This issue brief is part of a national project, Advancing Collective Impact for Improved Health Outcomes, funded by the W. K. Kellogg Foundation to strengthen the capacity of state Title V maternal and child health (MCH) programs and their partners to improve birth outcomes through health reform. AMCHP is working with state Title V MCH programs and their partners in state Medicaid agencies, organizations such as the March of Dimes and community groups to: 1) examine and explore opportunities to improve birth outcomes, particularly improved access to preconception health care, through changes to the health care delivery system, 2) strengthen partnerships between state Title V MCH programs and other key stakeholders such as state Medicaid agencies, providers, community health centers, and local health departments, and 3) identify specific strategies for financing preconception health, particularly for Medicaid-supported births. This issue brief explores how states can capitalize on the opportunities presented by health reform to improve birth outcomes, particularly through preconception health. It highlights state Title V MCH programs, particularly programs in the three states (Michigan, Oklahoma and Oregon) that participated in an action learning collaborative and are working to strengthen partnerships to implement preconception health activities, enhance preventive care for women, explore financing options for preconception care services, and use data to inform policy and program development.Delaware and Colorado also are featured as states that are working toward improved access to preconception care. The benefits of preconception health and health care are well documented for improving maternal and infant health outcomes. Many states and communities readily acknowledge the importance of preconception health and health care and are leading efforts to develop new ways of improving access to preconception care, financing of preconception care services, and using data to inform policy and program development. The ACA provides states and communities with new opportunities to develop and improve preconception health and ultimately improve birth outcomes.