create the framework for EPSDT. Between 1967 and 1989, Congress enacted a number of amendments to Title V, adding requirements to work closely with and assist Medicaid in a number of activities. Currently, the Title V law requires that state MCH programs to: assist with coordination of EPSDT, establish coordination agreements for with their State Medicaid programs, provide a toll-free number for families seeking Title V or Medicaid providers, provide outreach and facilitate enrollment of Medicaid eligible children and pregnant women, share data collection responsibilities, and provide services for children with special health care needs and disabilities not covered by Medicaid. Reciprocally, federal EPSDT rules call for coordination with Title V. These requirements call for Medicaid agencies to: 1. establishment of written agreements which provide for maximum utilization of Title V-supported services and aims to improve child health status; and 2. reimbursement of Title V providers for services rendered, even if such services are provided free of charge to low-income uninsured families. Children’s Health Insurance Program The Children’s Health Insurance Program was created in 1997 and reauthorized in 2009. Known as CHIP, the program was enacted following the 1994 failure of national health reform. The purpose of CHIP was to expand health insurance coverage for targeted, uninsured, low-income children with family incomes below 200 percent of the federal poverty level. The program provides states with federal funding to expand health insurance beyond Medicaid eligibility levels. In some states, CHIP is administered as part of the Medicaid program (referred to as Medicaid expansion states) and the covered children are eligible for EPSDT benefits. In other states, CHIP may be administered by the state and designed similar to Medicaid but not provide full EPSDT coverage, or CHIP may be administered as a private plan without the more comprehensive EPSDT benefits. Separate administration has proved to be the more popular implementation approach, in large part because the funding for each state is limited and does not provide for an entitlement. Health Reform Under the Patient Protection and Affordable Care Act Medicaid is expanded, particularly for adults. Only a small proportion of children are uninsured, an estimate 5-7 million. About half of the children currently uninsured are eligible for Medicaid or CHIP coverage but have not been enrolled in these programs. In some cases, eligible children are not enrolled because their parents are unaware of the potential coverage or are reluctant to apply for