AMERIGROUP CORP
EX-10.20.1
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<DESCRIPTION>EX-10.20.1
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<P align="right" style="font-size: 10pt">Exhibit&nbsp;10.20.1



<P align="right" style="font-size: 10pt"><B>HHSC Contract No.&nbsp;529-03-035-R</B>



<P align="left" style="font-size: 10pt"><B>STATE OF TEXAS</B>



<P align="left" style="font-size: 10pt"><B>COUNTY OF TRAVIS</B>



<P align="center" style="font-size: 10pt"><B>AMENDMENT 18<BR>
TO THE AGREEMENT BETWEEN THE<BR>
HEALTH &#038; HUMAN SERVICES COMMISSION<BR>
AND<BR>
AMERIGROUP TEXAS, INC.<BR>
FOR HEALTH SERVICES<BR>
TO THE<BR>
MEDICAID STAR PROGRAM<BR>
IN THE<BR>
HARRIS SERVICE DELIVERY AREA</B>



<P align="left" style="font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;THIS CONTRACT AMENDMENT (the &#147;Amendment&#148;) is entered
into between the HEALTH &#038; HUMAN SERVICES COMMISSION (&#147;HHSC&#148;), an administrative
agency within the executive department of the State of Texas, and <B>AMERIGROUP
TEXAS, INC</B>. (&#147;HMO&#148;), a health maintenance organization organized under the laws
of the State of Texas, possessing a certificate of authority issued by the
Texas Department of Insurance to operate as a health maintenance organization,
and having its principal office <B>at 1200 E. Copeland Rd. Suite&nbsp;200, Arlington,
TX 76011</B>. HHSC and CONTRACTOR may be referred to within this Amendment
individually as a &#147;Party&#148; and collectively as the
&#147;Parties.&#148;


<P align="left" style="font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;The Parties hereby agree to amend their Agreement as set forth herein.


<P align="center" style="font-size: 10pt"><B>ARTICLE 1. PURPOSE.</B>

<P align="left" style="font-size: 10pt"><U><B>Section&nbsp;1.01</B></U> <B><I>Authorization.</I></B>


<P align="left" style="font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;This Amendment is executed by the Parties in accordance with Article&nbsp;15.2 of
the Agreement.


<P align="left" style="font-size: 10pt"><B><U>Section&nbsp;1.02</U> </B><B><I>Effective Date.</I></B>



<P align="left" style="font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Except as specific below, the Effective Date of this Agreement is
<B>September&nbsp;1, 2004</B>. Upon execution by the parties, the term of this agreement is
extended through <B>August&nbsp;31, 2005</B>, unless extended or terminated sooner by HHSC,
in accordance with this Agreement.


<P align="center" style="font-size: 10pt"><B>ARTICLE 2. AMENDMENT TO THE OBLIGATIONS OF THE PARTIES</B>



<P align="left" style="font-size: 10pt"><B><U>Section&nbsp;2.01</U> </B><B><I>Modification </I></B><I>to Article&nbsp;4, Fiscal,</I>
<B><I>Financial, </I></B><I>Claims and </I><B><I>Insurance Requirements</I></B>




<P align="left" style="margin-left:3%; font-size: 10pt"><I>Article&nbsp;4, Fiscal, Financial, Claims and Insurance Requirements, is
amended by modifying Section&nbsp;4.6 as follows:</I>



<P align="left" style="margin-left:6%; font-size: 10pt">4.6.3 HMO understands that acceptance of funds under
this Contract acts as acceptance of the authority of
the State Auditor&#146;s Office (&#147;SAO&#148;), or any successor
agency, to conduct an investigation in connection
with those funds. HMO further agrees to cooperate
fully with the SAO or its successor in the conduct
of the audit or investigation, including providing
all records requested. HMO will ensure that this
clause concerning the authority to audit funds
received indirectly by subcontractors through
CONTRACTOR and the requirement to cooperate is
included in any subcontract it awards

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    <TD align="left" valign="top">HHSC Contract No.&nbsp;529-03-035-R
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    <TD>&nbsp;</TD>
    <TD align="center" valign="top">Page 1 of 8
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    <TD align="right" valign="top">Effective Date: September&nbsp;1, 2004</TD>
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<P align="right" style="font-size: 10pt">Exhibit&nbsp;10.20.1



