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3 • On September 27, 2000, the State submitted an amendment to its approved Title XXI plan. This amendment expands coverage under the Medicaid Expansion program for infants up to 1 year of age in families with incomes at or below 200 percent of the FPL. In addition, it expands coverage under the hawk-i program to children up to age 19 in families with income from 185 percent of the FPLP up to 200 percent of the FPL.

• On September 20, 2001, the State submitted an amendment to its approved Title XXI plan. Unity Choice from Wellmark Health Plan of Iowa is no longer participating as a managed health plan in hawk-i. The Iowa counties that Unity Choice had been covering are now covered by John Deere Health Plan of Iowa, Iowa Health Solutions, or Classic Blue from Wellmark Blue Cross Blue Shield of Iowa.

• On June 26, 2002, the State submitted an amendment to update and amend the CHIP State Plan to indicate the State’s compliance with the final CHIP regulations.

• On August 13, 2003, the State submitted an amendment to eliminate the 6-month waiting period for uninsured children who have been insured through an employer sponsored health plan in the 6 months prior to application for hawk-i and to indicate the expansion of Iowa Health Solutions coverage under the State's hawk-i program to two additional counties. This amendment also updates the effective date in the State plan to specify when Iowa began allowing depreciation of capital assets as a deduction to self- employment income.

• On June 20, 2005, the State submitted its eighth amendment to revise the process for children who no longer qualify for Medicaid to be referred to the hawk-i program; allow dental plans to participate in the hawk-i program; remove Iowa Health Solutions as a participating health plan in the hawk-i program; allow individuals to apply for the hawk-i program through the Internet; and revise the strategic objectives and performance goals.

• On March 31, 2006, the State submitted its ninth CHIP amendment to change the health care provider in 20 counties from Classic Blue (Wellmark Blue Cross Blue Shield of Iowa) to the John Deere Health Plan.

• On January 16, 2006, the State submitted its tenth CHIP amendment to make the following changes: (1) added a new managed care plan, Wellmark Health Plan of Iowa (WHPI) effective July 24, 2006. WHPI also expanded into 26 counties effective September 1, 2006, (it now covers a total of 69 counties in the State); (2) AmeriChoice and Delta Dental Health Plan of Iowa expanded into four counties (Carroll, Des Moines, Fayette, and Wayne) effective September 15, 2006; and, (3) changed the name of UnitedHealthcare of the River Valley to AmeriChoice, effective July 1, 2006. With this amendment approval, hawk-i members now have a choice of managed care plans in 43 counties in the State. Also, 27 counties are covered by a single managed care plan and the remaining 29 counties are covered by an indemnity plan.

• On October 6, 2007, Iowa submitted its eleventh amendment. This amendment revises the CHIP State plan by expanding the number of counties served by Wellmark Health Plan of Iowa and decreases the number of counties served by Wellmark Blue Cross Blue