The Fund supports networks of state health policy decision makers to help identify, inspire, and inform policy leaders.
A bipartisan group of state health policymakers from both the executive and legislative branches who are focused on improving population health.
Supporting networks of state officials, advocates, and others aiming to invest in and transform primary care.
Advancing state-based efforts to make health care more affordable for residents, employers, and states.
The Milbank Memorial Fund supports two state leadership programs for legislative and executive branch state government officials committed to improving population health.
A leadership development program for early and mid-career state government officials who are committed to improving the health of all people in their communities.
A leadership program for senior state government officials who are committed to improving population health.
The Fund focuses on creating an affordable health care system built on strong primary care and partnerships that improve health outcomes for all.
Improving state leaders ability to enact and implement evidence-based health policies.
Advancing policies that create a more prevention- and primary care-oriented health system.
Improving population health through policies that contain health care cost growth.
Our state health policy resources provide relevant data analysis and best practices.
The Fund publishes reports, issues briefs, and case studies on state health policy issues.
Short takes on health policy issues from Milbank staff and guest authors.
Insights from Milbank President Debra Lubar on state health policymaking.
Reported articles and Q&As on timely health policy issues, as well as foundation updates.
Upcoming and past Milbank Memorial Fund and Milbank Quarterly webinars featuring state health policymakers and researchers.
Updates and expert contact information for reporters.
The Milbank Memorial Fund is a private foundation that works to improve population health and health equity.
September 2, 2026
Quarterly Article
Shannon N. Ogden
Stephanie Loo
Megan B. Cole
Kathryn D. Thompson
Kenneth N. Lim
Sarah H. Gordon
Collette N. Ncube
Elizabeth W. Patton
Karen E. Lasser
Lois McCloskey
December 2025
September 2024
Back to The Milbank Quarterly
Policy Points:
Context: In the wake of a US maternal health crisis, Accountable Care Organizations (ACOs) may be a key opportunity to improve maternal health care. In 2018, Massachusetts Medicaid launched its ACO program through an 1115 waiver, which renewed and expanded in 2023. During the second waiver period, the ACOs expanded their emphasis on maternal health. However, there is limited understanding of how maternal health fits into Medicaid ACO strategic priorities, how ACOs implement maternal health initiatives, and the challenges they face. This study uses qualitative interviews with ACO leaders, clinicians, and care coordinators to explore how ACOs addressed maternal health care quality, while identifying key drivers of and challenges for change in maternal health care delivery across Massachusetts’ two waiver periods.
Methods: We conducted 23 semistructed interviews with 26 ACO leaders, clinicians, and care coordinators representing six of 17 Massachusetts Medicaid ACOs between September 2023 and December 2024. We analyzed professionally transcribed interviews using thematic analysis.
Findings: We identified three major themes: (1) Mandated ACO metrics drive maternal health priorities and practices, yet meeting metrics is challenging; (2) Shifts in Medicaid ACO priorities prompt the adaptation of existing programs or development of new initiatives to address maternal health; and (3) Health-related social needs initiatives within the ACO are viewed as critical to maternal health care. The themes emphasized how Medicaid ACOs and health care systems adapted their programming in response to state-level mandates to improve maternal health care quality.
Conclusions: Findings highlight the importance of aligning the design of Medicaid ACO programs with robust infrastructure and resources to support sustainable improvements in maternal health. Massachusetts’ Medicaid program achieved success in improving maternal care quality when it intentionally and strategically incorporated maternal health-specific provisions into Medicaid ACO contracts.