DEPARTMENT 

of HEALTH 

and HUMAN 

SERVICES 

Fiscal Year 

2017 

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 2017 President’s Budget 

request, totaling $2.0 billion, a net increase of +$28 million. The vast majority of ACL’s funding is allocated 

for grants that provide direct services and supports. ACL received modest increases in FY 2016 for many of 

these core services programs and our FY 2017 request maintains these increases while also requesting 

additional funding for three key areas. First, +$23.8 million is requested for nutrition and supportive services 

programs to help meet the needs of a growing senior population— and thereby reduce or delay the need for 

more expensive medical interventions and institutional services. Second, +$2 million is requested for Elder 

Justice/Adult Protective Services (APS). Historically, an absence of federal stewardship in APS has led to 

inconsistent data systems and no reporting requirements at the national level, and prevented APS programs 

from conducting meaningful program evaluations. The additional funding will further support states by 

providing significant, on-going technical assistance and resources for identifying promising and best practices, 

participating in national APS data collection efforts; and conducting research and evaluations to increase the 

knowledge base about effective APS programming and practices. Finally, +$3.6 million is requested for two 

cross-cutting programs—Lifespan Respite Care and Aging and Disability Resource Centers—to further 

develop more efficient, cost-effective and consumer responsive State-wide systems that support both seniors 

and those of all ages with disabilities, and their families and caregivers. 

The FY 2017 request also incorporates a new proposal to use up to 1% of the funds appropriated to ACL’s 

nutrition programs to develop innovative, evidence-based practices for senior nutrition. Examples of 

promising practices that enhance the quality and effectiveness of our nutrition program include service 

products that appeal to caregivers (such as web-based ordering systems and carryout meals), increased 

involvement of volunteers (such as retired chefs), new service models (testing variations and hybrid strategies) 

and other innovations to better serve older adults. These funds may be used to help develop and test additional 

models or to replicate models that have already been tested in other community-based settings. 

Finally, ACL continues to work towards the seamless integration of its recently transferred programs— 

including Traumatic Brain Injury, Limb Loss, and those programs transferred by the 2014 Workforce 

Innovation and Opportunity Act—having brought them all together under one roof in our recent move to the 

Mary E. Switzer building. These programs closely align with ACL’s vision that all people, regardless of age 

and disability, live with dignity, make their own choices, and participate fully in society. The transfer of these 

programs is a significant step in the evolution of ACL. ACL’s past few years have 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 

Executive Summary 

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

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

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

Appropriations Language............................................................................................................................ 19 

Appropriations Language Analysis............................................................................................................. 21 

Amounts Available for Obligation .............................................................................................................. 22 

Summary of Changes.................................................................................................................................. 23 

Budget Authority by Activity ..................................................................................................................... 24 

Authorizing Legislation .............................................................................................................................. 26 

Appropriations History Table ..................................................................................................................... 28 

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

Health and Independence for Older Adults 

Summary of Request................................................................................................................................... 31 

Home and Community-Based Supportive Services.................................................................................... 35 

Nutrition Services........................................................................................................................ 45 

Preventive Health Services ......................................................................................................................... 61 

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

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

Native American Nutrition and Supportive Services.................................................................................. 81 

Native American Nutrition & Supportive Services .................................................................................... 84 

Aging Network Support Activities ............................................................................................................. 87 

Caregiver and Family Support Services 

Summary of Request................................................................................................................................... 95 

Family Caregiver Support Services............................................................................................................ 99 

Native American Caregiver Support Services.......................................................................................... 107 

Alzheimer’s Disease Supportive Services Program.................................................................................. 111 

Alzheimer’s Disease Supportive Services Program.................................................................................. 114 

Lifespan Respite Care...............................................................................................................................121 

Protection of Vulnerable Adults 

Summary of Request................................................................................................................................. 129 

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Long-Term Care Ombudsman Program ................................................................................................... 131 

Prevention of Elder Abuse and Neglect.................................................................................................... 139 

Program Description and Accomplishments: ........................................................................................... 139 

Funding History: ....................................................................................................................................... 140 

Budget Request:........................................................................................................................................ 140 

Output Table: ............................................................................................................................................ 141 

Prevention of Elder Abuse and Neglect.................................................................................................... 141 

Senior Medicare Patrol Program............................................................................................................... 145 

Elder Rights Support Activities................................................................................................................ 151 

Disability Programs, Research and Services 

Summary of Request................................................................................................................................. 159 

State Councils on Developmental Disabilities.......................................................................................... 161 

Developmental Disabilities – Protection and Advocacy........................................................................... 170 

University Centers for Excellence in Developmental Disabilities............................................................ 178 

Developmental Disabilities – Projects of National Significance .............................................................. 186 

National Institute on Disability, Independent Living, and Rehabilitation Research................................. 192 

Independent Living ................................................................................................................................... 200 

Limb Loss Resource Center...................................................................................................................... 208 

Program Description and Accomplishments: ........................................................................................... 208 

Funding History: ....................................................................................................................................... 209 

Budget Request:........................................................................................................................................ 209 

Limb Loss Resource Center...................................................................................................................... 210 

Paralysis Resource Center......................................................................................................................... 212 

Traumatic Brain Injury ............................................................................................................................. 216 

Consumer Information, Access & Outreach 

Summary of Request................................................................................................................................. 224 

Aging and Disability Resource Centers.................................................................................................... 226 

State Health Insurance Assistance Programs............................................................................................ 232 

Voting Access for Individuals with Disabilities....................................................................................... 238 

Program Description and Accomplishments: ........................................................................................... 238 

Funding History: ....................................................................................................................................... 239 

Budget Request:........................................................................................................................................ 239 

Grant Awards Table:................................................................................................................................. 240 

Voting Access for Individuals with Disabilities Grant Awards................................................................ 240 

Assistive Technology ................................................................................................................................ 244 

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Alzheimer’s Disease Initiative - Outreach Campaign............................................................................... 256 

Program Administration ........................................................................................................................ 260 

Supplementary Tables 

Object Classification Table - Direct.............................................................................................266

Salaries and Expenses...............................................................................................................................267 

Detail of Full-Time Equivalent Employment (FTE)................................................................................. 268 

Detail of Positions..................................................................................................................................... 269 

Programs Proposed for Elimination .......................................................................................................... 270 

FTE Funded by the Affordable Care Act.................................................................................................. 271 

Physicians’ Comparability Allowance Worksheet.................................................................................... 272 

Significant Items in Appropriations Committee Reports.................................................................... 274 

Prevention and Public Health Fund...................................................................................................... 280 

Text Description Administration for Community Living Organizational Chart ............... 282 

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Introduction and Mission 

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

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

with disabilities live independently and fully participate in their communities. ACL’s mission is 

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

across the lifespan, and their families and caregivers. Those with disabilities or functional 

limitations of any type, regardless of age, have a common interest: access to home and communitybased supports and services that can help individuals to fully participate in all aspects of society, 

including having the option to live at home, which can be vital to an individual’s well-being, 

instead of moving into an institutional setting. ACL works to improve this access through program 

lines that address the unique needs of each population. 

ACL’s programs provide community-based services and supports that help people to remain 

independent while reducing costs to other public programs such as Medicaid. This is critical given 

the growth in the segments of the population that these programs serve: 

• The U.S. population over age 60 is projected to increase by 20 percent between 2014 and 

2020, from 64.8 million to 77.6 million.

1 

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

with disabilities, of which over 12 million required assistance with activities of daily living 

or instrumental activities of daily living. 2 

• Studies indicate that individuals with developmental disabilities comprise between 1.2 and 

1.65 percent of the U.S. population, or between 3.8 and 5.3 million individuals. 3 

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

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

http://www.census.gov/population/projections/data/national/2014/downloadablefiles.html. Accessed 08 January 

2015. 

2 U.S. Census Bureau, “Americans With Disabilities: 2010,” http://www.census.gov/prod/2012pubs/p70-131.pdf, 

Issued July 2012, Accessed 21 August 2014.

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

http://www.acl.gov/Programs/AIDD/DDA BOR ACT 2000/p2 tI subtitleA.aspx) and census estimates of U.S. 

Population, July 1, 2014 

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EXECUTIVE SUMMARY 

• The number of seniors age 65 and older with severe disabilities – defined as 3 or more 

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

is projected to increase by more than 20 percent by the year 2020. 4 

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

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

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

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

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

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

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

option. 

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

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

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

Accessed 10 January, 2016. 

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

http://www.rand.org/pubs/external_publications/EP66196.html. 

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Overview of Budget Request 

The Administration for Community Living is committed to the fundamental principle that older 

adults and people of all ages with disabilities should be able to live where they choose, with the 

people they choose, and fully participate in their communities. ACL’s programs provide homeand community-based services and supports, and invest in research and best practices, to make 

that principle a reality for millions of people. 

The FY 2017 discretionary request for the Administration for Community Living is 

$1,993,294,000, an increase of $28,444,000 over the FY 2016 enacted level. The request maintains 

the modest increases received in FY 2016 and continues to focus on sustaining core programs that 

promote self-determination, independence, productivity and community integration for older 

adults and people of all ages with disabilities, allowing them to remain independent and involved 

in their communities. The budget requests additional funding for four priority investment areas – 

nutrition and supportive services for older adults, adult protective services and elder justice, respite 

care, and streamlined access to community-based services. The request also includes funding to 

cover increased costs associated with ACL’s new headquarters location and external services. 

Finally the budget also reflects the transfer (consistent with the FY 2016 appropriation) of the 

Traumatic Brain Injury Program from the Health Resources and Services Administration to ACL. 

Services to Increase the Independence of Older Adults and People with Disabilities 

ACL’s community-based services and supports are a critical part of state and local efforts to ensure 

that older adults and people with disabilities can live at home with the supports they need in the 

community, rather than turning to more expensive institutional care. Recognizing the growing need 

for these services, ACL proposes additional investments in three key programs: 

• Home and Community-Based Supportive Services: ACL will invest an additional 

$10,000,000 in supportive services for older adults, for a total of $357,724,000. These 

services include information and assistance, transportation, case management, personal 

care services, chore services, senior centers and physical fitness programs. In combination 

with state and local funding, the budget will support over 31.8 million hours of assistance 

to seniors unable to perform daily activities of living such as bathing and dressing; 

22.3 million rides for critical activities such as visiting the doctor, pharmacy, or grocery 

stores; and 7.8 million hours of adult day services, to name just a few. 

• Nutrition Services: ACL will invest an additional $13,804,000 in nutrition programs 

(+$5,749,000 for meals provided in congregate settings such as community senior centers 

and +$8,055,000 for home-delivered meals), for a total of $848,557,000. These services 

help older Americans, many of whom are low-income, to remain independent and in their 

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EXECUTIVE SUMMARY 

own homes, delaying or preventing the need for more costly institutional services. Rising 

costs of providing meals are making it difficult for local programs to continue to serve as 

many existing clients. This increase in funding, leveraged further by state and local 

funding, will allow states to provide a total of 205 million meals to over 2 million older 

Americans nationwide. 

• Lifespan Respite Care: ACL will invest an additional $1,640,000 in the Lifespan Respite 

Care program to increase access to, and improve the quality of respite support for family 

caregivers of older adults and people of all ages with disabilities. The support of informal 

caregivers – typically family and friends – is often the critical factor in enabling a person 

to live independently in his or her home A 2014 Rand Corporation study found that the 

care provided by informal caregivers of elderly adults has an estimated economic value of 

$522 billion.

6 Investments in services such as respite care that help people meet the 

physical, mental, emotional and financial challenges of caregiving enables them to 

continue to provide these services, which in turn delays or prevents the much higher costs 

– which often are government-funded – of the loved one needing institutional care. 

Modernizing and Positioning Services for the Future 

This budget also includes investments to modernize ACL’s core services and improve innovation 

and efficiency. By utilizing evidence-based practices and promoting the adoption of proven models 

and practices across our aging and disability networks, ACL will help to ensure that services are 

able to address the evolving needs of the populations we serve and target resources to where they 

are most needed. ACL proposes to invest in the following areas: 

• Modernizing Senior Nutrition Programs: The FY 2017 request incorporates a new 

proposal to use up to one percent of the funds appropriated to ACL’s nutrition programs 

for modernization initiatives. These funds will support competitive grants to translate 

research into practice and expand evidence-based models for delivering services at the 

community level. Promising practices that enhance quality and effectiveness of nutrition 

programs range from relatively minor changes, such as adding service products that appeal 

to caregivers (for example, web-based ordering systems and carryout meals) and increased 

involvement of specialized volunteers (such as retired chefs) to implementation of 

significantly different service delivery models. These funds may be used to help develop 

and test additional models or to replicate models that have already been tested in other 

community-based settings. This effort would increase the knowledge base of our nutrition 

providers; drive improved health outcomes for program recipients by promoting higher 

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

http://www.rand.org/pubs/external_publications/EP66196.html. 

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EXECUTIVE SUMMARY 

service quality, and increase program efficiency through innovative service delivery 

models. 

• Elder Rights Support Activities/National Adult Protective Services System: Historically, 

an absence of federal stewardship in APS has led to inconsistent data systems, and an 

absence of reporting requirements at the national level, and prevented APS programs from 

conducting meaningful program evaluations. In turn, this has made it nearly impossible to 

work across states to prevent and address elder abuse and exploitation. ACL’s request 

includes an additional $2,000,000 in Elder Justice funding, for a total of $10,000,000, to 

build on work begun in 2015 to reduce abuse, neglect, and exploitation and prevent the 

damage they cause to the health and independence of seniors and adults with disabilities. 

With this funding, ACL will provide significant, on-going technical assistance and 

resources for: identifying promising and best practices; participating in national APS data 

collection efforts; and conducting research and evaluations to increase the knowledge base 

about effective APS programing and practices. In addition, ACL will continue to develop 

a national Adult Protective Services data system, including grants to states to test and 

develop infrastructure, while also providing funding for key research to enable 

development of evidence-based interventions that will effectively prevent, identify, report, 

and respond to abuse of adults of all ages. 

• Streamlining Access to Community-Based Services: The budget requests an additional 

$2,000,000, for a total of $8,119,000, for the Aging and Disability Resource Center 

program, which has a proven track record of success in supporting state efforts to develop 

more efficient, cost-effective, and consumer-responsive systems of information, one-onone person-centered counseling, and streamlined access to long-term services and supports 

in the community. Aging and Disability Resource Centers make it easier for Americans to 

learn about and obtain the long-term services and supports they need to remain living in 

their own homes and communities. 

Enhancing Interagency Collaboration: The FY 2017 request includes new language (HHS General 

Provision 224) to facilitate collaboration with other Federal agencies both inside and outside the 

Department to address common priorities through joint grant making. This language would permit 

agencies to enter into reimbursable agreements to transfer funds from one agency to another for 

the purposes of making grants, such as allowing NIDILRR to collaborate with Departments such 

as Transportation and the Department of Veteran’s Affairs on research projects to address the 

needs of disabled veterans. NIDILRR historically participated in this collaboration with VA, and 

this new general provision language is needed for NIDILRR to continue this collaboration with 

VA and other agencies now that the program has moved to HHS. 

Other Programmatic Investments 

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EXECUTIVE SUMMARY 

Funding for core ACL programs under the Older Americans Act (OAA), the Developmental 

Disabilities Assistance and Bill of Rights Act, the Rehabilitation Act, the Assistive Technology 

Act, and other legislation would otherwise be maintained in this request. 

The FY 2017 budget request includes $27,700,000 from the Prevention and Public Health Fund 

authorized by the Affordable Care Act. Of this, $8,000,000 will continue to fund Chronic Disease 

Self-Management Education programs, $5,000,000 will support Senior Falls Prevention programs, 

and the remaining $14,700,000 will continue activities under the President’s Alzheimer’s 

Initiative, including an outreach campaign and the development of more dementia-capable longterm service and support systems for people with Alzheimer's Disease and their caregivers. 

Also included is an estimated $18 million in funding for the Senior Medicare Patrol program, 

financed by the Health Care Fraud and Abuse Control (HCFAC) account. Finally, ACL’s program 

level includes $37,500,000 for activities related to the Medicare Improvements for Patients and 

Providers Act. 

No funding is requested for the Assistive Technology (AT) Alternative Financing Program, a oneyear competitive-grant program no longer authorized under current law, which was funded at $2 

million through appropriations in FY 2016. 

Enhancing Program Integrity and Oversight 

ACL’s request includes $41,063,000 for Program Administration, an increase of +$1,000,000 over 

the FY 2016 enacted level. This increase is necessary to fund higher occupancy and external 

services costs projected as a result of ACL’s headquarters move to the Switzer building. Prior 

increases for additional administrative resources have been provided to fund the costs related to 

ACL’s headquarters relocation and to meet the needs of programs transferred in from other 

agencies. 

Because prior administrative increases have been fully consumed by the increased costs associated 

with operating new programs and headquarters relocation, ACL has not been able to make the 

necessary investments in the people and systems needed to ensure the integrity of our core 

programs. These programs comprise over 80% of ACL’s budget, awarded through 15 programs 

as formula grants to states and tribes, making it critical that we provide our grantees with the 

support they need to effectively and efficiently serve older adults and people with disabilities, as 

well as their families and caregivers. 

Therefore, beginning in FY 2017, ACL will add an additional 18 FTE to conduct program 

monitoring and oversight and to provide technical assistance to its formula grantees. These new 

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EXECUTIVE SUMMARY 

FTE will be responsible for performing oversight, conducting program evaluations, and providing 

technical assistance to enhance program performance and systems development for the core 

formula grant programs. With the addition of these FTE, ACL will be able to increase the 

resources devoted to program monitoring and integrity activities from approximately 23 FTE to 

41 FTE. When fully implemented in FY 2017, these added resources will allow ACL to adequately 

staff both its central and regional office teams to engage more effectively with staff at the tribal, 

state and local levels to ensure programs are operating effectively and meeting the needs of the 

populations ACL serves. 

Conclusion 

The populations served by ACL are growing. The U.S. population over age 60 is projected to 

increase by 20 percent between 2014 and 2020, from 64.8 million to 77.6 million.7 The total 

number of Americans living with disabilities in 2010 was 56.7 million people, 12 million of whom 

require assistance with tasks like dressing, eating, and performing household chores. 8 

Most of these people can live in their own homes, with family, or in other independent settings, if 

they have access to the help they need. For many, this help comes through the community-based 

services and supports provided by ACL’s programs. In most cases, providing these services and 

supports are significantly less expensive than the cost of institutional care, which is often borne by 

Medicaid. This budget will allow ACL to continue to provide services and supports to people with 

disabilities and older adults so that they can live where they choose, with the people they choose, 

and fully participate in their communities. 

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

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

http://www.census.gov/population/projections/data/national/2014/downloadablefiles.html. Accessed 08 January 

2015. 

8 U.S. Census Bureau, “Americans With Disabilities: 2010,” http://www.census.gov/prod/2012pubs/p70-131.pdf, 

Issued July 2012, Accessed 21 August 2014. 

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Overview of Performance 

ACL’s mission is to maximize the independence, well-being, and health of older adults, people 

with disabilities across the lifespan, and their families and caregivers. ACL facilitates achievement 

of that mission through improvements in the analysis and availability of performance information 

while also enhancing the rigor of program evaluations. ACL’s focus on performance management, 

transparency and use of evidence will carry through as we continue the integration of ACL’s 

newest programs that serve the aging and disability communities (e.g. the Independent Living 

Programs, Assistive Technology Program, National Institute on Disability, Independent Living, 

and Rehabilitation Research (NIDILRR), Traumatic Brain Injury Program etc.). The Overview of 

Performance is organized around programs devoted to older adults and their caregivers and 

programs that serve the disability community along with a discussion of evaluation, data collection 

and dissemination activities; and performance management. 

Overview of Performance: Administration on Aging (AoA) 

ACL program activities that support older adults and their caregivers have a fundamental common 

purpose: to develop a comprehensive, coordinated and cost-effective system of home and 

community-based services that help elderly individuals maintain their health and independence in 

their homes and communities (Older Americans Act Section 301). This purpose led ACL to focus 

on three performance measures: 1) improving client outcomes; 2) effectively targeting services to 

vulnerable populations; and 3) improving efficiency. Each measure is representative of activities 

across the Aging Services Program budget and progress toward achievement of performance goals 

is tracked using a number of indicators. 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 2014 most outcome indicators 

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

inflationary factors, AoA outcome indicators demonstrate that services are continuing to be 

effective. Following are some key successes that are indicative of the performance of AoA 

programs and the Aging Network to meet demographic and fiscal challenges. 

• 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 Aging Network’s success at serving this 

vulnerable population is a proxy for nursing home delay and diversion. In FY 2005, onethird of home-delivered nutrition clients lived with three or more ADL impairments and 

by FY 2014 the proportion grew to 42%, a 26% increase. 

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EXECUTIVE SUMMARY 

• The FY 2017 performance budget also includes eleven core performance indicators 

supporting AoA’s commitment to improving client outcomes and four indicators related to 

effective targeting, capturing success with regards to increasing services to family 

caregivers and the most economically and socially vulnerable. 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. 

• 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 by nearly 20% over the last decade. In FY 2014, the Aging 

Network served 8,930 people per million dollars of OAA Title III funding. Since this 

measure’s introduction in FY 2005, AoA and the Aging Network have met or exceeded 

efficiency targets. For FY 2017, there are two efficiency indicators for AoA program 

activities, both of which consistently meet or exceed targets. 

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

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

these services. In 2014, over 95 percent of transportation clients and nearly 94% of 

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. Quality indicators are consistently high and are expected to meet or 

exceed targets in FY 2017. 

Overview of Performance: Disability Programs 

ACL works with our partners in every state and territory to facilitate achievement of the ACL 

mission and the goals embodied in the Rehabilitation Act and Developmental Disabilities 

Assistance and Bill of Rights Act (DD Act). For developmental disability programs, our 

performance measurement strategy focuses on four measures that address outcomes related to the 

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. The following highlights the Developmental Disabilities 

(DD) Network’s accomplishments in these three focus areas plus efforts to improve program 

efficiency. 

State Councils on Developmental Disabilities 

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EXECUTIVE SUMMARY 

State Councils on Developmental Disabilities work to promote the development of a 

comprehensive, person-centered and family-centered system that provides a coordinated array of 

culturally-competent services and other forms of assistance for people with developmental 

disabilities and their families. A key activity for many State Councils is leadership training for 

individuals with developmental disabilities and their family members to enhance civic engagement 

for creating more effective policy solutions. Many participants go on to leadership positions on 

State Councils and other disability focused organizations and engage in systems change efforts. 

AIDD measures 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 and are 

expected to continue to do so in FY 2017. 

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 DD 

Network’s efficiency tied to outcomes through measuring the number of individuals reached who 

are independent, self-sufficient and integrated into the community per thousand dollars of federal 

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

or exceeded for the last six years. 

Developmental Disabilities Protection and Advocacy Program 

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

maintains a system to protect the legal and human rights of all persons with developmental 

disabilities. PADD grantees are highly successful at meeting the needs of complainants: The 

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

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

demonstrates the rate of successful benefits accruing from the program. The rate of success has 

been consistently over 80 percent and trended upward since FY 2011. In FY 2014, over 

86 percent of consumers had their complaint corrected. While this result missed the ambitious 

target of 87.5 percent, the success rate is well over 80 percent. 

University Centers for Excellence in Developmental Disabilities 

UCEDDs are interdisciplinary academic centers 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 the provision of interdisciplinary training to students from a wide array of professional 

backgrounds to improve the quality of services and supports for people with developmental 

disabilities. 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 

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EXECUTIVE SUMMARY 

trained professionals were involved. The result for FY 2014 exceeded the target at 41.5 percent. 

Since FY 2009 this measure has steadily increased. 

Independent Living; National Institute on Disability, Independent Living, and Rehabilitation 

Research; and Assistive Technology Programs 

ACL is continuing the process of transferring several programs from the Department of Education 

(National Institute on Disability, Independent Living, and Rehabilitation Research; Independent 

Living Programs; and Assistive Technology Programs). As that process is completed and these 

programs become fully integrated into ACL, program performance is being reviewed and a set of 

meaningful measures will be adopted to manage the performance of these activities. The 

integration of these programs’ performance management activities will add to ACL’s and the 

disability networks’ already robust program and advocacy work. 

A few examples of these programs’ contribution to improving the lives of people with disabilities 

include: 

• Publication of groundbreaking research on disorders of consciousness. This work calls for a 

reconsideration of currently appropriate models of care and has practical implications for the 

timing and duration of rehabilitation services. The full collection of articles can be accessed at 

http://www.sciencedirect.com/science/journal/00039993/94/10. 

• Utilization of NIDILRR/ACL longitudinal data bases in areas of spinal cord injury, traumatic 

brain injury, and burn injury are fostering collaboration and research focusing on long-term 

outcomes and community integration of individuals who have experienced these traumatic 

injuries. 

• NIDILRR’s grant to the University of Richmond resulted in a rigorous return on investment 

model that estimated the long-term impacts of Vocational Rehabilitation (VR) services on 

likelihood of employment, subsequent earnings, and receipt of SSI and SSDI for VR 

applicants. 

In that same period, the Independent Living Programs provided services to hundreds of 

thousands of individuals with disabilities in their respective communities that included: 

• Nearly 1.5 million requests for information and referral services; 

• Core and related services to over 280,000 people; 

• Independent living and life skills training provided to over 90,000 people; 

• Peer counseling services to nearly 50,000 people; and 

• Advocacy and legal services for over 80,000 people. 

Program Evaluation and Performance Management 

12 
 

 

 

 

 

 

EXECUTIVE SUMMARY 

Program Evaluation and Research: 

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

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

is engaged in multiple program research and evaluation efforts that include AoA’s nutrition and 

caregiver programs as well as AIDD’s efforts regarding employment systems change. Following 

are brief descriptions of the array of evaluation activities underway at ACL. 

• The OAA Title III-C Elderly Nutrition Services program (ENSP) evaluation is designed to 

determine the effectiveness and efficiency of the OAA ENSP (Title III-C) in preventing 

the need for more costly interventions through the provision of healthy meals, social 

interaction, health promotion, and linking older adults to other appropriate services. Data 

about program operations have been collected from all State Units on Aging (SUA) and a 

sample of Area Agencies on Aging (AAA) and local service providers and a report is 

available at: 

http://www.aoa.acl.gov/Program_Results/Program_Evaluation.aspx. These local service 

providers were also asked to participate in a cost study, the primary objective of which was 

to determine the average costs of a congregate and home-delivered meal provided under the 

Elderly Nutrition Services Program and whether these average costs vary by how meals are 

prepared or by other program characteristics. The cost study report is available at: 

http://www.aoa.acl.gov/Program_Results/docs/Program_Eval/III_C_Assessment/NSPMeal-Cost-Analysis.pdf. Data will also be collected from a sample of consumers and 

members of a comparison group matched through Medicare records. An Inter-Agency 

Agreement with Centers for Medicare & Medicaid Services (CMS) will enhance this 

evaluation to include prospective analysis of healthcare utilization and cost. Consumer data 

will be collected three times over a one-year period. This outcome study is expected to be 

completed by the Fall of 2017. 

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

the first comprehensive federal evaluation of the NFCSP, which serves over 

800,000 family caregivers. The NFCSP process and outcome evaluations were designed 

to benefit policy and program decision-making; collect and analyze information on 

program processes and site operations; evaluate program efficiency and cost issues for 

approaches best suited to specific contexts; and evaluate the effectiveness of the program’s 

contribution to family caregivers in terms of three areas —of maintaining their health and 

well-being; improving their caregiving skills, and avoiding or delaying institutional care. 

Process data collection from SUAs, AAAs, and local service providers is completed and a 

report is expected in March 2016. Consumer-level data collection is pending OMB review 

with an outcome evaluation report anticipated for September 2018. 

13 
 

 

 

 

EXECUTIVE SUMMARY 

• An evaluability assessment of the OAA Title VI Tribal Grant Program was conducted in 

FY 2015 to provide ACL with a description of the program models in the field, an 

assessment of how well defined the programs/program services are, and information about 

what Federal and Tribal stakeholders want to get from an evaluation and how the 

evaluation data findings would be used. The assessment included working with an advisory 

group of Tribal leaders and interviews with grantees on each of the three program areas. A 

final report was completed in September 2015 and is available at: 

http://www.aoa.acl.gov/Program_Results/docs/EA-of-TitleVI-v2.pdf. ACL will use this 

information to design an evaluation approach including identification of the most 

promising program components and potential sites for a future evaluation. 

• In October 2014, ACL initiated a three-year project with funding support from the HHS 

Office on Women’s Health to identify and promote vetted, low-cost, community-based oral 

health services for older adults. The cross-Federal initiative will examine the existing 

fragmentation across Federal programs that result in a lack of oral health prevention and 

treatment services for older adults. The project goals is to determine what communitybased oral health programs for older adults and programs serving other populations which 

could be translated to older adults in community-based settings exist. Project deliverables 

include: an environmental scan of existing community-based oral health programs for older 

adults and programs serving other populations which could be translated to older adult 

community-based settings; a guide of promising practices identified through this project 

that also includes a user-friendly evaluation template for evaluating programs that are 

implemented; and a dissemination plan to promote the new guide widely among 

community stakeholders. 

• The Administration on Intellectual and Developmental Disabilities awarded a six-year 

contract in 2011 to evaluate the eight Partnerships in Employment Systems Change 

projects. The evaluation of the eight employment projects will inform ACL and its partners 

about how to best work to support competitive, integrated employment systems for 

individuals with intellectual and developmental disabilities. The 2015 project update 

found grantee outcomes that include: California’s creation and launch in June 2015 of an 

employment data monitoring tool integrated into the new Senior and Disabilities Services 

(SDS) data system which builds an expectation of employment into the plan of care; 

passage of the Mississippi Competitive Employment Act (March 2015); increased crosssystem and cross-agency collaboration, such as the California Works! Blueprint - a crossagency framework to support school to integrated, competitive employment (ICE) 

transition; and reductions in barriers to employment, such as significant increases in the 

number of Certified Employment Services Professionals (CESP) across New York. 

14 
 

 

 

 

EXECUTIVE SUMMARY 

• An external evaluation of NIDILRR and its grantees conducted under contract by the 

National Academy of Sciences (NAS) was released in 2012 (http://www.acl.gov/ 

Programs/NIDILRR/Grant-Funding/Programs/nidrr/external.aspx). The committee 

concluded that NIDILRR grants have produced valuable research, tools, and other outputs 

for advancing the field of disability and rehabilitation research in line with the agency’s 

mandate. An outgrowth of the evaluation is a ten-year evaluation plan completed under 

contract in 2013. The plan includes a set of research questions aimed at assessing the 

effectiveness and efficiency of NIDILRR’s operations as well as the quality and impacts 

of NIDILRR-funded activities and products. As part of the plan, a schedule of evaluation 

activities was developed which identifies the programmatic focus for each year’s analysis, 

and identifies specific questions to be addressed and the data source. The current phase of 

the contract is the development of the tools for collecting the data. 

ACL’s Internal Performance Management Plan 

ACL’s programs provide grants to States, local governments, universities, Tribal organizations, 

and non-profit entities that comprise the Aging and Disability Networks. Since ACL is not directly 

involved in hands-on service provision, the agency employs a program performance improvement 

strategy with multiple components (e.g. collaboration with other agencies and organizations, 

enhanced partnerships between Aging and Disability Networks, technical assistance, and senior 

leadership’s involvement in performance management) that are expected to yield performance 

improvements. 

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 that 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 used as appropriate in ACL internal discussions as decisions are 

made each year regarding funding levels to propose to the Department and OMB. 

15 
EXECUTIVE SUMMARY 

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

collaboratively with our state and other partners toward this end, the Aging Services and Disability 

Networks have demonstrated solid performance over the past ten years. 

16 
 

 

 

 

 

 

 

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-- -- -- --

-- -- -- --

-- -- -- --

All Purpose Table 

Administration for Community Living 

(dollars in thousands) 

Program FY 2015 

Final 

FY 2016 

Enacted 

FY 2017 

President' 

s Budget 

FY 2017 +/-

FY 2016 

Health & Independence for Older Adults 

Home & Community-Based Supportive Services...................................................... 347,724 347,724 357,724 10,000 

Nutrition Services........................................................................................................... 814,657 834,753 848,557 13,804 

Congregate Nutrition Services (non-add)............................................................ 438,191 448,342 454,091 5,749 

Home-Delivered Nutrition Services (non-add).................................................... 216,397 226,342 234,397 8,055 

Nutrition Services Incentive Program (non-add)................................................ 160,069 160,069 160,069 --

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

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

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

Native American Nutrition & Supportive Services................................................... 26,158 31,158 31,158 --

Aging Network Support Activities.............................................................................. 9,961 9,961 9,961 --

Holocaust Survivor Assistance {non-add}............................................................ 2,500 2,500 2,500 --

Subtotal, Health & Independence for Older Adults............................................... 1,231,348 1,256,444 1,280,248 23,804 

Caregiver & Family Support Services 

Family Caregiver Support Services.............................................................................. 145,586 150,586 150,586 --

Native American Caregiver Support Services............................................................ 6,031 7,531 7,531 --

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

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

Lifespan Respite Care.................................................................................................... 2,360 3,360 5,000 1,640 

Subtotal, Caregiver & Family Support Services...................................................... 168,277 176,777 178,417 1,640 

Protection of Vulnerable Adults 

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 /1 [HCFAC beginning FY 2016].................. 8,910 8,910 8,910 --

Health Care Fraud and Abuse Control [HCFAC] /2............................................ 8,710 8,710 8,710 --

Elder Rights Support Activities .................................................................................. 7,874 11,874 13,874 2,000 

Elder Justice {non-add}............................................................................................ 4,000 8,000 10,000 2,000 

Subtotal, Protection of Vulnerable Adults............................................................... 46,152 50,152 52,152 2,000 

Disability Programs, Research & Services 

State Councils on Developmental Disabilities........................................................... 71,692 73,000 73,000 --

Developmental Disabilities Protection and Advocacy............................................. 38,734 38,734 38,734 --

University Centers for Excellence in Developmental Disabilities............................ 37,674 38,619 38,619 --

Projects of National Significance................................................................................. 8,857 10,000 10,000 --

National Institute on Disability, Independent Living, and Rehab. Research /3.... 103,970 103,970 103,970 --

Independent Living /3.................................................................................................... 101,183 101,183 101,183 --

Limb Loss Resource Center.......................................................................................... 2,800 2,810 2,810 --

Paralysis Resource Center............................................................................................. 6,700 7,700 7,700 --

Traumatic Brain Injury 6/............................................................................................... 9,321 9,321 9,321 --

Subtotal, Disability Programs, Research & Services.............................................. 380,931 385,337 385,337 --
 

 

 

 

 

 

 

 

-- -- -- --

-- -- -- --

EXECUTIVE SUMMARY 

Program FY 2015 

Final 

FY 2016 

Enacted 

FY 2017 

President's 

Budget 

FY 2017 +/-

FY 2016 

Consumer Information, Access & Outreach 

Aging and Disability Resource Centers...................................................................... 6,119 6,119 8,119 2,000 

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

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

Assistive Technology /3............................................................................................... 33,000 34,000 32,000 (2,000) 

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

Medicare Improvements for Patients and Providers Act [TRA/BBA] /4............. 25,000 37,500 37,500 --

Subtotal, Consumer Information, Access & Outreach.......................................... 125,397 138,897 138,897 --

Program Administration /5............................................................................................ 37,709 40,063 41,063 1,000 

Subtotal, Program Level............................................................................................... 1,989,814 2,047,670 2,076,114 28,444 

Less: Funds From Mandatory Sources 

HCFAC Wedge Funds /2.............................................................................................. (8,710) (8,710) (8,710) --

HCFAC Funds for Senior Medicare Patrol Program /1........................................ -- (8,910) (8,910) --

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

Medicare Improvements for Patients and Providers Act /4..................................... (25,000) (37,500) (37,500) --

Total, Discretionary Budget Authority......................................................................... 1,928,404 1,964,850 1,993,294 28,444 

1/ The FY 2016 enacted appropriation states that it "fully funds" SMP through HCFAC appropriations to the Centers for Medicare & 

Medicaid Services, but it does not specify a number. This amount serves as a placeholder for FY 2016 and FY 2017 pending final decisions 

on the amounts by the Secretary of HHS. 

2/ $8,710,146 is a placeholder amount in FY 2016 and 2017. The Secretary and Attorney General will determine the final amount. 

3/ Funding for FY 2015 reflects the annualized amount transferred to ACL from the Department of Education, based on a determination order 

between the Department of Education and ACL. For FY 2016 and FY 2017, ACL is requesting funding for these programs directly. 

4/ Includes funding for four MIPPA programs: SHIPs, ADRCs, AAAs, and the National Center for Benefits Outreach Enrollment. Of these, 

funding for MIPPA SHIPs ($7.5 million in FY 2015, $13 million in FY 2016 and FY 2017), is currently appropriated to the Centers for 

Medicare and Medicaid Services (CMS) directly and transferred to ACL via an Intra-Departmental Delegation of Authority (IDDA). 

5/ Program Administration funding for FY 2015 includes the annualized amount transferred to ACL from the Department of Education, based 

on a determination order between the Department of Education and ACL. For FY 2016 and FY 2017, ACL is requesting these funds directly. 

6/ Funding is displayed comparably for FY 2015. Funding will be transferred from HRSA to ACL beginning in FY 2016 and is requested 

directly by ACL in the FY 2017 request. 

18 
 

EXECUTIVE SUMMARY 

Appropriations Language 

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, sections 1252 and 1253 of the PHS Act, section 

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

Social Security Act, the Developmental Disabilities Assistance and Bill of Rights Act, parts 2 

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

Act of 1998, titles II and VII (and section 14 with respect to such titles) of the Rehabilitation Act 

of 1973, and for Department-wide coordination of policy and program activities that assist 

individuals with disabilities, $1,941,179,000, 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 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 

of amounts made available under this heading to carry out sections 311, 331, and 336 of the 

OAA, up to one percent of such amounts shall be available for developing and implementing 

evidence-based practices for enhancing senior nutrition: 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 $2,000,000 shall be for competitive grants to support alternative 

financing programs that provide for the purchase of assistive technology devices, such as a lowinterest loan fund; an interest buy-down program; a revolving loan fund; a loan guarantee; or an 

insurance program: Provided further, That applicants shall provide an assurance that, and 

information describing the manner in which, the alternative financing program will expand and 

emphasize consumer choice and control: Provided further, That State agencies and communitybased disability organizations that are directed by and operated for individuals with 

disabilities shall be eligible to compete: Provided further, That in addition, the unobligated 

balance of amounts previously made available for the Health Resources and Services 

Administration to carry out functions under sections 1252 and 1253 of the PHS Act shall be 

transferred to this account, except for such sums as may be necessary to provide for an orderly 

transition of such functions to the Administration for Community Living: Provided further, That 

none of the funds made available under this heading may be used by an eligible system (as 

defined in section 102 of the Protection and Advocacy for Individuals with Mental Illness Act 

19 
EXECUTIVE SUMMARY 

(42 U.S.C. 10802)) to continue to pursue any legal action in a Federal or State court on behalf of 

an individual or group of individuals with a developmental disability (as defined in section 

102(8)(A) of the Developmental Disabilities and Assistance and Bill of Rights Act of 2000 (20 

U.S.C. 15002(8)(A)) that is attributable to a mental impairment (or a combination of mental and 

physical impairments), that has as the requested remedy the closure of State operated 

intermediate care facilities for people with intellectual or developmental disabilities, unless 

reasonable public notice of the action has been provided to such individuals (or, in the case 

of mental incapacitation, the legal guardians who have been specifically awarded authority by 

the courts to make healthcare and residential decisions on behalf of such individuals) who are 

affected by such action, within 90 days of instituting such legal action, which informs such 

individuals (or such legal guardians) of their legal rights and how to exercise such rights 

consistent with current Federal Rules of Civil Procedure: Provided further, That the limitations 

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

competent to consent nor has a legal guardian, nor shall the proviso apply in the case of 

individuals who are a ward of the State or subject to public guardianship.] (Department 

of Health and Human Services Appropriations Act, 2016.) 

20 
 

 

 

 

 

EXECUTIVE SUMMARY 

Appropriations Language Analysis 

Administration for Community Living 

Language Provision Explanation 

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 increase its set-aside from 

0.5% to 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 amounts made available 

under this heading to carry out sections 311, 331, 

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

amounts shall be available for developing and 

implementing evidence-based practices for 

enhancing senior nutrition: 

Authorizes ACL to use up to one percent of the 

total appropriations for the Nutrition Services 

Incentives Program, Congregate Nutrition 

Services and Home-Delivered Nutrition Services 

on demonstration grants to develop and 

implement innovative, evidence-based practices 

for enhancing senior nutrition programs. 

21 
 

 

 

 

 

-- -- --

-- -- --

EXECUTIVE SUMMARY 

Amounts Available for Obligation 

Administration for Community Living 

General Fund Discretionary Appropriation FY 2015 

Actual 

FY 2016 

Enacted 

FY 2017 

President's 

Budget 

Appropriation (L/HHS)................................................................. 1,621,141,000 1,912,735,000 1,941,179,000 

Across-the-board reductions (L/HHS)....................................... -- -- --

Subtotal, Appropriation (L/HHS, Ag, or Interior)................. 1,621,141,000 1,912,735,000 1,941,179,000 

Secretary's Transfer....................................................................... -- -- --

Subtotal, adjusted appropriation............................................. 1,621,141,000 1,912,735,000 1,941,179,000 

Transfer of Funds to Department of Agriculture 1/................. -2,549,334 -2,214,429 --

Comparable transfer from Health Resources Svcs Admin 2/.. 9,321,000 -- --

Comparable transfer from Department ofEducation 3/............ 233,252,566 -- --

Subtotal, adjusted general fund discr. appropriation........... 1,861,165,232 1,910,520,571 1,941,179,000 

Total, Discretionary Appropriation................................... 1,861,165,232 1,910,520,571 1,941,179,000 

Mandatory Appropriation: 

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

Appropriation (TRA/MACRA) MIPPA..................................... 17,500,000 24,500,000 24,500,000 

Subtotal, adjusted mandatory. appropriation........................ 45,200,000 52,200,000 52,200,000 

Offsetting collections from: 

Trust Funds: HCFAC.................................................................... 8,612,728 8,710,146 8,710,146 

Trust Funds: SMP........................................................................ -- 8,910,000 8,910,000 

Trust Funds: SHIPs HI/SMI......................................................... 52,020,978 52,115,000 52,115,000 

Subtotal, spending authority from offsetting collections... 60,633,706 69,735,146 69,735,146 

Unobligated balance, lapsing.......................................................... 968,821 -- --

Total obligations............................................................................ 1,967,967,759 2,032,455,717 2,063,114,146 

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

Appropriations on this table will therefore differ by this amount from amounts listed on ACL's 

All Purpose Table. 

2/ Funding shown includes comparable amounts appropriated to the Health Resources Services Administration (HRSA) for the Traumatic Brain 

Injury (TBI) transferred to ACL in FY 2016. 

3/ Funding shown includes FY 2014 estimated comparable amounts and FY 2015 estimated annualized amounts appropriated to the Department 

of Education for programs transferred to ACL by the Workforce Innovation and Opportunity Act. 

22 
-- -- -- --

-- -- -- --

-- -- -- --

-- -- -- --

EXECUTIVE SUMMARY 

Summary of Changes 

Administration for Community Living 

(Dollars in thousands) 

2016 

Total estimated budget authority........................................................................................................................... 1,964,850 

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

2017 

Total estimated budget authority........................................................................................................................... 1,993,294 

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

Net Change............................................................................................................................................................ 28,444 

Increases 

FY 2017 

PB FTE 

FY 2017 

PB BA 

FY 2017 +/-

FY 2016 

FTE 

FY 2017 +/-

FY 2016 

BA 

A. Built-in:

1. Program Administration............................................................... 185 41,063 8 1,000 

Subtotal, Built-in Increases....................................................... -- -- 8.0 1,000 

B. Program:

1. Home & Community Based Supportive Services.................... 2 357,724 2 10,000 

2. Nutrition Services......................................................................... 6 848,557 6 13,804 

3. Preventive Health Services......................................................... 0.7 19,848 0.7 --

4. Family Caregiver Support............................................................ 2 150,586 2 --

5. Long-Term Care Ombudsman Program..................................... 0.7 15,885 0.7 --

6. Prevention of Elder Abuse and Neglect.................................... 0.3 4,773 0.3 --

7. Lifespan Respite Care.................................................................. -- 5,000 -- 1,640 

8. Elder Rights Support Activities.................................................. 4 13,874 1 2,000 

9. Developmental Disabilities Programs........................................ 4.4 155,316 4.4 --

11. Independent Living.................................................................... 1 101,183 1 --

12. Aging and Disability Resource Centers.................................. -- 8,119 -- 2,000 

13. Medicare Improvement for Patients and Providers Act....... 6 37,500 1 -

Subtotal, Program Increases..................................................... -- -- 19.1 29,444 

Total Increases......................................................................... -- --

27.1 30,444 

Decreases: 

A. Program:

1. Assistive Technology................................................................. 0.9 32,000 0.9 (2,000) 

Subtotal, Program Decreases.................................................... 0.9 32000 0.9 (2,000) 

Total Decreases........................................................................ -- --

0.9 (2,000) 

Net Change............................................................................ -- -- 28 28,444 

23 
 

 

-- -- --

-- -- --

EXECUTIVE SUMMARY 

Budget Authority by Activity 

Administration for Community Living 

(Dollars in Thousands) 

Budget Authority by Activity FY 2015 

Actual 

FY 2016 

Enacted 

FY 2017 

President's 

Budget 

Health & Independence for Older Adults 

Home & Community-Based Supportive Services 347,724 347,724 357,724 

Nutrition Services 814,657 834,753 848,557 

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

Native American Nutrition & Supportive Services 26,158 31,158 31,158 

Aging Network Support Activities 9,961 9,961 9,961 

Subtotal, Health & Independence for Older Adults 

Caregiver & Family Support Services 

1,218,348 1,243,444 1,267,248 

Family Caregiver Support Services 145,586 150,586 150,586 

Native American Caregiver Support Services 6,031 7,531 7,531 

Alzheimer's Disease Supportive Services Program 3,800 4,800 4,800 

Lifespan Respite Care 2,360 3,360 5,000 

Subtotal, Caregiver & Family Support Services 

Protection of Vulnerable Adults 

157,777 166,277 167,917 

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/1 8,910 -- --

Elder Rights Support Activities 7,874 11,874 13,874 

Subtotal, Protection of Vulnerable Adults 

Disability Programs, Research & Services 

37,442 32,532 34,532 

State Councils on Developmental Disabilities 71,692 73,000 73,000 

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

University Centers for Excellence in Developmental Disabilities 37,674 38,619 38,619 

Projects of National Significance 8,857 10,000 10,000 

National Institute on Disability, Independent Living, and Rehab. Research 3/ 103,970 103,970 103,970 

Independent Living 3/ 101,183 101,183 101,183 

Limb Loss Resource Center 2,800 2,810 2,810 

Paralysis Resource Center 6,700 7,700 7,700 

Tramatic Brain Injury 6/ 9,321 9,321 9,321 

Subtotal, Disability Programs, Research & Services 380,931 385,337 385,337 

Consumer Information, Access & Outreach 

Aging and Disability Resource Centers [Discretionary] 6,119 6,119 8,119 

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

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

Assistive Technology 3/ 33,000 34,000 32,000 

Subtotal, Consumer Information, Access & Outreach 96,197 97,197 97,197 

Program Administration 5/ 37,709 40,063 41,063 

Total, Discretionary Budget Authority 1,928,404 1,964,850 1,993,294 

HCFAC Funds for Senior Medicare Patrol Program/1 8,910 8,910 

HCFAC Wedge Funds/ 2 8,710 8,710 8,710 

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

Chronic Disease Self-Management Education {non-add} 8,000 8,000 8,000 

24 
 

 

EXECUTIVE SUMMARY 

Budget Authority by Activity FY 2015 

Actual 

FY 2016 

Enacted 

FY 2017 

President's 

Budget 

Falls Prevention {non-add} 5,000 5,000 5,000 

Alzheimer's Disease Initiative - Specialized Supportive Services {non-add} 10,500 10,500 10,500 

Alzheimer's Disease Initiative - Communications Campaign {non-add} 4,200 4,200 4,200 

Medicare Improvements for Patients and Providers Act/4 25,000 37,500 37,500 

Aging and Disability Resource Centers {non-add} 5,000 5,000 5,000 

Area Agencies on Aging {non-add} 7,500 7,500 7,500 

National Center for Benefits Outreach and Enrollment {non-add} 5,000 12,000 12,000 

State Health Insurance Assistance Program {non-add} 7,500 13,000 13,000 

Total, Program Level 1,989,814 2,047,670 2,076,114 

1/ The FY 2016 enacted appropriation states that it "fully funds" SMP through HCFAC appropriations to the Centers for Medicare & 

Medicaid Services, but it does not specify a number. The amounts in FY 2016 and FY 2017 serve as placeholders pending final decisions 

on amounts by the Secretary of HHS. 

2/ $8,710,146 is a placeholder amount in FY 2016 and 2017. The Secretary and Attorney General will determine the final amount. 

3/ Funding for FY 2015 reflects the annualized amount transferred to ACL from the Department of Education, based on a determination 

order between the Department of Education and ACL. For FY 2016 and FY 2017, ACL is requesting funding for these programs directly. 

4/ Includes funding for four MIPPA programs: SHIPs, ADRCs, AAAs, and the National Center for Benefits Outreach Enrollment. Of 

these, funding for MIPPA SHIPs ($7.5 million in FY 2015, $13 million in FY 2016 and FY 2017), is currently appropriated to the Centers 

for Medicare and Medicaid Services (CMS) directly and transferred to ACL via an Intra-Departmental Delegation of Authority (IDDA). 

5/ Program Administration funding for FY 2015 includes the annualized amount transferred to ACL from the Department of Education, 

based on a determination order between the Department of Education and ACL. For FY 2016 and FY 2017, ACL is requesting these funds 

directly. 

6/ Funding is displayed comparably for FY 2015. Funding will be transferred from HRSA to ACL beginning in FY 2016 and is requested 

directly by ACL in the FY 2017 request. 

25 
 

 

 

 

 

 

 

 

 

 

 

EXECUTIVE SUMMARY 

Authorizing Legislation 

Administration for Community Living 

Program 

FY 2016 

Amount 

Authorized 

FY 2016 

Appropriations Act 

FY 2017 

Amount 

Authorized 

FY 2017 

President's 

Budget 

1) Home and Community-Based Supportive Services: 

OAA Section 

321...................................................................... 

Expired 347,724,000 Expired 357,724,000 

2) Nutrition Services OAA Sections 311, 331, and 336 

............................................ Expired 834,753,000 Expired 848,557,000 

3) Preventive Health Services: OAA Section 

361...................................................................... Expired 19,848,000 Expired 19,848,000 

4) National Family Caregiver Support Program: OAA 

Section 371...................................................................... Expired 150,586,000 Expired 150,586,000 

5) Native American Nutrition and Supportive Services: 

OAA Sections 613 and 

623...................................................... 

