State Unit on Aging Directors Letter #01-2023 

TO: State Unit on Aging Directors 

FROM: Alison Barkoff 

Acting Administrator/Assistant Secretary for Aging 

DATE: March 31, 2023 

SUBJECT: State Plan Guidance Equity Complement 

Background and Purpose 

The Administration for Community Living’s (ACL) Administration on Aging (AoA) provided 

updated State Plan Guidance in 2021 to align with the 2020 Older Americans Act (OAA) 

Reauthorization. The updated guidance provides requirements and recommendations for 

continued inclusion and to advance support around equity in state plans. It outlines provisions 

under the OAA reauthorization (OAA Sections 307(a)(30)(A) and 307 (a)(30)(C)) which 

includes determining services needed and effectiveness of programs for specific older minority 

individuals1

. This provision aligns with the Biden-Harris administration’s Executive Order 

(E.O.) 13985, Advancing Racial Equity and Support for Underserved Communities Through 

the Federal Government2

 and Executive Order 14091, Further Advancing Racial Equity and 

Support for Underserved Communities Through the Federal Government, issued February 16, 

20233. 

The Older Americans Act programs require funding be targeted for those with the “greatest 

social need” and E.O. 13985 requires each Federal government agency to assess its programs 

and policies, then ensure they deliver resources and benefits equitably to all. 

1 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 

2 Executive Order On Advancing Racial Equity and Support for Underserved Communities Through the Federal Government 

https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/20/executive-order-advancing-racial-equityand-support-for-underserved-communities-through-the-federal-government/ 3 Executive Order On Further Advancing Racial Equity and Support for Underserved Communities Through the Federal 

Government https://www.federalregister.gov/documents/2023/02/22/2023-03779/further-advancing-racial-equity-andsupport-for-underserved-communities-through-the-federal 
 

 

 

 

 

 

 

 

 

As defined in Sec. 2 of the E.O. 13985 Definitions. For purposes of this order: 

• The term “equity” means the consistent and systematic fair, just, and impartial treatment 

of all individuals, including individuals who belong to underserved communities that 

have been denied such treatment, such as 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; persons who live in rural areas; and 

persons otherwise adversely affected by persistent poverty or inequality. 

• The term “underserved communities” refers to populations sharing a particular 

characteristic, as well as geographic communities, that have been systematically denied a 

full opportunity to participate in aspects of economic, social, and civic life, as 

exemplified by the list in the preceding definition of “equity.” 

State Plans must address activities for how the state or territory will equitably provide services 

and supports to underserved communities by setting goals and providing assurances. This 

State Plan Guidance Complement provides technical assistance resources to State Units on 

Aging (SUA) and their network and provides examples of how SUAs may address the equity 

areas in their State Plans 

Examples of how SUAs may address the Equity Areas in their State Plans and Resources 

Areas to address Resources available 

Determining services needed and Leading Practices to Advance Equity and 

effectiveness of programs, policies and Support of Underserved Communities 

services for older Asian Americans and throughout Health and Human Services 

Pacific Islanders, older Native Americans, Programs 

older Hispanic Americans, older African 

Americans, and older lesbian, gay, bisexual, Equity Analysis Tool: National Center for Law 

and transgender (LGBT) persons and Elder Rights Capacity Building Module 

Older Adults' Equity Collaborative 

Examples of how SUAs have addressed in 

State Plans: 

• Inviting individuals of the targeted 

populations and entities that serve them to 

participate in focus groups, surveys, and 

public hearings and using data collected to 

inform the goals, objectives and strategies of 

the state/territories’ state plan 

• Reviewing service data to see if populations 

are effectively receiving services in 

proportion to Census data and setting goals to 

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Engagement in outreach to older Asian 

Americans and Pacific Islanders, older Native 

Americans, older Hispanic Americans, older 

African Americans, and older lesbian, gay, 

bisexual, and transgender (LGBT) persons 

replicate successes and address areas for 

improvement based on that data 

Older African Americans 

Older Hispanic Americans 

Older Native Americans 

Older Asian Americans and Pacific Islanders 

Older Lesbian, Gay, Bisexual, and Transgender 

(LGBT) persons 

Persons with disabilities: 

• Centers for Independent Living (CILs) 

