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Office of Program Policy Analysis and Government Accountability

Several Factors Can Delay Eligibility Determination for Medicaid Long-Term Care, Report No. 07-12, February 2007
 
Full report in PDF format


  • Although the Comprehensive Assessment and Review for Long-Term Care Services (CARES) Program fulfills many functions, its primary function is to conduct medical eligibility determination for Medicaid nursing home care or other long-term care services.  The CARES Program is also responsible for assisting elders who apply for the Nursing Home Diversion Program.
  • Delays in receiving physician forms, regional workload issues, and client unavailability can lengthen the time it takes the CARES Program to determine medical eligibility for long-term care services.  To a large extent these factors remain outside the program’s control.  Delays in receiving physician forms, the financial eligibility determination process, and the Medicaid managed care payment system contribute most to the time that elapses before an individual can be enrolled in the Nursing Home Diversion Program.
  • Current state initiatives may help address these delays.  The Legislature and agencies could consider other options, such as improving inter-agency electronic communication or reducing the CARES Program’s workload, but each of these options has potential barriers to implementation.

Which Government Program Summaries contain related information?

ACCESS Florida
Nursing Home Pre-Admission Screening (CARES)
Department of Elder Affairs

What other OPPAGA-related materials are available?

  • Report No. 09-15 Transition to Aging Resource Centers Complete; Enhancement of Elder Service System Continues,published in March 2009.
  • Report No. 06-45 The Nursing Home Diversion Program Has Successfully Delayed Nursing Home Entry, published in May 2006.
  • Report No. 06-10 Service Use for Nursing Home Diversion Waiver Clients Depends on Living Situation, published in February 2006.
  • Report No. 03-69 Progress Report: Services to Elders Program Has Improved Accountability and Oversight; Should Reduce Capitation Rate for Long-Term Care Pilot, published in December 2003.
  • Report No. 01-66 Justification Review: Services to Elders Program, Department of Elder Affairs, published in December 2001.

Copies of this report in print or alternate accessible format may be obtained by telephone (850/488-0021), by FAX (850/487-9213), in person, or by mail (OPPAGA Report Production, Claude Pepper Building, Room 312, 111 W. Madison St., Tallahassee, FL 32399-1475).
e-mail address: oppaga@oppaga.fl.gov


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