DEPARTMENT 

of HEALTH 

and HUMAN 

SERVICES

Fiscal Year 

2019 

Administration for 

Community Living

Justification of

Estimates for

Appropriations Committees
Back cover intentionally left blank.
DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Community Living

Washington, DC 20201

ii

I am pleased to present the Administration for Community Living’s (ACL) FY 2019 President’s Budget request, 

totaling $1.8 billion. The request maintains funding for many of ACL programs.

ACL’s request supports the priorities outlined by the President. It maintains high impact and focus on the 

mission and purpose of ACL, while assuring cost controls and the efficiency and effectiveness of services. In 

addition, ACL’s request creates flexibility for states to allocate resources to meet state-specific challenges and 

better serve the needs of their communities.

ACL improves the lives of older adults and people with disabilities through services, research, and education. 

ACL also strengthens communities, which benefit when everyone is able to contribute. To support its mission, 

ACL works in close partnership with state and local governments, tribes, industry, and nonprofit organizations 

to help older adults and people with disabilities live as independently as possible, with equal opportunities to 

earn a living, go to school, choose where to live, and make decisions about their lives.

People overwhelmingly prefer living in the community to living in institutional settings, and in most cases, 

supporting people as they remain in the community is significantly less expensive than institutional care. ACL 

remains committed to this mission. This budget will allow us to continue serving older adults and people with 

disabilities, and increase the responsiveness our programs to the needs within individual states.

Lance Robertson

Administrator and Assistant Secretary for Aging
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Table of Contents

Executive Summary

Introduction and Mission ................................................................................................................ 1

Overview of Budget Request ....................................................................................................................3

Overview of Performance .........................................................................................................................5

All Purpose Table ................................................................................................................................... 10

Appropriations Language........................................................................................................................ 13

Appropriations Language Analysis......................................................................................................... 14

Amounts Available for Obligation.......................................................................................................... 16

Summary of Changes - Continued.......................................................................................................... 18

Budget Authority by Activity ................................................................................................................. 18

Authorizing Legislation .......................................................................................................................... 22

Appropriations History Table ................................................................................................................. 27

Appropriations Not Authorized by Law ................................................................................................. 29

Health and Independence for Older Adults

Summary of Request............................................................................................................................... 30

Home and Community-Based Supportive Services................................................................................ 34

Nutrition Services ................................................................................................................................... 44

Preventive Health Services ..................................................................................................................... 59

Chronic Disease Self-Management Education........................................................................................ 67

Falls Prevention ...................................................................................................................................... 71

Native American Nutrition and Supportive Services.............................................................................. 75

Aging Network Support Activities ......................................................................................................... 81

Caregiver and Family Support Services

Summary of Request............................................................................................................................... 87

Family Caregiver Support Services ........................................................................................................ 91

Native American Caregiver Support Services ........................................................................................ 99

Alzheimer’s Disease Program............................................................................................................... 103

Alzheimer’s Disease Supportive Services Program.............................................................................. 107

Alzheimer’s Disease Initiative - Specialized Supportive Services ....................................................... 111

Lifespan Respite Care ........................................................................................................................... 115
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Protection of Vulnerable Adults

Summary of Request............................................................................................................................. 121

Long-Term Care Ombudsman Program ............................................................................................... 123

Prevention of Elder Abuse and Neglect................................................................................................ 129

Health Care Fraud and Abuse Control/Senior Medicare Patrol Program ............................................. 135

Elder Rights Support Activities ............................................................................................................ 141

Disability Programs, Research and Services

Summary of Request............................................................................................................................. 149

State Councils on Developmental Disabilities...................................................................................... 151

Developmental Disabilities – Protection and Advocacy....................................................................... 159

University Centers for Excellence in Developmental Disabilities........................................................ 167

Developmental Disabilities – Projects of National Significance .......................................................... 173

Independent Living ............................................................................................................................... 177

Limb Loss Resource Center.................................................................................................................. 185

Paralysis Resource Center..................................................................................................................... 189

Traumatic Brain Injury ......................................................................................................................... 193

National Institute on Disability, Independent Living, and Rehabilitation Research............................. 201

Consumer Information, Access & Outreach

Summary of Request............................................................................................................................. 207

Aging and Disability Resource Centers................................................................................................ 209

State Health Insurance Assistance Programs........................................................................................ 215

Voting Access for Individuals with Disabilities ................................................................................... 221

Assistive Technology............................................................................................................................225

Alzheimer’s Disease Initiative - Outreach Campaign ........................................................................... 237

Medicare Improvements for Patients and Providers Act Programs (MIPPA) ...................................... 239

Program Administration .................................................................................................................... 251

Supplementary Tables

Object Classification Table - Direct...................................................................................................... 254

Salaries and Expenses – Direct ............................................................................................................. 256

Detail of Full Time Equivalents (FTE)................................................................................................. 257

Detail of Positions................................................................................................................................. 259

FTEs Funded by P.L. 111-56 (CR) and Any Supplementals................................................................ 260

Summary of Proposed Changes in Performance Measures .................................................................. 264
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Physicians’ Comparability Allowance Worksheet................................................................................ 265

Programs Proposed for Elimination...................................................................................................... 266

Significant Items in Appropriations Committee Reports................................................................ 267

Text Description Administration for Community Living Organizational Chart (Page 6) .................... 269
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Introduction and Mission

The Administration for Community Living (ACL) works with states, localities, tribal 

organizations, nonprofit organizations, businesses, and families to help older adults and people 

with disabilities live independently, with equal opportunities to earn a living, go to school, choose 

where to live, and make decisions about their lives. ACL’s programs provide services that directly 

support people with disabilities, older adults, families and caregivers to make this possible. In most 

cases, these services and supports are significantly less expensive than institutional care, which 

most often is funded by Medicaid. In addition, ACL invests in research, innovation and education 

to improve the quality and availability of these services and advocates for older adults and people 

with disabilities. 

This is critical given the growth in the segments of the population that these programs serve:

• The U.S. population over age 60 is projected to increase by 13 percent between 2016 and 

2020, from 68.7 million to 77.6 million.1

• According to the U.S. Census Bureau, in 2010, there were 56.7 million Americans living 

with disabilities. Of these, more than 12 million required assistance with activities of 

daily living or instrumental activities of daily living.2

• Studies indicate that individuals with developmental disabilities comprise between 4 and 

5 million individuals.3

• The number of seniors age 65 and older with severe disabilities – defined as three or 

more limitations in activities of daily living – that are at greatest risk of nursing home 

admission, is projected to increase from 4.5 million individuals in 2016 to over 5 million 

(15 percent increase) by the year 2020.4

 1 U.S. Census Bureau, “2014 National Population Projections,” Table 1. Projected Population by Single Year of Age, 

Sex, Race, and Hispanic Origin for the United States: 2014 to 2060. Released December 2014, 

http://www.census.gov/population/projections/data/national/2014/downloadablefiles.html. Accessed 02 January 

2018. U.S. Census Bureau, Annual Estimates of the Resident Population for Selected Age Groups by Sex for the 

United States, States, Counties, and Puerto Rico Commonwealth and Municipios: April 1, 2010 to July 1, 2016. 

Released June 2017, https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk. 

Accessed 02 January 2018. 2 U.S. Census Bureau, “Americans with Disabilities: 2010,” Issued July 2012, https://www.census.gov/content/

dam/Census/library/publications/2012/demo/p70-131.pdf. Accessed 21 August 2014. 3 Extrapolated from Developmental Disabilities Assistance and Bill of Rights Act of 2000, Section 101(a)(1) (see 

https://acl.gov/Programs/AIDD/DDA_BOR_ACT_2000/p2_tI_subtitleA.aspx) and U.S. Census Bureau, Annual 

Estimates of the Resident Population: April 1, 2010 to July 1, 2016.

4 Ibid and Centers for Medicare & Medicaid Services, The characteristics and perceptions of the Medicare 

population. Data from the 2013 Medicare Current Beneficiary Survey. [data tables 2.5a and 2.6a]. 
EXECUTIVE SUMMARY

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http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS/Data-Tables-Items/2013CNP.html

Accessed 02 January, 2018. 

Meeting the long-term support needs of these populations can place tremendous strain on families, 

and if families become overwhelmed by the challenges of caregiving, the costs of providing this 

care will fall on other, more costly, government resources. For example, a 2014 Rand Corporation 

study found that the care provided by informal (family and friend) caregivers of elderly adults has 

an estimated economic value of $522 billion.5 Maintaining funding for community-based services 

and supports, including supports for family caregivers, is therefore critical to delaying, reducing, 

or eliminating reliance upon institutional residential services, a more expensive and less preferable 

option.

 

5 The Opportunity Costs of Informal Elder-Care in the United States. Rand Corporation. 

http://www.rand.org/pubs/external_publications/EP66196.html.
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Overview of Budget Request

ACL helps millions of Americans live independently and fully participate in society, including 

going to school, working, living in the community, and making daily decisions about life. To 

support its mission, ACL advocates across the federal government for older adults and people with 

disabilities, as well as families and caregivers; funds supportive services that are provided 

primarily by networks of community-based organizations; and invests in training, education, 

research and innovation.

The FY 2019 discretionary request for ACL is $1,781,181,000 a decrease of -$171,582,000 below 

the FY 2018 Annualized Continuing Resolution level. The FY 2019 Budget request generally 

maintains the majority of ACL’s programs at the FY 2018 Annualized Continuing Resolution 

Level. The Budget prioritizes direct services such as senior meals, caregiver support, and Centers 

for Independent Living. The Budget also prioritizes flexibility for States and Tribes to direct 

funding to activities that are most needed in their communities, and consolidates programs for 

efficiency.

 

Increasing Flexibility for States and Tribes

• Increased Authority to Transfer Funds between Programs: ACL is requesting to expand 

existing transfer authorities to give States and Tribes maximum flexibility to transfer 

funding between four Older Americans Act programs. These are: Home- and 

Community-Based Services, Nutrition Programs, Family and Caregiver Services and 

Preventive Health Services. This will provide States and Tribes the flexibility to allocate 

funding to best address their individual challenges. 

• Consolidating Preventive Health Services Activities: ACL proposes consolidating the 

Chronic Disease Self- Management Education (CDSME) and the Falls Prevention Program 

into the Preventive Health Services Program. This will allow States to expand on or shrink 

existing CDSME and Falls Prevention programs in order to best meet the challenges within 

their State. This newly consolidated program would provide states the flexibility to target 

funding to the greatest areas of need in their communities, increasing the ability of States’ 

to focus resources where they are most needed.

Consolidation for Efficiencies and Other Reductions

• Assistive Technology – Alternative Financing Grants: The Budget eliminates the $2 

million Alternative Financing Grant Competition, which is no longer authorized by the 

Assistive Technology Act. ACL’s Assistive Technology State grant program already 

includes alternative financing activities as an allowable activity, giving States the option 

to make decisions to best meet their own needs. 
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• Limb Loss Resource Center and Paralysis Resource Center: Other HHS grant programs 

provide services and resources to people with all types of disabilities. Savings from 

eliminating these programs total $9.1 million. 

• Consolidating Alzheimer’s Programs: ACL continues consolidation of the Alzheimer’s 

Disease Initiative – Specialized Supportive Services, Alzheimer’s Disease Supportive 

Services, and the National Alzheimer’s Call Center, into a single Alzheimer’s Disease 

Program. The single program allows for greater flexibility by centralizing funding into a 

single program. 

• State Health Insurance Program (SHIPs): The Budget eliminates funding for SHIPs. 

However it does shift targeted mandatory funding for the MIPPA program to 

discretionary funding in ACL. MIPPA funding provides grants to states for outreach 

activities targeted to low income and rural populations to provide beneficiary education 

and enrollment assistance for Medicare.

• National Institute on Disability, Independent Living, and Rehabilitation Research 

(NIDILRR): The FY 2019 Budget proposes to consolidate targeted HHS research 

programs within the National Institutes of Health (NIH), including NIDILRR as a new 

National Institute. The reorganization will improve efficiency by enabling NIDILRR to 

benefit from the NIH research infrastructure, the largest at HHS. 

• Additional Reductions: ACL proposes to reduce funding for State Councils on 

Developmental Disabilities, Projects of National Significance and Independent Living 

programs by -$29.9 million. ACL will work with grantees/States to identify ways to 

leverage additional resources through efficiencies and economies of scale. 

Conclusion 

Most people who are aging or who have significant disabilities can live in their own homes or in 

other independent settings if they have access to the help they need. For many, this help comes 

through the community-based services and supports provided by ACL’s programs. In most cases, 

providing these services and supports is significantly less expensive than the cost of institutional 

care, which is often borne by Medicaid. ACL remains committed to its central mission of 

supporting people with disabilities and older adults at a fiscally responsible level. Expanding both 

Federal and State flexibilities allows ACL and its State and Tribal partners to best support 

individuals to live independently, and fully integrate into their communities.

The FY 2019 Budget request includes a new general provision (Section 217) that, while applicable 

to HHS as a Department, addressed an area of particular concern to NIDILRR, as well as to other 

ACL programs. Within the Department, the provision would simplify the accounting processes 

used when one Operating Division (OPDIV) has agreed to issue and manage a grant on behalf of 

a second OPDIV. This general provision would allow HHS to use the reimbursable processing 

features within the accounting system, rather than the more cumbersome execution process 

currently used. 
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This provision would also enable an HHS OPDIV to collaborate in the same way with an outside 

Department for the purpose of making grants or cooperative agreements. Currently, the lack of 

specific authority precludes collaboration. The new proposed language would provide HHS 

OPDIVs with the authority to transfer funds via reimbursable agreements from one agency to 

another for the purposes of making grants, allowing NIDILRR to collaborate on a wider scale (e.g., 

with the Department of Veteran’s affairs on research projects to address the needs of disabled 

veterans). NIDILRR had such authority when it was part of the Department of Education. The 

same language was included in the FY 2018 request as well. 

Overview of Performance

ACL facilitates achievement of its mission through improvements in the analysis and availability 

of performance data while also enhancing the rigor of program evaluations. ACL program 

activities have a fundamental common purpose: to develop and support a comprehensive, 

coordinated, and cost-effective system of long-term services and supports that help older adults 

and people with disabilities maintain their health and independence in their homes and 

communities. This purpose led ACL to focus on the following performance goals: 1) improving 

consumer outcomes and delivery systems; 2) effectively targeting services to at-risk populations; 

3) improving program efficiency; and 4) promoting rights and preventing abuse of older adults 

and people with disabilities. Each performance goal represents activities spanning across ACL 

programs. Progress toward achievement is tracked using a number of performance measures. 

Taken together, the performance goals and their corresponding measures are designed to reflect 

ACL’s goals and objectives and in turn measure success in accomplishing ACL’s mission.

Performance Highlights 

An analysis of ACL’s program performance trends through FY 2016 illustrates that ACL programs 

continue to help individuals remain independent and in the community. Most performance 

measures and indicators have been maintained or steadily improved. Following are some key 

successes that are indicative of the potential of ACL and the Aging and Disability Networks to 

meet demographic and fiscal challenges.

ACL programs improve consumer outcomes and delivery systems. Consumers report that services 

contribute in an essential way to maintaining their independence and they express a high level of 

satisfaction with these services. In 2016, over 97 percent of OAA transportation clients and nearly

94 percent of caregivers rated services good to excellent. To help ensure the continuation of these 

trends, ACL uses various mechanisms to promote innovative service-delivery models for state and 

local program entities that show promise for generating measurable improvements in program 

activities. Quality indicators are consistently high and are expected to meet or exceed targets in 

FY 2019. 

ACL programs reach at-risk populations and target services to help individuals remain independent 

and in the community. For example, older adults who have three or more impairments in Activities 

of Daily Living (ADL) are at a high risk for nursing home entry. Increasing services to this 

population is one proxy for nursing home delay and diversion. In FY 2005, one-third of homedelivered nutrition clients lived with three or more ADL impairments and by FY 2016 the 
EXECUTIVE SUMMARY

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proportion grew to nearly 42 percent, a 26 percent increase. The FY 2019 performance budget 

includes ten core performance indicators supporting ACL’s commitment to improving client 

outcomes and program quality. While some indicators experience year-to-year variation, all 

indicators have trended in the desired direction and the vast majority meet or exceed targets 

annually. 

ACL programs are efficient. The Aging and Disability Networks are providing high-quality 

services and doing so in a prudent and cost-effective manner. In FY 2016 the Aging Network 

served over 8,800 people per million dollars of OAA Title III funding. The result is a 17 percent

increase over baseline. State Councils on Development Disabilities have achieved a similar 

increase in efficiency of 19 percent. For FY 2019, ACL’s efficiency indicators are expected to 

consistently meet or exceed targets.

ACL programs effectively address complaints of abuse, neglect, or violation of rights. The 

Developmental Disabilities Protection and Advocacy program (PADD) grantees are highly 

successful at meeting the needs of complainants. The annual performance measure of the 

percentage of individuals who have their complaint of abuse, neglect, discrimination, or other 

human or civil rights corrected compared to the total assisted demonstrates the rate of successful 

benefits accruing from the program. The rate of success has been consistently over 80 percent and 

trending upward since FY 2011. In FY 2016, the target was exceeded with over 88 percent of 

consumers having their complaint corrected. 

Program Evaluation and Research

In addition to robust performance measurement strategies, ACL employs rigorous program 

evaluation methods including longitudinal data collection and matched comparison groups. ACL 

is engaged in multiple program research and evaluation efforts. Examples of these efforts include:

• The OAA Title III-C Nutrition Services program (NSP) evaluation: A report of the 

process evaluation is available at: https://www.acl.gov/sites/default/files/programs/2017-

02/NSP-Process-Evaluation-Report.pdf. The cost study report is available at: 

https://www.acl.gov/sites/default/files/programs/2017-05/NSP-Meal-CostAnalysis_v2.pdf. The interim outcome study report is available at: 

https://www.acl.gov/sites/default/files/programs/2017-07/

AoA_outcomesevaluation_final.pdf. The final report, which includes a comparison of 

healthcare utilization among meal recipients and comparison group members, is expected 

to be completed by the spring of 2018. 

• The data collected to date provide information crucial for program operations and also 

show that the OAA Title III-C Nutrition Services Program (NSP) is meeting its stated 

goals. The program provides appropriate supportive services that are responsive to local 

community and individuals’ needs. For example, since the last evaluation was conducted 

in 1995, 15 percent more providers offer weekend meal service and almost 15 percent 

more sites provide specialized meal choices to meet the health needs of recipients. With 

nearly two-thirds of meal providers offering non-nutrition services to promote the well-
EXECUTIVE SUMMARY

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being of older Americans, the program is able to provide a continuum of care for older 

individuals and secure the opportunity for older individuals to receive managed in-home 

and community-based long-term care services. The program is using federal funds 

efficiently as the federal expenditure is $1.88 per home-delivered meal and $3.52 per 

congregate meal, but the evaluation research showed that if all costs are accounted for, 

the value of the meal is actually $11.06 for a home-delivered meal, and $10.69 for a 

congregate meal.

• The evaluation of the Title III-E National Family Caregiver Support Program (NFCSP): 

the process evaluation was completed in March 2016. The final report is available at: 

https://www.acl.gov/sites/default/files/programs/2017-02/NFCSP_Final_Reportupdate.pdf. Consumer-level data collection will be conducted from 2016 through 2018 

with an outcome-evaluation report to follow. 

• Based on the information collected to date, the program offers high-quality services to 

assist older individuals in avoiding institutions and does so in an efficient manner. The 

Federal program is filling an important service gap as 55 percent of current programs 

reported that, prior to the NFCP funding, they did not have a caregiver program. The 

program is using federal funds efficiently as approximately 40 percent supplement their 

programs using volunteers. Programs also frequently rely on partnerships to expand the 

scope and reach of their services, including organizations such as the Alzheimer’s 

Association (61 percent) and Aging and Disability Resource Centers/No Wrong Door 

systems (52 percent). Additionally, 42 percent responded that healthcare providers are 

among the three most important partners for administering their program.

• The evaluation of the Long-Term Care Ombudsman Program (LTCOP): A contract was 

awarded for a process evaluation in September 2015 for the purpose of better 

understanding how the program operates at the federal, state, and local levels 

independently and in conjunction with each other. The first round of data collection is 

complete and a second round is scheduled to begin in early 2018. The final report is 

expected in fall 2018. A separate contract was awarded for an outcome evaluation in 

September 2017. The outcome evaluation will gather data on: 1) the efficacy of the 

LTCOP in carrying out core functions of the program; 2) the long-term impacts for 

various stakeholders; 3) what system advocacy among Ombudsmen looks like; and 4) 

effective Ombudsmen practices. This evaluation is scheduled to run through March 2021.

• The evaluation of the OAA Title VI Tribal Grant Program: An evaluability assessment 

was conducted in FY 2015. The study examined the program characteristics of Title VI 

grantees’ nutritional, supportive, and caregiver support services to assess the feasibility 

of, and best approaches for, formal evaluation of the Title VI Program. The final report 

is available at: https://www.acl.gov/sites/default/files/programs/2017-02/EA-of-TitleVIv2.pdf. The results of that report are being implemented in a multi-year program 

evaluation that began in September 2016. 
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• ACL’s Partnerships in Employment (PIE) Systems Change Grants evaluation: This sixyear evaluation was initiated in 2011 and is ongoing. The purpose is to inform ACL and 

its partners how best to support competitive, integrated employment systems for 

individuals with intellectual and developmental disabilities. Accomplishments to date 

point to success in achieving project objectives, including enactment of employment-first 

legislation and the adoption or implementation policy recommendations. 

• ACL’s Evaluation for Model Approaches for Enhancing the Quality, Effectiveness, and 

Monitoring of Home and Community-Based Services for Individuals with 

Developmental Disabilities grantees began in September 2017. The grant program funds 

the development of innovative models for communities to support the quality of life of 

individuals with intellectual and developmental disabilities. The evaluation will measure 

the extent to which the models are able to achieve this as well as assessing whether 

successful models can be replicated in other sites and are scalable nationally, and whether 

the models are sustainable. The evaluation may also inform future ACL funding 

approaches.

• ACL’s Community of Practice Supporting Families Evaluation was initiated in 

September 2017. It will provide a retrospective look at the extent to which previous 

Communities of Practice grantees were able to implement the Life Course Framework 

(LCF). The evaluation will examine the effect of the community of practice model on 

grantees’ ability to build capacity across and within states to create policies, practices, 

and systems to better assist and support families that include a member with an 

intellectual or developmental disability (I/DD) across the lifespan. The evaluation will 

focus on identifying the key components of the LCF that contribute to states’ successful 

outcomes for improving supports for families with members with I/DD, how use of the 

framework effects policies and practices in the services delivery system, and lessons from 

grantees that can be used to improve the framework. Evaluation products are expected to 

include performance measures that can be used by ACL and communities implementing 

the framework to objectively measure their outcomes.

ACL’s Internal Program Performance Management Strategy

ACL employs a program performance management strategy with multiple components. This 

includes collaboration with other agencies and organizations, enhanced partnerships between 

Aging and Disability Networks, technical assistance, and senior leadership’s involvement in 

performance management. All of these efforts are expected to yield performance improvements. 

Developmental disability programs under ACL have implemented a quality-review system (QRS). 

The QRS uses a three-tiered model to review program compliance, outcomes, and fiscal 

operations. Results of reviews are used to target and coordinate technical assistance. These tiers 

involve: 1) annual standardized review for all grantees; 2) periodic in-depth review involving a 

team of reviewers; and 3) customized monitoring for programs at risk in terms of compliance and 

performance. ACL’s Older Americans Act Title III and Title VII state formula grant programs 

continue development of a formula grant monitoring framework. This framework combines 
EXECUTIVE SUMMARY

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assessments of grantee’s progress toward program goals and objectives with identification of risk 

or instances of fraud, waste, and abuse.

In addition to grant monitoring activities, there is a rigorous process in which each program within 

ACL develops Program Funding Plan Memoranda for senior management review and approval. 

The Memoranda detail the proposed discretionary grant and procurement activities for the program

and justify each proposed activity consistent with ACL’s mission and performance measures. ACL 

is implementing enhancements to this process, including formal reviews of Funding Opportunity 

Announcements (FOAs) to ensure alignment with ACL’s policy priorities. This process will also 

establish more rigorous requirements for grantees. All FOAs will indicate that measurable

performance metrics including measurable outcomes (that demonstrate value of the program) must 

be identified on the grant application and included on all progress reports. All grant programs will 

require an unbiased evaluation of the program. Ongoing funding may be based on progress reports 

to ensure that government funds are used effectively and efficiently. ACL will continue to explore 

and implement new and innovative ways to assess program performance, justify program

investments, and evaluate cost effectiveness of programs and services nationally. 

 

ACL senior management is directly engaged in performance management activities through grants 

and procurement planning. Senior leadership has established processes for use of performance data 

for management decision-making, including a quarterly discretionary dashboard, bi-weekly 

reports for the Administrator/Assistant Secretary, quarterly reviews of operating budgets, quarterly 

managers’ meetings, and bi-weekly center director meetings. By establishing a culture where 

performance improvement is expected and by working collaboratively with our grantee partners 

toward this goal, the Aging Services and Disability Networks will demonstrate solid performance.
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All Purpose Table

Administration for Community Living

(Dollars in Thousands) 

Health & Independence for Older Adults Final /1

FY2018

Annualized

CR

FY2019

President's

Budget

FY2018 +/-

FY2019

Home&Community-BasedSupportiveServices 349,426 347,846 350,224 2,378

Nutrition Services 833,284 832,064 837,753 5,689

 Congregate Nutrition Services (non-add) 449,313 447,284 450,342 3,058

 Home-DeliveredNutritionServices(non-add) 226,823 225,798 227,342 1,544

 NutritionServicesIncentiveProgram(non-add) 157,148 158,982 160,069 1,087

Preventive Health Services 19,802 19,713 24,848 5,135

ChronicDiseaseSelf-ManagementEducation[PPHF]/2 8,000 7,223 -- (7,223)

Elder Falls Prevention [PPHF]/2 5,000 4,515 -- (4,515)

NativeAmericanNutrition & SupportiveServices 31,136 30,996 31,208 212

AgingNetwork Support Activities 9,938 9,893 8,998 (895)

 HolocaustSurvivorAssistance{non-add} 2,494 2,500 2,495 (5)

 Subtotal, Health & Independence for Older Adults 1,256,586 1,252,250 1,253,031 781

Caregiver & Family Support Service s Final /1

FY2018

Annualized

CR

FY2019

President's

Budget

FY2018 +/-

FY2019

Family Caregiver Support Services 150,240 149,563 150,586 1,023

NativeAmericanCaregiverSupport Services 7,539 7,505 7,556 51

Alzheimer's Disease Program/3 -- -- 19,490 19,490

Alzheimer'sDiseaseSupportiveServicesProgram/3 4,789 4,767 -- (4,767)

Alzheimer's Disease Initiative -- Specialized Supportive 

Services[PPHF]/3. 10,500 9,480 -- (9,480)

LifespanRespite Care 3,352 3,337 3,360 23

 Subtotal,Caregiver & FamilySupport Services 176,420 174,652 180,992 6,340

Protection of Vulnerable Adults Final /1

FY2018

Annualized

CR

FY2019

President's

Budget

FY2018 +/-

FY2019

Long-Term Care Ombudsman Program 15,848 15,777 15,855 78

PreventionofElderAbuse & Neglect 4,762 4,741 4,773 32

 SeniorMedicarePatrolProgram/HCFAC /4 18,000 18,000 18,000 --

ElderRightsSupportActivities 13,847 13,780 11,874 (1,906)

Elder Justice {non-add} 9,981 9,932 8,000 (1,932)

Subtotal,Protectionof VulnerableAdults 52,457 52,298 50,502 (1,796)
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All Purpose Table - Continued

Administration for Community Living

(dollars in thousands) 

Disability Programs, Research & Service s Final /1

FY2018

Annualized

CR

FY2019

President's

Budget

FY2018 +/-

FY2019

State Councils on DevelopmentalDisabilities 72,833 72,504 56,000 (16,504)

DevelopmentalDisabilitiesProtectionandAdvocacy 38,645 38,471 38,734 263

UniversityCenters for Excellence inDevelopmental

Disabilities 38,530 38,357 32,546 (5,811)

Projects of NationalSignificance 9,977 9,932 1,050 (8,882)

Independent Living/5 100,951 100,496 95,997 (4,499)

LimbLossResourceCenter 2,494 2,483 -- (2,483)

Paralysis Resource Center 6,682 6,655 -- (6,655)

Traumatic Brain Injury/5 9,300 9,258 9,321 63

NationalInstitute on Disability, Independent Living, and 

Rehab. Research 103,731 103,264 -- (103,264)

 Subtotal, DisabilityPrograms,Research & Services 383,143 381,420 233,648 (147,772)

Program Final /1

FY2018

Annualized

CR

FY2019

President's

Budget

FY2018 +/-

FY2019

AgingandDisabilityResourceCenters 6,105 6,077 6,119 42

StateHealthInsuranceAssistanceProgram 47,115 46,795 -- (46,795)

VotingAccessforPeople withDisabilities(HAVA) 4,952 4,929 4,963 34

Assistive Technology 33,922 33,769 31,939 (1,830)

Alzheimer'sDisease Initiative--CommunicationsCampaign[PPHF]/3 4,200 3,792 -- (3,792)

Medicare Improvementsfor Patients and Providers Act [TRA/BBA]/6 34,913 37,500 37,500 --

 Aging and DisabilityResourceCenters {non-add} 4,655 5,000 5,000 --

 AreaAgenciesonAging{non-add} 6,983 7,500 7,500 --

 NationalCenterfor Benefits Outreach and Enrollment {non-add} 11,172 12,000 12,000 --

 State Health InsuranceAssistance Program {non-add}/5 12,103 13,000 13,000 --

 Subtotal,ConsumerInformation,Access& Outreach 131,207 132,862 80,521 (52,341)

 Program Administration 39,971 39,791 37,987 (1,804)

 Subtotal, Program Level 2,039,784 2,033,273 1,836,681 (196,592)
EXECUTIVE SUMMARY

12 

All Purpose Table - Continued

Administration for Community Living

(dollars in thousands) 

Less: Funds From Mandatory Source s Final /1

FY2018

Annualize

d CR

FY2019

President's

Budget

FY2018 +/-

FY2019

HCFAC Fundsfor Senior Medicare Patrol Program /4 (18,000) (18,000) (18,000) --

Prevention&PublicHealthFund (27,700) (25,010) -- 25,010

Medicare Improvementsfor Patients and Providers Act 6 (34,913) (37,500) -- 37,500

 Aging and DisabilityResourceCenters (4,655) (5,000) -- 5,000

 AreaAgenciesonAging{non-add} (6,983) (7,500) -- 7,500

 NationalCenterfor Benefits Outreach and Enrollment {non-add} (11,172) (12,000) -- 12,000

 State Health InsuranceAssistance Program {non-add}/5 (12,103) (13,000) -- 13,000

Total,DiscretionaryBudgetAuthority 1,959,170 1,952,763 1,818,681 (134,082)

 Total FTE 196 187 155 -32

1/ Reflects FY 2017 required and permissive transfers and recissions

2/ In FY 2017, and under the FY 2018 CR these programs were paid for out of the Prevention and Public Health Fund. 

3/Funding for Alzheimer's programs is being consolidated into the Alzheimer's Disease program.

4/ The FY 2017 enacted appropriation states that SMP/HCFAC is to be "fully funded" out of discretionary HCFAC appropriations to the Centers 

for Medicare & Medicaid Services based on the Secretary of HHS's determination of the amount needed to provide full. funding. The FY 2018 

amount serves as a placeholder for FY 2018 pending final decisions on the amount by the Secretary of HHS.

5/ Funding is currently appropriated to the Centers for Medicare and Medicaid Services (CMS) directly and transferred to ACL via an IntraDepartmental Delegation of Authority (IDDA).

6/ Funding shown reflects request to shift source of funding in FY 2019 from discretionary to mandatory.
13 

EXECUTIVE SUMMARY

Appropriations Language 

For carrying out, to the extent not otherwise provided, the Older Americans Act of 1965 

("OAA"), titles III and XXIX of the PHS Act, sections 1252 and 1253 of the PHS Act, section 

119 of the Medicare Improvements for Patients and Providers Act of 2008, title XX-B of the 

Social Security Act, the Developmental Disabilities Assistance and Bill of Rights Act, parts 

2 and 5 of subtitle D of title II of the Help America Vote Act of 2002, the Assistive 

Technology Act of 1998, title VII (and section 14 with respect to such title) of the 

Rehabilitation Act of 1973, and for Department-wide coordination of policy and program 

activities that assist individuals with disabilities, $1,781,181,000, together with $37,500,000 

to be transferred from the Federal Hospital Insurance Trust Fund and the Federal 

Supplementary Medical Insurance Trust Fund, to remain available until expended to carry 

out such section 119: Provided, That amounts appropriated under this heading may be used 

for grants to States under section 361 of the OAA only for disease prevention and health 

promotion programs and activities which have been demonstrated through rigorous 

evaluation to be evidence-based and effective: Provided further, That of amounts made 

available under this heading to carry out sections 311, 331, and 336 of the OAA, up to one 

percent of such amounts shall be available for developing and implementing evidencebased practices for enhancing senior nutrition: Provided further, That notwithstanding any 

other provision of this Act, funds made available under this heading to carry out section 311 

of the OAA may be transferred to the Secretary of Agriculture in accordance with such 

section: Provided further, that none of the funds made available under this heading may be 

used by an eligible system (as defined in section 102 of the Protection and Advocacy for 

Individuals with Mental Illness Act (42 U.S.C. 10802)) to continue to pursue any legal 

action in a Federal or State court on behalf of an individual or group of individuals with a 

developmental disability (as defined in section 102(8)(A) of the Developmental Disabilities 

and Assistance and Bill of Rights Act of 2000 (20 U.S.C. 15002(8)(A)) that is attributable to 

a mental impairment (or a combination of mental and physical impairments), that has as the 

requested remedy the closure of State operated intermediate care facilities for people with 

intellectual or developmental disabilities, unless reasonable public notice of the action has 

been provided to such individuals (or, in the case of mental incapacitation, the legal 

guardians who have been specifically awarded authority by the courts to make healthcare 

and residential decisions on behalf of such individuals) who are affected by such action, 

within 90 days of instituting such legal action, which informs such individuals (or such legal 

guardians) of their legal rights and how to exercise such rights consistent with current 

Federal Rules of Civil Procedure: Provided further, That the limitations in the immediately 

preceding proviso shall not apply in the case of an individual who is neither competent to 

consent nor has a legal guardian, nor shall the proviso apply in the case of individuals who 

are a ward of the State or subject to public guardianship.
EXECUTIVE SUMMARY 

Appropriations Language Analysis 

Administration for Community Living 

Language Provision Explanation

For carrying out, to the extent not otherwise provided, 

the Older Americans Act of 1965 ("OAA"), titles III and 

XXIX of the PHS Act, sections 1252 and 1253 of the 

PHS Act, section 119 of the Medicare Improvements 

for Patients and Providers Act of 2008, title XX-B of the 

Social Security Act, the Developmental Disabilities 

Assistance and Bill of Rights Act, parts 2 and 5 of 

subtitle D of title II of the Help America Vote Act of 

2002, the Assistive Technology Act of 1998 

Sets out the budget authority for the Aging 

and Disability Services Programs 

appropriation.

For carrying out....title VII (and section 14 with respect 

to such title) of the Rehabilitation Act of 1973, and for 

Department-wide coordination of policy and program 

activities that assist individuals with disabilities

Consistent with the proposed transfer of 

NIDILRR to NIH (authorized by title II of the 

Rehabilitation Act of 1973), the reference to 

title II of the Rehabilitation Act of 1973 is 

deleted. 

Together with $37,500,000 to be transferred from 

the Federal Hospital Insurance Trust Fund and the 

Federal Supplementary Medical Insurance Trust 

Fund, to remain available until expended to carry 

out such section 119:

Consistent with the shift to request 

discretionary funding for the Medicare 

enrollment assistance programs described 

in section 119 of MIPPA.

Provided, That amounts appropriated under this 

heading may be used for grants to States under 

section 361 of the OAA only for disease prevention 

and health promotion programs and activities which 

have been demonstrated through rigorous 

evaluation to be evidence-based and effective:

Limits use of funding provided for the 

Preventive Health Services program to 

programs and activities which have been 

proven to be evidence-based and effective. 

Provided further, That of amounts made available 

under this heading to carry out sections 311, 331, and 

336 of the OAA, up to one percent of such amounts 

shall be available for developing and implementing 

evidence- based practices for enhancing senior 

nutrition:

Adds back enacted FY 2017 appropriations 

language that allows ACL to use up to 1% of 

its appropriations for nutrition innovation 

demonstrations designed to develop and 

implement evidence-based practices that 

enhance senior nutrition.

Provided further, That notwithstanding any other 

provision of this Act, funds made available under this 

heading to carry out section 311 of the OAA may be 

transferred to the Secretary of Agriculture in 

accordance with such section:

Allows for transfer of Nutrition Services 

Incentives (NSIP) funding to USDA to 

provide reimbursement for commodities 

elected by States or Tribes in lieu of part or 

all of their NSIP allocation. 

14
EXECUTIVE SUMMARY 

Language Provision Explanation

Provided further, that none of the funds made 

available under this heading may be used by an 

eligible system (as defined in section 102 of the 

Protection and Advocacy for Individuals with Mental 

Illness Act (42 U.S.C. 10802)) to continue to pursue 

any legal action in a Federal or State court on behalf of 

an individual or group of individuals with a 

developmental disability (as defined in section 

102(8)(A) of the Developmental Disabilities and 

Assistance and Bill of Rights Act of 2000 (20 U.S.C. 

15002(8)(A)) that is attributable to a mental 

impairment (or a combination of mental and physical 

impairments), that has as the requested remedy the 

closure of State operated intermediate care facilities 

for people with intellectual or developmental 

disabilities, unless reasonable public notice of the 

action has been provided to such individuals (or, in the 

case of mental incapacitation, the legal guardians who 

have been specifically awarded authority by the courts 

to make healthcare and residential decisions on behalf 

of such individuals) who are affected by such action, 

within 90 days of instituting such legal action, which 

informs such individuals (or such legal guardians) of 

their legal rights and how to exercise such rights 

consistent with current Federal Rules of Civil 

Procedure:

Identifies the purpose for which funds can 

be used

Provided further, That the limitations in the 

immediately preceding proviso shall not apply in the 

case of an individual who is neither competent to 

consent nor has a legal guardian, nor shall the proviso 

apply in the case of individuals who are a ward of the 

State or subject to public guardianship.

Identifies the limitations that are not 

applicable to listed individuals. 

15
EXECUTIVE SUMMARY

16 

Amounts Available for Obligation

Administration for Community Living

General Fund Discretionary Appropriation: FY 2017

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Appropriation (L/HHS, Ag, or, Interior) 1,919,000,000 1,919,000,000 1,818,681,000

Across-the-board reductions (-.6791%) -- -13,031,931 --

Secretary's Transfer -4,390,000 -- --

Subtotal, adjusted appropriation 1,914,610,000 1,905,968,069 1,818,681,000

Transfer of Funds to Department of Agriculture 1/ -2,553,916 -2,752,453 --

Total, Discretionary Appropriation 1,912,056,084 1,903,215,616 1,818,681,000

Mandatory Appropriation: FY 2017

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

BA Transfer (PPACA) from Prevention Funds 27,700,000 25,010,000 --

Appropriation (TRA/MACRA) MIPPA 2/3/ 24,500,000 24,500,000 --

Sequestration of MIPPA Funding 1,690,500 -- --

Subtotal, mandatory appropriation 50,509,500 49,510,000 0

Offsetting collections from: FY 2017

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

 Trust Funds: HCFAC HI 4/ 18,429,568 18,000,000 18,000,000

 Trust Funds: SHIPs HI/SMI 47,115,000 46,795,042 --

Subtotal, offsetting collections 65,544,568 64,795,042 18,000,000

Unobligated balance, lapsing 751,685 -- --

Total obligations 2,027,358,467 2,017,520,658 1,836,681,000

1/ Funding transferred to the Department of Agriculture is included within the Nutrition Services Incentives Program. Discretionary 

appropriations on this table will therefore differ by this amount from amounts listed on ACL's APT.

2/ MIPPA Funding excludes $13,000,000 in each year directly appropriated to CMS for MIPPA-SHIP and then made available to ACL through 

an Intra-Departmental Delegation of Authority.

3/ MIPPA funding is being requested in FY 2019 as discretionary funding.

4/ Amounts for FY 2018 and FY 2019 are placeholders pending Secretarial decisions on the amount needed to fully fund the program. 

Appropriations language first included in FY 2016 directs the Secretary to fully fund this program from CMS discretionary appropriations for the 

HCFAC program. FY 2017 amount includes carryover.
EXECUTIVE SUMMARY

17 

Total estimated budget authority 1,952,763

(Obligations) 1,952,763

2019 President's Budget Total estimated budget authority 1,818,681

(Obligations) 1,818,681

Net Change 134,082

Summary of Changes

Administration for Community Living

(Dollars in thousands) 

Increases FY2019

PB FTE

FY 2019

PB BA

FY 2019

+/- 

FY 2018

FTE

FY 2019 +/- 

FY 2018

BA

A. Built-in: - - - -

Subtotal, Built-in Increases - - - -

A. Program:

Home and Community-Based Services - 350,224 - 2,378

Nutrition Services - 837,753 - 5,689

Preventive Health Services - 24,848 - 5,135

Native American Nutrition and Supportive Svcs - 31,208 - 212

Family Caregiver Support Services - 150,586 - 1,023

Native American Caregiver Support Svcs - 7,556 - 51

Alzheimer's Disease Program - 19,490 - 19,490

Lifespan Respite Services - 3,360 - 23

Long-Term Care Ombudsman Program - 15,855 - 78

Prevention of Elder Abuse and Neglect - 4,773 - 32

DD Protection and Advocacy - 38,734 - 263

Traumatic Brain Injury 1.6 9,321 0 63

Aging and Disability Resource Centers - 6,119 - 42

Voting Access for People with Disabilities - 4,963 - 34

Medicare Imp. for Patients & Providers Act. - - 6 37,500

 Subtotal, Program Increases 1/ - 1,504,790 6 72,013

 Total Increases - 1,504,790 6 72,013
EXECUTIVE SUMMARY

18 

Summary of Changes - Continued

Administration for Community Living

(Dollars in thousands) 

Decreases FY2019

PB FTE

FY 2019

PB BA

FY 2019 +/-

FY 2018

FTE

FY 2019 +/- 

FY 2018

BA

Program Administration 136.6 37,987 -31.4 (1,804)

Subtotal, Built-in Decreases - 37,987 -31.4 (1,804)

A. Program:

Aging Network Support Activities 0.4 8,998 0 (895)

Alzheimer's Disease Supportive Services

Program - 0 - (4,767)

Elder Rights Support Activities 2.7 11,874 0 (1,906)

State Councils on Developmental

Disabilities - 56,000 - (16,504)

 University Centers for Excellence in DD - 32,546 - (5,811)

Projects of National Significance - 1,050 - (8,882)

 Independent Living 0.8 95,997 0 (4,499)

Limb Loss Resource Center - 0 - (2,483)

Paralysis Resource Center - 0 - (6,655)

NIDILLRR - 0 - (103,264)

State Health Insurance Assistance

Program... 0.0 0 -5.0 (46,795)

Assistive Technology - 31,939 - (1,830)

 Subtotal, Program Decreases 3.5 238,404 -5.0 (204,291)

 Total Decreases - 276,391 -36.4 (206,095)

Net Change 1/ - - -30.4 (134,082)

1/ Excludes FTE and dollars from mandatory programs (MIPPA and HCFAC in FY 2018 and HCFAC)

Budget Authority by Activity

Administration for Community Living

(Dollars in thousands) 

Health & Independence for Older Adults FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Home & Community-Based Supportive Services 349,426 347,846 350,224

Nutrition Services 833,284 832,064 837,753

Preventive Health Services 19,802 19,713 24,848

Native American Nutrition & Supportive Services 31,136 30,996 31,208

Aging Network Support Activities 9,938 9,893 8,998

Subtotal, Health & Independence for Older Adults 1,243,586 1,240,512 1,253,031
EXECUTIVE SUMMARY

19 

Budget Authority by Activity - Continued

Administration for Community Living

(Dollars in thousands) 

Caregiver & Family Support Services FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Family Caregiver Support Services 150,240 149,563 150,586

Native American Caregiver Support Services 7,539 7,505 7,556

Alzheimer's Disease Program/1 -- -- 19,490

Alzheimer's Disease Supportive Services Program/1 4,789 4,767 --

Lifespan Respite Care 3,352 3,337 3,360

Subtotal, Caregiver & Family Support Services 165,920 165,173 180,992

Protection of Vulnerable Adults FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Long-Term Care Ombudsman Program 15,848 15,777 15,855

Prevention of Elder Abuse & Neglect 4,762 4,741 4,773

Elder Rights Support Activities 13,847 13,780 11,874

Subtotal, Protection of Vulnerable Adults 34,457 34,297 32,502

Disability Programs, Research & Services FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

 State Councils on Developmental Disabilities 72,833 72,504 56,000

Developmental Disabilities Protection and Advocacy 38,645 38,471 38,734

University Centers for Excellence in Developmental Disabilities 38,530 38,357 32,546

Projects of National Significance 9,977 9,932 1,050

Independent Living 100,951 100,496 95,997

Limb Loss Resource Center 2,494 2,483 --

Paralysis Resource Center 6,682 6,655 --

Traumatic Brain Injury 9,300 9,258 9,321

 National Institute on Disability, Independent Living, and Rehab. 

Research 103,731 103,264 --

Subtotal, Disability Programs, Research & Services 383,143 381,419 233,648
EXECUTIVE SUMMARY

20 

Budget Authority by Activity - Continued 

Administration for Community Living

(Dollars in thousands) 

Protection of Vulnerable Adults FY 2017 Final FY 2018 Annualized CR FY 2019 

President's Budget

Long-Term Care Ombudsman 

Program 15,848 15,777 15,855

Prevention of Elder Abuse & 

Neglect 4,762 4,741 4,773

Elder Rights Support Activities 13,847 13,780 11,874

Subtotal, Protection of 

Vulnerable Adults 34,457 34,297 32,502

Disability Programs, Research & Services FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's Budget

State Councils on Developmental Disabilities 72,833 72,504 56,000

Developmental Disabilities Protection and Advocacy 38,645 38,471 38,734

University Centers for Excellence in Developmental 

Disabilities 38,530 38,357 32,546

Projects of National Significance 9,977 9,932 1,050

Independent Living 100,951 100,496 95,997

Limb Loss Resource Center 2,494 2,483 --

Paralysis Resource Center 6,682 6,655 --

Traumatic Brain Injury 9,300 9,258 9,321

National Institute on Disability, Independent Living, and 

Rehab. Research 103,731 103,264 --

 Subtotal, Disability Programs, Research & Services 383,143 381,419 233,648
EXECUTIVE SUMMARY

21 

Budget Authority by Activity - Continued

Administration for Community Living

(Dollars in thousands)

Consumer Information, Access & Outreach FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Aging and Disability Resource Centers [Discretionary] 6,105 6,077 6,119

State Health Insurance Assistance Program 47,115 46,795 --

Voting Access for People with Disabilities (HAVA) 4,952 4,929 4,963

Assistive Technology 33,922 33,769 31,939

Medicare Improvements for Patients and Providers Act/2 -- -- 37,500

 Subtotal, Consumer Information, Access & Outreach 92,094 91,571 80,521

Program Administration 39,971 39,791 37,987

 Total, Discretionary Budget Authority 1,959,171 1,952,763 1,818,681

Total FTE 196 187 161

1/ Funding for Alzheimer's programs is being consolidated into the Alzheimer's Disease program.

2/ The Budget requests discretionary funding for MIPPA in FY 2019; in prior years funding was provided/requested

as mandatory funding.
EXECUTIVE SUMMARY

22 

Authorizing Legislation

Administration for Community Living

Services FY 2018 Amount 

Authorized 

FY 2018 

Annualized CR 

FY 2019 Amount 

Authorized

FY 2019 

President's 

Budget 

1) Home and CommunityBased Supportive 

Services

OAA Section 303 (a)(1)

364,456,847 347,845,629 372,196,069 350,224,000

2) Nutrition Services

OAA Section 303 

(b)(1)(2), 311(e) 

874,637,011 832,063,818 893,084,162 837,753,000

3) Preventive Health 

Services 

OAA Section 361

20,803,107 19,713,212 21,244,860 24,848,000

4) Chronic Disease Self 

Management Education: 

OAA Section 411 

NA NA NA - 

5) Falls Prevention:

OAA Section 411 NA NA NA - 

6) National Family 

Caregiver Support 

Program 

OAA Section 303 (e)

157,564,066 149,563,370 160,791,658 150,586,000

7) Native American 

Nutrition and Supportive 

Services: OAA Sections 

643

32,601,843 30,996,066 33,269,670 31,208,000

8) Native American 

Caregiver Support 

Program:

OAA Section 631

7,879,982 7,504,687 8,041,398 7,556,000

9) Alzheimer’s Disease 

Program

OAA Section 411 NA NA NA 19,490,000

10) Long-Term Care 

Ombudsman Program: 

OAA Section 702(a).

16,621,101 15,777,125 16,961,573 15,855,000
EXECUTIVE SUMMARY

23 

Authorizing Legislation – Continued

Administration for Community Living

Services FY 2018 Amount 

Authorized 

FY 2018 

Annualized CR 

FY 2019 Amount 

Authorized 

FY 2019 

President's 

Budget 

11) Prevention of Elder 

Abuse and Neglect: 

OAA Section 702(b)

4,994,178 4,740,587 5,096,480 4,773,000

12) Elder Rights Support 

Activities 

OAA Sections 201, 202, 

and 411, 751, and 752, as

amended. Social Security 

Act, Title XX-B, Section 

2042. 

12,424,234 13,779,782 12,678,736 11,874,000

13) Aging Network 

Support Activities: 

OAA Sections 202, 215 

and 411

10,422,587 9,893,355 10,636,086 8,998,000

14) Alzheimer's Disease 

Demonstration Grants 

Public Health Services 

Act Section 398

Expired 4,767,403 Expired - 

15) Lifespan Respite Care

Lifespan Respite Care Act 

of 2006 and Public Health 

Service Act Title XXIX

Expired 3,337,182 Expired 3,360,000

16) Program 

Administration:

OAA Section 216 (a)

40,063,000 39,790,932 40,063,000 37,987,000

17) Aging and Disability 

Resource Centers

OAA Sections 216 (b)(4)

6,402,551 6,077,446 6,533,703 6,119,000
EXECUTIVE SUMMARY

24 

Authorizing Legislation – Continued

Administration for Community Living

Services FY 2018 Amount 

Authorized 

FY 2018 

Annualized CR 

FY 2019 Amount 

Authorized 

FY 2019 

President's Budget 

18) State Health 

Insurance Assistance 

Program: 

Omnibus Budget 

Reconciliation Act of 

1990 Section 436

Expired 46,795,042 Expired - 

20) State Councils 

on Developmental 

Disabilities

DD Act Section 

129(a)

Expired 72,504,257 Expired 56,000,000

21) Protection and 

Advocacy

DD Act Section 145

Expired 38,470,957 Expired 38,734,000

22) University 

Centers for 

Excellence in 

Developmental 

Disabilities

DD Act Section 156.

Expired 38,356,738 Expired 32,546,000

23) Projects of 

National 

Significance DD Act 

Section 163

Expired 9,932,090 Expired 1,050,000

24) Voting 

Assistance for 

People with 

Disabilities

Help America Vote 

Act Section 291.

Expired 4,929,296 Expired 4,963,000
EXECUTIVE SUMMARY

25 

Authorizing Legislation – Continued

Administration for Community Living 

Services FY 2018 Amount 

Authorized 

FY 2018 

Annualized CR 

FY 2019 Amount 

Authorized 

FY 2019 

President's Budget 

25) Paralysis 

Resource Center 

Public Health 

Services Act 

Sections 311 and 

317(k)(2)

N/A 6,654,500 N/A - 

26) National Institute 

on Disability, 

Independent Living, 

and Rehabilitation 

Research 

4/Rehabilitation Act 

of 1973 201

116,860,000 103,263,940 119,608,000 - 

27) Independent 

Living Rehabilitation 

Act of 1973, Title 

VII, Parts B, C, and 

Chapter 

2Independent Living 

State Grants Section 

714

25,714,000 22,722,636 26,319,000 17,841,000

Independent Living

Centers for 

Independent

Living Section 727

88,013,000 77,773,231 90,083,000 78,156,000

28) Assistive 

Technology (AT)

AT Act (including 

but not limited to 

Section 4-6)

Expired 33,769,106 Expired 31,939,000

29) Limb Loss 

Resource Center 

Public Health 

Services Act, Title 

III

N/A 2,483,023 N/A - 
EXECUTIVE SUMMARY

26 

Authorizing Legislation – Continued

Administration for Community Living

Services FY 2018 Amount 

Authorized 

FY 2018 

Annualized CR 

FY 2019 Amount 

Authorized 

FY 2019 

President's Budget 

30) Traumatic Brain 

Injury 

Reauthorization Act 

of 2014 

Traumatic Brain 

Injury State Grants

5,500,000 9,257,701 5,500,000 9,321,000

Traumatic Brain 

Injury

Reauthorization Act 

of 2014

Traumatic Brain 

Injury Protection and 

Advocacy

3,100,000 9,257,701 3,100,000 9,321,000

31) Medicare 

Improvements for 

Patients and 

Providers 

Act/1Aging and 

Disability Resource 

Centers

5,000,000 5,000,000 5,000,000 5,000,000

Area Agencies on 

Aging 7,500,000 7,500,000 7,500,000 7,500,000

National Center for 

Benefits Outreach 

and Enrollment

12,000,000 12,000,000 12,000,000 12,000,000

State Health 

Insurance Assistance 

Program 13,000,000 13,000,000 13,000,000 13,000,000

Total Request Level - $1,990,263,111 - $1,818,681,000

Unfunded 

Authorizations

Budget Estimate to 

Congress House Allowance

Senate 

Allowance Appropriation

Legal Assistance 

OAA Section 702 

(b)

4,994,178 0 5,096,480 0 

1/ Funding in FY 2018 was provided of mandatory appropriations. Discretionary funding is being requested in FY 

2019.
EXECUTIVE SUMMARY

27 

Appropriations History Table

Administration for Community Living

Fiscal Year

Budget Estimate 

to Congress House Allowance

Senate 

Allowance Appropriation

FY 2010 /1 1,491,343,000 1,530,881,000 1,495,038,000 1,516,297,000

FY 2010 Transfer -- -- -- -224,298

Subtotal -- -- -- 1,516,072,702

FY 2011 1,624,733,000 1,651,178,000 1,659,383,000 1,500,323,000

FY 2011 Rescission -- -- -- -3,000,646

Subtotal -- -- -- 1,497,322,354

FY 2012 /2 2,237,944,000 1,471,324,000 1,534,701,000 1,473,703,000

FY 2012 Rescission -- -- -- -2,785,299

Subtotal -- -- -- 1,470,917,701

FY 2013 /3 1,978,336,000 N/A 1,708,105,000 1,645,291,724

FY 2013 Rescission -- -- -- -3,290,583

FY 2013 Sequestration -- -- -- -82,768,046

FY 2013 Transfers -- -- -- -6,133,066

Subtotal -- -- -- 1,553,100,029

FY 2014 /4 2,094,755,000 N/A 1,716,664,000 1,662,258,000

FY 2014 Transfers -- -- -- -6,433,605

Subtotal -- -- -- 1,655,824,395

FY 2015 /5 2,062,279,000 N/A 1,676,152,000 1,673,256,000

FY 2015 Transfers -- -- -- -2,549,334

Subtotal -- -- -- 1,670,706,666

FY 2016 /6 2,104,976,000 1,944,358,000 1,861,089,000 1,964,850,000

FY 2016 Transfers -- -- -- -2,214,429

Subtotal -- -- -- 1,962,635,571
EXECUTIVE SUMMARY

28 

Appropriations History Table – Continued

Administration for Community Living

Fiscal Year

Budget Estimate 

to Congress

House 

Allowance

Senate 

Allowance Appropriation

FY 2017 /7 1,993,294,000 1,981,275,000 1,935,435,000 1,966,115,000

FY 2017 Transfers -- -- -- -6,943,916

Subtotal -- -- -- 1,959,171,084

FY 2018 /8,9 1,851,449,000 2,237,224,000 1,966,115,000 1,952,763,111

FY 2019 1,818,681,000 -- -- --

1/ Includes $2,544,103,000 in FY 2010 budget authority appropriated to AoA and transferred to the Department of 

Agriculture for commodities purchases pursuant to Public Law 110-19.

