NOTICES

DEPARTMENT OF HUMAN SERVICES

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

[53 Pa.B. 2490]
[Saturday, May 6, 2023]

 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 2023 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 1, 2023.

 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 1, 2023, 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.

VALERIE A. ARKOOSH, 
Acting Secretary

 Fiscal Note: 14-NOT-1574. No fiscal impact; recommends adoption.

CO-PAYMENT CHART

FAMILY CO-PAYMENT SCALE EFFECTIVE MAY 1, 2023

(BASED ON THE 2022 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:	$7,709	$5	Less than:	$8,110	$5	Less than:	$8,763
$6	$7,709.01	$8,566	$6	$8,110.01	$9,268	$6	$8,763.01	$10,224
$7	$8,566.01	$9,422	$7	$9,268.01	$10,427	$8	$10,224.01	$11,684
$8	$9,422.01	$10,279	$8	$10,427.01	$11,586	$9	$11,684.01	$13,145
$9	$10,279.01	$11,135	$9	$11,586.01	$12,744	$10	$13,145.01	$14,605
$10	$11,135.01	$11,992	$11	$12,744.01	$13,903	$12	$14,605.01	$16,066
$11	$11,992.01	$12,849	$12	$13,903.01	$15,061	$13	$16,066.01	$17,526
$12	$12,849.01	$13,705	$13	$15,061.01	$16,220	$15	$17,526.01	$18,987
$13	$13,705.01	$14,562	$14	$16,220.01	$17,378	$17	$18,987.01	$20,447
$14	$14,562.01	$15,418	$16	$17,378.01	$18,537	$18	$20,447.01	$21,908
$15	$15,418.01	$16,275	$17	$18,537.01	$19,695	$20	$21,908.01	$23,368
$16	$16,275.01	$17,132	$19	$19,695.01	$20,854	$22	$23,368.01	$24,829
$17	$17,132.01	$17,988	$20	$20,854.01	$22,012	$24	$24,829.01	$26,289
$19	$17,988.01	$18,845	$22	$22,012.01	$23,171	$26	$26,289.01	$27,750
$20	$18,845.01	$19,701	$23	$23,171.01	$24,330	$28	$27,750.01	$29,211
$21	$19,701.01	$20,558	$25	$24,330.01	$25,488	$30	$29,211.01	$30,671
$22	$20,558.01	$21,414	$27	$25,488.01	$26,647	$32	$30,671.01	$32,132
$24	$21,414.01	$22,271	$28	$26,647.01	$27,805	$34	$32,132.01	$33,592
$25	$22,271.01	$23,128	$30	$27,805.01	$28,964	$36	$33,592.01	$35,053
$26	$23,128.01	$23,984	$32	$28,964.01	$30,122	$38	$35,053.01	$36,513
$28	$23,984.01	$24,841	$34	$30,122.01	$31,281	$40	$36,513.01	$37,974
$29	$24,841.01	$25,697	$36	$31,281.01	$32,439	$42	$37,974.01	$39,434
$31	$25,697.01	$26,554	$37	$32,439.01	$33,598	$45	$39,434.01	$40,895
$32	$26,554.01	$27,410	$39	$33,598.01	$34,757	$47	$40,895.01	$42,355
$34	$27,410.01	$28,267	$41	$34,757.01	$35,915	$50	$42,355.01	$43,816
$35	$28,267.01	$29,124	$43	$35,915.01	$37,074	$52	$43,816.01	$45,276
$37	$29,124.01	$29,980	$45	$37,074.01	$38,232	$55	$45,276.01	$46,737
$38	$29,980.01	$30,837	$47	$38,232.01	$39,391	$57	$46,737.01	$48,197
$40	$30,837.01	$31,693	$50	$39,391.01	$40,549	$60	$48,197.01	$49,658
$42	$31,693.01	$32,550	$52	$40,549.01	$41,708	$63	$49,658.01	$51,118
$43	$32,550.01	$33,406	$54	$41,708.01	$42,866	$65	$51,118.01	$52,579
$45	$33,406.01	$34,263	$56	$42,866.01	$44,025	$68	$52,579.01	$54,039
$47	$34,263.01	$34,737	$58	$44,025.01	$45,183	$71	$54,039.01	$55,500
$49	$34,737.01	$35,211	$61	$45,183.01	$46,342	$74	$55,500.01	$56,960
$52	$35,211.01	$35,684	$63	$46,342.01	$46,983	$77	$56,960.01	$58,421
$54	$35,684.01	$36,158	$66	$46,983.01	$47,624	$80	$58,421.01	$59,229
$57	$36,158.01	$36,632	$70	$47,624.01	$48,265	$84	$59,229.01	$60,037
$59	$36,632.01	$37,106	$73	$48,265.01	$48,906	$88	$60,037.01	$60,845
$62	$37,106.01	$37,580	$76	$48,906.01	$49,546	$92	$60,845.01	$61,653
$64	$37,580.01	$38,054	$80	$49,546.01	$50,187	$96	$61,653.01	$62,461
$67	$38,054.01	$38,528	$83	$50,187.01	$50,828	$101	$62,461.01	$63,269
$70	$38,528.01	$39,001	$87	$50,828.01	$51,469	$105	$63,269.01	$64,077
$73	$39,001.01	$39,475	$91	$51,469.01	$52,110	$110	$64,077.01	$64,885
$75	$39,475.01	$39,949	$94	$52,110.01	$52,751	$114	$64,885.01	$65,692
$78	$39,949.01	$40,423	$98	$52,751.01	$53,392	$119	$65,692.01	$66,500
$81	$40,423.01	$40,897	$102	$53,392.01	$54,033	$124	$66,500.01	$67,308
$84	$40,897.01	$41,371	$106	$54,033.01	$54,674	$129	$67,308.01	$68,116
$87	$41,371.01	$41,845	$110	$54,674.01	$55,315	$134	$68,116.01	$68,924
$90	$41,845.01	$42,318	$114	$55,315.01	$55,955	$139	$68,924.01	$69,732
$93	$42,318.01	$42,792	$118	$55,955.01	$56,596	$144	$69,732.01	$70,540
$97	$42,792.01	$43,266	$122	$56,596.01	$57,237	$149	$70,540.01	$71,348
$100	$43,266.01	$43,740	$126	$57,237.01	$57,878	$154	$71,348.01	$72,156
	200% FPIG	$29,160	$131	$57,878.01	$58,519	$159	$72,156.01	$72,964
			$135	$58,519.01	$59,160	$165	$72,964.01	$73,772
				200% FPIG	$39,440	$170	$73,772.01	$74,580
							200%FPIG	$49,720

