Arizona Administrative Code › Title 6 - ECONOMIC SECURITY › Chapter 6 - DEPARTMENT OF ECONOMIC SECURITY - DEVELOPMENTAL DISABILITIES › Article 12 - COST OF CARE PORTION › Appendix A - Cost of Care Portion Table

Current through Register Vol. 30, No. 28, July 12, 2024
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:
1. Find family size, include any children out
				of the home that are receiving Division services.
2. Find Monthly Family Income (round to the
				nearest whole dollar).
3. Move down
				the correct family size column to the cell that contains the range
				corresponding to the monthly family income.
4. From that cell move to the far left to the
				percent pay column.
5. The percent
				is the percent you are required to pay monthly for the services your family /
				child received.
6. The payment
				amount is not to exceed the cost of services provided.