DEPARTMENT 

of HEALTH 

and HUMAN 

SERVICES

Fiscal Year

2021

Administration for 

Community Living

Justification of 

Estimates for 

Appropriations Committees 
Back cover intentionally left blank. 
DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Community Living

Washington, DC 20201

ii 

I am pleased to present the Administration for Community Living’s (ACL) FY 2021 President’s Budget Request 

for $2.1 billion. The request reflects ACL’s need to make administrative investments to adequately support 

programs added during the rapid expansion of the agency. It also reflects a strategic focus on program 

innovation, a commitment to increasing state flexibility to meet the unique needs of their communities, and 

continued prioritization of programs that provide direct services for older adults and people of all ages with 

disabilities. 

The bulk of ACL’s request funds programs that directly support community living for older adults and people 

with disabilities. These programs work together to encourage and support independence, resilience and selfsufficiency, and the community-based organizations that provide them are critical partners to health care for 

improving outcomes and lowering health care costs for the people we serve. 

One of the hallmarks of our country is the freedom each of us has to build our lives around the people, 

communities and experiences we choose for ourselves. It includes equal opportunities to learn, work, and 

contribute, and the right to live free from abuse or neglect. That freedom is the birthright of every American, 

with and without disabilities, and it remains ours throughout our lives. The overwhelming majority of Americans 

want to live in the community, and our communities and our economy are stronger when everyone can 

contribute. ACL and I remain committed to making community living an option for every American, regardless 

of age or disability, and this budget aligns with that commitment. 

 

Lance Robertson 

Administrator and Assistant Secretary for Aging 
TIVE SUMMARY

iii

Table of Contents

Table of Contents.................................................................................................................................................... iii

Organization Chart.................................................................................................................................................... v

Executive Summary

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

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

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

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

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

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

Amounts Available for Obligation..........................................................................................................................26

Summary of Changes..............................................................................................................................................27

Budget by Activity..................................................................................................................................................28

Authorizing Legislation ..........................................................................................................................................29

Appropriations History ...........................................................................................................................................31

Appropriations Not Authorized by Law .................................................................................................................33

Program Authorizing Legislation Table .................................................................................................................35

Health and Independence for Older Adults

Health and Independence for Older Adults.............................................................................................................39

Home and Community-Based Supportive Services................................................................................................43

Nutrition Services...................................................................................................................................................53

Preventive Health Services.....................................................................................................................................69

Chronic Disease Self-Management Education........................................................................................................77

Falls Prevention ......................................................................................................................................................81

Native American Nutrition and Supportive Services..............................................................................................85

Aging Network Support Activities .........................................................................................................................91

Caregiver and Family Support Services

Caregiver and Family Support Services..................................................................................................................99

Family Caregiver Support Services......................................................................................................................101

Native American Caregiver Support Services ......................................................................................................109

Alzheimer’s Disease Program...............................................................................................................................115

Lifespan Respite Care...........................................................................................................................................121

Protection of Vulnerable Adults

Protection of Vulnerable Adults ...........................................................................................................................127

Long-Term Care Ombudsman Program ...............................................................................................................129

Prevention of Elder Abuse and Neglect................................................................................................................137

Health Care Fraud and Abuse Control/Senior Medicare Patrol Program .............................................................143

Elder Rights Support Activities............................................................................................................................149

Disability Programs, Research and Services

Disability Programs, Research and Services.........................................................................................................157
iv

State Councils on Developmental Disabilities......................................................................................................159

Developmental Disabilities – Protection and Advocacy.......................................................................................165

University Centers for Excellence in Developmental Disabilities........................................................................171

Developmental Disabilities – Projects of National Significance ..........................................................................177

Independent Living...............................................................................................................................................181

Limb Loss Resource Center..................................................................................................................................191

Paralysis Resource Center.....................................................................................................................................195

Traumatic Brain Injury .........................................................................................................................................199

National Institute on Disability, Independent Living, and Rehabilitation Research .............................................205

Consumer Information, Access and Outreach

Consumer Information, Access, and Outreach .....................................................................................................211

Aging and Disability Resource Centers................................................................................................................213

State Health Insurance Assistance Programs........................................................................................................219

Voting Access for Individuals with Disabilities ...................................................................................................225

Assistive Technology............................................................................................................................................231

Medicare Improvements for Patients and Providers Act Programs (MIPPA) ......................................................245

Program Administration 

Program Administration .......................................................................................................................................257

Nonrecurring Expense Fund

Nonrecurring Expenses Fund................................................................................................................................261

Supplementary Tables

Supplementary Tables...........................................................................................................................................265

Good Accounting Obligations in Government Act

Good Accounting Obligation in Government Act (GAO-IG Act) Report............................................................275

Legislative Proposals

Legislative Proposals............................................................................................................................................277

Significant Items

Significant Items...................................................................................................................................................283
v 

Organization Chart
EXECUTIVE SUMMARY 

1

Introduction and Mission 

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

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

with disabilities to live independently and participate fully in their communities. 

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

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

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

The U.S. population over age 60 is projected to increase by 6 percent between 2018 and 

2020, from 72.8 million to 77.1 million.1

1

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

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

Release Date: September 2018. https://www.census.gov/data/tables/2017/demo/popproj/2017-summary-tables.html. 

Accessed 10 December 2019. U.S. Census Bureau, Annual Estimates of the Resident Population for Selected Age 

Groups Sex, for the United States: April 1, 2010 to July 1, 2018. Released June 2019. 

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

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

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

2

 U.S. Census Bureau, “Americans with Disabilities: 2010,” Issued July 2012, 

https://www2.census.gov/library/publications/2012/demo/p70-131.pdf. Accessed 21 August 2014. 

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

3

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

https://www.acl.gov/sites/default/files/about-acl/2016-12/dd_act_2000.pdf) and U.S. Census Bureau, Annual 

Estimates of the Resident Population for Selected Age Groups by Sex for the United States, States, Counties, and 

Puerto Rico Commonwealth and Municipios: April 1, 2010 to July 1, 2017. Accessed 7 August 2018. 

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

limitations in activities of daily living – is projected to increase from 3.9 million individuals 

in 2018 to 4.2 million (6 percent increase) by the year 2020.4

4

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

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

Release Date: September 2018. https://www.census.gov/data/tables/2017/demo/popproj/2017-summary-tables.html. 

Accessed 10 December. U.S. Census Bureau, Annual Estimates of the Resident Population for Selected Age Groups 

by Sex, for the United States: April 1, 2010 to July 1, 2018: Released June 2019, 

https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml. Accessed 10 December 2019. Centers for Medicare & 

Medicaid Services, ACL analysis of 2016 Medicare Current Beneficiary Survey, , https://www.cms.gov/ResearchStatistics-Data-and-Systems/Research/MCBS/index. Accessed 10 December 2019. 

These individuals are at the 

greatest risk of nursing home admission

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

people of all ages, with and without disabilities, and have the same opportunities as 
2

everyone else to earn a living and to make decisions about their lives. Community living 

is preferred by older Americans and people with disabilities and is usually less expensive 

than institutional care. That combination of cost-effectiveness and consumer satisfaction 

makes community living an exceptional value. As we transform the health care to a system 

that pays for outcomes, and prioritizes care in the lowest-cost appropriate settings, the 

complimentary systems of non-medical long-term services and supports provided by 

ACL’s networks are expected to play an increasingly important role in the Department’s 

efforts to deliver more effective services at lower costs.
EXECUTIVE SUMMARY

3

Overview of the Budget Request 

To make community living possible for millions of older adults and people with disabilities, the 

Administration for Community Living (ACL) funds services and supports and invests in training, 

education, research, and innovation. In order to ensure that ACL’s programs are tailored to the 

unique needs of the people they serve, ACL works closely with States and Tribes and provides 

services primarily through networks of community-based organizations. ACL’s programs work 

together to encourage and support independence, resilience and self-sufficiency throughout the 

lifespan. As the primary system for addressing the many social determinants of health for older 

adults and people with disabilities, these programs also play a critical role in improving the health 

of Americans and reducing costs of care. 

The FY 2021 discretionary request for ACL is $2,108,207,000, or -$114,908,000 below the FY 

2020 Enacted level. ACL’s request prioritizes critical operational risk mitigation; creates 

opportunities for innovation and expands State flexibility to increase effectiveness and 

sustainability of programs; and supports States and communities in meeting the needs of older 

adults and people with disabilities. In addition, recognizing the importance of ensuring all citizens 

can participate in elections, the budget maintains support for voting access for people with 

disabilities. 

Risk Mitigation 

The request seeks an increase of +$1 million for Program Administration to provide additional 

staffing and to make mission critical investments in information technology, for a total request of 

$42.1 million. 

Since ACL was formed in 2012, many programs have been transferred to the agency; increased 

administrative resources are needed to ensure the full portfolio of ACL’s programs do not incur 

operational risk. For example, data gathering and reporting for transferred programs largely has 

been incorporated into existing systems that do not fully, or most efficiently, support the oversight 

and evaluation needs of the programs. The number of technology systems managed by ACL also 

has increased and additional funding is needed to meet cybersecurity and usability requirements, 

which also continue to increase in number and complexity. 

The requested Program Administration funding will allow ACL to add three additional FTE to 

increase support to functions such as program evaluation, IT operations, cybersecurity, and 

program monitoring and oversight in order to begin to mitigate these and similar risks. Without 

this additional funding, ACL will be forced to cut other core operating expenses, such as 

performance measurement, business process reengineering, and human capital development, 

increasing the exposure of ACL’s programs to operational risk.
EXECUTIVE SUMMARY 

TIVE SUMMARY

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Innovation 

The number of people served by ACL is growing at an unprecedented rate. The number of older 

adults in the United States ages 65 and older is projected to increase by 58 percent, from 49 million 

to nearly 78 million, between 2016 and 2035. The number of people with disabilities also is 

growing, in part because of the increasing lifespan of people with all types of disabilities. 

Innovation and flexibility are critical to providing effective services to increasing numbers of 

people with level funding. To this end, the FY 2021 Budget includes the following proposals: 

Increased State Flexibility: The budget continues a proposal to allow States to shift funding 

between four Older Americans Act programs--Home and Community Based Services, 

Nutrition Services, Family Caregiver Services, and Preventive Health Services. A second 

proposal would consolidate Chronic Disease Self-Management Education and the Falls 

Prevention programs into the Preventive Health Services program, at the current funding 

level of the Preventive Health Services Program (-$13 million, compared to the combined 

funding of the three programs). Both proposals increase States’ ability to meet their 

individual, and highly variable, local needs. 

Expanded State Innovation Authority: Based on three years of nutrition program successes 

in using up to 1% of nutrition appropriations to modernize and innovate, ACL proposes to 

extend this authority to the Home and Community-Based Services program. 

Employment Grants: The Budget includes $5 million within the Centers for Independent 

Living to test evidence-based models of employment support and training to help 

individuals with disabilities live independently and participate in all facets of American 

society including the workplace. 

 

Increased Response to the Opioid Crisis: 

The Budget provides an additional $4 million (for a total funding level of $6 million) within 

the Elder Justice Program to expand the two pilot technical assistance efforts funded in the 

FY 2020 Budget, to add 5 competitive State grants, and 2 competitive Tribal grants, and a 

small addition to the resource center to assist with the new Opioid efforts. 

Program Investment Summary 

The FY 2021 ACL budget request continues to fund programs and oversight activities with a 

commitment to fiscal responsibility. 

Prioritizes Direct Services Programs: The Budget maintains funding at the FY 2020

Enacted level for several of ACL’s direct services programs. These include Home and 

Community Based Supportive Services and Nutrition Services, which are the largest 

programs serving older adults, as well as the Alzheimer’s Disease Program, which provides
EXECUTIVE SUMMARY 

TIVE SUMMARY

5

 specialized services to support resilience and independence for people with disabilities and 

caregivers of individuals with Alzheimer’s. 

Maintain 2020 Budget Program Levels: The Budget maintains funding levels for fourteen 

programs flat with the FY 2020 President’s Budget levels, which represents a total 

reduction of -$143 million from the FY 2020 enacted levels. 

Program Eliminations: Funding for the Alternative Financing Grant Competition would 

be eliminated (-$2 million). This program is no longer authorized by the Assistive 

Technology Act, and it is redundant to ACL’s Assistive Technology State grant program, 

which allows states to offer alternative financing. 

Conclusion

With the appropriate services and supports, most people who are aging or who have disabilities of 

all types can live in their own homes or in other community settings—which is overwhelmingly 

preferred and typically less expensive. ACL remains committed to its central mission of 

supporting people with disabilities and older adults so they can live independently and fully 

participate in their communities. This budget allows ACL to continue to serve its populations while 

expanding program flexibilities and supporting targeted efforts to address the priorities identified 

by the President. 
EXECUTIVE SUMMARY 

TIVE SUMMARY

6

Overview of Performance 

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

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

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

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

following categories of performance measures: 1) improving consumer outcomes and delivery 

systems; 2) effectively targeting services to at risk populations; and 3) improving program 

efficiency. Each performance measure is aligned with a goal and represents activities that span 

across ACL. Progress toward the goal is tracked using performance indicators. 

Overview of Performance 

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

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

likelihood that the most vulnerable people receiving services will continue to remain in their homes 

(measure 2.10) and serving a disproportionately large percentage of people living in poverty (2.6), 

a having greater than 90% of respondents rates the services as good or excellent (2.9a/2.9b/2.9c). 

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

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

Unfortunately, with relatively stagnant funding and annual rises in expenditures per unit of service, 

we have not be able to meet our targets for people served per million dollars of HCBS funding 

(1.1) or thousand dollars of Title VI funding (1.3). This issue is also seen with regard to year over 

year reductions in the number of transportation (output C), case management (output F), and 

caregiver counseling and training (output J) services provided. Interestingly the unit cost for other 

services such as adult day care have declined over the past year (output E). ACL is closely 

monitoring these trends and once the new data collection system is in place for FY2022, ACL will 

have improved information for understanding such year to year changes.

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

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

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

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

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

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

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

with disabilities who interact with it. . 

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

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

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

Developmental Disabilities (UCEDDS) (measure 8D). ACL has several new performance 

measures for its disability programs, research, and services. These include three new measures 

related to the use and availability of assistive technology, and more robust measures of enforcing, 
EXECUTIVE SUMMARY 

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retaining, restoring, or expanding the rights of individuals with developmental disabilities 

(measure 8F and 8G). A significant performance-based accomplishment in this area is the drafting 

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

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

individuals with disabilities. 

ACL’s Internal Performance Management Process 

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

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

and priorities: 2) to support ACL’s budget justifications; and 3) to monitor program performance 

and support improvement. ACL employs a program performance management strategy with 

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

organizations, enhanced partnerships between aging and disability networks, and senior leadership 

involvement in performance management. 

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

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

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

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

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

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

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

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

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

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

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

measures, R1b, and R2 proposed last year, and R3 being proposed this year in the Summary of 

Proposed Changes in Performance Measures). The Plan emphasizes consumer relevance and 

scientific rigor, presents a 5-year agenda that is scientifically sound and accountable, and will 

contribute to the refinement of national policy affecting people with disabilities. 

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

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

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

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

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

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

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

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

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

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

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

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

enhancing this process by including formal reviews of Funding Opportunity Announcements 

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

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

the grant application and progress reports. 

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

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

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

high performance and delivery to accomplish our performance goals. 

ACL’s Use of Performance Information for Management Purposes 

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

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

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

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

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

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

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

and individuals with disabilities. For example, ACL funds: 

A Business Acumen Resource Center which uses research to provide resources to sustain 

disability organizations. Center recently has released the second module of their 

toolkit: “Disability Network Business Strategies: A Roadmap to financial and 

Programmatic Sustainability for Community-Based Organizations.” This resource is a 

“how-to’ guide designed to help Community-Based Organizations (CBOs) evaluate, plan, 

develop and implement strategies to help build and sustain their organizations in various 

business climates and provides information about which approaches are most likely to 

provide increased ROI for ACL to use when making future grants. 

Sixty-eight University Centers for Excellence in Developmental Disabilities Education, 

Research, and Service (UCEDDs) throughout the United States and its territories to serve 

as liaisons between academia and the community and fund model demonstrations to 

build evidence for addressing issues, finding solutions, and advancing research 

related to the needs of individuals with developmental disabilities and their families.

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

providers. Examples include: 

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

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

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

dementia capability in its entirety or broken down by sector. These data are reported 

AZL .3. 

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

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

risk of nursing home admission the opportunity to self-direct their care through Veteran 

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

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

serve more Veterans with same investment. The program has a very high satisfaction 

ratings from the veterans who have used it.

The VA is using the VDC case-mix methodology as an approach to determine the amount 

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

a Veteran should receive based on their needs related to Activities of Daily Living (ADLs) 

such as eating, bathing, dressing, behavioral health needs, and specialized rehabilitation. 

The Administration for Intellectual and Developmental Disabilities is building the capacity 

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

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

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

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

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

and system performance. 

With funding from ACL, the National Resource Centers at NCOA, in collaboration with 

the Evidence-Based Leadership Council, led an innovative vetting process to increase the 

number of programs available to ACL’s aging network that meet the Title III-D evidencebased criteria. This process resulted in adding six new health promotion programs and three 

new programs for preventing falls. 

ACL continually monitors its support of grantees to ensure the provision of high quality 

services. Three examples are provided below. 

State Councils on Developmental Disabilities are working with an ACL contractor to 

identify Council practices with evidence of positive self-advocacy outcomes. Once the 

effectiveness of these practices is verified using rigorous criteria, ACL will promote them 

to Councils to support and expand participation of individuals with developmental 

disabilities in cross-disability and culturally diverse leadership coalitions in furtherance of 

the legislative goal of empowering individuals and their families both to advocate for 

themselves and to seek long-term solutions through systems change, creating an 

environment of self-sufficiency, self-determination, inclusion, and acceptance.
EXECUTIVE SUMMARY 

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Protection and Advocacy for Individuals with Developmental Disabilities 

(PADD)/Protection and Advocacy for Voting Accessibility (PAVA) programs receive 

training and technical assistance (T/TA) from ACL. ACL is currently examining the utility 

of that support in order to build upon components and strategies that show value, develop 

an updated model for T/TA provision, and promote partnerships with other Federal 

stakeholders.

Voluntary Consensus Guidelines for State Adult Protective Services systems were developed by 

ACL to promote an effective adult protective services (APS) response across the country. ACL is 

engaged in a study of states to understand how/extent to which guidelines help states improve 

policy and practice of APS as states integrate the consensus guidelines into policy and practice. 

ACL will then refine and expand its support of APS systems so that all older adults and adults with 

disabilities, regardless of the state or jurisdiction in which they live, have similar protections and 

service delivery from APS systems. 

ACL also has several projects to improve its program administrative and performance data. 

These include: 

ACL’s Data Council, started in October 2019, will improve the coordination of ACL’s data 

governance writ large. This includes examining and enhancing processes and standards 

for defining, collecting, reviewing, certifying, analyzing, and presenting ACL data. This

will strengthen the evidence available about the value of ACL’s programs to individuals, 

families, and communities. With better data ACL can improve its performance reporting, 

evaluation and other research planning, and work more collaboratively with key 

stakeholders such as grantees, advocacy groups, and Congress. Topics for the first year 

include developing standards and guidelines for certifying ACL’s data submissions; 

determining which Federal standards (e.g., the Evidence Act of 2018, Federal Data 

Strategy) apply to ACL and how to best meet their requirements.

Data restructuring activities allow ACL to continue to assess the data hosted on the Aging, 

Independence, and Disability Program Data Portal (AGID), and test a potential 

restructuring of the data in order to make it useful and usable for stakeholders. 

Overview of ACL’s Evaluations and Other Evidence Building

In 2019, ACL started or continued evaluations of the following programs: 

New Evaluations: 

Designing an approach for an Adult Protective Services Client Outcomes Study 

Existing Evaluations: 

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

Community-Based Services for Individuals with Developmental Disabilities Grantees; 

Community of Practice Supporting Families;
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Partnerships in Employment Systems Change grants 

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

Efficiency of the Grant-making Process;

Older Americans Act Title VI Tribal Grants Programs; and 

Older Americans Act Long Term Care Ombudsman Program, 

In FY 2019, ACL published the number of evaluation reports on its website and data briefs on its 

data presentation portal AGID (www.AGID.ACL.Gov):

Older Americans Act Title VI Services - Nutrition (pdf)

Older Americans Act Nutrition Services Program (pdf)

National Survey of Older Americans Act Participants (pdf)

National Family Caregiver Support Program (pdf)

Title VI – Social Connectedness (pdf)

Using Data to Tell a Story with Soul (pdf)

Administration for Community Living Supports for Family Caregivers across the 

Lifespan (pdf)

Title VI Programs: Year 2 Interim Report (PDF)

Interim findings from the evaluation of the Living Well Program (PDF) 

Interim findings from the evaluation of ACL’s Communities of Practice for Supporting 

Families (PDF) 

Presentation of interim evaluation findings related to the process evaluation of the 

Long-term Care Ombudsman Program (LTCOP) (PowerPoint). 

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

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

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

evaluation findings to inform agency strategies and decision-making. 

Legislative Proposal:

ACL’s budget request includes a legislative proposal to increase the allowance for evaluation 

under Section 206(g) of the Older American Act from 1⁄2 of one percent to one percent. Increased 

investment in evaluation and related performance activities will permit more comprehensive 

reviews of programs and data to advance ACL’s learning agenda and other Federal EvidenceBuilding activities mandated under the Evidence Act of 2018 that supports administration and 

congressional actions for addressing this growing population’s changing needs. Additional 

funding would also allow ACL more flexibility to conduct specialized studies to examine 

differences in service and outcomes in targeted geographies and with important sub-populations. 

ACL would be better positioned to know what works best for whom and in what context.
EXECUTIVE SUMMARY

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Impact of Budget Changes on ACL’s Performance Targets

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

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

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

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

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

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

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

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

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

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

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

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

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

remain in their homes and communities (measure 2.10).
EXECUTIVE SUMMARY

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All Purpose Table

Administration for Community Living 

(Dollars in Thousands)

Program FY2019 

FimL'l 

FY2020 

[ meted 

FY2021 

Presideirs 

BuMet 

FY2021 Presideu:·s 

Budget +/- 2020 

[ m eted 

filllb & l11da2aldfJEt f

1 B 2r Older ~dlBS 

Horre & Comrunity-Based Stpp0rti,e Sernces ............................ 384.676 390.074 390.074 -

Nttrition Senices ........................................................................... 905.815 936.753 936.753 - Congregate Nutrition Seivices (non-add) ... 494.830 5103 42 510.342 -

Ho111e-De/ivered,\~1Mtion Se,vices (non-add) ... 251082 266.342 266.342 -

,Wtrition SeJvices lrcel1/Ne Pror;-am (non-add) ... 159.903 160.069 160.069 -

Pre,<!llli\e Heallh Services .............................................................. 24.822 24.848 24.848 -

Chronic Disease Self-i'vfana~ Education [PPHF)l2 .................. 8.000 8.000 - (8.000) 

Elder Falls Pre\elllion [PPHF)l2. .................................................... 5.000 5.000 - (5.000) 

Nali\e Atrerican Nutrition & Stpporti,e Services. .......................... 34.173 34.708 34.708 -

Aging Net\,od< Support Activities. .................................................. 16.400 12.461 11.503 (0.958) 

Holocaust Swvivor Assistarce {wn-add} ... 4.976 5.000 5.000 -

Care C01p (non-add) ... 

Stbtob.l, Heo.llh & Independence i>r Older Adtils. ....................... 

4.000 . 1,378.886 -

1,411.844 

- . 1,397.886 -

(13.958 

Care!:!iver & Frullh1 Sum01t Senrices 

Farrily Caregi\Cf Support Services ................................................. 180.999 185.936 150.586 (35350 

Nali\e Atrerican Care~<er Stpp0rt Sernces .................................. 10.046 10306 10306 . -

Alzheirret's Disease Program ......................................................... 19.996 26.500 26.500 - .-il:Jie.imsr s Dismse..fomDir8Ct .-ippropriations (},fon...idd) __________ . 5.296 11.800 26.500 14.700 .-il:Jie.imsrs Dis rose .fomPPHF (},fon....tdd} 2/ ______________________ 14.700 14.700 - (14.700 

Lifapan Respite Care ..................................................................... 4.096 6.11 0 3360 (1.750) 

Stbtolal, Caregi\<er & Fanily Stpport Services ............................. 215.136 228.852 190.752 (38.100 

Protection of Vulnemble AdtAts 

Lorg-Tenn Care Orrbudsrren Prog-arn ......................................... 16.868 17.885 15.855 (2.030) 

Pre,<!llOOn ofElder Abl.lle &Negl;ct ............................................. 4.768 4.773 4.773 -

Seni01• l-Juiictn Pafi•o/ Pror;-a11vHCFAC 13 ... 18.000 18.000 18.000 - Elder Rig!ts Support Adi,ities ....................................................... 15.819 15.874 17 .874 2.000 

EJdeJ· J11stia1 {non-ad:i} .. 11.958 12000 14.000 2.000 

Stbtolal, Protecfun of Vulnerable A dulls ...................................... 55.455 56.532 56.502 (0.030) 

Disabi!i!y Pmi:mms, Research & Se1vices 

Slate Councils on De\eloplfflltll Disabilities ................................... 75.921 78.000 56.000 (22.000 

De\eloplfflltll Disabilities Protection and Ad\'Ocacy ....................... 40.692 40.784 38.734 (2.050) 

Um't!l'sity Centers i>r E=nence in De,elopirental Disabilres ........ 40.478 41.619 32.546 (9.073) 

Projects ofNalional Sigzificance ..................................................... 11.958 12.250 1.050 (11 .200 

Independent Liwg. ........................................................................ 11 6.063 11 6.1 83 113.646 (2.537) 

Lirrb Loss Resource Center ............................................................ 3.488 4.000 4.000 -

Paraly-sis Resource Center .............................................................. 8.670 9.700 9.700 -

Tu.urralicBrain Injury .................................................................... 11.291 11321 11 321 - Nafuml Instittte on Disability, Independent Living. and RelBb. 

Research 108.592 111.970 90371 (11.599 

Stbtolal, Disability Programs, Research & Services ...................... 417.155 425.827 357 368 (68.459 
EXECUTIVE SUMMARY

14 

All Purpose Table - Continued

D"&·ision FY2019 

Final/1 

FY2021 FY2020 

Enacted 

Pl-esid ent's 

Btxlget 

FY 21121 Pl-esident's 

Btxlget +/- 2020 

Enacted 

Consmuel'lnfo1mation.Acce.ss and Outre.ach 

-~andDisibwtyResotrceCerters. ·······················-················· 8.091 8.119 6.119 (2.000 

State Health Im.ra.n:eA.ssistan,e Prograin .. 49. 115 52.115 36.115 (16.000 

V ~ Access for People " ithDisabmfies (HAV A). ....................... 6.956 7.463 7.463 - As,i,tive Teclmlogy ... 35.955 37.000 31.939 (5.061) 

Assisth:e Techmlogy - {ncmaldj .............................. -................ 33.962 35.000 31.939 (3.061) 

Assisth:e Tec/n,logy -Altemath:e Fman:;ingProgram {nonadd} 

Medicare Improvements for Pa6erts ani Pro,iders _1\,:t 

1.993 . 2.000 . - (2.000 

[IRA,OOA)/4 37.500 37.500 37.500 - C11·nmt La,,, M::ndato1y {non.addjl4. .................... _ ................ 37.5 00 24.146 - (24.146) 

Proposed Lao,, M::n:bto1y {non-add}. ....................................... - 13.354 37.500 24.146 

Subtotal, C ons..nner hfonna60!\ Access & Oureachl4 ................ 137.617 142.tn 119.136 (23.061) 

Program Adminisfra6on .. 40.921 41.063 42.063 1.000 

Subtota~ Pli,gJ'am Le<el/4 ........................................................... 2,245.170 2,306.315 2,163.707 (142608 

Less: Fwtds F1i,m Mandatot'V Sow-ces 

HCFAC Funds/ or Senior MxlicarePatro/ Program /3 ............. (18.000) (18.000 (I 8.000) -

Premiion& PtblicHealthFmd ... (27.7 00) (27.700 - 27.700 

Medicare Improvements for Pa6erts ani Pro,iders Acf4 ............... (37.5 00) (3Z50o; (3 7.500 - C11·nmt La,,, M::ndato1y {non.addjl4. .................... _ ................ (3Z500) (24.14~ - 24.146 

Proposed La,,, M::n:lato1y {non-add}. ....................................... - (13.354 (3 7.500) (24.146) 

Total, Discretiona,y Budget A11tho1uy ......................................... 2,161.970 2,223.115 2,108.207 (114.908 

NIF ................................................................................................. 4,850.000 

ACLData .................................................................................. 1,000 

Older Americans Act Pe1fonnan:;e System ............ ·-··············· 1,500 

ACLRep,nting Enlrrn::ements ................................ -............... 1,000 

ACLgav &1Ju:11rmnerds ........................................................... 500 

ACL Knawle<}ge A{amgemenl .................................................. 500 

HHS Accessibility and Usability Shared Se1vice Piiot .............. 350 

I/ Reflects FY 2019 requiredao:I p,nnissi~ transfe rsao:lrescissions of S7.345, excep the NSIP transfer to LEDA of Sl.9million. 

21 In FY 2019 ao:I FY 2020 these programs were fun<l,d rut of the Pre,~ntion ao:I Public Health Fund 

3/ In FY 2019 ao:I FY 2020 awopiations state that SM'/HCFAC is p id for out of disoreti:miy CM; aw opiati:ns fur ICFAC to the 

CemetS for M,dicare & M,dicaid Servi:es based on the Secretaiy of HHS' s determination fo the amount needed to pr°'ide full funding ao:I 

not less than the floor provad inaw op,at»ns lamiage. l he H W.a> amount seJVes asa paceml:ler tar H W.!Op,o:lln! tinal deC1S10ns 

on the amount by the Secretary of HHS. 

4/The FY 2020 awopiation e.,ten<l,d the MPPA p-ograms through May 22, 2020. The FY 2021 President's Budget extenls fuo:ling for 

these programs at the amualized level through FY 2021. 
EXECUTIVE SUMMARY

15 

Appropriations Language 

Administration for Community Living 

ADMINISTRATION FOR COMMUNITY LIVING

AGING AND DISABILITY SERVICES PROGRAMS

(INCLUDING TRANSFER OF FUNDS)

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

(‘‘OAA’’), the RAISE Family Caregivers Act, the Supporting Grandparents Raising

Grandchildren Act, titles III and XXIX of the PHS Act, sections 1252 and 1253 of the PHS

Act, section 119 of the Medicare Improvements for Patients and Providers Act of 2008, title

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

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

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

titles) of the Rehabilitation Act of 1973, and for Department-wide coordination of policy and

program activities that assist individuals with disabilities, [ $2,171,000,000]$2,072,092,000

together with [ $52,115,000]$36,115,000 to be transferred from the Federal Hospital 

Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund to carry

out section 4360 of the Omnibus Budget Reconciliation Act of 1990: Provided, That amounts 

appropriated under this heading may be used for grants to States under section 361 of the OAA

only for disease prevention and health promotion programs and activities which have been

demonstrated through rigorous evaluation to be evidence-based and effective: Provided further, 

That up to one percent of amounts made available under this heading to carry out section 321 of 

the OAA shall be available for developing and implementing evidence-based practices to 

enhance home and community-based supportive services: Provided further, That of amounts 

made available under this heading to carry out sections 311, 331, and 336 of the OAA, up to
EXECUTIVE SUMMARY

16

one percent of such amounts shall be available for developing and implementing evidence-based

practices for enhancing senior nutrition, including medically-tailored meals: Provided further,

That notwithstanding any other provision of this Act, funds made available under this

heading to carry outsection 311 of the OAA may be transferred to the Secretary of Agriculture in

accordance with such section: Provided further, That of the amount made available 

under this heading, $5,000,000 shall be available for a program under which the 

Secretary may make competitive grants to centers for independent living that 

have received grants under part C of chapter 1 of title VII of the Rehabilitation 

Act of 1973, to develop evidence-based interventions to increase employment of 

individuals with disabilities: [Provided further, That $2,000,000 shall be for

competitive grants to support alternative financing programs that provide for the

purchase of assistive technology devices,such as a low-interest loan fund; an interestbuydownprogram;arevolvingloanfund; aloanguarantee; or an insurance program: Provided

further, That applicants shall provide an assurance that, and information describing the

manner in which, the alternative financing program will expand and emphasize

consumer choice and control: Provided further, That State agencies and community-based

disability organizations that are directed by and operated for individuals with disabilities 

shall be eligible to compete:] Provided further, That none of the funds made available under

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

Advocacy for Individuals with Mental Illness Act (42 U.S.C. 10802)) to continue to pursue any

legal action in a Federal or State court on behalf of an individual or group of individuals with

a developmental disability (as defined in section 102(8)(A) ofthe Developmental Disabilities and

Assistance and Bill of Rights Act of 2000 (20 U.S.C. 15002(8)(A)) that is attributable to a
EXECUTIVE SUMMARY

17 

mental impairment (or a combination of mental and physical impairments), that has as the 

requested remedy the closure of State operated intermediate care facilities for people with

intellectual or developmental disabilities, unless reasonable public notice of the action has been

provided to such individuals (or, in the case of mental incapacitation, the legal guardians who

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

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

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

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

That the limitationsin the immediately preceding proviso shall not apply in the case of an

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

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

(Department of Health and Human Services Appropriations Act, 2020)

GENERAL PROVISIONS

SEC. 225. 

(a) IN GENERAL. Under the conditions listed in subsection (b), the Secretary or the head of a 

major organizational unit within the Department may in this fiscal year enter into a 

reimbursable agreement with the head of another major organizational unit within the 

Department or of another agency under which --

(1) the head of the ordering agency or unit delegates to the head of the servicing agency 

or unit the authority to issue a grant or cooperative agreement on behalf of the ordering 

agency or unit; 
EXECUTIVE SUMMARY

18 

(2) the servicing agency or unit will execute or manage a grant or cooperative agreement 

on behalf of the ordering agency or unit; and 

(3) the ordering agency or unit will reimburse the servicing unit or agency for the 

amount of the grant or cooperative agreement and for the service of executing or 

managing the grant or cooperative agreement. 

(b) CONDITIONS. The conditions for making an agreement described in subsection (a) are that 

(1) amounts are available; 

(2) the head of the ordering agency or unit decides the agreement is in the best interest of 

the United States Government; and 

(3) the agency or unit to execute or manage the grant or cooperative agreement is able to 

provide that service.

(c) PAYMENT. Payment shall be made promptly through the Intra-governmental Payment and 

Collection system at the request of the agency or unit providing the service. Payment may be in 

advance or on providing all or part of the service, and shall be for any part of the estimated or 

actual cost as determined by the agency or unit providing the service. A bill submitted or a 

request for payment is not subject to audit or certification in advance of payment. Proper 

adjustment of amounts paid in advance shall be made as agreed to by the heads of the agencies 

or units on the basis of the amount of the grant or cooperative agreement and the actual cost of 

service provided.

(d) LIMITATIONS ON FUNDS. A condition or limitation applicable to amounts for grant or 

cooperative agreements of the ordering agency or unit applies to an agreement made under this 

section and to a grant or cooperative agreement made under such agreement. 
EXECUTIVE SUMMARY

19 

(e) OBLIGATION OF APPROPRIATIONS. An agreement made under this section obligates an 

appropriation of the ordering agency or unit. The amount obligated is deobligated to the extent 

that the agency or unit providing the service has not incurred obligations, before the end of the 

period of availability of the appropriation, in--

(1) awarding the grant or cooperative agreement; or 

(2) providing the agreed-on services.

(f) NO EFFECT ON OTHER LAWS. This section does not affect other laws about reimbursable 

agreements.

SEC. 226. (a) IN GENERAL.—A State or tribal organization which receives grant funds 

attributable to appropriations under the heading "Department of Health and Human Services—

Administration for Community Living—Aging and Disability Services Programs" to carry out 

programs under parts B, C, D, or E of title III (with respect to States) or under title VI (with 

respect to tribal organizations) of the Older Americans Act of 1965 (OAA) may elect to transfer 

up to 100 percent of such received funds among such title III or title VI programs (respectively), 

subject to OAA sections 306(a)(9) and 307(a)(9) but notwithstanding any otherwise-applicable 

limitations on such transfers under the OAA or such heading. 

(b) NOTIFICATION OF PROPOSED TRANSFER; SECRETARIAL APPROVAL.— 

A State or tribal organization which elects to make a transfer under subsection (a) shall notify 

the Secretary of Health and Human Services of such proposed transfer, including a description 

of the amount to be transferred, the purposes of the transfer, the need for the transfer, and the 
EXECUTIVE SUMMARY

20 

impact of the transfer on the provision of services from which the funding would be transferred. 

The Secretary shall approve any such transfer unless the Secretary determines that such transfer 

is not consistent with the objectives of the OAA.

(c) RULES OF CONSTRUCTION.—No transfer of grant funds by a State or tribal organization 

under this section shall be construed— 

(1) as inconsistent with the authorized use of such funds under the OAA, including for 

purposes of OAA administration and oversight by the Secretary; or (2) to relieve the State or 

tribal organization from applicable reporting requirements under the OAA regarding the use of 

such funds. 
EXECUTIVE SUMMARY

21 

Appropriations Language Analysis 

Administration for Community Living 

Language Provision Explanation

For carrying out, to the extent not otherwise 

provided, the Older Americans Act of 1965 

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

Supporting Grandparents Raising Grandchildren 

Act, titles III and XXIX of the PHS Act, sections 

1252 and 1253 of the PHS Act, section 119 of the 

Medicare Improvements for Patients and 

Providers Act of 2008, title XX-B of the Social 

Security Act, the Developmental Disabilities 

Assistance and Bill of Rights Act, parts 2 and 5 of 

subtitle D of title II of the Help America Vote Act 

of 2002, the Assistive Technology Act of 1998, 

titles II and VII (and section 14 with respect to 

such titles) of the Rehabilitation Act of 1973, and 

for Department-wide coordination of policy and 

program activities that assist individuals with 

disabilities, [$2,171,000,000]$2,072,092,000, 

together with $[52,115,000]36,115,000 to be 

transferred from the Federal Hospital Insurance 

Trust Fund and the Federal Supplementary 

Medical Insurance Trust Fund to carry out section 

4360 of the Omnibus Budget Reconciliation Act of 

1990: 

Sets out the budget authority for the Aging and 

Disability Services Programs appropriation. 

Provided, That amounts appropriated under this 

heading may be used for grants to States under 

section 361 of the OAA only for disease 

prevention and health promotion programs and 

activities which have been demonstrated through 

rigorous evaluation to be evidence-based and 

effective: 

Limits use of funding provided for the Preventive 

Health Services program to programs and 

activities which have been proven to be 

evidence-based and effective. 

Provided further, That up to one percent of 

amounts made available under this heading to 

carry out section 321 of the OAA shall be 

available for developing and implementing 

evidence-based practices to enhance home and 

community-based supportive services: 

Proposes new language to allow ACL to use up to 

1% of appropriations for home and communitybased supportive services for innovation 

demonstrations to improve and enhance HCBS 

services, comparable to the innovation authority 

provided for the nutrition programs.
EXECUTIVE SUMMARY

22 

Provided further, That of amounts made available

under this heading to carry out sections 311,

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

such amounts shall be available for developing 

and implementing evidence-based practices for 

enhancing senior nutrition, including medicallytailored meals:

Continues existing language allowing ACL to use 

up to 1% of nutrition appropriations for 

innovation demonstrations to develop and 

implement evidence-based practices that 

enhance senior nutrition. 

Provided further, That notwithstanding any other 

provision of this Act, funds made available under 

this heading to carry out section 311 of the OAA 

may be transferred to the Secretary of 

Agriculture in accordance with such section:

Allows for transfer of Nutrition Services 

Incentives (NSIP) funding to USDA to provide 

reimbursement for commodities elected by 

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

allocation. 

Provided further, That of the amount made 

available under this heading, $5,000,000 shall be 

available for a program under which the 

Secretary may make competitive grants to 

centers for independent living that have received 

grants under part C of chapter 1 of title VII of the 

Rehabilitation Act of 1973, to develop evidencebased interventions to increase employment of 

individuals with disabilities: 

Allows $5 million of the funding provided to 

Centers for Independent Living (CILs) that have 

already received a formula grant, to be awarded 

competitively to develop evidence-based 

interventions that could be replicated and used 

by any CIL to increase the employment of 

individuals with disabilities. 

Provided further, that none of the funds made 

available under this heading may be used by an 

eligible system (as defined in section 102 of the 

Protection and Advocacy for Individuals with 

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

to pursue any legal action in a Federal or State 

court on behalf of an individual or group of 

individuals with a developmental disability (as 

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

Developmental Disabilities and Assistance and Bill 

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

is attributable to a mental impairment (or a 

combination of mental and physical 

impairments), that has as the requested remedy 

the closure of State operated intermediate care 

facilities for people with intellectual or 

developmental disabilities, unless reasonable 

public notice of the action has been provided to 

such individuals (or, in the case of mental 

incapacitation, the legal guardians who have 

Identifies the purpose, and limits on the use of 

funds provided for Protection and Advocacy. 
EXECUTIVE SUMMARY

23 

been specifically awarded authority by the courts 

to make healthcare and residential decisions on 

behalf of such individuals) who are affected by 

such action, within 90 days of instituting such 

legal action, which informs such individuals (or 

such legal guardians) of their legal rights and how 

to exercise such rights consistent with current 

Federal Rules of Civil Procedure:

Provided further, That the limitations in the 

immediately preceding proviso shall not apply in 

the case of an individual who is neither 

competent to consent nor has a legal guardian, 

nor shall the proviso apply in the case of 

individuals who are a ward of the State or subject 

to public guardianship. 

Identifies the limitations that are not applicable 

to listed individuals. 

GENERAL PROVISIONS 

Language Provision Explanation

(a) IN GENERAL. Under the conditions listed in 

subsection (b), the Secretary or the head of a 

major organizational unit within the Department 

may in this fiscal year enter into a reimbursable 

agreement with the head of another major 

organizational unit within the Department or of 

another agency under which -- 

(1) the head of the ordering agency or 

unit delegates to the head of the 

servicing agency or unit the authority to 

issue a grant or cooperative agreement 

on behalf of the ordering agency or unit;

(2) the servicing agency or unit will 

execute or manage a grant or 

cooperative agreement on behalf of the

ordering agency or unit; and

(3) the ordering agency or unit will 

reimburse the servicing unit or agency for 

the amount of the grant or cooperative 

agreement and for the service of 

executing or managing the grant or 

cooperative agreement.

Proposed language would simplify the accounting 

processes used when one Operating Division 

(OPDIV) has agreed to issue and manage a grant 

on behalf of a second OPDIV. This general 

provision would allow HHS to use the 

reimbursable processing features within the 

accounting system, rather than the more 

cumbersome execution process currently used. 

This provision would also enable an HHS OPDIV 

to collaborate in the same way with an outside 

Department for the purpose of making grants or 

cooperative agreements. Currently, the lack of 

specific authority precludes collaboration. The 

new proposed language would provide HHS 

OPDIVs with the authority to transfer funds via 

reimbursable agreements from one agency to 

another for the purposes of making grants, 

allowing NIDILRR to collaborate on a wider scale 

(e.g., with the Department of Veteran’s affairs on 

research projects to address the needs of 
EXECUTIVE SUMMARY

24 

(b) CONDITIONS. The conditions for making an 

agreement described in subsection (a) are that 

(1) amounts are available;

(2) the head of the ordering agency or 

unit decides the agreement is in the best 

interest of the United States Government; 

and 

(3) the agency or unit to execute or 

manage the grant or cooperative 

agreement is able to provide that service.

(c) PAYMENT. Payment shall be made promptly 

through the Intra-governmental Payment and 

Collection system at the request of the agency or 

unit providing the service. Payment may be in 

advance or on providing all or part of the service, 

and shall be for any part of the estimated or 

actual cost as determined by the agency or unit 

providing the service. A bill submitted or a 

request for payment is not subject to audit or 

certification in advance of payment. Proper 

adjustment of amounts paid in advance shall be 

made as agreed to by the heads of the agencies 

or units on the basis of the amount of the grant or 

cooperative agreement and the actual cost of 

service provided. 

(d) LIMITATIONS ON FUNDS. A condition or 

limitation applicable to amounts for grant or 

cooperative agreements of the ordering agency 

or unit applies to an agreement made under this 

section and to a grant or cooperative agreement 

made under such agreement.

(e) OBLIGATION OF APPROPRIATIONS. An 

agreement made under this section obligates an 

appropriation of the ordering agency or unit. The 

amount obligated is deobligated to the extent 

that the agency or unit providing the service has 

not incurred obligations, before the end of the 

period of availability of the appropriation, in-- 

(1) awarding the grant or cooperative 

agreement; or

(2) providing the agreed-on services.

(f) NO EFFECT ON OTHER LAWS. This section does 

not affect other laws about reimbursable 

agreements.

disabled veterans). Collaboration allows the 

grantees to create a synergy that cannot be 

realized when working in silos. That synergy 

brings opportunities to people with disabilities 

with greater speed and impact. NIDILRR had such 

authority when it was part of the Department of 

Education. The same language has been included 

in both the FY 2018 and FY 2019 requests. 
EXECUTIVE SUMMARY

25 

(a) IN GENERAL.—A State or tribal organization 

which receives grant funds attributable to 

appropriations under the heading "Department of 

Health and Human Services—Administration for 

Community Living—Aging and Disability Services 

Programs" to carry out programs under parts B, 

C, D, or E of title III (with respect to States) or 

under title VI (with respect to tribal organizations) 

of the Older Americans Act of 1965 (OAA) may 

elect to transfer up to 100 percent of such 

received funds among such title III or title VI 

programs (respectively), subject to OAA sections 

306(a)(9) and 307(a)(9) but notwithstanding any 

otherwise-applicable limitations on such transfers 

under the OAA or such heading. 

(b) NOTIFICATION OF PROPOSED TRANSFER; 

SECRETARIAL APPROVAL.— 

A State or tribal organization which elects to 

make a transfer under subsection (a) shall notify 

the Secretary of Health and Human Services of 

such proposed transfer, including a description of 

the amount to be transferred, the purposes of the 

transfer, the need for the transfer, and the impact 

of the transfer on the provision of services from 

which the funding would be transferred. The 

Secretary shall approve any such transfer unless 

the Secretary determines that such transfer is not 

consistent with the objectives of the OAA.

(c) RULES OF CONSTRUCTION.—No transfer of 

grant funds by a State or tribal organization 

under this section shall be construed— 

(1) as inconsistent with the authorized 

use of such funds under the OAA, including for 

purposes of OAA administration and oversight by 

the Secretary; or

(2) to relieve the State or tribal 

organization from applicable reporting 

requirements under the OAA regarding the use of 

such funds.

Proposed language would provide States the 

ability to transfer nearly all of the OAA title III 

funds the receive for Home and communitybased supportive services, Nutrition, Preventive 

Health and Family Caregivers between any of 

these programs to best address the unique needs 

of the people in each State. Comparable 

language is proposed to give Tribes the same 

flexibility with regard to funding they receive for 

OAA Title VI programs.
EXECUTIVE SUMMARY

26 

Amounts Available for Obligation

Administration for Community Living 

FY 2019

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

General Fund Discretionary Appropriation:

Appropriation (L/HHS, Ag, or, Interior).......................... 2,120,200,000 2,171,000,000 2,072,092,000

Secretary's Transfer................................................... 7,345,095 - -

Subtotal, adjusted appropriation............................... 2,112,854,905 2,171,000,000 2,072,092,000

Transfer of Funds to Department of Agriculture 1/.......... (1,902,259) (1,381,186) -

Total, Discretionary Appropriation..................... 2,110,952,646 2,169,618,814 2,072,092,000

Mandatory Appropriation:

BA Transfer (PPACA) from Prevention Funds 2/ 30,945,816 28,506,740 0

Appropriation (MACRA/FCAA) MIPPA 3/..................... 24,421,779 27,080,776 24,500,000 

Subtotal, adjusted mandatory appropriation............... 55,367,595 55,587,516 24,500,000 

Offsetting collections from:

Trust Funds: HCFAC HI 4/........................................ 17,965,073 18,098,804 18,000,000

Trust Funds: SHIP HI/SMI......................................... 49,115,000 52,115,000 36,115,000 

Subtotal, offsetting collections.................................. 67,080,073 70,213,804 54,115,000

Unobligated balance, lapsing.......................................... -1,016,177 - -

Total obligations...................................................... 2,232,384,137 2,295,420,134 2,150,707,000

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

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

ACL’s APT.

2/ Includes carryover funding in FY 2019 and FY 2020.

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

made available to ACL through an Intra-Departmental Delegation of Authority. Includes carryover in FY 2019 and 

FY 2020.

4/ FY 2019 and FY 2020 include carryover.
EXECUTIVE SUMMARY

27 

Summary of Changes

Administration for Community Living 

(Dollars in Thousands) 

2020 Enacted

Total estimated budget authority....................................................................................................... 2,223,115

(Obligations)...................................................................................................................................... 2,221,734

2021 President's Budget

Total estimated budget authority....................................................................................................... 2,108,207

(Obligations)...................................................................................................................................... 2,108,207

Net Change.................................................................................................................................... 114,908

FY 2020

FY 

2021 FY 2021

FY 2021 

+/- FY 

2020

FY 2021 +/- 

FY 2020

Final

PB 

FTE PB BA FTE BA

Increases:

A. Built-in:

1. Program Administration........................................... 41,063 

 

174 42,063 

 

3.0 

 

1,000 

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

 

3.0 

 

1,000 

A. Program:

1. Alzheimer's Disease Program (Direct Approps)..... 11,800 26,500 14,700

2. Elder Rights Support Activities................................ 15,874 3.0 17,874 0.4

 

2,000 

Subtotal, Program Increases............................ 27,674 

 

3.0 44,374 

 

0.4 

 

16,700 

Total Increases................................................ 

 

3.4 

 

17,700 

Decreases:

A. Built-in:

Subtotal, Built-in Decreases.............................. -

 

- -

 

-

 

-

A. Program:

1. Aging Network Support Activities........................... 12,461 0.4 11,503 (958)

2. Family Caregiver Support Services........................ 185,936 150,586 (35,350)

3. Lifespan Respite..................................................... 6,110 3,360 (2,750)

4. Long-Term Care Ombudsman Program................... 17,885 15,855 (2,030)

5. State Councils on Developmental Disabilities.......... 78,000 56,000 (22,000)

6. Developmental Disabilities Protection & Advocacy. 40,784 38,734 (2,050)

7. University Centers on Excellence in DD.................. 41,619 32,546 (9,073)

8. Projects of National Significance............................ 12,250 1,050 (11,200)

9. Independent Living.................................................. 116,183 1.0 113,646 (2,537)

9. National Institute on Disability, Independent Living.. 

 and Rehabilitation Research............................... 111,970 90,371 (21,599)

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

11. State Health Insurance Assistance Programs...... 52,115 4.0 36,115 0.6 (16,000)

12. Assistive Technology........................................... 37,000 31,939 

 

-

 

(5,061)

Subtotal, Program Decreases.......................... 

 

0.6 

 

(132,608)

Total Decreases.............................................. 

 

0.6 

 

(132,608)

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

 

4.0 

 

(114,908)
EXECUTIVE SUMMARY

28 

Budget by Activity

Administration for Community Living

FY 2019 

Final

FY 2020 

FY 2021 

President's 

Health & Independence for Older Adults

Home & Community-Based Supportive Services 384,676 390,074 390,074

Nutrition Services 905,815 936,753 936,753

Preventive Health Services 24,822 24,848 24,848

Native American Nutrition & Supportive Services 34,173 34,708 34,708

Aging Network Support Activities 16,400 12,461 11,503

 Subtotal, Health & Independence for Older Adults 1,365,886 1,398,844 1,397,886

Caregiver & Family Support Services

Family Caregiver Support Services 180,999 185,936 150,586

Native American Caregiver Support Services 10,046 10,306 10,306

Alzheimer's Disease Program 5,296 11,800 26,500

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

 -

-

Lifespan Respite Care 4,096 6,110 3,360

Subtotal, Caregiver & Family Support Services 200,436 214,152 190,752

Protection of Vulnerable Adults

Long-Term Care Ombudsman Program 16,868 17,885 15,855

Prevention of Elder Abuse & Neglect 4,768 4,773 4,773

Elder Rights Support Activities 15,819 15,874 17,874

Subtotal, Protection of Vulnerable Adults 37,455 38,532 38,502

Disability Programs, Research & Services

State Councils on Developmental Disabilities 75,921 78,000 56,000

Developmental Disabilities Protection and Advocacy 40,692 40,784 38,734

University Centers for Excellence in Developmental Disabilities 40,478 41,619 32,546

Projects of National Significance 11,958 12,250 1,050

Independent Living 116,063 116,183 113,646

Limb Loss Resource Center 3,488 4,000 4,000

Paralysis Resource Center 8,670 9,700 9,700

Traumatic Brain Injury 11,291 11,321 11,321

National Institute on Disability, Independent Living, and Rehab. 

Research 108,592 111,970 90,371

Subtotal, Disability Programs, Research & Services 417,155 425,827 357,368

Consumer Information, Access & Outreach

Aging and Disability Resource Centers [Discretionary] 8,091 8,119 6,119

State Health Insurance Assistance Program 49,115 52,115 36,115

Voting Access for People with Disabilities (HAVA) 6,956 7,463 7,463

Assistive Technology 35,955 37,000 31,939

Subtotal, Consumer Information, Access & Outreach 100,117 104,697 81,636

Program Administration 40,921 41,063 42,063

Total, Discretionary Budget Authority 2,161,970 2,223,115 # 2,108,207

 Total FTE 180 189 195

1/Reflects FY 2019 required and permissive transfers and rescissions except the NSIP transfer to USDA of $1.9 million which is shown for 

consistency with State funding tables.