Expired 31,158,000 Expired 31,158,000 

6) Native American Caregiver Support Program: OAA 

Section 631...................................................................... Expired 7,531,000 Expired 7,531,000 

7) Long-Term Care Ombudsman Program: OAA Section 

712..................................................................... Expired 15,885,000 Expired 15,885,000 

8) Prevention of Elder Abuse and Neglect: OAA Section 

721...................................................................... Expired 4,773,000 Expired 4,773,000 

9) Elder Rights Support Activities OAA Sections 201, 

202, and 411, 751, and 752, as amended. Social Security 

Act, Title XX-B, Section 2042.... 

Expired 11,874,000 Expired 13,874,000 

10) Aging Network Support Activities: OAA Sections 

202, 215 and 411............................................. Expired 9,961,000 Expired 9,961,000 

11) Alzheimer's Disease Demonstration Grants Public 

Health Services Act Section 398................................. Expired 4,800,000 Expired 4,800,000 

12) Lifespan Respite Care Lifespan Respite Care Act of 

2006 and Public Health Service Act Title 

XXIX.................................... Expired 3,360,000 Expired 5,000,000 

26 
 

 

 

 

 

 

 

 

-- -- -- --

EXECUTIVE SUMMARY 

Program Amount 

Authorized 

FY 2016 

Appropriations 

Act 

FY 2017 

Amount 

Authorized 

FY 2017 

President's 

Budget 

13) Program Administration: 

OAA Section 205...................................................................... Expired 40,063,000 Expired 41,063,000 

14) Aging and Disability Resource Centers 

OAA Sections 202b and 

411................................................... 

Expired 6,119,000 Expired 8,119,000 

15) State Health Insurance Assistance Program: 

Omnibus Budget Reconciliation Act of 1990 Section 4360 Expired 52,115,000 Expired 52,115,000 

16) State Councils on Developmental Disabilities 

DD Act Section 129(a).............................................................. Expired 73,000,000 Expired 73,000,000 

17) Protection and Advocacy 

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

18) University Centers for Excellence in Developmental 

Disabilities DD Act Section 

156.................................................................. 

Expired 38,619,000 Expired 38,619,000 

19) Projects of National Significance 

DD Act Section 163.................................................................. Expired 10,000,000 Expired 10,000,000 

20) Voting Assistance for People with Disabilities 

Help America Vote Act Section 

291....................................... 

Expired 4,963,000 Expired 4,963,000 

21) Paralysis Resource Center 

Public Health Services Act Sections 311 and 317(k)(2)....... N/A 7,700,000 N/A 7,700,000 

22) National Institute on Disability, Independent Living, 

and Rehabilitation Research 4/ 

Rehabilitation Act of 1973, Title II.......................................... 

103,970,000 103,970,000 112,001,000 103,970,000 

23) Independent Living Rehabilitation Act of 1973, Title VII, 

Parts B, C, and Chapter 2 

Independent Living State Grants........................................ 22,878,000 22,878,000 24,645,000 22,878,000 

Centers for Independent Living.......................................... 78,305,000 78,305,000 84,353,000 78,305,000 

24) Assistive Technology 

Assistive Technology Act of 1998........................................ Expired 34,000,000 Expired 32,000,000 

25) Limb Loss Resource Center 

Public Health Services Act, Title 

III....................................... 

N/A 2,810,000 N/A 2,810,000 

26) Traumatic Brain Injury 

Traumatic Brain Injury Reauthorization Act of 2014 .......... N/A 9,321,000 N/A 9,321,000 

Total Request Level -- $1,964,850,000 -- $1,993,294,000 

Unfunded Authorizations: 

1)Legal Assistance: 

OAA Section 

7311...................................................................... 

Such Sums 0 Such Sums 0 

27 
 

 

 

 

EXECUTIVE SUMMARY 

Appropriations History Table 

Administration for Community Living 

General Fund Appropriation: 

Budget Estimate 

to 

Congress 

House Allowance Senate 

Allowance Appropriation 

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 

Subtotal................................. -- -- -- 1,413,435,235 

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 

Subtotal................................. -- -- -- 1,591,343,000 

FY 2010 /3 1,491,343,000 1,530,881,000 1,495,038,000 1,516,297,000 

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

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

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

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

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

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

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

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

FY 2013 /6 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 

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

FY 2014 /7 2,094,755,000 N/A 1,716,664,000 1,662,258,000 

FY 2015 /8 2,062,279,000 N/A 1,676,152,000 1,673,256,000 

FY 2016 9/ 2,104,976,000 1,944,358,000 1,861,089,000 1,964,850,000 

FY 2017 1,993,294,000 -- -- --

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. 

6/ Includes $2,542,042 in FY 2013 budget authority appropriated to AoA and transferred to the Department of Agriculture for commodities 

purchases pursant to Public Law 113-6 

7/ Includes $2,391,605 in FY 2014 budget authority appropriated to AoA and transferred to the Department of Agriculture for commodities 

purchases pursant to Public Law 113-76. 

8/ Includes $2,549,334 in FY 2015 budget authority appropriated to AoA and transferred to the Department of Agriculture for commodities 

purchases pursant to Public Law 113-235. 

9/ Includes $2,214,429 in FY 2016 budget authority appropriated to AoA and transferred to the Department of Agriculture for commodities 

purchases pursant to Public Law 114-113. 

28 
 

 

EXECUTIVE SUMMARY 

Appropriations Not Authorized by Law 

Appropriations in FY 2016 

Program Last Year of 

Authorization 

Authorization 

Level 

Appropriations in 

Last Year of 

Authorization 

Appropriations in 

FY 2017 

Alzheimer's Disease 

Supportive Services: PHSA 

Section 398 

FY 2002 Such Sums $11,483,000 $4,800,000 

Older Americans Act FY 2011 Such Sums $1,927,486,000 $1,480,275,000 

Lifespan Respite Care: 

Lifespan Respite Care Act 

of 2006 

FY 2011 $94,810,000 $2,495,000 $3,360,000 

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 $160,353,000 

Voting Access for People 

with 

Disabilities: 

-- -- -- -- 

Help America Vote Act 

Section 291 FY 2005 $17,410,000 $13,879,000 $4,963,000 

Elder Justice / Adult 

Protective Services: Social 

Security Act, Title XX-B 

FY 2014 $129,000,000 $0 $8,000,000 

The Assistive Technology 

Act of 2004 FY 2010 Such Sums $25,000,000 $34,000,000 

29 
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Health and Independence for Older Adults 

Summary of Request 

The Administration on Aging’s Health and Independence for Older Adults 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. 

The U.S. population over age 60 is projected to increase by 20 percent, between 2014 and 2020, 

from 64.8 million to 77.6 million.9 In addition, the number of seniors age 65 and older with severe 

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

of nursing home admission, is projected to increase by more than 20 percent over the same 

period. 10 Health and Independence for Older Adults programs are vital to helping seniors remain 

in their homes and communities for as long as possible. For example, 61 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, 51 percent of seniors using transportation services rely on 

them for the majority of their trips to doctors’ offices, pharmacies, meal sites, and other critical 

daily activities that help them to remain in the community. 11 

ACL’s FY 2017 funding request for Health and Independence for Older Adults programs is 

$1,280,248,000, an increase of +$23,804,000 above the comparable FY 2016 enacted level. For 

FY 2017, specific program requests include: 

• $357,724,000 for Home and Community-Based Supportive Services (HCBSS), an increase 

of $10,000,000 over the FY 2016 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 

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

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

http://www.census.gov/population/projections/data/national/2014/downloadablefiles.html. Accessed 08 January 

2015. 

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

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

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

Accessed 10 January 2016. 

11 2015 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/. 

31 
 

 

 

 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

otherwise have to be even more intensively relied upon to provide care for their loved ones, 

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

• $848,557,000 for three Nutrition Services programs (Congregate Nutrition Services, 

Home-Delivered Nutrition Services and the Nutrition Services Incentives Program). This 

amount is an increase of +$13,804,000 above the FY 2016 enacted level. Nutrition Services 

help nearly 2.4 million older adults receive the meals they need to stay healthy and decrease 

their risk of disability. In FY 2017, these funds will support more than 205 million meals. 

• $19,848,000 for Preventive Health Services, the same as the FY 2016 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. ACL 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) from the 

Prevention and Public Health Fund (PPHF) authorized under the Affordable Care Act. This 

would continue funding at the FY 2016 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, from the PPHF, authorized under the Affordable Care 

Act. This would continue funding at the FY 2016 enacted level. Falls are the leading cause 

of both fatal and nonfatal injuries for those 65 and over. ACL's national infrastructure has 

enabled over 264,000 individuals throughout the country to participate in evidence-based 

chronic disease self-management education, falls prevention, diabetes self-management 

training, physical activity, nutrition education, and depression management programs. 

• $31,158,000 for Native American Nutrition and Supportive Services, the same as the 

FY 2016 enacted level. These funds will provide approximately 6.1 million meals and 

760,000 rides for Native American seniors to critical daily activities such as meal sites, 

medical appointments, and grocery stores. 

• $9,961,000 for Aging Network Support Activities, the same as the FY 2016 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 

32 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

mission to help older people, including survivors of the Holocaust, remain independent and 

live in their own homes and communities. 

33 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

Outcome and Outputs Table: 

Health and Independence for Older Adults 

Measure Year and Most Recent 

Result / 

Target for Recent Result 

/ 

(Summary of Result) 

FY 2016 

Target 

FY 2017 

Target 

FY 2017 

Target 

+/-FY 2016 

Target 

1.1 For Home and 

Community-based 

Services including 

Nutrition and Caregiver 

services increase the 

number of clients 

served per million 

dollars of Title III 

OAA funding. 

(Efficiency) 

FY 2014: 8,930 clients 

Target: 8,600 clients 

(Target Exceeded) 

8,700 clients 9,000 clients +300 clients 

2.10 Increase the 

likelihood that the most 

vulnerable people 

receiving Older 

Americans Act Home 

and Community-based 

and Caregiver Support 

Services will continue 

to live in their homes 

and communities. 

(Outcome) 

FY 2014: 63.8 weighted 

average 

Target: 62 weighted 

average 

(Target Exceeded) 

63 weighted 

average 

63.25 weighted 

average 

+0.25 weighted 

average 

3.3 The percentage of 

OAA clients served 

who live in rural areas 

is at least 15% greater 

than the percent of all 

US elders who live in 

rural areas. (Outcome) 

FY 2014: 36.5% 

Target: 26.2% 

(Target Exceeded) 

26.2% 26.2% Maintain 

3.6 The percentage of 

OAA clients served 

who live in poverty is 

150% greater than the 

percent of all U.S. 

elders living below the 

poverty level. 

(Outcome) 

FY 2014: 32.44% 

Target: 24.85% 

(Target Exceeded) 

24.75% 25.78% +1.03 

34 
 

 

 

 

Home and Community-Based Supportive Services 

Service FY 2015 

Final 

FY 2016 

Enacted 

FY 2017 

President's 

Budget 

FY 2017 +/-

FY 2016 

Home and Community-Based 

Supportive Services $347,724,000 $347,724,000 $357,724,000 +$10,000,000 

FTE 0 0 2 +2 

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

FY 2017 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 formula 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. Programs like HCBSS serve seniors holistically. While each service is valuable in and 

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

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

homes or other types of institutional care. 

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

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

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

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

While age alone does not determine the need for these long-term 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, 56 percent are unable to perform one or more critical activities of daily living 

and require long-term support. Data also show that over 92 percent of seniors have at least one 

35 
 

 

 

 

 

 

 

 

 

 

 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

chronic condition and 76 percent have at least two. 12 Providing a variety of supportive services 

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

and independent in their homes and communities, and therefore avoiding unnecessary, expensive 

nursing home care. 

Services provided by the HCBSS program in FY 2014 (the most recent available data) include: 

• Transportation Services provided 22.2 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 36.5 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 8.5 million hours of care for dependent adults in a 

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

(Output E). 

• Case Management Services provided 3.3 million hours of assistance in assessing needs, 

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

F). 

Continuing ACL’s commitment to provide services to those in most need, nearly 49 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. 13 Many of these 

individuals cannot safely drive a car, as nearly 77 percent of transportation riders have at least one 

of the following chronic conditions that could impair their ability to navigate safely: 14 

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

macular degeneration or cataracts); 

• 15 percent have had a stroke; 

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

from the 2013 Medicare Current Beneficiary Survey. [data tables 2.5a and 2.6a]. http://www.cms.gov/ResearchStatistics-Data-and-Systems/Research/MCBS/Data-Tables-Items/2013CNP.html. Accessed 10 January 2016. 

13 2015 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/. 

14 Id. 

36 
 

 

 

 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

• 10 percent have Alzheimer’s or dementia; 

• 4 percent have epilepsy; 

• 3 percent have Multiple Sclerosis; and 

• 3 percent have Parkinson’s disease. 

Of the transportation participants, 96 percent take daily medications, with over 19 percent taking 

10 to 20 medications daily. 15 Data from ACL’s National Surveys of OAA Participants show that 

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

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

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

while over 81 percent of clients receiving case management reported that, as a result of the services 

arranged by the case manager, they were better able to care for themselves. 16 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. 17 

Funding History: 

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

follows: 

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 ...................................$347,724,297 

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

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

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

15 2014 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/. 

16 Id. 

17 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. 

37 
 

 

 

 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

Budget Request: 

The FY 2017 request for Home and Community-Based Supportive Services is $357,724,000, an 

increase of $10,000,000 over the FY 2016 enacted level. HCBSS funding has not kept pace with 

demand in recent years. Additionally, service levels have been declining due to inflation and stable 

or declining State, and local funding for these programs. Although most HCBSS have had a 

downward trend in the provision of service units since at least 2007, the budget requested in FY 

2017 would help to slow the decline of or maintain these service unit measures of performance for 

home and community-based services. This funding will allow ACL to provide services to the 

increasing population in need, which can significantly reduce the risk of nursing home admission. 

At this level, the overall budget request will support 7.8 million hours of adult day care for older 

adults; 22.3 million rides for critical daily activities such as visiting the doctor, the pharmacy, or 

grocery stores; and 31.8 million hours of assistance to seniors who are unable to perform daily 

activities. 

HCBSS helps to delay the need for potentially more expensive institutional services. In addition, 

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

– also aid caregivers, who otherwise might have to be even more intensively involved with the 

care of their loved ones, taking time away from work and their other family responsibilities and 

further straining family budgets. Many of these caregivers are doubly challenged, as members of 

the so-called “sandwich generation,” by the need not only to care for their older loved ones, but 

also, in the current tight economy, to provide assistance to their adult children. 

Core OAA formula grant programs like HCBSS currently reach nearly one in six seniors, serving 

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

home admission and helping to keep them from joining the 1.9 million seniors who live in 

institutional settings.18 Nationally, 25 percent of individuals 60 and older live alone 19, and in 

FY 2014, 68 percent of the OAA transportation users were 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 

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

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

of Medicare Beneficiaries, by Age and by Gender and Age, 2013]. http://www.cms.gov/Research-Statistics-Dataand-Systems/Research/MCBS/Data-Tables-Items/2013CNP.html. Accessed 10 January 2016. 

19 Administration for Community Living, http://www.agid.acl.gov/DataGlance/. Data-at-a-Glance: American 

Community Survey (ACS) Public Use Microdata Sample (PUMS) 1-Year Files (2013), accessed January, 10, 

2016. 

38 
 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

in a State with higher home and community-based service expenditures had significantly lower 

risk of nursing home admissions.20 

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

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

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

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

match requirements. 

20 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. 

39 
 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

Outputs and Outcomes Table: 

Home and Community-Based Supportive Services 

Measure Year and Most Recent 

Result / 

Target for Recent Result / 

(Summary of Result) 

FY 2016 

Target 

FY 2017 

Target 

FY 2017 

Target 

+/-FY 2016 

Target 

1.1 For Home and 

Community-based 

Services including 

Nutrition and Caregiver 

services increase the 

number of clients served 

per million dollars of 

Title III OAA funding. 

(Efficiency) 

FY 2014: 8,930 clients 

Target: 8,600 clients 

(Target Exceeded) 

8,700 clients 9,000 clients +300 clients 

2.9b Maintain at 90% or 

higher the percentage of 

transportation clients 

who rate services good 

to excellent. (Outcome) 

FY 2014: 95.1% 

Target: 90% 

(Target Exceeded) 

90% 90% Maintain 

2.10 Increase the 

likelihood that the most 

vulnerable people 

receiving Older 

Americans Act Home 

and Community-based 

and Caregiver Support 

Services will continue to 

live in their homes and 

communities. 

(Outcome) 

FY 2014: 63.8 weighted 

average 

Target: 62 weighted 

average 

(Target Exceeded) 

63 weighted 

average 

63.25 weighted 

average 

+0.25 weighted 

average 

2.11 Increase the 

percentage of 

transportation clients 

who live alone. 

(Outcome) 

FY 2014: 67.6% 

Target: 67% 

(Target Exceeded) 

67.5% Discontinued N/A 

3.3 The percentage of 

OAA clients served who 

live in rural areas is at 

least 15% greater than 

the percent of all US 

elders who live in rural 

areas. (Outcome) 

FY 2014: 36.5% 

Target: 26.2% 

(Target Exceeded) 

26.2% 26.2% Maintain 

40 
 

 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

Measure Year and Most Recent 

Result / 

Target for Recent Result / 

(Summary of Result) 

FY 2016 

Target 

FY 2017 

Target 

FY 2017 

Target 

+/-FY 2016 

Target 

3.6 The percentage of 

OAA clients served who 

live in poverty is 150% 

greater than the percent 

of all U.S. elders living 

below the poverty level. 

(Outcome) 

FY 2014: 32.44% 

Target: 24.85% 

(Target Exceeded) 

24.75% 25.78% +1.03 

Indicator Year and Most Recent 

Result / 

FY 2016 

Projection 

FY 2017 

Projection 

FY 2017 

Projection 

+/-FY 2016 

Projection 

Output C: 

Transportation Service 

Units (Output) 

FY 2014: 22.2 M 22.0 M 22.3 M +0.3 M 

Output D: Personal 

Care, Homemaker and 

Chore Services units 

(Output) 

FY 2014: 36.5 M 31.8 M 31.8 M Maintain 

Output E: Adult Day 

Care/Day Health units 

(Output) 

FY 2014: 8.5 M 7.8 M 7.8 M Maintain 

Output F: Case 

Management Services 

units (Output) 

FY 2014: 3.3 M 3.9 M 3.9 M Maintain 

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

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

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

performance in achieving current strategic objectives. 

41 
 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

Grant Awards Tables: 

Home and Community-Based Supportive Services Grant Awards 

Award FY 2015 Final FY 2016 

Enacted 

FY 2017 

President’s 

Budget 

Number of 

Awards 56 56 56 

Average 

Award $6,147,264 $6,147,264 $6,324,049 

Range of 

Awards 

$215,155 -

$34,081,746 

$215,155 -

$34,081,746 

$221,342 -

$34,578,882 

42 
 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

ADMINISTRATION ON AGING 

FY 2017 DISCRETIONARY STATE FORMULA GRANTS 

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

State/Territory FY 2015 Actual 

FY 2016 

Enacted 

FY 2017 

President's Budget 

FY 2017 +/-

FY 2016 

Alabama......................................... 5,325,874 5,325,874 5,403,560 77,686 

Alaska............................................ 1,721,234 1,721,234 1,770,734 49,500 

Arizona.......................................... 6,478,530 6,478,530 7,006,205 527,675 

Arkansas........................................ 3,450,663 3,450,663 3,500,996 50,333 

California....................................... 34,081,746 34,081,747 34,578,882 497,135 

Colorado........................................ 4,095,054 4,095,054 4,761,264 666,210 

Connecticut.................................... 4,341,017 4,341,017 4,404,337 63,320 

Delaware........................................ 1,721,234 1,721,234 1,770,734 49,500 

District of Columbia...................... 1,721,234 1,721,234 1,770,734 49,500 

Florida........................................... 24,898,663 24,898,663 25,261,848 363,185 

Georgia.......................................... 7,795,519 7,795,519 8,605,854 810,335 

Hawaii........................................... 1,721,234 1,721,234 1,770,734 49,500 

Idaho.............................................. 1,721,234 1,721,234 1,770,734 49,500 

Illinois............................................ 14,316,068 14,316,068 14,524,890 208,822 

Indiana........................................... 6,827,801 6,827,801 6,927,395 99,594 

Iowa............................................... 4,199,620 4,199,620 4,260,878 61,258 

Kansas........................................... 3,383,554 3,383,554 3,432,908 49,354 

Kentucky....................................... 4,673,107 4,673,107 4,741,271 68,164 

Louisiana....................................... 4,726,948 4,726,948 4,795,898 68,950 

Maine............................................. 1,721,234 1,721,234 1,770,734 49,500 

Maryland....................................... 5,773,227 5,773,227 5,857,438 84,211 

Massachusetts.............................. 8,091,074 8,091,074 8,209,095 118,021 

Michigan........................................ 11,093,893 11,093,893 11,255,715 161,822 

Minnesota...................................... 5,420,599 5,420,599 5,499,667 79,068 

Mississippi..................................... 3,225,660 3,225,660 3,272,711 47,051 

Missouri......................................... 7,016,089 7,016,089 7,118,429 102,340 

Montana......................................... 1,721,234 1,721,234 1,770,734 49,500 

Nebraska........................................ 2,261,944 2,261,944 2,294,938 32,994 

Nevada........................................... 2,426,000 2,426,000 2,715,355 289,355 

New Hampshire............................. 1,721,234 1,721,234 1,770,734 49,500 

43 
 

 

 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

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

State/Territory FY 2015 Actual 

FY 2016 

Enacted 

FY 2017 

President's Budget 

FY 2017 +/-

FY 2016 

New Jersey.......................... 10,115,423 10,115,423 10,262,972 147,549 

New Mexico....................... 2,036,483 2,036,483 2,109,453 72,970 

New York........................... 23,934,312 23,934,312 24,283,431 349,119 

North Carolina.................... 9,234,231 9,234,231 9,829,657 595,426 

North Dakota...................... 1,721,234 1,721,234 1,770,734 49,500 

Ohio.................................... 13,618,168 13,618,168 13,816,810 198,642 

Oklahoma............................ 4,216,778 4,216,778 4,278,286 61,508 

Oregon................................ 4,074,931 4,074,931 4,320,274 245,343 

Pennsylvania....................... 17,622,920 17,622,920 17,879,977 257,057 

Rhode Island....................... 1,721,234 1,721,234 1,770,734 49,500 

South Carolina.................... 4,722,656 4,722,656 5,114,676 392,020 

South Dakota...................... 1,721,234 1,721,234 1,770,734 49,500 

Tennessee............................ 6,663,028 6,663,028 6,760,219 97,191 

Texas................................... 20,033,849 20,033,848 21,324,835 1,290,987 

Utah.................................... 1,839,934 1,839,934 2,020,899 180,965 

Vermont.............................. 1,721,234 1,721,234 1,770,734 49,500 

Virginia............................... 7,751,887 7,751,887 7,864,960 113,073 

Washington......................... 6,357,321 6,357,321 6,827,964 470,643 

West Virginia...................... 2,733,663 2,733,663 2,773,538 39,875 

Wisconsin........................... 6,298,516 6,298,516 6,390,390 91,874 

Wyoming............................ 1,721,234 1,721,234 1,770,734 

49,500 

Subtotal, States................... 337,532,792 337,532,792 347,307,417 9,774,625 

American Samoa................. 465,527 465,527 472,317 6,790 

Guam.................................. 860,617 860,617 885,367 24,750 

Northern Mariana Islands... 215,155 215,155 221,342 6,187 

Puerto Rico......................... 4,312,052 4,312,052 4,374,950 62,898 

Virgin Islands..................... 860,617 860,617 885,367 

24,750 

Subtotal, States and Territories 344,246,760 344,246,760 354,146,760 9,900,000 

Undistributed 1/................... 3,477,240 3,477,240 3,577,240 100,000 

TOTAL...................................... 347,724,000 347,724,000 357,724,000 10,000,000 

1/ The undistributed line reflects the amount reserved from the HCBSS appropriation for: statutory related 

activities, including contingencies; FTE and related overhead costs to conduct program monitoring and oversight; 

and for program support costs including information and systems, technical assistance and evaluation. Funds 

unused for these purposes at the end of the year are allocated to States. 

44 
 

 

 

 

 

 

Nutrition Services 

Service FY 2015 

Final 

FY 2016 

Enacted 

FY 2017 

President's 

Budget 

FY 2017 +/-

FY 2016 

Congregate Nutrition $438,191,000 $448,342,000 $454,091,000 +5,749,000 

Home Delivered $216,397,000 $226,342,000 $234,397,000 +$8,055,000 

Nutrition Services 

Incentive Program $160,069,000 $160,069,000 $160,069,000 --

Total $814,657,000 $834,753,000 $848,557,000 $13,804,000 

FTE -- -- 6 +6 

Authorizing Legislation: Sections 311, 331, 336, and 411 of the Older Americans Act of 1965, as 

amended 

FY 2017 Older Americans Act Authorization ...................................................................... Expired 

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

Program Description and Accomplishments: 

Nutrition Services help older Americans remain healthy and independent in their communities by 

providing meals and related services in a variety of settings (including congregate facilities such 

as senior centers) and via home-delivery to older adults who are homebound due to illness, 

disability, or geographic isolation. These services occur in all 50 states, the District of Columbia, 

and five territories through a network of more than 5,000 local nutrition service providers. 

Nutrition Services include: 

• Congregate Nutrition Services (Title III-C1): Provides funding for the provision of meals 

and other related services in a variety of congregate settings (e.g. senior centers, 

community centers, congregate dining facilities, school cafeterias, restaurants, farmers 

markets, hospital cafeterias, etc.) which helps to keep older individuals healthy and 

prevents the need for more costly medical interventions. Established in 1972, the program 

also presents opportunities for social engagement, health promotion activities, nutrition 

education, nutrition counseling and meaningful volunteer roles, all of which contribute to 

participants’ overall health and well-being. 

45 
 

 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

• 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, homedelivered meals are often the first in-home service that an older adult receives and are often 

the primary access point for other home and community-based services. Home-delivered 

meals also represent an essential service for some caregivers who also receive meals, 

helping them to maintain their own health and well-being while caring for their loved ones. 

• 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 State administrative costs. 

Recipients 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 older adults. States and tribes elected to spend 

nearly $2.2 million on commodities, including $130,374 assessed by USDA as 

administrative expenses, in FY 2016. 

Formula grants for congregate nutrition services and home-delivered nutrition services are 

allocated to states and territories based on their share of the population age 60 and over. Nutrition 

Services Incentive Program (NSIP) grants are provided to states, territories, and eligible tribal 

organizations based on the number of meals served in the prior fiscal year. The meals provided 

through these programs fulfill the standards set by the current Dietary Guidelines for Americans 

and provide a minimum of 33 percent of the dietary reference DRIntake, as established by the 

Food and Nutrition Board of the Institute of Medicine of the National Academy of Sciences. 

Nutrition services assist approximately 2.4 million (2014) diverse participants with characteristics 

that place them at higher risk for health care interventions as well as institutionalization. Because 

the prevalence of multiple chronic conditions is higher among congregate and home-delivered 

meal 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 to helping these older individuals avoid more serious 

medical care. 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 wellbeing. 

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. 21 Many of the most common chronic 

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

21 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 

46 
 

 

 

 

 

 

 

 

 

 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

as a primary prevention, risk reduction, or treatment modality. Data also show that Medicare 

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

example, the two-thirds of Medicare beneficiaries with two or more chronic conditions account 

for 93 percent of Medicare spending, and the one-third of Medicare beneficiaries with four or more 

chronic conditions account for almost three-fourths of Medicare spending. 22 

Data from ACL’s National Survey of OAA Participants indicate that about 44 percent of 

congregate and 62 percent of home-delivered participants have 6 or more chronic health 

conditions. About 30 percent of congregate and 53 percent of home-delivered participants take 

over six medications per day and some take as many as 20 medications. 23 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.24 

Data from the National Survey of OAA Participants indicate that about 19 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. 25 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 the National Survey of OAA 

Participants indicate that 10 percent of congregate and over 43 percent of home-delivered 

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

(IADLs), meaning that they may be unable to shop for groceries and prepare meals for themselves. 

The data also indicate that about 19 percent of congregate and 52 percent of home-delivered 

participants need help in getting outside the house, thus limiting their ability to shop for food 

themselves. 26 Although many of these older adults may rely on family and friends for assistance, 

22 Id. 23 2014 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/. 24 Kaiser et al. JAGS 2010; 58: 1734-1738 25 2014 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/. 26 Id. 

47 
 

 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

about 44 percent of congregate and 59 percent of home-delivered participants live alone. 27 Living 

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

Data from ACL’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 78 percent of congregate and 83 percent of home-delivered meal participants say 

they eat healthier meals due to the programs, and 61 percent of congregate and 92 percent of homedelivered meal recipients say that the meals enable them to continue living in their homes. 28 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. 29 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. 30 

ACL’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 42 percent in 2014 (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: 

• Home-Delivered Nutrition Services provided nearly 138 million meals to over 

837,000 individuals in FY 2014 (Output G). 

• Congregate Nutrition Services provided over 80.3 million meals to nearly 1.6 million 

seniors in a variety of community settings in FY 2014 (Output H). 

27 Id. 28 Id. 

29 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 30 Id. 

48 
 

 

 

 

 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

Funding History: 

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

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 ...................................$768,310,870 

FY 2014 ...................................$811,191,000 

FY 2015 ...................................$814,657,000 

FY 2016 ..................................$834,753,000 

Budget Request: 

The FY 2017 request for Nutrition Services is $848,557,000, an increase of +$13,804,000 above 

the FY 2016 enacted level. At this level, the budget request combined with state and local 

contributions will support an estimated 205 million home-delivered and congregate meals to more 

than 2.2 million elderly individuals in a variety of community settings. The FY 2017 request also 

incorporates a new proposal to add appropriations language that would allow the use of up to 

1 percent of the funds appropriated to ACL’s nutrition programs for development of innovative, 

evidence-based practices for senior nutrition aimed at enhancing the quality and effectiveness of 

the nutrition programs’ services. 

Nutrition Services need to be funded because they, like HCBSS, help to delay much more 

expensive medical and institutional services. Consistent with ACL’s commitment to target services 

to those most in need, approximately 67 percent of home-delivered meal recipients have annual 

incomes at or below $20,000. 31 Meals are especially critical for the survival of the nearly 

60 percent of Home-delivered recipients (52 percent of Congregate recipients) who report these 

meals as half or more of their food intake for the day and for the 45 percent of home-delivered 

meal recipients with severe disabilities who are projected to be served by these programs. 32 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. 

31 2014 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/. 

32 Id 

49 
 

 

 

 

 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

Federal support for Nutrition Services is not expected to serve every older American in need. 

While the funding request is nearly $14 million above the FY 2016 enacted level this increase 

represents a 1.7% increase for the program overall when considering state and local contributions. 

These programs also have strong partnerships with State and local governments, philanthropic 

organizations, and private donors that contribute funding. In FY 2014, State and local funding 

comprised approximately 64 percent of all the funding for home-delivered meals and congregate 

meals. The increased federal contribution will help to mitigate the effect of inflation and likely 

provide more than 1.3 million additional meals than would be served with stable funding and serve 

an estimated 13,000 additional older adults. 

In FY 2017, 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, continued cost increases that exceed increases in resources may result in some 

providers looking at cost cutting measures such as reducing menu choices or the frequency of 

deliveries. This could affect client satisfaction with the quality of service. 

While investments in nutrition services are clearly needed, it is also critical that ACL work with 

state and local partners to modernize these services and ensure that every dollar is spent effectively. 

As noted above, research clearly shows that providing nutrition services improves the health of 

participants and reduces their need for more expensive medical interventions and institutional care. 

Translating the knowledge generated by this research into evidence-based models for delivering 

services at the community level is essential to ensuring the continued efficacy of these programs 

and improving their efficiency. This knowledge is also needed to help to prepare these programs 

to meet the changing demands of seniors as the baby boom generation ages – for example, serving 

clients who will be more accustomed to interacting with service providers over the web and via 

smartphone apps than only by phone. 

As such, the FY 2017 budget would, through appropriations language, allow for up to 1 percent of 

the appropriations provided for nutrition to be invested in evidence-based innovation projects. 

Examples of innovative and promising practices that enhance the quality and effectiveness of our 

nutrition program include service products that appeal to caregivers (such as web-based ordering 

systems and carryout meals), increased involvement of volunteers (such as retired chefs), 

consideration of eating habits and choice (such as variable meal times, salad bars, or more fresh 

fruits and vegetables), new service models (testing variations and hybrid strategies) and other 

innovations to better serve the younger cohort of older adults whose needs and preferences may 

be different from those of older cohorts. These funds could be used to help develop and test 

additional models or to replicate models that have already been tested in other community-based 

settings. ACL anticipates awarding grants of up to $1 million each. As has been done with 

50 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

Preventive Health Services, ACL will provide guidance to potential grantees regarding acceptable 

evidence-based practices and interventions. 

51 
 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

Outcomes and Outputs Table: 

Nutrition Services 

Measure Year and Most Recent 

Result / 

Target for Recent Result 

/ 

(Summary of Result) 

FY 2016 

Target 

FY 2017 

Target 

FY 2017 

Target 

+/-FY 2016 

Target 

1.1 For Home and 

Community-based 

Services including 

Nutrition and Caregiver 

services increase the 

number of clients served 

per million dollars of Title 

III OAA funding. 

(Efficiency) 

FY 2014: 8,930 clients 

Target: 8,600 clients 

(Target Exceeded) 

8,700 clients 9,000 clients +300 clients 

2.9a Maintain at 90% or 

higher the percentage of 

clients receiving home 

delivered meal who rate 

services good to excellent. 

(Outcome) 

FY 2014: 88% 

Target: 90% 

(Target Not Met) 

90% 90% Maintain 

2.10 Increase the 

likelihood that the most 

vulnerable people 

receiving Older Americans 

Act Home and 

Community-based and 

Caregiver Support 

Services will continue to 

live in their homes and 

communities. (Outcome) 

FY 2014: 63.8 weighted 

average 

Target: 62 weighted 

average 

(Target Exceeded) 

63 weighted 

average 

63.25 weighted 

average 

+0.25 weighted 

average 

3.3 The percentage of 

OAA clients served who 

live in rural areas is at 

least 15% greater than the 

percent of all US elders 

who live in rural areas. 

(Outcome) 

FY 2014: 36.5% 

Target: 26.2% 

(Target Exceeded) 

26.2% 26.2% Maintain 

52 
 

 

 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

Measure Year and Most Recent 

Result / 

Target for Recent Result 

/ 

(Summary of Result) 

FY 2016 

Target 

FY 2017 

Target 

FY 2017 

Target 

+/-FY 2016 

Target 

3.5 Increase the percentage 

of older persons with 

severe disabilities who 

receive home-delivered 

meals. (Outcome) 

FY 2014: 42% 

Target: 44.3% 

(Target Not Met) 

45% 45.1% +0.1 

3.6 The percentage of 

OAA clients served who 

live in poverty is 150% 

greater than the percent of 

all U.S. elders living 

below the poverty level. 

(Outcome) 

FY 2014: 32.44% 

Target: 24.85% 

(Target Exceeded) 

24.75% 25.78% +1.03 

Indicator Year and Most Recent 

Result / 

FY 2016 

Projection 

FY 2017 

Projection 

FY 2017 

Projection 

+/-FY 2016 

Projection 

Output G: Number of 

Home-Delivered meals 

served (Output) 

FY 2014: 138 M 130.6 M 129 M -1.6 

Output H: Number of 

Congregate meals served 

(Output) 

FY 2014: 80.3 M 77.5 M 76 M -1.5 

Outputs G & H: Total 

Number of Meals (Output) 

FY 2014: 218 M 208.1 M 205 M -3.1 

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. 

53 
 

 

 

 

 

 

 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

Grant Awards Tables: 

Congregate Nutrition Programs Grant Awards 

Award FY 2015 Final FY 2016 Enacted FY 2017 

President’s Budget 

Number 

of 

Awards 

56 56 56 

Average 

Award $7,746,591 $7,926,046 $7,946,593 

Range 

of 

Awards 

$271,131 -

$43,329545 

$277,412 -

$45,080,599 

$278,131 -

$45,263,224 

Home-Delivered Nutrition Programs Grant Awards 

Award FY 2015 Final FY 2016 

Enacted 

FY 2017 

President’s 

Budget 

Number of 

Awards 56 56 56 

Average 

Award $3,825,590 $4,001,403 $4,101,948 

Range of 

Awards 

$133,896 -

$22,178,956 

$140,049 -

$23,373,557 

$143,568 -

$23,960,874 

Nutrition Services Incentive Program Grant Awards 

Award FY 2015 Final FY 2016 

Enacted 

FY 2017 

President’s 

Budget 

Number of Awards 33 317 317 317 

Average Award34 $499,734 $489,479 $499,900 

Range of Awards 35 $139 -

$16,839,155 

$140 -

$16,762,659 

$140 -

$16,589,163 

33 Number of awards includes 261 awards to Tribal organizations. 34 If the 261 awards to Tribal organizations are excluded from the “average award” calculation, the average award to 

States, DC, and the territories is $2,761,365 in FY 2015, $2,761,641 in FY 2016, and $2,733,057 in FY 2017. 

35 If the 261 award to Tribal organizations are excluded from the “range of awards” calculation, the smallest award 

to States, DC, and the territories is $57,977 in FY 2015, $57,983 in FY 2016, and $57,383 in FY 2017. 

54 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

ADMINISTRATION ON AGING 

FY 2017 DISCRETIONARY STATE FORMULA GRANTS 

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

State/Territory FY 2015 Actual 

FY 2016 

Enacted 

FY 2017 

President's Budget 

FY 2017 +/-

FY 2016 

Alabama......................................... 6,448,535 6,630,459 6,657,320 26,861 

Alaska............................................ 2,169,045 2,219,293 2,225,046 5,753 

Arizona.......................................... 8,927,511 9,321,402 9,359,164 37,762 

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

California....................................... 43,329,545 45,080,599 45,263,224 182,625 

Colorado........................................ 6,058,702 6,334,621 6,360,283 25,662 

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

Delaware........................................ 2,169,045 2,219,293 2,225,046 5,753 

District of Columbia...................... 2,169,045 2,219,293 2,225,046 5,753 

Florida........................................... 30,882,211 32,045,414 32,175,233 129,819 

Georgia.......................................... 11,007,936 11,449,654 11,496,038 46,384 

Hawaii........................................... 2,169,045 2,219,293 2,225,046 5,753 

Idaho.............................................. 2,169,045 2,219,293 2,225,046 5,753 

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

Indiana........................................... 8,266,359 8,499,079 8,533,510 34,431 

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

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

Kentucky....................................... 5,744,377 5,907,747 5,931,680 23,933 

Louisiana....................................... 5,645,998 5,774,297 5,797,690 23,393 

Maine............................................. 2,169,045 2,219,293 2,225,046 5,753 

Maryland....................................... 7,240,922 7,466,055 7,496,301 30,246 

Massachusetts.............................. 9,780,267 9,780,267 9,780,267 -

Michigan........................................ 13,443,686 13,819,524 13,875,509 55,985 

Minnesota...................................... 6,846,987 7,072,298 7,100,949 28,651 

Mississippi..................................... 3,891,114 3,891,114 3,891,114 -

Missouri......................................... 8,467,047 8,467,047 8,467,047 -

Montana......................................... 2,169,045 2,219,293 2,225,046 5,753 

Nebraska........................................ 2,738,802 2,738,802 2,738,802 -

Nevada........................................... 3,446,533 3,612,643 3,627,278 14,635 

New Hampshire............................. 2,169,045 2,219,293 2,225,046 5,753 

55 
 

 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

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

State/Territory FY 2015 Actual 

FY 2016 

Enacted 

FY 2017 

President's Budget 

FY 2017 +/-

FY 2016 

New Jersey.......................... 12,190,488 12,190,488 12,190,488 -

New Mexico....................... 2,718,255 2,806,521 2,817,891 11,370 

New York........................... 28,963,855 28,963,855 28,963,855 -

North Carolina.................... 12,624,403 13,077,861 13,130,841 52,980 

North Dakota...................... 2,169,045 2,219,293 2,225,046 5,753 

Ohio.................................... 16,393,785 16,393,785 16,393,785 -

Oklahoma............................ 5,080,736 5,080,736 5,080,736 -

Oregon................................ 5,533,521 5,747,906 5,771,192 23,286 

Pennsylvania....................... 21,279,716 21,279,716 21,279,716 -

Rhode Island....................... 2,169,045 2,219,293 2,225,046 5,753 

South Carolina.................... 6,536,987 6,804,818 6,832,385 27,567 

South Dakota...................... 2,169,045 2,219,293 2,225,046 5,753 

Tennessee............................ 8,555,440 8,820,689 8,856,423 35,734 

Texas................................... 27,192,651 28,371,616 28,486,552 114,936 

Utah.................................... 2,581,502 2,688,704 2,699,596 10,892 

Vermont.............................. 2,169,045 2,219,293 2,225,046 5,753 

Virginia............................... 10,031,513 10,366,665 10,408,661 41,996 

Washington......................... 8,734,066 9,084,261 9,121,062 36,801 

West Virginia...................... 3,305,947 3,305,947 3,305,947 -

Wisconsin........................... 7,665,166 7,900,689 7,932,696 32,007 

Wyoming............................ 2,169,045 2,219,293 2,225,046 

5,753 

Subtotal, States................... 425,615,109 435,489,049 436,611,794 1,122,745 

American Samoa................. 594,843 594,843 594,843 -

Guam.................................. 1,084,523 1,109,646 1,112,523 2,877 

Northern Mariana Islands... 271,131 277,412 278,131 719 

Puerto Rico......................... 5,158,961 5,277,984 5,299,366 21,382 

Virgin Islands..................... 1,084,523 1,109,646 1,112,523 

2,877 

Subtotal, States and Territories 433,809,090 443,858,580 445,009,180 1,150,600 

Undistributed 1/................... 4,381,910 4,483,420 9,081,820 4,598,400 

TOTAL...................................... 438,191,000 448,342,000 454,091,000 5,749,000 

1/ The undistributed line reflects the amount reserved from the Congregate Nutrition Services appropriation for: 

statutory related activities, including contingencies; FTE and related overhead costs to conduct program 

monitoring and oversight; and for program support costs including information and systems, technical assistance 

and evaluation. Funds unused for these purposes at the end of the year are allocated to States. 

56 
DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

ADMINISTRATION ON AGING 

FY 2017 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: Home-Delivered Nutrition Services (CFDA 93.045) 

State/Territory FY 2015 Actual 

FY 2016 

Enacted 

FY 2017 

President's Budget 

FY 2017 +/-

FY 2016 

Alabama......................................... 3,300,791 3,437,785 3,524,168 86,383 

Alaska............................................ 1,071,165 1,120,393 1,148,545 28,152 

Arizona.......................................... 4,569,698 4,832,995 4,954,435 121,440 

Arkansas........................................ 2,048,767 2,123,029 2,176,375 53,346 

California....................................... 22,178,956 23,373,557 23,960,874 587,317 

Colorado........................................ 3,101,249 3,284,398 3,366,926 82,528 

Connecticut.................................... 2,477,235 2,565,047 2,629,500 64,453 

Delaware........................................ 1,071,165 1,120,393 1,148,545 28,152 

District of Columbia...................... 1,071,165 1,120,393 1,148,545 28,152 

Florida........................................... 15,807,579 16,615,026 17,032,516 417,490 

Georgia.......................................... 5,634,597 5,936,459 6,085,626 149,167 

Hawaii........................................... 1,071,165 1,120,393 1,148,545 28,152 

Idaho.............................................. 1,071,165 1,120,393 1,148,545 28,152 

Illinois............................................ 8,052,146 8,373,552 8,583,956 210,404 

Indiana........................................... 4,231,275 4,406,634 4,517,361 110,727 

Iowa............................................... 2,180,137 2,260,928 2,317,739 56,811 

Kansas........................................... 1,856,324 1,932,025 1,980,572 48,547 

Kentucky....................................... 2,940,356 3,063,071 3,140,037 76,966 

Louisiana....................................... 2,865,596 2,993,879 3,069,107 75,228 

Maine............................................. 1,082,445 1,131,578 1,160,012 28,434 

Maryland....................................... 3,706,388 3,871,028 3,968,297 97,269 

Massachusetts.............................. 4,526,417 4,708,313 4,826,620 118,307 

Michigan........................................ 6,881,377 7,165,199 7,345,240 180,041 

Minnesota...................................... 3,504,745 3,666,872 3,759,010 92,138 

Mississippi..................................... 1,914,158 1,993,637 2,043,731 50,094 

Missouri......................................... 4,134,686 4,298,337 4,406,342 108,005 

Montana......................................... 1,071,165 1,120,393 1,148,545 28,152 

Nebraska........................................ 1,211,914 1,260,729 1,292,407 31,678 

Nevada........................................... 1,764,166 1,873,096 1,920,162 47,066 

New Hampshire............................. 1,071,165 1,120,393 1,148,545 28,152 

57 
 

 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

PROGRAM/CFDA NUMBER: Home-Delivered Nutrition Services (CFDA 93.045) 

State/Territory FY 2015 Actual 

FY 2016 

Enacted 

FY 2017 

President's Budget 

FY 2017 +/-

FY 2016 

New Jersey.......................... 5,839,280 6,062,752 6,215,092 152,340 

New Mexico....................... 1,391,385 1,455,136 1,491,699 36,563 

New York........................... 12,931,863 13,395,710 13,732,308 336,598 

North Carolina.................... 6,462,013 6,780,659 6,951,038 170,379 

North Dakota...................... 1,071,165 1,120,393 1,148,545 28,152 

Ohio.................................... 8,056,613 8,368,820 8,579,105 210,285 

Oklahoma............................ 2,499,780 2,594,510 2,659,703 65,193 

Oregon................................ 2,832,426 2,980,196 3,055,080 74,884 

Pennsylvania....................... 9,442,665 9,781,330 10,027,108 245,778 

Rhode Island....................... 1,071,165 1,120,393 1,148,545 28,152 

South Carolina.................... 3,346,067 3,528,187 3,616,841 88,654 

South Dakota...................... 1,071,165 1,120,393 1,148,545 28,152 

Tennessee............................ 4,379,246 4,573,384 4,688,301 114,917 

Texas................................... 13,919,016 14,710,222 15,079,849 369,627 

Utah.................................... 1,321,385 1,394,049 1,429,078 35,029 

Vermont.............................. 1,071,165 1,120,393 1,148,545 28,152 

Virginia............................... 5,134,799 5,374,947 5,510,005 135,058 

Washington......................... 4,470,679 4,710,042 4,828,392 118,350 

West Virginia...................... 1,475,026 1,523,328 1,561,605 38,277 

Wisconsin........................... 3,923,544 4,096,379 4,199,310 102,931 

Wyoming............................ 1,071,165 1,120,393 1,148,545 

28,152 

Subtotal, States................... 210,250,769 219,941,541 225,468,067 5,526,526 

American Samoa................. 136,498 140,049 143,568 3,519 

Guam.................................. 535,583 560,196 574,273 14,077 

Northern Mariana Islands... 133,896 140,049 143,568 3,519 

Puerto Rico......................... 2,640,701 2,736,549 2,805,311 68,762 

Virgin Islands..................... 535,583 560,196 574,273 

14,077 

Subtotal, States and Territories 214,233,030 224,078,580 229,709,060 5,630,480 

Undistributed 1/................... 2,163,970 2,263,420 4,687,940 2,424,520 

TOTAL...................................... 216,397,000 226,342,000 234,397,000 8,055,000 

1/ The undistributed line reflects the amount reserved from the Home-Delivered Nutrition appropriation for: 

statutory related activities, including contingencies; FTE and related overhead costs to conduct program 

monitoring and oversight; and for program support costs including information and systems, technical assistance 

and evaluation. Funds unused for these purposes at the end of the year are allocated to States. 

58 
DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

ADMINISTRATION ON AGING 

FY 2017 DISCRETIONARY STATE FORMULA GRANTS 

State/Territory FY 2015 Actual 

FY 2016 

Enacted 

FY 2017 

President's Budget 

FY 2017 +/-

FY 2016 

Alabama......................................... 3,265,986 3,266,312 3,232,505 (33,807) 

Alaska............................................ 464,911 464,958 460,145 (4,813) 

Arizona.......................................... 1,823,404 1,823,587 1,804,712 (18,875) 

Arkansas........................................ 2,607,066 2,607,326 2,580,339 (26,987) 

California....................................... 12,917,914 12,919,205 12,785,487 (133,718) 

Colorado........................................ 1,381,437 1,381,575 1,367,276 (14,299) 

Connecticut.................................... 1,508,605 1,508,756 1,493,140 (15,616) 

Delaware........................................ 691,298 691,367 684,211 (7,156) 

District of Columbia...................... 653,678 653,743 646,977 (6,766) 

Florida........................................... 6,337,801 6,338,435 6,272,830 (65,605) 

Georgia.......................................... 2,632,180 2,632,443 2,605,196 (27,247) 

Hawaii........................................... 445,222 445,266 440,657 (4,609) 

Idaho.............................................. 713,417 713,488 706,103 (7,385) 

Illinois............................................ 6,024,391 6,024,992 5,962,632 (62,360) 

Indiana........................................... 1,568,917 1,569,074 1,552,833 (16,241) 

Iowa............................................... 1,834,344 1,834,527 1,815,539 (18,988) 

Kansas........................................... 2,249,113 2,249,338 2,226,057 (23,281) 

Kentucky....................................... 1,714,897 1,715,069 1,697,317 (17,752) 

Louisiana....................................... 3,477,559 3,477,907 3,441,909 (35,998) 

Maine............................................. 597,153 597,213 591,031 (6,182) 

Maryland....................................... 1,580,901 1,581,059 1,564,695 (16,364) 

Massachusetts.............................. 6,414,572 6,415,213 6,348,814 (66,399) 

Michigan........................................ 7,437,452 7,438,195 7,361,208 (76,987) 

Minnesota...................................... 1,898,489 1,898,678 1,879,027 (19,651) 

Mississippi..................................... 1,623,075 1,623,237 1,606,436 (16,801) 

Missouri......................................... 4,016,600 4,017,002 3,975,425 (41,577) 

Montana......................................... 1,202,948 1,203,069 1,190,617 (12,452) 

Nebraska........................................ 1,135,537 1,135,651 1,123,897 (11,754) 

Nevada........................................... 1,299,820 1,299,950 1,286,495 (13,455) 

New Hampshire............................. 1,281,198 1,281,326 1,268,064 (13,262) 

59 
 

 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

PROGRAM/CFDA NUMBER: Nutrition Services Incentive Program (CFDA 93.053) 

State/Territory FY 2015 Actual 

FY 2016 

Enacted 

FY 2017 

President's Budget 

FY 2017 +/-

FY 2016 

New Jersey.......................... 3,780,589 3,780,967 3,741,833 (39,134) 

New Mexico....................... 2,275,381 2,275,609 2,252,055 (23,554) 

New York........................... 16,760,990 16,762,659 16,589,163 (173,496) 

North Carolina.................... 3,310,293 3,310,624 3,276,358 (34,266) 

North Dakota...................... 822,673 822,756 814,240 (8,516) 

Ohio.................................... 5,725,528 5,726,100 5,666,833 (59,267) 

Oklahoma............................ 2,093,814 2,094,023 2,072,350 (21,673) 

Oregon................................ 1,932,983 1,933,177 1,913,168 (20,009) 

Pennsylvania....................... 6,169,349 6,169,965 6,106,104 (63,861) 

Rhode Island....................... 426,018 426,061 421,651 (4,410) 

South Carolina.................... 1,524,809 1,524,961 1,509,178 (15,783) 

South Dakota...................... 895,832 895,921 886,648 (9,273) 

Tennessee............................ 1,552,490 1,552,645 1,536,575 (16,070) 

Texas................................... 11,351,786 11,352,920 11,235,414 (117,506) 

Utah.................................... 1,249,371 1,249,496 1,236,563 (12,933) 

Vermont.............................. 833,703 833,786 825,156 (8,630) 

Virginia............................... 2,038,493 2,038,696 2,017,595 (21,101) 

Washington......................... 2,167,497 2,167,713 2,145,277 (22,436) 

West Virginia...................... 1,653,699 1,653,864 1,636,746 (17,118) 

Wisconsin........................... 2,753,336 2,753,611 2,725,110 (28,501) 

Wyoming............................ -

867,688 858,707 

(8,981) 

Subtotal, States................... 150,986,120 151,001,203 149,438,298 (1,562,905) 

American Samoa................. 20,621 20,623 20,410 (213) 

Guam.................................. 355,916 355,952 352,268 (3,684) 

Northern Mariana Islands... 57,977 57,983 57,383 (600) 

Puerto Rico......................... 3,027,895 3,028,198 2,996,855 (31,343) 

-

Virgin Islands..................... 187,931 185,986 

(1,945) 

Subtotal, States and Territories 154,636,442 154,651,890 153,051,200 (1,600,690) 

Grants to Tribes 3,779,127 3,816,420 3,816,420 -

Undistributed 1/................... 1,653,431 1,600,690 3,201,380 1,600,690 

TOTAL...................................... 160,069,000 160,069,000 160,069,000 -

1/ The undistributed line reflects the amount reserved from the NSIP appropriation for: statutory related activities, 

including contingencies; FTE and related overhead costs to conduct program monitoring and oversight; and for 

program support costs including information and systems, technical assistance and evaluation. Funds unused for 

these purposes at the end of the year are allocated to States. This amount includes commodities that States elected 

to use instead of cash. 

