DEPARTMENT

of HEALTH

and HUMAN

SERVICES

Fiscal Year

2022 

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 FY 2022 President’s Budget Request for the Administration for Community Living. The request 

of $3.1 billion in program level includes critical investments to support the President’s priorities on COVID-19 recovery, 

improving support to caregivers, and advancing equity across our work, with a focus on people with disabilities and older 

adults who also are marginalized due to race, ethnicity, sexual orientation, gender identity, poverty, and/or other factors. 

It also reflects ACL’s continued prioritization of programs that provide direct services and funds the staff to meet the 

needs of ACL’s growing leadership roles across the federal government on aging and disability policy. 

People with disabilities and older adults have been disproportionately -- and devastatingly -- affected by the pandemic. In 

addition to increased risk of serious illness and death from COVID-19, many faced serious threat of institutionalization as 

the pandemic disrupted the services that make it possible for them to live in the community. People with disabilities and 

older adults also have been socially isolated and have faced barriers to accessing the vaccine. The pandemic has also 

exacerbated the challenges faced by families and other informal caregivers. With the suspension of many formal services 

and supports, demands on caregivers have increased. Many struggled to balance caregiving responsibilities and 

employment, forcing many to leave the workforce to support their loved ones. 

The aging and disability networks and the programs ACL funds have been crucial in meeting fundamental needs 

throughout the pandemic, and they will play an equally critical role as we begin to recover. Demand has been dramatically 

increased throughout the pandemic, and the networks filled gaps created as locations that provide formal services in the 

community closed and informal supports became unavailable due to safety requirements. Much of that need will continue 

well into the recovery. In addition, the populations of older adults and people with disabilities continues to grow. Although 

many of the innovations and adaptations developed to continue service delivery during the pandemic have shown promise 

for increasing capacity and efficiency during normal operations, additional investment is needed to meet the increased 

demand for services. 

This budget request recognizes the ongoing need for in-home supportive services and nutrition services; information and 

referrals to a range of community supports; assistance with transitions from institutional and congregate settings to safer 

settings in the community; and education about and assistance with accessing vaccinations. It also expands support for 

informal caregivers, including family and Native American caregivers. Finally, it includes funding for several initiatives 

that specifically advance equity. This includes expansion of nutrition and supportive services programs for Tribal elders, 

establishment of three new Rehabilitation Research and Training Centers focused on addressing disparate outcomes for 

multiply marginalized people with disabilities, an evaluation of the cultural competence of ACL’s disability programs and 

those programs’ outreach to underserved populations, community partnership grants focused on promoting equity, and 

grants to improve voting access for people with disabilities, as well as enhancement of ongoing efforts to target Older 

Americans Act programs to those in greatest social and economic need. 

Our communities are stronger when everyone is included, everyone is valued, and everyone can contribute. ACL and I 

remain committed to making community living an option for every American, regardless of age or disability, race or 

ethnicity, gender identity or sexual orientation, income or any other factor, and this budget aligns with that commitment. 

Alison Barkoff 

Acting 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........................................................................................................

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. 3

Overview of Performance ............ 11

All Purpose Table ...................... 17

Appropriations Language ............ 19

Appropriations Language Analysis 25

Amounts Available for Obligation . 31

Summary of Changes .................. 32

Budget Authority by Activity ....... 33

Authorizing Legislation ............... 34

Appropriations History................ 36

Appropriations Not Authorized by Law.............................................................................................. 38

Program Authorizing Legislation Table.............................................................................................. 40

Health and Independence for Older Adults 

Health and Independence for Older Adults .......................................................................................... 43

Home and Community-Based Supportive Services............................................................................... 49

Nutrition Services.......................................................................................................................... 59

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 ....................................................................................................

Preventive Health Services . 75

Chronic Disease Self-Management Education......... 83

Falls Prevention 87

Native American Nutrition and Supportive Services 91

Aging Network Support Activities 97

Caregiver and Family Support Services

Caregiver and Family Support Services ............................................................................................ 105

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 .................................................................................... 

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Family Caregiver Support Services .............. 109

Native American Caregiver Support Services 119

Alzheimer’s Disease Program..................... 123

Lifespan Respite Care 127

Protection of Vulnerable Adults

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

.

.

 ...........................................

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................................................ 133

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Long-Term Care Ombudsman Program 137

Prevention of Elder Abuse and Neglect 145

Health Care Fraud and Abuse Control/Senior Medicare Patrol Program . 151
iv

Elder Rights Support Activities ....................................................................................................... 155

Elder Justice/Adult Protective Services ............................................................................................ 161

Disability Programs, Research and Services

Disability Programs, Research and Services ...................................................................................... 171

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State Councils on Developmental Disabilities 173

Developmental Disabilities – Protection and Advocacy ............ 179

University Centers for Excellence in Developmental Disabilities 185

Developmental Disabilities – Projects of National Significance .. 191

Independent Living 195

Limb Loss Resource Center . 203

Paralysis Resource Center.... 207

Traumatic Brain Injury . ....................................................... 211

National Institute on Disability, Independent Living, and Rehabilitation Research .................................... 217

Consumer Information, Access and Outreach

Consumer Information, Access, and Outreach ................................................................................... 225

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 .................................................................................

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Aging and Disability Resource Centers ......... . 227

State Health Insurance Assistance Programs ... . 233

Voting Access for Individuals with Disabilities . 239

Assistive Technology. . 245

National Technical Assistance Center on Kinship and Grandfamilies ..................................................... 257

Medicare Improvements for Patients and Providers Act Programs (MIPPA) ............................................ 261

Program Administration .......................................................................................................... 271

Nonrecurring Expenses Fund.................................................................................................. 277

Supplementary Tables .............................................................................................................. 281

Good Accounting Obligation in Government Act (GAO-IG-ACT) Report........................ 293

Legislative Proposals ................................................................................................................ 295

Significant Items........................................................................................................................ 297

ACL Specific Requirements..................................................................................................... 303
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 15.7% percent between 2019 

and 2025, from 74.6 million to 86.3 million..1 

• 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 

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

• 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 2019 to 4 million (3.3 percent increase) by the year 2020.4

 These individuals are at the 

greatest risk of nursing home admission.

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 30 April 2021. 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, 2019. Released June 2020. https://www.census.gov/programssurveys/popest/data/tables.2019.html . Accessed 30 April 2021.

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. 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. 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 30 April 2021. 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, 2019: Released June 2020, 

https://www.census.gov/programs-surveys/popest/data/tables.2019.html . Accessed 30 April 2021. Centers for 

Medicare & Medicaid Services, ACL analysis of 2017 Medicare Current Beneficiary Survey, , 

https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS/index. Accessed 30 April 2021. 
2 

• 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 

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 people with disabilities and older adults, the 

Administration for Community Living (ACL) funds direct services and supports provided primarily 

through networks of community-based organizations; invests in training, education, research, and 

innovation; and advocates to ensure federal policy and programs consider the needs of both populations. 

ACL’s programs work together to encourage and support health, independence, resilience, and selfsufficiency throughout the lifespan and play a critical role in reducing costs of health care. ACL works 

closely with states, tribes, the aging and disability networks, and -- most important -- with older adults 

and people with disabilities, to ensure that ACL’s programs are tailored to the unique needs of the 

people they serve. 

ACL’s budget request, outlined below, prioritizes programs that provide direct services for the people 

ACL serves and includes critical investments to support the President’s priorities on COVID-19 

recovery, supporting caregivers and advancing equity. It also requests resources to meet the 

requirements of ACL’s growing leadership role across federal government on aging and disability 

issues. 

ACL is requesting budget authority of $3,008,907,000, an increase of $750,792,000 over the FY 2021 

Enacted level of $2,258,115,000. The request also includes $17.1 million in Public Health Services 

Evaluation funds to partially support three programs authorized by the Public Health Services Act: the 

Limb Loss Resource Center, the Paralysis Resource Center and the Traumatic Brain Injury program. 

Enhancing Supports for Older Americans and Persons with Disabilities and Recovery from the 

Pandemic (+$631.9 million)

People with disabilities and older adults have faced a disproportionate share of hardships during the 

COVID-19 pandemic. Most ACL programs have experienced a substantially higher demand for 

services, which will continue well into recovery. Although many of the innovations and adaptations 

developed to continue service delivery during the pandemic have shown promise for increasing 

capacity and efficiency during normal operations, additional investment is required to meet the 

increased need. Without these increases, ACL will be unable to maintain services for the significantly 

larger population of older adults and persons with disabilities who rely on these services 

In addition to significantly increased risk of serious illness and death from COVID-19, many faced 

serious threat of being forced to move from their homes into nursing homes and other institutional 

settings due to loss of critical services they rely upon to live in the community. Many who contracted 

the virus were unable to return home following a hospitalization for the same reason. 

Those who were able to remain in the community faced increased social isolation, and far too many 

have faced barriers in accessing health care, including COVID-19 testing, treatment and vaccinations. 

All of these impacts were even more pronounced for older adults and people with disabilities who face 

additional barriers due to race, ethnicity, sexual orientation or gender identity, income, language spoken 

or other factors. 
EXECUTIVE SUMMARY

4

The aging and disability networks and the programs ACL funds have been at the forefront of the 

nation’s efforts to support older adults and people with disabilities to live safely in the community 

during this public health emergency, and they will play an equally critical role as we begin to recover. 

As the pandemic took hold, the networks quickly adapted programs and formed new partnerships to 

continue to meet the needs of people who had received services before the pandemic. They also found 

ways to meet much of the increased demand caused by the loss of services and supports due to the 

closure of locations that provide services in the community and as informal supports became 

unavailable due to safety requirements. 

For example, the network significantly increased the number of home-delivered meals and created 

“grab-and-go” meals that could be picked up from congregate nutrition sites. They established virtual 

services, such as wellness checks and telephone reassurance, and employed video-teleconferencing 

services to promote face-to-face interaction for program participants with family members and program 

staff. In addition to meeting fundamental needs in the community, the networks also have played a 

crucial role in helping people transition from institutional settings, where risks from COVID-19 have 

been highest, to safer community settings. 

As the country begins to recover from the pandemic, ACL’s programs and the aging and disability 

networks face new challenges. For example, they play a pivotal role in helping older adults and people 

with disabilities access vaccines by providing outreach and education, facilitating vaccination 

appointments, working with vaccine providers to ensure website and vaccination site accessibility, and 

reaching people who cannot be vaccinated outside of their homes. As communities re-open, the return 

to pre-COVID service delivery systems is complicated by the reliance of those systems on volunteers, 

many of whom stopped volunteering during the pandemic. Many service providers in the community 

remain closed, continuing the need for alternate service delivery options, which can be more costly. 

The FY 2022 budget request includes an additional $629 million to help maintain services for this

population and address these challenges. It builds upon the foundation established through the 

substantial supplemental funding (and the increased flexibility for states to transfer funding between 

programs to meet local needs) provided by Congress for many ACL programs. It also provides a 

substantial increase to the developmental disability act authorized programs that have played, and will 

continue to play, a significant role in pandemic response and recovery, but which have not received 

supplemental funding. 

Specific requests include:

• Nutrition (+389.6 million) and Home and Community-Based Supportive Services (+$158 

million): Physical distancing resulted in a more sedentary lifestyle for many people served by 

these programs, and many older adults have experienced declines in physical and cognitive 

function. As a result, many who did not need the services and supports provided by the aging 

services network before the pandemic are expected to remain clients as we move into recovery 

from the pandemic. 

• Preventive Health Services (+$1.5 million): The importance of remote delivery of services that 

promote healthy behaviors and help people manage chronic disease became clear during the 
EXECUTIVE SUMMARY

5

pandemic. This funding will help cover the costs of developing, implementing, and sustaining 

virtual programs to deliver evidence-based interventions to people in their homes.

• Aging Network Support Activities (+$2.9 million): The additional funding will provide an 

additional $0.24 million for the Care Corps program and $2.745 million for Program 

Performance and Technical Assistance to support recovery from COVID-19, and particularly 

to increase participation of older adults and caregivers from minority or underserved 

populations in programs and services that enhance health and well-being. 

• Centers for Independent Living (+$29 million): During the pandemic, CILs have experienced 

increased demand for services as a result of the multiple risk factors and challenges faced by 

people with disabilities. CILs have relied on supplemental funding to ensure people with 

disabilities have access to food, social supports, personal protective equipment, information and 

more. They have also used this funding to transition people from nursing homes and other 

institutions back to the community and helped divert unnecessary institutional admissions. The 

increased need for CIL services is expected to continue well into FY 2022, as people with 

disabilities have disproportionately experienced loss of employment and will require a longer 

period of time to recover from the pandemic and the demand for help transitioning back to the 

community from institutional settings like nursing homes has never been higher. This increase 

in funding will support CILs in meeting this sustained demand. 

• DD Act Programs (+$19.6 million): Throughout the pandemic, many people with 

developmental disabilities have faced barriers to accessing services and discrimination in access 

to health care. Increased risk of serious illness and death from COVID-19 cut many off from 

informal supports and made it difficult for many to receive the formal services as they did before 

the pandemic. Without supplemental funding, the disability services networks have not been 

able to fully meet the increased needs. ACL’s budget request includes the following increases 

to begin to close the gaps and to meet the needs of people with disabilities and their families 

during recovery and beyond. ACL’s budget request includes a 12 percent increase for State 

Councils on Developmental Disabilities (+$9.5 million), University Centers for Excellence in 

Developmental Disabilities (+$5.1 million), and Developmental Disabilities Protection and 

Advocacy programs (+$5 million). 

• State Independent Living Services Grants (+$3.1 million): This 12 percent increase in funding 

to State Independent Living Services Grants will support states in expanding and improving 

independent living services through the provision of IL services as well as training, technical 

assistance, coordination, and evaluation activities. 

• Aging and Disability Resource Centers (+$15.3 million): With the requested funding, ACL will 

expand competitive ADRC grants from 8 grants to up to 25 grants in states across the country. 

Funding also will support a nationwide No Wrong Door (NWD) Resource Center, interoperability of social care referral systems, and the National Center on Advancing PersonCentered Practices and Systems (NCAPPS), which is a joint ACL/CMS initiative that helps 

states, tribes, and territories implement person-centered thinking, planning, and practices. 

• Disability Research: NIDILRR (+$2.8 million)/Projects of National Significance (+$0.5 

million): The requested budget will provide funding to NIDILRR to increase the number of 

grants made through its field-initiated grant competitions and to address emerging research gaps 

in disability, independent living, and rehabilitation research. In addition, the Projects of 
EXECUTIVE SUMMARY

6 

National Significance program will fund an evaluation of the Developmental Disabilities 

Assistance Bill of Rights Act programs to determine the quality, nature, and extent of their 

outreach to unserved and underserved populations. 

• State Health Insurance Assistance Programs (+$3.1 million): The request level allows SHIP 

grantees to expand capacity and supports integration of new technologies adopted during the

pandemic into regular program business processes.

• Assistive Technology (+$6.5 million): The pandemic resulted in a loss of crucial communitybased services, social isolation, and increased the need for access to assistive technology (AT); 

those needs will continue well into recovery. The budget request will fund additional grants to 

improve the ability of individuals of all ages who have disabilities and their families to obtain 

AT devices and services.

Consistent with the Administration’s commitment to advancing equity, all of these programs are 

targeted in large part to those in greatest social and economic need, with particular attention to people 

who: have low incomes, are racial or ethnic minorities, are LGBTQ, live in rural areas, have limited 

English proficiency, and/or are at risk of institutionalization. 

Expanding Focus on Caregiving (+$87) 

The Biden-Harris Administration has identified strengthening the care economy as a key priority and 

one that is crucial to our country’s economic recovery from COVID-19. In keeping with that priority, 

ACL’s budget request includes funding to improve support for family and other informal caregivers, 

whose challenges were exacerbated by the pandemic. With the suspension of many formal services 

and supports, demands on caregivers increased. Balancing caregiving responsibilities and 

employment became even more difficult, and many were forced to leave the workforce entirely to 

support their loved ones. With this long-term priority in mind, as well as the immediate need to focus 

on COVID recovery, ACL’s request to support caregivers includes the following: 

• Family Caregiver Support Services (+$61 million): Additional funds will allow for an increase 

in the level of services and supports available to family and informal caregivers--including 

information, assistance, counseling, respite care, and training--that assist family and informal 

caregivers who care for their older loved ones at home. Increasing direct services for those who 

are in the greatest socioeconomic need and building virtual infrastructure to meet needs during 

crises will be a particular focus. 

• Native American Caregiver Support Services (+$5 million): Native Americans have been 

especially vulnerable to, and harder hit by, COVID-19, and the rural locations many live in has 

made it particularly difficult to provide supportive services. Additional funding will tackle 

these challenges and expand information and outreach, access assistance, individual 

counseling, support groups and training, respite care, and other supplemental services.

• Alzheimer’s Disease Program (+$2.6 million): Funding will expand grants to states to support 

development or improvement of dementia capability and provide funding to dementia-capable 

community-based organizations (CBOs) that are prepared to expand their existing operations 

to address identified service gaps. CBOs that focus on underserved caregivers and those who 

have been waiting for services will be prioritized. 
EXECUTIVE SUMMARY

7 

• Lifespan Respite Care (+$7.1 million): The additional funding will address existing gaps in 

respite services and support the development of more efficient methods of delivering respite 

care across the aging and the disability populations. The increased funding also will increase 

technical support to grantees to support them in more equitably and effectively targeting 

caregivers who are from marginalized or underserved communities. 

• Long-Term Care Ombudsman/Prevention of Elder Abuse (+$11.3 million): The American 

Rescue Plan provided resources to begin planning for and implementing a return to on-site 

visitation and the resumption of direct contact with loved ones for residents of long-term care 

facilities. The request allows that work to continue into FY 2022, and expands coverage to 

other residential care facilities. It also supports training, education, and increasing public 

awareness activities to prevent elder abuse. 

Equity (+$41.2 million)

Consistent with one of President Biden’s top priorities, ACL is working to advance equity across all

of our work and programs, with a focus on people with disabilities and older adults who are multiply 

marginalized due to race, ethnicity, sexual orientation, gender identity, poverty, language spoken or 

other factors. ACL’s FY 2022 budget request includes funding to enhance ongoing efforts to target 

Older Americans Act programs to those in greatest social and economic need, as well as funding for 

several initiatives that specifically focus on improving equity. These include:

• Native American Nutrition and Supportive Services (+$35 million): This increase will provide 

an additional 2.4 million home-delivered meals and an additional 2.4 million congregate meals 

for Native American elders, who were particularly hard hit during the pandemic. Although 

tribes received almost $54 million in supplemental funding, the need for these services remains 

significantly elevated; the increased funding is needed to continue to meet that need. 

• Elder Justice/Adult Protective Services (+$1 million): The requested funding will continue 

ongoing Elder Justice work, including support to programs that ensure the rights of older adults

are protected in guardianship court proceedings. The increase of $1 million will expand 

programs addressing elder abuse and neglect as a result of the opioid crisis and will specifically 

target communities most affected by abuse of opioids and other substance abuse. This is in 

addition to $188 million in supplemental funding provided for Elder Justice/Adult Protective

Services in FY 2022. 

• National Institute on Disability, Independent Living, and Rehabilitation (+$2.8 million): The 

increase will fund three new Rehabilitation Research and Training Centers (RRTCs), one in 

each of NIDILRR’s three outcome domains: community living and participation, employment, 

and health and function. Each of these RRTCs will conduct research to support the 

development and testing of practices, policies, services, or supports to address the disparate 

outcomes experienced by people with disabilities from populations that have been historically 

underserved or marginalized. 
EXECUTIVE SUMMARY

8 

• Projects of National Significance (+$0.4 million): This will fund a second generation of grants 

to improve diversity, equity and inclusion in programs that serve people with developmental 

disabilities. 

• Voting Access for People with Disabilities ($2 million): Provides a 25 percent increase in grants 

to assist Protection and Advocacy systems in each state and territory to ensure equity and full 

participation in the electoral process for individuals with disabilities, including registering to 

vote, accessing polling places, and casting votes. 

Supporting ACL Programs (+$6 million) 

Finally, ACL’s request reflects a critical need for increased staff to fulfill its leadership responsibilities 

on aging and disability issues. This includes work to advance the President’s Caregiving Infrastructure 

Plan, as well as interagency work on the President’s priorities for expanding community living and 

home and community-based services for individuals with disabilities and older adults; advancing racial 

equity and support for underserved communities; ensuring equitable pandemic response and recovery; 

and improving and expanding access to care and treatment of COVID-19. ACL also is leading a 

disability policy workgroup within HHS and has taken leaderships roles on workgroups convened by 

the Domestic Policy Council focused on long-term services and supports, COVID-19, children with 

disabilities, and employment and anticipates extensive participation on additional workgroups. 

Specifically, the request includes support for the Administration’s National COVID-19 Strategy and 

Executive Orders (+6 FTE), fully staffing ACL’s role as Advisor on Aging and Disability across the 

Administration (+3 FTE), support for programmatic technical assistance and oversight (+3 FTE), 

providing vital support for IT services (+5 FTE), and funding for a new oversight contract for IT 

services. 

Conclusion 

In addition to the requested funding, the budget proposes to: 

• Double the allowance for funding for evaluation of aging services programs from one half of 

one percent to one percent of appropriations for direct-services programs for older adults; 

• Allow ACL to devote up to one percent of Home and Community Supportive Services funding 

to create innovation demonstrations similar to what is available in nutrition programs; 

• Permit employment demonstrations within the Centers for Independent Living; and, 

• Authority to transfer up to 100 percent of funding between programs for older adults to provide 

both states and tribes with flexibility as they transition out of the pandemic, similar to currently 

allowable authorities which are tied to the COVID-19 Public Health Emergency. 

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

can live in their own homes or in other community settings — which is overwhelmingly preferred, 

leads to better outcomes, and is cost-effective. The country’s communities are stronger when everyone 

is included, everyone is valued, and everyone can contribute. ACL remains committed to making 
EXECUTIVE SUMMARY

9 

community living an option for every American, regardless of age or disability, race or ethnicity, gender 

identity or sexual orientation, income or any other factor, and this budget aligns with that commitment. 
EXECUTIVE SUMMARY

10 

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EXECUTIVE SUMMARY

11 

Overview of Performance

 

The mission of the Administration for Community Living is to maximize the independence, well-being, 

and health of older adults, people with disabilities across the lifespan, and their families and caregivers 

so that all people, regardless of age and disability, can live with dignity, make their own choices, and 

participate fully in society. To measure the effective provision of high-quality services to at risk 

populations, ACL focuses on the following categories of performance measures: 1) increasing access 

to and satisfaction with ACL’s services 2) improving program efficiency; and 3) generating new 

knowledge about what works for older adults and people with disabilities. These measures support 

HHS Strategic Goal 3: Strengthen the Economic and Social Well-Being of Americans Across the 

Lifespan with a particular focus on Strategic Objective 3.4: Maximize the independence, well-being, 

and health of older adults, people with disabilities, and their families and caregivers. 

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), and having 

greater than 90% of respondents rate the services as good, very 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 stable funding and annual rises in expenditures per unit of service, we have not been 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 declines in the number of 

people receiving health and disease prevention services (output AB), and 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 has declined over the past 

year (output E). ACL is closely monitoring these trends and once the new data collection system is in 

place for FY 2022, ACL will have improved information for understanding such year to year changes. 

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, retaining, restoring, or expanding the rights of 

individuals with developmental disabilities (measure 8F and 8G). ACL also consistently meets it goals 

for the generation of new knowledge related to the treatment of opioid use disorders for people with 

disabilities (outcome R1b), the efficacy of interventions to improve employment outcomes for 

individuals with serious mental illness (outcome R2), and 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 R3). 

The Key Outputs and Outcomes reported in the FY 2022 Congressional Budget justification are based 

on the most recent actual data. Those data are from 2019 and were unaffected by COVID-19 and the 
EXECUTIVE SUMMARY

12 

COVID-19 supplemental funding. The projections and estimates for FY 2021 and FY 2022 include the 

budget amounts from the columns entitled “FY 2021 Enacted” and “FY 2022 President's Budget”. They 

do not include the FY2020 or FY 2021 supplemental funding. ACL did not develop new measures 

based on the COVID-19 supplemental funding. 

 

 

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 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. 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. ACL’s performance management strategy also set the foundation for its

2020-2022 learning agenda which is focused on caregivers and caregiver services. 

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. 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 each 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 plans detail proposed grant and procurement activities and 

justify 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 measurable performance metrics, including requiring 

outcomes demonstrating the value of the program in both the grant application and progress reports. 
EXECUTIVE SUMMARY

13 

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, weekly Leadership 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 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. The Center recently 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. 

• ACL funds Sixty-eight University Centers for Excellence in Developmental Disabilities 

Education, Research, and Service (UCEDDs) throughout the United States and its territories. 

UCEDDs serve as liaisons between academia and the community. One of many activities that 

UCEDDS perform is conducting 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 continually monitors its support of grantees to ensure the provision of high-quality services. For 

example:

• 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. This will further the legislative goal of empowering 

individuals and their families both to advocate for themselves and to seek long-term solutions 
EXECUTIVE SUMMARY

14 

through systems change, creating an environment of self-sufficiency, self-determination, 

inclusion, and acceptance. 

• A retrospective evaluation of the Alzheimer’s Disease Initiative – Specialized Supportive

Services (ADI-SSS) will use existing data to assess the impact of the grants with regard

primarily to improvement of the quality and effectiveness of programs and services dedicated

to individuals aging with intellectual and developmental disabilities with ADRD or those at

high risk of developing ADRD.

• The National Resource Center on Nutrition and Aging (NRC) provides research-based insight

into different programs and approaches that deliver nutrition-related home- and communitybased services (HCBS) administered through grants to the 56 states and territories.

• The Access to Respite Care and Help (ARCH) provides training and technical assistance to the

Lifespan Respite Network with a focus on performance measurement, sustainability, best

practices, and research. ACL has funded 33 states and the District of Columbia to establish or

enhance Statewide Lifespan Respite systems and ARCH provides training and technical

assistance to them as well. The National Alzheimer’s and Dementia Resource Center supports

grantees as they implement evidence-based interventions and innovative practices designed to

empower and assist caregivers of persons with Alzheimer’s disease and related disorders.

• 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. In 2020, the ACL Data Council produced a Data Quality 101 infographic, an

Annotated bibliography for existing Federal data standards, and a Data governance primer.
EXECUTIVE SUMMARY

15 

• The new Older Americans Act Performance System (OAAPS) improves performance data 

collection through an enhanced user interface, improved data validation tracking, and inclusion 

of a range of data error checks. In FY 2020 the OAAPS system was released for the collection 

of annual performance data for the OAA Long Term Care Ombudsman Program (LTCOP). In 

FY 2021 it started to accept OAA Tribal Grants program data, and in FY 2022 it will start 

accepting data for OAA Title III Home and Community Base Services, Nutrition services, and 

the National Family Caregiver Support Program (NFCSP) 

Overview of ACL’s Evaluations and Other Evidence Building

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

inform policy and practice. ACL’s Evaluation Policy reflects OMB guidance regarding evaluation 

standards and practices (M-20-12). In FY 2020, ACL started or continued evaluations of the following 

programs: 

New Evaluations: 

Social Determinants of Health and ACL. The purpose of this contract is to begin looking at how the 

services provided by ACL grantees influence the social determinants of health (SDOH). ACL’s 

programs address these conditions through grants designed to improve organizations and systems, and 

to mitigate their effects on individuals through the delivery of direct services such as providing 

nutrition, linking people to services, preventing/addressing violence, health education, mobilizing 

community partnerships, providing transportation, investing in economic support, social integration, 

and education, among many others. 

Older Americans Act Fidelity Evaluation. The Fidelity Evaluation is an evaluation of the conformity 

with which ACL and its grantees under the Older Americans Act implement the required evidencebased programs. 

Process Evaluation of the Aging Network and its Return on Investment. ACL is interested in 

understanding the current status of the Aging Network based on a comprehensive process evaluation 

of the Aging Network engaging all levels (federal, state, and local) and, from the information available, 

what are some feasible ways to evaluate the Aging Network with regards to its use of OAA funds, 

specifically with regards to return on investment. 

Continuing Evaluations: 

• Adult Protective Services Client Outcomes Study; 

• 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 (completed in 2020); 

• Partnerships in Employment Systems Change grants; 
EXECUTIVE SUMMARY

16 

• 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 2020, ACL published a number of evaluation reports on its website and data briefs on its 

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

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. With recent funding increases due to COVID-19 supplemental 

funding, it is expected that the level of service will rise. The level of growth is, in part, due to the ability 

of service providers to rapidly expand their administrative support structures and service provision 

capacity. 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 affect 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

17 

All Purpose Table

Administration for Community Living

(Dollars in Thousands)

FY 2020 

Supplemental 

Funding 

FY 2021 

Supplemental 

Funding 

 FY 2022 

President's 

Budget 

FY 2021 

Enacted

FY 2022 +/- 

FY 2021 Program FY 2020 Final

Health & Independence for Older Adults

Home & Community-Based Supportive Services............................. 390.074 200.000 392.574 460.000 550.574

918.000 1,341.385

 158.000

Nutrition Services.............................................................................. 936.753 720.000 951.753 389.632

Congregate Nutrition Services (non-add)..................................... 510.342 80.000 515.342 300.000 468.954 (46.388)

Home-Delivered Nutrition Services (non-add)............................. 266.342 640.000 276.342 618.000 703.431 427.089

Nutrition Services Incentive Program (non-add)......................... 160.069 - 160.069 - 169.000 8.931

Preventive Health Services................................................................ 24.848 - 24.848 44.000 26.339 1.491

Chronic Disease Self-Management Education [PPHF]/1.................. 8.000 - 8.000 - 8.000 -

Elder Falls Prevention [PPHF]/1....................................................... 5.000 - 5.000 - 5.000 -

Native American Nutrition & Supportive Services........................... 34.708 30.000 35.208 23.670 70.208 35.000

Aging Network Support Activities..................................................... 12.461 - 16.461 - 19.446 2.985

Holocaust Survivor Assistance {non-add}..................................... 5.000 - 5.000 - 5.000 -

Care Corp (non-add).....................................................................

Subtotal, Health & Independence for Older Adults........................ 1,411.844

- - 4.000

 950.000 1,433.844 1,445.670

 - 

 

4.240

2,020.952

 0.240

 587.108

Caregiver & Family Support Services

Family Caregiver Support Services................................................... 185.936 100.000 188.936 145.000 249.936 61.000

SGRG (non-add)............................................................................... 0.300 - 0.300 0.300 -

Raise (non-add)................................................................................ 0.400 - 0.400 0.400 -

Native American Caregiver Support Services................................... 10.306 - 10.806 15.806 5.000

Alzheimer's Disease Program............................................................ 26.500 - 27.500 - 30.060 2.560

 Alzheimer's Disease from Direct Appropriations {Non-Add}......................... 11.800 - 12.800 -

8.330 

 15.360 2.560

 Alzheimer's Disease from PPHF {Non-Add} /1............................................... 14.700 - 14.700 - 14.700 -

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

Subtotal, Caregiver & Family Support Services.............................. 228.852

 6.110 - 7.110

100.000 234.352 153.330

 - 

 310.022

14.220 

 

7.110

75.670

Protection of Vulnerable Adults

Long-Term Care Ombudsman Program............................................ 17.885 20.000 18.885 10.000 29.885 11.000

Prevention of Elder Abuse & Neglect............................................... 4.773 - 4.773 - 5.059 0.286

Senior Medicare Patrol Program/HCFAC /3................................. 18.000 - 20.000 - 20.000 -

Senior Medicare Patrol Program/HCFAC Wedge Funding .......... - - 2.000 - (2.000)

Elder Rights Support Activities ........................................................ 3.874 - 3.874 - 4.400 0.526

Elder Justice/ Adult Protective Services .......................................... 12.000 188.000 14.000 188.000 15.000 1.000

Elder Justice - Opioids (non-add) ..................................................................... 2.000 - 2.000 - 3.000 1.000

Elder Justice - Guardianship (non-add)............................................................. - 2.000 - 2.000 -

Elder Justice - Infrastructure............................................................................. 10.000 - 10.000 - 10.000 - Elder Justice - State APS Grants/ARP Funding/Other Activities {nonadd}/4/5 

Subtotal, Protection of Vulnerable Adults...................................... 56.532

- 188.000 - 188.000 - -

 208.000 63.532 198.000 74.344 10.812

Disability Programs, Research & Services

State Councils on Developmental Disabilities................................... 78.000 - 79.000 - 88.480 9.480

Developmental Disabilities Protection and Advocacy...................... 40.784 - 41.784 - 46.798 5.014

University Centers for Excellence in Developmental Disabilities..... 41.619 - 42.119 - 47.173 5.054

Projects of National Significance...................................................... 12.250 - 12.250 - 13.100 0.850

Independent Living............................................................................ 116.183 85.000 116.183 - 148.228 32.045

Limb Loss Resource Center.............................................................. 4.000 - 4.000 - 4.200 0.200

Limb Loss Resource Center - Direct Appropriations (non-add)........................... 4.000 - 4.000 - 1.465 (2.535)

Limb Loss Resource Center - PHS Evaluation (non add)..................................... - - - - 2.735 2.735

Paralysis Resource Center................................................................. 9.700 - 9.700 - 10.185 0.485

Paralysis Resource Center - Direct Appropriations (non add)............................ 9.700 - 9.700 - 3.553 (6.147)

Paralysis Resource Center - PHS Evaluation (non add)...................................... - - - - 6.632 6.632

Traumatic Brain Injury...................................................................... 11.321 - 11.321 - 11.887 0.566

Traumatic Brain Injury - Direct Appropriations non add................................... 11.321 11.321 4.148 (7.173)

Traumatic Brain Injury - PHS Evaluation non add.............................................. - - - - 7.739 7.739

National Institute on Disability, Independent Living, and Rehab. 

Research 111.970 - 112.970 - 118.619 5.649

Subtotal, Disability Programs, Research & Services...................... 425.827 85.000 429.327 - 488.670 59.343
EXECUTIVE SUMMARY

All Purpose Table – Continued

18 

Medicare Improvements for Patients and Providers Act/6............... (37.500)

Total, Discretionary Budget Authority............................................

NEF.....................................................................................................

ACL Data ....................................................................................

ACL Reporting Enhancements ...................................................

ACL.gov Enhancements ..............................................................

ACL Security Mitigation and Enhancements..............................

ACL Using Available Data to Visually Represent the Aging 

Disability Network

 2,223.115

- 

 2,258.115

 9.826

 2.000

 0.500

 1.000

 4.326

 2.000

(50.000) - (50.000) -

 3,008.907 750.792

2/Funding for the National Technical Assistance Center on Grandparents and Kinship Care is available until FY 2025 

3/The FY 2020 appropriation states that SMP/HCFAC can be paid for with discretionary CMS HCFAC appropriations and/or HCFAC Wedge funds, the 

amount based on the Secretary of HHS's determination but no less than the $20 million floor provided in appropriations language. The FY 2022 amount 

is a placeholder for the Secretary’s final decision.

4/Of the $188 million provided for Elder Justice activities under Subtitle B of Title XX of the Social Security Act, over 90% of funding will go out as 

State APS formula grants under Section 2042(b) of the Act.

5/Included in the ARP is $188 million for FY 2022 Elder Justice activities under Subtitle B of Title XX of the Social Security Act, at least $100 million 

of which must be used for State APS formula grants under Section 2042(b) of the Act. These funds are not reflected in this table.

6/ Elder Rights Support Activities funding levels have been lowered in FY 2020 and FY 2021 for comparability purposes to adjust for an Elder Justice/ 

Adult Protective Services Line 

7/ Funding is currently appropriated to the Centers for Medicare & Medicaid Services which transfers it, via an Intra-Departmental Delegation of 

Authority (IDDA)--to ACL to administer. 

1/ These programs are paid for out of the Prevention and Public Health Fund.

Division FY 2020 Final 

FY 2020 

Supplemental 

Funding 

FY 2021 

Enacted

FY 2021 

Supplemental 

Funding 

 FY 2022 

President's 

Budget 

FY 2022 +/- 

FY 2021

State Health Insurance Assistance Program...................................... 52.115 - 52.115 - 55.242 3.127

Voting Access for People with Disabilities (HAVA)......................... 7.463 - 7.963 - 9.963 2.000

Assistive Technology ........................................................................ 37.000

Nat. Tech. Assistance Center on Kinship and Grandfamilies /2....... -

-

 -

 

-

37.500 -

 10.000

 44.000

 -

 

-

6.500

Medicare Improvements for Patients and Providers Act 

[TRA/BBA] 37.500 - 50.000 - 50.000 -

Aging and Disability Resource Centers {non-add}....................... 5.000 - 5.000 - 5.000 -

Area Agencies on Aging {non-add}............................................... 7.500 - 15.000 - 15.000 -

National Center for Benefits Outreach and Enrollment {nonadd} 12.000 - 15.000 - 15.000 -

State Health Insurance Assistance Program {non-add}/6............ 13.000 - 15.000 - 15.000 -

Subtotal, Consumer Information, Access & Outreach.................... 142.197 50.000 155.697 10.000 182.662 26.965 

Program Administration ................................................................... 41.063 - 41.063 - 47.063 6.000

Subtotal, Program Level/4.............................................................. 2,306.315 1,393.000 2,357.815 1,807.000 3,123.713 765.898

Less: Funds From Mandatory Sources

HCFAC Funds for Senior Medicare Patrol Program /3................. (18.000) - (20.000) - (20.000) -

Senior Medicare Patrol Program/HCFAC Wedge Funding .......... - - (2.000) - - 2.000

Public Health Service Evaluation ................................................... - - - - (17.106) (17.106)

Prevention & Public Health Fund/1.................................................. (27.700) - (27.700) - (27.700) -

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

Consumer Information, Access and Outreach

 8.119 50.000 8.119 - 23.457 15.338
EXECUTIVE SUMMARY

Appropriations Language

Administration for Community Living

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, [ $2,206,000,000]$2,953,665,000 together with [ $52,115,000]$55,242,000 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 in addition to amounts provided herein, $17,106,000 shall be 

available to this appropriation, for the purposes under this heading, from amounts 

provided pursuant to section 241 of the PHS Act: Provided further, 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 of amounts 

made available under this heading to carry out section 321 of the OAA, up to one percent shall be 

available for grants to develop and implement 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 one percent of such amounts 

shall be available for developing and implementing evidence-based practices for enhancing senior 

19 
EXECUTIVE SUMMARY

20 

nutrition, including medically-tailored meals:[ ] Provided further, That notwithstanding any other 

provision of this Act, funds made available under this heading to carry out section 311 of the OAA

may be transferred to the Secretary of Agriculture in accordance with such section: [Provided further, 

That $2,000,000 shall be for competitive grants to support alternative financing programs 

that provide for the purchase of assistive technology devices,such as a low-interest loan fund; an 

interestbuy-down program; a revolving loan fund; a loan guarantee; or an insurance program: 

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

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

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

organizations that are directed by and operated for individuals with disabilities shall be

eligible to compete:] Provided further, That of the amount made available under this 

heading, up to $8,000,000 shall be available for the Secretary to make and evaluate 

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 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
EXECUTIVE SUMMARY

21 

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 (orsuch legal guardians) of their legal

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

Providedfurther, 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, 2021)

GENERAL PROVISIONS

SEC. 229. (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 
EXECUTIVE SUMMARY

22 

(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. 

