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Glossary

Level-of-care form

The physician-signed instrument a state uses to determine that a Medicaid waiver applicant meets the nursing facility level of care: Georgia's Form 5588, Florida's 3008, Pennsylvania's MA 570, Michigan's LOCD and their counterparts. It needs clinical documentation behind it and reaches a state validator on a clock.

Also level of care assessment, physician certification form, Form 5588, Form 3008, MA 570, LOCD

Every state that runs a Medicaid waiver for older adults and adults with disabilities has one of these, under its own name. Georgia’s is Form 5588, validated by Alliant. Florida’s is the 3008, reviewed by CARES. Pennsylvania’s is the MA 570, routed through the enrollment broker and the independent assessment entity. Michigan runs the Level of Care Determination online. North Carolina has the FL-2, Illinois the DON, Wisconsin the LTCFS, New York the PRI and SCREEN, Louisiana the 90-L, Texas the MN/LOC through TMHP. Indiana’s assessor has been Maximus since July 2025. The instruments differ in their scoring and agree in their structure: a physician attests to the applicant’s diagnoses, hospitalizations, medications and functional status, and the state’s assessor confirms the functional half.

Two facts about the form decide how long an application takes.

It is a clinical summary the physician is asked to write from records they may not have. The primary care physician signing a Georgia 5588 for a patient who was admitted twice this year and sees a neurologist is attesting to what the hospital and the neurologist found. If their own chart does not hold it, the form waits. Pennsylvania’s enrollment broker guide puts the whole process at “between two weeks and two months, mostly driven by how quickly the doctor returns the form”. Montana’s guidance says “the only reason for delay is that medical providers often do not quickly respond to requests for medical records”.

It runs on a clock that is not the 45-day one. The 45 days most people quote is the Medicaid financial eligibility standard in 42 CFR 435.912, and it governs the income and asset determination, not this one. The level-of-care clocks are the state’s: thirty days in Wisconsin, sixty from the records request in Iowa, ten in Tennessee, eleven to a result in Indiana. A request for information from the reviewer is shorter still, and an unanswered one closes the application.

The form is the state’s. The records behind it are the outside records the applicant’s providers hold, and getting them to the physician before the form does is what shortens the process. Nursing facility level of care is the threshold the form proves; the Medicaid waiver case management agency is who carries it.

Where it is defined

Vivlio for case managementThe physician's documentation behind the level-of-care form, retrieved before the state's clock runs out.

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