Final Process Evaluation of the Balancing Incentive Program

This is a follow-up to three earlier evaluation reports on the Balancing Incentive Program. The Balancing Incentive Program, legislated in the 2010 Affordable Care Act (ACA), 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 3 states withdrew prior to the end date of the Balancing Incentive Program. Participating states had to commit to achieving 4 program goals and file quarterly progress reports. First, states had to commit to reaching or exceeding a benchmark for spending on HCBS (50% of all Medicaid LTSS expenditures for all but 1 state, which was required to meet a benchmark of at least 25% spending on HCBS). The remaining 3 goals concerned development and implementation of administrative infrastructure: a no wrong door/single entry point information and referral system, a standardized needs assessment, and conflict-free case management. Participating states could also set voluntary state-specific goals and use Balancing Incentive Program funding not needed to achieve the mandatory goals to meet their voluntary goals. The preliminary process evaluation report described the strategies participating states used to achieve program goals from each state's start date through September 30, 2015. This final process evaluation report updates information on the strategies states used to meet Balancing Incentive Program goals through September 30, 2015 (the end date of the Balancing Incentive Program).