The State of Virginia has had a statewide nursing home preadmission screening program since 1977 and has made efforts to ensure appropriate placement of individuals in long term care settings. In a major effort to divert certain individuals from institutionalization, a personal care option has been provided. Using data from the Preadmission Screening Program, a study was conducted to examine cases from intermediate care (N=133), skilled care (N=1,088), and community-based care (N=1,390). The results of tabular and logistic regression analyses were used to discuss explanatory models for recommended care settings in an elderly Medicaid population. Significant explanatory variables for recommendations in an institutional setting were consistent with a need for long term supervision and care. Intermediate care recommendations were more often associated with individuals who were not mentally competent or had no one to provide informal support while skilled care individuals generally had specific nursing needs (dressings, decubitis ulcers, medication administration) and increased mobility restrictions while receiving rehabilitative care and services. (Data tables and references are included.) (Author/NB)