ArticleHealth services research2026
Evaluating the Affordable Care Act's Long-Term Services and Supports Rebalancing Programs.
Article in Health services research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed.
- Home- and Community-Based Services Spending and Living Arrangements Among Older Adults.JAMA health forum · 2026Article
- Medicaid Home-Based and Community-Based Services Long-Term Care Expenditures: Evaluation of the Balancing Incentive Program.Medical care · 2026Article
Corrections and comments
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Authors and funding
1 author.
Funding
Abstract
objectiveTo understand the impact of the Balancing Incentive Program (BIP) and Community First Choice State Plan Option (CFC) on LTSS rebalancing as measured by the size of and balance between the community and institutional LTSS workforces. STUDY SETTING AND
designUsing a stacked difference-in-difference design, this paper evaluates the impact of BIP and CFC on the number of LTSS workers per 1000 persons 65+, the number of community LTSS workers per 1000 persons 65+, the number of institutional LTSS workers per 1000 persons 65+, and the proportion of all LTSS workers employed in community-based settings. We also test the impact of BIP's performance targets by separately estimating program effects for states that had yet to meet BIP rebalancing targets upon entering the program. DATA SOURCES AND ANALYTICAL SAMPLE: Workforce and population data from the American Community Survey from 2005 to 2021. PRINCIPAL
findingsThis study finds that BIP resulted in a 13.24% (95% CI: 1.14%, 25.34%) increase in the size of the HCBS workforce in participating states, while finding no statistically significant effect for CFC (1.51%, 95% CI: -12.77%, 15.79%). The point estimate for growth in the HCBS workforce caused by BIP is twice as large in states bound by performance targets embedded within the BIP program (16.18%, 95% CI: 4.01%, 28.35%) as it is in states that are not (8.25%, 95% CI: -9.77%, 26.27%), suggesting that additional federal funding may be more effective when tied to performance targets for states. Neither program had a statistically significant effect on the size of the institutional workforce (BIP: 5.04%, 95% CI: -2.38%, 12.44%; CFC: 0.24%, 95% CI: -6.52%, 7.00%).
conclusionFederal policymakers seeking to increase investment in HCBS should ensure that additional funds are tied to measurable performance targets, incentivizing states to undertake expansions in HCBS that would not otherwise have taken place.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.