 $70,970
$149.00 $70,970.01 $72,780
200% FPIG $54,020 200% FPIG $61,940
Weekly Family Size: 7Weekly Family Size: 8
Co-pay Annual Income Co-payAnnual Income
$5.00 Less than: $8,660 $5.00 Less than: $8,660
$10.00 $8,660.01 $17,330 $10.00 $8,660.01 $18,200
$20.00 $17,330.01 $22,930 $21.00 $18,200.01 $24,890
$29.00 $22,930.01 $24,930 $31.00 $24,890.01 $26,890
$33.00 $24,930.01 $26,930 $35.00 $26,890.01 $28,890
$37.00 $26,930.01 $28,930 $39.00 $28,890.01 $30,890
$41.00 $28,930.01 $30,930 $43.00 $30,890.01 $32,890
$45.00 $30,930.01 $32,930 $47.00 $32,890.01 $34,890
$50.00 $32,930.01 $34,930 $51.00 $34,890.01 $36,890
$54.00 $34,930.01 $36,930 $56.00 $36,890.01 $38,890
$58.00 $36,930.01 $38,930 $60.00 $38,890.01 $40,890
$62.00 $38,930.01 $40,930 $64.00 $40,890.01 $42,890
$66.00 $40,930.01 $42,930 $68.00 $42,890.01 $44,890
$70.00 $42,930.01 $44,930 $72.00 $44,890.01 $46,890
$74.00 $44,930.01 $46,930 $76.00 $46,890.01 $48,890
$78.00 $46,930.01 $48,930 $80.00 $48,890.01 $50,890
$83.00 $48,930.01 $50,930 $84.00 $50,890.01 $52,890
$88.00 $50,930.01 $52,930 $88.00 $52,890.01 $54,890
$93.00 $52,930.01 $54,930 $93.00 $54,890.01 $56,890
$98.00 $54,930.01 $56,930 $98.00 $56,890.01 $58,890
$103.00 $56,930.01 $58,930 $103.00 $58,890.01 $60,890
$108.00 $58,930.01 $60,930 $108.00 $60,890.01 $62,890
$113.00 $60,930.01 $62,930 $113.00 $62,890.01 $64,890
$118.00 $62,930.01 $64,930 $118.00 $64,890.01 $66,890
$123.00 $64,930.01 $66,930 $123.00 $66,890.01 $68,890
$128.00 $66,930.01 $68,930 $128.00 $68,890.01 $70,890
$134.00 $68,930.01 $70,930 $133.00 $70,890.01 $72,890
$140.00 $70,930.01 $72,930 $138.00 $72,890.01 $74,890
$146.00 $72,930.01 $74,930 $143.00 $74,890.01 $76,890
$152.00 $74,930.01 $76,930 $149.00 $76,890.01 $78,890
$158.00 $76,930.01 $78,930 $155.00 $78,890.01 $80,890
$164.00 $78,930.01 $80,930 $161.00 $80,890.01 $82,890
$170.00 $80,930.01 $82,086 $167.00 $82,890.01 $84,890
$173.00 $84,890.01 $86,890
$179.00 $86,890.01 $88,890
$185.00 $88,890.01 $90,890
$191.00 $90,890.01 $91,392
200% FPIG $69,860 200% FPIG $77,780
Weekly Family Size: 9Weekly Family Size: 10
Co-pay Annual Income Co-payAnnual Income
$5.00 Less than: $8,660 $5.00 Less than: $8,660
$10.00 $8,660.01 $19,070 $10.00 $8,660.01 $19,930
$22.00 $19,070.01 $26,850 $23.00 $19,930.01 $28,810
$33.00 $26,850.01 $28,850 $35.00 $28,810.01 $30,810
$37.00 $28,850.01 $30,850 $39.00 $30,810.01 $32,810
$41.00 $30,850.01 $32,850 $43.00 $32,810.01 $34,810
$45.00 $32,850.01 $34,850 $47.00 $34,810.01 $36,810
$49.00 $34,850.01 $36,850 $51.00 $36,810.01 $38,810
$53.00 $36,850.01 $38,850 $55.00 $38,810.01 $40,810
$57.00 $38,850.01 $40,850 $59.00 $40,810.01 $42,810
$62.00 $40,850.01 $42,850 $63.00 $42,810.01 $44,810
$66.00 $42,850.01 $44,850 $68.00 $44,810.01 $46,810
$70.00 $44,850.01 $46,850 $72.00 $46,810.01 $48,810
$74.00 $46,850.01 $48,850 $76.00 $48,810.01 $50,810
$78.00 $48,850.01 $50,850 $80.00 $50,810.01 $52,810
$82.00 $50,850.01 $52,850 $84.00 $52,810.01 $54,810
$86.00 $52,850.01 $54,850 $88.00 $54,810.01 $56,810
$90.00 $54,850.01 $56,850 $92.00 $56,810.01 $58,810
$94.00 $56,850.01 $58,850 $96.00 $58,810.01 $60,810
$99.00 $58,850.01 $60,850 $100.00 $60,810.01 $62,810