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:	$8,813	$5	Less than:	$8,258	$5	Less than:	$9,466
$6	$8,813.01	$10,575	$6	$8,258.01	$10,322	$6	$9,466.01	$11,832
$8	$10,575.01	$12,338	$7	$10,322.01	$12,387	$8	$11,832.01	$14,199
$9	$12,338.01	$14,100	$9	$12,387.01	$14,451	$10	$14,199.01	$16,565
$11	$14,100.01	$15,863	$11	$14,451.01	$16,516	$12	$16,565.01	$18,932
$12	$15,863.01	$17,625	$13	$16,516.01	$18,580	$14	$18,932.01	$21,298
$14	$17,625.01	$19,388	$15	$18,580.01	$20,645	$17	$21,298.01	$23,665
$16	$19,388.01	$21,150	$17	$20,645.01	$22,709	$19	$23,665.01	$26,031
$18	$21,150.01	$22,913	$19	$22,709.01	$24,774	$21	$26,031.01	$28,397
$20	$22,913.01	$24,675	$21	$24,774.01	$26,838	$24	$28,397.01	$30,764
$22	$24,675.01	$26,438	$23	$26,838.01	$28,903	$27	$30,764.01	$33,130
$24	$26,438.01	$28,200	$26	$28,903.01	$30,967	$30	$33,130.01	$35,497
$26	$28,200.01	$29,963	$28	$30,967.01	$33,032	$33	$35,497.01	$37,863
$29	$29,963.01	$31,725	$31	$33,032.01	$35,096	$36	$37,863.01	$40,230
$31	$31,725.01	$33,488	$34	$35,096.01	$37,161	$39	$40,230.01	$42,596
$33	$33,488.01	$35,250	$36	$37,161.01	$39,225	$42	$42,596.01	$44,963
$36	$35,250.01	$37,013	$39	$39,225.01	$41,290	$45	$44,963.01	$47,329
$38	$37,013.01	$38,775	$42	$41,290.01	$43,354	$48	$47,329.01	$49,695
$41	$38,775.01	$40,538	$45	$43,354.01	$45,418	$51	$49,695.01	$52,062
$43	$40,538.01	$42,300	$48	$45,418.01	$47,483	$55	$52,062.01	$54,428
$46	$42,300.01	$44,063	$51	$47,483.01	$49,547	$58	$54,428.01	$56,795
$49	$44,063.01	$45,825	$54	$49,547.01	$51,612	$62	$56,795.01	$59,161
$51	$45,825.01	$47,588	$57	$51,612.01	$53,676	$65	$59,161.01	$61,528
$54	$47,588.01	$49,350	$60	$53,676.01	$55,741	$69	$61,528.01	$63,894
$57	$49,350.01	$51,113	$63	$55,741.01	$57,805	$73	$63,894.01	$66,261
$60	$51,113.01	$52,875	$67	$57,805.01	$59,870	$76	$66,261.01	$68,627
$63	$52,875.01	$54,638	$70	$59,870.01	$61,934	$80	$68,627.01	$70,994
$66	$54,638.01	$56,400	$74	$61,934.01	$63,999	$84	$70,994.01	$73,360
$69	$56,400.01	$58,163	$77	$63,999.01	$66,063	$88	$73,360.01	$75,726
$72	$58,163.01	$59,925	$81	$66,063.01	$68,128	$93	$75,726.01	$78,093
$75	$59,925.01	$61,688	$85	$68,128.01	$70,192	$97	$78,093.01	$80,459
$79	$61,688.01	$63,450	$88	$70,192.01	$72,257	$101	$80,459.01	$82,826
$82	$63,450.01	$65,213	$92	$72,257.01	$74,321	$106	$82,826.01	$85,192
$86	$65,213.01	$66,975	$96	$74,321.01	$76,386	$110	$85,192.01	$87,559
$89	$66,975.01	$68,738	$100	$76,386.01	$78,450	$115	$87,559.01	$89,925
$93	$68,738.01	$70,500	$104	$78,450.01	$80,515	$119	$89,925.01	$92,292
$96	$70,500.01	$71,475	$108	$80,515.01	$82,579	$124	$92,292.01	$94,658
$101	$71,475.01	$72,450	$113	$82,579.01	$83,721	$129	$94,658.01	$95,967
$106	$72,450.01	$73,425	$118	$83,721.01	$84,863	$136	$95,967.01	$97,276
$111	$73,425.01	$74,400	$124	$84,863.01	$86,005	$142	$97,276.01	$98,585
$116	$74,400.01	$75,375	$130	$86,005.01	$87,147	$149	$98,585.01	$99,894
$122	$75,375.01	$76,350	$136	$87,147.01	$88,289	$156	$99,894.01	$101,203
$127	$76,350.01	$77,325	$142	$88,289.01	$89,431	$163	$101,203.01	$102,512
$132	$77,325.01	$78,300	$149	$89,431.01	$90,573	$170	$102,512.01	$103,822
$138	$78,300.01	$79,275	$155	$90,573.01	$91,715	$178	$103,822.01	$105,131
$144	$79,275.01	$80,250	$162	$91,715.01	$92,857	$185	$105,131.01	$106,440
$149	$80,250.01	$81,225	$168	$92,857.01	$93,999	$193	$106,440.01	$107,749
$155	$81,225.01	$82,200	$175	$93,999.01	$95,141	$201	$107,749.01	$109,058
$161	$82,200.01	$83,175	$182	$95,141.01	$96,283	$208	$109,058.01	$110,367
$167	$83,175.01	$84,150	$189	$96,283.01	$97,425	$216	$110,367.01	$111,676
$173	$84,150.01	$85,125	$196	$97,425.01	$98,567	$224	$111,676.01	$112,985
$180	$85,125.01	$86,100	$203	$98,567.01	$99,710	$233	$112,985.01	$114,294
$186	$86,100.01	$87,075	$210	$99,710.01	$100,852	$241	$114,294.01	$115,603
$192	$87,075.01	$88,050	$218	$100,852.01	$101,994	$250	$115,603.01	$116,912
$199	$88,050.01	$89,025	$225	$101,994.01	$103,136	$258	$116,912.01	$118,221
$205	$89,025.01	$90,000	$233	$103,136.01	$104,278	$267	$118,221.01	$119,531
	200% FPIG	$60,000	$241	$104,278.01	$105,420	$276	$119,531.01	$120,840
				200% FPIG	$70,280		200% FPIG	$80,560

