Descriptive Overview and Summary of Balancing Incentive Program Participating States at Baseline

The Balancing Incentive Program is one of several provisions included in the 2009 Affordable Care Act designed to increase the provision of Medicaid home and community-based services (HCBS) and to improve the infrastructure for the provision of HCBS. Eligible states that applied and were approved as meeting the eligibility criteria receive enhanced federal financial participation for HCBS expenditures. The rate of the enhanced federal match and the target rate of HCBS expenditures that states must meet are dependent on the state's 2009 spending on HCBS as a percentage of all Medicaid long-term services and supports (LTSS) spending. States are also required to achieve three infrastructure goals: creation of a no wrong door/single entry point system of application for LTSS, implementation of a core standardized assessment, and establishment of a conflict-free case management system. This report on the baseline status of the 21 Balancing Incentives Program participating states is the first deliverable in an evaluation that focuses primarily on the actions states took to attain the required program goals and the challenges they faced.