What is the Balancing Incentive Program (BIP)?

The Balancing Incentive Program (BIP) was a federal initiative introduced as part of the Affordable Care Act (ACA) in 2010. Its primary goal was to incentivize states to increase the availability of home and community-based services (HCBS) for elderly and disabled individuals, thereby reducing reliance on institutional care, such as nursing homes.

The BIP provided additional federal funding to states that met certain criteria related to expanding their HCBS programs and improving access to long-term services and supports (LTSS) in community settings. States participating in the BIP were required to meet specific benchmarks, such as:

• Enhanced Federal Funding: States received an enhanced federal Medicaid matching rate for certain HCBS expenditures, incentivizing them to invest in community-based care over institutional care.
• State Plan Amendments (SPAs): Participating states were required to submit State Plan Amendments (SPAs) outlining their plans to expand HCBS services and improve access to LTSS.
• No Wrong Door Systems: States were encouraged to establish "No Wrong Door" systems, which provided streamlined access to LTSS for individuals regardless of where they entered the long-term care system.
• Quality Measurement and Improvement: States had to implement measures to monitor and improve the quality of HCBS services provided, ensuring that individuals received high-quality care in community settings.
• Person-Centered Planning: BIP required states to adopt person-centered planning approaches, which emphasized the individual's preferences and goals in determining their care plans.

Aging in Place & Time Limitations

The BIP aimed to promote the principle of "aging in place" and allow individuals to receive care and support services in their homes or communities, whenever feasible and appropriate. By investing in HCBS programs, states sought to improve the quality of life for elderly and disabled individuals while also containing healthcare costs associated with institutional care.

It's important to note that the BIP was a time-limited program, initially scheduled to run through September 2015, with the possibility of extensions. While the BIP formally ended in 2015, many of its principles and initiatives have influenced subsequent efforts to promote HCBS and community-based care for vulnerable populations.

Importance

The Balancing Incentive Program (BIP) holds significance for several reasons, primarily related to its impact on healthcare delivery, quality of life for individuals, and fiscal sustainability:

Promotion of Home and Community-Based Services (HCBS)

• BIP incentivized states to prioritize HCBS over institutional care, aligning with the preference of many individuals to receive care in their homes or communities.