DEPARTMENT 

of HEALTH 

and HUMAN 

SERVICES

Fiscal Year 

2018 

Administration for 

Community Living

Justification of 

Estimates for 

Appropriations Committees
DEPARTMENT OF HEALTH & HUMAN SERVICES 

Administration for Community Living

Washington, DC 20201

i 

I am pleased to present the Administration for Community Living’s (ACL) FY 2018 President’s Budget 

request, totaling $1.9 billion. While maintaining funding levels for the majority of its core direct services 

programs, ACL has reprioritized spending, consolidating programs to enable greater flexibility and more 

efficient operations and proposing to eliminate or reduce funding for programs that might be addressed at 

State and local levels or through other Federal programs. 

ACL has three small programs that serve people affected by Alzheimer’s Disease and Related Dementias: 

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

and Alzheimer’s Disease Initiative--Communications. Consolidating these programs into a single program, 

Alzheimer’s Disease, funded at the same total level, will increase flexibility and efficiency and enable 

grantees to better meet the needs of people affected by these illnesses. ACL also proposes to combine three 

closely related programs: State Councils on Developmental Disabilities; the State Grants component of the 

Independent Living programs, which supports State Independent Living Councils; and the State 

Implementation Partnership Grants component of the Traumatic Brain Injury program, which supports State 

Advisory Boards on Traumatic Brain Injury. ACL proposes to create a single cross-disability program, 

Partnerships for Innovation, Inclusion and Independence (PIII), that can target resources in each State to 

support the development of systems and services that increase opportunities for independence, integration, 

productivity, inclusion, and self-determination for people with all types of significant disabilities. The 

proposed integration of these three programs will eliminate overlap and streamline operations, while saving 

$57 million. 

ACL is proposing to eliminate discretionary funding for the State Health Insurance Assistance program, 

which augments online tools and 1-800-MEDICARE by providing one-on-one help to Medicare 

beneficiaries; resource centers on limb loss and paralysis, which expand services provided by other ACL 

programs; and the Assistive Technology’s Alternative Financing Program, which duplicates provisions in 

current law. Finally, funding would be reduced for the Chronic Disease Self-Management, Developmental 

Disability Projects of National Significance, the National Institute for Disability, Independent Living and 

Rehabilitation Research and ACL Program Administration. 

ACL’s programs provide home- and community-based services and supports and invest in research and 

innovation to help older adults and people of all ages with disabilities to live independently and fully 

participate in their communities. In most cases, providing these services and supports is significantly less 

expensive than the cost of institutional care. ACL remains committed to this central mission. This budget 

will allow us to continue serving our populations and refocus to more efficiently provide services on their 

behalf. 

Dan Berger 

Acting Administrator and Acting Assistant Secretary for Aging
ii

Table of Contents 

Executive Summary 

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

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

Overview of Performance ............................................................................................................... 6

All Purpose Table ......................................................................................................................... 13

Appropriations Language .............................................................................................................. 15

Appropriations Language Analysis ............................................................................................... 17

Amounts Available for Obligation................................................................................................ 18

Summary of Changes .................................................................................................................... 19

Budget Authority by Activity ....................................................................................................... 20

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

Appropriations History Table ....................................................................................................... 24

Appropriations Not Authorized by Law ....................................................................................... 25

Health and Independence for Older Adults 

Summary of Request ..................................................................................................................... 26

Home and Community-Based Supportive Services ...................................................................... 29

Nutrition Services ......................................................................................................................... 37

Preventive Health Services ........................................................................................................... 51

Chronic Disease Self-Management Education ............................................................................. 58

Falls Prevention ............................................................................................................................ 63

Native American Nutrition and Supportive Services.................................................................... 68

Aging Network Support Activities ............................................................................................... 73

Caregiver and Family Support Services 

Summary of Request ..................................................................................................................... 80

Family Caregiver Support Services .............................................................................................. 83

Native American Caregiver Support Services .............................................................................. 91

Alzheimer’s Disease Program ....................................................................................................... 95

Alzheimer’s Disease Supportive Services Program ..................................................................... 99

Alzheimer’s Disease Initiative - Specialized Supportive Services ............................................. 103

Lifespan Respite Care ................................................................................................................. 106

Protection of Vulnerable Adults 

Summary of Request ................................................................................................................... 112

Long-Term Care Ombudsman Program ..................................................................................... 114

Prevention of Elder Abuse and Neglect ...................................................................................... 121

Health Care Fraud and Abuse Control/Senior Medicare Patrol Program ................................... 126

Elder Rights Support Activities .................................................................................................. 131
iii

Disability Programs, Research, and Services_Toc483399451

Summary of Request ................................................................................................................... 138

Partnerships for Innovation, Inclusion and Independence .......................................................... 141

State Councils on Developmental Disabilities ............................................................................ 144

Developmental Disabilities – Protection and Advocacy ............................................................ 149

University Centers for Excellence in Developmental Disabilities ............................................. 155

Developmental Disabilities – Projects of National Significance ................................................ 160

Independent Living ..................................................................................................................... 163

Limb Loss Resource Center ........................................................................................................ 170

Paralysis Resource Center ........................................................................................................... 173

Traumatic Brain Injury ............................................................................................................... 176

National Institute on Disability, Independent Living, and Rehabilitation Research .................. 183

Consumer Information, Access, and Outreach 

Summary of Request ................................................................................................................... 188

Aging and Disability Resource Centers ...................................................................................... 190

State Health Insurance Assistance Programs .............................................................................. 195

Voting Access for Individuals with Disabilities ......................................................................... 200

Assistive Technology .................................................................................................................. 205

Alzheimer’s Disease Initiative - Outreach Campaign ................................................................ 216

Medicare Improvements for Patients and Providers Act Programs (MIPPA) ............................ 218

Program Administration .......................................................................................................... 229

Supplementary Tables

Object Classification Table - Direct ........................................................................................... 231

Salaries and Expenses ................................................................................................................. 232

Detail of Full-Time Equivalent Employment (FTE) .................................................................. 233

Detail of Positions ....................................................................................................................... 234

Programs Proposed for Elimination ............................................................................................ 235

FTE Funded by the Affordable Care Act .................................................................................... 236

Physicians’ Comparability Allowance Worksheet ..................................................................... 237

Significant Items in Appropriations Committee Reports ..................................................... 238
iv
EXECUTIVE SUMMARY 

1

Introduction and Mission 

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

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

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

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

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

limitations of any type, regardless of age, have a common interest: access to home and 

community-based supports and services that can help individuals to fully participate in all 

aspects of society, including having the option to live at home, which can be vital to an 

individual’s well-being, instead of moving into an institutional setting. ACL works to improve 

this access through program lines that address the unique needs of each population.

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

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

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

 The U.S. population over age 60 is projected to increase by 16 percent between 2015 and 

2020, from 66.8 million to 77.6 million.1

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

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

living or instrumental activities of daily living.2

 Studies indicate that individuals with developmental disabilities comprise between 

1.2 and 1.65 percent of the U.S. population, or between 3.9 and 5.3 million individuals.3

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

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

admission, is projected to increase by 18 percent by the year 2020.4

 

1

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

Age, Sex, Race, and Hispanic Origin for the United States: 2014 to 2060. Released December 2014. Accessed 08 

January 2015. 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, 

2015. Released June 2016. Accessed 29 March 2017. 

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: April 1, 2010 to July 1, 2016. 
EXECUTIVE SUMMARY 

2

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

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

providing this care will fall on other, more costly, government resources. For example, a 2014 

Rand Corporation study found that the care provided by informal (family and friend) caregivers 

of elderly adults has an estimated economic value of $522 billion.5

 Maintaining funding for 

community-based services and supports, including supports for family caregivers, is therefore 

critical to delaying, reducing, or eliminating reliance upon institutional residential services, a 

more expensive and less preferable option. 

 

4

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

population. Data from the 2013 Medicare Current Beneficiary Survey. [data tables 2.5a and 2.6a]. Accessed 10

January 2016.

5

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

3

Overview of Budget Request 

The Administration for Community Living (ACL) is committed to the fundamental principle that 

all people, regardless of age or disability, should be able to live where they choose, with the 

people they choose, and fully participate in their communities. By advocating across the federal 

government for older adults, people with disabilities, and families and caregivers; funding 

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

investing in training, education, research and innovation, ACL helps makes this principle a 

reality for millions of Americans. 

The FY 2018 discretionary request for the ACL is $1,851,450,000, a decrease of -$109,666,242

below the annualized FY 2017 Continuing Resolution level. The FY 2018 Budget request 

maintains the majority of ACL’s programs at the annualized FY 2017 Continuing Resolution 

level. The Budget prioritizes funding for critical programs that help support older Americans, 

individuals with disabilities, and their caregivers and connect them with direct services across the 

United States. Consistent with the President’s priorities, the Budget request also maximizes 

Federal investments by promoting efficiencies and supporting evidence-based programs. 

Streamlining Existing Program Operations, Decreasing Overlap and Increasing Flexibility 

ACL has identified existing activities where consolidation could enable greater flexibility and 

more efficient program operations. First, ACL has three small programs that serve people 

affected by Alzheimer’s Disease and Related Dementias: Alzheimer’s Disease Supportive 

Services, Alzheimer’s Disease Initiative--Specialized Supportive Services, and Alzheimer’s 

Disease Initiative--Communications. Consolidating these programs into a single program, 

Alzheimer’s Disease Program, funded at the same total level, will increase flexibility and 

efficiency and enable grantees to better meet the needs of people affected by these illnesses. 

ACL also proposes to combine three closely related programs: State Councils on Developmental 

Disabilities; the State Grants component of the Independent Living programs, which supports 

State Independent Living Councils; and the State Implementation Partnership Grants component 

of the Traumatic Brain Injury program, which supports State Advisory Boards on Traumatic 

Brain Injury. ACL proposes to create a single cross-disability program, Partnerships for 

Innovation, Inclusion and Independence (PIII), that can target resources in each State to support 

the development of systems and services that increase opportunities for independence, 

integration, productivity, inclusion, and self-determination for people with all types of significant 

disabilities. The proposed integration of these three programs will eliminate overlap and 

streamline operations, while saving $57 million. 
EXECUTIVE SUMMARY 

4

Devolving Program Responsibilities to States/local Communities 

ACL also reviewed its programs to determine which activities could be addressed at the State 

and local levels, or where other Federal programs provide similar services. Four programs were 

identified: 

 State Health Insurance Assistance Program (SHIP): While ACL will reduce the scale of 

its one-on-one person assistance through the State Health Insurance Assistance Program, 

Medicare beneficiaries will continue to have access to online tools such as Plan Finder 

and phone assistance such as CMS’s 1-800-MEDICARE helpline. Some states also 

support SHIP programs. The FY 2018 Budget reduces funding for SHIPs by $52 million. 

Funding specifically targeted to low-income seniors and seniors living in rural areas is 

maintained at $12 million. 

 Limb Loss Resource Center and Paralysis Resource Center: The mission and activities 

carried out by these programs are duplicative of other Federal efforts. Resources for 

individuals affected by limb loss or paralysis is also available through other ACL 

programs such as Aging and Disability Resource Centers, Centers for Independent Living 

(CILs) and Assistive Technology, which provide resources to people with all types of 

significant disabilities. Savings from eliminating these redundant programs total 

$3 million and $8 million, respectively. 

 Assistive Technology – Alternative Financing Program (AFP): In FY 2005, Congress 

amended the AT Act to eliminate the separate AFP authorization and instead authorized 

an AT State grant program that is inclusive of financing activities, including alternative 

financing loan programs. However, funding has continued to be appropriated for this 

program. Since there is no separate AFP discretionary grant program authorization in the 

AT Act, ACL is not requesting such funding within the AT Act appropriations request for 

FY 2018, resulting in savings of $2 million. 

The budget also proposes targeted reductions in funding totaling approximately $15.9 million 

across four programs – Chronic Disease Self-Management, Developmental Disability Projects of 

National Significance, the National Institute for Disability, Independent Living and 

Rehabilitation Research and ACL Program Administration. Savings would be achieved by 

restructuring existing activities to achieve greater efficiencies and reducing staff. 

Conclusion 

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

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

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

5

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

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

people with disabilities and older adults so that they can live independently, fully integrated in 

their communities.
6

Overview of Performance 

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

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

achievement of that mission through improvements in the analysis and availability of 

performance information while also enhancing the rigor of program evaluations. Below, an 

overview of performance is organized around programs devoted to older adults and their 

caregivers and programs that serve the disability community along with a discussion of 

evaluation, data collection and dissemination activities; and performance management.

Overview of Performance: Aging Service Programs 

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

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

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

independence in their homes and communities (Older Americans Act, Section 301). This purpose 

led ACL to focus on three performance measures: 1) improving consumer outcomes; 

2) effectively targeting services to vulnerable populations; and 3) improving efficiency. Each 

measure is representative of activities across the Aging Services Program budget and progress 

toward achievement is tracked using a number of indicators. Taken together, the three measures 

and their corresponding performance indicators are designed to reflect ACL’s goals and 

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

Performance Highlights 

An analysis of ACL’s performance trends shows that through FY 2015 most outcome indicators 

for older adult programs have been maintained or steadily improved. While service counts are 

declining for some services due to funding and inflationary factors, outcome indicators 

demonstrate that services are continuing to be effective. Following are some key successes that 

are indicative of the potential of ACL and the Aging Network to meet demographic and fiscal 

challenges. 

Older Americans Act (OAA) programs help older Americans remain independent and in the 

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

(ADL) are at a high risk for nursing home entry. Measures of the Aging Network’s success at 

serving this population is a proxy for nursing home delay and diversion. In FY 2005, one-third of 

home-delivered nutrition clients lived with three or more ADL impairments and by FY 2015 the 

proportion grew to nearly 42 percent, a 26 percent increase. The FY 2018 performance budget 

includes nine core performance indicators supporting AoA’s commitment to improving client 

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

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

annually. 
EXECUTIVE SUMMARY 

7

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

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

FY 2015 The Aging Network served nearly 8,800 people per million dollars of OAA Title III 

funding. While missing a very ambitious target, the result is a 17% increase over baseline. Since 

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

efficiency targets in all but one year. For FY 2018, there are two efficiency indicators for AoA 

program activities, both consistently meet or exceed targets. 

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

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

services. In 2015, over 95 percent of transportation clients and over 93 percent of caregivers 

rated services good to excellent. To help ensure the continuation of these trends, AoA uses 

various mechanisms to promote innovative service delivery models for state and local program 

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

Quality indicators are consistently high and are expected to meet or exceed targets in FY 2018. 

Overview of Performance: Disability Programs 

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

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

Assistance and Bill of Rights Act (DD Act). The ACL disability programs’ performance 

measurement strategy focuses on measures that address outcomes related to the purpose of the 

DD Act: to assist people with intellectual and developmental disabilities to become independent 

and integrated into their community, protect their legal and human rights, and improve the 

quality of services and supports. The following highlights the DD Network’s accomplishments in 

these focus areas.

Developmental Disabilities Protection and Advocacy Program 

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

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

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

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

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

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

been consistently over 80 percent and trending upward since FY 2011. In FY 2015, the target 

was exceeded with nearly 87 percent of consumers having their complaint corrected. 

University Centers for Excellence in Developmental Disabilities 

UCEDDs are interdisciplinary academic centers that engage in interdisciplinary pre-service 

training, community services, research, and information dissemination activities. One of the 
EXECUTIVE SUMMARY 

8

unique contributions UCEDDs make to the intellectual and developmental disabilities 

community is the provision of interdisciplinary training to students from a wide array of 

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

developmental disabilities. Pre-service training is a mechanism through which UCEDDs advance 

practice, scholarship and policy that impact the lives of people with developmental disabilities 

and their families. UCEDDs performance in this area is measured as the percentage of 

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

which UCEDD trained professionals were involved. The result for FY 2015 exceeded the target 

at 42.2 percent. Since FY 2009 this measure has steadily increased. 

ACL is redesigning and establishing robust data collection systems for the programs transferred 

from the Department of Education (National Institute on Disability, Independent Living, and 

Rehabilitation Research; Independent Living Programs; and Assistive Technology Programs). 

Program performance is being reviewed and a set of meaningful measures being developed to 

manage performance of these activities. The integration of these programs’ performance 

management activities will add to ACL’s and the disability network’s already robust program 

and advocacy work. 

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

include: 

 Self-assessment tool developed by the Rehabilitation Research and Training Center 

(RRTC) on Employer Practices: The tool gives employers information they can use to 

promote recruitment and hiring of people with disabilities, and to improve career 

development and retention practices for their employees with disabilities. The tool has 

been used by a variety of employers. 

 Development of new knowledge about aging with disability: The RRTC on Healthy 

Aging & Physical Disability has published a series of articles about the onset and 

experience of secondary conditions among people who are aging with physical 

disabilities. These findings highlight the need for interventions to help people aging with 

disability manage their conditions and optimize their health and wellness. Plain language 

research summaries of this work are available. 

 Factsheets on living with traumatic injuries by The Model Systems Knowledge 

Translation Center (MSKTC): MSKTC has worked with NIDILRR’s Model Systems 

grantees to develop and publish a variety of factsheets about living with spinal cord 

injury, traumatic brain injury, or burn injury. These research-based factsheets address 

topics that are directly relevant to the lives of people with these traumatic injuries and are 

written in language that all users can read and understand. In a span of one year, the 
EXECUTIVE SUMMARY 

9

factsheets in all three injury areas were downloaded more than 600,000 times, and the 

MSKTC web site received over 1,000,000 unique visitors, indicating users’ high levels of 

interest and active use of information.

During FY 2015, the Independent Living Programs provided services to hundreds of thousands 

of individuals with disabilities in their respective communities that included: 

 Over 760,000 requests for information and referral services; 

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

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

 Advocacy and legal services for over 70,000 people. 

Program Evaluation and Performance Management 

Program Evaluation and Research: 

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

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

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

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

NIDILRR’s multi-year evaluation plan. Examples of these efforts include: 

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

process evaluation and the NSP cost study report are available. The interim outcome 

study is expected to be available May 2017 with the final report, which will include 

comparison of healthcare unitization among meal recipients and comparison group 

members, is expected to be completed by the Spring of 2018. 

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

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

goals. The program provides appropriate supportive services 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 able to provide a continuum of 

care for older individuals and secure the opportunity for older individuals to receive 

managed in-home and community-based long-term care services. The program is using 

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

$3.52 per congregate meal, but the evaluation research showed that if all costs are 

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

$10.69 for a congregate meal. 
EXECUTIVE SUMMARY 

10

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

The process evaluation was completed in March 2016 and the final NFCSP report is 

available. Consumer-level data collection will be conducted from 2016 through 2018 

with an outcome evaluation report to follow. 

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

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

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

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

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

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

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

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

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

among the three most important partners for administering their program. 

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

was conducted in FY 2015. The final Tribal Grant Program report is available. A multiyear program evaluation based upon the evaluability assessment began in September 

2016.

 ACL/OWH Oral Health Project: A three-year project (2014-2017) with funding support 

from the HHS Office on Women’s Health to identify and promote vetted, low-cost, 

community-based oral health services for older adults. A new website to be launched in 

May 2017 will disseminate the results of this project including a searchable oral health 

program database with nearly 200 community-based programs and a community guide to 

adult oral health program implementation. The community guide includes essential tools 

for communities interested in planning, designing and implementing a new program or 

replicating or enhancing an existing program. 

 AIDD’s Partnerships in Employment (PIE) Systems Change Grants evaluation: This sixyear evaluation was initiated in 2011 and is on-going. The purpose is to inform ACL and 

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

individuals with intellectual and developmental disabilities. Accomplishments to date 

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

legislation and the adoption or implementation policy recommendations.

 The NIDILRR evaluation: The evaluation conducted by The National Academy of 

Sciences (NAS) was released in 2012. A ten-year evaluation plan was developed based 
EXECUTIVE SUMMARY 

11

on the NAS evaluation. The plan includes a set of research questions aimed at assessing 

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

impacts of NIDILRR-funded activities and products. Implementation is on-going.

ACL’s Internal Performance Management Plan 

ACL’s programs provide grants to the Aging and Disability Networks. ACL employs a program 

performance improvement strategy with multiple components (e.g. collaboration with other 

agencies and organizations, enhanced partnerships between Aging and Disability Networks, 

technical assistance, and senior leadership’s involvement in performance management) that are 

expected to yield performance improvements. 

ACL has implemented a quality review system (QRS) for developmental disability programs 

under ACL’s/AIDD. The QRS uses a three-tiered model to review program compliance, 

outcomes, and fiscal operations and use review results to target and coordinate technical 

assistance. The first tier is annual standardized review. The second tier is standardized, in-depth 

review involving a team of reviewers. These reviews are conducted on a periodic basis. Tier 

three is customized monitoring for programs that ACL has significant concerns in terms of 

compliance and performance. ACL continues development of a formula grant monitoring 

framework for Older Americans Act Title III and VII state formula grants. The framework 

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

identification of risk or instances of fraud, waste and abuse. 

In addition to grant monitoring improvements, ACL senior management is directly engaged in 

developing performance management activities through grants and procurement planning. There 

is a rigorous process in which each office within ACL develops Program Funding Plan 

Memoranda which detail the proposed discretionary grant and procurement activities for the 

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

measures. Senior leadership has established processes for use of performance data for 

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

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

managers’ meetings and bi-weekly center director meetings. 

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

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

with the Agency’s performance measures. This and other performance information are used 

during the year to update ACL’s Executive Leadership so that adjustments can be made as 

needed to ACL programs; it is also discussed and used as appropriate in ACL internal 

discussions as decisions are made each year regarding funding levels to propose to the 

Department and OMB. 
EXECUTIVE SUMMARY 

12

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

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

Networks demonstrate solid performance over the past ten years. 
EXECUTIVE SUMMARY 

13

All Purpose Table 

Administration for Community Living 

(dollars in thousands) 

Program

FY 2016 

Final

 FY 2017 

Annualized CR 

FY 2018 

President's 

Budget

FY 2018+/- 

FY 2017

Health & Independence for Older Adults

Home & Community-Based Supportive Services...................................................... 347,724 347,063 347,063 --

Nutrition Services........................................................................................................... 834,753 833,166 833,167

Congregate Nutrition Services (non-add)............................................................ 448,342 447,490 447,490 --

Home-Delivered Nutrition Services (non-add).................................................... 226,342 225,912 225,912 --

Nutrition Services Incentive Program (non-add)................................................ 160,069 159,765 159,765

Preventive Health Services........................................................................................... 19,848 19,810 19,810 --

Chronic Disease Self-Management Education [PPHF]/1.......................................... 8,000 8,000 (8,000) --

Chronic Disease Self-Management Education/1....................................................... -- -- 5,000 5,000

Elder Falls Prevention [PPHF]/1................................................................................... 5,000 5,000 (5,000) --

Elder Falls Prevention/1................................................................................................. -- -- 5,000 5,000

Native American Nutrition & Supportive Services................................................... 31,158 31,099 31,099 --

Aging Network Support Activities.............................................................................. 9,961 9,942 9,942 --

Holocaust Survivor Assistance {non-add}............................................................ 2,500 2,495 2,495 --

Subtotal, Health & Independence for Older Adults............................................... 1,256,444 1,254,080 1,251,081 (3,000)

Caregiver & Family Support Services

Family Caregiver Support Services.............................................................................. 150,586 150,300 150,300 --

Native American Caregiver Support Services............................................................ 7,531 7,517 7,517 --

Alzheimer's Disease Program/2..................................................................................... -- -- 19,490 19,490

Alzheimer's Disease Supportive Services Program/2................................................ 4,800 4,791 (4,791) --

Alzheimer's Disease Initiative -- Specialized Supportive Services [PPHF]/2......... 10,500 10,500 (10,500) --

Lifespan Respite Care.................................................................................................... 3,360 3,354 3,354 --

Subtotal, Caregiver & Family Support Services...................................................... 176,777 176,461 180,661 4,199

Protection of Vulnerable Adults

Long-Term Care Ombudsman Program....................................................................... 15,885 15,855 15,855 --

Prevention of Elder Abuse & Neglect......................................................................... 4,773 4,764 4,764 --

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

Elder Rights Support Activities .................................................................................. 11,874 11,851 11,851 --

Elder Justice {non-add}............................................................................................ 8,000 7,985 7,985 --

Subtotal, Protection of Vulnerable Adults............................................................... 50,532 50,470 50,470 --

Disability Programs, Research & Services

Partnerships for Innovation, Inclusion, and Independence/4................................. -- -- 45,000 45,000

State Councils on Developmental Disabilities/4........................................................ 73,000 72,861 (72,861) --

Developmental Disabilities Protection and Advocacy............................................. 38,734 38,660 38,660 --

University Centers for Excellence in Developmental Disabilities............................ 38,619 38,546 38,546 --

Projects of National Significance................................................................................. 10,000 9,981 7,600 (2,381)

Independent Living/4..................................................................................................... 101,183 100,991 78,156 (22,835)

Limb Loss Resource Center.......................................................................................... 2,810 2,805 (2,805) --

Paralysis Resource Center............................................................................................. 7,700 7,685 (7,685) --

Traumatic Brain Injury/4................................................................................................ 9,321 9,303 3,162 (6,141)

National Institute on Disability, Independent Living, and Rehab. Research........ 103,970 103,772 95,127 (8,645)

Subtotal, Disability Programs, Research & Services.............................................. 385,337 384,604.474 306,251 (78,354)
EXECUTIVE SUMMARY 

14

Consumer Information, Access & Outreach

Aging and Disability Resource Centers...................................................................... 6,119 6,107 6,107 --

State Health Insurance Assistance Program.............................................................. 52,115 52,016 (52,016) --

Voting Access for People with Disabilities (HAVA)................................................ 4,963 4,954 4,954 --

Assistive Technology .................................................................................................. 34,000 33,935 31,939 (1,996)

Assistive Technology - State Grants (non-add)....................................................... 32,000 31,939 31,939 --

Assistive Technology - Alternative Financing Program (non-add).................... 2,000 1,996 (1,996) --

Alzheimer's Disease Initiative--Communications Campaign [PPHF]/2................... 4,200 4,200 (4,200) --

Medicare Improvements for Patients and Providers Act [TRA/BBA] /5/6......... 37,500 34,913 37,500 2,588

Subtotal, Consumer Information, Access & Outreach.......................................... 138,897 136,125 80,500 (55,625)

Program Administration ................................................................................................ 40,063 39,987 37,987 (2,000)

Subtotal, Program Level............................................................................................... 2,048,050 2,041,727 1,906,950 (134,779)

Less: Funds From Mandatory Sources

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 /5/6.................................. (37,500) (34,913) (37,500) (2,588)

Total, Discretionary Budget Authority......................................................................... 1,964,850 1,961,115 1,851,450 (109,666)

1/ In FY 2016 and FY 2017 these programs were paid for out of the Prevention and Public Health Fund. Funding for FY 2018

 is requested out of ACL's direct appropriations.

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

3/ The FY 2016 enacted appropriation states that SMP/HCFAC is to be "fully funded" out of discretionary HCFAC appropriations to the 

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

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

4/Partnerships for Innovation, Inclusion, and Independence consolidate like activities in the State Councils on Developmental

 Disabilities, State Independent Living Councils, and State Advisory Boards on Traumatic Brain Injury. 

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

these, funding for MIPPA SHIPs ($13 million in FY 2016-FY 2018), is currently appropriated to the 

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

Authority (IDDA).

6/ MIPPA funding in FY 2016 was reduced by a 6.9% sequester, leaving $34,912,500 available for the program. 
EXECUTIVE SUMMARY 

15

Appropriations Language 

AGING AND DISABILITY SERVICES PROGRAMS 

(INCLUDING TRANSFER OF FUNDS) 

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

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

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

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

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

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

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

individuals with disabilities, [$1,912,735,000] $1,851,450,000, [, together with $52,115,000 to 

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

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

Budget Reconciliation Act of 1990]: Provided, That amounts appropriated under this heading 

may be used for grants to States under section 361 of the OAA only for disease prevention and 

health promotion programs and activities which have been demonstrated through rigorous 

evaluation to be evidence-based and effective: Provided further, That notwithstanding 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; 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 in 

addition, the unobligated balance of amounts previously made available for the Health 

Resources and Services Administration to carry out functions under sections 1252 and 1253 

of the PHS Act shall be transferred to this account, except for such sums as may be 

necessary to provide for an orderly transition of such functions to the Administration for 

Community Living:] Provided further, that none of the funds made available under this heading 

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

Individuals with Mental Illness Act (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 
EXECUTIVE SUMMARY 

16

developmental disabilities, unless reasonable public notice of the action has been provided to 

such individuals (or, in the case of mental incapacitation, the legal guardians who have been 

specifically awarded authority by the courts to make healthcare and residential decisions on 

behalf of such individuals) who are affected by such action, within 90 days of instituting such 

legal action, which informs such individuals (or such legal guardians) of their legal rights and 

how to exercise such rights consistent with current Federal Rules of Civil Procedure: Provided 

further, That the limitations in the immediately preceding proviso shall not apply in the case of 

an individual who is neither competent to consent nor has a legal guardian, nor shall the proviso 

apply in the case of individuals who are a ward of the State or subject to public guardianship.

Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget 

was prepared; therefore, the budget assumes this account is operating under the Further 

Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts included for 2017 reflect the 

annualized level provided by the continuing resolution. 
EXECUTIVE SUMMARY 

17

Appropriations Language Analysis 

ADMINISTRATION FOR COMMUNITY LIVING 

Language Provision Explanation

[, together with $52,115,000 to be transferred from 

the Federal Hospital Insurance Trust Fund and the 

Federal Supplementary Medical Insurance Trust 

Fund to carry out section 4360 of the Omnibus 

Budget Reconciliation Act of 1990]

Deletes language that provides 

appropriations for the State Health 

Insurance Assistance Program (SHIP) since 

the Budget does not request discretionary 

funding for this program.

[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; 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: 

Deletes language for provides 

appropriations for the Assistive 

Technology Alternative Financing Program 

since the Budget does not request funding 

for this program.

Provided further, That in addition, the unobligated 

balance of amounts previously made available for 

the Health Resources and Services Administration 

to carry out functions under sections 1252 and 

1253 of the PHS Act shall be transferred to this 

account, except for such sums as may be necessary 

to provide for an orderly transition of such 

functions to the Administration for Community 

Living:]

Deletes language related to transfer of the 

Traumatic Brain Injury (TBI) program 

from the Health Resources and Services 

Administration (HRSA) since transfer of 

the program was completed in FY 2016.
EXECUTIVE SUMMARY 

18

Amounts Available for Obligation 

Administration for Community Living 

FY 2016

Final

FY 2017 

Annualized 

CR

FY 2018 

President's 

Budget

General Fund Discretionary Appropriation:

Appropriation (L/HHS, Agriculture, or, 

Interior).................

1,912,735,000 1,912,735,000 1,851,450,000

Across-the-board reductions (Under CR 1 & 2). -- -3,636,106 --

Secretary's Transfer............................................. -2,166,000 -4,390,000 --

Subtotal, adjusted appropriation...................... 1,910,569,000 1,904,708,894 1,851,450,000

Transfer of Funds to Department of Agriculture 

1/. 

-2,214,429 -2,553,916 --

Total, Discretionary Appropriation.......... 1,908,354,571 1,902,154,978 1,851,450,000

Mandatory Appropriation:

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

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

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

Subtotal, mandatory. appropriation................... 52,200,000 50,509,500 24,500,000

Offsetting collections from:

 Trust Funds: HCFAC HI........................................ 17,428,101 18,571,899 18,000,000

 Trust Funds: SHIPs HI/SMI................................... 52,046,705 52,015,929 --

Subtotal, offsetting collections........................... 69,474,806 70,587,828 18,000,000

Unobligated balance, lapsing..................................... 630,145 -- --

Total obligations................................................... 2,029,399,232 2,023,252,306 1,893,950,000
EXECUTIVE SUMMARY 

19

Summary of Changes 

ADMINISTRATION FOR COMMUNITY LIVING 

(Dollars in thousands) 

2017

Total estimated budget authority......................................................................... 1,961,115

(Obligations)....................................................................................................... 1,954,171

2018

Total estimated budget authority........................................................................... 1,851,450

(Obligations)....................................................................................................... 1,851,450

Net Change..................................................................................................... 109,665

FY 

2018 

PB FY 2018

FY 2018 

+/- FY 

2017 FY 2018 +/- FY 2017

FTE PB BA FTE BA

Increases:

A. Built-in: 0 0 0 0

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

Program:

Chronic Disease Self-Management Education. 5,000 5,000

Elder Falls Prevention................................... 5,000 5,000

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

Partnerships for Innovation, Inclusion, and 

Independence 

45,000 0 45,000

Subtotal, Program Increases 1/.............. 74,490

Total Increases..................................... 74,490 0 74,490

Decreases:

Program Administration................................. 173.7 37,987 9.2 2,000

Subtotal, Built-in Decreases.................... 9.2 2,000

A. Program:

Alzheimer's Disease Supportive Services Program 0 4,791

State Councils on Developmental Disabilities.. 0 72,861

Projects of National Significance.................... 7,600 2,381

Independent Living........................................ 0.8 78,156 -0.1 22,835

Limb Loss Resource Center........................... 0 2,805

Paralysis Resource Center............................ 0 7,685

Traumatic Brain Injury................................... 0 3,162 1.4 6,141

National Institute on Disability, Independent 

Living, and Rehabilitation Research....

95,127 8,645

State Health Insurance Assistance Program... 0 0 5 52,016

Assistive Technology.................................... 31,939 0 1,996

Subtotal, Program Decreases.................. 6.3 182,156

Total Decreases.................................... 15.5 184,156

Net Change 1/................................... -15.5 109,666

1/Does not includes FTE increases associated with HCFAC (+1.6 FTE) and MIPPA (+2 FTE) 
EXECUTIVE SUMMARY 

20

Budget Authority by Activity 

ADMINISTRATION FOR COMMUNITY LIVING 

(Dollars in Thousands) 

FY 2016 

Actual

FY 2017 

Annualized 

CR

FY 2018 

President's 

Budget

Health & Independence for Older Adults

Home & Community-Based Supportive Services 347,724 347,063 347,063

Nutrition Services 834,753 833,166 833,167

Preventive Health Services 19,848 19,810 19,810

Native American Nutrition & Supportive Services 31,158 31,099 31,099

Chronic Disease Self-Management Education/1 -- 5,000 --

Falls Prevention/1 -- 5,000 --

Aging Network Support Activities 9,961 9,942 9,942

 Subtotal, Health & Independence for Older Adults 1,243,444 1,241,080 1,251,081

Caregiver & Family Support Services

Family Caregiver Support Services 150,586 150,300 150,300

Native American Caregiver Support Services 7,531 7,517 7,517

Alzheimer's Disease Program/2 -- 19,490 --

Alzheimer's Disease Supportive Services Program/2 4,800 4,791 --

Lifespan Respite Care 3,360 3,354 3,354

Subtotal, Caregiver & Family Support Services 166,277 165,962 180,661

Protection of Vulnerable Adults

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

Prevention of Elder Abuse & Neglect 4,773 4,764 4,764

Elder Rights Support Activities 11,874 11,851 11,851

Subtotal, Protection of Vulnerable Adults 32,532 32,470 32,470

Disability Programs, Research & Services

Partnerships for Innovation, Inclusion and Independence/3 0 0 45,000

State Councils on Developmental Disabilities 73,000 72,861 --

Developmental Disabilities Protection and Advocacy 38,734 38,660 38,660

University Centers for Excellence in Developmental Disabilities 38,619 38,546 38,546

Projects of National Significance 10,000 9,981 7,600

Independent Living 101,183 100,991 78,156

Limb Loss Resource Center 2,810 2,805 --

Paralysis Resource Center 7,700 7,685 --

Traumatic Brain Injury 9,321 9,303 3,162

National Institute on Disability, Independent Living, and Rehab. Research 103,970 103,772 95,127

Subtotal, Disability Programs, Research & Services 385,337 384,604 306,251
EXECUTIVE SUMMARY 

21

Consumer Information, Access & Outreach

Aging and Disability Resource Centers [Discretionary] 6,119 6,107 6,107

State Health Insurance Assistance Program 52,115 52,016 --

Voting Access for People with Disabilities (HAVA) 4,963 4,954 4,954

Assistive Technology 34,000 33,935 31,939

Subtotal, Consumer Information, Access & Outreach 97,197 97,012 43,000

Program Administration 40,063 39,987 37,987

Total, Discretionary Budget Authority 1,964,850 1,961,115 1,851,450

HCFAC Funds for Senior Medicare Patrol Program/4 18,000 18,000 18,000

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

 Chronic Disease Self-Management Education {non-add}/1 8,000 8,000 --

 Falls Prevention {non-add}/1 5,000 5,000 --

 Alzheimer's Disease Initiative - Specialized Supportive Services {non-add}/1/2 10,500 10,500 --

 Alzheimer's Disease Initiative - Communications Campaign {non-add}/1/2 4,200 4,200 --

Medicare Improvements for Patients and Providers Act/5 37,500 34,913 37,500

 Aging and Disability Resource Centers {non-add} 5,000 4,655 5,000

 Area Agencies on Aging {non-add} 7,500 6,983 7,500

 National Center for Benefits Outreach and Enrollment {non-add} 12,000 11,172 12,000

 State Health Insurance Assistance Program {non-add} 13,000 12,103 13,000

Total, Program Level 2,048,050 2,041,727 1,906,950

1/ In FY 2016 and FY 2017 these programs were paid for out of the Prevention and Public Health Fund. Funding for FY 2018

 is requested out of ACL's direct appropriations.

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

3/Partnerships for Innovation, Inclusion, and Independence consolidate like activities in the State Councils on

 Developmental Disabilities, State Independent Living Councils, and State Partnerships for Traumatic Brain Injury. 

4/ The FY 2016 enacted appropriation states that it "fully funds" SMP through discretionary HCFAC appropriations to the 

Centers for Medicare & Medicaid Services. This amount serves as a placeholder for FY 2018 pending final decisions on 

 the amounts by the Secretary of HHS.

5/ MIPPA funding in FY 2017 was reduced by a 6.9% sequester, leaving $34,912,500 available for the program. 
EXECUTIVE SUMMARY 

22

Authorizing Legislation 

ADMINISTRATION FOR COMMUNITY LIVING 

FY 2017 

Amount 

Authorized

FY 2017 

Annualized 

CR

FY 2018 

Amount 

Authorized

FY 2018 

President's 

Budget

1) Home and Community-Based Supportive Services:

OAA Section 303 (a)(1)............................................ 356,717,276 347,062,977 364,456,847 347,063,000

2) Nutrition Services

OAA Section 303 (b)(1)(2), 311(e) .......................... 856,189,192 833,166,135 874,637,011 833,166,000

3) Preventive Health Services:

OAA Section 361...................................................... 20,361,334 19,810,269 20,803,107 19,810,000

4) Chronic Disease Self-Management Education:

OAA Section 411 NA NA NA 5,000,000

5) Falls Prevention:

OAA Section 411 NA NA NA 5,000,000

6) National Family Caregiver Support Program:

OAA Section 303 (e)................................................ 154,336,482 150,299,736 157,564,066 150,300,000

7) Native American Nutrition and Supportive Services:

OAA Sections 643.................................................... 31,934,018 31,098,769 32,601,843 31,099,000

8) Native American Caregiver Support Program:

OAA Section 631..................................................... 7,718,566 7,516,684 7,879,982 7,517,000

9) Alzheimer's Disease Program:

OAA Section 411 NA NA NA 19,490,000

10) Long-Term Care Ombudsman Program:

OAA Section 702(a)................................................ 16,280,630 15,854,803 16,621,101 15,855,000

11) Prevention of Elder Abuse and Neglect:

OAA Section 702(b)................................................. 4,891,876 4,763,927 4,994,178 4,764,000

12) Elder Rights Support Activities

OAA Sections 201, 202, and 411, 751, and 752, as

amended. Social Security Act, Title XX-B, Section

2042.

10,856,828 11,851,428 11,083,873 11,851,000

13) Aging Network Support Activities:

OAA Sections 202, 215 and 411............................. 10,209,087 9,942,064 10,422,587 9,942,000

14) Alzheimer's Disease Demonstration Grants

Public Health Services Act Section 398................... Expired 4,790,875 Expired --

15) Lifespan Respite Care

Lifespan Respite Care Act of 2006 and Public 

Health Service Act Title XXIX.....................

Expired 3,353,613 Expired 3,354,000

16) Program Administration:

OAA Section 216 (a)................................................ 40,063,000 39,986,840 40,063,000 37,987,000

17) Aging and Disability Resource Centers

OAA Sections 216 (b)(4)............................... 6,271,399 6,107,368 6,402,551 6,107,000

18) State Health Insurance Assistance Program:

Omnibus Budget Reconciliation Act of 1990 

Section 4360

Expired 52,015,929 Expired --

19) Partnerships for Innovation, Inclusion, and 

independence

[See Appropriations Language} NA NA NA 45,000,000

20) State Councils on Developmental Disabilities

DD Act Section 129(a)............................ Expired 72,861,227 Expired --
EXECUTIVE SUMMARY 

23

FY 2017 

Amount 

Authorized

FY 2017 

Annualized 

CR

FY 2018 

Amount 

Authorized

FY 2018 

President's 

Budget

21) Protection and Advocacy

DD Act Section 145..................................... Expired 38,660,367 Expired 38,660,000

22) University Centers for Excellence in Developmental Disabilities

DD Act Section 156.................................. Expired 38,545,585 Expired 38,546,000

23) Projects of National Significance

DD Act Section 163................................... Expired 9,980,990 Expired 7,600,000

24) Voting Assistance for People with Disabilities

Help America Vote Act Section 291.................. Expired 4,953,565 Expired 4,954,000

25) Paralysis Resource Center

Public Health Services Act Sections 311 and 

317(k)(2)..

N/A 7,685,362 N/A --

26) National Institute on Disability, Independent 

Living, and Rehabilitation Research 4/

Rehabilitation Act of 1973 201.................. 114,325,000 103,772,353 116,860,000 95,127,000

27) Independent Living

Rehabilitation Act of 1973, Title VII, Parts B, 

C, and Chapter 2

Independent Living State Grants Section 714. 24,645,000 22,834,509 25,156,000 --

Centers for Independent Living Section 727.. 84,353,000 78,156,142 86,104,000 78,156,000

28) Assistive Technology

Assistive Technology Act of 1998............... Expired 33,935,367 Expired 31,939,000

29) Limb Loss Resource Center

Public Health Services Act, Title III............. N/A 2,804,658 N/A --

30) Traumatic Brain Injury Reauthorization Act of 

2014

Traumatic Brain Injury State Grants.......... 5,500,000 9,303,281 5,500,000 --

Traumatic Brain Injury Protection and 

Advocacy....

3,100,000 3,100,000 3,162,000

Total Request Level $1,961,114,823 $1,851,449,000

Unfunded Authorizations:

1) Legal Assistance:

OAA Section 702(b)................................ NA 0 NA 0
EXECUTIVE SUMMARY 

24

Appropriations History Table 

ADMINISTRATION FOR COMMUNITY LIVING 

Budget Estimate to 

Congress House Allowance Senate Allowance Appropriation

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

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

Subtotal 1,591,343,000 

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

FY 2010 Transfer -224,298 

Subtotal 1,516,072,702

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

FY 2011 Rescission -3,000,646 

Subtotal 1,497,322,354

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

FY 2012 Rescission -2,785,299 

Subtotal 1,470,917,701

FY 2013 /6 1,978,336,000 N/A 1,708,105,000 1,645,291,724 

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

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

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

Subtotal 1,553,100,029

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

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

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

FY 2017/10 1,993,294,000 1,981,275,000 1,935,435,000 1,961,114,823

FY 2018 1,851,450,000

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

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

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

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

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

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

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

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

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

6/ 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. 

7/ 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. 

8/ 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. 

9/ 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. 

10/ Appropriation is the Continuing Resolution level. 
EXECUTIVE SUMMARY 

25

Appropriations Not Authorized by Law 

APPROPRIATIONS IN FY 2017 

Program

Last Year of 

Authorization

Authorization 

Level

Appropriations 

in Last Year of 

Authorization

Appropriations in 

FY 2017 CR

Alzheimer's Disease 

Supportive Services:

PHSA Section 398 FY 2002 Such Sums $11,483,000 $4,790,875 

Lifespan Respite 

Care: Lifespan 

Respite Care Act of 

2006 FY 2011 $94,810,000 $2,495,000 $3,353,613 

State Health 

Insurance Assistance 

Programs: Omnibus 

Budget 

Reconciliation Act of 

1990 FY 1996 $10,000,000 N/A $52,015,929 

Developmental 

Disabilities

Assistance and Bill 

of Rights Act FY 2007 Such Sums $155,115,000 $160,048,169 

Voting Access for 

People with 

Disabilities:

Help America Vote 

Act - Section 291 FY 2005 $17,410,000 $13,879,000 $4,953,565 

Elder Justice / Adult 

Protective Services: 

Social Security Act, 

Title XX-B FY 2014 $129,000,000 $0 $7,984,792 

The Assistive 

Technology Act of 

2004 FY 2010 Such Sums $25,000,000 $33,935,367 

Partnerships for 

Innovation, 

Inclusion, and 

Independence NA NA NA NA
26

Health and Independence for Older Adults 

SUMMARY OF REQUEST 

The Administration on Aging’s Health and Independence for Older Adults programs, authorized 

primarily by the Older Americans Act, provide a foundation of supports that assist older 

individuals to remain healthy and independent in their homes and communities, avoiding more 

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

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

their homes), preventive health, and chronic disease self-management services. 

The U.S. population over age 60 is projected to increase by 16 percent between 2015 and 2020, 

from 66.8 million to 77.6 million.6 In addition, the number of seniors age 65 and older with 

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

greatest risk of nursing home admission, is projected to increase by 18 percent over the same 

period.7

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

in their homes and communities for as long as possible. For example, 63 percent of congregate 

and 93 percent of home-delivered meal recipients reported that the meals allowed them to 

continue living in their own homes.8 Additionally, 57 percent of seniors using transportation 

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

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

ACL’s FY 2018 funding request for Health and Independence for Older Adults programs is 

$1,251,080,000, a reduction of $3 million below the annualized FY 2017 Continuing Resolution 

level. For FY 2018, specific program requests include: 

 $347,063,000 for Home and Community-Based Supportive Services (HCBSS), 

maintaining the annualized FY 2017 Continuing Resolution level. HCBSS provides 

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

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

personal care services, chore services, and physical fitness programs. These services also 

 

6

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

Age, Sex, Race, and Hispanic Origin for the United States: 2014 to 2060. Released December 2014. Accessed 08 

January 2015. 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, 

2015: Released June 2016. Accessed 29 March 2017. 

7

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

population Data from the 2013 Medicare Current Beneficiary Survey. [data tables 2.5a and 2.6a]. Accessed 10 

January 2016. 

8

2016 National Survey of Older Americans Act Participants. 

9

 Ibid. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

27

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. 

 $833,167,000 for Nutrition programs, including Congregate Nutrition, Home-Delivered 

Nutrition and the Nutrition Services Incentives Program. The FY 2018 request maintains 

the annualized FY 2017 Continuing Resolution level for these programs. In FY 2018 the 

Nutrition Services programs will help nearly 2.3 million older adults receive the meals 

they need to stay healthy and decrease their risk of disability, and will support 

216 million meals. 

