The Romney administration will take a major step next month to reduce the state's overreliance on nursing homes, offering 118,000 low-income senior citizens the chance to enroll in a new managed care program that emphasizes primary and preventive health care and extensive services in the home.

The administration says it hopes to eventually save millions of dollars in the soaring Medicaid budget by keeping seniors healthy and out of hospitals and nursing homes. The program aims to better coordinate fragmented medical, psychiatric, and social services offered to low-income seniors covered by both Medicaid and Medicare. But the state's selection of two for-profit companies to help run it, and the checkered history of (Medicare) managed care, leaves some advocates concerned that seniors might be denied needed care.

"It provides one-stop shopping," said David P. Stevens, executive director of the Massachusetts Councils on Aging. " If the program is working correctly, the client will be afforded all the services they're eligible for without having to hunt for them. But the program should be viewed as an experiment. When there's a profit motive involved, clients may come out on the short end."

The voluntary program, called Senior Care Options, includes requirements that state officials say will ensure seniors get the care they need. A doctor, nurse, and geriatric social worker will evaluate each new patient and write a care plan that will be implemented only if seniors and their family caregivers approve.

Then the treatment team will assemble the services, drawing on programs now separately funded by Medicare, Medicaid, and the state Executive Office of Elder Affairs. Patients will be free to quit the program at any time and return to traditional Medicaid and Medicare.

Massachusetts is one of only several states to try combining the programs. To help attract seniors in the first year, Senior Care Options will cover services the state recently cut from Medicaid, including chiropractic care, dentures, eyeglasses, and hearing aids. It also will waive Medicaid copayments for prescription drugs.

The administration is pressing the plan because nearly 6 percent of Massachusetts residents older than 65 live in nursing homes, compared with just over 4 percent nationally.

After soliciting bids, the state selected three agencies to run the program - Commonwealth Care Alliance, a Boston nonprofit organization founded by advocates and by doctors; Senior Whole Health, a Boston for-profit organization founded by executives formerly associated with Neighborhood Health Plan; and Evercare, a division of for-profit UnitedHealth Group of Minnesota that provides elder care services in other states. Each is enrolling doctors, clinics, hospitals, and nursing homes. Seniors may sign up with any one of the agencies, beginning in March, and would be required to stay within that agency's network of providers for the most part. Seniors would be responsible for no premiums, copayments, or deductibles.

-Adapted from The Boston Globe, Author: Alice Dembner, Globe Staff, Date: 02/15/2004