One in three 65-year-olds will require long term care at some point in their lives. Medicaid currently covers 6 in 10 nursing home residents, however it does not cover care received at home or in assisted living unless there is a state waiver program that permits coverage of care in non-institutional settings. The Affordable Care Act?s (ACA) Balancing Incentives Program included additional federal funds for selected states that expanded Medicaid coverage to allow aged and disabled individuals to receive care services in home and community-based settings (HCBS). The intent of the BIP was to encourage states that spend 50% or more of total long-term care expenses on institutional care to ?balance? their expenditures by shifting care to HCBS. If successful, the BIP program may lead to an increase of Supplemental Security Income (SSI) claims because individuals living in the community are eligible for SSI whereas those who are institutionalized generally are not.