$104.00 $60,850.01 $62,850 $104.00 $62,810.01 $64,810
$109.00 $62,850.01 $64,850 $109.00 $64,810.01 $66,810
$114.00 $64,850.01 $66,850 $114.00 $66,810.01 $68,810
$119.00 $66,850.01 $68,850 $119.00 $68,810.01 $70,810
$124.00 $68,850.01 $70,850 $124.00 $70,810.01 $72,810
$129.00 $70,850.01 $72,850 $129.00 $72,810.01 $74,810
$134.00 $72,850.01 $74,850 $134.00 $74,810.01 $76,810
$139.00 $74,850.01 $76,850 $139.00 $76,810.01 $78,810
$144.00 $76,850.01 $78,850 $144.00 $78,810.01 $80,810
$149.00 $78,850.01 $80,850 $149.00 $80,810.01 $82,810
$154.00 $80,850.01 $82,850 $154.00 $82,810.01 $84,810
$160.00 $82,850.01 $84,850 $159.00 $84,810.01 $86,810
$166.00 $84,850.01 $86,850 $164.00 $86,810.01 $88,810
$172.00 $86,850.01 $88,850 $169.00 $88,810.01 $90,810
$178.00 $88,850.01 $90,850 $174.00 $90,810.01 $92,810
$184.00 $90,850.01 $92,850 $180.00 $92,810.01 $94,810
$190.00 $92,850.01 $94,850 $186.00 $94,810.01 $96,810
$196.00 $94,850.01 $96,850 $192.00 $96,810.01 $98,810
$202.00 $96,850.01 $98,850 $198.00 $98,810.01 $100,810
$207.00 $98,850.01 $100,698 $204.00 $100,810.01 $102,810
$210.00 $102,810.01 $104,810
$216.00 $104,810.01 $106,810
$222.00 $106,810.01 $108,810
$228.00 $108,810.01 $110,004
200% FPIG $85,700 200% FPIG $93,620
Weekly Family Size: 11Weekly Family Size: 12
Co-pay Annual Income Co-payAnnual Income
$5.00 Less than: $8,660 $5.00 Less than: $8,660
$10.00 $8,660.01 $20,800 $10.00 $8,660.01 $21,670
$24.00 $20,800.01 $30,770 $25.00 $21,670.01 $32,730
$37.00 $30,770.01 $32,770 $40.00 $32,730.01 $34,730
$41.00 $32,770.01 $34,770 $43.00 $34,730.01 $36,730
$45.00 $34,770.01 $36,770 $47.00 $36,730.01 $38,730
$49.00 $36,770.01 $38,770 $51.00 $38,730.01 $40,730
$53.00 $38,770.01 $40,770 $55.00 $40,730.01 $42,730
$57.00 $40,770.01 $42,770 $59.00 $42,730.01 $44,730
$61.00 $42,770.01 $44,770 $63.00 $44,730.01 $46,730
$65.00 $44,770.01 $46,770 $67.00 $46,730.01 $48,730
$69.00 $46,770.01 $48,770 $71.00 $48,730.01 $50,730
$74.00 $48,770.01 $50,770 $75.00 $50,730.01 $52,730
$78.00 $50,770.01 $52,770 $80.00 $52,730.01 $54,730
$82.00 $52,770.01 $54,770 $84.00 $54,730.01 $56,730
$86.00 $54,770.01 $56,770 $88.00 $56,730.01 $58,730
$90.00 $56,770.01 $58,770 $92.00 $58,730.01 $60,730
$94.00 $58,770.01 $60,770 $96.00 $60,730.01 $62,730
$98.00 $60,770.01 $62,770 $100.00 $62,730.01 $64,730
$102.00 $62,770.01 $64,770 $104.00 $64,730.01 $66,730
$106.00 $64,770.01 $66,770 $108.00 $66,730.01 $68,730
$110.00 $66,770.01 $68,770 $112.00 $68,730.01 $70,730
$114.00 $68,770.01 $70,770 $116.00 $70,730.01 $72,730
$119.00 $70,770.01 $72,770 $120.00 $72,730.01 $74,730
$124.00 $72,770.01 $74,770 $125.00 $74,730.01 $76,730
$129.00 $74,770.01 $76,770 $130.00 $76,730.01 $78,730
$134.00 $76,770.01 $78,770 $135.00 $78,730.01 $80,730
$139.00 $78,770.01 $80,770 $140.00 $80,730.01 $82,730
$144.00 $80,770.01 $82,770 $145.00 $82,730.01 $84,730
$149.00 $82,770.01 $84,770 $150.00 $84,730.01 $86,730
$154.00 $84,770.01 $86,770 $155.00 $86,730.01 $88,730
$159.00 $86,770.01 $88,770 $160.00 $88,730.01 $90,730
$164.00 $88,770.01 $90,770 $165.00 $90,730.01 $92,730
$169.00 $90,770.01 $92,770 $170.00 $92,730.01 $94,730
$174.00 $92,770.01 $94,770 $175.00 $94,730.01 $96,730
