Tuesday, February 25, 2014

Pennsylvania to Apply for Medicaid Balancing Incentive Program

Pennsylvania Department of Public Welfare Secretary Bev Mackereth testified on February 24, 2014 before the PA Senate Appropriations Committee.
Of particular note was her testimony that the Department is ready to submit an application to participate in the Affordable Care Act’s Balancing Incentive Program.
The Balancing Incentive Payments Program was created by the Affordable Care Act of 2010 (Section 10202) to encourage states to keep Medicaid funded care recipients at home rather than in more expensive institutions.
Participation in the program will get Pennsylvania a 2% enhancement in federal Medicaid matching funds (FMAP) on home and community based services. That would amount to $75 million according to the Secretary.
In return, Pennsylvania will need to commit to make structural reforms to increase nursing home diversions and to rebalance so that by September 30, 2015 it spends 50% of its total Long Term Services and Supports (LTSS) expenditures on non-institutionally based LTSS.
Pennsylvania must agree to use the enhanced FMAP only to provide new or expanded home and community-based LTSS. The program requires states to create a standardized set of eligibility assessments for everyone regardless of age or type of disability. Participating states must also provide affected consumers with an independent case manager who is not conflicted due to ties to a nursing home or other health provider.

However the federal government is unlikely to impose any penalties on states that fail to meet the goals or fully comply with the mandates of the program. And Pennsylvania seems unlikely to attain the 50% goal by September of 2015. But these are additional funds that Pennsylvania can use in support of its ongoing efforts to re-balance its LTSS system.   
More information on the Balancing Incentives Program is available on the Medicaid.gov website at the following link: http://tinyurl.com/al479us

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