(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--
EXECUTIVE SUMMARY

23 

(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. 230. (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.
EXECUTIVE SUMMARY

24 

(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

25 

Appropriations Language Analysis

ADMINISTRATION FOR COMMUNITY LIVING

AGING AND DISABILITY SERVICES PROGRAMS

(INCLUDING TRANSFER OF FUNDS)

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, [$2,206,000,000]$2,953,665,000, 

together with $[52,115,000]$55,242,000 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 in addition to amounts 

provided herein, $17,106,000 shall be 

available to this appropriation, for the 

purposes under this heading, from 

amounts provided pursuant to section 

241 of the PHS Act:

Requests an additional $17,106,000 from PHS 

Evaluation funding, to be used to partially 

fund three PHSA authorized programs—Limb 

Loss Resource Center, Paralysis Resource 

Center and Traumatic Brain Injury.
EXECUTIVE SUMMARY

26 

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 of amounts made 

available under this heading to carry out 

section 321 of the OAA, up to one percent 

shall be available for grants to develop and 

implement 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 

community-based supportive services for 

innovation demonstrations to improve and 

enhance HCBS services, comparable to the 

innovation authority provided for the nutrition 

programs. 

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 medically-tailored 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, up 

to $8,000,000 shall be available for 

the Secretary to make and evaluate 

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: 

Allows up to $8 million of the funding 

provided to Centers for Independent Living 

(CILs) that have already received a formula 

grant, to be awarded competitively to develop 

and evaluate 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 

Identifies the purpose, and limits on the use of 

funds provided for Protection and Advocacy. 
EXECUTIVE SUMMARY

27 

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 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. 
EXECUTIVE SUMMARY

28 

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. 

(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.

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 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 the 

request for FY 2018 through FY 2021. 
EXECUTIVE SUMMARY

29 

(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.

(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 

Proposed languages to address post-pandemic 

recovery needs provides States currently have 

flexible transfer authorities tied to the PHE 

for maximum flexibility for COVID response; 

this provision would allow states continued 

flexibility to address ongoing COVID 

response needs in the event that PHE 
EXECUTIVE SUMMARY

30 

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 otherwiseapplicable 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. 

flexibilities expire. The provision provides 

States the ability to transfer nearly all of the 

OAA title III funds the receive for Home and 

community-based 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

31 

Amounts Available for Obligation 

Administration for Community Living

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 2020 and FY 2021. 

3/ MIPPA Funding excludes $13,000,000 in FY 2020 and $15,000,000 in FY 2021 and FY 2022 directly 

appropriated to CMS for MIPPA-SHIP and then made available to ACL through an Intra-Departmental 

Delegation of Authority. Includes carryover in FY 2020 and FY 2021. 

4/ Amount for FY 2022 is a placeholder pending a Secretarial decision on the amount. FY 2020 and FY 2021 

amounts include carryover.

FY 2021 FY 2022 

FY 2020 Final Enacted President's Budget

General Fund Discretionary Appropriation:

Appropriation (L/HHS)........................................................... 2,171,000,000 2,206,000,000 2,953,665,000

Subtotal, Appropriation (L/HHS, Ag, or Interior).................... 2,171,000,000 2,206,000,000 2,953,665,000

Real Transfer to Department of Agriculture 1/.........................

Total, Discretionary Appropriation......................................

 (1,381,186)

2,169,618,814

 (1,347,714)

 2,204,652,286

- 

2,953,665,000

Supplemental Appropriation (FFCRA, P.L. 116-127)................ 250,000,000

Supplemental Appropriation (CARES, P.L. 116-136)............... 955,000,000

Supplemental Appropriation (CRRSAA, P.L. 116-260)............. - 275,000,000 - 

Supplemental Appropriation (Reconciliation) (ARPA P.L. 117-2)

Subtotal, adjusted discretionary appropriation......................

-

3,374,618,814

1,720,000,000

4,199,652,286

- 

2,953,665,000

Mandatory Appropriation:

BA Transfer (PPACA) from Prevention Funds 2/...................... 28,506,740 40,349,504 27,700,000

Appropriation, MIPPA (CARES, FY 2020/CAA, FY 2021) 3/.... 27,080,776 39,565,614 35,000,000

Subtotal, adjusted mandatory. appropriation........................ 55,587,516 79,915,118 62,700,000

Offsetting collections from:

 Federal Sources (PHS Evaluation Funds)............................. - - 17,106,000

 Trust Funds: HCFAC HI (Discretionary Appropriations) 4/.... 18,098,804 18,035,621 20,000,000

 Trust Funds: HCFAC HI (Mandatory Wedge) ..................... - 2,000,000 - 

 Trust Funds: SHIP HI/SMI.................................................. 52,115,000 52,115,000 55,242,000

 Subtotal, offsetting collections.......................................... 70,213,804 70,150,621 92,348,000

 (1,195,992) - - 

Total obligations................................................................. 3,499,224,142 4,349,718,025 3,108,713,000

Unobligated balance, lapsing.....................................................
EXECUTIVE SUMMARY

32 

Summary of Changes 

Administration for Community Living

(Dollars in Thousands) 

2021 Enacted

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

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

2,258,115

2,256,767

2022 President's Budget

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

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

3,008,907

3,008,907

Net Change.............................................................................................................................................................................................. 750,792

FTE BA FTE BA FTE BA

Increases:

A. Built-in:

 1. Annualization of On-board FTE, beginning of FY 2022 170.8 41,063 174.8 42,063 4.0 1,000

 2. Annualization of 2022 civilian pay increase................... - 23,912 500

Subtotal, Built-in Increases............................................ 1500

A. Program:

 1. Home and Community-Based Supportive Services...... 392,574 550,574 158,000

 2 Home-Delivered Nutrition Services................................. 276,342 703,431 427,089

 3. Nutrition Services Incentives Payments........................... 160,069 169,000 8,931

 4. Preventive Health Services............................................... 24,848 26,339 1,491

 5. Native American Nutrition and Supportive Services...... 35,208 70,208 35,000

 6. Aging Network Support Services..................................... .9 16,461 0.9 

 

 

19,446 0.0 2,985

 7. Family Caregiver Support Services................................. 188,936 249,936 

 

 

61,000

 8. Native American Caregiver Support Services............... 10,806 15,806 5,000

 9. Alzheimer's Disease Program......................................... 12,800 15,360 2,560

10. Lifespan Respite Care...................................................... 7,110 

 

 

 

 

14,220 7,110

11. Long-Term Care Ombudsman Program......................... 18,885 29,885 

 

 

 

11,000

12. Prevention of Elder Abuse and Neglect.......................... 4,773 5,059 286

13. Elder Rights Support Activities........................................ 3,874 4,400 526

14. Elder Justice/Adult Protective Services.......................... 2.6 14,000 2.6 15,000 0.0 1,000

15. State Councils on Developmental Disabilities............... 79,000 88,480 

 

 

 

 

9,480

16. Developmental Disabilities Protection & Advocacy...... 41,784 46,798 5,014

17. University Centers for Excellence in Devel. Disabilities 42,119 47,173 5,054

18. Projects of National Significance..................................... 12,250 13,100 850

19. Independent Living............................................................. 1 116,183 1.0 148,228 0.0 32,045

23. Natl. Institute on Disability, Indep. Living & Rehab Res. 112,970 118,619 5,649

24. Aging and Disability Resource Centers.......................... 8,119 23,457 15,338

25, State Health Insurance Assistance Programs................ 3.4 52,115 4.0 55,242 0.6 3,127

26. Voting Access for People with Disabilities..................... 7,963 9,963 2,000

27. Assistive Technology......................................................... 37,500 44,000 6,500

28. Program Administration.................................................... 174.80 41,063 191.8 45,563 17.0 4,500

Subtotal, Program Increases......................................... 17.6 811,535

Total Increases.............................................................. 21.6 813,035

Decreases:

A. Built-in:

Subtotal, Built-in Decreases.......................................... - 0.0 - 0.0 -

A. Program:

 1. Congregate Nutrition Services......................................... 515,342 468,954 (46,388)

 2 Limb Loss Resource Center 1/....................................... 4,000 1,465 (2,535)

 3 Paralysis Resource Center 1/.......................................... 9,700 3,553 (6,147)

 4. Traumatic Brain Injury 1/................................................... 1.2 11,321 1.2 4,148 0.0 (7,173)

Subtotal, Program Decreases....................................... 0.0 (62,243)

Total Decreases............................................................ 0.0 (62,243)

Net Change................................................................ 21.6 750,792

FY 2021 Enacted

FY 2022 President's 

Budget FY 2022 +/- FY 2021

1/ Reflects FY 2020 required and permissive transfers and rescissions, except the NSIP transfer to USDA of $1.35 million 

which is shown for consistency with State funding tables
EXECUTIVE SUMMARY

33 

Budget Authority by Activity

(Dollars in thousands) 

Administration for Community Living

FY 2020 

Final

FY 2021 

Enacted

FY 2022 

President's 

Budget

Health & Independence for Older Adults

Home & Community-Based Supportive Services 390,074 392,574 550,574

Nutrition Services 936,753 951,753 1,341,385

Preventive Health Services 24,848 24,848 26,339

Native American Nutrition & Supportive Services 34,708 35,208 70,208

Aging Network Support Activities 12,461 16,461 19,446

 Subtotal, Health & Independence for Older Adults 1,398,844 1,420,844 2,007,952

Caregiver & Family Support Services

Family Caregiver Support Services 185,936 188,936 249,936

Native American Caregiver Support Services 10,306 10,806 15,806

Alzheimer's Disease Program 11,800 12,800 15,360

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

Lifespan Respite Care 6,110 7,110 14,220

Subtotal, Caregiver & Family Support Services 214,152 219,652 295,322

Protection of Vulnerable Adults

Long-Term Care Ombudsman Program 17,885 18,885 29,885

Prevention of Elder Abuse & Neglect 4,773 4,773 5,059

Elder Rights Support Activities 3,874 3,874 4,400

Elder Justice/Adult Protective Services 12,000 14,000 15,000

Subtotal, Protection of Vulnerable Adults 38,532 41,532 54,344

Disability Programs, Research & Services

State Councils on Developmental Disabilities 78,000 79,000 88,480

Developmental Disabilities Protection and Advocacy 40,784 41,784 46,798

University Centers for Excellence in Developmental Disabilities 41,619 42,119 47,173

Projects of National Significance 12,250 12,250 13,100

Independent Living 116,183 116,183 148,228

Limb Loss Resource Center 4,000 4,000 1,465

Limb Loss Resource Center (PHS Evaluation Funds) [non-add] -- -- 2,735

Paralysis Resource Center (PRC) 9,700 9,700 3,553

PRC (PHS Evaluation Funds) [non-add] -- -- 6,632

Traumatic Brain Injury (TBI) 11,321 11,321 4,148

TBI (PHS Evaluation Funds) [non-add] -- -- 7,739

National Institute on Disability, Independent Living, and Rehab. Research 111,970 112,970 118,619

Subtotal, Disability Programs, Research & Services 425,827 429,327 # 471,564

Consumer Information, Access & Outreach

Aging and Disability Resource Centers [Discretionary] 8,119 8,119 23,457

State Health Insurance Assistance Program 52,115 52,115 55,242

Voting Access for People with Disabilities (HAVA) 7,463 7,963 9,963

Assistive Technology 37,000 37,500 44,000

Subtotal, Consumer Information, Access & Outreach 104,697 105,697 132,662

Program Administration 41,063 41,063 47,063

Total, Discretionary Budget Authority 2,223,115 2,258,115 # 3,008,907

 Total FTE 170 188 212

1/ Reflects FY 2020 required and permissive transfers and rescissions, except the NSIP of $1.35 million which is shown for 

consistency with State funding tables.
EXECUTIVE SUMMARY

34 

Authorizing Legislation

Administration for Community Living

Act, Title XX-B, Section 2042...................................................... N/A 14,000,000 N/A 15,000,000

14) Aging Network Support Activities:

 OAA Sections 202, 215 and 411.................................................. 19,804,267 16,461,000 20,992,522 19,446,000

15) Lifespan Respite Care

Lifespan Respite Care Act of 2006 and

Public Health Service Act Title XXIX.......................................... Expired 7,110,000 Expired 14,220,000

16) Program Administration:

OAA Section 216 (a)..................................................................... 46,573,655 41,063,000 49,368,074 47,063,000

17) Aging and Disability Resource Centers

OAA Sections 216 (b)(4).............................................................. 9,208,570 8,119,000 9,761,084 23,457,000

18) State Health Insurance Assistance Program:

 Omnibus Budget Reconciliation Act of 1990 Section 4360.......... Expired 52,115,000 Expired 55,242,000

19) State Councils on Developmental Disabilities

DD Act Section 129(a).................................................................. Expired 79,000,000 Expired 88,480,000

FY 2021 

Amount 

Authorized

FY 2021 

Amount 

Appropriated

FY 2022 

Amount 

Authorized

FY 2022 

President's 

Budget

1) Home and Community-Based Supportive Services:

OAA Section 303 (a)(1)................................................................ 436,750,931 392,574,000 462,955,987 550,574,000

2) Nutrition Services

OAA Section 303 (b)(1)(2), 311(e) ............................................. 1,028,439,252 951,753,000 1,090,145,607 1,341,385,000

3) Preventive Health Services:

OAA Section 361.......................................................................... 28,182,602 24,848,000 29,873,558 26,339,000

4) Chronic Disease Self Management Education:

 OAA Section 411......................................................................... Expired 8,000,000 Expired 8,000,000

5) Falls Prevention:

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

6) National Family Caregiver Support Program:

OAA Section 303 (e)..................................................................... 205,501,161 188,936,000 217,831,231 249,936,000

7) Native American Nutrition and Supportive Services:

OAA Section 643.......................................................................... 39,298,714 35,208,000 41,626,636 70,208,000

8) Native American Caregiver Support Program:

OAA Section 631.......................................................................... 11,405,515 10,806,000 12,089,846 15,806,000

9) Alzheimer's Disease Program:

OAA Section 411 N/A 12,800,000 N/A 15,360,000

Patient Protection & Affordable Care Act, Sect 4002 Expired 14,700,000 Expired 14,700,000

10) Long-Term Care Ombudsman Program:

OAA Section 702(a)..................................................................... 19,150,967 18,885,000 20,300,025 29,885,000

11) Prevention of Elder Abuse and Neglect:

OAA Section 702(b)..................................................................... 5,413,537 4,773,000 5,738,349 5,059,000

12) Elder Rights Support Activities

OAA Sections 201, 202, and 411, 751, and 752 as amended. 18,004,290 3,874,000 19,084,548 4,400,000

13) Elder Justice/Adult Protective Services

OAA Section 411 as amended and Social Security
EXECUTIVE SUMMARY

35 

Authorizing Legislation – Continued

Administration for Community Living 

1/ MIPPA Amounts are authorize and appropriated through 9/30/2023

20) Protection and Advocacy

DD Act Section 145...................................................................... Expired 41,784,000 Expired 46,798,000

21) University Centers for Excellence in Developmental Disabilities

DD Act Section 156...................................................................... Expired 42,119,000 Expired 47,173,000

22) Projects of National Significance 

DD Act Section 163...................................................................... Expired 12,250,000 Expired 13,100,000

23) Voting Assistance for People with Disabilities

Help America Vote Act Section 291............................................. Expired 7,963,000 Expired 9,963,000

24) Paralysis Resource Center 

Public Health Services Act Sections 311 and 317(k)(2)............... N/A 9,700,000 N/A 3,553,000

Section 241 of the Public Health Service (PHS) Act.................... Expired - Expired 6,632,000

25) National Institute on Disability, Independent Living, 

and Rehabilitation Research 4/

Rehabilitation Act of 1973 Sect. 201............................................ Expired 112,970,000 Expired 118,619,000

26) Independent Living 

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

Independent Living State Grants Section 714............................. Expired 25,378,000 Expired 28,423,000

Centers for Independent Living Section 727.............................. Expired 90,805,000 Expired 119,805,000

27) Assistive Technology (AT)

AT Act (including but not limited to Section 4-6)........................ Expired 37,500,000 Expired 44,000,000

28) Limb Loss Resource Center 

Public Health Services Act, Title III............................................. N/A 4,000,000 N/A 1,465,000

Section 241 of the Public Health Service (PHS) Act.................... Expired - Expired 2,735,000

29) Traumatic Brain Injury 

 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 2,682,000

Section 241 of the Public Health Service (PHS) Act.................... Expired - Expired 5,005,000

Traumatic Brain Injury Protection and Advocacy.......................... Expired 4,000,000 Expired 1,466,000

Section 241 of the Public Health Service (PHS) Act.................... Expired - Expired 2,734,000

30) Senior Medicare Patrols/Health Care Fraud and Abuse Prevention 

 OAA Section 411 and Health Insurance Portability and ..............

 Accountability Act (HIPAA) of 1996.......................................... Expired 20,000,000 Expired 20,000,000

 HCFAC Wedge Funding............................................................... Expired 2,000,000 Expired -

31) Medicare Improvements for Patients and Providers Act/1

Aging and Disabilty Resource Centers.......................................... 5,000,000 5,000,000 5,000,000 5,000,000

Area Agencies on Aging................................................................ 15,000,000 15,000,000 15,000,000 15,000,000

National Center for Benefits Outreach and Enrollment.................. 15,000,000 15,000,000 15,000,000 15,000,000

State Health Insurance Assistance Program................................... 15,000,000 15,000,000 15,000,000 15,000,000

Total Request Level

Unfunded Authorizations:

1) Legal Assistance:

OAA Section 702(b)..................................................................... 5,413,537 - 5,738,349 -

 2,357,815,000 3,123,713,000
EXECUTIVE SUMMARY

36 

Appropriations History

Administration for Community Living

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

Agriculture for commodities purchases pursuant to Public Law 113-6 

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

Agriculture for commodities purchases pursuant to Public Law 113-76. 

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

Agriculture for commodities purchases pursuant to Public Law 113-235.

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

Agriculture for commodities purchases pursuant to Public Law 114-113.

5/ 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. 

6/ 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. 

7/ House Allowance includes $300 million for the Senior Community Service Employment Program currently 

administered by the Department of Labor. 

8/ 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.

Budget Estimate 

to Congress

House Senate 

Allowance Allowance Appropriation

FY 2013 Annual /1 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 Annual /2 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 Annual /3 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 Annual /4 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 Annual /5 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 Annual /6,7 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

FY 2019 Annual /8 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

FY 2020 Annual /9

127)

2,032,671,000 2,349,343,000 2,175,415,000 2,223,115,000

250,000,000

Supplementals (P.L. 116-

136) 955,000,000

FY 2020 Transfers -1,381,186

Subtotal 3,426,733,814
EXECUTIVE SUMMARY

37 

Appropriations History 

Administration for Community Living

Budget 

Estimate to

Congress

House 

Allowance

Senate 

Allowance Appropriation

FY 2021 Annual /10

 

2,108,207,000 2,279,505,000 2,235,215,000 2,223,115,000 

Supplementals (P.L. 116-

260)

 

275,000,000 

Supplementals (P.L. 117-2)

 

1,532,000,000 

FY 2021 Transfers -1,347,714 

Subtotal

 

2,221,767,286 

FY 2022 Annual

 

3,008,907,000 

 

Supplementals (P.L. 117-2)

FY 2022 Transfers

188,000,000 

9/ 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 116-94. 

10/ Includes $1,347,714 in FY 2021 budget authority appropriated to ACL and transferred to the Department of 

Agriculture for commodities purchases pursuant to Public Law 116-260. 
EXECUTIVE SUMMARY

38 

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 2021

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 $14,000,000

Lifespan Respite Care: 

Lifespan Respite Care Act 

of 2006 FY 2011 $94,810,000 $2,495,000 $7,110,000

Assistive Technology: The 

Assistive Technology Act of 

2004 FY 2010 Such Sums $25,000,000 $37,500,000

Developmental Disabilities 

Programs: Developmental 

Disabilities Assistance and 

Bill of Rights Act FY 2007 Such Sums $155,115,000 $175,153,000

Paralysis Resource Center: 

Christopher and Dana Reeve 

Paralysis Act, title XIV of 

the Omnibus Public Land FY 2011 $25,000,000 $6,352,000 $9,700,000

Management Act of 2009, 

P.L. 111-11 and Public 

Health Service Act, Sections 

311 and 317(k)(2)

Limb Loss Resource 

Center: Public Health 

Service Act Section 301 (a) 

and Section 317 N/A N/A N/A $4,000,000
EXECUTIVE SUMMARY

39 

Appropriations Not Authorized by Law – Continued 

Administration for Community Living 

Program

Last Year of 

Authorization

Authorization 

Level

Appropriations in 

Last Year of 

Authorization

Appropriations in 

FY 2021

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 $229,153,000

Voting Access for People 

with Disabilities: Help 

America Vote Act - Section 

291 FY 2005 $17,410,000 $13,879,000 $7,963,000

State Health Insurance 

Assistance Programs: 

Omnibus Budget 

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

40 

Program Authorizing Legislation Table FY 2020 

Funding Level 

in the 

Authorization

Most Recent 

(Re)Authorizing 

Legislation

FY Auth. 

Expires or 

Expired

Location of Program 

Authorization 

Legal Citation 

Account Name Program Name (US Code) Nature of Expiration

Aging and Home and 

CommunityBased 

Supportive 

Services

Disability Services 

Programs

Older Americans Act (P.L. 

89-73): Section 321, 

Section 303(a)(1) 

(Authorization of 

Appropriations).

42 U.S.C. 3030d; 42 Older Americans 

Reauthorization Act of 

2016, P.L. 114-144

USC 3023

Expired FY 2019 Program Authority AND 

Auth of Appropriation

Aging and Congregate 

Nutrition 

Services

Disability Services

Programs

Older Americans Act (P.L. 

89-73): Section 331, 

Section 303(a)(1) 

(Authorization of 

Appropriations).

42 U.S.C. 3030e; 42 Older Americans 

Reauthorization Act of 

2016, P.L. 114-144

USC 3023

Expired FY 2019 Program Authority AND 

Auth of Appropriation

Aging and 

Disability Service

Programs

Home-Delivered Older Americans Act (P.L. 

89-73): Section 336, 

Section 303(a)(1) 

(Authorization of 

Appropriations).

s Nutrition

42 U.S.C. 3030f; 42 Older Americans 

Reauthorization Act of 

2016, P.L. 114-144

USC 3023

Expired FY 2019 Program Authority AND 

Auth of Appropriation

Aging and Nutrition 

Services 

Incentives 

Program

Disability Services

Programs

Older Americans Act (P.L. 

89-73): Section 311, 

Section 303(a)(1) 

(Authorization of 

Appropriations).

42 U.S.C. 3030a; 42 Older Americans 

Reauthorization Act of 

2016, P.L. 114-144

USC 3023

Expired FY 2019 Program Authority AND 

Auth of Appropriation

Aging and Preventive 

Disability Services Health Services

Programs

Older Americans Act (P.L. 

89-73): Section 361, 

Section 303(a)(1) 

(Authorization of 

Appropriations).

42 U.S.C. 3030n; 42 Older Americans 

Reauthorization Act of 

2016, P.L. 114-144

USC 3023

Expired FY 2019 Program Authority AND 

Auth of Appropriation

Aging and National Family 

Caregivers 

Support Services

Older Americans Act (P.L. 

89-73): Sections 371-374, 

Section 303(a)(1) 

(Authorization of 

Appropriations).

Disability Services

Programs

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 Service

Programs

s

Aging Network 

Support 

Activities

Older Americans Act, 

Section 411; Authorization 

of Appropriations, Sections 

216 and 411, P.L 89-73.

42 USC 3032a; 40 Older Americans 

Reauthorization Act of 

2016, P.L. 114-144

USC 3032(14)(b)(1)

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 Older Americans 

Reauthorization Act of 

2016, P.L. 114-144

USC 3032(14)(b)(2)

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 Older Americans 

Reauthorization Act of 

2016, P.L. 114-144

U.S.C. 3012; 40 

USC 3032(14)(b)(2)

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

41 

Program Authorizing Legislation Table - Continued 

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

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

42 

Program Authorizing Legislation Table – Continued 

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

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
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

43 

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. These programs are consistent with the 

priorities and policies of the Administration to address institutional bias, expand services that help 

older adults age in place, and have programming reflect the preferences of the population. These 

programs, that target underserved and marginalized populations, enable older individuals to 

maintain their health, independence and dignity and provide supports that enable them to remain 

in their own homes and communities. Two additional programs provide similar services for Native 

Americans; and another two address management of chronic disease and falls prevention, and a 

final program, Aging Network Support Activities, provide competitive grants and contracts for 

testing innovative new service approaches and other ways to support the aging services network. 

The U.S. population over age 60 is projected to increase by 15.7% percent between 2019 and 2025, 

from 74.6 million to 86.3 million..5 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 3.3 percent over the same period.6 Health 

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

and communities at a lower cost and improved quality of life 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 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

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 30 April 2021. 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, 2019. Released June 2020. https://www.census.gov/programssurveys/popest/data/tables.2019.html . Accessed 30 April 2021.

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 30 April 2021. 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, 2019: Released June 2020, 

https://www.census.gov/programs-surveys/popest/data/tables.2019.html . Accessed 30 April 2021. Centers for 

Medicare & Medicaid Services, ACL analysis of 2017 Medicare Current Beneficiary Survey, 

https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS/index. Accessed 30 April 2021.

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

8 Ibid. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

44 

ACL’s FY 2022 budget for Health and Independence for Older Adults is $2 billion, an increase of 

$587 million over the FY 2021 Enacted level. These programs were never intended to serve all 

older Americans. Thus, when as a result of the pandemic there was a spike in demand for services 

caused by older adults who hadn’t previously used them, Congress responded by providing almost 

$2.2 billion in additional funding between FY 2020 and FY 2021. Though demand is beginning 

to stabilize, these levels remain well above historical levels; additional resources, are necessary 

to help maintain service levels. A key characteristic of this increase above historic levels is that 

due to the sedentary nature of individuals during the pandemic, we have seen increases in declines 

of physical and cognitive functioning. As a result, many who may have been able to return safely 

to active community living are in need of services and supports and will instead remain clients of 

the aging services network. 

During the pandemic, the ability of older Americans to receive ACL-funded services and what 

they actually needed changed. Many were no longer able to easily access services, such as 

congregate nutrition or in-home supports due to the risk of contracting COVID-19. Already 

especially vulnerable due to their age or disabilities, the loss of crucial home and community-based 

services and nutrition supports further jeopardized their independence and ability to socially 

distance in their communities. For some, the loss of services also placed them at serious risk of 

entering congregate and institutional settings, the same settings where COVID-19 infections and 

deaths have been highest. Those people with disabilities and older adults who did remain in the 

community have faced increased social isolation and now are facing barriers in accessing vaccines. 

All of these impacts multiply for marginalized older adults. The FY 2022 request also reflects the 

Administration’s commitment to improving equity because all of these programs are targeted to

those in greatest social and economic need, with particular attention to low income, low-income 

minorities, rural, limited-English speaking, and those at risk of institutionalization. 

With COVID Supplemental funding, Congress increased the ability of states to transfer funding 

between programs to meet the specific needs of populations, expanded funding for home-delivered 

meals and for pick-up meals from congregate nutrition sites, and ACL encouraged the use of virtual 

services, such as wellness checks, telephone reassurance, and the use of electronic communications 

technologies (e.g. Skype, Facetime, Zoom) to promote face-to-face interaction with family 

members and program staff. In FY 2022, ACL is also requesting a general provision that would 

allow States and Tribes to continue to have maximum flexibility to transfer essentially 100% of 

their Title III or Title VI services funding between programs as they strive to achieve the best 

balance of services to meet the unique needs of their individual populations as the country begins 

to emerge from the pandemic, mirroring existing flexibilities which are tied to the PHE. 

In FY 2022 specific Health and Independence program requests include:

• $550.6 million for Home and Community-Based Supportive Services (HCBSS), an 

increase of $158 million over the FY 2021 Enacted level. Over the past two-years Congress 

has provided an additional $660 million in supplemental funding to meet the additional 

needs of older Americans for supportive services that would allow them to weather the 

pandemic from their homes and communities. These included services provided directly, 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

45 

and in many cases virtually, including information and referral, transportation, case 

management, personal care services, chore services, adult day care and physical fitness and 

wellness programs. The pandemic led the aging services network to try new approaches 

to overcome constraints resulting from the pandemic, something ACL hopes to continue to 

encourage by again including appropriations language to allow up to one percent of Home 

and Community-Based Supportive Services (HCBSS) funding to be used for innovation 

grants to test new ways that HCBSS funding can better address service challenges and the 

ongoing need to modernize. 

• $1,341.4 million for Congregate Nutrition, Home-Delivered Nutrition, and the Nutrition 

Services Incentives Program, an increase of +$389.6 million over the FY 2021 Enacted 

level of $951.8 million. The pandemic has resulted in a flood of new requests for nutrition 

services. Seniors, especially those at risk as a result of the pandemic, have turned in many 

cases to the aging services network for meals, allowing them to socially distance and to 

quarantine reducing the risk of contracting the virus. 

• $26.3 million for Preventive Health Services, an increase of +$1.5 million above the FY 

2021 Enacted level. This funding promotes healthy behaviors in order to prevent chronic 

disease and disability, thereby reducing the need for more costly medical interventions.

Social isolation resulting from the pandemic has increased the need to address healthy 

lifestyles by managing chronic diseases exacerbated by declines in physical functioning 

resulting from reduced access to community supports and evidence-based programs. This 

new funding will help cover the costs of transitioning to virtual programs that expanded 

their reach during the pandemic, including increased costs as grantees worked with 

developers to create evidence-based interventions that work at home. 

• $8 million for Chronic Disease Self-Management Program (CDSME), the same level as 

the FY 2021 Enacted level. CDSME programs help individuals to better manage their 

chronic conditions, such as diabetes, heart disease, cancer, HIV, depression, and pain. 

• $5 million for the Elder Falls Management Program (Falls), the same level as the FY 2021 

Enacted level. Falls prevention programs are low-cost, community-based interventions 

that can be delivered in small group or one-on-one formats, including virtually. The 

request maintains support the Falls program and its work. 

• $70.2 million for Native American Nutrition and Supportive Services an increase of +$35 

million over the FY 2021 Enacted level. The additional $35 million is estimated to provide 

an additional 2.4 million home delivered meals, and 2.4 million congregate meals. Tribes 

were especially hard hit during the pandemic and received almost $54 million in additional 

supplemental funding to address their needs. The request recognizes that many needs still 

continue at a heightened level and provides sufficient funding to continue to address these 

needs as the country emerges from the pandemic. The FY 2022 request also reflects the 

Administration’s commitment to improving equity, recognizing the lack of resources 

provided to address the lower life expectancy and health status that American Indians and 

Alaska Natives have experienced when compared to other Americans. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

46 

• $19.5 million for Aging Network Support Activities, an increase of +$2.9 million over the 

FY 2021 Enacted level. The additional funding will an increase of $240,000 for the Care 

Corps program and $2.745 for Program Performance and Technical Assistance to address 

priorities including equity, recovery from COVID-19 and caregiving, including both the 

informal and paid caregiver workforce. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

47 

Outcome and Outputs Table: 

Health and Independence for Older Adults

Measure Year and Most Recent FY 2021 FY 2022 FY 2022

1.1 For Home and 

Community-based 

Services including 

Nutrition and Caregiver 

services increase the 

FY 2019: 7,794 clients

Target:

8,900 clients

7,517 clients 7,458 clients -59 clients

number of clients served 

per million dollars of 

Title III OAA funding. 

(Efficiency)

(Target Not Met)

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 

FY 2019: 66.89 weighted 

average

Target:

63.6 weighted average

(Target Exceeded)

64.7 weighted 

average

64.3 weighted 

average

-0.4 weighted

average

live in their homes and 

communities. (Outcome)

3.3 The percentage of 

OAA clients served who 

FY 2019: 34.15% 34.9% 34.47% -0.43

live in rural areas is at 

least 15% greater than the 

percent of all US elders 

who live in rural areas. 

(Outcome)

Target:

26.2%

(Target Exceeded)

3.6 The percentage of 

OAA clients served who 

FY 2019: 33.4% 33.11% 33.26% +0.15

live in poverty is 150% 

greater than the percent 

of all U.S. elders living 

below the poverty level. 

(Outcome)

Target:

24.6%

(Target Exceeded)

Result /

Target for Recent Result /

Target Target Target

+/-FY 2021

Target

(Summary of Result)
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

48 

Indicator Year and Most Recent FY 2021 FY 2022 FY 2022

Result / Projection Projection

Projection

+/-FY 2021 

Projection

Output C: Transportation FY 2019: 20.4 M 18.3 M 19.5 M +1.2 M

Service Units (Output)

Output D: Personal Care, FY 2019: 49.3 M 52.1 M 54.3 M +2.2 M

Homemaker and Chore 

Services units (Output)

Output E: Adult Day FY 2019: 12.1 M 13.2 M 14.5 M +1.3 M

Care/Day Health units

(Output)

Output F: Case FY 2019: 3.3 M 2.5 M 2.6 M +0.1 M

Management Services 

units (Output)
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

TIVE SUMMARY

49 

Home and Community-Based Supportive Services

Services

FY 2020 Final FY 2021 

Enacted

FY 2022 

President’s 

Budget

FY 2022 +/- 

FY 2021

Supplemental Funding $200.000 $460.000 --- -$460.000 

Budget Authority $390.074 $392.574 $550.574 +$158.000 

Home and Community-Based 

Supportive Services – Program 

Level

$590.074 $852.574 $550.574 -$302.000 

*BA is in millions of dollars.

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

Law 89-73 

Most Recent Authorizing Legislation: Supporting Older Americans Act of 2020, Public Law 116-

131 

Current FY Authorization: .........................................................................................$462,955,987 

 

Authorization Expiration Date ........ . ..........................................................................................2024 

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 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

50 

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

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 older adults. 

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 Data also show that over 96 percent of seniors age 

85 and older have at least one chronic condition and 88 percent have at least two.11 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 serving nearly a half million seniors in their own communities who meet the 

disability criteria for nursing home admission13 and helping to keep them from joining the 

1.7 million seniors who live in institutional settings.14 Nationally, 24 percent of individuals 60 

and older live alone,

15 and in FY 2019, 44 percent of OAA consumers were individuals who live 

alone.16 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

Services provided by the HCBSS program in FY 2019 include: 

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 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. 

11 Ibid. 

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

13 Ibid.

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.

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. 

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

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.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

51 

• Transportation Services provided more than 20.4 million rides to doctor’s offices, grocery

stores, pharmacies, senior centers, meal sites, and other critical daily activities

(Output C).18

• Personal Care, Homemaker, and Chore Services provided more than 49.3 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

• Adult Day Care/Day Health provided over 12.1 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

• Case Management Services provided nearly 3.3 million hours of assistance in assessing

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

(Output F).21

Continuing ACL’s commitment to provide services to those most in need, 46 percent of passengers

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 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

Of the transportation participants, 96 percent take daily medications, with over 16 percent taking 

10 to 25 medications daily.24 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 In addition, a study 

published in the Journal of Aging and Health shows that the services provided by the HCBSS 

18 ACL’S OAA State Performance Report, FY 2018.

19 Id.

20 Id.

21 Id.

22 2019 National Survey of Older Americans Act Participants. https://agid.acl.gov/. 

23 Id. 24 Id.

25 Id.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

52 

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

During the pandemic Congress provided an additional $660 million in supplemental 

appropriations. The additional funding has allowed more seniors to receive a greater amount and 

range of flexible supportive services, allowing them to shelter-in-place or self-quarantine and 

supported social distancing to help minimize exposure to COVID-19. Services provided include 

personal care, homemaker and chore services; transportation to grocery stores, banks or doctors 

when necessary; and case management. Additionally, states and area agencies on aging have the 

flexibility to provide specific services intended to mitigate some of the isolation that might occur, 

including virtual friendly visiting, wellness checks, telephone reassurance, and the use of 

electronic communications technologies (e.g., Skype, FaceTime, Zoom) to promote face-to-face 

interaction with family members and program staff.

Funding History:

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

follows: 

FY 2013.....................................

FY 2014.................................

FY 2015.................................

FY 2016.................................

FY 2017................................. $349,426,000

FY 2018................................. 

FY 2019.................................

FY 2020.................................

FY 2021 Enacted.......................

FY 2022 President’s Budget...........

