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				Service Delivery Model				Benefit Maximums
State	Program	Phase or Component	Amend.#	FFS	PCCM	HMO/ Prepaid Health Plan	Medicaid Providers Approved for SCHIP	Annual or Lifetime Benefit Maximum	Annual Maximum	Lifetime Maximum
AK	AK Denali KidCare		NA	--	--	--	Yes	No	NA	NA
AL	AL SCHIP	Phase 1
AL	AL SCHIP	Phase 1	NA	--	Yes	Yes	Yes	No	NA	NA
AL	AL SCHIP	All Kids (Phase 2)
AL	AL SCHIP	All Kids (Phase 2)	1	Yes	NR	Yes	NR	NR	NR	NR
AL	AL SCHIP	All Kids (Phase 2)	2
AL	AL SCHIP	Plus (Phase 3)
AL	AL SCHIP	Plus (Phase 3)	2	Yes	NR	Yes	NR	NR	NR	NR
AR	AR SCHIP	Phase I - ARKids A
AR	AR SCHIP	Phase I - ARKids A	NA	--	Yes	No	Yes	No	NA	NA
AR	AR SCHIP	Phase II - ARKids B
AR	AR SCHIP	Phase II - ARKids B	1	No	Yes	No	Yes	NR	NA	NA
AS	AS SCHIP		NA	--	--	--	Yes	No	NA	NA
AZ	KidsCare		NA	Yes	NR	Yes	Yes	NR	NR	NR
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	Yes	--	Yes	Yes	No	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	NR	NR	Yes	NR	NR	NR	NR
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	NR	NR	Yes	NR	NR	NR	NR
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	Yes	NR	NR	Yes	NR	NR	NR
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	Yes	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	Yes	NR	NR	NR	NR	NR	NR
CA	Healthy Families	County Mental Health Program	2
CO	CHP+		NA	Yes	NR	Yes	Yes	NR	NR	NR
CO	CHP+		1
CO	CHP+		2	No
CT	HUSKY Program	Part A
CT	HUSKY Program	Part A	NA	--	--	Yes	Yes	No	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	NR	NR	Yes	Yes	NR	NR	NR
CT	HUSKY Program	Part B	1
CT	HUSKY Program	HUSKY Plus Plan for Children with Special Physical Health Needs	NA	Yes	Yes	No	No	NR	NR	NR
CT	HUSKY Program	HUSKY Plus Plan for Children with Special Physical Health Needs	1
CT	HUSKY Program	HUSKY Plus Behavioral Health Plan	NA	NR	NR	No	No	NR	NR	NR
CT	HUSKY Program	HUSKY Plus Behavioral Health Plan	1
DC	DC Healthy Kids		NA	Yes	--	Yes	Yes	No	NA	NA
DE	Delaware Healthy Children`s Program		NA	NR	NR	Yes	Yes	NR	NR	NR
DE	Delaware Healthy Children`s Program		1
FL	FL KidCare	Medicaid expansion
FL	FL KidCare	Medicaid expansion	NA	--	Yes	Yes	Yes	No	NA	NA
FL	FL KidCare	Medicaid expansion	1
FL	FL KidCare	Healthy Kids
FL	FL KidCare	Healthy Kids	NA	NR	NR	Yes	NR	NR	NR	NR
FL	FL KidCare	Healthy Kids	1
FL	FL KidCare	Healthy Kids	3
FL	FL KidCare	Healthy Kids	4
FL	FL KidCare	Medi-Kids	1	NR	Yes	Yes	Yes	No	NA	NA
FL	FL KidCare	Medi-Kids	4
FL	FL KidCare	CMS	1	NR	Yes	Yes	Yes	No	NA	NA
FL	FL KidCare	CMS	4
GA	Peach Care for Kids		NA	NR	Yes	Yes	Yes	NR	NR	NR
GA	Peach Care for Kids		0
