Office of Program Policy Analysis and Government Accountability
Office of Program Policy Analysis and Government Accountability

Several Factors Can Delay Eligibility Determination for Medicaid Long-Term Care

Report 07-12, February 2007




Report Summary

  • 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.


Related Reports
  1. Transition to Aging Resource Centers Complete; Enhancement of Elder Service System Continues
    Report 09-15 March 2009
  2. OPPAGA Report: The Nursing Home Diversion Program Has Successfully Delayed Nursing Home Entry
    Report 06-45 May 2006
  3. Service Use for Nursing Home Diversion Waiver Clients Depends on Living Situation
    Report 06-10 February 2006
  4. Progress Report: Services to Elders Program Has Improved Accountability and Oversight; Should Reduce Capitation Rate for Long-Term Care Pilot
    Report 03-69 December 2003
Copies of this report in print or alternate accessible format may be obtained by email OPPAGA@oppaga.fl.gov, telephone (850) 488-0021, or mail 111 W. Madison St., Room 312 Tallahassee, FL 32399-1475.
Copies of this report in print or alternate accessible format may be obtained by email OPPAGA@oppaga.fl.gov, telephone (850) 488-0021, or mail 111 W. Madison St., Room 312 Tallahassee, FL 32399-1475.
social services, health, nursing homes, home and community-based services, Medicaid, Medicaid waivers, diversion, nursing homes, nursing home diversion, long-term care, CARES, assessment, medical eligibility, financial eligibility , home and community-based care, elder affairs, medicaid waivers, aged and disabled, Long-Term Care, Nursing Home, Diversion, Elder Affairs, Home and Community Based Services, Medicaid Waiver, Assisted Living