DEPARTMENT

of HEALTH

and HUMAN

SERVICES

Fiscal Year

2014 

Administration for 

Community Living

Justification of Estimates for

Appropriations Committees 
Back cover intentionally left blank. 
i 

From the Administration for Community Living

I am pleased to present the first Administration for Community Living (ACL) budget request to 

the Congress. This includes FY 2014 budget requests for our two main program agencies: the 

Administration on Aging and the Administration on Intellectual and Developmental Disabilities.

Secretary Sebelius formed ACL as a single agency charged with working with States, localities, 

Tribal organizations, the nonprofit sector, businesses and families to help more seniors and 

people with disabilities have the option to live in their homes and to fully participate in their 

communities. For many of these individuals, access to home and community supports and 

services can make the difference between living at home and having to move into a nursing 

home or another institution. 

The national aging services network annually serves nearly 11 million seniors and their 

caregivers. These services are especially critical for the nearly three million seniors who receive 

intensive in-home services, half a million of whom meet the disability criteria for nursing home 

admission. The developmental disabilities network provides access for people with disabilities 

and their family members to facilitate living independently in a home of their choosing, 

receiving appropriate services and supports. The array of programs provided through these 

networks work toward ACL’s overarching goal of connecting Americans with the long-term 

community services and supports that they need. 

This budget recognizes the fiscal challenges of the nation and proposes simply to maintain most 

funding at current levels to keep these successful community-based programs, which work to 

protect the rights and interests of people with disabilities and older adults, as strong as possible. 

Our vision for ACL is about more than simply maintaining our current programs; we will 

continue to work to improve long-term services and supports for this country. Too many 

Americans experience unnecessary facility-based care simply because they are older or have a 

disability. Our nation’s long term services and supports system has a well-documented overreliance on institutional services. ACL will continue to promote a better understanding of the 

home and community-based options available to those with functional needs and where they can 

turn when they need assistance. 

ACL provides an opportunity to better align the medical, clinical, and community-based supports 

that comprise our nation’s long-term care delivery system. This will prove to be incredibly 

beneficial to older Americans and people with disabilities who often have a disproportionate 

reliance on our healthcare system. Through this improved alignment, we hope to see better health 

outcomes, quality of daily life, and increased efficiencies for these two often-vulnerable 

populations. 

Kathy Greenlee

Administrator & Assistant Secretary for Aging
ii

Table of Contents

From the Administration for Community Living ............................................................................ i

Organization Chart ......................................................................................................................... iv

Executive Summary

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

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

Overview of Performance ................................................................................................... 9

All Purpose Table ............................................................................................................. 23

Appropriations Language .................................................................................................. 25

Language Analysis ............................................................................................................ 26

Amounts Available for Obligation.................................................................................... 27

Summary of Changes ........................................................................................................ 28

Budget Authority by Activity ........................................................................................... 29

Authorizing Legislation .................................................................................................... 31

Appropriations History ..................................................................................................... 33

Appropriations Not Authorized By Law........................................................................... 34

Health and Independence

Summary of Request ......................................................................................................... 35

Home and Community-Based Supportive Services .......................................................... 39

Nutrition Services ............................................................................................................. 47

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

Chronic Disease Self-Management Education ................................................................. 65

Senior Community Service Employment Program........................................................... 71

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

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

Caregiver Services

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

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

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

Alzheimer’s Disease Supportive Services Program ....................................................... 103

Alzheimer’s Disease Initiative - Services ....................................................................... 109

Lifespan Respite Care ..................................................................................................... 113
iii

Protection of Vulnerable Adults

Summary of Request ....................................................................................................... 119

Adult Protective Services Demonstration Program ........................................................ 123

Long-Term Care Ombudsman Program ......................................................................... 129

Prevention of Elder Abuse and Neglect .......................................................................... 135

Senior Medicare Patrol Program ..................................................................................... 141

Elder Rights Support Activities ...................................................................................... 145

Programs for People with Developmental Disabilities

Summary of Request ....................................................................................................... 151

State Councils on Developmental Disabilities ................................................................ 153

Developmental Disabilities – Protection and Advocacy ................................................ 161

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

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

Consumer Information, Access, and Outreach

Summary of Request ....................................................................................................... 177

Aging and Disability Resource Centers .......................................................................... 179

Voting Access for Individuals with Disabilities ............................................................. 185

Alzheimer’s Disease Initiative - Outreach Campaign .................................................... 191

State Health Insurance Assistance Programs .................................................................. 193

National Clearinghouse on Long-Term Care Information.............................................. 197

Paralysis Resource Center ............................................................................................... 201

Program Administration.............................................................................................................. 205

Supplementary Tables

Budget Authority by Object Class .................................................................................. 209

Salaries and Expenses ..................................................................................................... 210

FTE Detail ....................................................................................................................... 211

Detail of Positions ........................................................................................................... 212

Programs Proposed for Elimination ................................................................................ 213

Federal Employment Funded by ACA ........................................................................... 214

Significant Items in Appropriations Committee Reports ............................................................ 215

Prevention and Public Health Fund ............................................................................................ 221
iv

Organization Chart
1 

Introduction and Mission

The Administration for Community Living (ACL) is the newest Operating Division within the 

U.S. Department of Health and Human Services (DHHS), formed by Secretary Sebelius in April 

2012 as a single agency charged to work with States, localities, Tribal organizations, nonprofit 

organizations, businesses and families to help more seniors and people with disabilities have the 

option to live in their homes and fully participate in their communities. ACL’s mission is to 

maximize the independence, well-being, and health of older adults, people with disabilities, and 

their families and caregivers.

Those with disabilities or functional limitations of any type, regardless of age, have a common 

interest. For these populations, access to home and community-based supports and services can 

make the difference in ensuring that people can fully participate in all aspects of society, 

including having the option to live at home instead of having little choice but to move into some 

form of institutional care. ACL works to improve this access through two distinct program lines 

that address the unique needs of each community: programs serving seniors and caregivers 

under ACL’s Administration on Aging (AoA) and programs for people with intellectual and 

developmental disabilities and their families under ACL’s Administration on Intellectual and 

Developmental Disabilities (AIDD). 

AoA advances the concerns and interests of older people, and works with and through the 

national aging services network to promote the development of comprehensive and coordinated 

systems of home and community-based care that are responsive to the needs and preferences of 

older people and their caregivers. The network is comprised of 56 State and Territorial Units on 

Aging (SUA), 629 Area Agencies on Aging (AAA), 256 Indian Tribal and Native Hawaiian 

organizations, nearly 20,000 direct service providers, and hundreds of thousands of volunteers. 

AoA’s core programs, authorized under the Older Americans Act (OAA), help seniors remain at 

home for as long as possible. These services complement existing medical and health care 

systems, help prevent hospital readmissions and support some of life’s most basic functions, 

such as bathing or preparing food. 

AIDD advances the concerns and interests of people with developmental disabilities and their 

families, working through a network that includes, in each State and Territory, State Councils on 

Developmental Disabilities, State Protection and Advocacy systems, and University Centers for 

Excellence in Developmental Disabilities (UCEDDs). AIDD programs fund capacity-building 

and systems change efforts to ensure that people 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 self-determination, 

independence, productivity, and integration and inclusion in all facets of community life. 
EXECUTIVE SUMMARY

2 

To enhance and strengthen these distinct program lines going forward, ACL will promote 

consistency and coordination in community living policy and seek to better align the medical, 

clinical, and community-based supports that are critical to both constituencies. ACL’s Center for 

Aging and Disability Policy will provide a focal point for these efforts to develop new polices 

and initiatives that support both older Americans and persons with disabilities in accessing 

services and supports and fully participating in their communities.
3 

Overview of Budget Request

The FY 2014 discretionary request for the Administration on Community Living (ACL) is 

$2,094,755,000, a reduction of -$57,704,000 from the FY 2012 enacted level.1 This budget—

ACL’s first— generally proposes to maintain funding at current levels for these successful 

community-based services and supports, which enable seniors and people with disabilities of any 

type, regardless of age, to remain in their communities and to fully participate in society. 

Under the request, three programs – the Department of Labor’s Senior Community Employment 

Program (SCSEP), the Centers for Medicare & Medicaid Services State Health Insurance 

Assistance Program (SHIPs), and the Center for Disease Control and Prevention’s Paralysis 

Resource Center (PRC) are all proposed for transfer to ACL. Each of these three programs will 

complement the existing population served and success provided by ACL. 

The FY 2014 program level also requests $24,700,000 from the Prevention and Public Health 

Fund authorized by the Affordable Care Act. Of this, $10,000,000 would support continued 

funding for Chronic Disease Self-Management Education programs across the nation. The 

remaining $14,700,000 would support the continuation of activities under the President’s 

Alzheimer’s Initiative, including an outreach campaign and the development of more dementiacapable long-term service and support systems designed to meet the needs of caregivers of 

individuals with Alzheimer's Disease. 

In addition, the overall budget includes $20,710,000 in mandatory funding that is appropriated or 

will be otherwise available in FY 2014. Of this total, $10,000,000 is for Aging and Disability 

Resource Centers (ADRCs) in the final year of funding authorized under the Affordable Care 

Act. In addition, $10,710,000 is available for Health Care Fraud and Abuse Control activities. 

ACL’s programs provide services and assistance to a growing segment of the population. The 

U.S. population over age 60 is projected to increase by 26 percent between 2012 and 2020, from

61 million to 77 million2

. Over the same period, 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 nearly 30 percent3. The US 

 

1 Note that totals include both AoA and AIDD funding for the first time. Comparisons to prior years are adjusted for 

comparability to include both bureaus.

2 U.S. Census Bureau, “2012 National Population Projections,” Table 1. Projected Population by Single Year of Age 

(0-99, 100+), Sex, Race, and Hispanic Origin for the United States: July 1, 2012 to July 1, 2060 released December 

2012, accessed 29 March 2013.

3 Data extrapolated by AoA from Ibid and Health Data Interactive, National Center on Health Statistics, Centers for 

Disease Control and Prevention, “Functional limitations among Medicare beneficiaries, ages 65+: US, 1992-2010.” 

< http://www.cdc.gov/nchs/hdi.htm> Accessed 28 August 2012. 
EXECUTIVE SUMMARY

4 

Census Bureau also estimates that 37 million people have a disability, representing 12.1 percent 

of the civilian noninstitutionalized population. Broken down by age group, this includes: 

• 4 percent of children 5 to 17, 

• 10 percent of people 18 to 64, and 

• 37 percent of adults 65 and older. 4

Studies indicate that individuals with developmental disabilities comprise between 1.2 and 

1.65 percent of the U.S. population, or between 3.7 and 5.2 million individuals.5

 

Maintaining funding for community-based services and supports for these two growing 

populations is vital. ACL’s services assist people to remain independent and in their 

communities, potentially delaying institutionalization. Institutional care can be more expensive 

to the government, and Medicaid is a major payer of these services. 

For example, a recent AARP study found that in 2009, approximately 42.1 million family 

caregivers provided assistance to adults with limitations in daily activities.6 These unpaid 

caregivers provided an AARP-estimated $450 billion in services. The long-term needs of today’s 

growing numbers of elderly place tremendous strain on families, and underscore the critical 

importance of ACL programs. If families become overwhelmed by the burdens of caregiving, the 

costs of providing this care could fall on other government resources.

To address these needs, most ACL funding would be maintained in this request for programs 

serving seniors and caregivers under the Administration on Aging, as well as for programs 

serving people with developmental disabilities and their families under the Administration on 

Intellectual and Developmental Disabilities (AIDD). Specific funding requests follow:

Administration on Aging (AoA) 

The request includes $1,454,924,000, an increase of +$7,527,000 over the FY 2012 enacted 

level, for programs to maintain seniors’ health and independence, caregiver services, and 

services to protect vulnerable older Americans. These include: 

 

4 U.S. Census Bureau, 2011 American Community Survey 1-Year Estimates. Table DP02: Selected Social 

Characteristics In The United States. <

http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_11_1YR_DP02&prodType

=table> Accessed 29 March 2013.

5 Extrapolated from Developmental Disabilities Assistance and Bill of Rights Act of 2000, Section 101(a)(1) and 

census estimates of U.S. Population, July 1, 2012

6 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
EXECUTIVE SUMMARY

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• Health and Independence Programs ($1,249,623,000), which 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 (both meals in 

congregate settings and those delivered to seniors in their homes), preventive health 

services, and related training and technical assistance activities. 

• Caregiver Services ($172,012,000), which support caregivers, elders, and people with 

disabilities by providing critical respite care and other support services for family 

caregivers, training and recruitment of care workers and volunteers, information and 

outreach, counseling, and other supplemental services. This also includes supports 

specifically focused on those caring for people with Alzheimer’s Disease.

• Services to Protect Vulnerable Older Americans ($43,287,000), which prevent, detect, 

and respond to elder abuse, neglect, and exploitation, both at home and in institutional 

settings. These programs help to prevent and mitigate the negative effects of abuse, 

neglect, and exploitation on the health and independence of seniors, and also help to 

detect and prevent fraud in Medicare and Medicaid.

7 This includes $8,000,000 in 

continued support for the Adult Protective Services program demonstrations, which 

received startup funding in FY 2012 from the Prevention and Public Health Fund. 

Administration on Intellectual and Developmental Disabilities (AIDD)

The request includes $167,983,000, the same as the FY 2012 enacted level, for five programs 

that address the needs of those with developmental disabilities. These include: 

• State Councils on Developmental Disabilities ($74,774,000), which engage in advocacy, 

capacity building, and systemic change activities that contribute to a coordinated and 

comprehensive system of community supports and services that promote selfdetermination, integration, and inclusion for people with developmental disabilities.

• State Protection and Advocacy systems ($40,865,000), which protect the legal and human 

rights of all people with developmental disabilities by pursuing legal, administrative and 

other appropriate remedies, including investigating incidents of abuse and neglect. 

 

7 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.
EXECUTIVE SUMMARY

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• University Centers for Excellence in Developmental Disabilities ($38,792,000), which 

conduct interdisciplinary training, community services, research, and information 

dissemination activities that promote opportunities for people with developmental 

disabilities to be independent, productive and integrated and included in the community. 

• Projects of National Significance ($8,317,000), which fund grants, contracts, and 

cooperative agreements to create opportunities for individuals with developmental 

disabilities to directly and fully contribute to and participate in all facets of community 

life. 

• Help America Vote Act (HAVA) grants ($5,235,000), which assist Protection and 

Advocacy systems to ensure full participation in the electoral process for individuals with 

disabilities, including registering to vote, casting a vote, and accessing polling places. 

Common Proposals

The budget proposes to transfer the Paralysis Resource Center from the Centers for Disease 

Control and Prevention to ACL. This program will benefit from ACL’s connections to the 

disability networks and focus on community living, and it will serve as an important component 

of ACL’s growing role as HHS’ source of disability expertise and advocacy. 

The FY 2014 budget request also continues to support the transfers to ACL of the State Health 

Insurance Assistance Program (SHIPs) from the Centers for Medicare & Medicaid Services 

(CMS) and of the Senior Community Service Employment Program (SCSEP) from the 

Department of Labor. These programs will benefit extensively from ACL’s connections to the

aging and disability networks, and will be made more efficient and effective under ACL’s 

administration. This budget includes a difficult decision to reduce the Senior Community Service 

Employment program by -$68,251,000; ACL intends to make improvements to program 

performance by developing a proposal to better target limited resources to individuals with the 

greatest need by considering all sources of income for future enrollees. 

In FY 2014, ACL is requesting $3,000,000 to restore funding for the National Long-Term Care 

Clearinghouse. Funding for this program originally authorized under the Deficit Reduction Act 

of 2005, was provided by the Affordable Care Act through FY 2015. However, mandatory 

funding was rescinded under the American Taxpayer Relief Act. The Clearinghouse provides 

important services that help educate consumers about their long-term care options. The FY 2014 

budget requests discretionary funding in order to continue operation of the Clearinghouse, 

contributing to efforts that prepare Americans to pay for long-term services and supports. 
EXECUTIVE SUMMARY

7 

Finally, ACL’s request includes a single budget line for Program Administration of $30,035,000, 

an increase of +$477,000 over the FY 2012 enacted level for ACL’s predecessor components, to 

carry out its programs. This request includes $2,167,500 in base funding which is reserved in 

FY 2013 for costs related to the expiration of ACL’s current headquarters lease and its move to a 

new building. ACL has delayed this move until FY 2014. Therefore, ACL requests that these 

funds be retained in its base to ensure that funding for the move continues to be available. 

Should these funds not be needed for that purpose, ACL will redirect these funds to support 

critical services. Funds would also pay for administrative costs related to the transfer of the 

Paralysis Resource Center and the cost of the FY 2014 pay raise. 

Looking to the future, ACL looks forward to opening a dialogue about how, during this time of 

limited resources, the Administration and HHS’s broader resources can be leveraged to 

contribute and enhance community living and full participation for all Americans. Finally, too 

many Americans continue to experience unnecessary entry into facility-based care simply 

because they are older or have a disability, which reflects the nation’s well-documented overreliance on institutional services. ACL looks forward to working with our partners on ways to 

increase community integration and care management targeted at helping ACL’s high-risk target 

populations avoid nursing home placement, Medicaid spend down, hospital readmission and 

emergency room visits, and entry into out-of-home 24 hours placement. 
8 

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9

Overview of Performance

In April 2012 AoA, AIDD, and the Office on Disability were reorganized into a single agency 

that supports both cross-cutting initiatives and efforts related to helping those with functional 

limitations live in the community. The Administration for Community Living (ACL) is focused 

on the unique needs of individual groups, such as persons with developmental disabilities or 

seniors with dementia, as well as the common issues that face individuals who need communitybased supports, to have the option of living in the community rather than in institutional settings. 

This new agency will work to maximize the independence, well-being, and health of older 

adults, people with disabilities across the lifespan, and their families and caregivers by advancing 

effective policies, services, and supports. The various components that came together to form 

ACL will continue their historical commitments to program performance. Below, an overview 

of performance is provided for AoA and AIDD. 

AoA Overview of Performance

AoA program activities have a fundamental common purpose which reflects the legislative intent 

of the Older Americans Act (OAA) and the AoA Mission: to develop a comprehensive, 

coordinated and cost-effective system of home and community-based services that helps elderly 

individuals maintain their health and independence in their homes and communities. 

The Aging Services Program’s fundamental purpose, in combination with the legislative intent 

that the National Aging Services Network actively participate in supporting community-based 

services with particular attention to serving economically and socially vulnerable elders, led 

AoA to focus on three measures: 1) improving efficiency; 2) improving client outcomes; and 

3) effectively targeting services to vulnerable elder populations. Each measure is representative 

of several activities across the Aging Services Program budget and progress toward achievement 

of each measure is tracked using a number of indicators. The efficiency measure and 

corresponding indicators are reflective of the Office of Management of Budget (OMB) 

requirements to measure efficiency for all program activities. The client outcome measure 

includes indicators focusing on consumer assessment of service quality and outcome indicators 

focusing on nursing home predictors, successful caregiver program operation and protection of 

the vulnerable elderly. The targeting measure and indicators focus on ensuring that States and 

communities serve the most vulnerable elders. Taken together, the three measures and their 

corresponding performance indicators are designed to reflect AoA’s goals and objectives and in 

turn measure success in accomplishing AoA’s mission. 

Consistent with this Administration’s emphasis on transparency and accountability, AoA has 

taken several steps to improve the analysis and availability of performance information while 

also enhancing the rigor of program evaluations. To this end, AoA has: 
EXECUTIVE SUMMARY

10

• Expanded the availability of performance information via an on-line system that enables 

National Aging Services Network professionals and the public to develop benchmarks and 

examine trends nationally and at the State level. 

• Submitted public use data sets to the http://www.data.gov/ system. 

• Further analyzed the results from the AoA’s National Survey of Older Americans Act 

Participants to help inform decision makers. Results show: 

o AoA is effectively reaching those most at risk of institutionalization; 

o Service recipients report Title III services enable them to remain in their own homes; 

and 

o Comparison of service recipients to the overall US population 60 and older shows 

that Title III serves older people who are less healthy and have more limitations than 

other older adults even after adjusting for demographic and socioeconomic 

differences between the groups.

• Tested through the Performance Outcomes Measurement Project (POMP) several methods 

for measuring the impact of services. Analysis of administrative data sets from four States, 

using Cox proportional hazards models, show a consistent lowering of the relative risk of 

nursing home placement with an increase in number of services utilized; and there was an 

increase in mean survival time in the community (i.e. months before nursing home entry) 

with increases in the total number of services used.8

• Conducted a comprehensive review of 2009 Title III-E National Family Caregiver Support 

performance data on a state by state basis. ACL regional staff prepared reports for states and 

held state level meetings covering topics such as outlier data, reasons for significant data 

variations, program design and variability as well as program/funding changes. 

• Employed rigorous program evaluation methods including longitudinal data collection and

matched comparison groups. Specifically:

 8 Brock, D. B., Rabinovich, B., Severynse, J., Ficke, R. (2011). Risk factors for nursing home placement among 

Older Americans Act service recipients: Summary analysis of data from five sources. December 2011.
EXECUTIVE SUMMARY

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o The Title III-C Elderly Nutrition Services program evaluation employs a complex 

design that includes three major components and several subcomponents. The major 

components include a process study that surveys each level of the National Aging 

Services Network on a large array of topics; a costs study that measures the actual 

cost of providing a meal by cost category (e.g. labor, food, overhead); and an 

individual outcome study. The individual outcome study will measure the program’s 

success at meeting the legislative intent of the program (reduce hunger and social 

isolation while improving health and well-being of consumers). In addition, AoA and 

Centers for Medicare and Medicaid Services (CMS) have entered into an InterAgency Agreement that will enhance this evaluation to include prospective analysis 

of healthcare utilization and cost data of program participants compared to a matched 

group of seniors who do not participate in the program. 

o The evaluation of the Title III-E National Family Caregiver Support program will be 

the first for this OAA program. It is designed as a longitudinal study with a 

comparison group so that the effects of the five service categories can be measured 

over time. 

o AoA has finalized the design and operational plan for an evaluation of Aging and 

Disability Resource Centers (ADRC). Data collection is scheduled to begin in the 

spring of 2013 pending satisfaction of Paperwork Reduction Act requirements. The 

evaluation includes a process evaluation examining populations served, services 

provided, and organizational characteristics including funding levels and 

partnerships. The evaluation also includes a quasi-experimental design that compares 

consumer experiences and outcomes associated with accessing long-term care 

services and supports through an ADRC to those of consumers from non-ADRC 

communities. 

o AoA awarded a contract in the fall of 2011 for the conduct of a process evaluation of 

its Chronic Disease Self Management Program (CDSME). The process evaluation 

will examine who the grantees serve, how local sites implement the program, what 

program completion rates are in general and by important subpopulations, and the 

extent to which grantees have built statewide distribution systems. The process 

evaluation will rely on existing program data such as consumer and site level data 

submitted by grantees and grantee progress reports. ACL is working closely with 

CMS to match the data from CDSME participants with their Medicare records to 

examine the implication of program participation on health care utilization. Initial 

reports should be completed spring 2013.
EXECUTIVE SUMMARY

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o AoA awarded a contract in the fall of 2011 to develop a design for a rigorous 

evaluation of the impact of the Long-Term Care Ombudsman Program (LTCOP). 

This evaluation will ultimately consider program efficiency, including cost and 

resource utilization, and program effectiveness at the client/family, facility, 

municipal/State, and national levels. An evaluation design report for ACL was

completed in January 2013. ACL is reviewing the report recommendations and 

implementation options.

o AoA awarded a contract in the fall of 2012 to complete an organizational analysis on 

the Senior Medicare Patrol (SMP) program. This analysis is divided into two parts—

an As-Is report and a To-Be report. The analysis looks at all aspects of the SMP 

program including its structure, management, performance measures, and results. 

Based on the results of the analysis, the program will determine how to best 

implement the changes recommended in the To-Be report. The As-Is analysis will be 

completed in June 2013 with the To-Be report completed in December 2013. 

Current Performance Information 

An analysis of AoA’s performance trends shows that through FY 2011 most outcome indicators 

have been maintained or steadily improved. While service counts are declining due to flat 

funding and inflationary factors, AoA outcome indicators demonstrate that services are 

continuing to be effective in helping older persons remain at home. Some key successes are 

indicative of the potential of AoA and the National Aging Services Network to meet the 

challenges posed by the growth of the vulnerable older adult population, the changing care 

preferences of aging baby boomers, the fiscal difficulties faced by State budgets, and the 

expanding needs of both the elderly and their caregivers. Below are some examples of these 

successes: 

• OAA programs help older Americans with severe disabilities remain independent and in the 

community: Older adults that have three or more impairments in Activities of Daily Living 

(ADL) are at a high risk for nursing home placement. Measures of the National Aging 

Services Network’s success at serving this vulnerable population is a proxy for success at 

nursing home delay and diversion. In FY 2003, the National Aging Services Network served 

home-delivered meals to 280,454 clients with three or more ADL impairments and by 

FY 2011 that number grew by 30% to 358,376 clients. Another approach to measuring 

AoA’s success is the nursing home predictor score. The components of this composite score 

are predictive of nursing home placement based on scientific literature and AoA’s POMP 

which develops and tests performance measures. The components include such items as the 

percent of clients who are transportation disadvantaged and the percent of congregate meal 

clients who live alone. As the score increases, the prevalence of nursing home predictors in 
EXECUTIVE SUMMARY

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the OAA service population increases. In 2003, the nursing home predictor score was 46.57 

and preliminary data show it has increased to 62.79 in FY 2011.

• OAA programs are efficient: The National Aging Services Network is providing high quality 

services to the neediest elders and doing so in a very prudent and cost-effective manner. AoA 

has significantly increased the number of clients served per million dollars of AoA Title III 

funding over the last decade. In FY 2011 The National Aging Services Network served 

8,881 people per million dollars of OAA Title III funding. Since this measure’s introduction 

in FY 2005, AoA and the National Aging Services Network have met or exceeded efficiency 

targets. 

• OAA programs build system capacity: OAA programs stay true to their original intent to 

“encourage and assist State agencies and Area Agencies on Aging to concentrate resources in 

order to develop greater capacity and foster the development and implementation of 

comprehensive and coordinated systems.” (OAA Section 301). This is evident in the 

leveraging of OAA funds with State/local or other funds (almost $3 in other funds for every 

dollar of OAA funds expended), as well as in the expansion of projects such as the Aging and 

Disability Resource Center initiative, which has grown to over 492 sites across 52 States and 

territories to date.

• OAA programs are high quality: OAA clients report that services contribute in an essential 

way to maintaining their independence and they express a high level of satisfaction with 

these services. In 2011, over 96% of transportation clients and caregivers rated services good 

to excellent. To help ensure the continuation of these trends in core programs, AoA uses its 

discretionary funding to test innovative service delivery models for State and local program 

entities that show promise for generating measurable improvements in program activities. 

For example, AoA has worked with CMS and the Department of Veterans Affairs to better 

integrate funding for long-term care service delivery, eliminate duplication and improve 

access to services through Aging and Disability Resource Centers. 

Performance for FY 2014 

Federal support for OAA programs is not expected to cover the cost of serving every senior. For 

Home and Community-based Services, with the same funding levels in FY 2014 as provided in 

FY 2012, outcomes are projected to show similar performance; however, service counts and 

other outputs are projected to decline because of rising costs, declining State and local program 

contributions, and staffing constraints at the State and local level. OAA programs have strong 

partnerships with State and local governments, philanthropic organizations, and private 

donations that contribute significant funding. States typically leverage resources of $2 or $3 per 

every OAA dollar. Regardless of the historic nature of State and local support for these 
EXECUTIVE SUMMARY

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programs, AoA expects declining leveraged funds, as State, local, and private budgets continue 

to face economic hardships. This may adversely impact performance through FY 2014. 

Performance Detail 

Taken as a whole, AoA’s performance measures and indicators form an interconnected system of

performance measurement akin to the three legs of a stool (efficiency, outcomes and targeting) 

holding up AoA’s mission and goals. Below is a summary of each measure, its indicators and 

their relationship to AoA’s mission and vision. 

Measure 1: Improve Efficiency 

Program efficiency is a necessary and important measure of the performance of AoA programs 

for two principal reasons. First, it is important to be a responsible steward of Federal funds. 

Second, the OAA intended Federal funds to act as catalyst in generating capacity for these 

program activities at the State and local levels. It is the expectation of the OAA that States and 

communities increasingly improve their capacity to serve elderly individuals efficiently and 

effectively with both Federal and State funds. 

Improvements in program efficiency support AoA’s mission and HHS’s strategic plan objective 

4.A to ensure program integrity and responsible stewardship. Through optimal utilization of 

resources, improvements in program efficiency ensure that affordable and accessible 

community-based long-term care is available to promote the well-being of seniors and their 

family caregivers. 

For FY 2014, there are two efficiency indicators for AoA program activities. Indicator 1.1 

addresses performance efficiency at all levels of the National Aging Services Network in the 

provision of home and community-based services, including caregiver services. Indicator 1.3 

demonstrates the efficiency of AoA in providing services to Native Americans. 

A summary of program efficiency indicators for FY 2014 follows: 

• Indicator 1.1: For Home and Community-based Services, including Nutrition Services, 

and Caregiver services, increase the number of clients served per million dollars of Title 

III OAA funding. 

• Indicator 1.3: Increase the number of units of service provided to Native Americans per 

thousand dollars of OAA funding. 

Measure 2: Improve Client Outcomes 
EXECUTIVE SUMMARY

15

While improving efficiency, AoA is committed to maintaining quality and improving client 

outcomes. The FY 2014 performance budget includes nine core performance indicators 

supporting AoA’s commitment to improving client outcomes. AoA has multiple quality 

assessment indicators in this plan reflecting separate assessments provided by elders for services 

such as meals, transportation and caregiver assistance. Also, in developing the outcome 

indicators, AoA included measures to assess AoA’s fundamental outcomes: to assist elders who 

wish to stay at home and in the community, and to measure results important to family 

caregivers. The measures for the Ombudsman program focus on the core purposes of this 

program: advocacy on behalf of older adults. 

This measure supports AoA’s overall mission, it is strongly tied to HHS Goal 3. Advance the 

Health, Safety and Well-Being of the American People and specifically Objectives 3.B promote 

economic & social well-being; 3.C improve services for people with disabilities and elderly; and 

3.D promote prevention and wellness.

A summary of the client outcome indicators for FY 2014 follows: 

• Indicator 2.6: Reduce the percent of caregivers who report difficulty in getting services. 

• Indicator 2.9a: 90% of home delivered meal clients rate services good to excellent. 

• Indicator 2.9b: 90% of transportation clients rate services good to excellent. 

• Indicator 2.9c: 90% of National Family Caregiver Support Program clients rate services 

good to excellent. 

• Indicator 2.10: Increase the likelihood that the most vulnerable people receiving OAA 

Home and Community-based and Caregiver Support Services will continue to live in 

their homes and communities. This will be tracked by the use of a “nursing home 

predictor index” which measures the prevalence of select characteristics of the service 

population that research has shown to be predictive of nursing home placement. An 

increasing score shows an increased proportion of the client population is high risk with 

respect to institutionalization. 

• Indicator 2.11: Increase the percentage of transportation clients who live alone. 

• Indicator 2.12: Decrease the average number of complaints per long-term care facility. 
EXECUTIVE SUMMARY

16

• Indicator 2.14: Decrease the number of complaints not resolved to the satisfaction of the 

nursing home resident. 

• Indicator ALZ.2: Increase number of individuals served with evidence-based 

interventions (Alzheimer Program). 

Measure 3: Effectively Target Services to Vulnerable Elderly 

AoA believes that targeting is of equal importance to efficiency and outcomes because it ensures 

that AoA and the National Aging Services Network will focus their services on the neediest, 

especially when resources are scarce. To help seniors remain independent, AoA and the National 

Aging Services Network must focus their efforts on those who are at the greatest risk of 

institutionalization. 

Effective targeting of OAA services supports AoA’s mission and HHS Goal 3. Advance the 

Health, Safety and Well-Being of the American People and specifically Objectives 3.B promote 

economic & social well-being; 3.C improve services for people with disabilities and elderly; and 

3.D promote prevention and wellness. AoA’s four indicators for effective targeting are crucial 

for ensuring that services are targeted to the most vulnerable client groups. A summary of the 

client outcome indicators for FY 2014 follows: 

• Indicator 3.1: Increase the number of caregivers served. 

• Indicator 3.2: Increase the number of older persons with severe disabilities who receive 

home-delivered meals. 

• Indicator 3.3: The percentage of OAA clients served who live in rural areas is at least 

10% greater than the percent of all US elders who live in rural areas. 

• Indicator 3.4: Increase the number of States that serve more elderly living below the 

poverty level than the prior year.

AIDD Overview of Performance

The purpose of the Developmental Disabilities Assistance and Bill of Rights Act of 2000 

(DD Act) is “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 self-determination, independence, 

productivity, and integration and inclusion in all facets of community life, through culturally 
EXECUTIVE SUMMARY

17

competent programs...” The Administration on Intellectual and Developmental Disabilities 

(AIDD) works with our partners in every state and territory to achieve the goals embodied in the 

DD Act. The AIDD Network consists of three programs – State Councils on Developmental 

Disabilities (SCDD), the Developmental Disabilities Protection and Advocacy program (PADD), 

and University Centers for Excellence in Developmental Disabilities (UCEDDs). Current data 

for the SCDD, PADD and UCEDDs are collected via annual program performance reports 

(PPRs). AIDD also implements the Projects of National Significance (PNS) which are designed 

to support the AIDD Network through data and research projects as well as fund innovative 

approaches to improving outcomes for those with developmental disabilities.

AIDD is undertaking multiple activities as part of a comprehensive review of performance 

measurement and data reporting activities across all DD Act programs, with an increased focus 

on outcomes. As a key part of this effort, AIDD has assembled a performance measurement 

workgroup to develop overarching performance measures across AIDD programs. With the 

reorganization into the Administration for Community Living, AIDD is now working with ACL 

performance staff as well as AIDD performance measurement workgroup members to integrate 

this process into the larger organization’s performance measurement and management strategy.

In addition, in 2005 AIDD engaged evaluation experts who conducted an independent study of 

the programs to assess program effectiveness and efficiency. The study utilized performance 

measurement workgroups to propose performance criteria for measuring program results. As 

part of the independent study, data was collected on a sample of 60 AIDD grantees 

(e.g., 20 SCDD, 20 PADDs, and 20 UCEDDs) in FY 2010. The final report for the study was 

issued in December 2011. AIDD is utilizing the proposed performance criteria to make 

improvements to the way in which programs are monitored periodically as a component of the 

AIDD performance measurement system. 

Finally, AIDD has established three program-specific performance measurement workgroups to 

review and evaluate the annual program performance reports used by the grantees to report on 

results. Through this process, AIDD will have in August 2013 data from the UCEDDs that is 

based on a more robust performance measurement system. AIDD will continue to work with the 

SCDD and the P&As in developing revised performance measures for the programs to better 

measure results and outcomes. 

State Councils on Developmental Disabilities

State Councils on Developmental Disabilities (SCDD) work in each state and the territories to 

promote the development of a comprehensive, statewide, person-centered and family-centered 

system that provides a coordinated array of culturally-competent services and other forms of 

assistance for people with developmental disabilities, including individuals with autism, and 
EXECUTIVE SUMMARY

18

their families. SCDD have a significant impact on promoting self sufficiency and community 

living for persons with developmental disabilities. The State Councils do not provide services 

directly, but rather review and analyze the quantity and quality of services that are provided at 

the State and local level. 

State Councils engage in a variety of activities that promote systems change and capacity 

building. Council activities include, but are not limited to, program and policy analysis, 

demonstration of new approaches, training, outreach, community support, interagency 

collaboration and coordination, and public education. A key activity for many Councils is 

leadership training to individuals with developmental disabilities and their family members to 

enhance civic engagement for creating more effective policy solutions.

At the end of each fiscal year, each State Council submits an annual Program Performance 

Report (PPR) that provides qualitative and quantitative data to describe its achievements during 

the past 12 months. The State Councils report in the PPR on the following outcome measure: 

Increase the percentage of individuals with developmental disabilities reached by the Councils 

who are independent, self-sufficient and integrated into the community. The FY 2012 results for 

State Councils will be available in July of 2013. In FY 2013, the program expects to increase the 

percentage by at least 0.1 percent over the previous year’s result, to demonstrate the impact the 

SCDD have on promoting self sufficiency and community living for persons with developmental 

disabilities.

The SCDD efficiency measure – the number of individuals with developmental disabilities 

reached by the Councils who are independent, self-sufficient and integrated into the community 

per $1,000 of federal funding – reflects performance data reported to AIDD on existing annual 

reports from the states. The AIDD collected data for this efficiency measure from the State 

Councils starting in FY 2006, finding 7.82 individuals with developmental disabilities reached 

per $1,000 federal funding (2005 constant dollars) to the Councils. The target for each 

successive year is a one percent increase over the previous year. FY 2012 results are expected to 

be available in July of 2013. This result is important given the economic pressures in the states, 

which works against systems change and capacity building efforts. 

AIDD is analyzing changes in performance to better understand the trends and to improve the 

provision of on-going technical assistance to the Councils. In FY 2011, AIDD engaged a 

workgroup of Council representatives and an expert in performance evaluation to review and 

evaluate the current measurement system used by Councils to report progress on an annual basis. 

As a result, new performance measures were drafted. In FY 2012, AIDD will continue to 

collaborate with the Councils, including members of the workgroup: to finalize the new draft 

measures, pilot the measures to ensure quality control in the data collection process using the 

new measures, and to develop a revised PPR template to ensure better narrative reports from the 
EXECUTIVE SUMMARY

19

Councils on their activities. AIDD anticipates the new PPR template, including the measures will 

be ready for use in the near future. 

Developmental Disabilities Protection and Advocacy Program

The Developmental Disabilities Protection and Advocacy program (PADD) establishes and 

maintains a Protection and Advocacy (P&A) system in each state and territory to protect the 

legal and human rights of all persons with developmental disabilities. The P&A system has the 

authority to pursue legal, administrative, and other appropriate remedies or approaches, including 

the authority to investigate incidents of abuse and neglect and to access client records. Grantees 

must be independent of any agency that provides services to people with developmental 

disabilities. The PADD program is one of eight P&A programs housed in three federal agencies 

(Department of Health of Human Services, Social Security Administration, and Department of 

Education), which positions the systems to work across a variety of disability populations. The 

PADD program provides training, legal and advocacy services and information and referral 

services to people with developmental disabilities and their families. PADD funds also support 

training and technical assistance to leadership and staff of the P&A system to improve their 

performance. 

PADD performance is reported through an annual 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. This measure demonstrates the rate of successful benefits 

accruing from the P&A program to individuals with developmental disabilities. Results for 

FY2012 are expected to be available in July of 2013. During the remainder of FY 2013, the 

program expects to further increase the result by one half of one percent over the previous year. 

As part of AIDD’s comprehensive review of performance measures and data reporting activities, 

a performance measurement workgroup was established in FY2012 to strategically review the 

PADD PPR to analyze program specific performance measurements and make recommendations 

for improvement. This workgroup has drafted revised measures for the PADD and anticipates 

having final measures by October 2013. The final measures will be pilot tested for quality 

control prior to full implementation. AIDD anticipates testing the new measures beginning in 

FY 2014. 

Developmental Disabilities – Projects of National Significance

Projects of National Significance (PNS) is a discretionary program providing grants, contracts 

and cooperative agreements to public or private non-profit entities that support and supplement 

the work of the SCDD, the PADD, and UCEDDs. PNS complement these other DD programs 

by supporting the development of national and state policies, including federal interagency 
EXECUTIVE SUMMARY

20

initiatives; through demonstration projects addressing innovative and emerging best practices to 

expand opportunities for individuals with developmental disabilities to contribute to, and 

participate in, all facets of community life. Current PNS initiatives include employment 

initiatives, technical assistance, longitudinal data collection and analysis, evaluation, and 

monitoring.

AIDD continues to undertake a comprehensive review of performance measurement and data 

reporting activities across all DD Act programs with an increased focus on outcomes, including, 

the establishment of performance measurement workgroups, enhancement and streamlining data 

collection, and engagement with evaluation experts to recommend improvements. 

University Centers for Excellence in Developmental Disabilities

UCEDDs are interdisciplinary education, research and public service units of a university system 

or are public or not-for-profit entities associated with universities that engage in interdisciplinary 

pre-service training, community services, research, and information dissemination activities. 

One of the unique contributions UCEDDs make to the intellectual and developmental disabilities 

community is in the area of training. UCEDDs provide interdisciplinary training to students 

from a wide array of professional backgrounds including but not limited to: pediatrics, social 

work, education, nursing, and administration to improve the quality of services and supports for 

people with developmental disabilities. UCEDDs also provide leadership in advising federal, 

state, and community policymakers about opportunities for individuals with developmental 

disabilities to exercise self-determination, be independent, productive, and integrated and 

included in all facets of community life. The UCEDDs use their federal grants to leverage 

additional funds to implement their core activities of interdisciplinary training, community 

service, research, and information dissemination.

A current measure used to demonstrate UCEDD performance in this area is the percentage of 

individuals with developmental disabilities receiving the benefit of services through activities in 

which UCEDD trained professionals were involved. The result for FY 2010 was 36.02 percent, 

which was slightly less than the target of 36.05 percent. A number of efforts are underway to 

increase the program’s reach to individuals with developmental disabilities, including providing 

technical assistance on a variety of topics such as outreach to unserved and underserved 

populations, strategies for leveraging funds for carrying out the core functions, and enhancing 

engagement of self-advocates. 

