Pennsylvania Code
Title 55 - HUMAN SERVICES
Part II - Public Assistance Manual
Subpart C - Eligibility Requirements
Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS
Subchapter E - THE CATEGORICALLY NEEDY BREAST AND CERVICAL CANCER PREVENTION AND TREATMENT PROGRAM FOR QUALIFIED WOMEN
RIGHT TO APPEAL AND FAIR HEARING
Appendix B - MEDICAID FOR CHILDREN WITH SPECIAL NEEDS MONTHLY PREMIUM CHART
Universal Citation: 55 PA Code ยง B
Current through Register Vol. 54, No. 44, November 2, 2024
| Family Size | ||||||||
|
Parents Annual Income Parents Annual Income |
2 | 3 | 4 | 5 | 6 | 7 | 8 | Each Additional member |
| $0-$39,999.99 | NO PREMIUM IF INCOME BELOW 200% FPIG | |||||||
| $40-$49,999.99 | $30 | $29 | $27 | $26 | $24 | $0 | $0 | $0 |
| $50-$59,999.99 | $40 | $38 | $36 | $34 | $33 | $31 | $0 | $0 |
| $60-$69,999.99 | $50 | $48 | $45 | $43 | $41 | $39 | $37 | $0 |
| $70-$79,999.99 | $60 | $57 | $54 | $51 | $49 | $46 | $43 | $0 |
| $80-$89,999.99 | $75 | $71 | $68 | $64 | $61 | $58 | $55 | (-$3) |
| $90-$99,999.99 | $100 | $95 | $90 | $86 | $81 | $77 | $73 | (-$4) |
| $100-$109,999.99 | $150 | $143 | $135 | $129 | $122 | $116 | $111 | (-$5) |
| $110-$119,999.99 | $200 | $190 | $181 | $171 | $163 | $155 | $148 | (-$7) |
| $120-$129,999.99 | $250 | $238 | $226 | $214 | $204 | $193 | $185 | (-$8) |
| $130-$139,999.99 | $300 | $285 | $271 | $257 | $244 | $232 | $222 | (-$10) |
| $140-$149,999.99 | $350 | $333 | $316 | $300 | $285 | $271 | $259 | (-$12) |
| $150-$159,999.99 | $400 | $380 | $361 | $343 | $326 | $310 | $297 | (-$13) |
| $160-$169,999.99 | $475 | $451 | $429 | $407 | $387 | $368 | $352 | (-$16) |
| $170-$179,999.99 | $600 | $570 | $542 | $514 | $489 | $464 | $442 | (-$22) |
| $180-$189,999.99 | $675 | $641 | $609 | $579 | $550 | $522 | $497 | (-$25) |
| $190-$199,999.99 | $800 | $760 | $722 | $686 | $652 | $619 | $588 | (-$31) |
| $200-$249,999.99 | $925 | $879 | $835 | $793 | $753 | $716 | $679 | (-$37) |
| $250-$299,999.99 | $1,000 | $950 | $903 | $857 | $815 | $774 | $739 | (-$35) |
| $300-$349,999.99 | $1,000 | $950 | $903 | $857 | $815 | $774 | $739 | (-$35) |
| $350-$399,999.99 | $1,000 | $950 | $903 | $857 | $815 | $774 | $739 | (-$35) |
| $400-$449.999.00 | $1,000 | $950 | $903 | $857 | $815 | $774 | $739 | (-$35) |
| $450-$499,999.99 | $1,000 | $950 | $903 | $857 | $815 | $774 | $739 | (-$35) |
| $500,000 + | $1,000 | $950 | $903 | $857 | $815 | $774 | $739 | (-$35) |
Disclaimer: These regulations may not be the most recent version. Pennsylvania may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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