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Case Studies of Balancing Incentive Program Implementation Process

Publication Date

The Affordable Care Act included several provisions designed to increase the provision of Medicaid home and community-based services (HCBS) and to improve the infrastructure for provision of those services. States that were, in 2009, spending less than 50% of total Medicaid long-term services and supports (LTSS) expenditures on HCBS were eligible to participate in the Balancing Incentive Program. Participating states receive an enhanced federal match rate for HCBS services. The rate of the enhanced federal match and the targeted rate of HCBS expenditures are dependent on the baseline spending of the state.

In exchange for the enhanced federal match rate, participating states are required to accomplish four goals: increase the percentage of total Medicaid LTSS dollars expended for HCBS to target goals; create an no wrong door/single entry point for people seeking LTSS; develop a core standardized assessment that can be used with all populations; and ensure a conflict-free case management process. This report describes findings from case studies in two states, which describe some of the challenges faced and strategies used to address these requirements. This report serves as a companion document to a process evaluation, which documents approaches to the required goals used in all of the participating states.