This report from the Center for Health Care Strategies, Inc. explores six case studies to identify options for decreasing costs and increasing quality in Medicaid's most needy populations. Overall suggestions include integrating care for dual eligibles, integrating behavioral and physical health, and expanding upon fee-for-service case management programs for primary care.

From the report:  

With the passage of health reform, Medicaid is poised to become the nation’s largest insurer — for as much as 25% of the population. But even before the addition of a potential 15-20 million people to Medicaid rolls, the recession and resulting unemployment are testing the limits of the nation’s publicly financed health coverage programs. For the first time in the past decade, Medicaid enrollment rose in every state last year. Enrollment growth averaged 7.5 percent nationally in FY2009, with rates of 10 percent or higher in 13 states and Maryland experiencing the steepest climb of more than 20 percent. On a parallel track, Medicaid spending rose by nearly eight percent — the highest increase in six years.

Full Report: Medicaid Best Buys: Critical Strategies to Focus on High-Need, High-Cost Beneficiaries (PDF | 113 KB) 

Center for Health Care Strategies, Inc. (2011). Medicaid best buys: critical strategies to focus on high-need, high-cost beneficiaries.