Family-centered, coordinated, comprehensive, and culturally competent care for children and youth with special healthcare needs is a national priority. Access to a primary care medical home is a US Maternal and Child Health Bureau performance measure. Most primary care practices lack methods by which to partner with families and improve care. Gaps remain in the number of children with access to a high-quality medical home. The Medical Home Index and Medical Home Family Index and Survey resulting from 10 pilot practices reveal improvements in practice capacity and subsequently in child and family outcomes.