Medicaid Home-Based and Community-Based Services Long-Term Care Expenditures: Evaluation of the Balancing Incentive...

Area of Science:

• Health Services Research
• Public Health Policy
• Health Economics

Background:

• The Balancing Incentive Program (BIP) aimed to boost Medicaid home-based and community-based services (HCBS) through financial incentives.
• Quantifying BIP's impact on HCBS spending is crucial for policymakers, providers, and consumers.

Purpose of the Study:

• To provide the first causal estimate of the Balancing Incentive Program's effect on Medicaid home-based and community-based services (HCBS) spending.
• To analyze the timing of BIP implementation across states and its impact on HCBS expenditure.

Main Methods:

• Utilized state-level expenditure data to compare HCBS spending as a percentage of Long-Term Services and Supports (LTSS) spending.
• Employed a synthetic control method, comparing 17 BIP participant states to a weighted average of 17 eligible non-participant states.
• Assessed cumulative changes in HCBS spending percentages in 2013, 2016, and 2019.

Main Results:

• BIP states cumulatively increased HCBS spending as a percentage of LTSS spending by an average of 5.2 percentage points from FY 2013 to 2019.
• The 95% confidence interval for this increase was 0.0 to 9.8 percentage points.
• This growth was observed in comparison to a synthetic control group of non-participant states.

Conclusions:

• The study provides a causal estimate of BIP's impact on HCBS spending in 17 states.
• The observed increase in HCBS spending represents substantial growth compared to previous studies.
• Findings offer valuable insights for state-run programs aiming to expand HCBS access.