Amendment 19 To Contract With Firstguard Health Plan Kansas, Inc.

Exhibit 10.3

ROBERT M. DAY, Ph.D, Director KATHLEEN SEBELIUS, GOVERNOR DIVISION OF HEALTH POLICY AND FINANCE

June 8, 2006

Jean Rumbaugh

FirstGuard Health Plan Kansas, Inc. 3801 Blue Parkway

Kansas City, MO 64130

RE: Amendment Nineteen Contract #02510

Dear Ms. Rumbaugh:

Enclosed for your files is a fully executed copy of Amendment Nineteen between the Division of Policy and Finance (DHPF) and FirstGuard Health Plan Kansas, Inc. Thank you for your assistance in getting this contract completed in a timely manner.

Should you have questions, don' t hesitate to contact me at 785-296-8623, or by e-mail at jwxd@srskansas.org.

Sincerely, /s/ John Dixon

John Dixon

Contract Manager

JD/ms Enclosure (1)

pc: DHPF central file

Landon State Office Building, 900 SW Jackson, Room 900N, Topeka, KS 66612 Phone 785-296-3981 Fax 785-296-4813 STATE OF KANSAS Contract No. 02510 Social and Rehabilitation Services Health Care Policy/Medicaid

AMENDMENT NINETEEN

to the

KANSAS HEALTHWAVE TITLE XIX AND TITLE XXI CAPITATED MANAGED CARE

HEALTH SERVICES CONTRACT

with

FIRSTGUARD HEALTH PLAN KANSAS, INC.

2007 SIX MONTH EXTENSION

The above referenced agreement, as amended, entered into by and between the Secretary of Social and Rehabilitation Services, hereinafter referred to as SRS, and FirstGuard Health Plan Kansas, Inc., a Kansas Corporation, hereinafter referred to as FG, on July 12, 2001, and transferred effective July 1, 2005 to the Director of Health Policy and Finance, hereinafter referred to as DHPF, is hereby amended by agreement of the parties.

The Kansas Legisla ...