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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 6 of 7 IMPORTANT PARENT COPAYMENT INFORMATION Effective July 1, 2025 - TABLE B 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 .50 3139 - 3451 15.50 3452 - 3765 34.50 3766 - 4079 56.50 4080 - 4393 81.50 4394 - 4706 110.00 4707 - 5020 141.00 5021 - 5334 175.50 5335 - 5648 186.50 5649 - 5961 197.50 5962 - 6275 208.50 6276 - 6589 219.50 6590 - 6903 230.50 6904 - 7059 241.50 Family Size 6 Monthly Income Monthly Co-Pay 0 - 3596 .50 3597 - 3955 18.00 3956 - 4315 39.50 4316 - 4675 64.50 4676 - 5034 93.50 5035 - 5394 126.00 5395 - 5753 162.00 5754 - 6113 201.50 6114 - 6473 214.00 6474 - 6832 226.50 6833 - 7192 239.00 7193 - 7551 252.00 7552 - 7911 264.50 7912 - 8091 277.00 Family Size 7 Monthly Income Monthly Co-Pay 0 - 4054 .50 4055 - 4460 20.50 4461 - 4865 44.50 4866 - 5270 73.00 5271 - 5676 105.50 5677 - 6081 142.00 6082 - 6487 182.50 6488 - 6892 227.00 6893 - 7298 241.50 7299 - 7703 255.50 7704 - 8108 269.50 8109 - 8514 284.00 8515 - 8919 298.00 8920 - 9122 312.00 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 247.00 7217 - 7530 252.50 7531 - 7844 263.50 7845 - 8158 274.50 8159 - 8471 285.50 8472 - 8628 296.50 Family Size 6 Monthly Income Monthly Co-Pay 8092 - 8270 283.00 8271 - 8630 289.50 8631 - 8990 302.00 8991 - 9349 314.50 9350 - 9709 327.50 9710 - 9889 340.00 Family Size 7 Monthly Income Monthly Co-Pay 9123 - 9325 319.50 9326 - 9730 326.50 9731 - 10135 340.50 10136 - 10541 355.00 10542 - 10946 369.00 10947 - 11149 383.00 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 296.50 Family Size 6 Monthly Income Monthly Co-Pay 9890 - 11420 340.00 Family Size 7 Monthly Income Monthly Co-Pay 11150 - 11679 383.00