Objectives The Balancing Incentive Program (BIP) was an optional program for states within the Patient Protection and Affordable Care Act to promote Medicaid-funded home and community-based services (HCBS) for older adults and persons with disabilities. Twenty-one states opted to participate in BIP, including several states steadfastly opposed to the health insurance provisions of the Affordable Care Act. This study focused on identifying what factors were associated with states’ participation in this program. Methods Event history analysis was used to model state adoption of BIP from 2011 to 2014. A range of potential factors was considered representing states’ economic, political, and programmatic conditions. Results The results indicate that states with a higher percentage of Democrats in the state legislature, fewer state employees per capita, and more nursing facility beds were more likely to adopt BIP. In addition, states with fewer home health agencies per capita, that devoted smaller proportions of Medicaid long-term care spending to HCBS, and that had more Money Follows the Person transitions were also more likely to pursue BIP. Discussion The findings highlight the role of partisanship, administrative capacity, and program history in state BIP adoption decisions. The inclusion of BIP in the Affordable Care Act may have deterred some states from participating in the program due to partisan opposition to the legislation. To encourage the adoption of optional HCBS programs, federal policymakers should consider the role of financial incentives, especially for states with limited bureaucratic capacity and that have made less progress rebalancing Medicaid long-term services and supports.

中文翻译：

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根据平价医疗法案改革长期护理的联邦激励措施：2011-2014 年平衡激励计划的国家采用

目标 平衡激励计划 (BIP) 是《患者保护和平价医疗法案》中各州的一项可选计划，旨在促进针对老年人和残疾人的 Medicaid 资助的家庭和社区服务 (HCBS)。21 个州选择参加 BIP，其中包括几个坚决反对“平价医疗法案”的健康保险条款的州。这项研究的重点是确定哪些因素与各州参与该计划有关。方法 事件历史分析用于模拟 2011 年至 2014 年各州对 BIP 的采用。考虑了代表各州经济、政治和规划条件的一系列潜在因素。结果结果表明，州立法机构中民主党人比例较高的州，人均州雇员较少，更多的护理机构床位更有可能采用 BIP。此外，人均家庭保健机构较少、将 Medicaid 长期护理支出用于 HCBS 的比例较小、资金随人转职较多的州也更有可能追求 BIP。讨论 调查结果突出了党派、行政能力和项目历史在州 BIP 采用决策中的作用。由于党派反对立法，将 BIP 纳入“平价医疗法案”可能会阻止一些州参与该计划。为了鼓励采用可选的 HCBS 计划，联邦政策制定者应考虑财政激励的作用，