In 2001 Washington, D.C. ceased paying for services to the uninsured via its underperforming public hospital and associated clinics. Instead, the District created a Medicaid-like coverage program known locally as the Alliance for people up to 200 percent of the federal poverty level who were not eligible for Medicaid. Low-income residents got better access to primary and specialty services, and budgetary costs were manageable. Enrollment reached over 50,000 and helped DC achieve among the lowest uninsured rates in the country. The Alliance also helped stabilize community health centers by giving them a more reliable revenue stream. Challenges remain in transforming the delivery system to meet population needs.