Preliminary Process Evaluation of the Balancing Incentive Program

Twenty-one states applied and were approved to participate in the Balancing Incentive Program enacted in the 2010 Affordable Care Act which offered enhanced Federal Financial Participation to states that were eligible for the program because their FY 2009 Medicaid spending on home and community-based services (HCBS) was less than 50% of their total Medicaid spending on long-term services and supports (LTSS). The preliminary process evaluation reports on state progress through September 2014 in meeting mandatory infrastructure development goals, the strategies that states adopted to increase their share of Medicaid LTSS spending going toward HCBS, and state efforts to involve consumers and other stakeholders in their planning for how to achieve program goals prior to the Balancing Incentive Program end date of September 30, 2015. Two states were excluded from the analysis because they had joined the program shortly before the application end date and had not yet submitted any quarterly reports. The two case studies, in Iowa and Ohio, examine in greater detail the strategies states adopted and the challenges they faced in striving to meet the Balancing Incentive Program's legislative mandated goals and additional, voluntary state-specific objectives.