The Balancing Incentive Program is a grant-funded program established by the Affordable Care Act through the Centers for Medicare and Medicaid Services (CMS). The goal of the program is to make structural changes to the way individuals access long term services and supports (LTSS) in order to rebalance institutional care with home and community based services. The desired result is to increase the amount spent on home and community based services to 50% of total spending on LTSS.


    As required by the funding authorization, Nevada Medicaid (Division of Health Care Financing and Policy) is the lead agency for the BIP. The BIP team, however, is made up of a large number of cross-functional and cross-agency contributors who have been instrumental in moving the project toward its goals and objectives. Many of the projects and workgroups related to BIP have been collaborations between Nevada's Aging and Disability Services Division and Nevada Medicaid. In addition, many other state agencies and contractors have contributed in important ways.
    Within Nevada Medicaid, the BIP is supervised by the Program Research and Development Unit, under the leadership of Unit Chief Gloria Macdonald. Other members of the core team include Cheyenne Pasquale (Aging & Disability Resource Center Project Manager), Crystal Wren (Waiver Operations Supervisor, LTSS), and Palisa Sturgis (MFP/FOCIS Project Director). Please feel free to use the links on this page to contact any member of the team with questions or input.



      Development of a Statewide system to enable consumers to access all long-term services and supports through any contact point they choose. The system will include a 1-800 number (Nevada 211), a website, and all offices and locations of “No Wrong Door” agencies. It will include tools and processes that make it convenient and easy for consumers to access the services they need, regardless of where they choose to look for information.

      Nevada’s No Wrong Door system will ensure that a potential consumer inquiring about long term services and supports, whether in person, by phone or over the internet, will receive information and assistance to access available benefits and services offered by state Health and Human Services agencies.

      CONFLICT-FREE CASE MANAGEMENT SERVICES: The State must ensure the independence of persons performing evaluations, assessments, and plans of care. Conflict-free case management ensures, at a minimum, that persons performing these functions are not:
      • related by blood or marriage to the individual,
      • related by blood or marriage to any paid caregiver of the individual,
      • financially responsible for the individual
      • empowered to make financial or health-related decisions on behalf of the individual,
      • providers of State plan LTSS for the individual, or
      • those who have interest in or are employed by a provider of State plan LTSS.

      CORE STANDARDIZED ASSESSMENT INSTRUMENTS: Development of core standardized assessment instruments for determining eligibility for non institutionally-based long-term services and supports to determine a beneficiary's needs for training, support services, medical care, transportation, and other services, and develop an individual service plan to address such needs.

        The Comprehensive Project Plan includes the following activities:

        1. Standardized information materials – for recipients and NWD case managers
        2. Case Management System
        3. Identify the operating agency & NWD/SEPs
        4. Identify service coverage and ensure accessibility
        5. LTSS website
        6. 1-800 number
        7. Advertising
        8. Core Standardized Assessment (CSA) and Core Data Set (CDS)
        9. Conflict-Free Case Management
        10. Data collection and reporting
        11. Sustainability
        12. Coordination with the State Health Insurance Exchange


          The No Wrong Door system is the portion of BIP that will have the most direct and visible impact on both state staff and consumers. It is no surprise, then, that the No Wrong Door System is the area of BIP that receives the most curiosity from both within and outside of state agencies.

          A No Wrong Door system is designed to give consumers consistent, streamlined access to information about available programs and services as well as making the referral and eligibility process as easy to understand and navigate as possible. It is a consumer-centric approach that will point Nevadans in need of social services directly to the program or service that is most likely to meet their need; or, if no state service is available, it will point them to a listing of community resources so that they may explore other alternatives.

          Nevada's No Wrong Door system begins with programs located within three divisions of the Department of Health and Human Services - Nevada Medicaid (DHCFP), Aging and Disability Services Division (ADSD), and the Division of Public and Behavioral Health (DPBH) - as well as Nevada's Aging and Disability Resource Centers (ADRC's). These agencies will use common tools and follow standardized procedures to provide information and referral (I&R) services to Nevada consumers seeking information about Health and Human Services Programs.