The problem of providing health care for the uninsured has regained national attention. A variety of approaches are being tried across the country including State High Risk Pools and other insurance pools, increased individual policy options, and expansion of Medicaid and Medical Assistance eligibility. One of the key design elements in these approaches often is the use of managed care. A review of important design features and risk factors is presented. Findings from a welfare-to-work demonstration project are described including enrollees who lose Medicaid but do not have employer based health benefits.