TennCare is a Medicaid 1115 waiver program that began on January 1, 1994, when the existing Medicaid population was shifted into managed care, and the program was opened up to uninsured Tennesseans. Tennessee residents were eligible for TennCare under the uninsured category if they did not have insurance on March 1, 1993. If enrollees have income levels above 100% of the poverty level, they are charged premiums and copayments based on an income sliding scale. The impetus for TennCare was fiscal, as the Medicaid program could not afford to continue operating under a fee for service arrangement. The rapid changeover to managed care resulted in cost savings that allowed more than 400,000 uninsured Tennesseans to obtain coverage through the program. On January 1, 1995, the state closed enrollment to the uninsured population, but remained open to those who were eligible for Medicaid. Enrollment was reopened for children under age 18 who did not have access to insurance on April 1, 1997. Adding another relatively healthy population (uninsured children) to the patient mix has contributed to keeping TennCare's costs low.