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

[47 Pa.B. 3447]
[Saturday, June 17, 2017]

 This notice increases the income limits codified in 55 Pa. Code Chapter 3041, Appendix B (relating to co-payment chart family co-payment scale (based on the 2017 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 1, 2017.

 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 1, 2017, 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.

THEODORE DALLAS, 
Secretary

Fiscal Note: 14-NOT-1137. No fiscal impact; (8) recommends adoption.

CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE EFFECTIVE MAY 1, 2017
(BASED ON THE 2017 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: $10,060 $5.00 Less than: $8,660 $5.00 Less than: $8,660
$10.00 $10,060.01 $12,060 $10.00 $8,660.01 $12,240 $10.00 $8,660.01 $14,420
$15.00 $12,060.01 $14,060 $16.00 $12,240.01 $14,240 $17.00 $14,420.01 $16,420
$20.00 $14,060.01 $16,060 $21.00 $14,240.01 $16,240 $22.00 $16,420.01 $18,420
$25.00 $16,060.01 $18,060 $25.00 $16,240.01 $18,140 $27.00 $18,420.01 $20,420
$30.00 $18,060.01 $20,060 $29.00 $18,140.01 $20,140 $31.00 $20,420.01 $22,320
$35.00 $20,060.01 $22,060 $33.00 $20,140.01 $22,140 $35.00 $22,320.01 $24,320
$40.00 $22,060.01 $24,060 $38.00 $22,140.01 $24,140 $39.00 $24,320.01 $26,320
$45.00 $24,060.01 $26,060 $43.00 $24,140.01 $26,140 $43.00 $26,320.01 $28,320
$50.00 $26,060.01 $28,060 $48.00 $26,140.01 $28,140 $48.00 $28,320.01 $30,320
$55.00 $28,060.01 $28,341 $53.00 $28,140.01 $30,140 $53.00 $30,320.01 $32,320
$58.00 $30,140.01 $32,140 $58.00 $32,320.01 $34,320
$64.00 $32,140.01 $34,140 $63.00 $34,320.01 $36,320
$70.00 $34,140.01 $36,140 $68.00 $36,320.01 $38,320
$76.00 $36,140.01 $38,164 $73.00 $38,320.01 $40,320
$79.00 $40,320.01 $42,320
$85.00 $42,320.01 $44,320
$91.00 $44,320.01 $46,320
$97.00 $46,320.01 $47,987
200% FPIG $24,120 200% FPIG $32,480 200% FPIG $40,840
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 $16,200 $10.00 $8,660.01 $16,450 $10.00 $8,660.01 $18,180
$19.00 $16,200.01 $18,600 $19.00 $16,450.01 $18,780 $21.00 $18,180.01 $20,180
$24.00 $18,600.01 $20,600 $23.00 $18,780.01 $20,780 $24.00 $20,180.01 $22,960
$28.00 $20,600.01 $22,600 $27.00 $20,780.01 $22,780 $28.00 $22,960.01 $24,960
$33.00 $22,600.01 $24,600 $31.00 $22,780.01 $24,780 $32.00 $24,960.01 $26,960
$37.00 $24,600.01 $26,600 $35.00 $24,780.01 $26,780 $36.00 $26,960.01 $28,960
$41.00 $26,600.01 $28,600 $40.00 $26,780.01 $28,780 $41.00 $28,960.01 $30,960
$45.00 $28,600.01 $30,600 $44.00 $28,780.01 $30,480 $46.00 $30,960.01 $32,960
$49.00 $30,600.01 $32,600 $47.00 $30,480.01 $32,480 $50.00 $32,960.01 $34,960
$53.00 $32,600.01 $34,600 $51.00 $32,480.01 $34,480 $54.00 $34,960.01 $36,960
$58.00 $34,600.01 $36,600 $55.00 $34,480.01 $36,480 $58.00 $36,960.01 $38,960
$63.00 $36,600.01 $38,600 $59.00 $36,480.01 $38,480 $62.00 $38,960.01 $40,960
$68.00 $38,600.01 $40,600 $63.00 $38,480.01 $40,580 $66.00 $40,960.01 $42,960
$73.00 $40,600.01 $42,600 $68.00 $40,580.01 $42,580 $70.00 $42,960.01 $44,960
$78.00 $42,600.01 $44,600 $73.00 $42,580.01 $44,580 $75.00 $44,960.01 $46,960
$83.00 $44,600.01 $46,600 $78.00 $44,580.01 $46,580 $80.00 $46,960.01 $48,960
$89.00 $46,600.01 $48,600 $83.00 $46,580.01 $48,580 $85.00 $48,960.01 $50,960
$95.00 $48,600.01 $50,600 $88.00 $48,580.01 $50,580 $90.00 $50,960.01 $52,960
$101.00 $50,600.01 $52,600 $93.00 $50,580.01 $52,580 $95.00 $52,960.01 $54,960
$107.00 $52,600.01 $54,600 $98.00 $52,580.01 $54,580 $100.00 $54,960.01 $56,960
$113.00 $54,600.01 $56,600 $103.00 $54,580.01 $56,580 $105.00 $56,960.01 $58,960
$118.00 $56,600.01 $57,810 $109.00 $56,580.01 $58,580 $110.00 $58,960.01 $60,960
$115.00 $58,580.01 $60,580 $115.00 $60,960.01 $62,960
