DEPARTMENT

of HEALTH

and HUMAN

SERVICES

Fiscal Year

2016 

Administration for 

Community Living

Justification of 

Estimates for

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

Washington, DC 20201

I am pleased to present the Administration for Community Living’s (ACL) FY 2016 President’s Budget 

request, totaling $2.1 billion, an increase of +$177 million, which focuses on two main goals. First it 

sustains the core ACL services that allow older adults and people of all ages with disabilities to remain 

independent. To this end, +$106 million would support investments in home and community based services 

(including nutrition programs) for seniors, Independent Living services for those with disabilities, and 

programs that support caregivers for older adults. Second, the request would add +$70 million to increase 

innovation and efficiency of ACL programs and to help them to modernize and be better positioned to meet 

future service needs. 

I would like to highlight several of these initiatives. Our Family Support Initiative would direct $15 million 

to encourage the use of community assets and opportunities to help families to reduce stress, improve 

emotional well-being, develop support skills, and plan for the future. Over 80 percent of the long-term 

services and supports provided to older Americans come from family caregivers while over 75 percent of 

people with developmental disabilities in this country rely primarily on family members, often for most of 

their lives. 

Second, ACL proposes to devote $20 million to modernize its older adult nutrition programs. These funds 

would support competitive grants to translate research into evidence-based models for delivering services at 

the community level. Nutrition services are particularly critical to keeping older Americans healthy and 

preventing the need for more costly medical interventions, and this effort would increase the knowledge base 

of nutrition providers, drive improved health outcomes for program recipients by promoting higher service 

quality, and increase program efficiency through innovative service delivery models. 

ACL is also proposing to increase funding by $21 million to continue to develop a national Adult Protective 

Services data system, including grants to states to test and develop infrastructure, while also providing 

funding for key research. Research in the area of adult protective services is essential to the future 

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

abuse of adults of all ages. 

The FY 2016 request also incorporates funds for programs transferred from the Department of Education by 

the Workforce Innovation and Opportunity Act. These programs—the National Institute on Disability, 

Independent Living, and Rehabilitation Research; Independent Living; and Assistive Technology—help 

further ACL’s vision that all people, regardless of age and disability, live with dignity, make their own 

choices, and participate fully in society. 

The three years since ACL’s creation have been a time of growth, learning, and a rededication of our efforts 

to ensure that all Americans, regardless of age or disability, can live and thrive in their communities. This 

budget will allow us to continue serving our populations and position us for greater successes on their behalf. 

Kathy Greenlee

Administrator and Assistant Secretary for Aging

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Table of Contents

Executive Summary

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

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

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

All Purpose Table ........................................................................................................................................................19

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

Appropriations Language Analysis .............................................................................................................................23

Amounts Available for Obligation ..............................................................................................................................24

Summary of Changes...................................................................................................................................................25

Budget Authority by Activity ......................................................................................................................................26

Authorizing Legislation...............................................................................................................................................28

Appropriations History Table ......................................................................................................................................30

Appropriations Not Authorized by Law ......................................................................................................................31

Health and Independence for Older Adults ............................................................................................................32

Home and Community-Based Supportive Services.....................................................................................................36

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

Preventive Health Services..........................................................................................................................................60

Chronic Disease Self-Management Education ............................................................................................................67

Falls Prevention ...........................................................................................................................................................73

Native American Nutrition and Supportive Services...................................................................................................79

Aging Network Support Activities..............................................................................................................................85

Caregiver and Family Support Services..................................................................................................................92

Family Caregiver Support Services.............................................................................................................................96

Family Support ..........................................................................................................................................................105

Native American Caregiver Support Services...........................................................................................................113

Alzheimer’s Disease Supportive Services Program ..................................................................................................117

Alzheimer’s Disease Initiative - Specialized Supportive Services............................................................................123

Lifespan Respite Care................................................................................................................................................127

Protection of Vulnerable Adults.............................................................................................................................133

Long-Term Care Ombudsman Program ....................................................................................................................135

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

Senior Medicare Patrol Program ...............................................................................................................................147

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

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Disability Programs, Research, and Services........................................................................................................159

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

Developmental Disabilities – Protection and Advocacy............................................................................................169

University Centers for Excellence in Developmental Disabilities.............................................................................177

Developmental Disabilities – Projects of National Significance ...............................................................................183

National Institute on Disability, Independent Living, and Rehabilitation Research..................................................188

Independent Living....................................................................................................................................................188

Consumer Information, Access, and Outreach.....................................................................................................202

Aging and Disability Resource Centers.....................................................................................................................206

State Health Insurance Assistance Programs.............................................................................................................213

Voting Access for Individuals with Disabilities........................................................................................................217

Assistive Technology ................................................................................................................................................223

Alzheimer’s Disease Initiative - Outreach Campaign................................................................................................229

National Clearinghouse for Long-Term Care Information ........................................................................................229

Limb Loss Resource Center.......................................................................................................................................237

Paralysis Resource Center .........................................................................................................................................241

Program Administration ............................................................................................................................................245

Supplementary Tables

Budget Authority by Object Class.............................................................................................................................249

Salaries and Expenses................................................................................................................................................250

Detail of Full-Time Equivalent Employment (FTE)..................................................................................................251

Detail of Positions .....................................................................................................................................................252

Programs Proposed for Elimination...........................................................................................................................253

FTE Funded by the Affordable Care Act...................................................................................................................254

Significant Items in Appropriations Committee Reports...........................................................................................255

Prevention and Public Health Fund ...........................................................................................................................257

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Introduction and Mission

The Administration for Community Living (ACL) is the single agency charged to work with 

States, localities, Tribal organizations, nonprofit organizations, businesses, and families to help 

older adults and people with disabilities live independently and fully participate in their 

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

adults, people with disabilities across the lifespan, and their families and caregivers. Those with 

disabilities or functional limitations of any type, regardless of age, have a common interest: 

access to home and community-based supports and services that can help individuals to fully 

participate in all aspects of society, including having the option to live at home, which can be 

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

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

Through its Administration on Aging (AoA), ACL works with and through its national aging 

services network to promote the development of comprehensive and coordinated systems of 

home and community-based services and supports that are responsive to the needs and 

preferences of older adults and their caregivers. The network is comprised of 56 State and 

Territorial Units on Aging (SUA), 618 Area Agencies on Aging (AAA), 264 Indian Tribal and 

Native Hawaiian organizations, nearly 20,000 direct service providers, and hundreds of 

thousands of volunteers. These services complement existing medical and health care systems, 

help prevent hospital readmissions, and support some of life’s most basic functions, such as 

bathing or preparing meals. These programs also support family caregivers, address issues of 

exploitation, neglect and abuse of older adults, and adapt services to the needs of Native 

Americans. 

Through its Administration on Intellectual and Developmental Disabilities (AIDD), ACL works 

through a network of States that includes, in each State and Territory, State Councils on 

Developmental Disabilities, State Protection and Advocacy systems, and University Centers for 

Excellence in Developmental Disabilities (UCEDDs) to address the needs of those with 

intellectual and developmental disabilities. AIDD programs fund capacity-building and systems 

change efforts to ensure that people with developmental disabilities and their families participate 

in the design of and have access to needed community services, individualized supports, and 

other forms of assistance that promote self-determination, independence, productivity, 

integration, and inclusion in all facets of community life. The transfer of the Independent Living 

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

Research from the Department of Education is a significant step in the evolution of ACL. These 

programs will allow ACL to further address the needs of individuals with disabilities, as well as 

enhance the agency’s effort to support and implement disability research. 

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EXECUTIVE SUMMARY

Finally, ACL promotes consistency and coordination in community living policy and seeks to 

better align the health, social, employment, family and community supports that are critical to 

both older adults and people with disabilities, through its Center for Policy and Evaluation (CPE) 

and Center for Consumer Access and Self-Determination (CCASD). These Centers support 

programs and activities that help provide both older Americans and people with disabilities 

information and access to long-term services and support, including the Assistive Technology 

program that was transferred by WIOA. Other programs transferred to ACL in recent years, such 

as the Limb Loss program, (transferred from the Centers for Disease Control in FY 2015), the 

Paralysis Resource Center (transferred from the Centers for Disease Control in FY 2014), and 

the State Health Insurance Assistance Program (transferred from the Centers for Medicare and 

Medicaid Services in FY 2014) also have expanded ACL’s ability to fulfill this important 

objective. 

2 
Overview of Budget Request

The FY 2016 discretionary request for the Administration for Community Living (ACL) is 

$2,095,655,000, an increase of +$176,572,000 over the FY 2015 enacted level. The budget

includes funding for three programs – Assistive Technology, Independent Living and the 

National Institute on Disability, Independent Living and Rehabilitation Research – transferred to 

ACL from the Department of Education by the Workforce Innovation and Opportunity Act 

(WIOA). 

In addition to ACL’s discretionary increases discussed below, the FY 2016 program level 

includes $27,700,000 from the Prevention and Public Health Fund authorized by the Affordable 

Care Act. Of this, $8,000,000 would continue to fund Chronic Disease Self-Management 

Education programs, $5,000,000 would support senior falls prevention programs, and the 

remaining $14,700,000 would continue activities under the President’s Alzheimer’s Initiative, 

including an outreach campaign and the development of more dementia-capable long-term 

service and support systems designed to meet the needs of individuals with Alzheimer's Disease 

and their caregivers. The overall program level also includes an estimated $8,710,000 in 

mandatory funding for FY 2016 for Health Care Fraud and Abuse Control activities. 

ACL’s FY 2016 Request 

ACL’s FY 2016 request focuses first on sustaining the core ACL services that allow older adults 

and people of all ages with disabilities to remain independent and in their communities. To this 

end, an additional $105,950,000 would support investments in home and community based 

services (including nutrition programs) for seniors, Independent Living services for those with 

disabilities, and programs that support caregivers and families. Second, the request would target 

a total of $70,275,000 for initiatives that focus on increasing innovation and improving the 

efficiency of ACL programs with an eye towards modernizing and better positioning them to 

meet future service needs of the aging and disability populations. These dollars would target the 

following areas: nutrition, increasing support for families caring for older adults and/or 

supporting people with disabilities, continued development of Adult Protective Services systems, 

Aging and Disability Resources Centers, additional research by the National Institute on 

Disability, Independent Living and Rehabilitation Research, and an initiative to assist youth with 

developmental disabilities to transition from adolescence to productive adulthood. The remainder 

of the increase over FY 2015 would provide the additional resources needed to fully support the 

operations of the three programs transferred under WIOA and address costs related to the 

relocation of ACL’s central office. 

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

Services provided through ACL’s core service programs can be the difference between 

remaining independent and having to seek institutional care for many older adults and 

individuals with disabilities. Yet in recent years, flat or declining budgets at both the Federal and 

State level have resulted in declines in service levels even as the populations in need have grown. 

Recognizing these trends and importance of addressing the growing need for these services, 

ACL invests in three key areas:

• Home and Community-Based Services: ACL invests +$43,458,000 to strengthen home 

and community-based services, including +$38,458,000 for services for older adults

(HCBSS), for a total of $386,182,000; and +$5,000,000 for Centers for Independent 

Living (CILs), for a total of $83,305,000. HCBSS for older adults include 

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

fitness programs. In combination with state and local funding, the budget will support 

over 28 million hours of assistance to seniors unable to perform daily activities; more 

than 23 million rides for critical activities such as visiting the doctor, pharmacy, or 

grocery stores; and nearly 8 million hours of adult day services. CILs provide people 

with disabilities a variety of services, including information and referral, independent 

living skills training, peer counseling, transition services, and individual and systems 

advocacy. The additional funding will enable CILs to continue to provide these services 

and also begin to address the new core service requirements added by WIOA. ACL’s 

home and community-based services are a critical part of state and local efforts to 

ensure that older adults and people with disabilities can live at home with the supports 

they need in the community, rather than turning to more expensive institutional care. 

 

• Nutrition Services: ACL invests +$42,842,000 (+$39,900,000 for Congregate and 

Home-Delivered Meals and +$2,942,000 for Native American Nutrition and Supportive 

Services) for a total of $883,657,000. Nutrition Services are a vital support for older 

Americans nationwide, many of whom are low-income, as meals provided through 

home delivery or in senior centers allow many older Americans to remain independent 

and living at home for as long as possible, delaying or preventing the need for more 

costly institutional services. This increase in funding, leveraged further by state and 

local funding, will allow States to provide a total of 208 million meals to over 2 million 

older Americans nationwide, helping to halt recent declines in service levels. 

• Caregiver Services— ACL invests an additional +$5,769,000 (+$5,000,000 for Family 

Caregiver Support Services and +$769,000 for Native American Caregiver Support) for 

a total of $157,386,000 in State and Native American caregiver support services for 

older adults. Increased support for caregivers is critical because it is often their 

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EXECUTIVE SUMMARY

availability – whether they are informal caregivers, paraprofessionals, or unrelated 

friends and neighbors who volunteer their time – that determines whether an older 

person can remain in his or her home. 

Modernizing and Positioning Services for the Future 

This budget also includes investments to modernize ACL’s core services by emphasizing greater 

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

proven models and practices across our aging and disability networks, ACL will help to ensure 

that services are able to address the evolving needs of the populations we serve and target 

resources to where they are most needed. ACL invests in the following areas: 

• Family Support Initiative: Aligned with the President’s effort on supporting middle-class 

families, ACL invests +$15,000,000 in a comprehensive and sustainable national effort to 

ensure the optimal deployment of public and private resources at the state and community 

level to assist family members caring for older adults and/or supporting people with 

disabilities across the lifespan. This initiative will incorporate evidence-based practices 

into existing public programs, will encourage innovation in local communities, and will 

leverage additional public and private resources to bolster the ability of families to 

support their loved ones to live self-determined and fulfilling lives, while still 

maintaining healthy, rewarding and economically viable balance for all family members. 

Over 80 percent of the long-term services and supports provided to older Americans 

come from family caregivers while over 75 percent of people with developmental 

disabilities in this country rely primarily on family members, often for most of their lives. 

The initiative will encourage use of community assets and opportunities to help families 

reduce stress, improve emotional well-being, develop support skills and knowledge, and 

plan for the future. Special attention will be given to efforts that assist families with 

balancing workforce participation and caregiving responsibilities, and those facing the 

dual demands of caring for older parents while raising children and/or supporting a 

family member with a disability, as well as approaches that reduce “caregiver burnout,” a 

major contributor to out of home placement into residential care. 

• Modernizing Senior Nutrition Programs: ACL invests +$20,000,000 to enhance and 

modernize its key nutrition programs. These funds would support competitive grants to 

translate research into evidence-based models for delivering services at the community 

level. Nutrition services are particularly critical to keeping older Americans healthy and 

preventing the need for more costly medical interventions, and this effort would increase 

the knowledge base of our nutrition providers, drive improved health outcomes for 

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program recipients by promoting higher service quality, and increase program efficiency 

through innovative service delivery models. 

• National Adult Protective Services System: ACL’s request includes an additional 

+$21,000,000 million, for a total of $25,000,000 in Elder Justice funding to continue to 

address the damaging impact of abuse, neglect, and exploitation on the health and 

independence of adults (including seniors and adults with disabilities) by making 

strategic investments in Adult Protective Services, research, and evaluation activities. 

With this funding, ACL will continue to develop a national Adult Protective Services 

data system, including grants to states to test and develop infrastructure, while also 

providing funding for key research. Research in the area of adult protective services is 

essential to the future development of evidence-based interventions that will effectively 

prevent, identify, report, and respond to abuse of adults of all ages.

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

+$13,881,000, for a total of $20,000,000, for the Aging and Disability Resource Center

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

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

supports at the community level. Aging and Disability Resource Centers make it easier 

for Americans nation-wide to learn about and obtain the long-term services and supports 

they need to remain living in their own homes and communities. At the same time, the 

budget would increases funding for the Lifespan Respite program by +$2,640,000, to 

$5,000,000, which funds grants to improve the quality and access to respite care for 

family caregivers of children or adults of any age with support needs. The budget also 

includes an additional $1,000,000 for the National Clearinghouse for Long-Term Care 

Information, which increases awareness of the need to plan ahead for long-term supports 

and services.

• Youth Transitions and Other Services for Individuals with Intellectual and 

Developmental Disabilities: The Budget provides +$5,000,000 within ACL’s Projects of 

National Significance as part of a broader HHS effort to help young Americans with 

disabilities in the midst of difficult transitions and provides them with the tools and 

supports they need to enter adulthood. This initiative will help youth with intellectual or 

developmental disabilities transition successfully from adolescence and the supportive 

environment of school into an adulthood that offers them post-secondary education and 

work opportunities, ultimately reducing the likelihood that they become solely dependent 

on Social Security, Medicaid, or other similar benefits. In addition, +$643,000 more 

would be provided for Projects of National Significance to support the needs of people 

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EXECUTIVE SUMMARY

with intellectual or developmental disabilities, and +$945,000 would be provided for 

University Centers for Excellence in Developmental Disabilities (UCEDDs).

• Conducting Innovative Disability Research: The request also includes +$4,030,000 to

bring the budget for the National Institute on Disability, Independent Living, and 

Rehabilitation Research to $108,000,000. NIDILRR generates knowledge and promotes 

its use to assist people with disabilities in performing activities of their choice in the 

community, while also seeking to expand society’s capacity to provide full opportunities 

and accommodations for people with disabilities. This program focuses on research in 

areas such as employment, health and function, technology for access and function, 

independent living and community integration, and other associated disability research 

areas for individuals with disabilities of all ages.

Funding for core ACL programs under the Older Americans Act, the Developmental Disabilities 

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

other legislation would otherwise be maintained in this request. ACL’s programs provide 

community-based services and supports to a growing segment of the population, which in turn 

can reduce costs to other public programs such as Medicaid. The U.S. population over age 60 is 

projected to increase by 20 percent between 2014 and 2020, from 64.8 million to 77.6 million.1

The 2010 census puts the total number of Americans with disabilities at 56.7 million people, of 

which over 12 million required assistance with activities of daily living or instrumental activities 

of daily living.2 Studies indicate that individuals with developmental disabilities currently 

comprise between 1.2 and 1.65 percent of the U.S. population, or between 3.7 and 5.2 million 

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

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

is projected to increase by more than 20 percent by the year 2020.4 Meeting the long-term 

support needs of these populations can place tremendous strain on families, and if families 

become overwhelmed by the challenges of caregiving, the costs of providing this care will fall on 

other, more costly, government resources. For example, a 2014 Rand Corporation study found 

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

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

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

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

2015. 

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

Issued July 2012, Accessed 21 August 2014.

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

census estimates of U.S. Population, July 1, 2012 4 Ibid and Centers for Medicare & Medicaid Services, The characteristics and perceptions of the Medicare 

population. Data from the 2012 Medicare Current Beneficiary Survey. [data tables 2.5a and 2.6a]. 

http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS/Data-Tables-Items/2012CNP.html. 

Accessed 23 October, 2014. 

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EXECUTIVE SUMMARY

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

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

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

preferable option. 

ACL’s request also includes $40,063,000 for Program Administration, an increase of 

+$2,354,000 over the FY 2015 enacted level to support an estimated 198 FTEs of the 221 total 

FTEs for the agency. This amount includes administrative costs for the implementation of 

programs transferring from the Department of Education as a result of the Workforce Innovation 

and Opportunity Act. It also provides funds for the higher rent costs projected as a result of 

ACL’s headquarters move in CY 2015 to the Switzer building. 

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

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

8 

 
Overview of Performance

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

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

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

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

performance management, transparency and use of evidence will carry through as we integrate 

ACL’s newest programs that serve the aging and disability communities (e.g. State Health 

Insurance Assistance Program (SHIP), Assistive Technology Program, National Institute on 

Disability, Independent Living, and Rehabilitation Research (NIDILRR), etc.). Below, an 

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

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

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

Overview of Performance: Aging Programs

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

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

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

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

led ACL to focus on three performance measures: 1) improving client outcomes; 2) effectively 

targeting services to vulnerable populations; and 3) improving efficiency. Each measure is 

representative of activities across the Aging Services Program budget and progress toward 

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

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

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

Performance Highlights 

An analysis of ACL’s performance trends shows that through FY 2013 most outcome indicators 

have been maintained or steadily improved. While most service counts are declining due to flat 

funding and inflationary factors, ACL outcome indicators demonstrate that services are 

continuing to be effective. Following are some key successes that are indicative of the potential 

of ACL and the Aging Network to meet demographic and fiscal challenges.

ACL programs help older Americans remain independent and in the community: Older 

adults that have three or more impairments in Activities of Daily Living (ADL) are at a high risk 

for nursing home entry. Measures of the Aging Network’s success at serving this vulnerable 

population is a proxy for nursing home delay and diversion. In FY 2005, one-third of homedelivered nutrition clients lived with three or more ADL impairments and by FY 2013 the 

proportion grew to 43.5%, a 30% increase. 

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EXECUTIVE SUMMARY

The FY 2016 performance budget includes eleven core performance indicators supporting 

ACL’s commitment to improving client outcomes and four indicators for effective targeting, 

capturing success with regards to increasing services to family caregivers and the most 

economically and socially vulnerable. While some indicators experience year-to-year variation, 

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

annually. 

These performance indicators support ACL’s overall mission and its strategic plan Goal 3,

“Work with older adults and people with disabilities as they fully engage and participate in their 

communities, make informed decisions, and exercise self-determination and control about their 

independence, well-being, and health” and Goal 4, “Enable people with disability and older 

adults to live in the community through the availability of and access to high-quality long-term 

services and supports, including supports to family caregivers.” They are strongly tied to HHS 

Goal 3, “Advance the Health, Safety and Well-being of the American People” and specifically 

Objectives 3.B (Promote economic and social well-being for individuals, families, and 

communities), 3.C (Improve the accessibility and quality of supportive services for people with 

disabilities and older adults), and 3.D (Promote prevention and wellness across the lifespan). 

ACL aging programs are efficient: The National Aging Services Network is providing high 

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

ACL has significantly increased the number of clients served per million dollars of Older 

Americans Act (OAA) Title III funding over the last decade. In FY 2013 The Aging Network 

served 9,753 people per million dollars of OAA Title III funding. Since this measure’s 

introduction in FY 2005, ACL and the Aging Network have met or exceeded efficiency targets. 

For FY 2016, there are two efficiency indicators for older adult program activities, both 

consistently meet or exceed targets. 

Improvements in program efficiency support ACL’s mission and Goal 5 of ACL’s Strategic 

Plan, “Implement management and workforce practices that support the integrity and efficient 

operations of programs serving people with disabilities and older adults and ensure stewardship 

of taxpayers’ dollars.” These indicators are linked to HHS’s Strategic Plan Goal 4, “Ensure 

Efficiency, Transparency, Accountability, and Effectiveness of HHS Programs” and specifically 

Objective 4.A (Strengthen program integrity and responsible stewardship by reducing improper 

payments, fighting fraud and integrating financial, performance, and risk management). Through 

optimal utilization of resources, improvements in program efficiency ensure that affordable and 

accessible community-based long-term care is available to promote the well-being of seniors and 

their family caregivers. 

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

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

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services. In 2013, over 94 percent of transportation clients and caregivers rated services good to 

excellent. To help ensure the continuation of these trends, AoA uses discretionary funding to test 

innovative service delivery models for state and local program entities that show promise for 

generating measurable improvements in program activities. Quality indicators are consistently 

high and are expected to meet or exceed targets in FY2016. 

Performance indicators of the quality of ACL programs and services support the agency’s overall 

mission and Goal 4 of its strategic plan, “Enable people with disability and older adults to live in 

the community through the availability of and access to high-quality long-term services and 

supports, including supports to family caregivers.” These indicators support the HHS Goal 3, 

“Advance the Health, Safety and Well-being of the American People” and specifically Objective 

3.C (Improve the accessibility and quality of supportive services for people with disabilities and 

older adults). 

Overview of Performance: Disability Programs

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

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

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

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

purpose of the DD Act: to assist people with intellectual and developmental disabilities to 

become independent and integrated into their community, protect their legal and human rights, 

and improve the quality of services and supports. These measures support ACL Goals 2, 3 and 

4: “Protect and enhance the rights; and prevent the abuse, neglect, and exploitation of older 

adults and people with disabilities”, “Work with older adults and people with disabilities as they 

fully engage and participate in their communities, make informed decisions, and exercise selfdetermination and control about their independence, well-being, and health” and “Enable people 

with disabilities and older adults to live in the community through the availability of and access 

to high-quality long-term services and supports, including supports for families and caregivers.”

ACL’s disability programs performance measures are most strongly linked with HHS Strategic 

Plan Goal 3, “Advance the Health, Safety and Well-Being of the American People” and 

specifically Objectives 3.B (Promote economic and social well-being for individuals, families, 

and communities) and 3.C (Improve the accessibility and quality of supportive services for 

people with disabilities and older adults). The following section highlights the DD Network’s 

accomplishments in three outcome focus areas plus efforts to improve program efficiency. 

State Councils on Developmental Disabilities

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

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

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

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

individuals with developmental disabilities and their family members to enhance civic 

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

positions on State Councils and other disability focused organizations and engage in systems 

change efforts. ACL measures the success of these activities in terms of the percent of people 

reached by State Councils who are independent, self-sufficient and integrated into the 

community. The results have consistently trended up and have met or exceeded performance 

targets since FY 2008 and are expected to continue to do so in FY 2016. 

Given limited resources and economic pressures that create barriers to systems change and 

capacity building, the efficient use of federal funds is paramount. ACL illustrates the Network’s 

efficiency tied to outcomes through measuring the number of individuals reached who are 

independent, self-sufficient and integrated into the community per $1000 of federal funding. 

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

exceeded for the previous five years.

Developmental Disabilities Protection and Advocacy Program 

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

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

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

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

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

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

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

University Centers for Excellence in Developmental Disabilities

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

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

unique contributions UCEDDs make to the intellectual and developmental disabilities 

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

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

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

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

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

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

which UCEDD trained professionals were involved. The result for FY 2013 exceeded the target 

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

As the programs transferred from the Department of Education (National Institute on Disability, 

Independent Living, and Rehabilitation Research; Independent Living Programs; and Assistive 

12 
EXECUTIVE SUMMARY

Technology Programs) become fully integrated into ACL, program performance will be 

reviewed and a set of meaningful measures will be adopted to manage performance of these 

activities. The integration of these programs’ performance management activities will add to 

ACL’s and the disability networks already robust program and advocacy work. 

ACL’s Commitment to Transparency, Accountability and Evaluation 

Consistent with this Administration’s emphasis on transparency, accountability and use of 

evidence, ACL continues to improve the analysis and availability of performance information 

while also enhancing the rigor of program evaluations. To this end, ACL has: 

• Supported increased access to program data and performance information. ACL 

continues to enhance the data portal (www.agid.acl.gov) which provides data 

visualization tools, downloadable data files, and data analysis tools which enables the 

development of benchmarks and trend analyses at the national and at the state level. 

Grantee reporting tools now include 5-year trend analysis and improved tools for 

identifying missing data. ACL recently launched new webpages that provide access to a 

wider array of Census and grantee performance data in easily accessible and 508 

compliant formats. ACL also supports efforts to facilitate developer use of federal data 

sets through http://www.data.gov/ and http://www.healthdata.gov/. 

• Enhanced support of efforts to measure Long-Term Services and Supports including 

service quality. ACL continues to partner with the National Institute on Disability, 

Independent Living and Rehabilitation Research (now a component of ACL) and others 

to advance data collection efforts to measure state progress with regards to competitive 

employment, housing choice, self-determination and service quality. ACL supports The 

National Core Indicators, Aging and Disability project that is working with states to 

develop a suite of surveys for states to use to measure LTSS system performance and 

quality across all ages, disabilities and payers. 

• Supported an on-going effort to enhance data collection and information dissemination to 

better understand and promote effective supports for families and for individuals who 

direct their own support. The intention of the six-year grant (Data Collection for 

Supporting Families) includes: generation of a standard set of key state indicators that 

can be used to benchmark progress; implementation of annual data collection effort that 

produces reliable, accurate national and state-by-state data about family supports that is 

comparable across states; production of an interactive website with an online data 

dashboard that can be used to track, compare and contrast progress made on achieving 

outcomes at the national and state levels; and design of a plan to develop an electronic, 

web-based data distribution system that will be easily accessible to families and people 

13 
EXECUTIVE SUMMARY

with intellectual or developmental disabilities. The grantee’s project website can be 

accessed here: https://fisp.umn.edu/. 

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

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

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

caregiver programs as well as efforts regarding employment systems change. New efforts are 

also underway to conduct evaluability assessments of selected programs as a precursor to formal 

evaluation designs. A key accomplishment in FY2014 was finalizing OMB PRA clearance to 

allow the collection of social security number (SSN) as part of the Title III-C Elderly Nutrition 

Services Program (ENSP) evaluation. This will allow ACL to link program recipients, and 

members of a matched comparison group, with their Medicare records for the purpose of 

analyzing the effects of the Title III-C ENSP on the health of recipients. While ACL is highly 

committed to all evaluation activities, a key priority in FY2015 and 2016 will be dissemination 

of data from completed evaluations to the field and developing programmatic recommendations 

that can help ACL to improve programs. Following are brief descriptions of the array of 

evaluation activities underway at ACL. 

• The OAA Title III-C Elderly Nutrition Services program evaluation employs a complex 

design that includes three major components and several subcomponents. The major 

components include a process study that covers a large array of topics; a cost study that 

measures the actual cost of providing a meal by cost category; and an individual outcome 

study. The individual outcome study will measure the program’s success at meeting the 

legislative intent of the program (reduce hunger and social isolation while improving 

health and well-being of consumers). In addition, ACL/AoA and Centers for Medicare & 

Medicaid Services (CMS) are entering into an Inter-Agency Agreement that will enhance 

this evaluation to include prospective analysis of healthcare utilization and cost. Data 

collection for the process study is ongoing with 100% of State Units on Aging and 80% 

of AAAs completing both parts of their data request (92% responded to the survey and 

83% responded to a separate data form). 

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

will be the first for this OAA program. It is designed as a longitudinal study with a 

comparison group so that the effects of the five service categories can be measured over 

time. The evaluation seeks to assess the impact of the program at the individual, program, 

and long-term care (LTC) policy/home and community-based service (HCBS) system 

levels. The evaluation will also examine how the program meets its goals and the extent 

to which the program has contributed to long-term care system efficiency. The process 

evaluation phase of the study is scheduled to begin data collection in early 2015. The 

outcome evaluation phase, to be completed in 2017, will gather information from a 

14 
EXECUTIVE SUMMARY

sample of caregivers receiving NFCSP services and from a comparable group of 

caregivers not receiving NFCSP services. 

• An evaluability assessment of the OAA Title VI Tribal Grant Program is underway to 

provide ACL with a description of the program models in the field, an assessment of how 

well defined the programs/program services are, and information about what Federal and 

Tribal stakeholders want to get from an evaluation and how the evaluation data findings 

would be used. ACL will use this information to identify the most promising program 

components and sites for a future evaluation. 

• The evaluation of the Aging and Disability Resource Centers (ADRC) was completed in 

November 2014. Process data collection was completed during the fall of 2013 

(preliminary results: http://www.aoa.acl.gov/Program_Results/docs/ADRC.pdf), and 

consumer-level data collection concluded in March 2014. The evaluation includes a 

process evaluation examining populations served, services provided, and organizational 

characteristics including funding levels and partnerships. The evaluation also an outcome 

study that collected information, from approximately 600 consumers at 33 sites, about 

their experience with an ADRC. A final report was completed in November 2014 and is 

expected to be posted on the ACL website in January 2105. 

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

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

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

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

individuals with intellectual and developmental disabilities. A recent project update 

found that early grantee outcomes include: creation, modification or alignment of policies 

that promote employment such as, Alaska’s passage in April 2014 of an Employment 

First Bill; removal of barriers to employment through agency and policy changes, such 

as, New York’s pilot testing of a Job Readiness Curriculum; increased number of 

individuals with I/DD accessing early work experiences such as, California and 

Wisconsin reporting that more than half of the pilot site students are engaged in 

Integrated, Competitive Employment (ICE); and increased cross-system and crossagency collaboration, such as, California, Iowa and Tennessee developing shared data 

systems.

ACL’s Internal Performance Management Plan

ACL’s programs provide grants to the Aging and Developmental Disability Networks. Since 

ACL is not directly involved in hands-on service provision, the Agency employs a program 

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

agencies and organizations, enhanced partnerships between Aging and DD Networks, technical 

15 
EXECUTIVE SUMMARY

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

to yield performance improvements. Examples of activity supporting the overall strategy follow: 

• Collaboration with other federal agencies. 

• Collaboration with non-governmental organizations. 

• Enhanced partnerships between Aging and AIDD Networks. 

• Programmatic technical assistance. 

• Improved performance measurement capacity and information collection tools. 

• Rigorous program evaluation. 

• Senior leadership’s involvement in performance management and reporting. 

Activities cited above are conducted directly by ACL’s Central and Regional Office staff, as well 

as through discretionary grants and contracts. 

In FY 2014, ACL initiated a formula grant monitoring framework for Older Americans Act Title 

III and VII state formula grants. The framework combines assessments of grantee’s progress 

toward program goals and objectives with identification of risk or instances of fraud, waste and 

abuse. An integrated team from program staff, regional offices, Office of Performance and 

Evaluation and Office of Grants Management are developing monitoring tools, evaluating 

monitoring efforts and providing staff training on the process. The approach will involve the 

review of a wide variety of information such as state plans, financial reports, program data and 

performance measures. State monitoring reports will include findings, recommendations and 

corrective actions; grantee response with timelines for corrective actions; and grant conditions 

when necessary. The financial component of the new framework is being tested using two 

quarters of fiscal data with the goal to automate fiscal reports. Automated fiscal reporting will 

improve efficiency and provide the ability for more extensive reviews which are essential to a 

successful monitoring framework and the targeting of technical assistance and continuous quality 

improvements. Based on the success with OAA Title III and VII programs, ACL will develop 

customized monitoring frameworks for AIDD State Grant Programs, OAA Title VI (Tribal 

Formula Grants), and ACL discretionary grants. 

In addition to the new grant monitoring framework, ACL senior management is directly engaged 

in developing performance management activities through grants and procurement planning. 

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

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

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

measures. Senior leadership has also implemented processes to better use performance data for 

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

the Administrator/Assistant Secretary, quarterly reviews of operating budgets, and bi-monthly 

managers meetings. 

16 
EXECUTIVE SUMMARY

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

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

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

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

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

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

Department and OMB. 

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

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

Developmental Disability Networks demonstrate solid performance over the past ten years.

17 
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All Purpose Table

Administration for Community Living

(dollars in thousands) 

Program

FY 2014 

Final

FY 2015 

Enacted

FY 2016 

President's 

Budget

FY 2016 +/- FY 

2015

Health & Independence for Older Adults

Home & Community-Based Supportive Services................................................................. 347,724 347,724 386,182 38,458

Nutrition Services...................................................................................................................... 811,191 814,657 874,557 59,900

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

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

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

Native American Nutrition & Supportive Services............................................................... 26,158 26,158 29,100 2,942

Aging Network Support Activities......................................................................................... 7,406 9,961 9,961 --

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

Subtotal, Health & Independence for Older Adults.......................................................... 1,225,327 1,231,348 1,332,648 101,300

Caregiver & Family Support Services

Family Caregiver Support Services......................................................................................... 145,586 145,586 150,586 5,000

Family Support........................................................................................................................... -- -- 15,000 15,000

Native American Caregiver Support Services....................................................................... 6,031 6,031 6,800 769

Alzheimer's Disease Supportive Services Program............................................................... 3,772 3,800 3,800 --

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

Lifespan Respite Care................................................................................................................ 2,342 2,360 5,000 2,640

Subtotal, Caregiver & Family Support Services................................................................. 168,231 168,277 191,686 23,409

Protection of Vulnerable Adults

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

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

Senior Medicare Patrol Program ............................................................................................ 8,888 8,910 8,910 --

Health Care Fraud and Abuse Control [HCFAC] 1/....................................................... 6,591 8,710 8,710 --

Elder Rights Support Activities ............................................................................................. 3,845 7,874 28,874 21,000

Elder Justice {non-add}....................................................................................................... -- 4,000 25,000 21,000

Subtotal, Protection of Vulnerable Adults.......................................................................... 39,982 46,152 67,152 21,000

Disability Programs, Research & Services

State Councils on Developmental Disabilities....................................................................... 70,692 71,692 71,692 --

Developmental Disabilities Protection and Advocacy........................................................ 38,634 38,734 38,734 --

University Centers for Excellence in Developmental Disabilities....................................... 36,674 37,674 38,619 945

Projects of National Significance............................................................................................. 8,821 8,857 14,500 5,643

Youth Transitions {non-add}............................................................................................... -- -- 5,000 5,000

National Institute on Disability, Independent Living, and Rehabilitation Research 4/... 103,970 103,970 108,000 4,030

Independent Living 4/............................................................................................................... 101,183 101,183 106,183 5,000

Subtotal, Disability Programs, Research & Services......................................................... 359,974 362,110 377,728 15,618

19 
EXECUTIVE SUMMARY

Consumer Information, Access & Outreach

Aging and Disability Resource Centers................................................................................. 15,347 6,119 20,000 13,881

Aging and Disability Resource Centers [Discretionary] {non-add}........................... 6,067 6,119 20,000 13,881

Aging and Disability Resource Centers [Mandatory] 2/ {non-add}........................... 9,280 -- -- --

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

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

Assistive Technology 4/.......................................................................................................... 33,000 33,000 31,000 (2,000)

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

National Clearinghouse for Long-Term Care Information................................................... -- -- 1,000 1,000

Limb Loss Resource Center 5/................................................................................................. 2,810 2,800 2,810 10

Paralysis Resource Center........................................................................................................ 6,683 6,700 6,700 --

Medicare Improvements for Patients and Providers Act [TRA/BBA] 3/........................ 17,500 8,750 -- (8,750)

Subtotal, Consumer Information, Access & Outreach...................................................... 136,618 118,647 122,788 4,141

Program Administration 6/........................................................................................................ 37,476 37,709 40,063 2,354

Subtotal, Program Level.......................................................................................................... 1,967,608 1,964,243 2,132,065 167,822

Less: Funds From Mandatory Sources

HCFAC Wedge Funds 1/.......................................................................................................... (6,591) (8,710) (8,710) --

ACA Direct Appropriations 2/ ................................................................................................ (9,280) -- -- --

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

Medicare Improvements for Patients and Providers Act 3/................................................ (17,500) (8,750) -- 8,750

Total, Discretionary Budget Authority.................................................................................... 1,906,537 1,919,083 2,095,655 176,572

1/ $8,710,146 is a placeholder amount in FY 2016. The Secretary and Attorney General will determine the final amount.

2/ Mandatory funding for ADRCs was provided under PL 111-148 in FY 2014. In FY 2016, all funding requested for this program is discretionary.

3/ Includes funding for ADRCs, AAAs, and the National Center for Benefits Outreach Enrollment. Funding for the SHIPs is appropriated to CMS 

 and administered by ACL through an Intra-Departmental Delegation of Authority (IDDA).

 4/ Funding for FY 2014 is displayed comparably. Funding for FY 2015 reflects the estimated annualized amount transferred to ACL, based on a 

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

5/ Funding for FY 2014 is displayed comparably. Funding for this program was appropriated to ACL beginning in FY 2015. 

6/ Funding for FY 2014 includes estimated comparable funding for programs transferred to ACL from the Department of Education by the 

 Workforce Innovation and Opportunity Act. Funding for FY 2015 includes the annualized amount transferred to ACL for program administration, 

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

20 
Appropriations Language

Administration for Community Living

Aging and Disability Services Programs

(including transfer of funds) 

For carrying out, to the extent not otherwise provided, the [OAA] Older Americans Act of 

1965 (“OAA”), titles III and XXIX of the PHS Act, section 119 of the Medicare Improvements 

for Patients and Providers Act of 2008, section 6021(d) of the Deficit Reduction Act of 2005, title 

XX–B of the Social Security Act, the Developmental Disabilities Assistance and Bill of Rights 

Act, parts 2 and 5 of subtitle D of title II of the Help America Vote Act of 2002, the Assistive 

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

Rehabilitation Act of 1973, and for Department-wide coordination of policy and program 

activities that assist individuals with disabilities, [$1,621,141,000] $2,043,540,000, together with 

$52,115,000 to be transferred from the Federal Hospital Insurance Trust Fund and the Federal 

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

Reconciliation Act of 1990: Provided, That, amounts appropriated under this heading may be 

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

promotion programs and activities which have been demonstrated through rigorous evaluation to 

be evidence-based and effective: Provided further, That, notwithstanding section 206(g) of the 

OAA, up to one percent of amounts appropriated to carry out programs authorized under title III 

of such Act shall be available for conducting evaluations, training, and technical assistance: 

[none of the funds provided shall be used to carry out sections 1701 and 1703 of the PHS 

Act (with respect to chronic disease self-management activity grants), except that such 

funds may be used for necessary expenses associated with administering any such grants 

awarded prior to the date of the enactment of this Act:] Provided further, That 

21 
EXECUTIVE SUMMARY

notwithstanding any other provision of this Act, funds made available under this heading to carry 

out section 311 of the OAA may be transferred to the Secretary of Agriculture in accordance 

with such section. 

22
EXECUTIVE SUMMARY

Appropriations Language Analysis

Administration for Community Living

Language Provision Explanation

...section 6021(d) of the Deficit Reduction Act 

of 2005... 

Provides authorization for the National 

Clearinghouse for Long-Term Care 

Information

... the Assistive Technology Act of 1998, titles 

II and VII (and section 14 with respect to such 

titles) of the Rehabilitation Act of 1973... 

Provides authorization for the Assistive 

Technology, Independent Living, and the 

National Institute on Disability, Independent 

Living, and Rehabilitation Research programs 

transferred to ACL from the Department of 

Education by the Workforce Innovation and 

Opportunity Act 

Provided further, That, notwithstanding section 

206(g) of the OAA, up to one percent of 

amounts appropriated to carry out programs 

authorized under title III of such Act shall be 

available for conducting evaluations, training, 

and technical assistance:

Authorizes ACL to increase its set-aside from 

0.5% to up to 1% of funding provided under 

Title III of the OAA to evaluate OAA 

programs and disseminate the results 

throughout the Aging Services Network 

23 
EXECUTIVE SUMMARY

Amounts Available for Obligation

Administration for Community Living

General Fund Discretionary Appropriation:

Appropriation (L/HHS)................................................................. 1,610,143,000 1,621,141,000 2,043,540,000

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

Subtotal, Appropriation (L/HHS, Ag, or Interior)................. 1,610,143,000 1,621,141,000 2,043,540,000

Secretary's Transfer....................................................................... -4,358,000 -- --

Subtotal, adjusted appropriation............................................. 1,605,785,000 1,621,141,000 2,043,540,000

Transfer of Funds to Department of Agriculture 1/................. -2,391,605 -2,549,334 --

Comparable transfer from Centers for Disease Control 2/....... 2,810,000 --

Comparable transfer from Department of Education 3/............ 245,827,000 245,827,000 --

Subtotal, adjusted general fund discr. appropriation........... 1,852,030,395 1,864,418,666 2,043,540,000

Total, Discretionary Appropriation................................... 1,852,030,395 1,864,418,666 2,043,540,000

Mandatory Appropriation:

Appropriation (PPACA) ADRCs................................................ 9,280,000 -- --

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

Appropriation (Taxpayer Relief Act) MIPPA............................ 17,500,000 8,750,000 --

Subtotal, adjusted mandatory. appropriation........................ 54,480,000 36,450,000 27,700,000

Offsetting collections from:

Trust Funds: HCFAC.................................................................... 6,590,974 8,710,146 8,710,146

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

Subtotal, spending authority from offsetting collections... 58,705,974 60,825,146 60,825,146

Unobligated balance, lapsing.......................................................... 684,512 -- --

Total obligations............................................................................ 1,965,900,881 1,961,693,812 2,132,065,146

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

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

All Purpose Table.

2/ Funding shown includes comparable amounts appropriated to CDC for the Limb Loss Resource Center program 

transferred to ACL in FY 2015.

3/ Funding shown includes FY 2014 estimated comparable amounts and FY 2015 estimated annualized amounts 

appropriated to the Department of Education for programs transferred to ACL by the Workforce Innovation and

Opportunity Act.

FY 2014

 Actual

FY 2015

Enacted

FY 2016 

President's 

Budget

24 
EXECUTIVE SUMMARY

Summary of Changes

Administration for Community Living

(Dollars in thousands) 

2015

1,919,083

2016

2,095,648

176,565

FY 2016 FY 2016

FY 2016 +/- 

FY 2015

FY 2016 +/- 

FY 2015

PB FTE PB BA FTE BA

Increases:

A. Program:

1. Home & Community Based Supportive Services.................................................... -- 386,182 -- 38,458

2. Nutrition Services......................................................................................................... -- 874,557 -- 59,900

3. Native American Nutrition & Supportive Services................................................. -- 29,100 -- 2,942

4. Family Caregiver Support Services............................................................................ -- 150,586 -- 5,000

5. Family Support.............................................................................................................. -- 15,000 -- 15,000

6. Native American Caregiver Support Services.......................................................... -- 6,800 -- 769

7. Lifespan Respite Care.................................................................................................. -- 5,000 -- 2,640

8. Elder Rights Support Activities................................................................................. 4 28,874 2 21,000

9. University Centers for Excellence in Developmental Disabilities......................... -- 38,619 -- 945

10. Projects of National Significance............................................................................. -- 14,500 -- 5,643

11. National Institute on Disability, Independent Living, and Rehab Research..... -- 108,000 -- 4,030

12. Independent Living.................................................................................................... -- 106,183 -- 5,000

13. Aging and Disability Resource Centers................................................................. -- 20,000 -- 13,881

14. National Clearinghouse for Long-Term Care Information ................................... -- 1,000 -- 1,000

15. Limb Loss Resource Center...................................................................................... -- 2,810 -- 10

16. Program Administration............................................................................................ 198 40,063 7 2,354

Subtotal, Program Increases..................................................................................... 202 1,827,274 9 178,572

Total Increases......................................................................................................... 1,827,274 178,572

Decreases:

A. Program:

1. Assistive Technology................................................................................................. 31000 -2000

Subtotal, Program Decreases................................................................................... 31,000 2,000

Total Decreases....................................................................................................... 2,000

Net Change........................................................................................................... 176,572

Net Change............................................................................................................................................................................................

Total estimated budget authority...........................................................................................................................................................

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

Total estimated budget authority...........................................................................................................................................................

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

25 
EXECUTIVE SUMMARY

Budget Authority by Activity

Administration for Community Living

(Dollars in Thousands) 

Health & Independence for Older Adults

Home & Community-Based Supportive Services 347,724 347,724 386,182

Nutrition Services 811,191 814,657 874,557

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

Native American Nutrition & Supportive Services 26,158 26,158 29,100

Aging Network Support Activities 7,406 9,961 9,961

Subtotal, Health & Independence for Older Adults 1,212,327 1,218,348 1,319,648

Caregiver & Family Support Services

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

Family Support -- -- 15,000

Native American Caregiver Support Services 6,031 6,031 6,800

Alzheimer's Disease Supportive Services Program 3,772 3,800 3,800

Lifespan Respite Care 2,342 2,360 5,000

Subtotal, Caregiver & Family Support Services 157,731 157,777 181,186

Protection of Vulnerable Adults

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

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

Senior Medicare Patrol Program 8,888 8,910 8,910

Elder Rights Support Activities 3,845 7,874 28,874

Subtotal, Vulnerable Adults 33,391 37,442 58,442

Disability Programs, Research & Services

State Councils on Developmental Disabilities 70,692 71,692 71,692

Protection and Advocacy 38,634 38,734 38,734

University Centers for Excellence in Developmental Disabilities 36,674 37,674 38,619

Projects of National Significance 8,821 8,857 14,500

National Institute on Disability, Independent Living, and Rehab. Research 4/ 103,970 103,970 108,000

Independent Living 4/ 101,183 101,183 106,183

Subtotal, Disability Programs, Research & Services 359,974 362,110 377,728

FY 2014

Actual

FY 2015

Enacted

FY 2016 

President's Budget

26 
EXECUTIVE SUMMARY

Consumer Information, Access & Outreach

Aging and Disability Resource Centers [Discretionary] 6,067 6,119 20,000

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

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

Assistive Technology 4/ 33,000 33,000 31,000

National Clearinghouse for Long-Term Care Information 3/ -- -- 1,000

Limb Loss Resource Center 5/ 2,810 2,800 2,810

Paralysis Resource Center 6,683 6,700 6,700

Subtotal, Consumer Information, Access & Outreach 105,638 105,697 118,588

Program Administration 37,476 37,709 40,056

Total, Discretionary Budget Authority 1,906,537 1,919,083 2,095,648

HCFAC Wedge Funds 1/ 6,591 8,710 8,710

ACA Direct Appropriations 9,280 -- --

ADRC Mandatory Funding (ACA) {Non-Add} 2/ 9,280 -- --

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

Chronic Disease Self-Management Education {Non-Add} 8,000 8,000 8,000

Falls Prevention {Non-Add} 5,000 5,000 5,000

Alzheimer's Disease Initiative - Services {Non-Add} 10,500 10,500 10,500

Alzheimer's Disease Initiative - Communications {Non-Add} 4,200 4,200 4,200

Taxpayer Relief Act/Bipartisan Budget Act 3/ 17,500 8,750 --

Aging and Disability Resource Centers {Non-Add} 5,000 2,500 --

Area Agencies on Aging {Non-Add} 7,500 3,750 --

National Center for Benefits Outreach & Enrollment {Non-Add} 5,000 2,500 --

Total, Program Level 1,967,608 1,964,243 2,132,058

1/ $8,710,146 is a placeholder amount in FY 2016. The Secretary and Attorney General will determine the final amount.

2/ Mandatory funding for ADRCs was provided under PL 111-148 in FY 2014. In FY 2016, all funding requested for this program is

 discretionary.

3/ Includes funding for ADRCs, AAAs, and the National Center for Benefits Outreach Enrollment. Funding for the SHIPs is 

 appropriated to CMS and administered by ACL through an Intra-Departmental Delegation of Authority (IDDA).

 4/ Funding for FY 2014 is displayed comparably. Funding for FY 2015 reflects the estimated annualized amount transferred to ACL,

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

programs directly.

5/ Funding for FY 2014 is displayed comparably. Funding for this program was transferred to ACL beginning in FY 2015. 

6/ Funding for FY 2014 includes estimated comparable funding for programs transferred to ACL from the Department of Education by

 the Workforce Innovation and Opportunity Act. Funding for FY 2015 includes the estimated annualized amount transferred to ACL

 for program administration, based on a determination order between the Department of Education and ACL. For FY 2016, 

ACL is requesting these funds directly.

27 
EXECUTIVE SUMMARY

Authorizing Legislation

Administration for Community Living

FY 2015 

Amount 

Authorized

FY 2015 

Appropriations 

Act

FY 2016 

Amount 

Authorized

FY 2016 

President's 

Budget

1) Home and Community-Based Supportive Services:

OAA Section 321................................................................................. Expired 347,724,000 Expired 386,182,000

2) Nutrition Services

OAA Sections 311, 331, and 336 1/................................................... Expired 814,657,000 Expired 874,557,000

3) Preventive Health Services:

OAA Section 361................................................................................. Expired 19,848,000 Expired 19,848,000

4) National Family Caregiver Support Program:

OAA Section 371................................................................................. Expired 145,586,000 Expired 150,586,000

5) Family Support:

OAA Title IV, and Developmental Disabilities 

Assistance and Bill of Rights Act Section 163............................... Expired 0 Expired 15,000,000

6) Native American Nutrition and Supportive Services: 

OAA Sections 613 and 623................................................................ Expired 26,158,000 Expired 29,100,000

7) Native American Caregiver Support Program: 

OAA Section 631................................................................................. Expired 6,031,000 Expired 6,800,000

8) Long-Term Care Ombudsman Program:

 OAA Section 712................................................................................ Expired 15,885,000 Expired 15,885,000

9) Prevention of Elder Abuse and Neglect: 

OAA Section 721................................................................................. Expired 4,773,000 Expired 4,773,000

10) Senior Medicare Patrol Program

 OAA Sections 201 and 202, as amended........................................ Expired 8,910,000 Expired 8,910,000

11) Elder Rights Support Activities

 OAA Sections 201, 202, and 411, 751, and 752, as Expired 7,874,000 Expired 28,874,000

amended. Social Security Act, Title XX-B, Section 2042...............

