Body
Revision 26-1; Effective March 1, 2026
2026 Co-pay Table
| Persons in Family or Household | 100% FPL Monthly $0 Co-pay | 133% FPL Monthly Up to $10 Co-pay | 150% FPL Monthly Up to $20 Co-pay | 185% FPL Monthly Up to $25 Co-pay | 200% FPL Monthly Up to $30 Co-pay |
|---|---|---|---|---|---|
| 1 | $1,330 | $1,769 | $1,995 | $2,461 | $2,660 |
| 2 | $1,804 | $2,399 | $2,705 | $3,337 | $3,607 |
| 3 | $2,277 | $3,028 | $3,415 | $4,212 | $4,554 |
| 4 | $2,750 | $3,658 | $4,125 | $5,088 | $5,500 |
| 5 | $3,224 | $4,287 | $4,835 | $5,964 | $6,447 |
| 6 | $3,697 | $4,917 | $5,545 | $6,839 | $7,394 |
| 7 | $4,170 | $5,547 | $6,255 | $7,715 | $8,340 |
| 8 | $4,644 | $6,176 | $6,965 | $8,591 | $9,287 |
| 9 | $5,117 | $6,806 | $7,675 | $9,466 | $10,234 |
| 10 | $5,590 | $7,435 | $8,385 | $10,342 | $11,180 |
| 11 | $6,064 | $8,065 | $9,095 | $11,218 | $12,127 |
| 12 | $6,537 | $8,694 | $9,805 | $12,093 | $13,074 |
| Extra | $474 | $630 | $710 | $876 | $947 |
*For families and households with more than 12 persons, add Extra for each additional person.
Note: No co-pay can be charged for a household below 100% FPL.
The contractor must waive the fee if a client self-declares an inability to pay. No client should be denied services based on an inability to pay. If a co-pay is charged, it may not exceed $30 or the cost of the visit or encounter, whichever is less. The FPL is calculated and published annually each calendar year at HHS FPL Guidelines.