<P align="left" style="font-size: 10pt"><U><B>Section </B><B><I>2.02</I></B></U> <B><I>Modification to </I></B><I>Article5, </I><B><I>Compliance with </I></B><I>State</I>
<B><I>and Federal </I></B><I>Laws</I>




<P align="left" style="margin-left:3%; font-size: 10pt"><I>Article&nbsp;5, Compliance with State and Federal Laws, is
amended by modifying Section&nbsp;5.3, as follows:</I>



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;5.3 FRAUD AND ABUSE COMPLIANCE PLAN



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;5.3.1 This contract is subject to all state and
federal laws and regulations relating to fraud and
abuse in health care and the Medicaid program. HMO
must cooperate and assist HHSC and any other state or
federal agency charged with the duty of identifying,
investigating, sanctioning or prosecuting suspected
fraud and abuse. HMO must provide originals and/or
copies of all records and information requested and
allow access to premises and provide records to HHSC
or its authorized agent(s), HHSC, CMS, the U.S.
Department of Health and Human Services, FBI, TDI,
and the Texas Attorney General&#146;s Medicaid Fraud
Control Unit. All copies of records must be provided
free of charge.



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;5.3.2 Compliance Plan. HMO must submit to HHSC
Office of Inspector General (HHSC-OIG) for approval a
written fraud and abuse compliance plan which is
based on the Model Compliance Plan issued by the U.S.
Department of Health and Human Services, the Office
of Inspector General (OIG), no later than 30&nbsp;days
after the effective date of the contract. HMO must
designate an officer or director in its organization
who has the responsibility and authority for carrying
out the provisions of its compliance plan. HMO must
submit any updates or modifications in its compliance
plan to HHSC-OIG for approval at least 30&nbsp;days prior
to the modifications going into effect. HMO&#146;s fraud
and abuse compliance plan must:



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;5.3.2.1 ensure that all officers, directors,
managers and employees know and understand the
provisions of HMO&#146;s fraud and abuse compliance plan.



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;5.3.2.2 contain procedures designed to prevent
and detect potential or suspected abuse and fraud in
the administration and delivery of services under
this contract.



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;5.3.2.3 contain provisions for the confidential
reporting of plan violations to the designated person
in HMO.



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;5.3.2.4 contain provisions for the investigation
and follow-up of any compliance plan reports.



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;5.3.2.5 ensure that the identity of individuals
reporting violations of the plan is protected.



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;5.3.2.6 contain specific and detailed internal
procedures for officers, directors, managers and
employees for detecting, reporting, and investigating
fraud and abuse compliance plan violations.



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;5.3.2.7 require any confirmed or suspected fraud
and abuse under state or federal law be reported to
HHSC, the Medicaid Provider

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    <TD align="left" valign="top">HHSC Contract No.&nbsp;529-03-035-R
</TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">Page 2 of 8
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    <TD align="right" valign="top">Effective Date: September&nbsp;1, 2004</TD>
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<P align="right" style="font-size: 10pt">Exhibit&nbsp;10.20.1




<P align="left" style="margin-left:6%; font-size: 10pt">Integrity section of the Office of Inspector General
of the Texas Health and Human Services Commission,
and/or the Medicaid Fraud Control Unit of the Texas
Attorney General.



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;5.3.2.8 ensure that no individual who reports
plan violations or suspected fraud and abuse is
retaliated against.



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;5.3.3 Training. HMO must designate executive and
essential personnel to attend mandatory training in
fraud and abuse detection, prevention and reporting.
The training will be conducted by the Office of
Inspector General, HHSC, and will be provided free of
charge. HMO must schedule and complete training no
later than 90&nbsp;days after the effective date of any
updates or modification of the written Model
Compliance Plan.



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;5.3.3.1 If HMO&#146;s personnel have attended OIG
training prior to the effective date of this
contract, they are not required to attend additional
OIG training unless new training is required due to
changes in federal and/or state law or regulations.
If additional OIG training is required, HHSC will
notify HMO to schedule this additional training.



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;5.3.3.2 If HMO updates or modifies its written
fraud and abuse compliance plan, HMO must train its
executive and essential personnel on these updates or
modifications no later than 90&nbsp;days after the
effective date of the updates or modifications.



