PRIMARY-CARE CASE-MANAGEMENT FOR MEDICAID RECIPIENTS - EVALUATION OF THE MARYLAND ACCESS TO CARE PROGRAM

A growing number of states are implementing Medicaid managed care prog rams, and primary care case management (PCCM) is an important componen t of many of these systems. In this paper, we present results of an ev aluation of one such PCCM program--the Maryland Access to Care (MAC) p rogram. The evaluation uses five years of Medicaid claims and eligibil ity data from the period before and after the program's introduction t o determine the program's impact on expenditures and service utilizati on. Results indicate that the program increased the probability that a Medicaid enrollee would use primary care and preventive services, but had little impact on use of specialty or emergency room services. The gatekeeper-program also was successful at controlling expenditures on ce an enrollee entered the health care system, largely through reducti ons in the use of ancillary services. The post-MAC increase in the pro bability of using services was so great, however, that all savings per user were negated, resulting in an estimated increase of about 3.4% i n Medicaid expenditures for the MAC-eligible population.