This case study examines Community Care of North Carolina (CCNC), “a public–private partnership between the state and 14 non-profit community care networks. The networks comprise essential local providers that deliver key components of a ‘medical home’ for low-income adults and children enrolled in Medicaid and the State Children’s Health Insurance Program. Community-based delivery systems promote the development of locally led approaches that leverage resources and relationships to meet statewide goals. Local networks and primary care physicians receive supplemental funding for care management and quality improvement initiatives supported by statewide performance measurement and benchmarking activities. Results suggest that the program has yielded cost savings while promoting improvements in care of patients with chronic conditions. CCNC’s experience may be relevant to other states considering how to improve primary care case management programs, or how to better address the needs of low-income individuals in areas that lack effective mechanisms for coordinating care.”