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				Footnotes (3-5)
State	Program	Phase or Component	Amend.#	Item Footnoted (3)	Footnote Text (3)	Item Footnoted (4)	Footnote Text (4)	Item Footnoted (5)	Footnote Text (5)
AK	AK Denali KidCare		NA
AL	AL SCHIP	Phase 1
AL	AL SCHIP	Phase 1	NA
AL	AL SCHIP	All Kids (Phase 2)
AL	AL SCHIP	All Kids (Phase 2)	1
AL	AL SCHIP	All Kids (Phase 2)	2
AL	AL SCHIP	Plus (Phase 3)
AL	AL SCHIP	Plus (Phase 3)	2
AR	AR SCHIP	Phase I - ARKids A
AR	AR SCHIP	Phase I - ARKids A	NA
AR	AR SCHIP	Phase II - ARKids B
AR	AR SCHIP	Phase II - ARKids B	1
AS	AS SCHIP		NA
AZ	KidsCare		NA	J40	Emergency transportation only.
AZ	KidsCare		1
AZ	KidsCare		2
AZ	KidsCare		3
AZ	KidsCare		4
CA	Healthy Families	Medi-Cal Expansion
CA	Healthy Families	Medi-Cal Expansion	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
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
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
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
CA	Healthy Families	California Children`s Services	2
CA	Healthy Families	County Mental Health Program
CA	Healthy Families	County Mental Health Program	NA
CA	Healthy Families	County Mental Health Program	2
CO	CHP+		NA	M11	Copayments are $2 for families with incomes between 101-150% FPL.
CO	CHP+		1
CO	CHP+		2
CT	HUSKY Program	Part A
CT	HUSKY Program	Part A	NA
CT	HUSKY Program	Part A	0
CT	HUSKY Program	Part A	1					J14	The amendment implements full mental health parity by eliminating all limitations previously imposed on inpatient and outpatient treatment of DSM IV mental health conditions or substance abuse problems.
CT	HUSKY Program	Part B
CT	HUSKY Program	Part B	NA
CT	HUSKY Program	Part B	1					J14	The amendment implements fully mental health parity by eliminating all limitations on inpatient and outpatient treatment of DSM IV mental health conditions or substance abuse problems.
CT	HUSKY Program	HUSKY Plus Plan for Children with Special Physical Health Needs	NA
CT	HUSKY Program	HUSKY Plus Plan for Children with Special Physical Health Needs	1
CT	HUSKY Program	HUSKY Plus Behavioral Health Plan	NA
CT	HUSKY Program	HUSKY Plus Behavioral Health Plan	1
DC	DC Healthy Kids		NA
DE	Delaware Healthy Children`s Program		NA
DE	Delaware Healthy Children`s Program		1
FL	FL KidCare	Medicaid expansion
FL	FL KidCare	Medicaid expansion	NA
FL	FL KidCare	Medicaid expansion	1
FL	FL KidCare	Healthy Kids
FL	FL KidCare	Healthy Kids	NA
FL	FL KidCare	Healthy Kids	1
FL	FL KidCare	Healthy Kids	3
FL	FL KidCare	Healthy Kids	4
FL	FL KidCare	Medi-Kids	1
FL	FL KidCare	Medi-Kids	4
FL	FL KidCare	CMS	1
FL	FL KidCare	CMS	4
GA	Peach Care for Kids		NA
GA	Peach Care for Kids		0
GA	Peach Care for Kids		1
GU	Guam SCHIP		NA
HI	HI SCHIP	Phase I	NA
HI	HI SCHIP	Phase I	1
IA	Hawk-I	Medicaid Expansion	NA
IA	Hawk-I	Medicaid Expansion	4
IA	Hawk-I	Separate State Program	1
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
ID	ID SCHIP		1
ID	ID SCHIP		2
IL	Kidcare	Phase 1	NA
IL	Kidcare	Phase 2	1	J19	All services available under Medicaid that are provided to participants of home and community based waivers are included under KidCare. Only the specialized services unique to the waivers are excluded.
IN	Hoosier Healthwise	Phase 1	NA
IN	Hoosier Healthwise	Phase 1	0
IN	Hoosier Healthwise	Phase 2	2
KS	HealthWave		NA
KS	HealthWave		1
KY	KCHIP	Medicaid Expansion
KY	KCHIP	Medicaid Expansion	NA
KY	KCHIP	Medicaid Expansion	1
KY	KCHIP	Insurance Product
KY	KCHIP	Insurance Product	NA
KY	KCHIP	Insurance Product	1
KY	KCHIP	Insurance Product	2
LA	LaCHIP		NA
LA	LaCHIP		1
MA	MassHealth	Standard	NA	M1	Copays for pharmacy ($0.50) and non-emergency use of emergency room ($3.00).
