Pennsylvania Code & Bulletin
COMMONWEALTH OF PENNSYLVANIA

• No statutes or acts will be found at this website.

The Pennsylvania Bulletin website includes the following: Rulemakings by State agencies; Proposed Rulemakings by State agencies; State agency notices; the Governor’s Proclamations and Executive Orders; Actions by the General Assembly; and Statewide and local court rules.

PA Bulletin, Doc. No. 19-908

NOTICES

DEPARTMENT OF
HUMAN SERVICES

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

[49 Pa.B. 3160]
[Saturday, June 15, 2019]

 This notice increases the income limits codified at 55 Pa. Code Chapter 3041, Appendix B (relating to co-payment chart family co-payment scale (based on the 2019 Federal Poverty Income Guidelines)) under 55 Pa. Code § 3041.107(b) (relating to availability and use of the Federal Poverty Income Guidelines). This increase is effective May 6, 2019.

 Section 3041.107(b) of 55 Pa. Code requires the Department of Human Services to update the co-payment schedule in 55 Pa. Code Chapter 3041, Appendix B to reflect changes in the Federal Poverty Income Guidelines (FPIG). Effective May 6, 2019, the income guidelines for the subsidized child care program are being raised due to increases in the FPIG. Under section 408.3 of the Human Services Code (62 P.S. § 408.3), the co-payment schedule is adjusted to reflect the increases. Chapter 3041, Appendix B of 55 Pa. Code also establishes the family co-payment levels according to the family's computed annual income and lists the weekly family co-payment based on the annual family income.

TERESA D. MILLER, 
Secretary

Fiscal Note: 14-NOT-1341. No fiscal impact; (8) recommends adoption.


CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE EFFECTIVE MAY 6, 2019
(BASED ON THE 2019 FEDERAL POVERTY INCOME GUIDELINES)

