NOTICES

DEPARTMENT OF HUMAN SERVICES

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

[52 Pa.B. 2434]
[Saturday, April 23, 2022]

 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 2022 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 2, 2022.

 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 2, 2022, 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.

MEG SNEAD, 
Acting Secretary

 Fiscal Note: 14-NOT-1505. No fiscal impact; (8) recommends adoption.

CO-PAYMENT CHART

FAMILY CO-PAYMENT SCALE EFFECTIVE MAY 2, 2022

(BASED ON THE 2022 FEDERAL POVERTY INCOME GUIDELINES)

Weekly	Family Size:	1	Weekly	Family Size:	2	Weekly	Family Size:	3
Co-pay	Annual Income		Co-pay	Annual Income		Co-pay	Annual Income
$5	Less than:	$7,186	$5	Less than:	$7,530	$5	Less than:	$8,118
$6	$7,186.01	$8,783	$6	$7,530.01	$8,606	$6	$8,118.01	$9,471
$7	$8,783.01	$9,581	$7	$8,606.01	$9,681	$7	$9,471.01	$10,824
$8	$9,581.01	$10,379	$8	$9,681.01	$10,757	$8	$10,824.01	$12,177
$9	$10,379.01	$11,178	$9	$10,757.01	$11,833	$10	$12,177.01	$13,530
$10	$11,178.01	$11,976	$10	$11,833.01	$12,909	$11	$13,530.01	$14,883
$11	$11,976.01	$12,775	$11	$12,909.01	$13,984	$12	$14,883.01	$16,236
$12	$12,775.01	$13,573	$12	$13,984.01	$15,060	$14	$16,236.01	$17,589
$13	$13,573.01	$14,371	$13	$15,060.01	$16,136	$15	$17,589.01	$18,942
$14	$14,371.01	$15,170	$15	$16,136.01	$17,211	$17	$18,942.01	$20,295
$15	$15,170.01	$15,968	$16	$17,211.01	$18,287	$19	$20,295.01	$21,648
$16	$15,968.01	$16,767	$18	$18,287.01	$19,363	$20	$21,648.01	$23,001
$17	$16,767.01	$17,565	$19	$19,363.01	$20,439	$22	$23,001.01	$24,354
$18	$17,565.01	$18,363	$20	$20,439.01	$21,514	$24	$24,354.01	$25,707
$20	$18,363.01	$19,162	$22	$21,514.01	$22,590	$26	$25,707.01	$27,060
$21	$19,162.01	$19,960	$23	$22,590.01	$23,666	$27	$27,060.01	$28,413
$22	$19,960.01	$20,759	$25	$23,666.01	$24,741	$29	$28,413.01	$29,766
$23	$20,759.01	$21,557	$26	$24,741.01	$25,817	$31	$29,766.01	$31,119
$24	$21,557.01	$22,356	$28	$25,817.01	$26,893	$33	$31,119.01	$32,472
$26	$22,356.01	$23,154	$30	$26,893.01	$27,969	$35	$32,472.01	$33,825
$27	$23,154.01	$23,952	$31	$27,969.01	$29,044	$37	$33,825.01	$35,178
$28	$23,952.01	$24,751	$33	$29,044.01	$30,120	$39	$35,178.01	$36,531
$30	$24,751.01	$25,549	$35	$30,120.01	$31,196	$42	$36,531.01	$37,884
$31	$25,549.01	$26,348	$37	$31,196.01	$32,271	$44	$37,884.01	$39,237
$33	$26,348.01	$27,146	$38	$32,271.01	$33,347	$46	$39,237.01	$40,590
$34	$27,146.01	$27,944	$40	$33,347.01	$34,423	$48	$40,590.01	$41,943
$36	$27,944.01	$28,743	$42	$34,423.01	$35,499	$51	$41,943.01	$43,296
$37	$28,743.01	$29,541	$44	$35,499.01	$36,574	$53	$43,296.01	$44,649
$39	$29,541.01	$30,340	$46	$36,574.01	$37,650	$55	$44,649.01	$46,002
$40	$30,340.01	$31,138	$48	$37,650.01	$38,726	$58	$46,002.01	$47,355
$42	$31,138.01	$31,937	$50	$38,726.01	$39,801	$60	$47,355.01	$48,708
	200% FPIG	$27,180	$52	$39,801.01	$40,877	$63	$48,708.01	$50,061
			$54	$40,877.01	$41,953	$66	$50,061.01	$51,414
			$56	$41,953.01	$43,029	$68	$51,414.01	$52,767
				200% FPIG	$36,620	$71	$52,767.01	$54,121
							200% FPIG	$46,060

