Family Size 2 School-Age Co-payment

Monthly Income Monthly Co-pay
$0-$531 $1
$532-$664 $1.50

Approval of new applications is closed for all income levels listed below, effective July 1, 2015, unless a family receives TANF, has a Special Needs child or is a Teen Parent in high school or GED full time.  Families that submit a change of information or redetermination will be income eligible if they fall within the levels below.

Monthly Income Monthly Co-pay
$665-$797 $5.50
$798-$930 $8.50
$931-$1062 $13.50
$1063-$1195 $19.50
$1196-$1328 $26.50
$1329-$1461 $34
$1462-$1593 $43
$1594-$1726 $52.50
$1727-$1859 $63.50
$1860-$1992 $75.00
$1993-$2124 $87.50
$2125-$2257 $101
$2258-$2390 $115.50
$2391-$2456 $125.00

Family Size 3 School-Age Co-payment

Monthly Income Monthly Co-pay
$0-$670 $1
$671-$838 $1.50

Approval of new applications is closed for all income levels listed below, effective July 1, 2015, unless a family receives TANF, has a Special Needs child or is a Teen Parent in high school or GED full time.  Families that submit a change of information or redetermination will be income eligible if they fall within the levels below.

Monthly Income  Monthly Co-pay
$839-$1005 $7
$1006-$1172 $11
$1173-$1340 $17
$1341-$1507 $24.50
$1508-$1675 $33.50
$1676-$1842 $43
$1843-$2009 $54
$2010-$2177 $66.50
$2178-$2344 $80
$2345-$2512 $94.50
$2513-$2679 $110.50
$2680-$2847 $127.50
$2848-$3014 $145.50
$3015-$3098 $157.50

Family Size 4 School-Age Co-payment

Monthly Income Monthly Co-pay
$0-$809 $1
$810-$1011 $1.50

Approval of new applications is closed for all income levels listed below, effective July 1, 2015, unless a family receives TANF, has a Special Needs child or is a Teen Parent in high school or GED full time.  Families that submit a change of information or redetermination will be income eligible if they fall within the levels below.

Monthly Income Monthly Co-pay
$1012-$1213 $8.50
$1214-$1415 $13.50
$1416-$1617 $21
$1618-$1819 $29.50
$1820-$2021 $40
$2022-$2223 $52
$2224-$2425 $65.50
$2426-$2628 $80
$2629-$2830 $96.50
$2831-$3032 $114
$3033 $3234 $133
$3235-$3436 $154
$3437 - $3638 $176
$3639 - $3739 $190

Family Size 5 School-Age Co-payment

Monthly Income Monthly Co-pay
$0-$  947 $1
$948-$1184 $1.50

Approval of new applications is closed for all income levels listed below, effective July 1, 2015, unless a family receives TANF, has a Special Needs child or is a Teen Parent in high school or GED full time.  Families that submit a change of information or redetermination will be income eligible if they fall within the levels below.

Monthly Income Monthly Co-pay
$1185-$1421 $10
$1422-$1658 $15.50
$1659-$1894 $24.50
$1895-$2131 $35
$2132-$2368 $47
$2369-$2605 $61
$2606-$2841 $76.50
$2842-$3078 $94
$3079-$3315 $113
$3316-$3552 $133.50
$3553-$3788 $156
$3789-$4025 $180
$4026-$4262 $206
$4263-$4380 $222

Family Size 6 School-Age Co-payment

Monthly Income Monthly Co-pay
$0-$1086 $1
$1087-$1358 $1.50

Approval of new applications is closed for all income levels listed below, effective July 1, 2015, unless a family receives TANF, has a Special Needs child or is a Teen Parent in high school or GED full time.  Families that submit a change of information or redetermination will be income eligible if they fall within the levels below.

Monthly Income Monthly Co-pay
$1359-$1629 $11
$1630-$1900 $18
$1901-$2172 $28
$2173-$2443 $40
$2444-$2715 $54
$2716-$2986 $70
$2987-$3257 $87.50
$3258-$3529 $107.50
$3530-$3800 $129.50
$3801-$4072 $153
$4073-$4343 $179
$4344-$4615 $206.50
$4616-$4886 $236
$4887-$5022 $255

Family Size 7 School-Age Co-payment

Monthly Income Monthly Co-pay
$0-$1225 $1
$1226-$1531 $1.50

Approval of new applications is closed for all income levels listed below, effective July 1, 2015, unless a family receives TANF, has a Special Needs child or is a Teen Parent in high school or GED full time.  Families that submit a change of information or redetermination will be income eligible if they fall within the levels below.

Monthly Income Monthly Co-pay
$1532-$1837 $12.50
$1838-$2143 $20
$2144-$2449 $31.50
$2450-$2755 $45
$2756-$3061 $61
$3062-$3367 $79
$3368-$3673 $99
$3674-$3980 $121.50
$3981-$4286 $146
$4287-$4592 $172.50
$4593-$4898 $201.50
$4899-$5204 $233
$5205-$5510 $266.50
$5511-$5663 $287.50

Family Size 8 School-Age Co-payment

Monthly Income Monthly Co-pay
$0-$1363 $1
$1364-$1704 $1.50

Approval of new applications is closed for all income levels listed below, effective July 1, 2015, unless a family receives TANF, has a Special Needs child or is a Teen Parent in high school or GED full time.  Families that submit a change of information or redetermination will be income eligible if they fall within the levels below.

Monthly Income Monthly Co-pay
$1705-$2045 $14
$2046-$2386 $22.50
$2387-$2726 $35
$2727-$3067 $50
$3068-$3408 $67.50
$3409-$3749 $87.50
$3750-$4089 $110
$4090-$4430 $135
$4431-$4771 $162.50
$4772-$5112 $192
$5113-$5452 $224.50
$5453-$5793 $259
$5794-$6134 $296.50
$6135-$6304 $320.50

Family Size 9 School-Age Co-payment

Monthly Income Monthly Co-pay
$0000 - $1502 $1
$1503 - $1878 $1.50

Approval of new applications is closed for all income levels listed below, effective July 1, 2015, unless a family receives TANF, has a Special Needs child or is a Teen Parent in high school or GED full time.  Families that submit a change of information or redetermination will be income eligible if they fall within the levels below.

Monthly Income Monthly Co-pay
$1879-$2253 $15.50
$2254-$2628 $24.50
$2629-$3004 $38.50
$3005-$3379 $55
$3380-$3755 $74.50
$3756-$4130 $96.50
$4131-$4505 $121.50
$4506-$4881 $149
$4882-$5256 $179
$5257-$5632 $212
$5633-$6007 $247.50
$6008-$6383 $285.50
$6384-$6758 $326.50
$6759-$6946 $353

Family Size 10 School-Age Co-payment

Monthly Income Monthly Co-pay
$0-$1641 $1
$1642-$2051 $1.50

Approval of new applications is closed for all income levels listed below, effective July 1, 2015, unless a family receives TANF, has a Special Needs child or is a Teen Parent in high school or GED full time.  Families that submit a change of information or redetermination will be income eligible if they fall within the levels below.

Monthly Income Monthly Co-pay
$2052-$2461 $17
$2462-$2871 $27
$2872-$3281 $42
$3282-$3691 $60.50
$3692-$4101 $81.50
$4102-$4511 $105.50
$4512-$4921 $132.50
$4922-$5332 $162.50
$5333-$5742 $195.50
$5743-$6152 $231.50
$6153-$6562 $270
$6563-$6972 $312
$6973-$7382 $356.50
$7383-$7587 $385.50