$179.00 $94,770.01 $96,770 $180.00 $96,730.01 $98,730
$184.00 $96,770.01 $98,770 $185.00 $98,730.01 $100,730
$189.00 $98,770.01 $100,770 $190.00 $100,730.01 $102,730
$195.00 $100,770.01 $102,770 $195.00 $102,730.01 $104,730
$201.00 $102,770.01 $104,770 $200.00 $104,730.01 $106,730
$207.00 $104,770.01 $106,770 $206.00 $106,730.01 $108,730
$213.00 $106,770.01 $108,770 $212.00 $108,730.01 $110,730
$219.00 $108,770.01 $110,770 $218.00 $110,730.01 $112,730
$225.00 $110,770.01 $112,770 $224.00 $112,730.01 $114,730
$231.00 $112,770.01 $114,770 $230.00 $114,730.01 $116,730
$237.00 $114,770.01 $116,770 $236.00 $116,730.01 $118,730
$243.00 $116,770.01 $118,770 $242.00 $118,730.01 $120,730
$249.00 $118,770.01 $119,310 $248.00 $120,730.01 $122,730
$254.00 $122,730.01 $124,730
$260.00 $124,730.01 $126,730
$266.00 $126,730.01 $128,616
200% FPIG $101,540 200% FPIG $109,460
Weekly Family Size: 13Weekly Family Size: 14
Co-pay Annual Income Co-payAnnual Income
$5.00 Less than: $8,660 $5.00 Less than: $8,660
$10.00 $8,660.01 $22,530 $10.00 $8,660.01 $23,400
$26.00 $22,530.01 $34,690 $27.00 $23,400.01 $36,650
$42.00 $34,690.01 $36,690 $44.00 $36,650.01 $38,650
$45.00 $36,690.01 $38,690 $47.00 $38,650.01 $40,650
$49.00 $38,690.01 $40,690 $51.00 $40,650.01 $42,650
$53.00 $40,690.01 $42,690 $55.00 $42,650.01 $44,650
$57.00 $42,690.01 $44,690 $59.00 $44,650.01 $46,650
$61.00 $44,690.01 $46,690 $63.00 $46,650.01 $48,650
$65.00 $46,690.01 $48,690 $67.00 $48,650.01 $50,650
$69.00 $48,690.01 $50,690 $71.00 $50,650.01 $52,650
$73.00 $50,690.01 $52,690 $75.00 $52,650.01 $54,650
$77.00 $52,690.01 $54,690 $79.00 $54,650.01 $56,650
$81.00 $54,690.01 $56,690 $83.00 $56,650.01 $58,650
$86.00 $56,690.01 $58,690 $87.00 $58,650.01 $60,650
$90.00 $58,690.01 $60,690 $92.00 $60,650.01 $62,650
$94.00 $60,690.01 $62,690 $96.00 $62,650.01 $64,650
$98.00 $62,690.01 $64,690 $100.00 $64,650.01 $66,650
$102.00 $64,690.01 $66,690 $104.00 $66,650.01 $68,650
$106.00 $66,690.01 $68,690 $108.00 $68,650.01 $70,650
$110.00 $68,690.01 $70,690 $112.00 $70,650.01 $72,650
$114.00 $70,690.01 $72,690 $116.00 $72,650.01 $74,650
$118.00 $72,690.01 $74,690 $120.00 $74,650.01 $76,650
$122.00 $74,690.01 $76,690 $124.00 $76,650.01 $78,650
$126.00 $76,690.01 $78,690 $128.00 $78,650.01 $80,650
$130.00 $78,690.01 $80,690 $132.00 $80,650.01 $82,650
$135.00 $80,690.01 $82,690 $136.00 $82,650.01 $84,650
$140.00 $82,690.01 $84,690 $140.00 $84,650.01 $86,650
$145.00 $84,690.01 $86,690 $145.00 $86,650.01 $88,650
$150.00 $86,690.01 $88,690 $150.00 $88,650.01 $90,650
$155.00 $88,690.01 $90,690 $155.00 $90,650.01 $92,650
$160.00 $90,690.01 $92,690 $160.00 $92,650.01 $94,650
$165.00 $92,690.01 $94,690 $165.00 $94,650.01 $96,650
$170.00 $94,690.01 $96,690 $170.00 $96,650.01 $98,650
$175.00 $96,690.01 $98,690 $175.00 $98,650.01 $100,650
$180.00 $98,690.01 $100,690 $180.00 $100,650.01 $102,650
$185.00 $100,690.01 $102,690 $185.00 $102,650.01 $104,650
$190.00 $102,690.01 $104,690 $190.00 $104,650.01 $106,650
$195.00 $104,690.01 $106,690 $195.00 $106,650.01 $108,650
$200.00 $106,690.01 $108,690 $200.00 $108,650.01 $110,650
$205.00 $108,690.01 $110,690 $205.00 $110,650.01 $112,650
