State Medicaid and SCHIP agencies provide vital health coverage to low-income populations and other groups, but they have limited administrative resources to support enrollment and renewal. This brief looks at experiences of some state Medicaid and SCHIP agencies in using a process change model to strengthen the way they approach enrollment and retention, concluding that committed leadership and resources are an effective model for changing Medicaid and SCHIP enrollment and retention processes rapidly and for sustaining improved processes. The brief also explores whether a process improvement collaborative is a worthwhile investment for states, finding that they have much to gain in terms of increased efficiency and savings using the model, which can be applied to any area of state administration.