NOTICES
DEPARTMENT OF
HUMAN SERVICES
Income Limits and Co-payments for the Subsidized Child Care Program
[49 Pa.B. 3160]
[Saturday, June 15, 2019]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 2019 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 6, 2019.
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 6, 2019, 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,
SecretaryFiscal Note: 14-NOT-1341. No fiscal impact; (8) recommends adoption.
CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE EFFECTIVE MAY 6, 2019
(BASED ON THE 2019 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: $10,490 $5 Less than: $8,660 $5 Less than: $8,660 $10 $10,490.01 $12,490 $10 $8,660.01 $12,910 $10 $8,660 $14,710 $15 $12,490.01 $14,490 $16 $12,910.01 $14,910 $17 $14,710 $16,710 $20 $14,490.01 $16,490 $21 $14,910.01 $16,910 $22 $16,710 $19,330 $25 $16,490.01 $18,490 $25 $16,910.01 $18,910 $27 $19,330 $21,330 $30 $18,490.01 $20,490 $29 $18,910.01 $20,910 $31 $21,330 $23,330 $35 $20,490.01 $22,490 $33 $20,910.01 $22,910 $35 $23,330 $25,330 $40 $22,490.01 $24,490 $38 $22,910.01 $24,910 $39 $25,330 $27,330 $45 $24,490.01 $26,490 $43 $24,910.01 $26,910 $43 $27,330 $29,330 $50 $26,490.01 $28,490 $48 $26,910.01 $28,910 $48 $29,330 $31,330 $55 $28,490.01 $29,352 $53 $28,910.01 $30,910 $53 $31,330 $33,330 $58 $30,910.01 $32,910 $58 $33,330 $35,330 $64 $32,910.01 $34,910 $63 $35,330 $37,330 $70 $34,910.01 $36,910 $68 $37,330 $39,330 $76 $36,910.01 $39,739 $73 $39,330 $41,330 $79 $41,330 $43,330 $85 $43,330 $45,330 $91 $45,330 $47,330 $97 $47,330 $50,126 200% FPIG $24,980 200% FPIG $33,820 200% FPIG $42,660
Weekly Family Size: 4 Weekly Family Size: 5 Weekly Family Size: 6 Co-pay
Annual Income
Co-pay
Annual Income
Co-pay
Annual Income
$5 Less than: $8,660 $5 Less than: $8,660 $5 Less than: $8,660 $10 $8,660.01 $16,400 $10 $8,660.01 $16,450 $10 $8,660.01 $18,180 $19 $16,400.01 $19,750 $19 $16,450.01 $20,170 $21 $18,180.01 $20,740 $24 $19,750.01 $21,750 $24 $20,170.01 $22,170 $24 $20,740.01 $24,590 $28 $21,750.01 $23,750 $27 $22,170.01 $24,170 $29 $24,590.01 $26,590 $33 $23,750.01 $25,750 $31 $24,170.01 $26,170 $32 $26,590.01 $28,590 $37 $25,750.01 $27,750 $35 $26,170.01 $28,170 $36 $28,590.01 $30,590 $41 $27,750.01 $29,750 $40 $28,170.01 $30,170 $41 $30,590.01 $32,590 $45 $29,750.01 $31,750 $44 $30,170.01 $32,170 $46 $32,590.01 $34,590 $49 $31,750.01 $33,750 $47 $32,170.01 $34,170 $50 $34,590.01 $36,590 $53 $33,750.01 $35,750 $51 $34,170.01 $36,170 $54 $36,590.01 $38,590 $58 $35,750.01 $37,750 $55 $36,170.01 $38,170 $58 $38,590.01 $40,590 $63 $37,750.01 $39,750 $59 $38,170.01 $40,170 $62 $40,590.01 $42,590 $68 $39,750.01 $41,750 $63 $40,170.01 $42,170 $66 $42,590.01 $44,590 $73 $41,750.01 $43,750 $68 $42,170.01 $44,170 $70 $44,590.01 $46,590 $78 $43,750.01 $45,750 $73 $44,170.01 $46,170 $75 $46,590.01 $48,590 $83 $45,750.01 $47,750 $78 $46,170.01 $48,170 $80 $48,590.01 $50,590 $89 $47,750.01 $49,750 $83 $48,170.01 $50,170 $85 $50,590.01 $52,590 $95 $49,750.01 $51,750 $88 $50,170.01 $52,170 $90 $52,590.01 $54,590 $101 $51,750.01 $53,750 $93 $52,170.01 $54,170 $95 $54,590.01 $56,590 $107 $53,750.01 $55,750 $98 $54,170.01 $56,170 $100 $56,590.01 $58,590 $113 $55,750.01 $57,750 $103 $56,170.01 $58,170 $105 $58,590.01 $60,590 $118 $57,750.01 $60,513 $109 $58,170.01 $60,170 $110 $60,590.01 $62,590 $115 $60,170.01 $62,170 $115 $62,590.01 $64,590 $121 $62,170.01 $64,170 $121 $64,590.01 $66,590 $127 $64,170.01 $66,170 $127 $66,590.01 $68,590 $134 $66,170.01 $70,900 $133 $68,590.01 $70,590 $139 $70,590.01 $72,590 $145 $72,590.01 $74,590 $151 $74,590.01 $76,590 $156 $76,590.01 $81,287 200% FPIG $51,500 200% FPIG $60,340 200% FPIG $69,180