2/ Includes $2,025,445 in FY 2012 budget authority appropriated to AoA and transferred to the 

Department of Agriculture for commodities purchases pursant to Public Law 112-74.

3/ Includes $2,542,042 in FY 2013 budget authority appropriated to ACL and transferred to the 

Department of Agriculture for commodities purchases pursant to Public Law 113-6

4/ Includes $2,391,605 in FY 2014 budget authority appropriated to ACL and transferred to the Department of 

Agriculture for commodities purchases pursant to Public Law 113-76.

5/ Includes $2,549,334 in FY 2015 budget authority appropriated to ACL and transferred to the Department of 

Agriculture for commodities purchases pursant to Public Law 113-235.

6/ Includes $2,214,429 in FY 2016 budget authority appropriated to ACL and transferred to the Department of 

Agriculture for commodities purchases pursant to Public Law 114-113.

7/ Includes $2,553,916 in FY 2017 budget authority appropriated to ACL and transferred to the Department of 

Agriculture for commodities purchases pursuant to Public Law 115-31.

8/ House Allowance includes $300 million for the Senior Community Service Employment Program currently 

administered by the Department of Labor.

9/ Appropriation is the annualized Continuing Resolution Level.
EXECUTIVE SUMMARY

29 

Appropriations Not Authorized by Law

Administration for Community Living

Program Last Year of

Authorization 

Authorization 

Level

Appropriations in

Last Year of

Authorization 

Appropriations in

FY 2018 1/

Alzheimer's Disease

Supportive Services: PHSA

Section 398 FY 2002 Such Sums $11,483,000 $4,767,403

Lifespan Respite Care:

Lifespan Respite Care Act of 

2006 FY 2011 $94,810,000 $2,495,000 $3,337,182

State Health Insurance

Assistance Programs:

Omnibus Budget

Reconciliation Act of 1990

FY 1996 $10,000,000 N/A $46,795,042

Developmental Disabilities 

Assistance and Bill of Rights

Act FY 2007 Such Sums $155,115,000 $159,264,042

Voting Access for People

with

Disabilities: Help America

Vote

FY 2005 $17,410,000 $13,879,000 $4,929,296

Elder Justice / Adult

Protective Services: Social

Security Act, Title XX-B FY 2014 $129,000,000 $0 $9,932,000

The Assistive Technology

Act of 2004 FY 2010 Such Sums $25,000,000 $33,769,106

1/ FY 2018 Appropriations based on Annualized CR levels.
EXECUTIVE SUMMARY

30 

Health and Independence for Older Adults

Summary of Request

ACL’s Health and Independence for Older Adults programs, provide a foundation of supports that 

assist older individuals to remain healthy and independent in their homes and communities, 

avoiding more expensive institutional care. These programs include home and community-based 

supportive services, nutrition services (meals in both congregate settings and those delivered to 

seniors in their homes), and preventive health. 

The U.S. population over age 60 is projected to increase by 13 percent between 2016 and 2020, 

from 68.7 million to 77.6 million.6 In addition, the number of seniors age 65 and older with severe 

disabilities (defined as 3 or more limitations in activities of daily living), who are at greatest risk 

of nursing home admission, is projected to increase by 15 percent over the same period.7 Health 

and Independence for Older Adults programs are vital to helping seniors remain in their homes 

and communities at a lower cost than institutional services, for as long as possible. For example, 

65 percent of congregate and 92 percent of home-delivered meal recipients reported that the meals 

allowed them to continue living in their own homes.8

 Additionally, 55 percent of seniors using

transportation services rely on them for the majority of their trips to doctors’ offices, pharmacies, 

meal sites, and other critical daily activities that help them to remain in the community.9

Currently States can transfer up to 30 percent of their funding for Nutrition and Home and 

Community-Based Supportive Services (HCBSS) between these programs, and up to 40 percent

of Nutrition funding between the two Nutrition programs. In FY 2019, to provide States with 

maximum flexibility, ACL is proposing a new general provision to add additional funding 

flexibility by giving States the ability to transfer nearly all of the funds they receive for HCBSS, 

Nutrition, Preventive Health and Family Caregivers Support Services between any of these 

programs to achieve the funding distribution that best addresses their individual State’s unique 

needs. 

 

6 U.S. Census Bureau, “2014 National Population Projections,” Table 1. Projected Population by Single Year of Age, 

Sex, Race, and Hispanic Origin for the United States: 2014 to 2060. Released December 2014, 

http://www.census.gov/population/projections/data/national/2014/downloadablefiles.html. Accessed 02 January 

2018. U.S. Census Bureau, Annual Estimates of the Resident Population for Selected Age Groups by Sex for the

United States, States, Counties, and Puerto Rico Commonwealth and Municipios: April 1, 2010 to July 1, 2016: 

Released June 2017, https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk. 

Accessed 02 January 2018. 7 Ibid and Centers for Medicare & Medicaid Services, The characteristics and perceptions of the Medicare population

Data from the 2013 Medicare Current Beneficiary Survey. [data tables 2.5a and 2.6a]. 

http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS/Data-Tables-Items/2013CNP.html. 

Accessed 02 January 2018. 

8 2017 National Survey of Older Americans Act Participants. https://agid.acl.gov/. 

9 Ibid. 
EXECUTIVE SUMMARY

31 

ACL’s FY 2019 funding request for Health and Independence for Older Adults programs is 

$1,253,031, a reduction of $481,000 below the FY 2018 Annualized Continuing Resolution level. 

For FY 2019, specific program requests include:

$350,224,000 for Home and Community-Based Supportive Services (HCBSS), which is an 

increase of $2,378,000 over the FY 2018 Annualized Continuing Resolution. HCBSS provides

grants to States to fund a broad array of low cost services that enable seniors to remain in their 

homes for as long as possible, including adult day care, transportation, case management, personal 

care services, chore services, and physical fitness programs. These services also aid caregivers, 

who might otherwise have to be even more intensively relied upon to provide care for their loved 

ones, taking more time away from their work and other family responsibilities. 

• $837,753,000 for Nutrition programs, including Congregate Nutrition, Home-Delivered 

Nutrition and the Nutrition Services Incentives Program. The FY 2019 request is an 

increase of $5,689,000 above the FY 2018 Annualized Continuing Resolution for these 

programs. In FY 2019, the Nutrition Services programs will help 2.4 million older adults 

receive the meals they need to stay healthy and decrease their risk of disability, and 

institutionalization, the requested funding level would support over 221.6 million meals.

• $24,848,000 for Preventive Health Services, $5,136,000 over the FY 2018 Annualized 

Continuing Resolution level. ACL proposes consolidating the Chronic Disease SelfManagement Education (CDSME) program and the Falls Prevention program into the 

Preventive Health Services program at this higher funding level. This newly consolidated 

program would provide states the flexibility to target funding to the greatest areas of need 

in their communities, increasing the ability of States to focus resources where they are 

most needed. 

• $31,208,000 for Native American Nutrition and Supportive Services, which is consistent 

with the FY 2018 Annualized Continuing Resolution Level. These funds will provide 

approximately 5.5 million meals and over 1 million rides for Native American seniors to 

critical daily activities such as meal sites, medical appointments, and grocery stores.

• $8,998,000 for Aging Network Support Activities, which is a decrease of -$895,000 

below the FY 2018 Annualized Continuing Resolution Level and reflects the 

consolidation of the Alzheimer’s Call Center into the Alzheimer’s Disease Program line.

Aging Network Support Activities funds competitive grants and contracts for ongoing 

activities which help seniors and their families obtain information about their care options 

and benefits; and which provide technical assistance to assist States, Tribes, and 

community providers of aging services to carry out their mission to help older people 

remain independent and live in their own homes and communities.
EXECUTIVE SUMMARY

32 

Outcome and Outputs Table:

Health and Independence for Older Adults

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2018

Target

FY 2019

Target

FY 2019

Target

+/-FY 2018

Target

1.1 For Home and 

Community-based 

Services including 

Nutrition and Caregiver 

services increase the 

number of clients served 

per million dollars of 

Title III OAA funding. 

(Efficiency)

FY 2016: 8,885 clients

Target:

8,700 clients

(Target Exceeded)

8,800 clients 8,900 clients +100 clients

2.10 Increase the 

likelihood that the most 

vulnerable people 

receiving Older 

Americans Act Home and 

Community-based and 

Caregiver Support 

Services will continue to 

live in their homes and 

communities. (Outcome)

FY 2016: 63.6 weighted 

average

Target:

63 weighted average

(Target Exceeded)

63.25 weighted 

average

63.6 weighted 

average

+0.35 weighted 

average

3.3 The percentage of 

OAA clients served who 

live in rural areas is at 

least 15% greater than the 

percent of all US elders 

who live in rural areas. 

(Outcome)

FY 2016: 35.4%

Target:

26.2%

(Target Exceeded)

26.2% 26.2% Maintain

3.6 The percentage of 

OAA clients served who 

live in poverty is 150% 

greater than the percent 

of all U.S. elders living 

below the poverty level. 

(Outcome)

FY 2016: 32.9%

Target:

24.75%

(Target Exceeded)

25.68% 24.6% -1.08 
EXECUTIVE SUMMARY

33 

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EXECUTIVE SUMMARY

34 

Home and Community-Based Supportive Services

Services FY 2017

Final

FY 2018

Annualized 

CR

FY 2019

President’s 

Budget

FY 19

+/- 

FY 18

Home and Community-Based 

Services $349,426 $347,846 $350,224 +$2,378

*BA is in thousands of dollars, FTE is a whole number.

Authorizing Legislation: Section 303 (a)(1) of the Older Americans Act of 1965, as amended

FY 2019 Older Americans Act Authorization .............................................................$364,456,847 

Allocation Method ..................................................................................................... Formula Grant 

Program Description and Accomplishments:

The Home and Community-Based Supportive Services (HCBSS) program, established in 1973, 

provides formula grants to states and territories based on their share of the population age 60 and 

over to fund a broad array of low cost services that enable seniors to remain in their homes for as 

long as possible. Programs like HCBSS serve seniors holistically. While each service is valuable 

in and of itself, it is often the combination of supports that, when tailored to the needs of the 

individual, ensures that clients can remain in their own homes and communities instead of entering 

nursing homes or other types of institutional care. 

 

In addition, the services funded by this program – particularly adult day care, personal care, and 

chore services – also aid caregivers, who otherwise might have to be even more intensively 

involved with the care of their loved ones, taking time away from work and their other family 

responsibilities and further straining family budgets. Many of these caregivers are doubly 

challenged, as members of the so-called “sandwich generation,” by the need not only to care for 

their older loved ones, but also to provide assistance to their adult children. 

 

The services provided to seniors through the HCBSS program include access services such as 

transportation, case management, and information and referral; in-home services such as personal 

care, chore, and homemaker assistance; and community services such as adult day care and 

physical fitness programs. In addition to these services, the HCBSS program also funds multipurpose senior centers, which coordinate and integrate services for the elderly. 

While age alone does not determine the need for these long-term services and supports, statistics 

show that both disability rates and the use of long-term supports increase with advancing age. 

Among those aged 85 and older, 55.7 percent are unable to perform one or more critical activities 
EXECUTIVE SUMMARY

35 

of daily living and require long-term support10 Data also show that over 92 percent of seniors 

have at least one chronic condition and 76 percent have at least two.

. 11 Providing a variety of 

supportive services that meet the diverse needs of these older individuals is crucial to enabling 

them to remain healthy and independent in their homes and communities, and therefore avoid 

unnecessary, expensive nursing home care. 

Core OAA formula grant programs like HCBSS currently reach more than one in six seniors12, 

serving nearly a half million seniors in their own communities who meet the disability criteria for 

nursing home admission13 and helping to keep them from joining the 1.9 million seniors who live 

in institutional settings.14 Nationally, 25 percent of individuals 60 and older live alone15, and in 

FY 2016, 43 percent of OAA consumers were individuals who live alone.16 Living alone is a key 

predictor of nursing home admission, and HCBSS services are critical to their ability to remain at 

home, especially for those who do not have an informal caregiver to assist with their care. Research 

has also shown that childless seniors who live in a State with higher home and community-based 

service expenditures had significantly lower risk of nursing home admissions.17

 

Services provided by the HCBSS program in FY 2016 include: 

• Transportation Services provided nearly 23.7 million rides to doctor’s offices, grocery 

stores, pharmacies, senior centers, meal sites, and other critical daily activities 

(Output C).18

• Personal Care, Homemaker, and Chore Services provided nearly 40.8 million hours of 

assistance to seniors unable to perform activities of daily living (such as eating, dressing, or 

bathing) or instrumental activities of daily living (such as shopping or light housework) 

(Output D).19

 

10 Centers for Medicare & Medicaid Services, The characteristics and perceptions of the Medicare population. 

Data from the 2013 Medicare Current Beneficiary Survey. [data table 2.5a]. http://www.cms.gov/ResearchStatistics-Data-and-Systems/Research/MCBS/Data-Tables-Items/2013CNP.html. Accessed 02 January 2018. 

11 Ibid. 

12 ACL’S OAA State Performance Report, FY 2016.

13 Ibid

14 Centers for Medicare & Medicaid Services, The characteristics and perceptions of the Medicare population. Data 

from the 2013 Medicare Current Beneficiary Survey. [Table 1.2 Demographic and Socioeconomic Characteristics 

of Medicare Beneficiaries, by Age and by Gender and Age, 2013]. http://www.cms.gov/Research-Statistics-Dataand-Systems/Research/MCBS/Data-Tables-Items/2013CNP.html. Accessed 02 January 2018. 

15 Administration for Community Living, https://agid.acl.gov/DataGlance/. Data-at-a-Glance: American Community 

Survey (ACS) Public Use Microdata Sample (PUMS) 1-Year Files (2015), accessed 02 January, 2018.

16 ACL’S OAA State Performance Report, FY 2016

17 Muramatsu, Naoko. “Risk of Nursing Home Admission Among Older Americans: Does States’ Spending on 

Home and Community-Based Services Matter?” May 2007. Journal of Gerontology: Psychological Sciences.

18 ACL’S OAA State Performance Report, FY 2016

19 Id
EXECUTIVE SUMMARY

36 

• Adult Day Care/Day Health provided over 10.5 million hours of care for dependent 

adults in a supervised, protective group setting during some portion of a twenty-four hour 

day (Output E).20 

• Case Management Services provided over 3.6 million hours of assistance in assessing 

needs, developing care plans, and arranging services for older persons or their caregivers 

(Output F).21 

Continuing ACL’s commitment to provide services to those in most need nearly 48 percent of 

riders on OAA-funded transportation are mobility impaired, meaning they do not own a car, or if 

they do own a car, they do not drive, and are not near public transportation.22 Many of these 

individuals cannot safely drive a car, as nearly 73 percent of transportation riders have at least one 

of the following chronic conditions that could impair their ability to navigate safely:23

 

• 65 percent of riders had a doctor tell them they had vision problems (including glaucoma, 

macular degeneration or cataracts);24 

• 14 percent have had a stroke;25

• 5 percent have Alzheimer’s disease or another type of dementia;26 

• 3 percent have epilepsy;27 

• 2 percent have Multiple Sclerosis;28 and

• 2 percent have Parkinson’s disease.29

Of the transportation participants, 96 percent take daily medications, with over 15 percent taking 

10 to 20 medications daily.30 Data from ACL’s National Surveys of OAA Participants show that 

services such as transportation are providing these seniors with the assistance and information they 

need to help them remain at home. For example, 55 percent of seniors using transportation services 

 

20 Id

21 Id

22 2017 National Survey of Older Americans Act Participants. https://agid.acl.gov/. 

23 Id

24 Id

25 Id

26 Id

27 Id

28 Id

29 Id 30 Id
EXECUTIVE SUMMARY

37 

rely on them for the majority of their transportation needs and would otherwise be homebound, 

while over 82 percent of clients receiving case management reported that, as a result of the services 

arranged by the case manager, they were better able to care for themselves.31 In addition, a study 

published in the Journal of Aging and Health shows that the services provided by the HCBSS 

program, what the article calls “personal care services,” are the critical services that enable frail 

seniors to remain in their homes and out of nursing home care.32

 

Funding History:

Funding for Home and Community-Based Supportive Services over the past ten years is as 

follows: 

FY 2010 ...................................$368,290,000 

FY 2011 .................................$367,611,000 

FY 2012 ...................................$366,916,000 

FY 2013 .................................$347,724,297 

FY 2014 ...................................$347,724,000 

FY 2015 ...................................$347,724,000 

FY 2016 .................................$347,724,000 

FY 2017 ...................................$349,426,000 

FY 2018 Annualized CR .........$347,845,629 

FY 2019 President’s Budget ....$350,224,000 

Budget Request:

The FY 2019 request for Home and Community-Based Supportive Services is $350,224,000, is an 

increase of $2,378,000 over the FY 2018 Annualized Continuing Resolution. At the proposed 

FY 2019 funding level ACL estimates that the program will support 10.3 million hours of adult 

day care for older adults; 22.5 million rides for activities such as visiting the doctor, the pharmacy, 

or grocery stores; and 45.5 million hours of assistance to seniors who are unable to perform daily 

activities. These estimates take into account State, local, and private funding streams that also 

support these activities. 

The strength of the Older Americans Act is that it gives States the ability to define needs from the 

bottom up and the flexibility to direct funding accordingly to best meet the needs of their 

communities. These programs have strong partnerships with State and local governments, 

philanthropic organizations, and private donors that contribute funding. States typically have 

 

31 Id

32 Chen, Ya Mei and Elaine Adams Thompson. Understanding Factors That Influence Success of Home- and 

Community-Based Services in Keeping Older Adults in Community Settings. 2010. Journal of Aging and Health. 

V. 22: 267. Available: http://jah.sagepub.com/cgi/content/abstract/22/3/267.
EXECUTIVE SUMMARY

38 

leveraged resources of 2 or 3 dollars for every OAA dollar, significantly exceeding the programs’ 

match requirements.33 

Currently States can transfer up to 30 percent of their funding for Nutrition and HCBSS between 

these programs, and up to 40 percent of Nutrition funding between the Nutrition programs. In FY 

2019, ACL is proposing a new general provision that would provide additional funding flexibility, 

and give States the ability to transfer nearly all of the funds they receive for HCBSS, Nutrition, 

Preventive Health and Caregivers between any of these programs to best address their individual 

State’s unique needs. 

 

Outputs and Outcomes Table:

Home and Community-Based Supportive Services

Measure

Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2018

Target

FY 2019

Target

FY 2019

Target

+/-FY 2018

Target

1.1 For Home and 

Community-based 

Services including 

Nutrition and Caregiver 

services increase the 

number of clients served 

per million dollars of 

Title III OAA funding. 

(Efficiency)

FY 2016: 8,885 clients

Target:

8,700 clients

(Target Exceeded)

8,800 clients 8,900 clients +100 clients

2.9b Maintain at 90% or 

higher the percentage of 

transportation clients who 

rate services good to 

excellent. (Outcome)

FY 2016: 97%

Target:

90%

(Target Exceeded)

90% 90% Maintain

2.10 Increase the 

likelihood that the most 

vulnerable people 

receiving Older 

Americans Act Home and 

Community-based and 

Caregiver Support 

Services will continue to 

live in their homes and 

communities. (Outcome)

FY 2016: 63.6 weighted 

average

Target:

63 weighted average

(Target Exceeded)

63.25 weighted 

average

63.6 weighted 

average

+0.35 weighted 

average

 

33 ACL’S OAA State Performance Report, FY 2016
EXECUTIVE SUMMARY

39 

Measure

Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2018

Target

FY 2019

Target

FY 2019

Target

+/-FY 2018

Target

3.3 The percentage of 

OAA clients served who 

live in rural areas is at 

least 15% greater than the 

percent of all US elders 

who live in rural areas. 

(Outcome)

FY 2016: 35.4%

Target:

26.2%

(Target Exceeded)

26.2% 26.2% Maintain

3.6 The percentage of 

OAA clients served who 

live in poverty is 150% 

greater than the percent 

of all U.S. elders living 

below the poverty level. 

(Outcome)

FY 2016: 32.9%

Target:

24.75%

(Target Exceeded)

25.68% 24.6% -1.08

Indicator Year and Most Recent 

Result /

FY 2018

Projection

FY 2019

Projection

FY 2019

Projection

+/-FY 2018

Projection

Output C: Transportation 

Service Units (Output) FY 2016: 23.7 M 22.9 M 22.5 M -0.4

Output D: Personal Care, 

Homemaker and Chore 

Services units (Output)

FY 2016: 40.8 M 43.6 M 45.5 M +1.9

Output E: Adult Day 

Care/Day Health units

(Output)

FY 2016: 10.6 M 10.3 M 10.3 M Maintain

Output F: Case 

Management Services 

units (Output)

FY 2016: 3.7 M 3.5 M 3.5 M Maintain

Note: For presentation within the budget, ACL highlighted specific measures that are most directly related to Home 

and Community-Based Supportive Services; however multiple performance outcomes are impacted by this program 

because ACL’s performance measures (efficiency, effective targeting, and client outcomes) assess network-wide 

performance in achieving current strategic objectives.
EXECUTIVE SUMMARY

40 

Grant Awards Tables:

Home and Community-Based Supportive Services Grant Awards 

Awards FY 2017 

Final

FY 2018 

Annualized 

CR 

FY 2019 

President's 

Budget

Number of 

Awards 56 56 56 

Average Award $6,200,409 $6,149,414 $6,191,460

Range of Awards $217,014 - 

$33,831,124 

$215,229 - 

$33,492,814 

$216,701 - 

$34,227,076 
EXECUTIVE SUMMARY

41 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2019 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Home and Community-Based Supportive Services (CFDA 93.044)

State/Territory FY 2017

Final

FY 2018

Annualized CR

FY 2019

President's 

Budget

FY 2019 +/- 

FY 2018

Alabama 5,286,709 5,233,842 5,181,504 (52,338)

Alaska 1,736,115 1,721,836 1,733,609 11,773

Arizona 6,936,367 6,945,445 7,194,411 248,966

Arkansas 3,425,288 3,391,035 3,357,125 (33,910)

California 33,831,124 33,492,814 34,227,076 734,262

Colorado 4,713,557 4,717,465 4,886,567 169,102

Connecticut 4,309,094 4,266,003 4,223,343 (42,660)

Delaware 1,736,115 1,721,836 1,733,609 11,773

District of Columbia 1,736,115 1,721,836 1,733,609 11,773

Florida 24,715,567 24,468,411 24,581,363 112,952

Georgia 8,496,385 8,461,586 8,764,900 303,314

Hawaii 1,736,115 1,721,836 1,733,609 11,773

Idaho 1,736,115 1,721,836 1,733,609 11,773

Illinois 14,210,793 14,068,685 13,927,998 (140,687)

Indiana 6,777,591 6,709,815 6,642,717 (67,098)

Iowa 4,168,738 4,127,051 4,085,780 (41,271)

Kansas 3,358,672 3,325,085 3,291,834 (33,251)

Kentucky 4,638,742 4,592,355 4,546,431 (45,924)

Louisiana 4,692,188 4,645,266 4,598,813 (46,453)

Maine. 1,736,115 1,721,836 1,733,609 11,773

Maryland 5,730,772 5,673,464 5,641,168 (32,296)

Massachusetts 8,031,575 7,951,259 7,871,746 (79,513)

Michigan 11,012,313 10,902,190 10,793,168 (109,022)

Minnesota 5,380,738 5,326,931 5,349,259 22,328

Mississippi 3,201,939 3,169,920 3,138,221 (31,699)

Missouri 6,964,495 6,894,850 6,825,902 (68,948)

Montana 1,736,115 1,721,836 1,733,609 11,773

Nebraska 2,245,310 2,222,857 2,200,628 (22,229)

Nevada 2,696,093 2,700,099 2,796,886 96,787

New Hampshire 1,736,115 1,721,836 1,733,609 11,773

PROGRAM/CFDA NUMBER: Home and Community-Based Supportive Services (CFDA 93.044)
EXECUTIVE SUMMARY

42 

State/Territory FY 2017

Final

FY 2018

Annualized CR

FY 2019

President's Budget

FY 2019 +/- 

FY 2018

New Jersey 10,041,037 9,940,627 9,841,221 (99,406)

New Mexico 2,065,826 2,047,025 2,120,403 73,378

New York 23,758,307 23,520,724 23,285,517 (235,207)

North Carolina 9,661,736 9,607,792 9,952,193 344,401

North Dakota 1,736,115 1,721,836 1,733,609 11,773

Ohio 13,518,024 13,382,844 13,249,016 (133,828)

Oklahoma 4,185,770 4,143,912 4,102,473 (41,439)

Oregon 4,253,413 4,228,106 4,379,667 151,561

Pennsylvania 17,493,327 17,318,394 17,145,210 (173,184)

Rhode Island 1,736,115 1,721,836 1,733,609 11,773

South Carolina 5,049,895 5,050,181 5,231,210 181,029

South Dakota 1,736,115 1,721,836 1,733,609 11,773

Tennessee 6,614,031 6,547,891 6,641,902 94,011

Texas 21,079,481 21,031,216 21,785,101 753,885

Utah 2,002,579 2,005,844 2,077,746 71,902

Vermont 1,736,115 1,721,836 1,733,609 11,773

Virginia 7,694,882 7,617,933 7,872,598 254,665

Washington 6,749,725 6,746,199 6,988,024 241,825

West Virginia 2,713,561 2,686,425 2,659,561 (26,864)

Wisconsin 6,252,199 6,189,677 6,127,780 (61,897)

Wyoming 1,736,115 1,721,836 1,733,609 11,773

Subtotal, States 340,527,338 337,735,086 340,123,379 2,388,293

American Samoa 462,103 457,482 452,907 (4,575)

Guam 868,057 860,918 866,804 5,886

Northern Mariana Islands 217,014 215,229 216,701 1,472

Puerto Rico 4,280,343 4,237,540 4,195,165 (42,375)

Virgin Islands 868,057 860,918 866,804 5,886

Subtotal, States and 

Territories 347,222,912 344,367,173 346,721,760 2,354,587

Undistributed 1/ 2,203,088 3,478,456 3,502,240 23,784

TOTAL 349,426,000 347,845,629 350,224,000 2,378,371

1/ Program Support –Includes funds for Older Americans Act statutory requirements, including program evaluation and disaster 

assistance; and grant and program reporting systems costs. Funds unused for these purposes at the end of the year are allocated 

to States.
EXECUTIVE SUMMARY

43 

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EXECUTIVE SUMMARY

44 

Nutrition Services

 

 

Nutrition

FY 2017

Final

FY 2018

Annualized 

CR

FY 2019

President’s

Budget

FY 2019 

+/- 

FY 2018

Congregate Nutrition $449,313 $447,284 $450,342 +$3,058

Home Delivered $226,823 $225,798 $227,342 +$1,544 

Nutrition Services Incentive 

Program 1/ $157,148 $158,982 $160,069 +$1,087

Total: $833,284 $832,064 $837,753 +$5,689

*BA is in thousands of dollars, FTE is a whole number.

1/ Includes $2,553,916 that was transferred to USDA to pay for State elections of commodities. 

Authorizing Legislation: Sections 311, 331 and 336 of the Older Americans Act of 1965, as 

amended

FY 2019 Older Americans Act Authorization .............................................................$893,084,162 

Allocation Method ..................................................................................................... Formula Grant 

Program Description and Accomplishments:

Nutrition Services help older Americans remain healthy and independent in their communities by 

providing meals and related services in a variety of community settings (including congregate 

facilities such as senior centers) and via home-delivery to older adults who are homebound due to 

illness, disability, or geographic isolation. These services occur in all 50 states, the District of 

Columbia, and five territories through a network of more than 5,000 local nutrition service 

providers.34 Nutrition Services currently include:

• Congregate Nutrition Services (Title III-C1): Provides funding for the provision of meals 

and other related services in a variety of community settings (e.g. senior centers, churches 

community centers, congregate dining facilities, school cafeterias, restaurants, farmers 

markets, hospital cafeterias, etc.) which help older individuals remain healthy and prevents 

the need for more costly medical interventions. Established in 1972, the program also 

presents opportunities for social engagement, health promotion activities, nutrition 

education, nutrition counseling and meaningful volunteer and social engagement roles, all 

of which contribute to participants’ overall health and well-being. Congregate Nutrition 

 

34 ACL’S OAA State Performance Report, FY 2016
EXECUTIVE SUMMARY

45 

Services provided 79.4 million meals to nearly 1.6 million seniors in a variety 

of community settings in FY 2016.35

• Home-Delivered Nutrition Services (Title III-C2): Provides funding for the delivery of

meals and related services to frail seniors who are home-bound. Established in 1978, homedelivered meals are often the first in-home service that an older adult receives and are often

the primary access point for other home- and community-based services. In addition to

providing a meal, this program helps frail home-bound seniors combat isolation and

maintain contact with the outside world. Home-delivered meals also represent an essential

service for some caregivers who also receive meals, helping them maintain their own health

and well-being while caring for their loved ones. Home-Delivered Nutrition Services

provided 145.5 million meals to over 868,000 individuals in FY 2016.36

• Nutrition Services Incentive Program (Title III-A): Provides a secondary source of funding

that must be used exclusively to provide meals, but which can be applied to either

congregate or home-delivered meals. Recipients can elect to receive part or all of their

grants as commodities from the U.S. Department of Agriculture if they determine that

doing so will enable them to better meet the needs of older adults. Six States and five tribes

elected to spend just over $2.5 million on commodities (including $132,415 assessed by

USDA as administrative expenses) in FY 2017.

Formula grants for congregate nutrition services and home-delivered nutrition services are 

allocated to states and territories based on their share of the population age 60 and over. Nutrition 

Services Incentive Program (NSIP) grants are provided to states, territories, and eligible tribal 

organizations based on the number of meals served in the prior fiscal year. The meals provided 

through these programs fulfill the standards set by the current Dietary Guidelines for Americans. 

Nutrition services assist over 2.4 million (2016)37 diverse participants with characteristics that 

place them at higher risk for health care interventions as well as institutionalization. For example:

• The percentage of home-delivered meal recipients with severe disabilities (3+ ADL) was

41 percent in 2016.38 This level of disability is frequently associated with nursing home

admission, and demonstrates the extreme frailty of a significant number of home-delivered

meal clients. Approximately 71 percent of home-delivered meal recipients have annual

incomes at or below $20,000.39 Nearly 61 percent of recipients of home-delivered meals

and 53 percent of participants in congregate meals report these meals as half or more of

their food intake for the day.40

35 Id

36 Id

37 Id

38 Id

39 2017 National Survey of Older Americans Act Participants. https://agid.acl.gov/.
EXECUTIVE SUMMARY

46 

• The prevalence of multiple chronic conditions is higher among congregate and 

home-delivered meal program participants than for the general Medicare population. In 

fact, data from ACL’s National Survey of OAA Participants indicate that about 47 percent 

of congregate and 64 percent of home-delivered participants have six or more chronic 

health conditions. About 21 percent of congregate and 40 percent of home-delivered 

participants take over six medications per day and some take as many as 20 medications.41

At the same time, most common chronic conditions such as hypertension, heart disease, 

diabetes, and osteoporosis are related to nutrition as a primary prevention, risk reduction, 

or treatment modality. Therefore, the provision of healthy meals, access to lifestyle 

modification programs, and evidence-based advice such as nutrition education and 

counseling are important to helping these older individuals avoid more serious medical 

care.

• About 15 percent of people who participate in congregate meal programs and 54 percent

of home-delivered participants need help in getting outside the house, thus limiting their 

ability to shop for food themselves.42

• About 47 percent of congregate participants and 58 percent of home-delivered participants 

live alone.43 Living alone is a risk factor for social isolation, poorer health, and nursing 

home placement.

Data show that Nutrition Services are effective in helping older adults improve their nutritional 

intake and remain at home. For example, 81 percent of congregate meal participants and 79 percent 

of home-delivered meal participants say they eat healthier meals due to the programs, and 65 

percent of congregate meal participants and 92 percent of home-delivered meal recipients say that 

the meals enable them to continue living in their homes.44 Eighty-eight percent of home-delivered 

meal clients rate service as good to excellent.45

In addition, states that invest more in delivering meals to older adults’ homes have lower rates of 

“low-care” seniors (defined as residents who have the functional capacity to live in a less careintensive environment) living in nursing homes, after adjusting for several other factors.46 For 

every $25 per year per older adult that states spend on home-delivered meals, they reduce their 

percentage of low-care nursing home residents compared to the national average by 1 percent.47

 

40 Id 41 Id 42 Id 43 Id 44 Id

45 Id 46 Thomas, K & Mor, V. The Relationship between Older Americans Act Title III State Expenditures & Prevalence 

of Low-Care Nursing Home Residents. Health Services Research. 12.3.12. 

http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12015/abstract
EXECUTIVE SUMMARY

47 

Funding History:

Comparable funding for Nutrition Services over the past ten years is as follows:

FY 2010 ...................................$819,353,000 

FY 2011 .................................$817,835,000 

FY 2012 ...................................$816,289,000 

FY 2013 .................................$768,310,870 

FY 2014 ...................................$811,191,000 

FY 2015 ...................................$814,657,000 

FY 2016 ..................................$834,753,000 

FY 2017 ...................................$833,284,084 

FY 2018 Annualized CR ..........$832,064,000

FY 2019 President’s Budget ....$837,753,000

Budget Request:

The FY 2019 request for Nutrition Services is $837,753,000, which is an increase of $5,689,000 

above the FY 2018 Annualized Continuing Resolution. This represents only a portion of the total 

funding for meals programs.48 Combined with these state and local contributions, the request is 

projected to provide approximately 221.6 million meals to more than 2.4 million older Americans 

in a variety of community settings. In FY 2019, the Nutrition programs are expected to continue 

to provide home-delivered meals that clients rate as good to excellent, ensuring that clients 

continue to receive high quality services. 

Currently, States can transfer up to 30 percent of their funding for Nutrition and HCBSS between 

these programs, and up to 40 percent of Nutrition funding between the congregate and homedelivered programs. ACL is proposing a new general provision to build on existing flexibility and 

give States the ability to transfer nearly all of the funds they receive for HCBSS, Nutrition, 

Preventive Health and Caregivers between any of these programs to best address their individual 

State’s needs.

Program Evaluation 

An evaluation of the OAA Title III-C Nutrition Services program (NSP) is ongoing; a report of 

the process evaluation is available at: https://www.acl.gov/sites/default/files/programs/2017-

 

47 Id.

48 J. Ziegler et al. Final Report: Older Americans Act Nutrition Programs Evaluation: Meal Cost Analysis. Sept 25, 

2015
EXECUTIVE SUMMARY

48 

02/NSP-Process-Evaluation-Report.pdf and the cost study report is available at: 

https://www.acl.gov/sites/default/files/programs/2017-05/NSP-Meal-Cost-Analysis_v2.pdf

The data collected to date provide information crucial for program operations and also show that 

the OAA Title III-C Nutrition Services Program (NSP) is meeting its stated goals. The program 

provides appropriate supportive services which are responsive to local community and individuals’ 

needs. For example, since the last evaluation was conducted in 1995, 15 percent more providers 

offer weekend meal service and almost 15 percent more sites provide specialized meal choices to 

meet the health needs of recipients. With nearly two-thirds of meal providers offering non-nutrition 

services to promote the well-being of older Americans, the program is a key component of a 

continuum of care that makes it possible for older adults to continue living in the community. 

The program also is using federal funds efficiently; the federal expenditure is $1.88 per home 

delivered meal and $3.52 per congregate meal, but when all costs are included, the value of the 

meal is actually $11.06 for a home-delivered meal and $10.69 for a congregate meal. 

Evaluation results are consistent with annual performance data that indicate the programs help 

participants to live independently in the community; eat healthier foods, improve their health and 

achieve or maintain a healthy weight. If the nutrition program were not available, sizeable 

percentages of participants (61 percent of home-delivered meal participants and 42 percent of 

congregate meal participants) indicated they would skip meals or eat less. 

Outcomes and Outputs Table:

Nutrition Services

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2018

Target

FY 2019

Target

FY 2019

Target

+/-FY 2018

Target

1.1 For Home and 

Community-based 

Services including 

Nutrition and Caregiver 

services increase the 

number of clients served 

per million dollars of 

Title III OAA funding. 

(Efficiency)

FY 2016: 8,885 clients

Target:

8,700 clients

(Target Exceeded)

8,800 clients 8,900 clients +100 clients

2.9a Maintain at 90% or 

higher the percentage of 

clients receiving home 

delivered meal who rate 

services good to 

excellent. (Outcome)

FY 2016: 88%

Target:

90%

(Target Not Met)

90% 90% Maintain
EXECUTIVE SUMMARY

49 

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2018

Target

FY 2019

Target

FY 2019

Target

+/-FY 2018

Target

2.10 Increase the 

likelihood that the most 

vulnerable people 

receiving Older 

Americans Act Home and 

Community-based and 

Caregiver Support 

Services will continue to 

live in their homes and 

communities. (Outcome)

FY 2016: 63.6 weighted 

average

Target:

63 weighted average

(Target Exceeded)

63.25 weighted 

average

63.6 weighted 

average

+0.35 weighted 

average

3.3 The percentage of 

OAA clients served who 

live in rural areas is at 

least 15% greater than the 

percent of all US elders 

who live in rural areas. 

(Outcome)

FY 2016: 35.4%

Target:

26.2%

(Target Exceeded)

26.2% 26.2% Maintain

3.5 Increase the 

percentage of older 

persons with severe 

disabilities who receive 

home-delivered meals. 

(Outcome)

FY 2016: 41.3%

Target:

45%

(Target Not Met)

42.4% 42.4% Maintain

3.6 The percentage of 

OAA clients served who 

live in poverty is 150% 

greater than the percent 

of all U.S. elders living 

below the poverty level. 

(Outcome)

FY 2016: 32.9%

Target:

24.75%

(Target Exceeded)

25.68% 24.6% -1.08
EXECUTIVE SUMMARY

50 

Indicator Year and Most Recent 

Result /

FY 2018

Projection

FY 2019

Projection

FY 2019

Projection

+/-FY 2018 

Projection

Output G: Number of 

Home-Delivered meals 

served (Output)

FY 2016: 145.5 M 145.8 M 146.3 M +0.5

Output H: Number of 

Congregate meals served 

(Output)

FY 2016: 79.4 M 76.3 M 75.3 M -1 

Outputs G & H: Total 

Number of Meals 

(Output)

FY 2016: 224.9 M 222.1 M 221.6 M -0.5

Note: For presentation within the budget, ACL highlighted specific measures that are most directly related to 

Nutrition Services, however multiple performance outcomes are impacted by this program because ACL’s 

performance measures (efficiency, effective targeting, and client outcomes) assess network-wide performance in 

achieving current strategic objectives. 
EXECUTIVE SUMMARY

51 

Grant Awards Tables:

Congregate Nutrition Programs Grant Awards 

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 56 56 56 

Average Award $7,961,029 $7,895,444 $7,949,510

Range of Awards $278,636 - 

$45,370,530 

$276,341 - 

$45,273,225 

$278,233 - 

$45,873,334 

Home-Delivered Nutrition Programs Grant Awards

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 56 56 56 

Average Award $4,018,820 $3,985,824 $4,013,118

Range of Awards $140,659 - 

$23,603,150 

$139,504 - 

$23,367,120 

$140,459 - 

$23,563,890 

Nutrition Services Incentive Program Grant Awards 

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards/1 326 326 326 

Average 

Award/2 $486,576 $482,798 $486,099 

Range of 

Awards/2

$48,929 - 

$13,095,076 

$48,540 - 

$12,990,961 

$48,880 - 

$13,081,945 

 1/ Number of Awards includes 56 States and 270 Tribes

 2/Grants to Tribes are excluded from the calculations for the average and the

 range of awards.
EXECUTIVE SUMMARY

52 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2019 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Congregate Nutrition Services (CFDA 93.045)

State/Territory FY 2017

Final

FY 2018

Annualized CR

FY 2019

President's Budget

FY 2019 +/-

FY 2018

Alabama 6,654,431 6,587,887 6,654,840 66,953

Alaska 2,229,088 2,210,724 2,225,863 15,139

Arizona 9,496,851 9,486,544 9,642,414 155,870

Arkansas 4,121,928 4,080,709 4,069,935 (10,774)

California 45,730,530 45,273,225 45,873,334 600,109

Colorado 6,453,514 6,443,371 6,549,293 105,922

Connecticut 5,189,037 5,137,147 5,085,776 (51,371)

Delaware 2,229,088 2,210,724 2,225,863 15,139

District of Columbia 2,229,088 2,210,724 2,225,863 15,139

Florida 32,559,130 32,412,699 32,945,527 532,828

Georgia 11,632,730 11,557,295 11,747,284 189,989

Hawaii 2,229,088 2,210,724 2,225,863 15,139

Idaho 2,229,088 2,210,724 2,225,863 15,139

Illinois 17,113,676 16,942,539 16,773,114 (169,425)

Indiana 8,533,317 8,447,984 8,528,519 80,535

Iowa 5,030,686 4,980,379 4,930,575 (49,804)

Kansas 4,049,004 4,008,514 3,968,429 (40,085)

Kentucky 5,928,874 5,869,585 5,919,611 50,026

Louisiana 5,825,212 5,766,960 5,850,507 83,547

Maine 2,229,088 2,210,724 2,225,863 15,139

Maryland 7,536,434 7,461,070 7,560,656 99,586

Massachusetts 9,682,464 9,585,639 9,489,783 (95,856)

Michigan 13,877,129 13,738,358 13,861,656 123,298

Minnesota 7,138,238 7,066,856 7,169,422 102,566

Mississippi 3,856,890 3,818,321 3,850,228 31,907

Missouri 8,382,377 8,298,553 8,297,160 (1,393)

Montana 2,229,088 2,210,724 2,225,863 15,139

Nebraska 2,711,414 2,684,300 2,657,457 (26,843)

Nevada 3,691,325 3,687,941 3,748,567 60,626

New Hampshire 2,229,088 2,210,724 2,225,863 15,139

PROGRAM/CFDA NUMBER: Congregate Nutrition Services (CFDA 93.045)
EXECUTIVE SUMMARY

53 

State/Territory FY 2017

Final

FY 2018

Annualized CR

FY 2019

President's Budget

FY 2019 +/- 

FY 2018

New Jersey 12,068,583 11,947,897 11,828,418 (119,479)

New Mexico 2,828,401 2,800,118 2,841,901 41,783

New York 28,674,216 28,387,474 28,103,599 (283,875)

North Carolina 13,228,258 13,122,845 13,338,570 215,725

North Dakota 2,229,088 2,210,724 2,225,863 15,139

Ohio 16,229,847 16,067,549 16,132,548 64,999

Oklahoma 5,029,929 4,979,630 5,006,303 26,673

Oregon 5,823,512 5,774,977 5,869,912 94,935

Pennsylvania 21,066,919 20,856,250 20,647,688 (208,562)

Rhode Island 2,229,088 2,210,724 2,225,863 15,139

South Carolina 6,914,007 6,897,813 7,011,205 113,392

South Dakota 2,229,088 2,210,724 2,225,863 15,139

Tennessee 8,879,923 8,791,124 8,901,904 110,780

Texas 28,860,736 28,725,579 29,197,796 472,217

Utah 2,741,809 2,739,691 2,784,728 45,037

Vermont 2,229,088 2,210,724 2,225,863 15,139

Virginia 10,481,870 10,380,715 10,551,363 170,648

Washington 9,241,311 9,214,326 9,365,800 151,474

West Virginia 3,272,888 3,240,159 3,207,757 (32,402)

Wisconsin 7,958,356 7,878,772 7,971,461 92,689

Wyoming 2,229,088 2,210,724 2,225,863 15,139

Subtotal, States 437,473,900 433,880,207 436,871,259 2,991,052

American Samoa 588,895 583,006 577,176 (5,830)

Guam 1,114,544 1,105,362 1,112,931 7,569

Northern Mariana Islands 278,636 276,341 278,233 1,892

Puerto Rico 5,247,083 5,194,612 5,220,050 25,438

Virgin Islands 1,114,544 1,105,362 1,112,931 7,569

Subtotal, States and 

Territories 445,817,602 442,144,890 445,172,580 3,027,690

Undistributed 1/ 3,495,398 5,138,837 5,169,420 30,583

TOTAL 449,313,000 447,283,727 450,342,000 3,058,273

1/ Program Support – Includes funds for Older Americans Act statutory requirements, including program evaluation and disaster 

assistance; and grant and program reporting systems costs. Funds unused for these purposes at the end of the year are allocated 

to States. 
EXECUTIVE SUMMARY

54 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2019 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Home-Delivered Nutrition Services (CFDA 93.045)

State/Territory FY 2017

Final

FY 2018

Annualized CR

FY 2019

President's Budget

FY 2019 +/-

FY 2018

Alabama 3,434,588 3,400,242 3,418,411 18,169

Alaska 1,125,270 1,116,031 1,123,673 7,642

Arizona 4,901,661 4,896,296 4,953,046 56,750

Arkansas 2,113,944 2,092,805 2,090,616 (2,189)

California 23,603,150 23,367,120 23,563,890 196,770

Colorado 3,330,888 3,325,620 3,364,194 38,574

Connecticut 2,555,699 2,530,142 2,534,498 4,356

Delaware 1,125,270 1,116,031 1,123,673 7,642

District of Columbia 1,125,270 1,116,031 1,123,673 7,642

Florida 16,804,923 16,729,184 16,923,224 194,040

Georgia 6,004,065 5,965,073 6,034,261 69,188

Hawaii 1,125,270 1,116,031 1,123,673 7,642

Idaho 1,125,270 1,116,031 1,123,673 7,642

Illinois 8,351,441 8,267,927 8,276,139 8,212

Indiana 4,404,348 4,360,305 4,380,869 20,564

Iowa 2,255,215 2,232,663 2,233,536 873

Kansas 1,931,835 1,912,517 1,921,849 9,332

Kentucky 3,060,102 3,029,501 3,040,743 11,242

Louisiana 3,006,599 2,976,533 3,005,247 28,714

Maine 1,130,464 1,119,159 1,125,114 5,955

Maryland 3,889,821 3,850,923 3,883,704 32,781

Massachusetts 4,718,223 4,671,041 4,697,792 26,751

Michigan 7,162,479 7,090,854 7,120,357 29,503

Minnesota 3,684,298 3,647,455 3,682,738 35,283

Mississippi 1,990,678 1,970,771 1,977,758 6,987

Missouri 4,290,047 4,247,147 4,262,026 14,879

Montana 1,125,270 1,116,031 1,123,673 7,642

Nebraska 1,261,576 1,248,960 1,256,147 7,187

Nevada 1,905,224 1,903,459 1,925,537 22,078

New Hampshire 1,125,270 1,116,031 1,123,673 7,642
EXECUTIVE SUMMARY

55 

PROGRAM/CFDA NUMBER: Home-Delivered Nutrition Services (CFDA 93.045)

State/Territory FY 2017

Final

FY 2018

Annualized CR

FY 2019

President's Budget

FY 2019 +/-

FY 2018

New Jersey 6,053,936 5,993,397 6,010,312 16,915

New Mexico 1,459,839 1,445,240 1,459,808 14,568

New York 13,344,159 13,210,717 13,235,717 25,000

North Carolina 6,827,574 6,773,101 6,851,662 78,561

North Dakota 1,125,270 1,116,031 1,123,673 7,642

Ohio 8,349,511 8,266,016 8,286,853 20,837

Oklahoma 2,590,327 2,564,424 2,571,602 7,178

Oregon 3,005,722 2,980,642 3,015,214 34,572

Pennsylvania 9,742,844 9,645,416 9,647,550 2,134

Rhode Island 1,125,270 1,116,031 1,123,673 7,642

South Carolina 3,568,565 3,560,172 3,601,466 41,294

South Dakota 1,125,270 1,116,031 1,123,673 7,642

Tennessee 4,583,244 4,537,412 4,572,667 35,255

Texas 14,896,051 14,826,149 14,998,116 171,967

Utah 1,415,145 1,414,038 1,430,439 16,401

Vermont 1,125,270 1,116,031 1,123,673 7,642

Virginia 5,410,065 5,357,804 5,419,949 62,145

Washington 4,769,769 4,755,795 4,810,957 55,162

West Virginia 1,512,100 1,496,979 1,485,785 (11,194)

Wisconsin 4,107,590 4,066,514 4,094,723 28,209

Wyoming 1,125,270 1,116,031 1,123,673 7,642

Subtotal, States 220,930,949 219,121,885 220,648,592 1,526,707

American Samoa 140,659 139,504 140,459 955

Guam 562,635 558,015 561,836 3,821

Northern Mariana Islands 140,659 139,504 140,459 955

Puerto Rico 2,716,380 2,689,216 2,681,398 (7,818)

Virgin Islands 562,635 558,015 561,836 3,821

Subtotal, States and 

Territories 225,053,917 223,206,139 224,734,580 1,528,441

Undistributed 1/ $1,769,083 2,591,981 2,607,420 15,439

TOTAL 226,823,000 225,798,120 227,342,000 1,543,880

1/ Program Support –includes funds for Older Americans Act statutory requirements, including program evaluation and disaster 

assistance; and grant and program reporting systems costs. Funds unused for these purposes at the end of the year are allocated 

to States. 
EXECUTIVE SUMMARY

TIVE SUMMARY

56 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2019 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Nutrition Services Incentive Program (CFDA 93.053)

State/Territory FY 2017

Final

FY 2018

Annualized CR

FY 2019

President's 

Budget

FY 2019 +/- 

FY2018

Alabama 3,261,707 3,235,775 3,258,437 22,662

Alaska 482,222 478,388 481,739 3,351

Arizona 1,749,512 1,735,602 1,747,758 12,156

Arkansas 2,473,090 2,453,427 2,470,610 17,183

California 13,095,076 12,990,961 13,081,945 90,984

Colorado 1,381,678 1,370,693 1,380,293 9,600

Connecticut 1,549,754 1,537,433 1,548,200 10,767

Delaware 736,785 730,927 736,046 5,119

District of Columbia 787,624 781,362 786,834 5,472

Florida 6,116,211 6,067,583 6,110,078 42,495

Georgia 2,853,558 2,830,870 2,850,697 19,827

Hawaii 484,828 480,974 484,342 3,368

Idaho 800,430 794,066 799,628 5,562

Illinois 5,771,528 5,725,641 5,765,741 40,100

Indiana 1,402,692 1,391,540 1,401,286 9,746

Iowa 1,673,647 1,660,341 1,671,969 11,628

Kansas 2,286,817 2,268,635 2,284,524 15,889

Kentucky 1,639,806 1,626,769 1,638,162 11,393

Louisiana 3,408,033 3,380,937 3,404,615 23,678

Maine 595,649 590,913 595,052 4,139

Maryland 1,627,181 1,614,244 1,625,549 11,305

Massachusetts 6,704,959 6,651,650 6,698,236 46,586

Michigan 7,676,756 7,615,720 7,669,058 53,338

Minnesota 1,798,504 1,784,204 1,796,700 12,496

Mississippi 1,520,183 1,508,096 1,518,659 10,563

Missouri 3,981,217 3,949,563 3,977,225 27,662

Montana 1,207,247 1,197,648 1,206,036 8,388

Nebraska 1,118,879 1,109,983 1,117,757 7,774

Nevada 1,542,779 1,530,513 1,541,232 10,719

New Hampshire 1,332,416 1,321,823 1,331,080 9,257

Michigan 7,676,756 7,615,720 7,669,058 53,338

Minnesota 1,798,504 1,784,204 1,796,700 12,496

Mississippi 1,520,183 1,508,096 1,518,659 10,563

Missouri 3,981,217 3,949,563 3,977,225 27,662
EXECUTIVE SUMMARY

57 

State/Territory FY 2017

Final

FY 2018

Annualized CR

FY 2019

President's 

Budget

FY 2019 +/- 

FY2018

Montana 1,207,247 1,197,648 1,206,036 8,388

Nebraska 1,118,879 1,109,983 1,117,757 7,774

Nevada 1,542,779 1,530,513 1,541,232 10,719

New Hampshire 1,332,416 1,321,823 1,331,080 9,257

PROGRAM/CFDA NUMBER: Nutrition Services Incentive Program (CFDA 93.053) 

State/Territory FY 2017

Final

FY 2018

Annualized CR

FY 2019

President's Budget

FY 2019 +/- 

FY 2018

New Jersey 3,558,963 3,530,667 3,555,394 24,727

New Mexico 2,328,708 2,310,193 2,326,373 16,180

New York 16,520,198 16,388,848 16,503,629 114,781

North Carolina 3,295,202 3,269,003 3,291,898 22,895

North Dakota 805,159 798,758 804,352 5,594

Ohio 5,678,193 5,633,048 5,672,500 39,452

Oklahoma 2,058,212 2,041,847 2,056,148 14,301

Oregon 1,889,136 1,874,116 1,887,241 13,125

Pennsylvania 6,349,218 6,298,737 6,342,851 44,114

Rhode Island 424,242 420,869 423,817 2,948

South Carolina 1,701,588 1,688,060 1,699,882 11,822

South Dakota 885,224 878,186 884,336 6,150

Tennessee 1,628,108 1,615,164 1,626,476 11,312

Texas 11,447,247 11,356,233 11,435,768 79,535

Utah 1,307,393 1,296,998 1,306,082 9,084

Vermont 810,909 804,462 810,096 5,634

Virginia 2,019,748 2,003,690 2,017,723 14,033

Washington 2,248,459 2,230,582 2,246,205 15,623

West Virginia 1,520,860 1,508,769 1,519,336 10,567

Wisconsin 2,795,630 2,773,403 2,792,827 19,424

Wyoming 855,934 849,129 855,076 5,947

Subtotal, States 151,189,099 149,987,043 151,037,498 1,050,455

American Samoa 135,436 134,360 135,301 941

Guam 400,139 396,957 399,738 2,781

Northern Mariana Islands 48,929 48,540 48,880 340

Puerto Rico 2,932,078 2,908,766 2,929,138 20,372

Virgin Islands 182,777 181,324 182,594 1,270

Subtotal, States and 

Territories 154,888,458 153,656,990 154,733,149 1,076,159

Grants to Tribes 3,735,161 3,735,161 3,735,161 - 

USDA Transfer Adjustment/2 2,553,916

Undistributed 1/ $1,078,297 1,589,820 1,600,690 10,870

TOTAL 157,148,000 158,981,971 160,069,000 1,087,029
EXECUTIVE SUMMARY

58 

1/ Program Support –includes funds for OAA statutory requirements, including program evaluation and disaster assistance; and 

grant and program reporting systems costs. Funds unused for these purposes at the end of the year are allocated to States. 

