What were the requirements of the Balancing Incentive Program?

Participating States were required to achieve benchmarks of 50% (States receiving 2% enhanced FMAP) and 25% (States receiving 5% enhanced FMAP) of total Medicaid LTSS expenditures for community LTSS no later than September 30, 2015. 

States also had to complete three structural changes by September 30, 2015:

  • No Wrong Door/Single Entry Point (NWD/SEP) System
  • Core Standardized Assessment Instrument(s)
  • Conflict-Free Case Management

Participating States must use the enhanced FMAP only for purposes of providing new or expanded offerings of community LTSS.

Finally, states could not restrict eligibility for community LTSS more than eligibility standards, methodologies, or procedures in place as of December 31, 2010.  Please reference State Medicaid Director Letter #09-005/ARRA #5 issued on August 19, 2009, for more information on the maintenance of eligibility. States were not eligible for the Balancing Incentive Program if they restricted eligibility for specific populations, even if they were simultaneously increasing access for other populations.  

States submitted Work Plans within six months from the date of application that described in detail the plans for achieving the requirements of the Balancing Incentive Program within the program period.