Adviser LeadingAge New York Summer 2015 July 2015 | Page 32

The Balancing Incentive Program Brings New Life to
Community-Based Long Term Care Services and Supports

New York’s

implementation of the Balancing
Incentive Program has created exciting
opportunities for providers of home- and community-based services
and the clients they serve. Established under the federal Affordable
Care Act, the Balancing Incentive Program (BIP) provides a financial
incentive for states to provide greater access to community-based,
long term services and supports (LTSS). The BIP requires participating
states to implement three major structural reforms: (i) a no wrong
door/single point of entry process for eligibility determinations; (ii)
a core standardized assessment for determining eligibility for noninstitutional LTSS, and (iii) a Conflict-Free Case Management system
(CFCM). By the end of the grant period, each participating state must
achieve a specified Medicaid spending target for community-based
LTSS.
New York State has been awarded nearly $600 million over three
years[1] in enhanced federal Medicaid matching funds to implement
the BIP. Under the grant, it is required to spend at least 50 percent
of its Medicaid long term care dollars on community-based LTSS by
the time the grant ends. Of the $600 million awarded, the State has
made available $47 million in BIP Innovation Fund grants to providers
of community-based LTSS to accomplish the following goals:
• Increase the number of individuals served in a non-institutional
setting;
• Improve access to community-based LTSS;
• Ensure stakeholders are engaged in creating lasting solutions; and
• Create innovative approaches to assisting individuals to transition
from institutional settings to the community or to remain in their
communities.
Fifty-four organizations statewide, including 15 LeadingAge New
York and Adult Day Health Care Council members, were awarded
BIP Innovation Fund grants. The seven members featured in this
article are engaged in a variety of activities all designed to either help
individuals transition from an institutional setting or remain in the
community in spite of requiring long term care or services

[1]
The federal grant is scheduled to expire on September 30, 2015 and all federal funds are to be
expended by that time. However, CMS recently announced a process by which states may request
an extension of time to spend their awards and accomplish their deliverables.

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Adviser a publication of LeadingAge New York | Summer 2015