This chapter discusses discharge planning as a game in a generalized sense that is applicable to different cohorts. It discusses the political-economic challenges of discharge planning and then suggests a game of practical strategies. Within the structure of federal and state laws and policies, numerous political-economic influences are a hegemonic reality in each locality. These influences are commercial insurance, public insurance, employee assistance program (EAP) providers, psychiatrists, treatment cohorts, and the provider organization. A clinician who has an appreciation of the local political-economic interests can negotiate the aftercare system more effectively in discharge planning. Discharge planning for specialty cohort areas such as gerontology, addiction, or eating disorders can be challenging. The psychiatrist is at the top of the proverbial food chain and has the final decision in the discharge-planning process. The psychiatrist chooses whether to refer a patient to the psychiatrist’s outpatient practice or to another provider.