State Unit on Aging Directors Letter #01-2021 

TO: State Unit on Aging Directors

FROM: Alison Barkoff

Acting Assistant Secretary for Aging

DATE: August 5, 2021 

SUBJECT: Guidance for Developing State Plans on Aging 

Purpose

This memorandum replaces State Unit on Aging (SUA) Directors Letter #02-2019 and serves 

as a guide for any new state plan taking effect on or after October 1, 2022. The guidance 

within this memorandum reflects changes to the Older Americans Act (OAA) as codified 

through the Supporting Older Americans Act of 2020 (P.L. 116-131). This legislation 

reauthorized the OAA and its programs from federal fiscal year (FFY) 2020 through 

2024. This guidance is also consistent with current Administration priorities as reflected in 

various Presidential Executive Orders and other priority-setting documents. 

Background

Congress originally passed the OAA in 1965 in response to concerns by policymakers about a 

lack of community social services for older persons. The original legislation established 

authority for grants to states for community planning and social services, research and 

development projects, and personnel training in the field of aging. The OAA also provides the 

foundation for the National Aging Network, which includes the Administration on Aging 

(AoA), State Units on Aging (SUA), Area Agencies on Aging (AAA), tribal organizations, 

service providers and volunteers. 

SUAs, an integral part of the network, are the designated agencies responsible for developing 

and administering a multi-year State Plan on aging that provides goals and objectives related to 

assisting older residents, their families, and caregivers. Additionally, the State Plan: 

• Documents the tangible outcomes expected from state long-term care reform efforts;

• Translates activities, data, and outcomes into proven best practices, which can be used to

leverage additional funding;

• Provides a blueprint for coordination and advocacy activities the state will undertake to

meet the needs of older adults, including integrating health and social services delivery

systems; and

• Builds capacity for long-term care efforts in the state.
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The Supporting Older Americans Act of 2020 reauthorized the OAA with an emphasis on 

addressing the impacts of social isolation, caregiving, malnutrition, and other key priorities. In 

this guidance you will find information on specific changes that were made, as well as 

information on priority areas added by the law. 

In the time since passage of the Supporting Older Americans Act of 2020, the COVID-19 

pandemic has caused significant disruptions in operations and programs for the aging network. 

In response, the network has been provided significant flexibilities through actions taken by 

the federal executive and congressional branches and received a substantial influx of 

supplemental funding to meet the dramatically increased needs of older adults. As you 

formulate your State Plans, ACL encourages states to keep in mind the impacts of COVID-19 

on the aging network, temporary flexibilities that may come to an end during the period of the 

State Plan and project periods of various supplemental funding that have been provided to 

states. 

In addition, the Biden Administration has articulated four key priorities that are guiding ACL’s 

work: COVID-19 recovery, advancing equity, expanding access to home and community-based 

services (HCBS), and building a caregiving infrastructure - which includes support for both paid 

and unpaid caregivers. 

As you develop your State Plan, ACL encourages you to include information about how the state 

will continue to address the ongoing effects of the COVID-19 pandemic. For example, you may 

wish to discuss how the state is: assisting the network with re-opening of in-person services; 

preparing for situations that may require temporary closure or partial closure of resumed inperson services; ensuring that all older adults have access to vaccinations; continuing virtual 

programming that proved as efficacious as in-person programming while increasing access for 

individuals with transportation and mobility concerns; addressing the social isolation and the 

mental and physical health ramifications of the pandemic for older adults; and other key 

priorities. Additionally, states should discuss their long-term preparedness planning for future 

public health emergencies and should address lessons learned from the COVID-19 pandemic that 

have informed their planning for other emergencies. To the extent possible, please also provide 

data on the number and types of people and organizations that will be targeted for such efforts 

and the measures that you will use to determine if these efforts have been successful. For 

example, if you are able to determine how many and what percentage of people that you would 

normally serve are still receiving services, how many are receiving virtual services, and how 

many of the people served are new clients who started receiving services during the pandemic. 

Other examples may include if you are able to determine changes in the percentages of those 

served who are at increased nutrition risk and/or risk for social isolation and/or have been 

assessed as having worse physical or mental health outcomes (e.g., more limitations in 

ADLs/IADLs; depression, loneliness). 

Ensuring equity in OAA funded services is not new for the aging network. The OAA has long 

required that funding be targeted to those with the “greatest social need,” and ACL’s past 

guidance has stated: 
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While the definition of “greatest social need” in the Older Americans Act includes 

isolation caused by racial or ethnic status, the definition is not intended to exclude the 

targeting of other populations that experience cultural, social or geographic isolation 

due to other factors. In some communities, such isolation may be caused by minority 

religious affiliation. In others, isolation due to sexual orientation or gender identity 

may restrict a person’s ability to perform normal daily tasks or live independently. 

Each planning and service area must assess their particular environment to determine 

those populations best targeted based on “greatest social need.” 

As you develop your State Plans, ACL encourages states and AAAs to take a broad approach 

to ensuring services are reaching older adults in greatest social need in line with recent 

Executive Orders by President Biden. These populations include: individuals who are Black, 

Latino, and Indigenous and Native American persons, Asian Americans and Pacific Islanders, 

and other persons of color; members of religious minorities; lesbian, gay, bisexual, 

transgender, and queer (LGBTQ+) persons; persons with disabilities; and persons who live in 

rural areas. 

The OAA reauthorization continued the requirement to target funding to those in greatest 

economic need (those with income at or below the poverty line) and explicitly notes that 

individuals with limited English proficiency are among those who may fall into both 

categories of greatest economic and greatest social need. The OAA also requires that State 

Plans provide assurances that AAAs will conduct efforts to facilitate the coordination of

community-based, long-term care services, for older individuals who are at risk of 

institutionalization. To the extent possible, states should describe how greatest economic and 

social need are determined, the number and percentage of such individuals in the state and the 

data sources used for this determination, and the number and percentage of such individuals 

receiving OAA services. 

COVID-19 has created a new national momentum toward addressing the Medicaid 

institutional bias, and there is a new focus on both disrupting the hospital-to-nursing home 

pipeline and helping people who live in institutions to return to living in the community. The 

availability of HCBS is fundamental to making it possible for older adults to age in place and 

achieving those goals. 

Ensuring access to HCBS is intrinsic to nearly all of the programs funded through the OAA, 

and the aging network is known for its continuous efforts to improve the quality and 

availability of HCBS . In their state plans, ACL encourages states to describe how they are 

building HCBS capacity and improving program quality through innovation, partnerships with 

other state and local agencies, community-based organizations (both within and outside the 

aging network), and other efforts that focus on ensuring older adults can live where they 

choose, with the people they choose, and with the ability to participate fully in their 

communities. 

Finally, ACL encourages states to address the needs of formal and informal caregivers and 

strengthening the direct care workforce. As states plan for use of funding for the National 
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Family Caregiver Support Program, they are encouraged to build off the key findings from the 

RAISE Family Caregiving Advisory Council and other national efforts.

Action Requested

States (through the SUA) may elect to develop a new State Plan for a two, three or four-year 

period. This guidance applies to new plans that will take effect on or after October 1, 2022. 

New State Plans are due to the appropriate ACL Regional Administrator on July 1 of the year in 

which they begin. In order to ensure a successful State Plan submission, states are strongly 

encouraged to work closely with their ACL Regional Administrator throughout State Plan

development including providing at least one complete draft of the plan prior to June 1. SUAs 

must use this updated guidance when creating new State Plans. 

State Plan Content

In order to facilitate a timely review of the State Plan, please provide a table of contents with page 

numbers. Please include the following sections: 

• Signed Verification of Intent page;

• Narrative; and

• Attachments A-C. 

Signed Verification of Intent Page from State Governor or Designee: 

The State Plan must be signed by the governor or the individual (designee) to whom the 

governor has granted signatory authority. If the plan is signed by a designee, please include 

documentation of designation. 

Narrative: 

The narrative portion of the State Plan should be no more than 30 pages. To stay within this 

maximum, the state may wish to submit lengthy survey information, demographics, etc., as 

separate attachments. The narrative should clearly address the following areas:

1. Executive Summary (3 pages) – The executive summary should stand alone in 

summarizing the state’s planned efforts on behalf of older individuals over the State 

Plan cycle. A well-written summary can aid the state in educating the public, 

lawmakers, and other agencies and can assist in securing additional resources.

2. Context – The context sets the stage for the State Plan and describes the issues 

addressed in the remainder of the document. A summary of needs assessment 

activities undertaken by the state, as well as the findings of such activities, should be 

included here. This should include the methods used to conduct the needs 

assessment, data showing the representativeness of the data collected, and how those 

data were used to guide plan development. Needs assessment findings should 
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correspond to the outlined goals and objectives in “4” below. Indicate how your state 

solicited input for development of the plan, e.g., public hearings, surveys, website, 

etc.

