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

Effective Date:

40

Approval Date: Contractors/Brokers (enrollment contractors) 6,727,513.80 Claims Processing 2,097,537.10 Outreach/Marketing Costs 325,000.00 Other (e.g. indirect Costs) 17,695.20 Health Services Initiatives - Total Administration Costs 11,535,315.30 TOTAL COST OF PROGRAM 136,409,727.30

FMAP FY10 = 76.15% SMAP FY10 = 23.85%

Funding Source: The state portion of the expenditures will be generated from the State’s tobacco settlement money. State general revenues will be used as a supplement, if needed.