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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 7 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 8 Monthly Income Monthly Co-Pay 0 - 4513 .50 4514 - 4964 22.50 4965 - 5415 49.50 5416 - 5866 81.00 5867 - 6318 117.50 6319 - 6769 158.00 6770 - 7220 203.00 7221 - 7671 252.50 7672 - 8123 268.50 8124 - 8574 284.50 8575 - 9025 300.00 9026 - 9476 316.00 9477 - 9928 331.50 9929 - 10153 347.50 Family Size 9 Monthly Income Monthly Co-Pay 0 - 4971 .50 4972 - 5468 25.00 5469 - 5965 54.50 5966 - 6462 89.50 6463 - 6959 129.50 6960 - 7456 174.00 7457 - 7953 223.50 7954 - 8450 278.50 8451 - 8948 296.00 8949 - 9445 313.00 9446 - 9942 330.50 9943 - 10439 348.00 10440 - 10936 365.50 10937 - 11184 383.00 Family Size 10 Monthly Income Monthly Co-Pay 0 - 5429 .50 5430 - 5972 28.00 5973 - 6515 61.00 6516 - 7058 99.00 7059 - 7601 143.00 7602 - 8144 192.00 81456 - 8687 246.00 8688 - 9230 305.50 9231 - 97732 324.00 9774 - 10315 342.50 10316 - 10858 361.00 10859 - 11401 379.50 11402 - 11944 398.00 11945 - 12216 418.00 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 350.50 10380 - 10830 361.50 10831 - 11281 379.00 11282 - 11733 395.00 11734 - 11939 410.50 Family Size 9 Monthly Income Monthly Co-Pay 11185 - 11433 391.50 11434 - 11930 400.00 11931 - 12198 417.50 Family Size 10 Monthly Income Monthly Co-Pay 12217 - 12458 427.50 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