AHCA CONTRACT NO. FA614

AMENDMENT NO. 9

THIS CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE
ADMINISTRATION, hereinafter referred to as the “Agency” and AMERIGROUP FLORIDA,
INC. D/B/A AMERIGROUP COMMUNITY CARE, hereinafter referred to as the “Vendor” or
“Health Plan”, is hereby amended as follows:

1. Effective September 1, 2008, Standard Contract, Section III, Item C.,
Contract Managers, sub-item 1,

is hereby amended to now read as follows:

  1.   The Agency’s Contract Manager’s name, address and telephone number for
this Contract is as follows:

Margaret Cavendish
Agency for Health Care Administration 2727 Mahan Drive, MS #50

Tallahassee, FL 32308

(850) 487-2355

2. Effective September 1, 2008, Attachment I, Scope of Services, is hereby
amended to include Exhibit

III-D, September 1, 2008 — August 31, 2009 Medicaid Non-Reform HMO Capitation
Rates, attached hereto and made a part of the Contract. All references in the
Contract to Exhibit III-C, January 1, 2008 — August 31, 2008 Medicaid Non-Reform
HMO Capitation Rates, shall hereinafter also refer to Exhibit III-D,
September 1, 2008 — August 31, 2009 Medicaid Non-Reform HMO Capitation Rates, as
appropriate.

3. Effective, December 1, 2008, Attachment II, Medicaid Prepaid Health Plan
Model Contract, Section V,

Covered Services, Item C, Expanded Services, sub-item 2 is hereby deleted in its
entirety and replaced with the following:

2. The following is a list of the Health Plan’s Expanded Services:

  a.   OTC Medications — Up to ten ($10.00) credit per household each month for
selected over- the-counter drugs and/or health supplies.

  b.   Respite Care Services — Annual maximum of not more than an initial
homehealth visit by RN @ $65.00 and eight (8) follow-up visits by an aide at
$23.00 per visit. Follow-up visits are four (4) hours in length. Maximum of
sixteen (16) hours in a given month and thirty- two (32) hours per year.

  c.   Enhanced Hearing Aid Benefit — Upgrade from standard medically necessary,
behind-theear hearing aid benefit to digital canal hearing aid up to $500.

All provisions in the Contract and any attachments thereto in conflict with this
Amendment shall be and are hereby changed to conform with this Amendment.

All provisions not in conflict with this Amendment are still in effect and are
to be performed at the level specified in the Contract.

This Amendment and all its attachments are hereby made a part of the Contract.

1

This Amendment cannot be executed unless all previous amendments to this
Contract have been fully executed.

IN WITNESS WHEREOF, the parties hereto have caused this seven (7) page Amendment
(which includes all attachments hereto) to be executed by their officials
thereunto duly authorized.

AMERIGROUP FLORIDA, INC. STATE OF FLORIDA, AGENCY
D/B/A AMERIGROUP COMMUNITY CARE FOR HEALTH CARE ADMISTRATIONSIGNED SIGNED

          BY: /S/ William L. McHugh
  BY:  
   
NAME: William L. McHugh
      NAME: Holly Benson  
   
TITLE: CEO
      TITLE: Secretary
 
       
DATE: 8/29/08
      DATE:  
    List of attachments/exhibits included as part of this Amendment:

Specify
Type
  Letter/
Number  
Description
 
       
Exhibit
  III-D   September 1, 2008 — August 31, 2009 Medicaid Non-Reform HMO

Capitation Rates (5 Pages)

2

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

EXHIBIT III-D
September 1, 2008 – August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area, Age and Eligibility Category

                                                                               
          TABLE 1                                                              
                         
General Rates:
                                                                               