MA	MassHealth	Family Assistance Direct Coverage	NA
MA	MassHealth	Family Assistance Premium Assistance	NA
MA	MassHealth	Common Health	NA
MD	Maryland Children`s Health Program	Phase I	NA
MD	Maryland Children`s Health Program	Phase I	1
MD	Maryland Children`s Health Program	Phase II	2
MD	Maryland Children`s Health Program	Phase II- ESI	2
ME	ME CHIP Medicaid Expansion		NA
ME	Cubcare		NA
ME	Cubcare		1
MI	MI SCHIP	MI CHILD	NA
MI	MI SCHIP	MI CHILD	1
MI	MI SCHIP	MI CHILD	2
MI	MI SCHIP	Medicaid Expansion	1
MI	MI SCHIP	Medicaid Expansion	2
MN	Minnesota Medical Assistance Program		NA
MO	MC+ for Kids		NA	B17	Mandatory period of no insurance does not apply if coverage is lost during the 6-month period because of (a) loss of employment due to factors other than voluntary termination; (b) change to a new employer that does not provide an option for dependent coverage; or (c)expiration of COBRA coverage period	B13	A net worth test of $250,000 is done in place of an asset test.
MO	MC+ for Kids		1
MP	CNMI SCHIP		NA
MS	MS SCHIP	Phase I
MS	MS SCHIP	Phase I	NA
MS	MS SCHIP	Phase II
MS	MS SCHIP	Phase II	1
MS	MS SCHIP	Phase II	2
MS	MS SCHIP	Phase II	3
MS	MS SCHIP	Employer-sponsored coverage	1
MT	MT SCHIP		NA
MT	MT SCHIP		1
NC	NC SCHIP		NA
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
ND	Healthy Steps	Phase II
ND	Healthy Steps	Phase II	1
NE	Kid`s Connection		NA
NE	Kid`s Connection		1
NH	Healthy Kids	Gold	NA
NH	Healthy Kids	Gold	1
NH	Healthy Kids	Silver	NA
NJ	KidCare	Plan A	NA
NJ	KidCare	Plan B	NA
NJ	KidCare	Plan B	1
NJ	KidCare	Plan B	3
NJ	KidCare	Plan B	4
NJ	KidCare	Plan C	NA
NJ	KidCare	Plan C	1
NJ	KidCare	Plan C	3
NJ	KidCare	Plan C	4
NJ	KidCare	Plan D	2
NJ	KidCare	Plan D	3
NJ	KidCare	Plan D	4
NJ	KidCare	1115 Demonstration	NA
NM	NM SCHIP		NA
NM	NM SCHIP		2
NM	NM SCHIP	1115 Demonstration	NA
NV	Nevada Check-Up		NA
NV	Nevada Check-Up		1
NY	NY SCHIP	CHPLUS
NY	NY SCHIP	CHPLUS
NY	NY SCHIP	CHPLUS	NA	M7	Premiums are on a sliding scale.
NY	NY SCHIP	CHPLUS	2
NY	NY SCHIP	Medicaid Expansion	2
OH	OH Child Health Plan		NA
OH	OH Child Health Plan		1
OK	SoonerCare		NA
OK	SoonerCare		1	B12	Income between 100 and 185% FPL is disregarded for those born between 10/30/80 and 10/30/83.
OR	OR SCHIP		NA
OR	OR SCHIP		2
OR	OR SCHIP		3
PA	PA SCHIP		NA
PA	PA SCHIP		1
PA	PA SCHIP		2
PA	PA SCHIP		3
PA	PA SCHIP		4
PR	PR SCHIP		NA
RI	RIte Care		NA	M2	No copayments for prenatal and well-baby visits.	B17	Applicants must be uninsured and cannot have dropped or refused coverage which would have cost less than $150/month in premiums per individual and $300/month in premiums per family within one year.
RI	RIte Care		1
RI	RIte Care	1115 Demonstration	NA
SC	Partners for Healthy Children		NA
SD	SD SCHIP		NA
SD	SD SCHIP		1
SD	SD SCHIP		2
SD	SD SCHIP	CHIP NM	3
TN	Tennessee`s CHIP	Phase I	NA
TX	Texas Healthy Steps	Phase I
TX	Texas Healthy Steps	Phase I	NA
TX	Texas Healthy Steps	Phase II
TX	Texas Healthy Steps	Phase II	1
UT	UT SCHIP		NA	B13A	State resident based on residency of parents
VA	VA SCHIP	Children's Medical Security Insurance Plan/Family Access to Medical Insurance Security Plan	NA
VA	VA SCHIP	Children's Medical Security Insurance Plan/Family Access to Medical Insurance Security Plan	1
VA	VA SCHIP	Family Access to Medical Insurance Security Plan (FAMIS) - ESI	1
VI	Virgin Island`s SCHIP		NA
VI	Virgin Island`s SCHIP		1
VT	VT SCHIP		NA
VT	VT SCHIP		1
VT	VT SCHIP		2
VT	VT SCHIP		3	M7	The maximum premium per household will increase to $50 per month on 2/1/2001 for families above 225% FPL.
WA	WA SCHIP		NA
WA	WA SCHIP		1
WI	BadgerCare	Medicaid expansion
WI	BadgerCare	Medicaid expansion	NA	L4	Beginning in 2000, plans will be required to submit their complete encounter data.	F10	New Medicaid data system checks eligibility for W-2, Food Stamps and Child Care.
WI	BadgerCare	Medicaid expansion	1
WI	BadgerCare	Employer-sponsored Coverage	1
WI	BadgerCare		NA
WV	WV SCHIP	Phase I	NA
WV	WV SCHIP	Phase I	2
WV	WV SCHIP	Phase II	1
WV	WV SCHIP	Phase II	2
WV	WV SCHIP	Phase II	3
WY	WY SCHIP	CHIP One	NA