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Administrative Notice A-07-2022 September 7, 2022 Page 9

Attachment C

PURCHASE OF CARE (POC) PROGRAM FFY 2023 OCTOBER 1, 2022 – SEPTEMBER 30, 2023

CHILD CARE INCOME ELIGIBILITY LIMITS & SLIDING FEE SCALE MONTHLY COPAYMENTS ARE BASED ON COUNTABLE FAMILY INCOME Family Size Maximum Gross Monthly Income at Application 185% FPL Maximum Gross Monthly Income at Redetermination 200% FPL Maximum Gross Monthly Income during Authorization 85% SMI Excessive Financial Burden for Copayments ≤ 40% FPL Waived Copayments ≤ 70% FPL 4% of Gross Income Applied to Copayments >70% - 105% FPL 9% of Gross Income Applied to Copayments >105% - 200% FPL 1 $2,096 $2,266 $3,894 $453 $793 $794 - $1,190 $1,191 - $2,266 2 $2,823 $3,052 $5,092 $610 $1,068 $1,069 - $1,602 $1,603 - $3,052 3 $3,552 $3,840 $6,290 $768 $1,344 $1,345 - $2,016 $2,017 - $3,840 4 $4,279 $4,626 $7,488 $925 $1,619 $1,620 - $2,429 $2,430 - $4,626 5 $5,006 $5,412 $8,686 $1,082 $1,894 $1,895 - $2,841 $2,842 - $5,412 6 $5,735 $6,200 $9,884 $1,240 $2,170 $2,171 - $3,255 $3,256 - $6,200 7 $6,462 $6,986 $10,108 $1,397 $2,445 $2,446 - $3,668 $3,669 - $6,986 8 $7,189 $7,772 $10,333 $1,554 $2,720 $2,721 - $4,080 $4,081 - $7,772 9 $7,918 $8,560 $10,557 $1,712 $2,996 $2,997 - $4,494 $4,495 - $8,560 10 $8,647 $9,348 $10,782 $1,870 $3,272 $3,273 - $4,908 $4,909 - $9,348 11 $9,376 $10,136 $11,007 $2,027 $3,548 $3,549 - $5,321 $5,322 - $10,136 12 $10,105 $10,924 $11,231 $2,185 $3,823 $3,824 - $5,735 $5,736 - $10,924 13 $10,834 $11,712 $11,456 $2,342 $4,099 $4,100 - $6,149 $6,150 - $11,712 14 $11,563 $12,500 $11,681 $2,500 $4,375 $4,376 - $6,563 $6,564 - $12,500 15 $12,291 $13,288 $11,905 $2,658 $4,651 $4,652 - $6,976 $6,977 - $13,288 16 $13,020 $14,076 $12,130 $2,815 $4,927 $4,928 - $7,390 $7,391 - $14,076 17 $13,749 $14,864 $12,354 $2,973 $5,202 $5,203 - $7,804 $7,805 - $14,864 18 $14,478 $15,652 $12,579 $3,130 $5,478 $5,479 - $8,217 $8,218 - $15,652