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;5.3.3.3 If HMO&#146;s executive and essential
personnel change or if HMO employs additional
executive and essential personnel, the new or
additional personnel must attend OIG training within
90&nbsp;days of employment by HMO.



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;5.3.4 HMO&#146;s failure to report potential or
suspected fraud or abuse may result in sanctions,
contract cancellation, or exclusion from
participation in the Medicaid program.



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;5.3.5 HMO must allow the Texas Medicaid Fraud
Control Unit and HHSC&#146;s Office of Inspector General,
to conduct private interviews of HMO&#146;s employees,
subcontractors and their employees, witnesses, and
patients. Requests for information must be complied
with in the form and the language requested. HMO&#146;s
employees and its subcontractors and their employees
must cooperate fully and be available in person for
interviews, consultation, grand jury proceedings,
pre-trial conference, hearings, trial and in any
other process.



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;5.3.6 Subcontractors. HMO must submit the
documentation described in Articles 5.3.6.1 through
5.3.6.3, in compliance with Texas Government Code
&#145;533.012, regarding any subcontractor providing
health care services under this contract except for
those providers who have re-enrolled as a provider in
the Medicaid program as required by Section&nbsp;2.07,
Chapter&nbsp;1153, Acts of the 75th Legislature, Regular
Session, 1997, or who modified a contract in
compliance with that section. HMO must submit
information in a format as specified by HHSC.
Documentation must be submitted no later than 120
days after the effective date of this contract.
Subcontracts entered into after the effective date of
this contract must be submitted no later than 90&nbsp;days
after the effective date of the subcontract. The

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    <TD align="left" valign="top">HHSC Contract No.&nbsp;529-03-035-R
</TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">Page 3 of 8
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">Effective Date: September&nbsp;1, 2004</TD>
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<P align="right" style="font-size: 10pt">Exhibit&nbsp;10.20.1




<P align="left" style="margin-left:6%; font-size: 10pt">required documentation required under this provision
is not subject to disclosure under Chapter&nbsp;552,
Government Code.



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;5.3.6.I a description <I>of </I>any financial or other
business relationship between HMO and its
subcontractor;



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;5.3.6.2 a copy <I>of </I>each type <I>of </I>contract between
HMO and its subcontractor;



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;5.3.6.3 a description of the fraud control
program used by any subcontractor. Per HHSC request,
and on an ad-hoc basis, HMOs will be required to
submit a list <I>of </I>Health-related Materials currently
being used, or used previously; HHSC may request the
review of selected materials from that list. HHSC
will provide HMO a reasonable amount <I>of </I>time to
respond to such requests, generally no less than 10
business days.



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;5.3.7 Special Investigations Unit. An HMO that
provides or arranges for the provision of health
care services to an individual under the Medical
Assistance Program (Medicaid), must arrange for a
special investigative unit to investigate fraudulent
claims and other types of program abuse by
recipients and providers. An HMO may choose to:



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;(1) Establish and maintain the special
investigative unit within the managed care
organization; or



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;(2) Contract with another entity for the investigation.



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;5.3.7.1 An HMO must develop a plan to prevent
and reduce waste, abuse, and fraud. The plan must
meet the requirements <I>of </I>the rules established by
HHSC and be submitted annually to the HHSCOIG for
approval each year the HMO is enrolled with the
State <I>of </I>Texas. The plan must be submitted 60&nbsp;days
prior to the start <I>of </I>the State fiscal year.



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;5.3.7.1.1 If the initial plan to prevent and
reduce waste, abuse, and fraud is not approved, the
HMO must resubmit the plan to HHSCOIG within 15
working days of receiving the denial letter, which
will explain the deficiencies. If the plan is not
resubmitted within the time allotted, the HMO will
be in default and sanctions may be imposed.



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;5.3.7.2 If the HMO elects to contract with
another entity for the investigation of fraudulent
claims and other types of program abuse as
referenced in paragraph (b)(2) of this section, the
HMO must adhere to all requirements of Chapter&nbsp;42, &#167;
438.230 of the Code of Federal Regulations.


