This paper reports on an examination of ten Health Insurance Flexibility and Accountability (HIFA) waiver demonstrations, a major Medicaid initiative of the Bush administration. Among other things, the study finds that the principal motivation for the HIFA waivers was to expand coverage, and not, as some had feared, to control costs. States showed a particular interest in providing coverage to groups that historically have been excluded from publicly-sponsored health programs. Coverage expansion under HIFA, however, has been far short of projections. The biggest obstacle for states in implementing (or maintaining) their demonstrations has been finding state funds. (Health Affairs Web Exclusive, April 25, 2006)