 $19,810,000 for Preventive Health Services, maintaining the annualized FY 2017 

Continuing Resolution level. These services support activities that educate older adults 

about the importance of healthy lifestyles and promote healthy behaviors that can help 

prevent, delay, or enable seniors to better cope with and manage chronic disease and 

disability, thereby reducing the need for more costly medical interventions. ACL is 

continuing to include appropriations language that requires States to use their Preventive 

Health Services funds for proven evidence-based prevention activities. 

 $5,000,000 for Chronic Disease Self-Management Education (CDSME), a reduction of 

-$3,000,000 from the annualized FY 2017 Continuing Resolution level of $8,000,000. 

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

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

 $5,000,000 for Falls Prevention, maintaining the same level of funding in FY 2018 as 

was provided in FY 2017 under the annualized FY 2017 Continuing Resolution. Falls 

are the leading cause of both fatal and nonfatal injuries for those 65 and over. 

 $31,099,000 for Native American Nutrition and Supportive Services, maintaining the 

annualized FY 2017 Continuing Resolution level. These funds will provide 

approximately 5.8 million meals and 900,000 rides for Native American seniors to 

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

 $9,942,000 for Aging Network Support Activities, maintaining the annualized FY 2017 

Continuing Resolution level. 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 

28

Outcome and Outputs Table: Health and Independence for Older Adults 

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2017

Target

FY 2018

Target

FY 2018

Target

+/-FY 2017

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 2015: 8,789 clients

Target:

9,250 clients

(Target Not Met)

9,000 clients 8,800 clients -200 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 2015: 62.7 weighted 

average

Target:

62.5 weighted average

(Target Exceeded)

63.25 weighted 

average

63.25 weighted 

average

Maintain

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 2015: 35.7%

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 2015: 32.66%

Target:

24.85%

(Target Exceeded)

25.78% 25.68% -0.1 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

29

Home and Community-Based Supportive Services 

FY 2016

Final

FY 2017

Annualized 

CR

FY 2018

President's 

Budget

FY 2018 +/-

FY 2017

Home and Community-Based 

Supportive Services $347,724 $347,063 $347,063 --

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

FY 2018 Older Americans Act Authorization .............................................................$364,456,847

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

Program Description and Accomplishments: 

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

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

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

possible. Programs like HCBSS serve seniors holistically. While each service is valuable in and 

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

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

homes or other types of institutional care. 

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

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

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

and physical fitness programs. In addition to these services, the HCBSS program also funds 

multi-purpose senior centers, which coordinate and integrate services for the elderly. 

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

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

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

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

at least one chronic condition and 76 percent have at least two.11 Providing a variety of 

 

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

Data from the 2013 Medicare Current Beneficiary Survey. [data table 2.5a]. Accessed 10 January 2016. 

11 Ibid. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

30

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. 

Services provided by the HCBSS program in FY 2015 (the most recent available data) include: 

 Transportation Services provided 23.6 million rides to doctor’s offices, grocery stores, 

pharmacies, senior centers, meal sites, and other critical daily activities (Output C). 

 Personal Care, Homemaker, and Chore Services provided over 38.9 million hours of 

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

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

(Output D).

 Adult Day Care/Day Health provided over 9.9 million hours of care for dependent adults in 

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

(Output E). 

 Case Management Services provided 3.6 million hours of assistance in assessing needs, 

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

(Output F). 

Continuing ACL’s commitment to provide services to those in most need, 46.3 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.12 Many of these 

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

one of the following chronic conditions that could impair their ability to navigate safely:13

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

macular degeneration or cataracts); 

 14 percent have had a stroke; 

 7 percent have Alzheimer’s or dementia; 

 4 percent have epilepsy; 

 

12 2016 National Survey of Older Americans Act Participants. 

13 Id. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

31

 2 percent have Multiple Sclerosis; and 

 3 percent have Parkinson’s disease. 

Of the transportation participants, 94 percent take daily medications, with over 17 percent taking 

10 to 20 medications daily.14 Data from ACL’s National Surveys of OAA Participants show that 

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

they need to help them remain at home. For example, 57 percent of seniors using transportation 

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

homebound, while over 80 percent of clients receiving case management reported that, as a result 

of the services arranged by the case manager, they were better able to care for themselves.15 In 

addition, a study published in the Journal of Aging and Health shows that the services provided 

by the HCBSS program, what the article calls “personal care services,” are the critical services 

that enable frail seniors to remain in their homes and out of nursing home care.16

Funding History: 

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

follows: 

FY 2009 ...................................$361,348,000

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

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

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

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

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

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

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

FY 2017 Annualized CR ..........$347,062,977

FY 2018 President’s Budget ....$347,063,000

 

14 2016 National Survey of Older Americans Act Participants. 

15 Id. 

16 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. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

32

Budget Request: 

The FY 2018 request for Home and Community-Based Supportive Services is $347,063,000, 

maintaining the annualized FY 2017 Continuing Resolution level. At the FY 2018 funding level 

ACL estimates that the program will support 10.2 million hours of adult day care for older 

adults; 22 million rides for activities such as visiting the doctor, the pharmacy, or grocery stores; 

and 40.3 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. 

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

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

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

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

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

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

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

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

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

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

in institutional settings.17 Nationally, 25 percent of individuals 60 and older live alone18, and in 

FY 2015, 48 percent of OAA consumers were individuals who live alone. 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 shown that childless seniors who live in a State with higher home and communitybased service expenditures had significantly lower risk of nursing home admissions.19

These programs also have strong partnerships with State and local governments, philanthropic 

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

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

requirements.

 

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

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

of Medicare Beneficiaries, by Age and by Gender and Age, 2013]. Accessed 10 January 2016. 

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

Microdata Sample (PUMS) 1-Year Files (2014), accessed March 29, 2017. 

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

Home and Community-Based Services Matter?” May 2007. Journal of Gerontology: Psychological Sciences. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

33

Outputs and Outcomes Table: Home and Community-Based Supportive Services 

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2017

Target

FY 2018

Target

FY 2018

Target

+/-FY 2017

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 2015: 8,789 clients

Target:

9,250 clients

(Target Not Met)

9,000 clients 8,800 clients -200 clients

2.9b Maintain at 90% or 

higher the percentage of 

transportation clients who 

rate services good to 

excellent. (Outcome)

FY 2015: 95.5%

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 2015: 62.7 weighted 

average

Target:

62.5 weighted average

(Target Exceeded)

63.25 weighted 

average

63.25 weighted 

average

Maintain

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 2015: 35.7%

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 2015: 32.66%

Target:

24.85%

(Target Exceeded)

25.78% 25.68% -0.1 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

34

Indicator Year and Most Recent 

Result /

FY 2017

Projection

FY 2018

Projection

FY 2018

Projection

+/-FY 2017

Projection

Output C: Transportation 

Service Units (Output)

FY 2015: 23.6 M 22.6 M 22.0 M -0.6

Output D: Personal Care, 

Homemaker and Chore 

Services units (Output)

FY 2015: 39.0 M 39.8 M 40.3 M +0.5

Output E: Adult Day 

Care/Day Health units

(Output)

FY 2015: 9.98 M 10.2 M 10.2 M Maintain

Output F: Case 

Management Services 

units (Output)

FY 2015: 3.6 M 3.4 M 3.3 M -0.1

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 

FY 2016 Final FY 2017

Annualized CR

FY 2018

President’s 

Budget

Number of 

Awards 56 56 56

Average 

Award $6,163,695 $6,135,577 $6,135,578

Range of 

Awards

$215,730 -

$34,172,853

$214,745 -

$33,831,125

$214,745 -

$33,492,815
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

35

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

ADMINISTRATION ON AGING 

FY 2018 DISCRETIONARY STATE FORMULA GRANTS 

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

State/Territory FY 2016 Actual FY 2017

Annualized CR

FY 2018

President's 

Budget

FY 2018 +/- FY 

2017

Alabama...................................... 5,340,110 5,286,709 5,233,842 (52,867)

Alaska.......................................... 1,725,835 1,717,962 1,717,962 -

Arizona........................................ 6,495,849 6,614,832 6,853,157 238,325

Arkansas...................................... 3,459,887 3,425,288 3,391,035 (34,253)

California................................... 34,172,853 33,831,125 33,492,815 (338,310)

Colorado...................................... 4,106,001 4,494,405 4,657,012 162,607

Connecticut................................. 4,352,620 4,309,094 4,266,003 (43,091)

Delaware..................................... 1,725,835 1,717,962 1,717,962 -

District of Columbia.................... 1,725,835 1,717,962 1,717,962 -

Florida......................................... 24,965,219 24,715,567 24,468,411 (247,156)

Georgia........................................ 7,816,357 8,101,353 8,394,460 293,107

Hawaii......................................... 1,725,835 1,717,962 1,717,962 -

Idaho............................................ 1,725,835 1,717,962 1,717,962 -

Illinois......................................... 14,354,336 14,210,793 14,068,685 (142,108)

Indiana......................................... 6,846,052 6,777,591 6,709,815 (67,776)

Iowa............................................. 4,210,846 4,168,738 4,127,051 (41,687)

Kansas......................................... 3,392,598 3,358,672 3,325,085 (33,587)

Kentucky..................................... 4,685,598 4,638,742 4,592,355 (46,387)

Louisiana..................................... 4,739,584 4,692,188 4,645,266 (46,922)

Maine.......................................... 1,725,835 1,717,962 1,717,962 -

Maryland..................................... 5,788,659 5,730,772 5,673,464 (57,308)

Massachusetts.............................. 8,112,702 8,031,575 7,951,259 (80,316)

Michigan..................................... 11,123,548 11,012,313 10,902,190 (110,123)

Minnesota.................................... 5,435,089 5,380,738 5,326,931 (53,807)

Mississippi.................................. 3,234,282 3,201,939 3,169,920 (32,019)

Missouri...................................... 7,034,843 6,964,495 6,894,850 (69,645)

Montana...................................... 1,725,835 1,717,962 1,717,962 -

Nebraska...................................... 2,267,990 2,245,310 2,222,857 (22,453)

Nevada........................................ 2,432,485 2,570,740 2,663,750 93,010

New Hampshire.......................... 1,725,835 1,717,962 1,717,962 -

 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

36

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

State/Territory FY 2016 Actual FY 2017

Annualized CR

FY 2018

President's Budget FY 2018 +/- FY 

2017

New Jersey.......................... 10,142,462 10,041,037 9,940,627 (100,410)

New Mexico....................... 2,041,926 2,021,507 2,041,044 19,537

New York........................... 23,998,290 23,758,307 23,520,724 (237,583)

North Carolina.................... 9,258,914 9,212,522 9,545,832 333,310

North Dakota...................... 1,725,835 1,717,962 1,717,962 -

Ohio.................................... 13,654,570 13,518,024 13,382,844 (135,180)

Oklahoma............................ 4,228,050 4,185,770 4,143,912 (41,858)

Oregon................................ 4,085,823 4,055,654 4,202,388 146,734

Pennsylvania....................... 17,670,027 17,493,327 17,318,394 (174,933)

Rhode Island....................... 1,725,835 1,717,962 1,717,962 -

South Carolina.................... 4,735,280 4,815,105 4,989,315 174,210

South Dakota...................... 1,725,835 1,717,962 1,717,962 -

Tennessee............................ 6,680,839 6,614,031 6,547,891 (66,140)

Texas................................... 20,087,400 20,099,410 20,826,607 727,197

Utah.................................... 1,844,852 1,909,470 1,978,555 69,085

Vermont.............................. 1,725,835 1,717,962 1,717,962 -

Virginia............................... 7,772,608 7,694,882 7,617,933 (76,949)

Washington......................... 6,374,314 6,435,903 6,668,754 232,851

West Virginia...................... 2,740,971 2,713,561 2,686,425 (27,136)

Wisconsin........................... 6,315,353 6,252,199 6,189,677 (62,522)

Wyoming............................ 1,725,835 1,717,962 1,717,962 -

Subtotal, States................... 338,435,042 336,917,194 336,964,641 47,447

American Samoa................. 466,771 462,103 $457,482 (4,621)

Guam.................................. 862,917 858,981 $858,981 -

Northern Mariana Islands... 215,730 214,745 $214,745 -

Puerto Rico......................... 4,323,579 4,280,343 4,237,540 (42,803)

Virgin Islands..................... 862,917 858,981 858,981 -

Subtotal, States and Territories 345,166,956 343,592,347 343,592,370 23

Program Support 1/................... 2,557,044 3,470,630 3,470,630 0

TOTAL...................................... 347,724,000 347,062,977 347,063,000 23

1/ Program Support –Includes funds for Older Americans Act statutory requirements, including program evaluation and disaster 

assistance; and grant and program reporting systems costs. Funds unused for these purposes at the end of the year are allocated 

to States. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

37

Nutrition Services 

FY 2016

Final

FY 2017

Annualized 

CR

FY 2018

President's 

Budget

FY 2018 +/-

FY 2017

Congregate Nutrition $448,342 $447,490 $447,490 --

Home Delivered $226,342 $225,912 $225,912 --

Nutrition Services 

Incentive Program $160,069 $159,765 $159,765 --

Total $834,753 $833,166 $833,166 --

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

amended 

FY 2018 Older Americans Act Authorization .............................................................$874,637,011

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

Program Description and Accomplishments: 

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

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

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

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

Columbia, and five territories through a network of more than 5,000 local nutrition service 

providers. 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, 

community centers, congregate dining facilities, school cafeterias, restaurants, farmers 

markets, hospital cafeterias, etc.) which helps to keep older individuals healthy and 

prevents the need for more costly medical interventions. Established in 1972, the program 

also presents opportunities for social engagement, health promotion activities, nutrition 

education, nutrition counseling and meaningful volunteer and social engagement roles, all 

of which contribute to participants’ overall health and well-being. 

 Home-Delivered Nutrition Services (Title III-C2): Provides funding for the delivery of 

meals and related services to frail seniors who are homebound. Established in 1978, 

home-delivered meals are often the first in-home service that an older adult receives and 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

38

are often the primary access point for other home and community-based services. In 

addition to providing a meal, this program helps frail home-bound seniors to combat 

isolation and to maintain contact with the outside world. Home-delivered meals also 

represent an essential service for some caregivers who also receive meals, helping them 

to maintain their own health and well-being while caring for their loved ones. 

 Nutrition Services Incentive Program (Title III-A): Provides a secondary source of 

funding that must be used exclusively to provide meals. Recipients can elect to receive 

part or all of their grants as commodities from the U.S. Department of Agriculture if they 

determine that doing so will enable them to better meet the needs of older adults. Six 

States and five tribes elected to spend just over $2.5 million on commodities, including 

$132,415 assessed by USDA as administrative expenses in FY 2017. 

Formula grants for congregate nutrition services and home-delivered nutrition services are 

allocated to states and territories based on their share of the population age 60 and over. 

Nutrition Services Incentive Program (NSIP) grants are provided to states, territories, and 

eligible tribal organizations based on the number of meals served in the prior fiscal year. The 

meals provided through these programs fulfill the standards set by the current Dietary Guidelines 

for Americans. 

Nutrition services assist approximately 2.4 million (2015) diverse participants with 

characteristics that place them at higher risk for health care interventions as well as 

institutionalization. Data from ACL’s National Survey of OAA Participants indicate that about 

43 percent of congregate and 65 percent of home-delivered participants have 6 or more chronic 

health conditions. About 28 percent of congregate and 51 percent of home-delivered participants 

take over six medications per day and some take as many as 20 medications.20

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

served in the congregate and home-delivered nutrition programs need healthy prepared meals—

not just access to food. Data from the National Survey of OAA Participants indicate that about 

20 percent of congregate and 53 percent of home-delivered participants need help in getting 

outside the house, thus limiting their ability to shop for food themselves.21 Although many of 

these older adults may rely on family and friends for assistance, about 47 percent of congregate 

and 59 percent of home-delivered participants live alone.22 Living alone is a risk factor for social 

isolation, poorer health, and nursing home placement. 

 

20 2014 National Survey of Older Americans Act Participants. 

21 Id. 

22 Id. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

39

The prevalence of multiple chronic conditions is higher among congregate and home-delivered 

meal program participants than for the general Medicare population. At the same time, most 

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

related to nutrition as a primary prevention, risk reduction, or treatment modality. Therefore, the 

provision of healthy meals, access to lifestyle modification programs, and evidence-based advice 

such as nutrition education and counseling are important to helping these older individuals avoid 

more serious medical care. 

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

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

example, data indicate that 78 percent of congregate and 83 percent of home-delivered meal 

participants say they eat healthier meals due to the programs, and 63 percent of congregate and 

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

their homes.23 The extra support provided by these programs can help older adults avoid more 

costly medical care, and the potential savings that can result from this are substantial. Data show 

that Medicare beneficiaries with multiple chronic conditions are the heaviest users of health care 

services. Among Medicare beneficiaries age 65 and over who are not dual eligibles (enrolled in 

Medicare and Medicaid), standardized Medicare per capita spending increases from $4,914 for 

persons with 2 to 3 chronic conditions to $28,076 for persons with 6 or more chronic 

conditions.24 Data also show that the two-thirds of Medicare beneficiaries with two or more 

chronic conditions account for 93 percent of Medicare spending.25

Using State Program Report data, made available on ACL’s data portal, independent research 

has found that states that invest more in delivering meals (both Federal, state, and all other 

sources of funding) to older adults’ homes have lower rates of “low-care” seniors in nursing 

homes who have the functional capacity to live in a less care-intensive environment, after 

adjusting for several other factors.26 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.27

ACL’s annual performance data also demonstrate that these programs are an efficient and 

effective means to help seniors remain healthy and independent in their homes and in the 

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

 

23 Id.

24 State Level Multiple Chronic Conditions (MCC) Table: Prevalence, Medicare Utilization and Spending. 2014. 

25 Centers for Medicare & Medicaid Services. Chronic Conditions among Medicare Beneficiaries, Chart Book. 

Baltimore, MD. 2011. 

26 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. 

27 Id.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

40

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

(3+ ADL) was 42 percent in 2015 (Outcome 3.5). This level of disability is frequently associated 

with nursing home admission, and demonstrates the extreme frailty of a significant number of 

home-delivered meal clients. The most recent data on how these nutrition programs, in 

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

independent in their homes include: 

 Home-Delivered Nutrition Services provided over 142.6 million meals to over 

859,000 individuals in FY 2015 (Output G). 

 Congregate Nutrition Services provided over 79.4 million meals to nearly 1.6 million 

seniors in a variety of community settings in FY 2015 (Output H). 

Funding History: 

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

FY 2009 ...................................$809,743,000

FY 2009 (ARRA) .......................$97,000,000

FY 2010 ...................................$819,353,000

FY 2011 ...................................$817,835,000

FY 2012 ...................................$816,289,000

FY 2013 ...................................$768,310,870

FY 2014 ...................................$811,191,000

FY 2015 ...................................$814,657,000

FY 2016 ..................................$834,753,000

FY 2017 Annualized CR ..........$833,166,135

FY 2018 President’s Budget ....$833,167,000
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

41

Budget Request: 

The FY 2018 request for Nutrition Services is $833,167,000, which maintains the annualized 

FY 2017 Continuing Resolution level for these programs. Federal support for Nutrition Services 

is not expected to serve every older American in need. Working in partnership with State and 

local governments, philanthropic organizations, and private donors that also contribute funding, 

allows for the level of support nutrition programs currently provide. Combined with state and 

local contributions the request is projected to support approximately 216 million home delivered 

and congregate meals to more than 2.3 million older Americans in a variety of community 

settings. 

Nutrition Services can help to delay much more expensive medical and institutional services. 

Consistent with ACL’s commitment to target services to those most in need, approximately 

71 percent of home-delivered meal recipients have annual incomes at or below $20,000.28 Meals 

are especially important to the survival of the nearly 61 percent of Home-delivered recipients 

(and 49 percent of Congregate recipients) who report these meals as half or more of their food 

intake for the day and for the 42 percent of home-delivered meal recipients with severe 

disabilities who are projected to be served by these programs.29 This population with severe 

disabilities is particularly important to serve since this level of disability is frequently an 

eligibility requirement for more costly nursing home admission. 

In FY 2018, the Nutrition programs are expected to continue to provide home-delivered meals 

that clients rate as good to excellent (Outcome 2.9a), ensuring that clients continue to receive 

high quality services. However, cost increases at the provider level may result in some providers 

looking at cost cutting measures such as reducing menu choices or the frequency of deliveries. 

While these decisions are made at the provider level, this in turn could affect client satisfaction 

with the quality of service.

ACL is engaged in multiple program research and evaluation efforts that include its nutrition 

programs. To date, for the OAA Title III-C Nutrition Services program (NSP) evaluation, a 

report of the NSP process evaluation and the NSP cost study report are available at.

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

the OAA Title III-C Nutrition Services Program (NSP) is meeting its stated goals. The program 

provides appropriate supportive services which are responsive to local community and 

individuals’ needs. For example, since the last evaluation was conducted in 1995, 15 percent 

more providers offer weekend meal service and almost 15 percent more sites provide specialized 

meal choices to meet the health needs of recipients. With nearly two-thirds of meal providers 

 

28 2016 National Survey of Older Americans Act Participants. 

29 Id
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

42

offering non-nutrition services to promote the well-being of older Americans the program is able 

to provide a continuum of care for older individuals and secure the opportunity for older 

individuals to receive managed in-home and community-based long-term care services. The 

program is using federal funds efficiently as the federal expenditure is $1.88 per home delivered 

meal and $3.52 per congregate meal, but evaluation research shows that if all costs are accounted 

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

congregate meal. 

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 was not available sizeable 

percentages of participants (61 percent of home-delivered meal participants and 42 percent of 

congregate meal participants) indicated they would skip meals or eat less. 

Outcomes and Outputs Table: 

Nutrition Services 

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2017

Target

FY 2018

Target

FY 2018

Target

+/-FY 2017

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 2015: 8,789 clients

Target:

9,250 clients

(Target Not Met)

9,000 clients 8,800 clients -200 clients

2.9a Maintain at 90% or 

higher the percentage of 

clients receiving home 

delivered meal who rate 

services good to 

excellent. (Outcome)

FY 2015: 89%

Target:

90%

(Target Not Met but 

Improved)

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 2015: 62.7 weighted 

average

Target:

62.5 weighted average

(Target Exceeded)

63.25 weighted 

average

63.25 weighted 

average

Maintain
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

43

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2017

Target

FY 2018

Target

FY 2018

Target

+/-FY 2017

Target

3.3 The percentage of 

OAA clients served who 

live in rural areas is at 

least 15% greater than the 

percent of all US elders 

who live in rural areas. 

(Outcome)

FY 2015: 35.7%

Target:

26.2%

(Target Exceeded)

26.2% 26.2% Maintain

3.5 Increase the 

percentage of older 

persons with severe 

disabilities who receive 

home-delivered meals. 

(Outcome)

FY 2015: 41.7%

Target:

44.8%

(Target Not Met)

45.1% 42.4% -2.7 

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 2015: 32.66%

Target:

24.85%

(Target Exceeded)

25.78% 25.68% -0.1 

Indicator Year and Most Recent 

Result /

FY 2017

Projection

FY 2018

Projection

FY 2018

Projection

+/-FY 2017

Projection

Output G: Number of 

Home-Delivered meals 

served (Output)

FY 2015: 143 M 143.3 M 142.4 M -0.9

Output H: Number of 

Congregate meals served 

(Output)

FY 2015: 79.4 M 75.3 M 73.6 M -1.7

Outputs G & H: Total 

Number of Meals 

(Output)

FY 2015: 222 M 218.6 M 216.0 M -2.6

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 

44

Grant Awards Tables: 

Congregate Nutrition Programs Grant Awards 

FY 2016 Final FY 2017

Annualized CR

FY 2018

President’s Budget

Number 

of 

Awards

56 56 56

Average 

Award $7,947,282 $7,910,978 $7,910,983

Range 

of 

Awards

$278,155 -

$42,269,354

$276,884 - 

$45,275,376

$276,884 -

$45,528,456

Home-Delivered Nutrition Programs Grant Awards 

FY 2016 Final FY 2017

Annualized CR

FY 2018

President’s 

Budget

Number of 

Awards 56 56 56

Average 

Award $4,012,032 $3,993,796 $3,993,801

Range of 

Awards

$140,421 -

$23,435,646

$139,783 - 

$23,432,673

$139,783 -

$23,457,705

Nutrition Services Incentive Program Grant Awards 

FY 2016 Final FY 2017

Annualized CR

FY 2018

President’s 

Budget

Number of Awards30 317 317 317

Average Award31 $492,536 $485,175 $485,176

Range of Awards32 $139 -

$16,626,262

$140 -

$16,824,117

$140 -

$16,824,143

 

30 Number of awards includes 261 awards to Tribal organizations. 

31 If the 261 awards to Tribal organizations are excluded from the “average award” calculation, the average award to 

States, DC, and the territories is $2,730,220 in FY 2016, $2,757,728 in FY 2017, and $2,757,733 in FY 2018. 

32 If the 261 award to Tribal organizations are excluded from the “range of awards” calculation, the smallest award 

to States, DC, and the territories is $53,085 in FY 2016, $53,717 in FY 2017, and $53,717 in FY 2018. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

45

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

ADMINISTRATION ON AGING 

FY 2018 DISCRETIONARY STATE FORMULA GRANTS 

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

State/Territory FY 2016 Actual FY 2017

Annualized CR

FY 2018

President's Budget FY 2018 +/- FY 

2017

Alabama...................................... 6,658,222 6,591,640 6,625,027 33,387

Alaska.......................................... 2,225,239 2,215,074 2,215,076 2

Arizona........................................ 9,360,431 9,402,329 9,454,887 52,558

Arkansas...................................... 4,163,564 4,121,928 4,080,709 (41,219)

California.................................... 45,269,354 45,275,376 45,528,456 253,080

Colorado...................................... 6,361,144 6,389,283 6,424,998 35,715

Connecticut................................. 5,241,452 5,189,037 5,137,147 (51,890)

Delaware..................................... 2,225,239 2,215,074 2,215,076 2

District of Columbia.................... 2,225,239 2,215,074 2,215,076 2

Florida......................................... 32,179,591 32,235,071 32,415,259 180,188

Georgia........................................ 11,497,595 11,516,950 11,581,328 64,378

Hawaii......................................... 2,225,239 2,215,074 2,215,076 2

Idaho............................................ 2,225,239 2,215,074 2,215,076 2

Illinois......................................... 17,286,541 17,113,676 16,942,539 (171,137)

Indiana......................................... 8,534,666 8,449,319 8,495,611 46,292

Iowa............................................. 5,081,501 5,030,686 4,980,379 (50,307)

Kansas......................................... 4,089,903 4,049,004 4,008,514 (40,490)

Kentucky..................................... 5,932,483 5,873,158 5,902,676 29,518

Louisiana..................................... 5,798,475 5,767,234 5,799,472 32,238

Maine.......................................... 2,225,239 2,215,074 2,215,076 2

Maryland..................................... 7,497,316 7,461,424 7,503,132 41,708

Massachusetts.............................. 9,780,267 9,682,464 9,585,639 (96,825)

Michigan..................................... 13,877,388 13,739,011 13,815,810 76,799

Minnesota.................................... 7,101,910 7,067,191 7,106,696 39,505

Mississippi.................................. 3,891,114 3,852,203 3,839,848 (12,355)

Missouri...................................... 8,467,047 8,382,377 8,298,553 (83,824)

Montana...................................... 2,225,239 2,215,074 2,215,076 2

Nebraska...................................... 2,738,802 2,711,414 2,684,300 (27,114)

Nevada........................................ 3,627,769 3,654,586 3,675,014 20,428

New Hampshire........................... 2,225,239 2,215,074 2,215,076 2
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

46

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

State/Territory FY 2016 Actual FY 2017

Annualized CR

FY 2018

President's Budget FY 2018 +/- FY 

2017

New Jersey.......................... 12,190,488 12,068,583 11,947,897 (120,686)

New Mexico....................... 2,818,273 2,800,251 2,815,903 15,652

New York........................... 28,963,855 28,674,216 28,387,474 (286,742)

North Carolina.................... 13,132,620 13,096,598 13,169,805 73,207

North Dakota...................... 2,225,239 2,215,074 2,215,076 2

Ohio.................................... 16,393,785 16,229,847 16,105,493 (124,354)

Oklahoma............................ 5,080,736 5,029,929 4,996,519 (33,410)

Oregon................................ 5,771,973 5,765,551 5,797,780 32,229

Pennsylvania....................... 21,279,716 21,066,919 20,856,250 (210,669)

Rhode Island....................... 2,225,239 2,215,074 2,215,076 2

South Carolina.................... 6,833,310 6,845,192 6,883,456 38,264

South Dakota...................... 2,225,239 2,215,074 2,215,076 2

Tennessee............................ 8,857,622 8,791,542 8,840,685 49,143

Texas................................... 28,490,410 28,573,487 28,733,207 159,720

Utah.................................... 2,699,962 2,714,519 2,729,693 15,174

Vermont.............................. 2,225,239 2,215,074 2,215,076 2

Virginia............................... 10,410,071 10,377,544 10,435,553 58,009

Washington......................... 9,122,298 9,149,333 9,200,476 51,143

West Virginia...................... 3,305,947 3,272,888 3,240,159 (32,729)

Wisconsin........................... 7,933,770 7,879,147 7,923,190 44,043

Wyoming............................ 2,225,239 2,215,074 2,215,076 2

Subtotal, States................... 436,649,478 434,686,869 434,745,522 58,653

American Samoa................. 594,843 588,895 583,006 (5,889)

Guam.................................. 1,112,620 1,107,537 1,107,538 1

Northern Mariana Islands... 278,155 276,884 276,884 -

Puerto Rico......................... 5,300,084 5,247,083 5,194,612 (52,471)

Virgin Islands..................... 1,112,620 1,107,537 1,107,538 1

Subtotal, States and Territories 445,047,800 443,014,805 443,015,100 295

Program Support 1/................... 3,294,200 4,474,897 4,474,900 3

TOTAL...................................... 448,342,000 447,489,702 447,490,000 298

1/ Program Support – Includes funds for Older Americans Act statutory requirements, including program evaluation and disaster 

assistance; and grant and program reporting systems costs. Funds unused for these purposes at the end of the year are allocated 

to States. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

47

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

ADMINISTRATION ON AGING 

FY 2018 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: Home-Delivered Nutrition Services (CFDA 93.045) 

State/Territory FY 2016 Actual FY 2017

Annualized CR

FY 2018

President's Budget FY 2018 +/- FY 

2017

Alabama...................................... 3,446,917 3,412,448 3,413,424 976

Alaska.......................................... 1,123,369 1,118,263 1,118,264 1

Arizona........................................ 4,845,833 4,866,258 4,871,457 5,199

Arkansas...................................... 2,128,668 2,107,381 2,100,918 (6,463)

California.................................... 23,435,646 23,432,673 23,457,705 25,032

Colorado...................................... 3,293,123 3,306,830 3,310,363 3,533

Connecticut................................. 2,571,861 2,546,142 2,539,950 (6,192)

Delaware..................................... 1,123,369 1,118,263 1,118,264 1

District of Columbia.................... 1,123,369 1,118,263 1,118,264 1

Florida......................................... 16,659,162 16,683,547 16,701,370 17,823

Georgia........................................ 5,952,229 5,960,700 5,967,068 6,368

Hawaii......................................... 1,123,369 1,118,263 1,118,264 1

Idaho............................................ 1,123,369 1,118,263 1,118,264 1

Illinois......................................... 8,395,795 8,311,837 8,299,978 (11,859)

Indiana......................................... 4,418,340 4,374,157 4,377,208 3,051

Iowa............................................. 2,266,934 2,244,265 2,241,318 (2,947)

Kansas......................................... 1,937,158 1,917,882 1,919,931 2,049

Kentucky..................................... 3,071,207 3,040,495 3,041,246 751

Louisiana..................................... 3,001,832 2,984,883 2,988,072 3,189

Maine.......................................... 1,134,584 1,123,238 1,123,498 260

Maryland..................................... 3,881,311 3,861,726 3,865,852 4,126

Massachusetts.............................. 4,720,820 4,684,145 4,689,149 5,004

Michigan..................................... 7,184,232 7,112,390 7,118,344 5,954

Minnesota.................................... 3,676,612 3,657,687 3,661,595 3,908

Mississippi.................................. 1,998,933 1,978,944 1,978,411 (533)

Missouri...................................... 4,309,755 4,266,657 4,263,612 (3,045)

Montana...................................... 1,123,369 1,118,263 1,118,264 1

Nebraska...................................... 1,264,078 1,252,464 1,253,802 1,338

Nevada........................................ 1,878,072 1,891,463 1,893,484 2,021

New Hampshire........................... 1,123,369 1,118,263 1,118,264 1
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

48

PROGRAM/CFDA NUMBER: Home-Delivered Nutrition Services (CFDA 93.045) 

State/Territory FY 2016 Actual FY 2017

Annualized CR

FY 2018

President's Budget FY 2018 +/- FY 

2017

New Jersey.......................... 6,078,857 6,018,068 6,016,631 (1,437)

New Mexico....................... 1,459,002 1,449,295 1,450,843 1,548

New York........................... 13,431,294 13,296,981 13,261,932 (35,049)

North Carolina.................... 6,798,671 6,778,260 6,785,502 7,242

North Dakota...................... 1,123,369 1,118,263 1,118,264 1

Ohio.................................... 8,391,051 8,307,140 8,298,061 (9,079)

Oklahoma............................ 2,601,402 2,575,388 2,574,365 (1,023)

Oregon................................ 2,988,113 2,984,012 2,987,200 3,188

Pennsylvania....................... 9,807,313 9,709,240 9,682,808 (26,432)

Rhode Island....................... 1,123,369 1,118,263 1,118,264 1

South Carolina.................... 3,537,560 3,542,790 3,546,575 3,785

South Dakota...................... 1,123,369 1,118,263 1,118,264 1

Tennessee............................ 4,585,533 4,550,140 4,555,001 4,861

Texas................................... 14,749,298 14,788,461 14,804,260 15,799

Utah.................................... 1,397,753 1,404,924 1,406,425 1,501

Vermont.............................. 1,123,369 1,118,263 1,118,264 1

Virginia............................... 5,389,225 5,370,990 5,376,728 5,738

Washington......................... 4,722,553 4,735,318 4,740,377 5,059

West Virginia...................... 1,527,374 1,512,100 1,499,924 (12,176)

Wisconsin........................... 4,107,261 4,077,922 4,082,279 4,357

Wyoming............................ 1,123,369 1,118,263 1,118,264 1

Subtotal, States................... 220,525,790 219,538,397 219,565,834 27,437

American Samoa................. 140,421 139,783 139,783 -

Guam.................................. 561,685 559,132 559,132 -

Northern Mariana Islands... 140,421 139,783 139,783 -

Puerto Rico......................... 2,743,818 2,716,380 2,689,216 (27,164)

Virgin Islands..................... 561,685 559,132 559,132 -

Subtotal, States and Territories 224,673,820 223,652,607 223,652,880 273

Program Support 1/................... 1,668,180 2,259,117 2,259,120 3

TOTAL...................................... 226,342,000 225,911,724 225,912,000 276

1/ Program Support –includes funds for Older Americans Act statutory requirements, including program evaluation and disaster 

assistance; and grant and program reporting systems costs. Funds unused for these purposes at the end of the year are allocated 

to States. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

49

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

ADMINISTRATION ON AGING 

FY 2018 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: Nutrition Services Incentive Program (CFDA 93.053)

State/Territory FY 2016 Actual FY 2017

Annualized CR

FY 2018

President's Budget FY 2018 +/- FY 

2017

Alabama....................................... 3,343,062 3,382,845 3,382,851 6

Alaska.......................................... 482,319 488,059 488,060 1

Arizona......................................... 1,850,582 1,872,604 1,872,608 4

Arkansas....................................... 2,547,704 2,578,021 2,578,026 5

California..................................... 13,100,197 13,256,090 13,256,114 24

Colorado....................................... 1,381,206 1,397,642 1,397,645 3

Connecticut.................................. 1,538,793 1,557,105 1,557,107 2

Delaware...................................... 500,490 505,072 505,073 1

District of Columbia.................... 795,581 805,048 805,050 2

Florida.......................................... 6,300,064 6,375,035 6,375,047 12

Georgia......................................... 2,758,744 2,791,573 2,791,578 5

Hawaii.......................................... 409,291 414,162 414,163 1

Idaho............................................ 737,226 746,209 746,211 2

Illinois.......................................... 6,134,768 6,207,772 6,207,783 11

Indiana......................................... 1,467,482 1,484,945 1,484,948 3

Iowa............................................. 1,758,186 1,779,109 1,779,112 3

Kansas.......................................... 2,036,030 2,092,222 2,092,226 4

Kentucky...................................... 1,670,281 1,690,158 1,690,161 3

Louisiana...................................... 3,472,592 3,513,916 3,513,923 7

Maine........................................... 596,374 603,471 603,472 1

Maryland...................................... 1,617,398 1,636,645 1,636,648 3

Massachusetts.............................. 5,123,191 4,999,895 4,999,907 12

Michigan...................................... 7,535,532 7,625,206 7,625,220 14

Minnesota..................................... 1,813,004 1,834,579 1,834,582 3

Mississippi................................... 1,544,079 1,562,454 1,562,457 3

Missouri....................................... 4,000,525 4,048,131 4,048,139 8

Montana....................................... 952,920 824,681 824,683 2

Nebraska...................................... 1,121,363 1,134,707 1,134,709 2

Nevada......................................... 1,262,846 1,291,947 1,291,950 3

New Hampshire........................... 1,183,758 1,197,845 1,197,847 2
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

50

PROGRAM/CFDA NUMBER: Nutrition Services Incentive Program (CFDA 93.053)

State/Territory FY 2016 Actual FY 2017

Annualized CR

FY 2018

President's Budget FY 2018 +/- FY 

2017

New Jersey.......................... 3,697,546 3,741,547 3,741,554 7

New Mexico....................... 2,322,927 2,350,570 2,350,575 5

New York........................... 16,626,262 16,824,117 16,824,143 26

North Carolina.................... 3,271,673 3,310,606 3,310,612 6

North Dakota...................... 808,445 818,065 818,067 2

Ohio.................................... 5,511,975 5,577,568 5,577,578 10

Oklahoma............................ 2,079,523 2,104,270 2,104,274 4

Oregon................................ 1,904,526 1,927,190 1,927,194 4

Pennsylvania....................... 6,322,179 6,397,413 6,397,425 12

Rhode Island....................... 399,849 404,607 404,608 1

South Carolina.................... 1,690,316 1,710,431 1,710,434 3

South Dakota...................... 877,494 887,936 887,937 1

Tennessee............................ 1,544,863 1,563,247 1,563,250 3

Texas................................... 11,187,189 11,320,317 11,320,338 21

Utah.................................... 1,366,184 1,382,441 1,382,444 3

Vermont.............................. 840,508 850,510 850,512 2

Virginia............................... 2,140,665 2,166,139 2,166,143 4

Washington......................... 2,263,353 2,290,288 2,290,292 4

West Virginia...................... 1,580,090 1,598,893 1,598,896 3

Wisconsin........................... 2,796,955 2,830,239 2,830,245 6

Wyoming............................ 860,761 871,004 871,006 2

Subtotal, States................... 149,128,871 150,624,546 150,624,827 281

American Samoa................. 120,587 122,022 122,022 -

Guam.................................. 406,456 411,293 411,294 1

Northern Mariana Islands... 53,085 53,717 53,717 -

Puerto Rico......................... 2,998,875 3,034,561 3,034,567 6

Virgin Islands..................... 184,443 186,638 186,638 -

Subtotal, States and Territories 152,892,317 154,432,777 154,433,065 288

Grants to Tribes 3,734,285 3,734,285 3,734,285 -

Program Support 1/................... 3,442,398 1,597,647 1,597,650 3

TOTAL...................................... 160,069,000 159,764,709 159,765,000 291

1/ Program Support –includes funds for Older Americans Act statutory requirements, including program evaluation and disaster 

assistance; and grant and program reporting systems costs. Funds unused for these purposes at the end of the year are allocated 

to States. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

51

Preventive Health Services 

FY 2016

Final

FY 2017

Annualized 

CR

FY 2018

President's 

Budget

FY 2018 +/-

FY 2017

Preventive Health Services......... $19,848 $19,810 $19,810 --

Authorizing Legislation: Section 361 of the Older Americans Act of 1965, as amended 

FY 2018 Older Americans Act Authorization ...............................................................$20,803,107

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

Program Description and Accomplishments: 

Preventive Health Services, established in 1987, provides formula grants to States and Territories 

to support evidence-based programs that educate older adults about the importance of healthy 

lifestyles and promote healthy behaviors that can help to prevent or delay chronic disease and 

disability, thereby reducing the need for more costly medical interventions. Preventive Health 

Services funding is allocated to gives States and Territories based on their share of the 

population age 60 and over and provide flexibility to allocate resources among evidence-based 

preventive health activities to best meet local needs. Priority has been given to providing access 

to programs for elders living in medically underserved areas of their state or who have the 

greatest economic need. 

Due in large part to advances in public health and medical care, Americans are leading longer 

and more active lives. On average, an American turning age 65 today can expect to live an 

additional 19.4 years.33 The population of older Americans is also growing, particularly the 

population age 85 and over, which is growing very rapidly, totaling 6.3 million in 2015 and 

projected to reach 9.1 million by the year 2030.34 One consequence of this increased longevity is 

the higher incidence of chronic diseases such as obesity, arthritis, diabetes, osteoporosis, and 

 

33 Xu JQ, Murphy SL, Kochanek KD, Arias E. Mortality in the United States, 2015. NCHS data brief, no 267. 

Hyattsville, MD: National Center for Health Statistics. 2016. Accessed 29 March 2017. 

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

Age, Sex, Race, and Hispanic Origin for the United States: 2014 to 2060. Released December 2014. Accessed 08 

January 2015. 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, 

2015: Released June 2016. Accessed 29 March 2017. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

52

depression, as well as the greater probability of injury from a fall, which quickly limits physical 

activity. 

To help address the increase in multiple chronic conditions and ensure the best use of limited 

funds, in FY 2012 ACL requested and Congress enacted appropriations language requiring states 

and territories to use their Preventive Health funds only on evidence-based programs that have 

been proven to enhance the wellness and fitness of older adults. The same language has been 

included in each subsequent year’s appropriations language. Other health services, such as health 

screenings, can be funded under the Home and Community-Based Supportive Services program. 

Evidence-based programs are interventions that have been proven through randomized control 

trials to be effective at helping participants adopt healthy behaviors, improve their health status, 

and reduce their use of hospital services and emergency room visits. Examples of evidence-based 

interventions include: 

 Self-Management Programs: Chronic Disease Self-Management Education (CDSME) 

programs are low-cost, evidence-based disease prevention models that use state-of-the-art 

techniques and employ leaders in the community to help individuals with chronic disease 

address issues related to the management and treatment of their condition, improve their 

health status, and reduce their need for more costly medical care. CDSME programs have 

been shown repeatedly, through multiple studies, to be effective at helping participants 

adopt healthy behaviors and improve their psychological and physical health status. Some 

evidence suggests that CDSME programs may also significantly reduce the use of 

hospital care and physician services, as well as reduce health care costs. 

 Physical Activity Programs: Physical activity programs are multi-component group 

exercise programs designed for community-based organizations and intended to promote 

physical activity among older adults. Components may include strength training using 

soft wrist and ankle weights; cardiovascular workouts using dancing, aerobics, or 

walking; and balance and posture exercises. Becoming more physically active has many 

positive benefits such as increased mobility and function, decreased pain and depression, 

and lower risk of type 2 diabetes, hypertension, coronary heart disease, obesity, and some 

cancers. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

53

 Medication Management Programs: Medication management programs focus on 

reviewing the multitude of medications that older adults are prescribed, focusing 

especially on high-risk medications. Medication management programs have been shown 

to reduce cardiovascular problems and unnecessary duplication of prescriptions. These 

programs have also been shown to improve medication usage rates and decrease 

medication errors among older adults.

 Falls Prevention Programs: Falls prevention programs help participants achieve 

improved strength, balance, and mobility; provide education on how to avoid falls and 

reduce fall risk factors; involve medication reviews and modifications; provide referrals 

for medical care management for fall risk factors; and provide home assessments to 

identify and reduce environmental hazards. Many people limit their activity after a fall, 

which can reduce strength, physical fitness, and mobility. 

 Depression Care Management: Depression is not a normal part of aging, yet it is a 

prevalent and disabling condition among older adults. Older adults with depression 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 2014 .................................................$19,848,000 

FY 2015 .................................................$19,848,000 

FY 2016 .................................................$19,848,000 

FY 2017 Annualized CR .......................$19,810,269 

FY 2018 President’s Budget ..................$19,810,000 

Budget Request: 

The FY 2018 request for Preventive Health Services is $19,810,000, maintaining the FY 2017 

annualized Continuing Resolution level. ACL is continuing to request appropriations language 

that requires states to use their Preventive Health Services funds to support proven 

evidence-based models that enhance the wellness and fitness of the aging community. 

Recognizing that the development of evidence-based programs is ongoing, ACL is working to 

improve access to information on evaluated interventions and reduce the lag time between the 

creation of scientific knowledge and its practical application in the field. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

54

ACL will continue to provide guidance regarding what meets the evidence-based requirement. 

ACL uses a graduated or tiered set of criteria for defining evidence-based interventions 

implemented through the OAA. The OAA Title III-D webpage contains definitions of evidencebased interventions, frequently asked questions, and program examples.35 Grantees can use the 

Title III-D Highest-Tier Criteria Evidence-Based Disease Prevention and Health Promotion 

Programs Cost Chart36 on the site to search the 45+ highest-level criteria programs listed. 

Underscoring the need for these programs, the 2015 National Survey of OAA Participants found 

that between 67 and 90 percent of clients across OAA services take three or more different 

prescription medications every day. In addition, between 20 and 43 percent of clients across 

OAA services reported having stayed overnight in a hospital in the past 12 months. Preventive 

Health Services funding has enabled the Aging Services Network to help older adults control 

their medications and health through the implementation of evidence-based DPHP programs. 

Over 65% of clients across OAA services report learning how to take care of a chronic illness or 

medical condition during the past year. Five to sixteen percent of respondents, representing over 

200,000 OAA clients, reported that they learned through a group class.37

Each of the evidence-based programs for which states could use these funds has been rigorously 

evaluated and found to be effective. By requiring states to use funding for one or more of these 

proven programs, ACL seeks to maximize the impact of this funding by providing benefits to 

individuals and achieving savings due to reduced medical costs. At the same time, states would 

continue to have the flexibility to use funding provided under the Home and Community-Based 

Supportive Services program to fund related health services, such as health screenings and 

physical fitness programs that do not meet these evidence-based requirements. 

 

35 http://www.aoa.gov/AoARoot/AoA_Programs/HPW/Title_IIID/index.aspx

36 http://www.ncoa.org/improve-health/center-for-healthy-aging/content-library/Title-IIID-Highest-Tier-EvidenceFINAL.pdf

37 2014 National Survey of Older Americans Act Participants. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

55

Output Table: 

Preventive Health Services 

Indicator Year and Most Recent 

Result /

FY 2017

Projection

FY 2018

Projection

FY 2018

Projection

+/-FY 2017

Projection

Output AB: The number 

of people served with 

health and disease 

prevention programs. 

