Evaluating the Affordable Care Act's Long-Term Services and Supports Rebalancing Programs

Area of Science:

• Health Services Research
• Health Policy
• Public Health

Background:

• Long-Term Supports and Services (LTSS) are increasingly shifting towards community-based settings.
• The Balancing Incentive Program (BIP) and Community First Choice (CFC) were federal initiatives aimed at supporting this rebalancing.
• Understanding the workforce implications of these programs is crucial for effective policy implementation.

Purpose of the Study:

• To evaluate the impact of BIP and CFC on the size and composition of the LTSS workforce.
• To determine if BIP's performance targets influenced its effectiveness in expanding the community-based LTSS workforce.

Main Methods:

• A stacked difference-in-difference design was employed to analyze the impact of BIP and CFC.
• Data from the American Community Survey (2005-2021) on workforce and population demographics were utilized.
• The study examined changes in the total, community, and institutional LTSS workforces per 1000 persons aged 65+.

Main Results:

• BIP significantly increased the home and community-based services (HCBS) workforce by 13.24% in participating states.
• The positive impact of BIP on the HCBS workforce was more pronounced in states with performance targets.
• Neither BIP nor CFC demonstrated a statistically significant effect on the institutional LTSS workforce size.

Conclusions:

• Tying federal funding for HCBS to measurable performance targets incentivizes states to expand community-based services.
• Policymakers should consider performance-based incentives to drive further growth in the HCBS sector.
• The findings suggest that strategic policy design can enhance the effectiveness of federal programs aimed at rebalancing LTSS.