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Winnebago Winnebago Mental Health Institute 457.54 Wisconsin Rapids Riverview Hospital Association 1,934.27 Woodruff Howard Young Medical Center, Inc. 2,509.65 Data Source: Gross Inpatient Revenue and Total Discharge Days, 2001 Wisconsin Hospital Fiscal Survey * Average Daily Charge is the sum of Gross Inpatient Revenue and Gross Inpatient Ancillary Revenue divided by Total Discharge Days. This page last updated in Release Number: 08-01 Release Date: 02/01/2008 Effective Date: 02/01/2008 39.8 Life Expectancy Table See the Life Expectancy Table at Social Security Administration site. This page last updated in Release Number: 09-04 Release Date: 09/09/09 Effective Date: 09/09/09 39.9 Reserved

This page last updated in Release Number: 24-02 Release Date: 08/22/2024 Effective Date: 08/22/2024 39.10 Medicaid Purchase Plan Premiums before August 1, 2020 only The following are MAPP premiums for months of eligibility up to and including July 2020 for members whose gross monthly income equals or exceeds 150 percent of the FPL for the appropriate fiscal test group size. For MAPP premiums for months of eligibility starting August 1, 2020 please reference SECTION 26.5 MAPP PREMIUMS. MAPP PREMIUM SCHEDULE prior to August 1, 2020 Sum of Adjusted Countable Unearned and Adjusted Earned Income The premium is: Sum of Adjusted Countable Unearned and Adjusted Earned Income The premium is: From To PREMIUM From To PREMIUM $0 $25.00 $0.00 500.01 525.00 500.00 25.01 50.00 25.00 525.01 550.00 525.00 50.01 75.00 50.00 550.01 575.00 550.00 75.01 100.00 75.00 575.01 600.00 575.00