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:	$8,152	$5	Less than:	$9,538	$5	Less than:	$8,740
$6	$8,152.01	$9,782	$7	$9,538.01	$11,446	$6	$8,740.01	$10,925
$7	$9,782.01	$11,412	$8	$11,446.01	$13,353	$8	$10,925.01	$13,109
$8	$11,412.01	$13,043	$10	$13,353.01	$15,261	$9	$13,109.01	$15,294
$10	$13,043.01	$14,673	$12	$15,261.01	$17,169	$11	$15,294.01	$17,479
$11	$14,673.01	$16,303	$13	$17,169.01	$19,076	$13	$17,479.01	$19,664
$13	$16,303.01	$17,933	$15	$19,076.01	$20,984	$15	$19,664.01	$21,849
$15	$17,933.01	$19,564	$17	$20,984.01	$22,891	$18	$21,849.01	$24,034
$17	$19,564.01	$21,194	$19	$22,891.01	$24,799	$20	$24,034.01	$26,219
$18	$21,194.01	$22,824	$22	$24,799.01	$26,707	$22	$26,219.01	$28,404
$20	$22,824.01	$24,455	$24	$26,707.01	$28,614	$25	$28,404.01	$30,589
$22	$24,455.01	$26,085	$26	$28,614.01	$30,522	$27	$30,589.01	$32,774
$24	$26,085.01	$27,715	$29	$30,522.01	$32,429	$30	$32,774.01	$34,959
$27	$27,715.01	$29,346	$31	$32,429.01	$34,337	$33	$34,959.01	$37,144
$29	$29,346.01	$30,976	$34	$34,337.01	$36,245	$36	$37,144.01	$39,328
$31	$30,976.01	$32,606	$36	$36,245.01	$38,152	$39	$39,328.01	$41,513
$33	$32,606.01	$34,237	$39	$38,152.01	$40,060	$41	$41,513.01	$43,698
$35	$34,237.01	$35,867	$41	$40,060.01	$41,967	$44	$43,698.01	$45,883
$38	$35,867.01	$37,497	$44	$41,967.01	$43,875	$47	$45,883.01	$48,068
$40	$37,497.01	$39,128	$47	$43,875.01	$45,783	$50	$48,068.01	$50,253
$42	$39,128.01	$40,758	$50	$45,783.01	$47,690	$54	$50,253.01	$52,438
$45	$40,758.01	$42,388	$53	$47,690.01	$49,598	$57	$52,438.01	$54,623
$47	$42,388.01	$44,018	$55	$49,598.01	$51,506	$60	$54,623.01	$56,808
$50	$44,018.01	$45,649	$59	$51,506.01	$53,413	$64	$56,808.01	$58,993
$53	$45,649.01	$47,279	$62	$53,413.01	$55,321	$67	$58,993.01	$61,178
$55	$47,279.01	$48,909	$65	$55,321.01	$57,228	$71	$61,178.01	$63,362
$58	$48,909.01	$50,540	$68	$57,228.01	$59,136	$74	$63,362.01	$65,547
$61	$50,540.01	$52,170	$71	$59,136.01	$61,044	$78	$65,547.01	$67,732
$64	$52,170.01	$53,800	$75	$61,044.01	$62,951	$82	$67,732.01	$69,917
$67	$53,800.01	$55,431	$78	$62,951.01	$64,859	$86	$69,917.01	$72,102
$70	$55,431.01	$57,061	$82	$64,859.01	$66,766	$89	$72,102.01	$74,287
$73	$57,061.01	$58,691	$85	$66,766.01	$68,674	$94	$74,287.01	$76,472
$76	$58,691.01	$60,322	$89	$68,674.01	$70,582	$98	$76,472.01	$78,657
$79	$60,322.01	$61,952	$93	$70,582.01	$72,489	$102	$78,657.01	$80,842
$82	$61,952.01	$63,582	$96	$72,489.01	$74,397	$106	$80,842.01	$83,027
$86	$63,582.01	$65,213	$100	$74,397.01	$76,305	$110	$83,027.01	$85,212
	200% FPIG	$55,500		200% FPIG	$64,940	$115	$85,212.01	$87,397
							200% FPIG	$74,380

