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COMMONWEALTH OF PENNSYLVANIA

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PA Bulletin, Doc. No. 22-129

NOTICES

DEPARTMENT OF HUMAN SERVICES

Co-payments for the Subsidized Child Care Program

[52 Pa.B. 502]
[Saturday, January 22, 2022]

 This notice decreases co-payments codified at 55 Pa. Code Chapter 3041, Appendix B (relating to co-payment chart family co-payment scale (based on the 2021 Federal Poverty Income Guidelines)) under 55 Pa. Code § 3041.107(b) (relating to availability and use of the Federal Poverty Income Guidelines). Chapter 3041, Appendix B of 55 Pa. Code 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. This decrease is effective January 17, 2022.

 Under section 408.3(b) of the Human Services Code (62 P.S. § 408.3(b)), the co-payment schedule is adjusted by notice published in the Pennsylvania Bulletin. Effective January 17, 2022, co-payments will be reduced to 3% to 7% of a family's income to meet the Federal recommendation for percent of family income obligated to child care expenses. The initiative will not increase any family's co-payment. Families in the lowest income brackets will continue to pay the minimum co-payment permitted by law. Families in higher income brackets will see a reduction in the co-payment. The Department of Human Services (Department) pays providers the Maximum Child Care Allowance base rate less the family weekly co-payment. If the family co-payment is decreased, the Department's contribution to providers will increase.

MEG SNEAD, 
Acting Secretary

Fiscal Note: 14-NOT-1488. No fiscal impact; (8) recommends adoption.

