After a dozen years, advocates for children won a case challenging the adequacy of care provided under Medicaid in Illinois. The case, filed back in 1992, charged that there was insufficient access to primary care or preventive measures.

The Illinois Department of Public Aid is preparing to propose a set of fixes, which would have to be approved by the plaintiffs and a federal judge. "We're hoping the remedy phase of this case gives all concerned a chance to shift gears and start working together to start fixing this thing," says John Bouman, director of advocacy at the Sargent Shriver National Center for Poverty Law and a co-counsel in the case.

According to evidence presented during the trial, during a 31/2 year period, more than 40 percent of the babies in Cook County who were eligible for Medicaid did not receive a single medical exam during the first 11 months of life. Only 8 percent of the infants received all six exams to which they were entitled.

Bouman says he's confident that Governor Rod Blagojevich's administration, which has cut Medicaid less than other states in response to recent budget shortfalls, will be sympathetic to stepping up levels of care. Administration officials confirm his opinion, but say that they still must work out the details.

The case was on hold for several years while Illinois sought a major managed care waiver, but once the state dropped its pleas for the waiver, the fight was back on. Similar cases are pending in other states, including California and Oklahoma.