• Protection & Advocacy programs 

• University Centers for Excellence in 

Developmental Disabilities Education, 

Research, and Service (UCEDDs) 

• State Councils on Developmental 

Disabilities 

• Assistive Technology (AT) Network 

• Aging and Disability Resource Centers 

(ADRCs) 

• National Institute on Disability, 

Independent Living, and Rehabilitation 

Research (NIDILRR) 

Persons who live in rural areas 

Also see CDC’s inclusive communication 

resource 

Examples of how SUAs have addressed in 

State Plans: 

• Contacting state and local organizations 

serving each of the target populations to 

receive feedback on outreach opportunities 

and issues 

• Developing and requiring training for staff 

conducting outreach to the identified 

populations 

• In addition to establishing policies and 

procedures that require coordination between 

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Title III services and Title VI Native 

American programs, the SUA provides state 

funding for outreach to Native American 

elders and family caregivers 

Impacting social determinants of health of 

older individuals 

Social Determinants of Health (SDOH) 

Department of Health and Human Services’ 

SDOH site 

Examples of how SUAs have addressed in 

State Plans: 

• Adopt and implement a tool* to identify 

unaddressed social determinants of health 

(SDOH)/health-related social needs (HRSN) 

for Title III participants. Then, study results 

and plan services to enhance the response to 

address the SDOH/HRSNs of older 

individuals in the state or territory 

• Coordinate state aging plans with state plans, 

priorities and programs related to housing and 

transportation for older adults and state 

Medicaid waiver planning and 

implementation 

• Collaborate with public health and health 

systems completing community health needs 

assessments and community health 

improvement plans 

*Note: Several the organizations in the 

network use the AHC screening tool from the 

Center for Medicare & Medicaid Innovation 

(CMMI). 

Ensuring meals can be adjusted for cultural 

considerations and preferences and providing 

medically tailored meals to the maximum 

extent practicable 

The National Resource Center on Nutrition and 

Aging 

CDC’s Cultural Food Preferences in Food 

Service 

Example of how SUAs have addressed in State 

Plans: 

• Provide training for Area Agencies on Aging 

(AAA) and providers on how to expand 

access to culturally and medically tailored 

meal options. Also, provide information to 

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the public about multi-cultural experiences 

and meals offered through Title III services. 

Then, measure success of efforts by surveying 

Title III participants reporting access to 

culturally and medically tailored meals 

Preparing, publishing, and disseminating ACL’s National Resource Centers 

educational materials on the health and 

economic welfare of older individuals Social Vulnerability Index 

Example of how SUAs have addressed in State 

Plans: 

• Work with key stakeholders to ensure every 

older person in the state or territory lives in a 

community that supports financial stability, 

secure housing, and reliable, affordable 

transportation. Then measure success by 

setting a goal to increase the median annual 

income of households with a householder over 

the age of 65 or an increase in the ability to 

access key benefits 

Supporting cultural experiences, activities, Modernizing Senior Centers Resource Center 

and services, including in the arts for Professionals 

National Center on Advancing PersonCentered Practices and Systems 

Example of how SUAs have addressed in State 

Plans: 

• Partner with state’s arts commission to 

establish presence within AAAs’ congregate 

nutrition sites to support cultural experiences, 

activities, and services, including the arts. 

Then, evaluate the success of the program in 

that setting 

Serving older adults living with HIV/AIDS ACL’s HIV/AIDS 

National Resource Center on LGBT+ Aging 

Example of how SUAs have addressed in State 

Plans: 

• Conducting a focus group comprised of 

people living with HIV and the organizations 

that serve them (AIDS Service Organizations 

or ASOs) as part of its needs assessment. 

Then, using feedback from the focus group to 

create goals, objectives and strategies to 

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increase the number of older individuals in the 

state living with HIV accessing Title III 

services 

Supporting participant-directed/person 

centered planning for older adults and their 

caregivers across the spectrum of long-term 

services and supports, including home, 

community, and institutional settings 

ACL’s Person Center Planning 

National Center on Advancing PersonCentered Practices and Systems 

Example of how SUAs have addressed in State 

Plans: 

• Implement and maintain person centered 

training for AAAs, provide AAAs with person 

centered planning tools and measure the 

number of AAAs using person centered 

planning tools effectively 

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