CO-PAYMENT CHART

FAMILY CO-PAYMENT SCALE EFFECTIVE JANUARY 17, 2022

(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: $7,567 $5 Less than: $8,187 $5 Less than: $7,741
$6 $7,567.01 $8,324 $6 $8,187.41 $9,211 $6 $7,741.01 $9,031
$7 $8,323.71 $9,080 $7 $9,210.84 $10,234 $7 $9,031.01 $10,321
$8 $9,080.41 $9,837 $8 $10,234.26 $11,258 $8 $10,321.01 $11,611
$9 $9,837.11 $10,594 $9 $11,257.69 $12,281 $9 $11,611.01 $12,902
$9 $10,593.81 $11,351 $10 $12,281.11 $13,305 $10 $12,902.01 $14,192
$10 $11,350.51 $12,107 $12 $13,304.54 $14,328 $12 $14,192.01 $15,482
$11 $12,107.21 $12,864 $13 $14,327.96 $15,351 $13 $15,482.01 $16,772
$12 $12,863.91 $13,621 $14 $15,351.39 $16,375 $15 $16,772.01 $18,062
$13 $13,620.61 $14,377 $15 $16,374.81 $17,398 $16 $18,062.01 $19,352
$14 $14,377.31 $15,134 $17 $17,398.24 $18,422 $18 $19,352.01 $20,642
$15 $15,134.01 $15,891 $18 $18,421.66 $19,445 $19 $20,642.01 $21,933
$16 $15,890.71 $16,647 $19 $19,445.09 $20,469 $21 $21,933.01 $23,223
$17 $16,647.41 $17,404 $21 $20,468.51 $21,492 $23 $23,223.01 $24,513
$19 $17,404.11 $18,161 $22 $21,491.94 $22,515 $24 $24,513.01 $25,803
$20 $18,160.81 $18,918 $24 $22,515.36 $23,539 $26 $25,803.01 $27,093
$21 $18,917.51 $19,674 $25 $23,538.79 $24,562 $28 $27,093.01 $28,383
$22 $19,674.21 $20,431 $27 $24,562.21 $25,586 $30 $28,383.01 $29,673
$23 $20,430.91 $21,188 $28 $25,585.64 $26,609 $32 $29,673.01 $30,964
$24 $21,187.61 $21,944 $30 $26,609.06 $27,632 $34 $30,964.01 $32,254
$26 $21,944.31 $22,701 $31 $27,632.49 $28,656 $36 $32,254.01 $33,544
$27 $22,701.01 $23,458 $33 $28,655.91 $29,679 $38 $33,544.01 $34,834
$28 $23,457.71 $24,214 $35 $29,679.34 $30,703 $40 $34,834.01 $36,124
$30 $24,214.41 $24,971 $36 $30,702.76 $31,726 $42 $36,124.01 $37,414
$31 $24,971.11 $25,728 $38 $31,726.19 $32,750 $44 $37,414.01 $38,705
$32 $25,727.81 $26,485 $40 $32,749.61 $33,773 $46 $38,705.01 $39,995
$34 $26,484.51 $27,241 $42 $33,773.04 $34,796 $48 $39,995.01 $41,285
$35 $27,241.21 $27,998 $44 $34,796.46 $35,820 $51 $41,285.01 $42,575
$37 $27,997.91 $28,755 $46 $35,819.89 $36,843 $53 $42,575.01 $43,865
$38 $28,754.61 $29,511 $48 $36,843.31 $37,867 $55 $43,865.01 $45,155
$40 $29,511.31 $30,268 $50 $37,866.74 $38,890 $58 $45,155.01 $46,445
200% FPIG $25,760 $52 $38,890.16 $39,914 $60 $46,445.01 $47,736
$54 $39,913.59 $40,937 $63 $47,736.01 $49,026
200% FPIG $34,840 $65 $49,026.01 $50,316
$68 $50,316.01 $51,606
200% FPIG $43,920
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: $9,341 $5 Less than: $9,118 $5 Less than: $8,361
