(1) There is no charge to the care receiver whose income is at or below forty percent of the state median income, based on family size.

(2) If the care receiver's gross income is above forty percent of the state median income, he or she is required to pay for part or all of the cost of the respite care services. The department will determine what amount the participant must contribute based on the state median income and family size.

(3) If the care receiver's gross income is one hundred percent or more of the state median income, the participant must pay the full cost of the respite care services.

(4) If the care receiver is experiencing extreme financial hardship (e.g., high medical expenses) and cannot pay for their share of the cost of the respite care services, the area agency on aging may grant an exception to policy and then must document this in the client's records.