(Output)

FY 2015: 1.5 M 1.4 M 1.4 M Maintain

Grant Awards Tables: 

Preventive Health Services Grant Awards 

FY 2016 Final FY 2017

Annualized CR

FY 2018

President’s 

Budget

Number of 

Awards 56 56 56

Average 

Award $351,660 $350,217 $350,213

Range of 

Awards

$12,308 -

$1,996,859

$12,258 -

$1,976,890

$12,257 -

$1,957,121
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

56

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

ADMINISTRATION ON AGING 

FY 2018 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: Preventive Health Services (CFDA 93.043) 

State/Territory FY 2016 Actual FY 2017

Annualized CR

FY 2018

President's Budget FY 2018 +/- FY 

2017

Alabama...................................... 312,046 308,926 305,837 (3,089)

Alaska.......................................... 98,465 98,061 98,060 (1)

Arizona........................................ 379,579 387,121 400,585 13,464

Arkansas...................................... 198,170 196,188 194,226 (1,962)

California.................................... 1,996,859 1,976,890 1,957,121 (19,769)

Colorado...................................... 239,931 263,029 272,215 9,186

Connecticut................................. 244,616 242,170 239,748 (2,422)

Delaware..................................... 98,465 98,061 98,060 (1)

District of Columbia.................... 98,465 98,061 98,060 (1)

Florida......................................... 1,458,822 1,444,234 1,429,792 (14,442)

Georgia........................................ 456,742 474,121 490,679 16,558

Hawaii......................................... 98,465 98,061 98,060 (1)

Idaho............................................ 98,465 98,061 98,060 (1)

Illinois......................................... 787,832 779,954 772,154 (7,800)

Indiana......................................... 400,043 396,043 392,083 (3,960)

Iowa............................................. 217,527 215,352 213,198 (2,154)

Kansas......................................... 179,543 177,748 175,971 (1,777)

Kentucky..................................... 273,799 271,061 268,350 (2,711)

Louisiana..................................... 276,954 274,184 271,442 (2,742)

Maine.......................................... 98,655 98,061 98,060 (1)

Maryland..................................... 338,256 334,873 331,524 (3,349)

Massachusetts............................. 435,955 431,595 427,279 (4,316)

Michigan..................................... 649,995 643,495 637,060 (6,435)

Minnesota.................................... 317,595 314,419 311,275 (3,144)

Mississippi.................................. 183,809 181,971 180,151 (1,820)

Missouri...................................... 396,418 392,454 388,529 (3,925)

Montana...................................... 98,465 98,061 98,060 (1)

Nebraska...................................... 116,982 115,812 114,654 (1,158)

Nevada........................................ 142,140 150,449 155,703 5,254

New Hampshire.......................... 98,465 98,061 98,060 (1)
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

57

PROGRAM/CFDA NUMBER: Preventive Health Services (CFDA 93.043) 

State/Territory FY 2016 Actual FY 2017

Annualized CR

FY 2018

President's Budget FY 2018 +/- FY 

2017

New Jersey.......................... 581,578 575,762 570,004 (5,758)

New Mexico....................... 119,318 118,125 119,304 1,179

New York........................... 1,289,327 1,276,434 1,263,670 (12,764)

North Carolina.................... 541,037 539,150 557,979 18,829

North Dakota...................... 98,465 98,061 98,060 (1)

Ohio.................................... 782,885 775,056 767,305 (7,751)

Oklahoma............................ 241,108 238,697 236,310 (2,387)

Oregon................................ 238,752 237,352 245,641 8,289

Pennsylvania....................... 953,977 944,437 934,993 (9,444)

Rhode Island....................... 98,465 98,061 98,060 (1)

South Carolina.................... 276,703 281,797 291,639 9,842

South Dakota...................... 98,465 98,061 98,060 (1)

Tennessee............................ 390,389 386,485 382,620 (3,865)

Texas................................... 1,173,791 1,176,290 1,217,371 41,081

Utah.................................... 107,803 111,749 115,652 3,903

Vermont.............................. 98,465 98,061 98,060 (1)

Virginia............................... 454,186 449,644 445,148 (4,496)

Washington......................... 372,478 376,652 389,807 13,155

West Virginia...................... 143,428 141,994 140,574 (1,420)

Wisconsin........................... 366,631 362,965 359,335 (3,630)

Wyoming............................ 98,465 98,061 98,060 (1)

Subtotal, States................... 19,317,239 19,239,471 19,241,708 2,237

American Samoa................. 12,308 12,258 12,257 (1)

Guam.................................. 49,232 49,030 49,030 -

Northern Mariana Islands... 12,308 12,258 12,257 (1)

Puerto Rico......................... 252,645 250,119 247,618 (2,501)

Virgin Islands..................... 49,232 49,030 49,030 -

Subtotal, States and Territories 19,692,964 19,612,166 19,611,900 (266)

Program Support 1/................... 155,036 198,103 198,100 (3)

TOTAL...................................... 19,848,000 19,810,269 19,810,000 (269)

1/ Program Support –Includes funds for Older Americans Act statutory requirements, including program evaluation and disaster 

assistance; and grant and program reporting systems costs. Funds unused for these purposes at the end of the year are allocated 

to States. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

58

Chronic Disease Self-Management Education 

FY 2016

Final

FY 2017

Enacted

FY 2018

President's 

Budget

FY 2017 +/-

FY 2016

CDSME - PPHF............... $8,000 $8,000 $0 -$8,000

CDSME – Discretionary..... $0 $0 $5,000 +$5,000

Total CDSME................. $8,000 $8,000 $5,000 -$3,000

 

Authorizing Legislation: Section 411 of the Older Americans Act of 1965, as amended 

FY 2018 Older Americans Act ........................................................ No specific amount authorized 

Allocation Method ............................. Competitive Grants/Cooperative Agreements and Contracts 

Program Description and Accomplishments: 

Chronic Disease Self-Management Education (CDSME) programs are low-cost, evidence-based 

prevention models that use state-of-the-art techniques to help those with chronic conditions 

address issues related to the management and treatment of their condition, build self-confidence, 

improve their health status, and reduce their need for more costly medical care. 

In the United States, over 76 percent of Medicare beneficiaries have multiple (2 or more) chronic 

conditions,38 placing them at greater risk for premature death, poor functional status, unnecessary 

hospitalizations, adverse drug events, and nursing home placement.39 Chronic conditions also 

impact health care costs, as 93 percent of Medicare expenditures are for beneficiaries with 

chronic conditions.40

CDSME programs have been shown repeatedly, to be effective at helping participants adopt 

healthy behaviors and improve their psychological and physical health status.41 Some evidence 

 

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

from the 2013 Medicare Current Beneficiary Survey. [data tables 2.5a]. Accessed 10 January 2016. 

39 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. 

40 Nawrocki J. CMS Provides Data on Care for Chronic Conditions to Find Better Care Models. NetNews. April 2, 

2013.

41 Brady TJ, Murphy L, O’Colmain BJ, Beauchesne D, Daniels B, Greenberg M, et al. A Meta-Analysis of Health 

Status, Health Behaviors, and Health Care Utilization Outcomes of the Chronic Disease Self-Management Program. 

Prev Chronic Dis 2013;10:120112. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

59

suggests that CDSME programs may also significantly reduce the use of hospital care and 

physician services and reduce health care costs.42 These in-person community-based programs 

emphasize an individual’s role in managing their health though a series of short workshops. Core 

topics covered include: techniques to deal with problems such as frustration, fatigue, pain and 

isolation; appropriate exercise for maintaining and improving strength, flexibility, and 

endurance; appropriate use of medications; communicating effectively with health professionals; 

and nutrition. 

Funding History: 

Funding for Chronic Disease Self-Management Education over the past five years is as follows: 

FY 2014 ...................................................$8,000,000 

FY 2015 ...................................................$8,000,000 

FY 2016 ..................................................$8,000,000 

FY 2017 Annualized CR ..........................$8,000,000 

FY 2018 President’s Budget ....................$5,000,000 

Budget Request: 

The FY 2018 request for CDSME is $5,000,000 which is -$3,000,000 below the FY 2017 

program level of $8,000,000. Funds support competitive grants to States, as well as related 

technical assistance and evaluation activities, including a National Resource Center. 

CDSME programs, by emphasizing an individual’s role in managing his/her illness, help 

participants to reduce their pain and depression, improve mobility and exercise, increase energy, 

and boost confidence in their ability to manage their conditions.43 A recent national study 

indicated that the program can also help participants achieve better care, better health, and lower 

health care costs. Participants reported significant improvements in aspects of their care 

(communication with their physicians, medication compliance, and health literacy), better health 

outcomes (self-assessed health, reduction in depression and quality of life), and reduced health 

 

42 Sobel, DS, Lorig,KR, Hobbs,M. Chronic Disease Self-Management Program: From Development to 

Dissemination. Permanente Journal; Spring 2002. Also Ory, M. G., et al. 2013. “Successes of a National Study of 

the Chronic Disease Self-Management Program: Meeting the Triple Aim of Health Care Reform.” Medical Care 

51(11), 992-998. 

43 Brady, TJ, Murphy, L: Sorting through the Evidence: Executive Summary of Arthritis Self-Management Program 

and the Chronic Disease Self-Management Program Meta-Analyses, May 2011, Centers for Disease Control and 

Prevention. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

60

care utilization (lower emergency room visits and hospitalizations), resulting in potential cost 

savings.44

Older Americans are disproportionately affected by a vast array of chronic diseases and 

conditions. For example, over 11 million adults over the age of 65 have diabetes.45 Minority 

elders – the fastest growing segment of the elderly population – are especially at risk of chronic 

illnesses and conditions. In FY 2016, nearly 25,000 individuals with chronic conditions 

completed the CDSME program through ACL’s network (Output CD1). Fifty-seven percent of 

participants reporting relevant data indicate that they have multiple chronic conditions, with the 

most common conditions being hypertension (38.5 percent), arthritis (33 percent), and diabetes 

(32.4 percent). Over one-third of the participants are minority elders, including 22.2 percent 

African-Americans and over 17 percent Hispanics. 

CDSME programs are also especially well-suited for delivery through ACL’s network of 

community based organizations, including senior centers, congregate meal programs, faith-based 

organizations and senior housing communities. At the community level, aging services provider 

organizations work in collaboration with public health agencies and health care providers. 

 

44 Whitelaw, N., Lorig, K., Smith, M. L., & Ory, M. G. (March 19, 2013). National Study of Chronic Disease SelfManagement Programs (CDSMP). Retrieved May 3, 2013. 

45Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its 

Burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services; 2014. Accessed on 

29 March 2017. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

61

Outcomes and Outputs Table: 

Chronic Disease Self-Management Education 

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2017

Target

FY 2018

Target

FY 2018

Target

+/-FY 2017

Target

CD2 Increase the 

percentage of individuals 

who complete the 

CDSME program. 

(Outcome)

FY 2015: 73%

Target:

75%

(Target Not Met)

75% 75% Maintain

Indicator Year and Most Recent 

Result /

FY 2017

Projection

FY 2018

Projection

FY 2018

Projection

+/-FY 2017

Projection

Output CD1: Total 

number of individuals 

with chronic conditions 

completing the CDSME 

program. (Output)

FY 2015: 35,975 20,000 7,500 -12,500

Grant Awards Table: 

Chronic Disease Self-Management Education Grant Awards 

FY 2016 Final FY 2017 

Annualized

FY 2018 

President’s 

Budget

Number of 

Awards 13 9 9

Average 

Award $574,742 $830,111 $830,111

Range of 

Awards $135,598 -

$1000,000

$150,000 -

$1,200,000

$150,000 -

$1,200,000
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

62

Resource and Program Data: 

Chronic Disease Self-Management Education 

(Dollars in Thousands) 

Mechanism

FY 2016 

Final

#

FY 2016 

Final

$

FY 2017 CR 

Annualized

#

FY 2017 CR 

Annualized

$

FY 2018 

President’s 

Budget

#

FY 2018 

President’s 

Budget

$

Formula Grants --

 

-- --

 

-- --

 

--

New Discretionary

Grants 12 

 

6,471 8 

 

6,471 8 

 

6,471 

Continuations Grants 1 

 

1,000 1 

 

1,000 1 

 

1,000 

Contracts 2 

 

289 2 

 

291 2 

 

291 

Interagency Agreements --

 

-- --

 

-- --

 

--

Program Support /1 --

 

240 

 

238 

 

238 

Total Resources

 

8,000 

 

8,000 

 

8,000 

1/Program Support – Includes funds for overhead, grant systems and review costs, and technology 

support costs. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

63

Falls Prevention 

FY 2016

Final

FY 2017

Annualized 

CR

FY 2018

President's 

Budget

FY 2018 +/-

FY 2017

Falls Prevention – PPHF...... $5,000 $5,000 $0 -$5,000

Falls Prevention –

Discretionary

$0 $0 $5,000 +$5,000

Falls Prevention Total: $5,000 $,5000 $,5000 --

Authorizing Legislation: Section 411 of the Older Americans Act of 1965, as amended 

FY 2018 Older Americans Act Authorization ................................. No specific amount authorized 

Allocation Method ............................. Competitive Grants/Cooperative Agreements and Contracts 

Program Description and Accomplishments: 

Falls are the leading cause of both fatal and nonfatal injuries for those 65 and over.46 In 2014, 

29% of older adults reported an estimated 29 million falls. In 2014 fall-related injuries resulted in 

2.8 million emergency room visits, over 800,000 hospitalizations, and about 24,000 deaths.47 Of 

those who fall, 20 to 30 percent will experience serious injuries, such as brain trauma, broken 

bones, or hip fractures.48 The average hospital stay for a hip fracture is one week, and about 

one-third of those with hip fractures stay in a nursing home for a year or more.49 These injuries 

may limit the ability of older adults to get around or live independently. Those who are not 

injured may develop a fear of falling, which may increase their actual risk of falling.50 Many 

people limit their activity after a fall, which may reduce strength, physical fitness, and mobility.51

The importance of preventing falls is underscored by the inclusion of falls prevention screening 

in annual Medicare wellness visit. 

 

46 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.

47 Burns ER, Stevens JA, Lee R. The direct costs of fatal and non-fatal falls among older adults—United States. J 

Safety Res 2016;58:99–103. Accessed 29 March 2017. 

48

 Stevens JA. Fatalities and injuries from falls among older adults – United States, 1993–2003 and 2001–2005. 

MMWR 2006b;55.45:1222–24. 

49 Centers for Disease Control and Prevention, Hip Fractures Among Older Adults: An Overview. Retrieved on 

February 5, 2014. 

50 Bell AJ, Talbot-Stern JK, Hennessy A. Characteristics and outcomes of older patients presenting to the emergency 

department after a fall: a retrospective analysis. Medical Journal of Australia 2000;173(4):176–7.

51 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.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

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.52 Even without a major injury, falls can cause an older adult 

to become fearful or depressed, making it difficult for them to stay active, which in turn 

increases the need for assistance. 

Falls prevention programs help participants to achieve improved strength, balance, and mobility 

and provide education on how to avoid falls and reduce fall risk factors. These programs may 

also involve medication reviews and modifications; provide referrals for medical care 

management for selected fall risk factors; and provide home hazard assessments of ways to 

reduce environmental hazards. Since 2006, more than 35,000 older adults in 38 states have been 

served via ACL-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 clearly demonstrated 

a reduction in falls through randomized controlled trials. For example, when compared with 

control groups, the risk of falling for participants in the Tai Chi: Moving for Better Balance 

intervention decreased by 55 percent;53 and the Stepping On program reduction was 31 percent.54

Matter of Balance is an evidence-based program designed to reduce the fear of falling and 

increase activity levels among older adults. Research has shown significant improvements for 

participants regarding their level of falls management (the degree of confidence participants 

perceive concerning their ability to manage the risk of falls and of actual falls); falls control (the 

degree to which participants perceive their ability to prevent falls); level of exercise; and social 

limitations with regard to concern about falling.55

In addition to reducing falls; these community-based interventions are proven to be 

cost-effective. Matter of Balance participation has been associated with total medical cost 

savings, and cost savings in the unplanned inpatient, skilled nursing facility, and home health 

settings. Participation was associated with a -$938 per participant decrease in total medical costs 

per year. This finding includes a -$517 reduction in unplanned hospitalization costs, a -$234 

reduction in skilled nursing facility costs, and an -$81 reduction in home health costs.56

 

52 Donald IP, Bulpitt CJ. The prognosis of falls in elderly people living at home. Age and Ageing 1999;28:121–5 

53 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.

54 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. 

55 Healy, T.C., Peng, C., Haynes, P., McMahon, E., Botler, J., & Gross, L. (2008). The feasibility and effectiveness 

of translating A Matter of Balance into a volunteer lay leader model. Journal of Applied Gerontology, 27(1): 34-51. 

56 Report to Congress: The Centers for Medicare & Medicaid Services’ Evaluation of Community-based Wellness 

and Prevention Programs
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

65

Additionally, a 2014 cost-benefit analysis found that the benefits from community-based falls 

prevention interventions covered their implementation costs and exceeded direct medical costs, 

resulting in a return on investment (ROI) of 64% for Stepping On, and an ROI of 509% for Tai 

Chi: Moving for Better Balance.57

Funding History: 

Funding for Falls Prevention over the past five years is as follows: 

FY 2014 ...................................................$5,000,000 

FY 2015 ...................................................$5,000,000 

FY 2016 ...................................................$5,000,000 

FY 2017 Annualized CR ..........................$5,000,000 

FY 2018 President’s Budget ....................$5,000,000 

Budget Request: 

ACL maintains funding for the Falls Prevention Program at $5,000,000, the same as the 

annualized FY 2017 Continuing Resolution level. Falls Prevention activities received their first 

dedicated funding in FY 2014, which was used to fund a national resource center and provide 

grants to States, Tribes, and other applicants to implement evidence-based falls prevention 

programs through ACL’s network of community-based provider organizations.

Grants for Falls Prevention programs are used to: 

 Promote and disseminate fall prevention tools, including education and evidence-based 

falls prevention material that can be delivered in community settings. 

 Align with the annual Medicare wellness visits that include screening for falls prevention 

and referrals to community-based interventions, as well as care transitions programs to 

reduce hospital readmissions due to falls. 

 Utilize and expand the local evidence-based program infrastructure for falls prevention 

programs started in the ACL Evidence-Based Disease and Disability Prevention Program. 

 Increase the number of older adults and adults with disabilities at risk for falls who attend 

an evidence-based falls prevention program in their communities. 

 

57 Carande-Kulis, V., et al., A cost–benefit analysis of three older adult fall prevention interventions, Journal of 

Safety Research (2015). Accessed March 23, 2015. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

66

 Gather and promote best practices for development, implementation, and sustainability of 

evidence-based falls prevention programs appropriate for a community setting, including 

innovative collaborations with integrated health care systems and large employer groups. 

Grantees are expected to implement at least one evidence-based falls prevention/management 

program; establish partnerships/coalitions with Falls Prevention coalitions, healthcare providers, 

public health officials, and Aging Disability Resource Centers; and cooperate with federal 

research efforts. Funds may also be used to fund other program support activities, such as a falls 

prevention resource center which will promote education on falls prevention and best practices 

for development, implementation, and sustainability of falls prevention/management programs. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

67

Grant Awards Table: 

Falls Prevention Program Grant Awards 

FY 2016 Final FY 2017

Annualized

FY 2018

President’s 

Budget

Number of 

Awards 9 10 9

Average 

Award $529,946 $476,214 $529,127

Range of 

Awards $85,000 -

$600,000

$150,000 -

$600,000

$150,000 -

$600,000

Resource and Program Data: 

Falls Prevention 

(Dollars in Thousands) 

Mechanism

FY 

2016 

Final

#

FY 2016 

Final

$

FY 2017

CR Annualized

#

FY 2017

CR Annualized

$

FY 2018 

President’s 

Budget

#

FY 2018 

President’s 

Budget

$

Formula Grants --

 

-- -- -- --

 

--

New Discretionary

Grants 2 

 

700 10 

 

4,762 9 

 

4,162 

Continuations Grants 7 

 

4,070 --

 -

- --

 

600 

Contracts 2 

 

223 --

 

200 --

 

200 

Interagency 

Agreements --

 

-- -- -- --

 

--

Program Support /1

 

7 

 

38 

 

38 

Total Resources

 

5,000 

 

5,000 

 

5,000 

1/ Program Support -- Includes funds for overhead, grant systems and review costs, and information technology 

support costs.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

68

Native American Nutrition and Supportive Services 

FY 2016

Final

FY 2017

Annualized 

CR

FY 2018

President's 

Budget

FY 2018 +/-

FY 2017

Native American Nutrition and

Supportive Services................. $31,158 $31,099 $31,099 --

Authorizing Legislation: Sections 201, 613, and 623 of the Older Americans Act of 1965, as 

amended. 

FY 2018 Older Americans Act Authorization ...............................................................$32,601,843

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

Program Description and Accomplishments: 

Native American Nutrition and Supportive Services provides grants to eligible tribal 

organizations to promote the delivery of Nutrition and Home and Community-Based Supportive 

Services to Native American, Alaskan Native, and Native Hawaiian elders. An estimated 

849,000 persons age 60 and over identify themselves as Native American or Alaska Native alone 

or in combination with another racial group.58 Over 492,000 of those elders identify as Native 

American or Alaskan Native with no other racial group.59

Native American Nutrition and Supportive Services grants support a broad range of services to 

older Native Americans, including adult day care; transportation; congregate and home-delivered 

meals; information and referral; and personal care, chore, and other supportive services. 

Currently ACL’s congregate meal program reaches 43 percent of eligible Native American 

seniors in participating Tribal organizations, home-delivered meals reach 19 percent of such 

persons, and supportive services reach 65 percent of such persons. These programs, which help 

to reduce the need for costly nursing home care and medical interventions, are responsive to the 

cultural diversity of Native American communities and represent an important part of each 

community’s comprehensive services. 

 

58 U.S. Census Bureau, Population Division, Annual Estimates of the Resident Population by Sex, Age, Race Alone 

or in Combination, and Hispanic Origen for the United States: April 1, 2010 to July 1 2015 Released June 2016. 

Accessed 29 March 2017.

59 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, 2015. Released June 2016. 

Accessed 29 March 2017. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

69

Services provided by this program in FY 2014 (the most recent year for which data are available) 

include: 

 Transportation Services, which provided nearly 788,000 rides to meal sites, medical 

appointments, pharmacies, grocery stores, and other critical daily activities (Output L). 

 Home-Delivered Nutrition Services, under which 2.6 million meals were provided to 

29,000 homebound Native American elders. The program also provides critical social 

contacts that help to reduce the risk of depression and isolation experienced by many 

home-bound Native American elders (Output M). 

 Congregate Nutrition Services, which provided 2.4 million meals to over 66,000 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 (Output N). 

 Information, Referral and Outreach Services, which provided over 859,000 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 (Output O). 

The Native American Nutrition and Supportive Services program also provides training and 

technical assistance to Tribal organizations to support the development of comprehensive and 

coordinated systems of services to meet the needs of Native American elders. Training and 

technical assistance is provided through national meetings, site visits, website, e-newsletters, 

telephone and written consultations, and through the Native American Resource Centers 

(funded under Aging Network Support Activities). 

Eligible Tribal organizations receive nutrition and supportive services formula grants based on 

their share of the American Indian, Alaskan Native, and Native Hawaiian population age 60 and 

over. Tribal organizations must represent at least 50 Native American elders age 60 and over to 

receive funding. There is no requirement for matching funds. In addition, Tribes may decide the 

age at which a member is considered an elder and thus eligible for services. In FY 2015, grants 

were awarded to 264 Tribal organizations (representing 400 Tribes), including one organization 

serving Native Hawaiian elders.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

70

Funding History: 

Funding for Native American Nutrition and Supportive Services over the past five years is as 

follows: 

FY 2014 .................................................$26,158,000 

FY 2015 .................................................$26,158,000 

FY 2016 .................................................$31,158,000 

FY 2017 Annualized CR ........................$31,098,769 

FY 2018 President’s Budget ..................$31,099,000 

Budget Request: 

The FY 2018 request for Native American Nutrition and Supportive Services is $31,099,000, 

maintaining the annualized FY 2017 Continuing Resolution level. Native American Nutrition 

and Supportive Services, like the same services that Home and Community-Based Supportive 

Services and Nutrition Services fund for States, help to postpone the need for much more 

expensive institutional services. The services provided using these funds, particularly adult day 

care, personal care, chore services, and home-delivered meals, also aid Native American 

caregivers, who might otherwise have to be even more intensively involved with the care of their 

loved ones, at the risk of their own health and careers. 

At the FY 2018 request level, these services will provide 900,000 rides (Output L), 3.0 million 

meals at home (Output M), and 2.8 million meals at congregate sites (Output N) to over 

100,000 Native American seniors. Services help Native American elders, many of whom have 

limitations in activities of daily living that make it difficult to care for themselves, to remain at 

home, in the community, or on the reservation for as long as possible. 

In FY 2018, 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 303, a 38 percent increase over the FY 2002 base of 220 (Outcome 1.3). Over the 

past several years Native American services have generally met or exceeded their efficiency and 

output targets for meals and trips due in part to increased contributions from tribal organizations.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

71

Outcomes and Outputs Table: 

Native American Nutrition and Supportive Services 

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2017

Target

FY 2018

Target

FY 2018

Target

+/-FY 2017

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 2015: 301

Target:

300

(Target Exceeded)

305 303 -2 

Indicator Year and Most Recent 

Result /

FY 2017

Projection

FY 2018

Projection

FY 2018

Projection

+/-FY 2017

Projection

Output L: Transportation 

Services units (Output)

FY 2015: 787,751 900,000 900,000 Maintain

Output M: HomeDelivered Nutrition meals

(Output)

FY 2015: 2.6 M 3.0 M 3.0 M Maintain

Output N: Congregate 

Nutrition meals (Output)

FY 2015: 2.4 M 2.8 M 2.8 M Maintain

Output O: Information, 

Referral and Outreach 

units (Output)

FY 2015: 859,524 1.1 M 1.1 M Maintain

Grant Awards Table: 

Native American Nutrition and Supportive Services Formula Grant Awards 

FY 2016 Final FY 2017

Annualized CR

FY 2018

President’s 

Budget

Number of 

Awards 264 270 270

Average 

Award $112,777 $111,998 $111,998

Range of 

Awards

$75,540 -

$1,505,000

$75,540 -

$1,505,000

$75,540 -

$1,505,000
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

72

Resource and Program Data: 

Native American Nutrition and Supportive Services 

(Dollars in Thousands) 

Mechanism

FY 2016 

Final

#

FY 2016 

Final

$

FY 2017

CR Annualized

#

FY 2017 CR 

Annualized

$

FY 2018 

President’s 

Budget

#

FY 2018 

President’s 

Budget

$

Formula Grants 264 

 

29,773 270 

 

30,240 270 

 

30,240 

New Discretionary

Grants 6 

 

236 1 

 

150 1 

 

150 

Continuations Grants 1 

 

150 --

 

-- --

 

--

Contracts 2 

 

872 1 

 

601 1 

 

601 

Interagency 

Agreements --

 

-- --

 

-- --

 

--

Program Support 1/

 

127 

 

109 

 

109 

Total Resources

 

31,158 

 

31,099 

 

31,099 

1/ Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and review, 

 and information technology support costs.
PROTECTION OF VULNERABLE ADULTS 

73

Aging Network Support Activities 

FY 2016

Final

FY 2017

Annualized 

CR

FY 2018

President's 

Budget

FY 2018 +/-

FY 2017

Aging Network Support Activities $9,961 $9,942 $9,942 --

Authorizing Legislation: Section 202, 215, and 411 of the Older Americans Act of 1965, as 

amended. 

FY 2017 Older Americans Act Authorization ................................. Multiple—See Titles II and IV 

Allocation Method ............................ Competitive Grants/Co-operative Agreements and Contracts 

Program Description and Accomplishments: 

The Aging Network Support Activities program provides competitive grants and contracts to 

support ongoing activities of national significance that help seniors and their families to obtain 

information about their care options and benefits; and provide technical assistance to help States, 

Tribes, and community providers of aging services to develop service systems that help older 

people remain independent and able to live in their own homes and communities. These 

activities provide critical and ongoing support for the national aging services network and help 

support the activities of ACL’s core service delivery programs. 

Competitive grants, cooperative agreements, and contracts for Aging Network Support Activities 

are awarded to eligible public or private agencies, tribal organizations, States, Area Agencies on 

Aging (AAAs), institutions of higher learning, and other organizations representing and/or 

serving older people, including faith-based organizations. Grantees are generally asked to 

provide a match equal to 25 percent of the project’s total cost. Project proposals are reviewed by 

external experts and project awards are made for periods of one to five years. In FY 2016, Aging 

Network Support Activities funded 28 grants with an average award of $350,000. These 

activities are described below. 

National Eldercare Locator and Engagement 

Older Americans and their caregivers face a complicated array of choices and decisions about 

health care, pensions, insurance, housing, financial management, and long-term care. The 

Eldercare Locator, created in 1991, helps seniors and their families navigate this complex 

environment by connecting those needing assistance with State and local agencies on aging that 

serve older adults and their caregivers. The Eldercare Locator can be accessed through a toll-free 

nationwide telephone line (800-677-1116) or 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 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

74

continues to grow as a resource tool for older adults and their caregivers, serving 871,362

individuals in 2016. This service is supplemented by and Information and Referral (I&R) 

Support Center which provides technical assistance and standards for the development of 

effective information and assistance systems. 

A growing body of research also suggests there is a correlation between social engagement and 

positive mental and physical outcomes in older adults. ACL is interested in expanding the reach 

of the Aging Services network to more effectively assist older adults to remain socially engaged 

and active. The Engagement and Older Adults Resource Center provides technical assistance and 

serves as a repository for innovations designed to increase the aging network’s ability to tailor 

social engagement activities to meet the diverse needs of older adults. 

National Alzheimer’s Call Center 

The National Alzheimer’s Call Center is a national information and counseling service for 

persons with Alzheimer’s disease, their family members, and informal caregivers. In the 

12-month period ending January 31, 2017, the National Alzheimer’s Call Center handled over 

305,000 calls through its national and local partners, and its on-line message board community 

recorded over 5.7 million page views. The National Alzheimer’s Call Center is available to 

people in all States, 24 hours a day, 7 days a week, 365 days a year to provide expert advice, care 

consultation, and information and referrals at the national and local levels regarding Alzheimer’s 

disease. Trained professional customer service staff and Master’s degree social workers are 

available at all times. The Call Center is accessible by telephone, website, or e-mail at no cost to 

the caller. Information provided may include basic information on caregiving, handling legal 

issues, resources for long-distance caregiving, and tips for working with the medical community. 

Local community-based organizations are directly involved to ensure local, on-the-ground 

capacity to respond to emergencies and on-going needs of individuals with Alzheimer’s, their 

families, and informal caregivers. The Call Center has multilingual capacity and responds to 

inquiries in at least 140 languages through its own bilingual staff and with the use of a language 

interpretation service. 

Pension Counseling and Retirement Information 

The Pension Counseling program, first funded in 1993, assists older Americans in accessing 

information about their retirement benefits and helps them negotiate with former employers or 

pension plans for due compensation. Currently there are 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 2015, data for the program show 

that: 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

75

 Pension Counseling projects have successfully recovered over $216 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 55,000 individuals by providing hands-on assistance in 

pursuing claims through administrative appeals processes, helping seniors to locate 

pension plans “lost” as a result of mergers and acquisition, answering queries about 

complex plan provisions, and making targeted referrals to other professionals for 

assistance. 

By producing fact sheets and other publications, hosting websites, and conducting outreach, 

education and awareness efforts, Pension Counseling projects also provide indirect services to 

tens of thousands of seniors and their families. 

ACL also supports the National Education and Resource Center on Women and Retirement 

Planning, which provides access to a one-stop gateway that integrates financial information and 

resources on retirement planning for health and long-term care. This project has made userfriendly financial education and retirement planning tools available to traditionally hard-to-reach 

individuals, including low-income women, women of color, women with limited English 

speaking proficiency, rural, and other “underserved” individuals. Information is offered through 

financial and retirement planning programs, workshops tailored to meet women’s special needs, 

and published in hard copy and web-based formats. Since its establishment in 1998, the Center 

has conducted approximately 200 workshops per year on strategies to access financial and 

retirement planning information. It has developed and published over 175 Fact Sheets tailored to 

the specific needs of hard-to-reach women and maintains an interactive website. 

National Resource Centers on Native American Elders 

The National Resource Centers on Native American Elders enhance knowledge about older 

Native Americans and thereby improve the delivery of services to them. Each resource center 

addresses at least two areas of primary concern which are specified in the OAA. These include 

health issues, long-term care (including in-home care), elder abuse, mental health, and other 

problems and issues facing Native communities. The Resource Centers are administered under 

cooperative agreements by institutions of higher education. The resource centers partner with 

Native American organizations and communities, educational institutions (including tribal 

colleges and universities), and professionals and paraprofessionals in the field. Resource centers 

have specialized areas of interest. For example, the University of North Dakota Resource Center 

has assisted Title VI grantees in assessing needs of tribal elders to determine program planning 

and direction. This process has developed a database of information about American Indian, 

Alaska Native and Native Hawaiian Elders. The University of Hawaii Resource Center has 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

76

focused on long term care needs of Native Hawaiian Elders. The University of Alaska Resource 

Center has focused on elder abuse and neglect issues within Native communities. 

National Minority Aging Organizations Technical Assistance Centers 

The National Minority Aging Organizations (NMAO) Technical Assistance Centers program 

works to reduce or eliminate health disparities among racial, ethnic, and other minority older 

individuals. These centers design and disseminate front line health promotion and disease 

prevention information that is culturally and linguistically appropriate for older individuals of 

African American, Hispanic, Asian American and Pacific Islander descent, American Indian and 

Alaska Native elders, as well as for older lesbian, gay, bisexual, and transgender (LGBT) adults. 

Each NMAO project pilots a practical, nontraditional, community-based intervention for 

reaching older individuals who experience barriers to accessing home and community-based 

services. Interventions are focusing on barriers due to language and low literacy as well as those 

directly related to cultural diversity. Strategies developed under this program incorporate the 

latest technology and facilitate the generation and dissemination of knowledge in forms that can 

assist minority older individuals to practice positive health behaviors and strengthen their 

capacity to maintain active, independent life styles. Examples of products resulting from these 

grants include a chronic disease self-management curriculum and manual tailored for racial and 

ethnic minority seniors, a series of bilingual Influenza Vaccination Promotion materials, a 

referral database of Chronic Disease Self-Management Education (CDSME) workshops, and a 

culturally appropriate caregiver manual/toolkit for American Indian and Alaskan Native 

caregivers caring for elders with dementia. 

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. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

77

Program Performance and Technical Assistance 

This activity supports cooperative efforts between ACL and selected states and AAAs to develop 

tools, performance measures, and best practices that can be used to effectively and efficiently 

identify the results produced through OAA programs on an ongoing basis. It also supports 

partnerships with National Aging Organizations to foster innovation and provide technical 

assistance to states, AAAs, and tribal organizations in strategic planning, program development, 

and performance improvement. 

Funding History: 

Comparable funding for Aging Network Support Activities over the past five years is as follows: 

FY 2014 ...................................................$7,406,000 

FY 2015 ...................................................$9,961,000 

FY 2016 ...................................................$9,961,000 

FY 2017 Annualized CR ..........................$9,942,064 

FY 2018 President’s Budget ....................$9,942,000 

Budget Request: 

The FY 2018 request for Aging Network Support Activities is $9,442,000, maintaining the 

annualized FY 2017 Continuing Resolution level. Programs funded by this request provide 

ongoing support for the national aging services network and are needed to support the activities 

of ACL’s core service delivery programs. Not only do they provide a variety of unique services, 

– such as the National Alzheimer’s Call Center and the National Eldercare Locator – these 

programs also considerably strengthen and streamline ACL’s core services, and are critical to our 

continuing success. 

Aging Network Support Activities outcomes are reflected in performance targets for Health and 

Independence for Older Adults and Caregiver and Family Support Services. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

78

Aging Network Support Activities includes funding for the following projects (dollars in thousands): 

Aging Network Support Activity

FY 2016

Final

FY 2017

Annualized 

CR

FY 2018

President’s 

Budget

National Eldercare Locator and Engagement ........................................ $2,038 $2,035 $2,035

National Alzheimer's Call Center.......................................................... 946 944 944

Pension Counseling and Retirement Information.................................. 1,858 1,854 1,854

National Resource Centers on Native Americans ................................. 655 653 653

National Minority Aging Organizations................................................ 1,165 1,163 1,163

Holocaust Survivor Assistance.............................................................. 2,500 2,495 2,495

Program Performance and Technical Assistance .................................. 799 798 798

Total, Aging Network Support Activities...................................... $9,961 $9,942 $9,942

Grant Awards Table: 

Aging Network Support Grant Awards 

FY 2016 Final FY 2017

Annualized CR

FY 2018

President’s 

Budget

Number of 

Awards 28 28 25

Average 

Award $349,951 $346,082 $387,612

Range of 

Awards

$50,000 -

$2,467,500

$20,000 -

$2,467,500

$20,000 -

$2,467,500
HEALTH AND INDEPENDENCE FOR OLDER ADULTS 

79

Resource and Program Data: 

Aging Network Support Activities 

(Dollars in thousands) 

Mechanism

FY 

2016 

Final

#

FY 2016 

Final

$

FY 2017

CR 

Annualized

#

FY 2017

CR Annualized

$

FY 2018 

President’s 

Budget

#

FY 2018 

President’s 

Budget

$

Formula Grants --

 

-- --

 -

- --

 

--

New Discretionary

Grants 5 

 

846 5 

 

578 10 

 

4,022 

Continuations Grants 23 

 

8,953 23 

 

9,113 15 

 

5,669 

Contracts 1 

 

10 --

 -

- --

 

--

Interagency 

Agreements --

 

-- --

 -

- --

 

--

Program Support 1/

 

152 

 

271 

 

271 

Total Resources

 

9,961 28 

 

9,961 25 

 

9,961 

1/ Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and review, 

and information technology support costs. 
PROTECTION OF VULNERABLE ADULTS 

80

Caregiver and Family Support Services 

Summary of Request 

Families are the nation’s primary provider of long-term care, but a number of factors including 

financial constraints, work and family demands, and the many challenges of providing care place 

great pressure on family caregivers. Caregiving responsibilities demand time and money from 

families who too often are already strapped for both. ACL’s caregiver programs provide services 

that address the needs of unpaid, informal caregivers, allowing many of them to continue to work 

while providing critically needed care. 

Better support for informal caregivers is critical because often it is their availability--whether 

they are family members or unrelated friends and neighbors who dedicate their time--that 

determine whether an older person can remain in his or her home. In 2013, approximately 

34.2 million adult caregivers provided uncompensated care to those 50 years of age and older.60

The economic cost of replacing unpaid caregiving of elderly adults is estimated to be between 

$470 billion61 and $522 billion annually,62 higher than that of all Medicaid spending in FY 2014 

(Federal and State: $476 billion).63

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.64 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-three percent of the caregivers 

served by OAA programs report that these services allow them to provide care longer than they 

otherwise could have.65

 

60 National Alliance for Caregiving, and AARP Public Policy Institute. Caregiving in the US, 2015 report. June 

2015 Washington DC.

61 S. C. Reinhard, L. Feinberg, R. Choula, and A. Houser, Valuing the Invaluable: 2015 Update, Undeniable 

Progress, but Big Gaps Remain (Washington, DC: AARP Public Policy Institute, July 2015). Accessed 01/13/2016

62 The Opportunity Costs of Informal Elder-Care in the United States. Rand Corporation. Also Valuing the 

Invaluable: 2011 Update, The Growing Contributions and Costs of Family Caregiving. AARP Public Policy 

Institute. July 2011. 

63 “Total Medicaid Spending,” The Henry J. Kaiser Family Foundation, 2014.

64 Schulz R, Beach SR. Caregiving as a risk factor for mortality. The Caregiver Health Effects study. JAMA 

December 15, 1999;282:2215-9.

65 2016 National Survey of Older Americans Act Participants. 
CAREGIVER AND FAMILY SUPPORT SERVICES 

81

At the same time, ACL recognizes that the need for more caregivers is growing every day. By 

2020, it is projected that there will be 16.4 million non-institutionalized seniors age 65 and over 

with 1+ ADL deficits, an increase of 2.5 million older adults (or an 18 percent increase between 

2015 and 2020) needing caregiver assistance.66 To address these caregiver-related needs, ACL 

requests a total of $180,661,000, an increase of +$4,199,125 above the annualized FY 2017 

Continuing Resolution level. The request includes: 

 $150,300,000 for Family Caregiver Support Services, maintaining the annualized 

FY 2017 Continuing Resolution level. This program makes a range of support services 

available to family and informal caregivers--including counseling, respite care, and 

training--that assist family and informal caregivers to care for their loved ones at home 

for as long as possible. Studies have shown that these supports can reduce caregiver 

depression, anxiety, and stress and enable them to provide care longer, thereby avoiding 

or delaying the need for costly nursing home care. 

 $7,517,000 for Native American Caregiver Support Services, maintaining the annualized 

FY 2017 Continuing Resolution level. This program makes a range of services available 

to Native American caregivers, including information and outreach, access assistance, 

individual counseling, support groups and training, respite care and other supplemental 

services. 

 $19,491,000 for a consolidated Alzheimer’s Disease Program. This is the first year 

funding is being requested for this program which consolidates three existing ACL 

Alzheimer’s programs into a single, more flexible program while maintaining the total 

level of funding available. Separate funding streams for the Alzheimer’s Disease 

Supportive Services program (ADSSP) and the Alzheimer’s Disease Initiative--

Specialized Services Program (ADI-SSS) are eliminated. 

 $3,354,000 for Lifespan Respite Care, maintaining the annualized FY 2017 Continuing 

Resolution 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. 

 

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

Age, Sex, Race, and Hispanic Origin for the United States: 2014 to 2060. Released December 2014. Accessed 08 

January 2015. Centers for Medicare & Medicaid Services, The characteristics and perceptions of the Medicare 

population. Data from the 2013 Medicare Current Beneficiary Survey. [data tables 2.5a]. Accessed 10 January 2016. 
CAREGIVER AND FAMILY SUPPORT SERVICES 

82

As a group, these programs support caregivers, elders, and people of all ages with disabilities by 

providing critical respite care and other support services for family caregivers, training and 

recruitment of care workers and volunteers, information and outreach, counseling, and other 

supplemental services. 
CAREGIVER AND FAMILY SUPPORT SERVICES 

83

Family Caregiver Support Services 

FY 2016

Final

FY 2017

Annualized 

CR

FY 2018

President's 

Budget

FY 2018 +/-

FY 2017

Family Caregiver Support 

Services

$150,586 $150,300 $150,300 --

Authorizing Legislation: Section 371 of the Older Americans Act of 1965, as amended. 

FY 2018 Older Americans Act Authorization .............................................................$157,564,066

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

Program Description and Accomplishments: 

The Family Caregiver Support Services Program provides formula grants to states and territories, 

based on their share of the population age 70 and over, to fund a range of supports that assist 

family and informal caregivers to care for their loved ones at home for as long as possible. The 

program includes five basic system components: information, access assistance, counseling and 

training, respite care, and supplemental services. These services work in conjunction with other 

OAA services to provide a coordinated set of supports that caregivers can access on behalf of 

themselves and the seniors for whom they provide care. Based on FY 2015 data, the most recent 

available, services included: 

 Access Assistance Services provided nearly 1.2 million contacts to caregivers assisting 

them in locating services from a variety of public and private agencies (Output I). 

 Counseling and Training Services provided over 116,000 caregivers with counseling, 

peer support groups, and training to help them better cope with the stresses of caregiving 

(Output J). 

 Respite Care Services provided over 67,000 caregivers with approximately 6.3 million 

hours of temporary relief, at home or in an adult day care or nursing home setting, from 

their caregiving responsibilities (Output K). 

Family and other informal caregivers are the backbone of America’s long-term care system. On a 

daily basis, these individuals assist relatives and other loved ones with tasks ranging from 

personal care and homemaking to more complex health-related interventions like medication 
CAREGIVER AND FAMILY SUPPORT SERVICES 

84

administration and wound care. The economic cost of replacing unpaid caregiving is estimated to 

be between $47067 and $522 billion annually, which is roughly equivalent to the cost of all

Medicaid spending in FY 2014 (Federal and state: $476 billion).68 The cost to replace that care 

with unskilled paid care at minimum wage was estimated at $221 billion, while replacing it with 

skilled nursing care could cost $642 billion annually. 

Research has also shown that caregiving exacts a heavy emotional, physical, and financial toll. 

Caregivers often experience conflicts between work and caregiving, with 25 percent reporting 

that they have had to make adjustments such as retiring or taking time away from work due to 

their caregiving responsibilities. As reported in ACL’s National Survey of OAA Participants, 

over 25 percent of caregivers are assisting two or more individuals. Over 70 percent of Title III 

caregivers are 60 or older, making them more susceptible to a decline in their own health, and 

29 percent describe their own health as fair to poor.69 The demands of caregiving can lead to a 

breakdown of the caregiver’s health, and the illness, hospitalization, or death of a caregiver 

increases the risk for institutionalization of the care recipient. 

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.70

Additionally, data from ACL’s National Surveys of caregivers of elderly clients also shows that 

OAA services, including those provided through the Family Caregiver Support Services 

Program, are effective in helping caregivers keep their loved ones at home. Approximately 

73 percent of caregivers of program clients reported that services enabled them to provide care 

longer than otherwise would have been possible.71 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. Nearly 40 percent of caregivers indicated that the care recipient would be 

unable to remain at home without the support services. Those respondents were then asked to 

identify where the care recipient would be living without services. A significant majority of 

 

67 S. C. Reinhard, L. Feinberg, R. Choula, and A. Houser, Valuing the Invaluable: 2015 Update, Undeniable 

Progress, but Big Gaps Remain (Washington, DC: AARP Public Policy Institute, July 2015). Accessed 01/13/2016 

68 “Total Medicaid Spending,” The Henry J. Kaiser Family Foundation, 2013. 

69 2016 National Survey of Older Americans Act Participants. 

70 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. 

71 2014 National Survey of Older Americans Act Participants.
CAREGIVER AND FAMILY SUPPORT SERVICES 

85

those caregivers, 74 percent, indicated that the care recipient would most likely be living in a 

nursing home or assisted living (see below). 

Funding History: 

Funding for Family Caregiver Support Services over the past five years is as follows: 

FY 2014 ...............................................$145,586,000 

FY 2015 ...............................................$145,586,000 

FY 2016 ...............................................$150,586,000 

FY 2017 Annualized CR ......................$150,299,736 

FY 2018 President’s Budget ................$150,300,000 

Budget Request: 

The FY 2018 request for Family Caregiver Support Services is $150,300,000, maintaining the 

annualized FY 2017 Continuing Resolution level. Funding for Family Caregiver Support 

Services will allow ACL to maintain services that give caregivers the assistance needed to help 

them sustain their caregiving and provide care longer. By helping caregivers so that they in turn 

can help to keep their loves ones independent and out of an institution for a longer period, 

investments in this program can reduce costs to the Federal government in other areas such as 

Medicaid. 

Deceased, 

2.26%

Other, 1.44%

Caregiver's 

Home, 8.79%

Home of 

Another Family 

Mem/Friend, 

13.45%

Assisted Living 

Facility, 19.98%

Nursing Home, 

54.07%

Where Care Recipient Would Live if Unable to 

have Caregiver's Support Services
CAREGIVER AND FAMILY SUPPORT SERVICES 

86

Funding at this level will allow 850,000 caregivers (Outcome 3.1) to receive supportive services, 

including respite care or other temporary relief from their caregiving responsibilities that will 

assist them to continue providing care for their loved ones. As many as 120,000 caregivers will 

also have the opportunity to participate in counseling, peer support groups, and training to help 

them better cope with the stresses of caregiving (Output J). 