$7 $9,341.01 $10,898 $6 $9,118.01 $10,942 $6 $8,361.01 $10,452
$8 $10,898.01 $12,455 $8 $10,942.01 $12,765 $7 $10,452.01 $12,542
$9 $12,455.01 $14,012 $9 $12,765.01 $14,589 $9 $12,542.01 $14,632
$11 $14,012.01 $15,569 $11 $14,589.01 $16,412 $11 $14,632.01 $16,723
$13 $15,569.01 $17,126 $13 $16,412.01 $18,236 $13 $16,723.01 $18,813
$14 $17,126.01 $18,683 $15 $18,236.01 $20,060 $15 $18,813.01 $20,903
$16 $18,683.01 $20,239 $17 $20,060.01 $21,883 $17 $20,903.01 $22,994
$18 $20,239.01 $21,796 $19 $21,883.01 $23,707 $19 $22,994.01 $25,084
$19 $21,796.01 $23,353 $21 $23,707.01 $25,530 $21 $25,084.01 $27,174
$21 $23,353.01 $24,910 $23 $25,530.01 $27,354 $24 $27,174.01 $29,265
$23 $24,910.01 $26,467 $25 $27,354.01 $29,178 $26 $29,265.01 $31,355
$25 $26,467.01 $28,024 $27 $29,178.01 $31,001 $29 $31,355.01 $33,445
$27 $28,024.01 $29,581 $30 $31,001.01 $32,825 $31 $33,445.01 $35,536
$29 $29,581.01 $31,138 $32 $32,825.01 $34,648 $34 $35,536.01 $37,626
$32 $31,138.01 $32,694 $35 $34,648.01 $36,472 $37 $37,626.01 $39,716
$34 $32,694.01 $34,251 $37 $36,472.01 $38,296 $40 $39,716.01 $41,807
$36 $34,251.01 $35,808 $40 $38,296.01 $40,119 $42 $41,807.01 $43,897
$38 $35,808.01 $37,365 $42 $40,119.01 $41,943 $45 $43,897.01 $45,987
$41 $37,365.01 $38,922 $45 $41,943.01 $43,766 $48 $45,987.01 $48,077
$43 $38,922.01 $40,479 $47 $43,766.01 $45,590 $51 $48,077.01 $50,168
$45 $40,479.01 $42,036 $50 $45,590.01 $47,414 $54 $50,168.01 $52,258
$48 $42,036.01 $43,593 $53 $47,414.01 $49,237 $58 $52,258.01 $54,348
$50 $43,593.01 $45,149 $56 $49,237.01 $51,061 $61 $54,348.01 $56,439
$53 $45,149.01 $46,706 $59 $51,061.01 $52,884 $64 $56,439.01 $58,529
$56 $46,706.01 $48,263 $62 $52,884.01 $54,708 $68 $58,529.01 $60,619
$58 $48,263.01 $49,820 $65 $54,708.01 $56,532 $71 $60,619.01 $62,710
$61 $49,820.01 $51,377 $68 $56,532.01 $58,355 $75 $62,710.01 $64,800
$64 $51,377.01 $52,934 $71 $58,355.01 $60,179 $78 $64,800.01 $66,890
$67 $52,934.01 $54,491 $75 $60,179.01 $62,002 $82 $66,890.01 $68,981
$70 $54,491.01 $56,048 $78 $62,002.01 $63,826 $86 $68,981.01 $71,071
$73 $56,048.01 $57,604 $81 $63,826.01 $65,650 $89 $71,071.01 $73,161
$76 $57,604.01 $59,161 $85 $65,650.01 $67,473 $93 $73,161.01 $75,252
$79 $59,161.01 $60,718 $88 $67,473.01 $69,297 $97 $75,252.01 $77,342
$82 $60,718.01 $62,275 $92 $69,297.01 $71,120 $101 $77,342.01 $79,432
200% FPIG$53,000 $96 $71,120.01 $72,944 $106 $79,432.01 $81,523
200% FPIG $62,080 $110 $81,523.01 $83,613
200% FPIG$71,160