       
Area
  1   2   3   4   5   6   7   8   9   10   11
TANF BTHM0+2M0
  1,113.37   1,113.37   1,217.57   1,067.51   1,214.96   1,056.56   1,092.94  
1,033.51   1,067.78   1,083.46   1,372.19
TANF 3M0-11MO
  187.38   187.38   206.51   181.92   206.53   181.19   186.84   177.08   181.58
  186.46   232.59
TANF AGE (1-5)
  101.38   101.38   112.28   99.04   112.30   98.87   101.87   96.67   98.82  
101.73   126.24
TANF AGE (6-13)
  61.45   61.45   69.11   61.51   69.38   61.99   63.49   60.37   61.05   63.88
  77.54
TANF AGE (14-20)Female
  129.49   129.49   143.30   126.30   143.25   126.18   129.77   123.15   126.06
  129.70   161.30
TANF AGE (14-20) Male
  69.52   69.52   77.85   69.23   78.21   69.68   71.35   68.03   68.67   71.87
  87.46
TANF AGE (21-54)Female
  255.23   255.23   283.53   250.83   284.08   251.35   258.27   245.23   249.80
  258.53   319.10
TANF AGE (21-54) Male
  153.37   153.37   171.42   152.26   172.12   153.20   157.02   149.29   151.41
  157.78   192.88
TANF AGE (55+) 318.51
  318.51   359.72   321.21   361.87   325.45   332.09   316.91   318.38   335.92
  404.23        
SSI-N BTHMO+2M0
  10,428.92   10,428.92   11,442.82   10,972.58   12,248.94   11,162.18  
11,810.40   10,525.98   11,078.29   14,344.29   14,488.14
SSI-N 3M0-11MO
  1,517.58   1,517.58   1,680.06   1,615.28   1,796.88   1,645.44   1,744.81  
1,550.30   1,635.46   2,132.34   2,131.88
SSI-N AGE (1-5)
  445.88   445.88   495.07   476.38   528.79   485.06   514.41   457.03   482.13
  629.36   628.05
SSI-N AGE (6-13)
  198.88   198.88   226.05   218.79   240.95   223.95   238.57   210.03   223.68
  297.17   289.19
SSI-N AGE (14-20) 213.14
          213.14   241.47   233.36   256.93   237.92   254.24   224.35   237.34
  314.18   307.93
SSI-N AGE (21-54)
  696.73   696.73   787.51   761.37   840.31   777.94   828.77   731.36   775.59
  1,027.07   1,004.54
SSI-N AGE (55+)
  700.31   700.31   795.55   770.55   849.11   788.05   840.70   740.14   785.85
  1,044.85   1,015.98
SSI-B
  305.88   305.88   340.56   297.82   225.19   274.94   373.98   256.24   219.29
  322.21   370.49
SSI-AB AGE (65-)
  94.80   94.80   90.01   90.35   81.19   79.31   84.56   78.77   84.42   94.02
  140.27
SSI-AB AGE (65+)
  85.77   85.77   81.98   82.40   75.29   72.63   77.61   72.23   77.20   86.21
  126.63

EXHIBIT III-D
September 1, 2008 – August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area, Age and Eligibility Category

TABLE 2
General + Mental Health Rates:

                                                                               
                  Area   1   2   3   4   5   6   7   8   9   10   11     TANF
BTHM0+2M0           1,113.39   1,113.40   1,217.58   1,067.52   1,214.97  
1,056.58   1,092.96   1,033.52   1,067.80   1,083.48   1,372.21 TANF 3M0-11MO  
187.40   187.41   206.52   181.93   206.54   181.21   186.86   177.09   181.60  
186.11   232.61         TANF AGE (1-5)   103.02   104.29   113.60   100.42  
113.51   100.72   103.65   97.93   100.37   103.65   127.86         TANF AGE
(6-13)   73.14   81.71   78.29   71.07   78.06   75.24   76.18   69.16   71.86  
77.24   88.83         TANF AGE (14-20)Female   140.42   142.91   149.38   132.64
  151.36   138.56   141.63   128.97   133.22   138.55   168.79         TANF AGE
(14-20) Male   80.45   82.94   83.93   75.57   86.32   82.06   83.21   73.85  
75.83   80.72   94.95         TANF AGE (21-54)Female   259.67   258.64   285.07
  252.44   287.37   256.38   263.09   246.72   251.62   260.78   321.01        
TANF AGE (21-54) Male   157.81   156.78   172.96   153.87   175.41   158.23  
161.84   150.78   153.23   160.03   194.79         TANF AGE (55+)   322.25  
321.46   361.06   322.61   364.65   329.70   336.16   318.20   319.95   337.87  
405.88         SSI-N BTHMO+2M0   10,429.00   10,429.08   11,442.89   10,972.69  
12,248.99   11,162.25   11,810.46   10,526.05   11,078.36   14,344.39  
14,488.22         SSI-N 3M0-11MO   1,517.66   1,517.74   1,680.13   1,615.39  
1,796.93   1,645.51   1,744.87   1,550.37   1,635.53   2,132.44   2,131.96      
  SSI-N AGE (1-5)   453.32   459.67   501.33   486.14   533.81   491.58   520.53
  463.03   488.46   637.71   635.02         SSI-N AGE (6-13)   246.93   277.70  
261.81   274.53   273.37   266.06   278.08   244.31   259.82   344.88   328.99  
      SSI-N AGE (14-20)   257.13   258.36   261.99   265.34   286.61   276.46  
290.41   244.03   248.08   341.56   330.76         SSI-N AGE (21-54)   778.13  
749.41   811.41   798.63   895.23   849.27   895.70   754.27   799.75   1,058.95
  1,031.14         SSI-N AGE (55+)   731.29   725.19   806.83   788.14   870.01
  815.20   866.18   750.96   797.26   1,059.91   1,028.54         SSI-B   306.09
  326.08   347.41   322.37   227.92   276.25   376.57   263.09   226.14   329.06
  377.72         SSI-AB AGE (65-)   106.45   109.81   98.99   107.12   94.01  
83.20   95.08   91.99   94.01   102.08   148.33        
SSI-AB AGE (65+)
    97.42       100.78       90.96       99.17       88.11       76.52      
88.13       85.45       86.79       94.27       134.69          

