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services in the benefit plan, including an increase in covered days for inpatient substance abuse facilities, and updates source of State funds to indicate that the State is receiving an approvable grant from the Robert Wood Johnson Foundation.

• Alabama submitted its sixth amendment November 23, 2004, to reopen enrollment in the ALL Kids program. This amendment also provides Alabama with general authority under the state plan to implement an enrollment cap in the future when funds are projected to be depleted before the end of the fiscal year.

• The State submitted its seventh amendment August 12, 2009. This amendment permits Alabama to expand the income eligibility level for children from its current income level up to 300 percent of the Federal poverty level (FPL). Additionally, this SPA will allow Alabama to apply cost-sharing requirements to children in this new expansion group. Premium amounts for this group will be $100 per year per child up to a family maximum of $300 per year. This SPA will also allow Alabama to apply copayments to health care services for children in families with incomes above 200 percent of the FPL, not to exceed $15 except the copayment for non-emergency use of the emergency room which will be $20. Additionally, this SPA modifies Alabama’s notification procedures for its premium grace period to come into compliance with the new requirements of section 504 of the CHIPRA. This amendment has an effective date of October 1, 2009.

• Alabama submitted its eighth amendment on October 27, 2009. This amendment includes a private foundation grant as an additional source of State funding. State General Fund appropriations, Tobacco Settlement funds, and a private grant. A Robert Wood Johnson Foundation (RWJF) grant was awarded to Alabama to increase enrollment and retention of eligible children in Alabama’s health insurance programs, known as ALL Kids and SOBRA Medicaid (the Alabama Medicaid program for pregnant women and children). The grant is for $994,883 and the award dates are February 15, 2009 - February 14, 2013. Amendment eight has an effective date of October 22, 2009.

• The State’s ninth CHIP amendment was submitted on September 22, 2010. This amendment has a retroactive effective date of October 1, 2009, for the establishment of a prospective payment system for federally qualified health centers and rural health clinics. This amendment also establishes that Alabama’s Title XXI dental benefits are compliant with Section 501 of the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA).

• The State’s tenth CHIP amendment was submitted on December 10, 2010 and was approved on January 20, 2011. This amendment has a retroactive effective date of January 1, 2011, to extend CHIP eligibility to children of employees of public agencies who are otherwise eligible under the State plan. The State will provide this coverage in accordance with the maintenance of effort (MOE) exception to the