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:	$10,674	$5	Less than:	$8,911	$5	Less than:	$9,817
$7	$10,674.01	$13,342	$6	$8,911.01	$11,882	$6	$9,817.01	$13,090
$9	$13,342.01	$16,011	$8	$11,882.01	$14,852	$9	$13,090.01	$16,362
$11	$16,011.01	$18,679	$10	$14,852.01	$17,822	$11	$16,362.01	$19,634
$14	$18,679.01	$21,347	$13	$17,822.01	$20,793	$14	$19,634.01	$22,907
$16	$21,347.01	$24,016	$15	$20,793.01	$23,763	$17	$22,907.01	$26,179
$19	$24,016.01	$26,684	$18	$23,763.01	$26,734	$20	$26,179.01	$29,451
$21	$26,684.01	$29,353	$21	$26,734.01	$29,704	$23	$29,451.01	$32,724
$24	$29,353.01	$32,021	$24	$29,704.01	$32,674	$26	$32,724.01	$35,996
$27	$32,021.01	$34,690	$27	$32,674.01	$35,645	$30	$35,996.01	$39,269
$30	$34,690.01	$37,358	$30	$35,645.01	$38,615	$33	$39,269.01	$42,541
$33	$37,358.01	$40,026	$34	$38,615.01	$41,586	$37	$42,541.01	$45,813
$37	$40,026.01	$42,695	$37	$41,586.01	$44,556	$41	$45,813.01	$49,086
$40	$42,695.01	$45,363	$41	$44,556.01	$47,526	$45	$49,086.01	$52,358
$44	$45,363.01	$48,032	$45	$47,526.01	$50,497	$49	$52,358.01	$55,630
$47	$48,032.01	$50,700	$49	$50,497.01	$53,467	$53	$55,630.01	$58,903
$51	$50,700.01	$53,369	$52	$53,467.01	$56,438	$58	$58,903.01	$62,175
$54	$53,369.01	$56,037	$56	$56,438.01	$59,408	$62	$62,175.01	$65,448
$58	$56,037.01	$58,705	$60	$59,408.01	$62,378	$66	$65,448.01	$68,720
$62	$58,705.01	$61,374	$64	$62,378.01	$65,349	$71	$68,720.01	$71,992
$65	$61,374.01	$64,042	$69	$65,349.01	$68,319	$76	$71,992.01	$75,265
$69	$64,042.01	$66,711	$73	$68,319.01	$71,290	$80	$75,265.01	$78,537
$73	$66,711.01	$69,379	$77	$71,290.01	$74,260	$85	$78,537.01	$81,809
$78	$69,379.01	$72,047	$82	$74,260.01	$77,230	$90	$81,809.01	$85,082
$82	$72,047.01	$74,716	$86	$77,230.01	$80,201	$95	$85,082.01	$88,354
$86	$74,716.01	$77,384	$91	$80,201.01	$83,171	$100	$88,354.01	$91,627
$91	$77,384.01	$80,053	$96	$83,171.01	$86,142	$106	$91,627.01	$94,899
$95	$80,053.01	$82,721	$101	$86,142.01	$89,112	$111	$94,899.01	$98,171
$100	$82,721.01	$85,390	$106	$89,112.01	$92,082	$117	$98,171.01	$101,444
$104	$85,390.01	$88,058	$111	$92,082.01	$95,053	$122	$101,444.01	$104,716
$109	$88,058.01	$90,726	$116	$95,053.01	$98,023	$128	$104,716.01	$107,988
$114	$90,726.01	$93,395	$122	$98,023.01	$100,994	$134	$107,988.01	$111,261
$119	$93,395.01	$96,063	$127	$100,994.01	$103,964	$140	$111,261.01	$114,533
$124	$96,063.01	$98,732	$133	$103,964.01	$106,934	$146	$114,533.01	$117,806
$129	$98,732.01	$101,400	$138	$106,934.01	$109,905	$152	$117,806.01	$121,078
$135	$101,400.01	$104,069	$144	$109,905.01	$112,875	$159	$121,078.01	$124,350
$140	$104,069.01	$106,737	$150	$112,875.01	$115,846	$165	$124,350.01	$127,623
$146	$106,737.01	$108,213	$156	$115,846.01	$118,816	$172	$127,623.01	$130,895
$153	$108,213.01	$109,689	$162	$118,816.01	$120,459	$179	$130,895.01	$132,705
$161	$109,689.01	$111,166	$170	$120,459.01	$122,102	$188	$132,705.01	$134,515
$168	$111,166.01	$112,642	$179	$122,102.01	$123,746	$197	$134,515.01	$136,326
$176	$112,642.01	$114,118	$187	$123,746.01	$125,389	$206	$136,326.01	$138,136
$184	$114,118.01	$115,594	$196	$125,389.01	$127,032	$216	$138,136.01	$139,946
$192	$115,594.01	$117,070	$205	$127,032.01	$128,675	$226	$139,946.01	$141,756
$200	$117,070.01	$118,546	$214	$128,675.01	$130,318	$236	$141,756.01	$143,567
$209	$118,546.01	$120,023	$223	$130,318.01	$131,961	$246	$143,567.01	$145,377
$217	$120,023.01	$121,499	$233	$131,961.01	$133,605	$256	$145,377.01	$147,187
$226	$121,499.01	$122,975	$242	$133,605.01	$135,248	$267	$147,187.01	$148,997
$235	$122,975.01	$124,451	$252	$135,248.01	$136,891	$277	$148,997.01	$150,807
$244	$124,451.01	$125,927	$262	$136,891.01	$138,534	$288	$150,807.01	$152,618
$253	$125,927.01	$127,404	$272	$138,534.01	$140,177	$299	$152,618.01	$154,428
$262	$127,404.01	$128,880	$282	$140,177.01	$141,820	$310	$154,428.01	$156,238
$272	$128,880.01	$130,356	$292	$141,820.01	$143,464	$322	$156,238.01	$158,048
$281	$130,356.01	$131,832	$303	$143,464.01	$145,107	$333	$158,048.01	$159,858
$291	$131,832.01	$133,308	$313	$145,107.01	$146,750	$345	$159,858.01	$161,669
$301	$133,308.01	$134,784	$324	$146,750.01	$148,393	$357	$161,669.01	$163,479
$311	$134,784.01	$136,261	$335	$148,393.01	$150,036	$369	$163,479.01	$165,289
	200% FPIG	$90,840	$346	$150,036.01	$151,679	$381	$165,289.01	$167,099
				200% FPIG	$101,120		200% FPIG	$111,400

