A new analysis conducted for the Kaiser Family Foundation's Commission on Medicaid and the Uninsured examines the implications of a downturn for health coverage and state programs. The authors estimate that a one percentage point increase in the national unemployment rate would increase Medicaid and SCHIP enrollment by 1 million and cause the number of uninsured to grow by 1.1 million. The analysis documents how federal fiscal relief during the last economic downturn of 2003-2004 helped to stabilize Medicaid eligibility and let states avoid deeper budget cuts. The authors also consider alternative approaches to targeted federal fiscal stimulus.