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Accountable care organizations (ACOs) are provider contracting models intended to improve population health while controlling cost. With careful design and monitoring they can also serve as a platform for improving health equity. While much of the innovation and research related to ACOs has occurred in the context of Medicare and commercial insurance, Medicaid ACOs may have the most to teach us about how payers can structure their ACO initiatives to improve care for the most disadvantaged patients and thereby improve health equity. We derived related insights about Medicaid ACOs from two sources: a review of published literature and reports on the implementation and impact of Medicaid ACOs, and interviews with Medicaid agency leaders and safety-net providers in four states with and four without Medicaid ACOs. More details can be found in a Commonwealth Fund Issue Brief where we summarize empirical evidence related to the impact of Medicaid ACOs and describe respondent views on the prospects for ACOs in their state, along with barriers and facilitators to successful implementation.