A UCEDD performance measurement workgroup has developed a UCEDD logic model that was 

used to make strategic updates to the UCEDD PPR template to ensure meaningful outcome 

measurements. New performance measures were pilot tested in 2012. UCEDDs began collecting 

data on the new measures in August 2012 and results will be reported in August 2013. 
EXECUTIVE SUMMARY

21

ACL’s Internal Performance Management Plan 

ACL’s programs provide grants to the Aging and Developmental Disability Networks. AIDD 

administers several programs via grants made to States, including the SCDD (formula grants), 

PADD (formula grants), and the UCEDDs (discretionary grants), which are directly included in 

AIDD’s current outcomes measures for the developmental disabilities programs. PNS, a 

discretionary program, also provide grants, contracts and cooperative agreements to support and 

supplement the work of AIDD and the DD Network. AIDD continues to strive to refine and 

improve the measures for these individual programs, as well as working to develop overarching, 

program-wide performance measures to reflect the success of the DD Network under the 

purposes of the DD Act.

The Administration on Aging provides formula grants to States or tribes and there is a great deal 

of flexibility in state program implementation. States, in turn, provide flexibility to the Area 

Agencies on Aging, where the home and community-based programs are actually administered. 

Since ACL is not directly involved in hands-on service provision, the Agency employs a 

program performance improvement strategy with multiple components that are expected to yield 

performance improvements. Examples of activity supporting the overall strategy follow: 

• Collaboration with other Federal agencies. 

• Collaboration with non-governmental organizations. 

• Enhanced partnerships between Aging and AIDD Networks. 

• Programmatic technical assistance. 

• Improved performance measurement capacity and information collection tools. 

• Rigorous program evaluation. 

• Program Innovations demonstration grants.

• Senior leadership’s involvement in performance management and reporting. 

Some activities cited above are conducted directly by ACL’s Central and Regional Office staff, 

and some are conducted through discretionary grants and contracts.

ACL senior management is directly engaged in developing these activities through grants and 

procurement planning. There is a rigorous process in which each office within ACL develops 

Program Funding Plan Memoranda which detail the proposed discretionary grant and 

procurement activities for the office and justify each proposed activity consistent with ACL’s 

mission and performance measures. Senior leadership has also implemented processes to better 

use performance data for management decision-making, including a quarterly discretionary 

dashboard, weekly reports for the Administrator/Assistant Secretary, quarterly reviews of 

operating budgets, and bi-monthly managers meetings. 
EXECUTIVE SUMMARY

22 

ACL also monitors senior manager performance by including measurable performance targets in 

performance plans. These performance targets must support ACL’s mission and are consistent 

with the Agency’s performance measures. 

This and other performance information are used during the year to update ACL’s Executive 

Leadership so that adjustments can be made as needed to ACL programs; it is also discussed and 

used as appropriate in ACL internal discussions as decisions are made each year regarding 

requested funding levels. 

By establishing a culture where performance improvement is expected and by working

collaboratively with our State and partners toward this end, the Aging Services and 

Developmental Disability Networks demonstrate solid performance over the past ten years. 
23 

All Purpose Table

Administration for Community Living

(dollars in thousands) 

FY 2012 FY 2013

Health and Independence

Home & Community-Based Supportive Services.................................................. 366,916 369,162 366,916 --

Congregate Nutrition Services ................................................................................. 439,070 441,757 439,070 --

Home-Delivered Nutrition Services ......................................................................... 216,830 218,157 216,830 --

Nutrition Services Incentive Program...................................................................... 160,389 161,371 160,389 --

Preventive Health Services........................................................................................ 20,944 21,073 20,944 --

Chronic Disease Self-Management Education [PPHF] 3/.................................... 10,000 N/A 10,000 --

Senior Community Service Employment Program ................................................ 448,251 450,994 380,000 (68,251)

Native American Nutrition & Supportive Services................................................ 27,601 27,770 27,601 --

Aging Network Support Activities.......................................................................... 7,873 7,921 7,873 --

Subtotal, Health and Independence...................................................................... 1,697,874 1,698,205 1,629,623 (68,251)

Caregiver Services

Family Caregiver Support Services.......................................................................... 153,621 154,561 153,621 --

Native American Caregiver Support Services........................................................ 6,364 6,403 6,364 --

Alzheimer's Disease Supportive Services Program................................................ 4,010 4,035 9,537 5,527

Alzheimer's Disease Initiative -- Services [PPHF] 3/............................................. -- N/A 10,500 10,500

Lifespan Respite Care................................................................................................. 2,490 2,506 2,490 --

Subtotal, Caregiver Services.................................................................................. 166,485 167,505 182,512 16,027

Protection of Vulnerable Adults

Adult Protective Services 4/...................................................................................... 6,000 TBD 8,000 2,000

Long-Term Care Ombudsman Program.................................................................... 16,761 16,864 16,761 --

Prevention of Elder Abuse & Neglect..................................................................... 5,036 5,067 5,036 --

Senior Medicare Patrol Program ............................................................................. 9,402 9,460 9,402 --

Health Care Fraud and Abuse Control 1/ [HCFAC] ............................................ 10,710 10,710 10,710 --

Elder Rights Support Activities .............................................................................. 4,088 4,113 4,088 --

Subtotal, Vulnerable Adults................................................................................... 51,997 46,214 53,997 2,000

Developmental Disabilities Programs

State Councils on Developmental Disabilities........................................................ 74,774 75,232 74,774 --

Protection and Advocacy.......................................................................................... 40,865 41,115 40,865 --

University Centers for Excellence in Developmental Disabilities........................ 38,792 39,029 38,792 --

Projects of National Significance.............................................................................. 8,317 8,368 8,317 --

Subtotal, Developmental Disabilities.................................................................... 162,748 163,744 162,748 --

FY 2014

Program Enacted Annual CR

President's 

Budget

FY 2014 +/- FY 

2012
EXECUTIVE SUMMARY

24 

Consumer Information, Access & Outreach

Aging and Disability Resource Centers (Discretionary) .................................... 6,457 6,497 -- (6,457)

Aging and Disability Resource Centers [ACA]..................................................... 10,000 10,000 10,000 --

Voting Access for People with Disabilities (HAVA)............................................. 5,235 5,267 5,235 --

Alzheimer's Disease Initiative--Communications Campaign [PPHF] 3/.............. 4,000 N/A 4,200 200

State Health Insurance Assistance Program ........................................................ 52,115 52,434 52,115 --

National Clearinghouse for Long-Term Care Information 5/................................ 3,000 86 3,000 --

Paralysis Resource Center 6/..................................................................................... 6,700 6,741 6,700 --

Subtotal, Consumer Information, Access & Outreach....................................... 87,507 81,025 81,250 (6,257)

Program Administration 2/......................................................................................... 29,558 29,739 30,035 477

Medicare Improvements for Patients and Providers Act (MIPPA)

State Health Insurance Assistance Programs [TRA]............................................ -- 7,500 -- --

Aging and Disability Resource Centers [TRA]...................................................... -- 5,000 -- --

Area Agencies on Aging [TRA].............................................................................. -- 7,500 -- --

National Center for Benefits Outreach Enrollment [TRA].................................... -- 5,000 -- --

Subtotal, Program Level........................................................................................... 2,196,169 2,211,432 2,140,165 (56,004)

Less: Funds From Mandatory Sources

HCFAC Wedge Funds 1/........................................................................................... 10,710 10,710 10,710 --

ACA Direct Appropriations ..................................................................................... 13,000 10,086 10,000 3,000

Prevention & Public Health Fund (ACA) 3/........................................................... 20,000 N/A 24,700 (4,700)

Taxpayer Relief Act.................................................................................................... -- 25,000 -- --

Total, Discretionary Budget Authority..................................................................... 2,152,459 2,165,636 2,094,755 (57,704)

1/ $10,710,000 is a placeholder amount for FY 2014. The Secretary and Attorney General will determine the final amount.

2/ Includes comparable transfers in FY 2012 of $1,264,000 for funds from OS for the Office of Disability, $4,982,000

 from ACF for the Administration on Developmental Disabilities, and $249,000 from CDC for the Paralysis Resource Center.

3/ The FY 2013 Prevention Fund Resources are reflected in the Office of the Secretary

4/ Funding for this activity was provided from the Prevention and Public Health Fund in FY 2012. The FY 2014 request is for 

discretionary funding.

5/ Funding for this program was provided by the Affordable Care Act in FY 2012 and FY 2013, but unobligated balances were rescinded 

by the Taxpayer Relief Act in FY 2013 (save for obligations through January 3, 2013). The FY 2014 request is for discretionary funding.

6/ Funding for this program was provided to the Centers for Disease Control and Prevention in FY 2012 and FY 2013. It is proposed 

for transfer to ACL in FY 2014.
25 

Appropriations Language

Administration for Community Living

Aging and Disability Services Programs 

(including transfer of funds) 

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

(``OAA''), [section 398 and title] titles III and XXIX of the PHS Act, section 119 of the Medicare 

Improvements for Patients and Providers Act of 2008, section 6021(d) of the Deficit Reduction 

Act of 2005, [and] 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, and for department-wide coordination of policy and program activities that assist 

individuals with disabilities, [$1,926,434,000] $2,042,640,000, together with [$51,902,000]

$52,115,000 to be transferred from the Federal Hospital Insurance Trust Fund and the Federal 

Supplementary Medical Insurance Trust Fund to carry out section 4360 of the Omnibus Budget 

[Reconcilliation]Reconciliation Act of 1990: 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, notwithstanding 

section 206(g) of the OAA, up to one percent of amounts appropriated to carry out programs 

authorized under title III of such Act shall be available for conducting evaluations, training and 

technical assistance: Provided further, That none of the funds provided shall be used to carry out 

sections 1701 and 1703 of the PHS Act (with respect to chronic disease self-management activity 

grants), except that such funds may be used for necessary expenses associated with administering 

any such grants awarded prior to the date of the enactment of this Act: 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, of the amounts provided under this heading, 

[$448,251,000] $380,000,000 shall be available for carrying out title V of the OAA: Provided 

further, That, with respect to the previous proviso, such funds shall be available through June 30, 

[2014]2015, and may be recaptured and reobligated in accordance with section 517(c) of the 

OAA. 

Note.--A full-year 2013 appropriation for this account was not enacted at the time the budget was 

prepared; therefore, this account is operating under a continuing resolution (P.L. 112-175). The 

amounts included for 2013 reflect the annualized level provided by the continuing resolution. 
26

Language Analysis

Administration for Community Living

Aging and Disability Services Programs

Language Provision Explanation

“titles III and XXIX of the PHS Act” Authorizes ACL to administer the Paralysis Resource 

Center and the Alzheimer’s Disease Supportive Services 

Program.

“section 6021(d) of the Deficit Reduction Act of 2005,” Authorizes ACL to administer the National 

Clearinghouse on Long-Term Care Information using 

discretionary funds.

“the Developmental Disabilities Assistance and Bill of 

Rights Act,”

Authorizes ACL to administer the programs of the 

Administration for Intellectual and Developmental 

Disabilities, including State Councils on Developmental 

Disabilities, Protection and Advocacy, University 

Centers for Excellence in Developmental Disabilities, 

and Projects of National Significance.

“parts 2 and 5 of subtitle D of title II of the Help 

America Vote Act of 2002,”

Authorizes ACL to administer the Voting Access for 

People with Disabilities program.

“and for department-wide coordination of policy and 

program activities that assist individuals with 

disabilities,”

Authorizes the use of ACL funds to support activities 

that were formerly part of the Office of Disability when 

it was created at the Office of the Secretary
27 

Amounts Available for Obligation

Administration for Community Living

(Dollars in Thousands) 

General Fund Discretionary Appropriation:

Appropriation (Annual)............................................................................... 1,473,700 1,479,920 1,481,462

Rescission...................................................................................................... (2,785) - -

Subtotal, adjusted appropriation............................................................ 1,470,915 1,479,920 1,481,462

Transfer of funds to Department of Agriculture...................................... (2,025) (2,542) -

Comparable transfer from Administration for Children and Families.... 172,965 174,024 172,965

Comparable transfer from General Departmental Management............. 1,264 1,272 1,264

Comparable transfer from Centers for Disease Control........................... 6,949 6,992 6,949

Comparable transfer from Department of Labor....................................... 448,251 450,994 380,000

Total, Discretionary Appropriation.................................................. 2,098,319 2,110,660 2,042,640

Mandatory Appropriation:

Appropriation (PPACA) ADRCs................................................................ 10,000 10,000 10,000

Appropriation (PPACA) National Long-Term Care Clearinghouse...... 3,000 86 -

Appropriation (PPACA) Prevention Funds.............................................. 20,000 1/ 24,700

Appropriation (Taxpayer Relief Act) MIPPA........................................... - 25,000 -

Subtotal, adjusted mandatory. appropriation....................................... 33,000 35,086 34,700

Offsetting collections from:

Trust Funds: HCFAC 2/............................................................................... 10,710 10,710 10,710

Trust Funds: SHIPs HI/SMI Trust Fund Transfer................................... 52,115 52,434 52,115

Subtotal, spending authority from offsetting collections................... 62,825 63,144 62,825

Unobligated balance, lapsing.......................................................................... (330)

Total obligations........................................................................................... 2,193,814 2,208,890 2,140,165

1/ The final FY 2013 allocation of the Prevention and Public Health Fund was not available during the development of the FY 2014 CJ.

2/ $10,710,000 is a placeholder amount for FY 2014. The Secretary and Attorney General will determine the final amount.

FY 2012 Actual

FY 2013 

Annualized CR

FY 2014 

President's Budget
28 

Summary of Changes

Administration for Community Living

(Dollars in Thousands) 

2012

 2,152,459

 2,152,129

2014

 2,094,755

 2,094,755

 (57,704)

FY 2014 FY 2014

FY 2014 +/- 

FY 2012

FY 2014 +/- 

FY 2012

PB FTE PB BA FTE BA

Increases:

A. Built-in:

1. FY 2014 pay inflation.................................................................... 196 30,035 3/ 477

Subtotal, Built-in Increases....................................................... - 477

A. Program:

1. Alzheimer's Disease Support Services Program....................... - 9,537 - 5,527

2. Adult Protective Services 1/....................................................... - 8,000 - 8,000

3. National Clearinghouse on Long-Term Care Information 2/.. - 3,000 - 3,000

Subtotal, Program Increases..................................................... - 16,527

Total Increases......................................................................... - 17,004

Decreases:

A. Program:

1. Senior Community Service Employment Program.................... - 380,000 - (68,251)

2. Aging and Disability Resource Centers (Discretionary)........ - - - (6,457)

Subtotal, Program Decreases.................................................... - (74,708)

Total Decreases........................................................................ - (74,708)

Net Change............................................................................ - (57,704)

1/ Funding for these activities was provided from the Prevention Fund in FY 2012, and is requested from 

 discretionary funding in FY 2014.

2/ Funding for this activity was provided from ACA funding in FY 2012, and is requested from discretionary

 funding in FY 2014.

3/ FTE in FY 2012 do not include FTE for AIDD, SHIPS or SCSEP, for which accurate actual data is unavailable.

Net Change............................................................................................................................................................

Total budget authority.............................................................................................................................................

(Obligations)..............................................................................................................................................................

Total estimated budget authority...........................................................................................................................

(Obligations)..............................................................................................................................................................
29

Budget Authority by Activity

Administration for Community Living

(Dollars in Thousands)

Health and Independence

Home & Community-Based Supportive Services................................................... 366,916 369,162 366,916

Congregate Nutrition Services ................................................................................. 439,070 441,757 439,070

Home-Delivered Nutrition Services ......................................................................... 216,830 218,157 216,830

Nutrition Services Incentive Program...................................................................... 160,389 161,371 160,389

Preventive Health Services........................................................................................ 20,944 21,073 20,944

Senior Community Service Employment Program ................................................ 448,251 450,994 380,000

Native American Nutrition & Supportive Services................................................ 27,601 27,770 27,601

Aging Network Support Activities........................................................................... 7,873 7,921 7,873

Subtotal, Health and Independence..................................................................... 1,687,874 1,698,205 1,619,623

Caregiver Services

Family Caregiver Support Services........................................................................... 153,621 154,561 153,621

Native American Caregiver Support Services......................................................... 6,364 6,403 6,364

Alzheimer's Disease Supportive Services Program................................................ 4,010 4,035 9,537

Lifespan Respite Care................................................................................................. 2,490 2,506 2,490

Subtotal, Caregiver Services.................................................................................. 166,485 167,505 172,012

Protection of Vulnerable Adults

Adult Protective Services [PPHF in FY 2012 & FY 2013]...................................... -- -- 8,000

Long-Term Care Ombudsman Program.................................................................... 16,761 16,864 16,761

Prevention of Elder Abuse & Neglect...................................................................... 5,036 5,067 5,036

Senior Medicare Patrol Program .............................................................................. 9,402 9,460 9,402

Elder Rights Support Activities .............................................................................. 4,088 4,113 4,088

Subtotal, Vulnerable Adults.................................................................................. 35,287 35,504 43,287

Developmental Disabilities Programs

State Councils on Developmental Disabilities........................................................ 74,774 75,232 74,774

Protection and Advocacy.......................................................................................... 40,865 41,115 40,865

University Centers for Excellence in Developmental Disabilities........................ 38,792 39,029 38,792

Projects of National Significance.............................................................................. 8,317 8,368 8,317

Subtotal, Developmental Disabilities................................................................... 162,748 163,744 162,748

Program

FY 2012 

Actual

FY 2013 

Annualized 

CR

FY 2014 

President's 

Budget
EXECUTIVE SUMMARY

30

Consumer Information, Access & Outreach

Aging and Disability Resource Centers (Discretionary) ..................................... 6,457 6,497 --

Voting Access for People with Disabilities (HAVA)............................................. 5,235 5,267 5,235

State Health Insurance Assistance Program ......................................................... 52,115 52,434 52,115

National Clearinghouse for Long-Term Care Information (Discretionary)......... -- -- 3,000

Paralysis Resource Center......................................................................................... 6,700 6,741 6,700

Subtotal, Consumer Information, Access & Outreach...................................... 70,507 70,939 67,050

Program Administration............................................................................................. 29,558 29,739 30,035

Subtotal, Discretionary Budget Authority............................................................. 2,152,459 2,165,636 2,094,755

HCFAC Wedge Funds 1/........................................................................................... 10,710 10,710 10,710

Affordable Care Act - Direct Appropriations

Aging and Disability Resource Centers [ACA]..................................................... 10,000 10,000 10,000

National Clearinghouse for Long-Term Care Information [ACA]........................ 3,000 86 --

Prevention and Public Health Fund 2/

Chronic Disease Self-Management Education [PPHF] ......................................... 10,000 TBD 10,000

Alzheimer's Disease Initiative -- Services [PPHF]................................................. -- TBD 10,500

Alzheimer's Disease Initiative--Communications Campaign [PPHF]................... 4,000 TBD 4,200

Adult Protective Services.......................................................................................... 6,000 TBD --

Medicare Improvements for Patients and Providers Act (MIPPA)

State Health Insurance Assistance Programs [TRA]............................................ -- 7,500 --

Aging and Disability Resource Centers [TRA]...................................................... -- 5,000 --

Area Agencies on Aging [TRA]............................................................................... -- 7,500 --

National Center for Benefits Outreach Enrollment [TRA]..................................... -- 5,000 --

Total, Program Level..................................................................................................... 2,196,169 2,211,432 2,140,165

1/ $10,710,000 is a placeholder amount for FY 2014. The Secretary and Attorney General will determine the final amount.

2/ The final FY 2013 allocation of the Prevention and Public Health Fund was not available during 

 the development of the FY 2014 CJ.
31 

Authorizing Legislation

Administration for Community Living

FY 2012 

Amount 

Authorized

FY 2012 

Appropriations 

Act

FY 2014 

Amount 

Authorized

FY 2014 

President's 

Budget

1) Home and CommunityBased Supportive Services:

OAA Section 321..................................................................... Expired $366,916,000 Expired $366,916,000

2) Nutrition Services

Services: OAA Sections 331 and 336.................................... Expired $655,900,000 Expired $655,900,000

3) Nutrition Services Incentive

Program: OAA Section 311 1/................................................ Expired $160,389,000 Expired $160,389,000

4) Preventive Health Services:

OAA Section 502..................................................................... Expired $20,944,000 Expired $20,944,000

5) National Family Caregiver 

Support Program: OAA Section 371.................................... Expired $153,621,000 Expired $153,621,000

6) Community Service Employment for Older Americans

Title V OAA Section 502........................................................ Expired $448,251,000 Expired $380,000,000

7) Native American Nutrition

and Supportive Services: 

OAA Sections 613 and 623..................................................... Expired $27,601,000 Expired $27,601,000

8) Native American Caregiver

Support Program: OAA Section 631.................................... Expired $6,364,000 Expired $6,364,000

9) Long-Term Care Ombudsman

Program: OAA Section 712..................................................... Expired $16,761,000 Expired $16,761,000

10) Prevention of Elder Abuse and

Neglect: OAA Section 721...................................................... Expired $5,036,000 Expired $5,036,000

11) Senior Medicare Patrol Program

 OAA Sections 201 and 202, as amended............................. Expired $9,402,000 Expired $9,402,000

12) Elder Rights Support Activities

 OAA Sections 201, 202, and 411, as amended.................... Expired $4,088,000 Expired $4,088,000

13) Aging Network Support 

Activities: OAA Sections 202, 215 and 411........................ Expired $7,873,000 Expired $7,873,000

14) Alzheimer's Disease Demonstration Grants

PHSA Section 398.................................................................... Expired $4,010,000 Expired $9,537,000
EXECUTIVE SUMMARY

32 

15) Lifespan Respite Care

Lifespan Respite Care Act of 2006........................................ Expired $2,490,000 Expired $2,490,000

Title XXIX of the Public Health Service Act.......................

16) Program Administration:

OAA Section 205..................................................................... Expired $29,558,000 Expired $30,035,000

17) Aging and Disability Resource Centers

OAA Section 202b................................................................... Expired $6,457,000 Expired $0

18) State Health Insurance Assistance Program:

Omnibus Budget Reconciliation Act of 1990.......................

 Section 4360............................................................................. Expired $52,115,000 Expired $52,115,000

19) Adult Protective Services

Social Security Act, Title XX-B, Section 2042 .................... $129,000,000 $0 $129,000,000 $8,000,000

& OAA Sections 751 and 752................................................ Expired

20) State Councils on Developmental Disabilities

DD Act Section 129(a)............................................................. Expired $74,774,000 Expired $74,774,000

21) Protection and Advocacy

DD Act Section 145................................................................. Expired $40,865,000 Expired $40,865,000

22) University Centers for Excellence in Developmental

 Disabilities

DD Act Section 156................................................................. Expired $38,792,000 Expired $38,792,000

23) Projects of National Significance 

DD Act Section 163................................................................. Expired $8,317,000 Expired $8,317,000

24) Voting Assistance for People with Disabilities

Help America Vote Act Section 291...................................... Expired $5,235,000 Expired $5,235,000

25) Paralysis Resource Center

PHSA Sections 311 and 317(k)(2).......................................... N/A $6,700,000 N/A $6,700,000

25) National Clearinghouse on Long-Term Care Information

Deficit Reduction Act of 2005 Section 6021(d).................... Expired $0 Expired $3,000,000

Total Request Level......................................................................... $2,152,459,000 $2,094,755,000

Unfunded Authorizations:

1) Legal Assistance:

OAA Section 731..................................................................... Such Sums $0 Such Sums
33 

Appropriations History

Administration for Community Living

Budget 

Estimate to 

Congress

House 

Allowance

Senate 

Allowance Appropriation

FY 2005 1,376,527,000 1,403,479,000 1,395,117,000 1,404,634,000

FY 2005 Rescission /1 -- -- -- -11,292,624

FY 2006 1,369,028,000 1,376,217,000 1,391,699,000 1,376,624,000

FY 2006 Rescission -- -- -- -13,766,240

FY 2006 Transfer -- -- -- -936,197

FY 2007 1,334,835,000 1,390,306,000 1,380,516,000 1,383,007,000

FY 2008 /2 1,335,146,000 1,417,189,000 1,451,585,000 1,438,567,000

FY 2008 Rescission -- -- -- -25,131,765

FY 2009 /3 1,381,384,000 1,492,741,000 1,478,156,000 1,491,343,000

FY 2009 ARRA /5 -- -- -- 100,000,000

FY 2010 /4 1,491,343,000 1,530,881,000 1,495,038,000 1,516,297,000

FY 2010 Transfer -224,298

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

FY 2011 Recission -3,000,646

FY 2012 /6 2,237,944,000 1,471,324,000 1,534,701,000 1,473,703,000

FY 2012 Recission -2,785,299

FY 2013 /7 1,978,336,000 N/A 1,708,105,000 1,479,919,717

FY 2014 2,140,165,000

1/ Reflects two separate rescissions of - $11,236,624 and -$56,000.

2/ Includes $2,659,000 in FY 2008 budget authority appropriated to AoA and transferred to the 

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

3/ Includes $2,681,000 in FY 2009 budget authority appropriated to AoA and transferred to the

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

4/ American Recovery and Reinvestment Act of 2009, Public Law 111-5.

5/ 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.

6/ 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.

7/ Final appropriation for FY 2013 is not available, the appropriation figure for FY 2013 reflects

 an annualized continuing resolution.
34 

Appropriations Not Authorized By Law

Administration for Community Living

Program

Last Year of 

Authorization Authorization Level

Appropriations in 

Last Year of 

Authorization

Appropriations 

Requested in 

FY 2014

Alzheimer's Disease 

Suppoertive Services: 

PHSA Section 398 FY 2002 Such Sums $11,483,000 $9,537,000

Older Americans Act 1/ FY 2011 Such Sums $1,927,486,000 $1,864,957,000

Lifespan Respite Care: 

Lifespan Respite Care Act 

of 2006 FY 2011 $94,810,000 $2,495,000 $2,490,000

State Health Insurance 

Assistance Programs: 

Omnibus Budget 

Reconciliation Act of 1990 FY 1996 $10,000,000 N/A $52,115,000

Developmental Disabilities

Assistance and Bill of 

Rights Act FY 2007 Such Sums $155,115,000 $162,748,000

National Clearinghouse for 

Long-Term Care: Deficit 

Reduction Act of 2005 

section 6021(d) FY 2010 $1,000,000 $3,000,000 $3,000,000
35 

Health and Independence

Summary of Request

The Administration on Aging’s Health and Independence Programs, authorized primarily by the 

Older Americans Act, 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), preventive 

health and chronic disease self-management services, and community employment services. 

The U.S. population over age 60 is projected to increase by 26 percent between 2012 and 2020, 

from 61 million to 77 million.9 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 more than 30 percent over the same

period.10 Health and Independence Programs are vital to helping seniors remain in their homes 

and communities for as long as possible. For example, 60 percent of congregate and 92 percent 

of home-delivered meal recipients reported that the meals allowed them to continue living in 

their own homes. Additionally, 53 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.11

The FY 2014 funding request for Health and Independence services is $1,629,623,000; a 

reduction of -$68,251,000 from the comparable FY 2012 enacted level. For FY 2014, specific 

program requests include: 

• $366,916,000 for Home and Community-Based Supportive Services (HCBSS), the same 

as the FY 2012 enacted level. HCBSS provides grants to States to fund a broad array of 

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 

 

9 U.S. Census Bureau, “2012 National Population Projections,” Table 1. Projected Population by Single Year of Age 

(0-99, 100+), Sex, Race, and Hispanic Origin for the United States: July 1, 2012 to July 1, 2060 released December 

2012, < http://www.census.gov/population/projections/data/national/2012/downloadablefiles.html> Accessed 29 

March 2013. 

10 10 Data extrapolated by AoA from Ibid and Health Data Interactive, National Center on Health Statistics, Centers 

for Disease Control and Prevention, “Functional limitations among Medicare beneficiaries, ages 65+: US, 1992-

2010.” < http://www.cdc.gov/nchs/hdi.htm > Accessed 28 August 2012.

11 2011 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID.
HEALTH AND INDEPENDENCE

36 

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. 

• $816,289,000 for three Nutrition Services programs (Congregate Nutrition Services, 

Home-Delivered Nutrition Services and the Nutrition Services Incentives Program), the 

same as the FY 2012 enacted level. Nutrition Services help over 2.5 million older adults 

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

FY 2014, these funds will support an estimated 214 million meals. 

• $20,944,000 for Preventive Health Services, the same as the FY 2012 enacted level. 

These services support activities that educate older adults about the importance of healthy 

lifestyles and promote healthy behaviors that can help prevent, delay, or enable seniors to 

better cope with and manage chronic disease and disability, thereby reducing the need for 

more costly medical interventions. AoA is continuing to include appropriations language 

that requires States to use their Preventive Health Services funds for proven 

evidence-based prevention activities. 

• $10,000,000 for Chronic Disease Self-Management Education (CDSME), requested 

again for FY 2014 from the Prevention and Public Health Fund (PPHF) appropriated 

under the Affordable Care Act. This would continue funding at the same level provided 

in FY 2012. CDSME programs have proven effective in helping people to better selfmanage their chronic conditions and reduce their need for more costly medical 

interventions. 

• $380,000,000 for the Senior Community Service Employment Program (SCSEP); a 

reduction of -$68,251,000 from the FY 2012 enacted level. SCSEP provides subsidized 

community-service employment and on-the-job training to low-income, unemployed 

older adults (to allow participants to enter or re-enter the workforce). Like the FY 2013

budget request, the FY 2014 budget proposes to transfer this program to ACL from the 

Department of Labor to allow it to be better integrated with other OAA community-based 

programs, while also enhancing participants’ employment prospects. As part of the 

proposed transfer, ACL intends to make improvements to program performance by better 

targeting limited resources to individuals with the greatest need, which will include 

proposed reforms to better align the program’s eligibility requirements with those of 

other HHS income maintenance programs by considering all sources of income for future 

enrollees.

• $27,601,000 for Native American Nutrition and Supportive Services, the same as the 

FY 2012 enacted level. These funds will provide approximately 4.5 million meals and 
HEALTH AND INDEPENDENCE

37

830,000 rides for Native American seniors to critical daily activities such as meal sites, 

medical appointments, and grocery stores.

• $7,873,000 for Aging Network Support Activities, the same as the FY 2012 enacted

level. These funds support competitive grants and contracts for ongoing activities which 

help seniors and their families obtain information about their care options and benefits, 

and which assist States, Tribes, and community providers of aging services carry out their 

mission to help older people remain independent and live in their own homes and 

communities.
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39

Home and Community-Based Supportive Services

FY 2012

Enacted

FY 2013

Annualized CR

FY 2014

President’s Budget

FY 2014+/-

FY 2012

Home and CommunityBased Supportive Services $366,916,000 $369,162,000 $366,916,000 --

Authorizing Legislation: Section 321 of the Older Americans Act of 1965, as amended

FY 2014 Older Americans Act Authorization......................................................................Expired

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

Program Description and Accomplishments:

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

provides grants to States and Territories based on their share of the population age 60 and over to 

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

possible. AoA’s programs, like the HCBSS program, serve seniors holistically; while each 

service is valuable in and of itself, it is often the combination of supports, when tailored to the 

needs of the individual, that ensures clients can remain in their own homes and communities 

instead of entering nursing homes or other types of institutional care. 

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 

multi-purpose senior centers, which coordinate and integrate services for the elderly.

While age alone does not determine the need for these long-term care 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 percent are unable to perform critical activities of daily living and 

require long-term support. Data also show that over 80 percent of seniors have at least one 

chronic condition and 50 percent have at least two. 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 to avoiding unnecessary, 

expensive nursing home care. 

Services provided by the HCBSS program in FY 2011, the most recent available data, include: 
HEALTH AND INDEPENDENCE

40

• Transportation Services provided nearly 25 million rides to doctor’s offices, grocery 

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

(Output C). 

• Personal Care, Homemaker, and Chore Services provided 27 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).

• Adult Day Care/Day Health provided 8 million hours of care for dependent adults in a 

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

(Output E). 

• 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). 

Continuing AoA’s commitment to provide services to those in most need, nearly 45 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. Many of these 

individuals cannot safely drive a car, as nearly 75 percent of transportation riders have at least 

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

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

macular degeneration or cataracts); 

• 6 percent have Alzheimer’s or dementia; 

• 2 percent have Multiple Sclerosis; 

• 16 percent have had a stroke;

• 5 percent have epilepsy; and 

• 2 percent have Parkinson’s disease. 

 

Of the transportation participants, 95 percent take daily medications, with 14 percent taking 10 to 

20 medications daily.12 Data from AoA’s national surveys of elderly clients show that services 

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

 12 2011 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID.
HEALTH AND INDEPENDENCE

41

to help them remain at home. For example, over half of seniors using transportation services rely 

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

80 percent of clients receiving case management reported that as a result of the services arranged 

by the case manager that they were better able to care for themselves.13 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.14 

Funding History:

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

follows:

FY 2004 ...................................$353,889,000

FY 2005 ...................................$354,136,000

FY 2006 ...................................$350,354,000

FY 2007 ...................................$350,595,000

FY 2008 ...................................$351,348,000

FY 2009 ...................................$361,348,000

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

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

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

FY 2013 CR......................$369,162,000

Budget Request:

The FY 2014 request for Home and Community-Based Supportive Services is $366,916,000, the 

same as the FY 2012 enacted level.

HCBSS helps to delay the need for potentially more expensive institutional services. 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, in the current tight economy, to provide assistance to their adult 

 

13 2011 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID.

14 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.
HEALTH AND INDEPENDENCE

42

children. The overall budget request will support 8.1 million hours of adult day care for older 

adults; 21.5 million rides for critical daily activities such as visiting the doctor, the pharmacy, or 

grocery stores; and 24.8 million hours of assistance to seniors who are unable to perform daily 

activities. 

AoA’s core formula grant programs currently reach one in five seniors, serving over a half 

million seniors in their own communities who meet the disability criteria for nursing home 

admission and helping to keep them from joining the 1.7 million seniors who live in institutional 

settings. Nationally, about 26 percent of individuals 60 and older live alone, and in FY 2014 

AoA projects 67 percent of the Older Americans Act transportation users will be individuals who 

live alone (Outcome 2.11). 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. Recent 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.15 

Federal support for Older Americans Act programs is not expected to cover the cost of serving 

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

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

leveraged resources of 2 or 3 dollars per every Older Americans Act dollar, significantly 

exceeding the programs’ match requirements.

Nonetheless, AoA projects a decline in certain measures of performance for home and 

community-based services in FY 2014 compared to FY 2011, specifically transportation units 

provided and personal care, homemaker, and chore service units provided. Declines in outputs 

are projected to be largely attributable both to inflation and to stable or declining Federal, State, 

and local funding for these programs. 

 15 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.
HEALTH AND INDEPENDENCE

43

Outputs and Outcomes Table:

Home and Community-Based Supportive Services Outputs and Outcomes

Measure Most Recent Result FY 2012

Target 

FY 2014

Target 

FY 2014 +/-

FY 2012

2.9b: 90% of transportation clients rate 

services good to excellent. (Outcome)

FY 2011: 97%

Target: 90% 

(Target Exceeded)

90% 90% Maintain

2.11: Increase the percentage of 

transportation clients who live alone.

(Outcome)

FY 2011: 64%

Target: 70% (Target Not Met) 70% 67% -3%

Indicator Most Recent Result FY 2012

Projection

FY 2014

Projection

FY 2014 +/-

FY 2012

Output C: Transportation Services 

units (Output) FY 2011: 24.7 M 23.5 M 21.5 M - 2.0 M

Output D: Personal Care, Homemaker 

and Chore Services units (Output) FY 2011: 27.0 M 30 M 24.8 M - 5.2 M

Output E: Adult Day Care/Day Health 

units (Output) FY 2011: 8.0 M 8.0 M 8.1 M + 0.1 M

Output F: Case Management Services 

units (Output) FY 2011: 3.6 M 3.7 M 3.7 M --

Note: FY 2011 data are preliminary. For presentation within the budget AoA 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 AoA’s performance measures (efficiency, effective targeting, and client 

outcomes) assess network-wide performance in achieving current strategic objectives.

Grant Awards Tables:

Home and Community-Based Supportive Services Grant Awards

FY 2012

Actual

FY 2013 

Annualized CR

FY 2014

President’s 

Budget

Number of 

Awards 56 56 56

Average 

Award $6,511,854 $6,526,257 $6,486,551

Range of 

Awards

$227,915 -

$36,265,662

$228,419 -

$36,439,718

$227,029 -

$36,081,266
HEALTH AND INDEPENDENCE

44 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2014 DISCRETIONARY STATE FORMULA GRANTS

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

State/Territory

FY 2012

Actual

FY 2013

Estimate

FY 2014

Request

FY 2014 +/- 

FY 2012

Alabama........................................... 5,571,772 5,533,296 5,478,865 -92,907

Alaska .............................................. 1,823,319 1,827,352 1,816,234 -7,085

Arizona ............................................ 7,406,195 7,481,386 7,407,792 1,597 

Arkansas.......................................... 3,502,121 3,500,996 3,500,996 -1,125

California......................................... 36,265,662 36,439,718 36,081,266 -184,396

Colorado .......................................... 4,885,597 4,975,708 4,926,762 41,165 

Connecticut...................................... 4,404,337 4,404,337 4,404,337 --

Delaware.......................................... 1,823,319 1,827,352 1,816,234 -7,085

District of Columbia ........................ 1,823,319 1,827,352 1,816,234 -7,085

Florida ............................................. 26,219,739 26,180,975 25,923,436 -296,303

Georgia ............................................ 9,116,311 9,210,029 9,119,431 3,120 

Hawaii ............................................. 1,823,319 1,827,352 1,816,234 -7,085

Idaho................................................ 1,823,319 1,827,352 1,816,234 -7,085

Illinois.............................................. 14,524,890 14,524,890 14,524,890 --

Indiana ............................................. 7,109,911 7,074,080 7,004,493 -105,418

Iowa ................................................. 4,260,878 4,260,878 4,260,878 --

Kansas ............................................. 3,432,908 3,432,908 3,432,908 --

Kentucky.......................................... 4,946,975 4,927,891 4,879,416 -67,559

Louisiana ......................................... 4,795,898 4,795,898 4,795,898 --

Maine............................................... 1,823,319 1,827,352 1,816,234 -7,085

Maryland.......................................... 6,117,674 6,130,691 6,070,384 -47,290

Massachusetts.................................. 8,209,095 8,209,095 8,209,095 --

Michigan.......................................... 11,516,437 11,465,963 11,353,174 -163,263

Minnesota ........................................ 5,744,649 5,762,674 5,705,988 -38,661

Mississippi....................................... 3,272,711 3,272,711 3,272,711 --

Missouri........................................... 7,118,429 7,118,429 7,118,429 --

Montana........................................... 1,823,319 1,827,352 1,816,234 -7,085

Nebraska .......................................... 2,294,938 2,294,938 2,294,938 --

Nevada............................................. 2,835,544 2,860,091 2,831,957 -3,587

New Hampshire ............................... 1,823,319 1,827,352 1,816,234 -7,085
HEALTH AND INDEPENDENCE

45 

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

State/Territory

FY 2012

Estimate

FY 2013

Estimate

FY 2014

Estimate

FY 2014 +/- 

FY 2012

New Jersey...................................... 10,262,972 10,262,972 10,262,972 --

New Mexico ................................... 2,298,174 2,309,618 2,286,899 -11,275

New York ....................................... 24,283,431 24,283,431 24,283,431 --

North Carolina ................................ 10,572,477 10,615,097 10,510,677 -61,800

North Dakota .................................. 1,823,319 1,827,352 1,816,234 -7,085

Ohio ................................................ 13,816,810 13,816,810 13,816,810 --

Oklahoma ....................................... 4,278,286 4,278,286 4,278,286 --

Oregon ............................................ 4,591,896 4,629,903 4,584,360 -7,536

Pennsylvania................................... 17,879,977 17,879,977 17,879,977 --

Rhode Island................................... 1,823,319 1,827,352 1,816,234 -7,085

South Carolina ................................ 5,443,562 5,488,929 5,434,935 -8,627

South Dakota .................................. 1,823,319 1,827,352 1,816,234 -7,085

Tennessee ....................................... 7,303,508 7,304,362 7,232,510 -70,998

Texas .............................................. 22,531,556 22,754,142 22,530,312 -1,244

Utah ................................................ 2,118,857 2,145,113 2,124,012 5,155 

Vermont.......................................... 1,823,319 1,827,352 1,816,234 -7,085

Virginia........................................... 8,467,596 8,495,438 8,411,869 -55,727

Washington..................................... 7,217,466 7,312,389 7,240,458 22,992 

West Virginia.................................. 2,773,538 2,773,538 2,773,538 --

Wisconsin ....................................... 6,509,748 6,488,260 6,424,436 -85,312

Wyoming ........................................ 1,823,319 1,827,352 1,816,234 -7,085 

Subtotal, States............................... 357,605,672 358,451,423 356,284,568 -1,321,104

American Samoa............................. 472,317 472,317 472,317 --

Guam .............................................. 911,660 913,676 908,117 -3,543

Northern Mariana Islands............... 227,915 228,419 227,029 -886

Puerto Rico ..................................... 4,534,616 4,490,869 4,446,692 -87,924

Virgin Islands ................................. 911,660 913,676 908,117 -3,543

Subtotal, States and Territories....... 364,663,840 365,470,380 363,246,840 -1,417,000

Undistributed 16/............................ 2,252,160 3,691,620 3,669,160 1,417,000

TOTAL 366,916,000 369,162,000 366,916,000 --

 

16/ The undistributed line reflects the amount reserved from the HCBSS appropriation for statutory related activities, including 

contingencies and for program support including information and systems, technical assistance, evaluation, monitoring and 

oversight. Funds unused for these purposes at the end of the year are allocated to States.
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47 

Nutrition Services

FY 2012

Enacted

FY 2013

Annualized CR

FY 2014

President’s Budget

FY 2014+/- 

FY 2012

Congregate Nutrition......... $439,070,000 $441,757,000 $439,070,000 --

Home-Delivered Nutrition.. $216,830,000 $218,157,000 $216,830,000 --

Nutrition Services Incentive 

Program........................ $160,389,000 $161,371,000 $160,389,000 --

Total........................... $816,289,000 $821,285,000 $816,289,000 --

Authorizing Legislation: Sections 311, 331, and 336 of the Older Americans Act of 1965, as 

amended

FY 2014 Older Americans Act Authorization ...................................................................... Expired

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

Program Description and Accomplishments:

Nutrition Services help seniors remain healthy and independent in their communities by 

providing meals and related services in a variety of settings (including congregate facilities such 

as senior centers) and via home-delivery to seniors who are homebound due to illness, disability, 

or geographic isolation. Nutrition Services include: 

• Congregate Nutrition Services (Title III-C1): Provides funding for the provision of meals 

and related services in a variety of congregate settings, which helps to keep older 

Americans healthy and prevents the need for more costly medical interventions. 