EXHIBIT III-D
September 1, 2008 – August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area, Age and Eligibility Category

                                                                               
          TABLE 3                                                              
                         
General + Mental Health + Dental Rates:
                                                                               
       
Area
  1   2   3   4   5   6   7   8   9   10   11
TANF BTHM0+2M0
  1,113.39   1,113.40   1,217.59   1,067.53   1,214.98   1,056.59   1,092.97  
1,033.53   1,067.81   1,083.49   1,372.22
TANF 3M0-11MO
  187.41   187.42   206.54   181.94   206.56   181.22   186.87   177.11   181.62
  186.12   232.62
TANF AGE (1-5)
  104.70   105.97   116.65   102.26   116.92   103.39   106.05   101.57   103.30
  106.08   131.59
TANF AGE (6-13)
  76.25   84.82   83.95   74.49   84.39   80.20   80.63   75.90   77.30   81.75
  96.51
TANF AGE (14-20)Female
  143.60   146.09   155.15   136.14   157.83   143.62   146.17   135.86   138.78
  143.16   176.76
TANF AGE (14-20)Male
  83.14   85.63   88.81   78.52   91.79   86.34   87.05   79.68   80.53   84.62
  101.67
TANF AGE (21-54)Female
  260.89   259.86   286.81   254.11   290.78   258.26   264.42   248.74   252.58
  261.51   321.87
TANF AGE (21-54) Male
  159.07   158.04   174.74   155.59   178.92   160.17   163.20   152.85   154.21
  160.78   195.67
TANF AGE (55+) 325.04
  324.25   365.03   326.43   372.44   334.00   339.20   322.80   322.14   339.53
  407.84        
SSI-N BTHMO+2M0
  10,429.00   10,429.08   11,442.89   10,972.69   12,249.00   11,162.25  
11,810.46   10,526.05   11,078.36   14,344.39   14,488.23
SSI-N 3M0-11MO
  1,517.66   1,517.74   1,680.14   1,615.39   1,796.94   1,645.52   1,744.88  
1,550.38   1,635.54   2,132.45   2,131.98
SSI-N AGE (1-5)
  454.94   461.29   504.46   487.92   538.03   494.62   523.53   466.45   491.05
  640.50   639.29
SSI-N AGE (6-13)
  249.33   280.10   266.45   277.17   279.64   270.56   282.52   249.39   263.67
  349.02   336.38
SSI-N AGE (14-20)
  259.19   260.42   265.98   267.61   291.99   280.33   294.23   248.39   261.39
  345.12   337.23
SSI-N AGE (21-54)
  779.46   750.74   813.29   800.51   898.93   851.77   897.25   756.55   800.93
  1,059.90   1,032.92
SSI-N AGE (55+)
  733.15   727.05   809.48   790.78   875.21   818.71   868.36   754.16   798.91
  1,061.24   1,031.04
SSI-B
  306.54   326.53   348.44   324.55   231.58   278.01   377.05   264.63   227.97
  329.88   381.06
SSI-AB AGE (65-)
  107.57   110.93   100.64   108.71   97.80   85.45   96.60   93.66   95.08  
103.38   150.49
SSI-AB AGE (65+)
  98.28   101.64   92.22   100.38   91.00   78.23   89.29   86.72   87.60  
95.25   136.34

