NOTICES
DEPARTMENT OF
PUBLIC WELFARE
Co-Payments for the Subsidized Child Care Program
[41 Pa.B. 5232]
[Saturday, October 1, 2011]
The purpose of this notice is to revise the co-payment schedule codified in 55 Pa. Code Chapter 3041, Appendix B (relating to co-payment chart family co-payment scale (based on the 2011 Federal Poverty Income Guidelines). The revised copayment schedule is effective October 3, 2011.
The act of June 30, 2011 (P. L. 89, No. 22) (Act 22) amended section 408.3 of the Public Welfare Code (code) (62 P. S. § 408.3), regarding co-payments for subsidized child care. Among other things, Act 22 directs the Department of Public Welfare (Department) to publish a notice in the Pennsylvania Bulletin setting forth the co-payment schedule for subsidized child care (section 408.3(b) of the code). Act 22 requires the Department to impose co-payments for the subsidized child care program based on a sliding income scale taking into account the Federal Poverty Income Guidelines (FPIG) (section 408.3(c)(1) of the code). Co-payment amounts must be a minimum of $5 per week and may increase at incremental amounts as determined by the Department, taking into account annual family income (section 408.3(c)(3) of the code). A family's co-payment shall not exceed 8% of the family's annual income if the family's annual income is 100% or less of the FPIG; or 11% of the family's annual income if the family's annual income exceeds 100% of the FPIG (section 408.3(c)(4) of the code).
The Department is revising the co-payment schedule for the subsidized child care program in accordance with the requirements set forth in Act 22. 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.
GARY D. ALEXANDER,
Secretary
Fiscal Note: 14-NOT-719. (1) General Fund; (2) Implementing Year 2011-12 is $17,796,000; (3) 1st Succeeding Year 2012-13 is $19,728,000; 2nd Succeeding Year 2013-14 is $19,728,000; 3rd Succeeding Year 2014-15 is $19,728,000; 4th Succeeding Year 2015-16 is $19,728,000; 5th Succeeding Year 2016-17 is $19,728,000; (4) Child Care Services: 2010-11 Program—$171,720,000; 2009-10 Program—$171,720,000; 2008-09 Program—$166,763,000; Child Care Assistance: 2010-11 Program—$189,582,000; 2009-10 Program—$198,147,000; 2008-09 Program—$201,956,000; (7) Child Care Services and Child Care Assistance; (8) recommends adoption. Funds have been included in the budget to cover this increase.
CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE EFFECTIVE 10/01/2011
(BASED ON THE 2011 FEDERAL POVERTY INCOME GUIDELINES)
| Weekly | Family Size: | 1 | Weekly | Family Size: | 2 |
|---|
| Co-pay | Annual Income | Co-Pay | Annual Income |
|---|
| $5.00 | Less than: | $8,890 | $5.00 | Less than: | $8,660 |
| $10.00 | $8,890.01 | $10,890 | $10.00 | $8,660.01 | $12,710 |
| $15.00 | $10,890.01 | $12,890 | $19.00 | $12,710.01 | $14,710 |
| $20.00 | $12,890.01 | $14,890 | $23.00 | $14,710.01 | $16,710 |
| $25.00 | $14,890.01 | $16,890 | $27.00 | $16,710.01 | $18,710 |
| $30.00 | $16,890.01 | $18,890 | $31.00 | $18,710.01 | $20,710 |
| $35.00 | $18,890.01 | $20,890 | $36.00 | $20,710.01 | $22,710 |
| $40.00 | $20,890.01 | $22,890 | $41.00 | $22,710.01 | $24,710 |
| $45.00 | $22,890.01 | $24,890 | $46.00 | $24,710.01 | $26,710 |
| $50.00 | $24,890.01 | $25,592 | $51.00 | $26,710.01 | $28,710 |
| | | $57.00 | $28,710.01 | $30,710 |
| | | $63.00 | $30,710.01 | $32,710 |
| | | $69.00 | $32,710.01 | $34,569 |
| | | | | |
| 200% FPIG | $21,780 | | 200% FPIG | $29,420 |
CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE EFFECTIVE 10/01/2011
(BASED ON THE 2011 FEDERAL POVERTY INCOME GUIDELINES)
| Weekly | Family Size: | 3 | Weekly | Family Size: | 4 |
|---|
| Co-pay | Annual Income | Co-Pay | Annual Income |
|---|
| $5.00 | Less than: | $8,660 | $5.00 | Less than: | $8,660 |
| $10.00 | $8,660.01 | $14,530 | $10.00 | $8,660.01 | $16,350 |
| $19.00 | $14,530.01 | $16,530 | $21.00 | $16,350.01 | $18,350 |
| $25.00 | $16,530.01 | $18,530 | $26.00 | $18,350.01 | $20,350 |
| $29.00 | $18,530.01 | $20,530 | $31.00 | $20,350.01 | $22,350 |
| $33.00 | $20,530.01 | $22,530 | $35.00 | $22,350.01 | $24,350 |
| $37.00 | $22,530.01 | $24,530 | $39.00 | $24,350.01 | $26,350 |
| $41.00 | $24,530.01 | $26,530 | $43.00 | $26,350.01 | $28,350 |
| $46.00 | $26,530.01 | $28,530 | $47.00 | $28,350.01 | $30,350 |
| $51.00 | $28,530.01 | $30,530 | $51.00 | $30,350.01 | $32,350 |
| $56.00 | $30,530.01 | $32,530 | $56.00 | $32,350.01 | $34,350 |
| $61.00 | $32,530.01 | $34,530 | $61.00 | $34,350.01 | $36,350 |
| $66.00 | $34,530.01 | $36,530 | $66.00 | $36,350.01 | $38,350 |
| $71.00 | $36,530.01 | $38,530 | $71.00 | $38,350.01 | $40,350 |
| $77.00 | $38,530.01 | $40,530 | $76.00 | $40,350.01 | $42,350 |
| $83.00 | $40,530.01 | $42,530 | $81.00 | $42,350.01 | $44,350 |
| $89.00 | $42,530.01 | $43,546 | $86.00 | $44,350.01 | $46,350 |
