State Balancing Incentive Payments Program (§10202 of HR 3590, The Patient Protection and Affordable Care Act)

Goals Expand community options to align resources with consumer preferences. Expand community options to align resources with consumer preferences. Alternative approach to Money Follows the Person. Alternative approach to Money Follows the Person. Replicate success of WA, OR by focusing on diversion. Replicate success of WA, OR by focusing on diversion. Complement non-Medicaid solutions like CLASS Act. Complement non-Medicaid solutions like CLASS Act.

SNF Utilization in Washington

State Balancing Incentives Payments Program Grant program. Grant program. Added federal $$ in the form of higher FMAP. Added federal $$ in the form of higher FMAP. 5 pct pt FMAP bump if less than 25% of Medicaid LTC spending is on HCBS. 5 pct pt FMAP bump if less than 25% of Medicaid LTC spending is on HCBS. 2 pct pt FMAP bump if Medicaid LTC spending on HCBS is less than 50% but more than 25%. 2 pct pt FMAP bump if Medicaid LTC spending on HCBS is less than 50% but more than 25%. Higher FMAP covers all HCBS for five years. Higher FMAP covers all HCBS for five years.

State Structural Changes Required Within 6 months, states must adopt: Within 6 months, states must adopt: Single Entry Point. Single Entry Point. Conflict free case management. Conflict free case management. Standardized assessment instrument. Standardized assessment instrument. State must submit plan to CMS. State must submit plan to CMS. Proposed budget that outlines new/expanded HCBS. Proposed budget that outlines new/expanded HCBS.

More Details Federal spending limited to $3 billion over 5 years. Federal spending limited to $3 billion over 5 years. MOE language that prevents changes in eligibility. MOE language that prevents changes in eligibility. Targets: Targets: - If in tier 1, should reach 25% by FY If in tier 1, should reach 25% by FY If in tier 2, should reach 50% by FY If in tier 2, should reach 50% by FY2016.

Implementation Steps Lead office likely to be CMS/CMSO/ Disabled and Elderly Health Programs Group. Lead office likely to be CMS/CMSO/ Disabled and Elderly Health Programs Group. Regulations to address: Regulations to address: Consequences if states fail to hit targets. Consequences if states fail to hit targets. Preference for consumer-direction. Preference for consumer-direction. Application to different populations. Application to different populations. Interaction with other programs. Interaction with other programs. Spending limits Spending limits RFP summer 2011? RFP summer 2011?

Making This Work Need to organize states to apply. Need to organize states to apply. Broad coalition to overcome provider politics, competing budget priorities Broad coalition to overcome provider politics, competing budget priorities SEIU very interested in working with state and local consumer groups. SEIU very interested in working with state and local consumer groups. Milestone on the way to a HCBS mandate. Milestone on the way to a HCBS mandate.

Impact on States: FL Spends only 11% of its Medicaid LTC funding on HCBS. Amendment would bring $95.5 million over five years. An additional 22,065 over 5 years and 130,058 people over 10 years would access home care and be able stay at home. Reduces state spending on LTC by $15 million over 5 years and $78 million over 10 years.

Impact on States: PA Spends only 9% of its Medicaid LTC funding on HCBS. Amendment would bring $85 million over five years. An additional 18,901 over 5 years and 103,669 people over 10 years would access home care and be able stay at home. Reduces state spending on LTC by $169 million over 5 years and $775 million over 10 years.

Major Uncertainties Expect revenues up in 2010 and 2011, but states will have experienced deep program cuts. Extension of ARRA funding. Waivers.

For Additional Information Lee Goldberg SEIU Healthcare (202)