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Journal of Applied Gerontology
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Targeting Long-Term Care for the Frail Elderly: Models From the Social/HMO Demonstration

Margaret MacAdam

Brandeis University

Jay Greenberg

The Long-Term Care Group

Merwyn Greenlick

Kaiser Foundation Hospitals and Kaiser Permanente Center for Health Research

Leonard Gruenberg

The Long-Term Care Data Institute

Joelyn Malone

United Health Care Corporation

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 assess ment 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.

Journal of Applied Gerontology, Vol. 10, No. 4, 389-405 (1991)
DOI: 10.1177/073346489101000402
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C. A. Green, J. Capitman, and W. Leutz
Expanded Care and Quality of Life Among Elderly Social HMO Members
Journal of Applied Gerontology, September 1, 2002; 21(3): 333 - 351.
[Abstract] [PDF]