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87 community; physicians who are board certified in pediatrics and family practice medicine; and a representative of a family of children with special needs.

9.9.1. Describe the process used by the State to ensure interaction with Indian Tribes and organizations in the State on the development and implementation of the procedures required in 42 CFR 457.125. States should provide notice and consultation with Tribes on proposed pregnant women expansions. (Section 2107(c)) (42CFR 457.120(c))

CA RESPONSE: Throughout the years, California has solicited and received input from various Indian Tribes, tribal affiliated organizations and boards on matters related to enrollment in the Medi-Cal and CHIP Programs. Several activities include:

• Participation in American Indian sponsored conferences, meetings and workgroups. • Coordinated distribution of targeted outreach materials to the American Indian population via conferences, clinics, and meetings. • Meetings with various tribal affiliated organizations and boards to identify acceptable documentation to demonstrate tribal affiliation for families to qualify for the Healthy Families cost sharing waiver.

9.9.2. For an amendment relating to eligibility or benefits (including cost sharing and enrollment procedures), describe how and when prior public notice was provided as required in 42 CFR 457.65(b) through (d).

CA RESPONSE: Initially, the public was informed of the premium and benefit change through budget hearings, legislative approval and enactment of the Chapter 157, Statutes of 2009 (Assembly Bill 1422) affecting premiums, and was again informed of those changes through promulgation of regulations in accordance with State law. Promulgation of regulations also entailed public meetings of the state.

The family contribution amounts increased for the highest income families pursuant to the Chapter 157, Statutes of 2009 (Assembly Bill 1422), which took effect on November 1, 2009. The family contribution increased for families with income greater than 150 percent and up to 250 percent FPL. In addition, benefit changes enacted by regulations increased co-payments for families with incomes greater than 150 percent and up to 250 percent FPL. Lastly, pursuant to regulations new families with children enrolled on or after November 1, 2009, will have limited dental plan choice effective November 1, 2009.

The dental benefit change aligns the CHIP rules with state employees dental benefit rules.