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: $9,428 $5 Less than: $10,495 $5 Less than: $8,672
$6 $9,428.01 $11,785 $7 $10,495.01 $13,119 $6 $8,672.01 $11,562
$8 $11,785.01 $14,142 $9 $13,119.01 $15,743 $8 $11,562.01 $14,453
$10 $14,142.01 $16,499 $11 $15,743.01 $18,366 $10 $14,453.01 $17,343
$12 $16,499.01 $18,856 $14 $18,366.01 $20,990 $12 $17,343.01 $20,234
$14 $18,856.01 $21,213 $16 $20,990.01 $23,614 $15 $20,234.01 $23,124
$17 $21,213.01 $23,571 $18 $23,614.01 $26,238 $18 $23,124.01 $26,015
$19 $23,571.01 $25,928 $21 $26,238.01 $28,862 $20 $26,015.01 $28,905
$21 $25,928.01 $28,285 $24 $28,862.01 $31,485 $23 $28,905.01 $31,796
$24 $28,285.01 $30,642 $27 $31,485.01 $34,109 $26 $31,796.01 $34,686
$27 $30,642.01 $32,999 $30 $34,109.01 $36,733 $29 $34,686.01 $37,577
$29 $32,999.01 $35,356 $33 $36,733.01 $39,357 $33 $37,577.01 $40,467
$32 $35,356.01 $37,713 $36 $39,357.01 $41,980 $36 $40,467.01 $43,358
$35 $37,713.01 $40,070 $39 $41,980.01 $44,604 $40 $43,358.01 $46,248
$39 $40,070.01 $42,427 $43 $44,604.01 $47,228 $43 $46,248.01 $49,139
$42 $42,427.01 $44,784 $46 $47,228.01 $49,852 $47 $49,139.01 $52,029
$45 $44,784.01 $47,141 $50 $49,852.01 $52,476 $51 $52,029.01 $54,920
$48 $47,141.01 $49,498 $53 $52,476.01 $55,099 $55 $54,920.01 $57,810
$51 $49,498.01 $51,855 $57 $55,099.01 $57,723 $59 $57,810.01 $60,701
$54 $51,855.01 $54,212 $61 $57,723.01 $60,347 $63 $60,701.01 $63,591
$58 $54,212.01 $56,569 $64 $60,347.01 $62,971 $67 $63,591.01 $66,482
$61 $56,569.01 $58,926 $68 $62,971.01 $65,594 $71 $66,482.01 $69,372
$65 $58,926.01 $61,283 $72 $65,594.01 $68,218 $75 $69,372.01 $72,263
$69 $61,283.01 $63,640 $76 $68,218.01 $70,842 $80 $72,263.01 $75,153
$72 $63,640.01 $65,997 $81 $70,842.01 $73,466 $84 $75,153.01 $78,044
$76 $65,997.01 $68,354 $85 $73,466.01 $76,089 $89 $78,044.01 $80,934
$80 $68,354.01 $70,712 $89 $76,089.01 $78,713 $93 $80,934.01 $83,825
$84 $70,712.01 $73,069 $94 $78,713.01 $81,337 $98 $83,825.01 $86,715
$88 $73,069.01 $75,426 $98 $81,337.01 $83,961 $103 $86,715.01 $89,606
$92 $75,426.01 $77,783 $103 $83,961.01 $86,585 $108 $89,606.01 $92,496
$97 $77,783.01 $80,140 $107 $86,585.01 $89,208 $113 $92,496.01 $95,387
$101 $80,140.01 $82,497 $112 $89,208.01 $91,832 $118 $95,387.01 $98,277
$105 $82,497.01 $84,854 $117 $91,832.01 $94,456 $124 $98,277.01 $101,168
$110 $84,854.01 $87,211 $122 $94,456.01 $97,080 $129 $101,168.01 $104,058
$114 $87,211.01 $89,568 $127 $97,080.01 $99,703 $135 $104,058.01 $106,949
$119 $89,568.01 $91,925 $132 $99,703.01 $102,327 $140 $106,949.01 $109,839
$124 $91,925.01 $94,282 $138 $102,327.01 $104,951 $146 $109,839.01 $112,730
200% FPIG $80,240 200% FPIG $89,320 $152 $112,730.01 $115,620
200% FPIG$98,400