3. Quality Management – Quality management of service programs encompasses three 

functions: data collection to assess ongoing program implementation, remediation of 

problem areas, and continuous improvement. An ideal way to achieve this is to 

include information about the level and frequency of services provided; the number 

and percentages of different demographic groups of people and organizations 

receiving services, along with the percentage of overall population and the percentage 

of people with the greatest economic and social need formed by each demographic 

group; and documentation of program quality (e.g., status as an evidence-based 

program). Describe any quality management activities the state will undertake during 

the State Plan cycle. 

4. Goals, Objectives, Strategies, and Outcomes – Goals are visionary statements that 

describe the strategic direction in which the state is moving. Objectives are the 

attainable, specific, and measurable steps the state will take to achieve its goals. 

Strategies outline how the state will achieve the goals and objectives. Outcomes 

document the measurable benefit older individuals should derive from the State Plan

goals, objectives and strategies. To the extent possible, outcome measures should 

include short-, intermediate-, and long-term outcomes: 

• Short-term outcomes typically include improvements in knowledge, awareness, or 

perceptions (such as increased knowledge about the benefits of exercise or 

increased awareness of residents’ rights among staff at long-term care facilities). 

• Intermediate outcomes typically include changes in behaviors, policies or 

processes (such as eating a healthier diet or better coordination of services). 

• Long term outcomes should reflect the goals of the OAA and/or specific programs 

(such as individuals who receive OAA services being able to remain in the 

community longer). 

States should have at least one goal, objective, strategy, and outcome measure for 

each key topic.

State Plan Key Topic Areas: 

State Plans must include measurable objectives that address State Plan requirements within each 

topic area below that is applicable to your state. In developing objectives, consider the role these 

topic areas serve in optimizing the state’s long-term services and supports system (LTSS) for 

older adults and their caregivers. 
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Older Americans Act (OAA) Core Programs Topic Area

Overview OAA core programs are found in Titles III (Supportive Services, Nutrition, 

Disease Prevention/Health Promotion and Caregiver Programs), VI (Native 

American Programs), and VII (Elder Rights Programs) and serve as the 

foundation of the national aging services network. All core programs must be 

addressed in the State Plan.

Areas to 

Address 

Describe plans and include objectives and the measures (data elements and 

sources) that you will use to demonstrate your progress towards: 

o Coordinating Title III programs with Title VI Native American 

programs (Sec. 307(a)(21)); 

o Ensuring incorporation of the new purpose of nutrition programming

to include addressing malnutrition (Sec. 330); 

o Preventing, detecting, assessing, intervening, and/or investigating elder 

abuse, neglect, and financial exploitation (Sec. 721(a)); 

o Supporting and enhancing multi-disciplinary responses to elder abuse, 

neglect and exploitation involving adult protective services, LTC 

ombudsman programs, legal assistance programs, law enforcement, 

health care professionals, financial institutions, and other essential 

partners across the state (Sec. 721(b)(10)(C)(v));

o Age and dementia friendly efforts (Sec. 201(f)(2));

o Screening for fall related TBI (Sec. 321(a)(8)); 

o Strengthening and/or expanding Title III & VII services; 

o Improving coordination between the Senior Community Service 

Employment Program (SCSEP) and other OAA programs; and

o Integrating core programs with ACL’s non-formula based grant 

programs.
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COVID-19 Topic Area 

Overview COVID-19 highlighted the overall importance of the services that make it 

possible for older adults to live independently, created a national awareness of the 

impact of social isolation on older adults and caregivers, and increased awareness 

of the need to plan for future disasters. It also transformed the aging network; 

drove rapid innovation and creation of new approaches that will endure beyond 

recovery; and increased awareness of the need to plan for future disasters. 

Finally, Congress provided significant increases in funding some of which remain 

available until expended. 

Areas to 

Address 

Describe plans and include objectives and the measures (data elements and 

sources) that you will use to demonstrate your progress towards: 

o Educating about the prevention of, detection of, and response to negative 

health effects associated with social isolation (Sec. 321(a)(8)); 

o Dissemination of information about state assistive technology entity and 

access to assistive technology options for serving older individuals (Sec. 

321(a)(11));

o Providing trauma-informed services (Sec. 102(41)); 

o Screening for suicide risk (Sec. 102(14)(G)); 

o Inclusion of screening of immunization status and infectious disease and 

vaccine-preventable disease as part of evidence-based health promotion 

programs (Sec. 102(14)(B) and (D)); 

o Providing services that are part of a public health emergency/emerging 

health threat and emergency preparedness (Sec. 307(a)(28) and (29)). 

o Expending American Rescue Plan funding and any other COVID-19 

supplemental funding still available for expenditure; and 

o Incorporating innovative practices developed during the pandemic that 

increased access to services particularly for those with mobility and 

transportation issues as well as those in rural areas.
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Equity Topic Area

Overview Serving individuals with the greatest economic and social need means ensuring 

equity in all aspects of plan administration. The State Plan should address 

activities to support these goals. 

Areas to 

Address 

Describe plans and include objectives and the measures (data elements and 

sources) that you will use to demonstrate your progress towards: 

o Determining services needed and effectiveness of programs, policies and 

services for older individuals whose needs were the focus of all centers 

funded under title IV in fiscal year 2019 (Sec. 307(a)(30)(A)) 1; 

o Engagement in outreach with older individuals whose needs were the 

focus of all centers funded under title IV in fiscal year 2019 (Sec. 

307(a)(30)(C)); 

o Impacting social determinants of health of older individuals (Sec. 

301(a)(1)(E)); 

o Ensuring meals can be adjusted for cultural considerations and preferences 

and providing medically tailored meals to the maximum extent practicable 

(Sec. 339(2)(A)(iii); 

o Preparing, publishing, and disseminating educational materials dealing 

with the health and economic welfare of older individuals (Sec. 202(a)(7)); 

o Supporting cultural experiences, activities, and services, including in the 

arts (Sec. 202(a)(5)); 

o Serving older adults living with HIV/AIDS; and

o Supporting participant-directed/person-centered planning for older adults 

and their caregivers across the spectrum of LTSS, including home, 

community, and institutional settings.

1 In 2019, ACL/AoA funded via Title IV the National Resource Centers on Native American Elders which provides 

research and technical information on health, long-term services and supports, elder abuse, mental health, and other 

issues relevant to older Native Americans as well as National Minority Aging Organizations Technical Assistance 

Centers that provide culturally and linguistically appropriate information on health promotion and disease 

prevention for Asian-Pacific American, Native American, Hispanic, and African-American older individuals, and

older lesbian, gay, bisexual, and transgender (LGBT) persons. See “Older Americans Act: Overview and Funding,” 

updated April 22,2020, available at: 

https://www.everycrsreport.com/files/20200422_R43414_8da38be015ac48bc094fd22d8baf9b8c00e21f34.pdf. 
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Expanding Access to HCBS Topic Area

Overview HCBS are fundamental to making it possible for older adults to age in place.

Areas to 

Address 

Describe plans and include objectives and the measures (data elements and 

sources) that you will use to demonstrate your progress towards: 

o Securing the opportunity for older individuals to receive managed inhome and community-based long-term care services (Sec. 301(a)(2)(D));

o Promoting the development and implementation of a state system of longterm care that is a comprehensive, coordinated system that enables older 

individuals to receive long-term care in home and community-based 

settings, in a manner responsive to the needs and preferences of the older 

individuals and their family caregivers (Sec. 305(a)(3));

o Ensuring that area agencies on aging will conduct efforts to facilitate the 

coordination of community-based, long-term care services for older 

individuals who: reside at home and are at risk of institutionalization 

because of limitations on their ability to function independently; are 

patients in hospitals and are at risk of prolonged institutionalization; or are 

patients in long-term care facilities, but who can return to their homes if 

community-based services are provided to them (sec. 307(a)(18(A)-(C));

o Working towards the integration of health, health care and social services 

systems, including efforts through contractual arrangements; and 

o Incorporating aging network services with HCBS funded by other entities 

such as Medicaid. 

Caregiving Topic Area

Overview Enhancing services and supports for caregivers.

Areas to 

Address 

Describe plans and include objectives and the measures (data elements and 

sources) that you will use to demonstrate your progress towards: 

o Documenting best practices related to caregiver support (Sec. 373(e)(1)); 

o Strengthening and supporting the direct care workforce (Sec. 411(a)(13))

o Implementing recommendations from the RAISE Family Caregiver 

Advisory Council; 

o Coordinating Title III caregiving efforts with the Lifespan Respite Care 

program; and 

o Coordinating with the National Technical Assistance Center on 

Grandfamilies and Kinship Families.
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Intrastate Funding Formula (IFF): 

IFF with no changes during this State Plan cycle

Each new State Plan submission must include a copy of the state’s current IFF and must include 

the required information set forth in Attachment C. 

