Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Level of Care Criteria

12/01/2003

To determine eligibility for both nursing home care and waiver services, applicants must be assessed through the Comprehensive Assessment and Review for Long Term Care Services (CARES) program administered by the Department of Elder Affairs. To be eligible, individuals must meet one of the following criteria:

  • Require assistance with four or more activities of daily living (ADLs) or three ADLs plus assistance with medication administration; OR

  • Require total help with one or more ADLs; OR

  • Have a diagnosis of Alzheimer's Disease or another type of dementia and require assistance with two or more ADLs.

CARES will periodically perform assessments on nursing facility residents to ascertain that they continue to meet the eligibility criteria, and to assess their potential for returning to the community. Private pay individuals may be assessed at their request at no charge. The goal of CARES is to place the applicant in the least restrictive, most appropriate setting with a preference for community placement whenever possible.

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