NR = not reported   NA = not applicable      -- = the state was not required to complete this section of the state plan             template and did not volunteer the information.

Identifiers				Cost Sharing
				Premiums
State	Program	Phase or Component	Amend.#	Premiums Required	Income Threshold for Premiums (%FPL)	Cap on Premium Amount Per Child	Maximum Per Child	Cap on Premium Amount Per Family	Maximum Per Family
AK	AK Denali KidCare		NA	No	NA	NA	NA	NA	NA
AL	AL SCHIP	Phase 1
AL	AL SCHIP	Phase 1	NA	No	NA	NA	NA	NA	NA
AL	AL SCHIP	All Kids (Phase 2)
AL	AL SCHIP	All Kids (Phase 2)	1	Yes	150	Yes	$5/month	Yes	$15/month
AL	AL SCHIP	All Kids (Phase 2)	2
AL	AL SCHIP	Plus (Phase 3)
AL	AL SCHIP	Plus (Phase 3)	2	No	NA	NA	NA	NA	NA
AR	AR SCHIP	Phase I - ARKids A
AR	AR SCHIP	Phase I - ARKids A	NA	No	NA	NA	NA	NA	NA
AR	AR SCHIP	Phase II - ARKids B
AR	AR SCHIP	Phase II - ARKids B	1	No	NA	NA		NA
AS	AS SCHIP		NA	--	--	--		--
AZ	KidsCare		NA	No	NA	NA	NA	NA	NA
AZ	KidsCare		1
AZ	KidsCare		2	Yes	150	Yes	$15/month	Yes	$20/month
AZ	KidsCare		3
AZ	KidsCare		4
CA	Healthy Families	Medi-Cal Expansion
CA	Healthy Families	Medi-Cal Expansion	NA	No	NA	NA	NA	NA	NA
CA	Healthy Families	Medi-Cal Expansion	1
CA	Healthy Families	Medi-Cal Expansion	2
CA	Healthy Families	Health Insurance Plan (MRMIB)
CA	Healthy Families	Health Insurance Plan (MRMIB)	NA	Yes	100	Yes	$9/month	Yes	$27/month
CA	Healthy Families	Health Insurance Plan (MRMIB)	2
CA	Healthy Families	Health Insurance Plan (MRMIB)	3
CA	Healthy Families	Health Insurance Plan (MRMIB)	4
CA	Healthy Families	Health Insurance Plan (MRMIB)	5
CA	Healthy Families	Access for Infants and Mothers (AIM)
CA	Healthy Families	Access for Infants and Mothers (AIM)	NA	Yes	NR	No	NA	Yes	2% annual family income
CA	Healthy Families	Access for Infants and Mothers (AIM)	2
CA	Healthy Families	Access for Infants and Mothers (AIM)	3
CA	Healthy Families	Access for Infants and Mothers (AIM)	4
CA	Healthy Families	Access for Infants and Mothers (AIM)	5
CA	Healthy Families	Child Health and Disability Prevention Program
CA	Healthy Families	Child Health and Disability Prevention Program	NA	No	NA	NA	NA	NA	NA
CA	Healthy Families	Child Health and Disability Prevention Program	2
CA	Healthy Families	Child Health and Disability Prevention Program	3
CA	Healthy Families	California Children`s Services
CA	Healthy Families	California Children`s Services	NA	NR	NR	NR	NR	NR	NR