| | | $92.00 | $46,350.01 | $48,350 |
| | | $98.00 | $48,350.01 | $50,350 |
| | | $104.00 | $50,350.01 | $52,350 |
| | | $110.00 | $52,350.01 | $52,523 |
| | | | | |
| 200% FPIG | $37,060 | | 200% FPIG | $44,700 |
CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE EFFECTIVE 10/01/2011
(BASED ON THE 2011 FEDERAL POVERTY INCOME GUIDELINES)
| Weekly | Family Size: | 5 | Weekly | Family Size: | 6 |
|---|
| Co-pay | Annual Income | Co-Pay | Annual Income |
|---|
| $5.00 | Less than: | $8,660 | $5.00 | Less than: | $8,660 |
| $10.00 | $8,660.01 | $18,170 | $10.00 | $8,660.01 | $19,990 |
| $23.00 | $18,170.01 | $20,170 | $25.00 | $19,990.01 | $21,990 |
| $27.00 | $20,170.01 | $22,170 | $29.00 | $21,990.01 | $23,990 |
| $32.00 | $22,170.01 | $24,170 | $33.00 | $23,990.01 | $25,990 |
| $37.00 | $24,170.01 | $26,170 | $38.00 | $25,990.01 | $27,990 |
| $41.00 | $26,170.01 | $28,170 | $43.00 | $27,990.01 | $29,990 |
| $45.00 | $28,170.01 | $30,170 | $47.00 | $29,990.01 | $31,990 |
| $49.00 | $30,170.01 | $32,170 | $51.00 | $31,990.01 | $33,990 |
| $53.00 | $32,170.01 | $34,170 | $55.00 | $33,990.01 | $35,990 |
| $57.00 | $34,170.01 | $36,170 | $59.00 | $35,990.01 | $37,990 |
| $62.00 | $36,170.01 | $38,170 | $63.00 | $37,990.01 | $39,990 |
| $67.00 | $38,170.01 | $40,170 | $67.00 | $39,990.01 | $41,990 |
| $72.00 | $40,170.01 | $42,170 | $72.00 | $41,990.01 | $43,990 |
| $77.00 | $42,170.01 | $44,170 | $77.00 | $43,990.01 | $45,990 |
| $82.00 | $44,170.01 | $46,170 | $82.00 | $45,990.01 | $47,990 |
| $87.00 | $46,170.01 | $48,170 | $87.00 | $47,990.01 | $49,990 |
| $92.00 | $48,170.01 | $50,170 | $92.00 | $49,990.01 | $51,990 |
| $97.00 | $50,170.01 | $52,170 | $97.00 | $51,990.01 | $53,990 |
| $103.00 | $52,170.01 | $54,170 | $102.00 | $53,990.01 | $55,990 |
| $109.00 | $54,170.01 | $56,170 | $107.00 | $55,990.01 | $57,990 |
| $115.00 | $56,170.01 | $58,170 | $112.00 | $57,990.01 | $59,990 |
| $121.00 | $58,170.01 | $60,170 | $118.00 | $59,990.01 | $61,990 |
| $126.00 | $60,170.01 | $61,500 | $124.00 | $61,990.01 | $63,990 |
| | | $130.00 | $63,990.01 | $65,990 |
| | | $136.00 | $65,990.01 | $67,990 |
| | | $142.00 | $67,990.01 | $69,990 |
| | | $147.00 | $69,990.01 | $70,477 |
| | | | | |
| 200% FPIG | $52,340 | | 200% FPIG | $59,980 |
CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE EFFECTIVE 10/01/2011
(BASED ON THE 2011 FEDERAL POVERTY INCOME GUIDELINES)
| Weekly | Family Size: | 7 | Weekly | Family Size: | 8 |
|---|
| Co-pay | Annual Income | Co-Pay | Annual Income |
|---|
| $5.00 | Less than: | $8,660 | $5.00 | Less than: | $8,660 |
| $10.00 | $8,660.01 | $21,810 | $10.00 | $8,660.01 | $23,630 |
| $26.00 | $21,810.01 | $23,810 | $28.00 | $23,630.01 | $25,630 |
| $30.00 | $23,810.01 | $25,810 | $32.00 | $25,630.01 | $27,630 |
| $34.00 | $25,810.01 | $27,810 | $36.00 | $27,630.01 | $29,630 |
| $38.00 | $27,810.01 | $29,810 | $40.00 | $29,630.01 | $31,630 |
| $43.00 | $29,810.01 | $31,810 | $44.00 | $31,630.01 | $33,630 |
| $48.00 | $31,810.01 | $33,810 | $49.00 | $33,630.01 | $35,630 |
| $52.00 | $33,810.01 | $35,810 | $54.00 | $35,630.01 | $37,630 |
| $56.00 | $35,810.01 | $37,810 | $58.00 | $37,630.01 | $39,630 |
| $60.00 | $37,810.01 | $39,810 | $62.00 | $39,630.01 | $41,630 |
| $64.00 | $39,810.01 | $41,810 | $66.00 | $41,630.01 | $43,630 |
| $68.00 | $41,810.01 | $43,810 | $70.00 | $43,630.01 | $45,630 |
| $72.00 | $43,810.01 | $45,810 | $74.00 | $45,630.01 | $47,630 |
| $76.00 | $45,810.01 | $47,810 | $78.00 | $47,630.01 | $49,630 |
| $81.00 | $47,810.01 | $49,810 | $82.00 | $49,630.01 | $51,630 |
| $86.00 | $49,810.01 | $51,810 | $86.00 | $51,630.01 | $53,630 |
| $91.00 | $51,810.01 | $53,810 | $91.00 | $53,630.01 | $55,630 |
| $96.00 | $53,810.01 | $55,810 | $96.00 | $55,630.01 | $57,630 |
| $101.00 | $55,810.01 | $57,810 | $101.00 | $57,630.01 | $59,630 |
| $106.00 | $57,810.01 | $59,810 | $106.00 | $59,630.01 | $61,630 |
| $111.00 | $59,810.01 | $61,810 | $111.00 | $61,630.01 | $63,630 |
| $116.00 | $61,810.01 | $63,810 | $116.00 | $63,630.01 | $65,630 |
| $121.00 | $63,810.01 | $65,810 | $121.00 | $65,630.01 | $67,630 |
| $126.00 | $65,810.01 | $67,810 | $126.00 | $67,630.01 | $69,630 |
| $132.00 | $67,810.01 | $69,810 | $131.00 | $69,630.01 | $71,630 |
| $138.00 | $69,810.01 | $71,810 | $136.00 | $71,630.01 | $73,630 |
| $144.00 | $71,810.01 | $73,810 | $141.00 | $73,630.01 | $75,630 |
| $150.00 | $73,810.01 | $75,810 | $147.00 | $75,630.01 | $77,630 |
| $156.00 | $75,810.01 | $77,810 | $153.00 | $77,630.01 | $79,630 |
| $163.00 | $77,810.01 | $79,454 | $159.00 | $79,630.01 | $81,630 |
| | | $165.00 | $81,630.01 | $83,630 |
| | | $171.00 | $83,630.01 | $85,630 |
| | | $177.00 | $85,630.01 | $87,630 |
| | | $184.00 | $87,630.01 | $88,431 |
| | | | | |
| 200% FPIG | $67,620 | | 200% FPIG | $75,260 |
CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE EFFECTIVE 10/01/2011
(BASED ON THE 2011 FEDERAL POVERTY INCOME GUIDELINES)
| Weekly | Family Size: | 9 | Weekly | Family Size: | 10 |
|---|
| Co-pay | Annual Income | Co-Pay | Annual Income |
|---|
| $5.00 | Less than: | $8,660 | $5.00 | Less than: | $8,660 |
| $10.00 | $8,660.01 | $25,450 | $10.00 | $8,660.01 | $27,270 |
| $30.00 | $25,450.01 | $27,450 | $32.00 | $27,270.01 | $29,270 |
| $34.00 | $27,450.01 | $29,450 | $36.00 | $29,270.01 | $31,270 |
| $38.00 | $29,450.01 | $31,450 | $40.00 | $31,270.01 | $33,270 |
| $42.00 | $31,450.01 | $33,450 | $44.00 | $33,270.01 | $35,270 |
| $46.00 | $33,450.01 | $35,450 | $48.00 | $35,270.01 | $37,270 |
| $50.00 | $35,450.01 | $37,450 | $52.00 | $37,270.01 | $39,270 |
| $55.00 | $37,450.01 | $39,450 | $56.00 | $39,270.01 | $41,270 |
| $60.00 | $39,450.01 | $41,450 | $61.00 | $41,270.01 | $43,270 |
| $64.00 | $41,450.01 | $43,450 | $66.00 | $43,270.01 | $45,270 |
| $68.00 | $43,450.01 | $45,450 | $70.00 | $45,270.01 | $47,270 |
| $72.00 | $45,450.01 | $47,450 | $74.00 | $47,270.01 | $49,270 |
| $76.00 | $47,450.01 | $49,450 | $78.00 | $49,270.01 | $51,270 |
| $80.00 | $49,450.01 | $51,450 | $82.00 | $51,270.01 | $53,270 |
| $84.00 | $51,450.01 | $53,450 | $86.00 | $53,270.01 | $55,270 |
| $88.00 | $53,450.01 | $55,450 | $90.00 | $55,270.01 | $57,270 |
| $92.00 | $55,450.01 | $57,450 | $94.00 | $57,270.01 | $59,270 |
| $97.00 | $57,450.01 | $59,450 | $98.00 | $59,270.01 | $61,270 |
| $102.00 | $59,450.01 | $61,450 | $102.00 | $61,270.01 | $63,270 |
| $107.00 | $61,450.01 | $63,450 | $107.00 | $63,270.01 | $65,270 |
| $112.00 | $63,450.01 | $65,450 | $112.00 | $65,270.01 | $67,270 |
| $117.00 | $65,450.01 | $67,450 | $117.00 | $67,270.01 | $69,270 |
| $122.00 | $67,450.01 | $69,450 | $122.00 | $69,270.01 | $71,270 |
| $127.00 | $69,450.01 | $71,450 | $127.00 | $71,270.01 | $73,270 |
| $132.00 | $71,450.01 | $73,450 | $132.00 | $73,270.01 | $75,270 |
| $137.00 | $73,450.01 | $75,450 | $137.00 | $75,270.01 | $77,270 |
| $142.00 | $75,450.01 | $77,450 | $142.00 | $77,270.01 | $79,270 |
| $147.00 | $77,450.01 | $79,450 | $147.00 | $79,270.01 | $81,270 |
| $152.00 | $79,450.01 | $81,450 | $152.00 | $81,270.01 | $83,270 |
| $158.00 | $81,450.01 | $83,450 | $157.00 | $83,270.01 | $85,270 |
| $164.00 | $83,450.01 | $85,450 | $162.00 | $85,270.01 | $87,270 |
| $170.00 | $85,450.01 | $87,450 | $167.00 | $87,270.01 | $89,270 |
| $176.00 | $87,450.01 | $89,450 | $173.00 | $89,270.01 | $91,270 |
| $182.00 | $89,450.01 | $91,450 | $179.00 | $91,270.01 | $93,270 |
| $188.00 | $91,450.01 | $93,450 | $185.00 | $93,270.01 | $95,270 |
| $194.00 | $93,450.01 | $95,450 | $191.00 | $95,270.01 | $97,270 |
| $200.00 | $95,450.01 | $97,408 | $197.00 | $97,270.01 | $99,270 |
| | | $203.00 | $99,270.01 | $101,270 |
| | | $209.00 | $101,270.01 | $103,270 |
| | | $215.00 | $103,270.01 | $105,270 |
| | | $221.00 | $105,270.01 | $106,385 |
| | | | | |
| 200% FPIG | $82,900 | | 200% FPIG | $90,540 |
CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE EFFECTIVE 10/01/2011
(BASED ON THE 2011 FEDERAL POVERTY INCOME GUIDELINES)
| Weekly | Family Size: | 11 | Weekly | Family Size: | 12 |
|---|
| Co-pay | Annual Income | Co-Pay | Annual Income |
|---|
| $5.00 | Less than: | $8,660 | $5.00 | Less than: | $8,660 |
| $10.00 | $8,660.01 | $29,090 | $10.00 | $8,660.01 | $30,910 |
| $34.00 | $29,090.01 | $31,090 | $36.00 | $30,910.01 | $32,910 |
| $38.00 | $31,090.01 | $33,090 | $39.00 | $32,910.01 | $34,910 |
| $42.00 | $33,090.01 | $35,090 | $43.00 | $34,910.01 | $36,910 |
| $46.00 | $35,090.01 | $37,090 | $47.00 | $36,910.01 | $38,910 |
| $50.00 | $37,090.01 | $39,090 | $51.00 | $38,910.01 | $40,910 |
| $54.00 | $39,090.01 | $41,090 | $55.00 | $40,910.01 | $42,910 |
| $58.00 | $41,090.01 | $43,090 | $59.00 | $42,910.01 | $44,910 |
| $62.00 | $43,090.01 | $45,090 | $63.00 | $44,910.01 | $46,910 |
| $67.00 | $45,090.01 | $47,090 | $67.00 | $46,910.01 | $48,910 |
| $72.00 | $47,090.01 | $49,090 | $72.00 | $48,910.01 | $50,910 |
| $76.00 | $49,090.01 | $51,090 | $77.00 | $50,910.01 | $52,910 |
| $80.00 | $51,090.01 | $53,090 | $81.00 | $52,910.01 | $54,910 |
| $84.00 | $53,090.01 | $55,090 | $85.00 | $54,910.01 | $56,910 |
| $88.00 | $55,090.01 | $57,090 | $89.00 | $56,910.01 | $58,910 |
| $92.00 | $57,090.01 | $59,090 | $93.00 | $58,910.01 | $60,910 |
| $96.00 | $59,090.01 | $61,090 | $97.00 | $60,910.01 | $62,910 |
| $100.00 | $61,090.01 | $63,090 | $101.00 | $62,910.01 | $64,910 |
| $104.00 | $63,090.01 | $65,090 | $105.00 | $64,910.01 | $66,910 |
| $108.00 | $65,090.01 | $67,090 | $109.00 | $66,910.01 | $68,910 |
| $112.00 | $67,090.01 | $69,090 | $113.00 | $68,910.01 | $70,910 |
| $117.00 | $69,090.01 | $71,090 | $117.00 | $70,910.01 | $72,910 |
| $122.00 | $71,090.01 | $73,090 | $122.00 | $72,910.01 | $74,910 |
