The Balancing Incentive Program (BIP)

Expanding Home and Community-Based Long-Term Services and Supports

One of the least known but very positive parts of the Affordable Care Act is the creation of the Balancing Incentive Program (BIP). The BIP authorizes monetary grants to individual states with a goal of increasing access to non-institutional long-term services and supports (LTSS). BIP increases the Federal Matching Assistance Percentage (FMAP) to states that make structural reforms to increase nursing home diversions and access to non-institutional LTSS. The BIP is intended to transform long-term care programs by improving performance, creating tools that help improve care planning and oversight.

As a requirement, BIP states must implement structural changes and provide new or expanded home and community-based LTSS. As of today, there are 18 states with active BIP projects. Those states are: Arkansas, Connecticut, Georgia, Iowa, Kentucky, Maryland, Mississippi, Missouri, New Hampshire, New Jersey, New York, Texas, Illinois, Maine, Ohio, Nevada, Massachusetts and Pennsylvania. Nebraska, Indiana and Louisiana were approved for BIP, but are no longer participating in the program.Balancing Incentive Program website.

For illustration purposes, I will focus attention on what New York State (NYS) is doing with BIP efforts. NYS has taken a multidisciplinary, multidimensional approach to the implementation of BIP which includes rebalancing the delivery of LTSS, promoting enhanced consumer choice, streamlining eligibility processes, improving access to and expanding community LTSS, and providing essential services in the least restrictive setting. These efforts will be supported by the three core principles put forth in the Balancing Incentive Program: No Wrong Door/Single Entry Point System, Core Standardized Assessment Instruments, and Conflict-Free Case Management Services.

For example, the NYS Office for People With Developmental Disabilities (OPWDD) has placed emphasis on employment, self-directed care, community skill development for successful transition to independent housing, and system improvements. The outcomes of these initiatives will include new employment opportunities that will expand skills, provide training, increase employment opportunities, and provide supports in manners which will most benefit individuals. In addition, day habilitation settings will be transformed into active skills and training centers to help individuals experience an even greater level of success within the community. The NYS Office of Mental Health (OMH) has used their BIP grant opportunities to continue its focus on recovery-based services and improving the service arrays that are available in both Personalized Recovery Oriented Services (PROS) and residential programs.

The team at Foothold Technology is very proud of our clients who have stepped forward and are leading the way with Balancing Incentive Program grants of their own. We are especially proud to be participating in our own BIP grant through our partnership with the New York State Rehabilitation Association (NYSRA) and others that assist community rehabilitation organizations to create the culture and operational expertise needed to transform and build new business models that will provide competitive, integrated employment opportunities for persons with intellectual and developmental disabilities. In the upcoming months we will keep you up to date on how our project is moving forward. If you are in one of the states that has BIP grants available, we encourage you to take a look at the innovations being created in your state and consider stepping forward with a grant opportunity of your own.