State programs
Level of care assessment
A level of care assessment is an evaluation that decides whether a person needs the level of care that a nursing facility provides. Medicaid waiver programs require it. The person must show a need that meets the state's institutional criteria. Each state sets its own tool and rules.
Why it matters for your family
The assessment looks at what help a person needs, such as bathing, dressing, eating, and moving, and often at memory and safety. A nurse or social worker usually does it, sometimes in the home. In Michigan, waiver agencies run the evaluation and the state gives the final decision. A common mistake is to hide problems. Describe a typical bad day, not the best one. Have a family member present. The person may still receive services at home. Passing the test does not mean moving to a facility. Ask for a copy of the result, and ask how to appeal if the person is denied.
Source: medicaid.gov
Related terms
- Home and community-based services (HCBS) waiverA home and community-based services (HCBS) waiver is a Medicaid program that pays for care at home or in the community instead of in a nursing home.
- Medicaid eligibilityMedicaid eligibility for long-term care depends on need, income, and assets.
- Care assessmentA care assessment is a review of a person's health, abilities, home and support to decide what help they need.
- Needs assessmentA needs assessment is a structured review of what help a person needs and what support they already have.
- MI Choice WaiverThe MI Choice Waiver is Michigan's Medicaid home and community-based services waiver for adults age 65 or older and adults 18 or older with a disability.
- STAR+PLUS Home and Community Based Services (HCBS) programThe STAR+PLUS Home and Community Based Services program is a Texas Medicaid waiver for adults who would otherwise need a nursing facility.