| $127.00 | $73,090.01 | $75,090 | $127.00 | $74,910.01 | $76,910 |
| $132.00 | $75,090.01 | $77,090 | $132.00 | $76,910.01 | $78,910 |
| $137.00 | $77,090.01 | $79,090 | $137.00 | $78,910.01 | $80,910 |
| $142.00 | $79,090.01 | $81,090 | $142.00 | $80,910.01 | $82,910 |
| $147.00 | $81,090.01 | $83,090 | $147.00 | $82,910.01 | $84,910 |
| $152.00 | $83,090.01 | $85,090 | $152.00 | $84,910.01 | $86,910 |
| $157.00 | $85,090.01 | $87,090 | $157.00 | $86,910.01 | $88,910 |
| $162.00 | $87,090.01 | $89,090 | $162.00 | $88,910.01 | $90,910 |
| $167.00 | $89,090.01 | $91,090 | $167.00 | $90,910.01 | $92,910 |
| $172.00 | $91,090.01 | $93,090 | $172.00 | $92,910.01 | $94,910 |
| $177.00 | $93,090.01 | $95,090 | $177.00 | $94,910.01 | $96,910 |
| $182.00 | $95,090.01 | $97,090 | $182.00 | $96,910.01 | $98,910 |
| $188.00 | $97,090.01 | $99,090 | $187.00 | $98,910.01 | $100,910 |
| $194.00 | $99,090.01 | $101,090 | $192.00 | $100,910.01 | $102,910 |
| $200.00 | $101,090.01 | $103,090 | $198.00 | $102,910.01 | $104,910 |
| $206.00 | $103,090.01 | $105,090 | $204.00 | $104,910.01 | $106,910 |
| $212.00 | $105,090.01 | $107,090 | $210.00 | $106,910.01 | $108,910 |
| $218.00 | $107,090.01 | $109,090 | $216.00 | $108,910.01 | $110,910 |
| $224.00 | $109,090.01 | $111,090 | $222.00 | $110,910.01 | $112,910 |
| $230.00 | $111,090.01 | $113,090 | $228.00 | $112,910.01 | $114,910 |
| $236.00 | $113,090.01 | $115,090 | $234.00 | $114,910.01 | $116,910 |
| $241.00 | $115,090.01 | $115,362 | $240.00 | $116,910.01 | $118,910 |
| | | $246.00 | $118,910.01 | $120,910 |
| | | $252.00 | $120,910.01 | $122,910 |
| | | $258.00 | $122,910.01 | $124,339 |
| 200% FPIG | $98,180 | | 200% FPIG | $105,820 |
CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE EFFECTIVE 10/01/2011
(BASED ON THE 2011 FEDERAL POVERTY INCOME GUIDELINES)
| Weekly | Family Size: | 13 | Weekly | Family Size: | 14 |
|---|
| Co-pay | Annual Income | Co-Pay | Annual Income |
|---|
| $5.00 | Less than: | $8,660 | $5.00 | Less than: | $8,660 |
| $10.00 | $8,660.01 | $32,730 | $10.00 | $8,660.01 | $34,550 |
| $38.00 | $32,730.01 | $34,730 | $41.00 | $34,550.01 | $36,550 |
| $41.00 | $34,730.01 | $36,730 | $44.00 | $36,550.01 | $38,550 |
| $45.00 | $36,730.01 | $38,730 | $47.00 | $38,550.01 | $40,550 |
| $49.00 | $38,730.01 | $40,730 | $51.00 | $40,550.01 | $42,550 |
| $53.00 | $40,730.01 | $42,730 | $55.00 | $42,550.01 | $44,550 |
| $57.00 | $42,730.01 | $44,730 | $59.00 | $44,550.01 | $46,550 |
| $61.00 | $44,730.01 | $46,730 | $63.00 | $46,550.01 | $48,550 |
| $65.00 | $46,730.01 | $48,730 | $67.00 | $48,550.01 | $50,550 |
| $69.00 | $48,730.01 | $50,730 | $71.00 | $50,550.01 | $52,550 |
| $73.00 | $50,730.01 | $52,730 | $75.00 | $52,550.01 | $54,550 |
| $78.00 | $52,730.01 | $54,730 | $79.00 | $54,550.01 | $56,550 |
| $83.00 | $54,730.01 | $56,730 | $84.00 | $56,550.01 | $58,550 |
| $87.00 | $56,730.01 | $58,730 | $89.00 | $58,550.01 | $60,550 |
| $91.00 | $58,730.01 | $60,730 | $93.00 | $60,550.01 | $62,550 |
| $95.00 | $60,730.01 | $62,730 | $97.00 | $62,550.01 | $64,550 |
| $99.00 | $62,730.01 | $64,730 | $101.00 | $64,550.01 | $66,550 |
| $103.00 | $64,730.01 | $66,730 | $105.00 | $66,550.01 | $68,550 |
| $107.00 | $66,730.01 | $68,730 | $109.00 | $68,550.01 | $70,550 |
| $111.00 | $68,730.01 | $70,730 | $113.00 | $70,550.01 | $72,550 |
| $115.00 | $70,730.01 | $72,730 | $117.00 | $72,550.01 | $74,550 |
| $119.00 | $72,730.01 | $74,730 | $121.00 | $74,550.01 | $76,550 |
| $123.00 | $74,730.01 | $76,730 | $125.00 | $76,550.01 | $78,550 |
| $127.00 | $76,730.01 | $78,730 | $129.00 | $78,550.01 | $80,550 |
| $132.00 | $78,730.01 | $80,730 | $133.00 | $80,550.01 | $82,550 |
| $137.00 | $80,730.01 | $82,730 | $138.00 | $82,550.01 | $84,550 |
| $142.00 | $82,730.01 | $84,730 | $143.00 | $84,550.01 | $86,550 |
| $147.00 | $84,730.01 | $86,730 | $148.00 | $86,550.01 | $88,550 |
| $152.00 | $86,730.01 | $88,730 | $153.00 | $88,550.01 | $90,550 |
| $157.00 | $88,730.01 | $90,730 | $158.00 | $90,550.01 | $92,550 |
| $162.00 | $90,730.01 | $92,730 | $163.00 | $92,550.01 | $94,550 |
| $167.00 | $92,730.01 | $94,730 | $168.00 | $94,550.01 | $96,550 |
| $172.00 | $94,730.01 | $96,730 | $173.00 | $96,550.01 | $98,550 |
| $177.00 | $96,730.01 | $98,730 | $178.00 | $98,550.01 | $100,550 |
| $182.00 | $98,730.01 | $100,730 | $183.00 | $100,550.01 | $102,550 |
| $187.00 | $100,730.01 | $102,730 | $188.00 | $102,550.01 | $104,550 |
| $192.00 | $102,730.01 | $104,730 | $193.00 | $104,550.01 | $106,550 |
| $197.00 | $104,730.01 | $106,730 | $198.00 | $106,550.01 | $108,550 |
| $202.00 | $106,730.01 | $108,730 | $203.00 | $108,550.01 | $110,550 |
| $207.00 | $108,730.01 | $110,730 | $208.00 | $110,550.01 | $112,550 |
| $213.00 | $110,730.01 | $112,730 | $213.00 | $112,550.01 | $114,550 |
| $219.00 | $112,730.01 | $114,730 | $218.00 | $114,550.01 | $116,550 |