Enacted Budget

-
EXECUTIVE SUMMARY

29 

Authorizing Legislation

Administration for Community Living 

FY 2020 

Amount 

Authorized

FY 2020 Amount 

Appropriated

FY 2021 

Amount 

Authorized

FY 2021 

President's 

Budget

1) Home and Community-Based Supportive Services:

OAA Section 303 (a)(1)..................................................... Expired 390,074,000 Expired 390,074,000 

2) Nutrition Services

OAA Section 303 (b)(1)(2), 311(e) ................................. Expired 936,753,000 Expired 936,753,000 

3) Preventive Health Services:

OAA Section 361................................................................ Expired 24,848,000 Expired 24,848,000 

4) Chronic Disease Self-Management Education:

OAA Section 411, Sections 311 and 317(k)(2) of the Public

. Health Service Act.................................................... Expired 8,000,000 Expired -

5) Falls Prevention:

OAA Section 411 ............................................................. Expired 5,000,000 Expired -

6) National Family Caregiver Support Program:

OAA Section 303 (e)......................................................... Expired 185,936,000 Expired 150,586,000 

7) Native American Nutrition and Supportive Services: 

OAA Section 643............................................................... Expired 34,708,000 Expired 34,708,000 

8) Native American Caregiver Support Program: 

OAA Section 631................................................................ Expired 10,306,000 Expired 10,306,000 

9) Alzheimer's Disease Program: 

OAA Section 411 Expired 11,800,000 Expired 26,500,000 

Patient Protection & Affordable Care Act, Sect 4002 N/A 14,700,000 -

10) Long-Term Care Ombudsman Program:

OAA Section 702(a).......................................................... Expired 17,885,000 Expired 15,855,000 

11) Prevention of Elder Abuse and Neglect: 

OAA Section 702(b).......................................................... Expired Expired 4,773,000 

12) Elder Rights Support Activities

OAA Sections 201, 202, and 411, 751, and 752, as 17,874,000 

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

13) Aging Network Support Activities: 

OAA Sections 202, 215 and 411...................................... Expired 12,461,000 Expired 11,503,000 

14) Lifespan Respite Care

Lifespan Respite Care Act of 2006 and

Public Health Service Act Title XXIX............................... Expired 6,110,000 Expired 3,360,000 

15) Program Administration:

OAA Section 216 (a).......................................................... Expired 41,063,000 Expired 42,063,000 

 4,773,000 

Expired 15,874,000 Expired
EXECUTIVE SUMMARY

30 

Authorizing Legislation – Continued

16) Aging and Disability Resource Centers

OAA Sections 216 (b)(4).................................................. Expired 8,119,000 Expired 6,119,000 

17) State Health Insurance Assistance Program:

Omnibus Budget Reconciliation Act of 1990 Section 4360 Expired 52,115,000 Expired 36,115,000 

18) State Councils on Developmental Disabilities

DD Act Section 129(a)....................................................... Expired 78,000,000 Expired 56,000,000 

19) Protection and Advocacy

DD Act Section 145............................................................ Expired 40,784,000 Expired 38,734,000 

20) University Centers for Excellence in Developmental Disabilities

DD Act Section 156............................................................ Expired 41,619,000 Expired 32,546,000 

21) Projects of National Significance 

DD Act Section 163............................................................ Expired 12,250,000 Expired 1,050,000 

22) Voting Assistance for People with Disabilities

Help America Vote Act Section 291................................ Expired 7,463,000 Expired 7,463,000 

24) Paralysis Resource Center 

Public Health Services Act Sections 311 and 317(k)(2). N/A 9,700,000 N/A 9,700,000 

25) National Institute on Disability, Independent Living, 

and Rehabilitation Research 4/

Rehabilitation Act of 1973 Sect. 201............................... 122,143,000 111,970,000 Expired 90,371,000 

26) Independent Living

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

Independent Living State Grants Section 714........... 26,877,000 25,378,000 Expired 23,731,684 

Centers for Independent Living Section 727............ 91,992,000 90,805,000 Expired 89,914,316 

27) Assistive Technology (AT)

AT Act (including but not limited to Section 4-6)....... Expired 37,000,000 Expired 31,939,000 

28) Limb Loss Resource Center 

Public Health Services Act, Title III................................... N/A 4,000,000 N/A 4,000,000 

29) Sections 1252 and 1253 of the Public Health Service Act

as amended by the Traumatic Brain Injury Reauthorization

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

Traumatic Brain Injury State Grants................................. Expired 7,321,000 Expired 7,321,000 

Traumatic Brain Injury Protection and Advocacy.......... Expired 4,000,000 Expired 4,000,000 

30) Medicare Improvements for Patients and Providers Act/1

Aging and Disabilty Resource Centers........................... 3,219,000 3,219,000 Expired 5,000,000 

Area Agencies on Aging.................................................... 4,831,000 4,831,000 Expired 7,500,000 

National Center for Benefits Outreach and Enrollment 7,726,000 7,726,000 Expired 12,000,000 

State Health Insurance Assistance Program................... 8,370,000 8,370,000 Expired 13,000,000

Total Request Level 2,274,961,000 2,145,707,000 

Unfunded Authorizations:

1) Legal Assistance:

OAA Section 702(b).......................................................... Expired - Expired -

1/ MIPPA amounts are authorized and appropriated only through.
EXECUTIVE SUMMARY

31 

Appropriations History

Administration for Community Living 

Budget 

Estimate to 

Congress

House 

Allowance

Senate 

Allowance Appropriation

FY 2012 /1

 

2,237,944,000 

 

1,471,324,000 

 

1,534,701,000 

 

1,473,703,000 

FY 2012 

Rescission -2,785,299 

Subtotal 1,470,917,701

FY 2013 /2

 

1,978,336,000 N/A 

 

1,708,105,000 

 

1,645,291,724 

FY 2013 

Rescission

 

-- 

 

-- 

 

-- -3,290,583 

FY 2013 

Sequestration

 

-- 

 

-- 

 

-- -82,768,046 

FY 2013 

Transfers

 

-- 

 

-- 

 

-- -6,133,066 

Subtotal 1,553,100,029

FY 2014 /3

 

2,094,755,000 N/A 

 

1,716,664,000 

 

1,662,258,000 

FY 2014 

Transfers -6,433,605 

Subtotal

 

1,655,824,395 

FY 2015 /4

 

2,062,279,000 N/A 

 

1,676,152,000 

 

1,673,256,000 

FY 2015 

Transfers -2,549,334 

Subtotal

 

1,670,706,666 

FY 2016 /5

 

2,104,976,000 

 

1,944,358,000 

 

1,861,089,000 

 

1,964,850,000 

FY 2016 

Transfers -2,214,429 

Subtotal

 

1,962,635,571 

FY 2017 /6

 

1,993,294,000 

 

1,981,275,000 

 

1,935,435,000 

 

1,966,115,000 

FY 2017 

Transfers -6,943,916 

Subtotal

 

1,959,171,084 

FY 2018 /7,8

 

1,851,449,000 

 

2,237,224,000 

 

1,966,115,000 

 

2,144,215,000 

FY 2018 

Transfers -7,951,453 

Subtotal

 

2,136,263,547 
EXECUTIVE SUMMARY

32 

Appropriations History – Continued

FY 2019 /9

 

1,818,681,000 

 

2,186,732,000 

 

2,149,515,000 

 

2,169,315,000 

FY 2019 Transfers -1,902,259 

Subtotal

 

2,167,412,741 

Budget 

Estimate to 

Congress

House 

Allowance

Senate 

Allowance Appropriation

FY 2020 /10

 

2,032,671,000 

 

2,349,343,000 

 

2,175,415,000 

 

2,223,115,000 

FY 2020 Transfers -1,381,186 

Subtotal

 

2,221,733,814 

FY 2021

 

2,108,207,000 

1/ 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.

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

 Department of Agriculture for commodities purchases pursant to Public Law 113-6

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

 Department of Agriculture for commodities purchases pursant to Public Law 113-76.

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

 Department of Agriculture for commodities purchases pursant to Public Law 113-235.

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

 Department of Agriculture for commodities purchases pursant to Public Law 114-113.

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

 Department of Agriculture for commodities purchases pursuant to Public Law 115-31.

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

 Department of Agriculture for commodities purchases pursuant to Public Law 115-31.

8/ House Allowance includes $300 million for the Senior Community Service Employment 

Program

 currently administered by the Department of Labor.

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

 Department of Agriculture for commodities purchases pursuant to Public Law 115-31.

10/ Includes $1,381,186 in FY 2020 budget authority appropriated to ACL and transferred to the 

 Department of Agriculture for commodities purchases pursuant to Public Law 115-31.
EXECUTIVE SUMMARY

33 

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 2020

Older Americans Act of 

1965 FY 2019 $1,585,693,875 $1,643,100,000 $1,682,600,000 

Traumatic Brain Injury: 

Sections 1252 and 1253 of 

the Public Health Service 

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

Elder Justice / Adult 

Protective Services: Social 

Security Act, Title XX-B FY 2014 $129,000,000 $12,000,000 $12,000,000 

Lifespan Respite Care: 

Lifespan Respite Care Act 

of 2006 FY 2011 $94,810,000 $2,495,000 $6,110,000 

Assistive Technology: 

The Assistive Technology 

Act of 2004 FY 2010 Such Sums $25,000,000 $37,000,000 

Developmental 

Disabilities Programs: 

Developmental 

Disabilities

Assistance and Bill of 

Rights Act FY 2007 Such Sums $155,115,000 $172,653,000 

Paralysis Resource 

Center: Christopher and 

Dana Reeve Paralysis Act, 

title XIV of the Omnibus 

Public Land Management 

Act of 2009, P.L. 111-11

and Public Health Service 

Act, Sections 311 and 

317(k)(2)

FY 2011 $25,000,000 $6,352,000 $9,700,000 
EXECUTIVE SUMMARY

34 

Appropriations Not Authorized by Law - Continued

Program

Last Year of 

Authorization

Authorization 

Level

Appropriations 

in Last Year of 

Authorization

Appropriations 

in FY 2020

Limb Loss Resource 

Center:

Public Health Service 

Act Section 301 (a) and 

Section 317 N/A N/A N/A $4,000,000 

Independent Living and 

the National Institute on 

Disability, Independent 

Living and Rehabilitation 

Research:

Rehabilitation Act of 

1973, Titles II & VII FY 2020 $214,135,000 $228,153,000 $228,153,000 

Voting Access for People 

with Disabilities:

Help America Vote Act - 

Section 291 FY 2005 $17,410,000 $13,879,000 $7,463,000 

State Health Insurance 

Assistance Programs: 

Omnibus Budget 

Reconciliation Act of 

1990 FY 1996 $10,000,000 N/A $52,115,000 
EXECUTIVE SUMMARY

35

Program Authorizing Legislation Table

Administration for Community Living 

Account Name Program Name

Location of Program 

Authorization 

Legal Citation 

(US Code)

Most Recent 

(Re)Authorizing 

Legislation

FY 2020 

Funding Level 

in the 

Authorization

FY Auth. 

Expires or 

Expired Nature of Expiration

Aging and 

Disability Services 

Programs

Home and 

CommunityBased 

Supportive 

Services

Older Americans Act (P.L. 

89-73): Section 321,

Section 303(a)(1) 

(Authorization of 

Appropriations).

42 U.S.C. 3030d; 42 

USC 3023

Older Americans 

Reauthorization Act of 

2016, P.L. 114-144

Expired FY 2019 Program Authority AND 

Auth of Appropriation

Aging and 

Disability Services 

Programs

Congregate 

Nutrition 

Services

Older Americans Act (P.L. 

89-73): Section 331,

Section 303(a)(1) 

(Authorization of 

Appropriations).

42 U.S.C. 3030e; 42 

USC 3023

Older Americans 

Reauthorization Act of 

2016, P.L. 114-144

Expired FY 2019 Program Authority AND 

Auth of Appropriation

Aging and 

Disability Services 

Programs

Home-Delivered 

Nutrition

Older Americans Act (P.L. 

89-73): Section 336,

Section 303(a)(1) 

(Authorization of 

Appropriations).

42 U.S.C. 3030f; 42 

USC 3023

Older Americans 

Reauthorization Act of 

2016, P.L. 114-144

Expired FY 2019 Program Authority AND 

Auth of Appropriation

Aging and 

Disability Services 

Programs

Nutrition 

Services 

Incentives 

Program

Older Americans Act (P.L. 

89-73): Section 311,

Section 303(a)(1) 

(Authorization of 

Appropriations).

42 U.S.C. 3030a; 42 

USC 3023

Older Americans 

Reauthorization Act of 

2016, P.L. 114-144

Expired FY 2019 Program Authority AND 

Auth of Appropriation

Aging and 

Disability Services 

Programs

Preventive 

Health Services

Older Americans Act (P.L. 

89-73): Section 361,

Section 303(a)(1) 

(Authorization of 

Appropriations).

42 U.S.C. 3030n; 42 

USC 3023

Older Americans 

Reauthorization Act of 

2016, P.L. 114-144

Expired FY 2019 Program Authority AND 

Auth of Appropriation

Aging and 

Disability Services 

Programs

National Family 

Caregivers 

Support Services

Older Americans Act (P.L. 

89-73): Sections 371-374,

Section 303(a)(1) 

(Authorization of 

Appropriations).

42 U.S.C. 3001 

note; 42 U.S.C. 

3030s; 42 U.S.C. 

3030s–1; 42 U.S.C. 

3030s–2; 42 USC 

3023

Older Americans 

Reauthorization Act of 

2016, P.L. 114-144

Expired FY 2019 Program Authority AND 

Auth of Appropriation

Aging and 

Disability Services 

Programs

Chronic Disease 

SelfManagement 

Education

Older Americans Act, 

Section 411, P.L 89-73.

42 USC 3032a Older Americans 

Reauthorization Act of 

2016, P.L. 114-144

Expired FY 2019 Program Authority

Aging and 

Disability Services 

Programs

Falls Prevention Older Americans Act, 

Section 411, P.L 89-73.

42 USC 3032a Older Americans 

Reauthorization Act of 

2016, P.L. 114-144

Expired FY 2019 Program Authority

Aging and 

Disability Services 

Programs

Aging Network 

Support 

Activities

Older Americans Act, 

Section 411; Authorization 

of Appropriations, Sections 

216 and 411, P.L 89-73.

42 USC 3032a; 40 

USC 3032(14)(b)(1)

Older Americans 

Reauthorization Act of 

2016, P.L. 114-144

Expired FY 2019 Program Authority AND 

Auth of Appropriation

Aging and 

Disability Services 

Programs

Alzheimer's 

Disease Program

Older Americans Act, 

Section 411, P.L 89-73.

42 USC 3032a Older Americans 

Reauthorization Act of 

2016, P.L. 114-144

Expired FY 2019 Program Authority

Aging and 

Disability Services 

Programs

Senior Medicare 

Patrols/Health 

Care Fraud and 

Abuse Control

Older Americans Act (P.L 

89-73): Section 411; and 

the Social Security Act as 

established by the Health 

Insurance Portability and 

Accountability Act of 1996 

(HIPAA) (P.L. 104-191): 

Section 1128C(a).

42 USC 3032a and 

42 USC 1320a-7c

Older Americans 

Reauthorization Act of 

2016, P.L. 114-144

Expired FY 2019 Program Authority

Aging and 

Disability Services 

Programs

Elder Rights 

Support 

Activities

Older Americans Act (P.L 

89-73): Section 411; and 

Sections 216 and 411 

(Authroization of 

Appropriations).

42 USC 3032a; 40 

USC 3032(14)(b)(2)

Older Americans 

Reauthorization Act of 

2016, P.L. 114-144

Expired FY 2019 Program Authority AND 

Auth of Appropriation

Aging and 

Disability Services 

Programs

Aging and 

Disability 

Resource 

Centers

Older Americans Act (P.L. 

89-73): Sections 202(b) and 

41; Section 216 

(Authorization of 

Appropriations)

42 USC 3032a; 42 

U.S.C. 3012; 40 

USC 3032(14)(b)(2)

Older Americans 

Reauthorization Act of 

2016, P.L. 114-144

Expired FY 2019 Program Authority AND 

Auth of Appropriation

Aging and 

Disability Services 

Programs

Native American 

Nutrition and 

Suportive 

Services

Older Americans Act (P.L. 

89-73): Sections 611 and 

621; Section 643 

(Authorization of 

Appropriations).

42 USC 3057n Older Americans 

Reauthorization Act of 

2016, P.L. 114-144

Expired FY 2019 Program Authority AND 

Auth of Appropriation
EXECUTIVE SUMMARY

36 

Program Authorizing Legislation Table - Continued

Account Name Program Name

Location of Program 

Authorization 

Legal Citation 

(US Code)

Most Recent 

(Re)Authorizing 

Legislation

FY 2020 

Funding Level 

in the 

Authorization

FY Auth. 

Expires or 

Expired Nature of Expiration

Aging and 

Disability Services 

Programs

Native American 

Caregivers 

Support 

Progeram

Older Americans Act (P.L. 

89-73): Section 631; 

Section 643 (Authorization 

of Appropriations).

42 USC 3057n Older Americans 

Reauthorization Act of 

2016, P.L. 114-144

Expired FY 2019 Program Authority AND 

Auth of Appropriation

Aging and 

Disability Services 

Programs

Long-Term Care 

Ombudsman 

Program

Older Americans Act (P.L. 

89-73): Section 731; 

Section 702(a) 

(Authorization of 

Appropriations).

42 USC 3058a Older Americans 

Reauthorization Act of 

2016, P.L. 114-144

Expired FY 2019 Program Authority AND 

Auth of Appropriation

Aging and 

Disability Services 

Programs

Prevention of 

Elder Abuse and 

Neglect

Older Americans Act, 

Section 721; Authorization 

of Appropriations, Section 

702(b), P.L. 89-73 Older 

Americans Act (P.L. 89-

73): Section 721; Section 

702(b) (Authorization of 

Appropriations).

42 USC 3058a Older Americans 

Reauthorization Act of 

2016, P.L. 114-144

Expired FY 2019 Program Authority AND 

Auth of Appropriation

Aging and 

Disability Services 

Programs

Lifespan Respite 

Care

Lifespan Respite Care Act

of 2006, Title XXIX,

Section 2905 of the Public

Health Service Act

42 USC 201 et seq. Lifespan Respite Care

Act of 2006, Title XXIX

of the Public Health

Service Act

Expired FY 2011 Program Authority AND 

Auth of Appropriation

Aging and 

Disability Services 

Programs

State Councils 

on 

Developmental 

Disabilities

Developmental Disabilities 

Assistance and Bill of 

Rights Act, Section 125; 

Authorization of 

Appropriations, Section 

129, P.L. 106-402

42 USC 15029 Developmental 

Disabilities Assistance 

and Bill of Rights Act of 

2000, P.L. 106-402

Expired FY 2007 Program Authority AND 

Auth of Appropriation

Aging and 

Disability Services 

Programs

Developmental 

Disabilities 

Protection and 

Advocacy

Developmental Disabilities 

Assistance and Bill of 

Rights Act, Section 141; 

Authorization of 

Appropriations, Section 

145, P.L. 106-402

42 USC 15045 Developmental 

Disabilities Assistance 

and Bill of Rights Act of 

2000, P.L. 106-402

Expired FY 2007 Program Authority AND 

Auth of Appropriation

Aging and 

Disability Services 

Programs

University 

Centers of 

Excellence in 

Developmental 

Disabilities

Developmental Disabilities 

Assistance and Bill of 

Rights Act, Section 151; 

Authorization of 

Appropriations, Section 

156, P.L. 106-402

42 USC 15066 Developmental 

Disabilities Assistance 

and Bill of Rights Act of 

2000, P.L. 106-402

Expired FY 2007 Program Authority AND 

Auth of Appropriation

Aging and 

Disability Services 

Programs

Projects of 

National 

Significance

Developmental Disabilities 

Assistance and Bill of 

Rights Act (P.L. 106-402): 

Section 161; Section 163 

(Authorization of 

Appropriations).

42 USC 15083 Developmental 

Disabilities Assistance 

and Bill of Rights Act of 

2000, P.L. 106-402

Expired FY 2007 Program Authority AND 

Auth of Appropriation

Aging and 

Disability Services 

Programs

Independent 

Living

Rehabilitation Act of 1973, 

Title VII, Parts B&C and 

Chapter 2, Sections 711 and 

721; Authorization of 

Appropriations, Sections 

714 and 727, P.L. 93-112

29 USC 796e-3 and 

29 USC 796f-6

Workforce Innovation 

and Opportunities Act of 

2014, P.L. 113-128

State Grants--

26,877,000; 

Centers for 

Independent 

Living--

91,992,000

FY 2020 Program Authority AND 

Auth of Appropriation
EXECUTIVE SUMMARY

37 

Program Authorizing Legislation Table - Continued

Account Name Program Name

Location of Program 

Authorization 

Legal Citation 

(US Code)

Most Recent 

(Re)Authorizing 

Legislation

FY 2020 

Funding Level 

in the 

Authorization

FY Auth. 

Expires or 

Expired Nature of Expiration

Aging and 

Disability Services 

Programs

National 

Institute on 

Disabilities, 

Independent 

Living and 

Rehabilitation 

Research

Rehabilitation Act of 1973, 

Title II (P.L. 93-112): 

Section 202(a)(1); Section 

201 (Authorization of 

Appropriations).

29 USC 761 Workforce Innovation 

and Opportunities Act of 

2014, P.L. 113-128

122,143,000 FY 2020 Program Authority AND 

Auth of Appropriation

Aging and 

Disability Services 

Programs

Limb Loss 

Resource Center Public Health Service

Act Section 301 (a) and

Section 317

42 USC 241(a); 42 

USC 247(b)

Public Health Service 

Act Section 301 (a) and 

Section 317

Expired N/A Program Authority

Aging and 

Disability Services 

Programs

Paralysis 

Resource Center

Christopher and Dana 

Reeve Paralysis Act, title 

XIV of the Omnibus Public 

Land Management Act of 

2009, P.L. 111-11 and 

Public Health Service Act, 

Sections 311 and 317(k)(2)

42 USC 284o Christopher and Dana 

Reeve Paralysis Act, title 

XIV of the Omnibus 

Public Land Management 

Act of 2009, P.L. 111-11 

and Public Health Service 

Act, Sections 311 and 

317(k)(2)

Expired FY 2013 Program Authority AND 

Auth of Appropriation

Aging and 

Disability Services 

Programs

Traumatic Brain 

Injury

Traumatic Brain Injury Act 

of 1996, P.L. 104-166

42 USC 280b et seq. Traumatic Brain Injury 

Reauthorization Act of 

2014, P.L. 113-196

Expired FY 2019 Program Authority AND 

Auth of Appropriation

Aging and 

Disability Services 

Programs

State Health 

Insurance 

Assistance 

Program

Omnibus Budget 

Reconciliation Act of 1990, 

Section 4360, P.L. 101-508

42 USC 1395b-4 Omnibus Budget 

Reconciliation Act of 

1990, Section 4360, P.L. 

101-508

Expired N/A Program Authority AND 

Auth of Appropriation

Aging and 

Disability Services 

Programs

Voting Access 

for People with 

Disabilities

Help America Vote Act of 

2002 (P.L. 107-252): 

Section 291; Section 292 

(Authorization of 

Appropriations) 

42 USC 15462 Help America Vote Act 

of 2002, Section 291, 

P.L 107-252

Expired FY 2005 Program Authority AND 

Auth of Appropriation

Aging and 

Disability Services 

Programs

Assistive 

Technology

Technology-Related for 

Individuals with Disabilities 

Assistance Act of 1988

29 USC 3007 Improving Access to 

Assistive Technology for 

Individuals with 

Disabilities Act of 2004, 

P.L. 108-364

Expired FY 2010 Program Authority AND 

Auth of Appropriation

Not Applicable Medicare 

Improvements 

for Patients and 

Providers Act

Medicare Improvements for 

Patients and Providers Act 

of 2008, Section 119, P.L. 

110-275

42 USC 1395 Consolidated 

Appropriations Act of 

2018, P.L. 115-141

Expired FY 2019 Appropriation in 

Authorizing Legislation

Aging and 

Disability Services 

Programs

Program 

Administration

Older Americans Act, 

Developmental Disabilities 

Assistance and Bill of 

Rights Act, the Help 

America Vote Act, the 

Assistive Technology Act, 

the Rehabilitation Act, 

Public Health Services Act, 

the Elder Justice Act

N/A Older Americans Act, 

Developmental 

Disabilities Assistance 

and Bill of Rights Act, the 

Help America Vote Act, 

the Assistive Technology 

Act, the Rehabilitation 

Act, Public Health 

Services Act, the Elder 

Justice Act

N/A N/A Program Authority
TIVE SUMMARY

38 

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HEALTH AND INDEPENDENCE FOR OLDER ADULTS

TIVE SUMMARY

39 

Health and Independence for Older Adults

Summary of Request

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

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

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

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

seniors in their homes), and preventive health services. 

The U.S. population over age 60 is projected to increase by 6 percent between 2018 and 2020, 

from 72.8 million to 77.1 million.

5

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

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

Release Date: September 2018. https://www.census.gov/data/tables/2017/demo/popproj/2017-summary-tables.html. 

Accessed 10 December 2019. U.S. Census Bureau, Annual Estimates of the Resident Population for Selected Age 

Groups by Sex, for the United States: April 1, 2010 to July 1, 2018. Released June 

2019.https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml. Accessed 10 December 2019.

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 6 percent over the same period.6

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

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

Release Date: September 2018. https://www.census.gov/data/tables/2017/demo/popproj/2017-summary-tables.html. 

Accessed 10 December 2019. U.S. Census Bureau, Annual Estimates of the Resident Population for Selected Age 

Groups by Sex for the United States: April 1, 2010 to July 1, 2018: Released June 2019, 

https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml. Accessed 10 December 2019. Centers for Medicare & 

Medicaid Services, ACL analysis of 2016 Medicare Current Beneficiary Survey, https://www.cms.gov/ResearchStatistics-Data-and-Systems/Research/MCBS/index. Accessed 10 December 2019.

Health and 

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

communities at a lower cost than institutional services. For example, 68 percent of congregate and 

88 percent of home-delivered meal recipients reported that the meals allowed them to continue 

living in their own homes.7

7 2019 National Survey of Older Americans Act Participants. https://agid.acl.gov/

 Additionally, 69 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

8 Ibid. 

The Budget includes proposals to introduce innovation into ACL programs including: 

• Allowing up to one percent of Home and Community Based Services funding to be used 

to conduct innovation demonstration grants to improve the provision of Home and 

Community Based Services; and

• Giving States maximum flexibility to transfer funding between HCBSS, Nutrition, 

Preventive Health Services, and Family Caregivers Support Services programs, to achieve 

the funding that best addresses the community’s unique needs of people in each state. 

. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

40 

ACL’s FY 2021 funding request for Health and Independence for Older Adults programs is 

$1.4 billion, a reduction of -$13.9 million below the FY 2020 Enacted level. FY 2021 specific 

program requests include: 

• $390.1 million for Home and Community-Based Supportive Services (HCBSS), the same 

as the FY 2020 Enacted level. The request includes a proposal to use up to 1% of program 

funding to conduct innovation grants, similar to the authority that ACL has for its nutrition 

programs. HCBSS provides grants to states to fund an array of low cost services that enable 

seniors to remain in their homes for as long as possible, including adult day care, 

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

fitness programs. These services also aid caregivers, who might otherwise have to be even 

more intensively relied upon to provide care for their loved ones, thus taking more time 

away from their work and other family responsibilities.

• $936.8 million for Congregate Nutrition, Home-Delivered Nutrition and the Nutrition 

Services Incentives Program, the same as the FY 2020 Enacted level. Nutrition Services 

programs will help over 2.25 million older adults receive the meals they need to stay 

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

level would support over 214.3 million meals.

• $24.8 million for Preventive Health Services, the same as the FY 2020 Enacted level. The 

request allows States the flexibility to also fund Chronic Disease Self-Management and 

Falls Prevention programs as part of their Preventive Health Services, to meet the greatest 

areas of need in their communities. ACL is not requesting separate funding for the Chronic 

Disease Self-Management Education (CDSME) program and the Falls Prevention 

programs. 

• $34.7 million for Native American Nutrition and Supportive Services, the same level as 

the FY 2020 Enacted level. These funds will provide approximately 4.2 million meals and 

566,090 rides for Native American seniors to critical daily activities such as meal sites, 

medical appointments, and grocery stores. 

• $11.5 million for Aging Network Support Activities, a reduction of -$0.9 million below 

the FY 2020 Enacted level. The level does not include funding for the Care Corps 

Demonstration Program, and includes a decrease in Program Performance and Technical 

Assistance. Aging Network Support Activities funds competitive grants and contracts for 

ongoing activities which help seniors and their families obtain information about their care 

options and benefits and which provide technical assistance to assist states, Tribes, and 

community providers of aging services to carry out their mission to help older people 

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

41 

Outcome and Outputs Table:

Health and Independence for Older Adults

Program: Health and Independence for Older Adults

Measure Year and Most Recent Result 

/ 

Target for Recent Result /

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-FY 2020

Target

1.1 For Home and 

Community-based 

Services including 

Nutrition and Caregiver 

services increase the 

number of clients served 

per million dollars of Title 

III OAA funding. 

(Efficiency)

FY 2018: 7,821 clients

Target:

8,800 clients

(Target Not Met)

7,799 clients 7,517 clients -282 clients

2.10 Increase the 

likelihood that the most 

vulnerable people 

receiving Older Americans 

Act Home and 

Community-based and 

Caregiver Support 

Services will continue to 

live in their homes and 

communities. (Outcome)

FY 2018: 66.7 weighted 

average

Target:

63.25 weighted average

(Target Exceeded)

64 weighted 

average

64.7 weighted 

average

+0.7 weighted 

average

3.3 The percentage of 

OAA clients served who 

live in rural areas is at 

least 15% greater than 

the percent of all US 

elders who live in rural 

areas. (Outcome)

FY 2018: 34.61%

Target:

26.2%

(Target Exceeded)

35.87% 34.9% -0.97 

3.6 The percentage of 

OAA clients served who 

live in poverty is 150% 

greater than the percent 

of all U.S. elders living 

below the poverty level. 

(Outcome)

FY 2018: 33.6%

Target:

25.68%

(Target Exceeded)

32.66% 33.11% +0.45 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

42 

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HEALTH AND INDEPENDENCE FOR OLDER ADULTS

TIVE SUMMARY

43 

Home and Community-Based Supportive Services

Services

FY 2019 

Final 

FY 2020 

Enacted 

FY 2021 

President’s 

Budget 

FY 2021 +/- FY 

2020

Home and Community-Based Supportive 

Services $384,676 $390,074 $390,074 --

*BA is in thousands of dollars.

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

Law 89-73 

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

114-144

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

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

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

Program Description and Accomplishments:

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

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

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

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

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

in their homes and communities, instead of entering institutional care.

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

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

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

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

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

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

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

9 The Sandwich Generation: Rising Financial Burdens for Middle-Aged Americans

http://www.pewsocialtrends.org/2013/01/30/the-sandwich-generation/. Accessed 12-3-2018
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

44 

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

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

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

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

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

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

Among those aged 85 and older, 48 percent are unable to perform one or more critical activities of 

daily living and require long-term support.

10

10 Centers for Medicare & Medicaid Services, ACL analysis of 2016 Medicare Current Beneficiary Survey, 

https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS/index. Accessed 10 December 2019. 

 Data also show that over 96 percent of seniors age 

85 and older have at least one chronic condition and 87 percent have at least two.11

11 Ibid. 

 Providing a 

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

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

avoid unnecessary, expensive nursing home care. 

Core Older Americans Act (OAA) formula grant programs like HCBSS currently reach more than 

one in six seniors,12

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

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

disability criteria for nursing home admission13

13 Ibid.

and helping to keep them from joining the 

1.7 million seniors who live in institutional settings.14

14 Centers for Medicare & Medicaid Services ACL analysis of 2016 Medicare Current Beneficiary Survey. 

https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS/index. Accessed 10 December 

2019.

 Nationally, 24 percent of individuals 60 and 

older live alone,

15

15 Administration for Community Living, https://agid.acl.gov/DataGlance/. Data-at-a-Glance: American Community 

Survey (ACS) Public Use Microdata Sample (PUMS) 1-Year Files (2017), accessed 10 December, 2019. 

and in FY 2017, 44 percent of OAA consumers were individuals who live 

alone.16

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

 Living alone is a key predictor of nursing home admission, and HCBSS services are 

critical to their ability to remain at home, especially for those who do not have an informal 

caregiver to assist with their care. Research has also shown that childless seniors who live in a 

state with higher home and community-based service expenditures had significantly lower risk of 

nursing home admissions.17

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.

Services provided by the HCBSS program in FY 2018 include: 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

45 

• Transportation Services provided more than 20.2 million rides to doctor’s offices, grocery 

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

(Output C).

18

18 ACL’S OAA State Performance Report, FY 2018.

• Personal Care, Homemaker, and Chore Services provided more than 47.8 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).19

19 Id.

• Adult Day Care/Day Health provided over 11.7 million hours of care for dependent adults 

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

(Output E).20

20 Id.

• Case Management Services provided nearly 3.5 million hours of assistance in assessing 

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

(Output F).21

21 Id.

Continuing ACL’s commitment to provide services to those most in need, 46 percent of riders on 

OAA-funded transportation are mobility impaired, meaning they do not own a car, or if they do 

own a car, they do not drive, and are not near public transportation.22

22 2019 National Survey of Older Americans Act Participants. https://agid.acl.gov/. 

 Many of these individuals 

cannot safely drive a car, as 71 percent of transportation riders have at least one chronic conditions 

that could impair their ability to navigate safely.

23

23 Id.

Of the transportation participants, 96 percent take daily medications, with over 20 percent taking 

10 to 25 medications daily.24

24 Id.

Data from ACL’s National Surveys of OAA Participants show that 

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

to help them remain at home. For example, 53 percent of seniors using transportation services rely 

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

Over 82 percent of clients receiving case management also reported that, as a result of the services 

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

25 Id.

In addition, a study 

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

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

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

26 Chen, Ya Mei and Elaine Adams Thompson. Understanding Factors That Influence Success of Home- and 

Community-Based Services in Keeping Older Adults in Community Settings. 2010. Journal of Aging and Health. 

V. 22: 267. Available: http://jah.sagepub.com/cgi/content/abstract/22/3/267. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

46 

Funding History:

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

follows:

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

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

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

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

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

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

FY 2018 ...................................$385,074,000 

FY 2019 ..................................$384,676,000 

FY 2020 Enacted .....................$390,074,000 

FY 2021 President’s Budget ....$390,074,000 

Budget Request:

The FY 2021 request for Home and Community-Based Supportive Services (HCBS) is 

$390,074,000 the same as the FY 2020 Enacted level. Within this level the Budget provides two 

areas of expanded flexibility. The creation of innovation funding authority, and the flexibility to 

shift up to one hundred percent of funding between nutrition programs, HCBS, and Preventive 

Health Services. 

\ 

Based on feedback over the years and ACL’s knowledge of needs and gaps in the field of aging, 

ACL anticipates testing innovative approaches in areas such as the following: 

• Transportation – key areas of need for innovations include specialized transportation, 

volunteer transportation, mobility management, and travel training. 

• Senior Centers – the transformation and modernization of senior centers to spark relevancy 

and the ability to attract new, younger participants and to expand into the areas of overall 

wellness as well as to position them as community hubs. 

• Intergenerational Programming – there is substantial research about the benefits of 

intergenerational programming for both older individuals as well as children. ACL is 

interested in testing it to combat social isolation, depression, and the benefits associated 

with civic engagement.

• Use of Technology – based on the roadmap outlined in the White House report, Emerging 

Technologies to Support an Aging Population, ACL is interested in exploring the practical 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

47 

+}?_”{P)gvuses of technology in providing HCBS supports and in enhancing the ability of 

individuals to live independently in their homes and communities. 

• Home Modification – ACL is interested in implementing and testing models that our 

National Resource Center on Aging in Place by Enhancing Access to Home Modifications 

has identified to make homes safer and more accessible.

• Dementia Innovations – ACL is interested in exploring the translation and expansion of 

the principles of dementia-friendly and dementia-capable communities.

• Case Management and Care Coordination – ACL is interested in testing the most effective 

means of providing care coordination, especially as the network interfaces with the 

healthcare sector in the provision of the social determinants of health.

• Aging in Place – ACL is interested in exploring flexible opportunities for communitybased organizations to test or take to scale innovating approaches to serve older adults and 

their caregivers.

Expanded Transfer Authority: Currently, states can transfer up to 30 percent of their funding for 

Nutrition and HCBSS between these programs, and up to 40 percent of Nutrition funding between 

the Nutrition programs. In FY 2021, ACL is continuing to propose a general provision that would 

provide additional funding flexibility, and give states the ability to transfer nearly all of the funds 

they receive for HCBSS, Nutrition, Preventive Health and Caregivers between any of these 

programs to best address the community unique needs of the people in each state. 

The Budget request supports an estimated additional 0.4 million units of adult day care for older 

adults; a reduction of -0.9 million rides for activities such as visiting the doctor, the pharmacy, or 

grocery stores; and an additional 0.4 million hours of assistance for seniors who are unable to 

perform daily activities. These estimates take into account State, local, and private funding streams 

that also support these activities.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

48 

Outputs and Outcomes Table:

Home and Community-Based Supportive Services 

Measure Year and Most Recent Result 

/ 

Target for Recent Result /

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-FY 2020

Target

1.1 For Home and 

Community-based 

Services including 

Nutrition and Caregiver 

services increase the 

number of clients served 

per million dollars of Title 

III OAA funding. 

(Efficiency)

FY 2018: 7,821 clients

Target:

8,800 clients

(Target Not Met)

7,799 clients 7,517 clients -282 clients

2.9b Maintain at 90% or 

higher the percentage of 

transportation clients 

who rate services good to 

excellent. (Outcome)

FY 2018: 94%

Target:

90%

(Target Exceeded)

90% 94% +4 

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 2018: 66.7 weighted 

average

Target:

63.25 weighted average

(Target Exceeded)

64 weighted 

average

64.7 weighted 

average

+0.7 weighted 

average

3.3 The percentage of 

OAA clients served who 

live in rural areas is at 

least 15% greater than 

the percent of all US 

elders who live in rural 

areas. (Outcome)

FY 2018: 34.61%

Target:

26.2%

(Target Exceeded)

35.87% 34.9% -0.97 

3.6 The percentage of 

OAA clients served who 

live in poverty is 150% 

greater than the percent 

of all U.S. elders living 

below the poverty level. 

(Outcome)

FY 2018: 33.6%

Target:

25.68%

(Target Exceeded)

32.66% 33.11% +0.45 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

49 

Indicator Year and Most Recent 

Result /

FY 2020

Projection

FY 2021

Projection

FY 2021

Projection

+/-FY 2020 

Projection

Output C: Transportation 

Service Units (Output)

FY 2018: 20,259,508 18.8 M 17.9 M -0.9 M

Output D: Personal Care, 

Homemaker and Chore 

Services units (Output)

FY 2018: 47,804,092 51.8 M 52.2 M +0.4 M

Output E: Adult Day 

Care/Day Health units

(Output)

FY 2018: 11,662,539 12.7 M 13.1 M +0.4 M

Output F: Case 

Management Services 

units (Output)

FY 2018: 3,515,043 2.8 M 2.7 M -0.1 M

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.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

50 

Grant Awards Tables:

Home and Community-Based Supportive Services Grant Awards 

FY 2019 

Final

FY 2020

Enacted

FY 2021 

President’s 

Budget

Number of 

Awards 56 56 56

Average Award $6,827,997 $6,895,951 $6,826,295

Range of Awards

$238,980/ 

$39,743,942

$241,358/ 

40,077,468

$238,920/ 

$39,672,649
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

51 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2021 DISCRETIONARY STATE FORMULA GRANTS

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

STATE/TERRITORY FY 2019 Final FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

Alabama 5,736,488 5,786,994 5,728,540 (58,454)

Alaska 1,911,839 1,930,866 1,911,362 (19,504)

Arizona 8,335,736 8,557,702 8,526,158 (31,544)

Arkansas 3,508,869 3,527,647 3,492,014 (35,633)

California 39,743,942 40,077,468 39,672,649 (404,819)

Colorado 5,699,077 5,818,782 5,760,006 (58,776)

Connecticut 4,317,097 4,332,729 4,288,964 (43,765)

Delaware 1,911,839 1,930,866 1,911,362 (19,504)

District of Columbia 1,911,839 1,930,866 1,911,362 (19,504)

Florida 28,572,320 29,014,716 28,721,638 (293,078)

Georgia 10,258,188 10,428,072 10,322,738 (105,334)

Hawaii 1,911,839 1,930,866 1,911,362 (19,504)

Idaho 1,911,839 1,942,995 1,923,369 (19,626)

Illinois 14,029,336 14,100,613 13,958,183 (142,430)

Indiana 7,396,558 7,465,207 7,389,801 (75,406)

Iowa 4,085,780 4,085,780 4,044,509 (41,271)

Kansas 3,291,834 3,291,834 3,258,583 (33,251)

Kentucky 5,114,777 5,154,501 5,102,435 (52,066)

Louisiana 5,072,693 5,115,472 5,063,801 (51,671)

Maine 1,911,839 1,930,866 1,911,362 (19,504)

Maryland 6,569,648 6,627,280 6,560,338 (66,942)

Massachusetts 7,942,180 8,012,991 7,932,052 (80,939)

Michigan 12,028,499 12,142,985 12,020,329 (122,656)

Minnesota 6,224,393 6,312,823 6,249,057 (63,766)

Mississippi 3,317,665 3,343,410 3,309,638 (33,772)

Missouri 7,183,739 7,242,037 7,168,885 (73,152)

Montana 1,911,839 1,930,866 1,911,362 (19,504)

Nebraska 2,200,628 2,200,628 2,178,399 (22,229)

Nevada 3,274,944 3,327,195 3,293,587 (33,608)

New Hampshire 1,911,839 1,930,866 1,911,362 (19,504)
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

52 

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

STATE/TERRITORY FY 2019 Final FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

 

New Jersey 10,179,027 10,179,027 10,076,209 (102,818)

New Mexico 2,453,623 2,485,576 2,415,442 (70,134)

New York 23,285,517 23,285,517 23,050,310 (235,207)

North Carolina 11,619,807 11,805,182 11,685,938 (119,244)

North Dakota 1,911,839 1,930,866 1,911,362 (19,504)

Ohio 13,962,633 14,073,418 13,931,262 (142,156)

Oklahoma 4,303,247 4,335,316 4,291,525 (43,791)

Oregon 5,054,067 5,119,419 5,067,708 (51,711)

Pennsylvania 17,145,210 17,145,210 16,972,026 (173,184)

Rhode Island 1,911,839 1,930,866 1,911,362 (19,504)

- - - -

South Carolina 6,116,777 6,232,652 6,169,696 (62,956)

South Dakota 1,911,839 1,930,866 1,911,362 (19,504)

Tennessee 7,697,603 7,778,235 7,699,667 (78,568)

Texas 25,454,775 25,890,035 25,628,519 (261,516)

Utah 2,441,265 2,492,613 2,457,565 (35,048)

Vermont 1,911,839 1,930,866 1,911,362 (19,504)

Virginia 9,168,569 9,293,610 9,199,735 (93,875)

Washington 8,110,742 8,253,685 8,170,314 (83,371)

West Virginia 2,659,561 2,659,561 2,632,697 (26,864)

Wisconsin 6,889,191 6,974,603 6,904,152 (70,451)

Wyoming 1,911,839 1,930,866 1,911,362 (19,504)

 Subtotal 375,299,912 379,083,912 375,254,782 (3,829,130)

American Samoa 452,907 452,907 448,332 (4,575)

Guam 955,920 965,433 955,681 (9,752)

Northern Mariana Islands 238,980 241,358 238,920 (2,438)

Puerto Rico 4,464,217 4,464,217 4,419,124 (45,093)

Virgin Islands 955,920 965,433 955,681 (9,752)

 Subtotal 382,367,856 386,173,260 382,272,520 (3,900,740)

Program Support 1/ 2,308,144 3,900,740 7,801,480 3,900,740

Total States/Territories 384,676,000 390,074,000 390,074,000 -

1/ Program Support- Includes funds for Older American Act statutory requirements, including evaluation and disaster assistance 

and grant and program reporting systems costs. Funds unused for these purposes at the end of the year are allocated to states. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

53 

Nutrition Services

Services

FY 2019 

Final 

FY 2020

Enacted

FY 2021 

President’s 

Budget Level

FY 2021 (+/-) FY 

2020

Congregate Nutrition 

Services $494,830 $510,342 $510,342 --

Home-Delivered Nutrition $251,082 $266,342 $266,342 --

Nutrition Services 

Incentive Program27

27 Includes $1,902,259 that was transferred to USDA to pay for State elections of commodities in FY 2019, and 

$1,381,186 that was transferred to USDA in FY 2020. 

$159,903 $160,069 $160,069 --

Total: $905,815 $936,753 $936,753 --

*BA is in thousands of dollars.

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

Public Law 89-73 

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

114-144 

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

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

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

Program Description and Accomplishments: 

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

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

facilities such as senior centers) and via home-delivery to older adults who are homebound due to 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

54 

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

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

providers.28

28 ACL’S OAA State Performance Report, FY 2016. 

Nutrition Services currently include: 

• Congregate Nutrition Services (Title III-C1): Provides funding for the provision of meals 

and other related services in a variety of community settings (e.g., senior centers, churches, 

community centers, congregate dining facilities, school cafeterias, restaurants, farmers 

markets, hospital cafeterias, etc.) which help older individuals remain healthy and prevents 

the need for more costly medical interventions. Established in 1972, the program also 

presents opportunities for social engagement, health promotion activities, nutrition 

education, nutrition counseling, and meaningful volunteer and social engagement roles, all 

of which contribute to participants’ overall health and well-being. Congregate Nutrition 

Services provided 73.6 million meals to more than 1.5 million seniors in a variety of 

community settings in 2018.29

29 Id.

• Home-Delivered Nutrition Services (Title III-C2): Provides funding for the delivery of 

meals and related services to frail seniors who are home-bound. Established in 1978, homedelivered meals are often the first in-home service that an older adult receives and are often 

the primary access point for other home and community-based services. In addition to 

providing a meal, this service helps frail home-bound seniors’ combat isolation and

maintain contact with the outside world. Home-delivered meals provided to caregivers 

also represent an essential service, helping them maintain their own health and well-being 

while caring for their loved ones. Home-Delivered Nutrition Services provided 147.0 

million meals to over 871,000 individuals in FY 2018.30

30 Id.

• Nutrition Services Incentive Program (Title III-A): Provides a secondary source of funding 

that must be used exclusively to provide meals, but which can be applied to either 

congregate or home-delivered meals. Recipients can elect to receive part or all of their 

grants as commodities from the U.S. Department of Agriculture if they determine that 

doing so will enable them to better meet the needs of older adults. Five states elected to 

spend over $1.2 million on commodities (plus $154,089 assessed by USDA as 

administrative expenses) in FY 2020. 

Consistent with the Administrator’s focus on identifying new ways to efficiently improve direct 

service programs, ACL, under its 1% Nutrition authority, is using $7.5 million in FY 2020 to fund 

nutrition innovations and test ways to modernize how meals are provided to a changing senior

population. One promising demonstration currently being carried out by the Georgia State 

University Research Foundation31

31 Double Blind Randomized Control Trial on the Effect of Evidence-Based Suicide Intervention Training on the 

Home-Delivered and Congregate Nutrition Program through the Atlanta Regional Commission.

that has drawn widespread attention is an effort to train 

volunteers who deliver home-delivered meals to recognize and report indicators of suicidal intent 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

55 

and other mental health issues, so that they can be addressed. Suicide is a significant problem 

among elderly individuals, many of whom may be isolated, live in rural areas at a distance from 

neighbors or be depressed.

32 Results from this demonstration can be used to support programs led 

by Veterans’ Affairs and Health and Human Services/Substance Abuse Mental Health Services 

Administration. 

Formula grants for congregate nutrition services and home-delivered nutrition services are 

allocated to states and territories based on their share of the population age 60 and over. Nutrition 

Services Incentive Program (NSIP) grants are provided to states, territories, and eligible tribal 

organizations based on the number of meals served in the prior fiscal year. The meals provided 

through these programs fulfill the standards set by the current Dietary Guidelines for Americans. 

Nutrition services assist over 2.4 million (2017)33

33 Id.

 diverse participants with characteristics that 

place them at higher risk for health care interventions as well as institutionalization. For example:

• The percentage of home-delivered meal recipients with severe disabilities (3+ ADL) was

38 percent in 2017.34

34 Id.

This level of disability is frequently associated with nursing home 

admission, and demonstrates the extreme frailty of a significant number of home-delivered 

meal clients. Approximately 67 percent of home-delivered meal recipients have annual 

incomes at or below $20,000.35

35 2019 National Survey of Older Americans Act Participants. https://agid.acl.gov/. 

 Nearly 61 percent of recipients of home-delivered meals, 

and 54 percent of participants in congregate meals, report these meals as half or more of 

their food intake for the day.36

36 Id.

• The prevalence of multiple chronic conditions is higher among congregate and 

home-delivered meal program participants in comparison to the general Medicare 

population. In fact, data from ACL’s National Survey of OAA Participants indicate that 

57 percent of congregate, and 64 percent of home-delivered, meal participants have six or 

more chronic health conditions. About 30 percent of congregate, and 54 percent of homedelivered, meal participants take over six medications per day and some take as many as 

20 medications.37

37 Id. 

• Nutrition is one of the major determinants of successful aging. It plays an important role 

in preventing and treating many of the most common chronic conditions, such as 

hypertension, heart disease, diabetes, osteoporosis, and obesity.

38

38 Kimokoti and Millen, 2016; Bernstein and Munoz, 2012. 

Therefore, the provision 

of healthy meals, access to lifestyle modification programs, and evidence-based advice, 

32 Older Adult Behavioral Health Technical Assistance Center. (2012). Issue B: Preventing Suicide in Older Adults 

https://www.ncoa.org/resources/issue-brief-4-preventing-suicide-in-older-adults/. Accessed December 21, 2018.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

56 

such as nutrition education and counseling, are important to helping these older individuals 

avoid more intensive and costly medical care.

• About 16 percent of people who participate in congregate meal programs, and 50 percent

of home-delivered participants, need help in getting outside the house, thus limiting their 

ability to shop for food themselves.39

39 Id.

• About 43 percent of congregate participants, and 58 percent of home-delivered 

participants, live alone.40

40 Id.

Living alone is a risk factor for social isolation, poorer health, 

and nursing home placement. 

Data has shown that Nutrition Services are effective in helping older adults improve their 

nutritional intake and remain at home. For example, 70 percent of congregate meal participants, 

and 83 percent of home-delivered meal participants, say they eat healthier meals due to the 

programs, and 67 percent of congregate meal participants, and 88 percent of home-delivered meal 

recipients, say that the meals enable them to continue living in their homes.41

41 Id.

 Eighty nine percent 

of congregate meal clients, and 91 percent of home-delivered meal clients, rate service as good to 

excellent.42

42 Id.

In addition, states that invest more in delivering meals to older adults’ homes have lower rates of 

“low-care” seniors (defined as residents who have the functional capacity to live in a less careintensive environment) living in nursing homes, after adjusting for several other factors.43

43 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. 

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.44

44 Id.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

57 

Funding History:

Comparable funding for Nutrition Services over the past ten years is as follows:

FY 2012 ...................................$816,289,000 

FY 2013 .................................$768,310,870 

FY 2014 ...................................$811,191,000 

FY 2015 ...................................$814,657,000 

FY 2016 ..................................$834,753,000 

FY 2017 ...................................$837,753,000 

FY 2018 ...................................$896,753,000

FY 2019 ..................................$905,815,000 

FY 2020 Enacted......................$936,753,000 

FY 2021 President’s Budget ....$936,753,000 

Budget Request:

The FY 2021 request is $936,753,000 for Nutrition Services, the same as the FY 2020 Enacted

level. The request demonstrates the Administration’s dedication to providing vital nutrition 

services. This request represents only a portion of the total funding for meals programs.45

45 J. Ziegler et al. Final Report: Older Americans Act Nutrition Programs Evaluation: Meal Cost Analysis. Sept 25, 

2015.

 

Combined with state and local contributions, the request is projected to provide over 214.3 million 

meals to more than 2.25 million older Americans in a variety of community settings. In FY 2021, 

the Nutrition programs are expected to continue to provide home-delivered meals that clients rate 

as good to excellent, ensuring that clients continue to receive high quality services. The FY 2021 

request also would continue to allow up to 1% of the funds appropriated for congregate and homedelivered nutrition be used for nutrition innovations. 

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

these programs, and up to 40 percent of Nutrition funding between the congregate and homedelivered programs. ACL is continuing to propose a general provision to build on existing 

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

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

individual State’s needs; and to allow Tribes to transfer funding between NSIP, Native American 

Nutrition and Supportive Services, and Native American Caregiver Support Services. 

An evaluation of the OAA Title III-C Nutrition Services program (NSP) is ongoing. The Process 

Evaluation of Older Americans Act Title III-C Nutrition Services Program Report is available at: 

https://www.acl.gov/sites/default/files/programs/2017-02/NSP-Process-Evaluation-Report.pdf

and the cost study report is available at: https://www.acl.gov/sites/default/files/programs/2017-

05/NSP-Meal-Cost-Analysis_v2.pdf. The first client outcome report is available at: 

https://www.acl.gov/sites/default/files/programs/2017-07/AoA_outcomesevaluation_final.pdf; 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

58 

and the second client outcome report is available at: 

https://acl.gov/sites/default/files/programs/2018-10/NSPevaluation_healthcareutilization.pdf

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

the OAA Title III-C Nutrition Services Program (NSP) is meeting its stated goals. The program 

provides appropriate supportive services which are responsive to local community and individuals’ 

needs. For example, since the last evaluation was conducted in 1995, 15 percent more providers 

offer weekend meal service and almost 15 percent more sites provide specialized meal choices to 

meet the health needs of recipients. With nearly two-thirds of meal providers offering non-nutrition 

services to promote the well-being of older Americans, the program is a key component of a 

continuum of care that makes it possible for older adults to continue living in the community. 

Evaluation results are consistent with annual performance data that indicate the programs help 

participants to live independently in the community, eat healthier foods, improve their health, and 

achieve or maintain a healthy weight. If the nutrition program were not available, 61 percent of 

home-delivered meal participants, and 42 percent of congregate meal participants, indicated they 

would skip meals or eat less.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

59 

Outcomes and Outputs Table:

Nutrition Services

Measure Year and Most Recent Result 

/ 

Target for Recent Result /

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-FY 2020

Target

1.1 For Home and 

Community-based 

Services including 

Nutrition and Caregiver 

services increase the 

number of clients served 

per million dollars of Title 

III OAA funding. 

(Efficiency)

FY 2018: 7,821 clients

Target:

8,800 clients

(Target Not Met)

7,799 clients 7,517 clients -282 clients

2.9a Maintain at 90% or 

higher the percentage of 

clients receiving home 

delivered meal who rate 

services good to 

excellent. (Outcome)

FY 2018: 91%

Target:

90%

(Target Exceeded)

90% 92% +2

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 2018: 66.7 weighted 

average

Target:

63.25 weighted average

(Target Exceeded)

64 weighted 

average

64.7 weighted 

average

+0.7 weighted

average

3.3 The percentage of 

OAA clients served who 

live in rural areas is at 

least 15% greater than 

the percent of all US 

elders who live in rural 

areas. (Outcome)

FY 2018: 34.61%

Target:

26.2%

(Target Exceeded)

35.87% 34.9% -0.97

3.5 Increase the 

percentage of older 

persons with severe 

disabilities who receive 

home-delivered meals. 

(Outcome)

FY 2018: 38.8%

Target:

42.4%

(Target Not Met)

42.2% 40.5% -1.7

3.6 The percentage of 

OAA clients served who 

live in poverty is 150% 

greater than the percent 

of all U.S. elders living 

FY 2018: 33.6%

Target:

25.68%

(Target Exceeded)

32.66% 33.11% +0.45
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

60 

Measure Year and Most Recent Result 

/ 

Target for Recent Result /

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-FY 2020

Target

below the poverty level. 

