Page 7

Four Person Household 47% Entrance Level: $67,679 67% Exit Level (at redetermination): $96,479 85% Exit Level (during eligibility period): $122,398 Gross income range Biweekly copayment From To $0 $24,112 $0 $24,113 $32,149 $2 $32,150 $39,930 $40 $39,931 $41,830 $42 $41,831 $43,731 $44 $43,732 $45,632 $46 $45,633 $47,533 $53 $47,534 $49,434 $55 $49,435 $51,349 $58 $51,350 $53,235 $60 $53,236 $55,150 $68 $55,151 $57,051 $71 $57,052 $58,952 $73 $58,953 $60,853 $90 $60,854 $62,753 $93 $62,754 $64,654 $111 $64,655 $66,555 $122 $66,556 $68,456 $133 $68,457 $70,356 $153 $70,357 $72,257 $165 $72,258 $74,158 $178 $74,159 $76,059 $200 $76,060 $77,960 $227 $77,961 $79,860 $256 $79,861 $81,761 $289 $81,762 $83,662 $324 $83,663 $85,563 $360 $85,564 $87,463 $389 $87,464 $89,379 $418 $89,380 $91,279 $448 $91,280 $93,180 $480 $93,181 $96,479 $520

Five Person Household 47% Entrance Level: $78,508 67% Exit Level (at redetermination): $111,915 85% Exit Level (during eligibility period): $141,982 Gross income range Biweekly copayment From To $0 $28,237 $0 $28,238 $37,649 $2 $37,650 $46,319 $47 $46,320 $48,524 $49 $48,525 $50,728 $51 $50,729 $52,933 $53 $52,934 $55,138 $62 $55,139 $57,343 $64 $57,344 $59,565 $66 $59,566 $61,753 $69 $61,754 $63,975 $79 $63,976 $66,179 $82 $66,180 $68,384 $84 $68,385 $70,589 $104 $70,590 $72,794 $108 $72,795 $74,999 $129 $75,000 $77,204 $141 $77,205 $79,409 $154 $79,410 $81,614 $177 $81,615 $83,819 $192 $83,820 $86,024 $206 $86,025 $88,228 $232 $88,229 $90,433 $264 $90,434 $92,638 $297 $92,639 $94,843 $336 $94,844 $97,048 $376 $97,049 $99,253 $418 $99,254 $101,458 $451 $101,459 $103,679 $485 $103,680 $105,884 $520 $105,885 $108,089 $556 $108,090 $111,915 $603