NOTICES
DEPARTMENT OF PUBLIC WELFARE
Income Limits and Co-payments for the Subsidized Child Care Program
[44 Pa.B. 2715]
[Saturday, May 3, 2014]This notice increases the income limits codified at 55 Pa. Code Chapter 3041, Appendix B (relating to co-payment chart family co-payment scale effective May 5, 2014 (based on the 2014 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 5, 2014.
Section 3041.107(b) of 55 Pa. Code requires the Department of Public Welfare 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 5, 2014, the income guidelines for the subsidized child care program are increased due to increases in the FPIG. Under section 408.3 of the Public Welfare 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.
BEVERLY D. MACKERETH,
SecretaryFiscal Note: 14-NOT-863. No fiscal impact; (8) recommends adoption.
CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE EFFECTIVE MAY 5, 2014
(BASED ON THE 2014 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 $5.00 Less than: $9,670 $5.00 Less than: $8,660 $5.00 Less than: $8,660 $10.00 $9,670.01 $11,670 $10.00 $8,660.01 $13,000 $10.00 $8,660.01 $13,900 $15.00 $11,670.01 $13,670 $16.00 $13,000.01 $13,730 $17.00 $13,900.01 $15,570 $20.00 $13,670.01 $15,670 $21.00 $13,730.01 $15,730 $22.00 $15,570.01 $17,570 $25.00 $15,670.01 $17,670 $25.00 $15,730.01 $17,730 $27.00 $17,570.01 $19,790 $30.00 $17,670.01 $19,670 $29.00 $17,730.01 $19,730 $31.00 $19,790.01 $21,790 $35.00 $19,670.01 $21,670 $33.00 $19,730.01 $21,730 $35.00 $21,790.01 $23,790 $40.00 $21,670.01 $23,670 $38.00 $21,730.01 $23,730 $39.00 $23,790.01 $25,790 $45.00 $23,670.01 $25,670 $43.00 $23,730.01 $25,730 $43.00 $25,790.01 $27,790 $50.00 $25,670.01 $27,425 $48.00 $25,730.01 $27,730 $48.00 $27,790.01 $29,790 $53.00 $27,730.01 $29,730 $53.00 $29,790.01 $31,790 $58.00 $29,730.01 $31,730 $58.00 $31,790.01 $33,790 $64.00 $31,730.01 $33,730 $63.00 $33,790.01 $35,790 $70.00 $33,730.01 $35,730 $68.00 $35,790.01 $37,790 $75.00 $35,730.01 $36,966 $73.00 $37,790.01 $39,790 $79.00 $39,790.01 $41,790 $85.00 $41,790.01 $43,790 $91.00 $43,790.01 $45,790 $96.00 $45,790.01 $46,507 200% FPIG $23,340 200% FPIG $31,460 200% FPIG $39,580
Weekly Family Size: 4 Weekly Family Size: 5 Weekly Family Size: 6 Co-pay Annual Income Co-pay Annual Income Co-pay Annual Income $5.00 Less than: $8,660 $5.00 Less than: $8,660 $5.00 Less than: $8,660 $10.00 $8,660.01 $15,850 $10.00 $8,660.01 $15,850 $10.00 $8,660.01 $17,000 $19.00 $15,850.01 $17,850 $19.00 $15,850.01 $17,910 $20.00 $17,000.01 $19,970 $24.00 $17,850.01 $19,850 $23.00 $17,910.01 $19,910 $24.00 $19,970.01 $21,970 $28.00 $19,850.01 $21,850 $27.00 $19,910.01 $21,910 $28.00 $21,970.01 $23,970 $33.00 $21,850.01 $23,850 $31.00 $21,910.01 $23,910 $32.00 $23,970.01 $25,970 $37.00 $23,850.01 $25,850 $35.00 $23,910.01 $25,910 $36.00 $25,970.01 $27,970 $41.00 $25,850.01 $27,850 $39.00 $25,910.01 $27,910 $41.00 $27,970.01 $29,970 $45.00 $27,850.01 $29,850 $43.00 $27,910.01 $29,910 $46.00 $29,970.01 $31,970 $49.00 $29,850.01 $31,850 $47.00 $29,910.01 $31,910 $50.00 $31,970.01 $33,970 $53.00 $31,850.01 $33,850 $51.00 $31,910.01 $33,910 $54.00 $33,970.01 $35,970 $58.00 $33,850.01 $35,850 $55.00 $33,910.01 $35,910 $58.00 $35,970.01 $37,970 $63.00 $35,850.01 $37,850 $59.00 $35,910.01 $37,910 $62.00 $37,970.01 $39,970 $68.00 $37,850.01 $39,850 $63.00 $37,910.01 $39,910 $66.00 $39,970.01 $41,970 $73.00 $39,850.01 $41,850 $68.00 $39,910.01 $41,910 $70.00 $41,970.01 $43,970 $78.00 $41,850.01 $43,850 $73.00 $41,910.01 $43,910 $75.00 $43,970.01 $45,970 $83.00 $43,850.01 $45,850 $78.00 $43,910.01 $45,910 $80.00 $45,970.01 $47,970 $89.00 $45,850.01 $47,850 $83.00 $45,910.01 $47,910 $85.00 $47,970.01 $49,970 $95.00 $47,850.01 $49,850 $88.00 $47,910.01 $49,910 $90.00 $49,970.01 $51,970 $101.00 $49,850.01 $51,850 $93.00 $49,910.01 $51,910 $95.00 $51,970.01 $53,970 $107.00 $51,850.01 $53,850 $98.00 $51,910.01 $53,910 $100.00 $53,970.01 $55,970 $112.00 $53,850.01 $55,850 $103.00 $53,910.01 $55,910 $105.00 $55,970.01 $57,970 $117.00 $55,850.01 $56,048 $109.00 $55,910.01 $57,910 $110.00 $57,970.01 $59,970 $115.00 $57,910.01 $59,910 $115.00 $59,970.01 $61,970 $121.00 $59,910.01 $61,910 $121.00 $61,970.01 $63,970 $127.00 $61,910.01 $63,910 $127.00 $63,970.01 $65,970 $134.00 $63,910.01 $65,589 $133.00 $65,970.01 $67,970 $139.00 $67,970.01 $69,970 $145.00 $69,970.01 $71,970 $150.00 $71,970.01 $73,970 $155.00 $73,970.01 $75,130 200% FPIG $47,700 200% FPIG $55,820 200% FPIG $63,940
Weekly Family Size: 7 Weekly Family Size: 8 Weekly Family Size: 9 Co-pay Annual Income Co-pay Annual Income Co-pay Annual Income $5.00 Less than: $8,660 $5.00 Less than: $8,660 $5.00 Less than: $8,660 $10.00 $8,660.01 $17,600 $10.00 $8,660.01 $18,800 $10.00 $8,660.01 $19,700 $21.00 $17,600.01 $20,000 $22.00 $18,800.01 $22,000 $23.00 $19,700.01 $23,700 $24.00 $20,000.01 $22,200 $26.00 $22,000.01 $24,090 $28.00 $23,700.01 $26,000 $27.00 $22,200.01 $24,030 $29.00 $24,090.01 $26,090 $31.00 $26,000.01 $28,000 $30.00 $24,030.01 $26,030 $33.00 $26,090.01 $28,090 $35.00 $28,000.01 $30,000 $34.00 $26,030.01 $28,030 $37.00 $28,090.01 $30,090 $39.00 $30,000.01 $32,000 $38.00 $28,030.01 $30,030 $41.00 $30,090.01 $32,090 $43.00 $32,000.01 $34,000 $42.00 $30,030.01 $32,030 $45.00 $32,090.01 $34,090 $47.00 $34,000.01 $36,000 $47.00 $32,030.01 $34,030 $49.00 $34,090.01 $36,090 $51.00 $36,000.01 $38,000 $52.00 $34,030.01 $36,030 $53.00 $36,090.01 $38,090 $55.00 $38,000.01 $40,000 $56.00 $36,030.01 $38,030 $58.00 $38,090.01 $40,090 $59.00 $40,000.01 $42,000 $60.00 $38,030.01 $40,030 $62.00 $40,090.01 $42,090 $64.00 $42,000.01 $44,150 $64.00 $40,030.01 $42,030 $66.00 $42,090.01 $44,090 $68.00 $44,150.01 $46,150 $68.00 $42,030.01 $44,030 $70.00 $44,090.01 $46,090 $72.00 $46,150.01 $48,150 $72.00 $44,030.01 $46,030 $74.00 $46,090.01 $48,090 $76.00 $48,150.01 $50,150 $76.00 $46,030.01 $48,030 $78.00 $48,090.01 $50,090 $80.00 $50,150.01 $52,150 $80.00 $48,030.01 $50,030 $82.00 $50,090.01 $52,090 $84.00 $52,150.01 $54,150 $85.00 $50,030.01 $52,030 $86.00 $52,090.01 $54,090 $88.00 $54,150.01 $56,150 $90.00 $52,030.01 $54,030 $90.00 $54,090.01 $56,090 $92.00 $56,150.01 $58,150 $95.00 $54,030.01 $56,030 $95.00 $56,090.01 $58,090 $96.00 $58,150.01 $60,150 $100.00 $56,030.01 $58,030 $100.00 $58,090.01 $60,090 $101.00 $60,150.01 $62,150 $105.00 $58,030.01 $60,030 $105.00 $60,090.01 $62,090 $106.00 $62,150.01 $64,150 $110.00 $60,030.01 $62,030 $110.00 $62,090.01 $64,090 $111.00 $64,150.01 $66,150 $115.00 $62,030.01 $64,030 $115.00 $64,090.01 $66,090 $116.00 $66,150.01 $68,150 $120.00 $64,030.01 $66,030 $120.00 $66,090.01 $68,090 $121.00 $68,150.01 $70,150 $125.00 $66,030.01 $68,030 $125.00 $68,090.01 $70,090 $126.00 $70,150.01 $72,150 $130.00 $68,030.01 $70,030 $130.00 $70,090.01 $72,090 $131.00 $72,150.01 $74,150 $136.00 $70,030.01 $72,030 $135.00 $72,090.01 $74,090 $136.00 $74,150.01 $76,150 $142.00 $72,030.01 $74,030 $140.00 $74,090.01 $76,090 $141.00 $76,150.01 $78,150 $148.00 $74,030.01 $76,030 $145.00 $76,090.01 $78,090 $146.00 $78,150.01 $80,150 $154.00 $76,030.01 $78,030 $151.00 $78,090.01 $80,090 $151.00 $80,150.01 $82,150 $160.00 $78,030.01 $80,030 $157.00 $80,090.01 $82,090 $156.00 $82,150.01 $84,150 $166.00 $80,030.01 $82,030 $163.00 $82,090.01 $84,090 $161.00 $84,150.01 $86,150 $172.00 $82,030.01 $84,671 $169.00 $84,090.01 $86,090 $167.00 $86,150.01 $88,150 $175.00 $86,090.01 $88,090 $173.00 $88,150.01 $90,150 $181.00 $88,090.01 $90,090 $179.00 $90,150.01 $92,150 $187.00 $90,090.01 $92,090 $185.00 $92,150.01 $94,150 $192.00 $92,090.01 $94,090 $191.00 $94,150.01 $96,150 $197.00 $94,090.01 $94,212 $197.00 $96,150.01 $98,150 $203.00 $98,150.01 $100,150 $209.00 $100,150.01 $102,150 $214.00 $102,150.01 $103,753 200% FPIG $72,060 200% FPIG $80,180 200% FPIG $88,300
