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• On July 28, 2003, Texas submitted a seventh amendment to revise the form of coverage from benchmark to Secretary-approved coverage as a result of the elimination and reduction of certain benefits. The amendment specifically: reduces mental health and substance abuse benefits; eliminates dental, vision, and hospice benefits; eliminates income disregards so that SCHIP eligibility is based on gross income, implements an assets test for families at or above 150 percent of the FPL, increases co-payment and monthly premiums, reduces the term of coverage from 12 months to 6 months, and establishes a 3-month waiting period between eligibility determination and when the child can begin to receive care.

• On March 8, 2004, Texas submitted an eighth amendment to use a private donation (Houston Endowment) as a source of funding consistent with Sections 1903(w) and 2107(e)(1)(C) of the Social Security Act. The Houston Endowment qualifies as an acceptable source of funding because it does not violate Federal provider-related donation rules. The State will use the private donation from the Houston Endowment to add State-certified Community Health Workers (CHW), also known as Promotoras, to enhance case-management services to hard-to-reach populations.

• On March 8, 2004, Texas submitted a ninth amendment to transition the coverage of car seats from an outreach program under its administrative cap to a Secretary- approved child health assistance benefit. CMS disapproved the amendment; CMS believes that car seats would be more appropriately characterized as a health services initiative funded under the administrative cap rather than as a Secretary- approved benefit.

• On August 26, 2004, Texas submitted a tenth amendment to implement a Primary Care Provider (PCP) model in its CHIP Exclusive Provider Organization delivery system.

• On September 2, 2005, Texas submitted an eleventh amendment to expand the services provided to enrolled families in CHIP including hospice care, skilled nursing facilities, vision, tobacco cessation, and chiropractic services. It also increases behavioral health benefits.

• On September 28, 2005 Texas submitted its twelfth amendment to provide a tiered dental benefit to enrollees. The benefit provides therapeutic and preventative services.

• On September 28, 2005 Texas submitted its thirteenth amendment proposing to

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