NOTICES

DEPARTMENT OF
HUMAN SERVICES

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

[50 Pa.B. 4617]
[Saturday, September 5, 2020]

 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 2020 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 4, 2020.

 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 4, 2020, 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-1402. No fiscal impact; (8) recommends adoption.

CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE EFFECTIVE MAY 4, 2020
(BASED ON THE 2020 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:	$5,997	$5	Less than:	$7,090	$5	Less than:	$7,656
$6	$5,997.01	$6,747	$7	$7,090.01	$8,103	$7	$7,656.01	$8,932
$7	$6,747.01	$7,497	$8	$8,103.01	$9,116	$8	$8,932.01	$10,208
$8	$7,497.01	$8,246	$10	$9,116.01	$10,129	$10	$10,208.01	$11,484
$10	$8,246.01	$8,996	$11	$10,129.01	$11,141	$12	$11,484.01	$12,761
$11	$8,996.01	$9,745	$13	$11,141.01	$12,154	$14	$12,761.01	$14,037
$12	$9,745.01	$10,495	$15	$12,154.01	$13,167	$16	$14,037.01	$15,313
$14	$10,495.01	$11,245	$17	$13,167.01	$14,180	$19	$15,313.01	$16,589
$15	$11,245.01	$11,994	$19	$14,180.01	$15,193	$21	$16,589.01	$17,865
$17	$11,994.01	$12,744	$21	$15,193.01	$16,206	$24	$17,865.01	$19,141
$19	$12,744.01	$13,494	$23	$16,206.01	$17,218	$26	$19,141.01	$20,417
$20	$13,494.01	$14,243	$25	$17,218.01	$18,231	$29	$20,417.01	$21,693
$22	$14,243.01	$14,993	$27	$18,231.01	$19,244	$32	$21,693.01	$22,969
$23	$14,993.01	$15,743	$30	$19,244.01	$20,257	$35	$22,969.01	$24,245
$25	$15,743.01	$16,492	$32	$20,257.01	$21,270	$37	$24,245.01	$25,521
$27	$16,492.01	$17,242	$34	$21,270.01	$22,283	$40	$25,521.01	$26,797
$28	$17,242.01	$17,992	$36	$22,283.01	$23,296	$42	$26,797.01	$28,073
$30	$17,992.01	$18,741	$38	$23,296.01	$24,308	$45	$28,073.01	$29,349
$32	$18,741.01	$19,491	$40	$24,308.01	$25,321	$48	$29,349.01	$30,625
$33	$19,491.01	$20,241	$43	$25,321.01	$26,334	$51	$30,625.01	$31,901
$35	$20,241.01	$20,990	$45	$26,334.01	$27,347	$54	$31,901.01	$33,177
$37	$20,990.01	$21,740	$48	$27,347.01	$28,360	$57	$33,177.01	$34,453
$39	$21,740.01	$22,490	$50	$28,360.01	$29,373	$60	$34,453.01	$35,729
$41	$22,490.01	$23,239	$53	$29,373.01	$30,386	$63	$35,729.01	$37,005
$43	$23,239.01	$23,989	$55	$30,386.01	$31,398	$66	$37,005.01	$38,282
$45	$23,989.01	$24,738	$58	$31,398.01	$32,411	$70	$38,282.01	$39,558
$47	$24,738.01	$25,488	$61	$32,411.01	$33,424	$73	$39,558.01	$40,834
$49	$25,488.01	$26,238	$64	$33,424.01	$34,437	$77	$40,834.01	$42,110
$51	$26,238.01	$26,987	$66	$34,437.01	$35,450	$80	$42,110.01	$43,386
$53	$26,987.01	$27,737	$69	$35,450.01	$36,463	$84	$43,386.01	$44,662
$56	$27,737.01	$28,487	$72	$36,463.01	$37,475	$87	$44,662.01	$45,938
$58	$28,487.01	$29,236	$75	$37,475.01	$38,488	$91	$45,938.01	$47,214
$60	$29,236.01	$29,986	$78	$38,488.01	$39,501	$95	$47,214.01	$48,490
	200% FPIG	$25,520	$81	$39,501.01	$40,514	$99	$48,490.01	$49,766
				200% FPIG	$34,480	$102	$49,766.01	$51,042
							200% FPIG	$43,440