12) Aging Network Support Activities: 

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

13) Alzheimer's Disease Demonstration Grants 1/

Public Health Services Act Section 398........................................... Expired 3,800,000 Expired 3,800,000

14) Lifespan Respite Care 1/

Lifespan Respite Care Act of 2006 and

Public Health Service Act Title XXIX.............................................. Expired 2,360,000 Expired 5,000,000

15) Program Administration:

OAA Section 205................................................................................. Expired 37,709,000 Expired 40,063,000

28 
EXECUTIVE SUMMARY

FY 2015 

Amount 

Authorized

FY 2015 

Appropriations 

Act

FY 2016 

Amount 

Authorized

FY 2016 

President's 

Budget

16) Aging and Disability Resource Centers

OAA Section 202b............................................................................... Expired 6,119,000 Expired 20,000,000

17) State Health Insurance Assistance Program:

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

18) State Councils on Developmental Disabilities

DD Act Section 129(a)........................................................................ Expired 71,692,000 Expired 71,692,000

19) Protection and Advocacy

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

20) University Centers for Excellence in Developmental Disabilities

DD Act Section 156............................................................................. Expired 37,674,000 Expired 38,619,000

21) Projects of National Significance 

DD Act Section 163............................................................................. Expired 8,857,000 Expired 14,500,000

22) Voting Assistance for People with Disabilities

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

23) Paralysis Resource Center 1/

Public Health Services Act Sections 311 and 317(k)(2)................. N/A 6,700,000 N/A 6,700,000

24) National Clearinghouse on Long-Term Care Information

Deficit Reduction Act of 2005 Section 6021(d)............................... Expired 0 Expired 1,000,000

25) National Institute on Disability, Independent Living, 

and Rehabilitation Research 4/

Rehabilitation Act of 1973, Title II.................................................... 103,970,000 103,970,000 112,001,000 108,000,000

26) Independent Living 4/

Rehabilitation Act of 1973, Title VII, Parts B, C, and Chapter 2

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

Centers for Independent Living.................................................... 78,305,000 78,305,000 84,353,000 83,305,000

27) Assistive Technology 4/

Assistive Technology Act of 1998................................................... Expired 33,000,000 Expired 31,000,000

28) Limb Loss Resource Center 5/

Public Health Services Act, Title III.................................................. N/A 2,800,000 N/A 2,810,000

Total Request Level $1,919,083,000 $2,095,655,000

Unfunded Authorizations:

1) Legal Assistance:

OAA Section 731................................................................................. Such Sums 0 Such Sums 0

29 
EXECUTIVE SUMMARY

Appropriations History Table

Administration for Community Living

Budget Estimate 

to Congress

House 

Allowance

Senate 

Allowance Appropriation

FY 2007 1,334,835,000 1,390,306,000 1,380,516,000 1,383,007,000

FY 2008 /1 1,335,146,000 1,417,189,000 1,451,585,000 1,438,567,000

FY 2008 Rescission -- -- -- -25,131,765

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

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

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

FY 2010 Transfer -224,298

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

FY 2011 Rescission -3,000,646

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

FY 2012 Rescission -2,785,299

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

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

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

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

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

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

FY 2016 2,095,655,000

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

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

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

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

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

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

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

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

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

6/ Includes $2,542,042 in FY 2013 budget authority appropriated to AoA and transferred to the 

 Department of Agriculture for commodities purchases pursant to Public Law 113-6

7/ Includes $2,391,605 in FY 2014 budget authority appropriated to AoA and transferred to the 

 Department of Agriculture for commodities purchases pursant to Public Law 113-76.

8/ Includes $2,549,334 in FY 2015 budget authority appropriated to AoA and transferred to the 

 Department of Agriculture for commodities purchases pursant to Public Law 113-235.

30 
EXECUTIVE SUMMARY

Appropriations Not Authorized by Law

Administration for Community Living

Program

Last Year of 

Authorization

Authorization 

Level

Appropriations 

in Last Year of 

Authorization

Appropriations 

in FY 2015

Alzheimer's Disease 

Suppoertive Services: 

PHSA Section 398 FY 2002 Such Sums $11,483,000 $3,800,000

Older Americans Act FY 2011 Such Sums $1,927,486,000 $1,474,645,000

Lifespan Respite Care: 

Lifespan Respite Care 

Act of 2006 FY 2011 $94,810,000 $2,495,000 $2,360,000

State Health Insurance 

Assistance Programs: 

Omnibus Budget 

Reconciliation Act of 

1990 FY 1996 $10,000,000 N/A $52,115,000

Developmental 

Disabilities

Assistance and Bill of 

Rights Act FY 2007 Such Sums $155,115,000 $156,957,000

National Clearinghouse 

for Long-Term Care: 

Deficit Reduction Act 

of 2005 section 6021(d) FY 2010 $1,000,000 $3,000,000 $0

Elder Justice / Adult 

Protective Services: 

Social Security Act, 

Title XX-B FY 2014 $129,000,000 $0 $4,000,000

31 
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Health and Independence for Older Adults

Summary of Request

The Administration on Aging’s Health and Independence Programs, authorized primarily by the 

Older Americans Act, provide a foundation of supports that assist older individuals to remain 

healthy and independent in their homes and communities, avoiding more expensive institutional 

care. These programs include home and community-based supportive services, nutrition services 

(meals in both congregate settings and those delivered to seniors in their homes), preventive 

health and chronic disease self-management services, and community employment services. 

The U.S. population over age 60 is projected to increase by 20 percent in six years, between 

2014 and 2020, from 64.8 million to 77.6 million.6 In addition, the number of seniors age 65 and 

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

are at greatest risk of nursing home admission, is projected to increase by more than 20 percent 

over the same period.7 Health and Independence Programs are vital to helping seniors remain in 

their homes and communities for as long as possible. For example, 61 percent of congregate and 

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

living in their own homes. Additionally, 52 percent of seniors using transportation services rely 

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

critical daily activities that help them to remain in the community.8

ACL’s FY 2016 funding request for Health and Independence services is $1,332,648,000; an 

increase of +$101,300,000 from the comparable FY 2015 enacted level. For FY 2016, specific 

program requests include: 

• $386,182,000 for Home and Community-Based Supportive Services (HCBSS), an 

increase of +$38,458,000 above the FY 2015 enacted level. HCBSS provides grants to 

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

long as possible, including adult day care, transportation, case management, personal care 

services, chore services, and physical fitness programs. These services also aid 

caregivers, who might otherwise have to be even more intensively relied upon to provide 

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

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

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

2015.

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

population Data from the 2012 Medicare Current Beneficiary Survey. [data tables 2.5a and 2.6a]. 

http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS/Data-Tables-Items/2012CNP.html. 

Accessed 23 October, 2014.

8 2012 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/.

33 

 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

• care for their loved ones, taking more time away from their work and other family 

responsibilities. 

• $874,557,000 for three Nutrition Services programs (Congregate Nutrition Services, 

Home-Delivered Nutrition Services and the Nutrition Services Incentives Program), and 

innovation dollars to modernize service delivery, an increase of +$59,900,000 above the 

FY 2015 enacted level. Nutrition Services help nearly 2.4 million older adults receive the 

meals they need to stay healthy and decrease their risk of disability. In FY 2016, these 

funds will support an estimated 208 million meals. 

• $19,848,000 for Preventive Health Services, the same as the FY 2015 enacted level. 

These services support activities that educate older adults about the importance of healthy 

lifestyles and promote healthy behaviors that can help prevent, delay, or enable seniors to 

better cope with and manage chronic disease and disability, thereby reducing the need for 

more costly medical interventions. ACL is continuing to include appropriations language 

that requires States to use their Preventive Health Services funds for proven 

evidence-based prevention activities. 

• $8,000,000 for Chronic Disease Self-Management Education (CDSME), requested again 

for FY 2016 from the Prevention and Public Health Fund (PPHF) authorized under the 

Affordable Care Act. This would continue funding at the same level proposed in the 

FY 2015 enacted level. CDSME programs have proven effective in helping people to 

better self-manage their chronic conditions and reduce their need for more costly medical 

interventions. 

• $5,000,000 for Falls Prevention, requested again for FY 2016 from the Prevention and 

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

continue funding at the same level proposed in the FY 2015 enacted level. Falls are the 

leading cause of both fatal and nonfatal injuries for those 65 and over. However, ACL's 

national infrastructure has enabled over 264,000 individuals throughout the country to 

participate in evidence-based chronic disease self-management education, falls 

prevention, diabetes self-management training, physical activity, nutrition education, and 

depression management programs.

• $29,100,000 for Native American Nutrition and Supportive Services, an increase of 

+$2,942,000 above the FY 2015 enacted level. These funds will provide approximately 

5.4 million meals and 620,000 rides for Native American seniors to critical daily

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

34 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

• $9,961,000 for Aging Network Support Activities, the same as the FY 2015 enacted 

level. These funds support competitive grants and contracts for ongoing activities which 

help seniors and their families obtain information about their care options and benefits, 

and which assist States, Tribes, and community providers of aging services in carrying 

out their mission to help older people, including survivors of the Holocaust, remain 

independent and live in their own homes and communities. 

Outcome Table:

Measure Most Recent Result FY 2015

Target

FY 2016

Target

FY 2016

+/- FY 2015

2.10: Increase the likelihood that the 

most vulnerable people receiving 

Older Americans Act Home and 

Community-based and Caregiver 

Support Services will continue to live 

in their homes and communities. 

(Outcome)

FY 2013: 64.2% 

Target: 63% 

(Target Exceeded)

62.5% 63.0% + 0.5

3.3: The % of Older American Act

clients served who live in rural areas is 

at least 15% greater than the percent of 

all US elders who live in rural areas. 

(Outcome)

FY 2013: 35.9% 

Target: 26.2% 

(Target Exceeded)

26.2% 26.2% Maintain

3.6: The percentage of OAA Clients 

served who live in poverty is at least 

150% greater than the percent of all 

US elders who live below poverty.

FY 2013: 31.6%

Target: 24.9% 

(Target Exceeded) 

24.85% 24.75% - 0.1

35 
This page intentionally left blank. 
Home and Community-Based Supportive Services

FY 2014 

Final

FY 2015 

Enacted

FY 2016 

President's 

Budget

FY 2016 +/- 

FY 2015

Home and CommunityBased Supportive Services $347,724,000 $347,724,000 $386,182,000 $38,458,000 

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

FY 2016 Older Americans Act Authorization ...................................................................... Expired

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

Program Description and Accomplishments:

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

provides grants to States and Territories based on their share of the population age 60 and over to 

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

possible. Programs like the HCBSS program serve seniors holistically. While each service is 

valuable in and of itself, it is often the combination of supports that, when tailored to the needs of 

the individual, ensures that clients can remain in their own homes and communities instead of 

entering nursing homes or other types of institutional care. 

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

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

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

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

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

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

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

those aged 85 and older, 58 percent are unable to perform critical activities of daily living and 

require long-term support. Data also show that over 90 percent of seniors have at least one 

chronic condition and 75 percent have at least two.9 Providing a variety of supportive services 

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

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

expensive nursing home care. 

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

from the 2012 Medicare Current Beneficiary Survey. [data tables 2.5a and 2.6a]. http://www.cms.gov/ResearchStatistics-Data-and-Systems/Research/MCBS/Data-Tables-Items/2012CNP.html. Accessed 23 October, 2014.

37 

 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

Services provided by the HCBSS program in FY 2013, the most recent available data, include: 

• Transportation Services provided 24.2 million rides to doctor’s offices, grocery stores, 

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

• Personal Care, Homemaker, and Chore Services provided nearly 30 million hours of 

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

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

(Output D).

• Adult Day Care/Day Health nearly 8 million hours of care for dependent adults in a 

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

(Output E). 

• Case Management Services provided 4 million hours of assistance in assessing needs, 

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

(Output F). 

Continuing ACL’s commitment to provide services to those in most need, nearly 47 percent of 

riders on OAA-funded transportation are mobility impaired, meaning they do not own a car, or if 

they do own a car they do not drive, and are not near public transportation.10 Many of these 

individuals cannot safely drive a car, as nearly 75 percent of transportation riders have at least 

one of the following chronic conditions that could impair their ability to navigate safely:11

 

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

macular degeneration or cataracts); 

• 7 percent have Alzheimer’s or dementia; 

• 2 percent have Multiple Sclerosis; 

• 14 percent have had a stroke; 

• 3 percent have epilepsy; and 

• 2 percent have Parkinson’s disease. 

 

10 2014 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/.

11 Id.

38 

 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

Of the transportation participants, 96 percent take daily medications, with over 12 percent taking 

10 to 20 medications daily.12 Data from ACL’s National Surveys of OAA Participants show that 

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

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

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

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

of the services arranged by the case manager that they were better able to care for themselves.13 

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

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

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

14 

Funding History:

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

follows: 

FY 2006 ...................................$350,354,000 

FY 2007 ...................................$350,595,000 

FY 2008 ...................................$351,348,000 

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

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

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

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

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

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

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

Budget Request:

The FY 2016 request for Home and Community-Based Supportive Services is $386,182,000, an 

increase of +$38,458,000 above the FY 2015 enacted level. HCBSS funding remained flat and 

has not kept pace with demand in recent years, which has led to declining levels of service due to 

inflation and stable or declining State, and local funding for these programs. The FY 2016 

request will allow ACL to increase services to the increasing number of the population in need, 

12 2014 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/.

13 Id.

14 Chen, Ya Mei and Elaine Adams Thompson. Understanding Factors That Influence Success of Home- and 

Community-Based Services in Keeping Older Adults in Community Settings. 2010. Journal of Aging and Health. 

V. 22: 267. Available: http://jah.sagepub.com/cgi/content/abstract/22/3/267.

39 

 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

which can significantly reduce the risk of nursing home admission. At this level, the overall 

budget request will support nearly 8 million hours of adult day care for older adults; 23.5 million 

rides for critical daily activities such as visiting the doctor, the pharmacy, or grocery stores; and 

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

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

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

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

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

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

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

their older loved ones, but also, in the current tight economy, to provide assistance to their adult 

children. 

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

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

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

in institutional settings.15 Nationally, 25 percent of individuals 60 and older live alone16, and in 

FY 2016 ACL projects 67.5 percent of the OAA transportation users will be individuals who live 

alone (Outcome 2.11). Living alone is a key predictor of nursing home admission, and HCBSS 

services are critical to their ability to remain at home, especially for those who do not have an

informal caregiver to assist with their care. Recent research has also shown that childless seniors 

who live in a State with higher home and community-based service expenditures had 

significantly lower risk of nursing home admissions.17 

Federal support for OAA programs is not expected to cover the cost of serving every senior. 

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

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

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

requirements. 

Although transportation, adult day care, and chore services have had a downward trend in the 

provision of service units since at least 2007, the budget requested in FY 2016 would provide an 

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

from the 2012 Medicare Current Beneficiary Survey. [Table 1.2 Demographic and Socioeconomic Characteristics 

of Medicare Beneficiaries, by Age and by Gender and Age, 2012]. http://www.cms.gov/Research-Statistics-Dataand-Systems/Research/MCBS/Data-Tables-Items/2012CNP.html. Accessed 23 October, 2014. 

16 Administration for Community Living, http://www.agid.acl.gov/DataGlance/. Data-at-a-Glance: American 

Community Survey (ACS) Public Use Microdata Sample (PUMS) 1-Year Files (2012), accessed January, 08, 

2015. 

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

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

40 

 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

increase in these service unit measures of performance for home and community-based services. 

Increases in outputs are projected despite inflation, which can often increase the cost per unit of 

service for these programs.

Outputs and Outcomes Table:

Home and Community-Based Supportive Services Outputs and Outcomes 

Measure Most Recent Result FY 2015 

Target 

FY 2016

Target 

FY 2016 +/- 

FY 2015 

2.9b: Maintain at 90% or higher the 

percentage of transportation clients 

who rate services good to excellent

(Outcome) 

FY 2013: 97% 

Target: 90% 

(Target Exceeded)

90% 90% Maintain

2.10: Increase the likelihood that the 

most vulnerable people receiving 

Older Americans Act Home and 

Community-based and Caregiver 

Support Services will continue to live 

in their homes and communities. 

(Outcome)

FY 2013: 64.2% 

Target: 63% 

(Target Exceeded)

62.5% 63.0% + 0.5

2.11: Increase the percentage of 

transportation clients who live alone.

(Outcome)

FY 2013: 68%

Target: 70% 

(Target Not Met)

67% 67.5% + 0.5

3.3: The % of OAA clients served who 

live in rural areas is at least 15% 

greater than the percent of all US 

elders who live in rural areas. 

(Outcome)

FY 2013: 35.9% 

Target: 26.2% 

(Target Exceeded)

26.2% 26.2% Maintain

3.6: The % of OAA clients served who 

live in poverty is at least 150% greater 

than the percent of all US elders who 

live below poverty.

FY 2013: 31.6% 

Target 24.85%

(Target Exceeded)

24.85% 24.75% - 0.1 

Indicator Most Recent Result FY 2015 

Projection 

FY 2016

Projection 

FY 2016 +/- 

FY 2015

Output C: Transportation Services 

units (Output) FY 2013: 24.2 M 23.0 M 23.5 M + 0.5 M 

Output D: Personal Care, Homemaker 

and Chore Services units (Output) FY 2013: 29.8 M 28.3 M 28.5 M + 0.2 M 

Output E: Adult Day Care/Day Health 

units (Output) FY 2013: 7.95 M 7.6 M 7.7 M + 0.1 M

Output F: Case Management Services 

units (Output) FY 2013: 4.0 M 4.0 M 4.0 M Maintain

Note: For presentation within the budget ACL highlighted specific measures that are most directly related to Home 

and Community-Based Supportive Services; however multiple performance outcomes are impacted by this program 

because ACL’s performance measures (efficiency, effective targeting, and client outcomes) assess network-wide 

performance in achieving current strategic objectives. 

41 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

Grant Awards Tables:

Home and Community-Based Supportive Services Grant Awards 

FY 2014 Final FY 2015 

Enacted

FY 2016 

President’s 

Budget

Number of 

Awards 56 56 56

Average 

Award $6,147,264 $6,147,264 $6,827,146

Range of 

Awards

$215,155 - 

$34,081,746

$215,155 - 

$34,081,746

$238,950 - 

$39,082,557

42 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2016 DISCRETIONARY STATE FORMULA GRANTS

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

State/Territory

FY 2014

Final

FY 2015 

Enacted

FY 2016 

President’s 

Budget

FY 2016 +/- 

FY 2015

Alabama........................................... 5,325,874 5,325,874 5,816,476 490,602

Alaska .............................................. 1,721,234 1,721,234 1,911,601 190,367

Arizona ............................................ 6,478,530 6,478,530 8,052,473 1,573,943

Arkansas.......................................... 3,450,663 3,450,663 3,610,227 159,564

California......................................... 34,081,746 34,081,746 39,082,557 5,000,811

Colorado .......................................... 4,095,054 4,095,054 5,464,852 1,369,798

Connecticut...................................... 4,341,017 4,341,017 4,404,337 63,320

Delaware.......................................... 1,721,234 1,721,234 1,911,601 190,367

District of Columbia ........................ 1,721,234 1,721,234 1,911,601 190,367

Florida ............................................. 24,898,663 24,898,663 27,855,262 2,956,599

Georgia ............................................ 7,795,519 7,795,519 9,928,983 2,133,464

Hawaii ............................................. 1,721,234 1,721,234 1,911,601 190,367

Idaho................................................ 1,721,234 1,721,234 1,911,601 190,367

Illinois.............................................. 14,316,068 14,316,068 14,524,890 208,822

Indiana ............................................. 6,827,801 6,827,801 7,456,124 628,323

Iowa ................................................. 4,199,620 4,199,620 4,260,878 61,258

Kansas ............................................. 3,383,554 3,383,554 3,432,908 49,354

Kentucky.......................................... 4,673,107 4,673,107 5,181,336 508,229

Louisiana ......................................... 4,726,948 4,726,948 5,049,599 322,651

Maine............................................... 1,721,234 1,721,234 1,911,601 190,367

Maryland.......................................... 5,773,227 5,773,227 6,531,196 757,969

Massachusetts.................................. 8,091,074 8,091,074 8,209,095 118,021

Michigan.......................................... 11,093,893 11,093,893 12,125,990 1,032,097

Minnesota ........................................ 5,420,599 5,420,599 6,175,873 755,274

Mississippi....................................... 3,225,660 3,225,660 3,373,026 147,366

Missouri........................................... 7,016,089 7,016,089 7,285,919 269,830

Montana........................................... 1,721,234 1,721,234 1,911,601 190,367

Nebraska .......................................... 2,261,944 2,261,944 2,294,938 32,994

Nevada............................................. 2,426,000 2,426,000 3,108,718 682,718

New Hampshire ............................... 1,721,234 1,721,234 1,911,601 190,367

43 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

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

State/Territory

FY 2014

Final

FY 2015 

Enacted

FY 2016 

President’s 

Budget

FY 2016 +/- 

FY 2015

New Jersey...................................... 10,115,423 10,115,423 10,289,663 174,240

New Mexico ................................... 2,036,483 2,036,483 2,451,822 415,339

New York ....................................... 23,934,312 23,934,312 24,283,431 349,119

North Carolina ................................ 9,234,231 9,234,231 11,387,010 2,152,779

North Dakota .................................. 1,721,234 1,721,234 1,911,601 190,367

Ohio ................................................ 13,618,168 13,618,168 14,196,928 578,760

Oklahoma ....................................... 4,216,778 4,216,778 4,404,977 188,199

Oregon ............................................ 4,074,931 4,074,931 4,991,148 916,217

Pennsylvania................................... 17,622,920 17,622,920 17,879,977 257,057

Rhode Island................................... 1,721,234 1,721,234 1,911,601 190,367

South Carolina ................................ 4,722,656 4,722,656 5,896,258 1,173,602

South Dakota .................................. 1,721,234 1,721,234 1,911,601 190,367

Tennessee ....................................... 6,663,028 6,663,028 7,716,870 1,053,842

Texas .............................................. 20,033,849 20,033,849 24,527,337 4,493,488

Utah ................................................ 1,839,934 1,839,934 2,328,474 488,540

Vermont.......................................... 1,721,234 1,721,234 1,911,601 190,367

Virginia........................................... 7,751,887 7,751,887 9,048,265 1,296,378

Washington..................................... 6,357,321 6,357,321 7,877,988 1,520,667

West Virginia.................................. 2,733,663 2,733,663 2,773,538 39,875

Wisconsin ....................................... 6,298,516 6,298,516 6,913,857 615,341

Wyoming ........................................ 1,721,234 1,721,234 1,911,601 190,367

Subtotal, States............................... 337,532,792 337,532,792 375,044,013 37,511,221

American Samoa............................. 465,527 465,527 472,317 6,790

Guam .............................................. 860,617 860,617 955,800 95,183

Northern Mariana Islands............... 215,155 215,155 238,950 23,795

Puerto Rico ..................................... 4,312,052 4,312,052 4,653,300 341,248

Virgin Islands ................................. 860,617 860,617 955,800 95,183

Subtotal, States and Territories....... 344,246,760 344,246,760 382,320,180 38,073,420

Undistributed 18/............................ 3,477,240 3,477,240 3,861,820 384,580

TOTAL 347,724,000 347,724,000 386,182,000 

 

38,458,000

18 The undistributed line reflects the amount reserved from the HCBSS appropriation for statutory related activities, 

including contingencies and for program support including information and systems, technical assistance, 

evaluation, monitoring and oversight. Funds unused for these purposes at the end of the year are allocated to States.

44 

 
Nutrition Services

FY 2014 

Final

FY 2015 

Enacted

FY 2016 

President's 

Budget

FY 2016 +/- 

FY 2015

Congregate Nutrition....... $438,191,000 $438,191,000 $458,091,000 $19,900,000

Home-Delivered Nutrition $216,397,000 $216,397,000 $236,397,000 $20,000,000

Nutrition Services Incentive 

Program....................... $156,603,000 $160,069,000 $160,069,000 --

Nutrition Innovation 

Demonstrations.............. -- -- $20,000,000 $20,000,000

Total........................... $811,191,000 $814,657,000 $874,557,000 $59,900,000

Authorizing Legislation: Sections 311, 331, 336, and 411 of the Older Americans Act of 1965, as 

amended

FY 2016 Older Americans Act Authorization ...................................................................... Expired

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

Program Description and Accomplishments:

Nutrition Services help seniors remain healthy and independent in their communities by 

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

as senior centers) and via home-delivery to seniors who are homebound due to illness, disability, 

or geographic isolation. Nutrition Services include: 

• Congregate Nutrition Services (Title III-C1): Provides funding for the provision of meals 

and related services in a variety of congregate settings, which helps to keep older 

Americans healthy and prevents the need for more costly medical interventions. 

Established in 1972, the program also presents opportunities for social engagement and 

meaningful volunteer roles, which contributes to their overall health and well-being. 

• Home-Delivered Nutrition Services (Title III-C2): Provides funding for the delivery of 

meals and related services to frail seniors who are homebound. Established in 1978, 

home-delivered meals are often the first in-home service that an older adult receives and 

serve as a primary access point for other home and community-based services. Homedelivered meals also represent an essential service for some caregivers who also receive 

meals, helping them to maintain their own health and well-being while caring for their 

loved ones. 

45 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

• Nutrition Services Incentive Program (Title III-A): Provides additional funding to States, 

Territories, and eligible Tribal Organizations that is used exclusively to purchase food 

and cannot be used to pay for other nutrition-related services or for administrative costs. 

Funds are awarded to States, Territories, and eligible Tribal Organizations based on the 

number of meals served in the prior Federal fiscal year. Recipients have the option to 

purchase commodities directly from the U.S. Department of Agriculture (USDA) with 

any portion of their award if they determine that doing so will enable them to better meet 

the needs of seniors. Seven States and five Tribes elected to spend nearly $2.4 million on 

commodities, including $141,939 assessed by USDA as administrative expenses, in 

FY 2014. 

Formula grants for Congregate Nutrition Services and Home-Delivered Nutrition Services are 

allocated to States and Territories based on their share of the population age 60 and over. 

Nutrition Services Incentive Program grants are provided to States, Territories, and eligible 

Tribal organizations based on the number of meals served in the prior Federal fiscal year. The 

meals provided through these programs fulfill the standards set by the Dietary Guidelines for 

Americans and provide a minimum of 33 percent of the Dietary Reference Intake, as established 

by the Food and Nutrition Board of the Institute of Medicine of the National Academy of 

Sciences. 

Nutrition Services help approximately 2.4 million older adults receive the meals they need to 

stay healthy and decrease their risk of disability. Studies have found that 50 percent of all 

persons age 85 and over are in need of assistance with instrumental activities of daily living 

(IADLs), including obtaining and preparing food.19 These nutrition programs help address their

needs. Serving Elders at Risk, a national evaluation of ACL’s nutrition program clients, found 

that nutrition services recipients are older, poorer, more likely to live alone, more likely to be 

minorities, in poorer health, in poorer nutritional status, more functionally impaired, and at 

higher nutritional risk than those in the general population. Nutrition Services provide an 

important opportunity for social interaction that helps to improve the general health status of 

participants, including homebound elders. A comparison of the number of social contacts of 

congregate and home-delivered meal participants showed that nutrition program clients had 

significantly more social contacts than older adults who did not participate in the program. 

Multiple chronic diseases and conditions negatively affect quality of life, contribute to declines 

in functioning and the ability to remain in the community, adversely impact individuals’ health, 

19 Hung et al. Recent trends in chronic disease, impairment and disability among older adults in the United States. 

BMC Geriatrics. 2011. 11:47.

46 

 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

and contribute to increased hospitalizations and health care costs.20 Many of the most common 

chronic conditions such as hypertension, heart disease, diabetes, and osteoporosis are related to 

nutrition as a primary prevention, risk reduction, or treatment modality. Data also show that 

Medicare beneficiaries with multiple chronic conditions are the heaviest users of health care 

services. For example, the two-thirds of Medicare beneficiaries with two or more chronic 

conditions account for 93 percent of Medicare spending, and the one-third of Medicare 

beneficiaries with four or more chronic conditions account for almost three-fourths of Medicare 

spending.21

Because the prevalence of multiple chronic conditions is higher among congregate and homedelivered meal program participants than for the general Medicare population, the provision of 

healthy meals, access to lifestyle modification programs, and evidence-based advice such as 

nutrition education and counseling are important to helping these individuals avoid more serious 

medical care. Data from ACL’s National Survey of OAA Participants indicate that about 

57 percent of congregate and 72 percent of home-delivered participants have 5 or more illnesses 

and conditions. About 32 percent of congregate and 51 percent of home-delivered participants 

take over six medications per day and some take as many as 30 medications.22 The congregate 

and home-delivered program participants are significantly less healthy than the general Medicare 

population and access to healthy meals is essential to their well-being. 

Prevalence for malnutrition or risk for malnutrition across the community- and facility-based 

care settings has varied based on factors used to determine malnutrition. A study applying 

similar criteria found the lowest prevalence (38 percent) among older adults in the community, 

compared to 91 percent in rehabilitation facilities, 86 percent in hospitals, and 67 percent in 

nursing homes.23 Data from the National Survey of OAA Participants indicate that about 

21 percent of congregate and 37 percent of home-delivered program participants stayed 

overnight in the hospital or a nursing home in the past year and thus might be at risk of 

malnutrition.24 Individuals transitioning between or among facility-based care settings and their

homes are likely to be in poorer health and at higher risk for poor nutrition, and have an 

increased need for healthy home-delivered and congregate meals as well as nutrition education 

and counseling to aid recovery and decrease the risk of readmission. 

Even if an older adult has not been hospitalized in the past year, the older adult participants 

served in the congregate and home-delivered nutrition programs demonstrate a greater need for 

healthy prepared meals, rather than simply access to food. Data from the National Survey of 

20 Lochner KA, Cox CS. Prevalence of Multiple Chronic Conditions among Medicare Beneficiaries, United States, 

2010. Prev Chronic Dis 2013; 10:120137. DOI http://dix.doi.org/10.5888/pcd10.12037 21 Id. 22 2014 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/. 23 Kaiser et al. JAGS 2010; 58: 1734-1738 24 2014 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/.

47 

 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

OAA Participants indicate that about 11 percent of congregate and over 40 percent of homedelivered participants indicate that they have 3 or more impairments in instrumental activities of 

daily living (IADLs), meaning that they may be unable to shop for groceries and prepare meals 

for themselves. The data also indicate that about 16 percent of congregate and 51 percent of 

home-delivered participants need help in getting outside the house, thus limiting their ability to 

shop for food themselves.25 Although many of these older adults may rely on family and friends 

for assistance, about 46 percent of congregate and 52 percent of home-delivered participants live 

alone.26 Living alone is a risk factor for social isolation, poorer health, and nursing home

placement.

Data from ACL’s National Survey of OAA Participants show that Nutrition Services are 

effectively helping older adults improve their nutritional intake and remain at home. For 

example, data indicate that 77 percent of congregate and 84 percent of home-delivered meal 

participants say they eat healthier meals due to the programs, and 61 percent of congregate and 

93 percent of home-delivered meal recipients say that the meals enable them to continue living in 

their homes.27 The extra support provided by these programs can help older adults avoid more

costly institutional care. Using State Program Report data, made available on ACL’s data portal 

(www.agid.acl.gov), independent research has found that states that invest more in delivering 

meals (both Federal, state, and all other sources of funding) to older adults’ homes have lower 

rates of “low-care” seniors in nursing homes who have the functional capacity to live in a less 

care-intensive environment, after adjusting for several other factors.28 For every $25 per year per 

older adult that states spend on home-delivered meals, they reduce their percentage of low-care 

nursing home residents compared to the national average by 1 percent.29

ACL’s annual performance data further demonstrate that these programs are an efficient and 

effective means to help seniors remain healthy and independent in their homes and in the

community. Eighty-nine percent of home-delivered meal clients rate service as good to excellent 

(Outcome 2.9a). Also, the percentage of home-delivered meal recipients with severe disabilities 

(3+ ADL) was 43.5 percent in 2013 (Outcome 3.5). This level of disability is frequently

associated with nursing home admission, and demonstrates the extreme frailty of a significant 

number of home-delivered meal clients. The most recent data on how these nutrition programs, 

in combination with state and local funding for nutrition, are helping seniors remain healthy and 

independent in their homes include: 

25 Id. 26 Id. 27 Id. 28 Thomas, K & Mor, V. The Relationship between Older Americans Act Title III State Expenditures & Prevalence 

of Low-Care Nursing Home Residents. Health Services Research. 12.3.12. 

http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12015/abstract

29 Id.

48 

 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

• Home-Delivered Nutrition Services provided 136 million meals to over 

830,000 individuals in FY 2013 (Output G). 

• Congregate Nutrition Services provided over 83.4 million meals to 1.6 million seniors in 

a variety of community settings in FY 2013 (Output H).

Funding History:

Comparable funding for Nutrition Services during the past ten years is as follows:

FY 2006 ...................................$714,578,000 

FY 2007 ...................................$735,070,000 

FY 2008 ...................................$758,003,000 

FY 2009 ...................................$809,743,000 

FY 2009 (ARRA) .......................$97,000,000 

FY 2010 ...................................$819,353,000 

FY 2011 ...................................$817,835,000 

FY 2012 ...................................$816,289,000 

FY 2013 ...................................$768,310,870 

FY 2014 ...................................$811,191,000 

FY 2015 ...................................$814,657,000 

Budget Request:

The FY 2016 request for Nutrition Services is $874,557,000, an increase of +$59,900,000 above 

the FY 2015 enacted level. This includes an additional $39,900,000 for congregate and homedelivered nutrition services. At this level, the budget request combined with state and local 

contributions will support approximately 208 million home-delivered and congregate meals to 

more than 2.3 million elderly individuals in a variety of community settings, which would allow

ACL to maintain approximately the same level of meals as is currently projected in FY 2015, 

and halt the decline in service levels for the first time since 2009-2010 when these programs 

received a one-time funding increase due to the American Recovery and Reinvestment Act. This 

budget also provides $20,000,000 to enable ACL to fund evidence-based demonstration grants, 

aimed at enhancing the quality and effectiveness of our nutrition program services. 

Nutrition Services must continue to be funded because they, like HCBSS, help to delay the need 

for much more expensive institutional services. Consistent with ACL’s commitment to target 

services to those most in need to help them maintain their health and independence, 

approximately 66 percent of home-delivered meal recipients have annual incomes at or below 

49 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

$20,000.30 Meals are especially critical for the survival of the nearly 62 percent of recipients 

who report these meals as half or more of their food intake for the day and for the 45 percent of 

home-delivered meal recipients with severe disabilities who are projected to be served in 

FY 2016.31 This population with severe disabilities is particularly important to serve since this 

level of disability is frequently an eligibility requirement for more costly nursing home 

admission. 

Federal support for Nutrition Services is not expected to serve every older American in need. 

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

organizations, and private donors that contribute funding. In FY 2013, State and local funding 

comprised approximately 63 percent of all the funding for home-delivered meals and congregate 

meals. Though all programs funded through OAA rely on State and local funding in some part, 

funding for congregate and home-delivered meals leverages more State and local financial 

support than many other OAA services. 

In FY 2016 these programs are expected to continue to provide home-delivered meals that clients 

rate as good to excellent (Outcome 2.9a), ensuring that clients continue to receive high quality 

services. However, as Federal funds do not keep up with inflation and State and local funding 

tightens, some providers may look at cost cutting measures such as reducing menu choices or the 

frequency of deliveries. This could affect client satisfaction with the quality of service. 

While investments in nutrition services are clearly needed, it is also critical that ACL work with 

our state and local partners to modernize these services and ensure that every dollar is spent 

effectively. As noted above, research clearly shows that providing nutrition services improves 

the health of participants and reduces their need for more expensive medical interventions and 

institutional care. Translating the knowledge generated by this research into evidence-based 

models for delivering services at the community level is essential to ensuring the continued 

efficacy of these programs and improving their efficiency. This knowledge is also needed to help 

to prepare these programs to meet the changing demands of seniors as the baby boom generation 

ages – for example, serving clients who will be more accustomed to interacting with service 

providers over the web and via smartphone apps than only by phone. 

Evidence-based innovation projects would focus on a number of priorities, including efforts to:

• Modernize the infrastructure and delivery mechanisms in use by the national aging 

network to insure that States and Tribal Organizations are able to maximize the return on 

investment in nutrition programs, both in terms of number of meals and seniors that they 

are able to serve and in terms of the impact that these programs have;

30 2014 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/.

31 Id

50 

 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

• Instill, increase, and then maintain consistent quality in meals and nutrition services 

through collaborative efforts among State Units on Aging, Area Agencies on Aging, 

Tribal organizations, and local nutrition service providers; 

• Improve quality, service and effectiveness of providing meals and other nutrition services 

to meet the special nutrition needs of ethnically and culturally appropriate diets as well as 

religious needs of diverse communities; 

• Utilize new food and food service technology and equipment as well as food service 

personnel (such as chefs) to reduce costs, improve service and delivery, and add value; 

• Enhance communication through effective use of health IT and other techniques to 

improve business practices and establish quality feedback procedures to report outcomes 

to the entities at risk for meal recipients’ health care costs; and

• Develop innovative ways to use existing nutrition sites for other health promotion 

activities that could receive sustainable funding outside the OAA, and likewise, develop 

innovative uses of existing nutrition sites as multi-purpose community sites and cafes for 

the broader populations and needs in the community. 

Examples of innovative and promising practices that enhance the quality and effectiveness of our

nutrition program include service products that appeal to caregivers (such as web-based ordering 

systems and carryout meals), increased involvement of volunteers (such as retired chefs), 

consideration of eating habits and choice (such as variable meal times, salad bars, or more fresh 

fruits and vegetables), new service models (testing variations and hybrid strategies) and other 

innovations to better serve the younger cohort of older adults whose needs and preferences may 

be different from those of older cohorts. Through this program, funds may be used to help 

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

community-based settings. 

ACL anticipates awarding approximately 20 grants of up to $1 million. As has been done with 

Preventive Health Services, ACL will provide guidance to potential grantees regarding 

acceptable evidence-based practices and interventions. 

51 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

Outcomes and Outputs Table:

Nutrition Services Outcomes and Outputs 

Measure Most Recent Result FY 2015

Target 

FY 2016 

Target 

FY 2016 +/- 

FY 2015

1.1: For Home and 

Community-Based Services 

including Nutrition 

Services, and Caregiver 

services increase the 

number of clients served 

per million dollars of ACL

funding. (Outcome)

FY 2013: 9,753

Target: 9,300

(Target Exceeded)

9,250 8,700 - 550

2.9a: Maintain at 90% or 

higher the percentage of 

home-delivered meal 

clients who rate services 

good to excellent. 

(Outcome)

FY 2012: 89% 

Target: 90% 

(Target Not Met)

90% 90% Maintain

3.5: Increase the percentage 

of older persons with severe 

disabilities who receive 

home-delivered meals.

(Outcome)

FY 2012: 43.5%

Target: Baseline 44.8% 45.0% +0.2 

Indicator Most Recent Result FY 2015

Projection 

FY 2016

Projection 

FY 2016 +/- 

FY 2015

Output G: Number of 

Home-Delivered meals 

served (Output)

FY 2013: 136 M 129 M 129 M Maintain

Output H: Number of 

Congregate meals served

(Output)

FY 2012: 83.4 M 79 M 79 M Maintain

Outputs G& H: Total 

Number of Meals (Outputs) FY 2012: 219.4 M 208 M 208 M Maintain

Note: For presentation within the budget ACL highlighted specific measures that are most directly related to 

Nutrition Services, however multiple performance outcomes are impacted by this program because ACL’s 

performance measures (efficiency, effective targeting, and client outcomes) assess network-wide performance in 

achieving current strategic objectives. 

52 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

Grant Awards Tables:

Congregate Nutrition Programs Grant Awards 

FY 2014 Final FY 2015 

Enacted

FY 2016 

President’s 

Budget

Number of 

Awards 56 56 56

Average 

Award $7,746,591 $7,746,591 $8,098,394

Range of 

Awards

$271,131 - 

$43,228,051

$271,131 - 

$43,228,051

$283,444 - 

$46,294,011

Home-Delivered Nutrition Programs Grant Awards

FY 2014 Final FY 2015 

Enacted

FY 2016 

President’s 

Budget

Number of 

Awards 56 56 56

Average 

Award $3,825,590 $3,825,590 $4,179,161

Range of 

Awards

$133,896 - 

$22,048,734

$133,896 - 

$22,048,734

$146,271 - 

$24,229,113

Nutrition Services Incentive Program Grant Awards 

FY 2014 Final FY 2015 

Enacted

FY 2016 

President’s

Budget

Number 

of 

Awards32

319 319 319

Average 

Award33 $490,919 $496,766 $496,766

Range of 

Awards34 $762 - 

$15,927,625

$779 - 

$16,113,431

$779 - 

$16,113,431

32 Number of awards includes 264 awards to Tribal organizations. 33 If the 264 awards to Tribal organizations are excluded from the “average award” calculation, the average award to 

States, DC, and the territories is $2,779,430 in FY 2014 and $2,881,242 in FY 2015 and FY 2016.

34 If the 264 award to Tribal organizations are excluded from the “range of awards” calculation, the smallest award 

to States, DC, and the territories is $58,437 in FY 2014 and $59,119 in FY 2015 and FY 2016.

53 

 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2016 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Congregate Nutrition Services (CFDA 93.045)

State/Territory

FY 2014

Final

FY 2015 

Enacted

FY 2016 

President’s 

Budget

FY 2016 +/- 

FY 2015

Alabama........................................... 6,511,955 6,511,955 6,889,723 377,768

Alaska .............................................. 2,169,045 2,169,045 2,267,550 98,505

Arizona ............................................ 8,895,789 8,895,789 9,538,304 642,515

Arkansas.......................................... 4,163,564 4,163,564 4,276,380 112,816

California......................................... 43,228,051 43,228,051 46,294,011 3,065,960

Colorado .......................................... 5,978,941 5,978,941 6,473,219 494,278

Connecticut...................................... 5,241,452 5,241,452 5,241,452 0

Delaware.......................................... 2,169,045 2,169,045 2,267,550 98,505

District of Columbia ........................ 2,169,045 2,169,045 2,267,550 98,505

Florida ............................................. 30,962,559 30,962,559 32,995,073 2,032,514

Georgia ............................................ 10,973,199 10,973,199 11,761,064 787,865

Hawaii ............................................. 2,169,045 2,169,045 2,267,550 98,505

Idaho................................................ 2,169,045 2,169,045 2,267,550 98,505

Illinois.............................................. 17,286,541 17,286,541 17,286,541 0

Indiana ............................................. 8,320,826 8,320,826 8,831,916 511,090

Iowa ................................................. 5,081,501 5,081,501 5,081,501 0

Kansas ............................................. 4,089,903 4,089,903 4,089,903 0

Kentucky.......................................... 5,791,780 5,791,780 6,137,389 345,609

Louisiana ......................................... 5,645,998 5,645,998 5,981,344 335,346

Maine............................................... 2,169,045 2,169,045 2,267,550 98,505

Maryland.......................................... 7,244,786 7,244,786 7,736,322 491,536

Massachusetts.................................. 9,780,267 9,780,267 9,780,267 0

Michigan.......................................... 13,524,083 13,524,083 14,363,460 839,377

Minnesota ........................................ 6,834,789 6,834,789 7,315,435 480,646

Mississippi....................................... 3,891,114 3,891,114 3,995,412 104,298

Missouri........................................... 8,467,047 8,467,047 8,630,306 163,259

Montana........................................... 2,169,045 2,169,045 2,267,550 98,505

Nebraska .......................................... 2,738,802 2,738,802 2,738,802 0

Nevada............................................. 3,420,814 3,420,814 3,682,334 261,520

New Hampshire ............................... 2,169,045 2,169,045 2,267,550 98,505

54 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

PROGRAM/CFDA NUMBER: Congregate Nutrition Services (CFDA 93.045)

State/Territory

FY 2014

Final

FY 2015 

Enacted

FY 2016 

President’s 

Budget

FY 2016 +/- 

FY 2015

New Jersey...................................... 12,190,488 12,190,488 12,190,488 0

New Mexico ................................... 2,727,494 2,727,494 2,904,229 176,735

New York ....................................... 28,963,855 28,963,855 28,963,855 0

North Carolina ................................ 12,616,135 12,616,135 13,488,124 871,989

North Dakota .................................. 2,169,045 2,169,045 2,267,550 98,505

Ohio ................................................ 16,393,785 16,393,785 16,816,524 422,739

Oklahoma ....................................... 5,080,736 5,080,736 5,217,776 137,040

Oregon ............................................ 5,508,448 5,508,448 5,912,107 403,659

Pennsylvania................................... 21,279,716 21,279,716 21,279,716 0

Rhode Island................................... 2,169,045 2,169,045 2,267,550 98,505

South Carolina ................................ 6,522,158 6,522,158 6,984,227 462,069

South Dakota .................................. 2,169,045 2,169,045 2,267,550 98,505

Tennessee ....................................... 8,608,241 8,608,241 9,140,776 532,535

Texas .............................................. 27,060,605 27,060,605 29,053,084 1,992,479

Utah ................................................ 2,556,342 2,556,342 2,758,120 201,778

Vermont.......................................... 2,169,045 2,169,045 2,267,550 98,505

Virginia........................................... 10,058,787 10,058,787 10,717,837 659,050

Washington..................................... 8,686,777 8,686,777 9,331,623 644,846

West Virginia.................................. 3,305,947 3,305,947 3,305,947 0

Wisconsin ....................................... 7,687,478 7,687,478 8,189,592 502,114

Wyoming ........................................ 2,169,045 2,169,045 2,267,550 98,505

Subtotal, States............................... 425,518,338 425,518,338 444,852,333 19,333,995

American Samoa............................. 594,843 594,843 594,843 0

Guam .............................................. 1,084,523 1,084,523 1,133,775 49,252

Northern Mariana Islands............... 271,131 271,131 283,444 12,313

Puerto Rico ..................................... 5,255,732 5,255,732 5,511,920 256,188

Virgin Islands ................................. 1,084,523 1,084,523 1,133,775

 

49,252

Subtotal, States and Territories....... 433,809,090 433,809,090 453,510,090 19,701,000

Undistributed 35/ ............................ 

 

4,381,910

 

4,381,910

 

4,580,910 199,000

TOTAL................................. 438,191,000 438,191,000 458,091,000 19,900,000

35 The undistributed line reflects the amount reserved from the Congregate Nutrition Services appropriation for 

statutory related activities, including contingencies and for program support including information and systems, 

technical assistance, evaluation, monitoring and oversight. Funds unused for these purposes at the end of the year 

are allocated to States.

55 

 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2016 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Home-Delivered Nutrition Services (CFDA 93.045)

State/Territory

FY 2014

Final

FY 2015 

Enacted

FY 2016 

President’s 

Budget

FY 2016 +/- 

FY 2015

Alabama........................................... 3,321,462 3,321,462 3,605,906 284,444

Alaska .............................................. 1,071,165 1,071,165 1,170,165 99,000

Arizona ............................................ 4,537,352 4,537,352 4,992,106 454,754

Arkansas.......................................... 2,068,715 2,068,715 2,238,149 169,434

California......................................... 22,048,734 22,048,734 24,229,113 2,180,379

Colorado .......................................... 3,049,595 3,049,595 3,387,918 338,323

Connecticut...................................... 2,498,252 2,498,252 2,706,223 207,971

Delaware.......................................... 1,071,165 1,071,165 1,170,165 99,000

District of Columbia ........................ 1,071,165 1,071,165 1,170,165 99,000

Florida ............................................. 15,792,643 15,792,643 17,268,784 1,476,141

Georgia ............................................ 5,596,948 5,596,948 6,155,442 558,494

Hawaii ............................................. 1,071,165 1,071,165 1,170,165 99,000

Idaho................................................ 1,071,165 1,071,165 1,170,165 99,000

Illinois.............................................. 8,082,580 8,082,580 8,796,462 713,882

Indiana ............................................. 4,244,089 4,244,089 4,622,401 378,312

Iowa ................................................. 2,193,513 2,193,513 2,381,662 188,149

Kansas ............................................. 1,863,836 1,863,836 2,027,917 164,081

Kentucky.......................................... 2,954,133 2,954,133 3,212,153 258,020

Louisiana ......................................... 2,872,528 2,872,528 3,130,483 257,955

Maine............................................... 1,081,160 1,081,160 1,182,503 101,343

Maryland.......................................... 3,695,248 3,695,248 4,048,995 353,747

Massachusetts.................................. 4,540,013 4,540,013 4,944,825 404,812

Michigan.......................................... 6,898,042 6,898,042 7,517,470 619,428

Minnesota ........................................ 3,486,126 3,486,126 3,828,713 342,587

Mississippi....................................... 1,925,602 1,925,602 2,091,097 165,495

Missouri........................................... 4,155,738 4,155,738 4,516,883 361,145

Montana........................................... 1,071,165 1,071,165 1,170,165 99,000

Nebraska .......................................... 1,217,228 1,217,228 1,323,940 106,712

Nevada............................................. 1,744,807 1,744,807 1,927,240 182,433

New Hampshire ............................... 1,071,165 1,071,165 1,170,165 99,000

56 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

PROGRAM/CFDA NUMBER: Home-Delivered Nutrition Services (CFDA 93.045)

State/Territory

FY 2014

Final

FY 2015 

Enacted

FY 2016 

President’s 

Budget

FY 2016 +/- 

FY 2015

New Jersey...................................... 5,884,229 5,884,229 6,379,045 494,816

New Mexico ................................... 1,391,175 1,391,175 1,519,999 128,824

New York ....................................... 13,027,753 13,027,753 14,127,245 1,099,492

North Carolina ................................ 6,434,937 6,434,937 7,059,342 624,405

North Dakota .................................. 1,071,165 1,071,165 1,170,165 99,000

Ohio ................................................ 8,110,984 8,110,984 8,801,342 690,358

Oklahoma ....................................... 2,514,252 2,514,252 2,730,852 216,600

Oregon ............................................ 2,809,618 2,809,618 3,094,247 284,629

Pennsylvania................................... 9,517,980 9,517,980 10,315,516 797,536

Rhode Island................................... 1,071,165 1,071,165 1,170,165 99,000

South Carolina ................................ 3,326,667 3,326,667 3,655,367 328,700

South Dakota .................................. 1,071,165 1,071,165 1,170,165 99,000

Tennessee ....................................... 4,390,687 4,390,687 4,784,050 393,363

Texas .............................................. 13,802,428 13,802,428 15,205,647 1,403,219

Utah ................................................ 1,303,878 1,303,878 1,443,530 139,652

Vermont.......................................... 1,071,165 1,071,165 1,170,165 99,000

Virginia........................................... 5,130,546 5,130,546 5,609,444 478,898

Washington..................................... 4,430,744 4,430,744 4,883,935 453,191

West Virginia.................................. 1,491,504 1,491,504 1,611,372 119,868

Wisconsin ....................................... 3,921,045 3,921,045 4,286,225 365,180

Wyoming ........................................ 1,071,165 1,071,165 1,170,165 99,000

Subtotal, States............................... 210,210,751 210,210,751 229,685,523 19,474,772

American Samoa............................. 136,498 136,498 146,271 9,773

Guam .............................................. 535,583 535,583 585,083 49,500

Northern Mariana Islands............... 133,896 133,896 146,271 12,375

Puerto Rico ..................................... 2,680,719 2,680,719 2,884,799 204,080

Virgin Islands ................................. 535,583 535,583 585,083 49,500

Subtotal, States and Territories....... 214,233,030 214,233,030 234,033,030 19,800,000

Undistributed 36/............................ 2,163,970 2,163,970 2,363,970 200,000

TOTAL................................... 216,397,000 216,397,000 236,397,000 20,000,000

36 The undistributed line reflects the amount reserved from the Home-Delivered Nutrition Services appropriation for 

statutory related activities, including contingencies and for program support including information and systems, 

technical assistance, evaluation, monitoring and oversight. Funds unused for these purposes at the end of the year 

are allocated to States.

57 

 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2016 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Nutrition Services Incentive Program (CFDA 93.053)

State/Territory

FY 2014

Final

FY 2015 

Enacted

FY 2016 

President’s Budget

FY 2016 +/-

FY 2015

Alabama .......................................... 3,053,645 3,089,267 3,089,267 --

Alaska ............................................. 428,688 433,689 433,689 --

Arizona............................................ 1,856,152 1,877,804 1,877,804 --

Arkansas.......................................... 2,642,603 2,673,429 2,673,429 --

California ........................................ 12,554,022 12,700,468 12,700,468 --

Colorado.......................................... 1,343,341 1,359,011 1,359,011 --

Connecticut ..................................... 1,484,120 1,501,432 1,501,432 --

Delaware ......................................... 677,792 685,699 685,699 --

District of Columbia........................ 498,188 503,999 503,999 --

Florida............................................. 6,272,912 6,346,087 6,346,087 --

Georgia............................................ 2,786,158 2,818,659 2,818,659 --

Hawaii............................................. 395,577 400,191 400,191 --

Idaho ............................................... 717,305 725,673 725,673 --

Illinois............................................. 6,096,331 6,167,446 6,167,446 --

Indiana............................................. 1,781,348 1,802,128 1,802,128 --

Iowa ................................................ 1,940,863 1,963,504 1,963,504 --

Kansas............................................. 2,221,633 2,247,549 2,247,549 --

Kentucky ......................................... 1,842,359 1,863,850 1,863,850 --

Louisiana......................................... 3,336,619 3,375,541 3,375,541 --

Maine .............................................. 606,114 613,185 613,185 --

Maryland ......................................... 1,571,488 1,589,819 1,589,819 --

Massachusetts.................................. 6,078,563 6,149,471 6,149,471 --

Michigan ......................................... 7,478,670 7,565,910 7,565,910 --

Minnesota........................................ 1,947,407 1,970,124 1,970,124 --

Mississippi ...................................... 1,633,374 1,652,428 1,652,428 --

Missouri .......................................... 4,055,402 4,102,709 4,102,709 --

Montana .......................................... 1,188,863 1,202,731 1,202,731 --

Nebraska ......................................... 1,317,323 1,332,689 1,332,689 --

Nevada ............................................ 1,140,975 1,154,285 1,154,285 --

New Hampshire............................... 1,142,862 1,156,193 1,156,193 --

58 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

PROGRAM/CFDA NUMBER: Nutrition Services Incentive Program (CFDA 93.053)

State/Territory

FY 2014

Final FY 2015 Enacted

FY 2016 

President’s 

Budget

FY 2016 +/- 

FY 2015

New Jersey ..................................... 3,677,969 3,720,873 3,720,873 --

New Mexico ................................... 2,106,453 2,131,025 2,131,025 --

New York ....................................... 15,927,625 16,113,431 16,113,431 --

North Carolina................................ 3,383,189 3,422,655 3,422,655 --

North Dakota .................................. 809,432 818,874 818,874 --

Ohio................................................ 5,592,141 5,657,375 5,657,375 --

Oklahoma ....................................... 2,155,059 2,180,198 2,180,198 --

Oregon............................................ 1,856,581 1,878,239 1,878,239 --

Pennsylvania................................... 5,918,127 5,987,163 5,987,163 --

Rhode Island................................... 426,360 431,333 431,333 --

South Carolina................................ 1,418,082 1,434,625 1,434,625 --

South Dakota .................................. 895,460 905,906 905,906 --

Tennessee ....................................... 1,578,163 1,596,573 1,596,573 --

Texas.............................................. 11,785,324 11,922,802 11,922,802 --

Utah ................................................ 1,379,023 1,395,109 1,395,109 --

Vermont.......................................... 796,027 805,312 805,312 --

Virginia........................................... 2,081,156 2,105,433 2,105,433 --

Washington..................................... 2,143,449 2,168,453 2,168,453 --

West Virginia ................................. 1,687,663 1,707,350 1,707,350 --

Wisconsin ....................................... 2,735,030 2,766,935 2,766,935 --

Wyoming........................................ 849,822 859,735 859,735 --

Subtotal, States............................... 149,292,832 151,034,369 151,034,369 --

American Samoa ............................ -- -- -- --

Guam.............................................. 332,811 336,693 336,693 --

Northern Mariana Islands............... 58,437 59,119 59,119 --

Puerto Rico..................................... 2,998,055 3,033,028 3,033,028 --

Virgin Islands................................. 186,505 188,681 188,681 --

Subtotal, States and Territories....... 152,868,640 154,651,890 154,651,890 --

Tribal Organizations........................ 3,734,360 3,816,420 3,816,420 --

Undistributed 37/............................. -- 1,600,690 1,600,690 --

TOTAL................................. 156,603,000 160,069,000 160,069,000 --

37 The undistributed line reflects the amount reserved from the NSIP appropriation for statutory related activities, 

including contingencies and for program support including information and systems, technical assistance, 

evaluation, monitoring and oversight. Funds unused for these purposes at the end of the year are allocated to States.

