Since the mid-nineties, there have been considerable changes in the policies and the service delivery structure for health care and social assistance pro-

grams. For more than 30 years, most federal income assistance for children came from the AFDC program. Most recently, the federal government has increasingly shifted the responsibility for children and families back to state governments by formulating new legislative policies and creating new programs. This “devolution” of federal responsibility is reflected in the passage of the Personal Responsibility and Work Opportunity Act of 1996 [P.L. 104-193], the creation of the Temporary Assistance for Needy Families (TANF) program, changes in eligibility requirements for Supplemental Security Income (Sullivan v. Zebley, 1990), the enactment of Title XXI of the Social Security Act [P. L. 105-33], and the establishment in 1997 of the State Children’s Health Insurance Program.