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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 7 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 8 Monthly Income Monthly Co-Pay 0 - 4643 .50 4644 - 5108 23.00 5109 - 5572 51.00 5573 - 6036 83.50 6037 - 6501 120.50 6502 - 6965 162.50 6966 - 7429 209.00 7430 - 7894 260.00 7895 - 8358 276.50 8359 - 8822 292.50 8823 - 9287 309.00 9288 - 9751 325.00 9752 - 10215 341.50 10216 - 10448 357.50 Family Size 9 Monthly Income Monthly Co-Pay 0 - 5117 .50 5118 - 5628 25.50 5629 - 6140 56.50 6141 - 6652 92.00 6653 - 7163 133.00 7164 - 7675 179.00 7676 - 8187 223.50 8188 - 8698 286.50 8699 - 9210 304.50 9211 - 9722 322.00 9723 - 10233 340.50 10234 - 10745 358.00 10746 - 11257 376.00 11258 - 11513 394.00 Family Size 10 Monthly Income Monthly Co-Pay 0 - 5590 .50 5591 - 6149 28.00 6150 - 6708 61.50 6709 - 7267 100.50 7268 - 7826 145.50 7827 - 8385 195.50 8386 - 8944 251.50 8945 - 9503 313.00 9504 - 10062 332.50 10063 - 10621 352.00 10622 - 11180 372.00 11181 - 11739 391.50 11740 - 12298 411.00 12299 - 12578 430.50 Family Size 8 Monthly Income Monthly Co-Pay 10449 - 10680 365.50 10681 - 11144 374.00 11145 - 11608 390.00 11609 - 12073 406.50 12074 - 12526 422.50 Family Size 9 Monthly Income Monthly Co-Pay 11514 - 11768 403.00 11769 - 12280 412.00 12281 - 12792 430.00 12793 - 12798 448.00 Family Size 10 Monthly Income Monthly Co-Pay 12579 - 12857 440.50 12858 - 13343 469.50 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