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2 Date Amendment #10 Submitted: January 16, 2007 Date Amendment #10 Approved: April 9, 2007 Date Amendment #10 Effective:

July 1, 2006 (Health Plan Name Change)

July 24, 2006 (Adds Wellmark Plan of Iowa)

September 1, 2006 (Expands WHPI counties)

September 15, 2006 (Expand into 4 counties for

AmeriChoice and Delta Dental)

Date Amendment #11 Submitted: October 6, 2007 Date Amendment #11 Approved: April 24, 2008 Date Amendment #11 Effective:

July 1, 2007

Date Amendment #12 Submitted: June 30, 2008 Date Amendment #12 Approved: July 29. 2008 Date Amendment #12 Effective:

June 1, 2008

Date Amendment #13 Submitted: February 24, 2009 Date Amendment #13 Approved: September 18, 2009 Date Amendment #13 Effective:

July 1, 2009

Background

• On June 1, 1998, Iowa submitted a Title XXI State Plan to provide health insurance coverage to uninsured children through an expansion of the State’s Title XIX Medicaid program. The Plan provides Medicaid Expansion coverage to children ages 6 through 18 in families with income from 100 percent up to 133 percent of the Federal Poverty Level (FPL).

Amendments

• On February 25, 1999, the State submitted an amendment, effective January 1, 1999, to its approved Title XXI plan. This amendment, entitled the hawk-i program, is the non- Medicaid component of Iowa’s CHIP program. Hawk-i provides health care coverage, via contracts with commercial health care plans, to children whose family income does not exceed 185 percent of the FPL.

• On December 29, 1999, the State submitted an amendment, effective October 1, 1999, to its approved Title XXI plan. This amendment allows for a 20-percent deduction to earned income in determining eligibility for the hawk-i program, and includes an additional managed health care plan, Unity Choice from Wellmark Health Plan of Iowa.

• On March 8, 2000, the State submitted an amendment, effective February 1, 2000, to its approved Title XXI plan. This amendment adds a third managed health care plan, John Deere Health Plan to selected counties in Iowa. The amendment also removes cost sharing for American Indian/Alaska Native children and also allows a deduction for depreciation of capital assets when considering self-employment income.