Established in 1972, the program also presents opportunities for social engagement and 

meaningful volunteer roles, which contribute to overall health and well-being. 

• Home-Delivered Nutrition Services (Title III-C2): Provides funding for the delivery of 

meals and related services to frail seniors who are homebound. Established in 1978, 

home-delivered meals are often the first in-home service that an older adult receives and 

serve as a primary access point for other home and community-based services. Homedelivered meals also represent an essential service for many caregivers, helping them to 

maintain their own health and well-being.
HEALTH AND INDEPENDENCE

48 

• Nutrition Services Incentive Program (Title III-A): Provides additional funding to States, 

Territories, and eligible Tribal Organizations that is used exclusively to provide meals 

and cannot be used to pay for other nutrition-related services or for administrative costs. 

Funds are awarded to States and Tribes based on the number of meals served in the prior 

Federal fiscal year. States and Tribes have the option to purchase commodities directly 

from the U.S. Department of Agriculture (USDA) with any portion of their award if they 

determine that doing so will enable them to better meet the needs of seniors. Seven States 

and two Tribes elected to spend just over $2.0 million on commodities, including 

$198,937 assessed by USDA as administrative expenses, in FY 2012. 

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 grants are provided to States, Territories, and Tribal 

organizations based on the number of meals served in the prior Federal fiscal year. The meals 

provided through these programs fulfill the standards set by the Dietary Guidelines for 

Americans and provide a minimum of 33 percent of the Dietary Reference Intake, as established 

by the Food and Nutrition Board of the Institute of Medicine of the National Academy of 

Sciences. 

Nutrition Services help approximately 2.5 million older adults receive the meals they need to 

stay healthy and decrease their risk of disability. Studies have found that 50 percent of all 

persons age 85 and over are in need of assistance with instrumental activities of daily living

(IADLs), including obtaining and preparing food. These nutrition programs help address their 

needs. Serving Elders at Risk, a national evaluation of AoA’s nutrition program clients, found 

that nutrition services recipients are older, poorer, more likely to live alone, more likely to be 

minorities, are sicker, in poorer health, in poorer nutritional status, more functionally impaired, 

and at higher nutritional risk than those in the general population. Nutrition Services provide an 

important opportunity for social interaction that helps to improve the general health status of 

participants, particularly homebound elders. A comparison of the number of social contacts of 

congregate and home-delivered meal participants showed that nutrition program clients had 

significantly more social contacts than people who did not participate in the program. 

Data from AoA’s national surveys of elderly clients show that the Nutrition Services are 

effectively helping seniors to improve their nutritional intake and remain at home. For example, 

77 percent of congregate and 83 percent of home-delivered meal recipients say they eat healthier 

meals due to the programs, and 60 percent of congregate and 91 percent of home-delivered meal 

recipients say that the meals enabled them to continue living in their own homes.17 In addition, 

 

17 2012 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID.
HEALTH AND INDEPENDENCE

49 

home-delivered meal and congregate meal participants had significantly better food energy;

protein; vitamins A, B6 & D, Riboflavin, Calcium, Phosphorous, Potassium, Magnesium and 

Zinc intakes compared to matched non-participant group of senior citizens.18 Seniors with 

deficiencies of these nutrients can experience osteoporosis, night blindness, decreased resistance 

to infection, fatigue, vasodilatation, and other illnesses. 

AoA’s annual performance data further demonstrate that these programs are an efficient and 

effective means to help seniors remain healthy and independent in their homes and in the 

community. Ninety percent of home-delivered meal clients rate service as good to excellent 

(Outcome 2.9a). Also, the number of home-delivered meal recipients with severe disabilities 

(3+ ADL) totaled over 358,000 in 2011 (Outcome 3.2). 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. The most recent data on how these nutrition programs 

are helping seniors remain healthy and independent in their homes include: 

• Home-Delivered Nutrition Services provided 139.1 million meals to nearly

860,000 individuals in FY 2011 (Output G). 

• Congregate Nutrition Services provided over 88.6 million meals to over 1.7 million 

seniors in a variety of community settings in FY 2011 (Output H). 

Funding History:

Comparable funding for Nutrition Services during the past ten years is as follows:

FY 2004 ...................................$714,462,000 

FY 2005 ...................................$718,696,000 

FY 2006 ...................................$714,578,000 

FY 2007 ...................................$735,070,000 

FY 2008 ...................................$758,003,000 

FY 2009 ...................................$809,743,000 

FY 2009 (ARRA) .......................$97,000,000 

FY 2010 ...................................$819,353,000 

FY 2011 ...................................$817,835,000 

FY 2012 ...................................$816,289,000 

FY 2013 CR. ............................$821,885,000 

 

18 Serving Elders at Risk – National Evaluation of the Elderly Nutrition Program, 1993-1995, pp.117-118
HEALTH AND INDEPENDENCE

50 

Budget Request:

The FY 2014 request for Nutrition Services is $816,289,000, the same as the FY 2012 enacted 

level. At this level, the budget request combined with state and local contributions will support 

214 million home-delivered and congregate meals to approximately two million elderly 

individuals in a variety of community settings.

Nutrition Services must continue to be funded because they, like HCBSS, help to put off the 

need for much more expensive institutional services. Consistent with AoA’s commitment to 

target services to those most in need to help them maintain their health and independence,

approximately 72 percent of home-delivered meal recipients have annual incomes at or below 

$20,000. Meals are especially critical for the survival of the nearly 60 percent of recipients who 

report these meals as half or more of their food intake for the day and for the 320,000 homedelivered meal recipients with severe disabilities who are projected to be served in FY 2014

(Outcome 3.2). This population with severe disabilities is particularly important to serve since 

this level of disability is frequently an eligibility requirement for more costly nursing home 

admission. 

Federal support for Nutrition Services is not expected to serve every senior. These programs 

have strong partnerships with State and local governments, philanthropic organizations, and 

private donors that contribute funding. In FY 2011, State and local funding comprised 

approximately 63 percent of all the funding for home-delivered meals and congregate meals. 

Though all programs funded through OAA rely on State and local funding in some part, funding 

for congregate and home-delivered meals leverages more State and local financial support than 

many other OAA services.

In FY 2014 these programs are expected to continue to provide home-delivered meals that clients 

rate as good to excellent (Outcome 2.9a), ensuring that clients continue to receive high quality 

services. However, as State and local funding tightens, some providers may look at cost cutting 

measures such as reducing menu choices or the frequency of deliveries. This could affect client 

satisfaction with the quality of service. 
HEALTH AND INDEPENDENCE

51 

Outcomes and Outputs Table:

Nutrition Services Outcomes and Outputs 

Measure Most Recent Result FY 2012

Target 

FY 2014

Target 

FY 2014 +/-

FY 2012

1.1: For Home and 

Community-based Services 

including Nutrition 

Services, and Caregiver 

services increase the 

number of clients served 

per million dollars of AoA 

funding. (Outcome) 

FY 2011: 8,881

Target: 8,350

(Target Exceeded)

8,600 8,600 Maintain

2.9a: 90% of home 

delivered meal clients rate 

services good to excellent.

(Outcome)

FY 2011: 90%19 

Target: 90% 

(Target Met)

90% 90% Maintain

3.2: Increase the number of 

older persons with severe 

disabilities who receive 

home-delivered meals.

(Outcome) 

FY 2011: 358,000

Target: 297,000

(Target Exceeded)

311,000 320,000 +9,000

Indicator Most Recent Result FY 2012

Projection

FY 2014 

Projection

FY 2014 +/-

FY 2012

Output G: Number of 

Home-Delivered meals 

served (Output)

FY 2011: 139.1 M 135 M 132 M -3.0 M

Output H: Number of 

Congregate meals served

(Output) 

FY 2011: 88.6 M 86.0 M 82.0 M -4.0 M 

Outputs G& H: Total 

Number of Meals (Outputs) FY 2011: 227.7 M 221 M 214 M -6 M 

Note: FY 2011 data are preliminary. 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. 

 

19 Based on upper range of survey confidence interval.
HEALTH AND INDEPENDENCE

52 

Grant Awards Tables:

Congregate Nutrition Programs Grant Awards

FY 2012

Actual

FY 2013

Annualized CR

FY 2014 

President’s 

Budget

Number of 

Awards 56 56 56

Average 

Award $7,792,398 $7,809,633 $7,762,130

Range of 

Awards

$272,734 -

$43,523,886

$273,337 -

$43,739,401

$271,675 -

$43,321,335

Home-Delivered Nutrition Programs Grant Awards

FY 2012

Actual

FY 2013

Annualized CR

FY 2014 

President’s 

Budget

Number of 

Awards 56 56 56

Average 

Award $3,848,203 $3,856,704 $3,833,245

Range of 

Awards

$134,687 -

$21,956,423

$134,985 -

$22,127,048

$134,164 -

$21,992,361

Nutrition Services Incentive Program Grant Awards 

FY 2012

Actual

FY 2013

Annualized CR

FY 2014 

President’s 

Budget

Number of 

Awards 309 309 309

Average 

Award20 $515,913 $517,014 $513,868

Range of 

Awards

$462 -

$15,385,495

$465 -

$15,417,072

$462 -

$15,323,269

 

20 If the 254 awards to Tribal organizations are excluded from the “average award” calculation, the average award to 

States, DC, and the territories is $2,839,008 in FY 2012, $2,844,836 in FY 2013 and $2,827,524 in FY 2014.
HEALTH AND INDEPENDENCE

53 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2014 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Congregate Nutrition Services (CFDA 93.045)

State/Territory

FY 2012

Actual

FY 2013

Estimate

FY 2014

Estimate

FY 2014 +/- 

FY 2012

Alabama........................................... 6,686,908 6,641,737 6,578,255 -108,653

Alaska .............................................. 2,181,871 2,186,697 2,173,397 -8,474

Arizona ............................................ 8,888,476 8,980,074 8,894,241 5,765

Arkansas.......................................... 4,203,036 4,170,837 4,163,564 -39,472

California......................................... 43,523,886 43,739,401 43,321,335 -202,551

Colorado .......................................... 5,863,402 5,972,452 5,915,367 51,965

Connecticut...................................... 5,241,452 5,241,452 5,241,452 --

Delaware.......................................... 2,181,871 2,186,697 2,173,397 -8,474

District of Columbia ........................ 2,181,871 2,186,697 2,173,397 -8,474

Florida ............................................. 31,467,368 31,425,602 31,125,233 -342,135

Georgia ............................................ 10,940,853 11,055,001 10,949,336 8,483

Hawaii ............................................. 2,181,871 2,186,697 2,173,397 -8,474

Idaho................................................ 2,181,871 2,186,697 2,173,397 -8,474

Illinois.............................................. 17,286,541 17,286,541 17,286,541 --

Indiana ............................................. 8,532,891 8,491,175 8,410,015 -122,876

Iowa ................................................. 5,081,501 5,081,501 5,081,501 --

Kansas ............................................. 4,089,903 4,089,903 4,089,903 --

Kentucky.......................................... 5,937,065 5,915,056 5,858,519 -78,546

Louisiana ......................................... 5,734,142 5,735,891 5,681,067 -53,075

Maine............................................... 2,181,871 2,186,697 2,173,397 -8,474

Maryland.......................................... 7,342,067 7,358,804 7,288,468 -53,599

Massachusetts.................................. 9,780,267 9,780,267 9,780,267 --

Michigan.......................................... 13,821,341 13,762,848 13,631,302 -190,039

Minnesota ........................................ 6,894,385 6,917,065 6,850,951 -43,434

Mississippi....................................... 3,891,114 3,891,114 3,891,114 --

Missouri........................................... 8,467,047 8,467,047 8,467,047 --

Montana........................................... 2,181,871 2,186,697 2,173,397 -8,474

Nebraska .......................................... 2,738,802 2,738,802 2,738,802 --

Nevada............................................. 3,403,051 3,433,030 3,400,217 -2,834

New Hampshire ............................... 2,181,871 2,186,697 2,173,397 -8,474
HEALTH AND INDEPENDENCE

54 

PROGRAM/CFDA NUMBER: Congregate Nutrition Services (CFDA 93.045)

State/Territory

FY 2012

Actual

FY 2013

Estimate

FY 2014

Request

FY 2014 +/- 

FY 2012

New Jersey...................................... 12,190,488 12,190,488 12,190,488 --

New Mexico ................................... 2,758,132 2,772,285 2,745,787 -12,345

New York ....................................... 28,963,855 28,963,855 28,963,855 --

North Carolina ................................ 12,688,457 12,741,535 12,619,750 -68,707

North Dakota .................................. 2,181,871 2,186,697 2,173,397 -8,474

Ohio ................................................ 16,393,785 16,393,785 16,393,785 --

Oklahoma ....................................... 5,092,422 5,080,736 5,080,736 -11,686

Oregon ............................................ 5,510,920 5,557,375 5,504,257 -6,663

Pennsylvania................................... 21,279,716 21,279,716 21,279,716 --

Rhode Island................................... 2,181,871 2,186,697 2,173,397 -8,474

South Carolina ................................ 6,533,039 6,588,483 6,525,509 -7,530

South Dakota .................................. 2,181,871 2,186,697 2,173,397 -8,474

Tennessee ....................................... 8,765,235 8,767,587 8,683,785 -81,450

Texas .............................................. 27,041,031 27,312,299 27,051,245 10,214

Utah ................................................ 2,542,925 2,574,826 2,550,216 7,291

Vermont.......................................... 2,181,871 2,186,697 2,173,397 -8,474

Virginia........................................... 10,162,304 10,197,261 10,099,795 -62,509

Washington..................................... 8,661,973 8,777,222 8,693,328 31,355

West Virginia.................................. 3,305,947 3,305,947 3,305,947 --

Wisconsin ....................................... 7,812,612 7,788,002 7,713,563 -99,049

Wyoming ........................................ 2,181,871 2,186,697 2,173,397 -8,474 

Subtotal, States............................... 427,882,662 428,894,063 426,300,420 -1,582,242

American Samoa............................. 594,843 594,843 594,843 --

Guam .............................................. 1,090,936 1,093,349 1,086,698 -4,238

Northern Mariana Islands............... 272,734 273,337 271,675 -1,059

Puerto Rico ..................................... 5,442,176 5,390,489 5,338,966 -103,210

Virgin Islands ................................. 1,090,936 1,093,349 1,086,698 -4,238

Subtotal, States and Territories....... 436,374,287 437,339,430 434,679,300 -1,694,987

Undistributed 21/............................ 2,695,713 4,417,570 4,390,700 1,694,987

 

TOTAL.................................. 439,070,000 441,757,000 439,070,000 --

 

21/ The undistributed line reflects the amount reserved from the Congregate Nutrition Services appropriation for statutory 

related activities, including contingencies and for program support including information and systems, technical assistance, 

evaluation, monitoring and oversight. Funds unused for these purposes at the end of the year are allocated to States.
HEALTH AND INDEPENDENCE

55 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2014 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Home-Delivered Nutrition Services (CFDA 93.045)

State/Territory

FY 2012

Actual

FY 2013

Estimate

FY 2014

Estimate

FY 2014 +/- 

FY 2012

Alabama........................................... 3,373,334 3,359,946 3,339,494 -33,840

Alaska .............................................. 1,077,497 1,079,877 1,073,309 -4,188

Arizona ............................................ 4,483,954 4,542,871 4,515,219 31,265

Arkansas.......................................... 2,120,299 2,109,958 2,097,115 -23,184

California......................................... 21,956,423 22,127,048 21,992,361 35,938

Colorado .......................................... 2,957,901 3,021,365 3,002,975 45,074

Connecticut...................................... 2,564,007 2,540,425 2,524,962 -39,045

Delaware.......................................... 1,077,497 1,079,877 1,073,309 -4,188

District of Columbia ........................ 1,077,497 1,079,877 1,073,309 -4,188

Florida ............................................. 15,874,292 15,897,697 15,800,929 -73,363

Georgia ............................................ 5,519,314 5,592,544 5,558,503 39,189

Hawaii ............................................. 1,077,497 1,079,877 1,073,309 -4,188

Idaho................................................ 1,077,497 1,079,877 1,073,309 -4,188

Illinois.............................................. 8,216,052 8,196,365 8,146,474 -69,578

Indiana ............................................. 4,304,574 4,295,546 4,269,399 -35,175

Iowa ................................................. 2,243,949 2,225,744 2,212,196 -31,753

Kansas ............................................. 1,895,772 1,890,763 1,879,255 -16,517

Kentucky.......................................... 2,995,061 2,992,330 2,974,116 -20,945

Louisiana ......................................... 2,892,693 2,901,693 2,884,031 -8,662

Maine............................................... 1,086,279 1,087,335 1,080,716 -5,563

Maryland.......................................... 3,703,841 3,722,698 3,700,038 -3,803

Massachusetts.................................. 4,599,080 4,588,199 4,560,271 -38,809

Michigan.......................................... 6,972,430 6,962,399 6,920,020 -52,410

Minnesota ........................................ 3,477,999 3,499,230 3,477,930 -69

Mississippi....................................... 1,954,691 1,946,834 1,934,984 -19,707

Missouri........................................... 4,231,795 4,215,199 4,189,541 -42,254

Montana........................................... 1,077,497 1,079,877 1,073,309 -4,188

Nebraska .......................................... 1,235,914 1,232,321 1,224,820 -11,094

Nevada............................................. 1,716,732 1,736,714 1,726,143 9,411

New Hampshire ............................... 1,077,497 1,079,877 1,073,309 -4,188
HEALTH AND INDEPENDENCE

56 

PROGRAM/CFDA NUMBER: Home-Delivered Nutrition Services (CFDA 93.045)

State/Territory

FY 2012

Actual

FY 2013

Estimate

FY 2014

Estimate

FY 2014 +/- 

FY 2012

New Jersey...................................... 6,019,557 5,974,276 5,937,911 -81,646

New Mexico ................................... 1,391,391 1,402,454 1,393,917 2,526

New York ....................................... 13,307,414 13,214,954 13,134,515 -172,899

North Carolina ................................ 6,400,925 6,445,734 6,406,499 5,574

North Dakota .................................. 1,077,497 1,079,877 1,073,309 -4,188

Ohio ................................................ 8,262,220 8,229,813 8,179,719 -82,501

Oklahoma ....................................... 2,568,966 2,557,373 2,541,806 -27,160

Oregon ............................................ 2,780,085 2,811,385 2,794,272 14,187

Pennsylvania................................... 9,761,855 9,677,307 9,618,401 -143,454

Rhode Island................................... 1,077,497 1,079,877 1,073,309 -4,188

South Carolina ................................ 3,295,711 3,333,005 3,312,718 17,007

South Dakota .................................. 1,077,497 1,079,877 1,073,309 -4,188

Tennessee ....................................... 4,421,784 4,435,378 4,408,381 -13,403

Texas .............................................. 13,641,345 13,816,844 13,732,742 91,397

Utah ................................................ 1,282,826 1,302,563 1,294,634 11,808

Vermont.......................................... 1,077,497 1,079,877 1,073,309 -4,188

Virginia........................................... 5,126,561 5,158,627 5,127,227 666

Washington..................................... 4,369,691 4,440,252 4,413,225 43,534

West Virginia.................................. 1,527,382 1,513,574 1,504,361 -23,021

Wisconsin ....................................... 3,941,216 3,939,822 3,915,841 -25,375

Wyoming ........................................ 1,077,497 1,079,877 1,073,309 -4,188

Subtotal, States............................... 211,405,279 211,897,109 210,607,309 -797,910

American Samoa............................. 136,498 136,498 136,498 --

Guam .............................................. 538,748 536,655 536,655 -2,094

Northern Mariana Islands............... 134,687 134,164 134,164 -523

Puerto Rico ..................................... 2,745,406 2,734,732 2,734,732 -35,045

Virgin Islands ................................. 538,748 536,655 536,655 -2,094

Subtotal, States and Territories....... 215,499,366 215,975,430 214,661,700 -837,666

Undistributed 22/............................ 1,330,634 2,181,570 2,168,300 837,666

 

TOTAL................................... 216,830,000 218,157,000 216,830,000 --

 

22/ The undistributed line reflects the amount reserved from the Home-Delivered Nutrition Services appropriation for statutory 

related activities, including contingencies and for program support including information and systems, technical assistance, 

evaluation, monitoring and oversight. Funds unused for these purposes at the end of the year are allocated to States.
HEALTH AND INDEPENDENCE

57 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2014 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Nutrition Services Incentive Program (CFDA 93.053)

State/Territory

FY 2012

Actual

FY 2013

Estimate

FY 2014

Estimate

FY 2014 +/-

FY 2012

Alabama .......................................... 2,933,316 2,939,337 2,921,450 -11,866

Alaska ............................................. 372,212 372,976 370,706 -1,506

Arizona............................................ 2,118,282 2,122,631 2,109,714 -8,568

Arkansas.......................................... 2,637,872 2,643,287 2,627,202 -10,670

California ........................................ 12,976,341 13,002,979 12,923,851 -52,490

Colorado.......................................... 1,499,399 1,502,477 1,493,333 -6,066

Connecticut ..................................... 1,441,776 1,444,736 1,435,944 -5,832

Delaware ......................................... 711,968 713,430 709,088 -2,880

District of Columbia........................ 505,439 506,477 503,395 -2,044

Florida ............................................. 7,187,763 7,202,519 7,158,689 -29,074

Georgia............................................ 2,768,572 2,774,256 2,757,373 -11,199

Hawaii............................................. 483,221 484,213 481,266 -1,955

Idaho ............................................... 728,541 730,036 725,594 -2,947

Illinois............................................. 6,902,253 6,916,422 6,874,333 -27,920

Indiana............................................. 1,788,180 1,791,850 1,780,946 -7,234

Iowa ................................................ 2,119,990 2,124,342 2,111,415 -8,575

Kansas............................................. 2,244,365 2,248,972 2,235,286 -9,079

Kentucky ......................................... 1,831,731 1,835,491 1,824,321 -7,410

Louisiana......................................... 3,277,072 3,283,799 3,263,816 -13,256

Maine .............................................. 629,641 630,934 627,094 -2,547

Maryland ......................................... 1,648,593 1,651,977 1,641,924 -6,669

Massachusetts.................................. 5,994,218 6,006,523 5,969,971 -24,247

Michigan ......................................... 7,257,628 7,272,526 7,228,270 -29,358

Minnesota........................................ 1,956,106 1,960,121 1,948,193 -7,913

Mississippi ...................................... 1,365,451 1,368,254 1,359,927 -5,524

Missouri .......................................... 4,070,380 4,078,736 4,053,915 -16,465

Montana .......................................... 1,201,609 1,204,075 1,196,748 -4,861

Nebraska ......................................... 1,168,951 1,171,350 1,164,222 -4,729

Nevada ............................................ 1,055,712 1,057,879 1,051,441 -4,271

New Hampshire............................... 1,180,291 1,182,714 1,175,517 -4,774
HEALTH AND INDEPENDENCE

58 

PROGRAM/CFDA NUMBER: Nutrition Services Incentive Program (CFDA 93.053)

State/Territory

FY 2012

Actual

FY 2013

Estimate

FY 2014

Estimate

FY 2014 +/-

FY 2012

New Jersey...................................... 3,667,607 3,675,136 3,652,772 -14,835

New Mexico ................................... 2,015,026 2,019,162 2,006,875 -8,151

New York ....................................... 15,385,495 15,417,072 15,323,269 -62,226

North Carolina ................................ 3,330,755 3,337,592 3,317,282 -13,473

North Dakota .................................. 814,498 816,170 811,203 -3,295

Ohio ................................................ 5,706,031 5,717,744 5,682,949 -23,082

Oklahoma ....................................... 2,337,289 2,342,087 2,327,834 -9,455

Oregon ............................................ 1,793,200 1,796,881 1,785,946 -7,254

Pennsylvania................................... 7,112,252 7,126,852 7,083,483 -28,769

Rhode Island................................... 449,215 450,137 447,398 -1,817

South Carolina ................................ 1,589,875 1,593,139 1,583,444 -6,431

South Dakota .................................. 965,896 967,879 961,989 -3,907

Tennessee ....................................... 1,675,968 1,679,408 1,669,188 -6,780

Texas .............................................. 12,079,291 12,104,087 12,030,429 -48,862

Utah ................................................ 1,368,532 1,371,342 1,362,996 -5,536

776,795

Vermont.......................................... 779,950 781,551 2,271,534 -3,155

Virginia........................................... 2,280,760 2,285,442 2,085,296 -9,226

Washington..................................... 2,093,766 2,098,064 1,651,112 -8,470

West Virginia.................................. 1,657,818 1,661,222 2,678,324 -6,706

Wisconsin ....................................... 2,689,202 2,694,722 776,795 -10,878

Wyoming ........................................ 793,487 795,116 790,278 -3,209

Subtotal, States............................... 152,642,789 152,956,124 152,025,340 -617,446

American Samoa ............................ -- -- -- --

Guam .............................................. 371,257 372,019 369,756 -1,501

Northern Mariana Islands............... 58,148 58,267 57,913 -235

Puerto Rico ..................................... 2,893,190 2,899,129 2,881,487 -11,703

Virgin Islands ................................. 180,074 180,444 179,346 -728

Subtotal, States and Territories....... 156,145,455 156,465,983 155,513,842 -631,613

Tribal Organizations........................ 3,271,693 3,291,307 3,271,268 -425

Undistributed 23/............................. 971,852 1,613,710 1,603,890 632,038

TOTAL................................. 160,389,000 161,371,000 160,389,000 --

 

23/ The undistributed line reflects the amount reserved from the NSIP appropriation for statutory related activities, including 

contingencies and for program support including information and systems, technical assistance, evaluation, monitoring and 

oversight. Funds unused for these purposes at the end of the year are allocated to States.
59 

Preventive Health Services

FY 2012

Enacted

FY 2013

Annualized CR

FY 2014

President’s Budget

FY 2014+/-

FY 2012

Preventive Health Services $20,944,000 $21,073,000 $20,944,000 --

Authorizing Legislation: Section 361 of the Older Americans Act of 1965, as amended 

FY 2014 Older Americans Act Authorization ...................................................................... Expired

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

Program Description and Accomplishments:

Preventive Health Services, established in 1987, provides formula grants to States and 

Territories, based on their share of the population aged 60 and over, to support activities that 

educate older adults about the importance of healthy lifestyles and promote healthy behaviors 

that can help to prevent or delay chronic disease and disability, thereby reducing the need for 

more costly medical interventions. Preventive Health Services gives States and Territories 

flexibility to allocate resources among the preventive health activities to best meet local needs. 

Priority has been given to providing services to those elders living in medically underserved 

areas of the 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. Average life expectancy has increased from less than 50 years at the turn 

of the 20th century to almost 78 years today. On average an American turning age 65 today can 

expect to live an additional 18.6 years. The population of older Americans is also growing, 

particularly the population age 85 and over, which is growing very rapidly, totaling 5.5 million in 

2010 and projected to reach 8.7 million by the year 2030. One consequence of this increased 

longevity is the higher incidence of chronic diseases such as obesity, arthritis, diabetes, 

osteoporosis, and depression, as well as the greater probability of injury from a fall, which 

quickly limits physical activity. 

In recent years, some States have increasingly shifted their funding to provide greater support to 

evidence-based approaches, especially to help individuals manage chronic diseases. In FY 2012, 

AoA requested and Congress enacted appropriations language requiring States to use their 

Preventive Health funds to support proven evidence-based models that enhance the wellness and 

fitness of the aging community. The same language is also proposed for FY 2014. Since 

evidence-based programs have demonstrated their effectiveness, AoA expects that States will be 
HEALTH AND INDEPENDENCE

60 

able to maximize the impact of these limited dollars. At the same time, if States wish to continue 

funding other health services, such as health screenings, they still have the flexibility to continue 

to use funds provided under the Home and Community-Based Services program for this purpose. 

 

Evidence-based programs are interventions that have been tested through randomized control 

trials and have been shown to be effective at helping participants adopt healthy behaviors, 

improve their health status, and reduce their use of hospital services and emergency room visits. 

Some examples of evidence-based interventions are: 

• Enhanced fitness and enhanced wellness programs: Enhanced fitness is a multicomponent group exercise program designed for community-based organizations and 

intended to promote physical activity among older adults. Strength training using soft 

wrist and ankle weights; cardiovascular workout using dancing, aerobics, or walking; and 

balance and posture exercises are used to increase the physical health of older adults. In 

addition, exercise has been proven to improve depression, which studies have shown that 

nearly 20 percent of U.S. adults 65 years and older experience. Exercise may also act as 

a buffer against many illnesses impacted by stress.

• Falls prevention: Falls prevention programs help participants to achieve improved

strength, balance, and mobility; provide education on how to avoid falls and reduce fall 

risk factors; 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. Recent studies have shown that in the United 

States more than one-third of adults age 65 and over fall each year. Of those who fall, 

20 to 30 percent will experience serious injuries, such as head trauma, broken bones, or 

hip fractures. These injuries may limit the ability of older adults to get around or live 

independently. Those who are not injured may develop a fear of falling, which may 

increase their actual risk of falling. Many people limit their activity after a fall, which 

may reduce strength, physical fitness, and mobility.24

• Medication management: 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 unnecessary 

duplication of prescriptions and cardiovascular problems. These programs have also been 

shown to improve medication usage rates and decrease medication errors among older 

adults.

 

24 Even, Jennifer. 2009. Senior Series. The Ohio State University Extension. 20 May 2009.
HEALTH AND INDEPENDENCE

61 

Funding History:

Funding for Preventive Health Services during the past five years is as follows: 

FY 2009 .................................................$21,026,000 

FY 2010 .................................................$21,026,000 

FY 2011 .................................................$20,984,000 

FY 2012 .................................................$20,944,000 

FY 2013 CR. ..........................................$21,073,000 

Budget Request:

The FY 2014 budget request for Preventive Health Services is $20,944,000, the same as the 

FY 2012 enacted level. AoA continues to request appropriations language that was included by 

Congress for FY 2012 which requires States to use their Preventive Health Services funds to 

support proven evidence-based models that enhance the wellness and fitness of the aging 

community. 

Recognizing that the development of evidence-based programs is ongoing, AoA will continue to 

provide guidance regarding what meets the evidence-based requirement. AoA uses a graduated 

or tiered set of criteria for defining evidence-based interventions implemented through the OAA. 

The OAA Title IIID webpage contains AoA’s definition of evidence-based interventions, 

frequently asked questions, and program examples.25 Thirty-nine evidence-based DPHP 

programs have been added to the OAA Title IIID webpage in the last year, and grantees can use 

this site to search the 35+ highest-level criteria programs listed. 

Underscoring the need for these programs, the 2012 National Survey of Older Americans Act 

Participants found that 68.64% of respondents take three or more different prescription 

medications every day. In addition, 24.29% reported they had to stay overnight in a hospital in 

the past 12 months. 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. Eleven percent of respondents reported that a group class had 

taught them about taking care of their chronic illnesses or medical condition.

Each of the evidence-based programs for which States could use these funds has been rigorously 

evaluated and found to be effective. By requiring States to use funding for one or more of these 

proven programs, AoA seeks to maximize the impact of this funding on providing benefits to 

individuals and on achieving savings due to reduced medical costs. At the same time, States 

 

25 http://www.aoa.gov/AoARoot/AoA_Programs/HPW/Title_IIID/index.aspx
HEALTH AND INDEPENDENCE

62 

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.

Output Table:

Preventive Health Services Output 

Indicator Most Recent 

Result 

FY 2012

Projection 

FY 2014

Projection 

FY 2014 

+/- FY 2012

Output AB: The number of people served with 

health and disease prevention programs 

(Output)

N/A N/A

N/A

(baseline set in 

FY 2013)

N/A

Grant Awards Tables:

Preventive Health Services Grant Awards

FY 2012

Actual

FY 2013

Annualized CR

FY 2014 

President’s 

Budget

Number of 

Awards 56 56 56

Average 

Award $374,006 $376,304 $374,000

Range of 

Awards

$13,090 -

$2,123,744

$13,170 -

$2,136,796

$13,090 -

$2,123,711
HEALTH AND INDEPENDENCE

63 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2014 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Preventive Health Services (CFDA 93.043)

State/Territory

FY 2012

Actual

FY 2013

Estimate

FY 2014

Estimate

FY 2014 +/-

FY 2012

Alabama .......................................... 331,874 333,913 331,869 -5

Alaska ............................................. 104,722 105,365 104,720 -2

Arizona............................................ 403,699 406,179 403,693 -6

Arkansas.......................................... 210,763 212,058 210,760 -3

California ........................................ 2,123,744 2,136,796 2,123,711 -33

Colorado.......................................... 255,177 256,744 255,173 -4

Connecticut ..................................... 260,160 261,758 260,156 -4

Delaware ......................................... 104,722 105,365 104,720 -2

District of Columbia........................ 104,722 105,365 104,720 -2

Florida ............................................. 1,551,522 1,561,053 1,551,497 -25

Georgia............................................ 485,765 488,749 485,757 -8

Hawaii............................................. 104,722 105,365 104,720 -2

Idaho ............................................... 104,722 105,365 104,720 -2

Illinois............................................. 837,894 843,042 837,881 -13

Indiana............................................. 425,464 428,077 425,457 -7

Iowa ................................................ 231,350 232,771 231,346 -4

Kansas............................................. 190,952 192,125 190,949 -3

Kentucky ......................................... 291,198 292,987 291,193 -5

Louisiana......................................... 294,553 296,362 294,548 -5

Maine .............................................. 104,924 105,568 104,922 -2

Maryland ......................................... 359,750 361,960 359,744 -6

Massachusetts.................................. 463,658 466,506 463,650 -8

Michigan ......................................... 691,299 695,546 691,288 -11

Minnesota........................................ 337,777 339,852 337,771 -6

Mississippi ...................................... 195,489 196,690 195,486 -3

Missouri .......................................... 421,608 424,198 421,601 -7

Montana .......................................... 104,722 105,365 104,720 -2

Nebraska ......................................... 124,415 125,179 124,413 -2

Nevada ............................................ 151,173 152,101 151,170 -3

New Hampshire............................... 104,722 105,365 104,720 -2
HEALTH AND INDEPENDENCE

64 

PROGRAM/CFDA NUMBER: Preventive Health Services (CFDA 93.043)

State/Territory

FY 2012

Actual

FY 2013

Estimate

FY 2014

Estimate

FY 2014 +/-

FY 2012

New Jersey ..................................... 618,534 622,334 618,524 -10

New Mexico ................................... 126,899 127,680 126,897 -2

New York ....................................... 1,371,257 1,379,680 1,371,234 -23

North Carolina................................ 575,417 578,952 575,408 -9

North Dakota .................................. 104,722 105,365 104,720 -2

Ohio................................................ 832,633 837,747 832,619 -14

Oklahoma ....................................... 256,429 258,005 256,425 -4

Oregon............................................ 253,923 255,483 253,919 -4

Pennsylvania................................... 1,014,597 1,020,829 1,014,580 -17

Rhode Island................................... 104,722 105,365 104,720 -2

South Carolina................................ 294,285 296,093 294,281 -4

South Dakota .................................. 104,722 105,365 104,720 -2

Tennessee ....................................... 415,196 417,747 415,190 -6

Texas .............................................. 1,248,379 1,256,048 1,248,359 -20

Utah ................................................ 114,654 115,358 114,652 -2

Vermont.......................................... 104,722 105,365 104,720 -2

Virginia........................................... 483,047 486,014 483,039 -8

Washington..................................... 396,147 398,580 396,141 -6

West Virginia ................................. 152,542 153,479 152,540 -2

Wisconsin ....................................... 389,928 392,323 389,922 -6

Wyoming........................................ 104,722 105,365 104,720 -2

Subtotal, States............................... 20,544,739 20,670,946 20,544,405 -334

American Samoa ............................ 13,090 13,170 13,090 --

Guam.............................................. 52,361 52,682 52,360 -1

Northern Mariana Islands............... 13,090 13,170 13,090 --

Puerto Rico..................................... 268,699 270,350 268,695 -4

Virgin Islands................................. 52,361 52,682 52,360 -1

Subtotal, States and Territories....... 20,944,340 21,073,000 20,944,000 -340

TOTAL................................. 20,944,000 21,073,000 20,944,000 --
65 

Chronic Disease Self-Management Education

FY 2012

Enacted

FY 2013

Annualized CR

FY 2014

President’s Budget

FY 2014+/-

FY 2012

CDSME ........................... $10,000,000 1/ $10,000,000 --

FTE.................................. 0 1/ 2 +2

1/ The FY 2013 Prevention Fund resources are reflected in the Office of the Secretary.

Authorizing Legislation: Sections 311 and 317(k)(2) of the Public Health Service Act, 

[42 U.S.C. Sections 243 and 247b(k)(2)] as amended, and the Patient Protection and Affordable 

Care Act (ACA), Section 4002 [42 U.S.C. 300u-11]

Allocation Method ............................ Competitive Grants/Co-operative Agreements and Contracts

Intended Recipients.....................................................................................States 

Program Description and Accomplishments: 

The Chronic Disease Self-Management Education (CDSME) program is a low-cost evidencebased disease prevention model that uses state-of-the-art techniques to help those 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. 

Data show that as an individual’s number of chronic conditions increases, there is a 

corresponding escalation in adverse outcomes including mortality, poor functional status, 

unnecessary hospitalizations, adverse drug events, duplicative tests, and conflicting medical 

advice, all of which lead to higher health costs and greater outlays for programs like Medicare 

and Medicaid. CDSME has been shown repeatedly, through multiple studies (including 

randomized control experiments, with both English and Spanish speaking populations) to be 

effective at helping participants to adopt healthy behaviors, improve their health status and 

reduce their use of hospital stays and emergency room visits. Studies indicate that the program 

significantly improves participant health status, reduces the use of hospital care and physician 

services26, and reduces health care costs. 

 

26 Sobel, DS, Lorig,KR, Hobbs,M. Chronic Disease Self-Management Program: From Development to 

Dissemination. Permanente Journal; Spring 2002. 
HEALTH AND INDEPENDENCE

66 

CDSME emphasizes an individual’s role in managing his/her illness. The program consists of a 

series of workshops that are conducted once a week for two and a half hours over six weeks in 

community settings such as churches, libraries, YW/MCAs, senior centers, public housing 

projects, community health centers and cooperative extension programs. People with different 

chronic health problems attend together, and the workshops are facilitated by two leaders who 

are certified trainers. One or both of the leaders are non-health professionals or lay people with 

chronic diseases themselves. Topics covered include: 1) techniques to deal with problems such 

as frustration, fatigue, pain and isolation; 2) appropriate exercise for maintaining and improving 

strength, flexibility, and endurance; 3) appropriate use of medications; 4) communicating 

effectively with health professionals; and 5) nutrition. 

Funding for CDSME is awarded in the form of competitive grants to states. External experts 

review project proposals, and project awards are made for periods of one to three years. In 

FY 2010 AoA funded 47 State grants for CDSME programs, with an average award of $574,468

for a two year project period, using funding provided under the Recovery Act. AoA also funded 

a Technical Assistance Resource Center through a grant to the National Council on Aging. 

Competitive grants and contracts are also used to support evaluation and technical assistance 

activities. 

Through these grants, as of January 31, 2012, 61,902 people had completed CDSME courses 

across the country, well ahead of the programmatic goal to reach 50,000 completers within two 

years from the award date. A new round of grants, funded in FY 2012 from PPHF resources, 

provided grants to States to continue these activities. These three-year grants will allow states to 

provide CDSME to approximately 87,000 adults to help them better manage chronic conditions. 

Funding History: 

FY 2009 .................................................................. 27

FY 2010 .................................................................. 28

FY 2011 .................................................................$0 

FY 2012 .................................................$10,000,000 

FY 2013 CR. .................................................... N/A29

 

27 In FY 2010, $30 million in Recovery Act funding was provided in coordination with the Centers for Disease 

Control and Prevention as part of its Recovery Act funding. An additional $2.5 million was also transferred from 

CDC to CMS for related evaluation and quality improvement purposes. No standalone funding was provided in FY 

2011. Stand-alone funding for the nationwide deployment of CDSME through the aging services network was 

requested for the first time in FY 2012 and provided from the Prevention and Public Health Fund

28 See above.

29 The FY 2013 Prevention Fund resources are reflected in the Office of the Secretary.
HEALTH AND INDEPENDENCE

67 

Budget Request: 

AoA requests FY 2014 funding totaling $10,000,000 for CDSME from the Prevention and 

Public Health Fund, the same as the FY 2012 enacted level. The Prevention and Public Health 

Fund (Section 4002) is designed to target resources to activities that invest in prevention and 

public health programs to improve our nation’s health while also restraining the rate of growth in 

public and private sector health care costs. CDSME, by emphasizing an individual’s role in 

managing his/her illness, helps participants to adopt healthy behaviors, improve their health 

status and reduce their use of hospital stays and emergency room visits. Studies indicate that the 

program significantly improves participant health status, reduces the use of hospital care and 

physician services, and reduces health care costs.30 This continued investment of resources will 

allow AoA, in coordination with its existing HHS partners and private philanthropy, to continue 

to build on past investments in CDSME and on AoA’s existing service delivery infrastructure as 

it pursues its goal of taking CDSME to scale nationwide.

Older Americans are disproportionately affected by a vast array of chronic diseases and 

conditions. Over 80 percent of adults 65 and over have at least one chronic condition, and 

roughly half suffer from two.31 Nearly half of older adults have hypertension and roughly one in 

five has heart disease, with a similar proportion having some type of cancer.32 The average 

75-year old has three chronic conditions and takes 4.5 medications.33 More than 65 percent of 

Americans aged 65 and over have some form of cardiovascular disease. One million adults age 

75+ have diabetes, a number that is expected to grow to 4 million by 2050 if nothing changes 

current growth rates.34 Minority elders – the fastest growing segment of the elderly population – 

are especially at risk of chronic illnesses and conditions. For example, among adults age 65+, 

65% of African-Americans had hypertension, compared to 47% of Whites; and 25% of 

Hispanics have diabetes, compared to 14% of Whites. 