Weekly	Family Size:	7	Weekly	Family Size:	8	Weekly	Family Size:	9
Co-pay	Annual Income		Co-pay	Annual Income		Co-pay	Annual Income
$5	Less than:	$9,849	$5	Less than:	$10,958	$5	Less than:	$9,050
$7	$9,849.01	$12,311	$7	$10,958.01	$13,698	$6	$9,050.01	$12,067
$8	$12,311.01	$14,773	$9	$13,698.01	$16,437	$8	$12,067.01	$15,084
$11	$14,773.01	$17,235	$12	$16,437.01	$19,177	$10	$15,084.01	$18,101
$13	$17,235.01	$19,698	$14	$19,177.01	$21,916	$13	$18,101.01	$21,118
$15	$19,698.01	$22,160	$17	$21,916.01	$24,656	$16	$21,118.01	$24,135
$17	$22,160.01	$24,622	$19	$24,656.01	$27,395	$18	$24,135.01	$27,151
$20	$24,622.01	$27,084	$22	$27,395.01	$30,135	$21	$27,151.01	$30,168
$22	$27,084.01	$29,547	$25	$30,135.01	$32,874	$24	$30,168.01	$33,185
$25	$29,547.01	$32,009	$28	$32,874.01	$35,614	$27	$33,185.01	$36,202
$28	$32,009.01	$34,471	$31	$35,614.01	$38,353	$31	$36,202.01	$39,219
$31	$34,471.01	$36,933	$34	$38,353.01	$41,093	$34	$39,219.01	$42,235
$34	$36,933.01	$39,395	$38	$41,093.01	$43,832	$38	$42,235.01	$45,252
$37	$39,395.01	$41,858	$41	$43,832.01	$46,572	$41	$45,252.01	$48,269
$40	$41,858.01	$44,320	$45	$46,572.01	$49,311	$45	$48,269.01	$51,286
$43	$44,320.01	$46,782	$48	$49,311.01	$52,051	$49	$51,286.01	$54,303
$47	$46,782.01	$49,244	$52	$52,051.01	$54,790	$53	$54,303.01	$57,319
$50	$49,244.01	$51,706	$56	$54,790.01	$57,530	$57	$57,319.01	$60,336
$53	$51,706.01	$54,169	$59	$57,530.01	$60,269	$61	$60,336.01	$63,353
$57	$54,169.01	$56,631	$63	$60,269.01	$63,009	$65	$63,353.01	$66,370
$60	$56,631.01	$59,093	$67	$63,009.01	$65,748	$70	$66,370.01	$69,387
$64	$59,093.01	$61,555	$71	$65,748.01	$68,488	$74	$69,387.01	$72,404
$68	$61,555.01	$64,018	$75	$68,488.01	$71,227	$78	$72,404.01	$75,420
$72	$64,018.01	$66,480	$80	$71,227.01	$73,967	$83	$75,420.01	$78,437
$76	$66,480.01	$68,942	$84	$73,967.01	$76,706	$88	$78,437.01	$81,454
$80	$68,942.01	$71,404	$89	$76,706.01	$79,446	$93	$81,454.01	$84,471
$84	$71,404.01	$73,866	$93	$79,446.01	$82,185	$97	$84,471.01	$87,488
$88	$73,866.01	$76,329	$98	$82,185.01	$84,925	$102	$87,488.01	$90,504
$92	$76,329.01	$78,791	$102	$84,925.01	$87,664	$108	$90,504.01	$93,521
$96	$78,791.01	$81,253	$107	$87,664.01	$90,404	$113	$93,521.01	$96,538
$101	$81,253.01	$83,715	$112	$90,404.01	$93,143	$118	$96,538.01	$99,555
$105	$83,715.01	$86,177	$117	$93,143.01	$95,883	$124	$99,555.01	$102,572
$110	$86,177.01	$88,640	$122	$95,883.01	$98,622	$129	$102,572.01	$105,588
$115	$88,640.01	$91,102	$128	$98,622.01	$101,362	$135	$105,588.01	$108,605
$119	$91,102.01	$93,564	$133	$101,362.01	$104,101	$141	$108,605.01	$111,622
$124	$93,564.01	$96,026	$138	$104,101.01	$106,841	$146	$111,622.01	$114,639
$129	$96,026.01	$98,488	$144	$106,841.01	$109,581	$152	$114,639.01	$117,656
	200% FPIG	$83,820		200% FPIG	$93,260	$158	$117,656.01	$120,673
							200% FPIG	$102,700

