This case study is primarily based on a site visit conducted in Ohio in May 2012 by staff from Mathematica Policy Research. The remainder of this report will describe recent Healthy Start program developments and their perceived effects in the key implementation areas of eligibility, enrollment, and retention; outreach; benefits; service delivery, quality, and access; cost-sharing; crowd-out; financing; and preparation for health care reform. The report concludes with cross-cutting lessons learned about the successes and challenges associated with administering Ohio’s M-CHIP program. Ohio was one of 10 states selected for study in the second congressionally mandated evaluation of CHIP, authorized by CHIPRA and overseen by the Assistant Secretary for Planning and Evaluation (ASPE). The report highlights changes to Ohio’s programs since 2006, with a particular focus on state responses to provisions of CHIPRA. In addition to interviewing 37 key informants (listed in Appendix A) in Columbus, Cincinnati, and Dayton, researchers conducted three focus groups for the study: one with parents of children currently enrolled in Healthy Start in Cincinnati, one with parents of children who were potentially eligible but not enrolled in Cincinnati, and one with parents of children currently enrolled in Healthy Start in a rural area, Newark, Licking County. A total of 24 parents participated in these focus groups. Findings from these focus groups are included throughout the report and serve to augment information gathered through stakeholder interviews.