| $225.00 | $114,730.01 | $116,730 | $224.00 | $116,550.01 | $118,550 |
| $231.00 | $116,730.01 | $118,730 | $230.00 | $118,550.01 | $120,550 |
| $237.00 | $118,730.01 | $120,730 | $236.00 | $120,550.01 | $122,550 |
| $243.00 | $120,730.01 | $122,730 | $242.00 | $122,550.01 | $124,550 |
| $249.00 | $122,730.01 | $124,730 | $248.00 | $124,550.01 | $126,550 |
| $255.00 | $124,730.01 | $126,730 | $254.00 | $126,550.01 | $128,550 |
| $261.00 | $126,730.01 | $128,730 | $260.00 | $128,550.01 | $130,550 |
| $267.00 | $128,730.01 | $130,730 | $266.00 | $130,550.01 | $132,550 |
| $273.00 | $130,730.01 | $132,730 | $272.00 | $132,550.01 | $134,550 |
| $278.00 | $132,730.01 | $133,316 | $278.00 | $134,550.01 | $136,550 |
| | | $284.00 | $136,550.01 | $138,550 |
| | | $290.00 | $138,550.01 | $140,550 |
| | | $295.00 | $140,550.01 | $142,293 |
| | | | | |
| 200% FPIG | $113,460 | | 200% FPIG | $121,100 |
CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE EFFECTIVE 10/01/2011
(BASED ON THE 2011 FEDERAL POVERTY INCOME GUIDELINES)
| Weekly | Family Size: | 15 | Weekly | Family Size: | 16 |
|---|
| Co-pay | Annual Income | Co-Pay | Annual Income |
|---|
| $5.00 | Less than: | $8,660 | $5.00 | Less than: | $8,660 |
| $10.00 | $8,660.01 | $36,370 | $10.00 | $8,660.01 | $40,190 |
| $43.00 | $36,370.01 | $38,370 | $48.00 | $40,190.01 | $42,190 |
| $46.00 | $38,370.01 | $40,370 | $51.00 | $42,190.01 | $44,190 |
| $49.00 | $40,370.01 | $42,370 | $55.00 | $44,190.01 | $46,190 |
| $53.00 | $42,370.01 | $44,370 | $59.00 | $46,190.01 | $48,190 |
| $57.00 | $44,370.01 | $46,370 | $63.00 | $48,190.01 | $50,190 |
| $61.00 | $46,370.01 | $48,370 | $67.00 | $50,190.01 | $52,190 |
| $65.00 | $48,370.01 | $50,370 | $71.00 | $52,190.01 | $54,190 |
| $69.00 | $50,370.01 | $52,370 | $75.00 | $54,190.01 | $56,190 |
| $73.00 | $52,370.01 | $54,370 | $79.00 | $56,190.01 | $58,190 |
| $77.00 | $54,370.01 | $56,370 | $83.00 | $58,190.01 | $60,190 |
| $81.00 | $56,370.01 | $58,370 | $87.00 | $60,190.01 | $62,190 |
| $85.00 | $58,370.01 | $60,370 | $91.00 | $62,190.01 | $64,190 |
| $90.00 | $60,370.01 | $62,370 | $96.00 | $64,190.01 | $66,190 |
| $95.00 | $62,370.01 | $64,370 | $101.00 | $66,190.01 | $68,190 |
| $99.00 | $64,370.01 | $66,370 | $105.00 | $68,190.01 | $70,190 |
| $103.00 | $66,370.01 | $68,370 | $109.00 | $70,190.01 | $72,190 |
| $107.00 | $68,370.01 | $70,370 | $113.00 | $72,190.01 | $74,190 |
| $111.00 | $70,370.01 | $72,370 | $117.00 | $74,190.01 | $76,190 |
| $115.00 | $72,370.01 | $74,370 | $121.00 | $76,190.01 | $78,190 |
| $119.00 | $74,370.01 | $76,370 | $125.00 | $78,190.01 | $80,190 |
| $123.00 | $76,370.01 | $78,370 | $129.00 | $80,190.01 | $82,190 |
| $127.00 | $78,370.01 | $80,370 | $133.00 | $82,190.01 | $84,190 |
| $131.00 | $80,370.01 | $82,370 | $137.00 | $84,190.01 | $86,190 |
| $135.00 | $82,370.01 | $84,370 | $141.00 | $86,190.01 | $88,190 |
| $139.00 | $84,370.01 | $86,370 | $145.00 | $88,190.01 | $90,190 |
| $143.00 | $86,370.01 | $88,370 | $149.00 | $90,190.01 | $92,190 |
| $148.00 | $88,370.01 | $90,370 | $153.00 | $92,190.01 | $94,190 |
| $153.00 | $90,370.01 | $92,370 | $158.00 | $94,190.01 | $96,190 |
| $158.00 | $92,370.01 | $94,370 | $163.00 | $96,190.01 | $98,190 |
| $163.00 | $94,370.01 | $96,370 | $168.00 | $98,190.01 | $100,190 |
| $168.00 | $96,370.01 | $98,370 | $173.00 | $100,190.01 | $102,190 |
| $173.00 | $98,370.01 | $100,370 | $178.00 | $102,190.01 | $104,190 |
| $178.00 | $100,370.01 | $102,370 | $183.00 | $104,190.01 | $106,190 |
| $183.00 | $102,370.01 | $104,370 | $188.00 | $106,190.01 | $108,190 |
| $188.00 | $104,370.01 | $106,370 | $193.00 | $108,190.01 | $110,190 |
| $193.00 | $106,370.01 | $108,370 | $198.00 | $110,190.01 | $112,190 |
| $198.00 | $108,370.01 | $110,370 | $203.00 | $112,190.01 | $114,190 |
| $203.00 | $110,370.01 | $112,370 | $208.00 | $114,190.01 | $116,190 |
| $208.00 | $112,370.01 | $114,370 | $213.00 | $116,190.01 | $118,190 |
| $213.00 | $114,370.01 | $116,370 | $218.00 | $118,190.01 | $120,190 |
| $218.00 | $116,370.01 | $118,370 | $223.00 | $120,190.01 | $122,190 |
| $223.00 | $118,370.01 | $120,370 | $228.00 | $122,190.01 | $124,190 |
| $228.00 | $120,370.01 | $122,370 | $233.00 | $124,190.01 | $126,190 |
| $233.00 | $122,370.01 | $124,370 | $238.00 | $126,190.01 | $128,190 |
| $238.00 | $124,370.01 | $126,370 | $243.00 | $128,190.01 | $130,190 |
| $244.00 | $126,370.01 | $128,370 | $248.00 | $130,190.01 | $132,190 |
| $250.00 | $128,370.01 | $130,370 | $253.00 | $132,190.01 | $134,190 |
| $256.00 | $130,370.01 | $132,370 | $259.00 | $134,190.01 | $136,190 |
| $262.00 | $132,370.01 | $134,370 | $265.00 | $136,190.01 | $138,190 |
| $268.00 | $134,370.01 | $136,370 | $271.00 | $138,190.01 | $140,190 |
| $274.00 | $136,370.01 | $138,370 | $277.00 | $140,190.01 | $142,190 |
| $280.00 | $138,370.01 | $140,370 | $283.00 | $142,190.01 | $144,190 |
