In the United States, Medicaid is the primary source of funding for many services on which individuals with intellectual and developmental disabilities depend. Case management, one such service, links individuals with intellectual and developmental disabilities to community-based speech and language therapy, adaptive technology, medical care, and other support services. Case management can facilitate navigation in a complex system of care. State and federal concerns about the rising cost of Medicaid and case management have led to changes in payment methodologies. This analysis of one state's case management expenditure during 2007 and 2008 found payment changes were associated with a decrease in the average annual cost per person. Comparing these two years, the largest decrease in cost was found among children and youth, those individuals with less severe disabilities, and persons from ethnic/racial minorities. As such changes could delay early intervention, over time, they could have a negative effect on both cost and outcomes. While this is a case study of a single service in a large urban area of one state, the results may apply to other health and human services and to other locales where fee-for-service arrangements are used.