 

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:	$7,696	$5	Less than:	$7,210	$5	Less than:	$8,263
$6	7,696.01	$9,236	$6	$7,210.01	$9,012	$7	$8,263.01	$10,328
$8	$9,236.01	$10,775	$8	$9,012.01	$10,815	$9	$10,328.01	$12,394
$10	$10,775.01	$12,314	$10	$10,815.01	$12,617	$11	$12,394.01	$14,460
$12	$12,314.01	$13,853	$12	$12,617.01	$14,420	$14	$14,460.01	$16,525
$15	$13,853.01	$15,393	$14	$14,420.01	$16,222	$17	$16,525.01	$18,591
$17	$15,393.01	$16,932	$17	$16,222.01	$18,025	$20	$18,591.01	$20,657
$20	$16,932.01	$18,471	$20	$18,025.01	$19,827	$23	$20,657.01	$22,722
$22	$18,471.01	$20,010	$23	$19,827.01	$21,629	$26	$22,722.01	$24,788
$25	$20,010.01	$21,550	$26	$21,629.01	$23,432	$30	$24,788.01	$26,853
$28	$21,550.01	$23,089	$30	$23,432.01	$25,234	$34	$26,853.01	$28,919
$32	$23,089.01	$24,628	$33	$25,234.01	$27,037	$38	$28,919.01	$30,985
$35	$24,628.01	$26,167	$37	$27,037.01	$28,839	$43	$30,985.01	$33,050
$39	$26,167.01	$27,707	$41	$28,839.01	$30,642	$47	$33,050.01	$35,116
$42	$27,707.01	$29,246	$45	$30,642.01	$32,444	$52	$35,116.01	$37,182
$45	$29,246.01	$30,785	$49	$32,444.01	$34,247	$56	$37,182.01	$39,247
$48	$30,785.01	$32,324	$53	$34,247.01	$36,049	$60	$39,247.01	$41,313
$51	$32,324.01	$33,864	$56	$36,049.01	$37,851	$64	$41,313.01	$43,379
$55	$33,864.01	$35,403	$60	$37,851.01	$39,654	$69	$43,379.01	$45,444
$58	$35,403.01	$36,942	$64	$39,654.01	$41,456	$73	$45,444.01	$47,510
$61	$36,942.01	$38,481	$68	$41,456.01	$43,259	$78	$47,510.01	$49,576
$65	$38,481.01	$40,021	$72	$43,259.01	$45,061	$83	$49,576.01	$51,641
$69	$40,021.01	$41,560	$76	$45,061.01	$46,864	$87	$51,641.01	$53,707
$72	$41,560.01	$43,099	$80	$46,864.01	$48,666	$92	$53,707.01	$55,773
$76	$43,099.01	$44,638	$85	$48,666.01	$50,469	$97	$55,773.01	$57,838
$80	$44,638.01	$46,178	$89	$50,469.01	$52,271	$102	$57,838.01	$59,904
$84	$46,178.01	$47,717	$94	$52,271.01	$54,074	$108	$59,904.01	$61,970
$88	$47,717.01	$49,256	$99	$54,074.01	$55,876	$113	$61,970.01	$64,035
$92	$49,256.01	$50,795	$103	$55,876.01	$57,678	$118	$64,035.01	$66,101
$97	$50,795.01	$52,335	$108	$57,678.01	$59,481	$124	$66,101.01	$68,166
$101	$52,335.01	$53,874	$113	$59,481.01	$61,283	$130	$68,166.01	$70,232
$105	$53,874.01	$55,413	$118	$61,283.01	$63,086	$135	$70,232.01	$72,298
$110	$55,413.01	$56,952	$123	$63,086.01	$64,888	$141	$72,298.01	$74,363
$114	$56,952.01	$58,492	$128	$64,888.01	$66,691	$147	$74,363.01	$76,429
$119	$58,492.01	$60,031	$134	$66,691.01	$68,493	$153	$76,429.01	$78,495
$124	$60,031.01	$61,570	$139	$68,493.01	$70,296	$159	$78,495.01	$80,560
	200% FPIG	$52,400	$145	$70,296.01	$72,098	$166	$80,560.01	$82,626
				200% FPIG	$61,360		200% FPIG	$70,320