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:	$9,882	$5	Less than:	$10,714	$5	Less than:	$11,546
$6	$9,882.01	$13,176	$7	$10,714.01	$14,286	$7	$11,546.01	$15,395
$9	$13,176.01	$16,471	$10	$14,286.01	$17,857	$10	$15,395.01	$19,244
$11	$16,471.01	$19,765	$12	$17,857.01	$21,428	$13	$19,244.01	$23,092
$14	$19,765.01	$23,059	$15	$21,428.01	$25,000	$16	$23,092.01	$26,941
$17	$23,059.01	$26,353	$18	$25,000.01	$28,571	$20	$26,941.01	$30,790
$20	$26,353.01	$29,647	$22	$28,571.01	$32,143	$23	$30,790.01	$34,638
$23	$29,647.01	$32,941	$25	$32,143.01	$35,714	$27	$34,638.01	$38,487
$26	$32,941.01	$36,235	$29	$35,714.01	$39,286	$31	$38,487.01	$42,336
$30	$36,235.01	$39,529	$32	$39,286.01	$42,857	$35	$42,336.01	$46,185
$34	$39,529.01	$42,823	$36	$42,857.01	$46,428	$39	$46,185.01	$50,033
$37	$42,823.01	$46,118	$40	$46,428.01	$50,000	$44	$50,033.01	$53,882
$41	$46,118.01	$49,412	$45	$50,000.01	$53,571	$48	$53,882.01	$57,731
$45	$49,412.01	$52,706	$49	$53,571.01	$57,143	$53	$57,731.01	$61,579
$49	$52,706.01	$56,000	$54	$57,143.01	$60,714	$58	$61,579.01	$65,428
$54	$56,000.01	$59,294	$58	$60,714.01	$64,285	$63	$65,428.01	$69,277
$58	$59,294.01	$62,588	$63	$64,285.01	$67,857	$68	$69,277.01	$73,126
$62	$62,588.01	$65,882	$68	$67,857.01	$71,428	$73	$73,126.01	$76,974
$67	$65,882.01	$69,176	$72	$71,428.01	$75,000	$78	$76,974.01	$80,823
$71	$69,176.01	$72,470	$77	$75,000.01	$78,571	$83	$80,823.01	$84,672
$76	$72,470.01	$75,765	$82	$78,571.01	$82,142	$89	$84,672.01	$88,520
$81	$75,765.01	$79,059	$88	$82,142.01	$85,714	$94	$88,520.01	$92,369
$86	$79,059.01	$82,353	$93	$85,714.01	$89,285	$100	$92,369.01	$96,218
$91	$82,353.01	$85,647	$98	$89,285.01	$92,857	$106	$96,218.01	$100,067
$96	$85,647.01	$88,941	$104	$92,857.01	$96,428	$112	$100,067.01	$103,915
$101	$88,941.01	$92,235	$110	$96,428.01	$100,000	$118	$103,915.01	$107,764
$106	$92,235.01	$95,529	$115	$100,000.01	$103,571	$124	$107,764.01	$111,613
$112	$95,529.01	$98,823	$121	$103,571.01	$107,142	$131	$111,613.01	$115,461
$117	$98,823.01	$102,117	$127	$107,142.01	$110,714	$137	$115,461.01	$119,310
$123	$102,117.01	$105,412	$134	$110,714.01	$114,285	$144	$119,310.01	$123,159
$129	$105,412.01	$108,706	$140	$114,285.01	$117,857	$151	$123,159.01	$127,008
$135	$108,706.01	$112,000	$146	$117,857.01	$121,428	$158	$127,008.01	$130,856
$141	$112,000.01	$115,294	$153	$121,428.01	$124,999	$165	$130,856.01	$134,705
$147	$115,294.01	$118,588	$160	$124,999.01	$128,571	$172	$134,705.01	$138,554
$153	$118,588.01	$121,882	$166	$128,571.01	$132,142	$179	$138,554.01	$142,402
$160	$121,882.01	$125,176	$173	$132,142.01	$135,714	$187	$142,402.01	$146,251
$166	$125,176.01	$128,470	$180	$135,714.01	$139,285	$194	$146,251.01	$150,100
$173	$128,470.01	$131,765	$187	$139,285.01	$142,857	$202	$150,100.01	$153,949
	200% FPIG	$112,140		200% FPIG	$121,580		200% FPIG	$131,020

