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Effective Date:

Approval Date:

Updated and amended effective August 24, 2001

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• Pennsylvania Bulletin Notice – The Pennsylvania Bulletin is the Commonwealth’s official method of communicating information and rulemaking. The Commonwealth will post a notice about the proposed plan and program design prior to the requested effective date of the SPA, and indicate how interested persons can obtain copies of the plan the Commonwealth submits to CMS.

9.10. Provide a one year projected budget. A suggested financial form for the budget is attached. The budget must describe: (Section 2107(d)) (42CFR 457.140)

Planned use of funds, including -- - Projected amount to be spent on health services; - Projected amount to be spent on administrative costs, such as outreach, child health initiatives, and evaluation; and - Assumptions on which the budget is based, including cost per child and expected enrollment.

Projected sources of non-Federal plan expenditures, including any requirements for cost-sharing by enrollees.

See Appendix G