REDEFINING BOUNDARIES IN THE FINANCING AND CARE OF DIABETES - THE MARYLAND EXPERIENCE

The story of the development of the Maryland Medicaid Diabetes Care Pr ogram is narrated in this policy case study. Maryland Medicaid, a fund ing authority willing to assume a proactive role, decided to promote h ealth care system changes expected to improve the health status of its recipients with diabetes. A state Medicaid budget crisis presented op portunities for financing new and expanded preventive services for tho se with this chronic disease. Specifically recounted is how Maryland M edicaid redefined its financing boundaries in an effort to overcome fi nance induced fragmentation in diabetes health care delivery. The diff iculties encountered by a single payer in moving unilaterally to alter health care practices are discussed. Two commentaries follow.