The smallest and most isolated counties in California have banded together to implement the expanded health coverage mandated by the Patient Protection and Affordable Care Act, better known as health reform. Under the bureaucratic umbrella of the relatively obscure County Medical Services Program, they will seek to provide the state’s poorest, most isolated patients with a “medical home,” something like a publicly funded HMO. But even as they forge ahead, they ask fundamental questions: Where will we find the primary care doctors needed? The specialists? The enrollment staff? And will the state and federal officials in charge of distributing the matching funds in support of the effort do so quickly enough to keep the program alive?