Fiscal reform in general and managed care in particular have recently become focal points of efforts around the country to reform child welfare systems. Because managed care could have an enormous impact on the delivery of child welfare services, it is essential that the child welfare field amass a cumulative record based on examination of seminal efforts to build child welfare reform around managed care principles. This paper summarizes results of a study that examines such efforts in four sites-Kansas; Hamilton County, Ohio; Tennessee; and District 13, Florida. The study concluded that child welfare officials in all sites were fundamentally concerned with the alignment of programmatic goals and fiscal incentives, and that although we speak of managed care and fiscal reform, we are likely seeing the emergence of explicit market pressures on the delivery of child welfare services. A related article was published in Policy and Practice, September 2000.