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:	$10,723	$5	Less than:	$11,629	$5	Less than:	$12,535
$7	$10,723.01	$14,297	$7	$11,629.01	$15,505	$8	$12,535.01	$16,713
$10	$14,297.01	$17,872	$10	$15,505.01	$19,382	$11	$16,713.01	$20,892
$12	$17,872.01	$21,446	$13	$19,382.01	$23,258	$14	$20,892.01	$25,070
$15	$21,446.01	$25,020	$17	$23,258.01	$27,134	$18	$25,070.01	$29,248
$18	$25,020.01	$28,595	$20	$27,134.01	$31,011	$22	$29,248.01	$33,426
$22	$28,595.01	$32,169	$24	$31,011.01	$34,887	$25	$33,426.01	$37,605
$25	$32,169.01	$35,744	$27	$34,887.01	$38,763	$29	$37,605.01	$41,783
$29	$35,744.01	$39,318	$31	$38,763.01	$42,640	$34	$41,783.01	$45,961
$32	$39,318.01	$42,892	$35	$42,640.01	$46,516	$38	$45,961.01	$50,140
$36	$42,892.01	$46,467	$39	$46,516.01	$50,392	$43	$50,140.01	$54,318
$40	$46,467.01	$50,041	$44	$50,392.01	$54,269	$47	$54,318.01	$58,496
$45	$50,041.01	$53,615	$48	$54,269.01	$58,145	$52	$58,496.01	$62,675
$49	$53,615.01	$57,190	$53	$58,145.01	$62,021	$57	$62,675.01	$66,853
$54	$57,190.01	$60,764	$58	$62,021.01	$65,898	$63	$66,853.01	$71,031
$58	$60,764.01	$64,338	$63	$65,898.01	$69,774	$68	$71,031.01	$75,209
$63	$64,338.01	$67,913	$68	$69,774.01	$73,650	$74	$75,209.01	$79,388
$68	$67,913.01	$71,487	$73	$73,650.01	$77,527	$79	$79,388.01	$83,566
$72	$71,487.01	$75,061	$79	$77,527.01	$81,403	$85	$83,566.01	$87,744
$77	$75,061.01	$78,636	$84	$81,403.01	$85,279	$91	$87,744.01	$91,923
$82	$78,636.01	$82,210	$89	$85,279.01	$89,155	$96	$91,923.01	$96,101
$88	$82,210.01	$85,784	$95	$89,155.01	$93,032	$102	$96,101.01	$100,279
$93	$85,784.01	$89,359	$101	$93,032.01	$96,908	$109	$100,279.01	$104,458
$98	$89,359.01	$92,933	$107	$96,908.01	$100,784	$115	$104,458.01	$108,636
$104	$92,933.01	$96,507	$113	$100,784.01	$104,661	$122	$108,636.01	$112,814
$110	$96,507.01	$100,082	$119	$104,661.01	$108,537	$128	$112,814.01	$116,992
$115	$100,082.01	$103,656	$125	$108,537.01	$112,413	$135	$116,992.01	$121,171
$121	$103,656.01	$107,231	$132	$112,413.01	$116,290	$142	$121,171.01	$125,349
$127	$107,231.01	$110,805	$138	$116,290.01	$120,166	$149	$125,349.01	$129,527
$134	$110,805.01	$114,379	$145	$120,166.01	$124,042	$156	$129,527.01	$133,706
$140	$114,379.01	$117,954	$152	$124,042.01	$127,919	$164	$133,706.01	$137,884
$146	$117,954.01	$121,528	$159	$127,919.01	$131,795	$171	$137,884.01	$142,062
$153	$121,528.01	$125,102	$166	$131,795.01	$135,671	$179	$142,062.01	$146,241
$160	$125,102.01	$128,677	$173	$135,671.01	$139,548	$187	$146,241.01	$150,419
$166	$128,677.01	$132,251	$181	$139,548.01	$143,424	$195	$150,419.01	$154,597
$173	$132,251.01	$135,825	$188	$143,424.01	$147,300	$203	$154,597.01	$158,775
$180	$135,825.01	$139,400	$196	$147,300.01	$151,177	$211	$158,775.01	$162,954
$188	$139,400.01	$142,974	$204	$151,177.01	$155,053	$219	$162,954.01	$167,132
$195	$142,974.01	$144,951	$212	$155,053.01	$157,197	$228	$167,132.01	$169,443
$205	$144,951.01	$146,929	$222	$157,197.01	$159,342	$240	$169,443.01	$171,755
$215	$146,929.01	$148,906	$233	$159,342.01	$161,486	$252	$171,755.01	$174,066
$225	$148,906.01	$150,883	$245	$161,486.01	$163,630	$264	$174,066.01	$176,377
$236	$150,883.01	$152,860	$256	$163,630.01	$165,775	$276	$176,377.01	$178,689
$247	$152,860.01	$154,838	$267	$165,775.01	$167,919	$288	$178,689.01	$181,000
$257	$154,838.01	$156,815	$279	$167,919.01	$170,063	$301	$181,000.01	$183,311
$269	$156,815.01	$158,792	$291	$170,063.01	$172,207	$314	$183,311.01	$185,623
$280	$158,792.01	$160,769	$303	$172,207.01	$174,352	$327	$185,623.01	$187,934
$291	$160,769.01	$162,747	$316	$174,352.01	$176,496	$340	$187,934.01	$190,246
$303	$162,747.01	$164,724	$329	$176,496.01	$178,640	$354	$190,246.01	$192,557
$315	$164,724.01	$166,701	$341	$178,640.01	$180,785	$368	$192,557.01	$194,868
$327	$166,701.01	$168,678	$354	$180,785.01	$182,929	$382	$194,868.01	$197,180
$339	$168,678.01	$170,656	$368	$182,929.01	$185,073	$396	$197,180.01	$199,491
$352	$170,656.01	$172,633	$381	$185,073.01	$187,218	$411	$199,491.01	$201,802
$364	$172,633.01	$174,610	$395	$187,218.01	$189,362	$426	$201,802.01	$204,114
$377	$174,610.01	$176,588	$409	$189,362.01	$191,506	$441	$204,114.01	$206,425
$390	$176,588.01	$178,565	$423	$191,506.01	$193,651	$456	$206,425.01	$208,736
$403	$178,565.01	$180,542	$437	$193,651.01	$195,795	$471	$208,736.01	$211,048
$417	$180,542.01	$182,519	$452	$195,795.01	$197,939	$487	$211,048.01	$213,359
	200% FPIG	$121,680		200% FPIG	$131,960		200% FPIG	$142,240