60 
 

 

 

 

 

 

Preventive Health Services 

FY 2017 

Service FY 2015 FY 2016 President's FY 2017 +/-

Final Enacted Budget FY 2016 

Preventive Health $19,848,000 $19,848,000 $19,848,000 --

Services......... 

FTE -- -- .7 +.7 

Authorizing Legislation: Section 361 of the Older Americans Act of 1965, as amended 

FY 2017 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 nation’s population aged 60 and over. These funds support 

evidence-based programs 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 evidence-based preventive health 

activities to best meet local needs. Priority has been given to providing access to programs for 

elders living in medically underserved areas of their state or who have the greatest economic need. 

Due in large part to advances in public health and medical care, Americans are leading longer and 

more active lives. On average, an American turning age 65 today can expect to live an additional 

19.3 years. 36 The population of older Americans is also growing, particularly the population age 

85 and over, which is growing very rapidly, totaling 6.2 million in 2014 and projected to reach 9.1 

million by the year 2030. 37 One consequence of this increased longevity is the higher incidence 

36 Murphy SL, Kochanek, KD, Xu JQ, Arias, E. Mortality in the United States, 2014. NCHS data brief, no 229, 

Hyattsville, MD: National Center for Health Statistics 2015 

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

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

http://www.census.gov/population/projections/data/national/2014/downloadablefiles.html. Accessed 08 January 

2015. 

61 
 

 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

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. 

To help address the increase in multiple chronic conditions and ensure the best use of limited 

funds, in FY 2012 ACL requested and Congress enacted appropriations language requiring states 

and territories to use their Preventive Health funds only on evidence-based programs that have 

been proven to enhance the wellness and fitness of older adults. The same language has been 

included in each subsequent year’s appropriation’s language. Other health services, such as health 

screenings, can be funded under the Home and Community-Based Supportive Services program. 

Evidence-based programs are interventions that have been proven through randomized control 

trials to be effective at helping participants adopt healthy behaviors, improve their health status, 

and reduce their use of hospital services and emergency room visits. Examples of evidence-based 

interventions include: 

• Self-Management Programs: Chronic Disease Self-Management Education (CDSME) 

programs are low-cost, evidence-based disease prevention models that use state-of-the-art 

techniques and leaders in the community to help individuals with chronic disease address 

issues related to the management and treatment of their condition, improve their health 

status, and reduce their need for more costly medical care. CDSME programs have been 

shown repeatedly, through multiple studies, to be effective at helping participants adopt 

healthy behaviors and improve their psychological and physical health status. Some 

evidence suggests that CDSME programs may also significantly reduce the use of hospital 

care and physician services, as well as reduce health care costs. 

• Physical Activity Programs: Physical activity programs are multi-component group 

exercise programs designed for community-based organizations and intended to promote 

physical activity among older adults. Components may include strength training using soft 

wrist and ankle weights; cardiovascular workouts using dancing, aerobics, or walking; and 

balance and posture exercises. Becoming more physically active has many positive benefits 

such as increased mobility and function, decreased pain and depression, and lower risk of 

type 2 diabetes, hypertension, coronary heart disease, obesity, and some cancers. 

62 
 

 

 

FY 2015 .................................................$19,848,000 

 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

• Medication Management Programs: Medication management programs focus on 

reviewing the multitude of medications that older adults are prescribed, focusing especially 

on high-risk medications. Medication management programs have been shown to reduce 

cardiovascular problems and unnecessary duplication of prescriptions. These programs 

have also been shown to improve medication usage rates and decrease medication errors 

among older adults. 

• Falls Prevention Programs: Falls prevention programs help participants achieve improved 

strength, balance, and mobility; provide education on how to avoid falls and reduce fall 

risk factors; involve medication reviews and modifications; provide referrals for medical 

care management for fall risk factors; and provide home assessments to identify and reduce 

environmental hazards. Many people limit their activity after a fall, which can reduce 

strength, physical fitness, and mobility. 

• Depression Care Management: Depression is not a normal part of aging, yet it is a 

prevalent and disabling condition among older adults. Older adults with depression 

frequently visit the doctor and emergency room, use more medication, stay longer in the 

hospital, and have substantially higher total health care costs than those without depression. 

Cost-effective, evidence-based interventions have been shown to reduce depressive 

symptoms and improve quality of life in older adults. 

Funding History: 

Funding for Preventive Health Services during the past five years is as follows: 

FY 2012 .................................................$20,944,000 

FY 2013 .................................................$19,848,825 

FY 2014 .................................................$19,848,000 

FY 2016 ...............................................$19,848,000 

Budget Request: 

The FY 2017 request for Preventive Health Services is $19,848,000, the same as the FY 2016 

enacted level. ACL currently reserves 1% of Preventive Health Services funds at the beginning of 

the year to pay for statutory related activities, contingencies and for program support, allocating 

any funds unused for these purposes to States at the end of the year. 

63 
 

 

 

 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

ACL continues to request appropriations language that 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/CPE/OPE/ADEPP.aspx and a link to the page is one resource on the 

Title III-D 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. 

ACL will continue to provide guidance regarding what meets the evidence-based requirement. 

ACL uses a graduated or tiered set of criteria for defining evidence-based interventions 

implemented through the OAA. The OAA Title III-D webpage contains definitions of evidencebased interventions, frequently asked questions, and program examples. 38 Grantees can use the 

Title III-D Highest-Tier Criteria Evidence-Based Disease Prevention and Health Promotion 

Programs Cost Chart39 on the site to search the 45+ highest-level criteria programs listed. 

Underscoring the need for these programs, the 2015 National Survey of OAA Participants found 

that between 70 and 89 percent of clients across OAA services take three or more different 

prescription medications every day. In addition, between 19 and 42 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. Over 

70% of clients across OAA services report learning how to take care of a chronic illness or medical 

condition during the past year. Four to sixteen percent of respondents, representing over 200,000 

OAA clients, reported that they learned through a group class. 40 

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, ACL seeks to maximize the impact of this funding by providing benefits to 

individuals and achieving savings due to reduced medical costs. At the same time, states would 

continue to have the flexibility to use funding provided under the Home and Community-Based 

38 http://www.aoa.gov/AoARoot/AoA_Programs/HPW/Title_IIID/index.aspx 

39 http://www.ncoa.org/improve-health/center-for-healthy-aging/content-library/Title-IIID-Highest-Tier-EvidenceFINAL.pdf 

40 2014 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/ 

64 
 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

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 

Indicator Year and Most Recent 

Result / 

FY 2016 

Projection 

FY 2017 

Projection 

FY 2017 

Projection 

+/-FY 2016 

Projection 

Output AB: The number 

of people served with 

health and disease 

prevention programs. 

(Output) 

FY 2014: 2.2 M 2.0 M 2.0 M Maintain 

Grant Awards Tables: 

Preventive Health Services Grant Awards 

Award FY 2015 Final FY 2016 

Enacted 

FY 2017 

President’s 

Budget 

Number of 

Awards 56 56 56 

Average 

Award $350,884 $350,884 $350,884 

Range of 

Awards 

$12,281 -

$1,992,449 

$12,281 -

$1,992,449 

$12,281 -

$1,992,449 

65 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

ADMINISTRATION ON AGING 

FY 2017 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: Preventive Health Services (CFDA 93.043) 

State/Territory FY 2015 Actual 

FY 2016 

Enacted 

FY 2017 

President's Budget 

FY 2017 +/-

FY 2016 

Alabama......................................... 311,357 311,357 311,357 -

Alaska............................................ 98,248 98,247 98,247 -

Arizona.......................................... 378,742 378,742 378,742 -

Arkansas........................................ 197,733 197,733 197,733 -

California....................................... 1,992,449 1,992,462 1,992,462 -

Colorado........................................ 239,401 239,401 239,401 -

Connecticut.................................... 244,076 244,076 244,076 -

Delaware........................................ 98,248 98,247 98,247 -

District of Columbia...................... 98,248 98,247 98,247 -

Florida........................................... 1,455,604 1,455,604 1,455,604 -

Georgia.......................................... 455,734 455,734 455,734 -

Hawaii........................................... 98,248 98,247 98,247 -

Idaho.............................................. 98,248 98,247 98,247 -

Illinois............................................ 786,094 786,094 786,094 -

Indiana........................................... 399,161 399,161 399,161 -

Iowa............................................... 217,047 217,047 217,047 -

Kansas........................................... 179,147 179,147 179,147 -

Kentucky....................................... 273,195 273,195 273,195 -

Louisiana....................................... 276,343 276,343 276,343 -

Maine............................................. 98,437 98,437 98,437 -

Maryland....................................... 337,509 337,509 337,509 -

Massachusetts.............................. 434,993 434,993 434,993 -

Michigan........................................ 648,562 648,561 648,561 -

Minnesota...................................... 316,895 316,895 316,895 -

Mississippi..................................... 183,404 183,404 183,404 -

Missouri......................................... 395,543 395,543 395,543 -

Montana......................................... 98,248 98,247 98,247 -

Nebraska........................................ 116,724 116,724 116,724 -

Nevada........................................... 141,827 141,827 141,827 -

New Hampshire............................. 98,248 98,247 98,247 -

66 
 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

PROGRAM/CFDA NUMBER: Preventive Health Services (CFDA 93.043 

State/Territory FY 2015 Actual 

FY 2016 

Enacted 

FY 2017 

President's Budget 

FY 2017 +/-

FY 2016 

New Jersey.......................... 580,295 580,295 580,295 -

New Mexico....................... 119,055 119,055 119,055 -

New York........................... 1,286,483 1,286,483 1,286,483 -

North Carolina.................... 539,844 539,844 539,844 -

North Dakota...................... 98,248 98,247 98,247 -

Ohio.................................... 781,158 781,158 781,158 -

Oklahoma............................ 240,576 240,576 240,576 -

Oregon................................ 238,225 238,225 238,225 -

Pennsylvania....................... 951,872 951,872 951,872 -

Rhode Island....................... 98,248 98,247 98,247 -

South Carolina.................... 276,092 276,092 276,092 -

South Dakota...................... 98,248 98,247 98,247 -

Tennessee............................ 389,528 389,528 389,528 -

Texas................................... 1,171,202 1,171,202 1,171,202 -

Utah.................................... 107,565 107,565 107,565 -

Vermont.............................. 98,248 98,247 98,247 -

Virginia............................... 453,184 453,184 453,184 -

Washington......................... 371,656 371,656 371,656 -

West Virginia...................... 143,112 143,112 143,112 -

Wisconsin........................... 365,822 365,822 365,822 -

Wyoming............................ -98,247 98,247 

-

Subtotal, States................... 19,274,622 19,274,622 19,274,622 -

American Samoa................. 12,281 12,281 12,281 -

Guam.................................. 49,124 49,124 49,124 -

Northern Mariana Islands... 12,281 12,281 12,281 -

Puerto Rico......................... 252,088 252,088 252,088 -

Virgin Islands..................... -

49,124 49,124 

-

Subtotal, States and Territories 19,649,520 19,649,520 19,649,520 -

Undistributed 1/................... 198,480 198,480 198,480 -

TOTAL...................................... 19,848,000 19,848,000 19,848,000 -

1/ The undistributed line reflects the amount reserved from the Preventive Health appropriation for: statutory 

related activities, including contingencies; FTE and related overhead costs to conduct program monitoring and 

oversight; and for program support costs including information and systems, technical assistance and evaluation. 

Funds unused for these purposes at the end of the year are allocated to States. 

67 
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Chronic Disease Self-Management Education 

FY 2017 

Grants FY 2015 FY 2016 President's FY 2017 +/-

Final Enacted Budget FY 2016 

CDSME............... $8,000,000 $8,000,000 $8,000,000 --

Note: Funding in FY 2015 and FY 2016 was provided from the Prevention and Public Health Fund, and FY 2017 

funding is requested from the same 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 2017 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 are low-cost, evidence-based 

prevention models that use state-of-the-art techniques to help those with chronic conditions 

address issues related to the management and treatment of their condition, build self-confidence, 

improve their health status, and reduce their need for more costly medical care. Proven CDSME 

programs include the Stanford University Chronic Disease Self-Management Program (CDSMP) 

which is appropriate for any type of chronic conditions, Enhance Wellness, the Spanish CDSMP, 

the Diabetes Self-Management Program (DSMP), Spanish DSMP, Chronic Pain Self-Management 

Program, Positive Self-Management Program for HIV, Arthritis Self-Management Program 

(ASMP), Cancer Thriving and Surviving, and online versions of the CDSMP, ASMP, and DSMP. 

In the United States, over 76 percent of Medicare beneficiaries have multiple (2 or more) chronic 

conditions,41 placing them at greater risk for premature death, poor functional status, unnecessary 

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

from the 2012 Medicare Current Beneficiary Survey. [Table 2.6a Self-Reported Health Conditions and Risk Factors 

of Non-institutionalized Medicare Beneficiaries, by Living Arrangement and Age, 2012]. 

http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS/Data-Tables-Items/2012CNP.html. 

Accessed 4 March, 2015. 

69 
 

 

 

 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

hospitalizations, adverse drug events, and nursing home placement. 42 Chronic conditions also 

impact health care costs, as 93 percent of Medicare expenditures are for beneficiaries with chronic 

conditions. 43 

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.44 Some evidence suggests that CDSME programs may also significantly reduce the use of 

hospital care and physician services and reduce health care costs. 45 

The in-person programs emphasize an individual’s role in managing though 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, YWCAs, YMCAs, 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 two to three years. In FY 2010, AoA funded 47 

state grants for CDSME programs using funding provided under the Recovery Act. The Recovery 

Act grants concluded in March 2013 with over 101,000 people completing CDSME courses, well 

exceeding the programmatic goal to reach 50,000 people. 

42 Vogeli C, Shields AE, Lee TA, Gibson TB, Marder WD, Weiss KB, Blumenthal D. Multiple chronic conditions: 

prevalence, health consequences, and implications for quality, care management, and costs. J Gen Intern Med 2007; 

22 (Suppl 3):391–395. http://www. ncbi.nlm.nih.gov/pmc/articles/PMC2150598. Also, Parekh, A.K., et al. 2011. 

Managing Multiple Chronic Conditions: a Strategic Framework for Improving Health Outcomes and Quality of Life, 

Public Health Rep. 126(4):460–71. 

43 Nawrocki J. CMS Provides Data on Care for Chronic Conditions to Find Better Care Models. NetNews. April 2, 

2013 http://health.wolterskluwerlb.com/2013/04/cms-provides-data-on-care-for-chronic-conditions-to-help-findbetter-care-models/ 

44 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 

45 Sobel, DS, Lorig,KR, Hobbs,M. Chronic Disease Self-Management Program: From Development to 

Dissemination. Permanente Journal; Spring 2002. Also Ory, M. G., et al. 2013. “Successes of a National Study of 

the Chronic Disease Self-Management Program: Meeting the Triple Aim of Health Care Reform.” Medical Care 

51(11), 992-998. 

70 
 

 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

A 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 allowed states to 

provide CDSME programs to approximately 80,000 adults to help them better manage chronic 

conditions. The funding not only increased access to CDSME programs, but also fostered the 

development of comprehensive, integrated delivery systems to embed and sustain these programs 

within the long-term supports and services and health care systems. ACL also funded a Resource 

Center through a grant to the National Council on Aging. In addition, competitive contracts were 

awarded to support a database, and related activities. Another round of two-year grants (8 total) 

were issued at the end of FY 2015. 

Funding History: 

Funding for Chronic Disease Self-Management Education during the past five years is as follows: 

FY 2012 .................................................$10,000,000 

FY 2013 ...................................................$7,086,000 

FY 2014 ...................................................$8,000,000 

FY 2015 ...................................................$8,000,000 

FY 2016 ..................................................$8,000,000 

Budget Request: 

The FY 2017 request for CDSME is $8,000,000 from the Prevention and Public Health Fund, the 

same as the enacted level for FY 2016. 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.46 

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, reduction in depression and quality of life), and 

reduced health care utilization (lower emergency room visits and hospitalizations), resulting in 

potential cost savings. 47 This continued investment of resources will allow ACL, in coordination 

46 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 

47 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 

71 
 

 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

with its existing HHS partners and private philanthropists, to continue to build on past investments 

in CDSME and on ACL’s existing service delivery infrastructure as it pursues its goal of taking 

CDSME to scale nationwide. 

Older Americans are disproportionately affected by a vast array of chronic diseases and conditions. 

For example, nearly 11 million adults over the age of 65 have diabetes. 48 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 2014 alone, nearly 35,000 individuals with chronic conditions completed the CDSME program 

through ACL’s network (Output CD1). Fifty-seven percent of participants reporting relevant data 

indicate that they have multiple chronic conditions, with the most common conditions being 

hypertension (38.5 percent), arthritis (33 percent), and diabetes (32.4 percent). Over one-third of 

the participants are minority elders, including 22.2 percent African-Americans and over 17 percent 

Hispanics. 

CDSME programs are also especially well-suited for delivery through ACL’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 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, 

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. 

ACL 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. ACL and CMS will establish protocols and mechanisms to 

track CDSME participants’ Medicare claims data to assess the impact of CDSME on health care 

utilization. 

48Centers for Disease Control and Prevention. National Diabetes Fact Sheet. 

http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf,Accessed May 4, 2013. 

72 
 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

Outcomes and Outputs Table: 

Chronic Disease Self-Management Education 

Measure Year and Most Recent 

Result / 

Target for Recent Result / 

(Summary of Result) 

FY 2016 

Target 

FY 2017 

Target 

FY 2017 

Target 

+/-FY 2016 

Target 

CD2 Increase the 

percentage of individuals 

who complete the 

CDSME program. 

(Outcome) 

FY 2014: 74% 

Target: 74% 

(Target Met) 

75% 75% Maintain 

Indicator Year and Most Recent 

Result / 

FY 2016 

Projection 

FY 2017 

Projection 

FY 2017 

Projection 

+/-FY 2016 

Projection 

Output CD1: Total 

number of individuals 

with chronic conditions 

completing the CDSME 

program. (Output) 

FY 2014: 34,905 20,000 20,000 Maintain 

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HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

Grant Awards Table: 

Chronic Disease Self-Management Education Grant Awards 

Award FY 2015 Final FY 2016 

Enacted 

FY 2017 

President’s 

Budget 

Number of 

Awards 9 9 9 

Average 

Award $830,763 $830,183 $830,183 

Range of 

Awards 

$711,510 -

$1,000,000 

$711,510 -

$1,000,000 

$711,510 -

$1,000,000 

Resource and Program Data: 

Chronic Disease Self-Management Education 

(Dollars in Thousands) 

Mechanism FY 2015 

Final # 

FY 2015 

Final $ 

FY 2016 

Enacted # 

FY 2016 

Enacted $ 

FY 2017 

President’s 

Budget # 

FY 2017 

President’s 

Budget $ 

Grants: -- -- -- -- -- --

Formula -- -- -- -- -- --

New 

Discretionary 8 6,477 9 -- -- --

Continuations

1 1,000 -- 7,472 9 7,472 

Contracts 2 311 2 288 2 288 

Interagency 

Agreements 1 6 -- -- -- --

Program 

Support /1 -- 206 -- 240 -- 240 

Total 

Resources -- 8,000 -- 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 2017 

Service FY 2015 FY 2016 President's FY 2017 +/-

Final Enacted Budget FY 2016 

Falls 

Prevention.................. $5,000,000 $5,000,000 $5,000,000 --

Note: Funding in FY 2015 and FY 2016 was provided from the Prevention and Public Health Fund, and FY 2017 

funding is requested from the same 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] 

FY 2017 Older Americans Act Authorization ...................................................................... Expired 

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. 49 One in three 

adults aged 65 and older falls each year.

50 In 2013, fall-related injuries resulted in 2.5 million 

emergency room visits, over 734,000 hospitalizations, about 25,500 deaths, and an estimated $34 

billion in direct medical costs. 51 Of those who fall, 20 to 30 percent will experience serious 

injuries, such as brain trauma, broken bones, or hip fractures. 52 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. 53 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. 54 Many people limit their activity after a fall, which may reduce strength, 

49 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. 50 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. 51 Centers for Disease Control and Prevention, Falls Among Older Adults: An Overview. 

http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html. Accessed March 23, 2015. 52 Stevens JA. Fatalities and injuries from falls among older adults – United States, 1993–2003 and 2001–2005. 

MMWR 2006b;55.45:1222–24. 

53 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 

54 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. 

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HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

physical fitness, and mobility. 55 The importance of preventing falls is underscored by the inclusion 

of falls prevention screening in the annual Medicare wellness visit. 

Falls can result in significant loss of independence and often trigger the onset of a series of growing 

needs. Americans over age 75 who fall are more than four times more likely to be admitted to a 

skilled nursing facility. 56 Even without a major injury, falls can cause an older adult to become 

fearful or depressed, making it difficult for them to stay active, which in turn increases the need 

for assistance. 

Falls prevention programs help participants 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 35,000 older adults in 38 states have been served via ACLsupported Falls Prevention/Management programs, including A Matter of Balance, Stepping On, 

and Tai Chi: Moving for Better Balance. 

Evidence-based, community Falls Prevention/Management programs have clearly demonstrated a 

reduction in falls through randomized controlled trials. For example, when compared with control 

groups, the risk of falling for participants in the Tai Chi: Moving for Better Balance intervention 

decreased by 55 percent; 57 and the Stepping On program reduction was 31 percent. 58 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. 59 

In addition to reducing falls; these community-based interventions are proven to be cost-effective. 

Matter of Balance participation has been associated with total medical cost savings, and cost 

savings in the unplanned inpatient, skilled nursing facility, and home health settings. Participation 

55 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. 

56 Donald IP, Bulpitt CJ. The prognosis of falls in elderly people living at home. Age and Ageing 1999;28:121–5 57 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. 58 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.

59 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. 

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HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

was associated with a -$938 decrease in total medical costs per year. This finding includes a -$517 

reduction in unplanned hospitalization costs, a -$234 reduction in skilled nursing facility costs, 

and an -$81 reduction in home health costs.60 Additionally, a 2014 cost-benefit analysis found that 

the benefits from community-based falls prevention interventions covered their implementation 

costs and exceeded direct medical costs, resulting in a return on investment (ROI) of 64% for 

Stepping On, and an ROI of 509% for Tai Chi: Moving for Better Balance. 61 

Funding History 

Funding for Falls Prevention during the past five years is as follows: 

FY 2012 .................................................................$0 

FY 2013 .................................................................$0 

FY 2014 ...................................................$5,000,000 

FY 2015 ...................................................$5,000,000 

FY 2016 ...................................................$5,000,000 

Budget Request: 

ACL is requesting $5,000,000 from the Prevention and Public Health Fund in FY 2017, the same 

as the enacted level for FY 2016. Falls Prevention activities received their first dedicated funding 

in FY 2014, which was used to fund a national resource center and provide grants to States, Tribes, 

and other applicants to implement evidence-based falls prevention programs through ACL’s 

network of community-based provider organizations. 

ACL’s Falls Prevention program aligns with and complements funding received by the Centers 

for Disease Control and Prevention (CDC), which also carries out falls prevention efforts. CDC’s 

falls prevention programs in the clinical/medical setting refer individuals at risk for falls to 

programs in the community, where ACL excels. ACL has a long-standing commitment to the 

translation of evidence-based prevention programs from the research setting into community 

practice, and funding to ACL leverages, rather than duplicates, what CDC has invested in provider 

training and program translation to improve access to evidence-based programs in local 

communities to prevent older adult falls. ACL's national infrastructure has enabled over 264,000 

individuals throughout the country to participate in evidence-based chronic disease selfmanagement education, falls prevention, diabetes self-management training, physical activity, 

nutrition education, and depression management programs. 

60 http://innovation.cms.gov/Files/reports/CommunityWellnessRTC.pdf 

61 Carande-Kulis, V., et al., A cost–benefit analysis of three older adult fall prevention interventions, Journal of 

Safety Research (2015), http://dx.doi.org/10.1016/j.jsr.2014.12.007. Accessed March 23, 2015. 

77 
 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

Grants for Falls Prevention programs are used to: 

• Promote and disseminate fall prevention tools, including education and evidence-based 

falls prevention material that can be delivered in community settings. 

• Align with the Affordable Care Act, including the annual Medicare wellness visits that 

include screening for falls prevention and referrals to community-based interventions, as 

well as care transitions programs to reduce hospital readmissions due to falls. 

• Utilize and expand the local evidence-based program infrastructure for falls prevention 

programs started in the ACL Evidence-Based Disease and Disability Prevention Program. 

• Increase the number of older adults and adults with disabilities at risk for falls who attend 

an evidence-based falls prevention program in their communities. 

• Gather and promote best practices for development, implementation, and sustainability of 

evidence-based falls prevention programs appropriate for a community setting, including 

innovative collaborations with integrated health care systems and large employer groups. 

Grantees are 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 other program support activities, such as a falls prevention resource center which 

will promote education on falls prevention and best practices for development, implementation, 

and sustainability of falls prevention/management programs. 

78 
 

 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

Grant Awards Table: 

Falls Prevention Program Grant Awards 

Award FY 2015 Final FY 2016 

Enacted 

FY 2017 

President’s 

Budget 

Number of 

Awards 9 10 9 

Average 

Award $529,946 $476,214 $529,127 

Range of 

Awards $300,000 -

$695,040 

$300,000 -

$695,040 

$300,000 -

$695,040 

Resource and Program Data: 

Falls Prevention 

(Dollars in Thousands) 

Grants: 

FY 2015 

Final # 

FY 2015 

Final $ 

FY 2016 

Enacted # 

FY 2016 

Enacted $ 

FY 2017 

President’s 

Budget # 

FY 2017 

President’s 

Budget $ 

Formula -- -- -- -- -- --

New Discretionary 2 700 10 4,762 9 4,162 

Continuations 7 4,070 -- -- -- 600 

Contracts 2 223 -- 200 -- 200 

Interagency Agreements -- -- -- -- -- --

-- Program Support /1 7 -- 38 -- 38 

Total Resources -- 5,000 -- 5,000 -- 5,000 

1/ Program Support -- Includes funds for grant systems and review, salaries and overhead, and information 

technology support costs. 

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Native American Nutrition and Supportive Services 

Services FY 2015 

Final 

FY 2016 

Enacted 

FY 2017 

President's 

Budget 

FY 2017 +/-

FY 2016 

Native American Nutrition & 

Supportive 

Services................. $26,158,000 $31,158,000 $31,158,000 --

Authorizing Legislation: Sections 201, 613, and 623 of the Older Americans Act of 1965, as 

amended 

FY 2017 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. An estimated 803,000 persons age 

60 and over identify themselves as Native American or Alaska Native alone or in combination 

with another racial group. 62 Over 295,000 of those elders identify as Native American or Alaskan 

Native with no other racial group. 63 

Native American Nutrition and Supportive Services grants support a broad range of services to 

older Native Americans, including adult day care; transportation; congregate and home-delivered 

meals; information and referral; and personal care, chore, and other supportive services. Currently 

ACL’s congregate meal program reaches 28 percent of eligible Native American seniors in 

participating Tribal organizations, home-delivered meals reach 20 percent of such persons, and 

supportive services reach 46 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. 

62 U.S. Census Bureau, Population Division, Annual Estimates of the Resident Population by Sex, Single Year of 

Age, Race Alone or in Combination, and Hispanic Origen for the United States: April 1, 2010 to July 1 2014 

Released June, 2015, accessed 25 August 2015. 

63 Administration for Community Living, http://www.agid.acl.gov/DataGlance/. Data-at-a-Glance: American 

Community Survey (ACS) Public Use Microdata Sample (PUMS) 1-Year Files (2013), accessed 25 August, 2015. 

81 
 

 

 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

Services provided by this program in FY 2014 (the most recent year for which data are available) 

include: 

• Transportation Services, which provided 754,441 rides to meal sites, medical 

appointments, pharmacies, grocery stores, and other critical daily activities (Output L). 

• Home-Delivered Nutrition Services, under which 2.6 million meals were provided to 

42,454 homebound Native American elders. The program also provides critical social 

contacts that help to reduce the risk of depression and isolation experienced by many homebound Native American elders (Output M). 

• Congregate Nutrition Services, which provided 2.5 million meals to 60,836 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 905,521 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, website, e-newsletters, 

telephone and written consultations, and through the Native American Resource Centers (funded 

under Aging Network Support Activities). 

Eligible Tribal organizations receive nutrition and supportive services formula grants based on 

their share of the American Indian, Alaskan Native, and Native Hawaiian population age 60 and 

over. Tribal organizations must represent at least 50 Native American elders age 60 and over to 

receive funding. There is no requirement for matching funds. In addition, Tribes may decide the 

age at which a member is considered an elder and thus eligible for services. In FY 2015, grants 

were awarded to 264 Tribal organizations (representing 400 Tribes), including one organization 

serving Native Hawaiian elders. 

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HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

Funding History: 

Funding for Native American Nutrition and Supportive Services during the past five years is as 

follows: 

FY 2012 .................................................$27,601,000 

FY 2013 .................................................$26,157,052 

FY 2014 .................................................$26,158,000 

FY 2015 .................................................$26,158,000 

FY 2016 .................................................$31,158,000 

Budget Request: 

The FY 2017 request for Native American Nutrition and Supportive Services is $31,158,000, the 

same as the FY 2016 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 postpone the need for much more expensive institutional services. The services 

provided using these funds, particularly adult day care, personal care, chore services, and homedelivered 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 2017 request level, these services will provide 769,000 rides (Output L), 3.2 million 

meals at home (Output M), and 2.9 million meals at congregate sites (Output N) to over 

100,000 Native American seniors. 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 they desire. 

In FY 2017, the targeted number of units of service, such as home-delivered meals and 

transportation trips, provided to Native Americans per thousand dollars of ACL funding is 

projected at 305, a 39 percent increase over the FY 2002 base of 220 (Outcome 1.3). Over the past 

several years Native American services have generally met or exceeded their efficiency and output 

targets for meals and trips due in part to increased contributions from tribal organizations. 

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HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

Outcomes and Outputs Table: 

Native American Nutrition & Supportive Services 

Measure Year and Most Recent 

Result / 

Target for Recent Result / 

(Summary of Result) 

FY 2016 

Target 

FY 2017 

Target 

FY 2017 

Target 

+/-FY 2016 

Target 

1.3 For Title VI 

Services, increase the 

number of units of 

service provided to 

Native Americans per 

thousand dollars of AoA 

funding. (Efficiency) 

FY 2014: 307 

Target: 300 

(Target Exceeded) 

304 305 +1 

Indicator Year and Most Recent 

Result / 

FY 2016 

Projection 

FY 2017 

Projection 

FY 2017 

Projection 

+/-FY 2016 

Projection 

Output L: Transportation 

Services units (Output) 

FY 2014: 754,441 800,000 769,000 -31,000 

Output M: HomeDelivered Nutrition 

meals (Output) 

FY 2014: 2.6 M 3.2 M 3.2 M Maintain 

Output N: Congregate 

Nutrition meals (Output) 

FY 2014: 2.5 M 2.9 M 2.9 M Maintain 

Output O: Information, 

Referral and Outreach 

units (Output) 

FY 2014: 905,521 1.1 M 1.1 M Maintain 

Grant Awards Table: 

Native American Nutrition & Supportive Services Grant Awards 

Award FY 2015 Final FY 2016 

Enacted 

FY 2017 

President’s 

Budget 

Number of 

Awards 264 264 264 

Average 

Award $96,567 $115,647 $115,647 

Range of 

Awards 

$63,870 -

$1,505,000 

$77,290 -

$1,505,000 

$77,290 -

$1,505,000 

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HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

Resource and Program Data: 

Native American Nutrition and Supportive Services 

(Dollars in Thousands) 

Mechanism 

FY 2015 

Final # 

FY 2015 

Final $ 

FY 2016 

Enacted # 

FY 2016 

Enacted $ 

FY 2017 

President’s 

Budget # 

FY 2017 

President’s 

Budget $ 

Grants: 

Formula 264 25,526 264 30,496 264 30,496 

New Discretionary 1 11 -- -- 1 150 

Continuations 1 150 1 150 -- --

Contracts 2 420 1 428 1 428 

Interagency Agreements -- -- -- -- -- --

Program Support 1/ -- 51 -- 83 -- 83 

Total Resources -- 26,158 -- 31,158 -- 31,158 

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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National Eldercare Locator and Engagement 

 

 

Aging Network Support Activities 

FY 2017 

Service FY 2015 FY 2016 President's FY 2017 +/-

Final Enacted Budget FY 2016 

Aging Network Support Activities $9,961,000 $9,961,000 $9,961,000 --

Authorizing Legislation: Section 201, 202, 215, and 411 of the Older Americans Act of 1965, as 

amended 

FY 2017 Older Americans Act Authorization ...................................................................... Expired 

Allocation Method ............................ Competitive Grants/Co-operative Agreements and Contracts 

Program Description and Accomplishments: 

The Aging Network Support Activities programs provide competitive grants and contracts to 

support ongoing activities of national significance that help seniors and their families to obtain 

information about their care options and benefits and 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 ACL’s core service delivery programs. 

Competitive grants, cooperative agreements, and contracts for Aging Network Support Activities 

are awarded to eligible public or private agencies, tribal organizations, States, Area Agencies on 

Aging (AAAs), institutions of higher learning, and other organizations representing and/or serving 

older people, including faith-based organizations. Grantees are generally asked to provide a match 

equal to 25 percent of the project’s total cost. Project proposals are reviewed by external experts 

and project awards are made for periods of one to five years. In FY 2015, Aging Network Support 

Activities funded 29 grants with an average award of $337,278. 

Older Americans and their caregivers face a complicated array of choices and decisions about 

health care, pensions, insurance, housing, financial management, and long-term care. The 

Eldercare Locator, created in 1991, helps seniors and their families navigate this complex 

environment by connecting those needing assistance with State and local agencies on aging that 

serve older adults and their caregivers. The Eldercare Locator can be accessed through a toll-free 

nationwide telephone line (800-677-1116) or website (http://www.eldercare.gov). The phone line 

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HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

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 

754,430 individuals in 2014. 

ACL also supports civic engagement efforts that help connect older adults with volunteer 

opportunities in their communities. In FY 2011, ACL/AoA launched the Aging Network’s 

Volunteer Collaborative. 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. In FY 2014, building on the work of the 

Collaborative, ACL funded a National Volunteer Resource Center that assists in developing and 

sustaining the volunteer capacity within the aging network as well as provide cost saving services 

to organizations within the network. 

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 July 31, 2015, the National Alzheimer’s Call Center handled over 319,000 calls through its 

national and local partners, and its on-line message board community recorded over 6.6 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 Master’s degree social workers are available at all times. The Call 

Center is accessible by telephone, website, or e-mail at no cost to the caller. Information provided 

may include basic information on caregiving, handling legal issues, resources for long-distance 

caregiving, and tips for working with the medical community. Local community-based 

organizations are directly involved to ensure local, on-the-ground capacity to respond to 

emergencies and on-going needs of individuals with Alzheimer’s, 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 Retirement 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. ACL currently funds six 

regional counseling projects covering 30 states. In 2014, data for the program show that: 

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HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

• Pension Counseling projects have successfully recovered over $206 million in client 

benefits, representing a return of more than nine dollars for every Federal dollar invested 

in the program. 

• Projects have directly served over 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. 

ACL also supports the National Education and Resource Center on Women and Retirement 

Planning, which provides access to a one-stop gateway that integrates financial information and 

resources on retirement planning for health and long-term care. This project has made user-friendly 

financial education and retirement planning tools available to traditionally hard-to-reach 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 in 1998, the Center has conducted approximately 

200 workshops per year on strategies to access financial and retirement planning information. It 

has developed and published over 175 Fact Sheets tailored to the specific needs of hard-to-reach 

women and maintains an interactive web site. 

National Resource Centers on Native American Elders 

The National Resource Centers on Native American Elders enhance knowledge about older Native 

Americans and thereby improve the delivery of services to them. Each resource center addresses 

at least two areas of primary concern which are specified in the OAA. These include health issues, 

long-term care (including in-home care), elder abuse, mental health, and other problems and issues 

facing Native communities. The Resource Centers are administered under cooperative agreements 

by institutions of higher education. The resource centers partner with Native American 

organizations and communities, educational institutions, including tribal colleges and universities, 

and professionals and paraprofessionals in the field. Resource centers have specialized areas of 

interest. For example, the University of North Dakota Resource Center has assisted Title VI 

grantees in assessing needs of tribal elders to determine program planning and direction. This 

process has 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 

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HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

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, ethnic, and other minority older 

individuals. These centers design and disseminate front line health promotion and disease 

prevention information that is culturally and linguistically appropriate for older individuals of 

African American, Hispanic, Asian American and Pacific Islander descent, American Indian and 

Alaska Native elders, as well as for older lesbian, gay, bisexual, and transgender (LGBT) adults. 

Each NMAO project pilots a practical, nontraditional, community-based intervention for reaching 

older individuals who experience barriers to accessing home and community-based services. 

Interventions are focusing on barriers due to language and low literacy 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 curriculum and manual tailored for racial 

and ethnic minority seniors, a series of bilingual Influenza Vaccination Promotion materials, a 

referral database of Chronic Disease Self-Management Education (CDSME) workshops, and a 

culturally appropriate caregiver manual/toolkit for American Indian and Alaskan Native caregivers 

caring for elders with dementia. 

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 2016, 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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Holocaust Survivor Assistance 

 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

The United States is home to an estimated 130,000 victims of Nazi persecution, approximately 25 

percent of whom are living in poverty. Because of the experiences they endured early on in their 

lives, Holocaust survivors are likely to have greater and more complex physical and mental health 

needs as they age. The nonprofit social service agencies that serve this population have projected 

that the need for supportive services will continue to grow and intensify over the next five to ten 

years. 

In FY 2015, ACL developed and implemented a program to provide supportive services for aging 

Holocaust survivors living in the United States. One cooperative agreement (amount: $2,467,500) 

was awarded to a national organization with demonstrated expertise in working with Holocaust 

survivors to advance the development and delivery of person-centered, trauma-informed 

supportive services. The program is focusing efforts on two fronts: 1) expanding the capacity of 

community-based agencies to provide direct services to Holocaust survivors in a person-centered, 

trauma-informed manner; and 2) developing and implementing a national technical assistance 

center devoted to expanding the aging services network’s capacity to deliver person-centered, 

trauma-informed services. 

Program Performance and Technical Assistance 

This activity supports cooperative efforts between ACL and selected states and AAAs to develop 

tools, performance measures, and best practices that can be used to effectively and efficiently 

identify the results produced through OAA programs on an ongoing basis. 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 2012 ...................................................$7,873,000 

FY 2013 ...................................................$7,431,864 

FY 2014 ...................................................$7,406,000 

FY 2015 ...................................................$9,961,000 

FY 2016 ...................................................$9,961,000 

Budget Request: 

The FY 2017 request for Aging Network Support Activities is $9,961,000, the same as the 

FY 2016 enacted level. Within this budget, $2,500,000 is specifically for Holocaust Survivors, the 

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HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

same amount of funding for this purpose as the FY 2016 enacted level. All programs funded by 

this request provide critical and ongoing support for the national aging services network and are 

needed to support the activities of ACL’s core service delivery programs. Not only do they provide 

a variety of unique services, – such as the National Alzheimer’s Call Center and the National 

Eldercare Locator –these programs also considerably strengthen and streamline ACL’s core 

services, and are critical to our continuing success. 

Aging Network Support Activities outcomes are reflected in performance targets for Health and 

Independence for Older Adults and Caregiver and Family Support Services. 

Aging Network Support Activities includes funding for the following projects (dollars in thousands): 

Activity FY 2015 

Final 

FY 2016 

Enacted 

FY 2017 

President’s 

Budget 

Aging Network Support Activities: 

National Eldercare Locator and Engagement............................. $2,038 $2,038 $2,038 

National Alzheimer's Call Center.......................................... 945 945 945 

Pension Counseling and Retirement Information........................ 1,858 1,858 1,858 

National Resource Centers on Native Americans........................ 655 655 655 

National Minority Aging Organizations................................... 1,165 1,165 1,165 

Holocaust Survivor Assistance............................................. 2,500 2,500 2,500 

Program Performance and Technical Assistance......................... 799 799 799 

Total, Aging Network Support Activities........................... $9,961 $9,961 $9,961 

Grant Awards Table: 

Aging Network Support Grant Awards 

Award FY 2015 Final FY 2016 

Enacted 

FY 2017 

President’s 

Budget 

Number of 

Awards 29 29 29 

Average 

Award $337,278 $334,629 $334,629 

Range of 

Awards 

$189,650 -

$2,467,500 

$189,650 -

$2,467,500 

$189,650 -

$2,467,500 

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-- -- -- -- -- --

HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

Resource and Program Data: 

Aging Network Support Activities 

(Dollars in thousands) 

Mechanism FY 2015 

Final# 

FY 2015 

Final $ 

FY 2016 

Enacted # 

FY 2016 

Enacted $ 

FY 2017 

President’s 

Budget # 

FY 2017 

President’s 

Budget $ 

Grants: 

Formula -- -- -- -- -- --

New Discretionary 13 4,817 4 741 2 359 

Continuations 16 4,965 25 8,963 27 9,345 

Contracts 3 74 -- -- -- --

Interagency 

Agreements -- -- -- -- -- --

Program Support 1/ -- 105 -- 257 -- 257 

Total Resources -- 9,961 29 9,961 29 9,961 

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 and Family Support Services 

Summary of Request 

Families are the nation’s primary provider of long-term care, but a number of factors including 

financial constraints, work and family demands, and the many challenges of providing care place 

great pressure on family caregivers. Caregiving responsibilities demand time and money from 

families who too often are already strapped for both. ACL’s caregiver programs provide services 

that address the needs of unpaid, informal caregivers, allowing many of them to continue to work 

while providing critically needed care. 

Better support for informal caregivers is critical because often it is their availability—whether they 

are informal family caregivers, paraprofessionals, or unrelated friends and neighbors who 

volunteer their time —that determine whether an older person can remain in his or her home. In 

2013, approximately 34.2 million adult caregivers provided uncompensated care to those 50 years 

of age and older. 64 The economic cost of replacing unpaid caregiving of elderly adults is estimated 

to be between $470 billion65 and $522 billion annually, 66 higher than that of all Medicaid spending 

in FY 2014 (Federal and state: $476 billion).67 

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. 68 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-four percent of the caregivers served by OAA 

programs report that these services allow them to provide care longer than they otherwise could.69 

64 National Alliance for Caregiving, and AARP Public Policy Institute. Caregiving in the US, 2015 report. June 2015 

Washington DC. 

65 S. C. Reinhard, L. Feinberg, R. Choula, and A. Houser, Valuing the Invaluable: 2015 Update, Undeniable 

Progress, but Big Gaps Remain (Washington, DC: AARP Public Policy Institute, July 2015). 

http://www.aarp.org/content/dam/aarp/ppi/2015/valuing-the-invaluable-2015-update-new.pdf. Accessed 01/13/2016 

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

http://www.rand.org/pubs/external_publications/EP66196.html. Also Valuing the Invaluable: 2011 Update, The 

Growing Contributions and Costs of Family Caregiving. AARP Public Policy Institute. July 2011. 

http://assets.aarp.org/rgcenter/ppi/ltc/i51-caregiving.pdf 

67 “Total Medicaid Spending,” The Henry J. Kaiser Family Foundation, 2014. http://kff.org/medicaid/stateindicator/total-medicaid-spending/. 68 Schulz R, Beach SR. Caregiving as a risk factor for mortality. The Caregiver Health Effects study. JAMA December 

15, 1999;282:2215-9. 69 2014 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/. 

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CAREGIVER AND FAMILY SUPPORT SERVICES 

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 17.8 million non-institutionalized seniors age 

65 and over with 1+ ADL deficits, an increase of 3.2 million seniors (or a 22 percent increase 

between 2014 and 2020) needing caregiver assistance. 70 To address these caregiver-related needs, 

ACL requests a total of $178,417,000, an increase of $1,640,000 above the FY 2016 enacted level. 

The request includes: 

• $150,586,000 for Family Caregiver Support Services, the same as the FY 2016 enacted 

level. This program makes a range of support services available to family and informal 

caregivers—including counseling, respite care, and training—that assist family and 

informal caregivers to care for their loved ones at home for as long as possible. Studies 

have shown that these supports can reduce caregiver depression, anxiety, and stress and 

enable them to provide care longer, thereby avoiding or delaying the need for costly 

nursing home care. 

• $7,531,000 for Native American Caregiver Support Services, the same as the FY 2016 

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. 

• $4,800,000 for Alzheimer’s Disease Supportive Services, the same as the FY 2016 

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. 

• $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 as in FY 2016. Funds will be used to expand efforts to 

develop more AD-capable long-term services and support 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. 

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

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

http://www.census.gov/population/projections/data/national/2014/downloadablefiles.html. Accessed 08 January 

2015.and Centers for Medicare & Medicaid Services, The characteristics and perceptions of the Medicare population. 

Data from the 2012 Medicare Current Beneficiary Survey. [data tables 2.5a]. http://www.cms.gov/ResearchStatistics-Data-and-Systems/Research/MCBS/Data-Tables-Items/2012CNP.html. Accessed 23 October, 2014. 

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CAREGIVER AND FAMILY SUPPORT SERVICES 

• $5,000,000 for Lifespan Respite Care, an increase of $1,640,000 above the FY 2016 

enacted level. This increase is to further develop more efficient, cost-effective methods that 

improve the quality of and access to respite care for family caregivers of children or adults 

of any age with special needs. 

As a group, these programs support caregivers, elders, and people 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. 

97 
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Family Caregiver Support Services 

FY 2017 

Service FY 2015 FY 2016 President's FY 2017 +/-

Final Enacted Budget FY 2016 

Family Caregiver Support $145,586,000 $150,586,000 $150,586,000 --

Services 

FTE -- -- 2 +2 

Authorizing Legislation: Section 371 of the Older Americans Act of 1965, as amended 

FY 2017 Older Americans Act Authorization ...................................................................... Expired 

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

Program Description and Accomplishments: 

The National Family Caregiver Support Program provides formula grants to states and territories, 

based on their share of the population age 70 and over, to fund a range of supports that assist family 

and informal caregivers to care for their loved ones at home for as long as possible. The program 

includes five basic system components: information, access assistance, counseling and training, 

respite care, and supplemental services. These services work in conjunction with other OAA 

services to provide a coordinated set of supports that caregivers can access on behalf of themselves 

and the seniors for whom they provide care. Based on FY 2014 data, the most recent available, 

services included: 

• Access Assistance Services provided nearly 1.4 million contacts to caregivers assisting 

them in locating services from a variety of public and private agencies (Output I). 

• Counseling and Training Services provided 125,134 caregivers with counseling, peer 

support groups, and training to help them better cope with the stresses of caregiving 

(Output J). 

• Respite Care Services provided nearly 67,000 caregivers with approximately 6.2 million 

hours of temporary relief, at home or in an adult day care or nursing home setting, from 

their caregiving responsibilities (Output K). 

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CAREGIVER AND FAMILY SUPPORT SERVICES 

Family and other informal caregivers are the backbone of America’s long-term care system. On a 

daily basis, these individuals assist relatives and other loved ones with tasks ranging from personal 

care and homemaking to more complex health-related interventions like medication administration 

and wound care. The economic cost of replacing unpaid caregiving is estimated to be between 

$47071 and $522 billion annually is potentially higher than that of all Medicaid spending in 

FY 2014 (Federal and state: $476 billion). 72 The cost to replace that care with unskilled paid care 

at minimum wage was estimated at $221 billion, while replacing it with skilled nursing care could 

cost $642 billion annually. 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 also shown that caregiving exacts a heavy emotional, physical, and financial toll. As 

reported in ACL’s National Survey of OAA Participants, nearly 20 percent of caregivers are 

assisting two or more individuals. Over 70 percent of Title III caregivers are 60 or older, making 

them more vulnerable to a decline in their own health, and 29 percent describe their own health as 

fair to poor. 73 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 National Family Caregiver 

Support 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. 74 

Additionally, data from ACL’s National Surveys of caregivers of elderly clients also shows that 

OAA services, including those provided through the National Family Caregiver Support Program, 

are effective in helping caregivers keep their loved ones at home. Approximately 74 percent of 

caregivers of program clients reported that services enabled them to provide care longer than 

otherwise would have been possible. 75 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 

71 S. C. Reinhard, L. Feinberg, R. Choula, and A. Houser, Valuing the Invaluable: 2015 Update, Undeniable 

Progress, but Big Gaps Remain (Washington, DC: AARP Public Policy Institute, July 2015). 

http://www.aarp.org/content/dam/aarp/ppi/2015/valuing-the-invaluable-2015-update-new.pdf. Accessed 01/13/2016 

72 “Total Medicaid Spending,” The Henry J. Kaiser Family Foundation, 2013. http://kff.org/medicaid/stateindicator/total-medicaid-spending/. 73 2014 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/. 74 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.