2/State levels include transfers for distributions of commodities which are provided by USDA to grantees, in FY 2017 the amount 

that was transferred out is shown for comparability purposes.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

59 

Preventive Health Services

Services

- 

FY 2017

Final

FY 2018

Annualized 

CR

FY 2019 

President’s 

Budget 

FY 2019 

+/- 

FY 2018

Preventive Health 

Services $19,802 $19,713 $24,848 +$5,135 

*BA is in thousands of dollars, FTE is a whole number.

Authorizing Legislation: Section 361 of the Older Americans Act of 1965, as amended 

FY 2018 Older Americans Act Authorization ...............................................................$20,803,107 

Allocation Method ..................................................................................................... Formula Grant 

Program Description and Accomplishments:

Preventive Health Services, established in 1987, provides formula grants to States and Territories

to support evidence-based programs that educate older adults about the importance of healthy 

lifestyles and promote healthy behaviors that can help prevent chronic disease and disability, 

thereby reducing the need for more costly medical interventions. Preventive Health Services 

funding is allocated to States and Territories based on their share of the population age 60 and 

over, and the program provide flexibility to allocate resources to best meet local needs. Priority 

has been given to providing access to programs for elders living in medically underserved areas of 

their state or who have the greatest economic need.

Due in large part to advances in public health and medical care, Americans are leading longer and 

more active lives. On average, an American turning age 65 today can expect to live an additional 

19.4 years.49 The population of older Americans is also growing, particularly the population age 

85 and over, which is projected to grow from 6.4 million in 2016 to 9.1 million by the year 2030.50 

One consequence of this increased longevity is a higher incidence of chronic diseases such as 

 

49 Kochanek KD, Murphy SL, Xu JQ, Arias E. Mortality in the United States, 2016. NCHS Data Brief, no 293. 

Hyattsville, MD: National Center for Health Statistics. 2017. https://www.cdc.gov/nchs/products/databriefs/

db293.htm. 50 U.S. Census Bureau, “2014 National Population Projections,” Table 1. Projected Population by Single Year of Age, 

Sex, Race, and Hispanic Origin for the United States: 2014 to 2060. Released December 2014, 

http://www.census.gov/population/projections/data/national/2014/downloadablefiles.html. Accessed 02 January 

2018. U.S. Census Bureau, Annual Estimates of the Resident Population for Selected Age Groups by Sex for the

United States, States, Counties, and Puerto Rico Commonwealth and Municipios: April 1, 2010 to July 1, 2016: 

Released June 2017, https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk. 

Accessed 02 January 2018. 
EXECUTIVE SUMMARY

60 

obesity, arthritis, diabetes, osteoporosis, and depression, as well as the greater probability of injury 

from a fall, which quickly limits physical activity.

 

To ensure the best use of limited funds, in FY 2012 ACL requested and Congress enacted 

appropriations language requiring states and territories to use their Preventive Health funds only 

on evidence-based programs that have been proven to enhance the wellness and fitness of older 

adults. The same language has been included in each subsequent year’s appropriations language. 

Evidence-based programs are interventions that have been proven through randomized control 

trials to be effective at helping participants adopt healthy behaviors, improve their health status, 

and reduce their use of hospital services and emergency room visits. Examples of evidence-based 

interventions include: 

• Self-Management Programs: Chronic Disease Self-Management Education (CDSME) 

programs are low-cost, disease prevention models that use state-of-the-art techniques and 

employ leaders in the community to help individuals with chronic disease address issues 

related to the management and treatment of their condition, improve their health status, 

and reduce their need for more costly medical care. CDSME programs have been shown

to be effective at helping participants adopt healthy behaviors and improve their 

psychological and physical health status. Some evidence suggests that CDSME programs 

may also significantly reduce the use of hospital care and physician services, as well as 

reduce health care costs.

• Physical Activity Programs: Physical activity programs are multi-component group 

exercise programs designed for community-based organizations to promote physical 

activity among older adults. Components may include strength training using soft wrist 

and ankle weights; cardiovascular workouts using dancing, aerobics, or walking; and 

balance and posture exercises. Becoming more physically active has many positive 

benefits such as increased mobility and function, decreased pain and depression, and 

lower risk of type 2 diabetes, hypertension, coronary heart disease, obesity, and some 

cancers.

• Medication Management Programs: Medication management programs focus on 

reviewing the multitude of medications that older adults are prescribed, focusing 

especially on high-risk medications. Medication management programs have been shown 

to reduce cardiovascular problems and unnecessary duplication of prescriptions. These 

programs have also been shown to improve medication usage rates and decrease 

medication errors among older adults.

• Falls Prevention Programs: Falls prevention programs help participants improve 

strength, balance, and mobility; provide education on avoiding falls and reduce fall risk 

factors; involve medication reviews and modifications; provide referrals for medical care 

management for fall risk factors; and provide home assessments to identify and reduce 

environmental hazards. 
EXECUTIVE SUMMARY

61 

• Depression Care Management: Depression is not a normal part of aging, yet it is a 

prevalent and disabling condition among older adults. Older adults with depression visit 

the doctor and emergency room more frequently, use more medication, stay longer in the 

hospital, and have substantially higher total health care costs than those without 

depression. Cost-effective, evidence-based interventions have been shown to reduce 

depressive symptoms and improve quality of life in older adults.

Funding History:

Funding for Preventive Health Services over the past five years is as follows:

FY 2015 .................................................$19,848,000 

FY 2016 ...............................................$19,848,000 

FY 2017 .................................................$19,802,000 

FY 2018 Annualized CR ........................$19,713,212 

FY 2019 President’s Budget ..................$24,848,000 

Budget Request:

The FY 2019 request for Preventive Health Services is $24,848,000, an increase of $5,135,000 

above the FY 2018 Annualized Continuing Resolution level. ACL proposes consolidating the 

Chronic Disease Self-Management Program and the Falls Prevention program into the Preventive 

Health Services program. This newly consolidated program would provide states the flexibility to 

target funding to the greatest areas of need in their communities, increasing the ability of States to 

focus resources where they are most needed.

ACL is proposing a new general provision that would build on existing flexibility and give States 

the ability to transfer nearly all of the funds they receive for HCBSS, Nutrition, Preventive Health 

and Caregivers between any of these programs to achieve the funding distribution that best 

addresses their individual State’s unique needs. 

ACL will continue to provide guidance regarding what meets the evidence-based requirement. 

ACL uses a graduated or tiered set of criteria for defining evidence-based interventions 

implemented through the OAA. The OAA Title III-D webpage contains definitions of evidencebased interventions, frequently asked questions, and program examples.51 Grantees can use the 

 
EXECUTIVE SUMMARY

62 

Title III-D Highest-Tier Criteria Evidence-Based Disease Prevention and Health Promotion 

Programs Cost Chart52 on the site to search the 45+ highest-level criteria programs listed. 

Underscoring the need for these programs, the 2017 National Survey of OAA Participants found 

that between 67 and 88 percent of clients across OAA services take three or more different 

prescription medications every day.53 In addition, between 19 and 38 percent of clients across 

OAA services reported having stayed overnight in a hospital in the past 12 months.54 Preventive 

Health Services funding has enabled the Aging Services Network to help older adults control their 

medications and health through the implementation of evidence-based DPHP programs. Over 72 

percent of clients across OAA services report learning how to take care of a chronic illness or 

medical condition during the past year.55 Four to thirteen percent of respondents, representing 

over 200,000 OAA clients, reported that they learned through a group class.56

Each of the evidence-based programs for which states could use these funds have been rigorously 

evaluated and found to be effective. By requiring states to use funding for one or more of these 

programs, ACL seeks to maximize the impact of this funding by providing benefits to individuals 

and achieving savings due to reduced medical costs. At the same time, states would continue to 

have the flexibility to use funding provided under the Home and Community-Based Supportive 

Services program to fund related health services, such as health screenings and physical fitness 

programs that do not meet these evidence-based requirements. 

 

51 https://www.acl.gov/programs/health-wellness/disease-prevention

52 http://www.ncoa.org/improve-health/center-for-healthy-aging/content-library/Title-IIID-Highest-Tier-EvidenceFINAL.pdf

53 2017 National Survey of Older Americans Act Participants. https://agid.acl.gov/. 

54 Id

55 Id

56 Id
EXECUTIVE SUMMARY

63 

Output Table:

Preventive Health Services

Indicator Year and Most Recent 

Result /

FY 2018

Projection

FY 2019

Projection

FY 2019

Projection

+/-FY 2018

Projection

Output AB: The number 

of people served with 

health and disease 

prevention programs. 

(Output)

FY 2016: 1.4 M 1.4 M 1.5 M +0.1

Grant Awards Tables:

Preventive Health Services Grant Awards

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 56 56 56 

Average Award $351,147 $348,501 $439,277 

Range of Awards $12,290 -

$1,976,890 

$12,198 -

$1,957,121 

$15,375 -

$2,579,311 
EXECUTIVE SUMMARY

64 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2019 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Preventive Health Services (CFDA 93.043)

State/Territory FY 2017

Final

FY 2018

Annualized CR

FY 2019

President's Budget

FY 2019 +/- 

FY 2018

Alabama 308,926 305,837 374,180 68,343

Alaska 98,321 97,580 122,998 25,418

Arizona 391,781 393,526 542,162 148,636

Arkansas 196,188 194,226 228,839 34,613

California 1,976,890 1,957,121 2,579,311 622,190

Colorado 266,214 267,277 368,246 100,969

Connecticut 242,170 239,748 277,427 37,679

Delaware 98,321 97,580 122,998 25,418

District of Columbia 98,321 97,580 122,998 25,418

Florida 1,444,234 1,429,792 1,852,421 422,629

Georgia 479,862 479,408 660,512 181,104

Hawaii 98,321 97,580 122,998 25,418

Idaho 98,321 97,580 122,998 25,418

Illinois 779,954 772,154 905,909 133,755

Indiana 396,043 392,083 479,531 87,448

Iowa 215,352 213,198 244,484 31,286

Kansas 177,748 175,971 210,366 34,395

Kentucky 271,061 268,350 332,841 64,491

Louisiana 274,184 271,442 328,955 57,513

Maine 98,321 97,580 123,155 25,575

Maryland 334,873 331,524 425,111 93,587

Massachusetts 431,595 427,279 514,222 86,943

Michigan 643,495 637,060 779,396 142,336

Minnesota 314,419 311,275 403,114 91,839

Mississippi 181,971 180,151 216,486 36,335

Missouri 392,454 388,529 466,523 77,994

Montana 98,321 97,580 122,998 25,418

Nebraska 115,812 114,654 137,498 22,844

Nevada 152,271 152,979 210,770 57,791

New Hampshire 98,321 97,580 122,998 25,418
EXECUTIVE SUMMARY

65 

PROGRAM/CFDA NUMBER: Preventive Health Services (CFDA 93.043)

State/Territory FY 2017

Final

FY 2018

Annualized CR

FY 2019

President's Budget

FY 2019 +/- 

FY 2018

New Jersey 575,762 570,004 657,890 87,886

New Mexico 118,125 116,944 159,791 42,847

New York 1,276,434 1,263,670 1,448,786 185,116

North Carolina 545,679 544,349 749,985 205,636

North Dakota 98,321 97,580 122,998 25,418

Ohio 775,056 767,305 907,081 139,776

Oklahoma 238,697 236,310 281,488 45,178

Oregon 240,226 239,552 330,046 90,494

Pennsylvania 944,437 934,993 1,056,024 121,031

Rhode Island 98,321 97,580 122,998 25,418

South Carolina 285,210 286,128 394,218 108,090

South Dakota 98,321 97,580 122,998 25,418

Tennessee 386,485 382,620 500,525 117,905

Texas 1,190,534 1,191,565 1,641,698 450,133

Utah 113,103 113,646 156,576 42,930

Vermont 98,321 97,580 122,998 25,418

Virginia 449,644 445,148 593,269 148,121

Washington 381,213 382,219 526,609 144,390

West Virginia 141,994 140,574 162,634 22,060

Wisconsin 362,965 359,335 448,210 88,875

Wyoming 98,321 97,580 122,998 25,418

Subtotal, States 19,291,234 19,146,486 24,152,265 5,005,779

American Samoa 12,290 12,198 15,375 3,177

Guam 49,161 48,790 61,499 12,709

Northern Mariana Islands 12,290 12,198 15,375 3,177

Puerto Rico 250,119 247,618 293,507 45,889

Virgin Islands 49,161 48,790 61,499 12,709

Subtotal, States and 

Territories 19,664,255 19,516,080 24,599,520 5,083,440

Undistributed 1/ 137,745 $197,132 $248,480 51,348

TOTAL 19,802,000 19,713,212 24,848,000 5,134,788

1/ Program Support –Includes funds for Older Americans Act statutory requirements, including program evaluation and disaster 

assistance; and grant and program reporting systems costs. Funds unused for these purposes at the end of the year are allocated 

to States.
EXECUTIVE SUMMARY

66 

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HEALTH AND INDEPENDENCE FOR OLDER ADULTS

67 

Chronic Disease Self-Management Education

 

-Service

FY 2017

Final

FY 2018

Annualized 

CR

FY 2018

President’s 

Budget

FY 2019

+/- 

FY 2018

CDSME -PPHF $8,000 $7,223 $0 -$7,223

*BA is in thousands of dollars, FTE is a whole number.

 

Authorizing Legislation: Section 411 of the Older Americans Act of 1965, as amended 

FY 2019 Older Americans Act ........................................................ No specific amount authorized 

Allocation Method ............................. Competitive Grants/Cooperative Agreements and Contracts

Program Description and Accomplishments:

Chronic Disease Self-Management Education (CDSME) programs are low-cost, evidence-based 

prevention models that use state-of-the-art techniques to help those with chronic conditions 

address issues related to the management and treatment of their condition, build self-confidence, 

improve their health status, and reduce their need for more costly medical care. Funds support 

competitive grants to States, as well as related technical assistance and evaluation activities, 

including a National Resource Center. 

In the United States, over 76 percent of Medicare beneficiaries have multiple (two or more) chronic 

conditions,57 placing them at greater risk for premature death, poor functional status, unnecessary 

hospitalizations, adverse drug events, and nursing home placement.58 Chronic conditions also 

impact health care costs, as 93 percent of Medicare expenditures are for beneficiaries with chronic 

conditions.59

Funding History:

Funding for Chronic Disease Self-Management Education over the past five years is as follows:

 

57 Centers for Medicare & Medicaid Services, The characteristics and perceptions of the Medicare population. Data 

from the 2013 Medicare Current Beneficiary Survey. [data tables 2.5a]. http://www.cms.gov/Research-StatisticsData-and-Systems/Research/MCBS/Data-Tables-Items/2013CNP.html. Accessed 02 January 2018. 

58 Vogeli C, Shields AE, Lee TA, Gibson TB, Marder WD, Weiss KB, Blumenthal D. Multiple chronic conditions: 

prevalence, health consequences, and implications for quality, care management, and costs. J Gen Intern Med 

2007; 22 (Suppl 3):391–395. http://www. ncbi.nlm.nih.gov/pmc/articles/PMC2150598. Also, Parekh, A.K., et al. 

2011. Managing Multiple Chronic Conditions: a Strategic Framework for Improving Health Outcomes and 

Quality of Life, Public Health Rep. 126(4):460–71.

59 Nawrocki J. CMS Provides Data on Care for Chronic Conditions to Find Better Care Models. NetNews. April 2, 

2013 http://health.wolterskluwerlb.com/2013/04/cms-provides-data-on-care-for-chronic-conditions-to-help-findbetter-care-models/
EXECUTIVE SUMMARY

68 

FY 2015 ...................................................$8,000,000 

FY 2016 ..................................................$8,000,000 

FY 2017 ..................................................$8,000,000 

FY 2018 Annualized CR ..........................$7,223,000 

FY 2019 President’s Budget ..................................$0 

Budget Request:

The FY 2019 Budget consolidates this activity into the Preventive Health Services program. In 

addition, ACL isrequesting a new general provision to appropriations language to build on existing 

flexibilities by giving States the ability to transfer up to 100 percent of the funds they receive for 

HCBSS, Nutrition, Preventive Health and Caregivers between any of these programs to best 

address their individual State’s needs. The shift in authority will allow States to expand on or 

shrink existing CDSME programs in order to best meet the challenges within their State.

 

Outcomes and Outputs Table:

Chronic Disease Self-Management Education 

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2018

Target

FY 2019

Target

FY 2019

Target

+/-FY 2018

Target

CD2 Increase the 

percentage of individuals 

who complete the 

CDSME program. 

(Outcome)

FY 2016: 74%

Target:

75%

(Target Not Met but 

Improved)

73% Discontinued N/A

Indicator Year and Most Recent 

Result /

FY 2018

Projection

FY 2019

Projection

FY 2019

Projection

+/-FY 2018

Projection

Output CD1: Total 

number of individuals 

with chronic conditions 

completing the CDSME 

program. (Output)

FY 2016: 37,750 21,800 Discontinued +8,200
EXECUTIVE SUMMARY

69 

Grant Awards Table:

Chronic Disease Self-Management Education Grant Awards

Awards FY 2017 

Final 

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 56 56 - 

Average Award $574,742 $830,111 -

Range of 

Awards

$150,000 - 

$1,000,000 

$150,000 - 

$1,000,000 - 

Resource and Program Data:

Chronic Disease Self-Management Education 

(Dollars in Thousands) 

Mechanism

FY 

2017

Final #

FY 2017

Final $

FY 2018

Annualized

CR #

FY 2018

Annualized

CR $

FY 2019

President’s 

Budget #

FY 2019

President’s 

Budget $

Grants:

Formula -- -- -- -- -- --

New Discretionary

9 6,457 11 6,426 -- --

Continuations

1 1,000 1 1,000 -- --

Contracts 1 291 1 291 -- --

Interagency 

Agreements -- -- -- -- -- --

Program Support /1 -- 252 -- 283 -- --

Total Resources -- 8,000 -- 8,000 -- --

1/Program Support – Includes funds for overhead, grant systems and review costs, and technology 

support costs. 
EXECUTIVE SUMMARY

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EXECUTIVE SUMMARY

71 

Falls Prevention

Service

FY 2017

Final

FY 2018

Annualized 

CR

FY 2019

President’s

Budget

FY 2019

+/- 

FY 2018

Falls Prevention - PPHF $5,000 $4,515 $0 -$4,515

*BA is in thousands of dollars, FTE is a whole number.

Authorizing Legislation: Section 411 of the Older Americans Act of 1965, as amended 

FY 2018 Older Americans Act Authorization ................................. No specific amount authorized 

Allocation Method ............................. Competitive Grants/Cooperative Agreements and Contracts 

Program Description and Accomplishments:

Falls are the leading cause of both fatal and nonfatal injuries for those 65 and over.60 Many people 

limit their activity after a fall, which may reduce strength, physical fitness, and mobility.61 Falls 

can also result in significant loss of independence and often trigger the onset of a series of growing 

needs. Americans over age 75 who fall are more than four times more likely to be admitted to a 

skilled nursing facility.62 Even without a major injury, falls can cause an older adult to become 

fearful or depressed, making it difficult for them to stay active, which in turn increases the need 

for assistance.

Falls prevention programs help participants improve strength, balance, and mobility and provide 

education on how to avoid falls and reduce fall risk factors. These programs also may involve 

medication reviews and modifications; provide referrals for medical care management for selected 

fall risk factors; and provide home hazard assessments of ways to reduce environmental hazards. 

Since September 2014, more than 46,000 older adults across 24 states have been served via ACLsupported falls prevention/management programs, including A Matter of Balance, Stepping On, 

and Tai Chi: Moving for Better Balance.

Evidence-based community falls prevention/management programs have clearly demonstrated a 

reduction in falls through randomized controlled trials. For example, when compared with control 

groups, the risk of falling for participants in the Tai Chi: Moving for Better Balance intervention 

 

60 Bergen G, Stevens MR, Burns ER. Falls and Fall Injuries Among Adults Aged ≥65 Years — United States, 2014. 

MMWR Morb Mortal Wkly Rep 2016;65:993–998. https://www.cdc.gov/mmwr/volumes/65/wr/mm6537a2.

htm?s_cid=mm6537a2_w

61 Vellas BJ, Wayne SJ, Romero LJ, Baumgartner RN, Garry PJ. Fear of falling and restriction of mobility in elderly 

fallers. Age and Ageing 1997;26:189–193.

62 Donald IP, Bulpitt CJ. The prognosis of falls in elderly people living at home. Age and Ageing 1999;28:121–5 
EXECUTIVE SUMMARY

72 

decreased by 55 percent;63 and the Stepping On program reduction was 31 percent.64 Matter of 

Balance is an evidence-based program designed to reduce the fear of falling and increase activity 

levels among older adults. Research has shown significant improvements for participants 

regarding their level of falls management (the degree of confidence participants perceive 

concerning their ability to manage the risk of falls and of actual falls); falls control (the degree to 

which participants perceive their ability to prevent falls); level of exercise; and social limitations 

with regard to concern about falling.65

In addition to reducing falls; these community-based interventions are proven to be cost-effective. 

Matter of Balance participation has been associated with total medical cost savings, and cost 

savings in the unplanned inpatient, skilled nursing facility, and home health settings. Participation 

was associated with a -$938 per participant decrease in total medical costs per year. This finding 

includes a -$517 reduction in unplanned hospitalization costs, a -$234 reduction in skilled nursing 

facility costs, and an -$81 reduction in home health costs.66 Additionally, a 2014 cost-benefit 

analysis found that the benefits from community-based falls prevention interventions covered their 

implementation costs and exceeded direct medical costs, resulting in a return on investment (ROI) 

of 64% for Stepping On, and an ROI of 509 percent for Tai Chi: Moving for Better Balance.67

Funding History

Funding for Falls Prevention over the past five years is as follows:

FY 2015 ...................................................$5,000,000 

FY 2016 ...................................................$5,000,000 

FY 2017 ...................................................$5,000,000 

FY 2018 Annualized CR ..........................$4,515,000 

FY 2019 President’s Budget ..................................$0 

Budget Request:

The FY 2019 Budget consolidates the Falls Prevention program into the Preventive Health 

Services program. ACL is requesting a new general provision to build on existing flexibility by 

giving States the ability to transfer nearly all of the funds they receive for HCBSS, Nutrition, 

Preventive Health and Caregivers between any of these programs to achieve the funding 

 

63 Fuzhong L, Harmer P, Fisher JK, Mcauley E. Tai Chi: Improving Functional Balance and Predicting Subsequent 

Falls in Older Persons. Med Sci Sports Exerc. (2004) 36 (12): 2046-2052. 64 Clemson L, Cumming RG, Kendig H, Swann M, Heard R, Taylor K. The Effectiveness of a Community-Based 

Program for Reducing the Incidence of Falls in the Elderly: A Randomized Trial. J Am Geriatr Soc. (Sept 2004) 52 

(9): 1487–1494. 65 Healy, T.C., Peng, C., Haynes, P., McMahon, E., Botler, J., & Gross, L. (2008). The feasibility and effectiveness of 

translating A Matter of Balance into a volunteer lay leader model. Journal of Applied Gerontology, 27(1): 34-51. 

66 http://innovation.cms.gov/Files/reports/CommunityWellnessRTC.pdf

67 Carande-Kulis, V., et al., A cost–benefit analysis of three older adult fall prevention interventions, Journal of 

Safety Research (2015), http://dx.doi.org/10.1016/j.jsr.2014.12.007. Accessed March 23, 2015.
EXECUTIVE SUMMARY

73 

distribution that best addresses their individual State’s unique needs. This shift in authority will 

allow states to expand on or shrink existing Falls Prevention programs in order to best meet the 

challenge within their state.

Grant Awards Table:

Falls Prevention Program Grant Awards

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 9 11 - 

Average Award $529,287 $433,102 -

Range of Awards $468,018-

$600,000 

$468,018-

$600,000 - 
EXECUTIVE SUMMARY

74 

Resource and Program Data:

Falls Prevention

(Dollars in Thousands) 

Mechanism

FY 

2017

Final 

#

FY 

2017

Final 

$

FY 2018

Annualized

CR #

FY 2018

Annualized

CR $

FY 2019

President’s 

Budget #

FY 2019

President’s 

Budget $

Grants: -- -- -- -- -- --

Formula -- -- -- -- -- --

New Discretionary 8 4,164 10 4,164 -- --

Continuations 1 600 1 600 -- --

Contracts 1 203 1 203 -- --

Interagency Agreements -- -- -- -- -- --

Program Support /1 -- 33 -- 33 -- --

Total Resources -- 5,000 -- 5,000 -- --

1/ Program Support -- Includes funds for overhead, grant systems and review costs, and information technology 

support costs.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

75 

Native American Nutrition and Supportive Services

Service

FY 2017

Final

FY 2018

Annualized 

CR

FY 2019

President’s 

Budget

FY 2019

+/- 

FY 2018

Native American 

Nutrition & Supportive 

Services

$31,136 $30,996 $31,208 +$212 

*BA is in thousands of dollars, FTE is a whole number.

Authorizing Legislation: Sections 201, 613, and 623 of the Older Americans Act of 1965, as 

amended.

FY 2018 Older Americans Act Authorization ...............................................................$32,601,843 

Allocation Method ..................................................................................................... Formula Grant 

Program Description and Accomplishments:

Native American Nutrition and Supportive Services provides grants to eligible tribal organizations 

to promote the delivery of Nutrition and Home and Community-Based Supportive Services to 

Native American, Alaskan Native, and Native Hawaiian elders. An estimated 895,000 people age 

60 and over identify themselves as Native American or Alaskan Native alone or in combination 

with another racial group.68 Over 520,000 of those elders identify as Native American or Alaskan 

Native with no other racial group.69

Native American Nutrition and Supportive Services grants support a broad range of services to 

older Native Americans, including adult day care; transportation; congregate and home-delivered 

meals; information and referral; and personal care, chore, and other supportive services. Currently 

ACL’s congregate meal program reaches 43 percent of eligible Native American seniors in 

participating Tribal organizations, home-delivered meals reach 19 percent of such persons, and 

supportive services reach 65 percent of such persons. These programs, which help to reduce the 

need for costly nursing home care and medical interventions, are responsive to the cultural 

traditions of Native American communities and represent an important part of each community’s 

comprehensive services.

 

68 U.S. Census Bureau, Population Division, Annual Estimates of the Resident Population by Sex, Age, Race Alone 

or in Combination, and Hispanic Origen for the United States: April 1, 2010 to July 1 2016. Released June 2017, 

https://factfinder.census.gov/bkmk/table/1.0/en/PEP/2015/PEPASR5H?slice=year~est72015. Accessed January 

2018.

69 U.S. Census Bureau, Population Division, Annual Estimates of the Resident Population by Sex, Single Year of 

Age, Race, and Hispanic Origin for the United States: April 1, 2010 to July 1, 2016. Released June 2017, 

https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk. Accessed January 2018. 
EXECUTIVE SUMMARY

76 

Services provided by this program in FY 2016 (the most recent year for which data are available) 

include: 

• Transportation Services, which provided over 1,000,000 rides to meal sites, medical 

appointments, pharmacies, grocery stores, and other critical daily activities.70

• Home-Delivered Nutrition Services, under which 2.5 million meals were provided to 

20,300 home bound Native American elders. The program also provides critical social 

contacts that help to reduce the risk of depression and isolation experienced by many 

home-bound Native American elders.71

• Congregate Nutrition Services, which provided 2.6 million meals to nearly 59,000 Native 

American elders in community-based settings, as well as an opportunity for elders to 

socialize and participate in a variety of activities, including cultural and wellness 

programs.72

• Information, Referral and Outreach Services, which provided nearly 922,000 hours of 

outreach and information on services and programs to Native American elders and their 

families, thereby empowering them to make informed choices about their service and 

care needs.73

The Native American Nutrition and Supportive Services program also provides training and 

technical assistance to Tribal organizations to support the development of comprehensive and 

coordinated systems of services to meet the needs of Native American elders. Training and 

technical assistance is provided through national meetings, site visits, website, e-newsletters, 

telephone and written consultations, and through the Native American Resource Centers (funded 

under Aging Network Support Activities).

Eligible Tribal organizations receive nutrition and supportive services formula grants based on 

their share of the American Indian, Alaskan Native, and Native Hawaiian population age 60 and 

over. Tribal organizations must represent at least 50 Native American elders age 60 and over to 

receive funding. There is no requirement for matching funds. In addition, Tribes may decide the 

age at which a member is considered an elder and thus eligible for services. In FY 2017, grants 

were awarded to 270 Tribal organizations (representing 400 Tribes and villages), including one 

organization serving Native Hawaiian elders.

 

70 ACL’s OAA Title VI Program Performance Report, PY 2016

71 Id

72 Id

73 Id
EXECUTIVE SUMMARY

77 

Funding History:

Funding for Native American Nutrition and Supportive Services over the past five years is as 

follows: 

FY 2015 .................................................$26,158,000 

FY 2016 .................................................$31,158,000 

FY 2017 .................................................$31,136,000 

FY 2018 Annualized CR ........................$30,996,066 

FY 2019 President’s Budget ..................$31,208,000 

Budget Request:

The FY 2019 request for Native American Nutrition and Supportive Services is $31,208,000, 

which is an increase of $212,000 above the FY 2018 Annualized Continuing Resolution. Native 

American Nutrition and Supportive Services, like the same services that Home and CommunityBased Supportive Services and Nutrition Services fund for States, help to postpone the need for 

much more expensive institutional services. The services provided using these funds, particularly 

adult day care, personal care, chore services, and home-delivered meals, also aid Native American 

caregivers, who might otherwise have to be even more intensely involved with the care of their 

loved ones, at the risk of their own health and careers. 

At the FY 2019 request level, these services will provide over 1,000,000 rides, 2.78 million meals 

at home, and 2.7 million meals at congregate sites to over 98,000 Native American seniors.74

In FY 2019, the targeted number of units of service, such as home-delivered meals and 

transportation trips, provided to Native Americans per thousand dollars of ACL funding is 

projected at 300, a 36 percent increase over the FY 2002 base of 220. Over the past several years 

Native American services have generally met or exceeded their efficiency and output targets for 

meals and trips due in part to increased contributions from tribal organizations. 

The strength of the Older Americans Act is that it gives Tribes the ability to define needs from the 

bottom up and the flexibility to direct funding accordingly to meet best meet these needs. In FY 

2019, ACL is proposing a new general provision to build on existing flexibility, by giving Tribes 

the ability to transfer nearly all of the funds they receive for Native American Nutrition and 

Support Services and Native American Caregiver Services between these programs to achieve the 

funding distribution that best addresses their individual Tribe’s unique needs.

 

74 Id
EXECUTIVE SUMMARY

78 

Outcomes and Outputs Table:

Native American Nutrition & Supportive Services 

 

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2018

Target

FY 2019

Target

FY 2019

Target

+/-FY 2018

Target

1.3 For Title VI Services, 

increase the number of 

units of service provided 

to Native Americans per 

thousand dollars of AoA 

funding. (Efficiency)

FY 2016: 269

Target:

304

(Target Not Met)

303 300 -3 

Indicator Year and Most Recent 

Result /

FY 2018

Projection

FY 2019

Projection

FY 2019

Projection

+/-FY 2018

Projection

Output L: Transportation 

Services units (Output) FY 2016: 1.05 M 1.06 M 1.08 M +0.02 M

Output M: HomeDelivered Nutrition meals

(Output)

FY 2016: 2.5 M 2.77 M 2.78 M +0.01M

Output N: Congregate 

Nutrition meals (Output) FY 2016: 2.6 M 2.7 M 2.7 M Maintain

Output O: Information, 

Referral and Outreach 

units (Output)

FY 2016: 921,611 890,000 885,000 -5,000

Grant Awards Table:

Native American Nutrition & Supportive Services Formula Grant Awards

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 271 271 271 

Average Award $112,272 $111,634 $112,417 

Range of Awards $73,990-

$1,505,000 

$73,990-

$1,505,000 

$73,990-

$1,505,000 
EXECUTIVE SUMMARY

79 

Resource and Program Data:

Native American Nutrition and Supportive Services 

(Dollars in Thousands) 

Mechanism

FY 

2017

Final 

#

FY 

2017

Final 

$

FY 2018

Annualized

CR #

FY 2018

Annualized

CR $

FY 2019

President’s 

Budget #

FY 2019

President’s 

Budget $

Grants:

Formula 270 30,276 270 30,103 270 30,315

New Discretionary -- -- 1 150 -- --

Continuations 1 150 -- -- 1 150

Contracts 1 601 1 627 1 627

Interagency Agreements -- -- -- -- -- --

Program Support 1/ -- 110 -- 116 -- 116

Total Resources -- 31,136 -- 30,996 -- 31,208

1/ Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and review,

and information technology support costs.
EXECUTIVE SUMMARY

80 

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HEALTH AND INDEPENDENCE FOR OLDER ADULTS

81 

Aging Network Support Activities

Service FY 2017 FY 2018Annualized

CR

FY 2019

President’s

Budget

FY 2019 

 +/- 

FY 2018

Aging Network Support 

Activities $9,938 $9,893 $8,998 -$895

*BA is in thousands of dollars, FTE is a whole number.

Authorizing Legislation: Section 202, 215, and 411 of the Older Americans Act of 1965, as amended

FY 2019 Older Americans Act Authorization ................................. Multiple—See Titles II and IV

Allocation Method ............................ Competitive Grants/Co-operative Agreements and Contracts

Program Description and Accomplishments:

The Aging Network Support Activities program provides competitive grants and contracts to 

support ongoing activities of national significance that help seniors and their families to obtain 

information about their care options and benefits; the program provides technical assistance to help 

States, Tribes, and community providers of aging services to develop service systems that help 

older people remain independent and able to live in their own homes and communities. These 

activities provide critical and ongoing support for the national aging services network and help 

support the activities of ACL’s core service delivery programs. 

Competitive grants, cooperative agreements, and contracts for Aging Network Support Activities 

are awarded to eligible public or private agencies, tribal organizations, States, Area Agencies on 

Aging (AAAs), institutions of higher learning, and other organizations representing and/or serving 

older people, including faith-based organizations. Grantees are generally asked to provide a match 

equal to 25 percent of the project’s total cost. Project proposals are reviewed by external experts 

and project awards are made for periods of one to five years. In FY 2017, Aging Network Support 

Activities funded 28 grants with an average award of $345,719. These activities are described 

below. 

National Eldercare Locator and Engagement 

Older Americans and their caregivers face a complicated array of choices and decisions about 

health care, pensions, insurance, housing, financial management, and long-term care. The 

Eldercare Locator, created in 1991, helps seniors and their families navigate this complex 

environment by connecting those needing assistance with State and local agencies on aging that 

serve older adults and their caregivers. The Eldercare Locator can be accessed through a toll-free 

nationwide telephone line (800-677-1116) or website (http://www.eldercare.gov). The phone line 

and website both connect those in need to providers in every zip code in the nation. The Eldercare 

Locator website continues to grow as a resource for older adults and their caregivers, serving 

871,362 individuals in 2016. This service is supplemented by an Information and Referral Support 

Center which provides technical assistance and standards for the development of effective 

information and assistance systems.

Final
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

82 

A growing body of research also suggests there is a correlation between social engagement and 

positive mental and physical outcomes in older adults. ACL is interested in expanding the reach 

of the Aging Services network to more effectively assist older adults to remain socially engaged 

and active. The Engagement and Older Adults Resource Center provides technical assistance and 

serves as a repository for innovations designed to increase the aging network’s ability to tailor 

social engagement activities to meet the needs of older adults.

National Alzheimer’s Call Center

The National Alzheimer’s Call Center is a national information and counseling service for persons 

with Alzheimer’s disease, their family members, and informal caregivers. As part of the 

consolidation of Alzheimer’s activities into a single program line the Call Center is being 

transferred to the Alzheimer’s Disease Program line. 

Pension Counseling and Retirement Information

The Pension Counseling program, assists older Americans in accessing information about their 

retirement benefits and helps them negotiate with former employers or pension plans for due 

compensation. Currently there are approximately 700,000 private (as well as thousands of public) 

pension and retirement plans in the United States. Given that an employee may have worked for 

several employers, and these employers may have merged, sold their plans, or gone bankrupt, it is 

very difficult for the average person to know where to go to get help in finding out whether he or 

she is receiving all of their pension benefits. ACL currently funds six regional counseling projects 

covering 30 states. In 2016 pension counseling projects recovered $11.4 million and helped 3,812 

people, data for the program show that: 

• Pension Counseling projects have successfully recovered over $228 million in client 

benefits, representing a return of more than nine dollars for every Federal dollar invested 

in the program. 

• Projects have directly served over 59,000 individuals by providing hands-on assistance in 

pursuing claims through administrative appeals processes, helping seniors to locate 

pension plans “lost” as a result of mergers and acquisition, answering queries about 

complex plan provisions, and making targeted referrals to other professionals for 

assistance.

By producing fact sheets and other publications, hosting websites, and conducting outreach, 

education and awareness efforts, Pension Counseling projects also provide indirect services to tens 

of thousands of seniors and their families. 

ACL also supports the National Education and Resource Center on Women and Retirement 

Planning, which provides access to a one-stop gateway that integrates financial information and 

resources on retirement planning for health and long-term care. This project has made user-friendly 

financial education and retirement planning tools available to traditionally hard-to-reach

individuals, including low-income women, women of color, women with limited English speaking 

proficiency, rural, and other “underserved” individuals. Information is offered through financial 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

83 

and retirement planning programs, workshops tailored to meet women’s special needs, and 

published in hard copy and web-based formats. Since its establishment, the Center has conducted 

approximately 200 workshops per year on strategies to access financial and retirement planning 

information. It has developed and published over 175 Fact Sheets tailored to the specific needs of 

hard-to-reach women and maintains an interactive web site.

National Resource Centers on Native American Elders

The National Resource Centers on Native American Elders enhance knowledge about older Native 

Americans and thereby improve the delivery of services to them. Each resource center addresses 

at least two areas of primary concern which are specified in the OAA. These include health issues, 

long-term care (including in-home care), elder abuse, mental health, and other problems and issues 

facing Native communities. The Resource Centers are administered under cooperative agreements 

by institutions of higher education. The resource centers partner with Native American 

organizations and communities, educational institutions (including tribal colleges and 

universities), and professionals and paraprofessionals in the field. Each Resource Center has 

specialized areas of interest. For example, the University of North Dakota Resource Center has 

assisted Title VI grantees in assessing needs of tribal elders to determine program planning and 

direction. This process has led to the development of a database of information about American 

Indian, Alaska Native and Native Hawaiian Elders. The University of Hawaii Resource Center 

has focused on long-term care needs of Native Hawaiian Elders. The University of Alaska 

Resource Center has focused on elder abuse and neglect issues within Native American or Alaskan 

Native communities.

National Minority Aging Organizations Technical Assistance Centers 

The National Minority Aging Organizations (NMAO) Technical Assistance Centers program 

works to reduce or eliminate health disparities among racial, ethnic, and other minority older 

individuals. These centers design and disseminate front line health promotion and disease 

prevention information that is culturally and linguistically appropriate for older individuals of 

African American, Hispanic, Asian American and Pacific Islander descent, American Indian and 

Alaska Native elders, as well as for older lesbian, gay, bisexual, and transgender (LGBT) adults. 

Each NMAO project pilots a practical, nontraditional, community-based intervention for reaching 

older individuals who experience barriers to accessing home and community-based services. 

Interventions are focusing on barriers due to language and low literacy. Strategies developed under 

this program incorporate the latest technology and facilitate the generation and dissemination of 

knowledge in forms that can assist minority older individuals to practice positive health behaviors 

and strengthen their capacity to maintain active, independent life styles. Examples of products 

resulting from these grants include a chronic disease self-management curriculum and manual 

tailored for racial and ethnic minority seniors, a series of bilingual Influenza Vaccination 

Promotion materials, a referral database of Chronic Disease Self-Management Education 

(CDSME) workshops, and a culturally appropriate caregiver manual/toolkit for American Indian 

and Alaskan Native caregivers caring for elders with dementia.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

84 

Holocaust Survivor Assistance 

The United States is home to an estimated 130,000 victims of Nazi persecution, approximately 25 

percent of whom are living in poverty. Because of the experiences they endured early on in their 

lives, Holocaust survivors are likely to have greater and more complex physical and mental health 

needs as they age. The nonprofit social service agencies that serve this population have projected 

that the need for supportive services will continue to grow and intensify over the next five to ten 

years.

In FY 2015, ACL developed and implemented a program to provide supportive services for aging 

Holocaust survivors living in the United States. A cooperative agreement was awarded to a 

national organization with demonstrated expertise in working with Holocaust survivors to advance 

the development and delivery of person-centered, trauma-informed supportive services. The 

program focused efforts on two fronts: 1) expanding the capacity of community-based agencies to 

provide direct services to Holocaust survivors in a person-centered, trauma-informed manner; and 

2) developing and implementing a national technical assistance center devoted to expanding the

aging services network’s capacity to deliver person-centered, trauma-informed services.

Program Performance and Technical Assistance

This activity supports cooperative efforts between ACL and selected states and AAAs to develop 

tools, performance measures, and best practices that can be used to effectively and efficiently 

identify the results produced through OAA programs on an ongoing basis. These efforts include 

partnerships with National Aging Organizations to foster innovation and provide technical 

assistance to states, AAAs, and tribal organizations in strategic planning, program development, 

and performance improvement. PPTA also supports efforts to expand the business acumen and 

contracting capacity of the community-based organizations (CBOs) within the Aging network. 

Medicaid, Medicare, Accountable Care Organizations, private insurers and other private pay 

models will offer increasing opportunities to CBOs to tap into new revenue streams outside of 

government grants, but securing contracts and interfacing with such payers requires thinking and 

operating differently. ACL’s Business Acumen Initiative seeks to strengthen CBOs from the 

inside, building their business skills and enhancing their effectiveness, efficiency and 

sustainability.

Funding History:

Comparable funding for Aging Network Support Activities over the past five years is as follows:

FY 2015 ...................................................$9,961,000 

FY 2016 ...................................................$9,961,000 

FY 2017 ...................................................$9,938,000 

FY 2018 Annualized CR ..........................$9,893,355 

FY 2019 President’s Budget ....................$8,998,000 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

85 

Budget Request:

The FY 2019 request for Aging Network Support Activities is $8,998,000, a reduction of 

-$895,355 below the FY 2018 Annualized Continuing Resolution Level. This reflects the 

consolidation of the Alzheimer’s Call Center into the Alzheimer’s Disease Program. Programs 

funded by this request provide ongoing support for the national aging services network and are 

needed to support the activities of ACL’s core service delivery programs. Not only do they provide 

a variety of unique services, – such as the Pension Counseling and the National Eldercare Locator 

– these programs also considerably strengthen and streamline ACL’s core services and are critical 

to our continuing success.75

The request will continue, as permitted by statute, to support .4 FTE for administration of the 

Pension Counseling program. 

Aging Network Support Activities outcomes are reflected in performance targets for Health and 

Independence for Older Adults and Caregiver and Family Support Services. 

Aging Network Support Activities includes funding for the following projects (dollars in thousands): 

Activity FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019

President’s 

Budget

Aging Network Support Activities:

National Eldercare Locator and Engagement $2,033 $2,019 $2,035

National Alzheimer's Call Center/1 944 938 --

Pension Counseling and Retirement Information 1,854 1,841 1,859

National Resource Centers on Native Americans 653 649 653

National Minority Aging Organizations 1,162 1,154 1,163

Holocaust Survivor Assistance 2,494 2,500 2,495

Program Performance and Technical Assistance 797 792 793

Total, Aging Network Support Activities $9,938 $9,893 $8,998

1/In FY 2019 ACL is proposing to transfer the Alzheimer’s Call Center to the Alzheimer’s Disease Program line. 

 

75 Please see page 231 for a discussion of how the MIPPA program helps hard to reach low income and Rural 

Medicare beneficiaries who qualify for either the Medicare savings plan or Low-Income Subsidy pay their Medicare 

premiums.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

86 

Grant Awards Table:

Aging Network Support Grant Awards 

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 28 26 25 

Average 

Award $348,397 $369,155 $349,284 

Range of 

Awards

$134,452-

$2,467,500 

$134,452-

$2,467,500 

$134,452-

$2,467,500 

Resource and Program Data:

Aging Network Support Activities

(Dollars in thousands) 

Mechanism

FY 2017

Final #

FY 2017

Final $

FY 2018

Annualized 

CR #

FY 2018

Annualized 

CR $

FY 2019

President’s 

Budget #

FY 2019

President’s 

Budget $

Grants:

Formula -- -- -- -- -- --

New Discretionary 5 417 11 4,219 1 100

Continuations 23 9,338 15 5,379 24 8,632

Contracts 1 25 -- -- -- --

Interagency Agreements -- -- -- -- -- --

Program Support 1/ -- 158 -- 295 -- 266

Total Resources 29 9,938 26 9,893 25 8,998

1/ Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and review, 

and information technology support costs.
CAREGIVER AND FAMILY SUPPORT SERVICES

87 

Caregiver and Family Support Services

Summary of Request

Families are the nation’s primary provider of long-term care, but a number of factors including 

financial constraints, work and family demands, and the many challenges of providing care place 

great pressure on family caregivers. Caregiving responsibilities demand time and money from 

families who too often are already strapped for both. ACL’s caregiver programs provide services 

that address the needs of unpaid, informal caregivers, allowing many of them to continue to work 

while providing critically needed care.

Better support for informal caregivers is critical because often it is their availability--whether they 

are family members or unrelated friends and neighbors who dedicate their time--that determine 

whether an older person can remain in his or her home. In 2013, approximately 34.2 million adult 

caregivers provided uncompensated care to those 50 years of age and older.76 The economic cost 

of replacing unpaid caregiving of elderly adults is estimated to be between $470 billion77 and $522 

billion annually,78 higher than that of all Medicaid spending in FY 2016 (Federal and State: $553

billion).79

 

The demands of caregiving can lead to a breakdown of the caregiver’s health, and the illness, 

hospitalization, or death of a caregiver increases the risk for institutionalization of the care 

recipient. Caregivers suffer from higher rates of depression than non-caregivers of the same age, 

and research indicates that caregivers suffer a mortality rate that is 63 percent higher than noncaregivers.80 Providing support that makes caregiving easier for family caregivers, such as 

information, counseling and training, respite care, or supplemental services, is critical to sustaining 

caregivers’ ability to continue in that role. Seventy-seven percent of the caregivers served by OAA 

programs report that these services allow them to provide care longer than they otherwise could

have.81

 

76 National Alliance for Caregiving, and AARP Public Policy Institute. Caregiving in the US, 2015 report. June 2015 

Washington DC. https://www.aarp.org/content/dam/aarp/ppi/2015/caregiving-in-the-united-states-2015-reportrevised.pdf Access 07 March 2018.

77 S. C. Reinhard, L. Feinberg, R. Choula, and A. Houser, Valuing the Invaluable: 2015 Update, Undeniable 

Progress, but Big Gaps Remain (Washington, DC: AARP Public Policy Institute, July 2015). 

http://www.aarp.org/content/dam/aarp/ppi/2015/valuing-the-invaluable-2015-update-new.pdf. Accessed 13 

January 2016

78 A.V Chari, et al. The Opportunity Costs of Informal Elder-Care in the United States. New Estimates from the 

American Time Use Survey. HSR June 2015:50(3): 871-882. Also Valuing the Invaluable: 2011 Update, The 

Growing Contributions and Costs of Family Caregiving. AARP Public Policy Institute. July 2011. 

http://assets.aarp.org/rgcenter/ppi/ltc/i51-caregiving.pdf 

79 “Federal and State Share of Medicaid Spending,” The Henry J. Kaiser Family Foundation, 7. https://www.kff.org/

medicaid/state-indicator/federalstate-share-of-spending/?dataView=1¤tTimeframe=0&sortModel=%

7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D. 80 Schulz R, Beach SR. Caregiving as a risk factor for mortality. The Caregiver Health Effects study. JAMA December 

15, 1999;282:2215-9. 81 2017 National Survey of Older Americans Act Participants https://agid.acl.gov/.
CAREGIVER AND FAMILY SUPPORT SERVICES

88 

By 2020, it is projected that there will be 16.4 million non-institutionalized seniors age 65 and 

over with 1+ ADL deficits, an increase of 2.1 million older adults (or 15 percent increase between 

2016 and 2020) needing caregiver assistance.82 To address these caregiver-related needs, ACL is 

proposing to provide States and Tribes greater flexibility by allowing them to transfer up to 100% 

of funding between Home and Community Based Supportive Services, Nutrition Programs, 

Family Caregiver Services, and Preventive Health Services. In addition, ACL requests a total of 

$180,992,000 an increase of +$5,319,358 above the FY 2018 Annualized Continuing Resolution 

level. The request includes:

• $150,586,000 for Family Caregiver Support Services, an increase of $1,023,000 over the 

FY 2018 Annualized Continuing Resolution level. This program makes a range of 

support services available to family and informal caregivers - including counseling, 

respite care, and training - that assist family and informal caregivers to care for their 

loved ones at home for as long as possible. Studies have shown that these supports can 

reduce caregiver depression, anxiety, and stress and enable them to provide care longer, 

thereby avoiding or delaying the need for costly nursing home care. 

• $7,556,000 for Native American Caregiver Support Services, an increase of $51,000 over 

the FY 2018 Annualized Continuing Resolution level. This program makes a range of 

services available to Native American caregivers, including information and outreach, 

access assistance, individual counseling, support groups and training, respite care and 

other supplemental services.

• $19,490,000 for a consolidated Alzheimer’s Disease Program. The FY 2019 budget 

incorporates the FY 2019 Budget proposal consolidating three existing ACL Alzheimer’s 

programs - the Alzheimer’s Disease Supportive Services program (ADSSP), the 

Alzheimer’s Disease Initiative - Specialized Services Program (ADI-SSS) and the ADI – 

communications campaign - into a single, more flexible program. The FY 2019 Budget 

also incorporates the Alzheimer’s Call Center previously funded from the ANSA 

program line into the consolidated program. This proposal will provide greater flexibility 

and support the agencies goal of improving efficiency and eliminating duplication and 

overlap. 

• $3,360,000 for Lifespan Respite Care, which is an increase of $23,000 over the FY 2018 

Annualized Continuing Resolution level. At this level the Lifespan Respite Care program 

will continue its efforts to develop more efficient, cost-effective methods that reach 

 

82 U.S. Census Bureau, “2014 National Population Projections,” Table 1. Projected Population by Single Year of 

Age, Sex, Race, and Hispanic Origin for the United States: 2014 to 2060. Released December 2014, 

http://www.census.gov/population/projections/data/national/2014/downloadablefiles.html. Accessed 02 January 

2018. Centers for Medicare & Medicaid Services, The characteristics and perceptions of the Medicare population. 

Data from the 2013 Medicare Current Beneficiary Survey. [data tables 2.5a]. http://www.cms.gov/ResearchStatistics-Data-and-Systems/Research/MCBS/Data-Tables-Items/2013CNP.html. Accessed 02 January 2018.
CAREGIVER AND FAMILY SUPPORT SERVICES

89 

across the aging and the disability populations to improve the quality of and access to 

respite care for family caregivers of children or adults of any age with special needs.

As a group, these programs support caregivers, elders, and people of all ages with disabilities by 

providing critical respite care and other support services for family caregivers, training of care 

volunteers, information and outreach, counseling, and other supplemental services.
CAREGIVER AND FAMILY SUPPORT SERVICES 

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CAREGIVER AND FAMILY SUPPORT SERVICES 

91 

Family Caregiver Support Services

 

Services

 

FY 2017

Final

FY 2018

Annualized 

CR

FY 2019

President’s

Budget

FY 2019 

+/- 

2018 

Family Caregiver Support 

Services $150,240 $149,563 $150,586 +$1,023 

*BA is in thousands of dollars, FTE is a whole number.

