Household Income Table
Income Eligibility for the CSHCS Program
Based on Health and Human Service Poverty Income Guidelines
Effective January 24, 2013
To be financially eligible for CSHCS, the gross household income must be less than or equal to 250% of the federal poverty income guidelines. Household means a group of related or non-related individuals who are not residents of an institution, but who are living as one economic unit. The applicant must also be medically eligible to receive services.
Effective July 1, 2010, The Children's Special Health Care Services Program began counting Supplemental Security Income (SSI) and Adoption Assistance Program (AAP) payments as income to evaluate CSHCS participants initial and ongoing financial eligibility for the program.
| Household Size | CSHCS Annual Income Equal To Or Less Than |
|---|---|
| 1 | $28,725 |
| 2 | $38,775 |
| 3 | $48,825 |
| 4 | $58,875 |
| 5 | $68,925 |
| 6 | $78,975 |
| 7 | $89,025 |
| 8 | $99,075 |
| 9 | $109,125 |
| 10 | $119,175 |
| 11 | $129,225 |
| 12 | $139,275 |
| For each additional member add: |
$10,050 |
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