While the majority of practice improvement efforts in the U.S. have supported community health centers and larger practice settings, there is increasing investment in quality improvement and redesign in small practices. These practices are critical to the care of low-income and racially and ethnically diverse Medicaid beneficiaries, yet are often under-resourced and disenfranchised from supports in the larger health care system.

This technical assistance brief describes how Medicaid can leverage its resources to facilitate and sustain improvements in care and reduce health disparities in small, under-resourced practices with high-volume Medicaid panels. It discusses the experiences of the four states participating in CHCS’ Reducing Disparities at the Practice Site initiative, which is testing five Medicaid levers for supporting these practices. Lessons are helpful to states looking to strengthen their primary care infrastructure and take advantage of opportunities presented in health reform.