Page 7

Appendix Page A-3-g 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 $2,063 $2,116 $1,521 $1,574 $1,138 $1,415 $1,468 $2,223 $2,276 $227 $280 2 $2,788 $2,860 $2,055 $2,127 $1,538 $1,911 $1,983 $3,003 $3,075 $306 $378 3 $3,512 $3,603 $2,589 $2,680 $1,937 $2,408 $2,499 $3,783 $3,874 $384 $475 4 $4,236 $4,345 $3,123 $3,232 $2,337 $2,904 $3,013 $4,564 $4,673 $462 $571 5 $4,960 $5,088 $3,657 $3,785 $2,736 $3,401 $3,529 $5,344 $5,472 $541 $669 6 $5,685 $5,832 $4,190 $4,337 $3,136 $3,897 $4,044 $6,124 $6,271 $619 $766 7 $6,409 $6,574 $4,724 $4,889 $3,535 $4,394 $4,559 $6,904 $7,069 $697 $862 8 $7,133 $7,317 $5,258 $5,442 $3,935 $4,890 $5,074 $7,685 $7,869 $775 $959 9 $7,857 $8,060 $5,792 $5,995 $4,334 $5,387 $5,590 $8,465 $8,668 $853 $1,056 10 $8,582 $8,803 $6,326 $6,547 $4,733 $5,884 $6,105 $9,245 $9,466 $931 $1,152 11 $9,306 $9,546 $6,860 $7,100 $5,133 $6,380 $6,620 $10,026 $10,266 $1,009 $1,249 12 $10,030 $10,289 $7,394 $7,653 $5,532 $6,877 $7,136 $10,806 $11,065 $1,087 $1,346 For more than 12, add: $400 for each additional person to increase the FPL. 13 14 15 16 17 18 19 20 $277 $296 $315 $333 $352 $371 $389 $408 2020 MAGI INCOME LIMITS EFFECTIVE MARCH 1, 2020 $781 for each additional person to increase the FPL. COE-075 - Low-Income Parents & Caretaker Relatives $78 for each additional person to increase the FPL. HH Size 5% Disregard Amt Use the chart below for the correct 5% disregard amount to use for households with more than 12 persons. 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 $725 for each additional person to increase the FPL. $534 for each additional person to increase the FPL. $497 for each additional person to increase the FPL.