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: $8,660 $5 Less than: $8,660 $5 Less than: $8,660 $10 $8,660.01 $18,180 $10 $8,660.01 $19,050 $10 $8,660.01 $19,900 $21 $18,180.01 $20,770 $22 $19,050.01 $22,420 $23 $19,900.01 $24,090 $24 $20,770.01 $23,340 $26 $22,420.01 $24,990 $28 $24,090.01 $26,090 $27 $23,340.01 $25,640 $29 $24,990.01 $29,430 $31 $26,090.01 $29,450 $30 $25,640.01 $29,010 $35 $29,430.01 $31,430 $35 $29,450.01 $33,850 $34 $29,010.01 $31,010 $38 $31,430.01 $33,430 $41 $33,850.01 $35,850 $38 $31,010.01 $33,010 $41 $33,430.01 $35,430 $44 $35,850.01 $37,850 $42 $33,010.01 $35,010 $45 $35,430.01 $37,430 $47 $37,850.01 $39,850 $48 $35,010.01 $37,010 $49 $37,430.01 $39,430 $51 $39,850.01 $41,850 $53 $37,010.01 $39,010 $54 $39,430.01 $41,430 $55 $41,850.01 $43,850 $57 $39,010.01 $41,010 $59 $41,430.01 $43,430 $60 $43,850.01 $45,850 $60 $41,010.01 $43,010 $63 $43,430.01 $45,430 $65 $45,850.01 $47,850 $64 $43,010.01 $45,010 $66 $45,430.01 $47,430 $69 $47,850.01 $49,850 $68 $45,010.01 $47,010 $70 $47,430.01 $49,430 $73 $49,850.01 $51,850 $72 $47,010.01 $49,010 $74 $49,430.01 $51,430 $77 $51,850.01 $53,850 $76 $49,010.01 $51,010 $78 $51,430.01 $53,430 $81 $53,850.01 $55,850 $80 $51,010.01 $53,010 $82 $53,430.01 $55,430 $85 $55,850.01 $57,850 $85 $53,010.01 $55,010 $86 $55,430.01 $57,430 $89 $57,850.01 $59,850 $90 $55,010.01 $57,010 $90 $57,430.01 $59,430 $93 $59,850.01 $61,850 $95 $57,010.01 $59,010 $95 $59,430.01 $61,430 $97 $61,850.01 $63,850 $100 $59,010.01 $61,010 $100 $61,430.01 $63,430 $101 $63,850.01 $65,850 $105 $61,010.01 $63,010 $105 $63,430.01 $65,430 $106 $65,850.01 $67,850 $110 $63,010.01 $65,010 $110 $65,430.01 $67,430 $111 $67,850.01 $69,850 $115 $65,010.01 $67,010 $115 $67,430.01 $69,430 $116 $69,850.01 $71,850 $120 $67,010.01 $69,010 $120 $69,430.01 $71,430 $121 $71,850.01 $73,850 $125 $69,010.01 $71,010 $125 $71,430.01 $73,430 $126 $73,850.01 $75,850 $130 $71,010.01 $73,010 $130 $73,430.01 $75,430 $131 $75,850.01 $77,850 $136 $73,010.01 $75,010 $135 $75,430.01 $77,430 $136 $77,850.01 $79,850 $142 $75,010.01 $77,010 $140 $77,430.01 $79,430 $141 $79,850.01 $81,850 $148 $77,010.01 $79,010 $145 $79,430.01 $81,430 $146 $81,850.01 $83,850 $154 $79,010.01 $81,010 $151 $81,430.01 $83,430 $151 $83,850.01 $85,850 $160 $81,010.01 $83,010 $157 $83,430.01 $85,430 $156 $85,850.01 $87,850 $166 $83,010.01 $85,010 $163 $85,430.01 $87,430 $161 $87,850.01 $89,850 $172 $85,010.01 $91,674 $169 $87,430.01 $89,430 $167 $89,850.01 $91,850 $175 $89,430.01 $91,430 $173 $91,850.01 $93,850 $181 $91,430.01 $93,430 $179 $93,850.01 $95,850 $187 $93,430.01 $95,430 $185 $95,850.01 $97,850 $193 $95,430.01 $97,430 $191 $97,850.01 $99,850 $198 $97,430.01 $102,061 $197 $99,850.01 $101,850 $203 $101,850.01 $103,850 $209 $103,850.01 $105,850 $216 $105,850.01 $112,448 200% FPIG $78,020 200% FPIG $86,860 200% FPIG $95,700