Weekly Family Size: 10 Weekly Family Size: 11 Weekly Family Size: 12 Co-pay Annual Income Co-pay Annual Income Co-pay Annual Income $5.00 Less than: $8,660 $5.00 Less than: $8,660 $5.00 Less than: $8,660 $10.00 $8,660.01 $20,500 $10.00 $8,660.01 $21,500 $10.00 $8,660.01 $22,500 $24.00 $20,500.01 $25,000 $25.00 $21,500.01 $28,270 $26.00 $22,500.01 $28,000 $30.00 $25,000.01 $28,000 $33.00 $28,270.01 $30,270 $33.00 $28,000.01 $34,330 $34.00 $28,000.01 $30,000 $36.00 $30,270.01 $32,270 $41.00 $34,330.01 $36,330 $37.00 $30,000.01 $32,000 $39.00 $32,270.01 $34,270 $45.00 $36,330.01 $38,330 $41.00 $32,000.01 $34,000 $43.00 $34,270.01 $36,270 $49.00 $38,330.01 $40,330 $45.00 $34,000.01 $36,000 $47.00 $36,270.01 $38,270 $53.00 $40,330.01 $42,330 $49.00 $36,000.01 $38,000 $51.00 $38,270.01 $40,270 $57.00 $42,330.01 $44,330 $53.00 $38,000.01 $40,000 $55.00 $40,270.01 $42,270 $61.00 $44,330.01 $46,330 $57.00 $40,000.01 $42,000 $59.00 $42,270.01 $44,270 $65.00 $46,330.01 $48,330 $61.00 $42,000.01 $44,000 $63.00 $44,270.01 $46,270 $69.00 $48,330.01 $50,330 $65.00 $44,000.01 $46,000 $67.00 $46,270.01 $48,270 $73.00 $50,330.01 $52,330 $70.00 $46,000.01 $48,210 $71.00 $48,270.01 $50,270 $78.00 $52,330.01 $54,330 $74.00 $48,210.01 $50,210 $76.00 $50,270.01 $52,270 $83.00 $54,330.01 $56,330 $78.00 $50,210.01 $52,210 $80.00 $52,270.01 $54,270 $87.00 $56,330.01 $58,330 $82.00 $52,210.01 $54,210 $84.00 $54,270.01 $56,270 $91.00 $58,330.01 $60,330 $86.00 $54,210.01 $56,210 $88.00 $56,270.01 $58,270 $95.00 $60,330.01 $62,330 $90.00 $56,210.01 $58,210 $92.00 $58,270.01 $60,270 $99.00 $62,330.01 $64,330 $94.00 $58,210.01 $60,210 $96.00 $60,270.01 $62,270 $103.00 $64,330.01 $66,330 $98.00 $60,210.01 $62,210 $100.00 $62,270.01 $64,270 $107.00 $66,330.01 $68,330 $102.00 $62,210.01 $64,210 $104.00 $64,270.01 $66,270 $111.00 $68,330.01 $70,330 $106.00 $64,210.01 $66,210 $108.00 $66,270.01 $68,270 $115.00 $70,330.01 $72,330 $111.00 $66,210.01 $68,210 $112.00 $68,270.01 $70,270 $119.00 $72,330.01 $74,330 $116.00 $68,210.01 $70,210 $116.00 $70,270.01 $72,270 $123.00 $74,330.01 $76,330 $121.00 $70,210.01 $72,210 $121.00 $72,270.01 $74,270 $128.00 $76,330.01 $78,330 $126.00 $72,210.01 $74,210 $126.00 $74,270.01 $76,270 $133.00 $78,330.01 $80,330 $131.00 $74,210.01 $76,210 $131.00 $76,270.01 $78,270 $138.00 $80,330.01 $82,330 $136.00 $76,210.01 $78,210 $136.00 $78,270.01 $80,270 $143.00 $82,330.01 $84,330 $141.00 $78,210.01 $80,210 $141.00 $80,270.01 $82,270 $148.00 $84,330.01 $86,330 $146.00 $80,210.01 $82,210 $146.00 $82,270.01 $84,270 $153.00 $86,330.01 $88,330 $151.00 $82,210.01 $84,210 $151.00 $84,270.01 $86,270 $158.00 $88,330.01 $90,330 $156.00 $84,210.01 $86,210 $156.00 $86,270.01 $88,270 $163.00 $90,330.01 $92,330 $161.00 $86,210.01 $88,210 $161.00 $88,270.01 $90,270 $168.00 $92,330.01 $94,330 $166.00 $88,210.01 $90,210 $166.00 $90,270.01 $92,270 $173.00 $94,330.01 $96,330 $171.00 $90,210.01 $92,210 $171.00 $92,270.01 $94,270 $178.00 $96,330.01 $98,330 $177.00 $92,210.01 $94,210 $176.00 $94,270.01 $96,270 $183.00 $98,330.01 $100,330 $183.00 $94,210.01 $96,210 $181.00 $96,270.01 $98,270 $188.00 $100,330.01 $102,330 $189.00 $96,210.01 $98,210 $186.00 $98,270.01 $100,270 $193.00 $102,330.01 $104,330 $195.00 $98,210.01 $100,210 $192.00 $100,270.01 $102,270 $198.00 $104,330.01 $106,330 $201.00 $100,210.01 $102,210 $198.00 $102,270.01 $104,270 $203.00 $106,330.01 $108,330 $207.00 $102,210.01 $104,210 $204.00 $104,270.01 $106,270 $209.00 $108,330.01 $110,330 $213.00 $104,210.01 $106,210 $210.00 $106,270.01 $108,270 $215.00 $110,330.01 $112,330 $219.00 $106,210.01 $108,210 $216.00 $108,270.01 $110,270 $221.00 $112,330.01 $114,330 $225.00 $108,210.01 $110,210 $222.00 $110,270.01 $112,270 $227.00 $114,330.01 $116,330 $231.00 $110,210.01 $113,294 $228.00 $112,270.01 $114,270 $233.00 $116,330.01 $118,330 $234.00 $114,270.01 $116,270 $239.00 $118,330.01 $120,330 $240.00 $116,270.01 $118,270 $245.00 $120,330.01 $122,330 $246.00 $118,270.01 $120,270 $251.00 $122,330.01 $124,330 $251.00 $120,270.01 $122,270 $257.00 $124,330.01 $126,330 $256.00 $122,270.01 $122,835 $263.00 $126,330.01 $128,330 $268.00 $128,330.01 $130,330 $273.00 $130,330.01 $132,330 $278.00 $132,330.01 $132,376 200% FPIG $96,420 200% FPIG $104,540 200% FPIG $112,660