| $286.00 | $140,370.01 | $142,370 | $289.00 | $144,190.01 | $146,190 |
| $292.00 | $142,370.01 | $144,370 | $295.00 | $146,190.01 | $148,190 |
| $298.00 | $144,370.01 | $146,370 | $301.00 | $148,190.01 | $150,190 |
| $304.00 | $146,370.01 | $148,370 | $307.00 | $150,190.01 | $152,190 |
| $310.00 | $148,370.01 | $150,370 | $313.00 | $152,190.01 | $154,190 |
| $315.00 | $150,370.01 | $151,270 | $319.00 | $154,190.01 | $156,190 |
| | | $325.00 | $156,190.01 | $158,190 |
| | | $331.00 | $158,190.01 | $160,190 |
| | | $336.00 | $160,190.01 | $160,247 |
| 200% FPIG | $128,740 | | 200% FPIG | $136,380 |
CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE EFFECTIVE 10/01/2011
(BASED ON THE 2011 FEDERAL POVERTY INCOME GUIDELINES)
| Weekly | Family Size: | 17 | Weekly | Family Size: | 18 |
|---|
| Co-pay | Annual Income | Co-Pay | Annual Income |
|---|
| $5.00 | Less than: | $8,660 | $5.00 | Less than: | $8,660 |
| $10.00 | $8,660.01 | $42,010 | $10.00 | $8,660.01 | $43,830 |
| $49.00 | $42,010.01 | $44,010 | $52.00 | $43,830.01 | $45,830 |
| $52.00 | $44,010.01 | $46,010 | $55.00 | $45,830.01 | $47,830 |
| $56.00 | $46,010.01 | $48,010 | $58.00 | $47,830.01 | $49,830 |
| $60.00 | $48,010.01 | $50,010 | $62.00 | $49,830.01 | $51,830 |
| $64.00 | $50,010.01 | $52,010 | $66.00 | $51,830.01 | $53,830 |
| $68.00 | $52,010.01 | $54,010 | $70.00 | $53,830.01 | $55,830 |
| $72.00 | $54,010.01 | $56,010 | $74.00 | $55,830.01 | $57,830 |
| $76.00 | $56,010.01 | $58,010 | $78.00 | $57,830.01 | $59,830 |
| $80.00 | $58,010.01 | $60,010 | $82.00 | $59,830.01 | $61,830 |
| $84.00 | $60,010.01 | $62,010 | $86.00 | $61,830.01 | $63,830 |
| $88.00 | $62,010.01 | $64,010 | $90.00 | $63,830.01 | $65,830 |
| $92.00 | $64,010.01 | $66,010 | $94.00 | $65,830.01 | $67,830 |
| $96.00 | $66,010.01 | $68,010 | $98.00 | $67,830.01 | $69,830 |
| $101.00 | $68,010.01 | $70,010 | $102.00 | $69,830.01 | $71,830 |
| $106.00 | $70,010.01 | $72,010 | $107.00 | $71,830.01 | $73,830 |
| $110.00 | $72,010.01 | $74,010 | $112.00 | $73,830.01 | $75,830 |
| $114.00 | $74,010.01 | $76,010 | $116.00 | $75,830.01 | $77,830 |
| $118.00 | $76,010.01 | $78,010 | $120.00 | $77,830.01 | $79,830 |
| $122.00 | $78,010.01 | $80,010 | $124.00 | $79,830.01 | $81,830 |
| $126.00 | $80,010.01 | $82,010 | $128.00 | $81,830.01 | $83,830 |
| $130.00 | $82,010.01 | $84,010 | $132.00 | $83,830.01 | $85,830 |
| $134.00 | $84,010.01 | $86,010 | $136.00 | $85,830.01 | $87,830 |
| $138.00 | $86,010.01 | $88,010 | $140.00 | $87,830.01 | $89,830 |
| $142.00 | $88,010.01 | $90,010 | $144.00 | $89,830.01 | $91,830 |
| $146.00 | $90,010.01 | $92,010 | $148.00 | $91,830.01 | $93,830 |
| $150.00 | $92,010.01 | $94,010 | $152.00 | $93,830.01 | $95,830 |
| $154.00 | $94,010.01 | $96,010 | $156.00 | $95,830.01 | $97,830 |
| $158.00 | $96,010.01 | $98,010 | $160.00 | $97,830.01 | $99,830 |
| $162.00 | $98,010.01 | $100,010 | $164.00 | $99,830.01 | $101,830 |
| $167.00 | $100,010.01 | $102,010 | $168.00 | $101,830.01 | $103,830 |
| $172.00 | $102,010.01 | $104,010 | $172.00 | $103,830.01 | $105,830 |
| $177.00 | $104,010.01 | $106,010 | $177.00 | $105,830.01 | $107,830 |
| $182.00 | $106,010.01 | $108,010 | $182.00 | $107,830.01 | $109,830 |
| $187.00 | $108,010.01 | $110,010 | $187.00 | $109,830.01 | $111,830 |
| $192.00 | $110,010.01 | $112,010 | $192.00 | $111,830.01 | $113,830 |
| $197.00 | $112,010.01 | $114,010 | $197.00 | $113,830.01 | $115,830 |
| $202.00 | $114,010.01 | $116,010 | $202.00 | $115,830.01 | $117,830 |
| $207.00 | $116,010.01 | $118,010 | $207.00 | $117,830.01 | $119,830 |
| $212.00 | $118,010.01 | $120,010 | $212.00 | $119,830.01 | $121,830 |
| $217.00 | $120,010.01 | $122,010 | $217.00 | $121,830.01 | $123,830 |
| $222.00 | $122,010.01 | $124,010 | $222.00 | $123,830.01 | $125,830 |
| $227.00 | $124,010.01 | $126,010 | $227.00 | $125,830.01 | $127,830 |
| $232.00 | $126,010.01 | $128,010 | $232.00 | $127,830.01 | $129,830 |
| $237.00 | $128,010.01 | $130,010 | $237.00 | $129,830.01 | $131,830 |
| $242.00 | $130,010.01 | $132,010 | $242.00 | $131,830.01 | $133,830 |
| $247.00 | $132,010.01 | $134,010 | $247.00 | $133,830.01 | $135,830 |
| $252.00 | $134,010.01 | $136,010 | $252.00 | $135,830.01 | $137,830 |
| $257.00 | $136,010.01 | $138,010 | $257.00 | $137,830.01 | $139,830 |
| $262.00 | $138,010.01 | $140,010 | $262.00 | $139,830.01 | $141,830 |
| $268.00 | $140,010.01 | $142,010 | $267.00 | $141,830.01 | $143,830 |
| $274.00 | $142,010.01 | $144,010 | $272.00 | $143,830.01 | $145,830 |
| $280.00 | $144,010.01 | $146,010 | $277.00 | $145,830.01 | $147,830 |
| $286.00 | $146,010.01 | $148,010 | $282.00 | $147,830.01 | $149,830 |
| $292.00 | $148,010.01 | $150,010 | $288.00 | $149,830.01 | $151,830 |
| $298.00 | $150,010.01 | $152,010 | $294.00 | $151,830.01 | $153,830 |
