States that have implemented health insurance coverage expansions over the past few years have developed creative strategies for using a portion of state money to leverage private, federal, and additional state dollars to cover the uninsured. While these are smart strategies for any economy, they are critical now that states are cutting programs to help close deficits. This project will examine lessons gained from these innovations, with the goal of helping states stretch limited dollars in order to maintain or expand coverage, or to enhance the cost-effectiveness of care. Three categories of innovation will be studied: 1) new state premium assistance programs that help low-wage workers buy into job-based or Medicaid coverage; 2) the use of uncompensated care funds, for example, to enable patients to visit primary care doctors rather than rely on emergency rooms; and 3) new state purchasing and care delivery strategies to foster cost-effective delivery of high-quality services. Project staff will develop up to 10 state profiles and four in-depth case studies that will provide state and federal policymakers with ideas about viable models of coverage as they weather the economic downturn. http://www.esresearch.org