Book Examined the process of service allocation in publicly funded home and community-based long term care programs in Indiana, Michigan, Ohio, and Wisconsin. Results indicate that care managers have no flexibility in determining financial eligibility, but most respondents stated that care managers use some measure of professional judgment, discretion, or flexibility in making functional eligibility determinations. Care managers have much flexibility in developing individualized care plans. In general, there are no formal rules that determine which services an individual will receive.
All programs attempt to address unmet needs by building on existing informal care.
All four states limit spending on home and community-based long term care services. The states also vary in the manner in which they meet the Medicaid requirement that the clients be given a choice of providers, from requiring that a client choose a provider from an approved agency to allowing the client to choose a provider who is a relative or friend. Resource constraints in program funding and availability of service providers are a major factor in care managers' ability to arrange for services. References are included, and appendixes contain the survey instrument, a description of the individuals interviewed, a description of the state programs, and a case management prescreening instrument. All rights reserverd.