EXHIBIT III-D
September 1, 2008 – August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area, Age and Eligibility Category

TABLE 4
General + Mental Health + Transportation Rates:

                                                                               
         
Area
  1   2   3   4   5   6   7   8   9   10   11
TANF BTHM0+2M0
  1,118.74   1,118.75   1,224.01   1,072.09   1,218.84   1,060.38   1,096.99  
1,038.81   1,072.91   1,086.47   1,375.30
TANF 3M0-11MO
  188.77   188.78   208.18   183.11   207.54   182.19   187.89   178.45   182.92
  186.89   233.40
TANF AGE (1-5)
  103.85   105.12   114.60   101.13   114.11   101.31   104.28   98.76   101.17
  104.12   128.34
TANF AGE (6-13)
  73.64   82.21   78.89   71.50   78.42   75.60   76.56   69.66   72.34   77.52
  89.12
TANF AGE (14-20)Female
  142.45   144.94   151.82   134.38   152.83   140.00   143.16   130.99   135.16
  139.69   169.97
TANF AGE (14-20) Male
  81.79   84.28   85.54   76.72   87.29   83.01   84.23   75.18   77.11   81.47
  95.73
TANF AGE (21-54)Female
  262.97   261.94   289.04   255.26   289.75   258.73   265.58   249.98   254.77
  262.62   322.92
TANF AGE (21-54) Male
  160.32   159.29   175.98   156.01   177.22   160.02   163.74   153.26   155.63
  161.43   196.24
TANF AGE (55+) 325.76
  324.97   365.28   325.61   367.18   332.19   338.80   321.67   323.30   339.83
  407.91        
SSI-N BTHMO+2M0
  10,468.09   10,468.17   11,492.20   11,011.02   12,280.81   11,193.75  
11,845.21   10,564.27   11,117.70   14,370.64   14,515.60
SSI-N 3M0-11MO
  1,543.33   1,543.41   1,712.51   1,640.55   1,817.81   1,666.20   1,767.68  
1,575.46   1,661.37   2,149.68   2,149.93
SSI-N AGE (1-5)
  458.61   464.96   508.01   491.32   538.12   495.85   525.23   468.20   493.79
  641.26   638.72
SSI-N AGE (6-13)
  249.36   280.13   264.88   276.91   275.35   268.01   280.23   246.69   262.27
  346.51   330.69
SSI-N AGE (14-20)
  263.26   264.49   269.71   271.34   291.59   281.39   295.85   250.01   264.24
  345.67   335.05
SSI-N AGE (21-54)
  798.19   769.47   836.72   818.29   911.55   865.43   913.53   773.87   819.93
  1,072.41   1,045.18
SSI-N AGE (55+)
  748.22   742.12   828.19   804.74   883.79   828.84   881.23   767.52   814.30
  1,071.28   1,040.40
SSI-B
  313.56   333.55   356.12   329.55   234.47   281.96   381.95   269.02   232.70
  334.36   382.84
SSI-AB AGE (65-)
  120.17   125.53   118.76   122.97   108.09   94.76   107.21   106.78   109.81
  114.42   160.77
SSI-AB AGE (65+)
  106.26   109.62   103.70   109.39   97.18   83.97   95.94   94.97   96.97  
102.22   142.70

EXHIBIT III-D
September 1, 2008 – August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area, Age and Eligibility Category

TABLE 5
General + Transportation Rates:

                                                                               
         
Area
  1   2   3   4   5   6   7   8   9   10   11
TANF BTHM0+2M0
  1,118.72   1,118.72   1,224.00   1,072.08   1,218.83   1,060.36   1,096.97  
1,038.80   1,072.89   1,086.45   1,375.28
TANF 3M0-11MO
  188.75   188.75   208.17   183.10   207.53   182.17   187.87   178.44   182.90
  186.87   233.38
TANF AGE (1-5)
  102.21   102.21   113.28   99.75   112.90   99.46   102.50   97.50   99.62  
102.20   126.72
TANF AGE (6-13)
  61.95   61.95   69.71   61.94   69.74   62.35   63.87   60.87   61.53   64.16
  77.83
TANF AGE (14-20)Female
  131.52   131.52   145.74   128.04   144.72   127.62   131.30   125.17   128.00
  130.84   162.48
TANF AGE (14-20) Male
  70.86   70.86   79.46   70.38   79.18   70.63   72.37   69.36   69.95   72.62
  88.24
TANF AGE (21-54)Female
  258.53   258.53   287.50   253.65   286.46   253.70   260.76   248.49   252.95
  260.37   321.01
TANF AGE (21-54) Male
  155.88   155.88   174.44   154.40   173.93   154.99   158.92   151.77   153.81
  159.18   194.33
TANF AGE (55+) 322.02
  322.02   363.94   324.21   364.40   327.94   334.73   320.38   321.73   337.88
  406.25        
SSI-N BTHMO+2M0
  10,468.01   10,468.01   11,492.13   11,010.91   12,280.76   11,193.68  
11,845.15   10,564.20   11,117.63   14,370.54   14,515.52
SSI-N 3M0-11MO
  1,543.25   1,543.25   1,712.44   1,640.44   1,817.76   1,666.13   1,767.62  
1,575.39   1,661.30   2,149.58   2,149.85
SSI-N AGE (1-5)
  451.17   451.17   501.75   481.56   533.10   489.33   519.11   462.20   487.46
  632.91   631.75
SSI-N AGE (6-13)
  201.31   201.31   229.12   221.17   242.93   225.90   240.72   212.41   226.13
  298.80   290.89
SSI-N AGE (14-20)
  219.27   219.27   249.19   239.36   261.91   242.85   259.68   230.33   243.50
  318.29   312.22
SSI-N AGE (21-54)
  716.79   716.79   812.82   781.03   856.63   794.10   846.60   750.96   795.77
  1,040.53   1,018.58
SSI-N AGE (55+)
  717.24   717.24   816.91   787.15   862.89   801.69   855.75   756.70   802.89
  1,056.22   1,027.84
SSI-B
  313.35   313.35   349.27   305.00   231.74   280.65   379.36   262.17   225.85
  327.51   375.61
SSI_AB AGE (65-)
  108.52   108.52   109.78   106.20   95.27   90.87   96.69   93.56   100.22  
106.36   152.71
SSI_AB AGE (65+)
  94.61   94.61   94.72   92.62   84.36   80.08   85.42   81.75   87.38   94.16
  134.64

EXHIBIT III-D
September 1, 2008 – August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area, Age and Eligibility Category

TABLE 6

General + Dental Rates:

                                                                               
                  Area   1   2   3   4   5   6   7   8   9   10   11     TANF
BTHM0+2M0           1,113.37   1,113.37   1,217.58   1,067.52   1,214.97  
1,056.57   1,092.95   1,033.52   1,067.79   1,083.47   1,372.20 TANF 3M0-11MO  
187.39   187.39   206.53   181.93   206.55   181.20   186.85   177.10   181.60  
186.10   232.60         TANF AGE (1-5)   103.06   103.06   115.33   100.88  
115.71   101.54   104.27   100.31   101.75   104.16   129.97         TANF AGE
(6-13)   64.56   64.56   74.77   64.93   75.71   66.95   67.94   67.11   66.49  
68.39   85.22         TANF AGE (14-20)Female   132.67   132.67   149.07   129.80
  149.72   131.24   134.31   130.04   131.62   134.31   169.27         TANF AGE
(14-20) Male   72.21   72.21   82.73   72.18   83.68   73.96   75.19   73.86  
73.37   75.77   94.18         TANF AGE (21-54)Female   256.45   256.45   285.27
  252.50   287.49   253.23   259.60   247.25   250.76   259.26   319.96        
TANF AGE (21-54) Male   154.63   154.63   173.20   153.96   175.63   155.14  
158.38   151.36   152.39   158.53   193.76         TANF AGE (55+)   321.30  
321.30   363.69   325.03   369.66   329.75   335.13   321.51   320.57   337.58  
406.19         SSI-N BTHMO+2M0   10,428.92   10,428.92   11,442.82   10,972.58  
12,248.95   11,162.18   11,810.40   10,525.98   11,078.29   14,344.29  
14,488.15         SSI-N 3M0-11MO   1,517.58   1,517.58   1,680.07   1,615.28  
1,796.89   1,645.45   1,744.82   1,550.31   1,635.47   2,132.35   2,131.90      
  SSI-N AGE (1-5)   447.50   447.50   498.20   478.16   533.01   488.10   517.41
  460.45   484.72   632.15   632.32         SSI-N AGE (6-13)   201.28   201.28  
230.69   221.43   247.22   228.45   243.01   215.11   227.53   301.31   296.58  
      SSI-N AGE (14-20)   215.20   215.20   245.46   235.63   262.31   241.79  
258.06   228.71   240.65   317.74   314.40         SSI-N AGE (21-54)   698.06  
698.06   789.39   763.25   844.01   780.44   830.32   733.64   776.77   1,028.02
  1,006.32         SSI-N AGE (55+)   702.17   702.17   798.20   773.19   854.31
  791.56   842.88   743.34   787.50   1,046.18   1,018.48         SSI-B   306.33
  306.33   341.59   300.00   228.85   276.70   374.46   257.78   221.12   323.03
  373.83         SSI-AB AGE (65-)   95.92   95.92   91.66   91.94   84.98  
81.56   86.08   80.44   85.49   95.32   142.43        
SSI-AB AGE (65+)
    86.63       86.63       83.24       83.61       78.18       74.34      
78.77       73.50       78.01       87.19       128.28          