Weekly Family Size: 1 Weekly Family Size: 2 Weekly Family Size: 3
Co-pay
Annual Income
Co-pay
Annual Income
Co-pay
Annual Income
$5 Less than: $10,490 $5 Less than: $8,660 $5 Less than: $8,660
$10 $10,490.01 $12,490 $10 $8,660.01 $12,910 $10 $8,660 $14,710
$15 $12,490.01 $14,490 $16 $12,910.01 $14,910 $17 $14,710 $16,710
$20 $14,490.01 $16,490 $21 $14,910.01 $16,910 $22 $16,710 $19,330
$25 $16,490.01 $18,490 $25 $16,910.01 $18,910 $27 $19,330 $21,330
$30 $18,490.01 $20,490 $29 $18,910.01 $20,910 $31 $21,330 $23,330
$35 $20,490.01 $22,490 $33 $20,910.01 $22,910 $35 $23,330 $25,330
$40 $22,490.01 $24,490 $38 $22,910.01 $24,910 $39 $25,330 $27,330
$45 $24,490.01 $26,490 $43 $24,910.01 $26,910 $43 $27,330 $29,330
$50 $26,490.01 $28,490 $48 $26,910.01 $28,910 $48 $29,330 $31,330
$55 $28,490.01 $29,352 $53 $28,910.01 $30,910 $53 $31,330 $33,330
$58 $30,910.01 $32,910 $58 $33,330 $35,330
$64 $32,910.01 $34,910 $63 $35,330 $37,330
$70 $34,910.01 $36,910 $68 $37,330 $39,330
$76 $36,910.01 $39,739 $73 $39,330 $41,330
$79 $41,330 $43,330
$85 $43,330 $45,330
$91 $45,330 $47,330
$97 $47,330 $50,126
200% FPIG $24,980 200% FPIG $33,820 200% FPIG $42,660
Weekly Family Size: 4 Weekly Family Size: 5 Weekly Family Size: 6
Co-pay
Annual Income
Co-pay
Annual Income
Co-pay
Annual Income
$5 Less than: $8,660 $5 Less than: $8,660 $5 Less than: $8,660
$10 $8,660.01 $16,400 $10 $8,660.01 $16,450 $10 $8,660.01 $18,180
$19 $16,400.01 $19,750 $19 $16,450.01 $20,170 $21 $18,180.01 $20,740
$24 $19,750.01 $21,750 $24 $20,170.01 $22,170 $24 $20,740.01 $24,590
$28 $21,750.01 $23,750 $27 $22,170.01 $24,170 $29 $24,590.01 $26,590
$33 $23,750.01 $25,750 $31 $24,170.01 $26,170 $32 $26,590.01 $28,590
$37 $25,750.01 $27,750 $35 $26,170.01 $28,170 $36 $28,590.01 $30,590
$41 $27,750.01 $29,750 $40 $28,170.01 $30,170 $41 $30,590.01 $32,590
$45 $29,750.01 $31,750 $44 $30,170.01 $32,170 $46 $32,590.01 $34,590
$49 $31,750.01 $33,750 $47 $32,170.01 $34,170 $50 $34,590.01 $36,590
$53 $33,750.01 $35,750 $51 $34,170.01 $36,170 $54 $36,590.01 $38,590
$58 $35,750.01 $37,750 $55 $36,170.01 $38,170 $58 $38,590.01 $40,590
$63 $37,750.01 $39,750 $59 $38,170.01 $40,170 $62 $40,590.01 $42,590
$68 $39,750.01 $41,750 $63 $40,170.01 $42,170 $66 $42,590.01 $44,590
$73 $41,750.01 $43,750 $68 $42,170.01 $44,170 $70 $44,590.01 $46,590
$78 $43,750.01 $45,750 $73 $44,170.01 $46,170 $75 $46,590.01 $48,590
$83 $45,750.01 $47,750 $78 $46,170.01 $48,170 $80 $48,590.01 $50,590
$89 $47,750.01 $49,750 $83 $48,170.01 $50,170 $85 $50,590.01 $52,590
$95 $49,750.01 $51,750 $88 $50,170.01 $52,170 $90 $52,590.01 $54,590
$101 $51,750.01 $53,750 $93 $52,170.01 $54,170 $95 $54,590.01 $56,590
$107 $53,750.01 $55,750 $98 $54,170.01 $56,170 $100 $56,590.01 $58,590
$113 $55,750.01 $57,750 $103 $56,170.01 $58,170 $105 $58,590.01 $60,590
$118 $57,750.01 $60,513 $109 $58,170.01 $60,170 $110 $60,590.01 $62,590
$115 $60,170.01 $62,170 $115 $62,590.01 $64,590
$121 $62,170.01 $64,170 $121 $64,590.01 $66,590
$127 $64,170.01 $66,170 $127 $66,590.01 $68,590
$134 $66,170.01 $70,900 $133 $68,590.01 $70,590
$139 $70,590.01 $72,590
$145 $72,590.01 $74,590
$151 $74,590.01 $76,590
$156 $76,590.01 $81,287
200% FPIG $51,500 200% FPIG $60,340 200% FPIG $69,180
Weekly Family Size: 7 Weekly Family Size: 8 Weekly Family Size: 9
Co-pay
Annual Income
Co-pay
Annual Income
Co-pay
Annual Income
$5 Less than: $8,660 $5 Less than: $8,660 $5 Less than: $8,660
$10 $8,660.01 $18,180 $10 $8,660.01 $19,050 $10 $8,660.01 $19,900
$21 $18,180.01 $20,770 $22 $19,050.01 $22,420 $23 $19,900.01 $24,090
$24 $20,770.01 $23,340 $26 $22,420.01 $24,990 $28 $24,090.01 $26,090
$27 $23,340.01 $25,640 $29 $24,990.01 $29,430 $31 $26,090.01 $29,450
$30 $25,640.01 $29,010 $35 $29,430.01 $31,430 $35 $29,450.01 $33,850
$34 $29,010.01 $31,010 $38 $31,430.01 $33,430 $41 $33,850.01 $35,850
$38 $31,010.01 $33,010 $41 $33,430.01 $35,430 $44 $35,850.01 $37,850