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: $8,660 $5 Less than: $8,660 $5 Less than: $8,660 $10 $8,660.01 $21,650 $10 $8,660.01 $22,510 $10 $8,660.01 $23,380 $25 $21,650.01 $25,980 $26 $22,510.01 $25,090 $27 $23,380.01 $31,170 $30 $25,980.01 $29,380 $29 $25,090.01 $28,540 $36 $31,170.01 $35,460 $34 $29,380.01 $31,580 $33 $28,540.01 $31,120 $41 $35,460.01 $38,860 $37 $31,580.01 $34,990 $36 $31,120.01 $33,710 $45 $38,860.01 $43,110 $41 $34,990.01 $38,270 $39 $33,710.01 $36,340 $50 $43,110.01 $45,110 $45 $38,270.01 $40,270 $43 $36,340.01 $40,690 $53 $45,110.01 $47,110 $49 $40,270.01 $42,270 $49 $40,690.01 $42,690 $57 $47,110.01 $49,110 $53 $42,270.01 $44,270 $52 $42,690.01 $44,690 $61 $49,110.01 $51,110 $57 $44,270.01 $46,270 $55 $44,690.01 $46,690 $65 $51,110.01 $53,110 $61 $46,270.01 $48,270 $59 $46,690.01 $48,690 $69 $53,110.01 $55,110 $66 $48,270.01 $50,270 $63 $48,690.01 $50,690 $73 $55,110.01 $57,110 $71 $50,270.01 $52,270 $67 $50,690.01 $52,690 $78 $57,110.01 $59,110 $75 $52,270.01 $54,270 $72 $52,690.01 $54,690 $83 $59,110.01 $61,110 $78 $54,270.01 $56,270 $77 $54,690.01 $56,690 $88 $61,110.01 $63,110 $82 $56,270.01 $58,270 $82 $56,690.01 $58,690 $92 $63,110.01 $65,110 $86 $58,270.01 $60,270 $86 $58,690.01 $60,690 $96 $65,110.01 $67,110 $90 $60,270.01 $62,270 $90 $60,690.01 $62,690 $100 $67,110.01 $69,110 $94 $62,270.01 $64,270 $94 $62,690.01 $64,690 $104 $69,110.01 $71,110 $98 $64,270.01 $66,270 $98 $64,690.01 $66,690 $108 $71,110.01 $73,110 $102 $66,270.01 $68,270 $102 $66,690.01 $68,690 $112 $73,110.01 $75,110 $106 $68,270.01 $70,270 $106 $68,690.01 $70,690 $116 $75,110.01 $77,110 $111 $70,270.01 $72,270 $110 $70,690.01 $72,690 $120 $77,110.01 $79,110 $116 $72,270.01 $74,270 $114 $72,690.01 $74,690 $124 $79,110.01 $81,110 $121 $74,270.01 $76,270 $119 $74,690.01 $76,690 $128 $81,110.01 $83,110 $126 $76,270.01 $78,270 $124 $76,690.01 $78,690 $133 $83,110.01 $85,110 $131 $78,270.01 $80,270 $129 $78,690.01 $80,690 $138 $85,110.01 $87,110 $136 $80,270.01 $82,270 $134 $80,690.01 $82,690 $143 $87,110.01 $89,110 $141 $82,270.01 $84,270 $139 $82,690.01 $84,690 $148 $89,110.01 $91,110 $146 $84,270.01 $86,270 $144 $84,690.01 $86,690 $153 $91,110.01 $93,110 $151 $86,270.01 $88,270 $149 $86,690.01 $88,690 $158 $93,110.01 $95,110 $156 $88,270.01 $90,270 $154 $88,690.01 $90,690 $163 $95,110.01 $97,110 $161 $90,270.01 $92,270 $159 $90,690.01 $92,690 $168 $97,110.01 $99,110 $166 $92,270.01 $94,270 $164 $92,690.01 $94,690 $173 $99,110.01 $101,110 $171 $94,270.01 $96,270 $169 $94,690.01 $96,690 $178 $101,110.01 $103,110 $177 $96,270.01 $98,270 $174 $96,690.01 $98,690 $183 $103,110.01 $105,110 $183 $98,270.01 $100,270 $179 $98,690.01 $100,690 $188 $105,110.01 $107,110 $189 $100,270.01 $102,270 $184 $100,690.01 $102,690 $193 $107,110.01 $109,110 $195 $102,270.01 $104,270 $189 $102,690.01 $104,690 $198 $109,110.01 $111,110 $201 $104,270.01 $106,270 $195 $104,690.01 $106,690 $203 $111,110.01 $113,110 $207 $106,270.01 $108,270 $201 $106,690.01 $108,690 $209 $113,110.01 $115,110 $213 $108,270.01 $110,270 $207 $108,690.01 $110,690 $215 $115,110.01 $117,110 $219 $110,270.01 $112,270 $213 $110,690.01 $112,690 $221 $117,110.01 $119,110 $225 $112,270.01 $114,270 $219 $112,690.01 $114,690 $227 $119,110.01 $121,110 $232 $114,270.01 $122,835 $225 $114,690.01 $116,690 $233 $121,110.01 $123,110 $231 $116,690.01 $118,690 $239 $123,110.01 $125,110 $237 $118,690.01 $120,690 $245 $125,110.01 $127,110 $243 $120,690.01 $122,690 $251 $127,110.01 $129,110 $249 $122,690.01 $124,690 $257 $129,110.01 $131,110 $255 $124,690.01 $126,690 $263 $131,110.01 $133,110 $261 $126,690.01 $133,222 $269 $133,110.01 $135,110 $275 $135,110.01 $137,110 $280 $137,110.01 $143,609 200% FPIG $104,540 200% FPIG $113,380 200% FPIG $122,220