EXHIBIT III-D
September 1, 2008 – August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area, Age and Eligibility Category

TABLE 7
General + Dental + Transportation Rates:

                                                                               
         
Area
  1   2   3   4   5   6   7   8   9   10   11
TANF BTHM0+2M0
  1,118.72   1,118.72   1,224.01   1,072.09   1,218.84   1,060.37   1,096.98  
1,038.81   1,072.90   1,086.46   1,375.29
TANF 3M0-11MO
  188.76   188.76   208.19   183.11   207.55   182.18   187.88   178.46   182.92
  186.88   233.39
TANF AGE (1-5)
  103.89   103.89   116.33   101.59   116.31   102.13   104.90   101.14   102.55
  104.63   130.45
TANF AGE (6-13)
  65.06   65.06   75.37   65.36   76.07   67.31   68.32   67.61   66.97   68.67
  85.51
TANF AGE (14-20) Female
  134.70   134.70   151.51   131.54   151.19   132.68   135.84   132.06   133.56
  135.45   170.45
TANF AGE (14-20) Male
  73.55   73.55   84.34   73.33   84.65   74.91   76.21   75.19   74.65   76.52
  94.96
TANF AGE (21-54) Female
  259.75   259.75   289.24   255.32   289.87   255.58   262.09   250.51   253.91
  261.10   321.87
TANF AGE (21-54) Male
  157.14   157.14   176.22   156.12   177.44   156.93   160.28   153.84   154.79
  159.93   195.21
TANF AGE (55+) 324.81
  324.81   367.91   328.03   372.19   332.24   337.77   324.98   323.92   339.54
  408.22        
SSI-N BTHMO+2M0
  10,468.01   10,468.01   11,492.13   11,010.91   12,280.77   11,193.68  
11,845.15   10,564.20   11,117.63   14,370.54   14,515.53
SSI-N 3M0-11MO
  1,543.25   1,543.25   1,712.45   1,640.44   1,817.77   1,666.14   1,767.63  
1,575.40   1,661.31   2,149.59   2,149.87
SSI-N AGE (1-5)
  452.79   452.79   504.88   483.34   537.32   492.37   522.11   465.62   490.05
  635.70   636.02
SSI-N AGE (6-13)
  203.71   203.71   233.76   223.81   249.20   230.40   245.16   217.49   229.98
  302.94   298.28
SSI-N AGE (14-20)
  221.33   221.33   253.18   241.63   267.29   246.72   263.50   234.69   246.81
  321.85   318.69
SSI-N AGE (21-54)
  718.12   718.12   814.70   782.91   860.33   796.60   848.15   753.24   796.95
  1,041.48   1,020.36
SSI-N AGE (55+)
  719.10   719.10   819.56   789.79   868.09   805.20   857.93   759.90   804.54
  1,057.55   1,030.34
SSI-B
  313.80   313.80   350.30   307.18   235.40   282.41   379.84   263.71   227.68
  328.33   378.95
SSI-AB AGE (65-)
  109.64   109.64   111.43   107.79   99.06   93.12   98.21   95.23   101.29  
107.66   154.87
SSI-AB AGE (65+)
  95.47   95.47   95.98   93.83   87.25   81.79   86.58   83.02   88.19   95.14
  136.29

