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DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail StoP 52-01-16 Baltimore, MD 21244F185O urs .FNITIS fl)R MÊDIC-'IRF & MIDIC]\ID 'TNVICf,S CENfTR IOB MEDICAfD & CHIP SERVICES Mari Cantwell Chief Deputy Director Department of Health Care Services 1501 Capitol Avenue, MS 0000 Sacramento, C A 9 5899 -7 4 13 DEC 2 7 2017 Dear Ms. Cantwell: This letter is to inform you that the centers for Medicare & Medicaid Seruices (cMS) has approved your children's Health Insurance Program (CHIP) state plan amendment (SPA), CA- iHfp SpÁ +ZO, submiued to CMS on June 27,2014. This SPA updates Califomia's full state plan by removing the former Ile althy Families component of the state's separate CHIP, which "ou".éd childre[up to age 19 above the Medicaid levels with income up to 250 percent of the Federal poverty level (FPL). The Heatthy Families popìulation was subsumed into the state's Medicaid program on January 1,2014. with this sPA, califomia's separate CHIP is now comprised of the following populations, effective January 1, 2014: c The county children's Health Initiative Program (CCHIP), which operates in San Francisco, san Mateo, and santa clara counties for children from age 0 to 19, who are above 261 percent FPL up to and including 317 percent Federal poverty level (FPL); o Children from conception to birth, under the "unbom" option for children with income from zero up to 317 percent of the FPL; and ¡ An infant population (linked to the unborn option), from age 0 to 2, who arc above 261 percent FPL and up to and including 3 17 percent FLP' The transition of the Healthy Fømilies poEiation from CHIP to Medicaid began on January 1, 2013, when Califomia received approval for a time limited section 1 I 15 demonstration to phase in Medicaid coverage of approximately 751,000 former Healtlry Familíes childten with income upto 250 percent ofthe FPL. This phase in was completed by December 31,2013. Upon càmpletion of the phase in, the state feceived approval on January 1,2014 to cover both new "*oil"". and transitioning Healthy Families children within this income range under Medicaid sPA CA-13-0021. CA CHIP SpA #20 also deletei outdated eligibility information and incorporates references to formerly approved MAGI SPAs throughout the current GHIP state plan template as appropriate. In addition, CtVtS is approving SPA CA-17-0045, which permits presumptive eligibility for