The Department of Health and Human Services Division of Long Term Care (Community Long Term Care, (CLTC) offers a variety of programs for individuals that are Medicaid eligible, require assistance with their care and choose either home-based or nursing home care. The most cost-effective programs include the Community Choices Program, HlV/AlDS Program, and the Mechanical Ventilator Dependent Program. Each program requires an initial nurse consultant assessment and medical level of care determination for the applicant to receive home-based services, or nursing home care under Medicaid sponsorship when other pay sources have been exhausted. This paper examines the nurse consultant's role in the process.