$42 $33,010.01 $35,010 $45 $35,430.01 $37,430 $47 $37,850.01 $39,850
$48 $35,010.01 $37,010 $49 $37,430.01 $39,430 $51 $39,850.01 $41,850
$53 $37,010.01 $39,010 $54 $39,430.01 $41,430 $55 $41,850.01 $43,850
$57 $39,010.01 $41,010 $59 $41,430.01 $43,430 $60 $43,850.01 $45,850
$60 $41,010.01 $43,010 $63 $43,430.01 $45,430 $65 $45,850.01 $47,850
$64 $43,010.01 $45,010 $66 $45,430.01 $47,430 $69 $47,850.01 $49,850
$68 $45,010.01 $47,010 $70 $47,430.01 $49,430 $73 $49,850.01 $51,850
$72 $47,010.01 $49,010 $74 $49,430.01 $51,430 $77 $51,850.01 $53,850
$76 $49,010.01 $51,010 $78 $51,430.01 $53,430 $81 $53,850.01 $55,850
$80 $51,010.01 $53,010 $82 $53,430.01 $55,430 $85 $55,850.01 $57,850
$85 $53,010.01 $55,010 $86 $55,430.01 $57,430 $89 $57,850.01 $59,850
$90 $55,010.01 $57,010 $90 $57,430.01 $59,430 $93 $59,850.01 $61,850
$95 $57,010.01 $59,010 $95 $59,430.01 $61,430 $97 $61,850.01 $63,850
$100 $59,010.01 $61,010 $100 $61,430.01 $63,430 $101 $63,850.01 $65,850
$105 $61,010.01 $63,010 $105 $63,430.01 $65,430 $106 $65,850.01 $67,850
$110 $63,010.01 $65,010 $110 $65,430.01 $67,430 $111 $67,850.01 $69,850
$115 $65,010.01 $67,010 $115 $67,430.01 $69,430 $116 $69,850.01 $71,850
$120 $67,010.01 $69,010 $120 $69,430.01 $71,430 $121 $71,850.01 $73,850
$125 $69,010.01 $71,010 $125 $71,430.01 $73,430 $126 $73,850.01 $75,850
$130 $71,010.01 $73,010 $130 $73,430.01 $75,430 $131 $75,850.01 $77,850
$136 $73,010.01 $75,010 $135 $75,430.01 $77,430 $136 $77,850.01 $79,850
$142 $75,010.01 $77,010 $140 $77,430.01 $79,430 $141 $79,850.01 $81,850
$148 $77,010.01 $79,010 $145 $79,430.01 $81,430 $146 $81,850.01 $83,850
$154 $79,010.01 $81,010 $151 $81,430.01 $83,430 $151 $83,850.01 $85,850
$160 $81,010.01 $83,010 $157 $83,430.01 $85,430 $156 $85,850.01 $87,850
$166 $83,010.01 $85,010 $163 $85,430.01 $87,430 $161 $87,850.01 $89,850
$172 $85,010.01 $91,674 $169 $87,430.01 $89,430 $167 $89,850.01 $91,850
$175 $89,430.01 $91,430 $173 $91,850.01 $93,850
$181 $91,430.01 $93,430 $179 $93,850.01 $95,850
$187 $93,430.01 $95,430 $185 $95,850.01 $97,850
$193 $95,430.01 $97,430 $191 $97,850.01 $99,850
$198 $97,430.01 $102,061 $197 $99,850.01 $101,850
$203 $101,850.01 $103,850
$209 $103,850.01 $105,850
$216 $105,850.01 $112,448
200% FPIG $78,020 200% FPIG $86,860 200% FPIG $95,700
Weekly Family Size: 10 Weekly Family Size: 11 Weekly Family Size: 12
Co-pay
Annual Income
Co-pay
Annual Income
Co-pay
Annual Income
$5 Less than: $8,660 $5 Less than: $8,660 $5 Less than: $8,660
$10 $8,660.01 $21,650 $10 $8,660.01 $22,510 $10 $8,660.01 $23,380
$25 $21,650.01 $25,980 $26 $22,510.01 $25,090 $27 $23,380.01 $31,170
$30 $25,980.01 $29,380 $29 $25,090.01 $28,540 $36 $31,170.01 $35,460
$34 $29,380.01 $31,580 $33 $28,540.01 $31,120 $41 $35,460.01 $38,860
$37 $31,580.01 $34,990 $36 $31,120.01 $33,710 $45 $38,860.01 $43,110
$41 $34,990.01 $38,270 $39 $33,710.01 $36,340 $50 $43,110.01 $45,110
$45 $38,270.01 $40,270 $43 $36,340.01 $40,690 $53 $45,110.01 $47,110
$49 $40,270.01 $42,270 $49 $40,690.01 $42,690 $57 $47,110.01 $49,110
$53 $42,270.01 $44,270 $52 $42,690.01 $44,690 $61 $49,110.01 $51,110
$57 $44,270.01 $46,270 $55 $44,690.01 $46,690 $65 $51,110.01 $53,110
$61 $46,270.01 $48,270 $59 $46,690.01 $48,690 $69 $53,110.01 $55,110
$66 $48,270.01 $50,270 $63 $48,690.01 $50,690 $73 $55,110.01 $57,110
$71 $50,270.01 $52,270 $67 $50,690.01 $52,690 $78 $57,110.01 $59,110
$75 $52,270.01 $54,270 $72 $52,690.01 $54,690 $83 $59,110.01 $61,110
$78 $54,270.01 $56,270 $77 $54,690.01 $56,690 $88 $61,110.01 $63,110
$82 $56,270.01 $58,270 $82 $56,690.01 $58,690 $92 $63,110.01 $65,110
$86 $58,270.01 $60,270 $86 $58,690.01 $60,690 $96 $65,110.01 $67,110
$90 $60,270.01 $62,270 $90 $60,690.01 $62,690 $100 $67,110.01 $69,110
$94 $62,270.01 $64,270 $94 $62,690.01 $64,690 $104 $69,110.01 $71,110
$98 $64,270.01 $66,270 $98 $64,690.01 $66,690 $108 $71,110.01 $73,110
$102 $66,270.01 $68,270 $102 $66,690.01 $68,690 $112 $73,110.01 $75,110
