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Family and Children's Medicaid MA-3255 NC HEALTH CHOICE

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II. POLICY FUNDAMENTALS AND ELIGIBILITY REQUIREMENTS

(II.A.2.)

NC HEALTH CHOICE INCOME LEVELS

Family Size

Monthly Income

133%-159%

Cost Sharing

159%-211%

Enrollment Fee &

Cost Sharing

1

1,294.01 - 1,547

1,547.01 – 2,052

2

1,744.01 - 2,085

2,085.01 – 2,766

3

2,194.01 - 2,623

2,623.01 – 3,480

4

2,644.01 - 3,161

3,161.01 – 4,194

5

3,094.01 - 3,699

3,699.01 – 4,908

6

3,544.01 - 4,237

4,237.01 – 5,622

7

3,994.01 - 4,774

4,774.01 – 6,336

8

4,444.01 - 5,312

5,312.01 – 7,050

Each Additional Add

$538

$714

REVISED 04/01/14 – CHANGE NO. 02-14

(II.A.)

REVISED 04/01/14 – CHANGE NO. 02-14

(II.A.9.b.)

REVISED 04/01/14 – CHANGE NO. 02-14

(II.A.9.c)

REISSUED 04/01/14 – CHANGE NO. 02-14

(II.C.)

REISSUED 04/01/14 – CHANGE NO. 02-14

(II.)

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