Targeting long-term care for the frail elderly: models from the Social/HMO demonstration

This study examined the effect of differing eligibility rules for receipt of long-term care services in the four sites of the Social/HMO National Demonstration Program. Data from the first year of Social/HMO enrollment were used to model the probability of receiving a comprehensive assessment of need for long-term care benefits. Sites using state criteria for Medicaid reimbursement of a nursing home stay were more likely to give assessments to elders with functional impairment problems, whereas those using broader eligibility criteria gave assessments to enrollees with a wider range of characteristics. The results indicate that decisions about eligibility for care have important access and cost implications for consumers, payers, and providers.