75 2014 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/. 

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CAREGIVER AND FAMILY SUPPORT SERVICES 

available. Nearly 40 percent of caregivers 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, 

80 percent, indicated that the care recipient would most likely be living in a nursing home or 

assisted living (see below). 

Funding History: 

Funding for Family Caregiver Support Services during the past five years is as follows: 

FY 2012 ...............................................$153,621,000 

FY 2013 ...............................................$145,585,801 

FY 2014 ...............................................$145,586,000 

FY 2015 ...............................................$145,586,000 

FY 2016 ...............................................$150,586,000 

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CAREGIVER AND FAMILY SUPPORT SERVICES 

Budget Request: 

The FY 2017 request for Family Caregiver Support Services is $150,586,000, the same as the 

enacted level for FY 2016. Funding for Family Caregiver Support Services will allow ACL to 

provide services that give caregivers the assistance often needed to help them sustain their 

caregiving and provide care longer. Funding at this level will allow 900,000 caregivers (Outcome 

3.1) to receive supportive services, including respite care or other temporary relief from their 

caregiving responsibilities that will assist caregivers to continue providing care for their loved 

ones. Approximately 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. 

In FY 2017, ACL expects the aging services network to meet or exceed the target of only 

26.8 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 2014, that rate had been reduced to 36 percent 

of caregivers reporting difficulty getting services. 

For FY 2017, the performance target for Family Caregiver Support Services Program participants 

who rate services good to excellent is 90 percent (Outcome 2.9c). The substantive improvements 

in program performance can be attributed to the successful implementation of the program. Clientreported assessment of service quality and program outcomes is also expected to remain at high 

levels. 

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CAREGIVER AND FAMILY SUPPORT SERVICES 

Outcomes and Outputs Table: 

Family Caregiver Support Services 

Measure Year and Most Recent 

Result / 

Target for Recent Result / 

(Summary of Result) 

FY 2016 

Target 

FY 2017 

Target 

FY 2017 

Target 

+/-FY 2016 

Target 

1.1 For Home and 

Community-based 

Services including 

Nutrition and Caregiver 

services increase the 

number of clients served 

per million dollars of 

Title III OAA funding. 

(Efficiency) 

FY 2014: 8,930 clients 

Target: 8,600 clients 

(Target Exceeded) 

8,700 clients 9,000 clients +300 clients 

2.6 Reduce the 

percentage of caregivers 

who participate in the 

National Family 

Caregiver Support 

Program who report 

difficulty in obtaining 

services. (Outcome) 

FY 2014: 36% 

Target: 28% 

(Target Not Met) 

27% 26.8% -0.2 

2.9c Maintain at 90% or 

higher the percentage of 

National Family 

Caregiver Support 

Program clients who rate 

services good to 

excellent. (Outcome) 

FY 2014: 93.6% 

Target: 90% 

(Target Exceeded) 

90% 90% Maintain 

2.10 Increase the 

likelihood that the most 

vulnerable people 

receiving Older 

Americans Act Home 

and Community-based 

and Caregiver Support 

Services will continue to 

live in their homes and 

communities. (Outcome) 

FY 2014: 63.8 weighted 

average 

Target: 62 weighted average 

(Target Exceeded) 

63 weighted 

average 

63.25 weighted 

average 

+0.25 weighted 

average 

3.1 Increase the number 

of caregivers served 

through the National 

Family Caregiver 

Support Program. 

(Outcome) 

FY 2014: 934,096 caregivers 

Target: 790,000 caregivers 

(Target Exceeded) 

825,000 

caregivers 

900,000 

caregivers 

+75,000 caregivers 

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CAREGIVER AND FAMILY SUPPORT SERVICES 

Indicator Year and Most Recent 

Result / 

FY 2016 

Projection 

FY 2017 

Projection 

FY 2017 

Projection 

+/-FY 2016 

Projection 

Output I: Caregivers 

access assistance units of 

service. (Output) 

FY 2014: 1.4 M 1.3 M 1.3 M Maintain 

Output J: Caregivers 

receiving counseling and 

training. (Output) 

FY 2014: 125,134 122,000 120,600 -1,400 

Output K: Caregivers 

receiving respite care 

services. (Output) 

FY 2014: 66,703 68,300 68,300 Maintain 

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

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

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

achieving current strategic objectives. 

Grant Awards Table: 

Family Caregiver Supportive Services Grant Awards 

Award FY 2015 Final FY 2016 

Enacted 

FY 2017 

President’s 

Budget 

Number of 

Awards 56 56 56 

Average 

Award $2,573,753 $2,662,145 $2,662,145 

Range of 

Awards 

$93,175 -

$14,733,109 

$93,175 -

$15,350,031 

$93,175 -

$15,350,031 

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CAREGIVER AND FAMILY SUPPORT SERVICES 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

ADMINISTRATION ON AGING 

FY 2017 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: Family Caregivers Support Services (CFDA 93.052) 

State/Territory FY 2015 Actual 

FY 2016 

Enacted 

FY 2017 

President's Budget 

FY 2017 +/-

FY 2016 

Alabama......................................... 2,201,423 2,273,071 2,273,071 -

Alaska............................................ 720,651 745,400 745,400 -

Arizona.......................................... 3,157,996 3,337,314 3,337,314 -

Arkansas........................................ 1,400,893 1,442,327 1,442,327 -

California....................................... 14,733,109 15,350,031 15,350,031 -

Colorado........................................ 1,906,838 2,000,285 2,000,285 -

Connecticut.................................... 1,710,575 1,746,825 1,746,825 -

Delaware........................................ 720,651 745,400 745,400 -

District of Columbia...................... 720,651 745,400 745,400 -

Florida........................................... 11,646,384 12,143,608 12,143,608 -

Georgia.......................................... 3,508,461 3,681,543 3,681,543 -

Hawaii........................................... 720,651 745,400 745,400 -

Idaho.............................................. 720,651 745,400 745,400 -

Illinois............................................ 5,435,283 5,564,836 5,564,836 -

Indiana........................................... 2,832,791 2,906,110 2,906,110 -

Iowa............................................... 1,549,356 1,575,411 1,575,411 -

Kansas........................................... 1,279,583 1,310,132 1,310,132 -

Kentucky....................................... 1,926,002 1,983,860 1,983,860 -

Louisiana....................................... 1,865,313 1,920,451 1,920,451 -

Maine............................................. 720,651 745,400 745,400 -

Maryland....................................... 2,411,157 2,496,960 2,496,960 -

Massachusetts.............................. 3,082,374 3,160,073 3,160,073 -

Michigan........................................ 4,603,309 4,726,419 4,726,419 -

Minnesota...................................... 2,372,201 2,442,543 2,442,543 -

Mississippi..................................... 1,273,578 1,311,331 1,311,331 -

Missouri......................................... 2,836,149 2,914,714 2,914,714 -

Montana......................................... 720,651 745,400 745,400 -

Nebraska........................................ 841,954 859,814 859,814 -

Nevada........................................... 1,113,372 1,182,221 1,182,221 -

New Hampshire............................. 720,651 745,400 745,400 -

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CAREGIVER AND FAMILY SUPPORT SERVICES 

PROGRAM/CFDA NUMBER: Family Caregivers Support Services (CFDA 93.052) 

State/Territory FY 2015 Actual 

FY 2016 

Enacted 

FY 2017 

President's Budget 

FY 2017 +/-

FY 2016 

Alabama......................................... 2,201,423 2,273,071 2,273,071 -

Alaska............................................ 720,651 745,400 745,400 -

Arizona.......................................... 3,157,996 3,337,314 3,337,314 -

Arkansas........................................ 1,400,893 1,442,327 1,442,327 -

California....................................... 14,733,109 15,350,031 15,350,031 -

Colorado........................................ 1,906,838 2,000,285 2,000,285 -

Connecticut.................................... 1,710,575 1,746,825 1,746,825 -

Delaware........................................ 720,651 745,400 745,400 -

District of Columbia...................... 720,651 745,400 745,400 -

Florida........................................... 11,646,384 12,143,608 12,143,608 -

Georgia.......................................... 3,508,461 3,681,543 3,681,543 -

Hawaii........................................... 720,651 745,400 745,400 -

Idaho.............................................. 720,651 745,400 745,400 -

Illinois............................................ 5,435,283 5,564,836 5,564,836 -

Indiana........................................... 2,832,791 2,906,110 2,906,110 -

Iowa............................................... 1,549,356 1,575,411 1,575,411 -

Kansas........................................... 1,279,583 1,310,132 1,310,132 -

Kentucky....................................... 1,926,002 1,983,860 1,983,860 -

Louisiana....................................... 1,865,313 1,920,451 1,920,451 -

Maine............................................. 720,651 745,400 745,400 -

Maryland....................................... 2,411,157 2,496,960 2,496,960 -

Massachusetts.............................. 3,082,374 3,160,073 3,160,073 -

Michigan........................................ 4,603,309 4,726,419 4,726,419 -

Minnesota...................................... 2,372,201 2,442,543 2,442,543 -

Mississippi..................................... 1,273,578 1,311,331 1,311,331 -

Missouri......................................... 2,836,149 2,914,714 2,914,714 -

Montana......................................... 720,651 745,400 745,400 -

Nebraska........................................ 841,954 859,814 859,814 -

Nevada........................................... 1,113,372 1,182,221 1,182,221 -

New Hampshire............................. 720,651 745,400 745,400 -

1/ The undistributed line reflects the amount reserved from the Family Caregiver Support Services appropriation 

for: statutory related activities, including contingencies; FTE and related overhead costs to conduct program 

monitoring and oversight; and for program support costs including information and systems, technical assistance 

and evaluation. Funds unused for these purposes at the end of the year are allocated to State. 

106 
 

 

 

 

 

 

Native American Caregiver Support Services 

FY 2017 

Service FY 2015 FY 2016 President's FY 2017 +/-

Final Enacted Budget FY 2016 

Native American Caregiver 

Support Services $6,031,000 $7,531,000 $7,531,000 --

Authorizing Legislation: Section 631 of the Older Americans Act of 1965, as amended 

FY 2017 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 populations 

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 

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CAREGIVER AND FAMILY SUPPORT SERVICES 

not replace the tradition of families caring for their elders. Rather, as expressed by multiple tribal 

leaders, the program provides support that strengthens the family caregiver role. 

Funding History: 

Funding for the Native American Caregiver Support Services during the past five years is as 

follows: 

FY 2012 ...................................................$6,364,000 

FY 2013 ...................................................$6,031,076 

FY 2014 ...................................................$6,031,000 

FY 2015 ...................................................$6,031,000 

FY 2016 ...................................................$7,531,000 

Budget Request: 

The FY 2017 request for Native American Caregiver Support Services is $7,531,000, the same as 

the enacted level for FY 2016. Continued 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. 

An estimated 803,000 persons age 60 and over identify themselves as Native American or Alaska 

Native alone or in combination with another racial group. 76 Over 295,000 of those elders identify 

as Native American or Alaskan Native with no other racial group77 . 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. In FY 2017, funding for the Native American 

76 U.S. Census Bureau, Population Division, Annual Estimates of the Resident Population by Sex, Single Year of 

Age, Race Alone or in Combination, and Hispanic Origin for the United States: April 1, 2010 to July 1, 2014 

Released June 2015, accessed 25 August 2015. 

77 Administration for Community Living, http://www.agid.acl.gov/DataGlance/. Data-at-a-Glance: American 

Community Survey (ACS) Public Use Microdata Sample (PUMS) 1-Year Files (2013), accessed 25 August, 2015. 

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CAREGIVER AND FAMILY SUPPORT SERVICES 

Caregiver Support Program will continue to assist family and informal caregivers, whose 

assistance is critical to enabling Native American elders to remain at home, in the community, 

and/or on the reservation. It is estimated that in FY 2017 more than 450,000 units of caregiverrelated services, including respite care, information and referral, caregiver training, lending 

closets, and support groups, will have been provided by Native American Tribal organizations. 

Outcome Table: 

Native American Caregivers Supportive Services 

Measure Year and Most Recent 

Result / 

Target for Recent Result / 

(Summary of Result) 

FY 2016 

Target 

FY 2017 

Target 

FY 2017 

Target 

+/-FY 2016 

Target 

3.1 Increase the number 

of caregivers served 

through the National 

Family Caregiver 

Support Program. 

(Outcome) 

FY 2014: 934,096 

caregivers 

Target: 790,000 caregivers 

(Target Exceeded) 

825,000 

caregivers 

900,000 

caregivers 

+75,000 caregivers 

Grant Awards Table: 

Native American Caregivers Supportive Services Grant Awards 

Award FY 2015 Final FY 2016 

Enacted 

FY 2017 

President’s 

Budget 

Number of 

Awards 233 231 231 

Average 

Award $25,882 $32,430 $32,430 

Range of 

Awards 

$1,639 -

$47,263 

$1,639 -

$47,263 

$1,639 -

$47,263 

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-- -- -- -- -- --

CAREGIVER AND FAMILY SUPPORT SERVICES 

Resource and Program Data: 

Native American Caregiver Support Services 

(Dollars in thousands) 

Mechanism 

FY 

2015 

Final # 

FY 2015 

Final $ 

FY 2016 

Enacted# 

FY 2016 

Enacted $ 

FY 2017 

President’s 

Budget# 

FY 2017 

President’s 

Budget $ 

Grants: 

Formula 231 6,016 231 7,491 231 7,491 

New Discretionary 2 14 -- -- -- --

Continuations -- -- -- -- -- --

Contracts -- -- -- -- -- --

Interagency Agreements -- -- -- -- -- --

Program Support 1/ -- 1 -- 40 -- 40 

Total Resources -- 6,031 -- 7,531 -- 7,531 

1/ Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and review, 

and information technology support costs. 

110 
 

 

 

 

 

Alzheimer’s Disease Supportive Services Program 

Program FY 2015 

Final 

FY 2016 

Enacted 

FY 2017 

President's 

Budget 

FY 2017 +/-

FY 2016 

ADSSP............................ $3,800,000 $4,800,000 $4,800,000 --

Authorizing Legislation: Section 398 of the Public Health Services Act, as amended 

FY 2017 Authorization ......................................................................................................... Expired 

Allocation Method ............................. Competitive Grants/Cooperative Agreements and Contracts 

Program Description and Accomplishments: 

The Alzheimer’s Disease Supportive Services Program (ADSSP) funds competitive grants to 

States to expand the availability of evidence-based services that support persons with Alzheimer’s 

disease and related dementias (ADRD) and their family caregivers, and create state-wide, personcentered, dementia-capable home and community-based service (HCBS) systems. These systems 

are able to identify persons with ADRD and their family caregivers, understand their unique 

circumstances, communicate appropriately with them, help them identify and choose services that 

meet their needs, and provide supports to ease caregiver stress. Dementia-capable systems also 

help persons with dementia and their family caregivers remain independent and in the community. 

The primary components of the ADSSP program include the translation and implementation of 

evidence-based supportive services for persons with ADRD and their caregivers at the community 

level; development and delivery of statewide person-centered, dementia-capable HCBS systems; 

and incorporation of evidence-based research in the formulation of innovative projects. 

Twelve states funded in prior program years continue to offer seven dementia specific evidencebased interventions. One example of an evidence-based intervention implemented through the 

ADSSP program is the New York University Caregiver Intervention (NYUCI), a spousal caregiver 

support program that, in a randomized-control trial, delayed institutionalization of persons with 

Alzheimer’s Disease by an average of 557 days. 78 The state of Minnesota has translated this 

intervention and results are consistent with the original study. 79 Due to the success of the 

78 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. 

79 Mittelman, M.S., Bartels, S.J. “Translating Research into Practice: Case Study of a Community-based Dementia 

Caregiver Intervention,” Health Affairs. April 2014 vol. 33 no. 4 587-595. 

111 
 

 

 

 

 

 

 

 

CAREGIVER AND FAMILY SUPPORT SERVICES 

translation of the NYUCI program in their states, Minnesota, California, and Georgia continue to 

offer it well beyond the program funding period. 

In recent years, ADSSP grant projects have been designed to ensure that states provide people with 

dementia and their family caregivers with access to a sustainable HCBS system that is dementiacapable. While projects funded since 2011 continue to focus on the use of evidence-based and 

evidence-informed caregiver interventions, more recent programs are designed around the 

development of sustainable and person-centered, dementia-capable state HCBS systems. There are 

presently 15 states engaged in projects dedicated to the development and delivery of dementiacapable service systems. 

Family caregivers remain the major source of support for most people with ADRD. The nature of 

the disease – a slow loss of cognitive and functional/physical independence – means that most 

people with Alzheimer’s disease are dependent upon family and HCBS for years. 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 ADRD, and their family caregivers. 

Overall, these ADSSP programs offer direct services and other supports to thousands of persons 

with ADRD and their caregivers. Programs ensure continuous quality improvement and evaluation 

of the state systems providing necessary services as beneficiaries access a variety of services from 

many different systems including aging, medical, and mental health. As the number of people with 

Alzheimer’s disease grows, it is increasingly important that health and HCBS systems effectively 

coordinate and are responsive to persons with ADRD and their caregivers. 

Funding History: 

Funding for the ADSSP program during the past five years is as follows: 

FY 2012 ...................................................$4,010,000 

FY 2013 ...................................................$3,785,653 

FY 2014 ...................................................$3,772,000 

FY 2015 ...................................................$3,800,000 

FY 2016 ...................................................$4,800,000 

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CAREGIVER AND FAMILY SUPPORT SERVICES 

Budget Request: 

The FY 2017 request for the Alzheimer’s Disease Supportive Services Program is $4,800,000, the 

same as the enacted level for FY 2016. 

The need for cutting edge approaches that serve those with Alzheimer’s and their caregivers 

continues to grow as the incidence of and population with the disease increase. One study estimates 

that there were 454,000 new cases of Alzheimer’s disease in 2010. The annual number of new 

cases is projected to be 615,000 by 2030, and 959,000 by 2050. 80 

The FY 2017 funding request will allow ACL to expand efforts to create statewide dementiacapable systems designed to ensure the people with dementia and their caregivers have access to 

dementia-capable home and community-based services (HCBS). Dementia-capable systems in 

states will foster better quality, enhance care coordination and improve population health at lower 

cost. This will enable communities across the nation to continue implementing evidence-based 

interventions such as the New York University Caregiver Intervention referenced above. In 

addition, without this funding, ACL will be unable to undertake subsequent translations of research 

funded by the National Institute on Aging, Centers for Disease Control and Prevention, and other 

science agencies. Funds will be used to broadly disseminate those translated, evidence-based 

interventions that have proven successful over the past 9 years of funding and to test new evidencebased interventions as they are identified. In addition, funds will be used to expand the delivery of 

dementia-capable LTSS, thus helping a much broader population of families struggling to cope 

with this disease. 

ACL is examining how these interventions can be effectively provided through State LTSS 

systems, while ensuring 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. 

ACL released a joint analysis of results from a six-state translation effort of the New York 

University Caregiver Intervention in FY 2015, which aims to significantly delay 

institutionalization of persons with dementia by providing education, support, and counseling to 

spousal and other family caregivers. ACL projects that it will also have an analysis 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, (2014). “2014 Alzheimer’s Disease Facts and Figures”. Accessed August 08, 2014 

from: http://www.alz.org/downloads/facts_figures_2014.pdf 

113 
 

 

CAREGIVER AND FAMILY SUPPORT SERVICES 

Outcome and Outputs Table: 

Alzheimer’s Disease Supportive Services Program 

Measure Year and Most Recent 

Result / 

Target for Recent Result / 

(Summary of Result) 

FY 2016 

Target 

FY 2017 

Target 

FY 2017 

Target 

+/-FY 2016 

Target 

ALZ.2 Increase number 

of individuals served with 

evidence-based 

interventions -

cumulative. (Outcome) 

FY 2014: 21,450 

Target: 

19,000 

(Target Exceeded) 

21,957 22,000 +43 

Indicator Year and Most Recent 

Result / 

FY 2016 

Projection 

FY 2017 

Projection 

FY 2017 

Projection 

+/-FY 2016 

Projection 

Output AC: Number of 

individuals served – 

cumulative 81 (Output) 

FY 2014: 46,860 52,900 54,700 +1,800 

Output AD: Percent of 

individuals served that 

are of a racial/ethnic 

minority (Output) 

FY 2014: 21% 22% Discontinued N/A 

81 Cumulative count began in 2008. 

114 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-- -- -- -- -- --

CAREGIVER AND FAMILY SUPPORT SERVICES 

Grant Awards Table: 

Alzheimer’s Disease Supportive Services Grant Awards 

Award FY 2015 Final FY 2016 

Enacted 

FY 2017 

President’s 

Budget 

Number of 

Awards 5 8 8 

Average 

Award $458,978 $478,172 $478,172 

Range of 

Awards 

$312,904-

$600,000 

$312,904-

$600,000 

$312,904-

$600,000 

Resource and Program Data: 

Alzheimer’s Disease Supportive Services Program 

(Dollars in thousands) 

Mechanism FY 2015 

Final # 

FY 2015 

Final $ 

FY 2016 

Enacted# 

FY 2016 

Enacted $ 

FY 2017 

President’s 

Budget # 

FY 2017 

President’s 

Budget $ 

Grants: 

Formula -- -- -- -- -- --

New Discretionary 5 2,295 8 3,825 8 3,825 

Continuations -- -- -- -- -- --

Contracts 3 1,314 3 824 3 824 

Interagency Agreements -- -- -- -- -- --

Program Support /1 -- 191 -- 150 -- 150 

Total Resources -- 3,800 -- 4,800 -- 4,800 

1/ Program Support -- Includes funds for Public Health Service Act statutory requirements, grant systems and 

review costs. 

115 
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Alzheimer’s Disease Initiative - Specialized Supportive Services 

FY 2017 

Services FY 2015 FY 2016 President's FY 2017 +/-

Final Enacted Budget FY 2016 

Alzheimer’s Disease 

Initiative – Services $10,500,000 $10,500,000 $10,500,000 --

(Prevention Fund) 

Note: Funding in FY 2015 and FY 2016 was provided from the Prevention and Public Health Fund, and FY 2017 

funding is requested from the same 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] 

FY 2017 Older Americans Act Authorization ...................................................................... Expired 

Allocation Method ............................ Competitive Grants/Co-operative Agreements and Contracts 

Program Description and Accomplishments: 

An estimated 5.2 million individuals in the United States are living with Alzheimer’s disease and 

related dementias (ADRD), and that number is expected to increase about 40% by 2025. 82 The 

anticipated increase is attributed to individuals living longer and is correlated to advances in 

medicine and technology, and social and environmental conditions. 83 The Alzheimer’s Disease 

Initiative - Specialized Supportive Services (ADI-SSS) - is designed to fill gaps in existing 

dementia-capable home and community-based service (HCBS) systems for persons living with 

ADRD and their family caregivers. 

The effects of ADRD are devastating for individuals living with the disease and their family 

caregivers, generally requiring significant levels of health care and the availability and provision 

of intensive HCBS. As the number of people with ADRD grows, it is increasingly important that 

effectively coordinated service delivery and health care systems are responsive to these individuals 

and their caregivers. Of the community dwelling individuals with ADRD, approximately one-third 

82 Alzheimer’s Association. 2014 Alzheimer’s Disease Facts and Figures. Accessed April 14, 2014 at 

http://www.alz.org/alzheimers_disease_facts_and_figures.asp . 

83 Vincent, GK, Velkof, VA. The Next Four Decades: The Older Population in the United States: 2010-2050. 

Washington, DC. US Census Bureau, 2010. 

117 
 

 

 

 

 

 

 

 

 

live alone, exposing them to numerous risks, including unmet needs, malnutrition and injury and 

various forms of neglect and exploitation.84 

The complexity of care of persons with advanced dementia, defined by the severity of functional 

and cognitive impairment, reliance on surrogate decision-making, and inability to live alone results 

in tremendous family/caregiver burden. 85 Behavioral symptoms such as repetitive speech, 

wandering, and sleep disturbances are core clinical features of ADRD. If untreated, these behaviors 

can accelerate disease progression, worsen functional decline and quality of life, cause significant 

caregiver distress, and result in earlier nursing home placement. 86 

Enhanced dementia capable HCBS systems designed to meet the needs of formal and informal 

caregivers of individuals with ADRD is critical to helping these individuals continue to provide 

care. The ADI-SSS provides funding for the development and implementation of specialized, 

person-centered services that help individuals remain independent and safe in their communities, 

while providing much needed supports to their caregivers. Through this program, ACL is working 

with public and private entities to identify and address the special needs of persons with ADRD 

and their caregivers. 

In an effort to fill some identified existing gaps in systems that service people with ADRD and 

their family caregivers, the ADI-SSS program dedicates resources toward the provision of both 

services and training to targeted special populations. Specifically, the program requires that funded 

programs do at least one of the following: 

• Develop and deliver supportive services to persons living alone with ADRD in 

communities; 

• Prepare individuals living with moderate to severe impairment and their caregivers for the 

future; 

• Improve the quality and effectiveness of programs and services provided to aging 

individuals with intellectual disabilities who have ADRD or who are at high risk of 

developing ADRD; and 

• Deliver behavioral symptom management training and expert consultation to family 

caregivers. 

84 Gould, E., Maslow, K., Yuen, P., Wiener, J. Providing Services for People with Dementia Who Live Alone: Issue 

Brief. Accessed April 14, 2014 at http://www.adrc-tae.acl.gov/tiki-index.php?page=adsspkey&filter=key . 

85 National Alzheimer Project Act Advisory Council on Alzheimer's Research, Care, and Services Meeting #15: 

Advanced Dementia Expert Panel Summary and Key Recommendations. (2015, January 26). January 26, 2015 InPerson Meeting. Retrieved from http://aspe.hhs.gov/daltcp/napa/012615/Mtg15-Slides4.shtml. 

86 Gitlin LN, Kales HC, Lyketsos CG. Nonpharmacologic Management of Behavioral Symptoms in Dementia. 

JAMA. 2012;308(19):2020-2029. doi:10.1001/jama.2012.36918. 

118 
 

 

 

 

 

Funding History: 

FY 2012 .................................................................$0 

FY 2013 .................................................................$0 

FY 2014 .................................................$10,500,000 

FY 2015 .................................................$10,500,000 

FY 2016 .................................................$10,500,000 

Budget Request: 

The FY 2017 request for ADI-SSS is $10,500,000 from the Prevention Public Health Fund, the 

same as the enacted level for FY 2016. Funds will enable ACL to continue the development and 

expansion of specialized supportive services for those impacted by the disease. 

At the FY 2017 funding level, ACL will expand its focus on strengthening dementia-capability 

through development of specialized supportive services in a handful of States, tribal entities, and/or 

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. 

ACL will hold a competition to award cooperative agreements to states, tribes, or other localities. 

Successful applicants will build on existing dementia-capable systems by providing specialized 

supportive services that will be integrated into: 

• information, screening, referral, and access; 

• LTSS 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 specialized supportive 

services for persons with dementia and their family caregivers including a: 

• comprehensive set of services; 

• robust quality assurance system; and 

• sustainable service system. 

The specialized supportive services resulting from this funding opportunity will assist people with 

Alzheimer’s disease and their family caregivers by ensuring that their unique needs are 

addressed. Since the focus of the cooperative agreements will be to facilitate permanent systems 

change, an emphasis will be placed on implementing specialized supportive services that can 

119 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-- -- -- -- -- --

operate out of ongoing funding streams and will not require new sources of funds to continue. 

ACL awarded 10 grants in September 2014 to begin this work. 

Grant Awards Table: 

Alzheimer’s Disease Initiative – Specialized Supportive Services 

Award FY 2015 Final FY 2016 

Enacted 

FY 2017 

President’s 

Budget 

Number of 

Awards 11 10 10 

Average 

Award $941,522 $980,331 $980,331 

Range of 

Awards 

$796,712 -

$995,890 

$796,712 -

$995,890 

$796,712 -

$995,890 

Resource and Program Data: 

Alzheimer’s Disease Initiative – Specialized Supportive Services 

(Dollars in thousands) 

Mechanism FY 2015 

Final # 

FY 2015 

Final $ 

FY 2016 

Enacted# 

FY 2016 

Enacted $ 

FY 2017 

President’s 

Budget # 

FY 2017 

President’s 

Budget $ 

Grants: 

Formula -- -- -- -- -- --

New Discretionary 11 10,357 10 9,803 10 9,803 

Continuations -- -- -- -- -- --

Contracts 2 114 2 639 2 639 

Interagency Agreements -- -- -- -- -- --

Program Support /1 -- 29 -- 58 -- 58 

Total Resources -- 10,500 -- 10,500 -- 10,500 

1/ Program Support -- Includes funds for Public Health Service Act statutory requirements, grant systems and 

review costs. 

120 
 

 

 

 

 

 

 

 

 

 

Lifespan Respite Care 

FY 2017 

Service FY 2015 FY 2016 President's FY 2017 +/-

Final Enacted Budget FY 2016 

Lifespan Respite Care $2,360,000 $3,360,000 $5,000,000 +$1,640,000 

Authorizing Legislation: Lifespan Respite Care Act of 2006, Title XXIX of the Public Health 

Service Act 

FY 2017 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. In 2015, AARP and the National Alliance for Caregiving estimated that 

43.5 million people served as unpaid family caregivers to an adult or child with special needs. For 

many of these caregivers, providing care can take a toll: nineteen percent report high levels of 

physical strain; eighteen percent experience high levels of financial strain; and thirty-eight percent 

of all family caregivers indicated they experienced high levels of emotional stress.87 Many 

caregivers report difficulty managing both physical and emotional stress and balancing work and 

family responsibilities. 

Numerous studies have shown respite to be among the most frequently requested supportive 

service for family caregivers. 88 Respite is second only to direct financial assistance as a key policy 

priority of surveyed family caregivers. 89 Even though respite services are often the preferred mode 

of family caregiver support, they are often under-used, difficult to find and access, unaffordable, 

87 National Alliance for Caregiving and AARP. Caregiving in the U.S. 2015 – Focused Look at Caregivers of 

Adults Age 50+. http://www.caregiving.org/wp-content/uploads/2015/05/2015_CaregivingintheUS_Care-RecipientsOver-50_WEB.pdf 

88 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 

89 National Alliance for Caregiving and AARP, 2009 

121 
 

 

 

 

 

 

 

or in short supply. As a result, nearly 90 percent of family caregivers receive no respite at all.90 

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. 91 

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 persons of all ages 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 the provision of information, outreach, and access assistance. 

The Lifespan Respite Care Program 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 funded 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, 33 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 community-based services 

90 National Alliance for Caregiving and AARP, 2009. 

91 National Alliance for Caregiving. (2012). Multiple Sclerosis Caregivers. Washington, DC: Author; The Arc, 2011. 

122 
 

and long-term services and supports (LTSS) system reform efforts across the age and 

disability spectrum; 

• In FY 2014, 16 states received three-year grants to focus on the provision of respite 

services, more fully integrate the concepts of Lifespan Respite in state LTSS reform 

activities, and ensure the long-term sustainability of program efforts beyond the Federal 

funding period; 

• Three Technical Assistance Resource Center cooperative agreements (the first awarded in 

FY 2009, the second awarded in FY 2012, and the third awarded in FY 2015), 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. In addition, ACL awarded a 

Lifespan Respite grant to Florida. 

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; 

123 
 

 

 

 

• 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.); and 

• Provision of direct respite services to family caregivers of children with intellectual and 

developmental disabilities, adults with physical disabilities, and older Americans. 

State grantees work in collaboration with Aging and Disability Resource Centers/No Wrong Door 

Systems and a public or private non-profit statewide respite care coalition or organization. Special 

emphasis is placed on implementing or enhancing lifespan respite care statewide and building or 

improving the capacity of their long-term care systems to respond to the comprehensive needs of 

care recipients. 

Funding History: 

Funding for the Lifespan Respite Care program during the past five years is as follows: 

FY 2012 ...................................................$2,490,000 

FY 2013 ...................................................$2,350,722 

FY 2014 ...................................................$2,342,000 

FY 2015 ...................................................$2,360,000 

FY 2016 ...................................................$3,360,000 

Budget Request: 

The FY 2017 request for Lifespan Respite is $5,000,000, an increase of +$1,640,000 above the 

FY 2016 enacted level. At this level, ACL will continue to make 19 new competitive grants 

available to support a range of possible activities to build or enhance Lifespan Respite Care 

Programs; further integrate and sustain Lifespan Respite activities into broader long-term services 

and supports in the State; and/or to provide additional respite services to family caregivers across 

the age and disability spectrum. ACL recognizes the unique opportunity the Lifespan Respite Care 

Program presents to consider the critical role that support for family caregivers plays in ensuring 

the health and independence of individuals across the age and disability spectrum. By expanding 

investments in this program, ACL seeks to provide more and better targeted services that will 

allow caregivers to continue to care for their loved ones longer and thereby allow more care 

124 
 

 

 

 

recipients to remain at home and independent for longer periods at lower cost than could be 

realized if these same individuals had to be institutionalized. 

The Lifespan Respite Care Program helps to ensure respite quality and choice; and allows for 

respite development, training and coordination regardless of age or disability. The Lifespan 

Respite Care program demonstrates ACL’s commitment supporting caregivers of children or 

adults of any age with special needs. According to the National Respite Coalition, nearly 

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. 92 

The resources requested for FY 2017 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 in two new state 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. 

92 National Respite Coalition Written Testimony to the House subcommittee on Labor, Health and Human Services, 

and Education Appropriations. April 12, 2010 

125 
 

Output Table: 

Lifespan Respite Care 

Indicator Year and Most Recent 

Result / 

FY 2016 

Projection 

FY 2017 

Projection 

FY 2017 

Projection 

+/-FY 2016 

Projection 

Output AJ The number 

of states that have 

participated in the 

Lifespan Respite Care 

program. (Output) 

FY2014: 33 35 37 +2 

Grant Awards Table: 

Lifespan Respite Care Grant Awards 

Award FY 2015 Final FY 2016 

Enacted 

FY 2017 

President’s 

Budget 

Number of 

Awards 18 26 20 

Average 

Award $127,648 $125,462 $242,500 

Range of 

Awards 

$73,000 -

$259,000 

$73,000 -

$259,000 

$120,000 -

$300,000 

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-- -- -- -- -- --

Resource and Program Data: 

Lifespan Respite Care Program 

(Dollars in thousands) 

Mechanism FY 

2015 # 

FY 

2015 $ 

FY 2016 

Enacted# 

FY 2016 

Enacted $ 

FY 2017 

President’s 

Budget # 

FY 2017 

President’s 

Budget $ 

Grants: 

Formula -- -- -- -- -- --

New Discretionary 2 440 9 1,160 19 4,600 

Continuations 16 1,858 17 2,102 1 250 

Contracts -- -- -- -- -- --

Interagency Agreements -- -- -- -- -- --

Program Support /1 -- 62 -- 98 -- 150 

Total Resources -- 2,360 -- 3,360 -- 5,000 

1/ Program Support -- Includes funds for Public Health Service Act statutory requirements, grant systems and 

review costs, overhead and information technology support costs. 

127 
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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, evidence indicates that the 

number of reported cases of elder abuse, neglect, and exploitation are on the rise. A 2004 national 

survey of State Adult Protective Services (APS) programs conducted by 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. 93 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. 94 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. 95 

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.96 

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. 97 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. 

93 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 

94Tatara, 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 

95 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 

96 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. 97 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. 

129 
 

 

 

 

 

 

PROTECTION OF VULNERABLE ADULTS 

The total FY 2017 program level request for Protection of Vulnerable Adults is $52,152,000, an 

increase of +$2 million above the comparable FY 2016 enacted level. For FY 2017, specific 

program requests include: 

• $15,885,000 for the Long-Term Care Ombudsman Program, the same as the FY 2016 

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 2016 enacted 

level. This program provides formula grants to states to train, educate, and promote public 

awareness of elder abuse prevention efforts. 

• $17,620,136 for the Senior Medicare Patrol Program, and related activities the same as the 

FY 2016 enacted level. SMP funds competitive grants to support a volunteer-based 

network that helps to prevent and combat healthcare fraud and abuse and helps to preserve 

the financial integrity of Medicare and Medicaid. This activity will be funded in FY 2016 

and FY 2017 from the Health Care Fraud and Abuse Control (HCFAC) account. The SMP 

program is also supported by mandatory 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, and pays for infrastructure that 

supports States’ Senior Medicare Patrols, as well as expansion grants to SMPs targeted to 

high-fraud states. 

• $10,000,000 for Elder Rights Support Activities, an increase of +$2 million above the 

FY 2016 enacted level. The request will expand ACL’s Elder Justice/Adult Protective 

Services activities to help fulfill the promise of the Elder Justice Act of 2009. Funds will 

support the implementation of a nationwide Adult Protective Services data system, and 

fund research and evaluation activities. This program also provides funding for resource 

centers and activities that provide information, training, and technical assistance on elder 

rights issues to the national Aging Services Network. 

These elder rights and elder justice programs 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. 

130 
 

 

 

 

 

Long-Term Care Ombudsman Program 

Program FY 2015 

Final 

FY 2016 

Enacted 

FY 2017 

President’s 

Budget 

FY 2017 +/-

FY 2016 

Long-Term Care Ombudsman 

Program $15,885,000 $15,885,000 $15,885,000 --

FTE -- -- .7 +0.7 

Authorizing Legislation: Section 712 of the Older Americans Act of 1965, as amended 

FY 2017 Older Americans Act Authorization ...................................................................... Expired 

Allocation Method ................................................................................................... Formula Grants 

Program Description and Accomplishments: 

The Long-Term Care (LTC) Ombudsman Program is a consumer advocacy program that improves 

the quality of life and quality of care for the estimated 3 million individuals who reside in 

71,561 long-term care facilities.98 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 9,500 ombudsmen (both staff and designated volunteers) who resolve complaints with and 

on behalf of these residents, advocate for systemic improvement of long-term services and 

supports, and routinely monitor the condition of long-term care facilities. 

A primary ombudsman duty is to identify, investigate, and resolve complaints that are made by or 

on behalf of residents. These complaints relate to action, inaction, or decisions of providers, public 

agencies, and others that may adversely affect residents’ health, safety, welfare or rights. 

Ombudsmen advocate on behalf of residents by representing their interests before government and 

administrative entities, providing information to residents and families about long-term services 

and supports, and educating the general public about issues related to long-term services and 

supports policies and regulations. 

Much of the efficiency of the ombudsman program is due to a strong reliance on volunteers who 

make up the bulk of those who resolve resident issues.99 All but three states have volunteer 

98 National Ombudsman Reporting System (NORS) – Federal Fiscal 2014. 99 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. 

131 
 

 

 

 

 

 

PROTECTION OF VULNERABLE ADULTS 

ombudsman programs. These trained and designated volunteer ombudsmen donated over 786,861 

hours in FY 2014. In FY 2014, output data for the Long-Term Care Ombudsman Program 

highlights the accomplishments achieved by this program and the important role that ombudsmen 

play in ensuring that the rights of long-term care facility residents are respected: 

• 1,294 paid and which represents 8,155 designated volunteer ombudsmen regularly visited 

residents in 27,913 facilities, more than 69 percent of all nursing home facilities and nearly 

29 percent of all licensed board and care facilities (Output S). At least another 

4,000 volunteers support these paid staff and volunteer ombudsmen. 

• Ombudsmen investigated and worked to resolve 191,553 complaints (Output Q). 

• Ombudsmen provided over 491,373 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). 

Today’s landscape is changing, however, as individuals in need of long-term services and supports 

are increasingly choosing to live in community settings. Encouraging community living is a 

strategic DHHS priority and has been supported by a number of Federal and State policies 

promoting alternatives to nursing homes and other institutional settings that recognize the value of 

consumer preference and the potential fiscal savings that can result. 

The desire to re-balance and thereby give consumers more community living options has been 

promoted and accelerated through a variety of Federal laws and initiatives: the Affordable Care 

Act, Olmstead implementation and enforcement, Money Follows the Person, Home and 

Community-Based Service (HCBS) revised regulations, and Medicaid managed care, to name a 

few. These evolving services and supports continue to change the long-term care landscape across 

the country. There is also a growing Federal awareness and response to the uncharted area of 

abuse, neglect and exploitation of older adults and individuals with disabilities. Addressing this 

troubling trend is also a priority of ACL. 

All of these changes have created new challenges for LTC Ombudsman Programs, as well as for 

Protection & Advocacy Systems serving the disability community that are also supported by ACL. 

Going forward, the newly published LTC Ombudsman rule will help bring needed consistency 

and strengthen LTC Ombudsman programs and the effectiveness of their services to individuals 

living in long-term care facilities. 

132 
 

 

 

 

 

PROTECTION OF VULNERABLE ADULTS 

Funding History: 

Funding for the Long-term Care Ombudsman Program during the past five years is as follows: 

FY 2012 .................................................$16,761,000 

FY 2013 .................................................$15,885,000 

FY 2014 .................................................$15,885,000 

FY 2015 .................................................$15,885,000 

FY 2016 .................................................$15,885,000 

Budget Request: 

The FY 2017 request for the LTC Ombudsman Program is $15,885,000, the same as the enacted 

level for FY 2016. 

Funds will continue to support the existing infrastructure and activities of the Ombudsman 

program. With the senior population continuing to grow, the need for safe, high-quality long-term 

care services (including non-nursing home alternatives) continues to increase, even as we seek to 

help more people remain in the community for longer periods. Outcome data (displayed in the 

summary tables at the end of this section) have demonstrated the success of this program in 

protecting older Americans in an efficient and effective manner. The percentage of the complaints 

processed by ombudsmen that were fully or partially resolved to the satisfaction of the resident 

has consistently remained near 75 percent, 100 demonstrating both the efficiency of the program 

and its ability to produce positive outcomes for residents. The FY 2014 average number of 

complaints per facility, at 2.62, exceeds the target of 3.0. Outcome 2.14 targets a decrease in 

complaints that the program was unable to resolve to the satisfaction of the resident. 

Ombudsman activities represent an important element of ACL’s focus on elder rights, which 

expands and improves upon ACL’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 regulations and 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 wellbeing 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. Going forward, outreach, access, complaint 

100 National Ombudsman Reporting System (NORS) 2014 – Complaint resolution: 11% needing no further action; 4% 

withdrawn; 4.5% not resolved to the satisfaction of the resident; 5% referred to other agency for resolution. 

133 
 

PROTECTION OF VULNERABLE ADULTS 

investigation and advocacy in board and care and assisted living will require ombudsmen to 

employ new strategies compared to the work now done primarily in nursing home settings. 

Outcomes and Outputs Table: 

Long-Term Care Ombudsman Program 

Measure Year and Most Recent 

Result / 

Target for Recent Result / 

(Summary of Result) 

FY 2016 

Target 

FY 2017 

Target 

FY 2017 

Target 

+/-FY 2016 

Target 

2.12 Decrease the 

average number of 

complaints per LTC 

facility. (Outcome) 

FY 2014: 2.6 

Target: 3 

(Target Exceeded) 

2.8 2.8 Maintain 

2.14 Decrease the number 

of complaints not 

resolved to the 

satisfaction of the 

resident. (Outcome) 

FY 2014: 8,675 

Target: 10,700 

(Target Exceeded) 

9,700 9,000 -700 

134 
PROTECTION OF VULNERABLE ADULTS 

Indicator Year and Most Recent 

Result / 

FY 2016 

Projection 

FY 2017 

Projection 

FY 2017 

Projection 

+/-FY 2016 

Projection 

Output Q: The Number 

of Complaints (Output) 

FY 2014: 191,553 192,000 193,000 +1,000 

Output R: Number of 

Ombudsman 

Consultations (Output) 

FY 2014: 491,373 490,000 490,000 Maintain 

Output S: Facilities 

regularly visited not in 

response to a complaint 

(Output) 

FY 2014: 27,913 27,600 27,600 Maintain 

Grant Awards Table: 

Long-Term Care Ombudsman Program Formula Grant Awards 

Award FY 2015 Final FY 2016 

Enacted 

FY 2017 

President’s 

Budget 

Number of 

Awards 56 56 56 

Average 

Award $280,824 $280,824 $280,824 

Range of 

Awards 

$9,829 -

$1,618,546 

$9,829 -

$1,640,388 

$9,829 -

$1,640,388 

135 
 

PROTECTION OF VULNERABLE ADULTS 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

ADMINISTRATION ON AGING 

FY 2017 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: Long-Term Care Ombudsman Program (CFDA 93.042) 

State/Territory FY 2015 Actual 

FY 2016 

Enacted 

FY 2017 

President's Budget 

FY 2017 +/-

FY 2016 

Alabama......................................... 242,304 241,269 241,269 -

Alaska............................................ 78,631 78,631 78,631 -

Arizona.......................................... 335,451 339,187 339,187 -

Arkansas........................................ 150,395 148,997 148,997 -

California....................................... 1,628,106 1,640,388 1,640,388 -

Colorado........................................ 227,656 230,504 230,504 -

Connecticut.................................... 181,848 180,019 180,019 -

Delaware........................................ 78,631 78,631 78,631 -

District of Columbia...................... 78,631 78,631 78,631 -

Florida........................................... 1,160,398 1,166,066 1,166,066 -

Georgia.......................................... 413,623 416,629 416,629 -

Hawaii........................................... 78,631 78,631 78,631 -

Idaho.............................................. 78,631 78,631 78,631 -

Illinois............................................ 591,090 587,668 587,668 -

Indiana........................................... 310,608 309,264 309,264 -

Iowa............................................... 160,039 158,675 158,675 -

Kansas........................................... 136,268 135,592 135,592 -

Kentucky....................................... 215,845 214,971 214,971 -

Louisiana....................................... 210,357 210,115 210,115 -

Maine............................................. 79,460 79,416 79,416 -

Maryland....................................... 272,077 271,674 271,674 -

Massachusetts.............................. 332,274 330,436 330,436 -

Michigan........................................ 505,146 502,864 502,864 -

Minnesota...................................... 257,275 257,346 257,346 -

Mississippi..................................... 140,514 139,916 139,916 -

Missouri......................................... 303,518 301,663 301,663 -

Montana......................................... 78,631 78,631 78,631 -

Nebraska........................................ 88,964 88,480 88,480 -

Nevada........................................... 129,503 131,457 131,457 -

New Hampshire............................. 78,631 78,631 78,631 -

136 
 

 

 

PROTECTION OF VULNERABLE ADULTS 

PROGRAM/CFDA NUMBER: Long-Term Care Ombudsman Program (CFDA 93.042) 

State/Territory FY 2015 Actual 

FY 2016 

Enacted 

FY 2017 

President's Budget 

FY 2017 +/-

FY 2016 

New Jersey.......................... 428,648 425,492 425,492 -

New Mexico....................... 102,138 102,123 102,123 -

New York........................... 949,298 940,130 940,130 -

North Carolina.................... 474,362 475,876 475,876 -

North Dakota...................... 78,631 78,631 78,631 -

Ohio.................................... 591,417 587,335 587,335 -

Oklahoma............................ 183,503 182,086 182,086 -

Oregon................................ 207,922 209,154 209,154 -

Pennsylvania....................... 693,164 686,467 686,467 -

Rhode Island....................... 78,631 78,631 78,631 -

South Carolina.................... 245,627 247,613 247,613 -

South Dakota...................... 78,631 78,631 78,631 -

Tennessee............................ 321,470 320,966 320,966 -

Texas................................... 1,021,763 1,032,384 1,032,384 -

Utah.................................... 96,999 97,836 97,836 -

Vermont.............................. 78,631 78,631 78,631 -

Virginia............................... 376,934 377,221 377,221 -

Washington......................... 328,182 330,557 330,557 -

West Virginia...................... 108,278 106,909 106,909 -

Wisconsin........................... 288,018 287,490 287,490 -

Wyoming............................ -78,631 78,631 

-

Subtotal, States................... 15,434,014 15,435,807 15,435,807 -

American Samoa................. 9,829 9,829 9,829 -

Guam.................................. 39,315 39,315 39,315 -

Northern Mariana Islands... 9,829 9,829 9,829 -

Puerto Rico......................... 193,848 192,055 192,055 -

Virgin Islands..................... -39,315 39,315 

-

Subtotal, States and Territories 15,726,150 15,726,150 15,726,150 -

Undistributed 1/................... 158,850 158,850 158,850 -

TOTAL...................................... 15,885,000 15,885,000 15,885,000 -

1/ The undistributed line reflects the amount reserved from the Long-Term Care Ombudsman appropriation for: 

statutory related activities, including contingencies; FTE and related overhead costs to conduct program 

monitoring and oversight; and for program support costs including information and systems, technical assistance 

and evaluation. Funds unused for these purposes at the end of the year are allocated to States. 

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Prevention of Elder Abuse and Neglect 

Service 

Prevention of Elder Abuse & 

Neglect...... 

FY 2015 

Final 

$4,773,000 

FY 2016 

Enacted 

$4,773,000 

FY 2017 

President’s 

Budget 

$4,773,000 

FY 2017 +/-

FY 2016 

--

FTE -- -- .3 +0.3 

Authorizing Legislation: Section 721 of the Older Americans Act of 1965, as amended 

FY 2017 Older Americans Act 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 ACL’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 2014, over $30 million of the Elder Abuse Prevention services expenditures was 

leveraged from non-OAA funds, a ratio of approximately $6.50 of non-OAA funds for every $1 

investment of ACL funds. 

Examples of state elder abuse prevention activities include: 

• In Kentucky, the local area agencies on aging participate in the Local Coordinating 

Councils on Elder Abuse, which have developed emergency elder shelters, distributed 

informational cards for law enforcement officers to have in the patrol cars which contain 

crucial resource information for victims of elder abuse, conducted training on a regular 

basis to first responders, provided a friendly visitor program for home-based seniors, and 

produced a prevention tool called the Kentucky Fraud Fighter Form. 

139 
 

 

PROTECTION OF VULNERABLE ADULTS 

• In Illinois, the State Department on Aging utilizes its elder abuse funds to support 

volunteer community based multi-disciplinary teams (M-Teams) that serve in a technical 

advisory role to more than 40 elder abuse provider agencies throughout the state. The 

objectives of the M-Team are to provide case consultation and assistance to caseworkers 

and to encourage cooperation among various service agencies. Each M-Team is 

composed of the M-Team Coordinator and representatives of the mental health, medical, 

legal, law enforcement, faith community, and financial professions. 

The Prevention of Elder Abuse and Neglect program demonstrates ACL’s ongoing commitment 

to protecting the rights of 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 2012 ...................................................$5,036,000 

FY 2013 ...................................................$4,773,000 

FY 2014 ...................................................$4,773,000 

FY 2015 ...................................................$4,773,000 

FY 2016 ...................................................$4,773,000 

Budget Request: 

The FY 2017 request for the Prevention of Elder Abuse and Neglect program is $4,773,000, the 

same as the FY 2016 enacted level. The FY 2017 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. 

Elder Abuse Prevention activities are important elements of ACL’s continued focus in FY 2017 

on elder rights and elder justice, which seeks to improve upon ACL’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 respond 

to 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 

140 
 

 

 

PROTECTION OF VULNERABLE ADULTS 

be developed and evaluated. Past examples of efforts undertaken by states include creation of 

informational cards for law enforcement officers to provide crucial resource information to victims 

of elder 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 

Indicator Year and Most Recent 

Result / 

FY 2016 

Projection 

FY 2017 

Projection 

FY 2017 

Projection 

+/-FY 2016 

Projection 

Output U: Elder Abuse 

prevention non-OAA 

service expenditures 

(Output, dollars in 

thousands) 

FY 2014: $30,897 $30,500 $30,500 Maintain 

Grant Awards Table: 

Prevention of Elder Abuse, Neglect, and Exploitation Grant Awards 

Award FY 2015 

Operating 

FY 2016 

President's 

Budget 

FY 2017 

Request 

Number of 

Awards 56 56 56 

Average Award $84,500 $84,500 $84,500 

Range of 

Awards 

$2,958 -

$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 2017 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: Prevention of Elder Abuse & Neglect (CFDA 93.041) 

State/Territory FY 2015 Actual 

FY 2016 

Enacted 

FY 2017 

President's Budget 

FY 2017 +/-

FY 2016 

Alabama......................................... 76,215 76,215 76,215 -

Alaska............................................ 23,660 23,660 23,660 -

Arizona.......................................... 81,500 81,500 81,500 -

Arkansas........................................ 48,157 48,157 48,157 -

California....................................... 471,073 471,073 471,073 -

Colorado........................................ 56,082 56,082 56,082 -

Connecticut.................................... 59,907 59,907 59,907 -

Delaware........................................ 23,660 23,660 23,660 -

District of Columbia...................... 23,660 23,660 23,660 -

Florida........................................... 344,252 344,252 344,252 -

Georgia.......................................... 103,321 103,321 103,321 -

Hawaii........................................... 23,660 23,660 23,660 -

Idaho.............................................. 23,660 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............................................. 23,660 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......................................... 23,660 23,660 23,660 -

Nebraska........................................ 29,770 29,770 29,770 -

Nevada........................................... 27,629 27,629 27,629 -

New Hampshire............................. 23,660 23,660 23,660 -

142 
 

 

PROTECTION OF VULNERABLE ADULTS 

PROGRAM/CFDA NUMBER: Prevention of Elder Abuse & Neglect (CFDA 93.041) 

State/Territory FY 2015 Actual 

FY 2016 

Enacted 

FY 2017 

President's Budget 

FY 2017 +/-

FY 2016 

New Jersey.......................... 143,950 143,950 143,950 -

New Mexico....................... 26,393 26,393 26,393 -

New York........................... 318,066 318,066 318,066 -

North Carolina.................... 126,782 126,782 126,782 -

North Dakota...................... 23,660 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....................... 23,660 23,660 23,660 -

South Carolina.................... 63,080 63,080 63,080 -

South Dakota...................... 23,660 23,660 23,660 -

Tennessee............................ 91,810 91,810 91,810 -

Texas................................... 274,281 274,281 274,281 -

Utah.................................... 24,837 24,837 24,837 -

Vermont.............................. 23,660 23,660 23,660 -

Virginia............................... 102,820 102,820 102,820 -

Washington......................... 86,291 86,291 86,291 -

West Virginia...................... 36,736 36,736 36,736 -

Wisconsin........................... 90,309 90,309 90,309 -

Wyoming............................ 23,660 23,660 23,660 -

Subtotal, States................... 4,648,207 4,648,207 4,648,207 -

American Samoa................. 2,958 2,958 2,958 -

Guam.................................. 11,830 11,830 11,830 -

Northern Mariana Islands... 2,958 2,958 2,958 -

Puerto Rico......................... 54,217 54,217 54,217 -

Virgin Islands..................... 11,830 11,830 11,830 

-

Subtotal, States and Territories 4,732,000 4,732,000 4,732,000 -

Undistributed 1/................... 41,000 41,000 41,000 -

TOTAL...................................... 4,773,000 4,773,000 4,773,000 -

1/ The undistributed line reflects the amount reserved from the Prevention of Elder Abuse & Neglect appropriation 

for: statutory related activities, including contingencies; FTE and related overhead costs to conduct program 

monitoring and oversight; and for program support costs including information and systems, technical assistance 

and evaluation. Funds unused for these purposes at the end of the year are allocated to States. 

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Senior Medicare Patrol Program 

FY 2017 FY 2017+/-

Service 

FY 2015 

Final 

FY 2016 

Enacted 

President’s 

Budget 

FY 2016 

Senior Medicare Patrol Program 

1/............. $8,910,000 $8,910,000 $8,910,000 --

HCFAC Expansion Grants 

(mandatory funding) 2/................. 5,331,814 5,331,814 5,331,814 --

HCFAC Infrastructure mandatory 

Funds 2/. 3,378,322 3,378,322 3,378,322 --

Total....................... 17,620,136 17,620,136 17,620,136 --

FTE........................ 7 7 7 --

1/ In FY 2015, $8.91M in ACL’s discretionary budget authority funded the SMP program. Beginning in FY 2016, direct funding 

will no longer be provided or requested for SMP. Instead, based on FY 2016 appropriations language, funding levels are determined 

by the Secretary of HHS and made available from discretionary appropriations for the Health Care Fraud and Abuse (HCFAC) 

account within the Centers for Medicare & Medicaid Services (CMS). The amounts shown for FY 2016 and FY 2017 are 

placeholders pending final funding level decisions by the Secretary. These funds are separate from current ACL funding for 

mandatory HCFAC funding which comes from "Wedge" dollars (see footnote 2, below). 

2/ Authorized by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), HCFAC Base Infrastructure funds and 

HCFAC Expansion Grants (provided to SMP program grantees) are funded from the mandatory HCFAC “Wedge” funds following 

decisions by the Secretary and the Attorney General. Mandatory HCFAC amounts in FY 2016 and FY 2017 are placeholders. 

Authorizing Legislation: Sections 201, 202, and 411 of the Older Americans Act of 1965, as 

amended 

FY 2017 Older Americans Act 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 
 

 

 

 

 

 

 

PROTECTION OF VULNERABLE ADULTS 

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 2014 shows that SMP projects: 

• Maintained 5,194 active volunteers who worked over 117,300 hours to educate 

beneficiaries about how to prevent Medicare and Medicaid fraud; 

• Educated 450,720 beneficiaries in 14,618 group education sessions and held 

202,064 one-on-one counseling sessions with or on behalf of beneficiaries; 

• Conducted 12,290 community outreach education events; and 

• Resolved 91,422 inquiries for information or assistance from beneficiaries. 

In addition, the Senior Medicare Patrol program’s data show that since the program’s inception 18 

years ago, SMP projects have educated nearly 4.9 million beneficiaries in 138,441 group education 

sessions and 1,643,744 one-on-one counseling sessions, and conducted 196,225 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). These funds are utilized 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. 

In the past six 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 ACL, 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 and continue program expansion and enhancement activities. 

ACL received $3.2 million from HCFAC funds for this same purpose in FY 2014 and $5.3 million 

in FY 2015. 

146 
 

PROTECTION OF VULNERABLE ADULTS 

Funding History: 

Comparable funding for the SMP discretionary appropriations is as follows: 

FY 2012 ...................................................$9,402,000 

FY 2013 ...................................................$8,875,000 

FY 2014 ...................................................$8,888,000 

FY 2015 ...................................................$8,910,000 

FY 2016 ............................................... $8,910,000* 

*Beginning in FY 2016, direct funding will no longer be provided or requested for SMP. Instead, based on FY 2016 appropriations 

language, funding levels are determined by the Secretary of HHS and made available from discretionary appropriations for the 

Health Care Fraud and Abuse (HCFAC) account within the Centers for Medicare & Medicaid Services (CMS). The amount shown 

for FY 2016 is a placeholder pending final funding level decisions by the Secretary. 

Budget Request: 

No discretionary budget authority funding is requested by ACL for the Senior Medicare Patrol 

program in FY 2017. Since FY 2016, based on FY 2016 appropriations language, SMP funding 

levels are determined by the Secretary of HHS, and made available from discretionary 

appropriations for the HCFAC account within the Centers for Medicare & Medicaid Services 

(CMS). Funding levels for FY 2016 and FY 2017 represent placeholders pending these final 

decisions. Additional funds may also be provided for SMP’s infrastructure and expansion grants 

through mandatory HCFAC funding. 

Since the program’s inception, SMP projects have educated over 4.9 million beneficiaries and 

received nearly 34,643 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. There is also no current mechanism to quantify the effects of prevention education 

conducted by the SMP, which hinders the program’s ability to measure the extent and cost of fraud 

and abuse. ACL is working to overcome these limitations by undertaking a variety of steps, 

including: 

• A program evaluation contract, concluded in 2013, to examine the program’s performance 

metrics, and a future realignment of those metrics to reflect the results of the program 

evaluation; 

147 
 

 

 

PROTECTION OF VULNERABLE ADULTS 

• An ongoing process in cooperation with OIG to track fraud referrals and their outcomes; 

and; 

• Award of a three year grant to conduct research on prevention education to determine how 

to best measure and quantify the effects of SMP program efforts. The results of this study 

should be available in the fall of 2016. 

Output Table: 

Senior Medicare Patrol Program 

Indicator Year and Most Recent 

Result / 

CY 2016 

Projection 

CY 2017 

Projection 

CY 2017 

Projection 

+/-CY 2016 

Projection 

Output W: Beneficiaries 

Educated and Served 

(Output) 

CY 2014: 769,846 650,000 650,000 Maintain 

Grant Awards Table: 

Senior Medicare Patrol Grant Awards 

Award FY 2015 Final FY 2016 

Enacted 

FY 2017 

President’s 

Budget 

Number of 

Awards 54 0 0 

Average 

Award $165,000 $0 $0 

Range of 

Awards 

$72,600-

$169,950 NA NA 

148 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-- -- -- -- -- --

PROTECTION OF VULNERABLE ADULTS 

Resource and Program Data: 

Senior Medicare Patrols 

(Dollars in thousands) 

Mechanism 

FY 

2015 

Final # 

FY 

2015 

Final $ 

FY 2016 

Enacted 2/# 

FY 2016 

Enacted 2/ $ 

FY 2017 

President’s 

Budget 2/ # 

FY 2017 

President’s 

Budget 2/ $ 

Grants: 

Formula -- -- -- -- -- --

New Discretionary 54 8,910 -- -- -- --

Continuations -- -- -- -- -- --

Contracts -- -- -- -- -- --

Interagency Agreements -- -- -- -- -- --

Program Support 1/ -- -- -- -- -- --

Total Resources -- 8,910 -- -- -- --

1/ Program Support -- Includes funds for overhead, grant systems and review costs, and 

information technology support costs. 

2 No discretionary budget authority funding is requested by ACL for the Senior Medicare 

Patrol program in FY 2017. Since FY 2016, based on FY 2016 appropriations language, SMP 

funding levels are determined by the Secretary of HHS, and made available from discretionary 

appropriations for the HCFAC account within the Centers for Medicare & Medicaid Services 

(CMS). 

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Elder Rights Support Activities 

Service FY 2015 

Final 

FY 2016 

Enacted 

FY 2017 

President's 

Budget 

FY 2017+/-

FY 2016 

Elder Rights Support Activities $7,874,000 $11,874,000 $13,874,000 +$2,000,000 

FTE 2 3 4 +1 

Authorizing Legislation: Sections 201, 202, 411, and 751 of the Older Americans Act of 1965, as 

amended, Title XX of the Social Security Act, Subtitle B, as amended by the Affordable Care Act. 

FY 2017 Older Americans Act Authorization ...................................................................... Expired 

Allocation Method ............................. Competitive Grants/Cooperative Agreements and Contracts 

Program Description and Accomplishments: 

Elder Rights Support Activities provide information, training, and technical assistance to assist 

States and communities to prevent, detect, and respond to elder abuse, neglect, and exploitation 

and support the development of coordinated systems of Adult Protective Services. The Elder 

Justice and Adult Protective Services program, along with the combination of legal systems 

development and assistance programs, the National Center on Elder Abuse, and the National LongTerm Care Ombudsman Resource Center, create a supportive framework for ACL’s Protection of 

Vulnerable Adults programs. 

The Elder Justice Act of 2009 established the Elder Justice Coordinating Council (EJCC) to 

coordinate activities related to elder abuse, neglect, and exploitation across the Federal 

government. As Chair of the EJCC, the Secretary of HHS has lead responsibility for identifying 

and proposing solutions to the problems surrounding elder abuse. The Secretary has assigned 

responsibility for implementing the EJCC to the Administration for Community Living. 

To combat the rising scourge of elder abuse, neglect, and exploitation in America, ACL’s goal is 

to put in place, in coordination with the Elder Justice Coordinating Council, a comprehensive 

system to provide a coordinated and seamless response for helping adult victims of abuse, to 

prevent abuse before it happens, and to develop new and innovative approaches to preventing, 

detecting, and responding to abuse, neglect, and exploitation. The Elder Rights Support Activities 

described below are essential components of ACL’s ongoing elder rights programs. 

151 
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PROTECTION OF VULNERABLE ADULTS 

Unlike Child Protective Services, which has been in existence for decades, a federal infrastructure 

to support basic programmatic standards for Adult Protective Services (APS) is just beginning. 

Historically, an absence of federal stewardship in APS has led to inconsistent data systems and 

non-uniform reporting requirements at the national level, and prevented APS programs from 

evaluating their services or conducting meaningful program evaluations. APS programs and 

administrators have lacked reliable information and guidance on best practice and standards for 

conducting case investigations and for staffing and managing APS programs. Additionally, GAO 

has identified challenges faced by APS programs across the country in collecting, maintaining, 

and reporting statewide, case-level data. These challenges include chronic underfunding, 

unprecedented budget reductions, and increasing caseloads and --have impaired States’ ability to 

assess client outcomes and the effectiveness of the services they are providing. 101 They have also 

given rise to systems that are less equipped to respond in an effective and timely way to reports of 

elder abuse, neglect and exploitation. 

In FY 2015, ACL received its first dedicated appropriation to support states in enhancing their APS 

systems statewide. Through ACL’s continued investment in the APS program in FY 2016, states 

will receive additional funding to test innovations and improvements in APS practice, services, 

data collection, and reporting, and to support the development and implementation of ACL’s 

National Adult Maltreatment Reporting System (NAMRS) effort. The APS program supports 

states by providing significant, on-going technical assistance to identify promising and best 

practices, participate in national APS data collection efforts; and conduct research and evaluations 

to increase the knowledge base about effective APS programming and practices. Through the APS 

program, ACL encourages states to seek system transformations that reflect a “person-centered 

approach” (i.e., practices and services that are based on people’s strengths, assets, goals, culture, 

and expectations, along with their needs) and that aim to improve the experiences, health, wellbeing, and outcomes of the individuals served by APS. 

Legal Assistance and Support 

Legal Assistance and Support provides funding for two different activities. Model Approaches 

help States develop and implement cost-effective, replicable approaches for integrating low-cost 

legal assistance mechanisms related to APS into the broader tapestry of State legal service delivery 

networks, such as senior legal helplines, law school clinics, and volunteer attorneys. Model 

Approaches projects ensure strong leadership at the State level, thereby enhancing the state’s 

overall capacity for legal service delivery and creating linkages between legal assistance providers 

and professionals in the broader community-based aging/disability and elder rights networks. 

These linkages include Areas Agencies on Aging (AAAs), Aging and Disability Resource Centers 

101 U.S. Government Accountability Office. (2011). ELDER JUSTICE: Stronger Federal Leadership Could 

Enhance National Response to Elder Abuse. (GAO-11-208). Washington, D.C.: U.S. Government Printing Office. 

152 
 

 

 

 

 

 

 

PROTECTION OF VULNERABLE ADULTS 

(ADRCs), State Long-Term Care Ombudsmen, and Adult Protective Services, and leverage the 

strengths and resources of both elder rights and aging/disability service networks for the provision 

of quality legal service on priority issues to older adults most in need. 

Recently, Model Approaches – Phase II grants were awarded that promote legal service delivery 

systems that are optimally responsive to complex legal issues emerging from cases of elder abuse, 

neglect, and financial exploitation. In addition, these new projects are expanding outreach efforts 

and implementing legal data collection/reporting systems that demonstrate the beneficial impact 

of legal services on the independence, health, and financial security of older adults. 

In addition to Model Approaches, Legal Assistance and Support grants fund a comprehensive 

national legal assistance support system serving professionals and advocates working in legal and 

aging/disability services networks. Through this funding, the National Legal Resource Center 

(NLRC) supports the leadership, knowledge, and systems capacity development of legal and aging 

provider organizations. The NLRC works to enhance the quality, cost effectiveness, and 

accessibility of legal assistance and elder rights protections available to older persons with social 

or economic needs. The audience targeted to receive support services through the NLRC includes 

a broad range of legal, elder rights, and aging/disability services professionals and advocates. 

These include Home and Community-Based Services legal providers, legal assistance developers, 

long-term care ombudsmen, Area Agency on Aging and Aging and Disability Resource Center 

staff, senior legal helplines, Adult Protective Services workers, and others involved in protecting 

the rights of older persons. 

In FY 2015, ACL funded four projects as collaborators under the NLRC. These projects provide 

core legal support functions for aging and legal networks, including case consultation, training, 

technical assistance on legal and aging systems development, and information development and 

dissemination. Recent expansions for the NLRC include greater focus on elder abuse prevention, 

advance care planning, and supported decision-making. 

National Center on Elder Abuse 

To support and enhance the activities of State and local programs to prevent elder abuse, neglect, and 

exploitation, ACL funds the National Center on Elder Abuse (NCEA). NCEA disseminates 

information to professionals and the public; collaborates on research; provides consultation; identifies 

and provides information about promising practices and interventions; answers inquiries and requests 

for information; operates a listserv forum for professionals; and advises on program and policy 

developments. NCEA also facilitates the exchange of strategies for uncovering and prosecuting fraud 

in areas such as telemarketing and sweepstakes scams. In 2014, the NCEA: 

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PROTECTION OF VULNERABLE ADULTS 

• Continued its outreach by serving subscribers to its newsletter as well as 2,037 members 

of the Elder Abuse Listserv, and created and managed a new social media platform for 

the NCEA Clearinghouse that included over 1,643 followers on Facebook. 

• Responded to over 350 individual public inquiries and requests for information regarding 

elder abuse. 

• Provided cost-effective trainings to professionals though live Webcast forums on issues 

relevant to elder justice, trained 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 17 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. 

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 the Money Follows the Person (MFP) 

demonstration project by working with CMS, ACL, and National Association of State Long-Term 

Care Ombudsman Programs (NASOP) to promote ombudsman coordination with MFP grantees, 

Aging and Disability Resource Centers (ADRCs), Centers for Independent Living, and other single 

point of entry programs; and furthering Federal efforts to support consumer choice and access to 

alternatives to nursing home care. The NORC also provides ombudsmen with training from 

national experts on such issues as: the Changing Long-Term Care System; Managing Program 

Goals and Priorities During Fiscal Crises; Minimum Data Set (MDS) 3.0 Section Q, Money 

Follows the Person and Nursing Home Transition; and, Advocacy in Assisted Living. The Center’s 

website continues to experience high utilization (over 40,000 monthly visits) by ombudsmen, 

consumers, and agencies. 

154 
 

 

 

PROTECTION OF VULNERABLE ADULTS 

Funding History: 

Comparable funding for Elder Rights Support Activities is as follows: 

FY 2012 ...................................................$4,088,000 

FY 2013 ...................................................$3,859,000 

FY 2014 ...................................................$3,845,000 

FY 2015 ...................................................$7,874,000 

FY 2016 .................................................$11,874,000 

Budget Request: 

The FY 2017 request for the four Elder Rights Support Activities is $13,874,000, an increase of 

+$2,000,000 from the FY 2016 enacted level, the entirety of which will be used to increase support 

for Elder Justice/Adult Protective Services. FY 2017 funding for Elder Rights Support Activities 

would be used as described below. 

Elder Justice/Adult Protective Services: 

The FY 2017 request for Elder Justice/Adult Protective Services is $10 million, an increase of +$2 

million over the FY 2016 enacted level. This request reflects ACL’s commitment to supporting 

and integrating State APS systems, as well as coordinating services related to elder abuse, neglect, 

and exploitation across the Federal government. The $10 million request would be used as follows: 

• Demonstration Grants to Enhance State APS Systems ($6 million) 

In FY 2015 as recommended by the GAO, ACL, in partnership with ASPE, undertook an 

effort to develop the technology infrastructure for a national APS data collection system, 

the National Adult Maltreatment Reporting System (NAMRS). The NAMRS tool is a 

process where all states can voluntarily report data collected through APS investigations. 

The NAMRS tool was pilot-tested and finalized in September 2015, and ACL now is 

engaged in the next phase of implementing the NAMRS tool nationwide. 

Similarly to what GAO found with the National Child Abuse and Neglect Data System 

(NCANDS), states will need significant assistance to improve their technological 

capacity to a level where they will be able to participate in national data collection 

efforts, like NAMRS. In FY 2015, ACL issued $3 million in competitive grants to assist 

states in improving and enhancing their APS programs and systems so that they can 

collect data in a manner consistent with national data collection efforts, such as NAMRS. 

155 
 

 

 

 

 

 

 

PROTECTION OF VULNERABLE ADULTS 

In FY 2016, ACL invested an additional $4 million to continue facilitating the 

improvement of state APS systems, as well as the phased implementation of the NAMRS 

begun in FY 2015. FY 2016 funds will support the expansion of participation in 

NAMRS to 20 additional states, bringing approximately two-thirds of the APS 

jurisdictions on-line in the second year of implementation. In FY 2017, ACL plans to 

continue supporting states in enhancing their programs, services, and data collection with 

a $6 million investment in grants to states. 

• NAMRS Operation and Maintenance, and Technical Assistance ($1.2million) 

GAO recommended significant, on-going technical assistance to states to facilitate their 

participation in a national APS data collection effort, as states previously needed with the 

NCANDS system. 102 In FY 2015, ACL funded a new contract to support state APS 

programs and NAMRS: the National APS Technical Assistance Resource Center. 

Funding in FY 2016 will expand ACL’s ability to provide technical assistance to states in 

participating with NAMRS, as well as to conduct an evaluation of APS practices. FY 

2017 funding will support the continued operation and maintenance of the NAMRS 

system, provide technical assistance to states using NAMRS, facilitate the analysis of the 

NAMRS data collected in 2016, and provide programmatic technical assistance to states. 

This activity supports and implements Recommendation 3 of the EJCC, “Develop a 

National Adult Protective Services System.” 

• Research ($2.05 million) 

Research in the area of elder abuse, neglect, and exploitation is still in its infancy, with 

little known about risk and protective factors for being a victim or perpetrator, nor about 

effective and evidence-based prevention, intervention, and remediation practices. Further 

research is also needed regarding the impacts of elder abuse on health and long-term care 

systems and on the costs of care. This fundamental research work is needed to develop 

credible benchmarks for elder abuse, neglect, and exploitation prevention or control. 

In FY 2016, ACL will invest $2.15 million in support of efforts aimed at increasing 

knowledge about effective prevention and intervention of abuse, neglect, and exploitation 

of older adults, native elders, adults with disabilities, people who self-neglect, 

guardianship abuse, and in support of the Elder Justice Coordinating Council. In FY 

2017, ACL will continue to invest in areas that build the foundational knowledge 

essential for understanding the problem and the best ways to prevent and address it. 

102 Id. 

156 
 

 

 

 

 

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PROTECTION OF VULNERABLE ADULTS 

• Program Implementation and Oversight ($0.75 million) 

The FY 2017 request includes $750,000 for salaries and overhead costs supporting four 

FTE carrying out the Elder Justice initiative and supporting the ongoing work of the 

EJCC. 

Other Elder Rights Support Activities: 

The FY 2017 request for the remaining three Elder Rights Support Activities is $3,874,000 in total, 

the same as the FY 2016 enacted levels for these activities. This would maintain current funding 

levels for Legal Assistance and Support activities (Statewide Model Approaches and Legal 

Assistance programs), the National Center on Elder Abuse, and the National Long-Term Care 

Ombudsman Resource Center. 

These programs provide the technical assistance, information, resources, referrals, and legal 

systems development and assistance activities that support the efforts of the entire spectrum of 

Protection of Vulnerable Adults programs. These activities, along with the Elder Justice and APS 

program, are a critical component of ACL’s successful elder rights programs and help to create a 

full array of services to prevent, detect, and resolve elder abuse, neglect, and exploitation. 

Continued support for these programs and resource centers will provide the best and most efficient 

services and supports possible to support ACL’s efforts to promote elder rights and elder justice. 

Elder Rights Support Activities includes funding for the following projects (dollars in thousands): 

Service FY 2015 Final FY 2016 Enacted 

FY 2017 

President’s 

Budget 

Elder Rights Support 

Activities 

Elder Justice & APS $4,000 $8,000 $10,000 

Legal Assistance and Support $2,593 $2,593 $2,593 

National Center on Elder 

Abuse $765 $765 $765 

LTC Ombudsman Resource 

Center $516 $516 $516 

Total, Elder Rights Support 

Activities $7,874 $11,874 $13,874 

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-- -- -- -- -- --

PROTECTION OF VULNERABLE ADULTS 

Grant Awards Table: 

Elder Rights Support Activities Grant Awards 

Award FY 2015 Final FY 2016 Enacted 

FY 2017 

President’s 

Budget 

Number of 

Awards 33 36 42 

Average 

Award $206,179 $236,707 $250,510 

Range of 

Awards 

$70,312 -

$723,752 

$70,312 -

$723,752 

$70,312 -

$723,752 

Resource and Program Data:

Elder Rights Support Activities 

(Dollars in thousands) 

Mechanism FY 2015 

Final # 

FY 2015 

Final $ 

FY 2016 

Enacted# 

FY 2016 

Enacted $ 

FY 2017 

President’s 

Budget # 

FY 2017 

President’s 

Budget $ 

Grants: 

Formula -- -- -- -- -- --

New Discretionary 18 3,702 32 7,068 11 2,516 

Continuations 15 3,102 4 1,453 31 8,005 

Contracts 4 965 3 2,347 3 2,347 

Interagency Agreements -- -- -- -- -- --

Program Support 1/ -- 105 -- 1,005 -- 1,005 

Total Resources -- 7,874 -- 11,874 -- 13,874 

1/ Program Support -- Includes funds for grant systems and review and information technology support costs. 

158 
 

 

Disability Programs, Research, and Services 

Summary of Request 

Disability Programs, Research, and Services fund capacity-building, knowledge generation, and 

systems change efforts to ensure that people with disabilities and their families participate in the 

design of and have access to needed community services, individualized supports, and other forms 

of assistance. These programs seek to promote self-determination, independence, productivity, and 

integration and inclusion in all facets of community life. 

The total FY 2017 request for Disability Programs, Research, and Services is $385,337,000, the 

same as the enacted FY 2016 level. For FY 2017, specific program requests include: 

• $73,000,000 to continue funding for State Councils on Developmental Disabilities 

(DD Councils) in each state and territory, the same as the FY 2016 enacted level. 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 for Developmental Disability Protection and Advocacy systems, the same as 

the FY 2016 enacted level. Protection and Advocacy systems in each state and territory 

protect the legal and human rights of all people with developmental disabilities, and have 

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

including the authority to investigate incidents of abuse and neglect. 

• $38,619,000 for University Centers for Excellence in Developmental Disabilities 

(UCEDDs), the same as the FY 2016 enacted level. UCEDDs in each state and territory 

undertake interdisciplinary pre-service training, community services, research, and 

information dissemination activities that promote opportunities for people with 

developmental disabilities to exercise self-determination and to be independent, 

productive, integrated, and included in the community. 

• $10,000,000 for Projects of National Significance, the same as the FY 2016 enacted level. 

Projects of National Significance 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. 

159 
 

 

 

DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

• $103,970,000 for the National Institute on Disability, Independent Living, and 

Rehabilitation Research (NIDILRR), the same as the FY 2016 enacted level. NIDILRR 

generates knowledge and promotes its use to improve the abilities of people with 

disabilities to perform activities of their choice in the community, and also to expand 

society’s capacity to provide full opportunities and accommodations for its citizens with 

disabilities. 

• $101,183,000 for Independent Living, the same as the FY 2016 enacted level. The 

Independent Living program provides financial assistance to improve independent living 

services, support statewide networks of centers for independent living, and foster working 

relationships among various entities to maximize the leadership, empowerment, 

independence, and productivity of individuals with disabilities and integrate these 

individuals into the mainstream of American society. 

• $2,810,000 for the Limb Loss Resource Center, the same as the FY 2016 enacted level. 

The program supports a national resource center and related activities that provide 

comprehensive information and resources to assist individuals and families dealing with 

limb loss. 

• $7,700,000 for the Paralysis Resource Center (PRC), the same as the FY 2016 enacted 

level. The PRC provides comprehensive information and referral services for people living 

with paralysis and their families and caregivers. 

• $9,321,000 for the Traumatic Brain Injury (TBI) program, the same as the comparable FY 

2016 enacted level. TBI, transferred to ACL in FY 2016 from the Health Resources and 

Services Administration (HRSA), provides increased access to comprehensive, 

coordinated family and person-centered service systems for individuals who have sustained 

a traumatic brain injury. The TBI program has two components: an aforementioned state 

grant program to support state-level infrastructure and service delivery system; and a 

protection and advocacy services program for individuals with TBI. 

160 
 

 

 

 

 

 

State Councils on Developmental Disabilities 

Council FY 2015 

Final 

FY 2016 

Enacted 

FY 2017 

President's 

Budget 

FY 2017+/-

FY 2016 

State Councils on Developmental 

Disabilities $71,692,000 $73,000,000 $73,000,000 --

FTE -- -- 1.3 +1.3 

Authorizing Legislation: Section 129(a) of the Developmental Disabilities Assistance and Bill of 

Rights Act 

FY 2017 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 charged with identifying the most 

pressing needs of people with developmental disabilities in their state and territory. Established 

in 1970, 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. 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 determines 

priority areas and 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 the way it delivers services and supports its 

citizens and constituencies; 

161 
 

 

DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

• Support activities that expand and/or improve the ability of individuals with 

developmental disabilities, families, supports, services and/or systems to promote, 

support and enhance self-determination, independence, productivity and inclusion in 

community life; and 

• Actively support policies and practices that promote self-determination and inclusion in 

the community and workforce for individuals with developmental disabilities and their 

families. 

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 DD Councils have a significant impact on promoting self-sufficiency and community living 

for persons with developmental disabilities. In FY 2014, DD Councils reported that 14.58 percent 

of individuals nationwide with developmental disabilities were independent, self-sufficient, and 

integrated into the community as a result of their efforts, exceeding the target of 14.43 

percent. Examples of DD Council activities include: 

• Early Intervention: The Maine Developmental Disabilities Council has engaged in and 

supported a variety of collaborative state level efforts to raise awareness about 

developmental and behavioral screening. Activities include awareness campaigns and 

training initiatives targeted at twelve pediatric and family practices that served an 

estimated 20,000 children with Medicaid coverage. Their combined efforts have 

facilitated significant, long-term systemic improvements towards early identification and 

coordinated care for young children with Autism Spectrum Disorder (ASD). Recent 

studies showed that in Maine children with ASD were more likely to be identified at a 

younger age and the developmental and autism screening rates more than doubled in the 

targeted sites. 

162 
 

 

 

 

DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

• Self-Advocacy: The Maryland Developmental Disabilities Council continues to support 

self-advocacy through Maryland's statewide self-advocacy group, People on the Go of 

Maryland (POG). Through two grants funded by the Council, (POG) continued to 

advocate for community supports, educate facilitators, and support local self-advocacy 

groups in becoming active in systems advocacy. POG educated 1,200 students and school 

staff about disability awareness by presenting in four different counties. POG also 

presented self-advocacy work at several local, state, and national conferences, including 

the Maryland Transitioning Youth Conference, National Disability Rights Network, and 

Ready at 21, a non-profit organization dedicated to transitioning youth to college, work, 

and life. 

• Community Living: The Illinois Developmental Disabilities Council published 2 reports 

that have been recognized throughout Illinois as a major influence on the Governor’s 

2012 “Rebalancing Initiative” to transition hundreds of people with disabilities from 

institutions back to the community. 103 Through collaboration with statewide 

organizations, the first of the two institutions closed in November 2012 and 183 people 

with developmental disabilities are now living in the community. The Governor’s office 

requested that the Council coordinate efforts to ensure a successful transition of 

individuals from state institutions into the community. Through collaboration with 

statewide organizations, the Council formed a workgroup and an initiative of peer-to-peer 

mentoring, in which self-advocates from the Alliance worked alongside staff to provide 

support for individuals as they sought a life beyond the institution. 

• Transition/Employment: The Kansas Developmental Disabilities Council provides 

funding to Project SEARCH, which provides real-life work experience to help youth with 

developmental disabilities make successful transitions from school to adult life. Project 

SEARCH in Kansas currently operates in 7 locations, has served more than 150 students, 

and have a 75% employment success rate for students with developmental disabilities. 

SEARCH interns have been hired in jobs working 15-40 hours per week and earning 

from $7.25 to $12 per hour. Three additional locations were established in 2014. Kansas 

has expanded the number of sites from six locations in the first year to 11 in eight 

communities as of September, 2015. Currently Project SEARCH sites are: University of 

Kansas in Lawrence; Lawrence Memorial Hospital; Butler Community College in El 

Dorado; Susan B. Allen Memorial Hospital in El Dorado; Sedgwick County Government 

in Wichita; Via Christi Hospital in Wichita; Newton Medical Center; Salina Regional 

Medical Center; McConnell Air Force Base in Derby; Hampton Inn in Mulvane; and 

Johnson County Government in Olathe. The Council also plans to expand the program to 

include a non-school program targeted towards young adults. 

103 The Council published “Blueprint for System Redesign in Illinois” and “Illinois at the Tipping Point,” in 2008 

and 2012, respectively. 

163 
 

 

 

 

 

 

 

DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

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”). 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 2012 .................................................$74,774,000 

FY 2013 .................................................$70,555,000 

FY 2014 .................................................$70,692,000 

FY 2015 .................................................$71,692,000 

FY 2016 .................................................$73,000,000 

Budget Request: 

The FY 2017 request for State Councils on Developmental Disabilities (DD Councils) is 

$73,000,000, the same as the FY 2016 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 2017, 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. In FY 2017, ACL will also provide Technical Assistance to State Councils 

from Projects of National Significance dollars. 

It is crucial to continue funding for DD Councils 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 DD 

Councils. All 56 Councils work to build leadership skills by providing individuals with 

developmental disabilities and their family members a variety of opportunities including 

opportunities to educate policymakers and participate in the design and redesign of systems 

impacting their lives. 

164 
 

 

DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

Outputs and Outcomes Table: 

State Councils on Developmental Disabilities 

Measure Year and Most Recent 

Result / 

Target for Recent Result / 

(Summary of Result) 

FY 2016 

Target 

FY 2017 

Target 

FY 2017 

Target 

+/-FY 2016 

Target 

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 2014: 14.58% 

Target: 14.43% 

(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, selfsufficient and integrated 

into the community per 

$1,000 of federal funding to 

the Councils. (Efficiency) 

FY 2014: 9.73 

Target: 9.72 

(Target Exceeded) 

Prior Result + 1% Prior Result + 1% N/A 

Indicator Year and Most Recent 

Result / 

FY 2016 

Projection 

FY 2017 

Projection 

FY 2017 

Projection 

+/-FY 2016 

Projection 

8i: Number of individuals 

with developmental 

disabilities reached by the 

Councils who are 

independent, selfsufficient and integrated 

into the community. 

(Output) 

FY 2014: 729,152 N/A N/A N/A 

8ii: Number of all 

individuals trained by the 

Councils. (Output) 

FY 2014: 369,182 N/A N/A N/A 

165 
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

Grant Awards Tables: 

State Councils on Developmental Disabilities Grant Awards 

Award FY 2015 Final FY 2016 

Enacted 

FY 2017 

President's 

Budget 

Number of 

Awards 56 56 56 

Average 

Award $1,275,750 $1,303,571 $1,290,536 

Range of 

Awards 

$246,128 -

$6,459,004 

$253,882 -

$6,543,380 

$251,429 -

$6,480,163 

166 
 

 

 

 

DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

ADMINISTRATION ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 

FY 2017 DISCRETIONARY STATE FORMULA GRANTS 2/ 

PROGRAM/CFDA NUMBER: State Councils on Developmental Disabilities (CFDA 93.630) 

State/Territory FY 2015 Actual 

FY 2016 

Enacted 

FY 2017 

President's Budget 

FY 2017 +/-

FY 2016 

New Jersey.......................... 1,533,290 1,553,320 1,538,313 (15,007) 

New Mexico....................... 483,919 490,241 485,504 (4,737) 

New York........................... 4,062,646 4,101,074 4,061,454 (39,620) 

North Carolina.................... 1,976,156 2,020,952 2,001,427 (19,525) 

North Dakota...................... 472,622 487,511 482,801 (4,710) 

Ohio.................................... 2,810,012 2,846,721 2,819,219 (27,502) 

Oklahoma............................ 885,680 897,250 888,581 (8,669) 

Oregon................................ 773,163 781,292 773,744 (7,548) 

Pennsylvania....................... 2,987,494 3,026,521 2,997,282 (29,239) 

Rhode Island....................... 472,622 487,511 482,801 (4,710) 

South Carolina.................... 1,082,855 1,097,001 1,086,403 (10,598) 

South Dakota...................... 472,622 487,511 482,801 (4,710) 

Tennessee............................ 1,442,550 1,461,395 1,447,276 (14,119) 

Texas................................... 4,742,116 4,813,917 4,767,410 (46,507) 

Utah.................................... 630,623 635,274 629,136 (6,138) 

Vermont.............................. 472,622 487,511 482,801 (4,710) 

Virginia............................... 1,482,561 1,501,929 1,487,419 (14,510) 

Washington......................... 1,170,066 1,170,579 1,159,270 (11,309) 

West Virginia...................... 732,246 739,342 732,199 (7,143) 

Wisconsin........................... 1,276,488 1,311,944 1,299,269 (12,675) 

Wyoming............................ 487,511 482,801 (4,710) 

Subtotal, States................... 67,982,884 69,452,541 68,781,573 (670,968) 

American Samoa................. 246,128 253,882 251,429 (2,453) 

Guam.................................. 246,128 253,882 251,429 (2,453) 

Northern Mariana Islands... 246,128 253,882 251,429 (2,453) 

Puerto Rico......................... 2,474,604 2,506,931 2,482,711 (24,220) 

Virgin Islands..................... 253,882 251,429 (2,453) 

Subtotal, States and Territories 71,442,000 72,975,000 72,270,000 (705,000) 

Undistributed 1/................... 250,000 25,000 730,000 705,000 

TOTAL...................................... 71,692,000 73,000,000 73,000,000 -

167 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

PROGRAM/CFDA NUMBER: State Councils on Developmental Disabilities (CFDA 93.630) 

State/Territory FY 2015 Actual 

FY 2016 

Enacted 

FY 2017 

President's Budget 

FY 2017 +/-

FY 2016 

New Jersey.......................... 1,533,290 1,553,320 1,538,313 (15,007) 

New Mexico....................... 483,919 490,241 485,504 (4,737) 

New York........................... 4,062,646 4,101,074 4,061,454 (39,620) 

North Carolina.................... 1,976,156 2,020,952 2,001,427 (19,525) 

North Dakota...................... 472,622 487,511 482,801 (4,710) 

Ohio.................................... 2,810,012 2,846,721 2,819,219 (27,502) 

Oklahoma............................ 885,680 897,250 888,581 (8,669) 

Oregon................................ 773,163 781,292 773,744 (7,548) 

Pennsylvania....................... 2,987,494 3,026,521 2,997,282 (29,239) 

Rhode Island....................... 472,622 487,511 482,801 (4,710) 

South Carolina.................... 1,082,855 1,097,001 1,086,403 (10,598) 

South Dakota...................... 472,622 487,511 482,801 (4,710) 

Tennessee............................ 1,442,550 1,461,395 1,447,276 (14,119) 

Texas................................... 4,742,116 4,813,917 4,767,410 (46,507) 

Utah.................................... 630,623 635,274 629,136 (6,138) 

Vermont.............................. 472,622 487,511 482,801 (4,710) 

Virginia............................... 1,482,561 1,501,929 1,487,419 (14,510) 

Washington......................... 1,170,066 1,170,579 1,159,270 (11,309) 

West Virginia...................... 732,246 739,342 732,199 (7,143) 

Wisconsin........................... 1,276,488 1,311,944 1,299,269 (12,675) 

Wyoming............................ 487,511 482,801 (4,710) 

Subtotal, States................... 67,982,884 69,452,541 68,781,573 (670,968) 

American Samoa................. 246,128 253,882 251,429 (2,453) 

Guam.................................. 246,128 253,882 251,429 (2,453) 

Northern Mariana Islands... 246,128 253,882 251,429 (2,453) 

Puerto Rico......................... 2,474,604 2,506,931 2,482,711 (24,220) 

Virgin Islands..................... 253,882 251,429 (2,453) 

Subtotal, States and Territories 71,442,000 72,975,000 72,270,000 (705,000) 

Undistributed 1/................... 250,000 25,000 730,000 705,000 

TOTAL...................................... 71,692,000 73,000,000 73,000,000 -

1/ The undistributed line reflects the amount reserved from the State DD Councils appropriation for: statutory 

related activities, including contingencies; FTE and related overhead costs to conduct program monitoring and 

oversight; and for program support costs including information and systems, technical assistance and evaluation. 

Funds unused for these purposes at the end of the year are allocated to States. 

2/ AoD/AIDD is in the final stages of developing a new formula for the State DD Councils and P&As. The 

estimates for non-minimum allotment States will likely change with the new formula. Those new estimates are 

estimated to be completed and released by April 1, 2016 to meet the statutory requirement as set forth in the 

Developmental Disabilities Assistance and Bill of Rights Act of 2000. 

168 

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Developmental Disabilities – Protection and Advocacy 

Service FY 2015 

Final 

FY 2016 

Enacted 

FY 2017 

President's 

Budget 

FY 2017+/-

FY 2016 

DD – Protection and Advocacy $38,734,000 $38,734,000 $38,734,000 --

FTE -- -- 1.3 +01.3 

Authorizing Legislation: Section 145 of the Developmental Disabilities Assistance and Bill of 

Rights Act 

FY 2017 Developmental Disabilities Assistance and Bill of Rights Act Authorization ...... Expired 

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

Program Description and Accomplishments: 

Established in 1975, Protection and Advocacy (P&As) provide a range of legal services to 

traditionally unserved or underserved individuals with developmental disabilities to ensure they 

are protected from abuse and neglect and are able to exercise their rights to make choices, 

contribute to society, and live independently. P&A systems have the authority to pursue legal, 

administrative, and other appropriate remedies or approaches, including the authority to investigate 

incidents of abuse and neglect and to promote system change. There is a P&A system in each State, 

the Territories, and the District of Columbia. There is also a Native American Consortium for a 

total of 57 P&As. 

P&As continue to play a key role in promoting community living, which is a strategic DHHS 

priority, and have been supported by a number of Federal and state policies and initiatives 

promoting alternatives to nursing homes and other institutional settings that recognize the value of 

consumer preference and the attendant potential fiscal savings that can result. The Affordable Care 

Act, Olmstead implementation and enforcement, Money Follows the Person, Home and 

Community Service (HCBS) revised regulations, and managed care, to name a few, are continuing 

to change the long-term care landscape across the country. Community living was also supported 

in the U.S. Supreme Court’s 1999 decision in Olmstead v. L.C. requires states to eliminate 

unnecessary segregation of people with disabilities, and to ensure that they receive services in the 

most integrated setting possible. 

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Examples of P&A accomplishments that increase opportunities for individuals with developmental 

disabilities to make decisions for themselves about where and with whom they live include: 

• The Illinois P&A and other legal and non-legal groups filed the lawsuit Ligas v. Hamos 

(formerly Ligas v. Maram) in 2005 on behalf of people with developmental disabilities 

living in large, private, state-funded institutions or who were likely to be placed there. 

The clients wanted to receive community services, but the state of Illinois denied their 

requests. In July 2011, a judge approved an agreement that required the state provide 

institution residents who want community placement with an individualized, independent 

evaluation, and the opportunity to live in the community with appropriate services. 

• The Georgia P&A oversees the implementation of the Georgia Olmstead settlement 

agreement. In its role, the P&A monitors the transition from institutions to community 

living for people with developmental disabilities as well as the development of 

community supports and services for people with developmental disabilities. Through 

this monitoring, the P&A has identified concerns about effective discharge planning and 

continuity of service between the hospitals and community services. 

P&As also provide substantial advocacy and legal services on educational issues, and work to 

ensure that students receive an appropriate education in an inclusive setting. Thirty-one percent of 

P&A cases are in the area of education. As one example, a result of Michigan P&A (MPAS) 

advocacy, the Michigan Department of Education (MDE) ordered four school districts, including 

the largest urban district in the state, and nine charter schools to make systemic policy and practice 

improvements in their handling of finding and identification of students who might need special 

education services and supports. Furthermore, MDE ordered 12 school districts and two charter 

schools to make systemic policy and practice improvements in their handling of discipline and 

disability-related behavior issues. 

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. 

As more individuals with developmental disabilities, including those who require long-term 

services and supports, choose to live in the community and States and Territories move to new 

models of services and supports, the demand for P&A legal service will likely increase and become 

more complex. These changes create new challenges for Protection and Advocacy programs as 

well as for the Long-Term Care Ombudsman program that is also supported by ACL. There is 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

also a growing federal awareness and response to the uncharted area of abuse, neglect and 

exploitation of older adults, and persons with disabilities. Addressing this troubling trend is also a 

priority of ACL. Going forward, P&As and LTCOP’s will need to learn a new regulatory and 

service environment at the same time that they will have to cope with the continuing accelerated 

growth of community based services. 

The number of people with intellectual and developmental disabilities receiving Home and 

Community Based waiver services has steadily increased with 87 percent of the P&A clients living 

in the community. 104 This creates a heightened role for P&As to monitor and develop new 

strategies to address these new services. A recent successful response example that built on the 

P&A as a national resource is the Representative Payee Program. SSA is providing funds for 

P&As to review organizational payees who did not necessarily employ beneficiaries and to require 

that the P&As review the financial records of a sample of beneficiaries selected by SSA. The goal 

is to ensure representative payees are performing their payee duties satisfactorily and to protect 

beneficiaries from misuse. 

Funding History: 

Funding for the program during the last five years has been as follows: 

FY 2012 .................................................$40,865,000 

FY 2013 .................................................$38,559,000 

FY 2014 .................................................$38,634,000 

FY 2015 .................................................$38,734,000 

FY 2016 .................................................$38,734,000 

Budget Request: 

The FY 2017 request for the Developmental Disabilities Protection and Advocacy program is 

$38,734,000, the same as the FY 2016 enacted level. This request will allow the P&A system to 

continue to provide training, legal and advocacy services both to groups and to individuals with 

developmental disabilities, as well as information and referral services. 

The P&As form a national system that play a critical role in ensuring that people with 

developmental disabilities are free of abuse and neglect. People with developmental disabilities, 

104 U.S. Profile, FY 1977 – 2013, State of the State in Developmental Disabilities. 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

including children, are at increased risk of experiencing abuse and neglect. 105 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.106 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 2014, the 57 P&As remedied 7,368 

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 in FY 2014: 

• 33 percent were resolved using short-term assistance strategies; 

• 31 percent were addressed through technical assistance in self-advocacy; 

• 12 percent involved investigation and monitoring; and 

• 15 percent were addressed through negotiation. 

105 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 106 U.S. Government Accountability Office. (2009). Selected Cases of Death and Abuse at Public and Private Schools 

and Treatment Centers. Washington, DC: U.S. Government Accountability Office. 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

Outputs and Outcomes Table: 

Developmental Disabilities Protection and Advocacy 

Measure Year and Most Recent 

Result / 

Target for Recent Result / 

(Summary of Result) 

FY 2016 

Target 

FY 2017 

Target 

FY 2017 

Target 

+/-FY 2016 

Target 

8B Increase the percentage 

of individuals who have 

their complaint of abuse, 

neglect, discrimination, or 

other human or civil rights 

corrected compared to the 

total assisted. (outcome) 

(Outcome) 

FY 2014: 86.24% 

Target: 87.54% 

(Target Not Met) 

Prior Result + 

0.5% 

Prior Result + 

0.5% 

N/A 

Indicator Year and Most Recent 

Result / 

FY 2016 

Projection 

FY 2017 

Projection 

FY 2017 

Projection 

+/-FY 2016 

Projection 

8iii: Number of clients 

receiving professional 

individual legal advocacy 

for the Protection and 

Advocacy program. 