(Outcome)

Indicator Year and Most Recent 

Result /

FY 2020 

Projection

FY 2021

Projection

FY 2021

Projection

+/-FY 2020

Projection

Output G: Number of 

Home-Delivered meals 

served (Output)

FY 2018: 146,995,223 148.8 M 146.2 M -2.6 M

Output H: Number of 

Congregate meals served 

(Output)

FY 2018: 73,644,475 70.5 M 68.1 M -2.4 M

Outputs G & H: Total 

Number of Meals (Output)

FY 2018: 220,639,698 219.3 M 214.3 M -5 M

Note: For presentation within the budget, ACL highlighted specific measures that are most directly related to Nutrition 

Services. However, multiple performance outcomes are impacted by this program because ACL’s performance 

measures (efficiency, effective targeting, and client outcomes) assess network-wide performance in achieving current 

strategic objectives. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

61 

Grant Awards Tables:

Congregate Nutrition Programs Grant Awards 

FY 2019 

Final

FY 2020

Enacted

FY 2021 

President’s 

Budget

Number of Awards 56 56 56

Average Award $8,836,250 $9,113,250 $9,113,250

Range of Awards

$303,976/ 

$51,215,322

$303,397/ 

$52,241,412

$303,397/ 

$52,241,412

Home-Delivered Nutrition Programs Grant Awards

FY 2019 

Final

FY 2020

Enacted

FY 2021 

President’s 

Budget 

Number of Awards 56 56 56

Average Award $4,436,507 $4,660,985 $4,660,985

Range of Awards

$155,278/ 

$26,014,649

$163,134/ 

$27,283,024

$163,134/ 

$27,283,024

Nutrition Services Incentive Program Grant Awards

FY 2019 

Final

FY 2020

Enacted

FY 2021 

President’s 

Budget

Number of Awards 270 270 270

Average Award $588,389 $580,991 $580,991

Range of Awards

$65,799 - 

$16,483,002

$64,952 - 

$16,226,419

$64,952 - 

$16,226,419
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

62 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2021 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Congregate Nutrition Services (CFDA 93.045)

STATE/TERRITORY FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

Alabama 7,392,223 7,543,409 7,543,409 -

Alaska 2,447,751 2,500,676 2,500,676 -

Arizona 10,741,697 11,155,058 11,227,347 72,289

Arkansas 4,521,642 4,598,326 4,598,326 -

California 51,215,322 52,241,412 52,241,412 -

Colorado 7,344,014 7,584,846 7,584,846 -

Connecticut 5,563,150 5,647,759 5,647,759 -

Delaware 2,447,751 2,500,676 2,500,676 -

District of Columbia 2,447,751 2,500,676 2,500,676 -

Florida 36,819,207 37,820,997 37,820,997 -

Georgia 13,219,030 13,593,104 13,593,104 -

Hawaii 2,447,751 2,500,676 2,500,676 -

Idaho 2,447,751 2,532,715 2,532,715 -

Illinois 18,078,652 18,380,301 18,380,301 -

Indiana 9,531,442 9,730,978 9,730,978 -

Iowa 4,930,575 4,930,575 4,930,575 -

Kansas 4,165,238 4,241,634 4,241,634 -

Kentucky 6,591,065 6,718,948 6,718,948 -

Louisiana 6,536,834 6,668,073 6,668,073 -

Maine 2,447,751 2,508,371 2,508,371 -

Maryland 8,465,859 8,638,732 8,638,732 -

Massachusetts 10,234,547 10,445,021 10,445,021 -

Michigan 15,500,309 15,828,512 15,828,512 -

Minnesota 8,020,953 8,228,833 8,228,833 -

Mississippi 4,275,249 4,358,171 4,358,171 -

Missouri 9,257,196 9,440,074 9,440,074 -

Montana 2,447,751 2,500,676 2,500,676 -

Nebraska 2,722,261 2,774,068 2,774,068 -

Nevada 4,220,197 4,337,035 4,337,035 -

New Hampshire 2,447,751 2,500,676 2,500,676 -
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

63 

PROGRAM/CFDA NUMBER: Congregate Nutrition Services (CFDA 93.045)

STATE/TERRITORY FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

New Jersey 13,117,020 13,246,259 13,246,259 -

New Mexico 3,161,817 3,239,975 3,180,683 (59,292)

New York 29,026,177 29,306,930 29,306,930 -

North Carolina 14,973,656 15,388,183 15,388,183 -

North Dakota 2,447,751 2,500,676 2,500,676 -

Ohio 17,992,696 18,344,852 18,344,852 -

Oklahoma 5,545,302 5,651,132 5,651,132 -

Oregon 6,512,832 6,673,218 6,673,218 -

Pennsylvania 20,869,802 21,232,902 21,232,902 -

Rhode Island 2,447,751 2,500,676 2,500,676 -

South Carolina 7,882,275 8,124,330 8,124,330 -

South Dakota 2,447,751 2,500,676 2,500,676 -

Tennessee 9,919,378 10,139,013 10,139,013 -

Texas 32,801,838 33,747,941 33,747,941 -

Utah 3,145,892 3,249,147 3,236,150 (12,997)

Vermont 2,447,751 2,500,676 2,500,676 -

Virginia 11,814,912 12,114,322 12,114,322 -

Washington 10,451,763 10,758,768 10,758,768 -

West Virginia 3,207,757 3,230,673 3,230,673 -

Wisconsin 8,877,632 9,091,470 9,091,470 -

Wyoming 2,447,751 2,500,676 2,500,676 -

 Subtotal 480,468,174 490,993,503 490,993,503 -

American Samoa 577,176 577,176 577,176 -

Guam 1,223,876 1,250,338 1,250,338 -

Northern Mariana 

Islands 305,969 312,584 312,584 -

Puerto Rico 5,751,221 5,751,221 5,751,221 -

Virgin Islands 1,223,876 1,250,338 1,250,338 -

 Subtotal 489,550,292 500,135,160 500,135,160 -

Program Support 1/ 5,279,708 10,206,840 10,206,840 -

Total 

States/Territories 494,830,000 510,342,000 510,342,000 -

1/ Program Support- Includes funds for Older American Act statutory requirements, including evaluation and disaster assistance 

and grant and program reporting systems costs. Funds unused for these purposes at the end of the year are allocated to states.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

64 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2021 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Home-Delivered Nutrition Services (CFDA 93.045)

STATE/TERRITORY FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

Alabama 3,754,855 3,939,538 3,939,538 -

Alaska 1,242,222 1,305,076 1,305,076 -

Arizona 5,456,208 5,825,717 5,863,469 37,752

Arkansas 2,296,753 2,401,471 2,401,471 -

California 26,014,649 27,283,024 27,283,024 -

Colorado 3,730,367 3,961,178 3,961,178 -

Connecticut 2,825,783 2,949,537 2,949,537 -

Delaware 1,242,222 1,305,076 1,305,076 -

District of Columbia 1,242,222 1,305,076 1,305,076 -

Florida 18,702,192 19,751,976 19,751,976 -

Georgia 6,714,562 7,098,985 7,098,985 -

Hawaii 1,242,222 1,305,076 1,305,076 -

Idaho 1,242,222 1,322,708 1,322,708 -

Illinois 9,182,990 9,599,093 9,599,093 -

Indiana 4,841,464 5,081,993 5,081,993 -

Iowa 2,444,855 2,557,396 2,557,396 -

Kansas 2,115,719 2,215,189 2,215,189 -

Kentucky 3,347,909 3,508,964 3,508,964 -

Louisiana 3,320,363 3,482,394 3,482,394 -

Maine 1,242,222 1,309,994 1,309,994 -

Maryland 4,300,205 4,511,569 4,511,569 -

Massachusetts 5,198,604 5,454,901 5,454,901 -

Michigan 7,873,330 8,266,424 8,266,424 -

Minnesota 4,074,216 4,297,500 4,297,500 -

Mississippi 2,171,598 2,276,050 2,276,050 -

Missouri 4,702,162 4,930,069 4,930,069 -

Montana 1,242,222 1,305,076 1,305,076 -

Nebraska 1,382,764 1,448,754 1,448,754 -

Nevada 2,143,635 2,265,012 2,265,012 -

New Hampshire 1,242,222 1,305,076 1,305,076 -
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

65 

PROGRAM/CFDA NUMBER: Home-Delivered Nutrition Services (CFDA 93.045)

STATE/TERRITORY FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

New Jersey 6,662,746 6,917,845 6,917,845 -

New Mexico 1,606,035 1,692,074 1,661,109 (30,965)

New York 14,743,749 15,305,514 15,305,514 -

North Carolina 7,605,818 8,036,463 8,036,463 -

North Dakota 1,242,222 1,305,076 1,305,076 -

Ohio 9,139,329 9,580,580 9,580,580 -

Oklahoma 2,816,718 2,951,298 2,951,298 -

Oregon 3,308,171 3,485,081 3,485,081 -

Pennsylvania 10,600,746 11,088,861 11,088,861 -

Rhode Island 1,242,222 1,305,076 1,305,076 -

South Carolina 4,003,775 4,242,923 4,242,923 -

South Dakota 1,242,222 1,305,076 1,305,076 -

Tennessee 5,038,515 5,295,089 5,295,089 -

Texas 16,661,584 17,624,827 17,624,827 -

Utah 1,597,945 1,696,864 1,690,077 (6,787)

Vermont 1,242,222 1,305,076 1,305,076 -

Virginia 6,001,345 6,326,692 6,326,692 -

Washington 5,308,938 5,618,756 5,618,756 -

West Virginia 1,621,442 1,687,216 1,687,216 -

Wisconsin 4,509,363 4,748,011 4,748,011 -

Wyoming 1,242,222 1,305,076 1,305,076 -

 Subtotal 243,970,288 256,393,366 256,393,366 -

American Samoa 155,278 163,134 163,134 -

Guam 621,111 652,538 652,538 -

Northern Mariana 

Islands 155,278 163,134 163,134 -

Puerto Rico 2,921,314 2,990,450 2,990,450 -

Virgin Islands 621,111 652,538 652,538 -

 Subtotal 248,444,380 261,015,160 261,015,160 -

Program Support 1/ 2,637,620 5,326,840 5,326,840 -

Total 

States/Territories 251,082,000 266,342,000 266,342,000 -

1/ Program Support- Includes funds for Older American Act statutory requirements, including evaluation and disaster assistance 

and grant and program reporting systems costs. Funds unused for these purposes at the end of the year are allocated to states. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

66 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2021 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Nutrition Services Incentive Program (CFDA 93.053)

STATE/TERRITORY FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

Alabama 3,305,548 3,263,000 3,263,000 -

Alaska 481,849 475,647 475,647 -

Arizona 1,830,611 1,807,048 1,807,048 -

Arkansas 2,398,139 2,367,271 2,367,271 -

California 13,339,978 13,168,269 13,168,269 -

Colorado 1,435,191 1,416,717 1,416,717 -

Connecticut 1,394,074 1,376,130 1,376,130 -

Delaware 727,481 718,117 718,117 -

District of Columbia 826,081 815,448 815,448 -

Florida 5,682,172 5,609,033 5,609,033 -

Georgia 2,741,635 2,706,346 2,706,346 -

Hawaii 505,007 498,507 498,507 -

Idaho 788,608 778,457 778,457 -

Illinois 6,939,566 6,850,242 6,850,242 -

Indiana 1,396,201 1,378,229 1,378,229 -

Iowa 1,496,973 1,477,704 1,477,704 -

Kansas 2,324,657 2,294,734 2,294,734 -

Kentucky 1,535,066 1,515,307 1,515,307 -

Louisiana 3,492,294 3,447,342 3,447,342 -

Maine 601,210 593,471 593,471 -

Maryland 1,657,806 1,636,467 1,636,467 -

Massachusetts 6,821,166 6,733,366 6,733,366 -

Michigan 7,725,865 7,626,420 7,626,420 -

Minnesota 1,773,889 1,751,056 1,751,056 -

Mississippi 1,426,940 1,408,573 1,408,573 -

Missouri 4,029,903 3,978,032 3,978,032 -

Montana 1,190,894 1,175,565 1,175,565 -

Nebraska 1,056,843 1,043,239 1,043,239 -

Nevada 1,637,388 1,616,312 1,616,312 -

New Hampshire 1,177,814 1,162,653 1,162,653 -
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

67 

PROGRAM/CFDA NUMBER: Nutrition Services Incentive Program (CFDA 93.053)

STATE/TERRITORY FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

New Jersey 3,458,191 3,413,678 3,413,678 - 

New Mexico 2,303,349 2,273,701 2,273,701 - 

New York 16,438,002 16,226,419 16,226,419 - 

North Carolina 3,278,529 3,236,329 3,236,329 - 

North Dakota 791,309 781,124 781,124 - 

Ohio 5,625,724 5,553,311 5,553,311 - 

Oklahoma 1,819,089 1,795,675 1,795,675 - 

Oregon 1,793,536 1,770,450 1,770,450 - 

Pennsylvania 6,610,409 6,525,322 6,525,322 - 

Rhode Island 403,439 398,246 398,246 - 

South Carolina 1,785,790 1,762,804 1,762,804 - 

South Dakota 954,326 942,042 942,042 - 

Tennessee 1,640,637 1,619,519 1,619,519 - 

Texas 11,891,629 11,738,563 11,738,563 - 

Utah 1,283,557 1,267,035 1,267,035 - 

Vermont 777,996 767,982 767,982 - 

Virginia 1,914,467 1,889,825 1,889,825 - 

Washington 2,362,994 2,332,578 2,332,578 - 

West Virginia 1,514,426 1,494,933 1,494,933 - 

Wisconsin 2,816,751 2,780,494 2,780,494 - 

Wyoming 885,838 874,436 874,436 - 

 Subtotal 152,090,837 150,133,168 150,133,168 - 

Indian Tribal Grants 3,678,177 3,678,177 3,678,177 - 

American Samoa 84,042 82,960 82,960 - 

Guam 395,828 390,733 390,733 - 

Northern Mariana 

Islands 65,799 64,952 64,952 - 

Puerto Rico 2,444,490 2,413,025 2,413,025 - 

Virgin Islands 105,969 104,605 104,605 - 

 Subtotal 158,865,142 156,867,620 156,867,620 - 

USDA Transfer1/ 1,902,259 - - - 

Program Support 1,037,858 3,201,380 3,201,380 - 

Total 

States/Territories 159,903,000 160,069,000 160,069,000 - 

1/ State levels include transfers for distributions of commodities which are provided by USDA to grantees; in FY 2018, the 

amount that was transferred is shown for comparability purposes.

2/Program Support- Includes funds for Older American Act statutory requirements, including evaluation and disaster assistance 

and grant and program reporting systems costs. Funds unused for these purposes at the end of the year are allocated to states. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

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Preventive Health Services

Services

FY 2019 

Final 

FY 2020

Enacted

FY 2021 President’s 

Budget

FY 2021 (+/-) FY 

2020

Preventive Health 

Services $24,822 $24,848 $24,848 --

*BA is in thousands of dollars.

Original Authorizing Legislation: Section 361 of the Older Americans Act of 1965, Public Law 

89-73 

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

114-144 

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

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

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

Program Description and Accomplishments:

Preventive Health Services, established in 1987, provides formula grants to States and Territories

to support evidence-based programs that educate older adults about the importance of healthy 

lifestyles and to promote healthy behaviors that can help prevent chronic disease and disability, 

thereby reducing the need for more costly medical interventions. Preventive Health Services 

funding is allocated to States and Territories based on their share of the population age 60 and 

over, and the program provides flexibility to allocate resources to best meet local needs. Priority 

is given to providing access to programs for elders living in medically underserved areas or those 

with the greatest economic need.

Due in large part to advances in public health and medical care, Americans are leading longer and 

more active lives. On average, an American turning age 65 today can expect to live an additional 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

70 

19.54 years.46

46 Murphy SL, Xu JQ, Kochanek KDArias E. Mortality in the United States, 2016. NCHS Data Brief, no 328. 

Hyattsville, MD: National Center for Health Statistics. 2018. https://www.cdc.gov/nchs/nvss/deaths.htm.. 

 The population of older Americans is also growing, particularly the population age 

85 and over, which is projected to grow from 6.5 million in 2018 to 9.1 million by the year 2030.47

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

Composition of the Population for the United States: 2017 to 2060. Released March 2018, 

https://www.census.gov/data/tables/2017/demo/popproj/2017-summary-tables.html. Accessed 10 December 2019. 

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

States: April 1, 2010 to July 1, 2018: Released June 2019, 

https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtm. Accessed 10 December 2019. 

 

One consequence of this increased longevity is a higher incidence of chronic diseases such as 

arthritis, cancer, and diabetes.48

48 Kingston, A., L. Robinson, H. Booth, M. Knapp, C. Jagger. 2018. Projections of multi-morbidity in the older 

population in England to 2035: estimates from the Population Ageing and Care Simulation (PACSim) model. Age 

and Ageing; 47: 374–380. 

In addition, approximately 25 percent of older adults report falling 

each year, with 3 million falls resulting in emergency department visits. This percentage is 

increasing for all older adults, but especially for those age 85 and over.49

49 Burns, E. R. Kakara. Deaths from Falls Among Persons Aged => 65 Years – United States, 2007-2016. MMWR 

Morb Mortal Wkly Rep 2018;67:509-514.

 

Since FY 2012, ACL has requested and Congress has enacted, appropriations language requiring 

states and territories to use their Preventive Health funds only on evidence-based programs that 

have been proven to enhance the wellness and fitness of older adults. The same language has been 

included in each subsequent year’s appropriations language. 

Evidence-based programs are interventions that have been proven through randomized control 

trials to be effective at helping participants adopt healthy behaviors, improve their health status, 

and reduce their use of hospital services and emergency room visits. Examples of evidence-based 

interventions include: 

• Self-Management Programs: Chronic Disease Self-Management Education (CDSME) 

programs are low-cost disease prevention models that use evidence-based, state-of-the-art 

techniques and employ leaders in the community to help individuals with chronic disease 

address issues related to the management and treatment of their condition, improve their 

health status, and reduce their need for more costly medical care. CDSME programs have 

been proven to be effective at helping participants adopt healthy behaviors and improve 

their psychological and physical health status. Evidence suggests that CDSME programs 

may also significantly reduce the use of hospital care and physician services, as well as 

reduce health care costs.

50

50 Ahn et al. 2013. The impact of chronic disease self-management programs: healthcare savings through a 

community-based intervention. BMC Public Health. 13(1141).

• Physical Activity Programs: Physical activity programs are multi-component group 

exercise programs designed for community-based organizations to promote physical 

activity among older adults. Components may include strength training using soft wrist 

and ankle weights; cardiovascular workouts using dancing, aerobics, or walking; and 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

71 

balance and posture exercises. Becoming more physically active has many positive benefits 

such as increased mobility and function, decreased pain and depression, and lower risk of 

type 2 diabetes, hypertension, coronary heart disease, obesity, and some cancers. 

• Medication Management Programs: Medication management programs focus on 

reviewing the multitude of medications that older adults are prescribed, focusing especially 

on high-risk medications. Medication management programs have been shown to reduce 

cardiovascular problems and unnecessary duplication of prescriptions. These programs 

have also been shown to improve medication usage rates and decrease medication errors 

among older adults.

• Falls Prevention Programs: Falls prevention programs help participants improve strength, 

balance, and mobility; provide education on avoiding falls and reducing fall risk factors; 

involve medication reviews and modifications; provide referrals for medical care 

management for fall risk factors; and provide home assessments to identify and reduce 

environmental hazards. 

• Depression Care Management: Depression is not a normal part of aging, yet it is a 

prevalent and disabling condition among older adults. Older adults with depression visit 

the doctor and emergency room more frequently, use more medication, stay longer in the 

hospital, and have substantially higher total health care costs than those without depression. 

Cost-effective, evidence-based interventions have been shown to reduce depressive 

symptoms and improve quality of life in older adults.

Funding History:

Funding for Preventive Health Services over the past five years is as follows:

FY 2017 .................................................$19,802,000 

FY 2018 .................................................$24,848,000 

FY 2019 ................................................$24,848,000 

FY 2020 Enacted....................................$24,848,000 

FY 2021 President’s Budget ..................$24,848,000 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

72 

Budget Request:

The FY 2021 request for Preventive Health Services is $24,848,000 the same as the FY 2020 

Enacted level. The Budget does not request separate funding for CDSME and Falls Prevention, 

and consolidates those programs into Preventive Health Services to allow States the flexibility to

also fund Chronic Disease Self-Management and Falls Prevention programs as part of their 

Preventive Health Services to meet the greatest areas of need in their communities. ACL continues 

to propose a general provision to maximize funding flexibility to allow states to transfer Older 

American Act funding, between HCBSS, Nutrition, Preventive Health, and Caregivers, to direct 

funding to activities that best addresses their individual State’s unique needs. 

ACL will continue to provide guidance regarding what meets the evidence-based requirement for 

this program. ACL uses a graduated or tiered set of criteria for defining evidence-based 

interventions implemented through the OAA. The OAA Title III-D webpage contains definitions 

of evidence-based interventions, frequently asked questions, and program examples.51

51 https://www.acl.gov/programs/health-wellness/disease-prevention.

 Grantees 

can use the Title III-D Highest-Tier Criteria Evidence-Based Disease Prevention and Health 

Promotion Programs Cost Chart52

52 http://www.ncoa.org/improve-health/center-for-healthy-aging/content-library/Title-IIID-Highest-Tier-EvidenceFINAL.pdf. 

on the site to search the 45+ highest-level criteria programs 

listed.

Each of the evidence-based programs for which states could use these funds have been rigorously 

evaluated and found to be effective. By requiring states to use funding for one or more of these 

programs, ACL seeks to maximize the impact of this funding by providing benefits to individuals 

and achieving savings due to reduced medical costs. At the same time, states continue to have the 

flexibility to use funding provided under the Home and Community-Based Supportive Services 

program to fund related health services, such as health screenings and physical fitness programs 

that do not meet these evidence-based requirements.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

73 

Output Table:

Preventive Health Services

Indicator Year and Most Recent 

Result /

FY 2020

Projection

FY 2021

Projection

FY 2021

Projection

+/-FY 2020

Projection

Output AB: The number 

of people served with 

health and disease 

prevention programs. 

(Output)

FY 2018: 755,096 593,949 520,123 -73,826

Grant Awards Tables:

Preventive Health Services Grant Awards

FY 2019 

Final 

FY 2020

Enacted 

FY 2021 

President’s 

Budget

Number of 

Awards 56 56 56

Average Award $440,352 $439,277 $439,277

Range of Awards

$15,412 - 

$2,581,995

$15,374 - 

$2,575,693

$15,374 - 

$2,575,693
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

74 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2021 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Preventive Health Services (CFDA 93.043)

STATE/TERRITORY FY 2019 Final FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

Alabama 372,676 371,766 371,766 -

Alaska 123,299 122,998 122,998 -

Arizona 541,538 540,216 543,759 3,543

Arkansas 227,957 227,401 227,401 -

California 2,581,995 2,575,693 2,575,691 (2)

Colorado 370,245 369,341 369,341 -

Connecticut 280,464 279,779 279,779 -

Delaware 123,299 122,998 122,998 -

District of Columbia 123,299 122,998 122,998 -

Florida 1,856,225 1,851,694 1,851,694 -

Georgia 666,432 664,805 664,805 -

Hawaii 123,299 122,998 122,998 -

Idaho 123,299 122,998 122,998 -

Illinois 911,428 909,203 909,203 -

Indiana 480,524 479,351 479,351 -

Iowa 242,656 242,064 242,064 -

Kansas 209,989 209,476 209,476 -

Kentucky 332,286 331,475 331,475 -

Louisiana 329,552 328,748 328,748 -

Maine 123,299 122,998 122,998 -

Maryland 426,803 425,761 425,761 -

Massachusetts 515,970 514,711 514,711 -

Michigan 781,442 779,535 779,535 -

Minnesota 404,373 403,386 403,386 -

Mississippi 215,535 215,009 215,009 -

Missouri 466,698 465,559 465,559 -

Montana 123,299 122,998 122,998 -

Nebraska 137,242 136,907 136,907 -

Nevada 212,759 212,240 212,240 -

New Hampshire 123,299 122,998 122,998 -
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

75 

PROGRAM/CFDA NUMBER: Preventive Health Services (CFDA 93.043)

STATE/TERRITORY FY 2019 Final FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

New Jersey 661,289 659,675 659,675 -

New Mexico 159,402 159,013 156,103 (2,910)

New York 1,463,342 1,459,770 1,459,770 -

North Carolina 754,891 753,048 753,048 -

North Dakota 123,299 122,998 122,998 -

Ohio 907,094 904,880 904,880 -

Oklahoma 279,564 278,882 278,882 -

Oregon 328,342 327,541 327,541 -

Pennsylvania 1,052,142 1,049,574 1,049,574 -

Rhode Island 123,299 122,998 122,998 -

South Carolina 397,382 396,412 396,412 -

South Dakota 123,299 122,998 122,998 -

Tennessee 500,081 498,860 498,860 -

Texas 1,653,691 1,649,655 1,649,655 -

Utah 158,599 158,212 157,579 (633)

Vermont 123,299 122,998 122,998 -

Virginia 595,644 594,190 594,190 -

Washington 526,921 525,635 525,635 -

West Virginia 161,146 160,753 160,753 -

Wisconsin 447,562 446,470 446,470 -

Wyoming 123,299 122,998 122,998 -

 Subtotal 24,214,768 24,155,664 24,155,662 (2)

American Samoa 15,412 15,374 15,375 1

Guam 61,649 61,499 61,499 -

Northern Mariana Islands 15,412 15,374 15,375 1

Puerto Rico 290,820 290,110 290,110 -

Virgin Islands 61,649 61,499 61,499 -

 Subtotal 24,659,710 24,599,520 24,599,520 -

Undistributed 1/ 162,290 248,480 248,480 -

Total States/Territories 24,822,000 24,848,000 24,848,000 -

1/ Program Support- includes funds for Older American Act statutory requirements, including program evaluation and disaster 

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

states.
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HEALTH AND INDEPENDENCE FOR OLDER ADULTS

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Chronic Disease Self-Management Education 

Services

FY 2019 

Final

FY 2020

Enacted

FY 2021 

President’s Budget

FY 2021 (+/-) FY 

2020

Chronic Disease SelfManagement 

Education

$8,000 $8,000 -- -$8,000

*BA is in thousands of dollars.

Authorizing Legislation: Section 411 of the Older Americans Act of 1965, Public Law 89-73. 

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

114-144, and Sections 311 and 317(k)(2) of the Public Health Service Act. 

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

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

Allocation Method ............................. Competitive Grants/Cooperative Agreements and Contracts

Program Description and Accomplishments: 

Chronic Disease Self-Management Education (CDSME) programs are low-cost, evidence-based 

prevention models that use state-of-the-art techniques to help those with chronic conditions 

address issues related to the management and treatment of their condition, build self-confidence, 

improve their health status, and reduce their need for more costly medical care. Funds support 

competitive grants to states, as well as related technical assistance and evaluation activities, 

including a National Resource Center. 

In the United States, 77 percent of Medicare beneficiaries age 65 and over have multiple (two or 

more) chronic conditions,53

53 Centers for Medicare & Medicaid Services, Centers for Medicare & Medicaid Services, ACL analysis of 2015 

Medicare Current Beneficiary Survey. https://www.cms.gov/Research-Statistics-Data-andSystems/Research/MCBS/index Accessed on 10 December 2019.

placing them at greater risk for premature death, poor functionalstatus, 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

78 

unnecessary hospitalizations, adverse drug events, and nursing home placement.54

54 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. Also, Parekh, A.K., et al. 

2011. Managing Multiple Chronic Conditions: a Strategic Framework for Improving Health Outcomes and 

Quality of Life, Public Health Rep. 126(4):460–71.

Chronic 

conditions also impact health care costs, as 93 percent of Medicare expenditures are for 

beneficiaries with chronic conditions.55

55 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/. 

Funding History:

Funding for Chronic Disease Self-Management Education over the past five years is as follows:

FY 2017 ..................................................$8,000,000 

FY 2018 ...................................................$8,000,000 

FY 2019 ..................................................$8,000,000 

FY 2020 Enacted .....................................$8,000,000 

FY 2021 President’s Budget ..................................$0 

Budget Request:

The FY 2021 Budget proposes to consolidate this activity into the Preventive Health Services 

program and, therefore, no funding is requested. This request represents a decrease of -$8,000,000 

below the FY 2020 Enacted level. ACL continues to propose a general provision that would build 

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

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

the funding distribution that best addresses their individual State’s unique needs and to modify

existing CDSME programs to best meet the needs within their state. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

79 

Grant Awards Table:

Chronic Disease Self-Management Education Grant Awards

FY 2019

Final

FY 2020

Enacted

FY 2021 

President’s Budget

Number of Awards 12 12 - 

Average Award $636,726 $636,726 - 

Range of Awards $149,925-

$1,000,000

$149,925-

$1,000,000 - 

Resource and Program Data: 

Chronic Disease Self-Management Education 

(Dollars in Thousands)

FY 2019 FY 2020 FY 2021

Final Enacted President’s Budget 

Mechanism # $ # $ # $

Grants:

Formula

 

--

 

--

 

--

 

--

 

--

 

--

New Discretionary

 

11 6,641 

 

11 6,641 

 

-- 

Continuations

 

1 1,000 

 

1 1,000 

 

-- 

Contracts

 

1 88 

 

1 88 

 

-- 

Interagency Agreements

 

--

 

--

 

--

 

--

 

--

 

--

Program Support56

 

-- 272 

 

-- 272 

 

-- 

Total Resources 8,000 8,000 

56 Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and review, 

and information technology support costs.
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HEALTH AND INDEPENDENCE FOR OLDER ADULTS

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Falls Prevention

Services

FY 2019 

Final 

FY 2020

Enacted

FY 2021 President’s 

Budget

FY 2021 (+/-) FY 

2020

Falls Prevention $5,000 $5,000 -- -$5,000

*BA is in thousands of dollars.

Original Authorizing Legislation: Section 411 of the Older Americans Act of 1965, Public Law 

89-73 

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

114-144 

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

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

Allocation Method ............................. Competitive Grants/Cooperative Agreements and Contracts 

Program Description and Accomplishments:

Falls are the leading cause of both fatal and nonfatal injuries for those 65 and over.57

57 Bergen G, Stevens MR, Burns ER. Falls and Fall Injuries Among Adults Aged ≥65 Years — United States, 2014. 

MMWR Morb Mortal Wkly Rep 2016;65:993–998. https://www.cdc.gov/mmwr/volumes/65/wr/mm6537a2.

htm?s_cid=mm6537a2_w

Many people 

limit their activity after a fall, which may reduce strength, physical fitness, and mobility.58

58 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.

Falls 

can also result in significant loss of independence and often trigger the onset of a series of growing 

needs. Americans over age 75 who fall are more than four times more likely to be admitted to a 

skilled nursing facility.59

59 Donald IP, Bulpitt CJ. The prognosis of falls in elderly people living at home. Age and Ageing 1999;28:121–5. 

Even without a major injury, falls can cause an older adult to become 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

82 

fearful or depressed, making it difficult for them to stay active, which in turn increases the need 

for assistance.

Falls prevention programs help participants improve strength, balance, and mobility, and provide 

education on how to avoid falls and reduce fall risk factors. These programs also may involve 

medication reviews and modifications; provide referrals for medical care management for selected 

fall risk factors; and provide home hazard assessments of ways to reduce environmental hazards. 

Since September 2014, more than 50,000 older adults across the U.S. have been served via ACLsupported falls prevention/management programs, including A Matter of Balance, Stepping On, 

and Tai Chi: Moving for Better Balance. 

Evidence-based community falls prevention/management programs have demonstrated a 

reduction in falls through randomized controlled trials. For example, when compared with control 

groups, the risk of falling for participants in the Tai Chi: Moving for Better Balance intervention 

decreased by 55 percent;60

60 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.

and the Stepping On program reduction was 31 percent.61

61 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.

A Matter of 

Balance is an evidence-based program designed to reduce the fear of falling and increase activity 

levels among older adults. 

Funding History

Funding for Falls Prevention over the past five years is as follows:

FY 2017 ...................................................$5,000,000 

FY 2018 ...................................................$5,000,000 

FY 2019 ..................................................$5,000,000 

FY 2020 Enacted......................................$5,000,000 

FY 2021 President’s Budget ..................................$0 

Budget Request:

The FY 2021 Budget proposes to consolidate the Falls Prevention program into the Preventive 

Health Services program and, therefore, no funding is requested. This represents a reduction

of -$5,000,000 below the Enacted FY 2020 level. ACL continues to propose a general provision 

that would build on existing flexibility and give states the ability to transfer nearly all of the funds 

they receive between Home and Community Based Services, Nutrition, Preventive Health and 

Caregivers to achieve the funding distribution that best addresses their individual State’s unique 

needs. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

83 

Grant Awards Table:

Falls Prevention Program Grant Awards

FY 2019 

Final

FY 2020

Enacted

FY 2021 

President’s 

Budget

Number of Awards 13 12 - 

Average Award $378,779 $410,508 - 

Range of Awards $147,364 - 

$750,000

$147,364-

$750,000 - 

Resource and Program Data: 

Falls Prevention

(Dollars in Thousands)

FY 2019 FY 2020 FY 2021

Final Enacted President’s Budget 

Mechanism # $ # $ # $

Grants:

Formula

 

--

 

--

 

--

 

--

 

--

 

--

New Discretionary

 

12 4,324 

 

11 4,324 

 

-- 

Continuations

 

1 600 

 

1 600 

 

-- 

Contracts

 

-- 

 

-- 

 

-- 

Interagency Agreements

 

--

 

--

 

--

 

--

 

--

 

--

Program Support62

 

-- 76 

 

-- 76 

 

-- 

Total Resources 5,000 5,000 

62 Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and review, 

and information technology support costs.
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HEALTH AND INDEPENDENCE FOR OLDER ADULTS

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Native American Nutrition and Supportive Services

Services

FY 2019 

Final 

FY 2020

Enacted

FY 2021 President’s 

Budget

FY 2021 (+/-) FY 

2020

Native American 

Nutrition and 

Supportive Services

$34,173 $34,708 $34,708 -- 

*BA is in thousands of dollars.

Original Authorizing Legislation: Sections 201, 613, and 623 of the Older Americans Act of 1965, 

Public Law 89-73 

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

114-144 

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

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

Allocation Method ....................................................... Formula Grant/Competitive Grant/Contract

Program Description and Accomplishments:

Native American Nutrition and Supportive Services provides grants to eligible tribal organizations 

to promote the delivery of Nutrition and Home and Community-Based Supportive Services to 

Native American, Alaskan Native, and Native Hawaiian elders. An estimated 944,000 people age 

60 and over identify themselves as Native American or Alaskan Native alone or in combination 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

86 

with another racial group.63

63 U.S. Census Bureau, Population Division, Annual Estimates of the Resident Population by Sex, Age, Race Alone

or in Combination, and Hispanic Origen for the United States: April 1, 2010 to July 1 2018. Released June 2019

https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtm. Accessed 10 December, 2019.

Over 578,000 of those elders identify as Native American or Alaskan 

Native with no other racial group.64

64 U.S. Census Bureau, Population Division, Annual Estimates of the Resident Population by Sex, Age, Race, and 

Hispanic Origin for the United States: April 1, 2010 to July 1, 2018. Released June 2019, 

https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml. Accessed 10 December, 2019. 

Native American Nutrition and Supportive Services grants support a broad range of services to 

older Native Americans, including adult day care; transportation; congregate and home-delivered 

meals; information and referral; and personal care, chore, and other supportive services. ACL’s 

congregate meal program currently reaches 43 percent of eligible Native American seniors in 

participating Tribal organizations. Home-delivered meals reach 19 percent of such persons, and 

supportive services reach 65 percent of such persons. These programs, which help to reduce the 

need for costly nursing home care and medical interventions, are responsive to the cultural 

traditions of Native American communities and represent an important part of each community’s 

comprehensive services. 

Services provided by this program in FY 2018 include: 

• Transportation Services, which provided over 566,000 rides to meal sites, medical 

appointments, pharmacies, grocery stores, and other critical daily activities.65

65 ACL’s OAA Title VI Program Performance Report, PY 2018.

• Home-Delivered Nutrition Services, under which almost 2.6 million meals were provided 

to more than 24,000 home bound Native American elders. The program also provides 

social contacts that help to reduce the risk of depression and isolation experienced by many 

home-bound Native American elders.66

66 Id.

• Congregate Nutrition Services, which provided more than 2.5 million meals to more than 

70,000 Native American elders in community-based settings, as well as an opportunity for 

elders to socialize and participate in a variety of activities, including cultural and wellness 

programs.67

67 Id.

• Information, Referral and Outreach Services, which provided more than 761,000 hours of 

outreach and information on services and programs to Native American elders and their 

families, thereby empowering them to make informed choices about their service and care 

needs.68

68 Id.

The Native American Nutrition and Supportive Services program also provides training and 

technical assistance to Tribal organizations to support the development of comprehensive and 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

87 

coordinated systems of services to meet the needs of Native American elders. Training and 

technical assistance is provided through national meetings, site visits, website, e-newsletters, 

telephone and written consultations, and through the Native American Resource Centers (funded 

under Aging Network Support Activities).

Eligible Tribal organizations receive nutrition and supportive services formula grants based on 

their share of the American Indian, Alaskan Native, and Native Hawaiian population age 60 and 

over. Tribal organizations must represent at least 50 Native American elders age 60 and over to 

receive funding. There is no requirement for matching funds. In addition, Tribes may decide the 

age at which a member is considered an elder and, thus, eligible for services. In FY 2018, grants 

were awarded to 270 Tribal organizations (representing 400 Tribes and villages), including one 

organization serving Native Hawaiian elders.

Funding History:

Funding for Native American Nutrition and Supportive Services over the past five years is as 

follows:

FY 2017 .................................................$31,136,000 

FY 2018 .................................................$33,208,000 

FY 2019 ................................................$34,173,000 

FY 2020 Enacted ...................................$34,708,000 

FY 2021 President’s Budget ..................$34,708,000 

Budget Request:

The FY 2021 request for Native American Nutrition and Supportive Services (NANSS) is 

$34,708,000, the same as the FY 2020 Enacted level. At the requested level NANSS provides a 

broad range of services, and reduces the need for more expensive institutional services. These 

services include adult day care, personal care, chore services, and home-delivered meals that also 

aid Native American caregivers, who might otherwise have to be even more intensely involved 

with the care of their loved ones, at the risk of their own health and careers. 

The FY 2021 Budget is estimated to provide funding for over 566 thousand rides, 2.1 million meals 

at home, and 2.1 million meals at congregate sites in Tribal communities.

69

69 Id.

In FY 2021, 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 to be 182, a 10 

percent decrease below the FY 2020 base of 203. This is largely due to yearly increases of almost 

9% in cost per client. Over the past several years, Native American services have generally met or 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

88 

exceeded their efficiency and output targets for meals and trips, due in part to increased 

contributions from tribal organizations. 

Outcomes and Outputs Table:

Native American Nutrition & Supportive Services

Measure Year and Most Recent Result 

/ 

Target for Recent Result /

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-FY 2020

Target

1.3 For Title VI Services, 

increase the number of 

units of service provided 

to Native Americans per 

thousand dollars of AoA 

funding. (Efficiency)

FY 2018: 204

Target:

303

(Target Not Met)

203 182 -21 

Indicator Year and Most Recent 

Result /

FY 2020

Projection

FY 2021

Projection

FY 2021

Projection

+/-FY 2020

Projection

Output L: Transportation 

Services units (Output)

FY 2018: 777,992 639,228 566,090 -73,138

Output M: HomeDelivered Nutrition meals

(Output)

FY 2018: 2,459,878 2.2 M 2.1 M -0.1 M

Output N: Congregate 

Nutrition meals (Output)

FY 2018: 2,505,536 2.2 M 2.1 M -0.1 M

Output O: Information, 

Referral and Outreach 

units (Output)

FY 2018: 761,438 628,311 557,614 -70,697
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

89 

Grant Awards Table:

Native American Nutrition & Supportive Services Formula Grant Awards

FY 2019

Final

FY 2020

Enacted

FY 2021 

President’s 

Budget

Number of Awards 275 272 272 

Average Award $121,134 $123,540 $123,540

Range of Awards $73,990-

$1,505,000

$73,990-

$1,505,000

$73,990-

$1,505,000

Resource and Program Data: 

Native American Nutrition and Supportive Services 

(Dollars in Thousands)

FY 2019

Final

FY 2020

Enacted

FY 2021

President’s Budget

Mechanism # $ # $ # $

Grants:

Formula

 

270

 

32,754

 

270

 

33,203

 

270

 

33,203

New Discretionary

 

1 200 

 

-- -- 

 

1 200

Continuations

 

4 358 

 

2 400 

 

1 200 

Contracts

 

1 721 

 

1 735 

 

1 735 

Interagency Agreements

 

--

 

--

 

--

 

--

 

--

 

--

Program Support70

 

-- 140 

 

-- 370 

 

-- 370 

Total Resources 34,173 34,708 34,708 

70 Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and review, 

and information technology support costs.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

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HEALTH AND INDEPENDENCE FOR OLDER ADULTS

91 

Aging Network Support Activities

Services

FY 2019 

Final 

FY 2020 

Enacted

FY 2021 President’s 

Budget

FY 2021 (+/-) FY 

2020 

Aging Network Support 

Activities $16,400 $12,461 $11,503 -$958

FTE .9 .9 .4 -.5

*BA is in thousands of dollars. 

Authorizing Legislation: Section 202, 215, and 411 of the Older Americans Act of 1965, Public Law 

89-73

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

114-144 

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

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

Allocation Method ............................ Competitive Grants/Co-operative Agreements and Contracts 

Program Description and Accomplishments:

The Aging Network Support Activities program provides competitive grants and contracts to 

support technical assistance to help States, Tribes, and community providers of aging services to 

develop service systems that help older people remain independent and able to live in their own 

homes and communities. The activities of national significance help seniors and their families to 

obtain information about their care options and benefits. The program also provides ongoing 

support for the national aging services network and helps support the activities of ACL’s core 

service delivery programs.

Competitive grants, cooperative agreements, and contracts for Aging Network Support Activities 

are awarded to eligible public or private agencies, tribal organizations, States, Area Agencies on 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

92 

Aging (AAAs), institutions of higher learning, and other organizations representing and/or serving 

older people, including faith-based organizations. Grantees are generally asked to provide a match 

equal to 25 percent of the project’s total cost. Project proposals are reviewed by external experts, 

and awards are made for periods of one to five years. 

National Eldercare Locator and Engagement 

Older Americans and their caregivers face a complicated array of choices and decisions regarding

health care, pensions, insurance, housing, financial management, and long-term care. The 

Eldercare Locator, created in 1991, helps seniors and their families navigate this complex 

environment by connecting those needing assistance with State and local agencies on aging that 

serve older adults and their caregivers. The Eldercare Locator can be accessed through a toll-free 

nationwide telephone line (800-677-1116) or website (http://www.eldercare.gov). The phone line 

and website both connect those in need to providers in every zip code in the nation. The Eldercare 

Locator website continues to grow as a resource for older adults and their caregivers, serving 

871,362 individuals in 2016. This service is supplemented by an Information and Referral Support 

Center which provides technical assistance and standards for the development of effective 

information and assistance systems.

Research suggests that social engagement remains an important determinant of physical health 

into very late adulthood.71

71 Katie E. Cherry, Erin Jackson Walker, Jennifer Silva Brown, Julia Volaufova, Lynn R. LaMotte, David A. Welsh, 

L. Joseph Su, S. Michal Jazwinski, Rebecca Ellis, Robert H. Wood, and Madlyn I. Frisard. 2013. “Social 

Engagement and Health in Younger, Older, and Oldest-Old Adults in the Louisiana Heathy Aging Study. J Appl 

Gerontol Feb 1;32(1):51-75. 

 ACL is interested in expanding the reach of the Aging Services network 

to more effectively assist older adults in remaining socially engaged and active. The Engagement 

and Older Adults Resource Center provides technical assistance, and serves as a repository for 

innovations designed to increase the aging network’s ability to tailor social engagement activities 

to meet the needs of older adults. 

Pension Counseling and Retirement Information

The Pension Counseling program assists older Americans in accessing information about their 

retirement benefits and helps them negotiate with former employers or pension plans for due 

compensation. Currently there are approximately 700,000 private (as well as thousands of public) 

pension and retirement plans in the United States. Given that an employee may have worked for 

several employers, and these employers may have merged, sold their plans, or gone bankrupt, it is 

very difficult for the average person to know where to go to get help in finding out whether he or 

she is receiving all of their pension benefits. ACL currently funds six regional counseling projects 

covering 30 states. In 2016 pension counseling projects recovered $11.4 million and helped 3,812 

people. The outcomes of these services are often the difference between dependence on 

government support and having sustainable income. Data for the program show that: 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

93 

• Since its inception, Pension Counseling projects have successfully recovered over $228 

million in client benefits, representing a return of more than nine dollars for every Federal 

dollar invested in the program.

• Projects have directly served over 59,000 individuals, by providing hands-on assistance in 

pursuing claims through administrative appeals processes, helping seniors to locate 

pension plans “lost” as a result of mergers and acquisition, answering queries about 

complex plan provisions, and making targeted referrals to other professionals for 

assistance.

Pension Counseling projects also provide indirect services to tens of thousands of seniors and their 

families through information sharing, hosting websites, and conducting outreach, education and 

awareness efforts. 

ACL also supports the National Education and Resource Center on Women and Retirement 

Planning, which provides access to a one-stop gateway that integrates financial information and 

resources on retirement planning with information on health and long-term care. This project made 

user-friendly financial education and retirement planning tools available to traditionally hard-toreach individuals, including low-income women, women of color, women with limited English 

speaking proficiency, rural, and other “underserved” individuals. Information is offered through 

financial and retirement planning programs, workshops tailored to meet women’s special needs, 

and is published in hard copy and web-based formats. Since its establishment, the Center has 

conducted approximately 200 workshops per year on strategies to access financial and retirement 

planning information. It also developed and published over 175 Fact Sheets tailored to the specific 

needs of hard-to-reach women. The Center maintains an interactive web site. This program is one 

that helps to create economic mobility for women who are most at risk of not having adequate 

savings for retirement.

National Resource Centers on Native American Elders

The National Resource Centers on Native American Elders enhance knowledge about older Native 

Americans and thereby improve the delivery of services to this important, but underserved, 

population. Each resource center addresses at least two areas of primary concern which are 

specified in the OAA. These include health issues, long-term care (including in-home care), elder 

abuse, mental health, and other problems and issues facing Native communities. The Resource 

Centers are administered under cooperative agreements by institutions of higher education. The 

resource centers partner with Native American organizations and communities, educational 

institutions (including tribal colleges and universities), and professionals and paraprofessionals in 

the field. Each Resource Center has specialized areas of interest. For example, the University of 

North Dakota Resource Center has assisted Title VI grantees in assessing needs of tribal elders to 

determine program planning and direction. This process has led to the development of a database 

of information about American Indian, Alaska Native, and Native Hawaiian Elders. The 

University of Hawaii Resource Center has focused on long-term care needs of Native Hawaiian 

Elders. The University of Alaska Resource Center has focused on elder abuse and neglect issues 

within Native American or Alaskan Native communities.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

94 

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 frontline health promotion and disease 

prevention information that is culturally and linguistically appropriate for older individuals of 

African American, Hispanic, Asian American and Pacific Islander descent, American Indian and 

Alaska Native elders, as well as for older lesbian, gay, bisexual, and transgender (LGBT) adults.

Each NMAO project pilots a practical, nontraditional, community-based intervention for reaching 

older individuals who experience barriers to accessing home and community-based services. 

Interventions are focused on barriers due to language and low literacy. Strategies developed under 

this program incorporate the latest technology and facilitate the generation and dissemination of 

knowledge in forms that can assist minority older individuals to practice positive health behaviors 

and strengthen their capacity to maintain active, independent life styles. Examples of products 

resulting from these grants include a chronic disease self-management curriculum and manual 

tailored for racial and ethnic minority seniors, a referral database of Chronic Disease SelfManagement Education (CDSME) workshops, a series of bilingual Influenza Vaccination 

Promotion materials, and a culturally appropriate caregiver manual/toolkit for American Indian 

and Alaskan Native caregivers caring for elders with dementia.

Holocaust Survivor Assistance

The United States is home to approximately 100,000 victims of Nazi persecution, approximately

25 percent of whom are living in poverty. Because of the experiences they endured early on in 

their lives, Holocaust survivors are likely to have greater and more complex physical and mental 

health needs as they age. The nonprofit social service agencies that serve this population have 

projected that the need for supportive services will continue to grow and intensify over the next 

five to ten years.

In FY 2015, ACL developed and implemented a program to provide supportive services for aging 

Holocaust survivors living in the United States. A cooperative agreement was awarded to a 

national organization with demonstrated expertise in working with Holocaust survivors to advance 

the development and delivery of person-centered, trauma-informed supportive services. The 

program focuses efforts on two fronts: 1) expanding the capacity of community-based agencies to 

provide direct services to Holocaust survivors in a person-centered, trauma-informed manner; and 

2) developing and implementing a national technical assistance center devoted to expanding the 

aging services network’s capacity to deliver person-centered, trauma-informed services.

Program Performance and Technical Assistance

This activity supports cooperative efforts between ACL and selected states and AAAs to develop 

tools, performance measures, and best practices that can be used to effectively and efficiently 

identify the results produced through OAA programs on an ongoing basis. These efforts include 

partnerships with National Aging Organizations to foster innovation and provide technical 

assistance to states, AAAs, and tribal organizations in strategic planning, program development, 

and performance improvement. Program Performance and Technical Assistance (PPTA) also 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

95 

supports efforts to expand the business acumen and contracting capacity of the community-based 

organizations (CBOs) within the Aging network. Medicaid, Medicare, Accountable Care 

Organizations, private insurers and other private pay models will offer increasing opportunities to 

CBOs to tap into new revenue streams outside of government grants, but securing contracts and 

interfacing with such payers requires thinking and operating differently. ACL’s Business Acumen 

Initiative seeks to strengthen CBOs from the inside, building their business skills and enhancing 

their effectiveness, efficiency, and sustainability.

Care Corps Program

In FY 2019 ACL put out a cooperative agreement to establish the National Volunteer Care Corps 

program. The program tests models of programming designed to place volunteers in communities 

to assist caregivers, older adults, and persons with disabilities in maintaining independence by 

providing non-medical care. The initial cooperative agreement tested a variety of different 

volunteering models. In FY 2020 ACL plans on continuing testing of the volunteer models set up 

using FY 2019 funding. 

Funding History: 

Comparable funding for Aging Network Support Activities over the past five years is as follows: 

FY 2017 ...................................................$9,938,000 

FY 2018 .................................................$12,461,000 

FY 2019 ................................................$16,400,000 

FY 2020 Enacted....................................$12,461,000 

FY 2021 President’s Budget ..................$11,503,000 

Budget Request:

The FY 2021 request for Aging Network Support Activities is $11,503,000, a reduction 

of -$958,000 million below the FY 2020 Enacted level. This level does not include funding for the 

Care Corps Program, which was not funded in the FY 2020 appropriation, and includes a decrease 

in the Program Performance and Technical Assistance line. Programs funded by this request 

provide ongoing support for the national aging services network and support the activities of 

ACL’s core service delivery programs. They provide a variety of unique services – such as the 

Pension Counseling and the National Eldercare Locator – and strengthen and streamline ACL’s 

core services.72

72 Please see page 231 for a discussion of how the MIPPA program helps hard to reach low income and Rural 

Medicare beneficiaries who qualify for either the Medicare savings plan or Low-Income Subsidy pay their Medicare 

premiums.

The request will continue, as permitted by statute, to support .4 FTE (costs not to exceed $100,000)

for administration of the Pension Counseling program. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

96 

Aging Network Support Activities outcomes are reflected in performance targets for Health and 

Independence for Older Adults and Caregiver and Family Support Services. 

Aging Network Support Activities includes funding for the following projects:

(dollars in thousands)

Activity FY 2019 

Final

FY 2020

Enacted

FY 2021

President’s 

Budget

Aging Network Support Activities:

National Eldercare Locator and Engagement 2,028 2,038 2,038

Pension Counseling and Retirement Information 1,850 1,858 1,858

National Resource Centers on Native Americans 652 655 655

National Minority Aging Organizations 1,160 1,165 1,165

Holocaust Survivor Assistance 4,976 5,000 5,000

Program Performance and Technical Assistance 1,737 1,745 788

 Care Corps 4,000 - - 

Total, Aging Network Support Activities 16,400 12,461 11,503

Grant Awards Table:

Aging Network Support Grant Awards 

FY 2019 

Final

FY 2020

Enacted

FY 2021 

President’s 

Budget

Number of 

Awards 27 25 24 

Average Award $563,175 $452,969 $459,339

Range of Awards $50,000-

$4,935,000

$50,000-

$4,935,000

$50,000-

$4,935,000
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

97 

Resource and Program Data: 

Aging Network Support Activities 

(Dollars in thousands)

FY 2019

Final

FY 2020

Enacted

FY 2021

President’s Budget 

Mechanism # $ # $ # $

Grants:

Formula

 

--

 

--

 

--

 

--

 

--

 

--

New Discretionary

 

2

 

6,268

 

10

 

6,869

 

5

 

1,004

Continuations

 

25

 

8,938

 

15

 

4,455

 

14 

 

10,020

Contracts

 

3

 

718

 

2 

 

821

 

2 

 

176

Interagency Agreements

 

--

 

--

 

--

 

--

 

--

 

--

Program Support73

 

--

 

477

 

--

 

316

 

--

 

303

Total Resources

 

16,400

 

12,461

 

11,503 

73 Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and review, 

and information technology support costs.
98 

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CAREGIVER AND FAMILY SUPPORT SERVICES

99 

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 by existing responsibilities. ACL’s caregiver 

programs provide services that address the needs of unpaid, informal caregivers, allowing them to 

continue to work while providing critically needed care.

Better support for informal caregivers is critical because often it is their availability—whether they 

are family members or unrelated friends and neighbors who dedicate their time—that determines 

whether an older person can remain in his or her home or must be institutionalized. In 2014, 

approximately 34.2 million adult caregivers provided uncompensated care to those 50 years of age 

and older.74

74 https://acl.gov/about-acl/reports-congress-and-president; FY15OAAReportCongress, page 25. 

An estimated 117 million Americans will need assistance of some kind by 2020.75

75 https://www.rand.org/pubs/external_publications/EP66196.html. 

These trends are already being felt in the marketplace, where employers are losing an estimated 

$33 billion per year due to employees’ caregiving responsibilities.76

76 http://www.caregiving.org/data/Caregiver%20Cost%20Study.pdf “The MetLife Caregiving Cost Study: 

Productivity Losses to U.S. Business, Page 17.

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.77

77 Schulz R, Beach SR. Caregiving as a risk factor for mortality. The Caregiver Health Effects study. JAMA December 

15, 1999;282:2215-9.

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-five percent of the caregivers served by OAA programs 

report that these services allow them to provide care longer than they otherwise could have.78

78 2018 National Survey of Older Americans Act Participants https://agid.acl.gov/. 

By 2020, the U.S. Census Bureau estimates there will be 13.1 million non-institutionalized seniors 

age 65 and over with 1+ ADL deficits, an increase of almost 800,000 older adults (or 6 percent 

increase between 2018 and 2020) needing caregiver assistance.79

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

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

Release Date: September 2018. https://www.census.gov/data/tables/2017/demo/popproj/2017-summary-tables.html. 

Accessed 10 December 2019. U.S. Census Bureau, Annual Estimates of the Resident Population for Selected Age 

Groups by Sex for the United States: April 1, 2010 to July 1, 2018: Released June 2019, 

https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml. Accessed 10 December 2019. Centers for Medicare & 

To help address these 
CAREGIVER AND FAMILY SUPPORT SERVICES

100 

Medicaid Services, ACL analysis of 2016 Medicare Current Beneficiary Survey, https://www.cms.gov/ResearchStatistics-Data-and-Systems/Research/MCBS/index. Accessed 10 December 2019.

caregiver-related needs, and to avoid an increasing burden on Medicare and Medicaid expenses 

for LTC, ACL proposes to expand existing transfer authorities to give States maximum flexibility 

to transfer funding between four Older Americans Act Programs. These are Home and Community 

Based Supportive Services, Nutrition Programs, Family Caregiver Services, and Preventive Health 

Services. In addition, ACL requests a total of $190.8 million for caregiver support programs, a 

reduction of -$38.1 million below the FY 2020 Enacted level. The request includes: 

• $150.6 million for Family Caregiver Support Services, a reduction of -$35.4 million below 

the FY 2020 Enacted level. This program makes a range of support services available to 

family and informal caregivers - including counseling, respite care, and training - that assist

family and informal caregivers to care for their loved ones at home for as long as possible. 

Studies have shown that these supports can reduce caregiver depression, anxiety, and 

stress, and enable them to provide care longer, thereby avoiding or delaying the need for 

costly nursing home care. 

• $10.3 million for Native American Caregiver Support Services, the same as the FY 2020 

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. 

• $26.5 million for the Alzheimer’s Disease Program the same as the FY 2020 Enacted level. 

The Alzheimer’s Disease Program includes two classes of competitive grants – to States 

that want to improve or develop their dementia systems capability, and to existing 

dementia capable community-based organizations that are prepared to address identified 

service gaps through expansion of their on-going activities. In addition, these funds 

support a training and technical assistance resource center and a national call center.

• $3.4 million for Lifespan Respite Care, a reduction of -$2.8 million below the FY 2020 

Enacted level. At this level, the Lifespan Respite Care program will continue its efforts to 

develop more efficient, cost-effective methods that reach across the aging and the 

disability populations to improve the quality of, and access to, respite care for family 

caregivers of children or adults of any age with special needs.
CAREGIVER AND FAMILY SUPPORT SERVICES

101 

Family Caregiver Support Services

Services

FY 2019 

Final 

FY 2020

Enacted

FY 2021 President’s 

Budget

FY 2021 (+/-) FY 

2020

Family Caregivers 

Support Services $180,999 $185,936 $150,586 -$35,350

*BA is in thousands of dollars.

Original Authorizing Legislation: Section 371 of the Older Americans Act of 1965, Public Law 

89-73. 

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

114-144 

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

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

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

Program Description and Accomplishments:

The Family Caregiver Support Services Program provides formula grants to states and territories, 

based on their share of the population age 70 and over, to fund a range of supports that assist family 

and informal caregivers to care for their loved ones at home for as long as possible. The program 

includes five basic system components: information, access assistance, counseling and training, 

respite care, and supplemental services. These services work in conjunction with other OAA 

services to provide a coordinated set of supports that caregivers can access on behalf of themselves 

and the seniors for whom they provide care. These services include: 

• Access Assistance Services provided nearly 1.6 million contacts to caregivers assisting 

them in locating services from a variety of public and private agencies (Output I).80

80 ACL’S OAA State Performance Report, FY 2018.
CAREGIVER AND FAMILY SUPPORT SERVICES

102 

• Counseling and Training Services provided over 111,000 caregivers with counseling, peer 

support groups, and training to help them better cope with the stresses of caregiving 

(Output J).81

81 Id.

• Respite Care Services provided over 58,500 caregivers with nearly 6.2 million hours of 

temporary relief, at home or in an adult day care or nursing home setting, from their 

caregiving responsibilities (Output K).82

82 Id.

Family and other informal caregivers are the backbone of America’s long-term care system. On a 

daily basis, these individuals assist relatives and other loved ones with tasks ranging from personal

care and homemaking to more complex health-related interventions like medication administration 

and wound care. The economic cost of replacing unpaid caregiving is estimated to be between 

$47083

83 Ibid.

and $522 billion annually, which is roughly equivalent to the cost of all Medicaid spending 

in FY 2016 (Federal and state: $553 billion).84

84 Ibid.

Research has also shown that caregiving exacts a heavy emotional, physical, and financial toll. 

Caregivers often experience conflicts between work and caregiving, with 65% reporting that 

providing care interfered with their job.

85

85 2018 National Survey of Older Americans Act Participants. https://agid.acl.gov/. 

According to data from ACL’s National Survey of OAA 

Participants, 22 percent of caregivers reported that they are assisting two or more individuals.86

86 Id.

 

Seventy-eight percent of Title III caregivers are 60 or older, making them more susceptible to a 

decline in their own health, and 35 percent describe their own health as fair to poor.87

87 Id.

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, often while 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.88

88 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.

Additionally, data from ACL’s National Surveys shows that ACL services are effective in helping 

caregivers keep their loved ones at home. Approximately 75 percent of caregivers of program 

clients reported that services enabled them to provide care longer than otherwise would have been 

possible.89

89 2018 National Survey of Older Americans Act Participants. https://agid.acl.gov/. 

Caregivers receiving services were also asked whether the care recipient would have 
CAREGIVER AND FAMILY SUPPORT SERVICES

103 

been able to live in the same residence if the services had not been available. Thirty six percent of 

caregivers indicated that the care recipient would be unable to remain at home without the support 

services.90

90 Id.

 Those respondents were then asked to identify where the care recipient would be living 

without services. A significant majority of those caregivers, 75 percent,91

91 Id.

indicated that the care 

recipient would most likely be living in a nursing home or assisted living (see below). 

Funding History:

Funding for Family Caregiver Support Services over the past five years is as follows:

FY 2017 ...............................................$150,240,000 

FY 2018 ...............................................$180,586,000 

FY 2019 ..............................................$180,999,000 

FY 2020 Enacted..................................$185,936,000 

FY 2021 President’s Budget ................$150,586,000 

Where Care Recipeint Would LIve if Unable to have 

Caregiver's Supportive Services

In Caregiver's 

Home , 5%

In The Home Of 

Another Family 

Member/Friend 

, 12%

In An Assisted 

Living Facility , 22%

In A Nursing 

Home , 53%

Care Recipient 

Would Have Died , 

1%

Other , 

6%
CAREGIVER AND FAMILY SUPPORT SERVICES

104 

Budget Request:

The FY 2021 request for Family Caregiver Support Services is $150,586,000, the same level as 

the FY 2020 President’s Budget. Funding for Family Caregiver Support Services will allow ACL 

to continue services that give caregivers the assistance needed to help them sustain their caregiving 

and provide care longer. By helping caregivers, so that they in turn can help to keep their loves 

ones independent and out of an institution for a longer period, investments in this program can 

reduce costs to the Federal government in other areas such as Medicaid.