 

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:	$9,315	$5	Less than:	$7,776	$5	Less than:	$8,566
$7	$9,315.01	$11,644	$6	$7,776.01	$10,368	$6	$8,566.01	$11,421
$10	$11,644.01	$13,973	$8	$10,368.01	$12,960	$9	$11,421.01	$14,276
$13	$13,973.01	$16,302	$11	$12,960.01	$15,552	$12	$14,276.01	$17,132
$15	$16,302.01	$18,631	$14	$15,552.01	$18,144	$15	$17,132.01	$19,987
$19	$18,631.01	$20,960	$17	$18,144.01	$20,736	$19	$19,987.01	$22,842
$22	$20,960.01	$23,289	$21	$20,736.01	$23,328	$23	$22,842.01	$25,697
$26	$23,289.01	$25,617	$25	$23,328.01	$25,921	$27	$25,697.01	$28,553
$30	$25,617.01	$27,946	$29	$25,921.01	$28,513	$32	$28,553.01	$31,408
$34	$27,946.01	$30,275	$33	$28,513.01	$31,105	$36	$31,408.01	$34,263
$38	$30,275.01	$32,604	$38	$31,105.01	$33,697	$42	$34,263.01	$37,118
$43	$32,604.01	$34,933	$43	$33,697.01	$36,289	$47	$37,118.01	$39,974
$48	$34,933.01	$37,262	$48	$36,289.01	$38,881	$53	$39,974.01	$42,829
$53	$37,262.01	$39,590	$53	$38,881.01	$41,473	$59	$42,829.01	$45,684
$59	$39,590.01	$41,919	$59	$41,473.01	$44,065	$65	$45,684.01	$48,539
$63	$41,919.01	$44,248	$65	$44,065.01	$46,657	$72	$48,539.01	$51,395
$68	$44,248.01	$46,577	$70	$46,657.01	$49,249	$77	$51,395.01	$54,250
$73	$46,577.01	$48,906	$76	$49,249.01	$51,841	$83	$54,250.01	$57,105
$78	$48,906.01	$51,235	$81	$51,841.01	$54,433	$89	$57,105.01	$59,960
$83	$51,235.01	$53,564	$86	$54,433.01	$57,025	$95	$59,960.01	$62,816
$88	$53,564.01	$55,892	$92	$57,025.01	$59,617	$101	$62,816.01	$65,671
$93	$55,892.01	$58,221	$98	$59,617.01	$62,209	$108	$65,671.01	$68,526
$98	$58,221.01	$60,550	$104	$62,209.01	$64,801	$114	$68,526.01	$71,381
$104	$60,550.01	$62,879	$110	$64,801.01	$67,393	$121	$71,381.01	$74,237
$110	$62,879.01	$65,208	$116	$67,393.01	$69,985	$127	$74,237.01	$77,092
$115	$65,208.01	$67,537	$122	$69,985.01	$72,577	$134	$77,092.01	$79,947
$121	$67,537.01	$69,866	$128	$72,577.01	$75,169	$141	$79,947.01	$82,802
$127	$69,866.01	$72,194	$135	$75,169.01	$77,762	$149	$82,802.01	$85,658
$133	$72,194.01	$74,523	$142	$77,762.01	$80,354	$156	$85,658.01	$88,513
$140	$74,523.01	$76,852	$148	$80,354.01	$82,946	$164	$88,513.01	$91,368
$146	$76,852.01	$79,181	$155	$82,946.01	$85,538	$171	$91,368.01	$94,223
$153	$79,181.01	$81,510	$163	$85,538.01	$88,130	$179	$94,223.01	$97,079
$159	$81,510.01	$83,839	$170	$88,130.01	$90,722	$187	$97,079.01	$99,934
$166	$83,839.01	$86,167	$177	$90,722.01	$93,314	$195	$99,934.01	$102,789
$173	$86,167.01	$88,496	$185	$93,314.01	$95,906	$203	$102,789.01	$105,644
$180	$88,496.01	$90,825	$192	$95,906.01	$98,498	$212	$105,644.01	$108,500
$187	$90,825.01	$93,154	$200	$98,498.01	$101,090	$220	$108,500.01	$111,355
	200% FPIG	$79,280	$208	$101,090.01	$103,682	$229	$111,355.01	$114,210
				200% FPIG	$88,240		200% FPIG	$97,200