CA	Healthy Families	California Children`s Services	2
CA	Healthy Families	County Mental Health Program
CA	Healthy Families	County Mental Health Program	NA	NR	NR	NR	NR	NR	NR
CA	Healthy Families	County Mental Health Program	2
CO	CHP+		NA	Yes	101	Yes	$20/month	Yes	$30/month
CO	CHP+		1
CO	CHP+		2		150		$25/enrollment period		$35/enrollment period
CT	HUSKY Program	Part A
CT	HUSKY Program	Part A	NA	No	NA	NA	NA	NA	NA
CT	HUSKY Program	Part A	0
CT	HUSKY Program	Part A	1
CT	HUSKY Program	Part B
CT	HUSKY Program	Part B	NA	Yes	235	Yes	$30/month	Yes	$50/month
CT	HUSKY Program	Part B	1
CT	HUSKY Program	HUSKY Plus Plan for Children with Special Physical Health Needs	NA	No	NA	NA	NA	NA	NA
CT	HUSKY Program	HUSKY Plus Plan for Children with Special Physical Health Needs	1
CT	HUSKY Program	HUSKY Plus Behavioral Health Plan	NA	No	NA	NA	NA	NA	NA
CT	HUSKY Program	HUSKY Plus Behavioral Health Plan	1
DC	DC Healthy Kids		NA	No	NA	NA	NA	NA	NA
DE	Delaware Healthy Children`s Program		NA	Yes	101	No	NA	Yes	$25/month
DE	Delaware Healthy Children`s Program		1
FL	FL KidCare	Medicaid expansion
FL	FL KidCare	Medicaid expansion	NA	No	NA	No	NA	No
FL	FL KidCare	Medicaid expansion	1
FL	FL KidCare	Healthy Kids
FL	FL KidCare	Healthy Kids	NA	Yes	101	NR		Yes	$15/month
FL	FL KidCare	Healthy Kids	1
FL	FL KidCare	Healthy Kids	3
FL	FL KidCare	Healthy Kids	4
FL	FL KidCare	Medi-Kids	1	Yes	NR	No	NA	Yes	$15/month
FL	FL KidCare	Medi-Kids	4
FL	FL KidCare	CMS	1	No	NA
FL	FL KidCare	CMS	4
GA	Peach Care for Kids		NA	Yes	NR	Yes	$7.50/month	Yes	$15/month
GA	Peach Care for Kids		0
GA	Peach Care for Kids		1
GU	Guam SCHIP		NA	No	NA	NA	NA	NA	NA
HI	HI SCHIP	Phase I	NA	No	NA	NA	NA	NA	NA
HI	HI SCHIP	Phase I	1
IA	Hawk-I	Medicaid Expansion	NA	No	NA	NA	NA	NA	NA
IA	Hawk-I	Medicaid Expansion	4
IA	Hawk-I	Separate State Program	1	Yes	150	Yes	$10/month	Yes	$20/month
IA	Hawk-I	Separate State Program	2
IA	Hawk-I	Separate State Program	3
IA	Hawk-I	Separate State Program	4
ID	ID SCHIP		NA	No	NA	NA	NA	NA	NA
ID	ID SCHIP		1
ID	ID SCHIP		2
IL	Kidcare	Phase 1	NA	No	NA	NA	NA	NA	NA
IL	Kidcare	Phase 2	1	Yes	150	Yes	$15/month	Yes	$30/month
IN	Hoosier Healthwise	Phase 1	NA	No	NA	NA	NA	NA	NA
IN	Hoosier Healthwise	Phase 1	0
IN	Hoosier Healthwise	Phase 2	2	Yes	150	Yes	$16.50/month	Yes	$24.75/month
KS	HealthWave		NA	Yes	151	No	NA	Yes	$15/month
KS	HealthWave		1
KY	KCHIP	Medicaid Expansion
