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

Effective Date:

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Approval Date: Section 1 General Description and Purpose of the State Child Health Plans and State Child Health Plan Requirements (Section 2101)

1.1 The state will use funds provided under Title XXI primarily for (Check appropriate box) (42 CFR 457.70):

1.1.1 Obtaining coverage that meets the requirements for a separate child health program (Section 2103); OR

1.1.2 Providing expanded benefits under the State’s Medicaid plan (Title XIX); OR

1.1.3 A combination of both of the above.

Medicaid expansion under Phase I of the CHIP program was approved June 26, 1998. State-designed child health program under Phase II of the program was approved December 22, 1999.

1.2 Please provide an assurance that expenditures for child health assistance will not be claimed prior to the time that the State has legislative authority to operate the State plan or plan amendment as approved by CMS. (42 CFR 457.40(d))

1.3 Please provide an assurance that the state complies with all applicable civil rights requirements, including title VI of the Civil Rights Act of 1964, title II of the Americans with Disabilities Act of 1990, section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, 45 CFR part 80, part 84, and part 91, and 28 CFR part 35. (42CFR 457.130)

1.4 Please provide the effective (date costs begin to be incurred) and implementation (date services begin to be provided) dates for this plan or plan amendment (42 CFR 457.65):

Original plan: Phase I - Medicaid Expansion  Effective:

October 1, 1997  Approval:

June 26, 1998  Implementation: July 1, 1998

Amendment 1: Phase II - State Program Addition  Submitted:

September 22, 1999  Approval:

December 22, 1999  Effective:

January 1, 2000

Amendment 2: CMS Template and End Continuous Eligibility  Submitted:

September 6, 2002  Approved:

November 26, 2002  Effective:

July 1, 2002

Amendment 3: Health Services Initiative  Submitted:

August 24, 2004  Withdrawn: May 30, 2006