Brazil is known for its vast internal diversity. Whether we consider its historical patterns of colonization, industrial development, internal migration, or ecological diversity, Brazil offers amazing contrasts. During the 1990s and 2000s some Brazilian municipalities were the sites of an amazing array of reforms: universal health programs, participatory budgeting programs, public policy councils, and conditional cash transfer programs flourished across Brazil. Multiple Brazilian municipalities were internationally recognized for creating innovative policy and institutional solutions to address a wide range of social and political problems, such as extreme poverty, low rates of vaccination, and a disengaged citizenry (United Nations 1996). However, patronage, clientelism, administrative malfeasance, corruption, and poor provision of public goods continue to plague many citizens and municipalities and limit efforts to improve well-being. In this chapter, we narrow the analytical lens to three municipalities to examine how participatory institutions, inclusive social policy, and local state capacity work on the ground to advance well-being.