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CMS recently released a State Medicaid Director Letter providing guidance to States on the State Balancing Incentives Program. States may take advantage of a time-limited increase in federal financial support available as part of this program, to shift the weight of spending toward home and community-based services as opposed to institutions.

In order to take advantage of the increased FMAP that is available between October 1, 2011 and September 30 2015, qualifying states must make certain required structural changes that promote increased utilization of home and community-based services including: creation of a "no wrong door single point of entry system"; development of "conflict-free" case management services; and development of statewide, uniform, core standardized assessment instruments for determining eligibility for non-institutional services.

How much FMAP States who apply and are selected for participation receive depends on their Medicaid spending on non-institutional services in 2009.