<P align="left" style="font-size: 10pt"><B><U>Section&nbsp;2.03</U> </B><B><I>Modification </I></B><I>to Article&nbsp;6, </I><B><I>Scope of Services</I></B>




<P align="left" style="margin-left:3%; font-size: 10pt"><I>Article&nbsp;6, Scope of Services, is amended by modifying
Section&nbsp;6.1.6.2, as follows:</I>



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;6.1.6.2 Value-added services can only be added
or removed by written amendment of this contract one
time per fiscal year. HMO

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    <TD align="left" valign="top">HHSC Contract No.&nbsp;529-03-035-R
</TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">Page 4 of 8
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">Effective Date: September&nbsp;1, 2004</TD>
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<P align="right" style="font-size: 10pt">Exhibit&nbsp;10.20.1




<P align="left" style="margin-left:6%; font-size: 10pt">cannot include a value-added service in any material
distributed to Members or prospective Members until
this contract has been amended to include that
value-added service or HMO has received written
approval from HHSC pending finalization of the
contract amendment.


<P align="left" style="font-size: 10pt"><U><B>Section </B><B><I>2.04</I></B></U> <B><I>Modification </I></B><I>to Article&nbsp;7, </I><B><I>Provider Network
Requirements</I></B>




<P align="left" style="margin-left:3%; font-size: 10pt"><I>Article&nbsp;7, Provider Network Requirements, is amended by mod
Eying Section&nbsp;7.6 as follows:</I>



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;7.6 PROVIDER COMPLAINT AND APPEAL PROCEDURES



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;7.6.1 HMO must develop, implement and maintain a
provider complaint system. The complaint and appeal
procedures must be in compliance with all applicable
state and federal law or regulations. All Member
complaints and/or appeals of an adverse determination
requested by the enrollee, or any person acting on
behalf of the enrollee, or a physician or provider
acting on behalf of the enrollee must comply with the
provisions of this Article. Modifications and
amendments to the complaint system must be submitted
to HHSC no later than 30&nbsp;days prior to the
implementation of the modification or amendment:



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;7.6.2 HMO must include the provider complaint and
appeal procedure in all network provider contracts or
in the provider manual.



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;7.6.3 HMO&#146;s complaint and appeal process cannot
contain provisions requiring a provider to submit a
complaint or appeal to HHSC for resolution in lieu of
the HMO&#146;s process.



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;7.6.4 HMO must establish mechanisms to ensure
that network providers have access to a person who can
assist providers in resolving issues relating to
claims payment, plan administration, education and
training, and complaint procedures.



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;7.6.5 Beginning August&nbsp;1, 2004, providers must
file appeals or adjustment requests within 120&nbsp;days
from the date of disposition, which is the date of the
Remittance and Status (R&#038;S) report on which the last
action on the claims appears; the deadline is
applicable to both paper and electronic submissions.



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;7.6.6 Fiscal Agent Payment Deadlines. The state&#146;s
Claims Administrator must finalize all claims,
including appeals, within 24&nbsp;months; the 24-month
deadline is a payment deadline, and is not the claims
filing deadline that is in place for claims
submissions and appeals. Please refer to Texas
Medicaid Bulletin, No.&nbsp;178, March/ April&nbsp;2004 edition,
&#147;Fiscal Agent Payment Deadlines&#148; for more specific
information regarding payment deadlines.

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    <TD align="left" valign="top">HHSC Contract No.&nbsp;529-03-035-R
</TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">Page 5 of 8
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">Effective Date: September&nbsp;1, 2004</TD>
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<P align="right" style="font-size: 10pt">Exhibit&nbsp;10.20.1



<P align="left" style="font-size: 10pt"><B><U>Section&nbsp;2.05</U> </B><B><I>Modification of Article&nbsp;13, Payment Provisions</I></B>




<P align="left" style="margin-left:3%; font-size: 10pt"><B><I>Article </I></B><I>13, Payment Provisions, is amended by modifying
Section&nbsp;13.1.1, as follows:</I>



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;13.1.1 HHSC will reimburse HMO based on a fixed
monthly Capitation Rate for each enrolled Member.
Capitation Rates for each HMO may vary by Service
Area and HMO. HHSC and/or contracted actuaries will
perform data analysis and calculate the Capitation
Rates for each Rate Period.