$210.00 $110,690.01 $112,690 $210.00 $112,650.01 $114,650
$215.00 $112,690.01 $114,690 $215.00 $114,650.01 $116,650
$221.00 $114,690.01 $116,690 $220.00 $116,650.01 $118,650
$227.00 $116,690.01 $118,690 $225.00 $118,650.01 $120,650
$233.00 $118,690.01 $120,690 $230.00 $120,650.01 $122,650
$239.00 $120,690.01 $122,690 $236.00 $122,650.01 $124,650
$245.00 $122,690.01 $124,690 $242.00 $124,650.01 $126,650
$251.00 $124,690.01 $126,690 $248.00 $126,650.01 $128,650
$257.00 $126,690.01 $128,690 $254.00 $128,650.01 $130,650
$263.00 $128,690.01 $130,690 $260.00 $130,650.01 $132,650
$269.00 $130,690.01 $132,690 $266.00 $132,650.01 $134,650
$275.00 $132,690.01 $134,690 $272.00 $134,650.01 $136,650
$281.00 $134,690.01 $136,690 $278.00 $136,650.01 $138,650
$287.00 $136,690.01 $137,922 $284.00 $138,650.01 $140,650
$290.00 $140,650.01 $142,650
$296.00 $142,650.01 $144,650
$302.00 $144,650.01 $146,650
$307.00 $146,650.01 $147,228
200% FPIG $117,380 200% FPIG $125,300
Weekly Family Size: 15Weekly Family Size: 16
Co-pay Annual Income Co-payAnnual Income
$5.00 Less than: $8,660 $5.00 Less than: $8,660
$10.00 $8,660.01 $25,130 $10.00 $8,660.01 $26,870
$29.00 $25,130.01 $38,610 $31.00 $26,870.01 $42,570
$47.00 $38,610.01 $40,610 $51.00 $42,570.01 $44,570
$50.00 $40,610.01 $42,610 $54.00 $44,570.01 $46,570
$53.00 $42,610.01 $44,610 $58.00 $46,570.01 $48,570
$57.00 $44,610.01 $46,610 $62.00 $48,570.01 $50,570
$61.00 $46,610.01 $48,610 $66.00 $50,570.01 $52,570
$65.00 $48,610.01 $50,610 $70.00 $52,570.01 $54,570
$69.00 $50,610.01 $52,610 $74.00 $54,570.01 $56,570
$73.00 $52,610.01 $54,610 $78.00 $56,570.01 $58,570
$77.00 $54,610.01 $56,610 $82.00 $58,570.01 $60,570
$81.00 $56,610.01 $58,610 $86.00 $60,570.01 $62,570
$85.00 $58,610.01 $60,610 $90.00 $62,570.01 $64,570
$89.00 $60,610.01 $62,610 $94.00 $64,570.01 $66,570
$93.00 $62,610.01 $64,610 $99.00 $66,570.01 $68,570
$98.00 $64,610.01 $66,610 $104.00 $68,570.01 $70,570
$102.00 $66,610.01 $68,610 $108.00 $70,570.01 $72,570
$106.00 $68,610.01 $70,610 $112.00 $72,570.01 $74,570
$110.00 $70,610.01 $72,610 $116.00 $74,570.01 $76,570
$114.00 $72,610.01 $74,610 $120.00 $76,570.01 $78,570
$118.00 $74,610.01 $76,610 $124.00 $78,570.01 $80,570
$122.00 $76,610.01 $78,610 $128.00 $80,570.01 $82,570
$126.00 $78,610.01 $80,610 $132.00 $82,570.01 $84,570
$130.00 $80,610.01 $82,610 $136.00 $84,570.01 $86,570
$134.00 $82,610.01 $84,610 $140.00 $86,570.01 $88,570
$138.00 $84,610.01 $86,610 $144.00 $88,570.01 $90,570
$142.00 $86,610.01 $88,610 $148.00 $90,570.01 $92,570
$146.00 $88,610.01 $90,610 $152.00 $92,570.01 $94,570
$150.00 $90,610.01 $92,610 $156.00 $94,570.01 $96,570
$155.00 $92,610.01 $94,610 $160.00 $96,570.01 $98,570
$160.00 $94,610.01 $96,610 $165.00 $98,570.01 $100,570
$165.00 $96,610.01 $98,610 $170.00 $100,570.01 $102,570
$170.00 $98,610.01 $100,610 $175.00 $102,570.01 $104,570
$175.00 $100,610.01 $102,610 $180.00 $104,570.01 $106,570
$180.00 $102,610.01 $104,610 $185.00 $106,570.01 $108,570
$185.00 $104,610.01 $106,610 $190.00 $108,570.01 $110,570
$190.00 $106,610.01 $108,610 $195.00 $110,570.01 $112,570
$195.00 $108,610.01 $110,610 $200.00 $112,570.01 $114,570