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:	$12,378	$5	Less than:	$13,210	$5	Less than:	$9,361
$8	$12,378.01	$16,504	$9	$13,210.01	$17,613	$6	$9,361.01	$14,042
$11	$16,504.01	$20,630	$12	$17,613.01	$22,017	$9	$14,042.01	$18,722
$14	$20,630.01	$24,756	$15	$22,017.01	$26,420	$12	$18,722.01	$23,403
$18	$24,756.01	$28,882	$19	$26,420.01	$30,823	$16	$23,403.01	$28,084
$21	$28,882.01	$33,008	$23	$30,823.01	$35,227	$20	$28,084.01	$32,764
$25	$33,008.01	$37,134	$27	$35,227.01	$39,630	$24	$32,764.01	$37,445
$29	$37,134.01	$41,260	$31	$39,630.01	$44,033	$28	$37,445.01	$42,126
$33	$41,260.01	$45,386	$35	$44,033.01	$48,436	$33	$42,126.01	$46,806
$37	$45,386.01	$49,512	$40	$48,436.01	$52,840	$38	$46,806.01	$51,487
$42	$49,512.01	$53,638	$45	$52,840.01	$57,243	$43	$51,487.01	$56,167
$47	$53,638.01	$57,764	$50	$57,243.01	$61,646	$48	$56,167.01	$60,848
$52	$57,764.01	$61,890	$55	$61,646.01	$66,050	$53	$60,848.01	$65,529
$57	$61,890.01	$66,016	$61	$66,050.01	$70,453	$59	$65,529.01	$70,209
$62	$66,016.01	$70,142	$66	$70,453.01	$74,856	$64	$70,209.01	$74,890
$67	$70,142.01	$74,268	$72	$74,856.01	$79,260	$70	$74,890.01	$79,570
$73	$74,268.01	$78,394	$78	$79,260.01	$83,663	$77	$79,570.01	$84,251
$78	$78,394.01	$82,520	$83	$83,663.01	$88,066	$82	$84,251.01	$88,932
$84	$82,520.01	$86,646	$89	$88,066.01	$92,470	$89	$88,932.01	$93,612
$89	$86,646.01	$90,772	$95	$92,470.01	$96,873	$95	$93,612.01	$98,293
$95	$90,772.01	$94,898	$102	$96,873.01	$101,276	$101	$98,293.01	$102,973
$101	$94,898.01	$99,024	$108	$101,276.01	$105,680	$108	$102,973.01	$107,654
$107	$99,024.01	$103,150	$115	$105,680.01	$110,083	$115	$107,654.01	$112,335
$114	$103,150.01	$107,276	$121	$110,083.01	$114,486	$122	$112,335.01	$117,015
$120	$107,276.01	$111,402	$128	$114,486.01	$118,889	$129	$117,015.01	$121,696
$127	$111,402.01	$115,528	$135	$118,889.01	$123,293	$136	$121,696.01	$126,377
$133	$115,528.01	$119,654	$142	$123,293.01	$127,696	$144	$126,377.01	$131,057
$140	$119,654.01	$123,780	$150	$127,696.01	$132,099	$151	$131,057.01	$135,738
$147	$123,780.01	$127,906	$157	$132,099.01	$136,503	$159	$135,738.01	$140,418
$154	$127,906.01	$132,032	$165	$136,503.01	$140,906	$167	$140,418.01	$145,099
$162	$132,032.01	$136,158	$172	$140,906.01	$145,309	$175	$145,099.01	$149,780
$169	$136,158.01	$140,284	$180	$145,309.01	$149,713	$183	$149,780.01	$154,460
$177	$140,284.01	$144,410	$188	$149,713.01	$154,116	$192	$154,460.01	$159,141
$184	$144,410.01	$148,536	$197	$154,116.01	$158,519	$200	$159,141.01	$163,821
$192	$148,536.01	$152,662	$205	$158,519.01	$162,923	$209	$163,821.01	$168,502
$200	$152,662.01	$156,788	$214	$162,923.01	$167,326	$218	$168,502.01	$173,183
$208	$156,788.01	$160,914	$222	$167,326.01	$171,729	$227	$173,183.01	$177,863
$217	$160,914.01	$165,041	$231	$171,729.01	$176,133	$236	$177,863.01	$182,544
	200% FPIG	$140,460		200% FPIG	$149,900	$246	$182,544.01	$187,225
							200% FPIG	$159,340

