By Jocelyn Guyer

On August 17, 2007, CMS sent a letter, known as the August 17th directive, to state health officials sharply restricting the ability of states to cover uninsured children using SCHIP funds. New data and analyses from state officials, research organizations, and policy experts raise significant questions about the basis for and the potential adverse effects of the August 17th directive, as well as the process by which CMS issued the policy. Drawing on these resourses, this issue brief provides an update on the impact of the directive as of April 2008, reporting that tens of thousands of children have lost out on coverage as a result of the directive.