 

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:	$9,355	$5	Less than:	$10,145	$5	Less than:	$10,935
$7	$9,355.01	$12,474	$7	$10,145.01	$13,527	$8	$10,935.01	$14,579
$10	$12,474.01	$15,592	$11	$13,527.01	$16,908	$12	$14,579.01	$18,224
$13	$15,592.01	$18,711	$14	$16,908.01	$20,290	$15	$18,224.01	$21,869
$17	$18,711.01	$21,829	$18	$20,290.01	$23,672	$20	$21,869.01	$25,514
$21	$21,829.01	$24,948	$22	$23,672.01	$27,053	$24	$25,514.01	$29,159
$25	$24,948.01	$28,066	$27	$27,053.01	$30,435	$29	$29,159.01	$32,804
$30	$28,066.01	$31,185	$32	$30,435.01	$33,817	$35	$32,804.01	$36,449
$35	$31,185.01	$34,303	$37	$33,817.01	$37,198	$40	$36,449.01	$40,093
$40	$34,303.01	$37,421	$43	$37,198.01	$40,580	$47	$40,093.01	$43,738
$45	$37,421.01	$40,540	$49	$40,580.01	$43,961	$53	$43,738.01	$47,383
$51	$40,540.01	$43,658	$56	$43,961.01	$47,343	$60	$47,383.01	$51,028
$58	$43,658.01	$46,777	$63	$47,343.01	$50,725	$67	$51,028.01	$54,673
$64	$46,777.01	$49,895	$70	$50,725.01	$54,106	$75	$54,673.01	$58,318
$71	$49,895.01	$53,014	$77	$54,106.01	$57,488	$83	$58,318.01	$61,962
$79	$53,014.01	$56,132	$85	$57,488.01	$60,870	$92	$61,962.01	$65,607
$85	$56,132.01	$59,251	$92	$60,870.01	$64,251	$99	$65,607.01	$69,252
$91	$59,251.01	$62,369	$99	$64,251.01	$67,633	$106	$69,252.01	$72,897
$97	$62,369.01	$65,487	$105	$67,633.01	$71,015	$114	$72,897.01	$76,542
$104	$65,487.01	$68,606	$113	$71,015.01	$74,396	$121	$76,542.01	$80,187
$111	$68,606.01	$71,724	$120	$74,396.01	$77,778	$129	$80,187.01	$83,832
$117	$71,724.01	$74,843	$127	$77,778.01	$81,160	$137	$83,832.01	$87,476
$125	$74,843.01	$77,961	$135	$81,160.01	$84,541	$146	$87,476.01	$91,121
$132	$77,961.01	$81,080	$143	$84,541.01	$87,923	$154	$91,121.01	$94,766
$139	$81,080.01	$84,198	$151	$87,923.01	$91,305	$163	$94,766.01	$98,411
$147	$84,198.01	$87,317	$159	$91,305.01	$94,686	$172	$98,411.01	$102,056
$154	$87,317.01	$90,435	$168	$94,686.01	$98,068	$181	$102,056.01	$105,701
$162	$90,435.01	$93,554	$176	$98,068.01	$101,450	$190	$105,701.01	$109,346
$170	$93,554.01	$96,672	$185	$101,450.01	$104,831	$199	$109,346.01	$112,990
$179	$96,672.01	$99,790	$194	$104,831.01	$108,213	$209	$112,990.01	$116,635
$187	$99,790.01	$102,909	$203	$108,213.01	$111,594	$219	$116,635.01	$120,280
$196	$102,909.01	$106,027	$212	$111,594.01	$114,976	$229	$120,280.01	$123,925
$204	$106,027.01	$109,146	$222	$114,976.01	$118,358	$239	$123,925.01	$127,570
$213	$109,146.01	$112,264	$231	$118,358.01	$121,739	$249	$127,570.01	$131,215
$222	$112,264.01	$115,383	$241	$121,739.01	$125,121	$260	$131,215.01	$134,859
$231	$115,383.01	$118,501	$251	$125,121.01	$128,503	$270	$134,859.01	$138,504
$241	$118,501.01	$121,620	$261	$128,503.01	$131,884	$281	$138,504.01	$142,149
$250	$121,620.01	$124,738	$271	$131,884.01	$135,266	$292	$142,149.01	$145,794
	200% FPIG	$106,160		200% FPIG	$115,120		200% FPIG	$124,080