Weekly	Family Size:	16	Weekly	Family Size:	17	Weekly	Family Size:	18
Co-pay	Annual Income		Co-pay	Annual Income		Co-pay	Annual Income
$5	Less than:	$9,916	$5	Less than:	$10,470	$5	Less than:	$11,025
$6	$9,916.01	$14,874	$7	$10,470.01	$15,706	$7	$11,025.01	$16,538
$10	$14,874.01	$19,832	$10	$15,706.01	$20,941	$11	$16,538.01	$22,050
$13	$19,832.01	$24,790	$14	$20,941.01	$26,176	$15	$22,050.01	$27,563
$17	$24,790.01	$29,747	$18	$26,176.01	$31,411	$19	$27,563.01	$33,075
$21	$29,747.01	$34,705	$22	$31,411.01	$36,646	$24	$33,075.01	$38,588
$26	$34,705.01	$39,663	$27	$36,646.01	$41,882	$28	$38,588.01	$44,100
$30	$39,663.01	$44,621	$32	$41,882.01	$47,117	$33	$44,100.01	$49,613
$35	$44,621.01	$49,579	$37	$47,117.01	$52,352	$39	$49,613.01	$55,125
$40	$49,579.01	$54,537	$42	$52,352.01	$57,587	$44	$55,125.01	$60,638
$45	$54,537.01	$59,495	$48	$57,587.01	$62,823	$50	$60,638.01	$66,150
$50	$59,495.01	$64,453	$53	$62,823.01	$68,058	$56	$66,150.01	$71,663
$56	$64,453.01	$69,411	$59	$68,058.01	$73,293	$62	$71,663.01	$77,175
$62	$69,411.01	$74,369	$65	$73,293.01	$78,528	$69	$77,175.01	$82,688
$68	$74,369.01	$79,327	$72	$78,528.01	$83,763	$76	$82,688.01	$88,200
$74	$79,327.01	$84,285	$79	$83,763.01	$88,999	$83	$88,200.01	$93,713
$81	$84,285.01	$89,242	$86	$88,999.01	$94,234	$90	$93,713.01	$99,225
$87	$89,242.01	$94,200	$92	$94,234.01	$99,469	$97	$99,225.01	$104,738
$94	$94,200.01	$99,158	$99	$99,469.01	$104,704	$104	$104,738.01	$110,250
$101	$99,158.01	$104,116	$106	$104,704.01	$109,939	$112	$110,250.01	$115,763
$107	$104,116.01	$109,074	$113	$109,939.01	$115,175	$119	$115,763.01	$121,275
$114	$109,074.01	$114,032	$121	$115,175.01	$120,410	$127	$121,275.01	$126,788
$122	$114,032.01	$118,990	$128	$120,410.01	$125,645	$135	$126,788.01	$132,300
$129	$118,990.01	$123,948	$136	$125,645.01	$130,880	$143	$132,300.01	$137,813
$137	$123,948.01	$128,906	$144	$130,880.01	$136,116	$152	$137,813.01	$143,325
$144	$128,906.01	$133,864	$152	$136,116.01	$141,351	$160	$143,325.01	$148,838
$152	$133,864.01	$138,822	$161	$141,351.01	$146,586	$169	$148,838.01	$154,350
$160	$138,822.01	$143,779	$169	$146,586.01	$151,821	$178	$154,350.01	$159,863
$168	$143,779.01	$148,737	$178	$151,821.01	$157,056	$187	$159,863.01	$165,375
$177	$148,737.01	$153,695	$187	$157,056.01	$162,292	$197	$165,375.01	$170,888
$185	$153,695.01	$158,653	$196	$162,292.01	$167,527	$206	$170,888.01	$176,400
$194	$158,653.01	$163,611	$205	$167,527.01	$172,762	$216	$176,400.01	$181,913
$203	$163,611.01	$168,569	$214	$172,762.01	$177,997	$226	$181,913.01	$187,425
$212	$168,569.01	$173,527	$224	$177,997.01	$183,232	$236	$187,425.01	$192,938
$221	$173,527.01	$178,485	$234	$183,232.01	$188,468	$246	$192,938.01	$198,450
$231	$178,485.01	$183,443	$244	$188,468.01	$193,703	$257	$198,450.01	$203,963
$241	$183,443.01	$188,401	$254	$193,703.01	$198,938	$267	$203,963.01	$209,475
$250	$188,401.01	$193,359	$264	$198,938.01	$204,173	$278	$209,475.01	$214,988
$260	$193,359.01	$198,317	$275	$204,173.01	$209,409	$289	$214,988.01	$220,501
	200% FPIG	$168,780		200% FPIG	$178,220		200% FPIG	$187,660

