This study examines whether use of primary, preventive, or emergency care changed as primary care case management (PCCM) programs for children were implemented in Alabama and Georgia. Using claims data we track the same children over time, and control for geographic availability of Medicaid providers, which also changed over this period. A decline in use of all three types of care was found to be associated with PCCM implementation, with use of primary and preventive care falling below national averages and recommended use rates. Family difficulties in shifting to exclusive use of unfamiliar providers is the primary reason for the decline in use rates.