$106 $68,270.01 $70,270 $106 $68,690.01 $70,690 $116 $75,110.01 $77,110
$111 $70,270.01 $72,270 $110 $70,690.01 $72,690 $120 $77,110.01 $79,110
$116 $72,270.01 $74,270 $114 $72,690.01 $74,690 $124 $79,110.01 $81,110
$121 $74,270.01 $76,270 $119 $74,690.01 $76,690 $128 $81,110.01 $83,110
$126 $76,270.01 $78,270 $124 $76,690.01 $78,690 $133 $83,110.01 $85,110
$131 $78,270.01 $80,270 $129 $78,690.01 $80,690 $138 $85,110.01 $87,110
$136 $80,270.01 $82,270 $134 $80,690.01 $82,690 $143 $87,110.01 $89,110
$141 $82,270.01 $84,270 $139 $82,690.01 $84,690 $148 $89,110.01 $91,110
$146 $84,270.01 $86,270 $144 $84,690.01 $86,690 $153 $91,110.01 $93,110
$151 $86,270.01 $88,270 $149 $86,690.01 $88,690 $158 $93,110.01 $95,110
$156 $88,270.01 $90,270 $154 $88,690.01 $90,690 $163 $95,110.01 $97,110
$161 $90,270.01 $92,270 $159 $90,690.01 $92,690 $168 $97,110.01 $99,110
$166 $92,270.01 $94,270 $164 $92,690.01 $94,690 $173 $99,110.01 $101,110
$171 $94,270.01 $96,270 $169 $94,690.01 $96,690 $178 $101,110.01 $103,110
$177 $96,270.01 $98,270 $174 $96,690.01 $98,690 $183 $103,110.01 $105,110
$183 $98,270.01 $100,270 $179 $98,690.01 $100,690 $188 $105,110.01 $107,110
$189 $100,270.01 $102,270 $184 $100,690.01 $102,690 $193 $107,110.01 $109,110
$195 $102,270.01 $104,270 $189 $102,690.01 $104,690 $198 $109,110.01 $111,110
$201 $104,270.01 $106,270 $195 $104,690.01 $106,690 $203 $111,110.01 $113,110
$207 $106,270.01 $108,270 $201 $106,690.01 $108,690 $209 $113,110.01 $115,110
$213 $108,270.01 $110,270 $207 $108,690.01 $110,690 $215 $115,110.01 $117,110
$219 $110,270.01 $112,270 $213 $110,690.01 $112,690 $221 $117,110.01 $119,110
$225 $112,270.01 $114,270 $219 $112,690.01 $114,690 $227 $119,110.01 $121,110
$232 $114,270.01 $122,835 $225 $114,690.01 $116,690 $233 $121,110.01 $123,110
$231 $116,690.01 $118,690 $239 $123,110.01 $125,110
$237 $118,690.01 $120,690 $245 $125,110.01 $127,110
$243 $120,690.01 $122,690 $251 $127,110.01 $129,110
$249 $122,690.01 $124,690 $257 $129,110.01 $131,110
$255 $124,690.01 $126,690 $263 $131,110.01 $133,110
$261 $126,690.01 $133,222 $269 $133,110.01 $135,110
$275 $135,110.01 $137,110
$280 $137,110.01 $143,609
200% FPIG $104,540 200% FPIG $113,380 200% FPIG $122,220
Weekly Family Size: 13 Weekly Family Size: 14 Weekly Family Size: 15
Co-pay
Annual Income
Co-pay
Annual Income
Co-pay
Annual Income
$5 Less than: $8,660 $5 Less than: $8,660 $5 Less than: $8,660
$10 $8,660.01 $25,110 $10 $8,660.01 $25,110 $10 $8,660.01 $29,440
$29 $25,110.01 $31,170 $29 $25,110.01 $31,170 $34 $29,440.01 $37,230
$36 $31,170.01 $35,480 $36 $31,170.01 $37,230 $43 $37,230.01 $39,820
$41 $35,480.01 $38,070 $43 $37,230.01 $39,800 $46 $39,820.01 $42,390
$44 $38,070.01 $40,660 $46 $39,800.01 $41,400 $49 $42,390.01 $44,620
$47 $40,660.01 $43,780 $49 $41,400.01 $44,760 $52 $44,620.01 $48,040
$51 $43,780.01 $47,530 $53 $44,760.01 $48,130 $56 $48,040.01 $52,370
$56 $47,530.01 $49,530 $57 $48,130.01 $51,950 $62 $52,370.01 $54,370
$59 $49,530.01 $51,530 $62 $51,950.01 $53,950 $65 $54,370.01 $56,370
$63 $51,530.01 $53,530 $65 $53,950.01 $55,950 $68 $56,370.01 $58,370
$67 $53,530.01 $55,530 $69 $55,950.01 $57,950 $72 $58,370.01 $60,370
$71 $55,530.01 $57,530 $73 $57,950.01 $59,950 $76 $60,370.01 $62,370
$75 $57,530.01 $59,530 $77 $59,950.01 $61,950 $80 $62,370.01 $64,370
$79 $59,530.01 $61,530 $81 $61,950.01 $63,950 $84 $64,370.01 $66,370
$84 $61,530.01 $63,530 $85 $63,950.01 $65,950 $88 $66,370.01 $68,370
$89 $63,530.01 $65,530 $90 $65,950.01 $67,950 $92 $68,370.01 $70,370
$94 $65,530.01 $67,530 $95 $67,950.01 $69,950 $97 $70,370.01 $72,370
$98 $67,530.01 $69,530 $100 $69,950.01 $71,950 $102 $72,370.01 $74,370
$102 $69,530.01 $71,530 $104 $71,950.01 $73,950 $107 $74,370.01 $76,370
$106 $71,530.01 $73,530 $108 $73,950.01 $75,950 $110 $76,370.01 $78,370
$110 $73,530.01 $75,530 $112 $75,950.01 $77,950 $114 $78,370.01 $80,370
