DEPARTMENT

of HEALTH

and HUMAN

SERVICES

Fiscal Year

2020

Administration for 

Community Living

Justification of

Estimates for

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

Washington, DC 20201

ii

On behalf of the Administration for Community Living (ACL), I am pleased to present the FY 

2020 President’s Budget request. The request of $2 billion represents strategic decision-making 

that aligns with the President’s goal of bringing government spending under control while striving 

to support core programs and activities. 

ACL’s request supports the programmatic priorities outlined by the President. This includes 

allocating an additional $2 million to assist with combating the opioid epidemic. The Budget also

invests in improving the effectiveness and efficiency of ACL’s programs and oversight activities. 

ACL’s request continues to support the flexibility for states to allocate resources and address 

state-specific challenges to better serve the needs of their communities. 

The proposed budget maintains the mission and purpose of ACL as we work each day with 

thousands of partners to improve the lives of older adults and people with disabilities through 

services, research, advocacy and education. These partners include state and local governments, 

tribes, industry, and nonprofit organizations who are creating opportunities for older adults and 

people with disabilities to earn a living, go to school, choose where to live, and make decisions 

about their lives.

Older adults and people with disabilities across the lifespan prefer to live in the community as 

opposed to living in institutional settings. In most cases, creating opportunities and supporting 

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

ACL remains committed to this mission and this budget aligns with this critical pursuit.

Lance Robertson

Administrator and Assistant Secretary for Aging
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Table of Contents 

TABLE OF CONTENTS............................................................................................................................................... III

ORGANIZATION CHART .............................................................................................................................................1

Executive Summary

INTRODUCTION AND MISSION....................................................................................................................................3

OVERVIEW OF THE BUDGET REQUEST .......................................................................................................................5

OVERVIEW OF PERFORMANCE ...................................................................................................................................7

ALL PURPOSE TABLE...............................................................................................................................................13

APPROPRIATIONS LANGUAGE..................................................................................................................................16

APPROPRIATIONS LANGUAGE ANALYSIS.................................................................................................................18

AMOUNTS AVAILABLE FOR OBLIGATION ................................................................................................................21

SUMMARY OF CHANGES ..........................................................................................................................................22

BUDGET BY ACTIVITY .............................................................................................................................................23

AUTHORIZING LEGISLATION....................................................................................................................................25

APPROPRIATIONS HISTORY......................................................................................................................................27

APPROPRIATIONS NOT AUTHORIZED BY LAW .........................................................................................................28

Health and Independence for Older Adults

HEALTH AND INDEPENDENCE FOR OLDER ADULTS .................................................................................................30

HOME AND COMMUNITY-BASED SUPPORTIVE SERVICES ........................................................................................34

NUTRITION SERVICES ..............................................................................................................................................43

PREVENTIVE HEALTH SERVICES..............................................................................................................................59

CHRONIC DISEASE SELF-MANAGEMENT EDUCATION..............................................................................................67

FALLS PREVENTION.................................................................................................................................................71

NATIVE AMERICAN NUTRITION AND SUPPORTIVE SERVICES ..................................................................................75

AGING NETWORK SUPPORT ACTIVITIES ..................................................................................................................81

Caregiver and Family Support Services

CAREGIVER AND FAMILY SUPPORT SERVICES .........................................................................................................89

FAMILY CAREGIVER SUPPORT SERVICES.................................................................................................................91

NATIVE AMERICAN CAREGIVER SUPPORT SERVICES...............................................................................................99

ALZHEIMER’S DISEASE PROGRAM.........................................................................................................................103

LIFESPAN RESPITE CARE .......................................................................................................................................107

Protection of Vulnerable Adults

PROTECTION OF VULNERABLE ADULTS.................................................................................................................113

LONG-TERM CARE OMBUDSMAN PROGRAM .........................................................................................................115

PREVENTION OF ELDER ABUSE AND NEGLECT ......................................................................................................122

HEALTH CARE FRAUD AND ABUSE CONTROL/SENIOR MEDICARE PATROL PROGRAM..........................................128

ELDER RIGHTS SUPPORT ACTIVITIES.....................................................................................................................132

Disability Programs and Services

DISABILITY PROGRAMS AND SERVICES .................................................................................................................140

STATE COUNCILS ON DEVELOPMENTAL DISABILITIES...........................................................................................142

DEVELOPMENTAL DISABILITIES – PROTECTION AND ADVOCACY .........................................................................148

UNIVERSITY CENTERS FOR EXCELLENCE IN DEVELOPMENTAL DISABILITIES........................................................154

DEVELOPMENTAL DISABILITIES – PROJECTS OF NATIONAL SIGNIFICANCE ...........................................................160

INDEPENDENT LIVING............................................................................................................................................164

LIMB LOSS RESOURCE CENTER .............................................................................................................................172

PARALYSIS RESOURCE CENTER.............................................................................................................................176
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TRAUMATIC BRAIN INJURY ...................................................................................................................................180

NATIONAL INSTITUTE ON DISABILITY, INDEPENDENT LIVING, AND REHABILITATION RESEARCH.........................186

Consumer Information, Access and Outreach

CONSUMER INFORMATION, ACCESS, AND OUTREACH ...........................................................................................191

AGING AND DISABILITY RESOURCE CENTERS .......................................................................................................193

STATE HEALTH INSURANCE ASSISTANCE PROGRAMS ...........................................................................................199

VOTING ACCESS FOR INDIVIDUALS WITH DISABILITIES.........................................................................................205

ASSISTIVE TECHNOLOGY.......................................................................................................................................209

MEDICARE IMPROVEMENTS FOR PATIENTS AND PROVIDERS ACT PROGRAMS (MIPPA).......................................222

Program Administration

PROGRAM ADMINISTRATION .................................................................................................................................234

Nonrecurring Expenses Fund

NONRECURRING EXPENSES FUND..........................................................................................................................237

Prevention and Public Health Fund

PREVENTION AND PUBLIC HEALTH FUND..............................................................................................................241

Supplementary Tables

OBJECT CLASSIFICATION TABLE - DIRECT ............................................................................................................243

SALARIES AND EXPENSES – DIRECT ......................................................................................................................244

DETAIL OF FULL TIME EQUIVALENTS (FTE) .........................................................................................................245

DETAIL OF POSITIONS............................................................................................................................................246

PROGRAMS PROPOSED FOR ELIMINATION..............................................................................................................247

FTES FUNDED BY P.L. 111-148 AND ANY SUPPLEMENTALS .................................................................................248

Significant Items

SIGNIFICANT ITEMS ...............................................................................................................................................250
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Organization Chart
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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 to live independently and participate fully in their communities. 

ACL works to achieve its mission by funding services and supports provided primarily by 

networks of community-based organizations and by investing in research, education and 

innovation. This is critical given the number of people these programs serve: 

• The U.S. population over age 60 is projected to increase by 9 percent between 2017 and

2020, from 70.8 million to 77.1 million.

1

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

disabilities of all ages living in the community. Of these, more than 12 million required

assistance with activities of daily living or instrumental activities of daily living.2

• There are an estimated 3.9 to 5.4 million individuals with developmental disabilities.3

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

limitations in activities of daily living – is projected to increase from 4.2 million individuals

in 2017 to 4.6 million (10 percent increase) by the year 2020.4 These individuals are at the

greatest risk of nursing home admission.

Community living means that older adults and people with disabilities live alongside people of all 

ages, with and without disabilities, and have the same opportunities as everyone else to earn a 

living and to make decisions about their lives. Community living is preferred by older Americans 

and people with disabilities and is usually less expensive than institutional care. That combination 

of cost-effectiveness and consumer satisfaction makes community living an exceptional value. As 

we transform the health care to a system that pays for outcomes, and which prioritizes care in the 

1 U.S. Census Bureau, “2017 National Population Projections,” Table 3. Projected 5-Year Age Groups and Sex 

Composition of the Population for the United States: 2017 to 2060. Original Release Date: March 2018, Revised 

Release Date: September 2018. Accessed 23 October 2018. U.S. Census Bureau, Annual Estimates of the Resident 

Population by Sex, Single Year of Age, Race and Hispanic Origin for the United States: April 1, 2010 to July 1, 

2017. Released June 2018,

2 U.S. Census Bureau, “Americans with Disabilities: 2010,” Issued July 2012. Accessed 21 August 2014.

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

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

States, States, Counties, and Puerto Rico Commonwealth and Municipios: April 1, 2010 to July 1, 2017. Accessed 7 

August 2018.

4

.S. Census Bureau, “2017 National Population Projections,” Table 3. Projected 5-Year Age Groups and Sex 

Composition of the Population for the United States: 2017 to 2060. Original Release Date: March 2018, Revised 

Release Date: September 2018. Accessed 23 October 2018. U.S. Census Bureau, Annual Estimates of the Resident 

Population by Sex, Single Year of Age, Race, and Hispanic Origin for the United States: April 1, 2010 to July 1, 

2017: Released June 2018. Accessed 24 July 2018. Centers for Medicare & Medicaid Services, ACL analysis of 

2015 Medicare Current Beneficiary Survey. Accessed 26 July 2018.
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lowest-cost appropriate settings, the complimentary systems of non-medical long-term services 

and supports provided by ACL’s networks are expected to play an increasingly important role in 

the Department’s efforts to deliver more effective services at lower costs.
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Overview of the Budget Request

With a mission of helping all Americans live independently and fully participate in their 

communities, the Administration for Community Living (ACL) advocates across the Federal 

government for older adults, people with disabilities and their families and caregivers. ACL funds 

services and supports provided primarily by networks of community-based organizations; and 

invests in training, education, research and innovation. 

The FY 2020 discretionary request for ACL is $2,032,671,000, a reduction of -$136,644,000 

below the FY 2019 Enacted level. ACL has worked to expand flexibility and invest in programs 

that provide direct services to older adults and people with all disabilities. 

The FY 2020 budget includes a request to increase the authority of Older Americans Act (OAA)

programs to shift funding to meet needs in states and to consolidate preventive health services 

activities. The Older Americans Act authorization expires in 2020. The Administration supports 

the reauthorization of the Older Americans Act and looks forward to working with and providing 

technical assistance to Congress. It also directs $2 million within the Elder Justice program toward 

opioid abuse cases. ACL has enhanced its focus on outcome measures that are required from 

grantees and has begun a robust program evaluation in 2019 that will continue to be developed 

throughout 2020.

Increasing Flexibility for States and Tribes

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

existing transfer authorities for States and Tribes to maximize flexibility to transfer funding

between four Older Americans Act programs. These programs are: Home and CommunityBased Services, Nutrition Services, Family Caregiver Services and Preventive Health

Services. This additional authority will provide States and Tribes the flexibility to allocate

funding to best address their individual challenges.

• The Budget continues to include the proposal to combine Chronic Disease

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

Preventive Health Services Program, increasing the ability of State’s to focus resources

where they are most needed, with savings of -$13.0 million.

The FY 2020 ACL budget request invests in programs that provide direct services and continues 

to maintain oversight activities at a fiscally responsible level.

• Capacity Building, Knowledge Generation, and Information Referral Activities, and Rights

Protection: The Budget continues to support programs which provide capacity building,

knowledge generation, and information and referral activities. Programs include State

Councils on Developmental Disabilities (-$20.0 million), University Centers for

Excellence in Developmental Disabilities (-$8.1 million), Aging and Disability Resource

Centers (-$2.0 million), Voting Access for People with Disabilities (-$2.0 million),

Traumatic Brain Injury (-$2.0 million), Developmental Disability Protection and
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Advocacy (-$2.0 million), and Lifespan Respite Care (-$0.8 million). Total savings 

produced: -$36.8 million. 

• Research and Demonstration: ACL’s research programs explore new ways of assisting 

older adults and people with disabilities to remain in their communities. Reductions 

include the National Institute on Disability, Independent Living, and Rehabilitation 

Research (-$18.6 million); Projects of National Significance (-$10.9 million); and the 

Alzheimer’s Disease Program (-$4.0 million). Funding is not included for the Care Corps 

program (-$5.0 million) which was newly funded in FY 2019. Total savings 

produced: -$38.6 million. 

• Direct Services: The Budget maintains funding at the FY 2019 Enacted level for ACL’s 

core direct service programs serving older Americans and person with disabilities. These 

include Home and Community Based Supportive Services, Nutrition Services, and Centers 

for Independent Living.

• Supportive Services. The Budget reduces the Caregiver Supportive Services Programs 

(-$33.1 million), State Health Insurance Assistance Program (-$13.0 million), State Grants 

for Independent Living (-$7.5 million), and the State Long-Term Care Ombudsman 

program (-$1.0 million). ACL is committed to identifying new ways to efficiently support

the purposes of these programs at this reduced level. Total savings produced -$54.7 million. 

• Program Administration: Funding for ACL program administration is reduced 

by -$2.1 million. This reduction results in a decrease of -9 FTE, and minimizing operating 

expenses such as travel, contracts, business process reengineering, human capital 

development, and funding supporting existing and emerging technological trends.

• Program Eliminations: Funding for the Alternative Financing Grant Competition, which is 

no longer authorized by the Assistive Technology Act would be eliminated (-$2 million). 

ACL’s Assistive Technology State grant program already includes alternative financing as 

an allowable activity, giving states the option to make decisions to best meet their own 

needs. In addition, funding for the Limb Loss Resource Center and Paralysis Resource 

Center would also be eliminated saving another -$12.2 million. Savings from eliminating 

these programs total -$14.2 million.

Conclusion

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

independent settings if they have access to the services and support they need. For millions, this 

help comes through the community-based services and supports provided by ACL’s programs. 

ACL remains committed to its central mission of supporting people with disabilities and older 

adults so they can live independently and fully participate in their communities. This budget allows 

ACL to continue to serve its populations while expanding program flexibilities and supporting 

targeted efforts to address the priorities identified by the HHS Secretary. 
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Overview of Performance

ACL programs and activities have a fundamental purpose: to develop and support a 

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

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

communities and participate fully in society. This purpose led ACL to focus on the following 

categories of performance measures: 1) improving consumer outcomes and delivery systems; 2) 

effectively targeting services to at risk populations; and 3) improving program efficiency. Each 

performance measure is aligned with a goal and represents activities that span across ACL. 

Progress toward the goal is tracked using performance indicators. 

Overview of Performance

ACL’s home and community-based programs, nutrition programs, and family caregiver support 

programs continue to meet or exceed their targets for most measures including the number of 

clients served per million dollars of funding (measure 1.1) and increasing the likelihood that the 

most vulnerable people receiving services will continue to remain in their homes (measure 2.10). 

ACL has exceeded its targets in terms of serving older Americans living in rural areas (measure 

3.3) and living in poverty (measure 3.6), which are risk factors for institutionalization. In terms 

of nutrition, supportive, and caregiver services for Native American elders, ACL continues to use

targeted technical assistance to meet its targets for the number of units of service provided per 

thousand dollars of funding (measure 1.3). A significant performance-based accomplishment for 

family and caregiver support programs is the implementation of a standardized method for 

measuring the progress of Alzheimer’s disease supportive services program grantees towards the 

outcome of improving the dementia-capability of long-term support systems to create dementiafriendly livable communities (measure AZL.3).

ACL’s performance in protecting vulnerable adults continues to exceed targets in areas such as 

reducing the number of complaints made to Long-Term Care Ombudsmen that are not resolved to 

the clients’ satisfaction (measure 2.14). ACL projects continued growth in the amount of funds 

that states can leverage for prevention of elder abuse and neglect based on their use of Older 

Americans Act (OAA) funding (measure output U). A significant performance-based 

accomplishment in this area is the design of a new Adult Protective Services (APS) Client 

outcomes study to determine how APS makes a difference in the lives of the older adults and adults 

with disabilities who interact with it. The only study examining the outcomes of older adults who 

were abused, comparing those who interacted with APS with those who did not, was conducted in 

1968. In FY 2018, ACL also began planning to develop an APS research agenda to build the 

evidence base for Adult Protective Services, and to provide guidance and tools needed by the field.

ACL continues to expand its reach through its disability programs, research, and services; for 

example, through an increased percentage of individuals with developmental disabilities served by 

people who have been trained by ACL funded University Centers for Excellence in Developmental 

Disabilities (UCEDDS) (measure 8D). ACL is proposing several new performance measures for 

its disability programs, research, and services. These include three new measures related to the 

use and availability of assistive technology, and more robust measures of enforcing, retaining, 
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restoring, or expanding the rights of individuals with developmental disabilities (measure 8F and 

8G). A significant performance-based accomplishment in this area is the drafting of new 

performance measures for three programs (Traumatic Brain Injury, Independent Living Services 

and Centers for Independent Living) to support program management and services to individuals 

with disabilities. 

ACL’s Internal Performance Management Process

ACL’s performance data is reported and tracked for three primary reasons: 1) to monitor the 

administration’s progress towards achieving our departmental and agency strategic goals, 

objectives, and priorities 2) to support ACL’s budget justifications; and 3) to monitor program 

performance and support improvement. ACL employs a program performance management 

strategy with multiple components. This includes coordination and collaboration with other 

agencies and organizations, enhanced partnerships between aging and disability networks, and 

senior leadership involvement in performance management. For example, in FY 2018, ACL’s 

Office for Performance and Evaluation partnered with the Assistance Secretary for Planning and 

Evaluation (ASPE) to develop a framework for evaluating ACL’s disability programs. The results 

of this work are expected in FY 2019 and will provide ACL with a roadmap for better evaluation 

and monitoring of these programs. 

ACL’s performance management strategy sets the foundation for a full learning agenda that will 

help ACL to identify the most important questions that need to be answered to improve program 

implementation and performance, strategically prioritize the questions and the research activities 

needed to answer them, and ultimately guide ACL’s ability to act on the results by using the 

information for policy decisions and continuous program improvement. The strategy presents a 

high-level approach to the planning, and implementation of performance management and 

represents ACL’s commitment to providing rigorous, relevant, and transparent performance data. 

The National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), 

Long-Range Plan is a five-year agenda to support ACL’s research efforts in the areas of applied 

disability, independent living, and rehabilitation research and will guide the development and 

refinement of performance measurement for NIDILRR’s programs (see proposed new 

performance measures R1a, R1b, and R2 in the Summary of Proposed Changes in Performance 

Measures). The Plan emphasizes consumer relevance and scientific rigor, presents a 5-year agenda 

that is scientifically sound and accountable, and will contribute to the refinement of national policy 

affecting people with disabilities.

ACL’s senior management directly engages in performance management activities through grants 

and procurement planning. Developmental disability programs under ACL have implemented a 

quality review system (QRS) that uses a three-tiered model to review program compliance, 

outcomes, and fiscal operations. ACL’s Older Americans Act Title III and VII state formula grant 

programs continue development of a formula-grant monitoring framework that combines 

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

and instances of fraud, waste and abuse. Older Americans Act programs also have an annual state 
EXECUTIVE SUMMARY

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review tool that assesses program performance and a state fiscal monitoring review tool that 

assesses fiscal operations. Results of reviews are used to target and coordinate technical assistance. 

In addition to monitoring grants, each program within ACL develops a Program Funding Plan for 

senior management review and approval. The plan details proposed grant and procurement 

activities and justifies how the activity supports ACL’s mission and performance goals. ACL is 

enhancing this process by including formal reviews of Funding Opportunity Announcements 

(FOAs) to ensure alignment with ACL’s priorities. All FOAs will identify measurable performance 

metrics, including requiring outcomes demonstrating the value of the program in both the grant 

application and progress reports. ACL also employs extensive program evaluation methods,

including longitudinal data collection and matched comparison groups. 

Senior leadership has established processes for use of performance data for management decisionmaking, including a periodic grants dashboard, monthly reports for the Administrator/Assistant 

Secretary, quarterly reviews of operating budgets, managers meetings and bi-weekly center 

director meetings. In collaboration with the aging and disability networks, ACL is committed to 

high performance and delivery to accomplish our performance goals. 

ACL’s Use of Performance Information for Management Purposes 

ACL grant awards are made, in part, based on the clarity and nature of proposed outcomes and 

whether the proposed project evaluation reflects a thoughtful and well-designed approach that will 

be able to successfully measure whether or not the project has achieved its proposed outcome. This 

approach includes the qualitative and/or quantitative methods necessary to measure outcomes; and 

is designed to capture “lessons learned” from the overall effort that might be of use to others, 

especially those who might be interested in replicating the project. ACL also works through its 

resource centers to help grantees use evidence to drive improvements in outcomes for older adults 

and individuals with disabilities.

ACL collects administrative data from grantees to improve its programs and the capacity of service 

providers. Examples include:

• In 2014, ACL developed a Dementia Capability Assessment Tool in support of its

programs to expand dementia capability in communities. In 2017, the tool was translated

into an on-line format, making it possible to analyze each program’s progress toward

dementia capability in its entirety or broken down by sector.

• Veteran Directed Care (VDC) formerly known as (Veterans Directed-Home and

Community-Based Services) data is used to make the business case to offer Veterans at 

risk of NH admission the opportunity to self-direct their care through Veteran Directed 

Care. For the same cost as serving one Veteran in a community nursing home, three 

Veterans could be served through VDC in the community. VDC enables the VA to serve 

more Veterans with same investment.
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• The VA is using the VDC case-mix methodology as an approach to determine the amount

of personal care services (Homemaker/Home Health Aide, Adult Day Care, Home Respite)

a Veteran should receive based on their ADL needs, behavioral health needs, and

specialized rehabilitation needs.

• The Administration for Intellectual and Developmental Disabilities is building the capacity

of state developmental disabilities agencies to gather vital information on service outcomes

through the National Data Measurement Project and the adoption of the National Core

Indicators (NCI) as the uniform dataset. The NCI framework comprises over 100 key

outcome indicators that are designed to gather valid and reliable data across five broad

domains: individual outcomes; family outcomes; health, welfare, and rights; staff stability;

and system performance.

• ACL develops and operates systems that support the collection and analysis of performance

data from grantees. These systems are designed to be enhanced and modified to support

improved outcome and quality performance measures.

ACL is also exploring methods for potentially redirecting funds to invest in higher performing 

models. Examples include: 

• The Paralysis Resource Center State Pilot Program is an effort to ensure program efficiency

and to test two approaches for making sub-awards to community-based organizations that

provide long-term services and supports to people with paralysis, their families, and their

support networks. Outcomes from the pilot will help ACL assess the most effective and

efficient ways to make such sub-awards and will determine how ACL funds this effort

going forward.

• The Chronic Disease Self-Management/Education and Falls Management Program grants

will be monitored using a new tool that allows grant officers to more clearly determine

grantees’ progress towards meeting their targeted service levels and, therefore, restrict or

withhold funding based on that progress.
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Overview of ACL’s Use Of Evaluations And Other Evidence-Based Approaches

In 2018, ACL started or continued evaluations of the following programs:

New Evaluations:

• Model Approaches for Enhancing the Quality, Effectiveness and Monitoring of Home and

Community-Based Services for Individuals with Developmental Disabilities Grantees;

• Community of Practice Supporting Families;

• Designing an approach for an Adult Protective Services Client Outcomes Study

Existing Evaluations: 

• Partnerships in Employment Systems Change grants

• Evaluation of the Longer-term outcomes of NIDILRR programs and the Effectiveness and

Efficiency of the Grant-making Process;

• Older Americans Act Title VI Tribal Grants Programs;

• Older Americans Act Long Term Care Ombudsman Program,

• Older Americans Act Nutrition Services Program; and,

• Older Americans Act National Family Caregiver Services Program.

In FY 2018, ACL published the:

• Evaluation of the ACL Title VI Programs: Year 1 Interim Report outlining the approach to

and the design of the evaluation. In addition, the report provides information on the

evaluation participants, timeline of the project, and initial findings

• Client Outcome Study: Part II which describes participants’ health and health care

utilization and examines overall wellness measured using longer-term outcomes related to

health and avoidance of institutionalization.

• Outcome Evaluation of the National Family Caregiver Support Program (NFCSP) which

describes the impact of the program on informal caregivers. Ninety-eight percent of the

caregivers said the NFCSP was “helpful”. Similarly, among those caregivers who received

educational services, 99 percent said the educational services received were “helpful” for

allowing them to continue providing quality care to their loved ones. Among caregivers

who used NFCSP respite care, as the respite hours per week increased so did the probability

of caregivers saying that the service allowed them to provide care longer.

The final report for the Older Americans Act Long Term Care Ombudsman Program process 

evaluation is expected in March 2019. This report will describe how Ombudsman programs 

identify, investigate and resolve complaints about the care residents receive with respect to their 

health, safety, welfare and rights; represent residents’ interests before government agencies and 

analyze, comment on, and monitor federal, state and local regulations, policies, and actions that 

potentially affect residents of long-term care facilities; and provide information and consultation 

to facilities and residents and their families as well as collaboration with other agencies. A study 
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to determine the efficacy of LTCOP in carrying out core functions as described in the Older 

Americans Act, the long-term impacts of the LTCOP’s for various stakeholders, what system 

advocacy among Ombudsman programs looks like, and effective or promising Ombudsman 

program practices is also being conducted.

ACL is committed to conducting rigorous, relevant evaluations and using evidence from 

evaluations to inform policy and practice. ACL adopted a learning agenda approach, which 

involves annual reviews with each ACL Office/Center to support the generation and use of 

evaluation findings to inform agency strategies and decision-making.

Impact of Budget Changes on ACL’s Performance Targets

Budget changes have a range of impacts on ACL performance targets. For targets that are highly 

budget sensitive, such increasing the number of caregivers served through the National Family 

Caregiver Support Program. (measure 3.1), as funding levels increase or decrease there is expected 

to be a related change in ACL’s projected targets. For other programs where funding level changes 

may affect program operations, the changes in ACL targets may be dependent on how programs 

react to funding level changes. For example, the evaluation of the Older Americans Act Nutrition 

Services Program found that based on changes in program costs or funding levels many agencies 

reported reducing staff or staff hours (47 percent), reducing the number of days of service per week 

at congregate locations (34 percent), reducing the number of congregate nutrition sites (33 

percent), and reducing the frequency of home-delivered meals (32 percent). However, many 

agencies also reported modifying menus or, in the home-delivered nutrition program, increasing 

the use of frozen meals (49 and 39 percent, respectively). Such changes may effect measures of 

program satisfaction, such as 2.9a, or the degree to which the programs can help those served 

remain in their homes and communities (measure 2.10).
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All Purpose Table

Administration for Community Living

(Dollars in Thousands)

Health & Independence for Older Adults FY 2018 

Final/1

FY 2019 

Enacted

FY 2020 

President's 

Budget

FY 2020 

President's 

Budget +/-FY 

2019 Enacted

Home & Community-Based Supportive Services 384,118 385,074 385,074 - 

Nutrition Services 894,528 906,753 906,753 - 

Congregate Nutrition Services (non-add) 489,125 495,342 495,342 - 

Home-Delivered Nutrition Services (non-add) 245,731 251,342 251,342 - 

Nutrition Services Incentive Program (non-add) 159,672 160,069 160,069 -

Preventive Health Services 24,786 24,848 24,848 - 

Chronic Disease Self-Management Education [PPHF]/2 8,000 8,000 -- (8,000)

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

Native American Nutrition & Supportive Services 33,129 34,208 34,208 - 

Aging Network Support Activities 12,430 17,461 11,503 (5,958)

Holocaust Survivor Assistance {non-add} 4,988 5,000 5,000 -

Care Corp (non-add) -- 5,000 -- (5000)

Subtotal, Health & Independence for Older Adults 1,361,992 1,381,344 1,362,386 (18,958)

Caregiver & Family Support Services FY 2018 

Final/1

FY 2019 

Enacted

FY 2020 

President's 

Budget

FY 2020 

President's 

Budget +/-FY 

2019 Enacted

Family Caregiver Support Services 180,138 181,186 150,586 (30,600)

Native American Caregiver Support Services 9,529 10,056 7,556 (2,500)

Alzheimer's Disease Program 23,478 23,500 19,490 (4,010)

Alzheimer's Disease from Direct Appropriations {Non-Add} 8,778 8,800 19,490 10,690 

Alzheimer's Disease from PPHF {Non-Add} 2/ 14,700 14,700 -- (14,700)

Lifespan Respite Care 4,100 4,110 3,360 (750)

Subtotal, Caregiver & Family Support Services 217,244 218,852 180,992 (37,860)

Protection of Vulnerable Adults FY 2018 

Final/1

FY 2019 

Enacted

FY 2020 

President's 

Budget

FY 2020 

President's 

Budget +/-FY 

2019 Enacted

Long-Term Care Ombudsman Program 16,843 16,885 15,855 (1,030)

Prevention of Elder Abuse & Neglect 4,761 4,773 4,773 - 

Senior Medicare Patrol Program/HCFAC /3 18,000 18,000 18,000 -

Elder Rights Support Activities 15,835 15,874 13,874 (2,000)

Elder Justice {non-add} 11,970 12,000 10,000 (2,000)

Subtotal, Protection of Vulnerable Adults 55,439 55,532 52,502 (3,030)
EXECUTIVE SUMMARY

14

All Purpose Table - Continued

Administration for Community Living

(Dollars in Thousands)

Disability Programs, Research & Services FY 2018 

Final/1

FY 2019 

Enacted

FY 2020 

President's 

Budget

FY 2020 

President's 

Budget +/-FY 

2019 Enacted

State Councils on Developmental Disabilities 75,943 76,000 56,000 (20,000)

Developmental Disabilities Protection and Advocacy 40,677 40,734 38,734 (2,000)

University Centers for Excellence in Developmental 

Disabilities 40,543 40,619 32,546 (8,073)

Projects of National Significance 11,770 12,000 1,050 (10,950)

Independent Living 112,902 116,183 108,646 (7,537)

Limb Loss Resource Center 3,491 3,500 -- (3,500)

Paralysis Resource Center 7,681 8,700 -- (8,700)

Traumatic Brain Injury 11,293 11,321 9,321 (2,000)

National Institute on Disability, Independent Living, and 

Rehab. Research 104,710 108,970 90,371 (18,599)

Subtotal, Disability Programs, Research & Services 409,010 418,027 336,668 (81,359)

Consumer Information, Access and Outreach FY 2018 

Final/1

FY 2019 

Enacted

FY 2020 

President's 

Budget

FY 2020 

President's 

Budget +/-FY 

2019 Enacted

Aging and Disability Resource Centers 8,099 8,119 6,119 (2,000)

State Health Insurance Assistance Program 49,115 49,115 36,115 (13,000)

Voting Access for People with Disabilities (HAVA) 6,946 6,963 4,963 (2,000)

Assistive Technology 35,911 36,000 31,939 (4,061)

Assistive Technology - (non-add) 34,000 34,000 31,939 (2,061)

Assistive Technology - Alternative Financing Program (nonadd) 1,911 2,000 -- (2,000)

Medicare Improvements for Patients and Providers Act 

[TRA/BBA]/4 37,500 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 {nonadd} 12,000 12,000 12,000 -

State Health Insurance Assistance Program {non-add}/4 13,000 13,000 13,000 -

Subtotal, Consumer Information, Access & Outreach 137,570 137,697 116,636 (21,061)

Program Administration FY 2018 

Final/1

FY 2019 

Enacted

FY 2020 

President's 

Budget

FY 2020 

President's 

Budget +/-FY 

2019 Enacted

Program Administration 40,961 41,063 38,987 (2,076)
EXECUTIVE SUMMARY

15

All Purpose Table - Continued

Administration for Community Living

(Dollars in Thousands)

Subtotal, Program Level FY 2018 

Final/1 

FY 2019 

Enacted

FY 2020 

President's 

Budget

FY 2020 

President's 

Budget +/-FY 

2019 Enacted

Subtotal, Program Level 2,222,216 2,252,515 2,088,171 (164,344)

Less: Funds from Mandatory Sources FY 2018 

Final/1

FY 2019 

Enacted

FY 2020 

President's 

Budget

FY 2020 

President's 

Budget +/-FY 

2019 Enacted

HCFAC Funds for Senior Medicare Patrol Program /3 (18,000) (18,000) (18,000) - 

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

Medicare Improvements for Patients and Providers Act (37,500) (37,500) (37,500) - 

Aging and Disability Resource Centers (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 {nonadd} (12,000) (12,000) (12,000) -

State Health Insurance Assistance Program {non-add}/4 (13,000) (13,000) (13,000) -

Category FY 2018 

Final/1

FY 2019 

Enacted

FY 2020 

President's 

Budget

FY 2020 

President's 

Budget +/-FY 

2019 Enacted

Total, Discretionary Budget Authority 2,139,016 2,169,315 2,032,671 (136,644)

Non-recurring Expense Fund (NEF)/5 - 5,000 - (5,000)

Total FTE 188 198 189 (9)

1/ Reflects FY 2018 required and permissive transfers and rescissions, except the NSIP transfer to USDA of 

$2.7 million which is shown for consistency with State funding tables.

2/ In FY 2018 and FY 2019 these programs were paid for out of the Prevention and Public Health Fund.

3/The FY 2018 and FY 2019 appropriations state that SMP/HCFAC is paid for out of discretionary CMS 

appropriations for HCFAC, to the Centers for Medicare & Medicaid Services based, on the Secretary of HHS's 

determination of the amount needed to provide full funding and not less than the floor provided in 

appropriations language. The FY 2020 amount serves as a placeholder for FY 2020 pending final decisions on 

the amount by the Secretary of HHS.

4/ Funding is currently appropriated to the Centers for Medicare & Medicaid Services directly and transferred 

to ACL via an Intra-Departmental Delegation of Authority (IDDA).

5/ Amounts notified are approximations of intended use. Amounts displayed here are current best estimates.
EXECUTIVE SUMMARY

16

Appropriations Language 

Administration for Community Living

AGING AND DISABILITY SERVICES PROGRAMS

(Including transfer of funds)

For carrying out, to the extent not otherwise provided, the Older Americans Act of 1965 ("OAA"), 

the RAISE Family Caregivers Act, the Supporting Grandparents Raising Grandchildren Act, 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, 

[$2,120,200,000]$1,996,556,000, together with [$49,115,000]$]$36,115,000 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 

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 low-interest 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 community-based disability 

organizations that are directed by and operated for individuals with disabilities shall be eligible 

to compete:] Provided further, that none of the funds made available under this heading may be used 

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

Mental Illness Act (42 U.S.C. 10802)) to continue to pursue any legal action in a Federal or State 

court on behalf of an individual or group of individuals with a developmental disability (as defined in 

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

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

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

care facilities for people with intellectual or developmental disabilities, unless reasonable public 

notice of the action has been provided to such individuals (or, in the case of mental incapacitation, the 
EXECUTIVE SUMMARY

17

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, 2019).
EXECUTIVE SUMMARY

18

Appropriations Language Analysis

Administration for Community Living

Language Provision Explanation

For carrying out, to the extent not otherwise 

provided, the Older Americans Act of 1965 

("OAA"), the RAISE Family Caregivers Act, the 

Supporting Grandparents Raising Grandchildren 

Act, 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, [$2,120,200,000]$1,996,556,000, 

together with [$49,115,000]$]$36,115,000 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: 

Sets out the budget authority for the Aging and 

Disability Services Programs appropriation 

Provided, That amounts appropriated under this 

heading may be used for grants to States under 

section 361 of the OAA only for disease 

prevention and health promotion programs and 

activities which have been demonstrated through 

rigorous evaluation to be evidence-based and 

effective:

Limits use of funding provided for the Preventive 

Health Services program to programs and 

activities which have been proven to be 

evidence-based and effective. 

Provided further, That of amounts made available 

under this heading to carry out sections 311, 331, 

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

amounts shall be available for developing and 

implementing evidence- based practices for 

enhancing senior nutrition:

Allows ACL to use up to 1% of its appropriations 

for nutrition innovation demonstrations designed 

to develop and implement evidence-based 

practices that enhance senior nutrition.
EXECUTIVE SUMMARY

19

Language Provision Explanation

Provided further, That notwithstanding any other 

provision of this Act, funds made available under 

this heading to carry out section 311 of the OAA 

may be transferred to the Secretary of 

Agriculture in accordance with such section:

Allows for transfer of Nutrition Services 

Incentives (NSIP) funding to USDA to provide 

reimbursement for commodities elected by 

States or Tribes in lieu of part or all of their NSIP 

allocation. 

[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; 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 

community-based disability organizations that 

are directed by and operated for individuals with 

disabilities shall be eligible to compete: 

Removes language that provides appropriations 

for the Assistive Technology Alternative Financing 

Program since the Budget does not include

funding for this program.
EXECUTIVE SUMMARY

20

Language Provision Explanation

Provided further, that none of the funds made 

available under this heading may be used by an 

eligible system (as defined in section 102 of the 

Protection and Advocacy for Individuals with 

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

to pursue any legal action in a Federal or State 

court on behalf of an individual or group of 

individuals with a developmental disability (as 

defined in section 102(8)(A) of the 

Developmental Disabilities and Assistance and Bill 

of Rights Act of 2000 (20 U.S.C. 15002(8)(A)) that 

is attributable to a mental impairment (or a 

combination of mental and physical 

impairments), that has as the requested remedy 

the closure of State operated intermediate care 

facilities for people with intellectual or 

developmental disabilities, unless reasonable 

public notice of the action has been provided to 

such individuals (or, in the case of mental 

incapacitation, the legal guardians who have 

been specifically awarded authority by the courts 

to make healthcare and residential decisions on 

behalf of such individuals) who are affected by 

such action, within 90 days of instituting such 

legal action, which informs such individuals (or 

such legal guardians) of their legal rights and how 

to exercise such rights consistent with current 

Federal Rules of Civil Procedure:

Identifies the purpose, and limits on the use of 

funds provided for Protection and Advocacy. 

Provided further, That the limitations in the 

immediately preceding proviso shall not apply in 

the case of an individual who is neither 

competent to consent nor has a legal guardian, 

nor shall the proviso apply in the case of 

individuals who are a ward of the State or subject 

to public guardianship.

Identifies the limitations that are not applicable 

to listed individuals. 
EXECUTIVE SUMMARY

21

Amounts Available for Obligation

Administration for Community Living

General Fund Discretionary Appropriation:

FY 2018 Final FY 2019 

Enacted

FY 2020 President's 

Budget

Appropriation (L/HHS, Ag, or, Interior) 2,095,100,000 2,120,200,000 1,996,556,000

Secretary's Transfer 5,199,000 -- --

Subtotal, adjusted appropriation 2,089,901,000 2,120,200,000 1,996,556,000

Transfer of Funds to Department of Agriculture 1/ -2,752,453 -1,902,259 --

Trust Fund Discretionary Appropriation: -- -- --

Appropriation Lines -- -- --

Transfer Lines -- -- --

Subtotal, adjusted trust fund discr. appropriation -- -- --

Total, Discretionary Appropriation 2,087,148,547 2,118,297,741 1,996,556,000

Mandatory Appropriation:

FY 2018 Final FY 2019 

Enacted

FY 2020 President's 

Budget

BA Transfer (PPACA) from Prevention Funds 2/... 24,180,907 31,752,598 --

Appropriation (TRA/MACRA) MIPPA 3/ 24,323,372 27,002,555 --

Subtotal, mandatory. appropriation 48,504,279 58,755,153 0

Offsetting collections from:

FY 2018 Final FY 2019 

Enacted

FY 2020 President's 

Budget

 Trust Funds: HCFAC HI 4/ 18,078,440 18,063,863 18,000,000

 Trust Funds: SHIPs HI/SMI 49,115,000 49,115,000 36,115,000

Subtotal, offsetting collections 67,193,440 67,178,863 54,115,000

Unobligated balance, lapsing 1,154,534 -- --

Total obligations 2,201,691,732 2,244,231,757 2,050,671,000

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

Program. Discretionary appropriations on this table will therefore differ by this amount from amounts listed on 

ACL's APT.

2/ Includes carryover funding in FY 2018 and FY 2019.

3/ MIPPA Funding excludes $13,000,000 in each year directly appropriated to CMS for MIPPA-SHIP and 

then made available to ACL through an Intra-Departmental Delegation of Authority. Includes carryover in FY 

2018 and FY 2019.

4/ Amount for FY 2020 is a placeholder pending a Secretarial decision on the amount. FY 2018 and FY 2019

amounts include carryover.
EXECUTIVE SUMMARY

22

Summary of Changes

Administration for Community Living

(Dollars in Thousands)

2019 Enacted

Total estimated budget authority ............. 2,169,315

(Obligations) .....................................2,169,315

2020 President's Budget

Total estimated budget authority ..............2,032,671

(Obligations) .....................................2,032,671

Net Change ........................................136,644

Category FY 2019 

Final

FY 2020 

PB FTE

FY 2020 

PB BA

FY 2020 

+/- FY 

2019 FTE

FY 2020 +/-

FY 2019 BA

Increases: - - - - -

A. Built-in: - - - - -

Subtotal, Built-in Increases 0 - 0 - 0

A. Program: - - - -

Subtotal, Program Increases - - - - 10,690 

Total Increases - - - - 10,690 

Decreases: - - - - -

A. Built-in: - - - - -

1. Program Administration 41,063 162.0 38,987 (9.0) (2,076)

Subtotal, Built-in Decreases - - (9.0) (2,076)

A. Program: - - - - -

1. Aging Network Support Activities 17,461 0.4 11,503 - (5,958)

2. Family Caregiver Support Services 181,186 - 150,586 - (30,600)

3. Native American Caregiver Support Services 10,056 - 7,556 - (2,500)

5. Lifespan Respite Care 4,110 - 3,360 - (750)

6. Long-Term Care Ombudsman Program 16,885 - 15,855 - (1,030)

7. Elder Rights Support Activities 15,874 2.6 13,874 - (2,000)

8. State Councils on Developmental Disabilities 76,000 - 56,000 - (20,000)

9. Developmental Disabilities Protection & Advocacy 40,734 - 38,734 - (2,000)

10. University Centers for Excellence in DD 40,619 - 32,546 - (8,073)

11. Projects of National Significance 12,000 - 1,050 - (10,950)

12. Independent Living 116,183 1.0 108,646 - (7,537)

13. Limb Loss Resource Center 3,500 - - - (3,500)

14. Paralysis Resource Center 8,700 - - - (8,700)

15. Traumatic Brain Injury 11,321 1.6 9,321 - (2,000)

16. Natl Inst on Disability, Ind. Living & Rehab Res. 108,970 - 90,371 - (18,599)

17. Aging and Disability Resource Centers 8,119 - 6,119 - (2,000)

18. State Health Insurance Assistance Program 49,115 4.4 36,115 - (13,000)

19. Voting Access for People with Disabilities 6,963 - 4,963 - (2,000)

20. Assistive Technology 36,000 - 31,939 - (4,061)

Subtotal, Program Decreases - - - - (145,258)

Total Decreases - - - (9.0) (147,334)

Net Change - - - (9.0) (136,644)
EXECUTIVE SUMMARY

23

Budget by Activity

(Dollars in thousands)

Administration for Community Living

Health & Independence for Older Adults

FY 2018 

Final 1/

FY 2019 

Enacted

FY 2020 

President's 

Budget

Home & Community-Based Supportive Services 384,118 385,074 385,074

Nutrition Services 894,528 906,753 906,753

Preventive Health Services 24,786 24,848 24,848

Native American Nutrition & Supportive Services 33,129 34,208 34,208

Aging Network Support Activities 12,430 17,461 11,503

 Subtotal, Health & Independence for Older Adults 1,348,992 1,368,344 1,362,386

Caregiver & Family Support Services

FY 2018 

Final 1/

FY 2019 

Enacted

FY 2020 

President's 

Budget

Family Caregiver Support Services 180,138 181,186 150,586

Native American Caregiver Support Services 9,529 10,056 7,556

Alzheimer's Disease Program 8,778 8,800 19,490

 PPHF Funding [non-add] 14,700 14,700 --

Lifespan Respite Care 4,100 4,110 3,360

Subtotal, Caregiver & Family Support Services 202,544 204,152 180,992

Protection of Vulnerable Adults

FY 2018 

Final 1/

FY 2019 

Enacted

FY 2020 

President's 

Budget

Long-Term Care Ombudsman Program 16,843 16,885 15,855

Prevention of Elder Abuse & Neglect 4,761 4,773 4,773

Elder Rights Support Activities 15,835 15,874 13,874

Subtotal, Protection of Vulnerable Adults 37,439 37,532 34,502

FY 2020 

Disability Programs, Research & Services

FY 2018 

Final 1/ 

FY 2019 

Enacted 

President's 

Budget 

State Councils on Developmental Disabilities 75,943 76,000 56,000 

Developmental Disabilities Protection and Advocacy 40,677 40,734 38,734 

University Centers for Excellence in Developmental Disabilities 40,543 40,619 32,546 

Projects of National Significance 11,770 12,000 1,050 

Independent Living 112,902 116,183 108,646 

Limb Loss Resource Center 3,491 3,500 --

Paralysis Resource Center 7,681 8,700 --

Traumatic Brain Injury 11,293 11,321 9,321 

National Institute on Disability, Independent Living, and Rehab. Research 104,710 108,970 90,371 

Subtotal, Disability Programs, Research & Services 409,010 418,027 336,668 
EXECUTIVE SUMMARY

24

Consumer Information, Access & Outreach

FY 2018 

Final 1/

FY 2019 

Enacted

FY 2020 

President's 

Budget

Aging and Disability Resource Centers [Discretionary] 8,099 8,119 6,119

State Health Insurance Assistance Program 49,115 49,115 36,115

Voting Access for People with Disabilities (HAVA) 6,946 6,963 4,963

Assistive Technology 35,911 36,000 31,939

Subtotal, Consumer Information, Access & Outreach 100,070 100,197 79,136

Program Administration

FY 2018 

Final 1/

FY 2019 

Enacted

FY 2020 

President's 

Budget

Program Administration 40,961 41,063 38,987

Total, Discretionary Budget Authority 

FY 2018 

Final 1/

FY 2019 

Enacted

FY 2020 

President's 

Budget

Total, Discretionary Budget Authority 2,139,016 2,169,315 2,032,671

 Total FTE 188 198 189

1/ Reflects FY 2018 required and permissive transfers and rescissions, except the NSIP transfer to USDA of $2.7 

million which is shown for consistency with State funding tables.
EXECUTIVE SUMMARY

25

Authorizing Legislation

Administration for Community Living

Category

FY 2019 

Amount 

Authorized

FY 2019 

Amount 

Appropriated

FY 2020 

Amount 

Authorized

FY 2020 

President's 

Budget

1) Home and Community-Based Supportive

Services: OAA Section 303 (a)(1) 372,196,069 385,074,000 Expired 385,074,000 

2) Nutrition Services: OAA Section 303 (b)(1)(2),

311(e) 893,084,162 906,753,000 Expired 906,753,000 

3) Preventive Health Services: OAA Section 361 21,244,860 24,848,000 Expired 24,848,000 

4) Chronic Disease Self Management Education:

OAA Section 411 NA 8,000,000 Expired - 

5) Falls Prevention: OAA Section 411 NA 5,000,000 Expired - 

6) National Family Caregiver Support Program:

OAA Section 303 (e) 160,791,658 181,186,000 Expired 150,586,000 

7) Native American Nutrition and Supportive

Services: OAA Sections 643 33,269,670 34,208,000 Expired 34,208,000 

8) Native American Caregiver Support Program:

OAA Section 631 8,041,398 10,056,000 Expired 7,556,000 

9) Alzheimer's Disease Program: - - - - 

OAA Section 411 NA 8,800,000 Expired 19,490,000 

Patient Protection & Affordable Care Act, Sect 

4002 NA 14,700,000 - - 

10) Long-Term Care Ombudsman Program: OAA

Section 702(a) 16,961,573 16,885,000 Expired 15,855,000 

11) Prevention of Elder Abuse and Neglect: OAA

Section 702(b) 5,096,480 4,773,000 Expired 4,773,000 

12) Elder Rights Support Activities: OAA Sections

201, 202, and 411, 751, and 752, as amended.

