Revision to AmountsFamily Size 2 School-Age Co-payment

Monthly Income Monthly Co-Pay
$0-534 $1.00
535-668 1.50
669-801 5.50
802-935 9.00
936-1068 13.50
1069-1202 19.50
1203-1335 26.50
1336-1469 34.50
1470-1602 43.00
1603-1736 53.00
1737-1869 63.50
1870-2003 75.50
2004-2136 88.00
2137-2163 101.50

Approval of new applications is closed for all income levels listed below, effective November 9, 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
$2164-2270 $101.50
2271-2403 116.00
2404-2470 125.50

Revision to AmountsFamily Size 3 School-Age Co-Payment

Monthly Income Monthly Co-Pay
$0-672 $1.00
673-840 1.50
841-1008 7.00
1009-1176 11.00
1177-1344 17.50
1345-1512 24.50
1513-1680 33.50
1681-1848 43.00
1849-2016 54.50
2017-2184 66.50
2185-2352 80.00
2353-2520 95.00
2521-2688 110.50
2689-2722 128.00

Approval of new applications is closed for all income levels listed below, effective November 9, 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
$2723-2856 $128.00
2857-3024 146.00
3025-3108 158.00

Revision to AmountsFamily Size 4 School-Age Co-Payment

Monthly Income Monthly Co-Pay
$0-810 $1.00
811-1013 1.50
1014-1215 8.50
1216-1418 13.50
1419-1620 21.00
1621-1823 30.00
1824-2025 40.00
2026-2228 52.00
2229-2430 65.50
2431-2633 80.50
2634-2835 96.50
2836-3038 114.00
3039-3240 133.50
3241-3281 154.00

Approval of new applications is closed for all income levels listed below, effective November 9, 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
$3282-3443 $154.00
3444-3645 176.00
3646-3747 190.50

Revision to AmountsFamily Size 5 School-Age Co-Payment

Monthly Income Monthly Co-Pay
$0-948 $1.00
949-1185 1.50
1186-1422 10.00
1423-1659 15.50
1660-1896 24.50
1897-2133 35.00
2134-2370 47.00
2371-2607 61.00
2608-2844 76.50
2845-3081 94.00
3082-3318 113.00
3319-3555 133.50
3556-3792 156.00
3793-3840 180.50

Approval of new applications is closed for all income levels listed below, effective November 9, 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
$3841-4029 $180.50
4030-4266 206.00
4267-4385 223.00

Family Size 6 School-Age Co-Payment

Monthly Income Monthly Co-Pay
$0-1086 $1.00
1087-1358 1.50
1359-1629 11.00
1630-1901 18.00
1902-2172 28.00
2173-2444 40.00
2445-2715 54.00
2716-2987 70.00
2988-3258 88.00
3259-3530 107.50
3531-3801 129.50
3802-4073 153.00
4074-4344 179.00
4345-4399 206.50

Approval of new applications is closed for all income levels listed below, effective November 9, 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
4400-4616 $206.50
4617-4887 236.00
4888-5023 255.00

Family Size 7 School-Age Co-Payment

Monthly Income Monthly Co-Pay
$0-1225 $1.00
1226-1531 1.50
1532-1837 12.50
1838-2143 20.00
2144-2449 31.50
2450-2755 45.00
2756-3061 61.00
3062-3367 79.00
3368-3673 99.00
3674-3980 121.50
3981-4286 146.00
4287-4592 172.50
4593-4898 201.50
4899-4959 233.00

Approval of new applications is closed for all income levels listed below, effective November 9, 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
$4960-5204 $233.00
5205-5510 266.50
5511-5663 287.50

Family Size 8 School-Age Co-payment

Monthly Income Monthly Co-Pay
$0-1363 $1.00
1364-1704 1.50
1705-2045 14.00
2046-2386 22.50
2387-2726 35.00
2727-3067 50.00
3068-3408 67.50
3409-3749 87.50
3750-4089 110.00
4090-4430 135.00
4431-4771 162.50
4772-5112 192.00
5113-5452 224.50
5453-5521 259.00

Approval of new applications is closed for all income levels listed below, effective November 9, 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
$5522-5793 $259.00
5794-6134 296.50
6135-6304 320.50

Family Size 9 School-Age Co-payment

Monthly Income Monthly Co-pay
$0-1502 $1.00
1503-1878 1.50
1879-2253 15.50
2254-2628 24.50
2629-3004 38.50
3005-3379 55.00
3380-3755 74.50
3756-4130 96.50
4131-4505 121.50
4506-4881 149.00
4882-5256 179.00
5257-5632 212.00
5633-6007 247.50
6008-6082 285.50

Approval of new applications is closed for all income levels listed below, effective November 9, 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
$6083-6383 $285.50
6384-6758 326.50
6759-6946 353.00

Family Size 10 School-Age Co-Payment

Monthly Income Monthly Co-Pay
$0-1641 $1.00
1642-2051 1.50
2052-2461 17.00
2462-2871 27.00
2872-3281 42.00
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 270.00
6563-6644 312.00

Approval of new applications is closed for all income levels listed below, effective November 9, 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
$6645-6972 $312.00
6973-7382 356.50
7383-7587 385.50