| $304.00 | $152,010.01 | $154,010 | $300.00 | $153,830.01 | $155,830 |
| $310.00 | $154,010.01 | $156,010 | $306.00 | $155,830.01 | $157,830 |
| $316.00 | $156,010.01 | $158,010 | $312.00 | $157,830.01 | $159,830 |
| $322.00 | $158,010.01 | $160,010 | $318.00 | $159,830.01 | $161,830 |
| $328.00 | $160,010.01 | $162,010 | $324.00 | $161,830.01 | $163,830 |
| $334.00 | $162,010.01 | $164,010 | $330.00 | $163,830.01 | $165,830 |
| $340.00 | $164,010.01 | $166,010 | $336.00 | $165,830.01 | $167,830 |
| $346.00 | $166,010.01 | $168,010 | $342.00 | $167,830.01 | $169,830 |
| $352.00 | $168,010.01 | $169,224 | $348.00 | $169,830.01 | $171,830 |
| | | $354.00 | $171,830.01 | $173,830 |
| | | $360.00 | $173,830.01 | $175,830 |
| | | $366.00 | $175,830.01 | $177,830 |
| | | $373.00 | $177,830.01 | $178,201 |
| | | | | |
| 200% FPIG | $144,020 | | 200% FPIG | $151,660 |
CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE EFFECTIVE 10/01/2011
(BASED ON THE 2011 FEDERAL POVERTY INCOME GUIDELINES)
| Weekly | Family Size: | 19 | Weekly | Family Size: | 20 |
|---|
| Co-pay | Annual Income | Co-Pay | Annual Income |
|---|
| $5.00 | Less than: | $8,660 | $5.00 | Less than: | $8,660 |
| $10.00 | $8,660.01 | $45,650 | $10.00 | $8,660.01 | $47,470 |
| $54.00 | $45,650.01 | $47,650 | $56.00 | $47,470.01 | $49,470 |
| $57.00 | $47,650.01 | $49,650 | $59.00 | $49,470.01 | $51,470 |
| $60.00 | $49,650.01 | $51,650 | $62.00 | $51,470.01 | $53,470 |
| $64.00 | $51,650.01 | $53,650 | $66.00 | $53,470.01 | $55,470 |
| $68.00 | $53,650.01 | $55,650 | $70.00 | $55,470.01 | $57,470 |
| $72.00 | $55,650.01 | $57,650 | $74.00 | $57,470.01 | $59,470 |
| $76.00 | $57,650.01 | $59,650 | $78.00 | $59,470.01 | $61,470 |
| $80.00 | $59,650.01 | $61,650 | $82.00 | $61,470.01 | $63,470 |
| $84.00 | $61,650.01 | $63,650 | $86.00 | $63,470.01 | $65,470 |
| $88.00 | $63,650.01 | $65,650 | $90.00 | $65,470.01 | $67,470 |
| $92.00 | $65,650.01 | $67,650 | $94.00 | $67,470.01 | $69,470 |
| $96.00 | $67,650.01 | $69,650 | $98.00 | $69,470.01 | $71,470 |
| $100.00 | $69,650.01 | $71,650 | $102.00 | $71,470.01 | $73,470 |
| $104.00 | $71,650.01 | $73,650 | $106.00 | $73,470.01 | $75,470 |
| $108.00 | $73,650.01 | $75,650 | $110.00 | $75,470.01 | $77,470 |
| $113.00 | $75,650.01 | $77,650 | $114.00 | $77,470.01 | $79,470 |
| $118.00 | $77,650.01 | $79,650 | $119.00 | $79,470.01 | $81,470 |
| $122.00 | $79,650.01 | $81,650 | $124.00 | $81,470.01 | $83,470 |
| $126.00 | $81,650.01 | $83,650 | $128.00 | $83,470.01 | $85,470 |
| $130.00 | $83,650.01 | $85,650 | $132.00 | $85,470.01 | $87,470 |
| $134.00 | $85,650.01 | $87,650 | $136.00 | $87,470.01 | $89,470 |
| $138.00 | $87,650.01 | $89,650 | $140.00 | $89,470.01 | $91,470 |
| $142.00 | $89,650.01 | $91,650 | $144.00 | $91,470.01 | $93,470 |
| $146.00 | $91,650.01 | $93,650 | $148.00 | $93,470.01 | $95,470 |
| $150.00 | $93,650.01 | $95,650 | $152.00 | $95,470.01 | $97,470 |
| $154.00 | $95,650.01 | $97,650 | $156.00 | $97,470.01 | $99,470 |
| $158.00 | $97,650.01 | $99,650 | $160.00 | $99,470.01 | $101,470 |
| $162.00 | $99,650.01 | $101,650 | $164.00 | $101,470.01 | $103,470 |
| $166.00 | $101,650.01 | $103,650 | $168.00 | $103,470.01 | $105,470 |
| $170.00 | $103,650.01 | $105,650 | $172.00 | $105,470.01 | $107,470 |
| $174.00 | $105,650.01 | $107,650 | $176.00 | $107,470.01 | $109,470 |
| $178.00 | $107,650.01 | $109,650 | $180.00 | $109,470.01 | $111,470 |
| $183.00 | $109,650.01 | $111,650 | $184.00 | $111,470.01 | $113,470 |
| $188.00 | $111,650.01 | $113,650 | $188.00 | $113,470.01 | $115,470 |
| $193.00 | $113,650.01 | $115,650 | $193.00 | $115,470.01 | $117,470 |
| $198.00 | $115,650.01 | $117,650 | $198.00 | $117,470.01 | $119,470 |
| $203.00 | $117,650.01 | $119,650 | $203.00 | $119,470.01 | $121,470 |
| $208.00 | $119,650.01 | $121,650 | $208.00 | $121,470.01 | $123,470 |
| $213.00 | $121,650.01 | $123,650 | $213.00 | $123,470.01 | $125,470 |
| $218.00 | $123,650.01 | $125,650 | $218.00 | $125,470.01 | $127,470 |
| $223.00 | $125,650.01 | $127,650 | $223.00 | $127,470.01 | $129,470 |
| $228.00 | $127,650.01 | $129,650 | $228.00 | $129,470.01 | $131,470 |
| $233.00 | $129,650.01 | $131,650 | $233.00 | $131,470.01 | $133,470 |
| $238.00 | $131,650.01 | $133,650 | $238.00 | $133,470.01 | $135,470 |
| $243.00 | $133,650.01 | $135,650 | $243.00 | $135,470.01 | $137,470 |
| $248.00 | $135,650.01 | $137,650 | $248.00 | $137,470.01 | $139,470 |
| $253.00 | $137,650.01 | $139,650 | $253.00 | $139,470.01 | $141,470 |
| $258.00 | $139,650.01 | $141,650 | $258.00 | $141,470.01 | $143,470 |
| $263.00 | $141,650.01 | $143,650 | $263.00 | $143,470.01 | $145,470 |
| $268.00 | $143,650.01 | $145,650 | $268.00 | $145,470.01 | $147,470 |
| $273.00 | $145,650.01 | $147,650 | $273.00 | $147,470.01 | $149,470 |
| $278.00 | $147,650.01 | $149,650 | $278.00 | $149,470.01 | $151,470 |