Authorizing Legislation: Section 371 of the Older Americans Act of 1965, as amended. 

FY 2018 Older Americans Act Authorization .............................................................$157,564,066 

Allocation Method ..................................................................................................... Formula Grant 

Program Description and Accomplishments:

The Family Caregiver Support Services Program provides formula grants to states and territories, 

based on their share of the population age 70 and over, to fund a range of supports that assist family 

and informal caregivers to care for their loved ones at home for as long as possible. The program 

includes five basic system components: information, access assistance, counseling and training, 

respite care, and supplemental services. These services work in conjunction with other OAA 

services to provide a coordinated set of supports that caregivers can access on behalf of themselves 

and the seniors for whom they provide care. Based on FY 2016 data, the most recent available, 

services included:

• Access Assistance Services provided nearly 1.2 million contacts to caregivers assisting 

them in locating services from a variety of public and private agencies (Output I).83

• Counseling and Training Services provided over 120,000 caregivers with counseling, 

peer support groups, and training to help them better cope with the stresses of caregiving 

(Output J).84

• Respite Care Services provided over 62,000 caregivers with nearly 6 million hours of 

temporary relief, at home or in an adult day care or nursing home setting, from their 

caregiving responsibilities (Output K).85

 

83 ACL’S OAA State Performance Report, FY 2016

84 Id

85 Id
CAREGIVER AND FAMILY SUPPORT SERVICES

92 

Family and other informal caregivers are the backbone of America’s long-term care system. On a 

daily basis, these individuals assist relatives and other loved ones with tasks ranging from personal

care and homemaking to more complex health-related interventions like medication administration 

and wound care. The economic cost of replacing unpaid caregiving is estimated to be between 

$47086 and $522 billion annually, which is roughly equivalent to the cost of all Medicaid spending 

in FY 2016 (Federal and state: $553 billion).87

Research has also shown that caregiving exacts a heavy emotional, physical, and financial toll. 

Caregivers often experience conflicts between work and caregiving, with 30 percent reporting that 

they have had to make adjustments such as retiring or taking time away from work due to their 

caregiving responsibilities.88 As reported in ACL’s National Survey of OAA Participants, over 

one-fifth of caregivers are assisting two or more individuals.89 Sixty percent of Title III caregivers 

are 60 or older, making them more susceptible to a decline in their own health, and 31 percent 

describe their own health as fair to poor.90 The demands of caregiving can lead to a breakdown of 

the caregiver’s health, and the illness, hospitalization, or death of a caregiver increases the risk for 

institutionalization of the care recipient.

Studies have shown that the types of supports provided through the Family Caregiver Support

Services Program can reduce caregiver depression, anxiety, and stress and enable them to provide 

care longer while often continuing to work, thereby avoiding or delaying the need for costly 

institutional care for their loved ones. For example, one study indicates that counseling and support 

for caregivers of individuals with Alzheimer’s disease can permit the care recipient to stay at home, 

at significantly less cost, for an additional year before being admitted to a nursing home.91

Additionally, data from ACL’s National Surveys shows that ACL services are effective in helping 

caregivers keep their loved ones at home. Approximately 77 percent of caregivers of program 

clients reported that services enabled them to provide care longer than otherwise would have been 

possible.92 Caregivers receiving services were also asked whether the care recipient would have 

been able to live in the same residence if the services had not been available. Over 40 percent of 

caregivers indicated that the care recipient would be unable to remain at home without the support 

services.93 Those respondents were then asked to identify where the care recipient would be living 

 

86 S. C. Reinhard, L. Feinberg, R. Choula, and A. Houser, Valuing the Invaluable: 2015 Update, Undeniable 

Progress, but Big Gaps Remain (Washington, DC: AARP Public Policy Institute, July 2015). 

http://www.aarp.org/content/dam/aarp/ppi/2015/valuing-the-invaluable-2015-update-new.pdf. Accessed 

01/13/2016

87 “Federal and State Share of Medicaid Spending,” The Henry J. Kaiser Family Foundation, 2017. 

https://www.kff.org/medicaid/state-indicator/federalstate-share-of-spending/?dataView=1¤tTimeframe

=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D. 

88 2017 National Survey of Older Americans Act Participants. https://agid.acl.gov/. 

89 Id

90 Id

91 A Family Intervention to Delay Nursing Home Placement of Patients with Alzheimer’s Disease. Aging and Dementia 

Research Center, New York University. Journal of the American Medical Association. December 4, 1996.

92 2017 National Survey of Older Americans Act Participants. https://agid.acl.gov/.
CAREGIVER AND FAMILY SUPPORT SERVICES

93 

without services. A significant majority of those caregivers, 77 percent,94 indicated that the care 

recipient would most likely be living in a nursing home or assisted living (see below). 

Funding History:

Funding for Family Caregiver Support Services over the past five years is as follows: 

FY 2015 ...............................................$145,586,000 

FY 2016 ...............................................$150,586,000 

FY 2017 ...............................................$150,240,000 

FY 2018 Annualized CR ......................$149,563,370 

FY 2019 President’s Budget ................$150,586,000 

 

93 Id

94 Id
CAREGIVER AND FAMILY SUPPORT SERVICES

94 

Budget Request:

The FY 2019 request for Family Caregiver Support Services is $150,586,000, which is an increase

of $1,023,000 above the FY 2018 Annualized Continuing Resolution. Funding for Family 

Caregiver Support Services will allow ACL to maintain services that give caregivers the assistance 

needed to help them sustain their caregiving and provide care longer. By helping caregivers so that 

they in turn can help to keep their loves ones independent and out of an institution for a longer 

period, investments in this program can reduce costs to the Federal government in other areas such 

as Medicaid.

Currently States can transfer up to 30 percent of their funding for Nutrition and HCBSS between 

these programs, and up to 40% of Nutrition funding between the Nutrition programs. In FY 2019, 

ACL is proposing a new general provision to provide additional funding flexibility to States for 

the ability to transfer nearly all of the funds they receive for HCBSS, Nutrition, Preventive Health 

and Caregivers between any of these programs to achieve the funding distribution that best 

addresses their individual State’s unique needs.

The requested funding level for Family Caregiver Supportive Services will allow

800,000 caregivers (Outcome 3.1) to receive supportive services, including respite care or other 

temporary relief from their caregiving responsibilities that will assist them to continue providing 

care for their loved ones. As many as 116,000 caregivers will also have the opportunity to 

participate in counseling, peer support groups, and training to help them better cope with the 

stresses of caregiving (Output J). 

In FY 2019, ACL expects (at the requested levels) the aging services network to be able to meet 

or exceed the target of only 30 percent of caregivers experiencing difficulty obtaining services 

(Outcome 2.6). This is a substantial accomplishment that occurred at the State level as a result of 

ongoing program development, better coordination, and integration of the Family Caregiver 

program into the array of State home and community-based services. Baseline levels from 2003 

showed that 64 percent of caregivers had difficulty getting services, and by 2016, that rate had 

been reduced to 34 percent of caregivers reporting difficulty getting services.95

For FY 2019, the performance target for Family Caregiver Support Services Program participants 

who rate services good to excellent is 90 percent (Outcome 2.9c). The substantive improvements 

in program performance can be attributed to the successful implementation of the program. Clientreported assessment of service quality and program outcomes is also expected to remain at high 

levels.

 

95 Id
CAREGIVER AND FAMILY SUPPORT SERVICES

95 

Outcomes and Outputs Table:

Family Caregiver Support Services 

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2018

Target

FY 2019

Target

FY 2019

Target

+/-FY 2018

Target

1.1 For Home and 

Community-based 

Services including 

Nutrition and Caregiver 

services increase the 

number of clients served 

per million dollars of 

Title III OAA funding. 

(Efficiency)

FY 2016: 8,885 clients

Target:

8,700 clients

(Target Exceeded)

8,800 clients 8,900 clients +100 clients

2.6 Reduce the 

percentage of caregivers 

who participate in the 

National Family 

Caregiver Support 

Program who report 

difficulty in obtaining 

services. (Outcome)

FY 2016: 34%

Target:

27%

(Target Not Met)

30% 30% Maintain

2.9c Maintain at 90% or 

higher the percentage of 

National Family 

Caregiver Support 

Program clients who rate 

services good to 

excellent. (Outcome)

FY 2016: 94%

Target:

90%

(Target Exceeded)

90% 90% Maintain

2.10 Increase the 

likelihood that the most 

vulnerable people 

receiving Older 

Americans Act Home and 

Community-based and 

Caregiver Support 

Services will continue to 

live in their homes and 

communities. (Outcome)

FY 2016: 63.6 weighted 

average

Target:

63 weighted average

(Target Exceeded)

63.25 weighted 

average

63.6 weighted 

average

+0.35 weighted 

average

3.1 Increase the number 

of caregivers served 

through the National 

Family Caregiver 

Support Program. 

(Outcome)

FY 2016: 741,388 caregivers

Target:

825,000 caregivers

(Target Not Met)

850,000 

caregivers

800,000 

caregivers -50,000 caregivers
CAREGIVER AND FAMILY SUPPORT SERVICES

96 

Indicator Year and Most Recent 

Result /

FY 2018

Projection

FY 2019

Projection

FY 2019

Projection

+/-FY 2018

Projection

Output I: Caregivers 

access assistance units of 

service. (Output)

FY 2016: 1.2 M 1.17 M 1.17 M Maintain

Output J: Caregivers 

receiving counseling and 

training. (Output)

FY 2016: 120,340 117,000 116,000 -1,000

Output K: Caregivers 

receiving respite care 

services. (Output)

FY 2016: 62,096 63,300 63,000 -300

Note: For presentation within the budget ACL highlighted specific measures that are most directly related to Family 

Caregiver Support Services, however multiple performance outcomes are impacted by this program because ACL’s 

performance measures (efficiency, effective targeting, and client outcomes) assess network-wide performance in 

achieving current strategic objectives.

 

Grant Awards Table:

Family Caregiver Supportive Services Grant Awards 

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 56 56 56 

Average Award $2,665,797 $2,644,067 $2,662,145 

Range of Awards $93,303 -

$15,484,352 

$92,542 -

$15,395,478 

$93,175 -

$15,500,742 
CAREGIVER AND FAMILY SUPPORT SERVICES

97 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2019 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Family Caregivers Support Services (CFDA 93.052)

State/Territory FY 2017

Final

FY 2018

Annualized CR

FY 2019

President's 

Budget

FY 2019 +/- 

FY 2018

Alabama 2,266,907 2,240,973 2,256,296 15,323

Alaska 746,423 740,338 745,400 5,062

Arizona 3,406,047 3,442,659 3,466,197 23,538

Arkansas 1,437,065 1,412,211 1,421,867 9,656

California 15,484,352 15,395,478 15,500,742 105,264

Colorado 2,027,990 2,035,446 2,049,363 13,917

Connecticut 1,730,978 1,698,773 1,710,388 11,615

Delaware 746,423 740,338 745,400 5,062

District of Columbia 746,423 740,338 745,400 5,062

Florida 12,289,081 12,321,931 12,406,181 84,250

Georgia 3,739,484 3,743,366 3,768,961 25,595

Hawaii 746,423 740,338 745,400 5,062

Idaho 746,423 740,338 745,400 5,062

Illinois 5,501,430 5,392,419 5,429,290 36,871

Indiana 2,886,096 2,838,028 2,857,433 19,405

Iowa 1,553,739 1,515,435 1,525,797 10,362

Kansas 1,298,812 1,270,397 1,279,084 8,687

Kentucky 1,976,309 1,949,163 1,962,491 13,328

Louisiana 1,919,754 1,900,466 1,913,460 12,994

Maine 746,423 740,338 745,400 5,062

Maryland 2,507,616 2,493,233 2,510,280 17,047

Massachusetts 3,146,938 3,107,290 3,128,536 21,246

Michigan 4,686,446 4,604,059 4,635,539 31,480

Minnesota 2,436,131 2,406,295 2,422,748 16,453

Mississippi 1,303,412 1,285,103 1,293,890 8,787

Missouri 2,893,349 2,841,211 2,860,637 19,426

Montana 746,423 740,338 745,400 5,062

Nebraska 851,506 835,346 841,058 5,712

Nevada 1,209,218 1,225,407 1,233,786 8,379

New Hampshire 746,423 740,338 745,400 5,062
CAREGIVER AND FAMILY SUPPORT SERVICES

98 

PROGRAM/CFDA NUMBER: Family Caregivers Support Services (CFDA 93.052) 

State/Territory FY 2017

Final

FY 2018

Annualized CR

FY 2019

President's Budget

FY 2019 +/- 

FY 2018

New Jersey 4,076,037 4,017,357 4,044,825 27,468

New Mexico 956,216 954,546 961,073 6,527

New York 8,972,729 8,833,034 8,893,429 60,395

North Carolina 4,459,693 4,448,064 4,478,477 30,413

North Dakota 746,423 740,338 745,400 5,062

Ohio 5,525,464 5,413,255 5,450,268 37,013

Oklahoma 1,737,501 1,711,710 1,723,414 11,704

Oregon. 1,925,376 1,928,362 1,941,547 13,185

Pennsylvania 6,680,302 6,525,278 6,569,894 44,616

Rhode Island 746,423 740,338 745,400 5,062

South Carolina 2,298,360 2,314,742 2,330,569 15,827

South Dakota 746,423 740,338 745,400 5,062

Tennessee 2,986,246 2,963,048 2,983,308 20,260

Texas 9,437,277 9,454,112 9,518,754 64,642

Utah 906,192 905,609 911,801 6,192

Vermont 746,423 740,338 745,400 5,062

Virginia 3,488,747 3,482,121 3,505,929 23,808

Washington 3,005,315 3,015,597 3,036,216 20,619

West Virginia 990,988 970,584 977,221 6,637

Wisconsin 2,721,498 2,675,291 2,693,583 18,292

Wyoming 746,423 740,338 745,400 5,062

Subtotal, States 146,424,100 145,191,793 146,184,532 992,739

American Samoa 93,303 92,542 93,175 633

Guam 373,212 370,169 372,700 2,531

Northern Mariana Islands 93,303 92,542 93,175 633

Puerto Rico 1,927,485 1,950,521 1,963,858 13,337

Virgin Islands 373,212 370,169 372,700 2,531

Subtotal, States and 

Territories 149,284,615 148,067,736 149,080,140 1,012,404

Undistributed 1/ 955,385 1,495,634 1,505,860 10,226

TOTAL 150,240,000 149,563,370 150,586,000 1,022,630

1/ Program Support – Includes funds for Older Americans Act statutory requirements, including program evaluation and disaster 

assistance; and grant and program reporting systems costs. Funds unused for these purposes at the end of the year are allocated 

to States. 
CAREGIVER AND FAMILY SUPPORT SERVICES 

99 

Native American Caregiver Support Services

Services

FY 2017

Final

FY 2018

Annualized 

CR

FY 2019

President’s 

Budget

FY 2019

+/- 

FY 2018

Native American Caregiver 

Support Services $7,539 $7,505 $7,556 +$51

*BA is in thousands of dollars, FTE is a whole number.

Authorizing Legislation: Section 631 of the Older Americans Act of 1965, as amended.

FY 2018 Authorization ....................................................................................................$7,879,982 

Allocation Method ..................................................................................................... Formula Grant 

Program Description and Accomplishments:

Native American Caregiver Support Services provide grants to eligible tribal organizations to 

support family and informal caregivers of Native American, Alaskan Native, and Native Hawaiian 

elders. This program, which helps to reduce the need for costly nursing home care and medical 

interventions, is responsive to the needs of Native American communities and represents an 

important part of each community’s comprehensive services. 

Native American Caregiver Support Services funding is allocated to eligible tribal organizations 

based on their share of the American Indian, Alaskan Native, and Native Hawaiian populations 

aged 60 and over. Tribal organizations must represent at least 50 Native American elders age 

60 and over and must also receive a grant under the Native American Nutrition and Supportive 

Services program to receive funding. There is no requirement for matching funds. Tribes may also 

decide the age at which a member is considered an elder and thus eligible for services. In addition, 

there is no limit on the percentage of funds that can be used for services to grandparents caring for 

grandchildren. 

Grants assist American Indian, Alaskan Native and Native Hawaiian families caring for older 

relatives with chronic illness or disability and grandparents caring for grandchildren. The program 

provides a variety of direct services that meet a range of caregiver needs, including information 

and outreach, access assistance, individual counseling, support groups and training, respite care, 

and other supplemental services. Tribal organizations coordinate with other programs to help 

support and create sustainable caregiver programs in Native American communities (many of 

which are geographically isolated). A core value of the Native American Caregiver Support 

Services program is that the program should not replace the tradition of families caring for their 

elders. Rather, as expressed by multiple tribal leaders, the program provides support that strengthens 

the family caregiver role.
CAREGIVER AND FAMILY SUPPORT SERVICES

100 

Funding History:

Funding for the Native American Caregiver Support Services over the past five years is as follows:

FY 2015 ...................................................$6,031,000 

FY 2016 ...................................................$7,531,000 

FY 2017 ...................................................$7,539,000 

FY 2018 Annualized CR ..........................$7,504,687 

FY 2019 President’s Budget ...................$7,556,000 

Budget Request:

The FY 2019 request for Native American Caregiver Support Services is $7,556,000, which is an 

increase of $51,000 above the FY 2018 Annualized Continuing Resolution. Continued support for 

caregivers is critical because often it is their availability – whether they are family members or 

unrelated friends and neighbors who volunteer their time – that determines whether an older person 

can remain in his or her home. 

The strength of the Older Americans Act is that it gives Tribes the ability to define needs from the 

bottom up and the flexibility to direct funding accordingly to meet best meet these needs. In FY 

2019, ACL is proposing a new general provision to build on existing flexibility, by giving Tribes 

the ability to transfer nearly all of the funds they receive for NANSS and NACSS between these 

programs to achieve the funding distribution that best addresses their individual Tribe’s unique 

needs.

An estimated 895,000 persons age 60 and over identify themselves as Native American or Alaskan 

Native alone or in combination with another racial group.96 Over 520,000 of those elders identify 

as Native American or Alaskan Native with no other racial group97. Caregiver Support Services 

help Native American elders, many of whom have limitations in activities of daily living that make 

it difficult to care for themselves, to remain at home, in the community, or on the reservation for 

as long as possible. Studies have shown that providing assistance to caregivers can help them cope 

with the emotional, physical and financial toll associated with caregiving, thereby enabling them 

to provide care for their loved ones longer and avoid or delay the need for costly nursing home 

care.

 

96 U.S. Census Bureau, Population Division, Annual Estimates of the Resident Population by Sex, Single Year of 

Age, Race Alone or in Combination, and Hispanic Origin for the United States: April 1, 2010 to July 1, 2016 

Released June 2017, accessed 02 January 2018.

97 U.S. Census Bureau, Population Division, Annual Estimates of the Resident Population by Sex, Single Year of 

Age, Race, and Hispanic Origin for the United States: April 1, 2010 to July 1, 2016. Release Date: June 2017. 

https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk. Accessed on 02 January 

2018.
CAREGIVER AND FAMILY SUPPORT SERVICES

101 

Performance data indicates that these programs are an efficient means to help Native American 

Elders remain independent and in the community. In FY 2019, funding for the Native American 

Caregiver Support Program will continue to assist family and informal caregivers, whose 

assistance is critical to enabling Native American elders to remain at home, in the community, 

and/or on the reservation. In FY 2019, an estimated 600,000 units of caregiver-related services, 

including respite care, information and referral, caregiver training and support groups, will have 

been provided by Native American Tribal organizations. 

Outcome Table:

Native American Caregivers Supportive Services 

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2018

Target

FY 2019

Target

FY 2019

Target

+/-FY 2018

Target

3.1 Increase the number 

of caregivers served 

through the National 

Family Caregiver 

Support Program. 

(Outcome)

FY 2016: 741,388 caregivers

Target:

825,000 caregivers

(Target Not Met)

850,000 

caregivers

800,000 

caregivers -50,000 caregivers
CAREGIVER AND FAMILY SUPPORT SERVICES

102 

Grant Awards Table:

Native American Caregivers Supportive Services Grant Awards

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 231 231 231 

Average Award $32,383 $32,235 $32,457 

Range of Awards $13,820-

$56,560 

 $13,820-

$56,560 

 $13,820-

$56,560 

Resource and Program Data:

Native American Caregiver Support Services

(Dollars in thousands) 

Mechanism FY 2017

Final #

FY 2017

Final $

FY 2018

Annualized

CR #

FY 2018

Annualized

CR $

FY 2019

President’s 

Budget #

FY 2019

President’s 

Budget $

Grants:

Formula 231 7,481 231 7,446 231 7,498

New Discretionary -- -- -- -- -- --

Continuations -- -- -- -- -- --

Contracts -- -- -- -- -- --

Interagency Agreements -- -- -- -- -- --

Program Support 1/ -- 58 -- 58 -- 58

Total Resources -- 7,539 -- 7,505 -- 7,556

1/ Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and review,

and information technology support costs.
CAREGIVER AND FAMILY SUPPORT SERVICES

103 

Alzheimer’s Disease Program

Service FY 2017

Final

FY 2018

Annualized 

CR

FY 2019

President’s

Budget

FY 2019 

+/- 

FY 2018

Alzheimer's Disease Program $0 $0 $19,490 +$19,490

*BA is in thousands of dollars, FTE is a whole number.

Authorizing Legislation: Section 411 of the Older Americans Act of 1965, as amended. 

FY 2018 Older Americans Act Authorization ................................. No specific amount authorized 

Allocation Method ............................ Competitive Grants/Co-operative Agreements and Contracts

Program Description and Accomplishments:

The effects of Alzheimer’s Disease and Related Dementias (ADRD) are devastating for 

individuals living with the disease and their family caregivers. Serving people with ADRD 

typically requires significant levels of medical care as well as the provision of person-centered, 

dementia-capable home and community-based services (HCBS). Of the individuals with ADRD

living in the community, approximately one-third live alone, exposing them to numerous risks, 

including unmet needs, malnutrition and injury and various forms of neglect and exploitation.98

As the number of people with ADRD is projected to grow by almost 300% by 205099 from an 

estimated 5.3 million individuals, it is important to develop effective and coordinated service 

delivery and health care systems that are responsive to these individuals and their caregivers. 

The complexity of care required by persons with advanced dementia – defined by the severity of 

functional and cognitive impairment, reliance on surrogate decision-making, and inability to live 

alone – results in tremendous family/caregiver burden.100 Behavioral symptoms such as repetitive 

speech, wandering, and sleep disturbances are core clinical characteristics of ADRD. If untreated, 

these behaviors can accelerate disease progression, worsen functional decline and quality of life, 

cause significant caregiver distress, and result in earlier nursing home placement.101

98 Gould, E., Maslow, K., Yuen, P., Wiener, J. Providing Services for People with Dementia Who Live Alone: Issue 

Brief. Accessed April 14, 2014 at http://www.adrc-tae.acl.gov/tiki-index.php?page=adsspkey&filter=key .

99 Alzheimer’s Association. 2017 Alzheimer’s Disease Facts and Figures. Accessed 09 May, 2017 at

http://www.alz.org/alzheimers_disease_facts_and_figures.asp. .

100 National Alzheimer Project Act Advisory Council on Alzheimer's Research, Care, and Services Meeting #15: 

Advanced Dementia Expert Panel Summary and Key Recommendations. (2015, January 26). January 26, 2015 

In-Person Meeting. Retrieved from http://aspe.hhs.gov/daltcp/napa/012615/Mtg15-Slides4.shtml. 

101 Gitlin LN, Kales HC, Lyketsos CG. Nonpharmacologic Management of Behavioral Symptoms in Dementia.

JAMA. 2012;308(19):2020-2029. doi:10.1001/jama.2012.36918.
CAREGIVER AND FAMILY SUPPORT SERVICES

104 

Establishing dementia capable home and community based service systems designed to meet the 

needs of formal and informal caregivers of individuals with ADRD is critical to helping these 

caregivers continue to provide care. The Alzheimer’s Disease Program provides funding for the 

development and implementation of these person-centered services and supports partnerships with 

public and private entities to identify and address the unique needs of persons with ADRD and 

their caregivers.

In an effort to fill some identified gaps in existing systems that support caregivers and people with 

ADRD, the Alzheimer’s Disease program dedicates resources for States and community-based 

organizations with proven capability in the provision of both services and training to targeted 

special populations. Through the Alzheimer’s Disease program, ACL will issue two classes of 

competitive grants – to States who want to improve/develop their dementia systems capability, 

and to existing dementia capable community-based organizations that are prepared to address 

identified service gaps through expansion of their on-going activities. Collectively these grants 

will seek to achieve the following objectives: 

• Create state-wide, person-centered, dementia-capable home and community-based

service systems;

• Translate and implement evidence-based supportive services for persons with ADRD

and their caregivers at the community level;

• Work with public and private entities to identify and address the special needs of persons

with ADRD and their caregivers; and

• Offer direct services and supports to thousands of persons with ADRD and their

caregivers.

To support this work, ACL funds a training and technical assistance resource center. The center 

works with grantees to share best practices, disseminate recent research findings, and develop issue 

briefs for States and communities. ACL also supports a national information and counseling 

service specifically targeted to persons with Alzheimer’s disease, their family members, and 

informal caregivers. Through the National Alzheimer’s Call Center, trained professional customer 

service staff and social workers are available at all times, by telephone, website, or email at no 

cost to the caller and provide information on caregiving, handling legal issues, resources for longdistance caregiving, and tips for working with the medical community. 
CAREGIVER AND FAMILY SUPPORT SERVICES

105 

Funding History:

This is the second year funding is requested: 

FY 2015 .................................................................$0 

FY 2016 .................................................................$0 

FY 2017 .................................................................$0 

FY 2018 Annualized CR ........................$19,490,000 

FY 2019 President’s Budget ..................$19,490,000 

Budget Request: 

In FY 2019, ACL is requesting $19,490,000, consistent with the FY 2018 Annualized Continuing 

Resolution to support Alzheimer’s Disease activities through a single grant program.. The funding 

level represents the consolidation of funding for the Alzheimer’s Disease Initiative – Specialized 

Supportive Services, Alzheimer’s Disease Initiative – Communications Campaign, Alzheimer’s 

Disease Supportive Services, and the National Alzheimer’s Call Center (an activity within the 

Aging Network Support activity line), into a single Alzheimer’s Disease Program. This approach 

allows for greater efficiency and flexibility to States, Territories, and Tribes by centralizing 

funding into a single program. 

The need for cutting edge approaches that serve those with Alzheimer’s disease and related 

dementias (ADRD) and their caregivers continues to grow. The population over the age of 65 

continues to rise, resulting in an increase in disease incidence. The number of individuals in 

America living with ADRD is projected to double from 48 million to 88 million by 2050. In 2017 

alone, an estimated 480,000 individuals developed some form of ADRD102

At this funding level ACL will maintain its ability to assist individuals with ADRD and their 

caregivers. ACL expects to support 35 grants. 

 

102 https://www.alz.org/documents_custom/2017-facts-and-figures.pdf
CAREGIVER AND FAMILY SUPPORT SERVICES

106 

Grant Awards Tables:

Alzheimer’s Disease Program/1

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards - - 34 

Average Award - - $507,416 

Range of Awards - - $276,127-

$1,000,000

1/The number of awards is an estimate and may change.

 

Resource and Program Data:

Alzheimer’s Disease Program

Mechanism FY 2017

Final #

FY 2017

Final $

FY 2018

Annualized

CR #

FY 2018

Annualized

CR $

FY 2019

President’s 

Budget #

FY 2019

President’s 

Budget $

Grants:

Formula -- -- -- -- -- --

New Discretionary -- -- -- -- 35 17,252

Continuations -- -- -- -- -- --

Contracts -- -- -- -- 1 2,000

Interagency Agreements -- -- -- -- -- --

Program Support /1 -- -- -- -- -- 238

Total Resources -- -- -- -- -- 19,490

1/The number of awards is an estimate and may change.

 2/ Program Support -- Includes funds for statutory requirements, grant systems and review costs.
CAREGIVER AND FAMILY SUPPORT SERVICES 

107 

Alzheimer’s Disease Supportive Services Program

-

Services FY 2017

Final

FY 2018

Annualized 

CR

FY 2019

President’s

Budget

FY 2019 

+/- 

FY 2018

Alzheimer’s Disease Initiative –

Supportive Services $4,789 $4,767 $0 -$4,767 

*BA is in thousands of dollars, FTE is a whole number.

Authorizing Legislation: Section 398 of the Public Health Services Act, as amended 

FY 2019 Authorization ......................................................................................................... Expired

Allocation Method ............................. Competitive Grants/Cooperative Agreements and Contracts 

Program Description and Accomplishments:

The Alzheimer’s Disease Supportive Services Program (ADSSP) funds competitive grants to 

States to expand the availability of evidence-based services that support persons with Alzheimer’s 

disease and related dementias (ADRD) and their family caregivers; and to create state-wide, 

person-centered, dementia-capable home and community-based service (HCBS) systems. These 

systems have been able to identify persons with ADRD and their family caregivers, understand 

their unique circumstances, communicate appropriately with them, help them identify and choose 

services that meet their needs, and provide supports to ease caregiver stress. Dementia-capable 

systems also help persons with dementia and their family caregivers to remain independent and in 

the community. The primary components of the ADSSP program include the translation and 

implementation of evidence-based supportive services for persons with ADRD and their caregivers 

at the community level; development and delivery of statewide person-centered, dementia-capable 

HCBS systems; and incorporation of evidence-based research in the formulation of innovative 

projects.

Funding History:

Funding for the ADSSP program over the past five years is as follows:

FY 2015 ...................................................$3,800,000 

FY 2016 ...................................................$4,800,000 

FY 2017 ...................................................$4,789,000 

FY 2018 Annualized CR ..........................$4,767,403 

FY 2019 President’s Budget ..................................$0 
CAREGIVER AND FAMILY SUPPORT SERVICES

108 

Budget Request:

The FY 2019 Budget request is $0, a decrease of -$4,767,000 from the FY 2018 Annualized 

Continuing Resolution. This program is consolidated into a broader Alzheimer’s Disease program

to achieve greater efficiency and flexibility in programming. 

Outcome and Outputs Table:

Alzheimer’s Disease Supportive Services Program

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2018

Target

FY 2019

Target

FY 2019

Target

+/-FY 2018

Target

ALZ.2 Increase number 

of individuals served with 

evidence-based 

interventions - 

cumulative. (Outcome)

FY 2016: 22,754

Target:

21,957

(Target Exceeded)

Discontinued Discontinued Maintain

ALZ.3 Improve dementia 

capability of long-term 

support systems to create 

dementia-friendly, livable 

communities. (Outcome)

FY 2017: Result Expected 

Dec 31, 2018

Target:

Set Baseline

(Pending)

-- -- --
CAREGIVER AND FAMILY SUPPORT SERVICES

109 

Indicator Year and Most Recent 

Result /

FY 2018

Projection

FY 2019

Projection

FY 2019

Projection

+/-FY 2018 

Projection

Output AC: Number of 

individuals served – 

cumulative103 (Output)

FY 2016: 61,066 Discontinued Discontinued N/A

Output AD: Percent of 

individuals served that are 

of a racial/ethnic minority 

(Output)

FY 2016: 23% Discontinued Discontinued N/A

Grant Awards Table:

Alzheimer’s Disease Supportive Services Grant Awards

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 6 6 - 

Average Award $527,833 $625,654 -

Range of Awards $309,000-

$650,000 

$300,000 - 

$650,000 - 

 

103 Cumulative count began in 2008.
CAREGIVER AND FAMILY SUPPORT SERVICES

110 

Resource and Program Data:

Alzheimer’s Disease Supportive Services Program

(Dollars in thousands) 

Mechanism

FY 

2017

Final 

#

FY 

2017

Final 

$

FY 2018

Annualized

CR # 

FY 2018

Annualized

CR $ 

FY 2019

President’s 

Budget #

FY 2019

President’s 

Budget $

Grants:

Formula

 

-- -- -- -- -- --

New Discretionary 6 3,167 6 3,754 -- --

Continuations -- -- -- -- -- --

Contracts 1 1,440 1 800 -- --

Interagency Agreements -- -- -- -- -- --

Program Support /1 -- 182 -- 213 -- --

Total Resources -- 4,789 -- 4,767 -- --

1/ Program Support -- Includes funds for Public Health Service Act statutory 

requirements, grant systems and review costs.
111 

Alzheimer’s Disease Initiative - Specialized Supportive Services

Service FY 2017

Final

FY 2018

Annualized 

CR

FY 2019

President’s

Budget

FY 2019

+/- 

FY 2018

Alzheimer’s Disease Initiative Services --

Prevention Fund $10,500 $9.480 $0 -$9.480 

*BA is in thousands of dollars, FTE is a whole number.

Authorizing Legislation: Section 411 of the Older Americans Act of 1965, as amended, and the 

Patient Protection and Affordable Care Act (ACA), Section 4002 [42 U.S.C. 300u-11] 

FY 2019 Older Americans Act Authorization .......................................... No specific authorization 

Allocation Method ............................ Competitive Grants/Co-operative Agreements and Contracts

Program Description and Accomplishments:

The Alzheimer’s Disease Initiative - Specialized Supportive Services (ADI-SSS) was designed to 

fill gaps in existing dementia-capable home and community-based service (HCBS) systems for 

persons living with ADRD and their family caregivers. The complexity of care of persons with 

advanced dementia is defined by the severity of functional and cognitive impairment, reliance on 

surrogate decision-making, and inability to live alone. This results in tremendous family/caregiver 

burden.104 Behavioral symptoms such as repetitive speech, wandering, and sleep disturbances are 

core clinical features of ADRD. If untreated, these behaviors can accelerate disease progression, 

worsen functional decline and quality of life, cause significant caregiver distress, and result in 

earlier nursing home placement.105

Implementing enhanced dementia capable HCBS systems designed to meet the needs of formal 

and informal caregivers of individuals with ADRD is critical to helping these individuals continue 

to provide care. The ADI-SSS has provided funding for the development and implementation of 

specialized, person-centered services that help individuals remain independent and safe in their 

communities, while providing much needed supports to their caregivers. Through this program, 

ACL has worked with public and private entities to identify and address the special needs of 

persons with ADRD and their caregivers. 

In an effort to fill some of the identified gaps in systems that service people with ADRD and their 

family caregivers, the ADI-SSS program dedicates resources toward the provision of both services 

 

104 National Alzheimer Project Act Advisory Council on Alzheimer's Research, Care, and Services Meeting #15: 

Advanced Dementia Expert Panel Summary and Key Recommendations. (2015, January 26). January 26, 2015 InPerson Meeting. Retrieved from http://aspe.hhs.gov/daltcp/napa/012615/Mtg15-Slides4.shtml.

105 Gitlin LN, Kales HC, Lyketsos CG. Nonpharmacologic Management of Behavioral Symptoms in Dementia.

JAMA. 2012;308(19):2020-2029. doi:10.1001/jama.2012.36918.
CAREGIVER AND FAMILY SUPPORT SERVICES

112 

and training to targeted special populations. Specifically, the program required that funded 

programs do at least one of the following: 

• Develop and deliver supportive services to persons living alone with ADRD in 

communities;

• Prepare individuals living with moderate to severe impairment and their caregivers for the 

future;

• Improve the quality and effectiveness of programs and services provided to aging 

individuals with intellectual disabilities who have ADRD or who are at high risk of 

developing ADRD; and 

• Deliver behavioral symptom management training and expert consultation to family 

caregivers.

Funding History:

Funding for the ADI-SSS program over the past five years is as follows:

FY 2015 .................................................$10,500,000 

FY 2016 .................................................$10,500,000 

FY 2017 .................................................$10,500,000 

FY 2018 Annualized CR ..........................$9,480,000 

FY 2019 President’s Budget ..................................$0 

Budget Request: 

The FY 2019 Budget Request is $0, a decrease of -$9,480,000 from the FY 2018 Annualized 

Continuing Resolution level. This program is consolidated into a broader Alzheimer’s Disease 

program to achieve greater efficiency and flexibility in programming.
CAREGIVER AND FAMILY SUPPORT SERVICES

113 

Outcome Table:

Alzheimer’s Disease Supportive Services Program

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2018

Target

FY 2019

Target

FY 2019

Target

+/-FY 2018

Target

ALZ.3 Improve dementia 

capability of long-term 

support systems to create 

dementia-friendly, livable 

communities. (Outcome)

FY 2017: Result Expected 

Dec 31, 2018

Target:

Set Baseline

(Pending)

-- -- --
CAREGIVER AND FAMILY SUPPORT SERVICES

114 

 

Grant Awards Table:

Alzheimer’s Disease Initiative – Specialized Supportive Services

Awards FY 2017 

Final 

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 11 10 - 

Average Award $934,049 $984,232 -

Range of Awards $832,952-

$995,890 

$850,000 - 

$1,000,000 - 

Resource and Program Data:

Alzheimer’s Disease Initiative – Specialized Supportive Services 

(Dollars in thousands) 

Mechanism

FY 

2017

Final 

#

FY 

2017

Final 

$

FY 2018

Annualized CR # 

FY 2018

Annualized

CR $ 

FY 2019

President’s 

Budget #

FY 2019

President’s 

Budget $

Grants:

Formula

 

--

 

--

 

--

 

--

 

--

 

--

New Discretionary 11 10,275 10 9,842 -- --

Continuations -- -- -- -- -- --

Contracts 1 189 1 600 -- --

Interagency Agreements -- -- -- -- -- --

Program Support /1 -- 37 -- 58 -- --

Total Resources -- 10,500 -- 10,500 -- --

1/ Program Support -- Includes funds for Public Health Service Act statutory requirements, grant systems and

review costs. 
115 

Lifespan Respite Care

Service

-

FY 2017

Final

FY 2018

Annualized

CR

FY 2019

President’s

Budget

FY 2019

+/- 

FY 2018

Lifespan Respite Care $3,352 $3,337 $3,360 +$23 

*BA is in thousands of dollars, FTE is a whole number.

Authorizing Legislation: Lifespan Respite Care Act of 2006, Title XXIX of the Public Health 

Service Act

FY 2019 Authorization ......................................................................................................... Expired

Allocation Method ............................................................................................. Competitive Grants

Program Description and Accomplishments:

Family caregiving is not just an aging issue. Family caregiving for persons with disabilities occurs 

across the age spectrum from birth to death. Family caregivers are often called upon to provide 

care to individuals of varying ages and disabilities and do so willingly, many are years cared for 

over a lifetime. In 2015, AARP and the National Alliance for Caregiving estimated that 43.5 

million people served as unpaid family caregivers to an adult or child with special needs. For 

many of these caregivers, providing care can take a toll: nineteen percent report high levels of 

physical strain; eighteen percent experience high levels of financial strain; and thirty-eight percent 

of all family caregivers indicated they experienced high levels of emotional stress.106 Many 

caregivers report difficulty managing both physical and emotional stress and balancing work and 

family responsibilities.

Numerous studies have shown respite to be among the most frequently requested supportive 

services for family caregivers.107 Respite is second only to direct financial assistance as a key 

policy priority of surveyed family caregivers.108 Even though respite services are often the 

preferred mode of family caregiver support, they are often under-used, difficult to find and access, 

unaffordable, or in short supply. As a result, nearly 90 percent of family caregivers receive no 

 

106 National Alliance for Caregiving and AARP. Caregiving in the U.S. 2015 – Focused Look at Caregivers of 

Adults Age 50+. http://www.caregiving.org/wp-content/uploads/2015/05/2015_CaregivingintheUS_CareRecipients-Over-50_WEB.pdf 107 The Arc. (2011). Still in the Shadows with Their Future Uncertain: A Report on Family and Individual Needs for 

Disability Supports (FINDS 2011). Wash, DC: Author ; National Family Caregivers Association. (2011). Allsup 

Family Caregiver Survey. Kensington, MD 108 National Alliance for Caregiving and AARP, 2009
CAREGIVER AND FAMILY SUPPORT SERVICES

116 

respite at all.109 The barriers to accessing and using respite services are often significant for specific 

populations such as family caregivers of individuals with Multiple Sclerosis, persons with 

intellectual and developmental disabilities, and for caregivers of veterans and individuals with 

Alzheimer’s disease, spinal cord injuries, autism, and serious emotional disorders. 110

The Lifespan Respite Care Program focuses on easing the burdens of caregiving by providing 

grants to eligible state organizations to improve the quality of, and access to, respite care for family 

caregivers of children or adults with special needs. The program provides ACL with a key vehicle 

to address the needs of caregivers while considering the important contributions they make in the 

lives of persons of all ages with disabilities. The goals of the Lifespan Respite Care Program differ 

from the Family Caregiver Support Services Program, which focuses on providing a variety of 

services to caregivers. Instead, the Lifespan Respite Care program focuses on providing a test-bed 

for needed infrastructure changes, and on filling gaps by putting in place coordinated systems of 

accessible, community-based respite care services for family caregivers of children and adults with 

special needs. These systems bring together and seek to coordinate respite care services for family 

caregivers; training and recruitment of respite care workers and volunteers; and the provision of 

information, outreach, and access assistance.

The Lifespan Respite Care Program also supports technical assistance activities designed to 

maintain a national database on respite care; provide training to state, community, and nonprofit 

respite care programs; and conduct public information, referral, and education programs on respite 

care. Since 2009, the Lifespan Respite Care Program has made grants to States to develop, expand, 

integrate and sustain their respite care systems, and funded a National Technical Assistance 

Resource Center. Examples of grantee accomplishments to date include: 

• Creation and adoption of statewide respite plans and/or policies to guide further 

development of respite and caregiver support programs; 

• Development or enhancement of training programs for respite care providers to expand 

the cadre of trained respite professionals;

• Replication and expansion of respite delivery modalities with a particular focus on 

person- centered planning and consumer direction; 

• Expansion of toll free “helplines,” dedicated websites and statewide respite registries to 

provide caregivers with information about available respite programs. 

• Development and deployment of marketing and awareness campaigns designed to 

educate caregivers about the importance of their work and the necessity to take a break;

• Development of data collection methodologies to track service provision and 

programmatic outcomes; 

 

109 National Alliance for Caregiving and AARP, 2009. 110 National Alliance for Caregiving. (2012). Multiple Sclerosis Caregivers. Washington, DC: Author; The Arc, 2011.
CAREGIVER AND FAMILY SUPPORT SERVICES

117 

• Broadening stakeholder collaborations to ensure representation of all age and disability 

groups, as well as the broadest possible cross section of the provider network; 

• Capacity building and network development at the local level to recruit and train 

volunteers to fill gaps in respite services, particularly in rural areas; and, 

• Provision of direct respite services to family caregivers of children with intellectual and 

developmental disabilities, adults with physical disabilities, and older Americans.

State grantees work in collaboration with Aging and Disability Resource Centers/No Wrong Door 

Systems and a public or private non-profit statewide respite care coalition or organization. Special 

emphasis is placed on implementing or enhancing lifespan respite care statewide and building or 

improving the capacity of their long-term care systems to respond to the comprehensive needs of 

care recipients.

Funding History:

Funding for the Lifespan Respite Care program during the past five years is as follows:

FY 2015 ...................................................$2,360,000 

FY 2016 ...................................................$3,360,000 

FY 2017 ...................................................$3,352,000 

FY 2018 Annualized CR ..........................$3,337,182 

FY 2019 President’s Budget ....................$3,360,000 

Budget Request:

The FY 2019 request for Lifespan Respite is $3,360,000, which is an increase of +$23,000 over 

the FY 2018 Annualized Continuing Resolution. At this level, ACL will continue to make 

competitive grants available to support a range of possible activities to build or enhance Lifespan 

Respite Care Programs; further integrate and sustain Lifespan Respite activities into broader longterm services and supports in the State; and/or to provide additional respite services to family 

caregivers across the age and disability spectrum. ACL recognizes the unique opportunity the 

Lifespan Respite Care Program presents to consider the critical role that support for family 

caregivers plays in ensuring the health and independence of individuals across the age and 

disability spectrum. By investing in this program, ACL seeks to provide more and better targeted 

services that will allow caregivers to continue to care for their loved ones longer and thereby allow 

more care recipients to remain at home and independent for longer periods at lower cost than could 

be realized if these same individuals had to be institutionalized.

The Lifespan Respite Care Program helps to ensure respite quality and choice; and allows for 

respite development, training and coordination regardless of age or disability. The Lifespan 

Respite Care program demonstrates ACL’s commitment supporting caregivers of children or 

adults of any age with special needs. According to the National Respite Coalition, nearly 
CAREGIVER AND FAMILY SUPPORT SERVICES

118 

90 percent of family caregivers of care recipients age 18 and older, and 81 percent of family 

caregivers of children with special needs currently are unable to access or use respite services. 

Caregivers report numerous barriers ranging from cost considerations and restrictive eligibility 

criteria to waiting lists, limited respite options, inadequate supply of trained providers or 

appropriate programs, and gaps in service availability.111 The resources requested for FY 2019 

will be used to address these issues by. 

• Expanding and enhancing respite care services to family members. 

• Improving the statewide dissemination and coordination of respite care, and

• Providing, supplementing, or improving access and quality of respite care services to 

family caregivers, thereby reducing family caregiver strain.

Output Table:

Lifespan Respite Care

Indicator Year and Most Recent 

Result /

FY 2018

Projection

FY 2019

Projection

FY 2019

Projection

+/-FY 2018

Projection

Output AJ: The number 

of states that have 

participated in the 

Lifespan Respite Care 

program. (Output)

FY 2016: 36 37 38 +1

 

111 National Respite Coalition Written Testimony to the House subcommittee on Labor, Health and Human Services, 

and Education Appropriations. April 12, 2010
CAREGIVER AND FAMILY SUPPORT SERVICES

119 

Grant Awards Table:

Lifespan Respite Care Grant Awards

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 15 15 16 

Average Award $215,678 $214,564 $202,580 

Range of Awards

$175,000 

- 

265,000 

$175,000 - 

265,000 

$175,000 - 

265,000 

Resource and Program Data:

Lifespan Respite Care Program

(Dollars in thousands) 

Mechanism

FY 

2017

Final 

#

FY 

2017

Final 

$

FY 2018

Annualized CR # 

FY 2018

Annualized

CR $ 

FY 2019

President’

s Budget #

FY 2019

President’s 

Budget $

Grants:

Formula -- -- -- -- -- --

New Discretionary 14 2,996 2 399 1 23 

Continuations 1 239 13 2,819 15 3,218 

Contracts -- -- -- -- -- --

Interagency Agreements -- -- -- -- -- --

Program Support /1 -- 117 -- 119 -- 119 

Total Resources -- 3,352 -- 3,337 -- 3,360 

1/ Program Support -- Includes funds for statutory requirements, grant systems and review costs, overhead and 

information technology support costs.
120 

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PROTECTION OF VULNERABLE ADULTS

121 

Protection of Vulnerable Adults

Summary of Request

Protection of Vulnerable Adults consists of several distinct but complementary programs designed 

to prevent, detect, and respond to elder abuse, neglect, and exploitation. As the population of older 

Americans increases, the problem of elder abuse, neglect, and exploitation continues to grow. 

While there is no single set of national elder abuse prevalence data, evidence indicates that the 

number of reported cases of elder abuse, neglect, and exploitation are on the rise. A 2004 national 

survey of State Adult Protective Services (APS) programs conducted by the National Center on 

Elder Abuse showed a 16 percent increase in the number of elder abuse cases from an identical 

study conducted in 2000.112 According to a 1998 national incidence study (the only such study 

ever conducted), 84 percent of all elder abuse incidents go unreported, meaning that for every 

reported case of abuse there are over five that go unreported.113 The most recent data on the 

prevalence of elder abuse, neglect, and exploitation suggest that at least 10 percent, or 

approximately 5 million older Americans, experience abuse each year, and many experience it in 

multiple forms.114

The negative effects of abuse, neglect, and exploitation on the health and independence of seniors 

is extensive. Research has demonstrated that older victims of even modest forms of abuse have 

dramatically higher (300 percent) morbidity and mortality rates than non-abused older people.115

The effects of abuse, neglect, and exploitation, impacts the health of older adults by increasing the 

likelihood of heart attacks, dementia, depression, chronic diseases, and psychological distress. 

These unnecessary health problems result in a growing number of seniors accessing the healthcare 

system more frequently (including emergency room visits and hospital admissions), and are 

ultimately forced to leave their homes and communities prematurely.116 Protection of Vulnerable 

Adults programs address this problem through a full array of services designed to prevent, detect, 

and respond to elder abuse, neglect, and exploitation, both at home and in institutional settings.

The total FY 2019 program level request for Protection of Vulnerable Adults is $50,502,000, 

which is a reduction of $1,796,000 the FY 2018 Annualized Continuing Resolution level. For FY 

2019, specific program requests include: 

 

112 Teaster, Pamela, et al. The 2004 Survey of State Adult Protective Services: Abuse of Adults 60 Years of Age and

Older. http://www.ncea.aoa.gov/NCEAroot/Main_Site/pdf/2-14-06%20FINAL%2060+REPORT.pdf 113Tatara, Toshio, et al. The National Elder Abuse Incidence Study Final Report. 1998. 

http://www.aoa.gov/AoARoot/AoA_Programs/Elder_Rights/Elder_Abuse/docs/ABuseReport_Full.pdf 

114 Beach SR, Schulz R, Castle NG, Rosen J. Financial Exploitation and Psychological Mistreatment Among Older 

Adults: Differences Between African Americans and Non-African Americans in a Population-Based Survey. 

Gerontologist 2010. 115 Lachs, M.S., Williams, C.S., O'Brien, S., Pillemer, K.A., & Charlson, M.E. (1998). “The Mortality of Elder 

Mistreatment.” JAMA. 280: 428-432. and Baker, M.W. (2007). “Elder Mistreatment: Risk, Vulnerability, and 

Early Mortality.” Journal of the American Psychiatric Nurses Association, Vol. 12, No. 6, 313-321. 116 Lachs M. S., Williams C., O'Brien S., Hurst L., Kossack A., Siegal A., et al. (1997). “ED use by older victims of 

family violence.” Annals of Emergency Medicine. 30:448-454.
PROTECTION OF VULNERABLE ADULTS

122 

• $15,855,000 for the Long-Term Care Ombudsman Program, an increase of +$77,875

above the FY 2018 Annualized Continuing Resolution. This consumer advocacy program 

improves the quality of care for the residents of long-term care facilities in all states. In FY 

2019 the program is projected to provide nearly half a million consultations; and address 

over 190,000 complaints with a historic resolution rate of nearly 75 percent. 

• $4,773,000 for Prevention of Elder Abuse and Neglect, an increase of +$32,413 above the 

FY 2018 Annualized Continuing Resolution level. This program provides formula grants 

to states to train, educate, and increase public awareness of how to prevent elder abuse.

• $18,000,000 for the Health Care Fraud and Abuse Control/Senior Medicare Patrol Program

(HCFAC/SMP), the same level of funding that was available in FY 2018. HCFAC/SMP 

funds competitive grants and related infrastructure to support a volunteer-based network 

that helps to prevent and combat healthcare fraud and abuse and helps to preserve the 

financial integrity of Medicare and Medicaid. 

• $11,874,000 for Elder Rights Support Activities, a decrease of -$1,906,782 below the FY 

2018 Annualized Continuing Resolution level. Funds will support the implementation of 

a nationwide Adult Protective Services data system, and fund research and evaluation 

activities. This program also provides funding for resource centers and activities that 

provide information, training, and technical assistance on elder rights issues to the national 

Aging Services Network.

These elder rights and elder justice programs these provide a foundation and establish best 

practices for States to expand and improve the protection of individuals living in their communities 

and in long-term care settings. Their programs increase the information and technical assistance 

available to the public, States, and localities in preventing and addressing abuse; protect the rights 

of older adults; reduce health-care fraud and abuse; and provide assistance to Tribes in developing 

elder justice systems. This multifaceted approach to preventing, detecting, and resolving elder 

abuse, neglect, and exploitation is essential to successfully fulfilling the shared mission of the 

Older Americans Act and the Elder Justice Act to maintain the health and independence of older 

Americans and adults with disabilities.
123 

Long-Term Care Ombudsman Program

Services FY 2017

Final

FY 2018

Annualized 

CR

FY 2019

President’s

Budget

FY 2019 

+/- 

FY 2018

Long-Term Care 

Ombudsman Program $15,848 $15,777 $15,855 $78 

*BA is in thousands of dollars, FTE is a whole number.

Authorizing Legislation: Section 712 of the Older Americans Act of 1965, as amended.

FY 2019 Older Americans Act Authorization ...............................................................$16,621,101 

Allocation Method ................................................................................................... Formula Grants 

Program Description and Accomplishments:

The Long-Term Care (LTC) Ombudsman Program is a consumer advocacy program that improves 

the quality of life and quality of care for the estimated 3 million individuals who reside in over 

75,000 long-term care facilities (over 16,000 licensed nursing facilities and nearly 60,000 

0licensed board and care facilities).

117 Formula grants to states and territories based on the number 

of individuals age 60 and older provide funding for the training, travel, and other operating costs 

of nearly 8,651 ombudsmen (both staff and designated volunteers) who resolve complaints with 

and on behalf of these residents, advocate for systemic improvement of long-term services and 

supports, and routinely monitor the condition of long-term care facilities.

A primary ombudsman duty is to identify, investigate, and resolve complaints that are made by or 

on behalf of residents. These complaints relate to action, inaction, or decisions of providers, public 

agencies, and others that may adversely affect residents’ health, safety, welfare or rights. 

Ombudsmen advocate on behalf of residents by representing their interests before government and 

administrative entities, providing information to residents and families about long-term services 

and supports, and educating the general public about issues related to long-term services and 

supports policies and regulations. 