CDSME serves this population and is especially well suited for delivery through AoA’s network 

of community based organizations, including senior centers, congregate meal programs, faithbased organizations and senior housing projects. In FY 2011 alone, 40,430 individuals with 

chronic conditions completed the CDSME program through AoA’s network (Output CD1). At 

the community level, aging services provider organizations work in collaboration with public 

 

30 Sobel, DS, Lorig,KR, Hobbs,M. Chronic Disease Self-Management Program: From Development to 

Dissemination. Permanente Journal; Spring 2002.

31 NCCDPHP. Healthy Aging: Preventing Disease and Improving Quality of Life Among Older Americans. 

Available at www.cdc.gov/nccdphp/aag/aag_aging.htm. Accessed September 14, 2004.

32 Centers for Disease Control and Prevention (CDC), National Center for Health Statistics, National Health 

Interview Survey, 2000-2001.

33 Alliance for Aging Research. Ten Reasons Why America Is Not Ready for the Coming Aging Boom. 2002.

34 NCCDPHP. Available at www.cdc.gov/nccdphp/bb_aging/index.htm. Accessed September 14, 2004.
HEALTH AND INDEPENDENCE

68 

health agencies and health care providers. Participant referrals to the CDSME program come 

from both clinical and community-based organizations. Clinical referrals come from communityhealth centers, physicians, hospitals, managed care organizations, and other health system 

components. Community referrals come from a variety of sources, including the Aging and

Disability Resources Centers. Funds will support competitive grants to States, as well as related 

technical assistance and evaluation activities such as:

• A proposed interagency agreement with the CMS Center for Strategic Planning to 

evaluate the impact of CDSME on participant health care utilization and cost by linking 

Medicare claims data to CDSME Medicare participants (both elderly and younger people 

with disabilities);

• A survey of participants (pre- and post) to evaluate the impact of CDSME on behaviors, 

health status, and quality of life; and 

• Continued funding for a National Technical Assistance Center on Evidence-Based 

Prevention Programs. 

Accountability and quality assurance will include tracking a combination of inputs and outputs. 

AoA will track the number of programs being conducted and the number of participants 

completing the program. Participant surveys (pre and post) will be used to track self-reported 

behavioral change and health status. AoA and CMS will establish protocols and mechanisms to 

track CDSME participants’ Medicare claims data to assess the impact of CDSME on health care 

utilization. 

Grant Awards Table:

Chronic Disease Self-Management Education Grant Awards

FY 2012

Actual

FY 2013

Annualized CR

FY 2014 

President’s 

Budget

Number of 

Awards 15-20 15-20 15-20

Average 

Award N/A N/A N/A

Range of 

Awards

$200,000 -

$575,000

$200,000 -

$575,000

$200,575 -

$575,000
HEALTH AND INDEPENDENCE

69 

Outputs and Outcomes Table: 

Evaluation 

In its initial evaluation design work, ACL partnered with the Agency for Healthcare Research 

and Quality and the Assistant Secretary for Planning and Evaluation to determine the most 

promising approach for rigorously evaluating the effectiveness of employing CDSME in the 

Aging Services Network. In FY 2010, ACL initiated a design contract through AHRQ for 

recommendations on how to best carry-out an evaluation. The evaluation design 

recommendations were completed in the spring of 2011. Using the recommendations as a 

foundation, ACL awarded a contract in fall 2011 for the conduct of an evaluation of how the 

CDSME program is being implemented through the aging network and its partners (i.e., a 

process evaluation) and a more detailed outcome evaluation design. The contract was modified 

in 2012 to eliminate the detailed outcome evaluation design as ACL is working with CMS to 

match CDSME participants with their Medicare records, and to identify a matched comparison 

group of similar Medicare recipients, in order to analyze changes in health care utilization 

between the two groups. The process evaluation is expected to be completed during the summer 

of 2013 and the results of the work with CMS are expected to be completed during the fall of 

2013. 

Indicator Most Recent 

Result 

FY 2012

Projection 

FY 2014

Projection 

FY 2014 

+/- FY 2012

Output CD1: Total number of 

individuals with chronic 

conditions completing the 

CDSME program (Output) 

FY 2011: 

40,430

20,000 20,000 Maintain

Output CD2: Percentage of 

individuals that report 1 or more 

health benefits (e.g. improved 

health status, increased physical 

activity, less fatigue, greater 

mobility, etc.) after completing the 

CDSME program (Outcome) 

N/A Baseline TBD TBD
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71 

Senior Community Service Employment Program

FY 2012

Enacted

FY 2013

Annualized CR

FY 2014

President’s Budget

FY 2014+/-

FY 2012

Senior Community Service 

Employment Program....... $448,251,000 $450,994,000 $380,000,000 -$68,251,000

FTE........................... 16 16 16 --

Authorizing Legislation: Section 502 of the Older Americans Act of 1965, as amended 

FY 2014 Older Americans Act Authorization ...................................................................... Expired

Allocation Method .......................................................................... Formula & Competitive Grants

Program Description and Accomplishments

The Senior Community Service Employment Program (SCSEP) provides time-limited, 

subsidized community service positions and employment training to low-income, unemployed 

older adults to allow them to earn additional income in order to maintain their economic 

independence. Participants must be currently unemployed adults aged 55 and older whose 

income, including pensions and other income, is below 125% of the federal poverty level. The 

program’s emphasis is on assisting those with the greatest social and economic needs and those 

living in rural areas. SCSEP’s goals are to provide opportunities for older individuals to serve 

their communities while gaining the marketable skills needed to obtain unsubsidized 

employment and to foster economic self-sufficiency. Community service employment 

assignments are based at 501(c)(3) non-profits or government agencies (also referred to as “host 

agencies”), and are chosen based on their ability to prepare participants to enter or re-enter the 

workforce. Participants are paid the highest of the Federal, state, or local minimum wage. 

SCSEP is currently administered by the Department of Labor but is proposed for transfer to ACL 

in FY 2014. 

In addition to wages and benefits, SCSEP provides the following programmatic services to 

participants: 

• Orientation and assessments; 

• Supportive services; 
HEALTH AND INDEPENDENCE

72 

• Participant training (e.g., on the job or in a classroom setting); and

• Placement assistance into unsubsidized employment. 

While enrolled in the program, all participants must be covered by workers’ compensation and 

offered an annual physical examination. Each participant’s skills and interests are assessed at 

least twice a year, leading to the development of an Individual Employment Plan (IEP). Under 

ACL’s administration, SCSEP’s focus on assuring that older individuals are equipped with the 

skills and knowledge necessary to succeed will remain in place while better aligning it with 

programs that provide other supportive services to seniors. 

SCSEP grants are based on a funding formula which allocates funds to every state, the District of 

Columbia (DC), and Puerto Rico (PR) based on U.S. Census data on the number of individuals 

in that jurisdiction who are 55 and older with low per-capita income. Currently, funds are 

reserved for purposes including pilots, demonstration and evaluation projects; grants to 

territories; and grants to national public or non-profit agencies to serve eligible American Indian 

and Pacific Island /Asian American individuals. 

The latest competition for national grantees was conducted in 2012. AoA collaborated with DOL 

on this competition to ensure a smooth transition if Congress authorizes the transfer of the 

program. Through this collaboration, AoA has provided input and suggestions related to 

priorities and targeting. 

In general, 75 percent of Federal funds under SCSEP must be spent on wages and benefits to 

participants with the remaining funds used for other participant costs. There is a cap on 

administrative expenses of 13.5 percent. The Federal funds provided to each of the 74 grantees 

can be no more than 90 percent of the total project amount, with the non-federal matching 

requirement either in cash or in-kind. 
HEALTH AND INDEPENDENCE

73 

Funding History

Funding for the Senior Community Service Employment Program at the Department of Labor 

during the past five years is as follows:

FY 2009 ...................................$571,925,000 

FY 2010 ................................... $825,425,00035

FY 2011 ..................................$449,100,000 

FY 2012 ...................................$448,251,000 

FY 2013 CR. ............................$450,994,000 

Budget Request

The FY 2014 request for SCSEP is $380,000,000, a reduction of -$68,251,000 from the FY 2012 

enacted level. Funds will continue to be used to provide formula grants to States and competitive 

grants to national organizations. This funding will also provide necessary administrative support, 

monitoring, and technical assistance; including funding for staff 16 FTE in FY 2014. 

This request continues to propose to transfer responsibility for SCSEP from the Department of 

Labor to the Administration for Community Living. SCSEP helps older individuals maintain 

their economic independence by providing much-needed employment income and training. The 

proposed transfer to ACL will allow for the placement of the program in an agency that has as 

one its priorities the mission of helping older Americans maintain their independence (both 

economic independence and living arrangements) and active participation in communities. This 

shift reflects the recognition that the SCSEP participants can benefit immensely from the strong 

integration of the program with the supports provided by AoA’s existing Aging Services 

programs and ACL’s service network connections. As a part of the proposed transfer to ACL’s 

administration, ACL will make improving program performance, including targeting the SCSEP 

program to people with the greatest need, a priority. This process is expected to include better 

aligning the program’s eligibility, income, and other requirements with those of other HHS 

income maintenance programs, in particular by considering all sources of income for future 

enrollees.

Demographic analysis indicates that older workers will account for an increasingly large portion 

of the available workforce in the decades ahead. Seniors’ participation in SCSEP helps 

employers recognize the value of older workers as both needed employees and mentors to 

younger workers. ACL will leverage the experience of the Department of Labor to continue 

encouraging and expanding job opportunities for aging workers, and work with the One-Stop 

Career Center system to place job-ready older workers in unsubsidized employment, helping to 

 

35 Includes a one-time special appropriation of $225,000,000 to serve low-income seniors affected by the recession.
HEALTH AND INDEPENDENCE

74 

break down the barriers to fair and diverse workplaces for these senior workers. ACL will use 

the requested funds to continue the vital work done by SCSEP as well as create program 

efficiencies within the context of the aging services network. Millions of hours of community 

service are provided by SCSEP participants each year to non-profit organizations and 

government agencies; more than 45,000,000 hours in each of the last few years. Community 

service is an equally valuable aspect of SCSEP funding that is inextricably linked to the public 

service employment wages and training that seniors receive while in the program. In FY 2014, 

ACL, in partnership with the DOL, the aging services network, and the workforce investment 

system, will continue to explore creative ideas that highlight opportunities for seniors to serve 

their communities while accessing employment training options. 

Outcome Table

Measure Most Recent 

Result 

PY 2012 

Projection 

PY 2014

Projection 

FY 2014 

+/- FY 2012

Output 1.1: Average earnings in the second and 

third quarters after exit (Outcome)

PY 2011: 

$7,580 $7,580 TBD TBD

Output 1.3: Percent of participants employed in 

the first quarter after exit (Outcome)

PY 2011: 

40.6% 40.6% TBD TBD

Output 1.4: Percent of participants employed in 

the first quarter after exit still employed in the 

second and third quarters after exit (Outcome)

PY 2011: 

72.9% 72.9% TBD TBD

These outcomes were developed and the data collected by the Department of Labor. Under the 

proposal to transfer SCSEP, ACL will work with all relevant parties to develop and refine 

performance measures and collect performance data.
75 

Native American Nutrition and Supportive Services

FY 2012

Enacted

FY 2013

Annualized CR

FY 2014

President’s Budget

FY 2014+/-

FY 2012

Native American Nutrition & Supportive 

Services....... $27,601,000 $27,770,000 $27,601,000 --

Authorizing Legislation: Sections 613 and 623 of the Older Americans Act of 1965, as amended 

FY 2014 Older Americans Act Authorization ...................................................................... Expired

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. According to the 

2010 Census, 282,917 people age 60+ identified as American Indian and Alaska Native alone 

and 377,479 people age 60+ identified as American Indian and Alaska Native alone or in 

combination with another racial group. 

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 AoA’s congregate meal program reaches 32 percent of eligible Native American 

seniors in participating Tribal organizations, home-delivered meals reach 14 percent of such 

persons, and supportive services reach 52 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 diversity of Native American communities and represent an important part of each 

community’s comprehensive services. 

Services provided by this program in FY 2011, the most recent year for which data are available, 

include: 

• Transportation Services, which provided over 794,775 rides to meal sites, medical 

appointments, pharmacies, grocery stores, and other critical daily activities (Output L).
HEALTH AND INDEPENDENCE

76 

• Home-Delivered Nutrition Services, under which 2.6 million meals were provided to 

nearly 29,007 homebound 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 (Output M).

• Congregate Nutrition Services, which provided 2.3 million meals to more than 

52,164 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 (Output N). 

• Information, Referral and Outreach Services, which provided over 1.3 million 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 (Output O).

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, 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 2012 grants 

were awarded to 256 Tribal organizations (representing 400 Tribes), including two 

organizations serving Native Hawaiian elders, with an average award of $105,593 and a range 

of grant awards from $72,220 to $1,505,000. 
HEALTH AND INDEPENDENCE

77 

Funding History:

Funding for Native American Nutrition and Supportive Services during the past five years is as 

follows: 

FY 2009 .................................................$27,208,000 

FY 2009 (ARRA) .....................................$3,000,000 

FY 2010 .................................................$27,704,000 

FY 2011 .................................................$27,653,000 

FY 2012 .................................................$27,601,000 

FY 2013 CR ...........................................$27,770,000 

Budget Request:

The FY 2014 request for Native American Nutrition and Supportive Services is $27,601,000, the 

same as the FY 2012 enacted level. 

Native American Nutrition and Supportive Services, like the same services that HCBSS and 

Nutrition Services fund for States, help to put off 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 intensively involved with the care of their loved ones, at the risk 

of their own health and careers. 

At the FY 2014 request level, these services will provide 830,000 rides (Output L), 2.5 million 

meals at home (Output M), and 2.0 million meals at congregate sites (Output N) to 

approximately 69,500 Native American seniors. Services will allow 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 they desire. 

In FY 2014 the targeted number of units of service, such as home-delivered meals and 

transportation trips, provided to Native Americans per thousand dollars of AoA funding is 

projected at 300, a 36 percent increase over the FY 2002 base of 220 (Outcome 1.3). Over the

past several years Native American services have met or exceeded their efficiency and output 

targets for meals and trips due in part to increased contributions from tribal organizations. 
HEALTH AND INDEPENDENCE

78 

Outcome and Outputs Table:

Native American Nutrition & Supportive Services Outcome and Outputs 

Measure Most Recent Result FY 2012 

Target 

FY 2014 

Target 

FY 2014 

+/- FY 2012

Output 1.3: For Title VI Services, increase 

the number of units of service provided to 

Native Americans per thousand dollars of 

AoA funding. (Outcome) 

FY 2011: 312

Target: 300

(Target Exceeded)

300 300 Maintain

Indicator Most Recent Result FY 2012 

Projection 

FY 2014

Projection 

FY 2014 

+/- FY 2012 

Output L: Transportation Services units

(Output) FY 2011: 795,000 830,000 830,000 --

Output M: Home-Delivered Nutrition 

meals (Output) FY 2011: 2.6 M 2.5 M 2.5 M --

Output N: Congregate Nutrition meals

(Output) FY 2011: 2.28 M 2.0 M 2.0 M --

Output O: Information, Referral and 

Outreach units (Output) FY 2011: 1.3 M 1.0 M 1.0 M --

Grant Awards Table:

Native American Nutrition & Supportive Services Grant Awards 

FY 2012

Actual

FY 2013

Annualized CR

FY 2014 

President’s 

Budget

Number of 

Awards 256 256 256

Average 

Award $105,593 $108,205 $107,547

Range of 

Awards

$72,220 -

$1,505,000

$74,130 -

$1,505,000

$73,650 -

$1,505,000
HEALTH AND INDEPENDENCE

79 

Resource and Program Data:

Native American Nutrition and Supportive Services 

(Dollars in Thousands) 

FY 2012 FY 2013 FY 2014

Enacted Annual CR President's Budget

Mechanism # $ # $ # $

Grants:

Formula 256 27,046 256 27,135 256 26,957

New Discretionary -- -- -- -- -- --

Continuations -- -- -- -- -- -- 

Contracts 1 534 1 561 1 570

Interagency Agreements -- -- -- -- -- --

Program Support 1/ 21 74 74

Total Resources 27,601 27,770 27,601

1/ Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and 

review, and information technology support costs.
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81 

Aging Network Support Activities

FY 2012

Enacted

FY 2013

Annualized CR

FY 2014

President’s Budget

FY 2014+/-

FY 2012

Aging Network Support 

Activities.................. $7,873,000 $7,921,000 $7,873,000 --

Authorizing Legislation: Section 201, 202, 215, and 411 of the Older Americans Act of 1965, as 

amended

FY 2014 Older Americans Act Authorization ...................................................................... Expired

Allocation Method ............................ Competitive Grants/Co-operative Agreements and Contracts

Program Description and Accomplishments:

Aging Network Support Activities programs provide competitive grants and contracts to support 

ongoing activities of national significance which help seniors and their families to obtain information 

about their care options and benefits, and which provide 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 AoA’s 

core service delivery programs. 

Competitive grants, cooperative agreements, and contracts for Aging Network Support Activities are 

awarded to eligible public or private agencies and organizations, States, and Area Agencies on Aging 

(AAAs), institutions of higher learning, and other organizations representing and/or serving older 

people, including faith-based organizations. Grantees are required 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 four years. In FY 2012, Aging Network Support Activities 

funded 23 grants with an average award of $301,070. 

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 
HEALTH AND INDEPENDENCE

82 

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 tool for older adults and their 

caregivers, serving over 647,867 individuals per year. 

This program also supports efforts to enhance discovery, documentation, and support for locallydeveloped program models and volunteer engagement strategies. Eighteen model programs

launched in FY 2011 involved older adults in civic engagement projects aimed at increasing 

services to frail elders, families of children with special needs, and grandparents raising 

grandchildren. These model programs also partnered with the Corporation for National and 

Community Service. 

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. In the 

12-month period ending January 31, 2012, the National Alzheimer’s Call Center handled over 

257,000 calls through its national and local partners, and its on-line message board community 

recorded over 12 million page views and over 110,000 individual postings. The National 

Alzheimer’s Call Center is available to people in all States, 24 hours a day, 7 days a week, 

365 days a year to provide expert advice, care consultation, and information and referrals at the 

national and local levels regarding Alzheimer’s disease. Trained professional customer service 

staff and masters degree social workers are available at all times. The Call Center is accessible 

by telephone, website, or e-mail at no cost to the caller. Information provided may include basic 

information on caregiving, handling legal issues, resources for long-distance caregiving, and tips 

for working with the medical community. Local community-based organizations are directly 

involved to ensure local, on-the-ground capacity to respond to emergencies and on-going needs 

of Alzheimer’s patients, their families, and informal caregivers. The Call Center has 

multilingual capacity and responds to inquiries in at least 140 languages through its own 

bilingual staff and with the use of a language interpretation service. 

Pension Counseling and Information 

The Pension Counseling program, first funded in 1993, 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 more than 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. AoA currently funds six

regional counseling projects covering 29 States. Data for the program shows that:
HEALTH AND INDEPENDENCE

83 

• Pension Counseling projects have successfully obtained a return of more than seven 

dollars for every Federal dollar invested in the program. 

• Projects have directly served over 40,000 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. 

National Education and Resource Center on Women and Retirement Planning

The National Education and Resource Center on Women and Retirement Planning, established in 

1998, provides women with access to a one-stop gateway that integrates financial information 

and resources on retirement, health, and planning for long-term care. This project has made userfriendly financial education and retirement planning tools available to traditionally hard-to-reach 

women, including average-income and low-income women, women of color, women with 

limited English speaking proficiency, rural, and other “underserved” women. Information is 

offered through financial and retirement planning programs, workshops tailored to meet 

women’s special needs, and publications in hard copy and Web-based formats. Since its 

establishment, the Center has conducted more than 20,000 workshops on strategies to access 

financial and retirement planning information for women and disseminated financial and 

retirement planning information tailored to the specific needs of hard-to-reach women. 

National Resource Centers on Native American Elders

The National Resource Centers on Native American Elders enhance knowledge about older 

Native Americans and thereby increase and 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. 

Resource centers have specialized areas of interest. 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 developed a database of information about American 

Indian, Alaska Native and Native Hawaiian Elders. The University of Hawaii Resource Center 
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84 

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 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 and ethnic 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. 

For example, the Center for American Indian and Alaska Native elders is developing a culturally 

appropriate caregiver manual/toolkit for caregivers caring for elders with dementia. 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 as well as those directly 

related to cultural diversity. Strategies developed under this program incorporate the latest 

technology and facilitate the generation and dissemination of knowledge in forms that can assist 

racial and ethnic 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 curricula and manual tailored for racial 

and ethnic minority seniors, a series of bilingual Influenza Vaccination Promotion materials, and 

a referral database of Chronic Disease Self-Management (CDSME) workshops. 

LGBT elders face a number of unique challenges as they strive to maintain their independence. 

The LGBT Resource Center, established in 2010, strives to meet three primary objectives: to 

educate mainstream aging services organizations about the existence and special needs of LGBT 

elders, to sensitize LGBT organizations about the existence and special needs of older adults, and 

to educate LGBT individuals about the importance of planning ahead for future long-term care 

needs. The national resource center formally began services in September 2010 with the 

launching of a website including training curricula and social networking tools. In 2014, with the 

groundwork and tools now in place and available, a primary Resource Center focus will be on 

the provision of training and technical assistance for community providers across the country. 

Program Performance and Technical Assistance 

This activity supports cooperative efforts between AoA and selected States and AAAs to develop 

various 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. It also 

supports partnerships with National Aging Organizations to foster innovation and provide 
HEALTH AND INDEPENDENCE

85 

technical assistance to States, AAAs, and Tribal organizations in strategic planning, program 

development, and performance improvement. 

Funding History:

Comparable funding for Aging Network Support Activities is as follows: 

FY 2009 ...................................................$8,200,000 

FY 2010 ...................................................$8,198,000 

FY 2011 ...................................................$8,184,000 

FY 2012 ...................................................$7,873,000 

FY 2013 CR. ............................................$7,921,000 

Budget Request:

The FY 2014 request for Aging Network Support Activities is $7,873,000, the same as the 

FY 2012 enacted level. The programs funded by this request provide critical and ongoing 

support for the national aging services network and are needed to support the activities of AoA’s 

core service delivery programs. Not only do they provide a variety of services, some of which – 

such as the National Alzheimer’s Call Center and the National Eldercare Locator – are not the 

responsibility of any other government agency, these programs also considerably strengthen and 

streamline AoA’s core services, and are critical to AoA’s continuing success.

Aging Network Support Activities outcomes are reflected in performance targets for Health and 

Independence and Caregiver Services. 

Aging Network Support Activities includes funding for the following projects (dollars in thousands): 

Activity

FY 2012

Enacted

FY 2013

Annualized 

CR

FY 2014 

President’s 

Budget

Aging Network Support Activities:

National Eldercare Locator and Engagement........................................ $ 2,151 $ 2,164 $ 2,151

National Alzheimer's Call Center ......................................................... 998 1,004 998

National Education & Resource Center on Women & Retirement....... 248 249 248

Pension Information and Counseling Program ..................................... 1,713 1,723 1,713

National Resource Centers on Native Americans................................. 691 695 691

National Minority Aging Organizations ............................................... 1,230 1,237 1,230

Program Performance and Technical Assistance .................................. 843 849 843

Total, Aging Network Support Activities...................................... $ 7,873 $ 7,921 $ 7,873
HEALTH AND INDEPENDENCE

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Grant Awards Table:

Aging Network Support Grant Awards 

FY 2012

Actual

FY 2013

Annualized CR

FY 2014 

President’s 

Budget

Number of 

Awards 23 20-23 20-23

Average 

Award $301,070 $301,070 $301,070

Range of 

Awards

$104,516 -

$1,121,518

$104,516 -

$1,121,518

$104,516 -

$1,121,518

Resource and Program Data:

Aging Network Support Activities

(Dollars in thousands) 

FY 2012 FY 2013 FY 2014

Enacted Annual CR President's Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary 8 1,627 11 4,614 2 1,039

Continuations 15 6,009 10 2,817 21 6,344

Contracts 1 48 3 142 3 142

Interagency Agreements 1 50 1 200 1 200

Program Support 1/ 139 148 148

Total Resources 7,873 7,921 7,873

1/ Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and 

review, and information technology support costs.
87 

Caregiver 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 informal family caregivers, paraprofessionals, or unrelated friends and neighbors who 

volunteer their time - that determines whether an older person can remain in his or her home. In 

2009, approximately 43.5 million adult caregivers provided uncompensated care to those 

50 years of age and older.36 AARP estimated the economic cost of replacing unpaid caregiving 

in 2009 to be about $450 billion, an increase from $375 billion in 2007 (cost if that care had to 

be replaced with paid services).37 

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.38 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-eight percent of the caregivers 

served by OAA programs report that these services allow them to provide care longer than they 

otherwise could.39 

At the same time, ACL recognizes that it must also address the growing need for more caregivers 

every day. By 2015, it is projected that there will be 12.9 million non-institutionalized seniors 

 

36 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

37 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

38 Schulz R, Beach SR. Caregiving as a risk factor for mortality. The Caregiver Health Effects study. JAMA 

December 15, 1999;282:2215-9.

39 2011 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID.
CAREGIVER SERVICES

88 

age 65 and over with 1+ ADL deficits, an increase of almost 2 million seniors (or 18 percent 

since 2008) needing caregiver assistance.40 

To address these caregiver-related needs, ACL requests a total of $182,512,000, an increase of 

+$16,027,000 over the FY 2012 enacted level. The request includes:

• $153,621,000 for Family Caregiver Support Services, the same as the FY 2012 enacted 

level. This program makes a range of support services available to family and informal 

caregivers in States, 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. 

• $6,364,000 for Native American Caregiver Support Services, the same as the FY 2012 

enacted 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. 

• $9,537,000 for Alzheimer’s Disease Supportive Services, an increase of +$5,527,000 

over the FY 2012 enacted level. This program is currently the only program at HHS

focused specifically on supportive services for those with Alzheimer’s Disease (AD) and 

their caregivers. One critical focus of this program is to support the family caregivers 

who provide countless hours of unpaid care, thereby enabling their family members with 

dementia to continue living in the community. Another focus is to expand the 

availability of evidence-based diagnostic and support services to those with Alzheimer’s. 

• $10,500,000 for services to individuals with Alzheimer’s Disease and their families under 

the President’s Alzheimer’s Initiative, funded from the Prevention and Public Health 

Fund. There were no funds allocated for this activity in FY 2012. Funds will be used to 

expand efforts to develop more AD-capable long-term services and supports systems 

designed to meet the needs of AD caregivers. Caregivers will be linked to interventions 

shown to decrease their burden and depression and thus improve their health outcomes. 

 

40 Data extrapolated by AoA from U.S. Census Bureau, “2008 National Population Projections,” released August 

2008, http://www.census.gov/population/www/projections/2008projections.html and Health Data Interactive, 

National Center on Health Statistics, Centers for Disease Control and Prevention, “Functional limitations among 

Medicare beneficiaries, ages 65+: US, 1992-2006.” Accessed 31 August 2009. 
CAREGIVER SERVICES

89 

• $2,490,000 for Lifespan Respite Care, the same as the FY 2012 enacted level. This 

program funds grants to improve the quality 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 with disabilities by providing 

critical respite care and other support services for family caregivers, training and recruitment of 

care workers and volunteers, information and outreach, counseling, and other supplemental 

services.
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91 

Family Caregiver Support Services

FY 2012

Enacted

FY 2013

Annualized CR

FY 2014

President’s Budget

FY 2014+/-

FY 2012

Family Caregiver Support 

Services........................ $153,621,000 $154,561,000 $153,621,000 --

Authorizing Legislation: Section 371 of the Older Americans Act of 1965, as amended 

FY 2014 Older Americans Act Authorization ...................................................................... Expired

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

Program Description and Accomplishments:

Family Caregiver Support Services provides 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 - 

including transportation services, homemaker services, home-delivered meals, and adult day care 

- to provide a coordinated set of supports for seniors which caregivers can access on their behalf.

Family Caregiver Support Services provide a variety of supports to family and informal 

caregivers. Based on FY 2011 data, the most recent available, services provided included: 

• Access Assistance Services provided over 1.3 million contacts to caregivers assisting 

them in locating services from a variety of public and private agencies (Output I).

• Counseling and Training Services provided over 128,000 caregivers with counseling, 

peer support groups, and training to help them better cope with the stresses of caregiving 

(Output J).

• Respite Care Services provided nearly 67,000 caregivers with 7 million hours of 

temporary relief - at home, or in an adult day care or nursing home setting - from their 

caregiving responsibilities (Output K).

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 
CAREGIVER SERVICES

92 

personal care and homemaking to more complex health-related interventions like medication 

administration and wound care. AARP estimated the economic cost of replacing unpaid 

caregiving in 2009 to be about $450 billion (the cost if that care had to be replaced with paid 

services).41 Caregivers often experience conflicts between work and caregiving, with 25 percent 

reporting that they have had to make adjustments such as retiring or taking time away from work 

due to their caregiving responsibilities.

Research has shown that caregiving exacts a heavy emotional, physical, and financial toll. As 

reported in AoA’s 2012 National Survey of OAA Participants, 22 percent of caregivers are 

assisting two or more individuals. Seventy-one percent of Title III caregivers are 60 or older, 

making them more vulnerable to a decline in their own health, and twenty-nine percent describe 

their own health as fair to poor.42 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.43

Additionally, data from AoA’s national surveys of caregivers of elderly clients also shows that 

OAA services, including those provided through Family Caregiver Support Services, are 

effective in helping caregivers keep their loved ones at home. Approximately 77 percent of 

caregivers of program clients reported in 2012 that services enabled them to provide care longer 

than otherwise would have been possible.44 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. Forty-three percent of the caregivers of nursing home eligible care recipients 

indicated that the care recipient would be unable to remain at home without the support services. 

Those respondents were then asked to identify where the care recipient would be living without 

services. A significant majority of those caregivers, 78 percent, indicated that the care recipient 

would most likely be living in a nursing home or assisted living (see below). 

 

41 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

42 2012 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID.

43 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.

44 2012 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID.
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(based on responses from care recipients unable to live independently) 45

Funding History:

Funding for Family Caregiver Support Services during the past five years is as follows: 

FY 2009 ...............................................$154,220,000 

FY 2010 ...............................................$154,197,000 

FY 2011 ...............................................$153,912,000 

FY 2012 ...............................................$153,621,000 

FY 2013 CR. ........................................$154,561,000 

Budget Request:

The FY 2014 request for Family Caregiver Support Services levels is $153,621,000, the same as 

the FY 2012 enacted level. With this proposed funding, 790,000 caregivers (Outcome 3.1) will 

 

45 2012 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID.

Nursing Home

61%

Assisted Living

17%

Other Family Home

8%

Caregiver's Home

10%

Other

2%

They Would Die

2%

Where Care Recipients with 3+ ADL Would Live if 

Unable to Have Caregiver Supportive Services
CAREGIVER SERVICES

94 

be provided with supportive services, including respite care or temporary relief from their 

caregiving responsibilities. This represents 30,000 caregivers more than the level served in 

FY 2011. Respite care is the service rated by caregivers as the most helpful. Nearly 

120,000 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). 

Caregivers state that these programs help keep their loved ones at home, as 83 percent of 

caregivers report these supportive services enable them to provide care longer.

In FY 2014, AoA expects the aging services network to meet or exceed the target of only 

28 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 2011 that rate had been reduced by more 

than half to 30 percent of caregivers reporting difficulty getting services.

For FY 2014, 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. Client-reported assessment of service quality and program outcomes is expected to 

remain at high levels, however some service outputs are expected to decline in FY 2014 

compared to FY 2010. Declines are projected to be largely attributable to declining leveraged 

funds, as State, local, and private budgets face economic hardships. 
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95 

Outcomes and Outputs Table:

Family Caregiver Support Services Outcomes and Outputs 

Measure Most Recent Result FY 2012

Target 

FY 2014

Target 

FY 2014 

+/- FY 2012

Outcome 2.6: Reduce the percent of 

caregivers who report difficulty in 

getting services. (Outcome) 

FY 2011: 30%

Target: 30%

(Target Met) 

28% 28% Maintain

Outcome 2.9c: 90% of NFCSP clients 

rate services good to excellent.

(Outcome) 

FY 2011: 96%

Target: 90%

(Target Exceeded)

90% 90% Maintain

Outcome 3.1: Increase the number of 

caregivers served. (Outcome) 

FY 2011: 819,598

Target: 790,000

(Target Exceeded)

792,000 790,000 -2,000

Indicator Most Recent Result FY 2012

Projection 

FY 2014 

Projection

FY 2014 

+/- FY 2012

Output I: Caregivers access assistance 

units of service. (Output) FY 2011: 1.3 M 950,000 915,000 -35,000

Output J: Caregivers receiving 

counseling and training. (Output) FY 2011: 128,685 124,000 122,000 -2,000

Output K: Caregivers receiving respite 

care services. (Output) FY 2011: 66,788 67,000 67,000 --

Note: FY 2011 data are preliminary. For presentation within the budget AoA highlighted specific measures that are 

most directly related to Family Caregiver Support Services, however multiple performance outcomes are impacted 

by this program because AoA’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 

FY 2012

Actual

FY 2013 

Annualized CR 

FY 2014 

President’s 

Budget

Number of 

Awards 56 56 56

Average 

Award $2,726,394 $2,732,418 $2,715,800

Range of 

Awards

$95,424 -

$15,442,307

$95,635 -

$15,553,918

$95,053 -

$15,459,324
CAREGIVER SERVICES

96 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION ON AGING

FY 2014 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Family Caregivers Support Services (CFDA 93.052)

State/Territory

FY 2012

Actual

FY 2013

Estimate

FY 2014

Estimate

FY 2014 +/-

FY 2012

Alabama.......................................... 2,351,563 2,347,598 2,333,321 -18,242

Alaska ............................................. 763,390 765,076 760,423 -2,967

Arizona ........................................... 3,164,166 3,238,861 3,219,163 54,997

Arkansas ......................................... 1,503,924 1,505,194 1,496,039 -7,885

California ........................................ 15,442,307 15,553,918 15,459,324 17,017

Colorado ......................................... 1,926,424 1,963,071 1,951,132 24,708

Connecticut..................................... 1,874,713 1,849,714 1,838,464 -36,249

Delaware......................................... 763,390 765,076 760,423 -2,967

District of Columbia ....................... 763,390 765,076 760,423 -2,967

Florida............................................. 12,070,518 12,187,704 12,113,581 43,063

Georgia ........................................... 3,547,261 3,614,235 3,592,254 44,993

Hawaii............................................. 763,390 765,076 760,423 -2,967

Idaho ............................................... 763,390 765,076 760,423 -2,967

Illinois............................................. 5,898,667 5,857,968 5,822,342 -76,325

Indiana ............................................ 3,054,144 3,042,965 3,024,458 -29,686

Iowa ................................................ 1,723,829 1,699,582 1,689,245 -34,584

Kansas............................................. 1,408,146 1,395,639 1,387,151 -20,995

Kentucky......................................... 2,059,860 2,062,117 2,049,576 -10,284

Louisiana ........................................ 1,991,274 1,995,930 1,983,792 -7,482

Maine .............................................. 766,439 765,076 760,423 -6,016

Maryland......................................... 2,524,149 2,535,834 2,520,412 -3,737

Massachusetts................................. 3,349,110 3,315,526 3,295,361 -53,749

Michigan......................................... 4,947,620 4,919,406 4,889,488 -58,132

Minnesota ....................................... 2,521,552 2,527,039 2,511,670 -9,882

Mississippi...................................... 1,363,666 1,360,029 1,351,757 -11,909

Missouri.......................................... 3,049,893 3,041,877 3,023,377 -26,516

Montana .......................................... 763,390 765,076 760,423 -2,967

Nebraska ......................................... 933,179 921,876 916,269 -16,910

Nevada ............................................ 1,095,922 1,125,972 1,119,124 23,202

New Hampshire .............................. 763,390 765,076 760,423 -2,967
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State/Territory

FY 2012

Actual

FY 2013

Estimate

FY 2014

Estimate

FY 2014 +/-

FY 2012

New Jersey................................. 4,381,530 4,331,860 4,305,515 -76,015

New Mexico .............................. 949,699 961,311 955,465 5,766

New York .................................. 9,679,695 9,582,512 9,524,234 -155,461

North Carolina ........................... 4,360,720 4,405,626 4,378,832 18,112

North Dakota ............................. 763,390 765,076 760,423 -2,967

Ohio ........................................... 5,998,353 5,952,469 5,916,267 -82,086

Oklahoma................................... 1,822,471 1,820,933 1,809,859 -12,612

Oregon ....................................... 1,908,337 1,924,500 1,912,796 4,459

Pennsylvania .............................. 7,379,177 7,270,632 7,226,414 -152,763

Rhode Island .............................. 763,390 765,076 760,423 -2,967

South Carolina ........................... 2,184,482 2,225,118 2,211,585 27,103

South Dakota ............................. 763,390 765,076 760,423 -2,967

Tennessee................................... 3,006,252 3,030,768 3,012,336 6,084

Texas.......................................... 9,176,247 9,313,287 9,256,646 80,399

Utah ........................................... 888,363 901,446 895,964 7,601

Vermont..................................... 763,390 765,076 760,423 -2,967

Virginia...................................... 3,445,502 3,479,460 3,458,299 12,797

Washington................................ 2,923,761 2,968,845 2,950,790 27,029

West Virginia............................. 1,079,225 1,065,973 1,059,490 -19,735

Wisconsin .................................. 2,887,461 2,864,463 2,847,042 -40,419

Wyoming ................................... 763,390 765,076 760,423 -2,967

Subtotal, States .......................... 149,800,281 150,107,246 149,194,333 -605,948 

American Samoa........................ 95,424 95,635 95,053 -371

Guam ......................................... 381,695 382,538 380,212 -1,483

Northern Mariana Islands .......... 95,424 95,635 95,053 -371

Puerto Rico ................................ 1,923,559 1,951,798 1,939,927 16,368

Virgin Islands ............................ 381,695 382,538 380,212 -1,438

Subtotal, States and Territories.. 152,678,078 153,015,390 152,084,790 -593,288 

Undistributed46 942,922 1,545,610 1,536,210 593,288 

TOTAL 153,621,000 154,561,000 153,621,000 -- 

 

46 The undistributed line reflects the amount reserved from the Family Caregiver Support Services appropriation for statutory 

related activities, including contingencies and for program support including information and systems, technical assistance, 

evaluation, monitoring and oversight. Funds unused for these purposes at the end of the year are allocated to States.
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99 

Native American Caregiver Support Services

FY 2012

Enacted

FY 2013

Annualized CR

FY 2014

President’s Budget

FY 2014+/-

FY 2012

Native American Caregiver 

Support Services.............. $6,364,000 $6,403,000 $6,364,000 --

Authorizing Legislation: Section 631 of the Older Americans Act of 1965, as amended 

FY 2014 Authorization ......................................................................................................... Expired

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

Program Description and Accomplishments:

Native American Caregiver Support Services provide grants to eligible Tribal organizations to 

provide support for 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 cultural diversity 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 population 

aged 60 and over. Tribal organizations must represent at least 50 Native American elders age 60 

and over and be receiving a grant under Title VI Part A or B 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, including the Volunteers In Service To America (VISTA) program, 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. 
CAREGIVER SERVICES

100

Rather, as expressed by multiple Tribal leaders, the program provides support that strengthens the 

family caregiver role. 

Funding History:

Funding for the Native American Caregiver Support Services during the past five years is as 

follows:

FY 2009 ...................................................$6,389,000

FY 2010 ...................................................$6,388,000

FY 2011 ...................................................$6,376,000

FY 2012 ...................................................$6,364,000

FY 2013 CR. ............................................$6,403,000

Budget Request:

The FY 2014 request for Native American Caregiver Support Services is $6,364,000, the same 

as the FY 2012 enacted level. Support for caregivers is critical since often it is their availability, 

whether they are informal family caregivers, paraprofessionals or unrelated friends and 

neighbors who volunteer their time, that determines whether an older person can remain in his or 

her home.

In the 2009 American Community Survey, approximately 301,000 persons age 60 and over 

identified themselves as American Indians or Alaskan Natives, and another 242,000 persons age 

60 and over identified themselves as part American Indian or Alaskan Native. 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 and desired. 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.

Performance data indicates that these programs are an efficient means to help Native American 

Elders remain independent and in the community. It should be noted that some service outputs 

for FY 2014 are expected to decline due to the economic downturn impacting Tribal government 

budgets.

In FY 2014 the Native American Caregiver Support Program will continue to assist family 

caregivers, whose assistance is critical to enabling Native American elders with disabilities to 

remain at home, in the community, and on the reservation. It is estimated that in FY 2014 more 
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101

than 320,000 units of caregiver-related services including respite care, information and referral, 

caregiver training, lending closets, and support groups will have been provided by Native 

American Tribal organizations.

