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18.2.1 MHN Income Standards – MAGI Income Limits (w/5%) and CHIP Premium Amounts Page 9

MAGI income max with 5% -CHIP 75, UWHS, MPW POV, MHK, & AEG- FPL included and CHIP premium amounts 7/1/2022-3/31/2023 # of Persons 1 2 3 4 5 6 7 8 9 10 11 #300% of Poverty SMHB & CHIP 75 3455 4654 5854 7054 8253 9453 10653 11852 13052 14252 15451 Premium 117 159 200 241 283 324 366 407 449 490 532 225% of Poverty CHIP 74 2549 3434 4319 5204 6089 6974 7859 8744 9629 10514 11399 Premium 48 65 82 99 115 132 150 167 184 200 217 #201% of Poverty UWHS 2333 3144 3954 4764 5575 6385 7195 8005 8816 9626 10436 #196% of Poverty MPW & MHK under 1 2277 3067 3858 4649 5439 6230 7020 7811 8602 9392 10183 185% of Poverty CHIP 73 2096 2823 3551 4279 5006 5734 6462 7189 7917 8645 9372 Premium 15 20 25 30 35 40 46 51 56 61 66 153%* of Poverty CHIP 4M 1733 2335 2936 3538 4140 4742 5344 5945 6547 7149 7751 150% of Poverty CHIP 71 & 72 1699 2289 2879 3469 4059 4649 5239 5829 6419 7009 7599 #148% of Poverty MHK 1733 2335 2937 3539 4140 4742 5344 5946 6548 7149 7751 141% of Poverty MPW HIF 1597 2152 2707 3261 3816 4370 4925 5480 6034 6589 7143 #133% of Poverty AEG 1563 2106 2649 3192 3735 4277 4820 5363 5906 6449 6991 110%* of Poverty 1246 1678 2111 2544 2976 3409 3842 4274 4707 5140 5572 MHF/MPW MHF 141 241 301 353 400 445 490 532 574 616 658 100% of Poverty (without 5%) 1133 1526 1920 2313 2706 3100 3493 3886 4280 4673 5066 *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 16651 17851 19050 20250 21450 22649 23849 25049 26248 27448 28648 Premium 573 614 656 697 739 780 822 863 904 946 987 225% of Poverty CHIP 74 12284 13169 14054 14939 15824 16709 17594 18479 19364 20249 21134 Premium 234 251 269 285 302 319 336 352 370 387 404 #201% of Poverty UWHS 11246 12057 12867 13677 14487 15298 16108 16918 17729 18529 19349

#196% of Poverty MPW & MHK under 1 10523 11283 12044 12804 13565 14325 15086 15846 16606 17367 18127 185% of Poverty CHIP 73 10100 10828 11555 12283 13011 13738 14466 15194 15921 16649 17377 Premium 71 76 82 87 92 97 102 107 113 118 123 153%* of Poverty CHIP 4M 8353 8954 9556 10158 10760 11362 11963 12565 13167 13769 14371 150% of Poverty CHIP 71 & 72 8189 8779 9369 9959 10549 11139 11729 12319 12909 13499 14089 #148% of Poverty MHK 8353 8955 9557 10158 10760 11362 11964 12566 13167 13769 14371 141% of Poverty MPW HIF 7698 8253 8807 9362 9916 10471 11026 11580 12135 12689 13244 #133% of Poverty AEG 7534 8077 8620 9163 9705 10248 10791 11334 11877 12419 12962 110%* of Poverty 6005 6438 6870 7303 7736 8168 8601 9034 9466 9899 10332 MHF/MPW MHF 700 742 784 826 868 910 952 994 1036 1078 1120 100% of Poverty (without 5%) 5460 5853 6246 6640 7033 7426 7820 8213 8606 9000 9393 *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 07/2022