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Page 6 of 8 7/1/2026 Appendix C-1 Schedule XIII - Tuberculosis (TB) Infected Individuals Monthly countable income and resources must be equal to or less than the following income (2 x Federal Benefit Rate + $85) and resource standard. Maximum income standard Maximum resource standard Individual only $2,073 $2,000 Schedule XIV - Refugee Medical Assistance Monthly countable income must be less than the following standards. Monthly countable income is defined as the gross unearned income added to the earned income less income exemptions. Earned income exemptions include $90 work related expenses, $30 and 1/3 of the balance. Rules are based on AFDC policy in effect on July 1, 1996. Refer to OAC 340:60-1-6.

A. Child(ren) and one or two adults included in the assistance payment. If there is more than one person in a refugee case, use the AFDC Standard for appropriate number of persons. Number of persons 1 2 3 4 5 6 7 8 9 or more Need standard $398 $499 $645 $798 $933 $1,068 $1,203 $1,323 $1,436 Monthly maximum gross income cannot exceed $736 $923 $1,193 $1,476 $1,726 $1,975 $2,225 $2,447 $2,656

B. Children only (no adults) included in the assistance payment. Number of children 1 2 3 4 5 6 7 8 9 or more Need standard $193 $380 $534 $687 $823 $967 $1,092 $1,211 $1,324 Monthly maximum gross income cannot exceed $357 $703 $987 $1,270 $1,522 $1,788 $2,020 $2,240 $2,449

C. Maximum reserve: The countable reserve must be equal to or less than $2,250 per refugee case. Non-liquid resources, excluding the home and $5,000 equity in one automobile, cannot exceed $2,250.