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.
MacAdam
M
M
Bigel Institute for Health Policy, Brandeis University, Waltham, MA.
Greenberg
J
J
Greenlick
M
M
Gruenberg
L
L
Malone
J
J
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003625:Data Collection; D004608:Eligibility Determination / Q000706:statistics & numerical data*; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D006279:Health Maintenance Organizations / Q000458:organization & administration*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006302:Health Services Research; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008134:Long-Term Care / Q000458:organization & administration*; D008297:Male; D015999:Multivariate Analysis; D010865:Pilot Projects; D015397:Program Evaluation; D012959:Socioeconomic Factors; D014481:United States