Gross Income Eligibility Limits and Sliding Fee Scale
Family Size | Income Eligibility Limit | 0-100% FPG 0% family co-pay | 101%-115% FPG 1% family co-pay | 116%-130% FPG 2% family co-pay | 131%-145% FPG 3% family co-pay | 146%-160% FPG 4% family co-pay | 161%-175% FPG 5% family co-pay | 176%-190% FPG 6% family co-pay | 191%-205% FPG 7% family co-pay | 206%-230% FPG 8% family co-pay | 231% FPG-elig. limit 9% family co-pay |
1 | 3,632 | 1,198 | 1,377 | 1,557 | 1,737 | 1,916 | 2,096 | 2,276 | 2,455 | 2,755 | 3,632 |
2 | 4,749 | 1,621 | 1,864 | 2,107 | 2,350 | 2,593 | 2,836 | 3,079 | 3,323 | 3,728 | 4,749 |
3 | 5,867 | 2,045 | 2,351 | 2,658 | 2,965 | 3,272 | 3,578 | 3,885 | 4,192 | 4,703 | 5,867 |
4 | 6,985 | 2,468 | 2,838 | 3,208 | 3,578 | 3,948 | 4,319 | 4,689 | 5,059 | 5,676 | 6,985 |
5 | 8,102 | 2,891 | 3,324 | 3,758 | 4,191 | 4,625 | 5,059 | 5,492 | 5,926 | 6,649 | 8,102 |
6 | 9,220 | 3,315 | 3,812 | 4,309 | 4,806 | 5,304 | 5,801 | 6,298 | 6,795 | 7,624 | 9,220 |
7 | 9,429 | 3,738 | 4,298 | 4,859 | 5,420 | 5,980 | 6,541 | 7,102 | 7,662 | 8,597 | 9,429 |
8 | 9,639 | 4,161 | 4,785 | 5,409 | 6,033 | 6,657 | 7,281 | 7,905 | 8,530 | 9,570 | 9,639 |
9 | 9,848 | 4,585 | 5,272 | 5,960 | 6,648 | 7,336 | 8,023 | 8,711 | 9,399 | 9,848 | - |
10 | 10,058 | 5,008 | 5,759 | 6,510 | 7,261 | 8,012 | 8,764 | 9,515 | 10,058 | - | - |
11 | 10,267 | 5,431 | 6,245 | 7,060 | 7,874 | 8,689 | 9,504 | 10,267 | - | - | - |
12 | 10,477 | 5,855 | 6,733 | 7,611 | 8,489 | 9,368 | 10,246 | 10,477 | - | - | - |
13 | 10,687 | 6,278 | 7,219 | 8,161 | 9,103 | 10,044 | 10,687 | - | - | - | - |
14 | 10,896 | 6,701 | 7,706 | 8,711 | 9,716 | 10,721 | 10,896 | - | - | - | - |
15 | 11,106 | 7,125 | 8,193 | 9,262 | 10,331 | 11,106 | - | - | - | - | - |
For each add'l, add | 209 | 423 | 486 | 549 | 613 | 209 | - | - | - | - | - |
Instructions:
Haw. Code R. tit. 17, Department of Human Services, ch. 798.3, subch. 5, exh. II