Weekly Family Size: 13 Weekly Family Size: 14 Weekly Family Size: 15 Co-pay
Annual Income
Co-pay
Annual Income
Co-pay
Annual Income
$5 Less than: $8,660 $5 Less than: $8,660 $5 Less than: $8,660 $10 $8,660.01 $25,110 $10 $8,660.01 $25,110 $10 $8,660.01 $29,440 $29 $25,110.01 $31,170 $29 $25,110.01 $31,170 $34 $29,440.01 $37,230 $36 $31,170.01 $35,480 $36 $31,170.01 $37,230 $43 $37,230.01 $39,820 $41 $35,480.01 $38,070 $43 $37,230.01 $39,800 $46 $39,820.01 $42,390 $44 $38,070.01 $40,660 $46 $39,800.01 $41,400 $49 $42,390.01 $44,620 $47 $40,660.01 $43,780 $49 $41,400.01 $44,760 $52 $44,620.01 $48,040 $51 $43,780.01 $47,530 $53 $44,760.01 $48,130 $56 $48,040.01 $52,370 $56 $47,530.01 $49,530 $57 $48,130.01 $51,950 $62 $52,370.01 $54,370 $59 $49,530.01 $51,530 $62 $51,950.01 $53,950 $65 $54,370.01 $56,370 $63 $51,530.01 $53,530 $65 $53,950.01 $55,950 $68 $56,370.01 $58,370 $67 $53,530.01 $55,530 $69 $55,950.01 $57,950 $72 $58,370.01 $60,370 $71 $55,530.01 $57,530 $73 $57,950.01 $59,950 $76 $60,370.01 $62,370 $75 $57,530.01 $59,530 $77 $59,950.01 $61,950 $80 $62,370.01 $64,370 $79 $59,530.01 $61,530 $81 $61,950.01 $63,950 $84 $64,370.01 $66,370 $84 $61,530.01 $63,530 $85 $63,950.01 $65,950 $88 $66,370.01 $68,370 $89 $63,530.01 $65,530 $90 $65,950.01 $67,950 $92 $68,370.01 $70,370 $94 $65,530.01 $67,530 $95 $67,950.01 $69,950 $97 $70,370.01 $72,370 $98 $67,530.01 $69,530 $100 $69,950.01 $71,950 $102 $72,370.01 $74,370 $102 $69,530.01 $71,530 $104 $71,950.01 $73,950 $107 $74,370.01 $76,370 $106 $71,530.01 $73,530 $108 $73,950.01 $75,950 $110 $76,370.01 $78,370 $110 $73,530.01 $75,530 $112 $75,950.01 $77,950 $114 $78,370.01 $80,370 $114 $75,530.01 $77,530 $116 $77,950.01 $79,950 $118 $80,370.01 $82,370 $118 $77,530.01 $79,530 $120 $79,950.01 $81,950 $122 $82,370.01 $84,370 $122 $79,530.01 $81,530 $124 $81,950.01 $83,950 $126 $84,370.01 $86,370 $126 $81,530.01 $83,530 $128 $83,950.01 $85,950 $130 $86,370.01 $88,370 $130 $83,530.01 $85,530 $132 $85,950.01 $87,950 $134 $88,370.01 $90,370 $134 $85,530.01 $87,530 $136 $87,950.01 $89,950 $138 $90,370.01 $92,370 $138 $87,530.01 $89,530 $140 $89,950.01 $91,950 $142 $92,370.01 $94,370 $143 $89,530.01 $91,530 $144 $91,950.01 $93,950 $146 $94,370.01 $96,370 $148 $91,530.01 $93,530 $149 $93,950.01 $95,950 $150 $96,370.01 $98,370 $153 $93,530.01 $95,530 $154 $95,950.01 $97,950 $154 $98,370.01 $100,370 $158 $95,530.01 $97,530 $159 $97,950.01 $99,950 $159 $100,370.01 $102,370 $163 $97,530.01 $99,530 $164 $99,950.01 $101,950 $164 $102,370.01 $104,370 $168 $99,530.01 $101,530 $169 $101,950.01 $103,950 $169 $104,370.01 $106,370 $173 $101,530.01 $103,530 $174 $103,950.01 $105,950 $174 $106,370.01 $108,370 $178 $103,530.01 $105,530 $179 $105,950.01 $107,950 $179 $108,370.01 $110,370 $183 $105,530.01 $107,530 $184 $107,950.01 $109,950 $184 $110,370.01 $112,370 $188 $107,530.01 $109,530 $189 $109,950.01 $111,950 $189 $112,370.01 $114,370 $193 $109,530.01 $111,530 $194 $111,950.01 $113,950 $194 $114,370.01 $116,370 $198 $111,530.01 $113,530 $199 $113,950.01 $115,950 $199 $116,370.01 $118,370 $203 $113,530.01 $115,530 $204 $115,950.01 $117,950 $204 $118,370.01 $120,370 $208 $115,530.01 $117,530 $209 $117,950.01 $119,950 $209 $120,370.01 $122,370 $213 $117,530.01 $119,530 $214 $119,950.01 $121,950 $214 $122,370.01 $124,370 $218 $119,530.01 $121,530 $219 $121,950.01 $123,950 $219 $124,370.01 $126,370 $224 $121,530.01 $123,530 $224 $123,950.01 $125,950 $224 $126,370.01 $128,370 $230 $123,530.01 $125,530 $229 $125,950.01 $127,950 $229 $128,370.01 $130,370 $236 $125,530.01 $127,530 $235 $127,950.01 $129,950 $234 $130,370.01 $132,370 $242 $127,530.01 $129,530 $241 $129,950.01 $131,950 $239 $132,370.01 $134,370 $248 $129,530.01 $131,530 $247 $131,950.01 $133,950 $244 $134,370.01 $136,370 $254 $131,530.01 $133,530 $253 $133,950.01 $135,950 $250 $136,370.01 $138,370 $260 $133,530.01 $135,530 $259 $135,950.01 $137,950 $256 $138,370.01 $140,370 $266 $135,530.01 $137,530 $265 $137,950.01 $139,950 $262 $140,370.01 $142,370 $272 $137,530.01 $139,530 $271 $139,950.01 $141,950 $268 $142,370.01 $144,370 $278 $139,530.01 $141,530 $277 $141,950.01 $143,950 $274 $144,370.01 $146,370 $284 $141,530.01 $143,530 $283 $143,950.01 $145,950 $280 $146,370.01 $148,370 $290 $143,530.01 $145,530 $289 $145,950.01 $147,950 $286 $148,370.01 $150,370 $297 $145,530.01 $153,996 $295 $147,950.01 $149,950 $292 $150,370.01 $152,370 $301 $149,950.01 $151,950 $298 $152,370.01 $154,370 $307 $151,950.01 $153,950 $304 $154,370.01 $156,370 $314 $153,950.01 $164,383 $310 $156,370.01 $158,370 $316 $158,370.01 $160,370 $322 $160,370.01 $162,370 $328 $162,370.01 $164,370 $334 $164,370.01 $166,370 $339 $166,370.01 $174,770 200% FPIG $131,060 200% FPIG $139,900 200% FPIG $148,740
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: $8,660 $5 Less than: $8,660 $5 Less than: $8,660 $10 $8,660.01 $29,430 $10 $8,660.01 $29,430 $10 $8,660.01 $30,310 $34 $29,430.01 $38,080 $34 $29,430.01 $37,220 $35 $30,310.01 $38,960 $44 $38,080.01 $43,270 $43 $37,220.01 $39,780 $45 $38,960.01 $48,120 $50 $43,270.01 $45,860 $46 $39,780.01 $47,560 $56 $48,120.01 $50,120 $53 $45,860.01 $48,860 $55 $47,560.01 $49,860 $59 $50,120.01 $52,660 $57 $48,860.01 $52,280 $58 $49,860.01 $52,410 $62 $52,660.01 $55,980 $61 $52,280.01 $56,790 $61 $52,410.01 $57,210 $66 $55,980.01 $58,650 $67 $56,790.01 $58,790 $67 $57,210.01 $59,210 $70 $58,650.01 $63,630 $70 $58,790.01 $60,790 $70 $59,210.01 $61,210 $76 $63,630.01 $65,630 $73 $60,790.01 $62,790 $73 $61,210.01 $63,210 $79 $65,630.01 $67,630 $77 $62,790.01 $64,790 $77 $63,210.01 $65,210 $82 $67,630.01 $69,630 $81 $64,790.01 $66,790 $81 $65,210.01 $67,210 $86 $69,630.01 $71,630 $85 $66,790.01 $68,790 $85 $67,210.01 $69,210 $90 $71,630.01 $73,630 $89 $68,790.01 $70,790 $89 $69,210.01 $71,210 $94 $73,630.01 $75,630 $93 $70,790.01 $72,790 $93 $71,210.01 $73,210 $98 $75,630.01 $77,630 $98 $72,790.01 $74,790 $97 $73,210.01 $75,210 $102 $77,630.01 $79,630 $103 $74,790.01 $76,790 $101 $75,210.01 $77,210 $106 $79,630.01 $81,630 $108 $76,790.01 $78,790 $106 $77,210.01 $79,210 $111 $81,630.01 $83,630 $113 $78,790.01 $80,790 $111 $79,210.01 $81,210 $116 $83,630.01 $85,630 $117 $80,790.01 $82,790 $116 $81,210.01 $83,210 $121 $85,630.01 $87,630 $120 $82,790.01 $84,790 $120 $83,210.01 $85,210 $126 $87,630.01 $89,630 $124 $84,790.01 $86,790 $124 $85,210.01 $87,210 $128 $89,630.01 $91,630 $128 $86,790.01 $88,790 $128 $87,210.01 $89,210 $132 $91,630.01 $93,630 $132 $88,790.01 $90,790 $132 $89,210.01 $91,210 $136 $93,630.01 $95,630 $136 $90,790.01 $92,790 $136 $91,210.01 $93,210 $140 $95,630.01 $97,630 $140 $92,790.01 $94,790 $140 $93,210.01 $95,210 $144 $97,630.01 $99,630 $144 $94,790.01 $96,790 $144 $95,210.01 $97,210 $148 $99,630.01 $101,630 $148 $96,790.01 $98,790 $148 $97,210.01 $99,210 $152 $101,630.01 $103,630 $152 $98,790.01 $100,790 $152 $99,210.01 $101,210 $156 $103,630.01 $105,630 $156 $100,790.01 $102,790 $156 $101,210.01 $103,210 $160 $105,630.01 $107,630 $160 $102,790.01 $104,790 $160 $103,210.01 $105,210 $164 $107,630.01 $109,630 $164 $104,790.01 $106,790 $164 $105,210.01 $107,210 $168 $109,630.01 $111,630 $169 $106,790.01 $108,790 $168 $107,210.01 $109,210 $172 $111,630.01 $113,630 $174 $108,790.01 $110,790 $173 $109,210.01 $111,210 $176 $113,630.01 $115,630 $179 $110,790.01 $112,790 $178 $111,210.01 $113,210 $180 $115,630.01 $117,630 $184 $112,790.01 $114,790 $183 $113,210.01 $115,210 $185 $117,630.01 $119,630 $189 $114,790.01 $116,790 $188 $115,210.01 $117,210 $190 $119,630.01 $121,630 $194 $116,790.01 $118,790 $193 $117,210.01 $119,210 $195 $121,630.01 $123,630 $199 $118,790.01 $120,790 $198 $119,210.01 $121,210 $200 $123,630.01 $125,630 $204 $120,790.01 $122,790 $203 $121,210.01 $123,210 $205 $125,630.01 $127,630 $209 $122,790.01 $124,790 $208 $123,210.01 $125,210 $210 $127,630.01 $129,630 $214 $124,790.01 $126,790 $213 $125,210.01 $127,210 $215 $129,630.01 $131,630 $219 $126,790.01 $128,790 $218 $127,210.01 $129,210 $220 $131,630.01 $133,630 $224 $128,790.01 $130,790 $223 $129,210.01 $131,210 $225 $133,630.01 $135,630 $229 $130,790.01 $132,790 $228 $131,210.01 $133,210 $230 $135,630.01 $137,630 $234 $132,790.01 $134,790 $233 $133,210.01 $135,210 $235 $137,630.01 $139,630 $239 $134,790.01 $136,790 $238 $135,210.01 $137,210 $240 $139,630.01 $141,630 $244 $136,790.01 $138,790 $243 $137,210.01 $139,210 $245 $141,630.01 $143,630 $249 $138,790.01 $140,790 $248 $139,210.01 $141,210 $250 $143,630.01 $145,630 $254 $140,790.01 $142,790 $253 $141,210.01 $143,210 $255 $145,630.01 $147,630 $259 $142,790.01 $144,790 $258 $143,210.01 $145,210 $260 $147,630.01 $149,630 $264 $144,790.01 $146,790 $263 $145,210.01 $147,210 $265 $149,630.01 $151,630 $270 $146,790.01 $148,790 $268 $147,210.01 $149,210 $270 $151,630.01 $153,630 $276 $148,790.01 $150,790 $273 $149,210.01 $151,210 $275 $153,630.01 $155,630 $282 $150,790.01 $152,790 $278 $151,210.01 $153,210 $280 $155,630.01 $157,630 $288 $152,790.01 $154,790 $284 $153,210.01 $155,210 $285 $157,630.01 $159,630 $294 $154,790.01 $156,790 $290 $155,210.01 $157,210 $290 $159,630.01 $161,630 $300 $156,790.01 $158,790 $296 $157,210.01 $159,210 $296 $161,630.01 $163,630 $306 $158,790.01 $160,790 $302 $159,210.01 $161,210 $302 $163,630.01 $165,630 $312 $160,790.01 $162,790 $308 $161,210.01 $163,210 $308 $165,630.01 $167,630 $318 $162,790.01 $164,790 $314 $163,210.01 $165,210 $314 $167,630.01 $169,630 $324 $164,790.01 $166,790 $320 $165,210.01 $167,210 $320 $169,630.01 $171,630 $330 $166,790.01 $168,790 $326 $167,210.01 $169,210 $326 $171,630.01 $173,630 $336 $168,790.01 $170,790 $332 $169,210.01 $171,210 $332 $173,630.01 $175,630 $342 $170,790.01 $172,790 $338 $171,210.01 $173,210 $338 $175,630.01 $177,630 $348 $172,790.01 $174,790 $344 $173,210.01 $175,210 $344 $177,630.01 $179,630 $355 $174,790.01 $185,157 $350 $175,210.01 $177,210 $350 $179,630.01 $181,630 $356 $177,210.01 $179,210 $356 $181,630.01 $183,630 $362 $179,210.01 $181,210 $362 $183,630.01 $185,630 $368 $181,210.01 $183,210 $368 $185,630.01 $187,630 $374 $183,210.01 $195,544 $374 $187,630.01 $189,630 $380 $189,630.01 $191,630 $386 $191,630.01 $193,630 $392 $193,630.01 $195,630 $397 $195,630.01 $205,931 200% FPIG $157,580 200% FPIG $166,420 200% FPIG $175,260