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: $9,472 $5 Less than: $10,272 $5 Less than: $11,072
$6 $9,472.01 $12,629 $7 $10,272.01 $13,696 $7 $11,072.01 $14,763
$8 $12,629.01 $15,786 $9 $13,696.01 $17,120 $10 $14,763.01 $18,453
$11 $15,786.01 $18,943 $12 $17,120.01 $20,544 $13 $18,453.01 $22,144
$14 $18,943.01 $22,101 $15 $20,544.01 $23,968 $16 $22,144.01 $25,835
$16 $22,101.01 $25,258 $18 $23,968.01 $27,392 $19 $25,835.01 $29,525
$19 $25,258.01 $28,415 $21 $27,392.01 $30,816 $22 $29,525.01 $33,216
$22 $28,415.01 $31,572 $24 $30,816.01 $34,240 $26 $33,216.01 $36,907
$25 $31,572.01 $34,729 $28 $34,240.01 $37,663 $30 $36,907.01 $40,597
$29 $34,729.01 $37,887 $31 $37,663.01 $41,087 $34 $40,597.01 $44,288
$32 $37,887.01 $41,044 $35 $41,087.01 $44,511 $38 $44,288.01 $47,979
$36 $41,044.01 $44,201 $39 $44,511.01 $47,935 $42 $47,979.01 $51,669
$40 $44,201.01 $47,358 $43 $47,935.01 $51,359 $46 $51,669.01 $55,360
$43 $47,358.01 $50,516 $47 $51,359.01 $54,783 $51 $55,360.01 $59,051
$47 $50,516.01 $53,673 $51 $54,783.01 $58,207 $55 $59,051.01 $62,741
$52 $53,673.01 $56,830 $56 $58,207.01 $61,631 $60 $62,741.01 $66,432
$56 $56,830.01 $59,987 $60 $61,631.01 $65,055 $65 $66,432.01 $70,123
$60 $59,987.01 $63,145 $65 $65,055.01 $68,479 $70 $70,123.01 $73,814
$64 $63,145.01 $66,302 $69 $68,479.01 $71,903 $75 $73,814.01 $77,504
$68 $66,302.01 $69,459 $74 $71,903.01 $75,327 $80 $77,504.01 $81,195
$73 $69,459.01 $72,616 $79 $75,327.01 $78,751 $85 $81,195.01 $84,886
$77 $72,616.01 $75,773 $84 $78,751.01 $82,175 $91 $84,886.01 $88,576
$82 $75,773.01 $78,931 $89 $82,175.01 $85,599 $96 $88,576.01 $92,267
$87 $78,931.01 $82,088 $94 $85,599.01 $89,023 $102 $92,267.01 $95,958
$92 $82,088.01 $85,245 $100 $89,023.01 $92,447 $107 $95,958.01 $99,648
$97 $85,245.01 $88,402 $105 $92,447.01 $95,871 $113 $99,648.01 $103,339
$102 $88,402.01 $91,560 $111 $95,871.01 $99,295 $119 $103,339.01 $107,030
$107 $91,560.01 $94,717 $116 $99,295.01 $102,719 $125 $107,030.01 $110,720
$113 $94,717.01 $97,874 $122 $102,719.01 $106,142 $132 $110,720.01 $114,411
$118 $97,874.01 $101,031 $128 $106,142.01 $109,566 $138 $114,411.01 $118,102
$124 $101,031.01 $104,188 $134 $109,566.01 $112,990 $145 $118,102.01 $121,792
$129 $104,188.01 $107,346 $140 $112,990.01 $116,414 $151 $121,792.01 $125,483
$135 $107,346.01 $110,503 $147 $116,414.01 $119,838 $158 $125,483.01 $129,174
$141 $110,503.01 $113,660 $153 $119,838.01 $123,262 $165 $129,174.01 $132,864
$147 $113,660.01 $116,817 $159 $123,262.01 $126,686 $172 $132,864.01 $136,555
$153 $116,817.01 $119,975 $166 $126,686.01 $130,110 $179 $136,555.01 $140,246
$159 $119,975.01 $123,132 $173 $130,110.01 $133,534 $186 $140,246.01 $143,936
$166 $123,132.01 $126,289 $180 $133,534.01 $136,958 $194 $143,936.01 $147,627
200% FPIG$107,480 200% FPIG $116,560 200% FPIG $125,640

