Access to water and sanitation services (WSS) in developing countries is constrained by the conditions of social inequality and the services affordability for the poorest households. Therefore, public policies related to WSS need to broaden in scope given the challenge of reaching all customers, especially the most vulnerable, in order to achieve a balance between the social and financial objectives of WSS. This paper will contribute to the understanding of the main access and subsidy policies in South American countries focusing on the Brazilian case study. The different experiences in this region have provided some interesting lessons about these issues for Brazil; the conclusion is that the current indirect and cross-subsidy policies are important, but the needed practices for expanding pro-poor access require direct demand-side subsidies. A more proactive intervention through public authorities is also needed. A new subsidization model for Brazil is highlighted and discussed.