Designing and implementing health care delivery system reform that cost-effectively promotes better health outcomes is a key global challenge. The governance of health care policy in the United States – a hallmark of which is state-level discretion – provides a unique opportunity to learn from a rich body of state-specific case studies. States have long been considered the “laboratories of democracy”; this is especially salient for the health care safety net, as states administer Medicaid and an umbrella of public health agencies tasked with serving the health needs of vulnerable populations. This panel includes four papers that explore various state-level interventions targeting the health of vulnerable and historically underserved populations. The first two papers examine the effects of transitioning Medicaid members away from the traditional fee-for-service delivery model into managed care plans. Across the country, many Medicaid members are now receiving coverage within a managed care benefit, however this is not universally true across eligibility categories (esp. disabled members). The inconclusive nature of the related literature on the associated health care effects is suggestive of heterogeneity across populations and time periods studied, motivating the importance of studying recent contexts and specific eligibility categories. Jim Marton and colleagues evaluate the recent transition of Kentucky Medicaid populations into managed care, finding that emergency room visits and inpatient visits – but not outpatient visits – decreased after the transition. Coady Wing and colleagues evaluate the impact of transitioning disabled beneficiaries into managed care coverage in Illinois; they find that contrary to program objectives, the transition was associated with a cost increase. The continued increase in managed care penetration is occurring within a broader secular trend of outcomes-focused reform efforts in Medicaid. Foundational to this movement is the need for a data infrastructure that can support the effective targeting of resource-intensive services such as care coordination that are emphasized in and financed under the Affordable Care Act. The objective of the third paper in the panel is to propose and test a case-finding tool that can be used for new and “churning” pediatric populations for whom state Medicaid agencies and insurers on the Marketplace lack recent medical records. Laura Wherry and her colleagues’ preliminary results suggest that a simple series of parent-reported health measures are meaningfully predictive of high-need pediatric patients, substantiating their potential use as input data for case-finding purposes. A final paper by Dana Patton measures the impact of state Offices of Minority Health on African-American infant mortality. Offices of Minority Health are public health agencies tasked with disease surveillance and community partnership building in the service of improving minority health. Her results suggest that the presence of OMH agencies is associated with decreases in Black infant mortality rates, and that this effect is strongest in states with low Medicaid spending. Together these papers explore state-level issues that speak to the universally important themes of implementing and administering capitation-based payment systems, targeting the efficient allocation of resource-intensive services, and ensuring that governmental public agencies protect and promote the health of vulnerable citizens.