NOTE: Single Planning and Service Areas are not required to distribute funds using an IFF. 

Single PSA State Plans must include a descriptive statement as to how the state determines the 

geographical distribution of the Title III funding and as to how the state targets the funding so 

that it reaches individuals with greatest economic and social need, with particular attention to 

low-income minority older individuals.

Revised IFFs during this State Plan cycle

Any revisions to the IFF must be clearly indicated and take into consideration the statutory 

requirements listed in Attachment C, Intrastate Funding Formula Requirements. Any change to 

IFF factors or weights requires approval by the Assistant Secretary for Aging. States must 

submit IFF revisions that do not coincide with a new State Plan submittal as a State Plan

amendment. Attachment C to this memo, Intrastate Funding Formula (IFF) Requirements, is a 

guide to the development of new or revised IFFs. 
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Attachments to the State Plan document: 

The number and type of State Plan attachments will vary from state to state; however, every State 

Plan must include Attachment A, State Plan Assurances and Activities, as well as Attachment B, 

Information Requirements. Other attachments to the plan could include demographic data, needs 

analysis, special initiatives, etc. In order to facilitate review of IFFs, please include your State 

IFF as Attachment C as part of the State Plan.

Attachment A – State Plan Assurances and Required Activities includes statutory 

assurances and activities related to the development/implementation of State Plans. It must 

be reviewed, signed (by the SUA director) and included as part of the State Plan. In 

addition, documentation of how the state will address each assurance must be maintained at the 

state and made available for review by ACL, as requested and appropriate. 

Attachment B – Information Requirements includes specific information requirements related 

to development/implementation of the State Plan. The state’s detailed responses to these 

requirements must be listed within the Attachment and submitted as part of the State Plan. 

Attachment C – IFF Requirements is a guide to the development of new or revised IFFs 

(provided for informational purposes) and also contains requirements applicable to all IFFs 

(including those to which no changes are being made). 

STATE PLAN RESOURCES

ACL National Resource Centers: 

https://acl.gov/node/2884

• SAGE Aging Network Planning Tools: 

https://www.lgbtagingcenter.org/resources/resources.cfm?s=36 

ADvancing States Tools for Planning: 

http://www.advancingstates.org/state-technical-assistance/tools-planning

ACL Regional Administrators:

https://acl.gov/about-acl/regional-offices
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State Plan Guidance Attachment A 

STATE PLAN ASSURANCES AND REQUIRED ACTIVITIES 

Older Americans Act, As Amended in 2020

By signing this document, the authorized official commits the State Agency on Aging to 

performing all listed assurances and activities as stipulated in the Older Americans Act, as 

amended in 2020. 

Sec. 305, ORGANIZATION

(a) In order for a State to be eligible to participate in programs of grants to States from allotments 

under this title—. . . 

 (2) The State agency shall— 

(A) except as provided in subsection (b)(5), designate for each such area after 

consideration of the views offered by the unit or units of general purpose local 

government in such area, a public or private nonprofit agency or organization as the area 

agency on aging for such area; 

(B) provide assurances, satisfactory to the Assistant Secretary, that the State agency will 

take into account, in connection with matters of general policy arising in the development 

and administration of the State plan for any fiscal year, the views of recipients of 

supportive services or nutrition services, or individuals using multipurpose senior centers 

provided under such plan; . . . 

(E) provide assurance that preference will be given to providing services to older 

individuals with greatest economic need and older individuals with greatest social need 

(with particular attention to low-income older individuals, including low-income minority 

older individuals, older individuals with limited English proficiency, and older 

individuals residing in rural areas), and include proposed methods of carrying out the 

preference in the State plan;

(F) provide assurances that the State agency will require use of outreach efforts described 

in section 307(a)(16); and 

(G)

(i) set specific objectives, in consultation with area agencies on aging, for each 

planning and service area for providing services funded under this title to low-income 

minority older individuals and older individuals residing in rural areas;
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(ii) provide an assurance that the State agency will undertake specific program 

development, advocacy, and outreach efforts focused on the needs of low-income 

minority older individuals; 

(iii) provide a description of the efforts described in clause (ii) that will be 

undertaken by the State agency; . . . 

(c) An area agency on aging designated under subsection (a) shall be—... 

 (5) in the case of a State specified in subsection (b)(5), the State agency; 

and shall provide assurance, determined adequate by the State agency, that the area agency on 

aging will have the ability to develop an area plan and to carry out, directly or through 

contractual or other arrangements, a program in accordance with the plan within the planning and 

service area. In designating an area agency on aging within the planning and service area or 

within any unit of general purpose local government designated as a planning and service area 

the State shall give preference to an established office on aging, unless the State agency finds 

that no such office within the planning and service area will have the capacity to carry out the 

area plan.

(d) The publication for review and comment required by paragraph (2)(C) of subsection (a) shall 

include— 

(1) a descriptive statement of the formula’s assumptions and goals, and the application of 

the definitions of greatest economic or social need, 

(2) a numerical statement of the actual funding formula to be used,

(3) a listing of the population, economic, and social data to be used for each planning and 

service area in the State, and

(4) a demonstration of the allocation of funds, pursuant to the funding formula, to each 

planning and service area in the State.

Note: States must ensure that the following assurances (Section 306) will be met by its 

designated area agencies on agencies, or by the State in the case of single planning and service 

area states.

Sec. 306, AREA PLANS 

 (a) Each area agency on aging designated under section 305(a)(2)(A) shall, in order to be 

approved by the State agency, prepare and develop an area plan for a planning and service area 

for a two-, three-, or four-year period determined by the State agency, with such annual 
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adjustments as may be necessary. Each such plan shall be based upon a uniform format for area 

plans within the State prepared in accordance with section 307(a)(1). Each such plan shall— 

 (1) provide, through a comprehensive and coordinated system, for supportive services, nutrition 

services, and, where appropriate, for the establishment, maintenance, modernization, or 

construction of multipurpose senior centers (including a plan to use the skills and services of 

older individuals in paid and unpaid work, including multigenerational and older individual to 

older individual work), within the planning and service area covered by the plan, including 

determining the extent of need for supportive services, nutrition services, and multipurpose 

senior centers in such area (taking into consideration, among other things, the number of older 

individuals with low incomes residing in such area, the number of older individuals who have 

greatest economic need (with particular attention to low-income older individuals, including lowincome minority older individuals, older individuals with limited English proficiency, and older 

individuals residing in rural areas) residing in such area, the number of older individuals who 

have greatest social need (with particular attention to low-income older individuals, including 

low-income minority older individuals, older individuals with limited English proficiency, and 

older individuals residing in rural areas) residing in such area, the number of older individuals at 

risk for institutional placement residing in such area, and the number of older individuals who 

are Indians residing in such area, and the efforts of voluntary organizations in the community), 

evaluating the effectiveness of the use of resources in meeting such need, and entering into 

agreements with providers of supportive services, nutrition services, or multipurpose senior 

centers in such area, for the provision of such services or centers to meet such need;

 (2) provide assurances that an adequate proportion, as required under section 307(a)(2), of the 

amount allotted for part B to the planning and service area will be expended for the delivery of 

each of the following categories of services— 

(A) services associated with access to services (transportation, health services (including 

mental and behavioral health services), outreach, information and assistance (which may 

include information and assistance to consumers on availability of services under part B 

and how to receive benefits under and participate in publicly supported programs for 

which the consumer may be eligible) and case management services);

(B) in-home services, including supportive services for families of older individuals with 

Alzheimer's disease and related disorders with neurological and organic brain 

dysfunction; and 

(C) legal assistance; 

and assurances that the area agency on aging will report annually to the State agency in detail the 

amount of funds expended for each such category during the fiscal year most recently concluded; 

 (3) (A) designate, where feasible, a focal point for comprehensive service delivery in each 

community, giving special consideration to designating multipurpose senior centers (including 

multipurpose senior centers operated by organizations referred to in paragraph (6)(C)) as such 

focal point; and
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(B) specify, in grants, contracts, and agreements implementing the plan, the identity of 

each focal point so designated; 

 (4) (A)

(i)

(I) provide assurances that the area agency on aging will— 

(aa) set specific objectives, consistent with State policy, for 

providing services to older individuals with greatest economic 

need, older individuals with greatest social need, and older 

individuals at risk for institutional placement;

(bb) include specific objectives for providing services to lowincome minority older individuals, older individuals with limited 

English proficiency, and older individuals residing in rural areas; 

and 

 (II) include proposed methods to achieve the objectives described in items 

(aa) and (bb) of sub-clause (I);

 (ii) provide assurances that the area agency on aging will include in each 

agreement made with a provider of any service under this title, a requirement that such provider 

will— 

(I) specify how the provider intends to satisfy the service needs of lowincome minority individuals, older individuals with limited English 

proficiency, and older individuals residing in rural areas in the area served 

by the provider; 

(II) to the maximum extent feasible, provide services to low-income 

minority individuals, older individuals with limited English proficiency, 

and older individuals residing in rural areas in accordance with their need 

for such services; and

(III) meet specific objectives established by the area agency on aging, for 

providing services to low-income minority individuals, older individuals 

with limited English proficiency, and older individuals residing in rural 

areas within the planning and service area; and

 (iii) with respect to the fiscal year preceding the fiscal year for which such plan is 

prepared — 

(I) identify the number of low-income minority older individuals in the 

planning and service area; 

(II) describe the methods used to satisfy the service needs of such minority 

older individuals; and
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(III) provide information on the extent to which the area agency on aging 

met the objectives described in clause (i). 

