Page 39

Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

39

Approval Date:

FMAP for FY 10 76.15% Information obtained from Milliman Actuary forecast Septemer 2009. Estimated Fiscal Impact of Amendment #7 SFY2011 Number of Enrollees Total Expense State General Funds Federal FMAP July-10 146 20,440 4,789 15,651 August-10 292 40,880 9,578 31,302 September-10 438 61,320 14,367 46,953 October-10 584 81,760 19,156 62,604 November-10 730 102,200 23,945 78,255 December-10 876 122,640 28,735 93,905 January-11 1,022 143,080 33,524 109,556 February-11 1,168 163,520 38,313 125,207 March-11 1,314 183,960 43,102 140,858 April-11 1,460 204,400 47,891 156,509 May-11 1,606 224,840 52,680 172,160 June-11 1,752 245,280 57,469 187,811 Total SFY2011 1,594,320 373,549 1,220,771

CURRENT & PROJECTED CHIP - PACKAGE A & C EXPENDITURES BENEFIT COSTS FY 2010 Budget Number of Enrollees PMPM Managed Care (RBMC) 116,608,485.00 67,368 144 Fee for Service (Traditional) 14,870,696.00 11,720 103 Total Benefit Costs 131,479,181.00

(Offsetting beneficiary cost sharing payments) (6,604,769.00)

Net Benefit Costs 124,874,412.00 79,088 Administration Costs FY 2010 Budget Personnel 147,930.76

General Administration 2,219,638.44

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Page 39

Official source

Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

39

Approval Date:

FMAP for FY 10 76.15% Information obtained from Milliman Actuary forecast Septemer 2009. Estimated Fiscal Impact of Amendment #7 SFY2011 Number of Enrollees Total Expense State General Funds Federal FMAP July-10 146 20,440 4,789 15,651 August-10 292 40,880 9,578 31,302 September-10 438 61,320 14,367 46,953 October-10 584 81,760 19,156 62,604 November-10 730 102,200 23,945 78,255 December-10 876 122,640 28,735 93,905 January-11 1,022 143,080 33,524 109,556 February-11 1,168 163,520 38,313 125,207 March-11 1,314 183,960 43,102 140,858 April-11 1,460 204,400 47,891 156,509 May-11 1,606 224,840 52,680 172,160 June-11 1,752 245,280 57,469 187,811 Total SFY2011 1,594,320 373,549 1,220,771

CURRENT & PROJECTED CHIP - PACKAGE A & C EXPENDITURES BENEFIT COSTS FY 2010 Budget Number of Enrollees PMPM Managed Care (RBMC) 116,608,485.00 67,368 144 Fee for Service (Traditional) 14,870,696.00 11,720 103 Total Benefit Costs 131,479,181.00

(Offsetting beneficiary cost sharing payments) (6,604,769.00)

Net Benefit Costs 124,874,412.00 79,088 Administration Costs FY 2010 Budget Personnel 147,930.76

General Administration 2,219,638.44