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IL444-3455B DEC Rev 06.26 Important Parent Co-payment Information State of Illinois Department of Human Services IMPORTANT PARENT CO-PAYMENT INFORMATION Page 6 of 7 Printed by Authority of the State of Illinois -0- Copies

Effective July 1, 2026 - TABLE B Maximum Monthly Income and Monthly Co-Pay by Family Size and Income Level at Time of New Application. Income can extend to the following ranges at the time of Redetermination and qualify for a new 12-month eligibility period. 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 http://idec.illinois.gov/resources/policies

Family Size 5 Monthly Income Monthly Co-Pay 0 - 3223 .50 3224 - 3546 16.00 3547 - 3868 35.50 3869 - 4190 58.00 4191 - 4513 84.00 4514 - 4835 113.00 4836 - 5157 145.00 5158 - 5480 180.50 5481 - 5802 192.00 5803 - 6124 203.00 6125 - 6447 214.50 6448 - 6769 225.50 6770 - 7091 237.00 7092 - 7253 248.00 Family Size 6 Monthly Income Monthly Co-Pay 0 - 3697 .50 3698 - 4066 18.50 4067 - 4436 40.50 4437 - 4806 66.50 4807 - 5175 96.00 5176 - 5545 129.50 5546 - 5915 166.50 5916 - 6284 207.00 6285 - 6654 220.00 6655 - 7024 233.00 7025 - 7393 246.00 7394 - 7763 259.00 7764 - 8133 271.50 8134 - 8318 284.50 Family Size 7 Monthly Income Monthly Co-Pay 0 - 4170 .50 4171 - 4587 21.00 4588 - 5004 46.00 5005 - 5421 75.00 5422 - 5838 108.50 5839 - 6255 146.00 6256 - 6672 187.50 6673 - 7089 233.50 7090 - 7506 248.00 7507 - 7923 262.50 7924 - 8340 277.50 8341 - 8757 292.00 8758 - 9174 306.50 9175 - 9383 321.00 Family Size 5 Monthly Income Monthly Co-Pay 7254 - 7414 254.00 7415 - 7736 259.50 7737 - 8058 271.00 8059 - 8381 282.00 8382 - 8703 293.50 8704 - 8864 304.50 Family Size 6 Monthly Income Monthly Co-Pay 8319 - 8502 291.00 8503 - 8872 297.50 8873 - 9242 310.50 9243 - 9611 323.50 9612 - 9981 336.50 9982 - 10166 349.50 Family Size 7 Monthly Income Monthly Co-Pay 9384 - 9591 328.50 9592 - 10008 335.50 10009 - 10425 350.50 10426 - 10842 365.00 10843 - 11259 379.50 11260 - 11468 394.00 Family Size 5 Monthly Income Monthly Co-Pay 8865 - 10529 304.50 Family Size 6 Monthly Income Monthly Co-Pay 10167 - 11981 349.50 Family Size 7 Monthly Income Monthly Co-Pay 11469 - 12253 394.00