Much of the success of the Affordable Care Act (ACA) will hinge on issues surrounding access to care, particularly as millions of individuals become newly-insured and strain the capacity of provider systems. New service delivery reforms in state Medicaid programs and the private sector, as well as provisions in the ACA focused on increasing primary care reimbursement and provider supply, and increasing funding for Community Health Centers, hold promise to improve access to quality care. Drawing on the experiences of ten study states participating in the Robert Wood Johnson Foundations health reform monitoring and implementation project, this brief examines how states are addressing the complex issues of provider capacity and access to care.