$200.00 $110,610.01 $112,610 $205.00 $114,570.01 $116,570
$205.00 $112,610.01 $114,610 $210.00 $116,570.01 $118,570
$210.00 $114,610.01 $116,610 $215.00 $118,570.01 $120,570
$215.00 $116,610.01 $118,610 $220.00 $120,570.01 $122,570
$220.00 $118,610.01 $120,610 $225.00 $122,570.01 $124,570
$225.00 $120,610.01 $122,610 $230.00 $124,570.01 $126,570
$230.00 $122,610.01 $124,610 $235.00 $126,570.01 $128,570
$235.00 $124,610.01 $126,610 $240.00 $128,570.01 $130,570
$240.00 $126,610.01 $128,610 $245.00 $130,570.01 $132,570
$245.00 $128,610.01 $130,610 $250.00 $132,570.01 $134,570
$251.00 $130,610.01 $132,610 $255.00 $134,570.01 $136,570
$257.00 $132,610.01 $134,610 $260.00 $136,570.01 $138,570
$263.00 $134,610.01 $136,610 $266.00 $138,570.01 $140,570
$269.00 $136,610.01 $138,610 $272.00 $140,570.01 $142,570
$275.00 $138,610.01 $140,610 $278.00 $142,570.01 $144,570
$281.00 $140,610.01 $142,610 $284.00 $144,570.01 $146,570
$287.00 $142,610.01 $144,610 $290.00 $146,570.01 $148,570
$293.00 $144,610.01 $146,610 $296.00 $148,570.01 $150,570
$299.00 $146,610.01 $148,610 $302.00 $150,570.01 $152,570
$305.00 $148,610.01 $150,610 $308.00 $152,570.01 $154,570
$311.00 $150,610.01 $152,610 $314.00 $154,570.01 $156,570
$317.00 $152,610.01 $154,610 $320.00 $156,570.01 $158,570
$324.00 $154,610.01 $156,534 $326.00 $158,570.01 $160,570
$332.00 $160,570.01 $162,570
$338.00 $162,570.01 $164,570
$345.00 $164,570.01 $165,840
200% FPIG $133,220 200% FPIG $141,140
Weekly Family Size: 17Weekly Family Size: 18
Co-pay Annual Income Co-payAnnual Income
$5.00 Less than: $8,660 $5.00 Less than: $8,660
$10.00 $8,660.01 $27,730 $10.00 $8,660.01 $28,600
$32.00 $27,730.01 $44,530 $33.00 $28,600.01 $46,490
$53.00 $44,530.01 $46,530 $56.00 $46,490.01 $48,490
$56.00 $46,530.01 $48,530 $59.00 $48,490.01 $50,490
$60.00 $48,530.01 $50,530 $62.00 $50,490.01 $52,490
$64.00 $50,530.01 $52,530 $66.00 $52,490.01 $54,490
$68.00 $52,530.01 $54,530 $70.00 $54,490.01 $56,490
$72.00 $54,530.01 $56,530 $74.00 $56,490.01 $58,490
$76.00 $56,530.01 $58,530 $78.00 $58,490.01 $60,490
$80.00 $58,530.01 $60,530 $82.00 $60,490.01 $62,490
$84.00 $60,530.01 $62,530 $86.00 $62,490.01 $64,490
$88.00 $62,530.01 $64,530 $90.00 $64,490.01 $66,490
$92.00 $64,530.01 $66,530 $94.00 $66,490.01 $68,490
$96.00 $66,530.01 $68,530 $98.00 $68,490.01 $70,490
$100.00 $68,530.01 $70,530 $102.00 $70,490.01 $72,490
$105.00 $70,530.01 $72,530 $106.00 $72,490.01 $74,490
$110.00 $72,530.01 $74,530 $111.00 $74,490.01 $76,490
$114.00 $74,530.01 $76,530 $116.00 $76,490.01 $78,490
$118.00 $76,530.01 $78,530 $120.00 $78,490.01 $80,490
$122.00 $78,530.01 $80,530 $124.00 $80,490.01 $82,490
$126.00 $80,530.01 $82,530 $128.00 $82,490.01 $84,490
$130.00 $82,530.01 $84,530 $132.00 $84,490.01 $86,490
$134.00 $84,530.01 $86,530 $136.00 $86,490.01 $88,490
$138.00 $86,530.01 $88,530 $140.00 $88,490.01 $90,490
$142.00 $88,530.01 $90,530 $144.00 $90,490.01 $92,490
$146.00 $90,530.01 $92,530 $148.00 $92,490.01 $94,490
$150.00 $92,530.01 $94,530 $152.00 $94,490.01 $96,490
$154.00 $94,530.01 $96,530 $156.00 $96,490.01 $98,490
$158.00 $96,530.01 $98,530 $160.00 $98,490.01 $100,490