Much of the efficiency of the ombudsman program is due to a strong reliance on volunteers who 

make up the bulk of those who resolve resident issues.118 All but three states have volunteer 

ombudsman programs. These trained and designated volunteer ombudsmen donated over 708,322 

hours in FY 2015. In FY 2016, output data for the Long-Term Care Ombudsman Program 

highlights the accomplishments achieved by this program and the important role that ombudsmen 

play in ensuring that the rights of long-term care facility residents are respected:

 

117 National Ombudsman Reporting System (NORS) – FFY 2016. 118 Shaughnessy, Carol V. The Role of Ombudsmen in Assuring Quality for Residents of Long-Term Care Facilities: 

Straining to Make Ends Meet. National Health Policy Forum. December 9, 2009. 
PROTECTION OF VULNERABLE ADULTS

124 

• 1,300 paid and 7,734 designated volunteer ombudsmen made quarterly visits to residents 

in more than 68 percent of all nursing home facilities and 28 percent of all licensed board 

and care facilities (Output S). At least another 3,750 volunteers support these paid staff 

and volunteer ombudsmen. 

• Ombudsmen investigated and worked to resolve over 199,000 complaints (Output Q). 

• Ombudsmen provided 520,000 consultations to individuals and facility managers and 

staff on such topics as residents’ rights, staffing levels, malnutrition, dementia care, 

depression, discharge procedures, financial exploitation and strategies to reduce the use 

of restraints and prevent the abuse and neglect of residents (Output R). 

The environment in which individuals seek LTSS continues to evolve as more people are 

increasingly choosing to live in community settings. Encouraging community living has been 

supported by a number of Federal and State policies that promote alternatives to nursing homes 

and other institutional settings, and that recognize the value of consumer preference and the 

potential fiscal savings that can result. These initiatives, include Olmstead implementation and 

enforcement, Money Follows the Person, Home and Community-Based Service waivers, and 

Medicaid managed care, to name a few. These evolving services and supports continue to change 

the long-term care landscape across the country. There is also a growing Federal awareness and 

response to the uncharted area of abuse, neglect, and exploitation of older adults and individuals 

with disabilities.

Funding History: 

Funding for the Long-term Care Ombudsman Program over the past five years is as follows:

FY 2015 .................................................$15,885,000 

FY 2016 .................................................$15,885,000 

FY 2017 .................................................$15,848,000 

FY 2018 Annualized CR ........................$15,777,125 

FY 2019 President’s Budget ..................$15,855,000 

Budget Request:

The FY 2019 Budget request for the LTC Ombudsman Program is $15,855,000, which is +$78,000 

above the FY 2018 Annualized Continuing Resolution. Funds will continue to support the existing 

infrastructure and activities of the Ombudsman program. With the senior population continuing to 

grow, the need for safe, high-quality long-term care services (including non-nursing home 

alternatives) continues to increase, even as we seek to help more people remain in the community 

for longer periods. Outcome data (displayed in the summary tables at the end of this section) have 

demonstrated the success of this program in protecting older Americans in an efficient and 

effective manner. The percentage of the complaints processed by ombudsmen that were fully or 
PROTECTION OF VULNERABLE ADULTS

125 

partially resolved to the satisfaction of the resident was 73 percent in FY 2016.

119 Reducing the 

number of complaints unresolved to the satisfaction of the resident is one indicator of program 

effectiveness. In FY 2016 the target was to have no more than 9,000 complaints unresolved. The 

program performed better than expected reducing the number of unresolved complaints to 8,986 

(Outcome Measure 2.14). Program success with advocacy for systemic improvement is measured 

as a reduction in the average number of complaints per facility. In FY 2016, the goal was set at an 

average of 2.8 complaints per facility. The program surpassed this goal by reducing the average 

number of complaints to 2.6 (Outcome Measure 2.12). These measures taken together demonstrate 

the efficacy of the program and its ability to produce positive outcomes for residents. 

 

Ombudsman activities represent an important element of ACL’s focus on elder rights and 

complements ACL’s successful elder rights programs to create a full array of services that prevent, 

detect, and resolve elder abuse, neglect, and exploitation. LTC Ombudsmen also support 

individuals who choose to transition out of nursing home facilities into more integrated settings. 

They also advocate for quality care and individual rights and well-being in other congregate longterm care settings, such as board and care and assisted living. In addition, LTC Ombudsmen serve 

individuals in these settings regardless of the individuals’ eligibility for Medicaid or other public 

benefits. Ombudsmen are the only federally-funded entity providing services to all of these 

residents. Going forward, outreach, access, complaint investigation and advocacy in board and 

care and assisted living will require ombudsmen to employ new strategies compared to the work 

now done primarily in nursing home settings. 

Outcomes and Outputs Table:

Long-Term Care Ombudsman Program

 

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2018

Target

FY 2019

Target

FY 2019

Target

+/-FY 2018

Target

2.12 Decrease the 

average number of 

complaints per LTC 

facility. (Outcome)

FY 2016: 2.6

Target:

2.8

(Target Exceeded)

2.6 2.6 Maintain

2.14 Decrease the number 

of complaints not 

resolved to the 

satisfaction of the 

resident. (Outcome)

FY 2016: 8,986

Target:

9,700

(Target Exceeded)

9,300 9,000 -300

 

119 National Ombudsman Reporting System (NORS) 2016 – Complaint resolution: 13% needing no further 

action; 4.5% withdrawn; 4.5% not resolved to the satisfaction of the resident; 5% referred to other agency 

for resolution.
PROTECTION OF VULNERABLE ADULTS

126 

Indicator Year and Most Recent 

Result /

FY 2018

Projection

FY 2019

Projection

FY 2019

Projection

+/-FY 2018

Projection

Output Q: The Number of 

Complaints (Output)

FY 2016: 199,493 193,000 193,000 Maintain

Output R: Number of 

Ombudsman 

Consultations (Output)

FY 2016: 494,234 480,000 470,000 -10,000

Output S: Facilities 

regularly visited not in 

response to a complaint

(Output)

FY 2016: 28,473 27,800 27,800 Maintain

Grant Awards Table:

Long-Term Care Ombudsman Program Formula Grant Awards

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 56 56 56 

Average Award $282,399 $278,917 $280,294 

Range of Awards $9,884 -

$1,658,796 

$9,762 -

$1,637,718 

$9,810 -

$1,645,806 
PROTECTION OF VULNERABLE ADULTS

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2019 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Long-Term Care Ombudsman Program (CFDA 93.042)

State/Territory FY 2017

Final

FY 2018

Annualized CR

FY 2019

President's Budget

FY 2019 +/-

FY 2018

Alabama 241,379 237,584 238,757 1,173

Alaska 79,072 78,097 78,482 385

Arizona 344,482 344,243 345,943 1,700

Arkansas 148,565 145,301 146,018 717

California 1,658,796 1,637,718 1,645,806 8,088

Colorado 234,091 233,816 234,970 1,154

Connecticut 179,611 176,151 177,020 869

Delaware 79,072 78,097 78,482 385

District of Columbia 79,072 78,097 78,482 385

Florida 1,181,029 1,176,187 1,181,993 5,806

District of Columbia 79,072 78,097 78,482 385

Florida 1,181,029 1,176,187 1,181,993 5,806

Georgia 421,958 419,389 421,459 2,070

Hawaii 79,072 78,097 78,482 385

Idaho 79,072 78,097 78,482 385

Illinois 586,929 575,203 578,042 2,839

Indiana 309,532 304,476 305,979 1,503

Iowa 158,494 155,234 156,000 766

Kansas 135,767 133,571 134,230 659

Kentucky 215,060 211,336 212,379 1,043

Louisiana 211,300 208,869 209,900 1,031

Maine 79,448 78,197 78,583 386

Maryland 273,372 269,923 271,255 1,332

Massachusetts 331,591 326,503 328,115 1,612

Michigan 503,370 494,874 497,317 2,443

Minnesota 258,928 255,955 257,219 1,264

Mississippi 139,902 137,457 138,135 678

Missouri 301,499 296,216 297,679 1,463

Montana 79,072 78,097 78,482 385

Nebraska 88,662 87,304 87,735 431

Nevada 133,897 133,827 134,488 661

New Hampshire 79,072 78,097 78,482 385
PROTECTION OF VULNERABLE ADULTS

128 

PROGRAM/CFDA NUMBER: Long-Term Care Ombudsman Program (CFDA 93.042)

State/Territory FY 2017

Final

FY 2018

Annualized CR

FY 2019

President's Budget

FY 2019 +/-

FY 2018

New Jersey 425,463 417,725 419,787 2,062

New Mexico 102,596 101,459 101,959 500

New York 937,811 919,900 924,441 4,541

North Carolina 479,833 476,200 478,550 2,350

North Dakota 79,072 78,097 78,482 385

Ohio 586,793 575,947 578,790 2,843

Oklahoma 182,045 178,730 179,612 882

Oregon 211,238 209,561 210,596 1,035

Pennsylvania 684,715 670,518 673,827 3,309

Rhode Island 79,072 78,097 78,482 385

South Carolina 250,794 250,307 251,542 1,235

South Dakota 79,072 78,097 78,482 385

Tennessee 322,105 317,806 319,375 1,569

Texas 1,046,876 1,042,389 1,047,535 5,146

Utah 99,455 99,418 99,908 490

Vermont 79,072 78,097 78,482 385

Virginia 380,213 376,694 378,553 1,859

Washington 335,213 334,368 336,018 1,650

West Virginia 106,066 103,264 103,774 510

Wisconsin 288,676 284,589 285,994 1,405

Wyoming 79,072 78,097 78,482 385

Subtotal, States 15,526,418 15,335,373 15,411,067 75,694

American Samoa 9,884 9,762 9,810 48

Guam 39,536 39,048 39,241 193

Northern Mariana Islands 9,884 9,762 9,810 48

Puerto Rico 189,058 186,361 187,281 920

Virgin Islands 39,536 39,048 39,241 193

Subtotal, States and 

Territories 15,814,316 15,619,354 15,696,450 77,096

Undistributed 1/ $33,684 157,771 158,550 779

TOTAL 15,848,000 15,777,125 15,855,000 77,875

1/ Program Support -- Includes funds for Older Americans Act statutory requirements, including disaster assistance, and grant 

and program reporting systems costs. Funds unused for these purposes at the end of the year are allocated to States.
129 

Prevention of Elder Abuse and Neglect

 

Services FY 2017

Final

FY 2018

Annualized 

CR

FY 2019

President’s

Budget

FY 2019

+/- 

FY 2018

Prevention of Elder Abuse & 

Neglect $4,762 $4,741 $4,773 +$32

*BA is in thousands of dollars, FTE is a whole number.

Authorizing Legislation: Section 702 (b) of the Older Americans Act of 1965, as amended.

FY 2019 Older Americans Act Authorization .................................................................$4,994,178 

Allocation Method ..................................................................................................... Formula Grant 

Program Description and Accomplishments:

The Prevention of Elder Abuse and Neglect program provides formula grants to states and 

territories based on their share of the population 60 and over, to train State and local officials and 

promote public awareness of elder abuse. The program also supports state and local elder abuse 

prevention coalitions and multi-disciplinary teams. These activities are important elements of 

ACL’s activities related to elder rights and elder justice. The program coordinates activities with 

state and local Adult Protective Services programs (over half of which are directly administered 

by State Units on Aging) and other professionals who work to address issues of elder abuse and 

elder justice. The importance of these services at the state and local level is demonstrated by the 

fact that states significantly leverage Older Americans Act (OAA) funds to obtain other funding 

for these activities. In FY 2016, over $30 million of the Elder Abuse Prevention services 

expenditures was leveraged from non-OAA funds, a ratio of nearly $7.00 of non-OAA funds for 

every $1 investment of ACL funds. 

Examples of state elder abuse prevention activities include: 

• In Kentucky, the local area agencies on aging participate in the Local Coordinating 

Councils on Elder Abuse, which have developed emergency elder shelters, distributed

informational cards for law enforcement officers to have in the patrol cars which contain 

crucial resource information for victims of elder abuse, conducted training on a regular 

basis to first responders, provided a friendly visitor program for home-based seniors, and 

produced a prevention tool called the Kentucky Fraud Fighter Form. 

• In Illinois, the State Department on Aging utilizes its elder abuse funds to support 

volunteer community based multi-disciplinary teams (M-Teams) that serve in a technical 

advisory role to more than 40 elder abuse provider agencies throughout the state. The 

objectives of the M-Team are to provide case consultation and assistance to caseworkers 

and to encourage cooperation among various service agencies. Each M-Team is 
PROTECTION OF VULNERABLE ADULTS

130 

composed of the M-Team Coordinator and representatives of the mental health, medical, 

legal, law enforcement, faith community, and financial professions. 

The Prevention of Elder Abuse and Neglect program demonstrates ACL’s ongoing commitment 

to protecting the rights of seniors and promoting their dignity and autonomy. Through education 

efforts, exposing problems that would otherwise be hidden from view, and providing a voice for 

those who cannot act for themselves, the program helps ensure that all older Americans are able 

to age with dignity in a safe environment. 

Funding History:

Funding for Prevention of Elder Abuse and Neglect over the past five years is as follows:

FY 2015 ...................................................$4,773,000 

FY 2016 ...................................................$4,773,000 

FY 2017 ...................................................$4,762,000 

FY 2018 Annualized CR ..........................$4,740,587 

FY 2019 President’s Budget ....................$4,773,000 

Budget Request:

The FY 2019 request for the Prevention of Elder Abuse and Neglect program is $4,773,000, which

is $32,000 above the FY 2018 Annualized Continuing Resolution. The FY 2019 request maintains 

the ability of states and territories to train law enforcement officials, develop and distribute 

educational materials, conduct public awareness campaigns, and create community coalitions and 

multidisciplinary teams to investigate and respond to elder abuse and neglect. States and AAAs 

also use this funding to coordinate their activities with fraud and crime prevention partnerships 

organized by sheriffs, police chiefs, and community organizations. 

Elder Abuse Prevention activities are important elements of ACL’s elder rights and elder justice

activities and complement Adult Protective Services by funding the infrastructure on which best 

practices may be developed and evaluated.
PROTECTION OF VULNERABLE ADULTS

131 

Output Table:

Prevention of Elder Abuse and Neglect 

Indicator Year and Most Recent 

Result /

FY 2018

Projection

FY 2019

Projection

FY 2019

Projection

+/-FY 2018

Projection

Output U: Elder Abuse 

prevention non-OAA 

service expenditures 

(Output, dollars in 

thousands)

FY 2016: $30,104 $30,600 $30,800 +200

Grant Awards Table:

Prevention of Elder Abuse, Neglect, and Exploitation Grant Awards 

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 56 56 56 

Average Award $84,685 $83,807 $84,380 

Range of Awards $2,964 - 

$471,073 

$2,934 - 

$467,207 

$2,954 - 

$470,407 
PROTECTION OF VULNERABLE ADULTS

132 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2019 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Prevention of Elder Abuse & Neglect (CFDA 93.041)

State/Territory FY 2017

Final

FY 2018

Annualized CR

FY 2019

President's 

Budget

FY 2019 +/- 

FY 2018

Alabama 76,215 75,590 76,107 517

Alaska 23,712 23,466 23,626 160

Arizona 84,481 80,831 81,384 553

Arkansas 48,157 47,762 48,089 327

California 471,073 467,207 470,407 3,200

Colorado 57,391 55,622 56,002 380

Connecticut 59,907 59,416 59,822 406

Delaware 23,712 23,466 23,626 160

District of Columbia 23,712 23,466 23,626 160

Florida 344,252 341,428 343,762 2,334

Georgia 103,450 102,473 103,174 701

Hawaii 23,712 23,466 23,626 160

Idaho 23,712 23,466 23,626 160

Illinois 197,384 195,765 197,103 1,338

Indiana 98,224 97,418 98,084 666

Iowa 55,927 55,468 55,847 379

Kansas 45,843 45,467 45,778 311

Kentucky 66,595 66,049 66,500 451

Louisiana 68,518 67,956 68,421 465

Maine 23,712 23,466 23,626 160

Maryland 78,087 77,446 77,976 530

Massachusetts 109,606 108,707 109,450 743

Michigan 160,862 159,542 160,633 1,091

Minnesota 76,347 75,721 76,238 517

Mississippi 45,198 44,827 45,134 307

Missouri 97,643 96,842 97,504 662

Montana 23,712 23,466 23,626 160

Nebraska 29,770 29,526 29,728 202

Nevada 32,827 27,402 27,590 188

New Hampshire 23,712 23,466 23,626 160
PROTECTION OF VULNERABLE ADULTS

133 

PROGRAM/CFDA NUMBER: Prevention of Elder Abuse & Neglect (CFDA 93.041)

State/Territory FY 2017

Final

FY 2018

Annualized CR

FY 2019

President's Budget

FY 2019 +/- 

FY 2018

New Jersey 143,950 142,769 143,745 976

New Mexico 26,393 26,176 26,356 180

New York 318,066 315,457 317,614 2,157

North Carolina 126,782 125,742 126,602 860

North Dakota 23,712 23,466 23,626 160

Ohio 197,185 195,567 196,905 1,338

Oklahoma 60,208 59,714 60,122 408

Oregon 56,795 56,329 56,714 385

Pennsylvania 242,944 240,951 242,598 1,647

Rhode Island 23,712 23,466 23,626 160

South Carolina 63,080 62,563 62,990 427

South Dakota 23,712 23,466 23,626 160

Tennessee 91,810 91,057 91,679 622

Texas 274,281 272,031 273,891 1,860

Utah 24,837 24,633 24,802 169

Vermont 23,712 23,466 23,626 160

Virginia 102,820 101,977 102,674 697

Washington 86,291 85,583 86,168 585

West Virginia 36,736 36,435 36,684 249

Wisconsin 90,309 89,568 90,181 613

Wyoming 23,712 23,466 23,626 160

Subtotal, States 4,658,500 4,610,075 4,641,596 31,521

American Samoa 2,964 2,934 2,954 20

Guam 11,856 11,733 11,813 80

Northern Mariana Islands 2,964 2,934 2,954 20

Puerto Rico 54,217 53,772 54,140 368

Virgin Islands 11,856 11,733 11,813 80

Subtotal, States and 

Territories 4,742,357 4,693,181 4,725,270 32,089

Undistributed 1/ 19,643 47,406 47,730 324

TOTAL 4,762,000 4,740,587 4,773,000 32,413

1/Program Support -- Includes funds for Older Americans Act statutory requirements, including disaster assistance, and grant and 

program reporting systems costs. Funds unused for these purposes at the end of the year are allocated to States.
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135 

Health Care Fraud and Abuse Control/Senior Medicare Patrol Program

-

Service FY 2017

Final

FY 2018

Annualized

CR

FY 2019

President’s

Budget

FY 2019

+/- 

FY 2018

Senior Medicare Patrol 

Program $18,000 $18,000 $18,000 $0

FTE 2/ 5 5 7 +2 

*BA is in thousands of dollars, FTE is a whole number.

Authorizing Legislation: Sections 201, 202, and 411 of the Older Americans Act of 1965, as 

amended. 

FY 2019 Older Americans Act Authorization ........................... Authorized—No Specific Amount 

Allocation Method ............................................................................................... Competitive Grant

Program Description and Accomplishments:

The Health Care Fraud and Abuse Control/Senior Medicare Patrol (SMP) program provides 

competitive grants to 53 states and territories to support a national network of volunteers whose 

purpose is to educate Medicare beneficiaries on preventing and identifying healthcare fraud and 

abuse. Projects use the skills of volunteers to conduct community outreach and education and 

provide information that empowers beneficiaries of Medicare and Medicaid and their families to 

prevent, identify and report fraud. Activities are carried out in partnership with the Centers for 

Medicare & Medicaid Services (CMS), the Office of Inspector General (OIG), healthcare 

providers, and other aging and elder rights professionals from around the country. 

Data obtained from the SMP Information and Reporting System (SIRS) for calendar year 2016 

shows that the 53 Senior Medicare Patrol projects: 

• Maintained 6,157 active SMP team members who worked over 413,395 hours to educate 

beneficiaries about how to prevent Medicare fraud, errors and abuse; 

• Educated 1,498,213 individuals during 26,307 group outreach and education events; and, 

• Responded to 187,705 individual inquiries for information or assistance from Medicare 

beneficiaries, family members, and caregivers related to Medicare fraud, errors and 

abuse.

Since the Senior Medicare Patrol program’s inception in 1997, program data show that SMP 

projects have educated nearly 35.6 million beneficiaries through 360,973 group outreach and 

education events and assisted approximately 2.5 million beneficiaries with individual inquires 
PROTECTION OF VULNERABLE ADULTS

136 

related to Medicare fraud, errors, and abuse. HHS-OIG reports that total savings directly 

attributable to the SMP projects are more than $124 million since 1997; however, this does not 

fully capture the total impact of the program on reducing Medicare fraud, including any sentinel 

effect that may result from these activities.

The SMP program historically has used approximately $3.4 million of its resources for 

infrastructure (including Federal staff support), technical assistance, and other program support 

and capacity-building activities designed to enhance program effectiveness. Activities funded 

with these dollars include support for project training and technical assistance provided by ACL’s 

National Consumer Protection Technical Resource Center.

Funding History:

Comparable funding for SMP discretionary appropriations over the past five years is as follows:

FY FTE

FY 2015 .................................................$17,620,000 7 

FY 2016 ...............................................$18,000,000 6 

FY 2017 ............................................... $18,000,000 5

FY 2018 Annualized CR ...................... $18,000,000 5

FY 2019 President’s Budget ..................$18,000,000 7 

Budget Request:

The FY 2019 Budget includes an estimate of $18 million in FY 2018 and FY 2019 for the 

HCFAC/SMP. Since FY 2016, appropriations language has charged the Secretary to fully fund 

the program at a level determined by the Secretary out of discretionary appropriations from the 

HCFAC account within the Centers for Medicare & Medicaid Services (CMS). In FY 2019, CMS 

plans to continue to support the SMP program and is requesting to change the appropriations 

language to provide the Secretary of HHS with greater flexibility in determining the funding 

amount and sources of funding (e.g. HCFAC mandatory or discretionary account) that this activity 

can be funded from. This request reflects an increase of 2 FTE over FY 2018, resulting from the 

shift of additional staff to work on SMP/HCFAC following elimination of the SHIP program. 

Since the Senior Medicare Patrol program’s inception, SMP projects have received more than 

35,000 complex issues (complaints) from Medicare beneficiaries who have detected billing errors, 

potential fraud, or other discrepancies. SMPs also have educated over 6.6 million beneficiaries in 

group or one-on-one counseling sessions and have reached more than 30 million people through 

community outreach events. The primary focus of these sessions is on education, prevention, and 

teaching beneficiaries how to protect themselves and avoid fraud in the first place and this is the 

true value of the SMP program. 

The total impact of these education and prevention activities is extremely difficult to quantify in 

dollars and cents. As HHS-OIG indicated in their June 2016 report on the SMP program: 
PROTECTION OF VULNERABLE ADULTS

137 

“We continue to emphasize the projects may not be receiving full credit for recoveries, 

savings, and cost avoidance attributable to their work. It is not always possible to track 

referrals to Medicare contractors or law enforcement from beneficiaries who have 

learned to detect fraud, waste, and abuse from the projects. In addition, the projects are 

unable to track the substantial savings derived from a sentinel effect whereby Medicare 

beneficiaries’ scrutiny of their bills reduce fraud and errors.” 

While SMPs make numerous referrals of potential fraud to the Centers for Medicare & Medicaid 

Services (CMS) and the HHS Office of Inspector General (HHS-OIG), it is difficult to track the 

actions (investigation, prosecution, collection) required to calculate the full savings to the 

government as a result of SMP referrals. All of these factors hinder the program’s ability to 

measure the extent and cost of fraud and abuse. ACL recognizes the importance of measuring the 

value of the SMP program impact to the fullest degree possible and is working to overcome these 

limitations by undertaking a variety of steps, including:

• Realigning the program’s performance metrics based on findings from a recent SMP 

program evaluation; 

• Ongoing collaboration with HHS-OIG to track fraud referrals and their outcomes; and, 

• Continuing research efforts on SMP prevention education to determine how to best 

measure and quantify the effects of SMP program efforts. Preliminary results appear to 

show it is possible to quantify and demonstrate the value of SMP prevention activities, but 

further follow-up is required, the results of which should be available in FY 2019. 

Despite the factors that have limited ACL’s ability to quantify the value of the SMP program in 

preventing, identifying, and reporting health care fraud, HHS-OIG has documented over $124.6 

million in savings attributable to the program as a result of beneficiary complaints since the 

program’s inception in 1997. 
PROTECTION OF VULNERABLE ADULTS

138 

Output Table:

Senior Medicare Patrol Program

Indicator Year and Most Recent 

Result /

FY 2018

Projection

FY 2019

Projection

FY 2019

Projection

+/-FY 2018

Projection

Output W: Beneficiaries 

Educated and Served

(Output)

CY 2016: 1,688,083 1,740,000 1,785,000 +45,000

Grant Awards Table:

Senior Medicare Patrol Grant Awards

 (Dollars in thousands) 

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 107 54 54 

Average Award $145,328 $297,592 $297,592 

Range of 

Awards

$95,831 

- 

$640,000 

 $95,831 - 

$640,000 

 $95,831 - 

$640,000 
PROTECTION OF VULNERABLE ADULTS

139 

Resource and Program Data:

Senior Medicare Patrols

(Dollars in thousands) 

Mechanism FY 2017

Final #

FY 2017

Final $

FY 2018

Annualized 

CR #

FY 2018

Annualized 

CR $

FY 2019

President’s 

Budget #

FY 2019

President’s 

Budget $

Grants:

Formula

 

-- -- -- -- -- --

New Discretionary

54 805 53 15,430 -- --

Continuations 53 14,745 1 640 54 16,070

Contracts 4 969 3 827 3 827

Interagency Agreements -- -- -- -- -- --

Program Support 1/ -- 1,481 -- 1,103 -- 1,103

Total Resources -- 18,000 -- 18,000 -- 18,000

1/ Program Support -- Includes funds for overhead, grant systems and review costs, and information technology

support costs.

2/ No discretionary budget authority funding is requested by ACL for the Senior Medicare Patrol program in

FY 2018. Since FY 2016, based on FY 2016 appropriations language, SMP funding levels are determined by the 

Secretary of HHS, and made available from discretionary appropriations for the HCFAC account within the Centers 

for Medicare & Medicaid Services (CMS).
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141 

Elder Rights Support Activities

Service FY 2017

Final

FY 2018

Annualized 

CR

FY 2019

President’s

Budget

FY 2019

+/- 

FY 2018

Elder Rights Support 

Activities $13,847 $13,780 $11,874 -$1,906 

FTE 2.5 2.7 2.7 -

*BA is in thousands of dollars, FTE is a whole number.

Authorizing Legislation: Sections 201, 202, 411, 751, and 752 of the Older Americans Act of 1965

as amended, Title XX of the Social Security Act, Subtitle B, as amended by the Affordable Care 

Act.

FY 2018 Older Americans Act Authorization ...............................................................$11,083,873 

Allocation Method ............................. Competitive Grants/Cooperative Agreements and Contracts 

Program Description and Accomplishments:

Elder Rights Support Activities provide information, training, and technical assistance to States 

and communities to prevent, detect, and respond to elder abuse, neglect, and exploitation and 

support the development of coordinated systems of Adult Protective Services. The Elder Justice 

and Adult Protective Services program, along with the National Center on Elder Abuse, the 

National Long-Term Care Ombudsman Resource Center, and legal systems development and 

assistance programs create an interconnected framework for carrying out ACL’s Protection of 

Vulnerable Adults programs. 

The Elder Justice Act of 2009 established the Elder Justice Coordinating Council (EJCC) to 

coordinate activities related to elder abuse, neglect, and exploitation across the Federal 

government. As Chair of the EJCC, the Secretary of HHS has lead responsibility for identifying 

and proposing solutions to the problems surrounding elder abuse. The Secretary has assigned 

responsibility for implementing the EJCC to the Administration for Community Living.

 

To combat the rising scourge of elder abuse, neglect, and exploitation in America, ACL’s goal is 

to put in place, in coordination with the Elder Justice Coordinating Council, a comprehensive 

system to provide a coordinated and seamless response for helping adult victims of abuse, to 

prevent abuse before it happens, and to develop new and innovative approaches to preventing, 

detecting, and responding to abuse, neglect, and exploitation. The Elder Rights Support Activities 

described below are key components of ACL’s ongoing elder rights programs. 
PROTECTION OF VULNERABLE ADULTS

142 

Adult Protective Services

Unlike Child Protective Services, which has been in existence for decades, a federal infrastructure 

to support basic programmatic standards for Adult Protective Services (APS) is just beginning. 

Historically, an absence of federal stewardship in APS has led to inconsistent data systems and 

non-uniform reporting requirements at the national level, and prevented APS programs from 

evaluating their services or conducting meaningful program evaluations. APS programs and 

administrators have lacked reliable information and guidance on best practice and standards for 

conducting case investigations and for staffing and managing APS programs. Additionally, GAO 

has identified challenges faced by APS programs across the country in collecting, maintaining, 

and reporting statewide, case-level data. These challenges include funding levels, budget 

reductions, and increasing caseloads. These challenges and have impaired States’ ability to assess 

client outcomes and the effectiveness of the services they are providing.120 They have also given 

rise to systems that are less equipped to respond in an effective and timely way to reports of elder 

abuse, neglect and exploitation. 

In FY 2015, ACL received its first dedicated appropriation to support states in enhancing their APS 

systems statewide. Through ACL’s continued investment in the APS program in FY 2016, states 

received additional funding to test innovations and improvements in APS practice, services, data

collection, and reporting, and to support the development and implementation of ACL’s National 

Adult Maltreatment Reporting System (NAMRS) effort. The APS program supports states by 

providing significant, on-going technical assistance to identify promising and best practices; 

participate in national APS data collection efforts; and conduct research and evaluations to increase 

the knowledge base about effective APS programming and practices. Through the APS program, 

ACL encourages states to seek system transformations that reflect “person-centered approach” 

(i.e., practices and services that are based on people’s strengths, assets, goals, culture, and 

expectations, along with their needs) and that aim to improve the experiences, health, well-being, 

and outcomes of the individuals served by APS. 

National Center on Elder Abuse 

To support and enhance the activities of State and local programs to prevent elder abuse, neglect, and 

exploitation, ACL funds the National Center on Elder Abuse (NCEA). NCEA disseminates 

information to professionals and the public; collaborates on research; provides consultation; identifies 

and provides information about promising practices and interventions; answers inquiries and requests 

for information; operates a listserv forum for professionals; and advises on program and policy 

developments. NCEA also facilitates the exchange of strategies for uncovering and prosecuting fraud 

in areas such as telemarketing and sweepstakes scams. Examples of past NCEA activities include:

• Responding to individual public inquiries and requests for information regarding elder 

abuse.

• Providing cost-effective trainings to professionals though live Webcast forums on issues 

relevant to elder justice, training professionals through presentations at national 

 

120 U.S. Government Accountability Office. (2011). ELDER JUSTICE: Stronger Federal Leadership Could Enhance 

National Response to Elder Abuse. (GAO-11-208). Washington, D.C.: U.S. Government Printing Office.
PROTECTION OF VULNERABLE ADULTS

143 

conferences, and creating and disseminating three research-themed training podcasts to

promote continual learning. 

• Continuing to support systems change by identifying local elder justice community 

coalitions and reaching out to them to learn how they leverage local resources and 

expertise to prevent and combat elder abuse, neglect, and exploitation, as well as offering

technical assistance on operating, invigorating, and sustaining coalitions.

National Long-Term Care Ombudsman Resource Center

The National Long-Term Care Ombudsman Resource Center (NORC) provides training and 

technical assistance to support the activities of State and local long-term care ombudsmen. The 

Center works to enhance the skills, knowledge and management capacity of the statewide 

ombudsman programs to enable them to handle resident complaints and represent resident 

interests. The Center also provides information to consumers and links them to ombudsmen who 

can help consumers navigate the long-term care system and resolve problems in nursing, board 

and care, and assisted living homes. 

The NORC engages in numerous projects and activities in support of long-term care ombudsman 

programs. Highlights include supporting the Money Follows the Person (MFP) demonstration 

project by working with CMS, ACL, and National Association of State Long-Term Care 

Ombudsman Programs (NASOP) to promote ombudsman coordination with MFP grantees, Aging 

and Disability Resource Centers (ADRCs), Centers for Independent Living, and other single point 

of entry programs; and furthering Federal efforts to support consumer choice and access to 

alternatives to nursing home care. The NORC also provides ombudsmen with training from 

national experts on such issues as the Changing Long-Term Care System, Money Follows the 

Person and Nursing Home Transition, and Advocacy in Assisted Living. The Center’s website 

continues to experience high utilization (over 40,000 monthly visits) by ombudsmen, consumers, and 

agencies.

Legal Assistance and Support 

Legal Assistance and Support provides funding for two different activities. Model Approaches 

help States develop and implement cost-effective, replicable approaches for integrating low-cost 

legal assistance mechanisms related to APS into the broader tapestry of State legal service delivery 

networks, such as senior legal helplines, law school clinics, and volunteer attorneys. Model 

Approaches projects ensure strong leadership at the State level, thereby enhancing the state’s 

overall capacity for legal service delivery and creating linkages between legal assistance providers 

and professionals in the broader community-based aging and disability and elder rights networks. 

These linkages include Area Agencies on Aging (AAAs), Aging and Disability Resource Centers 

(ADRCs), State Long-Term Care Ombudsmen, and Adult Protective Services, and leverage the 

strengths and resources of both elder rights and aging and disability service networks for the 

provision of quality legal service on priority issues to older adults most in need. 

 

Model Approaches – Phase II grants promote legal service delivery systems that are optimally 

responsive to complex legal issues emerging from cases of elder abuse, neglect, and financial 

exploitation. In addition, these projects support outreach efforts and implement legal data 
PROTECTION OF VULNERABLE ADULTS

144 

collection and reporting systems that demonstrate the beneficial impact of legal services on the 

independence, health, and financial security of older adults. 

In addition to Model Approaches, Legal Assistance and Support grants fund a comprehensive 

national legal assistance support system serving professionals and advocates working in legal and 

aging and disability services networks. Through this funding, the National Legal Resource Center 

(NLRC) supports the leadership, knowledge, and systems capacity development of legal and aging 

provider organizations. The NLRC works to enhance the quality, cost effectiveness, and 

accessibility of legal assistance and elder rights protections available to older persons with social 

or economic needs. The audience targeted to receive support services through the NLRC includes 

a broad range of legal, elder rights, and aging and disability services professionals and advocates. 

These include Home and Community-Based Services legal providers, legal assistance developers, 

long-term care ombudsmen, Area Agency on Aging and Aging and Disability Resource Center 

staff, senior legal helplines, Adult Protective Services workers, and others involved in protecting 

the rights of older persons. 

Funding History:

Comparable funding for Elder Rights Support Activities over the past five years is as follows:

 FTE

FY 2015 ...................................................$7,874,000 .2 

FY 2016 .................................................$11,874,000 .8 

FY 2017 .................................................$13,847,000 2.5 

FY 2018 Annualized CR ........................$13,779,782 2.7 

FY 2019 President’s Budget ..................$13,874,000 2.7 

Budget Request:

The FY 2019 Budget request for the four Elder Rights Support Activities is $11,874,000, a 

reduction of -$1,906,782 below the FY 2018 Annualized Continuing Resolution. 

Elder Justice/Adult Protective Services:

The FY 2019 Budget request for Elder Justice/Adult Protective Services is $8,000,000 a reduction 

of -$1,932,000 below the FY 2018 Annualized Continuing Resolution. At this funding level, ACL 

can continue to support State APS systems, as well as coordinate services related to elder abuse, 

neglect, and exploitation across the Federal government. With the FY 2019 Budget request ACL 

will:

• Provide Demonstration Grants to Enhance State APS Systems: As recommended by the

GAO, ACL, in partnership with ASPE, created a technology infrastructure for a national

APS data collection system, the National Adult Maltreatment Reporting System

(NAMRS). The NAMRS tool is a process where all states can voluntarily report data

FY
PROTECTION OF VULNERABLE ADULTS

145 

collected through APS investigations. In FY 2019, ACL will continue to provide grants 

to support State’s efforts to participate in NAMRS

• Operate and Maintain NAMRS and Provide Technical Assistance: GAO recommended 

significant, on-going technical assistance to states to facilitate their participation in a 

national APS data collection effort. In FY 2019, ACL will continue to support the 

operations and maintenance of the NAMRS system as well provide technical assistance 

to State’s in their use of the NAMRS system.

• Advance Research on Elder Abuse: Research in the area of elder abuse, neglect, and 

exploitation is still in its infancy, with little known about risk and protective factors for 

being a victim or perpetrator, nor about effective and evidence-based prevention, 

intervention, and remediation practices. Further research is also needed regarding the 

impacts of elder abuse on health and long-term care systems and on the costs of care. 

This fundamental research work is needed to develop credible benchmarks for elder 

abuse, neglect, and exploitation prevention or control. In FY 2019 ACL will continue to 

invest in areas that build the foundational knowledge essential for understanding the 

problem and the best ways to prevent and address it. 

• Program Implementation and Oversight: support salaries and overhead costs for staff 

totaling 2.7 FTE carrying out the Elder Justice initiative and supporting the ongoing work 

of the EJCC. 

Other Elder Rights Support Activities:

The FY 2019 request for the remaining three Elder Rights Support Activities essentially maintains 

the FY 2018 Annualized Continuing Resolution level for Legal Assistance and Support activities 

(Statewide Model Approaches and Legal Assistance programs), the National Center on Elder 

Abuse, and the National Long-Term Care Ombudsman Resource Center. 

These programs provide the technical assistance, information, resources, referrals, and systems 

development and assistance activities that support the efforts of the entire spectrum of Protection 

of Vulnerable Adults programs. These activities, along with the Elder Justice and APS program,

are a critical component of ACL’s elder rights programs and help to create a full array of services 

to prevent, detect, and resolve elder abuse, neglect, and exploitation. Continued support for these 

programs and resource centers will provide the best and most efficient services and supports 

possible to support ACL’s efforts to promote elder rights and elder justice.
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Elder Rights Support Activities includes funding for the following projects (dollars in thousands):

Elder Rights Support 

Activities 

FY 2017 

Final

FY 2018 

Annualized CR

FY 2019 

President’s 

Budget

Elder Justice & APS $9,981 $9,932 $8,000

Legal Assistance and 

Support $2,585 $2,565 $2,584

National Center on Elder 

Abuse $765 $765 $770

LTC Ombudsman Resource 

Center $516 $518 $521

Total, Elder Rights Support 

Activities $13,847 $13,780 $11,874
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Grant Awards Table:

Elder Rights Support Activities Grant Awards

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 40 41 35 

Average Award $268,697 $247,940 $236,735 

Range of Awards $70,312-

$749,987 

$70,312-

$749,987 

$70,312-

$749,987 

Resource and Program Data:

Elder Rights Support Activities

(Dollars in thousands) 

Mechanism FY 2017

Final #

FY 2017

Final $

FY 2018

Annualized

CR #

FY 2018

Annualized

CR $

FY 2019

President’s 

Budget #

FY 2019

President’s 

Budget $

Grants:

Formula -- -- -- -- -- --

New Discretionary 9 3,543 23 5,207 9 1,549

Continuations 31 7,205 18 4,958 26 6,737

Contracts 3 2,451 4 2,738 4 2,738

Interagency 

Agreements -- -- -- -- -- --

Program Support 1/ -- 648 -- 877 -- 851

Total Resources -- 13,847 -- 13,780 -- 11,874

1/ Program Support -- Includes funds for grant systems and review and information technology support costs.
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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

149 

Disability Programs and Services

Summary of Request

Disability Programs and Services fund capacity-building, knowledge generation, and systems 

change efforts to ensure that people with disabilities and their families participate in the design of 

and have access to needed community services, individualized supports, and other forms of 

assistance. These programs seek to promote the increased self-determination, independence, 

productivity, integration, and inclusion of such individuals in all facets of community life.

The total FY 2019 request for Disability Programs and Services is $233,648,000, a reduction of 

- $147,772,000 below the FY 2018 Annualized Continuing Resolution. In FY 2019, specific 

program requests include: 

• $56,000,000 is requested for State Councils on Developmental Disabilities (SCDD) a 

reduction of -$16,504,000 below the FY 2018 Annualized Continuing Resolution. State 

Councils are charged with engaging in advocacy, capacity building and systemic change 

activities that contribute to a coordinated and comprehensive system of community 

services that promote self-determination, and integration for people with developmental 

disabilities.

• $38,734,000 for Developmental Disability Protection and Advocacy systems, +$263,043 

above the FY 2018 Annualized Continuing Resolution. Protection and Advocacy systems 

in each state and territory protect the legal and human rights of all people with 

developmental disabilities. They have the authority to pursue legal, administrative and 

other appropriate remedies or approaches, including the authority to investigate incidents 

of abuse and neglect.

• $32,546,000 for University Centers for Excellence in Developmental Disabilities 

(UCEDDs), a decrease of -$5,810,738 below the FY 2018 Annualized Continuing 

Resolution. At the reduced funding level, based on statutory requirements for allocating 

funding, national training efforts would be discontinued and funding for remaining grants 

and contracts would be reduced by approximately 13 percent. UCEDDs in each state and 

territory undertake interdisciplinary pre-service training, community services, research, 

and information dissemination activities that promote opportunities for people with 

developmental disabilities to exercise self-determination and to be independent, 

productive, and included in the community. 

• $1,050,000 for Projects of National Significance, a decrease of -$8,882,090 below the 

FY 2018 Annualized Continuing Resolution level. In FY 2019, Projects of National 

Significance will focus solely on three longitudinal studies; The State of the States in 

Developmental Disabilities, Residential Information Systems Project, and the National 

Data Collection on Day and Employment Services for Individuals with Developmental 

Disabilities.
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150 

• $95,997,000 for Independent Living, a decrease of -$4,499,000 from the 

FY 2018 Annualized Continuing Resolution. Centers for Independent Living provide 

grants for consumer controlled, community-based, cross-disability, private nonprofit 

agencies that are designed and operated within a local community by individuals with 

significant disabilities and provide an array of independent living services. 

 

• No funding is requested for the Limb Loss Resource Center. Other HHS programs, such 

as Centers for Independent Living and Assistive Technology, provide services and 

resources to people with all types of significant disabilities. 

• No funding is requested for the Paralysis Resource Center. Other HHS programs, such as 

Centers for Independent Living and Assistive Technology, provide services and resources 

to people with all types of significant disabilities.

• $9,321,000 is requested for the Traumatic Brain Injury (TBI) program, which maintains 

the FY 2018 Annualized Continuing Resolution level. TBI Protection and Advocacy 

activities also will continue to be maintained at the FY 2018 Annualized Continuing 

Resolution. 

• The Fiscal Year 2019 Budget proposes to consolidate targeted HHS research programs 

within NIH, including NIDILRR as a new National Institutes of Health (NIH) 

Institute. The reorganization would create efficiencies by enabling NIDILRR to benefit 

from the NIH research infrastructure, the largest at HHS.

 
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151 

State Councils on Developmental Disabilities

Service

FY 2017

Final

FY 2018

Annualized

CR

FY 2019

President’s 

Budget

FY19 

+/- 

FY 2018

State Councils on 

Developmental 

Disabilities

$72,833 $ 72,504 $56,000 -$16,504

*BA is in thousands of dollars, FTE is a whole number.

Authorizing Legislation: Section 129(a) of the Developmental Disabilities Assistance and Bill of 

Rights Act 

FY 2019 Developmental Disabilities Assistance and Bill of Rights Act Authorization ...... Expired

Allocation Method ..................................................................................................... Formula Grant

Program Description and Accomplishments:

State Councils on Developmental Disabilities (SCDD) are charged with identifying and addressing

the most pressing needs of people with developmental disabilities in their state and territory. 

SCDDs set priorities and pursue systems change efforts designed to turn fragmented approaches 

into a comprehensive and effective statewide, person-centered and family-centered system. These 

systems provide a coordinated array of culturally-competent services and other forms of assistance 

for people with developmental disabilities, including individuals with autism and their family 

caregivers. 

While SCDDs do not provide services directly, a portion of their funding goes into local 

communities to support investments in innovation specific to the needs in the state or territory. 

SCDDs examine and conduct in-depth analysis of the quantity and quality of services and supports 

that are provided at the state and local level. Based on their analysis, each SCDD develops a 

strategic State Plan, with goals and objectives designed to move the state towards an effective, 

coordinated system of supports and services that advance community living for all people with 

developmental disabilities. In addition, Councils are the only entity in the state required to 

strengthen self-advocacy and to build leadership skills of individuals with developmental 

disabilities.

The authorizing statute requires that Councils use 70 percent of their federal funding to implement 

the State Plan, which includes support for innovation. While the State Plan can be implemented 

by Council staff, Councils have the authority to award grants and/or contracts, award funds to 

organizations in the state that serve individuals with DD. These could include the University 

Center of Excellence in Developmental Disabilities (UCEDD) or the Protection and Advocacy 

(P&A) agency but can also include other community-based organizations. Recent data indicates 

that 26 of 42 reporting Councils awarded grants or contracts with the rest doing work “in-house.” 

As an example of how funding is used to support innovation, the Georgia Council on 
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Developmental Disabilities worked with a network of colleges and universities to offer students 

with developmental disabilities an opportunity to receive a post-secondary experience. What began 

with one university and a $25,000 grant from the Council has grown to 6 universities/colleges and 

a budget of over $1.5 million including state and federal funds. Currently, there are 80 students 

enrolled in two and four-year programs across the state. A major focus of the programs is preparing 

students for employment. Data collected between 2011 and 2015 on students who attended these 

programs indicated that 57 percent gained employment, 22 percent were continuing their 

education, and 7 percent were seeking employment. Examples of other State Council on 

Developmental Disabilities’ activities include:

• Access to Health Care: The Maine Developmental Disabilities Council collaborated to 

expand a “medical home” model for individuals with developmental disabilities to ensure 

access to a primary care physician or regular health care provider to better coordinate 

their overall care. The Texas Council for Developmental Disabilities supported projects 

in ten targeted regions to increase capacity to provide culturally appropriate health care 

services, community services, behavior supports, and respite to support people with 

developmental disabilities and their families.

• Access to Dental Care: The California Developmental Disabilities Council partnered with 

coalitions to assist individuals with developmental disabilities and families in 

understanding managed care and assisted health plans to improve access to dental care, 

particularly anesthesia-based dental care. The Hawaii State Council on Developmental 

Disabilities worked with the state legislature to establish a donated dental services 

program that has assisted hundreds of individuals with developmental disabilities. The 

Montana Council on Developmental Disabilities worked with community health centers, 

dental associations, and donated dental program to increase dental care options and 

training for dental professionals, including procedures that might involve sedation. 

• Community Living: The Alaska Governor’s Council on Disabilities & Special Education 

collaborated on a HomeMap project to explore the use of enabling technologies to more 

cost-effectively support individuals and families with fewer paid staff hours in their 

HCBS waiver program. The North Carolina Council on Developmental Disabilities 

partnered with the P&A on a model demonstration to transition individuals out of Adult 

Care Homes (ACHs) and into HCBS settings. The Washington State Developmental 

Disabilities Council conducts independent quality of life surveys with individuals with 

disabilities transitioning from institutional to HCBS as part of the State’s Roads to 

Community (Money Follows the Person) programs. 

• Transportation: The Colorado Developmental Disabilities Council supported grassroots 

projects in rural areas which led to community action at the local level that increased 

transportation, livable communities, and meaningful participation of people with DD in 

their communities. The Florida Developmental Disabilities Council partnered with the 

Florida Department of Transportation to implement a transportation voucher pilot project 

in two Florida sites. The project contributed to voucher users gaining access to increased 

employment opportunities, training and higher wages. For example, prior to 

implementation of the program one participant had turned down a job a Walmart the year 
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153 

before due to not having available transportation. Through the program, she resubmitted 

her application, was hired and is getting to work at Walmart on time every day. 

To receive funds, each state and territory must have an established SCDD as prescribed under the 

Developmental Disabilities Assistance and Bill of Rights Act (“DD Act”). There are 56 Councils

whose members are appointed by the Governor and serve in a volunteer capacity. Under current 

law, not less than 60 percent of the SCDD membership must be composed of persons with 

developmental disabilities and their family members.

Funding History:

Funding for the program over the past five years is as follows: 

FY 2015 .................................................$71,692,000 

FY 2016 .................................................$73,000,000 

FY 2017 .................................................$72,833,000 

FY 2018 Annualized CR ........................$72,504,257 

FY 2019 President’s Budget ..................$56,000,000 

Budget Request: 

The FY 2019 request for State Councils on Developmental Disabilities (SCDD) is $56,000,000, 

which is -$17 million below the FY 2018 Annualized Continuing Resolution. 

ACL recognizes the value this program provides by focusing solely on developmental disabilities 

that are lifelong, significant and require ongoing support and by supporting investment and 

innovation tailored to needs in states or territories that improve the quality of life of those with 

developmental disabilities. ACL proposes to work with grantees to identify efficiencies in the 

operations of the councils to maximize funding for service provision. 
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Outputs and Outcomes Table:

State Councils on Developmental Disabilities * 

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2018

Target

FY 2019

Target

FY 2019

Target

+/-FY 2018

Target

8.1LT and 8A Increase 

the percentage of 

individuals with 

developmental 

disabilities reached by the 

Councils who are 

independent, selfsufficient and integrated 

into the community. 

(Outcome)

FY 2016: 14.93%

Target:

14.89%

(Target Exceeded)

Discontinued Discontinued Maintain

8E Increase the number 

of individuals with 

developmental 

disabilities reached by the 

Councils who are 

independent, selfsufficient and integrated 

into the community per 

$1,000 of federal funding 

to the Councils. 

(Efficiency)

FY 2016: 10.14

Target:

10.02

(Target Exceeded)

Discontinued Discontinued Maintain

8G Increase the 

percentage of people with 

developmental 

disabilities and their 

family members 

increasing their advocacy 

knowledge. (Outcome)

FY 2017: Result Expected 

Dec 31, 2018

Target:

Set Baseline

(Pending)

-- -- --
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Indicator Year and Most Recent 

Result /

FY 2018

Projection

FY 2019

Projection

FY 2019

Projection

+/-FY 2018

Projection

8i: Number of individuals 

with developmental 

disabilities reached by the 

Councils who are 

independent, selfsufficient and integrated 

into the community. 

(Output)

FY 2016: 758,638 N/A N/A N/A

8ii: Number of all 

individuals trained by the 

Councils. (Output)

FY 2016: 301,626 N/A N/A N/A

*ACL has redesigned grantee program performance reporting. As a result measures 8A and 8E have been discontinued and 

measure 8G has been developed. ACL’s performance management strategy includes the routine review of program performance 

data with adjustments to performance measures (e.g. revision, discontinuation and new development) as appropriate. New 

performance measures which result from this ongoing review will be included in the subsequent year’s budget.

Grant Awards Tables:

State Councils on Developmental Disabilities Grant Awards

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 56 56 56 

Average Award $1,299,907 $1,294,036 $999,317

Range of Awards $253,256 - 

$6,527,210 

$252,458 - 

$6,487,400 

$195,516 - 

$5,005,217 
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DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES

FY 2019 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: State Councils on Developmental Disabilities (CFDA 93.630)

State/Territory FY 2017

Final/1

FY 2018

Annualized CR

FY 2019

President's 

Budget

FY 2019 +/- 

FY 2018

Alabama 1,291,034 1,283,788 988,654 (295,134)

Alaska 486,307 484,775 375,435 (109,340)

Arizona 1,411,676 1,403,752 1,081,038 (322,714)

Arkansas 770,894 766,568 590,338 (176,230)

California 6,527,210 6,487,400 5,005,217 (1,482,183)

Colorado 880,804 875,860 674,506 (201,354)

Connecticut 687,124 683,268 526,188 (157,080)

Delaware 486,307 484,775 375,435 (109,340)

District of Columbia 486,307 484,775 375,435 (109,340)

Florida 3,655,639 3,635,124 2,799,430 (835,694)

Georgia 2,065,602 2,054,008 1,581,804 (472,204)

Hawaii 486,307 484,775 375,435 (109,340)

Idaho 486,307 484,775 375,435 (109,340)

Illinois 2,618,348 2,610,100 2,021,396 (588,704)

Indiana 1,484,870 1,480,192 1,146,338 (333,854)

Iowa 772,264 769,832 596,196 (173,636)

Kansas 613,072 611,140 473,300 (137,840)

Kentucky 1,198,210 1,191,486 917,570 (273,916)

Louisiana 1,372,326 1,368,004 1,059,454 (308,550)

Maine 486,307 484,775 375,435 (109,340)

Maryland 1,005,670 1,002,502 776,390 (226,112)

Massachusetts 1,362,510 1,354,864 1,043,390 (311,474)

Michigan 2,537,470 2,523,230 1,943,154 (580,076)

Minnesota 1,022,764 1,019,542 789,586 (229,956)

Mississippi 911,980 909,108 704,060 (205,048)

Missouri 1,364,596 1,356,936 1,044,986 (311,950)

Montana 486,307 484,775 375,435 (109,340)

Nebraska 486,307 484,775 375,435 (109,340)

Nevada 540,162 537,132 413,648 (123,484)

New Hampshire 486,307 484,775 375,435 (109,340)
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PROGRAM/CFDA NUMBER: State Councils on Developmental Disabilities (CFDA 93.630)

State/Territory FY 2017

Final/1

FY 2018

Annualized CR

FY 2019

President's Budget

FY 2019 +/- 

FY 2018

New Jersey 1,549,484 1,544,602 1,196,220 (348,382)

New Mexico 489,030 487,490 377,536 (109,954)

New York 4,090,946 4,067,986 3,132,780 (935,206)

North Carolina 2,015,964 2,004,650 1,543,794 (460,856)

North Dakota 486,307 484,775 375,435 (109,340)

Ohio 2,839,690 2,830,744 2,192,276 (638,468)

Oklahoma 895,034 892,214 690,978 (201,236)

Oregon 779,362 774,988 596,824 (178,164)

Pennsylvania 3,019,046 3,009,534 2,330,740 (678,794)

Rhode Island 486,307 484,775 375,435 (109,340)

South Carolina 1,094,290 1,090,844 844,806 (246,038)

South Dakota 486,307 484,775 375,435 (109,340)

Tennessee 1,457,786 1,453,194 1,125,430 (327,764)

Texas 4,802,026 4,775,076 3,677,316 (1,097,760)

Utah 633,704 630,148 485,280 (144,868)

Vermont 486,307 484,775 375,435 (109,340)

Virginia 1,498,220 1,493,500 1,156,646 (336,854)

Washington 1,167,690 1,161,136 894,196 (266,940)

West Virginia 737,516 735,192 569,372 (165,820)

Wisconsin 1,308,704 1,301,360 1,002,186 (299,174)

Wyoming 486,307 484,775 375,435 (109,340)

Subtotal, States 69,281,015 68,963,344 53,249,113 (15,714,231)

American Samoa 253,256 252,458 195,516 (56,942)

Guam 253,256 252,458 195,516 (56,942)

Northern Mariana Islands 253,256 252,458 195,516 (56,942)

Puerto Rico 2,500,740 2,492,860 1,930,602 (562,258)

Virgin Islands 253,256 252,458 195,516 (56,942)

Subtotal, States and 

Territories 72,794,779 72,466,036 55,961,779 (16,504,257)

Undistributed 1/ $38,221 38,221 38,221 -

TOTAL 72,833,000 72,504,257 56,000,000 (16,504,257)

1/ Program Support -- Includes funds for grant systems and review, and program reporting systems costs.
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Developmental Disabilities – Protection and Advocacy

Service FY 2017

Final

FY 2018

Annualized

CR

FY 2019

President’s 

Budget

FY19 

(+/-) 

FY 18

Developmental Disability 

Protection and Advocacy $38,645 $38,471 $38,734 +$263

*BA is in thousands of dollars, FTE is a whole number.

