The federal Healthy Start Initiative has been an integral, though often unrecognized, part of this nation’s health care safety net for 20 years. Federal Healthy Start has built its history and a substantial track record on serving vulnerable residents whose health and health care have been marginalized by virtue of race, gender, health status, economic status, and/or geography. Throughout its history, effective home visitation models have been deployed to achieve positive outcomes for some 524,484 women, children, and families in underserved urban and remote rural America. This impressive and steady growth has been accompanied by a relatively modest investment by the federal government with a return that has been at least as much in savings as was spent – savings resulting from projects moving low weight births to healthy higher weight births and thus avoiding expensive and lengthy hospital stays as well as the costs of continued care throughout the early years of life and possibly beyond.