An Assessment of Maryland Medicaid’s Rare and Expensive Case Management Program

Abstract

The Rare and Expensive Case Management Program provides intensive case management services to an especially vulnerable population comprised of primarily pediatric beneficiaries. This study examines the effect of the case management program on the pattern of costs. With its emphasis on obviating the need for acute care services and providing the necessary medical and assistive services in a timely manner, the case management program is expected to change the pattern of expenditures by category of service. Due to the low prevalence of conditions covered by the program, constituting a comparison group for the evaluation posed a major challenge. Employing an innovative methodological approach, a historical comparison group was modeled using statewide Medical Assistance claims files. The study design included a retrospective comparison of Medicaid beneficiaries enrolled in the program with a similar group before the case management program was implemented. The results bear out the anticipated pattern of shifts in cost of care from acute care to nonacute care services.