Identifying "appropriate" applicants for home and community based services: the MI Choice screening system

This research brief describes an initiative to design and test a screening system for Michigan's home and community based (HCBS) long-term care programs. The core of the system is 32 items from the Minimum Data Set for Home Care (MDS-HC), 1 which can be used as a series of questions asked over the telephone or as part of a complete assessment. The telephone screen is used to direct some individuals immediately to information and referral services, while others, determined to be potentially eligible for supportive services, receive an in-person evaluation that, among other things, suggests the "most appropriate" level of care. Testing of the system found that nearly a quarter of callers seeking long-term care assistance did not require costly in-person assessments. It also found that the MI Choice screening algorithm performed far better than other screening tools in predicting the appropriate level of care, as determined by the expert opinion of "gold standard" care managers. The study was supported by the Robert Wood Johnson Foundation and conducted through a collaboration of the Michigan Department of Community Health, the University of Michigan, and Boston's Hebrew Rehabilitation Center for the Aged.