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Page | 16 FAMIS PRENATAL COVERAGE INCOME LIMITS NOTE: The income charts in this section are associated with Chapter M23 – FAMIS Prenatal Coverage of the Medical Assistance Eligibility Manual. Income Chart Name: FAMIS Prenatal Coverage 200% FPL Income Limits - All Localities Effective: 1/13/26 Enroll Using Aid Category 110 Household Size 143% FPL Yearly Amount 143% FPL Monthly Amount 148% FPL (143% FPL + 5% FPL Disregard) 2 $30,946 $2,579 $2,669 3 $39,068 $3,256 $3,370 4 $47,190 $3,933 $4,070 5 $55,313 $4,610 $4,771 6 $63,435 $5,287 $5,472 7 $71,558 $5,964 $6,172 8 $79,680 $6,640 $6,873 Each additional, add $8,123 $677 $701

Enroll Using Aid Category 111

Household Size 200% FPL Yearly Amount 200% FPL Monthly Amount 205% FPL (200% FPL + 5% FPL Disregard) 2 $43,280 $3,607 $3,697 3 $54,640 $4,554 $4,668 4 $66,000 $5,500 $5,638 5 $77,360 $6,447 $6,608 6 $88,720 $7,394 $7,579 7 $100,080 $8,340 $8,549 8 $111,440 $9,287 $9,519 Each additional, add $11,360 $947 $971