Alabama made several changes to improve health care access for its low-income population. Effective outreach for SCHIP and streamlined enrollment for Medicaid and other insurance programs for the uninsured poor have increased coverage for children. The state has also increased Medicaid payment rates for physicians and dentists to improve access for enrollees. Budget pressures may threaten progress in these areas. Medicaid funding comes chiefly from intergovernmental transfers from hospitals in conjunction with use of the upper payment limit and disproportionate share hospital programs. Both of these programs are being cut back at the federal level. Since the structure of its tax system limits Alabama's ability to raise revenues, these changes in federal sources of financing represent the greatest current threat to health care programs for low income Alabamians.