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: $11,872 $5 Less than: $12,672 $5 Less than: $8,982
$8 $11,872.01 $15,830 $8 $12,672.01 $16,897 $6 $8,982.01 $13,473
$11 $15,830.01 $19,787 $11 $16,897.01 $21,121 $9 $13,473.01 $17,963
$14 $19,787.01 $23,744 $15 $21,121.01 $25,345 $12 $17,963.01 $22,454
$17 $23,744.01 $27,702 $18 $25,345.01 $29,569 $15 $22,454.01 $26,945
$20 $27,702.01 $31,659 $22 $29,569.01 $33,793 $19 $26,945.01 $31,436
$24 $31,659.01 $35,617 $26 $33,793.01 $38,017 $23 $31,436.01 $35,927
$28 $35,617.01 $39,574 $30 $38,017.01 $42,241 $27 $35,927.01 $40,418
$32 $39,574.01 $43,531 $34 $42,241.01 $46,465 $32 $40,418.01 $44,909
$36 $43,531.01 $47,489 $38 $46,465.01 $50,690 $36 $44,909.01 $49,399
$40 $47,489.01 $51,446 $43 $50,690.01 $54,914 $41 $49,399.01 $53,890
$45 $51,446.01 $55,404 $48 $54,914.01 $59,138 $46 $53,890.01 $58,381
$50 $55,404.01 $59,361 $53 $59,138.01 $63,362 $51 $58,381.01 $62,872
$54 $59,361.01 $63,318 $58 $63,362.01 $67,586 $56 $62,872.01 $67,363
$59 $63,318.01 $67,276 $63 $67,586.01 $71,810 $62 $67,363.01 $71,854
$65 $67,276.01 $71,233 $69 $71,810.01 $76,034 $67 $71,854.01 $76,344
$70 $71,233.01 $75,191 $74 $76,034.01 $80,258 $73 $76,344.01 $80,835
$75 $75,191.01 $79,148 $80 $80,258.01 $84,483 $79 $80,835.01 $85,326
$80 $79,148.01 $83,105 $86 $84,483.01 $88,707 $85 $85,326.01 $89,817
$86 $83,105.01 $87,063 $91 $88,707.01 $92,931 $91 $89,817.01 $94,308
$91 $87,063.01 $91,020 $97 $92,931.01 $97,155 $97 $94,308.01 $98,799
$97 $91,020.01 $94,978 $104 $97,155.01 $101,379 $104 $98,799.01 $103,290
$103 $94,978.01 $98,935 $110 $101,379.01 $105,603 $110 $103,290.01 $107,780
$109 $98,935.01 $102,892 $116 $105,603.01 $109,827 $117 $107,780.01 $112,271
$115 $102,892.01 $106,850 $123 $109,827.01 $114,051 $124 $112,271.01 $116,762
$121 $106,850.01 $110,807 $130 $114,051.01 $118,276 $131 $116,762.01 $121,253
$128 $110,807.01 $114,765 $136 $118,276.01 $122,500 $138 $121,253.01 $125,744
$134 $114,765.01 $118,722 $143 $122,500.01 $126,724 $145 $125,744.01 $130,235
$141 $118,722.01 $122,679 $151 $126,724.01 $130,948 $153 $130,235.01 $134,726
$148 $122,679.01 $126,637 $158 $130,948.01 $135,172 $160 $134,726.01 $139,216
$155 $126,637.01 $130,594 $165 $135,172.01 $139,396 $168 $139,216.01 $143,707
$162 $130,594.01 $134,552 $173 $139,396.01 $143,620 $176 $143,707.01 $148,198
$169 $134,552.01 $138,509 $181 $143,620.01 $147,844 $184 $148,198.01 $152,689
$177 $138,509.01 $142,466 $189 $147,844.01 $152,069 $192 $152,689.01 $157,180
$184 $142,466.01 $146,424 $197 $152,069.01 $156,293 $201 $157,180.01 $161,671
$192 $146,424.01 $150,381 $205 $156,293.01 $160,517 $209 $161,671.01 $166,161
$200 $150,381.01 $154,339 $213 $160,517.01 $164,741 $218 $166,161.01 $170,652
$208 $154,339.01 $158,296 $222 $164,741.01 $168,965 $227 $170,652.01 $175,143
200% FPIG $134,720 200% FPIG $143,800 $236 $175,143.01 $179,634
200% FPIG$152,880

