Original ArticlesThe Policy and Practice Legacy of the New Jersey Medicaid ACO Demonstration ProjectDeLia, Derek PhD; Yedidia, Michael J. PhDAuthor Information MedStar Health Research Institute, Hyattsville, Maryland (Dr DeLia); Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia (Dr DeLia); and Center for State Health Policy, Institute for Health, Health Care Policy, & Aging Research, Rutgers University, New Brunswick, New Jersey (Dr Yedidia). Correspondence: Derek DeLia, PhD, MedStar Health Research Institute, 6525 Belcrest Rd, Room 714, Hyattsville, MD 20782 ([email protected]). The work in this report was conducted pursuant to the enabling legislation of the New Jersey Medicaid Accountable Care Organization (ACO), Public Laws of 2011, Chapter 114. Support for this report was provided by a grant from The Nicholson Foundation and a grant from the Agency for Healthcare Research and Quality (AHRQ, grant no. R18HS023493). The content is solely the responsibility of the authors and does not necessarily represent the official views of AHRQ. The authors acknowledge assistance from Oliver Lontok. The authors have no conflicts of interest to declare in relation to this work. Journal of Ambulatory Care Management: January/March 2020 - Volume 43 - Issue 1 - p 2-10 doi: 10.1097/JAC.0000000000000308 Buy Metrics Abstract The New Jersey Medicaid Accountable Care Organization (ACO) Demonstration was created with a unique combination of features regarding ACO geography, involvement of managed care organizations (MCOs), and shared savings parameters. Ultimately, the Demonstration did not lead to a sustainable accountable care financing model and shared savings were deemphasized. Instead, the ACOs evolved into community health coalitions focused on coordinating and enhancing a wide range of activities in partnership with state government, private health systems, community leaders, and MCOs. Currently, the state is developing policy parameters to reposition the ACOs as regional partners to implement state-directed population health initiatives. © 2020 Wolters Kluwer Health, Inc. All rights reserved.