Authorizing Legislation: Section 145 of the Developmental Disabilities Assistance and Bill of 

Rights Act 

FY 2018 Developmental Disabilities Assistance and Bill of Rights Act Authorization ...... Expired

Allocation Method ..................................................................................................... Formula Grant 

Program Description and Accomplishments:

Developmental Disabilities Protection and Advocacy (P&As) programs provide a range of legal 

services to unserved or underserved individuals with developmental disabilities ensuring they are 

protected from abuse and neglect and are able to exercise their rights to make choices, contribute 

to society, and live independently. P&A systems have the authority to pursue a range of appropriate 

remedies or approaches, including the authority to investigate incidents of abuse and neglect, and 

to promote system change. There is a P&A system in each State, the Territories, and the District 

of Columbia. There is also a Native American Consortium for a total of 57 P&As.

P&As play a key role in promoting community living, and have been supported by a number of 

Federal and state initiatives promoting alternatives to nursing homes and other institutional settings 

that recognize the value of consumer preference and the attendant potential fiscal savings that can 

result. Community living was supported in the US Supreme Court’s 1999 decision in Olmstead v 

L.C. that requires States to eliminate unnecessary segregation and isolation of people with 

disabilities, and to ensure that they receive services in the most integrated setting appropriate to 

their needs. Olmstead implementation and enforcement, Money Follows the Person, Home and 

Community Service (HCBS) waivers, and Medicaid managed care programs, to name a few, are 

continuing to change the long-term care landscape across the country by expanding opportunities 

for community living. The number of people with intellectual and developmental disabilities 

receiving Home and Community-Based waiver services has steadily increased.

121 Approximately 

86 percent of the P&A clients now live in the community. This creates a heightened role for P&As 

to monitor and develop new strategies to address these new services.

These changes create new challenges for Protection and Advocacy programs as well as for the 

Long-Term Care Ombudsman program (LTCOP). P&As and LTCOP’s will increasingly need to 

 

121 U.S. Profile, FY 1977 – 2013, State of the State in Developmental Disabilities.
PROTECTION OF VULNERABLE ADULTS

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have the capacity to address the new challenges and at the same time they will have to cope with 

the continuing accelerated growth of community-based services.

P&As also engage in a full range of other efforts to promote the rights of individuals with 

developmental disabilities. P&As often provide information and referrals, as well as training and 

technical assistance to service providers, state legislators and other policymakers. They also 

conduct self-advocacy trainings and raise public awareness of legal and social issues affecting 

individuals with developmental disabilities and their families.

Funding History:

Funding for the program over the past five years is as follows: 

FY 2015 .................................................$38,734,000 

FY 2016 .................................................$38,734,000 

FY 2017 .................................................$38,645,000 

FY 2018 Annualized CR ........................$38,470,957 

FY 2019 President’s Budget ..................$38,734,000 

Budget Request: 

The FY 2019 request for the Developmental Disabilities Protection and Advocacy program is 

$38,734,000 an increase of $263,000 above the FY 2018 Annualized Continuing Resolution. This 

request will allow the P&A system to continue to provide training, legal and advocacy services 

both to groups and to individuals with developmental disabilities, as well as to continue to provide 

information and referral services.

The P&As form a national system that play a critical role in ensuring that people with 

developmental disabilities are free of abuse and neglect. People with developmental disabilities, 

including children, are at increased risk of experiencing abuse and neglect.122 The 57 P&As stay 

at the forefront of these issues. P&As maintain a presence in facilities that care for people with 

disabilities, where they monitor, investigate, and attempt to remedy adverse conditions. In 

FY 2016, 32,205 people with disabilities received rights training by P&As and 35,695 people with

disabilities received information and referral services. Of the inquiries and issues received by the 

P&As in FY 2016: 

• 78 percent of closed individual cases in which the client’s objective was fully or partially

met;

• 47 percent of individual clients who had their right enforced and/or restored by P&A

efforts;

122 Hibbard, R.A., Desch, L.W., Committee on Child Abuse and Neglect & Council on Children With Disabilities. 

(2007). Maltreatment of Children With Disabilities. Pediatrics, Vol. 119, No., pp. 1018 -1025
PROTECTION OF VULNERABLE ADULTS

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• 26 percent were resolved using short-term assistance/limited advocacy strategies;

• 43 percent were addressed through technical assistance in self-advocacy; 

• 10 percent involved investigation and monitoring; 

• 12 percent were addressed through negotiation; and 

• 12 percent of abuse and neglect cases were remedied by P&As. 

Without the P&A presence, people with developmental disabilities and their families would have 

limited or no access to cost-effective, advocacy and legal interventions.
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Outputs and Outcomes Table:

Developmental Disabilities Protection and Advocacy 

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2018

Target

FY 2019

Target

FY 2019

Target

+/-FY 2018

Target

8B Increase the 

percentage of individuals 

who have their complaint 

of abuse, neglect, 

discrimination, or other 

human or civil rights 

corrected compared to the 

total assisted. 

(Outcome)

FY 2016: 88.12%

Target:

87.36%

(Target Exceeded)

Discontinued Discontinued N/A

8F Increase the 

percentage of individuals 

with developmental 

disabilities whose rights 

were enforced, retained, 

restored or expanded. 

(Outcome)

FY 2017: Result Expected 

Dec 31, 2018

Target:

Set Baseline

(Pending)

-- -- --

Indicator Year and Most Recent 

Result /

FY 2018

Projection

FY 2019

Projection

FY 2019

Projection

+/-FY 2018 

Projection

8iii: Number of clients 

receiving professional 

individual legal advocacy 

for the Protection and 

Advocacy program. 

(Output)

FY 2016: 17,403 N/A N/A N/A

8iv: Number of people 

receiving information and 

referral from the 

Protection and Advocacy 

program. (Output)

FY 2016: 44,987 N/A N/A N/A
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Grant Awards Tables:

Developmental Disabilities – Protection and Advocacy Formula Grant Awards/1

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of Awards 57 57 57

Average Award $660,340 $657,348 $661,870

Range of Awards $205,808 -

$3,368,311

$205,808 -

$3,513,988

$205,808 -

$3,918,603

1/ Excludes grants to tribal organizations.
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DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES

FY 2019 DISCRETIONARY STATE FORMULA GRANTS 2/

PROGRAM/CFDA NUMBER: Developmental Disabilities – Protection and Advocacy (CFDA 93.630)

State/Territory FY 2017

Final/1

FY 2018

Annualized CR

FY 2019

President's 

Budget

FY 2019 +/- 

FY 2018

Alabama 581,326 544,719 485,185 (59,534)

Alaska 384,693 384,694 384,693 (1)

Arizona 693,630 703,411 719,475 16,064

Arkansas 393,051 389,998 384,693 (5,305)

California 3,368,311 3,513,988 3,918,603 404,615

Colorado 463,243 465,076 475,219 10,143

Connecticut 387,054 388,943 394,030 5,087

Delaware 384,693 384,694 384,693 (1)

District of Columbia 384,693 384,694 384,693 (1)

Florida 1,954,664 1,946,301 1,962,115 15,814

Georgia 1,054,137 1,046,490 1,046,312 (178)

Hawaii 384,693 384,694 384,693 (1)

Idaho 384,693 384,694 384,693 (1)

Illinois 1,226,808 1,217,467 1,245,269 27,802

Indiana 713,146 659,102 592,820 (66,282)

Iowa 384,693 384,694 384,693 (1)

Kansas 384,693 384,694 384,693 (1)

Kentucky 535,195 505,324 456,267 (49,057)

Louisiana 537,239 526,568 508,085 (18,483)

Maine 384,693 384,694 384,693 (1)

Maryland 487,463 503,823 541,357 37,534

Massachusetts 602,938 609,824 635,978 26,154

Michigan 1,121,176 1,030,029 900,204 (129,825)

Minnesota 502,368 498,901 497,606 (1,295)

Mississippi 409,051 407,448 400,929 (6,519)

Missouri 643,191 618,172 572,199 (45,973)

Montana 384,693 384,694 384,693 (1)

Nebraska 384,693 384,694 384,693 (1)

Nevada 384,693 384,694 384,693 (1)

New Hampshire 384,693 384,694 384,693 (1)
PROTECTION OF VULNERABLE ADULTS

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PROGRAM/CFDA NUMBER: Developmental Disabilities – Protection and Advocacy (CFDA 93.630)

State/Territory FY 2017

Final/1

FY 2018

Annualized CR

FY 2019

President's Budget

FY 2019 +/-

FY 2018

New Jersey 758,684 761,955 812,568 50,613

New Mexico 384,693 384,694 384,693 (1)

New York 1,801,964 1,811,435 1,896,825 85,390

North Carolina 1,062,747 1,028,642 971,988 (56,654)

North Dakota 384,693 384,694 384,693 (1)

Ohio 1,236,193 1,215,327 1,177,584 (37,743)

Oklahoma 395,264 394,979 393,290 (1,689)

Oregon 409,773 401,294 391,291 (10,003)

Pennsylvania 1,292,853 1,260,032 1,240,325 (19,707)

Rhode Island 384,693 384,694 384,693 (1)

South Carolina 550,926 522,120 473,006 (49,114)

South Dakota 384,693 384,694 384,693 (1)

Tennessee 705,805 677,485 630,220 (47,265)

Texas 2,463,437 2,546,563 2,700,665 154,102

Utah 384,693 384,694 384,693 (1)

Vermont 384,693 384,694 384,693 (1)

Virginia 728,405 742,875 771,924 29,049

Washington 640,525 654,268 692,149 37,881

West Virginia 384,693 384,694 384,693 (1)

Wisconsin 596,587 563,838 517,767 (46,071)

Wyoming 384,693 384,694 384,693 (1)

Subtotal, States 36,011,014 35,850,277 36,099,808 249,531

American Samoa 205,808 205,808 205,808 -

Guam 205,808 205,808 205,808 -

Northern Mariana Islands 205,808 205,808 205,808 - 

Puerto Rico 805,132 795,307 803,558 8,251

Virgin Islands 205,808 205,808 205,808 -

Subtotal, States and 

Territories 37,639,378 37,468,816 37,726,598 257,782

Native American 

Organization 205,808 205,808 205,808 - 

Undistributed 1/ $684,814 796,333 801,594 5,261

TOTAL 38,530,000 38,470,957 38,734,000 263,043

1/ Program Support—Includes funds for statutory technical assistance and/or minority set-asides; grant systems and review, and 

program reporting systems costs. 
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University Centers for Excellence in Developmental Disabilities

 

Service

FY 2017

Final

FY 2018

Annualized

CR

FY 2019

President’s

Budget

FY 2019 

+/- 

FY 2018

University Center of 

Excellence in Developmental 

Disabilities 

$38,530 $ 38,357 $32,546 -$5,811

*BA is in thousands of dollars, FTE is a whole number.

Authorizing Legislation: Section 156 of the Developmental Disabilities Assistance and Bill of 

Rights Act 

FY 2019 Developmental Disabilities Assistance and Bill of Rights Act Authorization ...... Expired

Allocation Method ............................................................................................... Competitive Grant

Program Description and Accomplishments:

University Centers for Excellence in Developmental Disabilities (UCEDDs), are interdisciplinary 

education, research and public service units of a university or not-for-profit entity associated with 

universities. UCEDDs advise Federal, State, and community policymakers about, and promote 

opportunities for individuals with developmental disabilities to exercise self-determination and to 

be independent, productive, integrated and included in all facets of community life. 

In FY 2017, the Administration on Intellectual and Developmental Disabilities (AIDD) funded 67 

University Centers. Funding from AIDD establishes the UCEDD and provides the infrastructure 

support for the Centers to engage in interdisciplinary pre-service training, continuing education, 

community services, research, and information dissemination activities. UCEDDs leverage 

additional funds for carrying out these core activities from a variety of sources, including federal, 

state, and local agencies; private foundations; donations; and fee-for-service earnings. In FY 2015, 

UCEDDs leveraged $15 per AIDD dollar invested. 

UCEDDs have played a key role in a number of advances in the disability field over the past five

decades. Many issues, such as early intervention, health care, community-based services, inclusive 

and meaningful education, transition from school to work, employment, housing, assistive 

technology, and transportation have been directly improved by the services, research, and training 

provided by UCEDDs. 

As liaisons to the community, including service delivery systems, UCEDDs positively affect the 

lives of individuals with developmental disabilities and their families in a variety of ways. UCEDD

accomplishments include: 

• Directing exemplary interdisciplinary pre-service preparation with faculty and trainees 

that represent a variety of disciplines. UCEDD interdisciplinary training programs are 
PROTECTION OF VULNERABLE ADULTS

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designed to: integrate knowledge and methods from two or more distinct disciplines; 

integrate direct contributions to the field made by people with disabilities and family 

members; and examine and advance professional practice, scholarship and policy that 

impacts the lives of people with developmental and other disabilities and their families.

• Providing community services that cut across Federal, State, and local systems to 

improve capacity and quality of services by incorporating evidence-based practices. 

Community services offer innovative designs and methods that addresses a local or 

universal need, can be replicated and promote the increased inclusion, integration, 

productivity, and human rights of individuals with developmental disabilities and their 

families including people with developmental disabilities from racial and ethnic minority 

backgrounds. 

• Contributing to the development of new knowledge through various research activities 

including basic or applied research, evaluation, and public policy analysis. UCEDD 

research engages people with developmental disabilities and their families in the 

development, design and implementation of research activities, as well as the 

dissemination of research information. New knowledge is generated by research and tied 

to practice using a variety of dissemination strategies. UCEDDs also bridge the gap 

between research and practice by developing a variety of products and resources that 

promotes improvement in knowledge and practice.

• Leading national efforts, including youth transition, autism services, supports and 

research, mental health services and supports, and supporting self-advocates and families. 

For example, the Carolina Institute for Developmental Disabilities at the University of 

North Carolina released findings from a study that examined the use of brain scans to 

identify early signs of autism in high-risk babies. The researchers were able to make 

reasonably accurate forecasts about which high-risk infants will later develop autism by 

scanning the brains of babies whose siblings have autism. The findings are important 

because early diagnosis of autism spectrum disorder (ASD) has been a significant 

challenge. 

UCEDDs also conduct national training initiatives to address unmet needs of people with 

developmental disabilities. Past training initiatives have supported post-secondary education 

opportunities for people with developmental disabilities, enhancing self-determination skills, and 

building partnerships with minority serving institutions.
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Funding History:

Funding for the program over the past five years is as follows: 

FY 2015 .................................................$37,674,000 

FY 2016 ... .............................................$38,619,000 

FY 2017 .................................................$38,530,000 

FY 2018 Annualized CR ........................$38,356,738 

FY 2019 President’s Budget ..................$32,546,000 

Budget Request: 

The FY 2019 request for UCEDDs is $32,546,000, which is -$6 million below the FY 2018 

Annualized Continuing Resolution. Funding of the UCEDDs will support the network of 

independent but interlinked centers, representing an expansive national resource for addressing 

issues, finding solutions, and advancing research related to the needs of individuals with 

developmental disabilities and their families. At the local level, UCEDDs are vital to the training 

of future professionals with the specialized expertise in developmental disabilities. Of the UCEDD 

trainees who graduated 5 to 10 years ago, 30 percent are in leadership positions including: 

• 1 percent in academic leadership; 

• 16 percent in clinical leadership; 

• 2 percent in public health leadership; and

• 28 percent in public policy and advocacy leadership. 

Overall, 42 percent of people with developmental disabilities are receiving services from former 

UCEDD trainees.

Funding for UCEDDs is important in that it supports specialized services at the local level and 

provides local organizations as well as state agencies with technical assistance to improve services 

and supports for people with developmental disabilities across the life span. UCEDDs currently 

operate very efficiently and are able to leverage significant additional Federal and non-Federal 

resources. ACL will work to provide technical and other assistance, including sharing best 

practices, to allow the UCEDDs to prioritize remaining funding and to leverage additional 

resources to continue to provide critical services. 
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Outcomes and Outputs Table:

University Centers for Excellence in Developmental Disabilities

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2018

Target

FY 2019

Target

FY 2019

Target

+/-FY 2018

Target

8D Increase the 

percentage of individuals 

with developmental 

disabilities who are 

receiving services 

through activities in 

which UCEDD trained 

professional were 

involved. (Outcome)

FY 2016: 43.31%

Target:

42.62%

(Target Exceeded)

Prior Result + 

1%

Prior Result + 

1%

N/A

Indicator Year and Most Recent 

Result /

FY 2018 

Projection

FY 2019

Projection

FY 2019 Projection

+/-FY 2018 

Projection

8viii: Number of 

professionals trained by 

UCEDDs. (Output)

FY 2016: 4,525 N/A N/A N/A

8ix: Number of people 

reached through UCEDD 

community training and 

technical assistance 

activities. (Output)

FY 2016: 951,213 N/A N/A N/A

8x: Number of people 

receiving direct or model 

demonstration services 

from UCEDDs. (Output)

FY 2016: 110,486 N/A N/A N/A
PROTECTION OF VULNERABLE ADULTS

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Grant Awards Tables:

University Centers of Excellence in Developmental Disabilities Grant Awards

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 84 82 67 

Average Award $449,202 $458,080 $475,310 

Range of 

Awards

 $40,018 - 

$547,000 

 $40,018 - 

$547,000 

 $40,018 - 

$547,000 

Resource and Program Data:

University Centers of Excellence in Developmental Disabilities

Mechanism FY 2017

Final # 

FY 2017

Final $ 

FY 2018

Annualized

CR #

FY 2018

Annualized

CR $

FY 2019

President’s 

Budget #

FY 2019

President’s 

Budget $

Grants:

Formula -- -- -- -- -- --

New Discretionary 59 24,058 32 10,213 3 1,426 

Continuations 25 13,675 50 27,350 64 30,420 

Contracts 1 717 1 717 1 623 

Interagency 

Agreements -- -- -- -- -- --

Program Support /1 -- 80 -- 77 -- 77 

Total Resources -- 38,530 -- 38,357 -- 32,546 

1/ Program Support -- Includes funds for overhead, grant systems and review costs, and information technology 

support costs. 
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Developmental Disabilities – Projects of National Significance

Service FY 2017

Final

FY 2018

Annualized

CR

FY 2019

President’s

Budget

FY 2019 

+/- 

FY 2018

Developmental Disabilities -

Projects of National 

Significance

$ 9,977 $9,932 $1,050 +$8,882

*BA is in thousands of dollars, FTE is a whole number.

Authorizing Legislation: Section 163 of the Developmental Disabilities Assistance and Bill of 

Rights Act 

FY 2019 Developmental Disabilities Assistance and Bill of Rights Act Authorization ...... Expired

Allocation Method ............................. Competitive Grants and Cooperative Agreements/Contracts 

Program Description and Accomplishments:

Projects of National Significance (PNS) is a discretionary program which provides grants, 

cooperative agreements, and contracts to public or private non-profit entities these grants fund 

innovative and promising practice demonstrations that expand opportunities for individuals with 

developmental disabilities to contribute to, and participate in, all facets of community life. 

Examples of PNS activities include:

• Grants to improve access to competitive, integrated supported employment for people with

intellectual and developmental disabilities. These grants with a particular focus on youth

and young adults, as well as the evaluation of such efforts and technical assistance to the

states that are funded.

• Community practice projects to build states’ capacities to support competitive, integrated

employment and family support activities for persons with intellectual and developmental

disabilities, as well as technical assistance to self-advocacy organizations.

• Longitudinal data collection projects as well as longitudinal research studies of trends in

residential services and supports, employment, community supports, family supports, and

quality indicators related to publicly funded DD services.

• A project to gather and disseminate information and provide technical assistance to people

and entities interested in supported decision making as an alternative to guardianship.

• A grant to equip disability organizations providing long term services and support with the

tools they need to partner and contract with health care payers and providers in delivery

system reform.
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Funding History: 

Funding for the program over the past five years is as follows: 

FY 2015 ...................................................$8,857,000 

FY 2016... ..............................................$10,000,000 

FY 2017 ...................................................$9,977,000 

FY 2018 Annualized CR ..........................$9,932,090 

FY 2019 President’s Budget ....................$1,050,000 

Budget Request:

The FY 2019 request for the Projects of National Significance program is $1,050,000, a reduction 

of --$8,882,000 below the FY 2018 Annualized Continuing Resolution. At the requested funding 

level, the PNS program will conduct three studies: The State of the States in Developmental 

Disabilities, Residential Information Systems Project, and the National Data Collection on Day 

and Employment Services for Individuals with Developmental Disabilities. 
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Grant Awards Tables:

Developmental Disabilities – Projects of National Significance Grant Awards

(Dollars in thousands) 

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 23 19 3 

Average Award $312,442 $378,220 $350,000 

Range of Awards

$225,000 

- 

$1,056,187

 $225,000 - 

$1,056,187 $350,000 

Resource and Program Data:

Developmental Disabilities – Projects of National Significance

(Dollars in thousands) 

Mechanism FY 2017

Final #

FY 2017

Final $

FY 2018

Annualized

CR # 

FY 2018

Annualized

CR $ 

FY 2019

President’s 

Budget #

FY 2019

President’s 

Budget $

Grants:

Formula

 

--

 

--

 

--

 

--

 

--

 

--

New Discretionary 4 2,302 3 1,050 -- --

Continuations 19 4,884 16 6,136 3 1,050 

Contracts 8 2,682 8 2,585 -- --

Interagency Agreements -- -- -- -- -- --

Program Support /1 -- 109 -- 161 -- --

Total Resources -- 9,977 27 9,932 3 1,050 

1/ Program Support -- Includes funds for grant systems, review costs, and technology support costs.
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Independent Living

 

Service

-

FY 2017

Final

FY 2018

Annualized

CR

FY 2019

President’s

Budget

FY 2019 

+/- 

FY 2018

Independent Living - 

State Grants $22,835 $22,723 $17,841 -$4,882

Centers for 

Independent Living $78,305 $77,773 $78,156 +$383

Total: $100,951 $100,496 $95,997 -$4,499

FTE .7 .8 .8 -

*BA is in thousands of dollars, FTE are actuals. 

Authorizing Legislation: Rehabilitation Act of 1973, Title VII, Parts B and C, and Chapter 2, 

as amended by the Workforce Innovation and Opportunities Act (Rehabilitation Act) 

FY 2019 Rehabilitation Act Authorizations: 

Independent Living State Grants ...............................................................................$25,156,000 

Centers for Independent Living .................................................................................$86,104,000 

Allocation Method ...................................................................... Formula and Discretionary Grants

Program Description and Accomplishments:

Independent Living (IL) programs maximize the leadership, empowerment, independence, and 

productivity of individuals with disabilities, and work to integrate these individuals into the 

mainstream of American society. Independent living programs provide financial assistance to 

sustain, expand, and improve independent living services; develop and support statewide networks 

of centers for independent living (CILs). They also foster working relationships among centers for 

independent living, Statewide Independent Living Councils, other Rehabilitation Act programs, 

and relevant Federal and non-Federal programs.

Independent Living Services State Grants

The Independent Living Services State Grants program supports formula grants to States, which 

must establish a Statewide Independent Living Council (SILC). Each State must also submit a 

State Plan for Independent Living. In addition to developing the State plan, the SILC may, 

consistent with the State plan and State law, work to coordinate services provided to individuals 

with disabilities, conduct resource development activities, and perform other functions to support 

the purposes of the law. Funds not used to operate the SILC must be used for one of the following 

purposes, consistent with the State plan: 

• To demonstrate ways to expand and improve independent living services, particularly 

those in unserved areas; 
DISABILITY PROGRAMS, RESEARCH, AND SERVICES

178 

• To provide independent living services;

• To support the operation of centers for independent living;

• To increase the capacity of public or nonprofit agencies and organizations and other

entities to develop comprehensive approaches or systems for providing independent

living services;

• To conduct studies and analyses, gather information, develop model policies and

procedures, and present information, approaches, strategies, findings, conclusions, and

recommendations to Federal, State, and local policymakers;

• To provide training on the independent living philosophy; and/or:

• To provide outreach to populations who are not served or are underserved by programs

under subtitle VII, Chapter 16 of the Rehabilitation Act, including minority groups and

urban and rural populations.

Typically, SILCs “pass through” approximately two thirds of their federal funding to Centers for 

Independent Living to carry out direct services. State grant funds are allotted based on total 

population, and participating States must match 10 percent of their grant with non-Federal cash or 

in-kind resources in the year for which the Federal funds are appropriated. 

Centers for Independent Living

The Centers for Independent Living (CIL) program provides grants to consumer-controlled, 

community-based, cross-disability, private nonprofit agencies that are designed and operated 

within a local community by individuals with disabilities. At a minimum, centers are required to 

provide the core independent living services of information and referral, independent living skills 

training, peer counseling, and individual and systems advocacy. The 2014 reauthorization of the 

Rehabilitation Act by the Workforce Innovation and Opportunity Act (WIOA) added a fifth core 

service that the CILs must provide to eligible individuals with significant disabilities. This fifth 

core service includes three components 

• Facilitate the transition of individuals with significant disabilities from nursing homes

and other institutions to home and community based residences, with necessary supports

to remain in the community;

• Assist individuals with significant disabilities at risk of institutionalization so that they

may remain in the community; and

• Facilitate the transition of youth who are individuals with significant disabilities that are

eligible for IDEA and who either completed school or left school to transition to

postsecondary life.

A population-based formula determines the total amount that is available for grants to centers in 

each State. WIOA requires that grants be awarded to any eligible agency that had been awarded a 

grant for the preceding fiscal year. In most cases, funds are awarded directly to centers for 

independent living. If State funding for CIL operation exceeds the level of Federal CIL funding in 

any fiscal year, the State may apply for the authority to award grants under this program through 

its designated state unit. There are currently only two States, Massachusetts and Minnesota, that 
DISABILITY PROGRAMS, RESEARCH, AND SERVICES

179 

are both eligible and have elected to manage their own CIL programs. In fiscal year 2015, 354 

centers and two States received funding from the CIL program. 

In addition to funding centers for independent living, the Department must annually reserve 

between 1.8 and 2 percent of the funds appropriated both for Independent Living Services State 

Grants and for Centers for Independent Living to provide (through grants, contracts, or cooperative 

agreements; or directly, for ILSSG) training and technical assistance with respect to planning, 

developing, conducting, administering, and evaluating centers for independent living. Section 

21(b)(1) of the Rehabilitation Act also allows for 1 percent of funds appropriated under subtitle 

VII to be set aside for minority outreach activities as described in Section 21(b)(2). 

Funding History:

Funding for Independent Living activities over the past five years is as follows:

Centers for Independent Living

FY 2015 .................................................$78,305,000 

FY 2016 .................................................$78,305,000 

FY 2017 .................................................$78,305,000 

FY 2018 Annualized CR ........................$77,773,231 

FY 2019 President’s Budget ..................$78,156,000 

Independent Living State Grants FTE

FY 2015 .................................................$22,878,000 -- 

FY 2016 ................................................$22,878,000 .3 

FY 2017 .................................................$22,878,000 .7 

FY 2018 Annualized CR ........................$22,722,636 .8 

FY 2019 President’s Budget ..................$17,841,000 .8 

Budget Request:

Independent Living Services State Grants

The FY 2019 Budget for Independent Living Services State Grants is $17,841,000 a reduction of 

-$4,882,000 million from the FY 2018 Annualized Continuing Resolution. This level will allow 

for continued support to ILS State Grants which support the State Independent Living Councils 

(SILCs) in their efforts to coordinate services provided to individuals with disabilities and which 

support direct services through funding provided to the Centers for Independent Living (CILs). 

ACL recognizes the value this program provides by focusing on the independence and productivity 

of individuals with disabilities and integrating them into the mainstream of society. ACL will 

work with grantees to identify ways — especially around the approximately 34 percent of Federal 
DISABILITY PROGRAMS, RESEARCH, AND SERVICES

180 

funding that is used to directly support State Independent Living Council activities — to achieve 

efficiencies and economies of scale.

ACL will also continue to reserve, as provided in statute 1.8 percent of available funding for the 

provision of technical assistance to the SILCs, including support for .8 FTE to provide direct 

Federal technical assistance.

Centers for Independent Living

The FY 2019 request for Centers for Independent Living (CILs) is $78,156,000. They will continue 

to provide the core requirements for information and referral services, independent living skills 

training, peer counseling, and individual and systems advocacy. They will continue to implement 

the new, fifth core service required by WIOA to facilitate the transition of individuals with 

significant disabilities into the community. As part of this requirement, CILs develop protocols, 

provide outreach and education, and provide and track activities. In 2015, CILs served about 

219,967 of the estimated 38 million individuals with a significant disability living in the United 

States.123

The request for the CIL program would continue support for existing centers, including any new 

center grants awarded in FY 2018. Approximately 75 new centers have been funded since FY 2000 

and these new and existing centers provide essential services that help individuals with disabilities 

to live independently and participate as productive members of their communities. 

Outcome and Output Table:

ACL is revising the grantee program performance reports (PPRs). These reports form the basis of 

performance measures. The report content is undergoing Information Collection Request (ICR) 

approval process required under the Paperwork Reduction Act. Once the revised PPR is approved 

and grantees have collected baseline data, performance measures will be developed and reported.

123 ACL, 704 Report, 2014. And U.S. Census Bureau, “Americans with Disabilities 2010” issued July 2012. 

https://www.census.gov/content/dam/Census/library/publications/2012/demo/p70-131.pdf. Accessed 04 January 

2014.
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Grant Awards Tables:

Independent Living Services State Grant Awards

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 56 56 56 

Average Award $395,346 $393,422 $308,690

Range of Awards $27,674 - 

$1,958,739 

$27,540 - 

$1,944,814 

$21,608 - 

$928,902 

1/ Independent Living State Grants are awarded to 77 entities across 56 state

and territory jurisdictions because some states have separate divisions for 

vocational rehabilitation and services for the blind.

Resource and Program Data:

Independent Living

(Dollars in Thousands) 

Mechanism FY 2017

Final #

FY 2017

Final $

FY 2018

Annualized 

CR #

FY 2018

Annualized 

CR $

FY 2019

President’s 

Budget #

FY 2019

President’s 

Budget $

Grants:

Formula /2 77 22,139 77 22,027 77 17,342 

New Discretionary 360 77,709 358 75,730 359 76,421 

Continuations 4 688 5 2,290 3 1,786 

Contracts -- -- -- -- -- --

Interagency 

Agreements -- -- -- -- -- --

Program Support /1 -- 415 -- 448 -- 448 

Total Resources -- 100,951 -- 100,496 -- 95,997 

1/ Program Support—Includes funds for statutory technical assistance and/or minority set-asides; grant systems and 

review, and program reporting systems costs.

2/ Independent Living State Grants are awarded to 77 entities across 56 state and territory jurisdictions because 

some states have separate divisions for vocational rehabilitation and services for the blind.
DISABILITY PROGRAMS, RESEARCH, AND SERVICES

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

FY 2019 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Independent Living State Grants (CFDA 84.169A)

State/Territory FY 2017

Final/1

FY 2018

Annualized CR

FY 2019

President's 

Budget

FY 2019 +/- 

FY 2018

Alabama 305,350 305,350 305,350 -

Alaska 305,350 305,350 305,350 -

Arizona 343,409 343,430 305,350 (38,080)

Arkansas 305,350 305,350 305,350 -

California 1,968,739 1,944,814 928,902 (1,015,912)

Colorado 305,350 305,350 305,350 - 

Connecticut 305,350 305,350 305,350 -

Delaware 305,350 305,350 305,350 -

District of Columbia 305,350 305,350 305,350 -

Florida 1,019,518 1,021,333 487,819 (533,514)

Georgia 513,744 510,872 305,350 (205,522)

Hawaii 305,350 305,350 305,350 -

Idaho 305,350 305,350 305,350 -

Illinois 646,777 634,308 305,350 (328,958)

Indiana 332,928 328,664 305,350 (23,314)

Iowa 305,350 305,350 305,350 -

Kansas 305,350 305,350 305,350 - 

Kentucky 305,350 305,350 305,350 -

Louisiana 305,350 305,350 305,350 -

Maine 305,350 305,350 305,350 -

Maryland 305,350 305,350 305,350 -

Massachusetts 341,717 337,519 305,350 (32,169)

Michigan 499,043 491,941 305,350 (186,591)

Minnesota 305,350 305,350 305,350 -

Mississippi 305,350 305,350 305,350 -

Missouri 305,971 305,350 305,350 - 

Montana 305,350 305,350 305,350 - 

Nebraska 305,350 305,350 305,350 -

Nevada 305,350 305,350 305,350 -

New Hampshire 305,350 305,350 305,350 -
DISABILITY PROGRAMS, RESEARCH, AND SERVICES

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PROGRAM/CFDA NUMBER: Independent Living State Grants (CFDA 84.169A)

State/Territory FY 2017

Final/1

FY 2018

Annualized CR

FY 2019

President's 

Budget

FY 2019 +/- 

FY 2018

New Jersey 450,532 443,193 305,350 (137,843)

New Mexico 305,350 305,350 305,350 -

New York 995,604 978,366 467,297 (511,069)

North Carolina 505,090 502,767 305,350 (197,417)

North Dakota 305,350 305,350 305,350 -

Ohio 584,083 575,485 305,350 (270,135)

Oklahoma 305,350 305,350 305,350 -

Oregon 305,350 305,350 305,350 -

Pennsylvania 643,886 633,450 305,350 (328,100)

Rhode Island 305,350 305,350 305,350 -

South Carolina 305,350 305,350 305,350 -

South Dakota 305,350 305,350 305,350 -

Tennessee 331,954 329,562 305,350 (24,212)

Texas 1,381,525 1,380,574 659,403 (721,171)

Utah 305,350 305,350 305,350 -

Vermont 305,350 305,350 305,350 -

Virginia 421,612 416,800 305,350 (111,450)

Washington 360,624 361,116 305,350 (55,766)

West Virginia 305,350 305,350 305,350 -

Wisconsin 305,350 305,350 305,350 -

Wyoming 305,350 305,350 305,350 -

Subtotal, States 21,723,306 21,616,094 16,894,871 (4,721,223)

American Samoa 27,674 27,540 21,608 (5,932)

Guam 27,674 27,540 21,608 (5,932)

Northern Mariana Islands 27,674 27,540 21,608 (5,932)

Puerto Rico 305,350 305,350 305,350 -

Virgin Islands 27,674 27,540 21,608 (5,932)

Subtotal, States and 

Territories 22,139,352 22,031,604 17,286,653 (4,744,951)

Undistributed 1/ $686,216 691,032 554,347 (136,685)

TOTAL 22,825,568 22,722,636 17,841,000 (4,881,636)

1/ Program Support—Includes funds for statutory technical assistance and/or minority set-asides; grant systems and review, and 

program reporting systems costs.
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Limb Loss Resource Center

Service FY 2017

Final

FY 2018

Annualized 

CR

FY 2019

President’s

Budget

FY 2019 

+/- 

FY 2018

Limb Loss Resource Center $2,494 $2,483 $0 -$2,483

*BA is in thousands of dollars, FTE is a whole number.

Authorizing Legislation: Public Health Service Act Section 301 (a) and Section 317, as 

amended, 42U.S.C. 241 (a); 42 U.S.C. 247 (b)

FY 2018 Authorization ................................................................................................................ 0

Allocation Method .......................................................................................... Competitive Grants

Program Description and Accomplishments:

Limb loss is the loss of all or part of an arm or leg due to trauma, infection, diabetes, heart 

diseases, cancers, or other diseases. An estimated two million people live with limb loss/limb 

difference in the United States.124 Each year, an additional 185,000 amputations occur.125 People 

with limb loss experience many barriers to successful community integration and full 

participation in life. They perceive a reduction in their participation in recreational activities,

satisfaction at work and difficulty navigating their community following the amputation of their 

limb.126 Individuals with limb loss report receiving little information about their rehabilitation 

from their healthcare provider either before or after their amputation.127

The National Limb Loss Resource Center (NLLRC) seeks to improve the health of people with 

limb loss, promote their well-being, improve their quality of life, reduce unnecessary medical 

expenditures, and provide support to families and caregivers. ACL’s Limb Loss Program 

supports programs and services including a national peer support program, educational events, 

 

124 Ziegler-Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R. Estimating the prevalence of limb 

loss in the United States: 2005 to 2050. Arch Phys Med Rehabil2008 Mar;89(3):422-9.

125 Owings M, Kozak LJ, National Center for Health S. Ambulatory and Inpatient Procedures in the United States, 

1996. Hyattsville, Md.: U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, 

National Center for Health Statistics; 1998

126 Ephraim PL, MacKenzie EJ, Wegener ST, Dillingham TR, Pezzin LE. Environmental barriers experienced by 

amputees: the Craig Hospital Inventory of Environmental Factors-Short Form. Arch Phys Med Rehabil2006 

Mar;87(3):328-33.

127 Seaman JP. Survey of individuals wearing lower limb prostheses. Journal of Prosthetics and 

Orthotics2010;22(4):257-65
DISABILITY PROGRAMS, RESEARCH, AND SERVICES

186 

trainings for consumers and healthcare professionals, consumer education materials, and 

information and referral services to disseminate information specific to living well with limb 

loss and to connect consumers to resources in their local communities.

Funding History:

Funding for the program over the past five years is as follows:

FY 2015/1 ................................................ $2,800,000 

FY 2016 ................................................... $2,810,000 

FY 2017 ................................................... $2,494,000 

FY 2018 Annualized CR ......................... $2,483,023 

FY 2019 President’s Budget .................................. $0 

1/ This program was funded at CDC through FY 2014 and transferred to ACL during FY 2015.

Budget Request:

No funding is requested in FY 2019 for the Limb Loss Resource Center, a reduction 

of -$2,483,023 below the FY 2018 Annualized Continuing Resolution. Other ACL and HHS 

programs, such as Aging and Disability Resource Centers, Centers for Independent Living and 

Assistive Technology provide services and resources for individuals with disabilities.

Limb Loss Resource Center

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of Awards 1 1 -

Average Award $2,430,310 $2,409,333 -

Range of Awards $2,430,310 $2,409,333 - 

1/ Program Support -- Includes funds for Public Health Service Act statutory 

requirements, grant systems and review costs.
DISABILITY PROGRAMS, RESEARCH, AND SERVICES

187 

Limb Loss Resource Center

Resource and Program Data 

(Dollars in thousands)

Mechanism FY 2017

Final #

FY 2017

Final $

FY 2017

Final #

FY 2017

Final $

FY 2019

President’s 

Budget #

FY 2019

President’s 

Budget $

Grants:

Formula -- -- -- -- -- --

New Discretionary -- -- -- -- -- --

Continuations 1 2,430 1 2,409 -- --

Contracts -- -- -- -- -- --

Interagency Agreements -- -- -- -- -- --

Program Support /1 -- 64 -- 74 -- --

Total Resources -- 2,494 -- 2,483 -- --

1/ Program Support – Includes funds for Public Health Service Act statutory requirements, grant systems and review 

costs.
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Paralysis Resource Center

 

Service FY 2017

Final

FY 2018

Annualized 

CR

FY 2019

President’s

Budget

FY 2019

+/- 

FY 2018

Paralysis Resource Center $6,682 $6,655 $0 -$6,655

*BA is in thousands of dollars, FTE is a whole number.

Authorizing Legislation: Sections 311 and 317(k)(2) of the Public Health Service Act [42 U.S.C. 

243 & 247b(k)(2)], as amended. 

Allocation Method ............................................................................................... Competitive Grant

Program Description and Accomplishments:

The Paralysis Resource Center (PRC) promotes the health and well-being of people living with 

paralysis and supports their families and caregivers by providing comprehensive information and 

referral services. The PRC seeks to bridge the information gap experienced not only by 

newly-paralyzed individuals, but also by those who have lived for some time with paralysis. This 

information promotes better health, encourages community involvement, and improves quality of 

life.

Nearly 5.4 million Americans, or one in 50 reported having some form of paralysis, defined as a 

central nervous system disorder resulting in difficulty or inability to move the upper or lower 

extremities.128 These individuals face health and other disparities, which often translate into 

exclusion from full participation in their communities. The Paralysis Resource Center offers 

activities and services aimed at increasing independent living for people with paralysis and related 

mobility impairments, and supporting integration into the physical and cultural communities in 

which they live.

 

128 Armour, Brian S., Elizabeth A. Courtney-Long, Michael H. Fox, Heidi Fredine, and Anthony Cahill. Prevalence 

and Causes of Paralysis—United States, 2013. Issue brief. Christopher and Dana Reeve Foundation, 23 Aug. 

2016. 
DISABILITY PROGRAMS, RESEARCH, AND SERVICES

190 

Funding History:

Funding for the program over the past five years is as follows: 

FY 2015 ...................................................$6,700,000 

FY 2016 ...................................................$7,700,000 

FY 2017 ...................................................$6,682,000 

FY 2018 Annualized CR ..........................$6,655,000 

FY 2019 President’s Budget ..................................$0 

Budget Request:

No funding is requested in FY 2019 for the Paralysis Resource Center (PRC), a decrease 

of -$6,655,000. Other ACL and HHS programs, such as Aging and Disability Resource Centers, 

Centers for Independent Living and Assistive Technology provide services and resources for 

individuals with disabilities.

Paralysis Resource Center

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 1 6 0 

Average Award $6,511,661 $1,073,692 N/A

Range of Awards $6,511,661 $190,970 - 

$5,487,651 N/A
DISABILITY PROGRAMS, RESEARCH, AND SERVICES

191 

Resource and Program Data:

Paralysis Resource Center

(Dollars in thousands) 

Mechanism FY 2017

Final #

FY 2017

Final $

FY 2018

Annualized

CR # 

FY 2018

Annualized

CR $ 

FY 2019

President’s 

Budget #

FY 2019

President’s 

Budget $

Grants:

Formula

 

--

 

--

 

--

 

--

 

--

 

--

New Discretionary -- -- 6 6,442 -- --

Continuations 1 6,512 -- -- -- --

Contracts -- -- -- -- -- --

Interagency 

Agreements -- -- -- -- -- --

Program Support /1 -- 170 -- 212 -- --

Total Resources -- 6,682 -- 6,655 -- --

1/ Program Support – Includes funds for Public Health Service Act statutory requirements, grant systems and review 

costs.
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193 

Traumatic Brain Injury

 

Service FY 2017

Final

FY 2018

Annualized 

CR

FY 2019

President’s

Budget

FY 2019

+/- 

FY 2018

Traumatic Brain Injury $9,300 $9,258 $9,321 +$63

FTE 1.4 1.6 1.6 -

*BA is in thousands of dollars, FTE is a whole number.

Authorizing Legislation: The Traumatic Brain Injury Reauthorization Act of 2014. 

FY 2019 Authorization ....................................................................................................$8,600,000 

Allocation Method ................................................... Formula Grant / Competitive Grant / Contract

Program Description and Accomplishments:

The Traumatic Brain Injury (TBI) Program develops comprehensive, coordinated family and 

person-centered service systems at the state and community level for individuals who sustain a 

TBI. In the United States, it is estimated at least 3.2 million Americans require long-term or lifelong assistance to perform activities of daily living as a result of TBI.129 In addition, these national 

estimates do not include individuals with TBI who are treated in military hospitals.

Individuals with TBI may need a variety of services and supports, including rehabilitation, 

counseling, academic and vocational accommodations, independent living assistance, 

transportation assistance, and vocational training. These services and supports are often 

fragmented across different State systems of care, making access difficult for families. ACL works 

across the lifespan, focusing on multiple life domains outside the health arena to achieve systems 

change, address fragmentation, and enhance service delivery.

The TBI Program includes two grant programs: the State Protection and Advocacy (P&A) Systems 

Grants (formula grant), and the TBI State Partnership Program (competitive grant).

State Protection and Advocacy Systems Grants 

TBI P&A grants are awarded to P&A organizations in states, territories, the District of Columbia, 

and one Native American Consortium to provide advocacy support for individuals with TBI and 

their families. Grantees use these funds to develop plans and provide P&A services -- including 

individual and family advocacy, self-advocacy training, self-advocacy assistance, information and 

referral services, and legal representation — to individuals who have experienced a TBI. P&A 

grants are formula based, with an average award of $50,000 for state grantees and $20,000 for 

territory grantees.

 

129 Traumatic Brain Injury in the United States: A Report to Congress. December 1999.http://www.cdc.gov/

ncipc/pub-res/tbi_congress/TBI_in_the_US.PDF 
DISABILITY PROGRAMS, RESEARCH, AND SERVICES

194 

A vital part of P&A activities is providing training and education to consumers and providers. TBI 

training is tailored to meet the needs of specific audiences, and is intended to increase awareness 

about legal concerns and individual rights around TBI, provide information on identification and 

funding of services, and provide support to facilitate full participation in all aspects of life. In FY 

2014, P&A grantees provided training to nearly 60,000 individuals. TBI training is provided to 

support groups, independent living centers, service providers, and caregivers, individuals with 

TBI, family members, state employees, hospital staff, university staff, and community 

representatives. Training has resulted in greater awareness for training participants of the needs of 

persons with TBI and the availability of resources and support services. 

State Partnership Program Grants

The State Partnership Program is designed to assist states in expanding and improving state and 

local capability to provide access to comprehensive and coordinated services for individuals with 

TBI and their families. The program addresses barriers to needed services encountered by children, 

youth, and adults with TBI. 

Starting in 2018, ACL is creating two tiers of grantees, which will work together to maximize the 

program’s impact nationally: Partner State grantees and Mentor State grantees. Both types of 

grantees are required to build and enhance their state TBI infrastructure by establishing and 

maintaining a State Advisory Board on Traumatic Brain Injury, creating an annual TBI state plan, 

and creating or expanding a state TBI registry. Mentor States have additional responsibilities, 

which include mentoring one or more Partner States and working together with other Mentor States 

and ACL to improve national coordination and collaboration around TBI services and supports. 

Amounts Available for

Grants

FY 2017

Final Level

FY 2018

Annualized CR

FY 2019 

President’s Budget 

State Grants for 

Demonstration Projects $5,065,314 $5,030,915 $5,065,314

Protection and Advocacy 

Grants $3,099,589 $3,078,540 $3,099,589
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195 

Funding History:

Funding for the program over the past five years is as follows: 

FY FTE

FY 2015 /1 ...............................................$9,321,000 --

FY 2016 /1... ...........................................$9,321,000 --

FY 2017 ...................................................$9,300,000 1.4 

FY 2018 Annualized CR /2......................$9,257,701 1.6 

FY 2019 President’s Budget ....................$9,321,000 1.6 

1/This program was funded at HRSA through FY 2015 and transferred to ACL at the beginning of FY 2016. Funding 

at HRSA included both grant and administrative funds.

2/ Partnerships for Innovation, Inclusion, and Independence consolidate like activities in the State Councils on 

Developmental Disabilities, State Independent Living Councils, and State Partnerships for Traumatic Brain Injury.

Budget Request:

The FY 2019 request for the Traumatic Brain Injury (TBI) program is $9,321,000, is consistent 

with the FY 2018 Annualized Continuing Resolution and will allow for continued support of 1.6 

FTE. 

This level will allow for continued support of the TBI Protection and Advocacy Formula Grants, 

and a new approach to State Implementation Partnership grants. Staring in FY 2018, ACL created

two tiers of TBI State Partnership Program grants. One targeted States that are developing their 

State’s TBI program, and the other targeted States that have more developed TBI programs and 

are willing to act as mentor’s to other States. In both cases grantees are expected to support 

comprehensive, coordinated family and person-centered service systems for individuals at the 

State and community level who are living with a TBI.

The TBI program also provides funding for a TBI technical assistance center (TBICC), which

provides technical assistance to grantees, maintains a national listserv on issues that affect TBI 

service delivery with approximately 1,500 subscribers, manages an online collaboration space for 

grantees to share promising practices for building and maintaining service-delivery infrastructure, 

and develops educational materials for the public about TBI. 
DISABILITY PROGRAMS, RESEARCH, AND SERVICES

196 

Grant Awards Tables:

Traumatic Brain Injury: Protection and Advocacy

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 57 57 57 

Average Award $54,379 $54,009 $54,379

Range of Awards $20,000 - 

$147,540 

$20,000 - 

$142,517 

$20,000 - 

$147,218 

Traumatic Brain Injury: State Implementation/Mentor Partnership

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 19 35 35 

Average 

Award $249,181 $136,835 $138,644 

Range of 

Awards

$20,000-

$147,540 

$75,000-

$275,000 

$75,000-

$275,000 
DISABILITY PROGRAMS, RESEARCH, AND SERVICES

197 

Resource and Program Data:

Traumatic Brain Injury

(Dollars in thousands) 

Mechanism

FY 

2017

Final #

FY 2017

Final $

FY 2018

Annualized 

CR #

FY 2018

Annualized 

CR $

FY 2019

President’s 

Budget #

FY 2019

President’s 

Budget $

Grants:

Formula

 

57 3,100 57 3,100 57 3,100 

New Discretionary -- -- 35 4,789 -- --

Continuations 19 4,734 -- -- 35 4,853 

Contracts 3 893 3 607 3 607 

Interagency 

Agreements -- -- -- -- -- --

Program Support /1 -- 573 -- 762 -- 762 

Total Resources -- 9,300 -- 9,258 -- 9,321 

1/ Program Support -- Includes funds for grant systems and review, and program reporting systems costs. 
DISABILITY PROGRAMS, RESEARCH, AND SERVICES

198 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

FY 2017 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: TBI Protection and Advocacy State Grants (CFDA 93.873)

State/Territory FY 2017

Final/1

FY 2018

Annualized CR

FY 2019

President's Budget

FY 2019 +/- 

FY 2018

Alabama 50,000 50,000 50,000 -

Alaska 50,000 50,000 50,000 -

Arizona 54,550 54,420 54,742 322

Arkansas 50,000 50,000 50,000 -

California 147,540 142,517 147,218 4,701

Colorado 50,603 50,630 50,764 134

Connecticut 50,000 50,000 50,000 -

Delaware 50,000 50,000 50,000 -

District of Columbia 50,000 50,000 50,000 -

Florida 93,233 91,715 93,888 2,173

Georgia 64,295 63,632 64,411 779

Hawaii 50,000 50,000 50,000 - 

Idaho 50,000 50,000 50,000 - 

Illinois 71,907 70,423 71,539 1,116

Indiana 53,950 53,608 53,890 282

Iowa 50,000 50,000 50,000 -

Kansas 50,000 50,000 50,000 -

Kentucky 50,000 50,000 50,000 -

Louisiana 50,000 50,000 50,000 -

Maine 50,000 50,000 50,000 -

Maryland 52,186 51,927 52,125 198

Massachusetts 54,453 54,095 54,401 306

Michigan 63,454 62,590 63,318 728

Minnesota 50,698 50,573 50,705 132

Mississippi 50,000 50,000 50,000 -

Missouri 52,408 52,135 52,344 209

Montana 50,000 50,000 50,000 -

Nebraska 50,000 50,000 50,000 -

Nevada 50,000 50,000 50,000 -

New Hampshire 50,000 50,000 50,000 -
DISABILITY PROGRAMS, RESEARCH, AND SERVICES

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PROGRAM/CFDA NUMBER: TBI Protection and Advocacy State Grants (CFDA 93.873) 

State/Territory FY 2017

Final/1

FY 2018

Annualized CR

FY 2019

President's Budget

FY 2019 +/- 

FY 2018

New Jersey 60,679 59,909 60,503 594

New Mexico 50,000 50,000 50,000 -

New York 91,865 89,352 91,406 2,054

North Carolina 63,800 63,186 63,943 757

North Dakota 50,000 50,000 50,000 -

Ohio 68,320 67,187 68,142 955

Oklahoma 50,000 50,000 50,000 -

Oregon 50,000 50,000 50,000 -

Pennsylvania 71,741 70,376 71,489 1,113

Rhode Island 50,000 50,000 50,000 - 

South Carolina 50,000 50,000 50,000 -

South Dakota 50,000 50,000 50,000 -

Tennessee 53,894 53,657 53,942 285

Texas 113,945 111,479 114,631 3,152

Utah 50,000 50,000 50,000 -

Vermont 50,000 50,000 50,000 -

Virginia 59,024 58,457 58,979 522

Washington 55,535 55,393 55,764 371

West Virginia 50,000 50,000 50,000 -

Wisconsin 51,509 51,279 51,445 166

Wyoming 50,000 50,000 50,000 - 

Subtotal, States 2,949,589 2,928,540 2,949,589 21,049

American Samoa 20,000 20,000 20,000 -

Guam 20,000 20,000 20,000 -

Northern Mariana Islands 20,000 20,000 20,000 -

Puerto Rico 50,000 50,000 50,000 -

Virgin Islands 20,000 20,000 20,000 -

Subtotal, States and 

Territories 3,079,589 3,058,540 3,079,589 21,049

Native American 

Organizations 20,000 20,000 20,000 - 

Undistributed - - - -

TOTAL 3,099,589 3,078,540 3,099,589 21,049

1/Program Support -- Includes funds for grant systems and review, and program reporting systems costs. 

