Page 6

Two Person Household 47% Entrance Level: $46,022 67% Exit Level (at redetermination): $65,606 85% Exit Level (during eligibility period): $83,231 Gross income range Biweekly copayment From To $0 $15,862 $0 $15,863 $21,149 $2 $21,150 $27,152 $27 $27,153 $28,444 $29 $28,445 $29,737 $30 $29,738 $31,030 $31 $31,031 $32,322 $36 $32,323 $33,615 $38 $33,616 $34,917 $39 $34,918 $36,200 $41 $36,201 $37,502 $46 $37,503 $38,795 $48 $38,796 $40,087 $49 $40,088 $41,380 $61 $41,381 $42,672 $63 $42,673 $43,965 $75 $43,966 $45,257 $83 $45,258 $46,550 $90 $46,551 $47,842 $104 $47,843 $49,135 $113 $49,136 $50,427 $121 $50,428 $51,720 $136 $51,721 $53,012 $155 $53,013 $54,305 $174 $54,306 $55,597 $197 $55,598 $56,890 $220 $56,891 $58,182 $245 $58,183 $59,475 $264 $59,476 $60,777 $284 $60,778 $62,070 $305 $62,071 $63,362 $326 $63,363 $65,606 $353

Three Person Household 47% Entrance Level: $56,850 67% Exit Level (at redetermination): $81,042 85% Exit Level (during eligibility period): $102,814 Gross income range Biweekly copayment From To $0 $19,987 $0 $19,988 $26,649 $2 $26,650 $33,541 $34 $33,542 $35,137 $35 $35,138 $36,734 $37 $36,735 $38,331 $38 $38,332 $39,927 $45 $39,928 $41,524 $47 $41,525 $43,133 $48 $43,134 $44,717 $50 $44,718 $46,326 $57 $46,327 $47,923 $59 $47,924 $49,519 $61 $49,520 $51,116 $76 $51,117 $52,712 $78 $52,713 $54,309 $93 $54,310 $55,906 $102 $55,907 $57,502 $112 $57,503 $59,099 $128 $59,100 $60,696 $139 $60,697 $62,292 $150 $62,293 $63,889 $168 $63,890 $65,486 $191 $65,487 $67,082 $215 $67,083 $68,679 $243 $68,680 $70,276 $272 $70,277 $71,872 $302 $71,873 $73,469 $326 $73,470 $75,078 $351 $75,079 $76,674 $377 $76,675 $78,271 $403 $78,272 $81,042 $436