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;The monthly Capitation Rate will consist of the
following components:


<P>
<TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="7%" nowrap align="right">1.</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>cost to cover the health care services</TD>
</TR>

<TR>
    <TD colspan="5">&nbsp;</TD>
</TR>

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="7%" nowrap align="right">2.</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>cost of administering the program; and</TD>
</TR>

<TR>
    <TD colspan="5">&nbsp;</TD>
</TR>

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="7%" nowrap align="right">3.</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>allowance for risk.</TD>
</TR>

</TABLE>


<P align="left" style="font-size: 10pt"><B><U>Section&nbsp;2.06</U> </B><B><I>Modification </I></B><I>of Article&nbsp;13, </I><B><I>Payment Provisions</I></B>




<P align="left" style="margin-left:3%; font-size: 10pt"><I>Article&nbsp;13, Payment Provisions, is amended by modifying
Section&nbsp;13.1.2, as follows:</I>



<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;13.1.2 The monthly capitation amounts and the
Delivery Supplemental Payment (DSP)&nbsp;amount,
effective as of September&nbsp;1, 2004, are listed below.

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="55%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="81%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="6%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="7%">&nbsp;</TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD nowrap align="center"><B>SDA</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3"><B>Monthly</B></TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD nowrap align="center"><B>Risk Group</B><HR size="1" noshade></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3"><B>Capitation Amounts</B><HR size="1" noshade></TD>
</TR>

<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom" style="background: #eeeeee">
    <TD><DIV style="margin-left:10px; text-indent:-10px">TANF Children (&#062; 1&nbsp;year of age)</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="right">$</TD>
    <TD align="right">69.01</TD>
    <TD>&nbsp;</TD>
</TR>

<TR valign="bottom">
    <TD><DIV style="margin-left:10px; text-indent:-10px">TANF Children (&#060; 1&nbsp;year of age)</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="right">$</TD>
    <TD align="right">382.27</TD>
    <TD>&nbsp;</TD>
</TR>

<TR valign="bottom" style="background: #eeeeee">
    <TD><DIV style="margin-left:10px; text-indent:-10px">TANF Adults</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="right">$</TD>
    <TD align="right">214.02</TD>
    <TD>&nbsp;</TD>
</TR>

<TR valign="bottom">
    <TD><DIV style="margin-left:10px; text-indent:-10px">Pregnant Women</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="right">$</TD>
    <TD align="right">339.86</TD>
    <TD>&nbsp;</TD>
</TR>

<TR valign="bottom" style="background: #eeeeee">
    <TD><DIV style="margin-left:10px; text-indent:-10px">Newborns (up to 12 Months of Age)</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="right">$</TD>
    <TD align="right">686.32</TD>
    <TD>&nbsp;</TD>
</TR>

<TR valign="bottom">
    <TD><DIV style="margin-left:10px; text-indent:-10px">Expansion Children (&#062; I year of Age)</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="right">$</TD>
    <TD align="right">76.80</TD>
    <TD>&nbsp;</TD>
</TR>

<TR valign="bottom" style="background: #eeeeee">
    <TD><DIV style="margin-left:10px; text-indent:-10px">Expansion Children (&#060; 1&nbsp;year of Age)</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="right">$</TD>
    <TD align="right">208.35</TD>
    <TD>&nbsp;</TD>
</TR>

<TR valign="bottom">
    <TD><DIV style="margin-left:10px; text-indent:-10px">Federal Mandate Children</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="right">$</TD>
    <TD align="right">71.65</TD>
    <TD>&nbsp;</TD>
</TR>

<TR valign="bottom" style="background: #eeeeee">
    <TD><DIV style="margin-left:10px; text-indent:-10px">Disabled/Blind Administration</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="right">$</TD>
    <TD align="right">I4.00</TD>
    <TD>&nbsp;</TD>
</TR>

<!-- End Table Body -->
</TABLE>
</DIV>




<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Delivery Supplemental Payment. A one-time per
pregnancy supplemental payment for each delivery
shall be paid to HMO as provided below in the
following amount: $3,419.20.