(B) provide assurances that the area agency on aging will use outreach efforts that will— 

(i) identify individuals eligible for assistance under this Act, with special 

emphasis on— 

(I) older individuals residing in rural areas;

(II) older individuals with greatest economic need (with particular 

attention to low-income minority individuals and older individuals 

residing in rural areas);

(III) older individuals with greatest social need (with particular attention to 

low-income minority individuals and older individuals residing in rural 

areas);

(IV) older individuals with severe disabilities;

(V) older individuals with limited English proficiency; 

(VI) older individuals with Alzheimer’s disease and related disorders with 

neurological and organic brain dysfunction (and the caretakers of such 

individuals); and 

(VII) older individuals at risk for institutional placement, specifically 

including survivors of the Holocaust; and 

(ii) inform the older individuals referred to in sub-clauses (I) through (VII) of 

clause (i), and the caretakers of such individuals, of the availability of such 

assistance; and

(C) contain an assurance that the area agency on aging will ensure that each activity 

undertaken by the agency, including planning, advocacy, and systems development, will 

include a focus on the needs of low-income minority older individuals and older 

individuals residing in rural areas. 

 (5) provide assurances that the area agency on aging will coordinate planning, identification, 

assessment of needs, and provision of services for older individuals with disabilities, with 

particular attention to individuals with severe disabilities, and individuals at risk for institutional 

placement, with agencies that develop or provide services for individuals with disabilities; 

 (6) provide that the area agency on aging will— 

(A) take into account in connection with matters of general policy arising in the 

development and administration of the area plan, the views of recipients of services under 

such plan; 
17 

(B) serve as the advocate and focal point for older individuals within the community by 

(in cooperation with agencies, organizations, and individuals participating in activities 

under the plan) monitoring, evaluating, and commenting upon all policies, programs, 

hearings, levies, and community actions which will affect older individuals; 

(C) (i) where possible, enter into arrangements with organizations providing day care 

services for children, assistance to older individuals caring for relatives who are children, 

and respite for families, so as to provide opportunities for older individuals to aid or assist 

on a voluntary basis in the delivery of such services to children, adults, and families;

(ii) if possible regarding the provision of services under this title, enter into 

arrangements and coordinate with organizations that have a proven record of 

providing services to older individuals, that— 

(I) were officially designated as community action agencies or community 

action programs under section 210 of the Economic Opportunity Act of 

1964 (42U.S.C. 2790) for fiscal year 1981, and did not lose the 

designation as a result of failure to comply with such Act; or

(II) came into existence during fiscal year 1982 as direct successors in 

interest to such community action agencies or community action 

programs; 

and that meet the requirements under section 676B of the Community Services 

Block Grant Act; and 

(iii) make use of trained volunteers in providing direct services delivered to older 

individuals and individuals with disabilities needing such services and, if possible, 

work in coordination with organizations that have experience in providing 

training, placement, and stipends for volunteers or participants (such as 

organizations carrying out Federal service programs administered by the 

Corporation for National and Community Service), in community service settings;

(D) establish an advisory council consisting of older individuals (including minority 

individuals and older individuals residing in rural areas) who are participants or who are 

eligible to participate in programs assisted under this Act, family caregivers of such 

individuals, representatives of older individuals, service providers, representatives of the 

business community, local elected officials, providers of veterans’ health care (if 

appropriate), and the general public, to advise continuously the area agency on aging on 

all matters relating to the development of the area plan, the administration of the plan and 

operations conducted under the plan; 

(E) establish effective and efficient procedures for coordination of— 

(i) entities conducting programs that receive assistance under this Act within the 

planning and service area served by the agency; and 
18 

(ii) entities conducting other Federal programs for older individuals at the local 

level, with particular emphasis on entities conducting programs described in 

section 203(b), within the area; 

(F) in coordination with the State agency and with the State agency responsible for 

mental and behavioral health services, increase public awareness of mental health 

disorders, remove barriers to diagnosis and treatment, and coordinate mental and 

behavioral health services (including mental health screenings) provided with funds 

expended by the area agency on aging with mental and behavioral health services 

provided by community health centers and by other public agencies and nonprofit private 

organizations; 

(G) if there is a significant population of older individuals who are Indians in the 

planning and service area of the area agency on aging, the area agency on aging shall 

conduct outreach activities to identify such individuals in such area and shall inform such 

individuals of the availability of assistance under this Act;

(H) in coordination with the State agency and with the State agency responsible for elder 

abuse prevention services, increase public awareness of elder abuse, neglect, and 

exploitation, and remove barriers to education, prevention, investigation, and treatment of 

elder abuse, neglect, and exploitation, as appropriate; and

(I) to the extent feasible, coordinate with the State agency to disseminate information 

about the State assistive technology entity and access to assistive technology options for 

serving older individuals; 

 (7) provide that the area agency on aging shall, consistent with this section, facilitate the 

areawide development and implementation of a comprehensive, coordinated system for 

providing long-term care in home and community-based settings, in a manner responsive to the 

needs and preferences of older individuals and their family caregivers, by— 

(A) collaborating, coordinating activities, and consulting with other local public and 

private agencies and organizations responsible for administering programs, benefits, and 

services related to providing long-term care;

(B) conducting analyses and making recommendations with respect to strategies for 

modifying the local system of long-term care to better— 

(i) respond to the needs and preferences of older individuals and family 

caregivers;

(ii) facilitate the provision, by service providers, of long-term care in home and 

community-based settings; and 

(iii) target services to older individuals at risk for institutional placement, to 

permit such individuals to remain in home and community-based settings; 

(C) implementing, through the agency or service providers, evidence-based programs to 

assist older individuals and their family caregivers in learning about and making 
19 

behavioral changes intended to reduce the risk of injury, disease, and disability among 

older individuals; and

(D) providing for the availability and distribution (through public education campaigns, 

Aging and Disability Resource Centers, the area agency on aging itself, and other 

appropriate means) of information relating to— 

(i) the need to plan in advance for long-term care; and

(ii) the full range of available public and private long-term care (including 

integrated long-term care) programs, options, service providers, and resources; 

 (8) provide that case management services provided under this title through the area agency on 

aging will— 

(A) not duplicate case management services provided through other Federal and State 

programs; 

(B) be coordinated with services described in subparagraph (A); and 

(C) be provided by a public agency or a nonprofit private agency that— 

(i) gives each older individual seeking services under this title a list of agencies 

that provide similar services within the jurisdiction of the area agency on aging;

(ii) gives each individual described in clause (i) a statement specifying that the 

individual has a right to make an independent choice of service providers and 

documents receipt by such individual of such statement; 

(iii) has case managers acting as agents for the individuals receiving the services 

and not as promoters for the agency providing such services; or

(iv) is located in a rural area and obtains a waiver of the requirements described in 

clauses (i) through (iii);

 (9) (A) provide assurances that the area agency on aging, in carrying out the State 

Long-Term Care Ombudsman program under section 307(a)(9), will expend not less than the 

total amount of funds appropriated under this Act and expended by the agency in fiscal year 

2019 in carrying out such a program under this title; 

(B) funds made available to the area agency on aging pursuant to section 712 shall be 

used to supplement and not supplant other Federal, State, and local funds expended to 

support activities described in section 712; 

 (10) provide a grievance procedure for older individuals who are dissatisfied with or denied 

services under this title;

 (11) provide information and assurances concerning services to older individuals who are 

Native Americans (referred to in this paragraph as "older Native Americans"), including— 
20 

(A) information concerning whether there is a significant population of older Native 

Americans in the planning and service area and if so, an assurance that the area agency on aging 

will pursue activities, including outreach, to increase access of those older Native Americans to 

programs and benefits provided under this title; 

(B) an assurance that the area agency on aging will, to the maximum extent practicable, 

coordinate the services the agency provides under this title with services provided under 

title VI; and 

(C) an assurance that the area agency on aging will make services under the area plan 

available, to the same extent as such services are available to older individuals within the 

planning and service area, to older Native Americans; 

 (12) provide that the area agency on aging will establish procedures for coordination of services 

with entities conducting other Federal or federally assisted programs for older individuals at the 

local level, with particular emphasis on entities conducting programs described in section 203(b) 

within the planning and service area.