Outcome Table:

Native American Caregivers Supportive Services Outcome

Measure Most Recent 

Result 

FY 2012

Target 

FY 2014

Target

FY 2014 

+/- FY 2012

Outcome 3.1: Increase the number of 

caregivers served. (Outcome)

FY 2011: 819,598

Target: 790,000

(Target Exceeded)

792,000 790,000 -2,000

Grant Awards Table:

Native American Caregivers Supportive Services Grant Awards

FY 2012 

Actual

FY 20123 

Annualized CR

FY 2014 

President’s 

Budget

Number of 

Awards 218 218 218

Average 

Award $29,119 $29,298 $29,120

Range of 

Awards

$13,360 -

$54,689

$13,450 -

$54,303

$13,360 -

$54,740
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102

Resource and Program Data:

Native American Caregiver Support Services

(Dollars in thousands)

FY 2012 FY 2013 FY 2014

Enacted Annual CR President's Budget

Mechanism # $ # $ # $

Grants:

Formula 218 6,362 218 6,387 218 6,348

New Discretionary -- -- -- -- -- --

Continuations -- -- -- -- -- --

Contracts -- -- -- -- -- --

Interagency Agreements -- -- -- -- -- --

Program Support 2 16 16

Total Resources 6,364 6,403 6,364

1/ Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and 

review, and information technology support costs.
103 

Alzheimer’s Disease Supportive Services Program

FY 2012

Enacted

FY 2013

Annualized CR

FY 2014

President’s Budget

FY 2014+/-

FY 2012

Alzheimer’s Disease Supportive 

Services Program.................. $4,010,000 $4,035,000 $9,537,000 +$5,527,000

Authorizing Legislation: Section 398 of the Public Health Services Act, as amended 

FY 2014 Authorization ......................................................................................................... Expired

Allocation Method ............................ Competitive Grants/Co-operative 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 interventions that help persons with dementia 

and their caregivers remain independent in the community as long as they desire it. The primary 

components of the ADSSP program include delivering evidence-based supportive services; 

translating and replicating evidence-based interventions for persons with dementia and their 

caregivers at the community level; incorporating evidence-based research in the formulation of 

innovative projects; and advancing changes to a State’s overall system of home and communitybased care. 

These changes are focused on expanding the aging services network’s capacity to assist those 

with dementia and their families by providing individualized and public information, education, 

and referrals about diagnostic, treatment and related services. The program also provides sources 

of assistance for services and legal rights assistance for people affected by Alzheimer’s disease

throughout a state’s long term services and support system. 

Funding for ADSSP was reduced by the Congress in FY 2012 to a level that only allowed AoA 

to issue continuation grants to 11 grantees. Through projects funded in prior years, seven States 

are in the process of translating four evidence-based interventions into practice and nine States 

are offering innovative programming for caregivers and their loved ones with dementia. One 

example of these promising interventions is the New York University Caregiver Intervention, a 

spousal caregiver support program that in a randomized-control trial delayed institutionalization 
CAREGIVER SERVICES

104 

of persons with dementia by an average of 557 days.47 In 2009, the average nursing home cost 

was $219 daily ($79,935 annually), which would mean an average savings of nearly $122,000 in 

institutional costs per person with dementia.48 Minnesota is translating this intervention now; 

early results appear to confirm the original study. Other grant projects are focused on innovations 

in areas of great need, such as programs to ensure that the States’ long term services and supports 

system are dementia capable. Overall, these demonstrations offer direct services and other 

supports to thousands of families, as well as support the continuous quality improvement and 

evaluation of these services. 

Family caregivers remain the major source of support for most people with Alzheimer’s disease. 

The nature of the disease - a slow loss of cognitive and functional/physical independence - 

means that most people with Alzheimer’s disease are cared for in the community for years. They 

may access a variety of services from many different systems including the aging, medical, and 

mental health service systems. As the number of people with Alzheimer’s disease grows, it is 

increasingly important that service delivery and health care systems are responsive to persons 

with dementia and are effectively coordinated. It is also important to ensure the availability of 

dementia-capable community-based social and health care services. 

Funding History:

Funding for the ADSSP program during the past five years is as follows: 

FY 2009 .................................................$11,464,000 

FY 2010 .................................................$11,462,000 

FY 2011 .................................................$11,441,000 

FY 2012 ...................................................$4,010,000 

FY 2013 CR .............................................$4,035,000 

Budget Request:

The FY 2014 request for the Alzheimer’s Disease Supportive Services Program is $9,537,000, an 

increase of +$5,527,000 compared to the FY 2012 enacted level. Continued funding will enable 

communities across the nation to continue implementing evidence-based interventions such as 

the New York University Caregiver Intervention referenced above. In addition, AoA will be 

 

47 Mittleman M, et al. (1996). “A Family Intervention to Delay Nursing Home Placement of Patients with 

Alzheimer’s Disease: a randomized, controlled trial,” Journal of the American Medical Association, 276; 1725-

1731.

48 Metlife. (October 2009), “MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Services, and 

Home Care Costs”, p. 4, Accessed August 17, 2010 

from: http://www.metlife.com/assets/cao/mmi/publications/studies/mmi-market-survey-nursing-home-assistedliving.pdf
CAREGIVER SERVICES

105

unable to undertake subsequent translations of research funded by NIA, CDC and other science 

agencies. The need for cutting edge approaches to serving this population continues as both the 

population and prevalence continue to increase. One study estimates that there were 454,000 new 

cases of Alzheimer’s disease in 2010; by 2030 the number of new cases annually is projected to 

be 615,000 and by 2050, 959,000. Currently over 5 million individuals have this disease. 49 

The FY 2014 funding request will allow ACL to continue to respond to this growing need by 

supporting new grants that provide direct services to approximately 35,000 persons with 

Alzheimer’s disease and their family caregivers. Funds will be used to broadly disseminate those 

translated, evidence-based interventions that have proven successful over the past 4 years of 

funding and to test new evidence-based interventions as they are identified. In addition, funds 

will be used to expand the delivery of dementia-capable home and community-based services, 

thereby potentially impacting the much broader population of families struggling to cope with 

this disease.

Using FY 2011 and FY 2012 funding, ADSSP is currently supporting 15 states in field testing 

9 evidence-based caregiver interventions, with the goal of embedding successful translations in 

state programs and funding streams. ACL is looking at how these interventions can be 

effectively provided through Aging Services Network programs while attempting to ensure 

fidelity to the original intervention. Successful translation of these research interventions to 

community settings will have a significant impact on supporting and sustaining family 

caregivers. 50 

By the close of FY 2013, ACL anticipates the release of evaluation results from a six-state 

translation effort of the New York University Caregiver Intervention (referenced above) which 

aims to significantly delay institutionalization of persons with dementia by providing education, 

support, and counseling to spousal and other family caregivers. In addition, ACL will have 

completed an evaluation of a three state translation of the Savvy Caregiver Intervention. This 

intervention trains caregivers to think about their situation objectively and provides them with 

the knowledge, skills, and attitudes they need to manage stress and carry out the caregiving role 

effectively.

 49 Alzheimer’s Association, (2011). “Alzheimer’s Disease Facts and Figures”., p. 17 and p. 34. Accessed August 30, 

2011 from: http://www.alz.org/alzheimers_disease_facts_figures.asp

50 The evidence-based projects have three year project periods to develop, implement and document fidelity of the 

translation to the original model. Actual dissemination/replication of the interventions occurs after the translations 

are shown to have proven fidelity to the original models in the new type of setting. Each of the States funded at the 

end of FY 2008 requested up to a 1-year no-cost extension to finalize their projects. Therefore, baselines to these 

and similar measures will be available starting in FY 2013 for the FY 2008 and subsequent grants after if/when the 

translation projects are proven successful.
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Outcome and Outputs Table:

Alzheimer’s Disease Supportive Services Program Outputs

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

Alzheimer’s Disease Supportive Services Programs, however multiple performance outcomes are impacted by this 

program because AoA’s performance measures (efficiency, effective targeting, and client outcomes) assess networkwide performance in achieving current strategic objectives.

Grant Awards Table:

Alzheimer’s Disease Supportive Services Grant Awards

FY 2012

Actual

FY 2013 

Annualized CR

FY 2014 

President’s 

Budget

Number of 

Awards 11 11 26

Average 

Award $271,073 $271,073 $271,073

Range of 

Awards

$138,559 -

$500,000

$138,559 -

$500,000

$138,559 -

$500,000

 51 Cumulative count began in 2008.

52 Cumulative count began in 2008.

Measure Most Recent Result FY 2012

Target

FY 2014

Target

FY 2014 

+/- FY 2012

Outcome ALZ2. Increase number 

of individuals served with 

evidence-based interventions –

cumulative51 (Outcome)

FY 2011: 9,518

Target: Baseline 8,800 19,000 +10,200

Indicator Most Recent Result FY 2012

Projection 

FY 2014

Projection 

FY 2014 

+/- FY 2012

Output AC: Number of 

individuals served – cumulative52

(Output)

FY 2011: 19,562 20,000 35,000 +15,000

Output AD: Percent of 

individuals served that are of a 

racial/ethnic minority (Output)

FY 2011: 23% 23% 24% +1%
107 

Resource and Program Data:

Alzheimer’s Disease Supportive Services Program

(Dollars in thousands) 

FY 2012 FY 2013 FY 2014

Enacted Annual CR President's Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary -- -- 6 3,289 12 8,390

Continuations 13 2,982 -- -- -- -- 

Contracts 1 922 1 638 1 798

Interagency Agreements -- -- -- -- -- --

Program Support 1/ 107 108 349

Total Resources 4,010 4,034 9,537

1/ Program Support -- Includes funds for Public Health Service Act statutory requirements, grant systems 

and review costs.
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109 

Alzheimer’s Disease Initiative - Services

FY 2012

Enacted

FY 2013

Annualized CR

FY 2014

President’s Budget

FY 2014+/-

FY 2012

Alzheimer’s Disease 

Initiative – PPHF......... -- $10,500,000 1/ +$10,500,000

1/ The FY 2013 Prevention Fund resources are reflected in the Office of the Secretary.

Authorizing Legislation: Sections 311 and 317(k)(2) of the Public Health Service Act, [42 

U.S.C. Sections 243 and 247b(k)(2)] as amended, and the Patient Protection and Affordable Care 

Act (ACA), Section 4002 [42 U.S.C. 300u-11]

FY 2014 Public Health Service Act Authorization............................................................... Expired

Allocation Method ............................ Competitive Grants/Co-operative Agreements and Contracts

Intended Recipients.....................................................................................States 

Program Description and Accomplishments: 

On February 7, 2012, the President announced a new effort to fight Alzheimer’s Disease. As 

many as 5.1 million people in the United States may have Alzheimer’s disease. The effects of 

Alzheimer’s can be devastating, both for individuals afflicted with the disease and for their 

families. People with Alzheimer’s may require significant amounts of health care and intensive 

long-term services and supports -- including, but not limited to, management of chronic 

conditions, help taking medications, round-the-clock supervision and care, or assistance with 

personal care activities, such as eating, bathing, and dressing. 

Research has shown that caregiving exacts a heavy emotional, physical, and financial toll. As 

reported in AoA’s 2011 National Survey of OAA Participants, 24 percent of all seniors’ 

caregivers are assisting two or more individuals. Sixty-eight percent of Title III caregivers are 

60 or older, making them more vulnerable to a decline in their own health, and thirty-four 

percent describe their own health as fair to poor.53 Caregivers also 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 non-caregivers.54 The demands of caregiving can 

 

53 2011 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID.

54 Schulz R, Beach SR. Caregiving as a risk factor for mortality. The Caregiver Health Effects study. JAMA 

December 15, 1999;282:2215-9.
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110 

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. 

Funding History: 

FY 2009 .................................................................$0 

FY 2010 .................................................................$0 

FY 2011 .................................................................$0 

FY 2012 .................................................................$0 

FY 2013 CR ........................................................ N/A55

Budget Request: 

The FY 2014 budget includes $10,500,000 from the Prevention and Public Health Fund for 

Alzheimer’s Disease Services as part of the President’s new efforts to fight Alzheimer’s Disease. 

No funding was allocated for this program in FY 2012. This funding will allow AoA to 

undertake new efforts to develop more dementia capable long-term service and support systems 

designed to meet the needs of caregivers of individuals with Alzheimer's Disease and related 

dementias (AD). Through these efforts AoA will work with lead agencies across State, local, and 

tribal governments and with the Aging Network to identify and address Alzheimer’s Disease 

caregivers’ needs when they seek assistance for themselves or the individual with Alzheimer’s 

Disease. 

ACL will use the $10.5 million it is requesting in FY 2014 to expand one particular evidencebased pilot on dementia capability by building and strengthening the dementia capability of a 

handful of states, tribal entities, or large localities. This pilot on dementia capability shows 

particular promise for broader use. A “dementia capable” home and community-based services 

system is able to identify those with dementia and their caregivers, help them choose services 

that meet their needs, and provide supports to ease the burden on caregivers. 

AoA will hold a competition to award cooperative agreements to States, tribes, or other 

localities. These entities will be charged with developing systems that coordinate or integrate 

access to a system-wide set of programs that are dementia capable including: 

• information, effective screening, referral and access 

• community-based and long-term care options counseling and assistance 

• streamlined applications and eligibility determinations for public programs 

 

55 The FY 2013 Prevention Fund resources are reflected in the Office of the Secretary.
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111

• person-centered, service coordination across multiple settings and across care transitions

The grantees will also be asked to develop three core components of a system for persons with 

dementia and their caregivers including: 

• Comprehensive set of services

• Robust quality assurance system

• Sustainable service system 

These systems will assist caregivers by ensuring that their needs, and the needs of their loved 

ones with Alzheimer’s disease, are addressed. Since the focus of the cooperative agreements 

will be to facilitate permanent systems change, an emphasis will be placed on implementing 

systems that can operate out of ongoing funding streams and will not require new sources of 

funds to maintain.
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113

Lifespan Respite Care

FY 2012

Enacted

FY 2013

Annualized CR

FY 2014

President’s Budget

FY 2014+/-

FY 2012

Lifespan Respite Care......... $2,490,000 $2,506,000 $2,490,000 --

Authorizing Legislation: Lifespan Respite Care Act of 2006, Title XXIX of the Public Health 

Service Act

FY 2014 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, often for long 

periods of time and for many years. AARP estimated, in 2009, that 65.7 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: a majority of caregivers (51%) caring for someone over age 18 

have medium or high levels of burden and 31% of all family caregivers indicated they 

experienced high levels of stress.56

Numerous studies have shown respite to be among the most frequently requested supportive 

service for family caregivers.57 Respite is second only to direct financial assistance as a key 

policy priority of surveyed family caregivers. 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. A 2009 survey found that many caregivers reported 

difficulty managing both physical and emotional stress and balancing work and family 

responsibilities. Despite this, nearly 90% of family caregivers receive no respite at all.58 

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 

 56 National Alliance for Caregiving and AARP. Caregiving in the U.S.: A Focused Look at Those Caring for the 

50+. 2009. http://www.aarp.org/research/surveys/care/ltc/hc/articles/caregiving_09.html

57 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

58 National Alliance for Caregiving and AARP, 2009.
CAREGIVER SERVICES

114

developmental disabilities, and for caregivers of veterans and individuals with Alzheimer’s 

disease, spinal cord injuries, autism, and serious emotional disorders. 59

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 of any age with special needs. In particular, this program 

provides ACL with another vehicle to address the needs of caregivers while considering the 

important contributions they make in the lives of all persons with disabilities. The goals of the 

Lifespan Respite Care program differ from the National Family Caregiver Support Program, 

which focuses on providing a variety of services to caregivers. Instead, Lifespan Respite Care 

programs focus on providing a testbed 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 provision of information, outreach, and access assistance.

Lifespan Respite also supports resource center activities designed to maintain a national database 

on lifespan respite care; provide training and technical assistance to grantees and State, 

community, and nonprofit respite care programs; and conduct public information, referral, and 

education programs on respite care. 

Since 2009, thirty states have been awarded grants of up to $200,000 each for three year projects. 

Additionally, in FY 2011, eight states were awarded expansion grants to focus specifically on 

providing respite services to meet demand and fill gaps in service where identified. Examples of 

grantee accomplishments to date include:

• 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 personcentered planning and consumer direction;

• Expansion of toll free “helplines” and dedicated websites 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;

 59 National Alliance for Caregiving. (2012). Multiple Sclersosis Caregivers. Washington, DC: Author; The Arc, 

2011.
CAREGIVER SERVICES

115

• The development of data collection methodologies to track service provision and outcomes 

development.

• Broadening stakeholder collaborations to ensure representation of all age and disability 

groups, as well as the broadest possible cross section of the provider network;

• Convening focus groups of respite consumers to inform project activities; and 

• Capacity building and network development at the local level to recruit and train 

volunteers to fill gaps in respite services, particularly in rural areas through partnerships 

with programs such as the Corporation for National Service (e.g., VISTA, Service 

Learning, Senior Companions, etc.)

Grantee States work in collaboration with Aging and Disability Resource Centers and a public or 

private non-profit statewide respite care coalition or organization, and special emphasis is placed 

on implementing or enhancing lifespan respite care statewide and who are 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 2009 ...................................................$2,500,000 

FY 2010 ...................................................$2,500,000

FY 2011 ...................................................$2,495,000

FY 2012 ...................................................$2,490,000

FY 2013 CR. ............................................$2,506,000

Note: Funding for the Lifespan Respite Care Act was appropriated in FY 2009 under the General Departmental 

Management Account in the HHS Office of the Secretary. Beginning in FY 2010 funding was appropriated directly 

to the Administration on Aging. 

Budget Request:

The FY 2014 request for Lifespan Respite is $2,490,000, the same as the FY 2012 enacted level. 

ACL recognizes the unique opportunity the Lifespan Respite Care Program presents to consider 

the critical role family caregivers play in ensuring the health and independence of individuals 

across the age and disability spectrum. No other programs allows for the ability to focus on 

family caregivers and care recipients as they age and their needs change over time. By 
CAREGIVER SERVICES

116

continuing to invest in this program, ACL seeks to provide resources 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 to include caregivers of children or 

adults of any age with special needs. According to the National Respite Coalition, nearly 90% of 

family caregivers of care recipients age 18 and older, and 81% 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.60

The resources requested for FY 2014 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.

The request will also allow ACL to focus on program development in new States not funded in 

previous years, by enabling them to establish and/or strengthen infrastructures that offer targeted 

Respite Information and Referral services. Additionally, it will further enable all States funded 

to date to continue infrastructure development, recruitment, and training of respite providers and 

volunteers, thus reducing the percentages of caregivers who do not have access to or use respite.

 60 National Respite Coalition Written Testimony to the House subcommittee on Labor, Health and Human Services, 

and Education Appropriations. April 12, 2010
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117 

Output Table:

Lifespan Respite Care Output

 

Grant Awards Table:

Lifespan Respite Care Grant Awards

FY 2012

Actual

FY 2013 

Annualized CR

FY 2014 

President’s 

Budget

Number of 

Awards 11 11 11

Average 

Award $220,456 $220,456 $220,456

Range of 

Awards

$135,000 -

$250,000

$135,000 -

$250,000

$135,000 -

$250,000

Resource and Program Data:

Lifespan Respite Care Program

(Dollars in thousands) 

FY 2012 FY 2013 FY 2014

Enacted Annual CR President's Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary 8 1,931 10 2,179 10 2,139

Continuations 3 494 1 250 1 249

Contracts -- -- -- -- -- --

Interagency Agreements -- -- -- -- -- --

Program Support 1/ 65 77 102

Total Resources 2,490 2,506 2,490

1/ Program Support -- Includes funds for Public Health Service Act statutory requirements, grant systems 

and review costs.

Indicator Most Recent 

Result 

FY 2012

Projection 

FY 2014

Projection 

FY 2014 

+/- FY 2012

Output AE: Increase the number 

of people served as a result of 

Lifespan Respite Care (Output)

N/A

N/A

(baseline set in FY 

2014

N/A (baseline set 

in FY 2013) N/A
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119

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, 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 AoA’s National 

Center on Elder Abuse showed a 16 percent increase in the number of elder abuse cases from an 

identical study conducted in 2000.61 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.62 Consistent with these 

earlier findings, 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.63

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.64 Additional adverse health impacts include an increased likelihood of heart attacks, 

dementia, depression, chronic diseases and psychological distress. The result of these 

unnecessary health problems is a growing number of seniors who access the healthcare system 

more frequently (including emergency room visits and hospital admissions), and are ultimately 

forced to leave their homes and communities prematurely.65 Protection of Vulnerable Adults 

 61 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

62 Tatara, 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

63 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.

Acierno R, Hernandez MA, Amstadter AB, Resnick HS, Steve K, Muzzy W et al. Prevalence and Correlates of 

Emotional, Physical, Sexual, and Financial Abuse and Potential Neglect in the United States: The National Elder 

Mistreatment Study. American Journal of Public Health 2010; 100(2):292-297

64 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. 

65 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

120

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 2014 request for Protection of Vulnerable Adults is $43,287,000; an increase of 

+$2,000,000 over the FY 2012 enacted level. For FY 2014, specific program requests include:

• $8,000,000 for the Adult Protective Services (APS) program authorized by the Elder 

Justice Act of 2010 (included in Subtitle H of the Affordable Care Act). APS funding will 

provide demonstration grants to test innovative approaches to reducing and addressing 

elder abuse in States and in Tribal settings. This funding will generate knowledge that 

can then be used to inform State and local efforts across the country to design and 

implement better approaches to protect our Nation’s older adults from abuse. Federal 

funding will also support evaluation of interventions designed to detect and prevent elder 

abuse, including financial exploitation; and improvement of the knowledge base about 

how to best implement these important activities. In FY 2012, an initial $6 million was 

provided for this program from the Prevention and Public Health Fund.

• $16,761,000 for the Long-Term Care Ombudsman Program, the same as the FY 2012

enacted level. This consumer advocacy program improves the quality of care for the 

residents of long-term care facilities in all States.

• $5,036,000 for Prevention of Elder Abuse and Neglect, the same as the FY 2012 enacted 

level. This program provides state formula grants to train, educate, and promote public 

awareness of elder abuse prevention efforts. 

• $9,402,000 for the Senior Medicare Patrol Program, the same as the FY 2012 enacted 

level. SMP funds competitive grants 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.

• $4,088,000 for Elder Rights Support Activities, the same as the FY 2012 enacted level. 

This program 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 will build a foundation and establish best practices 

for States to develop programs to expand and improve the protection of individuals living in their 

communities and in long-term care settings; increase the information and technical assistance 

available to the public, States, and localities in preventing and addressing abuse; protect the 
PROTECTION OF VULNERABLE ADULTS

121

rights of older adults and prevent their exploitation; 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.
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123

Adult Protective Services Demonstration Program

FY 2012

Enacted

FY 2013

Annualized CR

FY 2014

President’s Budget

FY 2014+/-

FY 2012

Adult Protective Services BA..... -- -- $8,000,000 +$8,000,000

Adult Protective Services (PPHF) $6,000,000 N/A66 -- -$6,000,000

FTE.................................... -- 1 1 +1

Authorizing Legislation: Title XX of the Social Security Act, Subtitle B, Section 2042, as 

amended by the Affordable Care Act, Subtitle H – Elder Justice Act, Sections 6701-6703;

Section 751 of the Older Americans Act, as amended

FY 2014 Social Security Act Authorization ..................................................................$25,000,000

Allocation Method ......................................................................Competitive Grants and Contracts

Program Description:

The Adult Protective Services (APS) Demonstration Program provides competitive grants to 

States to test and evaluate innovative approaches to preventing elder abuse, neglect, and 

exploitation. Current State and local APS programs provide a range of services designed to 

ensure the safety and well-being of elders who are in danger of being mistreated or neglected, are 

unable to take care of themselves or to protect themselves from harm, and who have no one to 

assist them. These services include:

• receiving and investigating reports of elder abuse, neglect, or exploitation;

• case planning, monitoring, evaluation, and other case work and services; and

• providing, arranging for, or facilitating the provision of medical, social service, 

economic, legal, housing, law enforcement, or other protective, emergency, or support 

services.

The increasing complexity of elder and adult abuse cases, coupled with a rising older population 

and difficult State and local budget conditions have presented challenges to State, local, and 

 66 The FY 2013 Prevention Fund resources are reflected in the Office of the Secretary.
PROTECTION OF VULNERABLE ADULTS

124

Tribal APS programs, particularly when it comes to developing the most promising and effective 

interventions possible to prevent elder abuse, neglect, and exploitation. 

A number of obstacles have prevented APS programs from evaluating their services, including a 

lack of resources, the increasing number and complexity of abuse cases, and the absence or

inadequacy of consistent data systems and uniform reporting requirements needed to conduct 

meaningful program evaluations. 

Many of these same challenges have limited efforts to develop new and innovative approaches to 

preventing, detecting, and responding to abuse, neglect, and exploitation. The APS 

Demonstration Program focuses on translating promising prevention interventions from other 

violence prevention areas to elder abuse, and evaluating both the effectiveness of the intervention 

as well as the comparative effectiveness of the initiative across states in order to build more 

effective and efficient elder abuse prevention interventions. 

Funding History:

FY 2012. ..................................................$6,000,000

FY 2013 CR. .......................................................N/A67

Note: No prior funding has been appropriated to this program. Funding in FY 2012 is being provided from the 

Affordable Care Act Prevention and Public Health Fund.

Budget Request:

The FY 2014 request for Adult Protective Services Program is $8,000,000, an increase of 

+$2,000,000 over the PPHF mandatory funding provided in FY 2012. FY 2014 represents the 

first time that this program would receive discretionary funding. The APS Demonstration funds

will provide competitive grants to expand the number of states that are currently working to 

translate and evaluate promising elder abuse prevention interventions from promising violence 

prevention efforts in related fields such as interpersonal violence and child maltreatment.

The request will continue funding for demonstration grants and associated evaluations and 

provide funding for an APS resource center to support the coordination, communication, and 

information availability and dissemination. It also includes the funds to support one FTE to carry 

out these activities.

The budget request is consistent with the findings of the recent GAO report on Federal elder 

justice efforts, as well as an earlier HHS report to Congress assessing the feasibility of 

 67 The FY 2013 Prevention Fund resources are reflected in the Office of the Secretary.
PROTECTION OF VULNERABLE ADULTS

125

establishing uniform standards for data collection, reporting, and dissemination of best practices 

regarding Elder Abuse. This report to Congress included a detailed analysis of the significant 

level of effort required to address the data collection and reporting requirements for APS. Taken 

together, these activities will complement each other, and will advance efforts to develop 

innovative approaches and best practices that can then be disseminated to APS programs 

nationwide.

The FY 2014 discretionary request for $8 million includes approximately $5.9 million to fund 

competitive grants to test promising approaches to meeting the growing challenges that State and 

local APS programs face. Elder abuse, neglect, and exploitation present complex problems that 

require multidisciplinary solutions that use the most effective and efficient interventions 

available. These competitive grants will allow State and local APS programs to develop and

evaluate innovative elder abuse prevention interventions and identify best practices that can then 

be disseminated to APS programs nationwide.

The ability of APS programs to employ tested, proven techniques is essential to ensuring that 

elders are able to receive protection and relief from abuse, neglect, and exploitation. Using the 

results of the APS State demonstrations, AoA will develop a compendium of best practices and 

lessons learned that APS programs across the nation can use to improve their programs. 

Additionally, AoA will present findings, conduct trainings and webinars to disseminate the 

results, and seek out ways to coordinate with other national, State and local entities to distribute 

the information. The cumulative results of these projects will allow AoA to establish a strong 

evidence-base for current and future projects.

Critical to the success of these efforts, AoA will provide APS State demonstration grantees with 

uniform definitions and reporting requirements to be used to track APS program results and 

compare them with other programs throughout the nation. Currently, APS programs have wide 

ranging definitions of elder abuse, neglect, and exploitation that make the combination of output 

data unreliable and comparative evaluations impossible to conduct. 

Additionally, in FY 2014 AoA will provide $1 million to support research and demonstration 

programs to test approaches to addressing the unique challenge of preventing, identifying, and 

responding to elder abuse, neglect, and exploitation within Tribal nations. At listening sessions

with Tribal grantees, elder abuse has been repeatedly raised as an issue of concern in these 

communities. In an effort to respond to these concerns, funds will provide competitive grants to 

eligible Tribal organizations, public agencies, and nonprofit organizations to support Tribes in 

the development of informational, legal, and supportive services to assist in the prevention, 

detection, and resolution of elder abuse, neglect, and exploitation. Funding will support 

coalition-building, training, and technical assistance; the development of statutes and codes; 
PROTECTION OF VULNERABLE ADULTS

126 

elder rights program development; and research for effectively preventing and addressing elder 

abuse within Tribal nations. 

Most of the balance of $1.1 million will fund contracts to evaluate these activities and support 

the continued development of data collection and reporting requirements associated with the 

state-level demonstration grants. These funds will also be used for the funding of an APS 

resource center, in keeping with a March 2011 GAO report on Elder Justice at the Federal level 

which indicated the need for additional resources that could provide more easily accessible and 

centrally available information on APS best practices. Lastly, a portion of the budget allocated 

for the evaluation and administration of APS State Demonstrations will be used to provide staff 

resources to support the grants management, technical assistance, coordination, and the 

development and dissemination of best practices that are essential to the success of the these 

demonstration projects. 

Output Table:

Adult Protective Services Output 

Indicator Most Recent Result FY 2012 

Projection 

FY 2014

Projection 

FY 2014 

+/- FY 2012

Output AP.1: Design Adult Protective 

Service evaluation to develop and test 

appropriate methods of addressing elder 

abuse, neglect and exploitation.

N/A Contract 

Awarded Ongoing N/A
PROTECTION OF VULNERABLE ADULTS

127 

Resource and Program Data:

Adult Protective Service

(Dollars in thousands) 

FY 2012 FY 2013 FY 2014

Enacted Annual CR President's Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary

Continuations

8 

--

 5,672 

--

--

--

--

--

9

--

6,900

--

Contracts -- -- -- -- 1 300

Interagency Agreements 1 288 -- -- 1 700

Program Support 1/ 40 -- 100

Total Resources 6,000 N/A 8,000

1/ Program Support -- Includes funds for salaries and overhead and grant systems and review costs.

2/ Funding for this activity was provided from the Prevention and Public Health Fund in FY 2012. The FY

2014 request is for discretionary funding.
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129 

Long-Term Care Ombudsman Program

FY 2012

Enacted

FY 2013

Annualized CR

FY 2014

President’s Budget

FY 2014+/-

FY 2012

Long-Term Care Ombudsman 

Program........................... $16,761,000 $16,864,000 $16,761,000 --

Authorizing Legislation: Section 712 of the Older Americans Act of 1965, as amended 

FY 2014 Older Americans Act Authorization ...................................................................... Expired

Allocation Method ................................................................................................... Formula Grants

Program Description and Accomplishments:

The Long-Term Care Ombudsman program is a consumer advocacy program that improves the 

quality of care for the estimated 2.9 million individuals who reside in 69,508 long-term care 

facilities.68 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 

10,000 ombudsmen (both staff and certified volunteers) who resolve complaints on behalf of 

these residents 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 the long-term 

care system, and educating the general public about issues related to long-term care policies and 

regulations. 

Much of the efficiency of the Ombudsman Program is due to the strong reliance on volunteers 

who make up the bulk of those who resolve resident issues.69 All but four States have volunteer 

ombudsman programs. These certified volunteer ombudsmen donated over 735,411 hours in 

FY 2011, a six percent increase over FY 2009. FY 2011 output data for the Long-Term Care 

Ombudsman Program highlights the accomplishments achieved by this program and the 

 

68 National Ombudsman Reporting System (NORS) – Federal Fiscal 2011.

69 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

130 

important role that ombudsmen play in ensuring that the rights of long-term care facility 

residents are respected: 

• 1,185 paid and 9,065 certified volunteer ombudsmen regularly visited residents in 

28,982 facilities, more than 70 percent of all nursing home facilities and nearly 

33 percent of all licensed board and care facilities (Output S). At least another 

3320 volunteers support these paid staff and certified volunteer ombudsmen. 

• Ombudsmen investigated and worked to resolve 204,044 complaints (Output Q). 

• Ombudsmen provided over 405,466 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). 

Funding History:

Funding for the Long-term Care Ombudsman Program during the past five years is as follows:

FY 2009 .................................................$16,328,000 

FY 2010 .................................................$16,825,000 

FY 2011 .................................................$16,793,000 

FY 2012 .................................................$16,761,000 

FY 2013 CR. ..........................................$16,864,000 

Budget Request:

The FY 2014 request for the Long-Term Care Ombudsman program is $16,761,000, the same as 

the FY 2012 enacted level. 

The number of older Americans is increasing rapidly. This is particularly true among the 

population age 85 and older. As a percentage of the population, the number of older Americans 

age 85 and older is growing faster than any other age cohort and is projected to reach nearly 

20 million by the year 2030. As this population grows, the need for safe, high-quality long-term 

care services (including non-nursing home alternatives) will 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) demonstrate 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 partially resolved to the 
PROTECTION OF VULNERABLE ADULTS

131

satisfaction of the resident has consistently remained near 73 percent,70 demonstrating both the 

efficiency of the program and its ability to produce positive outcomes for residents. The average 

number of complaints per facility, at 2.93, is on track to meet the projected 2012 target. A new 

outcome measure was added to further evaluate the level of success in resolving resident 

problems. Outcome 2.14 will target a decrease in complaints that are not resolved to the 

satisfaction of the resident. 

The FY 2014 request represents an important element of AoA’s focus on elder rights, which 

expands and improves upon AoA’s successful elder rights programs to create a full array of 

services to prevent, detect, and resolve elder abuse, neglect, and exploitation. This request also 

supports Federal policy for quality alternatives to nursing home care. LTC Ombudsmen 

advocate for quality care and individual rights and well-being in other congregate long-term 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. Outreach, access, complaint investigation and advocacy in board and care require 

Ombudsmen to employ new strategies compared to the work done in nursing home settings. 

Supporting volunteers to work in these often more intimate environments also requires additional 

support and training. 

 70 NORS 2011 – Complaint resolution: 10% needing no further action; 4% withdrawn; 5% not resolved to the 

satisfaction of the resident; 6% referred to other agency for resolution.
PROTECTION OF VULNERABLE ADULTS

132 

Outcomes and Outputs Table:

Long-Term Care Ombudsman Program Outcomes and Outputs 

Measure Most Recent Result FY 2012 

Target 

FY 2014 

Target 

FY 2014 

+/- FY 2012

Outcome 2.12: Decrease the average 

number of complaints per LTC facility

(Outcome)

FY 2011: 2.93

Target: 3.9

(Target Exceeded)

3.0 3.0 --

Outcome 2.14 : Decrease the number of 

complaints not resolved to the satisfaction 

of the resident (Outcome)

FY 2011: 10,642

Target: N/A 11,300 10,700 -600

Indicator Most Recent Result FY 2012 

Projection 

FY 2014 

Projection 

FY 2014 

+/- FY 2012

Output Q: Decrease the Number of 

Complaints (Output) FY 2011: 204,044 204,000 200,000 -4,000*

Output R: Number of Ombudsman 

Consultations (Output) FY 2011: 405,466 400,000 425,000 +25,000

Output S: Facilities regularly visited not in 

response to a complaint (Output) FY 2011: 28,982 35,000 29,000 -6,000

* Measure seeks a decrease in complaints. A negative change is the desired output.

Grant Awards Table:

Long-Term Care Ombudsman Program Grant Awards

FY 2012

Actual

FY 2013 

Annualized CR

FY 2014 

President’s 

Budget

Number of 

Awards 56 56 56

Average 

Award $298,628 $298,131 $296,311 

Range of 

Awards

$10,452 -

$1,703,874

$10,435 -

$1,710,478

$10,371 -

$1,700,035
PROTECTION OF VULNERABLE ADULTS

133 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2014 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Long-Term Care Ombudsman Program (CFDA 93.042)

State/Territory

FY 2012

Actual

FY 2013

Estimate

FY 2014

Estimate

FY 2014 +/-

FY 2012

Alabama .......................................... 261,779 259,733 258,147 -3,632

Alaska.............................................. 83,616 83,477 82,967 -649

Arizona ............................................ 347,967 351,176 349,032 1,065

Arkansas.......................................... 164,541 163,105 162,109 -2,432

California......................................... 1,703,874 1,710,478 1,700,035 -3,839

Colorado .................................. 229,541 233,560 232,133 2,592

Connecticut............................... 198,974 196,382 195,182 -3,792

Delaware .................................. 83,616 83,477 82,967 -649

District of Columbia ................... 83,616 83,477 82,967 -649

Florida ..................................... 1,231,886 1,228,935 1,221,429 -10,457

Georgia .................................... 428,313 432,319 429,678 1,365

Hawaii ..................................... 83,616 83,477 82,967 -649

Idaho ....................................... 83,616 83,477 82,967 -649

Illinois ..................................... 637,587 633,601 629,731 -7,856

Indiana..................................... 334,046 332,057 330,029 -4,017

Iowa ........................................ 174,136 172,056 171,005 -3,131

Kansas ..................................... 147,117 146,161 145,268 -1,849

Kentucky.................................. 232,425 231,315 229,902 -2,523

Louisiana.................................. 224,480 224,309 222,939 -1,541

Maine ...................................... 84,298 84,054 83,541 -757

Maryland .................................. 287,428 287,775 286,017 -1,411

Massachusetts............................ 356,900 354,680 352,514 -4,386

Michigan .................................. 541,079 538,212 534,925 -6,154

Minnesota................................. 269,902 270,500 268,848 -1,054

Mississippi................................ 151,689 150,496 149,576 -2,113

Missouri ................................... 328,398 325,846 323,856 -4,542

Montana ................................... 83,616 83,477 82,967 -649

Nebraska .................................. 95,910 95,262 94,680 -1,230

Nevada..................................... 133,223 134,253 133,433 210

New Hampshire ......................... 83,616 83,477 82,967 -649
PROTECTION OF VULNERABLE ADULTS

134 

PROGRAM/CFDA NUMBER: Long-Term Care Ombudsman Program (CFDA 93.042)

State/Territory

FY 2012

Actual

FY 2013

Estimate

FY 2014

Estimate

FY 2014 +/-

FY 2012

New Jersey ................................ 467,133 461,828 459,007 -8,126

New Mexico .............................. 107,975 108,413 107,751 -224

New York.................................. 1,032,690 1,021,552 1,015,312 -17,378

North Carolina ........................... 496,728 498,273 495,229 -1,499

North Dakota ............................. 83,616 83,477 82,967 -649

Ohio......................................... 641,170 636,187 632,301 -8,869

Oklahoma.................................. 199,358 197,692 196,484 -2,874

Oregon...................................... 215,742 217,328 216,000 258

Pennsylvania.............................. 757,545 748,082 743,513 -14,032

Rhode Island.............................. 83,616 83,477 82,967 -649

South Carolina ........................... 255,756 257,650 256,077 321

South Dakota ............................. 83,616 83,477 82,967 -649

Tennessee.................................. 343,142 342,867 340,773 -2,369

Texas........................................ 1,058,604 1,068,079 1,061,556 2,952

Utah ......................................... 99,550 100,692 100,077 527

Vermont.................................... 83,616 83,477 82,967 -649

Virginia .................................... 397,834 398,776 396,340 -1,494

Washington ............................... 339,099 343,243 341,147 2,048

West Virginia............................. 118,529 117,003 116,289 -2,240

Wisconsin ................................. 305,849 304,559 302,699 -3,150

Wyoming .................................. 83,616 83,477 82,967 -649

 

Subtotal, States............................... 16,405,589 16,380,213 16,280,168 -125,421

American Samoa ........................ 10,452 10,435 10,371 -81

Guam ....................................... 41,808 41,738 41,483 -325

Northern Mariana Islands ............. 10,452 10,435 10,371 -81

Puerto Rico................................ 213,051 210,801 209,514 -3,537

Virgin Islands............................. 41,808 41,738 41,483 -325

 

Subtotal, States and Territories....... 16,723,160 16,695,360 16,593,390 -129,770

 

Undistributed 71/............................ 37,840 168,640 167,610 129,770

TOTAL 16,761,000 16,864,000 16,761,000 --

 

71/ The undistributed line reflects the amount reserved from the Long-Term Care Ombudsman appropriation for statutory 

related activities, including contingencies and for program support including information and systems, technical assistance, 

evaluation, monitoring and oversight. Funds unused for these purposes at the end of the year are allocated to States..
135 

Prevention of Elder Abuse and Neglect

FY 2012

Enacted

FY 2013

Annualized CR

FY 2014

President’s Budget

FY 2014+/-

FY 2012

Prevention of Elder Abuse & 

Neglect........................... $5,036,000 $5,067,000 $5,036,000 --

Authorizing Legislation: Section 721 of the Older Americans Act of 1965, as amended 

FY 2014 Authorization ......................................................................................................... Expired

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 for training, education, and 

promoting 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 AoA’s focus on 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 2009 over $35 million of the Elder Abuse Prevention services 

expenditures was leveraged from non-OAA funds, a ratio of approximately $7 of non-OAA 

funds for every $1 investment of AoA 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, developed 

informational cards for law enforcement officers to have in the patrol cars which contain 

crucial resource information for victims of elder abuse, provided 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 Illinois Department on Aging utilizes its elder abuse funds to support 

volunteer community based multi-disciplinary teams (M-Teams) that serve in a technical 
PROTECTION OF VULNERABLE ADULTS

136 

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 

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 AoA’s ongoing commitment 

to protecting the rights of vulnerable 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 during the past five years is as follows: 

FY 2009 ...................................................$5,056,000 

FY 2010 ...................................................$5,055,000 

FY 2011 ...................................................$5,046,000 

FY 2012 ...................................................$5,036,000 

FY 2013 CR. ............................................$5,067,000 

Budget Request and Anticipated Accomplishments:

The FY 2014 request for the Prevention of Elder Abuse and Neglect program is $5,036,000, the 

same as the FY 2012 enacted level. The FY 2014 request will maintain 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. 

These activities are important elements of AoA’s continued focus in FY 2014 on elder rights and 

elder justice, which seeks to improve upon AoA’s successful elder rights programs, including the 

Prevention of Elder Abuse and Neglect program. This enhanced focus will allow the creation of 

a full array of services to protect elder rights and prevent, detect, and resolve elder abuse, 

neglect, and exploitation. Prevention of Elder Abuse and Neglect programs complement Adult 

Protective Services by funding the infrastructure on which best practices may be developed and 

evaluated.