States now can transfer up to 30 percent of their funding for Nutrition and HCBSS between these 

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

continues to propose a general provision to maximize funding flexibility for states to use Older 

American Act funding, between HCBSS, Nutrition, Preventive Health and Caregivers, to direct 

funding to activities that best addresses their individual State’s unique needs. 

The requested funding level for Family Caregiver Supportive Services will allow more than 

757,000 caregivers (Outcome 3.1) to receive supportive services, including respite care or other 

temporary relief from their caregiving responsibilities. At the requested level, ACL will continue 

support for the Raise Family Caregivers Act, and the Supporting Grandparents Raising 

Grandchildren Act. In addition, more than 93,000 caregivers will also have the opportunity to 

participate in counseling, peer support groups, and training to help them better cope with the 

stresses of caregiving (Output J). 

In FY 2021, ACL anticipates that the aging services network will be able to meet or exceed the 

target of only 30 percent of caregivers experiencing difficulty obtaining services (Outcome 2.6). 

This is a substantial accomplishment that has occurred at the State level as a result of ongoing 

program development, improved 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; by 2017, that rate had been reduced to 

33 percent of caregivers reporting difficulty getting services.92

92 Id.

For FY 2021, the performance target for Family Caregiver Support Services Program participants 

who rate services good to excellent is 90 percent (Outcome 2.9c). The substantive improvements 

in program performance can be attributed to the successful implementation of the program. Clientreported assessment of service quality and program outcomes is also expected to remain at high 

levels.
CAREGIVER AND FAMILY SUPPORT SERVICES

105 

Outcomes and Outputs Table:

Family Caregiver Support Services

Measure Year and Most Recent Result 

/ 

Target for Recent Result /

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-FY 2020

Target

1.1 For Home and 

Community-based 

Services including 

Nutrition and Caregiver 

services increase the 

number of clients served 

per million dollars of Title 

III OAA funding. 

(Efficiency)

FY 2018: 7,821 clients

Target:

8,800 clients

(Target Not Met)

7,799 clients 7,517 clients -282 clients

2.6 Reduce the 

percentage of caregivers 

who participate in the 

National Family Caregiver 

Support Program who 

report difficulty in 

obtaining services. 

(Outcome)

FY 2018: 31%

Target:

30%

(Target Not Met)

30% 30% Maintain

2.9c Maintain at 90% or 

higher the percentage of 

National Family Caregiver 

Support Program clients 

who rate services good to 

excellent. (Outcome)

FY 2018: 92%

Target:

90%

(Target Exceeded)

90% 92% +2

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 2018: 66.7 weighted 

average

Target:

63.25 weighted average

(Target Exceeded)

64 weighted 

average

64.7 weighted 

average

+0.7 weighted

average

3.1 Increase the number 

of caregivers served 

through the National 

Family Caregiver Support 

Program. (Outcome)

FY 2018: 814,495 caregivers

Target:

850,000 caregivers

(Target Not Met but 

Improved)

790,900 

caregivers

757,822 

caregivers

-33,078 caregivers
CAREGIVER AND FAMILY SUPPORT SERVICES

106 

Indicator Year and Most Recent 

Result /

FY 2020

Projection

FY 2021

Projection

FY 2021

Projection

+/-FY 2020

Projection

Output I: Caregivers 

access assistance units of 

service. (Output)

FY 2018: 1,632,838 2.0 M 1.8 M -0.2 M

Output J: Caregivers 

receiving counseling and 

training. (Output)

FY 2018: 111,571 112,296 93,301 -18,995

Output K: Caregivers 

receiving respite care 

services. (Output)

FY 2018: 58,576 62,227 53,860 -8,367

Note: For presentation within the budget ACL highlighted specific measures that are most directly related to Family 

Caregiver Support Services; however, multiple performance outcomes are impacted by this program because ACL’s 

performance measures (efficiency, effective targeting, and client outcomes) assess network-wide performance in 

achieving current strategic objectives.

Grant Awards Table:

Family Caregiver Supportive Services Grant Awards

FY 2019 

Final

FY 2020

Enacted

FY 2021 

President’s 

Budget

Number of 

Awards 56 56 56

Average Award $3,201,878 $3,287,083 $2,662,145

Range of Awards

$112,066 - 

$18,547,749

$115,048 - 

$19,017,356

$93,175 - 

$15,401,791
CAREGIVER AND FAMILY SUPPORT SERVICES

107 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2021 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Family Caregivers Support Services (CFDA 93.052)

STATE/TERRITORY FY 2019 Final FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

Alabama 2,697,025 2,771,402 2,244,505 (526,897)

Alaska 896,525 920,383 745,400 (174,983)

Arizona 4,156,306 4,355,339 3,527,306 (828,033)

Arkansas 1,702,583 1,740,632 1,409,704 (330,928)

California 18,547,749 19,017,356 15,401,791 (3,615,565)

Colorado 2,480,538 2,592,273 2,099,433 (492,840)

Connecticut 2,087,546 2,117,074 1,714,578 (402,496)

Delaware 896,525 920,383 745,400 (174,983)

District of Columbia 896,525 920,383 745,400 (174,983)

Florida 14,911,194 15,380,602 12,456,455 (2,924,147)

Georgia 4,597,268 4,781,511 3,872,454 (909,057)

Hawaii 896,525 920,383 745,400 (174,983)

Idaho 896,525 920,383 745,400 (174,983)

Illinois 6,573,783 6,695,017 5,422,166 (1,272,851)

Indiana 3,431,688 3,510,986 2,843,480 (667,506)

Iowa 1,800,443 1,829,695 1,481,835 (347,860)

Kansas 1,524,484 1,554,805 1,259,207 (295,598)

Kentucky 2,360,334 2,419,913 1,959,841 (460,072)

Louisiana 2,309,022 2,369,981 1,919,402 (450,579)

Maine 896,525 920,383 745,400 (174,983)

Maryland 3,024,971 3,109,111 2,518,010 (591,101)

Massachusetts 3,761,378 3,846,657 3,115,334 (731,323)

Michigan 5,568,827 5,704,564 4,620,018 (1,084,546)

Minnesota 2,892,508 2,966,887 2,402,825 (564,062)

Mississippi 1,540,996 1,580,147 1,279,731 (300,416)

Missouri 3,423,150 3,495,830 2,831,206 (664,624)

Montana 896,525 920,383 745,400 (174,983)

Nebraska 999,483 1,018,436 824,812 (193,624)

Nevada 1,511,606 1,573,618 1,274,443 (299,175)

New Hampshire 896,525 920,383 745,400 (174,983)
CAREGIVER AND FAMILY SUPPORT SERVICES

108 

PROGRAM/CFDA NUMBER: Family Caregivers Support Services (CFDA 93.052)

STATE/TERRITORY FY 2019 Final FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

 

New Jersey 4,878,287 4,916,958 3,982,150 (934,808)

New Mexico 1,150,802 1,196,291 968,852 (227,439)

New York 10,817,787 10,946,518 8,865,376 (2,081,142)

North Carolina 5,434,086 5,627,786 4,557,836 (1,069,950)

North Dakota 896,525 920,383 745,400 (174,983)

Ohio 6,534,226 6,678,212 5,408,556 (1,269,656)

Oklahoma 2,047,202 2,093,775 1,695,709 (398,066)

Oregon 2,326,220 2,419,195 1,959,260 (459,935)

Pennsylvania 7,825,257 7,962,592 6,448,751 (1,513,841)

Rhode Island 896,525 920,383 745,400 (174,983)

South Carolina 2,852,799 2,978,429 2,412,173 (566,256)

South Dakota 896,525 920,383 745,400 (174,983)

Tennessee 3,590,875 3,701,766 2,997,990 (703,776)

Texas 11,473,467 11,840,561 9,589,444 (2,251,117)

Utah 1,104,600 1,146,502 928,530 (217,972)

Vermont 896,525 920,383 745,400 (174,983)

Virginia 4,247,386 4,398,595 3,562,338 (836,257)

Washington 3,647,207 3,800,274 3,077,769 (722,505)

West Virginia 1,168,645 1,196,971 969,404 (227,567)

Wisconsin 3,193,316 3,270,752 2,648,920 (621,832)

Wyoming 896,525 920,383 745,400 (174,983)

 Subtotal 175,849,869 180,571,992 146,241,794 (34,330,198)

American Samoa 112,066 115,048 93,175 (21,873)

Guam 448,263 460,192 372,700 (87,492)

Northern Mariana Islands 112,066 115,048 93,175 (21,873)

Puerto Rico 2,334,663 2,354,168 1,906,596 (447,572)

Virgin Islands 448,263 460,192 372,700 (87,492)

 Subtotal 179,305,190 184,076,640 149,080,140 (34,996,500)

Program Support 1/ 1,693,810 1,859,360 1,505,860 (353,500)

Total States/Territories 180,999,000 185,936,000 150,586,000 (35,350,000)

1/ Program Support- includes funds for Older American Act statutory requirements, including program evaluation and disaster 

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

states.
CAREGIVER AND FAMILY SUPPORT SERVICES

109 

Native American Caregiver Support Services

Services

FY 2019 

Final 

FY 2020

Enacted

FY 2021 President’s 

Budget

FY 2021 (+/-) FY 

2020

Native American 

Caregiver Support 

Services

$10,046 $10,306 $10,306 --

*BA is in thousands of dollars.

Original Authorizing Legislation: Section 631 of the Older Americans Act of 1965, Public Law 

89-73 

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

114-144 

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

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

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

Program Description and Accomplishments:

Native American Caregiver Support Services provide grants to eligible tribal organizations to 

support family and informal caregivers of Native American, Alaskan Native, and Native Hawaiian 

elders. This program helps to reduce the need for costly nursing home care and medical 

interventions, is responsive to the needs of Native American communities, and represents an 

important part of each community’s comprehensive services.

Native American Caregiver Support Services funding is allocated to eligible tribal organizations 

based on their share of the American Indian, Alaskan Native, and Native Hawaiian populations 

aged 60 and over. Native organizations must represent at least 50 Native American elders age 

60 and over and must also receive a grant under the Native American Nutrition and Supportive 

Services program to receive funding. There is no requirement for matching funds. Tribes may also 

decide the age at which a member is considered an elder and, thus, eligible for services. In addition, 

there is no limit on the percentage of funds that can be used for services to grandparents caring for 

grandchildren. 
CAREGIVER AND FAMILY SUPPORT SERVICES

110 

Grants assist American Indian, Alaskan Native, and Native Hawaiian families caring for older 

relatives with chronic illness or disability, and grandparents caring for grandchildren. The 2017 

National Resource Center on Native American Aging’s Identifying Our Needs: A Survey of Elders

show that 33.7% of Native Elders have a family member as a caregiver; 28.3% are themselves 

caring for grandchildren and 10.2% of these Elders are the primary caregiver of a grandchild. The 

trending top five chronic diseases among Elders were high blood pressure (56.5%), arthritis 

(45.3%), diabetes (39.3%), cataracts (19.4%), and depression (13.3%). 

The Title VI program provides a variety of direct services that meet a range of caregiver needs, 

including information and outreach, access assistance, individual counseling, support groups and 

training, respite care, and other supplemental services. Native organizations coordinate with other 

programs to help support and create sustainable caregiver programs in Native American 

communities (many of which are geographically isolated). A core value of the Native American 

Caregiver Support Services program is that the program should not replace the tradition of families 

caring for their elders. Rather, as expressed by multiple tribal and other Native leaders, the program 

provides support that strengthens the family caregiver role.

Funding History:

Funding for the Native American Caregiver Support Services over the past five years is as follows:

FY 2017 ...................................................$7,539,000 

FY 2018 ...................................................$9,556,000 

FY 2019 ...............................................$10,046,000 

FY 2020 Enacted....................................$10,306,000 

FY 2021 President’s Budget ..................$10,306,000 

Budget Request:

The FY 2021 request for Native American Caregiver Support Services is $10,306,000, the same 

as the FY 2020 Enacted level. Often it is the availability of caregivers – whether they are family 

members or unrelated friends and neighbors who volunteer their time – that determines whether 

an older person can remain in his or her home. 

The strength of the Older Americans Act is that it gives Native communities the ability to define 

needs from the bottom up, and the flexibility to direct funding accordingly to best meet these 

needs. In FY 2021, ACL continues to propose a new general provision to build on existing 

flexibility by giving Native communities the ability to transfer nearly all of the funds they receive 

for Native American Nutrition and Supportive Services and Native American Caregiver Support 

Services between these programs to achieve the funding distribution that best addresses their 

individual community’s unique needs. 
CAREGIVER AND FAMILY SUPPORT SERVICES

111 

An estimated 994,000 persons age 60 and over identify themselves as Native American or Alaskan 

Native, alone or in combination with another racial group.93

93 U.S. Census Bureau, Population Division, Annual Estimates of the Resident Population by Sex, Age, Race Alone 

or in Combination, and Hispanic Origin for the United States: April 1, 2010 to July 1, 2018 Released June 2019. 

https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml. Accessed 10 December, 2019.

 Over 548,000 of those elders identify 

as Native American or Alaskan Native with no other racial group.

94

94 U.S. Census Bureau, Population Division, Annual Estimates of the Resident Population by Sex, Age, Race, and 

Hispanic Origin for the United States: April 1, 2010 to July 1, 2018. Release Date: June 2019. 

https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml. Accessed 10 December, 2019. 

 Caregiver Support Services 

help Native American elders, many of whom have limitations in activities of daily living that make 

it difficult to care for themselves, to remain at home, in the community, or on the reservation for 

as long as possible. Studies have shown that providing assistance to caregivers can help them cope 

with the emotional, physical, and financial toll associated with caregiving, thereby enabling them 

to provide care for their loved ones longer and avoid or delay the need for costly nursing home 

care.

Performance data indicates that these programs are an efficient means to help Native American 

Elders remain independent and in the community. In FY 2021, funding for the Native American 

Caregiver Support Program will continue to support family and informal caregivers, whose 

assistance is critical to enabling Native American elders to remain at home, in the community, 

and/or on the reservation. In FY 2021, an estimated 711,000 units of caregiver-related services, 

including respite care, information and referral, caregiver training and support groups, will have 

been provided by Native American Tribal organizations.
CAREGIVER AND FAMILY SUPPORT SERVICES

112 

Outcome Table:

Native American Caregivers Supportive Services 

Measure Year and Most Recent Result 

/ 

Target for Recent Result /

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-FY 2020

Target

3.1 Increase the number 

of caregivers served 

through the National 

Family Caregiver Support 

Program. (Outcome)

FY 2018: 814,495 caregivers

Target:

850,000 caregivers

(Target Not Met but 

Improved)

790,900 

caregivers

757,822 

caregivers

-33,078 caregivers

Grant Awards Table:

Native American Caregivers Supportive Services Grant Awards

FY 2019 

Final 

FY 2020

Enacted

FY 2021 

President’s 

Budget

Number of Awards 238 238 238

Average Award $41,655 $42,680 $42,680

Range of Awards $13,820-

$56,560 

$13,820-

$56,560 

$13,820-

$56,560 
CAREGIVER AND FAMILY SUPPORT SERVICES

113 

Resource and Program Data: 

Native American Caregiver Support Services

(Dollars in thousands)

FY 2019

Final

FY 2020

Enacted

FY 2021

President’s Budget 

Mechanism # $ # $ # $

Grants:

Formula

 

238

 

9,914

 

238

 

10,158

 

238

 

10,158

New Discretionary

 

-- 

 

-- 

 

-- 

Continuations

 

-- 

 

-- 

 

-- 

Contracts

 

-- 

 

-- 

 

-- 

Interagency Agreements

 

--

 

--

 

--

 

--

 

--

 

--

Program Support95

 

-- 132 

 

-- 148 

 

-- 148 

Total Resources 10,046 10,306 10,306 

95 Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and review, 

and information technology support costs.
CAREGIVER AND FAMILY SUPPORT SERVICES

114 

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CAREGIVER AND FAMILY SUPPORT SERVICES

115 

Alzheimer’s Disease Program

Services

FY 2019 

Final 

FY 2020

Enacted

FY 2021 President’s 

Budget

FY 2021 (+/-) FY 

2020

Direct $5,296 $11,800 $26,500 +$14,700

PPHF $14,700 $14,700 -- -$14,700

Total: $19,996 $26,500 $26,500 --

*BA is in thousands of dollars.

Authorizing Legislation: Section 411 of the Older Americans Act of 1965, Public Law 89-73 

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

114-144 

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

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

Allocation Method ............................. Competitive Grants/Cooperative Agreements and Contracts

Program Description and Accomplishments:

The effects of Alzheimer’s Disease and Related Dementias (ADRD) are devastating for 

individuals living with the disease and their family caregivers. Serving people with ADRD 

typically requires significant levels of medical care as well as the provision of person-centered, 

dementia-capable home and community-based services (HCBS). Approximately one-third of 

individuals with ADRD living in the community live alone, exposing them to numerous risks, 

including unmet needs, malnutrition, injury, and various forms of neglect and exploitation.96

96 Gould, E., Maslow, K., Yuen, P., Wiener, J. Providing Services for People with Dementia Who Live Alone: Issue 

Brief. Accessed April 14, 2014 at http://www.adrc-tae.acl.gov/tiki-index.php?page=adsspkey&filter=key.

As 
CAREGIVER AND FAMILY SUPPORT SERVICES

116 

the number of people with ADRD is projected to grow by almost 300 percent by 2050,97

97 Alzheimer’s Association. 2017 Alzheimer’s Disease Facts and Figures. Accessed 09 May, 2017 at

http://www.alz.org/alzheimers_disease_facts_and_figures.asp. 

from an 

estimated 5.3 million individuals, it is important to develop effective and coordinated service 

delivery and health care systems that are responsive to these individuals and their caregivers.

The complexity of care required by persons with advanced dementia – defined by the severity of 

functional and cognitive impairment, reliance on surrogate decision-making, and inability to live 

alone – results in tremendous family/caregiver burden.98

98 National Alzheimer Project Act Advisory Council on Alzheimer's Research, Care, and Services Meeting #15: 

Advanced Dementia Expert Panel Summary and Key Recommendations. (2015, January 26). January 26, 2015 

In-Person Meeting. Retrieved from http://aspe.hhs.gov/daltcp/napa/012615/Mtg15-Slides4.shtml. 

Behavioral symptoms, such as repetitive 

speech, wandering, and sleep disturbances, are core clinical characteristics of ADRD. If untreated, 

these behaviors can accelerate disease progression, worsen functional decline and quality of life, 

cause significant caregiver distress, and result in earlier nursing home placement.99

99 Gitlin LN, Kales HC, Lyketsos CG. Nonpharmacologic Management of Behavioral Symptoms in Dementia.

JAMA. 2012;308(19):2020-2029. doi:10.1001/jama.2012.36918.

Establishing dementia-capable home and community-based service systems designed to meet the 

needs of formal and informal caregivers of individuals with ADRD is critical to helping these 

caregivers continue to provide care. The Alzheimer’s Disease Program provides funding for the 

development and implementation of these person-centered services, and supports partnerships 

with public and private entities to identify and address the unique needs of persons with ADRD 

and their caregivers.

In FY 2018, ACL consolidated all of its Alzheimer’s and related dementias (ADRD) programs 

into a single, more flexible, program. The Alzheimer’s Disease Supportive Services Program 

(ADSSP), the Alzheimer’s Disease Initiative - Specialized Services Program (ADI-SSS), the ADI 

– Communications Campaign, and the Alzheimer’s Call Center (previously funded from the 

ANSA) were all consolidated into the Alzheimer’s Disease Programs Initiative (ADPI). The new 

ADPI improves the services that support caregivers and people with ADRD by dedicating 

resources for States and community-based organizations that provide both services and training to 

people with ADRD and those that support them. Through the ADPI, ACL issues two classes of 

competitive grants – to States and community-based organizations. Eligible applicants are those 

States that want to develop/improve the dementia capability of their home and community based 

service (HCBS) system, and community-based HCBS providers with existing dementia-capability 

that are prepared to expand their existing services and supports while addressing specific identified 

service gaps. 

Collectively these grants seek to achieve the following objectives:

• Create state-wide, person-centered, dementia-capable home and community-based 

service systems;

• Translate and implement evidence-based supportive services for persons with ADRD 

and their caregivers at the community level;
CAREGIVER AND FAMILY SUPPORT SERVICES

117 

• Work with public and private entities to identify and address the special needs of persons 

with ADRD and their caregivers; and 

• Offer direct services and supports to thousands of persons with ADRD and their 

caregivers.

To support this work, ACL also funds a training and technical assistance resource center. The 

center works with grantees to share best practices, disseminate recent research findings, and 

develop issue briefs for States and communities. 

Funding History:

FY 2017 .................................................................$0 

FY 2018/1 ..............................................$23,500,000 

FY 2019 .................................................$19,996,000 

FY 2020 Enacted ...................................$26,500,000 

FY 2021 President’s Budget ..................$26,500,000 

1/FY 2019 and FY 2020 totals each include $14.7 million in funding from the Prevention and Public Health Fund. 

Budget Request: 

In FY 2021, ACL is requesting $26,500,000 the same as the FY 2020 Enacted level. The need for 

cutting edge approaches for services and systems that help to support those with Alzheimer’s 

disease and related dementias (ADRD) and their caregivers is critical for helping them to remain 

in the community. At this funding level, ACL will continue to assist individuals with ADRD and 

their caregivers. 

Maintaining funding will allow ACL to continue to support community pilot projects that include 

dementia specific evidence-based interventions designed to support persons living with 

Alzheimer’s disease and related dementias and their caregivers. 

Each ADPI grantee dedicates a minimum of 50% of their total budget to the provision of dementia 

specific direct services. Program funded direct services come in many forms, including, but not 

limited to innovations in respite care such as:

• Volunteer companion programs, 

• Caregiver training,

• Respite and culturally competent Memory Cafés. 

ACL funded programs are launching education and awareness initiatives designed to identify and 

support persons living alone with dementia, resulting in a better trained paid and unpaid workforce. 

All programs include robust evaluations designed to demonstrate program impact and support 

sustainability beyond the federal funding period. At this funding level, ACL will continue to assist 

individuals with ADRD and their caregivers. 
CAREGIVER AND FAMILY SUPPORT SERVICES

118 

Outcome and Outputs Table:

Alzheimer’s Disease Program

Measure Year and Most Recent Result 

/ 

Target for Recent Result /

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-FY 2020

Target

ALZ.3 Improve dementia 

capability of long-term 

support systems to create 

dementia-friendly, livable 

communities. (Outcome)

FY 2018: 22%

Target:

22%

(Baseline)

33% 35% +2

*This is a developmental performance measure. ACL is currently collecting sufficient data to establish a baseline. To set a baseline,

the agency relies on 3 years of data. This process ensures that the data are stable and show a clear trend. The agency will set targets

for this measure once a baseline is established.

Grant Awards Tables:

Alzheimer’s Disease Program100

100 The number of awards is an estimate and may change.

FY 2019

Final

FY 2020

Enacted

FY 2021 

President’s 

Budget

Number of Awards 27 27 27

Average Award $613,908 $913,180 $931,180

Range of Awards $374,861-

$1,233,571

$374,861-

$1,233,571

$374,861-

$1,233,571
CAREGIVER AND FAMILY SUPPORT SERVICES

119 

Resource and Program Data: 

Alzheimer’s Disease Program

FY 2019

Final

FY 2020

Enacted

FY 2021

President’s Budget 

Mechanism # $ # $ # $

Grants:

Formula

 

--

 

--

 

--

 

--

 

--

 

--

New Discretionary 26 16,576 26 23,422

 

26

 

23,422

Continuations 1 1,234 1 1,234 1 1,234

Contracts 1 1,700 1 1,700 1 1,700

Interagency Agreements

 

--

 

--

 

--

 

--

 

--

 

--

Program Support

 

-- 488

 

-- 145

 

-- 145

Total Resources

 

-- 19,996

 

-- 26,500

 

-- 26,500
CAREGIVER AND FAMILY SUPPORT SERVICES

120 

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CAREGIVER AND FAMILY SUPPORT SERVICES

121 

Lifespan Respite Care

Services

FY 2019 

Final 

FY 2020

Enacted

FY 2021 

President’s Budget

FY 2021 (+/-) FY 

2020

Lifespan Respite 

Care $4,096 $6,110 $3,360 -$2,750

*BA is in thousands of dollars.

Original Authorizing Legislation: Lifespan Respite Care Act of 2006, Title XXIX of the Public 

Health Service Act

Most Recent Authorizing Legislation: Lifespan Respite Care Act of 2006, Title XXIX of the Public 

Health Service Act

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

Expiration Date ..........................................................................................................................2011 

Allocation Method ............................................................................................. Competitive Grants

Program Description and Accomplishments:

Family caregiving is not just an aging issue. Family caregiving for persons with disabilities occurs 

across the age spectrum from birth to death. Family caregivers are often called upon to provide 

care to individuals of varying ages and disabilities, and do so willingly. In 2015, AARP and the 

National Alliance for Caregiving estimated that 43.5 million people served as unpaid family 

caregivers to an adult or child with special needs. For many of these caregivers, providing care 

can take a toll: nineteen percent report high levels of physical strain; eighteen percent experience 

high levels of financial strain; and thirty-eight percent of all family caregivers indicated they 

experienced high levels of emotional stress.101

101 National Alliance for Caregiving and AARP. Caregiving in the U.S. 2015 – Focused Look at Caregivers of 

Adults Age 50+. http://www.caregiving.org/wp-content/uploads/2015/05/2015_CaregivingintheUS_CareRecipients-Over-50_WEB.pdf

 Many caregivers report difficulty managing both 

physical and emotional stress and balancing work and family responsibilities. 
CAREGIVER AND FAMILY SUPPORT SERVICES

122 

Numerous studies have shown respite to be among the most frequently requested supportive 

services for family caregivers.102

102 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. 

Respite is second only to direct financial assistance as a key 

policy priority of surveyed family caregivers.103

103 National Alliance for Caregiving and AARP, 2009. 

Even though respite services are often the 

preferred mode of family caregiver support, they are often under-used, difficult to find and access, 

unaffordable, or in short supply. As a result, nearly 90 percent of family caregivers receive no 

respite at all.104

104 National Alliance for Caregiving and AARP, 2009.

The barriers to accessing and using respite services are often significant for specific 

populations such as family caregivers of individuals with Multiple Sclerosis, persons with 

intellectual and developmental disabilities, and for caregivers of veterans and individuals with 

Alzheimer’s disease, spinal cord injuries, autism, and serious emotional disorders.105

105 National Alliance for Caregiving. (2012). Multiple Sclerosis Caregivers. Washington, DC: Author; The Arc, 2011.

The Lifespan Respite Care Program focuses on easing the burdens of caregiving by providing 

grants to eligible state organizations to improve the quality of, and access to, respite care for family 

caregivers of children or adults with special needs. The program provides ACL with a key vehicle 

to address the needs of caregivers, while considering the important contributions they make in the 

lives of persons of all ages with disabilities. The goals of the Lifespan Respite Care Program differ 

from the Family Caregiver Support Services Program, an ongoing formula grant program which 

focuses on five basic components. Instead, the Lifespan Respite Care program focuses on 

providing a test-bed for needed infrastructure changes, and on filling gaps by putting in place 

coordinated systems of accessible, community-based respite care services for family caregivers of 

children and adults with special needs. These systems bring together and seek to coordinate respite 

care services for family caregivers; training and recruitment of respite care workers and volunteers; 

and the provision of information, outreach, and access assistance. 

The Lifespan Respite Care Program also supports technical assistance activities designed to 

maintain a national database on respite care; provide training to state, community, and nonprofit 

respite care programs; and advance state systems and capacities to deliver respite care and address 

the systemic infrastructure necessary to mitigate gaps in respite care services, and conduct public 

information, referral, and education programs on respite care. Since its creation in 2009, the 

Lifespan Respite Care Program has made 101 grants to 38 States to develop, expand, integrate and 

sustain their respite care systems, and funded a National Technical Assistance Resource Center. 

Examples of grantee accomplishments include:

• Creation and adoption of statewide respite plans and/or policies to guide further 

development of respite and caregiver support programs; 

• Development or enhancement of training programs for respite care providers to expand 

the cadre of trained respite professionals;

• Replication and expansion of respite delivery modalities with a particular focus on 

person-centered planning and consumer direction; 
CAREGIVER AND FAMILY SUPPORT SERVICES

123 

• Expansion of toll free “helplines,” dedicated websites, and statewide respite registries, to 

provide caregivers with information about available respite programs.

• Development and deployment of marketing and awareness campaigns designed to 

educate caregivers about the importance of their work and the necessity to take a break;

• Development of data collection methodologies to track service provision and 

programmatic outcomes;

• Broadening stakeholder collaborations to ensure representation of all age and disability 

groups, as well as the broadest possible cross section of the provider network; 

• Capacity building and network development at the local level to recruit and train 

volunteers to fill gaps in respite services, particularly in rural areas; and 

• Provision of direct respite services to family caregivers of children with intellectual and 

developmental disabilities, adults with physical disabilities, and older Americans.

Since 2009, state grantees have reported providing an estimated 12,000 caregivers with over 

313,000 hours of respite care and training an estimated 12,345 caregivers during 469 respite 

training events. State grantees work in collaboration with Aging and Disability Resource 

Centers/No Wrong Door Systems and a public or private non-profit statewide respite care coalition 

or organization. Special emphasis is placed on implementing or enhancing lifespan respite care 

statewide and building or improving the capacity of their long-term care systems to respond to the 

comprehensive needs of care recipients.

Funding History:

Funding for the Lifespan Respite Care program during the past five years is as follows:

FY 2017 ...................................................$3,352,000 

FY 2018 ...................................................$4,110,000 

FY 2019 ...................................................$4,096,000 

FY 2020 Enacted......................................$6,110,000 

FY 2021 President’s Budget ....................$3,360,000 
CAREGIVER AND FAMILY SUPPORT SERVICES

124 

Budget Request:

The FY 2021 request for Lifespan Respite is $3,360,000, a reduction of -$2,750,000 below the 

FY 2020 Enacted Level. At this level, ACL will continue to make competitive grants available to 

support a range of possible activities to build or enhance Lifespan Respite Care Programs; further 

integrate, sustain, and advance Lifespan Respite activities into broader long-term services and 

supports in the State; and/or provide additional respite services to family caregivers across the age 

and disability spectrum. ACL recognizes the unique opportunity the Lifespan Respite Care 

Program presents to consider the critical role that support for family caregivers plays in ensuring 

the health and independence of individuals across the age and disability spectrum. By investing in 

this program, ACL seeks to provide increased 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, in more efficient and cost-effective methods through, training, and 

coordination regardless of age or disability. The Lifespan Respite Care program demonstrates 

ACL’s commitment to supporting caregivers of children or adults of any age with special needs. 

According to the National Respite Coalition, nearly 90 percent of family caregivers of care 

recipients age 18 and older, and 81 percent of family caregivers of children with special needs, 

currently are unable to access or use respite services. Caregivers report numerous barriers ranging 

from cost considerations and restrictive eligibility criteria to waiting lists, limited respite options, 

inadequate supply of trained providers or appropriate programs, and gaps in service availability.106

106 National Respite Coalition Written Testimony to the House subcommittee on Labor, Health and Human Services, 

and Education Appropriations. April 12, 2010. 

The resources requested for FY 2021 will be used to address these issues by: 

• Expanding, enhancing, and advancing respite care services to family members, 

• Improving the statewide dissemination and coordination of respite care, and 

• Providing, supplementing, or improving access and quality of respite care services to 

family caregivers, thereby reducing family caregiver strain.
CAREGIVER AND FAMILY SUPPORT SERVICES

125 

Output Table:

Lifespan Respite Care

Indicator Year and Most Recent 

Result /

FY 2020

Projection

FY 2021

Projection

FY 2021

Projection

+/-FY 2020

Projection

Output AJ: The number of 

states that have 

participated in the 

Lifespan Respite Care 

program. (Output)

FY 2018: 38 41 43 +2

Grant Awards Table:

Lifespan Respite Care Grant Awards

FY 2019 

Final

FY 2020

Enacted

FY 2021 

President’s 

Budget

Number of Awards 19 25 13

Average Award $209,809 $238,682 $247,474

Range of Awards $105,150 -

$278,546

$105,150 -

$278,546

$105,150 -

$278,546

Lifespan Respite Care Program

(Dollars in thousands)

FY 2019

Final

FY 2020

Enacted

FY 2021

President’s Budget 

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary -- -- 25 5,967 -- --

Continuations 19 3,986 -- -- 13 3,217

Contracts -- -- -- -- -- --

Interagency Agreements -- -- -- -- -- --

Program Support -- 109 -- 143 -- 143

Total Resources -- 4,096 -- 6,110 -- 3,360
126 

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PROTECTION OF VULNERABLE ADULTS

127 

Protection of Vulnerable Adults

Summary of Request

Protection of Vulnerable Adults consists of several distinct, but complementary, programs 

designed to prevent, detect, and respond to elder abuse, neglect, and exploitation. As the population 

of older Americans increases, the problem of elder abuse, neglect, and exploitation continues to 

grow. A 2004 national survey of State Adult Protective Services (APS) programs conducted by 

the National Center on Elder Abuse showed a 16 percent increase in the number of elder abuse 

cases from an identical study conducted in 2000.107

107 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. 

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.108 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.

108Tatara, 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. 

109

109 Acierno, R., Hernandez, M. A., Amstadter, A. B., Resnick, H. S., Steve, K., Muzzy, W., & Kilpatrick, D. G. 

(2010). Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the 

United States: The National Elder Mistreatment Study. American Journal of Public Health, 100(2), 292–297. 

doi:10.2105/AJPH.2009.163089.

The negative effects of abuse, neglect, and exploitation on the health and independence of seniors 

are 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.110

110 Baker, M. W., LaCroix, A. Z., Wu, C., Cochrane, B. B., Wallace, R., & Woods, N. F. (2009).

Mortality risk associated with physical and verbal abuse in women aged 50 to 79. Journal of the American Geriatrics 

Society, 57(10), 1799–1809. doi:10.1111/j.1532-5415.2009.02429.x

The effects of abuse, neglect, and exploitation impacts the health of older adults by increasing the 

likelihood of heart attacks, dementia, depression, chronic diseases, and psychological distress. 

These unnecessary health problems result in a growing number of seniors who are accessing the 

healthcare system more frequently (including emergency room visits and hospital admissions), and 

are ultimately forced to leave their homes and communities prematurely.111

111 Dong X, Simon MA. Association between elder abuse and use of ED: findings from the Chicago Health and Aging 

Project. Am J Emerg Med. 2013;31:693–698.

Protection of 

Vulnerable Adults programs address this problem through a full array of services designed to 

prevent, detect, and respond to elder abuse, neglect, and exploitation, both at home and in 

institutional settings.

The total FY 2021 request is $56.5 million a decrease of -$30,000 below the FY 2020 Enacted 

level. The request includes $6.0 million to help create innovative ways to combat the opioids 

epidemic, while maintaining funding for the Protection of Vulnerable Adults which helps ensure 

the resiliency of communities by protecting vulnerable populations:
PROTECTION OF VULNERABLE ADULTS

128 

• $17.9 million for Elder Rights Support Activities (ERSA), an increase of $2.0 million 

above the FY 2020 Enacted level. ERSA includes dedicated funding for Elder Justice/Adult 

Protective Services, as well as funding for resource centers and activities that provide 

information, training, and technical assistance on elder rights issues to the national Aging 

Services Network. Within the requested level, ACL will build on existing Elder 

Justice/Adult Protective Services grants by providing $6 million for technical assistance 

grants/and or contracts to address the growing number of elder abuse and neglect cases 

resulting from opioid misuse, which is +$4 million above FY 2020. 

• $15.9 million for the Long-Term Care Ombudsman Program, a reduction of -$2.0 million 

below the FY 2020 Enacted level. This consumer advocacy program improves the quality 

of care and quality of life for the residents of long-term care facilities in all states. In FY 

2021, the program is projected to provide over 500,000 consultations and address 190,000

complaints, with a historic resolution rate of approximately 82 percent. 

• $4.8 million for Prevention of Elder Abuse and Neglect, is the same as the FY 2020 Enacted 

level. This program provides formula grants to states to train, educate, and increase public 

awareness of how to prevent elder abuse.

• $18.0 million for the Health Care Fraud and Abuse Control/Senior Medicare Patrol 

Program (HCFAC/SMP), the same as the FY 2020 Enacted level. HCFAC/SMP funds 

competitive grants and related infrastructure to support a volunteer-based network that 

helps to prevent and combat healthcare fraud and abuse, and helps to preserve the financial 

integrity of Medicare and Medicaid. 

Together, these elder rights and elder justice programs provide a foundation and establish best 

practices for States to expand and improve the protection of individuals living in their communities 

and in long-term care settings. These programs (1) increase the information and technical 

assistance available to the public, States, and localities in preventing and addressing abuse; protect 

the rights of older adults; (2) reduce health-care fraud and abuse; and (3) provide assistance to 

Tribes in developing elder justice systems. This multifaceted approach to resolving elder abuse, 

neglect, and exploitation is essential to successfully fulfilling the shared mission of the Older 

mericans Act and the Elder Justice Act.
PROTECTION OF VULNERABLE ADULTS

129 

Long-Term Care Ombudsman Program

Services FY 2019 Final FY 2020 

Enacted

FY 2021 President’s 

Budget

FY 2021 (+/-) FY 

2020

Long-Term Care 

Ombudsman Program $16,868 $17,885 $15,855 -$2,030

*BA is in thousands of dollars.

Original Authorizing Legislation: Section 712 of the Older Americans Act of 1965, Public Law 

89-73. 

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

114-144 

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

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

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

Program Description and Accomplishments:

The Long-Term Care (LTC) Ombudsman Program is a consumer advocacy program that improves 

the quality of life and care for the estimated 3 million individuals who reside in over 74,000 longterm care facilities (over 16,000 licensed nursing facilities and over 57,000 licensed board and care 

facilities).

112 Formula grants to states and territories are based on the number of individuals age 60 

and older, and provide funding for the training, travel, and other operating costs of nearly 

7,460 designated staff and volunteers. Ombudsmen resolve complaints with, and on behalf of, 

these residents, while advocating for systemic improvement of long-term services and supports,

including routinely monitoring the condition of long-term care facilities.

A primary ombudsman duty is to identify, investigate, and resolve complaints that are made by or 

on behalf of residents. These complaints relate to action, inaction, or decisions of providers, public 

agencies, and others that may adversely affect residents’ health, safety, welfare, or rights. 

112 National Ombudsman Reporting System (NORS) – FFY 2016. 
PROTECTION OF VULNERABLE ADULTS

130 

Ombudsmen advocate on behalf of residents by representing their interests before government and 

administrative entities, while also providing information to residents and families about long-term 

services and supports and educating the general public about issues related to long-term services 

and supports policies and regulations. 

The efficiency of the ombudsman program is due to a strong reliance on volunteers who are the 

primary source in assisting to resolve resident issues.113

113 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. 

 All but three states have volunteer 

Ombudsman programs. These trained and designated volunteer ombudsmen donated over 591,362 

hours in FY 2017. In FY 2017, output data for the Long-Term Care Ombudsman Program 

highlights the accomplishments achieved by this program and the important role that ombudsmen 

play in ensuring that the rights of long-term care facility residents are respected:

• More than 29,000 facilities were regularly visited not in response to a complaint

(Output S). 

• Ombudsmen investigated and worked to resolve over 201,000 complaints (Output Q).

• Ombudsmen provided over 525,000 consultations to individuals and facility managers and 

staff on such topics as residents’ rights, staffing levels, malnutrition, dementia care, 

depression, discharge procedures, financial exploitation, and strategies to reduce the use of 

restraints and to prevent the abuse and neglect of residents (Output R). 

The environment in which individuals seek LTSS continues to evolve as more people are 

increasingly choosing to live in community settings. These changes create new challenges for the 

Long-Term Care Ombudsman program (LTCOP). Encouraging community living has been 

supported by a number of Federal and State policies that promote alternatives to nursing homes 

and other institutional settings and that recognize the value of consumer preference and the 

potential fiscal savings that can result. These initiatives include Olmstead implementation and 

enforcement, Money Follows the Person, Home and Community-Based Service waivers, and 

Medicaid managed care, to name a few. These evolving services and supports continue to change 

the long-term care landscape across the country. There is also a growing Federal awareness of, 

and response to, the uncharted area of abuse, neglect, and exploitation of older adults and 

individuals with disabilities.
PROTECTION OF VULNERABLE ADULTS

131 

Five Year Funding Table: 

Funding for the Long-term Care Ombudsman Program over the past five years is as follows:

FY 2017 .................................................$15,848,000 

FY 2018 .................................................$16,885,000 

FY 2019 .................................................$16,868,000 

FY 2020 Enacted ..................................$17,885,000 

FY 2021 President’s Budget .................$15,855,000 

Budget Request:

The FY 2021 Budget request for the LTC Ombudsman Program is $15,855,000, a reduction 

of -$2,030,000 below the FY 2020 Enacted level. Funds will continue to support the existing 

infrastructure and activities of the Ombudsman program. As the senior population continues to 

grow, the need for safe, high-quality long-term care services (including non-nursing home 

alternatives) increases, even as ACL seeks to help more people remain in the community for longer 

periods. 

Outcome data (displayed in the summary tables at the end of this section) have demonstrated the 

success of this program in protecting older Americans in an efficient and effective manner. The 

percentage of the complaints processed by ombudsmen that were fully or partially resolved to the 

satisfaction of the resident was 73 percent in FY 2016.

114

114 National Ombudsman Reporting System (NORS) 2016 – Complaint resolution: 13% needing no further 

action; 4.5% withdrawn; 4.5% not resolved to the satisfaction of the resident; 5% referred to other agency 

for resolution.

Reducing the number of complaints 

unresolved to the satisfaction of the resident is one indicator of program effectiveness. In FY 2016, 

the target was to have no more than 9,700 complaints unresolved. The program performed better 

than expected, reducing the number of unresolved complaints to 8,986 (Outcome Measure 

2.14). Program success with advocacy for systemic improvement is measured as a reduction in 

the average number of complaints per facility. In FY 2016, the goal was set at an average of 2.8 

complaints per facility. The program surpassed this goal by reducing the average number of 

complaints to 2.6 (Outcome Measure 2.12). These measures taken together demonstrate the 

efficacy of the program and its ability to produce positive outcomes for residents.

Ombudsman activities represent an important element of ACL’s focus on elder rights, and 

complements ACL’s successful elder rights programs, to create a full array of services that prevent, 

detect, and resolve elder abuse, neglect, and exploitation. LTC Ombudsmen also support 

individuals who choose to transition out of nursing home facilities into more integrated settings. 

They also advocate for quality care and individual rights and well-being in other congregate longterm care settings, such as board and care and assisted living. In addition, LTC Ombudsmen serve 

individuals in these settings regardless of the individuals’ eligibility for Medicaid or other public 

benefits. Ombudsmen are the only federally funded entity providing services to all of these 
PROTECTION OF VULNERABLE ADULTS

132 

residents. Going forward, outreach, access, complaint investigation and advocacy in board and 

care and assisted living will require ombudsmen to employ new strategies compared to the work 

now done primarily in nursing home settings. 

Outcomes and Outputs Table:

Long-Term Care Ombudsman Program 

Measure Year and Most Recent Result 

/ 

Target for Recent Result /

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-FY 2020

Target

2.12 Decrease the 

average number of 

complaints per LTC 

facility. (Outcome)

FY 2018: 2.6

Target:

2.6

(Target Met)

2.8 2.8 Maintain

2.14 Decrease the 

number of complaints not 

resolved to the 

satisfaction of the 

resident. (Outcome)

FY 2018: 9,700

Target:

9,300

(Target Not Met but 

Improved)

9,000 9,000 Maintain

Indicator Year and Most Recent 

Result /

FY 2020

Projection

FY 2021

Projection

FY 2021

Projection

+/-FY 2020

Projection

Output Q: The Number of 

Complaints (Output)

FY 2018: 194,516 184,791 190,000 +5,209

Output R: Number of 

Ombudsman 

Consultations (Output)

FY 2018: 543,385 535,000 535,000 Maintain

Output S: Facilities 

regularly visited not in 

response to a complaint

(Output)

FY 2018: 30,291 30,200 30,200 Maintain
PROTECTION OF VULNERABLE ADULTS

133 

Grant Awards Table:

Long-Term Care Ombudsman Program Formula Grant Awards

FY 2019 

Final 

FY 2020

Enacted

FY 2021 

President’s 

Budget 

Number of 

Awards 56 56 56

Average Award $300,613 $316,181 $280,294

Range of Awards

$10,521 - 

$1,762,724

$11,066 - 

$1,850,765

$9,810 - 

$1,640,697
PROTECTION OF VULNERABLE ADULTS

134 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2021 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Long-Term Care Ombudsman Program (CFDA 93.042)

STATE/TERRITORY FY 2019 Final FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

Alabama 254,425 267,241 236,909 (30,332)

Alaska 84,172 88,531 78,482 (10,049)

Arizona 369,707 395,192 350,337 (44,855)

Arkansas 155,625 162,905 144,415 (18,490)

California 1,762,724 1,850,765 1,640,697 (210,068)

Colorado 252,765 268,709 238,210 (30,499)

Connecticut 191,472 200,084 177,374 (22,710)

Delaware 84,172 88,531 78,482 (10,049)

District of Columbia 84,172 88,531 78,482 (10,049)

Florida 1,267,239 1,339,889 1,187,808 (152,081)

Georgia 454,971 481,565 426,906 (54,659)

Hawaii 84,172 88,531 78,482 (10,049)

Idaho 84,172 89,727 79,543 (10,184)

Illinois 622,229 651,161 577,253 (73,908)

Indiana 328,052 344,741 305,612 (39,129)

Iowa 165,661 173,483 153,792 (19,691)

Kansas 143,359 150,269 133,213 (17,056)

Kentucky 226,850 238,033 211,016 (27,017)

Louisiana 224,984 236,231 209,418 (26,813)

Maine 84,172 88,864 78,778 (10,086)

Maryland 291,377 306,045 271,308 (34,737)

Massachusetts 352,251 370,037 328,037 (42,000)

Michigan 533,488 560,759 497,111 (63,648)

Minnesota 276,064 291,524 258,435 (33,089)

Mississippi 147,145 154,397 136,873 (17,524)

Missouri 318,613 334,435 296,475 (37,960)

Montana 84,172 88,531 78,482 (10,049)

Nebraska 93,694 98,277 87,123 (11,154)

Nevada 145,250 153,649 136,209 (17,440)

New Hampshire 84,172 88,531 78,482 (10,049)
PROTECTION OF VULNERABLE ADULTS

135 

PROGRAM/CFDA NUMBER: Long-Term Care Ombudsman Program (CFDA 93.042)

STATE/TERRITORY FY 2019 Final FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

New Jersey 451,460 469,277 416,013 (53,264)

New Mexico 108,823 114,783 101,755 (13,028)

New York 999,019 1,038,260 920,415 (117,845)

North Carolina 515,361 545,159 483,282 (61,877)

North Dakota 84,172 88,531 78,482 (10,049)

Ohio 619,270 649,905 576,139 (73,766)

Oklahoma 190,858 200,203 177,480 (22,723)

Oregon 224,158 236,413 209,579 (26,834)

Pennsylvania 718,294 752,221 666,842 (85,379)

Rhode Island 84,172 88,531 78,482 (10,049)

South Carolina 271,291 287,822 255,153 (32,669)

South Dakota 84,172 88,531 78,482 (10,049)

Tennessee 341,404 359,196 318,426 (40,770)

Texas 1,128,970 1,195,593 1,059,890 (135,703)

Utah 108,275 115,108 102,043 (13,065)

Vermont 84,172 88,531 78,482 (10,049)

Virginia 406,644 429,176 380,463 (48,713)

Washington 359,727 381,152 337,890 (43,262)

West Virginia 109,867 114,453 101,463 (12,990)

Wisconsin 305,549 322,085 285,527 (36,558)

Wyoming 84,172 88,531 78,482 (10,049)

 Subtotal 16,531,151 17,392,629 15,418,514 (1,974,115)

American Samoa 10,521 11,066 9,810 (1,256)

Guam 42,086 44,265 39,241 (5,024)

Northern Mariana Islands 10,521 11,066 9,810 (1,256)

Puerto Rico 197,945 202,859 179,834 (23,025)

Virgin Islands 42,086 44,265 39,241 (5,024)

 Subtotal 16,834,310 17,706,150 15,696,450 (2,009,700)

Undistributed 1/ 33,690 178,850 158,550 (20,300)

Total States/Territories 16,868,000 17,885,000 15,855,000 (2,030,000)

1/ Program Support- includes funds for Older American Act statutory requirements, including program evaluation and disaster 

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

states.
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Prevention of Elder Abuse and Neglect

Services

FY 2019 

Final 

FY 2020 

Enacted

FY 2021 

President’s Budget

FY 2021 (+/-) FY 

2020

Prevention of Elder 

Abuse & Neglect $4,768 $4,773 $4,773 --

*BA is in thousands of dollars. 

Original Authorizing Legislation: Section 702(b) of the Older Americans Act of 1965, Public Law 

89-73. 

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

114-144 

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

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

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

Program Description and Accomplishments:

The Prevention of Elder Abuse and Neglect program provides formula grants to states and 

territories based on their share of the population 60 and over, to train State and local officials and 

promote public awareness of elder abuse. The program also supports state and local elder abuse 

prevention coalitions and multi-disciplinary teams. These activities are important elements of 

ACL’s activities related to elder rights and elder justice. The program coordinates activities with 

state and local Adult Protective Services programs (over half of which are directly administered 

by State Units on Aging) and other professionals who work to address issues of elder abuse and 

elder justice. The importance of these services at the state and local level is demonstrated by the 

fact that states significantly leverage Older Americans Act (OAA) funds to obtain other funding 

for these activities. In FY 2017, over $34 million of the Elder Abuse Prevention services 

expenditures was leveraged from non-OAA funds, a ratio of more than $8.00 of non-OAA funds 

for every $1 investment of ACL funds. 

Examples of state elder abuse prevention activities include:
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• In Kentucky, the local area agencies on aging participate in the Local Coordinating 

Councils on Elder Abuse, which have developed emergency elder shelters, distributed

informational cards for law enforcement officers to have in the patrol cars which contain 

crucial resource information for victims of elder abuse, conducted training on a regular 

basis to first responders, provided a friendly visitor program for home-based seniors, and 

produced a prevention tool called the Kentucky Fraud Fighter Form. 

• In Illinois, the State Department on Aging uses its elder abuse funds to support volunteer 

community-based multi-disciplinary teams (M-Teams) that serve in a technical advisory 

role to more than 40 elder abuse provider agencies throughout the state. The objectives of 

the M-Team are to provide case consultation and assistance to caseworkers and to 

encourage cooperation among various service agencies. Each M-Team is composed of the 

M-Team Coordinator and representatives of the mental health, medical, legal, law 

enforcement, faith community, and financial professions. 

The Prevention of Elder Abuse and Neglect program demonstrates ACL’s ongoing commitment 

to protecting the rights of seniors and promoting their dignity and autonomy. Through education 

efforts, exposing problems that would otherwise be hidden from view, and providing a voice for 

those who cannot act for themselves, the program helps ensure that all older Americans are able 

to age with dignity in a safe environment.

Funding History: 

Funding for Prevention of Elder Abuse and Neglect over the past five years is as follows:

FY 2017 ...................................................$4,762,000 

FY 2018 ..................................................$4,773,000 

FY 2019 ..................................................$4,768,000 

FY 2020 Enacted .....................................$4,773,000 

FY 2021 President’s Budget ....................$4,773,000 

Budget Request:

The FY 2021 request for the Prevention of Elder Abuse and Neglect program is $4,773,000, the 

same as the FY 2020 Enacted level. The FY 2021 request maintains the ability of States and 

territories to train law enforcement officials, develop and distribute educational materials, conduct 

public awareness campaigns, and create community coalitions and multidisciplinary teams to 

investigate and respond to elder abuse and neglect. States and AAAs will also use this funding to 

coordinate their activities with fraud and crime prevention partnerships organized by sheriffs, 

police chiefs, and community organizations.
PROTECTION OF VULNERABLE ADULTS

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Elder Abuse Prevention activities are important elements of ACL’s elder rights and elder justice 

activities, and complement Adult Protective Services by funding the infrastructure in which best 

practices may be developed and evaluated.

Output Table:

Prevention of Elder Abuse and Neglect 

Indicator Year and Most Recent 

Result /

FY 2020

Projection

FY 2021

Projection

FY 2021

Projection

+/-FY 2020

Projection

Output U: Elder Abuse 

prevention non-OAA 

service expenditures 

(Output, dollars in 

thousands)

FY 2018: $33,449 $32,132 $32,699 +567

Grant Awards Table:

Prevention of Elder Abuse, Neglect, and Exploitation Grant Awards 

FY 2019

Final 

FY 2020

Enacted

FY 2021 

President’s 

Budget 

Number of 

Awards 56 56 56

Average Award $84,789 $84,380 $84,380

Range of Awards

$2,968 - 

$471,074

$2,954 - 

$470,407

$2,954 - 

$470,407
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DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2021 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Prevention of Elder Abuse & Neglect (CFDA 93.041)

STATE/TERRITORY FY 2019 Final FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

Alabama 76,215 76,107 76,107 -

Alaska 23,741 23,626 23,626 -

Arizona 85,675 81,384 81,384 -

Arkansas 48,157 48,089 48,089 -

California 471,074 470,407 470,407 -

Colorado 58,560 56,002 56,002 -

Connecticut 59,907 59,822 59,822 -

Delaware 23,741 23,626 23,626 -

District of Columbia 23,741 23,626 23,626 -

Florida 344,252 343,762 343,762 -

Georgia 105,407 103,174 103,174 -

Hawaii 23,741 23,626 23,626 -

Idaho 23,741 23,626 23,626 -

Illinois 197,384 197,103 197,103 -

Indiana 98,224 98,084 98,084 -

Iowa 55,927 55,847 55,847 -

Kansas 45,843 45,778 45,778 -

Kentucky 66,595 66,500 66,500 -

Louisiana 68,518 68,421 68,421 -

Maine 23,741 23,626 23,626 -

Maryland 78,087 77,976 77,976 -

Massachusetts 109,606 109,450 109,450 -

Michigan 160,862 160,633 160,633 -

Minnesota 76,347 76,238 76,238 -

Mississippi 45,198 45,134 45,134 -

Missouri 97,643 97,504 97,504 -

Montana 23,741 23,626 23,626 -

Nebraska 29,770 29,728 29,728 -

Nevada 33,651 27,590 27,590 -

New Hampshire 23,741 23,626 23,626 -
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PROGRAM/CFDA NUMBER: Prevention of Elder Abuse & Neglect (CFDA 93.041)

STATE/TERRITORY FY 2019 Final FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

 

New Jersey 143,950 143,745 143,745 - 

New Mexico 26,393 26,356 26,356 - 

New York 318,066 317,614 317,614 - 

North Carolina 126,782 126,602 126,602 - 

North Dakota 23,741 23,626 23,626 - 

Ohio 197,185 196,905 196,905 - 

Oklahoma 60,208 60,122 60,122 - 

Oregon 56,795 56,714 56,714 - 

Pennsylvania 242,944 242,598 242,598 - 

Rhode Island 23,741 23,626 23,626 - 

South Carolina 63,080 62,990 62,990 - 

South Dakota 23,741 23,626 23,626 - 

Tennessee 91,810 91,679 91,679 - 

Texas 274,281 273,891 273,891 - 

Utah 25,085 24,802 24,802 - 

Vermont 23,741 23,626 23,626 - 

Virginia 102,820 102,674 102,674 - 

Washington 86,291 86,168 86,168 - 

West Virginia 36,736 36,684 36,684 - 

Wisconsin 90,309 90,181 90,181 - 

Wyoming 23,741 23,626 23,626 - 

 Subtotal 4,664,270 4,641,596 4,641,596 - 

American Samoa 2,968 2,954 2,954 - 

Guam 11,870 11,813 11,813 - 

Northern Mariana Islands 2,968 2,954 2,954 - 

Puerto Rico 54,217 54,140 54,140 - 

Virgin Islands 11,870 11,813 11,813 - 

 Subtotal 4,748,163 4,725,270 4,725,270 - 

Program Support 1/ 19,837 47,730 47,730 - 

Total States/Territories 4,768,000 4,773,000 4,773,000 - 

1/ Program Support- includes funds for Older American Act statutory requirements, including program evaluation and disaster 

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

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

Services

FY 2019 

Final 

FY 2020 

Enacted

FY 2021 

President’s 

Budget

FY 2021 (+/-) FY 

2020

Senior Medicare 

Patrol Program/1 $18,000 $18,000 $18,000 --

FTEs 3.25 4.5 3.75 -.75

*BA is in thousands of dollars, FTE is a whole number. 

1/ The FY 2019 and FY 2020 appropriations state that SMP/HCFAC is paid out of discretionary CMS appropriations 

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

amount needed to provide full funding and not less than the floor provided in appropriations language. The FY 2021 

amount serves as a placeholder for FY 2021 pending final decisions on the amount of the Secretary of HHS. 

