OBJECTIVES: Healthcare resource utilization and costs were evaluated for patients diagnosed with multiple sclerosis (MS) in the U.S. Medicaid program.  METHODS: Patients diagnosed with MS (International Classification of Disease, 9^thRevision, Clinical Modification [ICD-9-CM] diagnosis code 340) were identified using Medicaid data from 01JAN2008 through 31DEC2010. The initial diagnosis date was designated as the index date. Patients of the same age, race, and gender but without an MS diagnosis were identified and matched as the comparison cohort, with a randomly chosen index date to minimize selection bias. Patients in both groups were required to be at least age 18 years, and have continuous medical and pharmacy benefits 1 year before and 1 year post-index date. One-to-one propensity score matching (PSM) was used to compare health care costs and utilizations during the follow-up period, between the diseased and the comparison cohorts, and adjusted for baseline demographic and clinical characteristics.  RESULTS: After risk adjustment by PSM, a total of 14,179 patients in each cohort were matched. Significantly more MS patients had inpatient admissions (23.75% vs. 10.87%, p<0.0001) and long-term care (22.64% vs. 4.13%, p<0.0001), other service (99.70% vs. 89.00%, p<0.0001) and pharmacy visits (73.08% vs. 67.71%, p<0.0001) compared to those without an MS diagnosis. Higher health care utilization by MS patients led to significantly higher inpatient ($1,688 vs. $725, p<0.0001), long-term care ($14,189 vs. $2,778, p<0.0001), other service visit ($22,981 vs. $9,977, p<0.0001) and pharmacy costs ($5,284 vs. $1,785, p<0.0001) compared to those without MS.  CONCLUSIONS: Compared to patients in the comparator cohort, MS patients in the Medicaid program incurred substantially higher healthcare resource utilization and costs.