$121.00 $60,580.01 $62,580 $121.00 $62,960.01 $64,960
$127.00 $62,580.01 $64,580 $127.00 $64,960.01 $66,960
$134.00 $64,580.01 $67,633 $133.00 $66,960.01 $68,960
$139.00 $68,960.01 $70,960
$145.00 $70,960.01 $72,960
$151.00 $72,960.01 $74,960
$156.00 $74,960.01 $77,456
200% FPIG $49,200 200% FPIG $57,560 200% FPIG $65,920
Weekly Family Size: 7 Weekly Family Size: 8 Weekly Family Size: 9
Co-pay Annual Income Co-pay Annual Income Co-pay Annual Income
$5.00 Less than: $8,660 $5.00 Less than: $8,660 $5.00 Less than: $8,660
$10.00 $8,660.01 $18,140 $10.00 $8,660.01 $19,050 $10.00 $8,660.01 $19,900
$21.00 $18,140.01 $20,720 $22.00 $19,050.01 $22,320 $23.00 $19,900.01 $24,050
$24.00 $20,720.01 $23,140 $26.00 $22,320.01 $24,890 $28.00 $24,050.01 $26,050
$27.00 $23,140.01 $25,140 $29.00 $24,890.01 $27,320 $31.00 $26,050.01 $29,400
$30.00 $25,140.01 $27,140 $33.00 $27,320.01 $29,320 $35.00 $29,400.01 $31,400
$34.00 $27,140.01 $29,140 $37.00 $29,320.01 $31,320 $39.00 $31,400.01 $33,500
$38.00 $29,140.01 $31,140 $41.00 $31,320.01 $33,320 $43.00 $33,500.01 $35,500
$42.00 $31,140.01 $33,140 $45.00 $33,320.01 $35,320 $47.00 $35,500.01 $37,500
$48.00 $33,140.01 $35,140 $49.00 $35,320.01 $37,320 $51.00 $37,500.01 $39,500
$53.00 $35,140.01 $37,140 $54.00 $37,320.01 $39,320 $55.00 $39,500.01 $41,500
$57.00 $37,140.01 $39,000 $59.00 $39,320.01 $41,320 $60.00 $41,500.01 $43,500
$60.00 $39,000.01 $41,000 $63.00 $41,320.01 $43,000 $65.00 $43,500.01 $45,500
$64.00 $41,000.01 $43,000 $66.00 $43,000.01 $45,000 $69.00 $45,500.01 $47,500
$68.00 $43,000.01 $45,000 $70.00 $45,000.01 $47,000 $73.00 $47,500.01 $49,500
$72.00 $45,000.01 $47,000 $74.00 $47,000.01 $49,000 $77.00 $49,500.01 $51,500
$76.00 $47,000.01 $49,000 $78.00 $49,000.01 $51,000 $81.00 $51,500.01 $53,500
$80.00 $49,000.01 $51,000 $82.00 $51,000.01 $53,000 $85.00 $53,500.01 $55,500
$85.00 $51,000.01 $53,000 $86.00 $53,000.01 $55,000 $89.00 $55,500.01 $57,500
$90.00 $53,000.01 $55,000 $90.00 $55,000.01 $57,000 $93.00 $57,500.01 $59,500
$95.00 $55,000.01 $57,000 $95.00 $57,000.01 $59,000 $97.00 $59,500.01 $61,500
$100.00 $57,000.01 $59,000 $100.00 $59,000.01 $61,000 $101.00 $61,500.01 $63,500
$105.00 $59,000.01 $61,000 $105.00 $61,000.01 $63,000 $106.00 $63,500.01 $65,500
$110.00 $61,000.01 $63,000 $110.00 $63,000.01 $65,000 $111.00 $65,500.01 $67,500
$115.00 $63,000.01 $65,000 $115.00 $65,000.01 $67,000 $116.00 $67,500.01 $69,500
$120.00 $65,000.01 $67,000 $120.00 $67,000.01 $69,000 $121.00 $69,500.01 $71,500
$125.00 $67,000.01 $69,000 $125.00 $69,000.01 $71,000 $126.00 $71,500.01 $73,500
$130.00 $69,000.01 $71,000 $130.00 $71,000.01 $73,000 $131.00 $73,500.01 $75,500
$136.00 $71,000.01 $73,000 $135.00 $73,000.01 $75,000 $136.00 $75,500.01 $77,500
$142.00 $73,000.01 $75,000 $140.00 $75,000.01 $77,000 $141.00 $77,500.01 $79,500
$148.00 $75,000.01 $77,000 $145.00 $77,000.01 $79,000 $146.00 $79,500.01 $81,500
$154.00 $77,000.01 $79,000 $151.00 $79,000.01 $81,000 $151.00 $81,500.01 $83,500
$160.00 $79,000.01 $81,000 $157.00 $81,000.01 $83,000 $156.00 $83,500.01 $85,500
$166.00 $81,000.01 $83,000 $163.00 $83,000.01 $85,000 $161.00 $85,500.01 $87,500
$172.00 $83,000.01 $87,279 $169.00 $85,000.01 $87,000 $167.00 $87,500.01 $89,500
$175.00 $87,000.01 $89,000 $173.00 $89,500.01 $91,500
$181.00 $89,000.01 $91,000 $179.00 $91,500.01 $93,500
$187.00 $91,000.01 $93,000 $185.00 $93,500.01 $95,500
$193.00 $93,000.01 $95,000 $191.00 $95,500.01 $97,500
$198.00 $95,000.01 $97,102 $197.00 $97,500.01 $99,500
$203.00 $99,500.01 $101,500
$209.00 $101,500.01 $103,500
$216.00 $103,500.01 $106,925
200% FPIG $74,280 200% FPIG $82,640 200% FPIG $91,000
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 $21,650 $10.00 $8,660.01 $22,500 $10.00 $8,660.01 $23,380
