Nursing home placement (NHP) is costly, and the majority of older adults prefer to remain living in the community. The purpose of this research was to examine NHP among a cohort of participants in a home and community-based waiver program during 2002 to 2007 to develop a risk model for predicting who may transition to a nursing home. Methods: This longitudinal study was conducted on data from the minimum data set-home for care linked with medicaid claim files and death certificates. The sample included 6525 participants who had two assessments and survived through 2007 or had NHP. A risk index was developed to identify participants who had NHP. Results: Using the risk index, the probability of NHP was 50%, with sensitivity of 0.4 and specificity of 0.9. Forty percent of participants who had NHP were correctly identified. Conclusion: This NHP risk index may inform waiver agency personnel as to when participants may need more intense interventions, and consequently provide additional care to delay or prevent NHP when possible