Original Authorizing Legislation: Sections 201, 202, and 411 of the Older Americans Act of 1965, 

Public Law 89-73 and the Health Insurance Portability and Accountability Act (HIPAA) of 1996, 

P.L. 104-191 

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

114-144 

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

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

Allocation Method .............................................................................. Competitive Grant/Contracts

Program Description and Accomplishments:

The Health Care Fraud and Abuse Control/Senior Medicare Patrol (SMP) program provides 

competitive grants to 54 states and territories to support a national network of volunteers whose 

purpose is to educate Medicare beneficiaries on preventing and identifying healthcare fraud and 

abuse. Projects use the skills of volunteers to conduct community outreach and education and to 

provide information that empowers Medicare beneficiaries and their families to prevent, identify, 

and report fraud. Activities are carried out in partnership with the Centers for Medicare & 

Medicaid Services (CMS), the Office of Inspector General (OIG), healthcare providers, and other 

aging and elder rights professionals from around the country.
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Data obtained from the SMP Information and Reporting System (SIRS) for calendar year 2018 

shows that Senior Medicare Patrol projects:

• Maintained 6,935 active SMP team members who worked over 483,056 hours to educate 

beneficiaries about how to prevent Medicare fraud, errors, and abuse;

• Educated 1,713,194 individuals during 26,932 group outreach and education events;

• Generated almost $12 million in estimated Medicare/Medicaid savings due to the work of 

SMP projects; and 

• Responded to 278,761 individual inquiries for information or assistance from Medicare 

beneficiaries, family members, and caregivers related to Medicare fraud, errors, and abuse.

Since the Senior Medicare Patrol program’s inception in 1997, program data show that SMP 

projects have educated nearly 40.1 million beneficiaries through 414,247 group outreach and 

education events, and assisted approximately 2.7 million beneficiaries with individual inquires 

related to Medicare fraud, errors, and abuse. HHS-OIG reports that total savings directly 

attributable to the SMP projects are more than $126.84 million since 1997; however, this does not 

fully capture the total impact of the program on reducing Medicare fraud, including any sentinel 

effect that may result from these activities.

The SMP program historically has used approximately $3.1 million of its resources for 

infrastructure (including Federal staff support), technical assistance, and other program support 

and capacity-building activities designed to enhance program effectiveness. Activities funded 

with these dollars include support for project training and technical assistance provided by ACL’s 

National SMP Resource Center.

Funding History:

Comparable funding for SMP discretionary appropriations over the past five years is as follows:

FTE

FY 2017 ............................................... $18,000,000 5

FY 2018 .............................................. $18,000,000 5

FY 2019 ................................................$18,000,000 3.25 

FY 2020 Enacted....................................$18,000,000 4.5 

FY 2021 President’s Budget ................$18,000,000 3.75 

Budget Request:

The FY 2021 Budget includes $18,000,000 the same as the FY 2020 Enacted level. In FY 2018 

and FY 2019, funding for this program was provided to the Center for Medicare & Medicaid 

Services (CMS), at no less than $17,621,000. The FY 2021 request would support 3.75 FTE.
PROTECTION OF VULNERABLE ADULTS

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Since the Senior Medicare Patrol program’s inception, SMP projects have received more than

2.7 million inquiriesfrom Medicare beneficiaries about preventing, detecting, and reporting billing 

errors, potential fraud, or other discrepancies. SMPs also have educated more than 38.4 million 

people through group presentations and community outreach events. The primary focus of these 

sessions is on education, prevention, and teaching beneficiaries how to protect themselves and 

avoid fraud in the first place; this is the true value of the SMP program. 

As HHS-OIG indicated in their May 2018 report on the SMP program: 

“We note that the projects may not be receiving full credit for recoveries, savings, and cost 

avoidance attributable to their work. It is not always possible to track referrals to Medicare 

contractors or law enforcement from beneficiaries who have learned to detect fraud, waste, 

and abuse from the projects. In addition, the projects are unable to track the potentially

substantial savings derived from a sentinel effect whereby Medicare beneficiaries’ scrutiny 

of their bills reduce fraud and errors.” 

While SMPs make numerous referrals of potential fraud to CMS and the OIG, there are challenges 

to evaluating the investigation, prosecution, and collection that is required to calculate the full 

savings to the government as a result of SMP referrals. ACL recognizes the importance of 

measuring the value of the SMP program impact to the fullest degree possible and is working to 

overcome these limitations by undertaking a variety of steps, including: 

• Realigning the program’s performance metrics based on findings from a recent SMP 

program evaluation;

• Ongoing collaboration with HHS-OIG to track fraud referrals and their outcomes. 

HHS-OIG has documented over $126.8 million in savings attributable to the program as a result 

of beneficiary complaints since the program’s inception in 1997.
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Output Table:

Senior Medicare Patrol Program

Indicator Year and Most Recent 

Result /

FY 2020

Projection

FY 2021

Projection

FY 2021

Projection

+/-FY 2020

Projection

Output W: Beneficiaries 

Educated and Served

(Output)

CY 2018: 1,991,955 2,000,000 2,100,000 +100,000

Grant Awards Table:

Senior Medicare Patrol Grant Awards

(Dollars in thousands)

FY 2019 

Final 

FY 2020

Enacted

FY 2021 

President’s 

Budget 

Number of Awards 55 55 55

Average Award $302,617 $302,617 $302,617 

Range of Awards $95,000 -

$640,000 

$95,000 -

$640,000 

$95,000 -

$640,000 
PROTECTION OF VULNERABLE ADULTS

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Resource and Program Data: 

Senior Medicare Patrols

(Dollars in thousands)

FY 2019

Final

FY 2020

Enacted

FY 2021

President’s Budget 

Mechanism # $ # $ # $

Grants:

Formula

 

--

 

--

 

--

 

--

 

--

 

--

New Discretionary

 

-- -- 

 

1 640 

 

-- -- 

Continuations

 

55 16,644 

 

54 16,004 

 

55 16,644 

Contracts

 

3 528 

 

2 528 

 

2 528 

Interagency Agreements

 

--

 

--

 

--

 

--

 

--

 

--

Program Support115

115 Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and review, 

and information technology support costs.

 

-- 828 

 

-- 828 

 

-- 828 

Total Resources 18,000 18,000 18,000 
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Elder Rights Support Activities

Services

FY 2019 

Final 

FY 2020

Enacted

FY 2021 President’s 

Budget

FY 2021 (+/-) FY 

2020 

Elder Rights Support 

Activities $15,819 $15,874 $17,874 +$2,000

FTE 2.4 2.6 3.0 +.4

*BA is in thousands of dollars, FTE is a whole number.

Authorizing Legislation: Sections 201, 202, 411, 751 and 752 of the Older Americans Act of 1965, 

Public Law 89-73, Title XX of the Social Security Act, Subtitle B, as amended by the Affordable Care 

Act. 

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

114-144 

Current FY Authorization (OAA) ......................................................................................... Expired 

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

Allocation Method ............................ Competitive Grants/Co-operative Agreements and Contracts 

Program Description and Accomplishments:

Elder Rights Support Activities provide information, training, and technical assistance to States 

and communities to prevent detect, and respond to elder abuse, neglect, and exploitation, and 

support the development of coordinated systems of Adult Protective Services. The Elder Justice 

and Adult Protective Services program, along with the National Center on Elder Abuse, the 

National Long-Term Care Ombudsman Resource Center, and legal systems development 

programs create an interconnected framework for carrying out ACL’s Protection of Vulnerable 

Adults programs. 

The Elder Justice Act of 2009 established the Elder Justice Coordinating Council (EJCC) to 

coordinate activities related to elder abuse, neglect, and exploitation across the Federal 

government. As Chair of the EJCC, the Secretary of HHS has lead responsibility for identifying 
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and proposing solutions to the problems surrounding elder abuse. The Secretary has assigned 

responsibility for implementing the EJCC to the Administration for Community Living. 

To combat the rising scourge of elder abuse, neglect, and exploitation in America, ACL’s goal is 

to put in place, in coordination with the Elder Justice Coordinating Council, a comprehensive 

system to provide a coordinated and seamless response system. The Elder Rights Support 

Activities described below are key components of ACL’s ongoing elder rights programs. 

Adult Protective Services

Unlike Child Protective Services, which has been in existence for decades, a federal infrastructure 

to support basic programmatic standards for Adult Protective Services (APS) is in its infancy. 

Historically, an absence of stewardship in APS has led to inconsistent data systems and nonuniform reporting requirements at the national level. APS programs and administrators have lacked 

reliable information and guidance on best practice and standards for conducting case investigations 

and for staffing and managing APS programs. Additionally, GAO has identified challenges faced 

by APS programs across the country in collecting, maintaining, and reporting statewide case-level 

data. These challenges include funding levels, budget reductions, and increasing caseloads, as well 

as the growing complexity of cases due to factors such as growing opioid misuse. The challenges 

have impaired States’ ability to assess client outcomes and the effectiveness of the services they 

are providing.116

116 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.

They have also given rise to systems that are less equipped to respond in an 

effective and timely way to reports of elder abuse, neglect, and exploitation. 

In FY 2015, ACL received its first dedicated appropriation to support states in enhancing their APS 

systems statewide. Through ACL’s continued investment in the APS program in subsequent years, 

states have received additional funding to test innovations and improvements in APS practice,

services, data collection, and reporting, and to support the development and implementation of 

ACL’s National Adult Maltreatment Reporting System (NAMRS) effort. States are voluntarily 

reporting because they have recognized the value of having consistent data to build a national 

profile of perpetrators and victims that leads to effective interventions. The APS program supports 

states by providing significant, on-going technical assistance to identify promising best practices; 

participating in national APS data collection efforts; and conducting research and evaluations to 

increase the knowledge base about effective APS practices. Through the APS program, ACL 

encourages states to seek system transformations that reflect a “person-centered approach” (i.e., 

practices and services that are based on people’s strengths, assets, goals, culture, and expectations, 

along with their needs) and that aim to improve the experiences, health, well-being, and outcomes 

of the individuals served by APS. 

ACL is conducting research and evaluation activities to build the evidence-base for Adult 

Protective Services. Part of this effort involves updating the National Voluntary Consensus 

Guidelines on the 2-year schedule established at launch, including identifying areas where 

additional research on APS practice is needed. ACL plans to implement an outcome evaluation 
PROTECTION OF VULNERABLE ADULTS

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study to document the difference that APS makes in the lives of older adults and adults with 

disabilities. 

National Center on Elder Abuse 

To support and enhance the activities of State and local programs to prevent elder abuse, neglect, and 

exploitation, ACL funds the National Center on Elder Abuse (NCEA). NCEA disseminates 

information to professionals and the public; collaborates on research; provides consultation; identifies 

and provides information about promising practices and interventions; answers inquiries and requests 

for information; operates a listserv forum for professionals; and advises on program and policy 

developments. NCEA also facilitates the exchange of strategies for uncovering and prosecuting fraud 

in areas such as telemarketing and sweepstakes scams. Examples of past NCEA activities include:

• Responding to individual public inquiries and requests for information regarding elder 

abuse.

• Providing cost-effective trainings to professionals though live Webcast forums on issues 

relevant to elder justice, training professionals through presentations at national 

conferences, and creating and disseminating research-themed training podcasts to promote 

continual learning.

• Continuing to support systems change by identifying local elder justice community 

coalitions and reaching out to them to learn how they leverage local resources and expertise 

to prevent and combat elder abuse, neglect, and exploitation, as well as offering technical 

assistance on operating, invigorating, and sustaining coalitions. 

National Long-Term Care Ombudsman Resource Center

The National Long-Term Care Ombudsman Resource Center (NORC) provides training and 

technical assistance to support the activities of State and local long-term care ombudsmen. The 

Center works to enhance the skills, knowledge and management capacity of the statewide 

ombudsman programs to enable them to handle resident complaints and represent resident 

interests. The Center also provides information to consumers and links them to ombudsmen who 

can help consumers navigate the long-term care system and resolve problems in nursing, board 

and care, and assisted living homes.

The NORC engages in numerous projects and activities in support of long-term care ombudsman 

programs. Highlights include supporting the Money Follows the Person (MFP) demonstration 

project by working with CMS, ACL, and National Association of State Long-Term Care 

Ombudsman Programs (NASOP) to promote ombudsman coordination with MFP grantees, Aging 

and Disability Resource Centers (ADRCs), Centers for Independent Living, and other single point 

of entry programs. The NORC also provides ombudsmen with training from national experts on 

such issues as the Changing Long-Term Care System, Money Follows the Person and Nursing 

Home Transition, and Advocacy in Assisted Living. The Center’s website continues to experience 

high use (over 40,000 monthly visits) by ombudsmen, consumers, and agencies.
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Legal Assistance and Support 

Legal Assistance and Support provides funding for two different activities. Model Approaches 

grants help States develop and implement cost-effective, replicable approaches for integrating lowcost legal assistance mechanisms related to APS into the broader tapestry of State legal service 

delivery networks, such as senior legal helplines, law school clinics, and volunteer attorneys. 

Model Approaches projects ensure strong leadership at the State level, thereby enhancing the 

state’s overall capacity for legal service delivery and creating linkages between legal assistance 

providers and professionals in the broader community-based aging and disability and elder rights 

networks. These linkages include Area Agencies on Aging (AAAs), Aging and Disability 

Resource Centers (ADRCs), State Long-Term Care Ombudsmen, and Adult Protective Services, 

and leverage the strengths and resources of both elder rights and aging and disability service 

networks for the provision of quality legal service on priority issues to older adults most in need. 

Model Approaches – Phase II grants promote legal service delivery systems that are optimally 

responsive to complex legal issues emerging from cases of elder abuse, neglect, or financial 

exploitation. In addition, these projects support outreach efforts and implement legal data 

collection and reporting systems that demonstrate the beneficial impact of legal services on the 

independence, health, and financial security of older adults. 

In addition to Model Approaches, Legal Assistance and Support grants fund a comprehensive 

national legal assistance support system serving professionals and advocates working in legal and 

aging and disability services networks. Through this funding the National Center on Law and Elder 

Rights (NCLER)) supports the leadership, knowledge, and systems capacity development of legal 

and aging provider organizations. The NCLER works to enhance the quality, cost effectiveness, 

and accessibility of legal assistance and elder rights protections available to older persons with 

social or economic needs. The audience targeted to receive support services through the NCLER

includes a broad range of legal, elder rights, and aging and disability services professionals and 

advocates. These include Home and Community-Based Services legal providers, legal assistance 

developers, long-term care ombudsmen, Area Agency on Aging and Aging and Disability 

Resource Center staff, senior legal helplines, Adult Protective Services workers, and others 

involved in protecting the rights of older persons.

Funding History:

Comparable funding for Elder Rights Support Activities over the past five years is as follows:

FTE

FY 2017 .................................................$13,847,000 2.5 

FY 2018 ................................................$15,835,000 2.1 

FY 2019 ................................................$15,819,000 2.4 

FY 2020 Enacted .................................$15,874,000 2.6 

FY 2021 President’s Budget ..................$17,874,000 3.0 
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Budget Request:

The FY 2021 request is $17,874,000, an increase of +$2,000,000 above FY 2020 Enacted. This 

investment demonstrates ACL’s commitment to strengthening Adult Protective Services to 

address elder abuse and neglect nationwide. The additional funding would expand the pilot 

demonstration funded in the FY 2020 Budget to address opioid abuse within older adults that 

receive Adult Protective Services.

Opioid Focus 

APS is a direct, first responder social service response system in every state for vulnerable adults 

experiencing abuse, neglect and exploitation, including incidents that occur as a result of substance 

and opioid abuse. As APS is often the first community agency to interact with older adults and 

adults with disabilities impacted by the opioid crisis, it places APS in a strategic position to 

intervene early in the progression of addiction in the family and thereby minimize harm and costs 

associated with the Opioid epidemic. 

ACL will expand on the two pilot technical assistance efforts funded in the FY 2020 Budget, to 

add 5 competitive State grants, and 2 competitive Tribal grants, and a small addition to the resource 

center to assist with the new Opioid efforts. ACL is proposing to invest $6.0 million in opioidsrelated activities to maximize the impact on direct services through: 

• grants specifically targeted the most affected communities; 

• grants for projects that identify gaps in their communities which hinder APS from securing 

adequate services for clients affected by opioid and other substance abuse; and 

• Grants to identify home-and community-based social, health, and mental/behavioral health 

services needed for those APS clients impacted by the opioid epidemic, and to propose 

solutions that quickly fill those needs and identified gaps. 

Other Elder Rights Support Activities 

The FY 2020 request for the remaining three Elder Rights Support Activities (Statewide Model 

Approaches and Legal Assistance programs, the National Center on Elder Abuse, and the National 

Long-Term Care Ombudsman Resource Center) maintain funding at the same level as the FY 2020 

Enacted level. 

These programs provide the technical assistance, information, resources, referrals, and systems 

development and assistance activities that support the efforts of the entire spectrum of Protection 

of Vulnerable Adults programs. These activities, along with the Elder Justice and APS program,

are important components of ACL’s elder rights programs, and help to create a full array of 

services to prevent, detect, and resolve elder abuse, neglect, and exploitation. These programs and 

resource centers will help provide high-quality and efficient services and supports to further ACL’s 

efforts to promote elder rights and elder justice.
PROTECTION OF VULNERABLE ADULTS

154 

Elder Rights Support Activities includes funding for the following projects (dollars in thousands):

Elder Rights Support 

Activities

FY 2019 

Final FY 2020 Enacted 

FY 2021 

President’s 

Budget 

Elder Justice & APS $11,958 $12,000 $14,000

Legal Assistance and 

Support $2,583 $2,592 $2,592

National Center on Elder 

Abuse $763 $765 $765

LTC Ombudsman Resource 

Center $515 $516 $516

Total, Elder Rights Support 

Activities $15,819 $15,874 $17,874

Grant Awards Table:

Elder Rights Support Activities Grant Awards

FY 2019 

Final 

FY 2020

Enacted

FY 2021 

President’s 

Budget

Number of Awards 33 35 42

Average Award $317,275 $297,047 $295,158 

Range of Awards $200,058-

$1,251,784

$200,058-

$1,251,784

$200,058-

$1,251,784
PROTECTION OF VULNERABLE ADULTS

155 

Resource and Program Data: 

Elder Rights Support Activities 

(Dollars in thousands)

FY 2019

Final

FY 2020

Enacted

FY 2021

President’s Budget

Mechanism # $ # $ # $

Grants:

Formula

 

--

 

--

 

--

 

--

 

--

 

--

New Discretionary

 

16

 

4,086

 

5

 

1,841

 

21

 

6,544

Continuations

 

17

 

6,384

 

30

 

8,555

 

21

 

5,853

Contracts

 

4

 

4,171

 

6

 

4,138

 

6

 

4,138

Interagency Agreements

 

--

 

--

 

--

 

--

 

--

 

--

Program Support

 

--

 

1,178 --

 

1,339 --

 

1,339

Total Resources

 

15,819

 

15,874 

 

17,874
PROTECTION OF VULNERABLE ADULTS

156 

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DISABILITY PROGRAMS, RESEARCH AND SERVICES

157 

Disability Programs, Research and Services

Summary of Request

The Disability Programs and Services programs fund direct services, capacity-building, 

knowledge generation, and systems change efforts to ensure that people with disabilities and their 

families have access to the community services and supports they need to participate in all facets 

of community life to and live independently. A hallmark of these programs is that people with 

disabilities are included in their planning and design. 

The total FY 2021 request for Disability Programs and Services is $357.4 million, a decrease 

of -$68.5 million below the FY 2020 Enacted level. Specific requests include: 

• $56.0 million for State Councils on Developmental Disabilities (SCDD), a decrease 

of -$22.0 million from the FY 2020 Enacted level. State Councils are charged with 

advocacy, capacity building, and system change activities that contribute to a coordinated 

and comprehensive system of community services that promote self-determination and 

integration for people with developmental disabilities. 

• $38.7 million for Developmental Disability Protection and Advocacy systems, which 

is -$2.0 million below the FY 2020 Enacted level. Protection and Advocacy systems in 

each state and territory protect the legal and human rights of people with developmental 

disabilities. They have the authority to pursue legal, administrative and other remedies to 

address issues, including the authority to investigate incidents of abuse and neglect. 

• $32.6 million for University Centers for Excellence in Developmental Disabilities

Education, Research and Service (UCEDDs), a reduction of -$9.1 million from the 

FY 2020 Enacted level. UCEDDs in each state and territory undertake interdisciplinary 

pre-service training, community services, research, and information dissemination 

activities that promote opportunities for people with developmental disabilities to exercise 

self-determination and to be independent, productive, and included in the community. 

• $1.0 million for Projects of National Significance (PNS), -$11.2 million below the FY 2020 

Enacted level. At this funding level, PNS will focus solely on three longitudinal studies: 

The State of the States in Developmental Disabilities, Residential Information Systems 

Project, and the National Data Collection on Day and Employment Services for Individuals 

with Developmental Disabilities. 

• $113.6 million for Independent Living programs, -$2.5 million below the FY 2020 Enacted 

level. The request includes support for ongoing program evaluations and dedicates 

$5.0 million towards a new competitive grant program to increase employment for people 

with disabilities. These programs provide tools, resources, and supports, such as 

independent living skills training, assistance with transitioning from residential facilities to 

the community, and peer counseling and help support statewide independent living 

networks. 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

158 

• $25.0 million for the Limb Loss Resource Center, Paralysis Resource Center, and 

Traumatic Brain Injury programs. This is the same as the FY 2020 Enacted level. These

three programs increase resilience and support the independence of individuals who were 

born with or develop these disabilities. 

• $90.4 million for the National Institute on Disability, Independent Living and 

Rehabilitation Research (NIDILRR), a reduction of -$21.6 million from the FY 2020 

Enacted level. NIDILRR generates knowledge and promotes its use to improve the abilities 

of people with disabilities to live as independently as possible in the community. 

NIDILRR’s research supports and expands society’s capacity to provide full opportunities 

and accommodations for its citizens with disabilities.
DISABILITY PROGRAMS, RESEARCH AND SERVICES

159 

State Councils on Developmental Disabilities

Services

FY 2019 

Final 

FY 2020 

Enacted

FY 2021 

President’s 

Budget 

FY 2021 (+/-) FY 

2020 

State Councils on 

Developmental 

Disabilities

$75,921 $78,000 $56,000 -$22,000

*BA is in thousands of dollars.

Original Authorizing Legislation: Section 129(a) of the Developmental Disabilities Assistance and 

Bill of Rights Act, Public Law 106-402 

Most Recent Authorizing Legislation: Section 129(a) of the Developmental Disabilities Assistance 

and Bill of Rights Act of 2000, Public Law 106-402 

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

Authorization Expiration Date ...................................................................................................2007 

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

Program Description and Accomplishments:

State Councils on Developmental Disabilities (SCDD) are charged with identifying and addressing

the most pressing needs of people with developmental disabilities in their state and territory. 

SCDDs set priorities and pursue systems change efforts designed to turn fragmented approaches 

into a comprehensive and effective statewide, person-centered and family-centered system. These 

systems provide a coordinated array of culturally competent services and other forms of assistance 

for people with developmental disabilities, including individuals with autism and their family 

caregivers. 

While SCDDs do not provide services directly, a portion of their funding goes into local 

communities to support investments in innovation specific to the needs in the state or territory. 

SCDDs examine and conduct in-depth analysis of the quantity and quality of services and supports 

that are provided at the state and local level. Based on their analysis, each SCDD develops a 

strategic State Plan, with goals and objectives designed to move the state towards an effective, 

coordinated system of supports and services that advance community living for all people with 

developmental disabilities. In addition, Councils are the only entity in the state required to 

strengthen self-advocacy and to build leadership skills of individuals with developmental 

disabilities.
DISABILITY PROGRAMS, RESEARCH AND SERVICES

160 

The authorizing statute requires that Councils use 70 percent of their federal funding to implement 

the State Plan, which includes support for innovation. While the State Plan can be implemented 

by Council staff, Councils have the authority to award grants and/or contracts, or otherwise award 

funds to organizations in the state that serve individuals with DD. These could include the 

University Center of Excellence in Developmental Disabilities (UCEDD) or the Protection and 

Advocacy (P&A) agency but can also include other community-based organizations. Recent data 

indicates that 26 of 42 reporting Councils awarded grants or contracts with the rest doing work 

“in-house.” 

As an example of how funding is used to support innovation, the Georgia Council on 

Developmental Disabilities worked with a network of colleges and universities to offer students 

with developmental disabilities an opportunity to receive a post-secondary experience. What began 

with one university and a $25,000 grant from the Council has grown to 6 universities/colleges and 

a budget of over $1.5 million, including state and federal funds. Currently, there are 80 students 

enrolled in two and four-year programs across the state. A major focus of the programs is preparing 

students for employment. Data collected between 2011 and 2015 on students who attended these 

programs indicated that 57 percent gained employment, 22 percent were continuing their 

education, and 7 percent were seeking employment. Examples of other State Council on 

Developmental Disabilities’ activities include:

• Access to Health Care: The Maine Developmental Disabilities Council collaborated to 

expand a “medical home” model for individuals with developmental disabilities to ensure 

access to a primary care physician or regular health care provider to better coordinate their 

overall care. The Texas Council for Developmental Disabilities supported projects in ten 

targeted regions to increase capacity to provide culturally appropriate health care services, 

community services, behavior supports, and respite to support people with developmental 

disabilities and their families.

• Access to Dental Care: The California Developmental Disabilities Council partnered with 

coalitions to assist individuals with developmental disabilities and families in 

understanding managed care and assisted health plans in order to improve access to dental 

care, particularly anesthesia-based dental care. The Hawaii State Council on 

Developmental Disabilities worked with the state legislature to establish a donated dental 

services program that has assisted hundreds of individuals with developmental disabilities. 

The Montana Council on Developmental Disabilities worked with community health 

centers, dental associations, and donated dental program to increase dental care options and 

training for dental professionals, including procedures that might involve sedation. 

• Community Living: The Alaska Governor’s Council on Disabilities & Special Education 

collaborated on a HomeMap project to explore the use of enabling technologies to more 

cost-effectively support individuals and families with fewer paid staff hours in their HCBS 

waiver program. The North Carolina Council on Developmental Disabilities partnered with 

the P&A on a model demonstration to transition individuals out of Adult Care Homes 

(ACHs) and into HCBS settings. The Washington State Developmental Disabilities 

Council conducts independent quality of life surveys with individuals with disabilities 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

161 

transitioning from institutional to HCBS as part of the State’s Roads to Community (Money 

Follows the Person) programs.

• Transportation: The Colorado Developmental Disabilities Council supported grassroots 

projects in rural areas which led to community action at the local level that increased 

transportation, livable communities, and meaningful participation of people with 

Developmental Disabilities in their communities. The Florida Developmental Disabilities 

Council partnered with the Florida Department of Transportation to implement a 

transportation voucher pilot project in two Florida sites. The project contributed to voucher 

users gaining access to increased employment opportunities, training and higher wages. 

For example, prior to implementation of the program one participant had turned down a 

job at Walmart the year before due to not having available transportation. Through the 

program, she resubmitted her application, was hired and is getting to work at Walmart on 

time every day.

To receive funds, each state and territory must have an established State Council on Developmental 

Disabilities as prescribed under the Developmental Disabilities Assistance and Bill of Rights Act 

(“DD Act”). There are 56 Councils whose members are appointed by the Governor and serve in a 

volunteer capacity. Under current law, not less than 60 percent of the SCDD membership must be 

composed of persons with developmental disabilities and their family members.

Funding History:

Funding for the program over the past five years is as follows:

FY 2017 .................................................$72,833,000 

FY 2018 .................................................$75,943,000 

FY 2019 ................................................$75,921,000 

FY 2020 Enacted....................................$78,000,000 

FY 2021 President’s Budget ..................$56,000,000 

Budget Request: 

The FY 2021 request is $56,000,000 a reduction of -$22,000,000 below the FY 2020 Enacted 

level. ACL recognizes the value this program provides by focusing solely on developmental 

disabilities that are lifelong, significant and require ongoing support and by supporting investment 

and innovation tailored to needs in states or territories that improve the quality of life of those with 

developmental disabilities. 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

162 

Outputs and Outcomes Table:

State Councils on Developmental Disabilities 

Measure Year and Most Recent Result 

/ 

Target for Recent Result /

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-FY 2020

Target

8G Increase the 

percentage of people 

with developmental 

disabilities and their 

family members 

increasing their advocacy 

knowledge. (Outcome)

FY 2017: Result Expected Dec 

31, 2019

Target:

Set Baseline

(Pending)

FY 2017: Data not available. 

Contractual issues with data 

system vendor resulted in 

non-delivery of data to ACL. 

*This is a developmental performance measure. ACL is currently collecting sufficient data to establish a baseline. To set a 

baseline, the agency relies on 3 years of data. This process ensures that the data are stable and show a clear trend. The agency 

will set targets for this measure once a baseline is established). 

Grant Awards Tables:

State Councils on Developmental Disabilities Grant Awards 

FY 2019 

Final 

FY 2020

Enacted

FY 2021 

President’s 

Budget 

Number of 

Awards 56 56 56

Average Award $1,341,000 $1,376,488 $983,631

Range of Awards

$263,706 - 

$7,481,672

$271,272 - 

$7,706,334

$193,850 - 

$5,506,904
DISABILITY PROGRAMS, RESEARCH AND SERVICES

163 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES

FY 2021 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: State Councils on Developmental Disabilities (CFDA 93.630)

STATE/TERRITORY FY 2019 Final FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

Alabama 1,288,048 1,288,048 920,432 (367,616)

Alaska 506,372 520,902 372,232 (148,670)

Arizona 1,443,274 1,500,923 1,072,552 (428,371)

Arkansas 769,110 769,110 549,602 (219,508)

California 7,481,672 7,706,334 5,506,904 (2,199,430)

Colorado 970,674 1,052,292 751,966 (300,326)

Connecticut 712,150 712,150 508,900 (203,250)

Delaware 506,372 520,902 372,232 (148,670)

District of Columbia 506,372 520,902 372,232 (148,670)

Florida 3,778,592 4,114,172 2,939,966 (1,174,206)

Georgia 2,091,740 2,143,352 1,531,638 (611,714)

Hawaii 506,372 520,902 372,232 (148,670)

Idaho 506,372 520,902 372,232 (148,670)

Illinois 2,618,760 2,641,889 1,887,880 (754,009)

Indiana 1,485,102 1,488,546 1,063,706 (424,840)

Iowa 772,386 774,176 553,222 (220,954)

Kansas 613,170 614,590 439,184 (175,406)

Kentucky 1,195,440 1,195,440 854,254 (341,186)

Louisiana 1,372,542 1,375,724 983,084 (392,640)

Maine 506,372 520,902 372,232 (148,670)

Maryland 1,092,644 1,165,740 833,030 (332,710)

Massachusetts 1,360,152 1,360,152 971,956 (388,196)

Michigan 2,531,600 2,531,600 1,809,068 (722,532)

Minnesota 1,026,034 1,067,291 762,680 (304,611)

Mississippi 912,124 914,238 653,310 (260,928)

Missouri 1,361,440 1,361,440 972,878 (388,562)

Montana 506,372 520,902 372,232 (148,670)

Nebraska 506,372 520,902 372,232 (148,670)

Nevada 553,912 595,847 425,790 (170,057)

New Hampshire 506,372 520,902 372,232 (148,670)
DISABILITY PROGRAMS, RESEARCH AND SERVICES

164 

PROGRAM/CFDA NUMBER: State Councils on Developmental Disabilities (CFDA 93.630)

STATE/TERRITORY FY 2019 Final FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

 

New Jersey 1,631,672 1,691,276 1,208,576 (482,700)

New Mexico 507,174 520,902 372,232 (148,670)

New York 4,081,482 4,081,482 2,916,606 (1,164,876)

North Carolina 2,011,300 2,043,639 1,460,374 (583,265)

North Dakota 506,372 520,902 372,232 (148,670)

Ohio 2,840,136 2,846,720 2,034,250 (812,470)

Oklahoma 895,174 897,250 641,170 (256,080)

Oregon 777,558 811,758 580,078 (231,680)

Pennsylvania 3,019,520 3,026,520 2,162,734 (863,786)

Rhode Island 506,372 520,902 372,232 (148,670)

South Carolina 1,094,464 1,097,000 783,910 (313,090)

South Dakota 506,372 520,902 372,232 (148,670)

Tennessee 1,458,016 1,461,396 1,044,306 (417,090)

Texas 5,157,426 5,559,900 3,973,074 (1,586,826)

Utah 632,238 632,238 451,794 (180,444)

Vermont 506,372 520,902 372,232 (148,670)

Virginia 1,539,418 1,608,810 1,149,646 (459,164)

Washington 1,331,373 1,501,723 1,073,134 (428,589)

West Virginia 737,632 739,342 528,330 (211,012)

Wisconsin 1,305,678 1,305,678 933,030 (372,648)

Wyoming 506,372 520,902 372,232 (148,670)

 Subtotal 71,540,035 73,491,316 52,516,494 (20,974,822)

American Samoa 263,706 271,272 193,850 (77,422)

Guam 263,706 271,272 193,850 (77,422)

Northern Mariana Islands 263,706 271,272 193,850 (77,422)

Puerto Rico 2,501,130 2,506,930 1,791,440 (715,490)

Virgin Islands 263,706 271,272 193,850 (77,422)

 Subtotal 75,095,989 77,083,334 55,083,334 (22,000,000)

Undistributed 1/ 825,011 916,666 916,666 -

Total States/Territories 75,921,000 78,000,000 56,000,000 (22,000,000)

1/ Program Support- includes funds for technical assistance and/or minority set-asides; grant systems and review, and program 

reporting systems costs.
DISABILITY PROGRAMS, RESEARCH AND SERVICES

165 

Developmental Disabilities – Protection and Advocacy 

Services

FY 2019 

Final 

FY 2020

Enacted

FY 2021 President’s 

Budget 

FY 2021 (+/-) FY 

2020

Developmental 

Disability Protection 

and Advocacy

$40,692 $40,784 $38,734 -$2,050

*BA is in thousands of dollars.

Original Authorizing Legislation: Section 145 of the Developmental Disabilities Assistance and 

Bill of Rights Act, Public Law 106-402 

Most Recent Authorizing Legislation: Section 145 of the Developmental Disabilities Assistance 

and Bill of Rights Act of 2000, Public Law 106-402 

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

Authorization Expiration Date ...................................................................................................2007 

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

Program Description and Accomplishments:

Developmental Disabilities Protection and Advocacy (P&As) programs provide a range of legal 

services to unserved or underserved individuals with developmental disabilities, ensuring they are 

protected from abuse and neglect and are able to exercise their rights to make choices, contribute 

to society, and live independently. P&A systems have the authority to pursue a range of appropriate 

remedies or approaches, including the authority to investigate incidents of abuse and neglect, and 

to promote system change. There is a P&A system in each State, the Territories, and the District 

of Columbia. There is also a Native American Consortium for a total of 57 P&As.

P&As play a key role in promoting community living, and have been supported by a number of 

Federal and state initiatives promoting alternatives to nursing homes and other institutional settings 

that recognize the value of consumer preference and the attendant potential fiscal savings that can 

result. Money Follows the Person, Home and Community Service (HCBS) waivers, and Medicaid 

managed care programs, to name a few, are continuing to change the long-term care landscape 

across the country by expanding opportunities for community living. The number of people with 

intellectual and developmental disabilities receiving Home and Community-Based waiver services 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

166 

has steadily increased.117

117 U.S. Profile, FY 1977 – 2013, State of the State in Developmental Disabilities.

 Approximately 86 percent of the P&A clients now live in the 

community. This creates a heightened role for P&As to monitor and develop new strategies to 

address these new services.

These changes create new challenges for Protection and Advocacy programs, as well as for the 

Long-Term Care Ombudsman program (LTCOP). P&As and LTCOPs will increasingly need to 

have the capacity to address the new challenges and at the same time they will have to cope with 

the continuing accelerated growth of community-based services.

P&As also engage in a full range of other efforts to promote the rights of individuals with 

developmental disabilities. P&As often provide information and referrals, as well as training and 

technical assistance to service providers, state legislators and other policymakers. They also 

conduct self-advocacy trainings and raise public awareness of legal and social issues affecting 

individuals with developmental disabilities and their families.

Funding History:

Funding for the program over the past five years is as follows:

FY 2017 .................................................$38,645,000 

FY 2018 .................................................$40,677,000 

FY 2019 .................................................$40,692,000 

FY 2020 Enacted....................................$40,784,000 

FY 2021 President’s Budget ..................$38,734,000 

Budget Request: 

The FY 2021 request for the Developmental Disabilities Protection and Advocacy program is 

$38,734,000, a reduction of -$2,050,000 below the FY 2020 Enacted level. This request will allow 

the P&A system to continue to provide training, legal, and advocacy services both to groups and 

to individuals with developmental disabilities, as well as to continue to provide information and 

referral services.

The P&As form a national system that play a key role in ensuring that people with developmental 

disabilities are free of abuse and neglect. People with developmental disabilities, including 

children, are at increased risk of experiencing abuse and neglect.118

118 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. 

The 57 P&As stay at the 

forefront of these issues and maintain a presence in facilities that care for people with disabilities, 

where they monitor, investigate, and attempt to remedy any adverse conditions. In FY 2016, 

32,205 people with disabilities received rights training by P&As and 35,695 people with 

disabilities received information and referral services. 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

167 

Of the inquiries and issues received by the P&As in FY 2018: 

• 76 percent of closed individual cases in which the client’s objective was fully or partially 

met;

• 43 percent of individual clients who had their right enforced and/or restored by P&A 

efforts;

• 19 percent were resolved using short-term assistance/limited advocacy strategies;

• 49 percent were addressed through technical assistance in self-advocacy;

• 11 percent involved investigation and monitoring; 

• 11 percent were addressed through negotiation; and

• 14 percent of abuse and neglect cases were remedied by P&As

Without the P&A presence, people with developmental disabilities and their families would have 

limited or no access to cost-effective advocacy and legal interventions.

Outputs and Outcomes Table:

Developmental Disabilities Protection and Advocacy

Measure Year and Most Recent Result 

/ 

Target for Recent Result /

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-FY 2020

Target

8F Increase the 

percentage of individuals 

with developmental 

disabilities whose rights 

were enforced, retained, 

restored or expanded. 

(Outcome)

FY 2018: 78.9%

Target:

Not Defined

(Historical Actual)

Prior Result + 

1%

Prior Result + 

1%

N/A

*This is a developmental performance measure. ACL is currently collecting sufficient data to establish a baseline. To set a baseline, 

the agency relies on 3 years of data. This process ensures that the data are stable and show a clear trend. The agency will set targets 

for this measure once a baseline is established.

Indicator Year and Most Recent 

Result /

FY 2020

Projection

FY 2021

Projection

FY 2021

Projection

+/-FY 2020

Projection

8iii: Number of clients 

receiving professional 

individual legal advocacy 

for the Protection and 

FY 2018: 14,032 N/A N/A N/A
DISABILITY PROGRAMS, RESEARCH AND SERVICES

168 

Indicator Year and Most Recent 

Result /

FY 2020

Projection

FY 2021

Projection

FY 2021

Projection

+/-FY 2020

Projection

Advocacy program. 

(Output)

8iv: Number of people 

receiving information and 

referral from the 

Protection and Advocacy 

program. (Output)

FY 2018: 17,711 N/A N/A N/A

Grant Awards Tables:

Developmental Disabilities – Protection and Advocacy Formula Grant Awards119

119 Excludes grants to tribal organizations.

FY 2019 Final FY 2020

Enacted

FY 2021 

President’s 

Budget

Number of 

Awards 57 57 57

Average Award $698,726 $700,120 $664,155

Range of Awards

$216,435 - 

$3,998,921

$216,701 - 

$4,034,756

$205,809 - 

$3,820,564
DISABILITY PROGRAMS, RESEARCH AND SERVICES

169 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES

FY 2021 DISCRETIONARY STATE FORMULA GRANTS 2/

PROGRAM/CFDA NUMBER: Developmental Disabilities – Protection and Advocacy (CFDA 93.630)

STATE/TERRITORY FY 2019 Final FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

Alabama 504,146 508,323 485,841 (22,482)

Alaska 404,556 405,053 384,693 (20,360)

Arizona 732,031 776,138 734,924 (41,214)

Arkansas 404,556 405,053 384,693 (20,360)

California 3,998,921 4,034,756 3,820,564 (214,192)

Colorado 506,685 528,522 500,463 (28,059)

Connecticut 407,815 405,053 384,693 (20,360)

Delaware 404,556 405,053 384,693 (20,360)

District of Columbia 404,556 405,053 384,693 (20,360)

Florida 2,120,721 2,139,373 2,025,938 (113,435)

Georgia 1,056,977 1,094,021 1,036,018 (58,003)

Hawaii 404,556 405,053 384,693 (20,360)

Idaho 404,556 405,053 384,693 (20,360)

Illinois 1,273,675 1,278,967 1,211,026 (67,941)

Indiana 641,102 657,028 622,160 (34,868)

Iowa 404,556 405,053 384,693 (20,360)

Kansas 404,556 405,053 384,693 (20,360)

Kentucky 462,995 481,293 455,774 (25,519)

Louisiana 546,923 522,447 494,766 (27,681)

Maine 404,556 405,053 384,693 (20,360)

Maryland 587,033 576,778 546,271 (30,507)

Massachusetts 669,808 636,929 603,106 (33,823)

Michigan 1,021,390 1,005,483 952,074 (53,409)

Minnesota 515,593 531,910 503,800 (28,110)

Mississippi 410,751 419,388 398,131 (21,257)

Missouri 583,148 602,690 570,721 (31,969)

Montana 404,556 405,053 384,693 (20,360)

Nebraska 404,556 405,053 384,693 (20,360)

Nevada 404,556 405,053 384,693 (20,360)

New Hampshire 404,556 405,053 384,693 (20,360)
DISABILITY PROGRAMS, RESEARCH AND SERVICES

PROGRAM/CFDA NUMBER: Developmental Disabilities – Protection and Advocacy (CFDA 93.630)

STATE/TERRITORY FY 2019 Final FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

 

170 

New Jersey 862,406 817,441 774,023 (43,418)

New Mexico 404,556 405,053 384,693 (20,360)

New York 2,053,869 1,945,742 1,842,439 (103,303)

North Carolina 1,069,517 1,082,264 1,024,831 (57,433)

North Dakota 404,556 405,053 384,693 (20,360)

Ohio 1,210,263 1,187,608 1,124,562 (63,046)

Oklahoma 404,556 411,149 390,320 (20,829)

Oregon 415,057 424,475 402,091 (22,384)

Pennsylvania 1,273,771 1,289,089 1,220,660 (68,429)

Rhode Island 404,556 405,053 384,693 (20,360)

South Carolina 512,478 502,528 475,876 (26,652)

South Dakota 404,556 405,053 384,693 (20,360)

Tennessee 647,601 668,895 633,404 (35,491)

Texas 2,877,405 2,897,700 2,744,046 (153,654)

Utah 404,556 405,053 384,693 (20,360)

Vermont 404,556 405,053 384,693 (20,360)

Virginia 784,548 787,475 745,683 (41,792)

Washington 743,177 756,401 716,183 (40,218)

West Virginia 404,556 405,053 384,693 (20,360)

Wisconsin 533,911 534,615 508,065 (26,550)

Wyoming 404,556 405,053 384,693 (20,360)

 Subtotal 37,923,949 38,010,594 36,027,006 (1,983,588)

Indian Tribes 216,435 216,701 205,809 (10,892)

American Samoa 216,435 216,701 205,809 (10,892)

Guam 216,435 216,701 205,809 (10,892)

Northern Mariana Islands 216,435 216,701 205,809 (10,892)

Puerto Rico 821,254 812,758 800,806 (11,952)

Virgin Islands 216,435 216,701 205,809 (10,892)

 Subtotal 39,827,378 39,906,857 37,856,857 (2,050,000)

Undistributed 864,622 877,143 877,143 -

Total States/Territories 40,692,000 40,784,000 38,734,000 (2,050,000)

1/ Program Support- includes funds for technical assistance and/or minority set-asides; grant systems and review, and program 

reporting systems costs.
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171 

University Centers for Excellence in Developmental Disabilities

Services

FY 2019 

Final 

FY 2020 

Enacted 

FY 2021 

President’s 

Budget 

FY 2021 (+/-) FY 

2020

University Center of 

Excellence in 

Developmental 

Disabilities

$40,478 $41,619 $32,546 -$9,073

*BA is in thousands of dollars.

Original Authorizing Legislation: Section 156 of the Developmental Disabilities Assistance and 

Bill of Rights Act, Public Law 106-402 

Most Recent Authorizing Legislation: Section 156 of the Developmental Disabilities Assistance 

and Bill of Rights Act of 2000, Public Law 106-402 

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

Authorization Expiration Date ...................................................................................................2007 

Allocation Method ............................................................................................... Competitive Grant

Program Description and Accomplishments:

University Centers for Excellence in Developmental Disabilities (UCEDDs) are interdisciplinary 

education, research and public service units of a university or not-for-profit entities associated with 

universities. UCEDDs advise Federal, State, and community policymakers about, and promote, 

opportunities for individuals with developmental disabilities to exercise self-determination and to 

be independent, productive, integrated and included in all facets of community life. 

In FY 2018, the Administration on Intellectual and Developmental Disabilities (AIDD) funded 67 

UCEDDs. Funding from AIDD establishes the UCEDDs and provides the infrastructure support 

for the Centers to engage in interdisciplinary pre-service training, continuing education, 

community services, research, and information dissemination activities. UCEDDs leverage 

additional funds for carrying out these core activities from a variety of sources, including federal, 

state, and local agencies; private foundations; donations; and fee-for-service earnings. In FY 2015, 

UCEDDs leveraged $15 per AIDD dollar invested.

UCEDDs have played a key role in a number of advances in the disability field over the past five 

decades. Many services, such as early intervention, health care, community-based services, 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

172 

inclusive and meaningful education, transition from school to work, employment, housing, 

assistive technology, and transportation have been directly improved by the services, research, and 

training provided by UCEDDs. 

As liaisons to the community, including service delivery systems, UCEDDs positively affect the

lives of individuals with developmental disabilities and their families in a variety of ways. UCEDD

accomplishments include: 

• Directing exemplary interdisciplinary pre-service preparation with faculty and trainees that 

represent a variety of disciplines. UCEDD interdisciplinary training programs are designed 

to integrate knowledge and methods from two or more distinct disciplines; integrate direct 

contributions to the field made by people with disabilities and family members; and 

examine and advance professional practice, scholarship, and policy that impacts the lives 

of people with developmental and other disabilities and their families. 

• Providing community services that cut across Federal, State, and local systems to improve 

capacity and quality of services by incorporating evidence-based practices. Community 

services offer innovative designs and methods that address a local or universal need, can 

be replicated and promote the increased inclusion, integration, productivity, and human 

rights of individuals with developmental disabilities and their families, including people 

with developmental disabilities from racial and ethnic minority backgrounds. 

• Contributing to the development of new knowledge through various research activities 

including basic or applied research, evaluation, and public policy analysis. UCEDD 

research engages people with developmental disabilities and their families in the 

development, design and implementation of research activities, as well as the dissemination 

of research information. New knowledge is generated by research and tied to practice using 

a variety of dissemination strategies. UCEDDs also bridge the gap between research and 

practice by developing a variety of products and resources that promotes improvement in 

knowledge and practice. 

• Leading national efforts, including youth transition, autism services, supports and research, 

mental health services and supports, and supporting self-advocates and families. For 

example, the Carolina Institute for Developmental Disabilities at the University of North 

Carolina released findings from a study that examined the use of brain scans to identify 

early signs of autism in high-risk babies. The researchers were able to make reasonably 

accurate forecasts about which high-risk infants will later develop autism by scanning the 

brains of babies whose siblings have autism. The findings are important because early 

diagnosis of autism spectrum disorder (ASD) has been a significant challenge. 

When funding is sufficient, UCEDDs also conducts national training initiatives to address unmet 

needs of people with developmental disabilities. Training initiatives invest in addressing critical 

needs for people with disabilities, such as babies born with Neonatal Abstinence Syndrome, 

individuals with I/DD with co-occurring mental illness, and individuals from culturally diverse 

backgrounds. Past training initiatives have supported post-secondary education opportunities for 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

173 

people with developmental disabilities, enhancing self-determination skills, and building 

partnerships with minority serving institutions.

Funding History:

Funding for the program over the past five years is as follows:

FY 2017 .................................................$38,530,000 

FY 2018 .................................................$40,543,000 

FY 2019 ................................................$40,619,000 

FY 2020 Enacted....................................$41,619,000 

FY 2021 President’s Budget ..................$32,546,000 

Budget Request: 

The FY 2021 request is $32,546,000, a reduction of -$9,073,000 million below the FY 2020 

Enacted level. Funding of the UCEDDs will support the network of independent, but interlinked 

centers, representing an expansive national resource for addressing issues, finding solutions, and 

advancing research related to the needs of individuals with developmental disabilities and their 

families. Based on statutory requirements for allocating funding, national training initiatives would 

not be funded at the FY 2021 Budget level. 

At the local level, UCEDDs train future professionals with the specialized expertise in 

developmental disabilities. Of the UCEDD trainees who graduated 5 to 10 years ago, 30 percent 

are in leadership positions including: 

• 18 percent in academic leadership;

• 15 percent in clinical leadership;

• 4 percent in public health leadership; and 

• 32 percent in public policy and advocacy leadership. 

Funding for UCEDDs supports specialized services at the local level and provides local 

organizations as well as state agencies with technical assistance to improve services and supports 

for people with developmental disabilities across the life span. UCEDDs currently operate very 

efficiently and are able to leverage significant additional Federal and non-Federal resources. ACL 

will work to provide technical and other assistance, including sharing best practices, to allow the 

UCEDDs to prioritize remaining funding and to leverage additional resources for these services.
DISABILITY PROGRAMS, RESEARCH AND SERVICES

174 

Outcomes and Outputs Table:

University Centers for Excellence in Developmental Disabilities

Measure Year and Most Recent Result 

/ 

Target for Recent Result /

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-FY 2020

Target

8D Increase the 

percentage of individuals 

with developmental 

disabilities who are 

receiving services through 

activities in which UCEDD 

trained professional were 

involved. (Outcome)

FY 2018: 45.64%

Target:

45.01%

(Target Exceeded)

Prior Result + 1% Prior Result + 1% N/A

Indicator Year and Most Recent 

Result /

FY 2020 

Projection

FY 2021

Projection

FY 2021

Projection

+/-FY 2020

Projection

8viii: Number of 

professionals trained by 

UCEDDs. (Output)

FY 2018: 5,773 N/A N/A N/A

8ix: Number of people 

reached through UCEDD 

community training and 

technical assistance 

activities. (Output)

FY 2018: 1,506,279 N/A N/A N/A

8x: Number of people 

receiving direct or model 

demonstration services 

from UCEDDs. (Output)

FY 2018: 25,199 N/A N/A N/A
DISABILITY PROGRAMS, RESEARCH AND SERVICES

175 

Grant Awards Tables:

University Centers of Excellence in Developmental Disabilities Grant Awards

FY 2019 

Final 

FY 2020

Enacted

FY 2021 

President’s 

Budget

Number of Awards 74 75 67

Average Award $535,015 $543,091 $472,506 

Range of Awards $48,909 -

$700,000 

$48,909 -

$700,000 

$48,909 -

$700,000 

Resource and Program Data: 

University Centers of Excellence in Developmental Disabilities

FY 2019

Final

FY 2020

Enacted

FY 2021

President’s Budget 

Mechanism # $ # $ # $

Grants:

Formula

 

--

 

--

 

--

 

--

 

--

 

--

New Discretionary

 

4 2,162 

 

4 2,717 

 

2 1,517 

Continuations

 

70 37,429 

 

71 38,015 

 

65 30,141 

Contracts

 

1 817 

 

1 817 

 

1 817 

Interagency Agreements

 

--

 

--

 

--

 

--

 

--

 

--

Program Support120

120 Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and review, 

and information technology support costs.

 

-- 71 

 

-- 71 

 

-- 72 

Total Resources 40,478 41,619 32,546 
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177 

Developmental Disabilities – Projects of National Significance

Services

FY 2019 

Final 

FY 2020 

Enacted

FY 2021 

President’s 

Budget 

FY 2021 (+/-) FY 

2020

Developmental 

Disabilities - Projects 

of National 

Significance

$11,958 $12,250 $1,050 -$11,200

*BA is in thousands of dollars.

Original Authorizing Legislation: Section 163 of the Developmental Disabilities Assistance and 

Bill of Rights Act, Public Law 106-402 

Most Recent Authorizing Legislation: Section 163 of the Developmental Disabilities Assistance 

and Bill of Rights Act of 2000, Public Law 106-402 

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

Authorization Expiration Date ...................................................................................................2007 

Allocation Method ............................. Competitive Grants and Cooperative Agreements/Contracts

Program Description and Accomplishments:

Projects of National Significance (PNS) is a discretionary program which provides grants, 

cooperative agreements, and contracts to public or private non-profit entities to develop and test 

innovative and promising practice demonstrations that expand opportunities for individuals with 

developmental disabilities to contribute to, and participate in, all facets of community life. 

Examples of PNS activities include:

• Grants to improve access to competitive, integrated supported employment for people with 

intellectual and developmental disabilities. These grants include particular focus on youth 

and young adults, as well as the evaluation of such efforts and technical assistance to the 

states that are funded. 

• Longitudinal research studies of trends in residential services and supports, employment, 

Medicaid expenditures, and family supports related to publicly funded DD services. 

• Grants to state aging and disability consortium to advance a full continuum of decision 

support strategies, including supported decision making, as an alternative to guardianship.
DISABILITY PROGRAMS, RESEARCH AND SERVICES

178 

• Model system grants to strengthen state capacity around community monitoring to ensure 

quality community living. 

• A human dignity project that addresses health disparities for people with intellectual and 

developmental disabilities by developing protocols for medical providers to ensure equal 

access to health care. 

Funding History:

Funding for the program over the past five years is as follows:

FY 2017 ...................................................$9,977,000 

FY 2018 .................................................$11,770,000 

FY 2019 ................................................$11,958,000 

FY 2020 Enacted....................................$12,250,000 

FY 2021 President’s Budget ....................$1,050,000 

Budget Request:

The FY 2021 request for the Projects of National Significance is $1,050,000, a reduction 

of -$11,250,000, below the FY 2020 Enacted level. At the requested funding level, the PNS 

program provides continued support for three studies: The State of the States in Developmental 

Disabilities, Residential Information Systems Project, and the National Data Collection on Day 

and Employment Services for Individuals with Developmental Disabilities.
DISABILITY PROGRAMS, RESEARCH AND SERVICES

179 

Grant Awards Tables:

Developmental Disabilities – Projects of National Significance Grant Awards

(Dollars in thousands)

FY 2019 

Final 

FY 2020

Enacted

FY 2021 

President’s 

Budget 

Number of Awards 25 25 3 

Average Award $362,475 $372,375 $346,500 

Range of Awards $75,000 -

$964,239 

$75,000 -

$964,239 

$75,000 -

$964,239 

Resource and Program Data: 

Developmental Disabilities – Projects of National Significance

(Dollars in thousands)

FY 2019

Final

FY 2020

Enacted

FY 2021

President’s Budget 

Mechanism # $ # $ # $

Grants:

Formula

 

--

 

--

 

--

 

--

 

--

 

--

New Discretionary

 

4 725 

 

-- 248 

 

-- 

Continuations

 

21 8,337 

 

25 9,062 

 

3 1,040 

Contracts

 

8 2,298 

 

-- 2,298 

 

-- 

Interagency Agreements

 

2

 

402

 

--

 

402

 

--

 

--

Program Support121

121 Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and review, 

and information technology support costs.

 

-- 196 

 

-- 240 

 

-- 11 

Total Resources 11,958 12,250 1,050 
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181 

Independent Living

Services

FY 2019

Final 

FY 2020 

Enacted

FY 2021 

President’s 

Budget 

FY 2021 (+/-) FY 

2020

Independent Living - 

State Grants $25,352 $25,378 $17,841 -$7,537

Centers for 

Independent Living $90,712 $90,805 $95,805 $5,000

Total: $116,063 $116,183 $113,646 -$2,537

FTE 1.0 1.0 1.0 --

*BA is in thousands of dollars, FTE are actuals. 

Original Authorizing Legislation: Rehabilitation Act of 1973, Parts B and C, and Chapter 2, Public 

Law 93-12 

Most Recent Authorizing Legislation: Workforce Innovation and Opportunities Act of 2014

(Rehabilitation Act), Public Law 113-128 

Current FY Authorization: 

Independent Living State Grants ...............................................................................$26,319,000 

Centers for Independent Living .................................................................................$90,083,000 

Expiration Date: ........................................................................................................................2019 

Allocation Method ...................................................................... Formula and Discretionary Grants

Program Description and Accomplishments:

ACL’s Independent Living programs are rooted in the belief that people with disabilities should 

be able to live independently in their communities, with the same opportunities as people without 

disabilities. These programs provide tools, resources, and supports, such as independent living 

skills training, assistance with transitioning from residential facilities to the community, and peer 

counseling. In addition, the programs help support statewide networks of centers for independent 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

182 

living (CILs) and foster working relationships between CILs, Statewide Independent Living 

Councils, and other federal, state and community programs that address the needs of people with 

disabilities. 

Independent Living Services State Grants

The Independent Living Services (ILS) State Grants program funds formula grants to states and 

territories to support provision, expansion, and improvement of independent living services. 

Specifically, the program supports the operation of Statewide Independent Living Councils 

(SILC), as well as training and technical assistance to SILCs. 

SILCs work with the state’s centers for independent living to develop a State Plan for Independent 

Living, the state’s three-year roadmap for executing and improving independent living services. 