KY	KCHIP	Medicaid Expansion	NA	No	NA	NA	NA	NA	NA
KY	KCHIP	Medicaid Expansion	1
KY	KCHIP	Insurance Product
KY	KCHIP	Insurance Product	NA	Yes	100	No	NA	Yes	$20/month
KY	KCHIP	Insurance Product	1		150
KY	KCHIP	Insurance Product	2
LA	LaCHIP		NA	No	NA	NA	NA	NA	NA
LA	LaCHIP		1
MA	MassHealth	Standard	NA	--	--	--	--	--	--
MA	MassHealth	Family Assistance Direct Coverage	NA	Yes	151	No	NA	Yes	$30/month
MA	MassHealth	Family Assistance Premium Assistance	NA	Yes	151	No	NA	Yes	$30/month
MA	MassHealth	Common Health	NA	No	NA	NA	NA	NA	NA
MD	Maryland Children`s Health Program	Phase I	NA	No	NA	NA	NA	NA	NA
MD	Maryland Children`s Health Program	Phase I	1
MD	Maryland Children`s Health Program	Phase II	2	Yes	200	No		Yes	$47 per month
MD	Maryland Children`s Health Program	Phase II- ESI	2	Yes	200	No		Yes	$47 per month
ME	ME CHIP Medicaid Expansion		NA	No	NA	NA	NA	NA	NA
ME	Cubcare		NA	Yes	151	Yes	$15/month	Yes	$30/month
ME	Cubcare		1
MI	MI SCHIP	MI CHILD	NA	Yes	151	Yes	$8/month	Yes	$16/month
MI	MI SCHIP	MI CHILD	1			No	NA	Yes	$5/month
MI	MI SCHIP	MI CHILD	2
MI	MI SCHIP	Medicaid Expansion	1	No	NA	NA	NA	NA	NA
MI	MI SCHIP	Medicaid Expansion	2
MN	Minnesota Medical Assistance Program		NA	No	NA	NA	NA	NA	NA
MO	MC+ for Kids		NA	No	NA	NA	NA	NA	NA
MO	MC+ for Kids		1	Yes	225	No	NA	Yes	$68/month
MP	CNMI SCHIP		NA	No	NA	NA	NA	NA	NA
MS	MS SCHIP	Phase I
MS	MS SCHIP	Phase I	NA	No	NA	NA	NA	NA	NA
MS	MS SCHIP	Phase II
MS	MS SCHIP	Phase II	1	No
MS	MS SCHIP	Phase II	2	No
MS	MS SCHIP	Phase II	3
MS	MS SCHIP	Employer-sponsored coverage	1	No
MT	MT SCHIP		NA	Yes	NA	No	NA	Yes	$15 per year
MT	MT SCHIP		1	No		NA		NA
NC	NC SCHIP		NA	Yes	150	Yes	$50/year	Yes	$100/child/year
NC	NC SCHIP		1
NC	NC SCHIP		2
NC	NC SCHIP		3
NC	NC SCHIP		4
NC	NC SCHIP		5
ND	Healthy Steps	Phase I
ND	Healthy Steps	Phase I	NA	No	NA	NA	NA	NA	NA
ND	Healthy Steps	Phase II
ND	Healthy Steps	Phase II	1	No	NA	NA		NA
NE	Kid`s Connection		NA	No	NA	NA	NA	NA	NA
NE	Kid`s Connection		1
NH	Healthy Kids	Gold	NA	No	NA	NA	NA	NA	NA
NH	Healthy Kids	Gold	1
NH	Healthy Kids	Silver	NA	Yes	185	Yes	$40/month	Yes	$100/month
NJ	KidCare	Plan A	NA	No	NA	NA	NA	NA	NA
NJ	KidCare	Plan B	NA	No	NA	NA	NA	NA	NA
NJ	KidCare	Plan B	1
NJ	KidCare	Plan B	3
NJ	KidCare	Plan B	4
NJ	KidCare	Plan C	NA	Yes	151	No	NA	Yes	$15/month
NJ	KidCare	Plan C	1
NJ	KidCare	Plan C	3
NJ	KidCare	Plan C	4
NJ	KidCare	Plan D	2	Yes	201	No	NA	Yes	$100/month
NJ	KidCare	Plan D	3
NJ	KidCare	Plan D	4