EXHIBIT III-D
September 1, 2008 – August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area, Age and Eligibility Category

TABLE 8
General + Mental Health + Dental + Transportation Rates:

                                                                               
         
Area
  1   2   3   4   5   6   7   8   9   10   11
TANF BTHM0+2M0
  1,118.74   1,118.75   1,224.02   1,072.10   1,218.85   1,060.39   1,097.00  
1,038.82   1,072.92   1,086.48   1,375.31
TANF 3M0-11MO
  188.78   188.79   208.20   183.12   207.56   182.20   187.90   178.47   182.94
  186.90   233.41
TANF AGE (1-5)
  105.53   106.80   117.65   102.97   117.52   103.98   106.68   102.40   104.10
  106.55   132.07
TANF AGE (6-13)
  76.75   85.32   84.55   74.92   84.75   80.56   81.01   76.40   77.78   82.03
  96.80
TANF AGE (14-20)Female
  145.63   148.12   157.59   137.88   159.30   145.06   147.70   137.88   140.72
  144.30   177.94
TANF AGE (14-20) Male
  84.48   86.97   90.42   79.67   92.76   87.29   88.07   81.01   81.81   85.37
  102.45
TANF AGE (21-54)Female
  264.19   263.16   290.78   256.93   293.16   260.61   266.91   252.00   255.73
  263.35   323.78
TANF AGE (21-54) Male
  161.58   160.55   177.76   157.73   180.73   161.96   165.10   155.33   156.61
  162.18   197.12
TANF AGE (55+) 328.55
  327.76   369.25   329.43   374.97   336.49   341.84   326.27   325.49   341.49
  409.87        
SSI-N BTHMO+2M0
  10,468.09   10,468.17   11,492.20   11,011.02   12,280.82   11,193.75  
11,845.21   10,564.27   11,117.70   14,370.64   14,515.61
SSI-N 3M0-11MO
  1,543.33   1,543.41   1,712.52   1,640.55   1,817.82   1,666.21   1,767.69  
1,575.47   1,661.38   2,149.69   2,149.95
SSI-N AGE (1-5)
  460.23   466.58   511.14   493.10   542.34   498.89   528.23   471.62   496.38
  644.05   642.99
SSI-N AGE (6-13)
  251.76   282.53   269.52   279.55   281.62   272.51   284.67   251.77   266.12
  350.65   338.08
SSI-N AGE (14-20)
  265.32   266.55   273.70   273.61   296.97   285.26   299.67   254.37   267.55
  349.23   341.52
SSI-N AGE (21-54)
  799.52   770.80   838.60   820.17   915.25   867.93   915.08   776.15   821.11
  1,073.36   1,046.96
SSI-N AGE (55+)
  750.08   743.98   830.84   807.38   888.99   832.35   883.41   770.72   815.95
  1,072.61   1,042.90
SSI-B
  314.01   334.00   357.15   331.73   238.13   283.72   382.43   270.56   234.53
  335.18   386.18
SSI-AB AGE (65-)
  121.29   124.65   120.41   124.56   111.88   97.01   108.73   108.45   110.88
  115.72   162.93
SSI-AB AGE (65+)
  107.12   110.48   104.96   110.60   100.07   85.68   97.10   96.24   97.78  
103.20   144.35

EXHIBIT III-D
September 1, 2008 – August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area, Age and Eligibility Category

     
Area
  Corresponding Counties
Area 1
Area 2
Area 3
Area 4
Area 5
Area 6
Area 7
Area 8
Area 9
Area 10
Area 11
  Escambia, Okaloosa, Santa Rosa, Walton
Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon,
Liberty, Madison, Taylor, Washington, Wakulla
Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando,
Lafayette, Lake, Levy, Marlon, Putnam, Sumter, Suwannee, Union
Baker, Clay, Duval, Flagler, Nassau, St. Johns, Volusia
Pasco, Pinellas
Hardee, Highlands, Hillsborough, Manatee, Polk
Brevard, Orange, Osceola, Seminole
Charlotte, Collier, De Soto, Glades, Hendry, Lee, Sarasota
Indian River, Okeechobee, St. Lucie, Martin, Palm Beach
Broward
Dade, Monroe

3