This paper presents a set of strategies and options that California can use to leverage Medi-Cal, the State's Medicaid program, to move toward an equitable, advanced health delivery system for its children. Close to five million children are enrolled in Medi-Cal, more than two-thirds of whom are Black and Brown children. California's program alone covers more children than 23 other states combined. Among children under the age of five, almost two-thirds are enrolled in Medi-Cal with an estimated $3 billion spent on their care, half of that representing State and local (e.g., county) dollars. With the State's sweeping size and potential influence, the steps California takes at this pivotal moment can play a substantial role in transforming pediatric primary care for young children and their families in the months and years ahead. This report identifies three major sets of strategies that could be adopted relatively quickly to: (1) establish greater accountability for child health among California's Medi-Cal managed care plans; (2) realize the full potential of Medicaid's Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit for California's children; and (3) elevate a focus on children among the managed care plans and the State Medicaid agency. [This report was co-produced by Manatt Health with support from the J.B. and M.K. Pritzker Family Foundation, and Genentech Charitable Giving. For the Executive Summary, see ED610670.]