 

Family Size:

Weekly	Family Size:	13	Weekly	Family Size:	14	Weekly	15
Co-pay	Annual Income		Co-pay	Annual Income		Co-pay	Annual Income
$5	Less than:	$11,724	$5	Less than:	$8,343	$5	Less than:	$8,869
$9	$11,724.01	$15,632	$6	$8,343.01	$12,514	$6	$8,869.01	$13,303
$12	$15,632.01	$19,540	$9	$12,514.01	$16,685	$10	$13,303.01	$17,738
$16	$19,540.01	$23,448	$13	$16,685.01	$20,856	$14	$17,738.01	$22,172
$21	$23,448.01	$27,356	$18	$20,856.01	$25,028	$19	$22,172.01	$26,607
$26	$27,356.01	$31,264	$22	$25,028.01	$29,199	$24	$26,607.01	$31,041
$31	$31,264.01	$35,172	$28	$29,199.01	$33,370	$29	$31,041.01	$35,476
$37	$35,172.01	$39,081	$33	$33,370.01	$37,541	$36	$35,476.01	$39,910
$43	$39,081.01	$42,989	$40	$37,541.01	$41,713	$42	$39,910.01	$44,345
$50	$42,989.01	$46,897	$46	$41,713.01	$45,884	$49	$44,345.01	$48,779
$57	$46,897.01	$50,805	$53	$45,884.01	$50,055	$57	$48,779.01	$53,213
$64	$50,805.01	$54,713	$61	$50,055.01	$54,226	$65	$53,213.01	$57,648
$72	$54,713.01	$58,621	$69	$54,226.01	$58,398	$73	$57,648.01	$62,082
$81	$58,621.01	$62,529	$77	$58,398.01	$62,569	$82	$62,082.01	$66,517
$89	$62,529.01	$66,437	$86	$62,569.01	$66,740	$91	$66,517.01	$70,951
$98	$66,437.01	$70,345	$95	$66,740.01	$70,911	$101	$70,951.01	$75,386
$106	$70,345.01	$74,253	$105	$70,911.01	$75,083	$112	$75,386.01	$79,820
$114	$74,253.01	$78,161	$113	$75,083.01	$79,254	$120	$79,820.01	$84,255
$122	$78,161.01	$82,069	$122	$79,254.01	$83,425	$129	$84,255.01	$88,689
$130	$82,069.01	$85,977	$130	$83,425.01	$87,596	$138	$88,689.01	$93,123
$139	$85,977.01	$89,885	$139	$87,596.01	$91,768	$148	$93,123.01	$97,558
$147	$89,885.01	$93,793	$148	$91,768.01	$95,939	$157	$97,558.01	$101,992
$156	$93,793.01	$97,701	$157	$95,939.01	$100,110	$167	$101,992.01	$106,427
$165	$97,701.01	$101,609	$167	$100,110.01	$104,281	$177	$106,427.01	$110,861
$174	$101,609.01	$105,517	$176	$104,281.01	$108,453	$187	$110,861.01	$115,296
$184	$105,517.01	$109,425	$186	$108,453.01	$112,624	$198	$115,296.01	$119,730
$194	$109,425.01	$113,333	$196	$112,624.01	$116,795	$209	$119,730.01	$124,165
$203	$113,333.01	$117,242	$207	$116,795.01	$120,966	$220	$124,165.01	$128,599
$214	$117,242.01	$121,150	$217	$120,966.01	$125,138	$231	$128,599.01	$133,034
$224	$121,150.01	$125,058	$228	$125,138.01	$129,309	$242	$133,034.01	$137,468
$234	$125,058.01	$128,966	$239	$129,309.01	$133,480	$254	$137,468.01	$141,902
$245	$128,966.01	$132,874	$250	$133,480.01	$137,651	$266	$141,902.01	$146,337
$256	$132,874.01	$136,782	$262	$137,651.01	$141,823	$278	$146,337.01	$150,771
$267	$136,782.01	$140,690	$273	$141,823.01	$145,994	$290	$150,771.01	$155,206
$278	$140,690.01	$144,598	$285	$145,994.01	$150,165	$303	$155,206.01	$159,640
$290	$144,598.01	$148,506	$297	$150,165.01	$154,336	$316	$159,640.01	$164,075
$302	$148,506.01	$152,414	$309	$154,336.01	$158,508	$329	$164,075.01	$168,509
$314	$152,414.01	$156,322	$322	$158,508.01	$162,679	$342	$168,509.01	$172,944
	200% FPIG	$133,040	$335	$162,679.01	$166,850	$356	$172,944.01	$177,378
				200% FPIG	$142,000		200% FPIG	$150,960