GA	Peach Care for Kids		1
GU	Guam SCHIP		NA	--	--	--	Yes	No	NA	NA
HI	HI SCHIP	Phase I	NA	--	--	Yes	Yes	No	NA	NA
HI	HI SCHIP	Phase I	1
IA	Hawk-I	Medicaid Expansion	NA	--	--	Yes	Yes	No	NA	NA
IA	Hawk-I	Medicaid Expansion	4
IA	Hawk-I	Separate State Program	1	Yes	NR	Yes	NR	NR	NR	NR
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	--	--	--	Yes	No	NA	NA
ID	ID SCHIP		1
ID	ID SCHIP		2
IL	Kidcare	Phase 1	NA	Yes	NR	Yes	Yes	No	NA	NA
IL	Kidcare	Phase 2	1	Yes	NR	Yes	Yes	No
IN	Hoosier Healthwise	Phase 1	NA	--	No	Yes	Yes	No	NA	NA
IN	Hoosier Healthwise	Phase 1	0
IN	Hoosier Healthwise	Phase 2	2	No	Yes	Yes	Yes	NR	NR	NR
KS	HealthWave		NA	NR	NR	Yes	NR	NR	NR	NR
KS	HealthWave		1
KY	KCHIP	Medicaid Expansion
KY	KCHIP	Medicaid Expansion	NA	Yes	--	Yes	Yes	No	NA	NA
KY	KCHIP	Medicaid Expansion	1
KY	KCHIP	Insurance Product
KY	KCHIP	Insurance Product	NA	NR	NR	Yes	NR	NR	NR	NR
KY	KCHIP	Insurance Product	1
KY	KCHIP	Insurance Product	2	No	Yes		Yes
LA	LaCHIP		NA	--	Yes	Yes	Yes	No	NA	NA
LA	LaCHIP		1
MA	MassHealth	Standard	NA	No	Yes	Yes	Yes	No	NA	NA
MA	MassHealth	Family Assistance Direct Coverage	NA	No	Yes	Yes	Yes	NR	NR	NR
MA	MassHealth	Family Assistance Premium Assistance	NA	NR	NA	NR	NA	NR	NR	NR
MA	MassHealth	Common Health	NA	Yes	NR	No	NR	NR	NR	NR
MD	Maryland Children`s Health Program	Phase I	NA	--	--	Yes	Yes	No	NA	NA
MD	Maryland Children`s Health Program	Phase I	1
MD	Maryland Children`s Health Program	Phase II	2	Yes	NR	Yes	NR	NR	NA	NA
MD	Maryland Children`s Health Program	Phase II- ESI	2	Yes	NR	Yes	NR	NR	NA	NA
ME	ME CHIP Medicaid Expansion		NA	Yes	Yes	Yes	Yes	No	NA	NA
ME	Cubcare		NA	Yes	Yes	Yes	Yes	NR	NR	NR
ME	Cubcare		1
MI	MI SCHIP	MI CHILD	NA	Yes	NR	Yes	NR	NR	NR	NR
MI	MI SCHIP	MI CHILD	1
MI	MI SCHIP	MI CHILD	2
MI	MI SCHIP	Medicaid Expansion	1	--	--	--	Yes	No	NA	NA
MI	MI SCHIP	Medicaid Expansion	2
MN	Minnesota Medical Assistance Program		NA	--	--	Yes	Yes	No	NA	NA
MO	MC+ for Kids		NA	Yes	--	Yes	Yes	No	NA	NA
MO	MC+ for Kids		1
MP	CNMI SCHIP		NA	--	--	--	Yes	No	NA	NA
MS	MS SCHIP	Phase I
MS	MS SCHIP	Phase I	NA	Yes	--	Yes	Yes	No	NA	NA
MS	MS SCHIP	Phase II
MS	MS SCHIP	Phase II	1	Yes	Yes	Yes	NR
MS	MS SCHIP	Phase II	2
MS	MS SCHIP	Phase II	3
MS	MS SCHIP	Employer-sponsored coverage	1	Yes	Yes	Yes	NR	NR	NR	NR
MT	MT SCHIP		NA	No	NR	Yes	NR	NR	NR	NR
MT	MT SCHIP		1
NC	NC SCHIP		NA	Yes	NR	Yes	NR	Yes	NR	2000000
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	Yes	Yes	Yes	Yes	No	NA	NA
ND	Healthy Steps	Phase II
ND	Healthy Steps	Phase II	1	Yes				NR	NA	NA
NE	Kid`s Connection		NA	--	--	--	Yes	No	NA	NA
NE	Kid`s Connection		1