(Output) 

FY 2014: 17,327 N/A N/A N/A 

8iv: Number of people 

receiving information and 

referral from the 

Protection and Advocacy 

program. (Output) 

FY 2014: 38,790 N/A N/A N/A 

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Grant Awards Tables: 

Developmental Disabilities – Protection and Advocacy Formula Grant Awards 107 

Awards FY 2015 Final FY 2016 

Enacted 

FY 2017 

President's 

Budget 

Number of 

Awards 57 57 57 

Average 

Award $674,378 $674,170 $667,253 

Range of 

Awards 

$194,139 -

$3,312,386 

$205,808 -

$3,239,697 

$205,808 -

$3,197,054 

107 Excludes grants to tribal organizations. 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

ADMINISTRATION ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 

FY 2017 DISCRETIONARY STATE FORMULA GRANTS 2/ 

PROGRAM/CFDA NUMBER: Developmental Disabilities – Protection and Advocacy (CFDA 93.630) 

State/Territory FY 2015 Actual 

FY 2016 

Enacted 

FY 2017 

President's Budget 

FY 2017 +/-

FY 2016 

Alabama......................................... 622,622 612,842 604,775 (8,067) 

Alaska............................................ 362,881 384,693 384,693 -

Arizona.......................................... 680,282 679,160 670,220 (8,940) 

Arkansas........................................ 383,218 396,365 394,524 (1,841) 

California....................................... 3,312,386 3,239,697 3,197,054 (42,643) 

Colorado........................................ 452,679 455,700 451,390 (4,310) 

Connecticut.................................... 371,977 384,693 384,693 -

Delaware........................................ 362,881 384,693 384,693 -

District of Columbia...................... 362,881 384,693 384,693 -

Florida........................................... 1,911,603 1,911,812 1,886,647 (25,165) 

Georgia.......................................... 1,061,580 1,051,072 1,037,236 (13,836) 

Hawaii........................................... 362,881 384,693 384,693 -

Idaho.............................................. 362,881 384,693 384,693 -

Illinois............................................ 1,262,305 1,234,045 1,217,802 (16,243) 

Indiana........................................... 761,016 743,896 734,104 (9,792) 

Iowa............................................... 371,009 384,693 384,693 -

Kansas........................................... 362,881 384,693 384,693 -

Kentucky....................................... 578,171 565,714 558,268 (7,446) 

Louisiana....................................... 566,211 553,812 546,522 (7,290) 

Maine............................................. 362,881 384,693 384,693 -

Maryland....................................... 472,475 468,162 462,000 (6,162) 

Massachusetts.............................. 609,367 601,031 593,119 (7,912) 

Michigan........................................ 1,237,009 1,200,501 1,184,699 (15,802) 

Minnesota...................................... 516,882 507,870 501,184 (6,686) 

Mississippi..................................... 424,129 417,111 414,997 (2,114) 

Missouri......................................... 692,225 677,427 668,510 (8,917) 

Montana......................................... 362,881 384,693 384,693 -

Nebraska........................................ 362,881 384,693 384,693 -

Nevada........................................... 362,881 384,693 384,693 -

New Hampshire............................. 362,881 384,693 384,693 -

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PROGRAM/CFDA NUMBER: Developmental Disabilities – Protection and Advocacy (CFDA 93.630) 

State/Territory FY 2015 Actual 

FY 2016 

Enacted 

FY 2017 

President's Budget 

FY 2017 +/-

FY 2016 

New Jersey.......................... 747,718 732,670 723,026 (9,644) 

New Mexico....................... 362,881 384,693 384,693 -

New York........................... 1,815,506 1,779,591 1,756,166 (23,425) 

North Carolina.................... 1,101,546 1,088,462 1,074,135 (14,327) 

North Dakota...................... 362,881 384,693 384,693 -

Ohio.................................... 1,323,626 1,287,080 1,270,138 (16,942) 

Oklahoma............................ 414,125 400,908 395,630 (5,278) 

Oregon................................ 414,781 414,158 410,394 (3,764) 

Pennsylvania....................... 1,357,807 1,317,038 1,299,701 (17,337) 

Rhode Island....................... 362,881 384,693 384,693 -

South Carolina.................... 580,002 573,200 565,656 (7,544) 

South Dakota...................... 362,881 384,693 384,693 -

Tennessee............................ 748,529 735,507 725,825 (9,682) 

Texas................................... 2,438,361 2,394,955 2,363,430 (31,525) 

Utah.................................... 362,881 384,693 384,693 -

Vermont.............................. 362,881 384,693 384,693 -

Virginia............................... 737,204 725,629 716,078 (9,551) 

Washington......................... 630,441 620,334 612,168 (8,166) 

West Virginia...................... 362,881 384,693 384,693 -

Wisconsin........................... 637,263 622,558 614,363 (8,195) 

Wyoming............................ 362,881 384,693 384,693 -

Subtotal, States................... 36,128,794 36,086,860 35,728,314 (358,546) 

American Samoa................. 194,139 205,808 205,808 -

Guam.................................. 194,139 205,808 205,808 -

Northern Mariana Islands... 194,139 205,808 205,808 -

Puerto Rico......................... 859,831 825,493 814,626 (10,867) 

Virgin Islands..................... 194,139 205,808 205,808 -

Subtotal, States and Territories 37,765,181 37,735,585 37,366,172 (369,413) 

Native American Organization 194,139 205,808 205,808 -

Undistributed 1/................... 774,680 792,607 1,162,020 369,413 

TOTAL...................................... 38,734,000 38,734,000 38,734,000 -

1/ This line reflects the amount reserved from the P&A appropriation for statutory related activities, including 

training, technical assistance, grant systems, and review costs. Beginning in FY 2017, the undistributed line also 

includes an amount reserved from the Developmental Disabilities Protection and Advocacy appropriation for FTE 

and related overhead costs to conduct program monitoring and oversight and for program support costs including 

information and systems, technical assistance and evaluation. Funds unused for these purposes at the end of the year 

are allocated to States. 

2/ AoD/AIDD is in the final stages of developing a new formula for the State DD Councils and P&As. The estimates 

for non-minimum allotment States will likely change with the new formula. Those new estimates are estimated to be 

completed and released by April 1, 2016 to meet the statutory requirement as set forth in the Developmental 

Disabilities Assistance and Bill of Rights Act of 2000. 

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University Centers for Excellence in Developmental Disabilities 

Service FY 2015 

Final 

FY 2016 

Enacted 

FY 2017 

President's 

Budget 

FY 2017+/-

FY 2016 

University Centers of Excellence 

in Developmental Disabilities $37,674,000 $38,619,000 $38,619,000 --

FTE -- -- 1.5 +1.5 

Authorizing Legislation: Section 156 of the Developmental Disabilities Assistance and Bill of 

Rights Act 

FY 2017 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 or not-forprofit 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 and to be independent, productive, 

integrated and included in all facets of community life. 

UCEDDs have played a key role in a significant number of advances in the disability field over 

the past four decades. Many issues, such as early intervention, health care, community-based 

services, inclusive and meaningful education, transition from school to work, employment, 

housing, assistive technology, and transportation have been directly improved by the services, 

research, and training provided by UCEDDs. 

In FY 2015, the Administration on Intellectual and Developmental Disabilities (AIDD) awarded 

grants to continue funding for the 67 University Centers. Funding from AIDD establishes the 

UCEDD and provides the infrastructure support for the Centers to engage in interdisciplinary preservice training, continuing education, community services, research, and information 

dissemination activities. UCEDDs leverage additional funds for carrying out these core activities 

from a variety of sources, including federal, state, and local agencies; private foundations; 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

donations; and fee-for-service earnings. In FY 2014, UCEDDs leveraged over $15 per AIDD 

dollar invested. 

As liaisons to the community, including service delivery systems, UCEDDs serve to positively 

affect the lives of individuals with developmental disabilities and their families in a variety of ways. 

UCEDD accomplishments include: 

• Directing exemplary interdisciplinary pre-service preparation with faculty and trainees 

that represent a variety of disciplines, such as pediatrics, education, psychology and 

nursing, thereby expanding opportunities for students to learn about the differing 

perspectives of various professionals who are providing services to, and working on 

behalf of, individuals with developmental disabilities and their families. 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. 

• Providing community services that cut across Federal, State, and local systems to 

improve capacity and quality of services by incorporating evidence-based practices. 

UCEDD staff offer expertise and inform the field through training, technical assistance 

and demonstration, model activities for individuals with developmental disabilities and 

their families, and support for service organizations, professionals, paraprofessionals, 

students, systems, volunteers and others. Community services offer innovative designs 

and methods that addresses a local or universal need, can be replicated and promote the 

increased inclusion, integration, productivity, and human rights of individuals with 

developmental disabilities and their families (including people with developmental 

disabilities from racial and ethnic minority backgrounds) and improve access and use at 

community services and individualized supports in all aspects of community life. 

• Contributing to the development of new knowledge through various research activities 

including basic or applied research, evaluation, and public policy analysis. UCEDD 

research engages people with developmental disabilities and their families in the 

development, design and implementation of research activities, as well as the 

dissemination of research information. 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. 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

• UCEDDs work to bridge the gap between research and practice by developing a variety 

of products and resources that promotes improvement in knowledge and practice. 

UCEDDs also conduct national training and other initiatives to address unmet needs of people 

with developmental disabilities. Past training initiatives have supported post-secondary education 

opportunities for people with developmental disabilities, enhancing self-determination skills, and 

building partnerships with minority serving institutions. 

Funding History: 

Funding for the program during the last five years has been as follows: 

FY 2012 .................................................$38,792,000 

FY 2013 .................................................$36,602,000 

FY 2014 .................................................$36,674,000 

FY 2015 .................................................$37,674,000 

FY 2016 ... .............................................$38,619,000 

Budget Request: 

The FY 2017 request for UCEDDs is $38,619,000, the same as the FY 2016 enacted level. This 

request will provide operational and administrative support to maintain the existing 67 UCEDDs. 

This funding level will allow ACL to reserve up to 2% specified in law, totaling $772,380, to 

continue support for training and technical assistance (TA) to the UCEDDs to support 

improvements in the programs’ performance and ability to meet performance targets. Without this 

dedicated TA funding, ACL may need to make future adjustments to the UCEDD formula to 

provide flexibility for funding of training and TA, and prioritizing such training over National 

Training Initiative(s) (NTI) and supplemental grants to existing Centers or grants to new Centers, 

in order to maintain the UCEDD core grants at their current level and pay for TA to Centers, the 

Cost Of Living Adjustments, NTI and supplemental grants. Training and TA is vital to the 

UCEDDs to support improvements in the programs’ performance and ability to meet performance 

targets, which would otherwise not be possible due to provisions in the funding formula of the 

Developmental Disabilities Act that requires appropriated funds to provide COLA to Centers 

before funding NTIs and TA to Centers. 

Funding of the UCEDDs will support the network of independent but interlinked centers, 

representing an expansive national resource for addressing issues, finding solutions, and advancing 

research related to the needs of individuals with developmental disabilities and their families. At 

the local level, UCEDDs are vital to the training of future professionals with the specialized 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

expertise in developmental disabilities. Of the UCEDD trainees who graduated 5 to 10 years ago, 

30 percent are in leadership positions with: 

• 8 percent in academic leadership; 

• 7 percent in clinical leadership; 

• 7 percent in public health leadership; and 

• 5 percent in public policy and advocacy leadership. 

Over 40 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 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

independence, productivity, and inclusion through access to postsecondary education, resulting in 

improved long-term independent living and employment outcomes. 

Funding for UCEDDs also provides infrastructure support for initiatives with effects felt 

internationally, such as the 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 

ACL provides a critical infrastructure support that allows the UCEDD to leverage additional funds. 

There is a significant return on ACL’s investment. In FY 2014, the federal investment of 

$36.6 million in UCEDD grant awards leveraged $559.6 million in other resources to help 

UCEDD’s carry out their core activities. 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

Outcomes and Outputs Table: 

University Centers for Excellence in Developmental Disabilities 

Measure Year and Most Recent 

Result / 

Target for Recent Result / 

(Summary of Result) 

FY 2016 

Target 

FY 2017 

Target 

FY 2017 

Target 

+/-FY 2016 

Target 

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 2014: 41.47% 

Target: 41.39% 

(Target Exceeded) 

Prior Result + 1% Prior Result + 1% N/A 

Indicator Year and Most 

Recent Result / 

FY 2016 

Projection 

FY 2017 

Projection 

FY 2017 

Projection 

+/-FY 2016 

Projection 

8viii: Number of professionals 

trained by UCEDDs. (Output) 

FY 2014: 5,550 N/A N/A N/A 

8ix: Number of people reached 

through UCEDD community 

training and technical assistance 

activities. (Output) 

FY 2014: 781,043 N/A N/A N/A 

8x: Number of people receiving 

direct or model demonstration 

services from UCEDDs. 

(Output) 

FY 2014: 90,021 N/A N/A N/A 

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-- -- -- -- -- --

DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

Grant Awards Tables: 

University Centers of Excellence in Developmental Disabilities Grant Awards 

Award FY 2015 Final FY 2016 

Enacted 

FY 2017 

President’s 

Budget 

Number of 

Awards 81 67 67 

Average 

Award $455,935 $550,937 $550,937 

Range of 

Awards $545,919 $545,919 $545,919 

Resource and Program Data: 

Mechanism FY 2015 

Final # 

FY 2015 

Final $ 

FY 2016 

Enacted# 

FY 2016 

Enacted $ 

FY 2017 

President’s 

Budget # 

FY 2017 

President’s 

Budget $ 

Grants: 

Formula -- -- -- --

New Discretionary 17 1,992 2 1,358 42 23,238 

Continuations 64 34,939 65 35,555 25 13,675 

Contracts 1 717 1 1,630 1 1,630 

Interagency Agreements -- -- -- -- -- --

Program Support /1 -- 27 -- 77 -- 77 

Total Resources -- 37,674 -- 38,619 -- 38,619 

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Developmental Disabilities – Projects of National Significance 

FY 2017 

Project FY 2015 FY 2016 President's FY 2017 +/-

Final Enacted Budget FY 2016 

Developmental Disabilities— 

Projects of National $8,857,000 $10,000,000 $10,000,000 --

Significance 

Authorizing Legislation: Section 163 of the Developmental Disabilities Assistance and Bill of 

Rights Act 

FY 2017 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 

complement 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 advancing the development of national and state policies, including 

federal interagency initiatives; funding 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 supporting longitudinal data 

collection projects. Examples of PNS activities include: 

• In FY 2011 and 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 and technical assistance to the states funded. 

• In FY 2012, PNS also funded two community practice projects that will work to build 

states’ capacities to support competitive, integrated employment and family support 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

activities for persons with intellectual and developmental disabilities, as well as technical 

assistance to self-advocacy organizations. 

• 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. Most recently, the grantees conducting 

longitudinal research have been tasked with expanding their reach to U.S. Territories. 

• In FY 2014, PNS resources funded 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. 

• PNS resources support a $1,000,000 grant related to inclusive transportation for those with 

disabilities. 

• PNS resources also funded a grant to increase diversity among the current leaders within 

the DD Network and to enhance the cultural linguistic competence and leaderships skills 

of those leaders. 

• Training and Technical Assistance for Developmental Disability State Councils. 

In FY 2016, ACL/AIDD will continue to prioritize these efforts with the goal of bringing together 

entities such as state Developmental Disabilities agencies, 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. 

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.” 

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 to 

look at how to improve these outcomes. Demonstration projects have shown promising 

employment results for youth with intellectual and developmental disabilities when 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

Medicaid-funded LTSS, vocational rehabilitation, Social Security, and education systems 

collaborate. 

Funding History: 

Funding for the program during the last five years has been as follows: 

FY 2012 ...................................................$8,317,000 

FY 2013 ...................................................$8,828,000 

FY 2014 ...................................................$8,821,000 

FY 2015 ...................................................$8,857,000 

FY 2016... ..............................................$10,000,000 

Budget Request: 

The FY 2017 request for the Projects of National Significance program is $10,000,000, the same 

as the FY 2016 enacted level. This funding level includes $643,000 for technical assistance for the 

State Councils on Developmental Disabilities. In addition, ACL will provide self-advocacy 

organizations with an opportunity to thrive and grow through a targeted technical assistance effort. 

Funds will continue to support the Partnerships in Employment Systems Change projects as they 

continue to work toward a current need of the intellectual and developmental disabilities 

community. For example, 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. 

Consistent with the purpose of the Developmental Disabilities Act, including the promotion of 

self-determination, ACL 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. ACL proposes to continue funding a joint integrated training and technical 

assistance/resource center on supported decision making to advance work in this area. ACL also 

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 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

establishment of performance measurement workgroups, enhancement and streamlining data 

collection, and engagement with evaluation experts to recommend improvements. 

In FY 2017, 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, as well as older adults, in the development and planning 

of the community transportation systems. 

Grant Awards Tables: 

Developmental Disabilities – Projects of National Significance Grant Awards 

Award FY 2015 Final FY 2016 

Enacted 

FY 2017 

President’s 

Budget 

Number of 

Awards 26 32 32 

Average 

Award $291,947 $264,508 $264,516 

Range of 

Awards 

$100,000 -

$1,000,000 

$175,000 -

$1,000,000 

$175,000 -

$1,000,000 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

Resource and Program Data: 

Developmental Disabilities – Projects of National Significance 

(Dollars in thousands) 

Mechanism FY 2015 

Final # 

FY 2015 

Final $ 

FY 2016 

Enacted# 

FY 2016 

Enacted $ 

FY 2017 

President’s 

Budget # 

FY 2017 

President’s 

Budget $ 

Grants: 

Formula -- -- -- -- -- --

New Discretionary 1 10 17 3,600 14 4,600 

Continuations 25 7,581 14 4,600 17 3,600 

Contracts 6 1,347 6 1,612 6 1,612 

Interagency Agreements -- -- -- -- -- --

Program Support /2 -- 170 -- 189 -- 189 

Total Resources 32 9,107 37 10,000 37 10,000 

1/ Program Support -- Includes funds for grant systems, review costs, and technology support costs. 

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National Institute on Disability, Independent Living, and Rehabilitation 

Research 

FY 2017 

Program FY 2015 

Final 

FY 2016 

Enacted 

President's 

Budget 

FY 2017 +/-

FY 2016 

National Institute on 

Disability, Independent $103,970,000 $103,970,000 $103,970,000 --

Living and Rehabilitation 

Research 

Authorizing Legislation: Title II of the Rehabilitation Act of 1973, as amended 

FY 2017 Rehabilitation Act Authorization ..................................................................$114,325,000 

Allocation MethodDiscretionary Grants and Contracts 

............................................................................................................................................................ 

Program Description and Accomplishments: 

The mission of the National Institute on Disability, Independent Living, and Rehabilitation 

Research (NIDILRR) is to generate knowledge and promote its effective use to improve the 

abilities of people with disabilities to perform activities of their choice in the community, and to 

expand society’s capacity to provide full opportunities and accommodations for its citizens with 

disabilities. NIDILRR sponsors comprehensive and coordinated programs of research and related 

activities to maximize the full inclusion, social integration, employment, and independent living 

of individuals with disabilities of all ages. The purposes of NIDILRR are to: 

• Promote, coordinate, and provide for research, demonstration and training, and related 

activities with respect to individuals with disabilities; 

• Widely disseminate findings, conclusions, and recommendations resulting from its 

activities; and 

• Provide research-based knowledge toward advancing the quality of life of individuals with 

disabilities. 

NIDILRR's research is conducted through a network of individual research projects and centers of 

excellence located throughout the nation. Research funding is awarded through competitive grants, 

and most of the funds are awarded to universities or providers of rehabilitation or related services. 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

As required by the Rehabilitation Act in §202(h), NIDILRR operates under a Long-Range Plan 

(LRP), published April 4, 2013 in the Federal Register, entitled “Long-Range Plan for Fiscal Years 

2013-2017.” This plan outlines four long-term performance goals and strategies for achieving 

these goals. These goals are: 

• Goal 1: Create a portfolio of research, development, and other activities that balances 

domains, populations of focus, and who (whether NIDILRR or the grant applicant), defines 

the specific approach to a disability or rehabilitation research topic. NIDILRR’s outcome 

domains are community living and participation, employment, and health and function. 

• Goal 2: Support centers and projects that conduct well-designed research and development 

activities using a range of appropriate methods. 

• Goal 3: Promote the effective use of knowledge in areas of importance to individuals with 

disabilities and their families. 

• Goal 4: Improve program administration. 

The following is a description of the primary grant mechanisms under which NIDILRR makes 

awards: 

• Rehabilitation Research and Training Centers (RRTCs). RRTCs conduct research to 

improve rehabilitation methodologies and service delivery systems, alleviate or stabilize 

disabling conditions, and promote maximum social and economic independence for 

persons with disabilities. RRTC funding supports coordinated and advanced programs of 

research, training, technical assistance, and information dissemination in problem areas 

that are specified by NIDILRR. In addition, RRTCs provide training, including graduate, 

pre-service, and in-service training, to help rehabilitation personnel provide more effective 

rehabilitation services to individuals with disabilities; and serve as centers of excellence in 

rehabilitation research for providers and for individuals with disabilities and their 

representatives. 

• Rehabilitation Engineering Research Centers (RERCs). The RERCs conduct research on 

issues dealing with rehabilitation technology, including rehabilitation engineering and 

assistive technology devices and services. RERCs receive funding to conduct research or 

development activities to enhance independent living (including rehabilitation engineering 

and assistive technology) to enhance the opportunities of individuals with disabilities, and 

to diminish barriers that might limit their independence. Each RERC must provide training 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

opportunities to enable individuals, including individuals with disabilities, to become 

researchers and practitioners in the field of rehabilitation technology. 

• Model Systems. NIDILRR funds model systems projects in three areas: spinal cord injury, 

traumatic brain injury, and burn injury. Model systems funding supports grants to conduct 

research on interventions to meet the wide range of needs of individuals in these areas. 

Grantees in each of the three areas contribute to information on long-term community 

integration and functional outcomes by collecting and submitting longitudinal data to their 

respective injury-specific national databases. These model systems programs have become 

platforms for conducting multi-site research, including randomized controlled trials to 

determine the efficacy of interventions. 

o Spinal Cord Injury Model Systems. The Spinal Cord Injury (SCI) program funds 

research to meet the wide range of needs of individuals with spinal cord injuries. 

(See http://www.ncddr.org/rpp/hf/hfdw/mscis/.) Currently, the NIDILRR SCI 

model systems database is the largest of its kind in the world. The projects also 

disseminate information to individuals with SCI and others. 

o Traumatic Brain Injury Model Systems. The Traumatic Brain Injury (TBI) Model 

Systems projects are research grants designed to advance the understanding of 

TBI and its consequences and improve rehabilitation outcomes. Currently, the 

NIDILRR TBI model systems are the largest nonmilitary TBI service 

delivery/research entity participating in various intergovernmental efforts to 

improve treatment and outcomes for returning veterans. (See 

http://www.tbindsc.org.) 

o Burn Model Systems. The Burn Model Systems (BMS) projects are research 

grants designed to establish, demonstrate, and evaluate a model system of 

rehabilitation care for burn injury survivors. Projects aim to improve outcomes for 

burn survivors by conducting research to improve rehabilitation treatments for 

burn injuries. See http://mama.uchsc.edu/pub/NIDILRR/index.html. 

• Field-Initiated Projects (FIPs). Field-Initiated Projects supplement NIDILRR’s directed 

research and address a wide range of topics identified by investigators, including research, 

demonstrations, development, and knowledge translation. These projects allow NIDILRR 

to address emerging developments in the field beyond the scope of announced priorities. 

• Disability and Rehabilitation Research Projects (DRRPs). Grantees under this program 

focus on addressing problems encountered by people with disabilities through a variety of 

methods that may include research, demonstrations, training, dissemination, utilization, 

technical assistance, or combinations of these activities. These projects may be on topics 

identified by NIDILRR or may be identified by investigators. 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

• ADA National Network Centers (ADA Network). The ADA Network supports 10 regional 

centers that provide technical assistance, information, and training related to the 

requirements of the Americans with Disabilities Act (ADA). These efforts are designed to 

promote awareness and enforcement of the ADA. 

• Advanced Rehabilitation Research Training (ARRT). The ARRT program supports grants 

to institutions of higher education to provide advanced postdoctoral training in areas that 

are directly related to NIDILRR’s research domains, including community living and 

participation, employment, and health and function. Grants are made to institutions of 

higher education to recruit qualified persons with doctoral or similar advanced degrees and 

prepare them to conduct independent research in areas related to disability and 

rehabilitation. These training programs must operate in interdisciplinary environments and 

provide training in rigorous scientific methods. 

• Small Business Innovation Research (SBIR). SBIR awards support the development of new 

rehabilitation technologies that are useful to persons with disabilities by inviting the 

participation of small business firms with strong research capabilities in science, 

engineering, or educational technology. This 2-phase program takes a product from 

development to market readiness. During Phase I, firms conduct feasibility studies to 

evaluate the scientific and technical merit of an idea. During Phase II, they expand on the 

results and pursue further development. In order to be eligible, small businesses must be 

American-owned and independently operated and be for-profit with no more than 500 

employees. The principal researcher must be employed by the business. 

• Switzer Research Fellowships. Switzer research fellows receive 1-year fellowships to carry 

out discrete research activities that are related to NIDILRR’s research priorities or to pursue 

studies in areas of importance to the disability and rehabilitation community. This award 

is made to individuals. 

• Outreach to Minority Institutions. The Rehabilitation Act (§21) requires that 1 percent of 

funds appropriated for programs authorized under certain titles be reserved for awards to 

minority entities and Indian tribes, or to provide outreach and assistance to minority entities 

and Indian tribes. 

• Other Activities: NIDILRR funding also supports a variety of other activities, including 

knowledge translation; collaborative projects with other agencies; development and 

maintenance of grantee reporting systems; program review; and reporting, evaluation, 

long-range planning, and the Interagency Committee on Disability Research (ICDR). The 

primary purpose of the ICDR is to promote cooperation across various Federal agencies in 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

the development and execution of disability and rehabilitation research activities. (See 

http://www.icdr.us/.) 

Funding History: 

Funding for NIDILRR during the past five years is as follows: 

FY 2012 ...............................................$108,817,000 

FY 2013 ...............................................$103,125,000 

FY 2014 ...............................................$103,970,000 

FY 2015 ...............................................$103,970,000 

FY 2016... ...........................................$103,970,000 

Budget Request: 

ACL requests $103,970,000 for the National Institute on Disability, Independent Living, and 

Rehabilitation Research in FY 2017, the same as the FY 2016 enacted level. Funding at this level 

will enable NIDILRR to fund multiple Disability and Rehabilitation Research Projects (DRRPs) 

targeting improved employment outcomes for individuals with disabilities, and support 

NIDILRR’s Traumatic Brain Injury (TBI) and Burn Model Systems programs. About 79 percent 

of the funds requested would be used to cover the costs of grants that began in previous fiscal years 

($85 million). In addition, an estimated $23 million would be used to fund new grant awards under 

a potential revised regulatory framework that NIDILRR proposes to publish for its research in FY 

2017. 

The FY 2017 budget request also includes general provision (Section 224) that would address an 

area of particular concern to NIDILRR, but one which has also affected other ACL programs. For 

NIDILRR to be able to accept funding from another agency for the purpose of making grants or 

cooperative agreements, specific authority is required. The lack of such authority precludes 

collaboration. The new proposed language would provide HHS agencies with statutory authority 

to transfer funds via reimbursable agreements from one agency to another for the purposes of 

making grants, allowing NIDILRR to collaborate on a wider scale (e.g., with the Department of 

Veteran’s affairs on research projects to address the needs of disabled veterans). It would also 

improve the operational efficiency of NIDLIRR by allowing them to transfer funds via 

reimbursable agreements to other OPDIVs for the purposes of making grants or cooperative 

agreements on their behalf. 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

Through priorities published in the Federal register in FY 2013 based on NIDILRR’s revised 

Long-Range Plan (published in final in April 2013), NIDILRR established three domains: 

employment, health and function, and community living and participation to clarify its major areas 

of research. In addition, NIDLIRR identified four broad disability categories—physical, 

psychiatric, developmental/intellectual, and sensory, to identify its principal populations of 

interest. NIDILRR has published broad priorities using the domains and, in some cases, the 

disability categories, that allow applicants to respond with proposed research of their own choice. 

These more field-initiated priorities would remain in place for up to five years. Applicants who 

are not successful in one competition are able to revise and improve their application and resubmit 

in subsequent years. Use of these recurring topical priorities also simplifies management of 

NIDILRR’s competitions by reducing the need for annual rule-making. NIDILRR also reserves 

the right to publish agency-directed priorities as required to take advantage of new opportunities 

or respond to critical needs of individuals with disabilities and their families. 

During FY 2017, NIDILRR plans to focus on the following broad priority topics in its domain 

areas: 

Employment 

• Technology to improve employment outcomes for individuals with disabilities. 

• Individual and environmental factors associated with improved employment outcomes for 

individuals with disabilities. 

• Interventions that contribute to improved employment outcomes for individuals with 

physical disabilities. Interventions include any strategy, practice, program, policy, or tool 

that, when implemented as intended, contributes to improvements in outcomes for 

individuals with disabilities. 

• Effects of government practices, policies, and programs on employment outcomes for 

individuals with disabilities. 

• Practices and policies that contribute to improved employment outcomes for transitionaged youth with disabilities. 

• Vocational rehabilitation (VR) practices that contribute to improved employment 

outcomes for individuals with disabilities. 

Community Living and Participation 

• Technology to improve community living and participation outcomes for individuals with 

disabilities. 

• Individual and environmental factors associated with improved community living and 

participation outcomes for individuals with disabilities. 

• Interventions that contribute to improved community living and participation outcomes for 

individuals with physical disabilities. Interventions include any strategy, practice, program, 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

policy, or tool that, when implemented as intended, contributes to improvements in 

outcomes for individuals with disabilities. 

• Effects of government practices, policies, and programs on community living and 

participation outcomes for individuals with disabilities. 

• Practices and policies that contribute to improved community living and participation 

outcomes for transition-aged youth with disabilities. 

Health and Function 

• Technology to improve health and function outcomes for individuals with disabilities. 

• Individual and environmental factors associated with improved access to rehabilitation and 

health care and improved health and function outcomes for individuals with disabilities. 

• Interventions that contribute to improved health and function outcomes for individuals with 

disabilities. Interventions include any strategy, practice, program, policy, or tool that, when 

implemented as intended, contributes to improvements in outcomes for the specified 

population. 

• Effects of government practices, policies, and programs on health care access and on health 

and function outcomes for individuals with disabilities. 

• Practices and policies that contribute to improved health and function outcomes for 

transition-aged youth with disabilities. 

Outcomes and Output Table: 

ACL will work with all relevant parties to review, develop, or refine performance measures and 

performance data collection for all WIOA programs during the transition. 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

Grant Awards Tables: 

National Institute on Disability, Independent Living, and Rehabilitation Research 

(Dollars in Thousands) 

Award FY 2015 Final FY 2016 

Enacted 

FY 2017 

President’s 

Budget 

Number of 

Awards 225 227 222 

Average 

Award $449,619 $427,251 $436,185 

Range of 

Awards 

$70,000 – 

$1,246,000 

$70,000 – 

$1,246,000 

$70,000 – 

$1,246,000 

Resource and Program Data: 

National Institute on Disability, Independent Living, and Rehabilitation Research 

(Dollars in Thousands) 

Mechanism FY 2015 

Final # 

FY 2015 

Final $ 

FY 2016 

Enacted# 

FY 2016 

Enacted $ 

FY 2017 

President’s 

Budget # 

FY 2017 

President’s 

Budget $ 

Grants: 

Formula -- -- -- -- -- --

New Discretionary 54 15,096 80 34,115 60 20,308 

Continuations 164 82,921 147 62,871 162 76,525 

Contracts 7 4,718 8 5,587 7 5,745 

Peer Review of new grant 

applications 1 824 1 954 1 950 

Interagency Agreements 1 121 -- -- -- --

Program Support /1 -- 290 -- 443 -- 442 

Total Resources -- 103,970 -- 103,970 -- 103,970 

1/ Program Support -- Includes funds for statutory requirements, grant systems and review, salaries and overhead, 

and information technology support costs. 

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Independent Living 

Program FY 2015 

Final 

FY 2016 

Enacted 

FY 2017 

President’s 

Budget 

2017 +/-

FY 2016 

Independent Living State 

Grants........ $22,878,000 $22,878,000 $22,878,000 --

Centers for Independent 

Living.......... $78,305,000 $78,305,000 78,305,000 --

Total......... $101,183,00 

0 

$101,183,00 

0 

$101,183,00 

0 --

FTE /1...... -- 1.0 1.7 +0.7 

Authorizing Legislation: Rehabilitation Act of 1973, Title VII, Parts B and C, and Chapter 1, as 

amended by the Workforce Innovation and Opportunities Act (Rehabilitation Act) 

FY 2017 Rehabilitation Act Authorizations: 

Independent Living State Grants ..............................................................................$25,156,000 

Centers for Independent Living ................................................................................$86,104,000 

Allocation Method ...................................................................... Formula and Discretionary Grants 

Program Description and Accomplishments: 

Independent Living (IL) programs maximize the leadership, empowerment, independence, and 

productivity of individuals with disabilities, and work to integrate these individuals into the 

mainstream of American society. Independent living programs provide financial assistance to 

sustain, expand, and improve independent living services; develop and support statewide networks 

of centers for independent living; and foster working relationships among centers for independent 

living, Statewide Independent Living Councils, other Rehabilitation Act programs, and other 

relevant Federal and non-Federal programs. 

The Independent Living State Grants program supports formula grants to States, with funds 

allotted based on total population. States participating in the State Grants program must match 

10 percent of their grant with non-Federal cash or in-kind resources in the year for which the 

Federal funds are appropriated. The fiscal year 2014 State distributions were based on the July 1, 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

2012 estimates released in December 2012, and the fiscal year 2015 allotments will be based on 

the July 1, 2013 estimates published by the Census Bureau in December 2013. 

To be eligible for financial assistance under the Independent Living (IL) State Grants or Centers 

for Independent Living program, States are required to identify a Designated State Entity (DSE) 

to receive, disperse, and account for funds, and to establish a Statewide Independent Living 

Council (SILC). Each State must also submit a State Plan for Independent Living. In addition to 

developing the State plan, the SILC may, consistent with the State plan and State law, work to 

coordinate services provided to individuals with disabilities, conduct resource development 

activities, and perform other functions to support the purposes of the law. The remaining funds 

shall be used for one or more of the following purposes, consistent with the approved State plan: 

• To demonstrate ways to expand and improve independent living services, particularly those 

in unserved areas; 

• To provide independent living services; 

• To support the operation of centers for independent living; 

• To increase the capacity of public or nonprofit agencies and organizations and other entities 

to develop comprehensive approaches or systems for providing independent living 

services; 

• To conduct studies and analyses, gather information, develop model policies and 

procedures, and present information, approaches, strategies, findings, conclusions, and 

recommendations to Federal, State, and local policymakers; 

• To provide training on the independent living philosophy; and/or 

• To provide outreach to populations who are not served or are underserved by programs 

under subtitle VII, Chapter 16 of the Rehabilitation Act, including minority groups and 

urban and rural populations. 

Section 21(b)(1) of the Rehabilitation Act allows for 1 percent of funds appropriated under subtitle 

VII to be set aside for minority outreach activities as described in Section 21(b)(2). Activities may 

be carried out through a grant, contract, or cooperative agreement. 

The 2014 reauthorization of the Rehabilitation Act by the Workforce Innovation and Opportunity 

Act (WIOA) added a new requirement that the Department annually reserve between 1.8 and 2.0 

percent of the appropriated IL State funds to provide either directly or through grants, contracts, 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

or cooperative agreements, training and technical assistance to Statewide Independent Living 

Councils (SILCs). In addition, WIOA requires that the ACL Administrator conduct a survey of 

SILCs regarding their training and technical assistance needs. 

The Centers for Independent Living (CIL) program provides grants for consumer-controlled, 

community-based, cross-disability, private nonprofit agencies that are designed and operated 

within a local community by individuals with disabilities and provide an array of independent 

living services. At a minimum, centers are required to provide the core services of information and 

referral, independent living skills training, peer counseling, and individual and systems advocacy. 

WIOA added a fifth core service that the CILs must provide to eligible individuals with significant 

disabilities that requires CILs to: 

• Facilitate the transition of individuals with significant disabilities from nursing homes 

and other institutions to home and community based residences, with necessary supports 

to remain in the community; 

• Assist individuals with significant disabilities at risk of institutionalization so that they 

may remain in the community; and 

• Facilitate the transition of youth who are individuals with significant disabilities that are 

eligible for IDEA and who either completed school or left school to transition to 

postsecondary life. 

A population-based formula determines the total amount that is available for grants to centers in 

each State. WIOA requires that grants be awarded to any eligible agency that had been awarded a 

grant for the preceding fiscal year. In most cases, funds are awarded directly to centers for 

independent living. In fiscal year 2015, 354 centers and two States received funding from the CIL 

program. If State funding for CIL operation exceeds the level of Federal CIL funding in any fiscal 

year, the State may apply for the authority to award grants under this program through its 

designated state unit. There are currently only two States, Massachusetts and Minnesota, that are 

both eligible and have elected to manage their own CIL programs. 

In addition to funding centers for independent living, the Department must annually reserve 

between 1.8 and 2 percent of the funds appropriated for this program to provide (through grants, 

contracts, or cooperative agreements) training and technical assistance with respect to planning, 

developing, conducting, administering, and evaluating centers for independent living. The 

Rehabilitation Act requires the Department to conduct a survey of Statewide CILs to determine 

funding priorities for such grants, contracts or cooperative arrangements. 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

The following standards are used in evaluating compliance in the following areas: philosophy, 

including consumer control and equal access; provision of services on a cross-disability basis; 

support of the development and achievement of the independent living goals chosen by consumers; 

increasing the availability and quality of community options for independent living; provision of 

independent living core services; resource development; and community capacity-building 

activities, such as community advocacy, technical assistance, and outreach. 

Funding History: 

Funding for Independent Living activities during the past five years is as follows: 

Independent Living State Grants: 

FY 2012 .................................................$23,359,000 

FY 2013 .................................................$23,137,000 

FY 2014 .................................................$22,878,000 

FY 2015 .................................................$22,878,000 

FY 2016 ................................................$22,878,000 

Centers for Independent Living: 

FY 2012 .................................................$79,953,000 

FY 2013 .................................................$75,772,000 

FY 2014 .................................................$78,305,000 

FY 2015 .................................................$78,305,000 

FY 2016 .................................................$78,305,000 

Budget Request: 

The FY 2017 request for Independent Living is $101,183,000, the same as the FY 2016 enacted 

level. Of this amount, $22,878,000 is provided to the Independent Living State Grants program 

(IL State Grants) and $83,305,000 is for the Centers for Independent Living program (CIL). CILs 

will continue to provide the core requirements for information and referral services, independent 

living skills training, peer counseling, and individual and systems advocacy, as well as continue to 

implement the new, fifth core service required by WIOA to facilitate the transition of individuals 

with significant disabilities into the community. As part of this requirement, CILs are directed to 

develop protocols, provide outreach and education, and provide and track activities. In 2014, CILs 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

served about 280,000 of the estimated 38 million individuals with a significant disability living in 

the United States. 108 

The request for the CIL program would continue support for existing centers, including any new 

center grants awarded in FY 2016. Approximately 75 new centers have been funded, as funding 

for this program has increased since FY 2000. These new and existing centers provide essential 

services that help individuals with disabilities to live independently and participate as productive 

members of their communities. 

Outcome and Output Table: 

ACL will work with all relevant parties to review, develop, or refine performance measures and 

performance data collection for all WIOA programs during the transition. 

108 ACL, 704 Report, 2014. And U.S. Census Bureau, “Americans with Disabilities 2010” issued July 2012. 

Accessed 12/4/14. http://www.census.gov/prod/2012pubs/p70-131.pdf 

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-- -- -- -- -- --

DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

Grant Awards Tables: 

Independent Living Grant Awards 

Award FY 2015 Final FY 2016 

Enacted 

FY 2017 

President’s 

Budget 

Number of 

Awards 1/ 432 432 434 

Average 

Award $234,217 $233,997 $232,919 

Range of 

Awards 

$27,797 -

$1,978,662 

$27,770 -

$1,980,977 

$27,511 -

$1,945,901 

1/ Independent Living State Grants are awarded to 77 entities across 56 state 

and territory jurisdictions because some states have separate divisions for 

vocational rehabilitation and services for the blind. 

Resource and Program Data: 

Independent Living 

(Dollars in Thousands) 

Mechanism FY 2015 

Final # 

FY 2015 

Final $ 

FY 2016 

Enacted# 

FY 2016 

Enacted $ 

FY 2017 

President’s 

Budget # 

FY 2017 

President’s 

Budget $ 

Grants: 

Formula /2 77 22,878 77 22,216 77 22,216 

New Discretionary 3 993 2 1,195 2 1,429 

Continuations 352 77,311 353 77,676 355 77,442 

Contracts -- -- -- -- -- --

Interagency Agreements -- -- -- -- -- --

Program Support /1 -- 1 -- 97 -- 97 

Total Resources -- 101,183 -- 101,183 -- 101,183 

205 
 

 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

FY 2017 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: Independent Living State Grants (CFDA 84.169A) 

State/Territory FY 2015 Actual 

FY 2016 

Enacted 

FY 2017 

President's Budget 

FY 2017 +/-

FY 2016 

Alabama......................................... 305,350 305,350 305,350 -

Alaska............................................ 305,350 305,350 305,350 -

Arizona.......................................... 342,056 343,661 337,576 (6,085) 

Arkansas........................................ 305,350 305,350 305,350 -

California....................................... 1,978,662 1,980,977 1,945,901 (35,076) 

Colorado........................................ 305,350 305,350 305,350 -

Connecticut.................................... 305,350 305,350 305,350 -

Delaware........................................ 305,350 305,350 305,350 -

District of Columbia...................... 305,350 305,350 305,350 -

Florida........................................... 1,009,287 1,015,609 997,626 (17,983) 

Georgia.......................................... 515,779 515,498 506,370 (9,128) 

Hawaii........................................... 305,350 305,350 305,350 -

Idaho.............................................. 305,350 305,350 305,350 -

Illinois............................................ 664,955 657,590 645,947 (11,643) 

Indiana........................................... 339,179 336,788 330,825 (5,963) 

Iowa............................................... 305,350 305,350 305,350 -

Kansas........................................... 305,350 305,350 305,350 -

Kentucky....................................... 305,350 305,350 305,350 -

Louisiana....................................... 305,350 305,350 305,350 -

Maine............................................. 305,350 305,350 305,350 -

Maryland....................................... 306,036 305,350 305,350 -

Massachusetts.............................. 345,473 344,372 338,275 (6,097) 

Michigan........................................ 510,796 505,927 496,969 (8,958) 

Minnesota...................................... 305,350 305,350 305,350 -

Mississippi..................................... 305,350 305,350 305,350 -

Missouri......................................... 311,990 309,563 305,350 (4,213) 

Montana......................................... 305,350 305,350 305,350 -

Nebraska........................................ 305,350 305,350 305,350 -

Nevada........................................... 305,350 305,350 305,350 -

New Hampshire............................. 305,350 305,350 305,350 -

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

PROGRAM/CFDA NUMBER: Independent Living State Grants (CFDA 84.169A) 

State/Territory FY 2015 Actual 

FY 2016 

Enacted 

FY 2017 

President's Budget 

FY 2017 +/-

FY 2016 

New Jersey.......................... 459,369 456,319 448,239 (8,080) 

New Mexico....................... 305,350 305,350 305,350 -

New York........................... 1,014,359 1,008,100 990,251 (17,849) 

North Carolina.................... 508,341 507,667 498,679 (8,988) 

North Dakota...................... 305,350 305,350 305,350 -

Ohio.................................... 597,266 591,915 581,434 (10,481) 

Oklahoma............................ 305,350 305,350 305,350 -

Oregon................................ 305,350 305,350 305,350 -

Pennsylvania....................... 659,363 652,823 641,264 (11,559) 

Rhode Island....................... 305,350 305,350 305,350 -

South Carolina.................... 305,350 305,350 305,350 -

South Dakota...................... 305,350 305,350 305,350 -

Tennessee............................ 335,312 334,363 328,443 (5,920) 

Texas................................... 1,365,213 1,376,228 1,351,861 (24,367) 

Utah.................................... 305,350 305,350 305,350 -

Vermont.............................. 305,350 305,350 305,350 -

Virginia............................... 426,389 425,080 417,554 (7,526) 

Washington......................... 359,853 360,511 354,128 (6,383) 

West Virginia...................... 305,350 305,350 305,350 -

Wisconsin........................... 305,350 305,350 305,350 -

Wyoming............................ 305,350 305,350 305,350 

-

Subtotal, States................... 21,820,878 21,799,541 21,593,242 (206,299) 

American Samoa................. 27,797 27,770 27,511 (259) 

Guam.................................. 27,797 27,770 27,511 (259) 

Northern Mariana Islands... 27,797 27,770 27,511 (259) 

Puerto Rico......................... 305,350 305,350 305,350 -

Virgin Islands..................... 27,797 27,770 27,511 

(259) 

Subtotal, States and Territories 22,237,416 22,215,971 22,008,636 (207,335) 

Undistributed 1/................... 640,584 662,029 869,364 207,335 

TOTAL...................................... 22,878,000 22,878,000 22,878,000 -

1/ The undistributed line reflects the amount reserved from the Independent Living State Grants appropriation for: 

statutory related activities, including contingencies; FTE and related overhead costs to conduct program 

monitoring and oversight; and for program support costs including information and systems, technical assistance 

and evaluation. Funds unused for these purposes at the end of the year are allocated to States. 

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Limb Loss Resource Center 

Service FY 2015 

Final 

FY 2016 

Enacted 

FY 2017 

President's 

Budget 

FY 2017 +/-

FY 2016 

Limb Loss Resource Center $2,800,000 $2,810,000 $2,810,000 --

Authorizing Legislation: Public Health Service Act Section 301 (a) and Section 317, as amended, 

42U.S.C. 241 (a); 42 U.S.C. 247 (b) 

Allocation Method ............................................................................................... Competitive Grant 

Program Description and Accomplishments: 

Approximately 185,000 amputations occur in the United States each year, 109 and hospital costs 

associated with amputation total more than $8.3 billion annually. 110 The Limb Loss program seeks 

to improve the health of people with limb loss (PWLL) and promote their well-being, improve 

quality of life, prevent disease, reduce unnecessary medical expenditures, and provide support to 

their families and caregivers. 

Limb loss is the loss of all or part of an arm or leg due to trauma, infection, diabetes, heart diseases, 

cancer or other diseases. Approximately 2 million adults living in the U.S have limb loss, and 

approximately 58% of people living with limb loss are 65 or older. 111 The main causes of limb 

loss are vascular disease (54%) – including diabetes and peripheral arterial disease – trauma (45%), 

and cancer (less than 2%). The number of people with limb loss is expected to double by 2050, 

largely due to the rise of diabetes. 112 

109 Owings M, Kozak LJ, National Center for Health S. Ambulatory and Inpatient Procedures in the United States, 

1996. Hyattsville, Md.: U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, 

National Center for Health Statistics; 1998 

110 HCUP Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). Rockville, MD: 

Agency for Healthcare Research and Quality; 2009. 

111 Ziegler-Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R. Estimating the Prevalence of 

Limb Loss in the United States: 2005 to 2050. Archives of Physical Medicine and Rehabilitation, 2008;89(3):422-9 

112 HCUP Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). In. Rockville, MD: 

Agency for Healthcare Research and Quality; 2009. 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

The Limb Loss Program supports a national resource center and related activities that provides 

comprehensive information and resources to assist individuals and families dealing with limb loss. 

Program accomplishments also include a nationwide awareness campaign, highlighted by Limb 

Loss Awareness Month in April. In 2012, 40 state governors acknowledged April as Limb Loss 

Awareness Month and President Obama recognized Limb Loss Awareness Month in a letter 

addressed to the public. 

Funding History: 

Funding for the program during the last five years has been as follows: 

FY 2012 ...................................................$2,820,000 

FY 2013 ...................................................$2,788,000 

FY 2014 ...................................................$2,810,000 

FY 2015 ...................................................$2,800,000 

FY 2016 ...................................................$2,810,000 

Note: This program was funded at CDC through FY 2014 and transferred to ACL during FY 2015. 

Budget Request: 

The FY 2017 request is $2,810,000, the same as the FY 2016 enacted level. In FY 2015, Limb 

Loss funding supported the National Limb Loss Resource Center through a grant to the Amputee 

Coalition. The National Limb Loss Resource Center offers, at no cost, resources for people with 

limb loss, their families, friends, and the health care professionals involved in their lives. With the 

help of this information, people with limb loss can choose the best available options, discuss these 

options with their healthcare providers and caregivers, and plan for their future. 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

Limb Loss Resource Center 

Award FY 2015 Final FY 2016 

Enacted 

FY 2017 

President’s 

Budget 

Number of 

Awards 1 1 1 

Average 

Award $2,370,000 $2,736,987 $2,736,987 

Range of 

Awards NA NA NA 

1/ Program Support -- Includes funds for Public Health Service Act statutory requirements, grant systems 

and review costs. 

Limb Loss Resource Center 

Resource and Program Data 

(Dollars in thousands) 

Mechanism FY 2015 

Final # 

FY 2015 

Final $ 

FY 2016 

Enacted# 

FY 2016 

Enacted $ 

FY 2017 

President’s 

Budget # 

FY 2017 

President’s 

Budget $ 

Grants: 

Formula -- -- -- -- -- --

New Discretionary -- -- -- -- 1 2,737 

Continuations 1 2,730 1 2,737 -- --

Contracts -- -- -- -- -- --

Interagency Agreements -- -- -- -- -- --

Program Support /1 -- 70 -- 73 -- 73 

Total Resources -- 2,800 -- 2,810 -- 2,810 

1/ Program Support -- Includes funds for Public Health Service Act statutory requirements, grant 

systems and review costs. 

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Paralysis Resource Center 

Service FY 2015 

Final 

FY 2016 

Enacted 

FY 2017 

President's 

Budget 

FY 2017 +/-

FY 2016 

Paralysis Resource Center $6,700,000 $7,700,000 $7,700,000 --

Authorizing Legislation: Sections 311 and 317(k)(2) of the Public Health Service Act [42 U.S.C. 

243 & 247b(k)(2)], as amended. 

Allocation Method ............................................................................................... Competitive Grant 

Program Description and Accomplishments: 

The Paralysis Resource Center (PRC) promotes the health and well-being of people living with 

paralysis and supports their families and caregivers by providing comprehensive information and 

referral services. The PRC seeks to bridge the information gap experienced not only by newlyparalyzed 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. 

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. Under ACL, the PRC will benefit from extensive ties to ACL’s 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

disability networks including NIDILRR’s Spinal Cord Injury Model Systems, 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 2012 ...................................................$6,700,000 

FY 2013 ...................................................$6,352,000 

FY 2014 ...................................................$6,683,000 

FY 2015 ...................................................$6,700,000 

FY 2016.......................................$7,700,000 

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 

Budget Request: 

The FY 2017 request is $7,700,000, the same as the FY 2016 enacted level. 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. 113 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. 

113http://www.christopherreeve.org/site/c.mtKZKgMWKwG/b.5184241/k.ACBD/Average_age_average_length_of_ 

time_since_paralysis_and_SCI.htm 

213 
Resource and Program Data: 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

Paralysis Resource Center 

(Dollars in thousands) 

Mechanism 

FY 2015 

Final # 

FY 2015 

Final $ 

FY 2016 

Enacted # 

FY 2016 

Enacted $ 

FY 2017 

President’s Budget # 

FY 2017 

President’s Budget $ 

Grants: 

Formula -- -- -- -- -- --

New Discretionary 1 6,530 -- -- -- --

Continuations -- -- 1 7,506 1 7,506 

Contracts -- -- -- -- -- --

Interagency Agreements -- -- -- -- -- --

Program Support /1 -- 170 -- 194 -- 194 

Total Resources -- 6,700 -- 7,700 -- 7,700 

1/ Program Support -- Includes funds for Public Health Service Act statutory requirements, grant systems 

and review costs. 

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Traumatic Brain Injury 

FY 2017 FY 2017 +/- Program FY 2016 President’s FY 2016 

FY 2015 Final Enacted Budget 

Traumatic Brain Injury $9,321,000 $9,321,000 $9,321,000 

FTE 2 2 2 0 

Note: TBI was funded at the Health Resources and Services Administration in FY 2015, and transferred to ACL at 

the beginning of FY 2016. 

Authorizing Legislation: The Traumatic Brain Injury Reauthorization Act of 2014. 

FY 2017 Authorization ....................................................................................................$8,600,000 

Allocation Method ................................................... Formula Grant / Competitive Grant / Contract 

Program Description and Accomplishments: 

Public-Law 113–196, signed November 26, 2014, gave the Secretary of Health and Human 

Services (HHS) Secretary the authority to determine the placement of the Traumatic Brain Injury 

Act within HHS. The Secretary took this opportunity to conduct a review of the program, 

including extensive engagement with TBI stakeholders, and decided to move the program from 

the Health Resources and Services Administration (HRSA) to ACL since it closely aligns with 

ACL’s mission and goals to support the rights of older Americans and people of all ages with 

disabilities to live in their communities throughout their lifespan. ACL and HRSA will continue 

to collaborate to ensure continued linkages to HRSA’s public health programs and networks. 

The purpose of the federal Traumatic Brain Injury (TBI) Program is to develop comprehensive, 

coordinated family and person-centered service systems for individuals who sustain a TBI at the 

state and community level. TBIs occur when the head suddenly or violently hits an object, or an 

object enters brain issue causing disruption to typical activity. The majority of TBIs are considered 

mild although an estimated 80,000-90,000 of individuals who sustain a TBI annually will 

experience long-term, possibly life-long, challenges due to their injury. In the United States, it is 

estimated at least 3.2 million Americans require long-term or life-long assistance to perform 

activities of daily living as a result of TBI. 114 In addition, these national estimates do not include 

114 Traumatic Brain Injury in the United States: A Report to Congress. December 1999. 

http://www.cdc.gov/ncipc/pub-res/tbi_congress/TBI_in_the_US.PDF 

216 

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CONSUMER INFORMATION, ACCESS, AND OUTREACH 

individuals with TBI who are treated in military hospitals. TBI affects all age groups and can cause 

a range of symptoms, which may include memory loss, difficulty concentrating, confusion, 

irritability, personality changes, fatigue, and headaches. The CDC’s March 2014 Morbidity and 

Mortality Weekly Report (MMWR) noted that reducing the incidence of TBI requires an 

integration of public health and health care delivery systems to ensure efficient, effective care and 

rehabilitation is delivered to those who need it. Public health interventions include primary 

prevention, early management, and comprehensive approaches to rehabilitation and community 

reintegration. However, individuals with TBI may also need a variety of services and supports, 

including rehabilitation, counseling, academic and vocational accommodations, independent 

living assistance, transportation assistance, and vocational training. These services and supports 

are often fragmented across different State systems of care, making access difficult for families. 

Through our various funding streams ACL works across the lifespan and focuses on multiple life 

domains outside of the health arena focusing on systems change in order to address fragmentation 

and ensure enhanced service delivery. 

The TBI Program consists of two distinct grant efforts: 1) the State Implementation Partnership 

Grants (competitive grant), and 2) the State Protection and Advocacy (P&A) Systems Grants 

(formula grant). 

State Implementation Partnership Grants 

The goal of State Implementation Partnership Grants is to address barriers to needed services 

encountered by children, youth, and adults with TBI. States and Territories receive funds to assess 

the need for TBI services and the resources within their State or Territory. This is done through a 

needs and resource assessment designed to facilitate the development or expansion of a 

comprehensive, multidisciplinary, and easily accessible systems of care for individuals with TBI 

and their families. The system of services emphasizes early diagnosis, intervention and resource 

facilitation consistent with the model of medical home. A multi-year evaluation of state needs and 

resources indicated the need to focus on four areas for increasing access to rehabilitation and other 

services for individuals with TBI. The areas are as follows: 

• screening to identify individuals with TBI, 

• building a trained TBI workforce by providing professional training, 

• providing information about TBI to families and referrals to appropriate service 

providers, and 

• actively assisting families in navigating service systems to access resources for care, 

treatment, and support. 

In line with the focus areas of the program, two developmental measures have been established to 

assess 1) whether individuals with TBI and their families are able to access needed services as a 

result of their interaction with grantees, and 2) whether professionals receiving training from 

217 
 

 

 

 

 

 

 

CONSUMER INFORMATION, ACCESS, AND OUTREACH 

grantees report that they are better able to assess and meet the needs of individuals with TBI and 

their families. 

State Protection and Advocacy Systems Grants 

The P&A Program is the second component grant of the TBI Program. Section 1253 of the Public 

Health Service Act recognizes that State Protection and Advocacy (P&A) systems are critical to 

achieving the goals and objectives of the TBI Program. The P&A Program was authorized as a 

component of the Federal TBI Program in the Children’s Health Act of 2000 to support and protect 

the rights of individuals with TBI. Since the inception of the program, grants have been awarded 

to P&A organizations in states, territories, the District of Columbia, and one Native American 

Consortium to provide advocacy support for individuals with TBI and their families. Formula 

grants continue to be awarded to 57 states, territories, and one Native American consortium to 

develop plans to ensure P&A services, including individual and family advocacy, self-advocacy 

training, self-advocacy assistance, information and referral services, and legal representation. P&A 

grants are formula based, with an average award of $50,000 for state grantees and $20,000 for 

territory grantees. 

A vital part of P&A activities is providing training and education to consumers and providers. TBI 

training is tailored to meet the needs of specific audiences, and is intended to increase awareness 

about legal concerns and individual rights around TBI, provide information on identification and 

funding of services, and provide support to facilitate full participation in all aspects of life. In FY 

2014, P&A grantees provided training to nearly 60,000 individuals. Topics addressed included: 

• Signs and symptoms of TBI; 

• Disability rights; 

• Brain injury supports and services; 

• Medicaid waivers; 

• Transition planning; and 

• Special education services. 

These trainings were provided to support groups, independent living centers, service providers, 

caregivers, individuals with TBI, family members, state employees, hospital staff, university staff, 

and community representatives. They have resulted in greater awareness for training participants 

of the needs of persons with TBI and the availability of resources and support services. 

218 
 

 

 

CONSUMER INFORMATION, ACCESS, AND OUTREACH 

Programs 

FY 2015 

Final 

FY 2016 

Enacted 

FY 2017 

President’s Budget 

State Grants for 

Demonstration Projects $5,065,314 $5,065,314 $5,065,314 

Protection and 

Advocacy Grants $3,099,589 $3,099,589 $3,099,589 

Funding History: 

Funding for the program during the last five years has been as follows: 

FY 2012 ...................................................$9,760,000 

FY 2013 ...................................................$9,245,000 

FY 2014 ...................................................$9,321,000 

FY 2015 ...................................................$9,321,000 

FY 2016 ... ..............................................$9,321,000 

FY 2017 ...................................................$9,321,000 

Note: This program was funded at HRSA through FY 2015 and transferred to ACL at the beginning of FY 2016. 

Funding at HRSA included both grant and administrative funds. 

Budget Request: 

The FY 2017 request is $9,321,000, the same as the FY 2016 enacted level. TBI was funded at the 

Health Resources and Services Administration in FY 2015, and transferred to ACL at the start of 

FY 2016. This funding level currently supports 20 State Implementation Partnership grants which 

are anticipated to be awarded in FY 2016. 

TBI Protection and Advocacy grants will receive approximately $3.1 million in FY 2017 awarded 

to 57 states and territories, the same as FY 2015 and FY 2016. 

The TBI program also provides funding for a TBI technical assistance center (TBITAC) which is 

being renamed the Traumatic Brain Injury Coordinating Center (TBICC). The center was funded 

at approximately $442,000 for FY 2014, $500,000 for FY 2015, and is budgeted at $500,000 for 

FY 2016 and FY 2017 provided funds are available. The TBITAC has been responsible for 

providing technical assistance to grantees, maintaining a national listserv on issues that affect TBI 

service delivery with approximately 1,500 subscribers, maintaining an online collaboration space 

for grantees to share best practices for building and maintaining service-delivery infrastructure, 

and developing educational materials for the public about TBI. 

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CONSUMER INFORMATION, ACCESS, AND OUTREACH 

This request supports the program’s efforts to achieve its FY 2017 performance targets. Funding 

also includes costs associated with the grant review and award process, follow-up performance 

reviews, and information technology and other program support costs 

Outcomes and Outputs Table 

ACL will work with all relevant parties to review, develop, or refine performance measures and 

performance data collection for the Traumatic Brain Injury program. 

Grant Awards Tables: 

Traumatic Brain Injury: State Implementation Partnership / Protection and Advocacy 

Award FY 2015 

Final 

FY 2016 

Enacted 

FY 2017 

President’s Budget 

Number of 

Awards 20 / 57 20/ 57 20*/ 57 

Average 

Award $250,000 / $54,379 $250,000 / $54,379 $250,000* / $54,379 

Range of 

Awards 

$224,344 - $250,000 

/ $20,000 - $145,854 

$224,344 - $250,000 / 

$20,000 - $145,854 

$224,344 - $250,000* / 

$20,000 - $145,854 

*Note: Could potentially change in 2017 or after so that all states receive an award rather than 21. 

220 
Resource and Program Data: 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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CONSUMER INFORMATION, ACCESS, AND OUTREACH 

Traumatic Brain Injury 

(Dollars in thousands) 

Mechanism FY 

2015# 

FY 

2015 $ 

FY 2016 

Enacted# 

FY 2016 

Enacted $ 

FY 2017 

President’s 

Budget # 

FY 2017 

President’s 

Budget $ 

Grants: 

Formula 57 3,100 57 3,100 57 3,100 

New Discretionary -- -- 20 4,981 -- --

Continuations 20 4,981 -- -- 20 4,981 

Contracts 3 726 3 726 3 726 

Interagency Agreements 1 205 1 205 1 205 

Program Support /1 -- 310 -- 310 -- 310 

Total Resources 81 9,321 81 9,321 81 9,321 

1/ Program Support -- Includes funds for overhead, grant systems and review costs, and information 

technology support costs. 

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CONSUMER INFORMATION, ACCESS, AND OUTREACH 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

FY 2017 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: TBI Protection and Advocacy State Grants (CFDA 93.873) 

State FY 2015 Actual 

FY 2016 

Enacted 

FY 2017 

President's Budget 

FY 2017 +/-

FY 2016 

Alabama......................................... 50,000 50,000 50,000 -

Alaska............................................ 50,000 50,000 50,000 -

Arizona.......................................... 54,048 54,427 54,427 -

Arkansas........................................ 50,000 50,000 50,000 -

California....................................... 146,898 147,545 147,545 -

Colorado........................................ 50,000 50,433 50,433 -

Connecticut.................................... 50,000 50,000 50,000 -

Delaware........................................ 50,000 50,000 50,000 -

District of Columbia...................... 50,000 50,000 50,000 -

Florida........................................... 91,382 92,643 92,643 -

Georgia.......................................... 63,963 64,200 64,200 -

Hawaii........................................... 50,000 50,000 50,000 -

Idaho.............................................. 50,000 50,000 50,000 -

Illinois............................................ 73,419 72,281 72,281 -

Indiana........................................... 54,324 54,036 54,036 -

Iowa............................................... 50,000 50,000 50,000 -

Kansas........................................... 50,000 50,000 50,000 -

Kentucky....................................... 50,000 50,000 50,000 -

Louisiana....................................... 50,000 50,000 50,000 -

Maine............................................. 50,000 50,000 50,000 -

Maryland....................................... 52,187 52,235 52,235 -

Massachusetts.............................. 54,516 54,467 54,467 -

Michigan........................................ 64,552 63,655 63,655 -

Minnesota...................................... 50,774 50,727 50,727 -

Mississippi..................................... 50,000 50,000 50,000 -

Missouri......................................... 52,835 52,488 52,488 -

Montana......................................... 50,000 50,000 50,000 -

Nebraska........................................ 50,000 50,000 50,000 -

Nevada........................................... 50,000 50,000 50,000 -

New Hampshire............................. 50,000 50,000 50,000 -

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CONSUMER INFORMATION, ACCESS, AND OUTREACH 

PROGRAM/CFDA NUMBER: TBI Protection and Advocacy State Grants (CFDA 93.873) 

State/Territory FY 2015 Actual 

FY 2016 

Enacted 

FY 2017 

President's Budget 

FY 2017 +/-

FY 2016 

Alabama......................................... 50,000 50,000 50,000 -

Alaska............................................ 50,000 50,000 50,000 -

Arizona.......................................... 54,048 54,427 54,427 -

Arkansas........................................ 50,000 50,000 50,000 -

California....................................... 146,898 147,545 147,545 -

Colorado........................................ 50,000 50,433 50,433 -

Connecticut.................................... 50,000 50,000 50,000 -

Delaware........................................ 50,000 50,000 50,000 -

District of Columbia...................... 50,000 50,000 50,000 -

Florida........................................... 91,382 92,643 92,643 -

Georgia.......................................... 63,963 64,200 64,200 -

Hawaii........................................... 50,000 50,000 50,000 -

Idaho.............................................. 50,000 50,000 50,000 -

Illinois............................................ 73,419 72,281 72,281 -

Indiana........................................... 54,324 54,036 54,036 -

Iowa............................................... 50,000 50,000 50,000 -

Kansas........................................... 50,000 50,000 50,000 -

Kentucky....................................... 50,000 50,000 50,000 -

Louisiana....................................... 50,000 50,000 50,000 -

Maine............................................. 50,000 50,000 50,000 -

Maryland....................................... 52,187 52,235 52,235 -

Massachusetts.............................. 54,516 54,467 54,467 -

Michigan........................................ 64,552 63,655 63,655 -

Minnesota...................................... 50,774 50,727 50,727 -

Mississippi..................................... 50,000 50,000 50,000 -

Missouri......................................... 52,835 52,488 52,488 -

Montana......................................... 50,000 50,000 50,000 -

Nebraska........................................ 50,000 50,000 50,000 -

Nevada........................................... 50,000 50,000 50,000 -

New Hampshire............................. 50,000 50,000 50,000 -

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CONSUMER INFORMATION, ACCESS, AND OUTREACH 

Consumer Information, Access, and Outreach 

Summary of Request 

Older Americans and Americans with disabilities face a vast array of choices when trying to 

determine the right services and supports to assist them to remain active and independent in their 

communities. As the number of choices available to assist them grows, so too does the complexity 

of navigating these programs and selecting among them so as to determine which best suit the 

needs of each individual. 

A key part of ACL’s emphasis on community living is providing consumers with the information 

they need to make decisions about their independence and connecting them with the right services. 

Aging and Disability Resource Centers (ADRCs) and State Health Insurance Assistance Programs 

(SHIPs) help to address these needs by providing information, outreach, and assistance to seniors 

and people with disabilities, so that they can effectively access the services necessary for their 

independence. ADRCs serve as community-level “one stop shop” entry points into long-term 

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 objective and unbiased 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 people with disabilities and older Americans 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, and the Assistive Technology program helps support individuals with disabilities of 

all ages to obtain Assistive Technology devices and services. The Alzheimer’s Disease Initiative 

Outreach Campaign, funded from the Prevention and Public Health Fund, also helps those 

struggling with Alzheimer’s Disease to access services and plan for future needs. 

The FY 2017 request for these programs is $101,397,000, the same as the FY 2016 enacted level. 

Not included in this figure is $37,500,000 in mandatory funding for the Medicare Improvements 

for Patients and Providers Act. This request would provide: 

• $8,119,000 in discretionary funding for ADRCs, an increase of +$2 million over the FY 

2016 enacted level. ADRCs support state efforts to develop more efficient, cost-effective, 

and consumer-responsive systems of information and integrated access by creating “onestop shop” entry points into long-term care at the community-level. 

224 
 

 

 

 

 

CONSUMER INFORMATION, ACCESS, AND OUTREACH 

• $4,200,000 for the Alzheimer’s Disease Initiative Outreach Campaign, the same as the FY 

2016 enacted level. This outreach campaign informs those who are 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), the same as the 

FY 2016 enacted level. SHIPs provide free, one-on-one counseling and assistance to help 

Medicare beneficiaries who are aging or have a disability navigate the complexities of 

health and long-term care systems. The SHIPs, two-thirds of which are currently 

administered by State Units on Aging, fit naturally within ACL’s mission of promoting 

community living, and benefit from deeper connections to ACL’s aging and disability 

services networks. 

• $4,963,000 for HAVA, the same as the FY 2016 enacted level. HAVA grants assist 

Protection and Advocacy systems in each state and territory to ensure full participation in 

the electoral process for individuals with disabilities, including registering to vote, casting 

their votes, and accessing polling places. 

• $32,000,000 for Assistive Technology (AT), a reduction of -$2 million below the FY 

2016 enacted level, the result of ACL not requesting funding for the AT Alternative 

Financing Program. Assistive Technology grants financially supports state programs that 

maximize the ability of individuals with disabilities of all ages and their families to obtain 

AT devices and services, including computer or technology aids, modified driving controls, 

and durable medical equipment such as wheelchairs or walkers. 

225 
 

 

 

 

 

 

 

 

Aging and Disability Resource Centers 

Service FY 2015 

Final 

FY 2016 

Enacted 

FY 2017 

President's 

Budget 

FY 2017 +/-

FY 2016 

Aging and Disability 

Resource Centers $6,119,000 $6,119,000 $8,119,000 +2,000,000 

Authorizing Legislation: Sections 202b and 411 of the Older Americans Act of 1965, as amended. 

FY 2017 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” 115 (NWD) and “Single Points 

of Entry” programs, where people of all ages may turn for objective information and one-on-one 

assistance on their long-term services and support options. Since 2003, the Administration for 

Community Living, along with the Centers for Medicare & Medicaid Services (CMS) and in 2008 

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 thirteen ADRC/NWD-System states to build on, and promote the nationwide use of 

lessons learned and best practices from prior ADRC investments. 

ADRC/NWD systems help states make better use of taxpayer dollars by streamlining access to 

community services and supports (both publicly and privately funded) and diverting individuals 

from more costly forms of care, including institutional care and unnecessary hospital 

re-admissions. These systems are a key component in transforming states’ long-term services and 

115 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). 

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CONSUMER INFORMATION, ACCESS, AND OUTREACH 

support programs, work which is not only vital, but ongoing. Services for all populations and all 

payers provided by ADRC/NWD systems 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, that are available to them; 

• Streamlined access to publicly-supported long-term services and support programs for 

individuals who appear to be eligible for such programs; 

• Outreach and assistance to Medicare beneficiaries on their Medicare benefits including 

prevention and low-income subsidies; and, 

• Integrated options counseling and access points 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, CMS and the Veteran’s Health Administration have invested over $200 million in the 

Aging and Disability Resource Center/No Wrong Door System initiative since 2003. Recent 

accomplishments include: 

• In 2010 the Affordable Care Act provided $50 million dollars over five years to support the 

further development of the Aging & Disability Resource Center (ADRC) Program. The 

Affordable Care Act also funded the CMS Balancing Incentive Program to incentivize states to 

rebalance their Medicaid LTSS spending and required participating states to develop statewide 

No Wrong Door Systems to make it easier for consumers to learn about and access LTSS. CMS 

used the ADRC model to provide guidance to the twenty-five states that received Balancing 

Incentive Program grants and committed to building a NWD System. 

• In 2011, AARP in collaboration with The Commonwealth Fund, and The Scan Foundation 

published “Raising Expectations: A State Scorecard on Long-Term Services and Supports for 

Older Adults, People with Physical Disabilities, and Family Caregivers”, the first state scorecard 

on LTSS. The Scorecard measures state’s progress in developing high performing LTSS 

systems. ADRC’s were included as one of the key measures of access in the 2011 Report and 

the second edition published in 2014. 

227 
 

 

 

 

CONSUMER INFORMATION, ACCESS, AND OUTREACH 

• In 2012, 8 states received 3-year grants to transform their state LTSS access functions into a high 

performing No Wrong Door system that would serve all populations. These states also 

committed to working with Federal partners to develop national guidelines for state 

ADRC/NWD System that all states could use. The major learnings from this investment included 

the critical leadership role the state must play in the design, implementation and ongoing 

administration of a ADRC/NWD System. This includes having the full support of the Governor 

and key Cabinet-level officials and the active involvement of the multiple state agencies that 

have a role in LTSS including the State Medicaid Agency. The learnings from this investment in 

these 8 states resulted in development of the guidelines in “Key Elements of a NWD System of 

Access to LTSS for All Populations and Payers” which is available at 

http://www.acl.gov/Programs/CIP/OCASD/ADRC/docs/NWD-National-Elements.pdf 

• In 2014, using the lessons learned from the 2012 state grantees, 25 states received one year 

planning grants to develop plans to transform their multiple LTSS access programs and functions 

into a single statewide ADRC/NWD System for all populations and all payers. In 2015, 5 of the 

25 state planning grantees received 3-year awards to implement their planning grants and the 8 

states awarded 3-year grants in 2012 received a one-year grant to continue their work in 

developing their ADRC/NWD System. 

• In 2015, CMS issued the “No Wrong Door System Reference Document for Medicaid 

Administrative Claiming Guidance” to support state efforts to develop statewide ADRC/NWD 

Systems. This guidance can be found at: No Wrong Door System and Medicaid Administrative 

Claiming Reimbursement Guidance page. It is estimated that if all states took advantage of this 

guidance, it would generate over $100 million available annually to support state’s operations of 

their NWD/ADRC systems. 

• The Veterans Health Administration is using the ADRC\NWD System to deliver Veteran 

Directed Home and Community Based Services (VD-HCBS) to help Veterans with disabilities to 

continue living in the community and to have control over the LTSS they receive. To date, the 

Veterans Health Administration has invested $100 million into the VD-HCBS program which 

has served over 3,500 Veterans nationally. The VD-HCBS program is available in 31 states, the 

District of Columbia and Puerto Rico. 

228 
 

 

 

 

CONSUMER INFORMATION, ACCESS, AND OUTREACH 

Funding History: 

Comparable total funding for Aging and Disability Resource Centers is as follows: 

FY 2012 .................................................$16,457,000 

FY 2013 .................................................$15,585,000 

FY 2014 .................................................$15,347,000 

FY 2015 ...................................................$6,119,000 

FY 2016........................................$6,119,000 

Note: Mandatory appropriations of $10 million for FY 2010 through FY 2014 for ADRCs also were made under 

Section 2405 of P.L. 111-148, the Affordable Care Act of 2010. 

Budget Request: 

ACL’s FY 2017 request for ADRCs is $8,119,000 a +$2,000,000 increase over the FY 2016 

enacted level. 

ACL plans to invest $8,119,000 to fund state grantees to continue their development and operation 

of sustainable ADRC/NWD systems based on the national guidelines established by ACL, the 

Centers for Medicare and Medicaid Services (CMS) and the Veterans Health Administration 

(VHA). Funded states will replicate the national guidelines to develop person-centered, conflictfree access system for long-term services and supports for all populations and all payers. In 

addition to the grants to states, funding would be used to support a technical assistance contract. 

Activities funded by this proposal to develop sustainable ADRC/NWD systems represent a 

substantial state-wide reform of access to long-term services and supports. Building on past ADRC 

activities, the transformation brought about by this funding will include: 

• Funded states will show progress towards guidelines established by ACL, CMS, and VHA for 

ADRC/NWD Systems and be required to report on its progress and performance. 

• Funded states will commit to using Medicaid administrative funding to support the 

ADRC/NWD system infrastructure on an on-going basis; and 

• Funded states will ensure that local ADRC/NWD system sites: 

229 
 

 

 

 

CONSUMER INFORMATION, ACCESS, AND OUTREACH 

o Include a full range of organizations that play a formal reimbursable role in 

carrying out the ADRC/NWD system functions they have been designated by the 

state to perform to ensure the state’s ADRC/NWD system can effectively serve all 

LTSS populations; 

o Use nationally certified person-centered counselors to provide one-on-one 

assistance to consumers; and 

o Conduct formal functional and financial assessments that are required to 

determine an individual’s eligibility for the public LTSS programs that are 

administered by the state, including Medicaid. 

Finally, funded states’ ADRC/NWD systems, including local sites, will use the Federallyprescribed reporting data to continually evaluate performance and make improvements in 

ADRC/NWD systems at the state and local site level. Funded states will actively involve consumer 

stakeholders in this process. 

Grant Awards Tables: 

Aging and Disability Resource Centers

 (Dollars in Thousands) 

Award FY 2015 Final FY 2016 

Enacted 

FY 2017 

President’s 

Budget 

Number of 

Awards 20 14 14 

Average 

Award $261,500 $363,786 $453,571 

Range of 

Awards 

$6,617 -

$850,000 

$6,617 -

$850,000 

$6,627 -

$850,000 

230 
 

-- -- -- -- -- --

CONSUMER INFORMATION, ACCESS, AND OUTREACH 

Aging and Disability Resource Centers 

(Dollars in thousands) 

Mechanism 

FY 2015 

Final # 

FY 2015 

Final $ 

FY 2016 

Enacted # 

FY 2016 

Enacted $ 

FY 2017 

President’s 

Budget # 

FY 2017 

President’s 

Budget $ 

Grants: 

Formula -- - -- - -- -

New Discretionary 7 4,150 9 1,180 -- --

Continuations 13 1,080 5 3,913 14 6,350 

Contracts 1 864 1 950 1 1,669 

Interagency 

--

-

--

-

--

-

Agreements - - -

Program Support /1 -- 25 -- 76 -- 100 

Total Resources 6,119 -- -- 6,119 -- 8,119

 1/ Program Support -- Includes funds for overhead, grant systems and review costs, and information 

technology support costs. 

231 
 

 

State Health Insurance Assistance Programs 

Program FY 2015 

Final 

FY 2016 

Enacted 

FY 2017 

President's 

Budget 

FY 2017+/-

FY 2016 

State Health Insurance Assistance 

Programs (SHIP) $52,115,000 $52,115,000 $52,115,000 --

FTE 8 7 7 --

Authorizing Legislation: Section 4360 of the Omnibus Budget Reconciliation Act of 1990 

(42 U.S.C. 1395b-4). 

FY 2017 Authorization ......................................................................................................... Expired 

Allocation Method ....................................................... Formula and Competitive Grants/Contracts 

Program Description and Accomplishments: 

The State Health Insurance Assistance Program (SHIP) provides grants to States to fund 

infrastructure, training, and outreach support to over 14,000 (mostly volunteer) counselors in over 

1,300 community-based organizations in all 50 States, the District of Columbia, Guam, Puerto 

Rico, and the Virgin Islands. 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/Low-Income 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 understand and make optimal use of their 

Medicare benefits and 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 CY 2014, SHIPs had over 3.4 million one-on-one client 

contacts and more than 93,000 public and media events. SHIP activities align with the objective 

232 
 

CONSUMER INFORMATION, ACCESS, AND OUTREACH 

of developing a comprehensive, coordinated and cost-effective system of long-term services and 

supports that helps elderly individuals and people with disabilities maintain their health and 

independence in their homes and communities. 

Nearly two-thirds of the 54 state SHIP programs are already administered by State Units on Aging, 

with the remaining programs administered by State Insurance Commissions. At the community 

level, many SHIPs are either housed in or create local partnerships with Area Agencies on Aging. 

Similarly, almost 50 percent of the SHIPs are co-located with the Senior Medicare Patrol program, 

which is also administered by ACL. 

SHIP activities complement other ACL programs, 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, people 

eligible for both Medicaid and Medicare, and people with cognitive and/or mental disabilities. 

Funding History: 

Comparable funding for the State Health Insurance Assistance Program is as follows: 

FY 2012 ................................................. $52,115,000 

FY 2013 ................................................. $46,040,000 

FY 2014 ................................................. $52,115,000 

FY 2015 ................................................. $52,115,000 

FY 2016 ... ............................................ $52,115,000 

Budget Request: 

The SHIP budget request for FY 2017 is $52,115,000, the same as the FY 2016 enacted level. This 

includes funding for 7 FTEs 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 

program administration. Funds will also be used to provide administrative support for the SHIPs 

program, including technical assistance to grantees and management of data systems. 

233 
 

 

 

 

 

 

 

 

 

CONSUMER INFORMATION, ACCESS, AND OUTREACH 

The needs of the over 55 million Americans who depend on Medicare for their health care are 

multifaceted and diverse. More than one-quarter of beneficiaries have cognitive impairments;

116 

more than one-third have limitations in activities of daily living such as eating and 

dressing; one-fifth have not graduated from high school; and more than one in ten are over 85 years 

of age.

117 These beneficiaries can face any number of difficulties in trying to navigate the health 

care system. Recent changes in the system as a result of the Affordable Care Act (ACA) provide 

opportunities to beneficiaries for improved care, including increased Medicare preventive services 

and reduced out-of-pocket costs during the Medicare Part D coverage gap or “donut hole.” These 

opportunities have increased the responsibilities of the SHIP counselors in terms of training, 

outreach and one-on-one counseling. The counselor knowledge base also now needs to include the 

inter-relationship of Medicare, expanded state Medicaid programs, and the new Health Insurance 

Marketplace 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 complement to the information provided more generally through 

www.Medicare.gov and 1-800-MEDICARE. 

ACL will also seek legislation to fix a problem related to funding for the SHIP program that is 

provided for Medicare Improvements for Patients and Providers Act (MIPPA) activities. Currently 

this mandatory funding, which ACL awards as SHIP grantees, is appropriated to the Centers for 

Medicare and Medicaid and then transferred to ACL, a vestige of the period when the SHIP 

program was overseen by CMS. The proposed fix, in recognition that SHIP is now part of ACL 

as of 2014, would amend the authorization so that this funding is authorized directly to ACL. 

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

from the 2013 Medicare Current Beneficiary Survey. http://www.cms.gov/Research-Statistics-Data-andSystems/Research/MCBS/Data-Tables-Items/2013CNP.html. Accessed 10 January 2016 

117 Juliette Cubanski, Christina Swoope, Cristina Boccuti, Gretchen Jacobson, Giselle Casillas, Shannon Griffin, and 

Tricia Neuman. A Primer on Medicare: Key Facts About the Medicare Program and the People it Covers. Kaiser 

Family Foundation. Mar 20, 2015. http://kff.org/report-section/a-primer-on-medicare-what-is-the-role-of-medicarefor-dual-eligible-beneficiaries/+ 

234 
 

CONSUMER INFORMATION, ACCESS, AND OUTREACH 

Outputs Table: 

State Health Insurance Assistance Programs 

Indicator Year and Most Recent 

Result / 

FY 2016 

Projection 

FY 2017 

Projection 

FY 2017 

Projection 

+/-FY 2016 

Projection 

Output AH: Number of 

SHIP Public Media 

Events (Output) 

FY 2015: 97,500 97,500 97,000 Maintain 

Output AI: Number of 

SHIP Client Contacts 

(Output) 

FY 2015: 3.5 M 3.6 M 3.6 M Maintain 

Grant Awards Table: 

State Health Insurance Assistance Programs Grant Awards 

Awards FY 2015 Final FY 2016 

Enacted 

FY 2017 

President’s 

Budget 

Number of 

Awards 59 55 55 

Average 

Award $835,781 $890,494 $890,494 

Range of 

Awards 

$40,870 -

$5,028,121 

$40,870 -

$5,028,121 

$40,870 -

$5,028,121 

235 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-- -- -- -- -- --

CONSUMER INFORMATION, ACCESS, AND OUTREACH 

Resource and Program Data: 

State Health Insurance Assistance Program 

(Dollars in thousands) 

Mechanism 

FY 2015 

Final # 

FY 2015 

Final $ 

FY 2016 

Enacted# 

FY 2016 

Enacted $ 

FY 2017 

President’s 

Budget # 

FY 2017 

President’s 

Budget $ 

Grants: 

Formula -- -- -- --

New Discretionary 

-- --

4 390 -- -- 55 48,977 

Continuations 55 48,921 55 48,977 -- --

Contracts 4 1,072 3 1,192 3 1,192 

Interagency 

Agreements 1 124 1 147 1 147 

Program Support /1 -- 1,608 -- 1,799 -- 1,799 

Total Resources -- 52,115 -- 52,115 -- 52,115 

1/ Program Support -- Includes funds for salaries, benefits, contract fees, grant systems, and review costs. 

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-- -- -- -- --

Voting Access for Individuals with Disabilities 

Service 

Voting Access for People with 

Disabilities 

FY 2015 

Final 

$4,963,000 

FY 2016 

Enacted 

$4,963,999 

FY 2017 

President's 

Budget 

$4,963,000 

FY 2017+/-

FY 2016 

--

FTE -- -- .3 +0.3 

Authorizing Legislation: Section 291 of the Help America Vote Act 

FY 2017 Authorization .................................................................................................... Such Sums 

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

Program Description and Accomplishments: 

The Voting Access for Individuals with Disabilities program authorized by the Help America Vote 

Act (HAVA) provides formula grants to support Protection and Advocacy (P&A) systems in each 

state and territory to ensure full participation in the electoral process for individuals with 

disabilities, 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 two-year awards. 

HAVA P&A grantees use these funds to promote systematic efforts to ensure that individuals with 

disabilities have the opportunity to participate in every step of the electoral process. For example, 

grantees support systems change efforts to improve information on the location of accessible 

polling places, and 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. 

238 
 

 

 

CONSUMER INFORMATION, ACCESS, AND OUTREACH 

Through the program, ACL also makes discretionary grants to eligible nonprofit organizations to 

assist P&As in developing proficiency in the use of voting systems, identifying and implementing 

technologies to assist individuals with disabilities in voting, and demonstrating and evaluating the 

use of such systems and technologies. P&As also receive training and technical assistance for 

providing non-visual access in the voting process. These grants are authorized under section 291 

of HAVA as a seven percent set-aside of the total appropriation for P&As. As a result of the 

training and technical assistance, P&As 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 2012 ...................................................$5,235,000 

FY 2013 ...................................................$4,961,000 

FY 2014 ...................................................$4,963,000 

FY 2015 ...................................................$4,963,000 

FY 2016 ..................................................$4,963,000 

Budget Request: 

The FY 2017 request for Voting Access for Individuals with Disabilities is $4,963,000, unchanged 

from the FY 2016 enacted level. Beginning in FY 2017, An example of the activities undertaken 

with HAVA funding, in Charleston, SC the P&A sponsored a site used by an Election Protection 

(EP) volunteer attorney to staff a hotline and train law student volunteers to canvass polling places 

in Charleston for accessibility issues. Accessibility in voting continues to be an ongoing challenge 

throughout the country. A 2013 report by the National Council on Disability identified a 2012 

incident in Arizona where a voter who used a wheelchair could not get through the front door of 

her polling place to deliver an early ballot. The same report details a complaint from Bladensburg, 

MD where voters with disabilities were told that they had to “prove their disability” in order to be 

seated in line. Additionally, the Maryland P&A had to notify a Montgomery County judge to 

unlock the assigned accessible door to a polling place so that voters with disabilities could enter 

the building. 

Being able to participate fully in the election process is a right, not a privilege, and funding for this 

activity helps to ensure that individuals with the full range of disabilities are not denied the right 

to the same opportunity for access and participation in the electoral process as voters with no 

disabilities. 

239 
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

Grant Awards Table: 

Voting Access for Individuals with Disabilities Grant Awards 

Award FY 2015 Final FY 2016 

Enacted 

FY 2017 

President’s 

Budget 

Number 

of 

Awards 

55 55 55 

Average 

Award $82,421 $82,421 $81,535 

Range 

of 

Awards 

$35,000 -

$348,584 

$35,000 -

$347,489 

$35,000 -

$339,428 

240 
 

 

CONSUMER INFORMATION, ACCESS, AND OUTREACH 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

ADMINISTRATION ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 

FY 2017 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: Voting Access for Individuals with Disabilities (CFDA 93.618) 

State/Territory FY 2015 Actual 

FY 2016 

Enacted 

FY 2017 

President's Budget 

FY 2017 +/-

FY 2016 

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....................................... 348,584 347,489 339,428 (8,061) 

Colorado........................................ 70,000 70,000 70,000 -

Connecticut.................................... 70,000 70,000 70,000 -

Delaware........................................ 70,000 70,000 70,000 -

District of Columbia...................... 70,000 70,000 70,000 -

Florida........................................... 177,808 178,151 174,018 (4,133) 

Georgia.......................................... 90,866 90,425 88,327 (2,098) 

Hawaii........................................... 70,000 70,000 70,000 -

Idaho.............................................. 70,000 70,000 70,000 -

Illinois............................................ 117,146 115,350 112,674 (2,676) 

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........................................ 89,988 88,746 86,687 (2,059) 

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 -

241 
 

 

 

CONSUMER INFORMATION, ACCESS, AND OUTREACH 

PROGRAM/CFDA NUMBER: Voting Access for Individuals with Disabilities (CFDA 93.618) 

State/Territory FY 2015 Actual 

FY 2016 

Enacted 

FY 2017 

President's Budget 

FY 2017 +/-

FY 2016 

New Jersey.......................... 80,928 80,044 78,187 (1,857) 

New Mexico....................... 70,000 70,000 70,000 -

New York........................... 178,702 176,834 172,732 (4,102) 

North Carolina.................... 89,555 89,052 86,986 (2,066) 

North Dakota...................... 70,000 70,000 70,000 -

Ohio.................................... 105,222 103,830 101,421 (2,409) 

Oklahoma............................ 70,000 70,000 70,000 -

Oregon................................ 70,000 70,000 70,000 -

Pennsylvania....................... 116,161 114,514 111,857 (2,657) 

Rhode Island....................... 70,000 70,000 70,000 -

South Carolina.................... 70,000 70,000 70,000 -

South Dakota...................... 70,000 70,000 70,000 -

Tennessee............................ 70,000 70,000 70,000 -

Texas................................... 240,512 241,409 235,808 (5,601) 

Utah.................................... 70,000 70,000 70,000 -

Vermont.............................. 70,000 70,000 70,000 -

Virginia............................... 75,118 74,565 72,835 (1,730) 

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 -

Subtotal, States................... 4,440,590 4,430,409 4,390,960 (39,449) 

American Samoa................. 35,000 35,000 35,000 -

Guam.................................. 35,000 35,000 35,000 -

Northern Mariana Islands... - - - -

Puerto Rico......................... 70,000 70,000 70,000 -

Virgin Islands..................... - 35,000 35,000 -

Subtotal, States and Territories 4,615,590 4,605,409 4,565,960 (39,449) 

Undistributed 1/................... 347,410 357,591 397,040 39,449 

TOTAL...................................... 4,963,000 4,963,000 4,963,000 -

1/ This line reflects the amount reserved from the HAVA appropriation for statutory related activities, including 

training, technical assistance, grant systems, and review costs. Beginning in FY 2017, the undistributed line also 

includes an amount reserved from the HAVA appropriation for FTE and related overhead costs to conduct 

program monitoring and oversight. Funds unused for these purposes at the end of the year are allocated to States. 

242 
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Assistive Technology 

FY 2017 2017 +/-

Program FY 2015 FY 2016 President’s FY 2016 

Final Enacted Budget 

Assistive 

Technology............ $31,000,000 $32,000,000 $32,000,000 --

Alternative Financing 

Program.................................... 

. $2,000,000 $2,000,000 -- -$2,000,000 

Total............................... 

. $33,000,000 $34,000,000 $32,000,000 --

FTE .............................. -- -- .9 +0.9 

Authorizing Legislation: Assistive Technology Act of 1998 as amended 

FY 2017 Authorization .................................................................................................... Expired118 

Allocation Method ....................................................... Competitive and Formula Grants/Contracts 

Program Description and Accomplishments: 

The purpose of the Assistive Technology (AT) Act is to provide states with financial assistance 

that supports programs designed to maximize the ability of individuals with disabilities of all ages 

and their family members, guardians, advocates, and authorized representatives to obtain AT 

devices and AT services. AT devices are defined as any item, piece of equipment, or product 

system, whether acquired commercially, modified, or customized, that is used to increase, 

maintain, or improve functional capabilities of individuals with disabilities. Examples of such 

devices include computer or technology aids, modified driving controls, and durable medical 

equipment such as wheelchairs or walkers. Grants support comprehensive statewide programs that 

are designed to increase the: 

• Availability, funding, access, provision, and training for AT devices and services; 

• Ability of individuals with disabilities of all ages to secure and maintain possession of AT 

during periods of transition, such as transition between school or home and home and work; 

118 The GEPA extension expired September 30, 2011. The Administration proposes to continue funding this 

program in FY 2016 through appropriations language. Up to $1,235,000 may be used for National Activities, unless 

the amount available for AT State grants exceeds $20,953,534, in which case up to $1,900,000 may be used for 

National Activities. 

244 
 

Assistive Technology (AT) State Grant program 

 

 

 

 

CONSUMER INFORMATION, ACCESS, AND OUTREACH 

• Capacity of public and private entities to provide and pay for AT devices and services; 

• Involvement of individuals with disabilities in decisions about AT devices and services; 

• Coordination of AT-related activities among state and local agencies and other private 

entities; 

• Awareness and facilitation of changes in law, regulations, procedures, policies, practices, 

and organizational structures, in order to improve access to AT; and 

• Awareness of the benefits of AT among targeted individuals and entities in the general 

population. 

The AT State Grant program is a population-based formula grant program to support 

comprehensive statewide programs that maximize the ability of individuals with disabilities of all 

ages to access and acquire AT. States must establish consumer-responsive advisory councils with 

a majority membership of individuals with disabilities who use AT to advise on the planning, 

implementation, and evaluation of these statewide programs. 

Under the formula, states and territories are initially allocated a base amount equal to the amount 

of funds they received under the AT program in fiscal year 2004 (totaling $20,288,534). Any funds 

appropriated in excess of the fiscal year 2004 appropriation are initially distributed among the 

eligible entities with 50 percent of available funds distributed equally amongst them and 50 percent 

distributed according to the population of the state until each entity receives at least $410,000. If 

any appropriated funds remain after each State receives this minimum, they are further distributed 

with 20 percent divided equally amongst the states and 80 percent distributed according to their 

populations. To date, appropriated funds under this program have not been at a level to necessitate 

this second round of distribution. The FY 2015 state distributions are based on the July 1, 2013 

estimates published in December 2013. The FY 2016 state distributions will be based on the July 

1, 2014 estimates published in December 2014. The FY 2017 state distributions will be based on 

the July 1, 2015 estimates published in December 2015. 

Each state must set measurable goals, with timelines, that address the AT needs of individuals with 

disabilities related to: education (including goals related to the delivery of AT devices and services 

to students receiving services under the Individuals with Disabilities Education Act (IDEA)); 

employment (including goals related to the Rehabilitation Act’s Vocational Rehabilitation State 

Grant program); telecommunications and information technology; and community living. The 

state must determine whether it has met its goals each year. States are held accountable for a lack 

245 
 

 

 

CONSUMER INFORMATION, ACCESS, AND OUTREACH 

of progress toward these goals through technical assistance, as well as corrective actions and/or 

sanctions if states are determined to be in noncompliance with the applicable requirements of the 

AT Act or have not made substantial progress toward achieving the measurable goals. 

The state must implement each of the activities required under the program, which include 

state-level activities and state leadership activities. States must spend a minimum of 60 percent 

(unless the state elects to comply with the state flexibility provision in section 4(e)(6) of the AT 

Act, as described below) of their formula grant funds on four state-level activities: state financing 

programs, device reutilization programs, device loan programs, and device demonstrations. States 

may, however, direct their funds towards these activities in varying amounts if they use other state 

or non-federal funds to support these activities at a comparable or greater level. 

States may use up to 40 percent of their AT State Grant program funding on state leadership 

activities, with at least 5 percent of that amount devoted to technical assistance and training related 

to transition for students exiting school or adults entering community living. The state leadership 

activities include the provision of technical assistance and training to targeted individuals and 

entities focused on promoting the general awareness of the benefits of AT; skills development for 

persons involved in the assessment of the need for AT; the appropriate application of AT; and the 

integration of AT devices and services in plans required to be developed under other federal laws, 

such as the IDEA’s Individualized Education Program and the Rehabilitation Act’s Individualized 

Plan for Employment. In addition, states must use a portion of their grant funds on public 

awareness activities, including the continuation and maintenance of a statewide system of 

information and referral, and coordination and collaboration activities amongst entities in the states 

that are responsible for the provision of AT. 

The law provides states with flexibility to decide to carry out only two or three state-level activities, 

rather than all four. If a state elects to carry out two or three state-level activities, it must spend a 

minimum of 70 percent of its funds on those activities, while spending not more than 30 percent 

on the state leadership activities. 

The AT Act specifies what a state must include in its annual progress report, including data on: the 

state’s financing program, device loan program activities, device reutilization programs, and 

device demonstrations, including an analysis of those individuals who benefited from each of these 

programs; training activities; the statewide system of information and referral; and the outcomes 

of any improvement initiatives carried out by the state. The report must also provide data on the 

use of resources, including any contributed to the program by other public and private entities, and 

the level of customer satisfaction. 

246 
Protection and Advocacy for Assistive Technology 

 

Formula grants to protection and advocacy (P&A) systems established under the Developmental 

Disabilities Assistance and Bill of Rights Act support protection and advocacy services to assist 

individuals with disabilities of all ages in the acquisition, utilization, or maintenance of AT 

services or devices. Funds are distributed on a state population basis, with a minimum annual grant 

of $50,000. Territories must receive not less than $30,000 annually. Also, the Act requires a 

minimum award of $30,000 to the P&A system serving the American Indian consortium. The FY 

2015 state distributions are based on the July 1, 2013 estimates published in December 30, 2013. 

The FY 2016 state distributions will be based on the July 1, 2014 estimates published in December 

2014. The FY 2017 state distributions will be based on the July 1, 2015 estimates published in 

December 2015. 

National Activities 

 

CONSUMER INFORMATION, ACCESS, AND OUTREACH 

The AT Act provides authority for the provision of technical assistance—through grants, contracts, 

or cooperative agreements awarded on a competitive basis—to individuals with disabilities of all 

ages, to AT state grant program grantees, and to protection and advocacy systems. The AT Act 

also requires the Secretary to make an award to renovate, update, and maintain a national public 

Internet site (http://www.assistivetech.net). In addition, the AT Act includes authority for grants, 

contracts, or cooperative agreements to assist grantees in developing and implementing effective 

data collection and reporting systems. 

In designing technical assistance activities, input is considered from directors of AT State Grant 

programs and Alternative Financing Programs, individuals with disabilities who use AT, family 

members, and protection and advocacy service providers, among others. The technical assistance 

must respond to specific requests for information and disseminate information to states, entities 

funded under the AT Act, and any other public entities that seek information about AT. The 

technical assistance must provide model approaches for the removal of barriers to accessing AT, 

examples of effective program coordination, and practices that increase funding for AT devices. 

Funding History: 

Funding for the Assistive Technology Act Programs during the past five years is as follows: 

FY2012 .......................................................$30,839,603 

FY2013 .......................................................$29,226,000 

FY2014 .......................................................$31,000,000 

FY2015 .......................................................$31,000,000 

FY2016 .......................................................$32,000,000 

247 
 

 

CONSUMER INFORMATION, ACCESS, AND OUTREACH 

Funding for the Alternative Financing Program during the past five years is as follows: 

FY2012 .......................................................$1,996,220 

FY2013 .......................................................$1,892,000 

FY2014 .......................................................$2,000,000 

FY2015 .......................................................$2,000,000 

FY2016 .......................................................$2,000,000 

Budget Request: 

ACL’s FY 2017 request for Assistive Technology Act programs is $32,000,000, the same as the 

FY 2016 enacted level. At this level, 10 States would be funded at a level below the $410,000 

minimum. No funding is requested for the Alternative Financing Program, a reduction of -

$2,000,000 below the FY 2016 enacted level. 

The request includes $26,554,000 for the AT State Grant program, the same as the FY 2016 

enacted level. These funds will be used to carry out the third year of their 3-year state plan. State 

plans must describe how the state intends to carry out its AT State Grant program to meet the AT 

needs of individuals with disabilities in the state, achieve the measurable goals required by the AT 

Act, and comply with all applicable statutory and regulatory requirements. 

The request also includes $4,450,000 for the Protection and Advocacy for Assistive Technology 

(PAAT) program, the same as the FY 2016 enacted level. At this level, 28 states would receive 

$50,000, the minimum amount allowed by statute to carry out this program. Territories would each 

receive $30,000. Funds would assist individuals with disabilities of all ages in the acquisition, 

utilization, or maintenance of AT services or devices. 

The request would also provide $996,000 for National Activities, the same as the FY 2016 enacted 

level. The Act requires support for state training, technical assistance, data collection, and 

reporting assistance, and authorizes a one-time grant to provide national public awareness about 

AT, and support for AT research and development activities, which are all supported by 

competitively awarded grants. In FY 2017, funds would be used to provide state training and 

technical assistance, build out the AT Act informational website, and continue support for the AT 

Act data collection activities. 

Alternative Financing Program 

No funding is requested for the Assistive Technology (AT) Alternative Financing Program (AFP), 

a one-year competitive-grant program no longer authorized under current law, which was funded 

at $2 million through appropriations in FY 2016. In FY 2005, Congress amended the AT Act to 

248 
 

 

CONSUMER INFORMATION, ACCESS, AND OUTREACH 

eliminate the separate AFP authorization and instead authorized an AT State grant program that is 

inclusive of financing activities, including alternative financing loan programs. Since there is no 

separate AFP discretionary grant program authorization in the AT Act, ACL is not requesting such 

funding within the AT Act appropriations request for FY2017. 

Outcomes and Outputs Table: 

ACL will work with all relevant parties to review, develop, or refine performance measures and 

performance data collection for all WIOA programs during the transition. 

