This paper outlines a model of designing a service delivery system for a targeted population of high-risk Medicaid families. The Affordable Care Act (ACA) has created a new focus on a population that has high behavioral health and medical needs. Medicaid families are segmented into categories based on the criteria outlined in the ACA and a service delivery system is suggested. The model calls for the creation of specialty services in the community that reach out to high-risk families and provide ongoing integrated care that strives for improved health outcomes. The psychoanalytic principles used in attachment theory and power dynamics are offered as a method of creating new responses to complicated health and behavioral health problems in Medicaid families.