$347,724,297

$347,724,000

$347,724,000

$347,724,000

$385,074,000

$384,676,000

$390,074,000

$392,574,000

$550,574,000

Budget Request:

The FY 2022 Budget request for Home and Community-Based Supportive Services (HCBSS) is 

$550,574,000, an increase of $158,000,000 above the FY 2021 Enacted level of $392,574,000. 

While OAA programs often have waiting lists, and target funds to those in greatest social and 

economic need, the COVID-19 pandemic has resulted in a flood of new requests for services. A 

survey by Meals on Wheels America (MOWA) found a 95% increase in demand for nutrition 

services during the initial months of the pandemic that by the end of 2020 had stabilized at roughly 

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

53 

60% above annual nutrition levels. The demand for supportive services has closely tracked that 

for nutrition services during the same period of the pandemic. Funding for HCBSS has allowed 

more seniors to receive a greater amount and range of flexible supportive services that allows them 

to shelter-in-place or self-quarantine and has supported social distancing to help minimize 

exposure to COVID-19. These include personal care, homemaker and chore services; 

transportation to grocery stores, banks or doctors when necessary; and case management. 

Additionally, states and area agencies on aging have the flexibility to provide specific services 

intended to mitigate some of the isolation that might occur, including virtual friendly visiting, 

wellness checks, telephone reassurance, and the use of electronic communications technologies 

(e.g., Skype, FaceTime, Zoom) to promote face-to-face interaction with family members and 

program staff.

During the pandemic, $660 million was provided for supportive services through supplemental 

appropriations and the American Rescue Plan Act. These increases will help maintain services for 

the significantly larger population of older adults who have been relying on these services, many 

or all of whom are likely to remain at higher risk during FY 2022. . This level will allow ACL to 

continue to address the heightened demand from the pandemic as the country begins to transition 

away from the pandemic and back to more historical service levels. This funding will be 

especially critical, as it can also be used to assist COVID-19 vaccination administration. In 

addition, this funding source can also be directed by states to support caregivers, legal assistance 

to protect rights and combat evictions, or provide Ombudsman services to protect the rights of 

residents in institutional settings.

The Budget request supports an estimated additional 1.3 million units of adult day care for older 

adults; an addition of 1.2 million rides for activities such as visiting the doctor, the pharmacy, or 

grocery stores; and an additional 2.2 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.

In addition to providing sufficient funding to support the transition away from the pandemic, the 

Budget continues to propose two changes to appropriations language: the ability to use up to 1% 

of HCBSS funding to fund innovative demonstrations, the same authority that is currently 

available to the nutrition programs; and a provision allowing states continued flexibility to address 

ongoing COVID response needs in the event that PHE flexibilities expire. The provision allows 

States and Tribes to shift their respective funding between their services programs to better address 

needs during COVID recovery. 

• Innovation Demonstrations: Continuing to innovate in all of ACL’s programs is critical to

their effective and efficient management. 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:
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

54 

• Pandemic – ACL is interested in identifying lessons learned as a result of changes

required by the pandemic, including service models that work better and can be retained

and incorporated going forward

• Transportation – key areas ACL has identified as in need for innovations include

specialized transportation, volunteer transportation, mobility management, and 

travel training.

• Senior Centers – ACL is interested in exploring ways to transform and modernize

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 uses of technology in providing HCBSS 

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 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. During the Public Health Emergency

(PHE) up to 100% of the funding from any of the Title III programs (HCBSS, Nutrition,

Preventive Health, Caregivers) can be used for disaster assistance due to major disaster

declarations of emergencies that are in place. Should these emergency declarations expire,

it would result in more limited flexibility for States to transfer funding to address their

specific needs. As a result, ACL is proposing expanded transfer authority for States

involving Title III dollars and for Tribes using Title VI dollars (using a General Provision

appropriations language change) to address the need for another year of transfer flexibility.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

TIVE SUMMARY

55 

Outputs and Outcomes Table:

Home and Community-Based Supportive Services 

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2021

Target

FY 2022

Target

FY 2022

Target

+/-FY 2021

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 2019: 7,794 clients

Target:

8,900 clients

(Target Not Met)

7,517 clients 7,458 clients -59 clients

2.9b Maintain at 90% or FY 2019: 94% 94% 94% Maintain

higher the percentage of 

transportation clients Target:

who rate services good 90%

to excellent. (Outcome)

(Target Exceeded)

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 2019: 66.89 weighted 

average

Target:

63.6 weighted average

(Target Exceeded)

64.7 weighted 

average

64.3 weighted 

average

-0.4 weighted 

average

3.3 The percentage of FY 2019: 34.15% 34.9% 34.47% -0.43 

OAA clients served who 

live in rural areas is at Target:

least 15% greater than 26.2%

the percent of all US 

elders who live in rural (Target Exceeded)

areas. (Outcome)

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 2019: 33.4%

Target:

24.6%

(Target Exceeded)

33.11% 33.26% +0.15 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

56 

Indicator Year and Most Recent 

Result /

FY 2021

Projection

FY 2022

Projection

FY 2022

Projection

+/-FY 2021 

Projection

Output C: Transportation 

Service Units (Output)

FY 2019: 20.4 M 18.3 M 19.5 M +1.2 M

Output D: Personal Care, 

Homemaker and Chore 

Services units (Output)

FY 2019: 49.3 M 52.1 M 54.3 M +2.2 M

Output E: Adult Day 

Care/Day Health units

(Output)

FY 2019: 12.1 M 13.2 M 14.5 M +1.3 M

Output F: Case 

Management Services 

units (Output)

FY 2019: 3.3 M 2.5 M 2.6 M +0.1 M

Grant Awards Tables:

Home and Community-Based Supportive Services Grant Awards 

Note: For presentation within the budget, ACL highlighted specific measures that are most directly related to Home 

and Community-Based Supportive Services; however, multiple performance outcomes are impacted by this program 

because ACL’s performance measures (efficiency, effective targeting, and client outcomes) assess network-wide 

performance in achieving current strategic objectives.

Grant Awards Tables

FY 2020 

Final

FY 2021 

Enacted

FY 2022 

President's 

Budget

Number of Awards 56 56 56

Average Award $6,922,964 $6,940,148 $9,635,045 

Range of Awards $242,304 -

$40,300,259

$242,905 -

$40,399,387

$337,227 -

$56,148,817
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

57 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2022 DISCRETIONARY STATE FORMULA GRANTS

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

FY 2020

Final

FY 2021

Enacted

FY 2022

President's Budget

FY 2022 +/- 

STATE/TERRITORY FY 2021

Alabama 5,816,818 5,831,072 8,103,800 2,272,728

Alaska 1,938,430 1,943,241 2,697,813 754,572

Arizona 8,454,587 8,477,520 11,883,521 3,406,001

Arkansas 3,557,832 3,566,348 4,947,554 1,381,206

California 40,300,259 40,399,387 56,148,817 15,749,430

Colorado 5,779,876 5,795,279 8,106,433 2,311,154

Connecticut 4,377,232 4,387,808 6,086,980 1,699,172

Delaware 1,938,430 1,943,241 2,697,813 754,572

District of Columbia 1,938,430 1,943,241 2,697,813 754,572

Florida 28,975,154 29,049,467 40,513,466 11,463,999

Georgia 10,402,974 10,430,543 14,571,371 4,140,828

Hawaii 1,938,430 1,943,241 2,697,813 754,572

Idaho 1,938,816 1,944,123 2,719,702 775,579

Illinois 14,225,049 14,259,211 19,783,085 5,523,874

Indiana 7,500,185 7,518,684 10,453,167 2,934,483

Iowa 4,137,783 4,146,805 5,614,415 1,467,610

Kansas 3,336,977 3,344,971 4,622,013 1,277,042

Kentucky 5,186,326 5,198,911 7,220,568 2,021,657

Louisiana 5,143,701 5,156,472 7,169,548 2,013,076

Maine 1,938,549 1,943,410 2,702,005 758,595

Maryland 6,661,643 6,678,380 9,290,978 2,612,598

Massachusetts 8,053,410 8,073,137 11,219,841 3,146,704

Michigan 12,197,062 12,226,910 16,994,436 4,767,526

Minnesota 6,312,036 6,328,271 8,824,074 2,495,803

Mississippi 3,364,074 3,372,196 4,682,543 1,310,347

Missouri 7,284,265 7,302,158 10,147,604 2,845,446

Montana 1,938,430 1,943,241 2,697,813 754,572

Nebraska 2,230,133 2,235,407 3,071,390 835,983

Nevada 3,321,139 3,330,012 4,653,009 1,322,997

New Hampshire 1,938,430 1,943,241 2,697,813 754,572

New Jersey

New Mexico

New York

North Carolina

North Dakota

 10,320,045

 23,597,211

 2,488,129

 11,783,710

 1,938,430

 10,345,066

 2,494,300

 23,652,043

 11,814,518

 1,943,241

14,335,105

3,471,677

2,697,813

16,492,529

32,462,605

 3,990,039

 977,377

 8,810,562

 4,678,011

 754,572
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

58 

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

1/ Contingency Fund- Includes funds for Older American Act statutory requirements, including evaluation and disaster 

assistance; and grant and program reporting system costs, and innovation demonstration grants. Funds unused for these purposes 

at the end of the year are allocated to states.

FY 2020

Final

FY 2021

 Enacted 

FY 2022 FY 2022 +/- 

STATE/TERRITORY President's Budget FY 2021 

Ohio 14,157,984 14,192,196 19,708,404 5,516,208

Oklahoma 4,363,424 4,373,976 6,073,545 1,699,569

Oregon 5,125,139 5,137,936 7,153,081 2,015,145

Pennsylvania 17,370,923 17,410,305 23,783,640 6,373,335

Rhode Island 1,938,430 1,943,241 2,697,813 754,572

South Carolina 6,203,318 6,219,904 8,697,465 2,477,561

South Dakota 1,938,430 1,943,241 2,697,813 754,572

Tennessee 7,805,579 7,825,039 10,887,055 3,062,016

Texas 25,814,243 25,882,009 36,146,372 10,264,363

Utah 2,475,877 2,482,599 3,475,581 992,982

Vermont 1,938,430 1,943,241 2,697,813 754,572

Virginia 9,297,593 9,321,159 12,987,402 3,666,243

Washington 8,225,341 8,246,548 11,509,375 3,262,827

West Virginia 2,693,884 2,699,569 3,661,658 962,089

Wisconsin 6,986,017 7,003,736 9,755,907 2,752,171

Wyoming

 Subtotal 

 1,938,430 1,943,241 2,697,813 754,572

 380,527,027 381,473,036 529,807,664 148,334,628

American Samoa

Guam 453,095

969,215

453,134

971,621

460,029

1,348,906 377,285

6,895

Northern Mariana Islands 242,304 242,905 337,227 94,322

Puerto Rico 4,525,151 4,535,943 6,259,788 1,723,845

Virgin Islands

 Subtotal

Total States/Territories

969,215 971,621 1,348,906 377,285

 7,158,980 7,175,224

 387,686,007 388,648,260 539,562,520

9,754,856 

 150,914,260

2,579,632

Contingency Fund 1/ 2,387,993 3,925,740 11,011,480 7,085,740

 Subtotal Adjustments 2,387,993 3,925,740 11,011,480 7,085,740

TOTAL RESOURCES 390,074,000 392,574,000 550,574,000 158,000,000
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

59 

Nutrition Services

Services FY 2020 Final FY 2021 Enacted FY 2022 

President’s Budget

FY 2022 +/- 

FY 2021

Congregate 

Nutrition Services $510.342 $515.342 $468.954 - $46.388

Home- Delivered 

Nutrition Services $266.342 $276.342 $703.431 +$427.089 

Nutrition Services 

Incentive Program27 $160.069 $160.069 $169.000 +$8.931

Total Supplemental 

Funding $720.00 $918.00 --- -$918.00

Program Level $1,656,753 $1,869,753 $1,341,385 -$528,368

*BA is in millions 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: Supporting Older Americans Act of 2020, Public Law 116-

131 

Current FY Authorization .........................................................................................$1,090,145,607

Authorization Expiration Date ...................................................................................................2024 

Allocation Method .................................................................... Formula Grant/Competitive Grants

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. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

60 

Program Description and Accomplishments: 

Nutrition Services help older Americans remain healthy and independent in their communities by 

providing meals and related services in a variety of community settings (including congregate 

facilities such as senior centers) and via home-delivery to older adults who are homebound due to 

illness, disability, or geographic isolation. These services occur in all 50 states, the District of 

Columbia, and five territories through a network of more than 7,000 local nutrition service 

providers.28 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 201929

• Home-Delivered Nutrition Services (Title III-C2): Provides funding for the delivery of 

meals and related services to frail seniors who are homebound. Established in 1978, 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 homebound 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 150.0 million 

meals to over 883,000 individuals in FY 201930

• 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 $153,010 assessed by USDA as 

administrative expenses) in FY 2021. 

• Under its authority to use up to one percent of nutrition appropriations for innovation 

demonstrations, ACL is using $9.1 million in FY 2021 to fund nutrition innovations and 

28 ACL’S OAA State Performance Report, FY 2019.

29 Id.

30 Id.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

61 

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 that has drawn widespread attention is an effort to train volunteers 

who deliver home-delivered meals to recognize and report indicators of suicidal intent and 

other mental health issues, so that they can be addressed. Suicide is a significant problem 

among older adults, 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 (201933 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 or more 

Activities of Daily Living) was 41 percent in 2019.34 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 homedelivered meal recipients have annual incomes at or below $20,000.35 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

• The prevalence of multiple chronic conditions is higher among congregate and homedelivered- 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 home-delivered, meal 

participants take over six medications per day and some take as many as 20 medications.37

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.

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.

33 ACL’S OAA State Performance Report, FY 2019 

34 Id. 35 2019 National Survey of Older Americans Act Participants. https://agid.acl.gov/. 

36 Id. 37 Id. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

62 

• 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 Therefore, the provision 

of healthy meals, access to lifestyle modification programs, and evidence-based advice, 

such as nutrition education and counseling, are important to helping these older individuals 

avoid more 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

• About 43 percent of congregate participants, and 58 percent of home-delivered 

participants, live alone.40 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 Eighty nine percent 

of congregate meal clients, and 91 percent of home-delivered meal clients, rate service as good to 

excellent.42

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 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

38 Kimokoti and Millen, 2016; Bernstein and Munoz, 2012. 39 Id. 40 Id. 41 Id.

42 Id. 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. 44 Id.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

63 

Funding History:

Comparable funding for Nutrition Services over the past ten years is as follows:

FY 2013......................................

FY 2014.......................................

FY 2015.......................................

FY 2016.......................................

FY 2017.......................................

FY 2018.......................................

FY 2019.......................................

FY 2020.......................................

FY 2021 Enacted........................ 

FY 2022 President’s Budget....... 

 $768,310,870

 $811,191,000

 $814,657,000

 $834,753,000

 $837,753,000

 $896,753,000

 $905,815,000

 $936,753,000

 $951,753,000

$1,341,385,000

Budget Request:

The FY 2022 Budget request for Nutrition programs is $1,341,385,000, an increase of 

$389,632,000 over the FY 2021 Enacted level of $951,753,000. Even as the country starts 

transitioning away from a world defined by COVID-19 and the pandemic, more older Americans 

will continue to need home-delivered meals than will be able to go to congregate sites for meals. 

Thus, the request reduces funding for Congregate Nutrition by -$46,388,000 and substantially 

increases the request for home-delivered meals by +$427,089,000. An increase of +$8,931,000 is 

also requested for the Nutrition Services Incentive Program. This request represents only a portion 

of the total funding for meals programs. Combined with state and local contributions, the request 

is projected to provide over 291 million meals to more than 1.2 million older Americans in a 

variety of community settings. In FY 2022, 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.

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. However, during the public health emergency (PHE), up to 100% of the 

nutrition funding provided by the initial supplemental appropriations could be transferred between 

Congregate and Home-Delivered meals. Any of the funding provided for Title III programs 

(HCBSS, Nutrition, Preventive Health, Caregivers) could be used for disaster assistance due to 

major disaster declarations of emergencies that were in place. As the pandemic has begun to wane, 

these emergency declarations may expire resulting in more limited flexibility for States to transfer 

funding to address their specific needs. As a result, of the possible loss of the PHE authority ACL 

is proposing to allow transfer authority for States involving Title III dollars and for Tribes using 

Title VI dollars (using a General Provision appropriations language change) to address the need 

for another year of continued transfer flexibility in the event that existing transfer flexibilities

expire. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

64 

While OAA nutrition programs often have waiting lists, and target funds to those in greatest social 

and economic need, the COVID-19 pandemic has resulted in a flood of new requests for nutrition 

services. Seniors, especially those at higher risk, who previously might not have needed or used 

these services, were at greater risk as a result of the Pandemic and turned in many cases to the 

Aging Services Network for meals that allowed them to socially distance and to quarantine, 

thereby reducing their risk of contracting the virus. 

A survey by Meals on Wheels America (MOWA) found a 95% increase in demand for nutrition 

services during the initial months of the Pandemic that had stabilized at roughly 60% above annual 

nutrition levels at the end of 2020, almost a year into the Pandemic. During this period, 

$1.638billion has been provided for additional meals through supplemental appropriations and the 

American Rescue Plan Act. The Budget requests an increase of roughly 40% above the FY 2021 

annual level ($951.8 million) for nutrition programs, to maintain meals for this larger, stabilized 

population. Without this increase, ACL will be unable to maintain services for the significantly 

larger population of older adults who have been relying on these services, many or all of whom 

are likely to remain at higher risk during FY 2022. 

Data from the American Community Survey (2019) indicate that 8.8 million adults age 60 and 

older have an independent living disability meaning that they experience difficulty doing errands 

alone such as visiting a doctor’s office or shopping and 4.9 million have difficulty with self-care 

such as dressing or bathing. Older Americans Act supported home delivered nutrition services 

reach less than 1 million older adults (882,000 in 2019). 

A forty percent increase in total OAA nutrition funding would allow for reaching a substantial 

portion of this population that is economically and socially vulnerable and who have declined in 

functional ability due to being restricted to their homes, unable to be active or to avail themselves 

of active lifestyles and activities proven to delay or reduce the onset of chronic conditions. 

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; 

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 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

65 

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

66 

Outcomes and Outputs Table:

Nutrition Services

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2021

Target

FY 2022

Target

FY 2022

Target

+/-FY 2021

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 2019: 7,794 clients

Target:

8,900 clients

(Target Not Met)

7,517 clients 7,458 clients -59 clients

2.9a Maintain at 90% or 

higher the percentage of 

clients receiving home 

delivered meal who rate 

services good to 

excellent. (Outcome)

FY 2019: 91%

Target:

90%

(Target Exceeded)

92% 93% +1 

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 2019: 66.89 weighted 

average

Target:

63.6 weighted average

(Target Exceeded)

64.7 weighted 

average

64.3 weighted 

average

-0.4 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 2019: 34.15%

Target:

26.2%

(Target Exceeded)

34.9% 34.47% -0.43 

3.5 Increase the 

percentage of older 

persons with severe 

disabilities who receive 

home-delivered meals. 

(Outcome)

FY 2019: 42.7%

Target:

42.4%

(Target Exceeded)

40.5% 41% +0.5 

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 2019: 33.4%

Target:

24.6%

(Target Exceeded)

33.11% 33.26% +0.15 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

67 

Indicator Year and Most Recent 

Result /

FY 2021 

Projection

FY 2022

Projection

FY 2022

Projection

+/-FY 2021

Projection

Output G: Number 

of HomeDelivered meals 

served (Output)

FY 2019: 150.0 M 150.0 M 231.0 M +81.0 M

Output H: Number 

of Congregate 

meals served 

(Output)

FY 2019: 73.3 M 64.9 M 60.0 M -4.9 M

Outputs G & H: 

Total Number of 

Meals (Output)

FY 2019: 223.3 M 219.6 M 291.0 M +78.5 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

68 

Grant Awards Tables:

Congregate Nutrition Programs Grant Awards 

Grant Awards Tables

FY 2020 

Final

FY 2021 

Enacted

FY 2022 

President's 

Budget

Number of Awards 56 56 56

Average Award $9,113,250 $9,202,536 $8,374,179 

Range of Awards $315,008 -

$52,727,894

$398,098 -

$52,739,498

$287,234 -

$48,079,385

Home-Delivered Nutrition Programs Grant Awards

Grant Awards Tables

FY 2020 

Final

FY 2021 

Enacted

FY 2022 

President's 

Budget

Number of Awards 56 56 56

Average Award $4,697,348 $4,829,851 $12,310,043 

Range of Awards $164,407 - 

$27,495,875

$169,045 -

$28,207,490

$430,851 -

$71,893,608

Nutrition Services Incentive Program Grant Awards 

Grant Awards Tables

FY 2020 

Final

FY 2021 

Enacted

FY 2022 

President's 

Budget

Number of Awards 270 270 270

Average Award $2,837,918 $2,828,288 $2,986,091 

Range of Awards $68,616 -

$16,277,034

$68,065 -

$16,146,206

$71,862 -

$17,047,075
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

69 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2022 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Congregate Nutrition Services (CFDA 93.045)

FY 2020

Final

FY 2021

Enacted

FY 2022

President's Budget

FY 2022 +/- 

STATE/TERRITORY FY 2021

Alabama 7,610,634 7,612,169 6,939,594 (672,575)

Alaska 2,520,063 2,520,787 2,297,874 (222,913)

Arizona 11,064,838 11,071,398 10,083,979 (987,419)

 4,654,768 4,655,303 4,244,780 (410,523)

 52,727,894 52,739,498 48,079,385 (4,660,113)

 7,563,699 

 

7,567,721 6,894,337 (673,384)

 

 

 

5,726,651 5,727,581 5,222,516 

 

(505,065)

 2,520,063 2,520,787 2,297,874 (222,913)

2,520,063 2,520,787 2,297,874 (222,913)

37,914,475 37,928,764 34,564,751 (3,364,013)

 

 

13,612,688 13,619,824 12,409,623 (1,210,201)

2,520,063 2,520,787 2,297,874 (222,913)

 2,521,111 2,522,836 2,297,874 (224,962)

 18,610,777 

 

18,613,205 16,971,688 (1,641,517)

 9,813,195 9,815,434 8,947,828 (867,606)

 5,072,249 

 

5,072,768 4,628,674 (444,094)

 4,288,043 4,288,869 3,910,199 (378,670)

 6,785,599 6,786,710 6,187,491 (599,219)

 6,729,899 6,731,655 6,136,581 (595,074)

 2,520,387 2,521,179 2,297,874 (223,305)

 8,715,984 8,718,704 7,947,491 (771,213)

 10,536,972 10,539,074 9,607,881 (931,193)

 15,958,615 15,961,694 14,551,219 (1,410,475)

 8,259,245 8,262,511 7,529,827 (732,684)

 4,401,431 4,402,056 4,013,474 (388,582)

 9,530,518 

 

9,532,567 8,690,374 (842,193)

 2,520,063 2,520,787 2,297,874 

 

(222,913)

 2,802,578 2,803,232 2,555,576 

 

(247,656)

 4,345,796 4,348,252 3,961,793 (386,459)

Arkansas

California

Colorado

Connecticut

Delaware

District of Columbia

Florida

Georgia

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine 

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina North 

Dakota

 2,520,063 2,520,787 2,297,874 (222,913)

 13,500,437 13,503,128 12,313,859 (1,189,269)

 3,255,638 3,256,408 2,968,218 (288,190)

 29,874,471 29,879,330 27,248,892 (2,630,438)

 15,419,292 15,426,435 14,056,813 (1,369,622)

 2,520,063 2,520,787 2,297,874 (222,913)
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

70 

PROGRAM/CFDA NUMBER: Congregate Nutrition Services (CFDA 93.045)

1/ Contingency Fund- Includes funds for Older American Act statutory requirements, including evaluation and disaster 

assistance; and grant and program reporting system costs, and innovation demonstration grants. Funds unused for these purposes 

at the end of the year are allocated to states.

FY 2020

Final

FY 2021

 Enacted 

FY 2022

 President's Budget 

 FY 2022 +/- 

STATE/TERRITORY FY 2021 

Ohio 18,523,838 18,526,522 16,890,996 (1,635,526)

Oklahoma 5,708,918 5,709,776 5,205,761 (504,015)

Oregon 6,706,070 6,707,860 6,114,049 (593,811)

Pennsylvania 21,484,525 21,487,290 19,591,935 (1,895,355)

Rhode Island 2,520,063 2,520,787 2,297,874 (222,913)

South Carolina 8,117,572 8,122,087 7,399,640 (722,447)

South Dakota 2,520,063 2,520,787 2,297,874 (222,913)

Tennessee 10,212,955 10,215,718 9,312,010 (903,708)

Texas 33,779,197 33,795,326 30,793,368 (3,001,958)

Utah 3,239,999 3,242,009 2,953,267 (288,742)

Vermont 2,520,063 2,520,787 2,297,874 (222,913)

Virginia 12,165,716 12,169,744 11,091,480 (1,078,264)

Washington 10,763,347 10,767,566 9,811,797 (955,769)

West Virginia 3,301,263 3,300,977 3,011,345 (289,632)

Wisconsin 9,140,892 9,143,995 8,334,051 (809,944)

Wyoming 2,520,063 2,520,787 2,297,874 (222,913)

 Subtotal 494,682,869 494,825,832 451,048,904 (43,776,928)

American Samoa 577,697 577,713 541,835 (35,878)

Guam 1,260,031 1,260,394 1,148,938 (111,456)

Northern Mariana Islands 315,008 315,098 287,234 (27,864)

Puerto Rico 5,916,897 5,918,015 5,399,071 (518,944)

Virgin Islands 1,260,031 1,260,394 1,148,938 (111,456)

 Subtotal 9,329,664 9,331,614 8,526,016 (805,598)

Total States/Territories 504,012,533 504,157,446 459,574,920 (44,582,526)

Contingency Fund 1/ 6,329,467 11,184,554 9,379,080 (1,805,474)

 Subtotal Adjustments 6,329,467 11,184,554 9,379,080 (1,805,474)

TOTAL RESOURCES 510,342,000 515,342,000 468,954,000 (46,388,000)
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

71 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2022 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Home-Delivered Nutrition Services (CFDA 93.045)

FY 2020

Final

FY 2021

Enacted

FY 2022

President's Budget

FY 2022 +/- 

STATE/TERRITORY FY 2021

Alabama 3,970,273 4,070,511 10,374,683 6,304,172

Alaska 1,315,257 1,352,358 3,446,812 2,094,454

Arizona 5,871,167 6,096,598 15,538,654 9,442,056

Arkansas 2,420,206 2,474,089 6,305,815 3,831,726

California 27,495,875 28,207,490 71,893,608 43,686,118

Colorado 3,992,082 4,137,464 10,545,329 6,407,865

Connecticut 2,972,548 3,043,652 7,757,484 4,713,832

Delaware 1,315,257 1,352,358 3,446,812 2,094,454

District of Columbia 1,315,257 1,352,358 3,446,812 2,094,454

Florida 19,906,074 20,527,245 52,318,648 31,791,403

Georgia 7,154,368 7,413,631 18,895,432 11,481,801

Hawaii 1,315,257 1,352,358 3,446,812 2,094,454

Idaho 1,333,027 1,388,445 3,538,788 2,150,343

Illinois 9,673,982 9,894,599 25,218,778 15,324,179

Indiana 5,121,641 5,255,588 13,395,137 8,139,549

Iowa 2,577,348 2,633,829 6,712,951 4,079,122

Kansas 2,232,471 2,288,165 5,831,941 3,543,776

Kentucky 3,536,340 3,621,004 9,229,005 5,608,001

Louisiana 3,509,563 3,605,350 9,189,107 5,583,757

Maine 1,320,214 1,358,621 3,462,775 2,104,154

Maryland 4,546,766 4,678,882 11,925,264 7,246,382

Massachusetts 5,497,459 5,635,820 14,364,251 8,728,431

Michigan 8,330,916 8,538,685 21,762,904 13,224,219

Minnesota 4,331,027 4,468,997 11,390,321 6,921,324

Mississippi 2,293,807 2,347,006 5,981,912 3,634,906

Missouri 4,968,531 5,096,286 12,989,117 7,892,831

Montana 1,315,257 1,352,358 3,446,812 2,094,454

Nebraska 1,460,057 1,498,526 3,819,356 2,320,830

Nevada 2,282,683 2,368,624 6,037,010 3,668,386

New Hampshire 1,315,257 1,352,358 3,446,812 2,094,454

New Jersey 6,971,816 7,147,758 18,217,791 11,070,033

New Mexico 1,705,275 1,750,320 4,461,114 2,710,794

New York 15,424,922 15,794,495 40,256,090 24,461,595

North Carolina 8,099,160 8,375,820 12,971,984

North Dakota 1,315,257 1,352,358 3,446,812

21,347,804

 2,094,454
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

72 

PROGRAM/CFDA NUMBER: Home-Delivered Nutrition Services (CFDA 93.045)

1/ Program Support- Includes funds for Older American Act statutory requirements, including evaluation and disaster assistance; 

and grant and program reporting system costs, and innovation demonstration grants. Funds unused for these purposes at the end

of the year are allocated to states.

FY 2020

Final

FY 2021

 Enacted 

FY 2022

 President's Budget 

 FY 2022 +/- 

STATE/TERRITORY FY 2021 

Ohio 9,655,324 9,880,210 25,182,105 15,301,895

Oklahoma 2,974,323 3,044,156 7,758,769 4,714,613

Oregon 3,512,270 3,608,725 9,197,709 5,588,984

Pennsylvania 11,175,373 11,429,521 29,130,898 17,701,377

Rhode Island 1,315,257 1,352,358 3,446,812 2,094,454

South Carolina 4,276,025 4,435,469 11,304,865 6,869,396

South Dakota 1,315,257 1,352,358 3,446,812 2,094,454

Tennessee 5,336,400 5,483,713 13,976,568 8,492,855

Texas 17,762,330 18,377,421 46,839,302 28,461,881

Utah 1,710,102 1,777,550 4,530,517 2,752,967

Vermont 1,315,257 1,352,358 3,446,812 2,094,454

Virginia 6,376,051 6,565,145 16,732,859 10,167,714

Washington 5,662,591 5,842,066 14,889,919 9,047,853

West Virginia 1,700,379 1,726,342 4,399,999 2,673,657

Wisconsin 4,785,053 4,928,406 12,561,235 7,632,829

Wyoming

 Subtotal 

 1,315,257 1,352,358 3,446,812 2,094,454

 258,393,646 265,692,162 677,180,746 411,488,584

American Samoa 164,407 169,045 430,851 261,806

Guam 657,629 676,179 1,723,406 1,047,227

Northern Mariana Islands 164,407 169,045 430,851 261,806

Puerto Rico 3,013,781 3,089,022 7,873,120 4,784,098

Virgin Islands 657,629 676,179 1,723,406 1,047,227

 Subtotal

Total States/Territories

 4,657,853 4,779,470

 263,051,499 270,471,632

 

 689,362,380

12,181,634 7,402,164

 418,890,748

Contingency Fund 1/ 3,290,501 5,870,368 14,068,620 8,198,252

 Subtotal Adjustments 3,290,501 5,870,368 14,068,620 8,198,252

TOTAL RESOURCES 266,342,000 276,342,000 703,431,000 427,089,000
 

 

 

 

 

 

 

 President's Budget FY 2021

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2022 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Nutrition Services Incentive Program (CFDA 93.053)

FY 2020 FY 2021 FY 2022

STATE/TERRITORY Final Enacted

FY 2022 +/-

Alabama 3,221,143 3,195,253 3,373,531 178,278

Alaska 479,564 475,709 502,251 26,542

Arizona 1,909,639 1,894,290 1,999,982 105,692

Arkansas 2,368,292 2,349,257 2,480,333 131,076

California 13,341,044 13,233,813 13,972,189 738,376

Colorado 1,438,429 1,426,868 1,506,479 79,611

Connecticut 1,391,493 1,380,309 1,457,322 77,013

Delaware 724,684 718,859 758,968 40,109

District of Columbia 861,837 854,910 902,610 47,700

Florida 6,323,772 6,272,944 6,622,941 349,997

Georgia 3,057,665 3,033,089 3,202,319 169,230

Hawaii 497,199 493,203 520,721 27,518

Idaho 806,027 799,548 844,159 44,611

Illinois 7,385,172 7,325,813 7,734,554 408,741

Indiana 1,241,683 1,231,702 1,300,424 68,722

Iowa 1,395,772 1,384,553 1,461,804 77,251

Kansas 2,298,013 2,279,542 2,406,729 127,187

Kentucky 1,496,032 1,484,007 1,566,807 82,800

Louisiana 3,767,360 3,737,078 3,945,587 208,509

Maine 625,289 620,264 654,871 34,607

Maryland 1,646,882 1,633,646 1,724,795 91,149

Massachusetts 6,961,153 6,905,202 7,290,476 385,274

Michigan 7,846,090 7,783,026 8,217,277 434,251

Minnesota 1,746,160 1,732,125 1,828,768 96,643

Mississippi 1,489,656 1,477,682 1,560,129 82,447

Missouri 3,847,942 3,817,013 4,029,983 212,970

Montana 1,134,493 1,125,374 1,188,164 62,790

Nebraska 1,031,494 1,023,202 1,080,292 57,090

Nevada 1,686,683 1,673,126 1,766,478 93,352

New Hampshire 1,208,093 1,198,382 1,265,246 66,864

New Jersey 3,473,368 3,445,450 3,637,688 192,238

New Mexico 2,269,306 2,251,065 2,376,663 125,598

New York 16,277,034 16,146,206 17,047,075 900,869

North Carolina 3,378,519 3,351,363 3,538,351 186,988

North Dakota 805,142 798,670 843,231 44,561

73
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS

PROGRAM/CFDA NUMBER: Nutrition Services Incentive Program (CFDA 93.053)

STATE/TERRITORY

FY2020

Final

FY2021

Enacted

FY2022

President's Budget

FY2022 +/-

FY2021

Ohio 5,716,212 5,670,266 5,986,637 316,371

Oklahoma 1,791,402 1,777,004 1,876,151 99,147

Oregon 1,598,413 1,585,565 1,674,031 88,466

Pennsylvania 6,642,866 6,589,472 6,957,130 367,658

Rhode Island 418,528 415,164 438,328 23,164

South Carolina 1,772,670 1,758,422 1,856,532 98,110

South Dakota 951,768 944,118 996,794 52,676

Tennessee 1,698,053 1,684,406 1,778,386 93,980

Texas 10,225,621 10,850,239 11,455,624 605,385

Utah 1,316,522 1,305,940 1,378,804 72,864

Vermont 779,140 772,878 816,000 43,122

Virginia 1,914,861 1,899,470 2,005,450 105,980

Washington 2,342,795 2,323,963 2,453,628 129,665

West Virginia 1,539,044 1,526,674 1,611,855 85,181

Wisconsin 2,727,265 2,705,344 2,856,288 150,944

Wyoming 888,652 881,510 930,694 49,184

Subtotal 151,755,936 151,242,978 159,681,529 8,438,551

Indian Tribes 3,892,504 3,892,504 4,109,689 217,185

American Samoa 84,875 84,192 88,890 4,698

Guam 390,715 387,574 409,199 21,625

Northern Mariana Islands 68,616 68,065 71,862 3,797

Puerto Rico 2,709,041 2,687,267 2,837,202 149,935

Virgin Islands 106,586 105,730 111,629 5,899

Subtotal 7,252,337 7,225,332 7,628,471 403,139

Total States/Territories 159,008,273 158,468,310 167,310,000 8,841,690

Contingency Fund 1/ 1,060,727 1,600,690 1,690,000 89,310

Subtotal Adjustments 1,060,727 1,600,690 1,690,000 89,310

TOTAL RESOURCES 160,069,000 160,069,000 169,000,000 8,931,000

1/ Contingency Fund - 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.

2/ State levels include transfers for distributions of commodities which are provided by USDA to grantees; in FY 2021, the

amount that was transferred is shown for comparability purposes

74 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

TIVE SUMMARY

75 

Preventive Health Services

Services FY 2020 Final FY 2021 Enacted FY 2022 President’s 

Budget

FY 2022 +/- 

FY 2021

Preventive Health

Services – Budget 

Authority

$24.848 $24.848 $26.339 +$1.491 

*BA is in millions of dollars.

Original Authorizing Legislation: Section 361 of the Older Americans Act of 1965, Public Law 

89-73 

Most Recent Authorizing Legislation: Supporting Older Americans Act of 2020, Public Law 116-

131 

Current FY Authorization ..............................................................................................$28,182,602 

Authorization Expiration Date ...................................................................................................2024 

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 

19.6 years.45 The population of older Americans is also growing, particularly the population age 

45 Kochanek KD, Xu JQ, Arias E. Mortality in the United States, 2019. NCHS Data Brief, no 395. Hyattsville, MD: 

National Center for Health Statistics. 2020. https://www.cdc.gov/nchs/data/databriefs/db395-H.pdf. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

76 

85 and over, which is projected to grow from 6.6 million in 2019 to 9.1 million by the year 2030.46

One consequence of this increased longevity is a higher incidence of chronic diseases such as 

arthritis, cancer, and diabetes.47 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.48 

 

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.

49

• 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 

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. 

46 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 30 April 2021. 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, 2019: Released June 2020, https://www.census.gov/programssurveys/popest/data/tables.2019.html . Accessed 30 April 2021. 

47 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. 

48 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.

49 Ahn et al. 2013. The impact of chronic disease self-management programs: healthcare savings through a 

community-based intervention. BMC Public Health. 13(1141).
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

77 

• 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 2018................................. $24,848,000

FY 2019................................. $24,848,000

FY 2020................................. $24,848,000

FY 2021................................. $24,848,000

FY 2022 Enacted....................... $24,848,000

FY 2022 President’s Budget.......... $26,339,000

Budget Request:

The FY 2022 request for Preventive Health Services is $26,339,000 is an increase of +$1,491,000 

over the FY 2021 Enacted level of $24,848,000. These formula grants allow States to fund the 

provision of evidence-based programs that educate older adults about the importance of healthy 

lifestyles and promote healthy behaviors that can help prevent chronic disease and disability. 