 
PROTECTION OF VULNERABLE ADULTS

137

Output Table:

Prevention of Elder Abuse and Neglect Output

Indicator Most Recent Result FY 2012

Projection 

FY 2014

Projection 

FY 2014 

+/- FY 2012

Output U: Elder Abuse prevention nonOAA service expenditures (Output, 

results in thousands)

 FY 2011: $27,500 $27,000 $26,000 -$1,000

Grant Awards Table:

Prevention of Elder Abuse, Neglect, and Exploitation Grant Awards

FY 2012

Enacted

FY 2013

Annualized 

CR

FY 2014 

President’s 

Budget

Number of 

Awards 56 56 56

Average Award $89,732 $89,577 $89,029

Range of 

Awards

$3,141 -

$503,913

$3,135 -

$502,632

$3,116 -

$496,869
PROTECTION OF VULNERABLE ADULTS

138 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2014 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Prevention of Elder Abuse & Neglect (CFDA 93.041) 

State/Territory

FY 2012

Actual

FY 2013

Estimate

FY 2014

Estimate

FY 2014 +/- 

FY 2012

Alabama........................................... 77,420 76,324 76,215 -1,205

Alaska .............................................. 25,125 25,082 24,928 -197

Arizona ............................................ 102,909 103,195 102,011 -898

Arkansas.......................................... 48,662 48,157 48,157 -505

California......................................... 503,913 502,632 496,869 -7,044

Colorado .......................................... 67,886 68,633 67,846 -40

Connecticut...................................... 59,907 59,907 59,907 --

Delaware.......................................... 25,125 25,082 24,928 -197

District of Columbia ........................ 25,125 25,082 24,928 -197

Florida ............................................. 364,324 361,129 356,989 -7,335

Georgia ............................................ 126,671 127,039 125,583 -1,088

Hawaii ............................................. 25,125 25,082 24,928 -197

Idaho................................................ 25,125 25,082 24,928 -197

Illinois.............................................. 197,384 197,384 197,384 --

Indiana ............................................. 98,793 98,224 98,224 -569

Iowa ................................................. 55,927 55,927 55,927 --

Kansas ............................................. 45,843 45,843 45,843 --

Kentucky.......................................... 68,738 67,973 67,194 -1,544

Louisiana ......................................... 68,518 68,518 68,518 --

Maine............................................... 25,125 25,082 24,928 -197

Maryland.......................................... 85,005 84,564 83,595 -1,410

Massachusetts.................................. 109,606 109,606 109,606 --

Michigan.......................................... 160,862 160,862 160,862 --

Minnesota ........................................ 79,822 79,488 78,577 -1,245

Mississippi....................................... 45,198 45,198 45,198 --

Missouri........................................... 97,643 97,643 97,643 --

Montana........................................... 25,125 25,082 24,928 -197

Nebraska .......................................... 29,770 29,770 29,770 --

Nevada............................................. 39,400 39,451 38,999 -401

New Hampshire ............................... 25,125 25,082 24,928 -197
PROTECTION OF VULNERABLE ADULTS

139 

PROGRAM/CFDA NUMBER: Prevention of Elder Abuse & Neglect (CFDA 93.041) 

State/Territory

FY 2012

Actual

FY 2013

Estimate

FY 2014

Estimate

FY 2014 +/- 

FY 2012

New Jersey...................................... 143,950 143,950 143,950 --

New Mexico ................................... 31,933 31,858 31,493 -440

New York ....................................... 318,066 318,066 318,066 --

North Carolina ................................ 146,905 146,420 144,741 -2,164

North Dakota .................................. 25,125 25,082 24,928 -197

Ohio ................................................ 197,185 197,185 197,185 --

Oklahoma ....................................... 60,208 60,208 60,208 --

Oregon ............................................ 63,805 63,863 63,131 -674

Pennsylvania................................... 242,944 242,944 242,944 --

Rhode Island................................... 25,125 25,082 24,928 -197

South Carolina ................................ 75,639 75,712 74,844 -795

South Dakota .................................. 25,125 25,082 24,928 -197

Tennessee ....................................... 101,483 100,753 99,598 -1,885

Texas .............................................. 313,077 313,861 310,262 -2,815

Utah ................................................ 29,442 29,589 29,250 -192

Vermont.......................................... 25,125 25,082 24,928 -197

Virginia........................................... 117,658 117,182 115,839 -1,819

Washington..................................... 100,287 100,864 99,708 -579

West Virginia.................................. 36,736 36,736 36,736 --

Wisconsin ....................................... 90,453 90,309 90,309 -144

Wyoming ........................................ 25,125 25,082 24,928 -197

Subtotal, States............................... 4,930,597 4,923,033 4,893,245 -37,352

American Samoa............................. 3,141 3,135 3,116 -25

Guam .............................................. 12,563 12,541 12,464 -99

Northern Mariana Islands............... 3,141 3,135 3,116 -25

Puerto Rico ..................................... 63,009 61,945 61,235 -1,774

Virgin Islands ................................. 12,563 12,541 12,464 -99

Subtotal, States and Territories....... 5,025,014 5,016,330 4,985,640 -39,374

Undistributed 72/............................ 10,986 50,670 50,360 39,374

TOTAL 5,036,000 5,067,000 5,036,000 --

 

72/ The undistributed line reflects the amount reserved from the Prevention of Elder Abuse & Neglect appropriation for 

statutory related activities, including contingencies and for program support including information and systems, technical 

assistance, evaluation, monitoring and oversight. Funds unused for these purposes at the end of the year are allocated to 

States.
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141

Senior Medicare Patrol Program

FY 2012

Enacted

FY 2013

Annualized CR

FY 2014

President’s Budget

FY 2014+/-

FY 2012

Senior Medicare Patrol 

Program.................. $9,402,000 $9,460,000 $9,402,000 --

Authorizing Legislation: Sections 201, 202, and 491 of the Older Americans Act of 1965, as 

amended

FY 2014 Authorization .........................................................................................................Expired

Allocation Method ...............................................................................................Competitive Grant

Program Description and Accomplishments:

The Senior Medicare Patrol (SMP) program provides competitive grants to 54 States and 

Territories to support a national volunteer-based network of retired seniors whose purpose is to 

educate older adults on preventing and identifying healthcare fraud and abuse. Projects use the 

skills of retired professionals as 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, the Office of Inspector General (OIG), healthcare providers, and 

other aging and elder rights professionals from around the country.

Data obtained from the SMARTFACTS Data Tracking System for calendar year 2011 shows 

that, compared to Calendar Year 2010, SMP projects:

• Maintained 5,896 active volunteers who worked over 97,156 hours to educate 

beneficiaries about how to prevent Medicare and Medicaid fraud;

• Educated 436,775 beneficiaries in 11,256 group education sessions and held 71,880 oneon-one counseling sessions with or on behalf of beneficiaries; 

• Conducted 8,856 community outreach education events (42% increase); and

• Resolved 81,390 inquiries for information or assistance from beneficiaries.
PROTECTION OF VULNERABLE ADULTS

142

In addition, the SMARTFACTS data show that since the program’s inception 15 years ago, SMP 

projects have:

• Educated over 4.6 million beneficiaries in 96,224 group education sessions and 

1,184,767 one-on-one counseling sessions; 

• Conducted 83,918 community outreach education events; and 

• Documented over $106 million in savings, including Medicare and Medicaid funds 

recovered, beneficiary savings, and other savings as directly attributable to the project as 

a result of beneficiary complaints. This does not attempt to quantify the total savings 

that occur as a result of SMP program’s sentinel effect, impact on fraud deterrence, or 

calls to fraud hotlines or other non-SMP contacts.

The SMP program historically has been supported by approximately $3.4 million in Health Care 

Fraud and Abuse Control (HCFAC) funding authorized by the Health Insurance Portability and 

Accountability Act of 1996 (HIPAA) for infrastructure, technical assistance, and other SMP 

program support and capacity-building activities designed to enhance program effectiveness. 

Activities funded by HCFAC resources include support for project training and technical 

assistance provided by AoA’s National Consumer Technical Resource Center (Center). 

In the past three years, the critically important role of the SMP program continued to be

recognized by partners in Medicare fraud prevention in the private and public sectors. In 2010, 

the Centers for Medicare & Medicaid Services (CMS) provided funding for the award of an 

additional $9 million in grants from its Program Integrity funding, administered by AoA, 

targeted to help more than 50 Senior Medicare Patrol (SMP) programs fight Medicare fraud in

high fraud areas and expand the capacity of the program to reach more beneficiaries. In FY 2012

and FY 2013, SMP will receive an additional $7.3 million from HCFAC funds to again fight 

Medicare fraud in high-fraud areas.

In November 2010, the Administration on Aging received a national level commendation for the 

SMP program from the National Health Care Anti-Fraud Association (NHCAA), considered the 

leading national organization focused exclusively on the fight against health care fraud. The 

NHCAA’s members comprise more than 100 private health insurers and those public sector law 

enforcement and regulatory agencies having jurisdiction over health care fraud committed 

against both private payers and public programs. The award, given annually by the NHCAA,

recognizes an organization or individuals “who have done the most in the past year to raise 

public awareness about the problem of health care fraud in our nation’s health care system.” This 

organization’s decision to award the Senior Medicare Patrol program the NHCAA 2010 
PROTECTION OF VULNERABLE ADULTS

143

Excellence in Public Awareness Award is a major achievement, and a notable acknowledgement 

of the value of the SMP program.

Funding History:

Funding for the SMP discretionary appropriations is as follows:

FY 2009 ...................................................$9,439,000

FY 2010 ...................................................$9,438,000

FY 2011 ...................................................$9,420,000

FY 2012 ...................................................$9,402,000

FY 2013 CR.............................................$9,460,000

Budget Request:

The FY 2014 request for the Senior Medicare Patrol (SMP) program is $9,402,000; the same as 

the FY 2012 enacted level. This amount will enable AoA to continue the proven fraud prevention 

activities of the SMP program.

Since the program’s inception, SMP projects have educated over 4.6 million beneficiaries and 

received over 172,000 complex issues (complaints) from beneficiaries who have detected billing 

or other discrepancies based on that information. This has resulted in nearly $106 million in 

savings to Medicare, Medicaid, program beneficiaries, and others since 1997. While SMPs make 

numerous referrals of potential fraud to CMS program integrity contractors, there is no 

mechanism for tracking the actions (investigation, prosecution, collection) required to realize 

actual savings to the government as a result of these referrals. ACL is working to overcome this 

evaluation limitation by undertaking a variety of steps, including:

• A program evaluation contract to examine the program’s performance metrics;

• An ongoing pilot program in cooperation with OIG to track fraud referrals and their 

outcomes; and

• Working with OIG to better align the criteria for calculating the program’s savings with 

those used by both CMS and OIG for their respective performance reports.
PROTECTION OF VULNERABLE ADULTS

144

Outcomes and Outputs Table:

Senior Medicare Patrol Program Outcomes and Outputs

Indicator Most Recent Result FY 2012

Projection 

FY 2014

Projection 

FY 2014 

+/- FY 2012

Output W: Beneficiaries Educated and 

Served (Output) FY 2011: 536,489 550,000 600,000 +50,000

Grant Awards Table:

Senior Medicare Patrol Grant Awards

FY 2012

Enacted

FY 2013

Annualized CR

FY 2014 

President’s 

Budget

Number of 

Awards 54 54 54

Average 

Award $174,114 $174,114 $174,114

Range of 

Awards

$75,000-

$177,927

$75,000-

$177,927

$75,000-

$177,927

Resource and Program Data:

Senior Medicare Patrols

(Dollars in thousands)

FY 2012 FY 2013 FY 2014

Enacted Annual CR President's Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary 28 4,776 -- -- -- --

Continuations 26 4,626 54 9,460 54 9,402

Contracts -- -- -- -- -- --

Interagency Agreements -- -- -- -- -- --

Program Support 1/ -- -- --

Total Resources 9,402 9,460 9,402
145

Elder Rights Support Activities

FY 2012

Enacted

FY 2013

Annualized CR

FY 2014

President’s Budget

FY 2014+/-

FY 2012

Elder Rights Support 

Activities............... $4,088,000 $4,113,000 $4,088,000 --

Authorizing Legislation: Sections 201, 202, and 411 of the Older Americans Act of 1965, as 

amended

FY 2014 Older Americans Act Authorization......................................................................Expired

Allocation Method .............................Competitive Grants/Cooperative Agreements and Contracts

Program Description and Accomplishments:

Elder Rights Support Activities consists of four activities and resource centers that provide 

information, training, and technical assistance to assist States and communities to prevent, detect, 

and respond to elder abuse, neglect, and exploitation. The combination of legal systems 

development and assistance programs, the National Center on Elder Abuse, and the National 

Long-Term Care Ombudsman Resource Center create a supportive framework for AoA’s 

Protection of Vulnerable Adults programs. The Elder Rights Support Activities described below 

are essential components of AoA’s ongoing elder rights programs:

Model Approaches to Statewide Legal Assistance Systems 

Model Approaches to Statewide Legal Assistance Systems helps States develop and implement 

cost-effective, replicable approaches for integrating senior legal helplines into the broader 

tapestry of State legal service delivery networks. The cornerstone of these projects is legal 

helplines, which assist seniors in accessing quality legal services. By ensuring strong leadership 

at the State level, Model Approaches projects create linkages between the existing legal 

assistance community and service providers, and professionals in the broader community-based 

aging and elder rights networks, including Areas Agencies on Aging, Aging and Disability 

Resource Centers, State Long-Term Care Ombudsmen, and Adult Protective Services. These 

linkages leverage the strengths of both elder rights and aging service networks for the provision 

of quality service to seniors most in need.
PROTECTION OF VULNERABLE ADULTS

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National Legal Assistance and Support Projects

National Legal Assistance and Support grants fund a comprehensive national legal assistance 

support system serving professionals and advocates working in legal and aging services 

networks. These grants provide funding for the National Legal Resource Centers, which support

the leadership, knowledge, and systems capacity of legal and aging provider organizations. 

These centers work to enhance the quality, cost effectiveness, and accessibility of legal 

assistance and elder rights protections available to older persons with social or economic needs. 

AoA is funding four projects which provide core support functions for aging and legal networks 

including case consultation, training, technical assistance on legal and aging systems 

development, and information development and dissemination.

National Center on Elder Abuse

To support and enhance the activities of State and local programs to prevent Elder Abuse, Neglect, 

and Exploitation, AoA 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 development. NCEA also facilitates the exchange of strategies for uncovering and 

prosecuting fraud in areas such as telemarketing and sweepstakes scams. In 2012, the NCEA:

• Continued its outreach by serving 3,459 subscribers to its newsletter, 1,833 members to the 

Elder Abuse Listserv, and created and managed a new social media platform for the NCEA 

Clearinghouse and NCEA National Indigenous Elder Justice Initiative, with over 

1,000 friends on Facebook.

• Responded to over 450 individual public inquiries and requests for information regarding 

elder abuse and elder abuse in Indian Country.

• Provided cost-effective trainings to over 600 professionals though live Webcast forums on 

issues relevant to elder justice, trained over 1,000 professionals through presentations at 

national conferences, and created and disseminated three research-themed training podcasts 

to promote continual learning.

• Continued to support systems change by:

o Identifying 342 local elder justice community coalitions and beginning to reach out to 

those communities to learn how they leverage local resources and expertise to 
PROTECTION OF VULNERABLE ADULTS

147

prevent and combat elder abuse, neglect, and exploitation, as well as to offer 

technical assistance on operating, invigorating, and sustaining coalitions; and

o Compiling the first comprehensive inventory of tribal elder abuse codes, currently 

consisting of 48 codes from 17 states, the purpose of which is to provide best practice 

examples to other tribes in developing new codes to address elder abuse, neglect, and 

exploitation.

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 success of CMS’s Money Follows the Person 

(MFP) demonstration project by working with CMS, AoA, 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 points of entry programs; and furthering Federal efforts to support 

consumer choice and access to alternatives to nursing home care. NORC also provides

ombudsmen with training from national experts on such issues as: The Changing Long-Term 

Care System; Managing Program Goals and Priorities During Fiscal Crises; Minimum Data Set 

(MDS) 3.0 Section Q, Money Follows the Person, and Nursing Home Transition; Advocacy in 

Assisted Living. The Center’s website continues high utilization (over 40,000 monthly visits) by 

ombudsmen, consumers, and agencies.

Funding History:

Comparable funding for Elder Rights Support Activities is as follows:

FY 2009 ...................................................$4,104,000

FY 2010 ...................................................$4,103,000

FY 2011 ...................................................$4,096,000

FY 2012 ...................................................$4,088,000

FY 2013 CR.............................................$4,113,000
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Budget Request:

The FY 2014 request for Elder Rights Support Activities is $4,088,000, the same as the FY 2012

enacted level. This request reflects continuation of the current level of support services for elder 

rights and elder justice. These activities are a critical component of AoA’s successful elder rights 

programs and help to create a full array of services to prevent, detect, and resolve elder abuse, 

neglect, and exploitation. 

The National Center on Elder Abuse, the National Long-Term Care Ombudsman Resource 

Center, and the Statewide Model Approaches and Legal Assistance programs provide the 

technical assistance, information, resources, referrals, and legal systems development and 

assistance activities that support the efforts of the entire spectrum of Protection of Vulnerable 

Adults programs. Continued support for these programs and resource centers will provide the 

best and most efficient services and supports possible to support AoA’s efforts to promote elder 

rights and elder justice.

Elder Rights Support Activities includes funding for the following projects (dollars in thousands):

Activity

FY 2012

Enacted

FY 2013 

President’s 

Budget

FY 2014

Planning Level

Elder Rights Support Activities:

Model Approaches to Statewide Legal Assistance ........................... $ 1,992 $ 2,004 $ 1,992

National Legal Assistance and Support Projects.............................. 744 748 744

National Center on Elder Abuse ....................................................... 807 812 807

National Long-Term Care Ombudsman Resource Center................ 545 548 545

Total, Elder Rights Support Activities...................................... $ 4,088 $ 4,113 $ 4,088

Grant Awards Table:

Elder Rights Support Activities Grant Awards

FY 2012 

Estimated

FY 2013 

President’s 

Budget

FY 2014 

Planning Level

Number of 

Awards 27 27 27

Average 

Award $147,261 $147,261 $147,261

Range of 

Awards

$50,000 -

$561,000

$50,000 -

$561,000

$50,000 -

$561,000
PROTECTION OF VULNERABLE ADULTS

149

Resource and Program Data:

Elder Rights Support Activities

(Dollars in thousands)

FY 2012 FY 2013 FY 2014

Enacted Annual CR President's Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary -- -- 14 1,798 9 2,220

Continuations 28 4,001 10 2,220 14 1,773

Contracts 1 10 -- -- -- --

Interagency Agreements -- -- -- -- -- --

Program Support 1/ 77 95 95

Total Resources 4,088 4,113 4,088

1/ Program Support -- Includes funds for grant systems and review and information technology support costs.
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151

Programs for People with Developmental Disabilities

Summary of Request

Programs for people with developmental disabilities fund capacity-building and systems change 

efforts to assure that people with intellectual and 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 self-determination, independence, 

productivity, and integration and inclusion in all facets of community life. 

The total FY 2014 request for Programs for People with Developmental Disabilities authorized 

under the Developmental Disabilities Assistance and Bill of Rights Act is $162,748,000, the 

same as the FY 2012 enacted level for these programs. For FY 2014, specific program requests 

include:

• $74,774,000 to continue funding for State Councils on Developmental Disabilities 

(DD Councils) in each State and Territory. DD Councils are charged with engaging in 

advocacy, capacity building, and systemic change activities that contribute to a coordinated 

and comprehensive system of community supports and services that promote selfdetermination, integration and inclusion for people with developmental disabilities.

• $40,865,000 to continue funding for State Protection and Advocacy systems in each State 

and Territory to protect the legal and human rights of all people with developmental 

disabilities. The Protection and Advocacy system has the authority to pursue legal, 

administrative and other appropriate remedies or approaches, including the authority to 

investigate incidents of abuse and neglect. 

• $38,792,000 to continue funding for University Centers for Excellence in Developmental 

Disabilities (UCEDDs) in each state and territory. UCEDDs provide 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, integrated, and included in 

the community.

• $8,317,000 for Projects of National Significance, to fund grants, cooperative agreements, 

and contracts to explore innovative opportunities for individuals with developmental 

disabilities to directly and fully contribute to, and participate in, all facets of community 

life. Funds will also be used to support the development of national and State policies, 
PROGRAMS FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES

152

including Federal interagency initiatives; for demonstration projects addressing

innovative and emerging best practices; and for longitudinal data collection projects.
153

State Councils on Developmental Disabilities

FY 2012

Enacted

FY 2013

Annualized CR

FY 2014

President’s Budget

FY 2014+/-

FY 2012

State Councils on 

Developmental Disabilities $74,774,000 $75,232,000 $74,774,000 --

Authorizing Legislation: Section 129(a) of the Developmental Disabilities Assistance and Bill of 

Rights Act 

FY 2014 Developmental Disabilities Assistance and Bill of Rights Act Authorization ......Expired

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

Program Description and Accomplishments:

State Councils on Developmental Disabilities (SCDDs) are in a strategic position in each State 

and Territory to set priorities and pursue systems change efforts designed to turn fragmented 

approaches into a comprehensive and effective statewide, person-centered and family-centered 

system that provides a coordinated array of culturally-competent services and other forms of 

assistance for people with intellectual and developmental disabilities, including individuals with 

autism, and their families. 

SCDDs do not provide services directly, but rather examine and conduct in-depth analysis of the 

quantity and quality of services and supports that are provided at the State and local level. These 

studies help to identify the most pressing needs of people with developmental disabilities and 

their families and determine priority areas. Each SCDD develops a strategic State plan based on 

their analysis, 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. Working in partnership with stakeholders, including people with 

developmental disabilities, each State Council implements activities based on the strategic state 

plan to:

• Shift the way an organization or community makes decisions about policies, programs, 

and the allocation of its resources - and, ultimately, in the way it delivers services and 

supports its citizens and constituencies;
PROGRAMS FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES

154

• Support activities that expand and/or improve the ability of individuals with 

developmental disabilities, families, supports, services and/or systems to promote, 

support and enhance self-determination, independence, productivity and inclusion in 

community life; and

• Actively support policies and practices that promote self-determination and inclusion in 

the community and workforce for individuals with developmental disabilities and their 

families.

Councils also have a unique responsibility in supporting the growing self-advocacy movement. 

Each Council must ensure the State plan has activities aimed at:

• Establishing or strengthening a program for the direct funding of a State self-advocacy 

organization led by individuals with developmental disabilities;

• Promoting opportunities for individuals with developmental disabilities who are 

considered leaders to provide leadership training to individuals with developmental 

disabilities who may become leaders; and

• Supporting and expanding participation of individuals with developmental disabilities in 

cross-disability and culturally diverse leadership coalitions.

The State Councils have a significant impact upon promoting self sufficiency and community 

living for persons with developmental disabilities. In FY 2011, 13.66 percent of individuals 

nationwide with developmental disabilities were independent, self-sufficient, and integrated into 

the community as a result of SCDD efforts, exceeding the FY 2011 target of 13.45 percent. 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”). 

Examples of State Council activities include:

• The Pennsylvania Council monitors health services and changes to Medicaid and other 

health coverage systems and provides effective training to people with developmental 

disabilities and their families, including those with limited English proficiency and 

behavioral health issues, so that they can make informed decisions. This Council is 

promoting system change in mental health services provided to people with intellectual 

disabilities and addressing the need for accessible dental services. 

• In Iowa, thanks in part to the efforts of the State Council, 110 individuals including selfadvocates, family members, professionals and other advocates served as members of 
PROGRAMS FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES

155

workgroups created by the Iowa Legislature to develop recommendations for a complete 

system redesign to be considered during the 2012 legislative session.

• The Kansas Council provided funds for Project SEARCH, which is a collaborative 

project between local school districts, Vocational Rehabilitation, adult service providers 

and business to provide year-long internship opportunities for high school students with 

developmental disabilities to increase their job skills and build their resumes. The 

Council also provided start up funds for four individuals with developmental disabilities 

to start their own businesses. The businesses included lawn care services, original 

artwork production and sales, land-clearing services and a vending and food delivery 

business.

DD Council funding is allotted based on a formula that takes into account the population, the 

extent of need for services for persons with developmental disabilities, and financial need. There 

are 56 Councils. Council members are appointed by the Governor and serve in a volunteer 

capacity. Under current law, not less than 60 percent of the Council membership must be 

composed of persons with developmental disabilities and/or their family members. Councils 

engage in a range of activities including program and policy analysis, demonstration of new 

approaches, training, outreach, community support, and public education to effect systems 

change and build capacity. 

Funding History:

Funding for the program during the last five years has been as follows:

FY 2009 .................................................$74,316,000

FY 2010 .................................................$75,066,000

FY 2011 .................................................$74,916,000

FY 2012 .................................................$74,774,000

FY 2013 CR. ..........................................$75,232,000

Budget Request:

The FY 2014 budget request for State Councils is $74,744,000, the same as the FY 2012 enacted 

level. This request will provide continued support for advocacy, systems change and capacity 

building activities that improve services for people with developmental disabilities and their 

families. In FY 2014, the program expects to increase the percentage of individuals with 

developmental disabilities who are independent, self-sufficient and integrated into the 

community as a result of Council efforts by at least 0.1 percent over the previous year’s result. 
PROGRAMS FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES

156

Continued funding for State Councils is crucial as they are the entity in the States and Territories 

able to build and organize efforts aimed at turning fragmented approaches into innovative and 

cost-effective strategies that create opportunities for people with developmental disabilities and 

their families to:

• Make informed choices and decisions about their lives; 

• Live in homes and communities in which they can exercise their full rights and 

responsibilities as citizens;

• Pursue meaningful and productive lives; 

• Contribute to their families, their communities, their states, and the nation in multiple 

ways, including through competitive integrated employment; 

• Have interdependent friendships and relationships with others; 

• Live free of abuse, neglect, financial or sexual exploitation, and violations of their legal 

and human rights; and 

• Achieve full integration and inclusion in society as individuals, consistent with their 

unique strengths, resources, priorities, concerns, abilities, and capabilities. 

Advances in self-advocacy would be greatly impacted if funding were no longer available for 

State Councils. Councils such as the Indiana State Council would not be available to provide 

support as they did to Self Advocates of Indiana (SAI) in achieving the following 

accomplishments:

• Garnering financial support from the state Developmental Disabilities Services agency to 

support organizational operations;

• An SAI member becoming president of the national association of self-advocates, Self 

Advocates Becoming Empowered (SABE);

• 175 members participating in training to increase their knowledge of state and federal 

issues;

• Making nine presentations that facilitated at least 185 people to work with self 

advocates. 
PROGRAMS FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES

157

• Members becoming active participants in their communities through presentations, 

community service and fundraising activities with their groups and other organizations

The Administration on Intellectual and Developmental Disabilities (AIDD) is undertaking a 

comprehensive review of performance measurement and data reporting activities across all 

DD Act programs with an increased focus on outcomes. Steps taken to date include:

• Convening a performance measurement workgroup to devise a set of integrated 

performance measures that will provide measurable outcomes in the areas of health and 

wellness, community living, education, employment, and reduction of fraud and abuse 

for all parts of the Network. 

• Utilizing the results of an independent study that provided information on potential 

performance criteria for specific programs, establishment of performance measurement 

workgroups and engagement with evaluation experts to recommend improvements.

• Convening a workgroup of Council representatives and an expert in performance 

evaluation to review and evaluate the current measurement system used by Councils to 

report progress on an annual basis.

When implemented in FY 2015, the new performance measures will provide measurable 

outcomes in the areas of health and wellness, community living, education, employment, and 

fraud and abuse reduction for all parts of the Network.
PROGRAMS FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES

158

Outputs and Outcomes Table:

Measure Most Recent 

Result

FY 2012

Target

FY 2014

Target

FY 2014

+/- FY 2012

8.1LT and 8A: Increase the percentage of 

individuals with developmental disabilities 

reached by the Councils who are 

independent, self-sufficient and integrated 

into the community. (Outcome)

FY 2011: 13.66%

Target: 13.45%

(Target Exceeded)

Prior Result 

+0.1%

Prior Result 

+0.1% N/A

8E: Increase the number of individuals with 

developmental disabilities reached by the

Councils who are independent, self-sufficient 

and integrated into the community per $1,000 

of federal funding to the Councils. 

(Efficiency)

FY 2011: 9.08

Target: 8.59

(Target Exceeded)

Prior Result 

+1%

Prior Result 

+1% N/A

8i: Number of individuals with 

developmental disabilities reached by the 

Councils who are independent, self-sufficient 

and integrated into the community. (Output)

FY 2011: 680,127

(Actual) N/A N/A N/A

8ii: Number of all individuals trained by the 

Councils. (Output)

FY 2011: 84,697

(Actual) N/A N/A N/A

Grant Awards Tables:

State Councils on Developmental Disabilities Grant Awards

FY 2012

Actual

FY 2013

Annualized CR

FY 2014 

President’s 

Budget

Number of 

Awards 56 56 56

Average 

Award $1,335,257 $1,343,429 $1,335,250

Range of 

Awards

$248,766 -

$6,888,078

$249,344 -

$6,888,429

$249,218 -

$6,884,622
PROGRAMS FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES

159

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES

FY 2014 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: State Councils on Developmental Disabilities (CFDA 93.630)

State/Territory

FY 2012

Actual

FY 2013

Estimate

FY 2014

Estimate

FY 2014 +/-

FY 2012

Alabama........................................... 1,358,035 1,358,035 1,357,353 -682

Alaska .............................................. 477,688 478,797 478,556 868

Arizona ............................................ 1,476,807 1,476,807 1,476,066 -741

Arkansas.......................................... 797,737 797,737 797,336 -401

California......................................... 6,888,078 6,888,429 6,884,622 -3,456

Colorado .......................................... 911,313 928,928 910,855 -458

Connecticut...................................... 722,584 732,957 722,221 -363

Delaware.......................................... 477,688 478,797 478,556 868

District of Columbia ........................ 477,688 478,797 478,556 868

Florida ............................................. 3,710,543 3,789,410 3,708,681 -1,862

Georgia ............................................ 2,164,614 2,187,580 2,163,528 -1,086

Hawaii ............................................. 477,688 478,797 478,556 868

Idaho................................................ 477,688 478,797 478,556 868

Illinois.............................................. 2,626,795 2,626,795 2,625,477 -1,318

Indiana ............................................. 1,494,093 1,494,093 1,493,343 -750

Iowa ................................................. 772,384 774,177 773,788 1,404

Kansas ............................................. 613,166 614,589 614,280 1,114

Kentucky.......................................... 1,267,881 1,267,881 1,267,244 -637

Louisiana ......................................... 1,408,289 1,408,289 1,407,582 -707

Maine............................................... 477,688 478,797 478,556 868

Maryland.......................................... 1,005,825 1,008,160 1,007,654 1,829

Massachusetts.................................. 1,400,096 1,421,535 1,399,393 -703

Michigan.......................................... 2,586,883 2,634,817 2,585,619 -1,264

Minnesota ........................................ 1,022,921 1,025,295 1,024,780 1,859

Mississippi....................................... 960,915 960,915 960,432 -483

Missouri........................................... 1,372,331 1,387,768 1,371,642 -689

Montana........................................... 477,688 478,797 478,556 868

Nebraska .......................................... 477,688 478,797 478,556 868

Nevada............................................. 497,304 541,611 497,054 -250

New Hampshire ............................... 477,688 478,797 478,556 868
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160

PROGRAM/CFDA NUMBER: State Councils on Developmental Disabilities (CFDA 93.630)

State/Territory

FY 2012

Actual

FY 2013

Estimate

FY 2014

Estimate

FY 2014 +/-

FY 2012

New Jersey...................................... 1,582,970 1,588,525 1,582,175 -795

New Mexico ................................... 508,321 508,321 508,065 -256

New York ....................................... 4,355,559 4,371,343 4,353,373 -2,186

North Carolina ................................ 2,118,636 2,142,778 2,117,573 -1,063

North Dakota .................................. 477,688 478,797 478,556 868

Ohio ................................................ 2,858,499 2,858,499 2,857,064 -1,435

Oklahoma ....................................... 895,172 897,250 896,799 1,627

Oregon ............................................ 828,909 830,874 828,493 -416

Pennsylvania................................... 3,137,182 3,137,182 3,135,608 -1,574

Rhode Island................................... 477,688 478,797 478,556 868

South Carolina ................................ 1,137,865 1,137,865 1,137,294 -571

South Dakota .................................. 477,688 478,797 478,556 868

Tennessee ....................................... 1,512,170 1,512,170 1,511,411 -759

Texas .............................................. 5,084,018 5,172,582 5,081,467 -2,551

Utah ................................................ 676,092 677,632 675,752 -340

Vermont.......................................... 477,688 478,797 478,556 868

Virginia........................................... 1,498,451 1,501,929 1,501,175 2,724

Washington..................................... 1,254,427 1,254,427 1,253,797 -630

West Virginia.................................. 785,041 785,041 784,647 -394

Wisconsin ....................................... 1,298,680 1,322,309 1,298,028 -652

Wyoming ........................................ 477,688 478,797 478,556 868 

Subtotal, States............................... 71,278,218 71,727,693 71,271,455 -6,763

American Samoa............................. 248,766 249,344 249,218 452

Guam .............................................. 248,766 249,344 249,218 452

Northern Mariana Islands............... 248,766 249,344 249,218 452

Puerto Rico ..................................... 2,501,126 2,506,931 2,505,673 4,547

Virgin Islands ................................. 248,766 249,344 249,218 452

Subtotal, States and Territories....... 74,774,408 75,232,000 74,774,000 -408

TOTAL $74,774,000 $75,232,000 $74,774,000 --
161

Developmental Disabilities – Protection and Advocacy

FY 2012

Enacted

FY 2013

Annualized CR

FY 2014

President’s Budget

FY 2014+/-

FY 2012

Developmental Disabilities –

Protection and Advocacy $40,865,000 $41,115,000 $40,865,000 --

Authorizing Legislation: Section 145 of the Developmental Disabilities Assistance and Bill of 

Rights Act 

FY 2014 Developmental Disabilities Assistance and Bill of Rights Act Authorization ......Expired

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

Program Description and Accomplishments:

The Developmental Disabilities Protection and Advocacy program (PADD) provides formula 

grants to establish and maintain a Protection and Advocacy (P&A) system in each State, the 

Territories, and the District of Columbia, as well as a Native American Consortium to protect the 

legal and human rights of all persons with developmental disabilities. P&A systems have the 

authority to pursue legal, administrative, and other appropriate remedies or approaches, including 

the authority to investigate incidents of abuse and neglect. 

P&As provide legal support to traditionally unserved or underserved populations to help them 

navigate the legal system to achieve resolution and encourage systems change. P&As ensure that 

individuals with disabilities are able to exercise their rights to make choices, contribute to society 

and live independently.

While their focus is most often legal, 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.

In addition, P&As provide substantial advocacy and legal services on educational issues, and 

work to ensure that students receive an appropriate education in an inclusive setting. P&As have 
PROGRAMS FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES

162

also made great strides in increasing the opportunities for individuals with developmental 

disabilities to make decisions for themselves about where and with whom they live.

P&As have been involved in a significant number of landmark cases and work closely with other 

entities, especially State Councils on Developmental Disabilities and University Centers for 

Excellence in Developmental Disabilities. P&As also work to implement the U.S. Supreme 

Court’s 1999 decision in Olmstead v. L.C., which requires states to eliminate unnecessary 

segregation of people with disabilities, and to ensure that they receive services in the most 

integrated setting possible.

There are 57 Protection and Advocacy systems. Funding for the program is allotted to States and 

Territories based on population and the extent of need for persons with developmental 

disabilities, weighted by the per capita income for each State and Territory. 

Funding History:

Funding for the program during the last five years has been as follows:

FY 2009 .................................................$40,024,000

FY 2010 .................................................$41,024,000

FY 2011 .................................................$40,942,000

FY 2012 .................................................$40,865,000

FY 2013 CR. ..........................................$41,115,000

Budget Request:

The FY 2014 budget request for PADD is $40,865,000, the same as the FY 2012 enacted level. 

This request will allow the P&A system to provide training, legal and advocacy services both to 

groups and to individuals with developmental disabilities, as well as information and referral 

services. Additionally, this request will support training and technical assistance to leadership 

and staff of the P&A system to improve their performance. 

The P&As form a national system that serve a critical role of ensuring people with 

developmental disabilities are free of abuse and neglect. People with developmental disabilities 

are at an increased risk to experience abuse and neglect, including children.73 A 2009 report from 

the U.S. General Accountability Office found hundreds of allegations of abuse and neglect at 

public and private schools across the nation between the years 1990 and 2009, almost all of 

 73 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
PROGRAMS FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES

163

which involved children with disabilities.74 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 2011, the 57 P&As remedied 

9,470 complaints of abuse and neglect. 

Without the P&A presence, people with developmental disabilities and their families would have 

limited to no access to cost-effective, low level advocacy and legal interventions. Of the inquiries 

and issues received by the P&As:

• 38% were resolved using short-term assistance strategies; 

• 22% were addressed through technical assistance in self-advocacy;

• 15% involved investigation and monitoring; and 

• 12% were addressed through negotiation. 

AIDD continues to analyze its tracking of the percentage of individuals who have their complaint 

of abuse, neglect, discrimination, or other human or civil rights resolved. For FY 2014, the 

program expects to further increase the result by one half of one percent over the previous year. 

A performance measurement workgroup for the PADD program was established in FY 2012 to 

further analyze performance measurements and make recommendations for improvement. 

Developmental measures are planned for proposal in FY 2015 in collaboration with the AIDD 

performance measurement workgroup to address overarching performance measurements across 

AIDD Programs.

 74 U.S. General Accountability Office. (2009). Selected Cases of Death and Abuse at Public and Private Schools and 

Treatment Centers. Washington, DC: U.S. General Accountability Office.
PROGRAMS FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES

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Outputs and Outcomes Table:

Measure Most Recent Result FY 2012

Target

FY 2014

Target

FY 2014

+/- FY 2012

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 2011: 83.0%

Target: 92.76%

(Target Not Met)

Prior Result 

+0.5%

Prior Result 

+0.5% N/A

8iii: Number of clients receiving 

professional individual legal advocacy 

for the Protection and Advocacy 

program. (Output)

FY 2011: 21,374

(Actual) N/A N/A N/A

8iv: Number of people receiving 

information and referral from the 

Protection and Advocacy program. 

(Output)

FY 2011: 35,262

(Actual) N/A N/A N/A

8ix: Number of people reached 

through University Centers for 

Excellence in Developmental 

Disabilities (UCEDD) community 

training and technical assistance 

activities. (Output)

FY 2011: 1.19 M

(Actual) N/A N/A N/A

Grant Awards Tables:

Developmental Disabilities – Protection and Advocacy Grant Awards75

FY 2012

Actual

FY 2013

Annualized CR

FY 2014 

President’s 

Budget

Number of 

Awards 56 56 56

Average 

Award $711,456 $711,141 $711,462

Range of 

Awards

$205,808 -

$3,415,127

$205,808 -

$3,447,908

$205,888 -

$3,449,927

 75 Excludes grants to tribal organizations.
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165

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES

FY 2014 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Developmental Disabilities – Protection and Advocacy (CFDA 93.630)

State/Territory

FY 2012

Actual

FY 2013

Estimate

FY 2014

Estimate

FY 2014 +/-

FY 2012

Alabama........................................... 658,233 654,350 654,731 -3,502

Alaska .............................................. 384,693 384,693 384,693 --

Arizona ............................................ 683,799 691,110 691,515 7,716

Arkansas.......................................... 404,704 403,492 403,577 -1,127

California......................................... 3,415,127 3,447,908 3,449,927 34,800

Colorado .......................................... 463,637 467,345 467,545 3,908

Connecticut...................................... 398,099 396,711 396,792 -1,307

Delaware.......................................... 384,693 384,693 384,693 --

District of Columbia ........................ 384,693 384,693 384,693 --

Florida ............................................. 1,906,955 1,934,863 1,935,995 29,040

Georgia ............................................ 1,094,894 1,098,485 1,099,128 4,234

Hawaii ............................................. 384,693 384,693 384,693 --

Idaho................................................ 384,693 384,693 384,693 --

Illinois.............................................. 1,346,888 1,339,402 1,340,185 -6,703

Indiana ............................................. 810,261 810,508 810,982 721

Iowa ................................................. 395,039 393,891 393,970 -1,069

Kansas ............................................. 384,693 384,693 384,693 --

Kentucky.......................................... 620,005 614,825 615,183 -4,822

Louisiana ......................................... 598,023 596,389 596,736 -1,287

Maine............................................... 384,693 384,693 384,693 --

Maryland.......................................... 498,369 496,875 497,166 -1,203

Massachusetts.................................. 636,572 637,115 637,487 915

Michigan.......................................... 1,310,947 1,313,495 1,314,262 3,315

Minnesota ........................................ 541,679 540,829 541,145 -534

Mississippi....................................... 455,460 449,884 450,146 -5,314

Missouri........................................... 733,550 726,116 726,540 -7,010

Montana........................................... 384,693 384,693 384,693 --

Nebraska .......................................... 384,693 384,693 384,693 --

Nevada............................................. 384,693 384,693 384,693 --

New Hampshire ............................... 384,693 384,693 384,693 --
PROGRAMS FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES

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PROGRAM/CFDA NUMBER: Developmental Disabilities – Protection and Advocacy (CFDA 93.630)

State/Territory

FY 2012

Actual

FY 2013

Estimate

FY 2014

Estimate

FY 2014 +/-

FY 2012

New Jersey...................................... 789,686 787,223 787,682 -2,004

New Mexico ................................... 384,693 384,693 384,693 --

New York ....................................... 1,973,384 1,957,037 1,958,178 -15,206

North Carolina ................................ 1,137,732 1,144,750 1,145,419 7,687

North Dakota .................................. 384,693 384,693 384,693 --

Ohio ................................................ 1,438,540 1,425,051 1,425,884 -12,656

Oklahoma ....................................... 442,376 444,943 445,204 2,828

Oregon ............................................ 427,623 429,055 429,233 1,610

Pennsylvania................................... 1,481,540 1,467,060 1,467,917 -13,623

Rhode Island................................... 384,693 384,693 384,693 --

South Carolina ................................ 603,084 604,309 604,663 1,579

South Dakota .................................. 384,693 384,693 384,693 --

Tennessee ....................................... 793,941 791,892 792,355 -1,586

Texas .............................................. 2,518,653 2,547,232 2,548,724 30,071

Utah ................................................ 384,693 384,693 384,693 --

Vermont.......................................... 384,693 384,693 384,693 --

Virginia........................................... 773,699 770,509 770,959 -2,740

Washington..................................... 636,975 644,543 644,920 7,945

West Virginia.................................. 390,358 388,412 388,488 -1,870

Wisconsin ....................................... 684,850 680,622 681,020 -3,830

Wyoming ........................................ 384,693 384,693 384,693 -- 

Subtotal, States............................... 37,989,156 38,020,705 38,038,132 48,976

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 ..................................... 1,029,131 979,955 980,528 -48,603

Virgin Islands ................................. 205,808 205,808 205,808 --

Subtotal, States and Territories....... 39,841,519 39,823,892 39,841,892 373

Grants to Tribes 205,808 205,808 205,808 --

Training and Technical Assistance76 817,673 1,085,300 817,300 -373

TOTAL $40,865,000 $41,115,000 $40,865,000 --

 76 This line reflects the amount reserved from the P&A appropriation for statutory related activities, including 

training, technical assistance, grant systems, and review costs
167

University Centers for Excellence in Developmental Disabilities

FY 2012

Enacted

FY 2013

Annualized CR

FY 2014

President’s Budget

FY 2014+/-

FY 2012

University Centers for Excellence 

in Developmental Disabilities..... $38,792,000 $39,029,000 $38,792,000 --

Authorizing Legislation: Section 156 of the Developmental Disabilities Assistance and Bill of 

Rights Act 

FY 2014 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), first established in 

1963, are interdisciplinary education, research and public service units of a university system or 

public or not-for-profit entities associated with universities. UCEDDs provide leadership in 

advising Federal, State, and community policymakers about opportunities for individuals with 

developmental disabilities to exercise self-determination, be independent, productive, and 

integrated and included in all facets of community life. In FY 2012, the Administration on 

Intellectual and Developmental Disabilities (AIDD) plans to award 67 grants to continue funding 

for University Centers to engage in interdisciplinary pre-service training, community services, 

research, and information dissemination activities. The grant designates the Center and provides 

infrastructure support for UCEDDs to leverage additional funds for carrying out core activities. 

