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Date Amendment #10 Approved: January 20, 2011 Date Amendment #10 Effective: January 1, 2011

Date Amendment #11 Submitted: June 8, 2011 Date Amendment #11 Approved: June 15, 2011 Date Amendment #11 Effective: April 15, 2011

Background

• Implementation of Phase I of Alabama's CHIP plan began on February 1, 1998, with a Medicaid expansion of coverage for targeted low-income children under age 19, whose family income is below 100 percent of the Federal Poverty Level (FPL). This component of the CHIP program was phased out at the end of fiscal year 2002.

Amendments

• Alabama's first amendment was submitted on May 21, 1998. This amendment created a separate child health program known as Phase II, ALL Kids, for children under age 19 in families with incomes up to 200 percent of the FPL, and who are not eligible for Medicaid.

• Alabama's second amendment was submitted on July 1, 1999. This amendment created Phase III of Alabama’s CHIP program, known as ALL Kids Plus. ALL Kids Plus amended Alabama's separate child health program and provides an enhanced health benefits coverage package for children with special health care needs/conditions who are enrolled in ALL Kids. It was projected that 9 percent of the children enrolled in ALL Kids also would receive at least one service under ALL Kids Plus.

• Alabama’s third amendment was submitted on September 27, 2001. This amendment allows self-declaration of age on the CHIP application, incorporates some of the Medicaid income disregards, and makes cost sharing premium amounts equal between those who choose to pay in one lump sum and those who choose to pay in monthly installments.

• Alabama’s fourth amendment was submitted December 18, 2002. This amendment updates and amends the CHIP State plan to indicate the State’s compliance with the final CHIP regulation.

• Alabama’s fifth amendment was submitted October 30, 2003. This amendment institutes a waiting list, increases annual premiums from $50 to $100 per child for families with income above 150 percent of the FPL, imposes new annual premiums of $50 per child for families with income from 100 through 150 percent of the FPL, imposes copayments on nonpreventive services for enrollees with family income below 150 percent of the FPL, and raises copayments for enrollees with family income above 150 percent of the FPL. In addition, the amendment enhances certain