OBJECTIVES: To explore the association between race, comorbidities, and therapy use among patients with heart failure (HF) in a contemporary Medicaid population. METHODS: Medical/prescription/enrollment records from the Maryland State Medicaid Managed Care Organization/Fee-for-services, ages 18-64, non-dual enrolled, with HF diagnosis between July 1, 2005 to December 31, 2009, followed at least 3 months. Diagnosis for HF defined as earliest encounter claim that included ICD-9 code 428.xx.  Comorbidity diagnosis determined between earliest claim and within three months post-HF diagnosis.  First-line therapies ascertained using pharmacy claims with first-date-of-service between HF diagnosis and the end of follow up. Variation in comorbidities and therapy use across race/ethnicity is described. RESULTS: Among 15,764 HF patients, 60% (n=9,388) were black, 33% (n=5,158) white, 6% (n=919) other, 2% (n=299) Hispanic.  Over half were female (55%); 72% older than 44 years. Prevalence in race/ethnicity: COPD (40% white, 22% black, 20% other, 11% Hispanic; p<0.001), stroke (20-22%; p=0.17), renal dysfunction (38% Hispanic, 30% black, 27%other, 22% white; p<0.001), diabetes (38-42%; p=0.04), psychological disorder (65% white, 52% black, 46% other, 37% Hispanic; p<0.001), hyperlipidemia (44% white, 39% Hispanic, 31% other, 33% black; p<0.001), chronic ischemic heart disease (47% white, 41% black/Hispanic/other; p<0.001), hypertension (76% black, 72% Hispanic, 68% white, 67% other; p<0.001), other cardiovascular disease (76-80%; p=0.17). Excluding other cardiovascular disease, the median number of comorbid conditions was 3 in each race/ethnicity.  Among black, white, Hispanic and other, only 5.8%, 4.4%, 9.0%, and 7.3% had zero comorbidities, and 14.2%, 11.4%, 12.4%, 15.8% had only one comorbidity, respectively. Hispanics (53%) were less likely than blacks (62%), whites (61%), or others (57%) to be prescribed ACE-inhibitor/ARB, beta-blockers, aldosterone antagonists, and/or other cardiovascular drugs including combination nitrates/hydralazine (p<0.001). CONCLUSIONS: Whites were most likely to be diagnosed with COPD, psychological disorders, hyperlipidemia, and chronic ischemic heart disease. Hypertension was most likely among Blacks, and renal dysfunction most likely among Hispanics.