UCEDDs provide unique contributions to the intellectual and developmental disabilities 

community in the area of pre-service preparation. UCEDDs provide an array of interdisciplinary 

instructional programs to improve the quality of services and supports for people with 

developmental disabilities. UCEDD interdisciplinary training programs are 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
PROGRAMS FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES

168

• Examine and advance professional practice, scholarship and policy that impacts the lives 

of people with developmental and other disabilities and their families.

UCEDD trainees come from a wide array of professional backgrounds including, but not limited 

to, pediatrics, education, dentistry, nursing, allied health, and administration (e.g., public, health, 

education, etc.). On average, UCEDDs train nearly 2,800 future professionals each year. 

In addition to advancing the field through pre-service preparation, UCEDDs make strategic 

connections across multiple sectors to ensure people with developmental and other disabilities 

attain maximum physical, emotional, social, and economic well-being; and are independent, 

productive and fully participating members of their community consistent with their cultural 

values. UCEDD community services cut across Federal, State, and local systems to improve 

capacity and quality of services by incorporating evidence-based practices. UCEDDs are at the 

forefront of ensuring appropriate evaluation of disabilities and the use of evidence-based 

interventions for children and adults with developmental and other disabilities, such as Autism 

Spectrum Disorders, for which rates have increased in recent years. New knowledge is generated 

by research and tied to practice using a variety of dissemination strategies. 

Funding History:

Funding for the program during the last five years has been as follows:

FY 2009 .................................................$37,943,000

FY 2010 .................................................$38,943,000

FY 2011 .................................................$38,865,000

FY 2012 .................................................$38,792,000

FY 2013 CR. ..........................................$39,029,000

Budget Request:

The FY 2014 request is $38,792,000, the same as the FY 2012 enacted level. This request will 

provide operational and administrative support to maintain the existing 67 UCEDDs. This 

funding also will provide continued support for the training and technical assistance to the 

UCEDDs, which supports improvements in the programs’ performance and ability to meet 

performance targets.

Continued funding of the UCEDDs will support this 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 
PROGRAMS FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES

169

specialized expertise in developmental disabilities. Of the UCEDD trainees who graduated 5 to 

10 years ago, 82% are in leadership positions with: 

• 56% in academic leadership 

• 48% in clinical leadership 

• 25% in public health leadership 

• 28% in public policy and advocacy leadership

It is estimated that 36.05% of people with developmental disabilities are receiving services from 

former UCEDD trainees. 

In the absence of continued funding for UCEDDs, specialized services would no longer be 

available at the local level and local organizations as well as state agencies would not have the 

benefit of receiving technical assistance from UCEDDs to improve services and supports for 

people with developmental disabilities across the life span. A lack of funding would also create a 

tremendous gap in new knowledge generated by UCEDD-conducted research. For example, the 

M.I.N.D. Institute at the University of California, Davis has partnered with the Hmong Women’s 

Heritage Association and the United Iu-Mien Community, Inc. to study barriers to quality care 

among Southeast Asian communities, with the goal of improving health care and access to 

services for children and adults with developmental disabilities. Based on the findings, project 

staff and community partners are undertaking a public service campaign aimed at increasing the 

awareness of developmental disabilities, early identification and services for the Southeast Asian 

communities.

UCEDD funds help to place these centers in a strategic position to lead national efforts such as 

The National Gateway to Self-determination, which is a collaborative effort of five UCEDDs and 

the National Self-Determination Alliance to establish a sustainable, evidence-based training 

system that enhances self-determination training programs that lead to quality of life outcomes 

for individuals with developmental disabilities throughout the lifespan. Another example is The

Consortium to Enhance Postsecondary Education for Individuals with Developmental 

Disabilities, which is a project led by the Institute for Community Inclusion in Massachusetts in 

collaboration with seven UCEDDs (Delaware, Minnesota, Hawaii, South Carolina, Tennessee 

[Vanderbilt], Ohio, and California) and the Association of University Centers on Disabilities. 

The Consortium is conducting research, providing training and technical assistance, and 

disseminating information on promising practices that support individuals with developmental 

disabilities to increase their independence, productivity, and inclusion through access to 
PROGRAMS FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES

170

postsecondary education, resulting in improved long-term independent living and employment 

outcomes. 

Funding for UCEDDs also provides infrastructure support for initiatives with effects felt 

internationally such as The Border Project at the Sonoran UCEDD, University of Arizona which 

is providing the Arizona-Mexico Border Region with low cost durable medical equipment and 

assistive technologies and training. 

UCEDD designation and funding also aids these centers in seeking other sources of money to 

pursue activities that improve the lives of people with developmental disabilities. The grant from 

AIDD provides a critical infrastructure support that allows the UCEDD to leverage additional 

funds. There is a significant return on AIDD’s investment. In FY 2011, AIDD invested 

$35.8 million in UCEDD grant awards from which the UCEDDs leveraged $384.5 million to 

carry out their core activities. 

A UCEDD performance measurement workgroup developed a UCEDD logic model that was 

used to make necessary updates to ensure meaningful program performance report outcome 

measurements. New performance measures were implemented in August 2012. In addition, the 

AIDD performance measurement workgroup plans to propose developmental measures in 

FY 2015.
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171

Outputs and Outcomes Table:

Measure Most Recent Result FY 2012

Target

FY 2014

Target

FY 2014

+/- FY 2012

8D: Increase the percentage of 

individuals with developmental 

disabilities receiving the benefit of 

services through activities in which 

professionals were involved who 

completed University Centers of 

Excellence in Developmental 

Disabilities (UCEDDs) state-of-the-art 

training within the past 10 years. 

(Outcome)

FY 2011: 37.67%

Target: 36.38%

(Target Exceeded)

Prior Result 

+1%

Prior Result 

+1% N/A

8viii: Number of professionals trained 

by UCEDDs. (Output)

FY 2011: 5,594

(Actual) N/A N/A N/A

8ix: Number of people reached 

through UCEDD community training 

and technical assistance activities. 

(Output)

FY 2011: 1.19 million

(Actual) N/A N/A N/A

8x: Number of people receiving direct 

or model demonstration services from 

UCEDDs. (Output)

FY 2011: 97,069

(Actual) N/A N/A N/A

Grant Awards Tables:

University Centers of Excellence in Developmental Disabilities Grant Awards

FY 2012 

Actual

FY 2013 

Annualized CR

FY 2014 

President’s 

Budget

Number of 

Awards 6977 67 67

Average 

Award $550,782 $554,000 $554,000

Range of 

Awards

$442,988 -

$554,000

$554,000 -

$554,000

$554,000 -

$554,000

 77 The two National Training Initiative grants will end in FY 2013.
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Resource and Program Data:

University Centers of Excellence in Developmental Disabilities

(Dollars in thousands)

FY 2012 FY 2013 FY 2014

Enacted Annual CR President's Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary 44 24,154 18 10,151 4 1,763

Continuations 25 13,850 50 28,088 64 36,544

Contracts 1 788 1 787 1 481

Interagency Agreements -- -- 1 3,150 1 3,150

Program Support /1 1 -- --

Total Resources 38,792 39,029 38,792

1/ Program Support -- Includes funds for grant systems and review costs.
173

Developmental Disabilities – Projects of National Significance

FY 2012

Enacted

FY 2013

Annualized CR

FY 2014

President’s Budget

FY 2014+/-

FY 2012

Projects of National Significance $8,317,000 $8,368,000 $8,317,000 --

Authorizing Legislation: Section 163 of the Developmental Disabilities Assistance and Bill of 

Rights Act 

FY 2014 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 that support and 

supplement the work of the State Councils on Developmental Disabilities, the Protection and 

Advocacy systems for persons with Developmental Disabilities, and the University Centers for 

Excellence in Developmental Disabilities. PNS complements these other Developmental 

Disabilities (DD) programs by supporting the development of national and State policies, 

including Federal interagency initiatives; demonstration projects addressing innovative and 

emerging best practices to expand opportunities for individuals with developmental disabilities 

to contribute to, and participate in, all facets of community life; and longitudinal data collection 

projects.

In FY 2012, PNS resources funded systems change grants to improve access to competitive, 

integrated supported employment for people with intellectual and developmental disabilities, 

with a particular focus on youth and young adults, as well as the evaluation of such efforts. It 

also funded promising practices in states to promote competitive, integrated employment and 

family support activities. PNS funds continue to support the National Autism Resource and 

Information Center, 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. 

In FY 2014, AIDD will continue to prioritize these efforts to improve outcomes for individuals 

with developmental disabilities in competitive, integrated employment. AIDD will also continue 

to fund efforts to support promising practices for family support activities through training and 
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174

technical assistance. In addition, PNS funds will continue to support the National Autism 

Resource and Information Center 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. 

Funding History:

Funding for the program during the last five years has been as follows:

FY 2009 .................................................$14,162,000

FY 2010 .................................................$14,136,000

FY 2011 .................................................$14,134,000

FY 2012 ...................................................$8,317,000

FY 2013 CR.............................................$8,368,000

Budget Request:

The FY 2014 request for the Projects of National Significance program is $8,317,000, the same 

as the FY 2012 enacted level. The request will support continued funding for employment 

initiatives, technical assistance, longitudinal data collection and analysis, evaluation, and 

monitoring.

PNS projects reflect the current and emerging needs of individuals with developmental 

disabilities. For instance, AIDD will continue to fund the Partnerships in Employment Systems 

Change projects as they continue to work toward a current need of the intellectual and 

developmental disabilities community. In Wisconsin, individuals with intellectual and 

developmental disabilities enrolled in adult long-term care systems have community-based 

employment rates of only 9 to 14 percent. One of the project’s goals is to implement policy and 

legislative changes that will increase the number of students in Wisconsin, and ultimately 

nationally who are employed in integrated, community based settings after leaving high school 

or a post-secondary institution and who become economically self-sufficient. Without this 

funding, progress will not be made on this project and others like it, which does a disservice to 

individuals with intellectual and developmental disabilities in Wisconsin and the other seven 

states.

The National Autism Information Resource Center (the Autism Now project), provides high 

quality resources and information related to community-based services that support independent 

living and self-determination, treatment protocols that promote community-based experiences 

(e.g. education, employment, recreation, transportation, early intervention and child care), and 

evidence-based interventions for Autism Spectrum Disorder (ASD) service providers, 
PROGRAMS FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES

175

researchers, families, and people with ASD. This project intends to provide more robust 

materials for the autism community and partner with relevant organizations to improve support 

to individuals with ASD, their families, professionals, and the general public. The impetus of the 

program was a Congressional directive through the 2010 Senate committee report, and it has a 

unique target audience. Therefore, a lack of funding will create a significant gap in the autism 

community’s resources. 

AIDD continues to undertake a comprehensive review of performance measurement and data 

reporting activities across all DD Act programs with an increased focus on outcomes, including, 

the establishment of performance measurement workgroups, enhancement and streamlining data 

collection, and engagement with evaluation experts to recommend improvements. 

Grant Awards Tables:

Developmental Disabilities – Projects of National Significance Grant Awards

FY 2012 

Actual

FY 2013 

Annualized CR

FY 2014 

President’s 

Budget

Number of 

Awards 17 17 17

Average 

Award $356,449 $356,449 $356,449

Range of 

Awards

$190,000 -

$575,000

$190,000 -

$575,000

$190,000 -

$575,000

Resource and Program Data:

University Centers of Excellence in Developmental Disabilities

(Dollars in thousands)

FY 2012 FY 2013 FY 2014

Enacted Annual CR President's Budget /2

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary 8 2,962 6 201 2 500

Continuations 9 3,098 17 6,060 16 5,710

Contracts 6 1,508 5 1,348 5 1,348

Interagency Agreements -- -- -- -- -- --

Program Support /1 750 760 760

Total Resources 8,317 8,368 8,317

1/ Program Support -- Includes funds for grant systems and review costs.
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177

Consumer Information, Access, and Outreach

Summary of Request

Older Americans and Americans with disabilities face a vast array of choices when trying to 

determine the right services and supports to assist them to remain active and independent in their 

communities. As the number of choices available to assist them grows, so too does the 

complexity of navigating these programs and selecting among them so as to determine which 

best suit the needs of each individual. 

A key part of ACL’s emphasis on community living is providing consumers with the information 

they need to make decisions about their independence and connecting them with the right 

services. Aging and Disability Resource Centers (ADRCs) and the State Health Insurance 

Assistance Programs (SHIPs) help to address this need by providing information, outreach, and 

assistance to seniors and people with disabilities, so that they can access the services necessary 

for their independence. ADRCs serve as community-level “one stop shop” entry points into longterm care - including home and community-based services that can enable people to remain in 

their homes - for people of all ages who have chronic conditions and disabilities. SHIPs provide 

one-on-one counseling to help aging and disabled beneficiaries understand and make optimal use 

of their Medicare benefits.

Equally important, however, are the programs that help disabled individuals and seniors to more 

fully participate in all aspects of community life. Grants provided under the Help America Vote 

Act (HAVA) assist States in making polling places accessible to individuals with the full range 

of disabilities. Further, the Alzheimer’s Disease Initiative Communications Campaign, proposed 

to be funded from the Prevention and Public Health Fund, the National Clearinghouse for LongTerm Care Information, and the Paralysis Resource Center (proposed for transfer to ACL from 

CDC) each reach out to key populations to assist in accessing services and in planning for future 

needs. 

The FY 2014 request for these programs is $81,250,000, a reduction of -$6,257,000 from the 

FY 2012 enacted level. This request would provide:

• $10,000,000 for ADRCs using mandatory funds provided by the Affordable Care Act. As 

in the FY 2013 President’s Budget, no funding is requested from discretionary 

appropriations. ADRCs support State efforts to develop more efficient, cost-effective, 

and consumer-responsive systems of information and integrated access by creating “onestop shop” entry points into long-term care at the community-level. FY 2014 is the final 

year that funding will be provided for this program under ACA.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

178 

• $5,235,000 for HAVA grants to 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 a vote, and accessing polling places. 

• $4,200,000 for the Alzheimer’s Disease Initiative Outreach Campaign to inform people 

caring for people with Alzheimer’s disease about the federal, state, local, and nonprofit 

resources available to help them. This funding is proposed from the Prevention and 

Public Health Fund. 

• $52,115,000 for State Health Insurance Assistance Programs (SHIPs), proposed for 

transfer to ACL from the Centers for Medicare and Medicaid Services. SHIPs provide 

free, one-on-one counseling and assistance to help aging and disabled Medicare 

beneficiaries navigate the complexities of health and long-term care systems. The SHIPs, 

two-thirds of which are currently administered by State Units on Aging, fit naturally 

within ACL’s mission of promoting community living, and will benefit from deeper 

connection to ACL’s aging and disability services networks. 

• $3,000,000 for the National Clearinghouse for Long-Term Care Information, which seeks 

to increase awareness of the need to plan ahead for long-term care. FY 2014 is the first

year for which discretionary funding is being sought. 

• $6,700,000 for the Paralysis Resource Center (PRC), proposed for transfer to ACL from 

the Centers for Disease Control and Prevention. The PRC provides comprehensive 

information and referral services for people living with paralysis and their families and 

caregivers. Under ACL’s administration the PRC will benefit from extensive ties to 

ACL’s disability networks.
179 

Aging and Disability Resource Centers

FY 2012

Enacted

FY 2013

Annualized CR

FY 2014

President’s Budget

FY 2014+/-

FY 2012

Discretionary.......................... $6,457,000 $6,497,000 -- -$6,457,000

Affordable Care Act............ $10,000,000 $10,000,000 $10,000,000 --

 Total............................ $16,457,000 $16,497,000 $10,000,000 -$6,457,000

 FTE........................... 4 4 4 --

Authorizing Legislation: Section 202b of the Older Americans Act of 1965, as amended and 

Section 2405 of the Affordable Care Act, P.L. 111-148. 

Mandatory Appropriation: Section 2405 of the Affordable Care Act of 2010 

FY 2014 Older Americans Act Authorization ...................................................................... Expired

FY 2014 Mandatory Authorization ................................................................................$10,000,000 

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 “one-stop shop” entry points into long-term care at the community-level. ADRCs grew 

out of best practice innovations known as “No Wrong Door”78 and “Single Points of Entry” 

programs, where people of all ages may turn for objective information on their long-term 

services and support options. Since 2003, the Administration on Aging, along with the Centers 

for Medicare & Medicaid Services (CMS), have provided grants to States to develop the 

foundational infrastructure for delivering person-centered systems of information, one-on-one 

counseling, and access that make it easier for individuals to learn about and access their health 

and long-term services and support options. 

 

78 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

180

ADRCs are a key component in transforming States’ long-term supports and services programs. 

Services provided include:

• Targeted discharge planning, care transition and 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” options counseling and advice to help consumers, including private pay 

individuals, and their caregivers fully understand the options available to them.

• Streamlined access to all publicly supported long-term care services and support 

programs;

• Outreach and assistance to Medicare beneficiaries on their Medicare benefits including 

prevention and low-income subsidies; and

• Integrated options counseling and access-point to care transition and diversion support 

for Veterans served through the ACL/Department of Veterans Affairs (VA) VeteranDirected Home and Community Based Services Program partnership.

With FY 2012 funds, it was estimated that ADRCs would respond to over four million contacts 

to help individuals make better informed decisions about their health and long-term care options, 

with the vast majority of these decisions resulting in referrals for community-based services.

ADRCs help States make better use of taxpayer dollars by streamlining access to community 

services and supports and diverting individuals from more costly forms of care, including 

institutional care and unnecessary hospital re-admissions. High performing ADRC programs 

funded under this announcement will satisfy two of three statewide system change requirements 

States must meet in order to qualify for enhanced Federal match under the CMS Medicaid 

Balancing Incentive Program. 

AoA and CMS have invested over $100 million in the ADRC program since 2003. As a result of 

these investments: 

• Over 492 ADRC sites have been established across 50 states, three territories, and 

Washington, DC, by increasing the coordination and capacity of existing infrastructure in 

the aging, disability and Medicaid networks. Together these ADRC sites can reach 

roughly 63 percent of the U.S. population.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

181

• 24 States and Territories have achieved statewide coverage, and an additional 13 States 

have achieved 50 percent or more of statewide coverage. 

• 40 states with ADRC programs sites currently conduct care transitions through formal 

intervention with an additional 10 states currently planning to conduct activities also 

through formal interventions

• 25 States have developed statewide web-based directories available to consumers and 

service providers which improve the quality and consistency of the aging services 

network information and assistance provided across the state. 

Funding History:

Comparable discretionary funding for Aging and Disability Resource Centers is as follows:

FY 2009 .................................................$13,577,000 

FY 2010 .................................................$13,684,000 

FY 2011 ...................................................$6,469,000 

FY 2012 ...................................................$6,457,000 

FY 2013 CR. ............................................$6,497,000 

Note: Discretionary funding for ADRC activities was provided under Aging Network Support Activities in FY 2009 and 

FY 2010 and requested under Health and Long-term Care Programs in FY 2011.

Comparable mandatory funding for Aging and Disability Resource Centers is as follows:

 

FY 2010 .................................................$10,000,000 3 FTE

FY 2011 .................................................$10,000,000 3 FTE

FY 2012 .................................................$10,000,000 4 FTE

FY 2013 .................................................$10,000,000 4 FTE

Note: Mandatory appropriations of $10 million for FY 2010 through FY 2014 for ADRCs are made under Section 

2405 of P.L. 111-148, the Affordable Care Act of 2010. 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

182

Budget Request:

No discretionary funding is requested for Aging and Disability Resource Centers for FY 2014. 

Mandatory funding for ADRCs is currently appropriated ($10 million annually) through 

FY 2014 under the Affordable Care Act, P.L. 111-148. It should be noted that FY 2014 is the 

last year that funding under ACA is available without further action by the Congress. 

ACL intends to use this funding for ADRCs to support States and communities to continue to 

build the infrastructure needed to advance the ongoing integration of the programs efforts into 

States’ HCBS systems and create greater integration with the health care system. Special 

emphasis will be given to strengthening the capacity of existing ADRCs to carry-out options 

counseling, nursing home diversion, and care transitions that help reduce unnecessary hospital 

readmissions. Going forward, ACL will also continue to partner with CMS and the Veteran’s

Health Administration to assist States in reducing the growth in long-term care spending through

effective and efficient increases in non-institutional services and supports. 

ADRCs will also continue, with Department of Veteran’s Affairs (VA) funding, to serve clients 

under the current ACL/VA partnership. In FY 2008, the VA and AoA began working together to 

develop the Veterans Directed Home and Community Based Services Program (VD-HCBS), 

which is designed to serve Veterans of any age who are at risk of admission to a nursing home 

by providing them the opportunity to self-direct their care and access services to help them 

remain in the community. Rather than build a separate infrastructure to serve Veterans, the VA

made a strategic decision to use the aging network infrastructure – including using the ADRC as 

the integrated access point to empower the veterans to set-up their own service plan for longterm supports and services – as a delivery vehicle for VD-HCBS. Since inception of the program 

the VA has invested $40.8 million to help expand this program nationwide. HHS and the VA 

have worked together to develop Program Guidelines/National Standards, web based tools to 

track and scale program, and implement a National Training program for the VD-HCBS. 

Currently, 19 states and the District of Columbia are operating VD-HCBS programs with 

33 operational VAMCs, 82 operational AAA/ADRCs and over 775 veterans served (132 or 

17% under age 60). In FY 2012, it is projected that additional 28 VAMCs will be added.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

183

Outcome and Outputs Table:

Aging and Disability Resource Centers Outcome and Outputs

Note: For presentation within the budget AoA highlighted specific measures that are most directly related to Aging 

and Disability Resource Centers; however multiple performance outcomes are impacted by this program because 

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

performance in achieving current strategic objectives.

Resource and Program Data:

Aging and Disability Resource Centers (total)

(Dollars in thousands)

FY 2012 FY 2013 FY 2014

Enacted Annual CR President's Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary 44 12,527 38 6,294 -- --

Continuations 2 600 9 6,759 8 6,407

Contracts 1 2,500 1 2,538 1 2,801

Interagency Agreements -- -- 1 100 -- --

Program Support 1/ 830 807 792

Total Resources 16,457 16,496 10,000

1/ Program Support -- Includes funds for grant systems and review and information technology support costs.

Measure Most Recent Result FY 2012

Target

FY 2014

Target 

FY 2014 

+/- FY 2012

LTC.2: Percent of individuals 

who indicate ADRC information 

and counseling contribute to 

informed decision making 

(Outcome)

FY 2011: 77.7% 

(note: only 13 sites 

reporting)

Target set 

FY 13 83% N/A

Indicator Most Recent Result FY 2012 

Projection

FY 2014 

Projection 

FY 2014 

+/- FY 2012

Output AF: Total number of 

ADRC contacts (Output) FY 2011: 4,655,944 3.75 M 3.6 M -0.15 M

Output AG: Increase in the 

number of ADRC pilot programs 

(Output)

FY 2011: 367 310 280 -30
CONSUMER INFORMATION, ACCESS, AND OUTREACH

184

Aging and Disability Resource Centers (Discretionary)

(Dollars in thousands)

FY 2012 FY 2013 FY 2014

Enacted Annual CR President's Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary 36 3,344 38 3,559 -- --

Continuations 2 600 1 300 -- --

Contracts 1 2,500 1 2,538 -- --

Interagency Agreements -- -- 1 100 -- --

Program Support 1/ 13 -- --

Total Resources 6,457 6,496 --

1/ Program Support -- Includes funds for grant systems and review and information technology support costs.

Aging and Disability Resource Centers (Mandatory)

(Dollars in thousands)

FY 2012 FY 2013 FY 2014

Enacted Annual CR President's Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary 8 9,183 -- 2,374 -- --

Continuations -- -- 8 6,459 8 6,407

Contracts -- -- -- -- 1 2,801

Interagency Agreements -- -- -- -- -- --

Program Support 1/ 817 807 792

Total Resources 10,000 10,000 10,000

1/ Program Support -- Includes funds for grant systems and review and information technology support costs.
185

Voting Access for Individuals with Disabilities

FY 2012

Enacted

FY 2013

Annualized CR

FY 2014

President’s Budget

FY 2014+/-

FY 2012

Voting Access for 

People with Disabilities $5,235,000 $5,267,000 $5,235,000 --

Authorizing Legislation: Section 291 of the Help America Vote Act 

FY 2014 Authorization ....................................................................................................Such Sums

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

Program Description and Accomplishments:

The Voting Access for Individuals with Disabilities program is authorized by the Help America 

Vote Act (HAVA), P.L. 107-252. Funding currently supports Protection and Advocacy systems 

in each State and Territory, through formula grants, to ensure full participation in the electoral 

process for individuals with disabilities, including registering to vote, casting a vote, and 

accessing 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 a competitive one-year award. 

HAVA P&A grantees use funds to promote systematic efforts to ensure 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 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.

Providing Training and Technical Assistance to the P&As

Through the program, AIDD also makes discretionary grants to eligible nonprofit organizations 

to assist P&A’s in developing proficiency in the use of voting systems and technologies for 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

186

individuals with disabilities and demonstrating and evaluating the use of such systems and 

technologies. P&A’s 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. After receiving training and technical 

assistance, P&A’s may inform others on the availability of accessible voting equipment and its 

use.

Funding History:

Funding during the last five years has been as follows:

FY 2009 .................................................$17,410,000 

FY 2010 .................................................$17,410,000 

FY 2011 .................................................$17,375,000 

FY 2012 ...................................................$5,235,000

FY 2013 CR.............................................$5,267,000

Budget Request:

The FY 2014 budget request for Voting Access for Individuals with Disabilities to the Protection 

and Advocacy Systems and related technical assistance is $5,235,000, the same as the FY 2012 

enacted level. 

As an example of the activities undertaken with this 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. 

However, accessibility in voting continues to be an ongoing challenge throughout the country. A 

forthcoming report by the National Council on Disability identifies an incident in 2012 in 

Arizona where a voter who used a wheelchair could not get through the front door of her polling 

place to deliver an early ballot. The same report details a complaint from Bladensburg, MD 

where voters with disabilities were told that they had to “prove their disability” in order to be 

seated in line. Additionally, the Maryland P&A had to notify a Montgomery County judge to 

unlock the assigned accessible door to a polling place so that voters with disabilities could enter 

the building.

Being able to participate fully in the election process is a right, not a privilege, and 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.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

187

Accessibility in voting continues to be an ongoing challenge. Being able to participate fully in 

the election process is a right, not a privilege, and 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

FY 2012 

Actual

FY 2013 

President’s 

Budget

FY 2014 

Planning Level

Number of 

Awards 55 55 55

Average 

Award $88,521 $89,060 $88,519

Range of 

Awards

$35,000 -

$398,170

$35,000 -

$404,612

$35,000 -

$398,916
CONSUMER INFORMATION, ACCESS, AND OUTREACH

188

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES

FY 2014 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Voting Access for Individuals with Disabilities (CFDA 93.618)

State/Territory

FY 2012

Actual

FY 2013

Estimate

FY 2014

Estimate

FY 2014 +/-

FY 2012

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......................................... 398,170 404,612 398,916 746

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 ............................................. 200,948 204,578 201,697 749

Georgia ............................................ 103,541 105,364 103,880 339

Hawaii ............................................. 70,000 70,000 70,000 --

Idaho................................................ 70,000 70,000 70,000 --

Illinois.............................................. 137,133 138,148 136,203 -930

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 70,715 70,000 --

Michigan.......................................... 105,636 106,018 104,525 -1,111

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

189

PROGRAM/CFDA NUMBER: Voting Access for Individuals with Disabilities (CFDA 93.618)

State/Territory

FY 2012

Estimate

FY 2013

Estimate

FY 2014

Estimate

FY 2014 +/-

FY 2012

New Jersey...................................... 93,967 94,693 93,359 -608

New Mexico ................................... 70,000 70,000 70,000 --

New York ....................................... 207,113 208,954 206,012 -1,101

North Carolina ................................ 101,915 103,659 102,199 284

North Dakota .................................. 70,000 70,000 70,000 --

Ohio ................................................ 123,302 123,932 122,187 -1,115

Oklahoma ....................................... 70,000 70,000 70,000 --

Oregon ............................................ 70,000 70,000 70,000 --

Pennsylvania................................... 135,763 136,792 134,865 -898

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 .............................................. 268,755 275,611 271,730 2,975

Utah ................................................ 70,000 70,000 70,000 --

Vermont.......................................... 70,000 70,000 70,000 --

Virginia........................................... 85,515 86,915 85,691 176

Washington..................................... 71,872 73,319 72,286 414

West Virginia.................................. 70,000 70,000 70,000 --

Wisconsin ....................................... 70,000 70,000 70,000 --

Wyoming ........................................ 70,000 70,000 70,000 -- 

Subtotal, States............................... 4,693,630 4,723,310 4,693,550 -80

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....... 4,868,630 4,898,310 4,868,550 -80

Training and Technical Assistance79 366,370 368,690 366,450 80

TOTAL $5,235,000 $5,267,000 $5,235,000 --

 79 This line reflects the amount reserved from the HAVA appropriation for statutory related activities, including 

training, technical assistance, grant systems, and review costs
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191

Alzheimer’s Disease Initiative - Outreach Campaign

FY 2012

Enacted

FY 2013

Annualized CR

FY 2014

President’s Budget

FY 2014+/-

FY 2012

Alzheimer’s Disease 

Initiative – Outreach 

(Prevention Fund)

$4,000,000 $4,200,000 $4,200,000 --

Authorizing Legislation: Sections 311 and 317(k)(2) of the Public Health Service Act, 

[42 U.S.C. Sections 243 and 247b(k)(2)] as amended, and the Patient Protection and Affordable 

Care Act (ACA), Section 4002 [42 U.S.C. 300u-11]

FY 2014 Public Health Service Act Authorization...............................................................Expired

Allocation Method ............................................................................................................. Contracts

Program Description and Accomplishments:

On February 7, 2012, the President announced a new effort to fight Alzheimer’s disease, and in

FY 2012, the Department provided ACL with $4,000,000 in initial funding from the Prevention 

and Public Health Fund established under ACA to begin a public awareness Alzheimer’s Disease 

Outreach Campaign. Building on the ongoing Long-Term Care Awareness Campaign, AoA has 

already begun research on specific topic areas and messages. Focus groups will help refine 

messages that will be used to develop print, television, radio, web banner, and other mechanisms, 

such as social media. AoA will explore distribution through various media at different levels of 

cost. AoA and partners at HHS will schedule public events featuring the Surgeon General and 

notable advocates for persons with Alzheimer's disease. 

The campaign’s goal is 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 will 

feature a new government web site (alzheimers.gov). The campaign will also deploy television, 

radio and print advertisements as well as search engine optimization and advertisements on 

specific web sites. Traffic to the new web site will be studied to determine what information 

care givers appear to value most and to adjust outreach strategies accordingly. 

This initiative is envisioned as a public-private partnership. As such, ACL will reach out to nongovernmental entities such as philanthropic and other groups supporting persons with 

Alzheimer’s disease and their families. The goal will be to learn from other similarly-focused 

efforts and to coordinate with these groups where possible. 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

192

Funding History:

FY 2009 .................................................................$0

FY 2010 .................................................................$0

FY 2011 .................................................................$0

FY 2012 ...................................................$4,000,000

FY 2013 CR.....................................................N/A80

Budget Request:

The FY 2014 budget includes $4,200,000 in funding for the Alzheimer’s Disease Initiative 

Outreach Campaign from the Prevention and Public Health Fund (PPHF) under the Affordable 

Care Act, an increase of +$200,000 over the amount allocated for this activity in FY 2012. 

These funds will be used to continue to develop both the information available on the 

alzheimers.gov web site and the effectiveness of the media outreach. The experience of the first 

years of funding will be examined to determine if the new web site is indeed providing 

information of value to caregivers (analysis of web traffic and random surveys of users) and if 

the present media strategy is effective in reaching caregivers. Content on the web site will be 

refreshed and enhanced through a panel of subject matter experts using the results of the web 

traffic analysis. The media strategy will also be expanded to include social media elements such 

as blogs, Twitter feeds and social network posting and/or advertising.

A particular effort will be made in FY 2014 to examine the effectiveness of the content and the 

media for both Hispanic- and African-American populations both of which are at higher risk of 

Alzheimer’s disease than other groups.81 This may require development of specific additional 

outreach materials and further analysis to determine if content and messaging are culturally 

competent.

 80 The FY 2013 Prevention Fund resources are reflected in the Office of the Secretary.

81 Health Disparities and Alzheimer’s Disease. National Institute on Aging. Available at 

http://www.nia.nih.gov/alzheimers/publication/2011-2012-alzheimers-disease-progress-report/health-disparitiesand#disparities.
193

State Health Insurance Assistance Programs

FY 2012

Enacted

FY 2013

Annualized CR

FY 2014

President’s Budget

FY 2014+/-

FY 2012

State Health Insurance 

Assistance Programs.... $52,115,000 $52,434,000 $52,115,000 --

FTE........................ 10 10 10 --

Authorizing Legislation: Section 4360 of the Omnibus Budget Reconciliation Act of 1990 

(42 U.S.C. 1395b-4).

FY 2014 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 12,000 (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. Under the direction and support of State program directors 

and trainers, SHIP counselors receive extensive training and continuous ongoing information 

updates about health plan options, Medicare entitlement and enrollment, Medigap, long-term 

care insurance, Medicare Part D prescription drug benefits, preventive benefits, and programs for 

beneficiaries with limited income and resources such as the Medicare Part D Extra Help/LowIncome Subsidy, the Medicare Savings Programs, and Medicaid.

SHIPs provide free, one-on-one counseling and assistance to help aging and disabled Medicare 

and Medicaid beneficiaries as well as coming-of-agers navigate the complexities of health and 

long-term care systems. Services are provided via telephone and face-to-face interactive 

sessions, public education presentations and programs, and media activities. In FY 2010 SHIPs 

served 4.7 million clients. SHIP activities align with the objective of developing a 

comprehensive, coordinated and cost-effective system of home and community-based services 

that helps elderly individuals and people with disabilities maintain their health and independence 

in their homes and communities. 

The budget request would transfer the SHIP program from the Centers for Medicare and

Medicaid Services to the Administration for Community Living. This transfer reflects the natural 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

194

synergies between the SHIP programs and the networks that ACL serves. About two-thirds of 

the 54 State SHIP programs are already administered by State Units on Aging, with most of the 

remaining programs administered by State Insurance Commissions. 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. 

SHIP activities complement programs authorized through the Older Americans Act, including 

but not limited to Information and Referral/Assistance (I&R/A), Aging and Disability Resource 

Centers (ADRCs), and Benefits Counseling. SHIPs also have a long history of outreach and 

assistance to underserved populations, including people with limited incomes, under-65 

Medicare beneficiaries with disabilities, dual eligibles, and people with cognitive and/or mental 

disabilities. 

Funding History:

Comparable funding for the State Health Insurance Assistance Program is as follows:

FY 2009 .................................................$52,500,000

FY 2010 .................................................$46,960,000

FY 2011 .................................................$52,000,000

FY 2012 ................................................. $52,115,000

FY 2013 CR........................................... $52,434,000

In addition, the following legislative action has taken place since FY 2008 which provided 

additional mandatory funding for the SHIPs:

• The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) provided 

the SHIPs with an additional $7.5 million in FY 2009.

• The Affordable Care Act provides a total of $15 million to be distributed to states via 

formula grants in FY 2010 – FY 2012.

• The American Taxpayer Relief Act of 2012 extends MIPPA to provide an additional 

$7.5 million for SHIPs in FY 2013.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

195

Budget Request:

The SHIP budget request for FY 2014 is $52,115,000, the same as the comparable FY 2012 

enacted level. This includes funding for 10 FTE and related administrative expenses to 

administer the program. 

Funds will be used to continue SHIP grants at current levels. This funding will allow States to 

continue the personalized counseling that they have been providing and to make further 

improvements to better streamline the program. Funds will also be used to provide administrative 

support for the SHIPs program.

The needs of the over 46 million Americans who depend on Medicare for their health care are 

multifaceted and diverse. More than one-quarter of beneficiaries have cognitive impairments; 

almost one-third have limitations in activities of daily living such as eating and dressing; almost 

one-third have not graduated from high school; and more than one in ten are over 85 years of 

age. These beneficiaries can face any number of difficulties in trying to navigate the health care 

system. Recent and upcoming changes in the system as a result of the Affordable Care Act 

(ACA) will provide opportunities to beneficiaries for improved care, including increased 

Medicare preventive services. These opportunities will increase the responsibilities of the SHIP 

counselors in terms of training, outreach and one-on-one counseling. The counselor knowledge 

base will need to include the inter-relationship of Medicare, Early Retiree Insurance Program, 

Pre-Existing Condition Insurance Plan (PCIP), Medicare covered preventive benefits, state 

Medicaid programs, and planning for the State-based Exchanges in addition to other long-term 

care support options that beneficiaries need to remain in the community. 

Research has consistently found that Medicare beneficiaries prefer to receive information about 

Medicare and other supports through one-on-one assistance rather than through other means, 

such as written materials, mass media, and the internet. Given the large number and variety of 

private plan options available in the Medicare program and the new opportunities for 

beneficiaries through the ACA, the type of one-on-one beneficiary counseling and decisions 

support provided by SHIPs is an essential component to the information provided more generally 

through www.Medicare.gov and 1-800-MEDICARE. ACL’s unique connections to the aging 

services network as well as the greater efficiencies leveraged by a single point of management of 

these activities which are often co-located with ADRCs, makes transferring the SHIPs program 

to ACL a logical way to meet the needs of beneficiaries.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

196

Grant Awards Table:

State Health Insurance Assistance Programs Grant Awards

FY 2012 

Actual

FY 2013 

Annualized CR

FY 2014 

President’s 

Budget

Number of 

Awards 54 54 54

Average 

Award $861,689 $861,689 $861,689

Range of 

Awards

$37,943 -

$3,964,059

$37,943 -

$3,964,059

$37,943 -

$3,964,059

Outcomes and Outputs:

In FY 2009, the last year for which complete data are available, SHIPs reached over 4.7 million 

individuals through 54,656 public information and outreach events. 

Funds will be used to make SHIP grants to States to continue the personalized counseling that 

they provide and to make further improvements, which are anticipated to include:

• Continuing the number of community outreach and public forums to raise awareness of 

long-term care options including prevention and relevant ACA opportunities.

• Continuing the number of individual client contacts to individuals on Medicare under the 

age of 65.

• Tracking the number of individual client contacts of pre-retirees.

• Continuing the number of local and field counselors (paid and unpaid).

• Continuing the number of individual personalized counseling sessions.
197

National Clearinghouse on Long-Term Care Information

FY 2012

Enacted

FY 2013

Annualized CR

FY 2014

President’s Budget

FY 2014+/-

FY 2012

National Clearinghouse 

on Long-Term Care 

Information.............. $3,000,000 $85,523 $3,000,000 --

FTE........................ 1 * 1 --

Note: Funding for this program was provided by the Affordable Care Act in FY 2012 and FY 2013, but unobligated 

balances were rescinded by the Taxpayer Relief Act in FY 2013 (save for obligations through January 3, 2013). The 

FY 2014 request is for discretionary funding.

Authorizing Legislation: Section 6021(d) of the Deficit Reduction Act of 2005 (P.L. 106-224).

Mandatory Appropriation (FY 2012-2013): Title VIII of the Affordable Care Act, P.L. 111-148

FY 2014 Authorization ....................................................................................................$3,000,000

Allocation Method ...............................................................................................................Contract

Program Description and Accomplishments:

The National Clearinghouse for Long-Term Care Information (Clearinghouse) provides 

objective information on how to plan ahead for their long-term care needs. First authorized by 

the Deficit Reduction Act of 2005, the Clearinghouse educates consumers about public and 

private options available to plan and pay for long-term care. Beginning with the “Own Your 

Future” direct mail campaign in 2005, the Clearinghouse has progressed toward a state-of-the-art 

strategy using broadcast and social media to direct consumers to a web site containing objective 

information on how to plan ahead for long-term care. 

