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Texas has one of the highest rates of uninsured in the United States. In addition, the Medicaid program is one of the poorest programs, in terms of benefits, of any state in the union. This article summarizes how a large pediatric practice responded to this crisis in a large metropolitan area. Key ingredients for success include both physician practice leadership (they have significant resources at their disposal), extensive community involvement (to provide, in particular, monies for the program), and local hospital involvement (for emergency and inpatient services).