In FY 2018, ACL expects the aging services network 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 2015, that rate had been reduced to 33 

percent of caregivers reporting difficulty getting services. 

For FY 2018, the performance target for Family Caregiver Support Services Program 

participants who rate services good to excellent is 90 percent (Outcome 2.9c). The substantive 

improvements in program performance can be attributed to the successful implementation of the 

program. Client-reported assessment of service quality and program outcomes is also expected to 

remain at high levels.
CAREGIVER AND FAMILY SUPPORT SERVICES 

87

Outcomes and Outputs Table: 

Family Caregiver Support Services 

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2017

Target

FY 2018

Target

FY 2018

Target

+/-FY 2017

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 2015: 8,789 clients

Target:

9,250 clients

(Target Not Met)

9,000 clients 8,800 clients -200 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 2015: 33.25%

Target:

27%

(Target Not Met but 

Improved)

26.8% 30% +3.2 

2.9c Maintain at 90% or 

higher the percentage of 

National Family 

Caregiver Support 

Program clients who rate 

services good to 

excellent. (Outcome)

FY 2015: 93.4%

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 2015: 62.7 weighted 

average

Target:

62.5 weighted average

(Target Exceeded)

63.25 weighted 

average

63.25 weighted 

average

Maintain

3.1 Increase the number 

of caregivers served 

through the National 

Family Caregiver 

Support Program. 

(Outcome)

FY 2015: 757,403 caregivers

Target:

790,000 caregivers

(Target Not Met)

900,000 

caregivers

850,000 

caregivers

-50,000 caregivers
CAREGIVER AND FAMILY SUPPORT SERVICES 

88

Indicator Year and Most Recent 

Result /

FY 2017

Projection

FY 2018

Projection

FY 2018

Projection

+/-FY 2017

Projection

Output I: Caregivers 

access assistance units of 

service. (Output)

FY 2015: 1.2 M 1.30 M 1.35 M +500,000

Output J: Caregivers 

receiving counseling and 

training. (Output)

FY 2015: 116,542 123,000 120,000 -3,000

Output K: Caregivers 

receiving respite care 

services. (Output)

FY 2015: 67,305 66,000 66,000 Maintain

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

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

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

achieving current strategic objectives. 

Grant Awards Table: 

Family Caregiver Supportive Services Grant Awards 

FY 2016 Final FY 2017

Annualized CR

FY 2018

President’s 

Budget

Number of 

Awards 56 56 56

Average 

Award $2,669,169 $2,657,084 $2,657,089

Range of 

Awards

$93,421 -

$15,390,530

$92,998 -

$15,443,745

$92,998 -

$15,433,775
CAREGIVER AND FAMILY SUPPORT SERVICES 

89

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

ADMINISTRATION ON AGING 

FY 2018 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: Family Caregivers Support Services (CFDA 93.052) 

State/Territory FY 2016 Actual FY 2017

Annualized CR

FY 2018

President's Budget FY 2018 +/- FY 

2017

Alabama....................................... 2,279,069 2,259,498 2,259,502 4

Alaska.......................................... 747,367 743,983 743,985 2

Arizona......................................... 3,346,118 3,394,917 3,394,922 5

Arkansas....................................... 1,446,132 1,432,369 1,432,371 2

California..................................... 15,390,530 15,433,749 15,433,775 26

Colorado....................................... 2,005,562 2,021,363 2,021,366 3

Connecticut.................................. 1,751,433 1,725,321 1,725,324 3

Delaware...................................... 747,367 743,983 743,985 2

District of Columbia.................... 747,367 743,983 743,985 2

Florida.......................................... 12,175,645 12,248,919 12,248,940 21

Georgia......................................... 3,691,256 3,727,264 3,727,270 6

Hawaii.......................................... 747,367 743,983 743,985 2

Idaho............................................ 747,367 743,983 743,985 2

Illinois.......................................... 5,579,518 5,483,451 5,483,460 9

Indiana......................................... 2,913,777 2,876,664 2,876,669 5

Iowa............................................. 1,579,568 1,548,662 1,548,664 2

Kansas.......................................... 1,313,589 1,294,568 1,294,570 2

Kentucky...................................... 1,989,094 1,969,851 1,969,854 3

Louisiana...................................... 1,925,518 1,913,480 1,913,484 4

Maine........................................... 747,367 743,983 743,985 2

Maryland...................................... 2,503,548 2,499,421 2,499,425 4

Massachusetts.............................. 3,168,410 3,136,653 3,136,659 6

Michigan...................................... 4,738,888 4,671,130 4,671,138 8

Minnesota..................................... 2,448,987 2,428,170 2,428,174 4

Mississippi................................... 1,314,791 1,299,152 1,299,155 3

Missouri....................................... 2,922,404 2,883,893 2,883,898 5

Montana....................................... 747,367 743,983 743,985 2

Nebraska...................................... 862,082 848,723 848,724 1

Nevada......................................... 1,185,340 1,205,266 1,205,268 2

New Hampshire........................... 747,367 743,983 743,985 2
CAREGIVER AND FAMILY SUPPORT SERVICES 

90

PROGRAM/CFDA NUMBER: Family Caregivers Support Services (CFDA 93.052)

State/Territory FY 2016 Actual FY 2017

Annualized CR

FY 2018

President's Budget FY 2018 +/- FY 

2017

New Jersey.......................... 4,121,143 4,062,716 4,062,723 7

New Mexico....................... 952,990 953,090 953,092 2

New York........................... 9,085,852 8,943,406 8,943,421 15

North Carolina.................... 4,428,714 4,445,119 4,445,126 7

North Dakota...................... 747,367 743,983 743,985 2

Ohio.................................... 5,613,283 5,507,406 5,507,416 10

Oklahoma............................ 1,748,862 1,731,823 1,731,826 3

Oregon................................ 1,912,618 1,919,084 1,919,087 3

Pennsylvania....................... 6,797,425 6,658,471 6,658,482 11

Rhode Island....................... 747,367 743,983 743,985 2

South Carolina.................... 2,270,483 2,290,849 2,290,853 4

South Dakota...................... 747,367 743,983 743,985 2

Tennessee............................ 2,984,205 2,976,486 2,976,491 5

Texas................................... 9,354,202 9,406,435 9,406,451 16

Utah.................................... 900,695 903,231 903,233 2

Vermont.............................. 747,367 743,983 743,985 2

Virginia............................... 3,467,798 3,477,346 3,477,352 6

Washington......................... 2,972,693 2,995,494 2,995,499 5

West Virginia...................... 1,004,589 987,750 987,751 1

Wisconsin........................... 2,746,803 2,712,604 2,712,609 5

Wyoming............................ 747,367 743,983 743,985 2

Subtotal, States................... 146,609,385 145,945,573 145,945,829 256

American Samoa................. 93,421 92,998 92,998 -

Guam.................................. 373,684 371,992 371,993 1

Northern Mariana Islands... 93,421 92,998 92,998 -

Puerto Rico......................... 1,929,864 1,921,186 1,921,189 3

Virgin Islands..................... 373,684 371,992 371,993 1

Subtotal, States and Territories 149,473,459 148,796,739 148,797,000 261

Program Support 1/................... 1,112,541 1,502,997 1,503,000 3

TOTAL...................................... 150,586,000 150,299,736 150,300,000 264

1/ Program Support – Includes funds for Older Americans Act statutory requirements, including program evaluation and disaster 

assistance; and grant and program reporting systems costs. Funds unused for these purposes at the end of the year are allocated 

to States. 
CAREGIVER AND FAMILY SUPPORT SERVICES 

91

Native American Caregiver Support Services 

FY 2016

Final

FY 2017

Annualized 

CR

FY 2018

President's 

Budget

FY 2018 +/-

FY 2017

Native American Caregiver 

Support Services $7,531 $7,517 $7,517 --

Authorizing Legislation: Section 631 of the Older Americans Act of 1965, as amended. 

FY 2018 Authorization ....................................................................................................$7,879,982

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

Program Description and Accomplishments: 

Native American Caregiver Support Services provide grants to eligible tribal organizations to 

support family and informal caregivers of Native American, Alaskan Native, and Native 

Hawaiian elders. This program, which helps to reduce the need for costly nursing home care and 

medical interventions, is responsive to the cultural diversity of Native American communities 

and represents an important part of each community’s comprehensive services. 

Native American Caregiver Support Services funding is allocated to eligible tribal organizations 

based on their share of the American Indian, Alaskan Native, and Native Hawaiian populations 

aged 60 and over. Tribal organizations must represent at least 50 Native American elders age 60 

and over and must also receive a grant under the Native American Nutrition and Supportive 

Services program to receive funding. There is no requirement for matching funds. Tribes may 

also decide the age at which a member is considered an elder and thus eligible for services. In 

addition, there is no limit on the percentage of funds that can be used for services to grandparents 

caring for grandchildren. 

Grants assist American Indian, Alaskan Native and Native Hawaiian families caring for older 

relatives with chronic illness or disability and grandparents caring for grandchildren. The 

program provides a variety of direct services that meet a range of caregiver needs, including 

information and outreach, access assistance, individual counseling, support groups and training, 

respite care, and other supplemental services. Tribal organizations coordinate with other 

programs to help support and create sustainable caregiver programs in Native American 

communities (many of which are geographically isolated). A core value of the Native American 

Caregiver Support Services program is that the program should not replace the tradition of families 
CAREGIVER AND FAMILY SUPPORT SERVICES 

92

caring for their elders. Rather, as expressed by multiple tribal leaders, the program provides 

support that strengthens the family caregiver role. 

Funding History: 

Funding for the Native American Caregiver Support Services over the past five years is as 

follows: 

FY 2014 ...................................................$6,031,000 

FY 2015 ...................................................$6,031,000 

FY 2016 ...................................................$7,531,000 

FY 2017 Annualized CR ..........................$7,516,684 

FY 2018 President’s Budget ....................$7,517,000 

Budget Request: 

The FY 2018 request for Native American Caregiver Support Services is $7,517,000, 

maintaining the annualized FY 2017 Continuing Resolution level. Continued support for 

caregivers is critical since often it is their availability – whether they are family members or 

unrelated friends and neighbors who volunteer their time – that determines whether an older 

person can remain in his or her home. 

An estimated 849,000 persons age 60 and over identify themselves as Native American or 

Alaska Native alone or in combination with another racial group.72 Over 492,000 of those elders 

identify as Native American or Alaskan Native with no other racial group73. 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 2018, funding for the Native American 

 

72 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, 2015 

Released June 2016, accessed 30 March 2017. 

73 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, 2015. Release Date: June 2016. 

Accessed on 29 March 2017. 
CAREGIVER AND FAMILY SUPPORT SERVICES 

93

Caregiver Support Program will continue to assist family and informal caregivers, whose 

assistance is critical to enabling Native American elders to remain at home, in the community, 

and/or on the reservation. It is estimated that in FY 2018 more than 500,000 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 2017

Target

FY 2018

Target

FY 2018

Target

+/-FY 2017

Target

3.1 Increase the number 

of caregivers served 

through the National

Family Caregiver 

Support Program. 

(Outcome)

FY 2015: 757,403 caregivers

Target:

790,000 caregivers

(Target Not Met)

900,000 

caregivers

850,000 

caregivers

-50,000 caregivers

Grant Awards Table: 

Native American Caregivers Supportive Services Grant Awards 

FY 2016 Final FY 2017

Annualized CR

FY 2018

President’s 

Budget

Number of 

Awards 233 231 231

Average 

Award $25,882 $32,430 $32,430

Range of 

Awards

$14,270 -

$57,120

$14,270 -

$57,120

$14,270 -

$57,120
CAREGIVER AND FAMILY SUPPORT SERVICES 

94

Resource and Program Data: 

Native American Caregiver Support Services 

(Dollars in thousands) 

Mechanism

FY 

2016 

Final

#

FY 2016 

Final

$

FY 2017

CR Annualized

#

FY 2017

CR Annualized

$

FY 2018 

President’s 

Budget

#

FY 2018 

President’s 

Budget

$

Formula Grants 231 

 

6,016 231 

 

7,491 231 

 

7,491 

New Discretionary

Grants 2 

 

14 -- -- --

 

--

Continuations Grants --

 

-- -- -- --

 

--

Contracts --

 

-- -- -- --

 

--

Interagency 

Agreements --

 

-- -- -- --

 

--

Program Support 1/

 

1 

 

40 

 

40 

Total Resources

 

6,031 

 

7,531 

 

7,531 

1/ Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and review, 

and information technology support costs. 
CAREGIVER AND FAMILY SUPPORT SERVICES 

95

Alzheimer’s Disease Program 

FY 2016

Final

FY 2017

Annualized 

CR

FY 2018

President's 

Budget

FY 2018+/-

FY 2017

Alzheimer’s Disease Program $0 $0 $19,490 +$19,490

Authorizing Legislation: Section 411 of the Older Americans Act of 1965, as amended. 

FY 2018 Older Americans Act Authorization ................................. No specific amount authorized 

Allocation Method ............................ Competitive Grants/Co-operative Agreements and Contracts 

Program Description and Accomplishments: 

The effects of Alzheimer’s Disease and Related Dementias (ADRD) are devastating for 

individuals living with the disease and their family caregivers. Serving people with ADRD 

typically requires significant levels of health care as well as the provision of person-centered, 

dementia-capable home and community-based services (HCBS). Of the community dwelling 

individuals with ADRD, approximately one-third live alone, exposing them to numerous risks,

including unmet needs, malnutrition and injury and various forms of neglect and exploitation.74

As the number of people with ADRD is projected to grow by almost 300% by 205075 from an 

estimated 5.3 million individuals, it is increasingly important to develop effective and 

coordinated service delivery and health care systems that are responsive to these individuals and 

their caregivers. 

Three ACL programs--Alzheimer’s Disease Supportive Services, Alzheimer’s Disease Initiative-

-Specialized Supportive Services, and Alzheimer’s Disease Initiative--Communications 

Campaign--currently address the needs of individuals living with ADRD and their caregivers. 

Two of these programs fund demonstration grants and/or direct services and have some degree of 

overlap as well as significantly different requirements for grantees: 

 The Alzheimer’s Disease Supportive Services Program (ADSSP) funds competitive 

grants limited to States to expand the availability of evidence-based services that support 

persons with Alzheimer’s disease and related dementias (ADRD) and their family 

 

74 Gould, E., Maslow, K., Yuen, P., Wiener, J. Providing Services for People with Dementia Who Live Alone: Issue 

Brief. Accessed April 14, 2014.

75 Alzheimer’s Association. 2017 Alzheimer’s Disease Facts and Figures. Accessed May 9, 2017. 
CAREGIVER AND FAMILY SUPPORT SERVICES 

96

caregivers; and to create state-wide, person-centered, dementia-capable home and 

community-based service (HCBS) systems. Half of the funding must be used to provide 

direct services. The program’s primary components include the translation and 

implementation of evidence-based supportive services at the community level; 

development and delivery of statewide person-centered, dementia-capable HCBS 

systems; and incorporation of evidence-based research in the formulation of innovative 

projects. 

 The Alzheimer’s Disease Initiative - Specialized Supportive Services (ADI-SSS)

program was designed to fill gaps in existing dementia-capable home and 

community-based service (HCBS) systems. The ADI-SSS currently provides funding to 

develop and implement specialized, person-centered services that help individuals remain 

independent and safe in their communities, while providing much needed supports to 

their caregivers. 

The third program funds public awareness efforts, including support for two websites: 

Brainhealth.gov and Alzheimers.gov. 

In addition to these three programs, ACL also funds, and will continue to support within its 

Aging Network Support Activities line item, a single grant for the National Alzheimer’s Call 

Center, a national information and counseling service for persons with Alzheimer’s Disease, 

their family members and informal caregivers. 

Funding History: 

This is the first year funding is requested: 

FY 2014 .................................................................$0 

FY 2015 .................................................................$0 

FY 2016 .................................................................$0 

FY 2017 Annualized CR ........................................$0 

FY 2018 President’s Budget/1 ...............$19,490,000 
CAREGIVER AND FAMILY SUPPORT SERVICES 

97

Budget Request: 

In FY 2018 ACL is requesting $19,490,000 to fund a new consolidated Alzheimer’s Disease 

Program that replaces three existing ACL Alzheimer’s programs: Alzheimer’s Disease 

Supportive Services, Alzheimer’s Disease Initiative--Specialized Supportive Services, and 

Alzheimer’s Disease Initiative--Communications Campaign. 

The need for cutting edge approaches that serve those with Alzheimer’s and their caregivers 

continues to grow as the incidence of and population with the disease increase. One study 

estimates that there were 454,000 new cases of Alzheimer’s disease in 2010. The annual number 

of new cases is projected to be 615,000 by 2030, and 959,000 by 2050.76

Facing a growing population, at a time of tight budgetary constraints, ACL must be able to 

maximize the use of its funding. Consolidating similar Alzheimer’s Disease activities into a 

single grant program will provide greater flexibility to States, territories, Tribes and localities to 

meet the needs of their communities. 

Programmatically, combining the three programs into a single, more flexible program will give 

ACL the greatest ability to assist individuals with ADRC and their caregivers without changing 

funding levels. Under the Alzheimer’s Disease program, ACL will continue to support: 

 Creating state-wide, person-centered, dementia-capable home and community-based 

service (HCBS) systems. 

 Translating and implementing evidence-based supportive services for persons with 

ADRD and their caregivers at the community level. 

 Working with public and private entities to identify and address the special needs of 

persons with ADRD and their caregivers. 

 Offering direct services and other supports to thousands of persons with ADRD and their 

caregivers.

 

76 Alzheimer’s Association, (2014). “2014 Alzheimer’s Disease Facts and Figures”. Accessed August 08, 2014. 
CAREGIVER AND FAMILY SUPPORT SERVICES 

98

Grant Awards Tables: 

Alzheimer’s Disease Program/1

FY 2016 Final FY 2017 

Annualized CR

FY 2018 

President's 

Budget

Number of 

Awards NA NA 35

Average 

Award NA NA $492,919

Range of 

Awards NA NA

$276,127 -

$1,000,000

1/The number of awards is an estimate and may change. 

Resource and Program Data: 

Alzheimer’s Disease Program 

Mechanism

FY 2016 

Final

#

FY 2016 

Final

$

FY 2017

CR Annualized

#

FY 2017 CR 

Annualized

$

FY 2018 

President’s 

Budget

#

FY 2018 

President’s 

Budget

$

Formula Grants --

 

-- --

 

-- --

 

--

New Discretionary

Grants/1 --

 

-- --

 

-- 35 

 

17,252 

Continuations Grants --

 

-- --

 

-- --

 

--

Contracts --

 

-- --

 

-- 1 

 

2,000 

Interagency Agreements --

 

-- --

 

-- --

 

--

Program Support /2

 

-- --

 

--

 

238 

Total Resources

 

-- --

 

--

 

19,490 

1/The number of awards is an estimate and may change. 

2/ Program Support -- Includes funds for statutory requirements, grant systems and 

review costs. 
CAREGIVER AND FAMILY SUPPORT SERVICES 

99

Alzheimer’s Disease Supportive Services Program 

FY 2016

Final

FY 2017

Annualized 

CR

FY 2018

President's 

Budget

FY 2018 +/-

FY 2017

ADSSP............................ $4,800 $4,791 $0 -$4,791

Authorizing Legislation: Section 398 of the Public Health Services Act, as amended 

FY 2018 Authorization ......................................................................................................... Expired 

Allocation Method ............................. Competitive Grants/Cooperative Agreements and Contracts 

Program Description and Accomplishments: 

The Alzheimer’s Disease Supportive Services Program (ADSSP) funds competitive grants to 

States to expand the availability of evidence-based services that support persons with 

Alzheimer’s disease and related dementias (ADRD) and their family caregivers; and to create 

state-wide, person-centered, dementia-capable home and community-based service (HCBS) 

systems. 

These systems have been able to identify persons with ADRD and their family caregivers, 

understand their unique circumstances, communicate appropriately with them, help them identify 

and choose services that meet their needs, and provide supports to ease caregiver stress. 

Dementia-capable systems also help persons with dementia and their family caregivers remain 

independent and in the community. The primary components of the ADSSP program include the 

translation and implementation of evidence-based supportive services for persons with ADRD 

and their caregivers at the community level; development and delivery of statewide 

person-centered, dementia-capable HCBS systems; and incorporation of evidence-based research 

in the formulation of innovative projects. 

Twelve states funded in prior program years continue to offer seven dementia specific evidencebased interventions. One example of an evidence-based intervention implemented through the 

ADSSP program is the New York University Caregiver Intervention (NYUCI), a spousal 

caregiver support program that in a randomized-control trial delayed institutionalization of 
CAREGIVER AND FAMILY SUPPORT SERVICES 

100

persons with Alzheimer’s Disease by an average of 557 days.77 The state of Minnesota has 

translated this intervention and results are consistent with the original study.78 Due to the success 

of the translation of the NYUCI program in their states, Minnesota, California, and Georgia 

continue to offer it well beyond the program funding period. 

Funding History: 

Funding for the ADSSP program over the past five years is as follows: 

FY 2014 ...................................................$3,772,000 

FY 2015 ...................................................$3,800,000 

FY 2016 ...................................................$4,800,000 

FY 2017 Annualized CR ..........................$4,790,875 

FY 2018 President’s Budget ..................................$0 

Budget Request: 

The FY 2018 Budget Request is $.0.0, a decrease of $4,790,875 from the FY 2017 Annualized 

Continuing Resolution level. No funding is requested in FY 2018 for the Alzheimer’s Disease 

Supportive Services Program as funding for this and other Alzheimer’s programs is being 

consolidated into one program, the Alzheimer’s Disease Program.

 

77 Mittleman M, et al. (1996). “A Family Intervention to Delay Nursing Home Placement of Patients with 

Alzheimer’s Disease: a randomized, controlled trial,” Journal of the American Medical Association, 276; 1725-

1731.

78 Mittelman, M.S., Bartels, S.J. “Translating Research into Practice: Case Study of a Community-based Dementia 

Caregiver Intervention,” Health Affairs. April 2014 vol. 33 no. 4 587-595.
CAREGIVER AND FAMILY SUPPORT SERVICES 

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Outcome and Outputs Table: 

Alzheimer’s Disease Supportive Services Program 

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2017

Target

ALZ.2 Increase number 

of individuals served with 

evidence-based 

interventions -

cumulative. (Outcome)

FY 2016: 22,754

Target:

21,957

(Target Exceeded)

Discontinued

Indicator Year and Most Recent 

Result /

FY 2017

Projection

Output AC: Number of 

individuals served –

cumulative79 (Output)

FY 2016: 61,066 69,930

Output AD: Percent of 

individuals served that are 

of a racial/ethnic minority 

(Output)

FY 2016: 23% Discontinued

Grant Awards Table: 

Alzheimer’s Disease Supportive Services Grant Awards 

FY 2016 Final FY 2017 

Annualized CR

Number of 

Awards 9 5

Average 

Award $335,414 $751,787

Range of 

Awards

$276,127-

$600,000

$276,127-

$600,000

 

79 Cumulative count began in 2008. 
CAREGIVER AND FAMILY SUPPORT SERVICES 

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Resource and Program Data: 

Alzheimer’s Disease Supportive Services Program 

(Dollars in thousands) 

Mechanism

FY 2016 

Final

#

FY 2016 

Final

$

FY 2017

CR Annualized

#

FY 2017

CR Annualized

$

Formula Grants --

 

-- --

 -

-

New Discretionary

Grants 9 

 

3,019 5 

 

3,759 

Continuations Grants --

 

-- --

 -

-

Contracts 1 

 

1,565 1 

 

881 

Interagency Agreements --

 

-- --

 -

-

Program Support /1

 

216 

 

160 

Total Resources

 

4,800 

 

4,800 

1/ Program Support -- Includes funds for Public Health Service Act statutory requirements, 

grant systems and review costs.
CAREGIVER AND FAMILY SUPPORT SERVICES 

103

Alzheimer’s Disease Initiative - Specialized Supportive Services 

FY 2016

Final

FY 2017

Annualized 

CR

FY 2018

President's 

Budget

FY 2018 +/-

FY 2017

Alzheimer’s Disease Initiative –

Services --Prevention Fund $10,500 $10,500 $0 -$10,500

Authorizing Legislation: Section 411 of the Older Americans Act of 1965, as amended, and the 

Patient Protection and Affordable Care Act (ACA), Section 4002 [42 U.S.C. 300u-11] 

FY 2018 Older Americans Act Authorization .......................................... No specific authorization 

Allocation Method ............................ Competitive Grants/Co-operative Agreements and Contracts 

Program Description and Accomplishments: 

The Alzheimer’s Disease Initiative - Specialized Supportive Services (ADI-SSS) was designed 

to fill gaps in existing dementia-capable home and community-based service (HCBS) systems 

for persons living with ADRD and their family caregivers. The complexity of care of persons 

with advanced dementia is defined by the severity of functional and cognitive impairment, 

reliance on surrogate decision-making, and inability to live alone. This results in tremendous 

family/caregiver burden.80 Behavioral symptoms such as repetitive speech, wandering, and sleep 

disturbances are core clinical features of ADRD. If untreated, these behaviors can accelerate 

disease progression, worsen functional decline and quality of life, cause significant caregiver 

distress, and result in earlier nursing home placement.81

Enhanced dementia capable HCBS systems designed to meet the needs of formal and informal 

caregivers of individuals with ADRD is critical to helping these individuals continue to provide 

care. The ADI-SSS has provided funding for the development and implementation of 

specialized, person-centered services that help individuals remain independent and safe in their 

communities, while providing much needed supports to their caregivers. Through this program, 

ACL has worked with public and private entities to identify and address the special needs of 

persons with ADRD and their caregivers. 

 

80 National Alzheimer Project Act Advisory Council on Alzheimer's Research, Care, and Services Meeting #15: 

Advanced Dementia Expert Panel Summary and Key Recommendations. (2015, January 26). January 26, 2015 InPerson Meeting.

81 Gitlin LN, Kales HC, Lyketsos CG. Nonpharmacologic Management of Behavioral Symptoms in Dementia. 

JAMA. 2012;308(19):2020-2029. doi:10.1001/jama.2012.36918.
CAREGIVER AND FAMILY SUPPORT SERVICES 

104

In an effort to fill some of the identified gaps in systems that service people with ADRD and 

their family caregivers, the ADI-SSS program dedicates resources toward the provision of both 

services and training to targeted special populations. Specifically, the program required that 

funded programs do at least one of the following: 

 Develop and deliver supportive services to persons living alone with ADRD in 

communities; 

 Prepare individuals living with moderate to severe impairment and their caregivers for 

the future; 

 Improve the quality and effectiveness of programs and services provided to aging 

individuals with intellectual disabilities who have ADRD or who are at high risk of 

developing ADRD; and 

 Deliver behavioral symptom management training and expert consultation to family 

caregivers. 

Funding History: 

Funding for the ADI-SSS program over the past five years is as follows: 

FY 2014 .................................................$10,500,000 

FY 2015 .................................................$10,500,000 

FY 2016 .................................................$10,500,000 

FY 2017 Annualized CR ........................$10,500,000 

FY 2018 President’s Budget ..................................$0 

Budget Request: 

The FY 2018 Budget Request is $0, a decrease of $10,500,000 from the FY 2017 annualized 

Continuing Resolution level. No funding is requested in FY 2018 for the Alzheimer’s Disease 

Initiative—Specialized Supportive Services (ADI-SSS) program as funding for this and other 

Alzheimer’s programs is being consolidated into one program, the Alzheimer’s Disease 

Program.
CAREGIVER AND FAMILY SUPPORT SERVICES 

105

Grant Awards Table: 

Alzheimer’s Disease Initiative – Specialized Supportive Services 

FY 2016 Final FY 2017 

Annualized CR

Number of 

Awards 11 10

Average 

Award $939,167 $995,499

Range of 

Awards

$800,240 -

$1,000,000

$800,240 -

$1,000,000

Resource and Program Data: 

Alzheimer’s Disease Initiative – Specialized Supportive Services 

(Dollars in thousands) 

Mechanism

FY 2016 

Final

#

FY 2016 

Final

$

FY 2017

CR Annualized

#

FY 2017

CR Annualized

$

Formula Grants --

 

-- -- --

New Discretionary Grants 11 

 

10,331 10 9,955 

Continuations Grants --

 

-- -- --

Contracts 1 

 

100 2 500 

Interagency Agreements --

 

-- -- --

Program Support /1

 

69 45 

Total Resources

 

10,500 10,500 

1/ Program Support -- Includes funds for Public Health Service Act statutory requirements, grant systems 

and review costs.
CAREGIVER AND FAMILY SUPPORT SERVICES 

106

Lifespan Respite Care 

FY 2016

Final

FY 2017

Annualized 

CR

FY 2018

President's 

Budget

FY 2018 +/-

FY 2017

Lifespan Respite Care $3,360 $3,354 $3,354 --

Authorizing Legislation: Lifespan Respite Care Act of 2006, Title XXIX of the Public Health 

Service Act 

FY 2018 Authorization ......................................................................................................... Expired 

Allocation Method ............................................................................................. Competitive Grants 

Program Description and Accomplishments: 

Family caregiving is not just an aging issue. Family caregiving for persons with disabilities 

occurs across the age spectrum from birth to death. Family caregivers are often called upon to 

provide care to individuals of varying ages and disabilities and do so willingly, often for long 

periods of time and for many years. In 2015, AARP and the National Alliance for Caregiving 

estimated that 43.5 million people served as unpaid family caregivers to an adult or child with 

special needs. For many of these caregivers, providing care can take a toll: nineteen percent 

report high levels of physical strain; eighteen percent experience high levels of financial strain; 

and thirty-eight percent of all family caregivers indicated they experienced high levels of 

emotional stress.82 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.83 Respite is second only to direct financial assistance as a key 

policy priority of surveyed family caregivers.84 Even though respite services are often the 

preferred mode of family caregiver support, they are often under-used, difficult to find and 

access, unaffordable, or in short supply. As a result, nearly 90 percent of family caregivers 

 

82 National Alliance for Caregiving and AARP. Caregiving in the U.S. 2015 – Focused Look at Caregivers of Adults 

Age 50+. 

83 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 

84 National Alliance for Caregiving and AARP, 2009. 
CAREGIVER AND FAMILY SUPPORT SERVICES 

107

receive no respite at all.85 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. 86

The Lifespan Respite Care Program focuses on easing the burdens of caregiving by providing 

grants to eligible state organizations to improve the quality of, and access to, respite care for 

family caregivers of children or adults of any age with special needs. In particular, this program 

provides ACL with another vehicle to address the needs of caregivers while considering the 

important contributions they make in the lives of persons of all ages with disabilities. The goals 

of the Lifespan Respite Care Program differ from the 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 lifespan respite care; provide training and support to grantees 

and state, community, and nonprofit respite care programs; and conduct public information, 

referral, and education programs on respite care. Since 2009, the Lifespan Respite Care Program 

has made grants to States to develop, expand, integrate and sustain their respite care systems, and 

funded a National Technical Assistance Resource Center as follows: 

 Three Technical Assistance Resource Center cooperative agreements (the first awarded in 

FY 2009, the second awarded in FY 2012, and the third awarded in FY 2015) have also 

afforded the opportunity to provide basic and advanced technical assistance to grantees. 

Examples of grantee accomplishments to date include: 

 Creation and adoption of statewide respite plans and/or policies to guide further 

development of respite and caregiver support programs; 

 

85 National Alliance for Caregiving and AARP, 2009. 

86 National Alliance for Caregiving. (2012). Multiple Sclerosis Caregivers. Washington, DC: Author; The Arc, 

2011.
CAREGIVER AND FAMILY SUPPORT SERVICES 

108

 Development or enhancement of training programs for respite care providers to expand 

the cadre of trained respite professionals; 

 Replication and expansion of respite delivery modalities with a particular focus on 

person- centered planning and consumer direction; 

 Expansion of toll free “helplines,” dedicated websites and statewide respite registries to 

provide caregivers with information about available respite programs. 

 Development and deployment of marketing and awareness campaigns designed to 

educate caregivers about the importance of their work and the necessity to take a break; 

 Development of data collection methodologies to track service provision and 

programmatic outcomes; 

 Broadening stakeholder collaborations to ensure representation of all age and disability 

groups, as well as the broadest possible cross section of the provider network; 

 Convening focus groups of respite consumers to inform project activities; 

 Capacity building and network development at the local level to recruit and train 

volunteers to fill gaps in respite services, particularly in rural areas; and, 

 Provision of direct respite services to family caregivers of children with intellectual and 

developmental disabilities, adults with physical disabilities, and older Americans. 

State grantees work in collaboration with Aging and Disability Resource Centers/No Wrong 

Door Systems and a public or private non-profit statewide respite care coalition or organization. 

Special emphasis is placed on implementing or enhancing lifespan respite care statewide and 

building or improving the capacity of their long-term care systems to respond to the 

comprehensive needs of care recipients.
CAREGIVER AND FAMILY SUPPORT SERVICES 

109

Funding History: 

Funding for the Lifespan Respite Care program during the past five years is as follows: 

FY 2014 ...................................................$2,342,000 

FY 2015 ...................................................$2,360,000 

FY 2016 ...................................................$3,360,000 

FY 2017 Annualized CR ..........................$3,353,613 

FY 2018 President’s Budget ....................$3,354,000 

Budget Request: 

The FY 2018 request for Lifespan Respite is $3,354,000, maintaining the annualized FY 2017 

Continuing Resolution level. At this level, ACL will continue to make competitive grants 

available to support a range of possible activities to build or enhance Lifespan Respite Care 

Programs; further integrate and sustain Lifespan Respite activities into broader long-term 

services and supports in the State; and/or to provide additional respite services to family 

caregivers across the age and disability spectrum. ACL recognizes the unique opportunity the 

Lifespan Respite Care Program presents to consider the critical role that support for family 

caregivers plays in ensuring the health and independence of individuals across the age and 

disability spectrum. By investing in this program, ACL seeks to provide more and better targeted 

services that will allow caregivers to continue to care for their loved ones longer and thereby 

allow more care recipients to remain at home and independent for longer periods at lower cost 

than could be realized if these same individuals had to be institutionalized. 

The Lifespan Respite Care Program helps to ensure respite quality and choice; and allows for 

respite development, training and coordination regardless of age or disability. The Lifespan 

Respite Care program demonstrates ACL’s commitment supporting caregivers of children or 

adults of any age with special needs. According to the National Respite Coalition, nearly 

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.87 The resources requested for FY 2018 

will be used to address these issues by: 

 Expanding and enhancing respite care services to family members; 

 

87 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 

110

 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. 

ACL will add an additional State to those that we have already worked with to date to continue 

and expand infrastructure development, recruitment, and training of respite providers and 

volunteers, thus reducing the percentages of caregivers who do not have access to or use respite. 

Output Table: 

Lifespan Respite Care 

Indicator Year and Most Recent 

Result /

FY 2017

Projection

FY 2018

Projection

FY 2018

Projection

+/-FY 2017

Projection

Output AJ: The number 

of states that have 

participated in the 

Lifespan Respite Care 

program. (Output)

FY 2016: 36 37 38 +1

Grant Awards Table: 

Lifespan Respite Care Grant Awards 

FY 2016 Final FY 2017

Annualized CR

FY 2018

President’s 

Budget

Number of 

Awards 25 18 18

Average 

Award $130,312 $180,530 $180,530

Range of 

Awards

$73,668 -

$243,042

$73,638 -

$243,042

$73,638 -

$243,042
CAREGIVER AND FAMILY SUPPORT SERVICES 

111

Resource and Program Data: 

Lifespan Respite Care Program 

(Dollars in thousands) 

Mechanism

FY 2016 

Final

#

FY 2016 

Final

$

FY 2017

CR Annualized

#

FY 2017

CR Annualized

$

FY 2018 

President’s 

Budget

#

FY 2018 

President’s 

Budget

$

Formula Grants --

 

-- --

 

-- --

 

--

New Discretionary

Grants 8 

 

1,156 17 

 

3,011 2 

 

400 

Continuations

Grants 17 

 

2,101 1 

 

239 16 

 

2,850 

Contracts --

 

-- --

 

-- --

 

--

Interagency 

Agreements --

 

-- --

 

-- --

 

--

Program Support /1

 

102 

 

104 

 

104 

Total Resources

 

3,360 

 

3,354 

 

3,354 

1/ Program Support -- Includes funds for statutory requirements, grant systems and 

review costs, overhead and information technology support costs. 
PROTECTION OF VULNERABLE ADULTS 

112

Protection of Vulnerable Adults 

SUMMARY OF REQUEST 

Protection of Vulnerable Adults consists of several distinct but complementary programs 

designed to prevent, detect, and respond to elder abuse, neglect, and exploitation. As the 

population of older Americans increases, the problem of elder abuse, neglect, and exploitation 

continues to grow. While there is no single set of national elder abuse prevalence data, evidence 

indicates that the number of reported cases of elder abuse, neglect, and exploitation are on the 

rise. A 2004 national survey of State Adult Protective Services (APS) programs conducted by 

AoA’s National Center on Elder Abuse showed a 16 percent increase in the number of elder 

abuse cases from an identical study conducted in 2000.88 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.89 Consistent 

with these earlier findings, the most recent data on the prevalence of elder abuse, neglect, and 

exploitation suggest that at least 10 percent, or approximately 5 million older Americans, 

experience abuse each year, and many experience it in multiple forms.90

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.91 Additional adverse health impacts include an increased likelihood of heart attacks, 

dementia, depression, chronic diseases, and psychological distress. The result of these 

unnecessary health problems is a growing number of seniors who access the healthcare system 

more frequently (including emergency room visits and hospital admissions), and are ultimately 

forced to leave their homes and communities prematurely.92 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. 

 

88 Teaster, Pamela, et al. The 2004 Survey of State Adult Protective Services: Abuse of Adults 60 Years of Age and 

Older. 

89Tatara, Toshio, et al. The National Elder Abuse Incidence Study Final Report. 1998. 

90 Beach SR, Schulz R, Castle NG, Rosen J. Financial Exploitation and Psychological Mistreatment Among Older 

Adults: Differences Between African Americans and Non-African Americans in a Population-Based Survey. 

Gerontologist 2010. 

Acierno R, Hernandez MA, Amstadter AB, Resnick HS, Steve K, Muzzy W et al. Prevalence and Correlates of 

Emotional, Physical, Sexual, and Financial Abuse and Potential Neglect in the United States: The National Elder 

Mistreatment Study. American Journal of Public Health 2010; 100(2):292-297

91 Lachs, M.S., Williams, C.S., O'Brien, S., Pillemer, K.A., & Charlson, M.E. (1998). “The Mortality of Elder 

Mistreatment.” JAMA. 280: 428-432. and Baker, M.W. (2007). “Elder Mistreatment: Risk, Vulnerability, and 

Early Mortality.” Journal of the American Psychiatric Nurses Association, Vol. 12, No. 6, 313-321. 

92 Lachs M. S., Williams C., O'Brien S., Hurst L., Kossack A., Siegal A., et al. (1997). “ED use by older victims of 

family violence.” Annals of Emergency Medicine. 30:448-454.
PROTECTION OF VULNERABLE ADULTS 

113

The total FY 2018 program level request for Protection of Vulnerable Adults is $50,470,000, 

maintaining the annualized 2017 Continuing Resolution level. For FY 2018, specific program 

requests include: 

 $15,855,000 for the Long-Term Care Ombudsman Program, maintaining the annualized 

FY 2017 Continuing Resolution level. This consumer advocacy program improves the 

quality of care for the residents of long-term care facilities in all states. 

 $4,764,000 for Prevention of Elder Abuse and Neglect, maintaining the annualized 

FY 2017 Continuing Resolution level. This program provides formula grants to states to 

train, educate, and promote public awareness of elder abuse prevention efforts. 

 $18,000,000 for the Health Care Fraud and Abuse Control/Senior Medicare Patrol 

Program (HCFAC/SMP), the same level of funding that was available in FY 2017. 

HCFAC/SMP funds competitive grants and related infrastructure to support a volunteerbased network that helps to prevent and combat healthcare fraud and abuse and helps to 

preserve the financial integrity of Medicare and Medicaid. 

 $11,851,000 for Elder Rights Support Activities, maintaining the annualized FY 2017 

Continuing Resolution level. Funds will support the implementation of a nationwide 

Adult Protective Services data system, and fund research and evaluation activities. This 

program also provides funding for resource centers and activities that provide 

information, training, and technical assistance on elder rights issues to the national Aging 

Services Network. 

These elder rights and elder justice programs provide a foundation and establish best practices 

for States to develop programs to expand and improve the protection of individuals living in their 

communities and in long-term care settings; increase the information and technical assistance 

available to the public, States, and localities in preventing and addressing abuse; protect the 

rights of older adults and prevent their exploitation; reduce health-care fraud and abuse; and 

provide assistance to Tribes in developing elder justice systems. This multifaceted approach to 

preventing, detecting, and resolving elder abuse, neglect, and exploitation is essential to 

successfully fulfilling the shared mission of the Older Americans Act and the Elder Justice Act 

to maintain the health and independence of older Americans and adults with disabilities. 
PROTECTION OF VULNERABLE ADULTS 

114

Long-Term Care Ombudsman Program 

FY 2016

Final

FY 2017

Enacted

FY 2018

President’s 

Budget

FY 2018 +/-

FY 2017

Long-Term Care Ombudsman 

Program $15,885 $15,855 $15,855 --

Authorizing Legislation: Section 712 of the Older Americans Act of 1965, as amended. 

FY 2018 Older Americans Act Authorization ...............................................................$16,621,101

Allocation Method ................................................................................................... Formula Grants 

Program Description and Accomplishments: 

The Long-Term Care (LTC) Ombudsman Program is a consumer advocacy program that 

improves the quality of life and quality of care for the estimated 3 million individuals who reside 

in over 71,000 long-term care facilities.93 Formula grants to states and territories based on the 

number of individuals age 60 and older provide funding for the training, travel, and other 

operating costs of nearly 9,500 ombudsmen (both staff and designated volunteers) who resolve 

complaints with and on behalf of these residents, advocate for systemic improvement of 

long-term services and supports, and routinely monitor the condition of long-term care facilities. 

A primary ombudsman duty is to identify, investigate, and resolve complaints that are made by 

or on behalf of residents. These complaints relate to action, inaction, or decisions of providers, 

public agencies, and others that may adversely affect residents’ health, safety, welfare or rights. 

Ombudsmen advocate on behalf of residents by representing their interests before government 

and administrative entities, providing information to residents and families about long-term 

services and supports, and educating the general public about issues related to long-term services 

and supports policies and regulations. 

Much of the efficiency of the ombudsman program is due to a strong reliance on volunteers who 

make up the bulk of those who resolve resident issues.94 All but three states have volunteer 

ombudsman programs. These trained and designated volunteer ombudsmen donated over 

786,861 hours in FY 2014. In FY 2015, output data for the Long-Term Care Ombudsman 

 

93 National Ombudsman Reporting System (NORS) – Federal Fiscal 2014. 

94 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 

115

Program highlights the accomplishments achieved by this program and the important role that 

ombudsmen play in ensuring that the rights of long-term care facility residents are respected: 

 1,294 paid and 8,155 designated volunteer ombudsmen regularly visited residents in over 

27,500 facilities, more than 69 percent of all nursing home facilities and nearly 29 percent of 

all licensed board and care facilities (Output S). At least another 4,000 volunteers support 

these paid staff and volunteer ombudsmen. 

 Ombudsmen investigated and worked to resolve over 199,000 complaints (Output Q). 

 Ombudsmen provided 520,000 consultations to individuals and facility managers and staff 

on such topics as residents’ rights, staffing levels, malnutrition, dementia care, depression, 

discharge procedures, financial exploitation and strategies to reduce the use of restraints and 

prevent the abuse and neglect of residents (Output R). 

Today’s landscape is changing, however, as individuals in need of long-term services and 

supports are increasingly choosing to live in community settings. Encouraging community living 

has been supported by a number of Federal and State policies promoting alternatives to nursing 

homes and other institutional settings that recognize the value of consumer preference and the 

potential fiscal savings that can result. 

The move to re-balance and thereby give consumers more community living options has been 

driven by a variety of Federal laws and initiatives, including Olmstead implementation and 

enforcement, Money Follows the Person, Home and Community-Based Service waivers, and 

Medicaid managed care, to name a few. These evolving services and supports continue to change 

the long-term care landscape across the country. There is also a growing Federal awareness and 

response to the uncharted area of abuse, neglect and exploitation of older adults and individuals 

with disabilities. 

Funding History: 

Funding for the Long-term Care Ombudsman Program over the past five years is as follows: 

FY 2014 .................................................$15,885,000 

FY 2015 .................................................$15,885,000 

FY 2016 .................................................$15,885,000 

FY 2017 Annualized CR ........................$15,854,803 

FY 2018 President’s Budget ..................$15,855,000 
PROTECTION OF VULNERABLE ADULTS 

116

Budget Request: 

The FY 2018 request for the LTC Ombudsman Program is $15,855,000, maintaining the 

FY 2017 Annualized Continuing Resolution level. Funds will continue to support the existing 

infrastructure and activities of the Ombudsman program. With the senior population continuing 

to grow, the need for safe, high-quality long-term care services (including non-nursing home 

alternatives) continues to increase, even as we seek to help more people remain in the 

community for longer periods. Outcome data (displayed in the summary tables at the end of this 

section) have demonstrated the success of this program in protecting older Americans in an 

efficient and effective manner. The percentage of the complaints processed by ombudsmen that 

were fully or partially resolved to the satisfaction of the resident has consistently remained near 

75 percent,95 demonstrating both the efficiency of the program and its ability to produce positive 

outcomes for residents. The FY 2015 average number of complaints per facility, at 2.6, exceeds 

the target of 2.8. Outcome 2.14 targets a decrease in complaints that the program was unable to 

resolve to the satisfaction of the resident. 

Ombudsman activities represent an important element of ACL’s focus on elder rights and 

complements ACL’s successful elder rights programs to create a full array of services to 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 

long-term care settings, such as board and care and assisted living. In addition, LTC Ombudsmen 

serve individuals in these settings regardless of the individuals’ eligibility for Medicaid or other 

public benefits. Ombudsmen are the only federally-funded entity providing services to all of 

these residents. Going forward, outreach, access, complaint investigation and advocacy in board 

and care and assisted living will require ombudsmen to employ new strategies compared to the 

work now done primarily in nursing home settings. 

 

95 National Ombudsman Reporting System (NORS) 2014 – Complaint resolution: 11% needing no further action; 

4% withdrawn; 4.5% not resolved to the satisfaction of the resident; 5% referred to other agency for resolution. 
PROTECTION OF VULNERABLE ADULTS 

117

Outcomes and Outputs Table: 

Long-Term Care Ombudsman Program 

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2017

Target

FY 2018

Target

FY 2018

Target

+/-FY 2017

Target

2.12 Decrease the 

average number of 

complaints per LTC 

facility. (Outcome)

FY 2015: 2.6

Target:

2.8

(Target Exceeded)

2.8 2.6 -0.2 

2.14 Decrease the number 

of complaints not 

resolved to the 

satisfaction of the 

resident. (Outcome)

FY 2015: 8,968

Target:

9,700

(Target Exceeded)

9,000 9,000 Maintain

Indicator Year and Most Recent 

Result /

FY 2017

Projection

FY 2018

Projection

FY 2018

Projection

+/-FY 2017

Projection

Output Q: The Number of 

Complaints (Output)

FY 2015: 199,238 190,000 190,000 Maintain

Output R: Number of 

Ombudsman 

Consultations (Output)

FY 2015: 520,270 480,000 470,000 -10,000

Output S: Facilities 

regularly visited not in 

response to a complaint

(Output)

FY 2015: 27,559 27,500 27,500 Maintain
PROTECTION OF VULNERABLE ADULTS 

118

Grant Awards Table: 

Long-Term Care Ombudsman Program Formula Grant Awards 

FY 2016 Final FY 2017

Annualized CR

FY 2018

President’s 

Budget

Number of 

Awards 56 56 56

Average 

Award $282,815 $280,290 $280,294

Range of 

Awards

$9,899 -

$1,652,022

$9,810 -

$1,646,421

$9,810 -

$1,646,438
PROTECTION OF VULNERABLE ADULTS 

119

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

ADMINISTRATION ON AGING 

FY 2018 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: Long-Term Care Ombudsman Program (CFDA 93.042) 

State/Territory FY 2016 Actual FY 2017

Annualized CR

FY 2018

President’s 

Budget

FY 2018 +/-

FY2017

Alabama....................................... 242,979 239,577 239,580 3

Alaska........................................... 79,188 78,481 78,482 1

Arizona......................................... 341,592 341,910 341,915 5

Arkansas....................................... 150,054 147,456 147,458 2

California..................................... 1,652,022 1,646,421 1,646,438 17

Colorado....................................... 232,138 232,343 232,346 3

Connecticut.................................. 181,295 178,270 178,273 3

Delaware...................................... 79,188 78,481 78,482 1

District of Columbia..................... 79,188 78,481 78,482 1

Florida.......................................... 1,174,335 1,172,212 1,172,227 15

Georgia......................................... 419,583 418,808 418,813 5

Hawaii.......................................... 79,188 78,481 78,482 1

Idaho............................................. 79,188 78,481 78,482 1

Illinois.......................................... 591,835 582,547 582,555 8

Indiana.......................................... 311,457 307,221 307,225 4

Iowa.............................................. 159,800 157,310 157,312 2

Kansas.......................................... 136,554 134,753 134,755 2

Kentucky...................................... 216,495 213,455 213,457 2

Louisiana...................................... 211,605 209,723 209,725 2

Maine........................................... 79,979 78,855 78,855 -

Maryland...................................... 273,601 271,331 271,334 3

Massachusetts.............................. 332,779 329,115 329,120 5

Michigan...................................... 506,430 499,612 499,619 7

Minnesota..................................... 259,171 256,995 256,998 3

Mississippi................................... 140,908 138,858 138,860 2

Missouri....................................... 303,802 299,248 299,252 4

Montana....................................... 79,188 78,481 78,482 1

Nebraska....................................... 89,107 88,000 88,001 1

Nevada......................................... 132,389 132,897 132,899 2

New Hampshire............................ 79,188 78,481 78,482 1
PROTECTION OF VULNERABLE ADULTS 

120

PROGRAM/CFDA NUMBER: Long-Term Care Ombudsman Program (CFDA 93.042) 

 

State/Territory FY 2016 FY 2017 FY 2018 FY 2018 +/-

Actual Annualized CR President's Budget FY 2017

New Jersey.......................... 428,510 422,287 422,292 5

New Mexico....................... 102,848 101,830 101,831 1

New York........................... 946,796 930,810 930,822 12

North Carolina.................... 479,251 476,251 476,257 6

North Dakota...................... 79,188 78,481 78,482 1

Ohio.................................... 591,501 582,413 582,420 7

Oklahoma............................ 183,378 180,686 180,688 2

Oregon................................ 210,638 209,661 209,664 3

Pennsylvania....................... 691,335 679,603 679,612 9

Rhode Island....................... 79,188 78,481 78,482 1

South Carolina.................... 249,369 248,922 248,925 3

South Dakota...................... 79,188 78,481 78,482 1

Tennessee............................ 323,243 319,700 319,704 4

Texas................................... 1,039,705 1,039,061 1,039,074 13

Utah.................................... 98,530 98,713 98,714 1

Vermont.............................. 79,188 78,481 78,482 1

Virginia............................... 379,896 377,374 377,379 5

Washington......................... 332,901 332,711 332,715 4

West Virginia...................... 107,667 105,275 105,276 1

Wisconsin........................... 289,528 286,521 286,525 4

Wyoming............................ 79,188 78,481 78,482 1

Subtotal, States................... 15,545,262 15,410,507 15,410,699 192

American Samoa................. 9,899 9,810 9,810 -

Guam.................................. 39,594 39,241 39,241 -

Northern Mariana Islands... 9,899 9,810 9,810 -

Puerto Rico......................... 193,417 187,646 187,649 3

Virgin Islands..................... 39,594 39,241 39,241 -

Subtotal, States and Territories 15,837,665 15,696,255 15,696,450 195

Program Support 1/................... 47,335 158,548 158,550 2

TOTAL...................................... 15,885,000 15,854,803 15,855,000 197

1/ Program Support -- Includes funds for Older Americans Act statutory requirements, including disaster assistance, and grant 

and program reporting systems costs. Funds unused for these purposes at the end of the year are allocated to States. 
PROTECTION OF VULNERABLE ADULTS 

Prevention of Elder Abuse and Neglect 

FY 2016

Final

FY 2017

Annualized 

CR

FY 2018

President’s 

Budget

FY 2018 +/-

FY 2017

Prevention of Elder Abuse & 

Neglect...... $4,773 $4,764 $4,764 --

Authorizing Legislation: Section 702 (b) of the Older Americans Act of 1965, as amended. 

FY 2018 Older Americans Act Authorization .................................................................$4,994,178

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

Program Description and Accomplishments: 

The Prevention of Elder Abuse and Neglect program provides formula grants to states and 

territories based on their share of the population 60 and over for training State and local officials 

and promoting public awareness of elder abuse. The program also supports state and local elder 

abuse prevention coalitions and multi-disciplinary teams. These activities are important elements 

of ACL’s 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 2014, over $30 million of the Elder Abuse 

Prevention services expenditures was leveraged from non-OAA funds, a ratio of approximately 

$6.50 of non-OAA funds for every $1 investment of ACL funds. 

Examples of state elder abuse prevention activities include: 

 In Kentucky, the local area agencies on aging participate in the Local Coordinating 

Councils on Elder Abuse, which have developed emergency elder shelters, distributed 

informational cards for law enforcement officers to have in the patrol cars which contain 

crucial resource information for victims of elder abuse, conducted training on a regular 

basis to first responders, provided a friendly visitor program for home-based seniors, and 

produced a prevention tool called the Kentucky Fraud Fighter Form.

 In Illinois, the State Department on Aging utilizes its elder abuse funds to support 

volunteer community based multi-disciplinary teams (M-Teams) that serve in a technical 

advisory role to more than 40 elder abuse provider agencies throughout the state. The 
PROTECTION OF VULNERABLE ADULTS 

122

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 2014 ...................................................$4,773,000 

FY 2015 ...................................................$4,773,000 

FY 2016 ...................................................$4,773,000 

FY 2017 Annualized CR ..........................$4,763,927 

FY 2018 President’s Budget ....................$4,764,000 

Budget Request: 

The FY 2018 request for the Prevention of Elder Abuse and Neglect program is $4,764,000, 

maintaining the FY 2017 Annualized Continuing Resolution level. The FY 2018 request 

maintains the ability of states and territories to train law enforcement officials, develop and 

distribute educational materials, conduct public awareness campaigns, and create community 

coalitions and multidisciplinary teams to investigate and respond to elder abuse and neglect. 

States and AAAs also use this funding to coordinate their activities with fraud and crime 

prevention partnerships organized by sheriffs, police chiefs, and community organizations. 

Elder Abuse Prevention activities are important elements of ACL’s elder rights and elder justice 

activities which seek to improve upon ACL’s successful elder rights programs, including the 

Prevention of Elder Abuse and Neglect program. These programs support a full array of services 

to protect elder rights and prevent, detect, and respond to elder abuse, neglect, and exploitation. 

Prevention of Elder Abuse and Neglect programs complement Adult Protective Services by 

funding the infrastructure on which best practices may be developed and evaluated. Past 

examples of efforts undertaken by states include creation of informational cards for law 

enforcement officers to provide crucial resource information to victims of elder abuse, training to 
PROTECTION OF VULNERABLE ADULTS 

123

first responders, and community-based multidisciplinary teams that serve in a technical advisory 

role to elder abuse prevention agencies throughout a state. 

Output Table: 

Prevention of Elder Abuse and Neglect 

Indicator Year and Most Recent 

Result /

FY 2017

Projection

FY 2018

Projection

FY 2018

Projection

+/-FY 2017

Projection

Output U: Elder Abuse 

prevention non-OAA 

service expenditures 

(Output, dollars in 

thousands)

FY 2015: $31,749 $32,400 $32,700 +300

Grant Awards Table: 

Prevention of Elder Abuse, Neglect, and Exploitation Grant Awards 

FY 2016

Final

FY 2017

Annualized CR

FY 2018

Request

Number of 

Awards 56 56 56

Average Award $84,855 $84,500 $84,500

Range of 

Awards

$2,970 -

$471,073

$2,958 -

$471,073

$2,958 -

$471,073
PROTECTION OF VULNERABLE ADULTS 

124

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

ADMINISTRATION ON AGING 

FY 2018 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: Prevention of Elder Abuse & Neglect (CFDA 93.041) 

State/Territory FY 2016 Actual FY 2017

Annualized CR

FY 2018

President's Budget FY 2018 +/- FY 

2017

Alabama....................................... 76,215 76,215 76,215 -

Alaska.......................................... 23,759 23,660 23,660 -

Arizona........................................ 86,912 81,500 81,500 -

Arkansas...................................... 48,157 48,157 48,157 -

California..................................... 471,073 471,073 471,073 -

Colorado...................................... 59,061 56,082 56,082 -

Connecticut.................................. 59,907 59,907 59,907 -

Delaware...................................... 23,759 23,660 23,660 -

District of Columbia.................... 23,759 23,660 23,660 -

Florida.......................................... 344,252 344,252 344,252 -

Georgia........................................ 106,751 103,321 103,321 -

Hawaii.......................................... 23,759 23,660 23,660 -

Idaho............................................ 23,759 23,660 23,660 -

Illinois.......................................... 197,384 197,384 197,384 -

Indiana......................................... 98,224 98,224 98,224 -

Iowa............................................. 55,927 55,927 55,927 -

Kansas.......................................... 45,843 45,843 45,843 -

Kentucky...................................... 66,595 66,595 66,595 -

Louisiana..................................... 68,518 68,518 68,518 -

Maine........................................... 23,759 23,660 23,660 -

Maryland...................................... 78,087 78,087 78,087 -

Massachusetts.............................. 109,606 109,606 109,606 -

Michigan...................................... 160,862 160,862 160,862 -

Minnesota.................................... 76,347 76,347 76,347 -

Mississippi................................... 45,198 45,198 45,198 -

Missouri....................................... 97,643 97,643 97,643 -

Montana....................................... 23,759 23,660 23,660 -

Nebraska...................................... 29,770 29,770 29,770 -

Nevada........................................ 33,682 27,629 27,629 -

New Hampshire........................... 23,759 23,660 23,660 -
PROTECTION OF VULNERABLE ADULTS 

125

PROGRAM/CFDA NUMBER: Prevention of Elder Abuse & Neglect (CFDA 93.041)

State/Territory FY 2016 Actual FY 2017

Annualized CR

FY 2018

President's Budget FY 2018 +/- FY 

2017

New Jersey.......................... 143,950 143,950 143,950 -

New Mexico....................... 26,393 26,393 26,393 -

New York........................... 318,066 318,066 318,066 -

North Carolina.................... 126,782 126,782 126,782 -

North Dakota...................... 23,759 23,660 23,660 -

Ohio.................................... 197,185 197,185 197,185 -

Oklahoma............................ 60,208 60,208 60,208 -

Oregon................................ 56,795 56,795 56,795 -

Pennsylvania....................... 242,944 242,944 242,944 -

Rhode Island....................... 23,759 23,660 23,660 -

South Carolina.................... 63,445 63,080 63,080 -

South Dakota...................... 23,759 23,660 23,660 -

Tennessee............................ 91,810 91,810 91,810 -

Texas................................... 274,281 274,281 274,281 -

Utah.................................... 25,068 24,837 24,837 -

Vermont.............................. 23,759 23,660 23,660 -

Virginia............................... 102,820 102,820 102,820 -

Washington......................... 86,291 86,291 86,291 -

West Virginia...................... 36,736 36,736 36,736 -

Wisconsin........................... 90,309 90,309 90,309 -

Wyoming............................ 23,759 23,660 23,660 -

Subtotal, States................... 4,667,964 4,648,207 4,648,207 -

American Samoa................. 2,970 2,958 2,958 -

Guam.................................. 11,880 11,830 11,830 -

Northern Mariana Islands... 2,970 2,958 2,958 -

Puerto Rico......................... 54,217 54,217 54,217 -

Virgin Islands..................... 11,880 11,830 11,830 -

Subtotal, States and Territories 4,751,881 4,732,000 4,732,000 -

Program Support 1/................... 21,119 31,927 32,000 73

TOTAL...................................... 4,773,000 4,763,927 4,764,000 73

1/Program Support -- Includes funds for Older Americans Act statutory requirements, including disaster assistance, and grant and 

program reporting systems costs. Funds unused for these purposes at the end of the year are allocated to States. 
PROTECTION OF VULNERABLE ADULTS 

126

Health Care Fraud and Abuse Control/Senior Medicare Patrol Program 

FY 2016

Final

FY 2017

Annualized 

CR

FY 2018

President’s 

Budget

FY 2018+/-

FY 2017

Senior Medicare Patrol Program 1/. $18,000 $18,000 $18,000 --

FTE 2/..................... 6 5 7 +2

Authorizing Legislation: Sections 201, 202, and 411 of the Older Americans Act of 1965, as 

amended. 

FY 2018 Older Americans Act Authorization ........................... Authorized—No Specific Amount 

Allocation Method ............................................................................................... Competitive Grant 

Program Description and Accomplishments: 

The Health Care Fraud and Abuse Control/Senior Medicare Patrol (SMP) program provides 

competitive grants to 54 states and territories to support a national network of volunteers whose 

purpose is to educate Medicare beneficiaries on preventing and identifying healthcare fraud and 

abuse. Projects use the skills of volunteers to conduct community outreach and education and 

provide information that empowers beneficiaries of Medicare and Medicaid and their families to 

prevent, identify and report fraud. Activities are carried out in partnership with the Centers for 

Medicare & Medicaid Services (CMS), the Office of Inspector General (OIG), healthcare 

providers, and other aging and elder rights professionals from around the country. 

Data obtained from the SMP Information and Reporting System (SIRS) for calendar year 2016 

shows that the 53 Senior Medicare Patrol projects: 

 Maintained 6,157 active SMP team members who worked over 413,395 hours to educate 

beneficiaries about how to prevent Medicare fraud, errors and abuse; 

 Educated 1,498,213 individuals during 26,307 group outreach and education events; and, 

 Responded to 187,705 individual inquiries for information or assistance from Medicare 

beneficiaries, family members, and caregivers related to Medicare fraud, errors and 

abuse. 
PROTECTION OF VULNERABLE ADULTS 

127

Since the Senior Medicare Patrol program’s inception in 1997, program data show that SMP 

projects have educated nearly 35.6 million beneficiaries through 360,973 group outreach and 

education events and assisted approximately 2.5 million beneficiaries with individual inquires 

related to Medicare fraud, errors, and abuse. HHS-OIG reports that total savings directly 

attributable to the SMP projects are more than $124 million since 1997; however, this does not 

fully capture the total impact of the program on reducing Medicare fraud, including any sentinel 

effect that may result from these activities. 

The SMP program historically has used approximately $3.4 million of its resources for 

infrastructure (including Federal staff support), technical assistance, and other program support 

and capacity-building activities designed to enhance program effectiveness. Activities funded 

with these dollars include support for project training and technical assistance provided by 

ACL’s National Consumer Protection Technical Resource Center. 

Funding History: 

Comparable funding for SMP discretionary appropriations over the past five years is as follows: 

FY 2014 .................................................$15,479,000 

FY 2015 .................................................$17,620,000 

FY 2016 ...............................................$18,000,000 

FY 2017 ................................................ $18,000,000

FY 2018 President’s Budget ................. $18,000,000

Budget Request: 

The FY 2018 Budget includes a place holder of $18 million for the HCFAC/SMP program 

pending a final decision by the Secretary. Since FY 2016, appropriations language has charged 

the Secretary to fully fund the program at a level determined by the Secretary out of 

discretionary appropriations from the HCFAC account within the Centers for Medicare & 

Medicaid Services (CMS). In FY 2018, CMS plans to continue to support the SMP program and 

is requesting to change the appropriations language to provide the Secretary of HHS with greater 

flexibility in determining the funding amount and sources of funding (e.g. HCFAC mandatory or 

discretionary account) that this activity can be funded from. 

Since the Senior Medicare Patrol program’s inception, SMP projects have received more than 

35,000 complex issues (complaints) from Medicare beneficiaries who have detected billing 

errors, potential fraud, or other discrepancies. SMPs also have educated over 6.6 million 

beneficiaries in group or one-on-one counseling sessions and have reached more than 30 million 

people through community outreach events. The primary focus of these sessions is on education, 
PROTECTION OF VULNERABLE ADULTS 

128

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. 

However, the impact of these education and prevention activities is extremely difficult to 

quantify in dollars and cents. As HHS-OIG indicated in their June 2016 report on the SMP 

program: 

“We continue to emphasize the projects may not be receiving full credit for 

recoveries, savings, and cost avoidance attributable to their work. It is not always 

possible to track referrals to Medicare contractors or law enforcement from 

beneficiaries who have learned to detect fraud, waste, and abuse from the 

projects. In addition, the projects are unable to track the substantial savings 

derived from a sentinel effect whereby Medicare beneficiaries’ scrutiny of their 

bills reduce fraud and errors.” 

While SMPs make numerous referrals of potential fraud to the Centers for Medicare & Medicaid 

Services (CMS) and the HHS Office of Inspector General (HHS-OIG), it is difficult to track the 

actions (investigation, prosecution, collection) required to calculate the full savings to the 

government as a result of SMP referrals. All of these factors hinder the program’s ability to 

measure the extent and cost of fraud and abuse. 

ACL recognizes the importance of measuring the value of the SMP program impact to the fullest 

degree possible and is working to overcome these limitations by undertaking a variety of steps, 

including: 

 Realigning the program’s performance metrics based on findings from a recent SMP 

program evaluation; 

 Ongoing collaboration with HHS-OIG to track fraud referrals and their outcomes; and, 

 Continuing research efforts on SMP prevention education to determine how to best 

measure and quantify the effects of SMP program efforts. Preliminary results appear to 

show it is possible to quantify and demonstrate the value of SMP prevention activities, 

but further follow-up is required, the results of which should be available in FY 2019. 

Despite the factors that have limited ACL’s ability to quantify the value of the SMP program in 

preventing, identifying, and reporting health care fraud, HHS-OIG has documented over $124.6 

million in savings attributable to the program as a result of beneficiary complaints since the 

program’s inception in 1997. 
PROTECTION OF VULNERABLE ADULTS 

129

Output Table: 

Senior Medicare Patrol Program 

Indicator Year and Most Recent 

Result /

FY 2017

Projection

FY 2018

Projection

FY 2018

Projection

+/-FY 2017

Projection

Output W: Beneficiaries 

Educated and Served

(Output)

CY 2016: 703,482 740,000 775,000 +35,000

Grant Awards Table: 

Senior Medicare Patrol Grant Awards 

FY 2016 Final FY 2017

Annualized CR

FY 2018

President’s 

Budget

Number of 

Awards 54 56 56

Average 

Award $284,902 $277,015 $277,015

Range of 

Awards

$95,831-

$640,000

$95,831-

$640,000

$95,831-

$640,000
PROTECTION OF VULNERABLE ADULTS 

130

Resource and Program Data: 

Senior Medicare Patrols 

(Dollars in thousands) 

Mechanism

FY 2016 

Final

#

FY 2016 

Final

$

FY 2017

CR Annualized

#

FY 2017

CR 

Annualized

$

FY 2018 

President’s 

Budget

#

FY 2018 

President’s 

Budget

$

Formula Grants --

 

-- --

 

-- --

 

--

New Discretionary

Grants --

 

-- 3 

 

768 53 

 

14,745 

Continuations Grants 54 

 

15,385 53 

 

14,745 3 

 

768 

Contracts 2 

 

729 3 

 

821 3 

 

821 

Interagency 

Agreements --

 

-- --

 

-- --

 

--

Program Support 1/

 

1,886 

 

1,666 

 

1,666 

Total Resources 2/

 

18,000 

 

18,000 

 

18,000 

1/ Program Support -- Includes funds for overhead, grant systems and review costs, and information technology 

support costs. 

2/ No discretionary budget authority funding is requested by ACL for the Senior Medicare Patrol program in 

FY 2018. Since FY 2016, based on FY 2016 appropriations language, SMP funding levels are determined by the 

Secretary of HHS, and made available from discretionary appropriations for the HCFAC account within the Centers 

for Medicare & Medicaid Services (CMS). 
PROTECTION OF VULNERABLE ADULTS 

131

Elder Rights Support Activities 

FY 2016

Final

FY 2017

Annualized 

CR

FY 2018

President's 

Budget

FY 2018+/-

FY 2017

Elder Rights Support Activities $11,784 $11,851 $11,851 --

Authorizing Legislation: Sections 201, 202, 411, 751, and 752 of the Older Americans Act of 

1965 as amended, Title XX of the Social Security Act, Subtitle B, as amended by the Affordable 

Care Act. 

FY 2018 Older Americans Act Authorization ...............................................................$11,083,873

Allocation Method ............................. Competitive Grants/Cooperative Agreements and Contracts 

Program Description and Accomplishments: 

Elder Rights Support Activities provide information, training, and technical assistance to assist 

States and communities to prevent, detect, and respond to elder abuse, neglect, and exploitation 

and support the development of coordinated systems of Adult Protective Services. The Elder 

Justice and Adult Protective Services program, along with the National Center on Elder Abuse, 

the National Long-Term Care Ombudsman Resource Center, and legal systems development and 

assistance programs create a supportive framework for ACL’s Protection of Vulnerable Adults 

programs. 

The Elder Justice Act of 2009 established the Elder Justice Coordinating Council (EJCC) to 

coordinate activities related to elder abuse, neglect, and exploitation across the Federal 

government. As Chair of the EJCC, the Secretary of HHS has lead responsibility for identifying 

and proposing solutions to the problems surrounding elder abuse. The Secretary has assigned 

responsibility for implementing the EJCC to the Administration for Community Living. 

To combat the rising scourge of elder abuse, neglect, and exploitation in America, ACL’s goal is 

to put in place, in coordination with the Elder Justice Coordinating Council, a comprehensive 

system to provide a coordinated and seamless response for helping adult victims of abuse, to 

prevent abuse before it happens, and to develop new and innovative approaches to preventing, 

detecting, and responding to abuse, neglect, and exploitation. The Elder Rights Support 

Activities described below are key components of ACL’s ongoing elder rights programs.
PROTECTION OF VULNERABLE ADULTS 

132

Adult Protective Services 

Unlike Child Protective Services, which has been in existence for decades, a federal 

infrastructure to support basic programmatic standards for Adult Protective Services (APS) is 

just beginning. Historically, an absence of federal stewardship in APS has led to inconsistent 

data systems and non-uniform reporting requirements at the national level, and prevented APS 

programs from evaluating their services or conducting meaningful program evaluations. APS 

programs and administrators have lacked reliable information and guidance on best practice and 

standards for conducting case investigations and for staffing and managing APS programs. 

Additionally, GAO has identified challenges faced by APS programs across the country in 

collecting, maintaining, and reporting statewide, case-level data. These challenges include 

chronic underfunding, unprecedented budget reductions, and increasing caseloads and have 

impaired States’ ability to assess client outcomes and the effectiveness of the services they are 

providing.96 They have also given rise to systems that are less equipped to respond in an 

effective and timely way to reports of elder abuse, neglect and exploitation. 

In FY 2015, ACL received its first dedicated appropriation to support states in enhancing their 

APS systems statewide. Through ACL’s continued investment in the APS program in FY 2016, 

states received additional funding to test innovations and improvements in APS practice, 

services, data collection, and reporting, and to support the development and implementation of 

ACL’s National Adult Maltreatment Reporting System (NAMRS) effort. The APS program 

supports states by providing significant, on-going technical assistance to identify promising and 

best practices, participate in national APS data collection efforts; and conduct research and 

evaluations to increase the knowledge base about effective APS programming and practices. 

Through the APS program, ACL encourages states to seek system transformations that reflect 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. 

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: 

 

96 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 

133

 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 three research-themed training podcasts to 

promote continual learning. 

 Continuing to support systems change by identifying local elder justice community 

coalitions and reaching out to them to learn how they leverage local resources and 

expertise to prevent and combat elder abuse, neglect, and exploitation, as well as offering 

technical assistance on operating, invigorating, and sustaining coalitions. 

National Long-Term Care Ombudsman Resource Center 

The National Long-Term Care Ombudsman Resource Center (NORC) provides training and 

technical assistance to support the activities of State and local long-term care ombudsmen. The 

Center works to enhance the skills, knowledge and management capacity of the statewide 

ombudsman programs to enable them to handle resident complaints and represent resident 

interests. The Center also provides information to consumers and links them to ombudsmen who 

can help consumers navigate the long-term care system and resolve problems in nursing, board 

and care, and assisted living homes. 

The NORC engages in numerous projects and activities in support of long-term care ombudsman 

programs. Highlights include supporting the Money Follows the Person (MFP) demonstration 

project by working with CMS, ACL, and National Association of State Long-Term Care 

Ombudsman Programs (NASOP) to promote ombudsman coordination with MFP grantees, 

Aging and Disability Resource Centers (ADRCs), Centers for Independent Living, and other 

single point of entry programs; and furthering Federal efforts to support consumer choice and 

access to alternatives to nursing home care. The NORC also provides ombudsmen with training 

from national experts on such issues as: the Changing Long-Term Care System; Money Follows 

the Person and Nursing Home Transition; and, Advocacy in Assisted Living. The Center’s 

website continues to experience high utilization (over 40,000 monthly visits) by ombudsmen, 

consumers, and agencies.

Legal Assistance and Support 

Legal Assistance and Support provides funding for two different activities. Model Approaches 

help States develop and implement cost-effective, replicable approaches for integrating low-cost 

legal assistance mechanisms related to APS into the broader tapestry of State legal service 

delivery networks, such as senior legal helplines, law school clinics, and volunteer attorneys. 

Model Approaches projects ensure strong leadership at the State level, thereby enhancing the 
PROTECTION OF VULNERABLE ADULTS 

134

state’s overall capacity for legal service delivery and creating linkages between legal assistance 

providers and professionals in the broader community-based aging/disability and elder rights 

networks. These linkages include Areas Agencies on Aging (AAAs), Aging and Disability 

Resource Centers (ADRCs), State Long-Term Care Ombudsmen, and Adult Protective Services, 

and leverage the strengths and resources of both elder rights and aging/disability service 

networks for the provision of quality legal service on priority issues to older adults most in need. 

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 new projects support outreach efforts and implement legal data 

collection/reporting systems that demonstrate the beneficial impact of legal services on the 

independence, health, and financial security of older adults. 

In addition to Model Approaches, Legal Assistance and Support grants fund a comprehensive 

national legal assistance support system serving professionals and advocates working in legal 

and aging/disability services networks. Through this funding, the National Legal Resource 

Center (NLRC) supports the leadership, knowledge, and systems capacity development of legal 

and aging provider organizations. The NLRC works to enhance the quality, cost effectiveness, 

and accessibility of legal assistance and elder rights protections available to older persons with 

social or economic needs. The audience targeted to receive support services through the NLRC 

includes a broad range of legal, elder rights, and aging/disability services professionals and 

advocates. These include Home and Community-Based Services legal providers, legal assistance 

developers, long-term care ombudsmen, Area Agency on Aging and Aging and Disability 

Resource Center staff, senior legal helplines, Adult Protective Services workers, and others 

involved in protecting the rights of older persons. 

Funding History: 

Comparable funding for Elder Rights Support Activities over the past five years is as follows: 

FY 2014 ...................................................$3,845,000 

FY 2015 ...................................................$7,874,000 

FY 2016 .................................................$11,874,000 

FY 2017 Annualized CR ........................$11,851,428 

FY 2018 President’s Budget ..................$11,851,000 
PROTECTION OF VULNERABLE ADULTS 

135

Budget Request: 

The FY 2018 request for the four Elder Rights Support Activities is $11,851,000, maintaining 

the 2017 Annualized Continuing Resolution level. 

Elder Justice/Adult Protective Services: 

The FY 2018 request for Elder Justice/Adult Protective Services is $7,985,000, maintaining the 

FY 2017 Annualized Continuing Resolution level. This request reflects ACL’s continuing 

commitment to supporting and integrating State APS systems, as well as coordinating services 

related to elder abuse, neglect, and exploitation across the Federal government. With the 

FY 2018 request ACL will: 

Provide Demonstration Grants to Enhance State APS Systems: As recommended by the GAO, 

ACL, in partnership with ASPE, created a technology infrastructure for a national APS data 

collection system, the National Adult Maltreatment Reporting System (NAMRS). The NAMRS 

tool is a process where all states can voluntarily report data collected through APS 

investigations. In FY 2018 ACL will continue to provide grants to support State’s efforts to 

participate in NAMRS.

Operate and Maintain NAMRS and Provide Technical Assistance: GAO recommended 

significant, on-going technical assistance to states to facilitate their participation in a national 

APS data collection effort. In FY 2018 ACL will continue to support the operations and 

maintenance of the NAMRS system as well provide technical assistance to State’s in their use of 

the NAMRS system. 

Advance Research on Elder Abuse: Research in the area of elder abuse, neglect, and exploitation 

is still in its infancy, with little known about risk and protective factors for being a victim or 

perpetrator, nor about effective and evidence-based prevention, intervention, and remediation 

practices. Further research is also needed regarding the impacts of elder abuse on health and 

long-term care systems and on the costs of care. This fundamental research work is needed to 

develop credible benchmarks for elder abuse, neglect, and exploitation prevention or control. In 

FY 2018 ACL will continue to invest in areas that build the foundational knowledge essential for 

understanding the problem and the best ways to prevent and address it. 

Program Implementation and Oversight: support salaries and overhead costs for staff totaling 

2.7 FTE carrying out the Elder Justice initiative and supporting the ongoing work of the EJCC. 

Other Elder Rights Support Activities: 

The FY 2018 request for the remaining three Elder Rights Support Activities is $3,866,000 in 

total, maintaining the annualized FY 2017 Continuing Resolution levels for these activities. This 
PROTECTION OF VULNERABLE ADULTS 

136

would essentially maintain current funding levels for Legal Assistance and Support activities 

(Statewide Model Approaches and Legal Assistance programs), the National Center on Elder 

Abuse, and the National Long-Term Care Ombudsman Resource Center. 

These programs provide the technical assistance, information, resources, referrals, and systems 

development and assistance activities that support the efforts of the entire spectrum of Protection 

of Vulnerable Adults programs. These activities, along with the Elder Justice and APS program, 

are a critical component of ACL’s elder rights programs and help to create a full array of 

services to prevent, detect, and resolve elder abuse, neglect, and exploitation. Continued support 

for these programs and resource centers will provide the best and most efficient services and 

supports possible to support ACL’s efforts to promote elder rights and elder justice. 

Elder Rights Support Activities includes funding for the following projects (dollars in thousands): 

Elder Rights Support 

Activities FY 2016 Final FY 2017Annualized CR

FY 2018 

President’s 

Budget

Elder Justice & APS $8,000 $7,985 $7,985

Legal Assistance and Support $2,593 $2,587 $2,587

National Center on Elder 

Abuse $765 $764 $764

LTC Ombudsman Resource 

Center $516 $515 $515

Total, Elder Rights Support 

Activities $11,874 $11,851 $11,851
PROTECTION OF VULNERABLE ADULTS 

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Grant Awards Table: 

Elder Rights Support Activities Grant Awards 

FY 2016 Final FY 2017

Annualized CR

FY 2018 

President’s 

Budget

Number of 

Awards 35 31 31

Average 

Award $265,142 $270,490 $270,490 

Range of 

Awards

$70,312 - 

$723,752

$70,312 - 

$723,752

$70,312 - 

$723,752

Resource and Program Data: 

Elder Rights Support Activities 

(Dollars in thousands) 

Mechanism

FY 2016 

Final

#

FY 2016 

Final

$

FY 2017

CR Annualized

#

FY 2017

CR Annualized

$

FY 2018 

President’s 

Budget

#

FY 2018 

President’s 

Budget

$

Formula Grants --

 

-- --

 

-- --

 

--

New Discretionary

Grants 11 

 

2,253 2 

 

1,266 21 

 

5,870 

Continuations Grants 24 

 

7,027 29 

 

7,119 10 

 

2,515 

Contracts 5 

 

2,297 4 

 

2,635 4 

 

2,635 

Interagency 

Agreements --

 

-- --

 

-- --

 

--

Program Support 1/ --

 

297 

 

831 

 

831 

Total Resources

 

11,874 

 

11,851 

 

11,851 

1/ Program Support -- Includes funds for grant systems and review and information technology support costs.
138

Disability Programs, Research, and Services 

SUMMARY OF REQUEST 

Disability Programs, Research, and Services fund capacity-building, knowledge generation, and 

systems change efforts to ensure that people with disabilities and their families participate in the 

design of and have access to needed community services, individualized supports, and other 

forms of assistance. These programs seek to promote the increased self-determination, 

independence, productivity, integration, and inclusion of such individuals in all facets of 

community life. 

The total FY 2018 request for Disability Programs, Research, and Services is $306,251,000, a 

reduction of -$78,353,474 below the annualized FY 2017 Continuing Resolution level. For FY 

2018, specific program requests include: 

 $45,000,000 in first-time funding for a new grant program, Partnerships for Innovation, 

Inclusion and Independence (PIII). This program would align three existing programs –

State Councils on Developmental Disabilities, Independent Living State Grants that 

support State Independent Living Councils, and State Advisory Boards on Traumatic 

Brain Injury which support TBI State Implementation Partnership Grants – which have 

similar features and functions into one program with the primary function of serving as 

the statewide cross-disability partnership with members appointed by the Governor. The 

new Cross-Disability State Councils established under the PIII program will continue to 

engage in advocacy, capacity building and systems change to enhance the availability, 

quality and coordination of services and supports for persons with all types of significant 

disabilities and their families, while placing greater emphasis on supporting delivery of 

services that help to achieve independence, productivity, integration, self-determination 

and inclusion in the community. 

 No funding is requested for State Councils on Developmental Disabilities (SCDD), 

whose functions would be folded into the proposed new Partnerships for Innovation, 

Inclusion and Independence to provide a statewide cross-disability partnership supporting 

individuals with all types of significant disabilities in each state and territory. 

 $38,660,000 for Developmental Disability Protection and Advocacy systems, 

maintaining the annualized FY 2017 Continuing Resolution level. Protection and 

Advocacy systems in each state and territory protect the legal and human rights of all 

people with developmental disabilities, and have the authority to pursue legal, 

administrative and other appropriate remedies or approaches, including the authority to 

investigate incidents of abuse and neglect. 
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

139

 $38,546,000 for University Centers for Excellence in Developmental Disabilities 

(UCEDDs), maintaining the annualized FY 2017 Continuing Resolution level. UCEDDs 

in each state and territory undertake interdisciplinary pre-service training, community 

services, research, and information dissemination activities that promote opportunities for 

people with developmental disabilities to exercise self-determination and to be 

independent, productive, integrated, and included in the community. 

 $7,600,000 for Projects of National Significance, a reduction of -$2,380,990 below the 

annualized FY 2017 Continuing Resolution level. Projects of National Significance fund 

grants, cooperative agreements, and contracts to explore innovative opportunities for 

individuals with developmental disabilities to directly and fully contribute to, and 

participate in, all facets of community life. 

 $78,156,000 for Independent Living, a reduction of -$22,834,651 below the annualized 

FY 2017 Continuing Resolution level. No funding is requested for Independent Living 

State Grants that support State Independent Living Councils (SILC), whose functions 

would be folded into the proposed new Partnerships for Innovation, Inclusion and 

Independence to provide a statewide cross-disability partnership supporting individuals 

with all types of significant disabilities in each state and territory. The request maintains 

the current funding level for Centers for Independent Living, which provides grants for 

consumer controlled, community-based, cross-disability, private nonprofit agencies that 

are designed and operated within a local community by individuals with significant 

disabilities and provide an array of independent living services. 

 No funding is requested for the Limb Loss Resource Center. Resources for individuals 

affected by limb loss will continue to be available through other ACL programs, such as 

Centers for Independent Living and Assistive Technology, which provide resources to 

people with all types of significant disabilities. 

 No funding is requested for the Paralysis Resource Center. Resources for individuals 

living with paralysis will continue to be available through other ACL programs, such as 

Centers for Independent Living and Assistive Technology, which provide resources to 

people with all types of significant disabilities. 

 $3,162,000 for the Traumatic Brain Injury (TBI) program, a reduction of -$6,141,281 

below the annualized FY 2017 Continuing Resolution level. No funding is requested for 

the State Advisory Boards, the State Implementation Partnership Grants they support or 

for related administrative expenses. These functions would be folded into the proposed 

new Partnerships for Innovation, Inclusion and Independence to provide a statewide 
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

140

cross-disability partnership supporting individuals with all types of significant disabilities 

in each state and territory. TBI Protection and Advocacy activities will continue to be 

maintained at the annualized FY 2017 Continuing Resolution level. 

 $95,127,000 for the National Institute on Disability, Independent Living, and 

Rehabilitation Research (NIDILRR), a reduction of -$8,645,353 below the annualized FY 

2017 Continuing Resolution level. 
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

141

Partnerships for Innovation, Inclusion and Independence 

FY 2016

Final

FY 2017

Annualized 

CR

FY 2018

President's 

Budget

FY 2018+/-

FY 2017

Partnerships for Innovation, 

Inclusion and Independence $0 $0 $45,000 +$45,000

Authorizing Legislation: 

FY 2018 .........................................................................................................................$45,000,000

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

Program Description and Accomplishments: 

The Partnerships for Innovation Inclusion and Independence is a new program that consolidates: 

State Councils on Developmental Disabilities, Independent Living State Grants and Traumatic 

Brain Injury-State Implementation Partnership Grants. The consolidation would allow States, on 

behalf of all persons with any type of significant disability, to create a single cross-disability 

State Council to engage in capacity building, advocacy and systems change to enhance the 

availability, quality and coordination of services and supports that these individuals and their 

families use to achieve independence, productivity, integration, self-determination and inclusion 

in the community. 

The PIII program would align similar features and functions from the consolidated State council 

activities into one program. Each State council would include: 

 Members appointed by the Governor 

 Strategic priority setting based on data driven planning 

 Implementing change based on the strategic priority setting 

 Meaningful engagement with individuals with disabilities and their families 

 Seeding innovation to promote systems change and build capacity 

 Enhancing the availability, quality and coordination of services and supports persons 

with significant disabilities and their families rely on to lead full lives in the 

community.

Implementation activities would include: independent and other community living services and 

supports to individuals with significant disabilities; leadership development; system change; 

training and technical assistance; and outreach to unserved and underserved populations.
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

142

Funding History: 

This is the first year funding is requested for Partnerships for Innovation, Inclusion and 

Independence: 

FY 2014 .................................................................$0 

FY 2015 .................................................................$0 

FY 2016 .................................................................$0 

FY 2017 Annualized CR ........................................$0 

FY 2018 President’s Budget ..................$45,000,000 

Budget Request: 

The budget request for FY 2018 includes $45,000,000 in first-time funding for a new grant 

program, Partnerships for Innovation, Inclusion and Independence (PIII). This program would 

align three existing programs with similar features and functions into one program. 

The Partnership Grants will allow ACL to reduce duplication and overlap, and to more 

efficiently serve individuals with developmental disabilities, traumatic brain injury and other 

significant disabilities. Under Partnerships for Innovation, Inclusion and Independence, a single 

grant will be made to one primary designated entity to support a single Statewide CrossDisability Council appointed by the State’s Governor. The new Cross-Disability State Councils 

established under the PIII program will continue to engage in advocacy, capacity building and 

systems change to enhance the availability, quality and coordination of services and supports that 

persons with all types of significant disabilities and their families use to achieve independence, 

productivity, integration, self-determination and inclusion in the community. 

By funding a single entity, the PIII program will support states and territories in building and 

organizing systems change efforts aimed at turning fragmented approaches into innovative and 

cost-effective strategies that lead to greater independence and integration within the community--

for people with all types of significant disabilities and their families. The grants will also seek to 

enhance current services and supports available in the State.

ACL looks forward to working with Congress on the development of authorization language for 

this new program.
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

143

Grant Awards Tables: 

Partnerships for Innovation, Inclusion, and Independence 

FY 2016 Final FY 2017 

Annualized CR

FY 2018 

President's 

Budget

Number of 

Awards NA NA 56

Average 

Award NA NA $803,571 

Range of 

Awards NA NA

$250,000 -

$4,510,381 
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

144

State Councils on Developmental Disabilities 

FY 2016

Final

FY 2017

Annualized 

CR

FY 2018

President's 

Budget

FY 2018+/-

FY 2017

State Councils on Developmental 

Disabilities $73,000 $72,861 $0 -$72,861

Authorizing Legislation: Section 129(a) of the Developmental Disabilities Assistance and Bill of 

Rights Act 

FY 2018 Developmental Disabilities Assistance and Bill of Rights Act Authorization ...... Expired 

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

Program Description and Accomplishments: 

State Councils on Developmental Disabilities (SCDD) are charged with identifying the most 

pressing needs of people with developmental disabilities in their state and territory. Established 

in 1970, SCDDs work to set priorities and pursue systems change efforts designed to turn 

fragmented approaches into a comprehensive and effective statewide, person-centered and 

family-centered system that provides a coordinated array of culturally-competent services and 

other forms of assistance for people with developmental disabilities and their families. 

SCDDs do not provide services directly, but rather examine and conduct in-depth analysis of the 

quantity and quality of services and supports that are provided at the state and local level. Each 

SCDD develops a strategic state plan based on their analysis, with goals and objectives designed 

to move the state towards an effective, coordinated system of supports and services that advance 

community living for all people with developmental disabilities. 

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. 
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

145

Funding History: 

Funding for the program over the past five years is as follows: 

FY 2014 .................................................$70,692,000 

FY 2015 .................................................$71,692,000 

FY 2016 .................................................$73,000,000 

FY 2017 Annualized CR ........................$72,861,227 

FY 2018 President’s Budget ..................................$0 

Budget Request: 

The FY 2018 Budget Request is $0, a decrease of -$72,861,227 from the FY 2017 Annualized 

Continuing Resolution level. ACL proposes to consolidate State Councils on Developmental 

Disabilities and the parts of the other ACL programs that provide support for these separate 

Councils and Boards and to replace them with one, new cross-disability council which would 

operate in each state and territory. Please refer to the Partnerships for Innovation, Inclusion and 

Independence section for more information. 

Outputs and Outcomes Table: 

State Councils on Developmental Disabilities 

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2017

Target

8.1LT and 8A Increase 

the percentage of 

individuals with 

developmental 

disabilities reached by the 

Councils who are 

independent, selfsufficient and integrated 

into the community. 

(Outcome)

FY 2015: 14.88%

Target:

14.59%

(Target Exceeded)

Prior Result + 

0.1%

8E Increase the number 

of individuals with 

developmental 

disabilities reached by the 

Councils who are 

independent, selfsufficient and integrated 

into the community per 

$1,000 of federal funding 

to the Councils. 

(Efficiency)

FY 2015: 9.92

Target:

9.83

(Target Exceeded)

Prior Result + 

1%
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

146

Indicator Year and Most Recent 

Result /

FY 2017

Projection

8i: Number of individuals 

with developmental 

disabilities reached by the 

Councils who are 

independent, selfsufficient and integrated 

into the community. 

(Output)

FY 2015: 743,763 N/A

8ii: Number of all 

individuals trained by the 

Councils. (Output)

FY 2015: 390,068 N/A

Grant Awards Tables: 

State Councils on Developmental Disabilities Grant Awards 

FY 2016 Final FY 2017 

Annualized CR

Number of 

Awards 56 56

Average 

Award $1,303,571 $1,301,093

Range of 

Awards

$253,882 -

$6,543,380

$253,352 -

$6,529,688
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

147

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

ADMINISTRATION ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 

FY 2018 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: State Councils on Developmental Disabilities (CFDA 93.630) 

State/Territory FY 2016 Actual FY 2017

Annualized CR

Alabama...................................... 1,294,230 1,291,524

Alaska......................................... 487,511 486,491

Arizona........................................ 1,415,169 1,412,210

Arkansas...................................... 772,804 771,188

California.................................... 6,543,380 6,529,688

Colorado...................................... 882,984 881,156

Connecticut................................. 688,823 687,384

Delaware..................................... 487,511 486,491

District of Columbia................... 487,511 486,491

Florida......................................... 3,664,684 3,657,026

Georgia........................................ 2,070,716 2,066,386

Hawaii......................................... 487,511 486,491

Idaho........................................... 487,511 486,491

Illinois......................................... 2,624,831 2,619,340

Indiana......................................... 1,488,546 1,485,432

Iowa............................................. 774,177 772,556

Kansas......................................... 614,589 613,304

Kentucky..................................... 1,201,176 1,198,664

Louisiana..................................... 1,375,723 1,372,848

Maine.......................................... 487,511 486,491

Maryland..................................... 1,008,160 1,006,052

Massachusetts............................. 1,365,884 1,363,028

Michigan..................................... 2,543,752 2,538,432

Minnesota.................................... 1,025,295 1,023,152

Mississippi.................................. 914,238 912,326

Missouri...................................... 1,367,975 1,365,116

Montana...................................... 487,511 486,491

Nebraska..................................... 487,511 486,491

Nevada....................................... 541,498 540,366

New Hampshire.......................... 487,511 486,491
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

148

PROGRAM/CFDA NUMBER: State Councils on Developmental Disabilities (CFDA 93.630) 

State/Territory FY 2016 Actual FY 2017

Annualized CR

New Jersey.......................... 1,553,320 1,550,072

New Mexico....................... 490,241 489,214

New York........................... 4,101,074 4,092,498

North Carolina.................... 2,020,953 2,016,728

North Dakota...................... 487,511 486,491

Ohio.................................... 2,846,721 2,840,766

Oklahoma............................ 897,250 895,374

Oregon................................ 781,292 779,658

Pennsylvania....................... 3,026,521 3,020,190

Rhode Island....................... 487,511 486,491

South Carolina.................... 1,097,001 1,094,706

South Dakota...................... 487,511 486,491

Tennessee............................ 1,461,395 1,458,340

Texas................................... 4,813,917 4,803,850

Utah.................................... 635,274 633,944

Vermont.............................. 487,511 486,491

Virginia............................... 1,501,929 1,498,790

Washington......................... 1,170,579 1,168,132

West Virginia...................... 739,342 737,796

Wisconsin........................... 1,311,944 1,309,200

Wyoming............................ 487,511 486,491

Subtotal, States................... 69,452,541 69,307,310

American Samoa................. 253,882 253,352

Guam.................................. 253,882 253,352

Northern Mariana Islands... 253,882 253,352

Puerto Rico......................... 2,506,931 2,501,688

Virgin Islands..................... 253,882 253,352

Subtotal, States and Territories 72,975,000 72,822,406

Program Support 1/................... 25,000 38,821

TOTAL..................................... 73,000,000 72,861,227

1/ Program Support -- Includes funds for grant systems and review, and program 

reporting systems costs.
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

149

Developmental Disabilities – Protection and Advocacy 

FY 2016

Final

FY 2017

Annualized 

CR

FY 2018

President's 

Budget

FY 2018+/-

FY 2017

DD – Protection and Advocacy $38,734 $38,660 $38,660 --

Authorizing Legislation: Section 145 of the Developmental Disabilities Assistance and Bill of 

Rights Act 

FY 2018 Developmental Disabilities Assistance and Bill of Rights Act Authorization ...... Expired 

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

Program Description and Accomplishments: 

Established in 1975, Developmental Disabilities Protection and Advocacy (P&As) programs 

provide a range of legal services to traditionally unserved or underserved individuals with 

developmental disabilities to ensure they are protected from abuse and neglect and are able to 

exercise their rights to make choices, contribute to society, and live independently. P&A systems 

have the authority to pursue 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 in support of community living. The number of people with intellectual and 

developmental disabilities receiving Home and Community-Based waiver services has steadily 
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

150

increased.97 86 percent of the P&A clients 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) that is also supported by ACL. There is also a 

growing federal awareness and response to the uncharted area of abuse, neglect and exploitation 

of older adults, and persons with disabilities. P&As and LTCOP’s will increasingly need to have 

the capacity to address this issue at the same time that 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 2014 .................................................$38,634,000 

FY 2015 .................................................$38,734,000 

FY 2016 .................................................$38,734,000 

FY 2017 Annualized CR ........................$38,660,367 

FY 2018 President’s Budget ..................$38,660,000 

Budget Request: 

The FY 2018 request for the Developmental Disabilities Protection and Advocacy program is 

$38,660,000, maintaining the annualized FY 2017 Continuing Resolution 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 critical role in ensuring that people with 

developmental disabilities are free of abuse and neglect. People with developmental disabilities, 

 

97 U.S. Profile, FY 1977 – 2013, State of the State in Developmental Disabilities. 
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including children, are at increased risk of experiencing abuse and neglect.98 The 57 P&As stay 

at the forefront of these issues. P&As maintain a presence in facilities that care for people with 

disabilities, where they monitor, investigate, and attempt to remedy adverse conditions. In FY

2015, 42 percent of the 57 P&As cases remedied complaints of abuse and neglect.