Social Security Act, Title XX-B, Section 2042 12,678,736 15,874,000 Expired 13,874,000 

13) Aging Network Support Activities: OAA Sections

202, 215 and 411 10,636,086 17,461,000 Expired 11,503,000 

14) Lifespan Respite Care: Lifespan Respite Care

Act of 2006 and Public Health Service Act Title

XXIX Expired 4,110,000 Expired 3,360,000 

15) Program Administration: OAA Section 216 (a) 40,063,000 41,063,000 Expired 38,987,000 

16) Aging and Disability Resource Centers: OAA

Sections 216 (b)(4) 6,533,703 8,119,000 Expired 6,119,000 

17) State Health Insurance Assistance Program:

Omnibus Budget Reconciliation Act of 1990 Section

4360 Expired 49,115,000 Expired 36,115,000 

18) State Councils on Developmental Disabilities:

DD Act Section 129(a) Expired 76,000,000 Expired 56,000,000 

19) Protection and Advocacy: DD Act Section 145 Expired 40,734,000 Expired 38,734,000 

20) University Centers for Excellence in

Developmental Disabilities: DD Act Section 156 Expired 40,619,000 Expired 32,546,000 
EXECUTIVE SUMMARY

26

Category

FY 2019 

Amount 

Authorized

FY 2019 

Amount 

Appropriated

FY 2020 

Amount 

Authorized

FY 2020 

President's 

Budget

21) Projects of National Significance: DD Act

Section 163 Expired 12,000,000 Expired 1,050,000 

22) Voting Assistance for People with Disabilities:

Help America Vote Act Section 291 Expired 6,963,000 Expired 4,963,000 

24) Paralysis Resource Center: Public Health

Services Act Sections 311 and 317(k)(2) N/A 8,700,000 N/A - 

25) National Institute on Disability, Independent

Living, and Rehabilitation Research 4/:

Rehabilitation Act of 1973 Sect. 201 119,608,000 108,970,000 

122,143,000

90,371,000 

26) Independent Living: - - - - 

Rehabilitation Act of 1973, Title VII, Parts B, C, 

and Chapter 2, Independent Living State Grants 

Section 714 26,319,000 25,378,000 26,877,000 23,731,684 

Centers for Independent Living Section 727 90,083,000 90,805,000 91,992,000 84,914,316 

27) Assistive Technology (AT): AT Act (including but

not limited to Section 4-6) Expired 36,000,000 Expired 31,939,000 

28) Limb Loss Resource Center: Public Health

Services Act, Title III N/A 3,500,000 N/A - 

29) Sections 1252 and 1253 of the Public Health

Service Act as amended by the Traumatic Brain

Injury Reauthorization Act of 2014, P.L. 113-196 - - - - 

Traumatic Brain Injury State Grants 5,500,000 7,321,000 Expired 6,221,411 

Traumatic Brain Injury Protection and Advocacy 3,100,000 4,000,000 Expired 3,099,589 

30) Medicare Improvements for Patients and

Providers Act/1 - - - - 

Aging and Disability Resource Centers 5,000,000 5,000,000 5,000,000 5,000,000 

Area Agencies on Aging 7,500,000 7,500,000 7,500,000 7,500,000 

National Center for Benefits Outreach and 

Enrollment

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

12,000,000 

State Health Insurance Assistance Program 13,000,000 13,000,000 13,000,000 13,000,000

Total Request Level - 2,234,515,000 - 2,070,171,000 

Unfunded Authorizations:

FY 2019 

Amount 

Authorized

FY 2019 

Amount 

Appropriated

FY 2020 

Amount 

Authorized

FY 2020 

President's 

Budget

1) Legal Assistance: OAA Section 702(b) 5,096,480 - Expired -
EXECUTIVE SUMMARY

27

Appropriations History

Administration for Community Living

Category Budget Estimate 

to Congress House Allowance Senate Allowance Appropriation

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 /1 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 /2 1,978,336,000 N/A 1,708,105,000 1,645,291,724 

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

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

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

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

FY 2014 /3 2,094,755,000 N/A 1,716,664,000 1,662,258,000 

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

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

FY 2015 /4 2,062,279,000 N/A 1,676,152,000 1,673,256,000 

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

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

FY 2016 /5 2,104,976,000 1,944,358,000 1,861,089,000 1,964,850,000 

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

Subtotal -- -- -- 1,962,635,571 

FY 2017 /6 1,993,294,000 1,981,275,000 1,935,435,000 1,966,115,000 

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

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

FY 2018 /7,8 1,851,449,000 2,237,224,000 1,966,115,000 2,144,215,000 

FY 2018 Transfers -- -- -- -7,951,453 

Subtotal -- -- -- 2,136,263,547 

FY 2019 /9 1,818,681,000 2,186,732,000 2,149,515,000 2,169,315,000 

FY 2019 Transfers -- -- -- -1,902,259 

Subtotal -- -- -- 2,167,412,741 

FY 2020 2,032,671,000 -- -- -- 

1/ Includes $2,025,445 in FY 2012 budget authority appropriated to AoA and transferred to the Department of Agriculture for 

commodities purchases pursuant to Public Law 112-74.

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

commodities purchases pursuant to Public Law 113-6

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

commodities purchases pursuant to Public Law 113-76.

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

commodities purchases pursuant to Public Law 113-235.

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

commodities purchases pursuant to Public Law 114-113.

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

commodities purchases pursuant to Public Law 115-31.

7/ Includes $2,752,453 in FY 2018 budget authority appropriated to ACL and transferred to the Department of Agriculture for 

commodities purchases pursuant to Public Law 115-31.

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

the Department of Labor.

9/ Includes $1,902,259 in FY 2019 budget authority appropriated to ACL and transferred to the Department of Agriculture for 

commodities purchases pursuant to Public Law 115-31.
EXECUTIVE SUMMARY

28

Appropriations Not Authorized by Law

Administration for Community Living

Program Last Year of 

Authorization

Authorization 

Level

Appropriations in 

Last Year of 

Authorization

Appropriations 

in FY 2019

Older Americans Act of 1965 FY 2019 $1,585,693,875 $1,682,800,000 $1,682,800,000 

Traumatic Brain Injury: Sections 

1252 and 1253 of the Public 

Health Service Act

FY 2019 $8,600,000 $11,321,000 $11,321,000 

Elder Justice / Adult Protective 

Services: Social Security Act, 

Title XX-B

FY 2014 $129,000,000 $12,000,000 $12,000,000 

Lifespan Respite Care: Lifespan 

Respite Care Act of 2006 FY 2011 $94,810,000 $2,495,000 $4,110,000 

Assistive Technology: The 

Assistive Technology Act of 2004 FY 2010 Such Sums $25,000,000 $36,000,000 

Developmental Disabilities 

Programs: Developmental 

Disabilities Assistance and Bill of 

Rights Act

FY 2007 Such Sums $155,115,000 $169,353,000 

Voting Access for People with 

Disabilities: Help America Vote 

Act - Section 291

FY 2005 $17,410,000 $13,879,000 $6,963,000 

State Health Insurance 

Assistance Programs: Omnibus 

Budget Reconciliation Act of 1990

FY 1996 $10,000,000 N/A $49,115,000 
EXECUTIVE SUMMARY

29

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HEALTH AND INDEPENDENCE FOR OLDER ADULTS

30

Health and Independence for Older Adults

Summary of Request

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

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

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

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

seniors in their homes), and preventive health services. 

The U.S. population over age 60 is projected to increase by 9 percent between 2017 and 2020, 

from 70.8 million to 77.1 million.

5

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 10 percent over the same period.6 Health 

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

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

65 percent of congregate and 94 percent of home-delivered meal recipients reported that the meals 

allowed them to continue living in their own homes.7 Additionally, 60 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.8

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

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

of Nutrition funding between the Congregate and Home-Delivered Nutrition programs. In 

FY 2020, ACL is continuing to propose a general provision to maximize funding flexibility by 

giving States the ability to transfer funding between HCBSS, Nutrition, Preventive Health and 

Family Caregivers Support Services programs to achieve the funding that best addresses the

community’s unique needs of people in each state.

ACL’s FY 2020 funding request for Health and Independence for Older Adults programs is 

$1.4 billion, a reduction of -$18.9 million below the FY 2019 Enacted Level. For FY 2020 specific 

program requests include:

• $385.1 million for Home and Community-Based Supportive Services (HCBSS), the same

as the FY 2019 Enacted level. HCBSS provides grants to states to fund an array of low cost

5 U.S. Census Bureau, “2017 National Population Projections,” Table 3. Projected 5-Year Age Groups and Sex 

Composition of the Population for the United States: 2017 to 2060. Original Release Date: March 2018, Revised 

Release Date: September 2018. Accessed 23 October 2018. U.S. Census Bureau, Annual Estimates of the Resident 

Population by Sex, Single Year of Age, Race and Hispanic Origin for the United States: April 1, 2010 to July 1, 

2017. Released June 2018.

6 U.S. Census Bureau, “2017 National Population Projections,” Table 3. Projected 5-Year Age Groups and Sex 

Composition of the Population for the United States: 2017 to 2060. Original Release Date: March 2018, Revised 

Release Date: September 2018. Accessed 23 October 2018. U.S. Census Bureau, Annual Estimates of the Resident 

Population by Sex, Single Year of Age, Race and Hispanic Origin for the United States: April 1, 2010 to July 1, 

2017. Released June 2018.

7 2018 National Survey of Older Americans Act Participants.

8

Ibid.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

31

services that enable seniors to remain in their homes for as long as possible, including adult 

day care, transportation, case management, personal care services, chore services, and 

physical fitness programs. These services also aid caregivers, who might otherwise have 

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

time away from their work and other family responsibilities.

• $906.8 million for Nutrition programs, including Congregate Nutrition, Home-Delivered

Nutrition and the Nutrition Services Incentives Program. The FY 2020 request is the same

as the FY 2019 Enacted Level for these programs. In FY 2020, the Nutrition Services

programs will help over 2.3 million older adults receive the meals they need to stay healthy

and decrease their risk of disability and institutionalization. The requested funding level

would support over 221 million meals.

• $24.8 million for Preventive Health Services. This funding level, which is more than $5

million above historic levels, allows States the flexibility to also fund Chronic Disease SelfManagement and Falls Prevention programs as part of their Preventive Health Services to

meet the greatest areas of need in their communities. ACL is not requesting separate

funding for the Chronic Disease Self-Management Education (CDSME) program and the

Falls Prevention programs.

• $34.2 million for Native American Nutrition and Supportive Services, the same as the

FY 2019 Enacted Level. These funds will provide approximately 5.7 million meals and

840,000 rides for Native American seniors to critical daily activities such as meal sites,

medical appointments, and grocery stores.

• $11.5 million for Aging Network Support Activities, which is a reduction of -$5.9 million

below the FY 2019 Enacted level. The level does not include funding for the Care Corps

Demonstration Program and a reduction in efforts to assist state and Area Aging Agencies

through the Program Performance and Technical Assistance grants. Aging Network

Support Activities funds competitive grants and contracts for ongoing activities which help

seniors and their families obtain information about their care options and benefits; and

which provide technical assistance to assist states, Tribes, and community providers of

aging services to carry out their mission to help older people remain independent and live

in their own homes and communities.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

32

Outcome and Outputs Table:

Health and Independence for Older Adults

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2019

Target

FY 2020

Target

FY 2020 Target +/-FY 

2019 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 2017: 8,227 clients

Target:

9,000 clients

(Target Not Met)

8,900 clients 8,300 clients -600 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 2017: 63.7 weighted 

average

Target:

63.25 weighted average

(Target Exceeded)

63.6 weighted 

average

64 weighted 

average

+0.4 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 2017: 34.7%

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 2017: 32.8%

Target:

25.78%

(Target Exceeded)

24.6% 25.23% +0.63
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

33

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HEALTH AND INDEPENDENCE FOR OLDER ADULTS

34

Home and Community-Based Supportive Services

Services FY 2018

Final

FY 2019 

Enacted

FY 2020

President's 

Budget

FY 2020 +/-

FY 2019

Home & 

Community-Based 

Supportive 

Services*

384,118 385,074 385,074 -

*BA is in thousands of dollars.

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

Law 89-73

Most Recent Authorizing Legislation: Older Americans Reauthorization Act of 2016, Public Law 

114-144

Current FY Authorization: ..................................................................................................Expired

Authorization Expiration Date...................................................................................................2019

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

Program Description and Accomplishments:

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

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

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

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

it is the combination of supports tailored to the needs of the individual that ensures clients remain 

in their homes and communities instead of entering institutional care.

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

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

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

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

challenged, as members of the so-called “sandwich generation,” with nearly half (47%) of adults 

in their 40s and 50s having a parent age 65 or older and either raising a young child or financially 

supporting a grown child (age 18 or older)9.

9 The Sandwich Generation: Rising Financial Burdens for Middle-Aged Americans. Accessed 12-3-2018.
35

HEALTH AND INDEPENDENCE FOR OLDER ADULTS

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

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

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

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

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

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

Among those aged 85 and older, 53.6 percent are unable to perform one or more critical activities 

of daily living and require long-term support10. Data also show that over 95 percent of seniors age 

85 and older have at least one chronic condition and 80 percent have at least two.11 Providing a 

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

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

avoid unnecessary, expensive nursing home care. 

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

,

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

nursing home admission13 and helping to keep them from joining the 1.7 million seniors who live 

in institutional settings.14 Nationally, 24 percent of individuals 60 and older live alone15, and in 

FY 2017, 44 percent of OAA consumers were individuals who live alone.16 Living alone is a key 

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

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

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

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

Services provided by the HCBSS program in FY 2017 include: 

• Transportation Services provided more than 21.7 million rides to doctor’s offices, grocery

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

(Output C).18

• Personal Care, Homemaker, and Chore Services provided more than 42.3 million hours of

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

10 Centers for Medicare & Medicaid Services, ACL analysis of 2015 Medicare Current Beneficiary Survey. 

Accessed 30 October 2018.

11 Ibid. 

12 ACL’S OAA State Performance Report, FY 2017.

13 Ibid

14 Centers for Medicare & Medicaid Services, ACL analysis of 2015 Medicare Current Beneficiary Survey. 

Accessed 26 July 2018

15 Administration for Community Living. Data-at-a-Glance: American Community Survey (ACS) Public Use 

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

16 ACL’S OAA State Performance Report, FY 2017

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

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

18 ACL’S OAA State Performance Report, FY 2017
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

36

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

(Output D).19

• Adult Day Care/Day Health provided over 10.3 million hours of care for dependent adults

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

(Output E).20

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

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

(Output F).21

Continuing ACL’s commitment to provide services to those most in need 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.22 Many of these individuals 

cannot safely drive a car, as 72 percent of transportation riders have at least one of the following 

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

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

10 to 25 medications daily.24 Data from ACL’s National Surveys of OAA Participants show that 

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

to help them remain at home. For example, 60 percent of seniors using transportation services rely 

on ACL services for the majority of their transportation needs and would otherwise be homebound. 

Over 77 percent of clients receiving case management also reported that as a result of the services 

arranged by the case manager they were better able to care for themselves.25 In addition, a study 

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

program, specifically in this study personal care services, play an important role in helping frail 

older adults remain in their homes and out of nursing home care.26

19 Id

20 Id

21 Id

22 2018 National Survey of Older Americans Act Participants.

23 Id

24 Id

25 Id

26 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.
37

HEALTH AND INDEPENDENCE FOR OLDER ADULTS

Funding History: 

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

follows: 

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

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

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

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

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

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

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

FY 2018 ...................................$384,118,000

FY 2019 Enacted......................$385,074,000

FY 2020 President’s Budget ....$385,074,000

Budget Request:

The FY 2020 request for Home and Community-Based Supportive Services is $385,074,000, the 

same level as the FY 2019 Enacted level. At the proposed FY 2020 funding level, ACL estimates 

that the program will continue to support 10.2 million hours of adult day care for older adults; 

20.5 million rides for activities such as visiting the doctor, the pharmacy, or grocery stores; and 

50.9 million hours of assistance to seniors who are unable to perform daily activities. These 

estimates take into account State, local, and private funding streams that also support these 

activities.

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

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

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

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

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

match requirements.27

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

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

FY 2020, ACL is continuing to propose a new general provision that would provide additional 

funding flexibility, and give states the ability to transfer nearly all of the funds they receive for 

HCBSS, Nutrition, Preventive Health and Caregivers between any of these programs to best 

address the community unique needs of the people in each state.

27 ACL’S OAA State Performance Report, FY 2016
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

38

Outputs and Outcomes Table:

Home and Community-Based Supportive Services

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2019

Target

FY 2020

Target

FY 2020 Target

+/-FY 2019 Target

1.1 For Home and 

Community-based 

Services including 

Nutrition and Caregiver 

services increase the 

FY 2017: 8,227 clients

Target:

9,000 clients

8,900 clients 8,300 clients -600 clients

number of clients served 

per million dollars of Title 

III OAA funding. 

(Efficiency)

(Target Not Met)

2.9b Maintain at 90% or FY 2017: 94% 90% 90% Maintain

higher the percentage of 

transportation clients 

who rate services good 

to excellent. (Outcome)

Target:

90%

(Target Exceeded)

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 

FY 2017: 63.7 weighted 

average

Target:

63.25 weighted average

(Target Exceeded)

63.6 weighted 

average

64 weighted 

average

+0.4 weighted

average

live in their homes and 

communities. (Outcome)

3.3 The percentage of 

OAA clients served who 

FY 2017: 34.7% 26.2% 26.2% Maintain

live in rural areas is at 

least 15% greater than 

the percent of all US 

elders who live in rural 

areas. (Outcome)

Target:

26.2%

(Target Exceeded)

3.6 The percentage of 

OAA clients served who 

FY 2017: 32.8% 24.6% 25.23% +0.63

live in poverty is 150% 

greater than the percent 

of all U.S. elders living 

below the poverty level. 

(Outcome)

Target:

25.78%

(Target Exceeded)
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

39

Indicator Year and Most Recent 

Result /

FY 2019

Projection

FY 2020

Projection

FY 2020 Projection

+/-FY 2019

Projection

Output C: Transportation 

Service Units (Output)

FY 2017: 21.8 M 21.3 M 20.5 M -0.8

Output D: Personal Care, 

Homemaker and Chore 

Services units (Output)

FY 2017: 42.4 M 48.0 M 50.9 M +2.9 M

Output E: Adult Day 

Care/Day Health units

(Output)

FY 2017: 10.4 M 10.2 M 10.2 M Maintain

Output F: Case 

Management Services 

units (Output)

FY 2017: 3.6 M 3.4 M 3.4 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.

Grant Awards Tables:

Home and Community-Based Supportive Services Grant Awards

Awards FY 2018

Final

FY 2019

Enacted

FY 2020

President's 

Budget

Number of 

Awards 56 56 56

Average Award $6,816,935 $6,807,558 $6,807,558

Range of Awards

$457,482-

$39,627,417

$452,907-

$39,601,966

$452,907-

$39,601,966
40

HEALTH AND INDEPENDENCE FOR OLDER ADULTS

Department of Health and Human Services 

ADMINISTRATION FOR COMMUNITY LIVING 

FY 2020 DISCRETIONARY STATE/FORMULA GRANTS 

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

STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/-

FY 2019

Alabama 5,748,745 5,715,996 5,715,996 - 

Alaska 1,908,742 1,906,116 1,906,116 - 

Arizona 8,329,543 8,305,958 8,305,958 - 

Arkansas 3,515,790 3,496,335 3,496,335 - 

California 39,627,417 39,601,966 39,601,966 - 

Colorado 5,657,569 5,678,718 5,678,718 - 

Connecticut 4,266,003 4,301,675 4,301,675 - 

Delaware 1,908,742 1,906,116 1,906,116 - 

District of Columbia 1,908,742 1,906,116 1,906,116 - 

Florida 28,459,804 28,470,250 28,470,250 - 

Georgia 10,147,824 10,221,543 10,221,543 - 

Hawaii 1,908,742 1,906,116 1,906,116 - 

Idaho 1,908,742 1,906,116 1,906,116 - 

Illinois 14,068,685 13,979,218 13,979,218 - 

Indiana 7,367,312 7,370,136 7,370,136 - 

Iowa 4,127,051 4,085,780 4,085,780 - 

Kansas 3,325,085 3,291,834 3,291,834 - 

Kentucky 5,113,621 5,096,505 5,096,505 - 

Louisiana 5,053,926 5,054,571 5,054,571 - 

Maine 1,908,742 1,906,116 1,906,116 - 

Maryland 6,531,229 6,546,179 6,546,179 - 

Massachusetts 7,951,259 7,913,807 7,913,807 - 

Michigan 11,974,311 11,985,529 11,985,529 - 

Minnesota 6,193,264 6,202,158 6,202,158 - 

Mississippi 3,325,997 3,305,813 3,305,813 - 

Missouri 7,167,454 7,158,076 7,158,076 - 

Montana 1,908,742 1,906,116 1,906,116 - 

Nebraska 2,222,857 2,200,628 2,200,628 - 

Nevada 3,238,178 3,263,245 3,263,245 - 

New Hampshire 1,908,742 1,906,116 1,906,116 - 

New Jersey 10,107,547 10,142,664 10,142,664 - 

New Mexico 2,454,960 2,444,858 2,444,858 - 

New York 23,520,724 23,285,517 23,285,517 - 

North Carolina 11,522,447 11,578,297 11,578,297 - 

North Dakota 1,908,742 1,906,116 1,906,116 - 

Ohio 13,936,009 13,912,753 13,912,753 - 

Oklahoma 4,324,666 4,287,874 4,287,874 - 

Oregon 5,070,689 5,036,012 5,036,012 - 

Pennsylvania 17,318,394 17,145,210 17,145,210 - 

Rhode Island 1,908,742 1,906,116 1,906,116 - 

South Carolina 6,056,589 6,094,926 6,094,926 - 

South Dakota 1,908,742 1,906,116 1,906,116 -
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

41

STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/-

FY 2019

Tennessee 7,689,859 7,670,105 7,670,105 - 

Texas 25,222,348 25,363,842 25,363,842 - 

Utah 2,405,572 2,432,544 2,432,544 - 

Vermont 1,908,742 1,906,116 1,906,116 - 

Virginia 9,114,734 9,135,816 9,135,816 - 

Washington 8,090,592 8,081,768 8,081,768 - 

West Virginia 2,686,425 2,659,561 2,659,561 - 

Wisconsin 6,886,100 6,864,580 6,864,580 - 

Wyoming 1,908,742 1,906,116 1,906,116 - 

 Subtotal 374,634,225 374,161,755 374,161,755 - 

American Samoa 457,482 452,907 452,907 - 

Guam 954,371 953,058 953,058 - 

Northern Mariana Islands 238,593 238,265 238,265 - 

Puerto Rico 4,509,310 4,464,217 4,464,217 - 

Virgin Islands 954,371 953,058 953,058 - 

Subtotal 381,748,352 381,223,260 381,223,260 - 

Program Support28 2,369,648 3,850,740 3,850740 - 

Total States/Territories 384,118,000 385,074,000 385,074,000 - 

28 Program Support- Includes funds for Older American Act statutory requirements, including evaluation and 

disaster assistance; and grant and program reporting system costs. Funds unused for these purposes at the end of the 

year are allocated to states.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

42

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HEALTH AND INDEPENDENCE FOR OLDER ADULTS

43

Nutrition Services

Services FY 2018

Final

FY 2019 

Enacted

FY 2020

President's 

Budget

FY 2020 +/-

FY 2019

Congregate 

Nutrition Services 489,125 495,342 495,342 --

Home-Delivered 

Nutrition Services

245,731 251,342 251,342 --

Nutrition Services 

Incentive Program

159,672 160,069 160,069 --

Total* 894,528 906,753 906,753 --

*BA is in thousands of dollars.

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

Public Law 89-73

Most Recent Authorizing Legislation: Older Americans Reauthorization Act of 2016, Public Law 

114-144

Current FY Authorization.....................................................................................................Expired

Authorization Expiration Date...................................................................................................2019

Allocation Method .................................................................... Formula Grant/Competitive Grants

Program Description and Accomplishments: 

Nutrition Services help older Americans remain healthy and independent in their communities by 

providing meals and related services in a variety of community settings (including congregate 

facilities such as senior centers) and via home-delivery to older adults who are homebound due to 

illness, disability, or geographic isolation. These services occur in all 50 states, the District of 

Columbia, and five territories through a network of more than 7,000 local nutrition service 

providers.29 Nutrition Services currently include:

• Congregate Nutrition Services (Title III-C1): Provides funding for the provision of meals

and other related services in a variety of community settings (e.g. senior centers, churches

community centers, congregate dining facilities, school cafeterias, restaurants, farmers

29 ACL’S OAA State Performance Report, FY 2016
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

44

markets, hospital cafeterias, etc.) which help older individuals remain healthy and prevents 

the need for more costly medical interventions. Established in 1972, the program also 

presents opportunities for social engagement, health promotion activities, nutrition 

education, nutrition counseling and meaningful volunteer and social engagement roles, all 

of which contribute to participants’ overall health and well-being. Congregate Nutrition 

Services provided 76.2 meals to more than 1.5 million seniors in a variety of community 

settings in 2017.30

• Home-Delivered Nutrition Services (Title III-C2): Provides funding for the delivery of

meals and related services to frail seniors who are home-bound. Established in 1978, homedelivered meals are often the first in-home service that an older adult receives and are often

the primary access point for other home and community-based services. In addition to

providing a meal, this service helps frail home-bound seniors’ combat isolation and

maintain contact with the outside world. Home-delivered meals provided to caregivers

also represent an essential service, helping them maintain their own health and well-being

while caring for their loved ones. Home-Delivered Nutrition Services provided 144.0

million meals to over 862,000 individuals in FY 2017.31

• Nutrition Services Incentive Program (Title III-A): Provides a secondary source of funding

that must be used exclusively to provide meals, but which can be applied to either

congregate or home-delivered meals. Recipients can elect to receive part or all of their

grants as commodities from the U.S. Department of Agriculture if they determine that

doing so will enable them to better meet the needs of older adults. Six states and five tribes

elected to spend almost $2.8 million on commodities (including $135,278 assessed by

USDA as administrative expenses) in FY 2017.

Consistent with the Administrator’s focus on identifying new ways to efficiently improve direct 

service programs, ACL, under its 1% Nutrition authority, is using $3.5 million to fund nutrition 

innovations and test ways to modernize how meals are provided to a changing senior population. 

One promising demonstration currently being carried out by the Georgia State University Research 

Foundation32 has drawn widespread attention is an effort to train volunteers who deliver homedelivered meals to recognize and report indicators of suicidal intent and other mental health issues 

so that they can be addressed. Suicide is a significant problem among elderly individuals, many 

of whom may be isolated, live in rural areas at a distance from neighbors or be depressed33. Results 

from this demonstration can be used to support programs led by Veterans’ Affairs and Health and 

Human Services/Substance Abuse Mental Health Services Administration.

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 

30 Id

31 Id

32 Double Blind Randomized Control Trial on the Effect of Evidence-Based Suicide Intervention Training on the 

Home-Delivered and Congregate Nutrition Program through the Atlanta Regional Commission

33 Older Adult Behavioral Health Technical Assistance Center. (2012). Issue B: Preventing Suicide in Older Adults. 

Accessed December 21, 2018.
45

HEALTH AND INDEPENDENCE FOR OLDER ADULTS

Services Incentive Program (NSIP) grants are provided to states, territories, and eligible tribal 

organizations based on the number of meals served in the prior fiscal year. The meals provided 

through these programs fulfill the standards set by the current Dietary Guidelines for Americans. 

Nutrition services assist over 2.4 million (2017)34 diverse participants with characteristics that 

place them at higher risk for health care interventions as well as institutionalization. For example: 

• The percentage of home-delivered meal recipients with severe disabilities (3+ ADL) was

38 percent in 2017.

35 This level of disability is frequently associated with nursing home

admission, and demonstrates the extreme frailty of a significant number of home-delivered

meal clients. Approximately 67 percent of home-delivered meal recipients have annual

incomes at or below $20,000.36 Nearly 66 percent of recipients of home-delivered meals

and 54 percent of participants in congregate meals report these meals as half or more of

their food intake for the day.37

• The prevalence of multiple chronic conditions is higher among congregate and

home-delivered meal program participants in comparison to the general Medicare

population. In fact, data from ACL’s National Survey of OAA Participants indicate that

51 percent of congregate and 64 percent of home-delivered participants have six or more

chronic health conditions. About 31 percent of congregate and 49 percent of homedelivered participants take over six medications per day and some take as many as

20 medications.38

• Nutrition is one of the major determinants of successful aging. It plays an important role

in preventing and treating many of the most common chronic conditions such as

hypertension, heart disease, diabetes, osteoporosis, and obesity39. Therefore, the provision

of healthy meals, access to lifestyle modification programs, and evidence-based advice

such as nutrition education and counseling are important to helping these older individuals

avoid more intensive and costly medical care.

• About 16 percent of people who participate in congregate meal programs and 52 percent

of home-delivered participants need help in getting outside the house, thus limiting their

ability to shop for food themselves.40

• About 51 percent of congregate participants and 58 percent of home-delivered participants

live alone.41 Living alone is a risk factor for social isolation, poorer health, and nursing

home placement.

34 Id

35 Id

36 2018 National Survey of Older Americans Act Participants.

37 Id

38 Id

39 Kimokoti and Millen, 2016; Bernstein and Munoz, 2012.

40 Id

41 Id
46

HEALTH AND INDEPENDENCE FOR OLDER ADULTS

Data has shown that Nutrition Services are effective in helping older adults improve their 

nutritional intake and remain at home. For example, 76 percent of congregate meal participants 

and 81 percent of home-delivered meal participants say they eat healthier meals due to the 

programs, and 65 percent of congregate meal participants and 94 percent of home-delivered meal 

recipients say that the meals enable them to continue living in their homes.42 Ninety percent of 

congregate meal clients and 88 percent of home-delivered meal clients rate service as good to 

excellent.43

In addition, states that invest more in delivering meals to older adults’ homes have lower rates of 

“low-care” seniors (defined as residents who have the functional capacity to live in a less careintensive environment) living in nursing homes, after adjusting for several other factors.44 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.45

42 Id

43 Id

44 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.

45 Id.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

47

Funding History:

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

FY 2011 .................................$817,835,000

FY 2012 ...................................$816,289,000

FY 2013 .................................$768,310,870

FY 2014 ...................................$811,191,000

FY 2015 ...................................$814,657,000

FY 2016 ..................................$834,753,000

FY 2017 ...................................$833,284,084

FY 2018 ...................................$894,528,000

FY 2019 Enacted......................$906,753,000

FY 2020 President’s Budget ....$906.753,000

Budget Request:

The FY 2020 request for Nutrition Services is $906,753,000, the same as the FY 2019 Enacted 

level. This represents only a portion of the total funding for meals programs.46 Combined with 

these state and local contributions, the request is projected to provide over 221 million meals to 

more than 2.3 million older Americans in a variety of community settings. In FY 2020, the

Nutrition programs are expected to continue to provide home-delivered meals that clients rate as 

good to excellent, ensuring that clients continue to receive high quality services. The FY 2020 

request also would continue to allow up to 1% of the funds appropriated for congregate and homedelivered nutrition be used for nutrition innovations.

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

these programs, and up to 40 percent of Nutrition funding between the congregate and homedelivered programs. ACL is continuing to propose a general provision to build on existing 

flexibility and give states the ability to transfer nearly all of the funds they receive for HCBSS, 

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

individual State’s needs; and to allow Tribes to transfer funding between NSIP, Native American 

Nutrition and Supportive Services, and Native American Caregiver Support Services.

An evaluation of the OAA Title III-C Nutrition Services program (NSP) is ongoing. The Process 

Evaluation of Older Americans Act Title III-C Nutrition Services Program Report and the cost 

study report are available. The first client outcome report and the second client outcome report are 

also available.

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

the OAA Title III-C Nutrition Services Program (NSP) is meeting its stated goals. The program 

46 J. Ziegler et al. Final Report: Older Americans Act Nutrition Programs Evaluation: Meal Cost Analysis. Sept 25, 

2015.
48

HEALTH AND INDEPENDENCE FOR OLDER ADULTS

provides appropriate supportive services which are responsive to local community and individuals’ 

needs. For example, since the last evaluation was conducted in 1995, 15 percent more providers 

offer weekend meal service and almost 15 percent more sites provide specialized meal choices to 

meet the health needs of recipients. With nearly two-thirds of meal providers offering non-nutrition 

services to promote the well-being of older Americans, the program is a key component of a 

continuum of care that makes it possible for older adults to continue living in the community. 

Evaluation results are consistent with annual performance data that indicate the programs help 

participants to live independently in the community; eat healthier foods, improve their health and 

achieve or maintain a healthy weight. If the nutrition program were not available, 61 percent of 

home-delivered meal participants and 42 percent of congregate meal participants indicated they 

would skip meals or eat less. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

49

Outcomes and Outputs Table:

Nutrition Services

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2019

Target

FY 2020

Target

FY 2020 Target

2019 Target

+/-FY 

1.1 For Home and 

Community-based 

Services including 

Nutrition and Caregiver 

services increase the 

FY 2017: 8,227 clients

Target:

9,000 clients

8,900 clients 8,300 clients -600 clients

number of clients served 

per million dollars of Title 

III OAA funding. 

(Efficiency)

(Target Not Met)

2.9a Maintain at 90% or FY 2017: 88% 90% 90% Maintain

higher the percentage of 

clients receiving home 

delivered meal who rate 

Target:

90%

services good to 

excellent. (Outcome) (Target Not Met)

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 

FY 2017: 63.7 weighted 

average

Target:

63.25 weighted average

(Target Exceeded)

63.6 weighted 

average

64 weighted 

average

+0.4 weighted

average

live in their homes and 

communities. (Outcome)

3.3 The percentage of 

OAA clients served who 

FY 2017: 34.7% 26.2% 26.2% Maintain

live in rural areas is at 

least 15% greater than 

the percent of all US 

elders who live in rural 

areas. (Outcome)

Target:

26.2%

(Target Exceeded)

3.5 Increase the FY 2017: 41.8% 42.4% 42.2% -0.2

percentage of older 

persons with severe 

disabilities who receive 

Target:

45.1%

home-delivered meals. 

(Outcome) (Target Not Met but 

Improved)
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

50

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2019

Target

FY 2020

Target

FY 2020 Target +/-FY 

2019 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 2017: 32.8%

Target:

25.78%

(Target Exceeded)

24.6% 25.23% +0.63

Indicator Year and Most Recent 

Result /

FY 2019 

Projection

FY 2020

Projection

FY 2020 Projection

+/-FY 2019

Projection

Output G: Number of 

Home-Delivered meals 

served (Output)

FY 2017: 144.0 M 151.4 M 152.0 M +0.6

Output H: Number of 

Congregate meals served 

(Output)

FY 2017: 76.2 M 71.0 M 69.5 M -1.5

Outputs G & H: Total 

Number of Meals 

(Output)

FY 2017: 220.3 M 222.4 M 221.5 M -0.9

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.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

51

Grant Awards Tables:

Congregate Nutrition Programs Grant Awards

Awards FY 2018

Final

FY 2019

Enacted

FY 2020

President's 

Budget

Number of Awards 56 56 56

Average Award $8,654,806 $8,715,689 $8,715,689

Range of Awards

$302,918-

$50,755,067-

$305,049-

$51,058,342

$305,049-

$51,058,342

Home-Delivered Nutrition Programs Grant Awards

Awards FY 2018

Final

FY 2019

Enacted

FY 2020

President's 

Budget

Number of Awards 56 56 56

Average Award $4,347,834 $4,422,118 $4,422,118

Range of Awards

$152,174-

$25,529,249

$154,774-

$25,930,271

$154,774-

$25,930,271

Nutrition Services Incentive Program Grant Awards

Awards FY 2018

Final

FY 2019

Enacted

FY 2020

President's 

Budget

Number of Awards 270 270 270

Average Award $587,454 $586,920 $586,920

Range of Awards

$63,371-

$13,516,401

$63,312-

$13,503,806

$63,312-

$13,503,806
52

HEALTH AND INDEPENDENCE FOR OLDER ADULTS

Department of Health and Human Services 

ADMINISTRATION FOR COMMUNITY LIVING 

FY 2020 DISCRETIONARY STATE/FORMULA GRANTS 

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

STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/-

2019

FY 

Alabama $7,363,032 $7,369,566 $7,369,566 - 

Alaska 2,423,346 2,440,393 2,440,393 - 

Arizona 10,668,537 10,708,773 10,708,773 - 

Arkansas 4,503,048 4,507,783 4,507,783 - 

California 50,755,067 51,058,342 51,058,342 - 

Colorado 7,246,253 7,321,505 7,321,505 - 

Connecticut 5,459,141 5,546,099 5,546,099 - 

Delaware 2,423,346 2,440,393 2,440,393 - 

District of Columbia 2,423,346 2,440,393 2,440,393 - 

Florida 36,451,512 36,706,357 36,706,357 - 

Georgia 12,997,402 13,178,514 13,178,514 - 

Hawaii 2,423,346 2,440,393 2,440,393 - 

Idaho 2,423,346 2,440,393 2,440,393 - 

Illinois 17,826,260 18,023,241 18,023,241 - 

Indiana 9,436,104 9,502,229 9,502,229 - 

Iowa 4,980,379 4,930,575 4,930,575 - 

Kansas 4,139,537 4,152,472 4,152,472 - 

Kentucky 6,549,562 6,570,864 6,570,864 - 

Louisiana 6,473,104 6,516,799 6,516,799 - 

Maine 2,423,422 2,440,393 2,440,393 - 

Maryland 8,365,244 8,439,912 8,439,912 - 

Massachusetts 10,118,736 10,203,178 10,203,178 - 

Michigan 15,336,781 15,452,801 15,452,801 - 

Minnesota 7,932,375 7,996,369 7,996,369 - 

Mississippi 4,259,960 4,262,146 4,262,146 - 

Missouri 9,180,125 9,228,823 9,228,823 - 

Montana 2,423,346 2,440,393 2,440,393 - 

Nebraska 2,705,657 2,713,918 2,713,918 - 

Nevada 4,147,481 4,207,263 4,207,263 - 

New Hampshire 2,423,346 2,440,393 2,440,393 - 

New Jersey 12,945,816 13,076,817 13,076,817 - 

New Mexico 3,144,329 3,152,127 3,152,127 - 

New York 28,508,865 28,937,212 28,937,212 - 

North Carolina 14,758,029 14,927,762 14,927,762 - 

North Dakota 2,423,346 2,440,393 2,440,393 - 

Ohio 17,849,336 17,937,549 17,937,549 -

Oklahoma 5,539,061 5,528,306 5,528,306 -

Oregon 6,494,574 6,492,871 6,492,871 -

Pennsylvania 20,856,250 20,805,837 20,805,837 -
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

53

STATE/TERRITORY

FY 2018 

Final 

FY 2019 

Enacted 

FY 2020 

President's Budget 

FY 2020 +/- FY 

2019

Rhode Island 2,423,346 2,440,393 2,440,393 - 

South Carolina 7,757,321 7,858,116 7,858,116 - 

South Dakota 2,423,346 2,440,393 2,440,393 - 

Tennessee 9,849,224 9,888,976 9,888,976 - 

Texas 32,304,956 32,701,302 32,701,302 - 

Utah 3,081,073 3,136,250 3,136,250 - 

Vermont 2,423,346 2,440,393 2,440,393 - 

Virginia 11,674,214 11,778,699 11,778,699 - 

Washington 10,362,486 10,419,728 10,419,728 - 

West Virginia 3,240,159 3,207,757 3,207,757 - 

Wisconsin 8,819,765 8,850,422 8,850,422 - 

Wyoming 2,423,346 2,440,393 2,440,393 - 

Subtotal 475,584,329 479,022,369 479,022,369 - 

American Samoa 583,006 577,176 577,176 - 

Guam 1,211,673 1,220,196 1,220,196 - 

Northern Mariana Islands 302,918 305,049 305,049 - 

Puerto Rico 5,775,555 5,733,594 5,733,594 - 

Virgin Islands 1,211,673 1,220,196 1,220,196 - 

 Subtotal 484,669,154 488,078,580 488,078,580 - 

Program Support47 4,455,846 7,263,420 7,263,420 - 

Total States/Territories 489,125,000 495,342,000 495,342,000 -

47Program Support- Includes funds for Older American Act statutory requirements, including evaluation and disaster 

assistance; and grant and program reporting system costs, and innovation demonstration grants. Funds unused for 

these purposes at the end of the year are allocated to states. 
54

HEALTH AND INDEPENDENCE FOR OLDER ADULTS

Department of Health and Human Services 

ADMINISTRATION FOR COMMUNITY LIVING 

FY 2020 DISCRETIONARY STATE/FORMULA GRANTS 

CFDA NUMBER/PROGRAM NAME: Home-Delivered Nutrition Services (CFDA 93.045)

STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/- FY 

2019

Alabama 3,703,525 3,742,676 3,742,676 - 

Alaska 1,217,394 1,238,193 1,238,193 - 

Arizona 5,366,158 5,438,513 5,438,513 - 

Arkansas 2,264,985 2,289,303 2,289,303 - 

California 25,529,249 25,930,271 25,930,271 - 

Colorado 3,644,787 3,718,268 3,718,268 - 

Connecticut 2,745,889 2,816,618 2,816,618 - 

Delaware 1,217,394 1,238,193 1,238,193 - 

District of Columbia 1,217,394 1,238,193 1,238,193 - 

Florida 18,334,716 18,641,534 18,641,534 - 

Georgia 6,537,552 6,692,784 6,692,784 - 

Hawaii 1,217,394 1,238,193 1,238,193 - 

Idaho 1,217,394 1,238,193 1,238,193 - 

Illinois 8,966,416 9,153,206 9,153,206 - 

Indiana 4,746,258 4,825,761 4,825,761 - 

Iowa 2,419,826 2,436,925 2,436,925 - 

Kansas 2,082,142 2,108,857 2,108,857 - 

Kentucky 3,294,358 3,337,051 3,337,051 - 

Louisiana 3,255,901 3,309,594 3,309,594 - 

Maine 1,218,955 1,238,193 1,238,193 - 

Maryland 4,207,627 4,286,258 4,286,258 - 

Massachusetts 5,089,615 5,181,743 5,181,743 - 

Michigan 7,714,234 7,847,794 7,847,794 - 

Minnesota 3,989,898 4,061,002 4,061,002 - 

Mississippi 2,142,714 2,164,555 2,164,555 - 

Missouri 4,617,503 4,686,911 4,686,911 - 

Montana 1,217,394 1,238,193 1,238,193 - 

Nebraska 1,360,916 1,378,279 1,378,279 - 

Nevada 2,086,138 2,136,683 2,136,683 - 

New Hampshire 1,217,394 1,238,193 1,238,193 - 

New Jersey 6,511,605 6,641,137 6,641,137 - 

New Mexico 1,581,564 1,600,826 1,600,826 - 

New York 14,339,650 14,695,930 14,695,930 - 

North Carolina 7,423,129 7,581,150 7,581,150 - 

North Dakota 1,217,394 1,238,193 1,238,193 - 

Ohio 8,978,023 9,109,687 9,109,687 - 

Oklahoma 2,786,088 2,807,582 2,807,582 - 

Oregon 3,266,700 3,297,442 3,297,442 - 

Pennsylvania 10,452,210 10,566,364 10,566,364 -
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

55

STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/- FY 

2019

Rhode Island 1,217,394 1,238,193 1,238,193 - 

South Carolina 3,901,848 3,990,789 3,990,789 - 

South Dakota 1,217,394 1,238,193 1,238,193 - 

Tennessee 4,954,053 5,022,173 5,022,173 - 

Texas 16,249,043 16,607,544 16,607,544 - 

Utah 1,549,746 1,592,762 1,592,762 - 

Vermont 1,217,394 1,238,193 1,238,193 - 

Virginia 5,872,003 5,981,880 5,981,880 - 

Washington 5,212,218 5,291,719 5,291,719 - 

West Virginia 1,609,708 1,616,183 1,616,183 - 

Wisconsin 4,436,246 4,494,738 4,494,738 - 

Wyoming 1,217,394 1,238,193 1,238,193 - 

 Subtotal 239,051,924 243,179,001 243,179,001 - 

American Samoa 152,174 154,774 154,774 - 

Guam 608,697 619,096 619,096 - 

Northern Mariana Islands 152,174 154,774 154,774 - 

Puerto Rico 2,905,042 2,911,839 2,911,839 - 

Virgin Islands 608,697 619,096 619,096 - 

Subtotal 243,478,708 247,638,580 247,638,580 - 

Undistributed48 2,251,993 3,703,420 3,703,420 - 

Total States/Territories 245,730,701 251,342,000 251,342,000 - 

48 Program Support- Includes funds for Older American Act statutory requirements, including evaluation and 

disaster assistance; and grant and program reporting system costs, and innovation demonstration grants. Funds 

unused for these purposes at the end of the year are allocated to states. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

56

Department of Health and Human Services

ADMINISTRATION FOR COMMUNITY LIVING

FY 2020 DISCRETIONARY STATE/FORMULA GRANTS

CFDA NUMBER/PROGRAM NAME: Nutrition Services Incentive Program (CFDA 93.053)

STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/-

2019

FY 

Alabama 3,319,559 3,316,465 3,316,465 -

Alaska 487,540 487,086 487,086 -

Arizona 1,800,014 1,798,337 1,798,337 -

Arkansas 2,498,525 2,496,196 2,496,196 -

California 13,516,401 13,503,806 13,503,806 -

Colorado 1,440,867 1,439,524 1,439,524 -

Connecticut 1,392,557 1,391,259 1,391,259 -

Delaware 741,452 740,761 740,761 -

District of Columbia 770,098 769,380 769,380 -

Florida 5,731,389 5,726,048 5,726,048 -

Georgia 2,775,301 2,772,715 2,772,715 -

Hawaii 504,188 503,719 503,719 -

Idaho 768,591 767,875 767,875 -

Illinois 6,227,388 6,221,585 6,221,585 -

Indiana 1,358,677 1,357,411 1,357,411 -

Iowa 1,618,397 1,616,889 1,616,889 -

Kansas 2,307,769 2,305,619 2,305,619 -

Kentucky 1,604,054 1,602,559 1,602,559 -

Louisiana 3,375,063 3,371,918 3,371,918 -

Maine 613,602 613,030 613,030 -

Maryland 1,699,590 1,698,007 1,698,007 -

Massachusetts 6,879,314 6,872,903 6,872,903 -

Michigan 7,645,465 7,638,340 7,638,340 -

Minnesota 1,799,028 1,797,352 1,797,352 -

Mississippi 1,481,338 1,479,958 1,479,958 -

Missouri 3,960,093 3,956,403 3,956,403 -

Montana 1,209,037 1,207,911 1,207,911 -

Nebraska 1,108,560 1,107,527 1,107,527 -

Nevada 1,599,402 1,597,912 1,597,912 -

New Hampshire 1,044,445 1,043,471 1,043,471 -

New Jersey 3,459,732 3,456,508 3,456,508 -

New Mexico 2,333,383 2,331,209 2,331,209 -

New York 16,454,530 16,439,197 16,439,197 -

North Carolina 3,332,615 3,329,509 3,329,509 -

North Dakota 804,287 803,537 803,537 -

Ohio 5,650,620 5,645,355 5,645,355 -

Oklahoma 1,953,617 1,951,796 1,951,796 -

Oregon 1,811,390 1,809,702 1,809,702 -

Pennsylvania 6,661,340 6,655,133 6,655,133 -
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

57

STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/- FY 

2019

Rhode Island 446,318 445,902 445,902 -

South Carolina 1,750,463 1,748,831 1,748,831 -

South Dakota 933,266 932,397 932,397 -

Tennessee 1,634,416 1,632,893 1,632,893 -

Texas 11,528,360 11,517,618 11,517,618 -

Utah 1,190,694 1,189,584 1,189,584 -

Vermont 772,473 771,754 771,754 -

Virginia 1,965,257 1,963,425 1,963,425 -

Washington 2,199,137 2,197,087 2,197,087 -

West Virginia 1,547,458 1,546,016 1,546,016 -

Wisconsin 2,819,881 2,817,253 2,817,253 -

Wyoming 875,317 874,502 874,502 -

 Subtotal 151,402,258 151,261,174 151,261,174 -

Indian Tribal Grants 3,758,278 3,758,278 3,758,278 -

American Samoa 94,402 94,314 94,314 -

Guam 413,311 412,926 412,926 -

Northern Mariana Islands 63,371 63,312 63,312 -

Puerto Rico 2,777,299 2,774,711 2,774,711 -

Virgin Islands 103,692 103,595 103,595 -

Subtotal 158,612,611 158,468,310 158,468,310 -

USDA Transfer Adjustment49 2,752,453 - - -

Undistributed50 1,059,177 1,600,690 1,600,690 -

Total States/Territories 159,671,788 160,069,000 160,069,000 -

49 State levels include transfers for distributions of commodities which are provided by USDA to grantees, in FY 

2018 the amount that was transferred is shown for comparability purposes.

50 Program Support – includes funds for Older Americans Act statutory requirements, including program evaluation 

and disaster assistance; and grant and program reporting systems costs. Funds unused for these purposes at the end 

of the year are allocated to states.
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Preventive Health Services

Services FY 2018

Final

FY 2019 

Enacted

FY 2020

President's 

Budget

FY 2020 +/-

FY 2019

Preventive Health 

Services* 24,786 24,848 24,848 -

*BA is in thousands of dollars.

Original Authorizing Legislation: Section 361 of the Older Americans Act of 1965, Public Law 

89-73

Most Recent Authorizing Legislation: Older Americans Reauthorization Act of 2016, Public Law 

114-144

Current FY Authorization.....................................................................................................Expired

Authorization Expiration Date...................................................................................................2019

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

Program Description and Accomplishments:

Preventive Health Services, established in 1987, provides formula grants to States and Territories

to support evidence-based programs that educate older adults about the importance of healthy 

lifestyles and promote healthy behaviors that can help prevent chronic disease and disability, 

thereby reducing the need for more costly medical interventions. Preventive Health Services 

funding is allocated to States and Territories based on their share of the population age 60 and 

over, and the program provides flexibility to allocate resources to best meet local needs. Priority 

is given to providing access to programs for elders living in medically underserved areas or those 

with the greatest economic need.

Due in large part to advances in public health and medical care, Americans are leading longer and 

more active lives. On average, an American turning age 65 today can expect to live an additional 

19.4 years.51 The population of older Americans is also growing, particularly the population age 

85 and over, which is projected to grow from 6.5 million in 2017 to 9.1 million by the year 2030.52 

51 Kochanek KD, Murphy SL, Xu JQ, Arias E. Mortality in the United States, 2016. NCHS Data Brief, no 293. 

Hyattsville, MD: National Center for Health Statistics. 2017. 

52 U.S. Census Bureau, “2017 National Population Projections,” Table 3. Projected 5-Year Age Groups and Sex 

Composition of the Population for the United States: 2017 to 2060. Released March 2018. Accessed 24 July 

2018. U.S. Census Bureau, Annual Estimates of the Resident Population by Sex, Single Year of Age, Race, and 

Hispanic Origin for the United States: April 1, 2010 to July 1, 2017: Released June 2018, Accessed 24 July 2018.
60

HEALTH AND INDEPENDENCE FOR OLDER ADULTS

One consequence of this increased longevity is a higher incidence of chronic diseases such as 

arthritis, cancer, and diabetes.53 In addition, approximately 25 percent of older adults report falling 

each year with 3 million falls resulting in emergency department visits. This percentage is 

increasing for all older adults but especially for those age 85 and over.54 

Since FY 2012, ACL has requested and Congress has enacted, appropriations language requiring 

states and territories to use their Preventive Health funds only on evidence-based programs that 

have been proven to enhance the wellness and fitness of older adults. The same language has been 

included in each subsequent year’s appropriations language.