$25.00 $21,650.01 $25,980 $26.00 $22,500.01 $25,060 $27.00 $23,380.01 $31,170
$30.00 $25,980.01 $29,380 $29.00 $25,060.01 $28,510 $36.00 $31,170.01 $35,040
$34.00 $29,380.01 $31,580 $33.00 $28,510.01 $30,510 $41.00 $35,040.01 $38,040
$37.00 $31,580.01 $33,680 $36.00 $30,510.01 $33,000 $45.00 $38,040.01 $40,040
$41.00 $33,680.01 $35,680 $39.00 $33,000.01 $35,000 $49.00 $40,040.01 $42,040
$45.00 $35,680.01 $37,680 $43.00 $35,000.01 $37,860 $53.00 $42,040.01 $44,040
$49.00 $37,680.01 $39,680 $47.00 $37,860.01 $39,860 $57.00 $44,040.01 $46,040
$53.00 $39,680.01 $41,680 $51.00 $39,860.01 $41,860 $61.00 $46,040.01 $48,040
$57.00 $41,680.01 $43,680 $55.00 $41,860.01 $43,860 $65.00 $48,040.01 $50,040
$61.00 $43,680.01 $45,680 $59.00 $43,860.01 $45,860 $69.00 $50,040.01 $52,040
$66.00 $45,680.01 $47,680 $63.00 $45,860.01 $47,860 $73.00 $52,040.01 $54,040
$71.00 $47,680.01 $49,680 $67.00 $47,860.01 $49,860 $78.00 $54,040.01 $56,040
$75.00 $49,680.01 $51,480 $72.00 $49,860.01 $51,860 $83.00 $56,040.01 $58,040
$78.00 $51,480.01 $53,480 $77.00 $51,860.01 $53,860 $88.00 $58,040.01 $60,040
$82.00 $53,480.01 $55,480 $82.00 $53,860.01 $55,860 $92.00 $60,040.01 $62,040
$86.00 $55,480.01 $57,480 $86.00 $55,860.01 $57,860 $96.00 $62,040.01 $64,040
$90.00 $57,480.01 $59,480 $90.00 $57,860.01 $59,860 $100.00 $64,040.01 $66,040
$94.00 $59,480.01 $61,480 $94.00 $59,860.01 $61,860 $104.00 $66,040.01 $68,040
$98.00 $61,480.01 $63,480 $98.00 $61,860.01 $63,860 $108.00 $68,040.01 $70,040
$102.00 $63,480.01 $65,480 $102.00 $63,860.01 $65,860 $112.00 $70,040.01 $72,040
$106.00 $65,480.01 $67,480 $106.00 $65,860.01 $67,860 $116.00 $72,040.01 $74,040
$111.00 $67,480.01 $69,480 $110.00 $67,860.01 $69,860 $120.00 $74,040.01 $76,040
$116.00 $69,480.01 $71,480 $114.00 $69,860.01 $71,860 $124.00 $76,040.01 $78,040
$121.00 $71,480.01 $73,480 $119.00 $71,860.01 $73,860 $128.00 $78,040.01 $80,040
$126.00 $73,480.01 $75,480 $124.00 $73,860.01 $75,860 $133.00 $80,040.01 $82,040
$131.00 $75,480.01 $77,480 $129.00 $75,860.01 $77,860 $138.00 $82,040.01 $84,040
$136.00 $77,480.01 $79,480 $134.00 $77,860.01 $79,860 $143.00 $84,040.01 $86,040
$141.00 $79,480.01 $81,480 $139.00 $79,860.01 $81,860 $148.00 $86,040.01 $88,040
$146.00 $81,480.01 $83,480 $144.00 $81,860.01 $83,860 $153.00 $88,040.01 $90,040
$151.00 $83,480.01 $85,480 $149.00 $83,860.01 $85,860 $158.00 $90,040.01 $92,040
$156.00 $85,480.01 $87,480 $154.00 $85,860.01 $87,860 $163.00 $92,040.01 $94,040
$161.00 $87,480.01 $89,480 $159.00 $87,860.01 $89,860 $168.00 $94,040.01 $96,040
$166.00 $89,480.01 $91,480 $164.00 $89,860.01 $91,860 $173.00 $96,040.01 $98,040
$171.00 $91,480.01 $93,480 $169.00 $91,860.01 $93,860 $178.00 $98,040.01 $100,040
$177.00 $93,480.01 $95,480 $174.00 $93,860.01 $95,860 $183.00 $100,040.01 $102,040
$183.00 $95,480.01 $97,480 $179.00 $95,860.01 $97,860 $188.00 $102,040.01 $104,040
$189.00 $97,480.01 $99,480 $184.00 $97,860.01 $99,860 $193.00 $104,040.01 $106,040
$195.00 $99,480.01 $101,480 $189.00 $99,860.01 $101,860 $198.00 $106,040.01 $108,040
$201.00 $101,480.01 $103,480 $195.00 $101,860.01 $103,860 $203.00 $108,040.01 $110,040
$207.00 $103,480.01 $105,480 $201.00 $103,860.01 $105,860 $209.00 $110,040.01 $112,040
$213.00 $105,480.01 $107,480 $207.00 $105,860.01 $107,860 $215.00 $112,040.01 $114,040
$219.00 $107,480.01 $109,480 $213.00 $107,860.01 $109,860 $221.00 $114,040.01 $116,040
$225.00 $109,480.01 $111,480 $219.00 $109,860.01 $111,860 $227.00 $116,040.01 $118,040
$232.00 $111,480.01 $116,748 $225.00 $111,860.01 $113,860 $233.00 $118,040.01 $120,040
$231.00 $113,860.01 $115,860 $239.00 $120,040.01 $122,040
$237.00 $115,860.01 $117,860 $245.00 $122,040.01 $124,040
$243.00 $117,860.01 $119,860 $251.00 $124,040.01 $126,040
