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Missouri Application for the State Children’s Health Insurance Program Effective Date: 07/01/2011 Approval Date: Bold Italics Added Information Prior Approval Date: 09/28/2007 Strikethrough Deleted Information

- 5 - 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. (42 CFR 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) Response: Effective date (date State incurs costs): Initial Combination SCHIP State Plan Submission, SPA #3: September 1, 2007 SPA #4: Disapproved December 19, 2008 SPA #5: Effective May 1, 2009 SPA #6: Effective July 1, 2009 SPA #7: Withdrawn June 29, 2011 SPA #8: Effective July 1, 2011 Implementation date (date services begin): SPA #3: September 1, 2007 SPA #4: Disapproved December 19, 2008 SPA #5: May 1, 2009 SPA #6: July 1, 2009 SPA #7: Withdrawn June 29, 2011 SPA #8: Effective July 1, 2011