NOTICES
DEPARTMENT OF HUMAN SERVICES
Income Limits and Co-payments for the Subsidized Child Care Program
[54 Pa.B. 2594]
[Saturday, May 11, 2024]This notice increases the income limits codified at 55 Pa. Code Chapter 3042, Appendix B (relating to co-payment chart family co-payment scale (based on the 2024 Federal Poverty Income Guidelines)) under 55 Pa. Code § 3042.97(b) (relating to use of the Federal Poverty Income Guidelines and State Median Income). This increase is effective May 6, 2024.
Section 3042.97(b) of 55 Pa. Code requires the Department of Human Services to update the co-payment schedule in 55 Pa. Code Chapter 3042, Appendix B to reflect changes in the Federal Poverty Income Guidelines (FPIG). Effective May 6, 2024, 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 3042, 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.
VALERIE A. ARKOOSH,
SecretaryFiscal Note: 14-NOT-1629. No fiscal impact; recommends adoption.
CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE EFFECTIVE MAY 6, 2024
(BASED ON THE 2024 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: $7,963 $5 Less than: $8,406 $5 Less than: $9,102 $6 $7,963.01 $8,848 $6 $8,406.01 $9,607 $6 $9,102.01 $10,618 $7 $8,848.01 $9,733 $7 $9,607.01 $10,808 $8 $10,618.01 $12,135 $8 $9,733.01 $10,617 $8 $10,808.01 $12,009 $9 $12,135.01 $13,652 $9 $10,617.01 $11,502 $10 $12,009.01 $13,209 $11 $13,652.01 $15,169 $10 $11,502.01 $12,387 $11 $13,209.01 $14,410 $12 $15,169.01 $16,686 $11 $12,387.01 $13,272 $12 $14,410.01 $15,611 $14 $16,686.01 $18,203 $12 $13,272.01 $14,156 $14 $15,611.01 $16,812 $15 $18,203.01 $19,720 $13 $14,156.01 $15,041 $15 $16,812.01 $18,013 $17 $19,720.01 $21,237 $14 $15,041.01 $15,926 $17 $18,013.01 $19,214 $19 $21,237.01 $22,754 $16 $15,926.01 $16,811 $18 $19,214.01 $20,414 $21 $22,754.01 $24,271 $17 $16,811.01 $17,696 $20 $20,414.01 $21,615 $23 $24,271.01 $25,788 $18 $17,696.01 $18,580 $21 $21,615.01 $22,816 $25 $25,788.01 $27,305 $19 $18,580.01 $19,465 $23 $22,816.01 $24,017 $27 $27,305.01 $28,822 $20 $19,465.01 $20,350 $24 $24,017.01 $25,218 $29 $28,822.01 $30,339 $22 $20,350.01 $21,235 $26 $25,218.01 $26,419 $31 $30,339.01 $31,855 $23 $21,235.01 $22,119 $28 $26,419.01 $27,620 $33 $31,855.01 $33,372 $24 $22,119.01 $23,004 $29 $27,620.01 $28,820 $35 $33,372.01 $34,889 $26 $23,004.01 $23,889 $31 $28,820.01 $30,021 $37 $34,889.01 $36,406 $27 $23,889.01 $24,774 $33 $30,021.01 $31,222 $39 $36,406.01 $37,923 $29 $24,774.01 $25,658 $35 $31,222.01 $32,423 $42 $37,923.01 $39,440 $30 $25,658.01 $26,543 $37 $32,423.01 $33,624 $44 $39,440.01 $40,957 $32 $26,543.01 $27,428 $39 $33,624.01 $34,825 $47 $40,957.01 $42,474 $33 $27,428.01 $28,313 $41 $34,825.01 $36,026 $49 $42,474.01 $43,991 $35 $28,313.01 $29,198 $43 $36,026.01 $37,226 $52 $43,991.01 $45,508 $36 $29,198.01 $30,082 $45 $37,226.01 $38,427 $54 $45,508.01 $47,025 $38 $30,082.01 $30,967 $47 $38,427.01 $39,628 $57 $47,025.01 $48,542 $40 $30,967.01 $31,852 $49 $39,628.01 $40,829 $59 $48,542.01 $50,059 $41 $31,852.01 $32,737 $51 $40,829.01 $42,030 $62 $50,059.01 $51,575 $43 $32,737.01 $33,621 $54 $42,030.01 $43,231 $65 $51,575.01 $53,092 $45 $33,621.01 $34,506 $56 $43,231.01 $44,431 $68 $53,092.01 $54,609 $46 $34,506.01 $35,391 $58 $44,431.01 $45,632 $71 $54,609.01 $56,126 $48 $35,391.01 $35,880 $61 $45,632.01 $46,833 $74 $56,126.01 $57,643 $51 $35,880.01 $36,370 $63 $46,833.01 $48,034 $77 $57,643.01 $59,160 $53 $36,370.01 $36,859 $66 $48,034.01 $48,698 $80 $59,160.01 $60,677 $56 $36,859.01 $37,349 $69 $48,698.01 $49,363 $83 $60,677.01 $61,516 $58 $37,349.01 $37,838 $72 $49,363.01 $50,027 $87 $61,516.01 $62,355 $61 $37,838.01 $38,328 $76 $50,027.01 $50,691 $91 $62,355.01 $63,194 $64 $38,328.01 $38,817 $79 $50,691.01 $51,355 $96 $63,194.01 $64,034 $66 $38,817.01 $39,307 $83 $51,355.01 $52,020 $100 $64,034.01 $64,873 $69 $39,307.01 $39,796 $87 $52,020.01 $52,684 $105 $64,873.01 $65,712 $72 $39,796.01 $40,285 $90 $52,684.01 $53,348 $109 $65,712.01 $66,551 $75 $40,285.01 $40,775 $94 $53,348.01 $54,013 $114 $66,551.01 $67,390 $78 $40,775.01 $41,264 $98 $54,013.01 $54,677 $119 $67,390.01 $68,229 $81 $41,264.01 $41,754 $102 $54,677.01 $55,341 $124 $68,229.01 $69,068 $84 $41,754.01 $42,243 $106 $55,341.01 $56,006 $129 $69,068.01 $69,908 $87 $42,243.01 $42,733 $110 $56,006.01 $56,670 $134 $69,908.01 $70,747 $90 $42,733.01 $43,222 $114 $56,670.01 $57,334 $139 $70,747.01 $71,586 $93 $43,222.01 $43,712 $118 $57,334.01 $57,998 $144 $71,586.01 $72,425 $97 $43,712.01 $44,201 $122 $57,998.01 $58,663 $149 $72,425.01 $73,264 $100 $44,201.01 $44,690 $127 $58,663.01 $59,327 $155 $73,264.01 $74,103 $103 $44,690.01 $45,180 $131 $59,327.01 $59,991 $160 $74,103.01 $74,942 200% FPIG $30,120 $135 $59,991.01 $60,656 $166 $74,942.01 $75,782 $140 $60,656.01 $61,320 $171 $75,782.01 $76,621 200% FPIG $40,880 $177 $76,621.01 $77,460 200% FPIG $51,640
Weekly Family Size: 4 Weekly Family Size: 5 Weekly Family Size: 6 Co-pay
Annual Income
Co-pay
Annual Income
Co-pay
Annual Income
$5 Less than: $9,165 $5 Less than: $8,596 $5 Less than: $9,861 $6 $9,165.01 $10,998 $6 $8,596.01 $10,745 $7 $9,861.01 $12,326 $8 $10,998.01 $12,831 $7 $10,745.01 $12,894 $9 $12,326.01 $14,791 $9 $12,831.01 $14,664 $9 $12,894.01 $15,044 $11 $14,791.01 $17,256 $11 $14,664.01 $16,497 $11 $15,044.01 $17,193 $13 $17,256.01 $19,721 $13 $16,497.01 $18,330 $13 $17,193.01 $19,342 $15 $19,721.01 $22,186 $15 $18,330.01 $20,163 $15 $19,342.01 $21,491 $17 $22,186.01 $24,652 $17 $20,163.01 $21,996 $17 $21,491.01 $23,640 $20 $24,652.01 $27,117 $19 $21,996.01 $23,829 $20 $23,640.01 $25,789 $22 $27,117.01 $29,582 $21 $23,829.01 $25,662 $22 $25,789.01 $27,938 $25 $29,582.01 $32,047 $23 $25,662.01 $27,495 $24 $27,938.01 $30,087 $28 $32,047.01 $34,512 $25 $27,495.01 $29,328 $27 $30,087.01 $32,236 $31 $34,512.01 $36,977 $28 $29,328.01 $31,161 $30 $32,236.01 $34,385 $34 $36,977.01 $39,442 $30 $31,161.01 $32,994 $32 $34,385.01 $36,534 $37 $39,442.01 $41,908 $32 $32,994.01 $34,827 $35 $36,534.01 $38,683 $40 $41,908.01 $44,373 $35 $34,827.01 $36,660 $38 $38,683.01 $40,832 $43 $44,373.01 $46,838 $37 $36,660.01 $38,493 $41 $40,832.01 $42,982 $47 $46,838.01 $49,303 $40 $38,493.01 $40,326 $44 $42,982.01 $45,131 $50 $49,303.01 $51,768 $42 $40,326.01 $42,159 $47 $45,131.01 $47,280 $53 $51,768.01 $54,233 $45 $42,159.01 $43,992 $50 $47,280.01 $49,429 $57 $54,233.01 $56,698 $48 $43,992.01 $45,825 $53 $49,429.01 $51,578 $60 $56,698.01 $59,164 $50 $45,825.01 $47,658 $56 $51,578.01 $53,727 $64 $59,164.01 $61,629 $53 $47,658.01 $49,491 $59 $53,727.01 $55,876 $68 $61,629.01 $64,094 $56 $49,491.01 $51,324 $63 $55,876.01 $58,025 $72 $64,094.01 $66,559 $59 $51,324.01 $53,157 $66 $58,025.01 $60,174 $76 $66,559.01 $69,024 $62 $53,157.01 $54,990 $69 $60,174.01 $62,323 $80 $69,024.01 $71,489 $65 $54,990.01 $56,823 $73 $62,323.01 $64,472 $84 $71,489.01 $73,955 $69 $56,823.01 $58,656 $77 $64,472.01 $66,621 $88 $73,955.01 $76,420 $72 $58,656.01 $60,489 $80 $66,621.01 $68,770 $92 $76,420.01 $78,885 $75 $60,489.01 $62,322 $84 $68,770.01 $70,919 $97 $78,885.01 $81,350 $78 $62,322.01 $64,155 $88 $70,919.01 $73,069 $101 $81,350.01 $83,815 $82 $64,155.01 $65,988 $92 $73,069.01 $75,218 $106 $83,815.01 $86,280 $85 $65,988.01 $67,821 $96 $75,218.01 $77,367 $110 $86,280.01 $88,745 $89 $67,821.01 $69,654 $100 $77,367.01 $79,516 $115 $88,745.01 $91,211 $93 $69,654.01 $71,487 $104 $79,516.01 $81,665 $120 $91,211.01 $93,676 $96 $71,487.01 $73,320 $109 $81,665.01 $83,814 $124 $93,676.01 $96,141 $100 $73,320.01 $74,334 $113 $83,814.01 $85,963 $129 $96,141.01 $98,606 $105 $74,334.01 $75,348 $117 $85,963.01 $87,152 $135 $98,606.01 $99,970 $110 $75,348.01 $76,362 $123 $87,152.01 $88,341 $141 $99,970.01 $101,333 $116 $76,362.01 $77,376 $129 $88,341.01 $89,529 $148 $101,333.01 $102,697 $121 $77,376.01 $78,390 $136 $89,529.01 $90,718 $156 $102,697.01 $104,061 $126 $78,390.01 $79,404 $142 $90,718.01 $91,907 $163 $104,061.01 $105,424 $132 $79,404.01 $80,418 $148 $91,907.01 $93,096 $170 $105,424.01 $106,788 $138 $80,418.01 $81,432 $155 $93,096.01 $94,285 $178 $106,788.01 $108,152 $143 $81,432.01 $82,446 $161 $94,285.01 $95,474 $185 $108,152.01 $109,515 $149 $82,446.01 $83,460 $168 $95,474.01 $96,662 $193 $109,515.01 $110,879 $155 $83,460.01 $84,474 $175 $96,662.01 $97,851 $201 $110,879.01 $112,243 $161 $84,474.01 $85,488 $182 $97,851.01 $99,040 $209 $112,243.01 $113,606 $168 $85,488.01 $86,502 $189 $99,040.01 $100,229 $217 $113,606.01 $114,970 $174 $86,502.01 $87,516 $197 $100,229.01 $101,418 $225 $114,970.01 $116,334 $180 $87,516.01 $88,530 $204 $101,418.01 $102,607 $234 $116,334.01 $117,698 $187 $88,530.01 $89,544 $211 $102,607.01 $103,795 $242 $117,698.01 $119,061 $193 $89,544.01 $90,558 $219 $103,795.01 $104,984 $251 $119,061.01 $120,425 $200 $90,558.01 $91,572 $227 $104,984.01 $106,173 $260 $120,425.01 $121,789 $207 $91,572.01 $92,586 $234 $106,173.01 $107,362 $269 $121,789.01 $123,152 $214 $92,586.01 $93,600 $242 $107,362.01 $108,551 $278 $123,152.01 $124,516 200% FPIG $62,400 $251 $108,551.01 $109,740 $287 $124,516.01 $125,880 200% FPIG $73,160 200% FPIG $83,920
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: $11,125 $5 Less than: $9,292 $5 Less than: $10,240 $7 $11,125.01 $13,906 $6 $9,292.01 $12,389 $7 $10,240.01 $13,654 $10 $13,906.01 $16,687 $8 $12,389.01 $15,487 $9 $13,654.01 $17,067 $12 $16,687.01 $19,469 $11 $15,487.01 $18,584 $12 $17,067.01 $20,480 $14 $19,469.01 $22,250 $13 $18,584.01 $21,681 $15 $20,480.01 $23,894 $17 $22,250.01 $25,031 $16 $21,681.01 $24,778 $18 $23,894.01 $27,307 $20 $25,031.01 $27,812 $19 $24,778.01 $27,876 $21 $27,307.01 $30,720 $22 $27,812.01 $30,593 $22 $27,876.01 $30,973 $24 $30,720.01 $34,134 $25 $30,593.01 $33,375 $25 $30,973.01 $34,070 $27 $34,134.01 $37,547 $28 $33,375.01 $36,156 $28 $34,070.01 $37,168 $31 $37,547.01 $40,961 $31 $36,156.01 $38,937 $32 $37,168.01 $40,265 $35 $40,961.01 $44,374 $35 $38,937.01 $41,718 $35 $40,265.01 $43,362 $39 $44,374.01 $47,787 $38 $41,718.01 $44,500 $39 $43,362.01 $46,460 $43 $47,787.01 $51,201 $42 $44,500.01 $47,281 $43 $46,460.01 $49,557 $47 $51,201.01 $54,614 $45 $47,281.01 $50,062 $47 $49,557.01 $52,654 $51 $54,614.01 $58,027 $49 $50,062.01 $52,843 $51 $52,654.01 $55,751 $56 $58,027.01 $61,441 $53 $52,843.01 $55,625 $55 $55,751.01 $58,849 $60 $61,441.01 $64,854 $56 $55,625.01 $58,406 $59 $58,849.01 $61,946 $65 $64,854.01 $68,268 $60 $58,406.01 $61,187 $63 $61,946.01 $65,043 $69 $68,268.01 $71,681 $64 $61,187.01 $63,968 $67 $65,043.01 $68,141 $74 $71,681.01 $75,094 $68 $63,968.01 $66,749 $71 $68,141.01 $71,238 $79 $75,094.01 $78,508 $72 $66,749.01 $69,531 $76 $71,238.01 $74,335 $84 $78,508.01 $81,921 $77 $69,531.01 $72,312 $81 $74,335.01 $77,433 $89 $81,921.01 $85,334 $81 $72,312.01 $75,093 $85 $77,433.01 $80,530 $94 $85,334.01 $88,748 $85 $75,093.01 $77,874 $90 $80,530.01 $83,627 $99 $88,748.01 $92,161 $90 $77,874.01 $80,656 $95 $83,627.01 $86,724 $105 $92,161.01 $95,575 $94 $80,656.01 $83,437 $100 $86,724.01 $89,822 $110 $95,575.01 $98,988 $99 $83,437.01 $86,218 $105 $89,822.01 $92,919 $116 $98,988.01 $102,401 $104 $86,218.01 $88,999 $110 $92,919.01 $96,016 $122 $102,401.01 $105,815 $109 $88,999.01 $91,780 $116 $96,016.01 $99,114 $128 $105,815.01 $109,228 $114 $91,780.01 $94,562 $121 $99,114.01 $102,211 $134 $109,228.01 $112,641 $119 $94,562.01 $97,343 $127 $102,211.01 $105,308 $140 $112,641.01 $116,055 $124 $97,343.01 $100,124 $133 $105,308.01 $108,406 $146 $116,055.01 $119,468 $130 $100,124.01 $102,905 $138 $108,406.01 $111,503 $152 $119,468.01 $122,882 $135 $102,905.01 $105,687 $144 $111,503.01 $114,600 $159 $122,882.01 $126,295 $140 $105,687.01 $108,468 $150 $114,600.01 $117,697 $166 $126,295.01 $129,708 $146 $108,468.01 $111,249 $156 $117,697.01 $120,795 $172 $129,708.01 $133,122 $152 $111,249.01 $112,788 $163 $120,795.01 $123,892 $179 $133,122.01 $136,535 $160 $112,788.01 $114,326 $169 $123,892.01 $125,605 $186 $136,535.01 $138,423 $167 $114,326.01 $115,865 $178 $125,605.01 $127,319 $196 $138,423.01 $140,311 $175 $115,865.01 $117,403 $186 $127,319.01 $129,032 $205 $140,311.01 $142,200 $184 $117,403.01 $118,942 $195 $129,032.01 $130,745 $215 $142,200.01 $144,088 $192 $118,942.01 $120,481 $204 $130,745.01 $132,459 $225 $144,088.01 $145,976 $200 $120,481.01 $122,019 $214 $132,459.01 $134,172 $236 $145,976.01 $147,864 $209 $122,019.01 $123,558 $223 $134,172.01 $135,886 $246 $147,864.01 $149,753 $218 $123,558.01 $125,096 $233 $135,886.01 $137,599 $256 $149,753.01 $151,641 $227 $125,096.01 $126,635 $242 $137,599.01 $139,312 $267 $151,641.01 $153,529 $236 $126,635.01 $128,173 $252 $139,312.01 $141,026 $278 $153,529.01 $155,417 $245 $128,173.01 $129,712 $262 $141,026.01 $142,739 $289 $155,417.01 $157,305 $254 $129,712.01 $131,251 $273 $142,739.01 $144,452 $301 $157,305.01 $159,194 $264 $131,251.01 $132,789 $283 $144,452.01 $146,166 $312 $159,194.01 $161,082 $274 $132,789.01 $134,328 $294 $146,166.01 $147,879 $324 $161,082.01 $162,970 $283 $134,328.01 $135,866 $305 $147,879.01 $149,593 $336 $162,970.01 $164,858 $293 $135,866.01 $137,405 $316 $149,593.01 $151,306 $348 $164,858.01 $166,746 $303 $137,405.01 $138,944 $327 $151,306.01 $153,019 $360 $166,746.01 $168,635 $314 $138,944.01 $140,482 $338 $153,019.01 $154,733 $372 $168,635.01 $170,523 $324 $140,482.01 $142,021 $349 $154,733.01 $156,446 $385 $170,523.01 $172,411 200% FPIG $94,680 $361 $156,446.01 $158,159 $398 $172,411.01 $174,299 200% FPIG $105,440 200% FPIG $116,200
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: $11,188 $5 Less than: $12,137 $5 Less than: $13,085 $7 $11,188.01 $14,918 $8 $12,137.01 $16,182 $8 $13,085.01 $17,446 $10 $14,918.01 $18,647 $11 $16,182.01 $20,228 $12 $17,446.01 $21,808 $13 $18,647.01 $22,377 $14 $20,228.01 $24,273 $15 $21,808.01 $26,170 $16 $22,377.01 $26,106 $17 $24,273.01 $28,319 $19 $26,170.01 $30,531 $19 $26,106.01 $29,836 $21 $28,319.01 $32,364 $22 $30,531.01 $34,893 $23 $29,836.01 $33,565 $25 $32,364.01 $36,410 $26 $34,893.01 $39,254 $26 $33,565.01 $37,295 $28 $36,410.01 $40,455 $31 $39,254.01 $43,616 $30 $37,295.01 $41,024 $32 $40,455.01 $44,501 $35 $43,616.01 $47,978 $34 $41,024.01 $44,753 $37 $44,501.01 $48,546 $40 $47,978.01 $52,339 $38 $44,753.01 $48,483 $41 $48,546.01 $52,592 $44 $52,339.01 $56,701 $42 $48,483.01 $52,212 $46 $52,592.01 $56,637 $49 $56,701.01 $61,062 $47 $52,212.01 $55,942 $51 $56,637.01 $60,683 $55 $61,062.01 $65,424 $51 $55,942.01 $59,671 $56 $60,683.01 $64,728 $60 $65,424.01 $69,786 $56 $59,671.01 $63,401 $61 $64,728.01 $68,774 $66 $69,786.01 $74,147 $61 $63,401.01 $67,130 $66 $68,774.01 $72,819 $71 $74,147.01 $78,509 $66 $67,130.01 $70,860 $71 $72,819.01 $76,865 $77 $78,509.01 $82,870 $71 $70,860.01 $74,589 $77 $76,865.01 $80,911 $83 $82,870.01 $87,232 $76 $74,589.01 $78,318 $82 $80,911.01 $84,956 $88 $87,232.01 $91,594 $81 $78,318.01 $82,048 $88 $84,956.01 $89,002 $94 $91,594.01 $95,955 $86 $82,048.01 $85,777 $93 $89,002.01 $93,047 $101 $95,955.01 $100,317 $91 $85,777.01 $89,507 $99 $93,047.01 $97,093 $107 $100,317.01 $104,678 $97 $89,507.01 $93,236 $105 $97,093.01 $101,138 $113 $104,678.01 $109,040 $103 $93,236.01 $96,966 $111 $101,138.01 $105,184 $120 $109,040.01 $113,402 $108 $96,966.01 $100,695 $118 $105,184.01 $109,229 $127 $113,402.01 $117,763 $114 $100,695.01 $104,425 $124 $109,229.01 $113,275 $134 $117,763.01 $122,125 $120 $104,425.01 $108,154 $131 $113,275.01 $117,320 $141 $122,125.01 $126,486 $127 $108,154.01 $111,884 $137 $117,320.01 $121,366 $148 $126,486.01 $130,848 $133 $111,884.01 $115,613 $144 $121,366.01 $125,411 $156 $130,848.01 $135,210 $139 $115,613.01 $119,342 $151 $125,411.01 $129,457 $163 $135,210.01 $139,571 $146 $119,342.01 $123,072 $158 $129,457.01 $133,502 $171 $139,571.01 $143,933 $153 $123,072.01 $126,801 $166 $133,502.01 $137,548 $179 $143,933.01 $148,294 $160 $126,801.01 $130,531 $173 $137,548.01 $141,593 $187 $148,294.01 $152,656 $167 $130,531.01 $134,260 $181 $141,593.01 $145,639 $195 $152,656.01 $157,018 $174 $134,260.01 $137,990 $188 $145,639.01 $149,684 $203 $157,018.01 $161,379 $181 $137,990.01 $141,719 $196 $149,684.01 $153,730 $212 $161,379.01 $165,741 $188 $141,719.01 $145,449 $204 $153,730.01 $157,775 $220 $165,741.01 $170,102 $196 $145,449.01 $149,178 $212 $157,775.01 $161,821 $229 $170,102.01 $174,464 $204 $149,178.01 $151,241 $221 $161,821.01 $164,059 $238 $174,464.01 $176,877 $214 $151,241.01 $153,304 $232 $164,059.01 $166,297 $250 $176,877.01 $179,290 $225 $153,304.01 $155,367 $244 $166,297.01 $168,535 $263 $179,290.01 $181,702 $235 $155,367.01 $157,430 $255 $168,535.01 $170,773 $275 $181,702.01 $184,115 $246 $157,430.01 $159,493 $267 $170,773.01 $173,011 $288 $184,115.01 $186,528 $257 $159,493.01 $161,556 $279 $173,011.01 $175,248 $301 $186,528.01 $188,941 $269 $161,556.01 $163,619 $291 $175,248.01 $177,486 $314 $188,941.01 $191,353 $280 $163,619.01 $165,683 $304 $177,486.01 $179,724 $328 $191,353.01 $193,766 $292 $165,683.01 $167,746 $317 $179,724.01 $181,962 $341 $193,766.01 $196,179 $304 $167,746.01 $169,809 $330 $181,962.01 $184,200 $355 $196,179.01 $198,592 $316 $169,809.01 $171,872 $343 $184,200.01 $186,438 $370 $198,592.01 $201,004 $328 $171,872.01 $173,935 $356 $186,438.01 $188,676 $384 $201,004.01 $203,417 $341 $173,935.01 $175,998 $370 $188,676.01 $190,914 $399 $203,417.01 $205,830 $354 $175,998.01 $178,061 $384 $190,914.01 $193,152 $414 $205,830.01 $208,243 $367 $178,061.01 $180,124 $398 $193,152.01 $195,390 $429 $208,243.01 $210,655 $380 $180,124.01 $182,187 $412 $195,390.01 $197,628 $444 $210,655.01 $213,068 $393 $182,187.01 $184,250 $427 $197,628.01 $199,865 $460 $213,068.01 $215,481 $407 $184,250.01 $186,313 $441 $199,865.01 $202,103 $476 $215,481.01 $217,894 $421 $186,313.01 $188,376 $456 $202,103.01 $204,341 $492 $217,894.01 $220,306 $435 $188,376.01 $190,439 $472 $204,341.01 $206,579 $508 $220,306.01 $222,719 200% FPIG $126,960 200% FPIG $137,720 200% FPIG $148,480
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: $9,355 $5 Less than: $9,988 $5 Less than: $10,620 $6 $9,355.01 $14,033 $6 $9,988.01 $14,981 $7 $10,620.01 $15,929 $9 $14,033.01 $18,711 $10 $14,981.01 $19,975 $10 $15,929.01 $21,239 $12 $18,711.01 $23,388 $13 $19,975.01 $24,969 $14 $21,239.01 $26,549 $16 $23,388.01 $28,066 $17 $24,969.01 $29,963 $18 $26,549.01 $31,859 $20 $28,066.01 $32,744 $21 $29,963.01 $34,956 $23 $31,859.01 $37,169 $24 $32,744.01 $37,421 $26 $34,956.01 $39,950 $27 $37,169.01 $42,479 $28 $37,421.01 $42,099 $30 $39,950.01 $44,944 $32 $42,479.01 $47,788 $33 $42,099.01 $46,777 $35 $44,944.01 $49,938 $37 $47,788.01 $53,098 $38 $46,777.01 $51,454 $40 $49,938.01 $54,931 $43 $53,098.01 $58,408 $42 $51,454.01 $56,132 $45 $54,931.01 $59,925 $48 $58,408.01 $63,718 $48 $56,132.01 $60,810 $51 $59,925.01 $64,919 $54 $63,718.01 $69,028 $53 $60,810.01 $65,487 $57 $64,919.01 $69,913 $60 $69,028.01 $74,338 $59 $65,487.01 $70,165 $62 $69,913.01 $74,906 $66 $74,338.01 $79,647 $64 $70,165.01 $74,843 $69 $74,906.01 $79,900 $73 $79,647.01 $84,957 $70 $74,843.01 $79,520 $75 $79,900.01 $84,894 $80 $84,957.01 $90,267 $76 $79,520.01 $84,198 $82 $84,894.01 $89,888 $87 $90,267.01 $95,577 $82 $84,198.01 $88,876 $88 $89,888.01 $94,881 $94 $95,577.01 $100,887 $89 $88,876.01 $93,554 $95 $94,881.01 $99,875 $101 $100,887.01 $106,197 $95 $93,554.01 $98,231 $101 $99,875.01 $104,869 $108 $106,197.01 $111,506 $101 $98,231.01 $102,909 $108 $104,869.01 $109,863 $115 $111,506.01 $116,816 $108 $102,909.01 $107,587 $115 $109,863.01 $114,856 $123 $116,816.01 $122,126 $115 $107,587.01 $112,264 $122 $114,856.01 $119,850 $130 $122,126.01 $127,436 $122 $112,264.01 $116,942 $130 $119,850.01 $124,844 $138 $127,436.01 $132,746 $129 $116,942.01 $121,620 $138 $124,844.01 $129,838 $146 $132,746.01 $138,055 $136 $121,620.01 $126,297 $145 $129,838.01 $134,831 $154 $138,055.01 $143,365 $144 $126,297.01 $130,975 $153 $134,831.01 $139,825 $163 $143,365.01 $148,675 $151 $130,975.01 $135,653 $161 $139,825.01 $144,819 $172 $148,675.01 $153,985 $159 $135,653.01 $140,330 $170 $144,819.01 $149,813 $180 $153,985.01 $159,295 $167 $140,330.01 $145,008 $178 $149,813.01 $154,806 $189 $159,295.01 $164,605 $175 $145,008.01 $149,686 $187 $154,806.01 $159,800 $199 $164,605.01 $169,914 $183 $149,686.01 $154,363 $196 $159,800.01 $164,794 $208 $169,914.01 $175,224 $192 $154,363.01 $159,041 $205 $164,794.01 $169,788 $217 $175,224.01 $180,534 $200 $159,041.01 $163,719 $214 $169,788.01 $174,781 $227 $180,534.01 $185,844 $209 $163,719.01 $168,396 $223 $174,781.01 $179,775 $237 $185,844.01 $191,154 $218 $168,396.01 $173,074 $233 $179,775.01 $184,769 $247 $191,154.01 $196,464 $227 $173,074.01 $177,752 $242 $184,769.01 $189,763 $258 $196,464.01 $201,773 $236 $177,752.01 $182,429 $252 $189,763.01 $194,756 $268 $201,773.01 $207,083 $246 $182,429.01 $187,107 $262 $194,756.01 $199,750 $279 $207,083.01 $212,393 $255 $187,107.01 $189,695 $273 $199,750.01 $202,512 $290 $212,393.01 $215,330 $268 $189,695.01 $192,282 $287 $202,512.01 $205,275 $305 $215,330.01 $218,268 $282 $192,282.01 $194,870 $301 $205,275.01 $208,037 $320 $218,268.01 $221,205 $295 $194,870.01 $197,457 $315 $208,037.01 $210,800 $335 $221,205.01 $224,142 $309 $197,457.01 $200,045 $330 $210,800.01 $213,562 $351 $224,142.01 $227,079 $323 $200,045.01 $202,633 $345 $213,562.01 $216,325 $366 $227,079.01 $230,017 $337 $202,633.01 $205,220 $360 $216,325.01 $219,087 $383 $230,017.01 $232,954 $351 $205,220.01 $207,808 $375 $219,087.01 $221,850 $399 $232,954.01 $235,891 $366 $207,808.01 $210,395 $391 $221,850.01 $224,612 $416 $235,891.01 $238,829 $381 $210,395.01 $212,983 $407 $224,612.01 $227,374 $433 $238,829.01 $241,766 $396 $212,983.01 $215,571 $423 $227,374.01 $230,137 $450 $241,766.01 $244,703 $412 $215,571.01 $218,158 $440 $230,137.01 $232,899 $468 $244,703.01 $247,641 $428 $218,158.01 $220,746 $457 $232,899.01 $235,662 $486 $247,641.01 $250,578 $444 $220,746.01 $223,333 $474 $235,662.01 $238,424 $504 $250,578.01 $253,515 $460 $223,333.01 $225,921 $491 $238,424.01 $241,187 $522 $253,515.01 $256,452 $477 $225,921.01 $228,509 $509 $241,187.01 $243,949 $541 $256,452.01 $259,390 $493 $228,509.01 $231,096 $527 $243,949.01 $246,712 $560 $259,390.01 $262,327 $510 $231,096.01 $233,684 $545 $246,712.01 $249,474 $579 $262,327.01 $265,264 $528 $233,684.01 $236,271 $563 $249,474.01 $252,236 $599 $265,264.01 $268,202 $545 $236,271.01 $238,859 $582 $252,236.01 $254,999 $619 $268,202.01 $271,139 200% FPIG $159,240 200% FPIG $170,000 200% FPIG $180,760
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: $11,252 $5 Less than: $11,884 $5 Less than: $12,516 $7 $11,252.01 $16,878 $7 $11,884.01 $17,826 $8 $12,516.01 $18,774 $11 $16,878.01 $22,504 $11 $17,826.01 $23,768 $12 $18,774.01 $25,032 $15 $22,504.01 $28,130 $16 $23,768.01 $29,710 $17 $25,032.01 $31,290 $19 $28,130.01 $33,755 $21 $29,710.01 $35,652 $22 $31,290.01 $37,548 $24 $33,755.01 $39,381 $25 $35,652.01 $41,594 $27 $37,548.01 $43,806 $29 $39,381.01 $45,007 $31 $41,594.01 $47,536 $32 $43,806.01 $50,064 $34 $45,007.01 $50,633 $36 $47,536.01 $53,478 $38 $50,064.01 $56,322 $40 $50,633.01 $56,259 $42 $53,478.01 $59,420 $44 $56,322.01 $62,581 $45 $56,259.01 $61,885 $48 $59,420.01 $65,362 $50 $62,581.01 $68,839 $51 $61,885.01 $67,511 $54 $65,362.01 $71,304 $57 $68,839.01 $75,097 $57 $67,511.01 $73,137 $60 $71,304.01 $77,246 $64 $75,097.01 $81,355 $64 $73,137.01 $78,763 $67 $77,246.01 $83,188 $71 $81,355.01 $87,613 $70 $78,763.01 $84,389 $74 $83,188.01 $89,130 $78 $87,613.01 $93,871 $77 $84,389.01 $90,014 $82 $89,130.01 $95,072 $86 $93,871.01 $100,129 $85 $90,014.01 $95,640 $89 $95,072.01 $101,014 $94 $100,129.01 $106,387 $92 $95,640.01 $101,266 $97 $101,014.01 $106,956 $102 $106,387.01 $112,645 $99 $101,266.01 $106,892 $105 $106,956.01 $112,898 $110 $112,645.01 $118,903 $107 $106,892.01 $112,518 $113 $112,898.01 $118,840 $118 $118,903.01 $125,161 $114 $112,518.01 $118,144 $121 $118,840.01 $124,781 $127 $125,161.01 $131,419 $122 $118,144.01 $123,770 $129 $124,781.01 $130,723 $136 $131,419.01 $137,677 $130 $123,770.01 $129,396 $137 $130,723.01 $136,665 $144 $137,677.01 $143,935 $138 $129,396.01 $135,022 $146 $136,665.01 $142,607 $153 $143,935.01 $150,193 $146 $135,022.01 $140,648 $155 $142,607.01 $148,549 $163 $150,193.01 $156,451 $155 $140,648.01 $146,273 $164 $148,549.01 $154,491 $172 $156,451.01 $162,709 $164 $146,273.01 $151,899 $173 $154,491.01 $160,433 $182 $162,709.01 $168,967 $173 $151,899.01 $157,525 $182 $160,433.01 $166,375 $192 $168,967.01 $175,225 $182 $157,525.01 $163,151 $192 $166,375.01 $172,317 $202 $175,225.01 $181,483 $191 $163,151.01 $168,777 $202 $172,317.01 $178,259 $213 $181,483.01 $187,742 $201 $168,777.01 $174,403 $212 $178,259.01 $184,201 $223 $187,742.01 $194,000 $210 $174,403.01 $180,029 $222 $184,201.01 $190,143 $234 $194,000.01 $200,258 $220 $180,029.01 $185,655 $233 $190,143.01 $196,085 $245 $200,258.01 $206,516 $230 $185,655.01 $191,281 $243 $196,085.01 $202,027 $256 $206,516.01 $212,774 $241 $191,281.01 $196,907 $254 $202,027.01 $207,969 $268 $212,774.01 $219,032 $251 $196,907.01 $202,532 $265 $207,969.01 $213,911 $280 $219,032.01 $225,290 $262 $202,532.01 $208,158 $277 $213,911.01 $219,853 $291 $225,290.01 $231,548 $273 $208,158.01 $213,784 $288 $219,853.01 $225,795 $304 $231,548.01 $237,806 $284 $213,784.01 $219,410 $300 $225,795.01 $231,737 $316 $237,806.01 $244,064 $295 $219,410.01 $225,036 $312 $231,737.01 $237,679 $329 $244,064.01 $250,322 $307 $225,036.01 $228,148 $325 $237,679.01 $240,966 $342 $250,322.01 $253,784 $323 $228,148.01 $231,260 $341 $240,966.01 $244,253 $359 $253,784.01 $257,246 $339 $231,260.01 $234,372 $358 $244,253.01 $247,540 $377 $257,246.01 $260,708 $355 $234,372.01 $237,485 $375 $247,540.01 $250,827 $395 $260,708.01 $264,170 $371 $237,485.01 $240,597 $392 $250,827.01 $254,114 $413 $264,170.01 $267,632 $388 $240,597.01 $243,709 $410 $254,114.01 $257,401 $432 $267,632.01 $271,093 $405 $243,709.01 $246,821 $428 $257,401.01 $260,688 $451 $271,093.01 $274,555 $423 $246,821.01 $249,933 $446 $260,688.01 $263,975 $470 $274,555.01 $278,017 $440 $249,933.01 $253,045 $465 $263,975.01 $267,262 $490 $278,017.01 $281,479 $458 $253,045.01 $256,157 $484 $267,262.01 $270,549 $510 $281,479.01 $284,941 $477 $256,157.01 $259,270 $504 $270,549.01 $273,836 $530 $284,941.01 $288,403 $495 $259,270.01 $262,382 $523 $273,836.01 $277,123 $551 $288,403.01 $291,865 $514 $262,382.01 $265,494 $543 $277,123.01 $280,410 $572 $291,865.01 $295,327 $534 $265,494.01 $268,606 $564 $280,410.01 $283,697 $594 $295,327.01 $298,789 $553 $268,606.01 $271,718 $584 $283,697.01 $286,984 $615 $298,789.01 $302,251 $573 $271,718.01 $274,830 $605 $286,984.01 $290,271 $638 $302,251.01 $305,712 $593 $274,830.01 $277,942 $627 $290,271.01 $293,558 $660 $305,712.01 $309,174 $614 $277,942.01 $281,055 $648 $293,558.01 $296,845 $683 $309,174.01 $312,636 $635 $281,055.01 $284,167 $670 $296,845.01 $300,132 $706 $312,636.01 $316,098 $656 $284,167.01 $287,279 $693 $300,132.01 $303,419 $729 $316,098.01 $319,560 200% FPIG $191,520 200% FPIG $202,280 200% FPIG $213,040
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: $13,148 $5 Less than: $13,780 $5 Less than: $14,413 $8 $13,148.01 $19,722 $9 $13,780.01 $20,671 $9 $14,413.01 $21,619 $13 $19,722.01 $26,297 $13 $20,671.01 $27,561 $14 $21,619.01 $28,825 $18 $26,297.01 $32,871 $18 $27,561.01 $34,451 $19 $28,825.01 $36,031 $23 $32,871.01 $39,445 $24 $34,451.01 $41,341 $25 $36,031.01 $43,238 $28 $39,445.01 $46,019 $29 $41,341.01 $48,231 $31 $43,238.01 $50,444 $34 $46,019.01 $52,593 $35 $48,231.01 $55,122 $37 $50,444.01 $57,650 $40 $52,593.01 $59,167 $42 $55,122.01 $62,012 $44 $57,650.01 $64,856 $46 $59,167.01 $65,741 $48 $62,012.01 $68,902 $51 $64,856.01 $72,063 $53 $65,741.01 $72,315 $55 $68,902.01 $75,792 $58 $72,063.01 $79,269 $60 $72,315.01 $78,890 $63 $75,792.01 $82,682 $65 $79,269.01 $86,475 $67 $78,890.01 $85,464 $70 $82,682.01 $89,573 $73 $86,475.01 $93,682 $74 $85,464.01 $92,038 $78 $89,573.01 $96,463 $82 $93,682.01 $100,888 $82 $92,038.01 $98,612 $86 $96,463.01 $103,353 $90 $100,888.01 $108,094 $90 $98,612.01 $105,186 $95 $103,353.01 $110,243 $99 $108,094.01 $115,300 $99 $105,186.01 $111,760 $104 $110,243.01 $117,133 $108 $115,300.01 $122,507 $107 $111,760.01 $118,334 $113 $117,133.01 $124,024 $118 $122,507.01 $129,713 $116 $118,334.01 $124,908 $121 $124,024.01 $130,914 $127 $129,713.01 $136,919 $124 $124,908.01 $131,483 $130 $130,914.01 $137,804 $136 $136,919.01 $144,126 $133 $131,483.01 $138,057 $140 $137,804.01 $144,694 $146 $144,126.01 $151,332 $142 $138,057.01 $144,631 $149 $144,694.01 $151,584 $156 $151,332.01 $158,538 $152 $144,631.01 $151,205 $159 $151,584.01 $158,475 $166 $158,538.01 $165,744 $161 $151,205.01 $157,779 $169 $158,475.01 $165,365 $177 $165,744.01 $172,951 $171 $157,779.01 $164,353 $179 $165,365.01 $172,255 $187 $172,951.01 $180,157 $181 $164,353.01 $170,927 $190 $172,255.01 $179,145 $198 $180,157.01 $187,363 $191 $170,927.01 $177,501 $200 $179,145.01 $186,035 $210 $187,363.01 $194,569 $202 $177,501.01 $184,076 $211 $186,035.01 $192,926 $221 $194,569.01 $201,776 $212 $184,076.01 $190,650 $223 $192,926.01 $199,816 $233 $201,776.01 $208,982 $223 $190,650.01 $197,224 $234 $199,816.01 $206,706 $245 $208,982.01 $216,188 $234 $197,224.01 $203,798 $246 $206,706.01 $213,596 $257 $216,188.01 $223,395 $246 $203,798.01 $210,372 $258 $213,596.01 $220,486 $269 $223,395.01 $230,601 $257 $210,372.01 $216,946 $270 $220,486.01 $227,377 $282 $230,601.01 $237,807 $269 $216,946.01 $223,520 $282 $227,377.01 $234,267 $295 $237,807.01 $245,013 $281 $223,520.01 $230,094 $295 $234,267.01 $241,157 $308 $245,013.01 $252,220 $294 $230,094.01 $236,669 $308 $241,157.01 $248,047 $322 $252,220.01 $259,426 $306 $236,669.01 $243,243 $321 $248,047.01 $254,937 $336 $259,426.01 $266,632 $319 $243,243.01 $249,817 $334 $254,937.01 $261,828 $350 $266,632.01 $273,838 $332 $249,817.01 $256,391 $348 $261,828.01 $268,718 $364 $273,838.01 $281,045 $345 $256,391.01 $262,965 $362 $268,718.01 $275,608 $378 $281,045.01 $288,251 $359 $262,965.01 $266,602 $376 $275,608.01 $279,420 $394 $288,251.01 $292,237 $377 $266,602.01 $270,238 $395 $279,420.01 $283,231 $414 $292,237.01 $296,224 $396 $270,238.01 $273,875 $415 $283,231.01 $287,043 $434 $296,224.01 $300,210 $415 $273,875.01 $277,512 $435 $287,043.01 $290,854 $455 $300,210.01 $304,197 $434 $277,512.01 $281,148 $455 $290,854.01 $294,666 $476 $304,197.01 $308,183 $454 $281,148.01 $284,785 $475 $294,666.01 $298,477 $497 $308,183.01 $312,169 $474 $284,785.01 $288,422 $496 $298,477.01 $302,289 $519 $312,169.01 $316,156 $494 $288,422.01 $292,059 $518 $302,289.01 $306,101 $541 $316,156.01 $320,142 $515 $292,059.01 $295,695 $539 $306,101.01 $309,912 $564 $320,142.01 $324,129 $536 $295,695.01 $299,332 $561 $309,912.01 $313,724 $587 $324,129.01 $328,115 $557 $299,332.01 $302,969 $584 $313,724.01 $317,535 $611 $328,115.01 $332,102 $579 $302,969.01 $306,605 $607 $317,535.01 $321,347 $635 $332,102.01 $336,088 $601 $306,605.01 $310,242 $630 $321,347.01 $325,158 $659 $336,088.01 $340,074 $624 $310,242.01 $313,879 $654 $325,158.01 $328,970 $684 $340,074.01 $344,061 $647 $313,879.01 $317,515 $678 $328,970.01 $332,781 $709 $344,061.01 $348,047 $670 $317,515.01 $321,152 $702 $332,781.01 $336,593 $734 $348,047.01 $352,034 $693 $321,152.01 $324,789 $727 $336,593.01 $340,405 $760 $352,034.01 $356,020 $717 $324,789.01 $328,426 $752 $340,405.01 $344,216 $786 $356,020.01 $360,006 $742 $328,426.01 $332,062 $777 $344,216.01 $348,028 $813 $360,006.01 $363,993 $766 $332,062.01 $335,699 $803 $348,028.01 $351,839 $840 $363,993.01 $367,979 200% FPIG $223,800 200% FPIG $234,560 200% FPIG $245,320
[Pa.B. Doc. No. 24-659. Filed for public inspection May 10, 2024, 9:00 a.m.]
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