AG 1995 08 21 - Laserfiche WebLink

Home Browse Search

ADULT WELLNESS PROGRAM?~EE~SCA]bE--(GROSS INCOME) 100% OF FAMILY ZERO PAY TWENTY PERCENT FORTY PERCENT POVERTY SIZE PAY PAY SIXTY PERCENT EIGHTY PERCENT PULL PAY PAY PAY BEGINS $623 1 SO.TO $623 $624 TO --$778 $779 TO $934 $935 $836 2 $0 TO $836 $837 TO $1045 $1046 TO $1254 $1255 $]049 3 $0 TO $1049 $1050 TO $1311 $1312 TO $1574 $1575 $1263 4 $0TO $1263 $1264 TO $1578 $1579 TO $1894 $1895 $1476 5 $0 TO $1476 $1477 TO $1845 $1846 TO $2214 $2215 $1689 6 $0 TO $1689 $1690 TO $2111 $2112 TO $2534 12535 $1903 7 $0 TO $1903 $1904 TO $2378 $2379 TO. $2854 $2855 $2116 8 $0 TO.$2116 $2117 TO $2645 $2646 TO $3174 $3175 $2329 9 $0 TO $2329 $2330 TO $2911 $2912 TO $3494 $3495 $2543 10 $0 TO $2543 $2544 TO $3178 $3179 TO $3814 $3815 $2756 1! $0 TO $2756 $2757 TO $3445 $3446 TO $4134 $4135 $2969 12 $0 TO $2969 $2970 TO $3711 $3712 TO $4454 $4455 INSTRUCTIONS: AFTER DETERMINING SLIDYNG SCALE PAY CATEGORY, FIND bOLLAR AMOUNT NOTE: NO CHARGES HAY BE ASSESSED IF PATIENT IS MEDICAID ELIGIBLE, IF YEARLY SCALE. ANNUALIZED MONTHLY INCOME FIGURES MAY NOT EQUAL TItOSE ON ANNUAL DIV. OF MCH 711195 TO $1089 $1090 TO $1244 $1245 TO $1463 $1464 TO $1671 $1672 TO $1836 $1837 TO $2097 $2098 TO $2209 $2210 TO $2524 $2525 TO $2583 $2584 TO $2951 $2952 ~0 $2956 $2957 TO $3377 $3378 TO $3329 $3330 TO $3804 $3805 TO $3703 $3704 TO $4231 $4232 TO $4076 $4077 TO $4657 $4658 TO $4449 $4450 TO $5084 $5085 TO $4823 $4824 TO $5511 $5512 TO $5196 $5197 TO $5937 $5938 OF CHARGE ON APPROPRIATE SCi{EDULE. INCOME IS KNOWN, USEANNUAL SCALE DUE TO ROUNDING. 20% Pay 40% ~ay. 60% Pay 80% Pay $ 6.00 $12.oo $16.oo Full Pay. $20.O0 5-18-92: Appr~vedbyBoardofC~,l~ssioners. 09-06-94: Approved by Board of Commissioners to be effective 07-01-94.