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rays, topical fluoride treatments, space maintainers and sealants. Copayment amounts are detailed by benefit in the description of benefits in Attachment 6. ACCESS FOR INFANTS AND MOTHERS (AIM) PROGRAM Infants born to mothers enrolled in the AIM Program prior to July 1, 2004 do not have copayments. Infants born to mothers enrolled in the AIM Program on or after July 1, 2004 will be enrolled in the Healthy Families Program and subject to the cost sharing requirements. COUNTY CHILDREN’S HEALTH INSURANCE PROGRAM (C-CHIP) Copayments under the C-CHIP projects range from $5 - $15 when required for health, dental, and vision benefits. Attachment 6 provides a detailed description of the benefits provided and the related copay. 8.2.4. Other: N/A 8.3. Describe how the public will be notified, including the public schedule, of this cost-sharing (including the cumulative maximum) and changes to these amounts and any differences based on income. (Section 2103(e)((1)(B)) (42CFR 457.505(b)) The public will be notified of Healthy Families’ cost-sharing requirements, including differences based on income, in the Program’s application, enrollment materials and program regulations. Copays will also be listed in plan disclosure documents such as Evidence of Coverage (EOC) documents provided to each family. Agencies and individuals who help families with their application will also be familiar with the program’s cost-sharing requirements and be able to communicate them to families when discussing the program. COUNTY CHILDREN’S HEALTH INSURANCE PROGRAM (C-CHIP) Families applying for C-CHIP will be informed about the cost sharing requirements from the C-CHIP application, enrollment materials, and the same individuals conducting outreach; the local state trained application assistants, county social service staff, and the health plan staff. In addition, cost sharing information is Effective Date: Approval Date: November 1, 2009 HFP Family Contribution Increase November 1, 2009 HFP Co-Payment Increase November 1, 2009 HFP Limited Dental Plan Choice for New Subscribers

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