Without the P&A presence, people with developmental disabilities and their families would have 

limited to no access to cost-effective, low level advocacy and legal interventions. Of the inquiries 

and issues received by the P&As in FY 2015: 

 39 percent were resolved using short-term assistance strategies; 

 29 percent were addressed through technical assistance in self-advocacy; 

 10 percent involved investigation and monitoring; and 

 13 percent were addressed through negotiation.

 

98 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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Outputs and Outcomes Table: 

Developmental Disabilities Protection and Advocacy 

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2017

Target

FY 2018

Target

FY 2018

Target

+/-FY 2017

Target

8B Increase the 

percentage of individuals 

who have their complaint 

of abuse, neglect, 

discrimination, or other 

human or civil rights 

corrected compared to the 

total assisted. (Outcome)

FY 2015: 86.93%

Target:

86.67%

(Target Exceeded)

Prior Result + 

0.5%

Prior Result + 

0.5%

N/A

Indicator Year and Most Recent 

Result /

FY 2017

Projection

FY 2018

Projection

FY 2018

Projection

+/-FY 2017

Projection

8iii: Number of clients 

receiving professional 

individual legal advocacy 

for the Protection and 

Advocacy program. 

(Output)

FY 2015: 17,495 N/A N/A N/A

8iv: Number of people 

receiving information and 

referral from the 

Protection and Advocacy 

program. (Output)

FY 2015: 44,600 N/A N/A N/A

Grant Awards Tables: 

Developmental Disabilities – Protection and Advocacy Formula Grant Awards/1

FY 2016 Final FY 2017

Annualized CR

FY 2018

President's 

Budget

Number of 

Awards 57 57 57

Average 

Award $665,638 $664,214 $664,208

Range of 

Awards

$205,808 -

$3,239,698

$205,808 -

$3,370,139

$205,808 -

$3,538,527

1/ Excludes grants to tribal organizations. 
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DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

ADMINISTRATION ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 

FY 2018 DISCRETIONARY STATE FORMULA GRANTS 2/

PROGRAM/CFDA NUMBER: Developmental Disabilities – Protection and Advocacy (CFDA 93.630) 

State/Territory FY 2016 

Actual

FY 2017

Annualized 

CR

FY 2018

President's 

Budget

FY 2018 +/-

FY 2017

Alabama...................................... 612,842 581,642 551,293 (30,349)

Alaska.......................................... 384,693 384,693 384,694 1

Arizona........................................ 679,160 694,007 700,141 6,134

Arkansas...................................... 396,365 393,107 390,302 (2,805)

California.................................... 3,239,698 3,370,139 3,538,527 168,388

Colorado...................................... 455,700 463,433 469,709 6,276

Connecticut................................. 384,693 387,066 389,436 2,370

Delaware..................................... 384,693 384,693 384,694 1

District of Columbia.................... 384,693 384,693 384,694 1

Florida......................................... 1,911,812 1,955,727 1,970,417 14,690

Georgia........................................ 1,051,072 1,054,712 1,051,285 (3,427)

Hawaii......................................... 384,693 384,693 384,694 1

Idaho............................................ 384,693 384,693 384,694 1

Illinois......................................... 1,234,045 1,227,475 1,233,879 6,404

Indiana......................................... 743,896 713,533 686,489 (27,044)

Iowa............................................. 384,693 384,693 384,694 1

Kansas......................................... 384,693 384,693 384,694 1

Kentucky..................................... 565,714 535,486 508,446 (27,040)

Louisiana..................................... 553,812 537,531 524,601 (12,930)

Maine.......................................... 384,693 384,693 384,694 1

Maryland..................................... 468,162 487,728 503,818 16,090

Massachusetts.............................. 601,031 603,266 609,268 6,002

Michigan..................................... 1,200,501 1,121,786 1,055,934 (65,852)

Minnesota.................................... 507,870 502,630 498,663 (3,967)

Mississippi.................................. 417,111 409,127 401,669 (7,458)

Missouri...................................... 677,427 643,530 614,001 (29,529)

Montana...................................... 384,693 384,693 384,694 1

Nebraska...................................... 384,693 384,693 384,694 1

Nevada........................................ 384,693 384,693 384,694 1

New Hampshire.......................... 384,693 384,693 384,694 1
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PROGRAM/CFDA NUMBER: Developmental Disabilities – Protection and Advocacy (CFDA 93.630) 

State/Territory FY 2016 

Actual

FY 2017

Annualized CR

FY 2018

President's 

Budget

FY 2018 +/- FY 

2017

New Jersey.......................... 732,670 759,096 790,011 30,915

New Mexico....................... 384,693 384,693 384,694 1

New York........................... 1,779,591 1,802,944 1,836,388 33,444

North Carolina.................... 1,088,462 1,063,325 1,034,041 (29,284)

North Dakota...................... 384,693 384,693 384,694 1

Ohio.................................... 1,287,080 1,236,865 1,196,087 (40,778)

Oklahoma............................ 400,908 395,437 391,980 (3,457)

Oregon................................ 414,158 409,932 405,428 (4,504)

Pennsylvania....................... 1,317,038 1,293,555 1,280,064 (13,491)

Rhode Island....................... 384,693 384,693 384,694 1

South Carolina.................... 573,200 551,223 526,434 (24,789)

South Dakota...................... 384,693 384,693 384,694 1

Tennessee............................ 735,507 706,189 679,672 (26,517)

Texas................................... 2,394,954 2,464,777 2,526,194 61,417

Utah.................................... 384,693 384,693 384,694 1

Vermont.............................. 384,693 384,693 384,694 1

Virginia............................... 725,629 728,803 731,815 3,012

Washington......................... 620,334 640,873 660,379 19,506

West Virginia...................... 384,693 384,693 384,694 1

Wisconsin........................... 622,558 596,913 574,927 (21,986)

Wyoming............................ 384,693 384,693 384,694 1

Subtotal, States................... 36,086,860 36,025,717 36,025,178 (539)

American Samoa................. 205,808 205,808 205,808 -

Guam.................................. 205,808 205,808 205,808 -

Northern Mariana Islands... 205,808 205,808 205,808 -

Puerto Rico......................... 825,493 805,489 805,668 179

Virgin Islands..................... 205,808 205,808 205,808 -

Subtotal, States and Territories 37,735,585 37,654,438 37,654,078 (360)

Native American Organization $205,808 $205,808 $205,808 -

Program Support 1/................... $792,607 $800,121 $800,114 (7)

TOTAL...................................... 38,734,000 38,660,367 38,660,000 (367)

1/ Program Support—Includes funds for statutory technical assistance and/or minority set-asides; grant systems and review, and 

program reporting systems costs. 
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University Centers for Excellence in Developmental Disabilities 

FY 2016

Final

FY 2017

Annualized 

CR

FY 2018

President's 

Budget

FY 2018+/-

FY 2017

University Centers of Excellence 

in Developmental Disabilities $38,619 $38,546 $38,546 --

Authorizing Legislation: Section 156 of the Developmental Disabilities Assistance and Bill of 

Rights Act 

FY 2018 Developmental Disabilities Assistance and Bill of Rights Act Authorization ...... Expired 

Allocation Method ............................................................................................... Competitive Grant 

Program Description and Accomplishments: 

University Centers for Excellence in Developmental Disabilities (UCEDDs), first established in 

1963, are interdisciplinary education, research and public service units of a university or 

not-for-profit entities associated with universities. UCEDDs provide leadership, advising

Federal, State, and community policymakers about, and promote opportunities for individuals 

with developmental disabilities to exercise self-determination and to be independent, productive, 

integrated and included in all facets of community life. 

UCEDDs have played a key role in a significant number of advances in the disability field over 

the past four decades. Many issues, such as early intervention, health care, community-based 

services, inclusive and meaningful education, transition from school to work, employment, 

housing, assistive technology, and transportation have been directly improved by the services, 

research, and training provided by UCEDDs. 

In FY 2016, 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. 

As liaisons to the community, including service delivery systems, UCEDDs positively affect the 

lives of individuals with developmental disabilities and their families in a variety of ways. 

UCEDD accomplishments include: 
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 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 addresses a local or 

universal need, can be replicated and promote the increased inclusion, integration, 

productivity, and human rights of individuals with developmental disabilities and their 

families including people with developmental disabilities from racial and ethnic minority 

backgrounds. 

 Contributing to the development of new knowledge through various research activities 

including basic or applied research, evaluation, and public policy analysis. UCEDD 

research engages people with developmental disabilities and their families in the 

development, design and implementation of research activities, as well as the 

dissemination of research information. New knowledge is generated by research and tied 

to practice using a variety of dissemination strategies. 

 UCEDDs work to bridge the gap between research and practice by developing a variety 

of products and resources that promotes improvement in knowledge and practice. 

UCEDDs conduct national training and other initiatives to address unmet needs of people with 

developmental disabilities. Past training initiatives have supported post-secondary education 

opportunities for people with developmental disabilities, enhancing self-determination skills, and 

building partnerships with minority serving institutions. 

UCEDDs also lead 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 research 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. 
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157

Funding History: 

Funding for the program over the past five years is as follows: 

FY 2014 .................................................$36,674,000 

FY 2015 .................................................$37,674,000 

FY 2016 ... .............................................$38,619,000 

FY 2017 Annualized CR ........................$38,545,585 

FY 2018 President’s Budget ..................$38,546,000 

Budget Request: 

The FY 2018 request for UCEDDs is $38,546,000, maintaining the annualized FY 2017 

Continuing Resolution 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 are vital to the training of future 

professionals with the specialized expertise in developmental disabilities. Of the UCEDD 

trainees who graduated 5 to 10 years ago, 30 percent are in leadership positions including: 

 1 percent in academic leadership; 

 16 percent in clinical leadership; 

 2 percent in public health leadership; and 

 28 percent in public policy and advocacy leadership.

42 percent of people with developmental disabilities are receiving services from former UCEDD 

trainees. 

Funding for UCEDDs is important in that it supports specialized services at the local level and 

provides local organizations as well as state agencies with technical assistance to improve 

services and supports for people with developmental disabilities across the life span. 
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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 2017

Target

FY 2018

Target

FY 2018

Target

+/-FY 2017

Target

8D Increase the 

percentage of individuals 

with developmental 

disabilities receiving the 

benefit of services 

through activities in 

which professionals were 

involved who completed 

University Centers of 

Excellence in 

Developmental 

Disabilities (UCEDDs) 

state-of-the-art training 

within the past 10 years. 

(Outcome)

FY 2015: 42.2%

Target:

41.88%

(Target Exceeded)

Prior Result + 

1%

Prior Result + 

1%

N/A

Indicator Year and Most Recent 

Result /

FY 2017 

Projection

FY 2018

Projection

FY 2018

Projection

+/-FY 2017 

Projection

8viii: Number of 

professionals trained by 

UCEDDs. (Output)

FY 2015: 5,546 N/A N/A N/A

8ix: Number of people 

reached through UCEDD 

community training and 

technical assistance 

activities. (Output)

FY 2015: 770,149 N/A N/A N/A

8x: Number of people 

receiving direct or model 

demonstration services 

from UCEDDs. (Output)

FY 2015: 100,607 N/A N/A N/A
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Grant Awards Tables: 

University Centers of Excellence in Developmental Disabilities Grant Awards 

FY 2016 Final FY 2017

Annualized CR

FY 2018

President’s 

Budget

Number 

of Awards 88 82 82

Average 

Award $429,205 $460,890 $460,878

Range of 

Awards

$31,504 -

$547,000

$31,504,-

$550,000

$31,504,-

$550,000

Resource and Program Data: 

University Centers of Excellence in Developmental Disabilities 

Mechanism

FY 2016

Final

#

FY 2016

Final

$

FY 2017

CR Annualized

#

FY 2017

CR Annualized

$

FY 2018

President’s 

Budget

#

FY 2018

President’s 

Budget

$

Formula Grants -- -- -- -- -- --

New Discretionary

Grants 23 2,216 57 24,119 32 10,442

Continuations Grants 65 35,554 25 13,674 50 27,350

Contracts 1 813 1 717 1 717 

Interagency 

Agreements -- -- -- -- -- --

Program Support /1 -- 36 -- 36 -- 37

Total Resources -- 38,619 -- 38,546 -- 38,546 

1/ Program Support -- Includes funds for overhead, grant systems and review costs, and information technology 

support costs.
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Developmental Disabilities – Projects of National Significance 

FY 2016

Final

FY 2017

Annualized 

CR

FY 2018

President's 

Budget

FY 2018 +/-

FY 2017

Developmental Disabilities—

Projects of National 

Significance

$10,000 $9,981 $7,600 -$2,381

Authorizing Legislation: Section 163 of the Developmental Disabilities Assistance and Bill of 

Rights Act 

FY 2018 Developmental Disabilities Assistance and Bill of Rights Act Authorization ...... Expired 

Allocation Method ............................. Competitive Grants and Cooperative Agreements/Contracts 

Program Description and Accomplishments: 

Projects of National Significance (PNS) is a discretionary program which provides grants, 

cooperative agreements, and contracts to public or private non-profit entities to fund innovative 

and emerging promising practice demonstrations to 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, with a particular focus on youth and 

young adults, as well as the evaluation of such efforts and technical assistance to the 

states 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 increase diversity among the current leaders within the DD Network and to 

enhance the cultural linguistic competence and leaderships skills of those leaders. 

 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 2014 ...................................................$8,821,000 

FY 2015 ...................................................$8,857,000 

FY 2016... ..............................................$10,000,000 

FY 2017 Annualized CR ..........................$9,980,990 

FY 2018 President’s Budget ....................$7,600,000 

Budget Request: 

The FY 2018 request for the Projects of National Significance program is $7,600,000, a 

reduction of -$2,380,990 below the FY 2017 Annualized Continuing Resolution level. 

Reductions to achieve this lower funding level will include elimination of the current grant 

related to inclusive transportation for those with disabilities, since transportation issues can more 

appropriately be addressed with funding from the Department of Transportation, and elimination 

of technical assistance for the State Councils on Developmental Disabilities.

Funds will continue to support the Partnerships in Employment Systems Change projects as they 

continue to work toward a current need of the intellectual and developmental disabilities 

community. For example, in Wisconsin, individuals with intellectual and developmental 

disabilities enrolled in adult long-term care systems have community-based employment rates of 

only 9 to 14 percent. One of the project’s goals is to implement changes that will increase the 

number of students in Wisconsin, and ultimately nationally, who are employed in integrated, 

community-based settings after leaving high school or a post-secondary institution and who 

become economically self-sufficient. 

Consistent with the purpose of the Developmental Disabilities Act, including the promotion of 

self-determination, ACL has worked collaboratively to explore supported decision-making as an 
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162

alternative to guardianship, in order to maximize the opportunity for people with intellectual and 

developmental disabilities to live independently and to exert control and choice in their own 

lives. Funding will support the continuation of a joint integrated training and technical 

assistance/resource center on supported decision making to advance work in this area. 

Grant Awards Tables: 

Developmental Disabilities – Projects of National Significance Grant Awards 

FY 2016 Final FY 2017

Annualized CR

FY 2018

President’s 

Budget

Number 

of 

Awards

25 20 17

Average 

Award $301,240 $377,150 $351,235

Range of 

Awards

$5,000 -

$1,000,000

$209,463 -

$1,050,000

$209,463 -

$1,050,000

Resource and Program Data: 

Developmental Disabilities – Projects of National Significance 

(Dollars in thousands) 

Mechanism

FY 2016 

Final

#

FY 2016 

Final

$

FY 2017 CR 

Annualized

#

FY 2017 CR 

Annualized

$

FY 2018 

President’s 

Budget

#

FY 2018 

President’s 

Budget

$

Grants:

Formula -- -- -- -- -- --

New Discretionary 11 3,569 8 3,709 -- --

Continuations 14 3,962 12 3,834 17 5,971

Contracts 9 2,297 7 2,139 5 1,496

Interagency Agreements -- -- 1 150 -- --

Program Support /1 172 149 133

Total Resources 10,000 28 9,981 22 7,600

1/ Program Support -- Includes funds for grant systems, review costs, and technology support costs. 
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Independent Living 

FY 2016

Final

FY 2017

Annualized 

CR

FY 2018

President’s 

Budget

2018 +/-

FY 2017

Independent Living State 

Grants $22,878 $22,835 $0 -$22,835

Centers for Independent Living $78,305 $78,156 $78,156 --

Total $101,183 $100,991 $78,156 -$22,835

Authorizing Legislation: Rehabilitation Act of 1973, Title VII, Parts B and C, and Chapter 2, 

as amended by the Workforce Innovation and Opportunities Act (Rehabilitation Act) 

FY 2018 Rehabilitation Act Authorizations: 

Independent Living State Grants ...................................................................................$25,156,000

Centers for Independent Living .....................................................................................$86,104,000

Allocation Method ...................................................................... Formula and Discretionary Grants 

Program Description and Accomplishments: 

Independent Living (IL) programs maximize the leadership, empowerment, independence, and 

productivity of individuals with disabilities, and work to integrate these individuals into the 

mainstream of American society. Independent living programs provide financial assistance to 

sustain, expand, and improve independent living services; develop and support statewide 

networks of centers for independent living; and foster working relationships among centers for 

independent living, Statewide Independent Living Councils, other Rehabilitation Act programs, 

and other relevant Federal and non-Federal programs. 

Centers for Independent Living 

The Centers for Independent Living (CIL) program provides grants for consumer-controlled, 

community-based, cross-disability, private nonprofit agencies that are designed and operated 

within a local community by individuals with disabilities and provide an array of independent 

living services. At a minimum, centers are required to provide the core services of information 

and referral, independent living skills training, peer counseling, and individual and systems 

advocacy. 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: 
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164

 Facilitate the transition of individuals with significant disabilities from nursing homes 

and other institutions to home and community based residences, with necessary supports 

to remain in the community; 

 Assist individuals with significant disabilities at risk of institutionalization so that they 

may remain in the community; and 

 Facilitate the transition of youth who are individuals with significant disabilities that are 

eligible for IDEA and who either completed school or left school to transition to 

postsecondary life. 

A population-based formula determines the total amount that is available for grants to centers in 

each State. WIOA requires that grants be awarded to any eligible agency that had been awarded 

a grant for the preceding fiscal year. In most cases, funds are awarded directly to centers for 

independent living. In fiscal year 2015, 354 centers and two States received funding from the 

CIL program. If State funding for CIL operation exceeds the level of Federal CIL funding in any 

fiscal year, the State may apply for the authority to award grants under this program through its 

designated state unit. There are currently only two States, Massachusetts and Minnesota, that are 

both eligible and have elected to manage their own CIL programs. 

In addition to funding centers for independent living, the Department must annually reserve 

between 1.8 and 2 percent of the funds appropriated for this program to provide (through grants, 

contracts, or cooperative agreements) training and technical assistance with respect to planning, 

developing, conducting, administering, and evaluating centers for independent living. 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). 

Independent Living State Grants 

The Independent Living 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. 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. 
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165

Funding History: 

Funding for Independent Living activities over the past five years is as follows: 

Centers for Independent Living 

FY 2014 .................................................$78,305,000 

FY 2015 .................................................$78,305,000 

FY 2016 .................................................$78,305,000 

FY 2017 Annualized CR ........................$78,156,142 

FY 2018 President’s Budget ..................$78,156,000 

Independent Living State Grants

FY 2014 .................................................$22,878,000 

FY 2015 .................................................$22,878,000 

FY 2016 ............................................... $22,878,000 

FY 2017 Annualized CR ........................$22,834,509 

FY 2018 President’s Budget ..................................$0 

Budget Request: 

Centers for Independent Living 

The FY 2018 request for Centers for Independent Living (CILs) is $78,156,000, which maintains 

the annualized FY 2017 Continuing Resolution level. CILs will continue to provide the core 

requirements for information and referral services, independent living skills training, peer 

counseling, and individual and systems advocacy, as well as continue to implement the new, fifth 

core service required by WIOA to facilitate the transition of individuals with significant 

disabilities into the community. As part of this requirement, CILs are directed to develop 

protocols, provide outreach and education, and provide and track activities. In 2014, CILs served 

about 280,000 of the estimated 38 million individuals with a significant disability living in the 

United States.99

The request for the CIL program would continue support for existing centers, including any new 

center grants awarded in FY 2017. Approximately 75 new centers have been funded since FY 

2000 and these new and existing centers provide essential services that help individuals with 

disabilities to live independently and participate as productive members of their communities. 

 

99 ACL, 704 Report, 2014. And U.S. Census Bureau, “Americans with Disabilities 2010” issued July 2012. 

Accessed 12/4/14. Accessed 12/4/14. 
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166

Independent Living State Grants 

The FY 2018 Budget Request is $0, a decrease of -$22,834,509 from the FY 2017 annualized 

Continuing Resolution level. ACL proposes to consolidate the Independent Living State Grants 

and the State Independent Living Councils they support into one, new cross-disability council, 

funded through the Partnerships for Innovation, Inclusion and Independence Program, which 

would operate in each state and territory. Please refer to the Partnerships for Innovation, 

Inclusion and Independence section for additional information. 

Outcome and Output Table: 

ACL has reviewed and is revising the grantee program performance reports (PPRs). These 

reports form the basis of performance measures. The report content is undergoing Information 

Collection Request (ICR) approval process required under the Paperwork Reduction Act. Once 

the revised PPR is approved and grantees have collected baseline data, performance measures 

will be developed and reported. 

Grant Awards Table: 

Independent Living State Grant Awards 

FY 2016 Final FY 2017 

Annualized CR

Number of 

Awards 1/ 56 56

Average 

Award $396,714 $395,564

Range of 

Awards

$27,770 -

$1,980,977

$27,689 -

$1,970,797

1/ Independent Living State Grants are awarded to 77 entities across 56 state 

 and territory jurisdictions because some states have separate divisions for 

vocational rehabilitation and services for the blind. 
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167

Resource and Program Data: 

Independent Living 

(Dollars in Thousands) 

Mechanism

FY 2016 

Final

#

FY 2016 

Final

$

FY 2017 CR 

Annualized

#

FY 2017 CR 

Annualized

$

FY 2018 

President’s 

Budget

#

FY 2018 

President’s 

Budget

$

Formula Grants /2 77 22,216 77 22,216 -- --

New Discretionary

Grants 23 1,564 5 1,867 5 1,543

Continuations Grants 361 77,374 356 76,559 356 76,264

Contracts -- -- -- -- -- --

Interagency 

Agreements -- -- -- -- -- --

Program Support /1 29 349 349

Total Resources 101,183 100,991 78,156

1/ Program Support—Includes funds for statutory technical assistance and/or minority set-asides; grant systems and 

review, and program reporting systems costs. 

2/ Independent Living State Grants are awarded to 77 entities across 56 state and territory jurisdictions 

because some states have separate divisions for vocational rehabilitation and services for the blind. 
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

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DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

FY 2017 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: Independent Living State Grants (CFDA 84.169A)

State/Territory FY 2016 Actual FY 2017

Annualized CR

FY 2018

President's Budget FY 2018 +/- FY 

2017

Alabama...................................... 305,350 305,350 - (305,350)

Alaska......................................... 305,350 305,350 - (305,350)

Arizona........................................ 343,661 343,768 - (343,768)

Arkansas...................................... 305,350 305,350 - (305,350)

California.................................... 1,980,977 1,970,797 - (1,970,797)

Colorado...................................... 305,350 305,350 - (305,350)

Connecticut................................. 305,350 305,350 - (305,350)

Delaware..................................... 305,350 305,350 - (305,350)

District of Columbia.................. 305,350 305,350 - (305,350)

Florida......................................... 1,015,609 1,020,584 - (1,020,584)

Georgia........................................ 515,498 514,281 - (514,281)

Hawaii......................................... 305,350 305,350 - (305,350)

Idaho........................................... 305,350 305,350 - (305,350)

Illinois......................................... 657,590 647,453 - (647,453)

Indiana......................................... 336,788 333,276 - (333,276)

Iowa............................................. 305,350 305,350 - (305,350)

Kansas......................................... 305,350 305,350 - (305,350)

Kentucky..................................... 305,350 305,350 - (305,350)

Louisiana..................................... 305,350 305,350 - (305,350)

Maine.......................................... 305,350 305,350 - (305,350)

Maryland..................................... 305,350 305,350 - (305,350)

Massachusetts............................. 344,372 342,074 - (342,074)

Michigan..................................... 505,927 499,565 - (499,565)

Minnesota.................................... 305,350 305,350 - (305,350)

Mississippi.................................. 305,350 305,350 - (305,350)

Missouri...................................... 309,563 306,290 - (306,290)

Montana...................................... 305,350 305,350 - (305,350)

Nebraska..................................... 305,350 305,350 - (305,350)

Nevada........................................ 305,350 305,350 - (305,350)

New Hampshire.......................... 305,350 305,350 - (305,350)
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

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PROGRAM/CFDA NUMBER: Independent Living State Grants (CFDA 84.169A)

State/Territory FY 2016 Actual FY 2017

Annualized CR

FY 2018

President's Budget FY 2018 +/- FY 

2017

New Jersey.......................... 456,319 451,003 - (451,003)

New Mexico....................... 305,350 305,350 - (305,350)

New York........................... 1,008,100 996,645 - (996,645)

North Carolina.................... 507,667 505,618 - (505,618)

North Dakota...................... 305,350 305,350 - (305,350)

Ohio.................................... 591,915 584,693 - (584,693)

Oklahoma............................ 305,350 305,350 - (305,350)

Oregon................................ 305,350 305,350 - (305,350)

Pennsylvania....................... 652,823 644,559 - (644,559)

Rhode Island....................... 305,350 305,350 - (305,350)

South Carolina.................... 305,350 305,350 - (305,350)

South Dakota...................... 305,350 305,350 - (305,350)

Tennessee............................ 334,363 332,301 - (332,301)

Texas................................... 1,376,228 1,382,969 - (1,382,969)

Utah.................................... 305,350 305,350 - (305,350)

Vermont.............................. 305,350 305,350 - (305,350)

Virginia............................... 425,080 422,053 - (422,053)

Washington......................... 360,511 361,001 - (361,001)

West Virginia...................... 305,350 305,350 - (305,350)

Wisconsin........................... 305,350 305,350 - (305,350)

Wyoming............................ 305,350 305,350 - (305,350)

Subtotal, States................... 21,799,541 21,735,480 - (21,735,480)

American Samoa................. 27,770 27,689 - (27,689)

Guam.................................. 27,770 27,689 - (27,689)

Northern Mariana Islands... 27,770 27,689 - (27,689)

Puerto Rico......................... 305,350 305,350 - (305,350)

Virgin Islands..................... 27,770 27,689 - (27,689)

Subtotal, States and Territories 22,215,971 22,151,586 - (22,151,586)

Program Support 1/................... 662,029 682,923 - (682,923)

TOTAL..................................... 22,878,000 22,834,509 - (22,834,509)

1/ Program Support—Includes funds for statutory technical assistance and/or minority set-asides; grant systems and review, and 

program reporting systems costs
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

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Limb Loss Resource Center 

FY 2016

Final

FY 2017

Enacted

FY 2018

President's 

Budget

FY 2018 +/-

FY 2017

Limb Loss Resource Center $2,810 $2,805 $0 -$2,805

Authorizing Legislation: Public Health Service Act Section 301 (a) and Section 317, as 

amended, 42U.S.C. 241 (a); 42 U.S.C. 247 (b) 

FY 2018 Authorization ....................................................................................................................0

Allocation Method ............................................................................................. Competitive Grants 

Program Description and Accomplishments: 

Limb loss is the loss of all or part of an arm or leg due to trauma, infection, diabetes, heart 

diseases, cancers, or other diseases. An estimated two million people live with limb loss/limb 

difference in the United States.100 This number is expected to double by 2050, largely due to the 

rise of diabetes.101 Each year, an additional 185,000 amputations occur.102 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.103 Individuals with 

limb loss report receiving little information about their rehabilitation from their healthcare 

provider either before or after their amputation.104

 

100 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.

101 HCUP Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). Rockville, MD: 

Agency for Healthcare Research and Quality: 2009. 

102 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 

103 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.

104 Seaman JP. Survey of individuals wearing lower limb prostheses. Journal of Prosthetics and 

Orthotics2010;22(4):257-65
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

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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 helps 

pay for 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 2014/1 ................................................$2,810,000 

FY 2015/1 ................................................$2,800,000 

FY 2016 ...................................................$2,810,000 

FY 2017 Annualized CR ..........................$2,804,658 

FY 2018 President’s Budget ..................................$0 

1/ This program was funded at CDC through FY 2014 and transferred to ACL during FY 2015. 

Budget Request: 

No funding is requested in FY 2018 for the Limb Loss Resource Center because the mission and 

activities carried out by this program are duplicative of other Federal efforts. Resources for 

individuals affected by limb loss will continue to be available through other ACL programs, such 

as Aging and Disability Resource Centers, Centers for Independent Living and Assistive 

Technology, that provide services to people with all types of significant disabilities, as well as 

through ongoing NIDILRR research focused on improving health and function, employment, and 

community participation. 

Grant Awards Table: 

Limb Loss Resource Center 

FY 2016 Final FY 2017 

Annualized CR

Number of Awards 1 1

Average Award $2,727,237 $2,733,665

Range of Awards NA NA

1/ Program Support -- Includes funds for Public Health Service 

Act statutory requirements, grant systems and review costs. 
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

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Resource and Program Data: 

Limb Loss Resource Center 

(Dollars in Thousands) 

Mechanism

FY 2016 

Final

#

FY 2016 

Final

$

FY 2017

CR Annualized

#

FY 2017

CR Annualized

$

Formula Grants -- -- -- --

New Discretionary

Grants 1 2,727 -- --

Continuations Grants -- -- 1 2,734

Contracts -- -- -- --

Interagency Agreements -- -- -- --

Program Support /1 83 71

Total Resources 2,810 2,805
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

173

Paralysis Resource Center 

FY 2016

Final

FY 2017

Annualized 

CR

FY 2018

President's 

Budget

FY 2018 +/-

FY 2017

Paralysis Resource Center $7,700 $7,685 $0 -$7,685

Authorizing Legislation: Sections 311 and 317(k)(2) of the Public Health Service Act [42 U.S.C. 

243 & 247b(k)(2)], as amended. 

Allocation Method ............................................................................................... Competitive Grant 

Program Description and Accomplishments: 

The Paralysis Resource Center (PRC) promotes the health and well-being of people living with 

paralysis and supports their families and caregivers by providing comprehensive information and 

referral services. The PRC seeks to bridge the information gap experienced not only by 

newly-paralyzed individuals, but also by those who have lived for some time with paralysis. This 

information promotes better health, encourages community involvement, and improves quality of 

life. 

Nearly 5.4 million Americans, or one in 50 reported having some form of paralysis, defined as a 

central nervous system disorder resulting in difficulty or inability to move the upper or lower 

extremities.105 These individuals face health and other disparities, which often translate into 

exclusion from full participation in their communities.

The Paralysis Resource Center offers activities and services aimed at increasing independent 

living for people with paralysis and related mobility impairments, and supporting integration into 

the physical and cultural communities in which they live.

 

105 Armour, Brian S., Elizabeth A. Courtney-Long, Michael H. Fox, Heidi Fredine, and Anthony Cahill. Prevalence 

and Causes of Paralysis—United States, 2013. Issue brief. Christopher and Dana Reeve Foundation, 23 Aug. 2016. 
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

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Funding History: 

Funding for the program over the past five years is as follows: 

FY 2014/1 ................................................$6,683,000 

FY 2015 ...................................................$6,700,000 

FY 2016.......................................$7,700,000 

FY 2017 Annualized CR ..........................$7,685,362 

FY 2018 President’s Budget ..................................$0 

1/This program was transferred to ACL from CDC in FY 2014. 

Budget Request: 

No funding is requested in FY 2018 for the Paralysis Resource Center (PRC). Resources for 

individuals living with paralysis will continue to be available through other ACL programs, such 

as Aging and Disability Resource Centers, Centers for Independent Living and Assistive 

Technology, that provide services to people with all types of disabilities, as well as through 

ongoing NIDILRR research focused on improving health and function, employment, and 

community participation, including spinal injury research conducted through NIDILRR’s Spinal 

Cord Model Injury Systems grants. 

Paralysis Resource Center 

FY 2016 Final FY 2017 

Annualized CR

Number of 

Awards 2 1

Average 

Award $3,747,892 $7,491,131

Range of 

Awards NA NA
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

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Resource and Program Data: 

Paralysis Resource Center 

(Dollars in thousands) 

Mechanism

FY 2016 

Final

#

FY 2016 

Final

$

FY 2017

CR Annualized

#

FY 2017

CR Annualized

$

Formula Grants -- -- -- --

New Discretionary

Grants -- -- -- --

Continuations Grants 2 7,496 1 7,491

Contracts -- -- -- --

Interagency Agreements -- -- -- --

Program Support /1 204 194

Total Resources 7,700 7,685

1/ Program Support – Includes funds for Public Health Service Act statutory requirements, grant systems and review 

costs.
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

176

Traumatic Brain Injury 

FY 2016 Final

FY 2017

Annualized 

CR

FY 2018

President’s 

Budget

FY 2018 +/-

FY 2017

Traumatic Brain Injury $9,321 $9,303 $3,162 -$6,141

Authorizing Legislation: The Traumatic Brain Injury Reauthorization Act of 2014. 

FY 2018 Authorization ....................................................................................................$8,600,000

Allocation Method ................................................... Formula Grant / Competitive Grant / Contract 

Program Description and Accomplishments: 

The Traumatic Brain Injury (TBI) Program develops comprehensive, coordinated family and 

person-centered service systems for individuals at the state and community level who sustain a 

TBI. TBIs occur when the head suddenly or violently hits an object, or an object enters brain 

tissue causing disruption to normal brain activity. The majority of TBIs are considered mild 

although an estimated 80,000-90,000 individuals who annually sustain a TBI will experience 

long-term, possibly life-long, challenges due to their injury. In the United States, it is estimated 

at least 3.2 million Americans require long-term or life-long assistance to perform activities of 

daily living as a result of TBI.106 In addition, these national estimates do not include individuals 

with TBI who are treated in military hospitals. 

TBI affects all age groups and can cause a range of symptoms, which may include memory loss, 

difficulty concentrating, confusion, irritability, personality changes, fatigue, and headaches. In 

addition to health interventions including primary prevention, early management, and 

comprehensive approaches to rehabilitation and community reintegration, individuals with TBI 

may also need a variety of services and supports, including rehabilitation, counseling, academic 

and vocational accommodations, independent living assistance, transportation assistance, and 

vocational training. These services and supports are often fragmented across different State 

systems of care, making access difficult for families. ACL works across the lifespan, focusing on 

multiple life domains outside the health arena to achieve systems change, address fragmentation 

and ensure enhanced service delivery. 

 

106 Traumatic Brain Injury in the United States: A Report to Congress. December 1999. 
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

177

The TBI Program includes two grant programs: 1) the State Protection and Advocacy (P&A) 

Systems Grants (formula grant), the State Implementation Partnership Grants (competitive 

grant). 

State Protection and Advocacy Systems Grants 

The P&A Program is the second component grant of the TBI Program. Grants are awarded to 

P&A organizations in states, territories, the District of Columbia, and one Native American 

Consortium to provide advocacy support for individuals with TBI and their families. Grantees 

use these funds to develop plans and provide P&A services--including individual and family 

advocacy, self-advocacy training, self-advocacy assistance, information and referral services, 

and legal representation—to individuals who have experienced a TBI. P&A grants are formula 

based, with an average award of $50,000 for state grantees and $20,000 for territory grantees. 

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. 

State Advisory Boards and State Implementation Partnership Grants 

States are required to establish a State Advisory Board on Traumatic Brain Injury in order to 

receive funding for State Implementation Partnership Grants, which address barriers to needed 

services encountered by children, youth, and adults with TBI. States and Territories receive 

funds to assess the need for TBI services and the resources within their State or Territory. This is 

done through a needs and resource assessment designed to facilitate the development or 

expansion of a comprehensive, multidisciplinary, and easily accessible systems of care for 

individuals with TBI and their families. 

Programs

FY 2016

Final

FY 2017

Annualized CR

FY 2018

President’s Budget

State Grants for 

Demonstration Projects $5,065,314 $5,055,685 $0

Protection and Advocacy 

Grants $3,099,589 $3,093,697 $3,161,673
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

178

Funding History: 

Funding for the program over the past five years is as follows: 

FY 2014 /1 ...............................................$9,321,000 

FY 2015 /1 ...............................................$9,321,000 

FY 2016 /1... ...........................................$9,321,000 

FY 2017 Annualized CR ..........................$9,303,281 

FY 2018 President’s Budget /2 ................$3,162,000 

1/This program was funded at HRSA through FY 2015 and transferred to ACL at the beginning of FY 2016. 

Funding at HRSA included both grant and administrative funds. 

2/ Partnerships for Innovation, Inclusion, and Independence consolidate like activities in the State Councils on 

Developmental Disabilities, State Independent Living Councils, and State Partnerships for Traumatic Brain Injury. 

Budget Request: 

TBI Protection and Advocacy Grants 

The FY 2018 request for TBI Protection and Advocacy Grants, is $3,161,673, which maintains 

the annualized FY 2017 Continuing Resolution Level. This funding will be awarded to 57 states 

and territories by formula to insure continued support and protection of the rights of individuals 

of all ages who have experiences a TBI. 

These funds will continue to support training for groups, independent living centers, service 

providers, caregivers, individuals with TBI, family members, state employees, hospital staff, 

university staff, and community representatives to achieve greater awareness of the needs of 

persons with TBI and increase the availability of resources and support services. 

State Implementation Partnership Grants 

The FY 2018 Budget Request is $0, a decrease of -$6,141,281 from the FY 2017 annualized 

Continuing Resolution level. ACL proposes to consolidate the State Advisory Boards, along with 

the State Implementation Partnership Grants they support into one, new cross-disability council 

funded through the Partnerships for Innovation, Inclusion and Independence Program, which 

would operate in each state and territory. Please refer to the Partnerships for Innovation, 

Inclusion and Independence section for additional information. 
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

179

Grant Awards Tables: 

Traumatic Brain Injury: Protection and Advocacy 

FY 2016

Final

FY 2017

Annualized CR

FY 2018

President’s Budget

Number of 

Awards 57 57 57

Average Award $54,379 $54,014 $55,212

Range of 

Awards $20,000 - $147,545 $20,000 - $142,888 $20,000 - $158,039

Traumatic Brain Injury: State Implementation Partnership

FY 2016

Final

FY 2017 

Annualized CR

Number of 

Awards 19 19

Average Award $249,181 $249,181

Range of 

Awards $249,315 - $250,000 $249,315 - $250,000
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

180

Resource and Program Data: 

Traumatic Brain Injury 

(Dollars in thousands) 

Mechanism

FY 2016 

Final

#

FY 2016 

Final

$

FY 2017

CR 

Annualized

#

FY 2017

CR Annualized

$

FY 2018 

President’s 

Budget

#

FY 2018 

President’s 

Budget

$

Formula Grants 57 3,100 57 3,100 57 3,162

New Discretionary

Grants -- -- 20 4,981 -- --

Continuations Grants 18 4,784 -- -- -- --

Contracts 4 916 3 726 -- --

Interagency 

Agreements 1 188 1 205 -- --

Program Support /1 333 310 -- --

Total Resources 80 9,321 81 9,321 57 3,162

1/ Program Support -- Includes funds for grant systems and review, and program reporting systems costs. 
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

181

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

FY 2017 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: TBI Protection and Advocacy State Grants (CFDA 93.873)

State/Territory FY 2016 Actual FY 2017

Annualized CR

FY 2018

President's Budget

FY 2018 +/- FY 

2017

Alabama....................................... 50,000 50,000 50,000 -

Alaska.......................................... 50,000 50,000 50,000 -

Arizona........................................ 54,427 54,240 55,280 1,040

Arkansas...................................... 50,000 50,000 50,000 -

California..................................... 147,545 142,888 158,039 15,151

Colorado...................................... 50,433 50,478 50,919 441

Connecticut.................................. 50,000 50,000 50,000 -

Delaware...................................... 50,000 50,000 50,000 -

District of Columbia.................... 50,000 50,000 50,000 -

Florida.......................................... 92,643 91,117 98,025 6,908

Georgia........................................ 64,200 63,531 66,049 2,518

Hawaii.......................................... 50,000 50,000 50,000 -

Idaho............................................ 50,000 50,000 50,000 -

Illinois.......................................... 72,281 70,787 74,459 3,672

Indiana......................................... 54,036 53,669 54,617 948

Iowa............................................. 50,000 50,000 50,000 -

Kansas.......................................... 50,000 50,000 50,000 -

Kentucky...................................... 50,000 50,000 50,000 -

Louisiana..................................... 50,000 50,000 50,000 -

Maine........................................... 50,000 50,000 50,000 -

Maryland...................................... 52,235 51,986 52,667 681

Massachusetts.............................. 54,467 54,148 55,172 1,024

Michigan...................................... 63,655 62,729 65,119 2,390

Minnesota.................................... 50,727 50,569 51,023 454

Mississippi................................... 50,000 50,000 50,000 -

Missouri....................................... 52,488 52,198 52,912 714

Montana....................................... 50,000 50,000 50,000 -

Nebraska...................................... 50,000 50,000 50,000 -

Nevada......................................... 50,000 50,000 50,000 -

New Hampshire.......................... 50,000 50,000 50,000 -
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

182

PROGRAM/CFDA NUMBER: TBI Protection and Advocacy State Grants (CFDA 93.873)

 

State/Territory FY 2016 Actual FY 2017

Annualized CR

FY 2018

President's Budget

FY 2018 +/- FY 

2017

New Jersey.......................... 60,834 60,083 62,052 1,969

New Mexico....................... 50,000 50,000 50,000 -

New York........................... 92,216 89,813 96,513 6,700

North Carolina.................... 63,755 63,059 65,501 2,442

North Dakota...................... 50,000 50,000 50,000 -

Ohio.................................... 68,546 67,367 70,496 3,129

Oklahoma............................ 50,000 50,000 50,000 -

Oregon................................ 50,000 50,000 50,000 -

Pennsylvania....................... 72,010 70,629 74,276 3,647

Rhode Island....................... 50,000 50,000 50,000 -

South Carolina.................... 50,000 50,000 50,000 -

South Dakota...................... 50,000 50,000 50,000 -

Tennessee............................ 53,898 53,615 54,555 940

Texas................................... 113,152 110,862 120,912 10,050

Utah.................................... 50,000 50,000 50,000 -

Vermont.............................. 50,000 50,000 50,000 -

Virginia............................... 59,057 58,506 60,224 1,718

Washington......................... 55,385 55,179 56,368 1,189

West Virginia...................... 50,000 50,000 50,000 -

Wisconsin........................... 51,599 51,342 51,920 578

Wyoming............................ 50,000 50,000 50,000 -

Subtotal, States................... 2,949,589 2,928,795 2,997,098 68,303

American Samoa................. 20,000 20,000 20,000 -

Guam.................................. 20,000 20,000 20,000 -

Northern Mariana Islands... 20,000 20,000 20,000 -

Puerto Rico......................... 50,000 50,000 50,000 -

Virgin Islands..................... 20,000 20,000 20,000 -

Subtotal, States and Territories 3,079,589 3,058,795 3,127,098 68,303

Native American Organizations $20,000 $20,000 $20,000 -

Program Support /1................... - 14,902 14,902 -

TOTAL...................................... 3,099,589 3,093,697 3,162,000 68,303

1/Program Support -- Includes funds for grant systems and review, and program reporting systems costs. 
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

183

National Institute on Disability, Independent Living, and Rehabilitation 

Research 

FY 2016

Final

FY 2017

Annualized 

CR

FY 2018

President's 

Budget

FY 2018 +/-

FY 2017

National Institute on 

Disability, Independent Living 

and Rehabilitation Research

$103,970 $103,772 $95,127 -$8,645

Authorizing Legislation: Title II of the Rehabilitation Act of 1973, as amended 

FY 2018 Rehabilitation Act Authorization ..................................................................$116,860,000

Allocation Method .................................................................... Discretionary Grants and Contracts 

Program Description and Accomplishments: 

The mission of the National Institute on Disability, Independent Living, and Rehabilitation 

Research (NIDILRR) is to generate new knowledge and promote its effective use to improve the 

abilities of people with disabilities to perform activities of their choice in the community, and to 

expand society’s capacity to provide full opportunities and accommodations for its citizens with 

disabilities. NIDILRR sponsors comprehensive and coordinated programs of research and related 

activities to maximize the full inclusion, social integration, employment, and independent living 

of individuals with disabilities of all ages. 

NIDILRR conducts research through a network of individual research projects and centers of 

excellence across the nation. Research funding is awarded through competitive grants, and most 

of the funds are awarded to universities or providers of rehabilitation or related services. 

