Purpose: The purpose of this study was to compare the effectiveness of case management in elderly medicaid beneficiaries according to geographic location. Methods: Data were collected from 23,633 elderly medicaid beneficiaries assigned from over users of medicaid. We used the need assessment tool developed by the government, which consists of 19 items with four subscales. Results: Among elderly medicaid beneficiaries, statistically significant differences in effectiveness of case management were observed for quality of life, self-care competency, medical care utility, and support system. Differences in case management effectiveness were higher in urban areas than in metropolitan or rural areas. Conclusion: The differentiated and tailored intervention model based on characteristics of participants, resource distribution, and geographic location may be needed for effective case management for elderly medicaid beneficiaries.