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Appendix Page A-3-h 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 $2,083 $2,137 $1,535 $1,589 $1,149 $1,428 $1,482 $2,244 $2,298 $227 $281 2 $2,817 $2,890 $2,076 $2,149 $1,554 $1,931 $2,004 $3,034 $3,107 $306 $379 3 $3,551 $3,643 $2,617 $2,709 $1,959 $2,434 $2,526 $3,825 $3,917 $384 $476 4 $4,285 $4,395 $3,158 $3,268 $2,363 $2,938 $3,048 $4,616 $4,726 $462 $572 5 $5,019 $5,148 $3,699 $3,828 $2,768 $3,441 $3,570 $5,407 $5,536 $541 $670 6 $5,753 $5,901 $4,240 $4,388 $3,173 $3,944 $4,092 $6,197 $6,345 $619 $767 7 $6,487 $6,654 $4,781 $4,948 $3,578 $4,447 $4,614 $6,988 $7,155 $697 $864 8 $7,221 $7,407 $5,322 $5,508 $3,983 $4,950 $5,136 $7,779 $7,965 $775 $961 9 $7,954 $8,159 $5,863 $6,068 $4,387 $5,453 $5,658 $8,569 $8,774 $853 $1,058 10 $8,688 $8,912 $6,405 $6,629 $4,792 $5,957 $6,181 $9,360 $9,584 $931 $1,155 11 $9,422 $9,665 $6,946 $7,189 $5,197 $6,460 $6,703 $10,151 $10,394 $1,009 $1,252 12 $10,156 $10,418 $7,487 $7,749 $5,602 $6,963 $7,225 $10,942 $11,204 $1,087 $1,349 For more than 12, add: $405 for each additional person to increase the FPL. 13 14 15 16 17 18 19 20 $281 $300 $319 $337 $356 $375 $394 $413 HH Size 5% Disregard Amt $734 for each additional person to increase the FPL. $542 for each additional person to increase the FPL. $504 for each additional person to increase the FPL. $791 for each additional person to increase the FPL. $78 for each additional person to increase the FPL. Use the chart below for the correct 5% disregard amount to use for households with more than 12 2021 MAGI INCOME LIMITS EFFECTIVE MARCH 1, 2021 COE-088-Pregnant Women, COE-071 - Infants to Age 1, COE-029 Family 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