 (13) provide assurances that the area agency on aging will— 

(A) maintain the integrity and public purpose of services provided, and service providers, 

under this title in all contractual and commercial relationships; 

(B) disclose to the Assistant Secretary and the State agency— 

(i) the identity of each nongovernmental entity with which such agency has a 

contract or commercial relationship relating to providing any service to older 

individuals; and

(ii) the nature of such contract or such relationship; 

(C) demonstrate that a loss or diminution in the quantity or quality of the services 

provided, or to be provided, under this title by such agency has not resulted and will not 

result from such contract or such relationship; 

(D) demonstrate that the quantity or quality of the services to be provided under this title 

by such agency will be enhanced as a result of such contract or such relationship; and 

(E) on the request of the Assistant Secretary or the State, for the purpose of monitoring 

compliance with this Act (including conducting an audit), disclose all sources and 

expenditures of funds such agency receives or expends to provide services to older 

individuals; 

 (14) provide assurances that preference in receiving services under this title will not be given by 

the area agency on aging to particular older individuals as a result of a contract or commercial 

relationship that is not carried out to implement this title; 

 (15) provide assurances that funds received under this title will be used— 
21 

(A) to provide benefits and services to older individuals, giving priority to older 

individuals identified in paragraph (4)(A)(i); and

(B) in compliance with the assurances specified in paragraph (13) and the limitations 

specified in section 212;

 (16) provide, to the extent feasible, for the furnishing of services under this Act, consistent with 

self-directed care;

 (17) include information detailing how the area agency on aging will coordinate activities, and 

develop long-range emergency preparedness plans, with local and State emergency response 

agencies, relief organizations, local and State governments, and any other institutions that have 

responsibility for disaster relief service delivery;

 (18) provide assurances that the area agency on aging will collect data to determine— 

(A) the services that are needed by older individuals whose needs were the focus of all 

centers funded under title IV in fiscal year 2019; and 

(B) the effectiveness of the programs, policies, and services provided by such area agency 

on aging in assisting such individuals; and 

 (19) provide assurances that the area agency on aging will use outreach efforts that will 

identify individuals eligible for assistance under this Act, with special emphasis on those 

individuals whose needs were the focus of all centers funded under title IV in fiscal year 2019. 

(b)(1) An area agency on aging may include in the area plan an assessment of how prepared the 

area agency on aging and service providers in the planning and service area are for any 

anticipated change in the number of older individuals during the 10-year period following the 

fiscal year for which the plan is submitted. 

 (2) Such assessment may include— 

(A) the projected change in the number of older individuals in the planning and service 

area;

(B) an analysis of how such change may affect such individuals, including individuals 

with low incomes, individuals with greatest economic need, minority older individuals, 

older individuals residing in rural areas, and older individuals with limited English 

proficiency;

(C) an analysis of how the programs, policies, and services provided by such area agency 

can be improved, and how resource levels can be adjusted to meet the needs of the 

changing population of older individuals in the planning and service area; and 

(D) an analysis of how the change in the number of individuals age 85 and older in the 

planning and service area is expected to affect the need for supportive services.
22 

 (3) An area agency on aging, in cooperation with government officials, State agencies, tribal 

organizations, or local entities, may make recommendations to government officials in the 

planning and service area and the State, on actions determined by the area agency to build the 

capacity in the planning and service area to meet the needs of older individuals for— 

(A) health and human services;

(B) land use; 

(C) housing; 

(D) transportation;

(E) public safety;

(F) workforce and economic development; 

(G) recreation;

(H) education;

(I) civic engagement;

(J) emergency preparedness;

(K) protection from elder abuse, neglect, and exploitation; 

(L) assistive technology devices and services; and

(M) any other service as determined by such agency.

(c) Each State, in approving area agency on aging plans under this section, shall waive the 

requirement described in paragraph (2) of subsection (a) for any category of services described in 

such paragraph if the area agency on aging demonstrates to the State agency that services being 

furnished for such category in the area are sufficient to meet the need for such services in such 

area and had conducted a timely public hearing upon request. 

(d)(1) Subject to regulations prescribed by the Assistant Secretary, an area agency on aging 

designated under section 305(a)(2)(A) or, in areas of a State where no such agency has been 

designated, the State agency, may enter into agreement with agencies administering programs 

under the Rehabilitation Act of 1973, and titles XIX and XX of the Social Security Act for the 

purpose of developing and implementing plans for meeting the common need for transportation 

services of individuals receiving benefits under such Acts and older individuals participating in 

programs authorized by this title. 

 (2) In accordance with an agreement entered into under paragraph (1), funds appropriated under 

this title may be used to purchase transportation services for older individuals and may be pooled 
23 

with funds made available for the provision of transportation services under the Rehabilitation 

Act of 1973, and titles XIX and XX of the Social Security Act. 

(e) An area agency on aging may not require any provider of legal assistance under this title to 

reveal any information that is protected by the attorney-client privilege. 

(f)(1) If the head of a State agency finds that an area agency on aging has failed to comply with 

Federal or State laws, including the area plan requirements of this section, regulations, or 

policies, the State may withhold a portion of the funds to the area agency on aging available 

under this title.

 (2) (A) The head of a State agency shall not make a final determination withholding funds 

under paragraph (1) without first affording the area agency on aging due process in accordance 

with procedures established by the State agency. 

(B) At a minimum, such procedures shall include procedures for— 

(i) providing notice of an action to withhold funds; 

(ii) providing documentation of the need for such action; and 

(iii) at the request of the area agency on aging, conducting a public hearing 

concerning the action. 

 (3) (A) If a State agency withholds the funds, the State agency may use the funds withheld to 

directly administer programs under this title in the planning and service area served by the area 

agency on aging for a period not to exceed 180 days, except as provided in subparagraph (B). 

(B) If the State agency determines that the area agency on aging has not taken corrective 

action, or if the State agency does not approve the corrective action, during the 180-day 

period described in subparagraph (A), the State agency may extend the period for not 

more than 90 days. 

(g) Nothing in this Act shall restrict an area agency on aging from providing services not 

provided or authorized by this Act, including through— 

 (1) contracts with health care payers;

 (2) consumer private pay programs; or 

 (3) other arrangements with entities or individuals that increase the availability of home and 

community-based services and supports.

Sec. 307, STATE PLANS
24 

(a) Except as provided in the succeeding sentence and section 309(a), each State, in order to be 

eligible for grants from its allotment under this title for any fiscal year, shall submit to the 

Assistant Secretary a State plan for a two, three, or four-year period determined by the State 

agency, with such annual revisions as are necessary, which meets such criteria as the Assistant 

Secretary may by regulation prescribe. If the Assistant Secretary determines, in the discretion of 

the Assistant Secretary, that a State failed in 2 successive years to comply with the requirements 

under this title, then the State shall submit to the Assistant Secretary a State plan for a 1-year 

period that meets such criteria, for subsequent years until the Assistant Secretary determines that 

the State is in compliance with such requirements. Each such plan shall comply with all of the 

following requirements:

(1) The plan shall— 

(A) require each area agency on aging designated under section 305(a)(2)(A) to develop and 

submit to the State agency for approval, in accordance with a uniform format developed by 

the State agency, an area plan meeting the requirements of section 306; and

(B) be based on such area plans.

(2) The plan shall provide that the State agency will— 

(A) evaluate, using uniform procedures described in section 202(a)(26), the need for 

supportive services (including legal assistance pursuant to 307(a)(11), information and 

assistance, and transportation services), nutrition services, and multipurpose senior centers 

within the State;

(B) develop a standardized process to determine the extent to which public or private 

programs and resources (including volunteers and programs and services of voluntary 

organizations) that have the capacity and actually meet such need; and

(C) specify a minimum proportion of the funds received by each area agency on aging in the 

State to carry out part B that will be expended (in the absence of a waiver under section 

306(c) or 316) by such area agency on aging to provide each of the categories of services 

specified in section 306(a)(2).

(3) The plan shall— 

(A) include (and may not be approved unless the Assistant Secretary approves) the 

statement and demonstration required by paragraphs (2) and (4) of section 305(d) 

(concerning intrastate distribution of funds); and 

(B) with respect to services for older individuals residing in rural areas— 

(i) provide assurances that the State agency will spend for each fiscal year, not 

less than the amount expended for such services for fiscal year 2000...
25 

(ii) identify, for each fiscal year to which the plan applies, the projected costs of 

providing such services (including the cost of providing access to such services); 

and 

(iii) describe the methods used to meet the needs for such services in the fiscal 

year preceding the first year to which such plan applies. 

 (4) The plan shall provide that the State agency will conduct periodic evaluations of, and public 

hearings on, activities and projects carried out in the State under this title and title VII, including 

evaluations of the effectiveness of services provided to individuals with greatest economic need, 

greatest social need, or disabilities (with particular attention to low-income minority older 

individuals, older individuals with limited English proficiency, and older individuals residing in 

rural areas).

 (5) The plan shall provide that the State agency will— 

(A) afford an opportunity for a hearing upon request, in accordance with published 

procedures, to any area agency on aging submitting a plan under this title, to any provider 

of (or applicant to provide) services;

(B) issue guidelines applicable to grievance procedures required by section 306(a)(10); 

and 

(C) afford an opportunity for a public hearing, upon request, by any area agency on 

aging, by any provider of (or applicant to provide) services, or by any recipient of 

services under this title regarding any waiver request, including those under section 316. 

 (6) The plan shall provide that the State agency will make such reports, in such form, and 

containing such information, as the Assistant Secretary may require, and comply with such 

requirements as the Assistant Secretary may impose to insure the correctness of such reports.

 (7) (A) The plan shall provide satisfactory assurance that such fiscal control and fund 

accounting procedures will be adopted as may be necessary to assure proper disbursement of, 

and accounting for, Federal funds paid under this title to the State, including any such funds paid 

to the recipients of a grant or contract. 

(B) The plan shall provide assurances that— 

(i) no individual (appointed or otherwise) involved in the designation of the State 

agency or an area agency on aging, or in the designation of the head of any 

subdivision of the State agency or of an area agency on aging, is subject to a 

conflict of interest prohibited under this Act;

(ii) no officer, employee, or other representative of the State agency or an area 

agency on aging is subject to a conflict of interest prohibited under this Act; and 

(iii) mechanisms are in place to identify and remove conflicts of interest 

prohibited under this Act.
26 

 (8) (A) The plan shall provide that no supportive services, nutrition services, or in-home 

services will be directly provided by the State agency or an area agency on aging in the State, 

unless, in the judgment of the State agency— 

(i) provision of such services by the State agency or the area agency on aging is 

necessary to assure an adequate supply of such services;

(ii) such services are directly related to such State agency’s or area agency on 

aging’s administrative functions; or

(iii) such services can be provided more economically, and with comparable 

quality, by such State agency or area agency on aging. 

(B) Regarding case management services, if the State agency or area agency on aging is 

already providing case management services (as of the date of submission of the plan) 

under a State program, the plan may specify that such agency is allowed to continue to 

provide case management services.

(C) The plan may specify that an area agency on aging is allowed to directly provide 

information and assistance services and outreach.

 (9) The plan shall provide assurances that— 

(A) the State agency will carry out, through the Office of the State Long-Term Care 

Ombudsman, a State Long-Term Care Ombudsman program in accordance with section 

712 and this title, and will expend for such purpose an amount that is not less than an 

amount expended by the State agency with funds received under this title for fiscal year 

2019, and an amount that is not less than the amount expended by the State agency with 

funds received under title VII for fiscal year 2019; and

(B) funds made available to the State agency pursuant to section 712 shall be used to 

supplement and not supplant other Federal, State, and local funds expended to support 

activities described in section 712. 

 (10) The plan shall provide assurances that the special needs of older individuals residing in 

rural areas will be taken into consideration and shall describe how those needs have been met 

and describe how funds have been allocated to meet those needs. 

 (11) The plan shall provide that with respect to legal assistance — 

(A) the plan contains assurances that area agencies on aging will (i) enter into contracts 

with providers of legal assistance which can demonstrate the experience or capacity to deliver 

legal assistance; (ii) include in any such contract provisions to assure that any recipient of funds 

under division (i) will be subject to specific restrictions and regulations promulgated under the 

Legal Services Corporation Act (other than restrictions and regulations governing eligibility for 

legal assistance under such Act and governing membership of local governing boards) as 

determined appropriate by the Assistant Secretary; and (iii) attempt to involve the private bar in 

legal assistance activities authorized under this title, including groups within the private bar 

furnishing services to older individuals on a pro bono and reduced fee basis; 
27 

(B) the plan contains assurances that no legal assistance will be furnished unless the 

grantee administers a program designed to provide legal assistance to older individuals 

with social or economic need and has agreed, if the grantee is not a Legal Services 

Corporation project grantee, to coordinate its services with existing Legal Services 

Corporation projects in the planning and service area in order to concentrate the use of 

funds provided under this title on individuals with the greatest such need; and the area 

agency on aging makes a finding, after assessment, pursuant to standards for service 

promulgated by the Assistant Secretary, that any grantee selected is the entity best able to 

provide the particular services. 

(C) the State agency will provide for the coordination of the furnishing of legal assistance 

to older individuals within the State, and provide advice and technical assistance in the 

provision of legal assistance to older individuals within the State and support the 

furnishing of training and technical assistance for legal assistance for older individuals;

(D) the plan contains assurances, to the extent practicable, that legal assistance furnished 

under the plan will be in addition to any legal assistance for older individuals being 

furnished with funds from sources other than this Act and that reasonable efforts will be 

made to maintain existing levels of legal assistance for older individuals; and

(E) the plan contains assurances that area agencies on aging will give priority to legal 

assistance related to income, health care, long-term care, nutrition, housing, utilities, 

protective services, defense of guardianship, abuse, neglect, and age discrimination. 

 (12) The plan shall provide, whenever the State desires to provide for a fiscal year for services 

for the prevention of abuse of older individuals — 

(A) the plan contains assurances that any area agency on aging carrying out such services 

will conduct a program consistent with relevant State law and coordinated with existing 

State adult protective service activities for— 

(i) public education to identify and prevent abuse of older individuals; 

(ii) receipt of reports of abuse of older individuals; 

(iii) active participation of older individuals participating in programs under this 

Act through outreach, conferences, and referral of such individuals to other social 

service agencies or sources of assistance where appropriate and consented to by 

the parties to be referred; and 

(iv) referral of complaints to law enforcement or public protective service 

agencies where appropriate;

(B) the State will not permit involuntary or coerced participation in the program of 

services described in this paragraph by alleged victims, abusers, or their households; and

(C) all information gathered in the course of receiving reports and making referrals shall 

remain confidential unless all parties to the complaint consent in writing to the release of 
28 

such information, except that such information may be released to a law enforcement or 

public protective service agency.

 (13) The plan shall provide assurances that each State will assign personnel (one of whom shall 

be known as a legal assistance developer) to provide State leadership in developing legal 

assistance programs for older individuals throughout the State.

 (14) The plan shall, with respect to the fiscal year preceding the fiscal year for which such 

plan is prepared— 

(A) identify the number of low-income minority older individuals in the State, including 

the number of low-income minority older individuals with limited English proficiency; 

and 

(B) describe the methods used to satisfy the service needs of the low-income minority 

older individuals described in subparagraph (A), including the plan to meet the needs of 

low-income minority older individuals with limited English proficiency.

 (15) The plan shall provide assurances that, if a substantial number of the older individuals 

residing in any planning and service area in the State are of limited English-speaking ability, then 

the State will require the area agency on aging for each such planning and service area— 

(A) to utilize in the delivery of outreach services under section 306(a)(2)(A), the services 

of workers who are fluent in the language spoken by a predominant number of such older 

individuals who are of limited English-speaking ability; and 

(B) to designate an individual employed by the area agency on aging, or available to such 

area agency on aging on a full-time basis, whose responsibilities will include— 

 (i) taking such action as may be appropriate to assure that counseling assistance is 

made available to such older individuals who are of limited English-speaking ability in 

order to assist such older individuals in participating in programs and receiving assistance 

under this Act; and 

 (ii) providing guidance to individuals engaged in the delivery of supportive 

services under the area plan involved to enable such individuals to be aware of cultural 

sensitivities and to take into account effectively linguistic and cultural differences.

 (16) The plan shall provide assurances that the State agency will require outreach efforts that 

will— 

(A) identify individuals eligible for assistance under this Act, with special emphasis on— 

(i) older individuals residing in rural areas;

(ii) older individuals with greatest economic need (with particular attention to 

low-income older individuals, including low-income minority older individuals, 

older individuals with limited English proficiency, and older individuals residing 

in rural areas);
29 

(iii) older individuals with greatest social need (with particular attention to lowincome older individuals, including low-income minority older individuals, older 

individuals with limited English proficiency, and older individuals residing in 

rural areas);

(iv) older individuals with severe disabilities;

(v) older individuals with limited English-speaking ability; and

(vi) older individuals with Alzheimer’s disease and related disorders with 

neurological and organic brain dysfunction (and the caretakers of such 

individuals); and 

(B) inform the older individuals referred to in clauses (i) through (vi) of subparagraph 

(A), and the caretakers of such individuals, of the availability of such assistance.

 (17) The plan shall provide, with respect to the needs of older individuals with severe 

disabilities, assurances that the State will coordinate planning, identification, assessment of 

needs, and service for older individuals with disabilities with particular attention to individuals 

with severe disabilities with the State agencies with primary responsibility for individuals with 

disabilities, including severe disabilities, to enhance services and develop collaborative 

programs, where appropriate, to meet the needs of older individuals with disabilities. 

 (18) The plan shall provide assurances that area agencies on aging will conduct efforts to 

facilitate the coordination of community-based, long-term care services, pursuant to section 

306(a)(7), for older individuals who— 

(A) reside at home and are at risk of institutionalization because of limitations on their 

ability to function independently; 

(B) are patients in hospitals and are at risk of prolonged institutionalization; or 

(C) are patients in long-term care facilities, but who can return to their homes if 

community-based services are provided to them. 

 (19) The plan shall include the assurances and description required by section 705(a). 

 (20) The plan shall provide assurances that special efforts will be made to provide technical 

assistance to minority providers of services. 

 (21) The plan shall— 

(A) provide an assurance that the State agency will coordinate programs under this title 

and programs under title VI, if applicable; and 

(B) provide an assurance that the State agency will pursue activities to increase access by 

older individuals who are Native Americans to all aging programs and benefits provided 

by the agency, including programs and benefits provided under this title, if applicable, 

and specify the ways in which the State agency intends to implement the activities. 
30 

 (22) If case management services are offered to provide access to supportive services, the plan 

shall provide that the State agency shall ensure compliance with the requirements specified in 

section 306(a)(8). 

 (23) The plan shall provide assurances that demonstrable efforts will be made— 

 (A) to coordinate services provided under this Act with other State services that benefit 

older individuals; and 

 (B) to provide multigenerational activities, such as opportunities for older individuals to 

serve as mentors or advisers in child care, youth day care, educational assistance, at-risk youth 

intervention, juvenile delinquency treatment, and family support programs. 

 (24) The plan shall provide assurances that the State will coordinate public services within the 

State to assist older individuals to obtain transportation services associated with access to 

services provided under this title, to services under title VI, to comprehensive counseling 

services, and to legal assistance. 

 (25) The plan shall include assurances that the State has in effect a mechanism to provide for 

quality in the provision of in-home services under this title. 

 (26) The plan shall provide assurances that area agencies on aging will provide, to the extent 

feasible, for the furnishing of services under this Act, consistent with self-directed care.

 (27) (A) The plan shall include, at the election of the State, an assessment of how prepared the 

State is, under the State’s statewide service delivery model, for any anticipated change in the 

number of older individuals during the 10-year period following the fiscal year for which the 

plan is submitted. 

(B) Such assessment may include— 

(i) the projected change in the number of older individuals in the State; 

(ii) an analysis of how such change may affect such individuals, including 

individuals with low incomes, individuals with greatest economic need, minority 

older individuals, older individuals residing in rural areas, and older individuals 

with limited English proficiency;

(iii) an analysis of how the programs, policies, and services provided by the State 

can be improved, including coordinating with area agencies on aging, and how 

resource levels can be adjusted to meet the needs of the changing population of 

older individuals in the State; and

(iv) an analysis of how the change in the number of individuals age 85 and older 

in the State is expected to affect the need for supportive services.

 (28) The plan shall include information detailing how the State will coordinate activities, and 

develop long-range emergency preparedness plans, with area agencies on aging, local emergency 

response agencies, relief organizations, local governments, State agencies responsible for 
31 

emergency preparedness, and any other institutions that have responsibility for disaster relief 

service delivery.

 (29) The plan shall include information describing the involvement of the head of the State 

agency in the development, revision, and implementation of emergency preparedness plans, 

including the State Public Health Emergency Preparedness and Response Plan.

 (30) The plan shall contain an assurance that the State shall prepare and submit to the Assistant 

Secretary annual reports that describe— 

(A) data collected to determine the services that are needed by older individuals whose 

needs were the focus of all centers funded under title IV in fiscal year 2019; 

(B) data collected to determine the effectiveness of the programs, policies, and services 

provided by area agencies on aging in assisting such individuals; and 

(C) outreach efforts and other activities carried out to satisfy the assurances described in 

paragraphs (18) and (19) of section 306(a). 

Sec. 308, PLANNING, COORDINATION, EVALUATION, AND ADMINISTRATION OF 

STATE PLANS

(b)(3)(E) No application by a State under subparagraph (A) shall be approved unless it contains 

assurances that no amounts received by the State under this paragraph will be used to hire any 

individual to fill a job opening created by the action of the State in laying off or terminating the 

employment of any regular employee not supported under this Act in anticipation of filling the 

vacancy so created by hiring an employee to be supported through use of amounts received under 

this paragraph. 

Sec. 705, ADDITIONAL STATE PLAN REQUIREMENTS 

(a) ELIGIBILITY.—In order to be eligible to receive an allotment under this subtitle, a State 

shall include in the state plan submitted under section 307— 

 (1) an assurance that the State, in carrying out any chapter of this subtitle for which the State 

receives funding under this subtitle, will establish programs in accordance with the requirements 

of the chapter and this chapter;

 (2) an assurance that the State will hold public hearings, and use other means, to obtain the 

views of older individuals, area agencies on aging, recipients of grants under title VI, and other 

interested persons and entities regarding programs carried out under this subtitle; 
32 

 (3) an assurance that the State, in consultation with area agencies on aging, will identify and 

prioritize statewide activities aimed at ensuring that older individuals have access to, and 

assistance in securing and maintaining, benefits and rights; 

 (4) an assurance that the State will use funds made available under this subtitle for a chapter in 

addition to, and will not supplant, any funds that are expended under any Federal or State law in 

existence on the day before the date of the enactment of this subtitle, to carry out each of the 

vulnerable elder rights protection activities described in the chapter; 

 (5) an assurance that the State will place no restrictions, other than the requirements referred to 

in clauses (i) through (iv) of section 712(a)(5)(C), on the eligibility of entities for designation as 

local Ombudsman entities under section 712(a)(5). 

 (6) an assurance that, with respect to programs for the prevention of elder abuse, neglect, and 

exploitation under chapter 3— 

(A) in carrying out such programs the State agency will conduct a program of services 

consistent with relevant State law and coordinated with existing State adult protective 

service activities for— 

 (i) public education to identify and prevent elder abuse; 

 (ii) receipt of reports of elder abuse;

 (iii) active participation of older individuals participating in programs under this 

Act through outreach, conferences, and referral of such individuals to other social service 

agencies or sources of assistance if appropriate and if the individuals to be referred 

consent; and 

 (iv) referral of complaints to law enforcement or public protective service 

agencies if appropriate;

(B) the State will not permit involuntary or coerced participation in the program of 

services described in subparagraph (A) by alleged victims, abusers, or their households; 

and 

(C) all information gathered in the course of receiving reports and making referrals shall 

remain confidential except— 

(i) if all parties to such complaint consent in writing to the release of such 

information; 

(ii) if the release of such information is to a law enforcement agency, public 

protective service agency, licensing or certification agency, ombudsman program, 

or protection or advocacy system; or 

(iii) upon court order...
33 

___________________________________________ ____________________

Signature and Title of Authorized Official Date
34 

State Plan Guidance Attachment B 

INFORMATION REQUIREMENTS

IMPORTANT: States must provide all applicable information following each 

OAA citation listed below. Please note that italics indicate emphasis added to 

highlight specific information to include. The completed attachment must be 

included with your State Plan submission.

Section 305(a)(2)(E) 

Describe the mechanism(s) for assuring that preference will be given to providing services to 

older individuals with greatest economic need and older individuals with greatest social need 

(with particular attention to low-income older individuals, including low-income minority older 

individuals, older individuals with limited English proficiency, and older individuals residing in 

rural areas) and include proposed methods of carrying out the preference in the State plan; 

RESPONSE: 

Section 306(a)(6)(I) 

Describe the mechanism(s) for assuring that each Area Plan will include information detailing 

how the Area Agency will, to the extent feasible, coordinate with the State agency to disseminate 

information about the State assistive technology entity and access to assistive technology options 

for serving older individuals;

RESPONSE: 

Section 306(a)(17) 

Describe the mechanism(s) for assuring that each Area Plan will include information detailing 

how the Area Agency will coordinate activities and develop long-range emergency preparedness 

plans with local and State emergency response agencies, relief organizations, local and State 

governments and other institutions that have responsibility for disaster relief service delivery.

RESPONSE: 
35 

Section 307(a)(2) 

The plan shall provide that the State agency will —... 

(C) specify a minimum proportion of the funds received by each area agency on aging in the 

State to carry out part B that will be expended (in the absence of a waiver under sections 306 (c) 

or 316) by such area agency on aging to provide each of the categories of services specified in 

section 306(a)(2). (Note: those categories are access, in-home, and legal assistance. Provide 

specific minimum proportion determined for each category of service.)