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: $8,660 $5 Less than: $8,660 $5 Less than: $8,660 $10 $8,660.01 $31,170 $10 $8,660.01 $32,900 $10 $8,660.01 $45,890 $36 $31,170.01 $43,210 $38 $32,900.01 $45,000 $53 $45,890.01 $53,660 $50 $43,210.01 $49,200 $52 $45,000.01 $48,000 $62 $53,660.01 $55,390 $57 $49,200.01 $54,050 $56 $48,000.01 $54,220 $64 $55,390.01 $57,900 $63 $54,050.01 $56,050 $64 $54,220.01 $58,470 $67 $57,900.01 $59,940 $66 $56,050.01 $58,050 $70 $58,470.01 $60,470 $70 $59,940.01 $63,350 $69 $58,050.01 $60,050 $73 $60,470.01 $62,470 $74 $63,350.01 $68,890 $72 $60,050.01 $62,050 $76 $62,470.01 $64,470 $81 $68,890.01 $70,890 $77 $62,050.01 $64,050 $80 $64,470.01 $66,470 $84 $70,890.01 $72,890 $80 $64,050.01 $66,050 $85 $66,470.01 $68,470 $87 $72,890.01 $74,890 $84 $66,050.01 $68,050 $89 $68,470.01 $70,470 $90 $74,890.01 $76,890 $87 $68,050.01 $70,050 $92 $70,470.01 $72,470 $94 $76,890.01 $78,890 $91 $70,050.01 $72,050 $96 $72,470.01 $74,470 $98 $78,890.01 $80,890 $94 $72,050.01 $74,050 $99 $74,470.01 $76,470 $102 $80,890.01 $82,890 $100 $74,050.01 $76,050 $103 $76,470.01 $78,470 $106 $82,890.01 $84,890 $103 $76,050.01 $78,050 $106 $78,470.01 $80,470 $110 $84,890.01 $86,890 $107 $78,050.01 $80,050 $110 $80,470.01 $82,470 $114 $86,890.01 $88,890 $110 $80,050.01 $82,050 $113 $82,470.01 $84,470 $118 $88,890.01 $90,890 $114 $82,050.01 $84,050 $117 $84,470.01 $86,470 $122 $90,890.01 $92,890 $117 $84,050.01 $86,050 $120 $86,470.01 $88,470 $126 $92,890.01 $94,890 $121 $86,050.01 $88,050 $124 $88,470.01 $90,470 $131 $94,890.01 $96,890 $125 $88,050.01 $90,050 $127 $90,470.01 $92,470 $136 $96,890.01 $98,890 $129 $90,050.01 $92,050 $131 $92,470.01 $94,470 $141 $98,890.01 $100,890 $133 $92,050.01 $94,050 $135 $94,470.01 $96,470 $145 $100,890.01 $102,890 $137 $94,050.01 $96,050 $139 $96,470.01 $98,470 $149 $102,890.01 $104,890 $141 $96,050.01 $98,050 $143 $98,470.01 $100,470 $153 $104,890.01 $106,890 $145 $98,050.01 $100,050 $147 $100,470.01 $102,470 $157 $106,890.01 $108,890 $149 $100,050.01 $102,050 $151 $102,470.01 $104,470 $161 $108,890.01 $110,890 $153 $102,050.01 $104,050 $155 $104,470.01 $106,470 $165 $110,890.01 $112,890 $157 $104,050.01 $106,050 $159 $106,470.01 $108,470 $169 $112,890.01 $114,890 $161 $106,050.01 $108,050 $163 $108,470.01 $110,470 $173 $114,890.01 $116,890 $165 $108,050.01 $110,050 $167 $110,470.01 $112,470 $177 $116,890.01 $118,890 $169 $110,050.01 $112,050 $171 $112,470.01 $114,470 $181 $118,890.01 $120,890 $173 $112,050.01 $114,050 $175 $114,470.01 $116,470 $185 $120,890.01 $122,890 $177 $114,050.01 $116,050 $179 $116,470.01 $118,470 $189 $122,890.01 $124,890 $181 $116,050.01 $118,050 $183 $118,470.01 $120,470 $193 $124,890.01 $126,890 $185 $118,050.01 $120,050 $187 $120,470.01 $122,470 $197 $126,890.01 $128,890 $189 $120,050.01 $122,050 $191 $122,470.01 $124,470 $201 $128,890.01 $130,890 $194 $122,050.01 $124,050 $195 $124,470.01 $126,470 $205 $130,890.01 $132,890 $199 $124,050.01 $126,050 $199 $126,470.01 $128,470 $210 $132,890.01 $134,890 $204 $126,050.01 $128,050 $204 $128,470.01 $130,470 $215 $134,890.01 $136,890 $209 $128,050.01 $130,050 $209 $130,470.01 $132,470 $220 $136,890.01 $138,890 $214 $130,050.01 $132,050 $214 $132,470.01 $134,470 $225 $138,890.01 $140,890 $219 $132,050.01 $134,050 $219 $134,470.01 $136,470 $230 $140,890.01 $142,890 $224 $134,050.01 $136,050 $224 $136,470.01 $138,470 $235 $142,890.01 $144,890 $229 $136,050.01 $138,050 $229 $138,470.01 $140,470 $240 $144,890.01 $146,890 $234 $138,050.01 $140,050 $234 $140,470.01 $142,470 $245 $146,890.01 $148,890 $239 $140,050.01 $142,050 $239 $142,470.01 $144,470 $250 $148,890.01 $150,890 $244 $142,050.01 $144,050 $244 $144,470.01 $146,470 $255 $150,890.01 $152,890 $249 $144,050.01 $146,050 $249 $146,470.01 $148,470 $260 $152,890.01 $154,890 $254 $146,050.01 $148,050 $254 $148,470.01 $150,470 $265 $154,890.01 $156,890 $259 $148,050.01 $150,050 $259 $150,470.01 $152,470 $270 $156,890.01 $158,890 $264 $150,050.01 $152,050 $264 $152,470.01 $154,470 $275 $158,890.01 $160,890 $269 $152,050.01 $154,050 $269 $154,470.01 $156,470 $280 $160,890.01 $162,890 $274 $154,050.01 $156,050 $274 $156,470.01 $158,470 $285 $162,890.01 $164,890 $279 $156,050.01 $158,050 $279 $158,470.01 $160,470 $290 $164,890.01 $166,890 $284 $158,050.01 $160,050 $284 $160,470.01 $162,470 $295 $166,890.01 $168,890 $289 $160,050.01 $162,050 $289 $162,470.01 $164,470 $300 $168,890.01 $170,890 $294 $162,050.01 $164,050 $294 $164,470.01 $166,470 $305 $170,890.01 $172,890 $299 $164,050.01 $166,050 $299 $166,470.01 $168,470 $310 $172,890.01 $174,890 $304 $166,050.01 $168,050 $304 $168,470.01 $170,470 $315 $174,890.01 $176,890 $309 $168,050.01 $170,050 $309 $170,470.01 $172,470 $320 $176,890.01 $178,890 $315 $170,050.01 $172,050 $314 $172,470.01 $174,470 $325 $178,890.01 $180,890 $321 $172,050.01 $174,050 $319 $174,470.01 $176,470 $330 $180,890.01 $182,890 $327 $174,050.01 $176,050 $324 $176,470.01 $178,470 $335 $182,890.01 $184,890 $333 $176,050.01 $178,050 $330 $178,470.01 $180,470 $341 $184,890.01 $186,890 $339 $178,050.01 $180,050 $336 $180,470.01 $182,470 $347 $186,890.01 $188,890 $345 $180,050.01 $182,050 $342 $182,470.01 $184,470 $353 $188,890.01 $190,890 $351 $182,050.01 $184,050 $348 $184,470.01 $186,470 $359 $190,890.01 $192,890 $357 $184,050.01 $186,050 $354 $186,470.01 $188,470 $365 $192,890.01 $194,890 $363 $186,050.01 $188,050 $360 $188,470.01 $190,470 $371 $194,890.01 $196,890 $369 $188,050.01 $190,050 $366 $190,470.01 $192,470 $377 $196,890.01 $198,890 $375 $190,050.01 $192,050 $372 $192,470.01 $194,470 $383 $198,890.01 $200,890 $381 $192,050.01 $194,050 $378 $194,470.01 $196,470 $389 $200,890.01 $202,890 $387 $194,050.01 $196,050 $384 $196,470.01 $198,470 $395 $202,890.01 $204,890 $393 $196,050.01 $198,050 $390 $198,470.01 $200,470 $401 $204,890.01 $206,890 $399 $198,050.01 $200,050 $396 $200,470.01 $202,470 $407 $206,890.01 $208,890 $405 $200,050.01 $202,050 $402 $202,470.01 $204,470 $413 $208,890.01 $210,890 $411 $202,050.01 $204,050 $408 $204,470.01 $206,470 $419 $210,890.01 $212,890 $419 $204,050.01 $206,050 $414 $206,470.01 $208,470 $425 $212,890.01 $214,890 $424 $206,050.01 $216,318 $420 $208,470.01 $210,470 $431 $214,890.01 $216,890 $426 $210,470.01 $212,470 $437 $216,890.01 $218,890 $432 $212,470.01 $214,470 $443 $218,890.01 $220,890 $438 $214,470.01 $226,705 $449 $220,890.01 $222,890 $455 $222,890.01 $237,092 200% FPIG $184,100 200% FPIG $192,940 200% FPIG $201,780
[Pa.B. Doc. No. 19-908. Filed for public inspection June 14, 2019, 9:00 a.m.]
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