[----------------------- Gross Monthly Family Income ---------------------------)
|
WEEKLY CO-PAY AMOUNT
| |||||||||||||
FAMILY SIZE
|
CHILDREN IN SUBSIDIZED CARE:
| |||||||||||||
2
|
3
|
4
|
5
|
6
|
7
|
8
|
9
|
10 or more
|
1
|
2
|
3
|
4
|
5 or more
|
70% FPL
|
$905
|
$1,139
|
$1,374
|
$1,608
|
$1,843
|
$2,077
|
$2,312
|
$2,546
|
$2,781
|
6
|
10
|
16
|
21
|
27
|
75% FPL
|
$969
|
$1,221
|
$1,472
|
$1,723
|
$1,974
|
$2,226
|
$2,477
|
$2,728
|
$2,979
|
6
|
13
|
19
|
25
|
31
|
80% FPL
|
$1,034
|
$1,302
|
$1,570
|
$1,838
|
$2,106
|
$2,374
|
$2,642
|
$2,910
|
$3,178
|
9
|
15
|
21
|
28
|
34
|
85% FPL
|
$1,099
|
$1,383
|
$1,668
|
$1,953
|
$2,238
|
$2,522
|
$2,807
|
$3,092
|
$3,377
|
13
|
19
|
25
|
31
|
40
|
90% FPL
|
$1,163
|
$1,465
|
$1,766
|
$2,068
|
$2,369
|
$2,671
|
$2,972
|
$3,274
|
$3,575
|
15
|
24
|
31
|
39
|
46
|
95% FPL
|
$1,228
|
$1,546
|
$1,864
|
$2,183
|
$2,501
|
$2,819
|
$3,137
|
$3,456
|
$3,774
|
19
|
28
|
37
|
46
|
53
|
100% FPL
|
$1,293
|
$1,628
|
$1,963
|
$2,298
|
$2,633
|
$2,968
|
$3,303
|
$3,638
|
$3,973
|
21
|
31
|
40
|
51
|
59
|
105% FPL
|
$1,357
|
$1,709
|
$2,061
|
$2,412
|
$2,764
|
$3,116
|
$3,468
|
$3,819
|
$4,171
|
25
|
34
|
45
|
53
|
63
|
110% FPL
|
$1,422
|
$1,790
|
$2,159
|
$2,527
|
$2,896
|
$3,264
|
$3,633
|
$4,001
|
$4,370
|
28
|
38
|
46
|
57
|
66
|
115% FPL
|
$1,486
|
$1,872
|
$2,257
|
$2,642
|
$3,027
|
$3,413
|
$3,798
|
$4,183
|
$4,568
|
31
|
40
|
51
|
60
|
69
|
120% FPL
|
$1,551
|
$1,953
|
$2,355
|
$2,757
|
$3,159
|
$3,561
|
$3,963
|
$4,365
|
$4,767
|
34
|
45
|
53
|
62
|
73
|
125% FPL
|
$1,616
|
$2,034
|
$2,453
|
$2,872
|
$3,291
|
$3,709
|
$4,128
|
$4,547
|
$4,966
|
38
|
48
|
57
|
67
|
78
|
130% FPL
|
$1,680
|
$2,116
|
$2,551
|
$2,987
|
$3,422
|
$3,858
|
$4,293
|
$4,729
|
$5,164
|
40
|
52
|
63
|
74
|
85
|
135% FPL
|
$1,745
|
$2,197
|
$2,649
|
$3,102
|
$3,554
|
$4,006
|
$4,458
|
$4,911
|
$5,363
|
44
|
56
|
68
|
81
|
93
|
140% FPL
|
$1,810
|
$2,279
|
$2,748
|
$3,217
|
$3,686
|
$4,155
|
$4,624
|
$5,093
|
$5,562
|
46
|
59
|
73
|
85
|
99
|
145% FPL
|
$1,874
|
$2,360
|
$2,846
|
$3,331
|
$3,817
|
$4,303
|
$4,789
|
$5,274
|
$5,760
|
50
|
62
|
74
|
88
|
101
|
150% FPL
|
$1,939
|
$2,441
|
$2,944
|
$3,446
|
$3,949
|
$4,451
|
$4,954
|
$5,456
|
$5,959
|
53
|
65
|
79
|
91
|
105
|
155% FPL
|
$2,003
|
$2,523
|
$3,042
|
$3,561
|
$4,080
|
$4,600
|
$5,119
|
$5,638
|
$6,157
|
56
|
68
|
81
|
94
|
107
|
160% FPL
|
$2,068
|
$2,604
|
$3,140
|
$3,676
|
$4,212
|
$4,748
|
$5,284
|
$5,820
|
$6,356
|
59
|
73
|
85
|
98
|
111
|
165% FPL
|
$2,133
|
$2,685
|
$3,238
|
$3,791
|
$4,344
|
$4,896
|
$5,449
|
$6,002
|
$6,555
|
60
|
74
|
87
|
100
|
113
|
170% FPL
|
$2,197
|
$2,767
|
$3,336
|
$3,906
|
$4,475
|
$5,045
|
$5,614
|
$6,184
|
$6,753
|
62
|
79
|
91
|
105
|
117
|
175% FPL
|
$2,262
|
$2,848
|
$3,434
|
$4,021
|
$4,607
|
$5,193
|
$5,779
|
$6,366
|
$6,952
|
64
|
80
|
94
|
108
|
119
|
180% FPL
|
$2,327
|
$2,930
|
$3,533
|
$4,136
|
$4,739
|
$5,342
|
$5,945
|
$6,548
|
$7,151
|
66
|
83
|
98
|
111
|
122
|
185% FPL
|
$2,391
|
$3,011
|
$3,631
|
$4,250
|
$4,870
|
$5,490
|
$6,110
|
$6,729
|
$7,349
|
68
|
86
|
101
|
113
|
126
|
<<<------------185% of the Federal Poverty Level------------>>>
|
190% FPL
|
$2,456
|
$3,092
|
$3,729
|
$4,365
|
$5,002
|
$5,638
|
$6,275
|
$6,911
|
$7,548
|
69
|
87
|
104
|
116
|
128
|
195% FPL
|
$2,520
|
$3,174
|
$3,827
|
$4,480
|
$5,133
|
$5,787
|
$6,440
|
$7,093
|
$7,746
|
72
|
90
|
107
|
119
|
133
|
200% FPL
|
$2,585
|
$3,255
|
$3,925
|
$4,595
|
$5,265
|
$5,935
|
$6,605
|
$7,275
|
$7,945
|
74
|
92
|
110
|
122
|
135
|
<<<------------+200% of the Federal Poverty Level----------->>>
|