Children with medical complexity (CMC) generally require intensive family support and high-cost health care services – needs that may lead to out-of-home placement when they are not available or affordable. The Family First Prevention Services Act of 2018 offers resources to transform state foster care systems to emphasize prevention – and when necessary placement in a foster care home rather than an institution. CMC could benefit if states applied its goals to improve foster care prevention and placement options for CMC. Medicaid and Title V services also can help keep CMC at home. This report explores how states can leverage federal and state policy tools to improve options for CMC in or at risk of foster care placement.