Family Size 2
Monthly Income |
Monthly Co-Pay |
$0 - $542 |
$2.00 |
543-677 |
3.00 |
678-812 |
11.00 |
813-948 |
18.00 |
949-1083 |
28.00 |
1084-1218 |
40.00 |
1219-1354 |
54.00 |
1355-1489 |
70.00 |
1490-1624 |
88.00 |
1625-1760 |
107.00 |
1761-1895 |
129.00 |
1896-2030 |
153.00 |
2031-2166 |
178.00 |
2167-2193 |
206.00 |
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 a redetermination will be income eligible if they fall within the levels below.
Monthly Income |
Monthly Co-Pay |
$2194-2301 |
$206.00 |
2302-2436 |
235.00 |
2437-2504 |
254.00 |
Family Size 3
Monthly Income |
Monthly Co-Pay |
$0-681 |
$2.00 |
682-851 |
3.00 |
852-1021 |
14.00 |
1022-1192 |
22.00 |
1193-1362 |
35.00 |
1363-1532 |
50.00 |
1533-1702 |
68.00 |
1703-1872 |
88.00 |
1873-2042 |
110.00 |
2043-2213 |
135.00 |
2214-2383 |
162.00 |
2384-2553 |
192.00 |
2554-2723 |
224.00 |
2724-2757 |
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 a redetermination will be income eligible if they fall within the levels below.
Monthly Income |
Monthly Co-Pay |
$2758-2893 |
$259.00 |
2894-3063 |
296.00 |
3064-3149 |
320.00 |
Family Size 4
Monthly Income |
Monthly Co-Pay |
$0-820 |
$2.00 |
821-1025 |
3.00 |
1026-1230 |
17.00 |
1231-1435 |
27.00 |
1436-1640 |
42.00 |
1641-1845 |
60.00 |
1846-2050 |
81.00 |
2051-2255 |
105.00 |
2256-2460 |
133.00 |
2461-2665 |
162.00 |
2666-2870 |
195.00 |
2871-3075 |
231.00 |
3076-3280 |
270.00 |
3281-3321 |
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 a redetermination will be income eligible if they fall within the levels below.
Monthly Income |
Monthly Co-Pay |
$3322-3485 |
$312.00 |
3486-3690 |
357.00 |
3691-3793 |
385.00 |
Family Size 5
Monthly Income |
Monthly Co-Pay |
$0-960 |
$2.00 |
961-1200 |
3.00 |
1201-1439 |
20.00 |
1440-1679 |
32.00 |
1680-1919 |
49.00 |
1920-2159 |
71.00 |
2160-2399 |
95.00 |
2400-2639 |
123.00 |
2640-2878 |
155.00 |
2879-3118 |
190.00 |
3119-3358 |
229.00 |
3359-3598 |
271.00 |
3599-3838 |
316.00 |
3839-3886 |
365.00 |
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 a redetermination will be income eligible if they fall within the levels below.
Monthly Income |
Monthly Co-Pay |
$3887-4078 |
$365.00 |
4079-4317 |
417.00 |
4318-4437 |
451.00 |
Family Size 6
Monthly Income |
Monthly Co-Pay |
$0-1099 |
$2.00 |
1100-1374 |
3.00 |
1375-1648 |
23.00 |
1649-1923 |
36.00 |
1924-2198 |
56.00 |
2199-2472 |
81.00 |
2473-2747 |
109.00 |
2748-3022 |
141.00 |
3023-3296 |
178.00 |
3297-3571 |
218.00 |
3572-3846 |
262.00 |
3847-4120 |
310.00 |
4121-4395 |
362.00 |
4396-4450 |
418.00 |
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 a redetermination will be income eligible if they fall within the levels below.
Monthly Income |
Monthly Co-Pay |
$4451-4670 |
$418.00 |
4671-4944 |
478.00 |
4945-5082 |
516.00 |
Family Size 7
Monthly Income |
Monthly Co-Pay |
$0-1238 |
$2.00 |
1239-1548 |
3.00 |
1549-1857 |
26.00 |
1858-2167 |
41.00 |
2168-2476 |
64.00 |
2477-2786 |
91.00 |
2787-3095 |
123.00 |
3096-3405 |
159.00 |
3406-3714 |
200.00 |
3715-4024 |
245.00 |
4025-4333 |
295.00 |
4334-4643 |
349.00 |
4644-4952 |
408.00 |
4953-5014 |
471.00 |
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 a redetermination will be income eligible if they fall within the levels below.
Monthly Income |
Monthly Co-Pay |
$5015-5262 |
$471.00 |
5263-5571 |
538.00 |
5272-5726 |
582.00 |
Family Size 8
Monthly Income |
Monthly Co-Pay |
$0-1378 |
$2.00 |
1379-1722 |
3.00 |
1723-2066 |
28.00 |
2067-2411 |
45.00 |
2412-2755 |
71.00 |
2756-3099 |
101.00 |
3100-3444 |
137.00 |
3445-3788 |
177.00 |
3789-4132 |
223.00 |
4133-4477 |
273.00 |
4478-4821 |
328.00 |
4822-5165 |
388.00 |
5166-5510 |
454.00 |
5511-5579 |
524.00 |
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 a redetermination will be income eligible if they fall within the levels below.
Monthly Income |
Monthly Co-Pay |
$5580-5854 |
$524.00 |
5855-6198 |
599.00 |
6199-6371 |
647.00 |
Family Size 9
Monthly Income |
Monthly Co-Pay |
$0-1517 |
$2.00 |
1518-1896 |
3.00 |
1897-2275 |
31.00 |
2276-2655 |
50.00 |
2656-3034 |
78.00 |
3035-3413 |
112.00 |
3414-3792 |
151.00 |
3793-4171 |
195.00 |
4172-4550 |
245.00 |
4551-4930 |
301.00 |
4931-5309 |
361.00 |
5310-5688 |
428.00 |
5689-6067 |
500.00 |
6068-6143 |
577.00 |
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 a redetermination will be income eligible if they fall within the levels below.
Monthly Income |
Monthly Co-Pay |
$6144-6446 |
$577.00 |
6447-6825 |
660.00 |
6826-7015 |
713.00 |
Family Size 10
Monthly Income |
Monthly Co-Pay |
$0-1656 |
$2.00 |
1657-2070 |
3.00 |
2071-2484 |
34.00 |
2485-2898 |
54.00 |
2899-3312 |
85.00 |
3313-3726 |
122.00 |
3727-4140 |
164.00 |
4141-4554 |
213.00 |
4555-4968 |
268.00 |
4969-5382 |
328.00 |
5383-5796 |
395.00 |
5797-6210 |
467.00 |
6211-6624 |
545.00 |
6625-6707 |
630.00 |
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 a redetermination will be income eligible if they fall within the levels below.
Monthly Income |
Monthly Co-Pay |
$6708-7038 |
$630.00 |
7039-7452 |
720.00 |
7453-7659 |
778.00 |