In 2009, Legislative Bill 396 authorized the Nebraska Medical Home Pilot Program Act with the purpose of improving health care access and health outcomes for patients and containing costs in the Medicaid program. The act defined medical home for the state of Nebraska and authorized a medical home pilot program. In 2011, the Nebraska Medicaid Patient-Centered Medical Home (PCMH) pilot was launched with two participating primary care practices; the pilot ended in 2013. In 2014, a voluntary, two-year, multi-payer medical home pilot was launched with the support of the Nebraska Legislature through a Participation Agreement. Commercial insurers and Medicaid managed care plans were asked to support PCMH-recognized practices by linking payments to clinical, financial and patient satisfaction measures. The goals of the Agreement include contracting with approximately 10 clinics by the end of 2014 and 20 clinics by the end of 2015.