Income Eligibility for Tier I Rates
Providers whose income are within income eligibility guideliness according to the chart below, are eligible to receive Tier I (higher rates) reimbursement rates. Please contact the Heartland office for more information.
Gross Income Eligibility Guidelines
July 1, 2011 - June 30, 2012
Household Size | Annual Income | Monthly Income | Twice Month Income | Every Two Weeks | Weekly Income |
| 1 | $20,147 | $1,679 | $840 | $775 | $388 |
| 2 | 27,214 | 2,268 | 1,134 | 1,047 | 524 |
| 3 | 34,281 | 2,857 | 1,429 | 1,319 | 660 |
| 4 | 41,348 | 3,446 | 1,723 | 1,591 | 796 |
| 5 | 48,415 | 4,035 | 2,018 | 1,863 | 932 |
| 6 | 55,482 | 4,624 | 2,312 | 2,134 | 1,067 |
| 7 | 62,549 | 5,213 | 2,607 | 2,406 | 1,203 |
| 8 | 69,616 | 5,802 | 2,901 | 2,678 | 1,339 |
| For each additional Household Member, add: | 7,067 | 589 | 295 | 272 | 136 |
For quick access to an income application form, click on the form you need below:
Blue Income Eligibility Form -
Application to Receive Tier I Rates for All Children, including Provider's Own Children
Yellow Income Eligibility Form -
Parent/Guardian Application to Qualify Children for Tier I Rates