State that spent less than 50% of total Medicaid LTSS expenditures on community LTSS in 2009 were eligible for the Balancing Incentive Program. States that spent less than 25% were eligible for a 5% enhanced FMAP; states that spent between 25% and 50% were eligible for 2% enhanced FMAP.
State Medical Agencies applied for the Program, but they could designate an Operating Agency to manage Program-related activities.