DEPARTMENT OF ECONOMIC SECURITY DIVISION OF DEVELOPMENTAL DISABILITIES COST OF CARE PORTION TABLE
Income based on 200% of federal poverty guidelines issued January 23, 2009
PERCENT TO PAY OF SERVICES RECEIVED | FAMILY SIZE | ||||||||||||||||||||
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | ||||||||||||
M O N T H L Y F A M I L Y I N C O M E | |||||||||||||||||||||
0.0% | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||||||
to | $1,805 | to | $2,428 | to | $3,052 | to | $3,675 | to | $4,298 | to | $4,922 | to | $5,545 | to | $6,168 | to | $6,792 | to | $7,415 | ||
15.0% | $1,806 | $2,429 | $3,053 | $3,676 | $4,299 | $4,923 | $5,546 | $6,169 | $6,793 | $7,416 | |||||||||||
to | $2,058 | to | $2,768 | to | $3,479 | to | $4,190 | to | $4,900 | to | $5,611 | to | $6,321 | to | $7,032 | to | $7,743 | to | $8,453 | ||
20.0% | $2,059 | $2,769 | $3,480 | $4,191 | $4,901 | $5,612 | $6,322 | $7,033 | $7,744 | $8,454 | |||||||||||
to | $2,310 | to | $3,108 | to | $3,906 | to | $4,704 | to | $5,502 | to | $6,300 | to | $7,098 | to | $7,895 | to | $8,693 | to | $9,491 | ||
25.0% | $2,311 | $3,109 | $3,907 | $4,705 | $5,503 | $6,301 | $7,099 | $7,896 | $8,694 | $9,492 | |||||||||||
to | $2,563 | to | $3,448 | to | $4,333 | to | $5,219 | to | $6,104 | to | $6,989 | to | $7,874 | to | $8,759 | to | $9,644 | to | $10,529 | ||
30.0% | $2,564 | $3,449 | $4,334 | $5,220 | $6,105 | $6,990 | $7,875 | $8,760 | $9,645 | $10,530 | |||||||||||
to | $2,816 | to | $3,788 | to | $4,761 | to | $5,733 | to | $6,705 | to | $7,678 | to | $8,650 | to | $9,623 | to | $10,595 | to | $11,567 | ||
35.0% | $2,817 | $3,789 | $4,762 | $5,734 | $6,706 | $7,679 | $8,651 | $9,624 | $10,596 | $11,568 | |||||||||||
to | $3,069 | to | $4,128 | to | $5,188 | to | $6,248 | to | $7,307 | to | $8,367 | to | $9,427 | to | $10,486 | to | $11,546 | to | $12,606 | ||
40.0% | $3,070 | $4,129 | $5,189 | $6,249 | $7,308 | $8,368 | $9,428 | $10,487 | $11,547 | $12,607 | |||||||||||
to | $3,321 | to | $4,468 | to | $5,615 | to | $6,762 | to | $7,909 | to | $9,056 | to | $10,203 | to | $11,350 | to | $12,497 | to | $13,644 | ||
45.0% | $3,322 | $4,469 | $5,616 | $6,763 | $7,910 | $9,057 | $10,204 | $11,351 | $12,498 | $13,645 | |||||||||||
to | $3,574 | to | $4,808 | to | $6,042 | to | $7,277 | to | $8,511 | to | $9,745 | to | $10,979 | to | $12,213 | to | $13,448 | to | $14,682 | ||
50.0% | $3,575 | $4,809 | $6,043 | $7,278 | $8,512 | $9,746 | $10,980 | $12,214 | $13,449 | $14,683 | |||||||||||
to | $3,827 | to | $5,148 | to | $6,470 | to | $7,791 | to | $9,112 | to | $10,434 | to | $11,755 | to | $13,077 | to | $14,398 | to | $15,720 | ||
55.0% | $3,828 | $5,149 | $6,471 | $7,792 | $9,113 | $10,435 | $11,756 | $13,078 | $14,399 | $15,721 | |||||||||||
to | $4,079 | to | $5,488 | to | $6,897 | to | $8,306 | to | $9,714 | to | $11,123 | to | $12,532 | to | $13,940 | to | $15,349 | to | $16,758 | ||
60.0% | $4,080 | $5,489 | $6,898 | $8,307 | $9,715 | $11,124 | $12,533 | $13,941 | $15,350 | $16,759 | |||||||||||
to | $4,332 | to | $5,828 | to | $7,324 | to | $8,820 | to | $10,316 | to | $11,812 | to | $13,308 | to | $14,804 | to | $16,300 | to | $17,796 | ||
65.0% | $4,333 | $5,829 | $7,325 | $8,821 | $10,317 | $11,813 | $13,309 | $14,805 | $16,301 | $17,797 | |||||||||||
to | $4,585 | to | $6,168 | to | $7,751 | to | $9,335 | to | $10,918 | to | $12,501 | to | $14,084 | to | $15,668 | to | $17,251 | to | $18,834 | ||
70.0% | $4,586 | $6,169 | $7,752 | $9,336 | $10,919 | $12,502 | $14,085 | $15,669 | $17,252 | $18,835 | |||||||||||