Evidence-based programs are interventions that have been proven through randomized control 

trials to be effective at helping participants adopt healthy behaviors, improve their health status, 

and reduce their use of hospital services and emergency room visits. Examples of evidence-based 

interventions include:

• Self-Management Programs: Chronic Disease Self-Management Education (CDSME)

programs are low-cost disease prevention models that use state-of-the-art techniques and

employ leaders in the community to help individuals with chronic disease address issues

related to the management and treatment of their condition, improve their health status, and

reduce their need for more costly medical care. CDSME programs have been proven to be

effective at helping participants adopt healthy behaviors and improve their psychological

and physical health status. Evidence suggests that CDSME programs may also significantly

reduce the use of hospital care and physician services, as well as reduce health care costs55.

• Physical Activity Programs: Physical activity programs are multi-component group

exercise programs designed for community-based organizations to promote physical

activity among older adults. Components may include strength training using soft wrist

and ankle weights; cardiovascular workouts using dancing, aerobics, or walking; and

balance and posture exercises. Becoming more physically active has many positive benefits

such as increased mobility and function, decreased pain and depression, and lower risk of

type 2 diabetes, hypertension, coronary heart disease, obesity, and some cancers.

• Medication Management Programs: Medication management programs focus on

reviewing the multitude of medications that older adults are prescribed, focusing especially

on high-risk medications. Medication management programs have been shown to reduce

cardiovascular problems and unnecessary duplication of prescriptions. These programs

have also been shown to improve medication usage rates and decrease medication errors

among older adults.

53 Kingston, A., L. Robinson, H. Booth, M. Knapp, C. Jagger. 2018. Projections of multi-morbidity in the older 

population in England to 2035: estimates from the Population Ageing and Care Simulation (PACSim) model. Age 

and Ageing; 47: 374–380.

54 Burns, E. R. Kakara. Deaths from Falls Among Persons Aged => 65 Years – United States, 2007-2016. MMWR 

Morb Mortal Wkly Rep 2018;67:509-514.

55 Ahn et al. 2013. The impact of chronic disease self-management programs: healthcare savings through a 

community-based intervention. BMC Public Health. 13(1141).
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

61

• Falls Prevention Programs: Falls prevention programs help participants improve strength,

balance, and mobility; provide education on avoiding falls and reducing 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.

• Depression Care Management: Depression is not a normal part of aging, yet it is a

prevalent and disabling condition among older adults. Older adults with depression visit

the doctor and emergency room more frequently, use more medication, stay longer in the

hospital, and have substantially higher total health care costs than those without depression.

Cost-effective, evidence-based interventions have been shown to reduce depressive

symptoms and improve quality of life in older adults.

Funding History:

Funding for Preventive Health Services over the past five years is as follows:

FY 2016 ...............................................$19,848,000

FY 2017 .................................................$19,802,000

FY 2018 .................................................$24,786,000

FY 2019 Enacted....................................$24,848,000

FY 2020 President’s Budget ..................$24,848,000

Budget Request:

The FY 2020 request for Preventive Health Services is $24,848,000. This funding level, which is 

more than $5 million above historic levels, allows States the flexibility to also fund Chronic 

Disease Self-Management and Falls Prevention programs as part of their Preventive Health 

Services to meet the greatest areas of need in their communities. Separate funding for CDSME 

and Falls Prevention is no longer being requested. ACL continues to propose a new general 

provision to maximize funding flexibility for states to use Older American Act funding, between 

HCBSS, Nutrition, Preventive Health and Caregivers to direct funding to activities that best 

addresses their individual State’s unique needs.

ACL will continue to provide guidance regarding what meets the evidence-based requirement for 

this program. 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 evidence-based interventions, frequently asked questions, and program examples.56 Grantees 

can use the Title III-D Highest-Tier Criteria Evidence-Based Disease Prevention and Health 

56 Administration for Community Living Health Promotion webpage.
62

HEALTH AND INDEPENDENCE FOR OLDER ADULTS

Promotion Programs Cost Chart57 on the site to search the 45+ highest-level criteria programs 

listed. 

Each of the evidence-based programs for which states could use these funds have been rigorously 

evaluated and found to be effective. By requiring states to use funding for one or more of these 

programs, ACL seeks to maximize the impact of this funding by providing benefits to individuals 

and achieving savings due to reduced medical costs. At the same time, states continue to have the 

flexibility to use funding provided under the Home and Community-Based Supportive Services 

program to fund related health services, such as health screenings and physical fitness programs 

that do not meet these evidence-based requirements. 

57 Title III-D Highest-Tier Criteria Evidence-Based Disease Prevention and Health Promotion Programs Cost Chart 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

63

Output Table:

Preventive Health Services

Indicator Year and Most Recent 

Result /

FY 2019

Projection

FY 2020

Projection

FY 2020 Projection

+/-FY 2019

Projection

Output AB: The number 

of people served with 

health and disease 

prevention programs. 

(Output)

FY 2017: 837,300 787,490 726,969 -60,521

Grant Awards Tables:

Preventive Health Services Grant Awards

Awards FY 2018

Final

FY 2019

Enacted

FY 2020

President's 

Budget

Number of 

Awards 56 56 56

Average Award $439,654 $439,277 $439,277

Range of Awards $15,388-

$2,581,522

$15,375-

$2,575,541

$15,375-

$2,575,541
64

HEALTH AND INDEPENDENCE FOR OLDER ADULTS

Department of Health and Human Services 

ADMINISTRATION FOR COMMUNITY LIVING 

FY 2020 DISCRETIONARY STATE/FORMULA GRANTS 

CFDA NUMBER/PROGRAM NAME: Preventive Health Services (CFDA 93.043)

STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/- FY 

2019

Alabama 374,501 371,744 371,744 -

Alaska 123,103 122,998 122,998 -

Arizona 542,626 540,183 540,183 -

Arkansas 229,036 227,387 227,387 -

California 2,581,522 2,575,541 2,575,541 -

Colorado 368,561 369,319 369,319 -

Connecticut 277,665 279,762 279,762 -

Delaware 123,103 122,998 122,998 -

District of Columbia 123,103 122,998 122,998 -

Florida 1,854,009 1,851,582 1,851,582 -

Georgia 661,078 664,765 664,765 -

Hawaii 123,103 122,998 122,998 -

Idaho 123,103 122,998 122,998 -

Illinois 906,685 909,148 909,148 -

Indiana 479,942 479,322 479,322 -

Iowa 244,693 242,246 242,246 -

Kansas 210,546 209,464 209,464 -

Kentucky 333,126 331,455 331,455 -

Louisiana 329,237 328,728 328,728 -

Maine 123,261 122,998 122,998 -

Maryland 425,476 425,735 425,735 -

Massachusetts 514,663 514,680 514,680 -

Michigan 780,064 779,487 779,487 -

Minnesota 403,459 403,362 403,362 -

Mississippi 216,672 214,996 214,996 -

Missouri 466,923 465,530 465,530 -

Montana 123,103 122,998 122,998 -

Nebraska 137,616 136,898 136,898 -

Nevada 210,951 212,227 212,227 -

New Hampshire 123,103 122,998 122,998 -

New Jersey 658,454 659,635 659,635 -

New Mexico 159,928 159,003 159,003 -

New York 1,450,027 1,459,683 1,459,683 -

North Carolina 750,628 753,003 753,003 -

North Dakota 123,103 122,998 122,998 -

Ohio 907,859 904,826 904,826 -

Oklahoma 281,730 278,913 278,913 -

Oregon 330,329 327,521 327,521 -

Pennsylvania 1,056,929 1,049,511 1,049,511 -
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

65

STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/- FY 

2019

Rhode Island 123,103 122,998 122,998 -

South Carolina 394,555 396,388 396,388 -

South Dakota 123,103 122,998 122,998 -

Tennessee 500,955 498,831 498,831 -

Texas 1,643,105 1,649,555 1,649,555 -

Utah 156,711 158,202 158,202 -

Vermont 123,103 122,998 122,998 -

Virginia 593,778 594,154 594,154 -

Washington 527,060 525,603 525,603 -

West Virginia 162,774 161,146 161,146 -

Wisconsin 448,594 446,443 446,443 -

Wyoming 123,103 122,998 122,998 -

 Subtotal 24,172,964 24,154,952 24,154,952 -

American Samoa 15,388 15,375 15,375 -

Guam 61,552 61,499 61,499 -

Northern Mariana Islands 15,388 15,375 15,375 -

Puerto Rico 293,758 290,820 290,820 -

Virgin Islands 61,552 61,499 61,499 -

Subtotal 24,620,602 24,599,520 24,599,520 -

Undistributed58 165,737 248,480 248,480 -

Total States/Territories 24,786,339 24,848,000 24,848,000 -

58 Program Support-includes funds for Older American Act statutory requirements, including program evaluation 

and disaster assistance; and grant and program reporting systems costs. Funds unused for these purposes at the end 

of the year are allocated to states.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

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67

Chronic Disease Self-Management Education

Services FY 2018

Final

FY 2019 

Enacted

FY 2020

President's 

Budget

FY 2020 +/-

FY 2019

Chronic Disease 

Self-Management 

Education*

8,000 8,000 -- (8,000)

*BA is in thousands of dollars.

Authorizing Legislation: Section 411 of the Older Americans Act of 1965, Public Law 89-73.

Most Recent Authorizing Legislation: Older Americans Reauthorization Act of 2016, Public Law 

114-144

Current FY Authorization.....................................................................................................Expired

Authorization Expiration Date...................................................................................................2019

Allocation Method .............................Competitive Grants/Cooperative Agreements and Contracts

Program Description and Accomplishments:

Chronic Disease Self-Management Education (CDSME) programs are low-cost, evidence-based 

prevention models that use state-of-the-art techniques to help those with chronic conditions 

address issues related to the management and treatment of their condition, build self-confidence, 

improve their health status, and reduce their need for more costly medical care. Funds support 

competitive grants to states, as well as related technical assistance and evaluation activities, 

including a National Resource Center.

In the United States, 72 percent of Medicare beneficiaries age 65 and over have multiple (two or 

more) chronic conditions,59 placing them at greater risk for premature death, poor functional status, 

unnecessary hospitalizations, adverse drug events, and nursing home placement.60 Chronic 

conditions also impact health care costs, as 93 percent of Medicare expenditures are for 

beneficiaries with chronic conditions.61

59 Centers for Medicare & Medicaid Services, Centers for Medicare & Medicaid Services, ACL analysis of 2015 

Medicare Current Beneficiary Survey.

60 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. 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.

61 Nawrocki J. CMS Provides Data on Care for Chronic Conditions to Find Better Care Models. NetNews. April 2, 

2013.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

68

Funding History:

Funding for Chronic Disease Self-Management Education over the past five years is as follows:

FY 2016 ..................................................$8,000,000

FY 2017 ..................................................$8,000,000

FY 2018 ...................................................$8,000,000

FY 2019 Enacted......................................$8,000,000

FY 2020 President’s Budget ..................................$0

Budget Request:

The FY 2020 Budget continues to propose to consolidate this activity into the Preventive Health 

Services program and therefore no funding is requested. ACL continues to propose a new general 

provision that would build on existing flexibility and give states the ability to transfer nearly all of 

the funds they receive for HCBSS, Nutrition, Preventive Health and Caregivers between any of 

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

unique needs and to modify existing CDSME programs to best meet the needs within their state.

Grant Awards Table:

Chronic Disease Self-Management Education Grant Awards

Awards FY 2018 

Final

FY 2019 

Enacted

FY 2020 

President's 

Budget

Number of Awards 11 10 -

Average Award $449,010 $760,600 -

Range of Awards $107,447 -

$600,000

$50,000-

$1,000,000 -
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

69

Resource and Program Data:

Chronic Disease Self-Management Education 

(Dollars in Thousands)

Mechanism

FY 2018 

Final #

FY 2018 

Final $

FY 2019 

Enacted #

FY 2019 

Enacted $

FY 2020 

President’s 

Budget #

FY 2020 

President’s 

Budget $

Grants: -- -- -- -- -- --

Formula -- -- -- -- -- --

New Discretionary 10 6,623 9 6,606 -- --

Continuations 5 1,000 1 1,000 -- --

Contracts 1 105 1 161 -- --

Interagency Agreements -- -- -- -- -- --

Program Support62 -- 272 -- 233 -- --

Total Resources -- 8,000 -- 8,000 -- --

62 Program Support -- Includes funds for overhead, grant systems and review costs, and information technology 

support costs.
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HEALTH AND INDEPENDENCE FOR OLDER ADULTS

71

Falls Prevention

Services FY 2018

Final

FY 2019 

Enacted

FY 2020

President's 

Budget

FY 2020 +/-

FY 2019

Falls Prevention* 5,000 5,000 -- (5,000)

*BA is in thousands of dollars.

Original Authorizing Legislation: Section 411 of the Older Americans Act of 1965, Public Law 

89-73

Most Recent Authorizing Legislation: Older Americans Reauthorization Act of 2016, Public Law 

114-144

Current FY Authorization.....................................................................................................Expired

Authorization Expiration Date...................................................................................................2019

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.63 Many people 

limit their activity after a fall, which may reduce strength, physical fitness, and mobility.64 Falls 

can also result in significant loss of independence and often trigger the onset of a series of growing 

needs. Americans over age 75 who fall are more than four times more likely to be admitted to a 

skilled nursing facility.65 Even without a major injury, falls can cause an older adult to become 

fearful or depressed, making it difficult for them to stay active, which in turn increases the need 

for assistance.

Falls prevention programs help participants improve strength, balance, and mobility and provide 

education on how to avoid falls and reduce fall risk factors. These programs also may involve 

medication reviews and modifications; provide referrals for medical care management for selected 

fall risk factors; and provide home hazard assessments of ways to reduce environmental hazards. 

Since September 2014, more than 50,000 older adults across the U.S. have been served via ACL63 Bergen G, Stevens MR, Burns ER. Falls and Fall Injuries Among Adults Aged ≥65 Years — United States, 2014. 

MMWR Morb Mortal Wkly Rep 2016; 65:993–998.

64 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.

65 Donald IP, Bulpitt CJ. The prognosis of falls in elderly people living at home. Age and Ageing 1999;28:121–5
72

HEALTH AND INDEPENDENCE FOR OLDER ADULTS

supported 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 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;66 and the Stepping On program reduction was 31 percent.67 Matter of 

Balance is an evidence-based program designed to reduce the fear of falling and increase activity 

levels among older adults. 

Funding History 

Funding for Falls Prevention over the past five years is as follows: 

FY 2016 ...................................................$5,000,000

FY 2017 ...................................................$5,000,000

FY 2018 ...................................................$5,000,000

FY 2019 Enacted......................................$5,000,000

FY 2020 President’s Budget ..................................$0

Budget Request:

The FY 2020 Budget continues to propose to consolidate the Falls Prevention program into the 

Preventive Health Services program and therefore no funding is requested. ACL continues to 

propose a new general provision that would build on existing flexibility and give states the ability 

to transfer nearly all of the funds they receive between HCBSS, Nutrition, Preventive Health and 

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

needs.

66 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.

67 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.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

73

Grant Awards Table:

Falls Prevention Program Grant Awards

Awards FY 2018 

Final

FY 2019 

Enacted

FY 2019 

President's 

Budget

Number of Awards 11 11 -

Average Award $449,010 $448,026 -

Range of Awards $107,447-

$600,000

$107,447-

$600,000 -

Resource and Program Data:

Falls Prevention

(Dollars in Thousands)

Mechanism

FY 2018 

Final #

FY 2018 

Final $

FY 2019 

Enacted #

FY 2019 

Enacted $

FY 2020 

President’s 

Budget #

FY 2020 

President’s 

Budget $

Grants: -- -- -- -- -- --

Formula -- -- -- -- -- --

New Discretionary 10 4,339 10 4,328 -- --

Continuations 1 600 1 600 -- --

Contracts 1 17 -- -- -- --

Interagency Agreements -- -- -- -- -- --

Program Support68 -- 44 -- 72 -- --

Total Resources -- 5,000 -- 5,000 -- --

68 Program Support -- Includes funds for overhead, grant systems and review costs, and information technology 

support costs.
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75

Native American Nutrition and Supportive Services

Services FY 2018

Final

FY 2019 

Enacted

FY 2020

President's 

Budget

FY 2020 +/-

FY 2019

Native American 

Nutrition & 

Supportive Services*

33,129 34,208 34,208 -

*BA is in thousands of dollars.

Original Authorizing Legislation: Sections 201, 613, and 623 of the Older Americans Act of 1965, 

Public Law 89-73

Most Recent Authorizing Legislation: Older Americans Reauthorization Act of 2016, Public Law 

114-144

Current FY Authorization.....................................................................................................Expired

Authorization Expiration Date...................................................................................................2019

Allocation Method .......................................................Formula Grant/Competitive Grant/Contract

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 945,000 people age 

60 and over identify themselves as Native American or Alaskan Native alone or in combination 

with another racial group.69 Over 549,000 of those elders identify as Native American or Alaskan 

Native with no other racial group.70

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. ACL’s 

congregate meal program currently reaches 43 percent of eligible Native American seniors in 

participating Tribal organizations. Home-delivered meals reach 19 percent of such persons, and 

supportive services reach 65 percent of such persons. These programs, which help to reduce the 

69 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 2017. 

Released June 2018. Accessed July 31, 2018.

70 U.S. Census Bureau, Population Division, Annual Estimates of the Resident Population by Sex, Single Year of 

Age, Race, and Hispanic Origin for the United States: April 1, 2010 to July 1, 2017. Released June 2018. 

Accessed July 31, 2018. 
76

HEALTH AND INDEPENDENCE FOR OLDER ADULTS

need for costly nursing home care and medical interventions, are responsive to the cultural 

traditions of Native American communities and represent an important part of each community’s

comprehensive services 

Services provided by this program in FY 2017 include: 

• Transportation Services, which provided over 700,000 rides to meal sites, medical

appointments, pharmacies, grocery stores, and other critical daily activities.71

• Home-Delivered Nutrition Services, under which almost 2.5 million meals were provided

to more than 24,000 home bound Native American elders. The program also provides

social contacts that help to reduce the risk of depression and isolation experienced by many

home-bound Native American elders.72

• Congregate Nutrition Services, which provided almost 2.4 million meals to more than

61,000 Native American elders in community-based settings, as well as an opportunity for

elders to socialize and participate in a variety of activities, including cultural and wellness

programs.73

• Information, Referral and Outreach Services, which provided more than 810,000 hours of

outreach and information on services and programs to Native American elders and their

families, thereby empowering them to make informed choices about their service and care

needs.74

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 2018, grants 

were awarded to 270 Tribal organizations (representing 400 Tribes and villages), including one 

organization serving Native Hawaiian elders.

71 ACL’s OAA Title VI Program Performance Report, PY 2017

72 Id

73 Id

74 Id
77

HEALTH AND INDEPENDENCE FOR OLDER ADULTS

Funding History: 

Funding for Native American Nutrition and Supportive Services over the past five years is as 

follows: 

FY 2016 .................................................$31,158,000

FY 2017 .................................................$31,136,000

FY 2018 .................................................$33,129,000

FY 2019 Enacted....................................$34,208,000

FY 2020 President’s Budget ..................$34,208,000

Budget Request:

The FY 2020 request for Native American Nutrition and Supportive Services is $34,208,000, the 

same as the FY 2019 Enacted level. Native American Nutrition and Supportive Services, similar 

to services provided through the Home and Community-Based Supportive Services and Nutrition 

Services programs, fund a broad range of services and reduce the need for more expensive 

institutional services. These services include adult day care, personal care, chore services, and 

home-delivered meals that also aid Native American caregivers, who might otherwise have to be 

even more intensely involved with the care of their loved ones, at the risk of their own health and 

careers. In FY 2020, ACL continues to propose a general provision to build on existing flexibility 

by giving Native communities the ability to transfer nearly all of the funds they receive for NANSS 

and NACSS between these programs to achieve the funding distribution that best addresses their 

individual community’s unique needs.

At the FY 2020 request level, these services will support over 840,000 rides, 2.9 million meals at 

home, and 2.9 million meals at congregate sites.

75

In FY 2020, 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 283, a 29 percent increase over the FY 2002 base of 220. Over the past several years 

Native American services have generally met or exceeded their efficiency and output targets for 

meals and trips due in part to increased contributions from tribal organizations.

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

bottom up and the flexibility to direct funding accordingly to meet best meet these needs. In 

FY 2020, ACL continues to propose a new general provision to build on existing flexibility, by 

giving Tribes the ability to transfer nearly all of the funds they receive for Native American 

Nutrition and Support Services and Native American Caregiver Services between these programs 

to achieve the funding distribution that best addresses their individual Tribe’s unique needs.

75 Id
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

78

Outcomes and Outputs Table:

Native American Nutrition & Supportive Services

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2019

Target

FY 2020

Target

FY 2020

Target

+/-FY 2019

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 2017: 283

Target:

305

(Target Not Met but 

Improved)

300 290 -10

Indicator Year and Most Recent 

Result /

FY 2019

Projection

FY 2020

Projection

FY 2020

Projection

+/-FY 2019

Projection

Output L: Transportation 

Services units (Output)

FY 2017: 704,589 828,119 847,035 +18,916

Output M: HomeDelivered Nutrition meals

(Output)

FY 2017: 2.5 M 2.9 M 2.9 M Maintain

Output N: Congregate 

Nutrition meals (Output)

FY 2017: 2.4 M 2.9 M 2.9 M Maintain

Output O: Information, 

Referral and Outreach 

units (Output)

FY 2017: 810,216 795,660 711,195 -84,465
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

79

Grant Awards Table:

Native American Nutrition & Supportive Services Formula Grant Awards

Awards FY 2018 

Final

FY 2019 

Enacted

FY 2020 

President's 

Budget

Number of Awards 274 275 275

Average Award $117,451 $121,007 $121,007 

Range of Awards $73,990-

$1,505,000

$73,990-

$1,505,000

$73,990-

$1,505,000

Resource and Program Data:

Native American Nutrition and Supportive Services

(Dollars in Thousands)

Mechanism

FY 2018 

Final #

FY 2018 

Final $

FY 2019 

Enacted #

FY 2019 

Enacted $

FY 2020 

President’s 

Budget #

FY 2020 

President’s 

Budget $

Grants: -- -- -- -- -- --

Formula 270 31,926 270 32,765 270 32,765 

New Discretionary 1 152 1 200 3 112 

Continuations 3 103 4 312 2 400 

Contracts 1 827 1 721 1 721 

Interagency Agreements -- -- -- -- -- --

Program Support76 -- 121 -- 210 -- 210 

Total Resources 33,129 34,208 34,208 

76 Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and review, 

and information technology support costs.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

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HEALTH AND INDEPENDENCE FOR OLDER ADULTS

81

Aging Network Support Activities

Activities FY 2018

Final

FY 2019 

Enacted

FY 2020

President's 

Budget

FY 2020 +/-

FY 2019

Holocaust Survivor 

Assistance {non-add} 4,988 5,000 5,000 -

Care Corp (non-add) -- 5,000 -- (5,000)

Aging Network 

Support Activities* 12,430 17,461 11,503 (5,958)

*BA is in thousands of dollars.

Authorizing Legislation: Section 202, 215, and 411 of the Older Americans Act of 1965, Public Law 

89-73

Most Recent Authorizing Legislation: Older Americans Reauthorization Act of 2016, Public Law 

114-144

Current FY Authorization.....................................................................................................Expired

Authorization Expiration Date...................................................................................................2019

Allocation Method ............................Competitive Grants/Co-operative Agreements and Contracts

Program Description and Accomplishments:

The Aging Network Support Activities program provides competitive grants and contracts to 

support 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. The activities of national significance help seniors and their families to 

obtain information about their care options and benefits. The program also provides ongoing 

support for the national aging services network and helps 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 awards are made for periods of one to five years.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

82

National Eldercare Locator and Engagement

Older Americans and their caregivers face a complicated array of choices and decisions regarding

health care, pensions, insurance, housing, financial management, and long-term care. The 

Eldercare Locator, created in 1991, helps seniors and their families navigate this complex 

environment by connecting those needing assistance with State and local agencies on aging that 

serve older adults and their caregivers. The Eldercare Locator can be accessed through a toll-free 

nationwide telephone line (800-677-1116) or website (http://www.eldercare.gov). The phone line 

and website both connect those in need to providers in every zip code in the nation. The Eldercare 

Locator website continues to grow as a resource for older adults and their caregivers, serving 

871,362 individuals in 2016. This service is supplemented by an Information and Referral Support 

Center which provides technical assistance and standards for the development of effective 

information and assistance systems.

Research suggests that social engagement remains an important determinant of physical health 

into very late.77 ACL is interested in expanding the reach of the Aging Services network to more 

effectively assist older adults in remaining socially engaged and active. The Engagement and Older 

Adults Resource Center provides technical assistance and serves as a repository for innovations 

designed to increase the aging network’s ability to tailor social engagement activities to meet the 

needs of older adults.

Pension Counseling and Retirement Information

The Pension Counseling program assists older Americans in accessing information about their 

retirement benefits and helps them negotiate with former employers or pension plans for due 

compensation. Currently there are approximately 700,000 private (as well as thousands of public) 

pension and retirement plans in the United States. Given that an employee may have worked for 

several employers, and these employers may have merged, sold their plans, or gone bankrupt, it is 

very difficult for the average person to know where to go to get help in finding out whether he or 

she is receiving all of their pension benefits. ACL currently funds six regional counseling projects 

covering 30 states. In 2016 pension counseling projects recovered $11.4 million and helped 3,812. 

People data for the program show that:

• Pension Counseling projects have successfully recovered over $228 million in client

benefits, representing a return of more than nine dollars for every Federal dollar invested

in the program.

• Projects have directly served over 59,000 individuals by providing hands-on assistance in

pursuing claims through administrative appeals processes, helping seniors to locate

pension plans “lost” as a result of mergers and acquisition, answering queries about

complex plan provisions, and making targeted referrals to other professionals for

assistance.

77 Katie E. Cherry, Erin Jackson Walker, Jennifer Silva Brown, Julia Volaufova, Lynn R. LaMotte, David A. Welsh, 

L. Joseph Su, S. Michal Jazwinski, Rebecca Ellis, Robert H. Wood, and Madlyn I. Frisard. 2013. “Social

Engagement and Health in Younger, Older, and Oldest-Old Adults in the Louisiana Heathy Aging Study. J Appl

Gerontol Feb 1;32(1):51-75.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

83

Pension Counseling projects also provide indirect services to tens of thousands of seniors and their 

families through information sharing, hosting websites, and conducting outreach, education and 

awareness efforts.

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 with information health and long-term care. This project made 

user-friendly financial education and retirement planning tools available to traditionally hard-toreach individuals, including low-income women, women of color, women with limited English 

speaking proficiency, rural, and other “underserved” individuals. 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, the Center has 

conducted approximately 200 workshops per year on strategies to access financial and retirement 

planning information. It also 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 this important but underserved 

population. Each resource center addresses at least two areas of primary concern which are 

specified in the OAA. These include health issues, long-term care (including in-home care), elder 

abuse, mental health, and other problems and issues facing Native communities. The Resource 

Centers are administered under cooperative agreements by institutions of higher education. The 

resource centers partner with Native American organizations and communities, educational 

institutions (including tribal colleges and universities), and professionals and paraprofessionals in 

the field. Each Resource Center has specialized areas of interest. For example, the University of 

North Dakota Resource Center has assisted Title VI grantees in assessing needs of tribal elders to 

determine program planning and direction. This process has led to the development of a database 

of information about American Indian, Alaska Native and Native Hawaiian Elders. The University 

of Hawaii Resource Center has focused on long-term care needs of Native Hawaiian Elders. The 

University of Alaska Resource Center has focused on elder abuse and neglect issues within Native 

American or Alaskan Native communities.

National Minority Aging Organizations Technical Assistance Centers

The National Minority Aging Organizations (NMAO) Technical Assistance Centers program 

works to reduce or eliminate health disparities among racial, ethnic, and other minority older 

individuals. These centers design and disseminate front line health promotion and disease 

prevention information that is culturally and linguistically appropriate for older individuals of 

African American, Hispanic, Asian American and Pacific Islander descent, American Indian and 

Alaska Native elders, as well as for older lesbian, gay, bisexual, and transgender (LGBT) adults.

Each NMAO project pilots a practical, nontraditional, community-based intervention for reaching 

older individuals who experience barriers to accessing home and community-based services. 

Interventions are focused on barriers due to language and low literacy. Strategies developed under 

this program incorporate the latest technology and facilitate the generation and dissemination of 

knowledge in forms that can assist minority older individuals to practice positive health behaviors 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

84

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 referral database of Chronic Disease SelfManagement Education (CDSME) workshops, a series of bilingual Influenza Vaccination 

Promotion materials, and a culturally appropriate caregiver manual/toolkit for American Indian 

and Alaskan Native caregivers caring for elders with dementia.

Holocaust Survivor Assistance

The United States is home to an estimated 130,000 victims of Nazi persecution, approximately 25 

percent of whom are living in poverty. Because of the experiences they endured early on in their 

lives, Holocaust survivors are likely to have greater and more complex physical and mental health 

needs as they age. The nonprofit social service agencies that serve this population have projected 

that the need for supportive services will continue to grow and intensify over the next five to ten 

years.

In FY 2015, ACL developed and implemented a program to provide supportive services for aging 

Holocaust survivors living in the United States. A cooperative agreement was awarded to a 

national organization with demonstrated expertise in working with Holocaust survivors to advance 

the development and delivery of person-centered, trauma-informed supportive services. The 

program focused efforts on two fronts: 1) expanding the capacity of community-based agencies to 

provide direct services to Holocaust survivors in a person-centered, trauma-informed manner; and 

2) developing and implementing a national technical assistance center devoted to expanding the

aging services network’s capacity to deliver person-centered, trauma-informed services.

Program Performance and Technical Assistance

This activity supports cooperative efforts between ACL and selected states and AAAs to develop 

tools, performance measures, and best practices that can be used to effectively and efficiently 

identify the results produced through OAA programs on an ongoing basis. These efforts include 

partnerships with National Aging Organizations to foster innovation and provide technical 

assistance to states, AAAs, and tribal organizations in strategic planning, program development, 

and performance improvement. Program Performance and Technical Assistance (PPTA) also 

supports efforts to expand the business acumen and contracting capacity of the community-based 

organizations (CBOs) within the Aging network. Medicaid, Medicare, Accountable Care 

Organizations, private insurers and other private pay models will offer increasing opportunities to 

CBOs to tap into new revenue streams outside of government grants, but securing contracts and 

interfacing with such payers requires thinking and operating differently. In FY 2019 Care Corps 

will develop and test local models of caregiver support for older adults and people with disabilities. 

ACL’s Business Acumen Initiative seeks to strengthen CBOs from the inside, building their 

business skills and enhancing their effectiveness, efficiency and sustainability.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

85

Funding History:

Comparable funding for Aging Network Support Activities over the past five years is as follows:

FY 2016 ...................................................$9,961,000

FY 2017 ...................................................$9,938,000

FY 2018 .................................................$12,430,000

FY 2019 Enacted....................................$17,461,000

FY 2020 President’s Budget ..................$11,503,000

Budget Request:

The FY 2020 request for Aging Network Support Activities is $11,503,000, a reduction 

of -$5,958,000 below the FY 2019 Enacted level. This level does not include funding for the Care 

Corps Program and represents a reduction in efforts to assist Area Aging Agencies through the 

Program Performance and Technical Assistance efforts. Programs funded by this request provide 

ongoing support for the national aging services network and support the activities of ACL’s core 

service delivery programs. They provide a variety of unique services – such as the Pension 

Counseling and the National Eldercare Locator – and strengthen and streamline ACL’s core 

services.78

The request will continue, as permitted by statute, to support .4 FTE for administration of the 

Pension Counseling program.

Aging Network Support Activities outcomes are reflected in performance targets for Health and 

Independence for Older Adults and Caregiver and Family Support Services.

78 Please see page 224 for a discussion of how the MIPPA program helps hard to reach low income and Rural 

Medicare beneficiaries who qualify for either the Medicare savings plan or Low-Income Subsidy pay their Medicare 

premiums.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

86

Aging Network Support Activities includes funding for the following projects:

(dollars in thousands):

Activity

FY 2018 

Operational 

Level

FY 2019 

President’s 

Budget

FY 2020 

Request

Aging Network Support Activities:

National Eldercare Locator and Engagement 2,033 2,038 2,038

Pension Counseling and Retirement Information 1,849 1,858 1,858

National Resource Centers on Native Americans 653 655 655

National Minority Aging Organizations 1,162 1,165 1,165

Holocaust Survivor Assistance 4,988 5,000 5,000

Program Performance and Technical Assistance 1,744 1,745 788

Care Corps 0 5,000 0

Total, Aging Network Support Activities 12,430 17,461 11,503

Grant Awards Table:

Aging Network Support Grant Awards

Awards FY 2018 

Final

FY 2019 

Enacted

FY 2020 

President's 

Budget

Number of 

Awards 31 29 24

Average Award $393,198 $587,119 $465,768 

Range of Awards $134,452-

$2,467,500

$134,452-

$2,467,500

$134,452-

$2,467,500
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

87

Resource and Program Data:

Aging Network Support Activities

(Dollars in thousands)

Mechanism

FY 2018 

Final #

FY 2018 

Final $

FY 2019 

Enacted #

FY 2019 

Enacted $

FY 2020 

President’s 

Budget #

FY 2020 

President’s 

Budget $

Grants: -- -- -- -- -- --

Formula -- -- -- -- -- --

New Discretionary 16 6,651 3 8,077 10 6,987 

Continuations 15 5,538 26 8,949 14 4,192 

Contracts 1 20 2 120 2 120 

Interagency Agreements -- -- -- -- -- --

Program Support79 -- 221 -- 315 -- 205 

Total Resources -- 12,430 -- 17,461 -- 11,503 

79 Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and review, 

and information technology support costs.
88

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CAREGIVER AND FAMILY SUPPORT SERVICES

89

Caregiver and Family Support Services

Summary of Request

Families are the nation’s primary provider of long-term care, but a number of factors including 

financial constraints, work and family demands, and the many challenges of providing care place 

great pressure on family caregivers. Caregiving responsibilities demand time and money from 

families who too often are already strapped for both. ACL’s caregiver programs provide services 

that address the needs of unpaid, informal caregivers, allowing many of them to continue to work 

while providing critically needed care.

Better support for informal caregivers is critical because often it is their availability—whether they 

are family members or unrelated friends and neighbors who dedicate their time—that determines

whether an older person can remain in his or her home. In 2014, approximately 34.2 million adult 

caregivers provided uncompensated care to those 50 years of age and older.80 An estimated 117 

million Americans will need assistance of some kind by 2020.81 These trends are already being 

felt in the marketplace, where employers are losing an estimated $33 billion per year due to 

employees’ caregiving responsibilities.82

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.83

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-nine percent of the caregivers served by OAA programs 

report that these services allow them to provide care longer than they otherwise could have.84

By 2020 the U.S. Census Bureau estimates there will be 15.6 million non-institutionalized seniors 

age 65 and over with 1+ ADL deficits, an increase of 1.4 million older adults (or 10 percent 

increase between 2016 and 2020) needing caregiver assistance.85 To help address these caregiverrelated needs, Consistent with the FY 2019 Budget, ACL proposes to expand existing transfer 

authorities to give States and Tribes maximum flexibility to transfer funding between four Older 

80 FY15OAAReportCongress, page 25.

81 The Opportunity Costs of Informal Elder-Care in the United States. 

82 The MetLife Caregiving Cost Study: Productivity Losses to U.S. Business, Page 17.

83 Schulz R, Beach SR. Caregiving as a risk factor for mortality. The Caregiver Health Effects study. JAMA December 

15, 1999;282:2215-9.

84 2018 National Survey of Older Americans Act Participants.

85 U.S. Census Bureau, “2017 National Population Projections,” Table 3. Projected 5-Year Age Groups and Sex 

Composition of the Population for the United States: 2017 to 2060. Original Release Date: March 2018, Revised 

Release Date: September 2018. Accessed 23 October 2018. U.S. Census Bureau, Annual Estimates of the 

Resident Population by Sex, Single Year of Age, Race, and Hispanic Origin for the United States: April 1, 2010 to 

July 1, 2017: Released June 2018. Accessed 24 July 2018. Centers for Medicare & Medicaid Services, ACL 

analysis of 2015 Medicare Current Beneficiary Survey. Accessed 24 July 2018. Centers for Medicare & Medicaid 

Services, ACL analysis of 2015 Medicare Current Beneficiary Survey. Accessed 26 July 2018.
CAREGIVER AND FAMILY SUPPORT SERVICES

90

Americans Act Programs. These are Home and Community Based Supportive Services, Nutrition 

Programs, Family Caregiver Services, and Preventive Health Services. In addition, ACL requests 

a total of $181 million, the same level as the FY 2019 President’s Budget. The request includes:

• $150.6 million for Family Caregiver Support Services, a reduction of -$30.1 million from

the FY 2019 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. The request is consistent with the FY 2019 President’s Budget.

• $7.6 million for Native American Caregiver Support Services, a reduction of -$2.5 million

below FY 2019 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. The

request is consistent with the FY 2019 President’s Budget.

• $19.5 million for the Alzheimer’s Disease Program, a reduction of -$4.0 million below the

FY 2019 Enacted Level. The Alzheimer’s Disease program includes two classes of

competitive grants – to States who want to improve/develop their dementia systems

capability, and to existing dementia capable community-based organizations that are

prepared to address identified service gaps through expansion of their on-going activities.

In addition, ACL funds a training and technical assistance resource center and a national

call center. The request is consistent with the FY 2019 President’s Budget.

• $3.4 million for Lifespan Respite Care, a reduction of -$0.8 million from the FY 2019

Enacted Level. At this level the Lifespan Respite Care program will continue its efforts to

develop more efficient, cost-effective methods that reach across the aging and the

disability populations to improve the quality of and access to respite care for family

caregivers of children or adults of any age with special needs. The request is consistent

with the FY 2019 President’s Budget.
CAREGIVER AND FAMILY SUPPORT SERVICES

91

Family Caregiver Support Services

Services FY 2018

Final

FY 2019 

Enacted

FY 2020

President's 

Budget

FY 2020 +/-

FY 2019

Family Caregiver 

Support Services* 180,138 181,186 150,586 (30,600)

*BA is in thousands of dollars.

Original Authorizing Legislation: Section 371 of the Older Americans Act of 1965, Public Law 

89-73.

Most Recent Authorizing Legislation: Older Americans Reauthorization Act of 2016, Public Law 

114-144

Current FY Authorization.....................................................................................................Expired

Authorization Expiration Date...................................................................................................2019

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

Program Description and Accomplishments:

The Family Caregiver Support Services Program provides formula grants to states and territories, 

based on their share of the population age 70 and over, to fund a range of supports that assist family 

and informal caregivers to care for their loved ones at home for as long as possible. The program 

includes five basic system components: information, access assistance, counseling and training, 

respite care, and supplemental services. These services work in conjunction with other OAA 

services to provide a coordinated set of supports that caregivers can access on behalf of themselves 

and the seniors for whom they provide care. These services include: 

• Access Assistance Services provided nearly 1.3 million contacts to caregivers assisting

them in locating services from a variety of public and private agencies (Output I).86

• Counseling and Training Services provided over 108,000 caregivers with counseling, peer

support groups, and training to help them better cope with the stresses of caregiving

(Output J).87

• Respite Care Services provided over 58,900 caregivers with nearly 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).88

86 ACL’S OAA State Performance Report, FY 2016

87 Id

88 Id
CAREGIVER AND FAMILY SUPPORT SERVICES

92

Family and other informal caregivers are the backbone of America’s long-term care system. On a 

daily basis, these individuals assist relatives and other loved ones with tasks ranging from personal

care and homemaking to more complex health-related interventions like medication administration 

and wound care. The economic cost of replacing unpaid caregiving is estimated to be between 

$47089 and $522 billion annually, which is roughly equivalent to the cost of all Medicaid spending 

in FY 2016 (Federal and state: $553 billion).90

Research has also shown that caregiving exacts a heavy emotional, physical, and financial toll. 

Caregivers often experience conflicts between work and caregiving, with 28 percent reporting that 

they have had to make adjustments such as retiring or taking time away from work due to their 

caregiving responsibilities.91 According to data from ACL’s National Survey of OAA 

Participants, 22 percent of caregivers reported that they are assisting two or more individuals.92 

Seventy-three percent of Title III caregivers are 60 or older, making them more susceptible to a 

decline in their own health, and 31 percent describe their own health as fair to poor.93 The demands 

of caregiving can lead to a breakdown of the caregiver’s health, and the illness, hospitalization, or 

death of a caregiver increases the risk for institutionalization of the care recipient.

Studies have shown that the types of supports provided through the Family Caregiver Support 

Services Program can reduce caregiver depression, anxiety, and stress and enable them to provide 

care longer while often continuing to work, thereby avoiding or delaying the need for costly 

institutional care for their loved ones. For example, one study indicates that counseling and support 

for caregivers of individuals with Alzheimer’s disease can permit the care recipient to stay at home,

at significantly less cost, for an additional year before being admitted to a nursing home.94

Additionally, data from ACL’s National Surveys shows that ACL services are effective in helping 

caregivers keep their loved ones at home. Approximately 79 percent of caregivers of program 

clients reported that services enabled them to provide care longer than otherwise would have been 

possible.95 Caregivers receiving services were also asked whether the care recipient would have 

been able to live in the same residence if the services had not been available. Thirty eight percent 

of caregivers indicated that the care recipient would be unable to remain at home without the 

support services.96 Those respondents were then asked to identify where the care recipient would 

be living without services. A significant majority of those caregivers, 76 percent,97 indicated that 

the care recipient would most likely be living in a nursing home or assisted living (see below).

89 Ibid.

90 Ibid.

91 2018 National Survey of Older Americans Act Participants.

92 Id

93 Id

94 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.

95 2018 National Survey of Older Americans Act Participants.

96 Id

97 Id
CAREGIVER AND FAMILY SUPPORT SERVICES

93

Funding History:

Funding for Family Caregiver Support Services over the past five years is as follows:

FY 2016 ...............................................$150,586,000

FY 2017 ...............................................$150,240,000

FY 2018 ...............................................$180,138,000

FY 2019 Enacted..................................$181,186,000

FY 2020 President’s Budget ................$150,586,000

Budget Request:

The FY 2020 request for Family Caregiver Support Services is $150,586,000, the same level as 

the FY 2019 President’s Budget. Funding for Family Caregiver Support Services will allow ACL 

to continue services that give caregivers the assistance needed to help them sustain their caregiving 

and provide care longer. By helping caregivers so that they in turn can help to keep their loves 

ones independent and out of an institution for a longer period, investments in this program can 

reduce costs to the Federal government in other areas such as Medicaid.
CAREGIVER AND FAMILY SUPPORT SERVICES

94

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

programs, and up to 40 percent of Nutrition funding between the Nutrition programs. ACL 

continues to propose a new general provision to maximize funding flexibility for states to use 

Older American Act funding, between HCBSS, Nutrition, Preventive Health and Caregivers to 

direct funding to activities that best addresses their individual State’s unique needs.

The requested funding level for Family Caregiver Supportive Services will allow

800,000 caregivers (Outcome 3.1) to receive supportive services, including respite care or other 

temporary relief from their caregiving responsibilities. At the requested level, ACL will continue 

support for the Raise Family Caregivers Act, and the Supporting Grandparents Raising 

Grandchildren Act. In addition, as many as 105,000 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 2020, ACL anticipates the aging services network to be able to meet or exceed the target of 

only 30 percent of caregivers experiencing difficulty obtaining services (Outcome 2.6). This is a 

substantial accomplishment that occurred at the State level as a result of ongoing program 

development, better coordination, and integration of the Family Caregiver program into the array 

of State home and community-based services. Baseline levels from 2003 showed that 64 percent 

of caregivers had difficulty getting services, and by 2017, that rate had been reduced to 33 percent 

of caregivers reporting difficulty getting services.98

For FY 2020, 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.

98 Id
CAREGIVER AND FAMILY SUPPORT SERVICES

95

Outcomes and Outputs Table:

Family Caregiver Support Services

Measure Year and Most Recent 

Result / 

Target for Recent Result / 

(Summary of Result) 

FY 2019

Target

FY 2020

Target

FY 2020 Target

+/-FY 2019

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 2017: 8,227 clients

Target:

9,000 clients

(Target Not Met)

8,900 clients 8,300 clients -600 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 2017: 31%

Target:

26.8%

(Target Not Met but 

Improved)

30% 30% Maintain

2.9c Maintain at 90% or 

higher the percentage of 

National Family 

Caregiver Support 

Program clients who rate 

services good to 

excellent. (Outcome)

FY 2017: 93%

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 2017: 63.7 weighted 

average

Target:

63.25 weighted average

(Target Exceeded)

63.6 weighted 

average

64 weighted 

average

+0.4 weighted

average

3.1 Increase the number 

of caregivers served 

through the National 

Family Caregiver 

Support Program. 

(Outcome)

FY 2017: 791,934 caregivers

Target:

900,000 caregivers

(Target Not Met but 

Improved)

800,000 

caregivers

800,000 

caregivers

Maintain
CAREGIVER AND FAMILY SUPPORT SERVICES

96

Indicator Year and Most Recent 

Result /

FY 2019

Projection

FY 2020

Projection

FY 2020 Projection

+/-FY 2019

Projection

Output I: Caregivers 

access assistance units of 

service. (Output)

FY 2017: 1.3 M 1.41 M 1.23 M -0.18 M

Output J: Caregivers 

receiving counseling and 

training. (Output)

FY 2017: 108,665 121,492 105,438 -16,054

Output K: Caregivers 

receiving respite care 

services. (Output)

FY 2017: 58,956 64,412 57,177 -7,235

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

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

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

achieving current strategic objectives.

Grant Awards Table:

Family Caregiver Supportive Services Grant Awards

Awards FY 2018

Final

FY 2019

Enacted

FY 2020

President's 

Budget

Number of 

Awards 56 56 56

Average Award $3,196,770 $3,203,110 $2,662,145

Range of Awards

$111,887-

$18,613,674

$112,109-

$18,554,884

$93,175-

$15,421,200
CAREGIVER AND FAMILY SUPPORT SERVICES

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Department of Health and Human Services

ADMINISTRATION FOR COMMUNITY LIVING

FY 2020 DISCRETIONARY STATE/FORMULA GRANTS

CFDA NUMBER/PROGRAM NAME: Family Caregivers Support Services (CFDA 93.052)

STATE/TERRITORY

FY 2018 

Final

FY 2019

Enacted

FY 2020 

President's Budget 

FY 2020 +/- FY 

2019 

Alabama 2,709,415 2,698,062 2,242,394 (455,668)

Alaska 895,096 896,870 745,400 (151,470)

Arizona 4,162,295 4,157,904 3,455,687 (702,217)

Arkansas 1,707,413 1,703,237 1,415,582 (287,655)

California 18,613,674 18,554,884 15,421,200 (3,133,684)

Colorado 2,460,926 2,481,492 2,062,400 (419,092)

Connecticut 2,053,876 2,088,348 1,735,653 (352,695)

Delaware 895,096 896,870 745,400 (151,470)

District of Columbia 895,096 896,870 745,400 (151,470)

Florida 14,897,648 14,916,927 12,397,649 (2,519,278)

Georgia 4,525,861 4,599,036 3,822,318 (776,718)

Hawaii 895,096 896,870 745,400 (151,470)

Idaho 895,096 896,870 745,400 (151,470)

Illinois 6,519,625 6,576,311 5,465,656 (1,110,655)

Indiana 3,431,275 3,433,008 2,853,217 (579,791)

Iowa 1,832,214 1,801,135 1,496,946 (304,189)

Kansas 1,535,955 1,525,070 1,267,505 (257,565)

Kentucky 2,356,607 2,361,242 1,962,458 (398,784)

Louisiana 2,297,730 2,309,910 1,919,796 (390,114)

Maine 895,096 896,870 745,400 (151,470)

Maryland 3,014,406 3,026,134 2,515,058 (511,076)

Massachusetts 3,756,823 3,762,824 3,127,331 (635,493)

Michigan 5,566,469 5,570,968 4,630,103 (940,865)

Minnesota 2,909,295 2,893,620 2,404,925 (488,695)

Mississippi 1,553,735 1,541,589 1,281,234 (260,355)

Missouri 3,435,124 3,424,466 2,846,117 (578,349)

Montana 895,096 896,870 745,400 (151,470)

Nebraska 1,009,963 999,867 831,002 (168,865)

Nevada 1,481,560 1,512,187 1,256,798 (255,389)

New Hampshire 895,096 896,870 745,400 (151,470)

New Jersey 4,857,126 4,880,163 4,055,966 (824,197)

New Mexico 1,154,080 1,151,244 956,814 (194,430)

New York 10,679,449 10,821,947 8,994,259 (1,827,688)

North Carolina 5,377,865 5,436,175 4,518,075 (918,100)

North Dakota 895,096 896,870 745,400 (151,470)

Ohio 6,544,816 6,536,738 5,432,767 (1,103,971)

Oklahoma 2,069,518 2,047,989 1,702,110 (345,879)

Oregon 2,331,458 2,327,115 1,934,095 (393,020)

Pennsylvania 7,889,290 7,828,266 6,506,172 (1,322,094)
CAREGIVER AND FAMILY SUPPORT SERVICES

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STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/- FY 

2019

Rhode Island 895,096 896,870 745,400 (151,470)

South Carolina 2,798,605 2,853,896 2,371,910 (481,986)

South Dakota 895,096 896,870 745,400 (151,470)

Tennessee 3,582,430 3,592,256 2,985,570 (606,686)

Texas 11,430,354 11,477,879 9,539,412 (1,938,467)

Utah 1,094,914 1,105,025 918,401 (186,624)

Vermont 895,096 896,870 745,400 (151,470)

Virginia 4,210,006 4,249,020 3,531,415 (717,605)

Washington 3,645,963 3,648,609 3,032,406 (616,203)

West Virginia 1,173,471 1,169,094 971,649 (197,445)

Wisconsin 3,234,521 3,194,544 2,655,026 (539,518)

Wyoming 895,096 896,870 745,400 (151,470)

 Subtotal 175,542,003 175,917,491 146,207,276 (29,710,215)

American Samoa 111,887 112,109 93,175 (18,934)

Guam 447,548 448,435 372,700 (75,735)

Northern Mariana Islands 111,887 112,109 93,175 (18,934)

Puerto Rico 2,358,249 2,335,561 1,941,114 (394,447)

Virgin Islands 447,548 448,435 372,700 (75,735)

Subtotal 179,019,122 179,374,140 149,080,140 (30,294,000)

Program Support99 1,118,753 1,811,860 1,505,860 (306,000)

Total States/Territories 180,137,875 181,186,000 150,586,000 (30,600,000)

99 Program Support- includes funds for Older Americans Act statutory requirements, including program evaluation 

and disaster assistance; and grant and program reporting systems costs. Funds unused for these purposes at the end 

of the year are allocated to states.
CAREGIVER AND FAMILY SUPPORT SERVICES

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Native American Caregiver Support Services

Services FY 2018

Final

FY 2019 

Enacted

FY 2020

President's 

Budget

FY 2020 +/-

FY 2019

Native American 

Caregiver Support 

Services*

9,529 10,056 7,556 (2,500)

*BA is in thousands of dollars.