 

Weekly	Family Size:		Weekly	Family Size:	17	Weekly	Family Size:	18
Co-pay	Annual Income		Co-pay	Annual Income		Co-pay	Annual Income
$5	$0.00	$4,698	$5	$0.00	$4,961	$5	$0.00	$5,224
$5	$4,698.01	$9,395	$5	$4,961.01	$9,922	$5	$5,224.01	$10,448
$6	$9,395.01	$14,093	$7	$9,922.01	$14,883	$7	$10,448.01	$15,672
$10	$14,093.01	$18,791	$11	$14,883.01	$19,843	$12	$15,672.01	$20,896
$15	$18,791.01	$23,488	$16	$19,843.01	$24,804	$16	$20,896.01	$26,120
$20	$23,488.01	$28,186	$21	$24,804.01	$29,765	$22	$26,120.01	$31,344
$25	$28,186.01	$32,884	$27	$29,765.01	$34,726	$28	$31,344.01	$36,568
$31	$32,884.01	$37,581	$33	$34,726.01	$39,687	$35	$36,568.01	$41,792
$38	$37,581.01	$42,279	$40	$39,687.01	$44,648	$42	$41,792.01	$47,016
$45	$42,279.01	$46,977	$47	$44,648.01	$49,609	$50	$47,016.01	$52,241
$52	$46,977.01	$51,674	$55	$49,609.01	$54,569	$58	$52,241.01	$57,465
$60	$51,674.01	$56,372	$63	$54,569.01	$59,530	$67	$57,465.01	$62,689
$68	$56,372.01	$61,069	$72	$59,530.01	$64,491	$76	$62,689.01	$67,913
$77	$61,069.01	$65,767	$82	$64,491.01	$69,452	$86	$67,913.01	$73,137
$87	$65,767.01	$70,465	$92	$69,452.01	$74,413	$97	$73,137.01	$78,361
$97	$70,465.01	$75,162	$102	$74,413.01	$79,374	$108	$78,361.01	$83,585
$107	$75,162.01	$79,860	$113	$79,374.01	$84,334	$119	$83,585.01	$88,809
$118	$79,860.01	$84,558	$125	$84,334.01	$89,295	$132	$88,809.01	$94,033
$127	$84,558.01	$89,255	$135	$89,295.01	$94,256	$142	$94,033.01	$99,257
$137	$89,255.01	$93,953	$145	$94,256.01	$99,217	$152	$99,257.01	$104,481
$147	$93,953.01	$98,651	$155	$99,217.01	$104,178	$163	$104,481.01	$109,705