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:	$8,961	$5	Less than:	$9,565	$5	Less than:	$10,168
$6	$8,961.01	$13,441	$6	$9,565.01	$14,347	$6	$10,168.01	$15,253
$9	$13,441.01	$17,921	$9	$14,347.01	$19,129	$10	$15,253.01	$20,337
$12	$17,921.01	$22,401	$13	$19,129.01	$23,911	$14	$20,337.01	$25,421
$15	$22,401.01	$26,882	$16	$23,911.01	$28,694	$18	$25,421.01	$30,505
$19	$26,882.01	$31,362	$20	$28,694.01	$33,476	$22	$30,505.01	$35,590
$23	$31,362.01	$35,842	$25	$33,476.01	$38,258	$26	$35,590.01	$40,674
$27	$35,842.01	$40,322	$29	$38,258.01	$43,040	$31	$40,674.01	$45,758
$31	$40,322.01	$44,803	$34	$43,040.01	$47,823	$36	$45,758.01	$50,842
$36	$44,803.01	$49,283	$38	$47,823.01	$52,605	$41	$50,842.01	$55,926
$41	$49,283.01	$53,763	$43	$52,605.01	$57,387	$46	$55,926.01	$61,011
$46	$53,763.01	$58,244	$49	$57,387.01	$62,169	$52	$61,011.01	$66,095
$51	$58,244.01	$62,724	$54	$62,169.01	$66,952	$58	$66,095.01	$71,179
$56	$62,724.01	$67,204	$60	$66,952.01	$71,734	$64	$71,179.01	$76,263
$62	$67,204.01	$71,684	$66	$71,734.01	$76,516	$70	$76,263.01	$81,348
$67	$71,684.01	$76,165	$72	$76,516.01	$81,298	$76	$81,348.01	$86,432
$73	$76,165.01	$80,645	$78	$81,298.01	$86,081	$83	$86,432.01	$91,516
$79	$80,645.01	$85,125	$84	$86,081.01	$90,863	$90	$91,516.01	$96,600
$85	$85,125.01	$89,606	$91	$90,863.01	$95,645	$96	$96,600.01	$101,685
$91	$89,606.01	$94,086	$97	$95,645.01	$100,427	$103	$101,685.01	$106,769
$97	$94,086.01	$98,566	$104	$100,427.01	$105,210	$110	$106,769.01	$111,853
$103	$98,566.01	$103,046	$110	$105,210.01	$109,992	$117	$111,853.01	$116,937
$110	$103,046.01	$107,527	$117	$109,992.01	$114,774	$125	$116,937.01	$122,021
$117	$107,527.01	$112,007	$124	$114,774.01	$119,556	$132	$122,021.01	$127,106
$123	$112,007.01	$116,487	$132	$119,556.01	$124,339	$140	$127,106.01	$132,190
$130	$116,487.01	$120,967	$139	$124,339.01	$129,121	$148	$132,190.01	$137,274
$137	$120,967.01	$125,448	$147	$129,121.01	$133,903	$156	$137,274.01	$142,358
$145	$125,448.01	$129,928	$155	$133,903.01	$138,685	$164	$142,358.01	$147,443
$152	$129,928.01	$134,408	$162	$138,685.01	$143,468	$173	$147,443.01	$152,527
$160	$134,408.01	$138,889	$171	$143,468.01	$148,250	$181	$152,527.01	$157,611
$168	$138,889.01	$143,369	$179	$148,250.01	$153,032	$190	$157,611.01	$162,695
$175	$143,369.01	$147,849	$187	$153,032.01	$157,814	$199	$162,695.01	$167,779
$184	$147,849.01	$152,329	$196	$157,814.01	$162,597	$208	$167,779.01	$172,864
$192	$152,329.01	$156,810	$205	$162,597.01	$167,379	$218	$172,864.01	$177,948
$200	$156,810.01	$161,290	$214	$167,379.01	$172,161	$227	$177,948.01	$183,032
$209	$161,290.01	$165,770	$223	$172,161.01	$176,943	$237	$183,032.01	$188,116
$217	$165,770.01	$170,250	$232	$176,943.01	$181,726	$247	$188,116.01	$193,201
$226	$170,250.01	$174,731	$241	$181,726.01	$186,508	$257	$193,201.01	$198,285
$235	$174,731.01	$179,211	$251	$186,508.01	$191,290	$267	$198,285.01	$203,369
$245	$179,211.01	$181,689	$261	$191,290.01	$193,935	$278	$203,369.01	$206,181
$257	$181,689.01	$184,168	$274	$193,935.01	$196,581	$292	$206,181.01	$208,994
$270	$184,168.01	$186,646	$288	$196,581.01	$199,226	$306	$208,994.01	$211,806
$283	$186,646.01	$189,125	$302	$199,226.01	$201,872	$321	$211,806.01	$214,619
$296	$189,125.01	$191,603	$316	$201,872.01	$204,517	$336	$214,619.01	$217,431
$309	$191,603.01	$194,081	$330	$204,517.01	$207,163	$351	$217,431.01	$220,244
$323	$194,081.01	$196,560	$345	$207,163.01	$209,808	$366	$220,244.01	$223,056
$337	$196,560.01	$199,038	$359	$209,808.01	$212,454	$382	$223,056.01	$225,869
$351	$199,038.01	$201,517	$374	$212,454.01	$215,099	$398	$225,869.01	$228,681
$365	$201,517.01	$203,995	$390	$215,099.01	$217,744	$414	$228,681.01	$231,494
$380	$203,995.01	$206,473	$405	$217,744.01	$220,390	$431	$231,494.01	$234,306
$395	$206,473.01	$208,952	$421	$220,390.01	$223,035	$448	$234,306.01	$237,119
$410	$208,952.01	$211,430	$437	$223,035.01	$225,681	$465	$237,119.01	$239,931
$425	$211,430.01	$213,909	$454	$225,681.01	$228,326	$482	$239,931.01	$242,744
$441	$213,909.01	$216,387	$470	$228,326.01	$230,972	$500	$242,744.01	$245,556
$456	$216,387.01	$218,865	$487	$230,972.01	$233,617	$518	$245,556.01	$248,369
$473	$218,865.01	$221,344	$504	$233,617.01	$236,263	$536	$248,369.01	$251,181
$489	$221,344.01	$223,822	$522	$236,263.01	$238,908	$555	$251,181.01	$253,994
$505	$223,822.01	$226,301	$539	$238,908.01	$241,554	$574	$253,994.01	$256,806
$522	$226,301.01	$228,779	$557	$241,554.01	$244,199	$593	$256,806.01	$259,619
	200% FPIG	$152,520		200% FPIG	$162,800		200% FPIG	$173,080

