Using data from a two-month observation of referrals (N=320) to state hospitals and private facilities from five prescreening sites in Massachusetts, the authors discuss a number of factors predictive of referral destination. Overall, the probability of referral to a state hospital was approximately 60% greater than to a privately owned facility. Patients who were married, non-threatening to self or others, and privately insured were more likely to be referred to private settings. In addition, a significant positive effect of regional private bed supply was identified.