$249.00 $119,860.01 $121,860 $257.00 $126,040.01 $128,040
$255.00 $121,860.01 $123,860 $263.00 $128,040.01 $130,040
$261.00 $123,860.01 $126,571 $269.00 $130,040.01 $132,040
$275.00 $132,040.01 $134,040
$280.00 $134,040.01 $136,394
200% FPIG $99,360 200% FPIG $107,720 200% FPIG $116,080
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 $25,110 $10.00 $8,660.01 $25,110 $10.00 $8,660.01 $29,410
$29.00 $25,110.01 $31,160 $29.00 $25,110.01 $31,150 $34.00 $29,410.01 $37,110
$36.00 $31,160.01 $35,220 $36.00 $31,150.01 $37,000 $43.00 $37,110.01 $39,110
$41.00 $35,220.01 $37,220 $43.00 $37,000.01 $39,400 $46.00 $39,110.01 $41,580
$44.00 $37,220.01 $39,220 $46.00 $39,400.01 $41,400 $49.00 $41,580.01 $43,580
$47.00 $39,220.01 $42,220 $49.00 $41,400.01 $44,400 $52.00 $43,580.01 $46,580
$51.00 $42,220.01 $44,220 $53.00 $44,400.01 $46,400 $56.00 $46,580.01 $48,580
$55.00 $44,220.01 $46,220 $57.00 $46,400.01 $48,400 $60.00 $48,580.01 $50,580
$59.00 $46,220.01 $48,220 $61.00 $48,400.01 $50,400 $64.00 $50,580.01 $52,580
$63.00 $48,220.01 $50,220 $65.00 $50,400.01 $52,400 $68.00 $52,580.01 $54,580
$67.00 $50,220.01 $52,220 $69.00 $52,400.01 $54,400 $72.00 $54,580.01 $56,580
$71.00 $52,220.01 $54,220 $73.00 $54,400.01 $56,400 $76.00 $56,580.01 $58,580
$75.00 $54,220.01 $56,220 $77.00 $56,400.01 $58,400 $80.00 $58,580.01 $60,580
$79.00 $56,220.01 $58,220 $81.00 $58,400.01 $60,400 $84.00 $60,580.01 $62,580
$84.00 $58,220.01 $60,220 $85.00 $60,400.01 $62,400 $88.00 $62,580.01 $64,580
$89.00 $60,220.01 $62,220 $90.00 $62,400.01 $64,400 $92.00 $64,580.01 $66,580
$94.00 $62,220.01 $64,220 $95.00 $64,400.01 $66,400 $97.00 $66,580.01 $68,580
$98.00 $64,220.01 $66,220 $100.00 $66,400.01 $68,400 $102.00 $68,580.01 $70,580
$102.00 $66,220.01 $68,220 $104.00 $68,400.01 $70,400 $107.00 $70,580.01 $72,500
$106.00 $68,220.01 $70,220 $108.00 $70,400.01 $72,400 $110.00 $72,500.01 $74,500
$110.00 $70,220.01 $72,220 $112.00 $72,400.01 $74,400 $114.00 $74,500.01 $76,500
$114.00 $72,220.01 $74,220 $116.00 $74,400.01 $76,400 $118.00 $76,500.01 $78,500
$118.00 $74,220.01 $76,220 $120.00 $76,400.01 $78,400 $122.00 $78,500.01 $80,500
$122.00 $76,220.01 $78,220 $124.00 $78,400.01 $80,400 $126.00 $80,500.01 $82,500
$126.00 $78,220.01 $80,220 $128.00 $80,400.01 $82,400 $130.00 $82,500.01 $84,500
$130.00 $80,220.01 $82,220 $132.00 $82,400.01 $84,400 $134.00 $84,500.01 $86,500
$134.00 $82,220.01 $84,220 $136.00 $84,400.01 $86,400 $138.00 $86,500.01 $88,500
$138.00 $84,220.01 $86,220 $140.00 $86,400.01 $88,400 $142.00 $88,500.01 $90,500
$143.00 $86,220.01 $88,220 $144.00 $88,400.01 $90,400 $146.00 $90,500.01 $92,500
$148.00 $88,220.01 $90,220 $149.00 $90,400.01 $92,400 $150.00 $92,500.01 $94,500
$153.00 $90,220.01 $92,220 $154.00 $92,400.01 $94,400 $154.00 $94,500.01 $96,500
$158.00 $92,220.01 $94,220 $159.00 $94,400.01 $96,400 $159.00 $96,500.01 $98,500
$163.00 $94,220.01 $96,220 $164.00 $96,400.01 $98,400 $164.00 $98,500.01 $100,500
$168.00 $96,220.01 $98,220 $169.00 $98,400.01 $100,400 $169.00 $100,500.01 $102,500
$173.00 $98,220.01 $100,220 $174.00 $100,400.01 $102,400 $174.00 $102,500.01 $104,500
$178.00 $100,220.01 $102,220 $179.00 $102,400.01 $104,400 $179.00 $104,500.01 $106,500
$183.00 $102,220.01 $104,220 $184.00 $104,400.01 $106,400 $184.00 $106,500.01 $108,500
$188.00 $104,220.01 $106,220 $189.00 $106,400.01 $108,400 $189.00 $108,500.01 $110,500
$193.00 $106,220.01 $108,220 $194.00 $108,400.01 $110,400 $194.00 $110,500.01 $112,500
$198.00 $108,220.01 $110,220 $199.00 $110,400.01 $112,400 $199.00 $112,500.01 $114,500
$203.00 $110,220.01 $112,220 $204.00 $112,400.01 $114,400 $204.00 $114,500.01 $116,500
$208.00 $112,220.01 $114,220 $209.00 $114,400.01 $116,400 $209.00 $116,500.01 $118,500
