This paper examines the role that Medicaid plays in addressing six populations with serious health needs resulting in high costs. For each population profiled, we describe the condition and the need for services and supports, as well as the role of Medicaid in meeting those needs. We also include profiles of real people with these conditions and descriptions of model programs or cutting edge practices designed to meet the needs of these high cost populations with exceptional needs. As these populations will show and as policy makers think about the type of health care system our nation needs, it is important to consider Medicaid’s role in anchoring the broader health system.