This article describes: 1) internal and external factors enabling the expansion of health care access to Burmese and Karen refugees, 2) operational processes required to expand integrated primary health care services to this emerging community, 3) the importance of culturally and linguistically competent services that incorporate prior experiences of forced immigration, and 4) les- sons learned and what to expect when expanding health care access to new populations within a federally qualified health center (FQHC). This case study may provide a blueprint for other FQHCs seeking to respond to emerging immigrant and refugee populations. Such expansion gains relevance as the nation grows more diverse and continues to rely on FQHCs to respond to the health needs of medically underserved populations.