Health reform could completely change the landscape of Texas healthcare, bringing new people into the system while challenging smaller plans to meet requirements on their spending on medical care. Medicaid changes will be unlike those in any other state, with an estimated 2.2 million residents entering the system. The state has chosen managed care plans to coordinated care for those eligible for aged, blind and disabled Medicaid benefits in north Texas. Meanwhile the medical home concept has begun to appear in Texas, with private payors and the Medicaid program launching pilot initiatives.