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State of Illinois Department of Human Services IL444-3455B (R-07-25) Important Parent Copayment Information Printed by Authority of the State of Illinois -0- Copies Page 2 of 7 IMPORTANT PARENT COPAYMENT INFORMATION Effective July 1, 2025 - TABLE A Co-Pay Indicator A - For any month where the children are non-school age, or from June thru August where the children are school-age, or from September through May where the school-age children are approved for full-time care Maximum Monthly Income and Monthly Co-Pay by Family Size and Income Level at Time of New Application. Family Size 2 Monthly Income Monthly Co-Pay 0 - 1763 1.00 1764 - 1939 18.00 1940 - 2115 39.00 2116 - 2291 63.00 2292 - 2468 92.00 2469 - 2644 123.00 2645 - 2820 159.00 2821 - 2996 197.00 2997 - 3173 210.00 3174 - 3349 222.00 3350 - 3525 235.00 3526 - 3701 247.00 3702 - 3878 259.00 3879 - 3966 272.00 Family Size 3 Monthly Income Monthly Co-Pay 0 - 2221 1.00 2222 - 2443 22.00 2444 - 2665 49.00 2666 - 2887 80.00 2888 - 3109 116.00 3110 - 3331 156.00 3332 - 3553 200.00 3554 - 3775 249.00 3776 - 3998 264.00 3999 - 4220 280.00 4221 - 4442 295.00 4443 - 4664 311.00 4665 - 4886 327.00 4887 - 4997 342.00 Family Size 4 Monthly Income Monthly Co-Pay 0 - 2679 1.00 2680 - 2947 27.00 2948 - 3215 59.00 3216 - 3483 96.00 3484 - 3751 139.00 3752 - 4019 188.00 4020 - 4287 241.00 4288 - 4555 300.00 4556 - 4823 319.00 4824 - 5090 338.00 5091 - 5358 356.00 5359 - 5626 375.00 5627 - 5894 394.00 5895 - 6028 413.00 Income can extend to the following ranges at the time of Redetermination and qualify for a new 12-month eligibility period. Family Size 2 Monthly Income Monthly Co-Pay 3967 - 4054 278.00 4055 - 4230 284.00 4231 - 4406 296.00 4407 - 4583 308.00 4584 - 4759 321.00 4760 - 4847 333.00 Family Size 3 Monthly Income Monthly Co-Pay 4998 - 5108 350.00 5109 - 5330 358.00 5331 - 5552 373.00 5553 - 5774 389.00 5775 - 5996 404.00 5997 - 6107 420.00 Family Size 4 Monthly Income Monthly Co-Pay 6029 - 6162 422.00 6163 - 6430 431.00 6431 - 6698 450.00 6699 - 6966 469.00 6967 - 7234 488.00 7235 - 7368 506.00 Family Income in the following ranges at the time of redetermination will result in a 3-month eligibility extension, known as a Graduated Phase Out for more information, see CCAP Policy 02.03.01 https://www.dhs.state.il.us/page.aspx?item=10568 Family Size 2 Monthly Income Monthly Co-Pay 4848 - 5883 333.00 Family Size 3 Monthly Income Monthly Co-Pay 6108 - 7267 420.00 Family Size 4 Monthly Income Monthly Co-Pay 7369 - 8651 506.00