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Preliminary Outcome Evaluation of the Balancing Incentive Program

Publication Date

This is a follow-up to four earlier evaluation reports on the Balancing Incentive Program (BIP). The BIP, legislated in the 2010 Affordable Care Act, offered states temporary enhanced federal financial participation for Medicaid home and community-based services (HCBS). Participation was limited to states that, as of 2009, were allocating less than 50% of Medicaid spending on long-term services and supports (LTSS) toward HCBS. Twenty-one states applied and were approved to participate, although three states withdrew prior to the end date of the BIP. Participating states had to commit to achieving four program goals and file quarterly reports on progress toward these goals. First, states had to commit to reaching or exceeding a benchmark for spending on HCBS (50% of all Medicaid LTSS expenditures for all but one state, which was required to meet a benchmark of at least 25% spending on HCBS). The remaining three goals concerned development and implementation of administrative infrastructure: a no wrong door/single entry point (NWD/SEP) information and referral system, a standardized needs assessment, and conflict-free case management (CFCM). Participating states could also set voluntary state-specific goals and use BIP funding not needed to achieve the mandatory goals to meet their voluntary goals. This preliminary outcomes evaluation report indicates the extent to which participating states had completed or partially implemented the BIP's required infrastructure goals as well as states' own voluntary goals through September 30, 2015 (the end date of the BIP). Also reported are the percentages of LTSS spending allocated to HCBS compared to institutional care in BIP participating and non-participating states through September 30, 2014. When 2015 expenditure figures become available, a final outcomes report will be published. [33 PDF pages]