$213.00 $114,220.01 $116,220 $214.00 $116,400.01 $118,400 $214.00 $118,500.01 $120,500
$218.00 $116,220.01 $118,220 $219.00 $118,400.01 $120,400 $219.00 $120,500.01 $122,500
$224.00 $118,220.01 $120,220 $224.00 $120,400.01 $122,400 $224.00 $122,500.01 $124,500
$230.00 $120,220.01 $122,220 $229.00 $122,400.01 $124,400 $229.00 $124,500.01 $126,500
$236.00 $122,220.01 $124,220 $235.00 $124,400.01 $126,400 $234.00 $126,500.01 $128,500
$242.00 $124,220.01 $126,220 $241.00 $126,400.01 $128,400 $239.00 $128,500.01 $130,500
$248.00 $126,220.01 $128,220 $247.00 $128,400.01 $130,400 $244.00 $130,500.01 $132,500
$254.00 $128,220.01 $130,220 $253.00 $130,400.01 $132,400 $250.00 $132,500.01 $134,500
$260.00 $130,220.01 $132,220 $259.00 $132,400.01 $134,400 $256.00 $134,500.01 $136,500
$266.00 $132,220.01 $134,220 $265.00 $134,400.01 $136,400 $262.00 $136,500.01 $138,500
$272.00 $134,220.01 $136,220 $271.00 $136,400.01 $138,400 $268.00 $138,500.01 $140,500
$278.00 $136,220.01 $138,220 $277.00 $138,400.01 $140,400 $274.00 $140,500.01 $142,500
$284.00 $138,220.01 $140,220 $283.00 $140,400.01 $142,400 $280.00 $142,500.01 $144,500
$290.00 $140,220.01 $142,220 $289.00 $142,400.01 $144,400 $286.00 $144,500.01 $146,500
$297.00 $142,220.01 $146,217 $295.00 $144,400.01 $146,400 $292.00 $146,500.01 $148,500
$301.00 $146,400.01 $148,400 $298.00 $148,500.01 $150,500
$307.00 $148,400.01 $150,400 $304.00 $150,500.01 $152,500
$314.00 $150,400.01 $156,040 $310.00 $152,500.01 $154,500
$316.00 $154,500.01 $156,500
$322.00 $156,500.01 $158,500
$328.00 $158,500.01 $160,500
$334.00 $160,500.01 $162,500
$339.00 $162,500.01 $165,863
200% FPIG $124,440 200% FPIG $132,800 200% FPIG $141,160
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 $29,430 $10.00 $8,660.01 $29,430 $10.00 $8,660.01 $30,310
$34.00 $29,430.01 $38,070 $34.00 $29,430.01 $37,000 $35.00 $30,310.01 $38,960
$44.00 $38,070.01 $43,170 $43.00 $37,000.01 $39,540 $45.00 $38,960.01 $48,120
$50.00 $43,170.01 $45,560 $46.00 $39,540.01 $46,940 $56.00 $48,120.01 $50,120
$53.00 $45,560.01 $48,760 $55.00 $46,940.01 $48,940 $59.00 $50,120.01 $52,120
$57.00 $48,760.01 $50,760 $58.00 $48,940.01 $50,940 $62.00 $52,120.01 $55,120
$61.00 $50,760.01 $52,760 $61.00 $50,940.01 $52,940 $66.00 $55,120.01 $57,120
$65.00 $52,760.01 $54,760 $65.00 $52,940.01 $54,940 $70.00 $57,120.01 $59,120
$69.00 $54,760.01 $56,760 $69.00 $54,940.01 $56,940 $74.00 $59,120.01 $61,120
$73.00 $56,760.01 $58,760 $73.00 $56,940.01 $58,940 $78.00 $61,120.01 $63,120
$77.00 $58,760.01 $60,760 $77.00 $58,940.01 $60,940 $82.00 $63,120.01 $65,120
$81.00 $60,760.01 $62,760 $81.00 $60,940.01 $62,940 $86.00 $65,120.01 $67,120
$85.00 $62,760.01 $64,760 $85.00 $62,940.01 $64,940 $90.00 $67,120.01 $69,120
$89.00 $64,760.01 $66,760 $89.00 $64,940.01 $66,940 $94.00 $69,120.01 $71,120
$93.00 $66,760.01 $68,760 $93.00 $66,940.01 $68,940 $98.00 $71,120.01 $73,120
$98.00 $68,760.01 $70,760 $97.00 $68,940.01 $70,940 $102.00 $73,120.01 $75,120
$103.00 $70,760.01 $72,760 $101.00 $70,940.01 $72,940 $106.00 $75,120.01 $77,120
$108.00 $72,760.01 $74,760 $106.00 $72,940.01 $74,940 $111.00 $77,120.01 $79,120
$113.00 $74,760.01 $76,760 $111.00 $74,940.01 $76,940 $116.00 $79,120.01 $81,120
$117.00 $76,760.01 $78,660 $116.00 $76,940.01 $78,940 $121.00 $81,120.01 $83,120
$120.00 $78,660.01 $80,660 $120.00 $78,940.01 $80,940 $126.00 $83,120.01 $84,120
$124.00 $80,660.01 $82,660 $124.00 $80,940.01 $82,940 $128.00 $84,120.01 $86,120
$128.00 $82,660.01 $84,660 $128.00 $82,940.01 $84,940 $132.00 $86,120.01 $88,120
$132.00 $84,660.01 $86,660 $132.00 $84,940.01 $86,940 $136.00 $88,120.01 $90,120
$136.00 $86,660.01 $88,660 $136.00 $86,940.01 $88,940 $140.00 $90,120.01 $92,120
$140.00 $88,660.01 $90,660 $140.00 $88,940.01 $90,940 $144.00 $92,120.01 $94,120