Social isolation resulting from the pandemic has increased the need to address healthy lifestyles 

by managing chronic diseases exacerbated by declines in physical functioning resulting from 

reduced access to community supports and evidence-based programs. This new funding will help 

cover the costs of transitioning to virtual programs that expanded their reach during the pandemic, 

including increased costs as grantees worked with developers to create evidence-based 

interventions that work at home 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

78 

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.50 Grantees 

can use the Title III-D Highest-Tier Criteria Evidence-Based Disease Prevention and Health 

Promotion Programs Cost Chart51 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.

50 https://www.acl.gov/programs/health-wellness/disease-prevention.

51 http://www.ncoa.org/improve-health/center-for-healthy-aging/content-library/Title-IIID-Highest-Tier-EvidenceFINAL.pdf. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

TIVE SUMMARY

79 

Output Table:

Preventive Health Services

Indicator Year and Most Recent 

Result /

FY 2021

Projection

FY 2022

Projection

FY 2022

Projection

+/-FY 2021

Projection

Output AB: The number 

of people served with 

health and disease 

prevention programs. 

(Output)

FY 2019: 605,729 272,832 192,119 -80,514

Grant Awards Tables:

Preventive Health Services Grant Awards

Grant Awards Tables

FY 2020 

Final

FY 2021 

Enacted

FY 2022 

President's 

Budget

Number of Awards 56 56 56

Average Award $440,747 $439,277 $465,636

Range of Awards $15,426 -

$2,579,909

$15,375 -

$2,565,484

$16,297 -

$2,719,426
 

 

 

 

 

 

FY 2022 +/-

FY 2021

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HEALTH AND INDEPENDENCE FOR OLDER ADULTS

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2022 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Preventive Health Services (CFDA 93.043)

FY 2020

Final

FY 2021

Enacted

FY 2022

STATE/TERRITORY President's Budget

Alabama 372,527 370,215 392,430 22,215

Alaska 123,409 122,998 130,378 7,380

Arizona 550,886 554,488 587,761 33,273

Arkansas 227,086 225,020 238,522 13,502

California 2,579,909 2,565,484 2,719,426 153,942

Colorado 374,573 376,304 398,884 22,580

Connecticut 278,911 276,822 293,432 16,610

Delaware 123,409 122,998 130,378 7,380

District of Columbia 123,409 122,998 130,378 7,380

Florida 1,867,767 1,866,962 1,978,989 112,027

Georgia 671,287 674,273 714,733 40,460

Hawaii 123,409 122,998 130,378 7,380

Idaho 125,077 126,280 133,857 7,577

Illinois 907,700 899,918 953,918 54,000

Indiana 480,558 477,998 506,680 28,682

Iowa 241,830 239,548 253,922 14,374

Kansas 209,471 208,110 220,597 12,487

Kentucky 331,811 329,332 349,094 19,762

Louisiana 329,299 327,908 347,584 19,676

Maine 123,874 123,567 130,982 7,415

Maryland 426,619 425,546 451,081 25,535

Massachusetts 515,821 512,580 543,338 30,758

Michigan 781,681 776,597 823,197 46,600

Minnesota 406,376 406,457 430,847 24,390

Mississippi 215,226 213,461 226,270 12,809

Missouri 466,192 463,509 491,322 27,813

Montana 123,409 122,998 130,378 7,380

Nebraska 136,996 136,292 144,470 8,178

Nevada 214,182 215,427 228,354 12,927

New Hampshire 123,409 122,998 130,378 7,380

New Jersey 654,158 650,092 689,101 39,009

New Mexico 160,004 159,192 168,744 9,552

New York 1,447,305 1,436,516 1,522,715 86,199

North Carolina 759,936 761,785 807,496 45,711

North Dakota 123,409 122,998 130,378 7,380

80
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 24,848,000 24,848,000 26,339,600 1,491,600

HEALTH AND INDEPENDENCE FOR OLDER ADULTS

PROGRAM/CFDA NUMBER: Preventive Health Services (CFDA 93.043)

FY 2020 FY 2021 FY 2022 FY 2022 +/-

STATE/TERRITORY Final Enacted President's Budget FY 2021

Ohio 905,949 898,609 952,531 53,922

Oklahoma 279,078 276,867 293,481 16,614

Oregon 329,553 328,215 347,910 19,695

Pennsylvania 1,048,574 1,039,520 1,101,896 62,376

Rhode Island 123,409 122,998 130,378 7,380

South Carolina 401,215 403,408 427,614 24,206

South Dakota 123,409 122,998 130,378 7,380

Tennessee 500,709 498,746 528,673 29,927

Texas 1,666,622 1,671,435 1,771,729 100,294

Utah 160,458 161,669 171,370 9,701

Vermont 123,409 122,998 130,378 7,380

Virginia 598,258 597,103 632,932 35,829

Washington 531,315 531,338 563,222 31,884

West Virginia 159,545 157,012 166,433 9,421

Wisconsin 448,977 448,241 475,137 26,896

Wyoming 123,409 122,998 130,378 7,380

Subtotal 24,244,814 24,164,824 25,614,832 1,450,008

American Samoa 15,426 15,375 16,297 922

Guam 61,705 61,499 65,189 3,690

Northern Mariana Islands 15,426 15,375 16,297 922

Puerto Rico 282,780 280,948 297,806 16,858

Virgin Islands 61,705 61,499 65,189 3,690

Subtotal 437,042 434,696 460,778 26,082

Total States/Territories 24,681,856 24,599,520 26,075,610 1,476,090

Contingency Fund 1/ 166,144 248,480 263,990 15,510

Subtotal Adjustments 166,144 248,480 263,990 15,510

TOTAL RESOURCES

1/ Contingency Fund- 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.

81
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HEALTH AND INDEPENDENCE FOR OLDER ADULTS

83

Chronic Disease Self-Management Education

 

Services FY 2020 Final FY 2021 Enacted FY 2022 President’s 

Budget

FY 2022 +/- 

FY 2021

Chronic Disease 

Self-Management 

Education- PPHF

$8.000 $8.000 $8.000 ---

*BA is in millions of dollars.

Authorizing Legislation: Section 411 of the Older Americans Act of 1965, Public Law 89-73. 

Most Recent Authorizing Legislation: Supporting Older Americans Act of 2020, Public Law 116-

131, and Sections 311 and 317(k)(2) of the Public Health Service Act. 

Current FY Authorization ......................................................................................... None Specified

Authorization Expiration Date ...................................................................................................2024 

Allocation Method ............................. Competitive Grants/Cooperative Agreements and Contracts

Program Description and Accomplishments: 

In the United States, 77 percent of Medicare beneficiaries age 65 and over have multiple (two or 

more) chronic conditions,52 placing them at greater risk for premature death, poor functional status, 

unnecessary hospitalizations, adverse drug events, and nursing home placement.53 Chronic 

conditions also impact health care costs, as 93 percent of Medicare expenditures are for 

beneficiaries with chronic conditions.54

52 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.

53 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.

54 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/. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

84 

Chronic Disease Self-Management Education (CDSME) programs are low-cost, evidence-based 

prevention models based on rigorous research studies that are translated into practical and effective 

community-based programs. CDSME programs aim to help individuals better manage their 

chronic conditions, such as diabetes, heart disease, cancer, HIV, depression, and pain. Proven 

CDSME programs include Enhance Wellness, the Wellness Recovery Action Plan, and the 

Stanford University-developed suite of programs - Chronic Disease Self-Management Program 

(CDSMP), Tomando Control De la Salud (Spanish CDSMP), Diabetes Self-Management Program 

(DSMP), Program de Manejo Personal de la Diabetes (Spanish DSMP), Chronic Pain SelfManagement Program, Positive Self-Management Program for HIV, Arthritis Self-Management 

Program (ASMP), Cancer Thriving and Surviving. CDSME programs can be delivered in small 

groups or self-directed formats. 

CDSME programs emphasize an individual’s role in managing their condition though a series of 

workshops that are conducted one or more times per week over several weeks in remote settings 

(video conference, phone, and/or toolkit) and community settings (in hospitals, churches, libraries, 

YWCAs, YMCAs, senior centers, public housing projects, community health centers, and 

cooperative extension programs). People with different chronic health conditions attend together, 

and the workshops are facilitated by trained leaders - often non-health professionals or lay people 

with chronic diseases themselves. Core topics covered include: techniques to deal with problems 

such as frustration, fatigue, pain and isolation; appropriate exercise for maintaining and improving 

strength, flexibility, and endurance; appropriate use of medications; communicating effectively 

with health professionals; and nutrition. 

CDSME programs have been shown repeatedly, through multiple randomized control 

experiments, to be effective at helping participants adopt healthy behaviors and improve their 

psychological and physical health status.55 Some evidence suggests that CDSME programs may 

also significantly reduce the use of hospital care and physician services and reduce health care 

costs.56 A national study of CDSME programs, participants reported significant improvements in 

aspects of their care (communication with their physicians, medication compliance, and health 

literacy), better health outcomes (self-assessed health, reduction in depression and quality of life), 

and reduced health care utilization (lower emergency room visits and hospitalizations), resulting 

in potential cost savings.57

55 Brady TJ, Murphy L, O’Colmain BJ, Beauchesne D, Daniels B, Greenberg M, et al. A Meta-Analysis of Health 

Status, Health Behaviors, and Health Care Utilization Outcomes of the Chronic Disease Self-Management Program. 

Prev Chronic Dis 2013;10:120112. http://dx.doi.org/10.5888/pcd10.120112

56 Sobel, DS, Lorig,KR, Hobbs,M. Chronic Disease Self-Management Program: From Development to 

Dissemination. Permanente Journal; Spring 2002. Also Ory, M. G., et al. 2013. “Successes of a National Study of 

the Chronic Disease Self-Management Program: Meeting the Triple Aim of Health Care Reform.” Medical Care 

51(11), 992-998.

57 Whitelaw, N., Lorig, K., Smith, M. L., & Ory, M. G. (March 19, 2013). National Study of Chronic Disease SelfManagement Programs (CDSMP). Retrieved May 3, 2013 from http://www.ncoa.org/improve-health/center-forhealthy-aging/content-library/CDSMP_Grantee_Webinar_03_19_2013_ALL_FINAL.pdf
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

85 

Since FY 2012, through the Affordable Care Act’s Prevention and Public Health Fund, ACL has 

supported competitive grants to state agencies, community-based organizations, educational 

institutions, and other non-profit organizations, as well as technical assistance, education, and 

resources for the aging and disability services network, to increase the number of individuals who 

participate in evidence-based CDSME programs. 

Most recently, through FY 2021 CDSME funding, ACL awarded eight grants. This funding will 

increase access to CDSME programs, and foster the development of comprehensive, integrated 

delivery systems to embed and sustain these programs within the long-term services and supports, 

and health care systems. In FY 2021, ACL also continued to fund a National CDSME Resource 

Center to support technical assistance, education, and resource development. 

Funding History:

Funding for Chronic Disease Self-Management Education over the past five years is as follows:

FY 2018................................ $8,000,000

FY 2019................................ $8,000,000

FY 2020................................ $8,000,000

FY 2021 Enacted...................... $8,000,000

FY 2022 President’s Budget........ $8,000,000

Budget Request:

The FY 2022 Budget request for CDSME $8,000,000 in Prevention and Public Health Funds, the 

same as the enacted level for FY 2021. 

The continued investment of resources will allow ACL in coordination with its existing HHS 

partners, community based organizations (CBOs), and private philanthropists to continue its work 

on low-cost, evidence-based prevention models and rigorous research studies focused on helping 

individuals better manage their chronic conditions. These past investments in CDSME and on 

ACL’s existing service delivery infrastructure have assisted the goal of significant quality of care 

with physicians, increased health outcomes, reducing hospitalizations, while allowing individuals 

to achieve a healthy standard of living. ACL will continue to fund comprehensive grant programs, 

as well as a CDSME Resource Center. To date, more than 426,000 older adults have participated 

in CDSME programs supported by ACL grantees and their partners.

58 But there is a need to further 

58 ACL CDSME National Database, accessed April 13, 2021 (https://www.ncoa.org/professionals/health/center-forhealthy-aging/national-cdsme-resource-center/national-cdsme-database). 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

86 

broaden reach and ensure the sustainability of these impactful programs, particularly in 

communities who have been disproportionately impacted by COVID-19. 

Grant Awards Table:

Chronic Disease Self-Management Education Grant Awards

Grant Awards Tables

FY 2020 

Final

FY 2021 

Enacted

FY 2022 

President's 

Budget

Number of Awards 11 9 9

Average Award $693,599 $877,686 $877,686 

Range of Awards $299,333 - 

$1,458,567

$270,294 - 

$1,800,000

$270,294 - 

$1,800,000
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

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Falls Prevention

Services FY 2020 Final FY 2021 Enacted FY 2022 President’s 

Budget

FY 2022 +/- 

FY 2021

Falls PreventionPPHF $5.000 $5.000 $5.000 ---

*BA is in millions of dollars.

Original Authorizing Legislation: Section 411 of the Older Americans Act of 1965, Public Law 

89-73 

Most Recent Authorizing Legislation: Supporting Older Americans Act of 2020, Public Law 116-

131 

Current FY Authorization ......................................................................................... None Specified

Authorization Expiration Date ...................................................................................................2024 

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.59 Many people 

limit their activity after a fall, which may reduce strength, physical fitness, and mobility.60 Falls 

can also result in significant loss of independence and often trigger the onset of a series of growing 

needs. Fear of falling can lead older adults to limit their activities, which can result in more falls, 

further physical decline, depression, and social isolation. Americans over age 75 who fall are more 

than four times more likely to be admitted to a skilled nursing facility.61 Even without a major 

injury, falls can cause an older adult to become fearful or depressed, making it difficult for them 

to stay active, which in turn increases the need for assistance. Falls are also very costly to the 

59 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

60 Vellas BJ, Wayne SJ, Romero LJ, Baumgartner RN, Garry PJ. Fear of falling and restriction of mobility in elderly fallers. Age 

and Ageing 1997;26:189–193.

61 Donald IP, Bulpitt CJ. The prognosis of falls in elderly people living at home. Age and Ageing 1999;28:121–5. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

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healthcare system. In 2015, the total medical costs for falls totaled more than $50 billion.62 

Medicare and Medicaid paid 75% of these costs.63

Evidence-based falls prevention programs are low-cost, community-based interventions, that can 

be delivered in small group or one-on-one formats. These programs help participants improve 

strength, balance, and mobility, and provide education on how to avoid falls and reduce fall risk 

factors. Examples of evidence-based falls prevention programs include: A Matter of Balance, 

Stepping On, and Tai Ji Quan: Moving for Better Balance. Numerous studies have documented 

the efficacy of these programs in reducing falls and/or falls risk64,65, as well as their potential for 

cost savings and positive return on investment.

66,67 Programs are conducted one or more times per 

week over several weeks in remote (video conference) and/or community settings (hospitals, 

churches, libraries, YWCAs, YMCAs, senior centers, public housing projects, community health 

centers, and cooperative extension programs). The programs are facilitated by trained leaders, with 

fidelity to the original research (to ensure participants benefit fully from the intervention). 

Since FY 2014, through the Affordable Care Act’s Prevention and Public Health Fund 

(ACA/PPHF), ACL has supported competitive grants to state agencies, community-based 

organizations, educational institutions, and other non-profit organizations, as well as technical 

assistance, education, and resources for the aging and disability services network, to increase the 

number of individuals who participate in evidence-based falls prevention programs. 

Most recently, through FY 2021 Falls Prevention funding, ACL awarded 11 grants. This funding 

will increase access to evidence-based falls prevention programs, and foster the development of 

comprehensive, integrated delivery systems to embed and sustain these programs within the longterm services and supports, and health care systems. In FY 2021, ACL also continued to fund a 

National Falls Prevention Resource Center to support technical assistance, education, and resource 

development. 

62 Florence CS, Bergen G, Atherly A, Burns ER, Stevens JA, Drake C. Medical Costs of Fatal and Nonfatal Falls in Older Adults. 

Journal of the American Geriatrics Society, 2018 March, DOI:10.1111/jgs.15304

63 U.S. Center for Disease Control and Prevention: Older Adult Falls. Accessed April 13, 2021 from: 

https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html. 64 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. 65 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. 

66 Carande-Kulis, V., Stevens, J., Florence, C., Beattie, B.L., Arias, I. (2015). A cost-benefit analysis of three older adult falls 

prevention interventions. Journal of Safety Research, 52, 65–70. 

67 Report to Congress in November 2013: The Centers for Medicare & Medicaid Services’ Evaluation of Community-based 

Wellness and Prevention Programs under Section 4202 (b) of the Affordable Care Act. 

http://innovation.cms.gov/Files/reports/CommunityWellnessRTC.pdf
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

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Funding History

Funding for Falls Prevention over the past five years is as follows:

--

FY 2018................................ $5,000,000

FY 2019................................ $5,000,000

FY 2020................................ $5,000,000

FY 2021 Enacted...................... $5,000,000

FY 2022 President’s Budget......... $5,000,000

Budget Request:

The FY 2022 request for Falls Prevention is $5,000,000, in Prevention and Public Health Funds, 

the same as the enacted level for FY 2021. This continued investment of Falls Prevention 

resources allows for the continued community-based intervention, as well as studies to reduce 

fatal and nonfatal fall injuries that are attributed to falling in adults aged 65 and over. 

ACL’s existing service delivery infrastructure will work with older Americans to increase their 

ability to live healthy and independent lives, as well as ways to educate older Americans about 

ways to reduce their falls risk. ACL continues to align with and complement U.S. Centers for 

Disease Control and Prevention’s fall prevention efforts, which focus primarily on clinical 

providers and settings. The funding will continue to target and foster evidenced based grant 

programs, provide long term services and supports to healthcare systems; and to continue funding 

for the National Falls Prevention Resource Center, which will provide technical assistance, 

education, and resource development. 

Since 2014, more than 128,909 individuals have participated in falls prevention supported by ACL 

ACA/PPHF grantees and their partners.68 Continued levels of funding are necessary to further 

broaden the reach of the program by making awards to different sets of grantees, and to ensure the 

sustainability of these impactful programs, particularly in communities and populations who have 

been disproportionately impacted by COVID-19. 

68 ACL Falls Prevention National Database, accessed April 13, 2021 from Sound Generations. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

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Grant Awards Table:

Falls Prevention Program Grant Awards 

Grant Awards Tables

FY 2020 

Final

FY 2021 

Enacted

FY 2022 

President's 

Budget

Number of Awards 9 9 9

Average Award $547,001 $408,793 $408,793 

Range of Awards $271,611 - 

$1,2020,100

$273,057 -

$1,045,885

$273,057 -

$1,045,885
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

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Native American Nutrition and Supportive Services

Services FY 2020 Final FY 2021 Enacted FY 2022 

President’s Budget

FY 2022 +/- 

FY 2021

Native American 

Nutrition and 

Supportive Services 

- Budget Authority

$34.708 $35.208 $75.208 +$35.000

Supplemental 

Funding $30.000 $23,670 ---- -$23,670

Program Level $64.708 $58.878 $75.208 +$16.330

*BA is in millions 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: Supporting Older Americans Act of 2020, Public Law 116-

131 

Current FY Authorization ..............................................................................................$41,626,636 

Authorization Expiration Date ...................................................................................................2024 

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 1,042,122 people 

age 60 and over identify themselves as Native American or Alaskan Native alone or in combination 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

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with another racial group.69 Over 607,013 of those elders identify as Native American or Alaskan 

Native with no other racial group.70

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 24 percent71 of eligible Native American seniors in 

participating Tribal organizations. Home-delivered meals reach 8 percent of such persons, and 

supportive services reach 31 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 2019 include:

• Transportation Services, which provided over 762,852rides to meal sites, medical 

appointments, pharmacies, grocery stores, and other critical daily activities.72

• Home-Delivered Nutrition Services, through which almost 2.6 million meals were provided 

to more than 22,000 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.73

• Congregate Nutrition Services, which provided more than 2.6 million meals to more than 

65,000 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.74

• Information, Referral and Outreach Services, which provided more than 813,000 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.75

69 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, 2019. Released June 2020. . 

Released June 25, 2020 https://www2.census.gov/programs-surveys/popest/tables/2010-2019/national/asrh/ncest2019-asr5h.xlsx. Accessed 13 April, 2021.

70 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, 2019 Released June 25,2020, 

https://www2.census.gov/programs-surveys/popest/tables/2010-2019/national/asrh/nc-est2019-asr6h.xlsx. 

Accessed 13 April 2021. 

71 71 ACL’s OAA Title VI Application, FY 2020 compared to PY 2018 Program Performance Data.

72 ACL’s OAA Title VI Program Performance Report, PY 2019.

73 Id.

74 Id.

75 Id.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

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The Native American Nutrition and Supportive Services program also provides training and 

technical assistance to Tribal organizations to support the development of comprehensive and 

coordinated systems of services to meet the needs of Native American elders. Training and 

technical assistance is provided through national meetings, site visits, website, e-newsletters, 

telephone and written consultations, 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 282 Tribal organizations (representing over 400 Tribes and villages), including 

one organization serving Native Hawaiian elders.

During the pandemic grantees reported suspending congregate meals and other in-person 

activities in an effort to keep elders safe in response to the COVID-19 pandemic. Despite closed 

senior centers, grantees continued to provide meals for congregate participants through home 

delivery or using a drive up/pick up approach.76 Nearly all grantees continued and expanded meal 

delivery service. Many grantees reported a significant increase in the demand for meals overall, 

and some programs reported a nearly two-fold increase in elders needing meal support.77

Funding History:

Funding for Native American Nutrition and Supportive Services over the past five years is as 

follows: 

FY 2018..................................... $33,208,000

FY 2019..................................... $34,173,000

FY 2020..................................... $34,708,000

FY 2021 Enacted............................ $35,208,000

FY 2022 President’s Budget............. $70,208,000

76 Evaluation of the ACL Title VI Programs: Program Staff Interviews, COVID-19 Summary Memo

77 Id.
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

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Budget Request:

 

The FY 2022 request for Native American Nutrition and Supportive Services is $70,208,000, an 

increase of +$35,000,000 above the FY 2021 Enacted level of $35,208,000. During the pandemic 

Congress provided an additional $53.7 million bringing funding for Tribes into better alignment 

with Tribal needs. The request level reflects the Administration’s commitment to improving 

equity, providing funding to address the lower life expectancy and health status that American 

Indians and Alaska Natives experience. 

Supplemental funding for tribal elders, who have been disproportionately affected by the Pandemic 

has allowed Tribes and Tribal Organizations to provide meals and related supportive services, such 

as transportation directly to Native American elders. Annual funding for these tribal services has 

historically fallen well below Tribal needs, which during the Pandemic have sharply expanded. 

American Indian and Alaska Native people have long experienced lower health status when 

compared with other Americans. Lower life expectancy and the disproportionate disease burden 

are influenced by a combination of disproportionate poverty, barriers in accessing healthcare 

services, unequal educational and employment opportunities, and cultural differences. These are 

broad quality of life issues rooted in economic adversity and poor social conditions. 

American Indians and Alaska Natives continue to die at higher rates than other Americans in many 

categories, including chronic liver disease and cirrhosis, diabetes mellitus, unintentional injuries, 

assault/homicide, intentional self-harm/suicide, and chronic lower respiratory diseases

Historically, tribes receive from $76,500 to $186,900 per year to operate an entire program. This 

includes hiring staff including at a minimum a program director, a cook and fiscal manager; 

securing a building for a senior center; providing transportation; and purchasing food and supplies 

for meal delivery. It is apparent that this small amount of funding is insufficient to achieve the 

goals for one of our most underserved populations. 

At the FY 2022 request level, ACL projects Tribes will be able to provide an additional 2.1 million 

home delivered meals, and 2.2 million congregate meals. During the pandemic, some tribes 

reported a two-fold increase in demand; increased resources are needed to both meet Tribal needs, 

as well as the provision of additional flexibilities allowing Tribes to shift resources as needed to 

reopen or adapt to a post-pandemic world. Without the additional funding sought in the FY 2022 

budget, Tribes will be unable to maintain service levels for the significantly larger population of 

tribal elders who have been relying on these services, many or all of whom are likely to remain at 

higher risk during FY 2022. These additional funds remain especially critical to continuing efforts 

by Tribes to overcome and recover from the pandemic. In addition, the Budget includes a General 

Provision to allow 100% transfer authority between Title VI Tribal programs. 

ACL’s recent evaluation of the Native American Nutrition and Supportive Services found that 

these programs provide opportunities for improved health and wellness for elders. Elders 

receiving any Title VI services experienced significantly fewer hospitalizations and falls per year 

in comparison with elders who did not receive or participate in Title VI services. The difference 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

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was even greater for elders from programs that provide a higher number of services compared to 

programs that provide fewer services. Elders from higher-level service programs experienced 53% 

fewer hospitalization and 45% fewer falls per year.

Outcomes and Outputs Table:

Native American Nutrition & Supportive Services 

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2021

Target

FY 2022

Target

FY 2022

Target

+/-FY 2021

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 2019: 198

Target:

300 

(Target Not Met)

182 172 -10

Indicator Year and Most Recent 

Result /

FY 2021

Projection

FY 2022

Projection

FY 2022

Projection

+/-FY 2021

Projection

Output L: Transportation 

Services units (Output)

FY 2019: 762,852 631,991 1,066,053 +434,062

Output M: HomeDelivered Nutrition meals

(Output)

FY 2019: 2.6 M 2.5 M 4.6 M +2.1 M

Output N: Congregate 

Nutrition meals (Output)

FY 2019: 2.6 M 2.5 M 4.7 M +2.2 M

Output O: Information, 

Referral and Outreach 

units (Output)

FY 2019: 813,974 721,485 1,334,448 +612,963
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

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Grant Awards Table:

Native American Nutrition & Supportive Services Formula Grant Awards

Grant Awards Tables

FY 2020 

Final

FY 2021 

Enacted

FY 2022 

President's 

Budget

Number of Awards 272 282 282

Average Award $127,603 $124,851 $248,965 

Range of Awards $73,990 -

$1,505,000

$77,460 -

$1,505,000

$164,640 -

$1,505,000
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

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Aging Network Support Activities

Services FY 2020 Final FY 2021 Enacted FY 2022 

President’s Budget

FY 2022 +/- 

FY 2021

Aging Network 

Support Activities – 

Budget Authority 

$12.461 $16.461 $19.446 +$2.985

FTE 0.4 0.9 0.9 ---

*BA is in millions of dollars. 

Authorizing Legislation: Section 202, 215, and 411 of the Older Americans Act of 1965, Public Law 

89-73

Most Recent Authorizing Legislation: Supporting Older Americans Act of 2020, Public Law 116-

131 

Current FY Authorization ..............................................................................................$20,992,522 

Authorization Expiration Date ...................................................................................................2024 

Allocation Method ............................ Competitive Grants/Co-operative Agreements and Contracts

Program Description and Accomplishments:

Aging Network Support Activities provides competitive grants and contracts to support innovation 

and technical assistance to help States, Tribes, and community providers of aging services to 

develop service systems that help older people remain independent and able to live in their own 

homes and communities. These activities 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 

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 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

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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. 

In FY 2021, funding for the Eldercare Locator will be supplemented by $5.14 million in vaccine 

access funds provided by HHS’s Centers for Disease Control and Prevention (CDC). Funding will 

be used to expand the Locator to people with disabilities for the purpose of providing information 

and outreach about COVID-19 vaccinations to both older Americans and people of all ages with 

disabilities. 

Research suggests that social engagement remains an important determinant of physical health 

into very late adulthood.78 ACL is also 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.

78 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. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

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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 many people 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 number of people requiring this service continues to climb. The outcomes of these 

services are often the difference between dependence on government support and having 

sustainable income. Data for the program show that: 

• 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 for women 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-to-reach individuals, including low-income women, women of color, women 

with limited English 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. 
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

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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.

Older Adult Equity Collaborative

The Older Adult Equity Collaborative is a group of five National Minority Aging Organization 

Technical Assistance Resource Centers and a Coordinating Center for Minority Organizations 

Technical Assistance Resource Center that work to enhance access and 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. They provide targeted technical assistance 

and training to the aging services network and other relevant stakeholders and consumers. 

The goals of the Older Adult Equity Collaborative include promoting closer collaboration, 

coordination and cross-program efforts among minority aging organizations and other ACLfunded resource centers focused on older adults, family caregivers, and where applicable, persons 

with disabilities. In addition, they coordinate with other stakeholders and entities to promote 

greater equity and cross-sectional work on behalf of diverse older adults and their caregivers who 

have historically been disenfranchised or had limited access to services and supports. The 

purposes and goals of the Collaborative are directly aligned with the equity priorities of Biden 

Administration and Executive Orders. 

Each member of the Collaborative 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 AND INDEPENDENCE FOR OLDER ADULTS

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health behaviors and strengthen their capacity to maintain active, independent life styles and that 

are replicable throughout the aging services network. 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 Self-Management 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.

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 

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 

working 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.

Holocaust Survivor Assistance

The United States is home to approximately 80,000 victims of Nazi persecution, approximately 25 

percent of whom are living in poverty.79 Because of the experiences they endured early 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. 

79 Hoffman, Y., and Weiner, M., (2019). When More than Half a Billion Dollars is Not Enough. Prepared for the 

Harry and Jeanette Weinberg Foundation National Convening on Jewish Poverty, March 19, 2019.
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Care Corps

The Care Corps program provides funding for grants to test innovative ways to place volunteers 

able to provide non-medical care in communities to assist caregivers, older adults, and persons 

with disabilities to maintain their independence. 

Although there are myriad programs designed to provide volunteers to assist caregivers, older 

adults, and persons with disabilities in a variety of ways, there is often a lack of sufficient resources 

and infrastructure at the local level to support robust volunteer programs. In FY 2019, ACL 

awarded a cooperative agreement to a national organization. The grant is funding models that 

place volunteers in communities to assist caregivers, older adults, and persons with disabilities to 

maintain their independence by providing non-medical care in home-based or community–based 

settings. The program also will provide an opportunity for volunteers to learn valuable skills that 

they can use to pursue more formal employment in a variety of health and human services settings. 

The program will also evaluate the effectiveness of the local models in different communities 

nationally. 

The Care Corps grantee has in turn awarded 23 local volunteer grants to 20 states to implement 

innovative local community models to offer non-medical services. The local volunteer models are 

community-based and offer a wide range of non-medical volunteer services. These include caring 

calls and caring visits, respite, transportation, meal preparation, minor home cleaning and 

modifications, education, and training others. Grantees provide services to individuals of a variety 

of races and ethnicities including Hispanic, Native American, White, Black, Asian and Native 

Alaskan. Two grantees also serve new Americans. Additional projects are expected to receive 

initial funding in 2021. 

In FY 2020, the local volunteer grantees had to make changes to their project work plans to respond

to the Covid-19 pandemic. Some in-person projects moved to provide companionship and friendly 

visiting online and on the telephone. One project exercised flexibility by using its volunteer 

transportation program to provide COVID-19 vaccine appointments and transportation for older 

adults in need of the vaccine, thereby demonstrating the importance of volunteers in providing 

needed services. 

Funding History:

Comparable funding for Aging Network Support Activities over the past five years is as follows: 

FTE 

FY 2018................................ $12,461,000 0.4

FY 2019................................ $16,400,000 0.9

FY 2020................................ $12,461,000 0.4

FY 2021 Enacted..................... $16,461,000 0.9

FY 2022 President’s Budget........ $19,446,000 0.9
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

103 

Budget Request:

The FY 2022 request for Aging Network Support Activities (ANSA) is $19,446,000, an increase 

of +$2,985,000 above the FY 2021 Enacted level of $16,461,000. The additional funding requested 

is split between $240,000 for the Care Corps program and $2,745,000 for Program Performance 

and Technical Assistance to address priorities including equity, recovery from COVID-19 and 

caregiving, including both the informal and paid caregiver workforce. 

The COVID-19 pandemic significantly and negatively impacted older adults and their family 

caregivers. Grants will be targeted to advance equity by addressing barriers faced by minority 

older adults and their family caregivers who have historically been underserved and without 

access, and assist them with reengaging in all facets of daily life. This would include participating 

in and benefitting from supportive programs and services designed to enhance their health and 

well-being. The request for ANSA ensures that the aging network has the tools and resources 

needed to fully reengage minority populations. 

Aging Network Support Activities includes funding for the following projects:

(dollars in thousands)

Activity FY 2020 

Final 

FY 2021 

Enacted 

FY 2022

President’s 

Budget

Aging Network Support Activities:

National Eldercare Locator and Engagement 2,038 2,038 2,038

Pension Counseling and Retirement Information 1,858 1,858 1,858

National Resource Centers on Native Americans 655 655 655

 Older Adult Equity Collaborative 1,165 1,165 1,165

Program Performance and Technical Assistance 1,745 1,745 4,.490

Holocaust Survivors Assistance 5,000 5,000 5,000

Care Corps 0 4,000 4,240

Total, Aging Network Support Activities 12,461 16,461 19,446
HEALTH AND INDEPENDENCE FOR OLDER ADULTS

104 

Grant Awards Table:

Aging Network Support Grant Awards

Grant Awards Tables

FY 2020 

Final

FY 2021 

Enacted

FY 2022 

President's 

Budget

Number of Awards 25 25 35

Average Award $452,969 $592,446 $555,600 

Range of Awards $50,000 - 

$4,935,000

$75,000 - 

$4,935,000

$75,000 - 

$4,935,000
CAREGIVER AND FAMILY SUPPORT SERVICES

TIVE SUMMARY

105 

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. The Biden-Harris Administration has identified 

strengthening the care economy as a key priority and one that is crucial to our country’s economic 

recovery from COVID-19, as reflected in the American Jobs Plan. The plan expands and improves 

the working conditions for the paid caregiving workforce, including home care and direct care 

workers (who are primarily women of color, making this an equity issue), and ACL’s budget 

reflects his priorities in its request for funds to support family and other informal 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 and meet their other 

responsibilities while providing critically needed care. Additionally, several of ACL’s caregiver 

programs (e.g., Lifespan Respite Program; Alzheimer’s Disease Program Initiative) provide 

opportunities to states and communities to address critical workforce infrastructure needs, through 

training of respite care providers and the establishment of dementia capable systems of support. 

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, or the directsupport workforce or some combination of the two—that determines whether an older person or 

person with a disability can remain in his or her home or ends up institutionalized. In 2014, 

approximately 34.2 million adult caregivers provided uncompensated care to those 50 years of age 

and older.80 An estimated 117 million Americans will need assistance of some kind by 2020.81

Further, in 2017, an estimated 41 million family caregivers in the United States provided 34 billion 

hours of care to adults with chronic health conditions or disabilities.82 These trends are already 

being felt in the marketplace, where employers are losing an estimated $33 billion per year due to 

employees’ caregiving responsibilities.83 

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, 

80 https://acl.gov/about-acl/reports-congress-and-president; FY16OAAReportCongress, page 23. 

81 https://www.rand.org/pubs/external_publications/EP66196.html. 

82 Reinhard S, Feinberg LF, Houser A, Choula R, Evans M. Valuing the Invaluable: 2019 Update Charting a Path 

Forward. AARP Public Policy Institute; 2019. https://www.aarp.org/content/dam/aarp/ppi/2019/11/valuingtheinvaluable-2019-update-charting-a-path-forward.doi.10.26419-2Fppi.00082.001.pdf.)

83 http://www.caregiving.org/data/Caregiver%20Cost%20Study.pdf “The MetLife Caregiving Cost Study: 

Productivity Losses to U.S. Business, Page 17.
CAREGIVER AND FAMILY SUPPORT SERVICES

106 

and research indicates that caregivers suffer a mortality rate that is 63 percent higher than noncaregivers.84 

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-nine percent of the caregivers served by OAA programs 

report that these services allow them to provide care longer than they otherwise could have.85

By 2025, it is estimated there will be 14.8 million non-institutionalized seniors age 65 and over 

with one or more limitations in Activities of Daily Living (ADLs). This is an increase of more than 

2 million older adults (or 17 percent increase between 2020 and 2025) needing caregiver 

assistance.86 Further, according to the 2018 American Community Survey conducted by the U.S. 

Census Bureau, 41 million Americans (12.7 percent of the population of children and adults) 

currently have a disability or impairment.87 The vast majority of individuals needing long-term 

services and supports (LTSS) rely on uncompensated assistance from family and friends, 

supplemented by Medicaid for those who are eligible.88 

To address caregivers’ needs, ACL is requesting for FY 2022 a total of $310.022 million for 

caregiver support programs, an increase of $75.67 million from the FY 2021 Enacted level, to 

target the marginalized and disenfranchised aging, disability, Native American population. The 

request includes: 

• $249.936 million for Family Caregiver Support Services, an increase of $61.0 million 

above the FY 2021 Enacted Level. This level of funding is critical as the country emerges 

from the pandemic. Throughout the pandemic, caregivers have had to make up for the loss 

of formal services and supports, struggling to balance work and caregiving. Many 

caregivers have had to leave the workforce completely to be full-time caregivers, in some 

cases because given the risk of contracting COVID-19 in an institutional setting made it 

less risky to bring a loved one home and take care of them there. These additional funds 

will allow for an increase in the level of services and supports available to family and 

informal caregivers--including information, assistance, counseling, respite care, and 

training--that assist family and informal caregivers to care for their loved ones at home for 

as long as possible. They will also allow for increased care to disenfranchised and 

marginalized groups and those impacted the most by COVID-19. Studies have shown that 

84 Schulz R, Beach SR. Caregiving as a risk factor for mortality. The Caregiver Health Effects study. JAMA December 

15, 1999;282:2215-9. 85 2018 National Survey of Older Americans Act Participants https://agid.acl.gov/. 