Original Authorizing Legislation: Section 631 of the Older Americans Act of 1965, Public Law 

89-73

Most Recent Authorizing Legislation: Older Americans Reauthorization Act of 2016, Public Law 

114-144

Current FY Authorization.....................................................................................................Expired

Authorization Expiration Date...................................................................................................2019

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

Program Description and Accomplishments:

Native American Caregiver Support Services provide grants to eligible tribal organizations to 

support family and informal caregivers of Native American, Alaskan Native, and Native Hawaiian 

elders. This program helps to reduce the need for costly nursing home care and medical 

interventions, is responsive to the needs of Native American communities and represents an 

important part of each community’s comprehensive services.

Native American Caregiver Support Services funding is allocated to eligible tribal organizations 

based on their share of the American Indian, Alaskan Native, and Native Hawaiian populations

aged 60 and over. Native organizations must represent at least 50 Native American elders age 

60 and over and must also receive a grant under the Native American Nutrition and Supportive 

Services program to receive funding. There is no requirement for matching funds. Tribes may also 

decide the age at which a member is considered an elder and thus eligible for services. In addition, 

there is no limit on the percentage of funds that can be used for services to grandparents caring for 

grandchildren.

Grants assist American Indian, Alaskan Native and Native Hawaiian families caring for older 

relatives with chronic illness or disability and grandparents caring for grandchildren. The 2017 

National Resource Center on Native American Aging’s Identifying Our Needs: A Survey of Elders

show that 33.7% of Native Elders have a family member as a caregiver; and 28.3% are themselves 
CAREGIVER AND FAMILY SUPPORT SERVICES

100

caring for grandchildren and 10.2% of these Elders are the primary caregiver of a grandchild. The 

trending top five chronic diseases among Elders were high blood pressure (56.5%), arthritis 

(45.3%), diabetes (39.3%), cataracts (19.4%), and depression (13.3%).

The Title VI 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. Native organizations coordinate with other 

programs to help support and create sustainable caregiver programs in Native American 

communities (many of which are geographically isolated). A core value of the Native American 

Caregiver Support Services program is that the program should not replace the tradition of families 

caring for their elders. Rather, as expressed by multiple tribal and other Native leaders, the program 

provides support that strengthens the family caregiver role.

Funding History:

Funding for the Native American Caregiver Support Services over the past five years is as follows:

FY 2016 ...................................................$7,531,000

FY 2017 ...................................................$7,539,000

FY 2018 ...................................................$9,529,000

FY 2019 Enacted ...................................$10,056,000

FY 2020 President’s Budget ...................$7,556,000

Budget Request:

The FY 2020 request for Native American Caregiver Support Services is $7,556,000, a reduction 

of -$2.5 million below the FY 2019 Enacted Level. The request supports the same level as the FY 

2019 President’s Budget. Often it is the availability of caregivers – whether they are family 

members or unrelated friends and neighbors who volunteer their time – that determines whether 

an older person can remain in his or her home.

The strength of the Older Americans Act is that it gives Native communities the ability to define 

needs from the bottom up and the flexibility to direct funding accordingly to meet best meet these 

needs. In FY 2020, ACL continues to propose a new general provision to build on existing 

flexibility by giving Native communities the ability to transfer nearly all of the funds they receive 

for NANSS and NACSS between these programs to achieve the funding distribution that best 

addresses their individual community’s unique needs.
CAREGIVER AND FAMILY SUPPORT SERVICES

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An estimated 945,000 persons age 60 and over identify themselves as Native American or Alaskan

Native alone or in combination with another racial group.100 Over 549,000 of those elders identify 

as Native American or Alaskan Native with no other racial group101. Caregiver Support Services 

help Native American elders, many of whom have limitations in activities of daily living that make 

it difficult to care for themselves, to remain at home, in the community, or on the reservation for 

as long as possible. Studies have shown that providing assistance to caregivers can help them cope 

with the emotional, physical and financial toll associated with caregiving, thereby enabling them 

to provide care for their loved ones longer and avoid or delay the need for costly nursing home 

care.

Performance data indicates that these programs are an efficient means to help Native American 

Elders remain independent and in the community. In FY 2020, funding for the Native American 

Caregiver Support Program will continue to support family and informal caregivers, whose 

assistance is critical to enabling Native American elders to remain at home, in the community, 

and/or on the reservation. In FY 2020, an estimated 711,000 units of caregiver-related services,

including respite care, information and referral, caregiver training and support groups, will have 

been provided by Native American Tribal organizations.

Outcome Table:

Native American Caregivers Supportive Services 

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2019

Target

FY 2020

Target

FY 2020 Target +/-

FY 2019 Target

3.1 Increase the number 

of caregivers served 

through the National 

Family Caregiver 

Support Program. 

(Outcome)

FY 2017: 791,934 caregivers

Target:

900,000 caregivers

(Target Not Met but 

Improved)

800,000 

caregivers

800,000 

caregivers

Maintain

100 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, 2017

Released June 2018. Accessed July 31, 2018.

101 U.S. Census Bureau, Population Division, Annual Estimates of the Resident Population by Sex, Single Year of 

Age, Race, and Hispanic Origin for the United States: April 1, 2010 to July 1, 2017. Release Date: June 2018. 

Accessed July 31, 2018. 
CAREGIVER AND FAMILY SUPPORT SERVICES

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Grant Awards Table:

Native American Caregivers Supportive Services Grant Awards

Awards FY 2018 

Final

FY 2019 

Enacted

FY 2020 

President's 

Budget

Number of Awards 238 238 238

Average Award $39,552 $41,676 $31,172 

Range of Awards $13,820-

$56,560 

$13,820-

$56,560 

$13,820-

$56,560 

Resource and Program Data:

Native American Caregiver Support Services

(Dollars in thousands)

Mechanism

FY 2018 

Final #

FY 2018 

Final $

FY 2019 

Enacted #

FY 2019 

Enacted $

FY 2020 

President’s 

Budget #

FY 2020 

President’s 

Budget $

Grants: -- -- -- -- -- --

Formula 238 9,413 238 9,919 238 7,419 

New Discretionary -- -- -- -- -- --

Continuations -- -- -- -- -- --

Contracts 1 50 -- -- -- --

Interagency Agreements -- -- -- -- -- --

Program Support102 -- 65 -- 137 -- 137 

Total Resources 9,529 10,056 7,556 

102 Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and review, 

and information technology support costs.
CAREGIVER AND FAMILY SUPPORT SERVICES

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Alzheimer’s Disease Program

Alzheimer's 

Disease Program

FY 2018

Final

FY 2019 

Enacted

FY 2020

President's 

Budget

FY 2020 +/-

FY 2019

Alzheimer's Disease 

from (Direct 

Appropriations)

8,778 8,800 19,490 10,690

Alzheimer's Disease 

(from PPHF) 14,700 14,700 -- (14,700)

Alzheimer's Disease 

Program*

23,478 23,500 19,490 (4,010)

*BA is in thousands of dollars.

Authorizing Legislation: Section 411 of the Older Americans Act of 1965, Public Law 89-73

Most Recent Authorizing Legislation: Older Americans Reauthorization Act of 2016, Public Law 

114-144

Current FY Authorization.....................................................................................................Expired

Expiration Date ..........................................................................................................................2019

Allocation Method .............................Competitive Grants/Cooperative Agreements and Contracts

Program Description and Accomplishments:

The effects of Alzheimer’s Disease and Related Dementias (ADRD) are devastating for 

individuals living with the disease and their family caregivers. Serving people with ADRD 

typically requires significant levels of medical care as well as the provision of person-centered, 

dementia-capable home and community-based services (HCBS). Approximately one-third of 

individuals with ADRD living in the community live alone, exposing them to numerous risks, 

including unmet needs, malnutrition and injury, and various forms of neglect and exploitation.103

As the number of people with ADRD is projected to grow by almost 300 percent by 2050104, from 

an estimated 5.3 million individuals, it is important to develop effective and coordinated service 

delivery and health care systems that are responsive to these individuals and their caregivers.

103 Gould, E., Maslow, K., Yuen, P., Wiener, J. Providing Services for People with Dementia Who Live Alone: Issue 

Brief. Accessed April 14, 2014.

104 Alzheimer’s Association. 2017 Alzheimer’s Disease Facts and Figures. Accessed 09 May, 2017.
CAREGIVER AND FAMILY SUPPORT SERVICES

104

The complexity of care required by persons with advanced dementia – defined by the severity of 

functional and cognitive impairment, reliance on surrogate decision-making, and inability to live 

alone – results in tremendous family/caregiver burden.105 Behavioral symptoms such as repetitive 

speech, wandering, and sleep disturbances are core clinical characteristics of ADRD. If untreated, 

these behaviors can accelerate disease progression, worsen functional decline and quality of life, 

cause significant caregiver distress, and result in earlier nursing home placement.106

Establishing dementia-capable home and community-based service systems designed to meet the 

needs of formal and informal caregivers of individuals with ADRD is critical to helping these 

caregivers continue to provide care. The Alzheimer’s Disease Program provides funding for the 

development and implementation of these person-centered services and supports partnerships with 

public and private entities to identify and address the unique needs of persons with ADRD and 

their caregivers.

In FY 2018, three existing ACL Alzheimer’s programs were consolidated into a single, more 

flexible program. These programs were: the Alzheimer’s Disease Supportive Services program 

(ADSSP), the Alzheimer’s Disease Initiative - Specialized Services Program (ADI-SSS) and the 

ADI – Communications Campaign, along with the Alzheimer’s Call Center previously funded 

from the ANSA. This consolidated program improves the services that support caregivers and

people with ADRD by dedicating resources for States and community-based organizations 

providing both services and training to people with ADRD. Through the Alzheimer’s Disease 

program, ACL has issued two classes of competitive grants – to States who want to 

improve/develop their dementia systems capability, and to existing dementia capable communitybased organizations that are prepared to address identified service gaps through expansion of their 

on-going activities. Collectively these grants seek to achieve the following objectives:

• Create state-wide, person-centered, dementia-capable home and community-based

service systems;

• Translate and implement evidence-based supportive services for persons with ADRD

and their caregivers at the community level;

• Work with public and private entities to identify and address the special needs of persons

with ADRD and their caregivers; and

• Offer direct services and supports to thousands of persons with ADRD and their

caregivers.

To support this work, ACL also funds a training and technical assistance resource center. The 

center works with grantees to share best practices, disseminate recent research findings, and 

develop issue briefs for States and communities. 

105 National Alzheimer Project Act Advisory Council on Alzheimer's Research, Care, and Services Meeting #15: 

Advanced Dementia Expert Panel Summary and Key Recommendations. (2015, January 26). January 26, 2015 

In-Person Meeting.

106 Gitlin LN, Kales HC, Lyketsos CG. Nonpharmacologic Management of Behavioral Symptoms in Dementia.

JAMA. 2012;308(19):2020-2029. doi:10.1001/jama.2012.36918.
CAREGIVER AND FAMILY SUPPORT SERVICES

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Funding History:

FY 2016 .................................................................$0

FY 2017 .................................................................$0

FY 2018/1 ..............................................$23,478,000

FY 2019 Enacted/1 ................................$23,500,000

FY 2020 President’s Budget ..................$19,490,000

1/FY 2018 and FY 2019 totals each include $14.7 million in funding from the Prevention and Public Health Fund. 

Budget Request: 

In FY 2020, ACL is requesting $19,490,000, a reduction of -$4,010,000 below the FY 2019

Enacted Level and the same level as was requested in the FY 2019 President’s Budget to support 

Alzheimer’s Disease activities through a single, consolidated grant program. 

The need for cutting edge approaches for services and systems that help to support those with 

Alzheimer’s disease and related dementias (ADRD) and their caregivers is critical for helping them 

to remain in the community. At this funding level ACL will continue to assist individuals with 

ADRD and their caregivers. 

Outcome and Outputs Table:

Alzheimer’s Disease Program

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2019

Target

FY 2020

Target

FY 2020 Target

+/-FY 2019 Target

ALZ.3 Improve dementia 

capability of long-term 

support systems to 

create dementia-friendly, 

livable communities. 

(Outcome)

FY 2018: 22%

Target:

22%

(Baseline)

28% 33% +5
CAREGIVER AND FAMILY SUPPORT SERVICES

106

Grant Awards Tables:

Alzheimer’s Disease Program107

Awards FY 2018 

Final

FY 2019 

Enacted

FY 2020 

President's 

Budget

Number of Awards 20 22 22

Average Award $913,825 $984,276 $885,909

Range of Awards $350,000-

$1,233,571

$350,000-

$123,571

$350,000-

$123,571

Resource and Program Data:

Alzheimer’s Disease Program

Mechanism

FY 2018 

Final #

FY 2018 

Final $

FY 2019 

Enacted #

FY 2019 

Enacted $

FY 2020 

President’s 

Budget #

FY 2020 

President’s 

Budget $

Grants: -- -- -- -- -- --

Formula -- -- -- -- -- --

New Discretionary 20 18,277 21 20,420 -- --

Continuations -- 1 1,234 22 17,644 

Contracts 1 1,700 1 1,700 1 1,700 

Interagency Agreements -- -- -- -- -- --

Program Support108 -- 166 -- 146 -- 146 

Total Resources109 -- 20,142 -- 23,500 -- 19,490

107 The number of awards is an estimate and may change.

108 Program Support -- Includes funds for overhead, grant systems and review costs, and information technology 

support costs.

109 $3.4 million in FY 2018 funding remains available for future years.
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Lifespan Respite Care

Services FY 2018

Final

FY 2019 

Enacted

FY 2020

President's 

Budget

FY 2020 +/-

FY 2019

Lifespan Respite 

Care* 4,100 4,110 3,360 (750)

*BA is in thousands of dollars.

Original Authorizing Legislation: Lifespan Respite Care Act of 2006, Title XXIX of the Public 

Health Service Act

Most Recent Authorizing Legislation: Lifespan Respite Care Act of 2006, Title XXIX of the Public 

Health Service Act

Current FY Authorization.....................................................................................................Expired

Expiration Date ..........................................................................................................................2011

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. 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.110 Many caregivers report difficulty managing both 

physical and emotional stress and balancing work and family responsibilities.

Numerous studies have shown respite to be among the most frequently requested supportive 

services for family caregivers.111 Respite is second only to direct financial assistance as a key 

policy priority of surveyed family caregivers.112 Even though respite services are often the 

preferred mode of family caregiver support, they are often under-used, difficult to find and access, 

110 National Alliance for Caregiving and AARP. Caregiving in the U.S. 2015 – Focused Look at Caregivers of 

Adults Age 50+. 

111 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

112 National Alliance for Caregiving and AARP, 2009
CAREGIVER AND FAMILY SUPPORT SERVICES

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unaffordable, or in short supply. As a result, nearly 90 percent of family caregivers receive no 

respite at all.113 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. 114

The Lifespan Respite Care Program focuses on easing the burdens of caregiving by providing 

grants to eligible state organizations to improve the quality of, and access to, respite care for family 

caregivers of children or adults with special needs. The program provides ACL with a key vehicle 

to address the needs of caregivers while considering the important contributions they make in the 

lives of persons of all ages with disabilities. The goals of the Lifespan Respite Care Program differ 

from the Family Caregiver Support Services Program, which focuses on providing a variety of 

services to caregivers. Instead, the Lifespan Respite Care program focuses on providing a test-bed 

for needed infrastructure changes, and on filling gaps by putting in place coordinated systems of 

accessible, community-based respite care services for family caregivers of children and adults with 

special needs. These systems bring together and seek to coordinate respite care services for family 

caregivers; training and recruitment of respite care workers and volunteers; and the provision of 

information, outreach, and access assistance.

The Lifespan Respite Care Program also supports technical assistance activities designed to 

maintain a national database on respite care; provide training to state, community, and nonprofit 

respite care programs; and advance state systems and capacities to deliver respite care and address 

the systemic infrastructure necessary to mitigate gaps in respite care services, conduct public 

information, referral, and education programs on respite care. Since its creation in 2009, the 

Lifespan Respite Care Program has made 101 grants to 38 States to develop, expand, integrate and 

sustain their respite care systems, and funded a National Technical Assistance Resource Center. 

Examples of grantee accomplishments include:

• Creation and adoption of statewide respite plans and/or policies to guide further

development of respite and caregiver support programs;

• Development or enhancement of training programs for respite care providers to expand

the cadre of trained respite professionals;

• Replication and expansion of respite delivery modalities with a particular focus on

person- centered planning and consumer direction;

• Expansion of toll free “helplines,” dedicated websites and statewide respite registries to

provide caregivers with information about available respite programs.

• Development and deployment of marketing and awareness campaigns designed to

educate caregivers about the importance of their work and the necessity to take a break;

113 National Alliance for Caregiving and AARP, 2009.

114 National Alliance for Caregiving. (2012). Multiple Sclerosis Caregivers. Washington, DC: Author; The Arc, 2011.
CAREGIVER AND FAMILY SUPPORT SERVICES

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• 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;

• Capacity building and network development at the local level to recruit and train

volunteers to fill gaps in respite services, particularly in rural areas; and,

• Provision of direct respite services to family caregivers of children with intellectual and

developmental disabilities, adults with physical disabilities, and older Americans.

Since 2009, state grantees have reported providing an estimated 12,000 caregivers with over 

313,000 hours of respite care and training an estimated 12,345 caregivers during 469 respite 

training events. 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 2016 ...................................................$3,360,000

FY 2017 ...................................................$3,352,000

FY 2018 ...................................................$4,100,000

FY 2019 Enacted......................................$4,110,000

FY 2020 President’s Budget ....................$3,360,000

Budget Request:

The FY 2020 request for Lifespan Respite is $3,360,000 a reduction of -$750,000, from the 

FY 2019 Enacted Level and in this is the same level as the FY 2019 President’s Budget. At this 

level, ACL will continue to make competitive grants available to support a range of possible 

activities to build or enhance Lifespan Respite Care Programs; further integrate, sustain and 

advance Lifespan Respite activities into broader long-term services and supports in the State; 

and/or provide additional respite services to family caregivers across the age and disability 

spectrum. ACL recognizes the unique opportunity the Lifespan Respite Care Program presents to 

consider the critical role that support for family caregivers plays in ensuring the health and 

independence of individuals across the age and disability spectrum. By investing in this program, 

ACL seeks to provide more and better targeted services that will allow caregivers to continue to 

care for their loved ones longer and thereby allow more care recipients to remain at home and 
CAREGIVER AND FAMILY SUPPORT SERVICES

110

independent for longer periods at lower cost than could be realized if these same individuals had 

to be institutionalized.

The Lifespan Respite Care Program helps to ensure respite quality and choice; and allows for 

respite development, training and coordination regardless of age or disability. The Lifespan 

Respite Care program demonstrates ACL’s commitment to 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.115 The resources requested for FY 2020 will 

be used to address these issues by:

• Expanding, enhancing, and advancing respite care services to family members,

• Improving the statewide dissemination and coordination of respite care, and

• Providing, supplementing, or improving access and quality of respite care services to

family caregivers, thereby reducing family caregiver strain.

Output Table:

Lifespan Respite Care

Indicator Year and Most Recent FY 2019 FY 2020 FY 2020 Projection

Result / Projection Projection +/-FY 2019

Projection

Output AJ: The number FY 2017: 36 38 39 +1

of states that have 

participated in the 

Lifespan Respite Care 

program. (Output)

115 National Respite Coalition Written Testimony to the House subcommittee on Labor, Health and Human Services, 

and Education Appropriations. April 12, 2010
CAREGIVER AND FAMILY SUPPORT SERVICES

111

Grant Awards Table:

Lifespan Respite Care Grant Awards

Awards FY 2018 

Final

FY 2019 

Enacted

FY 2020 

President's 

Budget

Number of Awards 21 17 14

Average Award $190,103 $218,665 $211,952 

Range of Awards $88,333 -

$290,792

$88,333 -

$265,000

$88,333 -

$265,000

Lifespan Respite Care Program

(Dollars in thousands)

Mechanism

FY 2018 

Final #

FY 2018 

Final $

FY 2019 

Enacted #

FY 2019 

Enacted $

FY 2020 

President’s 

Budget #

FY 2020 

President’s 

Budget $

Grants: -- -- -- -- -- --

Formula -- -- -- -- -- --

New Discretionary 4 1,063 -- -- 10 2,174 

Continuations 17 2,929 17 3,717 4 793 

Contracts -- -- 2 200 2 200 

Interagency Agreements -- -- -- -- -- --

Program Support116 -- 108 -- 193 -- 193 

Total Resources -- 4,100 -- 4,110 -- 3,360 

116 Program Support -- Includes funds for Public Health Service Act statutory requirements, grant systems and 

review costs, overhead and information technology support costs.
112

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PROTECTION OF VULNERABLE ADULTS

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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. A 

2004 national survey of State Adult Protective Services (APS) programs conducted by the National 

Center on Elder Abuse showed a 16 percent increase in the number of elder abuse cases from an 

identical study conducted in 2000.117 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.118 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.119

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.120

The effects of abuse, neglect, and exploitation impacts the health of older adults by increasing the 

likelihood of heart attacks, dementia, depression, chronic diseases, and psychological distress. 

These unnecessary health problems result in a growing number of seniors who are accessing the 

healthcare system more frequently (including emergency room visits and hospital admissions), and 

are ultimately forced to leave their homes and communities prematurely.121 Protection of 

Vulnerable Adults programs address this problem through a full array of services designed to 

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

institutional settings.

The total FY 2020 program level request for Protection of Vulnerable Adults is $52.5 million, a 

decrease of -$3.0 million below the FY 2019 Enacted Level. For FY 2020, specific program 

requests include:

• $15.9 million for the Long-Term Care Ombudsman Program, a reduction of -$1.0 million

below the FY 2019 Enacted Level. This consumer advocacy program improves the quality

of care and quality of life for the residents of long-term care facilities in all states. In FY

2020 the program is projected to provide half a million consultations and address 201,000

117 Teaster, Pamela, et al. 2004 Survey of State Adult Protective Services: Abuse of Adults 60 Years of Age and Older. 

118 Tatara, Toshio, et al. The National Elder Abuse Incidence Study Final Report. 1998. 

119 Acierno, R., Hernandez, M. A., Amstadter, A. B., Resnick, H. S., Steve, K., Muzzy, W., & Kilpatrick, D. G. 

(2010). 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, 100(2), 292–297. 

doi:10.2105/AJPH.2009.163089

120 Baker, M. W., LaCroix, A. Z., Wu, C., Cochrane, B. B., Wallace, R., & Woods, N. F. (2009).

Mortality risk associated with physical and verbal abuse in women aged 50 to 79. Journal of the American Geriatrics 

Society, 57(10), 1799–1809. doi:10.1111/j.1532-5415.2009.02429.x

121 Dong X, Simon MA. Association between elder abuse and use of ED: findings from the Chicago Health and Aging 

Project. Am J Emerg Med. 2013;31:693–698
PROTECTION OF VULNERABLE ADULTS

114

complaints with a historic resolution rate of nearly 75 percent. The request is consistent 

with the FY 2019 President’s Budget request.

• $4.8 million for Prevention of Elder Abuse and Neglect, the same as the FY 2019 Enacted

Level. This program provides formula grants to states to train, educate, and increase public

awareness of how to prevent elder abuse.

• $18.0 million for the Health Care Fraud and Abuse Control/Senior Medicare Patrol

Program (HCFAC/SMP), the same as the FY 2019 Enacted Level. HCFAC/SMP funds

competitive grants and related infrastructure to support a volunteer-based network that

helps to prevent and combat healthcare fraud and abuse and helps to preserve the financial

integrity of Medicare and Medicaid.

• $13.9 million for Elder Rights Support Activities (ERSA), a reduction of -$2.0 million

below the FY 2019 Enacted Level. ERSA includes dedicated funding for Elder

Justice/Adult Protective Services as well as funding for resource centers and activities that

provide information, training, and technical assistance on elder rights issues to the national

Aging Services Network. Within the requested level ACL will build on existing Elder

Justice/Adult Protective Services grants by providing $2 million of the available funds to

technical assistance grants/and or contracts to address the opioid misuse amongst older

adults and support the Secretary’s efforts to combat the opioid crisis.

Together, these elder rights and elder justice programs provide a foundation and establish best 

practices for States to expand and improve the protection of individuals living in their communities 

and in long-term care settings. These programs increase the information and technical assistance 

available to the public, States, and localities in preventing and addressing abuse; protect the rights 

of older adults; reduce health-care fraud and abuse; and provide assistance to Tribes in developing 

elder justice systems. This multifaceted approach to resolving elder abuse, neglect, and 

exploitation is essential to successfully fulfilling the shared mission of the Older Americans Act 

and the Elder Justice Act.
PROTECTION OF VULNERABLE ADULTS

115

Long-Term Care Ombudsman Program

Program FY 2018

Final

FY 2019 

Enacted

FY 2020

President's 

Budget

FY 2020 +/-

FY 2019

Long-Term Care 

Ombudsman 

Program*

16,843 16,885 15,855 (1,030)

*BA is in thousands of dollars.

Original Authorizing Legislation: Section 712 of the Older Americans Act of 1965, Public Law 

89-73.

Most Recent Authorizing Legislation: Older Americans Reauthorization Act of 2016, Public Law 

114-144

Current FY Authorization.....................................................................................................Expired

Authorization Expiration Date...................................................................................................2019

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

Program Description and Accomplishments:

The Long-Term Care (LTC) Ombudsman Program is a consumer advocacy program that improves 

the quality of life and care for the estimated 3 million individuals who reside in over 75,000 longterm care facilities (over 16,000 licensed nursing facilities and nearly 60,000) licensed board and 

care facilities).

122 Formula grants to states and territories are based on the number of individuals 

age 60 and older and provide funding for the training, travel, and other operating costs of nearly 

8,651 ombudsmen (both staff and designated volunteers). Ombudsmen resolve complaints with,

and on behalf of these residents, while advocating for systemic improvement of long-term services 

and supports, including routinely monitoring 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; while also 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.

122 National Ombudsman Reporting System (NORS) – FFY 2016.
PROTECTION OF VULNERABLE ADULTS

116

The efficiency of the ombudsman program is due to a strong reliance on volunteers who are the 

primary source in assisting to resolve resident issues.123 All but three states have volunteer 

Ombudsman programs. These trained and designated volunteer ombudsmen donated over 708,322

hours in FY 2015. In FY 2017, 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:

• More than 29,000 facilities were regularly visited not in response to a complaint

(Output S).

• Ombudsmen investigated and worked to resolve over 201,000 complaints (Output Q).

• Ombudsmen provided over 525,000 consultations to individuals and facility managers

and staff on such topics as residents’ rights, staffing levels, malnutrition, dementia care,

depression, discharge procedures, financial exploitation and strategies to reduce the use

of restraints and prevent the abuse and neglect of residents (Output R).

The environment in which individuals seek LTSS continues to evolve as more people are 

increasingly choosing to live in community settings. These changes create new challenges for the 

Long-Term Care Ombudsman program (LTCOP). Encouraging community living has been 

supported by a number of Federal and State policies that promote alternatives to nursing homes 

and other institutional settings, and that recognize the value of consumer preference and the 

potential fiscal savings that can result. These initiatives include Olmstead implementation and 

enforcement, Money Follows the Person, Home and Community-Based Service waivers, and 

Medicaid managed care, to name a few. These evolving services and supports continue to change 

the long-term care landscape across the country. There is also a growing Federal awareness and 

response to the uncharted area of abuse, neglect, and exploitation of older adults and individuals 

with disabilities.

123 Shaughnessy, Carol V. The Role of Ombudsmen in Assuring Quality for Residents of Long-Term Care Facilities: 

Straining to Make Ends Meet. National Health Policy Forum. December 9, 2009.
PROTECTION OF VULNERABLE ADULTS

117

Five Year Funding Table: 

Funding for the Long-term Care Ombudsman Program over the past five years is as follows:

FY 2016 .................................................$15,885,000

FY 2017 .................................................$15,848,000

FY 2018 .................................................$16,843,000

FY 2019 Enacted....................................$16,885,000

FY 2020 President’s Budget ..................$15,855,000

Budget Request:

The FY 2020 Budget request for the LTC Ombudsman Program is $15,855,000, a reduction 

of -$1,030,000 below the FY 2019 Enacted Level the same as the level in the FY 2019 President’s 

Budget. Funds will continue to support the existing infrastructure and activities of the Ombudsman 

program. As the senior population continues to grow, the need for safe, high-quality long-term 

care services (including non-nursing home alternatives) increases 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 was 73 percent in FY 2016.

124 Reducing the number of complaints 

unresolved to the satisfaction of the resident is one indicator of program effectiveness. In FY 2016 

the target was to have no more than 9,700 complaints unresolved. The program performed better 

than expected reducing the number of unresolved complaints to 8,986 (Outcome Measure 

2.14). Program success with advocacy for systemic improvement is measured as a reduction in 

the average number of complaints per facility. In FY 2016, the goal was set at an average of 2.8 

complaints per facility. The program surpassed this goal by reducing the average number of 

complaints to 2.6 (Outcome Measure 2.12). These measures taken together demonstrate the 

efficacy of the program and its ability to produce positive outcomes for residents.

Ombudsman activities represent an important element of ACL’s focus on elder rights and 

complements ACL’s successful elder rights programs to create a full array of services that prevent, 

detect, and resolve elder abuse, neglect, and exploitation. LTC Ombudsmen also support 

individuals who choose to transition out of nursing home facilities into more integrated settings. 

They also advocate for quality care and individual rights and well-being in other congregate longterm care settings, such as board and care and assisted living. In addition, LTC Ombudsmen serve 

individuals in these settings regardless of the individuals’ eligibility for Medicaid or other public 

benefits. Ombudsmen are the only federally-funded entity providing services to all of these 

residents. Going forward, outreach, access, complaint investigation and advocacy in board and 

124 National Ombudsman Reporting System (NORS) 2016 – Complaint resolution: 13% needing no further action; 

4.5% withdrawn; 4.5% not resolved to the satisfaction of the resident; 5% referred to other agency for resolution.
PROTECTION OF VULNERABLE ADULTS

118

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 2019

Target

FY 2020

Target

FY 2020Target +/-

FY 2019 Target

2.12 Decrease the 

average number of 

complaints per LTC 

facility. (Outcome)

FY 2017: 2.7

Target:

2.8

(Target Exceeded)

2.6 2.6 Maintain

2.14 Decrease the number 

of complaints not 

resolved to the 

satisfaction of the 

resident. (Outcome)

FY 2017: 9,976

Target:

9,000

(Target Not Met)

9,000 9,700 +700

Indicator Year and Most Recent 

Result /

FY 2019

Projection

FY 2020

Projection

FY 2020 Projection

+/-FY 2019

Projection

Output Q: The Number of 

Complaints (Output)

FY 2017: 201,460 200,000 201,000 +1,000

Output R: Number of 

Ombudsman 

Consultations (Output)

FY 2017: 525,739 500,000 500,000 Maintain

Output S: Facilities 

regularly visited not in 

response to a complaint

(Output)

FY 2017: 29,137 27,500 28,500 +1,000

Grant Awards Table:

Long-Term Care Ombudsman Program Formula Grant Awards

Awards FY 2018

Final

FY 2019

Enacted

FY 2020

President's 

Budget

Number of 

Awards 56 56 56

Average Award $300,185 $298,503 $280,294

Range of Awards

$10,506-

$1,762,601

$10,448-

$1,750,349

$9,810- 

$1,643,576
PROTECTION OF VULNERABLE ADULTS

119

Department of Health and Human Services

ADMINISTRATION FOR COMMUNITY LIVING

FY 2020 DISCRETIONARY STATE/FORMULA GRANTS

CFDA NUMBER/PROGRAM NAME: Long-Term Care Ombudsman Program (CFDA 93.042)

STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget FY 2020 +/- FY 2019

Alabama 255,700 252,639 237,228 (15,411)

Alaska 84,052 83,581 78,482 (5,099)

Arizona 370,494 367,111 344,717 (22,394)

Arkansas 156,380 154,533 145,106 (9,427)

California 1,762,601 1,750,349 1,643,576 (106,773)

Colorado 251,645 250,991 235,681 (15,310)

Connecticut 189,583 190,128 178,530 (11,598)

Delaware 84,052 83,581 78,482 (5,099)

District of Columbia 84,052 83,581 78,482 (5,099)

Florida 1,265,873 1,258,344 1,181,585 (76,759)

Georgia 451,368 451,778 424,219 (27,559)

Hawaii 84,052 83,581 78,482 (5,099)

Idaho 84,052 83,581 78,482 (5,099)

Illinois 619,063 617,861 580,172 (37,689)

Indiana 327,693 325,749 305,879 (19,870)

Iowa 167,071 164,498 154,463 (10,035)

Kansas 143,756 142,352 133,669 (8,683)

Kentucky 227,450 225,258 211,517 (13,741)

Louisiana 224,795 223,405 209,777 (13,628)

Maine 84,160 83,581 78,482 (5,099)

Maryland 290,505 289,332 271,682 (17,650)

Massachusetts 351,399 349,779 328,442 (21,337)

Michigan 532,609 529,743 497,429 (32,314)

Minnesota 275,472 274,127 257,405 (16,722)

Mississippi 147,938 146,112 137,199 (8,913)

Missouri 318,804 316,377 297,078 (19,299)

Montana 84,052 83,581 78,482 (5,099)

Nebraska 93,961 93,037 87,362 (5,675)

Nevada 144,032 144,231 135,433 (8,798)

New Hampshire 84,052 83,581 78,482 (5,099)

New Jersey 449,577 448,291 420,945 (27,346)

New Mexico 109,194 108,060 101,468 (6,592)

New York 990,044 992,007 931,495 (60,512)

North Carolina 512,511 511,744 480,528 (31,216)

North Dakota 84,052 83,581 78,482 (5,099)

Ohio 619,864 614,924 577,413 (37,511)

Oklahoma 192,358 189,518 177,957 (11,561)

Oregon 225,541 222,585 209,007 (13,578)

Pennsylvania 721,646 713,253 669,744 (43,509)

Rhode Island 84,052 83,581 78,482 (5,099)

South Carolina 269,393 269,387 252,954 (16,433)

South Dakota 84,052 83,581 78,482 (5,099)

Tennessee 342,040 339,008 318,328 (20,680)

Texas 1,121,873 1,121,046 1,052,661 (68,385)

Utah 106,998 107,515 100,957 (6,558)
PROTECTION OF VULNERABLE ADULTS

120

STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget FY 2020 +/- FY 2019

Vermont 84,052 83,581 78,482 (5,099)

Virginia 405,417 403,790 379,159 (24,631)

Washington 359,864 357,203 335,413 (21,790)

West Virginia 111,138 109,096 102,441 (6,655)

Wisconsin 306,289 303,405 284,897 (18,508)

Wyoming 84,052 83,581 78,482 (5,099)

 Subtotal 16,504,723 16,415,119 15,413,782 (1,001,337)

American Samoa 10,506 10,448 9,810 (638)

Guam 42,026 41,790 39,241 (2,549)

Northern Mariana Islands 10,506 10,448 9,810 (638)

Puerto Rico 200,571 196,555 184,566 (11,989)

Virgin Islands 42,026 41,790 39,241 (2,549)

 Subtotal 16,810,358 16,716,150 15,696,450 (1,019,700)

Undistributed125 32,742 168,850 158,550 (10,300)

Total States/Territories 16,843,100 16,885,000 15,855,000 (1,030,000)

125 Program Support – includes funds for Older Americans Act statutory requirements, including disaster assistance, 

and grant and program reporting systems costs. Funds unused for these purposes at the end of the year are allocated 

to states.
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122

Prevention of Elder Abuse and Neglect

Services FY 2018

Final

FY 2019 

Enacted

FY 2020

President's 

Budget

FY 2020 +/-

FY 2019

Prevention of Elder 

Abuse & Neglect* 4,761 4,773 4,773 - 

*BA is in thousands of dollars.

Original Authorizing Legislation: Section 702(b) of the Older Americans Act of 1965, Public Law 

89-73.

Most Recent Authorizing Legislation: Older Americans Reauthorization Act of 2016, Public Law 

114-144

Current FY Authorization.....................................................................................................Expired

Authorization Expiration Date...................................................................................................2019

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

Program Description and Accomplishments:

The Prevention of Elder Abuse and Neglect program provides formula grants to states and 

territories based on their share of the population 60 and over, to train State and local officials and 

promote public awareness of elder abuse. The program also supports state and local elder abuse 

prevention coalitions and multi-disciplinary teams. These activities are important elements of 

ACL’s activities related to elder rights and elder justice. The program coordinates activities with 

state and local Adult Protective Services programs (over half of which are directly administered 

by State Units on Aging) and other professionals who work to address issues of elder abuse and

elder justice. The importance of these services at the state and local level is demonstrated by the 

fact that states significantly leverage Older Americans Act (OAA) funds to obtain other funding 

for these activities. In FY 2017, over $34 million of the Elder Abuse Prevention services 

expenditures was leveraged from non-OAA funds, a ratio of more than $8.00 of non-OAA funds 

for every $1 investment of ACL funds.

Examples of state elder abuse prevention activities include:

• In Kentucky, the local area agencies on aging participate in the Local Coordinating

Councils on Elder Abuse, which have developed emergency elder shelters, distributed

informational cards for law enforcement officers to have in the patrol cars which contain

crucial resource information for victims of elder abuse, conducted training on a regular

basis to first responders, provided a friendly visitor program for home-based seniors, and

produced a prevention tool called the Kentucky Fraud Fighter Form.
PROTECTION OF VULNERABLE ADULTS

123

• In Illinois, the State Department on Aging uses 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 seniors and promoting their dignity and autonomy. Through education 

efforts, exposing problems that would otherwise be hidden from view, and providing a voice for 

those who cannot act for themselves, the program helps ensure that all older Americans are able 

to age with dignity in a safe environment.

Funding History:

Funding for Prevention of Elder Abuse and Neglect over the past five years is as follows:

FY 2016 ...................................................$4,773,000

FY 2017 ...................................................$4,762,000

FY 2018 ..................................................$4,761,000

FY 2019 Enacted......................................$4,773,000

FY 2020 President’s Budget ....................$4,773,000

Budget Request:

The FY 2020 request for the Prevention of Elder Abuse and Neglect program is $4,773,000, the 

same as the FY 2019 Enacted Level. The FY 2020 request maintains the ability of States and 

territories to train law enforcement officials, develop and distribute educational materials, conduct 

public awareness campaigns, and create community coalitions and multidisciplinary teams to 

investigate and respond to elder abuse and neglect. States and AAAs will also use this funding to 

coordinate their activities with fraud and crime prevention partnerships organized by sheriffs, 

police chiefs, and community organizations.

Elder Abuse Prevention activities are important elements of ACL’s elder rights and elder justice

activities, and complement Adult Protective Services by funding the infrastructure on which best 

practices may be developed and evaluated.
PROTECTION OF VULNERABLE ADULTS

124

Output Table:

Prevention of Elder Abuse and Neglect

Indicator Year and Most Recent 

Result /

FY 2019

Projection

FY 2020

Projection

FY 2020 Projection

+/-FY 2019

Projection

Output U: Elder Abuse 

prevention non-OAA 

service expenditures 

(Output, dollars in 

thousands)

FY 2017: $34,809 $35,134 $35,402 +$268

Grant Awards Table:

Prevention of Elder Abuse, Neglect, and Exploitation Grant Awards

Awards FY 2018

Final

FY 2019

Enacted

FY 2020

President's 

Budget

Number of 

Awards 56 56 56

Average Award $84,680 $84,380 $84,380

Range of Awards

$2,964- 

$471,073

$2,954-

$470,407

$2,954- 

$470,407
PROTECTION OF VULNERABLE ADULTS

125

Department of Health and Human Services

ADMINISTRATION FOR COMMUNITY LIVING

FY 2020 DISCRETIONARY STATE/FORMULA GRANTS

CFDA NUMBER/PROGRAM NAME: Prevention of Elder Abuse & Neglect (CFDA 93.041)

STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/-

FY 2019

Alabama 76,215 76,107 76,107 -

Alaska 23,710 23,626 23,626 -

Arizona 84,438 81,384 81,384 -

Arkansas 48,157 48,089 48,089 -

California 471,073 470,407 470,407 -

Colorado 57,332 56,002 56,002 -

Connecticut 59,907 59,822 59,822 -

Delaware 23,710 23,626 23,626 -

District of Columbia 23,710 23,626 23,626 -

Florida 344,252 343,762 343,762 -

Georgia 103,321 103,174 103,174 -

Hawaii 23,710 23,626 23,626 -

Idaho 23,710 23,626 23,626 -

Illinois 197,384 197,103 197,103 -

Indiana 98,224 98,084 98,084 -

Iowa 55,927 55,847 55,847 -

Kansas 45,843 45,778 45,778 -

Kentucky 66,595 66,500 66,500 -

Louisiana 68,518 68,421 68,421 -

Maine 23,710 23,626 23,626 -

Maryland 78,087 77,976 77,976 -

Massachusetts 109,606 109,450 109,450 -

Michigan 160,862 160,633 160,633 -

Minnesota 76,347 76,238 76,238 -

Mississippi 45,198 45,134 45,134 -

Missouri 97,643 97,504 97,504 -

Montana 23,710 23,626 23,626 -

Nebraska 29,770 29,728 29,728 -

Nevada 32,814 27,590 27,590 -

New Hampshire 23,710 23,626 23,626 -

New Jersey 143,950 143,745 143,745 -

New Mexico 26,393 26,356 26,356 -

New York 318,066 317,614 317,614 -

North Carolina 126,782 126,602 126,602 -

North Dakota 23,710 23,626 23,626 -

Ohio 197,185 196,905 196,905 -

Oklahoma 60,208 60,122 60,122 -

Oregon 56,795 56,714 56,714 -

Pennsylvania 242,944 242,598 242,598 -

Rhode Island 23,710 23,626 23,626 -

South Carolina 63,080 62,990 62,990 -

South Dakota 23,710 23,626 23,626 -

Tennessee 91,810 91,679 91,679 -

Texas 274,281 273,891 273,891 -
PROTECTION OF VULNERABLE ADULTS

126

STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/-

FY 2019

Utah 24,837 24,802 24,802 -

Vermont 23,710 23,626 23,626 -

Virginia 102,820 102,674 102,674 -

Washington 86,291 86,168 86,168 -

West Virginia 36,736 36,684 36,684 -

Wisconsin 90,309 90,181 90,181 -

Wyoming 23,710 23,626 23,626 -

 Subtotal 4,658,230 4,641,596 4,641,596 -

American Samoa 2,964 2,954 2,954 -

Guam 11,855 11,813 11,813 -

Northern Mariana Islands 2,964 2,954 2,954 -

Puerto Rico 54,217 54,140 54,140 -

Virgin Islands 11,855 11,813 11,813 -

Subtotal 4,742,085 4,725,270 4,725,270 -

Program Support126 19,071 47,730 47,730 -

Total States/Territories 4,761,156 4,773,000 4,773,000 -

126 Program Support – includes funds for Older Americans Act statutory requirements, including disaster assistance, 

and grant and program reporting systems costs. Funds unused for these purposes at the end of the year are allocated 

to states.
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PROTECTION OF VULNERABLE ADULTS

Health Care Fraud and Abuse Control/Senior Medicare Patrol Program

Services FY 2018

Final

FY 2019 

Enacted

FY 2020

President's 

Budget

FY 2020 +/-

FY 2019

SMP/HCFAC* 18,000 18,000 18,000 -

FTE* 5 7 7 -

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

Original Authorizing Legislation: Sections 201, 202, and 411 of the Older Americans Act of 1965, 

Public Law 89-73 and the Health Insurance Portability and Accountability Act (HIPAA) of 1996, 

P.L. 104-191

Most Recent Authorizing Legislation: Older Americans Reauthorization Act of 2016, Public Law 

114-144

Current FY Authorization.....................................................................................................Expired

Authorization Expiration Date...................................................................................................2019

Allocation Method .............................................................................. Competitive Grant/Contracts

Program Description and Accomplishments:

The Health Care Fraud and Abuse Control/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 Medicare beneficiaries and their families to prevent, identify 

and report fraud. Activities are carried out in partnership with the Centers for Medicare & 

Medicaid Services (CMS), the Office of Inspector General (OIG), healthcare providers, and other 

aging and elder rights professionals from around the country.

Data obtained from the SMP Information and Reporting System (SIRS) for calendar year 2017

shows that Senior Medicare Patrol projects:

• Maintained 6,130 active SMP team members who worked over 433,728 hours to educate

beneficiaries about how to prevent Medicare fraud, errors and abuse;

• Educated 2,121,855 individuals during 26,429 group outreach and education events; and,

• Generated over $57 million in estimated Medicare/Medicaid savings due to the work of

SMP projects.

128
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129

• Responded to 226,261 individual inquiries for information or assistance from Medicare

beneficiaries, family members, and caregivers related to Medicare fraud, errors and abuse.

Since the Senior Medicare Patrol program’s inception in 1997, program data show that SMP 

projects have educated nearly 38.4 million beneficiaries through 387,315 group outreach and 

education events and assisted approximately 2.7 million beneficiaries with individual inquires 

related to Medicare fraud, errors, and abuse. HHS-OIG reports that total savings directly 

attributable to the SMP projects are more than $126.84 million since 1997; however, this does not 

fully capture the total impact of the program on reducing Medicare fraud, including any sentinel 

effect that may result from these activities.

The SMP program historically has used approximately $3.1 million of its resources for 

infrastructure (including Federal staff support), technical assistance, and other program support 

and capacity-building activities designed to enhance program effectiveness. Activities funded 

with these dollars include support for project training and technical assistance provided by ACL’s 

National SMP Resource Center.

Funding History:

Comparable funding for SMP discretionary appropriations over the past five years is as follows:

FTE

FY 2016 ...............................................$18,000,000 6

FY 2017 ............................................... $18,000,000 5

FY 2018 .............................................. $18,000,000 4.3

FY 2019 Enacted....................................$18,000,000 4.5

FY 2020 President’s Budget ..................$18,000,000 4.5

Budget Request:

The FY 2020 Budget includes an estimate of $18 million, the current funding level, for 

HCFAC/SMP. In FY 2018 and FY 2019, funding for this program was provided to the Center for 

Medicare & Medicaid Services (CMS), at no less than $17.621 million The FY 2020 request 

continues to support 4.5 FTE, the same level as the FY 2019 President’s Budget.

Since the Senior Medicare Patrol program’s inception, SMP projects have received more than

2.7 million inquiries from Medicare beneficiaries about preventing, detecting and reporting billing 

errors, potential fraud, or other discrepancies. SMPs also have educated more than 38.4 million 

people through group presentations and community outreach events. The primary focus of these 

sessions is on education, prevention, and teaching beneficiaries how to protect themselves and 

avoid fraud in the first place and this is the true value of the SMP program.
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As HHS-OIG indicated in their May 2018 report on the SMP program:

“We note that the projects may not be receiving full credit for recoveries, savings, and cost 

avoidance attributable to their work. It is not always possible to track referrals to Medicare 

contractors or law enforcement from beneficiaries who have learned to detect fraud, waste, 

and abuse from the projects. In addition, the projects are unable to track the potentially

substantial savings derived from a sentinel effect whereby Medicare beneficiaries’ scrutiny 

of their bills reduce fraud and errors.”

While SMPs make numerous referrals of potential fraud to CMS and the OIG, there are challenges 

to evaluating the (investigation, prosecution, collection that is required to calculate the full savings 

to the government as a result of SMP referrals. ACL recognizes the importance of measuring the 

value of the SMP program impact to the fullest degree possible and is working to overcome these 

limitations by undertaking a variety of steps, including:

• Realigning the program’s performance metrics based on findings from a recent SMP

program evaluation;

• Ongoing collaboration with HHS-OIG to track fraud referrals and their outcomes; and,

• Continuing research efforts on SMP prevention education to determine how to best

measure and quantify the effects of SMP program efforts. Preliminary results appear to

show it is possible to quantify and demonstrate the value of SMP prevention activities, but

further follow-up is required, the results of which should be available in FY 2019.

HHS-OIG has documented over $126.8 million in savings attributable to the program as a result 

of beneficiary complaints since the program’s inception in 1997.

