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This case study explains the trends in new Medicaid and SCHIP enrollment in North Carolina from 1999 into 2004. In particular, we are interested in examining the potential links between new enrollment and major outreach strategies or policy changes that took place in North Carolina at the state and local level, especially those associated with the CKF grant. Ideally, we would examine such links through a formal impacts analysis that estimates the effect of individual policy changes or outreach efforts on the number of children enrolling in Medicaid or SCHIP. This type of analysis is not possible, however, because many of the outreach efforts and policy changes occurred at the same time. In addition, no state or other geographic area is a defensible comparison group for a more rigorous analysis. The case study approach, which combines exploratory data analysis with in-depth key informant interviews, allows us to assess the potential influence that major outreach efforts or policy changes have had on new enrollments.