86 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. 

Centers for Medicare & Medicaid Services, ACL analysis of 2017 Medicare Current Beneficiary Survey, 

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

87 U.S. Census Bureau, American Community Survey 1-Year Estimates Subject Table, 2019. 

https://data.census.gov/cedsci/table?t=Older%20Population&tid=ACSST1Y2019.S0102&hidePreview=true

88 RAISE Report, 2020.
CAREGIVER AND FAMILY SUPPORT SERVICES

107 

caregiver 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. 

Increasing direct care services to those who have been severely marginalized, as well as 

focusing efforts on virtual infrastructure needs during emergency health crises and beyond, 

will increase the range of services available and offered to older Americans nationwide. 

 

• $15.806 million for Native American Caregiver Support Services, an increase of $5.0 

million over the FY 2021 Enacted level. This program makes a range of services 

comparable to those provided by the Family Caregivers program available to Native 

American caregivers, including information and outreach, access assistance, individual 

counseling, support groups and training, respite care, and other supplemental services. 

Native Americans are a group that has been especially vulnerable to, and harder hit by 

COVID-19. The rural makeup of the Native American population has made it hard to 

target direct care services but additional funding will address this challenge as well as offer 

additional services to this marginalized and underserved population. 

• $30.060 million for the Alzheimer’s Disease Initiative Program (ADPI), an increase of 

$2.56 million above the FY 2021 Enacted level. The ADPI includes two categories 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. 

Both of these grants also include direct service provisions. These funds also support a 

training and technical assistance resource center and a national call center. The increase in 

funding will also target direct care and engagement with community based organizations 

that will focus on dementia patients and their caregiving families who have been 

marginalized, underserved or have been in direct need of services. 

• $14.22 million for Lifespan Respite Care, an increase of $7.11 over the FY 2021 Enacted 

Level. This level of funding is critical as the country emerges from the pandemic. Given 

the central role that caregivers play in helping their loved ones to remain independent, 

providing caregivers with the respite care that they personally need to carry on and be 

effective is imperative. Recognizing this, the Administration has identified increasing 

resources to strengthen the care economy as a key priority and crucial to our country’s 

economic recovery from COVID-19. At this higher level, the Lifespan Respite Care 

program will be in a better position to address gaps in respite services at the State level 

and will continue efforts to develop more efficient, cost-effective methods of providing 

caregivers with respite that reaches across the aging and the disability populations. 

Funding will also increase outreach by the grantees to target to the aging and disability 

populations that have been marginalized and underserved. Finally, the increase will allow 

ACL to address ways to engage communities and cultures that have previously been 

unaware of available services, and increase assistance to those aging and disability 

populations that need more assistance. 
CAREGIVER AND FAMILY SUPPORT SERVICES

108 

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CAREGIVER AND FAMILY SUPPORT SERVICES

109 

Family Caregiver Support Services

Services FY 2020 Final FY 2021 Enacted

FY 2022 

President’s 

Budget

FY 2022 +/- 

FY 2021

Family Caregivers 

Support Services –

Budget Authority 

$185.936 $188.936 $249.936 +$61.000

RAISE [non-add] $0.400 $0.400 $0.400 ---

Supporting 

Grandparents 

Raising 

Grandchildren 

[non-add]

$0.300 $0.300 $0.300 ---

Supplemental 

Funding $100.000 $145.000 --- -$145.000

Program Level $285.936 $333.936 $249.936 -$84.000

*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: Supporting Older Americans Act of 2020, Public Law 116-

131 

Current FY Authorization ............................................................................................$230,901,105 

Authorization Expiration Date ...................................................................................................2024 

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

Program Description and Accomplishments:
CAREGIVER AND FAMILY SUPPORT SERVICES

110 

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 older adults for whom they provide care. In 2019 these services include: 

• Access Assistance Services provided nearly 1.4 million contacts to caregivers assisting 

them in locating services from a variety of public and private agencies (Output I).89

• Counseling and Training Services provided over 114,000 caregivers with counseling, peer 

support groups, and training to help them better cope with the stresses of caregiving 

(Output J).90

• Respite Care Services provided over 64,000 caregivers with nearly 6.5 million hours of 

temporary relief, at home or in an adult day care or nursing home setting, from their 

caregiving responsibilities (Output K).91

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 

$47092 and $522 billion annually, which is roughly equivalent to the cost of all Medicaid spending 

in FY 2016 (Federal and state: $553 billion).93

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.

94 According to data from ACL’s National Survey of OAA 

Participants, 21 percent of caregivers reported that they are assisting two or more individuals.95 

Seventy-nine percent of Title III caregivers are 60 or older, making them more susceptible to a 

decline in their own health, and 36 percent describe their own health as fair to poor.96 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.

89 ACL’S OAA State Performance Report, FY 2019.

90 Id.

91 Id.

92 Needs a new citation

93 Needs a new citation

94 2019 National Survey of Older Americans Act Participants. https://agid.acl.gov/. 

95 Id. 96 Id.
CAREGIVER AND FAMILY SUPPORT SERVICES

111 

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.97

Additionally, data from ACL’s National Surveys shows that ACL services are effective in helping 

caregivers keep their loved ones at home. Approximately 79 percent of caregivers of program 

clients reported that services enabled them to provide care longer than otherwise would have been 

possible.98 Caregivers receiving services were also asked whether the care recipient would have 

been able to live in the same residence if the services had not been available. Forty one percent of 

caregivers indicated that the care recipient would be unable to remain at home without the support 

services.99 Those respondents were then asked to identify where the care recipient would be living 

without services. A significant majority of those caregivers, 75 percent,100 indicated that the care 

recipient would most likely be living in a nursing home or assisted living (see below). 

97 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. 98 2019 National Survey of Older Americans Act Participants. https://agid.acl.gov/. 

99 Id.

100 Id.
CAREGIVER AND FAMILY SUPPORT SERVICES

112 

101

Funding History:

Funding for Family Caregiver Support Services over the past five years is as follows:

FY 2018.................................. $180,568,000

FY 2019.................................. $180,999,000

FY 2020.................................. $185,936,000

FY 2021 Enacted........................ $188,936,000

FY 2022 President’s Budget......... $249,936,000

Budget Request:

101 ACL did not administer the National Survey of Older Americans Act Participants in 2020 in deference to the 

level of burden that respondents and stakeholders were under due to COVID-19. This data reflected is from the 2019 

survey. 

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%

Where Care Recipient Would Live if Unable to have 

Caregiver's Supportive Services
CAREGIVER AND FAMILY SUPPORT SERVICES

113 

The FY 2022 budget request is $249,936,000, an increase of $61,000,000 million over the FY 

2021 Enacted Level. This level of funding is critical as the country emerges from the pandemic. 

Throughout the pandemic, caregivers have had to make up for the loss of formal services and 

supports, struggling to balance work and caregiving; services that have been available have often 

been virtual and more remote. Many caregivers have had to leave the workforce completely to be 

full-time caregivers, in some cases because they decided to bring a loved one home to take care of 

them rather than leave them in a congregate setting where they faced a high risk of contracting 

COVID-19. 

Given the central role they play in helping their loved ones to remain independent, providing 

caregivers with the services and respite care that they personally need in order to carry on and be 

effective is imperative. Strengthening the infrastructure of the care economy is a key priority and 

crucial to our country’s economic recovery from COVID-19, as reflected in the American Jobs 

Plan. 

This request also reflects the priorities in President Biden’s recently issued Job Plan that included 

supporting and expanding the care economy as a key component. This plan expands and improves 

the working conditions for the paid caregiving workforce, including home care and direct care

workers (who are primarily women and often women of color, making this an equity issue), and 

to provide supports to family and other informal caregivers. 

The budget increase for caregivers will support the higher level of services—both direct and 

virtual—that are needed by all types of caregivers as the country transitions back from the 

pandemic. The requested funding level for Family Caregiver Supportive Services will allow more 

than 1,309,375 caregivers (Outcome 3.1) to receive supportive services, including respite care or 

other temporary relief from their caregiving responsibilities. In addition, more than 114,340 

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). 

Finally, at the requested level, ACL also will continue active support for the Recognize, Assist, 

Include, Support and Engage (RAISE) Family Caregivers Act, and the Supporting Grandparents 

Raising Grandchildren Act (SGRG) as these groups focus on a national approach to address the 

needs of family caregivers of all ages and circumstances.

In FY 2022, ACL anticipates that the aging services network will be able to meet or exceed the 

target of only 31.2 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 2019, that rate had been reduced to 

31 percent of caregivers reporting difficulty getting services.102

102 Id.
CAREGIVER AND FAMILY SUPPORT SERVICES

114 

For FY 2022, the performance target for Family Caregiver Support Services Program participants 

who rate services good to excellent is 92 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
CAREGIVER AND FAMILY SUPPORT SERVICES

115 

Outcomes and Outputs Table:

Family Caregiver Support Services 

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2021

Target

FY 2022

Target

FY 2022

Target

+/-FY 2021

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 2019: 7,794 clients

Target:

8,900 clients

(Target Not Met)

7,517 clients 7,458 clients -59 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 2019: 31.2%

Target:

30%

(Target Not Met)

30% 29% -1 

2.9c Maintain at 90% or 

higher the percentage of 

National Family 

Caregiver Support 

Program clients who rate 

services good to 

excellent. (Outcome)

FY 2019: 92%

Target:

90%

(Target Exceeded)

92% 91% -1 

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 2019: 66.89 weighted 

average

Target:

63.6 weighted average

(Target Exceeded)

64.7 weighted 

average

64.3 weighted 

average

-0.4 weighted 

average

3.1 Increase the number 

of caregivers served 

through the National 

Family Caregiver 

Support Program. 

(Outcome)

FY 2019: 837,496 caregivers

Target:

800,000 caregivers

(Target Exceeded)

989,882 

caregivers

1,309,375 

caregivers

+319,493 caregivers
CAREGIVER AND FAMILY SUPPORT SERVICES

116 

Grant Awards Table:

Family Caregiver Supportive Services Grant Awards 

Grant Awards Tables

FY 2020 

Final

FY 2021 

Enacted

FY 2022 

President's 

Budget

Number of Awards 56 56 56

Average Award $3,287,319 $3,327,619 $4,361,380 

Range of Awards $115,056 - 

$19,018,726

$116,467 - 

$19,236,339

$152,648 - 

$25,212,322
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CAREGIVER AND FAMILY SUPPORT SERVICES

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2022 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Family Caregivers Support Services (CFDA 93.052)

FY 2020

Final

FY 2021

 Enacted

FY 2022

 President's Budget

 FY 2022 +/-

STATE/TERRITORY FY 2021 

Alabama 2,771,601 2,798,496 3,667,879 869,383

Alaska 920,449 931,733 1,221,186 289,453

Arizona 4,355,653 4,461,682 5,847,752 1,386,070

Arkansas 1,740,757 1,748,713 2,291,970 543,257

California 19,018,726 19,236,339 25,212,322 5,975,983

Colorado 2,592,460 2,660,746 3,487,336 826,590

Connecticut 2,117,226 2,120,159 2,778,810 658,651

Delaware 920,449 931,733 1,221,186 289,453

District of Columbia 920,449 931,733 1,221,186 289,453

Florida 15,381,708 15,597,883 20,443,539 4,845,656

Georgia 4,781,855 4,899,347 6,421,383 1,522,036

Hawaii 920,449 931,733 1,221,186 289,453

Idaho 920,449 939,278 1,231,075 291,797

Illinois 6,695,498 6,728,665 8,818,999 2,090,334

Indiana 3,511,238 3,543,658 4,644,535 1,100,877

Iowa 1,829,827 1,832,251 2,401,460 569,209

Kansas 1,554,917 1,563,933 2,049,786 485,853

Kentucky 2,420,087 2,444,643 3,204,098 759,455

Louisiana 2,370,152 2,397,569 3,142,400 744,831

Maine 920,449 932,988 1,222,831 289,843

Maryland 3,109,335 3,151,657 4,130,754 979,097

Massachusetts 3,846,934 3,876,283 5,080,494 1,204,211

Michigan 5,704,975 5,754,088 7,541,660 1,787,572

Minnesota 2,967,100 3,004,670 3,938,103 933,433

Mississippi 1,580,261 1,588,713 2,082,264 493,551

Missouri 3,496,082 3,519,288 4,612,594 1,093,306

Montana 920,449 931,733 1,221,186 289,453

Nebraska 1,018,509 1,027,473 1,346,669 319,196

Nevada 1,573,731 1,616,391 2,118,541 502,150

New Hampshire 920,449 931,733 1,221,186 289,453

New Jersey 4,917,312 4,940,721 6,475,611 1,534,890

New Mexico 1,196,376 1,216,868 1,594,901 378,033

New York 10,947,306 11,030,494 14,457,239 3,426,745

North Carolina 5,628,191 5,735,711 7,517,573 1,781,862

North Dakota 920,449 931,733 1,221,186 289,453

117 
 

 

 

 

 

 

 

CAREGIVER AND FAMILY SUPPORT SERVICES

PROGRAM/CFDA NUMBER: Family Caregivers Support Services (CFDA 93.052)

STATE/TERRITORY

FY2020

Final

FY2021

Enacted

FY2022

President's Budget

FY2022 +/-

FY2021

Ohio 6,678,692 6,720,913 8,808,839 2,087,926

Oklahoma 2,093,926 2,099,823 2,752,156 652,333

Oregon 2,419,369 2,472,658 3,240,816 768,158

Pennsylvania 7,963,165 7,980,831 10,460,164 2,479,333

Rhode Island 920,449 931,733 1,221,186 289,453

South Carolina 2,978,643 3,058,799 4,009,049 950,250

South Dakota 920,449 931,733 1,221,186 289,453

Tennessee 3,702,032 3,749,744 4,914,644 1,164,900

Texas 11,841,413 12,049,192 15,792,407 3,743,215

Utah 1,146,584 1,172,829 1,537,182 364,353

Vermont 920,449 931,733 1,221,186 289,453

Virginia 4,398,911 4,472,846 5,862,385 1,389,539

Washington 3,800,547 3,886,778 5,094,248 1,207,470

West Virginia 1,197,057 1,207,440 1,582,544 375,104

Wisconsin 3,270,988 3,306,357 4,333,513 1,027,156

Wyoming 920,449 931,733 1,221,186 289,453

Subtotal 180,584,981 182,795,980 239,583,571 56,787,591

American Samoa 115,056 116,467 152,648 36,181

Guam 460,225 465,867 610,593 144,726

Northern Mariana Islands 115,056 116,467 152,648 36,181

Puerto Rico 2,354,337 2,385,992 3,127,227 741,235

Virgin Islands 460,225 465,867 610,593 144,726

Subtotal 3,504,899 3,550,660 4,653,709 1,103,049

Total States/Territories 184,089,880 186,346,640 244,237,280 57,890,640

Contingency Fund 1/ 1,846,120 2,589,360 5,698,720 3,109,360

Subtotal Adjustments 1,846,120 2,589,360 5,698,720 3,109,360

TOTAL RESOURCES 185,936,000 188,936,000 249,936,000 61,000,000

1/ Contingency Fund- 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.

118 
CAREGIVER AND FAMILY SUPPORT SERVICES

119 

Native American Caregiver Support Services

Services FY 2020 Final FY 2021 Enacted FY 2022 

President’s Budget

FY 2022 +/- 

FY 2021

Native American 

Caregiver Support 

Services – Budget 

Authority 

$10.306 $10.806 $15.806 +$5.000

Supplemental 

Funding --- $8.330 ---- -$8.330

Program Level $10.306 $19.136 $15.806 -$3.330 

*BA is in millions of dollars.

Original Authorizing Legislation: Section 631 of the Older Americans Act of 1965, Public Law 

89-73 

Most Recent Authorizing Legislation: Supporting Older Americans Act of 2020, Public Law 116-

131 

Current FY Authorization ..............................................................................................$12,089,846 

Authorization Expiration Date ...................................................................................................2024 

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 
CAREGIVER AND FAMILY SUPPORT SERVICES

120 

60 and over and must also receive a grant under the Native American Nutrition and Supportive 

Services program to receive funding. There is no requirement for matching funds. Tribes may also 

decide the age at which a member is considered an elder and, thus, eligible for services. In addition, 

there is no limit on the percentage of funds that can be used for services to grandparents caring for 

grandchildren. 

Grants assist American Indian, Alaskan Native, and Native Hawaiian families caring for older 

relatives with chronic illness or disability, and grandparents caring for grandchildren. The 2020 

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 11% of these Elders are the primary caregiver of a grandchild. The 

trending top five chronic diseases among Elders were high blood pressure (58%), arthritis (45.3%), 

diabetes (39.3%), cataracts (20%), and depression (14%). 

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 2018................................... $9,556,000

FY 2019................................... $10,046,000

FY 2020................................... $10,306,000

FY 2021 Enacted......................... $10,806,000

FY 2022 President’s Budget............ $15,806,000

Budget Request:

The FY 2022 request, for Native American Caregiver Support Services is $15,806,000, which is 

an increase of $5,000,000 over the FY 2021 Enacted level. This level of funding is critical as the 

country emerges from the pandemic. Native Americans as a group have been especially vulnerable 

to, and harder hit by COVID-19. Further, because many Native Americans are located in more 

rural areas, caregiver services are often fewer and less accessible, and virtual services during the 

pandemic difficult to access for other reasons. 
CAREGIVER AND FAMILY SUPPORT SERVICES

121 

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 availability for caregivers and volunteers to continue to offer vital services 

to the American Indian/ Alaskan Native and Native Hawaiian elders living on the reservations has 

been dramatically impacted by the COVID-19 pandemic. In prior years, the ability to address the 

public health disparities within the Native American/Alaskan Native community had yet to be fully 

addressed, as this community experience health inequities including poorer health and quality of 

life indicators, when compared to those in other rural caregiving settings. In FY 2020, direct care 

services for caregivers in the Native American Indian communities were further impacted due to 

the lack of infrastructure to convert services to virtual settings to meet the needs of older Americans 

in these communities. COVID-19 often vastly decreased the extent to which caregivers’ needs 

could be or were being met in Native communities. 

An estimated 1,042,122 persons age 60 and over identify themselves as Native American or 

Alaskan Native, alone or in combination with another racial group.103 Over 607,000 of those elders 

identify as Native American or Alaskan Native with no other racial group.

104 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. The budget increase for caregivers will support the higher level of services—

both direct and virtual—that are needed by Native American caregivers as Tribes transition back 

from the pandemic. 

Performance data indicates that these programs are an efficient means to help Native American 

Elders remain independent and in the community. In FY 2022, funding for the Native American 

Caregiver Support Program will expand 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; while working to close the gaps with infrastructure and the ability to 

receive direct care and virtual services in times of public health emergencies. In FY 2021, an 

estimated 989,882 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. 

103 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, 2019. Released June 2020. . 

Released June 25, 2020 https://www2.census.gov/programs-surveys/popest/tables/2010-2019/national/asrh/ncest2019-asr5h.xlsx. Accessed 30 April, 2021.

104 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, 2019 Released June 25,2020, 

https://www2.census.gov/programs-surveys/popest/tables/2010-2019/national/asrh/nc-est2019-asr6h.xlsx. 

Accessed 30 April 2021.
CAREGIVER AND FAMILY SUPPORT SERVICES

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Outcome Table:

Native American Caregivers Supportive Services 

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2021

Target

FY 2022

Target

FY 2022

Target

+/-FY 2021

Target

3.1 Increase the number 

of caregivers served 

through the National 

Family Caregiver 

Support Program. 

(Outcome)

FY 2019: 837,496 caregivers

Target:

800,000 caregivers

(Target Exceeded)

989,882 

caregivers

1,309,375 

caregivers

+319,493 caregivers

Grant Awards Table:

Native American Caregivers Supportive Services Grant Awards 

Grant Awards Tables

FY 2020 

Final

FY 2021 

Enacted

FY 2022 

President's 

Budget

Number of Awards 238 251 251

Average Award $42,680 $42,041 $60,980 

Range of Awards

$13,820 - 

$56,560

$17,750 - 

$72,213

$26,390 - 

$106,570
CAREGIVER AND FAMILY SUPPORT SERVICES

123 

Alzheimer’s Disease Program

Services FY 2020 Final FY 2021 Enacted FY 2022 

President’s Budget

FY 2022 +/- 

FY 2021

Alzheimer’s Disease 

Program – Budget 

Authority 

$11.800 $12. 800 $15.360 +$2.560

PPHF $14.700 $14.700 $14.700 --

Program Level $26.500 $27.500 $30.060 +$2.560

*BA is in millions of dollars.

Authorizing Legislation: Section 411 of the Older Americans Act of 1965, Public Law 89-73 

Most Recent Authorizing Legislation: Supporting Older Americans Act of 2020, Public Law 116-

131 

Current FY Authorization ......................................................................................................... None 

Expiration Date ..........................................................................................................................2024 

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.105 As 

105 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.
CAREGIVER AND FAMILY SUPPORT SERVICES

124 

the number of people with ADRD is projected to grow by almost 300 percent by 2050,

106 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.107 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.108

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. Through the Alzheimer’s Disease Initiative Program (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;

• 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.

106 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. 

107 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. 

108 Gitlin LN, Kales HC, Lyketsos CG. Nonpharmacologic Management of Behavioral Symptoms in Dementia.

JAMA. 2012;308(19):2020-2029. doi:10.1001/jama.2012.36918.
CAREGIVER AND FAMILY SUPPORT SERVICES

125 

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 2018.............................. $23,500,000

FY 2019/1.............................. $19,996,000

FY 2020/1.............................. $26,500,000

FY 2021 Enacted1/.................. $27,500,000

FY 2022 President’s Budget 1/.... $30,060,000

1/Funding for FY 2019 on includes $14.7 million in funding from the Prevention and Public Health Fund. 

Budget Request: 

The FY 2022 President’s Budget request is $30,060,000, an increase of $2,560,000 over the FY 

2021 Enacted level. As previously noted, the number of people with ADRD is growing, increasing 

the need for, and pressure to address the needs of this population through additional resources. 

Testing and demonstrating 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 if 

they are to be able to remain longer in the community. At the proposed funding level, ACL will 

provide more community-based pilot projects and increase the focus on equity by targeting persons 

suffering from dementia and their caregivers from marginalized or underserved communities, 

including communities of color, rural communities, and others. 

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; and, 

• Respite and culturally competent Memory Cafés. 

ACL funded programs are also 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. The increased funding level will allow 

for ACL to continue to assist individuals with ADRD and their caregivers, while providing direct 

services to communities who have been marginalized and impacted by COVID-19. 
CAREGIVER AND FAMILY SUPPORT SERVICES

126 

Outcome and Outputs Table:

Alzheimer’s Disease Program

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2021

Target

FY 2022

Target

FY 2022

Target

+/-FY 2021

Target

ALZ.3 Improve dementia 

capability of long-term 

support systems to create 

dementia-friendly, livable 

communities. (Outcome)

FY 2019: 13%

Target:

Not Defined

(Historical Actual)

17% 17% Maintain

Grant Awards Tables:

Alzheimer’s Disease Program109

Grant Awards Tables

FY 2020 

Final

FY 2021 

Enacted

FY 2022 

President's 

Budget

Number of Awards 18 33 36

Average Award $722,995 $727,044 $727,044 

Range of Awards

$225,451 - 

$1,233,571

$225,451 - 

$1,233,571

$225,451 - 

$1,233,571

109 The number of awards is an estimate and may change.
CAREGIVER AND FAMILY SUPPORT SERVICES

127 

Lifespan Respite Care

 

Services FY 2020 Final FY 2021 Enacted FY 2022 

President’s Budget

FY 2022 +/- 

FY 2021

Lifespan Respite 

Care – Budget 

Authority

$6.110 $7.110 $14.220 +$7.110

*BA is in millions 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 2020, AARP and the 

National Alliance for Caregiving estimated that 54 million people served as unpaid family 

caregivers to an adult or child with disabilities. 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.110 Many caregivers report difficulty managing both 

physical and emotional stress and balancing work and family responsibilities. 

110 National Alliance for Caregiving and AARP. Caregiving in the U.S. 2020 – Focused Look at Caregivers of 

Adults Age 50+. http://www.caregiving.org/wp-content/uploads/2015/05/2015_CaregivingintheUS_CareRecipients-Over-50_WEB.pdf
CAREGIVER AND FAMILY SUPPORT SERVICES

128 

Numerous studies have shown respite care services to be among the most frequently requested 

supportive services for family caregivers.111 Respite is second only to direct financial assistance 

as a key policy priority of surveyed family caregivers.112 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.113 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.114

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 disabilities. The program provides ACL with a key vehicle to 

address the needs of all caregivers. Unlike the Family Caregiver Support Services Program that 

focuses on five basic services, the Lifespan Respite Care program focuses on providing 

opportunities to develop and test infrastructure changes and to fill gaps by putting in place 

coordinated systems of accessible, community-based respite care services for family caregivers of 

children and adults with disabilities. 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;

111 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. 112Care Giving in the United States (2021). https://www.caregiving.org/wp-content/uploads/2021/01/fullreport-caregiving-in-the-united-states-01-21.pdf (see page 4). 

113 Care Giving in the United States (2021).https://www.caregiving.org/wp-content/uploads/2021/01/fullreport-caregiving-in-the-united-states-01-21.pdf (see page 4) 114 National Alliance for Caregiving. (2012). Multiple Sclerosis Caregivers. Washington, DC: Author; The Arc, 2011.
CAREGIVER AND FAMILY SUPPORT SERVICES

129 

• Replication and expansion of respite delivery modalities with a particular focus on 

person-centered planning and consumer direction; 

• Expansion of toll free “helplines,” dedicated websites, and statewide respite registries, to 

provide caregivers with information about available respite programs. 

• Development and deployment of marketing and awareness campaigns designed to 

educate caregivers about the importance of their work and the necessity to take a break; 

• Development of data collection methodologies to track service provision and 

programmatic outcomes; 

• Broadening stakeholder collaborations to ensure representation of all age and disability 

groups, as well as the broadest possible cross section of the provider network; 

• 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 2018.............................. $4,110,000

FY 2019.............................. $4,096,000

FY 2020 .............................. $6,110,000

FY 2021 Enacted.................... $7,110,000

FY 2022 President’s Budget....... $14,220,000
CAREGIVER AND FAMILY SUPPORT SERVICES

130 

Budget Request:

 

The FY 2022 President’s Budget for Lifespan Respite is $14,220,000, an increase of $7,110,000 

over the FY 2021 Enacted level. This level of funding is critical as the country emerges from the 

pandemic. Given the central role that caregivers play in helping their loved ones to remain 

independent, providing caregivers with the respite care that they personally need to carry on and 

be effective is imperative. Recognizing this, the Administration has identified increasing resources 

to strengthen the care economy as a key priority and crucial to our country’s economic recovery 

from COVID-19. 

At this higher level, the Lifespan Respite Care program will be in a better position to address gaps 

in respite services at the State level and will continue efforts to develop more efficient, costeffective methods of providing caregivers with respite that reaches across the aging and the 

disability populations. Funding will also increase outreach by the grantees to target to the aging 

and disability populations that have been marginalized and underserved. Finally, the increase will 

allow ACL to address ways to engage communities and cultures that have previously been unaware 

of available services, and increase assistance to those aging and disability populations that need 

more assistance. 

ACL will use the additional funds to make competitive grants to support a range of possible 

activities to build or enhance Lifespan Respite Care Programs in additional States; 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, with a focus on reaching marginalized and underserved populations. 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, disability, race, and socio-economic 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 disabilities. 

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 disabilities, 

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.115

The resources requested for FY 2022 will be used to address these issues by: 

115 National Respite Coalition Written Testimony to the House subcommittee on Labor, Health and Human Services, 

and Education Appropriations. April 12, 2010. 
CAREGIVER AND FAMILY SUPPORT SERVICES

131 

• Expanding, enhancing, and advancing respite care direct care services to family members, 

as well as building on the virtual based infrastructure 

• Improving the statewide dissemination and coordination of respite care with community 

based organizations targeting disenfranchised, and

• Providing, supplementing, or improving access to marginalized families and caregivers, 

and quality of respite care services to family caregivers who have been impacted by the 

COVID-19 pandemic, thereby reducing family caregiver strain. 

Output Table:

Lifespan Respite Care

Indicator Year and Most Recent 

Result /

FY 2021

Projection

FY 2022

Projection

FY 2022

Projection

+/-FY 2021

Projection

Output AJ: The number 

of states that have 

participated in the 

Lifespan Respite Care 

program. (Output)

FY 2019: 38* 40 42 +2

*Increases in appropriations will be used to fund grants to states to build on previous efforts through “Lifespan 

Respite Program Enhancement Grants,” and states are expected to continue building and expanding their statewide 

efforts and serve more caregivers. 
CAREGIVER AND FAMILY SUPPORT SERVICES

132 

Grant Awards Table:

Lifespan Respite Care Grant Awards

Grant Awards Tables

FY 2020 

Final

FY 2021 

Enacted

FY 2022 

President's 

Budget

Number of Awards 21 29 30

Average Award $265,553 $236,298 $444,000 

Range of Awards

$99,320 - 

$329,215

$88,030 - 

$329,215

$176,060 - 

$658,430
PROTECTION OF VULNERABLE ADULTS

133 

Protection of Vulnerable Adults

Summary of Request

Protection of Vulnerable Adults consists of several distinct, but complementary, programs 

designed to promote the rights of older Americans and 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. Data from state Adult Protective Services 

(APS) agencies show an increasing trend in reports of adult maltreatment.116 These increases are 

concerning as other research estimates that as few as 1 in 23 cases of elder abuse,117 and 1 in 44 

cases of financial exploitation, ever come to the attention of authorities. According to a 1998 

national incidence study (the only such study ever conducted), 84 percent of all elder abuse

incidents go unreported, meaning that, for every reported case of abuse, there are over five that go 

unreported.118 The most recent data on the prevalence of elder abuse, neglect, and exploitation 

suggest that at least 10 percent, or approximately 5 million older Americans, experience abuse 

each year, and many experience it in multiple forms.119

The negative effects of abuse, neglect, and exploitation on the health and independence of seniors 

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.120 

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.

116 Teaster, P. B., Dugar, T., Mendiondo, M., Abner, E. L., Cecil, K. A., & Otto, J. M. (2004). The 2004 Survey of 

Adult Protective Services: Abuse of Vulnerable Adults 18 Years of Age and Older. Washington, D.C.: National 

Center on Elder Abuse, U.S. Administration for Community Living. National Research Council. (2003). Elder 

Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington, D.C.: The National Academies 

Press. New York City Dept for the Aging; Lifespan of Greater Rochester, Inc., & Weill Cornell Medical Ctr of 

Cornell University. (2011). Under the Radar: New York State Elder Abuse Prevalence Study. Rochester: Lifespan of 

Greater Rochester, Inc. 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. Am J Public Health, 100(2), 292–

297.

117 New York City Dept for the Aging; Lifespan of Greater Rochester, Inc., & Weill Cornell Medical Ctr of Cornell 

University. (2011). Under the Radar: New York State Elder Abuse Prevalence Study. Rochester: Lifespan of Greater 

Rochester, Inc.

118Tatara, Toshio, et al. The National Elder Abuse Incidence Study Final Report. 1998. 

http://www.aoa.gov/AoARoot/AoA_Programs/Elder_Rights/Elder_Abuse/docs/ABuseReport_Full.pdf. 119 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.

120 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
PROTECTION OF VULNERABLE ADULTS

134 

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.121 Protection of 

Vulnerable Adults programs address this problem through a full array of services designed to 

prevent, detect, and respond to, elder abuse, neglect, and exploitation, both at home and in 

institutional settings.

 

The total FY 2022 request is $74.344 million, an increase of +$10.8 million over the FY 2021 

Enacted level of $63.5 million. The requested increase builds on funding provided in the American 

Rescue Plan to transition State Long-Term Care Ombudsman programs from virtual back to inperson contact and visitation in facilities with adequate personal protective equipment and safety 

precautions in order to resolve complaints and problems in nursing facilities and to expand 

coverage to other residential care facilities, i.e., assisted living facilities, for which the Long-Term 

Care Ombudsman Program has had responsibility and authority, but insufficient funds to address. 

The request for Protection of Vulnerable Adults will help to ensure the resiliency of communities 

by protecting vulnerable populations. The request includes: 

• $29.9 million for Long-Term Care Ombudsman, an increase of $11 million over the FY 

2021 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 an 

additional $10 million in supplemental funding was provided in the American Rescue Plan 

to provide States the resources to plan for and begin to implement a return to on-site 

visitations and the resumption of direct contact and engagement with residents. The 

request allows that work to continue into FY 2022 as States return to a post COVID-19 

world and to expand coverage to other residential care facilities. 

• $5.1 million for the Prevention of Elder Abuse and Neglect an increase of $286,000 over 

the FY 2021 Enacted level of $4.8 million. The program provides formula grants to states 

to train, educate, and increase public awareness of how to prevent elder abuse, and has not 

received as significant increase in over a decade.

• $20 million for the Senior Medicare Patrol Program/Health Care Fraud and Abuse Control 

the same level as the FY 2021 Enacted level. But does not include $2 million in wedge 

funding received in FY 2021. 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.

• $4.4 million for the Elder Rights Support Activities (ERSA), an increase of $526,000 over 

the FY 2021 Enacted level of $3.9 million. The additional funding will go to the National 

121 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.
CAREGIVER AND FAMILY SUPPORT SERVICES

135 

Long-term Care Ombudsman Resource Center (NORC), which will support the increased 

request for the Long-Term Care Ombudsman program and coverage in residential care 

facilities.

 

• $15 million for Elder Justice/Adult Protective Services, an increase of $1 million over the 

FY 2021 Enacted level of $14 million. This funding is in addition to the $188 million in 

supplemental funding provided for Elder Justice/Adult Protective Services in FY 2021, and 

the $188 million provide in the American Rescue Plan for Elder Justice/Adult Protective 

Services in FY 2022. Continued support for guardianship efforts to ensure the rights of the 

elderly are protected in court proceedings, are part of ACL’s focus on equity. The increase 

of $1 million supports expanded opioid specific efforts specifically targeting communities 

most affected by opioids and other substance abuse; and to enable APS grantees to identify 

and procure home-and community-based social, health, and mental/behavioral health 

services needed for those APS clients impacted by the opioid epidemic, as well as to 

propose solutions that quickly fill those needs and identified gaps. 

Together, programs to protect vulnerable adults create a foundation from which States can 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; (2) protect the rights of older 

adults; (3) reduces health-care fraud and abuse; and (4) provides 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 Americans Act 

and the Elder Justice Act.
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Long-Term Care Ombudsman Program

Services FY 2020 Final FY 2021 Enacted

FY 2022 

President’s 

Budget

FY 2022 +/- 

FY 2021

Budget Authority $17.885 $18.885 $29.885 +$11.000

Supplemental 

Funding -- $10.000 -- -$10.000

Long-Term Care 

Ombudsman 

Program

$17.885 $28.885 $29.885 +$1.000

*BA is in millions of dollars.

Original Authorizing Legislation: Section 712 of the Older Americans Act of 1965, Public Law 

89-73. 

Most Recent Authorizing Legislation: Supporting Older Americans Act of 2020, Public Law 116-

131 

Current FY Authorization ................................................................................................19,150,967 

Authorization Expiration Date ...................................................................................................2024 

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 73,000 longterm care facilities (over 16,000 licensed nursing facilities and over 58,000 licensed board and care 

facilities).

122 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 

7,298 designated staff and volunteers. Ombudsmen resolve complaints with, and on behalf of, 

122 National Ombudsman Reporting System (NORS) – FFY 2019. 
PROTECTION OF VULNERABLE ADULTS

138 

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. 

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.123 All but three states have volunteer 

Ombudsman programs. These trained and designated volunteer ombudsmen donated over 514,094 

hours in FY 2019.124 In FY 2019, 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). 125

• Ombudsmen investigated and worked to resolve over 198,000 complaints (Output Q).126

• Ombudsmen provided over 559,000 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).127

The environment in which individuals seek long term services and supports (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 CommunityBased 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 

123 Shaughnessy, Carol V. The Role of Ombudsmen in Assuring Quality for Residents of Long-Term Care Facilities: 

Straining to Make Ends Meet. National Health Policy Forum. December 9, 2009. 

124 National Ombudsman Reporting System (NORS) – FFY 2019 

125 Id

126 Id

127 Id
PROTECTION OF VULNERABLE ADULTS

139 

growing Federal awareness of, and response to, the uncharted area of abuse, neglect, and 

exploitation of older adults and individuals with disabilities. 

Five Year Funding Table: 

Funding for the Long-term Care Ombudsman Program over the past five years is as follows:

FY 2018.............................. $16,885,000

FY 2019.............................. $16,868,000

FY 2020.............................. $17,885,000

FY 2021 Enacted.................... $18,885,000

FY 2022 President’s Budget ....... $29,885,000

Budget Request:

The FY 2022 request for the LTC Ombudsman Program is $29,885,000, an increase of 

+$11,000,000 above the FY 2021 Enacted level of $18,885,000, but only $1,000,000 above the 

total funding provided in FY 2021 when funding from the American Rescue Plan is included. 

The additional funding will allow States to carry out the planning provided for in FY 2021 and 

begin on-site visitations by providing the resources necessary to resume direct contact and 

engagement with residents and to continue expansion to cover residential care facilities and 

settings throughout the States. The additional funding for State programs is supported by the 

requested expansion of the National Long-term Care Ombudsman Resource Center (NORC) with 

ERSA funding. 

Individuals who reside in the 74,000 long-term care facilities across the country have been 

particularly hard hit by, and are particularly susceptible to, COVID-19. In a regular year there is 

increased demand as the senior population continues to grow. In FY 2022, States will be 

continuing their transitions from a COVID-19 to a COVID-19 recovery period. This means 

carrying out their plans from FY 2021 to resume on-site visitations, as well as dealing with the 

challenges of ensuring safety of those not only in nursing facilities but other residential care 

settings. 

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 a regular year. During COVID-19 State 

Ombudsman programs have faced new and unique challenges providing outreach and oversight 

while protecting residents from COVID-19. 

State LTC Ombudsman programs provide oversight in an efficient and effective manner. The 

percentage of the complaints processed by ombudsmen that were fully or partially resolved to the 
PROTECTION OF VULNERABLE ADULTS

140 

satisfaction of the resident was 713 percent in FY 2016.128 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 equity, 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 and facilitate 

individuals choosing to transition out of nursing home facilities into more integrated settings. They 

also advocate for quality care and individual rights and well-being in other congregate long-term 

care settings, such as board and care and assisted living, but need funding for staff, volunteers and 

PPE to cover these facilities. In addition, LTC Ombudsmen serve individuals in these settings 

regardless of the individuals’ eligibility for Medicaid or other public benefits. Ombudsmen are 

the only federally funded entity providing services to all of these residents. 

Outcomes and Outputs Table:

Long-Term Care Ombudsman Program

 

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2021

Target

FY 2022

Target

FY 2022

Target

+/-FY 2021

Target

2.12 Decrease the 

average number of 

complaints per LTC 

facility. (Outcome)

FY 2019: 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 2019: 10,785

Target:

9,000

(Target Not Met)

9,000 10,000 +1,000 

128 National Ombudsman Reporting System (NORS) 2019– Complaint resolution: 14% needing no further 

action; 5.0% withdrawn; 5.4% not resolved to the satisfaction of the resident; 4.4% referred to other

agency for resolution.
PROTECTION OF VULNERABLE ADULTS

141 

Indicator Year and Most Recent 

Result /

FY 2021

Projection

FY 2022

Projection

FY 2022

Projection

+/-FY 2021

Projection

Output Q: The Number of 

Complaints (Output)

FY 2019: 198,502 190,000 190,000 Maintain

Output R: Number of 

Ombudsman 

Consultations (Output)

FY 2019: 559,451 535,000 695,500 +160,500

Output S: Facilities 

regularly visited not in 

response to a complaint

(Output)

FY 2019: 29,168 30,200 36,460 +6,260

Grant Awards Table:

 FY 2020 

Final 

FY 2021 

Enacted 

FY 2022 

President's 

Budget

Number of 

Awards 56 56 56

Average Award $319,375 $333,860 $533,661 

Range of Awards $44,635-

$1,866,202

$46,740-

$1,949,822

$73,965 -

$3,085,537
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PROTECTION OF VULNERABLE ADULTS

Long-Term Care Ombudsman Program Formula Grant Awards

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2022 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Long-Term Care Ombudsman Program (CFDA 93.042)

FY 2020

Final

FY 2021

Enacted

FY 2022

President's Budget

FY 2022 +/-

STATE/TERRITORY FY 2021

Alabama 269,471 281,371 445,262 163,891

Alaska 89,269 93,481 147,931 54,450

Arizona 398,489 421,422 666,890 245,468

Arkansas 164,264 171,020 270,634 99,614

California 1,866,202 1,949,822 3,085,537 1,135,715

Colorado 270,951 285,999 452,586 166,587

Connecticut 201,753 210,390 332,937 122,547

Delaware 89,269 93,481 147,931 54,450

District of Columbia 89,269 93,481 147,931 54,450

Florida 1,351,067 1,418,930 2,245,419 826,489

Georgia 485,582 512,462 810,957 298,495

Hawaii 89,269 93,481 147,931 54,450

Idaho 90,475 95,975 151,878 55,903

Illinois 656,593 683,957 1,082,343 398,386

Indiana 347,616 363,289 574,894 211,605

Iowa 174,930 182,061 288,107 106,046

Kansas 151,522 158,168 250,296 92,128

Kentucky 240,019 250,299 396,092 145,793

Louisiana 238,201 249,217 394,379 145,162

Maine 89,606 93,914 148,616 54,702

Maryland 308,598 323,424 511,810 188,386

Massachusetts 373,124 389,572 616,487 226,915

Michigan 565,437 590,230 934,023 343,793

Minnesota 293,956 308,916 488,851 179,935

Mississippi 155,685 162,235 256,733 94,498

Missouri 337,224 352,277 557,469 205,192

Montana 89,269 93,481 147,931 54,450

Nebraska 99,097 103,585 163,920 60,335

Nevada 154,930 163,729 259,097 95,368

New Hampshire 89,269 93,481 147,931 54,450

New Jersey 473,192 494,084 781,874 287,790

New Mexico 115,740 120,990 191,463 70,473

New York 1,046,921 1,091,783 1,727,716 635,933

North Carolina 549,707 578,972 916,208 337,236

North Dakota 89,269 93,481 147,931 54,450

142
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 17,885,000 18,885,000 29,885,000 11,000,000

PROTECTION OF VULNERABLE ADULTS

PROGRAM/CFDA NUMBER: Long-Term Care Ombudsman Program (CFDA 93.042)

FY2020 FY2021 FY2022 FY2022 +/-

STATE/TERRITORY Final Enacted President's Budget FY2021

Ohio 655,327 682,962 1,080,769 397,807

Oklahoma 201,873 210,425 332,992 122,567

Oregon 238,385 249,450 394,749 145,299

Pennsylvania 758,496 790,057 1,250,244 460,187

Rhode Island 89,269 93,481 147,931 54,450

South Carolina 290,223 306,598 485,184 178,586

South Dakota 89,269 93,481 147,931 54,450

Tennessee 362,192 379,058 599,848 220,790

Texas 1,205,566 1,270,325 2,010,256 739,931

Utah 116,068 122,872 194,441 71,569

Vermont 89,269 93,481 147,931 54,450

Virginia 432,756 453,811 718,143 264,332

Washington 384,332 403,828 639,048 235,220

West Virginia 115,408 119,332 188,840 69,508

Wisconsin 324,771 340,672 539,105 198,433

Wyoming 89,269 93,481 147,931 54,450

Subtotal 17,537,708 18,365,774 29,063,338 10,697,564

American Samoa 11,159 11,685 18,491 6,806

Guam 44,635 46,740 73,965 27,225

Northern Mariana Islands 11,159 11,685 18,491 6,806

Puerto Rico 204,552 213,526 337,900 124,374

Virgin Islands 44,635 46,740 73,965 27,225

Subtotal 316,140 330,376 522,812 192,436

Total States/Territories 17,853,848 18,696,150 29,586,150 10,890,000

Contingency Fund 1/ 31,152 188,850 298,850 110,000

Subtotal Adjustments 31,152 188,850 298,850 110,000

TOTAL RESOURCES

1/ Contingency Fund – includes funds for Older Americans Act statutory requirements, including disaster assistance, and grant

and program reporting systems costs. Funds unused for these purposes at the end of the year are allocated to states.

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Prevention of Elder Abuse and Neglect

Services FY 2020 Final FY 2021 Enacted FY 2022 

President’s Budget

FY 2022 +/- 

FY 2021

Prevention of Elder 

Abuse and Neglect 

– Budget Authority

$4.773 $4.773 $5.059 +$0.286

*BA is in millions of dollars. 

Original Authorizing Legislation: Section 702(b) of the Older Americans Act of 1965, Public Law 

89-73. 

Most Recent Authorizing Legislation: Supporting Older Americans Act of 2020, Public Law 116-

131 

Current FY Authorization ................................................................................................$5,413,537 

Authorization Expiration Date ...................................................................................................2024 

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: 

• In Kentucky, the local area agencies on aging participate in the Local Coordinating 

Councils on Elder Abuse, which have developed emergency elder shelters, distributed 
PROTECTION OF VULNERABLE ADULTS

146 

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-Teams 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 2018................................... $4,773,000

FY 2019................................... $4,768,000

FY 2020................................... $4,773,000

FY 2021 Enacted......................... $4,773,000

FY 2022 President’s Budget........... $5,059,000

Budget Request:

The FY 2022 request for the Prevention of Elder Abuse and Neglect program is $5,059,000, an 

increase of +$286,000 over the FY 2021 Enacted level of $4,773,000. This increase is the first 

real increase States will receive in funding in the past decade. The increase 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

147 

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 2021

Projection

FY 2022

Projection

FY 2022

Projection

+/-FY 2021

Projection

Output U: Elder Abuse 

prevention non-OAA 

service expenditures 

(Output, dollars in 

thousands)

FY 2019: $33,433 $33,809 $33,809 Maintain

Grant Awards Table:

Prevention of Elder Abuse, Neglect, and Exploitation Grant Awards 

 FY 2020 

Final 

FY 2021 

Enacted 

FY 2022 

President's 

Budget 

Number of Awards 84 89 101

Average Award $484,620 $462,999 $458,028 

Range of Awards $48,909 -

$700,000 

$48,909 -

$571,732 

$48,909 -

$571,732 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PROTECTION OF VULNERABLE ADULTS

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON AGING

FY 2022 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Prevention of Elder Abuse & Neglect (CFDA 93.041) 

FY 2020 FY 2021 FY 2022 FY 2022 +/-

STATE/TERRITORY Final Enacted President's Budget FY 2021

Alabama 76,215 76,215 76,215 -

Alaska 23,769 23,660 25,042 1,382

Arizona 87,456 81,500 106,739 25,239

Arkansas 48,157 48,157 48,157 -

California 471,073 471,073 493,861 22,788

Colorado 59,453 56,082 72,439 16,357

Connecticut 59,907 59,907 59,907 -

Delaware 23,769 23,660 25,042 1,382

District of Columbia 23,769 23,660 25,042 1,382

Florida 344,252 344,252 359,392 15,140

Georgia 106,548 103,321 129,798 26,477

Hawaii 23,769 23,660 25,042 1,382

Idaho 23,769 23,660 25,042 1,382

Illinois 197,384 197,384 197,384 -

Indiana 98,224 98,224 98,224 -

Iowa 55,927 55,927 55,927 -

Kansas 45,843 45,843 45,843 -

Kentucky 66,595 66,595 66,595 -

Louisiana 68,518 68,518 68,518 -

Maine 23,769 23,660 25,042 1,382

Maryland 78,087 78,087 81,918 3,831

Massachusetts 109,606 109,606 109,606 -

Michigan 160,862 160,862 160,862 -

Minnesota 76,347 76,347 78,244 1,897

Mississippi 45,198 45,198 45,198 -

Missouri 97,643 97,643 97,643 -

Montana 23,769 23,660 25,042 1,382

Nebraska 29,770 29,770 29,770 -

Nevada 33,995 27,629 41,470 13,841

New Hampshire 23,769 23,660 25,042 1,382

New Jersey 143,950 143,950 143,950 -

New Mexico 26,393 26,393 30,645 4,252

New York 318,066 318,066 318,066 -

North Carolina 126,782 126,782 146,644 19,862

North Dakota 23,769 23,660 25,042 1,382

148 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PROTECTION OF VULNERABLE ADULTS

PROGRAM/CFDA NUMBER: Prevention of Elder Abuse & Neglect (CFDA 93.041) 

FY2020 FY2021 FY2022 FY2022 +/-

STATE/TERRITORY Final Enacted President's Budget FY2021

Ohio 197,185 197,185 197,185 -

Oklahoma 60,208 60,208 60,208 -

Oregon 56,795 56,795 63,182 6,387

Pennsylvania 242,944 242,944 242,944 -

Rhode Island 23,769 23,660 25,042 1,382

South Carolina 63,681 63,080 77,657 14,577

South Dakota 23,769 23,660 25,042 1,382

Tennessee 91,810 91,810 96,009 4,199

Texas 274,281 274,281 321,753 47,472

Utah 25,468 24,837 31,121 6,284

Vermont 23,769 23,660 25,042 1,382

Virginia 102,820 102,820 114,943 12,123

Washington 86,291 86,291 102,283 15,992

West Virginia 36,736 36,736 36,736 -

Wisconsin 90,309 90,309 90,309 -

Wyoming 23,769 23,660 25,042 1,382

Subtotal 4,669,776 4,648,207 4,922,891 274,684

American Samoa 2,971 2,958 3,130 172

Guam 11,884 11,830 12,521 691

Northern Mariana Islands 2,971 2,958 3,130 172

Puerto Rico 54,217 54,217 54,217 -

Virgin Islands 11,884 11,830 12,521 691

Subtotal 83,927 83,793 85,519 1,726

Total States/Territories 4,753,703 4,732,000 5,008,410 276,410

Contingency Fund 1/ 19,297 41,000 50,590 9,590

Subtotal Adjustments 19,297 41,000 50,590 9,590

TOTAL RESOURCES 4,773,000 4,773,000 5,059,000 286,000

1/ Program Support – includes funds for Older Americans Act statutory requirements, including disaster assistance, and grant and 

program reporting systems costs. Funds unused for these purposes at the end of the year are allocated to states. 

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Health Care Fraud and Abuse Control/Senior Medicare Patrol Program

Services FY 2020 Final FY 2021 Enacted FY 2022 

President’s Budget

FY 2022 +/- 

FY 2021

Direct $18.000 $20.000 $20.000 ----

Wedge -- $2.000 -- -$2,000

Program Level $18.000 $22.000 $20.000 -$2.000

FTEs 3.2 3.1 4.00 -----

*BA is in millions of dollars. FTE is a whole number, FTE for this activity are supported by program dollars.

1/ The FY 2020 appropriations language states that SMP/HCFAC is paid out of discretionary CMS HCFAC appropriations based 

on the Secretary of HHS’s determination of the amount needed to provide funding but not less than the floor of $20,000,000 

provided in appropriations language. The FY 2022 amount serves as a placeholder for pending a final decision on the amount by 

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: Supporting Older Americans Act of 2016, Public Law 116-

131 

Current FY Authorization ................................................................................................20,000,000 

Authorization Expiration Date ...................................................................................................2024 

Allocation Method .............................................................................. Competitive Grant/Contracts

Program Description and Accomplishments:
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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 team members, 

many that are volunteers, whose purpose is to educate Medicare beneficiaries on preventing and 

identifying healthcare fraud and abuse. Projects use the skills of local team members 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. 

Data obtained from the SMP Information and Reporting System (SIRS) for calendar year 2019 

shows that Senior Medicare Patrol projects:

• Maintained 6875 active SMP team members who worked over 549,958 hours to educate 

beneficiaries about how to prevent Medicare fraud, errors, and abuse; 

• Educated 1,912,019 individuals during 28,146 group outreach and education events; and

• Responded to 320,590 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, SMP projects have received more than 

3.3 million inquiries from Medicare beneficiaries about preventing, detecting, and reporting billing 

errors, potential fraud, or other discrepancies. SMPs also have educated more than 41.7 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 June 2020 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. HHS-OIG has documented over 

$129.2 million in savings attributable to the program as a result of beneficiary complaints since 

the program’s inception in 1997. 
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Funding History:

Comparable funding for SMP discretionary appropriations over the past five years is as follows:

FTE

FY 2018...................... $18,000,000 5

FY 2019..................... $18,000,000 3

FY 2020..................... $18,000,000 3

FY 2021 Enacted/1.................. $20,000,000 3

FY 2022 President’s Budget..... $20,000,000 4 

1/Does not includes $2 million in HCFAC “wedge” funding.

Budget Request:

The FY 2022 budget for Senior Medicare Patrols/Health Care Fraud and Abuse Control assumes 

$20,000,000, the same as the FY 2021 Enacted level; this funding level is expected to support 4 

FTE. It does not include the $2 million received in FY 2021 from wedge funding. Appropriation 

language provides that this program be funded at no less than $20,000,000, but leaves the final 

decision on the funding level to the Secretary of HHS. The Secretary is further directed to make 

funding for this program available from the discretionary HCFAC appropriation that Congress 

makes to the Centers for Medicare and Medicaid Services (CMS). 

There has been an increase in the need to combat fraud schemes that have been directly attributed 

to the COVID-19 pandemic. While the need for intervention efforts is on the rise, there is also a 

need for education and prevention to prevent fraud and schemes occurring in the form of testing 

sites, sign up initiatives, and follow-up calls to check on the status of the health and individuals of 

those on Medicare in the times post the pandemic. This is important due to the intersection of 

direct services and virtual services that have created many issues for Older Americans and 

Disabled Americans; where they are most vulnerable. 

HCFAC/SMP worked closely with ACL, CMS and the OIG to provide cases and complaints 

directly to investigators upon receipt to ensure the cases were getting in the right hands as quickly 

as possible. Efforts such as these led to the September 27, 2019, takedown that resulted in charges 

against 35 individuals for their alleged participation in health care fraud schemes involving $2.1 

billion in losses. 
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Congress increased the funding floor for this program to $20 million in FY 2021. ACL expects 

that the additional $2 million available as a result in FY 2021 and FY 2022 will provide a limited 

increase to individual SMP grantee capacity and infrastructure; possible efforts include: 

• Focus on recruiting, training, and retaining additional volunteers. 

• Revision of program business processes to increase capacity to conduct virtual public 

outreach and beneficiary assistance. 

Strengthening the infrastructure is projected to lead to an increase in both outreach events and 

individual interactions, in all communities, with more targeted outreach to those marginalized 

individuals who have been hit hardest by the pandemic. 

Output Table:

Senior Medicare Patrol Program

Indicator Year and Most Recent 

Result /

FY 2021

Projection

FY 2022

Projection

FY 2022

Projection

+/-FY 2021

Projection

Output W: Beneficiaries 

Educated and Served

(Output)

CY 2019: 1,912,019 2,100,000 2,100,000 Maintain

Grant Awards Table:

Senior Medicare Patrol Grant Awards

 (Dollars in thousands) 

 FY 2020 

Final 

FY 2021 

Enacted 

FY 2022 

President’s 

Budget 

Number of Awards 55 56 56

Average Award $301,219 $301,219 $301,219

Range of Awards $95,000 -

$1,000,000 

$95,000 -

$1,000,000

$95,000 -

$1,000,000
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Elder Rights Support Activities

Services FY 2020 Final FY 2021 Enacted FY 2022 

President’s Budget

FY 2022 +/- 

FY 2021

Elder Rights 

Support Activities 

– Budget Authority 

$3.874 $3.874 $4.400 +$0.526

*BA is in millions of dollars. 

Authorizing Legislation: Sections 201, 202, 411, 751 and 752 of the Older Americans Act of 1965, 

Public Law 89-73, 

Most Recent Authorizing Legislation: Supporting Older Americans Act of 2020, Public Law 116-

131 

Current FY Authorization (OAA) ..................................................................................$19,084,548 

Authorization Expiration Date ...................................................................................................2024 

Allocation Method ............................ Competitive Grants/Co-operative Agreements and Contracts

Program Description and Accomplishments:

Elder Rights Support Activities provide information, training, technical assistance and resources 

to States and communities to promote the rights of older Americans to live where they wish, 

whether in their own homes or in long-term congregate housing; These activities assist individuals 

to obtain necessary and appropriate health care, especially including care and services in their own 

homes; and to live free from hunger and free from abuse, neglect, and exploitation. The National 

Center on Elder Abuse, the National Long-Term Care Ombudsman Resource Center, the National 

Center for Law and Elder Rights, and the Legal Assistance Enhancement Grant Program comprise 

an interconnected framework for carrying out ACL’s Protection of Vulnerable Adults 

discretionary grants programs. 

To promote the rights of older Americans and to combat the rising scourge of elder abuse, neglect, 

and exploitation in America, ACL’s goal is to put in place, in coordination with its Elder 

Justice/Adult Protective Services programs and the Elder Justice Coordinating Council, a 

comprehensive approach that provides a coordinated and seamless response system that includes 

the Long-term Care Ombudsman Program, the national network of local legal assistance providers 

and other community services and alliances. The Elder Rights Support Activities described below 

are key components of ACL’s ongoing elder rights programs. 
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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 address 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 facilities, 

board and care homes, and assisted living facilities. 

The NORC engages in numerous projects and activities in support of long-term care ombudsman 

programs. Highlights include leading efforts to support ombudsmen and other advocates to 

address the dramatic morbidity and mortality that are the consequences of isolation resulting from 

the COVID pandemic. Additionally, the NORC has supported Ombudsmen through training and 

technical assistance to fight for the rights of residents to remain connected to family and loved 

ones through safe visitation, to return to their home in a facility following a hospitalization or a 

visit home, to contest improper eviction by nursing facilities and to retain a quality of life and 

quality of care. The NORC has partnered in all of this work with CMS, ACL, and the National 

Association of State Long-Term Care Ombudsman Programs (NASOP) the Long-term Care 

Ombudsman Program. The NORC has continued to support residents wishing to move to a 

community setting, including through working with the Money Follows the Person (MFP) 

program. 
PROTECTION OF VULNERABLE ADULTS

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Legal Assistance and Support 

Legal Assistance and Support provides funding for two different activities. The National Center 

on Law and Elder Rights provides technical assistance, training and capacity-building supports for 

the nation’s Older Americans Act-funded and other legal assistance providers and their partners in 

the aging and disability networks. In 2021, they have reached over 52,000 aging and disability 

network staff through webinars, conference presentations, technical assistance consultations on 

complex legal matters and capacity building. Common topics for trainings and case consultations 

have included strategies to support decisional capacity and guardianship revocation and reform, 

rights to combat community and long-term care evictions, and rights to Medicaid and Medicaid 

home and community-based services. NCLER’s webinar series on shifting to the remote practice 

of legal assistance and remote engagement with courts and administrative appeals forums was the 

earliest (mid-March 2020) provision of technical assistance during COVID-19 received by our 

legal assistance providers, and NCLER’s webinars on this and other cutting edge issues of elder 

rights consistently garner audiences of 3,000 to 4,000 participants. 

Through our discretionary grant program, Legal Assistance Enhancement Program (LAEP), legal 

assistance programs and community partners are working on replicable and sustainable 

innovations to expand the resources available to support elder rights. Current grantees are 

addressing a coordinated statewide approach to legal assistance in the following areas: a rural 

and frontier area in partnership with Area Agencies on Aging, the Long-Term Care Ombudsman 

Program, Adult Protective Services and aging network nonprofit partners; legal disaster response; 

legal support for grandparents raising grandchildren; coordinated approaches to supporting the 

rights of applicants and beneficiaries of Medicaid home and community-based services; and an 

easily accessible legal-social services response to financial exploitation. In future years, it is 

expected that these innovations will sustain themselves and be replicable throughout the country, 

Funding History:

Comparable funding for Elder Rights Support Activities over the past five years is as follows:

FY 2018........................... $3,874,000

FY 2019........................... $3,874,000

FY 2020........................... $3,874,000

FY 2021 Enacted................. $3,874,000

FY 2022 President’s Budget.... $4,400,000

1/Total funding and FTEs in all years have been adjusted for comparability purposes to remove Elder 

Justice/Adult Protective Services funding which, beginning in FY 2022 will be presented in a separate 

chapter. 
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Budget Request:

For FY 2022, $4,400,000 is requested, an increase of +$526,000 over the FY 2021 Enacted level 

of $3,874,000. The increase of $526,000 would be used to increase funding for the National Longterm Care Ombudsman Resource Center (NORC). Even before the pandemic, caregivers (many 

of whom are thrust into the positions for the first time) struggle to get the information they need 

to navigate the long-term care system. Expanding resources for NORC would improve the depth 

of information that can be provided, allowing consumers to more easily link to ombudsmen who 

can help them navigate the long-term care system and resolve problems in nursing facilities, board 

and care homes, and assisted living facilities. 

Elder Rights Support Activities

(dollars in thousands)

Elder Rights Support 

Activities 

FY 2020

Final

FY 2021 

Enacted

FY 2022 

President’s Budget 

FY 2022 +/- 

FY 2021

Legal Assistance and 

Support $2,592 $2,592 $2,592 - 

National Center on 

Elder Abuse $765 $765 $765 - 

LTC Ombudsman 

Resource Center $516 $516 $1,042 $526

Total, Elder Rights 

Support Activities/1 $3,874 $3,874 $4,400 $526

1/Total funding in FY 2020 and FY 2021 has been adjusted for comparability purposes to remove Elder 

Justice/Adult Protective Services funding which, beginning in FY 2022, will be presented in a separate 

chapter. 
PROTECTION OF VULNERABLE ADULTS

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Grant Awards Table:

Elder Rights Support Activities Grant Awards 

 FY 2020 

Final

FY 2021

Enacted 

FY 2022 

President’s 

Budget

Number of Awards 6 8 10

Average Award $308,559 $313,739 $337,324

Range of Awards $42,493-

$1,000,000

$42,493-

$1,000,000

$42,493-

$1,000,000
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Elder Justice/Adult Protective Services

Services FY 2020 Final FY 2021 Enacted FY 2022 

President’s Budget

FY 2022 +/- 

FY 2021

Opioids 

[non-add] $2.000 $2.000 $3.000 +$1.000

Guardianship 

[non-add] -- $2.000 $2.000 --

Infrastructure 

[non-add] $10.000 $10.000 10.000 --

Total Budget 

Authority $12.000 $14.000 $15.000 +$1.000

Supplemental 

Funding -- $188.000 $188.000 --

Program Level $12.000 $202.000 $203.000 +$1.000

FTEs 1.7 2.6 2.6 ---

*BA is in millions of dollars. FTE for this activity are supported by program dollars

Authorizing Legislation: Sections 411 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: Supporting Older Americans Act of 2020, Public Law 116-

131, Title XX of the Social Security Act, Subtitle B, as amended by the Affordable Care Act.

Current FY Authorization (OAA) ......................................................................................... Expired 

Authorization Expiration Date ...................................................................................................2024 
PROTECTION OF VULNERABLE ADULTS

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Allocation Method ............................ Competitive Grants/Co-operative Agreements and Contracts

Program Description and Accomplishments:

Elder Justice and Adult Protective Services provides funding to States and communities to support 

the development of coordinated systems of Adult Protective Services. Together with the National 

Center on Elder Abuse, the APS Technical Assistance Resource Center, the National Long-Term 

Care Ombudsman Resource Center, and the National Center for Law and Elder Rights, along with 

legal assistance providers, these 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 

and proposing solutions to the problems surrounding elder abuse. The Secretary has assigned 

responsibility for implementing the EJCC to the Administration for Community Living. Based on 

the increasing number of issues related to elder justice, two additional agencies have requested to 

join the Council in 2021, increasing the number of federal agencies/departments to a total of 

sixteen members. 

Adult Protective Services

Unlike Child Protective Services, which have been in existence for decades, a federal infrastructure 

to support basic programmatic standards for Adult Protective Services (APS) remains in its 

infancy. Historically, an absence of stewardship in APS has led to inconsistent data systems and 

non-uniform 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. These challenges have impaired States’ ability to assess client outcomes and the 

effectiveness of the services they are providing.129 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. 

129 U.S. Government Accountability Office. (2011). ELDER JUSTICE: Stronger Federal Leadership Could Enhance 

National Response to Elder Abuse. (GAO-11-208). Washington, D.C.: U.S. Government Printing Office.
PROTECTION OF VULNERABLE ADULTS

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In FY 2015, ACL received its first dedicated appropriation, totaling $4 million, to support states 

in enhancing their APS systems statewide. Since that time, funding has grown to between $12 

million and $14 million annually. This funding has allowed States 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 have been willing to voluntarily report because they have recognized the 

value of having consistent data to build a national profile of perpetrators and victims that leads to 

effective interventions. 

ACL’s 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 

study to document the difference that APS makes in the lives of older adults and adults with 

disabilities.

In FY 2021 ACL received $14 million under its annual appropriation. In addition to continuing 

the investments described above, ACL is using a portion of these funds to address the impact of 

opioid misuse on elder abuse and issues around guardianship. 

Opioids 

Opioid misuse can contribute to Elder Abuse in multiple ways: from stolen medications to adults 

being abused to provide cash to support an adult child’s drug habit to grandparents raising 

grandchildren because parents are addicted to older adults being addicted themselves. In FY 2021, 

ACL fully funded 3 elder justice grants focusing on how APS can most effectively respond to 

abuse, neglect and exploitation originating in opioid misuse. Learnings from these grants will be 

shared widely for replication. These grants are intended to continue ACL investments in opioidrelated activities to maximize the impact on direct services. They are specifically targeted to the 

most affected communities and identify gaps that hinder APS from securing adequate services for 

clients affected by opioid and other substance abuse. Further, these grants 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. 
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Guardianship 

Exploitation by guardians and conservators is another area that continues to receive significant 

state and national attention. In November 2016, the U.S. Government Accountability Office 

released a report titled “Elder Abuse: The Extent of Abuse by Guardians is Unknown, but Some 

Measures Exist to Help Protect Older Adults,” and the U.S. Senate Special Committee on Aging 

held hearings called “Trust Betrayed: Financial Abuse of Older Americans by Guardians and 

Others in Power”. Yet although recognized as a serious and pervasive problem, much remains 

unknown about the extent of the problem and effective methods to monitor guardianships and 

prevent guardianship abuse. In 2017, the Elder Justice Prevention and Prosecution Act amended 

the Elder Justice Act to add Section 2042(c)(2)(E), which authorizes grants to the highest state 

courts to better understand and remedy these issues. 

Historically, ACL has supported the development and implementation of Working 

Interdisciplinary Networks of Guardianship Stakeholders (WINGS), the prevailing national model 

for guardianship reform and the identification of appropriate alternatives to guardianship 

throughout our country. In addition, ACL has promoted, and provided technical assistance and 

trainings to partners and stakeholders on empowering self-determined decision-making by adults. 

FY 2021 is the first year funding has been appropriated to award grants to the highest state courts 

to undertake activities such as: 

• Develop systems to audit conservator and guardian accountings to verify accuracy, completeness 

and the appropriateness of expenditures

• Create and maintain case management systems to track cases for timely adjudication and 

monitoring of the well-being of wards 

• Establish and produce judicial training programs and curricula

• Undertake efforts to identify and implement initiatives to avoid and/or mitigate abuse by 

conservators and guardians 

• Explore how judicial systems may coordinate with the Social Security Administration and the 

Veterans Administration to identify and remove abusive fiduciaries 

• Create independent ombudsman programs for wards to voice concerns and seek redress from abuse

• Review and consider guardianship reforms based on the research and models developed by WINGS 

and other training, technical assistance, and capacity building tools, methods and approaches, 

including those developed by NCLER. 

Formula Grants 

In FY 2021, funding for Adult Protective Services took a major step forward with the appropriation 

of $188 million in two supplemental funding bills, no less than $100 million of which was directed 

to fund APS formula grants to States authorized by section 2042(b) of the Social Security Act. 

This funding is in addition to the $14 million in Elder Justice funding that ACL received under its 

annual appropriation. Of the $188 million, ACL has chosen to put $179,947,500 into these grants 

using the formula in the Elder Justice Act which is based on the percentage of the total number of 

elders in each State. The grants will be awarded to the agency or unit of State government that has 

the legal responsibility to provide adult protective services within the State. An additional 
PROTECTION OF VULNERABLE ADULTS

165 

$3,975,000 were directed to additional formula grants intended to enhance the Elder Justice 

capacity of the Long-term Care Ombudsman Programs. 

The FY 2021 funds are being used to: expand remote work capabilities, improve reporting systems 

(including improved linking to the National Adult Maltreatment Reporting System), improve 

responses to scams and fraud especially related to COVID-19, expand personnel resources, 

training/outreach costs related to COVID-19, increased travel/investigation costs, costs associated 

with assisting APS clients secure the least restrictive option for emergency or alternative housing, 

and acquisition of personal protective equipment for in-person investigations. 

Funding History:

Comparable funding for Elder Justice and Adult Protective Services over the past five years as follows:

FTE 

FY 2018........................... $10,000,000 2.1 

FY 2019........................... $12,000,000 2.4

FY 2020........................... $12,000,000 1.7 

FY 2021 Enacted................. $14,000, 000 2.6

FY 2021 Supplemental Funding130

FY 2022 President’s Budget....

FY 2022 Supplemental Funding131 

$188,000,000

$15,000,000

$188,000,000

2.6

Budget Request:

In FY 2022, the request for Elder Justice/Adult Protective Services is $15,000,000, an increase of 

$1,000,000 over the FY 2021 Enacted level. This funding level would allow ACL to maintain 

support for the infrastructure investments that it has made in Elder Justice and Adult Protective 

Services over the last seven years; provide $2 million for a second year of guardianship grants, 

and increase its investment in addressing the opioid crisis by $1,000,000 or 50 percent: 

2nd year Funding for Guardianship Grants to the Highest State Courts ($2 million)

With FY 2022 funding, highest state court grantees will be able to continue to assess the fairness, 

effectiveness, timeliness, safety, integrity, and accessibility of adult guardianship and 

conservatorship proceedings, and develop innovations to improve the experiences of individuals 

at risk of guardianship/conservatorship. Grantees will continue to carry out one or more of the 

following: 

• Develop systems to audit conservator and guardian accountings 

130 $100 million was provided by the Coronavirus Response and Relief Supplemental Act, P.L. 116-260 and an 

additional $88 million by the American Rescue Plan Act, P.L. 117-2.

131 $188 million was provided for FY 2022 by the American Rescue Plan Act, P.L. 117-2.
PROTECTION OF VULNERABLE ADULTS

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• Develop case management systems to track cases

• Develop judicial training programs and curricula 

• Identify and understand how to avoid and/or mitigate abuse by conservators and 

guardians 

• Explore and identify appropriate judicial approaches to alternatives to guardianship 

• Explore how judicial systems may coordinate with SSA and the VA to identify and 

remove abusive fiduciaries

• Create and independent ombudsman program for wards to voice concerns and seek 

redress from abuse 

These efforts will ensure that the rights of older adults are protected in court proceedings and in 

efforts to mitigate, reform and enhance access to alternatives to guardianship as part of ACL’s 

focus on equity. 

Funding to Address Opioid Misuse ($3 million) 

Increased funding to address the very complex issues associated with opioid abuse, APS 

discretionary grants will: target communities most affected by opioid and other substance abuse; 

and enable the APS grantees to identify and procure home-and community-based social, health, 

and mental/behavioral health services needed for those APS clients impacted by the opioid 

epidemic, as well as propose solutions that quickly fill those needs and identified gaps. 

Formula Grants: 

Supplemental funding provided in FY 2021 also provided $188 million for this purpose in FY 2022. 

Therefore, no additional funding is requested in the FY 2022 annual appropriation for these grants. Of 

the $188 million available for FY 2022: 

• $163.5 million in formula grants will go to State APS Agencies. The grants will expand 

and improve APS agencies’ ability to investigate allegations of abuse, neglect, and 

exploitation in the context of COVID-19. FY 2022 APS formula grants will be focused on 

the development of person-directed emergency shelters with wrap-around services, 

statewide elder justice networks, and enhancing and strengthening tribal Adult Protective 

Services. 

• Funding will also be used to expand remote work capabilities, improve reporting systems 

(including improved linking to the National Adult Maltreatment Reporting System), 

improve responses to scams and fraud especially related to COVID-19, expand personnel 

resources, training/outreach costs related to COVID-19, increased travel/investigation 

costs, costs associated with assisting APS clients secure the least restrictive option for 

emergency or alternative housing, and acquisition of personnel protection equipment for 

in-person investigations. This funding builds on the prior supplemental, which first 

provided funding for this program. 
PROTECTION OF VULNERABLE ADULTS

167 

• $18 million will go to formula grants to Long-Term Care Ombudsman programs to enhance 

their capacity to respond to and resolve complaints about abuse and neglect, specifically in 

residential care communities (assisted living, personal care homes and similar settings). 

Residential Care Communities serve persons similar to those in nursing homes, generally 

without federal oversight or regulation, thus making the Long-Term Care Ombudsman 

program presence essential. While the LTCOP has had the responsibility and authority to 

engage with residents of residential care communities, they have never had sufficient 

funding to carry out these duties. Funding will be used to build capacity to reach this 

underserved community to address abuse, neglect and exploitation in the context of 

COVID in the following ways: hire staff and recruit volunteers, training/outreach costs 

related to COVID-19, travel, volunteer management costs, training of facility staff and 

development of resident and family councils. 

• $5,000,000 for the acquisition of a national technical assistance, research and practice 

contract to serve as a national repository of knowledge and to support states in the 

implementation of their COVID-related and recovery activities.

• $1,500,000 for the 2nd year of the National APS Training Center established through a 

cooperative agreement to create or curate training targeted at improving the response of 

APS programs during COVID-19, and for training available through an e-learning system. 

APS agencies provide services and supports to our country’s most frail and vulnerable individuals, 

including older adults and people with disabilities, and those with the greatest socioeconomic 

needs.