$114 $75,530.01 $77,530 $116 $77,950.01 $79,950 $118 $80,370.01 $82,370
$118 $77,530.01 $79,530 $120 $79,950.01 $81,950 $122 $82,370.01 $84,370
$122 $79,530.01 $81,530 $124 $81,950.01 $83,950 $126 $84,370.01 $86,370
$126 $81,530.01 $83,530 $128 $83,950.01 $85,950 $130 $86,370.01 $88,370
$130 $83,530.01 $85,530 $132 $85,950.01 $87,950 $134 $88,370.01 $90,370
$134 $85,530.01 $87,530 $136 $87,950.01 $89,950 $138 $90,370.01 $92,370
$138 $87,530.01 $89,530 $140 $89,950.01 $91,950 $142 $92,370.01 $94,370
$143 $89,530.01 $91,530 $144 $91,950.01 $93,950 $146 $94,370.01 $96,370
$148 $91,530.01 $93,530 $149 $93,950.01 $95,950 $150 $96,370.01 $98,370
$153 $93,530.01 $95,530 $154 $95,950.01 $97,950 $154 $98,370.01 $100,370
$158 $95,530.01 $97,530 $159 $97,950.01 $99,950 $159 $100,370.01 $102,370
$163 $97,530.01 $99,530 $164 $99,950.01 $101,950 $164 $102,370.01 $104,370
$168 $99,530.01 $101,530 $169 $101,950.01 $103,950 $169 $104,370.01 $106,370
$173 $101,530.01 $103,530 $174 $103,950.01 $105,950 $174 $106,370.01 $108,370
$178 $103,530.01 $105,530 $179 $105,950.01 $107,950 $179 $108,370.01 $110,370
$183 $105,530.01 $107,530 $184 $107,950.01 $109,950 $184 $110,370.01 $112,370
$188 $107,530.01 $109,530 $189 $109,950.01 $111,950 $189 $112,370.01 $114,370
$193 $109,530.01 $111,530 $194 $111,950.01 $113,950 $194 $114,370.01 $116,370
$198 $111,530.01 $113,530 $199 $113,950.01 $115,950 $199 $116,370.01 $118,370
$203 $113,530.01 $115,530 $204 $115,950.01 $117,950 $204 $118,370.01 $120,370
$208 $115,530.01 $117,530 $209 $117,950.01 $119,950 $209 $120,370.01 $122,370
$213 $117,530.01 $119,530 $214 $119,950.01 $121,950 $214 $122,370.01 $124,370
$218 $119,530.01 $121,530 $219 $121,950.01 $123,950 $219 $124,370.01 $126,370
$224 $121,530.01 $123,530 $224 $123,950.01 $125,950 $224 $126,370.01 $128,370
$230 $123,530.01 $125,530 $229 $125,950.01 $127,950 $229 $128,370.01 $130,370
$236 $125,530.01 $127,530 $235 $127,950.01 $129,950 $234 $130,370.01 $132,370
$242 $127,530.01 $129,530 $241 $129,950.01 $131,950 $239 $132,370.01 $134,370
$248 $129,530.01 $131,530 $247 $131,950.01 $133,950 $244 $134,370.01 $136,370
$254 $131,530.01 $133,530 $253 $133,950.01 $135,950 $250 $136,370.01 $138,370
$260 $133,530.01 $135,530 $259 $135,950.01 $137,950 $256 $138,370.01 $140,370
$266 $135,530.01 $137,530 $265 $137,950.01 $139,950 $262 $140,370.01 $142,370
$272 $137,530.01 $139,530 $271 $139,950.01 $141,950 $268 $142,370.01 $144,370
$278 $139,530.01 $141,530 $277 $141,950.01 $143,950 $274 $144,370.01 $146,370
$284 $141,530.01 $143,530 $283 $143,950.01 $145,950 $280 $146,370.01 $148,370
$290 $143,530.01 $145,530 $289 $145,950.01 $147,950 $286 $148,370.01 $150,370
$297 $145,530.01 $153,996 $295 $147,950.01 $149,950 $292 $150,370.01 $152,370
$301 $149,950.01 $151,950 $298 $152,370.01 $154,370
$307 $151,950.01 $153,950 $304 $154,370.01 $156,370
$314 $153,950.01 $164,383 $310 $156,370.01 $158,370
$316 $158,370.01 $160,370
$322 $160,370.01 $162,370
$328 $162,370.01 $164,370
$334 $164,370.01 $166,370
$339 $166,370.01 $174,770
200% FPIG $131,060 200% FPIG $139,900 200% FPIG $148,740
Weekly
Family Size: 16 Weekly
Family Size: 17 Weekly Family Size: 18
Co-pay
Annual Income
Co-pay
Annual Income
Co-pay
Annual Income
$5 Less than: $8,660 $5 Less than: $8,660 $5 Less than: $8,660
$10 $8,660.01 $29,430 $10 $8,660.01 $29,430 $10 $8,660.01 $30,310
$34 $29,430.01 $38,080 $34 $29,430.01 $37,220 $35 $30,310.01 $38,960
$44 $38,080.01 $43,270 $43 $37,220.01 $39,780 $45 $38,960.01 $48,120
$50 $43,270.01 $45,860 $46 $39,780.01 $47,560 $56 $48,120.01 $50,120
$53 $45,860.01 $48,860 $55 $47,560.01 $49,860 $59 $50,120.01 $52,660
$57 $48,860.01 $52,280 $58 $49,860.01 $52,410 $62 $52,660.01 $55,980
$61 $52,280.01 $56,790 $61 $52,410.01 $57,210 $66 $55,980.01 $58,650
$67 $56,790.01 $58,790 $67 $57,210.01 $59,210 $70 $58,650.01 $63,630
$70 $58,790.01 $60,790 $70 $59,210.01 $61,210 $76 $63,630.01 $65,630
$73 $60,790.01 $62,790 $73 $61,210.01 $63,210 $79 $65,630.01 $67,630