| $283.00 | $149,650.01 | $151,650 | $283.00 | $151,470.01 | $153,470 |
| $288.00 | $151,650.01 | $153,650 | $288.00 | $153,470.01 | $155,470 |
| $293.00 | $153,650.01 | $155,650 | $293.00 | $155,470.01 | $157,470 |
| $299.00 | $155,650.01 | $157,650 | $298.00 | $157,470.01 | $159,470 |
| $305.00 | $157,650.01 | $159,650 | $303.00 | $159,470.01 | $161,470 |
| $311.00 | $159,650.01 | $161,650 | $308.00 | $161,470.01 | $163,470 |
| $317.00 | $161,650.01 | $163,650 | $314.00 | $163,470.01 | $165,470 |
| $323.00 | $163,650.01 | $165,650 | $320.00 | $165,470.01 | $167,470 |
| $329.00 | $165,650.01 | $167,650 | $326.00 | $167,470.01 | $169,470 |
| $335.00 | $167,650.01 | $169,650 | $332.00 | $169,470.01 | $171,470 |
| $341.00 | $169,650.01 | $171,650 | $338.00 | $171,470.01 | $173,470 |
| $347.00 | $171,650.01 | $173,650 | $344.00 | $173,470.01 | $175,470 |
| $353.00 | $173,650.01 | $175,650 | $350.00 | $175,470.01 | $177,470 |
| $359.00 | $175,650.01 | $177,650 | $356.00 | $177,470.01 | $179,470 |
| $365.00 | $177,650.01 | $179,650 | $362.00 | $179,470.01 | $181,470 |
| $371.00 | $179,650.01 | $181,650 | $368.00 | $181,470.01 | $183,470 |
| $377.00 | $181,650.01 | $183,650 | $374.00 | $183,470.01 | $185,470 |
| $383.00 | $183,650.01 | $185,650 | $380.00 | $185,470.01 | $187,470 |
| $389.00 | $185,650.01 | $187,178 | $386.00 | $187,470.01 | $189,470 |
| | | $392.00 | $189,470.01 | $191,470 |
| | | $398.00 | $191,470.01 | $193,470 |
| | | $404.00 | $193,470.01 | $195,470 |
| | | $410.00 | $195,470.01 | $196,155 |
| | | | | |
| 200% FPIG | $159,300 | | 200% FPIG | $166,940 |
CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE EFFECTIVE 10/01/2011
(BASED ON THE 2011 FEDERAL POVERTY INCOME GUIDELINES)
| Weekly | Family Size: | 21 | Weekly | Family Size: | 21 |
|---|
| Co-pay | Annual Income | Co-Pay | Annual Income |
|---|
| $5.00 | Less than: | $8,660 | $214.00 | $125,290.01 | $127,290 |
| $10.00 | $8,660.01 | $49,290 | $219.00 | $127,290.01 | $129,290 |
| $59.00 | $49,290.01 | $51,290 | $224.00 | $129,290.01 | $131,290 |
| $62.00 | $51,290.01 | $53,290 | $229.00 | $131,290.01 | $133,290 |
| $65.00 | $53,290.01 | $55,290 | $234.00 | $133,290.01 | $135,290 |
| $68.00 | $55,290.01 | $57,290 | $239.00 | $135,290.01 | $137,290 |
| $72.00 | $57,290.01 | $59,290 | $244.00 | $137,290.01 | $139,290 |
| $76.00 | $59,290.01 | $61,290 | $249.00 | $139,290.01 | $141,290 |
| $80.00 | $61,290.01 | $63,290 | $254.00 | $141,290.01 | $143,290 |
| $84.00 | $63,290.01 | $65,290 | $259.00 | $143,290.01 | $145,290 |
| $88.00 | $65,290.01 | $67,290 | $264.00 | $145,290.01 | $147,290 |
| $92.00 | $67,290.01 | $69,290 | $269.00 | $147,290.01 | $149,290 |
| $96.00 | $69,290.01 | $71,290 | $274.00 | $149,290.01 | $151,290 |
| $100.00 | $71,290.01 | $73,290 | $279.00 | $151,290.01 | $153,290 |
| $104.00 | $73,290.01 | $75,290 | $284.00 | $153,290.01 | $155,290 |
| $108.00 | $75,290.01 | $77,290 | $289.00 | $155,290.01 | $157,290 |
| $112.00 | $77,290.01 | $79,290 | $294.00 | $157,290.01 | $159,290 |
| $116.00 | $79,290.01 | $81,290 | $299.00 | $159,290.01 | $161,290 |
| $120.00 | $81,290.01 | $83,290 | $304.00 | $161,290.01 | $163,290 |
| $125.00 | $83,290.01 | $85,290 | $309.00 | $163,290.01 | $165,290 |
| $130.00 | $85,290.01 | $87,290 | $314.00 | $165,290.01 | $167,290 |
| $134.00 | $87,290.01 | $89,290 | $319.00 | $167,290.01 | $169,290 |
| $138.00 | $89,290.01 | $91,290 | $325.00 | $169,290.01 | $171,290 |
| $142.00 | $91,290.01 | $93,290 | $331.00 | $171,290.01 | $173,290 |
| $146.00 | $93,290.01 | $95,290 | $337.00 | $173,290.01 | $175,290 |
| $150.00 | $95,290.01 | $97,290 | $343.00 | $175,290.01 | $177,290 |
| $154.00 | $97,290.01 | $99,290 | $349.00 | $177,290.01 | $179,290 |
| $158.00 | $99,290.01 | $101,290 | $355.00 | $179,290.01 | $181,290 |
| $162.00 | $101,290.01 | $103,290 | $361.00 | $181,290.01 | $183,290 |
| $166.00 | $103,290.01 | $105,290 | $367.00 | $183,290.01 | $185,290 |
| $170.00 | $105,290.01 | $107,290 | $373.00 | $185,290.01 | $187,290 |
| $174.00 | $107,290.01 | $109,290 | $379.00 | $187,290.01 | $189,290 |
| $178.00 | $109,290.01 | $111,290 | $385.00 | $189,290.01 | $191,290 |
| $182.00 | $111,290.01 | $113,290 | $391.00 | $191,290.01 | $193,290 |
| $186.00 | $113,290.01 | $115,290 | $397.00 | $193,290.01 | $195,290 |
| $190.00 | $115,290.01 | $117,290 | $403.00 | $195,290.01 | $197,290 |
| $194.00 | $117,290.01 | $119,290 | $409.00 | $197,290.01 | $199,290 |
| $199.00 | $119,290.01 | $121,290 | $415.00 | $199,290.01 | $201,290 |
| $204.00 | $121,290.01 | $123,290 | $421.00 | $201,290.01 | $203,290 |
| $209.00 | $123,290.01 | $125,290 | $426.00 | $203,290.01 | $205,132 |
| | | | | |
| | | | 200% FPIG | $174,580 |
[Pa.B. Doc. No. 11-1702. Filed for public inspection September 30, 2011, 9:00 a.m.]
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