As required by the Rehabilitation Act in §202(h), NIDILRR operates under a Long-Range Plan 

(LRP). The current plan covers FY 2013-FY 2017. Work on the FY 2018-FY 2022 plan is 

underway. 

The primary grant mechanisms under which NIDILRR makes awards are: 

 Rehabilitation Research and Training Centers (RRTCs). RRTC research improves 

rehabilitation methodologies and service delivery systems, alleviates or stabilizes 

disabling conditions, and promotes maximum social and economic independence for 
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

184

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.
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

185

 Advanced Rehabilitation Research Training (ARRT). The ARRT program funds grants to 

institutions of higher education to recruit and train qualified persons with doctoral or 

similar advanced degrees and prepare them to conduct independent research in areas 

related to disability and rehabilitation.

 Small Business Innovation Research (SBIR). NIDILRR awards SBIR grants to small 

businesses toward 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 2014 ...............................................$103,970,000 

FY 2015 ...............................................$103,970,000 

FY 2016... ...........................................$103,970,000 

FY 2017 Annualized CR ......................$103,772,353 

FY 2018 President’s Budget ..................$95,127,000

Budget Request: 

ACL requests $95,127,000, a reduction of -$8,645,353, for the National Institute on Disability, 

Independent Living, and Rehabilitation Research in FY 2018. Of the remaining funding 

requested for NIDILRR, about 74 percent of the funds would be used to continue previous 

grants. In addition, an estimated $17.4 million would be used to fund new grant awards under a 

potential revised long-range plan framework that NIDILRR proposes to publish for its research 

in FY 2018. 

The HHS FY 2018 budget request also includes a new general provision (Section 224) that, 

while applicable to HHS as a Department, would address an area of particular concern to 

NIDILRR, as well as to other ACL programs. For an Operating Division (OPDIV) within HHS 

to be able to accept funding from another HHS OPDIV or from an outside Department for the 
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

186

purpose of making grants or cooperative agreements, specific authority is required. The lack of 

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

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

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

(e.g., with the Department of Veteran’s affairs on research projects to address the needs of 

disabled veterans). It would also improve the operational efficiency of NIDLIRR by allowing 

them to transfer funds via reimbursable agreements to other OPDIVs for the purposes of making 

grants or cooperative agreements on their behalf. 

Outcomes and Output Table: 

ACL is drawing upon NIDILRR’s evaluation investments and long-range plan to develop new 

performance measures that will be included in the FY 2019 budget proposal. 

Grant Awards Tables: 

National Institute on Disability, Independent Living, and Rehabilitation Research 

(Dollars in Thousands) 

FY 2016 Final FY 2017 

Annualized CR

FY 2018 

President’s 

Budget

Number of 

Awards 227 221 221

Average 

Award $429,329 $440,752 $401,185 

Range of 

Awards

$70,000 –

$1,246,000

$70,000 –

$1,246,000

$70,000 –

$1,246,000
DISABILITY PROGRAMS, RESEARCH, AND SERVICES 

187

Resource and Program Data: 

National Institute on Disability, Independent Living, and Rehabilitation Research 

(Dollars in Thousands) 

Mechanism

FY 

2016 

Final

#

FY 2016 

Final

$

FY 2017

CR 

Annualized

#

FY 2017

CR Annualized

$

FY 2018 

President’s 

Budget

#

FY 2018 

President’s 

Budget

$

Formula Grants -- -- -- --

New Discretionary

Grants 83 

 

33,762 73 

 

20,182 57 

 

11,595 

Continuations Grants 144 

 

63,695 148 

 

77,224 164 

 

77,230 

Contracts 13 

 

5,339 11 

 

5,234 11 

 

5,234 

Peer Review of new 

grant applications 1 

 

854 1 

 

900 1 

 

900 

Interagency 

Agreements 1 

 

15 1 

 

1 

Program Support /1

 

185 

 

167 --

 

167 

Total Resources

 

103,970 

 

103,722 

 

95,127 

1/ Program Support -- Includes funds for statutory requirements, grant systems and review, salaries and overhead, 

and information technology support costs. 
188

Consumer Information, Access, and Outreach 

SUMMARY OF REQUEST 

Older Americans and Americans with disabilities face an array of choices when trying to 

determine the right services and supports to assist them to remain active and independent in their 

communities. The complexity of navigating these programs and selecting among them so as to 

determine which best suit the needs of each individual can create challenges for individuals, 

especially for consumers who have not previously utilized these services. 

Consumer Information, Access and Outreach (CIAO) programs provide consumers with the 

information they need to make decisions about their independence and connect them with the 

right services. Programs such as Aging and Disability Resource Centers (ADRCs) help to 

address these needs by providing information, outreach, and assistance to seniors and people 

with disabilities, so that they can effectively access the services necessary for their 

independence. Through community-level “one stop shop” entry points into long-term services 

and supports, these programs provide access to home and community-based services that can 

enable people to remain in their homes.

The FY 2018 request for CIAO programs is $80,500,000, a reduction of $55,624,796 below the 

annualized FY 2017 Continuing Resolution level. This request would provide: 

 $6,107,000 in discretionary funding for Aging and Disability Resource Centers, 

maintaining the annualized FY 2017 Continuing Resolution level. ADRCs support state 

efforts to develop more efficient, cost-effective, and consumer-responsive systems of 

information and integrated access by creating “one-stop shop” entry points into long-term 

care at the community-level. 

 No funding is requested for the Alzheimer’s Disease Initiative Outreach Campaign, 

which is being consolidated along with other ACL Alzheimer’s programs into a single 

new Alzheimer’s Disease program. 

 No funding is requested for State Health Insurance Assistance Programs (SHIPs). 

Medicare beneficiaries who are aging or have a disability will continue to have access, 

through CMS’s 1-800-Medicare hotline and through services provided under other 

Federal and State programs to assistance in navigating the complexities of health and 

long-term care systems. 

 $4,954,000 for the Help America Vote Act (HAVA), maintaining the annualized FY 

2017 Continuing Resolution level. HAVA grants assist Protection and Advocacy systems 
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

189

in each state and territory to ensure full participation in the electoral process for 

individuals with disabilities, including registering to vote, casting their votes, and 

accessing polling places. 

 $31,939,169 for Assistive Technology (AT), a reduction of -$1,996,198 below the 

annualized FY 2017 Continuing Resolution level. Assistive Technology grants 

financially supports state programs that maximize the ability of individuals with 

disabilities of all ages and their families to obtain AT devices and services, including 

computer or technology aids, modified driving controls, and durable medical equipment 

such as wheelchairs or walkers. 

 $37,500,000 in mandatory funding for Medicare Improvements for Patients and Providers 

Act (MIPPA) programs, maintaining the same pre-sequester level of funding that was 

provided in FY 2017. As part of its request, ACL will request a two-year extension of the 

Medicare Access and CHIP Reauthorization Act (MACRA) through which funding is 

provided to ACL.
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

190

Aging and Disability Resource Centers 

FY 2016

Final

FY 2017

Annualized 

CR

FY 2018

President's 

Budget

FY 2018 +/-

FY 2017

Aging and Disability Resource 

Centers $6,119 $6,107 $6,107 --

Authorizing Legislation: Sections 202b and 411 of the Older Americans Act of 1965, as 

amended. 

FY 2018 Authorization ....................................................................................................$6,402,551

Allocation Method ............................ Competitive Grants/Co-operative Agreements and Contracts 

Program Description and Accomplishments: 

Aging and Disability Resource Centers (ADRCs) support state efforts to develop more efficient, 

cost-effective, and consumer-responsive systems of information and integrated access by 

creating consumer-friendly entry points into long-term care at the community-level. ADRCs 

grew out of best practice innovations in some states known as “No Wrong Door”107 (NWD) and 

“Single Points of Entry” programs, where people of all ages may turn for objective information 

and one-on-one assistance on their long-term services and support options. Since 2003, the 

Administration for Community Living, along with the Centers for Medicare & Medicaid 

Services (CMS), have entered into cooperative agreements with states to develop the 

foundational infrastructure for delivering one-on-one person-centered counseling and 

streamlined access to public programs that make it easier for individuals to learn about and 

access their health and long-term services and support options. Starting in 2008, the Veterans 

Health Administration (VHA) also began participating as a key partner in this effort. ACL, CMS, 

and the VHA are now working with thirteen ADRC/NWD-System states to build on, and 

promote the nationwide use of lessons learned and best practices from prior ADRC investments.

ADRC/NWD systems help states make better use of taxpayer dollars by streamlining access to 

community services and supports (both publicly and privately funded) and diverting individuals 

from more costly forms of care, including institutional care and unnecessary hospital 

 

107 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 

191

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, that are available to them; 

 Streamlined access to publicly-supported long-term services and support programs for 

individuals who appear to be eligible for such programs; 

 Outreach and assistance to Medicare beneficiaries on their Medicare benefits including 

prevention and low-income subsidies 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. Accomplishments include: 

 In 2014, 25 states received one year planning grants to develop plans to transform their 

multiple LTSS access programs and functions into a single statewide ADRC/NWD System 

for all populations and all payers. In 2015, 5 of the 25 state planning grantees received 3-year 

awards to implement their planning grants and the 8 states awarded 3-year grants in 2012 

received a one-year grant to continue their work in developing their ADRC/NWD System.

 In 2015, CMS issued the “No Wrong Door System Reference Document for Medicaid 

Administrative Claiming Guidance” to support state efforts to develop statewide 

ADRC/NWD Systems. It is estimated that if all states took advantage of this guidance, it 

would generate over $100 million available annually to support state’s operations of their 

NWD/ADRC systems. 

 The Veterans Health Administration is using the ADRC\NWD System to deliver Veteran 

Directed Home and Community Based Services (VD-HCBS) to help Veterans with 
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

192

disabilities to continue living in the community and to have control over the LTSS they 

receive. The VD-HCBS program is available in 31 states, the District of Columbia and 

Puerto Rico. 

Funding History: 

Comparable total five year funding for Aging and Disability Resource Centers is as follows: 

FY 2014/1 ..............................................$15,347,000 

FY 2015 ...................................................$6,119,000 

FY 2016 ...................................................$6,119,000 

FY 2017 Annualized CR ..........................$6,107,368 

FY 2018 President’s Budget ....................$6,107,000 

1/Mandatory appropriations of $10 million for FY 2010 through FY 2014 for ADRCs also were made under 

Section 2405 of P.L. 111-148, the Affordable Care Act of 2010. 

Budget Request: 

ACL’s FY 2018 request for ADRCs is $6,107,000 maintaining the annualized FY 2017 

Continuing Resolution level. This will provide States funding to continue their development and 

operation of sustainable ADRC/NWD systems based on the national guidelines established by 

ACL, CMS and the VHA. Funded states will replicate the national guidelines to develop 

person-centered, conflict-free access system for long-term services and supports for all 

populations and all payers. In addition to the grants to states, funding would be used to support a 

technical assistance contract. 

Activities funded by this proposal to develop sustainable ADRC/NWD systems represent a 

substantial state-wide reform of access to long-term services and supports. Building on past 

ADRC activities, the transformation brought about by this funding will include: 

 Funded states will show progress towards guidelines established by ACL, CMS, and VHA 

for ADRC/NWD Systems and be required to report on its progress and performance. 

 Funded states will commit to using Medicaid administrative funding to support the 

ADRC/NWD system infrastructure on an on-going basis; and 

 Funded states will ensure that local ADRC/NWD system sites: 

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 
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

193

state to perform to ensure the state’s ADRC/NWD system can effectively serve all 

LTSS populations; 

o Use nationally certified person-centered counselors to provide one-on-one 

assistance to consumers; and 

o Conduct formal functional and financial assessments that are required to 

determine an individual’s eligibility for the public LTSS programs that are 

administered by the state, including Medicaid. 

Finally, funded states’ ADRC/NWD systems, including local sites, will use the Federallyprescribed reporting data to continually evaluate performance and make improvements in 

ADRC/NWD systems at the state and local site level. Funded states will actively involve 

consumer stakeholders in this process. 

Grant Awards Tables: 

Aging and Disability Resource Centers 

(Dollars in Thousands) 

FY 2016 Final FY 2017

Annualized CR

FY 2018

President’s 

Budget

Number 

of 

Awards

15 15 15

Average 

Award $341,049 $336,508 $336,508

Range of 

Awards

$837,485 -

$1,000,000

$837,485 -

$1,000,000

$837,485 -

$1,000,000
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

194

Resource and Program Data: 

Aging and Disability Resource Centers 

(Dollars in Thousands) 

Mechanism

FY 2016 

Final

#

FY 2016 

Final

$

FY 2017

CR 

Annualized

#

FY 2017

CR Annualized

$

FY 2018 

President’s 

Budget

#

FY 2018 

President’s 

Budget

$

Formula Grants --

 

-- --

 

-- --

 

--

New Discretionary

Grants 10 

 

1,203 --

 

-- 15 

 

5,048 

Continuations

Grants 5 

 

3,913 15 

 

5,048 --

 

--

Contracts 1 

 

933 1 

 

947 1 

 

947 

Interagency 

Agreements --

 

-- --

 

-- --

 

--

Program Support /1

 

70 

 

113 

 

113 

Total Resources

 

6,119 

 

6,107 

 

6,107 

1/ Program Support -- Includes funds for overhead, grant systems and review costs, and information technology 

support costs.
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

195

State Health Insurance Assistance Programs 

FY 2016

Final

FY 2017

Annualized 

CR

FY 2018

President's 

Budget

FY 2018+/-

FY 2017

State Health Insurance Assistance 

Programs (SHIP) $52,115 $52,016 $0 -$52,016

Authorizing Legislation: Section 4360 of the Omnibus Budget Reconciliation Act of 1990 

(42 U.S.C. 1395b-4). 

FY 2018 Authorization ......................................................................................................... Expired 

Allocation Method ....................................................... Formula and Competitive Grants/Contracts 

Program Description and Accomplishments: 

The State Health Insurance Assistance Program (SHIP) provides grants to States to fund 

infrastructure, training, and outreach support to over 14,000 (mostly volunteer) counselors in 

over 1,300 community-based organizations in all 50 States, the District of Columbia, Guam, 

Puerto Rico, and the Virgin Islands. 

SHIPs provide counseling and assistance to help aging and disabled Medicare and Medicaid 

beneficiaries as well as coming-of-agers understand and use of their Medicare benefits. Services 

are provided via telephone and face-to-face interactive sessions, public education presentations 

and programs, and media activities. In CY 2015, SHIPs had over 3.4 million one-on-one client 

contacts and more than 100,000 public and media events. 

Nearly two-thirds of the 54 state SHIP programs are already administered by State Units on 

Aging, with the remaining programs administered by State Departments of Insurance. At the 

community level, many SHIPs are either housed in or create local partnerships with Area 

Agencies on Aging. Similarly, almost 50 percent of the SHIPs are co-located with the Senior 

Medicare Patrol program, which is also administered by ACL. 

Funding History: 

Funding for the State Health Insurance Assistance Program over the past five years is as follows: 

FY 2014 ................................................. $52,115,000 

FY 2015 ................................................. $52,115,000 

FY 2016 ... ............................................ $52,115,000 

FY 2017 Annualized CR ........................ $52,015,929 

FY 2018 President’s Budget .................. ............$0
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

196

Budget Request: 

The FY 2018 discretionary Budget Request for SHIPs is $0, a decrease of -$52,015,929 from the 

FY 2017 annualized Continuing Resolution level. While ACL will reduce the scale of its one-onone person assistance through the State Health Insurance Assistance Program, Medicare 

beneficiaries will continue to have access to online tools such as Plan Finder and phone 

assistance such as CMS’s 1-800-MEDICARE helpline. Some states also support SHIP programs. 

The FY 2018 Budget reduces funding for SHIPs by $52 million, but proposes to continue $12 

million in mandatory funding for this purpose specifically targeted to low-income seniors and 

seniors living in rural areas. 

Outputs Table: 

State Health Insurance Assistance Programs 

Indicator Year and Most Recent 

Result /

FY 2017

Projection

Output AH: Number of 

SHIP Public Media 

Events (Output)

CY 2016: 101,427 Discontinued

Output AI: Number of 

SHIP Client Contacts 

(Output)

CY 2016: 3.4 M Discontinued

Grant Awards Table: 

State Health Insurance Assistance Programs Grant Awards 

FY 2016 Final FY 2017 

Annualized CR

Number of 

Awards 56 55

Average 

Award $874,453 $892,324

Range of 

Awards

$40,870 -

$5,028,121

$40,870 -

$5,028,121
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

197

Resource and Program Data: 

State Health Insurance Assistance Program 

(Dollars in thousands) 

Mechanism

FY 2016 

Final

#

FY 2016 

Final

$

FY 2017

CR Annualized

#

FY 2017

CR Annualized

$

Formula Grants --

 

-- --

 -

-

New Discretionary

Grants --

 

-- 55 

 

49,078 

Continuations Grants 56 

 

48,969 --

 -

-

Contracts 3 

 

1,619 5 

 

1,327 

Interagency Agreements 1 

 

157 1 

 

157 

Program Support /1

 

1,369 

 

1,553 

Total Resources

 

52,115 

 

52,115 

1/ Program Support -- Reflects the amount used from the SHIP appropriation for staff and overhead, 

support contracts, training, technical assistance, data systems, grant systems, and grants review costs. 
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

198

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

CENTER FOR INTEGRATED PROGRAMS 

FY 2018 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: State Health Insurance Assistance Program (CFDA 93.324) 

State/Territory FY 2016 Actual FY 2017

Annualized CR

Alabama...................................... 881,268 890,068

Alaska.......................................... 251,057 238,504

Arizona........................................ 840,395 882,416

Arkansas...................................... 599,446 629,418

California..................................... 4,776,715 4,537,879

Colorado...................................... 601,830 631,922

Connecticut................................. 547,823 566,901

Delaware..................................... 200,984 211,033

District of Columbia.................... 152,732 160,369

Florida......................................... 2,815,107 2,901,082

Georgia........................................ 1,145,384 1,202,653

Hawaii......................................... 248,387 260,806

Idaho............................................ 384,430 403,652

Illinois.......................................... 1,515,119 1,590,875

Indiana......................................... 868,219 911,630

Iowa............................................. 756,340 718,523

Kansas......................................... 565,264 576,778

Kentucky..................................... 839,320 881,635

Louisiana..................................... 659,339 692,306

Maine........................................... 431,762 453,350

Maryland..................................... 756,515 772,326

Massachusetts.............................. 1,035,978 984,179

Michigan..................................... 1,595,545 1,515,768

Minnesota.................................... 1,021,318 970,252

Mississippi................................... 592,115 621,721

Missouri....................................... 914,939 960,686

Montana....................................... 611,568 580,990

Nebraska...................................... 456,409 433,589

Nevada......................................... 408,886 429,330

New Hampshire........................... 283,540 297,717
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

199

PROGRAM/CFDA NUMBER: State Health Insurance Assistance Program (CFDA 93.324) 

State/Territory FY 2016

Actual

FY 2017

Annualized CR

New Jersey.......................... 1,039,285 1,091,249

New Mexico....................... 433,907 450,327

New York........................... 2,538,553 2,462,096

North Carolina.................... 1,493,209 1,546,292

North Dakota...................... 268,186 261,644

Ohio.................................... 1,927,772 1,831,383

Oklahoma............................ 604,983 635,232

Oregon................................ 577,601 606,481

Pennsylvania....................... 2,169,481 2,061,007

Rhode Island....................... 267,489 280,863

South Carolina.................... 761,186 799,245

South Dakota...................... 343,932 326,735

Tennessee............................ 1,069,586 1,123,065

Texas................................... 2,613,306 2,743,941

Utah.................................... 352,016 369,617

Vermont.............................. 239,358 251,326

Virginia............................... 999,295 1,049,260

Washington......................... 880,099 924,104

West Virginia...................... 466,745 490,082

Wisconsin........................... 1,000,455 950,432

Wyoming............................ 318,717 302,781

Subtotal, States................... 47,122,895 47,465,520

Guam.................................. 42,914 50,000

Puerto Rico......................... 822,324 863,440

Virgin Islands..................... 45,887 50,000

Subtotal, States and Territories 48,034,020 48,428,960

Program Management 1/.......... 4,080,980 3,586,969

TOTAL..................................... 48,034,020 48,428,960

1/ Program Management -- Reflects the amount used from the SHIP appropriation for staff and overhead, support contracts, 

training, technical assistance, data systems, grant systems, and grants review costs. 

 
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

200

Voting Access for Individuals with Disabilities 

FY 2016

Final

FY 2017

Annualized 

CR

FY 2018

President's 

Budget

FY 2018+/-

FY 2017

Voting Access for People with 

Disabilities $4,963 $4,954 $4,954 --

Authorizing Legislation: Section 291 of the Help America Vote Act 

FY 2018 Authorization ......................................................................................................... Expired 

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

Program Description and Accomplishments: 

The Voting Access for Individuals with Disabilities program authorized by the Help America 

Vote Act (HAVA) provides formula grants to support Protection and Advocacy (P&A) systems 

in each state and territory to ensure full participation in the electoral process for individuals with 

disabilities. HAVA P&A programs help to 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, training and technical assistance grants to assist the 

P&As in their promotion of full participation in the electoral process are provided through 

competitive two-year awards. 

HAVA P&A grantees use these funds to promote systematic efforts to ensure that individuals 

with disabilities have the opportunity to participate in every step of the electoral process. For 

example, grantees support systems change efforts to improve information on the location of 

accessible polling places, and adopt voting procedures that enable individuals with disabilities to 

vote privately and independently. Grantees also work to educate election officials, poll workers, 

and election volunteers on the rights of voters with disabilities and best practices. P&As provide 

assistance to state and other government entities by surveying polling places, identifying 

potential modifications to make specific polling places accessible, and developing criteria for 

identifying accessible polling places. 

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 
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

201

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 2014 ...................................................$4,963,000 

FY 2015 ...................................................$4,963,000 

FY 2016 ..................................................$4,963,000 

FY 2017 Annualized CR ..........................$4,953,565 

FY 2018 President’s Budget ....................$4,954,000 

Budget Request: 

The FY 2018 request for Voting Access for Individuals with Disabilities is $4,954,000, 

maintaining the FY 2017 annualized Continuing Resolution level., An example of the activities 

undertaken with HAVA funding, in Charleston, SC the P&A sponsored a site used by an 

Election Protection (EP) volunteer attorney to staff a hotline and train law student volunteers to 

canvass polling places in Charleston for accessibility issues. Accessibility in voting continues to 

be an ongoing challenge throughout the country. A 2013 report by the National Council on 

Disability identified a 2012 incident in Arizona where a voter who used a wheelchair could not 

get through the front door of her polling place to deliver an early ballot. The same report details a 

complaint from Bladensburg, MD, where voters with disabilities were told that they had to 

“prove their disability” in order to be seated in line. Additionally, the Maryland P&A had to 

notify a Montgomery County judge to unlock the assigned accessible door to a polling place so 

that voters with disabilities could enter the building. 

Funding for this activity helps to ensure that individuals with the full range of disabilities are not 

denied the right to the same opportunity for access and participation in the electoral process as 

voters with no disabilities. 
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

202

Grant Awards Table: 

Voting Access for Individuals with Disabilities Grant Awards 

FY 2016 Final FY 2017

Annualized CR

FY 2018

President’s 

Budget

Number 

of 

Awards

55 55 55

Average 

Award $83,735 $83,351 $83,358

Range 

of 

Awards

$35,000 -

$347,490

$35,000 -

$343,306

$35,000 -

$343,389
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

203

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

ADMINISTRATION ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 

FY 2018 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: Voting Access for Individuals with Disabilities (CFDA 93.618) 

State/Territory FY 2016 Actual FY 2017

Annualized CR

FY 2018

President's Budget

FY 2018 +/- FY 

2017

Alabama....................................... 70,000 70,000 70,000 -

Alaska.......................................... 70,000 70,000 70,000 -

Arizona........................................ 70,000 70,000 70,000 -

Arkansas...................................... 70,000 70,000 70,000 -

California..................................... 347,490 343,306 343,389 83

Colorado...................................... 70,000 70,000 70,000 -

Connecticut.................................. 70,000 70,000 70,000 -

Delaware...................................... 70,000 70,000 70,000 -

District of Columbia.................... 70,000 70,000 70,000 -

Florida.......................................... 178,151 177,782 177,825 43

Georgia........................................ 90,425 89,586 89,607 21

Hawaii.......................................... 70,000 70,000 70,000 -

Idaho............................................ 70,000 70,000 70,000 -

Illinois.......................................... 115,350 112,784 112,811 27

Indiana......................................... 70,000 70,000 70,000 -

Iowa............................................. 70,000 70,000 70,000 -

Kansas.......................................... 70,000 70,000 70,000 -

Kentucky...................................... 70,000 70,000 70,000 -

Louisiana..................................... 70,000 70,000 70,000 -

Maine........................................... 70,000 70,000 70,000 -

Maryland...................................... 70,000 70,000 70,000 -

Massachusetts.............................. 70,000 70,000 70,000 -

Michigan...................................... 88,746 87,022 87,043 21

Minnesota.................................... 70,000 70,000 70,000 -

Mississippi................................... 70,000 70,000 70,000 -

Missouri....................................... 70,000 70,000 70,000 -

Montana....................................... 70,000 70,000 70,000 -

Nebraska...................................... 70,000 70,000 70,000 -

Nevada......................................... 70,000 70,000 70,000 -

New Hampshire........................... 70,000 70,000 70,000 -
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

204

PROGRAM/CFDA NUMBER: Voting Access for Individuals with Disabilities (CFDA 93.618)

State/Territory FY 2016 Actual FY 2017

Annualized CR

FY 2018

President's Budget

FY 2018 +/- FY 

2017

New Jersey.......................... 80,044 78,563 78,582 19

New Mexico....................... 70,000 70,000 70,000 -

New York........................... 176,834 173,612 173,654 42

North Carolina.................... 89,051 88,077 88,098 21

North Dakota...................... 70,000 70,000 70,000 -

Ohio.................................... 103,830 101,851 101,876 25

Oklahoma............................ 70,000 70,000 70,000 -

Oregon................................ 70,000 70,000 70,000 -

Pennsylvania....................... 114,514 112,280 112,307 27

Rhode Island....................... 70,000 70,000 70,000 -

South Carolina.................... 70,000 70,000 70,000 -

South Dakota...................... 70,000 70,000 70,000 -

Tennessee............................ 70,000 70,000 70,000 -

Texas................................... 241,409 240,908 240,966 58

Utah.................................... 70,000 70,000 70,000 -

Vermont.............................. 70,000 70,000 70,000 -

Virginia............................... 74,565 73,520 73,538 18

Washington......................... 70,000 70,000 70,000 -

West Virginia...................... 70,000 70,000 70,000 -

Wisconsin........................... 70,000 70,000 70,000 -

Wyoming............................ 70,000 70,000 70,000 -

Subtotal, States................... 4,430,409 4,409,291 4,409,696 405

American Samoa................. 35,000 35,000 35,000 -

Guam.................................. 35,000 35,000 35,000 -

Puerto Rico......................... 70,000 70,000 70,000 -

Virgin Islands..................... 35,000 35,000 35,000 -

Subtotal, States and Territories 4,605,409 4,584,291 4,584,696 405

Program Support 1/................... 357,591 369,274 369,304 30

TOTAL...................................... 4,963,000 4,953,565 4,954,000 435

1/ Program Support—Includes funds for statutory technical assistance and/or minority set-asides; grant systems and review, and 

program reporting systems costs. 
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

205

Assistive Technology 

FY 2016

Final

FY 2017

Annualized 

CR

FY 2018

President’s 

Budget

2018 +/-

FY 2017

Assistive Technology

ACT............ $32,000 $31,939 $31,939 --

Alternative Financing 

Program..................................... $2,000 $1,996 -- -$1,996

Total................................ $34,000 $33,395 $31,939 -$1,996

Authorizing Legislation: Assistive Technology Act of 1998 as amended 

FY 2018 Authorization ......................................................................................................... Expired 

Allocation Method ...................................................... Competitive and Formula Grants/Contracts 

Program Description and Accomplishments: 

Assistive Technology (AT) Act funding supports programs designed to maximize the ability of 

individuals with disabilities of all ages and their family members, guardians, advocates, and 

authorized representatives to obtain AT devices and AT services. AT devices are defined as any 

item, piece of equipment, or product system, whether acquired commercially, modified, or 

customized, that is used to increase, maintain, or improve functional capabilities of individuals 

with disabilities. Examples of such devices include computer or technology aids, modified 

driving controls, and durable medical equipment such as wheelchairs or walkers. Grants support 

comprehensive statewide programs that are designed to increase the: 

 Availability, funding, access, provision, and training for AT devices and services; 

 Ability of individuals with disabilities of all ages to secure and maintain possession of 

AT during periods of transition, such as transition between school or home and home and 

work; 

 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; 
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

206

 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 Grant program 

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 

consumer-responsive advisory councils with a majority membership of individuals with 

disabilities who use AT to advise on the planning, implementation, and evaluation of these 

statewide programs. 

Under the formula, states and territories are initially allocated a base amount equal to the amount 

of funds they received under the AT program in fiscal year 2004 (totaling $20,288,534). Any 

funds appropriated in excess of the fiscal year 2004 appropriation are initially distributed among 

the eligible entities with 50 percent of available funds distributed equally amongst them and 

50 percent distributed according to the population of the state until each entity receives at least 

$410,000. If any appropriated funds remain after each State receives this minimum, they are 

further distributed with 20 percent divided equally amongst the states and 80 percent distributed 

according to their populations. To date, appropriated funds under this program have not been at a 

level to necessitate this second round of distribution. The estimated FY 2018 state distributions 

are based on the July 1, 2016 estimates published in December 2016. 

The state must implement each of the activities required under the program, which include 

state-level activities and state leadership activities. States must spend a minimum of 60 percent 

(unless the state elects to comply with the state flexibility provision in section 4(e)(6) of the AT 

Act, as described below) of their formula grant funds on four state-level activities: state 

financing programs, device reutilization programs, device loan programs, and device 

demonstrations. States may, however, direct their funds towards these activities in varying 

amounts if they use other state or non-federal funds to support these activities at a comparable or 

greater level. 

States may use up to 40 percent of their AT State Grant program funding on state leadership 

activities. The state leadership activities include the provision of technical assistance and training 
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

207

to targeted individuals and entities focused on promoting the general awareness of the benefits of 

AT; skills development for persons involved in the assessment of the need for AT; the 

appropriate application of AT; and the integration of AT devices and services in plans required 

to be developed under other federal laws. 

In addition, states must use a portion of their grant funds on public awareness activities, 

including the continuation and maintenance of a statewide system of information and referral, 

and coordination and collaboration activities amongst entities in the states that are responsible 

for the provision of AT. The law provides states with flexibility to decide to carry out only two 

or three state-level activities, rather than all four. If a state elects to carry out two or three 

state-level activities, it must spend a minimum of 70 percent of its funds on those activities, 

while spending not more than 30 percent on the state leadership activities.

Protection and Advocacy for Assistive Technology 

Formula grants to protection and advocacy (P&A) systems, authorized under section 5 of the AT 

Act, support protection and advocacy services to assist individuals with disabilities of all ages in 

the acquisition, utilization, or maintenance of AT services or devices. Funds are distributed on a 

state population basis, with a minimum annual grant of $50,000. Territories must receive not less 

than $30,000 annually. Also, the Act requires a minimum award of $30,000 to the P&A system 

serving the American Indian consortium. The estimated FY 2018 distributions will be based on 

the July 1, 2016 estimates published in December 2016.

National Activities 

Section 6 of the AT Act provides authority for the provision of technical assistance and the 

development of implementation of data collection and reporting systems—through grants, 

contracts, or cooperative agreements awarded on a competitive basis—to individuals with 

disabilities of all ages, to AT state grant program grantees, and to protection and advocacy 

systems. The AT Act also requires the Secretary to make an award to renovate, update, and 

maintain a national public AT Internet site. 

 AT Data Analysis and Reporting Assistance: The National AT Data Analysis and 

Reporting grantee maintains and updates data collection and reporting systems for use by 

AT State Grants; provide ongoing review, training, and TA to entities submitting annual 

performance reports and State Plans for AT; work with ACL and states to use the systems 

to meet state and federal reporting requirements, including analyzing data, identifying 

trends, and developing reports regarding AT program performance and opportunities for 

program improvement. 

Alternative Financing Program 

ACL awarded three grants in FY 2015 and three grants in FY 2016. These grants were used to 

establish new financial loan programs in Indiana and Oregon and to expand existing financial 
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

208

loan programs in Georgia, Minnesota, Nebraska, and Pennsylvania. All six grantees fully drew 

down their grant awards and obligated the funds in a restricted account to be used for the 

alternative financing program. Both the Indiana and Oregon grantees successfully launched their 

new loan programs and are processing applications and making loans. The other four grantees 

are implementing activities as outlined in the grant proposals to expand and improve their 

alternative financing programs. 

 

Funding History: 

Funding for the Assistive Technology Act Programs over the past five years is as follows: 

FY2014 .......................................................$31,000,000 

FY2015 .......................................................$31,000,000 

FY2016 .......................................................$32,000,000 

FY2017 Annualized CR ..............................$31,939,169 

FY2018 President’s Budget ........................$31,939,000 

Funding for the Alternative Financing Program over the past five years and budget year is as 

follows: 

FY2014 .......................................................$2,000,000 

FY2015 .......................................................$2,000,000 

FY2016 .......................................................$2,000,000 

FY2017 Annualized CR ..............................$1,966,198 

FY2018 President’s Budget ....................................$0 

Budget Request: 

ACL’s FY 2018 request for Assistive Technology Act programs is $31,939,000, maintaining the 

annualized FY 2017 Continuing Resolution level. 

The request includes $26,503,360 for the AT State Grant program, maintaining the annualized 

FY 2017 Continuing Resolution level. These funds will be used to carry out the first 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. 
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

209

The request also includes $4,441,534 for the Protection and Advocacy for Assistive Technology 

(PAAT) program, maintaining the annualized FY 2017 Continuing Resolution level. At this 

level, 26 states would receive $50,000, the minimum amount allowed by statute to carry out this 

program. Territories would each receive $30,000. Funds would assist individuals with disabilities 

of all ages in the acquisition, utilization, or maintenance of AT services or devices. 

The request would also provide $994,105 for National Activities, maintaining the annualized 

FY 2017 Continuing Resolution level. The Act requires support for state training, technical 

assistance, data collection, and reporting assistance, and authorizes a one-time grant to provide 

national public awareness about AT, and support for AT research and development activities, 

which are all supported by competitively awarded grants. In FY 2018, funds would be used to 

provide state training and technical assistance, build out the AT Act informational website, and 

continue support for the AT Act data collection activities. 

Alternative Financing Program 

The FY 2018 Budget Request is $0, a decrease of $1,996,198 below the annualized FY 2017 

Continuing Resolution level. In FY 2005, Congress amended the AT Act to eliminate the 

separate AFP authorization and instead authorized an AT State grant program that is inclusive of 

financing activities, including alternative financing loan programs. Since there is no separate 

AFP discretionary grant program authorization in the AT Act, ACL is not requesting such 

funding within the AT Act appropriations request for FY 2018. 

Outcomes and Outputs Table: 

The State AT Programs continue to be a benefit to individuals with disabilities, older adults, 

Veterans, caregivers, professionals, schools, vocational rehabilitation agencies, healthcare 

providers and agencies by providing unique access to, and acquisition of, assistive technology 

devices and durable medical equipment. State AT Program data continues to show increased 

program use and performance. In fiscal year 2015, the State AT Programs, achieved the 

following: 

 66,571 individuals participated in assistive technology device demonstrations; 

 48,626 AT devices were provided on short-term loan to individuals with disabilities, 

service providers and agencies through the “try-before-you-buy” approach to AT; and 

 64, 617 AT devices were reutilized, saving consumers $28,020,737 by obtaining a gently 

used or refurbished AT device rather than a new one. 
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

210

Grant Awards Tables: 

Assistive Technology - State Grants 

FY 2016 Final FY 2017 

Annualized CR

FY 2018 

President’s 

Budget

Number of 

Awards 56 56 56

Average 

Award $473,852 $472,874 $472,871

Range of 

Awards

$125,498 -

$1,091,874

$125,498 -

$1,088,464

$125,498-

$1,088,448

Assistive Technology - Protection and Advocacy Grants 

FY 2016 Final FY 2017 

Annualized CR

FY 2018 

President’s 

Budget

Number of 

Awards 57 57 57

Average 

Award $77,927 $77,652 $77,652

Range of 

Awards

$30,000 -

$428,326

$30,000 -

$426,252

$30,000-

$426,253

Assistive Technology - Alternative Financing Program 

FY 2016 Final FY 2017 

Annualized CR

Number of 

Awards 3 3

Average 

Award $661,742 $661,742

Range of 

Awards

$661,742 -

$661,742

$661,742

$661,742
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

211

Resource and Program Data: 

Assistive Technology 

(Dollars in thousands) 

Mechanism

FY 2016 

Final

#

FY 2016 

Final

$

FY 2017

CR Annualized

#

FY 2017

CR Annualized

$

FY 2018 

President’s 

Budget

#

FY 2018 

President’s 

Budget

$

Formula Grants 112 

 

30,978 112 

 

30,916 112 

 

30,916 

New Discretionary

Grants 4 

 

2,558 4 

 

2,294 --

 

--

Continuations Grants 1 

 

319 1 

 

575 2 

 

888 

Contracts --

 

99 1 

 

98 1 

 

98 

Interagency 

Agreements --

 

-- --

 -

- --

 

--

Program Support /1

 

47 

 

52 

 

38 

Total Resources

 

34,000 

 

33,935 

 

31,939 

1/Program Support – Includes funds for grant systems and review, and program reporting systems costs.
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

212

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

FY 2017 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: Assistive Technology State Grants (CFDA 84.224A)

State/Territory FY 2016 Actual FY 2017

Annualized CR

FY 2018

President's 

Budget

FY 2018 +/- FY 

2017

Alabama...................................... 449,771 448,569 448,566 (3)

Alaska.......................................... 431,469 430,842 430,841 (1)

Arizona........................................ 614,250 613,578 613,574 (4)

Arkansas...................................... 473,712 472,830 472,828 (2)

California.................................... 1,091,874 1,088,464 1,088,448 (16)

Colorado...................................... 471,379 470,964 470,962 (2)

Connecticut................................. 408,305 407,155 407,153 (2)

Delaware..................................... 415,498 414,922 414,921 (1)

District of Columbia.................... 372,978 372,475 372,474 (1)

Florida......................................... 701,384 701,307 701,299 (8)

Georgia........................................ 600,656 599,651 599,646 (5)

Hawaii......................................... 449,746 449,109 449,108 (1)

Idaho............................................ 423,587 422,997 422,996 (1)

Illinois......................................... 610,511 607,751 607,746 (5)

Indiana......................................... 477,809 476,456 476,453 (3)

Iowa............................................. 447,790 446,932 446,930 (2)

Kansas......................................... 408,621 407,708 407,706 (2)

Kentucky..................................... 471,516 470,403 470,400 (3)

Louisiana..................................... 499,264 498,203 498,200 (3)

Maine.......................................... 462,506 461,762 461,760 (2)

Maryland..................................... 498,213 497,026 497,023 (3)

Massachusetts.............................. 518,603 517,476 517,473 (3)

Michigan..................................... 660,694 658,720 658,716 (4)

Minnesota.................................... 490,874 489,793 489,790 (3)

Mississippi.................................. 393,205 392,188 392,186 (2)

Missouri...................................... 556,320 555,026 555,023 (3)

Montana...................................... 444,639 444,041 444,039 (2)

Nebraska...................................... 456,271 455,587 455,585 (2)

Nevada........................................ 417,447 416,964 416,962 (2)

New Hampshire........................... 430,278 429,578 429,577 (1)
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

213

PROGRAM/CFDA NUMBER: Assistive Technology State Grants (CFDA 84.224A) 

State/Territory FY 2016 Actual FY 2017

Annualized CR

FY 2018

President's Budget

FY 2018 +/- FY 

2017

New Jersey.......................... 489,504 487,752 487,748 (4)

New Mexico....................... 444,847 443,986 443,985 (1)

New York........................... 708,323 705,144 705,136 (8)

North Carolina.................... 553,294 552,135 552,131 (4)

North Dakota...................... 371,524 371,047 371,046 (1)

Ohio.................................... 567,860 565,683 565,678 (5)

Oklahoma............................ 432,964 432,141 432,139 (2)

Oregon................................ 426,057 425,462 425,460 (2)

Pennsylvania....................... 696,350 693,946 693,940 (6)

Rhode Island....................... 370,261 369,579 369,578 (1)

South Carolina.................... 520,063 519,379 519,376 (3)

South Dakota...................... 420,122 419,512 419,511 (1)

Tennessee............................ 448,702 447,625 447,621 (4)

Texas................................... 892,445 892,528 892,518 (10)

Utah.................................... 457,285 456,798 456,796 (2)

Vermont.............................. 407,585 406,955 406,954 (1)

Virginia............................... 502,926 501,622 501,618 (4)

Washington......................... 485,973 485,365 485,362 (3)

West Virginia...................... 423,756 422,878 422,877 (1)

Wisconsin........................... 471,125 469,819 469,816 (3)

Wyoming............................ 363,720 363,120 363,119 (1)

Subtotal, States................... 25,603,856 25,550,953 25,550,794 (159)

American Samoa................. 125,528 125,517 125,517 -

Guam.................................. 126,558 126,540 126,540 -

Northern Mariana Islands... 125,498 125,498 125,498 -

Puerto Rico......................... 428,256 426,462 426,460 (2)

Virgin Islands..................... 126,008 125,986 125,986 -

Subtotal, States and Territories 26,535,704 26,480,956 26,480,795 (161)

Program Support 1/................... 18,296 22,565 22,565 -

TOTAL...................................... 26,554,000 26,503,521 26,503,360 (161)

 1/ Program Support -- Includes funds for grant systems and review, and program reporting systems costs.
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

214

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

FY 2017 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: Assistive Technology Protection and Advocacy (CFDA 84.343)

State/Territory FY 2016 Actual FY 2017

Annualized CR

FY 2018

President's 

Budget

FY 2018 +/- FY 

2017

Alabama...................................... 53,530 52,910 52,910 -

Alaska.......................................... 50,000 50,000 50,000 -

Arizona........................................ 74,306 74,352 74,352 -

Arkansas...................................... 50,000 50,000 50,000 -

California.................................... 428,326 426,252 426,253 1

Colorado...................................... 59,121 59,418 59,417 (1)

Connecticut................................. 50,000 50,000 50,000 -

Delaware..................................... 50,000 50,000 50,000 -

District of Columbia.................... 50,000 50,000 50,000 -

Florida......................................... 219,594 220,737 220,737 -

Georgia........................................ 111,460 111,231 111,231 -

Hawaii......................................... 50,000 50,000 50,000 -

Idaho............................................ 50,000 50,000 50,000 -

Illinois......................................... 142,183 140,035 140,034 (1)

Indiana......................................... 72,820 72,083 72,083 -

Iowa............................................. 50,000 50,000 50,000 -

Kansas......................................... 50,000 50,000 50,000 -

Kentucky..................................... 50,000 50,000 50,000 -

Louisiana..................................... 51,326 50,860 50,860 -

Maine.......................................... 50,000 50,000 50,000 -

Maryland..................................... 65,971 65,405 65,405 -

Massachusetts.............................. 74,460 73,986 73,985 (1)

Michigan..................................... 109,391 108,049 108,048 (1)

Minnesota.................................... 60,239 59,777 59,777 -

Mississippi.................................. 50,000 50,000 50,000 -

Missouri...................................... 66,933 66,246 66,246 -

Montana...................................... 50,000 50,000 50,000 -

Nebraska...................................... 50,000 50,000 50,000 -

Nevada........................................ 50,000 50,000 50,000 -

New Hampshire........................... 50,000 50,000 50,000 -
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

215

PROGRAM/CFDA NUMBER: Assistive Technology Protection and Advocacy (CFDA 84.343) 

State/Territory FY 2016 

Actual

FY 2017

Annualized CR

FY 2018

President's 

Budget

FY 2018 +/- FY 

2017

New Jersey.......................... 98,665 97,545 97,545 -

New Mexico....................... 50,000 50,000 50,000 -

New York........................... 217,970 215,560 215,559 (1)

North Carolina.................... 109,767 109,358 109,357 (1)

North Dakota...................... 50,000 50,000 50,000 -

Ohio.................................... 127,983 126,460 126,460 -

Oklahoma............................ 50,000 50,000 50,000 -

Oregon................................ 50,000 50,000 50,000 -

Pennsylvania....................... 141,153 139,409 139,408 (1)

Rhode Island....................... 50,000 50,000 50,000 -

South Carolina.................... 53,344 53,315 53,315 -

South Dakota...................... 50,000 50,000 50,000 -

Tennessee............................ 72,296 71,872 71,872 -

Texas................................... 297,567 299,116 299,115 (1)

Utah.................................... 50,000 50,000 50,000 -

Vermont.............................. 50,000 50,000 50,000 -

Virginia............................... 91,910 91,284 91,284 -

Washington......................... 77,949 78,079 78,079 -

West Virginia...................... 50,000 50,000 50,000 -

Wisconsin........................... 63,555 62,845 62,845 -

Wyoming............................ 50,000 50,000 50,000 -

Subtotal, States................... 4,241,819 4,226,184 4,226,177 (7)

American Samoa................. 30,000 30,000 30,000 -

Guam.................................. 30,000 30,000 30,000 -

Northern Mariana Islands... 30,000 30,000 30,000 -

Puerto Rico......................... 50,000 50,000 50,000 -

Virgin Islands..................... 30,000 30,000 30,000 -

Subtotal, States and Territories 4,411,819 4,396,184 4,396,177 (7)

Native American Organizations 1/ $30,000 $30,000 $30,000 -

Program Support 2/................... 8,181 15,357 15,357 -

TOTAL...................................... 4,450,000 4,441,541 4,441,534 (7)

1/ The Tribal Organizations line reflects the funds provided to Native Americans in New Mexico. 

2/ Program Support -- Includes funds for grant systems and review, and program reporting systems costs.
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

216

Alzheimer’s Disease Initiative - Outreach Campaign 

FY 2016

Final

FY 2017

Annualized 

CR

FY 2018

President's 

Budget

FY 2018 +/-

FY 2017

Alzheimer’s Disease 

Initiative—Outreach 

(Prevention Fund)

$4,200 $4,200 $0 -$4,200

Authorizing Legislation: Section 411 of the Older Americans Act of 1965, as amended and the 

Patient Protection and Affordable Care Act (ACA), Section 4002 [42 U.S.C. 300u-11] 

FY 2018 Authorization .................................................................... No specific amount authorized 

Allocation Method ............................................................................................................. Contracts 

Program Description and Accomplishments: 

In FY 2012, ACL received $4,000,000 in initial funding from the Prevention and Public Health 

Fund to begin a public awareness Alzheimer’s Disease Outreach Campaign. An estimated 

5.2 million individuals in the United States are living with Alzheimer’s disease and related 

dementias (ADRD), and that number is expected to increase by 40 percent by 2025.108 With the 

prevalence of this disease growing, this public awareness effort was designed to educate 

Americans who are at risk or who care for someone at risk of developing this disease. 