This amount includes commodities that States elected to use instead of cash.

59 

 
This page intentionally left blank. 
Preventive Health Services

FY 2014 

Final

FY 2015 

Enacted

FY 2016 

President's 

Budget

FY 2016 +/- 

FY 2015

Preventive Health 

Services $19,848,000 $19,848,000 $19,848,000 --

Authorizing Legislation: Section 361 of the Older Americans Act of 1965, as amended 

FY 2016 Older Americans Act Authorization ...................................................................... Expired

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

Program Description and Accomplishments:

Preventive Health Services, established in 1987, provides formula grants to States and Territories 

based on their share of the population aged 60 and over. These funds support activities that 

educate older adults about the importance of healthy lifestyles and promote healthy behaviors 

that can help to prevent or delay chronic disease and disability, thereby reducing the need for 

more costly medical interventions. Preventive Health Services funding gives States and 

Territories flexibility to allocate resources among preventive health activities to best meet local 

needs. Priority has been given to providing services to those elders living in medically 

underserved areas of their state or who have the greatest economic need. 

Due in large part to advances in public health and medical care, Americans are leading longer 

and more active lives. Average life expectancy has increased from less than 50 years at the turn 

of the 20th century to over 78 years today. On average, an American turning age 65 today can 

expect to live an additional 19.2 years.38 The population of older Americans is also growing, 

particularly the population age 85 and over, which is growing very rapidly, totaling 6.2 million in

2014 and projected to reach 9.1 million by the year 2030.39 One consequence of this increased 

longevity is the higher incidence of chronic diseases such as obesity, arthritis, diabetes, 

osteoporosis, and depression, as well as the greater probability of injury from a fall, which 

quickly limits physical activity.

38 National Center for Health Statistics. Health, United States, 2013: With Special Feature on Prescription Drugs. 

Hyattsville, MD. 2014. [ Web update: Table 18 Life expectancy at birth, at age 65, and at age 75, by sex, race, and 

Hispanic origin: United States, selected years 1900–2011] Updated data when available, Excel, PDF, and more 

data years: http://www.cdc.gov/nchs/hus/contents2013.htm#018. Accessed 12 January 2015. 

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

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

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

2015. 

61 

 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

In recent years, some States have increasingly shifted their funding to provide greater support to 

evidence-based approaches, especially to help individuals manage chronic diseases. In FY 2012, 

AoA requested and Congress enacted appropriations language requiring States to use their 

Preventive Health funds to support proven evidence-based models that enhance the wellness and 

fitness of the aging community. The same language has been included in each subsequent year’s 

appropriation’s language, and will also be included in the language proposed for FY 2016. 

Since evidence-based programs have demonstrated their effectiveness, ACL expects that States 

will be able to maximize the impact of these limited dollars. At the same time, if States wish to 

continue funding other health services, such as health screenings, they still have the flexibility to 

continue to use funds provided under the Home and Community-Based Supportive Services 

program for this purpose. 

 

Evidence-based programs are interventions that have been tested through randomized control 

trials and have been shown to be effective at helping participants adopt healthy behaviors, 

improve their health status, and reduce their use of hospital services and emergency room visits. 

Examples of evidence-based interventions include: 

• Enhanced fitness and enhanced wellness programs: Enhanced fitness is a multicomponent group exercise program designed for community-based organizations and 

intended to promote physical activity among older adults. Strength training using soft 

wrist and ankle weights; cardiovascular workout using dancing, aerobics, or walking; and 

balance and posture exercises are used to increase the physical health of older adults. In 

addition, exercise has been proven to improve depression, which studies have shown that 

nearly 20 percent of U.S. adults 65 years and older experience. Exercise may also act as 

a buffer against many illnesses impacted by stress.

• Medication management: Medication management programs focus on reviewing the 

multitude of medications that older adults are prescribed, focusing especially on high-risk 

medications. Medication management programs have been shown to reduce 

cardiovascular problems and unnecessary duplication of prescriptions. These programs 

have also been shown to improve medication usage rates and decrease medication errors 

among older adults.

62 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

Funding History:

Funding for Preventive Health Services during the past five years is as follows: 

FY 2011 .................................................$20,984,000 

FY 2012 .................................................$20,944,000 

FY 2013 .................................................$19,848,825 

FY 2014 .................................................$19,848,000 

FY 2015 .................................................$19,848,000 

Budget Request:

The FY 2016 budget request for Preventive Health Services is $19,848,000, the same as the 

FY 2015 enacted level. ACL continues to request appropriations language that was included by 

Congress since FY 2012, which requires States to use their Preventive Health Services funds to 

support proven evidence-based models that enhance the wellness and fitness of the aging 

community. 

Recognizing that the development of evidence-based programs is ongoing, ACL has invested in 

an Aging and Disability Evidence-Based Program and Practices (ADEPP) review process that 

consists of a rigorous review of evidence-based interventions involving two panels of 

independent expert reviewers. One set of reviewers assess and rate the quality of research; the 

other reviewers rate the program on readiness for dissemination. Intervention summaries are 

made available on ACL’s website at http://www.acl.gov/Programs/CDAP/OPE/ADEPP.aspx and 

a link to the page is one resource on the Title IIID webpage. ADEPP is one way that ACL is 

working to improve access to information on evaluated interventions and reduce the lag time 

between the creation of scientific knowledge and its practical application in the field.

ACL will continue to provide guidance regarding what meets the evidence-based requirement. 

ACL uses a graduated or tiered set of criteria for defining evidence-based interventions 

implemented through the OAA. The OAA Title IIID webpage contains definitions of evidencebased interventions, frequently asked questions, and program examples.40 Grantees can use the 

Title IIID Highest-Tier Criteria Evidence-Based Disease Prevention and Health Promotion 

Programs Cost Chart41 on the site to search the 45+ highest-level criteria programs listed.

Underscoring the need for these programs, the 2014 National Survey of OAA Participants found 

that between 71 and 90 percent of clients across OAA services take three or more different 

40 http://www.aoa.gov/AoARoot/AoA_Programs/HPW/Title_IIID/index.aspx

41 http://www.ncoa.org/improve-health/center-for-healthy-aging/content-library/Title-IIID-Highest-Tier-EvidenceFINAL.pdf

63 

 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

prescription medications every day. In addition, between 21 and 40 percent of clients across 

OAA services reported having stayed overnight in a hospital in the past 12 months. Preventive 

Health Services funding has enabled the Aging Services Network to help older adults control 

their medications and health through the implementation of evidence-based DPHP programs. 

Over 70% of clients across OAA services report learning how to take care of a chronic illness or 

medical condition during the past year. Six to thirteen percent of respondents, representing over 

230,000 OAA clients, reported that they learned through a group class.42

Each of the evidence-based programs for which States could use these funds has been rigorously 

evaluated and found to be effective. By requiring States to use funding for one or more of these 

proven programs, ACL seeks to maximize the impact of this funding on providing benefits to 

individuals and on achieving savings due to reduced medical costs. At the same time, States 

would continue to have the flexibility to use funding provided under the Home and 

Community-Based Supportive Services program to fund related health services, such as health 

screenings and physical fitness programs that do not meet these evidence-based requirements.

Output Table:

Preventive Health Services Output 

Indicator Most Recent 

Result 

FY 2015 

Projection 

FY 2016

Projection 

FY 2016 

+/- FY 2015

Output AB: The number of people served with 

health and disease prevention programs 

(Output)

FY 2013: 

1,543,983 1.5 M 1.5 M Maintain

Grant Awards Tables:

Preventive Health Services Grant Awards

FY 2014 Final FY 2015 

Enacted

FY 2016 

President’s 

Budget

Number of 

Awards 56 56 56

Average 

Award $350,884 $350,884 $350,884

Range of 

Awards

$12,281 -

$1,992,449

$12,281 -

$1,992,449

$12,281 -

$1,992,449

42 2014 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/

64 

 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2016 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Preventive Health Services (CFDA 93.043)

State/Territory

FY 2014

Final

FY 2015 

Enacted

FY 2016 

President’s 

Budget

FY 2016 +/- 

FY 2015

Alabama .......................................... 311,357 311,357 311,357 --

Alaska ............................................. 98,248 98,248 98,248 --

Arizona............................................ 378,742 378,742 378,742 --

Arkansas.......................................... 197,733 197,733 197,733 --

California ........................................ 1,992,449 1,992,449 1,992,449 --

Colorado.......................................... 239,401 239,401 239,401 --

Connecticut ..................................... 244,076 244,076 244,076 --

Delaware ......................................... 98,248 98,248 98,248 --

District of Columbia........................ 98,248 98,248 98,248 --

Florida............................................. 1,455,604 1,455,604 1,455,604 --

Georgia............................................ 455,734 455,734 455,734 --

Hawaii............................................. 98,248 98,248 98,248 --

Idaho ............................................... 98,248 98,248 98,248 --

Illinois............................................. 786,094 786,094 786,094 --

Indiana............................................. 399,161 399,161 399,161 --

Iowa ................................................ 217,047 217,047 217,047 --

Kansas............................................. 179,147 179,147 179,147 --

Kentucky ......................................... 273,195 273,195 273,195 --

Louisiana......................................... 276,343 276,343 276,343 --

Maine .............................................. 98,437 98,437 98,437 --

Maryland ......................................... 337,509 337,509 337,509 --

Massachusetts.................................. 434,993 434,993 434,993 --

Michigan ......................................... 648,562 648,562 648,562 --

Minnesota........................................ 316,895 316,895 316,895 --

Mississippi ...................................... 183,404 183,404 183,404 --

Missouri .......................................... 395,543 395,543 395,543 --

Montana .......................................... 98,248 98,248 98,248 --

Nebraska ......................................... 116,724 116,724 116,724 --

Nevada ............................................ 141,827 141,827 141,827 --

New Hampshire............................... 98,248 98,248 98,248 --

65 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

PROGRAM/CFDA NUMBER: Preventive Health Services (CFDA 93.043)

State/Territory

FY 2014

Final

FY 2015 

Enacted

FY 2016 

President’s 

Budget

FY 2016 +/- 

FY 2015

New Jersey ..................................... 580,295 580,295 580,295 --

New Mexico ................................... 119,055 119,055 119,055 --

New York ....................................... 1,286,483 1,286,483 1,286,483 --

North Carolina................................ 539,844 539,844 539,844 --

North Dakota .................................. 98,248 98,248 98,248 --

Ohio................................................ 781,158 781,158 781,158 --

Oklahoma ....................................... 240,576 240,576 240,576 --

Oregon............................................ 238,225 238,225 238,225 --

Pennsylvania................................... 951,872 951,872 951,872 --

Rhode Island................................... 98,248 98,248 98,248 --

South Carolina................................ 276,092 276,092 276,092 --

South Dakota .................................. 98,248 98,248 98,248 --

Tennessee ....................................... 389,528 389,528 389,528 --

Texas .............................................. 1,171,202 1,171,202 1,171,202 --

Utah ................................................ 107,565 107,565 107,565 --

Vermont.......................................... 98,248 98,248 98,248 --

Virginia........................................... 453,184 453,184 453,184 --

Washington..................................... 371,656 371,656 371,656 --

West Virginia ................................. 143,112 143,112 143,112 --

Wisconsin ....................................... 365,822 365,822 365,822 --

Wyoming........................................ 98,248 98,248 98,248 --

Subtotal, States............................... 19,274,622 19,274,622 19,274,622 --

American Samoa ............................ 12,281 12,281 12,281 --

Guam.............................................. 49,124 49,124 49,124 --

Northern Mariana Islands............... 12,281 12,281 12,281 --

Puerto Rico..................................... 252,088 252,088 252,088 --

Virgin Islands................................. 49,124 49,124 49,124 --

Subtotal, States and Territories....... 19,649,520 19,649,520 19,649,520 --

Undistributed43 ............................... 198,480 198,480 198,480 --

TOTAL................................. 19,848,000 19,848,000 19,848,000 --

43 The undistributed line reflects the amount reserved from the Preventive Health Services appropriation for 

statutory related activities, including contingencies and for program support including information and systems, 

technical assistance, evaluation, monitoring and oversight. Funds unused for these purposes at the end of the year 

are allocated to States.

66 

 
Chronic Disease Self-Management Education

FY 2014 Final

FY 2015 

Enacted

FY 2016 

President's 

Budget

FY 2016 +/- 

FY 2015

CDSME............... $8,000,000 $8,000,000 $8,000,000 --

Note: Funding in FY 2014 and FY 2015 was provided from the Prevention and Public Health Fund, and FY 2016 

funding is requested from the same source.

 

Authorizing Legislation: Sections 311 and 317(k)(2) of the Public Health Service Act, 

[42 U.S.C. Sections 243 and 247b(k)(2)] as amended, and the Patient Protection and Affordable 

Care Act (ACA), Section 4002 [42 U.S.C. 300u-11]

FY 2016 Public Health Service Act Authorization............................................................... Expired

Allocation Method ............................. Competitive Grants/Cooperative Agreements and Contracts 

Program Description and Accomplishments:

Chronic Disease Self-Management Education (CDSME) programs, such as the Stanford 

University Chronic Disease Self-Management Program (CDSMP), are low-cost, evidence-based 

prevention models that use state-of-the-art techniques to help those with chronic conditions 

address issues related to the management and treatment of their condition, build self-confidence, 

improve their health status, and reduce their need for more costly medical care. In addition to the 

CDSMP, which is appropriate for any type of chronic condition, there are other proven CDSME 

programs, including the Spanish CDSMP, the Diabetes Self-Management Program (DSMP), 

Spanish DSMP, Chronic Pain Self-Management Program, Positive Self-Management Program 

for HIV, Arthritis Self-Management Program, and online versions of the CDSMP and DSMP. 

In the United States, over 76 percent of older adults have multiple (2 or more) chronic 

conditions,44 placing them at greater risk for premature death, poor functional status, 

unnecessary hospitalizations, adverse drug events, and nursing home placement. 45 Chronic 

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

from the 2012 Medicare Current Beneficiary Survey. [Table 2.6a Self-Reported Health Conditions and Risk Factors 

of Non-institutionalized Medicare Beneficiaries, by Living Arrangement and Age, 2012]. 

http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS/Data-Tables-Items/2012CNP.html. 

Accessed 23 October, 2014. 

45 Vogeli C, Shields AE, Lee TA, Gibson TB, Marder WD, Weiss KB, Blumenthal D. Multiple chronic conditions: 

prevalence, health consequences, and implications for quality, care management, and costs. J Gen Intern Med 

2007;22(Suppl 3):391–395. http://www. ncbi.nlm.nih. gov/pmc/ articles/PMC2150598/; 

67 

 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

conditions also impact health care costs, as 93 percent of Medicare expenditures are for 

beneficiaries with chronic conditions. 46

CDSME programs have been shown repeatedly, through multiple studies (including randomized 

control experiments, with both English and Spanish speaking populations), to be effective at 

helping participants adopt healthy behaviors, and improve their psychological and physical 

health status. 47 Some evidence suggests that CDSME programs may also significantly reduce 

the use of hospital care and physician services and reduce health care costs.48

CDSMEs emphasize an individual’s role in managing his/her illness. The in-person programs 

consist of a series of workshops that are conducted once a week for two and a half hours over six 

to seven weeks in health care and community settings such as hospitals, churches, libraries, 

YW/MCAs, senior centers, public housing projects, community health centers, and cooperative 

extension programs. People with different chronic health problems attend together, and the 

workshops are facilitated by two trained leaders. One or both of the leaders are non-health 

professionals or lay people with chronic diseases themselves. Core topics covered include: 

techniques to deal with problems such as frustration, fatigue, pain and isolation; appropriate 

exercise for maintaining and improving strength, flexibility, and endurance; appropriate use of 

medications; communicating effectively with health professionals; and nutrition. 

Funding for CDSME is awarded in the form of competitive grants to states. External experts 

review project proposals, and project awards are made for periods of up to three years. In 

FY 2010, AoA funded 47 state grants for CDSME programs for a two year project period, using 

funding provided under the Recovery Act. ACL also funded a Resource Center through a grant 

to the National Council on Aging. Competitive grants and contracts are also used to support 

evaluation, data, and related activities. 

The Recovery Act grants concluded in March 2013. As of April 2013, over 101,000 people had 

completed CDSME courses across the country, well exceeding the programmatic goal to reach 

50,000 completers within two years from the award date. 

A new round of grants, funded in FY 2012 through the Prevention and Public Health Fund 

(PPHF), provided grants to 22 states to continue these activities. These three-year grants will 

46 Nawrocki J. CMS Provides Data on Care for Chronic Conditions to Find Better Care Models. NetNews. April 2, 

2013 http://health.wolterskluwerlb.com/2013/04/cms-provides-data-on-care-for-chronic-conditions-to-help-findbetter-care-models/

47 Brady TJ, Murphy L, O’Colmain BJ, Beauchesne D, Daniels B, Greenberg M, et al. A Meta-Analysis of Health 

Status, Health Behaviors, and Health Care Utilization Outcomes of the Chronic Disease Self-Management Program. 

Prev Chronic Dis 2013;10:120112. http://dx.doi.org/10.5888/pcd10.120112

48 Sobel, DS, Lorig,KR, Hobbs,M. Chronic Disease Self-Management Program: From Development to 

Dissemination. Permanente Journal; Spring 2002.

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HEALTH AND INDEPENDENCE FOR OLDER ADULTS

allow states to provide CDSME programs to approximately 80,000 adults to help them better 

manage chronic conditions. The funding is not only increasing access to CDSME programs, but 

also fostering the development of comprehensive, integrated delivery systems to embed and 

sustain these programs within the long-term supports and services and health care systems. 

Funding History:

Funding for Chronic Disease Self-Management Education during the past five years is as 

follows: 

FY 2011 .................................................................$0 

FY 2012 .................................................$10,000,000 

FY 2013 ...................................................$7,086,000 

FY 2014 ...................................................$8,000,000 

FY 2015 ...................................................$8,000,000 

Budget Request:

ACL requests FY 2016 funding totaling $8,000,000 for CDSME from the Prevention and Public 

Health Fund, the same as the FY 2015 enacted level. The Prevention and Public Health Fund 

(ACA Section 4002) is designed to target resources to activities that invest in prevention and 

public health programs to improve our nation’s health while also restraining the rate of growth in 

public and private sector health care costs. CDSME programs, by emphasizing an individual’s 

role in managing his/her illness, help participants to reduce their pain and depression, improve 

mobility and exercise, increase energy, and boost confidence in their ability to manage their 

conditions.49 A recent national study indicated that the program can also help participants 

achieve better care, better health, and lower health care costs. Participants reported significant 

improvements in aspects of their care (communication with their physicians, medication 

compliance, and health literacy), better health outcomes (self-assessed health, depression and 

quality of life), and reduced health care utilization (lower emergency room visits and 

hospitalizations), resulting in estimated potential cost savings.50 This continued investment of 

resources will allow ACL, in coordination with its existing HHS partners and private 

philanthropy, to continue to build on past investments in CDSME and on ACL’s existing service 

delivery infrastructure as it pursues its goal of taking CDSME to scale nationwide.

49 Brady, TJ, Murphy, L: Sorting through the Evidence: Executive Summary of Arthritis Self-Management Program 

and the Chronic Disease Self-Management Program Meta-Analyses, May 2011, Centers for Disease Control and 

Prevention. http://www.cdc.gov/arthritis/docs/ASMP-executive-summary.pdf

50 Whitelaw, N., Lorig, K., Smith, M. L., & Ory, M. G. (March 19, 2013). National Study of Chronic Disease SelfManagement Programs (CDSMP). Retrieved May 3, 2013 from http://www.ncoa.org/improve-health/center-forhealthy-aging/content-library/CDSMP_Grantee_Webinar_03_19_2013_ALL_FINAL.pdf

69 

 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

Older Americans are disproportionately affected by a vast array of chronic diseases and 

conditions. For example, nearly 11 million adults over the age of 65 have diabetes.51 Minority 

elders – the fastest growing segment of the elderly population – are especially at risk of chronic 

illnesses and conditions. CDSME programs are having a significant reach and impact on these 

populations. In FY 2013 alone, over 29,000 individuals with chronic conditions completed the 

CDSME program through ACL’s network (Output CD1). Nearly 61 percent of participants 

reporting relevant data indicate having multiple chronic conditions, with the most common 

conditions being hypertension (43.7 percent), arthritis (41.1 percent), and diabetes (31.2 percent). 

Over one-third of the participants are minority elders, including 23 percent African-Americans 

and over 16 percent Hispanics. 

CDSME programs are also especially well-suited for delivery through ACL’s network of 

community based organizations, including senior centers, congregate meal programs, faith-based 

organizations and senior housing projects. At the community level, aging services provider 

organizations work in collaboration with public health agencies and health care providers. 

Participant referrals to the CDSME program come from both clinical and community-based 

organizations. Clinical referrals come from community-health centers, physicians, hospitals, 

managed care organizations, and other health system components. Community referrals come 

from a variety of sources, including the Aging and Disability Resource Centers. 

Continued funds will support competitive grants to States, as well as related technical assistance 

and evaluation activities such as a contract for an online database quality assurance system, 

technical assistance on building the business acumen of states and local agencies to help them 

sustain their CDSME programs, and continued funding for a National Resource Center on 

Chronic Disease Self-Management Education Programs. 

Accountability and quality assurance will include tracking a combination of inputs and outputs. 

ACL will track the number of programs being conducted and the number of participants 

completing the program. Participant surveys (pre and post) will be used to track self-reported 

behavioral change and health status. ACL and CMS will establish protocols and mechanisms to 

track CDSME participants’ Medicare claims data to assess the impact of CDSME on health care 

utilization. 

51Centers for Disease Control and Prevention. National Diabetes Fact Sheet. 

http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf,Accessed May 4, 2013.

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HEALTH AND INDEPENDENCE FOR OLDER ADULTS

Outputs and Outcomes Table:

Evaluation 

In its initial evaluation design work, ACL partnered with the Agency for Healthcare Research 

and Quality and the Assistant Secretary for Planning and Evaluation to determine the most 

promising approach for rigorously evaluating the effectiveness of employing CDSME in the

Aging Services Network. In FY 2010, ACL initiated a design contract through AHRQ for 

recommendations on how to best carry out an evaluation. The evaluation design 

recommendations were completed in the spring of 2011. Using the recommendations as a 

foundation, ACL awarded a contract in the fall of 2011 for an evaluation of how the CDSME 

program is being implemented through the aging network and its partners (i.e., a process 

evaluation) and a more detailed outcome evaluation design. The contract was modified in 2012 

to eliminate the detailed outcome evaluation design as ACL is working with CMS to match 

CDSME participants with their Medicare records, and to identify a matched comparison group of 

similar Medicare recipients, in order to analyze changes in health care utilization between the 

two groups. The process evaluation was completed during the summer of 2013 and the final

report is available on the ACL website.

52 A retrospective outcome study conducted by CMS was 

completed in the fall of 2013. A copy of the CMS report which includes CDSME outcomes is 

available on the CMS website.53 CMS is currently conducting a prospective study to analyze 

beneficiary readiness to engage in community based wellness and prevention activities and to 

evaluate existing program impacts on both the health and wellbeing of participating 

beneficiaries.

52 http://www.aoa.acl.gov/Program_Results/Program_Evaluation.aspx

53 http://innovation.cms.gov/Files/reports/CommunityWellnessRTC.pdf

Measure Most Recent Result FY 2015

Target 

FY 2016 

Target 

FY 2016 +/- FY 

2015

CD2: Increase the percentage of 

individuals who complete the 

CDSME program (Outcome)

FY 2013: 74%

(Baseline) 75% 75% Maintain

Indicator Most Recent Result FY 2015 

Projection 

FY 2016

Projection 

FY 2016 

+/- FY 2015 

Output CD1: Total number of 

individuals with chronic 

conditions completing the 

CDSME program (Output)

FY 2013: 29,763 20,000 20,000 Maintain

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HEALTH AND INDEPENDENCE FOR OLDER ADULTS

Grant Awards Table:

Chronic Disease Self-Management Education Grant Awards 

FY 2014 Final FY 2015 

Enacted

FY 2016 

President’s 

Budget

Number of 

Awards 23 11 11

Average 

Award $329,517 $679,918 $679,918

Range of 

Awards

$152,000 - 

$1,000,000

$152,000 - 

$1,000,000

$152,000 - 

$1,000,000

Resource and Program Data:

Chronic Disease Self-Management Education 

(Dollars in Thousands) 

FY 2014 FY 2015 FY 2016

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary -- -- 10 6,479 11 7,479

Continuations 23 7,579 1 1,000 -- --

Contracts 2 218 2 284 2 284

Interagency Agreements -- -- -- -- -- --

Program Support 1/ 203 237 237

Total Resources 8,000 7,989 8,000

1/ Program Support -- Includes funds for grant systems and review, salaries and overhead, and information 

technology support costs.

72 
Falls Prevention

FY 2014 

Final FY 2015 Enacted

FY 2016 

President's 

Budget

FY 2016 +/- 

FY 2015

Falls 

Prevention............... $5,000,000 $5,000,000 $5,000,000 --

Note: Funding in FY 2014 and FY 2015 was provided from the Prevention and Public Health Fund, and FY 2016 

funding is requested from the same source.

Authorizing Legislation: Section 411 of the Older Americans Act of 1965, as amended, and the 

Patient Protection and Affordable Care Act (ACA), Section 4002 [42 U.S.C. 300u-11] 

Allocation Method ............................. Competitive Grants/Cooperative Agreements and Contracts 

Program Description and Accomplishments:

Falls are the leading cause of both fatal and nonfatal injuries for those 65 and over.54 One in 

three adults aged 65 and older falls each year.

55 In 2010, fall-related injuries resulted in 

2.3 million emergency room visits, over 660,000 hospitalizations, about 21,700 deaths, and an 

estimated $30 billion in direct medical costs.56 Of those who fall, 20 to 30 percent will 

experience serious injuries, such as brain trauma, broken bones, or hip fractures.57 The average 

hospital stay for a hip fracture is one week, and about one-third of those with hip fractures stay in 

a nursing home for a year or more.58 These injuries may limit the ability of older adults to get 

around or live independently. Those who are not injured may develop a fear of falling, which 

may increase their actual risk of falling.59 Many people limit their activity after a fall, which may 

reduce strength, physical fitness, and mobility.60 The importance of preventing falls is 

underscored by the inclusion of falls prevention screening in the annual Medicare wellness visit. 

54 Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web–based 

Injury Statistics Query and Reporting System (WISQARS) [online]. Accessed August 15, 2013. 55 Tromp AM, Pluijm SMF, Smit JH, et al. Fall-risk screening test: a prospective study on predictors for falls in 

community-dwelling elderly. J Clin Epidemiol 2001;54(8):837–844. 56 Centers for Disease Control and Prevention, Falls Among Older Adults: An Overview. Retrieved on February 5, 

2014 from http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html 57 Stevens JA. Fatalities and injuries from falls among older adults – United States, 1993–2003 and 2001–2005. 

MMWR 2006b;55.45:1222–24.

58 Centers for Disease Control and Prevention, Hip Fractures Among Older Adults: An Overview. Retrieved on 

February 5, 2014 from http://www.cdc.gov/HomeandRecreationalSafety/Falls/adulthipfx.html

59 Bell AJ, Talbot-Stern JK, Hennessy A. Characteristics and outcomes of older patients presenting to the 

emergency department after a fall: a retrospective analysis. Medical Journal of Australia 2000;173(4):176–7. 60 Vellas BJ, Wayne SJ, Romero LJ, Baumgartner RN, Garry PJ. Fear of falling and restriction of mobility in 

elderly fallers. Age and Ageing 1997;26:189–193.

73 

 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

Falls can result in significant loss of independence and often trigger the onset of a series of 

growing needs. For those over age 75, fallers are more than four times more likely to be admitted 

to a skilled nursing facility.

61 Even without a major injury, falls can cause an older adult to 

become fearful or depressed, making it difficult for them to stay active, which in turn increases 

the need for assistance.

Falls prevention programs help participants to achieve improved strength, balance, and mobility 

and provide education on how to avoid falls and reduce fall risk factors. These programs may 

also involve medication reviews and modifications; provide referrals for medical care 

management for selected fall risk factors; and provide home hazard assessments of ways to 

reduce environmental hazards. Since 2006, more than 27,000 older adults in 38 states have been 

served via ACL-supported Falls Prevention/Management programs, including A Matter of 

Balance, Stepping On, and Tai Chi: Moving for Better Balance. 

Randomized controlled trials of several community-based Falls Prevention/Management 

programs have clearly demonstrated a reduction in falls. When compared with control groups, 

the risk of falling for participants in the Tai Chi: Moving for Better Balance intervention was 

decreased 55 percent;62 and the Stepping On program reduction was 31 percent.63 Matter of 

Balance is an evidence-based program designed to reduce the fear of falling and increase activity 

levels among older adults. Research has shown significant improvements for participants 

regarding their level of falls management (the degree of confidence participants perceive 

concerning their ability to manage the risk of falls and of actual falls); falls control (the degree to 

which participants perceive their ability to prevent falls); level of exercise; and social limitations 

with regard to concern about falling.64 Matter of Balance participation has been associated with 

total medical cost savings, and cost savings in the unplanned inpatient, skilled nursing facility, 

and home health settings. Participation was associated with a -$938 decrease in total medical 

costs per year. This finding was driven by a -$517 reduction in unplanned hospitalization costs, a 

-$234 reduction in skilled nursing facility costs, and an -$81 reduction in home health costs.65

61 Donald IP, Bulpitt CJ. The prognosis of falls in elderly people living at home. Age and Ageing 1999;28:121–5 62 Fuzhong L, Harmer P, Fisher JK, Mcauley E. Tai Chi: Improving Functional Balance and Predicting Subsequent 

Falls in Older Persons. Med Sci Sports Exerc. (2004) 36 (12): 2046-2052. 63 Clemson L, Cumming RG, Kendig H, Swann M, Heard R, Taylor K. The Effectiveness of a Community-Based 

Program for Reducing the Incidence of Falls in the Elderly: A Randomized Trial. J Am Geriatr Soc. (Sept 2004) 52 

(9): 1487–1494. 64 Healy, T.C., Peng, C., Haynes, P., McMahon, E., Botler, J., & Gross, L. (2008). The feasibility and effectiveness 

of translating A Matter of Balance into a volunteer lay leader model. Journal of Applied Gerontology, 27(1): 34-51. 

65 http://innovation.cms.gov/Files/reports/CommunityWellnessRTC.pdf

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HEALTH AND INDEPENDENCE FOR OLDER ADULTS

Funding History

Funding for Falls Prevention during the past five years is as follows: 

FY 2011 .................................................................$0 

FY 2012 .................................................................$0 

FY 2013 .................................................................$0 

FY 2014 ...................................................$5,000,000 

FY 2015 ...................................................$5,000,000 

Budget Request:

ACL is requesting $5,000,000 from the Prevention and Public Health Fund in FY 2016, the same 

as the FY 2015 enacted level. Falls Prevention activities received their first funding in FY 2014, 

and funded a national resource center and provided grants to States, Tribes, and/or other 

applicants to implement evidence-based falls prevention programs through ACL’s network of 

community-based provider organizations that are sustained in community settings. 

ACL’s Falls Prevention program aligns with and complements funding received by the Centers 

for Disease Control and Prevention (CDC), which also carries out falls prevention efforts. CDC’s 

falls prevention programs in the clinical/medical setting refer individuals at risk for falls to 

programs in the community, where ACL excels. ACL has a long-standing commitment to the 

translation of evidence-based prevention programs from the research setting into community 

practice, and funding to ACL leverages, rather than duplicates, what CDC has invested in 

provider training and program translation to improve access to evidence-based programs in local 

communities to prevent older adult falls. ACL's national infrastructure has enabled over 264,000 

individuals throughout the country to participate in evidence-based chronic disease selfmanagement education, falls prevention, diabetes self-management training, physical activity, 

nutrition education, and depression management programs. 

Grants are used to: 

• Promote and disseminate fall prevention tools, including education and evidence-based 

falls prevention material that can be delivered in community settings.

• Align with the Affordable Care Act, including the annual Medicare wellness visits that 

include screening for falls prevention and referrals to community-based interventions, as 

well as care transitions programs to reduce hospital readmissions due to falls. 

75 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

• Utilize and expand the local evidence-based program infrastructure for falls prevention 

programs started in the ACL Evidence-Based Disease and Disability Prevention Program.

• Increase the number of older adults and adults with disabilities at risk for falls who attend 

an evidence-based falls prevention program in their communities.

• Gather and promote best practices for development, implementation, and sustainability of

evidence-based falls prevention programs appropriate for a community setting, including 

innovative collaborations with integrated health care systems and large employer groups. 

Grantees may be expected to implement at least one evidence-based falls 

prevention/management program; establish partnerships/coalitions with Falls Prevention 

coalitions, healthcare providers, public health officials, and ADRCs; and cooperate with federal 

research efforts. Funds may also be used to fund a falls prevention resource center which will 

promote education on falls prevention and best practices for development, implementation, and 

sustainability of falls prevention/management programs. 

Grant Awards Table:

Falls Prevention Program Grant Awards

FY 2014 Final FY 2015 

Enacted

FY 2016 

President’s 

Budget

Number of 

Awards 15 15 15

Average 

Award $323,238 $317,968 $317,968

Range of 

Awards

$200,000 - 

$450,000

$200,000 - 

$450,000

$200,000 - 

$450,000

76 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

Resource and Program Data:

Falls Prevention

(Dollars in Thousands) 

FY 2014 FY 2015 FY 2016

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary 15 4,839 14 4,370 15 4,770

Continuations -- -- 1 400 -- --

Contracts 1 104 1 197 1 197

Interagency Agreements -- -- -- -- -- --

Program Support 1/ 47 34 34

Total Resources 5,000 5,000 5,000

1/ Program Support -- Includes funds for grant systems and review, salaries and overhead, and information 

technology support costs.

77 
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Native American Nutrition and Supportive Services

FY 2014 

Final

FY 2015 

Enacted

FY 2016 

President's 

Budget

FY 2016 +/- 

FY 2015

Native American Nutrition 

& Supportive Services...... $26,158,000 $26,158,000 $29,100,000 $2,942,000

Authorizing Legislation: Sections 201, 613, and 623 of the Older Americans Act of 1965, as 

amended

FY 2016 Older Americans Act Authorization ...................................................................... Expired

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

Program Description and Accomplishments:

Native American Nutrition and Supportive Services provides grants to eligible Tribal 

organizations to promote the delivery of nutrition and home and community-based supportive 

services to Native American, Alaskan Native, and Native Hawaiian elders. An estimated 591,000 

persons age 60 and over identify themselves as Native American or Alaska Native alone or in 

combination with another racial group.66 Over 291,000 of those elders identify as Native 

American or Alaskan Native with no other racial group.67

Native American Nutrition and Supportive Services grants support a broad range of services to 

older Native Americans, including adult day care; transportation; congregate and home-delivered 

meals; information and referral; and personal care, chore, and other supportive services. 

Currently ACL’s congregate meal program reaches 24 percent of eligible Native American 

seniors in participating Tribal organizations, home-delivered meals reach 12 percent of such 

persons, and supportive services reach 41 percent of such persons. These programs, which help 

to reduce the need for costly nursing home care and medical interventions, are responsive to the 

cultural diversity of Native American communities and represent an important part of each 

community’s comprehensive services. 

66 U.S. Census Bureau, 2012 American Community Survey. . S0201: Selected Population Profile In The United 

States. http://factfinder.census.gov. Accessed 12 January 2015. And 2010 Census Summary File 2. DP-1-

Geography-United States POPGROUP-American Indian and Alaska Native alone or in combination with one or 

more other races (300, A01-Z99) & (100-299) or (300, A01-Z99) or (400-999): Profile of General Population and 

Housing Characteristics: 2010. Accessed 26 August 2013.

67 Administration for Community Living, http://www.agid.acl.gov/DataGlance/. Data-at-a-Glance: American 

Community Survey (ACS) Public Use Microdata Sample (PUMS) 1-Year Files (2012), accessed January, 08, 

2015. 

79 

 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

Services provided by this program in FY 2013, the most recent year for which data are available, 

include: 

• Transportation Services, which provided 661,435 rides to meal sites, medical 

appointments, pharmacies, grocery stores, and other critical daily activities (Output L).

• Home-Delivered Nutrition Services, under which 2.6 million meals were provided to 

25,192 homebound Native American elders. The program also provides critical social 

contacts that help to reduce the risk of depression and isolation experienced by many 

home-bound Native American elders (Output M). 

• Congregate Nutrition Services, which provided 2.4 million meals to 52,137 Native 

American elders in community-based settings, as well as an opportunity for elders to 

socialize and participate in a variety of activities, including cultural and wellness 

programs (Output N). 

• Information, Referral and Outreach Services, which provided 920,928 hours of outreach 

and information on services and programs to Native American elders and their families, 

thereby empowering them to make informed choices about their service and care needs 

(Output O). 

The Native American Nutrition and Supportive Services program also provides training and 

technical assistance to Tribal organizations to support the development of comprehensive and 

coordinated systems of services to meet the needs of Native American elders. Training and 

technical assistance is provided through national meetings, site visits, e-newsletters, telephone 

and written consultations, and through the Native American Resource Centers (funded under 

Aging Network Support Activities). 

Eligible Tribal organizations receive nutrition and supportive services formula grants based on 

their share of the American Indian, Alaskan Native, and Native Hawaiian population age 60 and 

over. Tribal organizations must represent at least 50 Native American elders age 60 and over to 

receive funding. There is no requirement for matching funds. In addition, Tribes may decide the 

age at which a member is considered an elder and thus eligible for services. In FY 2014, grants 

were awarded to 264 Tribal organizations (representing 400 Tribes), including one organization

serving Native Hawaiian elders, with an average award of $96,886 and a range of grant awards 

from $63,900 to $1,505,000. 

80 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

Funding History:

Funding for Native American Nutrition and Supportive Services during the past five years is as 

follows: 

FY 2011 .................................................$27,653,000 

FY 2012 .................................................$27,601,000 

FY 2013 .................................................$26,157,052 

FY 2014 .................................................$26,158,000 

FY 2015 .................................................$26,158,000 

Budget Request:

The FY 2016 request for Native American Nutrition and Supportive Services is $29,100,000, an 

increase of +$2,942,000 above the FY 2015 enacted level. 

 

Native American Nutrition and Supportive Services, like the same services that Home and

Community-Based Supportive Services and Nutrition Services fund for States, help to put off the 

need for much more expensive institutional services. The services provided using these funds, 

particularly adult day care, personal care, chore services, and home-delivered meals, also aid 

Native American caregivers, who might otherwise have to be even more intensively involved 

with the care of their loved ones, at the risk of their own health and careers. 

At the FY 2016 request level, these services will provide 620,000 rides (Output L), 2.9 million 

meals at home (Output M), and 2.5 million meals at congregate sites (Output N) to over 

74,000 Native American seniors. Services will allow Native American elders, many of whom

have limitations in activities of daily living that make it difficult to care for themselves, to 

remain at home, in the community, or on the reservation for as long as they desire. 

In FY 2016 the targeted number of units of service, such as home-delivered meals and 

transportation trips, provided to Native Americans per thousand dollars of ACL funding is 

projected at 304, a 38 percent increase over the FY 2002 base of 220 (Outcome 1.3). Over the

past several years Native American services have generally met or exceeded their efficiency and 

output targets for meals and trips due in part to increased contributions from tribal organizations. 

81 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

Outcome and Outputs Table:

Native American Nutrition & Supportive Services Outcome and Outputs 

Measure Most Recent Result FY 2015 

Target 

FY 2016 

Target 

FY 2016 

+/- FY 2015

Outcome 1.3: For Title VI Services, 

increase the number of units of service 

provided to Native Americans per 

thousand dollars of ACL funding.

(Outcome)

FY 2013: 303

Target: 300

(Target Exceeded) 

300 304 +4

Indicator Most Recent Result FY 2015 

Projection 

FY 2016 

Projection 

FY 2016 

+/- FY 2015 

Output L: Transportation Services units

(Output) FY 2013: 661,435 590,000 620,000 +30,000

Output M: Home-Delivered Nutrition 

meals (Output) FY 2013: 2.6 M 2.6 M 2.9 M +0.3 M

Output N: Congregate Nutrition meals

(Output) FY 2013: 2.4 M 2.3 M 2.5 M +0.2 M

Output O: Information, Referral and 

Outreach units (Output) FY 2013: 920,928 902,000 1.0 M +88,000

Grant Awards Table:

Native American Nutrition & Supportive Services Grant Awards 

FY 2014 Final FY 2015 

Enacted

FY 2016 

President’s 

Budget

Number of 

Awards 265 265 265

Average 

Award $97,086 $97,086 $107,951

Range of 

Awards

$63,900 - 

$1,505,000

$63,900 - 

$1,505,000

$71,780 - 

$1,505,000

82
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

Resource and Program Data:

Native American Nutrition and Supportive Services 

(Dollars in Thousands) 

FY 2014 FY 2015 FY 2016

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula 264 25,578 264 25,580 264 28,457 

New Discretionary 1 150 -- -- -- --

Continuations -- -- 1 150 1 150

Contracts 1 392 1 401 1 446

Interagency Agreements -- -- -- -- -- --

Program Support 1/ 38 27 47

Total Resources 26,158 26,158 29,100

1/ Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and 

review, salaries and overhead, and information technology support costs.

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Aging Network Support Activities

FY 2014 Final

FY 2015 

Enacted

FY 2016 

President's 

Budget

FY 2016 +/- 

FY 2015

Aging Network 

Support Activities $7,406,000 $9,961,000 $9,961,000 --

Authorizing Legislation: Section 201, 202, 215, and 411 of the Older Americans Act of 1965, as 

amended

FY 2016 Older Americans Act Authorization ...................................................................... Expired

Allocation Method ............................ Competitive Grants/Co-operative Agreements and Contracts

Program Description and Accomplishments:

Aging Network Support Activities programs provide competitive grants and contracts to support 

ongoing activities of national significance which help seniors and their families to obtain information 

about their care options and benefits, and which provide technical assistance to help States, Tribes, 

and community providers of aging services to develop service systems that help older people remain 

independent and able to live in their own homes and communities. These activities provide critical 

and ongoing support for the national aging services network and help support the activities of ACL’s 

core service delivery programs. 

Competitive grants, cooperative agreements, and contracts for Aging Network Support Activities are 

awarded to eligible public or private agencies and organizations, States, and Area Agencies on Aging 

(AAAs), institutions of higher learning, and other organizations representing and/or serving older 

people, including faith-based organizations. Grantees are required to provide a match equal to 

25 percent of the project’s total cost. Project proposals are reviewed by external experts and project 

awards are made for periods of one to five years. In FY 2014, Aging Network Support Activities 

funded 24 grants with an average award of $295,230. 

National Eldercare Locator and Engagement 

Older Americans and their caregivers face a complicated array of choices and decisions about 

health care, pensions, insurance, housing, financial management, and long-term care. The 

Eldercare Locator, created in 1991, helps seniors and their families navigate this complex 

environment by connecting those needing assistance with State and local agencies on aging that 

serve older adults and their caregivers. The Eldercare Locator can be accessed through a toll-free 

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HEALTH AND INDEPENDENCE FOR OLDER ADULTS

nationwide telephone line (800-677-1116) or website (http://www.eldercare.gov). The phone line 

and website both connect those in need to providers in every zip code in the nation. The 

Eldercare Locator website continues to grow as a resource tool for older adults and their 

caregivers, serving 738,234 individuals in FY 2013. 

ACL also supports civic engagement efforts that help connect older adults with volunteer 

opportunities in their communities. In FY 2011, ACL/AoA launched the Aging Network’s 

Volunteer Collaborative. The Collaborative is a partnership of a number of aging organizations 

and the Corporation for National and Community Service. It has assessed needs and barriers to 

volunteering, offers technical assistance through workshops and webinars, developed a robust 

website, and awarded small incentive grants. In FY 2014, building on the work of the 

Collaborative, ACL funded a National Volunteer Resource Center that will assist in developing 

and sustaining the volunteer capacity within the aging network as well as provide cost saving 

services to organizations within the network. 

National Alzheimer’s Call Center

The National Alzheimer’s Call Center is a national information and counseling service for 

persons with Alzheimer’s disease, their family members, and informal caregivers. In the 

12-month period ending January 31, 2013, the National Alzheimer’s Call Center handled over 

294,000 calls through its national and local partners, and its on-line message board community 

recorded over 5.2 million page views. The National Alzheimer’s Call Center is available to 

people in all States, 24 hours a day, 7 days a week, 365 days a year to provide expert advice, care 

consultation, and information and referrals at the national and local levels regarding Alzheimer’s 

disease. Trained professional customer service staff and Masters degree social workers are 

available at all times. The Call Center is accessible by telephone, website, or e-mail at no cost to 

the caller. Information provided may include basic information on caregiving, handling legal 

issues, resources for long-distance caregiving, and tips for working with the medical 

community. Local community-based organizations are directly involved to ensure local, on-theground capacity to respond to emergencies and on-going needs of Alzheimer’s patients, their 

families, and informal caregivers. The Call Center has multilingual capacity and responds to 

inquiries in at least 140 languages through its own bilingual staff and with the use of a language 

interpretation service.

Pension Counseling and Retirement Information

The Pension Counseling program, first funded in 1993, assists older Americans in accessing 

information about their retirement benefits and helps them negotiate with former employers or 

pension plans for due compensation. Currently there are more than 700,000 private (as well as 

thousands of public) pension and retirement plans in the United States. Given that an employee 

may have worked for several employers, and these employers may have merged, sold their plans, 

or gone bankrupt, it is very difficult for the average person to know where to go to get help in 

86 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

finding out whether he or she is receiving all of their pension benefits. ACL currently funds six 

regional counseling projects covering 29 States. Data for the program show that:

• Pension Counseling projects have successfully recovered over $175 million in client 

benefits, representing a return of more than eight dollars for every Federal dollar invested 

in the program. 

• Projects have directly served over 50,000 individuals by providing hands-on assistance in 

pursuing claims through administrative appeals processes, helping seniors to locate 

pension plans “lost” as a result of mergers and acquisition, answering queries about 

complex plan provisions, and making targeted referrals to other professionals for 

assistance.

By producing fact sheets and other publications; hosting websites; and conducting outreach, 

education and awareness efforts, Pension Counseling projects also provide indirect services to 

tens of thousands of seniors and their families. 

ACL also supports the National Education and Resource Center on Women and Retirement 

Planning, which provides access to a one-stop gateway that integrates financial information and 

resources on retirement planning for health and long-term care. This project has made userfriendly financial education and retirement planning tools available to traditionally hard-to-reach 

women, including low-income women, women of color, women with limited English speaking 

proficiency, rural, and other “underserved” women. Information is offered through financial and 

retirement planning programs, workshops tailored to meet women’s special needs, and published 

in hard copy and Web-based formats. Since its establishment 1998, the Center has conducted 

approximately 200 workshops per year on strategies to access financial and retirement planning 

information for women. It has developed and published over 175 Fact Sheets tailored to the 

specific needs of hard-to-reach women and maintains an interactive web site.

National Resource Centers on Native American Elders

The National Resource Centers on Native American Elders enhance knowledge about older 

Native Americans and thereby increase and improve the delivery of services to them. Each 

Resource Center addresses at least two areas of primary concern which are specified in the OAA. 

These include health issues, long-term care (including in-home care), elder abuse, mental health, 

and other problems and issues facing Native communities. The Resource Centers are 

administered under cooperative agreements by institutions of higher education. The Resource 

Centers partner with Native American organizations and communities, educational institutions 

including Tribal Colleges and Universities, and professionals and paraprofessionals in the field. 

Resource centers have specialized areas of interest. For example, the University of North Dakota 

Resource Center has assisted Title VI grantees in assessing needs of tribal elders to determine 

87 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

program planning and direction. This process has developed a database of information about 

American Indian, Alaska Native and Native Hawaiian Elders. The University of Hawaii 

Resource Center has focused on long term care needs of Native Hawaiian Elders. The 

University of Alaska Resource Center has focused on elder abuse and neglect issues within 

Native communities. 

National Minority Aging Organizations Technical Assistance Centers

The National Minority Aging Organizations (NMAO) Technical Assistance Centers Program 

works to reduce or eliminate health disparities among racial, ethnic, and other minority older 

individuals. These Centers design and disseminate front line health promotion and disease 

prevention information that is culturally and linguistically appropriate for older individuals of 

African American, Hispanic, Asian American and Pacific Islander descent, American Indian and 

Alaska Native elders, as well as for older lesbian, gay, bisexual, and transgender (LGBT) adults. 

Each NMAO project pilots a practical, nontraditional, community-based intervention for 

reaching older individuals who experience barriers to accessing home and community-based 

services. Interventions are focusing on barriers due to language and low literacy as well as those 

directly related to cultural diversity. Strategies developed under this program incorporate the 

latest technology and facilitate the generation and dissemination of knowledge in forms that can 

assist racial and ethnic minority older individuals to practice positive health behaviors and 

strengthen their capacity to maintain active, independent life styles. Examples of products 

resulting from these grants include a chronic disease self-management curricula and manual 

tailored for racial and ethnic minority seniors, a series of bilingual Influenza Vaccination 

Promotion materials, a referral database of Chronic Disease Self-Management (CDSME) 

workshops, and culturally appropriate caregiver manual/toolkit for American Indian and Alaskan 

Native caregivers caring for elders with dementia. 

LGBT elders also face a number of unique challenges as they strive to maintain their 

independence. The LGBT Resource Center, established in 2010, strives to meet three primary 

objectives: to educate mainstream aging services organizations about the existence and special 

needs of LGBT elders, to sensitize LGBT organizations about the existence and special needs of 

older adults, and to educate LGBT individuals about the importance of planning ahead for future 

long-term care needs. The national resource center formally began services in September 2010 

with the launching of a website including training curricula and social networking tools. In 2016, 

with the groundwork and tools now in place and available, a primary Resource Center focus will 

be on the provision of training and technical assistance for community providers across the 

country. 

Holocaust Survivor Assistance

The United States is home to an estimated 130,000 victims of Nazi persecution, approximately 

25 percent of whom are living in poverty. Because of the experiences they endured early on in 

88 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

their lives, Holocaust survivors are likely to have greater and more complex physical and mental 

health needs as they age. The nonprofit social service agencies that serve this population have 

projected that the need for supportive services will continue to grow and intensify over the next 

five to ten years. 

In FY 2015, ACL will develop a program to help provide supportive services for aging 

Holocaust survivors in the United States. The program will advance innovative approaches to 

help this population age with dignity and support in their homes and communities. 

Program Performance and Technical Assistance 

This activity supports cooperative efforts between ACL and selected States and AAAs to 

develop tools, performance measures, and best practices that can be used to effectively and 

efficiently identify the results produced through OAA programs on an ongoing basis. It also 

supports partnerships with National Aging Organizations to foster innovation and provide 

technical assistance to States, AAAs, and Tribal organizations in strategic planning, program 

development, and performance improvement. 

Funding History:

Comparable funding for Aging Network Support Activities is as follows: 

FY 2011 ...................................................$8,184,000 

FY 2012 ...................................................$7,873,000 

FY 2013 ...................................................$7,431,864 

FY 2014 ...................................................$7,406,000 

FY 2015 ...................................................$9,961,000 

Budget Request:

The FY 2016 request for Aging Network Support Activities is $9,961,000, the same as the 

FY 2015 enacted level. Within this budget, $2,500,000 is specifically for Holocaust Survivors, 

the same level of funding for this purpose provided in FY 2015. All programs funded by this 

request provide critical and ongoing support for the national aging services network and are 

needed to support the activities of ACL’s core service delivery programs. Not only do they 

provide a variety of services, some of which – such as the National Alzheimer’s Call Center and 

the National Eldercare Locator – are not the responsibility of any other government agency, 

these programs also considerably strengthen and streamline ACL’s core services, and are critical 

to our continuing success. 

Aging Network Support Activities outcomes are reflected in performance targets for Health and 

Independence and Caregiver Services. 

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HEALTH AND INDEPENDENCE FOR OLDER ADULTS

Aging Network Support Activities includes funding for the following projects (dollars in thousands): 

Activity

FY 2014 

Final

FY 2015 

Enacted

FY 2016 

President’s 

Budget

Aging Network Support Activities:

National Eldercare Locator and Engagement........................................ $ 2,023 $ 2,038 $ 2,038

National Alzheimer's Call Center.......................................................... 939 945 945

National Education & Resource Center on Women & Retirement ....... 233 235 235

Pension Information and Counseling Program...................................... 1,611 1,623 1,623

National Resource Centers on Native Americans ................................. 650 655 655

National Minority Aging Organizations................................................ 1,157 1,165 1,165

Holocaust Survivor Assistance.............................................................. 0 2,500 2,500

Program Performance and Technical Assistance .................................. 793 799 799

Total, Aging Network Support Activities...................................... $7,406 $9,961 $9,961 

Grant Awards Table:

Aging Network Support Grant Awards 

FY 2014 Final FY 2015 

Enacted

FY 2016 

President’s 

Budget

Number of 

Awards 28 26 33

Average 

Award $255,604 $377,865 $297,712

Range of 

Awards

$104,516 -

$1,121,518

$104,516 -

$2,391,817

$104,516 -

$2,391,817

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HEALTH AND INDEPENDENCE FOR OLDER ADULTS

Resource and Program Data:

Aging Network Support Activities

(Dollars in thousands) 

FY 2014 FY 2015 FY 2016

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary 6 897 11 4,936 10 3,126

Continuations 22 6,260 15 4,889 23 6,698

Contracts 2 35 2 20 2 20

Interagency Agreements 1 38 -- -- -- --

Program Support 1/ 177 117 117

Total Resources 7,406 9,961 9,961

1/ Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and 

review, and information technology support costs.

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Caregiver and Family Support Services

Summary of Request

Families are the nation’s primary provider of long-term care, but a number of factors including 

financial constraints, work and family demands, and the many challenges of providing care place 

great pressure on family caregivers. Caregiving responsibilities demand time and money from 

families who too often are already strapped for both. ACL’s caregiver programs provide services 

that address the needs of unpaid, informal caregivers, allowing many of them to continue to work 

while providing critically needed care. 

Better support for informal caregivers is critical because often it is their availability - whether 

they are informal family caregivers, paraprofessionals, or unrelated friends and neighbors who 

volunteer their time - that determines whether an older person can remain in his or her home. In 

2009, approximately 43.5 million adult caregivers provided uncompensated care to those 

50 years of age and older.68 In 2014, the Rand Corporation estimated the economic cost of 

replacing unpaid caregiving to be about $522 billion annually,69 higher than that of all Medicaid 

spending in FY 2013 (Federal and state: $431 billion).70 

The demands of caregiving can lead to a breakdown of the caregiver’s health, and the illness, 

hospitalization, or death of a caregiver increases the risk for institutionalization of the care 

recipient. Caregivers suffer from higher rates of depression than non-caregivers of the same age, 

and research indicates that caregivers suffer a mortality rate that is 63 percent higher than noncaregivers.71 Providing support that makes caregiving easier for family caregivers, such as 

information, counseling and training, respite care, or supplemental services, is critical to 

sustaining caregivers’ ability to continue in that role. Seventy-seven percent of the caregivers 

served by OAA programs report that these services allow them to provide care longer than they 

otherwise could.72 

68 Valuing the Invaluable: 2011 Update, The Growing Contributions and Costs of Family Caregiving. AARP Public 

Policy Institute. July 2011. http://assets.aarp.org/rgcenter/ppi/ltc/i51-caregiving.pdf

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

http://www.rand.org/pubs/external_publications/EP66196.html. Also Valuing the Invaluable: 2011 Update, The 

Growing Contributions and Costs of Family Caregiving. AARP Public Policy Institute. July 2011. 

http://assets.aarp.org/rgcenter/ppi/ltc/i51-caregiving.pdf

70 “Total Medicaid Spending,” The Henry J. Kaiser Family Foundation, 2013. http://kff.org/medicaid/stateindicator/total-medicaid-spending/. 71 Schulz R, Beach SR. Caregiving as a risk factor for mortality. The Caregiver Health Effects study. JAMA 

December 15, 1999;282:2215-9. 72 2014 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/.

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CAREGIVER AND FAMILY SUPPORT SERVICES

At the same time, ACL recognizes that it must also address the growing need for more caregivers 

every day. By 2020, it is projected that there will be 17.8 million non-institutionalized seniors 

age 65 and over with 1+ ADL deficits, an increase of 3.2 million seniors (or a 22 percent 

increase between 2014 and 2020) needing caregiver assistance.73 To address these caregiverrelated needs, ACL requests a total of $191,686,000, an increase of +$23,409,000 from the 

comparable FY 2015 enacted level level. The request includes:

• $150,586,000 for Family Caregiver Support Services, an increase of +$5,000,000 above 

the FY 2015 enacted level. This program makes a range of support services available to 

family and informal caregivers in States, including counseling, respite care, and training, 

that assist family and informal caregivers to care for their loved ones at home for as long 

as possible. Studies have shown that these supports can reduce caregiver depression, 

anxiety, and stress and enable them to provide care longer, thereby avoiding or delaying 

the need for costly nursing home care.

• $15,000,000 in funding for the new Family Support program. This program will utilize 

known, evidence-based approaches to develop and implement a sustainable national 

strategy to provide supports that bolster the ability of families to provide high-quality 

care for their loved ones while maintaining a quality of life for themselves by accessing 

multi-dimensional, flexible support and leveraging and enhancing their local community 

resources.

• $6,800,000 for Native American Caregiver Support Services, an increase of +$769,000 

above the FY 2015 enacted level. This program makes a range of services available to 

Native American caregivers, including information and outreach, access assistance, 

individual counseling, support groups and training, respite care and other supplemental 

services. 

• $3,800,000 for Alzheimer’s Disease Supportive Services, the same as the FY 2015 

enacted level. This program is currently the only program at HHS focused specifically on 

supportive services for those with Alzheimer’s Disease (AD) and their caregivers. One 

critical focus of this program is to support the family caregivers who provide countless 

hours of unpaid care, thereby enabling their family members with dementia to continue 

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

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

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

2015.and Centers for Medicare & Medicaid Services, The characteristics and perceptions of the Medicare 

population. Data from the 2012 Medicare Current Beneficiary Survey. [data tables 2.5a]. 

http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS/Data-Tables-Items/2012CNP.html. 

Accessed 23 October, 2014. 

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CAREGIVER AND FAMILY SUPPORT SERVICES

living in the community. Another focus is to expand the availability of evidence-based 

diagnostic and support services to those with Alzheimer’s. 

• $10,500,000 for services to individuals with Alzheimer’s Disease (AD) and their families 

under the President’s Alzheimer’s Initiative, funded from the Prevention and Public

Health Fund. The same amount was requested from the Prevention Fund in 

FY 2015. Funds will be used to expand efforts to develop more AD-capable long-term 

services and supports systems designed to meet the needs of AD caregivers. Caregivers 

will be linked to interventions shown to decrease their burden and depression and thus 

improve their health outcomes. 

• $5,000,000 for Lifespan Respite Care, an increase of +$2,640,000 above the FY 2015 

enacted level. This program funds grants to improve the quality and access to respite care 

for family caregivers of children or adults of any age with special needs. 

As a group, these programs support caregivers, elders, and people with disabilities by providing 

critical respite care and other support services for family caregivers, training and recruitment of 

care workers and volunteers, information and outreach, counseling, and other supplemental 

services.

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Family Caregiver Support Services

FY 2014 Final

FY 2015 

Enacted

FY 2016 

President's 

Budget

FY 2016 +/- FY 

2015

Family Caregiver 

Support Services $145,586,000 $145,586,000 $150,586,000 $5,000,000

Authorizing Legislation: Section 371 of the Older Americans Act of 1965, as amended 

FY 2016 Older Americans Act Authorization ...................................................................... Expired

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

Program Description and Accomplishments:

Family Caregiver Support Services provides grants to States and Territories, based on their share 

of the population age 70 and over, to fund a range of supports that assist family and informal 

caregivers to care for their loved ones at home for as long as possible. The program includes 

five basic system components: information, access assistance, counseling and training, respite 

care, and supplemental services. These services work in conjunction with other OAA services to 

provide a coordinated set of supports which caregivers can access on behalf of seniors. Family 

Caregiver Support Services provide a variety of supports to family and informal caregivers. 

Based on FY 2013 data, the most recent available, services provided included: 

• Access Assistance Services provided nearly 1.15 million contacts to caregivers assisting 

them in locating services from a variety of public and private agencies (Output I). 

• Counseling and Training Services provided 125,948 caregivers with counseling, peer 

support groups, and training to help them better cope with the stresses of caregiving 

(Output J).

• Respite Care Services provided more than 63,000 caregivers with 5.9 million hours of

temporary relief, at home or in an adult day care or nursing home setting, from their 

caregiving responsibilities (Output K).

Family and other informal caregivers are the backbone of America’s long-term care system. On 

a daily basis, these individuals assist relatives and other loved ones with tasks ranging from 

personal care and homemaking to more complex health-related interventions like medication 

administration and wound care. In 2014, a Rand Corporation study estimated the economic cost

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CAREGIVER AND FAMILY SUPPORT SERVICES

of replacing unpaid caregiving in to be about $522 billion annually,

74 higher than that of all

Medicaid spending in FY 2013 (Federal and state: $431 billion).75 The cost to replace that care 

with unskilled paid care at minimum wage was estimated at $221 billion, while replacing it with 

skilled nursing care could cost $642 billion, annually. Caregivers often experience conflicts

between work and caregiving, with 25 percent reporting that they have had to make adjustments 

such as retiring or taking time away from work due to their caregiving responsibilities.

Research has also shown that caregiving exacts a heavy emotional, physical, and financial toll. 

As reported in ACL’s National Survey of OAA Participants, 20 percent of caregivers are 

assisting two or more individuals. Sixty-seven percent of Title III caregivers are 60 or older, 

making them more vulnerable to a decline in their own health, and twenty-eight percent describe 

their own health as fair to poor.76 The demands of caregiving can lead to a breakdown of the 

caregiver’s health, and the illness, hospitalization, or death of a caregiver increases the risk for 

institutionalization of the care recipient. 

Studies have shown that the types of supports provided through the Family Caregiver Support 

Services Program can reduce caregiver depression, anxiety, and stress and enable them to 

provide care longer while often continuing to work, thereby avoiding or delaying the need for 

costly institutional care for their loved ones. For example, one study indicates that counseling 

and support for caregivers of individuals with Alzheimer’s disease can permit the care recipient 

to stay at home, at significantly less cost, for an additional year before being admitted to a 

nursing home.77

Additionally, data from ACL’s National Surveys of caregivers of elderly clients also shows that 

OAA services, including those provided through Family Caregiver Support Services, are 

effective in helping caregivers keep their loved ones at home. Approximately 77 percent of 

caregivers of program clients reported that services enabled them to provide care longer than 

otherwise would have been possible.78 Caregivers receiving services were also asked whether the 

care recipient would have been able to live in the same residence if the services had not been 

available. Forty-two percent of the caregivers of nursing home eligible care recipients indicated 

that the care recipient would be unable to remain at home without the support services. Those 

respondents were then asked to identify where the care recipient would be living without 

74 The Opportunity Costs of Informal Elder-Care in the United States. The Rand Corporation. 2014. 

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

75 “Total Medicaid Spending,” The Henry J. Kaiser Family Foundation, 2013. http://kff.org/medicaid/stateindicator/total-medicaid-spending/. 76 2014 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/. 77 A Family Intervention to Delay Nursing Home Placement of Patients with Alzheimer’s Disease. Aging and 

Dementia Research Center, New York University. Journal of the American Medical Association. December 4, 1996. 78 2014 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/.

98 

 
CAREGIVER AND FAMILY SUPPORT SERVICES

services. A significant majority of those caregivers, 77 percent, indicated that the care recipient 

would most likely be living in a nursing home or assisted living (see below). 

(based on responses from care recipients unable to live independently) 79

Funding History:

Funding for Family Caregiver Support Services during the past five years is as follows:

FY 2011 ...............................................$153,912,000 

FY 2012 ...............................................$153,621,000 

FY 2013 ...............................................$145,585,801 

FY 2014 ...............................................$145,586,000 

FY 2015 ...............................................$145,586,000 

79 2014 National Survey of Older Americans Act Participants. http://www.agid.acl.gov/.

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CAREGIVER AND FAMILY SUPPORT SERVICES

Budget Request:

The FY 2016 request for Family Caregiver Support Services is $150,586,000, an increase of 

+$5,000,000 above the FY 2015 enacted level. Funding for Family Caregiver Support Services 

has remained flat and not kept pace with demand or inflation in recent years. The FY 2016 

request will allow ACL to increase services, giving caregivers the assistance often needed to help 

them sustain their caregiving responsibilities and provide care longer. Funding at this level will 

allow 825,000 caregivers (Outcome 3.1) to receive supportive services, including respite care or 

other temporary relief from their caregiving responsibilities that will assist caregivers to continue 

providing care for their loved ones. Approximately 117,000 caregivers will also have the 

opportunity to participate in counseling, peer support groups, and training to help them better 

cope with the stresses of caregiving (Output J), as indicated by the fact that 77 percent of

caregivers report these services enable them to provide care longer.

In FY 2016, ACL expects the aging services network to meet or exceed the target of only 

27 percent of caregivers experiencing difficulty obtaining services (Outcome 2.6). This is a

substantial accomplishment that occurred at the State level as a result of ongoing program 

development, better coordination, and integration of the Family Caregiver program into the array 

of State home and community-based services. Baseline levels from 2003 showed that 64 percent 

of caregivers had difficulty getting services, and by 2013 that rate had been reduced by more 

than half to 31.6 percent of caregivers reporting difficulty getting services. 

For FY 2016, the performance target for Family Caregiver Support Services Program 

participants who rate services good to excellent is 90 percent (Outcome 2.9c). The substantive 

improvements in program performance can be attributed to the successful implementation of the 

program. Client-reported assessment of service quality and program outcomes is also expected 

to remain at high levels. 

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CAREGIVER AND FAMILY SUPPORT SERVICES

Outcomes and Outputs Table:

Family Caregiver Support Services Outcomes and Outputs 

Measure Most Recent Result FY 2015 

Target 

FY 2016

Target 

FY 2016 

+/- FY 2015

Outcome 2.6: Reduce the percent of 

caregivers who participate in the 

National Family Caregiver Support 

Program who report difficulty in 

getting services. (Outcome)

FY 2013: 31.6% 

Target: 28%

(Target Not Met) 

27% 27% Maintain

Outcome 2.9c: Maintain at 90% or 

higher the percentage of National 

Family Caregiver Support Program 

clients who rate services good to 

excellent. (Outcome)

FY 2013: 94.6% 

Target: 90%

(Target Exceeded)

90% 90% Maintain

Outcome 3.1: Increase the number of 

caregivers served through the National 

Family Caregiver Support Program.

(Outcome)

FY 2013: 1,046,159

Target: 800,000

(Target Exceeded)

790,000 825,000 + 35,000

Indicator Most Recent Result FY 2015 

Projection 

FY 2016 

Projection

FY 2016 

+/- FY 2015

Output I: Caregivers access assistance 

units of service. (Output) FY 2013: 1,148,615 1.03 M 1.05 M + 0.02 M

Output J: Caregivers receiving 

counseling and training. (Output) FY 2013: 125,948 118,000 117,000 - 1,000

Output K: Caregivers receiving respite 

care services. (Output) FY 2013: 63,080 67,000 68,600 + 1,600

Note: For presentation within the budget ACL highlighted specific measures that are most directly related to Family 

Caregiver Support Services, however multiple performance outcomes are impacted by this program because ACL’s 

performance measures (efficiency, effective targeting, and client outcomes) assess network-wide performance in 

achieving current strategic objectives. 

* Measure seeks a decrease in the percentage of caregivers who report difficulty getting services. A negative change 

is the desired output.

 

Grant Awards Table:

Family Caregiver Supportive Services Grant Awards 

FY 2014 Final FY 2015 

Enacted

FY 2016 

President’s 

Budget

Number of 

Awards 56 56 56

Average 

Award $2,573,753 $2,573,753 $2,662,145

Range of 

Awards

$90,081 - 

$14,702,604

$90,081 - 

$14,702,604

$93,175 - 

$15,239,106

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CAREGIVER AND FAMILY SUPPORT SERVICES

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION ON AGING

FY 2016 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Family Caregivers Support Services (CFDA 93.052)

State/Territory

FY 2014

Final

FY 2015 

Enacted

FY 2016 

President’s Budget

FY 2016 +/-

FY 2015

Alabama.......................................... 2,206,505 2,206,505 2,277,029 70,524 

Alaska ............................................. 720,651 720,651 745,400 24,749 

Arizona ........................................... 3,103,554 3,103,554 3,266,453 162,899 

Arkansas ......................................... 1,408,847 1,408,847 1,449,006 40,159 

California ........................................ 14,702,604 14,702,604 15,239,106 536,502 

Colorado ......................................... 1,878,721 1,878,721 1,972,327 93,606 

Connecticut..................................... 1,721,520 1,721,520 1,769,323 47,803 

Delaware......................................... 720,651 720,651 745,400 24,749 

District of Columbia ....................... 720,651 720,651 745,400 24,749 

Florida............................................. 11,546,017 11,546,017 12,046,368 500,351 

Georgia ........................................... 3,455,065 3,455,065 3,628,955 173,890 

Hawaii............................................. 720,651 720,651 745,400 24,749 

Idaho ............................................... 720,651 720,651 745,400 24,749 

Illinois............................................. 5,472,900 5,472,900 5,621,952 149,052 

Indiana ............................................ 2,849,523 2,849,523 2,930,081 80,558 

Iowa ................................................ 1,577,341 1,577,341 1,602,567 25,226 

Kansas............................................. 1,295,632 1,295,632 1,323,529 27,897 

Kentucky......................................... 1,935,102 1,935,102 1,992,149 57,047 

Louisiana ........................................ 1,874,587 1,874,587 1,929,375 54,788 

Maine .............................................. 720,651 720,651 745,400 24,749 

Maryland......................................... 2,396,329 2,396,329 2,493,966 97,637 

Massachusetts................................. 3,099,001 3,099,001 3,188,235 89,234 

Michigan......................................... 4,618,195 4,618,195 4,761,406 143,211 

Minnesota ....................................... 2,374,116 2,374,116 2,453,672 79,556 

Mississippi...................................... 1,281,036 1,281,036 1,317,318 36,282 

Missouri.......................................... 2,850,250 2,850,250 2,933,553 83,303 

Montana .......................................... 720,651 720,651 745,400 24,749 

Nebraska ......................................... 855,735 855,735 870,870 15,135 

Nevada ............................................ 1,087,045 1,087,045 1,151,609 64,564 

New Hampshire .............................. 720,651 720,651 745,400 24,749 

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CAREGIVER AND FAMILY SUPPORT SERVICES

State/Territory

FY 2014

Final

FY 2015 

Enacted

FY 2016 

President’s Budget

FY 2016 +/-

FY 2015

New Jersey................................. 4,044,765 4,044,765 4,155,915 111,150 

New Mexico .............................. 908,751 908,751 943,943 35,192 

New York .................................. 8,956,618 8,956,618 9,183,543 226,925 

North Carolina ........................... 4,195,336 4,195,336 4,379,698 184,362 

North Dakota ............................. 720,651 720,651 745,400 24,749 

Ohio ........................................... 5,551,309 5,551,309 5,674,469 123,160 

Oklahoma................................... 1,703,328 1,703,328 1,752,159 48,831 

Oregon ....................................... 1,820,805 1,820,805 1,893,203 72,398 

Pennsylvania .............................. 6,751,748 6,751,748 6,891,363 139,615 

Rhode Island .............................. 720,651 720,651 745,400 24,749 

South Carolina ........................... 2,125,724 2,125,724 2,231,258 105,534 

South Dakota ............................. 720,651 720,651 745,400 24,749 

Tennessee................................... 2,863,391 2,863,391 2,968,716 105,325 

Texas.......................................... 8,842,879 8,842,879 9,213,916 371,037 

Utah ........................................... 853,564 853,564 891,533 37,969 

Vermont..................................... 720,651 720,651 745,400 24,749 

Virginia...................................... 3,301,214 3,301,214 3,438,516 137,302 

Washington................................ 2,808,735 2,808,735 2,932,554 123,819 

West Virginia............................. 997,669 997,669 1,017,022 19,353 

Wisconsin .................................. 2,688,849 2,688,849 2,760,876 72,027 

Wyoming ................................... 720,651 720,651 745,400

 

24,749

Subtotal, States .......................... 141,372,773 141,372,773 146,237,733 4,864,960 

American Samoa........................ 90,081 90,081 93,175 3,094 

Guam ......................................... 360,325 360,325 372,700 12,375 

Northern Marianas Islands......... 90,081 90,081 93,175 3,094 

Puerto Rico ................................ 1,856,555 1,856,555 1,910,657 54,102 

Virgin Islands ............................ 360,325 360,325 372,700 12,375

Subtotal, States and Territories.. 144,130,140 144,130,140 149,080,140 4,950,000

Undistributed80 1,455,860 1,455,860 1,505,860 50,000

TOTAL 145,586,000 145,586,000 150,586,000 5,000,000

80 The undistributed line reflects the amount reserved from the Family Caregiver Support Services appropriation for 

statutory related activities, including contingencies and for program support including information and systems, 

technical assistance, evaluation, monitoring and oversight. Funds unused for these purposes at the end of the year 

are allocated to States.

103 

 
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Family Support

FY 2014 

Final

FY 2015 

Enacted

FY 2016 

President's 

Budget

FY 2016 +/- 

FY 2015

Family Support -- -- $15,000,000 $15,000,000

Authorizing Legislation: Title IV of the Older Americans Act of 1965, as amended, and Section 

163 of the Developmental Disabilities Assistance and Bill of Rights Act

FY 2016 Older Americans Act Authorization ..................................................................... Expired

FY 2016 Developmental Disabilities Assistance and Bill of Rights Act Authorization ...... Expired

Allocation Method ............................................................................................. Competitive Grants 

Program Description and Accomplishments:

Over eighty percent of the long-term services and supports provided to older adults in this 

country come from family members81 and over 72 percent of people with intellectual and 

developmental disabilities live with family caregivers, of which nearly 25 percent of the 

caregivers are over 60 years old.82 The White House’s Middle Class Task Force recognized that 

many caregivers are part of the “sandwich generation,” meaning that they care for their aging 

parents and children simultaneously, and as such, the Task Force recommended funding to 

address the needs of these caregivers as early as FY 2011. 

At any given time, approximately 42.1 million Americans are providing supports for an adult 

family member with limitations in daily activities. The average family caregiver for an adult is 

female, 49 years old, and works outside of the home. Nevertheless, she spends almost 20 hours 

per week providing assistance for an average of five years.83 Among family caregivers of 

children with intellectual/developmental disabilities (ID/DD), 58 percent report spending more 

than 40 hours per week providing support, including 40 percent who spend more than 80 hours.84

81 Congressional Budget Office. “Rising Demand for Long Term Services and Supports for Elderly People.” June 

2013. http://www.cbo.gov/sites/default/files/cbofiles/attachments/44363-LTC.pdf

82 “State of the States in Developmental Disabilities,” 2013, University of Colorado, Braddock et al. 

http://www.stateofthestates.org/documents/UnitedStates.pdf

83 “Valuing the Invaluable: 2011 Update.” AARP Public Policy Institute. July 2011. 

http://assets.aarp.org/rgcenter/ppi/ltc/i51-caregiving.pdf. 

84 “Still in the Shadows with Their Futures Uncertain.” The Arc. June 2011. 

http://www.thearc.org/document.doc?id=3672

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CAREGIVER AND FAMILY SUPPORT SERVICES

In the aggregate, the care provided by informal (family and friend) caregivers of elderly adults 

has an estimated economic value of $522 billion.85

For the sake of comparison, Medicaid spending on Long Term Services and Supports (LTSS) in 

FY 2012 amounted to $140 billion.86 The annual value of uncompensated caregiving is actually 

higher than that of all Medicaid spending (Federal and state: $431 billion) in the same year.

87

Two out of three older people with disabilities who receive LTSS at home get all of their care 

exclusively from family caregivers. Only 9 percent of at-home LTSS for this population is 

provided exclusively by paid providers.88 Seventy-five percent of families caring for a child with 

ID/DD report they cannot find afterschool care, non-institutional community services, trained 

and reliable home care providers, summer care, residential care, respite and other services.89

With the number of people currently needing LTSS at 10.9 million and expected to double by 

2050, the need for additional support is becoming increasingly costly and dire.90

The support provided by families to older adults and people with disabilities will never be 

replaced by paid services; yet, in order to ensure that families do not collapse under the weight of 

their caregiving responsibilities, families need to be supported. The impacts on family finances 

and workplace productivity can be staggering. In 2009, 27 percent of caregivers reported a 

moderate to high degree of financial hardship as a result of caring for a loved one.91 Although 

58 percent of family caregivers are currently employed while caring for their loved one, 69 

percent have had to make workplace accommodations, including in many cases ceasing to work 

entirely, in order to continue providing care.92 

The toll on caregivers extends far further than their wallets. Sixty-nine percent of family 

caregivers report that caring for a loved one is their major source of stress,93 and between 40 and 

70 percent of family caregivers of adults have clinically significant symptoms of depression, 

85 “The Opportunity Costs of Informal Elder-Care in the United States.” Rand Corporation. 

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

86 “Medicaid Expenditures for Long-Term Services and Supports in FFY 2012.”

http://nasuad.org/sites/nasuad/files/LTSS_Expenditures_2012.pdf

87 “Total Medicaid Spending,” The Henry J. Kaiser Family Foundation, 2013. http://kff.org/medicaid/stateindicator/total-medicaid-spending/. 

88 P. Doty, “The evolving balance of formal and informal, institutional and non-institutional long-term care for older 

Americans: A thirty-year perspective,” Public Policy & Aging Report 20, no. 1 (2010):3–9.

89 “Still in the Shadows with Their Futures Uncertain.” 

90 H. Stephen Kaye, Charlene Harrinson and Mitchell P. LaPlante, “Long-Term Care: Who Gets It, Who Provides It, 

Who Pays and How Much?” Health Affairs, 29, no.1 (2010). http://content.healthaffairs.org/content/29/1/11.full

91 NAC and AARP, Caregiving in the U.S. 2009.

92 NAC and AARP. Caregiving in the U.S. 2009.

93 Caring.com, 2011 Usage and Attitude Survey.

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CAREGIVER AND FAMILY SUPPORT SERVICES

with one-fourth to one-half meeting the criteria for major depression.94 The physical effects of 

caregiving are equally devastating, with highly-stressed family caregivers facing significantly 

increased rates of heart disease, hypertension, stroke, poorer immune function, slower wound 

healing, sleep problems, drug use, and even death.95 This physical and emotional strain on the 

caregiver has been shown to be a significant predictor of whether an elder will be admitted to a 

nursing home, regardless of how significant their care needs are.96

Demographic trends will place additional pressures on the rapidly growing numbers of 

unsupported, uncompensated family caregivers. Americans are living longer, but with longer 

life comes a host of chronic health conditions and disabilities which can require extensive, 

sophisticated care. Increasingly, this care is being provided by unpaid family caregivers, who are 

themselves older and frailer than ever before.97 These demographic trends present troubling 

questions about whether our current approach of primarily unsupported, unpaid family 

caregiving can be sustained. Additional attention and investments are needed to establish a 

comprehensive, coherent, and sustainable system of supports. The ever-growing segment of the 

American population caring for their loved ones is in crisis, and these trends may soon bring 

them to a breaking point. It has consistently been the policy of this administration (including 

through the creation of ACL) to support older people and people with disabilities to remain in 

their homes and communities. This cannot be fully accomplished without fully addressing the 

needs of the millions of working families that are providing care and support to their loved ones, 

and sometimes even to multiple generations of loved ones at once. 

ACL has invested well over $1.5 billion over the past ten years into providing services and 

supports for caregivers, primarily through Older Americans Act programs that address the needs 

of older adults and the caregiving challenges of their families. At the same time, the 

Administration on Intellectual and Developmental Disabilities identified several promising 

practices in supporting families caring for members with lifelong disabilities through Family 

Support grants (over $51 million since FY 1999) and other initiatives of the Developmental 

Disabilities Network. 

94 S. H. Zarit, “Assessment of family caregivers: A research perspective,” In Caregiver Assessment: Voices and 

Views from the Field: Report from a National Consensus Development Conference, Vol. II, edited by the Family

Caregiver Alliance. (San Francisco, CA: Family Caregiver Alliance, 2006), pp. 113–37.

95 “Valuing the Invaluable.”

96 Spillman, Brenda C. and Long, Sharon K. Does High Caregiver Stress Lead to Nursing Home Entry?Urban 

Institute. January 26, 2007. http://aspe.hhs.gov/daltcp/reports/2007/NHentry.htm

97 D. L. Redfoot and A. Houser, More Older People with Disabilities Living in the Community: Trends from the 

National Long-Term Care Survey, 1984–2004, AARP Public Policy Institute Research Report 2010-08 

(Washington, DC: AARP, September 2010).

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CAREGIVER AND FAMILY SUPPORT SERVICES

Through these investments, we have identified three primary strategies to be incorporated into 

programs and communities to improve support for families caring for older adults or people with 

disabilities: 

• Knowledge, training, and skill development 

• Emotional and social supports, and 

• Goods and services (instrumental supports).98

Each of these three areas of support is critical to families’ ability to facilitate full, productive 

lives in their communities for both the family members and the individual needing support. We 

have also identified two other important aspects that are essential to effectively supporting 

caregivers: first, families and caregivers need flexibility to be able to adapt the supports and 

services to their particular circumstances; and second, many caregiving solutions must be local 

and place-based, so communities can leverage their existing resources, thereby avoiding 

unnecessary duplication and encouraging local ownership. Consistent with other place-based 

strategies supported by the Administration, ACL’s Family Support program would be designed 

to “to catalyze and empower local action while busting silos, prioritizing public-private 

partnerships, and making existing programs more effective and efficient.” 99

Many of ACL’s prior and current efforts have been focused on the provision of goods and 

services (such as the National Family Caregiver Support Program and the AIDD Family Support 

Grants). Other programs, such as Lifespan Respite Care, the Alzheimer’s Disease Demonstration 

Grants, and the Supporting Families Community of Practice, have provided some opportunities 

to develop models for practice and to foster collaborations between state aging and/or disability 

agencies, public health departments, private foundations, universities, physicians and managed 

care organizations, as well as a variety of local community service providers and other 

community-based organizations. However, these investments have been limited to a specific 

service or segment of the population, and they have not produced the rigorous research and 

evidence-base needed to build foundational comprehensive, sustainable, systems of family 

support across the lifespan. 

98 Community of Practice, The Goal of Supporting Families, June 2013. http://supportstofamilies.org/cop/wpcontent/uploads/COP-four-pager-final.pdf

99 http://www.whitehouse.gov/administration/eop/oua/initiatives/neighborhood-revitalization

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CAREGIVER AND FAMILY SUPPORT SERVICES

Funding History:

Funding for the Family Support program during the past five years is as follows: 

FY 2011 .................................................................$0 

FY 2012 .................................................................$0 

FY 2013 .................................................................$0 

FY 2014 .................................................................$0 

FY 2015 .................................................................$0 

Budget Request:

In FY 2016, ACL requests $15,000,000 in new funding to develop and implement a 

comprehensive and sustainable national strategy to ensure the optimal deployment of public and 

private resources at the state and community level to support family caregivers in America, 

utilizing known evidence-based approaches, as well as developing innovative and promising 

practices. 

Rather than merely providing transitory social services, these approaches will decrease or even 

head off reliance on services such as Medicaid HCBS residential care, institutional care and 

nursing facility care. This initiative will focus instead on approaches that can bolster the ability 

of families to provide high-quality care for their loved ones while maintaining a quality of life 

for themselves by accessing multi-dimensional, flexible supports and leveraging and enhancing 

their local community resources. Of particular interest are supports and services for families 

balancing workforce participation and caregiving responsibilities. A focus on community-wide 

participation will access the vast array of existing community assets that can be used to build 

sustainable family caregiver support systems. 

Applicants are expected to be state partnerships including state units on aging, state disability 

agencies, mental health agencies and other agencies providing support to families across the 

lifespan. In addition, applicants must demonstrate meaningful engagement with the communities 

who will receive the bulk of the funding through sub-grants. For FY 2016, grants will be 

awarded to an estimated 5-7 states with this funding. States will be required to expend a 

minimum of 75% of the funds on evidence-based and promising practices in supports and 

services to family caregivers, and up to 25% on innovative approaches, data collection, and 

evaluation. 

Before applying, each state will undertake an environmental assessment, identifying both 

strengths and weaknesses in their service and support systems for families with caregiving needs, 

across the populations of older adults and people with disabilities, in the three categories 

identified above (knowledge, training and skill development; emotional and social supports; and 

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CAREGIVER AND FAMILY SUPPORT SERVICES

goods and services). This analysis of strengths and weaknesses will be included in their 

application, along with a proposal to use grant funds to augment areas of identified weakness. 

States would focus on the following priorities: 

• Ensure a comprehensive system of supporting caregiver families in the state to minimize 

out of home placement in residential care for older adults and people with disabilities and 

to improve family caregiver resiliency;

 

• Build upon existing caregiving and family support programs and expand promising and 

evidence-based approaches provided across the life course, particularly encompassing the 

working age population when economic stressors are most prevalent; 

• Expand supports that provide access to futures planning targeted towards families and 

caregivers, including benefits counseling, financial planning, advance care directives, and 

alternatives to guardianship; 

• Improve and expand the use of technology for purposes such as family mentoring, 

caregiver support groups, futures and benefits planning, and reducing caregiver isolation; 

• Develop, expand, and support peer-to-peer models such as family support networks and 

dementia care peer supports for caregivers that build upon strength-based models and the 

shared lived experience, as well as reduce isolation and improve emotional well-being;

• Work with local communities to develop and implement innovative approaches to 

supporting families through leveraging existing community assets through place-based 

strategies such as Asset-Based Community Development work;100 

• Develop rigorous evaluations, including use of rapid-cycle learning to enable adjustments 

in policy and practice that meets the needs of families and uses federal funds efficiently.

 

States will use these funds to deploy promising evidence-based approaches in a limited number 

of communities within their state. As these approaches are implemented and results are 

documented, a rapid-cycle evaluation will be used so that lessons learned can be used to refine 

the implementation as it is brought up to statewide scale. Grantee states will be expected to 

provide significant reporting to ACL and its evaluation contractor in order to facilitate the 

expansion of the evidence base surrounding family caregiving and supports. 

100 http://www.abcdinstitute.org/

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CAREGIVER AND FAMILY SUPPORT SERVICES

Grant Awards Tables:

Family Support Grant Awards 

FY 2014 Final FY 2015 

Enacted

FY 2016 

President’s 

Budget

Number of 

Awards -- -- 5-7 

Average 

Award -- -- $2,000,000

Range of 

Awards -- -- $1,000,000 -$5,000,000

Resource and Program Data: 

Family Support 

(Dollars in thousands) 

FY 2014 FY 2015 FY 2016

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary -- -- -- -- 5-7 12,000

Continuations -- -- -- -- -- --

Contracts -- -- -- -- 1 2,500

Interagency Agreements -- -- -- -- -- --

Program Support 1/ -- -- 500

Total Resources -- -- 15,000

1/ Program Support -- Includes funds for grant systems and review, salaries and overhead, and information 

technology support costs.

111 
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Native American Caregiver Support Services

FY 2014 

Final

FY 2015 

Enacted

FY 2016 

President's 

Budget

FY 2016 +/- 

FY 2015

Native American Caregiver 

Support Services............... $6,031,000 $6,031,000 $6,800,000 $769,000

Authorizing Legislation: Section 631 of the Older Americans Act of 1965, as amended 

FY 2016 Authorization ......................................................................................................... Expired

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

Program Description and Accomplishments:

Native American Caregiver Support Services provide grants to eligible Tribal organizations to 

provide support for family and informal caregivers of Native American, Alaskan Native, and 

Native Hawaiian elders. This program, which helps to reduce the need for costly nursing home 

care and medical interventions, is responsive to the cultural diversity of Native American 

communities and represents an important part of each community’s comprehensive services. 

Native American Caregiver Support Services funding is allocated to eligible Tribal organizations 

based on their share of the American Indian, Alaskan Native, and Native Hawaiian population 

aged 60 and over. Tribal organizations must represent at least 50 Native American elders age 

60 and over and be receiving a grant under the Native American Nutrition and Supportive 

Services program to receive funding. There is no requirement for matching funds. Tribes may 

also decide the age at which a member is considered an elder and thus eligible for services. In 

addition, there is no limit on the percentage of funds that can be used for services to grandparents 

caring for grandchildren. 

Grants assist American Indian, Alaskan Native and Native Hawaiian families caring for older 

relatives with chronic illness or disability and grandparents caring for grandchildren. The 

program provides a variety of direct services that meet a range of caregiver needs, including 

information and outreach, access assistance, individual counseling, support groups and training, 

respite care, and other supplemental services. Tribal organizations coordinate with other 

programs, including the Volunteers In Service To America (VISTA) program, to help support 

and create sustainable caregiver programs in Native American communities (many of which are 

geographically isolated). A core value of the Native American Caregiver Support Services 

program is that the program should not replace the tradition of families caring for their elders. 

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CAREGIVER AND FAMILY SUPPORT SERVICES

Rather, as expressed by multiple Tribal leaders, the program provides support that strengthens the 

family caregiver role. 

Funding History:

Funding for the Native American Caregiver Support Services during the past five years is as 

follows: 

FY 2011 ...................................................$6,376,000 

FY 2012 ...................................................$6,364,000 

FY 2013 ...................................................$6,031,076 

FY 2014 ...................................................$6,031,000 

FY 2015 ...................................................$6,031,000 

Budget Request:

The FY 2016 request for Native American Caregiver Support Services is $6,800,000, an increase 

of +$769,000 above the FY 2015 enacted level. Continued support for caregivers is critical since 

often it is their availability – whether they are informal family caregivers, paraprofessionals or 

unrelated friends and neighbors who volunteer their time – that determines whether an older 

person can remain in his or her home. 

An estimated 591,000 persons age 60 and over identify themselves as Native American or 

Alaska Native alone or in combination with another racial group.101 Over 291,000 of those 

elders identify as Native American or Alaskan Native with no other racial group102. Caregiver 

support services help Native American elders, many of whom have limitations in activities of 

daily living that make it difficult to care for themselves, to remain at home, in the community, or 

on the reservation for as long as possible and desired. Studies have shown that providing 

assistance to caregivers can help them cope with the emotional, physical and financial toll 

associated with caregiving, thereby enabling them to provide care for their loved ones longer and 

avoid or delay the need for costly nursing home care. 

101 U.S. Census Bureau, 2012 American Community Survey. . S0201: Selected Population Profile In The United 

States. http://factfinder.census.gov. Accessed 12 January 2015. And 2010 Census Summary File 2. DP-1-

Geography-United States POPGROUP-American Indian and Alaska Native alone or in combination with one or 

more other races (300, A01-Z99) & (100-299) or (300, A01-Z99) or (400-999): Profile of General Population and 

Housing Characteristics: 2010. Accessed 26 August 2013.

102 Administration for Community Living, http://www.agid.acl.gov/DataGlance/. Data-at-a-Glance: American 

Community Survey (ACS) Public Use Microdata Sample (PUMS) 1-Year Files (2012), accessed January, 08, 

2015. 

114 

 
CAREGIVER AND FAMILY SUPPORT SERVICES

Performance data indicates that these programs are an efficient means to help Native American 

Elders remain independent and in the community. In FY 2016, funding for the Native American 

Caregiver Support Program will continue to assist family and informal caregivers, whose 

assistance is critical to enabling Native American elders to remain at home, in the community, 

and/or on the reservation. It is estimated that in FY 2016 more than 420,000 units of caregiverrelated services including respite care, information and referral, caregiver training, lending 

closets, and support groups will have been provided by Native American Tribal organizations. 

Outcome Table:

Native American Caregivers Supportive Services Outcome

Measure Most Recent 

Result 

FY 2015 

Target 

FY 2016 

Target

FY 2016 

+/- FY 2015

Outcome 3.1: Increase the number of 

caregivers served through the National 

Family Caregiver Support Program.

(Outcome)

FY 2013: 1,046,159

Target: 800,000

(Target Exceeded)

790,000 825,000 + 35,000

Grant Awards Table:

Native American Caregivers Supportive Services Grant Awards

FY 2014 Final FY 2015 

Enacted

FY 2016 

President’s 

Budget

Number of 

Awards 231 231 231

Average 

Award $26,108 $26,043 $29,364

Range of 

Awards

$11,480 - 

$47,362

$11,480 - 

$47,362

$12,940 - 

$53,330

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CAREGIVER AND FAMILY SUPPORT SERVICES

Resource and Program Data:

Native American Caregiver Support Services

(Dollars in thousands) 

FY 2014 FY 2015 FY 2016

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula 231 6,031 231 6,016 231 6,783

New Discretionary -- -- -- -- -- --

Continuations -- -- -- -- -- --

Contracts -- -- -- -- -- --

Interagency Agreements -- -- -- -- -- --

Program Support 1/ -- 15 17

Total Resources 6,031 6,031 6,800

1/ Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and 

review, and information technology support costs.

116 
Alzheimer’s Disease Supportive Services Program

FY 2014 

Final

FY 2015 

Enacted

FY 2016 

President's Budget

FY 2016 +/- FY 

2015

ADSSP.............. $3,772,000 $3,800,000 $3,800,000 --

Authorizing Legislation: Section 398 of the Public Health Services Act, as amended 

FY 2016 Authorization ......................................................................................................... Expired

Allocation Method ............................. Competitive Grants/Cooperative Agreements and Contracts

Program Description and Accomplishments:

The Alzheimer’s Disease Supportive Services Program (ADSSP) funds competitive grants to 

States to expand the availability of evidence-based interventions and dementia-capable long term 

services and supports (LTSS) systems. These systems are able to identify those with dementia 

and their family caregivers, understand their unique circumstances, communicate appropriately 

with them, help them choose services that meet their needs, and provide supports to ease 

caregiver stress. Dementia-capable systems also help persons with dementia and their family 

caregivers remain independent. The primary components of the ADSSP program include 

delivering evidence-based LTSS; translating evidence-based interventions for persons with 

dementia and their caregivers at the community level; incorporating evidence-based research in 

the formulation of innovative projects; and promoting dementia-capable LTSS. The statute 

governing the ADSSP requires that States “expend not less than 50 percent of the federal grant 

funds for the provision of (direct) services” to individuals with Alzheimer’s disease or related 

dementias, and their family caregivers.

The most recent grant projects are designed to ensure that states provide people with dementia 

and their family caregivers with access to a sustainable home and community-based services 

(HCBS) system that is dementia capable. There are presently fifteen states engaged in projects 

dedicated to the implementation of dementia-capable services.

One example of an evidence-based intervention is the New York University Caregiver 

Intervention, a spousal caregiver support program that in a randomized-control trial delayed 

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CAREGIVER AND FAMILY SUPPORT SERVICES

institutionalization of persons with dementia by an average of 557 days.103 Minnesota has 

translated this intervention and results are consistent with the original study.104 Other grant 

projects are focused on innovations in areas of great need, such as programs to ensure that the 

States’ LTSS systems are dementia capable. Overall, these demonstrations offer direct services 

and other supports to thousands of families, while ensuring continuous quality improvement and 

evaluation of these services. 

Family caregivers remain the major source of support for most people with Alzheimer’s disease. 

The nature of the disease – a slow loss of cognitive and functional/physical independence – 

means that most people with Alzheimer’s disease rely on family and LTSS in the community for 

years. They may access a variety of services from many different systems including the aging, 

medical, and mental health service systems. As the number of people with Alzheimer’s disease 

grows, it is increasingly important that health and LTSS systems are responsive to persons with 

dementia and effectively coordinated. 

Funding History:

Funding for the ADSSP program during the past five years is as follows: 

FY 2011 .................................................$11,441,000 

FY 2012 ...................................................$4,010,000 

FY 2013 ...................................................$3,785,653 

FY 2014 ...................................................$3,772,000 

FY 2015 ...................................................$3,800,000 

Budget Request:

The FY 2016 request for the Alzheimer’s Disease Supportive Services Program is $3,800,000, 

the same as the FY 2015 enacted level. 

The need for cutting edge approaches that serve those with Alzheimer’s and their caregivers 

continues to grow as the incidence and population and with the disease increase. One study 

estimates that there were 454,000 new cases of Alzheimer’s disease in 2010. The annual number 

of new cases is projected to be 615,000 by 2030, and 959,000 by 2050. Currently, about 

5 million individuals have this disease. 105 

103 Mittleman M, et al. (1996). “A Family Intervention to Delay Nursing Home Placement of Patients with 

Alzheimer’s Disease: a randomized, controlled trial,” Journal of the American Medical Association, 276; 1725-

1731.

104 Mittelman, M.S., Bartels, S.J. “Translating Research into Practice: Case Study of a Community-based Dementia 

Caregiver Intervention,” Health Affairs. April 2014 vol. 33 no. 4 587-595.

105 Alzheimer’s Association, (2014). “2014 Alzheimer’s Disease Facts and Figures”. Accessed August 08, 2014 

from: http://www.alz.org/downloads/facts_figures_2014.pdf 

118 

 
CAREGIVER AND FAMILY SUPPORT SERVICES

The FY 2016 funding request will allow ACL to continue to respond to this growing need by 

supporting new grants that provide direct services to approximately 35,000 persons with 

Alzheimer’s disease and their family caregivers. This will enable communities across the nation 

to continue implementing evidence-based interventions such as the New York University 

Caregiver Intervention referenced above. In addition, without this funding, ACL will be unable 

to undertake subsequent translations of research funded by National Institute on Aging, Centers 

for Disease Control and Prevention, and other science agencies. Funds will be used to broadly 

disseminate those translated, evidence-based interventions that have proven successful over the 

past 6 years of funding and to test new evidence-based interventions as they are identified. In 

addition, funds will be used to expand the delivery of dementia-capable LTSS, thus helping a 

much broader population of families struggling to cope with this disease. 

ACL is examining how these interventions can be effectively provided through State LTSS 

systems, while ensuring fidelity to the original intervention. Successful translation of these 

research interventions to community settings will have a significant impact on supporting and 

sustaining family caregivers.

By the end of FY 2015, ACL anticipates the release a joint analysis of results from a six-state 

translation effort of the New York University Caregiver Intervention, which aims to significantly 

delay institutionalization of persons with dementia by providing education, support, and 

counseling to spousal and other family caregivers. ACL projects that it will also have an 

analysis of a three-state translation of the Savvy Caregiver Intervention. This intervention trains 

caregivers to think about their situation objectively and provides them with the knowledge, 

skills, and attitudes they need to manage stress and carry out the caregiving role effectively. 

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CAREGIVER AND FAMILY SUPPORT SERVICES

Outcome and Outputs Table:

Alzheimer’s Disease Supportive Services Program Outputs

Note: For presentation within the budget ACL highlighted specific measures that are most directly related to 

Alzheimer’s Disease Supportive Services Programs, however multiple performance outcomes are impacted by this 

program because ACL’s performance measures (efficiency, effective targeting, and client outcomes) assess 

network-wide performance in achieving current strategic objectives. 

Grant Awards Table:

Alzheimer’s Disease Supportive Services Grant Awards

FY 2014 Final FY 2015 

Enacted

FY 2016 

President’s 

Budget

Number of 

Awards 7 6 6 

Average 

Award $402,250 $475,376 $475,376

Range of 

Awards

$250,000-

$450,000

$250,000-

$600,000

$250,000-

$600,000

106 Cumulative count began in 2008.

107 Cumulative count began in 2008.

Measure Most Recent Result FY 2015 

Target 

FY 2016

Target 

FY 2016 

+/- FY 2015

Outcome ALZ2. Increase number 

of individuals served with 

evidence-based interventions – 

cumulative106 (Outcome)

FY 2013: 19,261

Target: 15,800 

(Target Exceeded)

21,500 21,957 + 457

Indicator Most Recent Result FY 2015 

Projection 

FY 2016

Projection 

FY 2016 

+/- FY 2015

Output AC: Number of 

individuals served – 

cumulative107 (Output)

FY 2013: 42,354 48,000 48,750 + 750 

Output AD: Percent of 

individuals served that are of a 

racial/ethnic minority (Output)

FY 2013: 21% 21% 21% Maintain

120 

 
CAREGIVER AND FAMILY SUPPORT SERVICES

Resource and Program Data:

Alzheimer’s Disease Supportive Services Program

(Dollars in thousands) 

FY 2014 FY 2015 FY 2016

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary 7 2,816 6 2,852 6 2,852

Continuations -- -- -- -- -- -- 

Contracts 1 791 1 791 1 791

Interagency Agreements -- -- -- -- -- --

Program Support 1/ 165 156 156

Total Resources 3,722 3,800 3,800

1/ Program Support -- Includes funds for Public Health Service Act statutory requirements, grant systems 

and review costs.

121 
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Alzheimer’s Disease Initiative - Specialized Supportive Services

FY 2014 

Final

FY 2015 

Enacted

FY 2016 

President's 

Budget

FY 2016 +/- FY 

2015

Alzheimer’s Disease 

Initiative – Services 

(Prevention Fund)

$10,500,000 $10,500,000 $10,500,000 --

Note: Funding in FY 2014 and FY 2015 was provided from the Prevention and Public Health Fund, and FY 2016 

funding is requested from the same source.

Authorizing Legislation: Section 411 of the Older Americans Act of 1965, as amended, and the 

Patient Protection and Affordable Care Act (ACA), Section 4002 [42 U.S.C. 300u-11] 

FY 2016 Older Americans Act Authorization ...................................................................... Expired

Allocation Method ............................ Competitive Grants/Co-operative Agreements and Contracts

Program Description and Accomplishments:

On January 4, 2011, the President announced a new effort to fight Alzheimer’s disease. An 

estimated 5 million people in the United States may have Alzheimer’s, the effects of which are 

devastating for people with the disease and their families. Individuals with Alzheimer’s generally 

require significant levels of health care and intensive long-term services and supports (LTSS) – 

including but not limited to management of chronic conditions, assistance with medication 

management, round-the-clock supervision and care due to behavioral symptoms, and assistance 

with personal care activities, such as eating, bathing, and dressing. 

Research has shown that caregiving exacts a heavy emotional, physical, and financial toll on 

family caregivers of persons with Alzheimer’s disease. They have a greater risk of stress and ill 

health than other caregivers. Dementia caregivers provide an average of one to four more years 

of care than caregivers for people with other conditions. (43 percent vs. 33 percent). They are 

also more likely to be providing care for five years or longer (32 percent vs. 28 percent).108 In 

another study, 44 percent of caregivers of people with dementia indicated depressive symptoms, 

compared with 27 percent of caregivers of people who had cognitive impairment but no 

dementia.109 Data from the 2010 BRFSS caregiver survey found that 7 percent of dementia 

108 Alzheimer’s Association, (2014). “2014 Alzheimer’s Disease Facts and Figures”. Accessed August 08, 2014 

from: http://www.alz.org/downloads/facts_figures_2014.pdf. 

109 Fisher GG, Franks MM, Plassman BL, Brown SL, Potter GG, Llewellyn D, et al. Caring for individuals with 

dementia and cognitive impairment, not dementia: Findings from The Aging, Demographics, and Memory Study. J 

Am Ger Soc 2011;59(3):488–94.

123 

 
CAREGIVER AND FAMILY SUPPORT SERVICES

caregivers say the greatest difficulty of caregiving is that it creates or aggravates their own health 

problems compared with 2 percent of other caregivers.110

Developing more dementia capable LTSS systems designed to meet the needs of caregivers of 

individuals with Alzheimer's Disease and related dementias is critical to helping these 

individuals continue to provide care. The Alzheimer’s Disease Initiative – Specialized 

Supportive Services fills gaps in dementia-capable LTSS systems for persons living with the 

disease and their family caregivers. The Initiative will provide specialized, person-centered 

services that will help them remain independent and safe in their communities. Through this 

Initiative, ACL is working with public and private entities to identify and address the special 

needs of persons with Alzheimer’s disease and their caregivers when they seek assistance. 

Examples of special needs are services for people living alone, those at highest risk of having 

Alzheimer’s, or people with behavioral symptoms that might lead to institutionalization. Public 

and private entities include, but are not limited to, State, local, and tribal governments, the Aging 

Network, and community level organizations. 

Funding History:

FY 2011 .................................................................$0 

FY 2012 .................................................................$0 

FY 2013 .................................................................$0 

FY 2014 .................................................$10,500,000 

FY 2015 .................................................$10,500,000 

Budget Request: 

The FY 2016 request for Alzheimer’s disease services is $10,500,000 to continue the President’s 

efforts to fight Alzheimer’s disease, and for development and expansion of the specialized 

supportive services for those impacted by the disease. This is the same level of funding that was 

requested in the FY 2015 enacted level. ACL renews its request of these funds, first provided in 

the FY 2014 Prevention and Public Health Fund appropriation. 

ACL will use the $10.5 million it is requesting in FY 2016 to expand approaches to improving 

care for those with Alzheimer’s disease and their caregivers that was initiated in FY 2014. This 

Initiative focuses on strengthening dementia-capability through development of specialized 

supportive services in a handful of States, tribal entities, and/or localities. A dementia-capable 

110 Bouldin ED, Andresen E. Caregiving Across the United States. Caregivers of persons with Alzheimer’s disease 

or dementia in Connecticut, New Hampshire, New Jersey, New York, and Tennessee. Data from the 2010 

Behavioral Risk Factor Surveillance System. Seattle, Wash.: University of Washington Department of 

Epidemiology; 2010.

