Inside the Billion-Dollar Bet That Medicaid Patients Deserve Better: Cityblock Health

Health care is the biggest line item in the American economy, and the people on public insurance often get the least from it.

National health spending runs about 20% of GDP, over $4 trillion a year. Medicare accounts for more than $900 billion of that and Medicaid more than $700 billion, according to CMS figures reported by CNBC in 2023. More than 92 million people were enrolled in Medicaid at the end of 2022. Cityblock Health was built around the people inside those numbers.

It began in 2017 as a spinout from Google's Sidewalk Labs, based in Brooklyn. The founders include Dr. Toyin Ajayi, Iyah Romm, and Bay Gross. Ajayi and Romm met in 2013, when she worked at Commonwealth Care Alliance, a program for people eligible for both Medicaid and Medicare. She wanted care delivered at home and in the community, not only in hospitals.

Ajayi's path explains the mission. Born in Boston to Nigerian parents, she grew up in Nairobi, studied at Stanford and Cambridge, and earned her medical degree at King's College London. She worked in Sierra Leone and practiced family medicine in Boston, where she saw patients labeled "noncompliant" when the system had really failed them.

Here's how Cityblock works:

• Who it serves: Medicaid, dual-eligible, and lower-income Medicare members, many with chronic conditions, mental health needs, and unstable housing or food access.
• How it delivers: one team combining primary care, behavioral health, and social services, in the community and at home.
• How it earns: value-based care, built on keeping members healthier and out of the hospital.

In March 2022, Ajayi, then president, became CEO. Investors have kept backing the model. In August 2026, Cityblock raised a $116 million Series E led by General Catalyst, bringing its total raised to roughly $1 billion. Earlier reporting valued the company at around $6 billion.

Here's what the industry can learn:

• Trust is a product. Care that comes to people, from teams rooted in their communities, repairs what the system broke.
• The "hard" patients are the market. The costliest, most complex members are where better care changes the numbers most.
• Technology serves the relationship. Cityblock pairs software with high-touch care, not instead of it.

At IndeedBlack, we think about employment, and health and work are tied together. Stable health makes it easier to show up, keep a job, and build. A care model designed around the people most systems overlook matters to anyone focused on economic mobility.

Learn more at cityblock.com. Dr. Toyin Ajayi is co-founder and CEO.