Weekly Family Size: 13 Weekly Family Size: 14 Weekly Family Size: 15 Co-pay Annual Income Co-pay Annual Income Co-pay Annual Income $5.00 Less than: $8,660 $5.00 Less than: $8,660 $5.00 Less than: $8,660 $10.00 $8,660.01 $24,150 $10.00 $8,660.01 $24,250 $10.00 $8,660.01 $28,510 $28.00 $24,150.01 $29,500 $28.00 $24,250.01 $30,300 $33.00 $28,510.01 $36,510 $35.00 $29,500.01 $34,390 $35.00 $30,300.01 $36,450 $43.00 $36,510.01 $38,510 $41.00 $34,390.01 $36,390 $43.00 $36,450.01 $38,450 $46.00 $38,510.01 $40,510 $44.00 $36,390.01 $38,390 $46.00 $38,450.01 $40,450 $49.00 $40,510.01 $42,510 $47.00 $38,390.01 $40,390 $49.00 $40,450.01 $42,450 $52.00 $42,510.01 $44,510 $51.00 $40,390.01 $42,390 $53.00 $42,450.01 $44,450 $56.00 $44,510.01 $46,510 $55.00 $42,390.01 $44,390 $57.00 $44,450.01 $46,450 $60.00 $46,510.01 $48,510 $59.00 $44,390.01 $46,390 $61.00 $46,450.01 $48,450 $64.00 $48,510.01 $50,510 $63.00 $46,390.01 $48,390 $65.00 $48,450.01 $50,450 $68.00 $50,510.01 $52,510 $67.00 $48,390.01 $50,390 $69.00 $50,450.01 $52,450 $72.00 $52,510.01 $54,510 $71.00 $50,390.01 $52,390 $73.00 $52,450.01 $54,450 $76.00 $54,510.01 $56,510 $75.00 $52,390.01 $54,390 $77.00 $54,450.01 $56,450 $80.00 $56,510.01 $58,510 $79.00 $54,390.01 $56,390 $81.00 $56,450.01 $58,450 $84.00 $58,510.01 $60,510 $84.00 $56,390.01 $58,390 $85.00 $58,450.01 $60,450 $88.00 $60,510.01 $62,510 $89.00 $58,390.01 $60,390 $90.00 $60,450.01 $62,450 $92.00 $62,510.01 $64,510 $93.00 $60,390.01 $62,390 $95.00 $62,450.01 $64,450 $96.00 $64,510.01 $66,510 $97.00 $62,390.01 $64,390 $99.00 $64,450.01 $66,450 $101.00 $66,510.01 $68,510 $101.00 $64,390.01 $66,390 $103.00 $66,450.01 $68,450 $105.00 $68,510.01 $70,510 $105.00 $66,390.01 $68,390 $107.00 $68,450.01 $70,450 $109.00 $70,510.01 $72,510 $109.00 $68,390.01 $70,390 $111.00 $70,450.01 $72,450 $113.00 $72,510.01 $74,510 $113.00 $70,390.01 $72,390 $115.00 $72,450.01 $74,450 $117.00 $74,510.01 $76,510 $117.00 $72,390.01 $74,390 $119.00 $74,450.01 $76,450 $121.00 $76,510.01 $78,510 $121.00 $74,390.01 $76,390 $123.00 $76,450.01 $78,450 $125.00 $78,510.01 $80,510 $125.00 $76,390.01 $78,390 $127.00 $78,450.01 $80,450 $129.00 $80,510.01 $82,510 $129.00 $78,390.01 $80,390 $131.00 $80,450.01 $82,450 $133.00 $82,510.01 $84,510 $133.00 $80,390.01 $82,390 $135.00 $82,450.01 $84,450 $137.00 $84,510.01 $86,510 $138.00 $82,390.01 $84,390 $139.00 $84,450.01 $86,450 $141.00 $86,510.01 $88,510 $143.00 $84,390.01 $86,390 $144.00 $86,450.01 $88,450 $145.00 $88,510.01 $90,510 $148.00 $86,390.01 $88,390 $149.00 $88,450.01 $90,450 $149.00 $90,510.01 $92,510 $153.00 $88,390.01 $90,390 $154.00 $90,450.01 $92,450 $154.00 $92,510.01 $94,510 $158.00 $90,390.01 $92,390 $159.00 $92,450.01 $94,450 $159.00 $94,510.01 $96,510 $163.00 $92,390.01 $94,390 $164.00 $94,450.01 $96,450 $164.00 $96,510.01 $98,510 $168.00 $94,390.01 $96,390 $169.00 $96,450.01 $98,450 $169.00 $98,510.01 $100,510 $173.00 $96,390.01 $98,390 $174.00 $98,450.01 $100,450 $174.00 $100,510.01 $102,510 $178.00 $98,390.01 $100,390 $179.00 $100,450.01 $102,450 $179.00 $102,510.01 $104,510 $183.00 $100,390.01 $102,390 $184.00 $102,450.01 $104,450 $184.00 $104,510.01 $106,510 $188.00 $102,390.01 $104,390 $189.00 $104,450.01 $106,450 $189.00 $106,510.01 $108,510 $193.00 $104,390.01 $106,390 $194.00 $106,450.01 $108,450 $194.00 $108,510.01 $110,510 $198.00 $106,390.01 $108,390 $199.00 $108,450.01 $110,450 $199.00 $110,510.01 $112,510 $203.00 $108,390.01 $110,390 $204.00 $110,450.01 $112,450 $204.00 $112,510.01 $114,510 $208.00 $110,390.01 $112,390 $209.00 $112,450.01 $114,450 $209.00 $114,510.01 $116,510 $213.00 $112,390.01 $114,390 $214.00 $114,450.01 $116,450 $214.00 $116,510.01 $118,510 $218.00 $114,390.01 $116,390 $219.00 $116,450.01 $118,450 $219.00 $118,510.01 $120,510 $224.00 $116,390.01 $118,390 $224.00 $118,450.01 $120,450 $224.00 $120,510.01 $122,510 $230.00 $118,390.01 $120,390 $229.00 $120,450.01 $122,450 $229.00 $122,510.01 $124,510 $236.00 $120,390.01 $122,390 $235.00 $122,450.01 $124,450 $234.00 $124,510.01 $126,510 $242.00 $122,390.01 $124,390 $241.00 $124,450.01 $126,450 $239.00 $126,510.01 $128,510 $248.00 $124,390.01 $126,390 $247.00 $126,450.01 $128,450 $244.00 $128,510.01 $130,510 $254.00 $126,390.01 $128,390 $253.00 $128,450.01 $130,450 $250.00 $130,510.01 $132,510 $260.00 $128,390.01 $130,390 $259.00 $130,450.01 $132,450 $256.00 $132,510.01 $134,510 $266.00 $130,390.01 $132,390 $265.00 $132,450.01 $134,450 $262.00 $134,510.01 $136,510 $272.00 $132,390.01 $134,390 $271.00 $134,450.01 $136,450 $268.00 $136,510.01 $138,510 $278.00 $134,390.01 $136,390 $277.00 $136,450.01 $138,450 $274.00 $138,510.01 $140,510 $284.00 $136,390.01 $138,390 $283.00 $138,450.01 $140,450 $280.00 $140,510.01 $142,510 $289.00 $138,390.01 $140,390 $289.00 $140,450.01 $142,450 $286.00 $142,510.01 $144,510 $294.00 $140,390.01 $141,917 $295.00 $142,450.01 $144,450 $292.00 $144,510.01 $146,510 $301.00 $144,450.01 $146,450 $298.00 $146,510.01 $148,510 $306.00 $146,450.01 $148,450 $304.00 $148,510.01 $150,510 $311.00 $148,450.01 $151,458 $310.00 $150,510.01 $152,510 $316.00 $152,510.01 $154,510 $322.00 $154,510.01 $156,510 $328.00 $156,510.01 $158,510 $333.00 $158,510.01 $160,510 $338.00 $160,510.01 $160,999 200% FPIG $120,780 200% FPIG $128,900 200% FPIG $137,020
Weekly Family Size: 16 Weekly Family Size: 17 Weekly Family Size: 18 Co-pay Annual Income Co-pay Annual Income Co-pay Annual Income $5.00 Less than: $8,660 $5.00 Less than: $8,660 $5.00 Less than: $8,660 $10.00 $8,660.01 $27,700 $10.00 $8,660.01 $28,600 $10.00 $8,660.01 $30,000 $32.00 $27,700.01 $36,300 $33.00 $28,600.01 $36,800 $35.00 $30,000.01 $38,500 $42.00 $36,300.01 $42,570 $43.00 $36,800.01 $44,630 $45.00 $38,500.01 $46,690 $50.00 $42,570.01 $44,570 $53.00 $44,630.01 $46,630 $55.00 $46,690.01 $48,690 $53.00 $44,570.01 $46,570 $56.00 $46,630.01 $48,630 $58.00 $48,690.01 $50,690 $57.00 $46,570.01 $48,570 $59.00 $48,630.01 $50,630 $61.00 $50,690.01 $52,690 $61.00 $48,570.01 $50,570 $63.00 $50,630.01 $52,630 $65.00 $52,690.01 $54,690 $65.00 $50,570.01 $52,570 $67.00 $52,630.01 $54,630 $69.00 $54,690.01 $56,690 $69.00 $52,570.01 $54,570 $71.00 $54,630.01 $56,630 $73.00 $56,690.01 $58,690 $73.00 $54,570.01 $56,570 $75.00 $56,630.01 $58,630 $77.00 $58,690.01 $60,690 $77.00 $56,570.01 $58,570 $79.00 $58,630.01 $60,630 $81.00 $60,690.01 $62,690 $81.00 $58,570.01 $60,570 $83.00 $60,630.01 $62,630 $85.00 $62,690.01 $64,690 $85.00 $60,570.01 $62,570 $87.00 $62,630.01 $64,630 $89.00 $64,690.01 $66,690 $89.00 $62,570.01 $64,570 $91.00 $64,630.01 $66,630 $93.00 $66,690.01 $68,690 $93.00 $64,570.01 $66,570 $95.00 $66,630.01 $68,630 $97.00 $68,690.01 $70,690 $97.00 $66,570.01 $68,570 $99.00 $68,630.01 $70,630 $101.00 $70,690.01 $72,690 $102.00 $68,570.01 $70,570 $103.00 $70,630.01 $72,630 $105.00 $72,690.01 $74,690 $107.00 $70,570.01 $72,570 $108.00 $72,630.01 $74,630 $110.00 $74,690.01 $76,690 $111.00 $72,570.01 $74,570 $113.00 $74,630.01 $76,630 $115.00 $76,690.01 $78,690 $115.00 $74,570.01 $76,570 $117.00 $76,630.01 $78,630 $120.00 $78,690.01 $80,690 $119.00 $76,570.01 $78,570 $121.00 $78,630.01 $80,630 $124.00 $80,690.01 $82,690 $123.00 $78,570.01 $80,570 $125.00 $80,630.01 $82,630 $128.00 $82,690.01 $84,690 $127.00 $80,570.01 $82,570 $129.00 $82,630.01 $84,630 $132.00 $84,690.01 $86,690 $131.00 $82,570.01 $84,570 $133.00 $84,630.01 $86,630 $136.00 $86,690.01 $88,690 $135.00 $84,570.01 $86,570 $137.00 $86,630.01 $88,630 $140.00 $88,690.01 $90,690 $139.00 $86,570.01 $88,570 $141.00 $88,630.01 $90,630 $144.00 $90,690.01 $92,690 $143.00 $88,570.01 $90,570 $145.00 $90,630.01 $92,630 $148.00 $92,690.01 $94,690 $147.00 $90,570.01 $92,570 $149.00 $92,630.01 $94,630 $152.00 $94,690.01 $96,690 $151.00 $92,570.01 $94,570 $153.00 $94,630.01 $96,630 $156.00 $96,690.01 $98,690 $155.00 $94,570.01 $96,570 $157.00 $96,630.01 $98,630 $160.00 $98,690.01 $100,690 $159.00 $96,570.01 $98,570 $161.00 $98,630.01 $100,630 $164.00 $100,690.01 $102,690 $164.00 $98,570.01 $100,570 $165.00 $100,630.01 $102,630 $168.00 $102,690.01 $104,690 $169.00 $100,570.01 $102,570 $169.00 $102,630.01 $104,630 $172.00 $104,690.01 $106,690 $174.00 $102,570.01 $104,570 $174.00 $104,630.01 $106,630 $176.00 $106,690.01 $108,690 $179.00 $104,570.01 $106,570 $179.00 $106,630.01 $108,630 $180.00 $108,690.01 $110,690 $184.00 $106,570.01 $108,570 $184.00 $108,630.01 $110,630 $185.00 $110,690.01 $112,690 $189.00 $108,570.01 $110,570 $189.00 $110,630.01 $112,630 $190.00 $112,690.01 $114,690 $194.00 $110,570.01 $112,570 $194.00 $112,630.01 $114,630 $195.00 $114,690.01 $116,690 $199.00 $112,570.01 $114,570 $199.00 $114,630.01 $116,630 $200.00 $116,690.01 $118,690 $204.00 $114,570.01 $116,570 $204.00 $116,630.01 $118,630 $205.00 $118,690.01 $120,690 $209.00 $116,570.01 $118,570 $209.00 $118,630.01 $120,630 $210.00 $120,690.01 $122,690 $214.00 $118,570.01 $120,570 $214.00 $120,630.01 $122,630 $215.00 $122,690.01 $124,690 $219.00 $120,570.01 $122,570 $219.00 $122,630.01 $124,630 $220.00 $124,690.01 $126,690 $224.00 $122,570.01 $124,570 $224.00 $124,630.01 $126,630 $225.00 $126,690.01 $128,690 $229.00 $124,570.01 $126,570 $229.00 $126,630.01 $128,630 $230.00 $128,690.01 $130,690 $234.00 $126,570.01 $128,570 $234.00 $128,630.01 $130,630 $235.00 $130,690.01 $132,690 $239.00 $128,570.01 $130,570 $239.00 $130,630.01 $132,630 $240.00 $132,690.01 $134,690 $244.00 $130,570.01 $132,570 $244.00 $132,630.01 $134,630 $245.00 $134,690.01 $136,690 $249.00 $132,570.01 $134,570 $249.00 $134,630.01 $136,630 $250.00 $136,690.01 $138,690 $254.00 $134,570.01 $136,570 $254.00 $136,630.01 $138,630 $255.00 $138,690.01 $140,690 $259.00 $136,570.01 $138,570 $259.00 $138,630.01 $140,630 $260.00 $140,690.01 $142,690 $264.00 $138,570.01 $140,570 $264.00 $140,630.01 $142,630 $265.00 $142,690.01 $144,690 $270.00 $140,570.01 $142,570 $269.00 $142,630.01 $144,630 $270.00 $144,690.01 $146,690 $276.00 $142,570.01 $144,570 $274.00 $144,630.01 $146,630 $275.00 $146,690.01 $148,690 $282.00 $144,570.01 $146,570 $280.00 $146,630.01 $148,630 $280.00 $148,690.01 $150,690 $288.00 $146,570.01 $148,570 $286.00 $148,630.01 $150,630 $285.00 $150,690.01 $152,690 $294.00 $148,570.01 $150,570 $292.00 $150,630.01 $152,630 $290.00 $152,690.01 $154,690 $300.00 $150,570.01 $152,570 $298.00 $152,630.01 $154,630 $296.00 $154,690.01 $156,690 $306.00 $152,570.01 $154,570 $304.00 $154,630.01 $156,630 $302.00 $156,690.01 $158,690 $312.00 $154,570.01 $156,570 $310.00 $156,630.01 $158,630 $308.00 $158,690.01 $160,690 $318.00 $156,570.01 $158,570 $316.00 $158,630.01 $160,630 $314.00 $160,690.01 $162,690 $324.00 $158,570.01 $160,570 $322.00 $160,630.01 $162,630 $320.00 $162,690.01 $164,690 $330.00 $160,570.01 $162,570 $328.00 $162,630.01 $164,630 $326.00 $164,690.01 $166,690 $336.00 $162,570.01 $164,570 $334.00 $164,630.01 $166,630 $332.00 $166,690.01 $168,690 $342.00 $164,570.01 $166,570 $340.00 $166,630.01 $168,630 $338.00 $168,690.01 $170,690 $348.00 $166,570.01 $168,570 $346.00 $168,630.01 $170,630 $344.00 $170,690.01 $172,690 $353.00 $168,570.01 $170,540 $352.00 $170,630.01 $172,630 $350.00 $172,690.01 $174,690 $358.00 $172,630.01 $174,630 $356.00 $174,690.01 $176,690 $364.00 $174,630.01 $176,630 $362.00 $176,690.01 $178,690 $370.00 $176,630.01 $180,081 $368.00 $178,690.01 $180,690 $374.00 $180,690.01 $182,690 $380.00 $182,690.01 $184,690 $386.00 $184,690.01 $186,690 $391.00 $186,690.01 $188,690 $396.00 $188,690.01 $189,622 200% FPIG $145,140 200% FPIG $153,260 200% FPIG $161,380