$144.00 $90,660.01 $92,660 $144.00 $90,940.01 $92,940 $148.00 $94,120.01 $96,120
$148.00 $92,660.01 $94,660 $148.00 $92,940.01 $94,940 $152.00 $96,120.01 $98,120
$152.00 $94,660.01 $96,660 $152.00 $94,940.01 $96,940 $156.00 $98,120.01 $100,120
$156.00 $96,660.01 $98,660 $156.00 $96,940.01 $98,940 $160.00 $100,120.01 $102,120
$160.00 $98,660.01 $100,660 $160.00 $98,940.01 $100,940 $164.00 $102,120.01 $104,120
$164.00 $100,660.01 $102,660 $164.00 $100,940.01 $102,940 $168.00 $104,120.01 $106,120
$169.00 $102,660.01 $104,660 $168.00 $102,940.01 $104,940 $172.00 $106,120.01 $108,120
$174.00 $104,660.01 $106,660 $173.00 $104,940.01 $106,940 $176.00 $108,120.01 $110,120
$179.00 $106,660.01 $108,660 $178.00 $106,940.01 $108,940 $180.00 $110,120.01 $112,120
$184.00 $108,660.01 $110,660 $183.00 $108,940.01 $110,940 $185.00 $112,120.01 $114,120
$189.00 $110,660.01 $112,660 $188.00 $110,940.01 $112,940 $190.00 $114,120.01 $116,120
$194.00 $112,660.01 $114,660 $193.00 $112,940.01 $114,940 $195.00 $116,120.01 $118,120
$199.00 $114,660.01 $116,660 $198.00 $114,940.01 $116,940 $200.00 $118,120.01 $120,120
$204.00 $116,660.01 $118,660 $203.00 $116,940.01 $118,940 $205.00 $120,120.01 $122,120
$209.00 $118,660.01 $120,660 $208.00 $118,940.01 $120,940 $210.00 $122,120.01 $124,120
$214.00 $120,660.01 $122,660 $213.00 $120,940.01 $122,940 $215.00 $124,120.01 $126,120
$219.00 $122,660.01 $124,660 $218.00 $122,940.01 $124,940 $220.00 $126,120.01 $128,120
$224.00 $124,660.01 $126,660 $223.00 $124,940.01 $126,940 $225.00 $128,120.01 $130,120
$229.00 $126,660.01 $128,660 $228.00 $126,940.01 $128,940 $230.00 $130,120.01 $132,120
$234.00 $128,660.01 $130,660 $233.00 $128,940.01 $130,940 $235.00 $132,120.01 $134,120
$239.00 $130,660.01 $132,660 $238.00 $130,940.01 $132,940 $240.00 $134,120.01 $136,120
$244.00 $132,660.01 $134,660 $243.00 $132,940.01 $134,940 $245.00 $136,120.01 $138,120
$249.00 $134,660.01 $136,660 $248.00 $134,940.01 $136,940 $250.00 $138,120.01 $140,120
$254.00 $136,660.01 $138,660 $253.00 $136,940.01 $138,940 $255.00 $140,120.01 $142,120
$259.00 $138,660.01 $140,660 $258.00 $138,940.01 $140,940 $260.00 $142,120.01 $144,120
$264.00 $140,660.01 $142,660 $263.00 $140,940.01 $142,940 $265.00 $144,120.01 $146,120
$270.00 $142,660.01 $144,660 $268.00 $142,940.01 $144,940 $270.00 $146,120.01 $148,120
$276.00 $144,660.01 $146,660 $273.00 $144,940.01 $146,940 $275.00 $148,120.01 $150,120
$282.00 $146,660.01 $148,660 $278.00 $146,940.01 $148,940 $280.00 $150,120.01 $152,120
$288.00 $148,660.01 $150,660 $284.00 $148,940.01 $150,940 $285.00 $152,120.01 $154,120
$294.00 $150,660.01 $152,660 $290.00 $150,940.01 $152,940 $290.00 $154,120.01 $156,120
$300.00 $152,660.01 $154,660 $296.00 $152,940.01 $154,940 $296.00 $156,120.01 $158,120
$306.00 $154,660.01 $156,660 $302.00 $154,940.01 $156,940 $302.00 $158,120.01 $160,120
$312.00 $156,660.01 $158,660 $308.00 $156,940.01 $158,940 $308.00 $160,120.01 $162,120
$318.00 $158,660.01 $160,660 $314.00 $158,940.01 $160,940 $314.00 $162,120.01 $164,120
$324.00 $160,660.01 $162,660 $320.00 $160,940.01 $162,940 $320.00 $164,120.01 $166,120
$330.00 $162,660.01 $164,660 $326.00 $162,940.01 $164,940 $326.00 $166,120.01 $168,120
$336.00 $164,660.01 $166,660 $332.00 $164,940.01 $166,940 $332.00 $168,120.01 $170,120
$342.00 $166,660.01 $168,660 $338.00 $166,940.01 $168,940 $338.00 $170,120.01 $172,120
$348.00 $168,660.01 $170,660 $344.00 $168,940.01 $170,940 $344.00 $172,120.01 $174,120
$355.00 $170,660.01 $175,686 $350.00 $170,940.01 $172,940 $350.00 $174,120.01 $176,120
$356.00 $172,940.01 $174,940 $356.00 $176,120.01 $178,120
$362.00 $174,940.01 $176,940 $362.00 $178,120.01 $180,120
$368.00 $176,940.01 $178,940 $368.00 $180,120.01 $182,120