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CAREGIVER AND FAMILY SUPPORT SERVICES

LTSS system is able to identify those with dementia and their caregivers, understand their unique 

circumstances, communicate appropriately with them, help them choose services that meet their 

needs, and provide supports to ease the burden on caregivers. 

ACL will hold a competition to award cooperative agreements to States, tribes, or other 

localities. Successful applicants will build on existing dementia-capable systems by providing 

specialized supportive services that will be integrated into: 

• information, screening, referral, and access; 

• LTSS options counseling and assistance; 

• streamlined applications and eligibility determinations for public programs; and

• person-centered, service coordination across multiple settings and across care transitions.

The grantees will also be asked to develop three core components of specialized supportive 

services for persons with dementia and their family caregivers including a: 

• comprehensive set of services;

• robust quality assurance system; and 

• sustainable service system. 

The specialized supportive services resulting from this funding opportunity will assist people 

with Alzheimer’s disease and their family caregivers by ensuring that their unique needs are 

addressed. Since the focus of the cooperative agreements will be to facilitate permanent systems 

change, an emphasis will be placed on implementing specialized supportive services that can 

operate out of ongoing funding streams and will not require new sources of funds to maintain. 

ACL awarded 10 grants in September 2014 to begin this work. 

Grant Awards Table:

Alzheimer’s Disease Initiative – Specialized Supportive Services

FY 2014 Final FY 2015 

Enacted

FY 2016 

President’s 

Budget

Number of 

Awards 10 10 10

Average 

Award $977,500 $982,500 $982,500

Range of 

Awards

$750,000 - 

$1,000,000

$750,000 - 

$1,000,000

$750,000 - 

$1,000,000

125 
CAREGIVER AND FAMILY SUPPORT SERVICES

Resource and Program Data:

Alzheimer’s Disease Initiative – Specialized Supportive Services

(Dollars in thousands) 

FY 2014 FY 2015 FY 2016

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary 10 9,775 10 9,825 10 9,825

Continuations -- -- -- -- -- --

Contracts 3 639 2 639 2 639

Interagency Agreements -- -- -- -- -- --

Program Support 1/ 86 36 36

Total Resources 10,500 10,500 10,500

1/ Program Support -- Includes funds for Public Health Service Act statutory requirements, grant systems 

and review costs.

126 
Lifespan Respite Care

FY 2014 

Final

FY 2015 

Enacted

FY 2016 

President's 

Budget

FY 2016 +/- FY 

2015

Lifespan Respite 

Care.............. $2,342,000 $2,360,000 $5,000,000 $2,640,000

Authorizing Legislation: Lifespan Respite Care Act of 2006, Title XXIX of the Public Health 

Service Act

FY 2016 Authorization ......................................................................................................... Expired

Allocation Method ............................................................................................. Competitive Grants

Program Description and Accomplishments:

Family caregiving is not just an aging issue. Family caregiving for persons with disabilities 

occurs across the age spectrum from birth to death. Family caregivers are often called upon to 

provide care to individuals of varying ages and disabilities and do so willingly, often for long 

periods of time and for many years. In 2009, AARP and the National Alliance for Caregiving 

estimated that 65.7 million people served as unpaid family caregivers to an adult or child with 

special needs. For many of these caregivers, providing care can take a toll: a majority of 

caregivers (51 percent) caring for someone over age 18 have medium or high levels of burden 

and 31 percent of all family caregivers indicated they experienced high levels of stress.111

Numerous studies have shown respite to be among the most frequently requested supportive 

service for family caregivers.112 Respite is second only to direct financial assistance as a key 

policy priority of surveyed family caregivers.113 Even though respite services are often the 

preferred mode of family caregiver support, they are often under-used, difficult to find and 

access, unaffordable, or in short supply. A 2009 survey found that many caregivers reported 

difficulty managing both physical and emotional stress and balancing work and family 

responsibilities. As a result, nearly 90 percent of family caregivers receive no respite at all.114

The barriers to accessing and using respite services are often significant for specific populations 

111 National Alliance for Caregiving and AARP. Caregiving in the U.S.: A Focused Look at Those Caring for the 

50+. 2009. http://www.aarp.org/research/surveys/care/ltc/hc/articles/caregiving_09.html 112 The Arc. (2011). Still in the Shadows with Their Future Uncertain: A Report on Family and Individual Needs 

for Disability Supports (FINDS 2011). Wash, DC: Author ; National Family Caregivers Association. (2011). 

Allsup Family Caregiver Survey. Kensington, MD 113 National Alliance for Caregiving and AARP, 2009 114 National Alliance for Caregiving and AARP, 2009.

127 

 
CAREGIVER AND FAMILY SUPPORT SERVICES

such as family caregivers of individuals with Multiple Sclerosis, persons with intellectual and 

developmental disabilities, and for caregivers of veterans and individuals with Alzheimer’s 

disease, spinal cord injuries, autism, and serious emotional disorders. 115 

The Lifespan Respite Care program focuses on easing the burdens of caregiving by providing 

grants to eligible State organizations to improve the quality of, and access to, respite care for 

family caregivers of children or adults of any age with special needs. In particular, this program 

provides ACL with another vehicle to address the needs of caregivers while considering the 

important contributions they make in the lives of persons of all ages with disabilities. The goals 

of the Lifespan Respite Care program differ from the National Family Caregiver Support 

Program, which focuses on providing a variety of services to caregivers. Instead, Lifespan 

Respite Care programs focus on providing a test-bed for needed infrastructure changes, and on 

filling gaps by putting in place coordinated systems of accessible, community-based respite care 

services for family caregivers of children and adults with special needs. These systems bring 

together and seek to coordinate respite care services for family caregivers; training and 

recruitment of respite care workers and volunteers; and provision of information, outreach, and 

access assistance. 

The Lifespan Respite care program also supports resource center activities designed to maintain 

a national database on lifespan respite care; provide training and technical assistance to grantees 

and State, community, and nonprofit respite care programs; and conduct public information, 

referral, and education programs on respite care. Since 2009, the Lifespan Respite Care Program 

has made grants to eligible state agencies and for the funding of a National Technical Assistance 

Resource Center as follows:

• Grants to new states each year have allowed for the initial development of Lifespan 

Respite Programs. To date, 32 states and the District of Columbia have received initial 

three-year grants;

• In FY 2011 and FY 2012, a total of ten states (eight in 2011 and two in 2012) were 

awarded competitive expansion supplements to focus specifically on providing respite 

services to meet demand and fill gaps in service where identified;

• Integration and Sustainability grants in FY 2012 and FY 2013 have been awarded to a 

total of fifteen states (seven in 2012 and eight in 2013) enabling them to more fully 

115 National Alliance for Caregiving. (2012). Multiple Sclerosis Caregivers. Washington, DC: Author; The Arc, 

2011.

128 

 
CAREGIVER AND FAMILY SUPPORT SERVICES

• embed the concept of respite and family support into statewide home and communitybased services and long-term services and supports (LTSS) system reform efforts across 

the age and disability spectrum; 

• In FY 2014, 16 states received three-year grants to focus on the provision of respite 

services, more fully integrate the concepts of Lifespan Respite in state LTSS reform 

activities, and ensure the long-term sustainability of program efforts beyond the Federal 

funding period; 

• Two Technical Assistance Resource Center cooperative agreements (the first awarded in 

FY 2009 and the second in FY 2012), have afforded the opportunity to provide basic and 

advanced technical assistance to grantees on a range of topics pertaining to general 

program development and implementation; population-specific respite information and 

training; program sustainability; the collection, synthesis and dissemination of available 

respite research information; and the development and maintenance of a National 

Registry of respite services.

Examples of grantee accomplishments to date include: 

• Creation and adoption of statewide respite plans and/or policies to guide further 

development of respite and caregiver support programs; 

• Development or enhancement of training programs for respite care providers to expand 

the cadre of trained respite professionals;

• Replication and expansion of respite delivery modalities with a particular focus on 

person- centered planning and consumer direction; 

• Expansion of toll free “helplines,” dedicated websites and statewide respite registries to 

provide caregivers with information about available respite programs. 

• Development and deployment of marketing and awareness campaigns designed to 

educate caregivers about the importance of their work and the necessity to take a break;

• Development of data collection methodologies to track service provision and 

programmatic outcomes; 

129 
CAREGIVER AND FAMILY SUPPORT SERVICES

• Broadening stakeholder collaborations to ensure representation of all age and disability 

groups, as well as the broadest possible cross section of the provider network; 

• Convening focus groups of respite consumers to inform project activities; and 

• Capacity building and network development at the local level to recruit and train 

volunteers to fill gaps in respite services, particularly in rural areas through partnerships 

with programs such as the Corporation for National Service (e.g., VISTA, Service 

Learning, Senior Companions, etc.); and

• Provision of direct respite services to family caregivers of children with intellectual and 

developmental disabilities, adults with physical disabilities, and older Americans.

Grantee States work in collaboration with Aging and Disability Resource Centers and a public or 

private non-profit statewide respite care coalition or organization. Special emphasis is placed on 

implementing or enhancing lifespan respite care statewide and building or improving the 

capacity of their long-term care systems to respond to the comprehensive needs of care 

recipients. 

Funding History:

Funding for the Lifespan Respite Care program during the past five years is as follows:

FY 2011 ...................................................$2,495,000 

FY 2012 ...................................................$2,490,000 

FY 2013 ...................................................$2,350,722 

FY 2014 ...................................................$2,342,000 

FY 2015 ...................................................$2,360,000 

Budget Request:

The FY 2016 request for Lifespan Respite is $5,000,000, an increase of +$2,640,000 above the 

FY 2015 enacted level. At this level, ACL will make competitive grants available to support a 

range of possible activities, including grants to two new states to begin work building or 

enhancing Lifespan Respite Programs; grants to further integrate and sustain Lifespan Respite 

activities into broader long-term services and supports in the state; and/or grants to provide 

additional respite services to family caregivers across the age and disability spectrum. ACL 

recognizes the unique opportunity the Lifespan Respite Care Program presents to consider the 

130 
CAREGIVER AND FAMILY SUPPORT SERVICES

critical role that support for family caregivers plays in ensuring the health and independence of 

individuals across the age and disability spectrum. By expanding investments in this program, 

ACL seeks to provide more and better targeted services that will allow caregivers to continue to 

care for their loved ones longer and thereby allow more care recipients to remain at home and 

independent for longer periods at lower cost than could be realized if these same individuals had 

to be institutionalized.

The Lifespan Respite Care Program helps to ensure respite quality and choice; and allows for 

respite development, training and coordination regardless of age or disability. The Lifespan 

Respite Care program demonstrates ACL’s commitment to include caregivers of children or 

adults of any age with special needs. According to the National Respite Coalition, nearly 

90 percent of family caregivers of care recipients age 18 and older, and 81 percent of family 

caregivers of children with special needs currently are unable to access or use respite services. 

Caregivers report numerous barriers ranging from cost considerations and restrictive eligibility 

criteria to waiting lists, limited respite options, inadequate supply of trained providers or 

appropriate programs and gaps in service availability.116 

The additional resources requested for FY 2016 will be used to address these issues by: 

• Expanding and enhancing respite care services to family members;

• Improving the statewide dissemination and coordination of respite care; and 

• Providing, supplementing, or improving access and quality of respite care services to 

family caregivers, thereby reducing family caregiver strain.

The request will also allow ACL to focus on program development in new States not funded in 

previous years, by enabling them to establish and/or strengthen infrastructures that offer targeted 

Respite Information and Referral services. Additionally, it will further enable all States funded 

to date to continue infrastructure development, recruitment, and training of respite providers and 

volunteers, thus reducing the percentages of caregivers who do not have access to or use respite. 

116 National Respite Coalition Written Testimony to the House subcommittee on Labor, Health and Human Services, 

and Education Appropriations. April 12, 2010

131 

 
CAREGIVER AND FAMILY SUPPORT SERVICES

Output Table:

Lifespan Respite Care Output

 

Grant Awards Table:

Lifespan Respite Care Grant Awards

FY 2014 Final FY 2015 

Enacted

FY 2016 

President’s 

Budget

Number of 

Awards 18 18 31

Average 

Award $126,278 $127,652 $286,177

Range of 

Awards

$75,000 - 

$200,000

$73,000 - 

$259,000

$73,000 - 

$500,000

Resource and Program Data:

Lifespan Respite Care Program

(Dollars in thousands) 

FY 2014 FY 2015 FY 2016

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary 17 2,024 2 440 17 2,754

Continuations 1 249 16 1,858 16 2,111

Contracts -- -- -- -- -- --

Interagency Agreements -- -- -- -- -- --

Program Support 1/ 69 62 135

Total Resources 2,342 2,360 5,000

1/ Program Support -- Includes funds for Public Health Service Act statutory requirements, grant systems 

and review costs.

Indicator Most Recent 

Result 

FY 2015 

Projection 

FY 2016 

Projection

FY 2016 

+/- FY 2015

Output AJ The number of states 

that have participated in the 

Lifespan Respite Care program.

(Output)

FY 2014: 33

(Actual) 34 36 + 2

132 
Protection of Vulnerable Adults

Summary of Request

Protection of Vulnerable Adults consists of several distinct but complementary programs 

designed to prevent, detect, and respond to elder abuse, neglect, and exploitation. As the 

population of older Americans increases, the problem of elder abuse, neglect, and exploitation 

continues to grow. While there is no single set of national elder abuse prevalence data, the 

number of reported cases of elder abuse, neglect, and exploitation are on the rise. A 2004 

national survey of State Adult Protective Services (APS) programs conducted by AoA’s National 

Center on Elder Abuse showed a 16 percent increase in the number of elder abuse cases from an 

identical study conducted in 2000.117 According to a 1998 national incidence study (the only 

such study ever conducted), 84 percent of all elder abuse incidents go unreported, meaning that 

for every reported case of abuse there are over five that go unreported.118 Consistent with these 

earlier findings, the most recent data on the prevalence of elder abuse, neglect, and exploitation 

suggest that at least 10 percent, or approximately 5 million, older Americans experience abuse 

each year, and many experience it in multiple forms.119

The negative effects of abuse, neglect, and exploitation on the health and independence of 

seniors is extensive. Research has demonstrated that older victims of even modest forms of abuse 

have dramatically higher (300 percent) morbidity and mortality rates than non-abused older 

people.120 Additional adverse health impacts include an increased likelihood of heart attacks, 

dementia, depression, chronic diseases and psychological distress. The result of these 

unnecessary health problems is a growing number of seniors who access the healthcare system 

more frequently (including emergency room visits and hospital admissions), and are ultimately 

forced to leave their homes and communities prematurely.121 Protection of Vulnerable Adults 

programs address this problem through a full array of services designed to prevent, detect, and 

respond to elder abuse, neglect, and exploitation, both at home and in institutional settings.

117 Teaster, Pamela, et al. The 2004 Survey of State Adult Protective Services: Abuse of Adults 60 Years of Age and 

Older. http://www.ncea.aoa.gov/NCEAroot/Main_Site/pdf/2-14-06%20FINAL%2060+REPORT.pdf 118Tatara, Toshio, et al. The National Elder Abuse Incidence Study Final Report. 1998. 

http://www.aoa.gov/AoARoot/AoA_Programs/Elder_Rights/Elder_Abuse/docs/ABuseReport_Full.pdf 

119 Beach SR, Schulz R, Castle NG, Rosen J. Financial Exploitation and Psychological Mistreatment Among Older 

Adults: Differences Between African Americans and Non-African Americans in a Population-Based Survey. 

Gerontologist 2010.

 Acierno R, Hernandez MA, Amstadter AB, Resnick HS, Steve K, Muzzy W et al. Prevalence and Correlates of 

Emotional, Physical, Sexual, and Financial Abuse and Potential Neglect in the United States: The National Elder 

Mistreatment Study. American Journal of Public Health 2010; 100(2):292-297

120 Lachs, M.S., Williams, C.S., O'Brien, S., Pillemer, K.A., & Charlson, M.E. (1998). “The Mortality of Elder 

Mistreatment.” JAMA. 280: 428-432. and Baker, M.W. (2007). “Elder Mistreatment: Risk, Vulnerability, and 

Early Mortality.” Journal of the American Psychiatric Nurses Association, Vol. 12, No. 6, 313-321. 121 Lachs M. S., Williams C., O'Brien S., Hurst L., Kossack A., Siegal A., et al. (1997). “ED use by older victims of 

family violence.” Annals of Emergency Medicine. 30:448-454.

133 

 
PROTECTION OF VULNERABLE ADULTS

The total FY 2016 request for Protection of Vulnerable Adults is $67,152,000; an increase of 

+$21,000,000 above the FY 2015 enacted level. For FY 2016, specific program requests include:

• $15,885,000 for the Long-Term Care Ombudsman Program, the same as the FY 2015 

enacted level. This consumer advocacy program improves the quality of care for the 

residents of long-term care facilities in all States.

• $4,773,000 for Prevention of Elder Abuse and Neglect, the same as the FY 2015 enacted 

level. This program provides formula grants to states to train, educate, and promote 

public awareness of elder abuse prevention efforts. 

• $8,910,000 for the Senior Medicare Patrol Program, the same as the FY 2015 enacted 

level. SMP funds competitive grants to support a volunteer-based network that helps to 

prevent and combat healthcare fraud and abuse and helps to preserve the financial 

integrity of Medicare and Medicaid. This program is also supported by Health Care Fraud 

and Abuse Control (HCFAC) “wedge” funding, the level for which is determined 

annually as a result of negotiations between the Attorney General and the Secretary of 

HHS. HCFAC funds pay for infrastructure that supports States’ Senior Medicare Patrols, 

as well as expansion grants to SMPs targeted to high-fraud states.

• $28,874,000 for Elder Rights Support Activities, an increase of +$21,000,000 above the 

FY 2015 enacted level. This program provides funding for resource centers and activities 

that provide information, training, and technical assistance on elder rights issues to the 

national Aging Services Network. The increase will advance ACL’s Elder Justice 

initiative to help fulfill the promise of the Elder Justice Act of 2009. Funds will support 

the implementation of a nationwide Adult Protective Services data system, and fund 

research and evaluation activities. 

These elder rights and elder justice programs will build a foundation and establish best practices 

for States to develop programs to expand and improve the protection of individuals living in their 

communities and in long-term care settings; increase the information and technical assistance 

available to the public, States, and localities in preventing and addressing abuse; protect the 

rights of older adults and prevent their exploitation; reduce health-care fraud and abuse; and 

provide assistance to Tribes in developing elder justice systems. This multifaceted approach to 

preventing, detecting, and resolving elder abuse, neglect, and exploitation is essential to 

successfully fulfilling the shared mission of the Older Americans Act and the Elder Justice Act 

to maintain the health and independence of older Americans and adults with disabilities.

134 
Long-Term Care Ombudsman Program

FY 2014 

Final

FY 2015 

Enacted

FY 2016 

President's Budget

FY 2016 +/- 

FY 2015

Long-Term Care 

Ombudsman Program $15,885,000 $15,885,000 $15,885,000 --

Authorizing Legislation: Section 712 of the Older Americans Act of 1965, as amended 

FY 2016 Older Americans Act Authorization ...................................................................... Expired

Allocation Method ................................................................................................... Formula Grants 

Program Description and Accomplishments:

The Long-Term Care (LTC) Ombudsman Program is a consumer advocacy program that 

improves the quality of life and quality of care for the estimated 2.9 million individuals who 

reside in 69,508 long-term care facilities.122 Formula grants to States and Territories based on the 

number of individuals age 60 and older provide funding for the training, travel, and other 

operating costs of nearly 10,000 ombudsmen (both staff and certified volunteers) who resolve 

complaints with and on behalf of these residents, advocate for systemic improvement of longterm care systems, and routinely monitor the condition of long-term care facilities. 

A primary Ombudsman duty is to identify, investigate, and resolve complaints that are made by 

or on behalf of residents. These complaints relate to action, inaction, or decisions of providers, 

public agencies, and others that may adversely affect residents’ health, safety, welfare or rights. 

Ombudsmen advocate on behalf of residents by representing their interests before government 

and administrative entities, providing information to residents and families about the long-term 

care system, and educating the general public about issues related to long-term care policies and 

regulations. 

Much of the efficiency of the Ombudsman Program is due to strong reliance on volunteers who 

make up the bulk of those who resolve resident issues.123 All but four States have volunteer 

ombudsman programs. These certified volunteer ombudsmen donated over 735,411 hours in 

FY 2011, a six percent increase over FY 2009. In FY 2013 output data for the Long-Term Care 

Ombudsman Program highlights the accomplishments achieved by this program and the 

122 National Ombudsman Reporting System (NORS) – Federal Fiscal 2011. 123 Shaughnessy, Carol V. The Role of Ombudsmen in Assuring Quality for Residents of Long-Term Care Facilities: 

Straining to Make Ends Meet. National Health Policy Forum. December 9, 2009. 

135 

 
PROTECTION OF VULNERABLE ADULTS

important role that ombudsmen play in ensuring that the rights of long-term care facility 

residents are respected: 

• 1,185 paid and 9,065 certified volunteer ombudsmen regularly visited residents in 

27,785 facilities, more than 70 percent of all nursing home facilities and nearly 33 percent of 

all licensed board and care facilities (Output S). At least another 3,320 volunteers support 

these paid staff and certified volunteer ombudsmen. 

• Ombudsmen investigated and worked to resolve 190,592 complaints (Output Q). 

• Ombudsmen provided over 464,806 consultations to individuals and facility managers and 

staff on such topics as residents’ rights, staffing levels, malnutrition, dementia care, 

depression, discharge procedures, financial exploitation and strategies to reduce the use of 

restraints and prevent the abuse and neglect of residents (Output R). 

Today’s landscape is changing, however, as individuals in need of long-term care services and 

supports are increasingly choosing to live in community settings. Encouraging community 

living is a strategic DHHS priority, as has been supported by a number of Federal and state 

policies promoting alternatives to nursing homes and other institutional settings that recognize 

the value of consumer preference and the attendant potential fiscal savings that can result. 

The desire to re-balance and thereby give consumers more community living options has been 

promoted and accelerated through a variety of federal laws and initiatives: the Affordable Care 

Act, Olmstead implementation and enforcement, Money Follows the Person, Home and 

Community Service (HCBS) revised regulations, and managed care, to name a few, are 

continuing to change the long-term care landscape across the country. There is also a growing 

federal awareness and response to the uncharted area of abuse, neglect and exploitation of older 

adults, and persons with disabilities. Addressing this troubling trend is also a priority of ACL.

All of these changes have created new challenges for LTC Ombudsman Programs as well as for 

Protection & Advocacy Systems serving the disability community that are also supported by 

ACL. Going forward, LTCOP’s and P&As will need to learn a new regulatory and service 

environment at the same time that they will have to cope with the continuing accelerated growth 

of community based services. 

136 
PROTECTION OF VULNERABLE ADULTS

Funding History: 

Funding for the Long-term Care Ombudsman Program during the past five years is as follows:

FY 2011 .................................................$16,793,000 

FY 2012 .................................................$16,761,000 

FY 2013 .................................................$15,885,000 

FY 2014 .................................................$15,885,000 

FY 2015 .................................................$15,885,000 

Budget Request:

The FY 2016 request for the LTC Ombudsman Program is $15,885,000, the same as the 

FY 2015 enacted level. 

Funds will continue to be spent to support the existing infrastructure and activities of the 

Ombudsman program. With the senior population continuing to grow, the need for safe, highquality long-term care services (including non-nursing home alternatives) continues to increase, 

even as we seek to help more people remain in the community for longer periods. Outcome data 

(displayed in the summary tables at the end of this section) have demonstrated the success of this 

program in protecting older Americans in an efficient and effective manner. The percentage of 

the complaints processed by ombudsmen that were fully or partially resolved to the satisfaction 

of the resident has consistently remained near 73 percent,124 demonstrating both the efficiency of 

the program and its ability to produce positive outcomes for residents. The FY 2013 average 

number of complaints per facility, at 2.72, exceeds the target of 3.0. Outcome 2.14 targets a 

decrease in complaints that the program was unable to resolve to the satisfaction of the resident. 

Ombudsman activities represent an important element of ACL’s focus on elder rights, which 

expands and improves upon ACL’s successful elder rights programs to create a full array of 

services to prevent, detect, and resolve elder abuse, neglect, and exploitation. This request also 

supports Federal regulations and policy for quality alternatives to nursing home care. LTC 

Ombudsmen frequently support individuals who choose to transition out of nursing home 

facilities into more integrated settings. They also advocate for quality care and individual rights 

and well-being in other congregate long-term care settings, such as board and care and assisted 

living. In addition, LTC Ombudsmen serve individuals in these settings regardless of the 

individuals’ eligibility for Medicaid or other public benefits. Ombudsmen are the only 

Federally-funded entity providing services to all of these residents. Going forward, outreach, 

access, complaint investigation and advocacy in board and care and assisted living will require 

124 NORS 2011 – Complaint resolution: 10% needing no further action; 4% withdrawn; 5% not resolved to the 

satisfaction of the resident; 6% referred to other agency for resolution.

137 

 
PROTECTION OF VULNERABLE ADULTS

Ombudsmen to employ new strategies compared to the work now done primarily in nursing 

home settings. 

Outcomes and Outputs Table:

Long-Term Care Ombudsman Program Outcomes and Outputs 

Measure Most Recent 

Result 

FY 2015 

Target

FY 2016 

Target

FY16 Target 

+/- FY 2015

Outcome 2.12: 

Decrease the average 

number of complaints 

per LTC facility

(Outcome *

FY 2013: 2.72

Target: 3.0

(Target Exceeded)

2.8 2.8 Maintain

Outcome 2.14 : 

Decrease the number 

of complaints not 

resolved to the 

satisfaction of the 

resident (Outcome)*

FY 2013: 9,090

Target: 10,778 9,700 9,700 Maintain

Indicator Most Recent 

Result

FY 2015 

Projection

FY 2016 

Projection

FY 2016 Projection 

+/- FY 2015

Output Q: Decrease 

the Number of 

Complaints (Output)

FY 2013: 190,592 190,000 190,000 Maintain

Output R: Number of 

Ombudsman 

Consultations

(Output)

FY 2013: 464,806 450,000 450,000 Maintain

Output S: Facilities 

regularly visited not 

in response to a 

complaint (Output)

FY 2013: 27,785 27,600 27,600 Maintain

* Measure seeks a decrease in complaints. A negative change is the desired output.

Grant Awards Table:

Long-Term Care Ombudsman Program Formula Grant Awards

FY 2014 Final FY 2015 

Enacted

FY 2016 

President’s 

Budget

Number of 

Awards 56 56 56

Average 

Award $280,824 $280,824 $280,824

Range of 

Awards

$9,829 - 

$1,618,546

$9,829 - 

$1,618,546

$9,829 - 

$1,618,546

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PROTECTION OF VULNERABLE ADULTS

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2016 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Long-Term Care Ombudsman Program (CFDA 93.042)

State/Territory

FY 2014

Final

FY 2015 

Enacted

FY 2016 

President’s 

Budget

FY 2016 +/- 

FY 2015

Alabama .......................................... 243,821 243,821 243,821 --

Alaska.............................................. 78,631 78,631 78,631 --

Arizona ............................................ 333,076 333,076 333,076 --

Arkansas.......................................... 151,860 151,860 151,860 --

California......................................... 1,618,546 1,618,546 1,618,546 --

Colorado .................................. 223,864 223,864 223,864 --

Connecticut............................... 183,391 183,391 183,391 --

Delaware .................................. 78,631 78,631 78,631 --

District of Columbia ................... 78,631 78,631 78,631 --

Florida ..................................... 1,159,301 1,159,301 1,159,301 --

Georgia .................................... 410,859 410,859 410,859 --

Hawaii ..................................... 78,631 78,631 78,631 --

Idaho ....................................... 78,631 78,631 78,631 --

Illinois ..................................... 593,323 593,323 593,323 --

Indiana..................................... 311,549 311,549 311,549 --

Iowa ........................................ 161,021 161,021 161,021 --

Kansas ..................................... 136,820 136,820 136,820 --

Kentucky.................................. 216,856 216,856 216,856 --

Louisiana.................................. 210,866 210,866 210,866 --

Maine ...................................... 79,365 79,365 79,365 --

Maryland .................................. 271,260 271,260 271,260 --

Massachusetts............................ 333,272 333,272 333,272 --

Michigan .................................. 506,369 506,369 506,369 --

Minnesota................................. 255,908 255,908 255,908 --

Mississippi................................ 141,354 141,354 141,354 --

Missouri ................................... 305,063 305,063 305,063 --

Montana ................................... 78,631 78,631 78,631 --

Nebraska .................................. 89,354 89,354 89,354 --

Nevada..................................... 128,082 128,082 128,082 --

New Hampshire ......................... 78,631 78,631 78,631 --

139 
PROTECTION OF VULNERABLE ADULTS

PROGRAM/CFDA NUMBER: Long-Term Care Ombudsman Program (CFDA 93.042)

State/Territory

FY 2014 

Final

FY 2015 

Enacted

FY 2016 

President’s Budget

FY 2016 +/-

FY 2015

New Jersey ................................ 431,948 431,948 431,948 --

New Mexico .............................. 102,123 102,123 102,123 --

New York.................................. 956,337 956,337 956,337 --

North Carolina ........................... 472,374 472,374 472,374 --

North Dakota ............................. 78,631 78,631 78,631 --

Ohio......................................... 595,409 595,409 595,409 --

Oklahoma.................................. 184,565 184,565 184,565 --

Oregon...................................... 206,248 206,248 206,248 --

Pennsylvania.............................. 698,693 698,693 698,693 --

Rhode Island.............................. 78,631 78,631 78,631 --

South Carolina ........................... 244,203 244,203 244,203 --

South Dakota ............................. 78,631 78,631 78,631 --

Tennessee.................................. 322,310 322,310 322,310 --

Texas........................................ 1,013,204 1,013,204 1,013,204 --

Utah ......................................... 95,715 95,715 95,715 --

Vermont.................................... 78,631 78,631 78,631 --

Virginia .................................... 376,622 376,622 376,622 --

Washington ............................... 325,251 325,251 325,251 --

West Virginia............................. 109,488 109,488 109,488 --

Wisconsin ................................. 287,835 287,835 287,835 --

Wyoming .................................. 78,631 78,631 78,631 --

 

Subtotal, States............................... 

 

15,431,077 15,431,077 15,431,077 --

American Samoa ........................ 9,829 9,829 9,829 --

Guam ....................................... 39,315 39,315 39,315 --

Northern Mariana Islands ............. 9,829 9,829 9,829 --

Puerto Rico................................ 196,785 196,785 196,785 --

Virgin Islands.............................

 

39,315 39,315 39,315 --

 

Subtotal, States and Territories....... 15,726,150 15,726,150 15,726,150 --

 

Undistributed125 .............................. 158,850 158,850 158,850 --

TOTAL 15,885,000 15,885,000 15,885,000 --

125 The undistributed line reflects the amount reserved from the Long-Term Care Ombudsman appropriation for 

statutory related activities, including contingencies and for program support including information and systems, 

technical assistance, evaluation, monitoring and oversight. Funds unused for these purposes at the end of the year 

are allocated to States.

140 

 
Prevention of Elder Abuse and Neglect

FY 2014 

Final

FY 2015 

Enacted

FY 2016 

President's 

Budget

FY 2016 +/- 

FY 2015

Prevention of Elder 

Abuse & Neglect...... $4,773,000 $4,773,000 $4,773,000 --

Authorizing Legislation: Section 721 of the Older Americans Act of 1965, as amended 

FY 2016 Older Americans Act Authorization ...................................................................... Expired

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

Program Description and Accomplishments:

The Prevention of Elder Abuse and Neglect program provides formula grants to States and 

Territories based on their share of the population 60 and over for training, education, and 

promoting public awareness of elder abuse. The program also supports State and local elder 

abuse prevention coalitions and multi-disciplinary teams. These activities are important elements 

of ACL’s focus on elder rights and elder justice. The program coordinates activities with State 

and local Adult Protective Services programs (over half of which are directly administered by 

State Units on Aging) and other professionals who work to address issues of elder abuse and 

elder justice. The importance of these services at the State and local level is demonstrated by the 

fact that States significantly leverage Older Americans Act (OAA) funds to obtain other funding 

for these activities. In FY 2012 over $28 million of the Elder Abuse Prevention services 

expenditures was leveraged from non-OAA funds, a ratio of approximately $7 ($6.85) of nonOAA funds for every $1 investment of ACL funds. 

Examples of State elder abuse prevention activities include: 

• In Kentucky, the local area agencies on aging participate in the Local Coordinating 

Councils on Elder Abuse, which have developed emergency elder shelters, developed 

informational cards for law enforcement officers to have in the patrol cars which contain 

crucial resource information for victims of elder abuse, provided training on a regular 

basis to first responders, provided a friendly visitor program for home-based seniors, and 

produced a prevention tool called the Kentucky Fraud Fighter Form. 

 

• In Illinois, the Illinois Department on Aging utilizes its elder abuse funds to support 

volunteer community based multi-disciplinary teams (M-Teams) that serve in a technical 

advisory role to more than 40 elder abuse provider agencies throughout the state. The 

141 
PROTECTION OF VULNERABLE ADULTS

objectives of the M-Team are to provide case consultation and assistance to caseworkers 

and to encourage cooperation among various service agencies. Each M-Team is 

composed of the M-Team Coordinator and representatives of the mental health, medical, 

legal, law enforcement, faith community, and financial professions. 

The Prevention of Elder Abuse and Neglect program demonstrates ACL’s ongoing commitment 

to protecting the rights of vulnerable seniors and promoting their dignity and autonomy. 

Through education efforts, exposing problems that would otherwise be hidden from view, and 

providing a voice for those who cannot act for themselves, the program helps ensure that all 

older Americans are able to age with dignity in a safe environment. 

Funding History:

Funding for Prevention of Elder Abuse and Neglect during the past five years is as follows:

FY 2011 ...................................................$5,046,000 

FY 2012 ...................................................$5,036,000 

FY 2013 ...................................................$4,773,000 

FY 2014 ...................................................$4,773,000 

FY 2015 ...................................................$4,773,000 

Budget Request and Anticipated Accomplishments:

The FY 2016 request for the Prevention of Elder Abuse and Neglect program is $4,773,000, the 

same as the FY 2015 enacted level. The FY 2016 request will maintain the ability of States and 

Territories to train law enforcement officials, develop and distribute educational materials, 

conduct public awareness campaigns, and create community coalitions and multidisciplinary 

teams to investigate and respond to elder abuse and neglect. States and AAAs also use this 

funding to coordinate their activities with fraud and crime prevention partnerships organized by 

sheriffs, police chiefs, and community organizations. 

These activities are important elements of ACL’s continued focus in FY 2016 on elder rights and 

elder justice, which seeks to improve upon ACL’s successful elder rights programs, including the 

Prevention of Elder Abuse and Neglect program. This enhanced focus will allow the creation of 

a full array of services to protect elder rights and prevent, detect, and resolve elder abuse, 

neglect, and exploitation. Prevention of Elder Abuse and Neglect programs complement Adult 

Protective Services by funding the infrastructure on which best practices may be developed and 

evaluated. Past examples of these efforts undertaken by states include creation of informational 

cards for law enforcement officers to provide crucial resource information to victims of elder 

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PROTECTION OF VULNERABLE ADULTS

abuse, training to first responders, and community-based multidisciplinary teams that serve in a 

technical advisory role to elder abuse prevention agencies throughout a state. 

 

Output Table:

Prevention of Elder Abuse and Neglect Output 

Indicator Most Recent Result FY 2015 

Projection

FY 2016 

Projection

FY 2016 +/- 

FY 2015

Output U: Elder Abuse prevention nonOAA service expenditures (Output, 

dollars in thousands)

 FY 2012: $28,452 $28,100 $27,900 -$200

Grant Awards Table:

Prevention of Elder Abuse, Neglect, and Exploitation Grant Awards 

FY 2014 

Final

FY 2015 

Enacted

FY 2016 

President’s 

Budget

Number of 

Awards 56 56 56

Average Award $84,500 $84,500 $84,500

Range of 

Awards

$2,958 - 

$471,073

$2,958 - 

$471,073

$2,958 - 

$471,073

143 
PROTECTION OF VULNERABLE ADULTS

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2016 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Prevention of Elder Abuse & Neglect (CFDA 93.041)

State/Territory

FY 2014

Final

FY 2015 

Enacted

FY 2016 

President’s 

Budget

FY 2016 +/- 

FY 2015

Alabama........................................... 76,215 76,215 76,215 --

Alaska .............................................. 23,660 23,660 23,660 --

Arizona ............................................ 81,500 81,500 81,500 --

Arkansas.......................................... 48,157 48,157 48,157 --

California......................................... 471,073 471,073 471,073 --

Colorado .......................................... 56,082 56,082 56,082 --

Connecticut...................................... 59,907 59,907 59,907 --

Delaware.......................................... 23,660 23,660 23,660 --

District of Columbia ........................ 23,660 23,660 23,660 --

Florida ............................................. 344,252 344,252 344,252 --

Georgia ............................................ 103,321 103,321 103,321 --

Hawaii ............................................. 23,660 23,660 23,660 --

Idaho................................................ 23,660 23,660 23,660 --

Illinois.............................................. 197,384 197,384 197,384 --

Indiana ............................................. 98,224 98,224 98,224 --

Iowa ................................................. 55,927 55,927 55,927 --

Kansas ............................................. 45,843 45,843 45,843 --

Kentucky.......................................... 66,595 66,595 66,595 --

Louisiana ......................................... 68,518 68,518 68,518 --

Maine............................................... 23,660 23,660 23,660 --

Maryland.......................................... 78,087 78,087 78,087 --

Massachusetts.................................. 109,606 109,606 109,606 --

Michigan.......................................... 160,862 160,862 160,862 --

Minnesota ........................................ 76,347 76,347 76,347 --

Mississippi....................................... 45,198 45,198 45,198 --

Missouri........................................... 97,643 97,643 97,643 --

Montana........................................... 23,660 23,660 23,660 --

Nebraska .......................................... 29,770 29,770 29,770 --

Nevada............................................. 27,629 27,629 27,629 --

New Hampshire ............................... 23,660 23,660 23,660 --

144 
PROTECTION OF VULNERABLE ADULTS

PROGRAM/CFDA NUMBER: Prevention of Elder Abuse & Neglect (CFDA 93.041) 

State/Territory

FY 2014 

Final

FY 2015 

Enacted

FY 2016 

President’s 

Budget

FY 2016 +/- 

FY 2015

New Jersey...................................... 143,950 143,950 143,950 --

New Mexico ................................... 26,393 26,393 26,393 --

New York ....................................... 318,066 318,066 318,066 --

North Carolina ................................ 126,782 126,782 126,782 --

North Dakota .................................. 23,660 23,660 23,660 --

Ohio ................................................ 197,185 197,185 197,185 --

Oklahoma ....................................... 60,208 60,208 60,208 --

Oregon ............................................ 56,795 56,795 56,795 --

Pennsylvania................................... 242,944 242,944 242,944 --

Rhode Island................................... 23,660 23,660 23,660 --

South Carolina ................................ 63,080 63,080 63,080 --

South Dakota .................................. 23,660 23,660 23,660 --

Tennessee ....................................... 91,810 91,810 91,810 --

Texas .............................................. 274,281 274,281 274,281 --

Utah ................................................ 24,837 24,837 24,837 --

Vermont.......................................... 23,660 23,660 23,660 --

Virginia........................................... 102,820 102,820 102,820 --

Washington..................................... 86,291 86,291 86,291 --

West Virginia.................................. 36,736 36,736 36,736 --

Wisconsin ....................................... 90,309 90,309 90,309 --

Wyoming ........................................ 23,660 23,660 23,660 --

Subtotal, States............................... 4,648,207 4,648,207 4,648,207 --

American Samoa............................. 2,958 2,958 2,958 --

Guam .............................................. 11,830 11,830 11,830 --

Northern Mariana Islands............... 2,958 2,958 2,958 --

Puerto Rico ..................................... 54,217 54,217 54,217 --

Virgin Islands ................................. 11,830 11,830 11,830

 

--

Subtotal, States and Territories....... 4,732,000 4,732,000 4,732,000 --

Undistributed 126/.......................... 41,000 41,000 41,000 --

TOTAL 4,773,000 4,773,000 4,773,000 --

126 The undistributed line reflects the amount reserved from the Prevention of Elder Abuse & Neglect appropriation 

for statutory related activities, including contingencies and for program support including information and systems, 

technical assistance, evaluation, monitoring and oversight. Funds unused for these purposes at the end of the year 

are allocated to States.

145 

 
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Senior Medicare Patrol Program

FY 2014 

Final

FY 2015 

Enacted

FY 2016 

President's 

Budget

FY 2016 +/- 

FY 2015

Senior Medicare Patrol 

Program................... $8,888,000 $8,910,000 $8,910,000 --

HCFAC Expansion 

Grants 1/................... $3,212,752 $5,331,814 $5,331,814 --

HCFAC Base Funds...... $3,378,222 $3,378,222 $3,378,222 --

Total....................... $15,478,974 $17,620,136 $17,620,136 --

FTE....................... 7 8 8 --

1/ Authorized by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), HCFAC Expansion 

Grants are provided to SMP program grantees to support infrastructure. HCFAC amounts in FY 2016 are 

placeholders. The Secretary and Attorney General will determine the final amount.

Authorizing Legislation: Sections 201, 202, and 411 of the Older Americans Act of 1965, as 

amended

FY 2016 Older Americans Act Authorization ...................................................................... Expired

Allocation Method ............................................................................................... Competitive Grant

Program Description and Accomplishments:

The Senior Medicare Patrol (SMP) program provides competitive grants to 54 States and 

Territories to support a national network of volunteers whose purpose is to educate Medicare 

beneficiaries on preventing and identifying healthcare fraud and abuse. Projects use the skills of 

volunteers to conduct community outreach and education and provide information that 

empowers beneficiaries of Medicare and Medicaid and their families to prevent, identify and 

report fraud. Activities are carried out in partnership with the Centers for Medicare & Medicaid 

Services (CMS), the Office of Inspector General (OIG), healthcare providers, and other aging 

and elder rights professionals from around the country. 

Data obtained from the SMARTFACTS Data Tracking System and published in the annual OIG 

report for calendar year 2012 shows that SMP projects: 

• Maintained 5,137 active volunteers who worked over 120,953 hours to educate 

beneficiaries about how to prevent Medicare and Medicaid fraud; 

147 
PROTECTION OF VULNERABLE ADULTS

• Educated 449,509 beneficiaries in 14,748 group education sessions and held 

113,457 one-on-one counseling sessions with or on behalf of beneficiaries; 

• Conducted 10,032 community outreach education events; and 

• Resolved 83,856 inquiries for information or assistance from beneficiaries. 

In addition, the Senior Medicare Patrol program’s data show that since the program’s inception 

17 years ago, SMP projects have educated nearly 4 million beneficiaries in 108,825 group 

education sessions and 1,292,647 one-on-one counseling sessions, and conducted 

93,894 community outreach education events. 

The SMP program historically has been supported by approximately $3.4 million in Health Care

Fraud and Abuse Control (HCFAC) funding authorized by the Health Insurance Portability and 

Accountability Act of 1996 (HIPAA) for infrastructure, technical assistance, and other program 

support and capacity-building activities designed to enhance program effectiveness. Activities 

funded by HCFAC resources include support for project training and technical assistance 

provided by ACL’s National Consumer Protection Technical Resource Center (Center). 

In the past five years, the critically important role of the SMP program has continued to be 

recognized by partners in Medicare fraud prevention in the private and public sectors. In 

FY 2010 and FY 2011, CMS provided funding for the award of an additional $9 million in grants 

from its Program Integrity funding, administered by ACL, targeted to help more than 50 SMP 

projects fight Medicare fraud in high fraud areas and expand the capacity of the program to reach 

more beneficiaries. In FY 2012 and FY 2013, ACL received an additional $7.3 million from 

HCFAC funds to again fight Medicare fraud and continue program expansion and enhancement 

activities. In FY 2014, ACL received $3.2 million from HCFAC funds for the same purpose. 

Funding History:

Funding for the SMP discretionary appropriations is as follows: 

FY 2011 ...................................................$9,420,000 

FY 2012 ...................................................$9,402,000 

FY 2013 ...................................................$8,875,000 

FY 2014 ...................................................$8,888,000 

FY 2015 ...................................................$8,910,000 

148 
PROTECTION OF VULNERABLE ADULTS

Budget Request:

The FY 2016 request for the Senior Medicare Patrol (SMP) program is $8,910,000, the same as 

the FY 2015 enacted level. This amount will enable ACL to continue the proven fraud 

prevention activities of the SMP program. The SMP program was also supported by $3.2 million 

in HCFAC expansion grants to States in FY 2014, and by $5.3 million in FY 2015. 

Since the program’s inception, SMP projects have educated over 3.5 million beneficiaries and 

received nearly 30,000 complex issues (complaints) from beneficiaries who have detected billing 

or other discrepancies based on that information. While SMPs make numerous referrals of 

potential fraud to CMS and the OIG, there is no mechanism for tracking the actions 

(investigation, prosecution, collection) required to realize actual savings to the government as a 

result of these referrals. There is also no current mechanism to quantify the effects of prevention 

education conducted by the SMP, which hinders the program’s ability to measure the extent and 

cost of fraud and abuse. ACL is working to overcome these limitations by undertaking a variety 

of steps, including: 

• A program evaluation contract, concluded in 2013, to examine the program’s 

performance metrics, and a future realignment of those metrics to reflect the results of the 

program evaluation; 

• An ongoing process in cooperation with OIG to track fraud referrals and their outcomes; 

and

• Award of a three year grant to conduct research on prevention education to determine 

how to best measure and quantify the effects of SMP program efforts. The results of this 

study should be available in the fall of 2016. 

Outcomes and Outputs Table:

Senior Medicare Patrol Program Outputs 

Indicator Most Recent Result CY 2015 

Projection 

CY 2016 

Projection 

FY 2016 

+/- FY 2015

Output W: Beneficiaries Educated and 

Served (Output) CY 2013: 738,234 500,000 600,000 + 100,000

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PROTECTION OF VULNERABLE ADULTS

Grant Awards Table:

Senior Medicare Patrol Grant Awards

FY 2014 Final FY 2015 

Enacted

FY 2016 

President’s 

Budget

Number of 

Awards 52 52 52 

Average 

Award $170,915 $171,346 $171,346

Range of 

Awards

$75,000-

$177,927

$75,000-

$177,927

$75,000-

$177,927

Resource and Program Data:

Senior Medicare Patrols

(Dollars in thousands) 

FY 2014 FY 2015 FY 2016

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary 24 4,206 52 8,910 -- --

Continuations 28 4,682 -- -- 52 8,910

Contracts -- -- -- -- -- --

Interagency Agreements -- -- -- -- -- --

Program Support 1/ -- -- --

Total Resources 8,888 8,910 8,910

150 
Elder Rights Support Activities

FY 2014 

Final

FY 2015 

Enacted

FY 2016 

President's Budget

FY 2016 +/- 

FY 2015

Elder Rights 

Support Activities $3,845,000 $7,874,000 $28,874,000 $21,000,000

FTE -- 2 4 + 2

Authorizing Legislation: Sections 201, 202, 411, and 751 of the Older Americans Act of 1965, as 

amended, Title XX of the Social Security Act, Subtitle B, as amended by the Affordable Care 

Act. 

FY 2016 Older Americans Act Authorization ...................................................................... Expired

Allocation Method ............................. Competitive Grants/Cooperative Agreements and Contracts

Program Description and Accomplishments:

Elder Rights Support Activities consist of activities that provide information, training, and 

technical assistance to assist States and communities to prevent, detect, and respond to elder 

abuse, neglect, and exploitation, and that support the development of coordinated systems of 

Adult Protective Services. The combination of legal systems development and assistance 

programs, the National Center on Elder Abuse, National Long-Term Care Ombudsman Resource 

Center, and Elder Justice and Adult Protective Services programs create a supportive framework 

for ACL’s Protection of Vulnerable Adults programs. The Elder Rights Support Activities 

described below are essential components of ACL’s ongoing elder rights programs: 

Model Approaches to Statewide Legal Assistance Systems 

Model Approaches to Statewide Legal Assistance Systems helps States develop and implement 

cost-effective, replicable approaches for integrating senior legal helplines into the broader 

tapestry of State legal service delivery networks. The cornerstone of these projects is legal 

helplines, which assist seniors in accessing quality legal services. By ensuring strong leadership 

at the State level, Model Approaches projects create linkages between the existing legal 

assistance community and service providers, and professionals in the broader community-based 

aging and elder rights networks, including Areas Agencies on Aging, Aging and Disability 

Resource Centers, State Long-Term Care Ombudsmen, and Adult Protective Services. These 

linkages leverage the strengths of both elder rights and aging service networks for the provision 

of quality service to seniors most in need. Recently, Model Approaches – Phase II grants were 

developed that promote legal service delivery systems that are optimally responsive to complex 

legal issues emerging from cases of elder abuse, neglect, and financial exploitation.

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National Legal Assistance and Support Projects 

National Legal Assistance and Support grants fund a comprehensive national legal assistance 

support system serving professionals and advocates working in legal and aging/disability 

services networks. These grants provide funding for the National Legal Resource Center 

(NLRC), which supports the leadership, knowledge, and systems capacity of legal and aging 

provider organizations. The NLRC works to enhance the quality, cost effectiveness, and 

accessibility of legal assistance and elder rights protections available to older persons with social 

or economic needs. ACL is funding four projects as partners under the NLRC which provide 

core support functions for aging and legal networks including case consultation, training, 

technical assistance on legal and aging systems development, and information development and 

dissemination.

National Center on Elder Abuse

To support and enhance the activities of State and local programs to prevent elder abuse, neglect, and 

exploitation, ACL funds the National Center on Elder Abuse (NCEA). NCEA disseminates 

information to professionals and the public; collaborates on research; provides consultation; 

identifies and provides information about promising practices and interventions; answers inquiries 

and requests for information; operates a listserv forum for professionals; and advises on program and 

policy development. NCEA also facilitates the exchange of strategies for uncovering and prosecuting 

fraud in areas such as telemarketing and sweepstakes scams. In 2012, the NCEA:

• Continued its outreach by serving 3,459 subscribers to its newsletter, 1,833 members to 

the Elder Abuse Listserv, and creating and managing a new social media platform for the 

NCEA Clearinghouse and NCEA National Indigenous Elder Justice Initiative, with over 

1,000 followers on Facebook. 

• Responded to over 450 individual public inquiries and requests for information regarding 

elder abuse and elder abuse in Indian Country. 

• Provided cost-effective trainings to over 600 professionals though live Webcast forums 

on issues relevant to elder justice, trained over 1,000 professionals through presentations 

at national conferences, and created and disseminated three research-themed training 

podcasts to promote continual learning. 

• Continued to support systems change by identifying 342 local elder justice community 

coalitions and reaching out to those communities to learn how they leverage local 

resources and expertise to prevent and combat elder abuse, neglect, and exploitation, as 

well as to offer technical assistance on operating, invigorating, and sustaining coalitions; 

and compiling the first comprehensive inventory of tribal elder abuse codes, currently 

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PROTECTION OF VULNERABLE ADULTS

consisting of 48 codes from 17 states, the purpose of which is to provide best practice 

examples to other tribes in developing new codes to address elder abuse, neglect, and 

exploitation.

National Long-Term Care Ombudsman Resource Center

The National Long-Term Care Ombudsman Resource Center (NORC) provides training and 

technical assistance to support the activities of State and local long-term care ombudsmen. The 

Center works to enhance the skills, knowledge and management capacity of the statewide 

ombudsman programs to enable them to handle resident complaints and represent resident 

interests. The Center also provides information to consumers and links them to ombudsmen who 

can help consumers navigate the long-term care system and resolve problems in nursing, board 

and care, and assisted living homes. 

The NORC engages in numerous projects and activities in support of long-term care ombudsman 

programs. Highlights include supporting the success of the Money Follows the Person (MFP) 

demonstration project by working with CMS, ACL, and National Association of State LongTerm Care Ombudsman Programs (NASOP) to promote ombudsman coordination with MFP 

grantees, Aging and Disability Resource Centers (ADRCs), Centers for Independent Living, and

other single point of entry programs; and furthering Federal efforts to support consumer choice 

and access to alternatives to nursing home care. NORC also provides ombudsmen with training 

from national experts on such issues as: the Changing Long-Term Care System; Managing 

Program Goals and Priorities During Fiscal Crises; Minimum Data Set (MDS) 3.0 Section Q, 

Money Follows the Person, and Nursing Home Transition; Advocacy in Assisted Living. The 

Center’s website continues high utilization (over 40,000 monthly visits) by ombudsmen, consumers, 

and agencies.

Elder Justice and Adult Protective Services

The Elder Justice Act of 2009 established the Elder Justice Coordinating Council (EJCC) to 

coordinate activities related to elder abuse, neglect, and exploitation across the Federal 

government. As Chair of the EJCC, the Secretary of HHS has lead responsibility for identifying 

and proposing solutions to the problems surrounding elder abuse. The Secretary has assigned 

responsibility for implementing the EJCC to the Administration for Community Living. 

To combat the rising scourge of elder abuse, neglect, and exploitation in America, ACL’s goal is 

to put in place, in coordination with the Elder Justice Coordinating Council, a comprehensive 

system to serve as a coordinated and seamless response for helping adult victims of abuse, to 

prevent abuse before it happens, and to develop new and innovative approaches to preventing, 

detecting, and responding to abuse, neglect, and exploitation. 