Weekly Family Size: 19 Weekly Family Size: 20 Weekly Family Size: 21 Co-pay Annual Income Co-pay Annual Income Co-pay Annual Income $5.00 Less than: $8,660 $5.00 Less than: $8,660 $5.00 Less than: $8,660 $10.00 $8,660.01 $30,300 $10.00 $8,660.01 $32,000 $10.00 $8,660.01 $33,770 $35.00 $30,300.01 $40,300 $37.00 $32,000.01 $41,330 $39.00 $33,770.01 $44,400 $47.00 $40,300.01 $48,750 $48.00 $41,330.01 $50,810 $52.00 $44,400.01 $52,870 $57.00 $48,750.01 $50,750 $60.00 $50,810.01 $52,810 $63.00 $52,870.01 $54,870 $60.00 $50,750.01 $52,750 $63.00 $52,810.01 $54,810 $66.00 $54,870.01 $56,870 $63.00 $52,750.01 $54,750 $66.00 $54,810.01 $56,810 $69.00 $56,870.01 $58,870 $67.00 $54,750.01 $56,750 $69.00 $56,810.01 $58,810 $72.00 $58,870.01 $60,870 $71.00 $56,750.01 $58,750 $73.00 $58,810.01 $60,810 $76.00 $60,870.01 $62,870 $75.00 $58,750.01 $60,750 $77.00 $60,810.01 $62,810 $80.00 $62,870.01 $64,870 $79.00 $60,750.01 $62,750 $81.00 $62,810.01 $64,810 $84.00 $64,870.01 $66,870 $83.00 $62,750.01 $64,750 $85.00 $64,810.01 $66,810 $88.00 $66,870.01 $68,870 $87.00 $64,750.01 $66,750 $89.00 $66,810.01 $68,810 $92.00 $68,870.01 $70,870 $91.00 $66,750.01 $68,750 $93.00 $68,810.01 $70,810 $96.00 $70,870.01 $72,870 $95.00 $68,750.01 $70,750 $97.00 $70,810.01 $72,810 $100.00 $72,870.01 $74,870 $99.00 $70,750.01 $72,750 $101.00 $72,810.01 $74,810 $104.00 $74,870.01 $76,870 $103.00 $72,750.01 $74,750 $105.00 $74,810.01 $76,810 $108.00 $76,870.01 $78,870 $107.00 $74,750.01 $76,750 $109.00 $76,810.01 $78,810 $112.00 $78,870.01 $80,870 $111.00 $76,750.01 $78,750 $113.00 $78,810.01 $80,810 $116.00 $80,870.01 $82,870 $116.00 $78,750.01 $80,750 $117.00 $80,810.01 $82,810 $120.00 $82,870.01 $84,870 $121.00 $80,750.01 $82,750 $122.00 $82,810.01 $84,810 $124.00 $84,870.01 $86,870 $126.00 $82,750.01 $84,750 $127.00 $84,810.01 $86,810 $128.00 $86,870.01 $88,870 $130.00 $84,750.01 $86,750 $132.00 $86,810.01 $88,810 $133.00 $88,870.01 $90,870 $134.00 $86,750.01 $88,750 $136.00 $88,810.01 $90,810 $138.00 $90,870.01 $92,870 $138.00 $88,750.01 $90,750 $140.00 $90,810.01 $92,810 $142.00 $92,870.01 $94,870 $142.00 $90,750.01 $92,750 $144.00 $92,810.01 $94,810 $146.00 $94,870.01 $96,870 $146.00 $92,750.01 $94,750 $148.00 $94,810.01 $96,810 $150.00 $96,870.01 $98,870 $150.00 $94,750.01 $96,750 $152.00 $96,810.01 $98,810 $154.00 $98,870.01 $100,870 $154.00 $96,750.01 $98,750 $156.00 $98,810.01 $100,810 $158.00 $100,870.01 $102,870 $158.00 $98,750.01 $100,750 $160.00 $100,810.01 $102,810 $162.00 $102,870.01 $104,870 $162.00 $100,750.01 $102,750 $164.00 $102,810.01 $104,810 $166.00 $104,870.01 $106,870 $166.00 $102,750.01 $104,750 $168.00 $104,810.01 $106,810 $170.00 $106,870.01 $108,870 $170.00 $104,750.01 $106,750 $172.00 $106,810.01 $108,810 $174.00 $108,870.01 $110,870 $174.00 $106,750.01 $108,750 $176.00 $108,810.01 $110,810 $178.00 $110,870.01 $112,870 $178.00 $108,750.01 $110,750 $180.00 $110,810.01 $112,810 $182.00 $112,870.01 $114,870 $182.00 $110,750.01 $112,750 $184.00 $112,810.01 $114,810 $186.00 $114,870.01 $116,870 $186.00 $112,750.01 $114,750 $188.00 $114,810.01 $116,810 $190.00 $116,870.01 $118,870 $190.00 $114,750.01 $116,750 $192.00 $116,810.01 $118,810 $194.00 $118,870.01 $120,870 $195.00 $116,750.01 $118,750 $196.00 $118,810.01 $120,810 $198.00 $120,870.01 $122,870 $200.00 $118,750.01 $120,750 $201.00 $120,810.01 $122,810 $202.00 $122,870.01 $124,870 $205.00 $120,750.01 $122,750 $206.00 $122,810.01 $124,810 $207.00 $124,870.01 $126,870 $210.00 $122,750.01 $124,750 $211.00 $124,810.01 $126,810 $212.00 $126,870.01 $128,870 $215.00 $124,750.01 $126,750 $216.00 $126,810.01 $128,810 $217.00 $128,870.01 $130,870 $220.00 $126,750.01 $128,750 $221.00 $128,810.01 $130,810 $222.00 $130,870.01 $132,870 $225.00 $128,750.01 $130,750 $226.00 $130,810.01 $132,810 $227.00 $132,870.01 $134,870 $230.00 $130,750.01 $132,750 $231.00 $132,810.01 $134,810 $232.00 $134,870.01 $136,870 $235.00 $132,750.01 $134,750 $236.00 $134,810.01 $136,810 $237.00 $136,870.01 $138,870 $240.00 $134,750.01 $136,750 $241.00 $136,810.01 $138,810 $242.00 $138,870.01 $140,870 $245.00 $136,750.01 $138,750 $246.00 $138,810.01 $140,810 $247.00 $140,870.01 $142,870 $250.00 $138,750.01 $140,750 $251.00 $140,810.01 $142,810 $252.00 $142,870.01 $144,870 $255.00 $140,750.01 $142,750 $256.00 $142,810.01 $144,810 $257.00 $144,870.01 $146,870 $260.00 $142,750.01 $144,750 $261.00 $144,810.01 $146,810 $262.00 $146,870.01 $148,870 $265.00 $144,750.01 $146,750 $266.00 $146,810.01 $148,810 $267.00 $148,870.01 $150,870 $270.00 $146,750.01 $148,750 $271.00 $148,810.01 $150,810 $272.00 $150,870.01 $152,870 $275.00 $148,750.01 $150,750 $276.00 $150,810.01 $152,810 $277.00 $152,870.01 $154,870 $280.00 $150,750.01 $152,750 $281.00 $152,810.01 $154,810 $282.00 $154,870.01 $156,870 $285.00 $152,750.01 $154,750 $286.00 $154,810.01 $156,810 $287.00 $156,870.01 $158,870 $290.00 $154,750.01 $156,750 $291.00 $156,810.01 $158,810 $292.00 $158,870.01 $160,870 $295.00 $156,750.01 $158,750 $296.00 $158,810.01 $160,810 $297.00 $160,870.01 $162,870 $300.00 $158,750.01 $160,750 $301.00 $160,810.01 $162,810 $302.00 $162,870.01 $164,870 $305.00 $160,750.01 $162,750 $306.00 $162,810.01 $164,810 $307.00 $164,870.01 $166,870 $310.00 $162,750.01 $164,750 $311.00 $164,810.01 $166,810 $312.00 $166,870.01 $168,870 $316.00 $164,750.01 $166,750 $316.00 $166,810.01 $168,810 $317.00 $168,870.01 $170,870 $322.00 $166,750.01 $168,750 $321.00 $168,810.01 $170,810 $322.00 $170,870.01 $172,870 $328.00 $168,750.01 $170,750 $327.00 $170,810.01 $172,810 $327.00 $172,870.01 $174,870 $334.00 $170,750.01 $172,750 $333.00 $172,810.01 $174,810 $332.00 $174,870.01 $176,870 $340.00 $172,750.01 $174,750 $339.00 $174,810.01 $176,810 $338.00 $176,870.01 $178,870 $346.00 $174,750.01 $176,750 $345.00 $176,810.01 $178,810 $344.00 $178,870.01 $180,870 $352.00 $176,750.01 $178,750 $351.00 $178,810.01 $180,810 $350.00 $180,870.01 $182,870 $358.00 $178,750.01 $180,750 $357.00 $180,810.01 $182,810 $356.00 $182,870.01 $184,870 $364.00 $180,750.01 $182,750 $363.00 $182,810.01 $184,810 $362.00 $184,870.01 $186,870 $370.00 $182,750.01 $184,750 $369.00 $184,810.01 $186,810 $368.00 $186,870.01 $188,870 $376.00 $184,750.01 $186,750 $375.00 $186,810.01 $188,810 $374.00 $188,870.01 $190,870 $382.00 $186,750.01 $188,750 $381.00 $188,810.01 $190,810 $380.00 $190,870.01 $192,870 $388.00 $188,750.01 $190,750 $387.00 $190,810.01 $192,810 $386.00 $192,870.01 $194,870 $394.00 $190,750.01 $192,750 $393.00 $192,810.01 $194,810 $392.00 $194,870.01 $196,870 $400.00 $192,750.01 $194,750 $399.00 $194,810.01 $196,810 $398.00 $196,870.01 $198,870 $406.00 $194,750.01 $196,750 $405.00 $196,810.01 $198,810 $404.00 $198,870.01 $200,870 $412.00 $196,750.01 $198,750 $411.00 $198,810.01 $200,810 $410.00 $200,870.01 $202,870 $417.00 $198,750.01 $199,163 $417.00 $200,810.01 $202,810 $416.00 $202,870.01 $204,870 $423.00 $202,810.01 $204,810 $422.00 $204,870.01 $206,870 $429.00 $204,810.01 $206,810 $428.00 $206,870.01 $208,870 $434.00 $206,810.01 $208,704 $434.00 $208,870.01 $210,870 $440.00 $210,870.01 $212,870 $445.00 $212,870.01 $214,870 $450.00 $214,870.01 $218,245 200% FPIG $169,500 200% FPIG $177,620 200% FPIG $185,740
[Pa.B. Doc. No. 14-943. Filed for public inspection May 2, 2014, 9:00 a.m.]
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