Alabama began enrolling children in its state-designed CHIP, ALL Kids, in October 1998. This paper examines the first year effects of ALL Kids on realized access to care for children with and without special needs. Methods. Mail survey data were collected between November 1999 and January 2000 from a random sample (n=6,200) of the 25,748 first-year enrollees (return rate: 60% [n=3,740]). Analysis. Frequencies and cross-tabulations were used to describe realized access to care for both groups before and after enrollment. Results. Seven questions identified children with special needs (n=996 [27%]). Before and after CHIP comparisons were made between the groups. There were no differences in access to a routine care provider. A small, but significant (p=.02), difference was seen for access to a sick care provider. Highly significant differences (p=<.001) were observed between the groups on timely access to services for routine, vision, dental, and specialty care, as well as for prescription drugs. In all cases children with special needs experienced more improvement in their access after ALL Kids than children without special needs. Implications. The CHIP in Alabama is benefiting all children. Further, children with special health needs are experiencing more improvement in realized access than those without special needs. Community outreach and enrollment efforts should target children with special needs as a group likely to benefit from CHIP services.