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:	$10,772	$5	Less than:	$11,376	$5	Less than:	$11,980
$7	$10,772.01	$16,159	$7	$11,376.01	$17,065	$7	$11,980.01	$17,970
$10	$16,159.01	$21,545	$11	$17,065.01	$22,753	$12	$17,970.01	$23,961
$14	$21,545.01	$26,931	$15	$22,753.01	$28,441	$16	$23,961.01	$29,951
$19	$26,931.01	$32,317	$20	$28,441.01	$34,129	$21	$29,951.01	$35,941
$23	$32,317.01	$37,703	$24	$34,129.01	$39,817	$26	$35,941.01	$41,931
$28	$37,703.01	$43,090	$29	$39,817.01	$45,505	$31	$41,931.01	$47,921
$33	$43,090.01	$48,476	$34	$45,505.01	$51,194	$36	$47,921.01	$53,911
$38	$48,476.01	$53,862	$40	$51,194.01	$56,882	$42	$53,911.01	$59,902
$43	$53,862.01	$59,248	$46	$56,882.01	$62,570	$48	$59,902.01	$65,892
$49	$59,248.01	$64,634	$52	$62,570.01	$68,258	$54	$65,892.01	$71,882
$55	$64,634.01	$70,021	$58	$68,258.01	$73,946	$61	$71,882.01	$77,872
$61	$70,021.01	$75,407	$64	$73,946.01	$79,634	$68	$77,872.01	$83,862
$67	$75,407.01	$80,793	$71	$79,634.01	$85,323	$75	$83,862.01	$89,852
$74	$80,793.01	$86,179	$78	$85,323.01	$91,011	$82	$89,852.01	$95,842
$81	$86,179.01	$91,565	$85	$91,011.01	$96,699	$90	$95,842.01	$101,833
$88	$91,565.01	$96,952	$93	$96,699.01	$102,387	$98	$101,833.01	$107,823
$95	$96,952.01	$102,338	$100	$102,387.01	$108,075	$106	$107,823.01	$113,813
$102	$102,338.01	$107,724	$108	$108,075.01	$113,764	$113	$113,813.01	$119,803
$109	$107,724.01	$113,110	$115	$113,764.01	$119,452	$121	$119,803.01	$125,793
$117	$113,110.01	$118,496	$123	$119,452.01	$125,140	$130	$125,793.01	$131,783
$124	$118,496.01	$123,883	$131	$125,140.01	$130,828	$138	$131,783.01	$137,773
$132	$123,883.01	$129,269	$140	$130,828.01	$136,516	$147	$137,773.01	$143,764
$140	$129,269.01	$134,655	$148	$136,516.01	$142,204	$156	$143,764.01	$149,754
$148	$134,655.01	$140,041	$157	$142,204.01	$147,893	$165	$149,754.01	$155,744
$157	$140,041.01	$145,427	$165	$147,893.01	$153,581	$174	$155,744.01	$161,734
$165	$145,427.01	$150,814	$175	$153,581.01	$159,269	$184	$161,734.01	$167,724
$174	$150,814.01	$156,200	$184	$159,269.01	$164,957	$194	$167,724.01	$173,714
$183	$156,200.01	$161,586	$193	$164,957.01	$170,645	$203	$173,714.01	$179,705
$192	$161,586.01	$166,972	$203	$170,645.01	$176,333	$214	$179,705.01	$185,695
$201	$166,972.01	$172,358	$213	$176,333.01	$182,022	$224	$185,695.01	$191,685
$211	$172,358.01	$177,745	$223	$182,022.01	$187,710	$235	$191,685.01	$197,675
$221	$177,745.01	$183,131	$233	$187,710.01	$193,398	$245	$197,675.01	$203,665
$231	$183,131.01	$188,517	$243	$193,398.01	$199,086	$256	$203,665.01	$209,655
$241	$188,517.01	$193,903	$254	$199,086.01	$204,774	$268	$209,655.01	$215,645
$251	$193,903.01	$199,289	$265	$204,774.01	$210,462	$279	$215,645.01	$221,636
$261	$199,289.01	$204,676	$276	$210,462.01	$216,151	$291	$221,636.01	$227,626
$272	$204,676.01	$210,062	$287	$216,151.01	$221,839	$302	$227,626.01	$233,616
$283	$210,062.01	$215,448	$299	$221,839.01	$227,527	$314	$233,616.01	$239,606
$294	$215,448.01	$218,428	$311	$227,527.01	$230,674	$327	$239,606.01	$242,920
$309	$218,428.01	$221,407	$326	$230,674.01	$233,820	$344	$242,920.01	$246,233
$324	$221,407.01	$224,387	$342	$233,820.01	$236,967	$361	$246,233.01	$249,547
$340	$224,387.01	$227,366	$359	$236,967.01	$240,113	$378	$249,547.01	$252,861
$356	$227,366.01	$230,346	$375	$240,113.01	$243,260	$395	$252,861.01	$256,175
$372	$230,346.01	$233,325	$392	$243,260.01	$246,407	$413	$256,175.01	$259,488
$388	$233,325.01	$236,305	$410	$246,407.01	$249,553	$432	$259,488.01	$262,802
$405	$236,305.01	$239,284	$427	$249,553.01	$252,700	$450	$262,802.01	$266,116
$422	$239,284.01	$242,264	$445	$252,700.01	$255,846	$469	$266,116.01	$269,429
$439	$242,264.01	$245,243	$464	$255,846.01	$258,993	$488	$269,429.01	$272,743
$456	$245,243.01	$248,223	$482	$258,993.01	$262,140	$508	$272,743.01	$276,057
$474	$248,223.01	$251,203	$501	$262,140.01	$265,286	$528	$276,057.01	$279,370
$492	$251,203.01	$254,182	$520	$265,286.01	$268,433	$548	$279,370.01	$282,684
$511	$254,182.01	$257,162	$540	$268,433.01	$271,579	$568	$282,684.01	$285,998
$530	$257,162.01	$260,141	$559	$271,579.01	$274,726	$589	$285,998.01	$289,312
$549	$260,141.01	$263,121	$579	$274,726.01	$277,873	$610	$289,312.01	$292,625
$568	$263,121.01	$266,100	$600	$277,873.01	$281,019	$632	$292,625.01	$295,939
$588	$266,100.01	$269,080	$621	$281,019.01	$284,166	$654	$295,939.01	$299,253
$608	$269,080.01	$272,059	$642	$284,166.01	$287,312	$676	$299,253.01	$302,566
$628	$272,059.01	$275,039	$663	$287,312.01	$290,459	$698	$302,566.01	$305,880
	200% FPIG	$183,360		200% FPIG	$193,640		200% FPIG	$203,920

