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Model Application Template for the State Children’s Health Insurance Program

Effective Date:

Approval Date: 5

Amended Consolidated Compliance Plan Submitted: March 1, 2005 Amended Consolidated Compliance Plan Approved: June 30, 2005

7th Amendment Effective (co-payment): February 1, 2004 7th Amendment Approved: August 24, 2001

8th Amendment Submitted: February 2006

8th Amendment Effective: January 1, 2006

8th Amendment Approved: May 10, 2006