Output Table:

Senior Medicare Patrol Program

Indicator Year and Most Recent 

Result /

FY 2019

Projection

FY 2020

Projection

FY 2020 Projection

+/-FY 2019

Projection

Output W: Beneficiaries 

Educated and Served

(Output)

CY 2017: 1,895,594 2,100,000 2,000,000 -100,000
PROTECTION OF VULNERABLE ADULTS

Grant Awards Table:

Senior Medicare Patrol Grant Awards

(Dollars in thousands)

Awards FY 2018 

Final

FY 2019 

Enacted

FY 2020 

President's 

Budget

Number of Awards 55 55 55

Average Award $294,634 $293,700 $293,700 

Range of Awards $95,000 -

$640,000 

$95,000 -

$640,000 

$95,000 -

$640,000 

Resource and Program Data:

Senior Medicare Patrols

(Dollars in thousands)

Mechanism

FY 2018 

Final #

FY 2018 

Final $

FY 2019 

Enacted #

FY 2019 

Enacted $

FY 2020 

President’s 

Budget #

FY 2020 

President’s 

Budget $

Grants: -- -- -- -- -- --

Formula -- -- -- -- -- --

New Discretionary 54 15,565 -- -- 1 640 

Continuations 1 640 55 16,153 54 15,513 

Contracts 2 763 2 870 -- 870 

Interagency Agreements -- -- -- -- -- --

Program Support127 -- 1,032 -- 977 -- 977 

Total Resources -- 18,000 -- 18,000 -- 18,000 

127 Program Support -- Includes funds for overhead, grant systems and review costs, and information technology 

support costs.

131
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Elder Rights Support Activities

Services FY 2018

Final

FY 2019 

Enacted

FY 2020

President's 

Budget

FY 2020 +/-

FY 2019

Elder Rights Support 

Activities* 15,835 15,874 13,874 (2,000)

FTEs* 2.1 2.6 2.6 0

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

Authorizing Legislation: Sections 201, 202, 411, 751 and 752 of the Older Americans Act of 1965, 

Public Law 89-73, Title XX of the Social Security Act, Subtitle B, as amended by the Affordable Care 

Act. 

Most Recent Authorizing Legislation: Older Americans Reauthorization Act of 2016, Public Law 

114-144

Current FY Authorization (OAA).........................................................................................Expired

Authorization Expiration Date...................................................................................................2019

Allocation Method ............................Competitive Grants/Co-operative Agreements and Contracts

Program Description and Accomplishments:

Elder Rights Support Activities provide information, training, and technical assistance to States 

and communities to prevent detect, and respond to elder, abuse neglect exploitation and support 

the development of coordinated systems of Adult Protective Services. The Elder Justice and Adult 

Protective Services program, along with the National Center on Elder Abuse, the National LongTerm Care Ombudsman Resource Center, and legal systems development programs create an 

interconnected framework for carrying out ACL’s Protection of Vulnerable Adults programs.

The Elder Justice Act of 2009 established the Elder Justice Coordinating Council (EJCC) to 

coordinate activities related to elder abuse, neglect, and exploitation across the Federal 

government. As Chair of the EJCC, the Secretary of HHS has lead responsibility for identifying 

and proposing solutions to the problems surrounding elder abuse. The Secretary has assigned 

responsibility for implementing the EJCC to the Administration for Community Living.

To combat the rising scourge of elder abuse, neglect, and exploitation in America, ACL’s goal is 

to put in place, in coordination with the Elder Justice Coordinating Council, a comprehensive 

system to provide coordinated and seamless response system. The Elder Rights Support Activities 

described below are key components of ACL’s ongoing elder rights programs.
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Adult Protective Services

Unlike Child Protective Services, which has been in existence for decades, a federal infrastructure 

to support basic programmatic standards for Adult Protective Services (APS) is in its infancy. 

Historically, an absence of stewardship in APS has led to inconsistent data systems and nonuniform reporting requirements at the national level. APS programs and administrators have lacked 

reliable information and guidance on best practice and standards for conducting case investigations 

and for staffing and managing APS programs. Additionally, GAO has identified challenges faced 

by APS programs across the country in collecting, maintaining, and reporting statewide, case-level 

data. These challenges include funding levels, budget reductions, and increasing caseloads, as well 

as the growing complexity of cases due to factors such as growing opioid misuse. The challenges 

have impaired States’ ability to assess client outcomes and the effectiveness of the services they 

are providing.128 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 subsequent years, 

states have received additional funding to test innovations and improvements in APS practice,

services, data collection, and reporting, and to support the development and implementation of 

ACL’s National Adult Maltreatment Reporting System (NAMRS) effort. States are voluntarily 

reporting because they have recognized the value of having consistent data to build a national 

profile of perpetrators and victims that leads to effective interventions. The APS program supports 

states by providing significant, on-going technical assistance to identify promising best practices; 

participate in national APS data collection efforts; and conduct research and evaluations to increase 

the knowledge base about effective APS 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, well-being, and outcomes of the 

individuals served by APS.

ACL is conducting research and evaluation activities to build the evidence-base for Adult 

Protective Services. This includes updating the National Voluntary Consensus Guidelines on the 

2-year schedule established at launch, including identifying areas where additional research on

APS practice is needed. ACL plans to implement an outcome evaluation study to document the

difference that APS makes in the lives of older adults and adults with disabilities.

National Center on Elder Abuse

To support and enhance the activities of State and local programs to prevent elder abuse, neglect, and 

exploitation, ACL funds the National Center on Elder Abuse (NCEA). NCEA disseminates 

information to professionals and the public; collaborates on research; provides consultation; identifies 

and provides information about promising practices and interventions; answers inquiries and requests 

for information; operates a listserv forum for professionals; and advises on program and policy 

developments. NCEA also facilitates the exchange of strategies for uncovering and prosecuting fraud 

in areas such as telemarketing and sweepstakes scams. Examples of past NCEA activities include:

128 U.S. Government Accountability Office. (2011). ELDER JUSTICE: Stronger Federal Leadership Could Enhance 

National Response to Elder Abuse. (GAO-11-208). Washington, D.C.: U.S. Government Printing Office.
PROTECTION OF VULNERABLE ADULTS

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• Responding to individual public inquiries and requests for information regarding elder

abuse.

• Providing cost-effective trainings to professionals though live Webcast forums on issues

relevant to elder justice, training professionals through presentations at national

conferences, and creating and disseminating research-themed training podcasts to promote

continual learning.

• Continuing to support systems change by identifying local elder justice community

coalitions and reaching out to them to learn how they leverage local resources and expertise

to prevent and combat elder abuse, neglect, and exploitation, as well as offering technical

assistance on operating, invigorating, and sustaining coalitions.

National Long-Term Care Ombudsman Resource Center

The National Long-Term Care Ombudsman Resource Center (NORC) provides training and 

technical assistance to support the activities of State and local long-term care ombudsmen. The 

Center works to enhance the skills, knowledge and management capacity of the statewide 

ombudsman programs to enable them to handle resident complaints and represent resident 

interests. The Center also provides information to consumers and links them to ombudsmen who 

can help consumers navigate the long-term care system and resolve problems in nursing, board 

and care, and assisted living homes.

The NORC engages in numerous projects and activities in support of long-term care ombudsman 

programs. Highlights include supporting the Money Follows the Person (MFP) demonstration 

project by working with CMS, ACL, and National Association of State Long-Term Care 

Ombudsman Programs (NASOP) to promote ombudsman coordination with MFP grantees, Aging 

and Disability Resource Centers (ADRCs), Centers for Independent Living, and other single point 

of entry programs. The NORC also provides ombudsmen with training from national experts on 

such issues as the Changing Long-Term Care System, Money Follows the Person and Nursing 

Home Transition, and Advocacy in Assisted Living. The Center’s website continues to experience 

high use (over 40,000 monthly visits) by ombudsmen, consumers, and agencies.

Legal Assistance and Support

Legal Assistance and Support provides funding for two different activities. Model Approaches 

grants help States develop and implement cost-effective, replicable approaches for integrating lowcost legal assistance mechanisms related to APS into the broader tapestry of State legal service 

delivery networks, such as senior legal helplines, law school clinics, and volunteer attorneys. 

Model Approaches projects ensure strong leadership at the State level, thereby enhancing the 

state’s overall capacity for legal service delivery and creating linkages between legal assistance 

providers and professionals in the broader community-based aging and disability and elder rights 

networks. These linkages include Area Agencies on Aging (AAAs), Aging and Disability 

Resource Centers (ADRCs), State Long-Term Care Ombudsmen, and Adult Protective Services, 

and leverage the strengths and resources of both elder rights and aging and disability service 

networks for the provision of quality legal service on priority issues to older adults most in need.
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Model Approaches – Phase II grants promote legal service delivery systems that are optimally 

responsive to complex legal issues emerging from cases of elder abuse, neglect, and financial 

exploitation. In addition, these projects support outreach efforts and implement legal data 

collection and reporting systems that demonstrate the beneficial impact of legal services on the 

independence, health, and financial security of older adults.

In addition to Model Approaches, Legal Assistance and Support grants fund a comprehensive 

national legal assistance support system serving professionals and advocates working in legal and 

aging and disability services networks. Through this funding the National Center on Law and Elder 

Rights (NCLER)) supports the leadership, knowledge, and systems capacity development of legal 

and aging provider organizations. The NCLER 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 NCLER

includes a broad range of legal, elder rights, and aging and disability services professionals and 

advocates. These include Home and Community-Based Services legal providers, legal assistance 

developers, long-term care ombudsmen, Area Agency on Aging and Aging and Disability 

Resource Center staff, senior legal helplines, Adult Protective Services workers, and others 

involved in protecting the rights of older persons.

Funding History:

Comparable funding for Elder Rights Support Activities over the past five years is as follows:

FTE

FY 2016 .................................................$11,874,000 .8

FY 2017 .................................................$13,847,000 2.5

FY 2018 ................................................$15,835,000 2.1

FY 2019 Enacted....................................$15,874,000 2.6

FY 2020 President’s Budget ................$13,874,000 2.6

Budget Request:

The FY 2020 Budget request for the four Elder Rights Support Activities is $13,874,000, a 

decrease of -$2,000,000 below the FY 2019 Enacted level. ACL is dedicating $2.0 million (in 

Elder Justice funding) to two demonstration projects to pilot technical assistance efforts that 

address opioid abuse within older adults that receive Adult Protective Services.
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Opioid Focus

APS is a direct, first responder social service response system in every state for vulnerable adults 

experiencing abuse, neglect and exploitation, including incidents that occur as a result of substance 

and opioid abuse. As APS is often the first community agency to interact with older adults and 

adults with disabilities impacted by the opioid crisis, it places APS in a strategic position to 

intervene early in the progression of addiction in the family and thereby minimize harm and costs 

associated with the Opioid epidemic.

ACL will make funding available for two competitive demonstration grantsthat will pilot technical 

assistance efforts ACL is proposing to invest $2.0 million to maximize the impact on direct 

services through:

• grants specifically targeted the most affected communities;

• grants that identify gaps in their communities which hinder APS from securing adequate

services for clients affected by opioid and other substance abuse; and

• identify home-and community-based social, health, and mental/behavioral health services

needed for those APS clients impacted by the opioid epidemic, and to propose solutions

that quickly fill those needs and identified gaps.

Other Elder Rights Support Activities

The FY 2020 request for the remaining three Elder Rights Support Activities (Statewide Model 

Approaches and Legal Assistance programs, the National Center on Elder Abuse, and the National 

Long-Term Care Ombudsman Resource Center) maintain funding at the same level as the FY 2019 

Enacted level. 

These programs provide the technical assistance, information, resources, referrals, and systems 

development and assistance activities that support the efforts of the entire spectrum of Protection 

of Vulnerable Adults programs. These activities, along with the Elder Justice and APS program,

are important components of ACL’s elder rights programs and help to create a full array of services 

to prevent, detect, and resolve elder abuse, neglect, and exploitation. These programs and resource 

centers will help provide high-quality and efficient services and supports to further ACL’s efforts 

to promote elder rights and elder justice.
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Elder Rights Support Activities includes funding for the following projects (dollars in thousands):

Elder Rights Support 

Activities

FY 2018

Final Level 

FY 2019 Enacted 

Level

FY 2020 

President’s 

Budget

Elder Justice & APS $11,970 $12,000 $10,000

Legal Assistance and 

Support $2,592 $2,584 $2,584

National Center on Elder 

Abuse $765 $770 $770

LTC Ombudsman Resource 

Center $518 $520 $520

Total, Elder Rights Support 

Activities $15,835 $15,874 $13,874

Grant Awards Table:

Elder Rights Support Activities Grant Awards

Awards FY 2018 

Final

FY 2019 

Enacted

FY 2020 

President's 

Budget

Number of Awards 36 34 34

Average Award $308,734 $323,257 $265,200 

Range of Awards $70,312-

$749,987

$70,312-

$749,987

$70,312-

$749,987
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Resource and Program Data:

Elder Rights Support Activities

(Dollars in thousands)

Mechanism

FY 2018 

Final #

FY 2018 

Final $

FY 2019 

Enacted #

FY 2019 

Enacted $

FY 2020 

President’s 

Budget #

FY 2020 

President’s 

Budget $

Grants: -- -- -- -- -- --

Formula -- -- -- -- -- --

New Discretionary 18 6,136 16 4,208 3 3,260 

Continuations 18 4,978 18 6,783 31 5,756 

Contracts 5 3,888 4 4,034 4 4,035 

Interagency Agreements -- -- -- -- -- --

Program Support129 -- 832 -- 849 -- 822 

Total Resources -- 15,835 -- 15,874 -- 13,874 

129 Program Support -- Includes funds for overhead, grant systems and review costs, and information technology 

support costs.
139

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Disability Programs and Services

Summary of Request

Disability Programs and Services fund capacity-building, knowledge generation, and systems 

change efforts to ensure that people with disabilities and their families participate in the design of 

and have access to needed community services, individualized supports, and other forms of 

assistance. These programs seek to promote the independence and inclusion of such individuals in 

all facets of community life.

The total FY 2020 request for Disability Programs and Services is $336.7 million, a reduction of 

-$81.4 million below the FY 2019 Enacted Level. In FY 2020, specific program requests include:

• $56.0 million for State Councils on Developmental Disabilities (SCDD), a reduction

of -$20.0 million below the FY 2019 Enacted Level. State Councils are charged with

engaging in advocacy, capacity building, and systemic change activities that contribute to

a coordinated and comprehensive system of community services that promote selfdetermination and integration for people with developmental disabilities. This request is

consistent with the FY 2019 President’s Budget.

• $38.7 million for Developmental Disability Protection and Advocacy systems, a decrease

of -$2.0, million below the FY 2019 Enacted Level. Protection and Advocacy systems in

each state and territory protect the legal and human rights of all people with developmental

disabilities. They have the authority to pursue legal, administrative and other appropriate

remedies or approaches, including the authority to investigate incidents of abuse and

neglect. This request is consistent with the FY 2019 President’s Budget.

• $32.6 million for University Centers for Excellence in Developmental Disabilities

(UCEDDs), a reduction of -$8.1 million below the FY 2019 Enacted Level. Based on

statutory requirements for allocating funding, national training efforts would not be funded.

UCEDDs in each state and territory undertake interdisciplinary pre-service training,

community services, research, and information dissemination activities that promote

opportunities for people with developmental disabilities to exercise self-determination and

to be independent, productive, and included in the community. This request is consistent

with the FY 2019 President’s Budget.

• $1.0 million for Projects of National Significance, a reduction of -$11 million below the

FY 2019 Enacted Level. In FY 2020, Projects of National Significance will focus solely

on three longitudinal studies; The State of the States in Developmental Disabilities,

Residential Information Systems Project, and the National Data Collection on Day and

Employment Services for Individuals with Developmental Disabilities. The request is

consistent with the FY 2019 President’s Budget.

• $108.6 million for Independent Living, a decrease of -$7.5 million below the FY 2019

Enacted Level. The requested level continues funding for Centers for Independent Living

grants at the 2019 Enacted level of $90.8 million and reduces the State Grants to -$17.8
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141

million. Centers for Independent Living provide grants for consumer controlled, 

community-based, cross-disability, private nonprofit agencies that are designed and 

operated within a local community by individuals with significant disabilities and provide 

an array of independent living services.

• Consistent with the FY 2019 Budget, no funding is requested for the Limb Loss Resource

Center. Other HHS programs, such as Centers for Independent Living and Assistive

Technology, provide services and resources to people with all types of significant

disabilities.

• Consistent with the FY 2019 Budget, no funding is requested for the Paralysis Resource

Center. Other HHS programs, such as Centers for Independent Living and Assistive

Technology, provide services and resources to people with all types of significant

disabilities.

• $9.3 million is requested for the Traumatic Brain Injury (TBI) program, a decrease

of -$2.0 million below the FY 2019 Enacted Level. TBI develops comprehensive,

coordinated family and person-centered service systems at the State and community level

for individuals who sustain a TBI. TBI Protection and Advocacy activities will continue to

be maintained at the FY 2019 Enacted Level. This request level is consistent with the FY

2019 President’s Budget.

• $90.4 million is requested for the National Institute on Disability, Independent Living and

Rehabilitation Research (NIDILRR), a reduction of -$18.6 million below the FY 2019

Enacted Level. NIDILRR generates knowledge and promotes its use to improve the

abilities of people with disabilities to live as independently as possible in the community.

NIDILRR’s research supports and expands society’s capacity to provide full opportunities

and accommodations for its citizens with disabilities.
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State Councils on Developmental Disabilities

Program FY 2018

Final

FY 2019 

Enacted

FY 2020

President's 

Budget

FY 2020 +/-

FY 2019

State Councils on 

Developmental 

Disabilities*

75,943 76,000 56,000 (20,000)

*BA is in thousands of dollars.

Original Authorizing Legislation: Section 129(a) of the Developmental Disabilities Assistance and 

Bill of Rights Act, Public Law 106-402

Most Recent Authorizing Legislation: Section 129(a) of the Developmental Disabilities Assistance 

and Bill of Rights Act of 2000, Public Law 106-402

Current FY Authorization.....................................................................................................Expired

Authorization Expiration Date...................................................................................................2007

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

Program Description and Accomplishments:

State Councils on Developmental Disabilities (SCDD) are charged with identifying and addressing

the most pressing needs of people with developmental disabilities in their state and territory. 

SCDDs set priorities and pursue systems change efforts designed to turn fragmented approaches 

into a comprehensive and effective statewide, person-centered and family-centered system. These 

systems provide a coordinated array of culturally-competent services and other forms of assistance 

for people with developmental disabilities, including individuals with autism and their family 

caregivers.

While SCDDs do not provide services directly, a portion of their funding goes into local 

communities to support investments in innovation specific to the needs in the state or territory. 

SCDDs examine and conduct in-depth analysis of the quantity and quality of services and supports 

that are provided at the state and local level. Based on their analysis, each SCDD develops a 

strategic State Plan, with goals and objectives designed to move the state towards an effective, 

coordinated system of supports and services that advance community living for all people with 

developmental disabilities. In addition, Councils are the only entity in the state required to 

strengthen self-advocacy and to build leadership skills of individuals with developmental 

disabilities.

The authorizing statute requires that Councils use 70 percent of their federal funding to implement 

the State Plan, which includes support for innovation. While the State Plan can be implemented 

by Council staff, Councils have the authority to award grants and/or contracts, award funds to 

organizations in the state that serve individuals with DD. These could include the University 
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Center of Excellence in Developmental Disabilities (UCEDD) or the Protection and Advocacy 

(P&A) agency but can also include other community-based organizations. Recent data indicates

that 26 of 42 reporting Councils awarded grants or contracts with the rest doing work “in-house.” 

As an example of how funding is used to support innovation, the Georgia Council on 

Developmental Disabilities worked with a network of colleges and universities to offer students 

with developmental disabilities an opportunity to receive a post-secondary experience. What began 

with one university and a $25,000 grant from the Council has grown to 6 universities/colleges and 

a budget of over $1.5 million including state and federal funds. Currently, there are 80 students 

enrolled in two and four-year programs across the state. A major focus of the programs is preparing 

students for employment. Data collected between 2011 and 2015 on students who attended these 

programs indicated that 57 percent gained employment, 22 percent were continuing their 

education, and 7 percent were seeking employment. Examples of other State Council on 

Developmental Disabilities’ activities include:

• Access to Health Care: The Maine Developmental Disabilities Council collaborated to

expand a “medical home” model for individuals with developmental disabilities to ensure

access to a primary care physician or regular health care provider to better coordinate their

overall care. The Texas Council for Developmental Disabilities supported projects in ten

targeted regions to increase capacity to provide culturally appropriate health care services,

community services, behavior supports, and respite to support people with developmental

disabilities and their families.

• Access to Dental Care: The California Developmental Disabilities Council partnered with

coalitions to assist individuals with developmental disabilities and families in

understanding managed care and assisted health plans in order to improve access to dental

care, particularly anesthesia-based dental care. The Hawaii State Council on

Developmental Disabilities worked with the state legislature to establish a donated dental

services program that has assisted hundreds of individuals with developmental disabilities.

The Montana Council on Developmental Disabilities worked with community health

centers, dental associations, and donated dental program to increase dental care options and

training for dental professionals, including procedures that might involve sedation.

• Community Living: The Alaska Governor’s Council on Disabilities & Special Education

collaborated on a HomeMap project to explore the use of enabling technologies to more

cost-effectively support individuals and families with fewer paid staff hours in their HCBS

waiver program. The North Carolina Council on Developmental Disabilities partnered with

the P&A on a model demonstration to transition individuals out of Adult Care Homes

(ACHs) and into HCBS settings. The Washington State Developmental Disabilities

Council conducts independent quality of life surveys with individuals with disabilities

transitioning from institutional to HCBS as part of the State’s Roads to Community (Money

Follows the Person) programs.

• Transportation: The Colorado Developmental Disabilities Council supported grassroots

projects in rural areas which led to community action at the local level that increased

transportation, livable communities, and meaningful participation of people with DD in
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their communities. The Florida Developmental Disabilities Council partnered with the 

Florida Department of Transportation to implement a transportation voucher pilot project 

in two Florida sites. The project contributed to voucher users gaining access to increased 

employment opportunities, training and higher wages. For example, prior to 

implementation of the program one participant had turned down a job at Walmart the year 

before due to not having available transportation. Through the program, she resubmitted 

her application, was hired and is getting to work at Walmart on time every day.

To receive funds, each state and territory must have an established SCDD as prescribed under the 

Developmental Disabilities Assistance and Bill of Rights Act (“DD Act”). There are 56 Councils

whose members are appointed by the Governor and serve in a volunteer capacity. Under current 

law, not less than 60 percent of the SCDD membership must be composed of persons with 

developmental disabilities and their family members.

Funding History:

Funding for the program over the past five years is as follows:

FY 2016 .................................................$73,000,000

FY 2017 .................................................$72,833,000

FY 2018 .................................................$75,943,000

FY 2019 Enacted....................................$76,000,000

FY 2020 President’s Budget ..................$56,000,000

Budget Request: 

The FY 2020 request for State Councils on Developmental Disabilities (SCDD) is $56,000,000, a 

reduction of -$20.0 million below the FY 2019 Enacted Level.

ACL recognizes the value this program provides by focusing solely on developmental disabilities 

that are lifelong, significant and require ongoing support and by supporting investment and 

innovation tailored to needs in states or territories that improve the quality of life of those with 

developmental disabilities. ACL proposes to work with grantees to identify efficiencies in the 

operations of the councils to maximize funding for service provision.
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Outputs and Outcomes Table:

State Councils on Developmental Disabilities

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2019

Target

FY 2020

Target

FY 2020 Target

+/-FY 2019

Target

8G Increase the 

percentage of people with 

developmental 

disabilities and their 

family members 

increasing their advocacy 

knowledge. (Outcome)

FY 2017: Result Expected 

June 30, 2019

Target:

Set Baseline

(Pending)

-- -- --

Grant Awards Tables:

State Councils on Developmental Disabilities Grant Awards

Awards FY 2018

Final

FY 2019

Enacted

FY 2020

President's 

Budget

Number of 

Awards 56 56 56

Average Award $1,344,109 $1,344,109 $988,909

Range of Awards

$264,316-

$7,499,029

$264,316-

$7,499,022

$194,466-

$5,517,304
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Department of Health and Human Services

ADMINISTRATION FOR COMMUNITY LIVING

FY 2020 DISCRETIONARY STATE/FORMULA GRANTS

CFDA NUMBER/PROGRAM NAME: State Councils on Developmental Disabilities (CFDA 93.630)

STATE/TERRITORY Final Enacted President's Budget

FY 2020 +/- FY 

2019

Alabama 1,291,034 1,291,034 949,860 -341,174

Alaska 507,546 507,546 373,420 (134,126)

Arizona 1,446,620 1,446,620 1,064,330 (382,290)

Arkansas 770,894 770,894 567,174 (203,720)

California 7,499,029 7,499,022 5,517,304 (1,981,718)

Colorado 972,924 972,924 715,814 (257,110)

Connecticut 713,800 713,800 525,168 (188,632)

Delaware 507,546 507,546 373,420 (134,126)

District of Columbia 507,546 507,546 373,420 (134,126)

Florida 3,787,345 3,787,350 2,786,488 (1,000,862)

Georgia 2,096,590 2,096,590 1,542,536 (554,054)

Hawaii 507,546 507,546 373,420 (134,126)

Idaho 507,546 507,546 373,420 (134,126)

Illinois 2,624,830 2,624,830 1,931,180 (693,650)

Indiana 1,488,546 1,488,546 1,095,176 (393,370)

Iowa 774,176 774,176 569,590 (204,586)

Kansas 614,590 614,590 452,176 (162,414)

Kentucky 1,198,210 1,198,210 881,566 (316,644)

Louisiana 1,375,724 1,375,724 1,012,170 (363,554)

Maine 507,546 507,546 373,420 (134,126)

Maryland 1,095,178 1,095,178 805,762 (289,416)

Massachusetts 1,363,306 1,363,306 1,003,032 (360,274)

Michigan 2,537,470 2,537,470 1,866,906 (670,564)

Minnesota 1,028,414 1,028,414 756,640 (271,774)

Mississippi 914,238 914,238 672,638 (241,600)

Missouri 1,364,596 1,364,596 1,003,982 (360,614)

Montana 507,546 507,546 373,420 (134,126)

Nebraska 507,546 507,546 373,420 (134,126)

Nevada 555,197 555,196 408,476 (146,720)

New Hampshire 507,546 507,546 373,420 (134,126)

New Jersey 1,635,456 1,635,456 1,203,262 (432,194)

New Mexico 508,351 508,350 374,010 (134,340)

New York 4,090,946 4,090,946 3,009,856 (1,081,090)

North Carolina 2,015,964 2,015,964 1,483,216 (532,748)

North Dakota 507,546 507,546 373,420 (134,126)

Ohio 2,846,720 2,846,720 2,094,434 (752,286)

Oklahoma 897,250 897,250 660,140 (237,110)

Oregon 779,362 779,362 573,406 (205,956)

Pennsylvania 3,026,520 3,026,520 2,226,720 (799,800)

Rhode Island 507,546 507,546 373,420 (134,126)

South Carolina 1,097,000 1,097,000 807,102 (289,898)

South Dakota 507,546 507,546 373,420 (134,126)
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STATE/TERRITORY Final Enacted President's Budget

FY 2020 +/- FY 

2019

Tennessee 1,461,396 1,461,396 1,075,200 (386,196)

Texas 5,169,382 5,169,382 3,803,298 (1,366,084)

Utah 633,704 633,704 466,238 (167,466)

Vermont 507,546 507,546 373,420 (134,126)

Virginia 1,542,988 1,542,988 1,135,232 (407,756)

Washington 1,334,454 1,334,458 981,805 (352,653)

West Virginia 739,342 739,342 543,960 (195,382)

Wisconsin 1,308,704 1,308,704 962,860 (345,844)

Wyoming 507,546 507,546 373,420 (134,126)

 Subtotal 71,705,894 71,705,894 52,756,587 (18,949,307)

American Samoa 264,316 264,316 194,466 (69,850)

Guam 264,316 264,316 194,466 (69,850)

Northern Mariana Islands 264,316 264,316 194,466 (69,850)

Puerto Rico 2,506,930 2,506,930 1,844,438 (662,492)

Virgin Islands 264,316 264,316 194,466 (69,850)

Subtotal 75,270,088 75,270,088 55,378,889 (19,891,199)

Undistributed130 672,770 729,912 621,111 (108,801)

Total States/Territories 75,942,858 76,000,000 56,000,000 (20,000,000)

130 Program Support – includes funds for grant systems and review, and program reporting systems costs.
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Developmental Disabilities – Protection and Advocacy

Program FY 2018

Final

FY 2019 

Enacted

FY 2020

President's 

Budget

FY 2020 +/-

FY 2019

Developmental 

Disabilities 

Protection and 

Advocacy*

40,677 40,734 38,734 (2,000)

*BA is in thousands of dollars.

Original Authorizing Legislation: Section 145 of the Developmental Disabilities Assistance and 

Bill of Rights Act, Public Law 106-402 

Most Recent Authorizing Legislation: Section 145 of the Developmental Disabilities Assistance 

and Bill of Rights Act of 2000, Public Law 106-402

Current FY Authorization.....................................................................................................Expired

Authorization Expiration Date...................................................................................................2007

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

Program Description and Accomplishments:

Developmental Disabilities Protection and Advocacy (P&As) programs provide a range of legal 

services to unserved or underserved individuals with developmental disabilities, ensuring they are 

protected from abuse and neglect and are able to exercise their rights to make choices, contribute 

to society, and live independently. P&A systems have the authority to pursue a range of appropriate 

remedies or approaches, including the authority to investigate incidents of abuse and neglect, and 

to promote system change. There is a P&A system in each State, the Territories, and the District 

of Columbia. There is also a Native American Consortium for a total of 57 P&As.

P&As play a key role in promoting community living, and have been supported by a number of 

Federal and state initiatives promoting alternatives to nursing homes and other institutional settings 

that recognize the value of consumer preference and the attendant potential fiscal savings that can 

result. Community living was supported in the US Supreme Court’s 1999 decision in Olmstead v 

L.C. that requires States to eliminate unnecessary segregation and isolation of people with

disabilities, and to ensure that they receive services in the most integrated setting appropriate to

their needs. Olmstead implementation and enforcement, Money Follows the Person, Home and

Community Service (HCBS) waivers, and Medicaid managed care programs, to name a few, are

continuing to change the long-term care landscape across the country by expanding opportunities

for community living. The number of people with intellectual and developmental disabilities
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receiving Home and Community-Based waiver services has steadily increased.131 Approximately 

86 percent of the P&A clients now live in the community. This creates a heightened role for P&As 

to monitor and develop new strategies to address these new services.

These changes create new challenges for Protection and Advocacy programs as well as for the 

Long-Term Care Ombudsman program (LTCOP). P&As and LTCOP’s will increasingly need to 

have the capacity to address the new challenges and at the same time they will have to cope with 

the continuing accelerated growth of community-based services.

P&As also engage in a full range of other efforts to promote the rights of individuals with 

developmental disabilities. P&As often provide information and referrals, as well as training and 

technical assistance to service providers, state legislators and other policymakers. They also 

conduct self-advocacy trainings and raise public awareness of legal and social issues affecting 

individuals with developmental disabilities and their families.

Funding History:

Funding for the program over the past five years is as follows:

FY 2016 .................................................$38,734,000

FY 2017 .................................................$38,645,000

FY 2018 .................................................$40,677,000

FY 2019 Enacted....................................$40,734,000

FY 2020 President’s Budget ..................$38,734,000

Budget Request: 

The FY 2020 request for the Developmental Disabilities Protection and Advocacy program is 

$38,734,000, a decrease of -$2.0 million below the FY 2019 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 to continue to provide information and 

referral services.

The P&As form a national system that play a key role in ensuring that people with developmental 

disabilities are free of abuse and neglect. People with developmental disabilities, including 

children, are at increased risk of experiencing abuse and neglect.132 The 57 P&As stay at the 

forefront of these issues and maintain a presence in facilities that care for people with disabilities, 

where they monitor, investigate, and attempt to remedy adverse conditions. In FY 2016, 32,205 

people with disabilities received rights training by P&As and 35,695 people with disabilities 

received information and referral services. 

131 U.S. Profile, FY 1977 – 2013, State of the State in Developmental Disabilities.

132 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
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Of the inquiries and issues received by the P&As in FY 2016:

• 78 percent of closed individual cases in which the client’s objective was fully or partially

met;

• 48 percent of individual clients who had their right enforced and/or restored by P&A

efforts;

• 25 percent were resolved using short-term assistance/limited advocacy strategies;

• 44 percent were addressed through technical assistance in self-advocacy;

• 9 percent involved investigation and monitoring;

• 13 percent were addressed through negotiation; and

• 12 percent of abuse and neglect cases were remedied by P&As

Without the P&A presence, people with developmental disabilities and their families would have 

limited or no access to cost-effective, advocacy and legal interventions.

Outputs and Outcomes Table:

Developmental Disabilities Protection and Advocacy

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2019

Target

FY 2020

Target

FY 2020

Target

+/-FY 2019

Target

8F Increase the 

percentage of individuals 

with developmental 

disabilities whose rights 

were enforced, retained, 

restored or expanded. 

(Outcome)

FY 2017: 78.1%

Target:

Not Defined

(Historical Actual)

-- -- --

Indicator Year and Most Recent FY 2019 FY 2020 FY 2020

Result / Projection Projection 

Projection

+/-FY 2019

Projection

8iii: Number of clients FY 2017: 14,618 N/A N/A N/A

receiving professional 

individual legal advocacy 

for the Protection and 

Advocacy program. 

(Output)
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Indicator Year and Most Recent 

Result /

FY 2019

Projection

FY 2020

Projection

FY 2020

Projection

+/-FY 2019

Projection

8iv: Number of people 

receiving information and 

referral from the 

Protection and Advocacy 

program. (Output)

FY 2017: 22,327 N/A N/A N/A

Grant Awards Tables:

Developmental Disabilities – Protection and Advocacy Formula Grant Awards133

Awards FY 2018

Final

FY 2019

Enacted

FY 2020

President's 

Budget

Number of 

Awards 57 57 57

Average Award $699,587 $699,465 $665,079

Range of Awards

$216,435-

$3,730,779

$216,435-

$4,004,860

$216,435-

$3,725,398

 

133 Excludes grants to tribal organizations.
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Department of Health and Human Services

ADMINISTRATION FOR COMMUNITY LIVING

FY 2020 DISCRETIONARY STATE/FORMULA GRANTS

CFDA NUMBER/PROGRAM NAME: Developmental Disabilities – Protection and Advocacy (CFDA 93.630)

STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/- FY 

2019

Alabama $578,212 $504,895 $469,662 (35,233)

Alaska 404,556 404,556 404,556 - 

Arizona 746,747 733,117 681,963 (51,154)

Arkansas 410,767 404,556 404,556 - 

California 3,730,779 4,004,860 3,725,398 (279,462)

Colorado 492,364 507,316 477,558 (29,758)

Connecticut 409,502 407,939 404,556 (3,383)

Delaware 404,556 404,556 404,556 - 

District of Columbia 404,556 404,556 404,556 - 

Florida 2,066,218 2,123,872 1,975,659 (148,213)

Georgia 1,110,944 1,058,547 984,682 (73,865)

Hawaii 404,556 404,556 404,556 - 

Idaho 404,556 404,556 404,556 - 

Illinois 1,292,508 1,275,567 1,186,561 (89,006)

Indiana 699,654 642,055 597,249 (44,806)

Iowa 404,556 404,556 404,556 - 

Kansas 404,556 404,556 404,556 - 

Kentucky 536,407 463,684 431,327 (32,357)

Louisiana 558,966 547,735 511,862 (35,873)

Maine 404,556 404,556 404,556 - 

Maryland 534,545 587,783 552,419 (35,364)

Massachusetts 647,433 670,803 623,994 (46,809)

Michigan 1,093,387 1,022,907 951,529 (71,378)

Minnesota 529,282 516,357 482,952 (33,405)

Mississippi 429,754 410,881 404,792 (6,089)

Missouri 656,217 584,015 543,259 (40,756)

Montana 404,556 404,556 404,556 - 

Nebraska 404,556 404,556 404,556 - 

Nevada 404,556 404,556 404,556 - 

New Hampshire 404,556 404,556 404,556 - 

New Jersey 808,962 863,686 803,421 (60,265)

New Mexico 404,556 404,556 404,556 - 

New York 1,923,114 2,056,920 1,913,390 (143,530)

North Carolina 1,091,960 1,071,105 996,362 (74,743)

North Dakota 404,556 404,556 404,556 - 

Ohio 1,290,170 1,212,058 1,127,487 (84,571)

Oklahoma 417,604 404,556 404,556 - 

Oregon 425,209 415,552 404,556 (10,996)

Pennsylvania 1,337,666 1,275,662 1,186,651 (89,011)

Rhode Island 404,556 404,556 404,556 - 

South Carolina 554,239 513,240 480,322 (32,918)

South Dakota 404,556 404,556 404,556 - 

Tennessee 719,167 648,563 603,303 (45,260)

Texas 2,703,555 2,881,679 2,680,588 (201,091)
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STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/- FY 

2019

Utah 404,556 404,556 404,556 - 

Vermont 404,556 404,556 404,556 - 

Virginia 788,673 785,713 730,878 (54,835)

Washington 694,618 744,280 692,350 (51,930)

West Virginia 404,556 404,556 404,556 - 

Wisconsin 598,542 534,705 497,389 (37,316)

Wyoming 404,556 404,556 404,556 - 

 Subtotal 37,968,285 37,965,728 36,022,351 -1,943,377

Indian Tribes 216,435 216,435 216,435 - 

American Samoa 216,435 216,435 216,435 - 

Guam 216,435 216,435 216,435 - 

Northern Mariana Islands 216,435 216,435 216,435 - 

Puerto Rico 825,982 821,609 804,986 (16,623)

Virgin Islands 216,435 216,435 216,435 - 

Subtotal 39,876,442 39,869,512 37,909,512 (1,960,000)

Undistributed134 800,416 864,488 824,488 (40,000)

Total States/Territories 40,676,858 40,734,000 38,734,000 (2,000,000)

134 Program Support – includes funds for technical assistance and/or minority set-asides; grant systems and review, 

and program reporting systems costs.
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University Centers for Excellence in Developmental Disabilities

Program FY 2018

Final

FY 2019 

Enacted

FY 2020

President's 

Budget

FY 2020 +/-

FY 2019

University Centers 

for Excellence in 

Developmental 

Disabilities*

40,543 40,619 32,546 (8,073)

*BA is in thousands of dollars.

Original Authorizing Legislation: Section 156 of the Developmental Disabilities Assistance and 

Bill of Rights Act, Public Law 106-402 

Most Recent Authorizing Legislation: Section 156 of the Developmental Disabilities Assistance 

and Bill of Rights Act of 2000, Public Law 106-402 

Current FY Authorization.....................................................................................................Expired

Authorization Expiration Date...................................................................................................2007

Allocation Method ...............................................................................................Competitive Grant

Program Description and Accomplishments:

University Centers for Excellence in Developmental Disabilities (UCEDDs) are interdisciplinary 

education, research and public service units of a university or not-for-profit entity associated with 

universities. UCEDDs advise Federal, State, and community policymakers about, and promote 

opportunities for individuals with developmental disabilities to exercise self-determination and to 

be independent, productive, integrated and included in all facets of community life.

In FY 2018, the Administration on Intellectual and Developmental Disabilities (AIDD) funded 67

University Centers. Funding from AIDD establishes the UCEDD and provides the infrastructure 

support for the Centers to engage in interdisciplinary pre-service training, continuing education, 

community services, research, and information dissemination activities. UCEDDs leverage 

additional funds for carrying out these core activities from a variety of sources, including federal, 

state, and local agencies; private foundations; donations; and fee-for-service earnings. In FY 2015, 

UCEDDs leveraged $15 per AIDD dollar invested.

UCEDDs have played a key role in a number of advances in the disability field over the past five 

decades. Many issues, such as early intervention, health care, community-based services, inclusive 

and meaningful education, transition from school to work, employment, housing, assistive 

technology, and transportation have been directly improved by the services, research, and training 

provided by UCEDDs.
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As liaisons to the community, including service delivery systems, UCEDDs positively affect the

lives of individuals with developmental disabilities and their families in a variety of ways. UCEDD

accomplishmentsinclude:

• Directing exemplary interdisciplinary pre-service preparation with faculty and trainees that

represent a variety of disciplines. 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. Community

services offer innovative designs and methods that address a local or universal need, can

be replicated and promote the increased inclusion, integration, productivity, and human

rights of individuals with developmental disabilities and their families including people

with developmental disabilities from racial and ethnic minority backgrounds.

• Contributing to the development of new knowledge through various research activities

including basic or applied research, evaluation, and public policy analysis. UCEDD

research engages people with developmental disabilities and their families in the

development, design and implementation of research activities, as well as the dissemination

of research information. New knowledge is generated by research and tied to practice using

a variety of dissemination strategies. UCEDDs also bridge the gap between research and

practice by developing a variety of products and resources that promotes improvement in

knowledge and practice.

• Leading national efforts, including youth transition, autism services, supports and research,

mental health services and supports, and supporting self-advocates and families. For

example, the Carolina Institute for Developmental Disabilities at the University of North

Carolina released findings from a study that examined the use of brain scans to identify

early signs of autism in high-risk babies. The researchers were able to make reasonably

accurate forecasts about which high-risk infants will later develop autism by scanning the

brains of babies whose siblings have autism. The findings are important because early

diagnosis of autism spectrum disorder (ASD) has been a significant challenge.

When funding is sufficient, UCEDDs also conduct national training initiatives to address unmet 

needs of people with developmental disabilities. Past training initiatives have supported postsecondary education opportunities for people with developmental disabilities, enhancing selfdetermination skills, and building partnerships with minority serving institutions.
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Funding History:

Funding for the program over the past five years is as follows:

FY 2016 ... .............................................$38,619,000

FY 2017 .................................................$38,530,000

FY 2018 .................................................$40,543,000

FY 2019 Enacted....................................$40,619,000

FY 2020 President’s Budget ..................$32,546,000

Budget Request: 

The FY 2020 request for UCEDDs is $32,546,000, a reduction of -$8.1 million below the FY 2019 

Enacted Level. 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 train future professionals with the specialized expertise in 

developmental disabilities. Of the UCEDD trainees who graduated 5 to 10 years ago, 30 percent 

are in leadership positions including:

• 18 percent in academic leadership;

• 15 percent in clinical leadership;

• 4 percent in public health leadership; and

• 32 percent in public policy and advocacy leadership.

Based on statutory requirements for allocating funding, national training efforts would not be 

funded at the request level. 

Funding for UCEDDs supports specialized services at the local level and provides local 

organizations as well as state agencies with technical assistance to improve services and supports 

for people with developmental disabilities across the life span. UCEDDs currently operate very 

efficiently and are able to leverage significant additional Federal and non-Federal resources. ACL 

will work to provide technical and other assistance, including sharing best practices, to allow the 

UCEDDs to prioritize remaining funding and to leverage additional resources for these services.
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Outcomes and Outputs Table:

University Centers for Excellence in Developmental Disabilities

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2019

Target

FY 2020

Target

FY 2020 Target

+/-FY 2019

Target

8D Increase the 

percentage of individuals 

with developmental 

disabilities who are 

receiving services 

through activities in 

which UCEDD trained 

professional were 

involved. (Outcome)

FY 2017: 44.56%

Target:

43.74%

(Target Exceeded)

Prior Result + 

1%

Prior Result + 

1%

N/A

Indicator Year and Most Recent 

Result / 

FY 2019 

Projection

FY 2020

Projection

FY 2020 Projection

+/-FY 2019

Projection

8viii: Number of 

professionals trained by 

UCEDDs. (Output) 

FY 2017: 5,038 N/A N/A N/A

8ix: Number of people 

reached through UCEDD 

community training and 

technical assistance 

FY 2017: 1,020,774 N/A N/A N/A

activities. (Output)

8x: Number of people 

receiving direct or model 

demonstration services 

FY 2017: 126,862 N/A N/A N/A

from UCEDDs. (Output)
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Grant Awards Tables:

University Centers of Excellence in Developmental Disabilities Grant Awards

Awards FY 2018 

Final

FY 2019 

Enacted

FY 2020 

President's 

Budget

Number of Awards 81 73 66

Average Award $488,117 $544,185 $571,604 

Range of Awards $48,909 -

$700,000 

$48,909 -

$700,000 

$48,909 -

$700,000 

Resource and Program Data:

University Centers of Excellence in Developmental Disabilities

Mechanism

FY 2018 

Final #

FY 2018 

Final $

FY 2019 

Enacted #

FY 2019 

Enacted $

FY 2020 

President’s 

Budget #

FY 2020 

President’s 

Budget $

Grants: -- -- -- -- -- --

Formula -- -- -- -- -- --

New Discretionary 31 12,188 5 2,297 1 297 

Continuations 50 27,350 68 37,429 65 37,429 

Contracts 1 929 1 817 1 817 

Interagency Agreements -- -- -- -- -- --

Program Support /1 -- 211 -- 192 -- 192 

Total Resources -- 40,677 -- 40,734 -- 38,734 
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Developmental Disabilities – Projects of National Significance

Program FY 2018

Final

FY 2019 

Enacted

FY 2020

President's 

Budget

FY 2020 +/-

FY 2019

Projects of National 

Significance* 11,770 12,000 1,050 (10,950)

*BA is in thousands of dollars.

Original Authorizing Legislation: Section 163 of the Developmental Disabilities Assistance and 

Bill of Rights Act, Public Law 106-402 

Most Recent Authorizing Legislation: Section 163 of the Developmental Disabilities Assistance 

and Bill of Rights Act of 2000, Public Law 106-402 

Current FY Authorization.....................................................................................................Expired

Authorization Expiration Date...................................................................................................2007

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 to develop and test

innovative and promising practice demonstrations that expand opportunities for individuals with 

developmental disabilities to contribute to, and participate in, all facets of community life. 

Examples of PNS activities include:

• Grants to improve access to competitive, integrated supported employment for people with

intellectual and developmental disabilities. These grants include particular focus on youth

and young adults, as well as the evaluation of such efforts and technical assistance to the

states that are funded.

• Community practice projects to build states’ capacities to support competitive, integrated

employment and family support activities for persons with intellectual and developmental

disabilities, as well as technical assistance to self-advocacy organizations.

• Longitudinal data collection projects as well as longitudinal research studies of trends in

residential services and supports, employment, community supports, family supports, and

quality indicators related to publicly funded DD services.
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• A project to gather and disseminate information and provide technical assistance to people

and entities interested in supported decision making as an alternative to guardianship.

• A grant to equip disability organizations providing long term services and support with the

tools they need to partner and contract with health care payers and providers in delivery

system reform.

Funding History:

Funding for the program over the past five years is as follows:

FY 2016... ..............................................$10,000,000

FY 2017 ...................................................$9,977,000

FY 2018 .................................................$11,770,000

FY 2019 Enacted....................................$12,000,000

FY 2020 President’s Budget ....................$1,050,000

Budget Request:

The FY 2020 request for the Projects of National Significance program is $1.0 million, a reduction 

of -$11.0 million below the FY 2019 Enacted Level. At the requested funding level, the PNS 

program provides continued support for three studies: The State of the States in Developmental 

Disabilities, Residential Information Systems Project, and the National Data Collection on Day 

and Employment Services for Individuals with Developmental Disabilities.

Grant Awards Tables:

Developmental Disabilities – Projects of National Significance Grant Awards

(Dollars in thousands)

Awards FY 2018 

Final

FY 2019 

Enacted

FY 2020 

President's 

Budget

Number of Awards 28 21 3

Average Award $328,590 $451,288 $350,000 

Range of Awards $225,000 -

$1,056,187 

$225,000 -

$1,056,187 $350,000
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Resource and Program Data:

Developmental Disabilities – Projects of National Significance

(Dollars in thousands)

Mechanism

FY 2018 

Final #

FY 2018 

Final $

FY 2019 

Enacted #

FY 2019 

Enacted $

FY 2020 

President’s 

Budget #

FY 2020 

President’s 

Budget $

Grants: -- -- -- -- -- --

Formula -- -- -- -- -- --

New Discretionary 6 3,065 2 1,107 -- --

Continuations 22 6,136 19 8,370 3 1,050 

Contracts 7 2,304 -- 2,304 -- --

Interagency Agreements 1 100 -- -- -- --

Program Support135 -- 166 -- 219 -- --

Total Resources -- 11,770 21 12,000 3 1,050 

135 Program Support -- Includes funds for overhead, grant systems and review costs, and information technology 

support costs
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Independent Living

Category FY 2018

Final

FY 2019

Enacted

FY 2020

President’s 

Budget

FY 2020 

Request +/- FY 

2019

Independent Living -

State Grants

24,878 25,378 17,841 -7,537

Centers for Independent 

Living

88,305 90,805 90,805 0

Independent Living 

Program*

113,183 116,183 108,646 -7,537

FTE 1 1 1 0

*BA is in thousands of dollars, FTE are actuals.

Original Authorizing Legislation: Rehabilitation Act of 1973, Parts B and C, and Chapter 2, Public 

Law 93-12

Most Recent Authorizing Legislation: Workforce Innovation and Opportunities Act of 2014

(Rehabilitation Act), Public Law 113-128

Current FY Authorization:

Independent Living State Grants...............................................................................$26,319,000

Centers for Independent Living.................................................................................$90,083,000

Expiration Date: ........................................................................................................................2019

Allocation Method ......................................................................Formula and Discretionary Grants

Program Description and Accomplishments:

Independent Living (IL) programs the maximize 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 and to develop and support statewide networks of centers for 

independent living (CILs). They also foster working relationships among centers for independent 

living, Statewide Independent Living Councils, other Rehabilitation Act programs, and relevant 

Federal and non-Federal programs.
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Independent Living Services State Grants

The Independent Living Services State Grants program supports formula grants to States, which 

must establish a Statewide Independent Living Council (SILC). Each State must also submit a 

State Plan for Independent Living. In addition to developing the State plan, the SILC may, 

consistent with the State plan and State law, work to coordinate services provided to individuals 

with disabilities, conduct resource development activities, and perform other functions to support 

the purposes of the law. Funds not used to operate the SILC must be used for one of the following 

purposes, consistent with the State plan:

• To demonstrate ways to expand and improve independent living services, particularly those

in unserved areas;

• To provide independent living services;

• To support the operation of centers for independent living;

• To increase the capacity of public or nonprofit agencies and organizations and other entities

to develop comprehensive approaches or systems for providing independent living

services;

• To conduct studies and analyses, gather information, develop model policies and

procedures, and present information, approaches, strategies, findings, conclusions, and

recommendations to Federal, State, and local policymakers;

• To provide training on the independent living philosophy; and/or:

• To provide outreach to populations who are not served or are underserved by programs

under subtitle VII, Chapter 16 of the Rehabilitation Act, including minority groups and

urban and rural populations.