Weekly	Family Size:	19	Weekly	Family Size:	20	Weekly	Family Size:	21
Co-pay	Annual Income		Co-pay	Annual Income		Co-pay	Annual Income
$5	Less than:	$11,580	$5	Less than:	$12,134	$5	Less than:	$12,689
$7	$11,580.01	$17,369	$8	$12,134.01	$18,201	$8	$12,689.01	$19,033
$11	$17,369.01	$23,159	$12	$18,201.01	$24,268	$12	$19,033.01	$25,378
$15	$23,159.01	$28,949	$16	$24,268.01	$30,336	$17	$25,378.01	$31,722
$20	$28,949.01	$34,739	$21	$30,336.01	$36,403	$22	$31,722.01	$38,066
$25	$34,739.01	$40,529	$26	$36,403.01	$42,470	$27	$38,066.01	$44,411
$30	$40,529.01	$46,319	$31	$42,470.01	$48,537	$33	$44,411.01	$50,755
$35	$46,319.01	$52,108	$37	$48,537.01	$54,604	$38	$50,755.01	$57,100
$41	$52,108.01	$57,898	$43	$54,604.01	$60,671	$45	$57,100.01	$63,444
$47	$57,898.01	$63,688	$49	$60,671.01	$66,738	$51	$63,444.01	$69,789
$53	$63,688.01	$69,478	$55	$66,738.01	$72,805	$58	$69,789.01	$76,133
$59	$69,478.01	$75,268	$62	$72,805.01	$78,872	$65	$76,133.01	$82,477
$66	$75,268.01	$81,057	$69	$78,872.01	$84,940	$72	$82,477.01	$88,822
$72	$81,057.01	$86,847	$76	$84,940.01	$91,007	$79	$88,822.01	$95,166
$80	$86,847.01	$92,637	$83	$91,007.01	$97,074	$87	$95,166.01	$101,511
$87	$92,637.01	$98,427	$91	$97,074.01	$103,141	$95	$101,511.01	$107,855
$95	$98,427.01	$104,217	$99	$103,141.01	$109,208	$104	$107,855.01	$114,199
$102	$104,217.01	$110,006	$107	$109,208.01	$115,275	$112	$114,199.01	$120,544
$110	$110,006.01	$115,796	$115	$115,275.01	$121,342	$120	$120,544.01	$126,888
$117	$115,796.01	$121,586	$123	$121,342.01	$127,409	$129	$126,888.01	$133,233
$125	$121,586.01	$127,376	$131	$127,409.01	$133,476	$137	$133,233.01	$139,577