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: $9,515 $5 Less than: $10,049 $5 Less than: $10,582
$6 $9,515.01 $14,273 $6 $10,049.01 $15,073 $7 $10,582.01 $15,873
$9 $14,273.01 $19,030 $10 $15,073.01 $20,097 $10 $15,873.01 $21,164
$13 $19,030.01 $23,788 $13 $20,097.01 $25,122 $14 $21,164.01 $26,455
$16 $23,788.01 $28,545 $17 $25,122.01 $30,146 $18 $26,455.01 $31,746
$20 $28,545.01 $33,303 $21 $30,146.01 $35,170 $23 $31,746.01 $37,037
$24 $33,303.01 $38,061 $26 $35,170.01 $40,194 $27 $37,037.01 $42,328
$29 $38,061.01 $42,818 $30 $40,194.01 $45,219 $32 $42,328.01 $47,619
$33 $42,818.01 $47,576 $35 $45,219.01 $50,243 $37 $47,619.01 $52,910
$38 $47,576.01 $52,333 $40 $50,243.01 $55,267 $42 $52,910.01 $58,201
$43 $52,333.01 $57,091 $46 $55,267.01 $60,292 $48 $58,201.01 $63,492
$48 $57,091.01 $61,848 $51 $60,292.01 $65,316 $54 $63,492.01 $68,783
$54 $61,848.01 $66,606 $57 $65,316.01 $70,340 $60 $68,783.01 $74,074
$60 $66,606.01 $71,364 $63 $70,340.01 $75,365 $66 $74,074.01 $79,365
$65 $71,364.01 $76,121 $69 $75,365.01 $80,389 $73 $79,365.01 $84,656
$71 $76,121.01 $80,879 $75 $80,389.01 $85,413 $79 $84,656.01 $89,947
$78 $80,879.01 $85,636 $82 $85,413.01 $90,437 $86 $89,947.01 $95,238
$84 $85,636.01 $90,394 $89 $90,437.01 $95,462 $93 $95,238.01 $100,529
$90 $90,394.01 $95,152 $95 $95,462.01 $100,486 $100 $100,529.01 $105,821
$96 $95,152.01 $99,909 $102 $100,486.01 $105,510 $107 $105,821.01 $111,112
$103 $99,909.01 $104,667 $109 $105,510.01 $110,535 $115 $111,112.01 $116,403
$110 $104,667.01 $109,424 $116 $110,535.01 $115,559 $122 $116,403.01 $121,694
$117 $109,424.01 $114,182 $123 $115,559.01 $120,583 $130 $121,694.01 $126,985
$124 $114,182.01 $118,939 $131 $120,583.01 $125,608 $138 $126,985.01 $132,276
$131 $118,939.01 $123,697 $138 $125,608.01 $130,632 $146 $132,276.01 $137,567
$138 $123,697.01 $128,455 $146 $130,632.01 $135,656 $154 $137,567.01 $142,858
$146 $128,455.01 $133,212 $154 $135,656.01 $140,680 $162 $142,858.01 $148,149
$154 $133,212.01 $137,970 $162 $140,680.01 $145,705 $171 $148,149.01 $153,440
$162 $137,970.01 $142,727 $171 $145,705.01 $150,729 $180 $153,440.01 $158,731
$170 $142,727.01 $147,485 $179 $150,729.01 $155,753 $189 $158,731.01 $164,022
$178 $147,485.01 $152,242 $188 $155,753.01 $160,778 $198 $164,022.01 $169,313
$186 $152,242.01 $157,000 $197 $160,778.01 $165,802 $207 $169,313.01 $174,604
$195 $157,000.01 $161,758 $206 $165,802.01 $170,826 $217 $174,604.01 $179,895
$204 $161,758.01 $166,515 $215 $170,826.01 $175,851 $226 $179,895.01 $185,186
$213 $166,515.01 $171,273 $224 $175,851.01 $180,875 $236 $185,186.01 $190,477
$222 $171,273.01 $176,030 $234 $180,875.01 $185,899 $246 $190,477.01 $195,768
$231 $176,030.01 $180,788 $244 $185,899.01 $190,923 $257 $195,768.01 $201,059
$240 $180,788.01 $185,545 $254 $190,923.01 $195,948 $267 $201,059.01 $206,350
$250 $185,545.01 $190,303 $264 $195,948.01 $200,972 $278 $206,350.01 $211,641
200% FPIG $161,960 200% FPIG $171,040 200% FPIG $180,120

