An assessment of Maryland Medicaid's Rare and Expensive Case Management Program.

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.

Medical malpractice claims filed by Medicaid and non-Medicaid recipients in Maryland.

Several databases available in Maryland are used to investigate whether Medicaid recipients are more likely than other persons to engage in medical malpractice litigation. All malpractice claims filed during 1985 and 1986 (N = 1037) were updated for outcomes through 1989 and described with regard to the payer status of claimants. The proportion of claims filed by persons enrolled in Medicaid before and/or during the alleged malpractice incident was lower than the proportion of state residents enrolled in Medicaid. In addition, the proportion of obstetric claims filed by Medicaid recipients was identical to their proportion of hospital discharges for obstetric services during the period in which the incidents occurred.