$134	$127,376.01	$133,166	$140	$133,476.01	$139,544	$146	$139,577.01	$145,921
$142	$133,166.01	$138,956	$149	$139,544.01	$145,611	$156	$145,921.01	$152,266
$151	$138,956.01	$144,745	$158	$145,611.01	$151,678	$165	$152,266.01	$158,610
$159	$144,745.01	$150,535	$167	$151,678.01	$157,745	$175	$158,610.01	$164,955
$168	$150,535.01	$156,325	$176	$157,745.01	$163,812	$185	$164,955.01	$171,299
$178	$156,325.01	$162,115	$186	$163,812.01	$169,879	$195	$171,299.01	$177,644
$187	$162,115.01	$167,905	$196	$169,879.01	$175,946	$205	$177,644.01	$183,988
$197	$167,905.01	$173,694	$206	$175,946.01	$182,013	$216	$183,988.01	$190,332
$206	$173,694.01	$179,484	$216	$182,013.01	$188,080	$226	$190,332.01	$196,677
$217	$179,484.01	$185,274	$227	$188,080.01	$194,148	$237	$196,677.01	$203,021
$227	$185,274.01	$191,064	$238	$194,148.01	$200,215	$248	$203,021.01	$209,366
$237	$191,064.01	$196,854	$249	$200,215.01	$206,282	$260	$209,366.01	$215,710
$248	$196,854.01	$202,643	$260	$206,282.01	$212,349	$272	$215,710.01	$222,054
$259	$202,643.01	$208,433	$271	$212,349.01	$218,416	$283	$222,054.01	$228,399
$270	$208,433.01	$214,223	$283	$218,416.01	$224,483	$295	$228,399.01	$234,743
$281	$214,223.01	$220,013	$294	$224,483.01	$230,550	$308	$234,743.01	$241,088
$292	$220,013.01	$225,803	$306	$230,550.01	$236,617	$320	$241,088.01	$247,432
$304	$225,803.01	$231,593	$319	$236,617.01	$242,685	$333	$247,432.01	$253,777
	200% FPIG	$197,100		200% FPIG	$206,540		200% FPIG	$215,980

[Pa.B. Doc. No. 22-610. Filed for public inspection April 22, 2022, 9:00 a.m.]

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