$374.00 $178,940.01 $185,509 $374.00 $182,120.01 $184,120
$380.00 $184,120.01 $186,120
$386.00 $186,120.01 $188,120
$392.00 $188,120.01 $190,120
$397.00 $190,120.01 $195,332
200% FPIG $149,520 200% FPIG $157,880 200% FPIG $166,240
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 $32,900 $10.00 $8,660.01 $45,890
$36.00 $30,300.01 $41,650 $38.00 $32,900.01 $45,000 $53.00 $45,890.01 $53,660
$50.00 $41,650.01 $47,300 $52.00 $45,000.01 $48,000 $62.00 $53,660.01 $55,360
$57.00 $47,300.01 $49,300 $56.00 $48,000.01 $51,480 $64.00 $55,360.01 $57,660
$62.00 $49,300.01 $51,300 $64.00 $51,480.01 $53,480 $67.00 $57,660.01 $59,660
$65.00 $51,300.01 $53,300 $68.00 $53,480.01 $55,480 $70.00 $59,660.01 $61,660
$68.00 $53,300.01 $55,300 $71.00 $55,480.01 $57,480 $74.00 $61,660.01 $63,660
$71.00 $55,300.01 $57,300 $75.00 $57,480.01 $59,480 $78.00 $63,660.01 $65,660
$77.00 $57,300.01 $59,300 $80.00 $59,480.01 $61,480 $82.00 $65,660.01 $67,660
$80.00 $59,300.01 $61,300 $85.00 $61,480.01 $63,480 $86.00 $67,660.01 $69,660
$84.00 $61,300.01 $63,300 $89.00 $63,480.01 $65,480 $90.00 $69,660.01 $71,660
$87.00 $63,300.01 $65,300 $92.00 $65,480.01 $67,480 $94.00 $71,660.01 $73,660
$91.00 $65,300.01 $67,300 $96.00 $67,480.01 $69,480 $98.00 $73,660.01 $75,660
$94.00 $67,300.01 $69,300 $99.00 $69,480.01 $71,480 $102.00 $75,660.01 $77,660
$100.00 $69,300.01 $71,300 $103.00 $71,480.01 $73,480 $106.00 $77,660.01 $79,660
$103.00 $71,300.01 $73,300 $106.00 $73,480.01 $75,480 $110.00 $79,660.01 $81,660
$107.00 $73,300.01 $75,300 $110.00 $75,480.01 $77,480 $114.00 $81,660.01 $83,660
$110.00 $75,300.01 $77,300 $113.00 $77,480.01 $79,480 $118.00 $83,660.01 $85,660
$114.00 $77,300.01 $79,300 $117.00 $79,480.01 $81,480 $122.00 $85,660.01 $87,660
$117.00 $79,300.01 $81,300 $120.00 $81,480.01 $83,480 $126.00 $87,660.01 $89,660
$121.00 $81,300.01 $83,300 $124.00 $83,480.01 $85,480 $131.00 $89,660.01 $91,660
$125.00 $83,300.01 $85,300 $127.00 $85,480.01 $87,480 $136.00 $91,660.01 $93,660
$129.00 $85,300.01 $87,300 $131.00 $87,480.01 $89,480 $141.00 $93,660.01 $95,660
$133.00 $87,300.01 $89,300 $135.00 $89,480.01 $91,480 $145.00 $95,660.01 $97,660
$137.00 $89,300.01 $91,300 $139.00 $91,480.01 $93,480 $149.00 $97,660.01 $99,660
$141.00 $91,300.01 $93,300 $143.00 $93,480.01 $95,480 $153.00 $99,660.01 $101,660
$145.00 $93,300.01 $95,300 $147.00 $95,480.01 $97,480 $157.00 $101,660.01 $103,660
$149.00 $95,300.01 $97,300 $151.00 $97,480.01 $99,480 $161.00 $103,660.01 $105,660
$153.00 $97,300.01 $99,300 $155.00 $99,480.01 $101,480 $165.00 $105,660.01 $107,660
$157.00 $99,300.01 $101,300 $159.00 $101,480.01 $103,480 $169.00 $107,660.01 $109,660
$161.00 $101,300.01 $103,300 $163.00 $103,480.01 $105,480 $173.00 $109,660.01 $111,660
$165.00 $103,300.01 $105,300 $167.00 $105,480.01 $107,480 $177.00 $111,660.01 $113,660
$169.00 $105,300.01 $107,300 $171.00 $107,480.01 $109,480 $181.00 $113,660.01 $115,660
$173.00 $107,300.01 $109,300 $175.00 $109,480.01 $111,480 $185.00 $115,660.01 $117,660
$177.00 $109,300.01 $111,300 $179.00 $111,480.01 $113,480 $189.00 $117,660.01 $119,660
$181.00 $111,300.01 $113,300 $183.00 $113,480.01 $115,480 $193.00 $119,660.01 $121,660
$185.00 $113,300.01 $115,300 $187.00 $115,480.01 $117,480 $197.00 $121,660.01 $123,660
$189.00 $115,300.01 $117,300 $191.00 $117,480.01 $119,480 $201.00 $123,660.01 $125,660
$194.00 $117,300.01 $119,300 $195.00 $119,480.01 $121,480 $205.00 $125,660.01 $127,660
$199.00 $119,300.01 $121,300 $199.00 $121,480.01 $123,480 $210.00 $127,660.01 $129,660
$204.00 $121,300.01 $123,300 $204.00 $123,480.01 $125,480 $215.00 $129,660.01 $131,660
$209.00 $123,300.01 $125,300 $209.00 $125,480.01 $127,480 $220.00 $131,660.01 $133,660
$214.00 $125,300.01 $127,300 $214.00 $127,480.01 $129,480 $225.00 $133,660.01 $135,660