$162.00 $98,530.01 $100,530 $164.00 $100,490.01 $102,490
$166.00 $100,530.01 $102,530 $168.00 $102,490.01 $104,490
$171.00 $102,530.01 $104,530 $172.00 $104,490.01 $106,490
$176.00 $104,530.01 $106,530 $176.00 $106,490.01 $108,490
$181.00 $106,530.01 $108,530 $181.00 $108,490.01 $110,490
$186.00 $108,530.01 $110,530 $186.00 $110,490.01 $112,490
$191.00 $110,530.01 $112,530 $191.00 $112,490.01 $114,490
$196.00 $112,530.01 $114,530 $196.00 $114,490.01 $116,490
$201.00 $114,530.01 $116,530 $201.00 $116,490.01 $118,490
$206.00 $116,530.01 $118,530 $206.00 $118,490.01 $120,490
$211.00 $118,530.01 $120,530 $211.00 $120,490.01 $122,490
$216.00 $120,530.01 $122,530 $216.00 $122,490.01 $124,490
$221.00 $122,530.01 $124,530 $221.00 $124,490.01 $126,490
$226.00 $124,530.01 $126,530 $226.00 $126,490.01 $128,490
$231.00 $126,530.01 $128,530 $231.00 $128,490.01 $130,490
$236.00 $128,530.01 $130,530 $236.00 $130,490.01 $132,490
$241.00 $130,530.01 $132,530 $241.00 $132,490.01 $134,490
$246.00 $132,530.01 $134,530 $246.00 $134,490.01 $136,490
$251.00 $134,530.01 $136,530 $251.00 $136,490.01 $138,490
$256.00 $136,530.01 $138,530 $256.00 $138,490.01 $140,490
$261.00 $138,530.01 $140,530 $261.00 $140,490.01 $142,490
$266.00 $140,530.01 $142,530 $266.00 $142,490.01 $144,490
$271.00 $142,530.01 $144,530 $271.00 $144,490.01 $146,490
$276.00 $144,530.01 $146,530 $276.00 $146,490.01 $148,490
$282.00 $146,530.01 $148,530 $281.00 $148,490.01 $150,490
$288.00 $148,530.01 $150,530 $286.00 $150,490.01 $152,490
$294.00 $150,530.01 $152,530 $292.00 $152,490.01 $154,490
$300.00 $152,530.01 $154,530 $298.00 $154,490.01 $156,490
$306.00 $154,530.01 $156,530 $304.00 $156,490.01 $158,490
$312.00 $156,530.01 $158,530 $310.00 $158,490.01 $160,490
$318.00 $158,530.01 $160,530 $316.00 $160,490.01 $162,490
$324.00 $160,530.01 $162,530 $322.00 $162,490.01 $164,490
$330.00 $162,530.01 $164,530 $328.00 $164,490.01 $166,490
$336.00 $164,530.01 $166,530 $334.00 $166,490.01 $168,490
$342.00 $166,530.01 $168,530 $340.00 $168,490.01 $170,490
$348.00 $168,530.01 $170,530 $346.00 $170,490.01 $172,490
$354.00 $170,530.01 $172,530 $352.00 $172,490.01 $174,490
$360.00 $172,530.01 $174,530 $358.00 $174,490.01 $176,490
$366.00 $174,530.01 $175,146 $364.00 $176,490.01 $178,490
$370.00 $178,490.01 $180,490
$376.00 $180,490.01 $182,490
$383.00 $182,490.01 $184,452
200% FPIG $149,060 200% FPIG $156,980
Weekly Family Size: 19Weekly Family Size: 20
Co-pay Annual Income Co-payAnnual Income
$5.00 Less than: $8,660 $5.00 Less than: $8,660
$10.00 $8,660.01 $29,470 $10.00 $8,660.01 $30,330
$34.00 $29,470.01 $48,450 $35.00 $30,330.01 $50,410
$58.00 $48,450.01 $50,450 $60.00 $50,410.01 $52,410
$61.00 $50,450.01 $52,450 $63.00 $52,410.01 $54,410
$64.00 $52,450.01 $54,450 $66.00 $54,410.01 $56,410
$68.00 $54,450.01 $56,450 $70.00 $56,410.01 $58,410
$72.00 $56,450.01 $58,450 $74.00 $58,410.01 $60,410
$76.00 $58,450.01 $60,450 $78.00 $60,410.01 $62,410
$80.00 $60,450.01 $62,450 $82.00 $62,410.01 $64,410
$84.00 $62,450.01 $64,450 $86.00 $64,410.01 $66,410
$88.00 $64,450.01 $66,450 $90.00 $66,410.01 $68,410
$92.00 $66,450.01 $68,450 $94.00 $68,410.01 $70,410
