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2 Date Amendment #11 Submitted:

April 21, 2008 Date Amendment #11 Approved:

April 3, 2009 Date Amendment #11 Effective:

January 1, 2009

Date Amendment #12 Submitted:

May 22, 2008 Date Amendment #12 Approved:

January 16, 2009 Date Amendment #12 Effective:

July 1, 2008

Date Amendment #13 Submitted:

June 28, 2010 Date Amendment #13 Approved:

December 06, 2010 Date Amendment #13 Effective:

July 1, 2009, for the HSI October 1, 2009, for Dental Coverage and the Application of Medicaid FQHC/RHC Payment Requirements to CHIP January 1, 2010, for the Social Security data match April 1, 2010, for the elimination of the 3- month sanction

• On September 8, 1999, Washington submitted a Title XXI State Plan to implement a new State Children’s Health Insurance Program (CHIP). The program provided comprehensive health care coverage to uninsured children under age 19 with family incomes above 200 percent up to and including 250 percent of the Federal poverty level (FPL).

Amendments

• The State submitted its first State Plan Amendment on May 7, 2001, which modified the assignment process and eliminated the requirement for families to select a plan as part of the application process. The amendment also eliminated the requirement for families to sign a written agreement to pay premiums as a condition of eligibility.

• A second amendment was submitted by the State on April 3, 2002. This amendment eliminated co-payment charges for children enrolled in CHIP.

• Washington submitted its third amendment on October 3, 2002, to update its State Plan to indicate compliance with the final CHIP regulations.

• Washington submitted its fourth amendment to its Title XXI State Plan to add coverage for unborn children with family incomes up to and including 185 percent of the FPL and not eligible for Medicaid. Coverage will include prenatal care and associated health services for children from conception through birth.

• On January 22, 2004, Washington submitted its fifth amendment to its Title XXI State Plan to change the duration of eligibility from 12 months to 6 months. This change will affect CHIP clients enrolled on and after July 2003, with a 6-month review date on and after December 31, 2003.

• On August 16, 2004, Washington submitted its sixth amendment to its Title XXI State plan to increase monthly premiums from $10 to $15 per child per month for families with