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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 3 of 7 IMPORTANT PARENT COPAYMENT INFORMATION Effective July 1, 2025 - TABLE A Maximum Monthly Income and Monthly Co-Pay by Family Size and Income Level at Time of New Application. Family Size 5 Monthly Income Monthly Co-Pay 0 - 3138 1.00 3139 - 3451 31.00 3452 - 3765 69.00 3766 - 4079 113.00 4080 - 4393 163.00 4394 - 4706 220.00 4707 - 5020 282.00 5021 - 5334 351.00 5335 - 5648 373.00 5649 - 5961 395.00 5962 - 6275 417.00 6276 - 6589 439.00 6590 - 6903 461.00 6904 - 7059 483.00 Family Size 6 Monthly Income Monthly Co-Pay 0 - 3596 1.00 3597 - 3955 36.00 3956 - 4315 79.00 4316 - 4675 129.00 4676 - 5034 187.00 5035 - 5394 252.00 5395 - 5753 324.00 5754 - 6113 403.00 6114 - 6473 428.00 6474 - 6832 453.00 6833 - 7192 478.00 7193 - 7551 504.00 7552 - 7911 529.00 7912 - 8091 554.00 Family Size 7 Monthly Income Monthly Co-Pay 0 - 4054 1.00 4055 - 4460 41.00 4461 - 4865 89.00 4866 - 5270 146.00 5271 - 5676 211.00 5677 - 6081 284.00 6082 - 6487 365.00 6488 - 6892 454.00 6893 - 7298 483.00 7299 - 7703 511.00 7704 - 8108 539.00 8109 - 8514 568.00 8515 - 8919 596.00 8920 - 9122 624.00 Income can extend to the following ranges at the time of Redetermination and qualify for a new 12-month eligibility period. Family Size 5 Monthly Income Monthly Co-Pay 7060 - 7216 494.00 7217 - 7530 505.00 7531 - 7844 527.00 7845 - 8158 549.00 8159 - 8471 571.00 8472 - 8628 593.00 Family Size 6 Monthly Income Monthly Co-Pay 8092 - 8270 566.00 8271 - 8630 579.00 8631 - 8990 604.00 8991 - 9349 629.00 9350 - 9709 655.00 9710 - 9889 680.00 Family Size 7 Monthly Income Monthly Co-Pay 9123 - 9325 639.00 9326 - 9730 653.00 9731 - 10135 681.00 10136 - 10541 710.00 10542 - 10946 738.00 10947 - 11149 766.00 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 5 Monthly Income Monthly Co-Pay 8629 - 10036 593.00 Family Size 6 Monthly Income Monthly Co-Pay 9890 - 11420 680.00 Family Size 7 Monthly Income Monthly Co-Pay 11150 - 11679 766.00