Other SILC functions vary between states, but may include coordination of services provided to 

individuals with disabilities and resource development activities. 

SILCs may retain up to 30 percent of the funding received through this grant for SILC operations. 

The remainder must be used for one or more of the following purposes, in accordance with their 

individual State Plans:

• To demonstrate ways to expand and improve independent living services, particularly those 

in unserved areas;

• To provide independent living services; 

• To support the operation of centers for independent living; 

• To increase the capacity of public or nonprofit agencies and organizations and other entities 

to develop comprehensive approaches or systems for providing independent living 

services;

• To conduct studies and analyses, gather information, develop model policies and 

procedures, and present information, approaches, strategies, findings, conclusions, and 

recommendations to federal, state, and local policymakers; 

• To provide training on the independent living philosophy; and/or 

• To provide outreach to populations who are not served or are underserved by programs 

under subtitle VII, Chapter 16 of the Rehabilitation Act, including minority groups and 

urban and rural populations. 

Typically, this “pass through” funding is awarded to centers for independent living to carry out 

direct services. 

State grant funds are allotted based on total population, and states must match 10 percent of their 

grant with non-federal cash or in-kind resources. 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

183 

Centers for Independent Living

The Centers for Independent Living (CIL) program provides grants to consumer-controlled, 

community-based, cross-disability, private nonprofit agencies that are designed and operated by 

individuals with disabilities. The services provided by CILs vary according to local needs, but all 

are required to provide the core independent living services of information and referral, 

independent living skills training, peer counseling, and individual and systems advocacy. The 2014 

reauthorization of the Rehabilitation Act by the Workforce Innovation and Opportunity Act 

(WIOA) added a fifth core service that the CILs must provide to eligible individuals with 

significant disabilities. This fifth core service includes three components: 

• Facilitate the transition of individuals with significant disabilities from nursing homes and 

other institutions to home and community based residences, with necessary supports to 

remain in the community;

• Assist individuals with significant disabilities at risk of institutionalization, so that they 

may remain in the community; and

• Facilitate the transition of youth who are individuals with significant disabilities that are 

eligible for IDEA and who either completed school or left school to postsecondary life. 

A population-based formula determines the total amount that is available for grants to centers in 

each state. WIOA requires that grants be awarded to any eligible agency that had been awarded a 

grant for the preceding fiscal year. In most cases, awards are made directly to centers for 

independent living. If state funding for CIL operation exceeds the level of federal CIL funding in 

any fiscal year, the state may apply for the authority to award grants under this program through 

its designated state unit. There are currently only two states, Massachusetts and Minnesota, that 

are both eligible and have elected to manage their own CIL programs. In fiscal year 2018, 284 

centers and 56 states and territories received funding from the CIL program. In that same year, 

CILs served about 236,743 of the estimated 38 million individuals with a significant disability 

living in the United States.122

122 ACL, 704 Report, 2014. And U.S. Census Bureau, “Americans with Disabilities 2010” issued July 2012. 

https://www.census.gov/content/dam/Census/library/publications/2012/demo/p70-131.pdf. Accessed 04 January 

2014. 

In addition to funding centers for independent living, the Department must annually reserve 

between 1.8 and 2 percent of the funds appropriated for both the Independent Living Services State 

Grants and the Centers for Independent Living program to provide (through grants, contracts, or 

cooperative agreements; or directly for the ILS State Grants) training and technical assistance for

planning, developing, conducting, administering, and evaluating independent living services and 

centers for independent living. Section 21(b)(1) of the Rehabilitation Act also allows for 1 percent 

of funds appropriated under subtitle VII to be set aside for minority outreach activities as described 

in Section 21(b)(2). 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

184 

Funding History:

Funding for Independent Living activities over the past five years is as follows: 

Centers for Independent Living

FY 2017 .................................................$78,305,000 

FY 2018 ................................................$88,305,000 

FY 2019 ................................................$90,805,000 

FY 2020 Enacted....................................$90,805,000 

FY 2021 President’s Budget ..................$95,805,000 

Independent Living State Grants FTE

FY 2017 .................................................$22,878,000 .7 

FY 2018 ................................................$24,878,000 .8 

FY 2019 ................................................$25,378,000 1.0 

FY 2020 Enacted....................................$25,378,000 1.0 

FY 2021 President’s Budget ..................$17,841,000 1.0 

Budget Request:

Independent Living Services State Grants

The FY 2021 request is $17,841,000, -$7,537,000 below the FY 2020 Enacted level. This will 

allow for continued support to State Independent Living Councils (SILCs) for service 

coordination, as well as support for direct services through funding provided to the centers for 

independent living. Within this funding level, ACL also will continue to reserve, in accordance 

with statute, at least 1.8 percent of funding for the provision of technical assistance to the SILCs, 

including support for one FTE to provide direct Federal technical assistance. 

Centers for Independent Living

The FY 2021 request for the Centers for Independent Living program is $95,805,000, +$5,000,000 

above the FY 2020 Enacted level. This funding continues to support CILs in meeting the core 

requirements for information and referral services, independent living skills training, peer 

counseling, and individual and systems advocacy; and will continue implementation of the new 

core service established by WIOA. As part of this requirement, CILs will develop protocols for 

supporting transitions, provide outreach and education, and track transition-related activities. 

Competitive Employment Grants: Within this funding level, the Budget proposes to create a 

$5 million competitive demonstration grant program to test models for supporting people with 

disabilities in securing and sustaining competitive, integrated employment, and build an evidencebase to assist centers for independent living across the country to expand and strengthen 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

185 

employment-related services. This request demonstrates the Administration’s commitment to 

improving employment outcomes for people with disabilities. 

“It is essential that we continue creating an environment in which Americans with 

disabilities have access to full participation in our economy and the ability to experience 

the benefits of employment.”123

123 Presidential Proclamation on National Disability Employment Awareness Month, 2019, issued September 30, 

2019. 

 –President Trump 

Because employment is critical to financial stability and economic mobility, it is a key social 

determinant of health. Research suggests that people who are employed are both healthier and 

happier. Employment is also fundamental to independence and individual resilience. However, 

there are meaningful barriers that prevent people with disabilities from accessing and sustaining 

employment, and while 74 percent of working-age adults without disabilities are employed, only 

30 percent of people with disabilities are working. Consequently, employment also may be a key 

contributor to health disparities between people with and without disabilities. 

Centers for independent living directly serve over 130,000 people with disabilities every year; they 

are uniquely positioned to deliver the employment-focused training and support that can empower 

people with disabilities to overcome many of the barriers to employment. 

While some CILs provide employment support and training, the current statute does not require 

CILs to provide such services or to connect services to employment outcomes and economic 

mobility. The Budget requests authority within the appropriation to conduct a demonstration 

program to identify successful models of employment support and training that could be adopted 

by CILs not currently providing these services and enhance the effectiveness of these services for 

CILs that already provide employment support and training. 

Continued support to CIL operations: The request will continue support for existing CILs, 

including any new center grants awarded in FY 2019. (Approximately 75 new centers have been 

funded since FY 2000). 

Legislative Proposals: ACL’s request includes legislative proposals to strengthen oversight and 

accountability of the Independent Living programs. Specifically, it proposes: 

Removal of Onsite Requirement for Grantee Compliance Reviews

ACL proposes to remove the requirement to conduct a prescribed number of onsite grantee 

compliance reviews each year and to instead utilize a more efficient and cost-effective process that 

employs a standardized tool the Compliance and Outcome Monitoring Protocol (COMP) to every 

grantee, every year. The COMP is comprised of three interwoven processes that can occur in any 

order or simultaneously:
DISABILITY PROGRAMS, RESEARCH AND SERVICES

186 

1. Standard Monitoring: is the continuous review of each CIL grantee that occurs every year. 

Federal staff use a standardized approach to assess select program, operational and fiscal 

management data. This monitoring includes, but is not limited to, the review of the program 

performance report, fiscal documents, and funds drawdown records. 

2. Comprehensive Review: Comprehensive Review is a more thorough review of a CIL’s 

operations and includes a thorough examination of all the components ACL monitors. A 

team, led by an ACL program officer, conducts an onsite or remote review (the latter is 

also referred to as a desktop review).

3. Targeted Review: Targeted Review employs remote and/or onsite reviews to identify and 

address concerns, including operations and financial management. Targeted Review 

involves focused monitoring of the grantee in specific areas of concern. This type of review 

is individualized based on the issue(s) with the program.

ACL would continue to leverage technology to conduct many routine monitoring activities 

remotely and would conduct onsite reviews as needed based on analysis of risk indicators. 

Authority to Conduct Program Evaluation and Performance Measurement Activities 

ACL proposes to explicitly authorize program evaluation and performance measurement as an 

allowable activity of appropriated funds. Specifically, the proposal authorizes Section 711A or 

Section 721(b) funds to be used for program evaluation and/or performance measurement of 

centers for independent living and Statewide Independent Living Councils. The Budget includes 

up to $1M in existing resources to be used for this purpose. 

Authority to Provide Direct Training and Technical Assistance to Centers for Independent Living

Current training and technical assistance (T/TA) by Federal staff is only authorized for the 

Independent Living Service’s Council program. As a result T/TA must be outsourced for Centers 

for Independent Living (CILs) which presents a barrier to Federal staff providing some T/TA 

directly. ACL proposes to strengthen training and technical assistance and improve consistency 

across IL programs by authorizing direct provision of training and technical assistance by ACL 

program staff to CILs. Currently, ACL has the authority to provide direct T/TA only to Statewide 

Independent Living Councils. 

Outcome and Output Table:

ACL has revised the grantee program performance reports (PPRs) to improve overall data quality, 

reduce grantee reporting burden, and increase reporting of program outcomes. These reports form 

the basis of performance measures. ACL is in the process of analyzing baseline data and 

developing performance measures. 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

187 

Grant Awards Tables:

Independent Living Services State Grant Awards124

124 Independent Living State Grants are awarded to 77 entities across 56 state and territory jurisdictions because 

some states have separate divisions for vocational rehabilitation and services for the blind.

FY 2019 

Final 

FY 2020

Enacted

FY 2021 

President’s Budget 

Number of 

Awards 56 56 56

Average Award $438,323 $439,025 $308,204

Range of Awards

$30,683 - 

$2,172,306

$30,732 - 

$2,170,807

$21,574 - 

$1,521,924

Resource and Program Data:

Independent Living 

(Dollars in Thousands)

FY 2019

Final 

FY 2020

Enacted

FY 2021

President’s Budget

Mechanism # $ # $ # $

Grants:

Formula

 

56

 

24,546

 

56

 

24,585

 

56

 

17,259

New Discretionary

 

358 89,080 

 

358 88,953 

 

358 93,524 

Continuations

 

4 1.925 

 

4 1,162 

 

4 1,350 

Contracts

 

-- 

 

1 1,000 

 

1 1,000 

Interagency Agreements

 

--

 

--

 

--

 

--

 

--

 

--

Program Support125

125 Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and review, 

and information technology support costs.

 

-- 513 

 

-- 513 

 

-- 513 

Total Resources 116,063 116,183 113,646 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

188 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

FY 2021 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Independent Living State Grants (CFDA 84.169A)

STATE/TERRITORY FY 2019 

Enacted

FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

Alabama 338,717 338,717 238,122 (100,595)

Alaska 338,717 338,717 238,122 (100,595)

Arizona 385,502 393,565 275,923 (117,642)

Arkansas 338,717 338,717 238,122 (100,595)

California 2,172,306 2,170,807 1,521,924 (648,883)

Colorado 338,717 338,717 238,122 (100,595)

Connecticut 338,717 338,717 238,122 (100,595)

Delaware 338,717 338,717 238,122 (100,595)

District of Columbia 338,717 338,717 238,122 (100,595)

Florida 1,152,968 1,168,863 819,474 (349,389)

Georgia 573,033 577,287 404,728 (172,559)

Hawaii 338,717 338,717 238,122 (100,595)

Idaho 338,717 338,717 238,122 (100,595)

Illinois 703,395 699,204 490,202 (209,002)

Indiana 366,302 367,236 257,464 (109,772)

Iowa 338,717 338,717 238,122 (100,595)

Kansas 338,717 338,717 238,122 (100,595)

Kentucky 338,717 338,717 238,122 (100,595)

Louisiana 338,717 338,717 238,122 (100,595)

Maine 338,717 338,717 238,122 (100,595)

Maryland 338,717 338,717 238,122 (100,595)

Massachusetts 376,906 378,776 265,554 (113,222)

Michigan 547,370 548,555 384,585 (163,970)

Minnesota 338,717 338,717 238,122 (100,595)

Mississippi 338,717 338,717 238,122 (100,595)

Missouri 338,717 338,717 238,122 (100,595)

Montana 338,717 338,717 238,122 (100,595)

Nebraska 338,717 338,717 238,122 (100,595)

Nevada 338,717 338,717 238,122 (100,595)

New Hampshire 338,717 338,717 238,122 (100,595)
DISABILITY PROGRAMS, RESEARCH AND SERVICES

189 

PROGRAM/CFDA NUMBER: Independent Living State Grants (CFDA 84.169A)

STATE/TERRITORY FY 2019 

Enacted

FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

New Jersey 494,807 488,881 342,748 (146,133)

New Mexico 338,717 338,717 238,122 (100,595)

New York 1,090,607 1,072,436 751,870 (320,566)

North Carolina 564,463 569,831 399,501 (170,330)

North Dakota 338,717 338,717 238,122 (100,595)

Ohio 640,571 641,492 449,742 (191,750)

Oklahoma 338,717 338,717 238,122 (100,595)

Oregon 338,717 338,717 238,122 (100,595)

Pennsylvania 703,588 702,825 492,741 (210,084)

Rhode Island 338,717 338,717 238,122 (100,595)

South Carolina 338,717 338,717 238,122 (100,595)

South Dakota 338,717 338,717 238,122 (100,595)

Tennessee 369,003 371,524 260,471 (111,053)

Texas 1,555,170 1,575,098 1,104,280 (470,818)

Utah 338,717 338,717 238,122 (100,595)

Vermont 338,717 338,717 238,122 (100,595)

Virginia 465,377 467,433 327,711 (139,722)

Washington 406,902 413,538 289,926 (123,612)

West Virginia 338,717 338,717 238,122 (100,595)

Wisconsin 338,717 338,717 238,122 (100,595)

Wyoming 338,717 338,717 238,122 (100,595)

 Subtotal 24,084,648 24,123,729 16,934,992 (7,188,737)

American Samoa 30,683 30,732 21,574 (9,158)

Guam 30,683 30,732 21,574 (9,158)

Northern Mariana Islands 30,683 30,732 21,574 (9,158)

Puerto Rico 338,717 338,717 238,122 (100,595)

Virgin Islands 30,683 30,732 21,574 (9,158)

 Subtotal 24,546,097 24,585,374 17,259,410 (7,325,964)

Undistributed 1/ 2/ 831,903 792,626 581,590 (211,036)

Total States/Territories 25,378,000 25,378,000 17,841,000 (7,537,000)

1/ Program Support -- includes funds for statutory technical assistance and/or minority set-asides; grant systems and review, and 

program reporting systems costs.

2/ In FY 2020 the President's Budget proposes to use funds for an evaluation of the program.
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DISABILITY PROGRAMS, RESEARCH AND SERVICES

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Limb Loss Resource Center 

Services

FY 2019 

Final

FY 2020 

Enacted

FY 2021 President’s 

Budget 

FY 2021 (+/-) FY 

2020 

Limb Loss Resource 

Center $3,488 $4,000 $4,000 --

*BA is in thousands of dollars.

Original Authorizing Legislation: Public Health Service Act Section 301 (a) and Section 317, as amended, 

42U.S.C. 241 (a); 42 U.S.C. 247 (b)

Most Recent Authorizing Legislation: N/A

Current FY Authorization ......................................................................................................................... NA 

Expiration Date: ................................................................................................................................. Expired 

Allocation Method ............................................................................................................ Competitive Grant 

Program Description and Accomplishments:

The National Limb Loss Resource Center (NLLRC) works to improve the health and well-being 

of people with limb loss and limb difference, promote their well-being, improve their quality of 

life, reduce unnecessary medical expenditures, and provide support to families, and caregivers. 

The NLLRC ensures the availability and accessibility of the most comprehensive, high-quality, 

evidence-based information, resources, and supports so that people with and without limb loss or 

limb difference can live, learn, work, play, and prosper in their communities. 

The NLLRC supports: 

• A national peer support program that reaches over 1,500 individuals annually; 

• Educational events that impacts nearly 2,000 individually annually; 

• A comprehensive website, 

• Trainings for consumers and healthcare professionals, consumer education materials that 

reaches more than 100,000 annually; and 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

192 

• Information and referral services to over 6,500 individuals to disseminate information 

specific to living well with limb loss and to connect consumers to resources in their local 

communities. 

In addition to ongoing efforts, every year the resource center hosts an annual conference that 

provides over 85 workshops for approximately 1200 individuals, 75% of the participants are 

people living with limb loss or limb difference. 

Limb loss is the amputation of all or part of an arm or leg due to trauma, infection, diabetes, heart 

diseases, cancers, or other diseases. A limb difference is a congenital issue affecting one or more 

limbs of an individual while still in the womb. An estimated two million people live with limb loss

or limb difference in the United States,

126

126 Ziegler-Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R. Estimating the prevalence of limb 

loss in the United States: 2005 to 2050. Arch Phys Med Rehabil2008 Mar;89(3):422-9.

and an estimated 185,000 amputations are performed in 

the country every year.127

127 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.

People with limb loss/limb difference experience many barriers to 

successful community (re)integration and full participation. They perceive a reduction in their 

participation in recreational activities and satisfaction at work and feel more impaired in their 

ability to navigate their community following the amputation of their limb.128

128 Ephraim PL, MacKenzie EJ, Wegener ST, Dillingham TR, Pezzin LE. Environmental barriers experienced by 

amputees: the Craig Hospital Inventory of Environmental Factors-Short Form. Arch Phys Med Rehabil2006 

Mar;87(3):328-33.

Additionally, people 

with limb loss/limb difference often experience anxiety and psychological distress, low rates of 

workforce participation, environmental barriers, and secondary co-morbidities associated with the 

amputation of a limb (e.g., back pain, arthritis). Furthermore, too many individuals with limb loss 

report receiving little information about their rehabilitation from their healthcare provider either 

before or after their amputation.129

129 Seaman JP. Survey of individuals wearing lower limb prostheses. Journal of Prosthetics and 

Orthotics2010;22(4):257-65.

Funding History:

Funding for the program over the past five years is as follows: 

FY 2017 ...................................................$2,494,000 

FY 2018 ...................................................$3,491,000 

FY 2019 ..................................................$3,500,000 

FY 2020 Enacted......................................$4,000,000 

FY 2021 President’s Budget ....................$4,000,000 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

193 

Budget Request:

The FY 2021 request for the Limb Loss Center is the same as the Enacted level of $4,000,000. 

The request supports the National Limb Loss Resource Center’s (NLLRC) programs which use 

traditional as well as innovative approaches to educate and inform people with limb loss or Limb 

difference, improving individual resiliency and expanding their ability to remain in the 

community. The NLLRC provides patient educational materials that help new amputees adjust to 

their new “normal”. First Step magazine & Your New Journey was distributed to approximately 

63,000 people after a new amputation was done. For children ages 8 to 18 with limb loss and limb 

difference an annual summer camp is offered free of charge to approximately 150 kids. This camp 

is a one of a kind and allows children the opportunity to participate in all kinds of camp activities 

and build a network of support that lasts well beyond the camp. All camp counselors are people 

with limb loss or limb difference.

Grants Awards Tables

FY 2019 

Final

FY 2020

Enacted

FY 2021 

President’s 

Budget

Number of Awards 1 1 1

Average Award $3,291,167 $3,840,897 $3,840,897

Range of Awards $3,291,167 $3,840,897 $3,840,897
DISABILITY PROGRAMS, RESEARCH AND SERVICES

194 

Resource and Program Data

FY 2019

Final

FY 2020

Enacted

FY 2021

President’s Budget 

Mechanism # $ # $ # $

Grants:

Formula

 

--

 

--

 

--

 

--

 

--

 

--

New Discretionary 1 3,291 -- -- -- --

Continuations

 

-- -- 1 3,841 1 3,841

Contracts

 

--

 

--

Interagency Agreements

 

--

 

--

 

--

 

--

 

--

 

--

Program Support 197 

 

159 159

Total Resources 3,488 

 

4,000

 

4,000
DISABILITY PROGRAMS, RESEARCH AND SERVICES

195 

Paralysis Resource Center

Services

FY 2019 

Final 

FY 2020 

Enacted

FY 2021 President’s 

Budget 

FY 2021 (+/-) FY 

2020

Paralysis Resource 

Center $8,670 $9,700 $9,700 --

*BA is in thousands of dollars.

Original Authorizing Legislation: Christopher and Dana Reeve Paralysis Act, title XIV of the 

Omnibus Public Land Management Act of 2009, P.L. 111-11; Sections 311 and 317(k)(2) of the 

Public Health Service Act [42 U.S.C. 243 & 247b(k)(2)], as amended. 

Most Recent Authorizing Legislation: Christopher and Dana Reeve Paralysis Act, title XIV of the 

Omnibus Public Land Management Act of 2009, P.L. 111-11; Sections 311 and 317(k)(2) of the 

Public Health Service Act [42 U.S.C. 243 & 247b(k)(2)], as amended. 

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

Expiration Date ..........................................................................................................................2011 

Allocation Method ............................................................................................... Competitive Grant

Program Description and Accomplishments:

The Paralysis Resource Center (PRC) offers a free, comprehensive, national source of 

informational support for people living with paralysis their families, and caregivers. The primary 

goals are to foster the involvement of people with paralysis in the community, promote their health 

and improve their quality of life. The PRC consists of a variety of services, communities, and 

programs, including: 

• Information specialists are trained to help anyone – from newly-paralyzed individuals and 

their family members, to persons who have lived with disabilities for quite some time – by 

providing individualized support and information with the ability to respond in over 170 

languages. The specialists have served over 100,000 individuals and families since its 

launch in 2002. 

• Peer & Family Support Program fosters peer-to-peer support, via trained and certified 

mentors. The ultimate goal is to help individuals find support and resources among the 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

196 

communities who best understand the day-to-day realities and long-term challenges 

individuals living with paralysis face. 

• The Quality of Life Grants Program has awarded over 3,151 grants, totaling more than $26 

million in financial support for fellow nonprofits serving individuals living with paralysis. 

The grants focus on programs or projects that foster community engagement and 

involvement, while promoting health and wellness for individuals living with paralysis. 

There are several opportunities available. 

• The Military & Veterans Program (MVP) supports the unique needs of current service 

members and veterans, regardless of when they served or how their injury was obtained. 

• Advocacy/Policy programs are designed to not only help individuals advocate for 

themselves, but also to advance important issues for the greater community of individuals 

with paralysis. 

Nearly 5.4 million Americans, or one in 50, report having some form of paralysis, defined as a 

central nervous system disorder resulting in difficulty or inability to move the upper or lower 

extremities.130 These individuals face health and other disparities, which often translate into 

exclusion from full participation in their communities.

Starting in FY 2018 commensurate with a funding increase, ACL began a small PRC State Pilot 

Program. The pilot program is designed to assess the most effective and efficient ways to provide 

quality of life grants that will enhance the capacity of community based disability programs and 

increase the services and supports available for individuals living with paralysis. By FY 2022 the 

State Pilot Program grantees will have completed their projects and we expect to learn how the 

pilot states were able to provide quality of life grants to state CBOs and if this approach is the most

efficient and effect way to increase services and supports to people living with paralysis. 

Funding History:

Funding for the program over the past five years is as follows:

FY 2017 ...................................................$6,682,000 

FY 2018 ...................................................$7,681,000 

FY 2019 ..................................................$8,700,000 

FY 2020 Enacted......................................$9,700,000 

FY 2021 President’s Budget ....................$9,700,000 

130 Armour, Brian S., Elizabeth A. Courtney-Long, Michael H. Fox, Heidi Fredine, and Anthony Cahill. Prevalence 

and Causes of Paralysis—United States, 2013. Issue brief. Christopher and Dana Reeve Foundation, 23 Aug. 

2016. 

2 National Spinal Cord Injury Statistical Center, 2017 SCI Statistics You Ought to Know, available at 

https://www.spinalcord.com/blog/2017-spinal-cord-injury-statistics-you-ought-to-know 2018 Accessed on 

12/11/19
DISABILITY PROGRAMS, RESEARCH AND SERVICES

197 

Budget Request:

The FY 2021 request for the Paralysis Resource Center is the same as the Enacted level of 

$9,700,000. The request supports the National Paralysis Resource Center and the PRC State Pilot 

Program. The work done by the program is vital for the support of the almost five and a half million 

Americans currently living with paralysis. Typical causes of paralysis include motor vehicle 

crashes, strokes, falls, acts of violence (primarily gunshot wounds), and sports/recreational 

activities. There are an estimated 17,500 new spinal cord injuries every year in the United States.

Paralysis Resource Center

FY 2019 

Final 

FY 2020

Enacted

FY 2021 

President’s 

Budget

Number of Awards 5 5 5 

Average Award $1,660,899 $1,865,342 $1,865,342

Range of Awards $199,494-

$7,505,000

$199,494-

$8,700,000

$199,494-

$8,700,000
DISABILITY PROGRAMS, RESEARCH AND SERVICES

198 

Resource and Program Data: 

Paralysis Resource Center

(Dollars in thousands) 

FY 2018

Final

FY 2019

Enacted

FY 2020

President’s Budget

Mechanism # $ # $ # $

Grants:

Formula

 

--

 

--

 

--

 

--

 

--

 

--

New Discretionary 2 1,399

 

--

 

2,015

 

5

 

9,327

Continuations 3 6,905 

 

5

 

7,311

 

--

Contracts 1 123 

 

1

 

100

 

1

 

100

Interagency Agreements

 

--

 

--

 

--

 

--

 

--

Program Support 242 

 

273

 

273

Total Resources 8,670 

 

9,700

 

--

 

9,700
DISABILITY PROGRAMS AND SERVICES

199 

Traumatic Brain Injury

Services

FY 2019 

Final 

FY 2020 

Enacted

FY 2021 President’s 

Budget 

FY 2021 (+/-) FY 

2020

Traumatic Brain Injury $11,291 $11,321 $11,321 --

FTE 1.6 1.6 1.6 --

*BA is in thousands of dollars.

Original Authorizing Legislation: Traumatic Brain Injury Act of 1996, P. L. 104-166 

Most Recent Authorizing Legislation: The Traumatic Brain Injury Reauthorization Act of 2014, 

P.L. 113-196 

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

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

Allocation Method ................................................... Formula Grant / Competitive Grant / Contract

Program Description and Accomplishments:

The Traumatic Brain Injury (TBI) Program develops comprehensive, coordinated family and 

person-centered service systems at the state and community level for individuals who sustain a 

TBI. According to the CDC, in 2014 there were more than two and a half million TBI-related 

emergency department visits, hospitalizations, and deaths occurred in the United States, including 

over 837,000 of these among children.131

131Centers for Disease Control and Prevention, TBI: Get the Facts, https://www.cdc.gov/traumaticbraininjury/get the 

facts.html.

Many of these individuals live the rest of their lives, with 

the resulting disability. In addition, these national estimates do not include individuals with TBI 

who are treated in military hospitals.

Individuals with TBI may need a variety of services and supports, including rehabilitation, 

counseling, academic and vocational accommodations, independent living assistance, 

transportation assistance, and vocational training. These services and supports are often 

fragmented across different State systems of care, making access difficult for families. ACL works 

across the lifespan, focusing on multiple life domains outside the health arena to achieve systems 

change, address fragmentation, and enhance service delivery. 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

200 

The TBI Program includes two grant programs: the State Protection and Advocacy (P&A) Systems 

Grants (formula grant), and the TBI State Partnership Program (competitive grant).

Protection and Advocacy Systems Grants 

TBI P&A grants are awarded to P&A organizations in states, territories, the District of Columbia, 

and one Native American Consortium to provide advocacy support for individuals with TBI and 

their families. Grantees use these funds to develop plans and provide P&A services – including 

individual and family advocacy, self-advocacy training, self-advocacy assistance, information and 

referral services, and legal representation – to individuals who have experienced a TBI. P&A 

grants are formula based, with an average award of $50,000 for state grantees and $20,000 for 

territory grantees.

A vital part of P&A activities is providing training and education to consumers and providers. TBI 

training is tailored to meet the needs of specific audiences, and is intended to increase awareness 

about legal concerns and individual rights around TBI, provide information on identification and 

funding of services, and provide support to facilitate full participation in all aspects of life. In FY 

2014, P&A grantees provided training to nearly 60,000 individuals. TBI training is provided to 

support groups, independent living centers, service providers, and caregivers, individuals with 

TBI, family members, state employees, hospital staff, university staff, and community 

representatives. Training has resulted in greater awareness for training participants of the needs of 

persons with TBI and the availability of resources and support services. 

State Partnership Program Grants 

The State Partnership Program is designed to assist states in expanding and improving state and 

local capability to provide access to comprehensive and coordinated services for individuals with 

TBI and their families. The program addresses barriers to needed services encountered by children, 

youth, and adults with TBI. 

Starting in 2018, ACL created two tiers of grantees, which are now working together to maximize 

the program’s impact nationally: Partner State grantees and Mentor State grantees. Both types of 

grantees are required to build and enhance their state TBI infrastructure by establishing and 

maintaining a State Advisory Board on Traumatic Brain Injury, creating an annual TBI state plan, 

and creating or expanding a state TBI registry. Mentor States have additional responsibilities, 

which include mentoring one or more Partner States and working together with other Mentor States 

and ACL to improve national coordination and collaboration around TBI services and supports. 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

201 

Funding History:

Funding for the program over the past five years is as follows: 

FTE

FY 2017 ...................................................$9,300,000 1.4 

FY 2018 .................................................$11,293,000 1.6 

FY 2019 ................................................$11,321,000 1.6 

FY 2020 Enacted....................................$11,321,000 1.6 

FY 2021 President’s Budget ..................$11,321,000 1.4 

Budget Request:

The FY 2021 request for the Traumatic Brain Injury (TBI) program is $11,321,000, the same level 

as the FY 2020 Enacted level. The request maintains support for the TBI program, including an 

FTE level of 1.4. 

The funding would support existing grant levels, and the TBI Protection and Advocacy Formula 

Grants, as well as the new approach to State Implementation Partnership grants. In FY 2021, ACL 

will continue the two tiered grants started in FY 2018 of TBI State Partnership Program grants. 

One targeted States that are developing their State’s TBI program, and the other targeted States 

that have more developed TBI programs and are willing to act as mentor’s to other States. In both 

cases, grantees are expected to support comprehensive, coordinated family and person-centered 

service systems for individuals at the State and community level who are living with a TBI. 

The TBI program also provides funding for a TBI technical assistance center (TBICC), which 

provides technical assistance to grantees, maintains a national listserv on issues that affect TBI 

service delivery (with approximately 1,500 subscribers), manages an online collaboration space 

for grantees to share promising practices for building and maintaining service-delivery 

infrastructure, and develops educational materials for the public about TBI.

Grant Awards Tables:

Traumatic Brain Injury: Protection and Advocacy 

FY 2019 

Final 

FY 2020

Enacted

FY 2021 

President’s 

Budget 

Number of Awards 57 57 57

Average Award $69,915 $70,158 $70,158

Range of Awards $20,000-

$318,471

$20,000-

$319,615

$20,000-

$319,615
DISABILITY PROGRAMS, RESEARCH AND SERVICES

202 

Traumatic Brain Injury: State Implementation/Mentor Partnership

FY 2019 

Final 

FY 2020

Enacted

FY 2021 

President’s 

Budget

Number of Awards 27 27 27

Average Award $205,203 $205,203 $205,203 

Range of Awards $150,000 -

$300,000

$150,000 -

$300,000

$150,000 -

$300,000

Resource and Program Data: 

Traumatic Brain Injury

(Dollars in thousands)

FY 2019

Final 

FY 2020

Enacted

FY 2021

President’s Budget 

Mechanism # $ # $ # $

Grants:

Formula

 

57 3,985

 

57 3,999

 

57 3,999

New Discretionary

 

3 450 -- --

 

27 5,540

Continuations 24 5,090 27 5,540 -- --

Contracts 6 949 6 949 6 949

Interagency Agreements -- -- -- -- --

Program Support /1 816 832 -- 832

Total Resources -- 11,291 -- 11,321 -- 11,321
DISABILITY PROGRAMS, RESEARCH AND SERVICES

203 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

FY 2021 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: TBI Protection and Advocacy State Grants (CFDA 93.873) 

STATE/TERRITORY FY 2019 Final FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

Alabama 55,622 55,729 55,729 -

Alaska 50,000 50,000 50,000 -

Arizona 71,862 73,111 73,111 -

Arkansas 50,000 50,000 50,000 -

California 318,471 319,615 319,615 -

Colorado 61,176 61,876 61,876 -

Connecticut 50,000 50,000 50,000 -

Delaware 50,000 50,000 50,000 -

District of Columbia 50,000 50,000 50,000 -

Florida 177,784 180,644 180,644 -

Georgia 97,744 98,593 98,593 -

Hawaii 50,000 50,000 50,000 -

Idaho 50,000 50,000 50,000 -

Illinois 115,736 115,503 115,503 -

Indiana 69,212 69,460 69,460 -

Iowa 50,000 50,000 50,000 -

Kansas 50,000 50,000 50,000 -

Kentucky 52,433 52,536 52,536 -

Louisiana 54,179 53,994 53,994 -

Maine 50,000 50,000 50,000 -

Maryland 64,551 64,518 64,518 -

Massachusetts 70,676 71,060 71,060 -

Michigan 94,202 94,608 94,608 -

Minnesota 60,945 61,234 61,234 -

Mississippi 50,000 50,000 50,000 -

Missouri 65,017 65,156 65,156 -

Montana 50,000 50,000 50,000 -

Nebraska 50,000 50,000 50,000 -

Nevada 50,000 50,000 50,000 -

New Hampshire 50,000 50,000 50,000 -
DISABILITY PROGRAMS, RESEARCH AND SERVICES

204 

PROGRAM/CFDA NUMBER: TBI Protection and Advocacy State Grants (CFDA 93.873) 

STATE/TERRITORY FY 2019 Final FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

New Jersey 86,947 86,331 86,331 - 

New Mexico 50,000 50,000 50,000 - 

New York 169,177 167,270 167,270 - 

North Carolina 96,562 97,559 97,559 - 

North Dakota 50,000 50,000 50,000 - 

Ohio 107,066 107,499 107,499 - 

Oklahoma 50,000 50,000 50,000 - 

Oregon 50,072 50,422 50,422 - 

Pennsylvania 115,763 116,005 116,005 - 

Rhode Island 50,000 50,000 50,000 - 

South Carolina 56,757 57,222 57,222 - 

South Dakota 50,000 50,000 50,000 - 

Tennessee 69,585 70,054 70,054 - 

Texas 233,294 236,989 236,989 - 

Utah 50,000 50,000 50,000 - 

Vermont 50,000 50,000 50,000 - 

Virginia 82,886 83,357 83,357 - 

Washington 74,816 75,881 75,881 - 

West Virginia 50,000 50,000 50,000 - 

Wisconsin 62,604 62,774 62,774 - 

Wyoming 50,000 50,000 50,000 - 

 Subtotal 3,835,139 3,849,000 3,849,000 - 

Indian Tribes 20,000 20,000 20,000 - 

American Samoa 20,000 20,000 20,000 - 

Guam 20,000 20,000 20,000 - 

Northern Mariana Islands 50,000 50,000 50,000 - 

Puerto Rico 20,000 20,000 20,000 - 

Virgin Islands 20,000 20,000 20,000 - 

Subtotal 3,985,139 3,999,000 3,999,000 - 

Undistributed 1/ 1,000 1,000 1,000 - 

Total States/Territories 3,986,139 4,000,000 4,000,000 -
DISABILITY PROGRAMS, RESEARCH AND SERVICES

205 

National Institute on Disability, Independent Living, and Rehabilitation Research

Services

FY 2019 

Final 

FY 2020 

Enacted

FY 2021 

President’s Budget

FY 2021 (+/-) FY 

2020

National Institute on 

Disability, Independent 

Living and 

Rehabilitation Research

$108,592 $111,970 $90,371 -$21,599

*BA is in thousands of dollars.

Original Authorizing Legislation: Title II of the Rehabilitation Act of 1973, Public Law 93-112 

Most Recent Authorizing Legislation: Title II of the Rehabilitation Act of 1973, as amended in 

2014 by the Workforce Innovation and Opportunity Act (WIOA), Public Law 113-128 

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

Expiration Date: ........................................................................................................................2019 

Allocation Method: ................................................................... Discretionary Grants and Contracts

Program Description and Accomplishments:

The mission of the National Institute on Disability, Independent Living, and Rehabilitation 

Research (NIDILRR) is to generate new knowledge and promote its effective use to improve the 

abilities of people with disabilities to perform activities of their choice in the community, and to 

expand society’s capacity to provide full opportunities and accommodations for its citizens with 

disabilities. NIDILRR sponsors comprehensive and coordinated programs of research and related 

activities to maximize the full inclusion, social integration, employment, and independent living 

of individuals with disabilities of all ages. 

NIDILRR conducts research through a network of individual research projects and centers of 

excellence across the nation. Research funding is awarded through competitive grants, and most 

of the funds are awarded to universities or providers of rehabilitation or related services.

As required by the Rehabilitation Act in §202(h), NIDILRR operates under a Long-Range Plan

(LRP). The current plan covers FY 2018 - FY 2023. 

The primary grant mechanisms under which NIDILRR makes awards are:

• Rehabilitation Research and Training Centers (RRTCs). RRTC research improves

rehabilitation methodologies and service delivery systems, alleviates or stabilizes disabling
DISABILITY PROGRAMS, RESEARCH AND SERVICES

206 

conditions, and promotes maximum social and economic independence for persons with 

disabilities. RRTCs also provide training to help rehabilitation personnel deliver more 

effective rehabilitation services.

• Rehabilitation Engineering Research Centers (RERCs). RERCs focus on rehabilitation 

technology, including rehabilitation engineering and assistive technology devices and 

services designed to diminish barriers to independence. RERCs also train individuals, 

including those with disabilities to become researchers and practitioners in the field of 

rehabilitation technology. 

• Model Systems. NIDILRR funds model systems networks in three rehabilitation areas: 

spinal cord injury, traumatic brain injury, and burn injury. In addition to participating in 

research, model systems grantees collect and contribute long-term community integration 

and functional outcomes data to their respective national databases. These model systems 

programs have become platforms for conducting multi-site research studies.

o Spinal Cord Injury (SCI) Model Systems. The SCI program funds research and 

dissemination activities to address the needs of SCI individuals, their family members, 

caregivers and other stakeholders. The NIDILRR SCI model systems longitudinal 

dataset is the largest of its kind in the world.

o Traumatic Brain Injury (TBI) Model Systems. TBI projects are research grants to 

improve TBI rehabilitation outcomes. The NIDILRR TBI model systems are the largest 

nonmilitary TBI service delivery/research entity participating in various 

intergovernmental efforts to improve treatment and outcomes for returning veterans.

o Burn Model Systems (BMS). BMS projects improve treatment and outcomes for burn 

injury survivors. 

• Field-Initiated Projects (FIPs). Field-Initiated Projects supplement NIDILRR’s directed 

research and development, capacity building and knowledge translation efforts by 

addressing a wide range of topics identified by investigators. 

• Disability and Rehabilitation Research Projects (DRRPs). Grantees focus on addressing 

problems encountered by people with disabilities through any combination of activities, 

including research, training, dissemination, and technical assistance.

• ADA National Network Centers (ADA Network). The ADA Network supports technical 

assistance, information, and training designed to promote increased understanding, 

awareness, and enforcement of the ADA.

• Advanced Rehabilitation Research Training (ARRT). The ARRT program funds grants to 

institutions of higher education to recruit and train qualified persons with doctoral or 

similar advanced degrees and prepare them to conduct independent research in areas 

related to disability and rehabilitation.
DISABILITY PROGRAMS, RESEARCH AND SERVICES

207 

• Small Business Innovation Research (SBIR). NIDILRR awards SBIR grants to small 

businesses to support the development of new rehabilitation technologies that promote 

increased accessibility and independence.

• Switzer Research Fellowships. The Switzer program awards 1-year fellowships to 

individuals to carry out research projects in areas of importance to the disability and 

rehabilitation community.

• Other Activities. NIDILRR funding also supports other activities, including knowledge 

translation; collaborative projects; development and maintenance of grantee reporting 

systems; program review; and reporting, evaluation, and long-range planning. 

Funding History:

Funding for NIDILRR over the past five years is as follows:

FY 2017 ..............................................$103,731,000 

FY 2018 ...............................................$104,710,000

FY 2019 ..............................................$108,970,000 

FY 2020 Enacted..................................$111,970,000 

FY 2021 President’s Budget ..................$90,371,000 

Budget Request:

The FY 2021 request is $90,371,000, a reduction of -$21,599,000 below the FY 2020 Enacted 

level. At the request level ACL would be able to fund all continuations of existing grants, and 

would be able to fund some new starts. 

Requested funds support NIDILRR’s ongoing innovation, allowing ACL to continue support for 

most existing grants. These NIDILRR programs and grants reflect ACL’s broad responsibility to 

generate new knowledge to promote a wide range of outcomes (health and function, employment, 

community living) across the breadth of disability populations (cognitive, physical, sensory, 

psychiatric). 

The FY 2021 President’s Budget continues to include a new general provision that, while 

applicable to HHS as a Department, addresses an area of particular concern to NIDILRR, as well 

as to other ACL programs. Within the Department, the provision would simplify the accounting 

processes used when one Operating Division (OPDIV) has agreed to issue and manage a grant on 

behalf of a second OPDIV. This general provision would allow HHS to use the reimbursable 

processing features within the accounting system, rather than the more cumbersome execution 

process currently used. This provision would also enable an HHS OPDIV to collaborate in the 

same way with an outside Department for the purpose of making grants or cooperative agreements. 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

208 

Currently, the lack of specific authority precludes collaboration. The new proposed language 

would provide HHS OPDIVs with the authority to transfer funds via reimbursable agreements 

from one agency to another for the purposes of making grants, allowing NIDILRR to collaborate 

on a wider scale (e.g., with the Department of Veteran’s affairs on research projects to address the 

needs of disabled veterans). Collaboration allows the grantees to create a synergy that cannot be 

realized when working in silos. That synergy brings opportunities to people with disabilities with 

greater speed and impact. NIDILRR had such authority when it was part of the Department of 

Education. The same language has been included in both the FY 2018 and FY 2019 requests. 

The FY 2021 Budget also proposes to eliminate the Disability, Independent Living, and 

Rehabilitation Research Advisory Council (DILRRAC). The establishment of a DILRRAC is 

authorized under the Rehabilitation Act in §205(a). Advisory Councils can play an important role 

in ensuring people with disabilities are represented in the development of federal policy and 

programs. The purpose of the NIDILRR advisory council, by statute, is to provide advice and 

counsel to the NIDILRR director on operational and programmatic matters; provide perspectives 

on the five-year plan; and engage on organizational priorities, stakeholder needs, and the tenets of 

the strategic plan. 

While the DILRRAC has been authorized since 1973, the committee has never formally 

convened. There is already within NIDILRR and ACL significant engagement of groups of 

stakeholders and advocates that represent the interests of people with disabilities, older adults, and 

the families and caregivers who support them. This includes the United States Access Board, the 

National Council on Disability, and the Interagency Committee on Disability 

Research. Additional stakeholder input comes through newsletters, program updates, and other 

means regarding progress and activities that stimulate inquiries and feedback on organizational 

priorities, programs, and initiatives. 

These methods for obtaining comments and responding to input are embedded in NIDILRR’s 

regular operations. In combination, they accomplish the purposes of the advisory committee, as 

defined in the statute. 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

209 

Outcomes and Output Table:

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-FY 2020

Target

R1b By 2023, generate 

new knowledge about the 

opioid treatment 

experiences and outcomes 

of people with disabilities 

to identify solutions to 

barriers to treatment of 

opioid use disorders. 

(Outcome)

FY 2018: Result Expected 

Jan 1, 2019

Target: In FY 2018, 

NIDILRR made two research 

grants that have a primary 

aim of generating new 

knowledge about opioid 

treatment experiences and 

outcomes of people with 

disabilities, and barriers to 

treatment of those opioid use 

disorders. 

(In Progress)

In FY 2020, 

these grantees 

will continue to 

collect and 

analyze data on 

this topic, and 

disseminate 

early results and 

informational 

products for 

stakeholders.

Conduct primary 

data collection 

and conduct 

secondary data 

analysis by 

September 2021.

N/A

R2 By 2023, assess the 

efficacy of an intervention 

to improve employment 

outcomes for individuals 

with serious mental 

illness. (Outcome)

FY 2018: Result Expected 

Jan 1, 2019

Target: In FY 2018, 

NIDILRR made a research 

grant to assess the efficacy of 

a career development 

program entitled "Helping 

Youth on the Path to 

Employment" (HYPE).

(In Progress)

In FY 2020, this 

grantee will 

continue data 

collection and 

disseminate 

early results and 

informational 

products to key 

stakeholders.

In FY 2021, this 

grantee will 

continue data 

collection and 

disseminate 

early results and 

informational 

products to key 

stakeholders.

N/A

R3 By 2023, grantee will 

generate new knowledge 

about the impact of (1) an 

ABLE account and (2) the 

joint impact of an ABLE 

account and financial 

management training on 

community living and 

participation of people 

with intellectual and 

developmental (I/DD) and 

cognitive disabilities. 

(Outcome)

In FY 2020, 

grantee will 

deliver 

interventions 

and collect 

baseline data.

In FY 2021, 

grantee will 

disseminate 

surveys twice a 

year to enrolled 

participants, and 

analyze 

outcomes data.

N/A

*As part of the 2020 budget cycle, ACL proposed three new measures for NIDILRR.measure (R3) replaces R1a proposed in 2020
DISABILITY PROGRAMS, RESEARCH AND SERVICES

210 

Grant Awards Tables:

National Institute on Disability, Independent Living, and Rehabilitation Research 

(Dollars in Thousands)

FY 2019 

Final 

FY 2020

Enacted

FY 2021 

President’s 

Budget

Number of 

Awards 213 242 184

Average Award $480,814 $436,705 $456,974

Range of 

Awards

$70,000-

$1,246,000

$70,000-

$1,246,000

$65,000-

$1,246,000

Resource and Program Data: 

National Institute on Disability, Independent Living, and Rehabilitation Research 

(Dollars in Thousands)

FY 2019

Final 

FY 2020

Enacted 

FY 2021

President’s Budget 

Mechanism # $ # $ # $

Grants:

Formula

 

-- --

 

-- --

 

-- --

New Discretionary

 

56

 

23,173

 

66

 

21,850

 

12

 

3,443

Continuations

 

157

 

79,079

 

176

 

83,833

 

172

 

80,640

Contracts

 

9

 

5,905

 

7

 

5,625

 

6

 

5,625

Interagency Agreements

 

--

 

40

 

2

 

90

 

2 90

Program Support /1

 

395

 

572

 

--

 

572

Total Resources

 

--

 

108,592

 

--

 

111,970

 

--

 

90,371
CONSUMER INFORMATION, ACCESS, AND OUTREACH

211 

Consumer Information, Access, and Outreach

Summary of Request

Older Americans and Americans with disabilities need an array of services and supports to assist 

them to remain active and independent in their communities. The complexity of navigating 

programs and selecting services that best addresses the needs of each individual can create 

challenges, especially for consumers who have not previously used such services and supports. 

Consumer Information, Access and Outreach (CIAO) programs provide consumers with the 

information they need to make informed decisions about their independence and connect them 

with the appropriate services. By providing community-level entry points into long-term services 

and supports, these programs provide access to low-cost home and community-based services that 

can enable people to remain in their homes. 

The FY 2021 request for CIAO programs is $119.1 million, a decrease of -$23.1 million below 

the FY 2020 Enacted level. This request would provide: 

• $6.1 million for Aging and Disability Resource Centers, a reduction of -$2.0 million below 

the FY 2020 Enacted level. The ADRC program supports state efforts to develop more 

efficient, cost-effective, and consumer-responsive systems of information and integrated 

access by creating “one-stop shop” entry points into long-term care at the community-level. 

• $36.1 million in discretionary appropriations for the State Health Insurance Assistance 

Program (SHIP) program, a reduction of -$16.0 million below the FY 2020 Enacted level. 

SHIP counselors help Medicare beneficiaries to fully understand the Medicare choices 

available to them, so that the beneficiaries can make informed enrollment and benefit 

decisions that ultimately reduce costs to both the beneficiary and Medicare. With the 

continued influx of Medicare advantage plans and the inherent complexity of health 

insurance decisions, the SHIP program is the only place where they can get the level of indepth counseling and assistance that the SHIPs provide to older adults and people with 

disabilities who struggle to find the plan that fits their financial and medical needs. 

• $7.5 million for the Voting Access for People with Disabilities Program grants, the same 

level as the FY 2020 Enacted level. These grants assist Protection and Advocacy systems 

in each state and territory to ensure full participation in the electoral process for individuals 

with disabilities, including registering to vote, casting their votes, and accessing polling 

places. The funding will be available to prepare for the upcoming elections. 

• $31.9 million for Assistive Technology (AT), a decrease of -$5.1 million below the FY 

2020 Enacted level. The reduction eliminates the Alternative Financing Program Grant 

Competition (-$2.0 million), as the AT State Grant Program already includes financing 

activities while giving states the flexibility to decide their own priorities, as well as an 

additional -$3.1 million reduction to the AT State Grants. AT programs improve the ability 

of individuals with disabilities of all ages and their families to obtain AT devices and 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

212 

services, including computer or technology aids, modified driving controls, and durable 

medical equipment such as wheelchairs or walkers.

• $37.5 million is requested in mandatory funding for the Medicare Patients and Providers 

Act (MIPPA) programs. This is the same level as the Annualized FY 2020 Enacted level. 

The Budget includes a legislative proposal to reauthorize mandatory funding for the 

MIPPA program for FY 2020 and FY 2021. This funding provides grants to states to fund 

additional outreach activities to the Medicaid Advantage and Low-Income Subsidy 

populations. The low-income subsidies prevent or delay institutionalization because many 

of the low income seniors are forced to skip prescribed medications and proper nutrition to 

make Medicare premium payments and other obligations. 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

213 

Aging and Disability Resource Centers

Services

FY 2019 

Final 

FY 2020 

Enacted

FY 2021 

President’s Budget 

FY 2021 (+/-) FY 

2020

Aging and Disability 

Resource Centers $8,091 $8,119 $6,119 -$2,000

*BA is in thousands of dollars. 

Original Authorizing Legislation: Sections 202(b) and 411 of the Older Americans Act of 1965, 

Public Law 89-73. 

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

114-144 

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

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

Allocation Method ............................... Competitive Grants/Cooperative Agreement and Contracts

Program Description and Accomplishments:

Aging and Disability Resource Centers (ADRCs) support state efforts to develop more efficient, 

cost-effective, and consumer-responsive systems of providing information and access to long-term 

services and supports, which often are referred to as “No Wrong Door” (NWD) systems. In these 

systems, multiple agencies retain responsibility for their respective services while coordinating to 

integrate access to those services through a single, standardized process. Community-based 

organizations like ADRCs deliver one-on-one, person-centered counseling and serve as consumerfriendly entry points to the system. 

Without these services, people seeking LTSS might otherwise make decisions based on inaccurate 

or incomplete information, which can lead them to select support and care options that are more 

expensive than necessary.132 By helping them connect to the services they need to live in the 

community, ADRCs/NWD systems help divert individuals from more costly forms of care, such 

132 Fox-Grage, W., and Neill Bowen, C., (2017). No Wrong Door: Person- and Family-Centered Practices in Long-Term Services and 

Supports. Retrieved from http://www.longtermscorecard.org/~/media/Microsite/Files/2017/AARP_PromisingPrac_NoWrongDoor.pdf.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

214 

as nursing homes and help them avoid unnecessary hospital admissions and re-admissions. A 

recent study of Medicaid beneficiaries found that initiating services through community-based 

LTSS is associated with dramatic differences in future long institutional stays, with less than one 

percent of people initiating LTSS in the community experiencing a long institutional stay and 73 

percent of people initiating care in an institution subsequently experiencing a long stay.133

133 Stewart., K., and Irvin, C.V. (2018). Does Early Use of Community-Based Long-Term Services and Supports Lead to Less Use of 

Institutional Care? Retrieved from https://www.medicaid.gov/medicaid/ltss/downloads/money-follows-theperson/hcbsasadiversiontoiltc.pdf. 

Since 

institutional care can cost three times as much as in-home supports, NWD systems are critical to 

decreasing health care utilization costs and are a key component in transforming states’ long-term 

services and support programs. 

Services for all populations and all payers provided by ADRC/NWD systems include: 

• Targeted discharge planning, care transition, and nursing home diversion support that 

integrates the medical and social service systems on behalf of older adults and individuals with 

disabilities, to help them remain in their own homes and communities after a hospitalization, 

rehabilitation, or skilled nursing facility visit; 

• “One-on-one” person-centered counseling to help consumers, families, and caregivers fully 

understand the options, including private pay options, that are available to them;

• Streamlined access to publicly supported long-term services and support programs for 

individuals who appear to be eligible for such programs; 

• Outreach and assistance to Medicare beneficiaries on their Medicare benefits, including 

prevention benefits and low-income subsidies provided as a result of receiving funding under 

the Medicare Improvements to Patients and Providers Act.

Since 2003, the Administration for Community Living and the Centers for Medicare & Medicaid 

Services (CMS) have entered into cooperative agreements with states to develop the infrastructure 

for these NWD systems. In 2008, the Veterans Health Administration (VHA) also began 

participating as a key partner. ACL, CMS, and VHA are now working with thirteen states to build 

on and promote best practices from prior ADRC/NWD investments. 

Currently, 56 states and territories have NWD activity, with an estimated 1,322 local agencies 

within the NWD systems actively serving older adults and people with disabilities. According to 

the AARP 2017 Scorecard, states have collectively achieved 60 percent progress toward 

developing a statewide NWD systems, as measured by criteria across five areas: 

• State governance and administration

• Target populations 

• Public outreach and coordination with key referral sources, 

• Person-centered counseling
CONSUMER INFORMATION, ACCESS, AND OUTREACH

215 

• Streamlined eligibility for public programs.134

134 AARP. (June 2017). Picking Up the Pace of Change, 2017: A State Scorecard on Long-Term Services and Supports for Older 

Adults, People with Physical Disabilities, and Family Caregivers. Retrieved from http://www.longtermscorecard.org/2017-scorecard.

Recent accomplishments include:

• Through the Veteran-Directed Care program, a partnership between the Veterans Health 

Administration and ACL, ADRCs provide integrated options counseling and access points to 

care transition and diversion support to help veterans with disabilities continue living in the 

community. Veterans and caregivers value the program because it gives veterans control over 

the care and support they receive in the community, and it enables them to design their care to 

fit their life rather than designing their life to fit the care provided. The VDC program is 

available in 39 states, the District of Columbia and Puerto Rico, and is serving more than 2,300 

veterans through 68 VA Medical Centers each day. 

• In 2016, ACL funded 8 states (CT, MA, MD, NH, OR, VT, WA, and WI) to coordinate their 

ADRC/NWD system with their statewide Assistive Technology (AT) Program. Coordination 

activities included cross training, assistive technology “toolkits” for ADRC staff, and increased 

collaboration with the Durable Medical Equipment (DME) state workgroups to coordinate 

related efforts on reuse models for AT and DME. As a result of this coordination, access to

assistive technology for people seeking long term services and supports has increased. 

• In FY 2017, the St. Louis Veteran Directed Care Program became the first to exceed a program 

census of 150 veterans. The St. Louis program has been a model of successful partnerships, 

and has contributed to a 24 percent decrease in inpatient days of care for enrolled veterans.

• In FY 2017, the VA Sunshine Network became the first Veterans Integrated Service Network 

(VISN to achieve full Veteran Directed Care coverage. The VA Sunshine Network includes 

seven Veterans Administration Medical Centers (VAMCs) serving a population of more than 

1.6 million veterans in Florida, South Georgia, Puerto Rico and the Caribbean. (Nationwide, 

21 VISNs oversee 168 VAMCs, which in turn serve 8.9 million veterans each year.) 

Funding History:

Funding for Aging and Disability Resource Centers over the last five years is as follows:

FY 2017 ...................................................$6,105,000 

FY 2018 ..................................................$8,099,000 

FY 2019 ..................................................$8,119,000 

FY 2020 Enacted......................................$8,119,000 

FY 2021 President’s Budget ....................$6,119,000 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

216 

Budget Request:

ACL’s FY 2021 request is $6,119,000, a decrease of -$2,000,000 below the FY 2020 Enacted 

level. This funding will be used to support states with the following efforts: 

 Conducting assessments of the needs of older adults and people with disabilities within 

each state, examining factors such as:

o Risk of long-term institutionalization

o Hospitalizations and risk of re-hospitalization

o Mortality rates

o Total health care expenditures 

 Identifying social determinants of health that cause high utilization

 Conducting person-centered assessments in order to empower individuals to make 

informed choices about their long-term care options, identifying community-based 

interventions and increasing access to public and private programs; and 

 Conducting follow-up assessments that address quality of life indicators and increase 

community tenure with a re-assessment of social determinants of health

As a result, ACL expects that: 

• Funded states will show progress towards guidelines established by ACL, CMS, and VHA for 

ADRC/NWD systems and be required to report on its progress and performance, 

• Funded states will commit to using Medicaid administrative funding to support the 

ADRC/NWD system infrastructure on an on-going basis; and

• Funded states will ensure that local ADRC/NWD system sites:

o Include a full range of organizations that play a formal reimbursable role in carrying 

out the ADRC/NWD system functions they have been designated by the state to 

perform to ensure the state’s ADRC/NWD system can effectively serve all LTSS 

populations; 

o Use nationally certified person-centered counselors to provide one-on-one assistance 

to consumers; and 

o Conduct formal functional and financial assessments that are required to determine an 

individual’s eligibility for the public LTSS programs that are administered by the state, 

including Medicaid. 