$156	$98,651.01	$103,348	$165	$104,178.01	$109,139	$174	$109,705.01	$114,929
$167	$103,348.01	$108,046	$176	$109,139.01	$114,100	$185	$114,929.01	$120,153
$177	$108,046.01	$112,744	$187	$114,100.01	$119,060	$197	$120,153.01	$125,377
$188	$112,744.01	$117,441	$198	$119,060.01	$124,021	$209	$125,377.01	$130,601
$199	$117,441.01	$122,139	$210	$124,021.01	$128,982	$221	$130,601.01	$135,825
$210	$122,139.01	$126,837	$221	$128,982.01	$133,943	$233	$135,825.01	$141,049
$221	$126,837.01	$131,534	$233	$133,943.01	$138,904	$246	$141,049.01	$146,273
$233	$131,534.01	$136,232	$246	$138,904.01	$143,865	$259	$146,273.01	$151,497
$245	$136,232.01	$140,930	$258	$143,865.01	$148,826	$272	$151,497.01	$156,722
$257	$140,930.01	$145,627	$271	$148,826.01	$153,786	$285	$156,722.01	$161,946
$269	$145,627.01	$150,325	$284	$153,786.01	$158,747	$299	$161,946.01	$167,170
$282	$150,325.01	$155,022	$298	$158,747.01	$163,708	$313	$167,170.01	$172,394
$295	$155,022.01	$159,720	$311	$163,708.01	$168,669	$328	$172,394.01	$177,618
$308	$159,720.01	$164,418	$325	$168,669.01	$173,630	$342	$177,618.01	$182,842
$321	$164,418.01	$169,115	$339	$173,630.01	$178,591	$357	$182,842.01	$188,066
$335	$169,115.01	$173,813	$353	$178,591.01	$183,551	$372	$188,066.01	$193,290
$349	$173,813.01	$178,511	$368	$183,551.01	$188,512	$388	$193,290.01	$198,514
$363	$178,511.01	$183,208	$383	$188,512.01	$193,473	$403	$198,514.01	$203,738
$377	$183,208.01	$187,906	$398	$193,473.01	$198,434	$419	$203,738.01	$208,962
	200% FPIG	$159,920		200% FPIG	$168,880		200% FPIG	$177,840

 