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Unlike Child Protective Services, there is currently no federal infrastructure to support basic 

programmatic standards for Adult Protective Services, which has led to inconsistent data systems 

and non-uniform reporting requirements at the national level and prevented APS programs from 

evaluating their services or conducting meaningful program evaluations. States are further 

challenged by the increasing complexity of elder and other adult abuse cases, the rising older 

population, and difficult State and local budget conditions. APS programs and administrators 

lack reliable information and guidance on best practice and standards for conducting case 

investigations and for staffing and managing APS programs. Additionally, GAO has identified 

the challenges faced by APS programs across the country in collecting, maintaining, and 

reporting statewide, case-level data. These challenges, which include chronic underfunding, 

unprecedented budget reductions, and increasing caseloads, impair States’ ability to assess client 

outcomes and the effectiveness of the services they are providing.127 They also lead to systems 

that are less equipped to respond in an effective and timely way to reports of elder abuse, neglect 

and exploitation. 

Funding will support demonstration grants to enhance state APS data systems; provide 

significant, on-going technical assistance to states to facilitate their participation on a regular 

basis in a national APS data collection efforts; enhance State APS services; and conduct research 

and oversight. As recommended by the GAO, in FY 2013 ACL, in partnership with ASPE, 

undertook an effort to begin developing the technology infrastructure for a national APS data 

collection system, the National Adult Maltreatment Reporting System (NAMRS), where all 

states can report data collected through APS investigations. Similarly to what GAO found with 

the National Child Abuse and Neglect Data System (NCANDS), states need significant 

assistance initially to improve their technological capacity to a level where they will be able to 

participate.

Funding History:

Comparable funding for Elder Rights Support Activities is as follows: 

FY 2011 ...................................................$4,096,000 

FY 2012 ...................................................$4,088,000 

FY 2013 ...................................................$3,859,000 

FY 2014 ...................................................$3,845,000 

FY 2015 ...................................................$7,874,000 

127 U.S. Government Accountability Office. (2011). ELDER JUSTICE: Stronger Federal Leadership Could 

Enhance National Response to Elder Abuse. (GAO-11-208). Washington, D.C.: U.S. Government Printing Office.

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PROTECTION OF VULNERABLE ADULTS

Budget Request:

The FY 2016 request for Elder Rights Support Activities is $28,874,000, an increase of 

+$21,000,000 above the FY 2015 enacted level. This request reflects ACL’s commitment to 

supporting and integrating State APS systems, as well as coordinating services related to elder 

abuse, neglect, and exploitation across the Federal government. The funding requested in 

FY 2016 will assist with the following efforts needed to expand and conduct research and 

evaluation of Adult Protective Services across the nation. 

Demonstration Grants to Enhance State APS Data Systems ($15 million) 

As recommended by the GAO, in FY 2013 ACL, in partnership with ASPE, undertook an effort 

to begin developing the technology infrastructure for a national APS data collection system, the 

National Adult Maltreatment Reporting System (NAMRS), where all states can report data 

collected through APS investigations. Similarly to what GAO found with the National Child 

Abuse and Neglect Data System (NCANDS), states need significant assistance initially to 

improve their technological capacity to a level where they will be able to participate.

In FY 2016, ACL is investing $15 million to continue the phased implementation of the NAMRS

begun in FY 2015. FY 2015 funding is being distributed through competitive grants to 

approximately ten states for APS program and service enhancements within a state, including to 

develop and/or update systems of technology that support the adult protective services program 

and track reports of elder and adult abuse and neglect from intake through final disposition and 

allow information exchange with NAMRS. FY 2016 funds will be used for additional new 

grants to expand participation in NAMRS to up to 15 additional states, bringing approximately 

45% of the 56 APS jurisdictions on-line in the second year of implementation.

NAMRS, Operation and Maintenance, and Technical Assistance ($3 million) 

GAO also recommended significant, on-going technical assistance to states to facilitate their 

participation on a regular basis in a national APS data collection effort, again as with 

NCANDS.128 FY 2016 funds will continue the implementation of NAMRS begun in FY 2015, 

to operate and maintain the system, and provide technical assistance to the approximately 

25 states ACL anticipates will use the system in the second year of operation. This activity 

supports and implements Recommendation 3 of the EJCC, “Develop a National Adult Protective 

Services System.”

128 Id.

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PROTECTION OF VULNERABLE ADULTS

Enhancing APS Services ($3.25 million) 

Currently, there exists only a basic understanding of the services provided by APS and the 

program standards for each state. Even less is known about the effectiveness of these services at 

reducing abuse and preventing re-referral to the APS system. A meta-analysis of service 

components for programs designed to intervene in family violence, specifically child protective 

services and adult protective services, will identify evidence-based and best practices for service 

delivery. This type of evaluation is needed to understand the current state of APS systems. 

Together, these complementary efforts will help guide the development of APS program 

standards to help states improve the quality and consistency of APS programs, and the design of 

more effective systems in the future. 

Because state APS program resources are already insufficient to meet the current need for 

services, states are not able to spare additional staff or resources to carry out the needed metaanalyses or evaluation to inform program design. Moreover, the effort required to carry out 

these activities is most efficiently carried out by a single entity, rather than having each of the 

states conduct their own evaluations of the same programs and resources, an unnecessary 

duplication of effort in an already stretched system. The FY 2016 President’s Budget recognizes 

the economy of scale achieved in having a comprehensive evaluation and analysis conducted, 

and proposes $3.25 million to continue the work of planning and executing the evaluation and 

meta-analysis begun in FY 2015. 

Research ($3 million)

Research in the area of elder abuse, neglect, and exploitation is still in its infancy, with little 

known about risk and protective factors for being a victim or perpetrator, nor about effective and 

evidence-based prevention, intervention, and remediation practices. Further research also is 

needed regarding the impacts of elder abuse on health and long-term care systems and on the 

costs of care. This fundamental research work is needed to develop credible benchmarks for 

elder abuse, neglect, and exploitation prevention or control. 

The FY 2016 President’s Budget includes $3 million for research grants to increase the evidencebase that establishes the benefits over harm of screening for elder abuse, neglect, and 

exploitation, and to invest in the foundational research essential for understanding the problem 

and the best ways to prevent and address it. 

Program Implementation and Oversight ($0.75 million) 

The FY 2016 President’s budget included $750,000 for salaries and overhead costs supporting 

four FTE carrying out the Elder Justice initiative and supporting the ongoing work of the EJCC. 

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The National Center on Elder Abuse, the National Long-Term Care Ombudsman Resource 

Center, the Statewide Model Approaches and Legal Assistance programs, and the Elder Justice 

and Adult Protective Services program, provide the technical assistance, information, resources, 

referrals, and legal systems development and assistance activities that support the efforts of the 

entire spectrum of Protection of Vulnerable Adults programs. These activities are a critical 

component of ACL’s successful elder rights programs and help to create a full array of services 

to prevent, detect, and resolve elder abuse, neglect, and exploitation. Continued support for these 

programs and resource centers will provide the best and most efficient services and supports 

possible to support ACL’s efforts to promote elder rights and elder justice. 

Elder Rights Support Activities includes funding for the following projects (dollars in thousands):

Activity

FY 2014 

Final

FY 2015 

Enacted

FY 2016 

President’s 

Budget

Elder Rights Support Activities:

Model Approaches to Statewide Legal Assistance ........................... $ 1,867 $ 1,888 $ 1,888

National Legal Assistance and Support Projects.............................. 697 705 705

National Center on Elder Abuse ....................................................... 765 765 765

National Long-Term Care Ombudsman Resource Center................ 516 516 516

Elder Justice and Adult Protective Services ..................................... -- 4,000 25,000

Total, Elder Rights Support Activities...................................... $ 3,845 $ 7,874 $ 28,874

Grant Awards Table:

Elder Rights Support Activities Grant Awards 

FY 2014 Final FY 2015 

Enacted

FY 2016 

President’s 

Budget

Number of 

Awards 21 29 19

Average 

Award $178,555 $232,961 $1,473,993

Range of 

Awards

$50,000 - 

$240,000

$50,000 - 

$350,000

$50,000 - 

$2,000,000

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PROTECTION OF VULNERABLE ADULTS

Resource and Program Data:

Elder Rights Support Activities

(Dollars in thousands) 

FY 2014 FY 2015 FY 2016

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary 2 1,232 16 3,867 11 17,099

Continuations 19 2,518 13 2,888 8 10,907

Contracts -- -- 1 795 -- --

Interagency Agreements -- -- -- -- -- --

Program Support 1/ 95 324 868

Total Resources 3,845 7,874 28,874

1/ Program Support -- Includes funds for grant systems and review and information technology support costs.

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Disability Programs, Research, and Services

Summary of Request

Disability programs, research, and services fund capacity-building, knowledge generation, and 

systems change efforts to assure that people with disabilities and their families participate in the 

design of and have access to needed community services, individualized supports, and other 

forms of assistance that promote self-determination, independence, productivity, and integration 

and inclusion in all facets of community life. 

The total FY 2016 request for Disability Programs, Research, and Services is $377,728,000, an 

increase of +$15,618,000 over the FY 2015 enacted level. For FY 2016, specific program 

requests include: 

• $71,692,000 to continue funding for State Councils on Developmental Disabilities 

(DD Councils) in each State and Territory, the same as the FY 2015 enacted level. DD 

Councils are charged with engaging in advocacy, capacity building, and systemic change 

activities that contribute to a coordinated and comprehensive system of community supports 

and services that promote self-determination, integration and inclusion for people with 

developmental disabilities.

• $38,734,000 for Developmental Disability Protection and Advocacy systems, the same as 

the FY 2015 enacted level. Protection and Advocacy systems in each State and Territory 

protect the legal and human rights of all people with developmental disabilities, and have

the authority to pursue legal, administrative and other appropriate remedies or 

approaches, including the authority to investigate incidents of abuse and neglect. 

• $38,619,000 for University Centers for Excellence in Developmental Disabilities 

(UCEDDs), an increase of +$945,000 above the FY 2015 enacted level. UCEDDs in each 

State and Territory provide interdisciplinary pre-service training, community services, 

research, and information dissemination activities that promote opportunities for people 

with developmental disabilities to exercise self-determination and to be independent, 

productive, integrated, and included in the community. 

• $14,500,000 for Projects of National Significance, an increase of +$5,643 above the 

FY 2015 enacted level. Projects of National Significance fund grants, cooperative 

agreements, and contracts to explore innovative opportunities for individuals with 

developmental disabilities, including transitioning youth, to directly and fully contribute 

to, and participate in, all facets of community life.

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

• $108,000,000 for the National Institute on Disability, Independent Living, and 

Rehabilitation Research (NIDILRR), an increase of +$4,030,000 above the FY 2015 

enacted level. NIDILRR was transferred to ACL in FY 2014 by the Workforce 

Innovation and Opportunity Act. NIDILRR generates knowledge and promotes its use to 

improve the abilities of people with disabilities to perform activities of their choice in the 

community, and also to expand society’s capacity to provide full opportunities and 

accommodations for its citizens with disabilities.

• $106,183,000 for Independent Living, an increase of +$5,000,000 above the FY 2015 

enacted level. The Independent Living program was transferred to ACL in FY 2014 by 

the Workforce Innovation and Opportunity Act, and provides financial assistance to 

improve independent living services, support statewide networks of centers for 

independent living, and foster working relationships among various entities to maximize 

the leadership, empowerment, independence, and productivity of individuals with 

disabilities, and to integrate these individuals into the mainstream of American society.

160 
State Councils on Developmental Disabilities

FY 2014 

Final

FY 2015 

Enacted

FY 2016 

President's Budget

FY 2016 +/- 

FY 2015

State DD Councils $70,692,000 $71,692,000 $71,692,000 --

Authorizing Legislation: Section 129(a) of the Developmental Disabilities Assistance and Bill of 

Rights Act 

FY 2016 Developmental Disabilities Assistance and Bill of Rights Act Authorization ...... Expired

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

Program Description and Accomplishments:

State Councils on Developmental Disabilities (DD Councils) are charged with identifying the 

most pressing needs of people with developmental disabilities in their state and territory. 

DD Councils are in a strategic position in each State and Territory to set priorities and pursue 

systems change efforts designed to turn fragmented approaches into a comprehensive and 

effective statewide, person-centered and family-centered system that provides a coordinated 

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

and developmental disabilities, including individuals with autism, and their families. 

DD Councils do not provide services directly, but rather examine and conduct in-depth analysis 

of the quantity and quality of services and supports that are provided at the State and local level. 

Each DD Council develops a strategic State plan based on their analysis, with goals and 

objectives designed to move the State towards an effective, coordinated system of supports and 

services that advance community living for all people with developmental disabilities. Working 

in partnership with stakeholders, including people with developmental disabilities, each State 

DD Council determines priority areas and implements activities based on the strategic state plan 

to: 

• Shift the way an organization or community makes decisions about policies, programs, 

and the allocation of its resources - and, ultimately, in the way it delivers services and 

supports its citizens and constituencies; 

• Support activities that expand and/or improve the ability of individuals with 

developmental disabilities, families, supports, services and/or systems to promote, 

support and enhance self-determination, independence, productivity and inclusion in 

community life; and

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

• Actively support policies and practices that promote self-determination and inclusion in 

the community and workforce for individuals with developmental disabilities and their 

families.

• DD Councils also have a unique responsibility in supporting the growing self-advocacy 

movement. Each Council must ensure the State plan has activities aimed at: 

• Establishing or strengthening a program for the direct funding of a State self-advocacy 

organization led by individuals with developmental disabilities;

• Promoting opportunities for individuals with developmental disabilities who are 

considered leaders to provide leadership training to individuals with developmental 

disabilities who may become leaders; and

• Supporting and expanding participation of individuals with developmental disabilities in 

cross-disability and culturally diverse leadership coalitions.

The State Councils have a significant impact upon promoting self-sufficiency and community 

living for persons with developmental disabilities. Due to increased technical assistance and 

guidance, Councils reported that in FY 2012, 14.33 percent of individuals nationwide with 

developmental disabilities were independent, self-sufficient, and integrated into the community 

as a result of their efforts, exceeding the FY 2012 target of 13.79 percent. To receive funds, each 

State and Territory must have an established DD Council as prescribed under the Developmental 

Disabilities Assistance and Bill of Rights Act (“DD Act”). Examples of State Council activities 

include: 

• Early Intervention: The Maine Developmental Disabilities Council has engaged in and 

supported a variety of collaborative state level efforts to raise awareness about 

developmental and behavioral screening. Activities include awareness campaigns and 

training initiatives targeted at twelve pediatric and family practices that served an 

estimated 20,000 children with Medicaid coverage. Their combined efforts have 

facilitated significant, long-term systemic improvements towards early identification and 

coordinated care for young children with Autism Spectrum Disorder (ASD). Recent 

studies showed that in Maine children with ASD were more likely to be identified at a 

younger age and the developmental and autism screening rates more than doubled in the 

targeted sites.

• Self-Advocacy: The Maryland Developmental Disabilities Council continues to support 

self-advocacy through Maryland's statewide self-advocacy group, People on the Go of 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

Maryland (POG). Through two grants funded by the Council, (POG) continued to 

advocate for community supports, educate facilitators, and support local self-advocacy 

groups in becoming active in systems advocacy. POG educated 1,200 students and school 

staff about disability awareness by presenting in four different counties. POG also 

presented self-advocacy work at several local, state, and national conferences, including 

the Maryland Transitioning Youth Conference, National Disability Rights Network, and 

Ready at 21, a non-profit organization dedicated to transitioning youth to college, work, 

and life. 

• Community Living: The Illinois Developmental Disabilities Council published 2 reports 

that have been recognized throughout Illinois as a major influence on the Governor’s 

2012 “Rebalancing Initiative” to transition hundreds of people with disabilities from 

institutions back to the community.129 Through collaboration with statewide 

organizations, the first of the two institutions closed in November 2012 and 183 people 

with developmental disabilities are now living in the community. The Governor’s office 

requested that the Council coordinate efforts to ensure a successful transition of 

individuals from state institutions into the community. Through collaboration with 

statewide organizations, the Council formed a workgroup and an initiative of peer-to-peer 

mentoring, in which self-advocates from the Alliance worked alongside staff to provide 

support for individuals as they sought a life beyond the institution. 

• Transition/Employment: The Kansas Developmental Disabilities Council provides 

funding to Project SEARCH, which provides real-life work experience to help youth with 

developmental disabilities make successful transitions from school to adult life. Project 

SEARCH in Kansas currently operates in 7 locations, has served more than 150 students, 

and have a 75% employment success rate for students with developmental disabilities. 

SEARCH interns have been hired in jobs working 15-40 hours per week and earning 

from $7.25 to $12 per hour. Three additional locations are planned for fall of 2014, and 

four more communities are working on applications to begin projects in their area. The 

Council also plans to expand the program to include a non-school program targeted 

towards young adults. 

DD Council funding is allotted based on a formula that takes into account the population, the 

extent of need for services for persons with developmental disabilities, and financial need. There 

are 56 Councils. Council members are appointed by the Governor and serve in a volunteer 

capacity. Under current law, not less than 60 percent of the Council membership must be 

composed of persons with developmental disabilities and/or their family members. 

129 The Council published “Blueprint for System Redesign in Illinois” and “Illinois at the Tipping Point,” in 2008 

and 2012, respectively.

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

Funding History:

Funding for the program during the last five years has been as follows: 

FY 2011 .................................................$74,916,000 

FY 2012 .................................................$74,774,000 

FY 2013 .................................................$70,555,000 

FY 2014 .................................................$70,692,000 

FY 2015 .................................................$71,692,000 

Budget Request: 

The FY 2016 budget request for State Councils is $71,692,000, the same as the FY 2015 enacted 

level. This request will provide continued support for advocacy, systems change and capacity 

building activities that improve services for people with developmental disabilities and their 

families. In FY 2016, the program expects to increase the percentage of individuals with 

developmental disabilities who are independent, self-sufficient and integrated into the 

community as a result of Council efforts by at least 0.1 percent over the previous year’s result. 

Within ACL’s Projects of National Significance (PNS) program, $643,000 will be used to ensure 

continued training and technical assistance for State Councils since the $76,000,000 trigger 

established in legislation for State Councils to fund these activities has not been met. This 

increase in PNS funds will provide for necessary technical assistance for State Councils, while 

allowing other PNS funds to support innovative projects that help persons with disabilities to live 

independently and to exert control and choice in their own lives. 

Continued funding for State Councils is crucial as they are the entity in the States and Territories 

able to build and organize systems change efforts aimed at turning fragmented approaches into 

innovative and cost-effective strategies that create opportunities for people with developmental 

disabilities and their families.

Advances in self-advocacy would be greatly impacted if funding were no longer available for 

State Councils. All 56 Councils work to build leadership skills by providing individuals with 

developmental disabilities and their family members a variety of opportunities including 

opportunities to educate policymakers and participate in the design and redesign of systems 

impacting their lives.

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

Outputs and Outcomes Table:

Measure Most Recent 

Result

FY 2015

Target

FY 2016

Target

FY 2016

+/- FY 2015

8.1LT and 8A: Increase the percentage of 

individuals with developmental disabilities 

reached by the Councils who are 

independent, self-sufficient and integrated 

into the community. (Outcome)

FY 2013: 14.42%

Target: 14.34% 

(Target Exceeded)

Prior Result 

+0.1%

Prior Result 

+0.1% N/A

8E: Increase the number of individuals with 

developmental disabilities reached by the 

Councils who are independent, self-sufficient 

and integrated into the community per $1,000 

of federal funding to the Councils. (Outcome)

FY 2013: 9.62

Target: 9.62

(Target Met) 

Prior Result 

+1%

Prior Result 

+1% N/A

8i: Number of individuals with 

developmental disabilities reached by the 

Councils who are independent, self-sufficient 

and integrated into the community. (Output)

FY 2013: 717,785

(Actual) N/A N/A N/A

8ii: Number of all individuals trained by the 

Councils. (Output)

FY 2013: 264,570

(Actual) N/A N/A N/A

Grant Awards Tables:

State Councils on Developmental Disabilities Grant Awards

FY 2014 Final FY 2015 

Enacted

FY 2016 

President’s 

Budget

Number of 

Awards 56 56 56

Average 

Award $1,262,357 $1,280,214 $1,280,214

Range of 

Awards

$235,613 - 

$6,508,782

$246,990 - 

$6,481,606

$246,990 - 

$6,481,606

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES

FY 2016 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: State Councils on Developmental Disabilities (CFDA 93.630)

State/Territory

FY 2014

Final

FY 2015 

Enacted

FY 2016 

President’s Budget

FY 2016 +/- 

FY 2015

Alabama........................................... 1,283,254 1,271,544 1,271,544 --

Alaska .............................................. 452,431 474,276 474,276 --

Arizona ............................................ 1,395,485 1,382,310 1,382,310 --

Arkansas.......................................... 753,809 755,220 755,220 --

California......................................... 6,508,782 6,481,606 6,481,606 --

Colorado .......................................... 861,131 853,001 853,001 --

Connecticut...................................... 682,794 676,347 676,347 --

Delaware.......................................... 452,431 474,276 474,276 --

District of Columbia ........................ 452,431 474,276 474,276 --

Florida ............................................. 3,506,220 3,473,119 3,473,119 --

Georgia ............................................ 2,045,418 2,026,107 2,026,107 --

Hawaii ............................................. 452,431 474,276 474,276 --

Idaho................................................ 452,431 474,276 474,276 --

Illinois.............................................. 2,482,149 2,600,050 2,600,050 --

Indiana ............................................. 1,411,820 1,474,493 1,474,493 --

Iowa ................................................. 731,546 766,868 766,868 --

Kansas ............................................. 580,746 608,786 608,786 --

Kentucky.......................................... 1,198,064 1,186,753 1,186,753 --

Louisiana ......................................... 1,330,740 1,362,735 1,362,735 --

Maine............................................... 452,431 474,276 474,276 --

Maryland.......................................... 952,645 998,642 998,642 --

Massachusetts.................................. 1,322,999 1,310,534 1,310,534 --

Michigan.......................................... 2,444,467 2,446,017 2,446,017 --

Minnesota ........................................ 968,836 1,015,615 1,015,615 --

Mississippi....................................... 908,001 905,607 905,607 --

Missouri........................................... 1,296,762 1,341,178 1,341,178 --

Montana........................................... 452,431 474,276 474,276 --

Nebraska .......................................... 452,431 474,276 474,276 --

Nevada............................................. 469,919 474,284 474,284 --

New Hampshire ............................... 452,431 474,276 474,276 --

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

PROGRAM/CFDA NUMBER: State Councils on Developmental Disabilities (CFDA 93.630)

State/Territory

FY 2014

Final

FY 2015 

Enacted

FY 2016 

President’s 

Budget

FY 2016 +/- 

FY 2015

New Jersey...................................... 1,495,803 1,538,655 1,538,655 --

New Mexico ................................... 480,330 485,612 485,612 --

New York ....................................... 4,115,718 4,076,862 4,076,862 --

North Carolina ................................ 2,001,972 1,983,072 1,983,072 --

North Dakota .................................. 452,431 474,276 474,276 --

Ohio ................................................ 2,701,094 2,819,846 2,819,846 --

Oklahoma ....................................... 847,842 888,779 888,779 --

Oregon ............................................ 783,264 775,869 775,869 --

Pennsylvania................................... 2,964,431 2,997,948 2,997,948 --

Rhode Island................................... 452,431 474,276 474,276 --

South Carolina ................................ 1,075,207 1,086,644 1,086,644 --

South Dakota .................................. 452,431 474,276 474,276 --

Tennessee ....................................... 1,428,901 1,447,598 1,447,598 --

Texas .............................................. 4,804,064 4,758,710 4,758,710 --

Utah ................................................ 638,862 632,830 632,830 --

Vermont.......................................... 452,431 474,276 474,276 --

Virginia........................................... 1,419,224 1,487,749 1,487,749 --

Washington..................................... 1,185,351 1,174,160 1,174,160 --

West Virginia.................................. 741,812 734,808 734,808 --

Wisconsin ....................................... 1,227,167 1,280,955 1,280,955 --

Wyoming ........................................ 452,431 

 

 474,276

 

 474,276 -- 

Subtotal, States............................... 67,380,663 68,220,777 68,220,777 --

American Samoa............................. 235,613 246,990 246,990 --

Guam .............................................. 235,613 246,990 246,990 --

Northern Mariana Islands............... 235,613 246,990 246,990 --

Puerto Rico ..................................... 2,368,885 2,483,263 2,483,263 --

Virgin Islands ................................. 235,613 246,990 246,990 --

Subtotal, States and Territories....... 70,692,000 71,692,000 71,692,000 --

TOTAL $70,692,000 $71,692,000 $71,692,000 --

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Developmental Disabilities – Protection and Advocacy

FY 2014 Final

FY 2015 

Enacted

FY 2016 

President's 

Budget

FY 2016 +/- FY 

2015

DD – Protection & 

Advocacy........... $38,634,000 $38,734,000 $38,734,000 --

Authorizing Legislation: Section 145 of the Developmental Disabilities Assistance and Bill of 

Rights Act 

FY 2016 Developmental Disabilities Assistance and Bill of Rights Act Authorization ...... Expired

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

Program Description and Accomplishments:

The Developmental Disabilities Protection and Advocacy program (P&A) provides formula 

grants to establish and maintain a P&A system in each State, the Territories, and the District of 

Columbia. The program also funds a Native American Consortium to protect the legal and 

human rights of Native Americans with developmental disabilities. There are 57 Protection and 

Advocacy systems. Funding for the program is allotted to States and Territories based on 

population and the extent of need for persons with developmental disabilities, weighted by the 

per capita income for each State and Territory. 

 

P&As provide legal support to traditionally unserved or underserved populations to help them 

navigate the legal system to achieve resolution of concerns and encourage systems change. They 

also ensure that individuals with disabilities are able to exercise their rights to make choices, 

contribute to society, and live independently. P&A systems have the authority to pursue legal, 

administrative, and other appropriate remedies or approaches, including the authority to 

investigate incidents of abuse and neglect. 

P&As have been involved in a significant number of landmark cases, including the U.S. 

Supreme Court’s 1999 decision in Olmstead v. L.C., which requires states to eliminate 

unnecessary segregation of people with disabilities, and to ensure that they receive services in 

the most integrated setting possible. 

P&As have made great strides in increasing opportunities for individuals with developmental 

disabilities to make decisions for themselves about where and with whom they live. Examples of 

P&A accomplishments include:

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

• The Illinois P&A and other legal and non-legal groups filed the lawsuit Ligas v. Hamos 

(formerly Ligas v. Maram) in 2005 on behalf of people with developmental disabilities 

living in large, private, state-funded institutions or who were likely to be placed there. 

The clients wanted to receive community services, but the state of Illinois denied their 

requests. In July 2011, a judge approved an agreement that required the state provide 

institution residents who want community placement with an individualized, independent 

evaluation, and the opportunity to live in the community with appropriate services. 

• The Georgia P&A oversees the implementation of the Georgia Olmstead settlement 

agreement. In its role, the P&A monitors the transition from institutions to community 

living for people with developmental disabilities as well as the development of 

community supports and services for people with developmental disabilities. Through 

this monitoring, the P&A has identified concerns about effective discharge planning and 

continuity of service between the hospitals and community services. 

P&As also provide substantial advocacy and legal services on educational issues, and work to 

ensure that students receive an appropriate education in an inclusive setting. Twenty-six percent 

of P&A cases are in the area of education. As one example:

• Nearly seven years after the lawsuit was filed, the New Jersey P&A, along with other 

legal firms and disability groups, entered into a settlement with the New Jersey 

Department of Education to ensure that New Jersey students with disabilities receive an 

appropriate education in the "least restrictive environment." The lawsuit cited New 

Jersey's failure to implement the Individuals with Disabilities Education Act (IDEA), 

which requires the provision of a "free and appropriate public education" in the "least 

restrictive environment" to all eligible students. The plaintiffs alleged that children were 

inappropriately and unnecessarily sent out of district and denied in-class aids, services 

and accommodations needed to receive an appropriate education in the general education 

classroom.

While their focus is most often legal, P&As also engage in a full range of other efforts to 

promote the rights of individuals with developmental disabilities. P&As often provide

information and referrals, as well as training and technical assistance to service providers, state 

legislators and other policymakers. They also conduct self-advocacy trainings and raise public 

awareness of legal and social issues affecting individuals with developmental disabilities and 

their families.

Today’s landscape is changing, however, as individuals in need of long-term care services and 

supports are increasingly choosing to live not in institutions but in other community settings. 

Encouraging community living is a strategic DHHS priority, and has been supported by a 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

number of Federal and state policies promoting alternatives to nursing homes and other 

institutional settings that recognize the value of consumer preference and the attendant potential 

fiscal savings that can result. 

The desire to re-balance and thereby give consumers more community living options has been 

promoted and accelerated through a variety of federal laws and initiatives: the Affordable Care 

Act, Olmstead implementation and enforcement, Money Follows the Person, Home and 

Community Service (HCBS) revised regulations, and managed care, to name a few, are 

continuing to change the long-term care landscape across the country. There is also a growing 

federal awareness and response to the uncharted area of abuse, neglect and exploitation of older 

adults, and persons with disabilities. Addressing this troubling trend is also a priority of ACL. 

All of these changes have created new challenges for Protection and Advocacy programs as well 

as for the Long-Term Care Ombudsman program that is also supported by ACL. Going forward, 

P&As and LTCOP’s will need to learn a new regulatory and service environment at the same 

time that they will have to cope with the continuing accelerated growth of community based 

services. The number of people with intellectual and developmental disabilities receiving Home 

and Community Based waiver services has steadily increased with 86 percent of the P&A clients 

living in the community.130 This creates a heightened role for P&As to monitor and develop new 

strategies to address these new services. A recent successful response example that built on the 

P&A as a national resource is the Representative Payee Program. SSA is providing funds for 

P&As to review organizational payees who did not necessarily employ beneficiaries and to 

require that the P&As review the financial records of a sample of beneficiaries selected by SSA. 

The goal is to ensure representative payees are performing their payee duties satisfactorily and to 

protect beneficiaries from misuse. 

Funding History:

Funding for the program during the last five years has been as follows: 

FY 2011 .................................................$40,942,000 

FY 2012 .................................................$40,865,000 

FY 2013 .................................................$38,559,000 

FY 2014 .................................................$38,634,000 

FY 2015 .................................................$38,734,000

130 U.S. Profile, FY 1977 – 2011, State of the State in Developmental Disabilities.

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

Budget Request: 

The FY 2016 budget request for PADD is $38,734,000, the same as the FY 2015 enacted level. 

This request will maintain the same level of funding provided through formula grants to States 

and Territories in FY 2015 to allow the P&A system to provide training, legal and advocacy 

services both to groups and to individuals with developmental disabilities, as well as information 

and referral services. The P&As form a national system that play a critical role in ensuring that 

people with developmental disabilities are free of abuse and neglect. People with developmental 

disabilities, including children, are at increased risk of experiencing abuse and neglect.131 A 2009 

report from the Government Accountability Office found hundreds of allegations of abuse and 

neglect at public and private schools across the nation between the years 1990 and 2009, almost 

all of which involved children with disabilities.132 The 57 P&As stay at the forefront of these 

issues. P&As maintain a presence in facilities that care for people with disabilities, where they 

monitor, investigate, and attempt to remedy adverse conditions. In FY 2011, the 57 P&As 

remedied 9,470 complaints of abuse and neglect. 

Without the P&A presence, people with developmental disabilities and their families would have 

limited to no access to cost-effective, low level advocacy and legal interventions. Of the inquiries 

and issues received by the P&As in FY 2013: 

• 31 percent were resolved using short-term assistance strategies; 

• 18 percent were addressed through technical assistance in self-advocacy; 

• 14 percent involved investigation and monitoring; and 

• 30 percent were addressed through negotiation. 

131 Hibbard, R.A., Desch, L.W., Committee on Child Abuse and Neglect & Council on Children With Disabilities. 

(2007). Maltreatment of Children With Disabilities. Pediatrics, Vol. 119, No., pp. 1018 -1025 132 U.S. Government Accountability Office. (2009). Selected Cases of Death and Abuse at Public and Private 

Schools and Treatment Centers. Washington, DC: U.S. Government Accountability Office.

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

Outputs and Outcomes Table:

Measure Most Recent Result FY 2015

Target

FY 2016

Target

FY 2016

+/- FY 2015

8B: Increase the percentage of 

individuals who have their complaint 

of abuse, neglect, discrimination, or 

other human or civil rights corrected 

compared to the total assisted. 

(Outcome)

FY 2013: 87.10% 

Target: 85.63% 

(Target Exceeded)

Prior Result 

+0.5%

Prior Result 

+0.5% N/A

8iii: Number of clients receiving 

professional individual legal advocacy 

for the Protection and Advocacy 

program. (Output)

FY 2013: 19,128

(Actual) N/A N/A N/A

8iv: Number of people receiving 

information and referral from the 

Protection and Advocacy program. 

(Output)

FY 2013: 43,736

(Actual) N/A N/A N/A

Grant Awards Tables:

Developmental Disabilities – Protection and Advocacy Formula Grant Awards133

FY 2014 Final FY 2015 

Enacted

FY 2016 

President’s 

Budget

Number of

Awards 56 56 56

Average 

Award $672,628 $674,378 $674,378

Range of 

Awards

$194,139 - 

$3,297,167

$194,139 - 

$3,308,268

$194,139 - 

$3,308,268

133 Excludes grants to tribal organizations.

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES

FY 2016 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Developmental Disabilities – Protection and Advocacy (CFDA 93.630)

State/Territory

FY 2014

Final

FY 2015 

Enacted

FY 2016 

President’s 

Budget

FY 2016 +/- 

FY 2015

Alabama........................................... 619,708 621,790 621,790 --

Alaska .............................................. 362,881 362,881 362,881 --

Arizona ............................................ 659,935 662,160 662,160 --

Arkansas.......................................... 382,159 382,623 382,623 --

California......................................... 3,297,167 3,308,268 3,308,268 --

Colorado .......................................... 447,027 448,132 448,132 --

Connecticut...................................... 373,697 374,133 374,133 --

Delaware.......................................... 362,881 362,881 362,881 --

District of Columbia ........................ 362,881 362,881 362,881 --

Florida ............................................. 1,864,949 1,871,228 1,871,228 --

Georgia ............................................ 1,045,869 1,049,391 1,049,391 --

Hawaii ............................................. 362,881 362,881 362,881 --

Idaho................................................ 362,881 362,881 362,881 --

Illinois.............................................. 1,265,728 1,269,981 1,269,981 --

Indiana ............................................. 764,876 767,447 767,447 --

Iowa ................................................. 372,163 372,593 372,593 --

Kansas ............................................. 362,881 362,881 362,881 --

Kentucky.......................................... 577,204 579,143 579,143 --

Louisiana ......................................... 566,770 568,672 568,672 --

Maine............................................... 362,881 362,881 362,881 --

Maryland.......................................... 466,854 468,424 468,424 --

Massachusetts.................................. 604,505 606,532 606,532 --

Michigan.......................................... 1,239,838 1,244,002 1,244,002 --

Minnesota ........................................ 512,759 514,482 514,482 --

Mississippi....................................... 424,574 425,999 425,999 --

Missouri........................................... 687,561 689,871 689,871 --

Montana........................................... 362,881 362,881 362,881 --

Nebraska .......................................... 362,881 362,881 362,881 --

Nevada............................................. 362,881 362,881 362,881 --

New Hampshire ............................... 362,881 362,881 362,881 --

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

PROGRAM/CFDA NUMBER: Developmental Disabilities – Protection and Advocacy (CFDA 93.630)

State/Territory

FY 2014

Final FY 2015 Enacted

FY 2016 

President’s 

Budget

FY 2016 +/- 

FY 2015

New Jersey...................................... 743,327 745,824 745,824 --

New Mexico ................................... 362,881 362,881 362,881 --

New York ....................................... 1,829,821 1,835,961 1,835,961 --

North Carolina ................................ 1,089,450 1,093,115 1,093,115 --

North Dakota .................................. 362,881 362,881 362,881 --

Ohio ................................................ 1,332,036 1,336,512 1,336,512 --

Oklahoma ....................................... 418,336 419,743 419,743 --

Oregon ............................................ 407,305 408,276 408,276 --

Pennsylvania................................... 1,370,712 1,375,314 1,375,314 --

Rhode Island................................... 362,881 362,881 362,881 --

South Carolina ................................ 573,680 575,609 575,609 --

South Dakota .................................. 362,881 362,881 362,881 --

Tennessee ....................................... 748,866 751,384 751,384 --

Texas .............................................. 2,432,653 2,440,848 2,440,848 --

Utah ................................................ 362,881 362,881 362,881 --

Vermont.......................................... 362,881 362,881 362,881 --

Virginia........................................... 729,693 732,147 732,147 --

Washington..................................... 618,587 620,668 620,668 --

West Virginia.................................. 365,960 366,370 366,370 --

Wisconsin ....................................... 637,929 640,072 640,072 --

Wyoming ........................................ 362,881 362,881 362,881 -- 

Subtotal, States............................... 36,003,556 36,098,572 36,098,572 --

 

American Samoa............................. 194,139 194,139 194,139 --

Guam .............................................. 194,139 194,139 194,139 --

Northern Mariana Islands............... 194,139 194,139 194,139 --

Puerto Rico ..................................... 887,069 890,053 890,053 --

Virgin Islands ................................. 194,139 194,139 194,139 --

Subtotal, States and Territories....... 37,667,181 37,765,181 37,765,181 --

Grants to Tribes 194,139 194,139 194,139 --

Training and Technical Assistance134 772,680 774,680 774,680 --

TOTAL $38,634,000 $38,734,000 $38,734,000 --

134 This line reflects the amount reserved from the P&A appropriation for statutory related activities, including 

training, technical assistance, grant systems, and review costs

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University Centers for Excellence in Developmental Disabilities

FY 2014 

Final

FY 2015 

Enacted

FY 2016 

President's Budget

FY 2016 +/- 

FY 2015

UCEDDs............ $36,674,000 $37,674,000 $38,619,000 $945,000 

Authorizing Legislation: Section 156 of the Developmental Disabilities Assistance and Bill of 

Rights Act 

FY 2016 Developmental Disabilities Assistance and Bill of Rights Act Authorization ...... Expired

Allocation Method ............................................................................................... Competitive Grant

Program Description and Accomplishments:

University Centers for Excellence in Developmental Disabilities (UCEDDs), first established in 

1963, are interdisciplinary education, research and public service units of a university system or 

public or not-for-profit entities associated with universities. UCEDDs provide leadership in, 

advise Federal, State, and community policymakers about, and promote opportunities for 

individuals with developmental disabilities to exercise self-determination, be independent, 

productive, and integrated and included in all facets of community life. In FY 2013, the 

Administration on Intellectual and Developmental Disabilities (ACL/AIDD) awarded 68 grants 

to continue funding for University Centers to engage in interdisciplinary pre-service training, 

community services, research, and information dissemination activities. The grant designates the 

Center and provides infrastructure support for UCEDDs to leverage additional funds for carrying 

out core activities. 

UCEDDs provide unique contributions to the intellectual and developmental disabilities 

community in the area of pre-service preparation. UCEDDs provide an array of interdisciplinary 

instructional programs to improve the quality of services and supports for people with 

developmental disabilities. UCEDD interdisciplinary training programs are designed to: 

• Integrate knowledge and methods from two or more distinct disciplines; 

• Integrate direct contributions to the field made by people with disabilities and family 

members; and

• Examine and advance professional practice, scholarship and policy that impacts the lives 

of people with developmental and other disabilities and their families. 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

UCEDD trainees come from a wide array of professional backgrounds including, but not limited 

to, pediatrics, education, dentistry, nursing, allied health, and administration (e.g., public, health, 

education, etc.). On average, UCEDDs train nearly 2,800 future professionals each year. 

In addition to advancing the field through pre-service preparation, UCEDDs make strategic 

connections across multiple sectors to ensure people with developmental and other disabilities 

attain maximum physical, emotional, social, and economic well-being; and are independent, 

productive and fully participating members of their community consistent with their cultural 

values. UCEDD community services cut across Federal, State, and local systems to improve 

capacity and quality of services by incorporating evidence-based practices. UCEDDs are at the 

forefront of ensuring appropriate evaluation of disabilities and the use of evidence-based 

interventions for children and adults with developmental and other disabilities, such as Autism 

Spectrum Disorders, for which rates have increased in recent years. New knowledge is generated 

by research and tied to practice using a variety of dissemination strategies. 

Funding History:

Funding for the program during the last five years has been as follows: 

FY 2011 .................................................$38,865,000 

FY 2012 .................................................$38,792,000 

FY 2013 .................................................$36,602,000 

FY 2014 .................................................$36,674,000 

FY 2015 .................................................$37,674,000 

Budget Request: 

The FY 2016 request for UCEDDs is $38,619,000, an increase of +$945,000 above the FY 2015 

enacted level. This request will provide operational and administrative support to maintain the 

existing 68 UCEDDs. This funding will also provide continued support for the training and 

technical assistance to the UCEDDs to support improvements in the programs’ performance and 

ability to meet performance targets, which would otherwise not be possible due to provisions in 

the funding formula of the Developmental Disabilities Act that requires appropriated funds to 

provide cost of living adjustments (COLA) to Centers before funding National Training 

Initiatives (NTI) and technical assistance to Centers. Without an increase in FY 2016, funding 

would not be at a level necessary to maintain the UCEDD core grants at their current level and

pay for the COLA, NTI grants, and technical assistance to Centers. The additional funds will 

provide sufficient money to award UCEDD grants with the COLA, continued funding of a 

National Training Initiative grant focused on violence against people with developmental 

disabilities, supplemental funds supporting people with developmental disabilities participating 

178 
DISABILITY PROGRAMS, RESEARCH, AND SERVICES

in UCEDD training programs, and technical assistance to Centers. 

Continued funding of the UCEDDs will support this network of independent but interlinked 

centers, representing an expansive national resource for addressing issues, finding solutions, and 

advancing research related to the needs of individuals with developmental disabilities and their 

families. At the local level, UCEDDs are vital to the training of future professionals with the 

specialized expertise in developmental disabilities. Of the UCEDD trainees who graduated 5 to 

10 years ago, 82 percent are in leadership positions with: 

• 56 percent in academic leadership 

• 48 percent in clinical leadership 

• 25 percent in public health leadership 

• 28 percent in public policy and advocacy leadership 

It is estimated that over 36 percent of people with developmental disabilities are receiving 

services from former UCEDD trainees. 

In the absence of continued funding for UCEDDs, specialized services would no longer be 

available at the local level and local organizations as well as state agencies would not have the 

benefit of receiving technical assistance from UCEDDs to improve services and supports for 

people with developmental disabilities across the life span. A lack of funding would also create a 

tremendous gap in new knowledge generated by UCEDD-conducted research. For example, a 

growing body of research has documented that persons with developmental and other disabilities 

are more likely to experience health disparities compared to the general population. The 

University of New Hampshire UCEDD is conducting the Health and Health Care Disparities 

among Individuals with Disabilities project to determine what factors relate to or explain health 

outcomes and health care access among the diverse populations of individuals with disabilities. 

The goal of the Health Disparities Project is to generate new knowledge about health access and 

health outcomes among sub-groups of people with disabilities and translate and disseminate the 

findings for researchers, policy makers, and others. 

UCEDD funds help to place these centers in a strategic position to lead national efforts such as 

The National Gateway to Self-determination, which is a collaborative effort of five UCEDDs and 

the National Self-Determination Alliance to establish a sustainable, evidence-based training 

system that enhances self-determination training programs that lead to quality of life outcomes 

for individuals with developmental disabilities throughout the lifespan. Another example is The 

Consortium to Enhance Postsecondary Education for Individuals with Developmental 

Disabilities, which is a project led by the Institute for Community Inclusion in Massachusetts in 

179 
DISABILITY PROGRAMS, RESEARCH, AND SERVICES

collaboration with seven UCEDDs (Delaware, Minnesota, Hawaii, South Carolina, Tennessee 

[Vanderbilt], Ohio, and California) and the Association of University Centers on Disabilities. 

The Consortium is conducting research, providing training and technical assistance, and 

disseminating information on promising practices that support individuals with developmental 

disabilities to increase their independence, productivity, and inclusion through access to 

postsecondary education, resulting in improved long-term independent living and employment 

outcomes. 

Funding for UCEDDs also provides infrastructure support for initiatives with effects felt 

internationally, such as the University of Hawaii UCEDD’s Asia-United States Partnership 

(AUSP). The goal of this partnership is to improve child health through cross-cultural exchanges 

in early childhood development with leaders in East Asia (Beijing, Shanghai, and Hong Kong 

SAR, Philippines, Singapore, and Thailand) and the United States. 

UCEDD designation and funding also aids these centers in seeking other sources of money to 

pursue activities that improve the lives of people with developmental disabilities. The grant from 

ACL provides a critical infrastructure support that allows the UCEDD to leverage additional 

funds. There is a significant return on ACL’s investment. In FY 2011, the Federal investment of 

$35.8 million in UCEDD grant awards leveraged $384.5 million in other resources to help 

UCEDD’s carry out their core activities. 

Outputs and Outcomes Table:

Measure Most Recent Result FY 2015

Target

FY 2016

Target

FY 2016

+/- FY 2015

8D: Increase the percentage of 

individuals with developmental 

disabilities receiving the benefit of 

services through activities in which 

professionals were involved who 

completed University Centers of 

Excellence in Developmental 

Disabilities (UCEDDs) state-of-the-art 

training within the past 10 years. 

(Outcome)

FY 2013: 40.98%

Target: 40.07% 

(Target Exceeded)

Prior Result 

+1%

Prior Result 

+1% N/A

8viii: Number of professionals trained 

by UCEDDs. (Output)

FY 2013: 5,891

(Actual) N/A N/A N/A

8ix: Number of people reached 

through UCEDD community training 

and technical assistance activities. 

(Output)

FY 2013: 691,369

(Actual) N/A N/A N/A

8x: Number of people receiving direct 

or model demonstration services from 

UCEDDs. (Output)

FY 2013: 81,295 

(Actual) N/A N/A N/A

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

Grant Awards Tables:

University Centers of Excellence in Developmental Disabilities Grant Awards

FY 2014 Final FY 2015 

Enacted

FY 2016 

President’s 

Budget

Number of 

Awards 67 72 68

Average 

Award $535,215 $512,785 $556,846

Range of 

Awards $535,215 $200,000 - 

$738,000

$200,000 - 

$738,000

Resource and Program Data:

University Centers of Excellence in Developmental Disabilities

(Dollars in thousands) 

FY 2014 FY 2015 FY 2016

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary 3 1,606 4 1,982 1 344

Continuations 64 34,254 68 34,939 67 37,522

Contracts 1 802 1 728 1 728

Interagency Agreements -- -- -- -- -- --

Program Support /1 12 25 25

Total Resources 36,674 37,674 38,619

1/ Program Support -- Includes funds for grant systems and review costs.

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Developmental Disabilities – Projects of National Significance

FY 2014 

Final

FY 2015 

Enacted

FY 2016 

President's Budget

FY 2016 +/- 

FY 2015

DD – Projects of 

National Significance $8,821,000 $8,857,000 $14,500,000 $5,643,000 

Authorizing Legislation: Section 163 of the Developmental Disabilities Assistance and Bill of 

Rights Act 

FY 2016 Developmental Disabilities Assistance and Bill of Rights Act Authorization ...... Expired

Allocation Method ............................. Competitive Grants and Cooperative Agreements/Contracts

Program Description and Accomplishments:

Projects of National Significance (PNS) is a discretionary program which provides grants, 

cooperative agreements, and contracts to public or private non-profit entities that support and 

complement the work of the State Councils on Developmental Disabilities, the Protection and 

Advocacy systems for persons with Developmental Disabilities, and the University Centers for 

Excellence in Developmental Disabilities. PNS complements these other Developmental 

Disabilities (DD) programs by supporting the development of national and State policies, 

including Federal interagency initiatives; demonstration projects addressing innovative and 

emerging best practices to expand opportunities for individuals with developmental disabilities 

to contribute to, and participate in, all facets of community life; and longitudinal data collection 

projects.

In FY 2013, PNS resources funded systems change grants to improve access to competitive,

integrated supported employment for people with intellectual and developmental disabilities, 

with a particular focus on youth and young adults, as well as the evaluation of such efforts. It 

also funded promising practices in states to promote competitive, integrated employment and 

family support activities, as well as technical assistance to self-advocacy organizations. PNS 

funds continue to support longitudinal research studies of trends in residential services and 

supports, employment, community supports, family supports, and quality indicators related to 

publicly funded DD services. In FY 2014, PNS resources funded a new project related to 

gathering and disseminating information and providing technical assistance to people and entities 

interested in supported decision making as an alternative to guardianship. In addition, Congress 

added $1,000,000 to the FY 2014 and FY 2015 appropriation to support a grant related to 

inclusive transportation for those with disabilities. 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

In FY 2016, ACL/AIDD will continue to prioritize these efforts as well as a Youth Transitions 

Initiative with the goal of bringing together entities such as state Developmental Disabilities 

agency, Department of Education, Vocational Rehabilitation, Council on Developmental 

Disabilities, University Centers for Excellence in Developmental Disabilities and other agencies 

to address the comprehensive needs of youth with intellectual and developmental disabilities as 

they transition from adolescence into young adult life across all systems – health, education, 

employment, human services, and community living. The July 2012 GAO Report, Students with 

Disabilities: Better Federal Coordination Could Lessen Challenges in the Transition from High 

School, strongly recommended development of an interagency approach across HHS, Education, 

Labor, and Social Security to work towards improving common outcomes for transitioning youth 

with disabilities and their families related to health, education, employment, support services and 

community living. HHS’ response to this report acknowledged that “more must be done toward 

developing a coordinated, integrated transition strategy.” The GAO report builds upon a long and 

demonstrated history of reports and data indicating the need to ensure that youth with disabilities 

are not exiting high school only to become dependent upon Supplemental Security Income (SSI), 

Social Security Disability Insurance (SSDI), and Medicaid at a cost of tens of billions of federal 

dollars – and that the lack of coordination across systems is a major contributor to this trend. 

Successful outcomes for youth with disabilities include engagement in productive activities, 

including paid employment, with quality health and functional status. In response to the GAO 

report, an interagency workgroup—(Federal Partners in Transition, FPT) led by senior leadership 

from each of four agencies (Education, Labor, Social Security, and HHS)—has been convened to 

look at how to improve these outcomes. Demonstration projects have shown promising 

employment results for youth with intellectual and developmental disabilities when Medicaidfunded LTSS, vocational rehabilitation, Social Security, and education systems collaborate. A 

prime example of the impact of Employment First policies can be seen from their 

implementation in Washington State. In 2005, King County in Washington State changed their 

approach to transitioning students with intellectual and developmental disabilities from school to 

employment by adopting a statewide Employment First policy coupled with supportive services. 

In just five years, the percent of youth with disabilities that are employed rose from six percent to 

56 percent. 

Building on the work of these demonstrations, through the Youth Transitions initiative, ACL will 

invest in state initiatives, with the goal of generating results similar to the Washington state 

model, that bring together entities such as state Developmental Disabilities agency, Department 

of Education, Vocational Rehabilitation, Council on Developmental Disabilities, University 

Centers for Excellence in Developmental Disabilities and other agencies to address the 

comprehensive needs of youth with intellectual and developmental disabilities as they transition 

from adolescence into young adult life across all systems – health, education, employment, 

human services, and community living. These entities will identify federal, state, and local laws, 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

regulations, and policies that create barriers to employment for youth with Intellectual or 

Developmental Disabilities, develop plans to deconstruct such barriers, and implement interagency programs that produce better outcomes for this population. ACL will also fund an 

evaluation component for the initiative in 2016. 

 

The models would be required to address transitioning across several systems for youth with 

Intellectual or Developmental Disabilities, including pediatric to adult health care, education to 

post-secondary education, and vocational systems to produce successful outcomes in 

competitive, integrated employment. Of specific interest is implementing approaches that 

provide ongoing long-term services and supports which will provide meaningful assistance to 

these youth into adulthood through Medicaid or other funding streams. Family supports will be 

critical to successful models as well, with a holistic approach on providing family members 

supporting their youth with targeting, ongoing assistance. For example, a successful model may 

include implementing training curriculums on best practices within and outside of disability 

services for accessing and coordinating community supports, leadership development, and selfadvocacy – and would be made available to youth, siblings, parents and other family supporting

the transitioning youth with Intellectual or Developmental Disabilities. 

Funding History:

Funding for the program during the last five years has been as follows: 

FY 2011 .................................................$14,134,000 

FY 2012 ...................................................$8,317,000 

FY 2013 ...................................................$8,828,000 

FY 2014 ...................................................$8,821,000 

FY 2015 ...................................................$8,857,000 

Budget Request: 

The FY 2016 request for the Projects of National Significance program is $14,500,000, an 

increase of +$5,643,000 above the FY 2015 enacted level. Within this request, $5,000,000 is to 

support ACL’s Youth Transitions initiative, which will support youth with disabilities

transitioning from childhood to adulthood, as well as enhance coordination across Federal 

agencies currently serving this population. The request also includes +$643,000 to support 

inclusive employment initiatives, transportation, technical assistance, longitudinal data collection 

and analysis, evaluation, and monitoring for the State Councils on Developmental Disabilities, as 

described in that program section. In addition, AIDD will provide self-advocacy organizations 

with an opportunity to thrive and grow through a targeted technical assistance effort.

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

PNS projects reflect the current and emerging needs of individuals with developmental 

disabilities. For instance, funds for Youth Transitions will fund demonstration projects in nine 

States through grants, cooperative agreements, and coordinated interagency program 

implementation to:

• Promote innovative utilization of health and long-term supports in coordination with 

education, vocational rehabilitation, and employment services; 

• Encourage integration of health and LTSS transition planning into secondary and postsecondary education programs; 

• Provide technical assistance and training to ensure integration of health and long-term 

supports with education, vocational rehabilitation and employment services; and

• Establish and implement a coordinated federal evaluation agenda to ensure that outcomes 

across systems are measured and reported.

