The number of Americans without health insurance fell in 1999. This was partly driven by improvements in the extent to which children have health care coverage. Many children who gained coverage were poor children, suggesting that efforts to enroll more Medicaid-eligible children into coverage and to implement the State Children's Health Insurance Program (SCHIP) are beginning to show results. However, recent Census data indicate that states still struggle to ensure that welfare reform does not end up causing families with children to miss out on coverage. Although children in poor families are gaining ground, they are still more likely to be uninsured than they were before enactment of the welfare law. Also, their parents' insurance situation is deteriorating. Data indicate that working does not protect poor adults against being uninsured. Poor children and adults in the key childrearing years are uninsured at far higher rates than children and adults from moderate-to-higher-income families. This paper describes how: SCHIP and Medicaid outreach efforts are showing results; Medicaid represents a major reason for improvements in coverage rates among poor children; and states ensure that welfare reform does not cause families with children to miss out on coverage. (SM)