Grant Awards Table:

Elder Justice/Adult Protective Services Grant Awards

 FY 2020 Final FY 2021 

Enacted 

FY 2022 

President's 

Budget 

Number of 

Awards 0 56 56

Average Award $0 $3,213,348 $3,213,348 

Range of 

Awards 0 $13,049,606 -$18,164,771

$1,226,250 -

$16,504,485
FY 2020 FY 2021 FY 2022 FY 2022 +/-

STATE/TERRITORY Final Enacted President's Budget FY 2021

Alabama - 2,621,286 2,381,696 (239,590)

Alaska - 1,349,606 1,226,250 (123,356)

Arizona - 3,900,416 3,543,912 (356,504)

Arkansas - 1,593,239 1,447,614 (145,625)

California - 18,164,771 16,504,485 (1,660,286)

Colorado - 2,664,402 2,420,871 (243,531)

Connecticut - 1,960,021 1,780,871 (179,150)

Delaware - 1,349,606 1,226,250 (123,356)

District of Columbia - 269,900 245,231 (24,669)

Florida - 13,218,925 12,010,693 (1,208,232)

Georgia - 4,774,154 4,337,789 (436,365)

Hawaii - 1,349,606 1,226,250 (123,356)

Idaho - 1,349,606 1,226,250 (123,356)

Illinois - 6,371,823 5,789,427 (582,396)

Indiana - 3,384,439 3,075,096 (309,343)

Iowa - 1,696,107 1,541,079 (155,028)

Kansas - 1,473,509 1,338,828 (134,681)

Kentucky - 2,331,817 2,118,685 (213,132)

Louisiana - 2,321,737 2,109,526 (212,211)

Maine - 1,349,606 1,226,250 (123,356)

Maryland - 3,013,059 2,737,660 (275,399)

Massachusetts - 3,629,298 3,297,574 (331,724)

Michigan - 5,498,655 4,996,069 (502,586)

Minnesota - 2,877,899 2,614,854 (263,045)

Mississippi - 1,511,400 1,373,256 (138,144)

Missouri - 3,281,854 2,981,887 (299,967)

Montana - 1,349,606 1,226,250 (123,356)

Nebraska - 1,349,606 1,226,250 (123,356)

Nevada - 1,525,322 1,385,905 (139,417)

New Hampshire - 1,349,606 1,226,250 (123,356)

New Jersey - 4,602,941 4,182,224 (420,717)

New Mexico - 1,349,606 1,226,250 (123,356)

New York - 10,171,178 9,241,515 (929,663)

North Carolina - 5,393,775 4,900,775 (493,000)

North Dakota - 1,349,606 1,226,250 (123,356)

 

 

 

PROTECTION OF VULNERABLE ADULTS

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES

FY 2022 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Elder Justice/ Adult Protective Services (CFDA 93.630)

168
 

 

 

 

 

Ohio - 6,362,557 5,781,008 (581,549)

Oklahoma - 1,960,345 1,781,166 (179,179)

Oregon - 2,323,910 2,111,501 (212,409)

Pennsylvania - 7,360,266 6,687,525 (672,741)

Rhode Island - 1,349,606 1,226,250 (123,356)

South Carolina - 2,856,308 2,595,236 (261,072)

South Dakota - 1,349,606 1,226,250 (123,356)

Tennessee - 3,531,345 3,208,574 (322,771)

Texas - 11,834,504 10,752,810 (1,081,694)

Utah - 1,349,606 1,226,250 (123,356)

Vermont - 1,349,606 1,226,250 (123,356)

Virginia - 4,227,754 3,841,331 (386,423)

Washington - 3,762,114 3,418,251 (343,863)

West Virginia - 1,349,606 1,226,250 (123,356)

Wisconsin - 3,173,745 2,883,659 (290,086)

Wyoming - 1,349,606 1,226,250 (123,356)

Subtotal - 177,238,471 161,038,583 (16,199,888)

American Samoa - 179,948 163,500 (16,448)

Guam - 179,948 163,500 (16,448)

Northern Mariana Islands - 179,948 163,500 (16,448)

Puerto Rico - 1,989,237 1,807,417 (181,820)

Virgin Islands - 179,948 163,500 (16,448)

Subtotal - 2,709,029 2,461,417 (247,612)

Total States/Territories - 179,947,500 163,500,000 (16,447,500)

Contingency Fund 1/ - 8,052,500 24,500,000 16,447,500

Subtotal Adjustments - 8,052,500 24,500,000 16,447,500

TOTAL RESOURCES - 188,000,000 188,000,000 -

PROTECTION OF VULNERABLE ADULTS

FY 2022 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Elder Justice/ Adult Protective Services (CFDA 93.630)

FY 2020 FY 2021 FY 2022 FY 2022 +/-

STATE/TERRITORY Final Enacted President's Budget FY 2021

169
170 

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DISABILITY PROGRAMS, RESEARCH AND SERVICES

171 

Disability Programs, Research and Services

Summary of Request

ACL’s Disability Research 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 and to live independently. A hallmark of these programs is that people with 

disabilities play a central role in their planning and design. 

The total FY 2022 request for Disability Programs and Services is $488,670,000, an increase of 

$59.3 million above the FY 2021 Enacted level. The requested level includes increases to support 

the critical work that ACL’s Disability Programs continue to do to support individuals with 

disabilities throughout the COVID-19 pandemic and into the post-pandemic recovery period. This 

includes a $32 million increase for Independent Living programs, which continue to see an 

increased demand for services – a result of the multiple risk factors faced by people with 

disabilities: increased risk for contracting the virus and for experiencing a loss of services and 

supports, social isolation, and food insecurity. 

In addition, the request includes a 12 percent increase for core Disability Services programs, none 

of which received supplemental appropriations during the pandemic despite the heightened 

demand for their services, and a 5 percent increase for the Limb Loss Resource Center, Paralysis 

Resource Center, Traumatic Brain Injury, and the National Institute on Disability, Independent

Living, and Rehabilitation Research. 

Specific requests include:

• $88.5 million for State Councils on Developmental Disabilities (SCDD), an increase of 

+$9.5 million above the FY 2021 Enacted level. State Councils are the only entity in each 

State and Territory with the mandate and the means to create life-altering change for people 

with developmental disabilities. Guided by people with developmental disabilities, 

families, and other key stakeholders, Councils recognize the potential of every person with 

developmental disabilities and act as champions for their equal opportunity in all aspects 

of community living. 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. 

• $46.8 million for Developmental Disabilities Protection and Advocacy systems, an 

increase of +$5.0 million above the FY 2021 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.
DISABILITY PROGRAMS, RESEARCH AND SERVICES

172 

• $47.2 million for University Centers for Excellence in Developmental Disabilities 

(UCEDDs), an increase of +$5.1 million from the FY 2021 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. 

• $13.1 million for Projects of National Significance (PNS), an increase of +$850,000 above 

the FY 2021 Enacted level. This funding will be used to support an evaluation of the 

Developmental Disabilities Assistance Bill of Rights Act programs to determine the 

quality, nature, and extent of their outreach to unserved and underserved populations, as 

well as new grants to promote intersectional equity through partnerships and knowledge 

exchange and transfer between people with disabilities who face barriers due to race, 

ethnicity or other factors and disability organizations. 

• $148.2 million for Independent Living programs, an increase of +$32.0 million above the 

FY 2021 Enacted level. Of the total increase, $29 million will provide additional funding 

for Centers for Independent Living (CILs) and $3 million will support the provision, 

expansion, and improvement of State Independent Living Services grants. 

• $26.3 million for the Limb Loss Resource Center, Paralysis Resource Center, and 

Traumatic Brain Injury programs. This is a combined increase of +$1.2 million above the 

FY 2021 Enacted level. The requested level represents a 5 percent increase for each of 

these important national resource centers. These three programs increase resilience and 

support the independence of individuals who were born with or develop these disabilities. 

• $118.6 million for the National Institute on Disability, Independent Living, and 

Rehabilitation Research (NIDILRR), an increase of +$5.6 million over the FY 2021 

Enacted level. As part of the Administration’s equity priority, NIDILRR will fund three 

new Rehabilitation Research and Training Centers (RRTCs) on community living and 

participation, employment, and health and function, with a focus addressing disparate 

outcomes experienced by people with disabilities who also face systemic barriers due to 

marginalization. In addition, the funding will allow NIDILRR to conduct additional fieldinitiated research to address emerging research gaps.
DISABILITY PROGRAMS, RESEARCH AND SERVICES

173 

State Councils on Developmental Disabilities

Services FY 2020 Final FY 2021 Enacted FY 2022 

President’s Budget

FY 2022 +/- 

FY 2021

State Councils on 

Developmental 

Disabilities – 

Budget Authority

$78.000 $79.000 $88.480 +$9.480

*BA is in millions 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 (SCDDs) are the only State level entity charged with 

identifying and addressing the most pressing needs of people with developmental disabilities in 

their state and/or territory. Driven by people with developmental disabilities, families, and other 

key stakeholders, SCDDs set priorities and pursue systems change efforts designed to turn 

fragmented approaches into a comprehensive and effective statewide, person-centered and familycentered system that are key to supporting people with developmental disabilities. SCDDs are the 

only entity mandated to provide support and funding for the leadership development of people 

with developmental disabilities. 

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 

identified by people with developmental disabilities and their families. 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 selfadvocacy and to build leadership skills of individuals with developmental disabilities. 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

174 

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 developmental disabilities. 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

175 

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 for lack of 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.

In addition to funding State Councils through formula grants, ACL annually reserves up to one

percent of the funds appropriated for the Developmental Disabilities State Councils, as required 

by authorizing statute, to provide training and technical assistance. 

Funding History:

Funding for the program over the past five years is as follows: 

FY 2018............................ $75.943,000

FY 2019............................ $75,921,000

FY 2020............................ $78,000,000

FY 2021 Enacted................... $79,000,000

FY 2022 President’s Budget.... $88,480,000

Budget Request: 

The FY 2022 request for SCDDs is $88,480,000, an increase of +$9,480,000 above the FY 2021 

Enacted level. Additional funding will expand the work that SCDDs do to advance equity, selfdetermination, and community living alongside people with developmental disabilities across the 

nation, an already important task made critical by the devastating impact of the COVID-19 

pandemic on the disability population. As the country recovers from the pandemic, the need to 

ensure that individuals with developmental disabilities and their families have access to essential 

community services, individualized supports, and other forms of assistance that promote self-
DISABILITY PROGRAMS, RESEARCH AND SERVICES

176 

determination, independence, productivity, integration, and inclusion in all facets of community 

life will be essential. The requested 12% increase will provide SCDDs with the resources they 

need to continue the crucial work that they have done to support people with developmental 

disabilities during the COVID-19 pandemic through the post-COVID recovery period. 

ACL recognizes the value this program provides by focusing 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.

Outputs and Outcomes Tab

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2021

Target

FY 2022

Target

FY 2022

Target

+/-FY 2021

Target

8G Increase the 

percentage of people with 

developmental 

disabilities and their 

family members 

increasing their advocacy 

knowledge. (Outcome)

FY 2019: 83.68%

Target:

Not Defined

(Historical Actual)

Set Baseline Set Baseline Maintain

*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 2020 

Final 

FY 2021 

Enacted 

FY 2022 

President's 

Budget

Number of 

Awards 56 56 56

Average Award $1,376,586 $1,351,163 $1,548,400

Range of Awards $277,608- 

$7,891,297

$274,744- 

$7,708,204

$307,713 -

$9,296,982
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DISABILITY PROGRAMS, RESEARCH AND SERVICES

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES

FY 2022 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: State Councils on Developmental Disabilities (CFDA 93.630)

FY 2020 FY 2021 FY 2022 FY 2022 +/-

STATE/TERRITORY Final Enacted President's Budget FY 2021

Alabama 1,317,944 1,287,864 1,298,443 10,579

Alaska 533,068 527,570 590,878 63,308

Arizona 1,536,283 1,500,930 1,637,443 136,513

Arkansas 786,962 769,002 791,404 22,402

California 7,891,297 7,708,204 9,296,982 1,588,778

Colorado 1,077,298 1,088,170 1,252,280 164,110

Connecticut 728,678 712,048 799,128 87,080

Delaware 533,068 527,570 590,878 63,308

District of Columbia 533,068 527,570 590,878 63,308

Florida 4,213,243 4,134,518 4,978,817 844,299

Georgia 2,193,860 2,143,424 2,448,582 305,158

Hawaii 533,068 527,570 590,878 63,308

Idaho 533,068 527,570 590,878 63,308

Illinois 2,704,214 2,642,154 2,883,061 240,907

Indiana 1,523,312 1,488,546 1,537,480 48,934

Iowa 792,256 774,176 774,176 -

Kansas 628,944 614,590 653,506 38,916

Kentucky 1,223,186 1,195,270 1,212,393 17,123

Louisiana 1,407,854 1,375,724 1,449,561 73,837

Maine 533,068 527,570 590,878 63,308

Maryland 1,193,722 1,166,854 1,312,734 145,880

Massachusetts 1,391,820 1,399,852 1,727,146 327,294

Michigan 2,590,362 2,531,242 2,531,242 -

Minnesota 1,092,901 1,080,418 1,221,342 140,924

Mississippi 935,592 914,238 970,887 56,649

Missouri 1,393,040 1,361,246 1,403,330 42,084

Montana 533,068 527,570 590,878 63,308

Nebraska 533,068 527,570 590,878 63,308

Nevada 610,335 596,084 740,330 144,246

New Hampshire 533,068 527,570 590,878 63,308

New Jersey 1,731,436 1,709,231 2,113,835 404,604

New Mexico 533,144 527,570 607,419 79,849

New York 4,176,220 4,080,906 4,980,330 899,424

North Carolina 2,093,337 2,059,287 2,445,731 386,444

North Dakota 533,068 527,570 590,878 63,308

177 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DISABILITY PROGRAMS, RESEARCH AND SERVICES

PROGRAM/CFDA NUMBER: State Councils on Developmental Disabilities (CFDA 93.630)

FY2020 FY2021 FY2022 FY2022 +/-

STATE/TERRITORY Final Enacted President's Budget FY2021

Ohio 2,913,208 2,846,720 2,886,384 39,664

Oklahoma 918,206 897,250 913,640 16,390

Oregon 831,242 813,444 927,679 114,235

Pennsylvania 3,097,206 3,026,520 3,065,892 39,372

Rhode Island 533,068 527,570 590,878 63,308

South Carolina 1,122,620 1,125,624 1,277,050 151,426

South Dakota 533,068 527,570 590,878 63,308

Tennessee 1,495,528 1,461,396 1,623,834 162,438

Texas 5,693,774 5,584,012 6,531,733 947,721

Utah 646,912 632,148 701,480 69,332

Vermont 533,068 527,570 590,878 63,308

Virginia 1,647,016 1,632,514 1,847,410 214,896

Washington 1,537,802 1,502,104 1,693,911 191,807

West Virginia 756,610 739,342 739,342 -

Wisconsin 1,335,982 1,305,492 1,336,950 31,458

Wyoming 533,068 527,570 590,878 63,308

Subtotal 75,226,298 73,814,094 82,885,179 9,071,085

American Samoa 277,608 274,744 307,713 32,969

Guam 277,608 274,744 307,713 32,969

Northern Mariana Islands 277,608 274,744 307,713 32,969

Puerto Rico 752,079 752,079 2,594,369 1,842,290

Virgin Islands 277,608 274,744 307,713 32,969

Subtotal 1,862,511 1,851,055 3,825,221 1,974,166

Total States/Territories 77,088,809 75,665,149 86,710,400 11,045,251

Contingency Fund 1/ 911,191 3,334,851 1,769,600 (1,565,251)

Subtotal Adjustments 911,191 3,334,851 1,769,600 (1,565,251)

TOTAL RESOURCES 78,000,000 79,000,000 88,480,000 9,480,000

1/ Contingency Fund- includes funds for technical assistance and/or minority set-asides; grant systems and review, and program

reporting systems costs.

178 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

179 

Developmental Disabilities – Protection and Advocacy

Services FY 2020 Final FY 2021 Enacted FY 2022 

President’s Budget

FY 2022 +/- 

FY 2021

Developmental 

Disabilities – 

Protection and 

Advocacy – Budget 

Authority

$40.784 $41.784 $46.798 +$5.014

*BA is in millions 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 

have access to health care, education, and employment opportunities; 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. In all, there are 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-Based 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 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

180 

waiver services has steadily increased.132 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 also 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. 

In addition to funding P&As through formula grants, ACL annually reserves 2 percent of the funds 

appropriated for the Developmental Disabilities P&A program, as required by authorizing statute, 

to provide training and technical assistance. 

Funding History:

Funding for the program over the past five years is as follows: 

FY 2018.................................. $40,677,000

FY 2019.................................. $40,692,000

FY 2020.................................. $40,784,000

FY 2021 Enacted........................ $41,784,000

FY 2022 President’s Budget........... $46,798,000

Budget Request: 

The FY 2022 request for the Developmental Disabilities Protection and Advocacy program is 

$46,798,000, an increase of +$5,014,000 above the FY 2021 Enacted level. Additional funding 

will expand the ongoing training, legal, and advocacy services to groups and to individuals with 

developmental disabilities, as well as continue the provision of information and referral services. 

While there has been no lessening of demand for P&A services, requests in recent years have 

lagged enacted levels. Furthermore, in any given year, P&As may be called upon to take on 

additional work in response to natural disasters and other emergencies to ensure individuals are 

protected from abuse and neglect. For example, most recently the P&As have played a critical role 

in states during the COVID-19 pandemic to ensure equal access for people with disabilities to 

132 U.S. Profile, FY 1977 – 2013, State of the State in Developmental Disabilities.
DISABILITY PROGRAMS, RESEARCH AND SERVICES

181 

medical care and protection from medical decisions that are being made based on discriminatory 

assumptions about quality of life. They have played a crucial role throughout the pandemic in 

protecting the legal rights of people with disabilities, from working with state and local entities to 

address accessibility barriers for people with disabilities seeking COVID-19 vaccines to ensuring 

that people with disabilities have access to in-person supports necessary for equal access to care 

in hospitals or in congregate settings to working with school districts to ensure students with 

disabilities had access to a free and appropriate education throughout the pandemic. The demand 

on P&As will continue as the nation begins to recover from the COVID-19 pandemic. 

Following below are examples of prior year achievements that might not be sustainable if funding 

for the P&A’s is not increased. 

In FY 2019, P&As were able to: 

• Close 77 percent of individual cases by fully or partially meeting the client’s objective;

• P&A efforts resulted in 45 percent of individual clients having their right enforced and/or 

restored;

• P&As addressed 49 percent of closed cases through technical assistance in self-advocacy; 

• P&As used investigation and monitoring to resolve 11 percent of cases; 

• Another 10 percent were addressed through negotiation; and 

• 16 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 2021

Target

FY 2022

Target

FY 2022

Target

+/-FY 2021

Target

8F Increase the 

percentage of individuals 

with developmental 

disabilities whose rights 

were enforced, retained, 

restored or expanded. 

(Outcome)

FY 2019: 78.6%

Target:

Not Defined

(Historical Actual)

Prior Result + 

1%

Prior Result + 

1%

N/A
DISABILITY PROGRAMS, RESEARCH AND SERVICES

182 

Indicator Year and Most Recent 

Result /

FY 2021

Projection

FY 2022

Projection

FY 2022

Projection

+/-FY 2021

Projection

8iii: Number of clients 

receiving professional 

individual legal advocacy 

for the Protection and 

Advocacy program. 

(Output)

FY 2019: 13,714 N/A N/A N/A

8iv: Number of people 

receiving information and 

referral from the 

Protection and Advocacy 

program. (Output)

FY 2019: 22,610 N/A N/A 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. 

Grant Awards Tables:

Developmental Disabilities – Protection and Advocacy Formula Grant Awards133

 FY 2020 

Final 

FY 2021 

Enacted 

FY 2022 

President's 

Budget

Number of 

Awards 56 56 56

Average Award $697,846 $723,759 $810,608 

Range of Awards $216,701-

$4,016,299

$222,010-

$4,152,122

$248,651 -

$4,662,107

133 Excludes grants to tribal organizations.
DISABILITY PROGRAMS, RESEARCH AND SERVICES 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

ADMINISTRATION ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 

FY 2022 DISCRETIONARY STATE FORMULA GRANTS 2/ 

PROGRAM/CFDA NUMBER: Developmental Disabilities - Protection and Advocacy (CFDA 93.630) 

FY2020 FY2021 FY2022 FY2022+/-

STATE/TERRITORY Final Enacted President's Budget FY2021 

Alabama 506,385 500,286 561,228 60,942 

Alaska 405,053 414,977 464,774 49,797 

Arizona 772,586 728,873 818,346 89,473 

Arkansas 405,053 414,977 464,774 49,797 

California 4,016,299 4,152,122 4,662,108 509,986 

Colorado 526,104 541,533 607,980 66,447 

Connecticut 405,053 414,977 464,774 49,797 

Delaware 405,053 414,977 464,774 49,797 

District of Columbia 405,053 414,977 464,774 49,797 

Florida 2,129,599 2,216,398 2,488,316 271,918 

Georgia 1,089,023 1,031,408 1,157,801 126,393 

Hawaii 405,053 414,977 464,774 49,797 

Idaho 405,053 414,977 464,774 49,797 

Illinois 1,273,116 1,270,573 1,426,630 156,057 

Indiana 654,024 640,008 718,510 78,502 

Iowa 405,053 414,977 464,774 49,797 

Kansas 405,053 414,977 464,774 49,797 

Kentucky 479,092 468,472 525,514 57,042 

Louisiana 520,060 526,314 583,972 57,658 

Maine 405,053 414,977 464,774 49,797 

Maryland 574,503 549,395 616,879 67,484 

Massachusetts 634,015 750,237 842,572 92,335 

Michigan 1,000,882 963,224 1,081,392 118,168 

Minnesota 529,842 518,568 582,253 63,685 

Mississippi 418,958 438,154 490,731 52,577 

Missouri 599,936 564,379 633,059 68,680 

Montana 405,053 414,977 464,774 49,797 

Nebraska 405,053 414,977 464,774 49,797 

Nevada 405,053 414,977 464,774 49,797 

New Hampshire 405,053 414,977 464,774 49,797 

New Jersey 813,702 899,882 1,010,642 110,760 

New Mexico 405,053 414,977 464,774 49,797 

New York 1,936,843 2,231,221 2,505,217 273,996 

North Carolina 1,077,316 1,051,514 1,180,359 128,845 

North Dakota 405,053 414,977 464,774 49,797 

183 
DISABILITY PROGRAMS, RESEARCH AND SERVICES 

PROGRAM/CFDA NUMBER: Developmental Disabilities - Protection and Advocacy (CFDA 93.630) 

FY2020 FY2021 FY2022 FY2022 +/-

STATF/DRRITORY Final Enacted President's Budget FY2021 

Ohio 1,182,177 1,180,579 1,325,298 144,719 

Oklahoma 410,755 414,977 464,774 49,797 

Oregon 422,900 423,693 475,691 51,998 

Pennsylvania 1,283,195 1,296,004 1,455,273 159,269 

Rhode Island 405,053 414,977 464,774 49,797 

South Carolina 500,233 543,399 609,931 66,532 

South Dakota 405,053 414,977 464,774 49,797 

Tennessee 665,837 701,097 787,019 85,922 

Texas 2,884,459 2,801,200 3,144,644 343,444 

Utah 405,053 414,977 464,774 49,797 

VenI10nt 405,053 414,977 464,774 49,797 

Vrrginia 783,876 792,575 889,858 97,283 

Washington 752,938 720,959 809,583 88,624 

West Vrrginia 405,053 414,977 464,774 49,797 

Wisconsin 532,169 529,415 594,397 64,982 

Wyoming 405,053 414,977 464,774 49,797 

Subtotal 37,881,990 38,575,953 43,275,005 4,699,052 

Indian Tribes 216,701 222,010 248,651 26,641 

American Samoa 216,701 222,010 248,651 26,641 

Guam 216,701 222,010 248,651 26,641 

Northern Mariana Islands 216,701 222,010 248,651 26,641 

Puerto Rico 811,723 844,477 875,800 31,323 

Vrrgin Islands 216,701 222,010 248,651 26,641 

Subtotal 1,895,228 1,954,527 2,119,055 164,528 

Total States/Territories 39,777,218 40,530,480 45,394,060 4,863,580 

Contingency Fund 1/ 1,006,782 1,253,520 1,403,940 150,420 

Subtotal Adjustments 1,006,782 1,253,520 1,403,940 150,420 

TOTAL RESOURCIS 40,784,000 41,784,000 46,798,000 5,014,000 

1/ Contingency Fund- includes funds for technical assistance and/or minority set-asides; grant systems and review, and program 

reporting systems costs. 

184 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

185 

University Centers for Excellence in Developmental Disabilities

Services FY 2020 Final FY 2021 Enacted FY 2022 

President’s Budget

FY 2022 +/- 

FY 2021

University Centers 

for Excellence in 

Developmental 

Disabilities – 

Budget Authority 

$41.619 $42.119 $47.173 $5.054

*BA is in millions 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 selfdetermination and to be independent, productive, integrated and included in all facets of 

community life.

In FY 2020, ACL funded 68 UCEDDs. Funding from ACL 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 2019 UCEDDs leveraged $18 per ACL 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, 

inclusive education, transition from school to work, employment, housing, assistive technology, 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

186 

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.

When funding is statutorily sufficient, UCEDDs also conduct national training initiatives on 

emerging issues at the national level 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 people with developmental disabilities, 

enhancing self-determination skills, and building partnerships with minority serving institutions. 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

187 

Funding History: 

Funding for the program over the past five years is as follows:

FY 2018................................... $40,543,000

FY 2019.................................. $40,619,000

FY 2020.................................. $41,619,000

FY 2021 Enacted....................... $42,119,000

FY 2022 President’s Budget............ $47,173,000

Budget Request: 

The FY 2022 request for UCEDDs is $47,173,000, an increase of +$5,054,000 above the FY 2021 

Enacted level. Funding for 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. 

As a part of the requested increase, ACL will fund a new round of competitive grants focused on 

diversity and intersectional equity by partnering with minority serving institutions. The 

Developmental Disabilities Assistance and Bill of Right Act of 2000 (DD Act of 2000) has long 

identified the importance of cultural competence and improving expectations and outcomes for 

people with developmental disabilities across the lifespan, including those from culturally and 

linguistically diverse backgrounds. These grants will build on previous efforts to ensure that 

individuals with developmental disabilities across the lifespan from racial and ethnic minority 

backgrounds and their families enjoy equitable opportunities to access and use community services 

and individualized supports. When funding is statutorily sufficient, UCEDDs also conduct national 

training initiatives on emerging issues at the national level 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 people with developmental 

disabilities, enhancing self-determination skills, and building partnerships with minority serving 

institutions.

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 different kinds of leadership positions, including: 

• 18 percent in academic leadership;

• 15 percent in clinical leadership; 

• 4 percent in public health leadership; and 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

188 

• 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 continue to provide technical and other assistance, including sharing best practices, to allow 

the UCEDDs to leverage additional resources for these services.

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 2021

Target

FY 2022

Target

FY 2022

Target

+/-FY 2021

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 2019: 45.89%

Target:

46.1%

(Target Not Met but 

Improved)

Prior Result + 

1%

Prior Result + 

1%

N/A
DISABILITY PROGRAMS, RESEARCH AND SERVICES

189 

Indicator Year and Most Recent 

Result /

FY 2021 

Projection

FY 2022

Projection

FY 2022

Projection

+/-FY 2021

Projection

8viii: Number of 

professionals trained by 

UCEDDs. (Output)

FY 2019: 6,214 N/A N/A N/A

8ix: Number of people 

reached through UCEDD 

community training and 

technical assistance 

activities. (Output)

FY 2019: 1,313,989 N/A N/A N/A

8x: Number of people 

receiving direct or model 

demonstration services 

from UCEDDs. (Output)

FY 2019: 13,446 N/A N/A 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. 

Grant Awards Tables:

University Centers of Excellence in Developmental Disabilities Grant Awards

 FY 2020 

Final 

FY 2021 

Enacted 

FY 2022 

President's 

Budget 

Number of 

Awards 84 89 101

Average Award $484,620 $462,999 $458,028 

Range of Awards $48,909 -

$700,000 

$48,909 -

$571,732 

$48,909 -

$571,732 
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Developmental Disabilities – Projects of National Significance

Services FY 2020 Final FY 2021 Enacted FY 2022 

President’s Budget

FY 2022 +/- 

FY 2021

Developmental 

Disabilities – Project 

of National 

Significance - 

Budget Authority

$12.250 $12.250 $13.100 +$0.850

*BA is in millions 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

192 

• 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 2018..................................... $11,770,000

FY 2019..................................... $11,958,000

FY 2020..................................... $12,250,000

FY 2021 Enacted........................... $12,250,000

FY 2022 President’s Budget.............. $13,100,000

Budget Request:

The FY 2021 request for the Projects of National Significance is $13,100,000, an increase of 

+$850,000 over the FY 2021 Enacted level. This requested increase will advance the 

Administration’s priorities around equity. Of the requested increase, at least $500,000 would fund 

an evaluation of the Developmental Disabilities Assistance and Bill of Rights Act Programs – State 

Councils on Developmental Disabilities, Developmental Disabilities Protection and Advocacy, 

and University Centers for Developmental Disabilities – to determine the quality, nature, and 

extent of their cultural competence and outreach to both unserved and underserved populations, 

including people with disabilities who are multiply marginalized based on their race, ethnicity or 

other factors. While each of these programs is required to be culturally competent and reach 

unserved and underserved populations, a thorough evaluation would help determine the 

effectiveness of these efforts while developing resources such as self-assessment and monitoring 

tools to guide future work in these essential areas. 

The remaining $350,000 of the requested increase would support a grant program to address 

diversity, equity, and inclusion that would fund up to five new community-based partnership grants 

to promote equity between multiply marginalized people with disabilities and disability 

organizations, with a focus on ACL grantees.
DISABILITY PROGRAMS, RESEARCH AND SERVICES

193 

Grant Awards Tables:

Developmental Disabilities – Projects of National Significance Grant Awards

(Dollars in thousands) 

 

FY 2020 

Enacted 

Level 

FY 2021 

President's 

Budget 

FY 2022 

Requested 

Level 

Number of Awards 24 26 28

Average Award $375,823 $375,381 $378,925 

Range of Awards $249,829-

$997,480 

$350,000-

$997,480 

$350,000-

$997,480 
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Independent Living

. 

Services FY 2020 Final FY 2021 Enacted FY 2022 

President’s Budget

FY 2022 +/- 

FY 2021

State Independent 

Living

ServicesGrants 

$25.378 $25.378 $28.423 +$3.045

Centers for 

Independent Living $90.805 $90.805 $119.805 +$29.000

Supplemental 

Funding $85.000 --- --- ---

Total Program Level $116.183 $116.183 $148.228 +$32.045

FTE 1.0 1.0 1.0 ---

*BA is in millions of dollars. 1.0 FTE for this activity are supported by program dollars.

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 ...................................................................................... Expired 

Centers for Independent Living ........................................................................................ Expired 

Expiration Date: ........................................................................................................................2020 

Allocation Method ...................................................................... Formula and Discretionary Grants 

Program Description and Accomplishments:
DISABILITY PROGRAMS, RESEARCH AND SERVICES

196 

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 

living (CILs) and foster working relationships between CILs, Statewide Independent Living 

Councils (SILCs), and other federal, state and community programs that address the needs of 

people with disabilities. 

State Independent Living Services Grants

The State Independent Living Services (ILS) Grants program funds formula grants to states and 

territories to support provision, expansion, and improvement of independent living services. 

Specifically, the program supports in part the operation of SILCs, 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 and 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. 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

197 

Typically, this “pass through” funding is awarded to centers for independent living and supports 

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. 

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. 

In fiscal year 2019, CILs served approximately 238,701of the estimated 55.2 million individuals 

with a significant disability living in the United States.134

In addition to funding centers for independent living, ACL 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). 

During the pandemic, CILs have experienced, and met, the increased demand for services—a 

result of the multiple risk factors faced by people with disabilities: increased risk for contracting 

the virus and for experiencing a loss of services and supports, social isolation, and food insecurity.

134 ACL, 704 Report, 2014. And U.S. Census Bureau, “Americans with Disabilities 2010” issued July 2012. 

https://www2.census.gov/library/publications/2012/demo/p70-131.pdf. Accessed 16 April 2021. 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

198 

Supported in part by emergency supplemental appropriations, CILs continue to work to ensure that 

people with disabilities have access to food, social supports, PPE, information, and are diverted 

from nursing homes and other institutional settings. 

Funding History:

Funding for Independent Living activities over the past five years is as follows:

Centers for Independent Living

FY 2018................................. $83,305,000

FY 2019................................. $90,805,000

FY 2020................................. $90,805,000

FY 2021 Enacted...................... $90,805,000

FY 2022 President’s Budget.......... $119,805,000

State Independent LivingServices Grants 

FTE 

FY 2018................................. $24,878,000 0.8

FY 2019................................. $25,378,000 1.0

FY 2020................................. $25,378,000 1.0

FY 2021 Enacted....................... $25,378,000 1.0

FY 2022 President’s Budget.......... $28,423,000 1.0

Budget Request:

State Independent Living Services Grants

The FY 2022 request for State Independent Living Services Grants is $28,423,000, an increase of 

+$3,045,000 above the FY 2021 Enacted level. The requested funding level would provide a 

12 percent increase in funding for grants to states, and the important work they do to support the 

provision, expansion, and improvement of independent living services, including training, 

technical assistance, coordination, and evaluation activities. As a part of this increase, ACL also 

will continue to reserve, in accordance with statute, at least 1.8 percent of funding for the provision 

of technical assistance, including support for one FTE to provide direct federal technical 

assistance. 

Centers for Independent Living

The FY 2022 request for the Centers for Independent Living program is $119,805,000, an increase 

of +$29,000,000 over the FY 2021 enacted level. This increase will provide the additional funding 

the CILs need to continue their pivotal pandemic efforts as the nation begins to recover from the 

COVID-19 pandemic. 

Even as the pandemic begins to recede, the need for CIL services is expected to continue well into 

FY 2022 as more people with disabilities have experienced loss of employment and/or access to 

services and supports and will require a longer recovery period to reconnect. Complicating 

recovery, there is a higher incidence of vaccine hesitancy in the disability community – both 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

199 

amongst people with disabilities and their support providers that will result in many people with 

disabilities continuing to be at risk for contracting COVID-19. 

 

 

In addition to pandemic support and recovery efforts, requested funding will 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 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: While some CILs provide employment support and training, the 

statute currently does not require CILs to provide such services or to connect services to 

employment outcomes and economic mobility. To address this, ACL is requesting appropriations 

language to use up to $8,000,000 to fund a competitive employment demonstration grant program 

to test models for supporting people with disabilities in securing and sustaining competitive, 

integrated employment, including related training and technical assistance and an evaluation. The 

goal of the program is to build evidence-based practices to assist CILs across the country to expand 

and strengthen the employment-related services that they provide.

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 significant barriers that prevent people with disabilities from accessing and sustaining 

employment. Consequently, employment may be a key contributor to health disparities between 

people with and without disabilities. 

Legislative Proposal: Removal of Requirement that Grantee Compliance Reviews Must Be 

Conducted Onsite 

ACL proposes to remove the requirement that a prescribed number of grantee compliance reviews 

must be conducted onsite each year. ACL is committed to conducting compliance reviews with a 

minimum of 15 percent of grantees annually, however, current technology and experience during 

the pandemic, have illustrated that conducting all compliance reviews onsite is not an effective 

and efficient use of resources. ACL proposes having the flexibility to determine the most 

appropriate approach and setting for reviews. To that end, ACL developed the Compliance and 

Outcome Monitoring Protocol (COMP), which is a standardized tool that provides a more efficient 

and cost-effective process for grantee compliance reviews as it uses remote technologies, reserving 

onsite methods for cases in which remote approaches would not be sufficient. The COMP is 

comprised of three interwoven processes that can occur in any order or simultaneously: 

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. 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

200 

2. 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 and/or remote review (the latter is also referred to as a 

desktop review). 

3. Targeted Review: is a review that is focused on monitoring of the grantee in specific areas 

of concern. This type of review is individualized based on the issue(s) with the program, 

including operations and financial management. The review is conducted onsite and/or 

remotely, depending on the nature of the issue(s) of concern. 

This approach leverages technology to conduct many routine monitoring activities remotely and 

uses a risk-based approach for more in-depth reviews. Reserving onsite activities for cases or 

issues that require a physical presence is a more efficient approach that maximizes program 

funding while ensuring sound program management, compliance, and oversight of grantees. 

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. 

Grant Awards Tables:

State Independent Living Services Grant Awards135

 FY 2020 

Final 

FY 2021 

Enacted 

FY 2022 

President's 

Budget 

Number of Awards 56 56 56

Average Award $439,105 $435,958 $488,267 

Range of Awards $30,737-

$2,171,583

$30,517 -

$2,132,224

$34,179 -

$2,388,066

135 Independent Living State Grants are awarded to 77 entities across 56 state and territory jurisdictions because 

some states have separate divisions for vocational rehabilitation and services for the blind.
 

 

 

 

 

 

 

 

 

 

 

 

 

 

DISABILITY PROGRAMS, RESEARCH AND SERVICES

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

FY 2022 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: State Independent Living Services Grants (CFDA 84.169A)

FY 2020

Final

FY 2021

Enacted

FY 2022

President's Budget

FY 2022 +/-

STATE/TERRITORY FY 2021

Alabama 338,717 338,717 379,358 40,641

Alaska 338,717 338,717 379,358 40,641

Arizona 393,705 392,787 439,916 47,129

Arkansas 338,717 338,717 379,358 40,641

California 2,171,583 2,132,224 2,388,066 255,842

Colorado 338,717 338,717 379,358 40,641

Connecticut 338,717 338,717 379,358 40,641

Delaware 338,717 338,717 379,358 40,641

District of Columbia 338,717 338,717 379,358 40,641

Florida 1,169,280 1,159,019 1,298,085 139,066

Georgia 577,493 572,956 641,702 68,746

Hawaii 338,717 338,717 379,358 40,641

Idaho 338,717 338,717 379,358 40,641

Illinois 699,453 683,819 765,867 82,048

Indiana 367,367 363,296 406,886 43,590

Iowa 338,717 338,717 379,358 40,641

Kansas 338,717 338,717 379,358 40,641

Kentucky 338,717 338,717 379,358 40,641

Louisiana 338,717 338,717 379,358 40,641

Maine 338,717 338,717 379,358 40,641

Maryland 338,717 338,717 379,358 40,641

Massachusetts 378,911 371,945 416,573 44,628

Michigan 548,751 538,928 603,592 64,664

Minnesota 338,717 338,717 379,358 40,641

Mississippi 338,717 338,717 379,358 40,641

Missouri 338,717 338,717 379,358 40,641

Montana 338,717 338,717 379,358 40,641

Nebraska 338,717 338,717 379,358 40,641

Nevada 338,717 338,717 379,358 40,641

New Hampshire 338,717 338,717 379,358 40,641

New Jersey 489,055 479,316 536,827 57,511

New Mexico 338,717 338,717 379,358 40,641

New York 1,072,818 1,049,787 1,175,747 125,960

North Carolina 570,035 565,976 633,885 67,909

North Dakota 338,717 338,717 379,358 40,641

201
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 25,378,000 25,378,000 28,423,000 3,045,000

DISABILITY PROGRAMS, RESEARCH AND SERVICES

PROGRAM/CFDA NUMBER: State Independent Living Services Grants (CFDA 84.169A)

FY2020 FY2021 FY2022 FY2022 +/-

STATE/TERRITORY Final Enacted President's Budget FY2021

Ohio 641,721 630,787 706,473 75,686

Oklahoma 338,717 338,717 379,358 40,641

Oregon 338,717 338,717 379,358 40,641

Pennsylvania 703,076 690,843 773,735 82,892

Rhode Island 338,717 338,717 379,358 40,641

South Carolina 338,717 338,717 379,358 40,641

South Dakota 338,717 338,717 379,358 40,641

Tennessee 371,657 368,528 412,746 44,218

Texas 1,575,659 1,564,726 1,752,471 187,745

Utah 338,717 338,717 379,358 40,641

Vermont 338,717 338,717 379,358 40,641

Virginia 467,600 460,608 515,875 55,267

Washington 413,685 410,928 460,234 49,306

West Virginia 338,717 338,717 379,358 40,641

Wisconsin 338,717 338,717 379,358 40,641

Wyoming 338,717 338,717 379,358 40,641

Subtotal 24,128,227 23,952,851 26,826,852 2,874,001

American Samoa 30,737 30,517 34,179 3,662

Guam 30,737 30,517 34,179 3,662

Northern Mariana Islands 30,737 30,517 34,179 3,662

Puerto Rico 338,717 338,717 379,358 40,641

Virgin Islands 30,737 30,517 34,179 3,662

Subtotal 461,665 460,785 516,074 55,289

Total States/Territories 24,589,892 24,413,636 27,342,926 2,929,290

Contingency Fund 788,108 964,364 1,080,074 115,710

Subtotal Adjustments 788,108 964,364 1,080,074 115,710

TOTAL RESOURCES

1/ Contingency Fund -- includes funds for statutory technical assistance and/or minority set-asides; grant systems and review, and

program reporting systems costs.