NH	Healthy Kids	Gold	NA	Yes	--	--	Yes	No	NA	NA
NH	Healthy Kids	Gold	1
NH	Healthy Kids	Silver	NA	NR	NR	Yes	NR	NR	NR	NR
NJ	KidCare	Plan A	NA	Yes	--	Yes	Yes	No	NA	NA
NJ	KidCare	Plan B	NA	Yes	No	Yes	Yes	NR	NR	NR
NJ	KidCare	Plan B	1
NJ	KidCare	Plan B	3
NJ	KidCare	Plan B	4
NJ	KidCare	Plan C	NA	Yes	No	Yes	Yes	NR	NR	NR
NJ	KidCare	Plan C	1
NJ	KidCare	Plan C	3
NJ	KidCare	Plan C	4
NJ	KidCare	Plan D	2	Yes	No	Yes	Yes	NR	NR	NR
NJ	KidCare	Plan D	3
NJ	KidCare	Plan D	4
NJ	KidCare	1115 Demonstration	NA
NM	NM SCHIP		NA	Yes	--	Yes	Yes	No	NA	NA
NM	NM SCHIP		2
NM	NM SCHIP	1115 Demonstration	NA
NV	Nevada Check-Up		NA	Yes	NR	Yes	Yes	NR	NR	NR
NV	Nevada Check-Up		1
NY	NY SCHIP	CHPLUS
NY	NY SCHIP	CHPLUS
NY	NY SCHIP	CHPLUS	NA	NR	NR	Yes	NR	NR	NR	NR
NY	NY SCHIP	CHPLUS	2				Yes
NY	NY SCHIP	Medicaid Expansion	2	--	--	Yes	Yes	No	NA	NA
OH	OH Child Health Plan		NA	Yes	--	Yes	Yes	No	NA	NA
OH	OH Child Health Plan		1
OK	SoonerCare		NA	--	Yes	Yes	Yes	No	NA	NA
OK	SoonerCare		1
OR	OR SCHIP		NA	Yes	Yes	Yes	Yes	NR	NR	NR
OR	OR SCHIP		2
OR	OR SCHIP		3
PA	PA SCHIP		NA	Yes	NR	Yes	NR	NR	NR	NR
PA	PA SCHIP		1
PA	PA SCHIP		2
PA	PA SCHIP		3
PA	PA SCHIP		4
PR	PR SCHIP		NA	--	--	Yes	Yes	No	NA	NA
RI	RIte Care		NA	Yes	--	Yes	Yes	No	NA	NA
RI	RIte Care		1
RI	RIte Care	1115 Demonstration	NA
SC	Partners for Healthy Children		NA	--	--	Yes	Yes	No	NA	NA
SD	SD SCHIP		NA	Yes	Yes	--	Yes	No	NA	NA
SD	SD SCHIP		1
SD	SD SCHIP		2
SD	SD SCHIP	CHIP NM	3	NR	Yes	NR	Yes	NR	NA	NA
TN	Tennessee`s CHIP	Phase I	NA	--	--	Yes	Yes	No	NA	NA
TX	Texas Healthy Steps	Phase I
TX	Texas Healthy Steps	Phase I	NA	--	--	--	Yes	No	NA	NA
TX	Texas Healthy Steps	Phase II
TX	Texas Healthy Steps	Phase II	1	NR	Yes	Yes	Yes
UT	UT SCHIP		NA	Yes	NR	Yes	NR	NR	NR	NR
VA	VA SCHIP	Children's Medical Security Insurance Plan/Family Access to Medical Insurance Security Plan	NA	--	Yes	Yes	Yes	NR	NR	NR
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	--	--	--	--	NR	NR	NR
VI	Virgin Island`s SCHIP		NA	--	--	--	Yes	No	NA	NA
VI	Virgin Island`s SCHIP		1
VT	VT SCHIP		NA	Yes	NR	Yes	Yes	NR	NR	NR
VT	VT SCHIP		1
VT	VT SCHIP		2		Yes
VT	VT SCHIP		3
WA	WA SCHIP		NA	Yes	Yes	No	Yes	No	NA	NA
WA	WA SCHIP		1			Yes
WI	BadgerCare	Medicaid expansion
WI	BadgerCare	Medicaid expansion	NA	Yes	--	Yes	Yes	No	NA	NA
WI	BadgerCare	Medicaid expansion	1
WI	BadgerCare	Employer-sponsored Coverage	1	--	--	--	--	NR	NR	NR
WI	BadgerCare		NA
WV	WV SCHIP	Phase I	NA	--	--	--	Yes	No	NA	NA
WV	WV SCHIP	Phase I	2
WV	WV SCHIP	Phase II	1	Yes	NR	NR	NR	NR	NR	NR
WV	WV SCHIP	Phase II	2
WV	WV SCHIP	Phase II	3
WY	WY SCHIP	CHIP One	NA	Yes	NR	NR	Yes	NR	NR	NR