; and (C) not later than 7 years after the approval of an application, the Secretary to transmit a notice to such qualifying political subdivision of the application’s approval or rejection for an extension under this subsection. (9) Limitation on number of demonstration projects The Secretary may not approve more than 100 demonstration projects under this subsection, which may consist of demonstration projects implemented by a single participating political subdivision or implemented as partnerships formed by multiple participating political subdivisions (as described in paragraph (3)(B)). (10) Application without regard to budget neutrality The Secretary shall not require, as a condition for carrying out the demonstration project under this subsection, that the demonstration project ensure that such model is budget neutral initially with respect to expenditures under the applicable title. (11) Report Not later than 4 years after the first date of the demonstration project, the Secretary shall submit a report to Congress on— (A) the effect of the demonstration project on— (i) the number of beneficiaries enrolled in demonstration projects under this subsection; and (ii) the amount of uncompensated care costs for State Medicaid plans; and (B) whether any States with a demonstration project under this subsection have expanded Medicaid coverage under the Patient Protection and Affordable Care Act. . (b) Payment to States Section 1903(a) of the Social Security Act ( 42 U.S.C. 1396b(a) ) is amended— (1) in paragraph (6)(B), by striking at the end and ; (2) in paragraph (7), by striking the period at the end and inserting ; and