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Addendum A

Financial Assistance Annual Income Guidelines
Effective Date: 1-21-2022
Percent of Guidelines 100% 150% 175% 200% 225%  
% of Reduction if Less than Guideline Household 100% 100% 80% 75% 72%  
Size of Household 1  $13,590  $20,385  $23,783  $27,180  $30,578  
  2  $18,310  $27,465  $32,043  $36,620  $41,198  
  3  $23,030  $34,545  $40,303  $46,060  $51,818  
  4  $27,750  $41,625  $48,563  $55,500  $62,438  
  5  $32,470  $48,705  $56,823  $64,940  $73,058  
  6  $37,190  $55,785  $65,083  $74,380  $83,678  
  7  $41,910  $62,865  $73,343  $83,820  $94,298  
  8  $46,630  $69,945  $81,603  $93,260  $104,918  
$4,720 for each additional person          
financial assistance, annual income guidelines, income guidelines, health services help