States Transition to Community Care through ACA Incentive Program

A new incentive program funded by the Affordable Care Act is designed to provide elderly patients with greater alternatives to nursing home care.

The Balancing Incentive Program, currently involving 17 states approved by the Department of Health and Human Services, will use its $3 billion appropriation to increase federal matching dollars for spending on community care services from now until September 2015. Approved states spent less than 50 percent of their Medicaid funds on home and community care. To qualify for enhanced matching payments, states must demonstrably reduce administrative hurdles to individuals seeking care outside the nursing home system.

Medicaid agencies in these states are required to provide additional training so caseworkers can fully inform patients of their rights and options; help them apply for waivers; and easily determine eligibility. A major program goal is to put Medicaid funds to more effective use. As of 2010, a single nursing home patient cost more than $6,000 per month and Medicaid covered almost two-thirds of those patients. An AARP study determined, however, that the same amount of money can help almost three patients receiving community or home care.

If the incentive program is effective it has the potential to be hugely popular; according to a 2010 survey conducted by AARP, 90 percent of Americans would prefer to be cared for at home than in a facility such as a nursing home.

One of the current major hurdles to securing long term care at home in each participating state is the waiver waiting period, which can be months compared to patients’ immediate eligibility for a nursing home placement. This is one element of “red tape” that the incentive program hopes to clear up. However, they will face opposition from nursing home owners who rely on high census numbers to maintain their profitability.

Of all the participating states, particular attention is focused on New Hampshire due to its similar successful efforts to help the developmentally disabled community. Since 1991 New Hampshire has had no state facilities to serve patients with developmental disabilities, making home and community care the only option. Today, more than 99 percent of New Hampshire’s developmentally disabled population receives some form of home or community care.

Participating states include: