DEPARTMENT

of HEALTH

and HUMAN

SERVICES

Fiscal Year

2015

Administration for 

Community Living

Justification of

Estimates for 

Appropriations Committees
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DEPARTMENT OF HEALTH & HUMAN SERVICES Administration for Community Living

Washington, DC 20201

I am pleased to present the Administration for Community Living’s (ACL) FY 2015 President’s Budget 

request. Like ACL’s first budget request in FY 2014, this request includes our two main program 

components: the Administration on Aging and the Administration on Intellectual and Developmental 

Disabilities.

ACL’s FY 2015 request matches the FY 2014 enacted level in nearly all respects, which reflects our first and 

highest priority: maintaining funding for ACL’s core programs. The vast majority of ACL’s funding is for 

direct services and supports, and the States, Tribes, and localities that depend upon these funds have limited 

options to offset losses of Federal funding. Maintaining funding for these programs is therefore critical to our 

efforts to help more people to have the option to live in their homes and to fully participate in their 

communities, including the more than 50 percent of home-delivered meal recipients who report that these 

meals represent the majority of their food in a given day.

This budget also includes several new initiatives. The first, recognizing the Administration on Aging’s 

longstanding emphasis on elder justice, is funding for the Elder Justice Act (EJA) at HHS. The issues of 

elder abuse, neglect, and exploitation affect millions of Americans. Reflecting HHS’ leadership of the Elder 

Justice Coordinating Council, funding the Elder Justice Act would firmly establish ACL as a federal resource

on nationwide issues of elder justice and respond to the call from the Government Accountability Office 

(GAO) for Federal leadership.

Second, ACL proposes a new initiative addressing the transition from adolescence to adulthood for young 

people with developmental disabilities. This initiative would respond to GAO and Congressional inquiries 

seeking to develop best practices and an evidence base in supporting young people with developmental 

disabilities in this particularly important transition.

In addition, ACL is proposing renewed mandatory funding for the Aging and Disability Resource Centers

(ADRC) program, which has demonstrated proven success in helping connect people to the resources they 

need to continue living independently in their communities. These successful systemic changes are ready to 

be expanded to the remaining States, but continued funding is vital to the program’s nationwide expansion.

Finally, ACL is proposing new funding to hold a White House Conference on Aging, as well as the 

establishment of a Holocaust Survivors Fund that would assist elderly Holocaust survivors to remain in their 

homes and communities.

ACL’s first year has been a time of growth, learning, and a rededication of our efforts to ensure that all 

people, regardless of age or disability, can live and thrive in their communities. This budget will allow us to 

continue serving our populations and position us for greater successes on their behalf. 

Kathy Greenlee

Administrator and Assistant Secretary for Aging

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Table of Contents

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

Appropriations Language Analysis .............................................................................................................................27

Amounts Available for Obligation ..............................................................................................................................28

Summary of Changes...................................................................................................................................................29

Budget Authority by Activity ......................................................................................................................................30

Authorizing Legislation...............................................................................................................................................32

Appropriations History Table ......................................................................................................................................34

Appropriations Not Authorized by Law ......................................................................................................................35

Health and Independence

Summary of Request ...................................................................................................................................................37

Home and Community-Based Supportive Services.....................................................................................................41

Nutrition Services........................................................................................................................................................49

Preventive Health Services..........................................................................................................................................63

Chronic Disease Self-Management Education ............................................................................................................69

Falls Prevention ...........................................................................................................................................................75

Senior Community Service Employment Program......................................................................................................79

Native American Nutrition and Supportive Services...................................................................................................85

Aging Network Support Activities..............................................................................................................................91

Caregiver Services

Summary of Request .................................................................................................................................................100

Family Caregiver Support Services...........................................................................................................................104

Native American Caregiver Support Services...........................................................................................................112

Alzheimer’s Disease Supportive Services Program ..................................................................................................115

Alzheimer’s Disease Initiative - Services..................................................................................................................121

Lifespan Respite Care................................................................................................................................................125

Protection of Vulnerable Adults

Summary of Request .................................................................................................................................................131

Elder Justice Initiative ...............................................................................................................................................135

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Long-Term Care Ombudsman Program ....................................................................................................................141

Prevention of Elder Abuse and Neglect.....................................................................................................................147

Senior Medicare Patrol Program ...............................................................................................................................153

Elder Rights Support Activities.................................................................................................................................157

Developmental Disabilities Programs

Summary of Request .................................................................................................................................................163

State Councils on Developmental Disabilities...........................................................................................................165

Developmental Disabilities – Protection and Advocacy............................................................................................171

University Centers for Excellence in Developmental Disabilities.............................................................................177

Developmental Disabilities – Projects of National Significance ...............................................................................183

Youth Transitions Initiative.......................................................................................................................................187

Consumer Information, Access & Outreach

Summary of Request .................................................................................................................................................191

Aging and Disability Resource Centers.....................................................................................................................193

Voting Access for Individuals with Disabilities........................................................................................................199

Alzheimer’s Disease Initiative - Outreach Campaign................................................................................................205

State Health Insurance Assistance Programs.............................................................................................................209

National Clearinghouse for Long-Term Care Information ........................................................................................213

Paralysis Resource Center .........................................................................................................................................217

White House Conference on Aging...........................................................................................................................221

Holocaust Survivor Assistance Fund.........................................................................................................................223

Program Administration ............................................................................................................................................225

Supplementary Tables

Budget Authority by Object Class.............................................................................................................................227

Salaries and Expenses................................................................................................................................................228

Detail of Full-Time Equivalent Employment (FTE)..................................................................................................229

Detail of Positions .....................................................................................................................................................231

FTE Funded by the Affordable Care Act...................................................................................................................233

Significant Items in Appropriations Committee Reports...........................................................................................235

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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. ACL serves as a single agency charged to work with States, localities, Tribal 

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

with disabilities 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 older adults 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), 618 Area Agencies on Aging (AAA), 246 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 older adults 

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 meals. These programs also support family caregivers, 

address issues of exploitation, neglect and abuse of older adults, and adapt services to the needs 

of Native American elders. 

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 such as rehabilitative services that 

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EXECUTIVE SUMMARY

promote self-determination, independence, productivity, integration, and inclusion in all facets of 

community life. 

ACL will continue to 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 older 

adults and people with disabilities. ACL’s Center for Aging and Disability Policy provides a 

focal point for these efforts to develop new policies and initiatives that support both older 

Americans and persons with disabilities in accessing services and supports while fully 

participating in their communities.

2
Overview of Budget Request

The FY 2015 President’s Budget discretionary request for the Administration on Community 

Living (ACL) is $2,062,279,000, a reduction of -$34,350,000 below the FY 2014 enacted level. 

This budget includes as its top priority the maintaining funding for ACL’s core programs. The 

vast majority of ACL’s funding is for direct services and supports, and the States, Tribes, and 

localities that depend upon these funds have limited options to offset losses in these areas.

Maintaining this funding, which has the strongest impact on America’s most vulnerable seniors, 

is critical to ensuring that they can continue to live in their homes and communities for as long as 

possible. 

Under the request, the Senior Community Service Employment Program (SCSEP), currently 

housed at the Department Labor, continues to be proposed to transfer to ACL. SCSEP is the only 

program authorized under the Older Americans Act (OAA) that is not currently housed at ACL, 

and would benefit immensely from better integration with other OAA community-based 

programs.

This budget also includes several new initiatives. The first, recognizing the Administration on 

Aging’s longstanding emphasis on elder justice, is for $25 million to fund the Elder Justice Act 

at HHS. The issues of elder abuse, neglect, and exploitation affect millions of Americans. 

Reflecting HHS’ leadership of the Elder Justice Coordinating Council, funding the Elder Justice 

Act would firmly establish HHS as a Federal leader on nationwide issues of elder justice and 

respond to the call from the Government Accountability Office (GAO) for Federal leadership.

Second, ACL proposes a new $5 million initiative addressing the transition from adolescence to 

adulthood for young people with developmental disabilities. This initiative would respond to 

GAO and Congressional inquiries seeking coordinated services to develop best practices and an 

evidence base in supporting young people with developmental disabilities in this particularly 

fraught transition, with the aim of improving health, education, and employment outcomes and 

helping these youth to be contributing members of their communities.

The Budget includes $20 million each year, for five years, starting in FY 2015 in mandatory 

funding for the Aging and Disability Resource Centers. ACL will use these funds to strengthen 

the program nationwide and implement national standards that will help States develop more 

efficient, cost-effective, and consumer-centered systems of long-term services and services and 

supports. 

Three additional programs are proposed for new funding in FY 2015. The budget includes 

$5,000,000 for the establishment of a Holocaust Survivor Fund, which will create a publicprivate partnership in order to address the unique needs of the country’s aging Holocaust 

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EXECUTIVE SUMMARY

survivor population. Holocaust survivors are an extremely vulnerable population, and they often 

experience unmet community support needs. This Fund would help bridge funding and service 

gaps, generating innovative approaches for the coordination of home and community-based 

services and supports to assist this population to age with dignity in their own homes and 

communities. ACL’s request also includes $3,000,000 for the decennial White House 

Conference on Aging. The last Conference was held in 2005 and addressed the aging of the baby 

boomer generation, and ACL looks forward to working with the White House in 2015 to develop 

a conference that will address the needs of today’s seniors. Finally, the request includes 

$1,000,000 to reestablish the National Clearinghouse on Long-Term Care, an outreach effort to 

help individuals plan for their future long-term care needs.

The FY 2015 program level also requests $27,700,000 from the Prevention and Public Health 

Fund authorized by the Affordable Care Act. Of this, $8,000,000 would support continued 

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

$5,000,000 would support falls prevention programs, and 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 dementia-capable long-term service and 

support systems designed to meet the needs of individuals with Alzheimer's Disease and their 

caregivers. In addition, the overall budget includes $10,710,000 in mandatory funding for Health 

Care Fraud and Abuse Control activities.1

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 million. 2 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 percent. 3

 The U.S.

Census Bureau also estimates that 37.6 million people have a disability, representing 12.2

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

• 4.1 percent of children 5 to 17,

• 10.1 percent of people 18 to 64, and 

• 35.9 percent of adults 65 and older. 4

1 $10,710,000 is a placeholder amount for FY 2015. The Secretary and Attorney General will determine the final 

amount. 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, <http://www.census.gov/population/projections/data/national/2012/downloadablefiles.html> 

Accessed 09 February 2014. 3 Ibid and Centers for Medicare & Medicaid Services, The characteristics and perceptions of the Medicare 

population (2011) [data table 2.5a]. http://www.cms.gov/Research-Statistics-Data-andSystems/Research/MCBS/Data-Tables-Items/2011CharAndPerc.html . Accessed 09 February 2014. 4 U.S. Census Bureau, 2012 American Community Survey 1-Year Estimates. Table DP02: Selected Social 

Characteristics In The United States. 

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Studies indicate that individuals with developmental disabilities comprise between 1.2 and 

1.65 percent of the U.S. population, or between 3.8 and 5.2 million individuals.5

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

is vital to both the individuals’ well-being and the government’s fiscal health. ACL’s services 

assist people to remain independent and in their communities. Institutional care can be more 

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

For example, an 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 support 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 challenges of caregiving, 

the costs of providing this care will fall on other, more costly 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 $1,466,277,000, an increase of +$25,000,000 over the FY 2014 enacted 

level, for programs to maintain seniors’ health and independence, support caregivers, and protect 

vulnerable older Americans. These include:

• Health and Independence Programs ($1,228,848,000), 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. 

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

pe=table Accessed 09 February 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, 2013 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

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• Caregiver Services ($168,277,000), 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 ($69,152,000), 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 $25 million for an 

initiative to begin funding the Elder Justice Act, specifically in the areas of Adult 

Protective Services and research and evaluation.

• Senior Community Service Employment Program ($380,000,000), which 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. The 

FY 2015 budget continues to propose the transfer of SCSEP from the Department of 

Labor. SCSEP it 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 the difficult decision to reduce the Senior 

Community Service Employment program by -$54,371,000 from the FY 2014 enacted. 

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.

Administration on Intellectual and Developmental Disabilities (AIDD)

The request includes $165,222,000, an increase of +$5,000,000 over the FY 2014 enacted level, 

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

• State Councils on Developmental Disabilities ($70,876,000), 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.

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.

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• State Protection and Advocacy Systems ($38,734,000), 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. 

• University Centers for Excellence in Developmental Disabilities ($36,769,000), 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 ($8,880,000), which fund discretionary 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. This includes $1,000,000, first appropriated directly to ACL in 

FY 2014, to support transportation initiatives that demonstrate the inclusion of people 

with disabilities and seniors in the development and planning of community 

transportation systems.

• Help America Vote Act (HAVA) grants ($4,963,000), 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.

• Youth Transitions Initiative ($5,000,000), to invest in initiatives that coordinate services 

to address the comprehensive needs of youth with intellectual and developmental 

disabilities as they transition from adolescence into young adult life across all domains –

health, education, employment, human services, and community living.

Aging and Disability Programs

The FY 2015 budget request also continues to fund the State Health Insurance Assistance 

Program (SHIPs) and the Paralysis Resource Center (PRC), both of which were transferred to 

ACL in FY 2014. 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. The 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. ACL is also requesting $20,000,000 in 

mandatory funding for the Aging and Disability Resource Centers program (existing mandatory 

funding for which expires in FY 2014), which has shown great promise and is ready to be taken 

to nationwide scale. In addition, ACL is requesting $1,000,000 to re-establish the National 

Clearinghouse on Long-Term Care, an outreach effort to help individuals plan for their future 

long-term care needs. 

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EXECUTIVE SUMMARY

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

the same as the FY 2014 enacted level, which would support an estimated 143 FTE. 

ACL looks forward to continuing a dialogue about how the Administration and HHS’s broader 

resources can be leveraged to contribute and enhance community living and full participation for 

all Americans. 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 welldocumented over-reliance 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 admission, hospital readmission, and 

emergency room visits.

8
Overview of Performance

The Administration for Community Living (ACL) is focused on the unique needs of individual 

groups, such as persons with developmental disabilities or frail seniors, and their caregivers as 

well as the common issues that face individuals who need community-based supports, to have 

the option of living in the community rather than in institutional settings. The agency’s mission 

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

and their families and caregivers. ACL accomplishes this by advancing effective policies, 

services, and supports. Below, an overview of performance is provided for Administration on 

Aging (AoA) and Administration on Intellectual and Developmental Disabilities (AIDD).

AoA Overview of Performance

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

of the Older Americans Act (OAA): 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 (OAA Section 301). 

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 performance 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 client outcome 

measure includes indicators focusing on consumer assessment of service quality, 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 ACL’s goals and objectives and in turn measure success in 

accomplishing ACL’s mission. 

Performance Highlights

An analysis of AoA’s performance trends shows that through FY 2012 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 

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

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

successes: 

• OAA programs help older Americans 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 entry. 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 2005, one-third of home-delivered nutrition clients (313,362) lived 

with three or more ADL impairments and by FY 2012 the proportion of clients with three 

or more impairments grew to 43.5% or 369,914 clients, a 30% increase. Another 

approach to measuring AoA’s success is the nursing home predictor score. The 

components of this composite score are predictive of nursing home entry based on 

scientific literature and AoA’s Performance Outcomes Measures Project (POMP) which 

developed and tested 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 the OAA service population increases, meaning AoA is reaching those most 

in need of help. In 2003, the nursing home predictor score was 46.57 and data show it has 

increased to 63.0 in FY 2012.

• 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 2012 The National Aging Services 

Network served 9,206 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 509 

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 

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EXECUTIVE SUMMARY

satisfaction with these services. In 2012, over 93 percent of transportation clients and 

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

trends, AoA uses 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 2015 

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 2015 as enacted in 

FY 2014, 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. Regardless of the historic nature of state and local support for 

these programs, AoA expects declining leveraged funds, as state, local, and private budgets face 

economic hardships. This will adversely impact performance through FY 2015. 

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 ACL’s goals and objectives and most strongly contributing to the HHS Strategic Plan 

goals of advancing the health, safety and well-being of the American people and ensuring 

efficiency, transparency, accountability and effectiveness of HHS programs. Below is a summary 

of each measure, its indicators and their relationship to ACL’s goals and the HHS Strategic Plan. 

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. For FY 2015, there are two efficiency indicators for 

AoA program activities, both consistently meet or exceed targets. Indicator 1.1 addresses 

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

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

the efficiency of AoA in providing services to Native Americans. 

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

4.A to strengthen program integrity and responsible stewardship by reducing improper payments, 

fighting fraud and integrating financial, performance, and risk management. 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. 

Measure 2: Improve Client Outcomes 

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

outcomes. The FY 2015 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 indicators 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 indicators for the national Long-Term Care Ombudsman Program (LTCOP) 

focus on the core purpose of this program: advocacy on behalf of older adults. While some 

indicators experience year-to-year variation, all indicators have trended in the desired direction 

and the vast majority meet or exceed targets annually.

This measure supports ACL’s overall mission and Goal 4 of its strategic plan; enable people with 

disability and older adults to live in the community through the availability of and access to highquality long-term services and supports, including supports to family caregivers. 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 and social well-being for individuals, families, 

and communities; 3.C improve the accessibility and quality of supportive services for people 

with disabilities and older adults; and 3.D promote prevention and wellness across the lifespan.

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. AoA’s four indicators for effective targeting capture success with regards to 

increasing services to family caregivers; providing services to those most at risk for 

12
EXECUTIVE SUMMARY

institutionalization; insuring that older adults living in rural areas are receiving long-term 

services and supports; and addressing the needs of the economically vulnerable. While some 

indicators that are more budget sensitive have experienced yearly fluctuations, the overall 

performance since FY 2006 has increased.

Effective targeting of OAA services supports ACL’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 for individuals, families, and communities; 3.C improve the 

accessibility and quality of supportive services for people with disabilities and older adults; and 

3.D promote prevention and wellness across the lifespan. 

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 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). 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.

The AIDD performance measurement strategy focuses on four measures that address outcomes 

related to the AIDD mission and purpose of the DD Act: to assist people with intellectual and 

developmental disabilities to become independent and integrated into their community, protect 

their legal and human rights, and improve the quality of services and supports. These measures 

support HHS Strategic Plan Goal 3. Advance the Health, Safety and Well-Being of the American 

People and specifically Objectives 3.B promote economic & social well-being for individuals, 

families, and communities; and 3.C improve the accessibility and quality of supportive services

for people with disabilities and older adults. The following highlights the AIDD Network’s 

accomplishments in these three focus areas plus efforts to improve program efficiency.

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 

13
EXECUTIVE SUMMARY

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 

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

living for persons with developmental disabilities. The State Councils engage in a variety of 

activities that promote systems change and capacity building. A key activity for many State 

Councils is leadership training to individuals with developmental disabilities and their family 

members to enhance civic engagement for creating more effective policy solutions. 

An independent evaluation8 found that State Councils fulfill their role in fostering leaders and 

self-advocacy and achieving systems change. Participants in leadership and self-advocacy 

training reported overwhelming satisfaction with the usefulness of the program. Many 

participants go on to leadership positions on State Councils and other disability-focused 

organizations and engage in systems change efforts. AIDD performance measure 8A (long-term 

objective 8.1) examines the success of these activities in terms of the percent of people reached 

by State Councils who are independent, self-sufficient and integrated into the community. The 

results have consistently trended up and have met or exceeded performance targets since FY 

2008. This measure demonstrates progress toward Council objectives across multiple systems 

including that adults have jobs of their choice; students have the education and support they need 

to reach their educational goals; and individuals have homes and live with others of their 

choosing.

Given limited resources and economic pressures that create barriers to systems change and 

capacity building, the efficient use of federal funds is paramount. AIDD illustrates the Networks 

efficiency tied to outcomes through measure 8E, i.e. the number of individuals reached who are 

independent, self-sufficient and integrated into the community per $1,000 of federal funding. 

This measure has shown an increasing trend since FY 2008. Targets have been reached or 

exceeded for four out of the previous five years.

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. 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 

8 Westat, Inc. National Independent Study of the Administration on Developmental Disabilities Programs: Final 

Report. Volume 1. Prepared for HHS Administration for Children and Families, Administration for Developmental 

Disabilities. Accessed May 28, 2013 at 

http://www.acf.hhs.gov/sites/default/files/add/national_independent_study_vi_final.pdf

14

 
EXECUTIVE SUMMARY

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

performance. Examples of PADD success include: 

• PADD grantees are highly successful at meeting the needs of complainants: The annual 

performance measure of the percentage of individuals who have their complaint of abuse, 

neglect, discrimination, or other human or civil rights corrected compared to the total 

assisted demonstrates the rate of successful benefits accruing from the P&A program to 

individuals with developmental disabilities. The rate of success has been consistently 

over 90 percent. Overall the measure trends upward but experiences year to year 

fluctuations which are to be expected given the overall high success rate.

• PADD grantees are efficient and responsive: An independent evaluation9 found that 

among the sampled grantees over 90 percent of calls are responded to within the 

maximum response time (e.g. 48 hours). 

In addition to individual advocacy, PADDs have demonstrated considerable success achieving 

system advocacy outcomes: closing residential facilities, influencing seclusion and restraint 

practices and issues related to access to services. 

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. Highlights of UCEDD performance include:

• UCEDDS have been successful at highly leveraging the funds received from AIDD: The 

University Center grants are expected to function as a catalyst to support infrastructure 

and maximize the leveraging of additional funds to implement their core activities of 

interdisciplinary training, community service, research, and information dissemination. 

9 Ibid

15

 
EXECUTIVE SUMMARY

The evaluation10 found the average ratio of total UCEDD funding to AIDD grant funds 

was about 14 to 1. All UCEDDS in the sample had ratios above 4 to 1. 

• UCEDD trained professionals are serving the disability community: Pre-service training 

is a mechanism through which UCEDDs advance practice, scholarship and policy that 

impact the lives of people with developmental disabilities and their families. UCEDDs 

performance in this area is measured as 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 2012 met the target at 37.7 percent. 

Since FY 2009 this measure has steadily increased.

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. 

ACL’s Commitment to Transparency, Accountability and Evaluation

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

AIDD continue to improve the analysis and availability of performance information while also 

enhancing the rigor of program evaluations. To this end, ACL has: 

• Supported increased access to program data and performance information. AoA 

continues to enhance the data portal (www.agid.acl.gov) which provides data 

visualization tools, downloadable data files, and data analysis tools which enables the 

development of benchmarks and trend analyses at the national and at the state level. AoA 

also supports efforts to facilitate developer use of federal data sets through 

http://www.data.gov/ and http://www.healthdata.gov/. A recent application was created 

using AoA’s Elder Care Locator data.

• Enhanced support of efforts to measure Long-Term Services and Supports including 

service quality. AIDD has partnered with the Department of Education’s National 

Institute on Disability and Rehabilitation Research and others to advance data collection 

efforts to measure state progress with regards to competitive employment, housing 

choice, self-determination and service quality.

10 Ibid.

16

 
EXECUTIVE SUMMARY

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

Participants to help inform decision makers. Results show that: AoA is effectively 

reaching those most at risk of institutionalization; service recipients report Title III 

services enable them to remain in their own homes; and in comparison to the overall US 

population 60 and older, the OAA programs are serving older people who are less healthy 

and have more limitations in function 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. This model is 

currently being further tested and refined with data from four additional States through 

ACL’s System’s Integration Program. 

• Applied results of an independent evaluation conducted by Westat11 to inform efforts to 

improve performance measurement across AIDD programs. AIDD continues to work 

with ACL performance staff and DD Network stakeholders to enhance the use of 

performance information in combination with external, national data collection efforts.

• Employed rigorous program evaluation methods including longitudinal data collection 

and matched comparison groups. 

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 covers a large array of topics; a costs study 

that measures the actual cost of providing a meal by cost category; 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, ACL/AoA and Centers 

for Medicare & Medicaid Services (CMS) have entered into an Inter-Agency 

Agreement that will enhance this evaluation to include prospective analysis of 

healthcare utilization and cost. Data collection for the process study is scheduled to 

begin in early 2014.

11 Ibid 

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EXECUTIVE SUMMARY

o The evaluation of the Title III-E National Family Caregiver Support Program 

(NFCSP) 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. The evaluation seeks to assess the impact of the program at the 

individual, program, and long-term care (LTC) policy/home and community-based 

service (HCBS) system levels. The evaluation will also examine how the program 

meets its goals and whether the program has contributed to long-term care system 

efficiency. The first process evaluation phase of the study is scheduled to begin in the 

summer of 2014. The second outcome evaluation phase, is expected to begin later this 

year, will gather information from a sample of caregivers receiving NFCSP services 

and from a comparable group of caregivers not receiving NFCSP services. 

o AoA is currently evaluating its Aging and Disability Resource Centers (ADRC). 

Process data collection was completed during the fall of 2013, and consumer-level 

data collection started during the summer of 2013 and is expected to conclude in 

March 2014. 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 

was completed in June of 2013 and examined 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 relied on existing program data such as 

consumer and site level data submitted by grantees and grantee progress reports. The 

final process evaluation report is available on the AoA website at: 

http://www.aoa.gov/AoARoot/Program_Results/Program_Evaluation.aspx. In 

addition to the process evaluation, 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. The final report was 

completed during the fall of 2013.

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 design considered program efficiency, including cost and resource 

utilization, and program effectiveness at the client/family, facility, municipal/state, 

18
EXECUTIVE SUMMARY

and national levels. An evaluation design report for ACL was completed in January 

2013 and is available at: 

http://www.aoa.gov/AoARoot/Program_Results/docs/LTCOP%20Evaluation%20Stu

dy%20Design_01312013.pdf. 

o The Administration on Intellectual and Developmental Disabilities awarded a sixyear contract in 2011 to evaluate the eight Partnerships in Employment Systems 

Change projects. The evaluation of the eight employment projects will inform AIDD 

and its partners how to best work to support competitive, integrated employment 

systems for individuals with intellectual and developmental disabilities. 

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

the Senior Medicare Patrol (SMP) program. This analysis was 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 was 

submitted in June 2013 and the To-Be report is scheduled for completion in January 

2014. 

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 to reflect the success of the DD Network 

under the purposes of the DD Act.

AoA provides formula grants to states or tribes and there is a great deal of flexibility in 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. 

19
EXECUTIVE SUMMARY

• Programmatic technical assistance. 

• Improved performance measurement capacity and information collection tools. 

• Rigorous program evaluation. 

• 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.

In FY 2014, ACL is initiating a formula grant monitoring framework for Older Americans Act 

(OAA) Title III and VII state formula grants. The framework combines assessments of grantee’s 

progress toward program goals and objectives with identification of risk or instances of fraud, 

waste and abuse. An integrated team from AoA’s program staff, ACL regional offices, Office of 

Performance and Evaluation and Office of Grants Management will develop monitoring tools, 

evaluate monitoring efforts and provide staff training on the process. The monitoring approach 

will involve the review of a wide variety of program performance data and information such as 

state plans, financial reports and annual program data and corresponding performance measures. 

Feedback and follow-up are essential to performance improvement and enhanced program 

integrity. ACL’s framework includes state specific monitoring reports that include findings, 

recommendations and recommended corrective actions; corresponding grantee response with 

timelines for corrective actions; and grant conditions when necessary. The new framework will 

be pilot tested with five to seven states in FY 2014. Based on the success with OAA Title III and 

VII, ACL will develop customized monitoring frameworks for AIDD State Grant Programs, 

OAA Title VI (Tribal Formula Grants), and ACL discretionary grants.

In addition to the new grant monitoring framework, ACL senior management is directly engaged 

in developing performance management 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. 

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 

20
EXECUTIVE SUMMARY

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

funding levels to propose to the Department and OMB. 

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.

21
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EXECUTIVE SUMMARY

All Purpose Table

Administration for Community Living

(dollars in thousands)

FY 2013 FY 2014

Program Final Enacted

President's 

Budget +/- FY 2014

Health and Independence

Home & Community-Based Supportive Services.................................................. 347,724 347,724 347,724 --

Congregate Nutrition Services ................................................................................. 416,104 438,191 438,191 --

Home-Delivered Nutrition Services ......................................................................... 205,489 216,397 216,397 --

Nutrition Services Incentive Program...................................................................... 146,718 160,069 160,069 --

Preventive Health Services........................................................................................ 19,849 19,848 19,848 --

Chronic Disease Self-Management Education [PPHF].................................... 7,086 8,000 8,000 --

Falls Prevention [PPHF]......................................................................................... -- 5,000 5,000 --

Senior Community Service Employment Program.................................................. 424,805 434,371 380,000 (54,371)

Native American Nutrition & Supportive Services................................................ 26,157 26,158 26,158 --

Aging Network Support Activities.......................................................................... 7,432 7,461 7,461 --

Subtotal, Health and Independence...................................................................... 1,601,364 1,663,219 1,608,848 (54,371)

Caregiver Services

Family Caregiver Support Services.......................................................................... 145,586 145,586 145,586 --

Native American Caregiver Support Services........................................................ 6,031 6,031 6,031 --

Alzheimer's Disease Supportive Services Program 5/........................................... 3,786 3,800 3,800 --

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

Lifespan Respite Care 5/............................................................................................ 2,351 2,360 2,360 --

Subtotal, Caregiver Services.................................................................................. 157,754 168,277 168,277 --

Protection of Vulnerable Adults

Elder Justice Initiative/APS....................................................................................... 2,000 -- 25,000 25,000

Long-Term Care Ombudsman Program.................................................................... 15,885 15,885 15,885 --

Prevention of Elder Abuse & Neglect..................................................................... 4,773 4,773 4,773 --

Senior Medicare Patrol Program ............................................................................. 8,875 8,910 8,910 --

Health Care Fraud and Abuse Control [HCFAC] 1/........................................ 10,847 6,590 10,710 4,120

Elder Rights Support Activities .............................................................................. 3,859 3,874 3,874 --

Subtotal, Vulnerable Adults................................................................................... 46,239 40,032 69,152 29,120

FY 2015

23
EXECUTIVE SUMMARY

Developmental Disabilities Programs

State Councils on Developmental Disabilities........................................................ 70,555 70,876 70,876 --

Protection and Advocacy.......................................................................................... 38,559 38,734 38,734 --

University Centers for Excellence in Developmental Disabilities........................ 36,602 36,769 36,769 --

Projects of National Significance 3/......................................................................... 8,828 8,880 8,880 --

Youth Transitions Initiative...................................................................................... -- -- 5,000 5,000

Subtotal, Developmental Disabilities.................................................................... 154,544 155,259 160,259 5,000

Consumer Information, Access & Outreach

Aging and Disability Resource Centers [Discretionary]...................................... 6,095 6,119 -- (6,119)

Aging and Disability Resource Centers [Mandatory] 2/.................................. 9,490 9,280 20,000 10,720

Voting Access for People with Disabilities (HAVA)............................................. 4,961 4,963 4,963 --

Alzheimer's Disease Initiative--Communications Campaign [PPHF]............ 150 4,200 4,200 --

State Health Insurance Assistance Program.......................................................... 46,040 52,115 52,115 --

National Clearinghouse for Long-Term Care Information 3/................................ 86 -- 1,000 1,000

Medicare Improvements for Patients and Providers Act [TRA/BBA] 4/......... 23,725 12,500 -- (12,500)

Paralysis Resource Center 5/..................................................................................... 6,352 6,700 6,700 --

Subtotal, Consumer Information, Access & Outreach....................................... 96,899 95,877 88,978 (6,899)

White House Conference on Aging........................................................................ -- -- 3,000 3,000

Holocaust Survivor Assistance Fund..................................................................... -- -- 5,000 5,000

Program Administration............................................................................................. 28,064 30,035 30,035 --

Subtotal, Program Level........................................................................................... 2,084,864 2,152,699 2,133,549 (19,150)

Less: Funds From Mandatory Sources

HCFAC Wedge Funds 1/........................................................................................... (10,847) (6,590) (10,710) (4,120)

ACA Direct Appropriations ..................................................................................... (9,576) (9,280) -- 9,280

ADRC Mandatory Funding....................................................................................... -- -- (20,000) (20,000)

Prevention & Public Health Fund (ACA)................................................................ (9,236) (27,700) (27,700) --

Taxpayer Relief Act/Bipartisan Budget Act 4/....................................................... (23,725) (12,500) -- 12,500

PHS Evaluation Fund 5/............................................................................................. -- -- (12,860) (12,860)

Total, Discretionary Budget Authority..................................................................... 2,031,480 2,096,629 2,062,279 (34,350)

1/ $10,710,000 is a placeholder amount for FY 2015. The Secretary and Attorney General will determine the final amount.

2/ Mandatory funding for ADRCs was provided by the Affordable Care Act in FY 2013 and FY 2014. The FY 2015 request is for 

 new mandatory funding.

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

 Taxpayer Relief Act (save for obligations through January 3, 2013). The FY 2015 request is for discretionary funding.

4/ Includes funding for SHIPs, ADRCs, AAAs, and the National Center for Benefits Outreach Enrollment

5/ For FY 2015, these funds are requested from amounts under section 241 of the Public Health Service Act 

24
EXECUTIVE SUMMARY

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"), 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, 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, [$1,610,143,000]$2,010,164,000, together with $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 Reconciliation Act of 1990: 

Provided, That, in addition to amounts provided herein, $12,860,000 shall be available from 

amounts available under section 241 of the PHS Act to supplement funds otherwise available for 

carrying out titles III and XXIX of such Act: Provided further, 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 

25
EXECUTIVE SUMMARY

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, 

$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, 2016, and may be 

recaptured and reobligated in accordance with section 517(c) of the OAA: Provided further, 

That $3,000,000 shall be available until September 30, 2016 for the White House Conference on 

Aging. 

26
EXECUTIVE SUMMARY

Appropriations Language Analysis

Administration for Community Living

Language Provision Explanation

...section 6021(d) of the Deficit Reduction Act 

of 2005...

Provides authorization for the National 

Clearinghouse for Long-Term Care 

Information

Provided, That, in addition to amounts 

provided herein, $12,860,000 shall be available 

from amounts available under section 241 of 

the PHS Act to supplement funds otherwise 

available for carrying out titles III and XXIX 

of such Act

Provides funding from amounts provided under 

section 241 of the Public Health Service Act 

for 3 programs: Alzheimer’s Disease 

Supportive Services Program, Lifespan Respite 

Care, and the Paralysis Resource Center

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:

Authorizes ACL to set-aside up to 1% of 

funding provided under Title III of the OAA to 

evaluate OAA programs and disseminate the 

results throughout the Aging Services Network

Provided further, That, of the amounts 

provided under this heading, $380,000,000 

shall be available for carrying out title V of the 

OAA: 

Authorizes ACL to administer the Senior 

Community Service Employment Program

Provided further, That with respect to the 

previous proviso, such funds shall be available 

through June 30, 2016, and may be recaptured 

and reobligated in accordance with section 

517(c) of the OAA:

Ensures that SCSEP funding is available in 

accordance with its current Program Year 

funding schedule, rather than a standard Fiscal 

Year schedule

Provided further, That $3,000,000 shall be 

available until September 30, 2016 for the 

White House Conference on Aging.

Ensures that funding for the White House 

Conference on Aging is available through the 

end of FY 2016 in order to hold the conference 

and resolve any expenses incurred after 

September 30, 2015

27
EXECUTIVE SUMMARY

Amounts Available for Obligation

Administration for Community Living

General Fund Discretionary Appropriation:

Appropriation (L/HHS)................................................................................ 1,470,917,701 1,610,143,000 2,010,164,000

Subtotal, Appropriation (L/HHS, Ag, or Interior)................................ 1,470,917,701 1,610,143,000 2,010,164,000

Rescission (Section 3004)............................................................................ -2,941,835 -- --

Sequestration................................................................................................. -73,995,986 -- --

Secretary's transfer....................................................................................... -5,496,008 -- --

Subtotal, adjusted appropriation............................................................ 1,388,483,872 1,610,143,000 2,010,164,000

Transfer of funds to Department of Agriculture...................................... -2,542,042 -2,391,605 --

Comparable transfer from Department of Labor....................................... 424,804,974 434,371,000 --

Comparable transfer from Centers for Disease Control........................... 6,352,000 -- --

Comparable transfer from General Departmental Management............. 1,197,616 -- --

Comparable transfer from Administration for Children and Families.... 163,418,541 -- --

Total, Discretionary Appropriation.................................................. 1,981,714,961 2,042,122,395 2,010,164,000

Mandatory Appropriation:

Appropriation (PPACA) ADRCs................................................................ 9,490,000 9,280,000 --

Appropriation (Requested) ADRCs........................................................... -- -- 20,000,000

Appropriation (PPACA) National Long-Term Care Clearinghouse...... 85,523 -- --

Appropriation (PPACA) Prevention Funds.............................................. 9,236,000 27,700,000 27,700,000

Appropriation (Taxpayer Relief Act) MIPPA........................................... 23,725,000 12,500,000 --

Subtotal, adjusted mandatory. appropriation....................................... 42,536,523 49,480,000 47,700,000

Offsetting collections from:

Trust Funds: HCFAC................................................................................... 9,575,523 6,590,000 10,710,000

Trust Funds: SHIPs HI/SMI........................................................................ 46,040,000 52,115,000 52,115,000

PHS Evaluation Funds................................................................................. -- -- 12,860,000

Subtotal, spending authority from offsetting collections................... 55,615,523 58,705,000 75,685,000

Unobligated balance, lapsing.......................................................................... -499,654 -- --

Total obligations........................................................................................... 2,079,367,353 2,150,307,395 2,133,549,000

FY 2013 Actual FY 2014 Enacted

FY 2015 

President's 

Budget

28
EXECUTIVE SUMMARY

Summary of Changes

Administration for Community Living

(Dollars in thousands)

2014

2,096,629

2015

2,062,279

-34,350

FY 2015 FY 2015

FY 2015 +/- 

FY 2014

FY 2015 +/- 

FY 2014

PB FTE PB BA FTE BA

Increases:

A. Program:

1. Elder Justice Initiative/APS............................................................. 4 25,000 4 25,000

2. Youth Transitions Initiative............................................................. 0 5,000 0 5,000

3. National Clearinghouse for Long-Term Care Information........... 0 1,000 0 1,000

4. White House Conference on Aging............................................... 0 3,000 0 3,000

5. Holocaust Survivor Fund................................................................. 0 5,000 0 5,000

Subtotal, Program Increases.......................................................... 39,000 39,000

Total Increases.............................................................................. 39,000

Decreases:

A. Built-In:

1. Shifts to PHS Funding...................................................................... 0 -12,860 0 -12,860

Subtotal, Program Decreases........................................................ -12,860 -12,860

A. Program:

1. Senior Community Service Program............................................... 10 380,000 0 -54,371

2. Aging and Disability Resource Centers (Discretionary)............. 0 0 0 -6,119

Subtotal, Program Decreases........................................................ 380,000 -60,490

Total Decreases............................................................................ -73,350

Net Change................................................................................ -34,350

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

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

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

29
EXECUTIVE SUMMARY

Budget Authority by Activity

Administration for Community Living

Health and Independence

Home & Community-Based Supportive Services 347,724 347,724 347,724

Congregate Nutrition Services 416,104 438,191 438,191

Home-Delivered Nutrition Services 205,489 216,397 216,397

Nutrition Services Incentive Program 146,718 160,069 160,069

Preventive Health Services 19,849 19,848 19,848

Senior Community Service Employment Program 424,805 434,371 380,000

Native American Nutrition & Supportive Services 26,157 26,158 26,158

Aging Network Support Activities 7,432 7,461 7,461

Subtotal, Health and Independence 1,594,278 1,650,219 1,595,848

Caregiver Services

Family Caregiver Support Services 145,586 145,586 145,586

Native American Caregiver Support Services 6,031 6,031 6,031

Alzheimer's Disease Supportive Services Program 4/ 3,786 3,800 --

Lifespan Respite Care 4/ 2,351 2,360 --

Subtotal, Caregiver Services 157,754 157,777 151,617

Protection of Vulnerable Adults

Elder Justice Initiative/APS -- -- 25,000

Long-Term Care Ombudsman Program 15,885 15,885 15,885

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

Senior Medicare Patrol Program 8,875 8,910 8,910

Elder Rights Support Activities 3,859 3,874 3,874

Subtotal, Vulnerable Adults 33,392 33,442 58,442

Developmental Disabilities Programs

State Councils on Developmental Disabilities 70,555 70,876 70,876

Protection and Advocacy 38,559 38,734 38,734

University Centers for Excellence in Developmental Disabilities 36,602 36,769 36,769

Projects of National Significance 3/ 8,828 8,880 8,880

Youth Transitions Initiative -- -- 5,000

Subtotal, Developmental Disabilities 154,544 155,259 160,259

FY 2013 

Actual

FY 2014 

Enacted

FY 2015 

President's 

Budget

30
EXECUTIVE SUMMARY

Consumer Information, Access & Outreach

Aging and Disability Resource Centers [Discretionary] 6,095 6,119 --

Voting Access for People with Disabilities (HAVA) 4,961 4,963 4,963

State Health Insurance Assistance Program 46,040 52,115 52,115

National Clearinghouse for Long-Term Care Information 3/ -- -- 1,000

Paralysis Resource Center 4/ 6,352 6,700 --

Subtotal, Consumer Information, Access & Outreach 63,448 69,897 58,078

White House Conference on Aging -- -- 3,000

Holocaust Survivor Assistance Fund -- -- 5,000

Program Administration 28,064 30,035 30,035

Total, Discretionary Budget Authority 2,031,480 2,096,629 2,062,279

HCFAC Wedge Funds 1/ 10,847 6,590 10,710

ACA Direct Appropriations 9,576 9,280 --

ADRC Mandatory Funding (ACA) {Non-Add} 9,490 9,280 --

National Clearinghouse for Long-Term Care Information {Non-Add} 86 -- --

ADRC Mandatory Funding (Non-ACA) 2/ -- -- 20,000

Prevention & Public Health Fund (ACA) 9,236 27,700 27,700

Chronic Disease Self-Management Education {Non-Add} 7,086 8,000 8,000

Falls Prevention {Non-Add} -- 5,000 5,000

Alzheimer's Disease Initiative - Services {Non-Add} -- 10,500 10,500

Alzheimer's Disease Initiative - Communications {Non-Add} 150 4,200 4,200

Adult Protective Services {Non-Add} 2,000 -- --

Taxpayer Relief Act/Bipartisan Budget Act 23,725 12,500 --

State Health Insurance Assistance Programs {Non-Add} 7,118 3,750 --

Aging and Disability Resource Centers {Non-Add} 4,745 2,500 --

Area Agencies on Aging {Non-Add} 7,118 3,750 --

National Center for Benefits Outreach & Enrollment {Non-Add} 4,745 2,500 --

PHS Evaluation Fund 4/ -- -- 12,860

Alzheimer's Disease Supportive Services Program {Non-Add} -- -- 3,800

Lifespan Respite Care {Non-Add} -- -- 2,360

Paralysis Resource Center {Non-Add} -- -- 6,700

Total, Program Level 2,084,864 2,152,699 2,133,549

1/ $10,710,000 is a placeholder amount for FY 2015. The Secretary and Attorney General will determine the 

 final amount.

2/ Mandatory funding for ADRCs was provided by the Affordable Care Act in FY 2013 and FY 2014. The FY 2015 

 request is for new mandatory funding.

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

 rescinded by the Taxpayer Relief Act (save for obligations through January 3, 2013). 

 The FY 2015 request is for discretionary funding.

4/ For FY 2015, these funds are requested from amounts under section 241 of the Public Health Service Act 

31
EXECUTIVE SUMMARY

Authorizing Legislation

Administration for Community Living

FY 2014 

Amount 

Authorized

FY 2014 

Appropriations 

Act

FY 2015 

Amount 

Authorized

FY 2015 

President's 

Budget

1) Home and CommunityBased Supportive Services:

OAA Section 321..................................................................... Expired 347,724,000 Expired 347,724,000

2) Nutrition Services

Services: OAA Sections 331 and 336.................................... Expired 654,588,000 Expired 654,588,000

3) Nutrition Services Incentive

Program: OAA Section 311 1/................................................ Expired 160,069,000 Expired 160,069,000

4) Preventive Health Services:

OAA Section 502..................................................................... Expired 19,848,000 Expired 19,848,000

5) National Family Caregiver 

Support Program: OAA Section 371.................................... Expired 145,586,000 Expired 145,586,000

6) Community Service Employment for Older Americans

Title V OAA Section 502........................................................ Expired 434,371,000 Expired 380,000,000

7) Native American Nutrition

and Supportive Services: 

OAA Sections 613 and 623..................................................... Expired 26,158,000 Expired 26,158,000

8) Native American Caregiver

Support Program: OAA Section 631.................................... Expired 6,031,000 Expired 6,031,000

9) Long-Term Care Ombudsman

Program: OAA Section 712..................................................... Expired 15,885,000 Expired 15,885,000

10) Prevention of Elder Abuse and

Neglect: OAA Section 721...................................................... Expired 4,773,000 Expired 4,773,000

11) Senior Medicare Patrol Program

 OAA Sections 201 and 202, as amended............................. Expired 8,910,000 Expired 8,910,000

12) Elder Rights Support Activities

 OAA Sections 201, 202, and 411, as amended.................... Expired 3,874,000 Expired 3,874,000

13) Aging Network Support 

Activities: OAA Sections 202, 215 and 411........................ Expired 7,461,000 Expired 7,461,000

14) Alzheimer's Disease Demonstration Grants 1/

PHSA Section 398.................................................................... Expired 3,800,000 Expired 0

32
EXECUTIVE SUMMARY

15) Lifespan Respite Care 1/

Lifespan Respite Care Act of 2006........................................ Expired 2,360,000 Expired 0

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

16) Program Administration:

OAA Section 205..................................................................... Expired 30,035,000 Expired 30,035,000

17) Aging and Disability Resource Centers

OAA Section 202b................................................................... Expired 6,119,000 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 Expired 25,000,000

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

20) State Councils on Developmental Disabilities

DD Act Section 129(a)............................................................. Expired 70,876,000 Expired 70,876,000

21) Protection and Advocacy

DD Act Section 145................................................................. Expired 38,734,000 Expired 38,734,000

22) University Centers for Excellence in Developmental

 Disabilities

DD Act Section 156................................................................. Expired 36,769,000 Expired 36,769,000

23) Projects of National Significance 

DD Act Section 163................................................................. Expired 8,880,000 Expired 8,880,000

24) Voting Assistance for People with Disabilities

Help America Vote Act Section 291...................................... Expired 4,963,000 Expired 4,963,000

25) Paralysis Resource Center 1/

PHSA Sections 311 and 317(k)(2).......................................... N/A 6,700,000 N/A 0

25) National Clearinghouse on Long-Term Care Information

Deficit Reduction Act of 2005 Section 6021(d).................... Expired 0 Expired 1,000,000

26) Youth Transitions Initiative

DD Act Section 163................................................................. Expired 0 Expired 5,000,000

27) White House Conference on Aging

OAA Sections 202 and 205..................................................... Expired 0 Expired 3,000,000

28) Holocaust Survivor Fund

OAA Section 411..................................................................... Expired 0 Expired 5,000,000

Total Request Level......................................................................... $2,096,629,000 $2,062,279,000

Unfunded Authorizations:

1) Legal Assistance:

OAA Section 731..................................................................... Such Sums 0 Such Sums 0

33
EXECUTIVE SUMMARY

Appropriations History Table

Administration for Community Living

Budget 

Estimate to 

Congress

House 

Allowance

Senate 

Allowance Appropriation

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

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

FY 2009 /2 1,381,384,000 1,492,741,000 1,478,156,000 1,491,343,000

FY 2009 ARRA /4 -- -- -- 100,000,000

FY 2010 /3 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 Rescission -3,000,646

FY 2012 /5 2,237,944,000 1,471,324,000 1,534,701,000 1,473,703,000

FY 2012 Rescission -2,785,299

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

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

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

FY 2013 Transfer -- -- -- -6,133,066

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

FY 2015 2,062,279,000

1/ 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.

2/ 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.

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

4/ 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.

5/ 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.

34
EXECUTIVE SUMMARY

Appropriations Not Authorized by Law

Administration for Community Living

Program

Last Year of 

Authorization

Authorization 

Level

Appropriations in 

Last Year of 

Authorization

Appropriations 

in FY 2014

Alzheimer's Disease 

Suppoertive Services: 

PHSA Section 398 FY 2002 Such Sums $11,483,000 $3,800,000

Older Americans Act FY 2011 Such Sums $1,927,486,000 $1,452,421,000

Lifespan Respite Care: 

Lifespan Respite Care 

Act of 2006 FY 2011 $94,810,000 $2,495,000 $2,360,000

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 $155,259,000

National 

Clearinghouse for 

Long-Term Care: 

Deficit Reduction Act 

of 2005 section 6021(d) FY 2010 $1,000,000 $3,000,000 $0

Social Security Act, 

Title XX-B FY 2014 $129,000,000 $0 $0

35
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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.12 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.13 Health and Independence Programs are vital to helping seniors remain in their homes 

and communities for as long as possible. For example, 68 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, 57 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.

14

The FY 2015 funding request for Health and Independence services is $1,608,848,000; a 

reduction of -$54,371,000 from the comparable FY 2014 enacted level. For FY 2015, specific 

program requests include:

• $347,724,000 for Home and Community-Based Supportive Services (HCBSS), the same 

as the FY 2014 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 

12 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 09 February 2014. 13 Ibid and Centers for Medicare & Medicaid Services, The characteristics and perceptions of the Medicare 

population (2011) [data table 2.5a]. http://www.cms.gov/Research-Statistics-Data-andSystems/Research/MCBS/Data-Tables-Items/2011CharAndPerc.html . Accessed 09 February 2014.

14 2013 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/.

37

 
HEALTH AND INDEPENDENCE

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. 

• $814,657,000 for three Nutrition Services programs (Congregate Nutrition Services, 

Home-Delivered Nutrition Services and the Nutrition Services Incentives Program), the 

same as the FY 2014 enacted level. Nutrition Services help over 2.3 million older adults 

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

FY 2015, these funds will support an estimated 208.7 million meals. 

• $19,848,000 for Preventive Health Services, the same as the FY 2014 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. 

• $8,000,000 for Chronic Disease Self-Management Education (CDSME), requested again 

for FY 2015 from the Prevention and Public Health Fund (PPHF) appropriated under the 

Affordable Care Act. This would continue funding at the FY 2014 enacted level. 

CDSME programs have proven effective in helping people to better self-manage their 

chronic conditions and reduce their need for more costly medical interventions. 

• $5,000,000 for Falls Prevention Programs, requested again for FY 2015 from the PPHF. 

This funding would be used to fund a national resource center and competitive grants to 

States, Tribes, and other applicants who have experience in evidence-based falls 

prevention programs. 

• $380,000,000 for the Senior Community Service Employment Program (SCSEP); a 

reduction of -$54,371,000 from the FY 2014 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 

and FY 2014 budget requests, the FY 2015 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.

38
HEALTH AND INDEPENDENCE

• $26,158,000 for Native American Nutrition and Supportive Services, the same as the 

FY 2014 enacted level. These funds will provide approximately 4.7 million meals and 

775,000 rides for Native American seniors to critical daily activities such as meal sites, 

medical appointments, and grocery stores.

• $7,461,000 for Aging Network Support Activities, the same as the FY 2014 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 in carrying

out their mission to help older people remain independent and live in their own homes 

and communities.

Outcome Table:

Measure Most Recent Result FY 2014

Target

FY 2015

Target

FY 2015

+/- FY 2014

2.10: Increase the likelihood that the 

most vulnerable people receiving 

Older Americans Act Home and 

Community-based and Caregiver 

Support Services will continue to live 

in their homes and communities. 

(Outcome)

FY 2012: 63%

Target: 62% 

(Target Exceeded)

62% 62.5% +0.5%

3.3: The % of OAA clients served who 

live in rural areas is at least 15% 

greater than the percent of all US 

elders who live in rural areas. 

(Outcome)

FY 2012: 36.87%

Target: 24.3% 

(Target Exceeded)

24.3% 26.2% +1.9%

3.4: Increase the number of States that 

serve more elderly living below the 

poverty level than the prior year.

FY 2012: 28

Target: 28

(Target Met)

Discontinued Discontinued N/A

3.6: The % of OAA clients served who 

live in poverty is at least 150% greater 

than the percent of all US elders who 

live below poverty.

FY 2012: 29.96%

(Baseline) 24.85% 24.85% Maintain

39
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Home and Community-Based Supportive Services

FY 2013 Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

Home and CommunityBased Supportive Services $347,724,000 $347,724,000 $347,724,000 --

Authorizing Legislation: Section 321 of the Older Americans Act of 1965, as amended

FY 2015 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 that, when tailored to 

the needs of the individual, ensures that clients can remain in their own homes and communities 

instead of entering nursing homes or other types of institutional care. 

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, 59 percent are unable to perform critical activities of daily living and 

require long-term support. Data also show that over 90 percent of seniors have at least one 

chronic condition and 75 percent have at least two.15 Providing a variety of supportive services 

that meet the diverse needs of these older individuals is crucial to enabling them to remain 

15 Centers for Medicare & Medicaid Services, The characteristics and perceptions of the Medicare population (2011) 

[data tables 2.5a, 2.6a]. http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS/Data-TablesItems/2011CharAndPerc.html . Accessed 25 July,2013.

41

 
HEALTH AND INDEPENDENCE

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 2012, the most recent available data, include: 

• Transportation Services provided 24.5 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 nearly 29 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 nearly 4 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:

• 69 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; 

• 13 percent have had a stroke;

• 5 percent have epilepsy; and 

• 3 percent have Parkinson’s disease. 

42
HEALTH AND INDEPENDENCE

Of the transportation participants, 95 percent take daily medications, with over 15 percent taking 

10 to 20 medications daily.16 Data from AoA’s National Surveys of OAA Participants show that 

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

they need to help them remain at home. For example, over half of seniors using transportation 

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

homebound, while over 85 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.17 

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.18

Funding History:

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

follows:

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 ...................................$347,724,000

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

Budget Request:

The FY 2015 request for Home and Community-Based Supportive Services is $347,724,000, the 

same as the FY 2014 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 

16 2013 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/.

17 2013 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/.

18 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.

43

 
HEALTH AND INDEPENDENCE

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 

children. The overall budget request will support 8 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 26.9 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 1.8 million seniors who live in institutional 

settings.19 Nationally, 25 percent of individuals 60 and older live alone20, and in FY 2015 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.21

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 2015 compared to FY 2012, 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. 

19 Centers for Medicare & Medicaid Services, The characteristics and perceptions of the Medicare population (2011) 

[data table 1.1]. http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS/Data-TablesItems/2011CharAndPerc.html . Accessed 25 July,2013.

20 Administration on Aging, agid.acl.gov. Data-at-a-Glance: American Community Survey (ACS) Public Use 

Microdata Sample (PUMS) 1-Year Files (2011), accessed August, 15, 2013. 21 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.

44

 
HEALTH AND INDEPENDENCE

Outputs and Outcomes Table:

Home and Community-Based Supportive Services Outputs and Outcomes

Measure Most Recent Result FY 2014

Target 

FY 2015

Target 

FY 2015 +/-

FY 2014

2.9b: Maintain at 90% or higher the 

percentage of transportation clients 

who rate services good to excellent

(Outcome)

FY 2012: 98.5%

Target: 90% 

(Target Exceeded)

90% 90% Maintain

2.11: Increase the percentage of 

transportation clients who live alone.

(Outcome)

FY 2012: 70%

Target: 70% 

(Target Met)

67% 67% Maintain

Indicator Most Recent Result FY 2014

Projection 

FY 2015

Projection 

FY 2015 +/-

FY 2014

Output C: Transportation Services

units (Output) FY 2012: 24.5 M 22 M 21.5 M - 0.5 M

Output D: Personal Care, Homemaker 

and Chore Services units (Output) FY 2012: 28.94 M 27.3 M 26.9 M - 0.4 M

Output E: Adult Day Care/Day Health 

units (Output) FY 2012: 8.0 M 8.0 M 8.0 M --

Output F: Case Management Services 

units (Output) FY 2012: 3.98 M 4.0 M 4.0 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 2013 Final FY 2014 

Enacted

FY 2015 

President’s 

Budget

Number of 

Awards 56 56 56

Average 

Award $6,172,606 $6,147,264 $6,147,264

Range of 

Awards

$216,042 -

$34,222,255

$215,155 -

$34,081,746

$215,155 -

$34,081,746

45
HEALTH AND INDEPENDENCE

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2015 DISCRETIONARY STATE FORMULA GRANTS

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

State/Territory

FY 2013

Final

FY 2014 

Enacted

FY 2015 

President’s 

Budget

FY 2015 +/-

FY 2014

Alabama........................................... 5,347,830 5,325,874 5,325,874 --

Alaska.............................................. 1,728,330 1,721,234 1,721,234 --

Arizona ............................................ 6,506,240 6,478,530 6,478,530 --

Arkansas.......................................... 3,464,888 3,450,663 3,450,663 --

California......................................... 34,222,255 34,081,746 34,081,746 --

Colorado .......................................... 4,111,937 4,095,054 4,095,054 --

Connecticut...................................... 4,358,913 4,341,017 4,341,017 --

Delaware.......................................... 1,728,330 1,721,234 1,721,234 --

District of Columbia ........................ 1,728,330 1,721,234 1,721,234 --

Florida ............................................. 25,001,310 24,898,663 24,898,663 --

Georgia ............................................ 7,827,657 7,795,519 7,795,519 --

Hawaii ............................................. 1,728,330 1,721,234 1,721,234 --

Idaho................................................ 1,728,330 1,721,234 1,721,234 --

Illinois.............................................. 14,375,088 14,316,068 14,316,068 --

Indiana ............................................. 6,855,949 6,827,801 6,827,801 --

Iowa ................................................. 4,216,933 4,199,620 4,199,620 --

Kansas ............................................. 3,397,503 3,383,554 3,383,554 --

Kentucky.......................................... 4,692,372 4,673,107 4,673,107 --

Louisiana ......................................... 4,746,436 4,726,948 4,726,948 --

Maine............................................... 1,728,330 1,721,234 1,721,234 --

Maryland.......................................... 5,797,027 5,773,227 5,773,227 --

Massachusetts.................................. 8,124,430 8,091,074 8,091,074 --

Michigan.......................................... 11,139,629 11,093,893 11,093,893 --

Minnesota ........................................ 5,442,946 5,420,599 5,420,599 --

Mississippi....................................... 3,238,958 3,225,660 3,225,660 --

Missouri........................................... 7,045,013 7,016,089 7,016,089 --

Montana........................................... 1,728,330 1,721,234 1,721,234 --

Nebraska.......................................... 2,271,269 2,261,944 2,261,944 --

Nevada............................................. 2,436,001 2,426,000 2,426,000 --

New Hampshire ............................... 1,728,330 1,721,234 1,721,234 --

46
HEALTH AND INDEPENDENCE

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

State/Territory

FY 2013

Final

FY 2014 

Enacted

FY 2015 

President’s 

Budget

FY 2015 +/-

FY 2014

New Jersey...................................... 10,157,125 10,115,423 10,115,423 --

New Mexico ................................... 2,044,878 2,036,483 2,036,483 --

New York ....................................... 24,032,984 23,934,312 23,934,312 --

North Carolina ................................ 9,272,300 9,234,231 9,234,231 --

North Dakota .................................. 1,728,330 1,721,234 1,721,234 --

Ohio................................................ 13,674,310 13,618,168 13,618,168 --

Oklahoma ....................................... 4,234,162 4,216,778 4,216,778 --

Oregon ............................................ 4,091,730 4,074,931 4,074,931 --

Pennsylvania................................... 17,695,572 17,622,920 17,622,920 --

Rhode Island................................... 1,728,330 1,721,234 1,721,234 --

South Carolina ................................ 4,742,125 4,722,656 4,722,656 --

South Dakota .................................. 1,728,330 1,721,234 1,721,234 --

Tennessee ....................................... 6,690,497 6,663,028 6,663,028 --

Texas .............................................. 20,116,440 20,033,849 20,033,849 --

Utah ................................................ 1,847,519 1,839,934 1,839,934 --

Vermont.......................................... 1,728,330 1,721,234 1,721,234 --

Virginia........................................... 7,738,845 7,751,887 7,751,887 --

Washington..................................... 6,383,529 6,357,321 6,357,321 --

West Virginia.................................. 2,744,933 2,733,663 2,733,663 --

Wisconsin ....................................... 6,324,483 6,298,516 6,298,516 --

Wyoming ........................................ 1,728,330 1,721,234 1,721,234 -- 

Subtotal, States............................... 338,924,306 337,532,792 337,532,792 --

American Samoa............................. 467,446 465,527 465,527 --

Guam .............................................. 864,165 860,617 860,617 --

Northern Mariana Islands............... 216,042 215,155 215,155 --

Puerto Rico ..................................... 4,329,829 4,312,052 4,312,052 --

Virgin Islands ................................. 864,165 860,617 860,617 --

Subtotal, States and Territories....... 345,665,953 344,246,760 344,246,760 --

Undistributed 22/............................ 2,058,047 3,477,240 3,477,240 --

TOTAL 347,724,000 347,724,000 347,724,000 --

22 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.

47

 
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Nutrition Services

FY 2013 Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

Congregate Nutrition....... $416,104,000 $438,191,000 $438,191,000 --

Home-Delivered Nutrition $205,489,000 $216,397,000 $216,397,000 --

Nutrition Services 

Incentive Program........... $146,718,000 $160,069,000 $160,069,000 --

Total........................... $768,311,000 $814,657,000 $814,657,000 --

Authorizing Legislation: Sections 311, 331, and 336 of the Older Americans Act of 1965, as 

amended

FY 2015 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 to the older Americans who 

congregate for social engagement and meaningful volunteer roles, which contributes to 

their 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 who themselves 

receive meals, helping them to maintain their own health and well-being.

49
HEALTH AND INDEPENDENCE

• Nutrition Services Incentive Program (Title III-A): Provides additional funding to States, 

Territories, and eligible Tribal Organizations that is used exclusively to purchase food

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 five Tribes elected to spend nearly $2.4 million on commodities, including $141,939

assessed by USDA as administrative expenses, in FY 2014. 

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.23 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, including 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. 

Multiple chronic diseases and conditions negatively affect quality of life, contribute to declines 

in functioning and the ability to remain in the community, adversely impact individuals’ health, 

and contribute to increased hospitalizations and health care costs.24 Many of the most common 

chronic conditions such as hypertension, heart disease, diabetes, and osteoporosis are related to 

23 Hung et al. Recent trends in chronic disease, impairment and disability among older adults in the United States. 

BMC Geriatrics. 2011. 11:47. 24 Lochner KA, Cox CS. Prevalence of Multiple Chronic Conditions among Medicare Beneficiaries, United States, 

2010. Prev Chronic Dis 2013; 10:120137. DOI http://dix.doi.org/10.5888/pcd10.12037

50

 
HEALTH AND INDEPENDENCE

nutrition as a primary prevention, risk reduction, or treatment modality. Medicare beneficiaries 

with multiple chronic conditions are the heaviest users of health care services. For example, the 

two-thirds of Medicare beneficiaries with 2 or more chronic conditions account for 93 percent of 

Medicare spending, and the one-third of Medicare beneficiaries with 4 or more chronic 

conditions account for almost three-fourths of Medicare spending.25

Because the prevalence of multiple chronic conditions is higher among congregate and homedelivered program participants than for the general Medicare population, the provision of healthy 

meals, access to lifestyle modification programs, and evidence-based advice such as nutrition 

education and counseling are important. Overall, 75 percent of Medicare beneficiaries had 2 or 

more chronic conditions26 and over 36 percent had 4 or more chronic conditions.27 Data from 

AoA’s National Survey of OAA Participants indicate that about 44 percent of congregate and 

63 percent of home-delivered participants have 6 to 15 illnesses and conditions. About 

30 percent of congregate and 52 percent of home-delivered participants take over 6 medications 

per day and some take as many as 30 medications.28 The congregate and home-delivered 

program participants are significantly less healthy than the general Medicare population and 

access to healthy meals is essential to their well-being. 

Prevalence for malnutrition or risk for malnutrition across the community- and facility-based 

care settings has varied based on factors used to determine malnutrition. A study applying 

similar criteria found the lowest prevalence (38 percent) among older adults in the community, 

compared to 91 percent in rehabilitation facilities, 86 percent in hospitals, and 67 percent in 

nursing homes.29 Data from AoA’s National Survey of OAA Participants indicate that about 

18 percent of congregate and 39 percent of home-delivered program participants stayed 

overnight in the hospital or a nursing home in the past year and thus might be at risk of 

malnutrition.30 Individuals transitioning between or among facility-based care settings and their 

homes are likely to be in poorer health and at higher risk for poor nutrition, and have an 

increased need for healthy home-delivered and congregate meals as well as nutrition education 

and counseling to aid recovery and decrease the risk of readmission.

Even if an older adult has not been hospitalized in the past year, the older adult participants 

served in the congregate and home-delivered nutrition programs demonstrate a greater need for 

healthy prepared meals, rather than simply access to food. Data from AoA’s National Survey of 

25 Id.

26 Centers for Medicare & Medicaid Services, The characteristics and perceptions of the Medicare population (2011) 

[data tables 2.6a]. http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS/Data-TablesItems/2011CharAndPerc.html Accessed 25 July, 2013. 27 Lochner KA, Cox CS. Prevalence of Multiple Chronic Conditions among Medicare Beneficiaries, United States, 

2010. Prev Chronic Dis 2013; 10:120137. DOI http://dix.doi.org/10.5888/pcd10.12037. 28 2013 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/.

29 Kaiser et al. JAGS 2010; 58: 1734-1738 30 2013 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/.

51

 
HEALTH AND INDEPENDENCE

OAA Participants indicate that about 17 percent of congregate and 59 percent of home-delivered 

participants indicate that they have 3 or more impairments in instrumental activities of daily 

living (IADLs), meaning that they are unable to shop for groceries and prepare meals for 

themselves. The data also indicate that about 51 percent of congregate and 81 percent of homedelivered participants need help in getting outside the house, thus limiting their ability to shop 

for food themselves.31 Although many of these older adults may rely on family and friends for 

assistance, about 49 percent of congregate and 54 percent of home-delivered participants live 

alone.32 Living alone is a risk factor for social isolation, poorer health, and nursing home 

placement.

Data from AoA’s National Survey of OAA Participants show that Nutrition Services are 

effectively helping older adults improve their nutritional intake and remain at home. For 

example, data indicate that 75 percent of congregate and 83 percent of home-delivered meal 

participants say they eat healthier meals due to the programs, and 68 percent of congregate and 

92 percent of home-delivered meal recipients say that the meals enable them to continue living in 

their homes.33 The extra support provided by these programs can help older adults avoid more 

costly institutional care. Using State Program Report data, made available on ACL’s data portal 

(www.agid.acl.gov), independent research has found that states that invest more in delivering 

meals (both Federal, state, and all other sources of funding) to older adults’ homes have lower 

rates of “low-care” seniors in nursing homes who have the functional capacity to live in a less 

care-intensive environment, after adjusting for several other factors.34 For every $25 per year per 

older adult that states spend on home-delivered meals, they reduce their percentage of low-care 

nursing home residents compared to the national average by 1 percent.35

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. Eighty-eight percent of home-delivered meal clients rate service as good to excellent 

(Outcome 2.9a). Also, the percentage of home-delivered meal recipients with severe disabilities 

(3+ ADL) was 43.5 percent in 2012 (Outcome 3.5). 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, 

in combination with state and local funding for nutrition, are helping seniors remain healthy and 

independent in their homes include:

31 Id. 32 Id. 33 Id. 34 Thomas, K & Mor, V. The relationship between Older Americans Act Title III State Expenditures & Prevalence 

of Low-Care Nursing Home Residents. Health Services Research. 12.3.12. 

http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12015/abstract 35 Id.

52

 
HEALTH AND INDEPENDENCE

• Home-Delivered Nutrition Services provided 137.4 million meals to over 

850,000 individuals in FY 2012 (Output G).

• Congregate Nutrition Services provided over 86.3 million meals to over 1.6 million 

seniors in a variety of community settings in FY 2012 (Output H).

Funding History:

Comparable funding for Nutrition Services during the past ten years is as follows:

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 ...................................$768,311,000

FY 2014 ...................................$814,657,000

Budget Request:

The FY 2015 request for Nutrition Services is $814,657,000, the same as the FY 2014 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 71 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 359,000 homedelivered meal recipients with severe disabilities who are projected to be served in FY 2015. 

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.

53
HEALTH AND INDEPENDENCE

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 2012, State and local funding comprised 

approximately 64 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 2015 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 Federal funds are reduced or do not keep up with inflation and 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.

54
HEALTH AND INDEPENDENCE

Outcomes and Outputs Table:

Nutrition Services Outcomes and Outputs

Measure Most Recent Result FY 2014

Target 

FY 2015

Target 

FY 2015 +/-

FY 2014

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 2012: 9,206

Target: 8,600

(Target Exceeded)

8,600 9,250 + 650

2.9a: Maintain at 90% or 

higher the percentage of 

home-delivered meal 

clients who rate services 

good to excellent. 

(Outcome)

FY 2012: 88% 

Target: 90%

(Target Not Met)

90% 90% Maintain

3.5: Increase the percentage 

of older persons with severe 

disabilities who receive 

home-delivered meals.

(Outcome)

FY 2012: 43.5%

Target: Baseline 44.3% 44.8% + 0.5%

Indicator Most Recent Result FY 2014

Projection 

FY 2015

Projection 

FY 2015 +/-

FY 2014

Output G: Number of 

Home-Delivered meals 

served (Output)

FY 2012: 137.4 M 130.9 M 128.4 M -2.5 M

Output H: Number of 

Congregate meals served

(Output)

FY 2012: 86.3 M 82.3 M 80.3 M -2.0 M

Outputs G& H: Total 

Number of Meals (Outputs) FY 2012: 223.7 M 213.2 M 208.7 M -4.5 M

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

Nutrition Services, however multiple performance outcomes are impacted by this program because ACL’s 

performance measures (efficiency, effective targeting, and client outcomes) assess network-wide performance in 

achieving current strategic objectives. 

55
HEALTH AND INDEPENDENCE

Grant Awards Tables:

Congregate Nutrition Programs Grant Awards

FY 2013 Final FY 2014 

Enacted

FY 2015 

President’s 

Budget

Number of 

Awards 56 56 56

Average 

Award $7,386,438 $7,746,591 $7,746,591

Range of 

Awards

$258,525 -

$39,623,562

$271,131 -

$43,228,051

$271,131 -

$43,228,051

Home-Delivered Nutrition Programs Grant Awards

FY 2013 Final FY 2014 

Enacted

FY 2015 

President’s 

Budget

Number of 

Awards 56 56 56

Average 

Award $3,647,723 $3,825,590 $3,825,590

Range of 

Awards

$127,670 -

$20,927,250

$133,896 -

$22,048,734

$133,896 -

$22,048,734

Nutrition Services Incentive Program Grant Awards

FY 2013 Final FY 2014 

Enacted

FY 2015 

President’s 

Budget

Number of 

Awards 309 309 309

Average 

Award36 $474,816 $518,023 $518,023

Range of 

Awards

$462 -

$14,534,734

$462 -

$15,449,628

$462 -

$15,449,628

36 If the 254 awards to Tribal organizations are excluded from the “average award” calculation, the average award to 

States, DC, and the territories is $2,546,417 in FY 2013 and $2,755,553 in FY 2014 and FY 2015.

56

 
HEALTH AND INDEPENDENCE

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2015 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Congregate Nutrition Services (CFDA 93.045)

State/Territory

FY 2013

Final

FY 2014 

Enacted

FY 2015 

President’s 

Budget

FY 2015 +/-

FY 2014

Alabama........................................... 6,068,408 6,511,955 6,511,955 --

Alaska.............................................. 2,068,203 2,169,045 2,169,045 --

Arizona ............................................ 8,135,056 8,895,789 8,895,789 --

Arkansas.......................................... 4,163,564 4,163,564 4,163,564 --

California......................................... 39,623,562 43,228,051 43,228,051 --

Colorado .......................................... 5,410,449 5,978,941 5,978,941 --

Connecticut...................................... 5,241,452 5,241,452 5,241,452 --

Delaware.......................................... 2,068,203 2,169,045 2,169,045 --

District of Columbia ........................ 2,068,203 2,169,045 2,169,045 --

Florida ............................................. 28,468,480 30,962,559 30,962,559 --

Georgia ............................................ 10,014,735 10,973,199 10,973,199 --

Hawaii ............................................. 2,068,203 2,169,045 2,169,045 --

Idaho................................................ 2,068,203 2,169,045 2,169,045 --

Illinois.............................................. 17,286,541 17,286,541 17,286,541 --

Indiana ............................................. 8,105,861 8,320,826 8,320,826 --

Iowa ................................................. 5,081,501 5,081,501 5,081,501 --

Kansas ............................................. 4,089,903 4,089,903 4,089,903 --

Kentucky.......................................... 5,570,252 5,791,780 5,791,780 --

Louisiana ......................................... 5,645,998 5,645,998 5,645,998 --

Maine............................................... 2,068,203 2,169,045 2,169,045 --

Maryland.......................................... 6,666,347 7,244,786 7,244,786 --

Massachusetts.................................. 9,780,267 9,780,267 9,780,267 --

Michigan.......................................... 12,926,499 13,524,083 13,524,083 --

Minnesota ........................................ 6,398,439 6,834,789 6,834,789 --

Mississippi....................................... 3,891,114 3,891,114 3,891,114 --

Missouri........................................... 8,467,047 8,467,047 8,467,047 --

Montana........................................... 2,068,203 2,169,045 2,169,045 --

Nebraska.......................................... 2,738,802 2,738,802 2,738,802 --

Nevada............................................. 3,109,985 3,420,814 3,420,814 --

New Hampshire ............................... 2,068,203 2,169,045 2,169,045 --

57
HEALTH AND INDEPENDENCE

PROGRAM/CFDA NUMBER: Congregate Nutrition Services (CFDA 93.045)

State/Territory

FY 2013

Final

FY 2014 

Enacted

FY 2015 

President’s 

Budget

FY 2015 +/-

FY 2014

New Jersey...................................... 12,190,488 12,190,488 12,190,488 --

New Mexico ................................... 2,511,415 2,727,494 2,727,494 --

New York ....................................... 28,963,855 28,963,855 28,963,855 --

North Carolina ................................ 11,542,567 12,616,135 12,616,135 --

North Dakota .................................. 2,068,203 2,169,045 2,169,045 --

Ohio................................................ 16,393,785 16,393,785 16,393,785 --

Oklahoma ....................................... 5,080,736 5,080,736 5,080,736 --

Oregon ............................................ 5,034,431 5,508,448 5,508,448 --

Pennsylvania................................... 21,279,716 21,279,716 21,279,716 --

Rhode Island................................... 2,068,203 2,169,045 2,169,045 --

South Carolina ................................ 5,968,512 6,522,158 6,522,158 --

South Dakota .................................. 2,068,203 2,169,045 2,169,045 --

Tennessee ....................................... 7,942,564 8,608,241 8,608,241 --

Texas .............................................. 24,742,235 27,060,605 27,060,605 --

Utah ................................................ 2,332,537 2,556,342 2,556,342 --

Vermont.......................................... 2,068,203 2,169,045 2,169,045 --

Virginia........................................... 9,237,708 10,058,787 10,058,787 --

Washington..................................... 7,951,293 8,686,777 8,686,777 --

West Virginia.................................. 3,305,947 3,305,947 3,305,947 --

Wisconsin ....................................... 7,586,993 7,687,478 7,687,478 --

Wyoming ........................................ 2,068,203 2,169,045 2,169,045 --

Subtotal, States............................... 405,835,683 425,518,338 425,518,338 --

American Samoa............................. 594,843 594,843 594,843 --

Guam .............................................. 1,034,101 1,084,523 1,084,523 --

Northern Mariana Islands............... 258,525 271,131 271,131 --

Puerto Rico ..................................... 4,883,248 5,255,732 5,255,732 --

Virgin Islands ................................. 1,034,101 1,084,523 1,084,523 --

Subtotal, States and Territories....... 413,640,501 433,809,090 433,809,090 --

Undistributed 37/............................ 2,463,499 4,381,910 4,381,910 --

TOTAL................................. 416,104,000 438,191,000 438,191,000 --

37 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.

58

 
HEALTH AND INDEPENDENCE

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2015 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Home-Delivered Nutrition Services (CFDA 93.045)

State/Territory

FY 2013

Final

FY 2014 

Enacted

FY 2015 

President’s 

Budget

FY 2015 +/-

FY 2014

Alabama........................................... 3,177,759 3,321,462 3,321,462 --

Alaska.............................................. 1,021,362 1,071,165 1,071,165 --

Arizona ............................................ 4,296,544 4,537,352 4,537,352 --

Arkansas.......................................... 1,995,550 2,068,715 2,068,715 --

California......................................... 20,927,250 22,048,734 22,048,734 --

Colorado .......................................... 2,857,538 3,049,595 3,049,595 --

Connecticut...................................... 2,402,675 2,498,252 2,498,252 --

Delaware.......................................... 1,021,362 1,071,165 1,071,165 --

District of Columbia ........................ 1,021,362 1,071,165 1,071,165 --

Florida ............................................. 15,035,675 15,792,643 15,792,643 --

Georgia ............................................ 5,289,299 5,596,948 5,596,948 --

Hawaii ............................................. 1,021,362 1,071,165 1,071,165 --

Idaho................................................ 1,021,362 1,071,165 1,071,165 --

Illinois.............................................. 7,751,933 8,082,580 8,082,580 --

Indiana ............................................. 4,062,628 4,244,089 4,244,089 --

Iowa ................................................. 2,105,057 2,193,513 2,193,513 --

Kansas ............................................. 1,788,240 1,863,836 1,863,836 --

Kentucky.......................................... 2,830,077 2,954,133 2,954,133 --

Louisiana ......................................... 2,744,355 2,872,528 2,872,528 --

Maine............................................... 1,028,376 1,081,160 1,081,160 --

Maryland.......................................... 3,520,842 3,695,248 3,695,248 --

Massachusetts.................................. 4,339,413 4,540,013 4,540,013 --

Michigan.......................................... 6,584,877 6,898,042 6,898,042 --

Minnesota ........................................ 3,309,491 3,486,126 3,486,126 --

Mississippi....................................... 1,841,271 1,925,602 1,925,602 --

Missouri........................................... 3,986,638 4,155,738 4,155,738 --

Montana........................................... 1,021,362 1,071,165 1,071,165 --

Nebraska.......................................... 1,165,501 1,217,228 1,217,228 --

Nevada............................................. 1,642,544 1,744,807 1,744,807 --

New Hampshire ............................... 1,021,362 1,071,165 1,071,165 --

59
HEALTH AND INDEPENDENCE

PROGRAM/CFDA NUMBER: Home-Delivered Nutrition Services (CFDA 93.045)

State/Territory

FY 2013

Final

FY 2014 

Enacted

FY 2015 

President’s 

Budget

FY 2015 +/-

FY 2014

New Jersey...................................... 5,650,333 5,884,229 5,884,229 --

New Mexico ................................... 1,326,408 1,391,175 1,391,175 --

New York ....................................... 12,498,399 13,027,753 13,027,753 --

North Carolina ................................ 6,096,226 6,434,937 6,434,937 --

North Dakota .................................. 1,021,362 1,071,165 1,071,165 --

Ohio................................................ 7,783,568 8,110,984 8,110,984 --

Oklahoma ....................................... 2,418,704 2,514,252 2,514,252 --

Oregon ............................................ 2,658,943 2,809,618 2,809,618 --

Pennsylvania................................... 9,152,573 9,517,980 9,517,980 --

Rhode Island................................... 1,021,362 1,071,165 1,071,165 --

South Carolina ................................ 3,152,280 3,326,667 3,326,667 --

South Dakota .................................. 1,021,362 1,071,165 1,071,165 --

Tennessee ....................................... 4,194,879 4,390,687 4,390,687 --

Texas .............................................. 13,067,653 13,802,428 13,802,428 --

Utah ................................................ 1,231,933 1,303,878 1,303,878 --

Vermont.......................................... 1,021,362 1,071,165 1,071,165 --

Virginia........................................... 4,878,911 5,130,546 5,130,546 --

Washington..................................... 4,199,488 4,430,744 4,430,744 --

West Virginia.................................. 1,431,503 1,491,504 1,491,504 --

Wisconsin ....................................... 3,726,193 3,921,045 3,921,045 --

Wyoming ........................................ 1,021,362 1,071,165 1,071,165 --

Subtotal, States............................... 200,407,871 210,210,751 210,210,751 --

American Samoa............................. 136,498 136,498 136,498 --

Guam .............................................. 510,681 535,583 535,583 --

Northern Mariana Islands............... 127,670 133,896 133,896 --

Puerto Rico ..................................... 2,579,096 2,680,719 2,680,719 --

Virgin Islands ................................. 510,681 535,583 535,583 --

Subtotal, States and Territories....... 204,272,497 214,233,030 214,233,030 --

Undistributed 38/............................ 1,216,503 2,163,970 2,163,970 --

TOTAL................................... 205,489,000 216,397,000 216,397,000 --

38 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.

60

 
HEALTH AND INDEPENDENCE

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2015 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Nutrition Services Incentive Program (CFDA 93.053)

State/Territory

FY 2013

Final

FY 2014 

Enacted

FY 2015 

President’s 

Budget

FY 2015 +/-

FY 2014

Alabama .......................................... 2,717,066 2,888,092 2,888,092 --

Alaska ............................................. 361,153 383,886 383,886 --

Arizona............................................ 1,852,626 1,969,240 1,969,240 --

Arkansas.......................................... 2,469,995 2,625,469 2,625,469 --

California ........................................ 11,778,198 12,519,580 12,519,580 --

Colorado.......................................... 1,257,978 1,337,162 1,337,162 --

Connecticut ..................................... 1,353,616 1,439,662 1,439,662 --

Delaware ......................................... 636,764 690,524 690,524 --

District of Columbia........................ 448,777 477,025 477,025 --

Florida............................................. 6,247,984 6,641,265 6,641,265 --

Georgia............................................ 2,584,490 2,747,171 2,747,171 --

Hawaii............................................. 449,797 478,109 478,109 --

Idaho ............................................... 686,740 731,746 731,746 --

Illinois............................................. 6,040,150 6,420,348 6,420,348 --

Indiana............................................. 1,713,783 1,821,658 1,821,658 --

Iowa ................................................ 1,853,368 1,970,028 1,970,028 --

Kansas............................................. 2,096,178 2,245,929 2,245,929 --

Kentucky......................................... 1,613,303 1,714,852 1,714,852 --

Louisiana......................................... 3,037,339 3,228,525 3,228,525 --

Maine .............................................. 562,507 597,914 597,914 --

Maryland......................................... 1,507,170 1,602,040 1,602,040 --

Massachusetts ................................. 5,582,108 6,038,694 6,038,694 --

Michigan ......................................... 6,758,859 7,184,297 7,184,297 --

Minnesota........................................ 1,723,958 1,832,473 1,832,473 --

Mississippi ...................................... 1,385,842 1,473,074 1,473,074 --

Missouri .......................................... 3,926,098 4,173,227 4,173,227 --

Montana .......................................... 1,113,135 1,204,909 1,204,909 --

Nebraska ......................................... 1,111,943 1,181,935 1,181,935 --

Nevada ............................................ 993,966 1,061,830 1,061,830 --

New Hampshire............................... 1,075,409 1,143,101 1,143,101 --

61
HEALTH AND INDEPENDENCE

PROGRAM/CFDA NUMBER: Nutrition Services Incentive Program (CFDA 93.053)

State/Territory

FY 2013

Final

FY 2014 

Enacted

FY 2015 

President’s 

Budget

FY 2015 +/-

FY 2014

New Jersey ..................................... 3,470,661 3,689,123 3,689,123 --

New Mexico ................................... 1,878,920 1,997,189 1,997,189 --

New York ....................................... 14,534,734 15,449,628 15,449,628 --

North Carolina................................ 3,147,453 3,345,570 3,345,570 --

North Dakota .................................. 756,288 803,892 803,892 --

Ohio................................................ 5,179,861 5,505,909 5,505,909 --

Oklahoma ....................................... 2,130,135 2,264,217 2,264,217 --

Oregon............................................ 1,665,493 1,770,327 1,770,327 --

Pennsylvania................................... 5,452,243 5,795,436 5,795,436 --

Rhode Island................................... 411,542 437,447 437,447 --

South Carolina................................ 1,518,521 1,614,105 1,614,105 --

South Dakota .................................. 851,097 904,670 904,670 --

Tennessee ....................................... 1,521,882 1,617,677 1,617,677 --

Texas.............................................. 10,766,639 11,444,347 11,444,347 --

Utah................................................ 1,254,473 1,333,436 1,333,436 --

Vermont.......................................... 749,547 796,727 796,727 --

Virginia........................................... 2,062,772 2,192,614 2,192,614 --

Washington..................................... 1,973,427 2,097,645 2,097,645 --

West Virginia ................................. 1,562,065 1,660,389 1,660,389 --

Wisconsin....................................... 2,550,472 2,711,012 2,711,012 --

Wyoming........................................ 766,328 814,564 814,564 --

Subtotal, States............................... 138,783,700 148,069,689 148,069,689 --

American Samoa ............................ -- -- -- --

Guam.............................................. 309,967 329,478 329,478 --

Northern Mariana Islands............... 43,406 46,139 46,139 --

Puerto Rico..................................... 2,747,118 2,920,036 2,920,036 --

Virgin Islands................................. 178,800 190,054 190,054 --

Subtotal, States and Territories....... 142,062,991 151,555,396 151,555,396 --

Tribal Organizations........................ 3,283,410 3,505,490 3,505,490 --

Undistributed 39/............................. 1,371,599 1,603,890 1,603,890 --

TOTAL................................. 146,718,000 160,069,000 160,069,000 --

39 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.

62

 
Preventive Health Services

FY 2013 

Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

Preventive Health Services $19,849,000 $19,848,000 $19,848,000 --

Authorizing Legislation: Section 361 of the Older Americans Act of 1965, as amended

FY 2015 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. These funds 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 funding gives States and 

Territories flexibility to allocate resources among preventive health activities to best meet local 

needs. Priority has been given to providing services to those elders living in medically 

underserved areas of their state or who have the greatest economic need.

Due in large part to advances in public health and medical care; Americans are leading longer 

and more active lives. Average life expectancy has increased from less than 50 years at the turn 

of the 20th century to over 78 years today. On average, an American turning age 65 today can 

expect to live an additional 19.1 years.40 The population of older Americans is also growing, 

particularly the population age 85 and over, which is growing very rapidly, totaling 5.9 million in 

2012 and projected to reach 8.9 million by the year 2030.41 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.

40 National Centers for Health Statistics, Health U.S., 2012: With Special Feature on Emergency Care. Table 18. 

Hyattsville, MD 2013.

41 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.

63

 
HEALTH AND INDEPENDENCE

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 was included in the FY 2014 appropriation 

and is also proposed for FY 2015. Since evidence-based programs have demonstrated their 

effectiveness, AoA expects that States will be 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 Supportive 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. 

Examples of evidence-based interventions include:

• 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.

• 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 

cardiovascular problems and unnecessary duplication of prescriptions. These programs 

have also been shown to improve medication usage rates and decrease medication errors 

among older adults.

64
HEALTH AND INDEPENDENCE

Funding History:

Funding for Preventive Health Services during the past five years is as follows:

FY 2010 .................................................$21,026,000

FY 2011 .................................................$20,984,000

FY 2012 .................................................$20,944,000

FY 2013 .................................................$19,849,000

FY 2014 .................................................$19,848,000

Budget Request:

The FY 2015 budget request for Preventive Health Services is $19,848,000, the same as the 

FY 2014 enacted level. AoA continues to request appropriations language that was included by 

Congress for FY 2012, and again for FY 2014, 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, ACL has invested in 

an Aging and Disability Evidence-Based Program and Practices (ADEPP) review process that 

consists of a rigorous review of evidence-based interventions involving two panels of 

independent expert reviewers. One set of reviewers assess and rate the quality of research; the 

other reviewers rate the program on readiness for dissemination. Intervention summaries are 

made available on ACL’s website at (http://www.acl.gov/Programs/CDAP/OPE/ADEPP.aspx) 

and a link to the page is one resource on the Title IIID webpage. ADEPP is one way that ACL is 

working to improve access to information on evaluated interventions and reduce the lag time 

between the creation of scientific knowledge and its practical application in the field.

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.42 Grantees 

can use the Title IIID Highest-Tier Criteria Evidence-Based Disease Prevention and Health 

Promotion Programs Cost Chart43 on the site to search the 45+ highest-level criteria programs 

listed.

42 http://www.aoa.gov/AoARoot/AoA_Programs/HPW/Title_IIID/index.aspx

43 http://www.ncoa.org/improve-health/center-for-healthy-aging/content-library/Title-IIID-Highest-Tier-EvidenceFINAL.pdf

65

 
HEALTH AND INDEPENDENCE

Underscoring the need for these programs, the 2013 National Survey of Older Americans Act 

Participants found that between 72 and 90 percent of clients across OAA services take three or 

more different prescription medications every day. In addition, between 17 and 38 percent of 

clients across OAA services reported having stayed 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.44

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 

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 2014

Projection 

FY 2015

Projection 

FY 2015

+/- FY 2014

Output AB: The number of people served with 

health and disease prevention programs 

(Output)

N/A

(baseline set in 

FY 2013)

N/A N/A TBD

Grant Awards Tables:

Preventive Health Services Grant Awards

FY 2013 Final FY 2014 

Enacted

FY 2015 

President’s 

Budget

Number of 

Awards 56 56 56

Average 

Award $352,345 $350,884 $350,884

Range of 

Awards

$12,332 -

$2,000,744

$12,281 -

$1,992,449

$12,281 -

$1,992,449

44 2013 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/.

66

 
HEALTH AND INDEPENDENCE

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2015 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Preventive Health Services (CFDA 93.043)

State/Territory

FY 2013

Final

FY 2014 

Enacted

FY 2015 

President’s 

Budget

FY 2015 +/-

FY 2014

Alabama .......................................... 312,653 311,357 311,357 --

Alaska ............................................. 98,657 98,248 98,248 --

Arizona............................................ 380,319 378,742 378,742 --

Arkansas.......................................... 198,557 197,733 197,733 --

California ........................................ 2,000,744 1,992,449 1,992,449 --

Colorado.......................................... 240,398 239,401 239,401 --

Connecticut ..................................... 245,092 244,076 244,076 --

Delaware ......................................... 98,657 98,248 98,248 --

District of Columbia........................ 98,657 98,248 98,248 --

Florida............................................. 1,461,664 1,455,604 1,455,604 --

Georgia............................................ 457,632 455,734 455,734 --

Hawaii............................................. 98,657 98,248 98,248 --

Idaho ............................................... 98,657 98,248 98,248 --

Illinois............................................. 789,367 786,094 786,094 --

Indiana............................................. 400,823 399,161 399,161 --

Iowa ................................................ 217,951 217,047 217,047 --

Kansas............................................. 179,893 179,147 179,147 --

Kentucky......................................... 274,333 273,195 273,195 --

Louisiana......................................... 277,493 276,343 276,343 --

Maine .............................................. 98,847 98,437 98,437 --

Maryland......................................... 338,915 337,509 337,509 --

Massachusetts ................................. 436,805 434,993 434,993 --

Michigan ......................................... 651,262 648,562 648,562 --

Minnesota........................................ 318,214 316,895 316,895 --

Mississippi ...................................... 184,167 183,404 183,404 --

Missouri .......................................... 397,190 395,543 395,543 --

Montana .......................................... 98,657 98,248 98,248 --

Nebraska ......................................... 117,210 116,724 116,724 --

Nevada ............................................ 142,417 141,827 141,827 --

New Hampshire............................... 98,657 98,248 98,248 --

67
HEALTH AND INDEPENDENCE

PROGRAM/CFDA NUMBER: Preventive Health Services (CFDA 93.043)

State/Territory

FY 2013

Final

FY 2014 

Enacted

FY 2015 

President’s 

Budget

FY 2015 +/-

FY 2014

New Jersey ..................................... 582,711 580,295 580,295 --

New Mexico ................................... 119,550 119,055 119,055 --

New York ....................................... 1,291,839 1,286,483 1,286,483 --

North Carolina................................ 542,091 539,844 539,844 --

North Dakota .................................. 98,657 98,248 98,248 --

Ohio................................................ 784,410 781,158 781,158 --

Oklahoma ....................................... 241,578 240,576 240,576 --

Oregon............................................ 239,217 238,225 238,225 --

Pennsylvania................................... 955,835 951,872 951,872 --

Rhode Island................................... 98,657 98,248 98,248 --

South Carolina................................ 277,242 276,092 276,092 --

South Dakota .................................. 98,657 98,248 98,248 --

Tennessee ....................................... 391,150 389,528 389,528 --

Texas .............................................. 1,176,078 1,171,202 1,171,202 --

Utah ................................................ 108,013 107,565 107,565 --

Vermont.......................................... 98,657 98,248 98,248 --

Virginia........................................... 455,071 453,184 453,184 --

Washington..................................... 373,204 371,656 371,656 --

West Virginia ................................. 143,708 143,112 143,112 --

Wisconsin ....................................... 367,345 365,822 365,822 --

Wyoming........................................ 98,657 98,248 98,248 --

Subtotal, States............................... 19,354,872 19,274,622 19,274,622 --

American Samoa ............................ 12,332 12,281 12,281 --

Guam.............................................. 49,328 49,124 49,124 --

Northern Mariana Islands............... 12,332 12,281 12,281 --

Puerto Rico..................................... 253,137 252,088 252,088 --

Virgin Islands................................. 49,328 49,124 49,124 --

Subtotal, States and Territories....... 19,731,329 19,649,520 19,649,520 --

Undistributed45 ............................... 117,671 198,480 198,480 --

TOTAL................................. 19,849,000 19,848,000 19,848,000 --

45 The undistributed line reflects the amount reserved from the Preventive Health 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.

68

 
Chronic Disease Self-Management Education

FY 2013 Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

CDSME............... $7,086,000 $8,000,000 $8,000,000 --

Note: Funding in FY 2013 and FY 2014 was provided from the Prevention and Public Health Fund, and FY 2015 

funding is requested again from that source.

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 2015 Public Health Service Act Authorization...............................................................Expired

Allocation Method .............................Competitive Grants/Cooperative Agreements and Contracts

Program Description and Accomplishments:

Chronic Disease Self-Management Education (CDSME) programs, such as the Stanford 

University Chronic Disease Self-Management Program (CDSMP), are low-cost, evidencebased prevention models that use state-of-the-art techniques to help those with chronic 

conditions address issues related to the management and treatment of their condition, build 

self-confidence, improve their health status, and reduce their need for more costly medical 

care. In addition to the CDSMP, which is appropriate for any type of chronic condition, 

there are other proven CDSME programs, including the Spanish CDSMP, the Diabetes SelfManagement Program (DSMP), Spanish DSMP, Chronic Pain Self-Management Program, 

Positive Self-Management Program for HIV, Arthritis Self-Management Program, and 

online versions of the CDSMP and DSMP.

In the United States, over 75 percent of older adults have multiple (2 or more) chronic 

conditions,46 placing them at greater risk for premature death, poor functional status, 

unnecessary hospitalizations, adverse drug events, and nursing home placement. 47 Chronic 

46 Centers for Medicare & Medicaid Services, The characteristics and perceptions of the Medicare population (2011) 

[data tables 1.1]. http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS/Data-TablesItems/2011CharAndPerc.html Accessed 25 July, 2013.

47 Vogeli C, Shields AE, Lee TA, Gibson TB, Marder WD, Weiss KB, Blumenthal D. Multiple chronic

conditions: prevalence, health consequences, and implications for quality, care management, and costs. J 

Gen Intern Med 2007;22(Suppl 3):391–395. http://www. ncbi.nlm.nih. gov/pmc/ articles/PMC2150598/; 

69

 
HEALTH AND INDEPENDENCE

conditions also impact health care costs: 93 percent of Medicare expenditures are for 

beneficiaries with chronic conditions. 48

CDSME programs have been shown repeatedly, through multiple studies (including randomized 

control experiments, with both English and Spanish speaking populations), to be effective at 

helping participants adopt healthy behaviors, and improve their psychological and physical 

health status. 49 Some evidence suggests that CDSME programs may also significantly reduce 

the use of hospital care and physician services and reduce health care costs.50

CDSMEs emphasize an individual’s role in managing his/her illness. The in-person programs 

consist of a series of workshops that are conducted once a week for two and a half hours over six 

to seven weeks in health care and community settings such as hospitals, 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 trained leaders. One or both of the leaders are non-health 

professionals or lay people with chronic diseases themselves. Core topics covered include: 

techniques to deal with problems such as frustration, fatigue, pain and isolation; appropriate 

exercise for maintaining and improving strength, flexibility, and endurance; appropriate use of 

medications; communicating effectively with health professionals; and 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 up to three years. In 

FY 2010, AoA funded 47 state grants for CDSME programs for a two year project period, using 

funding provided under the Recovery Act. AoA also funded a Resource Center through a grant to 

the National Council on Aging. Competitive grants and contracts are also used to support 

evaluation and related activities.

The Recovery Act grants concluded in March 2013. As of April 2013, over 101,000 people had 

completed CDSME courses across the country, well exceeding the programmatic goal to reach 

50,000 completers within two years from the award date. 

A new round of grants, funded in FY 2012 through the Prevention and Public Health Fund 

(PPHF), provided grants to 22 states to continue these activities. These three-year grants will 

allow states to provide CDSME programs to approximately 80,000 adults to help them better 

48 Nawrocki J. CMS Provides Data on Care for Chronic Conditions to Find Better Care Models. NetNews. April 2, 2013 

http://health.wolterskluwerlb.com/2013/04/cms-provides-data-on-care-for-chronic-conditions-to-help-find-bettercare-models/

49 Brady TJ, Murphy L, O’Colmain BJ, Beauchesne D, Daniels B, Greenberg M, et al. A Meta-Analysis of Health 

Status, Health Behaviors, and Health Care Utilization Outcomes of the Chronic Disease Self-Management Program. 

Prev Chronic Dis 2013;10:120112. http://dx.doi.org/10.5888/pcd10.120112

50 Sobel, DS, Lorig,KR, Hobbs,M. Chronic Disease Self-Management Program: From Development to 

Dissemination. Permanente Journal; Spring 2002.

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HEALTH AND INDEPENDENCE

manage chronic conditions. The funding is not only increasing access to CDSME programs but 

also fostering the development of comprehensive, integrated delivery systems to embed and 

sustain these programs within the long-term supports and services and health care systems. 

Funding History:

FY 2010 ..................................................................51

FY 2011 .................................................................$0

FY 2012 .................................................$10,000,000

FY 2013 ...................................................$7,086,000

FY 2014 ...................................................$8,000,000

Budget Request:

AoA requests FY 2015 funding totaling $8,000,000 for CDSME from the Prevention and Public 

Health Fund, the same as the FY 2014 enacted level. The Prevention and Public Health Fund 

(ACA 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 programs, by emphasizing an individual’s 

role in managing his/her illness, help participants to reduce their pain and depression, improve 

mobility and exercise, increase energy, and boost confidence in their ability to manage their 

conditions. 52 A recent national study indicated that the program can also help participants 

achieve better care, better health, and lower health care costs. Participants reported significant 

improvements in aspects of their care (communication with their physicians, medication 

compliance, and health literacy), better health outcomes (self-assessed health, depression and 

quality of life), and reduced health care utilization (lower emergency room visits and 

hospitalizations), resulting in estimated potential cost savings.53 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.

51 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. 52 Brady, TJ, Murphy, L: Sorting through the Evidence: Executive Summary of Arthritis Self-Management Program 

and the Chronic Disease Self-Management Program Meta-Analyses, May 2011, Centers for Disease Control and 

Prevention. http://www.cdc.gov/arthritis/docs/ASMP-executive-summary.pdf

53 Whitelaw, N., Lorig, K., Smith, M. L., & Ory, M. G. (March 19, 2013). National Study of Chronic Disease SelfManagement Programs (CDSMP). Retrieved May 3, 2013 from http://www.ncoa.org/improve-health/center-forhealthy-aging/content-library/CDSMP_Grantee_Webinar_03_19_2013_ALL_FINAL.pdf

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HEALTH AND INDEPENDENCE

Older Americans are disproportionately affected by a vast array of chronic diseases and 

conditions. For example, nearly 11 million adults over the age of 65 have diabetes.54 Minority 

elders – the fastest growing segment of the elderly population – are especially at risk of chronic 

illnesses and conditions. CDSME programs are having a significant reach and impact on these 

populations. In FY 2012 alone, 22,809 individuals with chronic conditions completed the 

CDSME program through AoA’s network (Output CD1). Nearly 61 percent of participants 

reporting relevant data indicate having multiple chronic conditions, with the most common 

conditions being hypertension (43.7 percent), arthritis (41.1 percent), and diabetes (31.2 percent). 

Over one-third of the participants are minority elders, including 23 percent African-Americans 

and over 16 percent Hispanics. 

CDSME programs are also especially well-suited for delivery through AoA’s network of 

community based organizations, including senior centers, congregate meal programs, faith-based 

organizations and senior housing projects. At the community level, aging services provider

organizations work in collaboration with public health agencies and health care providers. 

Participant referrals to the CDSME program come from both clinical and community-based 

organizations. Clinical referrals come from community-health centers, physicians, hospitals, 

managed care organizations, and other health system components. Community referrals come 

from a variety of sources, including the Aging and Disability Resource Centers. 

Continued funds will support competitive grants to States, as well as related technical assistance 

and evaluation activities such as a contract for an online database quality assurance system and 

technical assistance on building the business acumen of states and local agencies to help them 

sustain their CDSME programs and continued funding for a National Resource Center on 

Chronic Disease Self-Management Education 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. 

54Centers for Disease Control and Prevention. National Diabetes Fact Sheet. 

http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf,Accessed May 4, 2013.

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HEALTH AND INDEPENDENCE

Grant Awards Table:

Chronic Disease Self-Management Education Grant Awards

FY 2013 Final FY 2014 

Enacted

FY 2015 

President’s 

Budget

Number of 

Awards 23 23 23

Average 

Award $297,102 $325,425 $325,425

Range of 

Awards

$140,000 -

$790,000

$140,000 -

$1,000,000

$140,000 -

$1,000,000

Outputs and Outcomes Table:

Measure Most Recent Result FY 2014

Target 

FY 2015 

Target 

FY 2015 +/- FY 

2014

CD2: Increase the percentage of 

individuals who complete the 

CDSME program (Outcome)

FY 2012: 74% 

(Target: Baseline) 74% 75% + 1%

Indicator Most Recent Result FY 2014 

Projection 

FY 2015

Projection 

FY 2015

+/- FY 2014 

Output CD1: Total number of 

individuals with chronic 

conditions completing the 

CDSME program (Output)

FY 2012: 22,809 20,000 20,000 Maintain

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HEALTH AND INDEPENDENCE

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 the fall of 2011 for 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 was completed during the summer of 2013 and the final 

report is available on the AoA website at: 

http://www.aoa.gov/AoARoot/Program_Results/Program_Evaluation.aspx. The results of the 

work with CMS are expected to be completed during the fall of 2013.

Resource and Program Data:

Chronic Disease Self-Management Education

(Dollars in Thousands)

FY 2013 FY 2014 FY 2015

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary 1 790 -- -- 22 6,485

Continuations 22 6,043 23 7,485 1 1,000

Contracts 1 100 1 310 1 310

Interagency Agreements -- -- -- -- -- --

Program Support 1/ 153 205 205

Total Resources 7,086 8,000 8,000

1/ Program Support -- Includes funds for grant systems and review, salaries and overhead, and information 

technology support costs.

74
Falls Prevention

FY 2013

Final

FY 2014

Enacted

FY 2015

President’s Budget

FY 2015 +/-

FY 2014

Falls Prevention............... -- $5,000,000 $5,000,000 --

Note: Funding in FY 2014 was provided from the Prevention and Public Health Fund, and FY 2015 funding is 

requested again from that source.

Authorizing Legislation: Section 411 of the Older Americans Act of 1965, as amended, and the 

Patient Protection and Affordable Care Act (ACA), Section 4002 [42 U.S.C. 300u-11]

Allocation Method .............................Competitive Grants/Cooperative Agreements and Contracts 

Program Description and Accomplishments:

Falls are the leading cause of both fatal and nonfatal injuries for those 65 and over. 55 One in 

three adults aged 65 and older falls each year. 56 In 2010, fall-related injuries resulted in 

2.3 million emergency room visits, over 660,000 hospitalizations, about 21,700 deaths, and an 

estimated $30 billion in direct medical costs. 57 Of those who fall, 20 to 30 percent will 

experience serious injuries, such as brain trauma, broken bones, or hip fractures. 58 The average 

hospital stay for a hip fracture is one week and about one-third of those with hip fractures stay in 

a nursing home for a year or more. 59 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. 60 Many people limit their activity after a fall, which 

may reduce strength, physical fitness, and mobility.61 The importance of preventing falls is 

underscored by the inclusion of falls prevention screening in the annual Medicare wellness visit.

55 Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web–based 

Injury Statistics Query and Reporting System (WISQARS) [online]. Accessed August 15, 2013.

56 Tromp AM, Pluijm SMF, Smit JH, et al. Fall-risk screening test: a prospective study on predictors for falls in 

community-dwelling elderly. J Clin Epidemiol 2001;54(8):837–844.

57 Centers for Disease Control and Prevention, Falls Among Older Adults: An Overview. Retrieved on February 5, 

2014 from http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html

58 Stevens JA. Fatalities and injuries from falls among older adults – United States, 1993–2003 and 2001–2005. 

MMWR 2006b;55.45:1222–24.

59 Centers for Disease Control and Prevention, Hip Fractures Among Older Adults: An Overview. Retrieved on 

February 5, 2014 from http://www.cdc.gov/HomeandRecreationalSafety/Falls/adulthipfx.html 60 Bell AJ, Talbot-Stern JK, Hennessy A. Characteristics and outcomes of older patients presenting to the 

emergency department after a fall: a retrospective analysis. Medical Journal of Australia 2000;173(4):176–7.

61 Vellas BJ, Wayne SJ, Romero LJ, Baumgartner RN, Garry PJ. Fear of falling and restriction of mobility in 

elderly fallers. Age and Ageing 1997;26:189–193.

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HEALTH AND INDEPENDENCE

Falls can result in significant loss of independence and often trigger the onset of a series of 

growing needs. For those over age 75, fallers are more than four times more likely to be admitted 

to a skilled nursing facility62. And falls, even without a major injury, can cause an older adult to 

become fearful or depressed, making it difficult for them to stay active, which in turn increases 

the need for assistance.

Falls prevention programs help participants to achieve improved strength, balance, and mobility

and provide education on how to avoid falls and reduce fall risk factors. These programs may 

also involve medication reviews and modifications; provide referrals for medical care 

management for selected fall risk factors; and provide home hazard assessments of ways to 

reduce environmental hazards. Since 2006, more than 27,000 older adults in 38 states have been 

served via AoA-supported Falls Prevention/Management programs, including A Matter of 

Balance, Stepping On, and Tai Chi: Moving for Better Balance. 

Randomized controlled trials of several community-based Falls Prevention/Management 

programs have clearly demonstrated a reduction in falls. When compared with control groups, 

the risk of falling for participants in the Tai Chi: Moving for Better Balance intervention was 

decreased 55 percent;

63 and the Stepping On program reduction was 31 percent.64 Matter of 

Balance is an evidence-based program designed to reduce the fear of falling and increase activity 

levels among older adults. Research has shown significant improvements for participants 

regarding their level of falls management (the degree of confidence participants perceive 

concerning their ability to manage the risk of falls and of actual falls); falls control (the degree to 

which participants perceive their ability to prevent falls); level of exercise; and social limitations 

with regard to concern about falling.65 Matter of Balance participation has been associated with 

total medical cost savings, and cost savings in the unplanned inpatient, skilled nursing facility, 

and home health settings. Participation was associated with a $938 decrease in total medical 

costs per year. This finding was driven by a $517 reduction in unplanned hospitalization costs, a 

$234 reduction in skilled nursing facility costs, and an $81 reduction in home health costs.66

62 Donald IP, Bulpitt CJ. The prognosis of falls in elderly people living at home. Age and Ageing 1999;28:121–5 63 Fuzhong L, Harmer P, Fisher JK, Mcauley E. Tai Chi: Improving Functional Balance and Predicting Subsequent 

Falls in Older Persons. Med Sci Sports Exerc. (2004) 36 (12): 2046-2052. 64 Clemson L, Cumming RG, Kendig H, Swann M, Heard R, Taylor K. The Effectiveness of a Community-Based 

Program for Reducing the Incidence of Falls in the Elderly: A Randomized Trial. J Am Geriatr Soc. (Sept 2004) 52 

(9): 1487–1494. 65 Healy, T.C., Peng, C., Haynes, P., McMahon, E., Botler, J., & Gross, L. (2008). The feasibility and effectiveness 

of translating A Matter of Balance into a volunteer lay leader model. Journal of Applied Gerontology, 27(1): 34-51.

66 http://innovation.cms.gov/Files/reports/CommunityWellnessRTC.pdf

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HEALTH AND INDEPENDENCE

Funding History:

FY 2010 .....................................................$0

FY 2011 .....................................................$0

FY 2012 .....................................................$0

FY 2013 .....................................................$0

FY 2014 .......................................$5,000,000

Budget Request:

ACL is requesting $5,000,000 from the Prevention and Public Health Fund in FY 2015, the same 

as the FY 2014 enacted level. Since FY 2014 was the first year of funding and the funding 

opportunity announcement has not yet been issued at the time of this writing, programmatic 

decisions have not been finalized. However, we anticipate that the funds may be used to fund a 

national resource center and competitive grants to States, Tribes, and/or other applicants to 

implement evidence-based falls prevention programs through ACL’s network of communitybased provider organizations.

State and/or tribal grants might be used to: 

• Promote and disseminate fall prevention tools to support patient assessment and referral, 

and the use of evidence-based community programs;

• Better integrate health care and state/local health department activities in the delivery of 

fall prevention services in collaboration with the aging services network; 

• Provide, expand and sustain evidence-based community-based programs and community 

change strategies that reduce falls and falls risks;

• Utilize and expand the local evidence-based program infrastructure for falls 

prevention/management programs started in the AoA Evidence-Based Disease and 

Disability Prevention Program;

• Promote Community Integrated Health Care Systems and capitalize on opportunities 

within the Affordable Care Act, including Care Transitions programs to reduce hospital 

readmissions due to falls, and the annual Medicare wellness visits that include screening 

for falls prevention and referrals to community-based interventions to address modifiable 

risk factors; 

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HEALTH AND INDEPENDENCE

Grantees may be expected to implement at least one evidence-based falls 

prevention/management program; establish partnerships/coalitions with Falls Prevention 

coalitions, healthcare providers, public health officials, and ADRCs; and cooperate with federal 

research efforts. Funds may also be used to fund a falls prevention resource center which will 

promote best practices for development, implementation, and sustainability of falls 

prevention/management programs. 

Grant Awards Table:

Falls Prevention Program Grant Awards

FY 2013 Final FY 2014 

Enacted

FY 2015 

President’s 

Budget

Number of 

Awards -- 16 16

Average 

Award -- $297,563 $297,563

Range of 

Awards -- $200,000 -$450,000

$200,000 -

$450,000

Resource and Program Data:

Falls Prevention

(Dollars in Thousands)

FY 2013 FY 2014 FY 2015

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary -- -- 16 4,761 15 4,361

Continuations -- -- -- -- 1 400

Contracts -- -- 1 197 1 197

Interagency Agreements -- -- -- -- -- --

Program Support 1/ -- 42 42

Total Resources -- 5,000 5,000

1/ Program Support -- Includes funds for grant systems and review, salaries and overhead, and information 

technology support costs.

78
Senior Community Service Employment Program

FY 2013 Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014 PB

SCSEP................. $424,805,000 $434,371,000 $380,000,000 -$54,371,000

FTE................... 10 10 10 --

Authorizing Legislation: Section 502 of the Older Americans Act of 1965, as amended

FY 2015 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 is below 125 percent 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 (DOL) but is proposed for transfer to ACL in FY 2015.

In addition to wages and benefits, SCSEP provides the following programmatic services to 

participants: 

• Orientation and assessments;

• Supportive services;

• Participant training (e.g., on the job or in a classroom setting); and

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HEALTH AND INDEPENDENCE

• 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 that 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 also 

reserved for 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 provided input and suggestions related to priorities 

and targeting. 

In general, 75 percent of Federal funds for 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. 

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HEALTH AND INDEPENDENCE

Funding History

Funding for the Senior Community Service Employment Program at the Department of Labor 

during the past five years is as follows:

FY 2010 ...................................$825,425,00067

FY 2011 ..................................$449,100,000

FY 2012 ...................................$448,251,000

FY 2013 ...................................$424,805,000

FY 2014 ...................................$434,371,000

Budget Request

The FY 2015 request for SCSEP is $380,000,000, a reduction of -$54,371,000 from the FY 2014 

enacted level. 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 of its top 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.

In order to continue operations at this reduced level, ACL proposes to re-structure SCSEP solely 

as a community service program. In years past, SCSEP has been administered alongside the 

programs associated with the 1998 Workforce Investment Act (WIA), which provides the 

framework for a national workforce preparation and employment system designed to meet both 

the needs of the nation’s businesses and the needs of job seekers and those who want to further 

their careers. SCSEP has not fit well within this context, as older workers involved in the 

program were typically not looking to advance their career but rather to simply supplement their 

income during their retirement years. The older SCSEP worker is not looking to build a resume 

but rather to increase his or her income and contribute to the community. 

67 Includes a one-time special appropriation of $225,000,000 to serve low-income seniors affected by the recession.

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HEALTH AND INDEPENDENCE

Under ACL administration, emphasis would shift to integration with other OAA services, 

providing additional benefits to older people as well creating opportunities for them to become 

contributing members to local communities, aging services programs and the Aging Services 

Network as a whole. For example, seniors hired through the SCSEP program to provide 

assistance to older adults residing in public housing could also take part in Title IIIC nutrition 

programs or IIID exercise programs at their job site in addition to their supportive employment. 

In addition, new opportunities for seniors to assist other seniors are likely to arise when SCSEP 

is aligned with the Aging Services Network infrastructure and support system. The Department 

of Labor reports that currently nearly 1/3 of SCSEP employees are housed with public agencies 

with many of these in public libraries. Many others are in non-profit organizations serving as 

receptionists, security personnel and custodians.

In line with OAA requirements, Aging Network entities administering the SCSEP program 

would have the opportunity to directly target those in greatest need, both as SCSEP employees as 

well as through SCSEP placements in programs serving minorities or other underserved 

populations. ACL would also make improving program performance a priority. This would 

include targeting SCSEP to people with the greatest need. In this way, the program’s eligibility, 

income and other requirements could become better aligned with those of other HHS income 

maintenance programs. Additionally, ACL anticipates taking a close look at the balance of 

funding between state and national SCSEP grantees and targeting these limited funds to the areas 

where performance data indicate the potential for the largest impact.

ACL does not propose to undertake this reduction in SCSEP funding lightly. The proposed 

transfer of SCSEP to ACL provides a rare opportunity to assess the underlying structure of a 

program and to make changes that will not only improve program performance, but that will also 

improve targeting while making unfortunate but necessary funding reductions in light of the

extremely tight budget environment. 

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HEALTH AND INDEPENDENCE

Outcome Table

Measure Most Recent 

Result 

PY 2014

Projection 

PY 2015

Projection 

FY 2015

+/- FY 2014

Output 1.1: Average earnings in the second and 

third quarters after exit (Outcome)

PY 2012: 

$7,181 $7,564 TBD TBD

Output 1.3: Percent of participants employed in 

the first quarter after exit (Outcome)

PY 2012: 

41.7% 43.9% 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 2012: 

73.3% 73.4% TBD TBD

Note: 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.

83
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Native American Nutrition and Supportive Services

FY 2013 

Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

Native American Nutrition 

& Supportive Services...... $26,157,000 $26,158,000 $26,158,000 --

Authorizing Legislation: Sections 201, 613, and 623 of the Older Americans Act of 1965, as 

amended

FY 2015 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 

2011 American Community Survey, approximately 301,000 persons age 60 and over identified 

themselves as Native Americans or Alaskan Natives, and another 242,000 persons age 60 and 

over identified themselves as Native American or Alaskan Native 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.

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HEALTH AND INDEPENDENCE

Services provided by this program in FY 2012, the most recent year for which data are available, 

include:

• Transportation Services, which provided 712,509 rides to meal sites, medical 

appointments, pharmacies, grocery stores, and other critical daily activities (Output L).

• Home-Delivered Nutrition Services, under which 2.65 million meals were provided to 

22,287 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 nearly 2.38 million meals to 

49,511 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 917,810 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.

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HEALTH AND INDEPENDENCE

Funding History:

Funding for Native American Nutrition and Supportive Services during the past five years is as 

follows:

FY 2010 .................................................$27,704,000

FY 2011 .................................................$27,653,000

FY 2012 .................................................$27,601,000

FY 2013 .................................................$26,157,000

FY 2014 .................................................$26,158,000

Budget Request:

The FY 2015 request for Native American Nutrition and Supportive Services is $26,158,000, the 

same as the FY 2014 enacted level.

Native American Nutrition and Supportive Services, like the same services that Home and 

Community-Based Supportive Services 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 2015 request level, these services will provide 774,500 rides (Output L), 2.4 million 

meals at home (Output M), and 2.3 million meals at congregate sites (Output N) to 

approximately 77,600 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 2015 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.

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HEALTH AND INDEPENDENCE

Outcome and Outputs Table:

Native American Nutrition & Supportive Services Outcome and Outputs

Measure Most Recent Result FY 2014

Target 

FY 2015

Target 

FY 2015

+/- FY 2014

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 2012: 297

Target: 300

(Target Not Met)

300 300 Maintain

Indicator Most Recent Result FY 2014 

Projection 

FY 2015 

Projection 

FY 2015

+/- FY 2014

Output L: Transportation Services units

(Output) FY 2012: 712,509 784,000 774,500 -9,500

Output M: Home-Delivered Nutrition 

meals (Output) FY 2012: 2.65 M 2.4 M 2.4 M --

Output N: Congregate Nutrition meals

(Output) FY 2012: 2.38 M 2.26 M 2.265 M +5,000

Output O: Information, Referral and 

Outreach units (Output) FY 2012: 917,810 900,000 900,000 --

Grant Awards Table:

Native American Nutrition & Supportive Services Grant Awards

FY 2013 Final FY 2014 

Enacted

FY 2015 

President’s 

Budget

Number of 

Awards 256 256 256

Average 

Award $100,686 $100,016 $100,016

Range of 

Awards

$72,220 -

$1,505,000

$73,650 -

$1,505,000

$73,650 -

$1,505,000

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HEALTH AND INDEPENDENCE

Resource and Program Data:

Native American Nutrition and Supportive Services

(Dollars in Thousands)

FY 2013 FY 2014 FY 2015

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula 256 25,776 256 25,604 256 25,604

New Discretionary -- -- 1 150 -- --

Continuations -- -- -- -- 1 150

Contracts 1 366 1 366 1 366

Interagency Agreements -- -- -- -- -- --

Program Support 1/ 15 38 38

Total Resources 26,157 26,158 26,158

1/ Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and 

review, salaries and overhead, and information technology support costs.

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Aging Network Support Activities

FY 2013 Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014 PB

Aging Network 

Support Activities $7,432,000 $7,461,000 $7,461,000 --

Authorizing Legislation: Section 201, 202, 215, and 411 of the Older Americans Act of 1965, as 

amended

FY 2015 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 five 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 

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HEALTH AND INDEPENDENCE

toll-free nationwide telephone line (800-677-1116) or website (http://www.eldercare.gov). 

The phone line and website both connect those in need to providers in every zip code in the 

nation. The Eldercare Locator website continues to grow as a resource tool for older adults 

and their caregivers, serving 738,234 individuals in FY 2013.

ACL also continues to support civic engagement efforts that help connect older adults with 

volunteer opportunities in their communities. In FY 2011, AoA launched the Aging Network’s 

Volunteer Collaborative, which will help the aging network more effectively use and expand 

the number of volunteers. The Collaborative is a partnership of a number of aging 

organizations and the Corporation for National and Community Service. It has assessed needs 

and barriers to volunteering; offers technical assistance through workshops and webinars; 

developed a robust website; and awarded small incentive grants. It also developed a 

partnership with LexisNexis to reduce the cost for volunteer background checks.

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, 2013, the National Alzheimer’s Call Center handled over 

294,000 calls through its national and local partners, and its on-line message board 

community recorded over 5.2 million page views. 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 ongoing 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 

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HEALTH AND INDEPENDENCE

currently funds six regional counseling projects covering 29 States. Data for the program 

shows that:

• Pension Counseling projects have successfully recovered over $175 million in client 

benefits, representing a return of more than eight dollars for every Federal dollar 

invested in the program.

• Projects have directly served over 50,000 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 provides 

women with access to a one-stop gateway that integrates financial information and resources 

on retirement planning for health and long-term care. This project has made user-friendly 

financial education and retirement planning tools available to traditionally hard-to-reach 

women, including 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 published in hard copy and Web-based formats. Since its establishment 1998, the 

Center has conducted approximately 200 workshops per year on strategies to access financial 

and retirement planning information for women. It has developed and published over 175 Fact 

Sheets tailored to the specific needs of hard-to-reach women and maintains an interactive web 

site.

National Resource Centers on Native American Elders

The National Resource Centers on Native American Elders enhance knowledge about older 

Native Americans and thereby 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 

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HEALTH AND INDEPENDENCE

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 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.

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, a referral database of Chronic Disease Self-Management 

(CDSME) workshops, and culturally appropriate caregiver manual/toolkit for American 

Indian and Alaskan Native caregivers caring for elders with dementia.

LGBT elders also 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 2015, 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.

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HEALTH AND INDEPENDENCE

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HEALTH AND INDEPENDENCE

Program Performance and Technical Assistance

This activity supports cooperative efforts between AoA and selected States and AAAs to 

develop tools, performance measures, and best practices that can be used to effectively and 

efficiently identify the results produced through OAA programs on an ongoing basis. It also 

supports partnerships with National Aging Organizations to foster innovation and provide 

technical assistance to States, AAAs, and Tribal organizations in strategic planning, program 

development, and performance improvement.

Funding History:

Comparable funding for Aging Network Support Activities is as follows:

FY 2010 ...................................................$8,198,000

FY 2011 ...................................................$8,184,000

FY 2012 ...................................................$7,873,000

FY 2013 ...................................................$7,432,000

FY 2014 ...................................................$7,461,000

Budget Request:

The FY 2015 request for Aging Network Support Activities is $7,461,000, the same as the 

FY 2014 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. 

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HEALTH AND INDEPENDENCE

Aging Network Support Activities includes funding for the following projects (dollars in 

thousands): 

Activity

FY 2013

Final

FY 2014

Enacted

FY 2015 

President’s 

Budget

Aging Network Support Activities:

National Eldercare Locator and Engagement........................................ $2,030 $2,038 $2,038

National Alzheimer's Call Center.......................................................... 942 945 945

National Education & Resource Center on Women & Retirement....... 234 235 235

Pension Information and Counseling Program ..................................... 1,617 1,623 1,623

National Resource Centers on Native Americans................................. 652 655 655

National Minority Aging Organizations............................................... 1,161 1,165 1,165

Program Performance and Technical Assistance .................................. 796 799 799

Total, Aging Network Support Activities...................................... $7,432 $7,461 $7,461

Grant Awards Table:

Aging Network Support Grant Awards

FY 2013 Final FY 2014 

Enacted

FY 2015 

President’s 

Budget

Number of 

Awards 24 25 25

Average 

Award $303,542 $274,731 $285,720

Range of 

Awards

$104,516 -

$1,121,518

$104,516 -

$1,121,518

$104,516 -

$1,121,518

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HEALTH AND INDEPENDENCE

Resource and Program Data:

Aging Network Support Activities

(Dollars in thousands)

FY 2013 FY 2014 FY 2015

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary 18 5,329 7 1,046 7 1,603

Continuations 6 1,956 19 6,097 18 5,540

Contracts -- -- 1 25 1 25

Interagency Agreements 1 10 2 47 2 47

Program Support 1/ 137 246 246

Total Resources 7,432 7,461 7,461

1/ Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and 

review, and information technology support costs.

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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.68 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).69

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.70 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.71

At the same time, ACL recognizes that it must also address the growing need for more caregivers 

every day. By 2020, it is projected that there will be 16.2 million non-institutionalized seniors 

age 65 and over with 1+ ADL deficits, an increase of four million seniors (or a 35 percent 

68 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

69 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

70 Schulz R, Beach SR. Caregiving as a risk factor for mortality. The Caregiver Health Effects study. JAMA 

December 15, 1999;282:2215-9. 71 2013 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/.

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CAREGIVER SERVICES

between 2011 and 2020) needing caregiver assistance.72 To address these caregiver-related 

needs, ACL requests a total of $168,277,000, the same as the FY 2014 enacted level. The 

request includes:

• $145,586,000 for Family Caregiver Support Services, the same as the FY 2014 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.

• $6,031,000 for Native American Caregiver Support Services, the same as the FY 2014 

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.

• $3,800,000 for Alzheimer’s Disease Supportive Services, the same as the FY 2014 

enacted level. This program focuses 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. For FY 2015, these funds are requested from amounts 

provided under section 241 of the Public Health Service Act.

• $10,500,000 for services to individuals with Alzheimer’s Disease (AD) and their families 

under the President’s Alzheimer’s Initiative, funded from the Prevention and Public 

Health Fund. The same amount is available from the Prevention Fund in FY 

2014. 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.

72 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 and Centers for Medicare & Medicaid Services, The characteristics and perceptions of 

the Medicare population (2011) [data table 2.5a]. http://www.cms.gov/Research-Statistics-Data-andSystems/Research/MCBS/Data-Tables-Items/2011CharAndPerc.html . Accessed 25 July,2013. 

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CAREGIVER SERVICES

• $2,360,000 for Lifespan Respite Care, the same as the FY 2014 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. For FY 2015, these funds 

are requested from amounts provided under section 241 of the Public Health Service Act.

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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Family Caregiver Support Services

FY 2013 Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

Family Caregiver 

Support Services $145,586,000 $145,586,000 $145,586,000 --

Authorizing Legislation: Section 371 of the Older Americans Act of 1965, as amended

FY 2015 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 to 

provide a coordinated set of supports which caregivers can access on behalf of seniors. 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 1.1 million contacts to caregivers assisting 

them in locating services from a variety of public and private agencies (Output I).

• Counseling and Training Services provided 138,427 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 69,000 caregivers with 6.3 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 

personal care and homemaking to more complex health-related interventions like medication 

administration and wound care. AARP estimated the economic cost of replacing unpaid 

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CAREGIVER SERVICES

caregiving in 2009 to be about $450 billion (the cost if that care had to be replaced with paid 

services).73 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 2013 National Survey of OAA Participants, 19 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-seven percent describe 

their own health as fair to poor.74 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.75

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 78 percent of 

caregivers of program clients reported in 2013 that services enabled them to provide care longer 

than otherwise would have been possible.76 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-one 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). 

73 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 74 2013 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/. 75 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. 76 2013 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/.

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CAREGIVER SERVICES

(based on responses from care recipients unable to live independently) 77

Funding History:

Funding for Family Caregiver Support Services during the past five years is as follows:

FY 2010 ...............................................$154,197,000

FY 2011 ...............................................$153,912,000

FY 2012 ...............................................$153,621,000

FY 2013 ...............................................$145,586,000

FY 2014 ...............................................$145,586,000

77 2013 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/.

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CAREGIVER SERVICES

Budget Request:

The FY 2015 request for Family Caregiver Support Services is $145,586,000, the same as the 

FY 2014 enacted level. With this proposed funding, 790,000 caregivers (Outcome 3.1) will be 

provided with supportive services, including respite care or temporary relief from their 

caregiving responsibilities. 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 78 percent of 

caregivers report these supportive services enable them to provide care longer.

In FY 2015, AoA expects the aging services network to meet or exceed the target of only 

27 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 2012 that rate had been reduced by nearly

60 percent to 26 percent of caregivers reporting difficulty getting services.

For FY 2015, 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 2015

compared to FY 2012. Declines are projected to be largely attributable to declining leveraged 

funds, as State, local, and private budgets face economic hardships.

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CAREGIVER SERVICES

Outcomes and Outputs Table:

Family Caregiver Support Services Outcomes and Outputs

Measure Most Recent Result FY 2014 

Target 

FY 2015

Target 

FY 2015

+/- FY 2014

Outcome 2.6: Reduce the percent of 

caregivers who participate in the 

National Family Caregiver Support 

Program who report difficulty in 

getting services. (Outcome)

FY 2012: 26%

Target: 28%

(Target Exceeded)

28% 27% - 1.0%

Outcome 2.9c: Maintain at 90% or 

higher the percentage of National 

Family Caregiver Support Program 

clients who rate services good to 

excellent. (Outcome)

FY 2012: 93.8%

Target: 90%

(Target Exceeded)

90% 90% Maintain

Outcome 3.1: Increase the number of 

caregivers served through the National 

Family Caregiver Support Program.

(Outcome)

FY 2012: 867,546

Target: 792,000

(Target Exceeded)

790,000 790,000 Maintain

Indicator Most Recent Result FY 2014

Projection 

FY 2015

Projection

FY 2015

+/- FY 2014

Output I: Caregivers access assistance 

units of service. (Output) FY 2012: 1,131,781 1.05 M 1.04 M - 10,000

Output J: Caregivers receiving 

counseling and training. (Output) FY 2012: 138,427 121,000 118,000 - 3,000

Output K: Caregivers receiving respite 

care services. (Output) FY 2012: 68,995 65,900 66,100 + 200

Note: 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 2013 Final FY 2014 

Enacted

FY 2015 

President’s 

Budget

Number of 

Awards 56 56 56

Average 

Award $2,584,357 $2,573,753 $2,573,753

Range of 

Awards

$90,453 -

$14,711,105

$90,081 -

$14,702,604

$90,081 -

$14,702,604

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CAREGIVER SERVICES

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION ON AGING

FY 2015 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Family Caregivers Support Services (CFDA 93.052)

State/Territory

FY 2013

Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

Alabama......................................... 2,220,390 2,206,505 2,206,505 --

Alaska ............................................ 723,620 720,651 720,651 --

Arizona .......................................... 3,063,358 3,103,554 3,103,554 --

Arkansas ........................................ 1,423,632 1,408,847 1,408,847 --

California ....................................... 14,711,105 14,702,604 14,702,604 --

Colorado ........................................ 1,856,698 1,878,721 1,878,721 --

Connecticut.................................... 1,749,484 1,721,520 1,721,520 --

Delaware........................................ 723,620 720,651 720,651 --

District of Columbia ...................... 723,620 720,651 720,651 --

Florida............................................ 11,527,293 11,546,017 11,546,017 --

Georgia .......................................... 3,418,391 3,455,065 3,455,065 --

Hawaii............................................ 723,620 720,651 720,651 --

Idaho .............................................. 723,620 720,651 720,651 --

Illinois............................................ 5,540,545 5,472,900 5,472,900 --

Indiana ........................................... 2,878,077 2,849,523 2,849,523 --

Iowa ............................................... 1,607,487 1,577,341 1,577,341 --

Kansas............................................ 1,320,014 1,295,632 1,295,632 --

Kentucky........................................ 1,950,378 1,935,102 1,935,102 --

Louisiana ....................................... 1,887,778 1,874,587 1,874,587 --

Maine ............................................. 723,620 720,651 720,651 --

Maryland........................................ 2,398,426 2,396,329 2,396,329 --

Massachusetts................................ 3,135,868 3,099,001 3,099,001 --

Michigan........................................ 4,652,840 4,618,195 4,618,195 --

Minnesota ...................................... 2,390,107 2,374,116 2,374,116 --

Mississippi..................................... 1,286,333 1,281,036 1,281,036 --

Missouri......................................... 2,877,048 2,850,250 2,850,250 --

Montana ......................................... 723,620 720,651 720,651 --

Nebraska ........................................ 871,922 855,735 855,735 --

Nevada ........................................... 1,064,959 1,087,045 1,087,045 --

New Hampshire ............................. 723,620 720,651 720,651 --

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CAREGIVER SERVICES

State/Territory

FY 2013

Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

New Jersey................................. 4,097,131 4,044,765 4,044,765 --

New Mexico............................... 909,221 908,751 908,751 --

New York .................................. 9,063,268 8,956,618 8,956,618 --

North Carolina ........................... 4,166,899 4,195,336 4,195,336 --

North Dakota ............................. 723,620 720,651 720,651 --

Ohio ........................................... 5,629,924 5,551,309 5,551,309 --

Oklahoma................................... 1,722,263 1,703,328 1,703,328 --

Oregon ....................................... 1,820,218 1,820,805 1,820,805 --

Pennsylvania.............................. 6,876,661 6,751,748 6,751,748 --

Rhode Island .............................. 723,620 720,651 720,651 --

South Carolina ........................... 2,104,546 2,125,724 2,125,724 --

South Dakota ............................. 723,620 720,651 720,651 --

Tennessee................................... 2,866,541 2,863,391 2,863,391 --

Texas.......................................... 8,808,631 8,842,879 8,842,879 --

Utah ........................................... 852,599 853,564 853,564 --

Vermont..................................... 723,620 720,651 720,651 --

Virginia...................................... 3,290,920 3,301,214 3,301,214 --

Washington................................ 2,807,974 2,808,735 2,808,735 --

West Virginia............................. 1,008,212 997,669 997,669 --

Wisconsin .................................. 2,709,247 2,688,849 2,688,849 --

Wyoming ................................... 723,620 720,651 720,651 --

Subtotal, States .......................... 141,973,448 141,372,773 141,372,773 --

American Samoa........................ 90,453 90,081 90,081 --

Guam ......................................... 361,810 360,325 360,325 --

Northern Marianas Islands......... 90,453 90,081 90,081 --

Puerto Rico ................................ 1,846,036 1,856,555 1,856,555 --

Virgin Islands............................. 361,810 360,325 360,325 --

Subtotal, States and Territories.. 144,724,010 144,130,140 144,130,140 --

Undistributed78 861,990 1,455,860 1,455,860 --

TOTAL 145,586,000 145,586,000 145,586,000 --

78 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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Native American Caregiver Support Services

FY 2013 Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

Native American Caregiver 

Support Services............... $6,031,000 $6,031,000 $6,031,000 --

Authorizing Legislation: Section 631 of the Older Americans Act of 1965, as amended

FY 2015 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 the Native American Nutrition and Supportive 

Services program to receive funding. There is no requirement for matching funds. Tribes may 

also decide the age at which a member is considered an elder and thus eligible for services. In 

addition, there is no limit on the percentage of funds that can be used for services to grandparents 

caring for grandchildren.

Grants assist American Indian, Alaskan Native and Native Hawaiian families caring for older 

relatives with chronic illness or disability and grandparents caring for grandchildren. The 

program provides a variety of direct services that meet a range of caregiver needs, including 

information and outreach, access assistance, individual counseling, support groups and training, 

respite care, and other supplemental services. Tribal organizations coordinate with other 

programs, 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. 

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CAREGIVER SERVICES

Rather, as expressed by multiple Tribal leaders, the program provides support that strengthens the 

family caregiver role. 

Funding History:

Funding for Native American Caregiver Support Services during the past five years is as follows:

FY 2010 ...................................................$6,388,000

FY 2011 ...................................................$6,376,000

FY 2012 ...................................................$6,364,000

FY 2013 ...................................................$6,031,000

FY 2014 ...................................................$6,031,000

Budget Request:

The FY 2015 request for Native American Caregiver Support Services is $6,031,000, the same 

as the FY 2014 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 2015 are expected to decline due to the economic downturn impacting Tribal government 

budgets.

In FY 2015 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 2015 more 

than 320,000 units of caregiver-related services including respite care, information and referral, 

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CAREGIVER SERVICES

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 2014

Target 

FY 2015

Target

FY 2015

+/- FY 2014

Outcome 3.1: Increase the number of 

caregivers served through the National 

Family Caregiver Support Program.

(Outcome)

FY 2012: 867,546

Target: 792,000

(Target Exceeded)

790,000 790,000 Maintain

Grant Awards Table: Native American Caregivers Supportive Services Grant Awards

FY 2013 Final FY 2014 

Enacted

FY 2015 

President’s 

Budget

Number of 

Awards 218 218 218

Average 

Award $27,663 $27,663 $27,663

Range of 

Awards

$13,360 -

$54,689

$13,360 -

$54,740

$13,360 -

$54,740

Resource and Program Data: Native American Caregiver Support Services (Dollars in 

thousands)

FY 2013 FY 2014 FY 2015

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula 218 6,031 218 6,031 218 6,031

New Discretionary -- -- -- -- -- --

Continuations -- -- -- -- -- --

Contracts -- -- -- -- -- --

Interagency Agreements -- -- -- -- -- --

Program Support 1/ -- -- --

Total Resources 6,031 6,031 6,031

1/ Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and 

review, and information technology support costs.

114
Alzheimer’s Disease Supportive Services Program

FY 2013 Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

ADSSP.............. $3,786,000 $3,800,000 $3,800,000 --

Note: For FY 2015, these funds are requested from amounts under section 241 of the Public Health Service Act

Authorizing Legislation: Section 398 of the Public Health Services Act, as amended

FY 2015 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. The statute governing the ADSSP requires that States “expend not less than 50 

percent of the federal grant funds for the provision of (direct) services” to individuals with

Alzheimer’s disease or related dementias, their families and their caregivers.

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 (LTSS) system.

AoA presently supports 18 state grantees through this program. Eleven States continue to

translate eight evidence-based interventions into practice and 4 States are offering innovative 

programming for caregivers and their loved ones with dementia. Additionally, nine states are 

funded to design systems to ensure access to dementia capable home and community based 

services.

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CAREGIVER SERVICES

One example of an evidence-based intervention is the New York University Caregiver 

Intervention, a spousal caregiver support program that in a randomized-control trial delayed 

institutionalization of persons with dementia by an average of 557 days.79 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’ LTSS systems 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 2010 .................................................$11,462,000

FY 2011 .................................................$11,441,000

FY 2012 ...................................................$4,010,000

FY 2013 ...................................................$3,786,000

FY 2014 ...................................................$3.800,000

Budget Request:

The FY 2015 request for the Alzheimer’s Disease Supportive Services Program is $3,800,000, 

the same as the FY 2014 enacted level. For FY 2015, these funds are requested from amounts 

provided under section 241 of the Public Health Service Act. 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 

unable to undertake subsequent translations of research funded by National Institute on Aging, 

Centers for Disease Control and Prevention, and other science agencies. The need for cutting 

79 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.

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CAREGIVER SERVICES

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 about 5 million individuals have this disease. 80

The FY 2015 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. 

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. 81

By the end of the first quarter of FY 2014, 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 projects that it will have an analysis of the evaluations 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.

80 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

81 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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CAREGIVER SERVICES

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 2013 Final FY 2014 

Enacted

FY 2015 

President’s 

Budget

Number of 

Awards 5 10 10

Average 

Award $619,700 $285,100 $285,100

Range of 

Awards

$480,379 -

$748,660

$250,000-

$450,000

$250,000-

$450,000

82 Cumulative count began in 2008. 83 Cumulative count began in 2008.

Measure Most Recent Result FY 2014

Target 

FY 2015

Target 

FY 2015

+/- FY 2014

Outcome ALZ2. Increase number 

of individuals served with 

evidence-based interventions –

cumulative82 (Outcome)

FY 2012: 14,600

Target: 8,800 

(Target Exceeded)

19,000 21,500 + 2,500

Indicator Most Recent Result FY 2014

Projection 

FY 2015

Projection 

FY 2015

+/- FY 2014

Output AC: Number of 

individuals served – cumulative83

(Output)

FY 2012: 32,377 42,000 44,000 + 2,000

Output AD: Percent of 

individuals served that are of a 

racial/ethnic minority (Output)

FY 2012: 25% 21% 21% --

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CAREGIVER SERVICES

Resource and Program Data:

Alzheimer’s Disease Supportive Services Program

(Dollars in thousands)

FY 2013 FY 2014 FY 2015

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary 5 3,099 10 2,851 10 2,851

Continuations -- -- -- -- -- -- 

Contracts 1 604 1 791 1 791

Interagency Agreements -- -- -- -- -- --

Program Support 1/ 83 158 158

Total Resources 3,786 3,800 3,800

1/ Program Support -- Includes funds for Public Health Service Act statutory requirements, grant systems and 

review costs.

119
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Alzheimer’s Disease Initiative - Services

FY 2013 Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

Alzheimer’s Disease 

Initiative – Services 

(Prevention Fund)

-- $10,500,000 $10,500,000 --

Note: Funding in FY 2014 was provided from the Prevention and Public Health Fund, and FY 2015 funding is 

requested again from that source.

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 2015 Public Health Service Act Authorization...............................................................Expired

Allocation Method ............................Competitive Grants/Co-operative Agreements and Contracts

Program Description and Accomplishments:

On February 7, 2012, the President announced a new effort to fight Alzheimer’s Disease. About 

5 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 require significant amounts of health care and intensive long-term services and 

supports (LTSS) – including management of chronic conditions, help taking medications, roundthe-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.84 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.85 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. 

84 2013 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/. 85 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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CAREGIVER SERVICES

Caregivers of persons with Alzheimer’s disease are at an even greater risk of stress and ill health 

than other caregivers. Measured by duration of care, dementia caregivers provide care on 

average one to four years more than caregivers caring for someone with an illness other than 

Alzheimer's disease (43 percent vs. 33 percent). They are also more likely to be providing care 

for five years or longer (32 percent vs. 28 percent).86 In another study, 44 percent of caregivers 

of people with dementia indicated depressive symptoms, compared with 27 percent of caregivers 

of people who had cognitive impairment but no dementia.87 Data from the 2010 BRFSS 

caregiver survey found that 7 percent of dementia caregivers say the greatest difficulty of 

caregiving is that it creates or aggravates their own health problems compared with 2 percent of 

other caregivers.88

Developing more dementia capable LTSS systems designed to meet the needs of caregivers of 

individuals with Alzheimer's Disease and related dementias is critical to helping these 

individuals continue to provide care. Through this initiative, AoA will work with lead agencies 

across State, local, and tribal governments and with the Aging Network to identify and address 

the needs of persons with Alzheimer’s disease and their caregivers when they seek assistance.

Funding History:

FY 2010 .................................................................$0

FY 2011 .................................................................$0

FY 2012 .................................................................$0

FY 2013 .................................................................$0

FY 2014 .................................................$10,500,000

Budget Request:

The FY 2015 budget includes $10,500,000 from the Prevention and Public Health Fund for 

Alzheimer’s disease services as part of the President’s efforts to fight Alzheimer’s disease. The 

same amount was available in FY 2014.

ACL will use the $10.5 million it is requesting in FY 2015 to expand one particular approach to 

improving care for those with Alzheimer’s disease and their caregivers, which focuses on 

building and strengthening the dementia capability of a handful of States, tribal entities, or large 

86 Alzheimer's Association, 2011 Alzheimer's Disease Facts and Figures, Alzheimer's and Dementia , Vol.7, Issue 2. 87 Fisher GG, Franks MM, Plassman BL, Brown SL, Potter GG, Llewellyn D, et al. Caring for individuals with 

dementia and cognitive impairment, not dementia: Findings from The Aging, Demographics, and Memory Study. J 

Am Ger Soc 2011;59(3):488–94.

88 Bouldin ED, Andresen E. Caregiving Across the United States. Caregivers of persons with Alzheimer’s disease or 

dementia in Connecticut, New Hampshire, New Jersey, New York, and Tennessee. Data from the 2010 Behavioral 

Risk Factor Surveillance System. Seattle, Wash.: University of Washington Department of Epidemiology; 2010.

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CAREGIVER SERVICES

localities. A “dementia capable” LTSS system is able to identify those with dementia and their 

caregivers, understand their unique circumstances, communicate appropriately with them, 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; and

• 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; and

• 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.

123
Resource and Program Data:

Alzheimer’s Disease Initiative – Services

(Dollars in thousands)

FY 2013 FY 2014 FY 2015

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary -- -- 11 9,982 11 9,982

Continuations -- -- -- -- -- -- 

Contracts -- -- 1 500 1 500

Interagency Agreements -- -- -- -- -- --

Program Support 1/ -- 18 18

Total Resources -- 10,500 10,500

1/ Program Support -- Includes funds for Public Health Service Act statutory requirements, grant systems and 

review costs.

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PROTECTION OF VULNERABLE ADULTS

Lifespan Respite Care

FY 2013 Final

FY 2014

Enacted

FY 2015

Final

FY 2015 +/-

FY 2014

Lifespan Respite Care.. $2,351,000 $2,360,000 $2,360,000 --

Note: For FY 2015, these funds are requested from amounts provided under section 241 of the Public Health Service 

Act.

Authorizing Legislation: Lifespan Respite Care Act of 2006, Title XXIX of the Public Health 

Service Act

FY 2015 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 percent) caring for someone over age 

18 have medium or high levels of burden and 31 percent of all family caregivers indicated they 

experienced high levels of stress.89

Numerous studies have shown respite to be among the most frequently requested supportive 

service for family caregivers.90 Respite is second only to direct financial assistance as a key 

policy priority of surveyed family caregivers.91 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 percent of family caregivers receive no respite at all.92

89 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

90 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

91 National Alliance for Caregiving and AARP, 2009

92 National Alliance for Caregiving and AARP, 2009.

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CAREGIVER SERVICES

The barriers to accessing and using respite services are often significant for specific populations 

such as family caregivers of individuals with Multiple Sclerosis, persons with intellectual and 

developmental disabilities, and for caregivers of veterans and individuals with Alzheimer’s 

disease, spinal cord injuries, autism, and serious emotional disorders. 93

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 test-bed for needed infrastructure changes, and on filling gaps by 

putting in place coordinated systems of accessible, community-based respite care services for 

family caregivers of children and adults with special needs. These systems bring together and 

seek to coordinate respite care services for family caregivers; training and recruitment of respite 

care workers and volunteers; and 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, the Lifespan Respite Care Program has made grants to eligible state agencies and for 

the funding of a National Technical Assistance Resource Center as follows:

• Grants to new states each year have allowed for the initial development of Lifespan 

Respite Programs. To date, 31 states and the District of Columbia have received initial 

three-year grants.

• In FY 2011 and FY 2012, a total of ten states (eight in 2011 and two in 2012) were 

awarded competitive expansion supplements to focus specifically on providing respite 

services to meet demand and fill gaps in service where identified;

• Integration and Sustainability grants in FY 2012 and FY 2013 have been awarded to a 

total of fifteen states (seven in 2012 and eight in 2013) enabling them to more fully 

embed the concept of respite and family support into statewide home and communitybased services across the age and disability spectrum; and

93 National Alliance for Caregiving. (2012). Multiple Sclerosis Caregivers. Washington, DC: Author; The Arc, 

2011.

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CAREGIVER SERVICES

• Two Technical Assistance Resource Center cooperative agreements (the first awarded in 

FY 2009 and the second in FY 2012), have afforded the opportunity to provide basic and 

advanced technical assistance to grantees on a range of topics pertaining to general 

program development and implementation; population-specific respite information and 

training; program sustainability; the collection, synthesis and dissemination of available 

respite research information; and the development and maintenance of a National 

Registry of respite services.

Examples of grantee accomplishments to date include:

• Creation and adoption of statewide respite plans and/or policies to guide further 

development of respite and caregiver support programs;

• Development or enhancement of training programs for respite care providers to expand the 

cadre of trained respite professionals;

• Replication and expansion of respite delivery modalities with a particular focus on personcentered planning and consumer direction;

• Expansion of toll free “helplines,” dedicated websites and statewide respite registries to 

provide caregivers with information about available respite programs.

• Development and deployment of marketing and awareness campaigns designed to educate 

caregivers about the importance of their work and the necessity to take a break;

• Development of data collection methodologies to track service provision and 

programmatic outcomes;

• 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.)

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CAREGIVER SERVICES

Grantee States work in collaboration with Aging and Disability Resource Centers and a public or 

private non-profit statewide respite care coalition or organization. Special emphasis is placed on 

implementing or enhancing lifespan respite care statewide and building or improving the 

capacity of their long-term care systems to respond to the comprehensive needs of care 

recipients. 

Funding History:

Funding for the Lifespan Respite Care program during the past five years is as follows:

FY 2010 ...................................................$2,500,000

FY 2011 ...................................................$2,495,000

FY 2012 ...................................................$2,490,000

FY 2013 ...................................................$2,351,000

FY 2014 ...................................................$2,360,000

Budget Request:

The FY 2015 request for Lifespan Respite is $2,360,000, the same as the FY 2014 enacted level. 

For FY 2015, these funds are requested from amounts provided under section 241 of the Public 

Health Service Act. 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 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 percent of family caregivers of care recipients age 18 and older, and 81 percent of family 

caregivers of children with special needs currently are unable to access or use respite services. 

Caregivers report numerous barriers ranging from cost considerations and restrictive eligibility 

criteria to waiting lists, limited respite options, inadequate supply of trained providers or 

appropriate programs and gaps in service availability.94

94 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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CAREGIVER SERVICES

The resources requested for FY 2015 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.

Output Table:

Lifespan Respite Care Output

Grant Awards Table:

Lifespan Respite Care Grant Awards

FY 2013 Final FY 2014 

Enacted

FY 2015 

President’s 

Budget

Number of 

Awards 10 26 26

Average 

Award $230,199 $88,153 $88,153

Range of 

Awards

$115,968 -

$267,654

$50,000 -

$100,000

$50,000 -

$100,000

Resource and Program Data:

Lifespan Respite Care Program

(Dollars in thousands)

Indicator Most Recent 

Result 

FY 2014

Projection 

FY 2015 

Projection

FY 2015

+/- FY 2014

Output AE: Increase the number 

of people served as a result of 

Lifespan Respite Care (Output)

N/A

(Baseline in 

FY 2013)

TBD TBD N/A

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CAREGIVER SERVICES

FY 2013 FY 2014 FY 2015

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary 9 2,034 25 2,042 3 600

Continuations 1 268 1 249 23 1,691

Contracts -- -- -- -- -- --

Interagency Agreements -- -- -- -- -- --

Program Support 1/ 49 69 69

Total Resources 2,351 2,360 2,360

1/ Program Support -- Includes funds for Public Health Service Act statutory requirements, grant systems 

and review costs.

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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 2000.95 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.96 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.97

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.98 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.99 Protection of Vulnerable Adults 

95 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 96Tatara, 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 

97 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

98 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. 99 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.

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PROTECTION OF VULNERABLE ADULTS

programs address this problem through a full array of services designed to prevent, detect, and 

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

The issues of elder abuse, neglect, and exploitation affect millions of Americans. ACL’s FY 

2015 Elder Justice Initiative proposes +$25,000,000 to begin funding the Elder Justice Act. 

These funds will be used to fund Adult Protective Services, research, and evaluation activities.

The total FY 2015 request for Protection of Vulnerable Adults is $69,152,000; an increase of 

+$25,000,000 over the FY 2014 enacted level. For FY 2015, specific program requests include:

• $25,000,000 in discretionary funding for the Adult Protective Services (APS) program 

authorized by the Elder Justice Act of 2009 (included in Subtitle H of the Affordable 

Care Act) as part of ACL’s Elder Justice Initiative. APS funding will be used to develop 

program standards and data collection efforts. Funds will also be used to support the 

implementation of a nationwide APS data system, research to translate promising 

interventions from other violence prevention areas to elder abuse, and evaluations of the 

effectiveness of the intervention.

• $15,885,000 for the Long-Term Care Ombudsman Program, the same as the FY 2014 

enacted level. This consumer advocacy program improves the quality of care for the 

residents of long-term care facilities in all States.

• $4,773,000 for Prevention of Elder Abuse and Neglect, the same as the FY 2014 enacted 

level. This program provides formula grants to states to train, educate, and promote 

public awareness of elder abuse prevention efforts. 

• $8,910,000 for the Senior Medicare Patrol Program, the same as the FY 2014 enacted 

level. SMP funds competitive grants to support a volunteer-based network that helps to 

educate consumers on how to prevent healthcare fraud and abuse and helps to preserve 

the financial integrity of Medicare and Medicaid. This program is also supported by 

Health Care Fraud and Abuse Control (HCFAC) “wedge” funding, the level for which is 

determined annually as a result of negotiations between the Attorney General and the 

Secretary of HHS. HCFAC funds pay for infrastructure that supports States’ Senior 

Medicare Patrols, as well as expansion grants to SMPs targeted to high-fraud states.

• $3,874,000 for Elder Rights Support Activities, the same as the FY 2014 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.

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PROTECTION OF VULNERABLE ADULTS

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 

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.

133
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Elder Justice Initiative

FY 2013 Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

Elder Justice/APS $2,000,000 -- $25,000,000 +$25,000,000

FTE.................. 0 0 4 +4

1/ Funding for this activity was provided from the Prevention and Public Health Fund in FY 2013. The FY 2015 

request is for discretionary funding.

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; 

Sections 411 and 751 of the Older Americans Act, as amended

Program Description:

Combating the rising scourge of elder abuse, neglect, and exploitation in America remains one of 

ACL’s top priorities. A 2004 national survey showed a 16 percent increase in the number of 

elder abuse cases from an identical study conducted in 2000.100 Data is limited, but according to 

a 1998 national incidence study, 84 percent of all elder abuse incidents go unreported, meaning 

that for every reported case of abuse there are over five that go unreported.101

The negative effects of abuse, neglect, and exploitation on the health and independence of 

seniors are 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.102 Additional adverse health impacts include an increased likelihood of heart 

attacks, dementia, depression, chronic diseases and psychological distress.

The issues of elder abuse, neglect, and exploitation affect millions of Americans. Enactment of 

the Affordable Care Act included enactment of the Elder Justice Act. ACL’s FY 2015 Elder 

Justice Initiative proposes $25,000,000 to fund Elder Justice Act activities. These funds will be 

used to fund Adult Protective Services, research, and evaluation activities.

100 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 101 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 

102 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. 

135

 
PROTECTION OF VULNERABLE ADULTS

Adult Protective Services

Unlike Child Protective Services, there is currently no federal infrastructure for Adult Protective 

Services. Adult Protective Services (APS) programs are the principal state and local agencies 

responsible for receiving and responding to reports of abuse, neglect, and exploitation of 

vulnerable adults, including elders and people with disabilities. These current State and local 

APS programs provide a range of services designed to ensure the safety and well-being of adults

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 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.

APS programs exist in all states, and APS is a state-established, -administered, and primarily 

state-funded, program. There is currently no Federal infrastructure to support basic 

programmatic standards. State and local governments have created varied APS programs whose 

interventions reflect the unique parameters of their state authorizing legislation. The increasing 

complexity of elder and other adult abuse cases, the rising older population, difficult State and 

local budget conditions, and the absence or inadequacy of consistent data systems and uniform 

reporting requirements have presented challenges to State, local, and Tribal APS programs, 

particularly when it comes to developing the most promising and effective interventions possible 

to prevent adult abuse, neglect, and exploitation. These conditions also have prevented APS 

programs from evaluating their services or conducting 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 National Adult 

Protective Services (NAPS) program, to be funded by this initiative, will support a multifaceted 

approach to improving state APS systems and addressing these challenges. It would provide for 

the development of a national APS data system; provide competitive grants to States to test and 

evaluate innovative approaches to preventing adult abuse, neglect, and exploitation; and establish 

ACL as a Federal resource for APS. This funding 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 abuse prevention interventions. 

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PROTECTION OF VULNERABLE ADULTS

Research and Evaluation

The Elder Justice Act of 2009 established the Elder Justice Coordinating Council (EJCC) to 

coordinate activities related to elder abuse, neglect, and exploitation across the Federal 

government. As Chair of the EJCC, the Secretary of HHS has lead responsibility for identifying 

and proposing solutions to the problems surrounding elder abuse. The Secretary has assigned 

responsibility for implementing the EJCC to the Administration for Community Living. As part 

of that role, ACL has led the staff-level interagency Elder Justice Working Group (EJWG) 

efforts to review all Federal elder justice activities, consider insights and recommendations from 

experts in the field, and refine proposals for the key priority areas for Federal action to address 

elder abuse for consideration by the EJCC.

The findings of the EJCC indicate that research in the area of elder abuse, neglect, and 

exploitation is still in its early stages, with limited knowledge of risk and protective factors 

related to either victims or perpetrators, nor about effective and evidence-based prevention, 

intervention, and remediation practices. Many of these same challenges have limited efforts to 

develop new and innovative approaches to preventing, detecting, and responding to abuse, 

neglect, and exploitation. Our understanding of the phenomena of elder abuse is decades behind

our understanding of either child abuse or domestic violence. We know that elder abuse, neglect, 

and exploitation can have devastating consequences, including increased mortality, increases in 

occurrence and severity of chronic diseases, and the loss of savings and even homes. 

Additionally, we know that people with disabilities, including older adults, are 4 to 10 times 

more likely to be victims of violence, abuse or neglect.103 Research indicates that 11.5 percent of 

adults with a disability have been victims of sexual assault, versus 3.9 percent of adults without 

disabilities.104

However, we do not know the best way to effectively screen for elder and other adult abuse, 

neglect, and exploitation; what the best programs and practices are to address it; nor how to 

effectively prevent it from occurring, or reoccurring.

Moreover, there is no comprehensive system designed to serve as a coordinated and seamless 

response for helping adult victims of abuse, nor to preventing abuse before it happens. Through 

this Elder Justice Initiative proposal, ACL seeks to provide federal leadership, in coordination 

103 Petersilia JR. Crime victims with developmental disabilities: a review essay. Criminal Justice & Behavior

2001;28(6):655–94.

Sobsey D, Mansell S. An international perspective on patterns of sexual assault and abuse of people with 

disabilities. International Journal of Adolescent Medicine & Health 1994;7(2):153–78.

Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. 

Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 

2006.

104 Id.

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PROTECTION OF VULNERABLE ADULTS

with the Elder Justice Coordinating Council, on this issue. A critical step in this process is 

building a base of evidence and evaluation in order to construct a strong base for future 

leadership.

Funding History:

FY 2010 .................................................................$0

FY 2011 .................................................................$0

FY 2012 ...................................................$6,000,000

FY 2013 ...................................................$2,000,000

FY 2014 .................................................................$0

Note: Funding in FY 2012 and FY 2013 was provided from the Prevention and Public Health Fund. The FY 2015 

request is for discretionary funding.

Budget Request:

The FY 2015 request for the Elder Justice Initiative is $25,000,000 in first-time discretionary 

funding.

It is well documented that APS programs and administrators lack reliable information and 

guidance on best practice and standards for conducting case investigations and for staffing and 

managing APS programs. In addition, although all states currently have APS programs, these 

programs are chronically underfunded nationwide. State APS agencies are facing unprecedented 

budget reductions and APS caseloads are increasing. The economic downturn has impacted each 

of these trends, all of which lead to a system that is less equipped to respond in an effective and 

timely way to reports of elder abuse, neglect and exploitation.

Funding to support APS program work nationally is a top ACL priority. Funding under this 

proposal will support:

• APS National Data System Development and Technical Assistance: Funds will be used to 

implement a national APS data system, which is currently under development; and to 

provide technical assistance to states on using and interfacing with this system.

• APS Demonstration Grants: Funds will be used to award competitive grants to states to

test and demonstrate how to interface with the national data collection pilot project and to 

develop APS program standards to help states improve the quality and consistency of 

APS programs

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PROTECTION OF VULNERABLE ADULTS

• APS Evaluation: Funds will be used to design an exploratory study to understand the 

current state of APS systems across the country and the range of services provided and 

characteristics of adults addressed by each agency

Funding will also be used to advance a coordinated Federal research strategy to fill the gaps in 

knowledge and fund initial research on high priority areas. Such research is essential in order to 

develop evidence-based interventions to prevent, identify and report, and respond to elder abuse, 

neglect and exploitation. Grant funding would be used to increase the evidence-base on

screening for elder abuse, neglect, and exploitation. Preliminary priority areas include:

• Build the evidence-base for screening of elder abuse, neglect, and exploitation.

• Research to identify perpetrator characteristics, including why they abuse and how to 

develop preventive interventions.

• Characteristics of victims and risk factors for experiencing abuse.

• Research into the consequences of elder abuse, neglect, and financial exploitation, such 

as potential declines in health and increased risk for co-occurring types of elder abuse.

Output Table:

Adult Protective Services Output

Indicator Most Recent Result FY 2014 

Projection 

FY 2015

Projection 

FY 2015

+/- FY 2014

Output AP.1: Design Adult Protective 

Service evaluation to develop and test 

appropriate methods of addressing elder 

abuse, neglect and exploitation.

Contract Awarded Ongoing Ongoing N/A

139
Resource and Program Data:

Elder Justice Initiative/Adult Protective Services

(Dollars in thousands)

FY 2013 FY 2014 FY 2015

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary 1 503 -- -- 5-10 5,000

Continuations -- -- -- -- -- --

Contracts -- -- -- -- TBD 5,000

Interagency Agreements 1 1,455 -- -- TBD 14,250

Program Support 1/ 42 -- 750

Total Resources 2,000 -- 25,000

1/ Program Support -- Includes funds for salaries and benefits, contract fees, grant systems, and review costs

140
Long-Term Care Ombudsman Program

FY 2013 Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

Long-Term Care 

Ombudsman Program $15,885,000 $15,885,000 $15,885,000 --

Authorizing Legislation: Section 712 of the Older Americans Act of 1965, as amended

FY 2015 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 life and quality of care for the estimated 2.9 million individuals who reside in 

69,508 long-term care facilities.105 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 with 

and on behalf of these residents, advocate for systemic improvement of long-term care systems,

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.106 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 

105 National Ombudsman Reporting System (NORS) – Federal Fiscal 2011. 106 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. 

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PROTECTION OF VULNERABLE ADULTS

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 24,643

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 3,320 volunteers support these paid staff 

and certified volunteer ombudsmen.

• Ombudsmen investigated and worked to resolve 193,650 complaints (Output Q).

• Ombudsmen provided over 420,776 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 2010 .................................................$16,825,000

FY 2011 .................................................$16,793,000

FY 2012 .................................................$16,761,000

FY 2013 .................................................$15,885,000

FY 2014 .................................................$15,885,000

Budget Request:

The FY 2015 request for the Long-Term Care Ombudsman program is $15,885,000, the same as 

the FY 2014 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 

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PROTECTION OF VULNERABLE ADULTS

satisfaction of the resident has consistently remained near 73 percent,107 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. 

Outcome 2.14 targets a decrease in complaints that the program was unable to resolve to the 

satisfaction of the resident. 

The FY 2015 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

frequently support individuals who choose to transition out of nursing home facilities into more

integrated settings. They also advocate for quality care and individual rights and well-being in 

other congregate 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 and assisted living 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.

107 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.

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PROTECTION OF VULNERABLE ADULTS

Outcomes and Outputs Table:

Long-Term Care Ombudsman Program Outcomes and Outputs

Measure Most Recent Result FY 2014

Target 

FY 2015

Target 

FY 2015

+/- FY 2014

Outcome 2.12: Decrease the average 

number of complaints per LTC facility

(Outcome)

FY 2012: 2.73

Target: 3.9

(Target Exceeded)

3.0 2.8 - 0.2*

Outcome 2.14 : Decrease the number of 

complaints not resolved to the satisfaction 

of the resident (Outcome)

FY 2012: 9,705

Target: 11,300 10,700 9,700 - 1,000*

Indicator Most Recent Result FY 2014

Projection 

FY 2015

Projection 

FY 2015

+/- FY 2014

Output Q: Decrease the Number of 

Complaints (Output) FY 2012: 193,650 190,000 190,000 Maintain *

Output R: Number of Ombudsman 

Consultations (Output) FY 2012: 420,776 425,000 437,000 + 12,000

Output S: Facilities regularly visited not in 

response to a complaint (Output) FY 2012: 24,643 26,000 27,600 + 1,000

* Measure seeks a decrease in complaints. A negative change is the desired output.

Grant Awards Table:

Long-Term Care Ombudsman Program Grant Awards

FY 2013 Final FY 2014 

Enacted

FY 2015 

President’s 

Budget

Number of 

Awards 56 56 56

Average 

Award $283,392 $280,824 $280,824

Range of 

Awards

$9,919 -

$1,625,913

$9,829 -

$1,618,546

$9,829 -

$1,618,546

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PROTECTION OF VULNERABLE ADULTS

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2015 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Long-Term Care Ombudsman Program (CFDA 93.042)

State/Territory

FY 2013

Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

Alabama .......................................... 246,892 243,821 243,821 --

Alaska.............................................. 79,350 78,631 78,631 --

Arizona............................................ 333,813 333,076 333,076 --

Arkansas.......................................... 155,042 151,860 151,860 --

California......................................... 1,625,913 1,618,546 1,618,546 --

Colorado .................................. 222,012 223,864 223,864 --

Connecticut............................... 186,673 183,391 183,391 --

Delaware .................................. 79,350 78,631 78,631 --

District of Columbia ................... 79,350 78,631 78,631 --

Florida ..................................... 1,168,176 1,159,301 1,159,301 --

Georgia .................................... 410,945 410,859 410,859 --

Hawaii ..................................... 79,350 78,631 78,631 --

Idaho ....................................... 79,350 78,631 78,631 --

Illinois ..................................... 602,276 593,323 593,323 --

Indiana..................................... 315,640 311,549 311,549 --

Iowa ........................................ 163,550 161,021 161,021 --

Kansas ..................................... 138,935 136,820 136,820 --

Kentucky.................................. 219,879 216,856 216,856 --

Louisiana.................................. 213,219 210,866 210,866 --

Maine ...................................... 79,898 79,365 79,365 --

Maryland.................................. 273,547 271,260 271,260 --

Massachusetts............................ 337,145 333,272 333,272 --

Michigan .................................. 511,603 506,369 506,369 --

Minnesota................................. 257,126 255,908 255,908 --

Mississippi................................ 143,055 141,354 141,354 --

Missouri................................... 309,736 305,063 305,063 --

Montana ................................... 79,350 78,631 78,631 --

Nebraska .................................. 90,552 89,354 89,354 --

Nevada..................................... 127,615 128,082 128,082 --

New Hampshire ......................... 79,350 78,631 78,631 --

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PROTECTION OF VULNERABLE ADULTS

PROGRAM/CFDA NUMBER: Long-Term Care Ombudsman Program (CFDA 93.042)

State/Territory

FY 2013

Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2014 +/-

FY 2012

New Jersey ................................ 438,995 431,948 431,948 --

New Mexico .............................. 103,054 102,123 102,123 --

New York.................................. 971,046 956,337 956,337 --

North Carolina ........................... 473,638 472,374 472,374 --

North Dakota ............................. 79,350 78,631 78,631 --

Ohio......................................... 604,734 595,409 595,409 --

Oklahoma.................................. 187,918 184,565 184,565 --

Oregon...................................... 206,583 206,248 206,248 --

Pennsylvania.............................. 711,097 698,693 698,693 --

Rhode Island.............................. 79,350 78,631 78,631 --

South Carolina ........................... 244,912 244,203 244,203 --

South Dakota ............................. 79,350 78,631 78,631 --

Tennessee.................................. 325,915 322,310 322,310 --

Texas........................................ 1,015,273 1,013,204 1,013,204 --

Utah ......................................... 95,714 95,715 95,715 --

Vermont.................................... 79,350 78,631 78,631 --

Virginia .................................... 379,060 376,622 376,622 --

Washington ............................... 326,273 325,251 325,251 --

West Virginia............................. 111,219 109,488 109,488 --

Wisconsin ................................. 289,501 287,835 287,835 --

Wyoming .................................. 79,350 78,631 78,631 --

Subtotal, States............................... 15,570,374 15,431,077 15,431,077 --

American Samoa ........................ 9,919 9,829 9,829 --

Guam ....................................... 39,675 39,315 39,315 --

Northern Mariana Islands ............. 9,919 9,829 9,829 --

Puerto Rico................................ 200,379 196,785 196,785 --

Virgin Islands............................. 39,675 39,315 39,315 --

 

Subtotal, States and Territories....... 15,869,941 15,726,150 15,726,150 --

Undistributed108 .............................. 15,059 158,850 158,850 --

TOTAL 15,885,000 15,885,000 15,885,000 --

108 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..

146

 
Prevention of Elder Abuse and Neglect

FY 2013 Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

Prevention of Elder 

Abuse & Neglect...... $4,773,000 $4,773,000 $4,773,000 --

Authorizing Legislation: Section 721 of the Older Americans Act of 1965, as amended

FY 2015 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 2012 over $28 million of the Elder Abuse Prevention services 

expenditures was leveraged from non-OAA funds, a ratio of approximately $7 ($6.85) of nonOAA 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 

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PROTECTION OF VULNERABLE ADULTS

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 2010 ...................................................$5,055,000

FY 2011 ...................................................$5,046,000

FY 2012 ...................................................$5,036,000

FY 2013 ...................................................$4,773,000

FY 2014 ...................................................$4,773,000

Budget Request and Anticipated Accomplishments:

The FY 2015 request for the Prevention of Elder Abuse and Neglect program is $4,773,000, the 

same as the FY 2014 enacted level. The FY 2015 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 2015 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. Past examples of these efforts undertaken by states include creation of informational 

cards for law enforcement officers to provide crucial resource information to victims of elder 

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PROTECTION OF VULNERABLE ADULTS

abuse, training to first responders, and community-based multidisciplinary teams that serve in a 

technical advisory role to elder abuse prevention agencies throughout a state.

Output Table:

Prevention of Elder Abuse and Neglect Output

Indicator Most Recent Result FY 2014

Projection 

FY 2015

Projection 

FY 2015

+/- FY 2014

Output U: Elder Abuse prevention nonOAA service expenditures (Output, 

dollars in thousands)

FY 2012: $28,638 $28,300 $28,100 -$200

Grant Awards Table:

Prevention of Elder Abuse, Neglect, and Exploitation Grant Awards

FY 2013 

Final

FY 2014 

Enacted

FY 2015 

President’s 

Budget

Number of 

Awards 56 56 56

Average Award $85,154 $84,500 $84,500

Range of 

Awards

$2,980 -

$471,073

$2,958 -

$471,073

$2,958 -

$471,073

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PROTECTION OF VULNERABLE ADULTS

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2015 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Prevention of Elder Abuse & Neglect (CFDA 93.041)

State/Territory

FY 2013

Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

Alabama........................................... 76,215 76,215 76,215 --

Alaska.............................................. 23,843 23,660 23,660 --

Arizona ............................................ 89,944 81,500 81,500 --

Arkansas.......................................... 48,157 48,157 48,157 --

California......................................... 471,073 471,073 471,073 --

Colorado .......................................... 59,819 56,082 56,082 --

Connecticut...................................... 59,907 59,907 59,907 --

Delaware.......................................... 23,843 23,660 23,660 --

District of Columbia ........................ 23,843 23,660 23,660 --

Florida ............................................. 344,252 344,252 344,252 --

Georgia ............................................ 110,726 103,321 103,321 --

Hawaii ............................................. 23,843 23,660 23,660 --

Idaho................................................ 23,843 23,660 23,660 --

Illinois.............................................. 197,384 197,384 197,384 --

Indiana ............................................. 98,224 98,224 98,224 --

Iowa ................................................. 55,927 55,927 55,927 --

Kansas ............................................. 45,843 45,843 45,843 --

Kentucky.......................................... 66,595 66,595 66,595 --

Louisiana ......................................... 68,518 68,518 68,518 --

Maine............................................... 23,843 23,660 23,660 --

Maryland.......................................... 78,087 78,087 78,087 --

Massachusetts.................................. 109,606 109,606 109,606 --

Michigan.......................................... 160,862 160,862 160,862 --

Minnesota ........................................ 76,347 76,347 76,347 --

Mississippi....................................... 45,198 45,198 45,198 --

Missouri........................................... 97,643 97,643 97,643 --

Montana........................................... 23,843 23,660 23,660 --

Nebraska.......................................... 29,770 29,770 29,770 --

Nevada............................................. 34,385 27,629 27,629 --

New Hampshire ............................... 23,843 23,660 23,660 --

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PROTECTION OF VULNERABLE ADULTS

PROGRAM/CFDA NUMBER: Prevention of Elder Abuse & Neglect (CFDA 93.041)

State/Territory

FY 2013

Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

New Jersey...................................... 143,950 143,950 143,950 --

New Mexico ................................... 27,766 26,393 26,393 --

New York ....................................... 318,066 318,066 318,066 --

North Carolina ................................ 127,617 126,782 126,782 --

North Dakota .................................. 23,843 23,660 23,660 --

Ohio................................................ 197,185 197,185 197,185 --

Oklahoma ....................................... 60,208 60,208 60,208 --

Oregon ............................................ 56,795 56,795 56,795 --

Pennsylvania................................... 242,944 242,944 242,944 --

Rhode Island................................... 23,843 23,660 23,660 --

South Carolina ................................ 65,989 63,080 63,080 --

South Dakota .................................. 23,843 23,660 23,660 --

Tennessee ....................................... 91,810 91,810 91,810 --

Texas .............................................. 274,281 274,281 274,281 --

Utah ................................................ 25,789 24,837 24,837 --

Vermont.......................................... 23,843 23,660 23,660 --

Virginia........................................... 102,820 102,820 102,820 --

Washington..................................... 87,911 86,291 86,291 --

West Virginia.................................. 36,736 36,736 36,736 --

Wisconsin ....................................... 90,309 90,309 90,309 --

Wyoming ........................................ 23,843 23,660 23,660 --

Subtotal, States............................... 4,684,617 4,648,207 4,648,207 --

American Samoa............................. 2,980 2,958 2,958 --

Guam .............................................. 11,922 11,830 11,830 --

Northern Mariana Islands............... 2,980 2,958 2,958 --

Puerto Rico ..................................... 54,217 54,217 54,217 --

Virgin Islands ................................. 11,922 11,830 11,830 --

Subtotal, States and Territories....... 4,768,638 4,732,000 4,732,000 --

Undistributed 109/.......................... 4,362 41,000 41,000 --

TOTAL 4,773,000 4,773,000 4,773,000 --

109 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.

151

 
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Senior Medicare Patrol Program

FY 2013 Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

Senior Medicare 

Patrol Program..... $8,875,000 $8,910,000 $8,910,000 --

Authorizing Legislation: Sections 201, 202, and 411 of the Older Americans Act of 1965, as 

amended

FY 2015 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 network of volunteers whose purpose is to educate Medicare 

beneficiaries on preventing and identifying healthcare fraud and abuse. Projects use the skills of 

volunteers to conduct community outreach and education and provide information that 

empowers beneficiaries of Medicare and Medicaid and their families to prevent, identify and 

report fraud. Activities are carried out in partnership with the Centers for Medicare & Medicaid 

Services (CMS), the Office of Inspector General (OIG), healthcare providers, and other aging 

and elder rights professionals from around the country.

Data obtained from the SMARTFACTS Data Tracking System and published in the annual OIG 

report for calendar year 2011 shows that SMP projects:

• Maintained 5,671 active volunteers who worked over 88,169 hours to educate 

beneficiaries about how to prevent Medicare and Medicaid fraud;

• Educated 431,128 beneficiaries in 11,109 group education sessions and held 66,303 oneon-one counseling sessions with or on behalf of beneficiaries; 

• Conducted 8,800 community outreach education events; and

• Resolved 76,224 inquiries for information or assistance from beneficiaries.

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PROTECTION OF VULNERABLE ADULTS

In addition, the SMARTFACTS data show that since the program’s inception 16 years ago, SMP 

projects have educated over 3.5 million beneficiaries in 94,077 group education sessions and 

1,179,190 one-on-one counseling sessions, and conducted 83,862 community outreach education 

events.

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 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 ACL’s National Consumer Protection Technical Resource Center (Center).

In the past four years, the critically important role of the SMP program has continued to be 

recognized by partners in Medicare fraud prevention in the private and public sectors. In 

FY 2010 and FY 2011, 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 SMP 

projects fight Medicare fraud in high fraud areas and expand the capacity of the program to reach 

more beneficiaries. In FY 2012 and FY 2013, ACL received 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 

Excellence in Public Awareness Award is a major achievement, and a notable acknowledgement 

of the value of the SMP program.

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PROTECTION OF VULNERABLE ADULTS

Funding History:

Funding for the SMP discretionary appropriations is as follows:

FY 2010 ...................................................$9,438,000

FY 2011 ...................................................$9,420,000

FY 2012 ...................................................$9,402,000

FY 2013 ...................................................$8,875,000

FY 2014 PB..............................................$8,910,000

Budget Request:

The FY 2015 request for the Senior Medicare Patrol (SMP) program is $8,910,000, the same as 

the FY 2014 enacted level. This amount will enable ACL to continue the proven fraud 

prevention activities of the SMP program.

Since the program’s inception, SMP projects have educated over 3.5 million beneficiaries and 

received nearly 30,000 complex issues (complaints) from beneficiaries who have detected billing 

or other discrepancies based on that information. While SMPs make numerous referrals of 

potential fraud to CMS and the OIG, 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 process 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.

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PROTECTION OF VULNERABLE ADULTS

Outcomes and Outputs Table:

Senior Medicare Patrol Program Outputs

Indicator Most Recent Result CY 2014

Projection 

CY 2015

Projection 

FY 2015

+/- FY 2014

Output W: Beneficiaries Educated and 

Served (Output) CY 2012: 649,297 675,000 630,000 - 45,000

Grant Awards Table:

Senior Medicare Patrol Grant Awards

FY 2013 Final FY 2014 

Enacted

FY 2015 

President’s 

Budget

Number of 

Awards 54 54 54

Average 

Award $152,925 $165,000 $165,000

Range of 

Awards

$30,000-

$640,000

$75,000-

$177,927

$75,000-

$177,927

Resource and Program Data:

Senior Medicare Patrols

(Dollars in thousands)

FY 2013 FY 2014 FY 2015

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary -- -- 26 4,380 54 8,910

Continuations 54 8,875 28 4,530 -- --

Contracts -- -- -- -- -- --

Interagency Agreements -- -- -- -- -- --

Program Support 1/ -- -- --

Total Resources 8,875 8,910 8,910

156
Elder Rights Support Activities

FY 2013 Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

Elder Rights 

Support Activities $3,859,000 $3,874,000 $3,874,000 --

Authorizing Legislation: Sections 201, 202, and 411 of the Older Americans Act of 1965, as 

amended

FY 2015 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 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. Recently, Model Approaches – Phase II grants were 

developed that promote legal service delivery systems that are optimally responsive to complex 

legal issues emerging from cases of elder abuse, neglect, and financial exploitation.

National Legal Assistance and Support Projects

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PROTECTION OF VULNERABLE ADULTS

National Legal Assistance and Support grants fund a comprehensive national legal assistance 

support system serving professionals and advocates working in legal and aging/disability

services networks. These grants provide funding for the National Legal Resource Center

(NLRC), which supports the leadership, knowledge, and systems capacity of legal and aging 

provider organizations. The NLRC works to enhance the quality, cost effectiveness, and 

accessibility of legal assistance and elder rights protections available to older persons with social 

or economic needs. ACL is funding four projects as partners under the NLRC 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 creating and managing 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 identifying 342 local elder justice community 

coalitions and reaching out to those communities to learn how they leverage local resources 

and expertise to prevent and combat elder abuse, neglect, and exploitation, as well as to offer 

technical assistance on operating, invigorating, and sustaining coalitions; and 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.

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PROTECTION OF VULNERABLE ADULTS

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 point 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 2010 ...................................................$4,103,000

FY 2011 ...................................................$4,096,000

FY 2012 ...................................................$4,088,000

FY 2013 ...................................................$3,859,000

FY 2014 ...................................................$3,874,000

Budget Request:

The FY 2015 request for Elder Rights Support Activities is $3,874,000, the same as the FY 2014 

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.

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PROTECTION OF VULNERABLE ADULTS

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 2013

Final

FY 2014

Enacted

FY 2015

President’s 

Budget

Elder Rights Support Activities:

Model Approaches to Statewide Legal Assistance ........................... $1,881 $1,888 $1,888

National Legal Assistance and Support Projects .............................. 702 705 705

National Center on Elder Abuse ....................................................... 762 765 765

National Long-Term Care Ombudsman Resource Center................ 514 516 516

Total, Elder Rights Support Activities...................................... $3,859 $3,874 $3,874

Grant Awards Table:

Elder Rights Support Activities Grant Awards

FY 2013 Final FY 2014 

Enacted

FY 2015 

President’s 

Budget

Number of 

Awards 22 19 19

Average 

Award $171,318 $197,421 $197,421

Range of 

Awards

$50,000 -

$561,000

$50,000 -

$561,000

$50,000 -

$561,000

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PROTECTION OF VULNERABLE ADULTS

Resource and Program Data:

Elder Rights Support Activities

(Dollars in thousands)

FY 2013 FY 2014 FY 2015

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary 13 1,666 8 2,102 -- --

Continuations 9 2,103 11 1,649 19 3,751

Contracts -- -- -- -- -- --

Interagency Agreements -- -- -- -- -- --

Program Support 1/ 90 -- 123 123

Total Resources 3,859 3,874 3,874

1/ Program Support -- Includes funds for grant systems and review and information technology support costs.

161
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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 2015 request for Programs for People with Developmental Disabilities authorized 

under the Developmental Disabilities Assistance and Bill of Rights Act is $165,259,000, an 

increase of +$5,000,000 over the FY 2014 enacted level. For FY 2015, specific program 

requests include:

• $70,876,000 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 

self-determination, integration and inclusion for people with developmental disabilities.

• $38,734,000 to continue funding for State Protection and Advocacy systems in each State 

and Territory that 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. 

• $36,769,000 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.

• $8,880,000 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, 

including Federal interagency initiatives; for demonstration projects addressing 

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DEVELOPMENTAL DISABILITIES PROGRAMS

innovative and emerging best practices; and for longitudinal data collection projects. This 

program also includes $1,000,000 for grants to communities with models that best 

demonstrate the inclusion of people with disabilities and seniors in the development and 

planning of community transportation systems.

• $5,000,000 in new funding for a Youth Transitions initiative, to invest in supports

currently being developed to address the comprehensive needs of youth with intellectual 

and developmental disabilities as they transition from adolescence into young adult life 

across all systems – health, education, employment, human services, and community 

living.

164
State Councils on Developmental Disabilities

FY 2013 Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

State DD Councils $70,555,000 $70,876,000 $70,876,000 --

Authorizing Legislation: Section 129(a) of the Developmental Disabilities Assistance and Bill of 

Rights Act 

FY 2015 Developmental Disabilities Assistance and Bill of Rights Act Authorization ......Expired

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

Program Description and Accomplishments:

State Councils on Developmental Disabilities (DD Councils) 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. DD Councils 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 DD Council 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 

DD 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;

• 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

165
DEVELOPMENTAL DISABILITIES PROGRAMS

• Actively support policies and practices that promote self-determination and inclusion in 

the community and workforce for individuals with developmental disabilities and their 

families.

DD 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 DD Council 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 

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 

166
DEVELOPMENTAL DISABILITIES PROGRAMS

developmental disabilities to increase their job skills and build their resumes. The 

Council also provided startup 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.

Funding History:

Funding for the program during the last five years has been as follows:

FY 2010 .................................................$75,066,000

FY 2011 .................................................$74,916,000

FY 2012 .................................................$74,774,000

FY 2013 .................................................$70,555,000

FY 2014 .................................................$70,876,000

Budget Request:

The FY 2015 budget request for State Councils is $70,876,000, the same as the FY 2014 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 2015, 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.

Continued funding for State Councils is crucial as they are the entity in the States and Territories 

able to build and organize systems change efforts aimed at turning fragmented approaches into 

innovative and cost-effective strategies that create opportunities for people with developmental 

disabilities and their families.

Advances in self-advocacy would be greatly impacted if funding were no longer available for 

State Councils. All 56 Councils work to build leadership skills by providing individuals with 

developmental disabilities and their family members a variety of opportunities including 

167
DEVELOPMENTAL DISABILITIES PROGRAMS

opportunities to educate policymakers and participate in the design and redesign of systems 

impacting their lives.

Outputs and Outcomes Table:

Measure Most Recent 

Result

FY 2014

Target

FY 2015

Target

FY 2015

+/- FY 2014

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 2012: 14.33%

Target: 13.79%

(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. (Outcome)

FY 2012: 9.52

Target: 9.17

(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 2012: 706,588

(Actual) N/A N/A N/A

8ii: Number of all individuals trained by the 

Councils. (Output)

FY 2012: 256,865

(Actual) N/A N/A N/A

Grant Awards Tables:

State Councils on Developmental Disabilities Grant Awards

FY 2013 Final FY 2014 

Enacted

FY 2015 

President’s 

Budget

Number of 

Awards 56 56 56

Average 

Award $1,259,907 $1,262,357 $1,262,357

Range of 

Awards

$235,156 -

$6,496,150

$235,613 -

$6,508,782

$235,613 -

$6,508,782

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DEVELOPMENTAL DISABILITIES PROGRAMS

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES

FY 2015 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: State Councils on Developmental Disabilities (CFDA 93.630)

State/Territory

FY 2013

Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

Alabama........................................... 1,280,763 1,283,254 1,283,254 --

Alaska.............................................. 451,553 452,431 452,431 --

Arizona ............................................ 1,392,777 1,395,485 1,395,485 --

Arkansas.......................................... 752,346 753,809 753,809 --

California......................................... 6,496,150 6,508,782 6,508,782 --

Colorado .......................................... 859,459 861,131 861,131 --

Connecticut...................................... 681,469 682,794 682,794 --

Delaware.......................................... 451,553 452,431 452,431 --

District of Columbia ........................ 451,553 452,431 452,431 --

Florida ............................................. 3,499,415 3,506,220 3,506,220 --

Georgia ............................................ 2,041,448 2,045,418 2,045,418 --

Hawaii ............................................. 451,553 452,431 452,431 --

Idaho................................................ 451,553 452,431 452,431 --

Illinois.............................................. 2,477,331 2,482,149 2,482,149 --

Indiana ............................................. 1,409,080 1,411,820 1,411,820 --

Iowa ................................................. 730,126 731,546 731,546 --

Kansas ............................................. 579,619 580,746 580,746 --

Kentucky.......................................... 1,195,739 1,198,064 1,198,064 --

Louisiana ......................................... 1,328,158 1,330,740 1,330,740 --

Maine............................................... 451,553 452,431 452,431 --

Maryland.......................................... 950,796 952,645 952,645 --

Massachusetts.................................. 1,320,431 1,322,999 1,322,999 --

Michigan.......................................... 2,439,721 2,444,467 2,444,467 --

Minnesota ........................................ 966,956 968,836 968,836 --

Mississippi....................................... 906,239 908,001 908,001 --

Missouri........................................... 1,294,246 1,296,762 1,296,762 --

Montana........................................... 451,553 452,431 452,431 --

Nebraska.......................................... 451,553 452,431 452,431 --

Nevada............................................. 469,007 469,919 469,919 --

New Hampshire ............................... 451,553 452,431 452,431 --

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DEVELOPMENTAL DISABILITIES PROGRAMS

PROGRAM/CFDA NUMBER: State Councils on Developmental Disabilities (CFDA 93.630)

State/Territory

FY 2013

Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

New Jersey...................................... 1,492,899 1,495,803 1,495,803 --

New Mexico ................................... 479,397 480,330 480,330 --

New York ....................................... 4,107,730 4,115,718 4,115,718 --

North Carolina ................................ 1,998,086 2,001,972 2,001,972 --

North Dakota .................................. 451,553 452,431 452,431 --

Ohio................................................ 2,695,852 2,701,094 ,701,094 --

Oklahoma ....................................... 846,197 847,842 847,842 --

Oregon ............................................ 781,744 783,264 783,264 --

Pennsylvania................................... 2,958,678 2,964,431 2,964,431 --

Rhode Island................................... 451,553 452,431 452,431 --

South Carolina ................................ 1,073,121 1,075,207 1,075,207 --

South Dakota .................................. 451,553 452,431 452,431 --

Tennessee ....................................... 1,426,128 1,428,901 1,428,901 --

Texas .............................................. 4,794,740 4,804,064 4,804,064 --

Utah ................................................ 637,622 638,862 638,862 --

Vermont.......................................... 451,553 452,431 452,431 --

Virginia........................................... 1,416,470 1,419,224 1,419,224 --

Washington..................................... 1,183,050 1,185,351 1,185,351 --

West Virginia.................................. 740,372 741,812 741,812 --

Wisconsin ....................................... 1,224,785 1,227,167 1,227,167 --

Wyoming ........................................ 451,553 452,431 452,431 -- 

Subtotal, States............................... 67,249,889 67,380,663 67,380,663 --

American Samoa............................. 235,156 235,613 235,613 --

Guam .............................................. 235,156 235,613 235,613 --

Northern Mariana Islands............... 235,156 235,613 235,613 --

Puerto Rico ..................................... 2,364,288 2,368,885 2,368,885 --

Virgin Islands ................................. 235,156 235,613 235,613 --

Subtotal, States and Territories....... 70,554,801 70,692,000 70,692,000 --

TOTAL $70,554,801 $70,692,000 $70,692,000 --

170
Developmental Disabilities – Protection and Advocacy

FY 2013 Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

DD – Protection & 

Advocacy........... $38,559,000 $38,734,000 $38,734,000 --

Authorizing Legislation: Section 145 of the Developmental Disabilities Assistance and Bill of 

Rights Act 

FY 2015 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. The program also funds a Native American Consortium 

to protect the legal and human rights of Native Americans 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 of concerns 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 

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.

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DEVELOPMENTAL DISABILITIES PROGRAMS

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 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. In the first case of its kind, the Oregon P&A and co-counsels from other law firms filed 

suit on behalf of eight individuals with intellectual or developmental disabilities who are able 

and would prefer to work in an integrated employment setting, but instead are segregated in 

sheltered workshops. The case claims that the integration mandate under Title II of the 

Americans with Disabilities Act (ADA) applies to the provision of employment-related 

services. The U.S. Department of Justice supports the Plaintiffs’ case, making clear that it 

interprets the Title II integration mandate of the ADA to prohibit the unnecessary provision of 

employment-related services to persons with disabilities in segregated sheltered workshops, in 

which persons with disabilities have little to no opportunity to interact with non-disabled 

persons.

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 2010 .................................................$41,024,000

FY 2011 .................................................$40,942,000

FY 2012 .................................................$40,865,000

FY 2013 .................................................$38,559,000

FY 2014 .................................................$38,734,000

Budget Request:

The FY 2015 budget request for PADD is $38,734,000, the same as the FY 2014 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.

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DEVELOPMENTAL DISABILITIES PROGRAMS

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, 

including children, are at an increased risk to experience abuse and neglect.110 A 2009 report 

from the Government 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 

which involved children with disabilities.111 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 percent were resolved using short-term assistance strategies; 

• 22 percent were addressed through technical assistance in self-advocacy;

• 15 percent involved investigation and monitoring; and 

• 12 percent 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 2015, the 

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

110 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 111 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.

173

 
DEVELOPMENTAL DISABILITIES PROGRAMS

Outputs and Outcomes Table:

Measure Most Recent Result FY 2014

Target

FY 2015

Target

FY 2015

+/- FY 2014

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 2012: 85.2%

Target: 83.4%

(Target Exceeded)

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 2012: 18,189

(Actual) N/A N/A N/A

8iv: Number of people receiving 

information and referral from the 

Protection and Advocacy program. 

(Output)

FY 2012: 45,069

(Actual) N/A N/A N/A

Grant Awards Tables:

Developmental Disabilities – Protection and Advocacy Grant Awards112

FY 2013 Final FY 2014 

Enacted

FY 2015 

President’s 

Budget

Number of 

Awards 56 56 56

Average 

Award $671,308 $672,628 $672,628

Range of 

Awards

$194,139 -

$3,255,484

$194,139 -

$3,297,166

$194,139 -

$3,297,166

112 Excludes grants to tribal organizations.

174

 
DEVELOPMENTAL DISABILITIES PROGRAMS

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES

FY 2015 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Developmental Disabilities – Protection and Advocacy (CFDA 93.630)

State/Territory

FY 2013

Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

Alabama........................................... 617,829 619,708 619,708 --

Alaska.............................................. 362,881 362,881 362,881 --

Arizona ............................................ 652,541 659,935 659,935 --

Arkansas.......................................... 380,743 382,159 382,159 --

California......................................... 3,255,484 3,297,166 3,297,166 --

Colorado .......................................... 441,150 447,027 447,027 --

Connecticut...................................... 374,341 373,697 373,697 --

Delaware.......................................... 362,881 362,881 362,881 --

District of Columbia ........................ 362,881 362,881 362,881 --

Florida ............................................. 1,826,878 1,864,950 1,864,950 --

Georgia ............................................ 1,037,180 1,045,869 1,045,869 --

Hawaii ............................................. 362,881 362,881 362,881 --

Idaho................................................ 362,881 362,881 362,881 --

Illinois.............................................. 1,264,649 1,265,728 1,265,728 --

Indiana ............................................. 765,273 764,876 764,876 --

Iowa ................................................. 371,678 372,163 372,163 --

Kansas ............................................. 362,881 362,881 362,881 --

Kentucky.......................................... 580,510 577,204 577,204 --

Louisiana ......................................... 563,103 566,770 566,770 --

Maine............................................... 362,881 362,881 362,881 --

Maryland.......................................... 469,144 466,854 466,854 --

Massachusetts.................................. 601,556 604,505 604,505 --

Michigan.......................................... 1,240,187 1,239,838 1,239,838 --

Minnesota ........................................ 510,645 512,759 512,759 --

Mississippi....................................... 424,774 424,574 424,574 --

Missouri........................................... 685,591 687,561 687,561 --

Montana........................................... 362,881 362,881 362,881 --

Nebraska.......................................... 362,881 362,881 362,881 --

Nevada............................................. 362,881 362,881 362,881 --

New Hampshire ............................... 362,881 362,881 362,881 --

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DEVELOPMENTAL DISABILITIES PROGRAMS

PROGRAM/CFDA NUMBER: Developmental Disabilities – Protection and Advocacy (CFDA 93.630)

State/Territory

FY 2013

Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

New Jersey...................................... 743,286 743,327 743,327 --

New Mexico ................................... 362,881 362,881 362,881 --

New York ....................................... 1,847,809 1,829,821 1,829,821 --

North Carolina ................................ 1,080,862 1,089,450 1,089,450 --

North Dakota .................................. 362,881 362,881 362,881 --

Ohio................................................ 1,345,518 1,332,036 1,332,036 --

Oklahoma ....................................... 420,110 418,336 418,336 --

Oregon ............................................ 404,997 407,305 407,305 --

Pennsylvania................................... 1,385,181 1,370,712 1,370,712 --

Rhode Island................................... 362,881 362,881 362,881 --

South Carolina ................................ 570,582 573,680 573,680 --

South Dakota .................................. 362,881 362,881 362,881 --

Tennessee ....................................... 747,696 748,866 748,866 --

Texas .............................................. 2,405,074 2,432,653 2,432,653 --

Utah ................................................ 362,881 362,881 362,881 --

Vermont.......................................... 362,881 362,881 362,881 --

Virginia........................................... 727,507 729,693 729,693 --

Washington..................................... 608,571 618,587 618,587 --

West Virginia.................................. 366,505 365,960 365,960 --

Wisconsin ....................................... 642,636 637,929 637,929 --

Wyoming ........................................ 362,881 362,881 362,881 -- 

Subtotal, States............................... 35,891,448 36,003,556 36,003,556 --

American Samoa............................. 194,139 194,139 194,139 --

Guam .............................................. 194,139 194,139 194,139 --

Northern Mariana Islands............... 194,139 194,139 194,139 --

Puerto Rico ..................................... 925,263 887,069 887,069 --

Virgin Islands ................................. 194,139 194,139 194,139 --

Subtotal, States and Territories....... 37,787,406 37,861,320 37,861,320 --

Grants to Tribes 194,139 194,139 194,139 --

Training and Technical Assistance113 771,594 872,680 872,680 --

TOTAL $38,559,000 $38,734,000 $38,734,000 --

113 This line reflects the amount reserved from the P&A appropriation for statutory related activities, including 

training, technical assistance, grant systems, and review costs

176

 
University Centers for Excellence in Developmental Disabilities

FY 2013 Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

UCEDDs............ $36,602,000 $36,769,000 $36,769,000 --

Authorizing Legislation: Section 156 of the Developmental Disabilities Assistance and Bill of 

Rights Act 

FY 2015 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, 

advise Federal, State, and community policymakers about, and promote 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 2013, the 

Administration on Intellectual and Developmental Disabilities (AIDD) awarded 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

• Examine and advance professional practice, scholarship and policy that impacts the lives 

of people with developmental and other disabilities and their families. 

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DEVELOPMENTAL DISABILITIES PROGRAMS

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 2010 .................................................$38,943,000

FY 2011 .................................................$38,865,000

FY 2012 .................................................$38,792,000

FY 2013 .................................................$36,602,000

FY 2014 .................................................$36,769,000

Budget Request: 

The FY 2015 request for UCEDDs is $36,769,000, the same as the FY 2014 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 

specialized expertise in developmental disabilities. Of the UCEDD trainees who graduated 5 to 

10 years ago, 82 percent are in leadership positions with: 

178
DEVELOPMENTAL DISABILITIES PROGRAMS

• 56 percent in academic leadership 

• 48 percent in clinical leadership 

• 25 percent in public health leadership 

• 28 percent in public policy and advocacy leadership

It is estimated that over 36 percent 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, a 

growing body of research has documented that persons with developmental and other disabilities 

are more likely to experience health disparities compared to the general population. The 

University of New Hampshire UCEDD is conducting the Health and Health Care Disparities 

among Individuals with Disabilities project to determine what factors relate to or explain health 

outcomes and health care access among the diverse populations of individuals with disabilities. 

The goal of the Health Disparities Project is to generate new knowledge about health access and 

health outcomes among sub-groups of people with disabilities and translate and disseminate the 

findings for researchers, policy makers, and others.

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 

postsecondary education, resulting in improved long-term independent living and employment 

outcomes. 

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DEVELOPMENTAL DISABILITIES PROGRAMS

Funding for UCEDDs also provides infrastructure support for initiatives with effects felt 

internationally, such as the University of Hawaii UCEDD’s Asia-United States Partnership 

(AUSP). The goal of this partnership is to improve child health through cross-cultural exchanges 

in early childhood development with leaders in East Asia (Beijing, Shanghai, and Hong Kong 

SAR, Philippines, Singapore, and Thailand) and the United States.

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. 

Outputs and Outcomes Table:

Measure Most Recent Result FY 2014

Target

FY 2015

Target

FY 2015

+/- FY 2014

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 2012: 39.67%

Target: 38.04%

(Target Exceeded)

Prior Result 

+1%

Prior Result 

+1% N/A

8viii: Number of professionals trained 

by UCEDDs. (Output)

FY 2012: 5,289

(Actual) N/A N/A N/A

8ix: Number of people reached 

through UCEDD community training 

and technical assistance activities. 

(Output)

FY 2012: 852,603

(Actual) N/A N/A N/A

8x: Number of people receiving direct 

or model demonstration services from 

UCEDDs. (Output)

FY 2012: 145,460

(Actual) N/A N/A N/A

180
DEVELOPMENTAL DISABILITIES PROGRAMS

Grant Awards Tables:

University Centers of Excellence in Developmental Disabilities Grant Awards

FY 2013 Final FY 2014 

Enacted

FY 2015 

President’s 

Budget

Number of 

Awards 67 68 68

Average 

Award $535,215 $535,215 $535,215

Range of 

Awards $535,215 $535,215 $535,215

Resource and Program Data:

University Centers of Excellence in Developmental Disabilities

(Dollars in thousands)

FY 2013 FY 2014 FY 2015

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary 17 9,098 4 1,769 -- --

Continuations 50 26,761 64 34,254 68 36,023

Contracts 1 732 1 735 1 735

Interagency Agreements -- -- -- -- -- --

Program Support /1 11 11 11

Total Resources 36,602 36,769 36,769

1/ Program Support -- Includes funds for grant systems and review costs.

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Developmental Disabilities – Projects of National Significance

FY 2013 Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

DD – Projects of 

National Significance 1/ $8,828,000 $8,880,000 $8,880,000 --

1/ For comparability purposes, funding displayed in FY 2013 includes amounts transferred to ACL for inclusive

transportation. This funding was appropriated directly to ACL in FY 2014 and is reflected in the FY 2015 request.

Authorizing Legislation: Section 163 of the Developmental Disabilities Assistance and Bill of 

Rights Act 

FY 2015 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 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, PNS resources are 

expected to fund a new project related to gathering and disseminating information and providing 

technical assistance to people and entities interested in supported decision making as an 

alternative to guardianship.

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DEVELOPMENTAL DISABILITIES PROGRAMS

In FY 2015, 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 

technical assistance. In addition, PNS funds will continue to support longitudinal research 

studies of trends in residential services and supports, employment, community supports, family 

supports, and quality indicators related to publicly funded DD services and the supported 

decision making project.

Funding History:

Funding for the program during the last five years has been as follows:

FY 2010 .................................................$14,136,000

FY 2011 .................................................$14,134,000

FY 2012 ...................................................$8,317,000

FY 2013 ...................................................$8,828,000

FY 2014 ...................................................$8,880,000

Budget Request:

The FY 2015 request for the Projects of National Significance program is $8,880,000, the same 

as the FY 2014 enacted level. The request will support continued funding for employment 

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

monitoring. In addition, AIDD will provide self-advocacy organizations with an opportunity to 

thrive and grow through a targeted technical assistance effort.

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.

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DEVELOPMENTAL DISABILITIES PROGRAMS

Consistent with the purpose of the DD Act, including the promotion of self-determination, AIDD 

has worked collaboratively exploring supported decision-making and guardianship reform, to 

maximize the opportunity for people with intellectual and developmental disabilities and Older 

Americans to live independently and to exert control and choice in their own lives. AIDD 

proposes to continue funding a joint integrated training and technical assistance/resource center 

on supported decision making to advance work in this area.

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.

In FY 2015 ACL will also continue to issue grants totaling $1 million to communities with the 

models that best demonstrate the inclusion of people with disabilities, including intellectual and 

developmental and/or physical disabilities, and seniors in the development and planning of the 

community transportation systems. These funds were appropriated directly to ACL for the first 

time in FY 2014.

Grant Awards Tables:

Developmental Disabilities – Projects of National Significance Grant Awards

FY 2013 Final FY 2014 

Enacted

FY 2015 

President’s 

Budget

Number of 

Awards 21 25 25

Average 

Award $347,905 $289,000 $289,000

Range of 

Awards

$100,000 -

$575,000

$100,000 -

$575,000

$100,000 -

$575,000

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DEVELOPMENTAL DISABILITIES PROGRAMS

Resource and Program Data:

Developmental Disabilities – Projects of National Significance

(Dollars in thousands)

FY 2013 FY 2014 FY 2015

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary 4 300 6 790 19 6,435

Continuations 17 7,006 19 6,435 6 790

Contracts 6 1,305 7 1,377 7 1,377

Interagency Agreements -- -- -- -- -- --

Program Support /1 217 278 278

Total Resources 8,828 8,880 8,880

1/ Program Support -- Includes funds for salaries and benefits, contract fees, and grant systems and review 

costs.

186
Youth Transitions Initiative

FY 2013 Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

Youth Transitions -- -- $5,000,000 +$5,000,000

Authorizing Legislation: Section 163 of the Developmental Disabilities Assistance and Bill of 

Rights Act

Program Description:

Currently, there are insufficient supports available to transitioning youth with disabilities, and 

furthermore, there is insufficient coordination across Federal agencies currently serving this 

population. The July 2012 GAO Report, Students with Disabilities: Better Federal Coordination 

Could Lessen Challenges in the Transition from High School strongly recommended 

development of an interagency approach across HHS, Education, Labor, and Social Security to 

work towards improving common outcomes for transitioning youth with disabilities and their 

families related to health, education, employment, support services and community living. HHS’ 

response to this report acknowledged that “more must be done toward developing a coordinated, 

integrated transition strategy.” The GAO report builds upon a long and demonstrated history of 

reports and data indicating the need to ensure that youth with disabilities are not exiting high 

school only to become dependent upon SSI, SSDI and Medicaid at a cost of tens of billions of 

federal dollars – and that the lack of coordination across systems is a major contributor to this 

trend.

Successful outcomes for youth with disabilities include engagement in productive activities, 

including paid employment, with quality health and functional status. In response to the GAO

report, an interagency workgroup (Federal Partners in Transition, FPT) led by senior leadership 

from each of four agencies (Education, Labor, Social Security, and HHS) has been convened. 

Demonstration projects have shown promising employment results for youth with intellectual 

and developmental disabilities when Medicaid-funded LTSS, vocational rehabilitation, Social 

Security, and education systems collaborate. A prime example of the impact of Employment 

First policies can be seen from their implementation in Washington State. In 2005, King County 

in Washington State changed their approach to transitioning students with intellectual and 

developmental disabilities from school to employment by adopting a statewide Employment 

First policy coupled with supportive services. In just five years, the percent of youth with 

disabilities that are employed rose from six percent to 56 percent.

187
DEVELOPMENTAL DISABILITIES PROGRAMS

Models implemented under this initiative do not focus on the entire SSI population, but rather are 

targeted to transitioning youth with ID/DD, and would address ongoing needed supports. The 

models would be required to address transitioning across several systems for youth with ID/DD 

including pediatric to adult health care, education to post-secondary education and vocational 

systems to produce successful outcomes in competitive, integrated employment. Of specific 

interest is implementing approaches that provide ongoing long term services and supports which 

will provide meaningful assistance to these youth into adulthood through Medicaid or other 

funding streams. Family supports will be critical to successful models as well, with a holistic 

approach on providing family members supporting their youth with targeting, ongoing 

assistance. For example, a successful model may include implementing training curriculums on 

best practices within and outside of disability services for accessing and coordinating community 

supports, leadership development, and self-advocacy – and would be made available to youth, 

siblings, parents and other family supporting the transitioning youth with ID/DD.

Funding History:

FY 2010 .................................................................$0

FY 2011 .................................................................$0

FY 2012 .................................................................$0

FY 2013 .................................................................$0

FY 2014 .................................................................$0

Budget Request:

The FY 2015 request for the Youth Transitions Initiative is $5,000,000 in first-time funding. As 

the lead HHS entity in the Federal Partners in Transition effort, AIDD will invest in state 

initiatives, with the goal of generating results similar to the Washington state model, that bring 

together entities such as state Developmental Disabilities agency, Department of Education, 

Vocational Rehabilitation, Council on Developmental Disabilities, University Centers for 

Excellence in Developmental Disabilities and other agencies to address the comprehensive needs 

of youth with intellectual and developmental disabilities as they transition from adolescence into 

young adult life across all systems – health, education, employment, human services, and 

community living. These entities will identify federal, state, and local laws, regulations and 

policies that contribute as barriers to employment for youth with ID/DD, develop plans to 

deconstruct such barriers, and implement cross agency programs that that produce better 

outcomes for this population. AIDD will also fund an evaluation component for the initiative.

Through grants, cooperative agreements and coordinated interagency program implementation, 

activities are expected to:

188
DEVELOPMENTAL DISABILITIES PROGRAMS

• Promote innovative utilization of health and long-term supports in coordination with 

education, vocational rehabilitation, and employment services.

• Encourage integration of health and LTSS transition planning into secondary and postsecondary education programs.

• Provide technical assistance and training to ensure integration of health and long-term 

supports with education, vocational rehabilitation and employment services.

• Establish and implement a coordinated federal evaluation agenda to ensure that outcomes 

across systems are measured and reported.

Resource and Program Data:

Youth Transitions Initiative

(Dollars in thousands)

FY 2013 FY 2014 FY 2015

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary -- -- -- -- TBD 4,500

Continuations -- -- -- -- -- --

Contracts -- -- -- -- 1 500

Interagency Agreements -- -- -- -- -- --

Program Support /1 -- -- --

Total Resources -- -- 5,000

189
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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 (ADRC) and the State Health Insurance 

Assistance Program (SHIP) 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 services and supports – 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 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. The Alzheimer’s Disease Initiative Communications Campaign (proposed to be 

funded from the Prevention and Public Health Fund) the National Clearinghouse for Long-Term 

Care Information, and the Paralysis Resource Center each reach out to key populations to assist 

them in accessing services and in planning for future needs.

The FY 2015 request for these programs is $88,978,000, a decrease of -$6,899,000 from the 

FY 2014 enacted level. This request would provide:

• $20,000,000 in mandatory funding for ADRCs. No discretionary funding is requested in 

the FY 2015 President’s Budget, therefore, this request represents the sole source of 

funding for ADRCs going forward. 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 communitylevel. 

191
CONSUMER INFORMATION, ACCESS & OUTREACH

• $4,963,000 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) which 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, were transferred to ACL in 

FY 2014, and fit naturally within ACL’s mission of promoting community living. In 

FY 2015, the SHIPS will continue to benefit from deeper connection to ACL’s aging and 

disability services networks.

• $1,000,000 for the National Clearinghouse for Long-Term Care Information, an outreach

effort that increases awareness of the need to plan ahead for long-term care. In FY 2014 

ACL requested to shift funding for this program from mandatory funding under ACA to 

discretionary funding. This request is repeated in FY 2015.

• $6,700,000 for the Paralysis Resource Center (PRC), which provides comprehensive 

information and referral services for people living with paralysis and their families and 

caregivers. Transferred to ACL in FY 2014, the PRC will continue to benefit from 

extensive ties to ACL’s disability networks. For FY 2015, these funds are requested from 

amounts provided under section 241 of the Public Health Service Act.

192
Aging and Disability Resource Centers

FY 2013 Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

Discretionary.......... $6,095,000 $6,119,000 -- -$6,119,000

Mandatory............. $9,490,000 $9,280,000 $20,000,000 +$10,720,000

Total................ $15,585,000 $15,399,000 $20,000,000 +$4,601,000

FTE.................. 4 3 3 --

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.

FY 2015 Authorization .........................................................................................................Expired

Allocation Method ............................Competitive Grants/Co-operative Agreements and Contracts

Program Description and Accomplishments:

Aging and Disability Resource Centers (ADRCs) support State efforts to develop more efficient, 

cost-effective, and consumer-responsive systems of information and integrated access by 

creating consumer-friendly entry points into long-term care at the community-level. ADRCs 

grew out of best practice innovations in some states known as “No Wrong Door”114 (NWD) and 

“Single Points of Entry” programs, where people of all ages may turn for objective information 

and one-on-one assistance on their long-term services and support options. Since 2003, the 

Administration on Aging, along with the Centers for Medicare & Medicaid Services (CMS), and 

most recently the Veterans Health Administration (VHA), have entered into cooperative 

agreements with States to develop the foundational infrastructure for delivering one-on-one 

person-centered counseling and streamlined access to public programs that make it easier for 

individuals to learn about and access their health and long-term services and support options. 

ACL, CMS, and the VHA are now working with 8 ADRC states to build on the lessons learned 

and best practices from prior ADRC investments to develop national standards for a “highperforming” No Wrong Door system that serves all populations and all payers.

NWD/ADRC systems help States make better use of taxpayer dollars by streamlining access to 

community services and supports (both publicly and privately funded) and diverting individuals 

114 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).

193

 
CONSUMER INFORMATION, ACCESS & OUTREACH

from more costly forms of care, including institutional care and unnecessary hospital readmissions. These systems are a key component in transforming States’ long-term supports and 

services programs, work which is not only vital, but ongoing. Services provided by 

NWD/ADRC systems for all populations and all payers which highlight the need for continued 

funding include:

• Targeted discharge planning, care transition and nursing home diversion support that 

integrates the medical and social service systems on behalf of older adults and individuals 

with disabilities to help them remain in their own homes and communities after a 

hospitalization, rehabilitation or skilled nursing facility visit; 

• “One-on-one” person-centered counseling to help consumers, families, and caregivers 

fully understand the options, including private pay, available to them;

• Streamlined access to publicly-supported long-term care services and support programs

for individuals who appear to be eligible for such programs;

• Outreach and assistance to Medicare beneficiaries on their Medicare benefits including 

prevention 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.

• ACL is currently evaluating this program and expects a final evaluation report by the end 

of calendar year 2014. The evaluation includes process and outcomes studies and is 

designed to produce generalizable outcomes about the degree to which ADRCs are 

meeting their goals of effectively integrating and streamlining access to LTSS. The 

evaluation will also inform program refinement and continuous quality management.

With FY 2012 funds, ADRCs responded to more than five million contacts to help individuals 

make better informed decisions about their health and long-term services and support options, 

with the vast majority of these decisions resulting in referrals for community-based services. 

High performing NWD/ADRC systems that serve all populations including Medicaid-eligible 

individuals satisfy one of three statewide system change requirements states must meet in order 

to qualify for enhanced Federal match under the CMS Medicaid Balancing Incentive Program.

ACL and CMS have invested over $100 million in the ADRC initiative since 2003. As a result 

of these investments:

194
CONSUMER INFORMATION, ACCESS & OUTREACH

Over 509 ADRC sites have been established across 50 states, two territories, and Washington, 

DC, increasing the coordination and capacity of existing infrastructure in the aging, disability 

and Medicaid networks. Together these ADRC sites can reach roughly 77 percent of the U.S. 

population.

• 32 States and Territories have achieved statewide coverage, and an additional 5 States 

have achieved 50 percent or more of statewide coverage. 

• 41 states with ADRC programs sites currently conduct care transitions through formal 

interventions across 386 hospitals. To date, the cumulative number of persons who have 

completed a formal care transition program is 16,043.

• 42 states are actively partnering across ADRC and Money Follows the Person programs. 

The number of states where the ADRC is the Local Contact Agency is 30, with 

274 ADRC program sites performing nursing facility transitions.

Funding History:

Comparable total funding for Aging and Disability Resource Centers is as follows:

FY 2010 .................................................$23,684,000

FY 2011 .................................................$16,469,000

FY 2012 .................................................$16,457,000

FY 2013 .................................................$15,585,000

FY 2014 PB............................................$15,399,000

Note: Mandatory appropriations of $10 million for FY 2010 through FY 2014 for ADRCs were made under Section 

2405 of P.L. 111-148, the Affordable Care Act of 2010.

Budget Request:

ACL’s FY 2015 request for ADRCs is $20,000,000 each year for five years in new mandatory

funding, as the first year of five years of funding at that level. Mandatory funding under the 

Affordable Care Act expires in FY 2014, so this request will be the only source of funding 

proposed for ADRC activities in FY 2015.

Over the next five years, ACL intends to fund approximately 35 new state grantees to finalize 

their development and operation of sustainable No Wrong Door systems based on the national 

standards established by ACL, CMS and the VHA. Funded states will replicate the national 

standards to develop person-centered, conflict-free access system for long-term services and 

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CONSUMER INFORMATION, ACCESS & OUTREACH

supports for all populations and all payers. In addition to the grants to states, funding would be 

used to support a technical assistance contract and salaries for ACL staff administering ADRC 

activities.

Activities in the 35 states funded by this proposal to develop sustainable No Wrong Door 

systems represent a substantial state-wide reform of access to long-term services and supports. 

Building on past ADRC activities, the transformation brought about by this funding will include:

• Funded state’s program will meet national standards established by ACL/CMS and VHA 

for “No Wrong Door” Systems and be required to report on its progress and performance 

using federally prescribed efficiency and consumer outcome measures that align with the 

national standards;

• Governors of funded states will have to establish a multi-agency governance structure to 

oversee the development, financing and administration of its No Wrong Door System, 

and this structure must include the State Unit on Aging, the State Medicaid Agency, and 

the other state agencies responsible for serving the people with physical disabilities as 

well as those with intellectual and developmental disabilities;

• Funded states will commit to using Medicaid administrative funding to support the NWD 

infrastructure on an on-going basis; and

• Funded states will ensure that local NWD sites:

o Include a full range of organizations that play a formal reimbursable role in 

carrying out the NWD functions they have been designated by the state to 

perform to ensure the state’s NWD System can effectively serve all LTSS 

populations;

o Use nationally certified person-centered counselors to provide one-on-one 

assistance to consumers; and

o Conduct formal functional and financial assessments that are required to 

determine an individual’s eligibility for the public LTSS programs that are 

administered by the state, including Medicaid.

Finally, funded states’ NWD systems, including local sites, will use the federally prescribed 

reporting data to continually evaluate performance and make improvements in NWD systems at

the state and local site level. Funded states will actively involve consumer stakeholders in this 

process.

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CONSUMER INFORMATION, ACCESS & OUTREACH

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

(Dollars in thousands)

FY 2013 FY 2014 FY 2015

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary 10 6,698 15 5,634 TBD 11,202

Continuations 32 5,663 10 6,601 15 5,634

Contracts 2 2,367 1 2,530 1 2,530

Interagency Agreements -- -- -- -- -- --

Program Support /1 857 634 634

Total Resources 15,585 15,399 20,000

1/ Program Support -- Includes funds for salaries, benefits, contract fees, grant systems, and review costs.

Measure Most Recent Result FY 2014 

Target

FY 2015 

Target

FY 2015

+/- FY 2014

LTC.2: Percent of individuals 

who indicate ADRC information 

and counseling contribute to 

informed decision making 

(Outcome)

FY 2012: 91%

(Baseline set in

FY 2013)

83% 83% Maintain

Indicator Most Recent Result FY 2014 

Projection

FY 2015 

Projection 

FY 2015

+/- FY 2014

Output AF: Total number of 

ADRC contacts (Output) FY 2012: 5.2M 3.6 M 4.0 M + 400,000

Output AG: Increase in the 

number of ADRC programs 

(Output)

FY 2012: 468 280 300 + 20

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Voting Access for Individuals with Disabilities

FY 2013 Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

Voting Access for 

People with Disabilities $4,961,000 $4,963,000 $4,963,000 --

Authorizing Legislation: Section 291 of the Help America Vote Act 

FY 2015 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 (P&A) 

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 competitive one-year awards. 

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.

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CONSUMER INFORMATION, ACCESS & OUTREACH

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, identifying and 

implementing technologies to assist individuals with disabilities in voting, 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 2010 .................................................$17,410,000

FY 2011 .................................................$17,375,000

FY 2012 ...................................................$5,235,000

FY 2013 ...................................................$4,961,000

FY 2014 ...................................................$4,963,000

Note: FY 2011 was the final year of funding for an additional HAVA formula grant to State Election 

Commissioners. 

Budget Request:

The FY 2015 budget request for Voting Access for Individuals with Disabilities to the Protection

and Advocacy Systems and related technical assistance is $4,963,000, the same as the FY 2014 

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. 

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.

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CONSUMER INFORMATION, ACCESS & OUTREACH

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 2013 Final FY 2014 

Enacted

FY 2015 

President’s 

Budget

Number of 

Awards 55 55 55

Average 

Award $83,890 $83,920 $83,920

Range of 

Awards

$35,000 -

$347,600

$35,000 -

$348,401

$35,000 -

$348,401

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CONSUMER INFORMATION, ACCESS & OUTREACH

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES

FY 2015 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Voting Access for Individuals with Disabilities (CFDA 93.618)

State/Territory

FY 2013

Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

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......................................... 347,600 348,401 348,401 --

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 ............................................. 175,751 176,919 176,919 --

Georgia ............................................ 90,517 90,851 90,851 --

Hawaii ............................................. 70,000 70,000 70,000 --

Idaho................................................ 70,000 70,000 70,000 --

Illinois.............................................. 118,682 117,917 117,917 ---

Indiana ............................................. 70,000 70,000 70,000 --

Iowa ................................................. 70,000 70,000 70,000 --

Kansas ............................................. 70,000 70,000 70,000 --

Kentucky.......................................... 70,000 70,000 70,000 --

Louisiana ......................................... 70,000 70,000 70,000 --

Maine............................................... 70,000 70,000 70,000 --

Maryland.......................................... 70,000 70,000 70,000 --

Massachusetts.................................. 70,000 70,000 70,000 --

Michigan.......................................... 91,079 90,516 90,516 --

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 --

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CONSUMER INFORMATION, ACCESS & OUTREACH

PROGRAM/CFDA NUMBER: Voting Access for Individuals with Disabilities (CFDA 93.618)

State/Territory

FY 2013

Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2014 +/-

FY 2012

New Jersey...................................... 81,350 81,186 81,186 --

New Mexico ................................... 70,000 70,000 70,000 --

New York ....................................... 179,511 179,233 179,233 --

North Carolina ................................ 89,053 89,314 89,314 --

North Dakota .................................. 70,000 70,000 70,000 --

Ohio................................................ 106,469 105,727 105,727 --

Oklahoma ....................................... 70,000 70,000 70,000 --

Oregon ............................................ 70,000 70,000 70,000 --

Pennsylvania................................... 117,517 116,894 116,894 --

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 .............................................. 236,775 238,662 238,662 --

Utah ................................................ 70,000 70,000 70,000 --

Vermont.......................................... 70,000 70,000 70,000 --

Virginia........................................... 74,668 74,970 74,970 --

Washington..................................... 70,000 70,000 70,000 --

West Virginia.................................. 70,000 70,000 70,000 --

Wisconsin ....................................... 70,000 70,000 70,000 --

Wyoming ........................................ 70,000 70,000 70,000 -- 

Subtotal, States............................... 4,438,972 4,440,590 4,440,590 --

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....... 4,613,972 4,615,590 4,615,590 --

Training and Technical Assistance115 347,028 347,410 347,410 --

TOTAL $4,961,000 $4,963,000 $4,963,000 --

115 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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Alzheimer’s Disease Initiative - Outreach Campaign

FY 2013 Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

Alzheimer’s Disease 

Initiative – Outreach 

(Prevention Fund)

$150,000 $4,200,000 $4,200,000 --

Authorizing Legislation: Section 411 of the Older Americans Act of 1965, as amended

FY 2015 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 ACL received $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. During the first year of the Campaign, a new website (alzheimers.gov) was launched 

and a variety of outreach materials were developed. Going forward, AoA will continue to 

promote the new website to caregivers and associated organizations using materials already 

developed. Future efforts will feature Public Service Announcements instead of the paid media 

approach taken previously. Given the success of the television spot (awards from a health care 

and an advertising organization) this approach may reach a new and broader audience.

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 highlights 

the alzheimers.gov website and deploys 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.

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CONSUMER INFORMATION, ACCESS & OUTREACH

Funding History:

FY 2010 .................................................................$0

FY 2011 .................................................................$0

FY 2012 ...................................................$4,000,000

FY 2013 ......................................................$150,000

FY 2014 PB..............................................$4,200,000

Budget Request:

The FY 2015 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, the same as the amount provided for this activity in FY 2014.

These funds will be used to continue to develop both the information available on the

alzheimers.gov web site and the effectiveness of our outreach efforts. 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 2015 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.116 This may require development of specific additional 

outreach materials and further analysis to determine if content and messaging are culturally 

competent.

116 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.

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CONSUMER INFORMATION, ACCESS & OUTREACH

Resource and Program Data:

Alzheimer’s Disease Initiative – Outreach Campaign

(Dollars in thousands)

FY 2013 FY 2014 FY 2015

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary -- -- -- -- -- --

Continuations -- -- -- -- -- --

Contracts 1 150 1 4,200 1 4,200

Interagency Agreements -- -- -- -- -- --

Program Support /1 -- -- --

Total Resources 150 4,200 4,200

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State Health Insurance Assistance Programs

FY 2013 Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

State Health Insurance 

Assistance Programs...... $46,040,000 $52,115,000 $52,115,000 --

FTE......................... 5 5 5 --

Authorizing Legislation: Section 4360 of the Omnibus Budget Reconciliation Act of 1990 

(42 U.S.C. 1395b-4).

FY 2015 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.

In FY 2014 the SHIP program was transferred from the Centers for Medicare & Medicaid 

Services to the Administration for Community Living. This transfer reflects the natural synergies 

between the SHIP programs and the networks that ACL serves. About two-thirds of the 54 State 

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CONSUMER INFORMATION, ACCESS & OUTREACH

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. ACL is working closely with CMS to ensure an orderly transition of the 

program.

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 2010 .................................................$46,960,000

FY 2011 .................................................$52,000,000

FY 2012 .................................................$52,115,000

FY 2013 .................................................$46,040,000

FY 2014 .................................................$52,115,000

In addition, the following legislative action has taken place since FY 2010 which provided 

additional mandatory funding for the SHIPs:

• 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.

• The Bipartisan Budget Act of 2013 provides an additional $3.75 million for SHIPs in 

FY 2014.

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CONSUMER INFORMATION, ACCESS & OUTREACH

Budget Request:

The SHIP budget request for FY 2015 is $52,115,000, the same as the FY 2014 enacted level. 

This includes funding for 5 FTE and related administrative expenses to administer the program.

Funds will be used to continue SHIP grants and enable States to continue the personalized 

counseling that they have been providing while making 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.

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CONSUMER INFORMATION, ACCESS & OUTREACH

Grant Awards Table:

State Health Insurance Assistance Programs Grant Awards

FY 2013 Final FY 2014 

Enacted

FY 2015 

President’s 

Budget

Number of 

Awards 54 54 54

Average 

Award $852,593 $903,921 $903,921

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.

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National Clearinghouse for Long-Term Care Information

FY 2013 Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

National Clearinghouse 

on Long-Term Care 

Information................

$85,523 -- $1,000,000 +$1,000,000

Note: Funding for this program was provided by the Affordable Care Act in FY 2013, but unobligated balances were 

rescinded by the Taxpayer Relief Act in FY 2013 (save for obligations through January 3, 2013). The FY 2015 

request is for discretionary funding.

Authorizing Legislation: Section 6021(d) of the Deficit Reduction Act of 2005 (P.L. 106-224).

Mandatory Appropriation (FY 2013): Title VIII of the Affordable Care Act, P.L. 111-148

FY 2015 Authorization .........................................................................................................Expired

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, 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 an ongoing evaluation of both website content and outreach strategy and a 

more robust social media presence.

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CONSUMER INFORMATION, ACCESS & OUTREACH

Funding History:

Funding for the past 5 years is as follows: 

FY 2010 1/ ..............................................$3,000,000

FY 2011 1/ ..............................................$3,000,000 

FY 2012 ................................................. $3,000,000

FY 2013 2/ ....................................................$85,523

FY 2014 PB.........................................................$0

1/ Prior to FY 2012 funding for this activity was administered by CMS.

2/ Reflects obligations prior to January 3, 2013 when funding was rescinded.

Budget Request:

The FY 2015 President’s Budget request for the National Clearinghouse on Long-Term Care is 

$1,000,000, an increase of +$1,000,000 over the FY 2014 enacted level. This funding is 

requested in FY 2015 from discretionary funding, as mandatory funding previously appropriated 

by the Affordable Care Act for FY 2015 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. Approximately 70 percent of Americans over age 65 will require 

some type of long-term services and supports.117 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.118 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 

of information can seem overwhelming. The web site now features a decision tool to provide 

streamlined calls to action and related information. Longtermcare.gov is now the first organic 

search result in a Google search on the term “long-term care.” Continued funding will ensures 

that consumers will find objective information on how best to prepare for long-term care.

117 http://www.longtermcare.gov/LTC/Main_Site/Understanding/Definition/How_Much.aspx 118 http://www.longtermcare.gov/LTC/Main_Site/Paying/Costs/Index.aspx

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CONSUMER INFORMATION, ACCESS & OUTREACH

Resource and Program Data:

National Clearinghouse for Long-Term Care Information

(Dollars in thousands)

FY 2013 FY 2014 FY 2015

Final 2/ Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary -- -- -- -- -- --

Continuations -- -- -- -- -- --

Contracts -- -- -- -- 1 1,000

Interagency Agreements -- -- -- -- -- --

Program Support /1 86 -- --

Total Resources 86 -- 1,000

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 2013, but unobligated balances were 

rescinded by the Taxpayer Relief Act in FY 2013 (save for obligations through January 3, 2013). The FY 2015 

request is for discretionary funding.

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Paralysis Resource Center

FY 2013 Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

Paralysis Resource Center $6,352,000 $6,700,000 $6,700,000 --

Note: For comparability purposes, only the transferred amount of direct grant funding is displayed here. For 

FY 2015, these funds are requested from amounts provided under section 241 of the Public Health Service Act

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, in FY 2014 funding and 

administrative responsibilities for the PRC were transferred from the Centers for Disease Control 

217
CONSUMER INFORMATION, ACCESS & OUTREACH

and Prevention to ACL. Under ACL, the PRC will benefit from extensive ties to ACL’s

disability networks and will provide a valuable source of information as ACL continues to 

strengthen its policy and advocacy efforts in the field of disabilities. 

Funding History:

Funding for the program during the last five years has been as follows:

FY 2010 ...................................................$6,610,000

FY 2011 ...................................................$5,800,000

FY 2012 ...................................................$6,700,000

FY 2013 ...................................................$6,352,000

FY 2014 ...................................................$6,700,000

Note: This program was funded at CDC through FY 2013 and was transferred to ACL in FY 2014. Funding at CDC 

included both grant and administrative funds. For comparability purposes, since ACL has been appropriated

administrative funding for this program within its Program Administration line, only grant funding amounts are 

displayed.

Budget Request:

The FY 2015 President’s Budget request is $6,700,000, the same as the FY 2014 enacted level. 

For FY 2015, these funds are requested from amounts provided under section 241 of the Public 

Health Service Act.

The work done by the PRC 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.119 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.

119http://www.christopherreeve.org/site/c.mtKZKgMWKwG/b.5184241/k.ACBD/Average_age_average_length_of_

time_since_paralysis_and_SCI.htm

218

 
CONSUMER INFORMATION, ACCESS & OUTREACH

Resource and Program Data:

Paralysis Resource Center

(Dollars in thousands)

FY 2013 FY 2014 FY 2015

Final 2/ Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary -- -- 1 6,533 -- --

Continuations -- -- -- -- 1 6,533

Contracts -- -- -- -- -- --

Interagency Agreements -- -- -- -- -- --

Program Support /1 -- 167 167

Total Resources -- 6,700 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 2013. It was 

transferred to ACL in FY 2014. Resource and program data is not available prior to the proposed transfer to ACL.

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White House Conference on Aging

FY 2013 Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

White House 

Conference -- -- $3,000,000 +$3,000,000

Authorizing Legislation: Sections 202 and 205 of the Older Americans Act of 1965, as amended

FY 2015 Older Americans Act Authorization......................................................................Expired

Background:

This request is for funds to hold a White House Conference on Aging no later than December 31, 

2015. This conference, held once a decade, was last convened in 2005. This would be the sixth 

such Conference in our nation’s history.

White House Conferences on Aging have served as catalysts for developing aging policy for the 

past 40 years. Past White House Conferences on Aging have prompted the development of 

many of the programs that represent America’s commitment to the elderly. The 

recommendations made at these conferences have resulted in improvements in the public policies

which assist seniors and their families and led to better quality of life for older Americans.

Budget Request:

For FY 2015, $3,000,000 is requested, to remain available through FY 2016. 

ACL, working with the White House, is committed to creating a conference with the goal of 

broad participation from older adults, family caregivers, aging services providers, policy makers 

and advocates at the federal, state and local level. We will work with stakeholders to develop the 

structure for such a conference, including a focus on regional participation. We will strive to 

employ current technologies to facilitate efficient and effective participation by individuals in 

local and national events. ACL will work with other agencies within HHS and across the federal 

government in creating and supporting this conference.

221
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Holocaust Survivor Assistance Fund

FY 2013 Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

Holocaust Survivor 

Assistance Fund -- -- $5,000,000 +$5,000,000

Authorizing Legislation: Section 411 of the Older Americans Act of 1965, as amended

FY 2015 Older Americans Act Authorization......................................................................Expired

Allocation Method .............................................................................................Competitive Grants

Background:

The United States is home to an estimated 130,000 victims of Nazi persecution, approximately 

25 percent of whom are living in poverty. Because of the experiences they endured at the 

beginning of their lives, Holocaust survivors (“survivors”) are likely to have greater and more 

complex physical and mental health needs as they age. The nonprofit social service agencies that 

serve this population project that the need for supportive services will continue to grow and 

intensify over the next five to ten years, which will further widen existing funding and service 

gaps. 

Funding Request:

For FY 2015, the President’s Budget requests $5,000,000 in new funding to establish the 

Holocaust Survivor Assistance Fund (“Fund”). This would be amplified with additional 

matching dollars from the philanthropic sector. The Fund would target a leverage of 3:1 private 

to public dollars.

The Fund would help provide supportive services for survivors living in the United States, such 

as intensive case management services, legal assistance, and emergency assistance with 

survivors’ immediate service needs. The requested funds would be administered in accordance 

with input received through an extensive community engagement process that the Special Envoy 

for U.S. Holocaust Survivor Services is conducting with survivors, their families, and the various 

organizations that serve this population. 

The Fund will help bridge the funding and service gaps that this population is facing today. It 

will generate innovative approaches for the coordination of home- and community-based 

223
HOLOCAUST SURVIVOR ASSISTANCE FUND

services and will help this population age with dignity and support in their homes and 

communities.

224
Program Administration

FY 2013 Final

FY 2014

Enacted

FY 2015

President’s 

Budget

FY 2015 +/-

FY 2014

Program Administration $28,064,000 $30,035,000 $30,035,000 --

FTE120........................ 135 143 143 --

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 (EJA).

FY 2015 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. The majority of these funds cover pay, 

rent and security and external services, all of which are relatively fixed in the short term.

In FY 2012, ACL was created by bringing together three existing entities: the Administration 

on Aging (AoA), an HHS operating division; the Administration on Developmental Disabilities 

(ADD), part of the Administration for Children and Families (ACF); and the Office of Disability 

(OD), part of the HHS Office of the Secretary (OS). Consistent with the FY 2014 appropriation, 

ACL’s request reflects a single consolidated line item to fund program administration. In prior 

120 Overall comparable FTE for ACL are projected at 162 in FY 2013, 171 in FY 2014 and 178 in FY 2015. FTE 

numbers for Program Administration only reflect those FTE funded from the Program Administration budget line, 

comparably adjusted in FY 2013 to include FTE that came to ACL from the Office of Disability and the 

Administration on Developmental Disabilities. Program Administration FTE also include those 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 2013-FY 2015), SHIP funds (5 

FTE in each of FY 2013-FY 2015) or with CMS CMMI funds (2 FTE in FY 2014 and 3 FTE in FY 2015); ADRC 

FTE supported with mandatory funds (4 in FY 2013, 3 in each of FY 2014-FY 2015); FTE related to transferred or 

new programs (SCSEP, Elder Justice, White House Conference on Aging-10 in FY 2013 and FY 2014 and 16 in FY 

2015). These FTE are included in the appropriate narrative tables in other sections of this document.

225

 
PROGRAM ADMINISTRATION

years, funding was provided through a combination of direct appropriations to AoA and transfers 

of funding. 121

Funding History:

Comparable funding for ACL Program Administration since the agency’s creation in FY 2012 is 

as follows:

FY 2012 .................................................$29,558,000 145 FTE

FY 2013 .................................................$28,064,000 135 FTE

FY 2014 .................................................$30,035,000 143 FTE

Budget Request:

The FY 2015 request for Program Administration is $30,035,000, the same as the FY 2014 

enacted level. This request will support 143 FTE, the same level of FTE usage currently 

projected for FY 2014. The request includes $158,605 to cover the cost of a 1% FY 2015 pay 

raise, which would be offset through reductions to contractual and other obligations.

ACL 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 until renovations to the Mary E. Switzer building are complete. ACL is working with 

the HHS Facilities and Logistics Service (FLS) to refine the schedule and milestones and to ensure 

that cost estimates are sufficient to cover all costs associated with the transition to Switzer, including 

build-out, moving, and rent. ACL’s move is now estimated to occur in late 2014 or early 2015.

Performance Measures

Program Administration is not directly measured by ACL’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.

121 Funding totals in FY 2013 included comparable transfers from ACF of $4,859,206 and of $1,197,616 from OS.

226

 
SUPPLEMENTARY TABLES

Budget Authority by Object Class

Object Classification - Direct

Administration for Community Living

(Dollars in Thousands)

FY 2014 

Enacted

FY 2015 

Budget

FY 2015 +/- 

FY 2014

Personnel compensation:

Full-time permanent (11.1)................................................... 14,128 14,577 449

Other than full-time permanent (11.3)................................ 1,795 1,871 76

Other personnel compensation (11.5)................................ 141 142 1

Military personnel (11.7)...................................................... - - -

Special personnel services payments (11.8)..................... - - -

Subtotal personnel compensation.................................. 16,064 16,590 526

Civilian benefits (12.1)............................................................. 4,480 4,636 156

Military benefits (12.2)............................................................ - - -

Benefits to former personnel (13.0)...................................... - - -

Total Pay Costs........................................................................ 20,544 21,226 682

Travel and transportation of persons (21.0)........................ 340 397 57

Transportation of things (22.0).............................................. 3 3 0

Rental payments to GSA (23.1).............................................. 2,359 2,503 144

Communication, utilities, and misc. charges (23.3)............. 466 475 9

Printing and reproduction (24.0)............................................ 15 15 0

Other Contractual Services:

Advisory and assistance services (25.1).......................... 23,240 36,489 13,249

Other services (25.2)............................................................. 225 229 4

Purchase of goods and services from

government accounts (25.3)............................................. 6,338 7,377 1,039

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............................ 29,804 44,096 14,292

Supplies and materials (26.0).................................................. 57 68 11

Equipment (31.0)...................................................................... 13 20 8

Land and Structures (32.0) .................................................... - - -

Investments and Loans (33.0)................................................ - - -

Grants, subsidies, and contributions (41.0)......................... 1,990,914 1,941,359 (49,556)

Interest and dividends (43.0)................................................. - - -

Refunds (44.0).......................................................................... - - -

Total Non-Pay Costs............................................................... 2,023,970 1,988,935 (35,035)

Total Budget Authority by Object Class............................. 2,044,514 2,010,161 (34,353)

227
SUPPLEMENTARY TABLES

Salaries and Expenses

Administration for Community Living

(Dollars in Thousands)

FY 2014 

Enacted

FY 2015 

Budget

FY 2015 +/- 

FY 2014

Personnel compensation:

Full-time permanent (11.1)................................................... 14,128 14,577 449

Other than full-time permanent (11.3)................................ 1,795 1,871 76

Other personnel compensation (11.5)................................ 141 142 1

Military personnel (11.7)...................................................... - - -

Special personnel services payments (11.8)..................... - - -

Subtotal personnel compensation.................................. 16,064 16,590 526

Civilian benefits (12.1)............................................................. 4,480 4,636 156

Military benefits (12.2)............................................................ - - -

Benefits to former personnel (13.0)...................................... - - -

Total Pay Costs........................................................................ 20,544 21,226 682

Travel and transportation of persons (21.0)........................ 340 397 57

Transportation of things (22.0).............................................. 3 3 0

Rental payments to Others GSA (23.2)................................. 2,359 2,503 144

Communication, utilities, and misc. charges (23.3)............. 466 475 9

Printing and reproduction (24.0)............................................ 15 15 0

Other Contractual Services:

Advisory and assistance services (25.1).......................... 23,240 36,489 13,249

Other services (25.2)............................................................. 225 229 4

Purchase of goods and services from

government accounts (25.3)............................................. 6,338 7,377 1,039

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............................ 29,804 44,096 14,292

Supplies and materials (26.0).................................................. 57 68 11

Total Non-Pay Costs............................................................... 33,043 47,556 14,513

Total Salary and Expense....................................................... 53,587 68,782 15,195

Direct FTE................................................................................ 156 162 6

228
SUPPLEMENTARY TABLES

Detail of Full-Time Equivalent Employment (FTE)

Administration for Community Living

2013 

Actual 

Civilian 1/

2013 

Actual 

Military

2013 

Actual 

Total

2014 

Est. 

Civilian

2014 

Est. 

Military

2014 

Est. 

Total

2015 

Est. 

Civilian

2015 

Est. 

Military

2015 

Est. 

Total

Immediate Office of the ...................

 Administrator.................................

 Direct:............................................... 16 16 17 17 19 19

 Reimbursable:.................................. 0 0 0 0 0 0

 Total:............................................. 16 0 16 17 0 17 19 0 19

Administration on Aging................

 Direct:............................................... 28 28 28 28 32 32

 Reimbursable:.................................. 6 6 6 6 6 6

 Total:............................................. 34 0 34 34 0 34 38 0 38

Administration on Intellectual........

 & Developmental Disabilities......

 Direct:............................................... 21 21 24 24 24 24

 Reimbursable:.................................. 0 0 0 0 0 0

 Total:............................................. 21 0 21 24 0 24 24 0 24

Center for Management and ..........

 Budget.............................................

 Direct:............................................... 25 25 26 26 26 26

 Reimbursable:.................................. 1 1 1 1 1 1

 Total:............................................. 26 0 26 27 0 27 27 0 27

Center for Disability and Aging.....

 Policy...............................................

 Direct:............................................... 26 26 26 26 26 26

 Reimbursable:.................................. 2 2 4 4 5 5

 Total:............................................. 28 0 28 30 0 30 31 0 31

Office of Regional Operations........

 Direct:............................................... 33 33 35 35 35 35

 Reimbursable:.................................. 4 4 4 4 4 4

 Total:............................................. 37 0 37 39 0 39 39 0 39

FTE Total........................................... 162 0 162 171 0 171 178 0 178

229
SUPPLEMENTARY TABLES

Average GS Grade

FY 2011............................................... 12.8

FY 2012............................................... 12.8

FY 2013............................................... 12.9

FY 2014............................................... 12.8

FY 2015............................................... 12.8

1/ For FY 2013, accurate actual FTE data for SHIPs and SCSEP is not available, since staff working on these 

programs in CMS and the Dept. of Labor also work on other programs. As a result, FTE numbers for FY 2013

have been made comparable to the numbers included for these programs in FY 2014 and FY 2015.

230
SUPPLEMENTARY TABLES

Detail of Positions

Administration for Community Living

2013

 Actual 2014 Base 2015 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 $ 155,130 $ 155,577 $ 155,577

ES-6................................................................

ES-5................................................................ 2 2 2

ES-4................................................................ 2 2 2

ES-3................................................................ 1 1

ES-2................................................................

ES-1................................................................

Subtotal .................................................... 4 5 5

 Total - ES Salary $ 673,813 $ 823,750 $ 829,928

GS-15.............................................................. 28 26 27

GS-14.............................................................. 27 25 28

GS-13.............................................................. 48 59 69

GS-12.............................................................. 20 24 25

GS-11.............................................................. 6 6 8

GS-10.............................................................. 2 2 2

GS-9................................................................ 7 8 8

GS-8................................................................ 1 1 1

GS-7................................................................ 2 2 2

GS-6................................................................ 1 1 1

GS-5................................................................ 1 1 1

GS-4................................................................ 0 0 0

GS-3................................................................ 0 0 0

GS-2................................................................ 0 0 0

GS-1................................................................ 0 0 0

Subtotal .................................................... 143 155 172

 Total - GS Salary $ 14,975,626 $ 16,648,158 $ 17,673,416

231
SUPPLEMENTARY TABLES

2013

 Actual 2014 Base 2015 Budget

Average ES level ......................................... 3.2 3 3

Average ES salary........................................ $168,453 $164,750 $165,986

Average GS grade........................................ 12.9 12.8 12.8

Average GS salary....................................... $104,725 $103,207 $102,752

Average GS salary & benefits $134,048 $132,104 $131,523

232
SUPPLEMENTARY TABLES

FTE Funded by the Affordable Care Act

Administration for Community Living

(Dollars in thousands)

Program Section(s) $ FTEs CEs $ FTEs CEs $ FTEs CEs

Pre-existing programs funded by ACA (Mandatory)

 National Clearinghouse for Long-Term Care Information 1/ Title VIII $ 3,000 0 0 $ 3,000 1 0 $ 86 0 0

 Medicare Improvements for Patients & Providers Act Programs Section 3306 $ - 0 0 $ - 0 0 $ 25,000 0 0

New programs authorized and funded by ACA (Mandatory)

 Aging and Disability Resource Centers 2/ Section 2405 $ 10,000 3 0 $ 10,000 4 0 $ 9,490 4 0

New programs funded from the PPHF under ACA (Discretionary)

 Adult Protective Services (Prevention & Public Health Fund) Section 4002 $ - 0 0 $ 6,000 0 0 $ 2,000 0 0

 Chronic Disease Self-Management Education (PPHF) Section 4002 $ - 0 0 $ 10,000 0 0 $ 7,086 1 0

 Alzheimer's Disease Initiative--Supportive Services (PPHF) Section 4002 $ - 0 0 $ - 0 0 $ - 0 0

 Alzheimer's Disease Initiative--Communications (PPHF) Section 4002 $ - 0 0 $ 4,000 0 0 $ 150 0 0

 Falls Prevention--(PPHF) Section 4002 $ - 0 0 $ - 0 0 $ - 0 0

Programs authorized by ACA but funded by other sources (Discretionary)

 Elder Justice Initiative/Adult Protective Services 

Subtitle H, 

Sections 6701-

6703 $ - 0 0 $ - 0 0 $ - 0 0

FY 2011 FY 2012 FY 2013

Program Section(s) $ FTEs CEs $ FTEs CEs

Pre-existing programs funded by ACA (Mandatory)

 National Clearinghouse for Long-Term Care Information 1/ Title VIII $ - 0 0 $ - 0 0

 Medicare Improvements for Patients & Providers Act Programs Section 3306 $ - 0 0 $ - 0 0

New programs authorized and funded by ACA (Mandatory)

 Aging and Disability Resource Centers 2/ Section 2405 $ 9,280 3 0 $ - 0 0

New programs funded from the PPHF under ACA (Discretionary)

 Adult Protective Services (Prevention & Public Health Fund) Section 4002 $ - 0 0 $ - 0 0

 Chronic Disease Self-Management Education (PPHF) Section 4002 $ 8,000 0 0 $ 8,000 0 0

 Alzheimer's Disease Initiative--Supportive Services (PPHF) Section 4002 $ 10,500 0 0 $ 10,500 0 0

 Alzheimer's Disease Initiative--Communications (PPHF) Section 4002 $ 4,200 0 0 $ 4,200 0 0

 Falls Prevention--(PPHF) Section 4002 $ 5,000 0 0 $ 5,000 0 0

Programs authorized by ACA but funded by other sources (Discretionary)

 Elder Justice Initiative/Adult Protective Services 

Subtitle H, 

Sections 6701-

6703 $ - 0 0 $ 25,000 4 0

FY 2014 FY 2015

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Significant Items in Appropriations Committee Reports

Administration for Community Living

Community Living - The Committee encourages CMS and ACL to continue their joint 

expansion and support of home- and community-based services for individuals with disabilities 

through the Money Follows the Person program, the Community First Choice Option, and other 

programs. In support of this effort, the Committee encourages CMS and ACL to provide 

regulatory guidance and technical assistance to States and other interested parties regarding the 

various Federal tools that have been created to help them expand access to home- and 

community-based long-term services and supports. In addition, the Committee encourages CMS 

and ACL to create an interagency task force on implementing the Olmstead decision.

Actions Taken or To Be Taken - CMS and ACL will continue to collaborate on the joint 

expansion, financing and oversight of the full range of CMS and ACL initiatives that will help 

states develop consumer-centered systems of long-term services and supports. This past year, at 

the direction of the HHS Secretary, CMS and ACL co-convened the HHS Community Living 

Council comprised of all the HHS entities involved in Long-Term Services and Supports to 

ensure HHS-wide coordination of the Department’s work in this area, including its work on 

Olmstead. On the regulatory front, after extensive HHS-wide review and public input, CMS 

issued the Home and Community-Based Services Settings Final Rule establishing requirements 

for the qualities of settings that are eligible for reimbursements under Medicaid. In this final 

rule, CMS is moving away from defining home and community-based settings by “what they are 

not,” and toward defining them by the nature and quality of individuals’ experiences. The home 

and community-based setting provisions in this final rule establish a more outcome-oriented 

definition of home and community-based settings, rather than one based solely on a setting’s 

location, geography, or physical characteristics. The changes will maximize the opportunities for 

participants in HCBS programs to have access to the benefits of community living and to receive 

services in the most integrated setting and will effectuate the law’s intention for Medicaid HCBS 

to provide alternatives to services provided in institutions.

Protection of Vulnerable Older Americans - The Committee urges the Long-term Care 

Ombudsman program to include ombudsman training on the possible dangers of chemical and 

physical restraints, including portable adult bedrails, and how to safely minimize their use.

Actions Taken or To Be Taken - Since the early 1980’s States’ Long-Term Care Ombudsman 

Programs have worked to eliminate or reduce the use of chemical and physical restraints. The 

Administration for Community Living (ACL) funds the National Ombudsman Resource Center

(NORC) which provides ongoing training and technical assistance to long-term care ombudsman 

programs, including training on chemical and physical restraint reduction in long-term care 

facilities.

235
SIGNIFICANT ITEMS IN APPROPRIATIONS COMMITTEE REPORTS

In the past two years, the NORC, and its host agency, The National Consumer Voice for Quality 

Long-Term Care, have increased their focus on developing training materials related to chemical 

restraint reduction, specifically the reduction in the misuse of anti-psychotics. These materials 

can be found at: http://www.theconsumervoice.org/advocate/antipsychotic-drugs. Recent 

activities include:

• Hosting a webinar entitled "Ending Misuse of Anti-Psychotics in Long-Term Care."

• In-person training “The Antipsychotic Initiative and the Role of the Ombudsman” at a 

national training conference for State LTC Ombudsmen. 

• Promoting LTC Ombudsman participation in Advancing Excellence in America’s 

Nursing Homes, which has a medications goal that focuses on reduction of inappropriate 

use of antipsychotic drugs. 

• Supporting the CMS initiative to reduce the misuse of antipsychotic drugs in nursing 

homes by inviting CMS to participate in training opportunities and by promoting their 

training materials and webinars.

These activities in turn give State LTC Ombudsmen the tools to participate in state-level 

partnerships to focus on reducing chemical and physical restraints and often include training of 

long-term care providers, ombudsmen, residents and their families.

Further, ACL’s Office of Long-Term Care Ombudsman Programs works directly with long-term 

care provider associations and Advancing Excellence in America’s Nursing Homes Campaign on 

restraint reduction and related issues on a regular basis. ACL works closely with CMS on 

review of policies, resources, and proposed regulations for appropriate care in nursing facilities, 

including restraint reduction. A recent example was ACL’s review and comment on CMSdeveloped training for nursing home staff on person-centered dementia care, which directly 

relates to antipsychotic reduction and eliminating physical restraints.

Most recently, ACL initiated a new collaboration with the Consumer Products Safety 

Commission (CPSC) to promote consumer awareness of bedrail hazards which has resulted in 

the following outcomes: 

• CPSC developed a one page safety fact sheet on adult bed rail hazards see: 

http://www.cpsc.gov/en/Safety-Education/Neighborhood-Safety-Network/Posters/AdultBed-Rails/

• CPSC has convened a voluntary standards workgroup which includes a consumer 

advocate.

• CPSC, the Food and Drug Administration (FDA), ACL and other federal partners worked 

to develop consumer information resulting in a “Bedrail Safety” webpage which includes 

information for consumers and long-term care providers on adult portable bedrail safety. 

See 

236
SIGNIFICANT ITEMS IN APPROPRIATIONS COMMITTEE REPORTS

http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/HomeHealthandCo

nsumer/ConsumerProducts/BedRailSafety/default.htm

• These web-based resources were also shared with long-term care ombudsmen through the 

NORC and to the aging and disability networks through the ACL e-newsletter and other 

venues.

• The CPSC posted a “Petition Requesting a Ban or Standard on Adult Portable Bed 

Rails;” about a dozen local and state LTC Ombudsmen provided public comments to the 

CPSC. 

• ACL is working to develop a safety focus for Older American’s month in May 2014 with 

a theme “Safe Today. Healthy Tomorrow.” which will include information on bedrail 

safety. See http://www.acl.gov/NewsRoom/Observances/oam/2014/Index.aspx

Improving Transportation for Older Americans - The Committee is aware of the growing need 

for transportation services for older Americans and urges ACL to support efforts to encourage 

private-public partnerships to carry out section 416 of the OAA.

Actions Taken or To Be Taken - ACL is the co-chair of the United We Ride Health and 

Transportation Workgroup. In December 2013, this workgroup began holding monthly listening 

sessions in webinar format for all federal agencies involved in the Coordinating Council on 

Access and Mobility. The goal of the listening sessions is to learn about transportation 

innovation, discover synergies and encourage cross-collaboration to avoid duplication. To date, 

sessions have highlighted innovations that intersect health and transportation by the Federal 

Highways Administration, the Department of Transportation’s Office of the Secretary, and the 

Veteran’s Administration (VA). ACL is also working closely with Federal Transit 

Administration (FTA) and their National Center for Mobility Management (NCMM) to stimulate 

mobility management at all levels to help encourage private-public partnerships to increase rides 

at the same or reduced cost.

In addition, ACL’s Inclusive Transportation Project, in coordination with FTA, seeks to identify 

and translate the process used by community transportation systems to fully include older adults 

and people with disabilities in project work groups that identify barriers, identify solutions, 

implement solutions, and evaluate progress. The intent of the inclusive process is to improve 

community transportation by incorporating older adults and people with disabilities into the 

planning/work process, including the promotion of private-public partnerships.

Adult Protective Services Demonstration - This new program, as authorized in the Elder Justice 

Act, will provide competitive grants to States to test and evaluate innovative approaches to 

preventing and responding to elder abuse. The Committee encourages ACL to test innovative 

practices in local communities that develop partnerships across disciplines for the prevention, 

investigation, and prosecution of abuse, including financial abuse against the elderly.

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Actions Taken or To Be Taken - Currently, most communities do not have comprehensive 

elder abuse prevention efforts that engage a broad set of individuals and institutions that can play 

a role in combating abuse, such as health professionals, law enforcement and legal services 

agencies, social workers, clergy, and community organizations. However, promising 

multidisciplinary models and certain strategies from other family violence prevention programs 

exist that could qualify for pilot testing elder abuse interventions. In FY 2012, ACL received 

$5.5 million from the Prevention and Public Health Fund to test and evaluate comprehensive 

approaches to preventing elder abuse. Five states received funding to test interventions, and all 

the projects include multidisciplinary approaches that involve the state unit on aging; adult 

protective services; local community social services, health, and behavioral health providers; and 

law enforcement. Using the results of these prevention projects, ACL will develop a 

compendium of best practices and lessons learned that APS programs across the nation can use 

to improve their programs.

Aging and Disability Resource Centers- These centers provide information, one-on-one 

counseling, and access for individuals to learn about their long-term services and support options 

with the goal of allowing seniors and individuals with disabilities to maintain their independence. 

The Committee urges ACL to improve coordination among ADRCs, area agencies on aging, and 

centers for independent living to ensure that there is `no wrong door' to access services.

Actions Taken or To Be Taken - ACL will continue to partner with CMS and the Veteran’s 

Health Administration to promote the development of a no wrong door model that serves all 

LTSS populations and that involve a broad range of local organizations with the capacity to 

serve the various LTSS populations, including the area agencies on aging and the centers for 

independent living, in the operations of a state’s no wrong door system. This is one of the main 

objectives of the special 3-year funding that was made available to 8 states in 2012 as they work 

with ACL, CMS and the VHA to develop national standards for a No Wrong Door Systems that 

will serve all LTSS populations and all LTSS payers.

Community Living - The Committee encourages CMS and ACL to continue their joint 

expansion and support of home- and community-based services for individuals with disabilities 

through the Money Follows the Person program, the Community First Choice Option, and other 

programs. In support of this effort, the Committee encourages CMS and ACL to provide 

regulatory guidance and technical assistance to States and other interested parties regarding the 

various Federal tools that have been created to help them expand access to home- and 

community-based long-term services and supports. In addition, the Committee encourages CMS 

and ACL to create an interagency task force on implementing the Olmstead decision.

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Actions Taken or To Be Taken - CMS and ACL will continue to collaborate on the joint 

expansion, financing, and oversight of the full range of CMS and ACL initiatives that will help 

states develop consumer-centered systems of long-term services and supports. This past year, at 

the direction of the HHS Secretary, CMS and ACL co-convened the HHS Community Living 

Council comprised of all the HHS entities involved in LTSS to ensure HHS-wide coordination of 

the Department’s work in this area, including its work on Olmstead. On the regulatory front, 

after extensive HHS-wide review and public input, CMS issued the Home and CommunityBased Services Settings Final Rule establishing requirements for the qualities of setting s that are 

eligible for reimbursements under Medicaid. In this final rule, CMS is moving away from 

defining home and community-based settings by “what they are not,” and toward defining them 

by the nature and quality of individuals’ experiences. The home and community-based setting 

provisions in this final rule establish a more outcome-oriented definition of home and 

community-based settings, rather than one based solely on a setting’s location, geography, or 

physical characteristics. The changes will maximize the opportunities for participants in HCBS 

programs to have access to the benefits of community living and to receive services in the most 

integrated setting and will effectuate the law’s intention for Medicaid HCBS to provide 

alternatives to services provided in institutions.

Protection of Vulnerable Older Americans - The Committee urges the Long-term Care 

Ombudsman program to include ombudsman training on the possible dangers of chemical and 

physical restraints, including portable adult bedrails, and how to safely minimize their use.

Actions Taken or To Be Taken - Since the early 1980’s, state Long-Term Care Ombudsman 

Programs have worked to eliminate or reduce the use of chemical and physical restraints. The 

Administration for Community Living (ACL) funds the National Ombudsman Resource Center

(NORC) which provides ongoing training and technical assistance to long-term care ombudsman 

programs, including training on chemical and physical restraint reduction in long-term care 

facilities.

In the past two years, the NORC, and its host agency, The National Consumer Voice for Quality 

Long-Term Care, have increased their focus on developing training materials related to chemical 

restraint reduction, specifically the reduction in the misuse of anti-psychotics. These materials 

can be found at: http://www.theconsumervoice.org/advocate/antipsychotic-drugs.

Recent activities include:

• Hosting a webinar entitled "Ending Misuse of Anti-Psychotics in Long-Term Care."

• In-person training “The Antipsychotic Initiative and the Role of the Ombudsman” at a 

national training conference for State LTC Ombudsmen. 

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SIGNIFICANT ITEMS IN APPROPRIATIONS COMMITTEE REPORTS

• Promoting LTC Ombudsman participation in Advancing Excellence in America’s 

Nursing Homes, which has a medications goal that focuses on reduction of inappropriate 

use of antipsychotic drugs. 

• Supporting the CMS initiative to reduce the misuse of antipsychotic drugs in nursing 

homes by inviting CMS to participate in training opportunities and by promoting their 

training materials and webinars.

• These activities in turn give State LTC Ombudsmen the tools to participate in state-level 

partnerships to focus on reducing chemical and physical restraints and often include 

training of long-term care providers, ombudsmen, residents and their families.

Further, ACL’s Office of Long-Term Care Ombudsman Programs works directly with long-term 

care provider associations and Advancing Excellence in America’s Nursing Homes Campaign on 

restraint reduction and related issues on a regular basis. ACL works closely with CMS on 

review of policies, resources, and proposed regulations for appropriate care in nursing facilities, 

including restraint reduction. A recent example was ACL’s review and comment on CMSdeveloped training for nursing home staff on person-centered dementia care, which directly 

relates to antipsychotic reduction and eliminating physical restraints.

Most recently, ACL initiated a new collaboration with the Consumer Products Safety 

Commission (CPSC) to promote consumer awareness of bedrail hazards which has resulted in 

the following outcomes: 

• CPSC developed a one page safety fact sheet on adult bed rail hazards see: 

http://www.cpsc.gov/en/Safety-Education/Neighborhood-Safety-Network/Posters/AdultBed-Rails/

• CPSC has convened a voluntary standards workgroup which includes a consumer 

advocate.

• CPSC, the Food and Drug Administration (FDA), ACL and other federal partners worked 

to develop consumer information resulting in a “Bedrail Safety” webpage which includes 

information for consumers and long-term care providers on adult portable bedrail safety. 

See 

http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/HomeHealthandCo

nsumer/ConsumerProducts/BedRailSafety/default.htm

• These web-based resources were also shared with long-term care ombudsmen through the 

NORC and to the aging and disability networks through the ACL e-newsletter and other 

venues.

• The CPSC posted a “Petition Requesting a Ban or Standard on Adult Portable Bed 

Rails;” about a dozen local and state LTC Ombudsmen provided public comments to the 

CPSC. 

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SIGNIFICANT ITEMS IN APPROPRIATIONS COMMITTEE REPORTS

• The ACL/AoA is working to develop a safety focus for Older American’s month in May, 

2014 with a theme “Safe Today. Healthy Tomorrow.” which will include information on 

bedrail safety. See http://www.acl.gov/NewsRoom/Observances/oam/2014/Index.aspx

Improving Transportation for Older Americans - The Committee is aware of the growing need 

for transportation services for older Americans and urges ACL to support efforts to encourage 

private-public partnerships to carry out section 416 of the OAA.

Actions Taken or To Be Taken - ACL is the co-chair of the United We Ride Health and 

Transportation Workgroup. In December 2013, this workgroup began holding monthly listening 

sessions in webinar format for all federal agencies involved in the Coordinating Council on 

Access and Mobility. The goal of the listening sessions is to learn about transportation 

innovation, discover synergies and encourage cross-collaboration to avoid duplication. To date, 

sessions have highlighted innovations that intersect health and transportation by FHWA, DoT’s 

Office of the Secretary, and the VA. Attached is the February 2014 listening session 

announcement, which featured the VA’s mobility management initiative and ROI metrics.

In addition, ACL is working closely with FTA and their National Center for Mobility 

Management (NCMM) (see attached flyer). Currently, FTA, NCMM and ACL are working to 

stimulate mobility management at all levels to help encourage private-public partnerships to 

increase rides at the same or reduced cost.

Lastly, the ACL Inclusive Transportation Project, in coordination with FTA, seeks to identify 

and translate the process used by community transportation systems to fully include older adults 

and people with disabilities in project work groups that identify barriers, identify solutions, 

implement solutions, and evaluate progress. The intent of the inclusive process is to improve 

community transportation by incorporating older adults and people with disabilities into the 

planning/work process, including the promotion of private-public partnerships.

Adult Protective Services Demonstration - This new program, as authorized in the Elder Justice 

Act, will provide competitive grants to States to test and evaluate innovative approaches to 

preventing and responding to elder abuse. The Committee encourages ACL to test innovative 

practices in local communities that develop partnerships across disciplines for the prevention, 

investigation, and prosecution of abuse, including financial abuse against the elderly.

Actions Taken or To Be Taken - Currently, most communities do not have comprehensive 

elder abuse prevention efforts that engage a broad set of individuals and institutions that can play 

a role in combating abuse, such as health professionals, law enforcement and legal services 

agencies, social workers, clergy, and community organizations. However, promising 

multidisciplinary models and certain strategies from other family violence prevention programs 

241
SIGNIFICANT ITEMS IN APPROPRIATIONS COMMITTEE REPORTS

exist that could qualify for pilot testing elder abuse interventions. In FY 2012, ACL received 

$5.5 million from the Prevention and Public Health Fund, as well as $2 million in FY 2013, to 

test and evaluate comprehensive approaches to preventing elder abuse. Five states received 

funding to test interventions, and all the projects include multidisciplinary approaches that 

involve the state unit on aging; adult protective services; local community social services, health,

and behavioral health providers; and law enforcement. Using the results of these prevention 

projects, AoA will develop a compendium of best practices and lessons learned that APS 

programs across the nation can use to improve their programs. The information garnered from 

this investment will be used as a starting place in FY 2015 for expanding best practices into 

developing standards to detect and report elder abuse, neglect and exploitation, as outlined under 

the Elder Justice Initiative.

Aging and Disability Resource Centers- These centers provide information, one-on-one 

counseling, and access for individuals to learn about their long-term services and support options 

with the goal of allowing seniors and individuals with disabilities to maintain their independence. 

The Committee urges ACL to improve coordination among ADRCs, area agencies on aging, and 

centers for independent living to ensure that there is `no wrong door' to access services.

Actions Taken or To Be Taken - ACL will continue to partner with CMS and the Veteran’s 

Health Administration to promote the development of a no wrong door model that serves all 

LTSS populations and that involve a broad range of local organizations with the capacity to 

serve the various LTSS populations, including the area agencies on aging and the centers for 

independent living, in the operations of a state’s no wrong door system. This is one of the main 

objectives of the special 3-year funding that was made available to 8 states in 2012 as they work 

with ACL, CMS and the VHA to develop national standards for a No Wrong Door Systems that 

will serve all LTSS populations and all LTSS payers.

State Health Insurance Assistance Program-The Committee concurs with the administration's 

proposal to transfer this grant program to ACL from CMS and includes bill language that reflects 

this transfer. About two-thirds of the 54 State SHIPs are already administered by State units on 

aging. SHIP activities are aligned with ACL's mission to develop a comprehensive system of 

home- and community-based services to help seniors maintain their health and independence.

Actions Taken or To Be Taken - ACL and CMS welcome Congress’s decision to include the 

transfer of the SHIPs in the budget it sent to the President, and the ACL and CMS Administrators 

have already sent a joint communique to the SHIPs stating their commitment to an orderly and 

timely transfer of the program that will be seamless for the state SHIP operations. To that end, 

an ACL/SHIP team has been established and is already working on the many operational details 

that will need to be addressed as part of the orderly transfer.

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