<P align="left" style="font-size: 10pt"><U><B>Section </B><B><I>2.07</I></B></U> <B><I>Modification of </I></B><I>Article </I><B><I>19, </I></B><I>Term</I>




<P align="left" style="margin-left:3%; font-size: 10pt"><I>Article&nbsp;19, Term, is amended by modifying Section&nbsp;19, as follows:</I>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="30%"></TD>
    <TD width="5%"></TD>
    <TD width="30%"></TD>
    <TD width="5%"></TD>
    <TD width="30%"></TD>
</TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&nbsp;</TD>
</TR>

<TR valign="bottom">
    <TD align="left" valign="top">HHSC Contract No.&nbsp;529-03-035-R
</TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">Page 6 of 8
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">Effective Date: September&nbsp;1, 2004</TD>
</TR>

<!-- End Table Body -->
</TABLE>
</DIV>



<P align="center" style="font-size: 10pt">&nbsp;
</DIV>

<!-- PAGEBREAK -->
<P><HR noshade><P>
<H5 align="left" style="page-break-before:always">&nbsp;</H5><P>

<DIV style="font-family: 'Times New Roman',Times,serif">


<P align="right" style="font-size: 10pt">Exhibit&nbsp;10.20.1




<P align="left" style="margin-left:6%; font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;19A The effective date of this contract is
August&nbsp;31, 1999. The contract will terminate on
August&nbsp;31, 2005, unless extended or terminated
earlier as provided for elsewhere in this contract.

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="30%"></TD>
    <TD width="5%"></TD>
    <TD width="30%"></TD>
    <TD width="5%"></TD>
    <TD width="30%"></TD>
</TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&nbsp;</TD>
</TR>

<TR valign="bottom">
    <TD align="left" valign="top">HHSC Contract No.&nbsp;529-03-035-R
</TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">Page 7 of 8
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">Effective Date: September&nbsp;1, 2004</TD>
</TR>

<!-- End Table Body -->
</TABLE>
</DIV>



<P align="center" style="font-size: 10pt">&nbsp;
</DIV>

<!-- PAGEBREAK -->
<P><HR noshade><P>
<H5 align="left" style="page-break-before:always">&nbsp;</H5><P>

<DIV style="font-family: 'Times New Roman',Times,serif">


<P align="right" style="font-size: 10pt">Exhibit&nbsp;10.20.1



<P align="center" style="font-size: 10pt"><B>ARTICLE 3. REPRESENTATIONS AND AGREEMENT OF THE PARTIES</B>



<P align="left" style="font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;The Parties contract and agree that the terms of the Agreement will remain
in effect and continue to govern except to the extent modified in this
Amendment.


<P align="left" style="font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;By signing this Amendment, the Parties expressly understand and agree that
this Amendment is hereby made a part of the Agreement as though it were set out
word for word in the Agreement.


<P align="left" style="font-size: 10pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<B>IN WITNESS HEREOF, HHSC and the CONTRACTOR have each caused this Amendment
to be signed and delivered by its duly authorized representative.</B>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="2%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="25%">&nbsp;</TD>
    <TD width="20%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="30%">&nbsp;</TD>
</TR>

<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD colspan="3" valign="top" align="left"><B>AMERIGROUP TEXAS, INC.</B></TD>
    <TD>&nbsp;</TD>
    <TD colspan="3" valign="top" align="left"><B>HEALTH &#038; HUMAN SERVICES COMMISSION</B></TD>
</TR>

<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>

<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">By:
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">/s/Eric Yoder
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">By:</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>

<TR style="font-size: 1px">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top"><HR size="1" noshade>&nbsp;
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top"><HR size="1" noshade>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">Eri Yoder
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">Albert Hawkins</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">President and CEO
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">Executive Commissioner</TD>
</TR>

<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>

<TR valign="bottom">
    <TD colspan="3" valign="top" align="left">Date: 7/23/04</TD>
    <TD>&nbsp;</TD>
    <TD colspan="2" valign="top" align="left">Date:</TD>
    <TD align="left" valign="top"><BR><HR size="1" noshade>&nbsp;
</TD>
</TR>

<!-- End Table Body -->
</TABLE>
</DIV>


<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="30%"></TD>
    <TD width="5%"></TD>
    <TD width="30%"></TD>
    <TD width="5%"></TD>
    <TD width="30%"></TD>
</TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&nbsp;</TD>
</TR>

<TR valign="bottom">
    <TD align="left" valign="top">HHSC Contract No.&nbsp;529-03-035-R
</TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">Page 8 of 8
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">Effective Date: September&nbsp;1, 2004</TD>
</TR>

<!-- End Table Body -->
</TABLE>
</DIV>




<P align="center" style="font-size: 10pt">&nbsp;
</DIV>


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