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• An eighth amendment was submitted by the State on July 24, 2003, to implement a health services initiative, which includes: o Case management and oral health education for parents of young children: oral health professionals will provide one-on-one health education and will follow-up with families to ensure that parents keep their children’s dental appointments, and/or schedule needed follow-up care. o Innovative preventive services: primary care providers will form partnerships with dental providers to ensure that children are receiving appropriate dental screenings and referrals for treatment. Some projects will use innovative techniques, such as fluoride varnishes, to facilitate the prevention of early childhood tooth decay. o Mobile dental vans: dental vans will circulate among preschools in low-income areas to provide dental screenings, parent/child education and ensure that children screened are linked with a “dental home.”

• A ninth amendment was submitted by the State on September 9, 2003. This amendment allows the State to provide presumptive eligibility to children with family incomes from 100 to 200 percent of the FPL through the Child Health and Disability Prevention (CHDP) program.

• A tenth amendment was submitted by the State on December 15, 2003. This amendment allows the State to claim for the State’s rural health demonstration projects as a health services initiative under the SCHIP 10 percent administrative cap. The rural health demonstration projects, which were previously approved under the California SCHIP State plan, aim to improve access to health care services for low-income medically underserved and uninsured populations in rural areas and special populations who have rural occupations. By claiming for the rural health demonstrations under the 10 percent cap, the State has the flexibility to provide services for all low-income children, thereby benefiting all low-income children, not just SCHIP enrollees. The amendment also allows the State to use tobacco taxes as a new source of State funding.

• An eleventh amendment was received March 23, 2005, to increase premiums for children with family incomes from above 200 percent of the FPL up to and including 250 percent of the FPL. The amendment also provides for school-based outreach for the Healthy Families Program through a partnership between the State and the David and Lucile Packard Foundation.

• A twelfth amendment was submitted June 30, 2005, to extend health care coverage to unborn children with family income up to 300 percent of the Federal poverty level (FPL).

• A thirteenth amendment was received on July 12, 2007, to add a fifth county (Santa Cruz) to their County Program allowing children to be enrolled from 250 percent to 300 percent of the FPL. However, it was subsequently withdrawn by the State on 11/6/08.

• A fourteenth amendment was submitted by the State on April 2, 2009 in response to program changes enacted by the Legislature to increase premiums, place a cap on dental benefits, limit