NJ	KidCare	1115 Demonstration	NA
NM	NM SCHIP		NA	NR	NR	NR	NR	NR	NR
NM	NM SCHIP		2
NM	NM SCHIP	1115 Demonstration	NA
NV	Nevada Check-Up		NA	Yes	NR	No	NA	Yes	$50/quarter
NV	Nevada Check-Up		1
NY	NY SCHIP	CHPLUS
NY	NY SCHIP	CHPLUS
NY	NY SCHIP	CHPLUS	NA	Yes	151	Yes	$13/month	Yes	$52/month
NY	NY SCHIP	CHPLUS	2		133		$15/month		$45/month
NY	NY SCHIP	Medicaid Expansion	2	No	NA	NA	NA	NA	NA
OH	OH Child Health Plan		NA	No	NA	NA	NA	NA	NA
OH	OH Child Health Plan		1
OK	SoonerCare		NA	No	NA	NA	NA	NA	NA
OK	SoonerCare		1
OR	OR SCHIP		NA	No	NA	NA	NA	NA	NA
OR	OR SCHIP		2
OR	OR SCHIP		3
PA	PA SCHIP		NA	No	NA	NA	NA	NA	NA
PA	PA SCHIP		1
PA	PA SCHIP		2
PA	PA SCHIP		3
PA	PA SCHIP		4
PR	PR SCHIP		NA	No	NA	NA	NA	NA	NA
RI	RIte Care		NA	Yes	185	Yes	$12.46/month	No	NA
RI	RIte Care		1				$12.46/month
RI	RIte Care	1115 Demonstration	NA
SC	Partners for Healthy Children		NA	No	NA	NA	NA	NA	NA
SD	SD SCHIP		NA	No	NA	NA	NA	NA	NA
SD	SD SCHIP		1
SD	SD SCHIP		2
SD	SD SCHIP	CHIP NM	3	No
TN	Tennessee`s CHIP	Phase I	NA	No	NA	NA	NA	NA	NA
TX	Texas Healthy Steps	Phase I
TX	Texas Healthy Steps	Phase I	NA	No	NA	NA	NA	NA	NA
TX	Texas Healthy Steps	Phase II
TX	Texas Healthy Steps	Phase II	1	Yes	151	Yes	$18/month	Yes	$18
UT	UT SCHIP		NA	No	NA	NA	NA	NA	NA
VA	VA SCHIP	Children's Medical Security Insurance Plan/Family Access to Medical Insurance Security Plan	NA	No	NA	NA	NA	NA	NA
VA	VA SCHIP	Children's Medical Security Insurance Plan/Family Access to Medical Insurance Security Plan	1	Yes	150	Yes	$15	Yes	$45
VA	VA SCHIP	Family Access to Medical Insurance Security Plan (FAMIS) - ESI	1	Yes	150	Yes	$15	Yes	$45
VI	Virgin Island`s SCHIP		NA	No	NA	NA	NA	NA	NA
VI	Virgin Island`s SCHIP		1
VT	VT SCHIP		NA	Yes	185	No	NA	Yes	$10/month/ household
VT	VT SCHIP		1						$25/month
VT	VT SCHIP		2
VT	VT SCHIP		3						$25/month
WA	WA SCHIP		NA	Yes	NR	Yes	$10/month	Yes	$30/month
WA	WA SCHIP		1
WI	BadgerCare	Medicaid expansion
WI	BadgerCare	Medicaid expansion	NA	No	NA	NA	NA	NA	NA
WI	BadgerCare	Medicaid expansion	1	Yes	150	No	NA	Yes	3-3.5% of family income in monthly payments
WI	BadgerCare	Employer-sponsored Coverage	1	Yes	150	No		Yes	3-3.5 percent of family income in monthly payments
WI	BadgerCare		NA
WV	WV SCHIP	Phase I	NA	No	NA	NA	NA	NA	NA
WV	WV SCHIP	Phase I	2
WV	WV SCHIP	Phase II	1	No	NA	NA	NA	NA	NA
WV	WV SCHIP	Phase II	2
WV	WV SCHIP	Phase II	3	No
WY	WY SCHIP	CHIP One	NA	No	NA	NA	NA	NA	NA