INTRODUCTION: This study identifies important risk factors, race and predictors of heart failure (HF) in a chronic obstructive pulmonary disease (COPD) Medicaid population, to help inform plans and better target interventions for COPD disease management. METHODS: A retrospective analysis was performed for all medical claims of Medicaid COPD patients, between January 1, 2001-December, 31, 2003. COPD patients were included if they had at least one claim with ICD-9 codes 491.xx, 4922.xx, or 496.xx, in the primary, secondary or tertiary diagnosis. We used multivariate logistic regression models to evaluate associations between heart failure and race, adjusting for age, gender, cardiovascular diseases and risk factors. RESULTS: Total of 13,924 COPD patients, mean age 42. African Americans (OR= 1.25 p=0.0001 CI 1.12-1.40) were more likely to have HF than others during their follow up, even after adjusting for age, gender and clinical risk factors. Patients older than 60 (OR=5.13 p<0.0001 CI 4.16-6.32) and those between 40 and 60 (OR= 3.34 p<0.0001 CI 2.75-4.05) were more likely to have HF than those younger than 40. Hypertension (OR=2.30 p<0.0001 CI 2.02-2.61), diabetes (OR=2.16 p<0.0001 CI 1.93-2.42), obesity (OR=2.18 p<0.0001 CI 1.91-2.48), acute myocardial infarction (OR=3.09 p<0.0001 CI 2.56-3.73) and cardiomyopathy (OR=15.76 p<0.0001 CI 12.95-19.18) were also significant predictors of heart failure. Gender and urban residence were not significant in the model. CONCLUSIONS: Medicaid patients, with COPD, who are African American, older than 40, with a diagnosis of hypertension, obesity, diabetes, cardiomyopathy or myocardial infarction are at significantly higher risk for heart failure. Managed care plans may need to consider those risk factors in Medicaid patients with COPD.