To ensure that the demonstration grants will be targeted within states where aging and disabled 

populations have the most limited access to long-term services and supports, ACL will use the 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

217 

national LTSS State Scorecard ADRC/NWD Assessment Metrics to target those states most in 

need. 

Grant Awards Tables:

 Aging and Disability Resource Centers 

(Dollars in Thousands)

FY 2019 

Final

FY 2020

Enacted

FY 2021 

President’s 

Budget

Number of Awards 10 10 10

Average Award $589,011 $589,011 $389,011 

Range of Awards $528,483 -

$600,000

$528,483 -

$600,000

$328,483 -

$400,000
CONSUMER INFORMATION, ACCESS, AND OUTREACH

218 

Resource and Program Data: 

Aging and Disability Resource Centers

(Dollars in Thousands)

FY 2019

Final 

FY 2020

Enacted

FY 2021

President’s Budget

Mechanism # $ # $ # $

Grants:

Formula

 

--

 

--

 

--

 

--

 

--

 

--

New Discretionary

 

-- -- 

 

10 5,890 

 

-- -- 

Continuations

 

10 5,890 

 

-- -- 

 

10 3,890 

Contracts

 

2 2,021 

 

2 2,021 

 

2 2,021 

Interagency Agreements

 

--

 

--

 

--

 

--

 

--

 

--

Program Support135

135 Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and review, 

and information technology support costs.

 

-- 180 

 

-- 208 

 

-- 208 

Total Resources 8,091 8,119 6,119 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

219 

State Health Insurance Assistance Programs

Services

FY 2019 

Final 

FY 2020

Enacted

FY 2021 

President’s 

Budget 

FY 2021 (+/-) FY 

2020 

State Health 

Insurance Assistance 

Programs

$49,115 $52,115 $36,115 -$16,000

FTE 3.4 4.4 4.0 -.4

* BA is in thousands of dollars.

**In addition to discretionary appropriations, the Budget also proposes to extend $13M in targeted mandatory funding 

under the MIPPA program. These additional funds also go to SHIPS, which use them to provide additional outreach 

activities to targeted SHIP subpopulations, specifically low-income seniors and seniors living in rural areas. 

Original Authorizing Legislation: Section 4360 of the Omnibus Budget Reconciliation Act of 1990 

(42 U.S.C. 1395b-4), P.L. 101-508 

Most Recent Authorizing Legislation: Section 4360 of the Omnibus Budget Reconciliation Act of 

1990 (42 U.S.C. 1395b-4), Public Law 101-508 

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

Authorization Expiration Date .................................................................................................... N/A

Allocation Method ....................................................... Formula and Competitive Grants/Contracts

Program Description and Accomplishments:

State Health Insurance Programs (SHIPs) provide counseling and assistance to help older adults 

and people with disabilities who are Medicare eligible or dual eligible with Medicaid beneficiaries 

(including newly enrolled beneficiaries) understand, select and use their Medicare benefits. 

Services are provided via telephone and through face-to-face interactive sessions, public education 

presentations and programs, and media activities. As described below, SHIPs support the 

Secretary’s objective of addressing the costs and availability of health insurance.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

220 

The SHIP program provides grants to all 50 States, the District of Columbia, Guam, Puerto Rico, 

and the U.S. Virgin Islands to fund the infrastructure, training, and outreach needed to support 

nearly 16,000 counselors, most of whom are volunteers, in over 1,300 community-based 

organizations. Nearly two-thirds of the 54 state SHIP programs are administered by State Units on 

Aging, with the remaining programs administered by State Departments of Insurance. At the 

community level, many SHIPs are either housed in or create local partnerships with Area Agencies 

on Aging. Similarly, almost 50 percent of the SHIPs are co-located with the Senior Medicare Patrol 

program, and work collaboratively with them to educate beneficiaries and help deter or prevent 

Medicare fraud and abuse.

The national network of the aforementioned 15,000 highly trained SHIP counselors provides local 

community-based assistance to the ever increasing number of Medicare beneficiaries. In 2017, an 

estimated 3,500,000 Medicare beneficiaries used SHIP services. In addition to the 1,750,000 hours 

of direct one-on-one services, SHIPs reached an additional 3,000,000 people in public events 

explaining Medicare and its benefits. These state grantees invested more than 500,000 hours 

leading these educational events. To provide accurate and comprehensive assistance to Medicare 

beneficiaries, the program’s counselors provided nearly 350,000 hours of training. 

SHIPs assist Medicare beneficiaries in accessing, understanding, and connecting to the healthcare 

system, thus improving their customer service experience with Medicare. Accessing affordable 

health insurance can be difficult even for those with Medicare. SHIP counselors help Medicare 

beneficiaries to fully understand the Medicare choices available to them so that the beneficiaries 

can make informed enrollment and benefit decisions that ultimately reduce costs to both the 

beneficiary and Medicare. CMS as well as Medicare Advantage and Part D plans refer clients to 

SHIPs when their cases are too complicated for the 1-800 Medicare call center. Most clients utilize 

SHIP every year because of the complexity of their situations, including prescription needs, and 

the counseling can help to save them thousands of dollars per year. The average session time that 

a SHIP counselor spends with a client is 30 minutes, more than three times the 9.5 minute average 

call to the 1-800 Medicare call center. This reflects the greater complexity of issues handled by 

SHIPs in comparison to 1-800 Medicare. 

Funding History:

Funding for the State Health Insurance Assistance Program over the past five years is as follows: 

FTE

FY 2017 ................................................. $47,115,000 5.0 

FY 2018 ................................................ $49,115,000 4.1

FY 2019 ................................................ $49,115,000 4.4 

FY 2020 Enacted.................................... $52,115,000 4.4 

FY 2021 President’s Budget .................. $36,115,000 4.0 

Budget Request:

The FY 2021 request for the State Health Insurance Assistance programs (SHIP) is $36,115,000 a 

reduction of -$16,000,000 below the FY 2020 Enacted level. The SHIP program is the only place 

that provides the level of in-depth counseling and assistance that the SHIPs provide to older adults 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

221 

and people with disabilities who struggle to find the plan that fits their financial and medical needs. 

The requested level would result in proportionate reductions in grants to States and Territories 

when compared to the FY 2020 Enacted level. 

Grant Awards Table:

State Health Insurance Assistance Programs Grant Awards

FY 2019

Final

FY 2020

Enacted

FY 2021 

President’s 

Budget

Number of Awards 54 54 54 

Average Award $830,859 $830,859 $610,943

Range of Awards $46,351 -

$4,206,661

$46,351 -

$4,206,662

$34,083 -

$3,093,221

Resource and Program Data: 

State Health Insurance Assistance Program

(Dollars in thousands)

FY 2019

Final 

FY 2020

Enacted

FY 2021

President’s Budget

Mechanism # $ # $ # $

Grants:

Formula -- -- -- -- -- --

New Discretionary -- -- 55 49,597 -- -- 

Continuations 55 46,597 -- -- 55 33,597 

Contracts 5 1,552 5 1,552 -- 1,552 

Interagency Agreements -- -- -- -- -- --

Program Support136

136 Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and review, 

and information technology support costs.

 

-- 996 

 

-- 966 

 

-- 966 

Total Resources 49,115 52,115 36,115 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

222 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

CENTER FOR INTEGRATED PROGRAMS

FY 2019 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: State Health Insurance Assistance Program (CFDA 93.324) 

STATE/TERRITORY FY 2019 Final FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

Alabama 837,434 891,288 577,110 (314,178)

Alaska 224,399 227,000 196,909 (30,091)

Arizona 830,235 979,677 654,045 (325,632)

Arkansas 592,198 666,071 464,402 (201,669)

California 4,269,535 4,056,058 2,446,693 (1,609,365)

Colorado 594,554 701,574 505,518 (196,056)

Connecticut 533,378 561,304 398,997 (162,307)

Delaware 198,553 234,293 235,024 731

District of Columbia 150,886 178,045 184,087 6,042

Florida 2,729,528 3,007,853 1,881,221 (1,126,632)

Georgia 1,131,535 1,335,211 892,877 (442,334)

Hawaii 245,383 289,552 264,337 (25,215)

Idaho 379,783 403,494 305,164 (98,330)

Illinois 1,496,800 1,594,610 1,026,075 (568,535)

Indiana 857,722 1,012,112 675,594 (336,518)

Iowa 676,033 642,231 441,853 (200,378)

Kansas 514,445 533,727 384,613 (149,114)

Kentucky 829,500 885,147 599,523 (285,624)

Louisiana 651,368 749,373 513,179 (236,194)

Maine 426,541 418,755 315,286 (103,469)

Maryland 726,655 782,127 532,818 (249,309)

Massachusetts 925,981 958,592 638,786 (319,806)

Michigan 1,426,134 1,497,028 969,594 (527,434)

Minnesota 912,876 867,232 582,222 (285,010)

Mississippi 584,956 644,719 452,593 (192,126)

Missouri 903,877 1,026,923 684,549 (342,374)

Montana 546,634 519,302 262,090 (257,212)

Nebraska 407,949 405,192 306,160 (99,032)

Nevada 403,942 476,652 351,464 (125,188)

New Hampshire 280,112 330,532 281,256 (49,276)
CONSUMER INFORMATION, ACCESS, AND OUTREACH

PROGRAM/CFDA NUMBER: State Health Insurance Assistance Program (CFDA 93.324) 

STATE/TERRITORY FY 2019 Final FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

223 

New Jersey 1,026,719 1,101,022 724,031 (376,991)

New Mexico 423,698 452,185 334,233 (117,952)

New York 2,316,502 2,441,793 1,532,722 (909,071)

North Carolina 1,454,853 1,562,729 1,009,128 (553,601)

North Dakota 246,172 248,921 210,613 (38,308)

Ohio 1,723,085 1,664,799 1,069,955 (594,844)

Oklahoma 597,669 688,969 478,849 (210,120)

Oregon 570,617 673,328 509,873 (163,455)

Pennsylvania 1,939,131 1,900,998 1,212,964 (688,034)

Rhode Island 264,254 280,308 228,676 (51,632)

South Carolina 751,982 887,339 601,356 (285,983)

South Dakota 307,414 292,043 234,183 (57,860)

Tennessee 1,056,654 1,125,830 744,017 (381,813)

Texas 2,581,709 2,843,517 1,778,543 (1,064,974)

Utah 347,761 410,358 310,340 (100,018)

Vermont 236,464 271,035 224,474 (46,561)

Virginia 987,212 1,164,910 775,945 (388,965)

Washington 869,459 1,021,086 680,082 (341,004)

West Virginia 461,101 498,513 363,519 (134,994)

Wisconsin 894,229 956,873 643,012 (313,861)

Wyoming 284,876 270,632 203,194 (67,438)

 Subtotal 44,630,487 47,632,862 31,893,747 (15,739,115)

Guam 47,043 55,511 60,500 4,989

Puerto Rico 812,380 777,368 523,412 (253,956)

Virgin Islands 47,043 55,511 62,332 6,821

 Subtotal 45,536,953 48,521,252 32,539,991 (15,981,261)

Undistributed 1/ 3,578,047 3,593,748 3,575,009 (18,739)

Total States/Territories 49,115,000 52,115,000 36,115,000 (16,000,000)

1/ Program Support- reflects the amount used from the SHIP appropriation for the staff and overhead, support contracts, training 

assistance, data systems, grant systems, and grant review costs.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

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Voting Access for Individuals with Disabilities

Services

FY 2019 

Final 

FY 2020 

Enacted

FY 2021 President’s 

Budget 

FY 2021 (+/-) FY 

2020

Voting Access for 

Individuals with 

Disabilities

$6,956 $7,463 $7,463 - 

*BA is in thousands of dollars. 

Original Authorizing Legislation: Section 291 of the Help America Vote Act of 2002, Public Law 

107-252 

Most Recent Authorizing Legislation: Section 291 of the Help America Vote Act of 2002, Public 

Law 107-252 

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

Authorization Expiration Date ...................................................................................................2005 

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

Program Description and Accomplishments:

The Voting Access for Individuals with Disabilities program authorized by the Help America Vote 

Act (HAVA) provides formula grants to support Protection and Advocacy (P&A) systems in each 

state and territory in ensuring full participation in the electoral process for individuals with 

disabilities. HAVA P&A programs help to ensure that individuals with disabilities are able to 

exercise their rights to register to vote, cast a vote, and access polling places. These funds provide 

services to individuals with disabilities within the state, as well as advocacy for and education 

about the electoral process, and monitoring of the accessibility of the electoral process, for people 

with disabilities. Additionally, competitive training and technical assistance grants assist the P&As 

in their promotion of full participation in the electoral process. 

HAVA P&A grantees use these funds to promote systematic efforts to ensure that individuals with 

disabilities have the opportunity to participate in every step of the electoral process. For example, 

grantees support systems change efforts to improve information on the location of accessible 

polling places, and to adopt voting procedures that enable individuals with disabilities to vote 

privately and independently. Grantees also work to educate election officials, poll workers, and 

election volunteers on the rights of voters with disabilities and best practices. P&As provide 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

226 

assistance to state and other government entities by surveying polling places, identifying potential 

modifications to make specific polling places accessible, and developing criteria for identifying 

accessible polling places.

Through the program, ACL also makes discretionary grants to eligible nonprofit organizations to 

assist HAVA 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 TA grants are authorized 

under section 291 of HAVA as a seven percent set-aside of the HAVA appropriation. As a result 

of the training and technical assistance, P&As inform others on the availability of accessible voting 

equipment and its use. 

Funding History:

Funding over the past five years is as follows:

FY 2017 ...................................................$4,952,000 

FY 2018 ..................................................$6,946,000 

FY 2019 ..................................................$6,963,000 

FY 2020 Enacted......................................$7,463,000 

FY 2021 President’s Budget ...................$7,463,000 

Budget Request:

The FY 2021 Budget request for the Voting Access for Individuals with Disabilities Program is 

$7,463,000, the same level as the FY 2020 Enacted level. HAVA funding supports activities such 

as training on voting rights, making sure polling places are accessible, and assisting with the 

adoption of voting procedures that enable individuals with disabilities to vote privately and 

independently. Grantees successfully sponsored a site to staff a hotline and train law student 

volunteers to canvass polling places in Charleston, South Carolina for accessibility issues. 

Funding for activities such as this helps to ensure that individuals with the full range of disabilities 

are not denied the right to the same opportunity for access and participation in the electoral process 

as voters without disabilities.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

227 

Grant Awards Table:

Voting Access for Individuals with Disabilities Grant Awards

FY 2019 

Final 

FY 2020

Enacted

FY 2021 

President’s 

Budget 

Number of Awards 57 57 57

Average Award $117,098 $126,335 $126,335

Range of Awards

$49,104 - 

$481,726

$52,630 - 

$524,292

$52,630 - 

$524,292
CONSUMER INFORMATION, ACCESS, AND OUTREACH

228 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES

FY 2019 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Voting Access for Individuals with Disabilities (CFDA 93.618)

STATE/TERRITORY FY 2019 Final FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

Alabama 98,209 105,261 105,261 -

Alaska 98,209 105,261 105,261 -

Arizona 98,209 105,261 105,261 -

Arkansas 98,209 105,261 105,261 -

California 481,726 524,292 524,292 -

Colorado 98,209 105,261 105,261 -

Connecticut 98,209 105,261 105,261 -

Delaware 98,209 105,261 105,261 -

District of Columbia 98,209 105,261 105,261 -

Florida 255,679 282,303 282,303 -

Georgia 127,074 139,426 139,426 -

Hawaii 98,209 105,261 105,261 -

Idaho 98,209 105,261 105,261 -

Illinois 155,983 168,871 168,871 -

Indiana 98,209 105,261 105,261 -

Iowa 98,209 105,261 105,261 -

Kansas 98,209 105,261 105,261 -

Kentucky 98,209 105,261 105,261 -

Louisiana 98,209 105,261 105,261 -

Maine 98,209 105,261 105,261 -

Maryland 98,209 105,261 105,261 -

Massachusetts 98,209 105,261 105,261 -

Michigan 121,383 132,487 132,487 -

Minnesota 98,209 105,261 105,261 -

Mississippi 98,209 105,261 105,261 -

Missouri 98,209 105,261 105,261 -

Montana 98,209 105,261 105,261 -

Nebraska 98,209 105,261 105,261 -

Nevada 98,209 105,261 105,261 -

New Hampshire 98,209 105,261 105,261 -
CONSUMER INFORMATION, ACCESS, AND OUTREACH

229 

PROGRAM/CFDA NUMBER: Voting Access for Individuals with Disabilities (CFDA 93.618)

STATE/TERRITORY FY 2019 Final FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

New Jersey 109,727 118,074 118,074 - 

New Mexico 98,209 105,261 105,261 - 

New York 241,850 259,014 259,014 - 

North Carolina 125,174 137,625 137,625 - 

North Dakota 98,209 105,261 105,261 - 

Ohio 142,051 154,933 154,933 - 

Oklahoma 98,209 105,261 105,261 - 

Oregon 98,209 105,261 105,261 - 

Pennsylvania 156,026 169,746 169,746 - 

Rhode Island 98,209 105,261 105,261 - 

South Carolina 98,209 105,261 105,261 - 

South Dakota 98,209 105,261 105,261 - 

Tennessee 98,209 105,261 105,261 - 

Texas 344,870 380,417 380,417 - 

Utah 98,209 105,261 105,261 - 

Vermont 98,209 105,261 105,261 - 

Virginia 103,201 112,894 112,894 - 

Washington 98,209 105,261 105,261 - 

West Virginia 98,209 105,261 105,261 - 

Wisconsin 98,209 105,261 105,261 - 

Wyoming 98,209 105,261 105,261 - 

 Subtotal 6,194,895 6,685,261 6,685,261 - 

American Samoa 49,104 52,630 52,630 - 

Guam 49,104 52,630 52,630 - 

Northern Mariana Islands - - - - 

Puerto Rico 98,209 105,261 105,261 - 

Virgin Islands 49,104 52,630 52,630 - 

 Subtotal 6,440,416 6,948,412 6,948,412 - 

Undistributed 1/ 515,584 514,588 514,588 - 

Total States/Territories 6,956,000 7,463,000 7,463,000 - 

1/ Program Support- includes funds for statutory technical assistance and/or minority set-asides; grant systems and review, and 

program reporting systems costs.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

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231 

Assistive Technology

Services

FY 2019 

Final 

FY 2020

Enacted

FY 2021 

President’s 

Budget 

FY 2021 (+/-) FY 

2020 

Assistive Technology $33,962 $35,000 $31,939 -$3,061

Alternative Financing 

Grant Competition $1,993 $2,000 -- -$2,000

Total: $35,955 $37,000 $31,939 -$5,061

*BA is in thousands of dollars. 

Original Authorizing Legislation: Technology-Related for Individuals with Disabilities Assistance 

Act of 1988, Public Law 100-407 

Most Recent Authorizing Legislation: Improving Access to Assistive Technology for Individuals 

with Disabilities Act of 2004, (including but not limited to AT Act Sections 4-6 authorized 

programs), Public Law 108-364 

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

Authorization Expiration Date ...................................................................................................2010 

Allocation Method ................................................. Formula and Competitive Grants and Contracts

Program Description and Accomplishments:

Assistive Technology (AT) programs are designed to maximize the ability of individuals with 

disabilities of all ages and their family members, guardians, advocates, and authorized 

representatives to obtain AT devices and AT services. AT devices are defined as any item, piece 

of equipment, or product system, whether acquired commercially, modified, or customized, that is 

used to increase, maintain, or improve functional capabilities of individuals with disabilities. 

Examples of such devices include computer or technology aids, modified driving controls, and 

durable medical equipment such as wheelchairs or walkers. Grants support comprehensive 

statewide programs that are designed to increase the:

• Availability, funding, access, provision, and training for AT devices and services; 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

232 

• 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 to post-school 

employment or education or maintaining or transitioning to community living; 

• Capacity of public and private entities to provide and pay for AT devices and services; 

• Involvement of individuals with disabilities in decisions about AT devices and services; 

• Coordination of AT-related activities among state and local agencies and private entities; 

• Awareness and facilitation of changes in law, regulations, procedures, policies, practices, 

and organizational structures, in order to improve access to AT; and 

• Awareness of the benefits of AT among targeted individuals and entities in the general 

population. 

Assistive Technology (AT) State Grants

The AT State Grant program, authorized under section 4 of the AT Act, is a population-based 

formula grant program to support comprehensive statewide programs that maximize the ability of 

individuals with disabilities of all ages to access and acquire AT. States must establish consumerresponsive advisory councils with a majority membership of individuals with disabilities who use 

AT to advise on the planning, implementation, and evaluation of these statewide programs. 

Under the formula, states and territories are initially allocated a base amount equal to the amount 

of funds they received under the AT program in fiscal year 2004. Funds appropriated in excess of 

the fiscal year 2004 appropriation are initially distributed among the eligible entities with 50 

percent of available funds distributed equally amongst them and 50 percent distributed according 

to the population of the state until each entity receives at least $410,000. If any appropriated funds 

remain after each State receives this minimum, they are further distributed with 20 percent divided 

equally amongst the states and 80 percent distributed according to their populations. 

States must implement each of the activities required under the program, which include state-level 

activities and state leadership activities. States must spend a minimum of 60 percent (unless the 

state elects to comply with the state flexibility provision in section 4(e)(6) of the AT Act, as 

described below) of their formula grant funds on four state-level activities: state financing 

programs, device reutilization programs, device loan programs, and device demonstrations. States 

may, however, direct their funds towards these activities in varying amounts if they use other state 

or non-federal funds to support these activities at a comparable or greater level. 

States may use up to 40 percent of their AT State Grant program funding on state leadership 

activities. The state leadership activities include the provision of technical assistance and training 

to targeted individuals and entities focused on promoting the general awareness of the benefits of 

AT; skills development for persons involved in the assessment of the need for AT; the appropriate 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

233 

application of AT; and the integration of AT devices and services in plans required to be developed 

under other federal laws. 

States must also use a portion of their grant funds on public awareness activities, including the 

continuation and maintenance of a statewide system of information and referral, and coordination 

and collaboration activities amongst entities in the states that are responsible for the provision of 

AT. The law provides states with flexibility to decide to carry out only two or three state-level 

activities, rather than all four. If a state elects to carry out two or three state-level activities, it must 

spend a minimum of 70 percent of its funds on those activities, while spending not more than 30 

percent on the state leadership activities. 

State AT Programs continue to provide a set of integrated state level and state leadership 

activities/services that directly benefit individuals with disabilities, older adults, Veterans, caregivers, 

professionals, schools, vocational rehabilitation agencies, healthcare providers, and agencies, by 

providing unique access to, and acquisition of, assistive technology devices including durable medical 

equipment. State AT Program data continues to show increased program use and performance. In fiscal 

year 2017, the 56 State AT Program Section 4 grantees, achieved the following: 

• 72,559 individuals participated in assistive technology device demonstrations, exploring 

devices to support decision-making about consumer-AT match;

• 49,721 AT devices were provided on short-term loan to individuals with disabilities, service 

providers and agencies through the “try-before-you-buy” approach to AT decision-making;

• 70,673 AT devices were reused, saving consumers more than $28 million by obtaining a gently 

used or refurbished AT device rather than a new one; 

• 908 financial loans totaling over $7.8 million at an average interest rate of 3.89% were made 

to enable consumers to purchase needed AT; 

• 4,859 AT devices at a value of more than $3.7 million were provided to consumers through 

externally funded programs administered by State AT Programs; 

• 2,333 AT devices were acquired by consumers at a savings of more than $0.7 million over full 

retail price through externally funded innovative programs administered by State AT Programs 

that are designed to reduce the cost of AT such as cooperative buying programs. 

• 107,658 individuals participated in training events on AT products/services, AT funding, 

accessible information and communication technology, AT within transition from school to 

work and congregate care to community living and related AT topics.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

234 

Protection and Advocacy for Assistive Technology Grants 

Formula grants to protection and advocacy (P&A) systems, authorized under section 5 of the AT 

Act, support protection and advocacy services to assist individuals with disabilities of all ages in 

the acquisition, use, or maintenance of AT services or devices. Funds are distributed on a state 

population basis, with a minimum annual grant of $50,000. Territories must receive not less than 

$30,000 annually. Also, the Act requires a minimum award of $30,000 to the P&A system serving 

the American Indian consortium. 

National Activities Grants 

Section 6 of the AT Act provides authority for the provision of technical assistance and the 

development and implementation of data collection and reporting systems—through grants, 

contracts, or cooperative agreements awarded on a competitive basis—to individuals with 

disabilities of all ages, to AT state program grantees, and to protection and advocacy systems. The 

AT Act also requires the Secretary to make an award to renovate, update, and maintain the National 

Public Interest Website.

137

137https://at3center.net/ and https://catada.info/

Alternative Financing Competitive Grants for Assistive Technology

In FY 2019, ACL issued three new grants to Florida, Nebraska and Pennsylvania for the expansion 

of existing programs and supplemented the four grants that received awards in FY 2019. ACL 

awarded four new grants in FY 2018 to Massachusetts, Missouri, Oklahoma and Washington, for 

the expansion of existing programs in addition to the nine grants issued in FY 2015 through 

2017. The FY 2017 awards were used to establish new financial loan programs in North Carolina 

and South Dakota, and to expand an existing program in Louisiana. Both Indiana and Oregon, 

which received new AFP grants in FY 2016 successfully launched their loan programs and are 

processing applications for loans to purchase AT devices. The other four grantees received awards 

to expand existing programs in Georgia, Minnesota, Nebraska, and Pennsylvania. 

Funding History:

Funding for the Assistive Technology Act Programs (including but not limited to AT Act 

Sections 4-6 authorized programs) over the past five years is as follows:

FY 2017 .....................................................$31,926,588 

FY 2018 .....................................................$33,911,000 

FY 2019 .....................................................$34,000,000 

FY 2020 Enacted.........................................$35,000,000 

FY 2021 President’s Budget .......................$31,939,000 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

235 

Funding for the Alternative Financing Grant Competition over the past five years and budget 

year is as follows:

FY 2017 .....................................................$2,000,000 

FY 2018 .....................................................$1,911,000 

FY 2019 .....................................................$2,000,000 

FY 2020 Enacted.........................................$2,000,000 

FY 2021 President’s Budget ................................. $0 

Budget Request:

ACL’s FY 2021 request for Assistive Technology programs, is $31,939,000 a decrease 

of -$5,061,000 below the FY 2020 Enacted level. The request eliminates the Alternative Financing 

program. 

The request includes funding for the AT State Grant program. State plans must describe how the 

state intends to carry out its AT State Grant program to meet the AT needs of individuals with 

disabilities in the state, achieve the measurable goals required by the AT Act, and comply with all 

applicable statutory and regulatory requirements. 

The request also includes funding for the Protection and Advocacy for Assistive Technology 

(PAAT) program. At this funding level, 26 states would receive $50,000, the minimum amount 

allowed by statute to carry out this program. Territories would each receive $30,000. Funds would 

assist individuals with disabilities of all ages in the acquisition, use, or maintenance of AT services 

or devices. 

The request would continue funding for National Activities. The Act requires support for state 

training, technical assistance, data collection, and reporting assistance, and authorizes a one-time 

grant to provide national public awareness about AT, and support for AT research and 

development activities, which are all supported by competitively awarded grants. In FY 2020, 

funds would be used to provide state training and technical assistance, build out the AT Act 

informational website, and continue support for the AT Act data collection activities.

Alternative Financing Grant Competition for Assistive Technology 

No funding is requested in FY 2020. The AT State grant program already includes financing 

activities that allow States to make decisions to best meet specific needs. 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

236 

Outcomes and Outputs Table:

Measure Year and Most Recent Result 

/ 

Target for Recent Result /

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-FY 2020

Target

AT1 Maintain at 90% or 

higher the number of 

device demonstrations 

and short-term device 

loans that result in 

positive decision-making 

to ensure consumerequipment match (avoid 

inappropriate device 

acquisition). (Outcome)

FY 2018: 94.98%

Target:

90%

(Target Exceeded)

90% 90% Maintain

AT2 Increase the 

percentage of recipients 

who acquire AT through 

reuse and state financing 

activities who were 

unable to afford or 

otherwise obtain the AT 

they need without the 

State AT Program. 

(Outcome)

FY 2018: 87%

Target:

85%

(Target Exceeded)

85% 85% Maintain

AT3 Maintain at 95% or 

higher the percentage of 

program beneficiaries 

who are highly satisfied 

or satisfied with state 

level activity services they 

receive from the State AT 

Program with at least a 

90% response rate. 

(Outcome)

FY 2018: 99.21%

Target:

95%

(Target Exceeded)

95% 95% Maintain

Indicator Year and Most Recent 

Result /

FY 2020

Projection

FY 2021

Projection

FY 2021

Projection

+/-FY 2020

Projection

Output ATi: Device 

Demonstrations Provided 

(Output)

FY 2018: 38,709 40,000 40,500 +500
CONSUMER INFORMATION, ACCESS, AND OUTREACH

237 

Measure Year and Most Recent Result 

/ 

Target for Recent Result /

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-FY 2020

Target

Output ATii: Short-Term 

Device Loans Made 

(Output)

FY 2018: 32,353 33,000 33,250 +250

Output ATiii: Recipients 

of Reused Devices 

(Output)

FY 2018: 59,149 59,500 59,750 +250

Output ATiv: State 

Financing Device 

Recipients (Output)

FY 2018: 6,457 6,500 6,750 +250
CONSUMER INFORMATION, ACCESS, AND OUTREACH

238 

Grant Awards Tables:

Assistive Technology Act - State Grants

FY 2019 

Final 

FY 2020

Enacted

FY 2021 

President’s 

Budget

Number of Awards 56 56 56

Average Award $502,389 $520,767 $472,542

Range of Awards $125,608-

$1,202,506

$125,682-

$1,272,330

$125,474-

$1,084,863

Assistive Technology Act - Protection and Advocacy Grants 

FY 2019 

Final 

FY 2020

Enacted

FY 2021 

President’s 

Budget 

Number of Awards 57 57 57

Average Award $83,327 $83,619 $77,330

Range of Awards $30,000-

$471,082

$30,000-

$471,667

$30,000-

$420,249

Assistive Technology Act – National Grant Activities 

FY 2019 

Final 

FY 2020

Enacted

FY 2021 

President’s 

Budget

Number of Awards 2 2 --

Average Award $445,345 $445,345 --

Range of Awards $317,942- 

$572,748

$317,942- 

$572,748 N/A
CONSUMER INFORMATION, ACCESS, AND OUTREACH

239 

Alternative Financing Grant Competition for Assistive Technology 

FY 2019 

Final 

FY 2020

Enacted

FY 2021 

President’s 

Budget

Number of Awards 3 3 - 

Average Award $579,541 $663,,055 - 

Range of Awards $487,116-

$625,754

~$663,055-

$663,055 - 

Resource and Program Data: 

Assistive Technology 

(Dollars in thousands)

FY 2019

Final 

FY 2020

Enacted

FY 2021

President’s Budget

Mechanism # $ # $ # $

Grants:

Formula

 

112

 

32,895

 

112

 

33,929

 

112

 

30,869

New Discretionary

 

7 1,990 

 

7 1,997 

 

-- -- 

Continuations

 

2 891 

 

2 898 

 

2 893 

Contracts

 

1 99 

 

1 99 

 

1 99 

Interagency Agreements

 

--

 

--

 

--

 

--

 

--

 

--

Program Support138

138 Program Support -- Includes funds for Older Americans Act statutory requirements, grant systems and review, 

and information technology support costs.

 

-- 81 

 

-- 78 

 

-- 78 

Total Resources 35,955 37,000 31,939 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

240 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

FY 2019 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Assistive Technology State Grants (CFDA 84.224A)

STATE/TERRITORY FY 2019 

Enacted

FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

Alabama 476,253 493,680 447,757 (45,923)

Alaska 448,515 459,495 430,517 (28,978)

Arizona 648,018 670,584 615,337 (55,247)

Arkansas 496,145 510,702 472,430 (38,272)

California 1,202,506 1,272,330 1,084,863 (187,467)

Colorado 501,681 521,223 472,002 (49,221)

Connecticut 431,591 446,692 406,139 (40,553)

Delaware 433,265 444,682 414,766 (29,916)

District of Columbia 390,232 401,288 372,453 (28,835)

Florida 774,102 819,885 706,958 (112,927)

Georgia 642,492 669,333 600,417 (68,916)

Hawaii 468,373 480,327 448,561 (31,766)

Idaho 443,581 456,567 423,438 (33,129)

Illinois 653,665 682,059 604,073 (77,986)

Indiana 508,719 529,010 475,721 (53,289)

Iowa 470,545 485,326 446,473 (38,853)

Kansas 430,572 444,841 406,987 (37,854)

Kentucky 497,210 514,016 469,806 (44,210)

Louisiana 525,412 542,049 497,056 (44,993)

Maine 480,908 492,852 461,421 (31,431)

Maryland 527,808 546,708 496,070 (50,638)

Massachusetts 550,374 571,188 517,041 (54,147)

Michigan 698,783 724,161 657,383 (66,778)

Minnesota 519,832 538,605 489,729 (48,876)

Mississippi 415,129 429,559 391,399 (38,160)

Missouri 585,803 605,096 554,116 (50,980)

Montana 462,609 474,248 443,944 (30,304)

Nebraska 476,293 489,208 455,364 (33,844)

Nevada 441,037 455,944 417,588 (38,356)

New Hampshire 448,794 460,898 429,393 (31,505)
CONSUMER INFORMATION, ACCESS, AND OUTREACH

241 

PROGRAM/CFDA NUMBER: Assistive Technology State Grants (CFDA 84.224A)

STATE/TERRITORY FY 2019 

Enacted

FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

New Jersey 525,605 547,785 485,447 (62,338)

New Mexico 464,894 478,038 443,516 (34,522)

New York 768,950 804,674 698,921 (105,753)

North Carolina 594,757 621,632 553,271 (68,361)

North Dakota 388,730 399,827 370,757 (29,070)

Ohio 609,848 637,748 564,056 (73,692)

Oklahoma 457,607 473,598 431,532 (42,066)

Oregon 452,332 469,121 426,044 (43,077)

Pennsylvania 740,449 769,686 691,431 (78,255)

Rhode Island 388,034 399,497 369,213 (30,284)

South Carolina 548,491 566,769 520,045 (46,724)

South Dakota 437,588 448,964 419,395 (29,569)

Tennessee 480,657 501,411 447,803 (53,608)

Texas 983,969 1,041,902 898,752 (143,150)

Utah 481,107 496,478 457,605 (38,873)

Vermont 424,315 435,186 406,662 (28,524)

Virginia 538,571 561,886 501,143 (60,743)

Washington 521,184 543,996 487,263 (56,733)

West Virginia 442,839 455,339 421,999 (33,340)

Wisconsin 499,782 518,664 468,962 (49,702)

Wyoming 380,332 391,080 362,754 (28,326)

 Subtotal 27,180,288 28,195,837 25,535,773 (2,660,064)

American Samoa 125,608 125,682 125,474 (208)

Guam 126,975 127,251 126,566 (685)

Northern Mariana Islands 125,617 125,698 125,485 (213)

Puerto Rico 449,020 462,045 423,033 (39,012)

Virgin Islands 126,266 126,435 125,998 (437)

 Subtotal 28,133,774 29,162,948 26,462,329 (2,700,619)

Undistributed 1/ 41,052 41,052 41,052 -

Total States/Territories 28,174,826 29,204,000 26,503,381 (2,700,619)

1/ Program Support-- includes funds for grant systems and review, and program reporting systems costs.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

242 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

FY 2019 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Assistive Technology Protection and Advocacy (CFDA 84.343)

STATE/TERRITORY FY 2019 

Enacted

FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

Alabama 58,083 58,281 51,928 (6,353)

Alaska 50,000 50,000 50,000 -

Arizona 83,599 85,512 76,191 (9,321)

Arkansas 50,000 50,000 50,000 -

California 471,082 471,667 420,249 (51,418)

Colorado 66,810 67,912 60,509 (7,403)

Connecticut 50,000 50,000 50,000 -

Delaware 50,000 50,000 50,000 -

District of Columbia 50,000 50,000 50,000 -

Florida 250,031 253,966 226,282 (27,684)

Georgia 124,267 125,431 111,758 (13,673)

Hawaii 50,000 50,000 50,000 -

Idaho 50,000 50,000 50,000 -

Illinois 152,537 151,921 135,360 (16,561)

Indiana 79,436 79,792 71,094 (8,698)

Iowa 50,000 50,000 50,000 -

Kansas 50,000 50,000 50,000 -

Kentucky 53,072 53,280 50,000 (3,280)

Louisiana 55,814 55,564 50,000 (5,564)

Maine 50,000 50,000 50,000 -

Maryland 72,112 72,051 64,197 (7,854)

Massachusetts 81,735 82,299 73,328 (8,971)

Michigan 118,702 119,188 106,195 (12,993)

Minnesota 66,446 66,906 59,613 (7,293)

Mississippi 50,000 50,000 50,000 -

Missouri 72,843 73,050 65,087 (7,963)

Montana 50,000 50,000 50,000 -

Nebraska 50,000 50,000 50,000 -

Nevada 50,000 50,000 50,000 -

New Hampshire 50,000 50,000 50,000 -
CONSUMER INFORMATION, ACCESS, AND OUTREACH

PROGRAM/CFDA NUMBER: Assistive Technology Protection and Advocacy (CFDA 84.343)

STATE/TERRITORY FY 2019 

Enacted

FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

243 

New Jersey 107,303 106,222 94,643 (11,579)

New Mexico 50,000 50,000 50,000 -

New York 236,507 233,015 207,614 (25,401)

North Carolina 122,409 123,811 110,314 (13,497)

North Dakota 50,000 50,000 50,000 -

Ohio 138,913 139,381 124,187 (15,194)

Oklahoma 50,000 50,000 50,000 -

Oregon 50,000 50,000 50,000 -

Pennsylvania 152,579 152,707 136,061 (16,646)

Rhode Island 50,000 50,000 50,000 -

South Carolina 59,866 60,622 54,013 (6,609)

South Dakota 50,000 50,000 50,000 -

Tennessee 80,021 80,723 71,924 (8,799)

Texas 337,251 342,232 304,925 (37,307)

Utah 50,000 50,000 50,000 -

Vermont 50,000 50,000 50,000 -

Virginia 100,921 101,562 90,491 (11,071)

Washington 88,240 89,852 80,057 (9,795)

West Virginia 50,000 50,000 50,000 -

Wisconsin 69,054 69,319 61,763 (7,556)

Wyoming 50,000 50,000 50,000 -

 Subtotal 4,549,633 4,566,266 4,207,783 (358,483)

Native American Organizations 1/ 30,000 30,000 30,000 -

American Samoa 30,000 30,000 30,000 -

Guam 30,000 30,000 30,000 -

Northern Mariana Islands 50,000 50,000 50,000 -

Puerto Rico 30,000 30,000 30,000 -

Virgin Islands 30,000 30,000 30,000 -

 Subtotal 4,749,633 4,766,266 4,407,783 (358,483)

Undistributed 2/ 50,367 33,734 33,734 -

Total States/Territories 4,800,000 4,800,000 4,441,517 (358,483)
CONSUMER INFORMATION, ACCESS, AND OUTREACH

244 

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CONSUMER INFORMATION, ACCESS, AND OUTREACH

245 

Medicare Improvements for Patients and Providers Act Programs (MIPPA)

Services

FY 2019 

Final 

FY 2020 

Enacted139

139The FY 2020 appropriation extended the MIPPA programs through May 22, 2020. The Budget proposes to extend 

funding through 2021 at levels equal to 2019 Enacted. 

FY 2021 

President’s 

Budget 

FY 2021 (+/-) FY 

2020

ADRCs $5,000 $5,000 $5,000 --

AAAs $7,500 $7,500 $7,500 --

NCBOE $12,000 $12,000 $12,000 --

SHIP140

140 MIPPA-SHIP funding is currently appropriated to CMS and transferred to ACL.

$13,000 $13,000 $13,000 --

Total: $37,500 $37,500 $37,500 --

Current Law $37,500 $24,146 -- -$24,146

Proposed Law -- $13,354 $37,500 +$24,146

FTE 3.4 4.0 4.0 --

*BA is in thousands of dollars, FTE is a whole number. 

Original Authorizing Legislation: Medicare Improvements for Patients and Providers Act of 2008, 

Section 119, Public Law 110-275 

Most Recent Authorizing Legislation: Consolidated Appropriations Act of 2018, Public Law 115-

141 

Current FY Authorization of Funds ......................................................................... FY 2020 Partial 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

246 

Authorization Expiration Date ......................................................................................... Permanent

Allocation Method ............................................ Competitive Grants/Formula Grants and Contracts

Program Description and Accomplishments:

The Medicare Improvements for Patients and Providers Act (MIPPA) programs provide funding 

to key segments of ACL’s network of community-based service providers – including Area

Agencies on Aging (AAA), Aging Disability Resource Centers (ADRCs), and State Health 

Insurance Assistance Programs (SHIPs) – to undertake additional activities, above and beyond 

their basic information and referral functions, focused on in-person enrollment assistance too hard 

to reach low-income and rural Medicare beneficiaries who qualify for either Medicare Savings 

Plans (MSP) or a Low Income Subsidy (LIS). MIPPA funds also support the National Center for 

Benefits Outreach and Enrollment. For beneficiaries who qualify, MSPs pay their Medicare Part 

A or/and Part B premiums and co-insurance costs and the LIS subsidizes their Medicare 

prescription drug costs, including premiums, deductibles and drug co-pays. Beneficiaries are 

eligible for these programs if they have minimal assets and incomes below 150 percent of the 

Federal Poverty Level. 

Grants provide support for beneficiary education and enrollment assistance so that Medicare 

beneficiaries can access MSP and LIS programs that they qualify for but are not yet enrolled in. 

MIPPA funding is not used to support the day-day services of AAAs, ADRCs and SHIPs. Instead, 

it supports additional counseling that goes beyond the assistance what would normally be 

provided, both to identify older Americans and those with disabilities in need, and to provide much 

more intensive counseling to these specific populations. In FY 2016, MIPPA State Grantees 

conducted over 22,000 public and media events, served over 2.5 million people, and completed 

over 164,000 total applications for LIS and MSP benefits combined.

The National Center for Benefits Outreach and Enrollment (NCBOE) coordinates efforts to inform 

older adults and beneficiaries with disabilities about the benefits available under Federal and state 

programs, with an emphasis on providing information on the LIS and MSP which help Medicare 

beneficiaries pay for their Medicare coverage. The NCBOE also supports a nationwide network of 

59 local Benefit Enrollment Centers which provide low-income benefits information and 

enrollment assistance. NCBOE accomplishes its mission by providing tools, resources, and 

technology that help local, state, and regional organizations find, counsel, and assist seniors and 

younger adults with disabilities in applying for and enrolling in the benefits for which they may 

be eligible. It also works to generate and disseminate new knowledge about best practices and 

cost-effective strategies for benefits outreach and enrollment. In FY 2017, the NCBOE and 

Benefits Enrollment Centers directly assisted with over 149,000 applications for the LIS, MSP, 

and other low income benefits. 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

247 

Funding History: 

In each of fiscal years 2015 through 2019, MIPPA was funded through mandatory appropriations. 

Funding for MIPPA over the past five years is as follows:

FY 2017 ....................................$34,912,500 

FY 2018 .................................... $37,500,000 

FY 2019 ....................................$37,500,000 

FY 2020 Enacted/2 ....................$23,566,870 

FY 2021 President’s Budget/1...$37,500,000 

__________________

1/ Reflects request for mandatory funding in FY 2020 and FY 2021. 

2/The program was funded through May 22nd 2020; the annualized level of this funding is $37.5 million.

Budget Request:

The FY 2021 Budget includes a legislative proposal to extend Medicare Improvements for Patients 

and Providers Act (MIPPA) programs funding to provide mandatory appropriations at the current 

level of $37,500,000 per year for two years (FY 2020 and FY 2021). 

MIPPA remains the only national level program providing one-on-one counseling specifically 

targeting hard-to-reach beneficiaries who qualify for either the Medicare Savings Plans (MSP) or 

the Social Security Low-Income Subsidy (LIS). Continued funding is needed so that the 

beneficiaries who are eligible for these programs do not lose the in-depth assistance with enrolling 

in these programs that MIPPA funding supports. To the extent that these individuals fail to enroll, 

each beneficiary would lose not only an estimated $4,900 annually in LIS savings (per SSA 

estimates)141

141 https://www.ssa.gov/benefits/medicare/prescriptionhelp/. 

and/or $437 per month in Medicare Part A Premium Savings and $135.5 per month 

in Part B Premiums through MSP, but also additional assistance with Medicare Part A and B 

copayments and deductibles and benefits from other programs to which they are also entitled.142

142 https://www.medicare.gov/pubs/pdf/10050-Medicare-and-You.pdf. 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

248 

Grant Awards Tables:

MIPPA – Aging Disability and Resource Centers 

FY 2019 

Final

FY 2020

Enacted/1

 1/Assumes full year funding

FY 2021 

President’s 

Budget 

Number of Awards 49 49 49

Average Award $97,560 $97,560 $97,560

Range of Awards $13,077- 

$400,476

$13,077- 

$400,476

$13,077- 

$400,476

MIPPA – Area Agencies on Aging143

143 Awards to Tribes were not included in the calculation of the average award, or the range of awards. Awards to 

tribes are $1,000 per Tribe.

FY 2019 

Final 

FY 2020

Enacted/1

 1/Assumes full year funding

FY 2021

President’s 

Budget

Number of Awards 49 49 49

Average Award $140,413 $140,413 $140,413

Range of Awards $11,097- 

$562,690

$11,097- 

$562,690

$11,097- 

$562,690

MIPPA – National Center for Benefits Outreach and Enrollment

FY 2019 

Final 

FY 2020

Enacted/1

 1/Assumes full year funding

FY 2021 

President’s 

Budget

Number of Awards 1 1 1 

Average Award $11,000,000 $11,000,000 $11,000,000

Range of Awards N/A N/A N/A
CONSUMER INFORMATION, ACCESS, AND OUTREACH

249 

MIPPA – State Health Insurance Assistance Programs

FY 2019 

Final 

FY 2020

Enacted/1

FY 2021 

President’s 

Budget 

Number of Awards 51 51 51

Average Award $244,639 $244,639 $244,639

Range of Awards $30,955-

$1,015,619

$30,955-

$1,015,619

$30,955-

$1,015,619

 1/Assumes full year funding

Resource and Program Data: 

Medicare Improvements for Patients and Providers Act Programs

(Dollars in Thousands)

FY 2019

Final 

FY 2020

Enacted 

FY 2021

President’s Budget 

Mechanism # $ # $ # $

Grants:

Formula

 

149

 

24,407

 

149

 

24,407

 

149

 

24,407

New Discretionary

 

--

 

391

 

1

 

11,391

 

--

 

391

Continuations

 

1

 

110,000

 

-- --

 

1

 

11,000

Contracts

 

2

 

664

 

2

 

664

 

2

 

664

Interagency Agreements

 

--

 

--

 

--

 

--

 

-- --

Program Support /1

 

1,038

 

1,038

 

--

 

1,038

Total Resources

 

--

 

37,500

 

--

 

37,500

 

--

 

37,500
CONSUMER INFORMATION, ACCESS, AND OUTREACH

250 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2019 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: MIPPA - ADRC (CFDA 93.071)

STATE/TERRITORY FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

Alabama 95,748 95,748 95,748 -

Alaska 8,481 8,481 8,481 -

Arizona 113,079 113,079 113,079 -

Arkansas 58,700 58,700 58,700 -

California 171,964 171,964 171,964 -

Colorado 78,725 78,725 78,725 -

Connecticut 62,297 62,297 62,297 -

Delaware 17,970 17,970 17,970 -

District of Columbia - - - -

Florida 400,476 400,476 400,476 -

Georgia 151,355 151,355 151,355 -

Hawaii 24,352 24,352 24,352 -

Idaho 28,199 28,199 28,199 -

Illinois 204,770 204,770 204,770 -

Indiana 114,073 114,073 114,073 -

Iowa 56,745 56,745 56,745 -

Kansas 48,283 48,283 48,283 -

Kentucky 85,312 85,312 85,312 -

Louisiana 78,885 78,885 78,885 -

Maine 30,358 30,358 30,358 -

Maryland 92,648 92,648 92,648 -

Massachusetts 120,890 120,890 120,890 -

Michigan 175,178 175,178 175,178 -

Minnesota 90,829 90,829 90,829 -

Mississippi 55,367 55,367 55,367 -

Missouri 6,937 6,937 6,937 -

Montana 14,313 14,313 14,313 -

Nebraska 31,147 31,147 31,147 -

Nevada 45,303 45,303 45,303 -

New Hampshire 26,515 26,515 26,515 -
CONSUMER INFORMATION, ACCESS, AND OUTREACH

PROGRAM/CFDA NUMBER: MIPPA – ADRC (CFDA 93.071) 

STATE/TERRITORY FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

251 

New Jersey 147,893 147,893 147,893 - 

New Mexico 37,153 37,153 37,153 - 

New York 331,109 331,109 331,109 - 

North Carolina 111,180 111,180 111,180 - 

North Dakota - - - - 

Ohio 213,365 213,365 213,365 - 

Oklahoma 67,101 67,101 67,101 - 

Oregon 75,286 75,286 75,286 - 

Pennsylvania 250,326 250,326 250,326 - 

Rhode Island 20,105 20,105 20,105 - 

South Carolina 93,725 93,725 93,725 - 

South Dakota 15,537 15,537 15,537 - 

Tennessee 122,365 122,365 122,365 - 

Texas 362,429 362,429 362,429 - 

Utah 32,246 32,246 32,246 - 

Vermont 13,077 13,077 13,077 - 

Virginia 134,207 134,207 134,207 - 

Washington 118,939 118,939 118,939 - 

West Virginia 41,074 41,074 41,074 - 

Wisconsin 104,421 104,421 104,421 - 

Wyoming - - - - 

 Subtotal 4,780,437 4,780,437 4,780,437 - 

Puerto Rico - - - - 

 Subtotal 4,780,437 4,780,437 4,780,437 - 

Undistributed 1/ 219,563 219,563 219,563 - 

Total States/Territories 5,000,000 5,000,000 5,000,000 - 

1/ Program Support- reflects the amount used from the MIPPA appropriation for staff and overhead, support, contracts, training, 

technical assistance, data systems, grant systems, and grants review costs.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

252 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2019 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: MIPPA - AAA (CFDA 93.071) 

STATE/TERRITORY FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

Alabama 149,246 149,246 149,246 -

Alaska 18,058 18,058 18,058 -

Arizona 121,722 121,722 121,722 -

Arkansas 137,894 137,894 137,894 -

California 562,690 562,690 562,690 -

Colorado 74,054 74,054 74,054 -

Connecticut 53,575 53,575 53,575 -

Delaware 24,224 24,224 24,224 -

District of Columbia 8,542 8,542 8,542 -

Florida 416,509 416,509 416,509 -

Georgia 231,916 231,916 231,916 -

Hawaii 39,185 39,185 39,185 -

Idaho 53,756 53,756 53,756 -

Illinois 233,922 233,922 233,922 -

Indiana 162,383 162,383 162,383 -

Iowa 100,739 100,739 100,739 -

Kansas 70,886 70,886 70,886 -

Kentucky 178,100 178,100 178,100 -

Louisiana 124,486 124,486 124,486 -

Maine 59,585 59,585 59,585 -

Maryland 78,901 78,901 78,901 -

Massachusetts 114,976 114,976 114,976 -

Michigan 211,191 211,191 211,191 -

Minnesota 124,484 124,484 124,484 -

Mississippi 127,166 127,166 127,166 -

Missouri 169,934 169,934 169,934 -

Montana 40,584 40,584 40,584 -

Nebraska 50,201 50,201 50,201 -

Nevada 47,859 47,859 47,859 -

New Hampshire 37,817 37,817 37,817 -
CONSUMER INFORMATION, ACCESS, AND OUTREACH

PROGRAM/CFDA NUMBER: MIPPA - AAA (CFDA 93.071)

STATE/TERRITORY FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

253 

New Jersey 112,269 112,269 112,269 - 

New Mexico 60,440 60,440 60,440 - 

New York 403,202 403,202 403,202 - 

North Carolina 293,470 293,470 293,470 - 

North Dakota - - - - 

Ohio 250,046 250,046 250,046 - 

Oklahoma 107,538 107,538 107,538 - 

Oregon 93,058 93,058 93,058 - 

Pennsylvania 286,443 286,443 286,443 - 

Rhode Island 17,145 17,145 17,145 - 

South Carolina 149,368 149,368 149,368 - 

South Dakota 28,245 28,245 28,245 - 

Tennessee 205,458 205,458 205,458 - 

Texas 456,771 456,771 456,771 - 

Utah 42,859 42,859 42,859 - 

Vermont 28,316 28,316 28,316 - 

Virginia 173,426 173,426 173,426 - 

Washington 116,121 116,121 116,121 - 

West Virginia 83,805 83,805 83,805 - 

Wisconsin 136,583 136,583 136,583 - 

Wyoming - - - - 

 Subtotal 6,869,148 6,869,148 6,869,148 - 

Puerto Rico 11,097 11,097 11,097 - 

 Subtotal 6,880,245 6,880,245 6,880,245 - 

Undistributed 1/ 619,755 619,755 619,755 - 

Total States/Territories 7,500,000 7,500,000 7,500,000 - 

1/ Program Support- reflects the amount used from the MIPPA appropriation for staff and overhead, support, contracts, training, 

technical assistance, data systems, grant systems, and grants review costs.
CONSUMER INFORMATION, ACCESS, AND OUTREACH

254 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2018 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: MIPPA - SHIP (CFDA 93.071) 

STATE/TERRITORY FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

Alabama 269,071 269,071 269,071 -

Alaska 32,541 32,541 32,541 -

Arizona 219,562 219,562 219,562 -

Arkansas 248,553 248,553 248,553 -

California 1,015,619 1,015,619 1,015,619 -

Colorado 133,530 133,530 133,530 -

Connecticut 96,673 96,673 96,673 -

Delaware 43,663 43,663 43,663 -

District of Columbia 15,423 15,423 15,423 -

Florida 751,552 751,552 751,552 -

Georgia 418,048 418,048 418,048 -

Hawaii 70,652 70,652 70,652 -

Idaho 96,843 96,843 96,843 -

Illinois 421,849 421,849 421,849 -

Indiana 292,746 292,746 292,746 -

Iowa 181,467 181,467 181,467 -

Kansas 127,707 127,707 127,707 -

Kentucky 320,917 320,917 320,917 -

Louisiana 224,495 224,495 224,495 -

Maine 107,322 107,322 107,322 -

Maryland 142,345 142,345 142,345 -

Massachusetts 207,495 207,495 207,495 -

Michigan 380,777 380,777 380,777 -

Minnesota 224,347 224,347 224,347 -

Mississippi 229,129 229,129 229,129 -

Missouri 306,293 306,293 306,293 -

Montana 73,101 73,101 73,101 -

Nebraska 90,434 90,434 90,434 -

Nevada 86,334 86,334 86,334 -

New Hampshire 68,126 68,126 68,126 -
CONSUMER INFORMATION, ACCESS AND OUTREACH

255 

 

PROGRAM/CFDA NUMBER: MIPPA -SHIP (CFDA 93.071)

STATE/TERRITORY FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

Difference 

(+/-) 2020

New Jersey 202,700 202,700 202,700 - 

New Mexico 108,938 108,938 108,938 - 

New York 727,589 727,589 727,589 - 

North Carolina 529,050 529,050 529,050 - 

North Dakota 35,557 35,557 35,557 - 

Ohio 450,907 450,907 450,907 - 

Oklahoma 193,795 193,795 193,795 - 

Oregon 167,703 167,703 167,703 - 

Pennsylvania 516,620 516,620 516,620 - 

Rhode Island 30,955 30,955 30,955 - 

South Carolina 269,313 269,313 269,313 - 

South Dakota 50,872 50,872 50,872 - 

Tennessee 370,365 370,365 370,365 - 

Texas 823,861 823,861 823,861 - 

Utah 77,251 77,251 77,251 - 

Vermont 50,997 50,997 50,997 - 

Virginia 312,637 312,637 312,637 - 

Washington 209,335 209,335 209,335 - 

West Virginia 151,000 151,000 151,000 - 

Wisconsin 246,108 246,108 246,108 - 

Wyoming 34,302 34,302 34,302 - 

 Subtotal 12,456,469 12,456,469 12,456,469 - 

Puerto Rico 20,105 20,105 20,105 - 

 Subtotal 12,476,574 12,476,574 12,476,574 - 

Undistributed 1/ 523,426 523,426 523,426 - 

Total States/Territories 13,000,000 13,000,000 13,000,000 - 

1/ Program Support- reflects the amount used from the MIPPA appropriation for staff and overhead, support, contracts, training, 

technical assistance, data systems, grant systems, and grants review costs.
256 

 

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PROGRAM ADMINISTRATION

257 

 

Program Administration 

Services

FY 2019 

Final 

FY 2020

Enacted

FY 2021 

President’s 

Budget 

FY 2021(+/-) FY 

2020 

Program 

Administration $40,921 $41,063 $42,063 +$1,000

FTE 162 171 174 +3 

*BA is in thousands of dollars; FTE is a whole number. FTE numbers above for Program Administration only reflect 

those FTE funded from the Program Administration budget line. Other sources of funding for ACL FTE include

staff charged to reimbursable and mandatory funding sources.