to | $4,837 | to | $6,508 | to | $8,178 | to | $9,849 | to | $11,520 | to | $13,190 | to | $14,861 | to | $16,531 | to | $18,202 | to | $19,872 | ||
75.0% | $4,838 | $6,509 | $8,179 | $9,850 | $11,521 | $13,191 | $14,862 | $16,532 | $18,203 | $19,873 | |||||||||||
to | $5,090 | to | $6,848 | to | $8,606 | to | $10,364 | to | $12,121 | to | $13,879 | to | $15,637 | to | $17,395 | to | $19,153 | to | $20,910 | ||
80.0% | $5,091 | $6,849 | $8,607 | $10,365 | $12,122 | $13,880 | $15,638 | $17,396 | $19,154 | $20,911 | |||||||||||
to | $5,343 | to | $7,188 | to | $9,033 | to | $10,878 | to | $12,723 | to | $14,568 | to | $16,413 | to | $18,258 | to | $20,103 | to | $21,948 | ||
85.0% | $5,344 | $7,189 | $9,034 | $10,879 | $12,724 | $14,569 | $16,414 | $18,259 | $20,104 | $21,949 | |||||||||||
to | $5,596 | to | $7,528 | to | $9,460 | to | $11,393 | to | $13,325 | to | $15,257 | to | $17,190 | to | $19,122 | to | $21,054 | to | $22,987 | ||
90.0% | $5,597 | $7,529 | $9,461 | $11,394 | $13,326 | $15,258 | $17,191 | $19,123 | $21,055 | $22,988 | |||||||||||
to | $5,848 | to | $7,868 | to | $9,887 | to | $11,907 | to | $13,927 | to | $15,946 | to | $17,966 | to | $19,985 | to | $22,005 | to | $24,025 | ||
95.0% | $5,849 | $7,869 | $9,888 | $11,908 | $13,928 | $15,947 | $17,967 | $19,986 | $22,006 | $24,026 | |||||||||||
to | $6,101 | to | $8,208 | to | $10,315 | to | $12,422 | to | $14,528 | to | $16,635 | to | $18,742 | to | $20,849 | to | $22,956 | to | $25,063 | ||
100.0% | $6,102 | $8,209 | $10,316 | $12,423 | $14,529 | $16,636 | $18,743 | $20,850 | $22,957 | $25,064 | |||||||||||
Or greater | Or greater | Or greater | Or greater | Or greater | Or greater | Or greater | Or greater | Or greater | Or greater |
PERCENT TO PAY OF SERVICES RECEIVED | FAMILY SIZE | ||||||||||||||||||||
11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | ||||||||||||
M O N T H L Y F A M I L Y I N C O M E | |||||||||||||||||||||
0.0% | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||||||
to | $8,038 | to | $8,662 | to | $9,285 | to | $9,908 | to | $10,532 | to | $11,155 | to | $11,778 | to | $12,402 | to | $13,025 | to | $13,648 | ||
15.0% | $8,039 | $8,663 | $9,286 | $9,909 | $10,533 | $11,156 | $11,779 | $12,403 | $13,026 | $13,649 | |||||||||||
to | $9,164 | to | $9,874 | to | $10,585 | to | $11,296 | to | $12,006 | to | $12,717 | to | $13,427 | to | $14,138 | to | $14,849 | to | $15,559 | ||
20.0% | $9,165 | $9,875 | $10,586 | $11,297 | $12,007 | $12,718 | $13,428 | $14,139 | $14,850 | $15,560 | |||||||||||
to | $10,289 | to | $11,087 | to | $11,885 | to | $12,683 | to | $13,481 | to | $14,278 | to | $15,076 | to | $15,874 | to | $16,672 | to | $17,470 | ||
25.0% | $10,290 | $11,088 | $11,886 | $12,684 | $13,482 | $14,279 | $15,077 | $15,875 | $16,673 | $17,471 | |||||||||||
to | $11,414 | to | $12,300 | to | $13,185 | to | $14,070 | to | $14,955 | to | $15,840 | to | $16,725 | to | $17,610 | to | $18,496 | to | $19,381 | ||
30.0% | $11,415 | $12,301 | $13,186 | $14,071 | $14,956 | $15,841 | $16,726 | $17,611 | $18,497 | $19,382 | |||||||||||
to | $12,540 | to | $13,512 | to | $14,485 | to | $15,457 | to | $16,429 | to | $17,402 | to | $18,374 | to | $19,347 | to | $20,319 | to | $21,291 | ||
35.0% | $12,541 | $13,513 | $14,486 | $15,458 | $16,430 | $17,403 | $18,375 | $19,348 | $20,320 | $21,292 | |||||||||||
to | $13,665 | to | $14,725 | to | $15,785 | to | $16,844 | to | $17,904 | to | $18,964 | to | $20,023 | to | $21,083 | to | $22,143 | to | $23,202 | ||
