support management and oversight roles is challenged by programmatic restrictions within federal programs such as VFC, Medicaid, and SCHIP and the absence of general funds at the federal or state level (apart from the Section 317 grants) that can support monitoring and assessment functions. Health agencies realized that they were expected to assume new responsibilities that were difficult to justify and were unable to obtain the necessary resources to exercise this role.

States initially had broad discretion in the use of federal funds, although CDC provided guidance each year to emphasize certain program objectives and priorities. In 1998, CDC announced a set of required activities under 18 program components to guide state programs and to provide a basis for comparison of state efforts (information provided by CDC) (see