Table of Contents
Title Page
Acknowledgements

Executive Summary	i
I.  Introduction and Purpose	I-1
Measuring program performance	I-2
Planning and designing the evaluation	I-3
Organization of the Evaluation	I-6
II.  HealthChoice Background, Program Description and Demographic Changes	II-1
Background	II-1
Program description	II-5
MCO Responsibilities & Reimbursement	II-8
Plan Transitions	II-13
Demographic changes	II-20
III.  Medical Home and Prevention-Oriented care	III-1
Length of eligibility and enrollment	III-2
Service utilization - General	III-5
Emergency Room Utilization	III-17
Utilization by Coverage Category	III-21
Subpopulation Analysis - Children with Special Health Care Needs	III-27
Subpopulation Analysis - Individuals with Chronic Illness	III-49
Subpopulation Analysis - Individuals with HIV/AIDS	III-55
Subpopulation Analysis - Pregnant Women	III-59
Subpopulation Analysis - Other	III-63
Utilization of Specific Services	III-69
Public Perception	III-95
IV.  Build on the Strengths of Maryland’s Health Care Delivery System	IV-1
Provider network adequacy	IV-2
Physician reimbursement and Medicaid fee-for-service participation	IV-8
Graduate Medical Education	IV-14
Federally Qualified Health Centers	IV-16
Local Health Departments	IV-19
Historic provider protections	IV-23
V.  Value and Predictability	V-1
Compliance with Federal regulations	V-2
Adequacy of Program funding	V-5
Stability of financial platform	V-8
Budget predictability	V-10
Risk adjustment’s contribution to value	V-11
Administrative costs	V-14
Overall Conclusions	V-18
VI.  Hold MCOs accountable	VI-1
Annual Quality of Care Audit	VI-2
MCO Encounter Data	VI-7
Prompt pay	VI-11
Compliant and Grievance	VI-13
Workgroups and Committees	VI-15
VII.  Summary and recommendations	VII-1
Appendix 1 – Background
Appendix 2 – Comparison to other states
Index of Charts