Engagement of Providers and Advocates in a Rebalancing Initiative to Increase HCBS Access for Medicaid Beneficiaries

Published in: Journal of the American Medical Directors Association (2020). doi: 10.1016/j.jamda.2019.12.015

Posted on RAND.org on January 29, 2020

by Daniel Siconolfi, Sangeeta C. Ahluwalia, Regina A. Shih, Esther M. Friedman, Debra Saliba

Efforts to rebalance long-term services and supports (LTSS) toward increased home- and community-based services (HCBS) will engage and affect multiple stakeholder groups, including governmental stakeholders (eg, Medicaid administrators) and diverse nongovernmental stakeholders such as service providers, advocates, and consumers. The most recent large-scale rebalancing effort was the Balancing Incentive Program, which incentivized states that were spending less than 50% of Medicaid LTSS expenditures on HCBS to rebalance their LTSS spending toward HCBS. States were required to apply for BIP participation and implement structural changes to their LTSS systems.

Prior research has described perspectives of governmental stakeholders in the context of BIP, but there has been little attention to the perspectives of nongovernmental stakeholders. The ability for states to successfully plan and implement high-quality LTSS programs, including managed LTSS, will undoubtedly require engagement and collaboration between governmental and nongovernmental stakeholders. This study, therefore, offers a description of the type and extent of stakeholder engagement in BIP, which will have relevance to other LTSS policy initiatives.

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