Although the primary goal of the State Children's Health Insurance Program (SCHIP) is to extend health insurance coverage to the estimated 10 million uninsured low-income children in America, SCHIP also presents an opportunity to insure one of our nation's most vulnerable groups: children with special health care needs (CSHCN). Recent research has revealed that children with disabilities and chronic illnesses may make up 17 percent of low-income uninsured children, or roughly one of every six children eligible under SCHIP. Understanding the implications of this potentially high prevalence of CSHCN is important given the large variety of SCHIP programs implemented in the last three years -- roughly two-thirds of the states have used the flexibility in the law to design and implement new child health insurance programs, either separately or in combination with Medicaid expansions. Therefore, even at this early stage of implementation, it is reasonable to ask how, or how well, SCHIP will respond to the needs of children with chronic illnesses and disabilities. This study begins to answer this question, based on a qualitative analysis of the implementation experiences of an 18-state sample.