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3 income above 200 through 250 percent of the Federal poverty level (FPL) and to raise the family maximum for premiums from $30 to $45 per month. This amendment also reduces the number of consecutive months a client can be in arrears on paying premiums from 4 months to 3 months and reduces the waiting period for reinstating benefits after termination from 4 months to 3 months.

• On May 2, 2006, Washington submitted its seventh amendment to its Title XXI State Plan to extend the State Children’s Health Insurance Program (CHIP) continuous eligibility period from 6 months to 12 months, and to update the State plan to reflect the name change and organizational changes that occurred within the agency that administers CHIP.

• On November 27, 2006, Washington submitted its eighth amendment to its Title XXI State Plan. This amendment was withdrawn by the State on December 27, 2006.

• On January 25, 2007, Washington submitted its ninth amendment to its Title XXI State plan. This amendment was withdrawn by the State on February 5, 2008.

• On April 3, 2008, Washington submitted its tenth amendment to its Title XXI State plan. This SPA permits Washington to institute a pilot Application Agent program to assist families applying for CHIP and other child health programs in the state. Application Agents will receive a $75 fee for each application that results in new coverage. Washington is also seeking funding to finance a media campaign for its Apple Health for Kids program.

• On April 21, 2008, Washington submitted its eleventh amendment to its Title XXI State plan. This amendment seeks to increase the financial eligibility standard for its separate CHIP from the current family net income eligibility level at or below 250 percent of the FPL to family net income at or below 300 percent of the FPL. The SPA also proposes a two-child maximum premium limit. Cost sharing for children above 200 percent of the FPL up to and including 250 percent of the FPL will decrease in total from $15 per child per month, with a maximum of $45 per family to $20 per child per month, with a maximum of $40 per family. And cost sharing for children from 251 percent of the FPL up to and including 300 percent of the FPL is proposed to be $30 per month per child; up to a family maximum of $60 per month.

• On May 22, 2008, Washington submitted its twelfth amendment to its Title XXI State plan. This SPA permits Washington to increase children’s mental health outpatient services from up to 12 hours per calendar year to up to 20 hours per calendar year for those children receiving mental health benefits through managed care or the fee-for-service (FFS) system.

• On June 28, 2010, Washington submitted its thirteenth amendment to its Title XXI State plan. This SPA permits Washington to obtain Federal matching funds to implement a new health service initiative (HIS) to fund the Washington Poison Control System and to expand eligibility to uninsured non-citizen optional targeted low-income children, who have gross family incomes up to and including 300 percent of the Federal poverty level, and who are lawfully residing in the United States, as permitted by section 214 of the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA). This amendment also eliminates the 3 month sanction for families that have not paid their premium and acknowledges existing practices in Washington’s title XXI State Plan that are in compliance with CHIPRA sections 211 (Citizenship Documentation Requirement), 501 (Dental