Over the past three years, National Academy for State Health Policy (NASHP) staff have provided technical assistance to Medicaid officials in 16 states that are designing and launching medical home demonstrations targeting low-income populations. With the passage of the Affordable Care Act (ACA), even states with the most successful medical home programs will need continued support to strengthen those efforts and capitalize on the ACA's numerous opportunities for creating a strong primary care foundation. In particular, state officials will need guidance on how to turn pilots into permanent programs, expand multipayer support, and create systems of integrated care. In this project, NASHP will help up to 17 experienced states sustain, strengthen, and expand their medical home initiatives and create useful models for all states.