This is the final report of the Balancing Incentive Program evaluation. Five earlier progress reports on the Balancing Incentive Program (BIP) have already been published. 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. Of the 18 states that participated in the Balancing Incentive Program, most met their HCBS spending and infrastructure implementation goals. Even the states that fell somewhat short of spending 50 percent or more of their Medicaid LTSS dollars on home and community-based services succeeded in greatly increasing the percentage of their LTCSS spending going toward HCBS.