$77 $62,790.01 $64,790 $77 $63,210.01 $65,210 $82 $67,630.01 $69,630
$81 $64,790.01 $66,790 $81 $65,210.01 $67,210 $86 $69,630.01 $71,630
$85 $66,790.01 $68,790 $85 $67,210.01 $69,210 $90 $71,630.01 $73,630
$89 $68,790.01 $70,790 $89 $69,210.01 $71,210 $94 $73,630.01 $75,630
$93 $70,790.01 $72,790 $93 $71,210.01 $73,210 $98 $75,630.01 $77,630
$98 $72,790.01 $74,790 $97 $73,210.01 $75,210 $102 $77,630.01 $79,630
$103 $74,790.01 $76,790 $101 $75,210.01 $77,210 $106 $79,630.01 $81,630
$108 $76,790.01 $78,790 $106 $77,210.01 $79,210 $111 $81,630.01 $83,630
$113 $78,790.01 $80,790 $111 $79,210.01 $81,210 $116 $83,630.01 $85,630
$117 $80,790.01 $82,790 $116 $81,210.01 $83,210 $121 $85,630.01 $87,630
$120 $82,790.01 $84,790 $120 $83,210.01 $85,210 $126 $87,630.01 $89,630
$124 $84,790.01 $86,790 $124 $85,210.01 $87,210 $128 $89,630.01 $91,630
$128 $86,790.01 $88,790 $128 $87,210.01 $89,210 $132 $91,630.01 $93,630
$132 $88,790.01 $90,790 $132 $89,210.01 $91,210 $136 $93,630.01 $95,630
$136 $90,790.01 $92,790 $136 $91,210.01 $93,210 $140 $95,630.01 $97,630
$140 $92,790.01 $94,790 $140 $93,210.01 $95,210 $144 $97,630.01 $99,630
$144 $94,790.01 $96,790 $144 $95,210.01 $97,210 $148 $99,630.01 $101,630
$148 $96,790.01 $98,790 $148 $97,210.01 $99,210 $152 $101,630.01 $103,630
$152 $98,790.01 $100,790 $152 $99,210.01 $101,210 $156 $103,630.01 $105,630
$156 $100,790.01 $102,790 $156 $101,210.01 $103,210 $160 $105,630.01 $107,630
$160 $102,790.01 $104,790 $160 $103,210.01 $105,210 $164 $107,630.01 $109,630
$164 $104,790.01 $106,790 $164 $105,210.01 $107,210 $168 $109,630.01 $111,630
$169 $106,790.01 $108,790 $168 $107,210.01 $109,210 $172 $111,630.01 $113,630
$174 $108,790.01 $110,790 $173 $109,210.01 $111,210 $176 $113,630.01 $115,630
$179 $110,790.01 $112,790 $178 $111,210.01 $113,210 $180 $115,630.01 $117,630
$184 $112,790.01 $114,790 $183 $113,210.01 $115,210 $185 $117,630.01 $119,630
$189 $114,790.01 $116,790 $188 $115,210.01 $117,210 $190 $119,630.01 $121,630
$194 $116,790.01 $118,790 $193 $117,210.01 $119,210 $195 $121,630.01 $123,630
$199 $118,790.01 $120,790 $198 $119,210.01 $121,210 $200 $123,630.01 $125,630
$204 $120,790.01 $122,790 $203 $121,210.01 $123,210 $205 $125,630.01 $127,630
$209 $122,790.01 $124,790 $208 $123,210.01 $125,210 $210 $127,630.01 $129,630
$214 $124,790.01 $126,790 $213 $125,210.01 $127,210 $215 $129,630.01 $131,630
$219 $126,790.01 $128,790 $218 $127,210.01 $129,210 $220 $131,630.01 $133,630
$224 $128,790.01 $130,790 $223 $129,210.01 $131,210 $225 $133,630.01 $135,630
$229 $130,790.01 $132,790 $228 $131,210.01 $133,210 $230 $135,630.01 $137,630
$234 $132,790.01 $134,790 $233 $133,210.01 $135,210 $235 $137,630.01 $139,630
$239 $134,790.01 $136,790 $238 $135,210.01 $137,210 $240 $139,630.01 $141,630
$244 $136,790.01 $138,790 $243 $137,210.01 $139,210 $245 $141,630.01 $143,630
$249 $138,790.01 $140,790 $248 $139,210.01 $141,210 $250 $143,630.01 $145,630
$254 $140,790.01 $142,790 $253 $141,210.01 $143,210 $255 $145,630.01 $147,630
$259 $142,790.01 $144,790 $258 $143,210.01 $145,210 $260 $147,630.01 $149,630
$264 $144,790.01 $146,790 $263 $145,210.01 $147,210 $265 $149,630.01 $151,630
$270 $146,790.01 $148,790 $268 $147,210.01 $149,210 $270 $151,630.01 $153,630
$276 $148,790.01 $150,790 $273 $149,210.01 $151,210 $275 $153,630.01 $155,630
$282 $150,790.01 $152,790 $278 $151,210.01 $153,210 $280 $155,630.01 $157,630
$288 $152,790.01 $154,790 $284 $153,210.01 $155,210 $285 $157,630.01 $159,630
$294 $154,790.01 $156,790 $290 $155,210.01 $157,210 $290 $159,630.01 $161,630
$300 $156,790.01 $158,790 $296 $157,210.01 $159,210 $296 $161,630.01 $163,630
$306 $158,790.01 $160,790 $302 $159,210.01 $161,210 $302 $163,630.01 $165,630
$312 $160,790.01 $162,790 $308 $161,210.01 $163,210 $308 $165,630.01 $167,630
$318 $162,790.01 $164,790 $314 $163,210.01 $165,210 $314 $167,630.01 $169,630