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:	$12,584	$5	Less than:	$13,188	$5	Less than:	$13,792
$8	$12,584.01	$18,876	$8	$13,188.01	$19,782	$9	$13,792.01	$20,688
$12	$18,876.01	$25,169	$13	$19,782.01	$26,376	$13	$20,688.01	$27,584
$17	$25,169.01	$31,461	$18	$26,376.01	$32,971	$18	$27,584.01	$34,480
$22	$31,461.01	$37,753	$23	$32,971.01	$39,565	$24	$34,480.01	$41,376
$27	$37,753.01	$44,045	$28	$39,565.01	$46,159	$29	$41,376.01	$48,273
$32	$44,045.01	$50,337	$34	$46,159.01	$52,753	$35	$48,273.01	$55,169
$38	$50,337.01	$56,629	$40	$52,753.01	$59,347	$42	$55,169.01	$62,065
$44	$56,629.01	$62,921	$46	$59,347.01	$65,941	$48	$62,065.01	$68,961
$51	$62,921.01	$69,213	$53	$65,941.01	$72,535	$55	$68,961.01	$75,857
$57	$69,213.01	$75,506	$60	$72,535.01	$79,129	$63	$75,857.01	$82,753
$64	$75,506.01	$81,798	$67	$79,129.01	$85,723	$70	$82,753.01	$89,649
$71	$81,798.01	$88,090	$75	$85,723.01	$92,317	$78	$89,649.01	$96,545
$79	$88,090.01	$94,382	$83	$92,317.01	$98,912	$86	$96,545.01	$103,441
$86	$94,382.01	$100,674	$91	$98,912.01	$105,506	$95	$103,441.01	$110,337
$95	$100,674.01	$106,966	$99	$105,506.01	$112,100	$104	$110,337.01	$117,233
$103	$106,966.01	$113,258	$108	$112,100.01	$118,694	$113	$117,233.01	$124,129
$111	$113,258.01	$119,550	$116	$118,694.01	$125,288	$122	$124,129.01	$131,025
$119	$119,550.01	$125,843	$125	$125,288.01	$131,882	$131	$131,025.01	$137,922
$128	$125,843.01	$132,135	$134	$131,882.01	$138,476	$140	$137,922.01	$144,818
$136	$132,135.01	$138,427	$143	$138,476.01	$145,070	$149	$144,818.01	$151,714
$145	$138,427.01	$144,719	$152	$145,070.01	$151,664	$159	$151,714.01	$158,610
$154	$144,719.01	$151,011	$162	$151,664.01	$158,258	$169	$158,610.01	$165,506
$164	$151,011.01	$157,303	$172	$158,258.01	$164,853	$179	$165,506.01	$172,402
$173	$157,303.01	$163,595	$182	$164,853.01	$171,447	$190	$172,402.01	$179,298
$183	$163,595.01	$169,887	$192	$171,447.01	$178,041	$201	$179,298.01	$186,194
$193	$169,887.01	$176,180	$202	$178,041.01	$184,635	$212	$186,194.01	$193,090
$203	$176,180.01	$182,472	$213	$184,635.01	$191,229	$223	$193,090.01	$199,986
$214	$182,472.01	$188,764	$224	$191,229.01	$197,823	$234	$199,986.01	$206,882
$224	$188,764.01	$195,056	$235	$197,823.01	$204,417	$246	$206,882.01	$213,778
$235	$195,056.01	$201,348	$247	$204,417.01	$211,011	$258	$213,778.01	$220,674
