Although many physicians may practice medical home medicine, most of the health care system is set up for acute episodic care. For children and youth with special health care needs (CYSHCN), this is costly and inefficient care and unsatisfactory for the patient and family. Transition or the purposeful planned movement of adolescents and young adults with chronic conditions from child-centered to adult-centered care began to evolve in the 1980s as more and more CYSHCN survived into adulthood. There is some progress being made in the implementation of the medical home that may facilitate a more effective transition of young individuals who have developmental disabilities. The greatest barrier to successful transition remains ensuring affordable, continuous health insurance coverage for all young people with special health care needs throughout adolescence and adulthood and engaging adult-oriented health care systems to take over the medical care of these young individuals.