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This report describes how states are implementing fiscal reforms to contain costs or improve the performance of their child welfare systems. 23 initiatives in 22 states are described. The report also identifies issues that the implementation of fiscal reforms face and describes how well fiscal reforms appear to be working. Many of these reforms are based on the managed care model used in medicine for the past 30 years, while other reforms use approaches such as the privatization of services, performance contracting, and integrated funding. The report concludes by identifying several challenges faced by fiscal reform initiatives that must be solved if they are to be implemented widely.