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Accountable care can be a useful tool for providing safety-net providers with more sustainable and flexible financing for meeting their patients’ needs. However, most safety-net organizations face multiple existing barriers to advancing accountable care in the safety net. Further, accountable care is at an inflection point, and several health policy proposals may affect accountable care. Currently, there are Congressional debates on broader reconciliation legislation that include proposals impacting accountable care, particularly in Medicaid and the health care safety net, and the Centers for Medicare and Medicaid Innovation (CMMI) is ending the first innovation model to include Federally Qualified Health Centers. This Forefront article summarizes the current state of policy issues relevant to advancing accountable care in the safety net and recent changes introduced by the Centers for Medicare and Medicaid Services (CMS) in their 2024 Medicaid Managed Care Access, Finance, and Quality Final Rule (see summary in exhibit 1). In addition, we explore opportunities where Medicaid managed care policy can better support accountable care for safety-net providers.