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Appendix Page A-3-b COE-073- Children Age 6 to 19 HH Size 194% FPL 194% + 5% Disregard 143% FPL 143% + 5% Disregard 107% FPL (no 5% disregard) 133% FPL 133% + 5% Disregard 209% FPL 209% + 5% Disregard State Set Income Limit Limit + 5% Disregard 1 $1,903 $1,952 $1,403 $1,452 $1,050 $1,305 $1,354 $2,050 $2,099 $227 $276 2 $2,576 $2,642 $1,899 $1,965 $1,421 $1,766 $1,832 $2,775 $2,841 $306 $372 3 $3,248 $3,332 $2,395 $2,479 $1,792 $2,227 $2,311 $3,500 $3,584 $384 $468 4 $3,921 $4,022 $2,890 $2,991 $2,163 $2,688 $2,789 $4,224 $4,325 $462 $563 5 $4,593 $4,711 $3,386 $3,504 $2,534 $3,149 $3,267 $4,949 $5,067 $541 $659 6 $5,266 $5,402 $3,882 $4,018 $2,905 $3,610 $3,746 $5,673 $5,809 $619 $755 7 $5,939 $6,092 $4,377 $4,530 $3,276 $4,071 $4,224 $6,398 $6,551 $697 $850 8 $6,611 $6,781 $4,873 $5,043 $3,647 $4,532 $4,702 $7,122 $7,292 $775 $945 9 $7,284 $7,472 $5,369 $5,557 $4,017 $4,994 $5,182 $7,847 $8,035 $853 $1,041 10 $7,956 $8,161 $5,865 $6,070 $4,388 $5,455 $5,660 $8,571 $8,776 $931 $1,136 11 $8,629 $8,851 $6,360 $6,582 $4,759 $5,916 $6,138 $9,296 $9,518 $1,009 $1,231 12 $9,301 $9,541 $6,856 $7,096 $5,130 $6,377 $6,617 $10,120 $10,360 $1,087 $1,327 For more than 12, add: $371 for each additional person to increase the FPL. 13 14 15 16 17 18 19 20 $257 $274 $292 $309 $326 $344 $361 $378 HH Size 5% Disregard Amt $673 for each additional person to increase the FPL. $496 for each additional person to increase the FPL. $462 for each additional person to increase the FPL. $725 for each additional person to increase the FPL. For more than 8 persons, add $78 for each additional person to the State Set Income Limit Use the chart below for the correct 5% disregard amount to use for households with more than 12 persons. 2015 MAGI INCOME LIMITS EFFECTIVE MARCH 1, 2015 COE-088-Pregnant Women, COE-071 - Infants to Age 1, COE-029 Family Planning Waiver COE-072 - Children Age 1 to Age 6 COE-074- Children Age 6 to Age 19 COE-099 - CHIP COE-075 - Low-Income Parents & Caretaker Relatives