$324 $164,790.01 $166,790 $320 $165,210.01 $167,210 $320 $169,630.01 $171,630
$330 $166,790.01 $168,790 $326 $167,210.01 $169,210 $326 $171,630.01 $173,630
$336 $168,790.01 $170,790 $332 $169,210.01 $171,210 $332 $173,630.01 $175,630
$342 $170,790.01 $172,790 $338 $171,210.01 $173,210 $338 $175,630.01 $177,630
$348 $172,790.01 $174,790 $344 $173,210.01 $175,210 $344 $177,630.01 $179,630
$355 $174,790.01 $185,157 $350 $175,210.01 $177,210 $350 $179,630.01 $181,630
$356 $177,210.01 $179,210 $356 $181,630.01 $183,630
$362 $179,210.01 $181,210 $362 $183,630.01 $185,630
$368 $181,210.01 $183,210 $368 $185,630.01 $187,630
$374 $183,210.01 $195,544 $374 $187,630.01 $189,630
$380 $189,630.01 $191,630
$386 $191,630.01 $193,630
$392 $193,630.01 $195,630
$397 $195,630.01 $205,931
200% FPIG $157,580 200% FPIG $166,420 200% FPIG $175,260
Weekly Family Size: 19 Weekly Family Size: 20 Weekly Family Size: 21
Co-pay
Annual Income
Co-pay
Annual Income
Co-pay
Annual Income
$5 Less than: $8,660 $5 Less than: $8,660 $5 Less than: $8,660
$10 $8,660.01 $31,170 $10 $8,660.01 $32,900 $10 $8,660.01 $45,890
$36 $31,170.01 $43,210 $38 $32,900.01 $45,000 $53 $45,890.01 $53,660
$50 $43,210.01 $49,200 $52 $45,000.01 $48,000 $62 $53,660.01 $55,390
$57 $49,200.01 $54,050 $56 $48,000.01 $54,220 $64 $55,390.01 $57,900
$63 $54,050.01 $56,050 $64 $54,220.01 $58,470 $67 $57,900.01 $59,940
$66 $56,050.01 $58,050 $70 $58,470.01 $60,470 $70 $59,940.01 $63,350
$69 $58,050.01 $60,050 $73 $60,470.01 $62,470 $74 $63,350.01 $68,890
$72 $60,050.01 $62,050 $76 $62,470.01 $64,470 $81 $68,890.01 $70,890
$77 $62,050.01 $64,050 $80 $64,470.01 $66,470 $84 $70,890.01 $72,890
$80 $64,050.01 $66,050 $85 $66,470.01 $68,470 $87 $72,890.01 $74,890
$84 $66,050.01 $68,050 $89 $68,470.01 $70,470 $90 $74,890.01 $76,890
$87 $68,050.01 $70,050 $92 $70,470.01 $72,470 $94 $76,890.01 $78,890
$91 $70,050.01 $72,050 $96 $72,470.01 $74,470 $98 $78,890.01 $80,890
$94 $72,050.01 $74,050 $99 $74,470.01 $76,470 $102 $80,890.01 $82,890
$100 $74,050.01 $76,050 $103 $76,470.01 $78,470 $106 $82,890.01 $84,890
$103 $76,050.01 $78,050 $106 $78,470.01 $80,470 $110 $84,890.01 $86,890
$107 $78,050.01 $80,050 $110 $80,470.01 $82,470 $114 $86,890.01 $88,890
$110 $80,050.01 $82,050 $113 $82,470.01 $84,470 $118 $88,890.01 $90,890
$114 $82,050.01 $84,050 $117 $84,470.01 $86,470 $122 $90,890.01 $92,890
$117 $84,050.01 $86,050 $120 $86,470.01 $88,470 $126 $92,890.01 $94,890
$121 $86,050.01 $88,050 $124 $88,470.01 $90,470 $131 $94,890.01 $96,890
$125 $88,050.01 $90,050 $127 $90,470.01 $92,470 $136 $96,890.01 $98,890
$129 $90,050.01 $92,050 $131 $92,470.01 $94,470 $141 $98,890.01 $100,890
$133 $92,050.01 $94,050 $135 $94,470.01 $96,470 $145 $100,890.01 $102,890
$137 $94,050.01 $96,050 $139 $96,470.01 $98,470 $149 $102,890.01 $104,890
$141 $96,050.01 $98,050 $143 $98,470.01 $100,470 $153 $104,890.01 $106,890
$145 $98,050.01 $100,050 $147 $100,470.01 $102,470 $157 $106,890.01 $108,890
$149 $100,050.01 $102,050 $151 $102,470.01 $104,470 $161 $108,890.01 $110,890
$153 $102,050.01 $104,050 $155 $104,470.01 $106,470 $165 $110,890.01 $112,890
$157 $104,050.01 $106,050 $159 $106,470.01 $108,470 $169 $112,890.01 $114,890
$161 $106,050.01 $108,050 $163 $108,470.01 $110,470 $173 $114,890.01 $116,890
$165 $108,050.01 $110,050 $167 $110,470.01 $112,470 $177 $116,890.01 $118,890
$169 $110,050.01 $112,050 $171 $112,470.01 $114,470 $181 $118,890.01 $120,890
$173 $112,050.01 $114,050 $175 $114,470.01 $116,470 $185 $120,890.01 $122,890
$177 $114,050.01 $116,050 $179 $116,470.01 $118,470 $189 $122,890.01 $124,890
$181 $116,050.01 $118,050 $183 $118,470.01 $120,470 $193 $124,890.01 $126,890
$185 $118,050.01 $120,050 $187 $120,470.01 $122,470 $197 $126,890.01 $128,890
$189 $120,050.01 $122,050 $191 $122,470.01 $124,470 $201 $128,890.01 $130,890
$194 $122,050.01 $124,050 $195 $124,470.01 $126,470 $205 $130,890.01 $132,890
$199 $124,050.01 $126,050 $199 $126,470.01 $128,470 $210 $132,890.01 $134,890