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: $11,116 $5 Less than: $11,649 $5 Less than: $12,182
$7 $11,116.01 $16,673 $7 $11,649.01 $17,473 $8 $12,182.01 $18,274
$11 $16,673.01 $22,231 $11 $17,473.01 $23,298 $12 $18,274.01 $24,365
$15 $22,231.01 $27,789 $16 $23,298.01 $29,122 $16 $24,365.01 $30,456
$19 $27,789.01 $33,347 $20 $29,122.01 $34,947 $21 $30,456.01 $36,547
$24 $33,347.01 $38,904 $25 $34,947.01 $40,771 $26 $36,547.01 $42,638
$29 $38,904.01 $44,462 $30 $40,771.01 $46,596 $31 $42,638.01 $48,730
$34 $44,462.01 $50,020 $35 $46,596.01 $52,420 $37 $48,730.01 $54,821
$39 $50,020.01 $55,578 $41 $52,420.01 $58,245 $43 $54,821.01 $60,912
$45 $55,578.01 $61,135 $47 $58,245.01 $64,069 $49 $60,912.01 $67,003
$50 $61,135.01 $66,693 $53 $64,069.01 $69,894 $55 $67,003.01 $73,094
$57 $66,693.01 $72,251 $59 $69,894.01 $75,718 $62 $73,094.01 $79,186
$63 $72,251.01 $77,809 $66 $75,718.01 $81,543 $69 $79,186.01 $85,277
$70 $77,809.01 $83,366 $73 $81,543.01 $87,367 $76 $85,277.01 $91,368
$76 $83,366.01 $88,924 $80 $87,367.01 $93,192 $84 $91,368.01 $97,459
$83 $88,924.01 $94,482 $87 $93,192.01 $99,016 $92 $97,459.01 $103,550
$91 $94,482.01 $100,040 $95 $99,016.01 $104,841 $100 $103,550.01 $109,642
$98 $100,040.01 $105,597 $103 $104,841.01 $110,665 $107 $109,642.01 $115,733
$105 $105,597.01 $111,155 $110 $110,665.01 $116,490 $115 $115,733.01 $121,824
$113 $111,155.01 $116,713 $118 $116,490.01 $122,314 $124 $121,824.01 $127,915
$120 $116,713.01 $122,271 $126 $122,314.01 $128,138 $132 $127,915.01 $134,006
$128 $122,271.01 $127,828 $134 $128,138.01 $133,963 $141 $134,006.01 $140,098
$136 $127,828.01 $133,386 $143 $133,963.01 $139,787 $149 $140,098.01 $146,189
$145 $133,386.01 $138,944 $152 $139,787.01 $145,612 $158 $146,189.01 $152,280
$153 $138,944.01 $144,502 $160 $145,612.01 $151,436 $168 $152,280.01 $158,371
$162 $144,502.01 $150,059 $169 $151,436.01 $157,261 $177 $158,371.01 $164,462
$171 $150,059.01 $155,617 $179 $157,261.01 $163,085 $187 $164,462.01 $170,554
$180 $155,617.01 $161,175 $188 $163,085.01 $168,910 $197 $170,554.01 $176,645
$189 $161,175.01 $166,733 $198 $168,910.01 $174,734 $207 $176,645.01 $182,736
$198 $166,733.01 $172,290 $208 $174,734.01 $180,559 $217 $182,736.01 $188,827
$208 $172,290.01 $177,848 $218 $180,559.01 $186,383 $228 $188,827.01 $194,918
$218 $177,848.01 $183,406 $228 $186,383.01 $192,208 $239 $194,918.01 $201,010
$228 $183,406.01 $188,964 $239 $192,208.01 $198,032 $250 $201,010.01 $207,101
$238 $188,964.01 $194,521 $249 $198,032.01 $203,857 $261 $207,101.01 $213,192
$248 $194,521.01 $200,079 $260 $203,857.01 $209,681 $272 $213,192.01 $219,283
$259 $200,079.01 $205,637 $271 $209,681.01 $215,506 $284 $219,283.01 $225,374
$270 $205,637.01 $211,195 $283 $215,506.01 $221,330 $296 $225,374.01 $231,466
$281 $211,195.01 $216,752 $294 $221,330.01 $227,155 $308 $231,466.01 $237,557
$292 $216,752.01 $222,310 $306 $227,155.01 $232,979 $320 $237,557.01 $243,648
200% FPIG $189,200 200% FPIG $198,280 200% FPIG $207,360
[Pa.B. Doc. No. 22-129. Filed for public inspection January 21, 2022, 9:00 a.m.]



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