$96.00 $68,450.01 $70,450 $98.00 $70,410.01 $72,410
$100.00 $70,450.01 $72,450 $102.00 $72,410.01 $74,410
$104.00 $72,450.01 $74,450 $106.00 $74,410.01 $76,410
$108.00 $74,450.01 $76,450 $110.00 $76,410.01 $78,410
$112.00 $76,450.01 $78,450 $114.00 $78,410.01 $80,410
$117.00 $78,450.01 $80,450 $118.00 $80,410.01 $82,410
$122.00 $80,450.01 $82,450 $123.00 $82,410.01 $84,410
$126.00 $82,450.01 $84,450 $128.00 $84,410.01 $86,410
$130.00 $84,450.01 $86,450 $132.00 $86,410.01 $88,410
$134.00 $86,450.01 $88,450 $136.00 $88,410.01 $90,410
$138.00 $88,450.01 $90,450 $140.00 $90,410.01 $92,410
$142.00 $90,450.01 $92,450 $144.00 $92,410.01 $94,410
$146.00 $92,450.01 $94,450 $148.00 $94,410.01 $96,410
$150.00 $94,450.01 $96,450 $152.00 $96,410.01 $98,410
$154.00 $96,450.01 $98,450 $156.00 $98,410.01 $100,410
$158.00 $98,450.01 $100,450 $160.00 $100,410.01 $102,410
$162.00 $100,450.01 $102,450 $164.00 $102,410.01 $104,410
$166.00 $102,450.01 $104,450 $168.00 $104,410.01 $106,410
$170.00 $104,450.01 $106,450 $172.00 $106,410.01 $108,410
$174.00 $106,450.01 $108,450 $176.00 $108,410.01 $110,410
$178.00 $108,450.01 $110,450 $180.00 $110,410.01 $112,410
$182.00 $110,450.01 $112,450 $184.00 $112,410.01 $114,410
$186.00 $112,450.01 $114,450 $188.00 $114,410.01 $116,410
$191.00 $114,450.01 $116,450 $192.00 $116,410.01 $118,410
$196.00 $116,450.01 $118,450 $196.00 $118,410.01 $120,410
$201.00 $118,450.01 $120,450 $201.00 $120,410.01 $122,410
$206.00 $120,450.01 $122,450 $206.00 $122,410.01 $124,410
$211.00 $122,450.01 $124,450 $211.00 $124,410.01 $126,410
$216.00 $124,450.01 $126,450 $216.00 $126,410.01 $128,410
$221.00 $126,450.01 $128,450 $221.00 $128,410.01 $130,410
$226.00 $128,450.01 $130,450 $226.00 $130,410.01 $132,410
$231.00 $130,450.01 $132,450 $231.00 $132,410.01 $134,410
$236.00 $132,450.01 $134,450 $236.00 $134,410.01 $136,410
$241.00 $134,450.01 $136,450 $241.00 $136,410.01 $138,410
$246.00 $136,450.01 $138,450 $246.00 $138,410.01 $140,410
$251.00 $138,450.01 $140,450 $251.00 $140,410.01 $142,410
$256.00 $140,450.01 $142,450 $256.00 $142,410.01 $144,410
$261.00 $142,450.01 $144,450 $261.00 $144,410.01 $146,410
$266.00 $144,450.01 $146,450 $266.00 $146,410.01 $148,410
$271.00 $146,450.01 $148,450 $271.00 $148,410.01 $150,410
$276.00 $148,450.01 $150,450 $276.00 $150,410.01 $152,410
$281.00 $150,450.01 $152,450 $281.00 $152,410.01 $154,410
$286.00 $152,450.01 $154,450 $286.00 $154,410.01 $156,410
$291.00 $154,450.01 $156,450 $291.00 $156,410.01 $158,410
$296.00 $156,450.01 $158,450 $296.00 $158,410.01 $160,410
$301.00 $158,450.01 $160,450 $301.00 $160,410.01 $162,410
$307.00 $160,450.01 $162,450 $306.00 $162,410.01 $164,410
$313.00 $162,450.01 $164,450 $311.00 $164,410.01 $166,410
$319.00 $164,450.01 $166,450 $316.00 $166,410.01 $168,410
$325.00 $166,450.01 $168,450 $321.00 $168,410.01 $170,410
$331.00 $168,450.01 $170,450 $327.00 $170,410.01 $172,410
$337.00 $170,450.01 $172,450 $333.00 $172,410.01 $174,410
$343.00 $172,450.01 $174,450 $339.00 $174,410.01 $176,410
$349.00 $174,450.01 $176,450 $345.00 $176,410.01 $178,410
$355.00 $176,450.01 $178,450 $351.00 $178,410.01 $180,410
$361.00 $178,450.01 $180,450 $357.00 $180,410.01 $182,410
