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18.2.1 MHN Income Standards – MAGI Income Limits (w/5%) and CHIP Premium Amounts Page 8

MAGI income max with 5% -CHIP 75, UWHS, MPW POV, MHK, & AEG- FPL included and CHIP premium amounts 4/1/2023-6/30/2023 # of Persons 1 2 3 4 5 6 7 8 9 10 11 #300% of Poverty SMHB & CHIP 75 3706 5013 6319 7625 8932 10238 11545 12851 14158 15464 16770 Premium 117 159 200 241 283 324 366 407 449 490 532 225% of Poverty CHIP 74 2734 3698 4662 5625 6589 7553 8517 9480 10444 11408 12372 Premium 48 65 82 99 115 132 150 167 184 200 217 #201% of Poverty UWHS 2503 3386 4268 5150 6033 6915 7798 8680 9562 10445 11327 #196% of Poverty MPW & MHK under 1 2443 3304 4165 5025 5886 6747 7608 8469 9330 10191 11052 185% of Poverty CHIP 73 2248 3041 3833 4625 5418 6210 7003 7795 8588 9380 10172 Premium 15 20 25 30 35 40 46 51 56 61 66 153%* of Poverty CHIP 4M 1859 2515 3170 3825 4481 5136 5792 6447 7102 7758 8413 150% of Poverty CHIP 71 & 72 1823 2465 3108 3750 4393 5035 5678 6320 6963 7605 8248 #148% of Poverty MHK 1859 2515 3170 3825 4481 5136 5792 6447 7102 7758 8413 141% of Poverty MPW HIF 1714 2318 2922 3525 4129 4733 5337 5941 6545 7149 7753 #133% of Poverty AEG 1677 2268 2859 3450 4042 4633 5224 5815 6406 6997 7588 110%* of Poverty 1337 1808 2279 2750 3221 3692 4164 4635 5106 5577 6048 MHF/MPW MHF 141 241 301 353 400 445 490 532 574 616 658 100% of Poverty (without 5%) 1215 1644 2072 2500 2929 3357 3785 4214 4642 5070 5499 *Income Ranges for CHIP 4M-Ages 1 through 5=148%-153% and ages 6 through 18=110%-153%; #=5% disregard applied at this level. # of Persons 12 13 14 15 16 17 18 19 20 21 22 #300% of Poverty SMHB & CHIP 75 18077 19383 20690 21996 23302 24609 25915 27222 28528 29835 31141 Premium 573 614 656 697 739 780 822 863 904 946 987 225% of Poverty CHIP 74 13335 14299 15263 16227 17190 18154 19118 20082 21045 22009 22973 Premium 234 251 269 285 302 319 336 352 370 387 404 #201% of Poverty UWHS 12209 13092 13974 14857 15739 16621 17504 18386 19268 20151 21033 #196% of Poverty MPW & MHK under 1 11913 12774 13635 14496 15357 16218 17079 17940 18801 19662 20523 185% of Poverty CHIP 73 10965 11757 12550 13342 14134 14927 15719 16512 17304 18097 18889 Premium 71 76 82 87 92 97 102 107 113 118 123 153%* of Poverty CHIP 4M 9068 9724 10379 11034 11690 12345 13000 13656 14311 14966 15622 150% of Poverty CHIP 71 & 72 8890 9533 10175 10818 11460 12103 12745 13388 14030 14673 15315 #148% of Poverty MHK 9068 9724 10379 11034 11690 12345 13000 13656 14311 14966 15622 141% of Poverty MPW HIF 8357 8961 9565 10169 10773 11377 11981 12585 13189 13793 14397 #133% of Poverty AEG 8179 8770 9361 9953 10544 11135 11726 12317 12908 13499 14090 110%* of Poverty 6519 6991 7462 7933 8404 8875 9346 9818 10289 10760 11231 MHF/MPW MHF 700 742 784 826 868 910 952 994 1036 1078 1120 100% of Poverty (without 5%) 5927 6355 6784 7212 7640 8069 8497 8925 9354 9782 10210 *Income Ranges for CHIP 4M-Ages 1 through 5=148%-153% and ages 6 through 18=110%-153%; #=5% disregard applied at this level.

Revised 04/2023