40.0% | $13,666 | $14,726 | $15,786 | $16,845 | $17,905 | $18,965 | $20,024 | $21,084 | $22,144 | $23,203 | |||||||||||
to | $14,791 | to | $15,937 | to | $17,084 | to | $18,231 | to | $19,378 | to | $20,525 | to | $21,672 | to | $22,819 | to | $23,966 | to | $25,113 | ||
45.0% | $14,792 | $15,938 | $17,085 | $18,232 | $19,379 | $20,526 | $21,673 | $22,820 | $23,967 | $25,114 | |||||||||||
to | $15,916 | to | $17,150 | to | $18,384 | to | $19,619 | to | $20,853 | to | $22,087 | to | $23,321 | to | $24,555 | to | $25,790 | to | $27,024 | ||
50.0% | $15,917 | $17,151 | $18,385 | $19,620 | $20,854 | $22,088 | $23,322 | $24,556 | $25,791 | $27,025 | |||||||||||
to | $17,041 | to | $18,363 | to | $19,684 | to | $21,006 | to | $22,327 | to | $23,649 | to | $24,970 | to | $26,292 | to | $27,613 | to | $28,934 | ||
55.0% | $17,042 | $18,364 | $19,685 | $21,007 | $22,328 | $23,650 | $24,971 | $26,293 | $27,614 | $28,935 | |||||||||||
to | $18,167 | to | $19,575 | to | $20,984 | to | $22,393 | to | $23,802 | to | $25,210 | to | $26,619 | to | $28,028 | to | $29,437 | to | $30,845 | ||
60.0% | $18,168 | $19,576 | $20,985 | $22,394 | $23,803 | $25,211 | $26,620 | $28,029 | $29,438 | $30,846 | |||||||||||
to | $19,292 | to | $20,788 | to | $22,284 | to | $23,780 | to | $25,276 | to | $26,772 | to | $28,268 | to | $29,764 | to | $31,260 | to | $32,756 | ||
65.0% | $19,293 | $20,789 | $22,285 | $23,781 | $25,277 | $26,773 | $28,269 | $29,765 | $31,261 | $32,757 | |||||||||||
to | $20,417 | to | $22,001 | to | $23,584 | to | $25,167 | to | $26,750 | to | $28,334 | to | $29,917 | to | $31,500 | to | $33,084 | to | $34,667 | ||
70.0% | $20,418 | $22,002 | $23,585 | $25,168 | $26,751 | $28,335 | $29,918 | $31,501 | $33,085 | $34,668 | |||||||||||
to | $21,543 | to | $23,213 | to | $24,884 | to | $26,554 | to | $28,225 | to | $29,895 | to | $31,566 | to | $33,236 | to | $34,907 | to | $36,578 | ||
75.0% | $21,544 | $23,214 | $24,885 | $26,555 | $28,226 | $29,896 | $31,567 | $33,237 | $34,908 | $36,579 | |||||||||||
to | $22,668 | to | $24,426 | to | $26,184 | to | $27,942 | to | $29,699 | to | $31,457 | to | $33,215 | to | $34,973 | to | $36,731 | to | $38,488 | ||
80.0% | $22,669 | $24,427 | $26,185 | $27,943 | $29,700 | $31,458 | $33,216 | $34,974 | $36,732 | $38,489 | |||||||||||
to | $23,793 | to | $25,639 | to | $27,484 | to | $29,329 | to | $31,174 | to | $33,019 | to | $34,864 | to | $36,709 | to | $38,554 | to | $40,399 | ||
85.0% | $23,794 | $25,640 | $27,485 | $29,330 | $31,175 | $33,020 | $34,865 | $36,710 | $38,555 | $40,400 | |||||||||||
to | $24,919 | to | $26,851 | to | $28,784 | to | $30,716 | to | $32,648 | to | $34,581 | to | $36,513 | to | $38,445 | to | $40,378 | to | $42,310 | ||
90.0% | $24,920 | $26,852 | $28,785 | $30,717 | $32,649 | $34,582 | $36,514 | $38,446 | $40,379 | $42,311 | |||||||||||
to | $26,044 | to | $28,064 | to | $30,083 | to | $32,103 | to | $34,123 | to | $36,142 | to | $38,162 | to | $40,181 | to | $42,201 | to | $44,221 | ||
95.0% | $26,045 | $28,065 | $30,084 | $32,104 | $34,124 | $36,143 | $38,163 | $40,182 | $42,202 | $44,222 | |||||||||||
to | $27,170 | to | $29,276 | to | $31,383 | to | $33,490 | to | $35,597 | to | $37,704 | to | $39,811 | to | $41,918 | to | $44,025 | to | $46,131 | ||
100.0% | $27,171 | $29,277 | $31,384 | $33,491 | $35,598 | $37,705 | $39,812 | $41,919 | $44,026 | $46,132 | |||||||||||
Or greater | Or greater | Or greater | Or greater | Or greater | Or greater | Or greater | Or greater | Or greater | Or greater |
To determine amount to pay:
Ariz. Admin. Code tit. 6, ch. 6, art. 12, app A