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	$0.00	$5,487	$5	$0.00	$5,750	$5	$0.00	$6,014
$5	$5,487.01	$10,975	$5	$5,750.01	$11,501	$5	$6,014.01	$12,027
$7	$10,975.01	$16,462	$8	$11,501.01	$17,251	$8	$12,027.01	$18,041
$12	$16,462.01	$21,949	$13	$17,251.01	$23,002	$13	$18,041.01	$24,055
$17	$21,949.01	$27,436	$18	$23,002.01	$28,752	$19	$24,055.01	$30,068
$23	$27,436.01	$32,924	$24	$28,752.01	$34,503	$25	$30,068.01	$36,082
$29	$32,924.01	$38,411	$31	$34,503.01	$40,253	$32	$36,082.01	$42,096
$36	$38,411.01	$43,898	$38	$40,253.01	$46,004	$40	$42,096.01	$48,109
$44	$43,898.01	$49,385	$46	$46,004.01	$51,754	$48	$48,109.01	$54,123
$52	$49,385.01	$54,873	$55	$51,754.01	$57,505	$57	$54,123.01	$60,137
$61	$54,873.01	$60,360	$64	$57,505.01	$63,255	$67	$60,137.01	$66,150
$70	$60,360.01	$65,847	$73	$63,255.01	$69,005	$77	$66,150.01	$72,164
$80	$65,847.01	$71,334	$84	$69,005.01	$74,756	$88	$72,164.01	$78,177
$90	$71,334.01	$76,822	$95	$74,756.01	$80,506	$99	$78,177.01	$84,191
$102	$76,822.01	$82,309	$106	$80,506.01	$86,257	$111	$84,191.01	$90,205
$113	$82,309.01	$87,796	$119	$86,257.01	$92,007	$124	$90,205.01	$96,218
$125	$87,796.01	$93,283	$131	$92,007.01	$97,758	$137	$96,218.01	$102,232
$138	$93,283.01	$98,771	$145	$97,758.01	$103,508	$151	$102,232.01	$108,246
$149	$98,771.01	$104,258	$156	$103,508.01	$109,259	$163	$108,246.01	$114,259
$160	$104,258.01	$109,745	$168	$109,259.01	$115,009	$175	$114,259.01	$120,273
$171	$109,745.01	$115,232	$179	$115,009.01	$120,759	$188	$120,273.01	$126,287
$183	$115,232.01	$120,720	$191	$120,759.01	$126,510	$200	$126,287.01	$132,300
$195	$120,720.01	$126,207	$204	$126,510.01	$132,260	$213	$132,300.01	$138,314
$207	$126,207.01	$131,694	$217	$132,260.01	$138,011	$227	$138,314.01	$144,328
$219	$131,694.01	$137,181	$230	$138,011.01	$143,761	$240	$144,328.01	$150,341
$232	$137,181.01	$142,669	$243	$143,761.01	$149,512	$254	$150,341.01	$156,355
$245	$142,669.01	$148,156	$257	$149,512.01	$155,262	$268	$156,355.01	$162,369
$258	$148,156.01	$153,643	$271	$155,262.01	$161,013	$283	$162,369.01	$168,382
$272	$153,643.01	$159,130	$285	$161,013.01	$166,763	$298	$168,382.01	$174,396
$286	$159,130.01	$164,618	$299	$166,763.01	$172,514	$313	$174,396.01	$180,410
$300	$164,618.01	$170,105	$314	$172,514.01	$178,264	$329	$180,410.01	$186,423
$314	$170,105.01	$175,592	$329	$178,264.01	$184,014	$344	$186,423.01	$192,437
$329	$175,592.01	$181,079	$345	$184,014.01	$189,765	$361	$192,437.01	$198,450
$344	$181,079.01	$186,567	$361	$189,765.01	$195,515	$377	$198,450.01	$204,464
$359	$186,567.01	$192,054	$377	$195,515.01	$201,266	$394	$204,464.01	$210,478
$375	$192,054.01	$197,541	$393	$201,266.01	$207,016	$411	$210,478.01	$216,491
$391	$197,541.01	$203,028	$410	$207,016.01	$212,767	$428	$216,491.01	$222,505
$407	$203,028.01	$208,516	$427	$212,767.01	$218,517	$446	$222,505.01	$228,519
$424	$208,516.01	$214,003	$444	$218,517.01	$224,268	$464	$228,519.01	$234,532
$440	$214,003.01	$219,490	$461	$224,268.01	$230,018	$483	$234,532.01	$240,546
	200% FPIG	$186,800		200% FPIG	$195,760		200% FPIG	$204,720

[Pa.B. Doc. No. 20-1226. Filed for public inspection September 4, 2020, 9:00 a.m.]

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