Typically, SILCs “pass through” approximately two thirds of their federal funding to Centers for 

Independent Living to carry out direct services. State grant funds are allotted based on total 

population, and participating States must match 10 percent of their grant with non-Federal cash or 

in-kind resources in the year for which the Federal funds are appropriated.

Centers for Independent Living

The Centers for Independent Living (CIL) program provides grants to consumer-controlled, 

community-based, cross-disability, private nonprofit agencies that are designed and operated 

within a local community by individuals with disabilities. At a minimum, centers are required to 

provide the core independent living services of information and referral, independent living skills 

training, peer counseling, and individual and systems advocacy. The 2014 reauthorization of the 

Rehabilitation Act by the Workforce Innovation and Opportunity Act (WIOA) added a fifth core 

service that the CILs must provide to eligible individuals with significant disabilities. This fifth 

core service includes three components:
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• Facilitate the transition of individuals with significant disabilities from nursing homes and 

other institutions to home and community based residences, with necessary supports to 

remain in the community;

• Assist individuals with significant disabilities at risk of institutionalization so that they may 

remain in the community; and

• Facilitate the transition of youth who are individuals with significant disabilities that are 

eligible for IDEA and who either completed school or left school to transition to 

postsecondary life.

A population-based formula determines the total amount that is available for grants to centers in 

each State. WIOA requires that grants be awarded to any eligible agency that had been awarded a 

grant for the preceding fiscal year. In most cases, funds are awarded directly to centers for 

independent living. If State funding for CIL operation exceeds the level of Federal CIL funding in 

any fiscal year, the State may apply for the authority to award grants under this program through 

its designated state unit. There are currently only two States, Massachusetts and Minnesota, that 

are both eligible and have elected to manage their own CIL programs. In fiscal year 2015, 354 

centers and two States received funding from the CIL program.

In addition to funding centers for independent living, the Department must annually reserve 

between 1.8 and 2 percent of the funds appropriated for both Independent Living Services State 

Grants and for Centers for Independent Living to provide (through grants, contracts, or cooperative 

agreements; or directly, for ILSSG) training and technical assistance with respect to planning, 

developing, conducting, administering, and evaluating centers for independent living. Section 

21(b)(1) of the Rehabilitation Act also allows for 1 percent of funds appropriated under subtitle 

VII to be set aside for minority outreach activities as described in Section 21(b)(2).

Funding History:

Funding for Independent Living activities over the past five years is as follows:

Centers for Independent Living

FY 2016 .................................................$78,305,000

FY 2017 .................................................$78,305,000

FY 2018 ................................................$88,305,000

FY 2019 Enacted....................................$90,805,000

FY 2020 President’s Budget ..................$90,805,000
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Independent Living State Grants FTE

FY 2016 ................................................$22,878,000 .3

FY 2017 .................................................$22,878,000 .7

FY 2018 ................................................$24,878,000 .8 

FY 2019 Enacted....................................$25,378,000 1.0

FY 2020 President’s Budget ..................$17,841,000 1.0

Budget Request:

Independent Living Services State Grants

The FY 2020 request for Independent Living Services State Grants is $17,841,000, a reduction of 

-$7.5 million below the FY 2019 Enacted Level. This level will allow for continued support to 

ILS State Grants which support the State Independent Living Councils (SILCs) in their efforts to 

coordinate services provided to individuals with disabilities and which support direct services 

through funding provided to the Centers for Independent Living (CILs).

ACL recognizes the value this program provides by focusing on the independence and productivity 

of individuals with disabilities and integrating them into the mainstream of society. 

ACL will also continue to reserve, as provided in statute at least 1.8 percent of available funding 

for the provision of technical assistance to the SILCs, including support for .8 FTE to provide 

direct Federal technical assistance.

Centers for Independent Living

The FY 2020 request for Centers for Independent Living (CILs) is $90,805,000 equal to the FY 

2019 Enacted Level. This funding will continue to provide the core requirements for information 

and referral services, independent living skills training, peer counseling, and individual and 

systems advocacy; and will continue implementation of the new, fifth core service required by 

WIOA. As part of this requirement, CILs will develop protocols, provide outreach and education, 

and provide and track activities. In 2015, CILs served about 219,967 of the estimated 38 million 

individuals with a significant disability living in the United States.136

The request for the CIL program will continue support for existing centers, including any new 

center grants awarded in FY 2019. Approximately 75 new centers have been funded since 

FY 2000.

Included in the FY 2020 request level is funding of up to $1 million to conduct an evaluation of 

the Centers for Independent Living program, as part of ACL’s focus on generating outcome data 

and supporting robust program evaluation.

136 ACL, 704 Report, 2014. And U.S. Census Bureau, “Americans with Disabilities 2010” issued July 2012. 

Accessed 04 January 2014. 
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Outcome and Output Table:

ACL is revising the grantee program performance reports (PPRs) to improve overall data quality, 

reduce grantee reporting burden, and increase reporting of program outcomes. These reports 

form the basis of performance measures. Comments received during the Information Collection 

Request (ICR) approval process are under review. Once complete and revised PPR is approved 

and grantees have collected baseline data, performance measures will be developed and reported.

Grant Awards Tables:

Independent Living Services State Grant Awards137

Awards FY 2018

Final

FY 2019

Enacted

FY 2020

President's 

Budget

Number of 

Awards 56 56 56

Average Award $430,133 $437,573 $308,123

Range of Awards

$30,109-

$2,137,194

$30,630-

$2,165,083

$21,569-

$1,526,937

137 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.
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Resource and Program Data:

Independent Living

(Dollars in Thousands)

Mechanism

FY 2018 

Final #

FY 2018 

Final $

FY 2019 

Enacted #

FY 2019 

Enacted $

FY 2020 

President’s 

Budget #

FY 2020 

President’s 

Budget $

Grants: -- -- -- -- -- --

Formula138 56 24,087 56 24,571 56 17,255

New Discretionary 2 421 357 88,292 358 87,998

Continuations 361 87,893 5 2,816 2 1,888 

Contracts -- -- -- -- 1 1,000 

Interagency Agreements -- -- -- -- -- --

Program Support139 -- 501 -- 505 -- 505 

Total Resources -- 112,902 -- 116,183 -- 108,646 

138 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.

139 Program Support -- Includes funds for overhead, grant systems and review costs, and information technology 

support costs.
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Department of Health and Human Services

ADMINISTRATION FOR COMMUNITY LIVING

FY 2020 DISCRETIONARY STATE/FORMULA GRANTS

CFDA NUMBER/PROGRAM NAME: Independent Living State Grants (CFDA 84.169A)

STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/- FY 

2019 

Alabama 332,044 338,717 238,122 (100,595)

Alaska 332,044 338,717 238,122 (100,595)

Arizona 377,402 384,221 270,974 (113,247)

Arkansas 332,044 338,717 238,122 (100,595)

California 2,137,194 2,165,083 1,526,937 (638,146)

Colorado 332,044 338,717 238,122 (100,595)

Connecticut 332,044 338,717 238,122 (100,595)

Delaware 332,044 338,717 238,122 (100,595)

District of Columbia 332,044 338,717 238,122 (100,595)

Florida 1,122,363 1,149,136 810,433 (338,703)

Georgia 561,408 571,128 402,790 (168,338)

Hawaii 332,044 338,717 238,122 (100,595)

Idaho 332,044 338,717 238,122 (100,595)

Illinois 697,053 701,057 494,424 (206,633)

Indiana 361,175 365,085 257,477 (107,608)

Iowa 332,044 338,717 238,122 (100,595)

Kansas 332,044 338,717 238,122 (100,595)

Kentucky 332,044 338,717 238,122 (100,595)

Louisiana 332,044 338,717 238,122 (100,595)

Maine 332,044 338,717 238,122 (100,595)

Maryland 332,044 338,717 238,122 (100,595)

Massachusetts 370,907 375,654 264,931 (110,723)

Michigan 540,603 545,551 384,752 (160,799)

Minnesota 332,044 338,717 238,122 (100,595)

Mississippi 332,044 338,717 238,122 (100,595)

Missouri 332,044 338,717 238,122 (100,595)

Montana 332,044 338,717 238,122 (100,595)

Nebraska 332,044 338,717 238,122 (100,595)

Nevada 332,044 338,717 238,122 (100,595)

New Hampshire 332,044 338,717 238,122 (100,595)

New Jersey 487,033 493,162 347,805 (145,357)

New Mexico 332,044 338,717 238,122 (100,595)

New York 1,075,146 1,086,982 766,598 (320,384)

North Carolina 552,500 562,587 396,767 (165,820)

North Dakota 332,044 338,717 238,122 (100,595)

Ohio 632,411 638,442 450,264 (188,178)

Oklahoma 332,044 338,717 238,122 (100,595)

Oregon 332,044 338,717 238,122 (100,595)

Pennsylvania 696,111 701,250 494,559 (206,691)

Rhode Island 332,044 338,717 238,122 (100,595)

South Carolina 332,044 338,717 238,122 (100,595)

South Dakota 332,044 338,717 238,122 (100,595)

Tennessee 362,163 367,777 259,376 (108,401)

Texas 1,517,139 1,550,001 1,093,144 (456,857)

Utah 332,044 338,717 238,122 (100,595)
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STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/- FY 

2019

Vermont 332,044 338,717 238,122 (100,595)

Virginia 458,029 463,831 327,118 (136,713)

Washington 396,837 405,549 286,015 (119,534)

West Virginia 332,044 338,717 238,122 (100,595)

Wisconsin 332,044 338,717 238,122 (100,595)

Wyoming 332,044 338,717 238,122 (100,595)

 Subtotal 23,634,970 24,042,874 16,930,512 (7,112,362)

American Samoa 30,109 30,630 21,569 (9,061)

Guam 30,109 30,630 21,569 (9,061)

Northern Mariana Islands 30,109 30,630 21,569 (9,061)

Puerto Rico 332,044 338,717 238,122 (100,595)

Virgin Islands 30,109 30,630 21,569 (9,061)

 Subtotal 24,087,450 24,504,111 17,254,910 (7,249,201)

Undistributed 790,550 873,889 586,090 287,799 

Total States/Territories 24,878,000 25,378,000 17,841,000 (7,537,000)

Ohio 632,411 638,442 450,264 (188,178)

Oklahoma 332,044 338,717 238,122 (100,595)

Oregon 332,044 338,717 238,122 (100,595)

Pennsylvania 696,111 701,250 494,559 (206,691)

Rhode Island 332,044 338,717 238,122 (100,595)

South Carolina 332,044 338,717 238,122 (100,595)

South Dakota 332,044 338,717 238,122 (100,595)

Tennessee 362,163 367,777 259,376 (108,401)

Texas 1,517,139 1,550,001 1,093,144 (456,857)

Utah 332,044 338,717 238,122 (100,595)

Vermont 332,044 338,717 238,122 (100,595)

Virginia 458,029 463,831 327,118 (136,713)

Washington 396,837 405,549 286,015 (119,534)

West Virginia 332,044 338,717 238,122 (100,595)

Wisconsin 332,044 338,717 238,122 (100,595)

Wyoming 332,044 338,717 238,122 (100,595)

 Subtotal 23,634,970 24,042,874 16,930,512 (7,112,362)

American Samoa 30,109 30,630 21,569 (9,061)

Guam 30,109 30,630 21,569 (9,061)

Northern Mariana Islands 30,109 30,630 21,569 (9,061)

Puerto Rico 332,044 338,717 238,122 (100,595)

Virgin Islands 30,109 30,630 21,569 (9,061)

 Subtotal 24,087,450 24,504,111 17,254,910 (7,249,201)

Undistributed140 141 790,550 873,889 586,090 287,799 

Total States/Territories 24,878,000 25,378,000 17,841,000 (7,537,000)

140 Program Support – includes funds for statutory technical assistance and/or minority set-asides; grant systems and 

review, ad program reporting systems costs.

141 In FY 2020 the President’s Budget proposes to use funds for an evaluation of the program.
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Limb Loss Resource Center

Program FY 2018

Final

FY 2019 

Enacted

FY 2020

President's 

Budget

FY 2020 +/-

FY 2019

Limb Loss Resource 

Center* 3,491 3,500 -- (3,500)

*BA is in thousands of dollars.

Original 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)

Most Recent Authorizing Legislation: N/A

Current FY Authorization......................................................................................................................... NA 

Expiration Date: .................................................................................................................................Expired 

Allocation Method ............................................................................................................ Competitive Grant

Program Description and Accomplishments:

Limb loss is the loss of all or part of an arm or leg due to trauma, infection, diabetes, heart diseases, 

cancers, or other diseases. An estimated two million people live with limb loss/limb difference in 

the United States.142 Each year, an additional 185,000 amputations occur.143 People with limb loss 

experience many barriers to successful community integration and full participation in life. They 

perceive a reduction in their participation in recreational activities, satisfaction at work and 

difficulty navigating their community following the amputation of their limb.144 Individuals with 

limb loss report receiving little information about their rehabilitation from their healthcare provider 

either before or after their amputation.145

The National Limb Loss Resource Center (NLLRC) seeks to improve the health of people with 

limb loss, promote their well-being, improve their quality of life, reduce unnecessary medical 

expenditures, and provide support to families and caregivers. ACL’s Limb Loss Program supports 

142 Ziegler-Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R. Estimating the prevalence of limb 

loss in the United States: 2005 to 2050. Arch Phys Med Rehabil2008 Mar;89(3):422-9.

143 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

144 Ephraim PL, MacKenzie EJ, Wegener ST, Dillingham TR, Pezzin LE. Environmental barriers experienced by 

amputees: the Craig Hospital Inventory of Environmental Factors-Short Form. Arch Phys Med Rehabil2006 

Mar;87(3):328-33.

145 Seaman JP. Survey of individuals wearing lower limb prostheses. Journal of Prosthetics and 

Orthotics2010;22(4):257-65
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programs and services including a national peer support program, educational events, trainings for 

consumers and healthcare professionals, consumer education materials, and information and 

referral services to disseminate information specific to living well with limb loss and to connect 

consumers to resources in their local communities.

Funding History:

Funding for the program over the past five years is as follows:

FY 2016 ...................................................$2,810,000

FY 2017 ...................................................$2,494,000

FY 2018 ...................................................$3,491,000

FY 2019 Enacted......................................$3,500,000

FY 2020 President’s Budget ..................................$0

Budget Request:

No funding is requested in FY 2020 for the Limb Loss Resource Center, consistent with the 

proposal in the FY 2019 President’s Budget. Other ACL and HHS programs, such as Aging and 

Disability Resource Centers, Centers for Independent Living and Assistive Technology provide 

services and resources for individuals with all types of disabilities.

Grants Awards Tables

Awards FY 2018 

Final

FY 2019 

Enacted

FY 2020 

President's 

Budget

Number of Awards 1 1 N/A

Average Award $3,397,142 $3,292,907 N/A

Range of Awards $3,397,142 $3,292,907 N/A
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Resource and Program Data

Mechanism

FY 2018 

Final #

FY 2018 

Final $

FY 2019 

Enacted #

FY 2019 

Enacted $

FY 2020 

President’s 

Budget #

FY 2020 

President’s 

Budget $

Grants: -- -- -- -- -- --

Formula -- -- -- -- -- --

New Discretionary -- -- 1 3,293 -- --

Continuations 1 3,397 -- -- -- --

Contracts -- -- -- -- -- --

Interagency Agreements -- -- -- -- -- --

Program Support146 -- 94 -- 207 -- --

Total Resources -- 3,491 -- 3,500 -- --

146 Program Support -- Includes funds for Public Health Service Act statutory requirements, grant systems and 

review costs.
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Paralysis Resource Center

Program FY 2018

Final

FY 2019 

Enacted

FY 2020

President's 

Budget

FY 2020 +/-

FY 2019

Paralysis Resource 

Center* 7,681 8,700 -- (8,700)

*BA is in thousands of dollars.

Original Authorizing Legislation: Christopher and Dana Reeve Paralysis Act, title XIV of the 

Omnibus Public Land Management Act of 2009, P.L. 111-11; Sections 311 and 317(k)(2) of the 

Public Health Service Act [42 U.S.C. 243 & 247b(k)(2)], as amended.

Most Recent Authorizing Legislation: Christopher and Dana Reeve Paralysis Act, title XIV of the 

Omnibus Public Land Management Act of 2009, P.L. 111-11; Sections 311 and 317(k)(2) of the 

Public Health Service Act [42 U.S.C. 243 & 247b(k)(2)], as amended.

Current FY Authorization.....................................................................................................Expired

Expiration Date ..........................................................................................................................2011

Allocation Method ...............................................................................................Competitive Grant

Program Description and Accomplishments:

The Paralysis Resource Center (PRC) promotes the health and well-being of people living with 

paralysis and supports their families and caregivers by providing comprehensive information and 

referral services. The PRC seeks to bridge the information gap experienced not only by 

newly-paralyzed individuals, but also by those who have lived for some time with paralysis. This 

information promotes better health, encourages community involvement, and improves quality of 

life.

Nearly 5.4 million Americans, or one in 50 reported having some form of paralysis, defined as a 

central nervous system disorder resulting in difficulty or inability to move the upper or lower 

extremities.147 These individuals face health and other disparities, which often translate into 

exclusion from full participation in their communities. The Paralysis Resource Center offers 

activities and services aimed at increasing independent living for people with paralysis and related 

mobility impairments, and supports integration into the physical and cultural communities in 

which they live.

147 Armour, Brian S., Elizabeth A. Courtney-Long, Michael H. Fox, Heidi Fredine, and Anthony Cahill. Prevalence 

and Causes of Paralysis—United States, 2013. Issue brief. Christopher and Dana Reeve Foundation, 23 Aug. 

2016. 
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Funding History:

Funding for the program over the past five years is as follows:

FY 2016 ...................................................$7,700,000

FY 2017 ...................................................$6,682,000

FY 2018 ...................................................$7,681,000

FY 2019 Enacted......................................$8,700,000

FY 2020 President’s Budget ..................................$0

Budget Request:

No funding is requested in FY 2020 for the Paralysis Resource Center, consistent with the proposal

in the FY 2019 President’s Budget. Other ACL and HHS programs, such as Aging and Disability 

Resource Centers, Centers for Independent Living and Assistive Technology provide services and 

resources for individuals with all types of disabilities.
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Paralysis Resource Center

Awards FY 2018 

Final

FY 2019 

Enacted

FY 2020 

President's 

Budget

Number of Awards 3 5 N/A

Average Award $2,489,561 $1,662,332 N/A

Range of Awards $273,447 -

$7,001,532

$200,000 -

$7,511,661 N/A

Resource and Program Data:

Paralysis Resource Center

(Dollars in thousands)

Mechanism

FY 2018 

Final #

FY 2018 

Final $

FY 2019 

Enacted #

FY 2019 

Enacted $

FY 2020 

President’s 

Budget #

FY 2020 

President’s 

Budget $

Grants: -- -- -- -- -- --

Formula -- -- -- -- -- --

New Discretionary 3 7,469 2 1,400 -- --

Continuations -- -- 3 6,912 -- --

Contracts -- -- 1 125 -- --

Interagency Agreements -- -- -- -- -- --

Program Support148 -- 212 -- 263 -- --

Total Resources -- 7,681 -- 8,700 -- --

148 Program Support -- Includes funds for Public Health Service Act statutory requirements, grant systems and 

review costs.
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DISABILITY PROGRAMS AND SERVICES

Traumatic Brain Injury

Program FY 2018

Final

FY 2019 

Enacted

FY 2020

President's 

Budget

FY 2020 +/-

FY 2019

Traumatic Brain 

Injury* 11,293 11,321 9,321 (2,000)

*BA is in thousands of dollars.

Original Authorizing Legislation: Traumatic Brain Injury Act of 1996, P. L. 104-166

Most Recent Authorizing Legislation: The Traumatic Brain Injury Reauthorization Act of 2014, 

P.L. 113-196

Current FY Authorization.....................................................................................................Expired

Expiration Date ..........................................................................................................................2019

Allocation Method ...................................................Formula Grant / Competitive Grant / Contract

Program Description and Accomplishments:

The Traumatic Brain Injury (TBI) Program develops comprehensive, coordinated family and 

person-centered service systems at the state and community level for individuals who sustain a 

TBI. In the United States, it is estimated at least 3.2 million Americans require long-term or lifelong assistance to perform activities of daily living as a result of TBI.149 In addition, these national 

estimates do not include individuals with TBI who are treated in military hospitals.

Individuals with TBI may need a variety of services and supports, including rehabilitation, 

counseling, academic and vocational accommodations, independent living assistance, 

transportation assistance, and vocational training. These services and supports are often 

fragmented across different State systems of care, making access difficult for families. ACL works

across the lifespan, focusing on multiple life domains outside the health arena to achieve systems 

change, address fragmentation, and enhance service delivery.

The TBI Program includes two grant programs: the State Protection and Advocacy (P&A) Systems 

Grants (formula grant), and the TBI State Partnership Program (competitive grant).

Protection and Advocacy Systems Grants 

TBI P&A grants are awarded to P&A organizations in states, territories, the District of Columbia, 

and one Native American Consortium to provide advocacy support for individuals with TBI and 

their families. Grantees use these funds to develop plans and provide P&A services – including 

individual and family advocacy, self-advocacy training, self-advocacy assistance, information and 

149 Traumatic Brain Injury in the United States: A Report to Congress. December 1999.

180
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181

referral services, and legal representation – to individuals who have experienced a TBI. P&A 

grants are formula based, with an average award of $50,000 for state grantees and $20,000 for 

territory grantees.

A vital part of P&A activities is providing training and education to consumers and providers. TBI 

training is tailored to meet the needs of specific audiences, and is intended to increase awareness 

about legal concerns and individual rights around TBI, provide information on identification and 

funding of services, and provide support to facilitate full participation in all aspects of life. In FY 

2014, P&A grantees provided training to nearly 60,000 individuals. TBI training is provided to 

support groups, independent living centers, service providers, and caregivers, individuals with 

TBI, family members, state employees, hospital staff, university staff, and community 

representatives. Training has resulted in greater awareness for training participants of the needs of 

persons with TBI and the availability of resources and support services.

State Partnership Program Grants

The State Partnership Program is designed to assist states in expanding and improving state and 

local capability to provide access to comprehensive and coordinated services for individuals with 

TBI and their families. The program addresses barriers to needed services encountered by children, 

youth, and adults with TBI.

Starting in 2018, ACL is creating two tiers of grantees, which will work together to maximize the 

program’s impact nationally: Partner State grantees and Mentor State grantees. Both types of 

grantees are required to build and enhance their state TBI infrastructure by establishing and 

maintaining a State Advisory Board on Traumatic Brain Injury, creating an annual TBI state plan, 

and creating or expanding a state TBI registry. Mentor States have additional responsibilities, 

which include mentoring one or more Partner States and working together with other Mentor States 

and ACL to improve national coordination and collaboration around TBI services and supports.

Funding History:

Funding for the program over the past five years is as follows:

FTE

FY 2016... ...............................................$9,321,000 --

FY 2017 ...................................................$9,300,000 1.4

FY 2018 .................................................$11,293,000 1.6

FY 2019 Enacted....................................$11,321,000 1.6

FY 2020 President’s Budget ....................$9,321,000 1.6

Budget Request:

The FY 2020 request for the Traumatic Brain Injury (TBI) program is $9,321,000, a reduction of 

-$2.0 million below the FY 2020 Enacted Level. This level will continue to support 1.6 FTE.

This level will allow for continued support of the TBI Protection and Advocacy Formula Grants

as well as the new approach to State Implementation Partnership grants. In FY 2018, ACL created 

two tiers of TBI State Partnership Program grants. One targeted States that are developing their 
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State’s TBI program, and the other targeted States that have more developed TBI programs and 

are willing to act as mentor’s to other States. In both cases grantees are expected to support 

comprehensive, coordinated family and person-centered service systems for individuals at the 

State and community level who are living with a TBI.

The TBI program also provides funding for a TBI technical assistance center (TBICC), which 

provides technical assistance to grantees, maintains a national listserv on issues that affect TBI 

service delivery with approximately 1,500 subscribers, manages an online collaboration space for 

grantees to share promising practices for building and maintaining service-delivery infrastructure, 

and develops educational materials for the public about TBI.

Grant Awards Tables:

Traumatic Brain Injury: Protection and Advocacy

Awards FY 2018 

Final

FY 2019 

Enacted

FY 2020 

President's 

Budget

Number of Awards 24 24 24

Average Award $220,728 $224,625 $199,625 

Range of Awards $20,000-

$147,540

$75,000-

$275,000

$75,000-

$275,000

Traumatic Brain Injury: State Implementation/Mentor Partnership

Awards FY 2018 

Final

FY 2019 

Enacted

FY 2020 

President's 

Budget

Number of Awards 57 57 57

Average Award $70,175 $70,175 $54,379 

Range of Awards $20,000-

$321,491

$20,000-

$321,027

$20,000-

$146,992
DISABILITY PROGRAMS AND SERVICES

Resource and Program Data:

Traumatic Brain Injury

(Dollars in thousands)

Mechanism

FY 2018 

Final #

FY 2018 

Final $

FY 2019 

Enacted #

FY 2019 

Enacted $

FY 2020 

President’s 

Budget #

FY 2020 

President’s 

Budget $

Grants: -- -- -- -- -- --

Formula 57 4,000 57 4,000 57 3,100 

New Discretionary 24 5,297 -- 300 -- --

Continuations -- -- 24 5,091 24 4,791 

Contracts 4 1,077 4 1,081 3 581 

Interagency Agreements -- -- -- -- -- --

Program Support /1 -- 919 -- 849 -- 849 

Total Resources -- 11,293 -- 11,321 -- 9,321 

183
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Department of Health and Human Services

ADMINISTRATION FOR COMMUNITY LIVING

FY 2020 MANDATORY DISCRETIONARY STATE/FORMULA GRANTS

CFDA NUMBER/PROGRAM NAME: TBI Protection and Advocacy State Grants (CFDA 93.873)

STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/- FY 

2019

Alabama 55,998 55,791 50,000 (5,791)

Alaska 50,000 50,000 50,000 - 

Arizona 71,962 72,179 54,825 (17,354)

Arkansas 50,000 50,000 50,000 - 

California 321,491 321,027 146,992 (174,035)

Colorado 61,226 61,396 50,831 (10,565)

Connecticut 50,000 50,000 50,000 - 

Delaware 50,000 50,000 50,000 - 

District of Columbia 50,000 50,000 50,000 - 

Florida 177,592 179,064 94,416 (84,648)

Georgia 98,053 98,296 64,499 (33,797)

Hawaii 50,000 50,000 50,000 - 

Idaho 50,000 50,000 50,000 - 

Illinois 117,287 116,451 71,224 (45,227)

Indiana 69,662 69,505 53,834 (15,671)

Iowa 50,000 50,000 50,000 - 

Kansas 50,000 50,000 50,000 - 

Kentucky 52,706 52,573 50,000 (2,573)

Louisiana 54,595 54,334 50,000 (4,334)

Maine 50,000 50,000 50,000 - 

Maryland 64,901 64,801 52,092 (12,709)

Massachusetts 71,041 70,981 54,381 (16,600)

Michigan 95,103 94,721 63,175 (31,546)

Minnesota 61,067 61,162 50,744 (10,418)

Mississippi 50,000 50,000 50,000 - 

Missouri 65,492 65,271 52,266 (13,005)

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 - 

New Jersey 87,507 87,402 60,463 (26,939)

New Mexico 50,000 50,000 50,000 - 

New York 170,897 170,379 91,199 (79,180)

North Carolina 96,790 97,102 64,057 (33,045)

North Dakota 50,000 50,000 50,000 - 

Ohio 108,121 107,702 67,983 (39,719)
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STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/- FY 

2019

Oklahoma 50,000 50,000 50,000 -

Oregon 50,054 50,190 50,000 (190)

Pennsylvania 117,153 116,478 71,234 (45,244)

Rhode Island 50,000 50,000 50,000 -

South Carolina 56,753 56,936 50,000 (6,936)

South Dakota 50,000 50,000 50,000 -

Tennessee 69,802 69,881 53,973 (15,908)

Texas 233,569 235,079 115,164 (119,915)

Utah 50,000 50,000 50,000 -

Vermont 50,000 50,000 50,000 -

Virginia 83,395 83,303 58,945 (24,358)

Washington 74,718 75,159 55,928 (19,231)

West Virginia 50,000 50,000 50,000 -

Wisconsin 63,065 62,837 51,364 (11,473)

Wyoming 50,000 50,000 50,000 -

 Subtotal 3,850,000 3,850,000 2,949,589 (900,411)

Indian Tribes 20,000 20,000 20,000 -

American Samoa 20,000 20,000 20,000 -

Guam 20,000 20,000 20,000 -

Northern Mariana Islands 20,000 20,000 20,000 -

Puerto Rico 50,000 50,000 50,000 -

Virgin Islands 20,000 20,000 20,000 -

 Subtotal 4,000,000 4,000,000 3,099,589 (900,411)

Undistributed150- - - -

Total States/Territories 4,000,000 4,000,000 3,099,589 (900,411)

150 Program Support – includes funds for grant systems and review, and program reporting systems costs.
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National Institute on Disability, Independent Living, and Rehabilitation 

Research

Program FY 2018

Final

FY 2019 

Enacted

FY 2020

President's 

Budget

FY 2020 +/-

FY 2019

National Institute on 

Disability, 

Independent Living, 

and Rehab. Research*

104,710 108,970 90,371 (18,599)

*BA is in thousands of dollars.

Original Authorizing Legislation: Title II of the Rehabilitation Act of 1973, Public Law 93-112

Most Recent Authorizing Legislation: Title II of the Rehabilitation Act of 1973, as amended in 

2014 by the Workforce Innovation and Opportunity Act (WIOA), Public Law 113-128

Current FY Authorization:....................................................................................................Expired

Expiration Date: ........................................................................................................................2019

Allocation Method: ...................................................................Discretionary Grants and Contracts

Program Description and Accomplishments:

The mission of the National Institute on Disability, Independent Living, and Rehabilitation 

Research (NIDILRR) is to generate new knowledge and promote its effective use to improve the 

abilities of people with disabilities to perform activities of their choice in the community, and to 

expand society’s capacity to provide full opportunities and accommodations for its citizens with 

disabilities. NIDILRR sponsors comprehensive and coordinated programs of research and related 

activities to maximize the full inclusion, social integration, employment, and independent living 

of individuals with disabilities of all ages.

NIDILRR conducts research through a network of individual research projects and centers of 

excellence across the nation. Research funding is awarded through competitive grants, and most 

of the funds are awarded to universities or providers of rehabilitation or related services.

As required by the Rehabilitation Act in §202(h), NIDILRR operates under a Long-Range Plan

(LRP). The current plan covers FY 2018 - FY 2023.

The primary grant mechanisms under which NIDILRR makes awards are:

• Rehabilitation Research and Training Centers (RRTCs). RRTC research improves

rehabilitation methodologies and service delivery systems, alleviates or stabilizes disabling
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conditions, and promotes maximum social and economic independence for persons with 

disabilities. RRTCs also provide training to help rehabilitation personnel deliver more 

effective rehabilitation services.

• Rehabilitation Engineering Research Centers (RERCs). RERCs focus on rehabilitation

technology, including rehabilitation engineering and assistive technology devices and

services designed to diminish barriers to independence. RERCs also train individuals,

including those with disabilities to become researchers and practitioners in the field of

rehabilitation technology.

• Model Systems. NIDILRR funds model systems networks in three rehabilitation areas:

spinal cord injury, traumatic brain injury, and burn injury. In addition to participating in

research, model systems grantees collect and contribute long-term community integration

and functional outcomes data to their respective national databases. These model systems

programs have become platforms for conducting multi-site research studies.

o Spinal Cord Injury Model Systems. The SCI program funds research and dissemination

activities to address the needs of SCI individuals, their family members, caregivers and

other stakeholders. The NIDILRR SCI model systems longitudinal dataset is the largest

of its kind in the world.

o Traumatic Brain Injury (TBI) Model Systems. TBI projects are research grants to

improve TBI rehabilitation outcomes. The NIDILRR TBI model systems are the largest

nonmilitary TBI service delivery/research entity participating in various

intergovernmental efforts to improve treatment and outcomes for returning veterans.

o Burn Model Systems (BMS). BMS projects improve treatment and outcomes for burn

injury survivors.

• Field-Initiated Projects (FIPs). Field-Initiated Projects supplement NIDILRR’s directed

research and development, capacity building and knowledge translation efforts by

addressing a wide range of topics identified by investigators.

• Disability and Rehabilitation Research Projects (DRRPs). Grantees focus on addressing

problems encountered by people with disabilities through any combination of activities

including research, training, dissemination, and technical assistance.

• ADA National Network Centers (ADA Network). The ADA Network supports, technical

assistance, information, and training designed to promote increased understanding,

awareness, and enforcement of the ADA.

• Advanced Rehabilitation Research Training (ARRT). The ARRT program funds grants to

institutions of higher education to recruit and train qualified persons with doctoral or

similar advanced degrees and prepare them to conduct independent research in areas

related to disability and rehabilitation.
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• Small Business Innovation Research (SBIR). NIDILRR awards SBIR grants to small

businesses to support the development of new rehabilitation technologies that promote

increased accessibility and independence.

• Switzer Research Fellowships. The Switzer program awards 1-year fellowships to

individuals to carry out research projects in areas of importance to the disability and

rehabilitation community.

• Other Activities. NIDILRR funding also supports other activities, including knowledge

translation; collaborative projects; development and maintenance of grantee reporting

systems; program review; and reporting, evaluation, and long-range planning.

Funding History:

Funding for NIDILRR over the past five years is as follows:

FY 2016... ...........................................$103,970,000

FY 2017 ..............................................$103,731,000

FY 2018 ...............................................$104,710,000

FY 2019 Enacted..................................$108,970,000

FY 2020 President’s Budget .................$90,371,000

Budget Request:

The FY 2020 Budget requests $90.4 million, a reduction of -$18.6 million below the FY 2019 

Enacted Level, for the National Institute on Disability, Independent Living, and Rehabilitation 

Research (NIDILRR). At this level, NIDILRR will make most continuation awards for ongoing 

multi-year grants and eliminate new FY 2020 grants for disability and rehabilitation research and 

development (R&D). 

The FY 2020 President’s Budget continues to include a new general provision that, while 

applicable to HHS as a Department, addresses an area of particular concern to NIDILRR, as well 

as to other ACL programs. Within the Department, the provision would simplify the accounting 

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

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

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

process currently used. This provision would also enable an HHS OPDIV to collaborate in the 

same way with an outside Department for the purpose of making grants or cooperative agreements. 

Currently, the lack of specific authority precludes collaboration. The new proposed language 

would provide HHS OPDIVs with the authority to transfer funds via reimbursable agreements 

from one agency to another for the purposes of making grants, allowing NIDILRR to collaborate 

on a wider scale (e.g., with the Department of Veteran’s affairs on research projects to address the 
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needs of disabled veterans). NIDILRR had such authority when it was part of the Department of 

Education. The same language has been included in both the FY 2018 and FY 2019 requests.

Outcomes and Output Table:

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2019

Target

FY 2020

Target

FY 2020 Target

+/-FY 2019

Target

R1a: By 2023, generate 

new knowledge toward 

interventions to mediate 

the impact of opioid 

misuse by individuals 

with disabilities. 

(Outcome)

FY 2018: Result Expected 

Jan 1, 2019

Target: In FY 2018, 

NIDILRR made a research 

grant to develop knowledge 

toward better assessment and 

treatment of opioid use 

disorder among people with 

disabilities.

(In Progress)

In FY 2019, this 

grantee will 

conduct a 

systematic 

literature review 

on assessment of 

opioid use 

disorder, and 

disseminate 

early products 

from these 

efforts. The 

grantee will also 

recruit and 

collect data from 

research 

participants.

In FY 2020, this 

grantee will 

continue data 

collection, and 

disseminate 

early results.

N/A

R1b: By 2023, generate 

new knowledge about the 

opioid treatment 

experiences and 

outcomes of people with 

disabilities to identify 

solutions to barriers to 

treatment of opioid use 

disorders. (Outcome)

FY 2018: Result Expected 

Jan 1, 2019

Target: In FY 2018, 

NIDILRR made two research 

grants that have a primary 

aim of generating new 

knowledge about opioid 

treatment experiences and 

outcomes of people with 

disabilities, and barriers to 

treatment of those opioid use 

disorders.

(In Progress)

In FY 2019, 

these grantees 

will conduct 

systematic 

literature 

reviews on 

opioid use 

disorder among 

people with 

disabilities, and 

disseminate 

early products

In FY 2020, 

these grantees 

will continue to 

collect and 

analyze data on 

this topic, and 

disseminate 

early results and 

informational 

products for 

stakeholders.

N/A

R2: By 2023, assess the 

efficacy of an 

intervention to improve 

employment outcomes 

for individuals with 

serious mental illness. 

(Outcome)

FY 2018: Result Expected 

Jan 1, 2019

Target: In FY 2018, 

NIDILRR made a research 

grant to assess the efficacy of 

a career development 

program entitled "Helping 

Youth on the Path to 

Employment" (HYPE).

(In Progress)

In FY 2019, this 

grantee will 

begin data 

collection for a 

randomized trial 

of the HYPE 

intervention.

In FY 2020, this 

grantee will 

continue data 

collection and 

disseminate 

early results and 

informational 

products to key 

stakeholders. 

N/A
DISABILITY PROGRAMS AND SERVICES

Grant Awards Tables:

National Institute on Disability, Independent Living, and Rehabilitation Research

(Dollars in Thousands)

Awards FY 2017 

Final

FY 2019 

Enacted

FY 2020 

President's 

Budget

Number of 

Awards 223 213 159

Average Award $439,971 $480,814 $527,134 

Range of 

Awards

$70,000-

$1,246,000

$70,000-

$1,246,000

$145,000-

$1,246,000

Resource and Program Data:

National Institute on Disability, Independent Living, and Rehabilitation Research

(Dollars in Thousands)

Mechanism

FY 2018 

Final #

FY 2018 

Final $

FY 2019 

Enacted #

FY 2019 

Enacted $

FY 2020 

President’s 

Budget #

FY 2020 

President’s 

Budget $

Grants: -- -- -- -- -- --

Formula -- -- -- -- -- --

New Discretionary 66 25,553 56 23,335 -- --

Continuations 157 72,560 157 79,079 159 83,814 

Contracts 18 6,094 9 5,905 9 5,905 

Interagency Agreements 1 88 2 40 2 40 

Program Support151-- 415 -- 612 -- 612 

Total Resources -- 104,710 -- 108,970 -- 90,371 

151 Program Support -- Includes funds for overhead, grant systems and review costs, and information technology 

support costs.

190
CONSUMER INFORMATION, ACCESS, AND OUTREACH

191

Consumer Information, Access, and Outreach

Summary of Request

Older Americans and Americans with disabilities need an array of services and supports to assist 

them to remain active and independent in their communities. The complexity of navigating 

programs and selecting services that best suit the needs of each individual can create challenges, 

especially for consumers who have not previously used services. Consumer Information, Access 

and Outreach (CIAO) programs provide consumers with the information they need to make 

informed decisions about their independence and connect them with the appropriate services. By 

providing community-level entry points into long-term services and supports, these programs 

provide access to low-cost home and community-based services that can enable people to remain 

in their homes.

The FY 2020 request for CIAO programs is $116.6 million, a decrease of -$21.1 million below

the FY 2019 Enacted Level. This request would provide:

• $6.1 million for Aging and Disability Resource Centers, a reduction of -$2.0 million below

the FY 2019 Enacted Level. ADRCs support state efforts to develop more efficient, costeffective, and consumer-responsive systems of information and integrated access by

creating “one-stop shop” entry points into long-term care at the community-level. The

request is consistent with the FY 2019 President’s Budget request.

• $36.1 million in discretionary appropriations for the State Health Insurance Assistance

Program (SHIP) program, a reduction of -$13.0 million below the FY 2019 Enacted Level.

Separately, the Budget also proposes to extend $13M in targeted mandatory funding under

the MIPPA program which goes to SHIPS, to provide additional outreach activities to

targeted SHIP subpopulations, specifically low-income seniors and seniors living in rural

areas. SHIP counselors help Medicare beneficiaries to fully understand the Medicare

choices available to them so that the beneficiaries can make informed enrollment and

benefit decisions that ultimately reduce costs to both the beneficiary and Medicare. With

the continued influx of Medicare advantage plans and the inherent complexity of health

insurance decisions, the SHIP program is the only program that provides needed

information and assistance to older adults and people with disabilities who struggle to find

the plan that fits their financial and medical needs. The proposed reduction would result in

a proportional cut in the size of grants.

• $4.9 million for the Voting Access for People with Disabilities Program grants, a reduction

of -$2.0 million below the FY 2019 Enacted Level. These 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. The request is consistent with the FY 2019 President’s

Budget request.

• $31.9 million for Assistive Technology (AT), a reduction of -$4.1 million below the

FY 2019 Enacted level. The reduction eliminates the Alternative Financing Grant
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192

Competition (-$2.0 million), as the AT State Grant Program already includes financing 

activities while giving states the flexibility to decide their own priorities. An 

additional -$2.1 million reduction brings the AT request in line with the FY 2019 

President’s Budget. AT 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.

• $37.5 million in mandatory funding for the Medicare Patients and Providers Act (MIPPA)

programs. This proposal extends the 2019 Enacted current funding levels through FY 2021.

This funding provides grants to states to fund additional outreach activities to the Medicaid

Advantage and Low-Income Subsidy populations. The low income subsidies prevent or

delay institutionalization because many of the low income seniors are forced to skip

prescribed medications and proper nutrition to make Medicare premium payments and

other obligations.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

193

Aging and Disability Resource Centers

Program FY 2018

Final

FY 2019 

Enacted

FY 2020

President's 

Budget

FY 2020 +/-

FY 2019

Aging and Disability 

Resource Centers* 8,099 8,119 6,119 (2,000)

*BA is in thousands of dollars.

Original Authorizing Legislation: Sections 202(b) and 411 of the Older Americans Act of 1965, 

Public Law 89-73.

Most Recent Authorizing Legislation: Older Americans Reauthorization Act of 2016, Public Law 

114-144

Current FY Authorization.....................................................................................................Expired

Authorization Expiration Date...................................................................................................2019

Allocation Method ...............................Competitive Grants/Cooperative Agreement 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”152 (NWD) and “Single Points 

of Entry” programs, where people of all ages may turn for objective information and one-on-one 

assistance on their long-term services and support options. Since 2003, the Administration for 

Community Living, along with the Centers for Medicare & Medicaid Services (CMS), have 

entered into cooperative agreements with states to develop the foundational infrastructure for 

delivering one-on-one person-centered counseling and streamlined access to public programs that 

make it easier for individuals to learn about and access their health and long-term services and 

support options. Starting in 2008, the Veterans Health Administration (VHA) also began 

participating as a key partner in this effort. ACL, CMS, and the VHA are now working with 

thirteen ADRC/NWD-System states to build on and promote the nationwide use of lessons learned 

and best practices from prior ADRC investments.

152 In a “No Wrong Door” entry system, multiple agencies retain responsibility for their respective services while 

coordinating with each other to integrate access to those services through a single, standardized entry process that 

is administered and overseen by a coordinating entity (Allison Armor-Garb, Point of Entry Systems for Long-Term 

Care: State Case Studies, prepared for the New York City Department of Aging, 2004).
CONSUMER INFORMATION, ACCESS, AND OUTREACH

194

ADRC/NWD systems help states make better use of taxpayer dollars by streamlining access to 

community services and supports (both publicly and privately funded) and diverting individuals 

from more costly forms of care, including institutional care and unnecessary hospital 

re-admissions. These systems are a key component in transforming states’ long-term services and 

support programs. Services for all populations and all payers provided by ADRC/NWD systems

include:

• Targeted discharge planning, care transition and nursing home diversion support that integrates

the medical and social service systems on behalf of older adults and individuals with

disabilities to help them remain in their own homes and communities after a hospitalization,

rehabilitation, or skilled nursing facility visit;

• “One-on-one” person-centered counseling to help consumers, families, and caregivers fully

understand the options, including private pay options, that are available to them;

• Streamlined access to publicly-supported long-term services and support programs for

individuals who appear to be eligible for such programs;

• Outreach and assistance to Medicare beneficiaries on their Medicare benefits including

prevention benefits and low-income subsidies provided as a result of receiving funding under

the Medicare Improvements to Patients and Providers Act; and,

• Integrated options counseling and access points to care transition and diversion support for

Veterans served through the ACL/Department of Veterans Affairs (VA) Veteran-Directed

Home and Community-Based Services program partnership.

ACL, CMS and VHA have invested over $200 million in the Aging and Disability Resource 

Center/No Wrong Door System initiative since 2003. Recent accomplishments include:

• The Veterans Health Administration is using the ADRC\NWD System to deliver Veteran

Directed Home and Community Based Services (VD-HCBS) to help Veterans with disabilities

to continue living in the community and to have control over the LTSS they receive. The

Veteran Directed Care program is available in 35 states, the District of Columbia and Puerto

Rico and is serving more than 2,000 Veterans through 65 VA Medical Centers each day.

• In 2016, ACL funded 8 states (CT, MA, MD, NH, OR, VT, WA, and WI) to coordinate their

ADRC/No Wrong Door (NWD) System with their statewide Assistive Technology (AT)

Program. Coordination activities included cross training, assistive technology “toolkits” for

ADRC staff, and increased collaboration with the Durable Medical Equipment (DME) state

workgroups to coordinate related efforts on reuse models for AT and DME. As a result of this

coordination, access to assistive technology for people seeking long term services and supports

has increased.

• In FY 2017, the St. Louis Veteran Directed Care Program became the first Veteran Directed

Care Program to exceed a program census of 150 Veterans. The St. Louis program has been a
CONSUMER INFORMATION, ACCESS, AND OUTREACH

195

model of successful partnerships and has contributed to a 24 percent decrease in inpatient days 

of care for enrolled Veterans.

• In FY 2017, the VA Sunshine Network, also known Veterans Integrated Service Network

(VISN), became the first VISN to achieve full Veteran Directed Care coverage. The VA

Sunshine Network includes seven Veterans Administration Medical Centers (VAMCs) serving

a population of more than 1.6 million Veterans in Florida, South Georgia, Puerto Rico and the

Caribbean. VA is comprised of 21 VISNs nationwide that oversee 168 VAMCs serving 8.9

million Veterans each year. Veterans and caregivers value the Veteran Directed Care program

because it gives Veterans control over their long term services and supports and enables them

to design their care to fit their life rather than designing their life to fit the care provided.

Funding History:

Funding for Aging and Disability Resource Centers over the last five years is as follows:

FY 2016 ...................................................$6,119,000

FY 2017 ...................................................$6,105,000

FY 2018 ..................................................$8,099,000

FY 2019 Enacted......................................$8,119,000

FY 2020 President’s Budget ....................$6,119,000

Budget Request:

ACL’s FY 2020 request for ADRCs is $6,119,000, a reduction of -$2,000,000 below the FY 2019 

Enacted level and the same as the level in the FY 2019 President’s Budget. This will provide 

States funding to continue their development and operation of sustainable ADRC/NWD systems 

based on the national guidelines established by ACL, CMS and VHA. Funded states will replicate 

the national guidelines to develop person-centered, conflict-free access system for long-term 

services and supports for all populations and all payers. In addition to the grants to states, funding 

would be used to support a technical assistance contract.153

Activities funded by this program to develop sustainable ADRC/NWD systems represent a 

substantial state-wide reform of access to long-term services and supports. Building on past ADRC 

activities, the transformation brought about by this funding will include:

• Progress towards guidelines established by ACL, CMS, and VHA for ADRC/NWD Systems

to report on its progress and performance,

153 Please see page 224 for a discussion of how the MIPPA program helps hard to reach low income and Rural 

Medicare beneficiaries who qualify for either the Medicare savings plan or Low Income Subsidy pay their Medicare 

premiums, in part through formula grants to ADRC grantees.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

196

• A commitment to using Medicaid administrative funding to support the ADRC/NWD system

infrastructure on an on-going basis; and

• Ensuring that local ADRC/NWD system sites:

o Include a full range of organizations that play a formal reimbursable role in carrying

out the ADRC/NWD system functions they have been designated by the state to

perform to ensure the state’s ADRC/NWD system can effectively serve all LTSS

populations;

o Use nationally certified person-centered counselors to provide one-on-one assistance

to consumers; and

o Conduct formal functional and financial assessments that are required to determine an

individual’s eligibility for the public LTSS programs that are administered by the

state, including Medicaid.

Finally, funded states’ ADRC/NWD systems, including local sites, will use the Key Elements of a 

NWD System of Access to LTSS for All Populations and Payers to continually evaluate 

performance and make improvements in ADRC/NWD systems at the state and local site level. The 

ADRC/NWD Key Elements framework has been adopted as a national benchmark in the AARP 

LTSS Scorecard to measure affordability and access state-level performance of LTSS systems that 

assist older people, adults with disabilities, and their family caregivers. 

