This policy options paper, prepared by CHCS through funding from the California HealthCare Foundation, outlines possible approaches to the design of an enhanced medical home model that would provide access to a primary care provider, as well as targeted care management support for high-risk beneficiaries. It was developed to inform the California Department of Health Care Services in establishing a new statewide infrastructure of Enhanced Medical Homes for approximately 360,000 fee-for-service Medi-Cal Seniors and Persons with Disabilities (SPD).