New York to downsize hospitals and nursing homes. On January 1, the recommendations of the New York State Commission on Health Care Facilities in the 21st Century became law when the state legislature failed to rule on the proposals. Nine hospitals, including five in New York City, will close to reduce excess capacity and bolster the state's financially troubled institutional health care system. Forty-eight other hospitals will merge, downsize, or convert to clinics or outpatient facilities. The plan cuts 7%-approximately 4,200-of the state's hospital beds. About 3,000 nursing home beds will be eliminated and replaced by noninstitutional alternatives. An estimated $806 million will be saved annually, $249 million of that from Medicaid and $322 million from Medicare. The costs of the changes-estimated at $1.2 billion-will be borne by the state and federal governments, which allocated $1.5 billion in the Federal-State Health Reform Partnership. The commission contends that this "rightsizing" will modernize New York's health care system by centralizing expertise and equipment to better meet the needs of patients. Read the report at http://www.nyhealthcarecommission.org.

Five states report fewer children's health insurance enrollments under a new regulation, even though 17 states boosted the number of children and families covered by publicly provided insurance in 2006. According to a January report from the Kaiser Commission on Medicaid and the Uninsured, since July 2006, when proof of citizenship became a federal requirement for renewing Medicaid coverage (see In the News, "2006: The Year in Review," January), the number of children being enrolled under that program has declined in Iowa, Louisiana, New Hampshire, Virginia, and Wisconsin. In New Hampshire, complete applications (those containing all the required documentation) declined by almost 50% from the previous year. According to the report, Resuming the Path to Health Coverage for Children and Parents (available at http://www.kff.org/medicaid/upload/7608.pdf), many state officials attribute the drop in enrollments not to the culling of ineligible families but rather to eligible families being unable to provide the required documentation.

Carol Potera