Grant Awards Tables:

Aging and Disability Resource Centers

(Dollars in Thousands)

Awards FY 2018 

Final

FY 2019 

Enacted

FY 2020 

President's 

Budget

Number of Awards 10 10 10

Average Award $563,566 $589,011 $439,011 

Range of Awards $502,154 -

$573,675

$528,483 -

$600,000

$393,897 -

$447,202
CONSUMER INFORMATION, ACCESS, AND OUTREACH

197

Resource and Program Data:

Aging and Disability Resource Centers

(Dollars in Thousands)

Mechanism

FY 2018 

Final #

FY 2018 

Final $

FY 2019 

Enacted #

FY 2019 

Enacted $

FY 2020 

President’s 

Budget #

FY 2020 

President’s 

Budget $

Grants: -- -- -- -- -- --

Formula -- -- -- -- -- --

New Discretionary 10 5,636 -- -- 10 4,390 

Continuations -- -- 10 5,890 -- --

Contracts 5 2,264 5 2,040 5 1,540 

Interagency Agreements -- -- -- -- -- --

Program Support154-- 200 -- 189 -- 189 

Total Resources -- 8,099 -- 8,119 -- 6,119 

154 Program Support -- Includes funds for overhead, grant systems and review costs, and information technology 

support costs.
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State Health Insurance Assistance Programs

Program FY 2018

Final

FY 2019 

Enacted

FY 2020

President's 

Budget

FY 2020 +/-

FY 2019

State Health 

Insurance Assistance 

Programs*

49,115 49,115 36,115 (13,000)

FTEs* 4.1 4.4 4.4 0

* BA is in thousands of dollars.

**In addition to discretionary appropriations, the Budget also proposes to extend $13M in targeted mandatory 

funding under the MIPPA program. These additional funds also go to SHIPS, which use them to provide 

additional outreach activities to targeted SHIP subpopulations, specifically low-income seniors and seniors 

living in rural areas. 

Original Authorizing Legislation: Section 4360 of the Omnibus Budget Reconciliation Act of 1990 

(42 U.S.C. 1395b-4), P.L. 101-508

Most Recent Authorizing Legislation: Section 4360 of the Omnibus Budget Reconciliation Act of 

1990 (42 U.S.C. 1395b-4), Public Law 101-508

Current FY Authorization.....................................................................................................Expired

Authorization Expiration Date....................................................................................................N/A

Allocation Method ....................................................... Formula and Competitive Grants/Contracts

Program Description and Accomplishments:

State Health Insurance Programs (SHIPs) provide counseling and assistance to help older adults 

and people with disabilities who are Medicare and Medicaid beneficiaries (including newly 

enrolled beneficiaries) understand, select and use their Medicare benefits. Services are provided 

via telephone and through face-to-face interactive sessions, public education presentations and 

programs, and media activities. As described below, SHIPs support the Secretary’s objective of 

addressing the costs and availability of health insurance.

The SHIP program provides grants to all 50 States, the District of Columbia, Guam, Puerto Rico, 

and the U.S. Virgin Islands to fund the infrastructure, training, and outreach needed to support 

nearly 15,000 (mostly volunteer) counselors in over 1,300 community-based organizations. Nearly 

two-thirds of the 54 state SHIP programs are administered by State Units on Aging, with the 

remaining programs administered by State Departments of Insurance. At the community level, 

many SHIPs are either housed in or create local partnerships with Area Agencies on Aging. 

199
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200

Similarly, almost 50 percent of the SHIPs are co-located with the Senior Medicare Patrol program 

and work collaboratively with them to educate beneficiaries and help deter or prevent Medicare 

fraud and abuse.

The national network of the aforementioned 15,000 highly trained SHIP counselors provides local 

community-based assistance to the ever increasing number of Medicare beneficiaries. In 2017, an 

estimated 3,500,000 Medicare beneficiaries used SHIP services. In addition to the 1,750,000 hours 

of direct one-on-one services, SHIPs reached an additional 3,000,000 people in public events 

explaining Medicare and its benefits. These state grantees invested more than 500,000 hours 

leading these educational events. To provide accurate and comprehensive assistance to Medicare 

beneficiaries, the program’s counselors provided nearly 350,000 hours of training.

SHIPs assist Medicare beneficiaries in accessing, understanding, and connecting to the healthcare 

system, thus improving their customer service experience with Medicare. Accessing affordable 

health insurance can be difficult even for those with Medicare. SHIP counselors help Medicare 

beneficiaries to fully understand the Medicare choices available to them so that the beneficiaries 

can make informed enrollment and benefit decisions that ultimately reduce costs to both the 

beneficiary and Medicare. CMS as well as Medicare Advantage and Part D plans refer clients to 

SHIPs when their cases are too complicated for the 1-800 Medicare call center. The average 

session time that a SHIP counselor spends with a client is 30 minutes, more than three times the 

9.5 minute average call to the 1-800 Medicare call center. This reflects the greater complexity of 

issues handled by SHIPs in comparison to 1-800 Medicare. 

Funding History:

Funding for the State Health Insurance Assistance Program over the past five years is as follows:

FTE

FY 2016 ... ............................................ $52,115,000 6.0

FY 2017 ................................................. $47,115,000 5.0

FY 2018 ................................................ $49,115,000 4.1

FY 2019 Enacted.................................... $49,115,000 4.4

FY 2020 President’s Budget .................. $36,115,000 4.4

Budget Request:

The FY 2020 request for the State Health Insurance Assistance programs (SHIP) is $36,115,000, 

a decrease of -$13,000,000 below the FY 2019 Enacted Level. The SHIP program is the only 

program that provides needed information and assistance to older adults and people with 

disabilities who struggle to find the plan that fits their financial and medical needs. The proposed 

cut proportionately reduces grants to States and Territories but maintains ACL’s capability to 

provide supports to all States and Territories. 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

201

Grant Awards Table:

State Health Insurance Assistance Programs Grant Awards

Awards FY 2018 

Final

FY 2019 

Enacted

FY 2020 

President's 

Budget

Number of Awards 54 54 54

Average Award $830,859 $830,859 $610,943 

Range of Awards $46,351-

$4,206,661

$46,351-

$4,206,662

$34,083-

$3,093,221

Resource and Program Data:

State Health Insurance Assistance Program

(Dollars in thousands)

Mechanism

FY 2018 

Final #

FY 2018 

Final $

FY 2019 

Enacted #

FY 2019 

Enacted $

FY 2020 

President’s 

Budget #

FY 2020 

President’s 

Budget $

Grants: -- -- -- -- -- --

Formula -- -- -- -- -- --

New Discretionary 55 44,861 55 45,588 55 32,588 

Continuations 1 950 1 950 1 950 

Contracts 4 2,056 4 1,594 4 1,594 

Interagency Agreements -- -- - -- -- --

Program Support155 -- 1,248 -- 983 -- 983 

Total Resources -- 49,115 -- 49,115 -- 36,115 

155 Program Support -- Includes funds for overhead, grant systems and review costs, and information technology 

support costs.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

202

Department of Health and Human Services

(OPDIV NAME)

FY 2020 MANDATORY DISCRETIONARY STATE/FORMULA GRANTS

CFDA NUMBER/PROGRAM NAME: State Health Insurance Assistance Program (CDFA 93.324)

STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/- FY 

2019

Alabama 825,102 825,102 606,710 (218,392)

Alaska 221,095 221,095 162,574 (58,521)

Arizona 818,010 818,010 601,495 (216,515)

Arkansas 583,477 583,477 429,039 (154,438)

California 4,206,661 4,206,661 3,093,221 (1,113,440)

Colorado 585,799 585,799 430,747 (155,052)

Connecticut 525,524 525,524 386,426 (139,098)

Delaware 195,629 195,629 143,849 (51,780)

District of Columbia 148,664 148,664 109,315 (39,349)

Florida 2,689,333 2,689,333 1,977,507 (711,826)

Georgia 1,114,872 1,114,872 819,782 (295,090)

Hawaii 241,769 241,769 177,776 (63,993)

Idaho 374,190 374,190 275,148 (99,042)

Illinois 1,474,757 1,474,757 1,084,411 (390,346)

Indiana 845,091 845,091 621,408 (223,683)

Iowa 666,078 666,078 489,777 (176,301)

Kansas 506,869 506,869 372,708 (134,161)

Kentucky 817,285 817,285 600,962 (216,323)

Louisiana 641,775 641,775 471,907 (169,868)

Maine 420,260 420,260 309,024 (111,236)

Maryland 715,955 715,955 526,453 (189,502)

Massachusetts 912,344 912,344 670,860 (241,484)

Michigan 1,405,133 1,405,133 1,033,215 (371,918)

Minnesota 899,434 899,434 661,367 (238,067)

Mississippi 576,341 576,341 423,792 (152,549)

Missouri 890,566 890,566 654,847 (235,719)

Montana 538,584 538,584 396,029 (142,555)

Nebraska 401,942 401,942 295,554 (106,388)

Nevada 397,993 397,993 292,650 (105,343)

New Hampshire 275,987 275,987 202,937 (73,050)

New Jersey 1,011,600 1,011,600 743,845 (267,755)

New Mexico 417,458 417,458 306,963 (110,495)

New York 2,282,389 2,282,389 1,678,275 (604,114)

North Carolina 1,433,429 1,433,429 1,054,022 (379,407)

North Dakota 242,547 242,547 178,348 (64,199)

Ohio 1,697,711 1,697,711 1,248,352 (449,359)

Oklahoma 588,867 588,867 433,003 (155,864)

Oregon 562,214 562,214 413,404 (148,810)

Pennsylvania 1,910,575 1,910,575 1,404,875 (505,700)

Rhode Island 260,363 260,363 191,449 (68,914)

South Carolina 740,909 740,909 544,802 (196,107)

South Dakota 302,887 302,887 222,717 (80,170)

Tennessee 1,041,093 1,041,093 765,531 (275,562)

Texas 2,543,690 2,543,690 1,870,414 (673,276)

Utah 342,639 342,639 251,948 (90,691)

Vermont 232,982 232,982 171,315 (61,667)
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203

STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/- FY 

2019

Virginia 972,675 972,675 715,223 (257,452)

Washington 856,655 856,655 629,911 (226,744)

West Virginia 454,311 454,311 334,062 (120,249)

Wisconsin 881,061 881,061 647,857 (233,204)

Wyoming 280,681 280,681 206,389 (74,292)

 Subtotal 43,973,254 43,973,254 32,334,197 (11,639,057)

Guam 46,351 46,351 34,083 (12,268)

Puerto Rico 800,417 800,417 588,559 (211,858)

Virgin Islands 46,351 46,351 34,083 (12,268)

 Subtotal 44,866,373 44,866,373 32,990,921 (11,875,452)

Undistributed 156 4,248,627 4,248,627 3,124,079 (1,124,548)

Total States/Territories 49,115,000 49,115,000 36,115,000 (13,000,000)

156 Program Support – reflects the amount used from the SHIP appropriation for staff and overhead, support 

contracts, training assistance, data systems, grant systems, and grants review costs.
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205

Voting Access for Individuals with Disabilities

Program FY 2018

Final

FY 2019 

Enacted

FY 2020

President's 

Budget

FY 2020 +/-

FY 2019

Voting Access for 

People with 

Disabilities*

6,946 6,963 4,963 (2,000)

*BA is in thousands of dollars.

Original Authorizing Legislation: Section 291 of the Help America Vote Act of 2002, Public Law 

107-252

Most Recent Authorizing Legislation: Section 291 of the Help America Vote Act of 2002, Public 

Law 107-252

Current FY Authorization.....................................................................................................Expired

Authorization Expiration Date...................................................................................................2005

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 in ensuring full participation in the electoral process for individuals with 

disabilities. HAVA P&A programs help to ensure that individuals with disabilities are able to 

exercise their rights to register to vote, cast a vote, and access polling places. These funds provide 

services to individuals with disabilities within the state, as well as advocacy for and education 

about the electoral process and monitoring of the accessibility of the electoral process for people 

with disabilities. Additionally, competitive training and technical assistance grants assist the P&As 

in their promotion of full participation in the electoral process.

HAVA P&A grantees use these funds to promote systematic efforts to ensure that individuals with 

disabilities have the opportunity to participate in every step of the electoral process. For example, 

grantees support systems change efforts to improve information on the location of accessible 

polling places, and to adopt voting procedures that enable individuals with disabilities to vote 

privately and independently. Grantees also work to educate election officials, poll workers, and 

election volunteers on the rights of voters with disabilities and best practices. P&As provide 

assistance to state and other government entities by surveying polling places, identifying potential 

modifications to make specific polling places accessible, and developing criteria for identifying 

accessible polling places.
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206

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 over the past five years is as follows:

FY 2016 ..................................................$4,963,000

FY 2017 ...................................................$4,952,000

FY 2018 ..................................................$6,946,000

FY 2019 Enacted......................................$6,963,000

FY 2020 President’s Budget ....................$4,963,000

Budget Request:

The FY 2020 Budget request for the Voting Access for Individuals with Disabilities Program is 

$4,963,000, a reduction of -$2,000,000 below the FY 2019 Enacted level and the same as the level 

in the FY 2019 President’s Budget. HAVA funding supports activities such as training on voting 

rights, making sure polling places are accessible, assisting with the adoption of voting procedures 

that enable individuals with disabilities to vote privately and independently. Grantees successfully 

sponsored a site to staff a hotline and train law student volunteers to canvass polling places in 

Charleston, South Carolina for accessibility issues Funding for activities such as this helps to 

ensure that individuals with the full range of disabilities are not denied the right to the same 

opportunity for access and participation in the electoral process as voters with no disabilities.

Grant Awards Table:

Voting Access for Individuals with Disabilities Grant Awards

Awards FY 2018

Final

FY 2019

Enacted

FY 2020

President's 

Budget

Number of 

Awards 57 57 57

Average Award $113,329 $113,287 $80,655

Range of Awards

$49,104-

$486,322

$49,104-

$485,172 

$35,000-

$344,750
CONSUMER INFORMATION, ACCESS, AND OUTREACH

Department of Health and Human Services

ADMINISTRATION FOR COMMUNITY LIVING

FY 2020 DISCRETIONARY STATE/FORMULA GRANTS

CFDA NUMBER/PROGRAM NAME: Voting Access for Individuals with Disabilities (CFDA 93.618)

STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/- FY 

2019 

Alabama 98,209 98,209 70,000 (28,209)

Alaska 98,209 98,209 70,000 (28,209)

Arizona 98,209 98,209 70,000 (28,209)

Arkansas 98,209 98,209 70,000 (28,209)

California 486,322 485,172 344,750 (140,422)

Colorado 98,209 98,209 70,000 (28,209)

Connecticut 98,209 98,209 70,000 (28,209)

Delaware 98,209 98,209 70,000 (28,209)

District of Columbia 98,209 98,209 70,000 (28,209)

Florida 255,396 257,509 182,978 (74,531)

Georgia 127,749 127,984 90,941 (37,043)

Hawaii 98,209 98,209 70,000 (28,209)

Idaho 98,209 98,209 70,000 (28,209)

Illinois 158,616 157,100 111,630 (45,470)

Indiana 98,209 98,209 70,000 (28,209)

Iowa 98,209 98,209 70,000 (28,209)

Kansas 98,209 98,209 70,000 (28,209)

Kentucky 98,209 98,209 70,000 (28,209)

Louisiana 98,209 98,209 70,000 (28,209)

Maine 98,209 98,209 70,000 (28,209)

Maryland 98,209 98,209 70,000 (28,209)

Massachusetts 98,209 98,209 70,000 (28,209)

Michigan 123,015 122,252 86,869 (35,383)

Minnesota 98,209 98,209 70,000 (28,209)

Mississippi 98,209 98,209 70,000 (28,209)

Missouri 98,209 98,209 70,000 (28,209)

Montana 98,209 98,209 70,000 (28,209)

Nebraska 98,209 98,209 70,000 (28,209)

Nevada 98,209 98,209 70,000 (28,209)

New Hampshire 98,209 98,209 70,000 (28,209)

New Jersey 110,825 110,512 78,527 (31,985)

New Mexico 98,209 98,209 70,000 (28,209)

New York 244,651 243,581 173,081 (70,500)

North Carolina 125,722 126,070 89,581 (36,489)

North Dakota 98,209 98,209 70,000 (28,209)

Ohio 143,906 143,068 101,660 (41,408)

Oklahoma 98,209 98,209 70,000 (28,209)

Oregon 98,209 98,209 70,000 (28,209)

Pennsylvania 158,401 157,143 111,661 (45,482)

Rhode Island 98,209 98,209 70,000 (28,209)

South Carolina 98,209 98,209 70,000 (28,209)

South Dakota 98,209 98,209 70,000 (28,209)

Tennessee 98,209 98,209 70,000 (28,209)

207
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208

STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/- FY 

2019

Texas 345,227 347,339 246,808 (100,531)

Utah 98,209 98,209 70,000 (28,209)

Vermont 98,209 98,209 70,000 (28,209)

Virginia 104,225 103,940 73,856 (30,084)

Washington 98,209 98,209 70,000 (28,209)

West Virginia 98,209 98,209 70,000 (28,209)

Wisconsin 98,209 98,209 70,000 (28,209)

Wyoming 98,209 98,209 70,000 (28,209)

 Subtotal 6,214,206 6,211,821 4,422,342 (1,789,479)

American Samoa 49,104 49,104 35,000 (14,104)

Guam 49,104 49,104 35,000 (14,104)

Northern Mariana Islands - - - -

Puerto Rico 98,209 98,209 70,000 (28,209)

Virgin Islands 49,104 49,104 35,000 (14,104)

Subtotal 6,459,727 6,457,342 4,597,342 (1,860,000)

Undistributed157 503,273 505,658 365,658 1,649,479 

Total States/Territories 6,963,000 6,963,000 4,963,000 (2,000,000)

157 Program Support- includes funds for statutory technical assistance and/or minority set-asides; grant systems and 

review, and program reporting systems costs.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

209

Assistive Technology

Assistive Technology FY 2018

Final

FY 2019 

Enacted

FY 2020

President's 

Budget

FY 2020 +/-

FY 2019

Assistive Technology 34,000 34,000 31,939 (2,061)

Alternative Financing

Competitive Grants 1,911 2,000 -- (2,000)

Assistive Technology* 35,911 36,000 31,939 (4,061)

*BA is in thousands of dollars.

Original Authorizing Legislation: Technology-Related for Individuals with Disabilities Assistance 

Act of 1988, Public Law 100-407 

Most Recent Authorizing Legislation: Improving Access to Assistive Technology for Individuals 

with Disabilities Act of 2004, (including but not limited to AT Act Sections 4-6 authorized 

programs), Public Law 108-364 

Current FY Authorization.....................................................................................................Expired

Authorization Expiration Date...................................................................................................2010

Allocation Method .................................................Formula and Competitive Grants and Contracts

Program Description and Accomplishments:

Assistive Technology (AT) programs are designed to maximize the ability of individuals with 

disabilities of all ages and their family members, guardians, advocates, and authorized 

representatives to obtain AT devices and AT services. AT devices are defined as any item, piece 

of equipment, or product system, whether acquired commercially, modified, or customized, that is 

used to increase, maintain, or improve functional capabilities of individuals with disabilities. 

Examples of such devices include computer or technology aids, modified driving controls, and 

durable medical equipment such as wheelchairs or walkers. Grants support comprehensive 

statewide programs that are designed to increase the:

• Availability, funding, access, provision, and training for AT devices and services;

• Ability of individuals with disabilities of all ages to secure and maintain possession of AT

during periods of transition, such as transition between school or home and home and work;
CONSUMER INFORMATION, ACCESS, AND OUTREACH

210

• 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.

Assistive Technology (AT) State Grants

The AT State Grant program, authorized under section 4 of the AT Act, is a population-based 

formula grant program to support comprehensive statewide programs that maximize the ability of 

individuals with disabilities of all ages to access and acquire AT. States must establish consumerresponsive advisory councils with a majority membership of individuals with disabilities who use 

AT to advise on the planning, implementation, and evaluation of these statewide programs. 

Under the formula, states and territories are initially allocated a base amount equal to the amount 

of funds they received under the AT program in fiscal year 2004 (totaling $20,288,534). Any funds 

appropriated in excess of the fiscal year 2004 appropriation are initially distributed among the 

eligible entities with 50 percent of available funds distributed equally amongst them and 50 percent 

distributed according to the population of the state until each entity receives at least $410,000. If 

any appropriated funds remain after each State receives this minimum, they are further distributed 

with 20 percent divided equally amongst the states and 80 percent distributed according to their 

populations. To date, appropriated funds under this program have not been at a level to necessitate 

this second round of distribution. The estimated FY 2020 state distributions will be based on the 

July 1, 2016 estimates published in December 2016.

States must implement each of the activities required under the program, which include state-level 

activities and state leadership activities. States must spend a minimum of 60 percent (unless the 

state elects to comply with the state flexibility provision in section 4(e)(6) of the AT Act, as 

described below) of their formula grant funds on four state-level activities: state financing 

programs, device reutilization programs, device loan programs, and device demonstrations. States 

may, however, direct their funds towards these activities in varying amounts if they use other state 

or non-federal funds to support these activities at a comparable or greater level. 

States may use up to 40 percent of their AT State Grant program funding on state leadership 

activities. The state leadership activities include the provision of technical assistance and training 

to targeted individuals and entities focused on promoting the general awareness of the benefits of 

AT; skills development for persons involved in the assessment of the need for AT; the appropriate 

application of AT; and the integration of AT devices and services in plans required to be developed 

under other federal laws.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

211

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. 

State AT Programs continue to provide a set of integrated state level and state leadership 

activities/services that directly benefit individuals with disabilities, older adults, Veterans, caregivers, 

professionals, schools, vocational rehabilitation agencies, healthcare providers and agencies by 

providing unique access to, and acquisition of, assistive technology devices including durable medical 

equipment. State AT Program data continues to show increased program use and performance. In fiscal 

year 2017, the 56 State AT Program Section 4 grantees, achieved the following: 

• 80,096 individuals participated in assistive technology device demonstrations, exploring

devices to support decision-making about consumer-AT match;

• 52,374 AT devices were provided on short-term loan to individuals with disabilities, service

providers and agencies through the “try-before-you-buy” approach to AT decision-making;

• 74,205 AT devices were reused, saving consumers $29,988,784 by obtaining a gently used or

refurbished AT device rather than a new one;

• 853 financial loans totaling $7,665,522 at an average interest rate of 3.68% were made to

enable consumers to purchase needed AT;

• 5,768 AT devices at a value of $3,836,113 were provided to consumers through externally

funded programs administered by State AT Programs;

• 3,735 AT devices were acquired by consumers at a savings of $1,373,345 over full retail price

through externally funded innovative programs administered by State AT Programs that are

designed to reduce the cost of AT such as cooperative buying programs.

• 125,783 individuals participated in training events on AT products/services, AT funding,

accessible information and communication technology, AT within transition from school to

work and congregate care to community living and related AT topics.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

212

Protection and Advocacy for Assistive Technology Grants 

Formula grants to protection and advocacy (P&A) systems, authorized under section 5 of the AT 

Act, support protection and advocacy services to assist individuals with disabilities of all ages in 

the acquisition, use, or maintenance of AT services or devices. Funds are distributed on a state 

population basis, with a minimum annual grant of $50,000. Territories must receive not less than 

$30,000 annually. Also, the Act requires a minimum award of $30,000 to the P&A system serving 

the American Indian consortium. 

National Activities Grants 

Section 6 of the AT Act provides authority for the provision of technical assistance and the 

development and implementation of data collection and reporting systems—through grants, 

contracts, or cooperative agreements awarded on a competitive basis—to individuals with 

disabilities of all ages, to AT state program grantees, and to protection and advocacy systems. The 

AT Act also requires the Secretary to make an award to renovate, update, and maintain the National

Public Interest Website158.

Alternative Financing Competitive Grants for Assistive Technology

ACL awarded four new grants in FY 2018 to Massachusetts, Missouri, Oklahoma and Washington 

for the expansion of existing programs in addition to the nine grants issued in FY 2015 through 

2017. The FY 2017 awards were used to establish new financial loan programs in North Carolina 

and South Dakota and to expand an existing program in Louisiana. Both the new AFP grants 

awarded in FY 2016 to Indiana and Oregon successfully launched their loan programs and are 

processing applications for loans to purchase AT devices. The other four grantees received awards 

to expand existing programs in Georgia, Minnesota, Nebraska, and Pennsylvania. 

Funding History:

Funding for the Assistive Technology Act Programs (including but not limited to AT Act 

Sections 4-6 authorized programs) over the past five years is as follows:

FY 2016 ......................................................$32,000,000

FY 2017 .....................................................$31,926,588

FY 2018 .....................................................$33,911,000

FY 2019 Enacted.........................................$34,000,000

FY 2020 President’s Budget .......................$31,939,000

158 National Assistive Technology Act Technical Assistance and Training (AT3) Center and Center for Assistive 

Technology Act Data Assistance (CATADA).
CONSUMER INFORMATION, ACCESS, AND OUTREACH

213

Funding for the Alternative Financing Grant Competition over the past five years and budget 

year is as follows:

FY 2016 ......................................................$2,000,000

FY 2017 .....................................................$2,000,000

FY 2018 .....................................................$1,911,000

FY 2019 Enacted.........................................$2,000,000

FY 2020 President’s Budget ................................. $0

Budget Request:

ACL’s FY 2020 request for Assistive Technology programs is $31,939,000 a reduction 

of -$4,061,000 below the FY 2019 Enacted Level and the same level as the FY 2019 President’s 

Budget. This funding level eliminates the Alternative Financing Grant Competition for Assistive 

Technology. 

The request includes funding for the AT State Grant program 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 funding for the Protection and Advocacy for Assistive Technology 

(PAAT) program. At this funding level, 26 states would receive $50,000, the minimum amount 

allowed by statute to carry out this program. Territories would each receive $30,000. Funds would 

assist individuals with disabilities of all ages in the acquisition, use, or maintenance of AT services 

or devices. 

The request would continue funding for National Activities. 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 2020, 

funds would be used to provide state training and technical assistance, build out the AT Act 

informational website, and continue support for the AT Act data collection activities.

Alternative Financing Grant Competition for Assistive Technology 

No funding is requested in FY 2020. The AT State grant program already includes financing 

activities that allow States to make decisions to best meet specific needs.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

214

Outcomes and Outputs Table:

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2019

Target

FY 2020

Target

FY 2020 Target

+/-FY 2019

Target

AT1: Maintain at 90% or 

higher the number of 

device demonstrations 

and short-term device 

loans that result in 

positive decision-making 

to ensure consumerequipment match (avoid 

inappropriate device 

acquisition). (Outcome)

FY 2017: 90.98%

Target:

90%

(Target Exceeded)

90% 90% Maintain

AT2: Increase the 

percentage of recipients 

who acquire AT through 

reuse and state financing 

activities who were 

unable to afford or 

otherwise obtain the AT 

they need without the 

State AT Program. 

(Outcome)

FY 2017: 84%

Target:

85%

(Target Not Met)

85% 85% Maintain

AT3: Maintain at 95% or 

higher the percentage of 

program beneficiaries 

who are highly satisfied 

or satisfied with state 

level activity services 

they receive from the 

State AT Program with at 

least a 90% response rate. 

(Outcome)

FY 2017: 99.21%

Target:

95%

(Target Exceeded)

95% 95% Maintain

Indicator Year and Most Recent 

Result / 

FY 2019 

Projection

FY 2020

Projection

FY 2020 Projection

+/-FY 2019

Projection

Output ATi: Device 

Demonstrations Provided 

FY 2017: 49,056 50,000 50,000 Maintain

(Output)

Output ATii: Short-Term 

Device Loans Made 

FY 2017: 37,239 37,750 38,000 +250

(Output)
CONSUMER INFORMATION, ACCESS, AND OUTREACH

215

Indicator Year and Most Recent 

Result /

FY 2019 

Projection

FY 2020

Projection

FY 2020 Projection

+/-FY 2019

Projection

ATiii: Recipients of 

Reused Devices.

(Output)

FY 2017: 57,782 N/A 58,250 Maintain

ATiv: State Financing 

Device Recipients. 

(Output)

FY 2017: 7,303 7,300 7,300 Maintain

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2019

Target

FY 2020

Target

FY 2020 Target

+/-FY 2019

Target

ALZ.3 Improve dementia 

capability of long-term 

support systems to 

create dementia-friendly, 

livable communities. 

(Outcome)

FY 2018: 22%

Target:

22%

(Baseline)

28% 33% +5

Grant Awards Tables:

Assistive Technology Act - State Grants

Awards FY 2018 

Final

FY 2019 

Enacted

FY 2020 

President's 

Budget

Number of Awards 56 56 56

Average Award $502,958 $502,910 $472,542 

Range of Awards $125,628-

$1,204,903

$125,616-

$1,204,534

$125,483-

$1,086,134

Assistive Technology Act - Protection and Advocacy Grants

Awards FY 2018 

Final

FY 2019 

Enacted

FY 2020 

President's 

Budget

Number of Awards 57 57 57

Average Award $83,655 $83,619 $77,330 

Range of Awards $30,000-

$474,275

$30,000 -

$473,456

$30,000 -

$421,922
CONSUMER INFORMATION, ACCESS, AND OUTREACH

216

Assistive Technology Act – National Grant Activities 

Awards FY 2018 

Final

FY 2019 

Enacted

FY 2020 

President's 

Budget

Number of Awards 2 2 2

Average Award $447,597 $447,097 $447,097 

Range of Awards $320,194 -

$575,000

$319,694 -

$574,500

$319,694 -

$574,500

Alternative Financing Grant Competition for Assistive Technology

Awards FY 2018 

Final

FY 2019 

Enacted

FY 2020 

President's 

Budget

Number of Awards 4 3 -

Average Award $473,733 $497,850 -

Range of Awards $236,883 -

$552,683

$487,465 -

$662,103 -

Assistive Technology 

(Dollars in thousands)

Mechanism

FY 2018 

Final #

FY 2018 

Final $

FY 2019 

Enacted #

FY 2019 

Enacted $

FY 2020 

President’s 

Budget #

FY 2020 

President’s 

Budget $

Grants: -- -- -- -- -- --

Formula 112 32,934 112 32,932 112 28,871 

New Discretionary 3 1,895 4 1,991 3 2,886 

Continuations 2 895 2 894 -- --

Contracts 1 99 1 99 1 99 

Interagency Agreements -- -- -- -- -- --

Program Support -- 88 -- 84 -- 84 

Total Resources -- 35,911 -- 36,000 -- 31,939 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

217

Department of Health and Human Services

ADMINISTRATION FOR COMMUNITY LIVING

FY 2020 DISCRETIONARY STATE/FORMULA GRANTS

CFDA NUMBER/PROGRAM NAME: Assistive Technology State Grants (CFDA 84.224A)

STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/- FY 

2019

Alabama 477,105 476,749 447,815 (28,934)

Alaska 448,950 448,828 430,566 (18,262)

Arizona 648,282 648,608 614,146 (34,462)

Arkansas 496,680 496,558 472,452 (24,106)

California 1,204,903 1,204,534 1,086,134 (118,400)

Colorado 501,972 502,209 471,385 (30,824)

Connecticut 432,259 432,030 406,416 (25,614)

Delaware 433,587 433,588 414,753 (18,835)

District of Columbia 390,481 390,543 372,400 (18,143)

Florida 772,871 775,310 704,795 (70,515)

Georgia 642,828 643,234 599,962 (43,272)

Hawaii 468,891 468,716 448,679 (20,037)

Idaho 443,721 443,937 423,153 (20,784)

Illinois 655,761 654,511 605,116 (49,395)

Indiana 509,553 509,294 475,734 (33,560)

Iowa 471,159 470,964 446,492 (24,472)

Kansas 431,216 430,981 407,110 (23,871)

Kentucky 497,933 497,687 469,838 (27,849)

Louisiana 526,343 525,899 497,457 (28,442)

Maine 481,348 481,247 461,447 (19,800)

Maryland 528,533 528,356 496,383 (31,973)

Massachusetts 551,064 550,958 516,899 (34,059)

Michigan 700,077 699,504 657,438 (42,066)

Minnesota 520,237 520,358 489,612 (30,746)

Mississippi 415,910 415,541 391,487 (24,054)

Missouri 586,719 586,353 554,221 (32,132)

Montana 462,967 462,936 443,872 (19,064)

Nebraska 476,712 476,658 455,350 (21,308)

Nevada 441,065 441,450 417,359 (24,091)

New Hampshire 449,192 449,133 429,315 (19,818)

New Jersey 526,437 526,283 486,686 (39,597)

New Mexico 465,408 465,266 443,525 (21,741)

New York 770,787 770,108 702,522 (67,586)

North Carolina 594,979 595,492 552,623 (42,869)

North Dakota 389,172 389,043 370,741 (18,302)

Ohio 611,257 610,644 564,199 (46,445)

Oklahoma 458,377 458,061 431,563 (26,498)

Oregon 452,625 452,795 425,750 (27,045)

Pennsylvania 742,294 741,295 691,890 (49,405)

Rhode Island 388,450 388,361 369,274 (19,087)

South Carolina 548,740 548,993 519,673 (29,320)

South Dakota 437,966 437,907 419,310 (18,597)

Tennessee 481,125 481,234 447,548 (33,686)

Texas 982,921 985,501 896,091 (89,410)
CONSUMER INFORMATION, ACCESS, AND OUTREACH

218

STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/- FY 

2019

Utah 481,238 481,524 457,166 (24,358)

Vermont 424,720 424,623 406,661 (17,962)

Virginia 539,364 539,226 501,011 (38,215)

Washington 521,111 521,792 486,325 (35,467)

West Virginia 443,583 443,199 422,160 (21,039)

Wisconsin 500,699 500,318 469,007 (31,311)

Wyoming 380,794 380,638 362,790 (17,848)

 Subtotal 27,210,366 27,208,977 25,534,301 (1,674,676)

American Samoa 125,628 125,616 125,483 (133)

Guam 127,011 127,000 126,568 (432)

Northern Mariana Islands 125,633 125,625 125,490 (135)

Puerto Rico 450,688 449,448 424,482 (24,966)

Virgin Islands 126,295 126,282 126,005 (277)

Subtotal 28,165,621 28,162,948 26,462,329 (1,700,619)

Undistributed159 38,379 41,052 41,052 -

Total States/Territories 28,204,000 28,204,000 26,503,381 (1,700,619)

159 Program Support – includes funds for grant systems and review, and program reporting systems costs.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

219

Department of Health and Human Services

ADMINISTRATION FOR COMMUNITY LIVING

FY 2020 DISCRETIONARY STATE/FORMULA GRANTS

CFDA NUMBER/PROGRAM NAME: Assistive Technology Protection and Advocacy (CFDA 84.343)

STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/- FY 

2019

Alabama 58,766 58,376 52,022 (6,354)

Alaska 50,000 50,000 50,000 - 

Arizona 83,751 84,021 74,876 (9,145)

Arkansas 50,000 50,000 50,000 - 

California 474,275 473,456 421,922 (51,534)

Colorado 66,949 67,146 59,838 (7,308)

Connecticut 50,000 50,000 50,000 - 

Delaware 50,000 50,000 50,000 - 

District of Columbia 50,000 50,000 50,000 - 

Florida 249,070 251,291 223,939 (27,352)

Georgia 124,585 124,893 111,299 (13,594)

Hawaii 50,000 50,000 50,000 - 

Idaho 50,000 50,000 50,000 - 

Illinois 154,687 153,306 136,619 (16,687)

Indiana 80,150 79,836 71,146 (8,690)

Iowa 50,000 50,000 50,000 - 

Kansas 50,000 50,000 50,000 - 

Kentucky 53,614 53,340 50,000 (3,340)

Louisiana 56,571 56,096 50,000 (6,096)

Maine 50,000 50,000 50,000 - 

Maryland 72,700 72,476 64,587 (7,889)

Massachusetts 82,310 82,147 73,206 (8,941)

Michigan 119,968 119,300 106,315 (12,985)

Minnesota 66,700 66,781 59,512 (7,269)

Mississippi 50,000 50,000 50,000 - 

Missouri 73,625 73,210 65,242 (7,968)

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 - 

New Jersey 108,080 107,844 96,106 (11,738)

New Mexico 50,000 50,000 50,000 - 

New York 238,591 237,699 211,827 (25,872)

North Carolina 122,608 123,026 109,635 (13,391)

North Dakota 50,000 50,000 50,000 - 

Ohio 140,342 139,613 124,417 (15,196)

Oklahoma 50,000 50,000 50,000 -

Oregon 50,000 50,000 50,000 -

Pennsylvania 154,478 153,348 136,657 (16,691)

Rhode Island 50,000 50,000 50,000 -

South Carolina 59,948 60,168 53,619 (6,549)

South Dakota 50,000 50,000 50,000 -

Tennessee 80,369 80,425 71,671 (8,754)

Texas 336,677 338,951 302,058 (36,893)

Utah 50,000 50,000 50,000 -
CONSUMER INFORMATION, ACCESS, AND OUTREACH

220

STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/- FY 

2019

Vermont 50,000 50,000 50,000 -

Virginia 101,644 101,430 90,390 (11,040)

Washington 88,064 88,685 79,032 (9,653)

West Virginia 50,000 50,000 50,000 -

Wisconsin 69,827 69,402 61,848 (7,554)

Wyoming 50,000 50,000 50,000 -

 Subtotal 4,568,349 4,566,266 4,207,783 (358,483)

Native American Organizations160 30,000 30,000 30,000 -

American Samoa 30,000 30,000 30,000 -

Guam 30,000 30,000 30,000 -

Northern Mariana Islands 30,000 30,000 30,000 -

Puerto Rico 50,000 50,000 50,000 -

Virgin Islands 30,000 30,000 30,000 -

Subtotal 4,768,349 4,766,266 4,407,783 (358,483)

Undistributed161 31,651 33,734 33,734 -

Total States/Territories 4,800,000 4,800,000 4,441,517 (358,483)

160 The Tribal Organizations line reflects the funds provided to Native Americans in New Mexico.

161 Program Support – includes funds for grant systems and review, and program reporting systems costs.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

221

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CONSUMER INFORMATION, ACCESS, AND OUTREACH

222

Medicare Improvements for Patients and Providers Act Programs (MIPPA)

Medicare 

Improvements for 

Patients and 

Providers Act

FY 2018

Final

FY 2019 

Enacted

FY 2020

President's 

Budget

FY 2020 +/-

FY 2019

Aging and Disability 

Resource Centers 5,000 5,000 5,000 -

Area Agencies on 

Aging 7,500 7,500 7,500 -

National Center for 

Benefits Outreach 

and Enrollment

12,000 12,000 12,000 -

State Health 

Insurance Assistance 

Program

13,000 13,000 13,000 -

Total* 37,500 37,500 37,500 -

FTE* 4 3.9 3.9 0

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

Original Authorizing Legislation: Medicare Improvements for Patients and Providers Act of 2008, 

Section 119, Public Law 110-275

Most Recent Authorizing Legislation: Consolidated Appropriations Act of 2018, Public Law 115-

141 

Current FY Authorization.....................................................................................................Expired

Authorization Expiration Date...................................................................................................2019

Allocation Method ............................................Competitive Grants/Formula Grants and Contracts

Program Description and Accomplishments:

The Medicare Improvements for Patients and Providers Act (MIPPA) programs provide funding 

to key segments of ACL’s network of community-based service providers – including Area 

Agencies on Aging (AAA), Aging Disability Resource Centers (ADRCs), and State Health 

Insurance Assistance Programs (SHIPs) – to undertake additional activities above and beyond their 

basic information and referral functions focused on in-person enrollment assistance to hard to 

reach low-income and rural Medicare beneficiaries who qualify for either Medicare Savings Plans 

(MSP) or a Low Income Subsidy (LIS). MIPPA funds also support the National Center for 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

223

Benefits Outreach and Enrollment. For beneficiaries who qualify, MSPs pay their Medicare Part 

A or/and Part B premiums and co-insurance costs and the LIS subsidizes their Medicare 

prescription drug costs, including premiums, deductibles and drug co-pays. Beneficiaries are 

eligible for these programs if they have minimal assets and incomes below 150 percent of the 

Federal Poverty Level.

Grants provide support for beneficiary education and enrollment assistance so that Medicare 

beneficiaries can access MSP and LIS programs that they qualify for but are not yet enrolled in. 

MIPPA funding is not used to support the day-day services of AAAs, ADRCs and SHIPs. Instead, 

it supports additional counseling that goes beyond the assistance what would normally be 

provided, both to identify older Americans and those with disabilities in need, and to provide much 

more intensive counseling to these specific populations. In FY 2016, MIPPA State Grantees 

conducted over 22,000 public and media events, served over 2.5 million people, and completed 

over 164,000 total applications for LIS and MSP benefits combined.

The National Center for Benefits Outreach and Enrollment (NCBOE) coordinates efforts to inform 

older adults and beneficiaries with disabilities about the benefits available under Federal and state 

programs, with an emphasis on providing information on the LIS and MSP which help Medicare 

beneficiaries pay for their Medicare coverage. The NCBOE also supports a nationwide network of 

59 local Benefit Enrollment Centers which provide low-income benefits information and 

enrollment assistance. NCBOE accomplishes its mission by providing tools, resources, and 

technology that help local, state, and regional organizations find, counsel, and assist seniors and 

younger adults with disabilities in applying for and enrolling in the benefits for which they may 

be eligible. It also works to generate and disseminate new knowledge about best practices and 

cost-effective strategies for benefits outreach and enrollment. In FY 2017, the NCBOE and 

Benefits Enrollment Centers directly assisted with over 149,000 applications for the LIS, MSP, 

and other low income benefits.

Funding History:

In each of fiscal years 2015 through 2019, MIPPA was funded through mandatory appropriations. 

Funding for MIPPA over the past five years is as follows:

FY 2016 ...................................$37,500,000

FY 2017 ....................................$34,912,500 

FY 2018 .................................... $37,500,000

FY 2019 Enacted........................$37,500,000

FY 2020 President’s Budget/2...$37,500,000

__________________

1/ Reflects a 6.9% sequester.

2/ Reflects request for mandatory funding in FY 2020.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

224

Budget Request:

The FY 2020 Budget includes a legislative proposal to extend $37,500,000 in funding for Medicare 

Improvements for Patients and Providers Act (MIPPA) programs funding in FYs 2020 and 2021, 

the same as the current funding level. Funding for these programs expires in 2019.

MIPPA remains the only national level program providing one-on-one counseling specifically 

targeting hard-to-reach beneficiaries who qualify for either the Medicare Savings Plans (MSP) or 

the Social Security Low-Income Subsidy (LIS). Continued funding is needed so that the 

beneficiaries who are eligible for these programs do not lose the in-depth assistance with enrolling 

in these programs that MIPPA funding supports. To the extent that these individuals fail to enroll, 

each beneficiary would lose not only an estimated $4,900 annually in LIS savings (per SSA 

estimates)162 and/or $437 per month in Medicare Part A Premium Savings and $135.5 per month 

in Part B Premiums through MSP, but also additional assistance with Medicare Part A and B 

copayments and deductibles and benefits from other programs to which they are also entitled.163 

Grant Awards Tables:

MIPPA – Aging Disability and Resource Centers

Awards FY 2018 

Final

FY 2019 

Enacted

FY 2020 

President's 

Budget

Number of Awards 49 49 49

Average Award $95,605 $97,579 $97,579 

Range of Awards $6,798 -

$168,519

$6,938-

$171,997

$6,938-

$171,997

MIPPA – Area Agencies on Aging164

Awards FY 2018 

Final

FY 2019 

Enacted

FY 2020 

President's 

Budget

Number of Awards 49 49 49

Average Award $137,329 $140,212 $140,212 

Range of Awards $8,368-

$551,218

$8,544-

$562,793

$8,544-

$562,793

162 Extra Help with Medicare Prescription Drug Plan Costs.

163 Medicare & You.

164 Awards to Tribes were not included in the calculation of the average award, or the range of awards. Awards to 

tribes are $1,000 per Tribe.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

225

MIPPA – National Center for Benefits Outreach and Enrollment

Awards FY 2018 

Final

FY 2019 

Enacted

FY 2020 

President's 

Budget

Number of Awards 1 1 1

Average Award $11,281,282 $11,281,282 $11,281,282 

Range of Awards $11,281,282 $11,281,282 $11,281,282 

MIPPA – State Health Insurance Assistance Programs

Awards FY 2018 

Final

FY 2019 

Enacted

FY 2020 

President's 

Budget

Number of Awards 51 51 51

Average Award $239,829 $244,666 $244,666 

Range of Awards $15,120-

$995,650

$15,425-

$1,015,730

$15,425-

$1,015,730
CONSUMER INFORMATION, ACCESS, AND OUTREACH

226

Resource and Program Data:

Medicare Improvements for Patients and Providers Act Programs

(Dollars in Thousands)

Mechanism

FY 2018 

Final #

FY 2018 

Final $

FY 2019 

Enacted #

FY 2019 

Enacted $

FY 2020 

President’s 

Budget #

FY 2020 

President’s 

Budget $

Grants: -- -- -- -- -- --

Formula 423 23,926 423 24,923 423 24,923 

New Discretionary -- -- -- -- 1 11,000 

Continuations 1 11,281 1 11,000 -- --

Contracts 2 1,069 2 558 2 558 

Interagency Agreements -- -- -- -- -- --

Program Support165 -- 1,224 -- 1,018 -- 1,018 

Total Resources -- 37,500 -- 37,500 -- 37,500 

165 Program Support -- Includes funds for overhead, grant systems and review costs, and information technology 

support costs.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

227

Department of Health and Human Services

ADMINISTRATION FOR COMMUNITY LIVING

FY 2020 DISCRETIONARY STATE/FORMULA GRANTS

CFDA NUMBER/PROGRAM NAME: MIPPA - ADRC (CFDA 93.071)

STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/-

FY 2019

Alabama 93,830 95,767 95,767 -

Alaska 8,311 8,483 8,483 -

Arizona 110,813 113,100 113,100 -

Arkansas 57,524 58,711 58,711 -

California 168,519 171,997 171,997 -

Colorado 77,148 78,740 78,740 -

Connecticut 61,049 62,309 62,309 -

Delaware 17,610 17,973 17,973 -

District of Columbia - - - -

Florida 392,453 400,553 400,553 -

Georgia 148,323 151,384 151,384 -

Hawaii 23,864 24,357 24,357 -

Idaho 27,634 28,204 28,204 -

Illinois 200,667 204,809 204,809 -

Indiana 111,788 114,095 114,095 -

Iowa 55,608 56,756 56,756 -

Kansas 47,316 48,293 48,293 -

Kentucky 83,603 85,329 85,329 -

Louisiana 77,305 78,901 78,901 -

Maine 29,750 30,364 30,364 -

Maryland 90,792 92,666 92,666 -

Massachusetts 118,468 120,913 120,913 -

Michigan 171,668 175,211 175,211 -

Minnesota 89,009 90,846 90,846 -

Mississippi 54,258 55,378 55,378 -

Missouri 6,798 6,938 6,938 -

Montana 14,026 14,315 14,315 -

Nebraska 30,523 31,153 31,153 -

Nevada 44,395 45,311 45,311 -

New Hampshire 25,984 26,520 26,520 -

New Jersey 144,930 147,921 147,921 -

New Mexico 36,409 37,160 37,160 -

New York 324,475 331,172 331,172 -

North Carolina 108,953 111,202 111,202 -

North Dakota - - - -

Ohio 209,090 213,406 213,406 -

Oklahoma 65,757 67,114 67,114 -

Oregon 73,778 75,301 75,301 -

Pennsylvania 245,311 250,374 250,374 -

Rhode Island 19,702 20,109 20,109 -

South Carolina 91,847 93,743 93,743 -

South Dakota 15,226 15,540 15,540 -

Tennessee 119,913 122,388 122,388 -

Texas 355,168 362,498 362,498 -

Utah 31,599 32,251 32,251 -
CONSUMER INFORMATION, ACCESS, AND OUTREACH

228

STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/-

FY 2019

Vermont 12,815 13,079 13,079 -

Virginia 131,518 134,233 134,233 -

Washington 116,556 118,962 118,962 -

West Virginia 40,251 41,082 41,082 -

Wisconsin 102,328 104,440 104,440 -

Wyoming - - - -

 Subtotal 4,684,662 4,781,351 4,781,351 -

Puerto Rico - - - -

Subtotal 4,684,662 4,781,351 4,781,351 -

Undistributed166 315,338 218,649 218,649

Total States/Territories 5,000,000 5,000,000 5,000,000 -

166 Program Support – reflects the amount used from the MIPPA appropriation for staff and overhead, support 

contracts, training, technical assistance, data systems, grant systems, and grants review costs.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

229

Department of Health and Human Services

ADMINISTRATION FOR COMMUNITY LIVING

FY 2020 DISCRETIONARY STATE/FORMULA GRANTS

CFDA NUMBER/PROGRAM NAME:PROGRAM/CFDA NUMBER: MIPPA - AAA (CFDA 93.071)

STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/- FY 

2019

Alabama 146,203 149,273 149,273 - 

Alaska 17,690 18,061 18,061 - 

Arizona 119,240 121,744 121,744 - 

Arkansas 135,083 137,920 137,920 - 

California 551,218 562,793 562,793 - 

Colorado 72,544 74,067 74,067 - 

Connecticut 52,483 53,585 53,585 - 

Delaware 23,730 24,228 24,228 - 

District of Columbia 8,368 8,544 8,544 - 

Florida 408,018 416,586 416,586 - 

Georgia 227,188 231,959 231,959 - 

Hawaii 38,386 39,192 39,192 - 

Idaho 52,660 53,766 53,766 - 

Illinois 229,153 233,965 233,965 - 

Indiana 159,072 162,412 162,412 - 

Iowa 98,685 100,757 100,757 - 

Kansas 69,441 70,899 70,899 - 

Kentucky 174,469 178,133 178,133 - 

Louisiana 121,948 124,509 124,509 - 

Maine 58,370 59,596 59,596 - 

Maryland 77,292 78,915 78,915 - 

Massachusetts 112,632 114,997 114,997 - 

Michigan 206,885 211,229 211,229 - 

Minnesota 121,946 124,507 124,507 - 

Mississippi 124,573 127,189 127,189 - 

Missouri 166,470 169,966 169,966 - 

Montana 39,757 40,592 40,592 - 

Nebraska 49,178 50,211 50,211 - 

Nevada 46,883 47,867 47,867 - 

New Hampshire 37,046 37,824 37,824 - 

New Jersey 109,980 112,289 112,289 - 

New Mexico 59,208 60,451 60,451 - 

New York 394,982 403,276 403,276 - 

North Carolina 287,487 293,524 293,524 - 

North Dakota - - - - 

Ohio 244,948 250,092 250,092 -

Oklahoma 105,346 107,558 107,558 -

Oregon 91,161 93,075 93,075 -

Pennsylvania 280,603 286,495 286,495 -

Rhode Island 16,795 17,148 17,148 -

South Carolina 146,323 149,396 149,396 -

South Dakota 27,669 28,250 28,250 -

Tennessee 201,269 205,495 205,495 -

Texas 447,459 456,855 456,855 -

Utah 41,985 42,867 42,867 -
CONSUMER INFORMATION, ACCESS, AND OUTREACH

230

STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/- FY 

2019

Vermont 27,739 28,322 28,322 -

Virginia 169,890 173,458 173,458 -

Washington 113,754 116,143 116,143 -

West Virginia 82,096 83,820 83,820 -

Wisconsin 133,798 136,608 136,608 -

Wyoming - - - -

 Subtotal 6,729,103 6,870,408 6,870,408 -

Puerto Rico 10,871 11,099 11,099 -

Subtotal 6,739,974 6,881,507 6,881,507 -

Undistributed167 760,026 618,493 618,493 -

Total States/Territories 7,500,000 7,500,000 7,500,000 -

167 Program Support – reflects the amount used from the MIPPA appropriation for staff and overhead, support 

contracts, training, technical assistance, data systems, grant systems, and grants review costs.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

231

Department of Health and Human Services

ADMINISTRATION FOR COMMUNITY LIVING

FY 2020 MANDATORY DISCRETIONARY STATE/FORMULA GRANTS

CFDA NUMBER/PROGRAM NAME: MIPPA - SHIP (CFDA 93.071)

STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/- FY 

2019

Alabama 263,781 269,101 269,101 - 

Alaska 31,901 32,544 32,544 - 

Arizona 215,245 219,586 219,586 - 

Arkansas 243,666 248,580 248,580 - 

California 995,650 1,015,730 1,015,730 - 

Colorado 130,905 133,545 133,545 - 

Connecticut 94,772 96,683 96,683 - 

Delaware 42,805 43,668 43,668 - 

District of Columbia 15,120 15,425 15,425 - 

Florida 736,775 751,634 751,634 - 

Georgia 409,829 418,094 418,094 - 

Hawaii 69,263 70,660 70,660 - 

Idaho 94,939 96,854 96,854 - 

Illinois 413,555 421,896 421,896 - 

Indiana 286,990 292,778 292,778 - 

Iowa 177,899 181,487 181,487 - 

Kansas 125,196 127,721 127,721 - 

Kentucky 314,607 320,952 320,952 - 

Louisiana 220,081 224,520 224,520 - 

Maine 105,212 107,334 107,334 - 

Maryland 139,546 142,360 142,360 - 

Massachusetts 203,415 207,517 207,517 - 

Michigan 373,290 380,818 380,818 - 

Minnesota 219,936 224,372 224,372 - 

Mississippi 224,624 229,154 229,154 - 

Missouri 300,271 306,327 306,327 - 

Montana 71,664 73,109 73,109 - 

Nebraska 88,656 90,444 90,444 - 

Nevada 84,637 86,344 86,344 - 

New Hampshire 66,787 68,134 68,134 - 

New Jersey 198,715 202,723 202,723 - 

New Mexico 106,796 108,950 108,950 - 

New York 713,283 727,668 727,668 - 

North Carolina 518,648 529,108 529,108 - 

North Dakota 34,858 35,561 35,561 - 

Ohio 442,041 450,956 450,956 -
CONSUMER INFORMATION, ACCESS, AND OUTREACH

232

STATE/TERRITORY

FY 2018

Final

FY 2019

Enacted

FY 2020

President's Budget

FY 2020 +/- FY 

2019

Oklahoma 189,985 193,817 193,817 - 

Oregon 164,406 167,722 167,722 - 

Pennsylvania 506,462 516,676 516,676 - 

Rhode Island 30,346 30,958 30,958 - 

South Carolina 264,018 269,343 269,343 - 

South Dakota 49,872 50,878 50,878 - 

Tennessee 363,083 370,406 370,406 - 

Texas 807,663 823,952 823,952 - 

Utah 75,732 77,259 77,259 - 

Vermont 49,994 51,002 51,002 - 

Virginia 306,490 312,671 312,671 - 

Washington 205,219 209,358 209,358 - 

West Virginia 148,031 151,016 151,016 - 

Wisconsin 241,269 246,135 246,135 - 

Wyoming 33,627 34,306 34,306 - 

 Subtotal 12,211,555 12,457,836 12,457,836 - 

Puerto Rico 19,710 20,108 20,108 - 

 Subtotal 12,231,265 12,477,944 12,477,944 - 

Undistributed168 768,735 522,056 522,056 - 

Total States/Territories 13,000,000 13,000,000 13,000,000 - 

168 Program support – reflects the amount used from the MIPPA appropriation for staff and overhead, support 

contracts, training, technical assistance, data systems, grant systems, and grants review costs.
233

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PROGRAM ADMINISTRATION

234

Program Administration

Category FY 2018 

Final

FY 2019

Enacted

FY 2020 

President’s 

Budget 

FY 2020

+/- FY 2019

Program 

Administration*

$40,961 $41,063 $38,987 -$2,076

FTE169* 169 177 168 -9

*BA is in thousands of dollars; FTE is a whole number. FTE numbers above for Program Administration only reflect

those FTE funded from the Program Administration budget line. Other sources of funding for ACL FTE include

staff charged to reimbursable and mandatory funding sources.