$246	$201,348.01	$207,640	$258	$211,011.01	$217,605	$270	$220,674.01	$227,570
$258	$207,640.01	$213,932	$270	$217,605.01	$224,199	$282	$227,570.01	$234,467
$269	$213,932.01	$220,224	$282	$224,199.01	$230,794	$295	$234,467.01	$241,363
$281	$220,224.01	$226,517	$295	$230,794.01	$237,388	$308	$241,363.01	$248,259
$293	$226,517.01	$232,809	$307	$237,388.01	$243,982	$321	$248,259.01	$255,155
$305	$232,809.01	$239,101	$320	$243,982.01	$250,576	$335	$255,155.01	$262,051
$318	$239,101.01	$245,393	$333	$250,576.01	$257,170	$348	$262,051.01	$268,947
$330	$245,393.01	$251,685	$346	$257,170.01	$263,764	$362	$268,947.01	$275,843
$344	$251,685.01	$255,166	$360	$263,764.01	$267,412	$377	$275,843.01	$279,658
$361	$255,166.01	$258,646	$378	$267,412.01	$271,060	$396	$279,658.01	$283,473
$379	$258,646.01	$262,127	$397	$271,060.01	$274,707	$415	$283,473.01	$287,287
$397	$262,127.01	$265,608	$416	$274,707.01	$278,355	$435	$287,287.01	$291,102
$415	$265,608.01	$269,089	$435	$278,355.01	$282,003	$455	$291,102.01	$294,917
$434	$269,089.01	$272,569	$455	$282,003.01	$285,651	$476	$294,917.01	$298,732
$453	$272,569.01	$276,050	$475	$285,651.01	$289,298	$497	$298,732.01	$302,547
$473	$276,050.01	$279,531	$495	$289,298.01	$292,946	$518	$302,547.01	$306,362
$493	$279,531.01	$283,011	$516	$292,946.01	$296,594	$540	$306,362.01	$310,176
$513	$283,011.01	$286,492	$537	$296,594.01	$300,242	$562	$310,176.01	$313,991
$533	$286,492.01	$289,973	$559	$300,242.01	$303,889	$584	$313,991.01	$317,806
$554	$289,973.01	$293,453	$581	$303,889.01	$307,537	$607	$317,806.01	$321,621
$575	$293,453.01	$296,934	$603	$307,537.01	$311,185	$631	$321,621.01	$325,436
$597	$296,934.01	$300,415	$626	$311,185.01	$314,833	$654	$325,436.01	$329,250
$619	$300,415.01	$303,896	$648	$314,833.01	$318,481	$678	$329,250.01	$333,065
$641	$303,896.01	$307,376	$672	$318,481.01	$322,128	$703	$333,065.01	$336,880
$664	$307,376.01	$310,857	$695	$322,128.01	$325,776	$727	$336,880.01	$340,695
$687	$310,857.01	$314,338	$719	$325,776.01	$329,424	$752	$340,695.01	$344,510
$710	$314,338.01	$317,818	$744	$329,424.01	$333,072	$778	$344,510.01	$348,324
$733	$317,818.01	$321,299	$769	$333,072.01	$336,719	$804	$348,324.01	$352,139
	200% FPIG	$214,200		200% FPIG	$224,480		200% FPIG	$234,760

 

[Pa.B. Doc. No. 23-608. Filed for public inspection May 5, 2023, 9:00 a.m.]

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