Funds will also continue to support the Partnerships in Employment Systems Change projects as 

they continue to work toward a current need of the intellectual and developmental disabilities 

community. In Wisconsin, individuals with intellectual and developmental disabilities enrolled in 

adult long-term care systems have community-based employment rates of only 9 to 14 percent. 

One of the project’s goals is to implement policy and legislative changes that will increase the 

number of students in Wisconsin, and ultimately nationally who are employed in integrated, 

community based settings after leaving high school or a post-secondary institution and who 

become economically self-sufficient. Without this funding, progress will not be made on this 

project and others like it, which does a disservice to individuals with intellectual and 

developmental disabilities in Wisconsin and the other seven states. 

Consistent with the purpose of the Developmental Disabilities Act, including the promotion of 

self-determination, ACL has worked collaboratively exploring supported decision-making and 

guardianship reform, to maximize the opportunity for people with intellectual and developmental 

disabilities and Older Americans to live independently and to exert control and choice in their 

own lives. ACL proposes to continue funding a joint integrated training and technical 

assistance/resource center on supported decision making to advance work in this area. 

ACL continues to undertake a comprehensive review of performance measurement and data 

reporting activities across all DD Act programs with an increased focus on outcomes, including, 

the establishment of performance measurement workgroups, enhancement and streamlining data 

collection, and engagement with evaluation experts to recommend improvements. 

In FY 2016 ACL will also continue to issue grants totaling $1 million to communities with the 

models that best demonstrate the inclusion of people with disabilities, including intellectual and 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

developmental and/or physical disabilities, and seniors in the development and planning of the 

community transportation systems. These funds were appropriated directly to ACL for the first 

time in FY 2014. 

Grant Awards Tables:

Developmental Disabilities – Projects of National Significance Grant Awards

FY 2014 Final FY 2015 

Enacted

FY 2016 

President’s 

Budget

Number of 

Awards 27 25 37

Average 

Award $280,356 $288,876 $345,125

Range of 

Awards

$100,000 - 

$575,000

$100,000 - 

$575,000

$100,000 - 

$575,000

Resource and Program Data:

Developmental Disabilities – Projects of National Significance

(Dollars in thousands) 

FY 2014 FY 2015 FY 2016

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary 6 770 -- -- 10 5,000

Continuations 21 6,800 25 7,222 27 7,770

Contracts 5 1,065 7 1,343 7 1,363

Interagency Agreements -- -- -- -- -- --

Program Support /1 187 292 368

Total Resources 8,821 8,857 14,500

1/ Program Support -- Includes funds for salaries and benefits, contract fees, and grant systems and review 

costs.

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National Institute on Disability, Independent Living, and Rehabilitation 

Research

FY 2014 

Final

FY 2015 

Enacted

FY 2016 

President's 

Budget

FY 2016 +/- 

FY 2015

National Institute on Disability, 

Independent Living, and 

Rehabilitation Research.......... $103,970,000 $103,970,000 $108,000,000 $4,030,000 

Authorizing Legislation: Title II of the Rehabilitation Act of 1973, as amended

FY 2016 Rehabilitation Act Authorization ..................................................................$112,001,000 

Allocation Method .................................................................... Discretionary Grants and Contracts 

Program Description and Accomplishments:

The mission of the National Institute on Disability, Independent Living, and Rehabilitation 

Research (NIDILRR) is to generate knowledge and promote its effective use to improve the 

abilities of people with disabilities to perform activities of their choice in the community, and 

also to expand society’s capacity to provide full opportunities and accommodations for its 

citizens with disabilities. NIDILRR sponsors comprehensive and coordinated programs of 

research and related activities to maximize the full inclusion, social integration, employment, and 

independent living of individuals with disabilities of all ages. The purposes of NIDILRR are to: 

• Promote, coordinate, and provide for research, demonstration and training, and related 

activities with respect to individuals with disabilities; 

• Widely disseminate findings, conclusions, and recommendations resulting from its activities; 

and

• Provide research-based knowledge toward advancing the quality of life of individuals with 

disabilities. 

NIDILRR's research is conducted through a network of individual research projects and centers 

of excellence located throughout the nation. Most funding is awarded through competitive 

grants, and most of the funds are awarded to universities or providers of rehabilitation or related 

services.

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

As required by the Rehabilitation Act in §202(h), NIDILRR operates under a Long-Range Plan 

(LRP), published April 4, 2013 in the Federal Register, entitled “Long-Range Plan for Fiscal 

Years 2013-2017.” This plan outlines four long-term performance goals and its strategies for 

achieving these goals. These goals are:

• Goal 1: Create a portfolio of research, development, and other activities that balances 

domains, populations of focus, and who, whether NIDILRR or the grant applicant, defines 

the specific approach to a disability or rehabilitation research topic. 

• Goal 2: Support centers and projects that conduct well-designed research and development 

activities using a range of appropriate methods. 

• Goal 3: Promote the effective use of knowledge in areas of importance to individuals with 

disabilities and their families. 

• Goal 4: Improve program administration. 

The following is a description of the primary grant mechanisms under which NIDILRR makes 

awards: 

• Rehabilitation Research and Training Centers (RRTCs). RRTCs receive funding to conduct 

coordinated and advanced programs of research, training, and information dissemination in 

problem areas that are specified by NIDILRR. More specifically, RRTCs conduct research to 

improve rehabilitation methodologies and service delivery systems, alleviate or stabilize 

disabling conditions, and promote maximum social and economic independence for persons 

with disabilities. In addition, RRTCs provide training, including graduate, pre-service, and 

in-service training, to help rehabilitation personnel provide more effective rehabilitation 

services to individuals with disabilities; and serve as centers of excellence in rehabilitation 

research for providers and for individuals with disabilities and their representatives. 

Typically, awards are for 5 years. 

• Rehabilitation Engineering Research Centers (RERCs). The RERCs conduct research on 

issues dealing with rehabilitation technology, including rehabilitation engineering and 

assistive technology devices and services. RERC activities include developing and 

disseminating innovative methods of applying advanced technology, scientific achievements, 

and psychological and social knowledge to rehabilitation issues such as the removal of 

environmental barriers; developing and disseminating technology designed to lessen the 

effects of sensory loss, mobility impairment, chronic pain, and communication difficulties; 

scientific research to assist in meeting the employment and independent living needs of 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

individuals with severe disabilities; and stimulating the production and distribution of 

equipment in the private sector, as well as clinical evaluations of equipment. Each RERC 

must provide training opportunities to enable individuals, including individuals with 

disabilities, to become researchers and practitioners in the field of rehabilitation technology. 

Typically, awards are for 5 years. 

• Model Systems. NIDILRR funds model systems projects in three areas: spinal cord injury, 

traumatic brain injury, and burn injury. Model systems funding supports 5-year grants to 

establish innovative projects for the delivery, demonstration, and evaluation of 

comprehensive medical, vocational, and other rehabilitation services to meet the wide range 

of needs of individuals in these areas. Grantees in each of the three areas contribute to their 

respective injury-specific national database that is supported by NIDILRR funding. These 

model systems programs have become platforms for conducting multi-site research, 

including randomized controlled trials to determine the efficacy of interventions.

o Spinal Cord Injury Model Systems. The Spinal Cord Injury (SCI) program funds 

research to meet the wide range of needs of individuals with spinal cord injuries. 

(See http://www.ncddr.org/rpp/hf/hfdw/mscis/.) The projects also disseminate 

information to individuals with SCI and others.

o Traumatic Brain Injury Model Systems. The Traumatic Brain Injury (TBI) Model 

Systems projects are research grants designed to advance the understanding of 

TBI and its consequences and improve rehabilitation outcomes. Currently, the 

NIDILRR TBI model systems is the largest nonmilitary TBI service 

delivery/research entity participating in various intergovernmental efforts to 

improve treatment and outcomes for returning veterans. (See 

http://www.tbindsc.org.) 

o Burn Model Systems. The Burn Model Systems (BMS) projects are research 

grants designed to establish, demonstrate, and evaluate a model system of care for 

burn injury survivors. Projects aim to reduce disability by improving treatment 

and rehabilitation. See http://mama.uchsc.edu/pub/NIDILRR/index.html.

• Field-Initiated Projects (FIPs). Field-Initiated Projects supplement NIDILRR’s directed 

research and address a wide range of topics identified by investigators, including research, 

demonstrations, development, and knowledge translation. These projects allow NIDILRR to 

address emerging developments in the field beyond the scope of announced priorities. Most 

of these awards are made for 3 years. 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

• Disability and Rehabilitation Research Projects (DRRPs). Grantees under this program focus 

on discrete research topics identified by NIDILRR and address problems encountered by 

people with disabilities through a variety of methods that may include research, 

demonstrations, training, dissemination, utilization, technical assistance, or combinations of 

these activities. 

• ADA National Network Centers (ADA Network). The ADA Network supports 10 regional 

centers that provide detailed technical assistance, disseminate information, and provide 

training related to the requirements of the Americans with Disabilities Act (ADA) and 

promote awareness of the ADA. Typically, these awards are for 5 years. 

• Advanced Rehabilitation Research Training (ARRT). The ARRT program supports grants to 

institutions of higher education to provide advanced postdoctoral training in areas that are 

directly related to NIDILRR’s research domains, including community living and 

participation, employment, and health and function. Grants are made to institutions of higher 

education to recruit qualified persons with doctoral or similar advanced degrees and prepare 

them to conduct independent research in areas related to disability and rehabilitation. These 

training programs must operate in interdisciplinary environments and provide training in 

rigorous scientific methods. 

• Small Business Innovation Research (SBIR). SBIR awards support the development of new 

rehabilitation technologies that are useful to persons with disabilities by inviting the 

participation of small business firms with strong research capabilities in science, engineering, 

or educational technology. This 2-phase program takes a product from development to 

market readiness. During Phase I, firms conduct feasibility studies to evaluate the scientific 

and technical merit of an idea. During Phase II, they expand on the results and pursue further 

development. In order to be eligible, small businesses must be American-owned and 

independently operated and be for-profit with no more than 500 employees. The principal 

researcher must be employed by the business. 

• Switzer Research Fellowships. Switzer research fellows receive 1-year fellowships to carry 

out discrete research activities that are related to NIDILRR’s research priorities or to pursue 

studies in areas of importance to the disability and rehabilitation community. 

• Outreach to Minority Institutions. The Rehabilitation Act (§21) requires that 1 percent of 

funds appropriated for programs authorized under certain titles be reserved for awards to 

minority entities and Indian tribes, or to provide outreach and assistance to minority entities 

and Indian tribes. 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

• Other Activities: NIDILRR funding also supports a variety of other activities, including 

knowledge translation; collaborative projects with other agencies; development and 

maintenance of grantee reporting systems; program review; and reporting, evaluation, longrange planning, and the Interagency Committee on Disability Research (ICDR). The primary 

purpose of the ICDR is to promote cooperation across various Federal agencies in the 

development and execution of disability and rehabilitation research activities. (See 

http://www.icdr.us/.) 

Funding History:

Funding for NIDILRR during the past five years is as follows: 

FY 2011 ...............................................$109,023,000 

FY 2012 ...............................................$108,817,000 

FY 2013 ...............................................$103,125,000 

FY 2014 ...............................................$103,970,000 

FY 2015 ...............................................$103,970,000 

Budget Request:

ACL requests $108,000,000 for the National Institute on Disability, Independent Living, and 

Rehabilitation Research in FY 2016, an increase of +$4,030,000 above the FY 2015 enacted 

level. Funding at this level will enable NIDILRR to fund Rehabilitation Engineering Research 

Centers (RERCs) on technologies to improve employment outcomes of individuals with 

disabilities, support community living strategies for families of individuals with disabilities, and 

support NIDILRR’s Spinal Cord Injury (SCI) program. About 72 percent of the funds requested 

would be used to cover the costs of grants that began in previous fiscal years ($77 million). In 

addition, an estimated $31.4 million would be used to fund new grant awards under a revised 

regulatory framework that NIDILRR proposes to publish for its research in fiscal year 2016. 

ACL plans to publish a Notice of Proposed Rule Making in FY 2016 that would amend 34 CFR 

Part 350, governing NIDILRR’s Disability and Rehabilitation Research Projects and Centers 

Program. NIDILRR believes that these regulations will strengthen its overall research portfolio 

by expanding opportunities for field-initiated work within a clear framework that is designed to 

both encourage innovation and promote rigorous research, and by allowing for a regular schedule 

of competitions in pre-established priority areas. To establish clear and consistent requirements 

for similar types of projects, the regulations will define the types of projects to be supported and 

specify the application requirements for each of them. Under the proposed framework, NIDILRR 

would support the following four types of projects. 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

• Exploration and Discovery: Generate new and refined analyses, findings, hypotheses, and 

theories that enhance knowledge of the barriers to and facilitators of improved outcomes for 

individuals with disabilities. This research can also be used to identify existing practices, 

programs, or policies that are associated with better outcomes for individuals with 

disabilities. The results from this work may either inform the development of interventions or 

lead to evaluations of interventions. 

• Intervention Development: Generate and test interventions—such as research tools, products, 

programs, practices, and policies—that have potential to improve outcomes for individuals 

with disabilities. NIDILRR supports grants to develop innovative interventions or to improve 

existing interventions. 

• Intervention Efficacy: Evaluate the efficacy of interventions—such as research tools, 

products, programs, practices, and policies—to determine whether they are feasible and 

practical and can have a positive impact on outcomes for individuals with disabilities. 

Efficacy studies can be used to assess the strength of an intervention’s impact on a desired 

outcome. Efficacy studies often apply experimental or quasi-experimental research methods.

• Scale-up Evaluation: Conduct evaluations to determine whether interventions—such as 

research tools, products, programs, practices, and policies—are effective in producing 

improved outcomes for individuals with disabilities when implemented in multiple realworld settings.

Through priorities published in the Federal Register in fiscal year 2013 based on NIDILRR’s 

revised Long-Range Plan (published in final in April 2013), NIDILRR established three 

domains—employment, health and function, and community living and participation. To 

improve outcomes for people with disabilities, NIDILRR will expand research across these 

domains. 

Within each domain, NIDILRR plans to structure its competitions to target its 

research/investments in four broad disability categories—physical, psychiatric, 

developmental/intellectual, and sensory disabilities. These priorities would remain in place for 

up to five years. Having these priority areas in place for a prolonged period of time would 

provide the field with stable opportunities for funding. Applicants who are not successful in one 

competition would be able to revise and improve their applications knowing that there will soon 

be another opportunity to have their proposal funded. Using recurring topical priorities would 

also simplify the management of NIDILRR’s competitions by reducing the need for annual rulemaking. 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

NIDILRR established the use of these domains beginning in fiscal year 2012 through rulemaking on individual grant priorities under the DRRP, RRTC, and RERC programs. During 

fiscal year 2016, NIDILRR plans to focus on the following broad priority topics in its domain 

areas:

Employment 

• Technology to improve employment outcomes for individuals with physical disabilities.

• Individual and environmental factors associated with improved employment outcomes 

for individuals with physical disabilities.

• Interventions that contribute to improved employment outcomes for individuals with 

physical disabilities. Interventions include any strategy, practice, program, policy, or tool 

that, when implemented as intended, contributes to improvements in outcomes for 

individuals with physical disabilities.

• Effects of government practices, policies, and programs on employment outcomes for 

individuals with physical disabilities.

• Practices and policies that contribute to improved employment outcomes for transitionaged youth with physical disabilities.

• Vocational rehabilitation (VR) practices that contribute to improved employment 

outcomes for individuals with physical disabilities.

Community Living and Participation 

• Technology to improve community living and participation outcomes for individuals with 

physical disabilities.

• Individual and environmental factors associated with improved community living and 

participation outcomes for individuals with physical disabilities.

• Interventions that contribute to improved community living and participation outcomes 

for individuals with physical disabilities. Interventions include any strategy, practice, 

program, policy, or tool that, when implemented as intended, contributes to 

improvements in outcomes for individuals with physical disabilities.

• Effects of government practices, policies, and programs on community living and 

participation outcomes for individuals with physical disabilities.

• Practices and policies that contribute to improved community living and participation 

outcomes for transition-aged youth with physical disabilities.

Health and Function 

• Technology to improve health and function outcomes for individuals with intellectual and 

developmental disabilities.

• Individual and environmental factors associated with improved access to rehabilitation 

and health care and improved health and function outcomes for individuals with 

intellectual and developmental disabilities.

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

• Interventions that contribute to improved health and function outcomes for individuals 

with intellectual and developmental disabilities. Interventions include any strategy, 

practice, program, policy, or tool that, when implemented as intended, contributes to 

improvements in outcomes for the specified population. 

• Effects of government practices, policies, and programs on health care access and on 

health and function outcomes for individuals with intellectual and developmental 

disabilities.

• Practices and policies that contribute to improved health and function outcomes for 

transition-aged youth with intellectual and developmental disabilities.

Output Table:

ACL will work with all relevant parties to review, develop, or refine performance measures and 

performance data collection for all WIOA programs during the transition.

Resource and Program Data:

National Institute on Disability, Independent Living, and Rehabilitation Research 

(Dollars in Thousands) 

FY 2014 FY 2015 FY 2016

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

New Discretionary 72 20,919 58 16,893 77 32,993

Continuations

 

165 

 

77,324 166 79,524 147 68,397

Contracts 4,927 6,229 5,910

Peer Review of new grant 

applications 800 824 700

Interagency Agreements -- -- -- 500 -- --

Total Resources 103,970 103,970 108,000

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Independent Living

FY 2014 

Final

FY 2015 

Enacted

FY 2016 

President's 

Budget

FY 2016 +/- 

FY 2015

Independent Living State 

Grants................................. $22,878,000 $22,878,000 $22,878,000 $0

Centers for Independent 

Living................................. $78,305,000 $78,305,000 $83,305,000 $5,000,000

Total................................... $101,183,000 $101,183,000 $106,183,000 $5,000,000 

Authorizing Legislation: Rehabilitation Act of 1973, Title VII, Parts B and C, and Chapter 2, as 

amended by the Workforce Innovation and Opportunities Act (Rehabilitation Act) 

FY 2016 Rehabilitation Act Authorizations: 

 Independent Living State Grants ..............................................................................$24,645,000 

 Centers for Independent Living ................................................................................$84,353,000 

Allocation Method ...................................................................... Formula and Discretionary Grants

Program Description and Accomplishments:

Independent living (IL) programs maximize the leadership, empowerment, independence, and 

productivity of individuals with disabilities, and work to integrate these individuals into the 

mainstream of American society. Independent living programs provide financial assistance to 

sustain, expand, and improve independent living services; develop and support statewide 

networks of centers for independent living; and foster working relationships among State 

independent living rehabilitation programs, centers for independent living, Statewide 

Independent Living Councils, Rehabilitation Act programs outside of Title VII, and other 

relevant Federal and non-Federal programs.

The Independent Living State Grants program supports formula grants to States, with funds 

allotted based on total population. States participating in the State Grants program must match 

10 percent of their grant with non-Federal cash or in-kind resources in the year for which the 

Federal funds are appropriated. The fiscal year 2014 State distributions were based on the July 1, 

2012 estimates released in December 2012, and the fiscal year 2015 allotments will be based on 

the July 1, 2013 estimates published by the Census Bureau in December 2013. 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

To be eligible for financial assistance under the Independent Living (IL) State Grants or Centers 

for Independent Living program, States are required to establish a Statewide Independent Living 

Council (SILC). Each State must also submit a State Plan for Independent Living. In addition to 

developing the State plan, the Council may, consistent with the State plan and State law, work to 

coordinate services provided to individuals with disabilities, conduct resource development 

activities, and perform other functions to support the purposes of the law. The remaining funds 

shall be used for one or more of the following purposes, consistent with the approved State plan: 

• To demonstrate ways to expand and improve independent living services, particularly 

those in unserved areas of the State’’ after ‘‘disabilities’ ; 

• To provide independent living services; 

• To support the operation of centers for independent living; 

• To increase the capacity of public or nonprofit agencies and organizations and other 

entities to develop comprehensive approaches or systems for providing independent 

living services;

• To conduct studies and analyses, gather information, develop model policies and 

procedures, and present information, approaches, strategies, findings, conclusions, and 

recommendations to Federal, State, and local policymakers; 

• To provide training on the independent living philosophy; and/or 

• To provide outreach to populations who are not served or are underserved by programs 

under Title VII of the Rehabilitation Act, including minority groups and urban and rural 

populations. 

The 2014 reauthorization of the Workforce Innovation and Opportunity Act (WIOA) added a 

new requirement that the Department annually reserve between 1.8 and 2.0 percent of the 

appropriated IL State funds to provide either directly or through grants, contracts, or cooperative 

agreements, training and technical assistance to Statewide Independent Living Councils (SILCs). 

In addition, WIOA requires that the ACL Administrator conduct a survey of SILCs regarding 

their training and technical assistance needs. 

The Centers for Independent Living (CIL) program provides grants for consumer-controlled, 

community-based, cross-disability, private nonprofit agencies that are designed and operated 

within a local community by individuals with disabilities and provide an array of independent 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

living services. At a minimum, centers are required to provide the core services of information 

and referral, independent living skills training, peer counseling, transition services, and

individual and systems advocacy. The 2014 reauthorization of the Workforce Innovation and 

Opportunity Act added a fifth core service that the CILs must provide to eligible individuals with 

significant disabilities that requires CILs to:

• Facilitate the transition of individuals with significant disabilities from nursing homes 

and other institutions to home and community based residences, with necessary supports 

to remain in the community;

• Assist individuals with significant disabilities at risk of institutionalization so that they 

may remain in the community; and

• Facilitate the transition of youth who are individuals with significant disabilities who are 

eligible for IDEA and who either completed school or left school to transition to 

postsecondary life. 

A population-based formula determines the total amount that is available for discretionary grants 

to centers in each State. In most cases, funds are awarded directly to centers for independent 

living. In fiscal year 2013, 354 centers and two States received funding from the CIL program. If 

State funding for CIL operation exceeds the level of Federal CIL funding in any fiscal year, the 

State may apply for the authority to award grants under this program through its designated state 

unit. There are currently only two States, Massachusetts and Minnesota, that are both eligible 

and have elected to manage their own CIL programs.

In addition to funding centers for independent living, the Department must award between 

1.8 and 2 percent of the funds appropriated for this program for grants, contracts, or cooperative 

agreements to provide training and technical assistance with respect to planning, developing, 

conducting, administering, and evaluating centers for independent living. The Rehabilitation Act 

requires the Department to conduct a survey of Statewide CILs to determine funding priorities 

for such grants, contracts or cooperative arrangements. 

The WIOA requires that within a year after the date of enactment of the law, ACL shall develop 

and publish in the Federal Register indicators of minimum compliance for centers for 

independent living, and indicators of minimum compliance for Statewide Independent Living 

Councils, consistent with the requirements of the law. 

The following standards are used in evaluating compliance in the following areas: philosophy, 

including consumer control and equal access; provision of services on a cross-disability basis; 

support of the development and achievement of the independent living goals chosen by 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

consumers; increasing the availability and quality of community options for independent living; 

provision of independent living core services; resource development; and community capacitybuilding activities, such as community advocacy, technical assistance, and outreach. WIOA 

requires that grants be awarded to any eligible agency that had been awarded a grant for the 

preceding fiscal year.

Funding History:

Funding for Independent Living activities during the past five years is as follows:

Independent Living State Grants: 

FY 2011 .................................................$23,403,000 

FY 2012 .................................................$23,359,000 

FY 2013 .................................................$23,137,000 

FY 2014 .................................................$22,137,000 

FY 2015 .................................................$22,878,000 

Centers for Independent Living: 

FY 2011 .................................................$80,105,000 

FY 2012 .................................................$79,953,000 

FY 2013 .................................................$75,772,000 

FY 2014 .................................................$78,305,000 

FY 2015 .................................................$78,305,000 

Budget Request:

ACL’s FY 2016 budget request is for $106,183,000, an increase of +$5,000,000 above the 

FY 2015 enacted level. Of this amount, $22,900,000 is provided to the Independent Living State 

Grants program (IL State Grants) and $83,300,000 million is for the Centers for Independent 

Living program (CIL). At these levels, State Grants will remain the same as the FY 2015 levels, 

and CILs will continue to provide the core requirements for information and referral services, 

independent living skills training, peer counseling, and individual and systems advocacy. The 

+$5,000,000 requested increase will also be provided to the CILs to implement the new, fifth 

core service required by the 2014 Workforce Innovation and Opportunity Act to facilitate the 

transition of individuals with significant disabilities into the community. As part of this 

requirement, CILs are directed to develop protocols, provide outreach and education, and 

provide and track activities. In 2012, CILs served about 213,000 of the estimated 38 million 

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DISABILITY PROGRAMS, RESEARCH, AND SERVICES

individuals with a significant disability living in the United States.135 The new fifth core service 

represents a significant new activity for many CILs, and without additional resources, CILs will 

be forced to reduce current service levels in order to provide this new core service.

The request for the CIL program would continue support for existing centers, including any new 

center grants awarded in FY 2015. Approximately 75 new centers have been funded, as funding 

for this program has increased since FY 2000. These new and existing centers provide essential 

services that help individuals with disabilities to live independently and participate as productive 

members of their communities.

Output Table:

ACL will work with all relevant parties to review, develop, or refine performance measures and 

performance data collection for all WIOA programs during the transition.

135 Department of Education, “Annual Report: Fiscal Year 2012: Report on Federal Activities Under the 

Rehabilitation Act of 1973, as Amended,” issued 2014. Accessed 12/4/14. 

http://www2.ed.gov/about/reports/annual/rsa/2012/rsa-2012-annual-report.pdf. 

U.S. Census Bureau, “Americans with Disabilities 2010” issued July 2012. Accessed 12/4/14. 

http://www.census.gov/prod/2012pubs/p70-131.pdf

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Consumer Information, Access, and Outreach

Summary of Request

Older Americans and Americans with disabilities face a vast array of choices when trying to 

determine the right services and supports to assist them to remain active and independent in their 

communities. As the number of choices available to assist them grows, so too does the 

complexity of navigating these programs and selecting among them so as to determine which 

best suit the needs of each individual. 

A key part of ACL’s emphasis on community living is providing consumers with the information 

they need to make decisions about their independence and connecting them with the right 

services. Aging and Disability Resource Centers (ADRCs) and the State Health Insurance 

Assistance Programs (SHIPs) help to address this need by providing information, outreach, and 

assistance to seniors and people with disabilities, so that they can access the services necessary 

for their independence. ADRCs serve as community-level “one stop shop” entry points into longterm services and supports - including home and community-based services that can enable 

people to remain in their homes - for people of all ages who have chronic conditions and 

disabilities. SHIPs provide one-on-one counseling to help aging and disabled beneficiaries 

understand and make optimal use of their Medicare benefits. 

Equally important, however, are the programs that help people with disabilities and older 

Americans to more fully participate in all aspects of community life. Grants provided under the 

Help America Vote Act (HAVA) assist States in making polling places accessible to individuals 

with the full range of disabilities, and the Assistive Technology program helps support 

individuals with disabilities to obtain Assistive Technology devices and services. Further, the 

Alzheimer’s Disease Initiative Communications Campaign, funded from the Prevention and 

Public Health Fund, the National Clearinghouse for Long-Term Care Information, the Limb Loss 

Resource Center, and the Paralysis Resource Center, each reach out to key populations to assist 

them in accessing services and in planning for future needs. 

The FY 2016 request for these programs is $122,788,000, an increase of +$4,141,000 above the 

FY 2015 enacted level. This request would provide: 

• $20,000,000 in discretionary funding for ADRCs, an increase of +$13,881,000 above the 

FY 2015 enacted level. FY 2014 is the final year that mandatory funding was provided 

for this program under the ACA. Therefore, this discretionary request represents the sole 

source of funding for ADRCs going forward. ADRCs support State efforts to develop 

more efficient, cost-effective, and consumer-responsive systems of information and 

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CONSUMER INFORMATION, ACCESS, AND OUTREACH

integrated access by creating “one-stop shop” entry points into long-term care at the 

community-level. 

• $4,200,000 for the Alzheimer’s Disease Initiative Outreach Campaign, the same as the 

FY 2015 enacted level. This outreach campaign informs those who are caring for people 

with Alzheimer’s disease about the Federal, state, local, and nonprofit resources available 

to help them. This funding is proposed from the Prevention and Public Health Fund. 

• $52,115,000 for State Health Insurance Assistance Programs (SHIPs), transferred to ACL 

from the Centers for Medicare and Medicaid Services in FY 2014. SHIPs provide free, 

one-on-one counseling and assistance to help aging and disabled Medicare beneficiaries 

navigate the complexities of health and long-term care systems. The SHIPs, two-thirds of 

which are currently administered by State Units on Aging, fit naturally within ACL’s 

mission of promoting community living, and benefit from deeper connections to ACL’s 

aging and disability services networks. 

• $4,963,000 for HAVA, the same as the FY 2015 enacted level. HAVA grants assist 

Protection and Advocacy systems in each State and Territory to ensure full participation 

in the electoral process for individuals with disabilities, including registering to vote, 

casting a vote, and accessing polling places. 

• $31,000,000 for Assistive Technology, a decrease of -$2,000,000 below the FY 2015 

enacted level. Assistive Technology was transferred to ACL from the Department of 

Education in FY 2014 by the Workforce Innovation and Opportunity Act, and financially 

supports State programs that maximize the abilities of individuals with disabilities and 

their families to obtain AT devices and services, including computer or technology aids, 

modified driving controls, and durable medical equipment such as wheelchairs or 

walkers.

• $1,000,000 for the National Clearinghouse for Long-Term Care Information. This

outreach effort increases awareness of the need to plan ahead for long-term care.

• $2,810,000 for Limb Loss, an increase of +$10,000 above the FY 2015 enacted level. 

The Limb Loss program was transferred to ACL from the Centers for Disease Control in 

FY 2015, and supports a national resource center and related activities that provide

comprehensive information and resources to assist individuals and families dealing with 

limb loss.

• $6,700,000 for the Paralysis Resource Center (PRC), the same as the FY 2015 enacted 

level. The PRC was transferred to ACL from the Centers for Disease Control and 

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CONSUMER INFORMATION, ACCESS, AND OUTREACH

Prevention in FY 2014, and provides comprehensive information and referral services for 

people living with paralysis and their families and caregivers. Under ACL’s 

administration the PRC benefits from extensive ties to ACL’s disability networks.

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206 
Aging and Disability Resource Centers

FY 2014 Final

FY 2015 

Enacted

FY 2016 

President's 

Budget

FY 2016 +/- FY 

2015

Discretionary.......... $6,067,000 $6,119,000 $20,000,000 $13,881,000 

Mandatory............. $9,280,000 -- -- --

Total.................... $15,347,000 $6,119,000 $20,000,000 $13,881,000 

FTE...................... 3 -- -- --

Authorizing Legislation: Section 202b of the Older Americans Act of 1965, as amended and 

Section 2405 of the Affordable Care Act, P.L. 111-148. 

FY 2016 Authorization ......................................................................................................... Expired

 

Allocation Method ............................ Competitive Grants/Co-operative Agreements and Contracts

Program Description and Accomplishments:

Aging and Disability Resource Centers (ADRCs) support State efforts to develop more efficient, 

cost-effective, and consumer-responsive systems of information and integrated access by 

creating consumer-friendly entry points into long-term care at the community-level. ADRCs 

grew out of best practice innovations in some states known as “No Wrong Door”136 (NWD) and 

“Single Points of Entry” programs, where people of all ages may turn for objective information 

and one-on-one assistance on their long-term services and support options. Since 2003, the 

Administration for Community Living, along with the Centers for Medicare & Medicaid 

Services (CMS) and most recently the Veterans Health Administration (VHA), have entered into 

cooperative agreements with States to develop the foundational infrastructure for delivering oneon-one person-centered counseling and streamlined access to public programs that make it easier 

for individuals to learn about and access their health and long-term services and support options. 

ACL, CMS, and the VHA are now working with eight ADRC states to build on the lessons 

learned and best practices from prior ADRC investments to develop national standards for a 

“high-performing” NWD system that serves all populations and all payers.

136 In a “No Wrong Door” entry system, multiple agencies retain responsibility for their respective services while 

coordinating with each other to integrate access to those services through a single, standardized entry process that is 

administered and overseen by a coordinating entity (Allison Armor-Garb, Point of Entry Systems for Long-Term 

Care: State Case Studies, prepared for the New York City Department of Aging, 2004).

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CONSUMER INFORMATION, ACCESS, AND OUTREACH

NWD/ADRC systems help States make better use of taxpayer dollars by streamlining access to 

community services and supports (both publicly and privately funded) and diverting individuals 

from more costly forms of care, including institutional care and unnecessary hospital readmissions. These systems are a key component in transforming States’ long-term supports and 

services programs, work which is not only vital, but ongoing. Services for all populations and all 

payers provided by NWD/ADRC systems which highlight the need for continued funding 

include: 

• Targeted discharge planning, care transition and nursing home diversion support that 

integrates the medical and social service systems on behalf of older adults and individuals 

with disabilities to help them remain in their own homes and communities after a 

hospitalization, rehabilitation or skilled nursing facility visit; 

• “One-on-one” person-centered counseling to help consumers, families, and caregivers 

fully understand the options, including private pay, available to them; 

• Streamlined access to publicly-supported long-term care services and support programs 

for individuals who appear to be eligible for such programs; 

• Outreach and assistance to Medicare beneficiaries on their Medicare benefits including 

prevention and low-income subsidies; and, 

• Integrated options counseling and access points to care transition and diversion support 

for Veterans served through the ACL/Department of Veterans Affairs (VA) VeteranDirected Home and Community-Based Services Program partnership.

In November 2014, ACL completed an evaluation of this program, and the final evaluation 

report is available on ACL’s website.

137 The evaluation includes process and outcome studies 

and is designed to produce generalizable outcomes about the degree to which ADRCs are 

meeting their goals of effectively integrating and streamlining access to LTSS. The evaluation 

results will also inform program refinement and continuous quality management. 

With FY 2012 funds, ADRCs responded to more than five million contacts to help individuals 

make better informed decisions about their health and long-term services and support options, 

with the vast majority of these decisions resulting in referrals for community-based services. 

High performing NWD/ADRC systems that serve all populations including Medicaid-eligible 

137 ACL. “National Study of Aging and Disability Resource Centers: Process and Outcome Study Report,” issued 

November 30, 2014. http://www.aoa.acl.gov/Program_Results/docs/ADRCs-final-study-report.pdf. 

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CONSUMER INFORMATION, ACCESS, AND OUTREACH

individuals satisfy one of three statewide system change requirements states must meet in order 

to qualify for enhanced Federal match under the CMS Medicaid Balancing Incentive Program. 

ACL and CMS have invested over $100 million in the ADRC initiative since 2003. As a result 

of these investments: 

• Over 509 ADRC sites have been established across 50 states, two territories, and 

Washington, DC, increasing the coordination and capacity of existing infrastructure in 

the aging, disability and Medicaid networks. Together these ADRC sites can reach 

roughly 77 percent of the U.S. population. 

• 32 States and Territories have achieved statewide coverage, and an additional 5 States 

have achieved 50 percent or more of statewide coverage. 

• 41 states with ADRC programs sites currently conduct care transitions through formal 

interventions across 386 hospitals. To date, the cumulative number of persons who have 

completed a formal care transition program is 16,043. 

• 42 states are actively partnering across ADRC and Money Follows the Person programs. 

The number of states where the ADRC is the Local Contact Agency is 30, with 

274 ADRC program sites performing nursing facility transitions.

Funding History: 

Comparable total funding for Aging and Disability Resource Centers is as follows:

FY 2011 .................................................$16,469,000 

FY 2012 .................................................$16,457,000 

FY 2013 .................................................$15,585,000 

FY 2014 .................................................$15,347,000 

FY 2015 ...................................................$6,119,000 

 

Note: Mandatory appropriations of $10 million for FY 2010 through FY 2014 for ADRCs were made under 

Section 2405 of P.L. 111-148, the Affordable Care Act of 2010. 

Budget Request:

ACL’s FY 2016 request for ADRCs is $20,000,000 in discretionary funding, an increase 

$13,881,000 above the FY 2015 enacted level.

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CONSUMER INFORMATION, ACCESS, AND OUTREACH

ACL hopes to invest $20,000,000 to fund approximately 35 new state grantees to finalize their 

development and operation of sustainable NWD systems based on the national standards 

established by ACL, CMS and the VHA. Funded states will replicate the national standards to 

develop person-centered, conflict-free access system for long-term services and supports for all 

populations and all payers. In addition to the grants to states, funding would be used to support a 

technical assistance contract.

Activities in the 35 states funded by this proposal to develop sustainable NWD systems represent 

a substantial state-wide reform of access to long-term services and supports. Building on past 

ADRC activities, the transformation brought about by this funding will include: 

• Funded state’s program will meet national standards established by ACL, CMS, and 

VHA for NWD Systems and be required to report on its progress and performance using 

Federally prescribed efficiency and consumer outcome measures that align with the 

national standards; 

• Governors of funded states will have to establish a multi-agency governance structure to 

oversee the development, financing and administration of its NWD System, and this 

structure must include the State Unit on Aging, the State Medicaid Agency, State 

Independent Living programs, and the other state agencies responsible for serving the 

people with physical disabilities as well as those with intellectual and developmental 

disabilities;

• Funded states will commit to using Medicaid administrative funding to support the NWD 

infrastructure on an on-going basis; and 

• Funded states will ensure that local NWD sites:

o Include a full range of organizations that play a formal reimbursable role in 

carrying out the NWD functions they have been designated by the state to 

perform to ensure the state’s NWD System can effectively serve all LTSS 

populations; 

o Use nationally certified person-centered counselors to provide one-on-one 

assistance to consumers; and

o Conduct formal functional and financial assessments that are required to 

determine an individual’s eligibility for the public LTSS programs that are

administered by the state, including Medicaid.

Finally, funded states’ NWD systems, including local sites, will use the Federally-prescribed 

reporting data to continually evaluate performance and make improvements in NWD systems at 

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CONSUMER INFORMATION, ACCESS, AND OUTREACH

the state and local site level. Funded states will actively involve consumer stakeholders in this 

process.

Outcome and Outputs Table:

Aging and Disability Resource Centers Outcome and Outputs 

 

Note: For presentation within the budget ACL highlighted specific measures that are most directly related to Aging 

and Disability Resource Centers; however multiple performance outcomes are impacted by this program because 

ACL’s performance measures (efficiency, effective targeting, and client outcomes) assess network-wide 

performance in achieving current strategic objectives.

Resource and Program Data:

Aging and Disability Resource Centers 

(Dollars in thousands) 

Discretionary and Mandatory 

FY 2014 FY 2015 FY 2016

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary 30 5,827 6 4,185 9 10,973

Continuations 9 6,601 9 1,221 15 6,227

Contracts 2 2,283 1 530 2 2,530

Interagency Agreements -- -- -- -- -- --

Program Support /1 636 183 250

Total Resources 15,347 6,119 20,000

1/ Program Support -- Includes funds for salaries, benefits, contract fees, grant systems, and review costs.

Measure Most Recent Result FY 2015 

Target

FY 2016 

Target

FY 2016 

+/- FY 2015

LTC.2: Percent of individuals 

who indicate ADRC information 

and counseling contribute to 

informed decision making 

(Outcome)

FY 2013: 75% 

Target:80%

(Target Not Met)

83% 83% Maintain

Indicator Most Recent Result FY 2015 

Projection

FY 2016 

Projection

FY 2016 

+/- FY 2015

Output AF: Total number of 

ADRC contacts (Output) FY 2013: 4.3 M 4.0 M 4.5 M + 0.5 M

Output AG: Increase in the 

number of ADRC programs 

(Output)

FY 2013: 509 509 509 Maintain

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State Health Insurance Assistance Programs

FY 2014 

Final

FY 2015 

Enacted

FY 2016 

President's 

Budget

FY 2016 +/- 

FY 2015

State Health Insurance 

Assistance Programs...... $52,115,000 $52,115,000 $52,115,000 --

FTE......................... 2 8 8 --

Authorizing Legislation: Section 4360 of the Omnibus Budget Reconciliation Act of 1990 

(42 U.S.C. 1395b-4).

FY 2016 Authorization ......................................................................................................... Expired

Allocation Method ....................................................... Formula and Competitive Grants/Contracts

Program Description and Accomplishments:

The State Health Insurance Assistance Program (SHIP) provides grants to States to fund 

infrastructure, training, and outreach support to over 12,000 (mostly volunteer) counselors in 

over 1,300 community-based organizations in all 50 States, the District of Columbia, Guam, 

Puerto Rico, and the Virgin Islands. Under the direction and support of State program directors 

and trainers, SHIP counselors receive extensive training and continuous ongoing information 

updates about health plan options, Medicare entitlement and enrollment, Medigap, long-term 

care insurance, Medicare Part D prescription drug benefits, preventive benefits, and programs for 

beneficiaries with limited income and resources such as the Medicare Part D Extra Help/LowIncome Subsidy, the Medicare Savings Programs, and Medicaid.

SHIPs provide free, one-on-one counseling and assistance to help aging and disabled Medicare 

and Medicaid beneficiaries as well as coming-of-agers navigate the complexities of health and 

long-term care systems. Services are provided via telephone and face-to-face interactive 

sessions, public education presentations and programs, and media activities. In CY 2013, SHIPs 

had nearly 2.9 million one-on-one client contacts and more than 87,000 Public and Media events. 

SHIP activities align with the objective of developing a comprehensive, coordinated and costeffective system of home and community-based services that helps elderly individuals and 

people with disabilities maintain their health and independence in their homes and communities.

In FY 2014 the SHIP program was transferred from the Centers for Medicare & Medicaid 

Services to the Administration for Community Living. This transfer reflects the natural synergies 

between the SHIP programs and the networks that ACL serves. About two-thirds of the 54 state 

SHIP programs are already administered by State Units on Aging, with most of the remaining 

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CONSUMER INFORMATION, ACCESS, AND OUTREACH

programs administered by State Insurance Commissions. At the community level, many SHIPs 

are either housed in or create local partnerships with Area Agencies on Aging. Similarly, almost 

50 percent of the SHIPs are co-located with the Senior Medicare Patrol program, which is also 

administered by ACL.

SHIP activities complement programs authorized through the Older Americans Act, including 

but not limited to Information and Referral/Assistance (I&R/A), Aging and Disability Resource 

Centers (ADRCs), and Benefits Counseling. SHIPs also have a long history of outreach and 

assistance to underserved populations, including people with limited incomes, under-65 

Medicare beneficiaries with disabilities, dual eligibles, and people with cognitive and/or mental 

disabilities. 

Funding History:

Comparable funding for the State Health Insurance Assistance Program is as follows:

FY 2011 .................................................$52,000,000 

FY 2012 ................................................. $52,115,000 

FY 2013 ................................................. $46,040,000 

FY 2014 ................................................. $52,115,000 

FY 2015 ................................................. $52,115,000 

Budget Request:

The SHIP budget request for FY 2016 is $52,115,000, the same as the level requested in the 

FY 2015 enacted level. This includes funding for 8 FTEs and related administrative expenses to 

administer the program. 

Funds will be used to continue SHIP grants and enable States to continue the personalized 

counseling that they have been providing while making further improvements to better 

streamline the program. Funds will also be used to provide administrative support for the SHIPs 

program, including technical assistance to grantees and management of data systems.

The needs of the over 46 million Americans who depend on Medicare for their health care are 

multifaceted and diverse. More than one-quarter of beneficiaries have cognitive impairments; 

almost one-third have limitations in activities of daily living such as eating and dressing; almost 

one-third have not graduated from high school; and more than one in ten are over 85 years of 

age. These beneficiaries can face any number of difficulties in trying to navigate the health care 

system. Recent and upcoming changes in the system as a result of the Affordable Care Act 

(ACA) will provide opportunities to beneficiaries for improved care, including increased 

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CONSUMER INFORMATION, ACCESS, AND OUTREACH

Medicare preventive services. These opportunities will increase the responsibilities of the SHIP 

counselors in terms of training, outreach and one-on-one counseling. The counselor knowledge 

base will need to include the inter-relationship of Medicare, Early Retiree Insurance Program, 

Pre-Existing Condition Insurance Plan (PCIP), Medicare covered preventive benefits, state 

Medicaid programs, and planning for the State-based Exchanges in addition to other long-term 

care support options that beneficiaries need to remain in the community. 

Research has consistently found that Medicare beneficiaries prefer to receive information about 

Medicare and other supports through one-on-one assistance rather than through other means, 

such as written materials, mass media, and the internet. Given the large number and variety of 

private plan options available in the Medicare program and the new opportunities for 

beneficiaries through the ACA, the type of one-on-one beneficiary counseling and decisions 

support provided by SHIPs is an essential component to the information provided more generally 

through www.Medicare.gov and 1-800-MEDICARE. 

Outcomes and Outputs: 

In CY 2013, SHIPs had over 2.9 million one-on-one client contacts and more than 88,000 Public 

and Media events 

Funds will be used to make SHIP grants to States to continue the personalized counseling that 

they provide and to make further improvements, which are anticipated to include:

• Continuing the number of community outreach and public forums to raise awareness of 

long-term care options including prevention and relevant ACA opportunities. 

• Continuing the number of individual client contacts to individuals on Medicare under the 

age of 65. 

Outcome and Outputs Table:

State Health Insurance Assistance Programs

Indicator Most Recent Result FY 2015 

Projection

FY 2016 

Projection

FY 2016 

+/- FY 2015

Output AH: Number of SHIP 

Public Media Events (Output) FY 2013: 88,084 90,000 95,000 + 5,000

Output AI: Number of SHIP 

Client Contacts (Output) FY 2013: 2,917,918 3 M 3 M Maintain

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CONSUMER INFORMATION, ACCESS, AND OUTREACH

Grant Awards Table:

State Health Insurance Assistance Programs Grant Awards

FY 2014 Final FY 2015 

Enacted

FY 2016 

President’s 

Budget

Number of 

Awards 54 55 55

Average 

Award $925,879 $892,772 $892,772

Range of 

Awards

$44,760 - 

$5,507,717

$44,760 - 

$5,507,717

$44,760 - 

$5,507,717

Resource and Program Data:

State Health Insurance Assistance Program

(Dollars in thousands) 

FY 2014 FY 2015 FY 2016

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary 65 6,553 1 156 54 48,352

Continuations 54 43,905 55 48,736 1 750

Contracts 3 480 3 1,427 3 702

Interagency Agreements 3 968 1 164 1 500

Program Support /1 209 1,632 1,811

Total Resources 52,115 52,115 52,115

1/ Program Support -- Includes funds for salaries, benefits, contract fees, grant systems, and review costs.

216 
Voting Access for Individuals with Disabilities

FY 2014 Final

FY 2015 

Enacted

FY 2016 

President's 

Budget

FY 2016 +/- 

FY 2015

Voting Access for 

People with Disabilities $4,963,000 $4,963,000 $4,963,000 --

Authorizing Legislation: Section 291 of the Help America Vote Act 

FY 2016 Authorization .................................................................................................... Such Sums 

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

Program Description and Accomplishments:

The Voting Access for Individuals with Disabilities program is authorized by the Help America 

Vote Act (HAVA), P.L. 107-252. Funding currently supports Protection and Advocacy (P&A) 

systems in each State and Territory, through formula grants, to ensure full participation in the 

electoral process for individuals with disabilities, including registering to vote, casting a vote, 

and accessing polling places. These funds provide services to individuals with disabilities within 

the State, as well as advocacy for and education about the electoral process and monitoring of the 

accessibility of the electoral process for people with disabilities. Additionally, training and 

technical assistance grants to assist the P&As in their promotion of full participation in the 

electoral process are provided through competitive one-year awards. 

HAVA P&A grantees use funds to promote systematic efforts to ensure individuals with 

disabilities have the opportunity to participate in every step of the electoral process. For 

example, grantees support systems change efforts to improve information on the location of 

accessible polling places, and adopt voting procedures that enable individuals with disabilities to 

vote privately and independently. Grantees also work to educate election officials, poll workers, 

and election volunteers on the rights of voters with disabilities and best practices. P&As provide 

assistance to State and other government entities by surveying polling places, identifying 

potential modifications to make specific polling places accessible, and developing criteria for 

identifying accessible polling places.

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CONSUMER INFORMATION, ACCESS, AND OUTREACH

Through the program, ACL also makes discretionary grants to eligible nonprofit organizations to 

assist P&As in developing proficiency in the use of voting systems, identifying and 

implementing technologies to assist individuals with disabilities in voting, and demonstrating 

and evaluating the use of such systems and technologies. P&As also receive training and 

technical assistance for providing non-visual access in the voting process. These grants are 

authorized under section 291 of HAVA as a seven percent set-aside of the total appropriation for 

P&As. After receiving training and technical assistance, P&As may inform others on the 

availability of accessible voting equipment and its use.

Funding History:

Funding during the last five years has been as follows: 

FY 2011 .................................................$17,375,000 

FY 2012 ...................................................$5,235,000 

FY 2013 ...................................................$4,961,000 

FY 2014 ...................................................$4,963,000 

FY 2015 ...................................................$4,963,000 

Note: FY 2011 was the final year of funding for an additional HAVA formula grant to State Election 

Commissioners. 

Budget Request:

The FY 2016 budget request for Voting Access for Individuals with Disabilities to the Protection 

and Advocacy Systems and related technical assistance is $4,963,000, the same as the FY 2015 

enacted level. 

As an example of the activities undertaken with this funding, in Charleston, SC the P&A 

sponsored a site used by an Election Protection (EP) volunteer attorney to staff a hotline and 

train law student volunteers to canvass polling places in Charleston for accessibility issues. 

Accessibility in voting continues to be an ongoing challenge throughout the country. A 2013 

report by the National Council on Disability identified a 2012 incident in Arizona where a voter 

who used a wheelchair could not get through the front door of her polling place to deliver an 

early ballot. The same report details a complaint from Bladensburg, MD where voters with 

disabilities were told that they had to “prove their disability” in order to be seated in line. 

Additionally, the Maryland P&A had to notify a Montgomery County judge to unlock the 

assigned accessible door to a polling place so that voters with disabilities could enter the 

building. 

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CONSUMER INFORMATION, ACCESS, AND OUTREACH

Being able to participate fully in the election process is a right, not a privilege, and funding for 

this activity helps to ensure that individuals with the full range of disabilities are not denied the 

right to the same opportunity for access and participation in the electoral process as voters with 

no disabilities.

Grant Awards Table:

Voting Access for Individuals with Disabilities Grant Awards

FY 2014 Final FY 2015 

Enacted

FY 2016 

President’s 

Budget

Number of 

Awards 55 55 55

Average 

Award $83,920 $83,920 $83,920

Range of 

Awards

$35,000 - 

$348,401

$35,000 - 

$348,401

$35,000 - 

$348,401

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CONSUMER INFORMATION, ACCESS, AND OUTREACH

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES

FY 2016 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Voting Access for Individuals with Disabilities (CFDA 93.618)

State/Territory

FY 2014

Final

FY 2015 

Enacted

FY 2016 

President’s 

Budget

FY 2016 +/- 

FY 2015

Alabama........................................... 70,000 70,000 70,000 --

Alaska .............................................. 70,000 70,000 70,000 --

Arizona ............................................ 70,000 70,000 70,000 --

Arkansas.......................................... 70,000 70,000 70,000 --

California......................................... 348,401 348,401 348,401 --

Colorado .......................................... 70,000 70,000 70,000 --

Connecticut...................................... 70,000 70,000 70,000 --

Delaware.......................................... 70,000 70,000 70,000 --

District of Columbia ........................ 70,000 70,000 70,000 --

Florida ............................................. 176,919 176,919 176,919 --

Georgia ............................................ 90,851 90,851 90,851 --

Hawaii ............................................. 70,000 70,000 70,000 --

Idaho................................................ 70,000 70,000 70,000 --

Illinois.............................................. 117,917 117,917 117,917 ---

Indiana ............................................. 70,000 70,000 70,000 --

Iowa ................................................. 70,000 70,000 70,000 --

Kansas ............................................. 70,000 70,000 70,000 --

Kentucky.......................................... 70,000 70,000 70,000 --

Louisiana ......................................... 70,000 70,000 70,000 --

Maine............................................... 70,000 70,000 70,000 --

Maryland.......................................... 70,000 70,000 70,000 --

Massachusetts.................................. 70,000 70,000 70,000 --

Michigan.......................................... 90,516 90,516 90,516 --

Minnesota ........................................ 70,000 70,000 70,000 --

Mississippi....................................... 70,000 70,000 70,000 --

Missouri........................................... 70,000 70,000 70,000 --

Montana........................................... 70,000 70,000 70,000 --

Nebraska .......................................... 70,000 70,000 70,000 --

Nevada............................................. 70,000 70,000 70,000 --

New Hampshire ............................... 70,000 70,000 70,000 --

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CONSUMER INFORMATION, ACCESS, AND OUTREACH

PROGRAM/CFDA NUMBER: Voting Access for Individuals with Disabilities (CFDA 93.618)

State/Territory

FY 2014

Final

FY 2015 

Enacted

FY 2016 

President’s 

Budget

FY 2016 +/- 

FY 2015

New Jersey...................................... 81,186 81,186 81,186 --

New Mexico ................................... 70,000 70,000 70,000 --

New York ....................................... 179,233 179,233 179,233 --

North Carolina ................................ 89,314 89,314 89,314 --

North Dakota .................................. 70,000 70,000 70,000 --

Ohio ................................................ 105,727 105,727 105,727 --

Oklahoma ....................................... 70,000 70,000 70,000 --

Oregon ............................................ 70,000 70,000 70,000 --

Pennsylvania................................... 116,894 116,894 116,894 --

Rhode Island................................... 70,000 70,000 70,000 --

South Carolina ................................ 70,000 70,000 70,000 --

South Dakota .................................. 70,000 70,000 70,000 --

Tennessee ....................................... 70,000 70,000 70,000 --

Texas .............................................. 238,662 238,662 238,662 --

Utah ................................................ 70,000 70,000 70,000 --

Vermont.......................................... 70,000 70,000 70,000 --

Virginia........................................... 74,970 74,970 74,970 --

Washington..................................... 70,000 70,000 70,000 --

West Virginia.................................. 70,000 70,000 70,000 --

Wisconsin ....................................... 70,000 70,000 70,000 --

Wyoming ........................................ 70,000 70,000 70,000 -- 

Subtotal, States............................... 4,440,590 4,440,590 4,440,590 --

American Samoa............................. 35,000 35,000 35,000 --

Guam .............................................. 35,000 35,000 35,000 --

Puerto Rico ..................................... 70,000 70,000 70,000 --

Virgin Islands ................................. 35,000 35,000 35,000 --

Subtotal, States and Territories....... 4,615,590 4,615,590 4,615,590 --

Training and Technical Assistance138 347,410 347,410 347,410 --

TOTAL $4,963,000 $4,963,000 $4,963,000 --

138 This line reflects the amount reserved from the HAVA appropriation for statutory related activities, including 

training, technical assistance, grant systems, and review costs

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Assistive Technology

FY 2014 

Final FY 2015 Enacted

FY 2016 

President's 

Budget

FY 2016 +/- 

FY 2015

Assistive Technology $33,000,000 $33,000,000 $31,000,000 ($2,000,000)

Note: In FY 2014 and FY 2015, $2,000,000 was appropriated for an alternative financing program (AFP). In fiscal 

year 2005 Congress amended the Assistive Technology Act to eliminate the separate AFP and establish an AT State 

grant program that requires States to conduct State financing activities, including alternative financing loan 

programs. Since the AFP program is no longer authorized by law, ACL is not requesting funds for it in FY 2016.