RESPONSE: 

Section 307(a)(3) 

The plan shall— 

... 

(B) with respect to services for older individuals residing in rural areas— 

(i) provide assurances the State agency will spend for each fiscal year not less than the 

amount expended for such services for fiscal year 2000;

(ii) identify, for each fiscal year to which the plan applies, the projected costs of 

providing such services (including the cost of providing access to such services); and

(iii) describe the methods used to meet the needs for such services in the fiscal year 

preceding the first year to which such plan applies.

RESPONSE: 

Section 307(a)(10) 

The plan shall provide assurance that the special needs of older individuals residing in rural areas 

are taken into consideration and shall describe how those needs have been met and describe how 

funds have been allocated to meet those needs. 

RESPONSE: 
36 

Section 307(a)(14) 

(14) The plan shall, with respect to the fiscal year preceding the fiscal year for which such plan is 

prepared— 

(A) identify the number of low-income minority older individuals in the State, including 

the number of low income minority older individuals with limited English proficiency; 

and 

(B) describe the methods used to satisfy the service needs of the low-income minority 

older individuals described in subparagraph (A), including the plan to meet the needs of 

low-income minority older individuals with limited English proficiency. 

RESPONSE: 

Section 307(a)(21) 

The plan shall — 

. . . 

(B) provide an assurance that the State agency will pursue activities to increase access by older 

individuals who are Native Americans to all aging programs and benefits provided by the 

agency, including programs and benefits provided under this title, if applicable, and specify the 

ways in which the State agency intends to implement the activities. 

RESPONSE: 

Section 307(a)(27) 

(A) The plan shall include, at the election of the State, an assessment of how prepared the State 

is, under the State’s statewide service delivery model, for any anticipated change in the number 

of older individuals during the 10-year period following the fiscal year for which the plan is 

submitted. 

(B) Such assessment may include— 

(i) the projected change in the number of older individuals in the State;

(ii) an analysis of how such change may affect such individuals, including individuals 

with low incomes, individuals with greatest economic need, minority older individuals, 

older individuals residing in rural areas, and older individuals with limited English 

proficiency;
37 

(iii) an analysis of how the programs, policies, and services provided by the State can be 

improved, including coordinating with area agencies on aging, and how resource levels 

can be adjusted to meet the needs of the changing population of older individuals in the 

State; and

(iv) an analysis of how the change in the number of individuals age 85 and older in the 

State is expected to affect the need for supportive services

RESPONSE: 

Section 307(a)(28) 

The plan shall include information detailing how the State will coordinate activities, and develop 

long-range emergency preparedness plans, with area agencies on aging, local emergency 

response agencies, relief organizations, local governments, State agencies responsible for 

emergency preparedness, and any other institutions that have responsibility for disaster relief 

service delivery.

RESPONSE: 

Section 307(a)(29) 

The plan shall include information describing the involvement of the head of the State agency in 

the development, revision, and implementation of emergency preparedness plans, including the 

State Public Health Emergency Preparedness and Response Plan.

RESPONSE: 

Section 705(a) ELIGIBILITY — 

In order to be eligible to receive an allotment under this subtitle, a State shall include in the State 

plan submitted under section 307—. . .

(7) a description of the manner in which the State agency will carry out this title in accordance 

with the assurances described in paragraphs (1) through (6). 
38 

(Note: Paragraphs (1) of through (6) of this section are listed below) 

In order to be eligible to receive an allotment under this subtitle, a State shall include in the 

State plan submitted under section 307— 

(1) an assurance that the State, in carrying out any chapter of this subtitle for which the State 

receives funding under this subtitle, will establish programs in accordance with the requirements 

of the chapter and this chapter; 

(2) an assurance that the State will hold public hearings, and use other means, to obtain the 

views of older individuals, area agencies on aging, recipients of grants under title VI, and other 

interested persons and entities regarding programs carried out under this subtitle; 

(3) an assurance that the State, in consultation with area agencies on aging, will identify and 

prioritize statewide activities aimed at ensuring that older individuals have access to, and 

assistance in securing and maintaining, benefits and rights; 

(4) an assurance that the State will use funds made available under this subtitle for a chapter in 

addition to, and will not supplant, any funds that are expended under any Federal or State law in 

existence on the day before the date of the enactment of this subtitle, to carry out each of the 

vulnerable elder rights protection activities described in the chapter;

(5) an assurance that the State will place no restrictions, other than the requirements referred to 

in clauses (i) through (iv) of section 712(a)(5)(C), on the eligibility of entities for designation as 

local Ombudsman entities under section 712(a)(5); 

(6) an assurance that, with respect to programs for the prevention of elder abuse, neglect, and 

exploitation under chapter 3— 

(A) in carrying out such programs the State agency will conduct a program of services 

consistent with relevant State law and coordinated with existing State adult protective 

service activities for- 

(i) public education to identify and prevent elder abuse; 

(ii) receipt of reports of elder abuse;

 (iii) active participation of older individuals participating in programs under 

this Act through outreach, conferences, and referral of such individuals to other 

social service agencies or sources of assistance if appropriate and if the 

individuals to be referred consent; and 

 (iv) referral of complaints to law enforcement or public protective service 

agencies if appropriate;

 (B) the State will not permit involuntary or coerced participation in the program of 

services described in subparagraph (A) by alleged victims, abusers, or their households; 

and 
39 

 (C) all information gathered in the course of receiving reports and making referrals 

shall remain confidential except— 

 (i) if all parties to such complaint consent in writing to the release of such 

information; 

 (ii) if the release of such information is to a law enforcement agency, public 

protective service agency, licensing or certification agency, ombudsman program, 

or protection or advocacy system; or

 (iii) upon court order.

RESPONSE: 
40 

State Plan Guidance Attachment C

INTRASTATE (IFF) FUNDING FORMULA REQUIREMENTS

Requirements Applicable to IFF Revisions:

OAA, Sec. 305(a)(2)(C)

“States shall, 

(C) in consultation with area agencies, in accordance with guidelines issued by the Assistant 

Secretary, and using the best available data, develop and publish for review and comment a 

formula for distribution within the State of funds received under this title that takes into account- 

(i) the geographical distribution of older individuals in the State; and

(ii)the distribution among planning and service areas of older individuals with greatest 

economic need and older individuals with greatest social need, with particular attention 

to low-income minority older individuals.” 

OAA, Sec. 305(d) 

(d) The publication for review and comment required by paragraph (2)(C) of subsection (a) shall 

include— 

(1) a descriptive statement of the formula’s assumptions and goals, and the application of 

the definitions of greatest economic or social need, 

(2) a numerical statement of the actual funding formula to be used, 

(3) a listing of the population, economic, and social data to be used for each planning 

and service area in the State, and 

(4) a demonstration of the allocation of funds, pursuant to the funding formula, to each 

planning and service area in the State. 

Requirements Applicable to all IFFs Generally

All IFFs must contain the following:

• A descriptive statement of the formula. 

• A list of the data used by planning and service area. 

• A descriptive statement of each factor (i.e. 70+ living alone – number of people who are 

70 and older that live alone) and weight/percentage used for each factor (i.e. 70+ living 

alone = 5%).
41 

• Allocations of funds by planning and service area based on the IFF segmented by Part of 

Title III (e.g., chart of PSA X, IIIB Supportive Services, $900,000). 

• States must provide the source of the data used to run in the IFF. States must use the 

“best available data.” In most cases, the best available data is the most current US 

Census. A state also may use more recent US Census estimates from the American 

Community Survey; other more recent data of equivalent quality available in the State 

also may be considered. 

• A numerical/mathematical statement of the formula is required for Parts B, C, D and E. 

• A separate descriptive and numerical/mathematical statement may be provided for Title 

III Part D – Evidence Based Disease Prevention and Health Promotion Services, to target 

the medically underserved and which there are a large number of older individuals who 

have the greatest economic need for such services, per Section 362 of the OAA. If a 

separate formula is used for Part D, a separate descriptive and numerical/mathematical 

statement is required.

• A statement explaining how NSIP funds are distributed. 

• States may use a base amount in their IFFs to ensure viable funding across the entire 

state.

• Statement that discloses if, prior to distribution under the IFF to the AAAs, funds are 

deducted from Title III funds for: State Plan Administration, Area Plan Administration, 

and/or Long Term Care Ombudsman allocations.

• The IFF should include information on how the formula affects funding to each planning 

and service area.

Requirements Applicable to Single Planning and Service Area States

A numerical/mathematical statement is not required for Single Planning and Service Area states. 

However, Single Planning and Service Areas must include a descriptive statement as to how the 

state determines the geographical distribution of the Title III funding and how the state targets 

the funding to reach individuals with greatest economic and social need, with particular attention 

to low-income minority older individuals.