$219.00 $127,300.01 $129,300 $219.00 $129,480.01 $131,480 $230.00 $135,660.01 $137,660
$224.00 $129,300.01 $131,300 $224.00 $131,480.01 $133,480 $235.00 $137,660.01 $139,660
$229.00 $131,300.01 $133,300 $229.00 $133,480.01 $135,480 $240.00 $139,660.01 $141,660
$234.00 $133,300.01 $135,300 $234.00 $135,480.01 $137,480 $245.00 $141,660.01 $143,660
$239.00 $135,300.01 $137,300 $239.00 $137,480.01 $139,480 $250.00 $143,660.01 $145,660
$244.00 $137,300.01 $139,300 $244.00 $139,480.01 $141,480 $255.00 $145,660.01 $147,660
$249.00 $139,300.01 $141,300 $249.00 $141,480.01 $143,480 $260.00 $147,660.01 $149,660
$254.00 $141,300.01 $143,300 $254.00 $143,480.01 $145,480 $265.00 $149,660.01 $151,660
$259.00 $143,300.01 $145,300 $259.00 $145,480.01 $147,480 $270.00 $151,660.01 $153,660
$264.00 $145,300.01 $147,300 $264.00 $147,480.01 $149,480 $275.00 $153,660.01 $155,660
$269.00 $147,300.01 $149,300 $269.00 $149,480.01 $151,480 $280.00 $155,660.01 $157,660
$274.00 $149,300.01 $151,300 $274.00 $151,480.01 $153,480 $285.00 $157,660.01 $159,660
$279.00 $151,300.01 $153,300 $279.00 $153,480.01 $155,480 $290.00 $159,660.01 $161,660
$284.00 $153,300.01 $155,300 $284.00 $155,480.01 $157,480 $295.00 $161,660.01 $163,660
$289.00 $155,300.01 $157,300 $289.00 $157,480.01 $159,480 $300.00 $163,660.01 $165,660
$294.00 $157,300.01 $159,300 $294.00 $159,480.01 $161,480 $305.00 $165,660.01 $167,660
$299.00 $159,300.01 $161,300 $299.00 $161,480.01 $163,480 $310.00 $167,660.01 $169,660
$304.00 $161,300.01 $163,300 $304.00 $163,480.01 $165,480 $315.00 $169,660.01 $171,660
$309.00 $163,300.01 $165,300 $309.00 $165,480.01 $167,480 $320.00 $171,660.01 $173,660
$315.00 $165,300.01 $167,300 $314.00 $167,480.01 $169,480 $325.00 $173,660.01 $175,660
$321.00 $167,300.01 $169,300 $319.00 $169,480.01 $171,480 $330.00 $175,660.01 $177,660
$327.00 $169,300.01 $171,300 $324.00 $171,480.01 $173,480 $335.00 $177,660.01 $179,660
$333.00 $171,300.01 $173,300 $330.00 $173,480.01 $175,480 $341.00 $179,660.01 $181,660
$339.00 $173,300.01 $175,300 $336.00 $175,480.01 $177,480 $347.00 $181,660.01 $183,660
$345.00 $175,300.01 $177,300 $342.00 $177,480.01 $179,480 $353.00 $183,660.01 $185,660
$351.00 $177,300.01 $179,300 $348.00 $179,480.01 $181,480 $359.00 $185,660.01 $187,660
$357.00 $179,300.01 $181,300 $354.00 $181,480.01 $183,480 $365.00 $187,660.01 $189,660
$363.00 $181,300.01 $183,300 $360.00 $183,480.01 $185,480 $371.00 $189,660.01 $191,660
$369.00 $183,300.01 $185,300 $366.00 $185,480.01 $187,480 $377.00 $191,660.01 $193,660
$375.00 $185,300.01 $187,300 $372.00 $187,480.01 $189,480 $383.00 $193,660.01 $195,660
$381.00 $187,300.01 $189,300 $378.00 $189,480.01 $191,480 $389.00 $195,660.01 $197,660
$387.00 $189,300.01 $191,300 $384.00 $191,480.01 $193,480 $395.00 $197,660.01 $199,660
$393.00 $191,300.01 $193,300 $390.00 $193,480.01 $195,480 $401.00 $199,660.01 $201,660
$399.00 $193,300.01 $195,300 $396.00 $195,480.01 $197,480 $407.00 $201,660.01 $203,660
$405.00 $195,300.01 $197,300 $402.00 $197,480.01 $199,480 $413.00 $203,660.01 $205,660
$411.00 $197,300.01 $199,300 $408.00 $199,480.01 $201,480 $419.00 $205,660.01 $207,660
$419.00 $199,300.01 $201,300 $414.00 $201,480.01 $203,480 $425.00 $207,660.01 $209,660
$424.00 $201,300.01 $205,155 $420.00 $203,480.01 $205,480 $431.00 $209,660.01 $211,660
$426.00 $205,480.01 $207,480 $437.00 $211,660.01 $213,660
$432.00 $207,480.01 $209,480 $443.00 $213,660.01 $215,660
$438.00 $209,480.01 $214,978 $449.00 $215,660.01 $217,660
$455.00 $217,660.01 $224,801
200% FPIG $174,600 200% FPIG $182,960 200% FPIG $191,320
[Pa.B. Doc. No. 17-1015. Filed for public inspection June 16, 2017, 9:00 a.m.]



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