Authorizing Legislation: Assistive Technology Act of 1998 

FY 2016 Assistive Technology Act of 1998..................................................................... Expired139

Allocation Method ........................................................................ Competitive and Formula Grants 

Program Description and Accomplishments:

The purpose of the Assistive Technology (AT) Act is to provide States with financial assistance 

that supports programs designed to maximize the ability of individuals with disabilities of all 

ages and their family members, guardians, advocates, and authorized representatives to obtain 

AT devices and AT services. AT devices are defined as any item, piece of equipment, or product 

system, whether acquired commercially, modified, or customized, that is used to increase, 

maintain, or improve functional capabilities of individuals with disabilities. A few examples of 

such devices are computer or technology aids, modified driving controls, and durable medical 

equipment such as wheelchairs or walkers. Grants support comprehensive statewide programs

that are designed to increase the:

• Availability of, funding for, access to, provision of, and training about AT devices and 

services; 

• Ability of individuals with disabilities of all ages to secure and maintain possession of AT 

during periods of transition, such as transition between school or home and home and work; 

• Capacity of public and private entities to provide and pay for AT devices and services; 

• Involvement of individuals with disabilities in decisions about AT devices and services; 

139 The GEPA extension expired September 30, 2011. The Administration proposes to continue funding this 

program in FY 2016 through appropriations language. Up to $1,235,000 may be used for National Activities, unless 

the amount available for AT State grants exceeds $20,953,534, in which case up to $1,900,000 may be used for 

National Activities.

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CONSUMER INFORMATION, ACCESS, AND OUTREACH

• Coordination of AT-related activities among State and local agencies and other private 

entities; 

• Awareness of and facilitate changes in law, regulations, procedures, policies, practices, and 

organizational structures, in order to improve access to AT; and 

• Awareness of the benefits of AT among targeted individuals and entities in the general 

population. 

Assistive Technology (AT) State grant program 

The AT State grant program is a population-based formula grant program to support 

comprehensive statewide programs that maximize the ability of individuals with disabilities of 

all ages to access and acquire AT. States must establish consumer-responsive advisory councils 

with a majority membership of individuals with disabilities who use AT to advise on the 

planning, implementation, and evaluation of these statewide programs. 

Under the formula, States and outlying areas are initially allocated a base amount equal to the 

amount of funds they received under the AT program in fiscal year 2004 (totaling $20,288,534). 

Any funds appropriated in excess of the fiscal year 2004 appropriation are initially distributed 

among the eligible entities with 50 percent of available funds distributed equally amongst them 

and 50 percent distributed according to the population of the State until each entity receives at 

least $410,000. If any appropriated funds remain after each State receives this minimum, they are 

distributed with 20 percent divided equally amongst the States and 80 percent distributed 

according to their populations. To date, appropriated funds under this program have not been at a 

level to necessitate this second round of distribution. The fiscal year 2013 State distributions 

were based on the July 1, 2011 estimates published in December 2011. The fiscal year 2014 

State distributions are based on the July 1, 2012 estimates published on December 20, 2012. The 

fiscal year 2015 State distributions would be based on the July 1, 2013 estimates published on 

December 30, 2013. 

Each State must set measurable goals, with timelines, that address the AT needs of individuals 

with disabilities related to: education (including goals related to the delivery of AT devices and 

services to students receiving services under the Individuals with Disabilities Education Act 

(IDEA)); employment (including goals related to the Rehabilitation Act’s Vocational 

Rehabilitation State Grant program); telecommunications and information technology; and 

community living. The State must determine whether it has met its goals each year. States are 

held accountable for a lack of progress toward these goals through technical assistance, as well 

as corrective actions and/or sanctions if States are determined to be in noncompliance with the 

applicable requirements of the AT Act or have not made substantial progress toward achieving 

the measureable goals. 

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CONSUMER INFORMATION, ACCESS, AND OUTREACH

The State must implement each of the activities required under the program, which include Statelevel activities and State leadership activities. States must spend a minimum of 60 percent 

(unless the State elects to comply with the State flexibility provision in section 4(e)(6) of the AT 

Act, as described below) of their formula grant funds on four State-level activities: State 

financing programs, device reutilization programs, device loan programs, and device 

demonstrations. States may, however, direct their funds towards these activities in varying 

amounts if they use other State or non-Federal funds to support these activities at a comparable 

or greater level. 

States may use up to 40 percent of their AT State grant program funding on State leadership 

activities, with at least 5 percent of that amount devoted to technical assistance and training 

related to transition for students exiting school or adults entering community living. The State 

leadership activities include the provision of technical assistance and training to targeted 

individuals and entities focused on promoting the general awareness of the benefits of AT; skills 

development for persons involved in the assessment of the need for AT; the appropriate 

application of AT; and the integration of AT devices and services in plans required to be 

developed under other Federal laws, such as the IDEA’s Individualized Education Program and 

the Rehabilitation Act’s Individualized Plan for Employment. In addition, States must use a 

portion of their grant funds on public awareness activities, including the continuation and 

maintenance of a statewide system of information and referral, and coordination and 

collaboration activities amongst entities in the States that are responsible for the provision of AT. 

The law provides States with flexibility to decide to carry out only two or three State-level 

activities, rather than all four. If a State elects to carry out two or three State-level activities, it 

must spend a minimum of 70 percent of its funds on those activities, while spending not more 

than 30 percent on the State leadership activities. 

The AT Act specifies what a State must include in its annual progress report, including data on: 

the State’s financing program, device loan program activities, device reutilization programs, and 

device demonstrations, including an analysis of those individuals who benefited from each of 

these programs; training activities; the statewide system of information and referral; and the 

outcomes of any improvement initiatives carried out by the State. The report must also provide 

data on the use of resources, including any contributed to the program by other public and 

private entities, and the level of customer satisfaction. 

Protection and Advocacy for Assistive Technology 

Formula grants for protection and advocacy (P&A) systems established under the Developmental 

Disabilities Assistance and Bill of Rights Act support protection and advocacy services to assist 

individuals with disabilities of all ages in the acquisition, utilization, or maintenance of AT 

services or devices. Funds are distributed on a State population basis, with a minimum annual 

grant of $50,000. Outlying areas must receive not less than $30,000 annually. Also, the Act 

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CONSUMER INFORMATION, ACCESS, AND OUTREACH

requires a minimum award of $30,000 to the P&A system serving the American Indian 

consortium. The fiscal year 2013 State distributions were based on the 

July 1, 2011 estimates published in December 2011. The fiscal year 2014 State distributions are 

based on the July 1, 2012 estimates published on December 20, 2012. The fiscal year 2015 State 

distributions would be based on the July 1, 2013 estimates published on December 30, 2013. 

National Activities 

The AT Act provides authority for the provision of technical assistance—through grants, 

contracts, or cooperative agreements awarded on a competitive basis—to individuals with 

disabilities of all ages, to AT State grant program grantees, and to protection and advocacy 

systems. The AT Act also requires the Secretary to make an award to renovate, update, and 

maintain a national public Internet site (http://www.assistivetech.net). In addition, the AT Act 

includes authority for grants, contracts, or cooperative agreements to assist grantees in 

developing and implementing effective data collection and reporting systems.

In designing technical assistance activities, input from directors of AT State grant programs and 

Alternative Financing programs, individuals with disabilities who use AT, family members, and 

protection and advocacy service providers, among others is considered. The technical assistance 

must respond to specific requests for information and disseminate information to States, entities 

funded under the AT Act, and any other public entities that seek information about AT. The 

technical assistance must provide model approaches for the removal of barriers to accessing AT, 

examples of effective program coordination, and practices that increase funding for AT devices. 

Funding History:

Funding for Assistive Technology during the past five years is as follows: 

FY 2011 .................................................$30,898,000 

FY 2012 .................................................$32,836,000 

FY 2013 .................................................$31,118,000 

FY 2014 .................................................$33,000,000 

FY 2015 .................................................$33,000,000 

Budget Request:

ACL’s FY 2016 budget request for Assistive Technology (AT) programs is $31,000,000, a 

decrease of -$2,000,000 below the FY 2015 enacted level. The request does not include funds for 

an alternative financing program (AFP), a one-year competitive grant program that was 

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CONSUMER INFORMATION, ACCESS, AND OUTREACH

authorized through appropriations language in both FY 2014 and FY 2015. In fiscal year 2005 

Congress amended the AT Act to eliminate the separate AFP and establish an AT State grant 

program that requires States to conduct State financing activities, including alternative financing 

loan programs. Since the AFP program is no longer authorized by law, ACL is not requesting 

funds for it in FY 2016. 

Funding is requested for the AT State grant program, the Protection and Advocacy for Assistive 

Technology program, and National Activities. These programs enable individuals with 

disabilities to acquire technology they might not otherwise be able to obtain—technology that 

improves their quality of life, and in many cases, enables them to work or participate in other 

productive endeavors. 

Assistive Technology (AT) State grant program 

The request includes $25.704 million for the AT State grant program, the same as the fiscal year 

2015 level. These funds will be used by States to carry out the second year of their 3-year State 

plan. State plans must describe how the State intends to carry out its AT State grant program to 

meet the AT needs of individuals with disabilities in the State, achieve the measurable goals 

required by the AT Act, and comply with all applicable statutory and regulatory requirements. 

Protection and Advocacy for Assistive Technology 

The fiscal year 2016 President’s Budget includes $4.3 million for the Protection and Advocacy 

for Assistive Technology (PAAT) program, the same as the fiscal year 2015 enacted level. At 

this level, 28 States would receive $50,000, the minimum amount allowed under the AT Act for 

the protection and advocacy systems established under the Developmental Disabilities 

Assistance and Bill of Rights Act to carry out this program. Outlying areas each would receive 

$30,000. Funds would be used to assist individuals with disabilities of all ages in the acquisition, 

utilization, or maintenance of AT services or devices. 

National Activities 

The fiscal year 2016 President’s Budget also includes $996,000 for National Activities, the same 

as the fiscal year 2015 enacted level. The Act requires support for State training, technical 

assistance, data collection, and reporting assistance, and authorizes a one-time grant to provide 

national public awareness about AT, and support for AT research and development activities. To 

support these activities, RSA competitively awards 3 grants. In fiscal year 2016, funds would be 

used for 2 new competitions in order to award a grant for State training and technical assistance, 

and a grant award for the AT Act informational website. Funds would also be used to continue 

support for the AT Act data collection activities in fiscal year 2016.

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CONSUMER INFORMATION, ACCESS, AND OUTREACH

Output Table:

ACL will work with all relevant parties to review, develop, or refine performance measures and 

performance data collection for all WIOA programs during the transition.

228 
National Clearinghouse for Long-Term Care Information

FY 2014 

Final

FY 2015 

Enacted

FY 2016 President's 

Budget

FY 2016 +/- FY 

2015

National Clearinghouse for Long-Term 

Care Information... -- -- $1,000,000 $1,000,000

Authorizing Legislation: Section 6021(d) of the Deficit Reduction Act of 2005 (P.L. 106-224). 

FY 2016 Authorization ......................................................................................................... Expired

Allocation Method ............................................................................................................... Contract

Program Description and Accomplishments:

The National Clearinghouse for Long-Term Care Information (Clearinghouse) provides 

objective information on how to plan ahead for a person’s long-term care needs. First authorized 

by the Deficit Reduction Act of 2005, the Clearinghouse educates consumers about public and 

private options available to plan and pay for long-term care. Beginning with the “Own Your 

Future” direct mail campaign in 2005, the Clearinghouse has progressed toward a state-of-the-art 

strategy using broadcast and social media to direct consumers to a web site containing objective 

information on how to plan ahead for long-term care. 

The American Taxpayer Relief Act repealed Title VIII of the Affordable Care Act, which 

included the mandatory funding for the Clearinghouse, save for amounts obligated through 

January 3, 2013. However, the Clearinghouse pre-dates the Affordable Care Act and has a 

separate and important purpose. Accordingly, ACL is continuing to request discretionary funding 

to continue the Clearinghouse’s important educational and informative mission. Clearinghouse 

initiatives will include an ongoing evaluation of both website content and outreach strategy and a 

more robust social media presence. 

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CONSUMER INFORMATION, ACCESS, AND OUTREACH

Funding History:

Funding for the past 5 years is as follows: 

FY 2011 1/ ...............................................$3,000,000 

FY 2012 ...................................................$3,000,000 

FY 2013 2/ ....................................................$85,523 

FY 2014 .................................................................$0 

FY 2015 .................................................................$0 

1/ Prior to FY 2012, funding for this activity was administered by CMS. 

2/ Reflects obligations prior to January 3, 2013 when funding was rescinded.

Budget Request:

The FY 2016 Request for the National Clearinghouse on Long-Term Care is $1,000,000, an 

increase of +$1,000,000 above the FY 2015 enacted level. 

The need for a comprehensive, objective, and easy-to-use source for information on long-term 

care has never been greater. As Americans live longer lives, their need to plan for their long-term 

care increases dramatically. Approximately 70 percent of Americans over age 65 will require 

some type of long-term services and supports.140 Costs for this care can range from $19,000 per 

year for a home health aide to assist three times per week to $83,585 per year for nursing home 

care.

141 Many consumers are not aware that Medicare does not cover long-term care needs, 

placing recipients of this care at high risk of spend-down to Medicaid. Americans need a reliable 

source of information about these costs and how to plan for and afford them, and the 

415,039 visits to the site recorded during the last 9 months of 2012 indicate that there is a strong 

demand for this information. 

In addition to the costs of operating the website, this request also supports activities designed to 

raise awareness of and direct traffic to the website. These activities include digital banner 

advertisements and search engine optimization, with extensive market research determining how 

best to reach prospective consumers. Additionally, as the Clearinghouse has grown, the amount 

of information can seem overwhelming. The web site now features a decision tool to provide 

streamlined calls to action and related information. Longtermcare.gov is now the first organic 

search result in a Google search on the term “long-term care.” Continued funding will ensures 

that consumers will find objective information on how best to prepare for long-term care. 

140 http://www.longtermcare.gov/LTC/Main_Site/Understanding/Definition/How_Much.aspx 141 http://www.longtermcare.gov/LTC/Main_Site/Paying/Costs/Index.aspx

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CONSUMER INFORMATION, ACCESS, AND OUTREACH

Resource and Program Data:

National Clearinghouse for Long-Term Care Information

(Dollars in thousands) 

FY 2014 FY 2015 FY 2016

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary -- -- -- -- -- --

Continuations -- -- -- -- -- --

Contracts -- -- -- -- 1 985

Interagency Agreements -- -- -- -- -- --

Program Support 1/ -- -- 15

Total Resources -- -- 1,000

1/ Program Support -- Includes funds for salaries and overhead and information technology support costs.

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Alzheimer’s Disease Initiative - Outreach Campaign

FY 2014 Final

FY 2015 

Enacted

FY 2016 

President's 

Budget

FY 2016 +/- FY 

2015

Alzheimer’s Disease 

Initiative – Outreach 

(Prevention Fund)

$4,200,000 $4,200,000 $4,200,000 --

Note: Funding in FY 2014 and FY 2015 was provided from the Prevention and Public Health Fund, and FY 2016 

funding is requested from the same source.

Authorizing Legislation: Section 411 of the Older Americans Act of 1965, as amended, and the 

Patient Protection and Affordable Care Act (ACA), Section 4002 [42 U.S.C. 300u-11] 

FY 2016 Authorization ......................................................................................................... Expired

Allocation Method ............................................................................................................. Contracts

Program Description and Accomplishments:

On January 4, 2011, the President announced a new effort to fight Alzheimer’s disease, and in 

FY 2012, ACL received $4,000,000 in initial funding from the Prevention and Public Health 

Fund to begin a public awareness Alzheimer’s Disease Outreach Campaign. According to one 

study, approximately 5 million American’s are currently battling Alzheimer’s, and nearly half a 

million new cases develop each year.142 With the prevalence of this disease growing, public 

awareness is a critical component of a larger effort to effectively educate Americans who are at 

risk or who care for someone at risk of developing this disease. 

During the first year of the Campaign, a new website (alzheimers.gov) was launched and a 

variety of outreach materials were developed. Going forward, ACL will continue to promote the 

new website to caregivers and associated organizations using materials already developed. 

Future efforts will feature Public Service Announcements instead of the paid media approach 

taken previously. Given the success of the television spot (awards from a health care and an 

advertising organization) this approach may reach a new and broader audience. 

The campaign’s goal is to inform people caring for people with Alzheimer’s disease that there

are federal, state, local, and nonprofit resources available to help them. The campaign highlights 

the alzheimers.gov website and deploys television, radio and print advertisements as well as 

search engine optimization and advertisements on specific web sites. Traffic to the new web site 

142 Alzheimer’s Association, (2011). “Alzheimer’s Disease Facts and Figures”., p. 17 and p. 34. Accessed August 

30, 2011 from: http://www.alz.org/alzheimers_disease_facts_figures.asp

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CONSUMER INFORMATION, ACCESS, AND OUTREACH

will be studied to determine what information care givers appear to value most and to adjust 

outreach strategies accordingly. 

Funding History:

FY 2011 .................................................................$0 

FY 2012 ...................................................$4,000,000 

FY 2013 ......................................................$150,000 

FY 2014 ...................................................$4,200,000 

FY 2015 ...................................................$4,200,000 

Budget Request: 

The FY 2016 budget includes $4,200,000 in funding for the Alzheimer’s Disease Initiative 

Outreach Campaign from the Prevention and Public Health Fund (PPHF) under the Affordable 

Care Act, the same as the amount requested from the Fund in FY 2015. 

As recommended by the Clinical Care Subcommittee of the President’s Advisory Council on 

Alzheimer’ Research, Care, and Services, the majority of the funds will be used to launch a new 

awareness campaign for older adults with memory or other brain health problems. The campaign 

will seek to reduce the cultural stigma associated with Alzheimer’s disease and encourage older 

adults who are experiencing memory or other brain health problems to seek an early diagnosis 

from their doctor. Funding for FY 2016 will focus on expanding the new campaign to subpopulations that may not have been reached in prior years, which may require development of 

specific outreach materials and further analysis to determine if content and messaging are 

culturally competent.

A small portion of the funds will be used to maintain and develop the Caregivers campaign 

initially developed in 2012. These funds will be used to update the information currently 

available on the alzheimers.gov web site. Content on the web site will be refreshed and enhanced 

through a panel of subject matter experts. 

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CONSUMER INFORMATION, ACCESS, AND OUTREACH

Resource and Program Data:

Alzheimer’s Disease Initiative – Outreach Campaign

(Dollars in thousands) 

FY 2014 FY 2015 FY 2016

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary -- -- -- -- -- --

Continuations -- -- -- -- -- --

Contracts 2 4,102 2 4,058 2 4,058

Interagency Agreements -- -- -- -- -- --

Program Support /1 98 142 142

Total Resources 4,200 4,200 4,200

1/ Program Support -- Includes funds for overhead, grant systems and review costs, and information 

technology support costs.

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Limb Loss Resource Center

FY 2014 Final

FY 2015 

Enacted

FY 2016 

President's 

Budget

FY 2016 +/- 

FY 2015

Limb Loss Resource 

Center $2,810,000 $2,800,000 $2,810,000 $10,000 

Note: This program was funded at CDC through FY 2014 and was transferred to ACL in FY 2015. 

Authorizing Legislation: Public Health Service Act Section 301 (a) and Section 317, as 

amended, 42U.S.C. 241 (a); 42 U.S.C. 247 (b) 

Allocation Method ............................................................................................... Competitive Grant

Program Description and Accomplishments:

Approximately 185,000 amputations occur in the United States each year143, and hospital costs 

associated with amputation total more than $8.3 billion annually144. The Limb Loss program 

seeks to improve the health of people with limb loss (PWLL) and promote their well-being, 

improve quality of life, prevent disease, reduce unnecessary medical expenditures, and provide 

support to their families and caregivers. 

Limb loss is the loss of all or part of an arm or leg due to trauma, infection, diabetes, heart 

diseases, cancer or other diseases. Approximately 2 million adults living in the U.S have limb 

loss, and approximately 58% of people living with limb loss are 65 or older145. The main causes 

of limb loss are vascular disease (54%) – including diabetes and peripheral arterial disease – 

trauma (45%) and cancer (less than 2%). The number of people with limb loss is expected to 

double by 2050, largely due to the rise of diabetes.146

The Limb Loss Program supports a national resource center and related activities that provides 

comprehensive information and resources to assist individuals and families dealing with Limb 

Loss. Program accomplishments also include a nationwide awareness campaign, highlighted by 

143 Owings M, Kozak LJ, National Center for Health S. Ambulatory and Inpatient Procedures in the United States, 

1996. Hyattsville, Md.: U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, 

National Center for Health Statistics; 1998

144 HCUP Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). Rockville, MD: 

Agency for Healthcare Research and Quality; 2009.

145 Ziegler-Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R. Estimating the Prevalence of 

Limb Loss in the United States: 2005 to 2050. Archives of Physical Medicine and Rehabilitation, 2008;89(3):422-9 

146 HCUP Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). In. Rockville, MD: 

Agency for Healthcare Research and Quality; 2009.

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CONSUMER INFORMATION, ACCESS, AND OUTREACH

Limb Loss Awareness Month in April. In 2012, 40 state governors acknowledged April as Limb 

Loss Awareness Month and President Obama recognized Limb Loss Awareness Month in a 

letter addressed to the public.

Funding History:

Funding for the program during the last five years has been as follows: 

FY 2011 ...................................................$2,836,000 

FY 2012 ...................................................$2,820,000 

FY 2013 ...................................................$2,788,000 

FY 2014 ...................................................$2,810,000 

FY 2015 ...................................................$2,800,000 

Note: This program was funded at CDC through FY 2014 and transferred to ACL in FY 2015. 

Budget Request: 

The FY 2016 request is $2,810,000; an increase of +$10,000 above the FY 2015 enacted level. In 

FY 2014, limb loss funding supported the National Limb Loss Resource Center through a grant 

to the Amputee Coalition. The National Limb Loss Resource Center offers, at no cost, resources 

for people with limb loss, their families, friends, and the health care professionals involved in 

their lives. With the help of this information, people with limb loss can choose the best available 

options, discuss these options with their healthcare providers and caregivers, and plan for their 

future.

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CONSUMER INFORMATION, ACCESS, AND OUTREACH

Resource and Program Data:

Limb Loss Resource Center

(Dollars in thousands) 

FY 2014 FY 2015 FY 2016

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary -- -- -- -- 1 2,740

Continuations 1 2,100 1 2,730 -- --

Contracts -- -- -- -- -- --

Interagency Agreements -- -- -- -- -- --

Program Support 1/ 710 70 70

Total Resources 2/ 2,810 2,800 2,810

1/ Program Support -- Includes funds for Public Health Service Act statutory requirements, grant systems and review 

costs.

2/ Funding for this program was provided to the Centers for Disease Control and Prevention in FY 2014. It was 

transferred to ACL in FY 2015.

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Paralysis Resource Center

FY 2014 Final

FY 2015 

Enacted

FY 2016 

President's 

Budget

FY 2016 +/- 

FY 2015

Paralysis Resource 

Center $6,683,000 $6,700,000 $6,700,000 --

Authorizing Legislation: Sections 311 and 317(k)(2) of the Public Health Service Act [42 U.S.C. 

243 & 247b(k)(2)], as amended. 

Allocation Method ............................................................................................... Competitive Grant

Program Description and Accomplishments:

The Paralysis Resource Center (PRC) promotes the health and well-being of people living with 

paralysis and supports their families and caregivers by providing comprehensive information and 

referral services. The PRC seeks to bridge a wide information gap experienced not only by 

newly-paralyzed individuals, but also by those who have lived for some time with paralysis. This 

information promotes better health, encourages community involvement, and improves quality of 

life.

The PRC provides information specialists fluent in English and Spanish to answer paralysisrelated questions via a toll-free phone call or email. The PRC also operates an information 

clearinghouse that provides access to a variety of paralysis-related publications. Additionally, the 

PRC publishes and distributes a free Paralysis Resource Guide, as well as informational videos 

and training materials.

The PRC is operated via a cooperative agreement, currently with the Christopher and Dana 

Reeve Foundation. The Reeve Foundation is supported in its operation of the PRC by a network 

of 40 members of its “Paralysis Task Force.” This task force is united in meeting the needs of 

people living with paralysis via research, information-gathering and dissemination, and advocacy 

efforts. The current cooperative agreement runs through May 2015. 

With the formation of ACL, HHS has a new operating division focused on maximizing the 

independence, well-being, and health of older adults, people with disabilities, and their families 

and caregivers. Due to the natural synergies with the aims of the PRC, in FY 2014 funding and 

administrative responsibilities for the PRC were transferred from the Centers for Disease Control 

and Prevention to ACL. Under ACL, the PRC will benefit from extensive ties to ACL’s 

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CONSUMER INFORMATION, ACCESS, AND OUTREACH

disability networks and will provide a valuable source of information as ACL continues to 

strengthen its policy and advocacy efforts in the field of disabilities. 

Funding History:

Funding for the program during the last five years has been as follows: 

FY 2011 ...................................................$5,800,000 

FY 2012 ...................................................$6,700,000 

FY 2013 ...................................................$6,352,000 

FY 2014 ...................................................$6,683,000 

FY 2015 ...................................................$6,700,000 

Note: This program was funded at CDC through FY 2013 and was transferred to ACL in FY 2014. Funding at CDC 

included both grant and administrative funds. For comparability purposes, since ACL has been appropriated 

administrative funding for this program within its Program Administration line, only grant funding amounts are 

displayed.

Budget Request: 

The FY 2016 request is $6,700,000, the same as the FY 2015 enacted level. The work done by 

the PRC is vital for the support of the 6 million Americans currently living with paralysis. The 

average age of those reporting that they are paralyzed is 52 years old, and the average person 

reports having been paralyzed for 15.6 years.147 Providing information, resources, and support to 

these individuals and their families is critical in avoiding adverse secondary health outcomes 

such as depression, infection, chronic pain issues, and upper extremity problems, all of which 

can seriously degrade quality of life and increase medical costs.

147http://www.christopherreeve.org/site/c.mtKZKgMWKwG/b.5184241/k.ACBD/Average_age_average_length_of_

time_since_paralysis_and_SCI.htm

242 

 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

Resource and Program Data:

Paralysis Resource Center

(Dollars in thousands) 

FY 2014 FY 2015 FY 2016

Final Enacted President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary -- -- 1 6530 -- --

Continuations 1 6,590 -- -- 1 6,530

Contracts -- -- -- -- -- --

Interagency Agreements -- -- -- -- -- --

Program Support 1/ 93 170 170

Total Resources 2/ 6,683 6,700 6,700

1/ Program Support -- Includes funds for Public Health Service Act statutory requirements, grant systems and review 

costs.

2/ Funding for this program was provided to the Centers for Disease Control and Prevention in FY 2013. It was 

transferred to ACL in FY 2014.

243
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Program Administration

FY 2014 Final

FY 2015 

Enacted

FY 2016 

President's 

Budget

FY 2016 +/- 

FY 2015

Program Administration $37,476,000 $37,709,000 $40,063,000 $2,354,000

FTE148........................ 181 191 198 +7

Note: Funding and FTEs for FY 2014 include estimated comparable funding for programs transferred to ACL from 

the Department of Education by the Workforce Innovation and Opportunity Act. Funding for FY 2015 includes the 

estimated annualized amount transferred to ACL for program administration, based on a determination order 

between the Department of Education and ACL. For FY 2016, ACL is requesting these funds directly.

Authorizing Legislation: Older Americans Act of 1965 (OAA), the Developmental Disabilities 

Assistance and Bill of Rights Act (DD Act), the Help America Vote Act (HAVA), the Assistive 

Technology Act of 1998, the Rehabilitation Act of 1973, the Public Health Services Act (PHSA), 

the Elder Justice Act (EJA), the Medicare Improvements for Patients and Providers Act 

(MIPPA), and the Omnibus Budget and Reconciliation Act of 1990. 

FY 2016 Authorization ............................................................................... See Program Narratives 

Allocation Method ....................................................................................... Direct Federal/Contract

Program Description and Accomplishments:

In FY 2012, the Administration for Community Living (ACL) was created by bringing together 

three existing entities: the Administration on Aging (AoA), an HHS operating division; the 

Administration on Developmental Disabilities (AIDD), then a part of the Administration for 

Children and Families (ACF); and the Office of Disability (OD), then a part of the HHS Office 

of the Secretary (OS). In FY 2014, Congress for the first time provided a consolidated Program 

Administration appropriation for ACL. (In prior years, funding was provided through a 

combination of direct appropriations to AoA and transfers from ACL’s predecessor agencies). 

The FY 2014 appropriation also transferred the State Health Insurance Assistance Program 

(SHIP) and the Paralysis Resource Center program to ACL. Later in 2014, as part of the 

148 FTE numbers above for Program Administration only reflect those FTE funded from the Program Administration 

budget line. Not included are reimbursable FTE supported with HCFAC funds (7 FTE in 2014 and 8 FTE in each of 

FY 2015-FY 2016) and CMS CMMI funds (2 FTE in FY 2014 and 3 FTE in FY 2015-FY 2016); ADRC FTE 

supported with mandatory funds (3 in FY 2014); or FTE funded by programs (SHIP funds--2 FTE in FY 2014 and 8 

FTE in each of FY 2015-FY 2016; Elder Justice-2 in FY 2015 and 4 in FY 2016). These FTE are included in the 

appropriate narrative tables in other sections of this document. 

245 

 
PROGRAM ADMINISTRATION

Workforce Innovation and Opportunity Act (WIOA), Congress transferred three complementary 

Department of Education programs—Independent Living, Assistive Technology, and the 

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

to ACL. This budget incorporates resources that have been transferred from the Department of 

Education to ACL to support the ongoing operation of these programs. 

Program Administration funds the direction and support of ACL programs established under the 

Older Americans Act (OAA), the Developmental Disabilities Assistance and Bill of Rights Act 

(DD Act), the Help America Vote Act (HAVA), the Assistive Technology Act of 2004, the 

Rehabilitation Act of 1973, the Public Health Services Act (PHSA), the Elder Justice Act, the 

Medicare Improvements for Patients and Providers Act (MIPPA), and the Omnibus Budget and 

Reconciliation Act (OBRA) of 1990. The majority of these funds cover pay, rent and security 

and external shared services, all of which are relatively fixed in the short term. ACL’s 

appropriation also includes language that allows Program Administration funds to be used for 

Department-wide coordination of policy and program activities that assist individuals with 

disabilities (consistent with the role previously performed by the Office of Disability), as ACL’s 

Principal Deputy Administrator also serves as the Secretary’s Senior Advisor on Disability 

Policy. 

In FY 2015, Program Administration funding will support 191 of ACL’s 212 FTE in both central 

office and in ACL’s regional offices. Forty-six of these FTE represent the annualized level of 

FTE expected to provide program and administrative support for the three programs the Work 

Innovations and Opportunity Act transferred to ACL. Other sources of funding for ACL FTE 

included staff charged to program and reimbursable funding sources such as Elder Justice, 

Health Care Fraud and Abuse Control, and the State Health Insurance Assistance Program. 

246 
PROGRAM ADMINISTRATION

Funding History:

Funding for ACL Program Administration since the agency’s creation in FY 2012 is as follows: 

FY 2012 $29,558,000 145 FTE*

FY 2013 $28,064,000 135 FTE*

FY 2014 $37,476,263 181 FTE**

FY 2015 $37,709,263 191 FTE**

* Funding for FY 2012 and FY 2013 reflects actual funding and FTEs provided to ACL for Program Administration, 

not comparably adjusted for programs transferred to ACL from the Department of Education by the Workforce 

Innovation and Opportunity Act (WIOA).

** Funding and FTEs for FY 2014 includes estimated comparable funding for programs transferred by WIOA. 

Funding for FY 2015 includes the estimated annualized amount transferred to ACL for program administration, 

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

these funds directly.

Budget Request:

The FY 2016 request for Program Administration is $40,063,000, an increase of +$2,354,000 

over the comparably adjusted FY 2015 enacted level. Of this increase, +$1,354,000 is needed to 

bring direct and administrative support staff for WIOA programs to 53 FTE and to provide the 

full level of administrative support these three new programs require. This includes an increase 

in salaries and benefits related to new FTE of $500,000, an increase of $290,000 for internal 

program IT needs, and an increase of $564,000 for additional shared/external services costs. 

The remaining increase of $1,000,000 is needed for other ACL administrative needs. These 

include approximately $850,000 to cover the increased rent costs that will result from the 

relocation of ACL’s Headquarters to the Switzer Building in the HHS Southwest complex. This 

increase reflects partial amortization of relocation costs through loan vehicles offered by the 

General Services Administration (GSA), which are repaid by tenants as part of their annual rent 

costs. The $850,000 increase will support the repayment of the Federal Acquisition Service 

(FAS) loans for furniture ($368,000) and for information technology and audiovisual equipment 

($352,000) as well the GSA Consolidation Fund loan ($130,000) for construction and build out. 

The remaining increase would be applied to the 1.3% FY 2016 pay raise. 

ACL Headquarters Lease Renewal Process

The ten-year lease on ACL’s headquarters space ended on September 30, 2012, although ACL 

continues to occupy the same space under a temporarily extended lease at a higher monthly cost until 

renovations to the Mary E. Switzer building are complete. ACL is working with the HHS Facilities 

and Logistics Service (FLS) to refine the schedule and milestones and to ensure that cost estimates 

247
PROGRAM ADMINISTRATION

are sufficient to cover all costs associated with the transition to Switzer, including build-out, moving, 

and rent. ACL’s move is now estimated to occur in the Summer of 2015. 

 

248
SUPPLEMENTARY TABLES

Budget Authority by Object Class

Object Classification - Direct

Administration for Community Living

(Dollars in Thousands)

FY 2015

Base

FY 2016 

Request

FY 2016 +/- 

FY 2015

Personnel compensation:

Full-time permanent (11.1).................................................. 18,291 24,174 5,883

Other than full-time permanent (11.3)............................... 2,305 3,010 705

Other personnel compensation (11.5)............................... 198 261 64

Military personnel (11.7)..................................................... -- -- --

Special personnel services payments (11.8).................... -- -- --

Subtotal personnel compensation................................ 20,794 27,446 6,652

Civilian benefits (12.1)............................................................. 6,014 7,965 1,950

Military benefits (12.2)............................................................ -- -- --

Benefits to former personnel (13.0)...................................... -- -- --

Total Pay Costs........................................................................ 26,808 35,411 8,603

Travel and transportation of persons (21.0)........................ 567 781 214

Transportation of things (22.0).............................................. 4 5 2

Rental payments to GSA (23.1).............................................. 2,165 3,432 1,267

Rental payments to Others (23.2).......................................... -- -- --

Communication, utilities, and misc. charges (23.3)............. 475 485 10

Printing and reproduction (24.0)............................................ 15 16 1

Other Contractual Services:

Advisory and assistance services (25.1)......................... 15,991 28,287 12,296

Other services (25.2)............................................................ 800 2,414 1,614

Purchase of goods and services from

government accounts (25.3)........................................... 4,961 5,884 923

Operation and maintenance of facilities (25.4)................ 81 84 3

Research and Development Contracts (25.5).................. -- -- --

Medical care (25.6)............................................................... -- -- --

Operation and maintenance of equipment (25.7)............ 4 4 --

Subsistence and support of persons (25.8)..................... -- -- --

Subtotal Other Contractual Services.......................... 21,837 36,673 14,836

Supplies and materials (26.0).................................................. 77 89 12

Equipment (31.0)...................................................................... 46 47 1

Land and Structures (32.0) .................................................... -- -- --

Investments and Loans (33.0)................................................ -- -- --

Grants, subsidies, and contributions (41.0)......................... 1,814,974 1,974,268 159,294

Interest and dividends (43.0)................................................. -- -- --

Refunds (44.0).......................................................................... -- -- --

Total Non-Pay Costs............................................................... 1,840,160 2,015,796 175,636

Total Budget Authority by Object Class............................. 1,866,968 2,051,207 184,239

249
SUPPLEMENTARY TABLES

Salaries and Expenses

Administration for Community Living

(Dollars in Thousands) 

FY 2015 

Enacted

FY 2016 

Budget

FY 2016 +/- 

FY 2015

Personnel compensation:

Full-time permanent (11.1).................................. 18,291 24,174 5,883

Other than full-time permanent (11.3)................... 2,305 3,010 705

Other personnel compensation (11.5).................. 198 261 64

Military personnel (11.7)..................................... -- -- --

Special personnel services payments (11.8)......... -- -- --

Subtotal personnel compensation................ 20,794 27,446 6,652

Civilian benefits (12.1)........................................... 6,014 7,965 1,950

Military benefits (12.2)........................................... -- -- --

Benefits to former personnel (13.0)........................ -- -- --

Total Pay Costs................................................... 26,808 35,411 8,603

Travel and transportation of persons (21.0).............. 567 781 214

Transportation of things (22.0)................................ 4 5 2

Rental payments to GSA (23.1)............................. 2,165 3,432 1,267

Rental payments to Others (23.2)........................... -- -- --

Communication, utilities, and misc. charges (23.3).. 475 485 10

Printing and reproduction (24.0).............................. 15 16 1

Other Contractual Services:

Advisory and assistance services (25.1)............... 15,991 28,287 12,296

Other services (25.2).......................................... 800 2,414 1,614

Purchase of goods and services from

government accounts (25.3)............................. 4,961 5,884 923

Operation and maintenance of facilities (25.4)....... 81 84 3

Research and Development Contracts (25.5)........ -- -- --

Medical care (25.6)............................................ -- -- --

Operation and maintenance of equipment (25.7)... 4 4 --

Subsistence and support of persons (25.8)........... -- -- --

Subtotal Other Contractual Services............ 21,837 36,673 14,836

Supplies and materials (26.0)................................. 77 89 12

Total Non-Pay Costs........................................... 25,140 41,481 16,341

Total Salary and Expense.................................. 51,948 76,892 24,944

Direct FTE........................................................... 193 202 9

250 
SUPPLEMENTARY TABLES

Detail of Full-Time Equivalent Employment (FTE)

Administration for Community Living

2014 

Actual 

Civilian 

2014 

Actual 

Military

2014 

Actual 

Total

2015 

Est. 

Civilian

2015 

Est. 

Military

2015 

Est. 

Total

2016 

Est. 

Civilian

2016 

Est. 

Military

2016 

Est. 

Total

Immediate Office of the .......................

 Administrator...................................

 Direct:.............................................. 45 45 50 50 56 56

 Reimbursable:................................... 0 0 0 0 0 0

 Total:............................................. 45 0 45 50 0 50 56 0 56

Administration on Aging.......................

 Direct:.............................................. 23 23 25 25 25 25

 Reimbursable:................................... 0 0 0 0 0 0

 Total:............................................. 23 0 23 25 0 25 25 0 25

Administration on Intellectual................

 & Developmental Disabilities..............

 Direct:.............................................. 20 20 21 21 21 21

 Reimbursable:................................... 0 0 0 0 0 0

 Total:............................................. 20 0 20 21 0 21 21 0 21

Center for Policy and ..........................

 Evaluation........................................ 

 Direct:.............................................. 23 23 24 24 25 25

 Reimbursable:................................... 0 0 0 0 0 0

 Total:............................................. 23 0 23 24 0 24 25 0 25

Center for Management and .................

 Budget............................................ 

 Direct:.............................................. 34 34 38 38 39 39

 Reimbursable:................................... 1 1 1 1 1 1

 Total:............................................. 35 0 35 39 0 39 40 0 40

Center for Consumer Access ...............

 and Self Determination......................

 Direct:.............................................. 10 10 11 11 12 12

 Reimbursable:................................... 9 9 12 12 12 12

 Total:............................................. 19 0 19 23 0 23 24 0 24

Office of Regional Operations................

 Direct:.............................................. 26 26 26 26 26 26

 Reimbursable:................................... 4 4 4 4 4 4

 Total:............................................. 30 0 30 30 0 30 30 0 30

FTE Total........................................... 195 0 195 212 0 212 221 0 221

Average GS Grade

FY 2012............................................. 12.8

FY 2013............................................. 12.9

FY 2014............................................. 13.0

FY 2015............................................. 12.9

FY 2016............................................. 12.9

251 
SUPPLEMENTARY TABLES

Detail of Positions

Administration for Community Living

2014

 Actual

2015

Enacted

2016

Budget

Executive level I ..............................

Executive level II..............................

Executive level III ............................

Executive level IV............................. 1 1 1

Executive level V.............................

Subtotal ......................................

Total - Exec. Level Salaries $155,500 $155,947 $155,947

ES-6...............................................

ES-5............................................... 2 2 2

ES-4............................................... 2 2 2

ES-3............................................... 2 2 2

ES-2............................................... 1 1 1

ES-1............................................... 1 1 1

Subtotal ...................................... 8 8 8

 Total - ES Salary $1,179,086 $1,303,076 $1,315,781

GS-15............................................. 33 32 32

GS-14............................................. 37 38 38

GS-13............................................. 64 74 83

GS-12............................................. 26 29 29

GS-11............................................. 9 12 12

GS-10............................................. 1 1 1

GS-9.............................................. 4 4 4

GS-8.............................................. 1 1 1

GS-7.............................................. 3 4 4

GS-6.............................................. 1 1 1

GS-5.............................................. 0 0 0

GS-4.............................................. 0 0 0

GS-3.............................................. 1 1 1

GS-2.............................................. 0 0 0

GS-1.............................................. 0 0 0

Subtotal ...................................... 180 197 206

 Total - GS Salary

Average ES level ............................. 3.4 3.4 3.4

Average ES salary........................... $147,386 $162,885 $164,473

Average GS grade............................ 13.0 12.9 12.9

Average GS salary........................... $105,691 $100,665 $101,657

Average Special Pay categories 

Administratively Determined (AD) .. $128,692 $129,667 $130,931

252 
SUPPLEMENTARY TABLES

Programs Proposed for Elimination

Administration for Community Living

ACL does not have any programs proposed for elimination. 

253 
SUPPLEMENTARY TABLES

FTE Funded by the Affordable Care Act

Administration for Community Living

(Dollars in thousands) 

Program Section Total FTEs CEs Total FTEs CEs

Pre-existing programs funded by ACA (Mandatory)

 National Clearinghouse for Long-Term Care Information Title VIII $ - 0 0 $ 1,000 0 0

 Medicare Improvements for Patients & Providers Act Programs Section 3306 $ - 0 0 - $ 0 0

New programs authorized and funded by ACA (Mandatory)

 Aging and Disability Resource Centers Section 2405 $ - 0 0 - $ 0 0

New programs funded from the PPHF under ACA (Discretionary)

 Adult Protective Services (Prevention & Public Health Fund) Section 4002 $ - 0 0 - $ 0 0

 Chronic Disease Self-Management Education (PPHF) Section 4002 $ 8,000 0 0 $ 8,000 0 0

 Alzheimer's Disease Initiative--Supportive Services (PPHF) Section 4002 10,500$ 0 0 10,500$ 0 0

 Alzheimer's Disease Initiative--Communications (PPHF) Section 4002 $ 4,200 0 0 $ 4,200 0 0

 Falls Prevention--(PPHF) Section 4002 $ 5,000 0 0 $ 5,000 0 0

Programs authorized by ACA but funded by other sources 

(Discretionary) 

 Elder Justice Initiative/Adult Protective Services 

Subtitle H, 

Sections 

6701-6703 $ 4,000 2 0 25,000$ 4 0

FY 2015 FY 2016

Program Section Total FTEs CEs Total FTEs CEs Total FTEs CEs

Pre-existing programs funded by ACA (Mandatory)

 National Clearinghouse for Long-Term Care Information Title VIII $ 1 0 3,000 $ 0 0 - 86 $ 0 0

 Medicare Improvements for Patients & Providers Act Programs Section 3306 $ 0 0 - $ 25,000 0 0 - $ 0 0

New programs authorized and funded by ACA (Mandatory)

 Aging and Disability Resource Centers Section 2405 $ 10,000 4 0 $ 4 0 9,490 $ 3 0 9,280

New programs funded from the PPHF under ACA (Discretionary)

 Adult Protective Services (Prevention & Public Health Fund) Section 4002 $ 0 0 6,000 $ 0 0 - 2,000 $ 0 0

 Chronic Disease Self-Management Education (PPHF) Section 4002 $ 10,000 0 0 $ 1 0 7,086 $ 0 0 8,000

 Alzheimer's Disease Initiative--Supportive Services (PPHF) Section 4002 $ 0 0 - - $ 0 0 $ 10,500 0 0

 Alzheimer's Disease Initiative--Communications (PPHF) Section 4002 $ 0 0 4,000 $ 150 0 0 $ 0 0 4,200

 Falls Prevention--(PPHF) Section 4002 $ 0 0 - - $ 0 0 $ 0 0 5,000

Programs authorized by ACA but funded by other sources 

(Discretionary) 

 Elder Justice Initiative/Adult Protective Services 

Subtitle H, 

Sections 6701-

6703 $ 0 0 - - $ 0 0 - $ 0 0

FY 2012 FY 2013 FY 2014

254 
Significant Items in Appropriations Committee Reports

Administration for Community Living

Home and Community-Based Supportive Services: ACL is directed to work with States to 

prioritize innovative service models, like naturally occurring retirement communities, which help 

older Americans remain independent as they age. 

Actions Taken or To Be Taken: The 2006 reauthorization of the Older Americans Act (OAA) 

included provisions for the Community Innovations for Aging in Place (CIAIP) program. In 

2009, the program funded fourteen demonstration projects designed to assist communities in 

their efforts to enable older adults to sustain their independence and age in place in their homes 

and communities. The grantees, representing communities across the nation, implemented a wide 

variety of community assistance models including but not limited to Naturally Occurring 

Retirement Communities (NORCs). A Technical Assistance Grant (TAG) was also awarded to 

assist the grantees in their efforts. The TAG grantee was supported by a variety of experts with

extensive experience in relation to aging in place, livable communities, naturally occurring 

retirement communities (NORCs), disability, community partnerships, evaluation, and models of 

sustainability.

Through the CIAIP program, grantees identified barriers to aging in place in their communities 

and developed strategies for making their communities more aging friendly, including providing 

older individuals with linkages to comprehensive and coordinated health care and social services 

that are critical to aging. Services provided under the program included care management, 

evidence-based disease prevention and health promotion programs, education, socialization, 

recreation, and civic engagement. In their initiatives, grantees collaborated with other community 

agencies, such as Aging and Disability Resource Centers (ADRCs), area agencies on aging 

(AAAs), local providers of health and social services, housing entities, community development 

organizations, philanthropic organizations, as well as foundations. 

Despite the conclusion of the demonstration program period in 2012, experts continue to 

reference the successful program and taut the value of the implementation of strategies that 

facilitate aging in place. Most recently, in her December 14, 2014 Huffington Post Public Health 

Blog, former Assistant Surgeon General, Susan Blumenthal, M.D. provided an overview of the 

CIAIP program and stated that it “demonstrated several effective ways of helping older adults 

age in place.”149

The success of the CIAIP program is validated by the sustained activities of a number of 

grantees, as well as the awards they received and continue to receive that relate to the activities 

149 http://www.huffingtonpost.com/susan-blumenthal/post_8756_b_6315082.html

255 

 
SIGNIFICANT ITEMS IN APPROPRIATIONS COMMITTEE REPORTS

conducted under the grant. Below are examples of continued program activities and the awards 

grantees received.

• With funding from the City of Austin, Texas, set to begin in October of 2015, CIAIP 

grantee Family Eldercare of Austin Texas is funding a collaborative modeled after their 

Living Well! CIAIP project. The 2015 project will include services to be delivered at 

eight affordable senior housing communities in the City of Austin. 

• The New York City Department on Aging continues to demonstrate their commitment to 

supporting Aging in Place activities by dedicating their OAA Disease Prevention, Health 

Promotion Program resources to fund NORCs. 

• In June of 2013, the Family Eldercare of Austin Texas Living Well! program was the 

third-place winner of the American Association of Service Coordinator’s 

2013 Innovations in Service Coordination Award sponsored by Critical Signal 

Technologies (CST).

• In August of 2012, CIAIP grantee Jewish Family Service of New Mexico and The Pueblo 

of Zuni! won the 2012 Grantmakers in Aging Diversity Award for their CIAIP 

partnership. 

• In 2011, the Atlanta Regional Commission’s Lifelong Mableton project received the U.S. 

Environmental Protection Agency’s Building Healthy Communities for Active Aging 

Initiative Commitment Award.

Limb Loss: Funding and administrative responsibility for the Limb Loss Program is transferred 

from CDC to ACL in fiscal year 2015 because the program is better aligned with the ACL 

mission of increasing the independence and well-being of people with disabilities. ACL is 

directed to work with CDC on a smooth transition of the program, which ensures that support for 

current grantees is continued in fiscal year 2015. 

Actions Taken or To Be Taken: ACL continues to work with CDC on a smooth transition of 

the Limb Loss program. The current grant award will expire March 31, 2015. Due to the recent 

transfer of the program, ACL will continue the grant for an additional year, develop a funding 

announcement in late summer 2015 that could include new priorities, openly recomplete the 

grant in the Fall of 2015, and issue the grant award prior to March 31, 2016. 

256 
Prevention and Public Health Fund

Administration for Community Living

In FY 2016, ACL is proposing the following funding from the Prevention and Public Health 

fund: 

FY 2014 

Enacted

FY 2015 

Enacted

FY 2016 

President’s Budget

Chronic Disease SelfManagement Education............ $8,000,000 $8,000,000 $8,000,000

Falls Prevention..................... $5,000,000 $5,000,000 $5,000,000

Alzheimer’s Disease Initiative –

Services.............................. $10,500,000 $10,500,000 $10,500,000

Alzheimer’s Disease Initiative –

Communications Campaign...... $4,200,000 $4,200,000 $4,200,000

 Total $27,700,000 $27,700,000 $27,700,000

A summary of each item requested in FY 2016 follows. More detailed requests are found in 

separate sections elsewhere in this volume.

Chronic Disease Self-Management Education (CDSME)

• $8,000,000 for Chronic Disease Self-Management Education (CDSME), requested again 

for FY 2016 from the Prevention and Public Health Fund (PPHF) appropriated under the 

Affordable Care Act. This would maintain the funding at the level enacted in FY 2014 

and FY 2015. CDSME programs have proven effective in helping people to better selfmanage their chronic conditions and reduce their need for more costly medical 

interventions. Funding for CDSME is awarded in the form of competitive grants to states.

Falls Prevention 

• $5,000,000 for Falls Prevention Programs, unchanged from the FY 2014 and FY 2015 

enacted budgets from PPHF. This FY 2016 funding would be used to fund a national 

resource center and competitive grants to States, Tribes, and other applicants who have 

experience in evidence-based falls prevention programs. 

257 
PREVENTION AND PUBLIC HEALTH FUND

Alzheimer’s Disease Initiative - Services

• $10,500,000 for services to individuals with Alzheimer’s Disease (AD) and their families 

under the President’s Alzheimer’s Initiative, funded from the Prevention and Public 

Health Fund. For FY 2016, the request is at the same level as the FY 2014 and FY 2015 

enacted budgets. Funds will be used to expand efforts to develop more AD-capable longterm services and supports systems designed to meet the needs of AD 

caregivers. Caregivers will be linked to interventions shown to decrease their burden and 

depression and thus improve their health outcomes. The funding is used to award 

cooperative agreements to States, tribes, or other localities, and these entities are charged 

with developing systems that coordinate or integrate access to a system-wide set of 

programs. 

Alzheimer’s Disease Initiative – Communications Campaign 

• $4,200,000 for the Alzheimer’s Disease Initiative Outreach Campaign to inform people 

caring for people with Alzheimer’s disease about the federal, state, local, and nonprofit 

resources available to help them. For FY 2016, the request is at the same level as the FY 

2014 and FY 2015 enacted budgets. This funding is proposed from the Prevention and 

Public Health Fund. The funding mechanism used is a contract. 

258