Grant Awards Tables: 

Assistive Technology Total Grant Awards 

Award FY 2015 Final FY 2016 

Enacted 

FY 2017 

President’s 

Budget 

Number of 

Awards 119 116 113 

Average 

Award $277,261 $284,220 $274,137 

Range of 

Awards 

$100,000 -

$1,032,987 

$100,000 -

$1,091,612 

$100,000-

$1,074,635 

249 
 

-- -- -- -- -- -- 

CONSUMER INFORMATION, ACCESS, AND OUTREACH 

Mechanism 

FY 2015 

Final # 

FY 2015 

Final $ 

FY 2016 

Enacted # 

FY 2016 

Enacted $ 

FY 2017 

President’s 

Budget # 

FY 2017 

President’s Budget $ 

Grants: 

Formula 113 30,004 113 30,978 113 30,978 

New Discretionary 3 2,000 3 1,992 -- --

Continuations 3 990 -- -- -- --

Contracts -- -- 2 962 2 962 

Interagency 

Agreements -- -- -- -- -- --

Program Support /1 -- 6 -- 68 -- 60 

Total Resources -- 33,000 -- 34,000 -- 32,000 

250 
 

 

CONSUMER INFORMATION, ACCESS, AND OUTREACH 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

FY 2017 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: Assistive Technology State Grants (CFDA 84.224A) 

State/Territory FY 2015 Actual 

FY 2016 

Enacted 

FY 2017 

President's Budget 

FY 2017 +/-

FY 2016 

Alabama......................................... 435,779 449,771 445,536 (4,235) 

Alaska............................................ 422,568 431,469 428,809 (2,660) 

Arizona.......................................... 597,228 614,250 609,294 (4,956) 

Arkansas........................................ 462,071 473,712 470,199 (3,513) 

California....................................... 1,032,987 1,091,874 1,074,635 (17,239) 

Colorado........................................ 456,167 471,379 466,951 (4,428) 

Connecticut.................................... 395,956 408,305 404,550 (3,755) 

Delaware........................................ 406,287 415,498 412,763 (2,735) 

District of Columbia...................... 364,080 372,978 370,349 (2,629) 

Florida........................................... 666,456 701,384 691,386 (9,998) 

Georgia.......................................... 579,562 600,656 594,411 (6,245) 

Hawaii........................................... 439,901 449,746 446,825 (2,921) 

Idaho.............................................. 413,426 423,587 420,584 (3,003) 

Illinois............................................ 586,957 610,511 603,200 (7,311) 

Indiana........................................... 461,618 477,809 472,905 (4,904) 

Iowa............................................... 435,895 447,790 444,222 (3,568) 

Kansas........................................... 397,029 408,621 405,132 (3,489) 

Kentucky....................................... 458,031 471,516 467,449 (4,067) 

Louisiana....................................... 485,442 499,264 495,106 (4,158) 

Maine............................................. 452,886 462,506 459,619 (2,887) 

Maryland....................................... 482,588 498,213 493,546 (4,667) 

Massachusetts.............................. 502,007 518,603 513,643 (4,960) 

Michigan........................................ 640,597 660,694 654,521 (6,173) 

Minnesota...................................... 475,969 490,874 486,406 (4,468) 

Mississippi..................................... 381,564 393,205 389,681 (3,524) 

Missouri......................................... 540,829 556,320 551,621 (4,699) 

Montana......................................... 435,334 444,639 441,870 (2,769) 

Nebraska........................................ 445,890 456,271 453,173 (3,098) 

Nevada........................................... 405,603 417,447 413,982 (3,465) 

New Hampshire............................. 420,649 430,278 427,393 (2,885) 

251 
 

 

 

 

CONSUMER INFORMATION, ACCESS, AND OUTREACH 

PROGRAM/CFDA NUMBER: Assistive Technology State Grants (CFDA 84.224A) 

State/Territory FY 2015 Actual 

FY 2016 

Enacted 

FY 2017 

President's Budget 

FY 2017 +/-

FY 2016 

New Jersey.......................... 470,373 489,504 483,703 (5,801) 

New Mexico....................... 434,326 444,847 441,671 (3,176) 

New York........................... 675,651 708,323 698,383 (9,940) 

North Carolina.................... 532,464 553,294 547,108 (6,186) 

North Dakota...................... 362,497 371,524 368,864 (2,660) 

Ohio.................................... 545,650 567,860 561,042 (6,818) 

Oklahoma............................ 420,047 432,964 429,102 (3,862) 

Oregon................................ 412,921 426,057 422,159 (3,898) 

Pennsylvania....................... 672,782 696,350 689,075 (7,275) 

Rhode Island....................... 360,958 370,261 367,480 (2,781) 

South Carolina.................... 505,737 520,063 515,835 (4,228) 

South Dakota...................... 411,024 420,122 417,419 (2,703) 

Tennessee............................ 432,336 448,702 443,816 (4,886) 

Texas................................... 847,552 892,445 879,742 (12,703) 

Utah.................................... 445,375 457,285 453,781 (3,504) 

Vermont.............................. 398,832 407,585 404,968 (2,617) 

Virginia............................... 484,306 502,926 497,360 (5,566) 

Washington......................... 468,676 485,973 480,891 (5,082) 

West Virginia...................... 413,556 423,756 420,670 (3,086) 

Wisconsin........................... 456,042 471,125 466,542 (4,583) 

Wyoming............................ 355,005 363,720 361,119 

(2,601) 

Subtotal, States................... 24,787,466 25,603,856 25,360,491 (243,365) 

American Samoa................. 125,000 125,528 125,507 (21) 

Guam.................................. 125,000 126,558 126,496 (62) 

Northern Mariana Islands... 125,000 125,498 125,478 (20) 

Puerto Rico......................... 416,534 428,256 424,520 (3,736) 

Virgin Islands..................... 125,000 126,008 125,968 

(40) 

Subtotal, States and Territories 25,704,000 26,535,704 26,288,460 (247,244) 

Undistributed 1/................... - 18,296 265,540 247,244 

TOTAL...................................... 25,704,000 26,554,000 26,554,000 -

1/ The undistributed line reflects the amount reserved from the Assistive Technology State Grants appropriation 

for: statutory related activities, including contingencies; FTE and related overhead costs to conduct program 

monitoring and oversight; and for program support costs including information and systems, technical assistance 

and evaluation. Funds unused for these purposes at the end of the year are allocated to States. 

252 
 

 

CONSUMER INFORMATION, ACCESS, AND OUTREACH 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

FY 2017 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: Assistive Technology Protection and Advocacy (CFDA 84.343) 

State/Territory FY 2015 Actual 

FY 2016 

Enacted 

FY 2017 

President's Budget 

FY 2017 +/-

FY 2016 

Alabama......................................... 51,229 53,530 52,869 (661) 

Alaska............................................ 50,000 50,000 50,000 -

Arizona.......................................... 70,230 74,306 73,389 (917) 

Arkansas........................................ 50,000 50,000 50,000 -

California....................................... 406,256 428,326 423,037 (5,289) 

Colorado........................................ 55,835 59,121 58,391 (730) 

Connecticut.................................... 50,000 50,000 50,000 -

Delaware........................................ 50,000 50,000 50,000 -

District of Columbia...................... 50,000 50,000 50,000 -

Florida........................................... 207,225 219,594 216,883 (2,711) 

Georgia.......................................... 105,899 111,460 110,084 (1,376) 

Hawaii........................................... 50,000 50,000 50,000 -

Idaho.............................................. 50,000 50,000 50,000 -

Illinois............................................ 136,528 142,183 140,428 (1,755) 

Indiana........................................... 69,640 72,820 71,921 (899) 

Iowa............................................... 50,000 50,000 50,000 -

Kansas........................................... 50,000 50,000 50,000 -

Kentucky....................................... 50,000 50,000 50,000 -

Louisiana....................................... 50,000 51,326 50,692 (634) 

Maine............................................. 50,000 50,000 50,000 -

Maryland....................................... 62,835 65,971 65,157 (814) 

Massachusetts.............................. 70,932 74,460 73,540 (920) 

Michigan........................................ 104,876 109,391 108,040 (1,351) 

Minnesota...................................... 57,446 60,239 59,496 (743) 

Mississippi..................................... 50,000 50,000 50,000 -

Missouri......................................... 64,057 66,933 66,107 (826) 

Montana......................................... 50,000 50,000 50,000 -

Nebraska........................................ 50,000 50,000 50,000 -

Nevada........................................... 50,000 50,000 50,000 -

New Hampshire............................. 50,000 50,000 50,000 -

253 
 

 

 

 

 

CONSUMER INFORMATION, ACCESS, AND OUTREACH 

PROGRAM/CFDA NUMBER: Assistive Technology Protection and Advocacy (CFDA 84.343) 

State/Territory FY 2015 Actual 

FY 2016 

Enacted 

FY 2017 

President's Budget 

FY 2017 +/-

FY 2016 

New Jersey.......................... 94,317 98,665 97,447 (1,218) 

New Mexico....................... 50,000 50,000 50,000 -

New York........................... 208,267 217,970 215,279 (2,691) 

North Carolina.................... 104,372 109,767 108,412 (1,355) 

North Dakota...................... 50,000 50,000 50,000 -

Ohio.................................... 122,630 127,983 126,403 (1,580) 

Oklahoma............................ 50,000 50,000 50,000 -

Oregon................................ 50,000 50,000 50,000 -

Pennsylvania....................... 135,379 141,153 139,410 (1,743) 

Rhode Island....................... 50,000 50,000 50,000 -

South Carolina.................... 50,605 53,344 52,685 (659) 

South Dakota...................... 50,000 50,000 50,000 -

Tennessee............................ 68,846 72,296 71,403 (893) 

Texas................................... 280,304 297,567 293,893 (3,674) 

Utah.................................... 50,000 50,000 50,000 -

Vermont.............................. 50,000 50,000 50,000 -

Virginia............................... 87,546 91,910 90,776 (1,134) 

Washington......................... 73,884 77,949 76,987 (962) 

West Virginia...................... 50,000 50,000 50,000 -

Wisconsin........................... 60,862 63,555 62,771 (784) 

Wyoming............................ -50,000 50,000 

-

Subtotal, States................... 4,100,000 4,241,819 4,205,500 (36,319) 

American Samoa................. 30,000 30,000 30,000 -

Guam.................................. 30,000 30,000 30,000 -

Northern Mariana Islands... 30,000 30,000 30,000 -

Puerto Rico......................... 50,000 50,000 50,000 -

Virgin Islands..................... -

30,000 30,000 

-

Subtotal, States and Territories 4,270,000 4,411,819 4,375,500 (36,319) 

Native American Organizations 1/ 30,000 30,000 30,000 -

Undistributed 2/................... - $8,181 445,000 436,819 

TOTAL...................................... 4,300,000 4,450,000 4,850,500 400,500 

1/ The Tribal Organizations line reflects the funds provided to Native Americans in New Mexico. 

2/ The undistributed line reflects the amount reserved from the Assistive Technology Protection and Advocacy 

appropriation for: statutory related activities, including contingencies; FTE and related overhead costs to conduct 

program monitoring and oversight; and for program support costs including information and systems, technical 

assistance and evaluation. Funds unused for these purposes at the end of the year are allocated to States. 

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Alzheimer’s Disease Initiative - Outreach Campaign 

Program FY 2015 

Final 

FY 2016 

Enacted 

FY 2017 

President's 

Budget 

FY 2017 +/-

FY 2016 

Alzheimer’s Disease 

Initiative—Outreach 

(Prevention Fund) 

$4,200,000 $4,200,000 $4,200,000 --

Note: Funding in FY 2015 and FY 2016 was provided from the Prevention and Public Health Fund, and FY 2016 

and FY 2017 funding is requested from the same 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] 

FY 2017 Authorization ......................................................................................................... Expired 

Allocation Method ............................................................................................................. Contracts 

Program Description and Accomplishments: 

On January 4, 2011, the President announced a new effort to fight Alzheimer’s disease, and in FY 

2012, ACL received $4,000,000 in initial funding from the Prevention and Public Health Fund to 

begin a public awareness Alzheimer’s Disease Outreach Campaign. An estimated 5.2 million 

individuals in the United States are living with Alzheimer’s disease and related dementias 

(ADRD), and that number is expected to increase by 40 percent by 2025. 119 With the prevalence 

of this disease growing, public awareness is a critical component of a larger effort to effectively 

educate Americans who are at risk or who care for someone at risk of developing this disease. 

During the first year of the Campaign, a new website (alzheimers.gov) was launched and a variety 

of outreach materials were developed. Going forward, ACL 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, including awards from a health care and an 

advertising organization, this approach may reach a new and broader audience. 

119 Alzheimer’s Association. 2014 Alzheimer’s Disease Facts and Figures. Accessed April 14, 2014 at 

http://www.alz.org/alzheimers_disease_facts_and_figures.asp . 

256 
 

 

CONSUMER INFORMATION, ACCESS, AND OUTREACH 

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. 

Funding History: 

FY 2012 ...................................................$4,000,000 

FY 2013 ......................................................$150,000 

FY 2014 ...................................................$4,200,000 

FY 2015 ...................................................$4,200,000 

FY 2016... ...............................................$4,200,000 

Budget Request: 

For FY 2017, ACL requests $4,200,000 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 in FY 2016 levels as set in the PPHF. 

As recommended by the Clinical Care Subcommittee of the President’s Advisory Council on 

Alzheimer’ Research, Care, and Services, the majority of the funds will be used to launch a new 

awareness campaign for older adults with memory or other brain health problems. The campaign 

will seek to reduce the cultural stigma associated with Alzheimer’s disease and encourage older 

adults who are experiencing memory or other brain health problems to seek an early diagnosis 

from their doctor. Funding for FY 2017 will focus on expanding the new campaign to 

sub-populations that may not have been reached in prior years, which may require development of 

specific outreach materials and further analysis to determine if content and messaging are 

culturally competent. 

A small portion of the funds will be used to maintain and develop the Caregivers campaign initially 

developed in 2012. These funds will be used to update the information currently available on the 

alzheimers.gov web site. Content on the web site will be refreshed and enhanced through a panel 

of subject matter experts. 

257 
 

 

 

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CONSUMER INFORMATION, ACCESS, AND OUTREACH 

Alzheimer's Disease Initiative--Outreach Campaign 

Resource and Program Data 

(Dollars in thousands) 

Mechanism 

FY 

2015 Final # 

FY 

2015 Final $ 

FY 2016 

Enacted # 

FY 2016 

Enacted $ 

FY 2017 

President’s 

Budget # 

FY 2017 

President’s 

Budget $ 

Grants: 

- - -

Formula -- - -- - -- -

- - -

New Discretionary -- - -- - -- -

- - -

Continuations -- - -- - -- -

Contracts 1 4,058 1 4,139 1 4,139 

Interagency 

Agreements --

-

- --

-

- --

-

-

Program Support /1 -- 142 -- 61 -- 61 

Total Resources -- 4,200 -- 4,200 -- 4,200 

1/ Program Support -- Includes funds for overhead, grant systems and review costs, and information 

technology support costs. 

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Program Administration 

FY 2017 

Service FY 2015 FY 2016 President’s FY 2017 +/-

Final Enacted Budget FY 2016 

Program 

Administration $37,709,000 $40,063,000 $41,063,000 +$1,000,000 

FTE120.................. 178.6 177.6 185.6 +8 

Note: Funding and FTE for FY 2015 reflects the annualized dollars and FTE transferred to ACL for program 

administration, based on a determination order between the Department of Education and ACL. Funding for the 

programs was directly appropriated to ACL in FY 2016. 

Authorizing Legislation: Older Americans Act (OAA), the Developmental Disabilities Assistance 

and Bill of Rights Act (DD Act), the Help America Vote Act (HAVA), the Assistive Technology 

(AT) Act, the Rehabilitation Act, the Public Health Services Act (PHSA), the Elder Justice Act 

(EJA), the Medicare Improvements for Patients and Providers Act (MIPPA), and the Omnibus 

Budget and Reconciliation Act of 1990. 

FY 2017 Authorization ............................................................................... See Program Narratives 

Allocation Method ....................................................................................... Direct Federal/Contract 

Program Description and Accomplishments: 

In FY 2012, the Administration for Community Living (ACL) was created by bringing together 

three existing entities: the Administration on Aging (AoA), an HHS operating division; the 

Administration on Developmental Disabilities (ADD), then a part of the Administration for 

Children and Families (ACF); and the Office of Disability (OD), then a part of the HHS Office of 

the Secretary (OS). ACL was created with the mission of assisting seniors and people of all ages 

with disabilities to live independently and to be able to fully participate in their communities. In 

120 FTE numbers above for Program Administration only reflect those FTE funded from the Program Administration 

budget line. Other sources of funding for ACL FTE include staff charged to reimbursable and mandatory funding 

sources such as the Health Care Fraud and Abuse Control account (7 FTE in each of FY 2015-FY 2017), Medicare 

Improvements for Patients and Providers Act (MIPPA) activities (5 FTE in FY 2016 and 6 FTE in FY 2017), and 

funding received from the Centers for Medicare & Medicaid Services for activities performed on behalf of dual 

Medicare/Medicaid beneficiaries funds (3 FTE in FY 2015-FY 2017). ACL also supports a limited number of FTE 

from within its various program line items All FTE charged to program dollars are included in the appropriate 

narrative tables in other sections of this document. 

260 
 

 

 

 

 

PROGRAM ADMINISTRATION 

the ensuing years, ACL has continued to grow, bringing together other programs from inside and 

outside of HHS that share its mission. The FY 2014 appropriation transferred the State Health 

Insurance Assistance Program (SHIP) and the Paralysis Resource Center program to ACL. Later 

in 2014, as part of the Workforce Innovation and Opportunity Act (WIOA), Congress transferred 

three complementary Department of Education programs—Independent Living, Assistive 

Technology, and the National Institute on Disability, Independent Living and Rehabilitation 

Research (NIDILRR)—to ACL. This was followed in FY 2015 by the Limb Loss Resource 

Center, transferred from the Centers for Disease Control and Prevention, and at the beginning of 

FY 2016, the Traumatic Brain Injury (TBI) program, transferred from the Health Resources and 

Services Administration (HRSA). 

Program Administration funds the direction and support of ACL programs established under the 

Older Americans Act (OAA), Developmental Disabilities Assistance and Bill of Rights Act (DD 

Act), Rehabilitation Act, Help America Vote Act (HAVA), Assistive Technology (AT) Act, Public 

Health Services Act (PHSA), Elder Justice Act, Medicare Improvements for Patients and Providers 

Act (MIPPA), and Omnibus Budget and Reconciliation Act (OBRA) of 1990. The majority of 

these funds cover salaries and benefits, rent and security, and external shared services, all of which 

are relatively fixed in the short term. ACL’s appropriation also includes language that allows 

Program Administration funds to be used for Department-wide coordination of policy and program 

activities that assist individuals with disabilities (consistent with the role previously performed by 

the Office of Disability), as ACL’s Principal Deputy Administrator also serves as the Secretary’s 

Senior Advisor on Disability Policy. 

In FY 2016, Program Administration funding will support 177.6 of ACL’s 206 FTE in both central 

office and in ACL’s regional offices. Other sources of funding for ACL FTE include staff charged 

to reimbursable and mandatory funding sources such as the Health Care Fraud and Abuse Control 

account, Medicare Improvements for Patients and Providers Act (MIPPA) activities, and funding 

received from the Centers for Medicare & Medicaid Services for activities performed on behalf of 

dual Medicare/Medicaid beneficiaries. ACL also supports a limited number of FTE from within 

its various program line items, as described in more detail below. 

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PROGRAM ADMINISTRATION 

Funding History: 

Funding for ACL Program Administration since the agency’s creation in FY 2012 is as follows: 

FY 2012121 $29,558,000 145 FTE 

FY 2013 $28,064,000 135 FTE 

FY 2014 $29,802,000 135 FTE 

FY 2015122 $37,709,000 184 FTE 

FY 2016 $40,063,000 178.6 FTE 

Note that the above FTE numbers do not include FTE funding from reimbursable or program 

sources. 

Budget Request: 

Higher Occupancy Costs 

ACL’s request includes $41,063,000 and 185.6 FTE for Program Administration, a net increase of 

+$1,000,000 and +9 FTE over the FY 2016 enacted level. This funding increase is necessary to 

fund higher occupancy and external services costs projected as a result of ACL’s growth as well 

its headquarters move to the Switzer building. In prior years additional administrative resources 

have been provided to fund the costs related to ACL’s headquarters relocation and to meet the 

needs of programs transferred in from other agencies. Remaining costs will fund the FY 2016 

1.6% pay raise. 

In December 2015, ACL relocated to the Mary E. Switzer building as part of a long-standing plan 

to consolidate the HHS real estate footprint by moving from leased space into Federally owned 

and managed buildings. Headquarters space in the Switzer building was established prior to the 

transfer to ACL of programs and 40 staff positions from the Department of Education. Additional 

space for these staff was negotiated on part of the second floor of the Switzer building. The FY 

2016 appropriation provided the requested increase of $850,000 to cover increased rent related to 

the 1st floor space. ACL experienced higher than expected rental costs covering a second floor 

build out in FY 2016 and requests an increase in funding to cover the higher rental costs in FY 

2017. In addition to higher space-related costs, the actual move has highlighted other occupancy 

costs related to IT, further design and configuration work, and additional modifications that were 

121 Funding for FY 2012 through FY 2014 reflects actual funding and FTEs provided to ACL for Program 

Administration, not comparably adjusted for programs transferred to ACL from the Department of Education by the 

Workforce Innovation and Opportunity Act (WIOA). 

122 Funding and FTEs for FY 2015 reflect annualized dollars and FTE actually transferred to ACL for program 

administration, based on a determination order between the Department of Education and ACL. 

262 
FY 2017 1.6% Pay Raise 

External Services/Investments in ACL staff development 

 

 

 

 

 

 

 

 

 

 

 

PROGRAM ADMINISTRATION 

not foreseen prior to the move. Together, $415,000 in additional funding is requested to cover 

these higher occupancy costs. 

The majority of ACL’s Program Administration budget request covers resources needed for fixed 

costs including salaries and benefits, shared services/JFAs, and rent. Expenditures for these three 

activities require approximately 90% of ACL’s administrative resources. This leaves ACL with 

extremely limited resources to invest either in its employees or in upgrades to its systems and 

infrastructure. Therefore, ACL requests that $260,000 of its request be used, first, to offset any 

additional increases in either its external services or JFAs, and second, for investment in 

management support and in its workforce. Simply put, hiring additional staff is not enough—ACL 

needs to make continued investments in their training and development if it wishes to remain a 

cutting edge agency. ACL also needs to invest to insure that its business processes and systems 

reflect the agency’s expanding mission. 

In FY 2017, ACL estimates that approximately $325,000 in additional funding is needed to pay 

for the President’s proposed 1.6% FY 2017 pay raise. 

FTE 

In Program Administration, FTE levels are expected to increase in FY 2017 by 9 to account for 

projected hiring in FY 2016 that is not expected to occur until late in the fiscal year resulting in 

the need to annualize these hires in FY 2017. FY 2016 hiring primarily reflects the need to staff 

and fully support the programs that were transferred from the Department of Education in FY 2015 

by the Workforce Innovation and Opportunities Act. 

While ACL has received increases in its Program Administration appropriation in recent years, as 

noted above these resources have been almost exclusively related to the costs of ACL’s central 

office relocation, and the need to support the new programs that have been transferred to the 

agency since ACL’s creation. As such, ACL has not been able to make many of the needed 

investments in people and systems that would help to ensure the integrity of its core programs. 

These programs comprise over 80% of ACL’s budget awarded through 15 formula grant programs 

to states and tribes, making it critical that the agency provide its grantees with the support they 

need to effectively and efficiently serve older adults and people with disabilities, as well as their 

families and caregivers. 

Therefore, beginning in FY 2017, ACL will add an additional 18 FTE to conduct program 

monitoring and oversight and to provide technical assistance to our formula grantees. These 18 

additional FTE would be responsible for performing oversight, conducting program evaluations, 

and providing technical assistance to enhance program performance and systems development for 

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PROGRAM ADMINISTRATION 

the core formula grant programs. With the addition of these 18 FTE, ACL will be able to increase 

the resources devoted to program monitoring and integrity activities from approximately 23 FTE 

to 41 FTE. When fully implemented in FY 2017, these added resources will allow ACL to 

adequately staff both its central and regional office teams to engage more effectively with staff at 

the tribal, state and local levels to ensure programs are operating effectively and meeting the needs 

of the populations ACL serves. 

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SUPPORTING EXHIBITS 

Object Classification Table - Direct 

Administration for Community Living 

(Dollars in Thousands) 

Personnel Compensation FY 2016 

Base 

FY 2017 

Request 

FY 2017 +/-

FY 2016 

Full-time permanent (11.1).................................. 19,333 22,637 3,304 

Other than full-time permanent (11.3)................... 2,123 2,248 125 

Other personnel compensation (11.5).................. 564 564 0 

Military personnel (11.7)..................................... - - -

Special personnel services payments (11.8) ........ - - -

Subtotal personnel compensation........................ 22,020 25,448 3,429 

Civilian benefits (12.1)........................................ 5,399 6,320 921 

Military benefits (12.2)........................................ - - -

Benefits to former personnel (13.0)...................... - - -

Subtotal Pay Costs, .......................................... 27,419 31,768 4,349 

Travel and transportation of persons (21.0)........... 568 568 -

Transportation of things (22.0)............................. 2 2 -

RentalpaymentstoGSA(23.1).......................... 2,811 3,092 281 

Communication, utilities, and misc. charges (23.3) 374 374 -

Printing and reproduction (24.0)........................... 15 15 -

Other Contractual Services: 

Advisory and assistance services (25.1)............... 25,539 25,504 -35 

Other services (25.2).......................................... 167 167 0 

Purchase of goods and services from................... 9,732 11,038 1,307 

government accounts (25.3)................................ - - -

Operation and maintenance of facilities (25.4)....... - - -

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.................... 35,438 36,709 1,271 

Supplies and materials (26.0).............................. 50 50 0 

Equipment (31.0)............................................... 35 35 0 

Land and Structures (32.0) ................................ - - -

Investments and Loans (33.0.............................. - - -

Grants, subsidies, and contributions (41.0).......... 1,846,025 1,868,568 22,543 

Interest and dividends (43.0)............................... - - -

Refunds (44.0)................................................... - - -

Subtotal Non-Pay Costs..................................... 1,885,316 1,909,411 24,095 

Total Direct BA by Object Class.......................... 1,912,735 1,941,179 28,444 

Average Cost per FTE 

(excluding reimbursables from other agencies) 

Civilian FTEs 184 211 27 

Civilian Average Salary/Benefits 149,016 150,560 1,544 

Percent change 1.04% 

Military FTEs 0 0 0 

Military Average Salary N/A N/A N/A 

Percent change N/A N/A N/A 

Total OPDIV FTEs 184 211 27 

Total OPDIV Average Salary/Benefits 149,016 150,560 1,544 

Percent change - 1.04% 

266 

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- - - 

Salaries and Expenses 

Administration for Community Living 

(Dollars in Thousands) 

Personnel compensation: FY 2016 

Base 

FY 2017 

Request 

FY 2017 +/-

FY 2016 

Full-time permanent (11.1).................................. 19,333 22,637 3,304 

Other than full-time permanent (11.3)................... 2,123 2,248 125 

Other personnel compensation (11.5).................. 564 564 -

Military personnel (11.7)..................................... - - -

Special personnel services payments (11.8) ........ - - -

Subtotal personnel compensation.................. 22,020 25,448 3,429 

Civilian benefits (12.1)........................................ 5,399 6,320 921 

Military benefits (12.2)........................................ - - -

Benefits to former personnel (13.0)...................... - - -

Total Pay Costs................................................. 27,419 31,768 4,349 

Travel and transportation of persons (21.0)........... 568 568 -

Transportation of things (22.0)............................. 2 2 -

Rental payments to GSA (23.1).......................... 2,811 3,092 281 

Communication, utilities, and misc. charges (23.3) 374 374 -

Printing and reproduction (24.0)........................... 15 15 -

Other Contractual Services:................................ 

Advisory and assistance services (25.1)............... 25,539 25,504 (35) 

Other services (25.2).......................................... 167 167 -

Purchase of goods and services from................... 9,732 11,038 1,307 

government accounts (25.3)................................ - - -

Operation and maintenance of facilities (25.4)....... - - -

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.............. 35,438 36,709 1,271 

Supplies and materials (26.0).............................. 50 50 -

Total Non-Pay Costs.......................................... 39,256 40,808 1,552 

Total Salary and Expenses................................. 66,675 72,576 5,901 

Direct FTE........................................................ 184 211 27 

267 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Detail of Full-Time Equivalent Employment (FTE) 

Administration for Community Living 

Organization 

2015 

Est. 

Civilian 

2015 

Est. 

Military 

2015 

Est. 

Total 

2016 

Est. 

Civilian 

2016 

Est. 

Military 

2016 

Est. 

Total 

2017 

Est. 

Civilian 

2017 

Est. 

Military 

2017 

Est. 

Total 

Immediate Office of the 

Administrator................................... - - - - - - - - - - - -

Direct:.............................................. 18 - - 18 20 - - 20 20 - - 20 

Reimbursable:................................... 1 - - 1 0 - - 0 0 - - 0 

Total:............................................. 19 - 0 19 20 0 20 20 - 0 20 

Administration on Aging....................... - - - - - - - - - - - -

Direct:.............................................. 25 - - 25 25 - - 25 36 - - 36 

Reimbursable:................................... 1 - - 1 1 - - 1 1 - - 1 

Total:............................................. 26 0 26 26 0 26 37 - 0 37 

Administration on Disabilities................ - - - - - - - - - - - -

Direct:.............................................. 29 - - 29 31 - - 31 37 - - 37 

Reimbursable:................................... 0 - - 0 0 - - 0 0 - - 0 

Total:............................................. 29 - 0 29 31 - 0 31 37 - 0 37 

Center for Policy and .......................... - - - - - - - - - - - -

Evaluation........................................ - - - - - - - - - - - -

Direct:.............................................. 14 - - 14 10 - - 10 10 - - 10 

Reimbursable:................................... 0 - - 0 0 - - 0 0 - - 0 

Total:............................................. 14 - 0 14 10- 0 10 10 - 0 10 

Center for Management and Budget...... - - - - - - - - - - - -

Direct:.............................................. 32 - - 32 32 - - 32 40 - - 40 

Reimbursable:................................... 1 - - 1 1 - - 1 1 - - 1 

Total:............................................. 33 - 0 33 33 - 0 33 41 0 41 

Center for Integrated Programs............. - - - - - - - - - - - -

Direct:.............................................. 10 - - 10 10 - - - - - - -

- - - - - - - 10 10 - - 10 

Reimbursable:................................... 12 - - 12 15 15 16 - - 16 

Total:............................................. 22 - 0 22 25 0 25 26 - 0 26 

Office of Regional Operations................ 

Direct:.............................................. 26 - - 26 28 - - 28 30 - - 30 

Reimbursable:................................... 3 - - 3 5 - - 5 5 - - 5 

Total:............................................. 29 - 0 29 33 - 0 33 35 - 0 35 

National Institute on Disability, ............. 

Independent Living, and .................. 

Rehabilitation Research.................. 

Direct:.............................................. 

28 

- -

28 28 

- -

28 28 

- -

28 

Reimbursable:................................... 0 - - 0 0 - - 0 0 - - 0 

Total:............................................. 28 - 0 28 28 - 0 28 28 - 0 28 

FTE Total........................................... 200 - 0 200 206 - 0 206 234 - 0 234 

268 

 Average GS Grade 

FY 2013............................................. 12.9 

FY 2014............................................. 13.0 

FY 2015............................................. 12.8 

FY 2016............................................. 12.8 

FY 2017............................................. 12.8 
Detail of Positions 

Administration for Community Living 

Level 2015 

Actual 

2016 

Enacted 

2017 

Budget 

Executive level I ........................................... - - -

Executive level II.......................................... - - -

Executive level III ........................................ - - -

Executive level IV......................................... 1 1 1 

Executive level V.......................................... - - -

Subtotal .................................................... - - -

Total - Exec. Level Salaries 155500 157770 159348 

ES-6................................................................ - - -

ES-5................................................................ 2 2 2 

ES-4................................................................ 2 2 2 

ES-3................................................................ 2 2 1 

ES-2................................................................ 1 1 1 

ES-1................................................................ 1 1 1 

Subtotal .................................................... 8 8 7 

Total - ES Salary $1,303,076 $1,317,345 $1,164,770 

GS-15.............................................................. 33 31 31 

GS-14.............................................................. 37 48 53 

GS-13.............................................................. 63 66 72 

GS-12.............................................................. 30 33 38 

GS-11.............................................................. 13 14 16 

GS-10.............................................................. 1 1 1 

GS-9................................................................ 7 11 12 

GS-8................................................................ 1 0 0 

GS-7................................................................ 4 3 3 

GS-6................................................................ 1 1 1 

GS-5................................................................ 0 0 0 

GS-4................................................................ 0 0 0 

GS-3................................................................ 1 1 1 

GS-2................................................................ 0 0 0 

GS-1......................................................... 0 

Subtotal .................................................... 191 209 228 

Total - GS Salary - - -

Average ES level ......................................... 3.4 3.4 3.3 

Average ES salary........................................ $162,885 $164,668 $166,396 

Average GS grade........................................ 12.8 12.8 12.8 

Average GS salary....................................... $104,693 $112,412 $112,776 

Average Special Pay categories 

Administratively Determined (AD) ...... $130,487 $132,409 $133,733 

269 
Programs Proposed for Elimination 

Administration for Community Living 

ACL has no programs proposed for elimination. 

270 
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FTE Funded by the Affordable Care Act 

Administration for Community Living 

Program Section FY 2013 

Total 

FY 2013 

FTEs 

FY 2013 

CEs 

FY 2014 

Total 

FY 2014 

FTEs 

FY 2014 

CEs 

FY 2015 

Total 

FY 

2015 

FTEs 

FY 

2015 

CEs 

Pre-existing programs funded by ACA (Mandatory) 

National Clearinghouse for Long-Term Care Information Title VIII $ 86 0 0 $ - 0 0 $ - 0 0 

Medicare Improvements for Patients & Providers Act Programs 

New programs authorized and funded by ACA (Mandatory) 

Section 3306 $ 25,000 0 0 $ - 0 0 $ - 0 0 

Aging and Disability Resource Centers 

New programs funded from the PPHF under ACA (Discretionary) 

Section 2405 $ 9,490 4 0 $ 9,280 3 0 $ - 0 0 

Adult Protective Services (Prevention & Public Health Fund) Section 4002 $ 2,000 0 0 $ - 0 0 $ - 0 0 

Chronic Disease Self-Management Education (PPHF) Section 4002 $ 7,086 1 0 $ 8,000 0 0 $ 8,000 0 0 

Alzheimer's Disease Initiative--Supportive Services (PPHF) Section 4002 $ - 0 0 $ 10,500 0 0 $ 10,500 0 0 

Alzheimer's Disease Initiative--Communications (PPHF) Section 4002 $ 150 0 0 $ 4,200 0 0 $ 4,200 0 0 

Falls Prevention--(PPHF) 

Programs authorized by ACA but funded by other sources 

(Discretionary) Elder Justice Initiative/Adult Protective 

Services 

Section 4002 

Subtitle H, 

Sections 6701- 

$ - 0 0 $ 5,000 0 0 $ 5,000 0 0 

6703 $ - 0 0 $ - 0 0 $ 4,000 2 0 

Program 

Section FY 2016 

Total FY 2016 

FTEs 

FY 

2016 

CEs 

FY 2017 

Total FY 2017 

FTEs 

FY 

2017 

CEs 

Pre-existing programs funded by ACA (Mandatory) 

National Clearinghouse for Long-Term Care Information Title VIII $ 1,000 0 0 $ - 0 0 

Medicare Improvements for Patients & Providers Act Programs 

New programs authorized and funded by ACA (Mandatory) 

Section 3306 $ - 0 0 $ - 0 0 

Aging and Disability Resource Centers 

New programs funded from the PPHF under ACA (Discretionary) 

Section 2405 $ - 0 0 $ - 0 0 

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) 

Programs authorized by ACA but funded by other sources (Discretionary) Elder Justice 

Initiative/Adult Protective Services 

Section 4002 

Subtitle H, 

Sections 6701- 

$ 5,000 0 0 $ 5,000 0 0 

6703 $ 8,000 3 0 $ 10,000 4 0 

271 

-

-

-
Physicians’ Comparability Allowance Worksheet 

Administration for Community Living 

ACL does not have anything to submit for this section. 

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Significant Items in Appropriations Committee Reports 

Administration for Community Living 

Home-and Community-Based Supportive Services: The Committee directs ACL to work with 

States to prioritize innovative service models, like naturally occurring retirement communities 

(NORCS), which help older Americans remain independent as they age. 

Actions Taken or To Be Taken: ACL appreciates and supports the Committee’s continued 

interest in innovative service models that help older adults remain independent as they age. The 

2015 White House Conference on Aging provided an important platform to highlight the need to 

focus on innovative strategies in the areas of housing, transportation, health care, and long-term 

services and supports in order to support healthy aging and aging in place. 

ACL continues to work with states and others in the aging network to encourage livable 

communities and aging in place. We are committed to expanding the availability and accessibility 

of housing and service options that keep older adults living in the community by working in 

partnership with sister HHS agencies such as Office of the Assistant Secretary for Planning and 

Evaluation (ASPE) and the Centers for Medicare and Medicaid Services (CMS), as well as HUD 

to bring together housing and human services agencies on the state and local levels. For example, 

ACL worked with ASPE and HUD to develop design options for a demonstration of publicly 

assisted rental housing coordinated with health and long-term care services and supports for lowincome older adults. ACL continues to support HUD’s efforts to foster the development of 

replicable housing plus supportive service models that offer the most effective and cost-efficient 

approaches to meeting the needs of vulnerable populations. 

ACL has also provided national leadership to help community-based organizations build networks 

with the capability to respond to delivery systems reform happening around the country including 

efforts to improve integration between hospitals, insurers, health care providers, and the 

community-based organizations (CBOs) that often provide day-to-day support to older people and 

people with disabilities. 

Healthier Foods: The Committee encourages ACL to partner with organizations to review, 

identify, and disseminate best practices to provide healthier foods and menu options for seniors. 

These practices could include better food produce procurement, preparation techniques, and 

improved menu planning and recipe documentation to facilitate changes that support healthier 

meals. Coalitions of manufacturers, food service providers, and food service distributors could 

also be developed to explore ways to promote best practices and provide a more appropriate 

selection of healthier ready-to-use ingredients. 

274 
 

 

 

 

 

 

 

 

 

 

Actions Taken or To Be Taken: ACL appreciates and supports the Committee’s continued 

interest in and support of healthy eating for older adults. We fund a national resource center that 

disseminates best practices in the field that include how to incorporate changes to support healthier 

meals. We work together with our colleagues in the Office of the Assistant Secretary for Health as 

well as with USDA to collaborate on ways to improve menu planning and food service distribution. 

We have convened a “brain trust” consisting of thought leaders and food service innovators to 

discuss ways to combat senior hunger, encourage healthier ready-to-use ingredients, and 

incorporate innovations in both congregate and home-delivered meals. Our resource center 

supports a listserv for state nutritionists and we use this method to communicate changes that 

support healthier meals. The 2015-2020 Dietary Guidelines for Americans were recently 

announced, which encourage healthy eating patterns. ACL was an active member of the 

HHS/USDA committee that developed the Guidelines and we will continue to support them. 

There is always room for improvement and the FY 2017 request incorporates a proposal that would 

allow the use of up to 1 percent of ACL’s nutrition programs for development of innovative, 

evidence-based practices for senior nutrition aimed at enhancing the quality and effectiveness of 

nutrition programs’ services. 

Examples of promising practices that enhance the quality and effectiveness of our nutrition 

program include service products that appeal to caregivers (such as web-based ordering systems 

and carryout meals), increased involvement of volunteers (such as retired chefs), new service 

models (testing variations and hybrid strategies) and other innovations to better serve older adults. 

These funds may be used to help develop and test additional models or to replicate models that 

have already been tested in other community-based settings. 

Tribal Advisory Council: The Committee encourages ACL to continue with their plans to establish 

a Tribal Advisory Council focusing on issues that affect the aging Indian population. 

Actions Taken or To Be Taken: ACL appreciates and supports the Committee’s continued 

interest in and support of issues affecting older American Indians. We are currently developing a 

new ACL Tribal Consultation Policy; we have followed the HHS Policy to this point, adding a 

special focus on Tribal Elders. We actively participate in all HHS Tribal Consultations, including 

Budget Consultations. We actively participate in the Secretary’s Tribal Advisory Council 

(STAC), bringing a focus on Tribal Elders issues and needs. We participate with the National 

Congress of American Indians (NCAI), the National Indian Health Board (NIHB) the National 

Council of Urban Indian Health (NCUIH), the National Indian Council on Aging. We hold an 

annual consultation with tribal elders’ needs and issues each August in conjunction with our 

National Title VI Training. We have several advisory committees on various program 

initiatives. We are very interested in developing a Tribal Advisory Council if resources are made 

available and it is authorized by law. 

275 
 

 

 

 

 

 

Elder Falls Prevention: The Committee intends that these funds should be used in coordination 

with CDC for public education about the risk of these falls, as well as implementation and 

dissemination of community-based strategies that have been proven to reduce the incidence of falls 

among seniors. 

Actions Taken or To Be Taken: ACL has worked with CDC injury prevention staff for many 

years, coordinating our public education about the risk of falls and how to reduce the incidence of 

falls among seniors. CDC was an active participant in our Falls Summit held last year in 

conjunction with the White House Conference on Aging. We hold bi-monthly meetings with CDC 

staff and are currently working on formalizing our successful informal collaborations through a 

memorandum of understanding to be signed by the administrators of both agencies. CDC’s falls 

prevention grantees attend the annual meetings our national falls resource center holds, 

encouraging one-on-one collaborations between each of our agencies’ grantees. We participate in 

joint Twitter chats to help educate the public about the risk of falls, and have taken and support 

CDCs online training for falls reduction in clinical settings. Our complementary missions (CDC 

on the clinical aspect and ACL on the community programs) work well together and we plan to 

continue this relationship. 

Aging and Disability Resource Centers: 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: Since 2003, ACL (then the Administration on Aging) and the 

Centers for Medicare & Medicaid Services (CMS), in collaboration with the Veterans Health 

Administration (VHA), have been supporting state efforts to implement consumer friendly systems 

of access that make it easier for consumers and their families to learn about and quickly access 

long-term services and supports (LTSS). In 2012, ACL, CMS and VHA fully adopted the No 

Wrong Door System model which was the primary recommendation from Centers for Independent 

Living (CILs) across the country. This model also recognizes the recommendations from CILs that 

no specific organization or network has the capacity, expertise, or authority to carry out all the 

functions in a NWD System and ADRCs, AAAs, and CILs must be included. 

In 2012, ACL published a competitive Funding Opportunity Announcement that incorporated this 

vision. As a result, ACL, CMS and VHA awarded three-year grants to 8 states to transform state 

LTSS access functions into a single No Wrong Door system that would serve all populations. This 

investment has resulted in a number of lessons learned which are used by federal partners to create 

276 
 

 

 

the “Key Elements of a NWD System of Access to LTSS for All Populations and Payers” 123 and 

has contributed to improved coordination. The NWD System Key Elements specifically require 

States to use a formal process for ensuring the ongoing and meaningful involvement of key 

stakeholders such as CILs in the development and implementation of their NWD System. ACL 

also learned that states would benefit from a planning grant to enable the inclusion of key 

stakeholders in the development of the state’s NWD System. In 2014, ACL used the NWD System 

Key Elements as the basis to fund 25 states to develop 3-year plans they could use to begin to 

transform their various LTSS access programs and functions into a high-performing NWD System 

which coordinates LTSS access activities across ADRCs, AAAs and CILs consistent with the 

NWD System Key Elements. In 2015, ACL awarded 5 of the 25 states that received planning 

grants a 3-year implementation grant to transform the LTSS access functions into a NWD System. 

The 2012 NWD System grantees also worked closely with the VA Medical Centers that serve 

Veterans within their states to expand access to the Veteran-Directed Home and Community Based 

Services (VD-HCBS) program. The VD-HCBS program is provided to Veterans by ADRCs, 

AAAs, CILs and State Agencies through the state’s NWD System. On December 1, 2015 the U.S. 

Department of Veterans Affairs published an interim final rule recognizing the ADRCs, AAAs, 

CILs and State Agencies as providers. 

With the passage and signing of the Workforce Innovation and Opportunity Act (WIOA) in July 

of 2014, the Independent Living (IL) Programs were transferred from the Department of Education 

to ACL. This transfer of the IL programs and the creation of the Independent Living 

Administration (ILA) within ACL will foster greater collaboration and partnership with all of the 

programs within ACL including ADRCs and AAAs. This in turn should provide additional 

information, resources and trainings to ADRCs, AAAs and CILs to further expand the “no wrong 

door” access to LTSS at the state and community level. 

Further efforts to improve coordination across ADRCs, AAAs and CILs are also occurring through 

the relationship ACL has developed with the National Council for Independent Living (NCIL). 

NCIL is providing technical assistance to states and identifying promising practices which actively 

involve CILs as part of the NWD System. 

Muscular Dystrophy: The Committee directs ACL to provide an update on all programs relevant 

to the Duchenne population, particularly those focused on supporting transitions of persons with 

Duchenne into adulthood. The Committee encourages ACL to develop plans for conducting 

123 http://www.acl.gov/Programs/CIP/OCASD/ADRC/docs/NWD-National-Elements.pdf 

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comprehensive studies focused on evaluating the cost-effectiveness of independent living 

programs and supports for persons living with various forms of muscular dystrophy. 

Actions Taken or To Be Taken: ACL appreciates the opportunity to provide an update on all 

programs relevant to the Duchenne population, particularly those focused on supporting transitions 

of persons with Duchenne into adulthood. The Administration on Disabilities (AoD) administers 

a number of programs relevant to the Duchenne population and other people with disabilities 

including those authorized under the Developmental Disabilities Assistance and Bill of Rights Act 

of 2000 (DD Act), as well as the Independent Living programs which are authorized in Title VII 

of the Rehabilitation Act of 1973 (as amended). ACL also includes, the National Institute on 

Disability, Independent Living, and Rehabilitation Research (NIDILRR), which conducts research 

and promotes its effective use to improve the abilities of all people with disabilities to perform 

activities of their choice in the community. 

The DD Act authorized the State Councils on Developmental Disabilities, the Protection and 

Advocacy Agencies (P&As) and the University Centers for Excellence in Developmental 

Disabilities (UCEDDs). Separately each program may conduct research or provide programming 

in the area of Duchenne’s and support the transition of people with Duchenne’s into 

adulthood. Funding provided through the Administration on Disabilities is to establish systems 

that provide services to people based on the definition of developmental disabilities in the DD Act 

which is inclusive of Duchenne’s (pending severity and age of inset) and other developmental 

disabilities. The same is true of the Independent Living programs which, via statute, must provide 

cross-disability programming and cannot focus on a specific disability type. Nevertheless, later in 

the fiscal year ACL will query the DD and Independent Living networks to provide an update to 

the relevant committees of jurisdiction in congress on all programs relevant to the Duchenne’s 

population, particularly those focused on supporting transitions of persons with Duchenne into 

adulthood. 

In NIDILRR ACL funded a 5-year “Rehabilitation Research and Training Center Promoting 

Healthy Aging for Individuals with Long-Term Physical Disabilities” at the University of 

Washington. The project provides $875,000 per year (through 2017) to conduct research 

to better understand the factors associated with healthy aging in persons with spinal cord injury 

(SCI), multiple sclerosis (MS), late effects of polio (PPS), and muscular dystrophy (MD). Research 

activities focus on the impact of secondary conditions and barriers to health care access; testing 

the feasibility of community-based health and wellness intervention to promote healthy aging in 

persons with SCI, MS, PPS, and MD; developing an intervention to promote positive 

psychological adjustment in persons with MS; enhancing understanding of the effect of federal 

programs such as Medicaid Managed Care on receipt of and satisfaction with health care services; 

and serving as a national resource center on aging with long-term physical disabilities. 

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Four interrelated scientific studies on healthy aging and disability make up this project and are 

conducted with the full involvement of consumers and key stakeholder groups. Project I continues 

a recently-completed, longitudinal survey of 1,600 individuals with long-term physical disabilities, 

creating the largest longitudinal database of secondary health conditions in the target population. 

Project II tests the efficacy of an existing, empirically-supported health and wellness intervention 

in promoting healthy aging for adults with SCI, MS, MD, or PPS in collaboration with a large, 

regional community senior services agency. Project III develops and pilot tests a novel intervention 

designed to promote positive psychological factors that are key to healthy aging in individuals 

with MS. Project IV builds on an existing study of Medicaid Managed Care to evaluate the impact 

of Medicaid Managed Care on health care utilization, function, and consumer satisfaction in a 

sample of more than 14,000 individuals with long-term physical disabilities. 

Dissemination activities associated with this project will include a state-of-the-science conference 

on aging with disabilities, publication of findings from the studies in national and international 

journals and presentations of the findings at high profile scientific conferences in the field. 

No funding was provided by Congress to develop plans for conducting comprehensive studies 

focused on evaluating the cost-effectiveness of independent living programs and supports for 

persons living with various forms of muscular dystrophy. At this time ACL has no plans for new 

agency-directed research priorities specifically focused on muscular dystrophy. 

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Prevention and Public Health Fund 

Administration for Community Living 

In FY 2017, ACL is proposing the following funding from the Prevention and Public Health 

fund: 

Service 

FY 2 

FY 2015 Enacted 

015 Enacted 

FY 2016 

Enacted 

FY 2017 President’s 

Budget 

Chronic Disease SelfManagement 

Education............ 

$8,000,000 $8,000,000 $8,000,000 

Falls 

Prevention..................... $5,000,000 $5,000,000 $5,000,000 

Alzheimer’s Disease 

Initiative – Services......... $10,500,000 $10,500,000 $10,500,000 

Alzheimer’s Disease 

Initiative – Communications 

Campaign...... $4,200,000 $4,200,000 $4,200,000 

Total $27,700,000 $27,700,000 $27,700,000 

A summary of each item requested in FY 2017 follows. More detailed requests are found in 

separate sections elsewhere in this volume. 

Chronic Disease Self-Management Education (CDSME) 

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

for FY 2017 from the Prevention and Public Health Fund (PPHF) appropriated under the 

Affordable Care Act. This would maintain the funding at the level enacted in FY 2015 and 

FY 2016. CDSME programs have proven effective in helping people to better self-manage 

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

Funding for CDSME is awarded in the form of competitive grants to states. 

Falls Prevention 

• $5,000,000 for Falls Prevention Programs, unchanged from the FY 2015 and FY 2016 

enacted budgets from PPHF. This FY 2017 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. 

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Alzheimer’s Disease Initiative - Services 

• $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. For FY 2017, the request is at the same level as the FY 2015 and FY 2016 enacted 

budgets. 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. The funding is used to award cooperative agreements to 

States, tribes, or other localities, and these entities are charged with developing systems 

that coordinate or integrate access to a system-wide set of programs. 

Alzheimer’s Disease Initiative – Communications Campaign 

• $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. For FY 2017, the request is at the same level as the FY 

2015 and FY 2016 enacted budgets. This funding is proposed from the Prevention and 

Public Health Fund. The funding mechanism used is a contract. 

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Text Description Administration for Community Living Organizational Chart 

The U.S. Administration for Community Living (ACL) is led by the Administrator, who also serves as the 

Assistant Secretary for Aging. The Administrator is directly supported by the Principal Deputy Administrator. 

The following staff offices report directly to the Administrator: 

• Office of External Affairs 

• Office of Regional Operations, which includes ten offices located in various regions of the United 

States 

ACL is comprised of the following units, which report directly to the Administrator: 

• Administration on Aging 

• Administration on Disabilities 

• Center of Integrated Programs 

• Center for Management and Budget 

• Center for Policy and Evaluation 

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

The Administration on Aging is led by the Assistant Secretary for Aging, who is directly supported by 

the Deputy Assistant Secretary for Aging. Reporting directly to the Deputy Assistant Secretary for Aging 

are the following offices: 

• Office of Supportive and Caregiver Services 

• Office of Nutrition and Health Promotion Programs 

• Office of Elder Justice and Adult Protective Services 

• Office of American Indian, Alaskan Native and Native Hawaiian Programs 

• Office of Long-Term Care Ombudsman Programs 

The Administration on Disability is headed by a Commissioner, who reports directly to the ACL Administrator, 

and a Deputy Commissioner who also serves as Director of Independent Living. Reporting directly to the 

Commissioner and Deputy Commissioner are the following offices: 

• Administration on Intellectual and Developmental Disabilities 

• Independent Living Administration 

Reporting directly to the Deputy Administrator of the Center for Integrated programs are the following 

offices: 

• Office of Healthcare Information and Counseling 

• Office of Consumer Access and Self-Determination 

• Office of Integrated Care Innovations 

Reporting directly to the Deputy Administrator of the Center for Management and Budget are the following offices: 

• Office of Budget and Finance 

• Office of Administration and Personnel 

• Office of Grants Management 

• Office of Information Resources Management 

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