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MC DC Healthcare Alliance (200% of the FPL) See AX: Parents, except for Pregnant Women. Childless Adult Medicaid (200% of the FPL) See AX: Parents, except for Pregnant Women

EXHIBIT VI-4 TANF STANDARD OF ASSISTANCE AND PAYMENT LEVELS

Group Size Standard of Assistance Full Payment Levels (effective January 1, 2009) Reduced Payment Levels For Families Receiving TANF over 60 Months (effective October 1, 2013) 1 $450 $270 $162 2 $560 $336 $202 3 $712 $428 $257 4 $870 $528 $314 5 $1,002 $602 $362 6 $1,178 $708 $425 7 $1,352 $812 $488 8 $1,494 $897 $539 9 $1,642 $987 $593 10 $1,786 $1,072 $644 11 $1,884 $1,131 $679 12 $2,024 $1,216 $730 13 $2,116 $1,271 $763 14 $2,232 $1,340 $804 15 $2,316 $1,391 $835 16 $2,432 $1,461 $877 17 $2,668 $1,602 $962 18 $2,730 $1,639 $983 19 $2,786 $1,673 $1,004