CSHCN present a challenge to the primary care provider. These children are medically complex, require services and supports well beyond those that typically developing children require, and command a considerable proportion of the pediatric health care budget. How clinics are organized can have a considerable impact on the delivery of care to this heterogeneous group of complicated children. In this article, the authors articulate the philosophic underpinnings of one clinic-the SCC-located in an academic tertiary care center. Establishing a multidisciplinary medical home with a noncategoric approach to health care is one way of serving patients who have special health care needs. The more common medical problems encountered in the SCC are identified, along with strategies to address them. The ethics of caring for CSHCN are complex and controversial and have only been touched on in the context of providing a medical home. It is clear that CSHCN are going to increase in numbers as technology and medical care change. Thus, it is incumbent on child health care providers to develop resources to meet the needs of this complicated population. There needs to be a change in the way CSHCN and their families are addressed, accepting them as individuals worthy of the same care, concern, and respect that typically developing children receive. The establishment of a medical home with a noncategoric approach to care may be one step in achieving comprehensive care for this population of underserved children.