$204 $126,050.01 $128,050 $204 $128,470.01 $130,470 $215 $134,890.01 $136,890
$209 $128,050.01 $130,050 $209 $130,470.01 $132,470 $220 $136,890.01 $138,890
$214 $130,050.01 $132,050 $214 $132,470.01 $134,470 $225 $138,890.01 $140,890
$219 $132,050.01 $134,050 $219 $134,470.01 $136,470 $230 $140,890.01 $142,890
$224 $134,050.01 $136,050 $224 $136,470.01 $138,470 $235 $142,890.01 $144,890
$229 $136,050.01 $138,050 $229 $138,470.01 $140,470 $240 $144,890.01 $146,890
$234 $138,050.01 $140,050 $234 $140,470.01 $142,470 $245 $146,890.01 $148,890
$239 $140,050.01 $142,050 $239 $142,470.01 $144,470 $250 $148,890.01 $150,890
$244 $142,050.01 $144,050 $244 $144,470.01 $146,470 $255 $150,890.01 $152,890
$249 $144,050.01 $146,050 $249 $146,470.01 $148,470 $260 $152,890.01 $154,890
$254 $146,050.01 $148,050 $254 $148,470.01 $150,470 $265 $154,890.01 $156,890
$259 $148,050.01 $150,050 $259 $150,470.01 $152,470 $270 $156,890.01 $158,890
$264 $150,050.01 $152,050 $264 $152,470.01 $154,470 $275 $158,890.01 $160,890
$269 $152,050.01 $154,050 $269 $154,470.01 $156,470 $280 $160,890.01 $162,890
$274 $154,050.01 $156,050 $274 $156,470.01 $158,470 $285 $162,890.01 $164,890
$279 $156,050.01 $158,050 $279 $158,470.01 $160,470 $290 $164,890.01 $166,890
$284 $158,050.01 $160,050 $284 $160,470.01 $162,470 $295 $166,890.01 $168,890
$289 $160,050.01 $162,050 $289 $162,470.01 $164,470 $300 $168,890.01 $170,890
$294 $162,050.01 $164,050 $294 $164,470.01 $166,470 $305 $170,890.01 $172,890
$299 $164,050.01 $166,050 $299 $166,470.01 $168,470 $310 $172,890.01 $174,890
$304 $166,050.01 $168,050 $304 $168,470.01 $170,470 $315 $174,890.01 $176,890
$309 $168,050.01 $170,050 $309 $170,470.01 $172,470 $320 $176,890.01 $178,890
$315 $170,050.01 $172,050 $314 $172,470.01 $174,470 $325 $178,890.01 $180,890
$321 $172,050.01 $174,050 $319 $174,470.01 $176,470 $330 $180,890.01 $182,890
$327 $174,050.01 $176,050 $324 $176,470.01 $178,470 $335 $182,890.01 $184,890
$333 $176,050.01 $178,050 $330 $178,470.01 $180,470 $341 $184,890.01 $186,890
$339 $178,050.01 $180,050 $336 $180,470.01 $182,470 $347 $186,890.01 $188,890
$345 $180,050.01 $182,050 $342 $182,470.01 $184,470 $353 $188,890.01 $190,890
$351 $182,050.01 $184,050 $348 $184,470.01 $186,470 $359 $190,890.01 $192,890
$357 $184,050.01 $186,050 $354 $186,470.01 $188,470 $365 $192,890.01 $194,890
$363 $186,050.01 $188,050 $360 $188,470.01 $190,470 $371 $194,890.01 $196,890
$369 $188,050.01 $190,050 $366 $190,470.01 $192,470 $377 $196,890.01 $198,890
$375 $190,050.01 $192,050 $372 $192,470.01 $194,470 $383 $198,890.01 $200,890
$381 $192,050.01 $194,050 $378 $194,470.01 $196,470 $389 $200,890.01 $202,890
$387 $194,050.01 $196,050 $384 $196,470.01 $198,470 $395 $202,890.01 $204,890
$393 $196,050.01 $198,050 $390 $198,470.01 $200,470 $401 $204,890.01 $206,890
$399 $198,050.01 $200,050 $396 $200,470.01 $202,470 $407 $206,890.01 $208,890
$405 $200,050.01 $202,050 $402 $202,470.01 $204,470 $413 $208,890.01 $210,890
$411 $202,050.01 $204,050 $408 $204,470.01 $206,470 $419 $210,890.01 $212,890
$419 $204,050.01 $206,050 $414 $206,470.01 $208,470 $425 $212,890.01 $214,890
$424 $206,050.01 $216,318 $420 $208,470.01 $210,470 $431 $214,890.01 $216,890
$426 $210,470.01 $212,470 $437 $216,890.01 $218,890
$432 $212,470.01 $214,470 $443 $218,890.01 $220,890
$438 $214,470.01 $226,705 $449 $220,890.01 $222,890
$455 $222,890.01 $237,092
200% FPIG $184,100 200% FPIG $192,940 200% FPIG $201,780
[Pa.B. Doc. No. 19-908. Filed for public inspection June 14, 2019, 9:00 a.m.]



No part of the information on this site may be reproduced for profit or sold for profit.

This material has been drawn directly from the official Pennsylvania Bulletin full text database. Due to the limitations of HTML or differences in display capabilities of different browsers, this version may differ slightly from the official printed version.