HOME CARE PROGRAM

VOLUNTARY CO-PAYMENT AND COST SHARING SCHEDULES

Effective Date:

January 1, 2007

VOLUNTARY CO-PAYMENT:

Family Size

Annual Gross Income

Voluntary Co-payment

1

$10,092

or less

$7/month

2

$13,531

or less

$10/month

COST SHARING:

One Person

Monthly

Two Person Family

Monthly

Annual Gross Income

Co-payment

Annual Gross Income

Co-payment

$10,093

-

$12,311

$7

$13,532

-

$16,969

$13

$12,312

-

$14,527

$9

$16,970

-

$20,395

$16

$14,528

-

$16,045

$20

$20,396

-

$22,121

$38

$16,046

-

$17,193

$29

$22,122

-

$23,843

$58

$17,194

-

$18,338

$38

$23,844

-

$25,570

$72

$18,339

-

$19,483

$54

$25,571

-

$27,295

$85

$19,484

-

$20,630

$72

$27,296

-

$29,017

$95

$20,631

-

$21,774

$100

$29,018

-

$30,743

$110

$21,775

-

$22,947

$125

$30,744

-

$32,470

$135

OVER INCOME COST SHARING FOR RESPITE CARE:

One Person

Monthly

Two Person Family

Monthly

Annual Gross Income

Co-payment

Annual Gross Income

Co-payment

$22,948

-

$24,866

50%

$32,471

-

$33,569

50%

$24,867

-

$26,730

55%

$33,570

-

$35,433

55%

$26,731

-

$28,596

60%

$35,434

-

$37,300

60%

$28,597

-

$30,460

65%

$37,301

-

$39,163

65%

$30,461

-

$32,325

70%

$39,164

-

$41,028

70%

$32,326

-

$34,192

75%

$41,029

-

$42,893

75%

$34,193

-

$36,054

80%

$42,894

-

$44,759

80%

$36,055

-

$37,919

85%

$44,760

-

$46,623

85%

$37,920

-

$39,786

90%

$46,624

-

$48,489

90%

$39,787

-

$41,650

95%

$48,490

-

$50,355

95%

$41,651

and over

100%

$50,356

and over

100%