$367.00 $180,450.01 $182,450 $363.00 $182,410.01 $184,410
$373.00 $182,450.01 $184,450 $369.00 $184,410.01 $186,410
$379.00 $184,450.01 $186,450 $375.00 $186,410.01 $188,410
$385.00 $186,450.01 $188,450 $381.00 $188,410.01 $190,410
$391.00 $188,450.01 $190,450 $387.00 $190,410.01 $192,410
$397.00 $190,450.01 $192,450 $393.00 $192,410.01 $194,410
$403.00 $192,450.01 $193,758 $399.00 $194,410.01 $196,410
$405.00 $196,410.01 $198,410
$411.00 $198,410.01 $200,410
$417.00 $200,410.01 $202,410
$424.00 $202,410.01 $203,064
200% FPIG $164,900 200% FPIG $172,820
Weekly Family Size: 21Weekly Family Size: 21
Co-pay Annual Income Co-payAnnual Income
$5.00 Less than: $8,660 $222.00 $130,370.01 $132,370
$10.00 $8,660.01 $32,070 $227.00 $132,370.01 $134,370
$37.00 $32,070.01 $52,370 $232.00 $134,370.01 $136,370
$63.00 $52,370.01 $54,370 $237.00 $136,370.01 $138,370
$66.00 $54,370.01 $56,370 $242.00 $138,370.01 $140,370
$69.00 $56,370.01 $58,370 $247.00 $140,370.01 $142,370
$72.00 $58,370.01 $60,370 $252.00 $142,370.01 $144,370
$76.00 $60,370.01 $62,370 $257.00 $144,370.01 $146,370
$80.00 $62,370.01 $64,370 $262.00 $146,370.01 $148,370
$84.00 $64,370.01 $66,370 $267.00 $148,370.01 $150,370
$88.00 $66,370.01 $68,370 $272.00 $150,370.01 $152,370
$92.00 $68,370.01 $70,370 $277.00 $152,370.01 $154,370
$96.00 $70,370.01 $72,370 $282.00 $154,370.01 $156,370
$100.00 $72,370.01 $74,370 $287.00 $156,370.01 $158,370
$104.00 $74,370.01 $76,370 $292.00 $158,370.01 $160,370
$108.00 $76,370.01 $78,370 $297.00 $160,370.01 $162,370
$112.00 $78,370.01 $80,370 $302.00 $162,370.01 $164,370
$116.00 $80,370.01 $82,370 $307.00 $164,370.01 $166,370
$120.00 $82,370.01 $84,370 $312.00 $166,370.01 $168,370
$124.00 $84,370.01 $86,370 $317.00 $168,370.01 $170,370
$129.00 $86,370.01 $88,370 $322.00 $170,370.01 $172,370
$134.00 $88,370.01 $90,370 $327.00 $172,370.01 $174,370
$138.00 $90,370.01 $92,370 $332.00 $174,370.01 $176,370
$142.00 $92,370.01 $94,370 $338.00 $176,370.01 $178,370
$146.00 $94,370.01 $96,370 $344.00 $178,370.01 $180,370
$150.00 $96,370.01 $98,370 $350.00 $180,370.01 $182,370
$154.00 $98,370.01 $100,370 $356.00 $182,370.01 $184,370
$158.00 $100,370.01 $102,370 $362.00 $184,370.01 $186,370
$162.00 $102,370.01 $104,370 $368.00 $186,370.01 $188,370
$166.00 $104,370.01 $106,370 $374.00 $188,370.01 $190,370
$170.00 $106,370.01 $108,370 $380.00 $190,370.01 $192,370
$174.00 $108,370.01 $110,370 $386.00 $192,370.01 $194,370
$178.00 $110,370.01 $112,370 $392.00 $194,370.01 $196,370
$182.00 $112,370.01 $114,370 $398.00 $196,370.01 $198,370
$186.00 $114,370.01 $116,370 $404.00 $198,370.01 $200,370
$190.00 $116,370.01 $118,370 $410.00 $200,370.01 $202,370
$194.00 $118,370.01 $120,370 $416.00 $202,370.01 $204,370
$198.00 $120,370.01 $122,370 $422.00 $204,370.01 $206,370
$202.00 $122,370.01 $124,370 $428.00 $206,370.01 $208,370
$207.00 $124,370.01 $126,370 $434.00 $208,370.01 $210,370
$212.00 $126,370.01 $128,370 $441.00 $210,370.01 $212,370
$217.00 $128,370.01 $130,370
200% FPIG $180,740


[Pa.B. Doc. No. 12-946. Filed for public inspection May 18, 2012, 9:00 a.m.]



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