Every year more than 500,000 children with special health care needs (CSHCN), patients who need more consistent medical care or face significant consequences and complications, transition to adult-oriented providers. Yet these patients may encounter even greater difficulty in transitions of care than healthy adolescents and young adults, whether it is finding a provider who is comfortable managing their condition, re-establishing trust with a new provider, having providers address their unique psychosocial needs, or maintaining sufficient insurance coverage. Several models have been described with the goal of improving the transition process for patients, families, and providers. However, little evidence exists as to the actual impact of these programs on patient outcomes. This review highlights current understanding and expectations of transition for young adults with special health care needs, describes the state of transition medicine in South Carolina, and outlines areas for research and improvement on the local, regional, and national level.