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West Virginia Income Maintenance Manual Chapter 22

West Virginia Income Maintenance Manual Page 50 Chapter 22 West Virginia Children’s Health Insurance Program (WVCHIP)

APPENDIX B: WVCHIP MONTHLY INCOME LIMITS AND ENROLLMENT GROUPS

AG Size WVCHIP Gold WVCHIP Blue WVCHIP Pregnancy Blue WVCHIP Premium WVCHIP Pregnancy Premium Limited Co-Pays Full Co-Pays Full Co-Pays and Premiums Net Income Less Than or Equal To 150% FPL Net Income Less Than or Equal to 211% FPL Gross Income Less Than or Equal to 300% FPL 1 $1,995 $2,807 $3,990 2 $2,705 $3,806 $5,410 3 $3,415 $4,804 $6,830 4 $4,125 $5,803 $8,250 5 $4,835 $6,802 $9,670 6 $5,545 $7,800 $11,090 7 $6,255 $8,799 $12,510 8 $6,965 $9,798 $13,930 9 $7,675 $10,797 $15,350 10 $8,385 $11,795 $16,770 11 $9,095 $12,794 $18,190 12 $9,805 $13,793 $19,610 13 $10,515 $14,792 $21,030 14 $11,225 $15,790 $22,450 15 $11,935 $16,789 $23,870 16 $12,645 $17,788 $25,290 17 $13,355 $18,787 $26,710 18 $14,065 $19,785 $28,130 19 $14,775 $20,784 $29,550 20 $15,485 $21,783 $30,970