Home and Community Balanced Incentives Act of 2009

Home and Community Balanced Incentives Act of 2009 - Amends title XIX (Medicaid) of the Social Security to increase the federal medical assistance percentage (FMAP) for a balancing incentive payment state and any other state in which less than 50% of the total FY2009 expenditures for medical assistance for long-term services and supports (LTSS) are for non-institutionally-based (home and community-based) LTSS.

Directs the Secretary of Health and Human Services to award grants to states to: (1) support the development of a common national set of coding methodologies and databases related to the provision of home and community-based LTSS; and (2) make certain structural changes to the state Medicaid program.

Directs the Secretary to develop specifications for standardization of: (1) reporting of assessment data for LTSS for each population served; and (2) outcomes measures that track assessment processes for LTSS for each such population that maintain and enhance individual function, independence, and stability.

Directs the Secretary to promulgate regulations to ensure that all states develop service systems that are designed to: (1) allocate resources for services in a manner that is responsive to the changing needs and choices of beneficiaries receiving home and community-based LTSS, and that provides strategies for beneficiaries receiving such services to maximize their independence; (2) provide the support and coordination needed for a beneficiary in need of such services to design an individualized, self-directed, community-supported life; and (3) improve coordination among all providers of such services under federally and state-funded programs.

Directs the Secretary to assess, on an ongoing basis and based on measures specified by the Agency for Healthcare Research and Quality, the safety, quality, and outcomes of home and community-based LTSS.

Changes from 150% of the poverty line to 300% of the supplemental security income (SSI) benefit rate the income eligibility level for providing home and community-based services under the state plan amendment option for elderly and disabled individuals. Authorizes additional state options to provide home and community-based services.

Removes the limitation on the scope of services.

Creates an eligibility category to provide full Medicaid benefits to individuals receiving home and community-based services under a state plan amendment.

Applies spousal impoverishment protections to recipients of home and community-based services.

Authorizes states to elect to exclude up to six months of the average cost of nursing facility services from assets or resources for home and community-based services eligibility determinations.

Directs the Secretary to create a template to streamline the process of approving, monitoring, evaluating, and renewing state proposals to conduct a program that combines Medicaid waiver authorities into a single program under which the state provides home and community-based services to individuals based on individualized assessments and care plans.