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CSHCS Home > What's New > Household Income Table Household Income Table

Revised Documentation for Income Verification

INCOME ELIGIBILITY GUIDELINES FOR THE CSHCS PROGRAMS BASED ON HEALTH AND HUMAN SERVICES POVERTY INCOME GUIDELINES
The following information must be used by the CSHCS program. Guidelines for use of this form are calculated from HCFA income guidelines. 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.

NOTE: CSHCS defines a pregnant woman as one family member.

Household
Size		 Effective Date
January 23, 2009
1 $27,075  
2 $36,425  
3 $45,775  
4 $55,125  
5 $64,475  
6 $73,825  
7 $83,175  
8 $92,525  
9 $101,875  
10 $111,225  
11 $120,575  
12 $129,925  
For each additional
member add:		  $9,350  

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