During the first year of the Campaign, a new website (alzheimers.gov) was launched and a 

variety of outreach materials were developed in partnership with the National Institute on Aging 

(NIA) and other stakeholders. Going forward, ACL and NIA will continue to utilize materials 

already developed to inform people caring for people with Alzheimer’s disease that there are 

federal, state, local, and nonprofit resources available to help them. The campaign highlights the 

alzheimers.gov website and deploys television, radio and print advertisements as well as search 

engine optimization and advertisements on specific websites. 

 

108 Alzheimer’s Association. 2014 Alzheimer’s Disease Facts and Figures. Accessed April 14, 2014. 
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

217

Funding History: 

Funding for the Alzheimer’s Disease Initiative—Outreach Campaign over the last five years is as 

follows: 

FY 2014 ...................................................$4,200,000 

FY 2015 ...................................................$4,200,000 

FY 2016... ...............................................$4,200,000 

FY 2017 Annualized CR ..........................$4,200,000 

FY 2018 President’s Budget ..................................$0 

Budget Request: 

The FY 2018 Budget Request is $0, a decrease of -$4,200,000 from the annualized FY 2017 

Continuing Resolution level. No funding is requested in FY 2018 for the Alzheimer’s Disease 

Supportive Services Program since Alzheimer’s Disease activities are being consolidated into 

one program, the Alzheimer’s Disease Program. 

Resource and Program Data: 

Alzheimer’s Disease Initiative –Outreach Campaign 

(Dollars in thousands) 

Mechanism

FY 2016 

Final

#

FY 2016 

Final

$

FY 2017

CR Annualized

#

FY 2017

CR Annualized

$

Formula Grants --

 

-- --

 -

-

New Discretionary

Grants --

 

-- --

 -

-

Continuations Grants --

 

-- --

 -

-

Contracts 1 

 

4,107 1 

 

4,132 

Interagency Agreements --

 

-- --

 -

-

Program Support /1

 

94 

 

68 

Total Resources

 

4,200 

 

4,200 

1/ Program Support -- Includes funds for overhead, grant systems and review costs, and information 

technology support costs. 
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

218

Medicare Improvements for Patients and Providers Act Programs (MIPPA) 

FY 2016

Final

FY 2017

Annualized 

CR 1/

FY 2018

President's 

Budget

FY 2018 +/-

FY 2017

MIPPA Programs: $37,500 $34,913 $37,500 +$2,588

Area Agencies on Aging [NonAdd] $7,500 $6,983 $7,500 +$517

Aging & Disability Resource 

Centers [Non-Add] $5,000 $4,655 $5.000 +$345

Nat’l Ctr for Benefits & Outreach Enrollment [Non-Add] 

$12,000 $11,172 $12,000 +$828

State Health Insurance Asst. 

Programs [Non-Add] $13,000 12,103 $13,000 +$897

FTEs 4 4 6 +2

1/ Funding in FY 2017 reflects a 6.9% sequester. 

Authorizing Legislation: Medicare Improvements for Patients and Providers Act of 2008, 

Section 119 (42 U.S.C. 1395b-3 note) as amended. 

FY 2018 Authorization ......................................................................................................... Expired 

Allocation Method ............................................ Competitive Grants/Formula Grants and Contracts 

Program Description and Accomplishments: 

The Medicare Improvements for Patients and Providers Act (MIPPA) programs provide funding 

to support targeted in-person enrollment assistance specifically to hard to reach low-income and 

rural Medicare beneficiaries who qualify for either Medicare Savings Plans (MSP) or a Low 

Income Subsidy (LIS) and also support the National Center for Benefits Outreach and 

Enrollment. For beneficiaries who qualify, MSPs pay their Medicare Part A or/and Part B 

premiums and co-insurance costs and the LIS subsidizes their Medicare prescription drug costs, 

including premiums, deductibles and drug co-pays. Beneficiaries are eligible for these programs 

if they have minimal assets and incomes below 135% of the Federal Poverty Level. 

Grants to state-level provide 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 SHIP. Instead, 

it supports additional counseling that goes beyond the assistance what would normally be 

provided, both to identify older Americans and those with disabilities in need, and by providing 

much more intensive counseling to these specific populations. 
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

219

In FY 2016, MIPPA State Grantees conducted over 22,000 public and media events, served over 

2.5 million people, and completed over 164,000 total applications for LIS and MSP benefits 

combined. 

The National Center for Benefits Outreach and Enrollment coordinates efforts to inform older 

adults and beneficiaries with disabilities about the benefits available under Federal and state 

programs, with an emphasis on providing information on the LIS and MSP which help Medicare 

beneficiaries pay for their Medicare coverage. The NCBOE also supports a nationwide network 

of 59 local Benefit Enrollment Centers which provide low-income benefits information and 

enrollment assistance. NCBOE accomplishes its mission by providing tools, resources, and 

technology that help local, state, and regional organizations find, counsel, and assist seniors and 

younger adults with disabilities in applying for and enrolling in the benefits for which they may 

be eligible. It also works to generate and disseminate new knowledge about best practices and 

cost-effective strategies for benefits outreach and enrollment. In FY 2016, the NCBOE and 

Benefits Enrollment Centers directly assisted with over 134,000 applications for the LIS, MSP, 

and other low income benefits. 

Funding History: 

Funding for MIPPA over the past five years is as follows: 

FY 2014 .....................................$25,000,000

FY 2015 .....................................$25,000,000

FY 2016 ....................................$37,500,000

FY 2017 1/ .................................$34,912,500 

FY 2018 President’s Budget ..... $37,500,000

__________________ 

1/ Reflects a 6.9% sequester. 

Budget Request: 

Funding for MIPPA totaling $37,500,000 will be requested in FY 2018 for a two-year proposed 

extension of the Medicare Access and Chip Reauthorization Act (MACRA), maintaining funding 

at the enacted FY 2017 level. 

The Budget eliminates discretionary funding for the State Health Insurance Assistance Program, 

but maintains funding to provide one-on-one counseling specifically targeting hard-to-reach lowincome and rural beneficiaries who qualify for either the Medicare Savings Plans (MSP) or the 

Social Security Low-Income Subsidy (LIS). Continued funding is needed so that the 

beneficiaries who are eligible for these programs do not lose the in-depth assistance with 

enrolling in these programs that MIPPA dollars support. To the extent that these individuals fail 
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

220

to enroll, each beneficiary would lose not only an estimated $4,000 annually in LIS savings (per 

SSA estimates) and/or $411 per month in Medicare Part A Premium Savings and $121.80 per 

month in Part B Premiums through MSP, but also additional assistance with Medicare Part A and 

B copayments and deductibles and benefits from other programs to which they qualify. 

Grant Awards Tables: 

MIPPA – Area Agencies on Aging 

FY 2016 Final FY 2017 

Annualized CR

FY 2018 

President’s 

Budget

Number of 

Awards/1 136 321 321

Average 

Awards/2 $52,239 $20,502 $19,948

Range of

Awards/3

$2,080 -

$596,380

$1,000 -

$542,797

$1,000 -

$527,511

1/FY 2016 reflects the actual number of grants given including 47 States, and the District of 

Columbia and 89 Tribes. In FY 2017 and FY 2018 we estimate all eligible States the District of 

Columbia and 270 Tribes apply for grants. 

2/If awards to Tribes are excluded from the “average award” calculation the average award to 

States and DC are FY 2016 $145,618, $123,749 in FY 2017, and $120,264 in FY 2018. 

3/If the awards to Tribes are excluded from the “range of awards” calculation, the smallest award 

to States and DC is $5,363 in FY 2016, $4,887 in FY 2017, and $4,750 in FY 2018. 

MIPPA – Aging Disability and Resource Centers 

FY 2016 Final FY 2017 

Annualized CR

FY 2018 

President’s 

Budget

Number of 

Awards 47 51 51

Average 

Award $101,031 $86,238 $83,915

Range of 

Awards

$6,328 -

$435,709

$2,702 -

$398,179

$2,629 -

$387,447
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

221

MIPPA – National Center for Benefits Outreach and Enrollment 

FY 2016 Final FY 2017 

Annualized CR

FY 2018 

President’s 

Budget

Number of 

Awards 1 1 1

Average 

Award $11,417,383 $10,574,438 $10,290,018

Range of 

Awards N/A N/A N/A

MIPPA –State Health Insurance Assistance Programs 

FY 2016 Final FY 2017 

Annualized CR

FY 2018 

President’s 

Budget

Number of 

Awards 48 51 51

Average 

Award $257,687 $225,142 $218,827

Range of 

Awards $0 - $1,073,060 $8,892 -$987,527

$8,642 -

$959,830
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

222

Resource and Program Data: 

Medicare Improvements for Patients and Providers Act Programs 

(Dollars in Thousands) 

Mechanism

FY 2016 

Final

#

FY 2016 

Final

$

FY 2017

CR Annualized

#

FY 2017

CR Annualized

$

FY 2018 

President’s 

Budget

#

FY 2018 

President’s 

Budget

$

Formula Grants 232 

 

24,225 423 

 

22,462 423 

 

21,843.265 

New Discretionary

Grants --

 

-- 1 

 

10,574 --

 

--

Continuations Grants 1 

 

11,417 --

 

-- 1 

 

10,720.000 

Contracts 1 

 

692 1 

 

524 4 

 

2,661.864 

Interagency 

Agreements --

 

-- --

 

-- --

 

402.273 

Program Support /1

 

1,165 

 

1,353 --

 

1,872.598 

Total Resources 234 

 

37,500 425 

 

34,913 57 

 

37,500 

1/ 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 

223

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING 

ADMINISTRATION ON AGING 

FY 2018 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: MIPPA - AAA (CFDA 93.071) 

State/Territory FY 2016 Actual FY 2017

Annualized CR

FY 2018

President's 

Budget

FY 2018 +/- FY 

2017

Alabama...................................... 188,860 171,798 166,959 (4,839)

Alaska......................................... 12,748 11,573 11,247 (326)

Arizona........................................ 86,308 78,498 76,287 (2,211)

Arkansas...................................... 142,299 129,346 125,703 (3,643)

California.................................... 320,240 291,583 283,370 (8,213)

Colorado...................................... 85,738 78,006 75,809 (2,197)

Connecticut................................. 37,090 33,754 32,803 (951)

Delaware..................................... 21,178 19,247 18,705 (542)

District of Columbia................... 5,363 4,887 4,750 (137)

Florida......................................... 339,213 308,773 300,076 (8,697)

Georgia........................................ 279,997 254,649 247,476 (7,173)

Hawaii......................................... - 28,779 27,968 (811)

Idaho........................................... 52,199 47,411 46,076 (1,335)

Illinois......................................... 262,703 238,989 232,257 (6,732)

Indiana......................................... 181,091 164,685 160,046 (4,639)

Iowa............................................. 101,608 92,261 89,662 (2,599)

Kansas......................................... 87,503 79,518 77,277 (2,241)

Kentucky..................................... 211,750 192,496 187,074 (5,422)

Louisiana..................................... 129,168 117,502 114,192 (3,310)

Maine.......................................... 42,349 38,403 37,321 (1,082)

Maryland..................................... 100,140 91,167 88,599 (2,568)

Massachusetts............................. 75,262 68,512 66,582 (1,930)

Michigan..................................... 231,829 210,859 204,920 (5,939)

Minnesota.................................... 106,787 96,995 94,263 (2,732)

Mississippi.................................. 144,906 131,685 127,976 (3,709)

Missouri...................................... 188,141 171,037 166,221 (4,816)

Montana...................................... 44,433 40,363 39,227 (1,136)

Nebraska..................................... 54,280 49,299 47,911 (1,388)

Nevada....................................... 49,163 44,745 43,486 (1,259)

New Hampshire.......................... 40,577 36,866 35,828 (1,038)
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

224

 PROGRAM/CFDA NUMBER: MIPPA – AAA (CFDA 93.071)

State/Territory FY 2016 Actual FY 2017

Annualized CR

FY 2018

President's Budget

FY 2018 +/- FY 

2017

New Jersey.......................... 128,430 117,027 113,731 (3,296)

New Mexico....................... 60,412 54,906 53,360 (1,546)

New York........................... 327,115 297,781 289,393 (8,388)

North Carolina.................... 327,293 297,639 289,255 (8,384)

North Dakota...................... - 22,354 21,724 (630)

Ohio.................................... 246,912 224,581 218,256 (6,325)

Oklahoma............................ 123,675 112,414 109,247 (3,167)

Oregon................................ 91,365 83,028 80,689 (2,339)

Pennsylvania....................... 307,303 279,606 271,730 (7,876)

Rhode Island....................... - 18,903 18,370 (533)

South Carolina.................... 178,273 162,188 157,620 (4,568)

South Dakota...................... 30,321 27,533 26,758 (775)

Tennessee............................ 201,010 182,730 177,584 (5,146)

Texas................................... 596,380 542,797 527,511 (15,286)

Utah.................................... 39,384 35,798 34,789 (1,009)

Vermont.............................. 23,352 21,187 20,590 (597)

Virginia............................... 214,778 195,348 189,846 (5,502)

Washington......................... 109,523 99,568 96,763 (2,805)

West Virginia...................... 100,752 91,569 88,990 (2,579)

Wisconsin........................... 114,848 104,287 101,350 (2,937)

Wyoming............................ - 16,291 15,832 (459)

Subtotal, States................... 6,844,049 6,311,221 6,133,459 (177,762)

Tribes............................ 260,520 270,000 270,000 -

Subtotal, States and Territories 7,104,569 6,581,221 6,403,459 (177,762)

Program Management /1.......... 395,431 401,779 1,096,541 694,762

TOTAL..................................... 7,500,000 6,983,000 7,500,000 517,000

1/ Program Management -- Reflects the amount used from the MIPPA appropriation for staff and overhead, support contracts, 

training, technical assistance, data systems, grant systems, and grants review costs. 
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

225

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

ADMINISTRATION ON AGING 

FY 2018 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: MIPPA - ADRC (CFDA 93.071) 

State/Territory FY 2016 Actual FY 2017

Annualized CR

FY 2018

President's 

Budget

FY 2018 +/- FY 

2017

Alabama...................................... 110,173 100,683 97,970 (2,713)

Alaska......................................... 6,328 5,783 5,627 (156)

Arizona........................................ 113,102 103,360 100,575 (2,785)

Arkansas...................................... 69,489 63,504 61,793 (1,711)

California.................................... 187,539 171,385 166,768 (4,617)

Colorado...................................... 78,820 72,031 70,090 (1,941)

Connecticut................................. 74,187 67,797 65,970 (1,827)

Delaware..................................... 19,398 17,727 17,249 (478)

District of Columbia................... 10,207 9,328 9,077 (251)

Florida......................................... 435,709 398,179 387,447 (10,732)

Georgia........................................ 160,390 146,575 142,625 (3,950)

Hawaii......................................... - 24,598 23,936 (662)

Idaho........................................... 29,724 27,164 26,432 (732)

Illinois......................................... 219,202 200,322 194,924 (5,398)

Indiana......................................... 131,386 120,069 116,834 (3,235)

Iowa............................................. 16,902 15,446 15,030 (416)

Kansas......................................... 56,685 51,802 50,407 (1,395)

Kentucky..................................... 99,200 90,655 88,212 (2,443)

Louisiana..................................... 89,357 81,660 79,460 (2,200)

Maine.......................................... 34,568 31,590 30,739 (851)

Maryland..................................... 102,191 93,389 90,873 (2,516)

Massachusetts............................. 138,308 126,395 122,990 (3,405)

Michigan..................................... 200,896 183,592 178,645 (4,947)

Minnesota.................................... 102,212 93,408 90,891 (2,517)

Mississippi.................................. 30,659 28,018 27,263 (755)

Missouri...................................... 8,068 7,373 7,175 (198)

Montana...................................... 15,716 14,362 13,975 (387)

Nebraska..................................... 7,492 6,847 6,662 (185)

Nevada....................................... 45,147 41,259 40,147 (1,112)

New Hampshire.......................... 28,352 25,910 25,212 (698)

 
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

226

 PROGRAM/CFDA NUMBER: ADRC - ADRC (CFDA 93.071)

State/Territory FY 2016 Actual FY 2017

Annualized CR

FY 2018

President's Budget

FY 2018 +/- FY 

2017

New Jersey.......................... 173,558 158,609 154,335 (4,274)

New Mexico....................... 40,680 37,176 36,175 (1,001)

New York........................... 215,859 197,266 191,951 (5,315)

North Carolina.................... 122,424 111,879 108,864 (3,015)

North Dakota...................... - 2,702 2,629 (73)

Ohio.................................... 247,990 226,629 220,522 (6,107)

Oklahoma............................ 78,748 71,965 70,026 (1,939)

Oregon................................ 29,553 27,007 26,280 (727)

Pennsylvania....................... 298,141 272,461 265,120 (7,341)

Rhode Island....................... - 21,833 21,245 (588)

South Carolina.................... 100,290 91,652 89,182 (2,470)

South Dakota...................... 17,878 16,338 15,898 (440)

Tennessee............................ 137,400 125,565 122,181 (3,384)

Texas................................... 275,079 251,385 244,611 (6,774)

Utah.................................... 34,206 31,260 30,417 (843)

Vermont.............................. 14,501 13,252 12,895 (357)

Virginia............................... 127,379 116,407 113,271 (3,136)

Washington......................... 44,643 40,797 39,698 (1,099)

West Virginia...................... 50,040 45,730 44,498 (1,232)

Wisconsin........................... 118,683 108,460 105,538 (2,922)

Wyoming............................ - 9,567 9,309 (258)

Subtotal, States................... 4,748,459 4,398,151 4,279,643 (118,508)

Program Management 1/.......... 251,541 256,849 720,357 463,508

TOTAL..................................... 5,000,000 4,655,000 5,000,000 345,000

1/ Program Management -- Reflects the amount used from the MIPPA appropriation for staff and overhead, support contracts, 

training, technical assistance, data systems, grant systems, and grants review costs. 
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

227

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

ADMINISTRATION ON AGING 

FY 2018 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: MIPPA - SHIP (CFDA 93.071) 

State/Territory FY 2016 Actual FY 2017

Annualized CR

FY 2018

President's 

Budget

FY 2018 +/- FY 

2017

Alabama...................................... 339,760 312,558 303,791 (8,767)

Alaska.......................................... 22,921 21,056 20,466 (590)

Arizona........................................ 155,261 142,813 138,807 (4,006)

Arkansas...................................... 255,943 235,325 228,723 (6,602)

California.................................... 576,266 530,489 515,608 (14,881)

Colorado...................................... 154,251 141,918 137,938 (3,980)

Connecticut................................. 66,734 61,411 59,688 (1,723)

Delaware..................................... 38,089 35,017 34,034 (983)

District of Columbia.................... 9,654 8,892 8,642 (250)

Florida......................................... 610,361 561,763 546,005 (15,758)

Georgia........................................ 503,688 463,292 450,297 (12,995)

Hawaii......................................... 56,938 52,359 50,890 (1,469)

Idaho............................................ 93,867 86,257 83,837 (2,420)

Illinois......................................... 472,616 434,803 422,606 (12,197)

Indiana......................................... 325,759 299,618 291,213 (8,405)

Iowa............................................. 182,701 167,853 163,144 (4,709)

Kansas......................................... 157,374 144,670 140,612 (4,058)

Kentucky..................................... 380,872 350,215 340,391 (9,824)

Louisiana..................................... 232,376 213,775 207,779 (5,996)

Maine.......................................... 76,120 69,868 67,908 (1,960)

Maryland..................................... 180,193 165,865 161,212 (4,653)

Massachusetts.............................. 135,424 124,647 121,150 (3,497)

Michigan..................................... 417,048 383,624 372,863 (10,761)

Minnesota.................................... 192,033 176,468 171,517 (4,951)

Mississippi.................................. 260,615 239,580 232,860 (6,720)

Missouri...................................... 338,410 311,175 302,447 (8,728)

Montana...................................... 79,904 73,435 71,376 (2,059)

Nebraska...................................... 97,607 89,692 87,176 (2,516)

Nevada........................................ 88,458 81,408 79,124 (2,284)

New Hampshire........................... 72,973 67,072 65,191 (1,881)
CONSUMER INFORMATION, ACCESS, AND OUTREACH 

228

PROGRAM/CFDA NUMBER: MIPPA -SHIP (CFDA 93.071)

State/Territory FY 2016 Actual FY 2017

Annualized CR

FY 2018

President's Budget

FY 2018 +/- FY 

2017

New Jersey.......................... 231,157 212,911 206,939 (5,972)

New Mexico....................... 108,655 99,894 97,091 (2,803)

New York........................... 588,604 541,764 526,567 (15,197)

North Carolina.................... 588,755 541,505 526,315 (15,190)

North Dakota...................... - 40,669 39,528 (1,141)

Ohio.................................... 444,184 408,589 397,128 (11,461)

Oklahoma............................ 222,443 204,518 198,781 (5,737)

Oregon................................ 164,322 151,056 146,818 (4,238)

Pennsylvania....................... 552,877 508,698 494,428 (14,270)

Rhode Island....................... - 34,390 33,426 (964)

South Carolina.................... 320,727 295,076 286,799 (8,277)

South Dakota...................... 54,522 50,092 48,688 (1,404)

Tennessee............................ 361,553 332,448 323,123 (9,325)

Texas................................... 1,073,060 987,527 959,830 (27,697)

Utah.................................... 70,838 65,129 63,302 (1,827)

Vermont.............................. 41,980 38,546 37,465 (1,081)

Virginia............................... 386,373 355,405 345,435 (9,970)

Washington......................... 196,999 181,149 176,066 (5,083)

West Virginia...................... 181,208 166,594 161,920 (4,674)

Wisconsin........................... 206,511 189,734 184,412 (5,322)

Wyoming............................ - 29,638 28,807 (831)

Subtotal, States................... 12,368,984 11,482,250 11,160,163 (322,087)

Program Management 1/.......... 631,016 620,750 1,839,837 1,219,087

TOTAL..................................... 13,000,000 12,103,000 13,000,000 897,000

1/ Program Management -- Reflects the amount used from the MIPPA appropriation for staff and overhead, support contracts, 

training, technical assistance, data systems, grant systems, and grants review costs. 
Program Administration 

FY 2016

Final

FY 2017

Annualized 

CR

FY 2018

President’s 

Budget

FY 2018 +/-

FY 2017

Program 

Administration $40,063 $39,987 $37,987 -$2,000

FTE/1.................. 170.6 172.7 160.6 -12.1

1/ FTE numbers above for Program Administration only reflect those FTE funded from 

the Program Administration budget line. Other sources of funding for ACL FTE include staff 

charged to reimbursable and mandatory funding sources. 

Authorizing Legislation: Older Americans Act (OAA), the Developmental Disabilities 

Assistance and Bill of Rights Act (DD Act), the Help America Vote Act (HAVA), the Assistive 

Technology (AT) Act, the Rehabilitation Act, the Public Health Services Act (PHSA), the Elder 

Justice Act (EJA), and the Medicare Improvements for Patients and Providers Act (MIPPA). 

FY 2018 Authorization ............................................................................... See Program Narratives 

Allocation Method ....................................................................................... Direct Federal/Contract 

Program Description and Accomplishments: 

ACL’s mission is to assist seniors and people of all ages with disabilities to live independently 

and to be able to fully participate in their communities. Program Administration funds the 

direction and support of ACL programs established under the Older Americans Act (OAA), 

Developmental Disabilities Assistance and Bill of Rights Act (DD Act), Rehabilitation Act, Help 

America Vote Act (HAVA), Assistive Technology (AT) Act, Public Health Services Act 

(PHSA), Elder Justice Act, and the Medicare Improvements for Patients and Providers Act 

(MIPPA). The majority of these funds cover salaries and benefits, rent and security, and external 

shared services, all of which are relatively fixed in the short term. ACL’s appropriation also 

includes language that allows Program Administration funds to be used for Department-wide 

coordination of policy and program activities that assist individuals with disabilities (consistent 

with the role previously performed by the Office of Disability), as ACL’s Principal Deputy 

Administrator also serves as the Secretary’s Senior Advisor on Disability Policy. 

In FY 2017, Program Administration funding will support 172.7 of ACL’s 199 FTE in both 

central office and in ACL’s regional offices. Other sources of funding for ACL FTE include 

staff supported by reimbursable and mandatory funding sources such as the Health Care Fraud 

and Abuse Control account, Medicare Improvements for Patients and Providers Act (MIPPA) 

activities, and funding received from the Centers for Medicare & Medicaid Services for activities 
PROGRAM ADMINISTRATION 

230

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 2014 $29,802,000 135.0 FTE 

FY 2015/1 $37,709,000 184.0 FTE 

FY 2016 $40,063,000 170.6 FTE 

FY 2017 CR $39,986,840 172.7 FTE 

FY 2018 PB $37,987,000 160.6 FTE 

1/Funding and FTEs for FY 2015 reflect annualized dollars and FTE actually transferred to ACL for program 

administration, based on a determination order between the Department of Education and ACL. 

Budget Request: 

ACL’s request includes $37,987,000 for Program Administration, a net decrease of -$1,999,840 

below the annualized FY 2017 Continuing Resolution level. ACL estimates that it will need to 

make significant reductions in funds for activities such as travel, training and key contracts. ACL 

believes that these reductions can be accommodated primarily through attrition and the agency 

anticipates only minimal, if any, new hiring through FY 2018. 
SUPPLEMENTARY TABLES 

 231

Object Classification Table - Direct 

Administration for Community Living 

(Dollars in Thousands) 

FY 2017 

Annualized 

CR

FY 2018 

President's 

Budget

FY 2018 +/-

FY 2017

Personnel compensation:

Full-time permanent (11.1)...................................... 21,820 20,929 (891)

Other than full-time permanent (11.3)..................... 1,035 993 (42)

Other personnel compensation (11.5)....................... 243 233 (10)

Military personnel (11.7).......................................... - - -

Special personnel services payments (11.8)............. - - -

Subtotal personnel compensation...................... 23,097 22,154 (943)

Civilian benefits (12.1).................................................. 6,768 6,587 (181)

Military benefits (12.2).................................................. - - -

Benefits to former personnel (13.0)............................. - - -

Total Pay Costs............................................................ 29,865 28,742 (1,123)

Travel and transportation of persons (21.0)................... 584 597 12

Transportation of things (22.0)....................................... - - -

Rental payments to GSA (23.1)...................................... 3,149 3,184 35

Rental payments to Others (23.2)................................... - - -

Communication, utilities, and misc. charges (23.3)........ 315 193 (122)

Printing and reproduction (24.0)...................................... 173 161 (11)

Other Contractual Services:

Advisory and assistance services (25.1)...................... 27,879 27,223 (656)

Other services (25.2).................................................... 180 183 3

Purchase of goods and services from -

government accounts (25.3)..................................... 10,402 10,149 (253)

Operation and maintenance of facilities (25.4)............ 53 54 2

Research and Development Contracts (25.5)............... - - -

Medical care (25.6)...................................................... - - -

Operation and maintenance of equipment (25.7)......... 10 11 1

Subsistence and support of persons (25.8)................... - - -

Subtotal Other Contractual Services.................... 38,524 37,621 (903)

Supplies and materials (26.0)......................................... 101 103 3

Equipment (31.0)............................................................ 24 26 2

Land and Structures (32.0) ............................................. - - -

Investments and Loans (33.0).......................................... - - -

Grants, subsidies, and contributions (41.0)..................... 1,968,993 1,836,323 (132,670)

Interest and dividends (43.0)............................................ - - -

Refunds (44.0).................................................................. - - -

Total Non-Pay Costs....................................................... 1,969,117 1,836,452 (132,665)

Total Budget Authority by Object Class....................... 2,041,727 1,906,949 (134,778)
SUPPLEMENTARY TABLES 

232

Salaries and Expenses 

Administration for Community Living 

(Dollars in Thousands) 

FY 2017 

Annualized 

CR

FY 2018 

President's 

Budget

FY 2018 +/- 

FY 2017

Personnel compensation:

Full-time permanent (11.1).................................................. 21,820 20,929 (891)

Other than full-time permanent (11.3)............................... 1,035 993 (42)

Other personnel compensation (11.5)............................... 243 233 (10)

Military personnel (11.7)..................................................... - - -

Special personnel services payments (11.8).................... - - -

Subtotal personnel compensation................................ 23,097 22,154 (943)

Civilian benefits (12.1)............................................................. 6,768 6,587 (181)

Military benefits (12.2)............................................................ - - -

Benefits to former personnel (13.0)...................................... - - -

Total Pay Costs........................................................................ 29,865 28,742 (1,123)

Travel and transportation of persons (21.0)........................ 584 597 12

Transportation of things (22.0).............................................. - - -

Rental payments to GSA (23.1).............................................. 3,149 3,184 35

Rental payments to Others (23.2).......................................... - - -

Communication, utilities, and misc. charges (23.3)............. 315 193 (122)

Printing and reproduction (24.0)............................................ 173 161 (11)

Other Contractual Services:

Advisory and assistance services (25.1)......................... 27,879 27,223 (656)

Other services (25.2)............................................................ 180 183 3

Purchase of goods and services from -

government accounts (25.3)........................................... 10,402 10,149 (253)

Operation and maintenance of facilities (25.4)................ 53 54 2

Research and Development Contracts (25.5).................. - - -

Medical care (25.6)............................................................... - - -

Operation and maintenance of equipment (25.7)............ 10 11 1

Subsistence and support of persons (25.8)..................... - - -

Subtotal Other Contractual Services.......................... 38,524 37,621 (903)

Supplies and materials (26.0).................................................. 101 103 3

Equipment (31.0)...................................................................... 24 26 2

Total Non-Pay Costs............................................................... 125 129 4

Total Budget Authority by Object Class............................. 72,734 70,626 (2,108)

Total Salary and Expense.................................. 29,865 28,742 (1,123)

Direct FTE........................................................... 172 171 159
SUPPLEMENTARY TABLES 

233

Detail of Full-Time Equivalent Employment (FTE) 

Administration for Community Living 

2016 

Actual 

Civilian

2016 

Actual 

Military

2016 

Actual 

Total

2017 

Est. 

Civilian

2017 

Est. 

Military

2017 

Est. 

Total

2018 

Est. 

Civilian

2018 

Est. 

Military

2018 

Est. 

Total

Immediate Office of the Administrator................... 

 Direct:................................................................ 20 20 18 18 20 20

 Reimbursable:..................................................... 0 0 0 0 0 0

 Total:.............................................................. 20 0 20 18 0 18 20 0 20

Administration on Aging........................................ 

 Direct:................................................................ 22 22 25 25 22 22

 Reimbursable:..................................................... 1 1 3 3 3 3

 Total:.............................................................. 23 0 23 28 0 28 25 0 25

Administration on Disabilities................................. 

 Direct:................................................................ 27 27 27 27 24 24

 Reimbursable:..................................................... 0 0 2 2 1 1

 Total:.............................................................. 27 0 27 29 0 29 25 0 25

Center for Policy and Evaluation............................ 

 Direct:................................................................ 6 6 6 6 6 6

 Reimbursable:..................................................... 4 4 5 5 7 7

 Total:.............................................................. 10 0 10 11 0 11 13 0 13

Center for Management and Budget...................... 

 Direct:................................................................ 31 31 33 33 29 29

 Reimbursable:..................................................... 0 0 1 1 1 1

 Total:.............................................................. 31 0 31 34 0 34 30 0 30

Center for Integrated Programs............................. 

 Direct:................................................................ 9 9 8 8 8 8

 Reimbursable:..................................................... 19 19 17 17 16 16

 Total:.............................................................. 28 0 28 25 0 25 24 0 24

Office of Regional Operations............................... 

 Direct:................................................................ 28 28 25 25 22 22

 Reimbursable:..................................................... 0 0 0 0 0 0

 Total:.............................................................. 28 0 28 25 0 25 22 0 22

National Institute on Disability, Independent Living, 

and Rehabilitation Research...................................

 Direct:................................................................ 29 29 29 29 28 28

 Reimbursable:..................................................... 0 0 0 0 0 0

 Total:.............................................................. 29 0 29 29 0 29 28 0 28

OPDIV FTE Total.............................................. 196 196 199 199 187 187

Average GS Grade

FY 2014............................................................... 13

FY 2015............................................................... 12.8

FY 2016............................................................... 13.6

FY 2017............................................................... 13.6

FY 2018............................................................... 13.6
SUPPLEMENTARY TABLES 

234

Detail of Positions 

Administration for Community Living 

2016

Actual

2017

Annualized 

CR

2018 

President's 

Budget

Executive level I .......................................... 0 0 0 

Executive level II.......................................... 0 0 0 

Executive level III ........................................ 0 0 0 

Executive level IV........................................ 0 0 1 

Executive level V.......................................... 0 0 0 

Subtotal .................................................... 0 0 1 

Total - Exec. Salaries (Excludes Benefits). $ -- $ -- $ 161,900 

ES-6............................................................ 0 0 0 

ES-5............................................................ 2 0 2 

ES-4............................................................ 1 0 0 

ES-3............................................................ 1 2 2 

ES-2............................................................ 2 0 0 

ES-1............................................................ 0 1 1 

Subtotal ................................................... 6 3 5 

Total - ES Salary (Excludes Benefits)...... $ 1,010,321 $ 541,661 $ 845,061 

GS-15.......................................................... 32 35 33 

GS-14.......................................................... 55 53 51 

GS-13.......................................................... 59 64 54 

GS-12.......................................................... 18 20 19 

GS-11.......................................................... 15 15 15 

GS-10.......................................................... 1 1 1 

GS-9............................................................ 5 4 4 

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............................................................ 1 0 0 

GS-2............................................................ 0 0 0 

GS-1............................................................ 0 0 0 

Subtotal .................................................... 190 196 181 

Total - GS Salary (Excludes Benefits)..... $ 21,043,669 $ 22,505,143 $ 21,279,162 

Average ES level ......................................... 0 0 3

Average ES salary........................................ $ -- $ -- $ 169,012 

Average GS grade........................................ 13.6 13.6 13.3

Average GS salary........................................ $ 110,756 $ 114,822 $ 117,564 

Average AD salary $ 130,665 $ 135,670 $ 137,762 
SUPPLEMENTARY TABLES 

235

Programs Proposed for Elimination 

Administration for Community Living 

Program FY 2017 CR Rationale 

State Councils on Developemental Disabilities 72,861

The State Councils o n Developmental Disabilities; along with the State Grants component o f

the Independent Living programs,; and the State Implementation Partnership Grants

component of the Traumatic Brain Injury program would be combined to create a single crossdisability program, Partnerships for Innovation, Inclusion and Independence (PIII), that can

target resources in each State t o support the development o f systems and services that

increase opportunities for independence, integration, productivity, inclusion, and selfdetermination for people with all types o f significant disabilities. The proposed integration o f

these three programs will eliminate overlap and streamline operations.

Limb Loss Resource Center 2,805

The mission and activities carried out by the Limb Loss Resource Center are duplicative o f

other Federal efforts. Support for individuals affected b y limb loss is also available through

other ACL programs such as Aging and Disability Resource Centers, Centers for

Independent Living (CILs) and Assistive Technology, which provide services t o people with

all types of significant disabilities.

Paralysis Resource Center 7,685

The mission and activities carried out by the Paralysis Resource Center are duplicative o f

other Federal efforts. Support for individuals affected b y limb loss is also available through

other ACL programs such as Aging and Disability Resource Centers, Centers for

Independent Living (CILs) and Assistive Technology, which provide services t o people with

all types of significant disabilities.

State Health Insurance Assistance Programs 52,016

While ACL will reduce the scale of its one-on-one person assistance through the State Health 

Insurance Assistance Program, Medicare beneficiaries will continue to have access to online 

tools such as Plan Finder and phone assistance such as CMS’s 1-800-MEDICARE helpline. 

Some states also support SHIP programs. 
SUPPLEMENTARY TABLES 

236

FTE Funded by the Affordable Care Act 

Administration for Community Living 

(Dollars in thousands) 

Program Section Total FTEs CEs Total FTEs CEs Total FTEs CEs

Pre-existing programs funded by ACA (Mandatory)

 National Clearinghouse for Long-Term Care Information Title VIII $ 0 0 -$ 0 0 -$ 0 0 86

 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 $ 0 0 4,200$ 0 0 4,200$ 0 0 150

 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

Program Section Total FTEs CEs Total FTEs CEs Total FTEs CEs

Pre-existing programs funded by ACA (Mandatory)

 National Clearinghouse for Long-Term Care Information Title VIII 1,000$ 0 0 -$ 0 0 -$ 0 0

 Medicare Improvements for Patients & Providers Act Programs Section 3306 -$ 0 0 -$ 0 0 -$ 0 0

New programs authorized and funded by ACA (Mandatory)

 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 -$ 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

 Falls Prevention--(PPHF) Section 4002 5,000$ 0 0 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 8,000$ 1 0 7,985$ 3 0 7,985$ 3 0

FY 2016 FY 2017

FY 2013 FY 2014 FY 2015

FY 2018
SUPPLEMENTARY TABLES 

237

Physicians’ Comparability Allowance Worksheet 

Administration for Community Living 

ACL does not have anything to submit for this section. 
Significant Items in Appropriations Committee Reports 

Administration for Community Living 

Aging and Disability Services Programs (H Rept. 114-699/Page 101) 

The Committee understands ACL has proposed to expand the administrative capacity of grant 

programs by shifting funds from grants to support new staff. The Committee recognizes this 

additional capacity may enhance program oversight and performance. However, the Committee’s 

intent for appropriating these funds is to expand program dollars available for grants, not to 

expand ACL’s administrative capacity. The Committee is concerned about the programmatic 

impact a shift in funds will have on grantees. The Committee directs ACL to maintain the fiscal 

year 2015 funding for the grants for all programs, and where there were increases provided in 

fiscal year 2016, the Committee directs ACL to increase grants by the same amount. The 

Committee requests additional detail in the fiscal year 2018 budget request under each program 

for any proposed reduction in the amount for grants, including the amount of the reduction for 

grants and the increase proposed for administrative staff.

Action Taken or To Be Taken: ACL no longer plans to expand the administrative capacity of 

grant programs by shifting funds from grants to support new staff. The proposal will not be

implemented in FY 2017 and is not proposed in the FY 2018 President’s Budget. Programs that 

have been historically subject to statutory set-asides and program support requirements will 

continue but no new programs will be subject to set-asides in FY 2017 or the FY 2018 

President’s Budget to fund additional staff. Existing grant costs for each program can be found in 

the mechanism tables included in the Congressional Justification.

Olmstead v. L.C. 527 U.S. 581 (1999) – H. Rept. 114-699/Pages 104-5 

The Committee notes that the Developmental Disabilities Assistance and Bill of Rights Act of 

2000 does not require closure of long-term care facilities for persons unable to care for 

themselves. The Committee notes that the 1999 U.S. Supreme Court decision in Olmstead v. 

L.C. does not mandate deinstitutionalization. ‘‘We emphasize that nothing in the Americans with 

Disabilities Act or its implementing regulations condones termination of institutional settings for 

persons unable to handle or benefit from community settings... Nor is there any Federal 

requirement that community-based treatment be imposed on patients who do not desire it.’’ 

Olmstead v. L.C. 119 S. Ct. 2176, 2187 (1999). The Committee asks for a report on the current 

Olmstead enforcement activities within ACL. 

Action Taken or To Be Taken: The Administration for Community Living does not have 

statutory authority to enforce Olmstead activities. The Department of Justice has the authority to 

enforce’’ Olmstead v. L.C. 119 S. Ct. 2176, 2187 (1999) and ACL defers to the DOJ on any 

enforcement activities and decisions related to the Olmstead ruling. 

A small portion of ACL grantee activities are specifically focused on Olmstead. Examples 

include participation on State Olmstead task forces, training for various stakeholders on 

Olmstead and ADA requirements, technical assistance to States in the implementation of State 
SIGNIFICANT ITEMS IN APPROPRIATION COMMITTEE REPORTS 

239

Olmstead plans and State enforcement of Olmstead, and technical assistance to self-advocacy 

groups on Olmstead. Some grantees are given responsibility for monitoring consent decrees or 

other settlement agreements related to Olmstead and the ADA to ensure appropriate services and 

supports are in place for quality community living. 

Assistive Technology - H. Rept. 114-699/Page 106 

This funding is intended 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 otherwise 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 creditbuilding 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. 

Action Taken or To Be Taken: No funding is requested for the Assistive Technology (AT) 

Alternative Financing Program (AFP), a one-year competitive-grant program no longer 

authorized under current law, which was funded at $2 million through appropriations in FY 

2017. In FY 2005, Congress amended the AT Act to eliminate the separate AFP authorization 

and instead authorized an AT State grant program that is inclusive of financing activities. 

Training and technical assistance is provided to the entities funded under the AT Act for all 

required state leadership and state-level activities, including state financing. We expect State AT 

programs to continue to serve the unique needs of their state by conducting financing activities 

which can include cash loans for the purchase of assistive technology devices, credit-building 

activities, financial education, and information about funding resources to acquire assistive 

technology devices and services. Since there is no separate AFP discretionary grant program 

authorization in the AT Act, ACL is only requesting funding in FY 2018 for the State AT grant 

program, which supports state financing activities nationwide.

Medicaid Licensed Intermediate Care Facilities - H. Rept. =114-699/Page 105/Within 180 

Days of enactment of this act. 

There is a nationwide trend towards deinstitutionalization of patients with intellectual or 

developmental disabilities in favor of community based settings. The Department is strongly 

urged to continue to factor the needs and desire of patients, their families, caregivers, and other 

stakeholders, as well as the need to provide proper settings for care, into its enforcement of the 

Developmental Disabilities Act. The Committee maintains bill language requiring notification of 

affected individuals of their legal rights in this regard. 
SIGNIFICANT ITEMS IN APPROPRIATION COMMITTEE REPORTS 

240

Action Taken or To Be Taken: ACL works towards maximizing the independence, well-being, 

and health of older adults, people with disabilities, and their families and caregivers. ACL 

understands that many people with intellectual and developmental disabilities need specialized, 

individualized services and supports to live as independently as possible. 

ACL recognizes the important role of family members and caregivers in ensuring that individual 

preferences are honored and needs are met. We also recognize that when significant support is 

needed, the preferences of the individual are not the only factor in determining how to best 

support that person. The availability of services and supports in a variety of settings, the 

resources and availability of family caregivers, and other factors also must be considered. 

Muscular Dystrophy – H. Rept. 114-699/Page 106 

The Committee is aware that ACL is included in the Muscular Dystrophy Coordinating 

Committee under the Muscular Dystrophy CARE Act Amendments enacted in September 2014. 

The Committee supports programs and initiatives focused on the transitions of persons with 

Duchenne into adulthood. The Committee requests a report on ACL’s plans to conduct 

comprehensive studies focused on demonstrating the cost-effectiveness of independent living 

programs and supports for persons living with various forms of muscular dystrophy. 

Muscular Dystrophy – S. Rept. 114-274/Page 151 

The Committee is aware that the ACL is included in the Muscular Dystrophy Coordinating 

Committee under the Muscular Dystrophy CARE Act Amendments enacted in September 2014. 

The Committee supports programs and initiatives focused on the transitions of persons with 

Duchenne into adulthood. The Committee requests a report within 180 days of enactment of this 

act on the administration’s plans to conduct comprehensive studies focused on demonstrating the 

cost-effectiveness of independent living programs and supports for persons living with various 

forms of muscular dystrophy. 

Action Taken or To be Taken: Developing a comprehensive report on the cost-effectiveness of 

independent living programs and support for persons living with various forms of muscular 

dystrophy would cost an estimated $4 million. No appropriations have been provided for this 

purpose, and as a result ACL is unable to provide the requested report. 

Home and Community-Based Supportive Services - H. Rept. 114-274/Page 145 

The Committee recommends an appropriation of $347,724,000 for the Home and 

Community-Based Supportive Services program. This program provides formula grants to States 

and territories to fund a wide range of social services that enable seniors to remain independent 

and in their homes for as long as possible. State agencies on aging award funds to designated 

area agencies on aging that, in turn, make awards to local service providers. This activity 

supports services such as transportation, adult day care, physical fitness programs, and in-home 

assistance such as personal care and homemaker assistance. The Committee directs ACL to work 

with States to prioritize innovative service models, like naturally occurring retirement 
SIGNIFICANT ITEMS IN APPROPRIATION COMMITTEE REPORTS 

241

communities [NORCs], which help older Americans remain independent as they age. The 

Committee notes that NORCs, and similar settings, are a more cost-effective alternative to longterm care that enables older Americans to be more engaged in their communities while living at 

home. 

Action Taken or To Be Taken: ACL appreciates and supports the Committee’s continued 

interest in innovative service models that help older adults remain independent as they age. ACL 

continues to work with other Federal partners, states and localities to encourage livable 

communities and develop innovative models, such as NORCs and the World Health 

Organization’s Age-Friendly Communities that support aging in place. In particular, ACL 

recognizes housing as an important social determinant of health for older adults and persons with 

disabilities and has worked with the Department of Housing and Urban Development (HUD) on 

several initiatives. 

ACL is continuing to contribute to the implementation on the Department of Housing and Urban 

Development’s Supportive Services Demonstration for Elderly Households in Assisted 

Multifamily Housing Program in a number of roles. This effort will support a housing-withservices demonstration project for low-income older adults to test service models that can 

demonstrate the potential to delay or avoid the need for institutional long-term care. In addition, 

the model will test and measure the benefit and impact of having on-site service provision by an 

Enhanced Service Coordinator and a Wellness Nurse of services provided by an Enhanced 

Service Coordinator and a Wellness Nurse.

Aging and Disability Resource Centers - H. Rept. 114-274/Page 148 

The Committee recommendation includes $6,119,000 for Aging and Disability Resource Centers 

[ADRCs]. These centers provide information, one-on-one counseling, and access for individuals 

to learn about their long-term services and support options with the goal of allowing seniors and 

individuals with disabilities to maintain their independence. The Committee urges ACL to 

improve coordination among ADRCs, area agencies on aging, and centers for independent living 

to ensure that there is ‘‘no wrong door’’ to access services. 

Action Taken or To Be Taken: The ADRC program is dedicated to expanding the use of “no 

wrong door” modeled after the NWD System Key Elements, which require full participation of 

AAAs, ADRCs and CILs. As part of ACL’s efforts, ACL has developed the first national 

training program for Person Centered Thinking, Planning and Practice which provides consisting 

training across aging and disability organizations; enhanced collaboration between HHS and the 

Veteran’s Health Administration through the creation of the ADRC/NWD system and 

implementation of the Veteran Directed HCBS program; partnered with the National Council for 

Independent Living to provide technical assistance to States that are implementing “no wrong 

door” systems to ensure full participation of AAAs, ADRCs, CILs; and required in all current 

NWD System Funding Opportunities that each state agency that represents AAAs, ADRCs and 

CILs be included in any NWD System Governing Body.
SIGNIFICANT ITEMS IN APPROPRIATION COMMITTEE REPORTS 

242

State Health Insurance Assistance Program - H. Rept. 114-274/Page 148 

Due to budget constraints, the Committee recommendation does not include funding for the State 

Health Insurance assistance Program. The Committee expects ACL, in coordination with CMS 

and States, to continue to provide accurate and understandable health insurance information to 

Medicare beneficiaries and their families through existing HHS programs that support these 

activities. 

Action Taken or To Be Taken: While ACL will reduce the scale of its one-on-one person 

assistance through the State Health Insurance Assistance Program, Medicare beneficiaries will 

continue to have access to online tools such as Plan Finder and phone assistance such as CMS’s 

1-800-MEDICARE helpline. Some states also support SHIP programs. The FY 2018 Budget 

reduces funding for SHIPs by $52 million. Funding specifically targeted to low-income seniors 

and seniors living in rural areas is maintained at $12 million.