Authorizing Legislation: Older Americans Act (OAA) of 1965, P.L. 89-73, the Developmental 

Disabilities Assistance and Bill of Rights Act (DD Act), the Help America Vote Act (HAVA), the 

Assistive Technology (AT) Act, the Rehabilitation Act, the Public Health Services Act (PHSA), 

and the Elder Justice Act (EJA). 

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

114-144, the Developmental Disabilities Assistance and Bill of Rights Act of 2000, Public Law 

106-402, the Help America Vote Act of 2002, Public Law 107-252, Improving Access to Assistive 

Technology for Individuals with Disabilities Act of 2004, (including but not limited to AT Act 

Sections 4-6 authorized programs), Titles II and VII of the Rehabilitation Act of 1973, as amended 

in 2014 by the Workforce Innovation and Opportunity Act (WIOA), Public Law 113-128, the 

Public Health Service Act (PHSA), and the Elder Justice Act (Title XX-B of the Social Security 

Act). 

Current FY Authorization ........................................................................................................... N/A

Authorization Expiration Date .................................................................................................... N/A

Allocation Method ....................................................................................... Direct Federal/Contract

Program Description and Accomplishments:

ACL’s mission is to assist older adults and people of all ages with disabilities to live as 

independently as possible and to fully participate in their communities. Program Administration
PROGRAM ADMINISTRATION

258 

 

funds the direction and support of ACL programs established under the Older Americans Act 

(OAA), Developmental Disabilities Assistance and Bill of Rights Act (DD Act), Rehabilitation 

Act (RA), Help America Vote Act (HAVA), Assistive Technology (AT) Act, Public Health 

Service Act (PHSA), and the Elder Justice Act (Title XX-B of the Social Security Act). These

funds cover salaries and benefits, rent and security, and external shared services, costs that are

relatively fixed in the short term. ACL’s appropriation also includes language that allows Program 

Administration funds to be used for Department-wide coordination of policy and program 

activities that assist individuals with disabilities (consistent with the role previously performed by 

the Office of Disability). 

In FY 2019, Program Administration funding supported 163 of the 181 FTE in ACL’s central and 

regional offices. Other sources of funding for ACL FTE include staff supported by reimbursable 

and mandatory funding sources such as the Health Care Fraud and Abuse Control (HCFAC) 

account, Medicare Improvements for Patients and Providers Act (MIPPA) activities, and money 

received from the Centers for Medicare & Medicaid Services (CMS) for activities performed on 

behalf of dual Medicare/Medicaid beneficiaries. ACL also supports a limited number of FTE from 

various program line items.

Funding History:

Funding for ACL Program Administration over the past five years is as follows:

FTE

FY 2017 .................................................$40,063,000 170.6 

FY 2018 ................................................$40,063,000 170.1 

FY 2019 ................................................$41,063,000 163.0 

FY 2020 Annualized CR ......................$41,063,000 171.0 

FY 2021 President’s Budget ..................$42,063,000 174.0 

Budget Request:

ACL’s requests $42,063,000 for Program Administration, an increase of $1,000,000 and 3 FTE 

over the FY 2020 Enacted level. 

Half of this increase would be used to investment in ACL’s technology needs, providing support 

for the President’s Management Agenda objectives of information technology modernization, data 

accountability, and transparency. The balance would support an additional 3 FTE over FY 2020 

projected levels, bringing to 174 FTE the total supported with Program Administration funding. 

This FTE level will help to provide ACL with staff that it needs to provide proper oversight and 

administration and allow for a small investment in additional IT staff. 
PROGRAM ADMINISTRATION

259 

 

More specifically, the requested funding would: 

o Invest approximately half a million dollars in portfolio management and oversight 

of its 50+ program-related IT systems. This will improve the agency’s ability to 

meet its Federal Information Technology Acquisition Reform Act (FITARA) 

requirements to manage, validate and verify all contracts with technology tasks and 

deliverables to reduce risks associated with contractor performance.

o Increase funding for ACL’s core IT service and support contract, to increase 

capabilities in cybersecurity monitoring, analysis, and incident response 

capabilities; 

o Fund critical software licenses and services to support ACL’s systems and to “make 

whole” ACL’s use of licenses for its systems and staff; and 

o Improve use of technology and data by ACL staff, grantees and other communitybased organizations providing human services to older adults, people with 

disabilities, and caregivers. Funding would also be directed towards ensuring the 

accessibility and usability of ACL’s systems as required by Section 508 of the 

Rehabilitation Act. 

The balance of the funding would be invested in FTE, bringing staffing paid for by Program 

Administration to a total of 174 (of the 195 FTE that support ACL overall). Over the past two 

fiscal years, ACL has seen first-hand the consequences that being unable to fill vacant positions 

and cutting other core expenses have had on ACL’s operations. It has resulted in delays, missed 

deadlines, and reduced ability to provide technical assistance, all of which have a negative impact 

on the ability of ACL grantees to do their work. Additional staff will alleviate inefficiencies in

day-to-day operations, staff burnout and lower morale, increase the agency’s ability to address

operational problems (e.g., privacy and security of data being compromised; grants and contracts 

being inadequately monitored), and enhance ACL’s ability to engage on the President’s 

Management Agenda. 
260 

 

Section Break
NONRECURRING EXPENSES FUND

261 

 

Nonrecurring Expenses Fund

(Dollars in Thousands)

FY 2019144

144 Notification submitted to the Committees on Appropriations in the House of Representatives and the Senate on December 4, 2018 

FY 2020145

145 HHS has not yet notified for FY 2020

FY 2021146

146 HHS has not yet notified for FY 2021

Notification147

147 Pursuant to Section 223 of Division G of the Consolidated Appropriation Act, 2008, notification is required of planned use

$4,850,000 - -

Authorizing Legislation:

Authorization...................................Section 223 of Division G of the Consolidated Appropriations 

Act, 2008

Allocation Method.......................................................................................Direct Federal, 

Competitive Contract 

Program Description and Accomplishments

The Nonrecurring Expenses Fund (NEF) permits HHS to transfer unobligated balances of expired 

discretionary funds from FY 2008 and subsequent years into the NEF account. Congress 

authorized use of the funds for capital acquisitions necessary for the operation of the Department, 

specifically information technology (IT) and facilities infrastructure acquisitions. 

Summary Statement: ACL continues to work to augment, replace, or modernize its portfolio of 

IT systems. In FY 2019, ACL NEF plans included funding for planning, development and 

enhancement work on the following systems and projects: 

• ACL Data (formerly known as Aging and Disability Data Analysis and Presentation 

System) – Replacement of AGID

• ACL Older Americans Act Performance System (formerly known as ACL Titles and 

Administrative Data Reporting System) -- Replacement of NAPIS Cards/SPR/NORS

• ACL Reporting (formerly known as ACL MIS Replacement)

• ACL.gov Enhancements 

• ACL Knowledge Management(formerly known as ACL Intranet and Knowledge 

Management)

• Accessibility and Usability Shared Service Pilot

ACL Data

FY 2019: $1.0 million
NONRECURRING EXPENSES FUND

262 

 

ACL Data is a critical tool for business intelligence, analysis and presentation of data from 

different programs and sources – a capability established as a requirement for transformation by 

ACL as part of the President’s Management Agenda and the “Reimagine HHS” initiatives, 

particularly the Leveraging the Power of Data Strategic Shift.” In FY 2019, ACL continued the 

foundational work of organizing and categorizing administrative and programmatic data to 

support the implementation of ACL Data, addressing data governance, and exploring the 

technology required to develop a “data lake.” 

ACL Older Americans Act Performance System (formerly ACL Titles and ACL 

Administrative Data Reporting System)

FY 2019: $1.5 million 

Consistent with ACL original FY 2016 proposal for this project, the additional NEF funds were 

used to complete development and implementation of the new system to enable reporting for the 

three sets of formula grant programs authorized by Titles III, VI, and VII of the OAA. 

Development enabling the performance reporting of grants from all three titles of the OAA was 

completed in FY 2019. The ACL OAAPS module supporting Title VII was put into production in 

July 2019; the Title VI module has been tested and will enter production in April 2020; and the 

Title III module has been tested and will enter production in October 2021. 

The planning, development, and implementation of the ACL OAAPS project is wholly funded by 

the NEF.

ACL Reporting Enhancements 

FY 2019: $1.0 million

The current release of ACL Reporting supports six programs across two ACL Centers and greatly 

simplifies the submission of program plans and performance reports. The work undertaken in FY 

2019 completed the initial scope of work for collecting performance reporting data from ACL’s 

disability programs. 

ACL.gov Enhancements 

FY 2019: $0.5 million 

In FY 2019 ACL and its contractor completed enhancements to ACL.gov that: 

• Enhanced the security of the system;

• Provided a "self-serve" option for members of the public seeking to contact ACL for 

information about services. This will connect people to the information they need 

immediately, and reduce the manpower requirements for responding to inquiries; 

• Simplified the process for requesting an ACL leader to speak at an event; 
NONRECURRING EXPENSES FUND

263 

 

• Made updates to existing content to improve the currency and accuracy of ACL.gov, 

including fully incorporating content for all ACL programs representing our aging and 

disability communities; and

• Increased the consistency of content between programs across the agency. 

ACL Knowledge Management

FY 2019: $0.5 million 

In FY 2019, ACL completed development a modern, cloud-based platform to support the ACL 

Knowledge Management business requirement. In addition, one administrative workflow 

supporting event planning for ACL senior leaders was developed and implemented, and a system 

to coordinate and catalogue requests for technical assistance and responses was planned and 

designed. 

HHS Accessibility and Usability Shared Service Pilot 

FY 2019: $0.35 million 

In FY 2019, ACL and the HHS Office of the CIO undertook planning and market research required 

to develop a business case and a pilot for the Accessibility and Usability Shared Service (FY 2020) 

for consideration within ACL and HHS. Due to competing priorities at both ACL and the HHS 

OCIO, work on the business case and pilot was put on hold. None of the $350,000 was expended 

during FY 2019.
264 

 

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SUPPLEMENTARY TABLES

265 

 

Supplementary Tables
SUPPLEMENTARY TABLES

266 

Object Classification Table - Direct

Administration for Community Living 

(Dollars in Thousands)

Budget Authority by Object

FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

FY 2021 +/- 

FY 2020

Personnel compensation:

Full-time permanent (11.1).................................. 20,745 22,228 22,831 603

Other than full-time permanent (11.3)................... 835 894 919 24

Other personnel compensation (11.5).................. 290 311 320 8 

Military personnel (11.7).....................................

Special personnel services payments (11.8).........

Subtotal personnel compensation................ 21,870 23,434 24,069 635

Civilian benefits (12.1)........................................... 6,705 7,206 7,402 195

Military benefits (12.2)...........................................

Benefits to former personnel (13.0)........................ 20

Total Pay Costs................................................... 28,595 30,640 31,471 831

Travel and transportation of persons (21.0).............. 407 418 441 23

Transportation of things (22.0)................................ 1 1 1 0 

Rental payments to GSA (23.1)............................. 3,258 3,350 3,674 324

Rental payments to Others (23.2)...........................

Communication, utilities, and misc. charges (23.3).. 85 87 94 7 

Printing and reproduction (24.0).............................. 5 5 7 2 

Other Contractual Services:

Advisory and assistance services (25.1)............... 32,298 33,211 35,446 2,235

Other services (25.2).......................................... 193 199 218 19

Purchase of goods and services from

government accounts (25.3)............................. 11,445 11,769 12,983 1,214

Operation and maintenance of facilities (25.4)....... 1 1 1 0 

Research and Development Contracts (25.5)........

Medical care (25.6)............................................

Operation and maintenance of equipment (25.7)... 9 9 9 0 

Subsistence and support of persons (25.8)...........

Subtotal Other Contractual Services............ 43,946 45,189 48,656 3,468

Supplies and materials (26.0)................................. 44 45 49 4 

Equipment (31.0).................................................. 1 5 7 2 

Land and Structures (32.0) ...................................

Investments and Loans (33.0)................................

Grants, subsidies, and contributions (41.0)............. 2,085,629 2,143,375 2,023,806 (119,569)

Interest and dividends (43.0)..................................

Refunds (44.0)......................................................

Total Non-Pay Costs........................................... 2,133,375 2,192,475 2,076,736 (115,739)

Total Budget Authority by Object Class.............. 2,161,970 2,223,115 2,108,207 (114,908)
SUPPLEMENTARY TABLES

267 

Salaries and Expenses – Direct

Administration for Community Living 

(Dollars in Thousands)

FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

FY 2021 

+/- FY 

2020

Personnel compensation:

Full-time permanent (11.1).................................. 20,745 22,228 22,831 603

Other than full-time permanent (11.3)................... 835 894 919 24

Other personnel compensation (11.5).................. 290 311 320 8 

Military personnel (11.7).....................................

Special personnel services payments (11.8).........

Subtotal personnel compensation................ 21,870 23,434 24,069 635

Civilian benefits (12.1)........................................... 6,705 7,206 7,402 195

Military benefits (12.2)...........................................

Benefits to former personnel (13.0)........................ 20

Total Pay Costs................................................... 28,595 30,640 31,471 831

Travel and transportation of persons (21.0).............. 407 418 441 23

Transportation of things (22.0)................................ 1 1 1 0 

Rental payments to GSA (23.1)............................. 3,258 3,350 3,674 324

Rental payments to Others (23.2)...........................

Communication, utilities, and misc. charges (23.3).. 85 87 94 7 

Printing and reproduction (24.0).............................. 5 5 7 2 

Other Contractual Services:

Advisory and assistance services (25.1)............... 32,298 33,211 35,446 2,235

Other services (25.2).......................................... 193 199 218 19

Purchase of goods and services from

government accounts (25.3)............................. 11,445 11,769 12,983 1,214

Operation and maintenance of facilities (25.4)....... 1 1 1 0 

Research and Development Contracts (25.5)........

Medical care (25.6)............................................

Operation and maintenance of equipment (25.7)... 9 9 9 0 

Subsistence and support of persons (25.8)...........

Subtotal Other Contractual Services............ 43,946 45,189 48,656 3,468

Supplies and materials (26.0)................................. 44 45 49 4 

Total Non-Pay Costs........................................... 47,745 49,096 52,923 3,828

Total Salary and Expense.................................. 76,340 79,736 84,395 4,659

Direct FTE........................................................... 168 177 180 3 
SUPPLEMENTARY TABLES

268 

Detail of Full Time Equivalents (FTE)

Administration for Community Living

2019 

Actual 

Civilian

2019 

Actual 

Military

2019 

Actual 

Total

2020 

Est. 

Civilian

2020 

Est. 

Military

2020 

Est. 

Total

2021 

Est. 

Civilian

2021 

Est. 

Military

2021 

Est. 

Total

Immediate Office of the Administrator

Direct: 14.0 14 15 15 15 15

Reimbursable: 0 0 0 0 0 0

Total:........................................................ 14.0 0 14.0 15.0 0 15 15.0 0 15

Administration on Aging

Direct: 19.9 19.9 32 32 35 35

Reimbursable: 4.3 4.3 4.5 4.5 4.5 4.5

Total:........................................................ 24.2 24.2 36.5 0 36.5 39.5 0 39.5

Administration on Disabilities

Direct: 21.0 21.0 26 26 26 26

Reimbursable: 1.6 1.6 1.6 1.6 1.6 1.6

Total:........................................................ 22.6 0 22.6 27.6 0 27.6 27.6 0 27.6

Center for Policy and Evaluation

Direct: 8.0 8.0 13 13 13 13

Reimbursable: 4.2 4.2 4.2 4.2 4.2 4.2

Total:........................................................ 12.2 0 12.2 17.2 0 17.2 17.2 0 17.2

Center for Management and Budget

Direct: 35.7 35.7 39 39 42 42

Reimbursable: 0 0.0 0 0 0 0

Total:........................................................ 35.7 0 35.7 39.0 0 39.0 42.0 0 42

Center for Innovation and Partnerships

Direct: 8.7 8.7 8 8 8 8

Reimbursable: 12.0 12.0 12.0 12 12.0 12

Total:........................................................ 20.7 0 20.7 20.0 0 20 20.0 0 20

Center for Regional Operations

Direct: 21.9 21.9 10.0 10.0 10.0 10

Reimbursable: 0 0.0 0 0 0 0

Total:........................................................ 21.9 0 21.9 10.0 0 10.0 10.0 0 10

National Institute on Disability, Independent Living, 

and Rehabilitation Research

Direct: 28.8 28.8 24 24 24 24

Reimbursable: 0 0 0 0 0 0

Total:........................................................ 28.8 0 28.8 24.0 0 24 24.0 0 24

ACL FTE 

Total............................................. 180.0 0.00 180.0 189.3 0.00 189.3 195.3 0.00 195.3

 

Average GS Grade 

 

FY 2017 13.1

FY 2018 13.1

FY 2019 13.3

FY 2020 13.2

FY 2021 13.2

 

 

 

 

 
SUPPLEMENTARY TABLES

269 

Detail of Positions

Administration for Community Living

FY 2019

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

Executive level I 0 0 0

Executive level II 0 0 0

Executive level III 0 0 0

Executive level IV 1 1 1

Executive level V 0 0 0 

Subtotal Executive Level 

Positions. 1 0 0

Total - Exec. Level Salaries 158,500 158,500 158,500

SES............................................... 6 7 7 

Subtotal SES positions................. 6 7 7

 Total - ES Salary 1,042,864 1,219,864 1,222,598

GS-15 25 28 28

GS-14 52 54 55

GS-13 46 57 61

GS-12 23 29 30

GS-11 7 8 8

GS-10 1 1 1

GS-9 3 2 2

GS-8 0 0 0

GS-7 1 2 2

GS-6 0 0 0

GS-5 0 0 0

GS-4 0 0 0

GS-3 0 0 0

GS-2 0 0 0

GS-1 0 0 0 

Subtotal 158 181 187

 Total - GS Salary $19,395,902 $ 22,214,260 $22,846,426

Average ES salary $ 173,811 $ 174,266 $ 174,657 

Average GS grade 13.3 13.2 13.2

Average GS salary $ 122,759 $ 122,731 $ 122,173 
SUPPLEMENTARY TABLES

270 

FTE Funded by P.L. 111-148 and Any Supplementals

Administration for Community Living 

FY 2010 FY 2011 FY 2012

Program Section Total FTEs CEs Total FTEs CEs Total FTEs CEs

Pre-existing programs funded by ACA (Mandatory)

 National Clearinghouse for Long-Term Care Information Title VIII $ - 0 0 $ 3,000 0 0 $ 3,000 1 0

 Medicare Improvements for Patients & Providers Act Programs Section 3306 $ - 0 0 $ - 0 0 $ - 0 0

New programs authorized and funded by ACA (Mandatory)

 Aging and Disability Resource Centers Section 2405 $ 10,000 0 0 $ 10,000 3 0 $ 10,000 4 0

New programs funded from the PPHF under ACA (Discretionary)

 Adult Protective Services (Prevention & Public Health Fund) Section 4002 $ - 0 0 $ - 0 0 $ 6,000 0 0

 Chronic Disease Self-Management Education (PPHF) Section 4002 $ - 0 0 $ - 0 0 $ 10,000 0 0

 Alzheimer's Disease Initiative--Supportive Services (PPHF) Section 4002 $ - 0 0 $ - 0 0 $ - 0 0

 Alzheimer's Disease Initiative--Communications (PPHF) Section 4002 $ - 0 0 $ - 0 0 $ 4,000 0 0

 Falls Prevention--(PPHF) Section 4002 $ - 0 0 $ - 0 0 $ - 0 0

Programs authorized by ACA but funded by other sources (Discretionary)

 Elder Justice Initiative/Adult Protective Services Subtitle H, Sections 

6701-6703 $ - 0 0 $ - 0 0 $ - 0 0

FY 2013 FY 2014 FY 2015

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 $ 86 0 0 $ - 0 0 $ - 0 0

 Medicare Improvements for Patients & Providers Act Programs Section 3306 $ 25,000 0 0 $ - 0 0 $ - 0 0

New programs authorized and funded by ACA (Mandatory)

 Aging and Disability Resource Centers Section 2405 $ 9,490 4 0 $ 9,280 3 0 $ - 0 0

New programs funded from the PPHF under ACA (Discretionary)

 Adult Protective Services (Prevention & Public Health Fund) Section 4002 $ 2,000 0 0 $ - 0 0 $ - 0 0

 Chronic Disease Self-Management Education (PPHF) Section 4002 $ 7,086 1 0 $ 8,000 0 0 $ 8,000 0 0

 Alzheimer's Disease Initiative--Supportive Services (PPHF) Section 4002 $ - 0 0 $ 10,500 0 0 $ 10,500 0 0

 Alzheimer's Disease Initiative--Communications (PPHF) Section 4002 $ 150 0 0 $ 4,200 0 0 $ 4,200 0 0

 Falls Prevention--(PPHF) Section 4002 $ - 0 0 $ 5,000 0 0 $ 5,000 0 0

Programs authorized by ACA but funded by other sources (Discretionary)

 Elder Justice Initiative/Adult Protective Services 6701-6703 $ - 0 0 $ - 0 0 $ 4,000 2 0

 
SUPPLEMENTARY TABLES

271 

 

Funded by P.L. 111-148 and Any Supplementals - Continued

Administration for Community Living 

FY 2016 FY 2017 FY 2018

Program Section Total FTEs CEs Total FTEs CEs Total FTEs CEs

Pre-existing programs funded by ACA (Mandatory)

 National Clearinghouse for Long-Term Care Information Title VIII $ - 0 0 $ - 0 0 $ - 0 0

 Medicare Improvements for Patients & Providers Act Programs Section 3306 $ - 0 0 $ - 0 0 $ - 0 0

New programs authorized and funded by ACA (Mandatory)

 Aging and Disability Resource Centers Section 2405 $ - 0 0 $ - 0 0 $ - 0 0

New programs funded from the PPHF under ACA (Discretionary)

 Adult Protective Services (Prevention & Public Health Fund) Section 4002 $ - 0 0 $ - 0 0 $ - 0 0

 Chronic Disease Self-Management Education (PPHF) Section 4002 $ 8,000 0 0 $ 8,000 0 0 $ 8,000 0 0

 Alzheimer's Disease Initiative--Supportive Services (PPHF) Section 4002 $ 10,500 0 0 $ 10,500 0 0 $ - 0 0

 Alzheimer's Disease Initiative--Communications (PPHF) Section 4002 $ 4,200 0 0 $ 4,200 0 0 $ - 0 0

 Alzheimer's Disease Program--(PPHF Allocation) Section 4002 $ - 0 0 $ - 0 0 $ 14,700 0 0

 Falls Prevention--(PPHF) Section 4002 $ 5,000 0 0 $ 5,000 0 0 $ 5,000 0 0

Programs authorized by ACA but funded by other sources (Discretionary)

 Elder Justice Initiative/Adult Protective Services 6701-6703 $ 8,000 1 0 $ 10,000 2.5 0 $ 12,000 2.1 0

FY 2019 FY 2020Annualized CR FY 2021

Program Section Total FTEs CEs Total FTEs CEs Total FTEs CEs

Pre-existing programs funded by ACA (Mandatory)

 National Clearinghouse for Long-Term Care Information Title VIII $ - 0 0 $ - 0 0 $ - 0 0

 Medicare Improvements for Patients & Providers Act Programs Section 3306 $ - 0 0 $ - 0 0 $ - 0 0

New programs authorized and funded by ACA (Mandatory)

 Aging and Disability Resource Centers Section 2405 $ - 0 0 $ - 0 0 $ - 0 0

New programs funded from the PPHF under ACA (Discretionary)

 Adult Protective Services (Prevention & Public Health Fund) Section 4002 $ - 0 0 $ - 0 0 $ - 0 0

 Chronic Disease Self-Management Education (PPHF) Section 4002 $ 8,000 0 0 $ 8,000 0 0 $ - 0 0

 Alzheimer's Disease Initiative--Supportive Services (PPHF) Section 4002 $ - 0 0 $ - 0 0 $ - 0 0

 Alzheimer's Disease Initiative--Communications (PPHF) Section 4002 $ - 0 0 $ - 0 0 $ - 0 0

 Alzheimer's Disease Program--(PPHF Allocation) Section 4002 $ 14,700 0 0 $ 14,700 0 0 $ - 0 0

 Falls Prevention--(PPHF) Section 4002 $ 5,000 0 0 $ 5,000 0 0 $ - 0 0

Programs authorized by ACA but funded by other sources (Discretionary)

 Elder Justice Initiative/Adult Protective Services 6701-6703 $ 12,000 2.35 0 $ 12,000 2.6 0 $ 14,000 3 0

 
SUPPLEMENTARY TABLES

272 

Programs Proposed for Elimination

Administration for Community Living 

Program FY 2020

Enacted Rationale 

Chronic Disease 

Self-Management 

Education148

148 This program was proposed for elimination in the FY 2019, and FY 2020 President's Budget.

8,000

CDSME programs provide models for helping 

people to better self-manage their chronic 

conditions. These models can be picked up by States 

under the expanded flexibilities allowing States to 

transfer nearly all of the funds they receive for 

HCBS, Nutrition, Preventive Health and Caregivers 

programs.

Elder Falls 

Prevention149

149 This program was proposed for elimination in the FY 2019, and FY 2020 President's Budget.

5,000

Falls prevention programs which educate 

participants on how to reduce falls and fall risk 

factors, can be picked up by States as needed under 

the expanded flexibilities allowing States to transfer 

nearly all of the funds they receive for HCBS, 

Nutrition, Preventive Health and Caregivers 

programs.
SUPPLEMENTARY TABLES

273 

Physicians Comparability

Administration for Community Living 

ACL does not have anything to submit 
SUPPLEMENTARY TABLES

274 

Performance Measures Proposed Changes

Administration for Community Living 

Unique 

Identifier

Change 

Type

Original in 

FY 2019 

CJ

Proposed Change Reason for Change HHS

Performance

Plan 

(APP/R)

Measure

R1a Discontinue ---- By 2023, generate new 

knowledge toward 

interventions to mediate the 

impact of opioid misuse by 

individuals with disabilities. 

OMB advised that two 

Opioid-related 

measures was not an 

accurate reflection of 

the scope of the work 

conducted by ACL's 

NIDILRR. This 

measure is to be 

replaced with a new 

measure R3.

No

R3 New ---- By 2023, grantee will 

generate new knowledge 

about the impact of (1) an 

ABLE account and (2) the 

joint impact of an ABLE 

account and financial 

management training on 

community living and 

participation of people with 

intellectual and 

developmental (I/DD) and 

cognitive disabilities. 

New measure reflecting 

a mission to promote 

effective use of new 

knowledge. The focus 

is on the outcome 

domain of community 

living.

No
GOOD ACCOUNTING OBLIGATIONS IN GOVERNMENT ACT

275 

 

Good Accounting Obligation in Government Act (GAO-IG Act) Report

Administration for Community Living 

The information below addresses the requirements of the Good Accounting Obligation in 

Government Act (GAO-IG Act; Public Law 115-414) to provide a report identifying each public 

recommendation issued by the Government Accountability Office (GAO) and federal Offices of 

Inspectors General (OIG) which remains unimplemented for one year or more from the annual 

budget justification submission date. The recommendations below apply specifically to this 

division of HHS. Please refer to the General Departmental Management budget justification for 

more information on the Department’s overall progress in implementing GAO and OIG 

recommendations.

Appendix 1: OIG-GAO Open Recommendations

Report 

Number Report Title Report 

Date

Recommendation 

Text

Concur / 

NonConcur

Impleme

ntation 

Timeline

Implement

ation 

Status

Implementation Updates and Constraints

GAO-18-

232

Older Adult 

Housing: Future 

Collaborations on 

Housing and 

Health Services 

Should Include 

Relevant 

Agencies and 

Define Outcomes

4/26/2018 The Secretary of 

Health and Human 

Services should 

work with HUD and 

USDA's Rural 

Development to 

define common 

outcomes and 

identify 

opportunities to 

include USDA in 

future collaborative 

efforts on older 

adult housing and 

health services.

Concur 2020 In Progress Promoting Aging in Place by Enhancing Access to Home 

Modifications (grant): In September 2018, HHS/ACL awarded a 

cooperative agreement to the University of Southern California 

Leonard Davis School of Gerontology to address barriers to home 

modification access and service delivery that support aging in 

place. A key objective of the project will be improving 

coordination and building new partnerships among federal, state, 

and local home modification programs and professionals. The 

project established a steering committee that includes 

representatives from HUD, CMS, and USDA. The first steering 

committee meeting was held on April 23. At the meeting 

participants discussed pressing challenges and opportunities for 

improving the coordination of home modification service delivery.

Home Care Cooperative Initiative: HHS/ACL and USDA 

collaboration on strategies to replicate Home Care co-ops in 

responses to shortages of direct service workers. The follow 

activities have occurred:

o ACL participated in the 3rd annual Home Care Co-op 

Conference held November 13-15, 2018 in Dulles, VA. 

o USDA, Rural Development presented during ACL’s National 

Respite Network Webinar, December 6, 2018

o ACL hosted a strategic planning meeting for Home Care 

Cooperative Initiative with USDA, Rural Development, February 

25, 2019, which resulted in a National Homecare Replication 

Initiative. This is a multi-year initiative to design, implement and 

scale the homecare cooperative model nationwide.

o ACL and USDA conducted a joint presentation at the national 

Village to Village Network Conference, September 18-20, 2019.

ACL and HUD Supportive Housing Collaboration:

o ACL is working with HUD to identify collaboration 

opportunities across local HUD entities and ACL’s No Wrong 

Door network. ACL/HUD are building off existing work where 

ACL mapped HUD’s 7 IWISH demonstration sites and crosswalked them with ACL’s NWD system and AoA’s Chronic Disease 

Self- Management Programs to encourage cross-pollination and 

leveraging of resources. ACL is exploring how to expand this 

effort to include additional IWISH sites.

o ACL continues to support HUD in promoting integrated housing 

opportunities through work on development and promotion of 

Notices of Funding Availability for 811 Mainstream Housing 

Vouchers and Project Rental Assistance for Section 811 Supportive 

Housing for Persons with Disabilities. ACL worked with multiple 

program offices in the development of the NOFAs and has 

disseminated the NOFAs to our networks and listserv.
GOOD ACCOUNTING OBLIGATIONS IN GOVERNMENT ACT

276 

 

Appendix 2: OIG-GAO Closed, Unimplemented Recommendations

Report 

Number

Report 

Title

Report 

Date Recommendation Text Implementation Status

Reason for nonimplementation

GAO-11-

237

OLDER 

AMERICAN

S ACT:

More Should 

Be Done to 

Measure the 

Extent of 

Unmet Need 

for Services

3/30/2011 To help ensure that agencies have adequate and consistent 

information about older adults' needs and the extent to which they 

are met, the Secretary of Health and Human Services should partner 

with other government agencies that provide services to Older 

Americans and, as appropriate, convene a panel or work group of 

researchers, agency officials, and others to develop consistent 

definitions of need and unmet need and to propose interim and longterm uniform data collection procedures for obtaining information 

on older adults with unmet needs for services provided from sources 

like Title III.

Closed, 

Unimplemented

Recommendation 

not feasible

HEHS-94-

37

OLDER 

AMERICAN

S ACT:

Title III 

Funds Not 

Distributed 

According 

to Statute

1/18/1994

AOA should revise its current method of calculating state grant 

funds under title III of the Older Americans Act to allot more funds 

in proportion to current elderly populations, as required by law, 

while still satisfying the statutory minimum requirements. Such a 

revised method should compute title III allotments first on current 

shares of states' elderly populations, then raise only those state 

allotments that do not meet the hold-harmless and/or 0.5-percent 

minimum funding levels, and, finally, lower allotments of 

Closed, 

Unimplemented

Non-concur
LEGISLATIVE PROPOSALS

277 

 

 

Legislative Proposals

FISCAL YEAR 2021 HHS LEGISLATIVE PROPOSAL

Administration for Community Living 

Inclusion of Program Evaluation and Performance Measurement Activities with 

Reserved Training and Technical Assistance Funds

Proposal: Explicitly authorize program evaluation and performance measurement as an allowable 

activity of funds currently appropriated for training and technical assistance to Centers for 

Independent Living (CILs) and Statewide Independent Living Councils (SILCs). 

Current Law: Section 711A(a) of the Rehabilitation Act, as amended (Rehabilitation Act), 29 

U.S.C. 796e-O, and Section 721(b) of the Rehabilitation Act, 29 U.S.C. 796f, requires that no less 

than 1.8 percent and not more than 2 percent of funds appropriated for the Independent Living 

Services program and the Centers for Independent Living (CILs) program be made available for 

training and technical assistance to SILCs and CILs. Neither section explicitly authorizes the use 

of such funds for program evaluation and/or performance measurement. 

Rationale: The current statute does not explicitly authorize Section 711A or Section 721(b) funds 

to be used for program evaluation and/or performance measurement of CILs and/or SILCs. This 

proposal would give the Administrator flexibility to conduct program evaluation and performance 

measurement activities. This proposal is consistent with language included in other ACL 

programs, such as the Older Americans Act, that enables ACL to conduct performance 

measurement and evaluation of the programs it funds under that Act.

It is consistent with the President’s initiative to improve operational efficiency and decrease 

unwarranted regulation and guidance, and with the HHS Secretary's Relmagine HHS initiative to 

streamline business processes in the execution of day-to-day operations.

Budget Impact: None 

Personnel Requirements: No change 

Effective Date: October 1, 2020 
LEGISLATIVE PROPOSALS

278 

 

 

FISCAL YEAR 2021 HHS LEGISLATIVE PROPOSAL

Administration for Community Living 

Removal of Requirement that Annual Grantee Compliance Reviews Occur Onsite

Proposal: Remove the requirement that Center for Independent Living annual grantee compliance 

reviews be conducted “onsite.” Allow the Administrator to determine the most effective method 

for annual grantee compliance reviews. 

Current Law: Section 706(c)(1) of the Rehabilitation Act of 1973, as amended ("Rehabilitation 

Act"), 29 U.S.C. 796d-1, requires the Administrator to conduct onsite compliance reviews of at 

least 15 percent of the Centers for Independent Living funded under section 722 of the 

Rehabilitation Act, 29 U.S.C. 796f-1, on an annual basis. 

Rationale: As the program has increased the total number of grantees, it has become increasingly 

difficult to meet the statutory requirement to conduct onsite compliance reviews of at least 15 

percent of grantees on an annual basis. This proposal creates a more efficient monitoring process 

by shifting resources to support a three-tier compliance review system that incorporates a grantee 

dashboard applicable to 100 percent of grantees, targeted compliance reviews determined by the 

issue of concern, and comprehensive onsite reviews, when applicable. The requirement for onsite 

compliance reviews was added to the Rehabilitation Act in 1988 when the number of grantees was 

approximately 52, requiring eight annual onsite compliance reviews. In 2019, there are 282 

grantees, requiring 42 annual onsite compliance reviews. Historically, the program has not met 

the requirement. As demonstrated by pilot desktop reviews conducted in FY2019, today’s 

technology provides tools and options supporting dynamic, efficient remote compliance reviews 

that were not available in 1988. This proposal gives the Administrator the authority to determine 

the most effective method for conducting annual compliance reviews, including allowing for 

remote reviews, while continuing to ensure that CILs are monitored and complying with the 

Rehabilitation Act. 

It is consistent with the current Administration's priorities to improve operational efficiency and 

decrease unwarranted regulation and guidance and with the HHS Secretary's Relmagine HHS 

initiative to streamline business processes in the execution of day-to-day operations.

Budget Impact: None 

Personnel Requirements: No change 

Effective Date: Upon enactment 
LEGISLATIVE PROPOSALS

279 

 

 

FISCAL YEAR 2021 HHS LEGISLATIVE PROPOSAL

Administration for Community Living 

Provide Direct Training and Technical Assistance to Centers for Independent Living

Proposal: Add the flexibility for direct training and technical assistance (T/TA) by program staff 

to the Centers for Independent Living program authorization. Allow the Administrator to 

determine the most appropriate funding method for delivery of training and technical assistance to 

Centers for Independent Living. 

Current Law: Title VII Subchapter B, Section 711A(a) of the Rehabilitation Act, 29 U.S.C. 796e0, requires that no less than 1.8 percent and not more than 2 percent of funds appropriated and 

made available for use under Subchapter B be reserved, either directly or through grants, contracts 

or cooperative agreements, to provide T/TA to Statewide Independent Living Councils. In 

contrast, Section 721(b) of the Rehabilitation Act, 29 U.S.C. 796f, requires that no less than 1.8 

percent and not more than 2 percent of funds appropriated for use under Subchapter C be reserved 

to provide, through grants, contracts or cooperative agreements, T/TA to Centers for Independent 

Living. 

Rationale: Current statute imposes unnecessary restrictions over T/TA funding mechanisms for 

the Centers for Independent Living program. Historically the full T/TA funding has been awarded 

through a cooperative agreement. This proposal gives the Administrator authority to diversify 

T/TA and utilize funds to support necessary activities by program staff. By adding the language 

“either directly” to the funding mechanisms, the proposal would resolve the inconsistency between 

T/TA delivery by the two Independent Living programs, increasing program efficiency. 

It is consistent with the Administration’s priorities to improve operational efficiency and with the 

HHS Secretary's Relmagine HHS initiative to streamline business processes in the execution of 

day-to-day operations. 

Budget Impact: None 

Personnel Requirements: No change 

Effective Date: October 1, 2020 
LEGISLATIVE PROPOSALS

280 

 

 

FISCAL YEAR 2021 DHHS LEGISLATIVE PROPOSAL

Administration for Community Living 

Enhance Resources for Evaluation, Training & Technical Assistance

Proposal: Increase the allowance for evaluation from 1⁄2 percent to 1 percent for enhanced 

evaluation and data collection. 

Current Law: Section 206(g) of the Older Americans Act permits the use of up to 1⁄2 of 1 percent 

to conduct evaluations of programs and to review their effectiveness.

Rationale: Due to the increasing demographics and complexity of needs of the aging population, 

the demand for information about aging programs and their effectiveness is increasing. As a result, 

additional resources are needed to more quickly and comprehensively review programs and 

provide data that supports administration and congressional actions for addressing these changing 

needs.

Budget Impact: None. 

This is a non-budget related discretionary item that is budget neutral. It would result in reduced 

levels of funding passed through to States for services. No increases in the total budget are needed 

to implement this proposal. The amount is taken from existing amounts appropriated. The 

maximum amount of the allowances based on FY 2020, if full authority was utilized:

• 1⁄2% -- $7,681,131 

• 1% -- $15,362,262 

Personnel Requirements: No change. 

Effective Date: Effective upon enactment. 

Suggested draft bill language: 

Section 206(g) -- 

From the total amount appropriated for each fiscal year to carry out title III, the Secretary 

may use such sums as may be necessary, but not to exceed 1⁄2 of 1 percent of such amount, 

for purposes of conducting evaluations under this section, either directly or through grants 

or contracts. 
LEGISLATIVE PROPOSALS

281 

 

 

FISCAL YEAR 2021 HHS LEGISLATIVE PROPOSAL

Administration for Community Living 

Medicare Improvements for Patients and Providers Act (MIPPA) Program

Proposal: Continue operation of the Medicare Improvements for Patients and Providers Act 

(MIPPA) program, which provides additional funding to State Health Insurance Assistance 

Programs (SHIPs), Area Agencies on Aging (AAAs), and Aging and Disability Resource Centers 

(ADRCs) to conduct one-on-one counseling specifically targeting hard-to-reach beneficiaries; and 

to support the National Center for Benefits Outreach and Enrollment (NCBOE). Through FY 

2021, provide mandatory appropriations at the current level of $37.5 million. 

Current Law: Medicare Improvements for Patients and Providers Act of 2008, Section 119 (42 

U.S.C. 1395b-3 note) as amended.

Rationale: MIPPA funding provides targeted in-person enrollment assistance to Medicare 

beneficiaries who qualify for either the Medicare Savings Plans (MSP) or the Social Security Low‐

Income Subsidy (LIS). Beneficiaries are eligible for these programs if they have minimal assets 

and incomes below 135% of the Federal Poverty Level. Some individuals with slightly higher 

incomes may qualify for partial assistance under LIS. 

Three funding streams provide formula grants to States – to access the resources of Area Agencies 

on Aging (AAAs) and tribes, Aging and Disability Resource Centers (ADRCs), and State Health 

Insurance Assistance Programs (SHIPs) – to provide services to eligible beneficiaries. MIPPA 

funding is not used to support the day-day services of these entities, but to go beyond the assistance 

normally provided, both in terms of identifying older Americans and those with disabilities in 

need, and to provide much more intensive counseling and enrollment assistance (up to several 

hours per beneficiary) that focuses on those qualifying for the Medicare LIS or MSP.

A fourth funding stream under MIPPA provides for a National Center for Benefits Outreach and

Enrollment (NCBOE) which coordinates efforts to inform older adults and beneficiaries with 

disabilities about the low-income benefits available under federal and state programs, with an 

emphasis on providing information on programs to help Medicare beneficiaries access their 

Medicare coverage, specifically the LIS and MSP. In addition, the NCBOE supports a nationwide 

network of 87 local Benefit Enrollment Centers which provide low-income benefits information 

and enrollment assistance to the public. 

MIPPA, initially passed in 2008, provided funding beginning in FY 2009 to extend the reach of 

these existing programs to provide targeted in-person enrollment assistance to Medicare 

beneficiaries, and has been funded nearly annually through a series of funding or extenders bills. 

Funding provided through MIPPA does not replace base funding that is used to provide other 
LEGISLATIVE PROPOSALS

282 

 

 

services through these programs, and without the additional MIPPA funding, SHIPs, ADRCs, and 

AAAs may not be able to carry out these targeted outreach and counseling activities, meaning that 

beneficiaries could lose this assistance and bear higher out of pocket costs. Most recently, the 

Further Consolidated Appropriations Act, 2020 extended funding for MIPPA to May 22,2020 

leaving the MIPPA program unfunded, without further action by the Congress, after that date. 

Continued funding is needed so that the beneficiaries eligible for these programs do not lose indepth assistance with enrolling in the programs that MIPPA dollars support. To the extent that 

these individuals fail to enroll, each beneficiary would lose not only an estimated $4,000 annually 

in LIS savings (per SSA estimates) and/or $437 per month in Medicare Part A Premium Savings 

and $135.50 per month in Part B Premiums through MSP, but also additional assistance with 

Medicare Part A and B copayments and deductibles and benefits from other programs to which 

they are also entitled.

Budget Impact: $13.4 M in FY 2020, $37.5 M in FY 2021 

Personnel Requirements: No change 

Effective Date: October 1, 2020
SIGNIFICANT ITEMS

283 

 

 

Significant Items

1 -Protection of Vulnerable Older Americans. The agreement includes a $1,000,000 increase 

for expansion of the ombudsman program to assisted living facilities.

Action to be Taken: ACL will use the additional funding to begin to expand the ombudsman 

program to assisted living facilities.

2 - National Family Caregiver Strategy. The agreement includes $100,000 for the Family 

Caregiving Advisory Council.

Action to be Taken: ACL appreciates the continued support for the Family Caregiving Advisor 

Counsel and will use the additional funding as intended to support the activities of the Council.

3 - Aging Network Support Activities. Within the total for Aging Network Support Activities 

(ANSA), the agreement provides not less than $5,000,000 for the Holocaust Survivor's Assistance 

program. 

Action to be Taken: The Administration for Community Living will use the funding to support 

the Holocaust Survivor’s Assistance program. 

4 - Alzheimer's Disease Program.-The agreement includes up to $2,000,000 for the National 

Alzheimer's Call Center and a $3,000,000 increase for expanding direct services, including respite 

care, for paid and unpaid caregivers. 

Action to be Taken: From the additional funding provided for the Alzheimer’s Disease Program 

in the final appropriation, ACL will continue to provide support for the Alzheimer’s Call Center 

and for efforts to support and/or expand direct services, including respite care, for paid and 

unpaid caregivers. 

5 - Paralysis Resource Center.-The agreement includes $9,700,000 for the Paralysis Resource 

Center (PRC) and directs ACL to continue support for the National PRC at not less than 

$8,700,000. 

Action to be Taken: The Administration for Community Living plans on funding the National 

Paralysis Resource Center at no less than $8,700,000 consistent with the Committee guidance. 
SIGNIFICANT ITEMS

284 

 

 

6 - Developmental Disabilities State Councils. –ACL is instructed to provide not less than 

$700,000 for technical assistance and training for the State Councils on Developmental 

Disabilities.

Action to be Taken: Consistent with direction provided by both the Committee and the 

Developmental Disabilities Assistance and Bill of Rights Act, the Administration for Community 

Living will provide at least $700,000 for technical assistance and training for the State Councils 

on Developmental Disabilities in FY 2020. 

7 - Developmental Disabilities Protection and Advocacy – “The Committee encourages the 

Department to ensure that protection and advocacy program grantees provide services for people 

with disabilities to navigate Medicaid systems, including in rural and urban States with Medicaid 

managed care arrangements. The Committee requests the Department provide a report on the 

extent to which protection and advocacy grantees currently provide legal, administrative, and other 

human rights services to help individuals with disabilities understand and navigate their respective 

State’s Medicaid system. This report should be submitted to the Committees on Appropriations of 

the House of Representatives and the Senate no later than 90 days after enactment. (FY2020 LaborHHS Appropriations Act, Report p. 185/Final FY 2020 Labor-HHS Appropriations Act, Report 

117)”

Action to be Taken: ACL will provide the requested report as soon as is practicable on the range 

of P&A legal advocacy services related to Medicaid services and supports that were provided to 

individuals with intellectual and developmental disabilities. The range of legal advocacy services 

to individuals with intellectual and developmental disabilities includes self-advocacy 

assistance, limited advocacy, administrative remedies, negotiation, mediation/alternative dispute 

resolution, and litigation. In FY 2018, 40 P&As addressed 1,175 individual complaints cases 

related to Medicaid. For example, the Louisiana P&A provided direct legal representation in 37 

cases representing individuals with intellectual and developmental disabilities who were being 

denied or faced the loss of necessary Medicaid benefits.

8 - Intermediate Care Facilities—“The Department is encouraged to factor the needs and desires 

of patients, their families, caregivers, legal representatives, and other stakeholders, as well as the 

need to provide proper settings for care, into its enforcement of the Developmental Disabilities 

Act. (FY2020 Labor-HHS Appropriations Act, Report p. 185/Final FY 2020 Labor-HHS 

Appropriations Act, Report p. 117)” 

Action to be Taken: ACL will continue to work to expand home- and community-based services 

and supports and to improve the quality of long-term services and support. ACL communicates 

regularly with a variety of stakeholders, including groups with vested interests in the quality of life 

of individuals with intellectual and developmental disabilities. ACL will continue to communicate 
SIGNIFICANT ITEMS

285 

with various stakeholders and use their insights in the oversight of the programs authorized under 

the Developmental Disabilities Assistance and Bill of Right Act. 

9 - University Centers for Excellence in Developmental Disabilities.-The agreement includes 

$1,000,000 to establish a pilot program to support partnerships between existing University 

Centers for Excellence in Developmental Disabilities and highly-qualified, non-profit service 

providers to develop models that offer individuals with Intellectual and Developmental Disabilities 

and their families with community-based adult transition and daytime services to support 

independent living. 

Action to be Taken: ACL will apply the additional funding provided for UCEDDs to a pilot 

program to support partnerships between existing University Centers for Excellence in 

Developmental Disabilities and highly-qualified, non-profit service providers as intended by the 

Committee. 

10 - Aging Disability Resource Centers –“The Committee urges ACL to improve coordination 

among ADRCs, area agencies on aging, and centers for independent living to ensure that there 

is ‘‘no wrong door’’ to access services. (FY2020 Labor-HHS Appropriations Act, Report p. 184).” 

Action to be Taken: ACL efforts and activities to improve and enhance coordination among 

ADRCs, Area Agencies on Aging and Centers for Independent Living to ensure there is a “no 

wrong door” to access long term services and supports include: 

• In FY 2017, ACL developed guidance outlining four key elements of a No Wrong Door 

(NWD) System. The guidance provides a framework for states to use to adopt a NWD 

System. These elements emphasize the need for coordination of multiple agencies and 

organizations at the state and local level, including ADRC, AAAs and CILs. The four 

key elements include 1) state governance and administration; 2) public outreach and 

coordination with key referral sources; 3) person-centered counseling; and 4) streamlined 

eligibility for public programs. Since release of this guidance, ACL has provided targeted 

technical assistance to support states in fully adopting these key elements. States have 

demonstrated that NWD Systems facilitate more streamlined services for individuals, 

improve individuals’ quality of life, and strengthen LTSS networks, all by formalizing 

relationships among ADRCs, AAAs, CILS and other community based organizations, and 

improving administrative efficiency through established state governing bodies for NWD 

Systems. No Wrong Door System Key Elements can be found at:

https://nwd.acl.gov/pdf/NWD-National-Elements.pdf

• In FY 2019, ACL: 

o Coordinated a series of educational webinars that targeted outreach and 

engagement of CILs to educate and inform then about the Veteran Directed Care 
SIGNIFICANT ITEMS

286 

(VDC) program. Over 230 CIL Directors attended these webinars and 

approximately half have expressed interest in becoming VDC providers. 

o Collaborated with the AARP Public Policy Institute on The Long-Term Services 

and Supports State Scorecard. The scorecard helps states to evaluate the 

performance of their LTSS access systems (i.e. NWD Systems) in the areas of state 

governance and administration, target populations, public outreach and 

coordination with key referral sources, person-centered counseling, and 

streamlined eligibility for public programs. The scorecard provides comparable 

state data to benchmark performance, measure progress, and identify areas for 

improvement. Preliminary data indicates that most states improved their overall 

scores between the 2017 and 2020 scorecards. The top ten scoring states all 

reported fully or partially functioning multi-state agency bodies that coordinate the 

State government’s work to develop a single NWD System for all people needing 

LTSS, regardless of income, age, or disability. In addition, the top ten scoring states 

have built strong collaborative partnerships between the state aging and disability 

agencies and the state Medicaid agency. 

o AARP State Scorecard Reference (June 2017): Picking Up the Pace of Change, 

2017: A State Scorecard on Long-Term Services and Supports for Older Adults, 

People with Physical Disabilities, and Family Caregivers. Retrieved from 

http://www.longtermscorecard.org/2017-scorecard. 

• For FY 2020, ACL:

o Will propose a funding opportunity to target and support states in improving their 

NWD System governance and administration structure to enhance statewide data 

collection capabilities and to promote network development across communitybased organizations. ACL envisions this funding opportunity will support states 

in improving their governance structures in order to establish state leadership, 

management and oversight of NWD System functions, making the overall system 

more consumer-driven and cost effective. 

o Will continue providing technical assistance and support to states and aging and 

disability network agencies (e.g., AAAs, CILs, and ADRCs) in areas of business 

acumen that will enhance NWD System key elements.

11 - Reorganization.—“The Committee is disappointed that the ACL reorganization was not 

included in the President’s budget request. For the purposes of transparency with the public and in 

accordance with the spirit of an annual budget justification and review process, the Committee

encourages ACL to submit future reorganization proposals through CJs so that Congress may fully 

consider any reorganization in the context of the annual budget process and with input from 

stakeholders. The Committee strongly urges ACL to engage with stakeholders as ACL implements 

its reorganization plan. (FY2020 Labor-HHS Appropriations Act, Report p. 181)” 

Following executive branch approval of the ACL reorganization, notification to Congress occurred 

via letter on April 3, 2019, as required by law. The ACL reorganization was announced in the 
SIGNIFICANT ITEMS

287 

Federal Register on May 8, 2019 and implementation was completed August 4, 2019. ACL’s 

statement of organization, functions, and delegations of authority are available at: 

https://acl.gov/about-acl/organization. 

Action to be Taken: The ACL reorganization was focused on the goal of promoting an efficient 

operating platform that allows ACL to enhance services and functions as well as reduce duplication 

and improve consistency, responsiveness, efficiency and overall impact. 

ACL’s reorganization did not involve any changes to ACL’s overall number of FTEs. The 

reorganization did not involve any significant changes to its budget. No staff experienced a 

demotion or reduction in salary or benefits. 

While the overall number of ACL’s FTEs did not change, the reorganization did involve sensitive 

personnel decisions. As a result, ACL deemed it to be inappropriate to include people outside of 

ACL's executive leadership in discussions about the reorganization until the week of its 

announcement. However, since the reorganization was announced, ACL actively engaged with 

stakeholders to explain the staff and organizational changes and address concerns. This 

engagement began with telephone meetings with a wide range of aging and disability organizations

on May 9, the day after the reorganization was posted in the Federal Register, and engagement 

continued in the weeks and months thereafter. This engagement included sharing updates and 

answering questions about the implementation of the reorganization broadly at national 

conferences of aging and disability stakeholders in June, July and August, and has also included 

individual grantee outreach as applicable last Summer and Fall regarding the ACL team member 

to contact for regarding their grant award and technical assistance.

In these conversations, ACL shared that the reorganization did not alter the organization’s mission, 

functions, authorizing statutes, programs, or funding. ACL continues to be fully committed to 

community living for everyone regardless of age or disability. Some organizational units within 

ACL have been renamed to allow for consistent nomenclature across the organization, and to 

update office titles to reflect the current work of the respective office. Concerns regarding the 

provision of technical assistance and training by the regional offices were also addressed. The 

expansion of the regional administrator role from five offices to all 10 regional offices enhances 

ACL presence in the regions. 

Previous to this reorganization, ACL regional administrators only focused on Older Americans 

Act activities, while all disability issues were handled through the central office. With this 

reorganization, ACL has put both a disability and older adult focus in all 10 regions, bringing new 

awareness to regional offices, states and stakeholders of the resources and technical assistance 

available from ACL. This enhanced focus provides more synergy with regional activity and 

support. 

ACL does anticipate some immediate and forthcoming consistency and improved efficiency 

through the reassignment of positions in two areas. Effective August 4, ACL centralized all grants 
SIGNIFICANT ITEMS

288 

officer positions into the Office of Grants Management by reassigning three positions from ACL’s 

research arm, the National Institute on Disability, Independent Living, and Rehabilitation Research 

(NIDILRR). 

ACL also had 23 FTEs across the 10 regions, all focused on technical assistance related to older 

adult issues. Through the reorganization, 18 of these FTE positions have been relocated to ACL’s 

headquarters in Washington DC effective August 4, which centralizes all state liaison work on 

aging programs to allow for enhanced responsiveness to requests, with more consistency, and the 

capability of cross training is enhanced. In addition, with the co-location of all technical assistance 

and programmatic staff, opportunities for aging and disability services to learn from one another 

improves dramatically and enhances ACL effectiveness and impact. 

During the first year following the reorganization ACL is negotiating new lease agreements in 

each of the 10 HHS regions as a result of the reduced footprint needed moving forward. ACL will 

not be in a position to share the net outcome of these changes until the lease negotiations are 

finalized and actual cost of changing from one office location to another is complete.
289 

 

 

Text Description Administration for Community Living Organizational Chart

 (Page 1) 

The U.S. Administration for Community Living (ACL) is led by the Administrator, who also 

serves as the Assistant Secretary for Aging. The Administrator is directly supported by the 

Principal Deputy Administrator. The following report to the Office of the Administrator:

• Administration on Aging, which includes four offices:

o Office of Supportive and Caregiver Services

o Office of Nutrition and Health Promotion Programs

o Office of Elder Justice and Adult Protective Services

o Office of American Indian, Alaskan Native and Native Hawaiian Programs

• Administration on Disabilities, which includes three offices:

o Office of Intellectual and Developmental Disability Programs

o Office of Independent Living Programs 

o Office of Disability Services Innovations

• Center for Innovation and Partnership, which includes three offices: 

o Office of Interagency Innovation

o Office of Network Advancement

o Office of Healthcare Information and Counseling

• Center for Management and Budget, which includes four offices: 

o Office of Budget and Finance 

o Office of Grants Management

o Office of Administration and Personnel 

o Office of Information Resources Management

• Center for Policy and Evaluation, which includes two offices: 

o Office of Policy Analysis and Development

o Office of Performance and Evaluation

• Center for Regional Operations, which includes ten regional offices

• National Institute on Disability, Independent Living, and Rehabilitation Research, which 

includes two offices:

o Office of Research Administration

o Office of Research Sciences

• Office of External Affairs
290 

The Deputy Assistant Secretary for Aging also serves as the Director of the Office of Long-Term 

Care Ombudsman Programs, consistent with Section 201 of the Older Americans Act. 

The Administration on Disabilities is headed by a Commissioner who also serves as: 

• Commissioner of the Administration on Developmental Disabilities, as described by the 

Developmental Disabilities Act 

• Director of the Independent Living Administration, reporting directly to the ACL 

Administrator in carrying out those functions, consistent with Section 701A of the 

Rehabilitation Act.