2/ Reflects actual grant awards.
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National Institute on Disability, Independent Living, and Rehabilitation 

Research

Service FY 2017

Final

FY 2018

Annualized

CR

FY 2019 

President’s

Budget 1/

FY 2019

+/- 

FY 2018

National Institute on 

Disability, Independent Living 

and Rehabilitation Research $103,731 $103,264 $0 -$103,264

*BA is in thousands of dollars, FTE is a whole number.

1/ The FY 2019 President’s Budget proposes to transfer NIDILRR to the National Institutes of Health (NIH). 

Authorizing Legislation: Title II of the Rehabilitation Act of 1973, as amended

FY 2019 Rehabilitation Act Authorization ..................................................................$119,608,000 

Allocation Method .................................................................... Discretionary Grants and Contracts

Program Description and Accomplishments:

The mission of the National Institute on Disability, Independent Living, and Rehabilitation 

Research (NIDILRR) is to generate new knowledge and promote its effective use to improve the 

abilities of people with disabilities to perform activities of their choice in the community, and to 

expand society’s capacity to provide full opportunities and accommodations for its citizens with 

disabilities. NIDILRR sponsors comprehensive and coordinated programs of research and related 

activities to maximize the full inclusion, social integration, employment, and independent living 

of individuals with disabilities of all ages.

NIDILRR conducts research through a network of individual research projects and centers of 

excellence across the nation. Research funding is awarded through competitive grants, and most 

of the funds are awarded to universities or providers of rehabilitation or related services.

As required by the Rehabilitation Act in §202(h), NIDILRR operates under a Long-Range Plan 

(LRP). The current plan covers FY 2013 - FY 2017. Work on the FY 2018 - FY 2022 plan is 

underway. 

The primary grant mechanisms under which NIDILRR makes awards are:

• Rehabilitation Research and Training Centers (RRTCs). RRTC research improves 

rehabilitation methodologies and service delivery systems, alleviates or stabilizes disabling 

conditions, and promotes maximum social and economic independence for persons with 

disabilities. RRTCs also provide training to help rehabilitation personnel deliver more 

effective rehabilitation services.
DISABILITY PROGRAMS, RESEARCH, AND SERVICES

202 

• Rehabilitation Engineering Research Centers (RERCs). RERCs focus on rehabilitation

technology, including rehabilitation engineering and assistive technology devices and

services designed to diminish barriers to independence. RERCs also train individuals,

including those with disabilities to become researchers and practitioners in the field of

rehabilitation technology.

• Model Systems. NIDILRR funds model systems networks in three rehabilitation areas:

spinal cord injury, traumatic brain injury, and burn injury. In addition to participating in

research, model systems grantees collect and contribute long-term community integration

and functional outcomes data to their respective national databases. These model systems

programs have become platforms for conducting multi-site research studies.

o Spinal Cord Injury Model Systems. The SCI program funds research and dissemination

activities to address the needs of SCI individuals, their family members, caregivers and

other stakeholders. The NIDILRR SCI model systems longitudinal dataset is the largest

of its kind in the world.

o Traumatic Brain Injury (TBI) Model Systems. TBI projects are research grants to

improve TBI rehabilitation outcomes. The NIDILRR TBI model systems are the largest

nonmilitary TBI service delivery/research entity participating in various

intergovernmental efforts to improve treatment and outcomes for returning veterans.

o Burn Model Systems (BMS). BMS projects improve treatment and outcomes for burn

injury survivors.

• Field-Initiated Projects (FIPs). Field-Initiated Projects supplement NIDILRR’s directed

research and development, capacity building and knowledge translation efforts by

addressing a wide range of topics identified by investigators.

• Disability and Rehabilitation Research Projects (DRRPs). Grantees focus on addressing

problems encountered by people with disabilities through any combination of activities

including research, training, dissemination, and technical assistance.

• ADA National Network Centers (ADA Network). The ADA Network supports, technical

assistance, information, and training designed to promote increased understanding,

awareness, and enforcement of the ADA.

• Advanced Rehabilitation Research Training (ARRT). The ARRT program funds grants to

institutions of higher education to recruit and train qualified persons with doctoral or

similar advanced degrees and prepare them to conduct independent research in areas

related to disability and rehabilitation.

• Small Business Innovation Research (SBIR). NIDILRR awards SBIR grants to small

businesses to support the development of new rehabilitation technologies that promote

increased accessibility and independence.
DISABILITY PROGRAMS, RESEARCH, AND SERVICES

203 

• Switzer Research Fellowships. The Switzer program awards 1-year fellowships to

individuals to carry out research projects in areas of importance to the disability and

rehabilitation community.

• Other Activities. NIDILRR funding also supports other activities, including knowledge

translation; collaborative projects; development and maintenance of grantee reporting

systems; program review; and reporting, evaluation, and long-range planning.

Funding History:

Funding for NIDILRR over the past five years is as follows: 

FY 2015 ...............................................$103,970,000 

FY 2016... ...........................................$103,970,000 

FY 2017 ..............................................$103,731,000 

FY 2018 Annualized CR ......................$103,263,940

FY 2019 Request....................................................$0 

Budget Request:

The FY 2019 Budget consolidates NIDILRR into NIH, and provides $95 million for these 

activities, which is a decrease of -$8 million below the FY 2018 Annualized Continuing 

Resolution. This consolidation allows NIDILRR to benefit from NIH’s research infrastructure, and 

complements existing NIH portfolios addressing disability and aging. The Budget includes 

NIDILRR as a separate entity within NIH, though over time, NIH will assess the feasibility of 

integrating these research activities more fully into existing NIH Institutes and Centers. 

The FY 2019 budget request includes a new general provision (Section 217) that, while applicable 

to HHS as a Department, addressed an area of particular concern to NIDILRR, as well as to other 

ACL programs. Within the Department, the provision would simplify the accounting processes 

used when one Operating Division (OPDIV) has agreed to issue and manage a grant on behalf of 

a second OPDIV. This general provision would allow HHS to use the reimbursable processing 

features within the accounting system, rather than the more cumbersome execution process 

currently used. This provision would also enable an HHS OPDIV to collaborate in the same way 

with an outside Department for the purpose of making grants or cooperative agreements. Currently, 

the lack of specific authority precludes collaboration. The new proposed language would provide 

HHS OPDIVs with the authority to transfer funds via reimbursable agreements from one agency 

to another for the purposes of making grants, allowing NIDILRR to collaborate on a wider scale 

(e.g., with the Department of Veteran’s affairs on research projects to address the needs of disabled 

veterans). NIDILRR had such authority when it was part of the Department of Education. The 

same language was included in the FY 2018 request as well.
DISABILITY PROGRAMS, RESEARCH, AND SERVICES

204 

Outcomes and Output Table:

As the program is being transferred ACL is not proposing new performance measures. 

Grant Awards Tables:

National Institute on Disability, Independent Living, and Rehabilitation Research 

(Dollars in Thousands) 

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 220 218 - 

Average Award $443,422 $443,206 -

Range of Awards $70,000-

$1,246,000 

$70,000-

$1,246,000 -
DISABILITY PROGRAMS, RESEARCH, AND SERVICES

205 

Resource and Program Data:

National Institute on Disability, Independent Living, and Rehabilitation Research 

(Dollars in Thousands) 

Mechanism

FY 

2017

Final #

FY 

2017

Final $

FY 2018

Annualized 

CR #

FY 2018

Annualized 

CR $

FY 2019

President’s 

Budget #

FY 2019

President’s 

Budget $

Grants:

Formula -- -- -- -- -- --

New Discretionary 72 21,679 63 24,079 -- --

Continuations 148 75,874 155 72,540 -- --

Contracts 10 5,805 13 6,193 -- --

Interagency Agreements -- -- 2 85 -- --

Program Support /1 -- 373 -- 367 -- --

Total Resources -- 103,731 -- 103,264 -- --

1/ Program Support -- Includes funds for statutory requirements, grant systems and review, salaries and overhead, 

and information technology support costs.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

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207 

Consumer Information, Access, and Outreach

Summary of Request

Older Americans and Americans with disabilities face an array of choices when trying to determine 

the right services and supports to assist them to remain active and independent in their 

communities. The complexity of navigating these programs and selecting among them so as to 

determine which services best suit the needs of each individual can create challenges for 

individuals, especially for consumers who have not previously utilized these services. 

Consumer Information, Access and Outreach (CIAO) programs provide consumers with the 

information they need to make decisions about their independence and connect them with the right 

services. By providing community-level entry points into long-term services and supports, these 

programs provide access to home and community-based services that can enable people to remain 

in their homes. 

The FY 2019 request for CIAO programs is $80,521,000, a reduction of -$50,162,390 below the 

FY 2018 Annualized Continuing Resolution level. This request would provide: 

• $6,119,000 an increase of $+41,554 over the FY 2018 Annualized Continuing Resolution

level. ADRCs support state efforts to develop more efficient, cost-effective, and consumerresponsive systems of information and integrated access by creating “one-stop shop” entry

points into long-term care at the community-level.

• No funding is requested for the Alzheimer’s Disease Initiative Outreach Campaign, as this

is being consolidated along with other ACL Alzheimer’s programs into a single new

Alzheimer’s Disease program, consistent with ACL’s efforts to consolidate programs to

increase efficiencies.

• The FY 2019 Budget shifts mandatory funding for the Medicare Improvements for Patients

and Providers Act (MIPPA) programs to discretionary funding. The Budget proposes

$37,500,000, the same level as FY 2018 for these programs which provide grants to states

to fund outreach activities to populations in need.

• The Budget reduces funding for SHIPs and proposes to shift $13 million in targeted

mandatory funding under the MIPPA program for SHIPs, to discretionary funding under

the MIPPA program to provide outreach activities to SHIP grantees specifically targeted

to low-income seniors and seniors living in rural areas. CMS, in coordination with ACL

and states, will work to ensure that existing CMS resources continue to provide accurate,

comprehensive, understandable information to individuals. Medicare beneficiaries who are

aging or have a disability will continue to have access, through CMS’s 1-800-Medicare

hotline and through services provided under State programs to assist in navigating the

complexities of health and long-term care systems.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

208 

• $4,963,000 an increase of +$33,704 over the FY 2018 Annualized Continuing Resolution

for the Voting Access for People with Disabilities Program Help American Vote Act

(HAVA) grants assist Protection and Advocacy systems in each state and territory to ensure

full participation in the electoral process for individuals with disabilities, including

registering to vote, casting their votes, and accessing polling places.

• $31,939,000 for Assistive Technology (AT), a decrease of -$1,830,160 below the FY 2018

Annualized Continuing Resolution. Assistive Technology grants support state programs

that maximize the ability of individuals with disabilities of all ages and their families to

obtain AT devices and services, including computer or technology aids, modified driving

controls, and durable medical equipment such as wheelchairs or walkers. The Budget

eliminates funding for a separate alternative financing program grant competition. The

State AT grant program already includes the authority to provide alternative financing if

the State chooses.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

209 

Aging and Disability Resource Centers

Service FY 2017

Final

FY 2018

Annualized 

CR

FY 2019

President’s

Budget

FY 2019

+/- 

FY 2018

Aging and Disability 

Resource Centers $6,105 $6,077 $6,119 +$42 

*BA is in thousands of dollars, FTE is a whole number.

Authorizing Legislation: Sections 202b and 411 of the Older Americans Act of 1965, as amended

FY 2018 Authorization ....................................................................................................$6,402,551 

Allocation Method ............................ Competitive Grants/Co-operative Agreements and Contracts

Program Description and Accomplishments:

Aging and Disability Resource Centers (ADRCs) support state efforts to develop more efficient, 

cost-effective, and consumer-responsive systems of information and integrated access by creating 

consumer-friendly entry points into long-term care at the community-level. ADRCs grew out of 

best practice innovations in some states known as “No Wrong Door”130 (NWD) and “Single Points 

of Entry” programs, where people of all ages may turn for objective information and one-on-one 

assistance on their long-term services and support options. Since 2003, the Administration for 

Community Living, along with the Centers for Medicare & Medicaid Services (CMS), have 

entered into cooperative agreements with states to develop the foundational infrastructure for 

delivering one-on-one person-centered counseling and streamlined access to public programs that 

make it easier for individuals to learn about and access their health and long-term services and 

support options. Starting in 2008, the Veterans Health Administration (VHA) also began 

participating as a key partner in this effort. ACL, CMS, and the VHA are now working with 

thirteen ADRC/NWD-System states to build on, and promote the nationwide use of lessons learned 

and best practices from prior ADRC investments. 

ADRC/NWD systems help states make better use of taxpayer dollars by streamlining access to 

community services and supports (both publicly and privately funded) and diverting individuals 

from more costly forms of care, including institutional care and unnecessary hospital 

re-admissions. These systems are a key component in transforming states’ long-term services and 

support programs. Services for all populations and all payers provided by ADRC/NWD systems

include:

130 In a “No Wrong Door” entry system, multiple agencies retain responsibility for their respective services while 

coordinating with each other to integrate access to those services through a single, standardized entry process that 

is administered and overseen by a coordinating entity (Allison Armor-Garb, Point of Entry Systems for Long-Term 

Care: State Case Studies, prepared for the New York City Department of Aging, 2004).
CONSUMER INFORMATION, ACCESS, AND OUTREACH

210 

• Targeted discharge planning, care transition and nursing home diversion support that 

integrates the medical and social service systems on behalf of older adults and individuals 

with disabilities to help them remain in their own homes and communities after a 

hospitalization, rehabilitation, or skilled nursing facility visit; 

• “One-on-one” person-centered counseling to help consumers, families, and caregivers fully 

understand the options, including private pay options, that are available to them;

• Streamlined access to publicly-supported long-term services and support programs for 

individuals who appear to be eligible for such programs; 

• Outreach and assistance to Medicare beneficiaries on their Medicare benefits including 

prevention benefits and low-income subsidies provided as a result of receiving funding under 

the Medicare Improvements to Patients and Providers Act; and, 

• Integrated options counseling and access points to care transition and diversion support for 

Veterans served through the ACL/Department of Veterans Affairs (VA) Veteran-Directed 

Home and Community-Based Services program partnership.

ACL, CMS and VHA have invested over $200 million in the Aging and Disability Resource 

Center/No Wrong Door System initiative since 2003. Recent accomplishments include: 

• The Veterans Health Administration is using the ADRC\NWD System to deliver Veteran 

Directed Home and Community Based Services (VD-HCBS) to help Veterans with 

disabilities to continue living in the community and to have control over the LTSS they 

receive. The VD-HCBS program is available in 34 states, the District of Columbia and 

Puerto Rico and is serving more than 2,000 Veterans through 62 VA Medical Centers each 

day. 

• In 2016, ACL funded 8 states (CT, MA, MD, NH, OR, VT, WA, and WI) to coordinate their 

ADRC/No Wrong Door (NWD) System with their statewide Assistive Technology (AT) 

Program. Coordination activities included cross training, assistive technology “toolkits” for 

ADRC staff, and increased collaboration with the Durable Medical Equipment (DME) state 

workgroups to coordinate related efforts on reuse models for AT and DME. As a result of 

this coordination, access to assistive technology for people seeking long term services and 

supports has increased. 

• In FY 2017, the St. Louis VD-HCBS Program became the first VD-HCBS Program to 

exceed a program census of 150 Veterans in December 2016. The St. Louis program has 

been a model of successful partnerships and has contributed to a 24 percent decrease in 

inpatient days of care for enrolled Veterans.

• In FY 2017, the VA Sunshine Network, also known Veterans Integrated Service Network 

(VISN) 8, became the first VISN to achieve full VD-HCBS coverage. The VA Sunshine 

Network includes seven VAMCs serving a population of more than 1.6 million Veterans in 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

211 

Florida, South Georgia, Puerto Rico and the Caribbean. VA is comprised of 21 VISNs 

nationwide that oversee 168 VAMCs serving 8.9 million Veterans each year. Veterans and 

caregivers value the VD-HCBS program because it gives Veterans control over their long 

term services and supports and enables them to design their care to fit their life rather than 

designing their life to fit the care provided. 

Funding History:

Funding for Aging and Disability Resource Centers over the last five years is as follows:

FY 2015 ...................................................$6,119,000 

FY 2016 ...................................................$6,119,000 

FY 2017 ...................................................$6,105,000 

FY 2018 Annualized CR ..........................$6,077,446 

FY 2019 President’s Budget ....................$6,119,000 

Budget Request:

ACL’s FY 2019 request for ADRCs is $6,119,000, which maintains the FY 2018 Annualized 

Continuing Resolution Level. This will provide States funding to continue their development and 

operation of sustainable ADRC/NWD systems based on the national guidelines established by 

ACL, CMS and the VHA. Funded states will replicate the national guidelines to develop 

person-centered, conflict-free access system for long-term services and supports for all populations 

and all payers. In addition to the grants to states, funding would be used to support a technical 

assistance contract.131

Activities funded by this program to develop sustainable ADRC/NWD systems represent a 

substantial state-wide reform of access to long-term services and supports. Building on past ADRC 

activities, the transformation brought about by this funding will include: 

• Funded states will show progress towards guidelines established by ACL, CMS, and VHA for

ADRC/NWD Systems and be required to report on its progress and performance,

• Funded states will commit to using Medicaid administrative funding to support the

ADRC/NWD system infrastructure on an on-going basis; and

• Funded states will ensure that local ADRC/NWD system sites:

o Include a full range of organizations that play a formal reimbursable role in carrying

out the ADRC/NWD system functions they have been designated by the state to

131 Please see page 231 for a discussion of how the MIPPA program helps hard to reach low income and Rural 

Medicare beneficiaries who qualify for either the Medicare savings plan or Low Income Subsidy pay their Medicare 

premiums, in part through formula grants to ADRC grantees.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

212 

perform to ensure the state’s ADRC/NWD system can effectively serve all LTSS 

populations; 

o Use nationally certified person-centered counselors to provide one-on-one assistance 

to consumers; and 

o Conduct formal functional and financial assessments that are required to determine an 

individual’s eligibility for the public LTSS programs that are administered by the 

state, including Medicaid.

Finally, funded states’ ADRC/NWD systems, including local sites, will use the Key Elements of a 

NWD System of Access to LTSS for All Populations and Payers to continually evaluate 

performance and make improvements in ADRC/NWD systems at the state and local site level. The 

ADRC/NWD Key Elements framework has been adopted as a national benchmark in the AARP 

LTSS Scorecard to measure affordability and access state-level performance of LTSS systems that 

assist older people, adults with disabilities, and their family caregivers. 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

213 

Grant Awards Tables:

 Aging and Disability Resource Centers

 (Dollars in Thousands) 

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 13 11 11 

Average Award $388,279 $400,428 $404,206 

Range of Awards $198,615-

$754,480 

$198,615-

$754,480 

$198,615-

$754,480 

Resource and Program Data:

Aging and Disability Resource Centers

 (Dollars in Thousands) 

Mechanism

FY 2017

Final #

FY 2017

Final $

FY 2018

Annualized

CR #

FY 2018

Annualized

CR $

FY 2019

President’s 

Budget #

FY 2019

President’s 

Budget $

Grants:

Formula

 

-- -- -- -- -- --

New Discretionary -- -- 11 4,405 -- 42 

Continuations 13 5,048 -- -- 11 4,404 

Contracts 1 940 1 1,500 1 1,500 

Interagency 

Agreements -- -- -- -- -- --

Program Support /1 -- 117 -- 173 -- 173 

Total Resources -- 6,105 -- 6,077 -- 6,119 

1/ Program Support -- Includes funds for overhead, grant systems and review costs, and information technology 

support costs.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

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215 

State Health Insurance Assistance Programs

Service FY 2017

Final

FY 2018

Annualized 

CR

FY 2019

President’s

Budget

FY 2019

+/- 

FY 2018

State Health Insurance Assistance 

Program (SHIP) $47,115 $46,795 $0 -$46,795

FTE 5 5 - -5

*BA is in thousands of dollars, FTE is a whole number.

Authorizing Legislation: Section 4360 of the Omnibus Budget Reconciliation Act of 1990 

(42 U.S.C. 1395b-4) 

FY 2018 Authorization ......................................................................................................... Expired

Allocation Method ....................................................... Formula and Competitive Grants/Contracts

Program Description and Accomplishments:

The State Health Insurance Assistance Program (SHIP) provides grants to States to fund 

infrastructure, training, and outreach support to over 14,000 (mostly volunteer) counselors in over 

1,300 community-based organizations in all 50 States, the District of Columbia, Guam, Puerto 

Rico, and the Virgin Islands. 

 

SHIPs provide counseling and assistance to help aging and disabled Medicare and Medicaid 

beneficiaries as well as newly enrolled beneficiaries understand and use of their Medicare benefits. 

Services are provided via telephone and through face-to-face interactive sessions, public education 

presentations and programs, and media activities. In CY 2016, SHIPs had over 3.3 million oneon-one client contacts and more than 102,000 public and media events. 

Nearly two-thirds of the 54 state SHIP programs are administered by State Units on Aging, with 

the remaining programs administered by State Departments of Insurance. At the community level, 

many SHIPs are either housed in or create local partnerships with Area Agencies on Aging. 

Similarly, almost 50 percent of the SHIPs are co-located with the Senior Medicare Patrol program, 

which is also administered by ACL.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

216 

Funding History:

Funding for the State Health Insurance Assistance Program over the past five years is as follows: 

FY FTE

FY 2015 ................................................. $52,115,000 7.5 

FY 2016 ... ............................................ $52,115,000 6.0 

FY 2017 ................................................. $47,115,000 5.0 

FY 2018 Annualized CR ........................ $46,795,042 5.0

FY 2019 President’s Budget .................. ............$0 0.0 

Budget Request:

The FY 2019 discretionary Budget Request for SHIPs is $0 a reduction of -$46,795,000 below the 

FY 2018 Annualized Continuing Resolution. While ACL will reduce the scale of its one-on-one 

person assistance through the State Health Insurance Assistance Program, CMS, in coordination 

with ACL and states, will work to ensure that existing CMS resources continue to provide accurate, 

comprehensive, understandable information to individuals. Medicare beneficiaries will continue 

to have access to online tools such as Plan Finder and to phone assistance such as CMS’s 1-800-

MEDICARE helpline. Some states also support SHIP programs using State funds. .132

Outputs Table:

State Health Insurance Assistance Programs

Indicator Year and Most Recent 

Result /

FY 2018

Projection

FY 2019

Projection

FY 2019

Projection

+/-FY 2018

Projection

Output AH: Number of 

SHIP Public Media 

Events (Output)

CY 2016: 101,472 Discontinued Discontinued N/A

Output AI: Number of 

SHIP Client Contacts 

(Output)

CY 2016: 3.4 M Discontinued Discontinued N/A

132 Please see page 231for a discussion of how the MIPPA program helps hard to reach low income and Rural 

Medicare beneficiaries who qualify for either the Medicare savings plan or Low Income Subsidy pay their Medicare 

premiums. The MIPPA program includes formula grants to SHIP grantees. 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

217 

Grant Awards Table:

State Health Insurance Assistance Programs Grant Awards

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 54 54 - 

Average Award $804,815 $791,408 -

Range of Awards $44,898-

$4,074,803 

$44,150-

$4,006,921 - 

Resource and Program Data:

State Health Insurance Assistance Program

(Dollars in thousands) 

Mechanism

FY 

2017

Final #

FY 

2017

Final $

FY 2018

Annualized

CR #

FY 2018

Annualized

CR $

FY 2019

President’s 

Budget #

FY 2019

President’s 

Budget $

Grants:

Formula

 

-- -- -- -- -- --

New Discretionary 55 44,410 -- -- -- --

Continuations -- -- 55 43,686 -- --

Contracts 4 1,177 4 1,878 -- --

Interagency Agreements 1 157 1 160 -- --

Program Support /1 -- 1,370 -- 1,071 -- --

Total Resources -- 47,115 -- 46,795 -- --

1/ Program Support -- Reflects the amount used from the SHIP appropriation for staff and overhead, support 

contracts, training, technical assistance, data systems, grant systems, and grants review costs.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

218 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

CENTER FOR INTEGRATED PROGRAMS

FY 2019 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: State Health Insurance Assistance Program (CFDA 93.324) 

State/Territory FY 2017

Final

FY 2018

Annualized CR

FY 2019

President's 

Budget

FY 2019 +/- 

FY 2018

Alabama 799,239 785,924 - (785,924)

Alaska 214,165 210,597 - (210,597)

Arizona 792,368 779,168 - (779,168)

Arkansas 565,188 555,773 - (555,773)

California 4,074,803 4,006,921 - (4,006,921)

Colorado 567,437 557,984 - (557,984)

Connecticut 509,051 500,571 - (500,571)

Delaware 189,497 186,340 - (186,340)

District of Columbia 144,004 141,605 - (141,605)

Florida 2,605,036 2,561,639 - (2,561,639)

Georgia 1,079,926 1,061,936 - (1,061,936)

Hawaii 234,191 230,290 - (230,290)

Idaho 362,461 356,423 - (356,423)

Illinois 1,428,532 1,404,734 - (1,404,734)

Indiana 818,602 804,965 - (804,965)

Iowa 645,200 634,452 - (634,452)

Kansas 490,981 482,802 - (482,802)

Kentucky 791,667 778,479 - (778,479)

Louisiana 621,659 611,303 - (611,303)

Maine 407,087 400,305 - (400,305)

Maryland 693,513 681,960 - (681,960)

Massachusetts 883,747 869,025 - (869,025)

Michigan 1,361,089 1,338,415 - (1,338,415)

Minnesota 871,241 856,727 - (856,727)

Mississippi 558,276 548,976 - (548,976)

Missouri 862,651 848,280 - (848,280)

Montana 521,702 513,011 - (513,011)

Nebraska 389,343 382,857 - (382,857)

Nevada 385,518 379,096 - (379,096)

New Hampshire 267,336 262,882 - (262,882)
CONSUMER INFORMATION, ACCESS, AND OUTREACH

219 

PROGRAM/CFDA NUMBER: State Health Insurance Assistance Program (CFDA 93.324) 

State/Territory FY 2017

Final

FY 2018

Annualized CR

FY 2019

President's Budget

FY 2019 +/- 

FY 2018

New Jersey 979,891 963,567 - (963,567)

New Mexico 404,373 397,637 - (397,637)

New York 2,210,848 2,174,018 - (2,174,018)

North Carolina 1,388,498 1,365,367 - (1,365,367)

North Dakota 234,944 231,030 - (231,030)

Ohio 1,644,496 1,617,100 - (1,617,100)

Oklahoma 570,409 560,907 - (560,907)

Oregon 544,591 535,519 - (535,519)

Pennsylvania 1,850,688 1,819,857 - (1,819,857)

Rhode Island 252,202 248,001 - (248,001)

South Carolina 717,685 705,729 - (705,729)

South Dakota 293,393 288,505 - (288,505)

Tennessee 1,008,460 991,660 - (991,660)

Texas 2,463,958 2,422,911 - (2,422,911)

Utah 331,899 326,370 - (326,370)

Vermont 225,679 221,919 - (221,919)

Virginia 942,186 926,490 - (926,490)

Washington 829,803 815,979 - (815,979)

West Virginia 440,071 432,740 - (432,740)

Wisconsin 853,444 839,226 - (839,226)

Wyoming 271,883 267,354 - (267,354)

Subtotal, States 42,594,911 41,885,323 - (41,885,323)

Guam 44,898 44,150 - (44,150)

Puerto Rico 775,328 762,412 - (762,412)

Virgin Islands 44,898 44,150 - (44,150)

Subtotal, States and 

Territories 43,460,035 42,736,034 - (42,736,034)

Undistributed 1/ $3,654,965 $4,058,968 - (4,058,968)

TOTAL 47,115,000 46,795,002 - (46,795,002)

1/ Program Management -- Reflects the amount used from the SHIP appropriation for staff and overhead, support contracts, 

training, technical assistance, data systems, grant systems, and grants review costs.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

220 

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CONSUMER INFORMATION, ACCESS, AND OUTREACH

221 

Voting Access for Individuals with Disabilities

Service

FY 2017

Final

FY 2018

Annualized 

CR

FY 2019

President’s

Budget

FY 2019 

+/- 

FY 2018

Voting Access for 

People with Disabilities $4,952 $4,929 $4,963 +$34 

*BA is in thousands of dollars, FTE is a whole number.

Authorizing Legislation: Section 291 of the Help America Vote Act 

FY 2018 Authorization ......................................................................................................... Expired

Allocation Method ..................................................................................................... Formula Grant 

Program Description and Accomplishments:

The Voting Access for Individuals with Disabilities program authorized by the Help America Vote 

Act (HAVA) provides formula grants to support Protection and Advocacy (P&A) systems in each 

state and territory to ensure full participation in the electoral process for individuals with 

disabilities. HAVA P&A programs help to insure that individuals with disabilities are able to 

exercise their rights to register to vote, cast a vote, and access polling places. These funds provide 

services to individuals with disabilities within the state, as well as advocacy for and education 

about the electoral process and monitoring of the accessibility of the electoral process for people 

with disabilities. Additionally, training and technical assistance grants to assist the P&As in their 

promotion of full participation in the electoral process are provided through competitive two-year 

awards. 

HAVA P&A grantees use these funds to promote systematic efforts to ensure that individuals with 

disabilities have the opportunity to participate in every step of the electoral process. For example, 

grantees support systems change efforts to improve information on the location of accessible 

polling places, and to adopt voting procedures that enable individuals with disabilities to vote 

privately and independently. Grantees also work to educate election officials, poll workers, and 

election volunteers on the rights of voters with disabilities and best practices. P&As provide 

assistance to state and other government entities by surveying polling places, identifying potential 

modifications to make specific polling places accessible, and developing criteria for identifying 

accessible polling places.

Through the program, ACL also makes discretionary grants to eligible nonprofit organizations to 

assist P&As in developing proficiency in the use of voting systems, identifying and implementing 

technologies to assist individuals with disabilities in voting, and demonstrating and evaluating the 

use of such systems and technologies. P&As also receive training and technical assistance for 

providing non-visual access in the voting process. These grants are authorized under section 291 

of HAVA as a seven percent set-aside of the total appropriation for P&As. As a result of the 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

222 

training and technical assistance, P&As inform others on the availability of accessible voting 

equipment and its use. 

Funding History:

Funding over the past five years is as follows:

FY 2015 ...................................................$4,963,000 

FY 2016 ..................................................$4,963,000 

FY 2017 ...................................................$4,952,000 

FY 2018 Annualized CR ..........................$4,929,296 

FY 2019 President’s Budget ....................$4,963,000 

Budget Request:

The FY 2019 Budget request for the Voting Access for Individuals with Disabilities Program is 

$4,963,000, which maintains the FY 2018 Annualized Continuing Resolution. An example of the 

activities undertaken with HAVA funding, in Charleston, SC the P&A sponsored a site used by an 

Election Protection (EP) volunteer attorney to staff a hotline and train law student volunteers to 

canvass polling places in Charleston for accessibility issues. Funding for this activity helps to 

ensure that individuals with the full range of disabilities are not denied the right to the same 

opportunity for access and participation in the electoral process as voters with no disabilities. 

Grant Awards Table:

Voting Access for Individuals with Disabilities Grant Awards

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 55 55 55 

Average Award $83,324 $82,940 $83,510

Range of Awards $35,000 -

$343,008 

$35,000 -

$337,953 

$35,000 -

$344,347 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

223 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES

FY 2019 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Voting Access for Individuals with Disabilities (CFDA 93.618)

State/Territory FY 2017

Final/1

FY 2018

Annualized CR

FY 2019

President's 

Budget

FY 2019 +/- 

FY 2018

Alabama 70,000 70,000 70,000 -

Alaska 70,000 70,000 70,000 -

Arizona 70,000 70,000 70,000 -

Arkansas 70,000 70,000 70,000 -

California 343,008 337,953 344,347 6,394

Colorado 70,000 70,000 70,000 -

Connecticut 70,000 70,000 70,000 -

Delaware 70,000 70,000 70,000 -

District of Columbia 70,000 70,000 70,000 - 

Florida 177,628 177,479 180,837 3,358

Georgia 89,508 88,775 90,455 1,680

Hawaii 70,000 70,000 70,000 -

Idaho 70,000 70,000 70,000 -

Illinois 112,686 110,225 112,310 2,085

Indiana 70,000 70,000 70,000 -

Iowa 70,000 70,000 70,000 -

Kansas 70,000 70,000 70,000 -

Kentucky 70,000 70,000 70,000 -

Louisiana 70,000 70,000 70,000 - 

Maine 70,000 70,000 70,000 -

Maryland 70,000 70,000 70,000 -

Massachusetts 70,000 70,000 70,000 -

Michigan 86,947 85,485 87,103 1,618

Minnesota 70,000 70,000 70,000 -

Mississippi 70,000 70,000 70,000 -

Missouri 70,000 70,000 70,000 -

Montana 70,000 70,000 70,000 -

Nebraska 70,000 70,000 70,000 -

Nevada 70,000 70,000 70,000 - 

New Hampshire 70,000 70,000 70,000 -
CONSUMER INFORMATION, ACCESS, AND OUTREACH

224 

PROGRAM/CFDA NUMBER: Voting Access for Individuals with Disabilities (CFDA 93.618)

State/Territory FY 2017

Final/1

FY 2018

Annualized CR

FY 2019

President's Budget

FY 2019 +/- 

FY 2018

New Jersey 78,495 77,014 78,471 1,457

New Mexico 70,000 70,000 70,000 -

New York 173,462 170,012 173,229 3,217

North Carolina 88,001 87,367 89,020 1,653

North Dakota 70,000 70,000 70,000 - 

Ohio 101,763 100,003 101,895 1,892

Oklahoma 70,000 70,000 70,000 -

Oregon 70,000 70,000 70,000 -

Pennsylvania 112,183 110,076 112,158 2,082

Rhode Island 70,000 70,000 70,000 -

South Carolina 70,000 70,000 70,000 -

South Dakota 70,000 70,000 70,000 -

Tennessee 70,000 70,000 70,000 -

Texas 240,699 239,904 244,443 4,539

Utah 70,000 70,000 70,000 - 

Vermont 70,000 70,000 70,000 -

Virginia 73,456 72,428 73,798 1,370

Washington 70,000 70,000 70,000 -

West Virginia 70,000 70,000 70,000 -

Wisconsin 70,000 70,000 70,000 -

Wyoming 70,000 70,000 70,000 -

Subtotal, States 4,407,836 4,386,721 4,418,066 31,345

American Samoa 35,000 35,000 35,000 -

Guam 35,000 35,000 35,000 -

Puerto Rico 70,000 70,000 70,000 - 

Virgin Islands 35,000 35,000 35,000 -

Subtotal, States and 

Territories 4,582,836 4,561,721 4,593,066 31,345

Undistributed 1/ 369,164 367,575 369,934 2,359

TOTAL 4,952,000 4,929,296 4,963,000 33,704

1/ Program Support—Includes funds for statutory technical assistance and/or minority set-asides; grant systems and review, and 

program reporting systems costs. 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

225 

Assistive Technology

 

Service FY 2017

Final

FY 2018

Annualized 

CR

FY 2019

President’s 

Budget

FY 2019

+/- 

FY 2018

Assistive Technology $31,927,000 $31,782,688 $31,939,000 +$156,312

Alternative Financing 

Grant Competition $1,995,000 $1,986,418 $0 -$1,986,418

Total: $33,922,000 $33,769,106 $31,939,000 -$1,830,106

*BA is in thousands of dollars, FTE is a whole number.

Authorizing Legislation: Assistive Technology Act of 1998 as amended

FY 2018 Authorization ......................................................................................................... Expired

Allocation Method ...................................................... Competitive and Formula Grants/Contracts

Program Description and Accomplishments:

Assistive Technology (AT) programs are designed to maximize the ability of individuals with 

disabilities of all ages and their family members, guardians, advocates, and authorized 

representatives to obtain AT devices and AT services. AT devices are defined as any item, piece 

of equipment, or product system, whether acquired commercially, modified, or customized, that is 

used to increase, maintain, or improve functional capabilities of individuals with disabilities. 

Examples of such devices include computer or technology aids, modified driving controls, and 

durable medical equipment such as wheelchairs or walkers. Grants support comprehensive 

statewide programs that are designed to increase the:

• Availability, funding, access, provision, and training for AT devices and services; 

• Ability of individuals with disabilities of all ages to secure and maintain possession of AT 

during periods of transition, such as transition between school or home and home and work; 

• Capacity of public and private entities to provide and pay for AT devices and services; 

• Involvement of individuals with disabilities in decisions about AT devices and services; 

• Coordination of AT-related activities among state and local agencies and other private 

entities; 

• Awareness and facilitation of changes in law, regulations, procedures, policies, practices, 

and organizational structures, in order to improve access to AT; and 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

226 

• Awareness of the benefits of AT among targeted individuals and entities in the general 

population. 

Assistive Technology (AT) State Grants 

The AT State Grant program, authorized under section 4 of the AT Act, is a population-based 

formula grant program to support comprehensive statewide programs that maximize the ability of 

individuals with disabilities of all ages to access and acquire AT. States must establish consumerresponsive advisory councils with a majority membership of individuals with disabilities who use 

AT to advise on the planning, implementation, and evaluation of these statewide programs. 

Under the formula, states and territories are initially allocated a base amount equal to the amount 

of funds they received under the AT program in fiscal year 2004 (totaling $20,288,534). Any funds 

appropriated in excess of the fiscal year 2004 appropriation are initially distributed among the 

eligible entities with 50 percent of available funds distributed equally amongst them and 50 percent 

distributed according to the population of the state until each entity receives at least $410,000. If 

any appropriated funds remain after each State receives this minimum, they are further distributed 

with 20 percent divided equally amongst the states and 80 percent distributed according to their 

populations. To date, appropriated funds under this program have not been at a level to necessitate 

this second round of distribution. The estimated FY 2018 state distributions are based on the July 

1, 2016 estimates published in December 2016. 

The state must implement each of the activities required under the program, which include 

state-level activities and state leadership activities. States must spend a minimum of 60 percent 

(unless the state elects to comply with the state flexibility provision in section 4(e)(6) of the AT 

Act, as described below) of their formula grant funds on four state-level activities: state financing 

programs, device reutilization programs, device loan programs, and device demonstrations. States 

may, however, direct their funds towards these activities in varying amounts if they use other state 

or non-federal funds to support these activities at a comparable or greater level. 

States may use up to 40 percent of their AT State Grant program funding on state leadership 

activities. The state leadership activities include the provision of technical assistance and training 

to targeted individuals and entities focused on promoting the general awareness of the benefits of 

AT; skills development for persons involved in the assessment of the need for AT; the appropriate 

application of AT; and the integration of AT devices and services in plans required to be developed 

under other federal laws. 

In addition, states must use a portion of their grant funds on public awareness activities, including 

the continuation and maintenance of a statewide system of information and referral, and 

coordination and collaboration activities amongst entities in the states that are responsible for the 

provision of AT. The law provides states with flexibility to decide to carry out only two or three 

state-level activities, rather than all four. If a state elects to carry out two or three state-level 

activities, it must spend a minimum of 70 percent of its funds on those activities, while spending 

not more than 30 percent on the state leadership activities. 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

227 

The State AT Programs continue to benefit individuals with disabilities, older adults, Veterans, 

caregivers, professionals, schools, vocational rehabilitation agencies, healthcare providers and 

agencies by providing unique access to, and acquisition of, assistive technology devices and 

durable medical equipment. State AT Program data continues to show increased program use and 

performance. In fiscal year 2016, the State AT Programs, achieved the following:

• 72,808 individuals participated in assistive technology device demonstrations; 

• 54,274 AT devices were provided on short-term loan to individuals with disabilities, 

service providers and agencies through the “try-before-you-buy” approach to AT; and 

• 79,223 AT devices were reutilized, saving consumers $31,673,585 by obtaining a gently 

used or refurbished AT device rather than a new one. 

Protection and Advocacy for Assistive Technology Grants 

Formula grants to protection and advocacy (P&A) systems, authorized under section 5 of the AT 

Act, support protection and advocacy services to assist individuals with disabilities of all ages in 

the acquisition, utilization, or maintenance of AT services or devices. Funds are distributed on a 

state population basis, with a minimum annual grant of $50,000. Territories must receive not less 

than $30,000 annually. Also, the Act requires a minimum award of $30,000 to the P&A system 

serving the American Indian consortium. 

National Activities Grants 

Section 6 of the AT Act provides authority for the provision of technical assistance and the 

development and implementation of data collection and reporting systems—through grants, 

contracts, or cooperative agreements awarded on a competitive basis—to individuals with 

disabilities of all ages, to AT state grant program grantees, and to protection and advocacy systems. 

The AT Act also requires the Secretary to make an award to renovate, update, and maintain a 

national public Internet site (https://at3center.net/).

Alternative Financing Competitive Grants for Assistive Technology

ACL awarded three new grants in FY 2017 in addition to the three grants issued in both FY 2015 

and FY 2016. The FY 2017 grants were used to establish new financial loan programs in North 

Carolina and South Dakota and to expand an existing program in Louisiana. Both the new AFP 

grants awarded in FY 2016 to Indiana and Oregon successfully launched their loan programs and 

are processing applications and making loans. The other four grantees that received awards to 

expand existing programs in Georgia, Minnesota, Nebraska and Pennsylvania are implementing 

activities as outlined in the grant proposals to expand and improve their alternative financing 

programs. 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

228 

Funding History:

Funding for the Assistive Technology Act Programs (including but not limited to AT Act 

Sections 4-6 authorized programs) over the past five years is as follows: 

FY 2015 ......................................................$31,000,000 

FY 2016 ......................................................$32,000,000 

FY 2017 Final .............................................$31,926,588 

FY 2018 Annualized CR .............................$31,782,688 

FY 2019 President’s Budget .......................$31,939,000 

Funding for the Alternative Financing Grant Competition over the past five years and budget 

year is as follows:

FY 2015 ......................................................$2,000,000 

FY 2016 ......................................................$2,000,000 

FY 2017 Final .............................................$1,995,412 

FY 2018 Annualized CR .............................$1,986,418 

FY 2019 President’s Budget ................................. $0 

Budget Request:

ACL’s FY 2019 request for Assistive Technology programs is $31,939,000, a reduction 

of -$1,830,000 below the FY 2018 Annualized Continuing Resolution level of $33,769,000. 

 

The request includes $26,503,381 for the AT State Grant program, maintaining the FY 2018 

President’s Budget level. These funds will be used to carry out the second year of their 3-year state 

plan. State plans must describe how the state intends to carry out its AT State Grant program to 

meet the AT needs of individuals with disabilities in the state, achieve the measurable goals 

required by the AT Act, and comply with all applicable statutory and regulatory requirements. 

The request also includes $4,441,000 for the Protection and Advocacy for Assistive Technology 

(PAAT) program, maintaining the FY 2018 President’s Budget. At this funding level, 26 states 

would receive $50,000, the minimum amount allowed by statute to carry out this program. 

Territories would each receive $30,000. Funds would assist individuals with disabilities of all ages 

in the acquisition, utilization, or maintenance of AT services or devices. 

The request would also provide $994,101 for National Activities, maintaining the FY 2018 

President’s Budget. The Act requires support for state training, technical assistance, data 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

229 

collection, and reporting assistance, and authorizes a one-time grant to provide national public 

awareness about AT, and support for AT research and development activities, which are all 

supported by competitively awarded grants. In FY 2019, funds would be used to provide state 

training and technical assistance, build out the AT Act informational website, and continue support 

for the AT Act data collection activities.

Alternative Financing Grant Competition for Assistive Technology 

The FY 2019 Budget Request is $0, a reduction of -$1,986,000 from the FY 2018 Annualized 

Continuing Resolution. The AT State grant program already includes financing activities that 

allow States to make decisions to best meet their own needs. The Budget eliminates the Alternative 

Financing Grant Competition, which is no longer authorized by the AT Act. 

Outcomes and Outputs Table:

ACL is establishing a new data collection system for the Assistive Technology program. Once 

complete, new performance measures will be established.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

230 

Grant Awards Tables:

Assistive Technology Act - State Grants

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 56 56 56 

Average Award $472,688 $470,555 $472,872

Range of Awards $125,497 -

$1.087,735 

$125,484 - 

$1,078,529 

$125,501 -

$1,091,837 

Assistive Technology Act - Protection and Advocacy Grants 

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 57 57 57 

Average Award $154,191 $153,489 $154,251 

Range of Awards $30,000 -

$426,000 

$30,000 -

$421,935 

$30,000 -

$425,090 

 Assistive Technology Act – National Grant Activities 

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 2 2 2 

Average 

Award $441,832 $441,832 $441,832 

Range of 

Awards

$309,983 

- 573,681 

$309,983 - 

$573,681 

$309,983 - 

$573,681 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

231 

Alternative Financing Grant Competition for Assistive Technology 

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number 

of Awards 3 3 - 

Average 

Award $664,700 $662,139 - 

Range of 

Awards

$664,700 -

$664,669 

$662,139 -

$662,139 - 

Assistive Technology 

(Dollars in thousands) 

Mechanism FY 2017

Final # 

FY 2017

Final $ 

FY 2018

Annualized

CR #

FY 2018

Annualized

CR $

FY 2019

President’s 

Budget #

FY 2019

President’s 

Budget $

Grants:

Formula

 

112 30,895 112 30,725 112 30,859 

New Discretionary 4 2,304 3 1,971 -- --

Continuations 1 574 2 888 2 895

Contracts 1 98 1 99 1 99 

Interagency Agreements -- -- -- -- -- --

Program Support /1 -- 51 -- 87 -- 87 

Total Resources -- 33,922 -- 33,769 -- 31,939 

1/Program Support – Includes funds for grant systems and review, and program reporting systems costs. 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

232 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

FY 2019 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Assistive Technology State Grants (CFDA 84.224A)

State/Territory FY 2017

Final/1

FY 2018

Annualized CR

FY 2019

President's 

Budget

FY 2019 +/- 

FY 2018

Alabama 448,391 446,162 448,189 2,027

Alaska 430,730 429,444 430,120 676

Arizona 613,368 611,600 614,305 2,705

Arkansas 472,682 470,940 472,353 1,413

California 1,087,735 1,078,529 1,091,837 13,308

Colorado 470,777 469,148 471,398 2,250

Connecticut 406,997 404,887 406,492 1,605

Delaware 414,807 413,498 414,243 745

District of Columbia 372,364 371,144 371,800 656

Florida 700,881 698,219 705,411 7,192

Georgia 599,386 596,767 600,581 3,814

Hawaii 448,986 447,480 448,381 901

Idaho 422,871 421,602 422,587 985

Illinois 607,444 602,787 607,417 4,630

Indiana 476,249 473,698 476,306 2,608

Iowa 446,781 445,013 446,473 1,460

Kansas 407,561 405,701 407,087 1,386

Kentucky 470,231 468,173 470,061 1,888

Louisiana 498,028 495,904 497,872 1,968

Maine 461,641 460,206 461,075 869

Maryland 496,829 494,389 496,795 2,406

Massachusetts 517,267 514,712 517,379 2,667

Michigan 658,461 655,077 658,765 3,688

Minnesota 489,604 487,471 489,714 2,243

Mississippi 392,040 390,168 391,581 1,413

Missouri 554,828 552,363 554,794 2,431

Montana 443,924 442,626 443,401 775

Nebraska 455,456 453,972 455,031 1,059

Nevada 416,818 415,459 416,856 1,397

New Hampshire 429,457 428,041 428,911 870
CONSUMER INFORMATION, ACCESS, AND OUTREACH

233 

PROGRAM/CFDA NUMBER: Assistive Technology State Grants (CFDA 84.224A)

State/Territory FY 2017

Final/1

FY 2018

Annualized CR

FY 2019

President's Budget

FY 2019 +/- 

FY 2018

New Jersey 487,507 484,167 487,533 3,366

New Mexico 443,853 442,186 443,301 1,115

New York 704,725 698,542 705,449 6,907

North Carolina 551,873 549,372 553,132 3,760

North Dakota 370,935 369,622 370,303 681

Ohio 565,396 561,577 565,818 4,241

Oklahoma 431,978 430,041 431,761 1,720

Oregon 425,297 423,818 425,593 1,775

Pennsylvania 693,639 689,368 693,993 4,625

Rhode Island 369,462 368,071 368,851 780

South Carolina 519,200 517,525 519,584 2,059

South Dakota 419,398 418,117 418,833 716

Tennessee 447,418 445,219 447,833 2,614

Texas 891,985 888,149 897,718 9,569

Utah 456,650 455,324 456,757 1,433

Vermont 406,845 405,539 406,177 638

Virginia 501,387 498,572 501,763 3,191

Washington 485,149 483,438 486,261 2,823

West Virginia 422,749 421,054 422,088 1,034

Wisconsin 469,626 467,215 469,542 2,327

Wyoming 363,011 361,722 362,347 625

Subtotal, States 25,540,677 25,423,818 25,551,852 128,034

American Samoa 125,516 125,484 125,501 17

Guam 126,537 126,548 126,602 54

Northern Mariana Islands 125,497 125,487 125,504 17

Puerto Rico 426,306 423,773 425,325 1,552

Virgin Islands 125,984 125,997 126,032 35

Subtotal, States and 

Territories 26,470,517 26,351,107 26,480,816 129,709

Undistributed 1/ $22,565 22,565 22,565 -

TOTAL 26,493,082 26,373,672 26,503,381 129,709

1/ Program Support -- Includes funds for grant systems and review, and program reporting systems costs. 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

234 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

FY 2019 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Assistive Technology Protection and Advocacy (CFDA 84.343)

State/Territory FY 2017

Final/1

FY 2018

Annualized CR

FY 2019

President's 

Budget

FY 2019 +/- 

FY 2018

Alabama 52,879 52,280 52,671 391

Alaska 50,000 50,000 50,000 -

Arizona 74,307 74,508 75,066 558

Arkansas 50,000 50,000 50,000 -

California 426,000 421,935 425,090 3,155

Colorado 59,382 59,560 60,006 446

Connecticut 50,000 50,000 50,000 -

Delaware 50,000 50,000 50,000 -

District of Columbia 50,000 50,000 50,000 -

Florida 220,605 221,581 223,239 1,658

Georgia 111,165 110,835 111,665 830

Hawaii 50,000 50,000 50,000 -

Idaho 50,000 50,000 50,000 - 

Illinois 139,951 137,615 138,645 1,030

Indiana 72,040 71,304 71,838 534

Iowa 50,000 50,000 50,000 -

Kansas 50,000 50,000 50,000 -

Kentucky 50,000 50,000 50,000 -

Louisiana 50,830 50,327 50,704 377

Maine 50,000 50,000 50,000 -

Maryland 65,366 64,676 65,160 484

Massachusetts 73,941 73,226 73,774 548

Michigan 107,984 106,728 107,527 799

Minnesota 59,741 59,339 59,783 444

Mississippi 50,000 50,000 50,000 -

Missouri 66,206 65,499 65,989 490

Montana 50,000 50,000 50,000 -

Nebraska 50,000 50,000 50,000 -

Nevada 50,000 50,000 50,000 -

New Hampshire 50,000 50,000 50,000 -
CONSUMER INFORMATION, ACCESS, AND OUTREACH

235 

PROGRAM/CFDA NUMBER: Assistive Technology Protection and Advocacy (CFDA 84.343)

State/Territory FY 2017

Final/1

FY 2018

Annualized CR

FY 2019

President's 

Budget

FY 2019 +/- 

FY 2018

New Jersey 97,487 96,152 96,872 720

New Mexico 50,000 50,000 50,000 -

New York 215,431 212,259 213,848 1,589

North Carolina 109,292 109,077 109,893 816

North Dakota 50,000 50,000 50,000 -

Ohio 126,385 124,853 125,787 934

Oklahoma 50,000 50,000 50,000 -

Oregon 50,000 50,000 50,000 -

Pennsylvania 139,325 137,429 138,457 1,028

Rhode Island 50,000 50,000 50,000 -

South Carolina 53,283 53,331 53,731 400

South Dakota 50,000 50,000 50,000 -

Tennessee 71,829 71,499 72,035 536

Texas 298,937 299,519 301,761 2,242

Utah 50,000 50,000 50,000 -

Vermont 50,000 50,000 50,000 -

Virginia 91,229 90,426 91,103 677

Washington 78,032 78,345 78,931 586

West Virginia 50,000 50,000 50,000 -

Wisconsin 62,807 62,120 62,585 465

Wyoming 50,000 50,000 50,000 -

Subtotal, States 4,224,434 4,204,423 4,226,160 21,737

American Samoa 30,000 30,000 30,000 -

Guam 30,000 30,000 30,000 -

Northern Mariana Islands 30,000 30,000 30,000 -

Puerto Rico 50,000 50,000 50,000 -

Virgin Islands 30,000 30,000 30,000 -

Subtotal, States and Territories 4,394,434 4,374,423 4,396,160 21,737

Native American Organizations 

1/ 30,000 30,000 30,000 - 

Undistributed 2/ $15,357 15,357 15,357 -

TOTAL 4,439,791 4,419,780 4,441,517 21,737

1/ The Tribal Organizations line reflects the funds provided to Native Americans in New Mexico.

2/ Program Support -- Includes funds for grant systems and review, and program reporting systems costs. 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

236 

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237 

Alzheimer’s Disease Initiative - Outreach Campaign

Service FY 2017

Final

FY 2018

Annualized 

CR

FY 2019

President’s

Budget

FY 2019

+/- 

FY 2018

Alzheimer's Disease Initiative - 

Outreach (PPHF) $4,200 $3,792 $0 -$3,792 

*BA is in thousands of dollars, FTE is a whole number.

Authorizing Legislation: Section 411 of the Older Americans Act of 1965, as amended and the 

Patient Protection and Affordable Care Act (ACA), Section 4002 [42 U.S.C. 300u-11] 

FY 2018 Authorization .................................................................... No specific amount authorized 

Allocation Method ............................................................................................................. Contracts

Program Description and Accomplishments:

In FY 2012, ACL received $4,000,000 in initial funding from the Prevention and Public Health 

Fund to begin a public awareness Alzheimer’s Disease Outreach Campaign. An estimated 

5.2 million individuals in the United States are living with Alzheimer’s disease and related 

dementias (ADRD), and that number is expected to increase by 40 percent by 2025.133 With the 

prevalence of this disease growing, this public awareness effort was designed to educate 

Americans who are at risk or who care for someone at risk of developing this disease. 

