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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 4 of 7 IMPORTANT PARENT COPAYMENT INFORMATION Effective July 1, 2025 - TABLE A Family Size 8 Monthly Income Monthly Co-Pay 0 - 4513 1.00 4514 - 4964 45.00 4965 - 5415 99.00 5416 - 5866 162.00 5867 - 6318 235.00 6319 - 6769 316.00 6770 - 7220 406.00 7221 - 7671 505.00 7672 - 8123 537.00 8124 - 8574 569.00 8575 - 9025 600.00 9026 - 9476 632.00 9477 - 9928 663.00 9929 - 10153 695.00 Family Size 9 Monthly Income Monthly Co-Pay 0 - 4971 1.00 4972 - 5468 50.00 5469 - 5965 109.00 5966 - 6462 179.00 6463 - 6959 259.00 6960 - 7456 348.00 7457 - 7953 447.00 7954 - 8450 557.00 8451 - 8948 592.00 8949 - 9445 626.00 9446 - 9942 661.00 9943 - 10439 696.00 10440 - 10936 731.00 10937 - 11184 766.00 Family Size 10 Monthly Income Monthly Co-Pay 0 - 5429 1.00 5430 - 5972 54.00 5973 - 6515 119.00 6516 - 7058 195.00 7059 - 7601 282.00 7602 - 8144 380.00 8145 - 8687 489.00 8688 - 9230 608.00 9231 - 9773 646.00 9774 - 10315 684.00 10316 - 10858 722.00 10859 - 11401 760.00 11402 - 11944 798.00 11945 - 12216 836.00 Income can extend to the following ranges at the time of Redetermination and qualify for a new 12-month eligibility period. Family Size 8 Monthly Income Monthly Co-Pay 10154 - 10379 711.00 10380 - 10830 727.00 10831 - 11281 758.00 11282 - 11733 790.00 11734 - 11939 821.00 Family Size 9 Monthly Income Monthly Co-Pay 11185 - 11433 783.00 11434 - 11930 800.00 11931 - 12198 835.00 Family Size 10 Monthly Income Monthly Co-Pay 12217 - 12458 855.00 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 8 Monthly Income Monthly Co-Pay See Maximum Above Family Size 9 Monthly Income Monthly Co-Pay See Maximum Above Family Size 10 Monthly Income Monthly Co-Pay See Maximum Above