OBJECTIVES: To determine the impact of MTM services on healthcare utilization and total healthcare expenditures.  METHODS: A comprehensive community-based pharmacist-led MTM program was initiated among Texas Medicaid patients aged 18-64 years with chronic hypertension, having at least 4 maintenance medications and who were continuously enrolled one year pre- and post-index (date of first MTM encounter).  MTM data from participating pharmacies and Texas Medicaid medical and prescription claims were extracted from 4/28/2011-9/10/2014. Healthcare utilization and total expenditures were evaluated for a period of one-year pre- and post-index date. The primary outcomes were number of and expenditures on: inpatient and outpatient claims (e.g., physician visits, outpatient procedures, laboratory tests) and prescriptions. Bivariate paired analyses were employed to compare outcome variables pre- and post-MTM program implementation.      RESULTS: Although 141 patients received MTM services, 81 met the inclusion criteria. Patients were 50.2±9.3 years old with the majority (83.9%) having between 1 and 4 MTM encounters in the one-year post-period.  From pre- to post-, the proportion of inpatient claims decreased by 28.2% (from 30.9% to 22.2%; p=0.26), but not significantly. The mean number of outpatient and prescription claims decreased significantly: by 30.1% [82.62(±62.15) to 57.65(±48.82); (p<0.0001)]; and by 13.5% [88.86(±66.49) to 76.89(±67.66); (p=0.043)], respectively. Total expenditures decreased significantly pre- to post by 31.4% from $27,543.15 (±$25,442.98) to $18,888.96 (±$21,429.53); (p<0.0001).  CONCLUSIONS: The Texas MTM pilot program demonstrated favorable economic outcomes. Total expenditures for patients with hypertension decreased significantly after MTM exposure. Although there were reduction in expenditures on inpatient, outpatient and prescription claims, provision of MTM services to Medicaid recipients may have the biggest impact on inpatient and outpatient healthcare utilization.