State Variations and Trends in Preadmission Screening Programs

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Abstract
Nursing home costs have increased dramatically and comprise a large share of state Medicaid budgets. To control the use of nursing home beds, state policymakers have established preadmission screening programs to assess apphcants' functional, psychological, and medical status to determine whether they are in need of nursing home care. States are becoming increasingly stringent in their screening and are linking their preadmission screening programs to community-based alternatives funded by Medicaid waiver, state general funds, or both. States vary greatly in their specific program characteristics. These variations include: geographic basis (statewide/local), population screened (Medicaid/private pay), client origin (hospital/commu nity), whether decisions are binding, timing of screen (prior to/after admission), and who does the assessment (state staff/contract agency/provider). Descriptive data on these and other features of state preadmission screening programs from 1978 to 1992 are presented.