During the first year of the Campaign, a new website (alzheimers.gov) was launched and a variety 

of outreach materials were developed in partnership with the National Institute on Aging (NIA) 

and other stakeholders. Going forward, ACL and NIA will continue to utilize materials already 

developed to inform people caring for people with Alzheimer’s disease that there are federal, state, 

local, and nonprofit resources available to help them. The campaign highlights the alzheimers.gov 

website and deploys television, radio and print advertisements as well as search engine 

optimization and advertisements on specific web sites. 

 

133 Alzheimer’s Association. 2014 Alzheimer’s Disease Facts and Figures. Accessed April 14, 2014 at

http://www.alz.org/alzheimers_disease_facts_and_figures.asp . 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

238 

Funding History:

Funding for the Alzheimer’s Disease Initiative—Outreach Campaign over the last five years is as 

follows: 

FY 2015 ...................................................$4,200,000 

FY 2016... ...............................................$4,200,000 

FY 2017 ...................................................$4,200,000 

FY 2018 Annualized CR ..........................$3,792,000 

FY 2019 President’s Budget ..................................$0 

Budget Request: 

The FY 2019 Budget consolidates Alzheimer’s programs into a single grant making Program in 

ACL. The Alzheimer’s Disease Program will provide greater flexibility to States, territories, Tribes 

and localities to meet the specific needs of their communities.

Resource and Program Data: 

Alzheimer’s Disease Initiative –Outreach Campaign

(Dollars in thousands) 

Mechanism FY 2017

Final # 

FY 2017

Final $ 

FY 2018

Annualized

CR #

FY 2018

Annualized

CR $

FY 2019

President’s 

Budget #

FY 2019

President’s 

Budget $

Grants:

Formula -- -- -- -- -- --

New Discretionary -- -- -- -- -- --

Continuations -- -- -- -- -- --

Contracts 1 4,132 1 4,142 -- --

Interagency Agreements -- -- -- -- -- --

Program Support /1 -- 68 -- 58 -- --

Total Resources -- 4,200 -- 4,200 -- --

1/ Program Support -- Includes funds for overhead, grant systems and review costs, and information 

technology support costs.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

239 

Medicare Improvements for Patients and Providers Act Programs (MIPPA)

Service FY 2017/1

Final

FY 2018/2

Annualized 

CR

FY 2019/3

President’s

Budget

FY 2019 

+/- 

FY 2018

MIPPA Programs: $34,913 $37,500 $37,500 +$0 

Aging and Disability 

Resource Centers $4,655 $5,000 $5,000 +$0 

Area Agencies on Aging $6,983 $7,500 $7,500 +$0 

National Center for 

Benefits & Outreach 

Enrollment $11,172 $12,000 $12,000 +$0 

State Health Insurance 

Assistance Programs $12,103 $13,000 $13,000 +$0 

FTE 4 4 6 +2

*BA is in thousands of dollars, FTE is a whole number.

1/ Funding in FY 2017 reflects a 6.9% sequester.

2/ Funding for these programs ended in FY 2017. Funding shown, reflects request for mandatory funding.

3/ The FY 2019 Budget requests the discretionary MIPPA funding for these programs in FY 2019.

Authorizing Legislation: Medicare Improvements for Patients and Providers Act of 2008, Section 

119 (42 U.S.C. 1395b-3 note) as amended.

FY 2018 Authorization ......................................................................................................... Expired

Allocation Method ............................................ Competitive Grants/Formula Grants and Contracts

Program Description and Accomplishments:

The Medicare Improvements for Patients and Providers Act (MIPPA) programs provide funding 

to support targeted in-person enrollment assistance too hard to reach low-income and rural 

Medicare beneficiaries who qualify for either Medicare Savings Plans (MSP) or a Low Income 

Subsidy (LIS). MIPPA funds also support the National Center for Benefits Outreach and 

Enrollment. For beneficiaries who qualify, MSPs pay their Medicare Part A or/and Part B 

premiums and co-insurance costs and the LIS subsidizes their Medicare prescription drug costs, 

including premiums, deductibles and drug co-pays. Beneficiaries are eligible for these programs 

if they have minimal assets and incomes below 135 percent of the Federal Poverty Level. 

 

Grants to states provide support for beneficiary education and enrollment assistance so that 

Medicare beneficiaries can access MSP and LIS programs that they qualify for but are not yet 

enrolled in. MIPPA funding is not used to support the day-day services of AAAs, ADRCs and 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

240 

SHIP. Instead, it supports additional counseling that goes beyond the assistance what would 

normally be provided, both to identify older Americans and those with disabilities in need, and to

provide much more intensive counseling to these specific populations. In FY 2016, MIPPA State 

Grantees conducted over 22,000 public and media events, served over 2.5 million people, and 

completed over 164,000 total applications for LIS and MSP benefits combined. 

 

The National Center for Benefits Outreach and Enrollment coordinates efforts to inform older 

adults and beneficiaries with disabilities about the benefits available under Federal and state 

programs, with an emphasis on providing information on the LIS and MSP which help Medicare 

beneficiaries pay for their Medicare coverage. The NCBOE also supports a nationwide network of 

59 local Benefit Enrollment Centers which provide low-income benefits information and 

enrollment assistance. NCBOE accomplishes its mission by providing tools, resources, and 

technology that help local, state, and regional organizations find, counsel, and assist seniors and 

younger adults with disabilities in applying for and enrolling in the benefits for which they may 

be eligible. It also works to generate and disseminate new knowledge about best practices and 

cost-effective strategies for benefits outreach and enrollment. In FY 2016, the NCBOE and 

Benefits Enrollment Centers directly assisted with over 134,000 applications for the LIS, MSP, 

and other low income benefits. 

 

Funding History:

In each of fiscal years 2015 through 2018, MIPPA was funded through mandatory appropriations. 

Funding for MIPPA over the past five years is as follows:

FY 2015 .....................................$25,000,000 

FY 2016 ...................................$37,500,000 

FY 2017 1/ .................................$34,912,500 

FY 2018 Annualized CR 2/....... $37,500,000 

FY 2019 President’s Budget 3/ .$37,500,000 

__________________ 

1/ Reflects a 6.9% sequester.

2/ Reflects request for mandatory funding.

3/ Reflects requests for discretionary funding beginning in FY 2019.

Budget Request:

The FY 2019 Budget shifts mandatory funding for programs funded by the Medicare Access and 

Chip Reauthorization Act (MACRA) to discretionary funding. The Budget requests $37,500,000 

for these programs to be included in ACL’s annual discretionary budget beginning in FY 2019. 

The Budget eliminates discretionary funding for the State Health Insurance Assistance Program, 

but maintains funding to provide one-on-one counseling specifically targeting hard-to-reach lowincome and rural beneficiaries who qualify for either the Medicare Savings Plans (MSP) or the 

Social Security Low-Income Subsidy (LIS). Continued funding is needed so that the beneficiaries 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

241 

who are eligible for these programs do not lose the in-depth assistance with enrolling in these 

programs that MIPPA dollars support. 

 

To the extent that these individuals fail to enroll, each beneficiary would lose not only an estimated 

$4,000 annually in LIS savings (per SSA estimates) and/or $411 per month in Medicare Part A 

Premium Savings and $121.80 per month in Part B Premiums through MSP, but also additional 

assistance with Medicare Part A and B copayments and deductibles and benefits from other 

programs to which they qualify. 

 

Grant Awards Tables:

MIPPA – Aging Disability and Resource Centers

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 49 49 49 

Average Award $90,875 $96,118 $91,420 

Range of Awards $7,885 -

$372,352 

$8,340 -

393,837 

$7,922 -

$374,586 

MIPPA – Area Agencies on Aging/1

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 49 49 49 

Average Award $130,270 $137,787 $131,052 

Range of Awards $7,938 -

$522,887 

$8,396 -

$553,058 

$7,986 -

$553,058 

1/Awards to Tribes were not included in the calculation of the average award, or the range of awards. 

Awards to tribes are $1,000 per Tribe.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

242 

MIPPA – National Center for Benefits Outreach and Enrollment 

Awards FY 2017 

Final/1

FY 2018 

Annualized 

CR

FY 2019 

President’s 

Budget

Number of 

Awards 1 1 1 

Average 

Award $10,732,645 $11,357,868 $11,357,868 

Range of 

Awards $10,732,645 $11,357,868 $11,357,868 

MIPPA – State Health Insurance Assistance Programs

Awards FY 2017 

Final

FY 2018 

Annualized 

CR

FY 2019 

President's 

Budget

Number of 

Awards 51 51 51 

Average Award $227,506 $240,633 $240,633 

Range of Awards $28,833 -

$946,016 

$30,497 -

$1,000,601 

$30,497 -

$1,000,601 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

243 

Resource and Program Data:

Medicare Improvements for Patients and Providers Act Programs 

(Dollars in Thousands)

Mechanism FY 2017 

Final

FY 2017 

Final

FY 2018

Annualized 

CR

FY 2018

Annualized 

CR

FY 2019

President’s 

Budget

FY 2019

President’s 

Budget

Grants:

Formula 423 22,709 423 24,099 423 22,845 

New Discretionary 1 10,733 -- -- -- -- 

Continuations -- -- 1 11,358 1 10,766 

Contracts 1 133 2 844 2 2,496 

Interagency 

Agreements -- -- -- -- -- -- 

Program Support /1 -- 1,338 -- 1,199 -- 1,394 

Total Resources 425 34,913 426 37,500 426 37,500 

1/ Note the “New Grants” in FY 2018 and FY 2019 are supplemental actions to the single continuing grant. 

2/ Program Support -- Reflects the amount used from the MIPPA appropriation for staff and overhead, support 

contracts, training, technical assistance, data systems, grant systems, and grants review costs.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

244 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2019 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: MIPPA - ADRC (CFDA 93.071) 

State/Territory FY 2017

Final

FY 2018

Annualized CR

FY 2019

President's 

Budget

FY 2019 +/- 

FY 2018

Alabama 89,024 94,161 89,558 (4,603)

Alaska 7,885 8,340 7,932 (408)

Arizona 105,137 111,203 105,768 (5,436)

Arkansas 54,578 57,727 54,905 (2,822)

California 159,888 169,114 160,847 (8,266)

Colorado 73,197 77,420 73,636 (3,784)

Connecticut 57,922 61,264 58,270 (2,995)

Delaware 16,708 17,672 16,808 (864)

District of Columbia 8,144 8,614 8,193 (421)

Florida 372,352 393,837 374,586 (19,251)

Georgia 140,726 148,846 141,570 (7,276)

Hawaii 22,642 23,948 22,778 (1,171)

Idaho 26,219 27,732 26,376 (1,356)

Illinois 190,389 201,374 191,531 (9,843)

Indiana 106,062 112,182 106,698 (5,483)

Iowa 52,760 55,804 53,077 (2,728)

Kansas 44,893 47,483 45,162 (2,321)

Kentucky 79,321 83,898 79,797 (4,101)

Louisiana 73,346 77,578 73,786 (3,792)

Maine 28,226 29,855 28,395 (1,459)

Maryland 86,142 91,112 86,659 (4,454)

Massachusetts 112,400 118,885 113,074 (5,811)

Michigan 162,876 172,274 163,853 (8,421)

Minnesota 84,450 89,323 84,957 (4,366)

Mississippi 51,479 54,449 51,788 (2,661)

Missouri 6,450 6,822 6,489 (333)

Montana 13,308 14,076 13,388 (688)

Nebraska 28,960 30,631 29,134 (1,497)

Nevada 42,121 44,551 42,374 (2,178)

New Hampshire 24,653 26,075 24,801 (1,275)
CONSUMER INFORMATION, ACCESS, AND OUTREACH

245 

PROGRAM/CFDA NUMBER: MIPPA – ADRC (CFDA 93.071)

State/Territory FY 2017

Final

FY 2018

Annualized CR

FY 2019

President's Budget

FY 2019 +/-

FY 2018

New Jersey 137,507 145,441 138,332 (7,109)

New Mexico 34,544 36,537 34,751 (1,786)

New York 307,856 325,619 309,703 (15,916)

North Carolina 103,373 109,338 103,993 (5,344)

North Dakota - - - -

Ohio 198,381 209,828 199,571 (10,256)

Oklahoma 62,389 65,989 62,763 (3,226)

Oregon 69,999 74,038 70,419 (3,619)

Pennsylvania 232,747 246,177 234,143 (12,033)

Rhode Island 18,693 19,772 18,805 (966)

South Carolina 87,143 92,171 87,666 (4,505)

South Dakota 14,446 15,280 14,533 (747)

Tennessee 113,771 120,336 114,454 (5,882)

Texas 336,977 356,421 338,999 (17,422)

Utah 29,981 31,711 30,161 (1,550)

Vermont 12,159 12,861 12,232 (629)

Virginia 124,782 131,982 125,531 (6,451)

Washington 110,586 116,967 111,250 (5,717)

West Virginia 38,189 40,393 38,418 (1,974)

Wisconsin 97,087 102,689 97,670 (5,019)

Wyoming - - - -

Subtotal, States 4,452,868 4,709,798 4,479,585 (230,213)

Undistributed 1/ $202,132 $290,202 $520,415 230,213

TOTAL/2 4,655,000 5,000,000 5,000,000 -

1/ Program Management -- Reflects the amount used from the MIPPA appropriation for staff and overhead, support contracts, 

training, technical assistance, data systems, grant systems, and grants review costs.

2/Totals in FY 2017 include $1,589,846 in carryover funding. 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

246 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2019 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: MIPPA - AAA (CFDA 93.071) 

State/Territory FY 2017

Final

FY 2018

Annualized CR

FY 2019

President's 

Budget

FY 2019 +/- 

FY 2018

Alabama 138,689 146,691 139,521 (7,170)

Alaska 16,781 17,749 16,882 (868)

Arizona 113,111 119,638 113,790 (5,848)

Arkansas 128,140 135,534 128,909 (6,625)

California 522,887 553,058 526,024 (27,033)

Colorado 68,815 72,786 69,228 (3,558)

Connecticut 49,786 52,659 50,085 (2,574)

Delaware 22,510 23,809 22,645 (1,164)

District of Columbia 7,938 8,396 7,986 (410)

Florida 387,047 409,380 389,369 (20,010)

Georgia 215,511 227,946 216,804 (11,142)

Hawaii 36,413 38,514 36,631 (1,883)

Idaho 49,953 52,835 50,253 (2,583)

Illinois 217,375 229,918 218,679 (11,238)

Indiana 150,896 159,603 151,801 (7,801)

Iowa 93,613 99,014 94,175 (4,840)

Kansas 65,872 69,673 66,267 (3,406)

Kentucky 165,502 175,051 166,495 (8,556)

Louisiana 115,680 122,355 116,374 (5,981)

Maine 55,370 58,565 55,702 (2,863)

Maryland 73,319 77,550 73,759 (3,791)

Massachusetts 106,843 113,008 107,484 (5,524)

Michigan 196,252 207,576 197,430 (10,146)

Minnesota 115,678 122,353 116,372 (5,981)

Mississippi 118,170 124,988 118,879 (6,109)

Missouri 157,914 167,026 158,861 (8,164)

Montana 37,714 39,890 37,940 (1,950)

Nebraska 46,650 49,342 46,930 (2,412)

Nevada 44,473 47,039 44,740 (2,299)

New Hampshire 35,142 37,170 35,353 (1,817)
CONSUMER INFORMATION, ACCESS, AND OUTREACH

247 

PROGRAM/CFDA NUMBER: MIPPA - AAA (CFDA 93.071) 

State/Territory FY 2017

Final

FY 2018

Annualized CR

FY 2019

President's 

Budget

FY 2019 +/- 

FY 2018

New Jersey 104,327 110,347 104,953 (5,394)

New Mexico 56,165 59,406 56,502 (2,904)

New York 374,681 396,300 376,929 (19,371)

North Carolina 272,711 288,446 274,347 (14,099)

North Dakota - - - -

Ohio 232,358 245,765 233,752 (12,013)

Oklahoma 99,932 105,698 100,532 (5,166)

Oregon 86,476 91,466 86,995 (4,471)

Pennsylvania 266,181 281,540 267,778 (13,762)

Rhode Island 15,932 16,851 16,028 (824)

South Carolina 138,802 146,811 139,635 (7,176)

South Dakota 26,247 27,761 26,404 (1,357)

Tennessee 190,924 201,940 192,070 (9,871)

Texas 424,461 448,952 427,008 (21,945)

Utah 39,827 42,125 40,066 (2,059)

Vermont 26,313 27,831 26,471 (1,360)

Virginia 161,159 170,458 162,126 (8,332)

Washington 107,908 114,134 108,555 (5,579)

West Virginia 77,877 82,371 78,344 (4,026)

Wisconsin 126,922 134,245 127,684 (6,562)

Wyoming - - - -

Subtotal, States 6,383,247 6,751,560 6,421,546 (330,014)

Tribes 270,000 270,000 270,000 -

Subtotal, States and Territories 6,653,247 7,021,560 6,691,546 (330,014)

Undistributed $329,753 $478,440 $808,454 330,014

TOTAL/2 6,983,000 7,500,000 7,500,000 -

1/ Program Management -- Reflects the amount used from the MIPPA appropriation for staff and overhead, support contracts, 

training, technical assistance, data systems, grant systems, and grants review costs.

2/Totals in FY 2017 include carryover funding of $1,460,154 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

248 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2018 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: MIPPA - SHIP (CFDA 93.071) 

State/Territory FY 2017

Final

FY 2018

Annualized CR

FY 2019

President's Budget

FY 2019 +/- 

FY 2018

Alabama 250,631 265,092 265,092 -

Alaska 30,311 32,060 32,060 -

Arizona 204,515 216,316 216,316 -

Arkansas 231,519 244,878 244,878 -

California 946,016 1,000,601 1,000,601 -

Colorado 124,379 131,556 131,556 -

Connecticut 90,048 95,244 95,244 -

Delaware 40,671 43,018 43,018 -

District of Columbia 14,366 15,195 15,195 -

Florida 700,047 740,440 740,440 -

Georgia 389,399 411,867 411,867 -

Hawaii 65,810 69,607 69,607 -

Idaho 90,206 95,411 95,411 -

Illinois 392,939 415,612 415,612 -

Indiana 272,683 288,417 288,417 -

Iowa 169,031 178,784 178,784 -

Kansas 118,955 125,819 125,819 -

Kentucky 298,924 316,172 316,172 -

Louisiana 209,110 221,176 221,176 -

Maine 99,967 105,735 105,735 - 

Maryland 132,590 140,240 140,240 -

Massachusetts 193,275 204,427 204,427 -

Michigan 354,681 375,146 375,146 -

Minnesota 208,972 221,030 221,030 -

Mississippi 213,426 225,741 225,741 -

Missouri 285,302 301,764 301,764 -

Montana 68,092 72,021 72,021 -

Nebraska 84,236 89,096 89,096 -

Nevada 80,418 85,058 85,058 - 

New Hampshire 63,458 67,120 67,120 -
CONSUMER INFORMATION, ACCESS, AND OUTREACH

249 

PROGRAM/CFDA NUMBER: MIPPA -SHIP (CFDA 93.071) 

State/Territory FY 2017

Final

FY 2018

Annualized CR

FY 2019

President's 

Budget

FY 2019 +/- 

FY 2018

New Jersey 188,809 199,703 199,703 -

New Mexico 101,472 107,327 107,327 -

New York 677,726 716,831 716,831 -

North Carolina 492,793 521,227 521,227 -

North Dakota 33,120 35,031 35,031 -

Ohio 420,005 444,239 444,239 -

Oklahoma 180,514 190,930 190,930 -

Oregon 156,210 165,223 165,223 -

Pennsylvania 481,215 508,981 508,981 - 

Rhode Island 28,833 30,497 30,497 - 

South Carolina 250,857 265,331 265,331 -

South Dakota 47,386 50,120 50,120 -

Tennessee 344,983 364,889 364,889 -

Texas 767,401 811,680 811,680 -

Utah 71,957 76,109 76,109 -

Vermont 47,502 50,243 50,243 -

Virginia 291,211 308,014 308,014 -

Washington 194,989 206,240 206,240 -

West Virginia 140,652 148,768 148,768 - 

Wisconsin 229,242 242,469 242,469 -

Wyoming 31,951 33,795 33,795 -

Subtotal, States 11,602,805 12,272,287 12,272,287 -

Undistributed 1/ $500,195 $727,713 $727,713 -

TOTAL 500,195 727,713 727,713 -

1/ Program Management -- Reflects the amount used from the MIPPA appropriation for staff and overhead, support contracts, 

training, technical assistance, data systems, grant systems, and grants review costs.
250

CONSUMER INFORMATION, ACCESS, AND OUTREACH 

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251 

Program Administration

Service FY 2017

Final

FY 2018

Annualized 

CR

FY 2019

President’s 

Budget 

FY 2019

+/- 

FY 2018

Program Administration $39,971 $39,791 $37,987 -$1,804

FTE/1 170 155 123 -32

*BA is in thousands of dollars, FTE is a whole number.

1/ FTE numbers above for Program Administration only reflect those FTE funded from the Program Administration 

budget line. Other sources of funding for ACL FTE include staff charged to reimbursable and mandatory funding 

sources.

Authorizing Legislation: Older Americans Act (OAA), the Developmental Disabilities Assistance 

and Bill of Rights Act (DD Act), the Help America Vote Act (HAVA), the Assistive Technology 

(AT) Act, the Rehabilitation Act, the Public Health Services Act (PHSA), the Elder Justice Act 

(EJA),and the Medicare Improvements for Patients and Providers Act (MIPPA). 

 

FY 2018 Authorization ............................................................................... See Program Narratives 

Allocation Method ....................................................................................... Direct Federal/Contract

Program Description and Accomplishments:

ACL’s mission is to assist seniors and people of all ages with disabilities to live independently and 

to be able to fully participate in their communities. Program Administration funds the direction 

and support of ACL programs established under the Older Americans Act (OAA), Developmental 

Disabilities Assistance and Bill of Rights Act (DD Act), Rehabilitation Act, Help America Vote 

Act (HAVA), Assistive Technology (AT) Act, Public Health Services Act (PHSA), Elder Justice 

Act, and the Medicare Improvements for Patients and Providers Act (MIPPA). The majority of 

these funds cover salaries and benefits, rent and security, and external shared services, all of which 

are relatively fixed in the short term. ACL’s appropriation also includes language that allows 

Program Administration funds to be used for Department-wide coordination of policy and program 

activities that assist individuals with disabilities (consistent with the role previously performed by 

the Office of Disability), as ACL’s Principal Deputy Administrator also serves as the Secretary’s 

Senior Advisor on Disability Policy.

 

In FY 2019, Program Administration funding will support 123 of ACL’s 155 FTE in both central 

office and in ACL’s regional offices. Other sources of funding for ACL FTE include staff 

supported by reimbursable and mandatory funding sources such as the Health Care Fraud and 

Abuse Control account, Medicare Improvements for Patients and Providers Act (MIPPA) 

activities, and funding received from the Centers for Medicare & Medicaid Services for activities 
PROGRAM ADMINISTRATION

252 

performed on behalf of dual Medicare/Medicaid beneficiaries. ACL also supports a limited number 

of FTE from various program line items. 

 

Funding History:

Funding for ACL Program Administration over the past five years is as follows:

 

FY 2015 /1 $37,709,000 184.0 FTE

FY 2016 $40,063,000 170.6 FTE 

FY 2017 Final 2/ $39,971,000 170.1 FTE

FY 2018 Continuing Resolution $39,791,000 155.0 FTE

FY 2019 President’s Budget $37,987,000 122.6 FTE

1/Funding and FTEs for FY 2015 reflect annualized dollars and FTE actually transferred to ACL for program 

administration, based on a determination order between the Department of Education and ACL. 

2/Reflects FY 2017 Operating level (Appropriation of $40,063,000 less Secretary’s transfer of $92,000).

Budget Request:

ACL’s request includes $37,987,000 for Program Administration, a decrease of -$1.8 million and 

-32 FTE below the FY 2018 Annualized Continuing Resolution. The FTE reduction reflects the 

transfer of thirty-two National Institute on Disability, Independent Living and Rehabilitation 

Research (NIDILRR) staff to the National Institutes of Health (NIH); however, the requested 

funding level is not reduced to reflect this transfer and includes the approximately $4 million 

attributable to these FTE. 
253 

Section Break
SUPPLEMENTARY TABLES

254 

Object Classification Table - Direct

Administration for Community Living

(Dollars in Thousands) 

Personnel compensation: FY 2017

Final

FY 2018

Annualized 

CR

FY 2019

President’s 

Budget

FY 2019 +/-

FY 2018

Full-time permanent (11.1) 21,048 20,551 18,089 (2,461)

Other than full-time permanent (11.3) 316 320 322 2

Other personnel compensation (11.5) 283 287 288 1

Military personnel (11.7) - - - - 

Special personnel services payments (11.8) - - - - 

Subtotal personnel compensation 21,647 21,158 18,699 (2,458)

Civilian benefits (12.1) 6,478 6,150 5,186 (964)

Military benefits (12.2) - - - - 

Benefits to former personnel (13.0) - - - - 

Total Pay Costs 28,125 27,308 23,885 (3,423)

Travel and transportation of persons (21.0) 380 355 308 (47)

Transportation of things (22.0) 1 1 1 (0)

Rental payments to GSA (23.1) 2,359 2,609 2,653 44

Rental payments to Others (23.2) - - - - 

Communication, utilities, and misc. charges (23.3) 362 338 293 (46)

Printing and reproduction (24.0) 111 102 90 (12)

Advisory and assistance services (25.1) 21,276 21,214 25,210 3,995

Other services (25.2) 164 163 156 (8)

Purchase of goods and services from

government accounts (25.3) 11,318 11,285 10,750 (534)

Operation and maintenance of facilities (25.4) - - - - 

Research and Development Contracts (25.5) - - - - 

Medical care (25.6) - - - - 
SUPPLEMENTARY TABLES

255 

Other Contractual Services: FY 2017

Final

FY 2018

Annualized 

CR

FY 2019

President’s 

Budget

FY 2019 

+/- FY 

2018

Operation and maintenance of equipment (25.7) 10 10 9 (0)

Subsistence and support of persons (25.8) - - - - 

Subtotal Other Contractual Services 32,767 32,672 36,125 3,453

Supplies and materials (26.0) 49 48 46 (2)

Equipment (31.0) 49 48 46 (2)

Land and Structures (32.0) - - - - 

Investments and Loans (33.0) - - - - 

Grants, subsidies, and contributions (41.0)

1,847,854 1,842,485 1,755,234 (87,251)

Interest and dividends (43.0) - - - - 

Refunds (44.0) - - - - 

Total Non-Pay Costs 1,883,931 1,878,660 1,794,796 (83,864)

Total Budget Authority by Object Class 1,912,056 1,905,968 1,818,681 (87,287)
SUPPLEMENTARY TABLES

256 

Salaries and Expenses – Direct

Administration for Community Living

(Dollars in Thousands) 

Personnel compensation FY 2017

Final

FY 2018

Annualized

CR

FY 2019 

President’s 

Budget

FY 2019

+/- FY 2018

Full-time permanent (11.1) 21,048 20,551 18,089 (2,461)

Other than full-time permanent (11.3) 316 320 322 2 

Other personnel compensation (11.5) 283 287 288 1 

Military personnel (11.7) - - - - 

Special personnel services payments (11.8) - - - - 

 Subtotal personnel compensation 21,647 21,158 18,699 (2,458)

Civilian benefits (12.1) 6,478 6,150 5,186 (964)

Military benefits (12.2) - - - - 

Benefits to former personnel (13.0) - - - - 

Total Pay Costs 28,125 27,308 23,885 (3,423)

Travel and transportation of persons (21.0) 380 355 308 (47)

Transportation of things (22.0) 1 1 1 (0)

Rental payments to GSA (23.1) 2,359 2,609 2,653 44

Rental payments to Others (23.2)

Communication, utilities, and misc. charges (23.3) 362 338 293 (46)

Printing and reproduction (24.0) 111 102 90 (12)

Other Contractual Services:

Advisory and assistance services (25.1) 21,276 21,214 25,210 3,995

Other services (25.2) 164 163 156 (8)

Purchase of goods and services from

government accounts (25.3) 11,318 11,285 10,750 (534)

Operation and maintenance of facilities (25.4) - - - - 

Research and Development Contracts (25.5) - - - - 

Medical care (25.6) - - - - 

Operation and maintenance of equipment (25.7) 10 10 9 (0)

Subsistence and support of persons (25.8) - - - - 

Subtotal Other Contractual Services 32,767 32,672 36,125 3,453
SUPPLEMENTARY TABLES

257 

Personnel compensation FY 2017

Final

FY 2018

Annualized

CR

FY 2019 

President’s 

Budget

FY 2019

+/- FY 2018

Supplies and materials (26.0) 49 48 46 (2)

Total Non-Pay Costs 36,028 36,126 39,516 3,390

Total Salary and Expense 64,153 63,434 63,401 (33)

Direct FTE 182 170 145 (25)

Detail of Full Time Equivalents (FTE)

Administration for Community Living 

Immediate Office of the 

Administrator

2017 

Est. 

Civilian

2017 

Est. 

Military

2017 

Est. 

Total

208 Est. 

Civilian

2018 

Est. 

Military

2018 

Est. 

Total

2019 

Actual 

Civilian

2019 

Actual 

Military

2019 

Actual 

Total

Direct: 18 - 18 16 - 16 15 - 15

Reimbursable: 0 - 0 0 - 0 0 - 0

Total: 18 0 18 16 0 16 15 0 15

Administration on Aging 2017 

Est. 

Civilian

2017 

Est. 

Military

2017 

Est. 

Total

2018 

Est. 

Civilian

2018 

Est. 

Military

2018 

Est. 

Total

2019 

Actual 

Civilian

2019 

Actual 

Military

2019 

Actual 

Total

Direct: 21 - 21 21 - 21 21 - 21

Reimbursable: 3 - 3 3 - 3 3 - 3

Total: 24 0 24 24 0 24 24 0 24

Administration on 

Disabilities

2017 

Est. 

Civilian

2017 

Est. 

Military

2017 

Est. 

Total

2018 

Est. 

Civilian

2018 

Est. 

Military

2018 

Est. 

Total

2019 

Actual 

Civilian

2019 

Actual 

Military

2019 

Actual 

Total

Direct: 24 - 24 23 - 23 23 - 23

Reimbursable: 2 - 2 2 - 2 2 - 2

Total: 26 0 26 25 0 25 25 0 25

Center for Policy and 

Evaluation

2017 

Est. 

Civilian

2017 

Est. 

Military

2017 

Est. 

Total

2018 

Est. 

Civilian

2018 

Est. 

Military

2018 

Est. 

Total

2019 

Actual 

Civilian

2019 

Actual 

Military

2019 

Actual 

Total

Direct: 9 - 9 9 - 9 9 - 9

Reimbursable: 5 - 5 6 - 6 7 - 7

Total: 14 0 14 15 0 15 16 0 16
SUPPLEMENTARY TABLES

258 

Center for 2017 Est. 

Civilian

2017 

Est. 

Military

2017 Est. 

Total

2018 Est. 

Civilian

2018 Est. 

Military

2018 

Est. 

Total

2019 

Actual 

Civilian

2019 

Actual 

Military

2019 

Actual 

Total

Direct: 37 - 37 30 - 30 30 - 30

Reimbursable: 0 - 0 0 - 0 0 - 0

Total: 37 0 37 30 0 30 30 0 30

Center for Integrated

Programs

2017 

Est. 

Civilian

2017 

Est. 

Military

2017 

Est. 

Total

2018 

Est. 

Civilian

2018 

Est. 

Military

2018 

Est. 

Total

2019 

Actual 

Civilian

2019 

Actual 

Military

2019 

Actual 

Total

Direct: 5 - 5 4 - 4 10 - 10

Reimbursable: 16 - 16 17 - 17 10 - 10

Total: 21 0 21 21 0 21 20 0 20

Office of Regional 

Operations

2017 

Est. 

Civilian

2017 

Est. 

Military

2017 

Est. 

Total

2018 

Est. 

Civilian

2018 

Est. 

Military

2018 

Est. 

Total

2019 

Actual 

Civilian

2019 

Actual 

Military

2019 

Actual 

Total

Direct: 26 - 26 25 - 25 25 - 25

Reimbursable: 0 - 0 0 - 0 0 - 0

Total: 26 0 26 25 0 25 25 0 25

National Institute on 

Disability, Independent 

Living, and Rehabilitation 

Research.

2017 

Est. 

Civilian

2017 

Est. 

Military

2017 

Est. 

Total

2018 

Est. 

Civilian

2018 

Est. 

Military

2018 

Est. 

Total

2019 

Actual 

Civilian

2019 

Actual 

Military

2019 

Actual 

Total

Direct: 30 - 30 31 - 31 0 - 0

Reimbursable: 0 - 0 0 - 0 0 - 0

Total: 30 0 30 31 0 31 0 0 0

National Institute on 

Disability, Independent 

Living, and Rehabilitation 

Research.

2017 

Est. 

Civilian

2017 

Est. 

Military

2017 

Est. 

Total

2018 

Est. 

Civilian

2018 

Est. 

Military

2018 

Est. 

Total

2019 

Actual 

Civilian

2019 

Actual 

Military

2019 

Actual 

Total

OPDIV FTE Total 196 - 196 187 - 187 155 - 155

Average GS Grade FY 2015 - - - - - - 12.8 - -

Average GS Grade FY 2016 - - - - - - 13.6 - -

Average GS Grade FY 2017 - - - - - - 13.1 - -

Average GS Grade FY 2018 - - - - - - 13.1 - -

Average GS Grade FY 2019 - - - - - - 13.0 - -

Management 

and Budget
SUPPLEMENTARY TABLES

259 

Detail of Positions

Administration for Community Living

-GS Level 2017 Final 2018 Annualized CR 2019 President’s Budget

Executive level I 0 0 0

Executive level II 0 0 0

Executive level III 0 0 0

Executive level IV 1 1 1

Executive level V 0 0 0

 Subtotal 1 1 1

 Total - Exec. Salaries (Excludes Benefits) $ 155,500 $ 155,500 $ 155,500

Executive Salary 5 7 6

 Subtotal 5 7 6

 Total - ES Salary (Excludes Benefits) $ 838,867 $ 1,152,276 $ 986,941

GS-15 31 29 23

GS-14 52 51 33

GS-13 60 57 55

GS-12 22 23 22

GS-11 13 11 8 

GS-10 1 1 1 

GS-9 3 3 3

GS-8 0 0 0

GS-7 3 3 2

GS-6 1 1 1

GS-5 0 0 0

GS-4 0 0 0

GS-3 0 0 0

GS-2 0 0 0

GS-1 0 0 0 

 Subtotal 186 179 148

 Total - GS Salary (Excludes Benefits). $21,448.871 $20,967,240 $16, 678,616

Average ES salary $167,773 $164,611 $164,490

Average GS grade 13.1 13.1 13.0

Average GS salary $115,317 $117,135 $112,693
SUPPLEMENTARY TABLES

260 

FTEs Funded by P.L. 111-56 (CR) and Any Supplementals

Administration for Community Living

(Program Level in Millions)

Pre-existing programs funded by ACA 

(Mandatory)

Section FY 

2010

Total

FY 

2010

FTEs

FY 

2010

CEs

FY 2011 

Total

FY 

2011 

FTEs

FY 

2011

CEs

FY 2012 

Total

FY 

2012 

FTEs

FY 

2012 

CEs

National Clearinghouse for Long-Term Care 

Information

Title VIII $ - 0 0 $ 3,000 0 0 $ 3,000 1 0

Medicare Improvements for Patients & Providers 

Act Programs

Section 3306 $ - 0 0 $ - 0 0 $ - 0 0

New programs authorized and funded by ACA 

(Mandatory)

Section FY 

2010

Total

FY 

2010

FTEs

FY 

2010

CEs

FY 2011 

Total

FY 

2011 

FTEs

FY 

2011

CEs

FY 2012 

Total

FY 

2012 

FTEs

FY 

2012 

CEs

Aging and Disability Resource Centers Section 2405 $ - 0 0 $10,000 3 0 $10,000 4 0

New programs funded from the PPHF under 

ACA (Discretionary)

Section FY 

2010

Total

FY 

2010

FTEs

FY 

2010

CEs

FY 2011 

Total

FY 

2011 

FTEs

FY 

2011

CEs

FY 2012 

Total

FY 

2012 

FTEs

FY 

2012 

CEs

Adult Protective Services (Prevention & Public 

Health Fund)

Section 4002 $ - 0 0 $ - 0 0 $ 6,000 0 0

Chronic Disease Self-Management Education 

(PPHF)

Section 4002 $ - 0 0 $ - 0 0 $ 10,000 0 0

Alzheimer's Disease Initiative--Supportive Services 

(PPHF)

Section 4002 $ - 0 0 $ - 0 0 $ - 0 0

Alzheimer's Disease Initiative--Communications 

(PPHF)

Section 4002 $ - 0 0 $ - 0 0 $ 4,000 0 0

Falls Prevention--(PPHF) Section 4002 $ - 0 0 $ - 0 0 $ - 0 0

Programs authorized by ACA but funded by 

other sources (Discretionary) 

Section FY 

2010

Total

FY 

2010

FTEs

FY 

2010

CEs

FY 2011 

Total

FY 

2011 

FTEs

FY 

2011

CEs

FY 2012 

Total

FY 

2012 

FTEs

FY 

2012 

CEs

Elder Justice Initiative/Adult Protective Services Subtitle H, 

Sections 6701-

6703

$ - 0 0 $ - 0 0 $ - 0 0

Pre-existing programs funded by ACA 

(Mandatory)

Section FY 2013

Total

FY 201

FTEs

FY 2013

CEs

FY 2014 

Total

FY 2014

CEs 

FTEs

FY 

2014

CEs

FY 2015 

Total

FY 

2015 

FTEs

FY 

2015 

CEs

National Clearinghouse for Long-Term Care 

Information

Title VIII $ 86 0 0 $ - 0 0 $ - 0 0

Medicare Improvements for Patients & Providers 

Act Programs

Section 3306 $ 25,000 0 0 $ - 0 0 $ - 0 0

New programs authorized and funded by ACA 

(Mandatory)

Section FY 2013

Total

FY 201

FTEs

FY 2013

CEs

FY 2014 

Total

FY 2014

CEs 

FTEs

FY 

2014

CEs

FY 2015 

Total

FY 

2015 

FTEs

FY 

2015 

CEs

Aging and Disability Resource Centers Section 2405 $ 9,490 4 0 $ 9,280 3 0 $ - 0 0
SUPPLEMENTARY TABLES

261 

FTEs Funded by P.L. 111-56 (CR) and Any Supplementals - Continued

Administration for Community Living

(Program Level in Millions)

New programs funded from the PPHF under 

ACA (Discretionary)

Section FY 2013

Total

FY 201

FTEs

FY 2013

CEs

FY 2014 

Total

FY 2014

CEs 

FTEs

FY 

2014

CEs

FY 2015 

Total

FY 

2015 

FTEs

FY 

2015 

CEs

Adult Protective Services (Prevention & Public 

Health Fund)

Section 4002 $ 2,000 0 0 $ - 0 0 $ - 0 0

Chronic Disease Self-Management Education 

(PPHF)

Section 4002 $ 7,086 1 0 $ 8,000 0 0 $ 8,000 0 0

Alzheimer's Disease Initiative--Supportive 

Services (PPHF)

Section 4002 $ - 0 0 $ 10,500 0 0 $ 10,500 0 0

Alzheimer's Disease Initiative--Communications 

(PPHF)

Section 4002 $ 150 0 0 $ 4,200 0 0 $ 4,200 0 0

Falls Prevention--(PPHF) Section 4002 $ - 0 0 $ 5,000 0 0 $ 5,000 0 0

Programs authorized by ACA but funded by 

other sources (Discretionary)

Section FY 2013

Total

FY 201

FTEs

FY 2013

CEs

FY 2014 

Total

FY 2014

CEs 

FTEs

FY 

2014

CEs

FY 2015 

Total

FY 

2015 

FTEs

FY 

2015 

CEs

Elder Justice Initiative/Adult Protective Services Subtitle H, 

Sections 

6701- 

6703 

$ - 0 0 $ - 0 0 $ 4,000 0 0

Pre-existing programs funded by ACA 

(Mandatory)

Section FY 2016 

Total

FY 

2016 

FTEs

FY 

2016 

CEs

FY 2017 

Total

FY 2017 

FTEs

FY 2017 

CEs

FY 2018 

Annualized CR 

Total

FY 2018 

Annualized CR 

FTEs

FY 2018 

Annualized CR 

CEs

National Clearinghouse for Long-Term 

Care Information

Title VIII $ 1,000 0 0 $ - 0 0 $ - 0 0

Medicare Improvements for Patients & 

Providers Act Programs

Section 

3306

$ - 0 0 $ - 0 0 $ - 0 0

New programs authorized and funded 

by ACA (Mandatory)

Section FY 2016 

Total

FY 

2016 

FTEs

FY 

2016 

CEs

FY 2017 

Total

FY 2017 

FTEs

FY 2017 

CEs

FY 2018 

Annualized CR 

Total

FY 2018 

Annualized CR 

FTEs

FY 2018 

Annualized CR 

CEs

Aging and Disability Resource Centers Section 

2405

$ - 0 0 $ - 0 0 $ - 0 0
SUPPLEMENTARY TABLES

262 

FTEs Funded by P.L. 111-56 (CR) and Any Supplementals - Continued

Administration for Community Living 

 (Program Level in Millions) 

New programs funded from the PPHF 

under ACA (Discretionary)

Section FY 2016 

Total

FY 

2016 

FTEs

FY 

2016 

CEs

FY 2017 

Total

FY 2017 

FTEs

FY 2017 

CEs

FY 2018 

Annualized CR 

Total

FY 2018 

Annualized CR 

FTEs

FY 2018 

Annualized CR 

CEs

Adult Protective Services (Prevention & 

Public Health Fund)

Section 

4002

$ - 0 0 $ - 0 0 $ - 0 0

Chronic Disease Self-Management 

Education (PPHF)

Section 

4002

$ 8,000 0 0 $ 8,000 0 0 $ 7,223 0 0

Alzheimer's Disease Initiative--

Supportive Services (PPHF)

Section 

4002

$ 10,500 0 0 $ 10,500 0 0 $ 9,480 0 0

Alzheimer's Disease Initiative--

Communications (PPHF)

Section 

4002

$ 4,200 0 0 $ 4,200 0 0 $ 3,792 0 0

Falls Prevention--(PPHF) Section 

4002

$ 5,000 0 0 $ 5,000 0 0 $ 4,515 0 0

Programs authorized by ACA but 

funded by other sources 

(Discretionary)

Section FY 2016 

Total

FY 

2016 

FTEs

FY 

2016 

CEs

FY 2017 

Total

FY 2017 

FTEs

FY 2017 

CEs

FY 2018 

Annualized CR 

Total

FY 2018 

Annualized CR 

FTEs

FY 2018 

Annualized CR 

CEs

Elder Justice Initiative/Adult Protective 

Services

6703 $ 8,000 1 0 $ 10,000 2.5 0 $ 9,932 2.7 0

Pre-existing programs funded by ACA (Mandatory) Section FY 2019 

Total FY 2019 FTEs CEs

National Clearinghouse for Long-Term Care Information Title VIII $ - 0 0

Medicare Improvements for Patients & Providers Act Programs New 

programs authorized and funded by ACA (Mandatory)

Section 3306 $ - 0 0 

New programs authorized and funded by ACA (Mandatory) Section FY 2019 

Total

FY 2019 FTEs CEs

Aging and Disability Resource Centers Section 2405 $ - 0 0

New programs funded from the PPHF under ACA (Discretionary) Section FY 2019 

Total FY 2019 FTEs CEs

Adult Protective Services (Prevention & Public Health Fund) Section 4002 $ - 0 0 

Chronic Disease Self-Management Education (PPHF) Section 4002 $ - 0 0 

Alzheimer's Disease Initiative--Supportive Services (PPHF) Section 4002 $ - 0 0 

Alzheimer's Disease Initiative--Communications (PPHF) Section 4002 $ - 0 0 

Falls Prevention--(PPHF) Programs authorized by ACA but funded by other 

sources (Discretionary)

Section 4002 

Subtitle H, 

Sections 

6701-6703

$ 8,000 2.7 0 
SUPPLEMENTARY TABLES

263 

FTEs Funded by P.L. 111-56 (CR) and Any Supplementals - Continued

Administration for Community Living

(Program Level in Millions)

Programs authorized by ACA but funded by other sources 

(Discretionary) Section FY 2019

Total FY 2019 FTEs CEs

Elder Justice Initiative/Adult Protective Services Subtitle H, 

Sections 

6701-6703

$8,000 2.7 0 
SUPPLEMENTARY TABLES

264 

Summary of Proposed Changes in Performance Measures 

Administration for Community Living 

Unique 

Identifier

Change 

Type

Prior 

Content in 

FY 2018 CJ

Change Reason for 

Change

HHS 

Performance 

Plan (APP/R) 

Measure

ALZ.3 New --

Improve dementia capability of 

long-term support systems to 

create dementia-friendly, livable 

communities.

New 

measure 

that reflects 

the overall 

goal of the 

program

Yes

8F New --

As a result of the Protection and 

Advocacy Program’s individual or 

systemic advocacy, the percentage 

of individuals with developmental 

disabilities whose right to be safe, 

receive an appropriate education, 

live in the community, be 

economically self-sufficient and/or 

participate in their communities is 

enforced, retained, restored or 

expanded

New 

measure 

that reflects 

the overall 

goal of the 

program

Yes

8G New --

Increase the percentage of people 

with developmental disabilities and 

their family members increasing 

their advocacy knowledge

New 

measure 

that reflects 

the overall 

goal of the 

program

No

CD2 Retire

Increase the 

percentage 

of 

individuals 

who 

complete the 

CDSME 

program. 

(Outcome)

Goal discontinued in FY 2019

Program 

eliminated 

in 

President's 

FY 2019 

budget

No

CD1 Retire

Total 

number of 

individuals 

with chronic 

conditions 

completing 

the CDSME 

program. 

(Output)

Goal discontinued in FY 2019

Program 

eliminated 

in 

President's 

FY 2019 

budget

No
SUPPLEMENTARY TABLES

265 

Physicians’ Comparability Allowance Worksheet

Administration for Community Living

ACL does not have anything to submit for this section. 
SUPPLEMENTARY TABLES

266 

Programs Proposed for Elimination

Administration for Community Living

(Dollars in thousands) 

Program FY 2018 

Annualized CR Rationale 

Chronic Disease 

Self-Management 

Education

8,000

CDSME programs provide models for helping 

people to better self-manage their chronic 

conditions. These models can be picked up by States 

under the expanded flexibilities allowing States to 

transfer up to 100% of the funds they receive for 

HCBS, Nutrition, Preventive Health and Caregivers 

programs.

Elder Falls 

Prevention 5,000

Falls prevention programs which educate 

participants on how to reduce falls and fall risk 

factors, can be picked up by States as needed under 

the expanded flexibilities allowing States to transfer 

up to 100% of the funds they receive for HCBS, 

Nutrition, Preventive Health and Caregivers 

programs.

Limb Loss Resource 

Center* 2,483

Other ACL programs such as Aging Disability 

Resource Center’s (ADRC's), Centers for 

Independent Living (CIL'S), and Assistive 

Technology (AT), provide resources and services to 

people with significant disabilities. 

Paralysis Resource 

Center* 6,655

Other ACL programs such as Aging Disability 

Resource Center’s (ADRC's), Centers for 

Independent Living (CIL'S), and Assistive 

Technology (AT), provide resources and services to 

people with significant disabilities. 

State Health 

Insurance Assistance 

Programs*

46,795

While ACL will reduce the scale of its one-on-one 

person assistance through the State Health 

Insurance Assistance Program, Medicare 

beneficiaries will continue to have access to online 

tools such as Plan Finder and phone assistance such 

as CMS’s 1-800-MEDICARE helpline. Some states 

also support SHIP programs. CMS in coordination 

with ACL and states will work to ensure that 

existing CMS resources continue to provide 

accurate, comprehensive, understandable 

information to individuals.

*These programs were proposed for elimination in the FY 2018 President's Budget.
SUPPLEMENTARY TABLES

267 

Significant Items in Appropriations Committee Reports

Administration for Community Living

1. Developmental Disabilities Protection and Advocacy—The Committee strongly urges the

DD Act programs (state developmental disabilities councils, protection and advocacy

systems and university centers for excellence in developmental disabilities) to continually

consult with parents and guardians of those individuals within these facilities. The

Committee urges the Administration on Community Living to monitor this matter and to

include an update on the efforts to ensure compliance with bill language requiring

notification in the fiscal year 2019 Congressional Justification. The Committee strongly

urges the Department to ensure that DD Act programs properly account for the needs and

desires of patients, their families, and caregivers, and the importance of affording patients the

proper setting for their care, into their enforcement of the ADA. (Page 97, H. Rept. 115-244)

Action To Be Taken: The DD Act programs (State Councils on Developmental Disabilities, 

Protection and Advocacy Systems, and University Centers for Excellence in Developmental 

Disabilities) do not enforce the ADA, but work to assure that individuals with developmental 

disabilities and their families participate in the design of and have access to needed 

community services, individualized supports, and other forms of assistance that promote selfdetermination, independence, productivity, and integration and inclusion in all facets of 

community life. 

The DD Act programs are required to consult with and get input from the public on the needs 

of individuals with developmental disabilities and their families. The DD Act programs use a 

variety of strategies to receive such input, including public forums, surveys, visits to 

institutions, training events, and other venues. In addition, individuals with developmental 

disabilities and family members are required members of the State Councils that are 

responsible for developing the State Plan; and at least one of the Council members must be 

an individual with a developmental disability who resides or previously resided in an 

institution, or a family member or guardian of such an individual. University Centers are 

required to have a Consumer Advisory Committee comprised of individuals with 

developmental disabilities and families that assists with the development of the Center’s 

plan. AIDD monitors how the DD Act programs receive input as required under the Act and 

ensures technical assistance is provided where needed. AIDD will continue to provide such 

oversight and technical assistance.

2. Home- and Community-Based Supportive Services - The Committee directs ACL to work

with States to prioritize innovative service models, like naturally occurring retirement

communities [NORCs], which help older Americans remain independent as they age. (Page

143, S. Rept. 115-150)

Action To Be Taken: The Administration for Community Living (ACL) has a long and 

successful history of supporting and advancing innovative service models that support the 

independence of older adults and their family caregivers. These innovations have included 
SUPPLEMENTARY TABLES

268 

the concept of aging in place and livable communities, the basic principles inherent in 

naturally occurring retirement communities. Further, these innovations have focused on 

improving access to services and supports, enhancing choice and control over the services 

received, and building dementia capability at the state and community levels. 

Beginning in 2003, the Administration on Aging (later brought into ACL) partnered with the 

Centers for Medicare and Medicaid Services (CMS) to launch the Aging and Disability 

Resource Center/No Wrong Door program so that individuals of any age with a disability and 

their family caregivers could more easily access needed long-term services and supports 

(LTSS). In 2012, ACL and CMS expanded their collaboration to include the Department of 

Veterans Affairs (VA) to create with the Veteran-Directed Home and Community-Based 

Services (VD-HCBS) program, providing veterans of all ages and their family caregivers 

improved access to, and greater choice and control over the services and supports they 

receive. 

Through the Alzheimer’s Disease Supportive Services Program (ADSSP) and more recently, 

the Alzheimer’s Disease Initiative – Specialized Supportive Services (ADI-SSS) program134, 

ACL is making it possible for states and communities, respectively, to improve HCBS to 

become dementia capable by improving the responsiveness to the needs of persons with 

Alzheimer’s disease and related dementias (ADRD) and their families, identifying and filling 

gaps in services and supports, and improving the quality and effectiveness of programs and 

services. ACL will continue to look for opportunities to advance these age-friendly principles 

and other innovative service models in both its formula and discretionary grant programs and 

help states identify, prioritize, and implement them in effective and sustainable ways.

134 The FY 2019 Budget consolidates Alzheimer’s programs into a single grant making Program in ACL. The 

Alzheimer’s Disease Program will provide greater flexibility to States, territories, Tribes and localities to meet the 

specific needs of their communities.
SUPPLEMENTARY TABLES

269 

Text Description Administration for Community Living Organizational Chart 

(Page 6)

The U.S. Administration for Community Living (ACL) is led by the Administrator, who also 

serves as the Assistant Secretary for Aging. The Administrator is directly supported by the 

Principal Deputy Administrator. The following staff offices report directly to the Administrator:

• Office of External Affairs

• Office of Regional Operations, which includes ten offices located in various regions of

the United States

ACL is comprised of the following units, which report directly to the Administrator: 

• Administration on Aging

• Administration on Disabilities

• Center of Integrated Programs

• Center for Management and Budget

• Center for Policy and Evaluation

• National Institute on Disability, Independent Living, and Rehabilitation Research

The Administration on Aging is led by the Assistant Secretary for Aging, who is directly 

supported by the Deputy Assistant Secretary for Aging. Reporting directly to the Deputy 

Assistant Secretary for Aging are the following offices:

• Office of Supportive and Caregiver Services

• Office of Nutrition and Health Promotion Programs

• Office of Elder Justice and Adult Protective Services

• Office of American Indian, Alaskan Native and Native Hawaiian Programs

• Office of Long-Term Care Ombudsman Programs

The Administration on Disability is headed by a Commissioner, who reports directly to the ACL 

Administrator, and a Deputy Commissioner who also serves as Director of Independent Living. 

Reporting directly to the Commissioner and Deputy Commissioner are the following offices: 

• Administration on Intellectual and Developmental Disabilities

• Independent Living Administration

Reporting directly to the Deputy Administrator of the Center for Integrated programs are the 

following offices: 

• Office of Healthcare Information and Counseling

• Office of Consumer Access and Self-Determination

• Office of Integrated Care Innovations

Reporting directly to the Deputy Administrator of the Center for Management and Budget are the 

following offices: 

• Office of Budget and Finance

• Office of Administration and Personnel

• Office of Grants Management

• Office of Information Resources Management
SUPPLEMENTARY TABLES

270 

Reporting directly to the Director of the Center for Policy and Evaluation are the following 

offices:

• Office of Policy Analysis and Development

• Office of Performance and Evaluation

Reporting directly to the Director of the National Institute on Disability, Independent Living, and 

Rehabilitation Research are the following offices:

• Office of Research Sciences

• Office of Research Evaluation and Administration