With spending totaling more than $15 billion a year, one of the largest public subsidy programs to help pay for health care services for the uninsured is the Medicaid disproportionate share hospital (DSH) program. Although the DSH program sometimes has been highly controversial, this study provides some insights on the experiences of five community programs that have used DSH funds in a positive way: To provide health care services to the uninsured. While each program is unique and faces it own set of circumstances, several lessons are drawn to guide other communities as they search for local solutions to the growing problem of caring for the uninsured.