Authorizing Legislation: Older Americans Act (OAA) of 1965, P.L. 89-73, 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 Service Act (PHSA), 

and the Elder Justice Act (EJA).

Most Recent Authorizing Legislation: Older Americans Reauthorization Act of 2016, Public Law 

114-144, the Developmental Disabilities Assistance and Bill of Rights Act of 2000, Public Law

106-402, the Help America Vote Act of 2002, Public Law 107-252, Improving Access to Assistive

Technology for Individuals with Disabilities Act of 2004, (including but not limited to AT Act

Sections 4-6 authorized programs), Titles II and VII of the Rehabilitation Act of 1973, as amended

in 2014 by the Workforce Innovation and Opportunity Act (WIOA), Public Law 113-128, the

Public Health Service Act (PHSA), and the Elder Justice Act (Title XX-B of the Social Security

Act).

Current FY Authorization...........................................................................................................N/A

Authorization Expiration Date....................................................................................................N/A

Allocation Method .......................................................................................Direct Federal/Contract

Program Description and Accomplishments:

ACL’s mission is to assist older adults and people of all ages with disabilities to live as 

independently as possible and to fully participate in their communities. Program Administration 

funds the direction and support of ACL programs established under the Older Americans Act 

(OAA), Developmental Disabilities Assistance and Bill of Rights Act (DD Act), Rehabilitation 

Act (RA), Help America Vote Act (HAVA), Assistive Technology (AT) Act, Public Health 

169 Comparable display—does not reflect the proposed transfer of 31 NIDILRR FTE to NIH.
235

PROGRAM ADMINISTRATION

Service Act (PHSA), and the Elder Justice Act (Title XX-B of the Social Security Act). These

funds cover salaries and benefits, rent and security, and external shared services, costs that 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). 

In FY 2020, Program Administration funding will support 168 of ACL’s 189 FTE in both central 

office and in ACL’s regional offices. Other sources of funding for ACL FTE include staff 

supported by reimbursable and mandatory funding sources such as the Health Care Fraud and 

Abuse Control account, Medicare Improvements for Patients and Providers Act (MIPPA) 

activities, and money 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 various program line items. 

Funding History: 

Funding for ACL Program Administration over the past five years is as follows: 

FY 2016 $40,063,000 170.6 FTE

FY 2017 $40,063,000 170.1 FTE

FY 2018 $40,961,000 168.8 FTE

FY 2019 Enacted $41,063,000 177.0 FTE

FY 2020 President’s Budget $38,987,000 168.0 FTE

Budget Request:

ACL’s request for Program Administration is $38,987,000 a decrease of -$2,076,000 that will

require a reduction in FTE of -9 FTE below the FY 2019 Enacted Level in addition to reductions 

in operating expenses such as travel, and contracts for IT, communications, business process 

reengineering, human capital development, and funding supporting existing and emerging 

technological trends.

At the request level, ACL will maintain basic cybersecurity and technology operations. 

Specifically, at the request level, ACL will continue planning efforts to:

• Meaningfully engage in HHS-mandated cyber-hygiene activities to identify, remediate, and

prevent vulnerabilities across the entire portfolio of approximately 40 ACL developed and

operated systems and reduce the existing backlog of security issues, including issuing and

maintaining authority to operate (PMA Cap Goal 13).

• Carry out continuous diagnostics and mitigation as mandated by OMB and DHS, as well as

related directives such as BOD-18-01 that requires monitoring and securing of e-mail and other

network traffic (PMA Cap Goal 13).
PROGRAM ADMINISTRATION

236

• Fully comply with the oversight requirements of FITARA that requires the CIO to work with

the CFO and Acquisitions officials to review and approve all technology expenditures (PMA

Cap Goal 10).

• Add additional content to its website that provides data on ACL investments by state and

community that would support more proactive messaging and dissemination of information to

vulnerable populations, caption livestreamed meetings and events, transcribe speeches and

webinars, and remediate products created by grantees to ensure accessibility
NONRECURRING EXPENSES FUND

237

Nonrecurring Expenses Fund

Category FY 20182 FY 20193 FY 20204

Notification1 - $4,850 TBD

*BA is in thousands of dollars.

Authorizing Legislation:

Authorization.............Section 223 of Division G of the Consolidated Appropriations Act, 2008

Allocation Method................................................Direct Federal, Competitive Contract 

Program Description and Accomplishments

The Nonrecurring Expenses Fund (NEF) permits HHS to transfer unobligated balances of expired 

discretionary funds from FY 2008 and subsequent years into the NEF account. Congress 

authorized use of the funds for capital acquisitions necessary for the operation of the Department, 

specifically information technology (IT) and facilities infrastructure investments. Since FY 2015, 

ACL has received $11.8 million in NEF Funding. Allocations have been used to develop or update 

the agency’s website, reporting and performance systems; to develop systems that allow the 

agency to make better use of performance data; to develop tools around knowledge management; 

and to cover capital investments in FY 2015 supporting ACL’s move to the Mary E. Switzer 

Building at 330 C Street SW, and the Workforce Innovation and Opportunity Act of 2014-

mandated transfer of programs from the Department of Education. 

Budget Allocation

The requested FY 2019 NEF funding will support the following projects:

• ACL.gov: ACL will invest NEF funding to develop additional enhancements to the

ACL.gov website to improve functionality. Planned enhancements include:

o Enhance security controls for the system and implement required cybersecurity

monitoring;

o Integrate ACL.gov with information available through other HHS systems such as

Grants Solutions;

o Present information about ACL programs and funding that allow stakeholders and

the public to more clearly understand how ACL invests its program resources;

o Provide a "self-serve" option for members of the public seeking to contact ACL

for information about services. This will connect people to the information they
NONRECURRING EXPENSES FUND

238

need immediately, and reduce the manpower requirements for responding to 

inquiries; 

o Allow users to “follow” topics on the website and notify them when new content

is available; and

o Simplify the process for requesting an ACL leader to speak at an event.

The results of the projects will ultimately enhance the security of the system, improves 

integration of data and information available from other systems, improves data sharing to 

address the evolving needs of its aging and disability networks, and improves users’ 

customer experience when engaging with ACL through ACL.gov. ($0.5 million) 

• ACL Reporting: ACL developed and operates a shared service system that supports

submission, review, and analysis of State plans and performance reports. ACL Reporting

currently supports four grant programs in the Administration on Disabilities and the Center

for Integrated Programs--State Councils on Developmental Disabilities, Assistive

Technology, Independent Living and Developmental Disabilities Protection and Advocacy

– that use the system to submit nine separate grantee multi-year plans and annual program

performance reports. Enhancements and new functionality planned for FY 2019 with NEF

funds include:

o Enhance security controls for the system and implement required cybersecurity

monitoring;

o Integrate ACL Reporting with information available through other HHS systems

such as Grants Solutions; and

o Implement Application Program Interfaces allowing grantees to securely transmit

plans and performance reports from their systems to ACL Reporting and reduce

burden from repeated data entry.

ACL Reporting replaced four legacy systems that could no longer be operated, and has 

enhanced security and efficiency compared to these end-of-life software platforms. ($1.0

million)

• ACL Older Americans Act Performance System: ACL has completed initial

development of a system to replace three legacy program performance reporting systems

supporting the Older Americans Act Titles III, VI, and VII programs. As of August 2018,

the testing of the pilot system supporting submission of program performance reports for

the Long-Term Care Ombudsman program authorized under Title VII of the Older Act was

successfully completed. The project will continue with testing of the pilot system for the

Title III programs in FY 2019, and development of the Title VI Older Indians program

performance report in FY 2019 and 2020. The Title VII reports will go into production in

FY 2019; Title III reporting will enter production in FY 2020; and Title VI, in FY 2021.

($1.5 million)

• ACL Data: The ACL Data project is ACL’s highest priority system development effort.

The Aging Integrated Data (AGID) system, which this project will replace, provides public

access to Administration for Community Living (ACL) data sets. In keeping with its

mandate under the Older Americans Act (OAA), ACL makes available statistical
NONRECURRING EXPENSES FUND

239

information on the older population through a variety of media. ACL has also taken the 

initiative to make available to the public OAA program data as reported by states and other 

grantees, as well as special data sets on aging developed by the Census Bureau. Public

dissemination of data about the needs and circumstances of older persons has been a part 

of the ACL mission for many years. 

However, AGID is not configured to accept and present data from other ACL programs, 

so ACL has not been able to expand the data presented by AGID to the disability-focused 

programs that are part of the Administration on Disability, or the programs supporting 

person-centered services that are a part of the Center for Integrated Programs. ACL 

currently does not have the data dictionaries, metadata libraries, and business intelligence 

tools that allow the association of disparate data sets and the analysis of data sets to identify 

patterns indicating trends in program performance. The work funded by NEF in FY 2019 

will continue development of ACL-wide tools allowing the analysis and dissemination of 

all program and administrative data produced by ACL programs. 

ACL Data is a critical tool for business intelligence, analysis and presentation of data from 

different programs and sources – a capability established as a requirement for 

transformation by ACL as part of the President’s Management Agenda and the “Reimagine 

HHS” initiatives, particularly the Leveraging the Power of Data Strategic Shift.” ($1.0

million)

• ACL Knowledge Management: ACL is currently developing a number of tools to support

increased transparency and achieve administrative efficiencies across its program,

leadership, and administrative offices. As with other ACL projects, the ACL Knowledge

Management tools are developed in the Microsoft Azure cloud, and are designed and

developed to inherit the security controls the Azure cloud provides while adding security

and management controls required for FISMA low and moderate systems. ($0.5 million)

• HHS Accessibility and Usability Shared Service Pilot. ACL and the HHS Office of the

CIO propose to develop an Accessibility and Usability Shared Service Pilot to provide

services to support of HHS employees and customers served by HHS who need accessible

and usable systems and assistive technology tools to work effectively and fully benefit

from HHS services. The services to be provided include provisioning assistive technology

solutions for HHS employees requiring reasonable accommodation; assessing systems,

websites, and digital content to determine if they meet or exceed the WCAG 2.0 (AA)

success criteria; providing direction on how to make content, applications, and websites

accessible and usable; and addressing policy questions on how accessibility, usability, and

differing functional ability throughout the lifespan intersect with technology, employment,

and the provision of health and human services.

This project responds to the HHS CIO Council request for an HHS accessibility and 

usability shared service to supplement and possibly replace existing services provided by 

HHS Operating and Staff Divisions. This is a critical need for the Department in the face 

of a changing workforce and the audiences that ACL and HHS serves, where the number 
NONRECURRING EXPENSES FUND

240

of individuals with intellectual or developmental disabilities throughout their life span, and 

who age into disability is increasing rapidly. ($0.35 million)

___________________________

1 Pursuant to Section 223 of Division G of the Consolidated Appropriation Act, 2008, notification is required of 

planned use.

2 There was no Congressional notification for the planned uses of NEF funds in FY 2018. 

3 The FY 2019 Notification was submitted to the Committees on Appropriations in the House of Representatives 

and the Senate on December 4, 2018.

4 Amounts notified are approximations of intended use. Amounts displayed here are current best estimates.

5 HHS has not yet notified for FY 2020. 
PREVENTION AND PUBLIC HEALTH FUND

241

Prevention and Public Health Fund

Prevention and Public 

Health Fund 

FY 2018

Final

FY 2019 

Enacted

FY 2020

President's 

Budget

FY 2020 +/-

FY 2019

Chronic Disease SelfManagement Education

8,000 8,000 0 (8,000)

Elder Falls Prevention 5,000 5,000 0 (5,000)

Alzheimer’s Disease Program 14,700 14,700 0 (14,700)

*BA is in thousands of dollars.

Authorizing Legislation: Multiple

Current FY Authorization.....................................................................................................Expired

Expiration Date .................................................................................................................Undefined

Allocation Method .............................Competitive Grants/Cooperative Agreements and Contracts

Prevention and Public Health Fund Activities:

Chronic Disease Self-Management Education (CDSME) 2020 Request $0:

Chronic Disease Self-Management Education (CDSME) programs are low-cost, evidence-based 

prevention models that use state-of-the-art techniques to help those with chronic conditions 

address issues related to the management and treatment of their condition, build self-confidence, 

improve their health status, and reduce their need for more costly medical care. Funds support 

competitive grants to States, as well as related technical assistance and evaluation activities, 

including a National Resource Center. The 2020 Budget consolidates this program into the 

Preventative Health program. 

Falls Prevention Program: FY 2020 Request $0:

Falls prevention programs help participants improve strength, balance, and mobility and provide 

education on how to avoid falls and reduce fall risk factors. These programs also may involve 

medication reviews and modifications; provide referrals for medical care management for selected 

fall risk factors; and provide home hazard assessments of ways to reduce environmental hazards. 

Since September 2014, more than 50,000 older adults across the U.S. have been served via ACLsupported falls prevention/management programs, including A Matter of Balance, Stepping On, 

and Tai Chi: Moving for Better Balance. Funds support competitive grants to States, as well as 
PREVENTION AND PUBLIC HEALTH FUND

242

related technical assistance and evaluation activities, including a National Resource Center. The 

2020 Budget consolidates this program into the Preventative Health program. 

Alzheimer’s Disease Program: FY 2020 Request $0:

The Alzheimer’s Disease Program helps to fill identified gaps in existing systems that support 

caregivers and people with ADRD by dedicating resources for States and community-based 

organizations with proven capability in the provision of both services and training to targeted 

special populations. Through the Alzheimer’s Disease program, ACL issues two classes of 

competitive grants – to States who want to improve/develop their dementia systems capability, 

and to existing dementia capable community-based organizations that are prepared to address 

identified service gaps through expansion of their on-going activities. Collectively these grants 

will seek to achieve the following objectives:

• Create state-wide, person-centered, dementia-capable home and community-based

service systems;

• Translate and implement evidence-based supportive services for persons with ADRD

and their caregivers at the community level;

• Work with public and private entities to identify and address the special needs of persons

with ADRD and their caregivers; and

• Offer direct services and supports to thousands of persons with ADRD and their

caregivers.

To support this work, ACL funds a training and technical assistance resource center. The center 

works with grantees to share best practices, disseminate recent research findings, and develop issue 

briefs for States and communities.

The 2020 Budget consolidates these funds into a single Alzheimer’s Disease program in ACL. 
SUPPLEMENTARY TABLES

243

Object Classification Table - Direct

Administration for Community Living

(Dollars in Thousands)

Category FY 2018 

Final

FY 2019 

Enacted

FY 2020 

President's 

Budget

FY 2020 

+/- FY 

2019

Personnel compensation: -- -- -- -- 

Full-time permanent (11.1) 20,435 20,759 19,548 (1,211)

Other than full-time permanent (11.3) 695 706 665 (41)

Other personnel compensation (11.5) 261 265 250 (15)

Military personnel (11.7) -- -- -- -- 

Special personnel services payments (11.8) -- -- -- -- 

Subtotal personnel compensation 21,391 21,730 20,463 (1,267)

Civilian benefits (12.1) 6,652 6,757 6,363 (394)

Military benefits (12.2) -- -- -- -- 

Benefits to former personnel (13.0) -- -- -- -- 

Total Pay Costs 28,043 28,487 26,826 (1,661)

Travel and transportation of persons (21.0) 298 303 286 (18)

Transportation of things (22.0) -- -- -- -- 

Rental payments to GSA (23.1) 4,431 4,501 4,560 59 

Rental payments to Others (23.2) -- -- -- -- 

Communication, utilities, and misc. charges (23.3) 104 106 100 (6)

Printing and reproduction (24.0) 56 57 54 (3)

Other Contractual Services: -- -- -- -- 

Advisory and assistance services (25.1) 27,008 27,435 25,835 (1,600)

Other services (25.2) 117 119 112 (7)

Purchase of goods and services from -- -- -- -- 

government accounts (25.3) 9,300 9,448 8,897 (551)

Operation and maintenance of facilities (25.4) 230 233 220 (14)

Research and Development Contracts (25.5) -- -- -- -- 

Medical care (25.6) -- -- -- -- 

Operation and maintenance of equipment (25.7) 4 4 4 (0)

Subsistence and support of persons (25.8) -- -- -- -- 

Subtotal Other Contractual Services 36,659 37,239 35,068 (2,172)

Supplies and materials (26.0) 38 38 36 (2)

Equipment (31.0) 6 6 6 (0)

Land and Structures (32.0) -- -- -- -- 

Investments and Loans (33.0) -- -- -- -- 

Grants, subsidies, and contributions (41.0) 2,017,513 2,049,462 1,929,622 (119,840)

Interest and dividends (43.0) -- -- -- -- 

Refunds (44.0) -- -- -- -- 

Total Non-Pay Costs 2,059,106 2,091,713 1,969,730 (121,983)

Total Budget Authority by Object Class 2,087,149 2,120,200 1,996,556 (123,644)
SUPPLEMENTARY TABLES

244

Salaries and Expenses – Direct

Administration for Community Living

(Dollars in Thousands)

Category FY 2018 

Final

FY 2019 

Enacted

FY 2020 

President's 

Budget

FY 2020 

+/- FY 

2019

Personnel compensation: -- -- -- -- 

Full-time permanent (11.1) 20,435 20,759 19,548 (1,211)

Other than full-time permanent (11.3) 695 706 665 (41)

Other personnel compensation (11.5) 261 265 250 (15)

Military personnel (11.7) -- -- -- -- 

Special personnel services payments (11.8) -- -- -- -- 

Subtotal personnel compensation 21,391 21,730 20,463 (1,267)

Civilian benefits (12.1) 6,652 6,757 6,363 (394)

Military benefits (12.2) -- -- -- -- 

Benefits to former personnel (13.0) -- -- -- -- 

Total Pay Costs 28,043 28,487 26,826 (1,661)

Travel and transportation of persons (21.0) 298 303 286 (18)

Transportation of things (22.0) -- -- -- -- 

Rental payments to GSA (23.1) 4,431 4,501 4,560 59 

Rental payments to Others (23.2) -- -- -- -- 

Communication, utilities, and misc. charges (23.3) 104 106 100 (6)

Printing and reproduction (24.0) 56 57 54 (3)

Other Contractual Services: -- -- -- -- 

Advisory and assistance services (25.1) 27,008 27,435 25,835 (1,600)

Other services (25.2) 117 119 112 (7)

Purchase of goods and services from -- -- -- -- 

government accounts (25.3) 9,300 9,448 8,897 (551)

Operation and maintenance of facilities (25.4) 230 233 220 (14)

Research and Development Contracts (25.5) -- -- -- -- 

Medical care (25.6) -- -- -- -- 

Operation and maintenance of equipment (25.7) 4 4 4 (0)

Subsistence and support of persons (25.8) -- -- -- -- 

Subtotal Other Contractual Services 36,659 37,239 35,068 (2,172)

Supplies and materials (26.0) 38 38 36 (2)

Total Non-Pay Costs 41,586 42,245 40,102 (2,143)

Total Salary and Expense 69,629 70,732 66,928 (3,804)

Direct FTE 188.26 198.35 189.35 (9.00)
SUPPLEMENTARY TABLES

245

Detail of Full Time Equivalents (FTE)

Administration for Community Living

Category

2018 

Actual 

Civilian

2018 

Actual 

Military

2018 

Actual 

Total

2019 

Est. 

Civilian

2019 

Est. 

Military

2019 

Est. 

Total

2020 

Est. 

Civilian

2020 

Est. 

Military

2020 

Est. 

Total

Immediate Office of the 

Administrator -- -- -- -- -- -- -- -- -- 

 Direct: 18 -- 18 16 -- 16 15 -- 15

 Reimbursable: 0 -- 0 0 0 0 -- 0

 Total: 18 0 18 16 0 16 15 0 15

Administration on Aging -- -- -- -- -- -- -- -- -- 

 Direct: 26 -- 26 27 -- 27 26 -- 26

 Reimbursable: 0 -- 0 0 -- 0 0 -- 0

 Total: 26 0 26 27 0 27 26 0 26

Administration on Disabilities -- -- -- -- -- -- -- -- -- 

 Direct: 27 -- 27 27 -- 27 26 -- 26

 Reimbursable: 0 -- 0 0 -- 0 0 -- 0

 Total: 27 0 27 27 0 27 26 0 26

Center for Policy and 

Evaluation -- -- -- -- -- -- -- -- -- 

 Direct: 10 -- 10 13 -- 13 13 -- 13

 Reimbursable: 1 -- 1 0 -- 0 0 -- 0

 Total: 11 0 11 13 0 13 13 0 13

Center for Management and 

Budget -- -- -- -- -- -- -- -- -- 

 Direct: 35 -- 35 37 -- 37 35 -- 35

 Reimbursable: 1 -- 1 1 -- 1 1 -- 1

 Total: 35 0 35 38 0 38 36 0 36

Center for Integrated 

Programs -- -- -- -- -- -- -- -- -- 

 Direct: 7 -- 7 9 -- 9 8 -- 8

 Reimbursable: 13 -- 13 13 -- 13 13 -- 13

 Total: 20 0 20 22 0 22 21 0 21

Office of Regional Operations -- -- -- -- -- -- -- -- -- 

 Direct: 22 -- 22 25 -- 25 24 -- 24

 Reimbursable: 0 -- 0 0 -- 0 0 -- 0

 Total: 22 0 22 25 0 25 24 0 24

National Institute on Disability, 

Independent Living, and 

Rehabilitation Research -- -- -- -- -- -- -- -- -- 

 Direct: 29 -- 29 31 -- 31 29 -- 29

 Reimbursable: 0 -- 0 -- -- 0 0 -- 0

 Total: 29 0 29 31 0 31 29 0 29

ACL FTE Total 188.26 0.00 188.26 198.35 0.00 198.35 189.35 0.00 189.35

Average GS Grade

FY 2016: 13.6

FY 2017: 13.1

FY 2018: 13.1

FY 2019: 13.1

FY 2020: 13.0
SUPPLEMENTARY TABLES

246

Detail of Positions

Administration for Community Living

Position FY 2018

Final

FY 2019 

Enacted

FY 2020 

President's 

Budget

Executive level I 0 0 0

Executive level II 0 0 0

Executive level III 0 0 0

Executive level IV 1 1 1

Executive level V 0 0 0

Subtotal Executive Level Positions 1 1 1

Total - Exec. Level Salaries 155,500 155,500 155,500

Executive Salary 7 8 8 

Subtotal ES positions 7 8 8

 Total - ES Salary (Excludes Benefits) 1,167,147 1,385,791 1,393,090

GS-15 28 28 26

GS-14 53 53 50

GS-13 58 60 57

GS-12 27 30 29

GS-11 8 7 7

GS-10 1 1 1

GS-9 4 6 6

GS-8 0 0 0

GS-7 3 3 3

GS-6 1 1 1

GS-5 0 0 0

GS-4 0 0 0

GS-3 0 0 0

GS-2 0 0 0

GS-1 0 0 0

Subtotal 183 189 180

 Total - GS Salary $21,620,690 $22,283,418 $21,148,557 

Average ES salary $166,735 $173,224 $174,136

Average GS grade 13.1 13.1 13.0

Average GS salary $118,146 $117,902 $117,492
SUPPLEMENTARY TABLES

247

Programs Proposed for Elimination

Program

FY 2020

President’s 

Budget

Rationale 

Chronic Disease 

Self-Management 

Education170

No funding is 

requested

CDSME programs provide models for helping 

people to better self-manage their chronic 

conditions. These models can be picked up by States 

under the expanded flexibilities allowing States to 

transfer up to 100% of the funds they receive for 

HCBS, Nutrition, Preventive Health and Caregivers 

programs.

Elder Falls 

Prevention171

No funding is 

requested

Falls prevention programs which educate 

participants on how to reduce falls and fall risk 

factors, can be picked up by States as needed under 

the expanded flexibilities allowing States to transfer 

up to 100% of the funds they receive for HCBS, 

Nutrition, Preventive Health and Caregivers 

programs.

Limb Loss Resource 

Center172 3,500

Other ACL programs such as Aging Disability 

Resource Center’s (ADRC's), Centers for 

Independent Living (CIL'S), and Assistive 

Technology (AT), provide resources and services to 

people with significant disabilities. 

Paralysis Resource 

Center173 8,700

Other ACL programs such as Aging Disability 

Resource Center’s (ADRC's), Centers for 

Independent Living (CIL'S), and Assistive 

Technology (AT), provide resources and services to 

people with significant disabilities. 

170 Funding is not requested in the FY 2020 President's Budget.

171 Funding is not requested in the FY 2020 President's Budget.

172 This program was proposed for elimination in the FY 2020 President's Budget.

173 This program was proposed for elimination in the FY 2020 President's Budget.
SUPPLEMENTARY TABLES

248

FTEs Funded by P.L. 111-148 and Any Supplementals

Administration for Community Living

(Dollars in Thousands)

Program Section FY 2010 

Total

FY 

2010 

FTEs

FY 

2010 

CEs

FY 2011 

Total

FY 

2011 

FTEs

FY 

2011 

CEs

FY 2012 

Total

FY 

2012 

FTEs

FY 

2012 

CEs

Pre-existing programs funded by ACA 

(Mandatory) - - - - - - - - - -

National Clearinghouse for Long-Term 

Care Information Title VIII $ - 0 0 $3,000 0 0 $3,000 1 0

Medicare Improvements for Patients & 

Providers Act Programs Section 3306 $ - 0 0 $ - 0 0 $ - 0 0

New programs authorized and funded by 

ACA (Mandatory) - - - - - - - - - -

Aging and Disability Resource Centers Section 2405 $10,000 0 0 $10,000 3 0 $10,000 4 0

New programs funded from the PPHF 

under ACA (Discretionary) - - - - - - - - - -

Adult Protective Services (Prevention 

& Public Health Fund) Section 4002 $ - 0 0 $ - 0 0 $6,000 0 0

Chronic Disease Self-Management 

Education (PPHF) Section 4002 $ - 0 0 $ - 0 0 $10,000 0 0

Alzheimer's Disease Initiative--

Supportive Services (PPHF) Section 4002 $ - 0 0 $ - 0 0 $ - 0 0

Alzheimer's Disease Initiative--

Communications (PPHF) Section 4002 $ - 0 0 $ - 0 0 $4,000 0 0

Falls Prevention--(PPHF) Section 4002 $ - 0 0 $ - 0 0 $ - 0 0

Programs authorized by ACA but funded 

by other sources (Discretionary) - - - - - - - - - -

Elder Justice Initiative/Adult Protective 

Services 

Subtitle H, 

Sections 6701-

6703 $ - 0 0 $ - 0 0 $ - 0 0

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 Section 3306 $25,000 0 0 $ - 0 0 $ - 0 0

New programs authorized and funded by 

ACA (Mandatory) - - - - - - - - - -

Aging and Disability Resource Centers Section 2405 $9,490 4 0 $9,280 3 0 $ - 0 0

New programs funded from the PPHF 

under ACA (Discretionary) - - - - - - - - - -

Adult Protective Services (Prevention 

& Public Health Fund) Section 4002 $2,000 0 0 $ - 0 0 $ - 0 0

Chronic Disease Self-Management 

Education (PPHF) Section 4002 $7,086 1 0 $8,000 0 0 $8,000 0 0

Alzheimer's Disease Initiative--

Supportive Services (PPHF) Section 4002 $ - 0 0 $10,500 0 0 $10,500 0 0

Alzheimer's Disease Initiative--

Communications (PPHF) Section 4002 $150 0 0 $4,200 0 0 $4,200 0 0

Falls Prevention--(PPHF) Section 4002 $ - 0 0 $5,000 0 0 $5,000 0 0

Programs authorized by ACA but funded 

by other sources (Discretionary) - - - - - - - - - -

Elder Justice Initiative/Adult Protective 

Services 

Subtitle H, 

Sections 6701-

6703 $ - 0 0 $ - 0 0 $4,000 2 0
SUPPLEMENTARY TABLES

249

FTEs Funded by P.L. 111-148 and Any Supplementals - Continued

Administration for Community Living

(Dollars in Thousands)

Program Section

FY 

2016 

Total

FY 

2016 

FTEs

FY 

2016 

CEs

FY 2017 

Total

FY 

2017 

FTEs

FY 

2017 

CEs

FY 2018 

Total

FY 

2018 

FTEs

FY 

2018 

CEs

Pre-existing programs funded by ACA 

(Mandatory) - - - - - - - - - -

National Clearinghouse for Long-Term 

Care Information Title VIII $ - 0 0 $ - 0 0 $ - 0 0

Medicare Improvements for Patients & 

Providers Act Programs Section 3306 $ - 0 0 $ - 0 0 $ - 0 0

New programs authorized and funded by 

ACA (Mandatory) - - - - - - - - - -

Aging and Disability Resource Centers Section 2405 $ - 0 0 $ - 0 0 $ - 0 0

New programs funded from the PPHF 

under ACA (Discretionary) - - - - - - - - - -

Adult Protective Services (Prevention 

& Public Health Fund) Section 4002 $ - 0 0 $ - 0 0 $ - 0 0

Chronic Disease Self-Management 

Education (PPHF) Section 4002 $8,000 0 0 $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 $ - 0 0

Alzheimer's Disease Initiative--

Communications (PPHF) Section 4002 $4,200 0 0 $4,200 0 0 $ - 0 0

Alzheimer's Disease Program--(PPHF 

Allocation) Section 4002 $ - 0 0 $ - 0 0 $14,700 0 0

Falls Prevention--(PPHF) Section 4002 $5,000 0 0 $5,000 0 0 $5,000 0 0

Programs authorized by ACA but funded 

by other sources (Discretionary) - - - - - - - - - -

Elder Justice Initiative/Adult Protective 

Services 

Subtitle H, 

Sections 6701-

6703 $8,000 1 0 $10,000 2.5 0 $12,000 2.1 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 $ - 0 0 $ - 0 0

Medicare Improvements for Patients & 

Providers Act Programs Section 3306 $ - 0 0 $ - 0 0

New programs authorized and funded by 

ACA (Mandatory) - - - - - - -

Aging and Disability Resource Centers Section 2405 $ - 0 0 $ - 0 0

New programs funded from the PPHF 

under ACA (Discretionary) - - - - - - -

Adult Protective Services (Prevention 

& Public Health Fund) Section 4002 $ - 0 0 $ - 0 0

Chronic Disease Self-Management 

Education (PPHF) Section 4002 $8,000 0 0 $ - 0 0

Alzheimer's Disease Initiative--

Supportive Services (PPHF) Section 4002 $ - 0 0 $ - 0 0

Alzheimer's Disease Initiative--

Communications (PPHF) Section 4002 $ - 0 0 $ - 0 0

Alzheimer's Disease Program--(PPHF 

Allocation) Section 4002 $14,700 0 0 $ - 0 0

Falls Prevention--(PPHF) Section 4002 $5,000 0 0 $ - 0 0

Programs authorized by ACA but funded 

by other sources (Discretionary) - - - - - - -

Elder Justice Initiative/Adult Protective 

Services 

Subtitle H, 

Sections 6701-

6703 $12,000 2.6 0 $10,000 2.6 0
SIGNIFICANT ITEMS

250

Significant Items

1-Care Corps Grants.—In addition to existing aging network support activities funded under

Section 411 of the Older Americans Act, the Committee includes $5,000,000 for grants to public

agencies or private nonprofit agencies for the purpose of placing volunteers in communities to

assist family caregivers and/or assist seniors and individuals with disabilities in maintaining

independence by providing non-medical care. Such grants shall be consistent with the

requirements of the Nationwide Program for National and State Background checks on direct

patient access employees of long-term care facilities and providers, and the worker displacement

and grievance provisions in the AmeriCorps program.

Action to be Taken: The Administration for Community Living (ACL) plans to issue one 

cooperative agreement to a national organization to test a variety of state/local models of what a 

robust “CARECORPS” program could consist of. Using stakeholder feedback, this approach is 

the best means of providing us with consistent data and conducting evaluation of the mini-grants 

so that we can better report to Congress consistent information and assessment about what a fullydeveloped “CARECORPS” program should entail. ACL also reviewed the various versions of 

legislation that have been introduced by Congress as well as the specific report language provided 

with the $5,000,000 appropriation to ensure we would test a comprehensive range of 

“CARECORPS” models. As a result, we are planning to focus on an array of innovations and 

approaches to effectively provide caregiver support through differing community service models.

2- Developmental Disabilities Protection and Advocacy - The Committee strongly urges the

Department to ensure that DD Act programs properly account for the needs and desires of patients,

their families and caregivers, and the importance of affording patients the proper setting for their

care, into enforcement of the Americans with Disabilities Act.

Action to be Taken: The DD Act programs (State Councils on Developmental Disabilities, 

Protection and Advocacy Systems, and University Centers for Excellence in Developmental 

Disabilities) do not enforce the Americans with Disabilities Act, but work to ensure that 

individuals with developmental disabilities and their families participate in the design of and have 

access to needed community services, individualized supports, and other forms of assistance that 

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

of community life. 

The DD Act programs are required to consult with and get input from the public on the needs of 

individuals with developmental disabilities and their families. The DD Act programs use a variety 

of strategies to receive such input, including public forums, surveys, visits to institutions, and

training events. In addition, individuals with developmental disabilities and family members are 

required members of the State Councils that are responsible for developing the State Plan; and at 

least one of the Council members must be an individual with a developmental disability who 

resides or previously resided in an institution, or a family member or guardian of such an 

individual. University Centers are also required to have a Consumer Advisory Committee 

comprised of individuals with developmental disabilities and families that assists with the 
SIGNIFICANT ITEMS

251

development of the Center’s plan. AIDD monitors how the DD Act programs receive input as 

required under the Act and ensures technical assistance is provided where needed. AIDD will 

continue to provide such oversight and technical assistance.

3 - Independent Living - The Committee expects ACL to distribute funds as soon as possible.

Action to be Taken: ACL provided grants for Centers for Independent Living in September of 

2018 that covers the grant period September 30, 2018 through September 29th of 2019 (new grants 

for grant period September 2019 through September 2020 will be issued in the fourth quarter of 

FY 2019). State Independent Living Grants will already have been put out by the publication of 

the FY 2020 CJ. 

4 - Assistive Technology - Of this amount, the Committee provides $2,000,000 for competitive 

grants to support existing and new alternative financing programs that provide for the purchase of 

AT devices. The Committee intends for this funding to support the expansion of existing 

programs and the creation of new programs that allow greater access to affordable financing to 

help people with disabilities purchase the specialized technologies required to live independently, 

to succeed at school and work and to live active and productive lives. Programs that have 

previously received funding are eligible to compete but must report on how the prior funding has 

been used, including the number of loans extended and individuals served, funding leveraged, and 

asset development programs created. The Committee intends for applicants to incorporate 

credit-building activities into their programs, including financial education and information about 

other possible funding sources. Successful applicants must emphasize consumer choice and 

control and build programs that will provide financing for the full array of AT devices and services 

and ensure that all people, regardless of type of disability or health condition, age, level of income, 

and residence have access to the program. AT programs 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.

Action to be Taken: The Assistive Technology program at ACL has a long history of funding a 

separate grant competition for Alternative Financing programs using funds provided for this 

purpose. As in past years, the funding will be made available to state entities through the 

competitive grant process and will allow for the expansion of current programs and/or the creation 

of new programs. ACL shares the Committee’s goal of incorporating credit-building activities into 

state programs, including financial education and information about other possible funding sources 

allowing people with disabilities to continue to live in their communities. 

5 - Program Administration - The Achieving a Better Live Experience Act of 2014 or ABLE 

Act (PL 113–295) allows individuals and families to save for the purpose of supporting individuals 

with disabilities in maintaining their health, independence, and quality of life. The Committee 

strongly encourages the Administration on Community Living through its programs supporting 

individuals living with a disability to raise awareness on the eligibility and benefits of these 

accounts. The Committee requests an update on this effort in the fiscal year 2020 

Congressional Justification.
SIGNIFICANT ITEMS

252

Action to be Taken: ACL continues to disseminate information and resources in order to raise 

awareness about the Achieving a Better Life Experience Act to our grantees, stakeholders and 

training and technical assistance providers.

6 - 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.

Action to be Taken: ACL has a long and successful history of supporting and advancing 

innovative service models that support the independence of older adults and their family 

caregivers. These innovations have included the concept of aging in place and livable 

communities, the basic principles inherent in naturally occurring retirement communities. Further, 

these innovations have focused on improving access to services and supports, enhancing choice 

and control over the services received, and building dementia capability at the state and community 

levels. Beginning in 2003, ACL (then, the Administration on Aging) partnered with the Centers 

for Medicare & Medicaid Services (CMS) to launch the Aging and Disability Resource Center/No 

Wrong Door program so that individuals of any age with a disability and their family caregivers 

could more easily access needed long-term services and supports (LTSS). In 2012, ACL and CMS 

expanded their collaboration to include the Department of Veterans Affairs (VA) to create with 

the Veteran-Directed Home and Community-Based Services (VD-HCBS) program, providing 

veterans of all ages and their family caregivers improved access to, and greater choice and control 

over, the services and supports they receive. Through the newly formed Alzheimer’s Disease 

Program Initiative in the last fiscal year, ACL is making it possible for states and communities, 

respectively, to improve HCBS to become dementia-capable by improving the responsiveness to 

the needs of persons with ADRD and their families, identifying and filling gaps in services and 

supports, and improving the quality and effectiveness of programs and services. ACL will continue 

to look for opportunities to advance these age-friendly principles and other innovative service 

models in both its formula and discretionary grant programs and help states identify, prioritize and 

implement them in effective and sustainable ways.

7 - National Family Caregiver Support Program.—The Committee notes that the RAISE 

Family Caregivers Act (Public Law 115–119) signed into law this year requires HHS to establish 

a Family Caregiving Advisory Council and develop a new national strategy to support family 

caregivers, including resources, best practices, challenges, and programs to enhance the long-term 

care caregiving workforce. The Committee includes $300,000 to establish the Council, which shall 

include representatives of relevant Departments and agencies and individuals with expertise 

and experience in family caregiving and long-term care supports, including caregivers.

Action to be Taken: On October 12, 2018, ACL placed a notice in the Federal Register seeking 

nominations for non-federal members for the Family Caregiving Advisory Council established by 

the RAISE Act. The call for nominations for the non-federal members closed on 

December 3, 2018. Simultaneously, ACL is reaching out to senior leadership and career-level staff 

of multiple federal agencies to enlist their participation on the Councils. With the funding provided 
SIGNIFICANT ITEMS

253

by the Committee, ACL will proceed with convening the Council to begin carrying out the 

requirements of the RAISE Act.

8 - 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.

Action to be Taken: ACL continues to strengthen our relationship and coordination with our 

colleagues in the CDC Division of Unintentional Injury Prevention on the topic of older adult falls 

prevention and related public education activities. 

ACL funds the National Falls Prevention Resource Center, a five-year, three million dollar 

cooperative agreement to: 1) increase public awareness and educate consumers and professionals 

about the risks of falls and how to prevent falls; 2) support and stimulate the implementation, 

dissemination, and sustainability of evidence-based falls prevention programs and strategies to 

reduce the incidence of falls among older adults and adults with disabilities; and 3) serve as the 

national clearinghouse of tools, best practices, and other information on falls and falls prevention. 

This grant has been awarded to the National Council on Aging (NCOA). Accordingly, ACL 

convenes a monthly call between our team at ACL, the Resource Center team at NCOA, and our 

colleagues at CDC who oversee that agency’s efforts to educate providers and build partnerships 

within the healthcare sector. Through these meetings and other ad hoc communication, ACL, 

NCOA, and CDC work closely to align our falls prevention work. ACL, CDC, and the National 

Falls Prevention Resource Center also collaborate annually to observe Falls Prevention Awareness 

Day – working closely with national, state, and local partners across the nation to provide 

education about the impact of falls and fall prevention strategies.

The other way ACL disperses our falls prevention appropriation has been through discretionary 

grants to organizations across the U.S. implementing community-based falls prevention programs. 

These grantees include health departments, universities, tribal organizations, and communitybased nonprofits. We stay in close contact with our colleagues at CDC throughout the FOA 

publication, review, and award cycle. CDC colleagues also attend our annual grantee meeting held 

in-person in the Washington, D.C. area. And many of our grantees are implementing ACLsupported community-based programs (such as Tai Chi for Arthritis) alongside CDC-supported 

clinical programs (such as the STEADI toolkit). 

9 - Aging and Disability Resource Centers - The Committee urges ACL to improve 

coordination among ADRCs, agencies on aging, and centers for independent living to ensure that 

there is ‘‘no wrong door’’ to access services.

Action to be Taken: The Administration for Community Living agrees with the Committee’s goal 

to improve coordination between the Aging and Disability Resource Centers (ADRCs), Area 

Agencies on Aging (AAAs), and Centers for Independent Living (CILs) as well as all parts of the 

broader aging and disability networks. ACL continues to invest in breaking down the walls 

between these entities so that there is “no wrong door” for an older adult, person with disability, 
SIGNIFICANT ITEMS

254

or a caregiver to access the full services that our networks provide. ACL works with CMS and the 

Veterans Health Administration (VA) to promote, encourage, and improve coordination between 

ADRCs, AAAs and CILs. The “Key Elements of a No Wrong Door System of Access to LTSS 

for All Populations and Payers” includes measures that ensures that states have a formal multistate agency body that coordinates the State government’s work to develop a single NWD System 

for all people needing LTSS, regardless of income, age or disability. This body includes the state 

Medicaid agency, the state unit on aging, and the state agencies that serve or represent the interests 

of individuals with physical disabilities, intellectual and developmental disabilities and the state 

authorities administering mental health services. 

The “No Wrong Door System and Medicaid Administrative Claiming Reimbursement Guidance” 

published by CMS clearly states that “A NWD System builds on the strength of existing entities 

such as Aging and Disability Resource Centers, Area Agencies on Aging and Centers for 

Independent Living, by providing a single, more coordinated system of information and access for 

all persons seeking long-term services and supports. This minimizes confusion, enhances

individual choice, and supports informed decision-making. The VA Mission Act recognizes 

ADRCs, AAAs and CILs as entities that can engage in a Veteran Care Agreement. Veteran 

Directed Care (VDC) technical assistance webinars and educational sessions feature both the 

AAAs and CILs offering the program and highlight areas of coordination. We welcome the 

Committee’s continued support towards these goals.

10a – Paralysis Resource Center - House Report 115-862 – House Appropriations Committee 

Report – July 23, 2018 - The Committee recommends $7,700,000 for the Paralysis Resource 

Center, which is the same as the fiscal year 2018 enacted level and $7,700,000 above the fiscal 

year 2019 budget request. The Paralysis Resource Center offers activities and services aimed at 

increasing independent living for people with paralysis and related mobility impairments, and 

supporting integration into the physical and cultural communities in which they live.

Action to be Taken: The Administration for Community Living plans on funding the National 

Paralysis Resource Center at no less than the amount the grantee received in fiscal year 2018.

10b – Paralysis Resource Center - Senate Report 115-289 – Senate Appropriations Committee 

Report – June 28, 2018 - The Committee includes $8,700,000 for the National Paralysis Resource 

Center [PRC], an increase of $1,000,000. This program has long provided essential, 

comprehensive information, and referral services that promote independence and quality of life 

for the 5,400,000 people living with paralysis and their families. The Committee directs ACL to 

continue support for the national PRC at not less than $7,700,000. 

Action to be Taken: The Administration for Community Living plans on funding the National 

Paralysis Resource Center at no less than the amount the grantee received in fiscal year 2018.
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256

Text Description Administration for Community Living Organizational Chart

(Page 1)

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
257

• Office of Grants Management

• Office of Information Resources Management

Reporting directly to the Director of the Center for Policy and Evaluation are the following 

offices:

• Office of Policy Analysis and Development

• Office of Performance and Evaluation

Reporting directly to the Director of the National Institute on Disability, Independent Living, and 

Rehabilitation Research are the following offices:

• Office of Research Sciences

• Office of Research Evaluation and Administration