The American Taxpayer Relief Act repealed Title VIII of the Affordable Care Act (the 

Community Living Assistance Services and Supports or CLASS program), which included the 

mandatory funding for the Clearinghouse, save for amounts obligated through January 3, 2013. 

However, the Clearinghouse pre-dates the Affordable Care Act and has a separate and important 

purpose. Accordingly, ACL is requesting discretionary funding to continue the Clearinghouse’s 

important educational and informative mission. Clearinghouse initiatives will include a more 

robust evaluation of both website content and outreach strategy and a refreshed web site that 

includes a decision tool that matches calls to action with user provided information. 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

198

Funding History:

Funding for the past 5 years is as follows: 

FY 2009 1/ ..............................................$3,000,000

FY 2010 1/ ..............................................$3,000,000

FY 2011 1/ ..............................................$3,000,000 

FY 2012 ................................................. $3,000,000

FY 2013 2/ ..................................................$85,523

1/ Funding for the clearinghouse was first provided directly to ACL in FY 2012. Prior to FY 2012, the 

Administration on Aging received funding for this activity through an Intra-Agency Agreement (IAA) with CMS. 

2/ Reflects obligations prior to January 3, 2013 when funding was rescinded.

Budget Request:

The FY 2014 President’s Budget request for the National Clearinghouse on Long-Term Care is 

$3,000,000, the same amount as appropriated in FY 2012 and prior years by the Affordable Care 

Act. This funding is requested in FY 2014 from discretionary funding, as mandatory funding 

previously appropriated by the Affordable Care Act for FY 2014 was rescinded by the American 

Taxpayer Relief Act. 

The need for a comprehensive, objective, and easy-to-use source for information on long-term 

care has never been greater. As Americans live longer lives, their need to plan for their long-term 

care increases dramatically. On average, someone who is 65 today will require some type of 

long-term services and supports for three years.82 Costs for this care can range from $19,000 per 

year for a home health aide to assist three times per week to $83,585 per year for nursing home 

care.83 Many consumers are not aware that Medicare does not cover long-term care needs, 

placing recipients of this care at high risk of spend-down to Medicaid. Americans need a reliable 

source of information about these costs and how to plan for and afford them, and the 

415,039 visits to the site recorded during the last 9 months of 2012 indicate that there is a strong 

demand for this information.

In addition to the costs of operating the website, this request also supports activities designed to 

raise awareness of and direct traffic to the website. These activities include digital banner 

advertisements and search engine optimization, with extensive market research determining how 

best to reach prospective consumers. Additionally, as the Clearinghouse has grown, the amount 

 82 http://www.longtermcare.gov/LTC/Main_Site/Understanding/Definition/How_Much.aspx

83 http://www.longtermcare.gov/LTC/Main_Site/Paying/Costs/Index.aspx
CONSUMER INFORMATION, ACCESS, AND OUTREACH

199

of information available can seem overwhelming. Requested funds will support the development 

of a decision tool to provide a streamlined set of calls to action and related information. This 

will assist consumers who are just starting the planning process without sacrificing the extensive 

detail that current consumers rely on for more in-depth issues. 

Resource and Program Data:

National Clearinghouse for Long-Term Care Information

(Dollars in thousands)

FY 2012 FY 2013 FY 2014

Enacted Annual CR /2 President's Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary -- -- -- -- -- --

Continuations -- -- -- -- -- --

Contracts 1 2,496 -- -- 1 2,872

Interagency Agreements 1 31 -- -- 1 33

Program Support /1 473 86 95

Total Resources 3,000 86 3,000

1/ Program Support -- Includes funds for salaries and overhead and information technology support costs.

2/ Funding for this program was provided by the Affordable Care Act in FY 2012 and FY 2013, but 

unobligated balances were rescinded by the Taxpayer Relief Act in FY 2013 (save for obligations through 

January 3, 2013). The FY 2014 request is for discretionary funding.
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201

Paralysis Resource Center

FY 2012

Enacted

FY 2013

Annualized CR

FY 2014

President’s Budget

FY 2014+/-

FY 2012

Paralysis Resource Center $6,700,000 $6,741,000 $6,700,000 --

Note: For comparability purposes, only the transferred amount of direct grant funding is displayed here.

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 a wide 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.

The PRC provides information specialists fluent in English and Spanish to answer paralysisrelated questions via a toll-free phone call or email. The PRC also operates an information 

clearinghouse that provides access to a variety of paralysis-related publications. Additionally, the 

PRC publishes and distributes a free Paralysis Resource Guide, as well as informational videos 

and training materials.

The PRC is operated via a cooperative agreement, currently with the Christopher and Dana 

Reeve Foundation. The Reeve Foundation is supported in its operation of the PRC by a network 

of 40 members of its “Paralysis Task Force.” This task force is united in meeting the needs of 

people living with paralysis via research, information-gathering and dissemination, and advocacy 

efforts. The current cooperative agreement runs through May 2014.

With the formation of ACL, HHS has a new operating division focused on maximizing the 

independence, well-being, and health of older adults, people with disabilities, and their families 

and caregivers. Due to the natural synergies with the aims of the PRC, the FY 2014 President’s 

Budget proposes to transfer funding and administrative responsibilities for the PRC from the 

Centers for Disease Control and Prevention to ACL. Under ACL, the PRC would benefit from 

extensive ties to disability networks and would provide a valuable source of information as ACL 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

202

continues to strengthen its policy and advocacy efforts in the field of disabilities. ACL 

anticipates that the PRC will be an early step in growing ACL as HHS’ source of disability 

expertise and advocacy, and ACL looks forward to engaging with other programs both inside 

and outside HHS in order to present an expanded role in FY 2015.

Funding History:

Funding for the program during the last five years has been as follows:

FY 2009 ...................................................$5,479,000

FY 2010 ...................................................$6,610,000

FY 2011 ...................................................$5,800,000

FY 2012 ...................................................$6,700,000

FY 2013 C.R. ...........................................$6,741,000

Note: Funding for this program at CDC included both grant and administrative funds. For comparability purposes, 

since ACL has separately requested increased administrative funding for this program, only grant funding amounts 

are displayed.

Budget Request:

The FY 2014 President’s Budget request is $6,700,000, the same as the comparable FY 2012 

enacted level. This reduction recognizes the tight budgetary environment while continuing to 

provide funding for the valuable information and referral work done by the PRC.

This work is vital for the support of the 6 million Americans currently living with paralysis. The 

average age of those reporting that they are paralyzed is 52 years old, and the average person 

reports having been paralyzed for 15.6 years.84 Providing information, resources, and support to 

these individuals and their families is critical in avoiding adverse secondary health outcomes 

such as depression, infection, chronic pain issues, and upper extremity problems, all of which 

can seriously degrade quality of life and increase medical costs.

 84http://www.christopherreeve.org/site/c.mtKZKgMWKwG/b.5184241/k.ACBD/Average_age_average_length_of_t

ime_since_paralysis_and_SCI.htm
CONSUMER INFORMATION, ACCESS, AND OUTREACH

203

Resource and Program Data:

Paralysis Resource Center

(Dollars in thousands)

FY 2012 FY 2013 FY 2014

Enacted Annual CR President's Budget /2

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary -- -- -- -- 1 6,465

Continuations 1 6,535 1 6,573 -- --

Contracts -- -- -- -- -- --

Interagency Agreements -- -- -- -- -- --

Program Support /1 165 168 234

Total Resources 6,700 6,741 6,700

1/ Program Support -- Includes funds for Public Health Service Act statutory requirements, grant systems 

and review costs.

2/ Funding for this program was provided to the Centers for Disease Control and Prevention in FY 2012 

and FY 2013. It is proposed for transfer to ACL in FY 2014.
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205

Program Administration

FY 2012

Enacted

FY 2013

Annualized CR

FY 2014

President’s Budget

FY 2014+/-

FY 2012

Program Administration $29,558,000 $29,739,000 $30,035,000 +$477,000

FTE85..................... 145 145 154 +9

Authorizing Legislation: Older Americans Act of 1965 (OAA), the Developmental Disabilities 

Assistance and Bill of Rights Act (DD Act), the Help America Vote Act (HAVA), the Public 

Health Services Act (PHSA) and the Elder Justice Act. 

FY 2014 Authorization .................................................... All Expired Except the Elder Justice Act 

Allocation Method .......................................................................................Direct Federal/Contract

Program Description and Accomplishments:

Program Administration funds the direction of Administration for Community Living (ACL)

programs established under the Older Americans Act (OAA), the Developmental Disabilities 

Assistance and Bill of Rights Act (DD Act), the Help America Vote Act (HAVA), the Public 

Health Services Act (PHSA) and the Elder Justice Act. In addition, a small portion of these 

funds will be used to oversee and to close-out activities originally funded under the American 

Recovery and Reinvestment Act (ARRA) of 2009. 

In FY 2012, ACL was created through the combination of three existing entities: the 

Administration on Aging (AoA), a freestanding HHS operating division; the Administration on 

Developmental Disabilities (ADD), part of the Administration for Children and Families (ACF); 

 

85 Overall FTE for ACL are projected at 184 in FY 2012, 187 in FY 2013, and 196 in FY 2014. FTE numbers for 

Program Administration only reflect those FTE funded from the Program Administration budget line, comparably 

adjusted to include FTE coming to ACL from the Office of Disability, the Administration on Developmental 

Disabilities, the Paralysis Resource Center, FTE related to funding provided via Intra-Departmental Delegations 

of Authority (IDDA) and Interagency Agreements (IAA). Not included are reimbursable FTE supported with 

HCFAC funds (8 FTE in each of FY 2012-FY 2014), FTE supported with mandatory funds (ADRCs and the 

National Clearinghouse on Long-Term Care Information-5 in FY 2012 and 4 in each of FY 2013-FY 2014), FTE 

related to transferred or new programs (SHIPs and SCSEP-26 in each of fiscal years 2012-2014) or FTE funded 

from the Prevention and Public Health Fund (CDSME) 1 FTE in FY 2012, 2 FTE in each of FY 2013 and FY 

2014. These FTE are included in the appropriate narrative tables in other sections of this document. 
PROGRAM ADMINISTRATION

206

and the Office of Disability (OD), part of the HHS Office of the Secretary (OS). FY 2014 is the 

first budget year in which the resources to administer ACL are requested in a single line item; 

amounts for FY 2012 and FY 2013 were provided through transfers of funding from ACF and 

OS, and are shown comparably. Funding totals in these years include comparable transfers from 

ACF of $4,982,000 in FY 2012 and $5,127,400 in FY 2013, and from OS of $1,264,000 in 

FY 2012 and $1,266,000 in FY 2013. ACL Program Administration funding will support the 

FTE overseeing the ACL programs currently funded with discretionary appropriations.

What Program Administration funding does not provide funding for is the FTE that will carry 

out many of the new programs that are proposed to come to, or to be funded under ACL 

beginning in FY 2014. Funding to support the 28 FTE in FY 2014 and related administrative 

expenses for these programs is requested separately as part of each program’s respective request. 

These include 10 FTE for the State Health Insurance Assistance Program (SHIPs), proposed for 

transfer to AoA from the Centers for Medicare & Medicaid Services; 16 FTE for the Senior 

Community Service Employment Program, proposed for transfer from the Department of Labor; 

and 1 FTE for the Adult Protective Services Demonstration program. Funding also does not 

include resources for 14 additional FTE that will continue to be charged to these existing 

mandatory programs: Aging and Disability Resource Centers (ADRC) funding (4 FTE), Health 

Care Fraud and Abuse (HCFAC) funding (8 FTE), and Chronic Disease Self-Management 

Education (CDSME) (2 FTE). 

Funding History:

Comparable funding for ACL Program Administration since the agency’s creation in FY 2012 is 

as follows:

FY 2012 ................................................$29,309,000 145 FTE

FY 2013 CR. ..........................................$29,653,000 145 FTE

FTE numbers have been adjusted to reflect comparable levels that include staff from the Office 

of Disability and the Administration on Developmental Disabilities. These numbers exclude 

FTE paid for with HCFAC funds and with direct mandatory appropriations, and FTE for three 

new or to be transferred programs. 

Budget Request:

The FY 2014 request for Program Administration is $30,035,000, an increase of $477,000 over 

the FY 2012 comparable enacted level. This request will support 154 FTE, an increase of 

+9 FTE over the FY 2012 comparable level. This total reflects a comparable adjustment of 
PROGRAM ADMINISTRATION

207

38 FTE in FY 2012 and 40 FTE in FY 2013 and FY 2014 for staff coming to ACL from ACF, 

from OS, and for one FTE related to the transfer of the Paralysis Resource Center. 

The increase of $477,000 will be used to cover the estimated $192,300 cost of the projected 

FY 2014 pay raise as well as $133,000 in estimated costs for regional office moves. The balance, 

together with any funding not needed for moving costs, will be applied toward the cost of adding 

up to eight additional regional FTE as discussed below.

The FY 2013 President’s Budget request for Program Administration includes $2,167,500 to 

cover headquarters move-related costs, specifically higher headquarters rent for ACL’s existing 

building under the current extended lease, and additional rent that must be paid for the new 

headquarters location during the time that renovations are being made. Recent events have 

suggested that the move, previously anticipated to occur in late FY 2013, is likely to be delayed 

into the first or second quarter of FY 2014. Therefore, ACL requests that these funds be retained 

in its base to ensure that funding for the move continues to be available in FY 2014 as needed. 

Should these funds not be needed for the move, ACL will redirect these funds to hire up to eight 

additional staff in ACL’s regional offices. 

Various relocations of regional office space will also need to be funded in FY 2014. The Denver 

Regional Office currently occupies temporary space and is relocating back to the Federal 

building in Region VIII. The cost of this move is expected to be approximately $68,500. The 

Region X office in Seattle currently holds an expiring lease and will relocate to new office space 

in order to maximize space efficiencies. 

Additional hires would address the continuing need in ACL regional offices for additional staff 

with sufficient expertise to conduct fiscal and programmatic oversight activities in ACL regional 

offices. These positions are critical to helping ensure that grantees understand and comply with 

laws, regulations, and program rules. Regional staff serve as the primary project officers for 

Older Americans Act formula grant programs (as well as for the related Tribal programs), 

conducting oversight and monitoring, as well as providing technical assistance. 

ACL currently has only 33 regional staff overseeing 447 OAA State formula grants (across 8 

different programs) as well as 727 OAA Tribal grants (across 3 different programs). Additional 

regional staff are needed to increase the level of oversight provided to these core programs,

provide additional technical assistance to grantees, and enhance analysis of existing program and 

fiscal data. The need for additional regional staff is even greater as current regional staff are also 

being asked to take on new responsibilities related to programs serving persons with disabilities. 

By redirecting funding to address these staffing shortages, ACL will be able to begin to add the 

new FTE that the regional offices must have to support these efforts. 
PROGRAM ADMINISTRATION

208

AoA Headquarters Lease Renewal Process

The ten-year lease on ACL’s headquarters space ended on September 30, 2012, although ACL 

continues to occupy the same space under a temporarily extended lease at a significantly higher 

monthly cost. The new headquarters location will not only provide an opportunity to reduce 

ACL’s physical footprint, but more importantly to also consolidate its staff from three locations 

to one central space. The new space is currently under lease through April 2013, after which 

ACL will be able to initiate renovations to meet its unique needs. ACL is working with the HHS 

Facilities and Logistics Service (FLS) to finalize the move once renovations are complete, with the 

move now estimated to occur by the end of calendar year 2013. 

Remaining relocation costs are currently estimated to total approximately $3,000,000 to cover 

procurement of systems furniture and IT, the physical move and to surplus outdated furniture at 

the current location. Funding to cover these costs was included in a consolidated FY 2013 

Departmental request for the Public Health and Social Services Emergency Fund associated with 

procuring new long term leases centrally. ACL will continue to work closely with FLS staff to 

refine our schedule and milestones and ensure that cost estimates are sufficient to cover all costs 

associated with the lease renewal, including build-out, moving, and rent. 

Performance Measures

Improving program efficiency, improving client outcomes, and effective targeting of services to 

vulnerable elders are the three performance measures used to assess the effectiveness of the 

AoA’s Aging Services programs as a whole. Program Administration is not directly measured 

by AoA’s performance indicators, nor by specific outcomes, and it does not have specific output 

measures. Rather, the program provides the administrative resources that enable ACL to carry 

out its programmatic activities and achieve its performance goals.
SUPPLEMENTARY TABLES

209

Budget Authority by Object Class

Administration for Community Living

(Dollars in Thousands)

FY 2012 

Enacted

FY 2014 

Budget

FY 2014 +/- 

FY 2012

Personnel compensation:

Full-time permanent (11.1).................................................. 17,168 18,047 879

Other than full-time permanent (11.3)............................... 330 332 2

Other personnel compensation (11.5)............................... 148 149 1

Military personnel (11.7)..................................................... - - -

Special personnel services payments (11.8).................... - - -

Subtotal personnel compensation................................ 17,646 18,528 882

Civilian benefits (12.1)............................................................. 4,655 4,683 28

Military benefits (12.2)............................................................ - - -

Benefits to former personnel (13.0)...................................... - - -

Total Pay Costs........................................................................ 22,301 23,211 910

Travel and transportation of persons (21.0)........................ 728 509 (219)

Transportation of things (22.0).............................................. 3 3 -

Rental payments to GSA (23.1).............................................. 3,334 3,354 20

Communication, utilities, and misc. charges (23.3)............. 181 181 -

Printing and reproduction (24.0)............................................ 16 16 -

Other Contractual Services:

Advisory and assistance services (25.1)......................... 19,882 23,722 3,840

Other services (25.2)............................................................ 520 446 (74)

Purchase of goods and services from

government accounts (25.3)........................................... 8,160 8,160 -

Operation and maintenance of facilities (25.4)................ 1 1 -

Research and Development Contracts (25.5).................. - - -

Medical care (25.6)............................................................... - - -

Operation and maintenance of equipment (25.7)............ - - -

Subsistence and support of persons (25.8)..................... - - -

Subtotal Other Contractual Services.......................... 28,563 32,329 3,766

Supplies and materials (26.0).................................................. 132 132 -

Equipment (31.0)...................................................................... 238 238 -

Land and Structures (32.0) .................................................... - - -

Investments and Loans (33.0)................................................ - - -

Grants, subsidies, and contributions (41.0)......................... 2,096,963 2,034,782 (62,181)

Interest and dividends (43.0)................................................. - - -

Refunds (44.0).......................................................................... - - -

Total Non-Pay Costs............................................................... 2,130,158 2,071,544 (58,614)

Total Budget Authority by Object Class............................. 2,152,459 2,094,755 (57,704)
SUPPLEMENTARY TABLES

210 

Salaries and Expenses

Administration for Community Living

(Dollars in Thousands) 

FY 2012 

Enacted

FY 2014 

Budget

FY 2014 +/- 

FY 2012

Personnel compensation:

Full-time permanent (11.1).................................................. 17,168 18,047 879

Other than full-time permanent (11.3)............................... 330 332 2

Other personnel compensation (11.5)............................... 148 149 1

Military personnel (11.7)..................................................... - - -

Special personnel services payments (11.8).................... - - -

Subtotal personnel compensation................................ 17,646 18,528 882

Civilian benefits (12.1)............................................................. 4,655 4,683 28

Military benefits (12.2)............................................................ - - -

Benefits to former personnel (13.0)...................................... - - -

Total Pay Costs........................................................................ 22,301 23,211 910

Travel and transportation of persons (21.0)........................ 728 509 (219)

Transportation of things (22.0).............................................. 3 3 -

Rental payments to Others GSA (23.2)................................. 3,334 3,354 20

Communication, utilities, and misc. charges (23.3)............. 181 181 -

Printing and reproduction (24.0)............................................ 16 16 -

Other Contractual Services:

Advisory and assistance services (25.1)......................... 19,882 23,722 3,840

Other services (25.2)............................................................ 520 446 (74)

Purchase of goods and services from

government accounts (25.3)........................................... 8,160 8,160 -

Operation and maintenance of facilities (25.4)................ 1 1 -

Research and Development Contracts (25.5).................. - - -

Medical care (25.6)............................................................... - - -

Operation and maintenance of equipment (25.7)............ - - -

Subsistence and support of persons (25.8)..................... - - -

Subtotal Other Contractual Services.......................... 28,563 32,329 3,766

Supplies and materials (26.0).................................................. 132 132 -

Total Non-Pay Costs............................................................... 32,957 36,524 3,567

Total Salary and Expense....................................................... 55,258 59,735 4,477

Direct FTE................................................................................ 111 179 188
SUPPLEMENTARY TABLES

211 

FTE Detail

Administration for Community Living

2012 

Actual 

Civilian 1/

2012 

Actual 

Military

2012 

Actual 

Total

2013 

Est. 

Civilian

2013 

Est. 

Military

2013 

Est. 

Total

2014 

Est. 

Civilian

2014 

Est. 

Military

2014 

Est. 

Total

Immediate Office of the ...................

 Administrator.................................

 Direct:............................................... 15 15 17 17 17 17

 Reimbursable:.................................. 0 0 0 0 0

 Total:............................................. 15 0 15 17 0 17 17 0 17

Administration on Aging................

 Direct:............................................... 25 25 34 31 34 34

 Reimbursable:.................................. 3 3 3 3 3 3 6

 Total:............................................. 28 0 28 37 0 37 37 0 37

Administration on Intellectual........

 & Developmental Disabilities......

 Direct:............................................... 0 0 24 24 25 25

 Reimbursable:.................................. 0 0 0 0

 Total:............................................. 0 0 0 24 0 24 25 0 25

Center for Management and ..........

 Budget.............................................

 Direct:............................................... 24 24 33 33 33 33

 Reimbursable:.................................. 0 0 0 0

 Total:............................................. 24 0 24 33 0 33 33 0 33

Center for Disability and Aging.....

 Policy...............................................

 Direct:............................................... 19 19 26 26 26 26

 Reimbursable:.................................. 0 0 0 0

 Total:............................................. 19 0 19 26 0 26 26 0 26

Office of Regional Operations........

 Direct:............................................... 28 28 45 45 53 53

 Reimbursable:.................................. 5 5 5 0 5 5 0 5

 Total:............................................. 33 0 33 50 0 50 58 0 58

OPDIV FTE Total............................. 119 0 119 187 0 187 196 0 196

Average GS Grade

FY 2010............................................... 12.8

FY 2011............................................... 12.8

FY 2012............................................... 12.8

FY 2013............................................... 12.7

FY 2014............................................... 12.7

1/ FTE in FY 2012 do not include FTE for AIDD, SHIPS or SCSEP, for which accurate actual data is unavailable.
SUPPLEMENTARY TABLES

212 

Detail of Positions

Administration for Community Living

2012

 Actual 2013 Base 2014 Budget

Executive level I ...........................................

Executive level II..........................................

Executive level III ........................................

Executive level IV......................................... 1 1 1

Executive level V..........................................

Subtotal .................................................... 1 1 1

Total - Exec. Level Salaries $154,981 $155,578 $157,134

ES-6................................................................

ES-5................................................................ 2 2 2

ES-4................................................................

ES-3................................................................

ES-2................................................................ 3 2 2

ES-1................................................................

Subtotal .................................................... 5 4 4

 Total - ES Salary $835,624 $655,924 $655,924

GS-15.............................................................. 24 26 26

GS-14.............................................................. 29 28 31

GS-13.............................................................. 51 52 77

GS-12.............................................................. 20 24 31

GS-11.............................................................. 7 7 9

GS-10.............................................................. 2 2 2

GS-9................................................................ 6 9 9

GS-8................................................................ 1 1 1

GS-7................................................................ 3 2 2

GS-6................................................................ 1 1 1

GS-5................................................................ 0 0 0

GS-4................................................................ 2 2 2

GS-3................................................................ 0 0 0

GS-2................................................................ 0 0 0

GS-1................................................................ 0 0 0

Subtotal .................................................... 146 154 191

 Total - GS Salary

Average ES level ......................................... 3.2 3.5 3.5

Average ES salary........................................ $167,125 $163,981 $163,981

Average GS grade........................................ 12.8 12.7 12.7

Average GS salary....................................... $101,032 $100,740 $100,897

Average GS salary/benefits........................ $129,321 $128,747 $129,148
SUPPLEMENTARY TABLES

213

Programs Proposed for Elimination

Administration for Community Living

ACL has no programs proposed for elimination.
SUPPLEMENTARY TABLES

214 

Federal Employment Funded by ACA

Administration for Community Living

Program Section(s) $ /1 FTEs CEs $ /1 FTEs CEs

New programs authorized and funded by PPACA

 Aging and Disability Resource Centers Section 2405 $ 10,000 3 0 $ 10,000 4 0

New programs funded from the PPHF under PPACA

 Adult Protective Services (Prevention & Public Health Fund) Section 4002 $ 0 0 - $ 6,000 0 0

 Chronic Disease Self-Management Education (PPHF) Section 4002 $ 0 0 - $ 10,000 0 0

 Alzheimer's Disease Initiative--Supportive Services (PPHF) Section 4002 $ 0 0 - - $ 0 0

 Alzheimer's Disease Initiative--Communications (PPHF) Section 4002 $ 0 0 - $ 4,000 0 0

Pre-existing programs funded by PPACA 

 National Clearinghouse for Long-Term Care Information 2/ Title VIII $ 3,000 0 0 $ 3,000 1 0

 Medicare Improvements for Patients & Providers Act Programs Section 3306 $ 0 0 - - $ 0 0

Programs authorized by PPACA but funded by other sources 0 0 0 0 0 0

Oversight and administration activities 0 0 0 0 0 0

FY 2011 FY 2012

Program Section(s) $ /1 FTEs CEs $ /1 FTEs CEs

New programs authorized and funded by PPACA

 Aging and Disability Resource Centers Section 2405 $ 10,000 4 0 $ 10,000 4 0

New programs funded from the PPHF under PPACA

 Adult Protective Services (Prevention & Public Health Fund) Section 4002 N/A 0 0 - $ 0 0

 Chronic Disease Self-Management Education (PPHF) Section 4002 N/A 0 0 $ 10,000 2 0

 Alzheimer's Disease Initiative--Supportive Services (PPHF) Section 4002 N/A 0 0 $ 10,500 0 0

 Alzheimer's Disease Initiative--Communications (PPHF) Section 4002 N/A 0 0 $ 4,200 0 0

Pre-existing programs funded by PPACA 

 National Clearinghouse for Long-Term Care Information 2/ Title VIII $ 86 0 0 - $ 0 0

 Medicare Improvements for Patients & Providers Act Programs Section 3306 $ 25,000 0 0 - $ 0 0

Programs authorized by PPACA but funded by other sources 0 0 0 0 0 0

Oversight and administration activities 0 0 0 0 0 0

FY 2013 FY 2014

1/ Indicate total amount of funding for Program X under the denoted section(s) of PPACA.

2/ Funding for the clearinghouse was first provided directly to ACL in FY 2012. Prior to FY2012, the Administration on Aging received funding for this 

 activity through an Intra-Agency Agreement (IAA with CMS).
215 

Significant Items in Appropriations Committee Reports

Item 1

Mental Health- The Committee notes that approximately 20 to 25 percent of older adults have a 

mental or behavioral health problem, with white men aged 85 and older having the highest rates 

of suicide of any group in the United States. The Committee urges ACL to expand its efforts to 

address the mental and behavioral health needs of older adults, including implementation of the 

mental and behavioral health provisions in the OAA. The Committee also urges ACL to 

designate an officer responsible for administering mental health services for older Americans. 

 

Action taken or to be taken

The Administration on Aging (AoA) within ACL is an active partner with the Substance Abuse 

and Mental Health Services Administration (SAMHSA) on a variety of initiatives. AoA and 

SAMHSA entered into a Memorandum of Understanding in FY 2011 to formally collaborate on 

the Older Adult Targeted Capacity Expansion (TCE) Grant Program. Five grants were awarded 

to community organizations to provide services for older adults through aging-mental health 

partnerships. An Older Adults Technical Assistance Center was also established to provide 

assistance to the TCE grantees, State Units on Aging, Area Agencies on Aging, and other 

community aging and mental health providers to assist them in developing, implementing and 

sustaining effective mental health programs for older adults. Mental health screening, treatment 

services for older individuals and increasing public awareness and reducing the stigma associated 

with mental disorders in older individuals will be key components of the work of the grantees 

and the Center. AoA and SAMHSA will continue to collaborate on technical assistance 

activities for this program. In addition, AoA and SAMHSA have made two joint presentations at 

national conferences regarding older adults mental health programs. 

AoA also participates in mental-health related workgroups and committees both inside and 

outside the Department of Health and Human Services (DHHS), including: the Federal 

Workgroup on Suicide Prevention; the Federal Mental Health Coalition; the Action Alliance for 

Suicide Prevention and its Clinical Care Workgroup; and the HHS Behavioral Health 

Coordinating Council and its Prescription Drug Abuse sub-committee. An Aging Services 

Program Specialist, with extensive knowledge in the prevention and treatment of mental health 

issues among older adults, has been designated to provide guidance both within and outside 

AoA, on behavioral health program and policy development. AoA also commissioned a study in 

FY2 011 through the National Council on Aging’s Center for Health Aging entitled “Advancing 

Older Adult Mental Health: Lessons Learned from Partnerships between State Units on Aging 

and State Mental health Authorities”. The purpose of this study was to learn from the 

experiences of five strong state partnerships that have increased or improved access to evidencebased or evidence-informed (EB/EI) interventions shown to improve the health of older adults 
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and adults with/or at risk of mental health or substance use disorders. The results of this study 

will help inform AoA program and policy development in the area of mental health. 

Through its health programs, AoA has also encouraged States and Area Agencies on Aging to 

use evidence-based programs designed to reduce reduce/prevent depression and improve quality 

of life in older adults including Healthy IDEAS (Identifying Depression, Empowering Activities 

for Seniors) and PEARLS (Program to Encourage Rewarding Lives for Seniors. State plan 

guidance developed by AoA for FY 2013, similar to past guidance, will direct States and Area 

Agencies on Aging to implement the provisions related to mental and behavioral health that were 

signed into law as part of the Older Americans Act Amendments of 2006.

Item 2

The Committee recognizes the essential role of family caregivers who provide a significant 

proportion of our Nation's health and long-term services and supports for the chronically ill and 

aging. Respite care can provide family caregivers with relief necessary to maintain their own 

health, bolster family stability and well being, and avoid or delay more costly nursing home or 

foster care placements. The Committee urges the Secretary to ensure that State agencies, as well 

as aging and disability research centers [ADRCs], use these funds to serve all age groups, 

chronic conditions, and disability categories equitably and without preference. 

Action taken or to be taken

Family caregivers are the cornerstone of long term services and supports in the United States. 

Family members provide an estimated 80% of the assistance necessary to keep individuals of all 

ages independent in their homes and communities. In recognition of the critical role families 

play in the lives of older individuals with long-term care needs, Congress created the National 

Family Caregiver Support Program (NFCSP) as part of the 2000 reauthorization of the Older 

Americans Act. Under the NFCSP the following populations of family caregivers are eligible to 

be served: adult family members caring for individuals 60 years of age and older; adult family 

members caring for individuals of any age with Alzheimer’s disease and related disorders; 

grandparents and other relatives (age 55 and older) providing care to children under the age of 

18; and grandparents and other relatives (age 55 and older) providing care to adults, age 18 –

59 years of age, with disabilities. 

For over twelve years, the Administration on Aging (AoA) has supported the Aging Network’s 

implementation of the requirements of the NFCSP in a variety of ways. During that time, states 

and local communities have made tremendous progress in designing and administering flexible,

accessible, and consumer-directed Caregiver Support Programs. To support program 

implementation efforts, in 2001 AoA funded 28 National Innovations Programs and 11 Projects 

of National Significance to foster the development and testing of new approaches for sustaining 

the efforts of families and other informal caregivers of those intended to be served by the 
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NFCSP. Those projects broke ground in several key areas including state/local caregiver 

coalition development; enhancing the capacity of the aging network to meet the needs of this 

new population of service recipient; and applying concepts of the NFCSP to persons with 

developmental disabilities through enhanced planning and coordinating of supportive services to 

older caregivers of children and adults with intellectual and developmental disabilities. In 2009, 

AoA once again funded targeted technical assistance to the aging network to further strengthen 

its ability to meet program objectives. As a result, the aging network was again supported in 

program and infrastructure development with targeted training, one-on-on guidance and the 

dissemination of best practices in program development.

Family caregiving is a lifespan issue. Many family members provide care for loved ones with 

special needs over the course of several years, or an entire lifetime. To address the specific 

respite and related needs of family caregivers across the lifespan, AoA began implementation of 

the Lifespan Respite Care Program in 2009. Lifespan respite programs are coordinated systems 

of accessible, community-based respite care services for family caregivers of children or adults 

of all ages with special needs. Such systems bring together disparate funding streams to help 

support, expand and streamline the delivery of respite services while providing a mechanism for 

the recruitment and training of a respite workforce and support and empower family caregivers. 

Since 2009, 30 states and the District of Columbia have been actively engaged in implementing 

the requirements of the Lifespan Respite Program via grants from AoA. Each of the grantees 

has used their initial three-year grant to advance the following objectives: expand and enhance 

respite services, improve dissemination and coordination of respite services, and provide, 

supplement or improve access and quality of respite services. Specific activities have included 

the creation of dedicated respite web sites, worker registries and data bases of new and existing 

respite programs; development and deployment of new training programs for volunteer and paid 

respite workers; the creation of voucher respite programs to maximize consumer choice and 

control over how respite services are obtained; and the development and deployment of 

marketing and outreach campaigns to more effectively target and educate family caregivers 

about the need to take time for themselves.

Item 3

The Committee notes that falls are the leading cause of fatal and nonfatal injuries for those 65 

and older. Each year, 1-in-3 Americans aged 65 and older falls. Every 15 seconds, an older adult 

is treated in the emergency room for a fall-related injury. Preventing falls will help seniors stay 

independent and in their homes, avoiding costly hospitalizations and hip fractures, which 

frequently lead to nursing home placement. The Committee intends that funds provided to ACL 

should be used for public education about the risk of these falls, as well as implementation and 

dissemination of community-based strategies that have been proven to reduce the incidence of 

falls among seniors. 
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Action taken or to be taken

No funding was provided by the Congress for this activity. However, AoA has recognized for 

some time that Elder Falls Prevention is one of many evidence-based approaches with the 

potential to make positive differences in outcomes for seniors. AoA will continue to encourage 

States to look at this approach in conjunction with available Preventive Health Services funds 

which beginning in FY 2012 must be spent on evidence-based activities similar to a discretionary 

funding opportunity AoA made available in 2006.

During 2006-2007, AoA initiated its state-based Evidence-Based Disease and Disability 

Prevention Program. Through both public and private partnerships, 27 states have deployed 

evidence-based interventions whose primary focus is to help enable adults to maintain their 

health, wellness, and independence. AoA required each state to implement the Stanford 

University Chronic Disease Self-Management Education (CDSME) program. In addition, each 

state participating in this grant program was required to select and implement one or more other 

evidence-based programs, including Falls Management programs such as Matter of Balance, 

which addresses fear of falling, and Stepping On and Tai Chi, which build muscle strength and 

improve balance to prevent falls. 

Since 2004 AoA and CDC have partnered on three activities related to older adult falls: 

• Supporting a collaborative initiative by the National Council on Aging (NCOA), the 

Archstone Foundation, the Home Safety Council, and other partners to address the 

growing problem of falls and fall-related injuries among adults aged 65 years and older. 

The Falls Free Coalition, formed in 2004 as a result of this initiative, includes more than 

55 organizations and employs a collective approach to promoting a national fall 

prevention action plan. 

• Assessing the long-term impact of Matter of Balance, a program designed to reduce fear 

of falling, increase self-efficacy and a sense of control in relation to fall risk, and increase 

physical and social activity. 

• Estimating the average program implementation and maintenance costs and comparing 

these costs across three AoA-funded fall prevention programs: Matter of Balance, Tai 

Chi: Moving for Better Balance, and Stepping On.

Finally, AoA will continue to coordinate with the Centers for Disease Control and Prevention 

around efforts like CDC’s Unintentional Injury Program.

Item 4

The Committee strongly supports the SMP program, administered by ACL with historical 

financial assistance from CMS. The Committee is concerned that the return on investment [ROI] 

calculation included in the performance metrics of the program does not adequately reflect 

outcome data on SMP fraud referrals. The Committee requests that a more accurate ROI 
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calculation be developed for this important program. The Committee requests that ACL, CMS, 

DOJ, and the HHS OIG work to improve the process of informing beneficiaries when their tips 

directly result in a conviction, a recovery, or a change to Medicare policies.

Action taken or to be taken

The Administration for Community Living’s Senior Medicare Patrol (SMP) program fully agrees 

with the requests of the Committee. Much ground work has been done to better demonstrate the 

return on investment (ROI) for this program and more work is planned. 

To accurately quantify the ROI for the SMP program, one must first understand some of the 

issues inherent in the program. The SMP program is a key part of the much larger fraud 

prevention and mitigation activities of HHS and DOJ. The mission of the program is to 

“Empower and assist Medicare beneficiaries, their families, and caregivers to prevent, detect, 

and report healthcare fraud, errors, and abuse through outreach, counseling, and education.” 

The SMP program accomplishes its mission by developing a network of nearly 5,000 volunteers 

to reach out to Medicare beneficiaries across the country. Annually, the SMP message directly 

reaches more than 2,000,000 people, plus untold others reached through media campaigns. While 

the SMP program does receive complaints of potential fraud which are properly provided to the 

OIG or to CMS, we also educate beneficiaries on how to go directly to law enforcement if they 

suspect fraud. While the direct link between the beneficiary and law enforcement is appropriate, 

it decreases the demonstrable impact of the SMP, because law enforcement is unaware of the 

important role played by the SMP program in effecting the referral. 

Once a referral of potential fraud is provided to the OIG or CMS, it is outside the SMP 

program’s authority to further pursue that matter, as the SMP program is not designed to be, nor 

should it be, investigative in nature. The decisions to pursue criminal investigation and any 

subsequent prosecution in these cases are made by the proper authorities at OIG, CMS, or DOJ. 

The SMP program is unable to reflect ROI for those referrals of potential fraud which law 

enforcement chooses not to pursue. In addition, SMP referrals may work in concert with other 

information sources or referrals received by law enforcement to prosecute a case. Yet, in such 

cases the SMP, as one of multiple contributors to a successful prosecution, does not receive 

attribution for the resulting monetary outcome.

While the above programmatic issues are inherent to this program, the SMP program has begun 

taking steps to mitigate these issues:

• The SMP program currently has a contract for a program evaluation. Part of the 

evaluation is to examine the performance metrics that are currently being tracked to 

identify if they are appropriate for the program and whether the metrics are accurately 

being reported from each of the 54 SMP projects. The results of this evaluation, 

anticipated in December 2013, will help the program better quantify ROI. 
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• The SMP program has been operating a pilot program with 20% of the states for nine 

months. When one of the pilot states has a potential fraud referral, they send it to the 

SMP national Program Managers who meet in person with OIG investigators in 

Washington, DC. This relationship has developed to the point that the SMP program has 

begun getting back much more detailed outcomes from fraud referrals. Due to the success 

of the pilot, the program will roll this out nationally on May 1st. This should provide the 

program the opportunity to better identify its ROI. 

• The SMP program has been working with the OIG – Office of Evaluations to better align 

the criteria for calculating the program’s savings with those used by both CMS and OIG 

for their respective performance reports. Starting with the upcoming OIG performance 

report on the SMP program (due May 2013), new standards enabling better reflection of 

the program’s ROI will be in place. 

The SMP program will continue to work with its partners at both HHS and DOJ to more 

accurately demonstrate the ROI of the program and ensure that the results of the referrals are 

being provided back to the beneficiaries when appropriate. It should be noted however, that any 

measure of the SMP program’s return on investment would be necessarily understated because it 

would not include the deterrence effect of the program. ACL cannot calculate the amount of 

fraud that would have occurred but for the heightened scrutiny resulting from SMP’s outreach 

and education efforts. 
221

Prevention and Public Health Fund

Administration for Community Living

Activities proposed for funding from the Prevention and Public Health Fund are addressed more 

fully throughout the ACL FY 2014 Congressional Justification. A summary of these activities 

follows.

Chronic Disease Self-Management Education - ACL requests FY 2014 funding for Chronic 

Disease Self-Management Education totaling $10,000,000 from the Prevention and Public 

Health Fund, the same as the FY 2012 enacted level. CDSME, by emphasizing an individual’s

role in managing his/her illness, helps participants to adopt healthy behaviors, improve their 

health status and reduce their use of hospital stays and emergency room visits. Funds for 

CDSME will support competitive grants to states as well as an inter-agency agreement with 

CMS to evaluate the program’s impact on healthcare utilization, a participant survey, and a 

technical resource center on evidence-based disease prevention programs. 

Alzheimer’s Disease Initiative – Services - The FY 2014 budget includes $10,500,000 for 

Alzheimer’s Disease Services from the PPHF. No funding was allocated for this program in 

FY 2012. ACL will use these funds to award competitive cooperative agreements to states, 

tribes, and/or large localities to expand a proven evidence-based pilot on dementia capability. 

The demands of caregiving for a person with Alzheimer’s disease 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. The systems created through these grants will assist 

caregivers by ensuring that their needs, and the needs of their loved ones with Alzheimer’s 

disease, are addressed. Since the focus of these cooperative agreements will be to facilitate 

permanent systems change, an emphasis will be placed on implementing systems that can 

operate out of ongoing funding streams and will not require new sources of funds to maintain.

Alzheimer’s Disease Initiative – Outreach Campaign – ACL is requesting $4,200,000 from 

the PPHF in FY 2014 to continue its efforts on a public awareness Alzheimer’s Disease outreach 

campaign. This represents an increase of +$200,000 over the FY 2012 amount received. The 

campaign’s goal is to inform people caring for people with Alzheimer’s disease about the

federal, state, local, and nonprofit resources available to help them. These funds will be used in 

cooperation with the existing contractor to continue to develop both the information available on 

the alzheimers.gov web site and the effectiveness of the media outreach.