A marketbased system that counts on competition to restrain costs is just not a reality in far too many communities in this Nation. These communities. largely rural and innercity. have neither incomes nor population to attract large managed care corporations to compete for their care. and most forprofit HMOtype plans that receive a perparticipant capitated rate do not want this population which is often comprised of individuals and families that require more extensive care due to age. language barriers. homelessness. lack of transportation. and other factors than the general population. Typically care has been received from a very fragmented nonsystem of health departments. badly strained hospital emergency rooms. free clinics that depend on volunteers. and in those communities fortunate enough to have them. from federally funded community. migrant. and homeless health centers. What these communities need is the ability to organize existing resources for maximum efficiency and to be able to fill holes in service delivery to create casemanaged. integrated systems of care that serve the needs of their particular community. Under this bill the Federal Government and States can limit Medicaid increases while experimenting with new service delivery and financing mechanisms. communities would be empowered to determine and address their unique needs. all providers would be encouraged to participate and to negotiate a fair reimbursement with friends and neighbors they know and trust. families that have had no medical home would be provided one and coverage for services would be affordable.