2/ In FY 2021 the President's Budget proposes to use funds for an evaluation of the program.

202
DISABILITY PROGRAMS, RESEARCH AND SERVICES

203 

Limb Loss Resource Center 

Services FY 2020 Final FY 2021 Enacted FY 2022 

President’s Budget

FY 2022 +/- 

FY 2021

Limb Loss Resource 

Center – Budget 

Authority 

$4.000 $4.000 $1.465 -$2,535

PHS Evaluation 

Funding --- --- 2.735 +2.735

Program Level $4.000 $4.000 $4.200 +$0.200

*BA is in millions 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/or 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 

and/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; 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

204 

• A comprehensive website, 

• Trainings for consumers and healthcare professionals, consumer education materials that 

reaches more than 100,000 annually; and

• 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 1,200 individuals, 75% of whom are people living 

with limb loss and/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 and/or limb difference in the United States,

136 and an estimated 185,000 amputations are 

performed in the country every year.137 People with limb loss and/or 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 a limb(s).

138 

Additionally, people with limb loss and/or 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.139

Funding History:

Funding for the program over the past five years is as follows: 

FY 2018.................................. $3,491,000

FY 2019.................................. $3,500,000

FY 2020.................................. $4,000,000

FY 2021 Enacted......................... $4,000,000

FY 2022 President’s Budget.......... $4,200,000

136 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.

137 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.

138 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.

139 Seaman JP. Survey of individuals wearing lower limb prostheses. Journal of Prosthetics and 

Orthotics2010;22(4):257-65.
DISABILITY PROGRAMS, RESEARCH AND SERVICES

205 

Budget Request:

The FY 2022 request for the Limb Loss Center is $4,200,000, an increase of +$200,000 above the 

FY 2021 Enacted level. For FY 2022, ACL is requesting to partially fund this program with PHS 

Evaluation Fund dollars. Section 241 of the Public Health Service (PHS) Act authorizes HHS to 

assess or “tap” PHS Act-authorized programs to pay for certain activities across the Department. 

The funds generated through this assessment are referred to as PHS Evaluation Funds and 

authorized for a broad range of uses, including activities to support the evaluation and 

implementation of PHS Act authorized programs of which the Limb Loss Center is one. 

The request supports the National Limb Loss Resource Center’s (NLLRC) programs which use 

both traditional and innovative approaches to educate and inform people with limb loss and/or 

limb difference, improving individual resiliency and expanding their ability to remain in the 

community. The requested five percent increase will provide additional support to expand the 

reach and impact of the NLLRC, including connecting those with limb loss and/or limb difference 

with the information and support they need as the nation recovers from the COVID-19 pandemic. 

The NLLRC provides patient educational materials that help new amputees adjust to their new 

“normal.” First Step Magazine and Your New Journey was distributed to approximately 63,000 

people after a new amputation. 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 a number of camp activities while 

building a network of support that lasts well beyond the camp. All camp counselors are people 

with limb loss or limb difference. 

Grants Awards Tables

Limb Loss Resource Center Grant Awards

 FY 2020 

Final 

FY 2021 

Requested 

FY 2022 

President's 

Budget 

Number of Awards 1 1 1

Average Award $3,884,003 $3,884,003 $4,084,003 

Range of Awards $3,884,003 $3,884,003 $4,084,003 
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206 

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207 

Paralysis Resource Center

Services FY 2020 Final FY 2021 Enacted FY 2022 

President’s Budget

FY 2022 +/- 

FY 2021

Paralysis Resource 

Center – Budget 

Authority

$9.700 $9.700 $3.553 -$6.147

PHS Evaluation 

Funds --- --- $6.632 +$6.632

Program Level $9.700 $9.700 $10.185 +$0.485

*BA is in millions 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: 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

208 

• Information specialists are trained to help anyone – from newly paralyzed individuals and 

their family members, to persons who have lived with disabilities for longer periods of time 

– by providing individualized support and information with the ability to respond in over 

170 languages. PRC 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 

communities who best understand the day-to-day realities and long-term challenges that

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 nonprofit organizations 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 sustained. 

• 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.140 These individuals face health and other disparities, which often translate into 

exclusion from full participation in their communities.

Starting in FY 2018, 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 the end of FY 2022, the State Pilot Program 

grantees will have completed their projects and ACL expects to learn how the pilot states were 

able to provide quality of life grants to state community-based organizations and if this approach 

is the most efficient and effect way to increase services and supports to people living with 

paralysis.

140 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

209 

Funding History:

Funding for the program over the past five years is as follows: 

FY 2018................................... $7,681,000

FY 2019................................... $8,700,000

FY 2020................................... $9,700,000

FY 2021 Enacted......................... $9,700,000

FY 2022 President’s Budget............ $10,185,000

Budget Request:

The FY 2022 request for the Paralysis Resource Center (PRC) is $10,185,000, an increase of 

+$485,000 above the FY 2021 Enacted level. For FY 2022, ACL is requesting to partially fund 

this program with PHS Evaluation Fund dollars. Section 241 of the Public Health Service (PHS) 

Act authorizes HHS to assess or “tap” PHS Act-authorized programs to pay for certain activities 

across the Department. The funds generated through this assessment are referred to as PHS 

Evaluation Funds and authorized for a broad range of uses, including activities to support the 

evaluation and implementation of PHS Act authorized programs of which the Limb Loss Center 

is one. 

Of the increase for the Paralysis Resource Center, $300,000 is requested to provide additional 

support to the PRC. 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. 

The remaining $185,000 of the increase is requested to support a national project to develop a 

national paralysis and physical disability quality of life action plan that will promote health and 

wellness that enhances full participation, independent living, and self-sufficiency. The action plan 

would then be used as a guide to fund partnerships with State-based disability and health programs 

to promote healthy living with paralysis. 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

210 

Grant Awards Table:

Paralysis Resource Center

 FY 2020 

Final 

FY 2021 

Enacted

FY 2022 

President's 

Budget 

Number of 

Awards 5 1 1 

Average Award $1,880,241 $8,700,000 $9,185,000 

Range of Awards $175,168 - 

$6,511,661 $8,700,000 $9,185,000
DISABILITY PROGRAMS, RESEARCH, AND SERVICES

211 

Traumatic Brain Injury

Services FY 2020 Final FY 2021 Enacted FY 2022 

President’s Budget

FY 2022 +/- 

FY 2021

Traumatic Brain 

Injury – Budget 

Authority

$11.321 $11.321 $4.148 +$4.148

Traumatic Brian 

Injury – PHS 

Evaluation 

--- --- $7.739 +$7.739

Program Level $11.321 $11.321 $11.887 +$0.566

FTE 1.2 1.2 1.2 ---

*BA is in thousands of dollars. 1.2 FTE for this activity are supported by program 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, more than two and a half million TBI-related emergency 

department visits, hospitalizations, and deaths occurred in the United States, including over 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

212 

837,000 involving children.141 Many of these individuals live the rest of their lives with the 

resulting disability. 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.

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 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. 

State TBI partnerships 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. States have been collaborating to 

141Centers for Disease Control and Prevention, TBI: Get the Facts, https://www.cdc.gov/traumaticbraininjury/get the 

facts.html. 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

213 

address a variety of critical issues, including individuals with TBI and criminal justice, healthy 

living with a TBI, person-centered design, and employment. In fiscal year 2021, ACL will be 

awarding a new round of TBI state partnership grants to continue to strengthen state infrastructure 

to support people with TBI living in the community. 

Funding History:

Funding for the program over the past five years is as follows: 

FTE 

FY 2018.......................... $11,293,000 1.6

FY 2019.......................... $11,321,000 1.6

FY 2020.......................... $11,321,000 1.2

FY 2021 Enacted............... $11,321,000 1.2

FY 2022 President’s Budget... $11,887,000 1.2

Budget Request:

The FY 2022 request for the Traumatic Brain Injury (TBI) program is $11,887,000, an increase of 

+$566,000 above the FY 2021 Enacted level. The majority of the requested 5 percent increase 

would provide a total of $200,000 in additional support to the TBI Protection and Advocacy (P&A) 

Formula Grants to support the crucial direct services work that TBI P&As have provided during 

the COVID-19 pandemic through the post-pandemic recovery period. For FY 2022, ACL is 

requesting to partially fund this program with PHS Evaluation Fund dollars. Section 241 of the 

Public Health Service (PHS) Act authorizes HHS to assess or “tap” PHS Act-authorized programs 

to pay for certain activities across the Department. The funds generated through this assessment 

are referred to as PHS Evaluation Funds and authorized for a broad range of uses, including 

activities to support the evaluation and implementation of PHS Act authorized programs of which 

the Traumatic Brain Injury is one. 

The remaining $366,000 of the increase would provide an increase for existing TBI State 

Partnership Program grants. In FY 2021, ACL will fund a new round TBI State Partnership grants 

that will continue to advance the work of states to improve services and supports for people with 

TBI. The requested increase would provide small increases to these projects and their ongoing 

efforts 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 funding would also support a TBI technical assistance center (TBICC), that would 

provide technical assistance to grantees, maintain a national listserv on issues that affect TBI 

service delivery (with approximately 1,500 subscribers), manage an online collaboration space for 

grantees to share promising practices for building and maintaining service-delivery infrastructure, 

and develop educational materials for the public about TBI. 

Grant Awards Tables:
DISABILITY PROGRAMS, RESEARCH AND SERVICES

214 

Traumatic Brain Injury: Protection and Advocacy 

 FY 2020 

Final 

FY 2021 

Enacted 

FY 2022 

President's 

Budget 

Number of Awards 28 28 28

Average Award $205,203 $205,203 $215,203 

Range of Awards $143,800 -

$300,000

$143,800 -

$300,000

$153,800 -

$310,000

Traumatic Brain Injury: State Implementation/Mentor Partnership

 FY 2020 

Final 

FY 2021 

Enacted 

FY 2022 

President's 

Budget 

Number of Awards 57 57 57

Average Award $70,175 $69,474 $72,947 

Range of Awards $20,000-

$319,615

$20,000-

$311,602

$20,000-

$345,075
DISABILITY PROGRAMS, RESEARCH AND SERVICES 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

FY 2022 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: TBI Protection and Advocacy State Grants (CFDA 93.873) 

FY 2020 FY 2021 FY 2022 FY 2022 +/-

STATE/TERRITORY Final Enacted President's Budget FY 2021 

Alabama 55,729 55,285 57,585 2,300 

Alaska 50,000 50,000 50,000 -

Arizona 73,111 72,878 77,319 4,441 

Arkansas 50,000 50,000 50,000 -

California 319,615 311,602 345,075 33,473 

Colorado 61,876 61,622 64,692 3,070 

Connecticut 50,000 50,000 50,000 -

Delaware 50,000 50,000 50,000 -

District of Columbia 50,000 50,000 50,000 -

Florida 180,644 178,036 195,266 17,230 

Georgia 98,593 97,605 105,053 7,448 

Hawaii 50,000 50,000 50,000 -

Idaho 50,000 50,000 50,000 -

Illinois 115,503 112,819 122,118 9,299 

Indiana 69,460 68,831 72,779 3,948 

Iowa 50,000 50,000 50,000 -

Kansas 50,000 50,000 50,000 -

Kentucky 52,536 52,060 53,968 1,908 

Louisiana 53,994 53,401 55,472 2,071 

Maine 50,000 50,000 50,000 -

Maryland 64,518 63,746 67,076 3,330 

Massachusetts 71,060 70,018 74,110 4,092 

Michigan 94,608 92,935 99,814 6,879 

Minnesota 61,234 60,739 63,703 2,964 

Mississippi 50,000 50,000 50,000 -

Missouri 65,156 64,426 67,838 3,412 

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 -

New Jersey 86,331 84,754 90,638 5,884 

New Mexico 50,000 50,000 50,000 -

New York 167,270 163,045 178,452 15,407 

North Carolina 97,559 96,647 103,978 7,331 

North Dakota 50,000 50,000 50,000 -

215 
Ohio 107,499 105,542 113,954 8,412 

Oklahoma 50,000 50,000 50,000 -

Oregon 50,422 50,209 51,892 1,683 

Pennsylvania 116,005 113,784 123,199 9,415 

Rhode Island 50,000 50,000 50,000 -

South Carolina 57,222 57,104 59,625 2,521 

South Dakota 50,000 50,000 50,000 -

Tennessee 70,054 69,549 73,584 4,035 

Texas 236,989 233,715 257,718 24,003 

Utah 50,000 50,000 50,000 -

Vermont 50,000 50,000 50,000 -

Virginia 83,357 82,187 87,759 5,572 

Washington 75,881 75,368 80,111 4,743 

West Virginia 50,000 50,000 50,000 -

Wisconsin 62,774 62,093 65,222 3,129 

Wyoming 50,000 50,000 50,000 -

 Subtotal 3,849,000 3,810,000 4,008,000 198,000 

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 20,000 20,000 20,000 -

Puerto Rico 50,000 50,000 50,000 -

Virgin Islands 20,000 20,000 20,000 -

 Subtotal 150,000 150,000 150,000 -

Total States/Territories 3,999,000 3,960,000 4,158,000 198,000 

Contingency Fund 1,000 40,000 42,000 2,000 

 Subtotal Adjustments 1,000 40,000 42,000 2,000 

TOTAL RESOURCES 4,000,000 4,000,000 4,200,000 200,000 

DISABILITY PROGRAMS, RESEARCH AND SERVICES 

PROGRAM/CFDA NUMBER: TBI Protection and Advocacy State Grants (CFDA 93.873) 

FY 2020 FY 2021 FY 2022 FY 2022 +/-

STATE/TERRITORY Final Enacted President's Budget FY 2021 

1/ Contingency Fund – includes funds for grant systems and review, and program reporting systems costs. 

216 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

217 

National Institute on Disability, Independent Living, and Rehabilitation 

Research

Services FY 2020 Final FY 2021 Enacted FY 2022 

President’s Budget

FY 2022 +/- 

FY 2021

National Institute on 

Disability, 

Independent Living, 

and Rehabilitation 

Research – Budget 

Authority

$111.970 $112.970 $118.619 +$5.649

*BA is in millions 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 people 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 funding generates new knowledge and promotes the effective use of this knowledge to 

allow people with disabilities to function at the highest level of health status possible, to function 

and navigate community living and to be able to gain competitive, integrated employment through 

the use of technology and evidence-based research. NIDILRR utilizes nationwide listening 

sessions with stakeholders to address the challenges and needs of people with disabilities, issues 

funding grants to address these issues, and then translates the findings into practical applications 

within a short timeframe. NIDILRR focuses not only on research to improve opportunities for 

people with disabilities but also on insuring that advances in research are quickly and effectively 

translated into practical interventions, including new commercially available products. NIDILRR 

conducts research through a network of individual research projects and centers of excellence 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

218 

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 

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 PROGRAMS, RESEARCH AND SERVICES

219 

• 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.

• 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 2018................................ $104,710,000

FY 2019................................ $108,970,000

FY 2020................................ $111,970,000

FY 2021 Enacted...................... $112,970,000

FY 2022 President’s Budget......... $118,619,000

Budget Request:

The FY 2022 request is $118,619,000 an increase of +$5,649,000 over the FY 2021 Enacted 

level of $112,970,000. The request includes: 

• +$2.8 million for expanding intersectional equity research. NIDILRR will fund three new 

Rehabilitation Research and Training Centers (RRTCs), one in each of its three outcome 

domains: community living and participation, employment, and health and function. Each 

of these RRTCs will conduct research toward the development and testing of practices, 

policies, services, or supports to address the disparate outcomes experienced by people 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

220 

with disabilities from racial and ethnic backgrounds who experience not just discrimination 

based on their disability but are also historically underserved and marginalized, including 

due to race or ethnicity. The RRTCs will provide training and technical assistance to 

promote cultural competence in the field of disability, independent living, and 

rehabilitation research. The RRTCs will also train early career disability researchers, with 

a focus on researchers with disabilities from racial and ethnic minority populations. 

 

• +$2.8 million to expand the number of field-initiated grant competitions to address 

emerging research gaps in disability, independent living, and rehabilitation research. 

The FY 2022 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. 

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 each budget request since FY 2018. 
DISABILITY PROGRAMS, RESEARCH AND SERVICES

221 

Outcomes and Output Table:

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2021

Target

FY 2022

Target

FY 2022

Target

+/-FY 2021

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 2019: 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.

Target: In FY 2019, these 

grantees will conduct 

systematic literature reviews 

on opioid use disorder 

among people with 

disabilities, and disseminate 

early products.

(Target Met)

Conduct primary 

data collection 

and conduct 

secondary data 

analysis by 

September 2021.

Complete 

analysis of data 

and publish peer 

reviewed results 

by September 

2022.

N/A

R2 By 2023, assess the 

efficacy of an 

intervention to improve 

employment outcomes 

for individuals with 

serious mental illness. 

(Outcome)

FY 2019: 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 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).

Target: In FY 2019, this 

grantee will begin data 

collection for a randomized 

trial of the HYPE 

intervention.

(Target Met)

In FY 2021, this 

grantee will 

continue data 

collection and 

disseminate 

early results and 

informational 

products to key 

stakeholders.

Recruit research 

participants and 

train 

intervention 

providers by 

September 2022.

N/A
DISABILITY PROGRAMS, RESEARCH AND SERVICES

222 

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2021

Target

FY 2022

Target

FY 2022

Target

+/-FY 2021

Target

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)

FY 2019: In FY 2018, 

NIDILRR made a research 

grant to develop knowledge 

regarding the effects of 

ABLE accounts in increasing 

community living and 

participation for individuals

with intellectual and 

developmental disabilities 

(I/DD) and cognitive 

disabilities.

Target: Grantee will design 

the training curriculum, the 

recruitment materials, and 

will train trainers.

(Target Met)

In FY 2021, 

grantee will 

disseminate 

surveys twice a 

year to enrolled 

participants, and 

analyze 

outcomes data.

In FY 2022, 

grantee will 

disseminate 

surveys twice a 

year to enrolled 

participants, 

analyze 

outcomes data, 

and provide 

technical 

assistance to 

stakeholders.

N/A

*As part of the 2020 budget cycle, ACL proposed three new measures for NIDILRR. 
DISABILITY PROGRAMS, RESEARCH, AND SERVICES

223 

Grant Awards Tables:

National Institute on Disability, Independent Living, and Rehabilitation Research

(Dollars in Thousands) 

 FY 2020 

Final

FY 2021 

Enacted

FY 2022 

President's 

Budget

Number of Awards 213 243 250

Average Award $480,814 $447,065 $447,745 

Range of Awards

$70,000 - 

$1,246,000

$70,000 - 

$1,246,000 

$70,000 - 

$1,246,000 
224 

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CONSUMER INFORMATION, ACCESS AND OUTREACH

225 

Consumer Information, Access, and Outreach

Summary of Request

Older Americans and Americans with disabilities can benefit from an array of services and 

supports that are available to assist them to remain active and independent in their communities. 

However, the complexity of navigating programs and selecting services that best address 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 

information they need to make informed decisions about their independence and connect them 

with 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. In FY 2021, the range of outreach offered by ACL will 

expand as a result of the American Rescue Plan (ARP) Act, which funds a new program to provide 

resources to assist Grandfamilies or Kinship families. 

The FY 2022 request for CIAO programs is $182.7 million, an increase of $27.0 million above the 

FY 2021 Enacted level of $155.7 million. This request includes: 

• $23.5 million, an increase of $15.3 million over the FY 2021 Enacted level of $8.1 million, 

for Aging Disability Resource Centers. In FY 2020, for the first time, ADRCs were able 

to be funded as a national program when the Coronavirus Aid, Relief and Economic 

Security (CARES) Act provided $50 million to ADRCs to connect people to services 

during the COVID-19 pandemic. The request allows ACL to continue to fund a nationallevel program and allow ADRCs to continue to provide efficient, cost-effective, and 

consumer-responsive systems of information and integrated access by providing “one-stop 

shop” entry points into long-term care at the community-level. 

• $55.2 million, an increase of $3.1 million over the FY 2021 Enacted level of $52.1 million, 

for the State Health Insurance Assistance (SHIP) program. The request level allows SHIP 

grantees to expand capacity while also incorporating new technologies adopted during the 

COVID-19 pandemic into program business processes. 

• $9.9 million, an increase of $2 million over the FY 2021 Enacted level of $7.9 million, for 

the Voting Access for People with Disabilities program. These grants assist Protection and 

Advocacy systems in each state and territory to ensure equity and full participation in the 

electoral process for individuals with disabilities, including registering to vote, casting their 

votes, and accessing polling places. 

• $44 million, an increase of $6.5 million over the FY 2021 Enacted level of $37.5 million, 

for Assistive Technology (AT). Consistent with prior years, the Budget does not request 
CONSUMER INFORMATION, OUTREACH AND ACCESS

226 

any funding for the Alternative Funding Program. AT programs improve the ability of 

individuals with disabilities of all ages and their families to obtain AT devices and services. 

The pandemic resulted in a loss of crucial community-based services, social isolation, and 

increased the need for access to assistive technology. The need for access to AT was 

highlighted during the pandemic but continues as individuals with disabilities recover from 

the conditions created during the pandemic. 

• National Technical Assistance Center on Kinship and Grandfamilies: The American 

Rescue Plan (ARP) Act provided $10 million, available over five years, to create a National 

Technical Assistance Center to provide technical assistance and resources to organizations 

that serve grandfamilies, where one or more children are being raised by a grandparent, 

and kinship families, where one or more children are being raised by a relative. Efforts 

will be focused on families where the primary caregiver is 55 or older or the child has one 

or more disabilities. As funding was provided in the ARP through FY 2025, no additional 

funding is requested in the FY 2022 Budget. 

• $50 million in mandatory funding for the Medicare Improvements for Patients and 

Providers Act (MIPPA) programs, the same level as in FY 2021, and which was extended

through FY 2023 by PL 116-260. This funding provides grants to States’ ADRCs, Area 

Agencies on Aging and SHIPs to fund more extensive outreach to the Medicaid Advantage 

and Low-Income Subsidy populations, as well as support for a National Center on Benefits 

Outreach and Enrollment. 
CONSUMER INFORMATION, OUTREACH AND ACCESS

227 

Aging and Disability Resource Centers

Services FY 2020 Final FY 2021 Enacted FY 2022 

President’s Budget

FY 2022 +/- 

FY 2021

Aging and Disability 

Resource Centers – 

Budget Authority

$8.119 $8.119 $23.457 +$15.338

Supplemental 

Funding $50.000 ---

Program Level $58.119 $8.119 $23.457 +$15.338

*BA is in millions 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: Supporting Older Americans Act of 2020, Public Law 116-

131 

Current FY Authorization ................................................................................................$9,208,570 

Authorization Expiration Date ...................................................................................................2024 

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. 
CONSUMER INFORMATION, OUTREACH AND ACCESS

228 

Without these services, people seeking Long Term Services and Supports (LTSS) might otherwise 

make decisions based on inaccurate or incomplete information, which could lead them to select 

support and care options that are more expensive than necessary.142 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 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.143 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 through assistance provided with funding under 

the Medicare Improvements to Patients and Providers Act (MIPPA).

Since 2003, ACL (or its predecessor) and 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. 

Currently, 56 states and territories have NWD activity, with an estimated 618 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 

142 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.

143 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. 
CONSUMER INFORMATION, OUTREACH AND ACCESS

229 

• Public outreach and coordination with key referral sources, 

• Person-centered counseling

• Streamlined eligibility for public programs.144 

Recent accomplishments include: 

• In 2016, ACL funded 8 states to coordinate their ADRC/NWD system with their statewide 

Assistive Technology (AT) Programs. Since then the ADRC/NWD program has assisted in 

the coordination of activities such as creating assistive technology “toolkits”, and increased 

collaboration with the Durable Medical Equipment (DME) state workgroups. 

• 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 response to the pandemic, Congress provided in FY 2020 an additional $50 million in 

supplemental funding through the Coronavirus Aid, Relief, and Economic Security (CARES) 

Act to expand ADRC funding to all 50 States, Guam and Puerto Rico. This funding increase 

allowed ADRCs to have nationwide coverage for the first time in its history. The expanded 

funding allowed ADRCs to increase and enhance services and functions in response to 

COVID-19 access challenges that included: 

o Virtual assessments for social determinants of health needs (standardized 

screenings);

o Care transitions (hospital-to-home and nursing home-to-home) follow-up; 

o State or local Information and Referral to community based services; 

o Virtual short and long-term Care Coordination; 

o Tele-functional and clinical assessments; and

o Person-centered plan development. 

144 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.
CONSUMER INFORMATION, ACCESS AND OUTREACH

230 

Funding History:

 

 

 

Funding for Aging and Disability Resource Centers over the last five years is as follows:

FY 2018.................................. $8,099,000

FY 2019.................................. $8,119,000

FY 2020.................................. $8,119,000

FY 2020 Supplemental Funds.........

FY 2021 Enacted........................ 

 $50,000,000

 $8,119,000

FY 2022 President’s Budget........... $23,457,000

Budget Request:

The FY 2022 request for Aging and Disability Resource Centers is $23,457,000, an increase of 

$15,338,000 above the FY 2021 Enacted level of $8,119,000. The FY 2022 request seeks to 

maintain the progress begun with the one-time infusion of $50 million in CARES Act funding by 

providing ongoing funding to scale this program nationwide. With this increased funding ACL 

will be able to expand competitive ADRC grants from 8 grants to up to 25 grants in States across 

the country. Funding would also support a nationwide No Wrong Door (NWD) Resource Center, 

interoperability of social care referral systems, and the National Center on Advancing PersonCentered Practices and Systems (NCAPPS), which is a joint ACL/CMS initiative that helps States, 

Tribes, and Territories implement person-centered thinking, planning, and practice. 

Maintaining ADRC/No Wrong Door (NWD) funding in FY 2022 will allow ADRCs to continue 

their roles (providing Information and Referral/Assistance (I&R/A) services) in critical postpandemic areas such as continuing support for vaccinations, outreach, registration and 

transportation services and providing services to mitigate social isolation. Many states have seen 

an unprecedented and sustained increase in demand for I&R/A. This is evidenced by 

approximately 4.5 million unique visitors who accessed states’ NWD websites from April toSeptember 2020 across 33 states and over 2 million people across all states who received I&R/A 

services, of which approximately 588,000 received person-centered counseling. In addition, FY 

2022 NWD funding would be used to develop resources/technical assistance (TA) and best 

practices that address the growing cohort of COVID-19 patients with “long haul” symptoms in the 

community, raise awareness of home and community-based services (HCBS) options. 

Without continued funding, ACL estimates that over a year’s time over 1.0 million people will not 

receive critical person-centered counseling services by ADRCs during the first year of recovery 

from the pandemic while the demand for HCBS will remain high with an increased number of 

older adults and people with disabilities needing guidance and counseling on their options to 

remain at home and in their communities. 
CONSUMER INFORMATION, OUTREACH AND ACCESS

231 

The ADRC/NWD System brings together state and community long-term care funding and 

resources (state-level Medicaid, Aging and Disability organizations as well as local-level AAAs, 

ADRCs, CILs, Traumatic Brain Injury (TBI) organizations, Mental Health and behavioral health 

providers, and other CBOs) to coordinate access and service delivery for older adults and people 

with disabilities in the community (regardless of age or payer source). Without this coordination, 

individuals seeking services often may make five or more different calls in an attempt to connect 

to services only to be told they are ineligible based on age, or income or other factors. The ADRCs 

bring coordination across communities of organizations and programs so that an individual looking 

for services can make one call, and if they are ineligible for a service, a person centered counselor 

will work with them to identify and activate other services to meet their needs. If additional funding 

is not provided in FY 2022, more than 50% of states will not have the capacity through a 

coordinated NWD System infrastructure to ensure seamless access to HCBS for all populations 

when most individuals that need LTSS will want to remain supported in the community and avoid 

institutional stays.

Grant Awards Tables:

 Aging and Disability Resource Centers 

 (Dollars in Thousands) 

 FY 2020 

Final 

FY 2021 

Enacted 

FY 2022 

President's 

Budget 

Number of 

Awards 53 53 53

Average Award $88,172 $89,522 $221,292 

Range of Awards $1,456 - 

$388,635

$694 - 

$37,6342

$221,986 - 

$609,927
CONSUMER INFORMATION, OUTREACH AND ACCESS

232 

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233 

State Health Insurance Assistance Programs

Services FY 2020 Final FY 2021 Enacted FY 2022 

President’s Budget

FY 2022 +/- 

FY 2021

State Health 

Insurance Assistance 

Programs – Program 

Level

$52.115 $52.115 $55.242 +$3.127

FTE 3.6 3.4 4.0 ---

* BA is in millions of dollars. 4.0 FTE for this activity are supported by program dollars.

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 Assistance Programs (SHIPs) provide counseling and assistance to help 

older adults and people with disabilities who are Medicare eligible or who have dual eligibility for 

Medicare and Medicaid (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.

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 
CONSUMER INFORMATION, OUTREACH AND ACCESS

234 

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 13,500 highly trained SHIP counselors (of which 47% were volunteers) 

provides local community-based assistance to the ever increasing number of Medicare 

beneficiaries. In 2019, an estimated 6.000,000 Medicare beneficiaries used SHIP services. In 

addition to the 2,400,000 hours of direct one-on-one services, SHIPs reached 3,600,000 people in 

public events explaining Medicare and its benefits. These state grantees invested more than 

1,550,000 hours leading these educational events. 

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. 

The SHIP program is the only place that provides the level of in-depth 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. 

Funding History: 

Funding for the State Health Insurance Assistance Program over the past five years is as follows: 

FTE

FY 2018........................... $49,115,000 4.1

FY 2019........................... $49,115,000 4.4

FY 2020........................... $52,115,000 3.6

FY 2021Enacted.................. $52,115,000 3.4

FY 2022 President’s Budget.... $55,242,000 4.0
CONSUMER INFORMATION, OUTREACH AND ACCESS

235 

Budget Request:

The FY 2022 request for the State Health Insurance Assistance programs (SHIP) is $55,242,000, 

an increase of $3,127,000 above the FY 2021 Enacted level. The request would allow SHIP 

grantees to expand capacity, while also incorporating new technologies adopted during the 

COVID-19 epidemic into program business processes. 

During the Pandemic SHIPs were instrumental in: 

1. helping state grantees to boost their virtual capacity, increasing their ability to reach people 

remotely (a need that emerged during the COVID-19 pandemic) and prepare for future 

crises; 

2. supporting increased education on emerging models of value-based care and on choices in 

care delivery settings; and 

3. continuing work to combat the Opioid crisis. 

In FY 2022 ACL expects SHIP grantees will continue to provide virtual public outreach and 

beneficiary assistance until the threat of the virus is gone. 

Grant Awards Table:

State Health Insurance Assistance Programs Grant Awards

 FY 2020 

Final 

FY 2021 

Enacted 

FY 2022 

President's 

Budget 

Number of Awards 54 54 54

Average Award $896,329 $901,176 $961,215 

Range of Awards $55,551-

$4,056,058

$58,287-

$3,9918,979

$62,170-

$4,180,064
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONSUMER INFORMATION, OUTREACH AND ACCESS 

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) 

FY 2020 

Final 

FY 2021 

Enacted 

FY 2022 

President's Budget 

FY 2022 +/-

STATE/TERRITORY FY 2021 

Alabama 886,001 886,979 946,070 59,091 

Alaska 237,601 235,596 251,292 15,696 

Arizona 947,652 954,405 1,017,988 63,583 

Arkansas 698,794 730,526 779,194 48,668 

California 4,056,058 3,918,979 4,180,064 261,085 

Colorado 701,574 736,971 786,068 49,097 

Connecticut 549,001 553,093 589,940 36,847 

Delaware 234,293 246,008 262,397 16,389 

District of Columbia 178,045 186,947 199,402 12,455 

Florida 2,914,883 2,926,303 3,121,255 194,952 

Georgia 1,335,211 1,327,286 1,415,711 88,425 

Hawaii 289,552 304,030 324,285 20,255 

Idaho 439,835 417,843 445,680 27,837 

Illinois 1,535,531 1,530,605 1,632,575 101,970 

Indiana 1,000,203 1,014,734 1,082,336 67,602 

Iowa 705,080 719,611 767,552 47,941 

Kansas 556,979 565,421 603,090 37,669 

Kentucky 978,810 1,019,438 1,087,354 67,916 

Louisiana 732,675 723,642 771,852 48,210 

Maine 483,819 459,628 490,249 30,621 

Maryland 760,213 761,096 811,801 50,705 

Massachusetts 937,428 936,284 998,660 62,376 

Michigan 1,446,388 1,502,853 1,602,974 100,121 

Minnesota 867,232 880,142 938,778 58,636 

Mississippi 690,248 724,760 773,044 48,284 

Missouri 1,036,368 1,044,044 1,113,599 69,555 

Montana 519,302 493,337 526,203 32,866 

Nebraska 433,202 444,379 473,984 29,605 

Nevada 469,766 486,004 518,382 32,378 

New Hampshire 330,532 347,059 370,180 23,121 

New Jersey 1,101,022 1,105,999 1,179,681 73,682 

New Mexico 458,984 476,564 508,313 31,749 

New York 2,364,417 2,375,143 2,533,377 158,234 

North Carolina 1,569,004 1,556,558 1,660,257 103,699 

North Dakota 264,698 277,933 296,449 18,516 

236 
CONSUMER INFORMATION, OUTREACH AND ACCESS 

PROGRAM/CFDA NUMBER: State Health Insurance Assistance Program (CFDA 93.324) 

FY 2020 FY 2021 FY 2022 FY 2022 +/-

STATE/TERRITORY Final Enacted President's Budget FY 2021 

Ohio 1,636,931 1,678,766 1,790,606 111,840 

Oklahoma 705,249 740,511 789,844 49,333 

Oregon 673,328 706,994 754,094 47,100 

Pennsylvania 1,842,174 1,813,023 1,933,808 120,785 

Rhode Island 280,308 285,923 304,971 19,048 

South Carolina 879,884 849,295 905,876 56,581 

South Dakota 312,625 328,179 350,042 21,863 

Tennessee 1,141,110 1,125,798 1,200,799 75,001 

Texas 2,731,313 2,794,773 2,980,963 186,190 

Utah 407,733 397,969 424,482 26,513 

Vermont 279,028 292,979 312,497 19,518 

Virginia 1,152,325 1,136,969 1,212,715 75,746 

Washington 985,468 984,898 1,050,513 65,615 

West Virginia 544,099 525,414 560,417 35,003 

Wisconsin 966,371 997,985 1,064,471 66,486 

Wyoming 270,632 284,164 303,095 18,931 

Subtotal 47,518,979 47,813,840 50,999,229 3,185,389 

Guam 55,511 58,287 62,170 3,883 

Puerto Rico 771,761 733,173 782,017 48,844 

Virgin Islands 55,511 58,287 62,170 3,883

 Subtotal 882,783 849,747 906,357 56,610 

Total States/Territories 48,401,762 48,663,587 51,905,586 3,241,999 

Contingency Fund 3,713,238 3,451,413 3,346,414 (104,999) 

Subtotal Adjustments 3,713,238 3,451,413 3,346,414 (104,999) 

TOTAL RESOURCES 52,115,000 52,115,000 55,252,000 3,137,000 

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. 

237 
CONSUMER INFORMATION, ACCESS AND OUTREACH

238 

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239 

Voting Access for Individuals with Disabilities

Services FY 2020 Final FY 2021 Enacted FY 2022 

President’s Budget

FY 2022 +/- 

FY 2021

Voting Access for 

Individuals with 

Disabilities – Budget 

Authority

$7.463 $7.963 $9.963 +$2.000

*BA is in millions 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 
CONSUMER INFORMATION, OUTREACH AND ACCESS

240 

election volunteers on the rights of voters with disabilities and best practices. P&As provide 

assistance to state and other government entities by surveying polling places, identifying potential 

modifications to make specific polling places accessible, and developing criteria for identifying 

accessible polling places.

Through the program, ACL also makes discretionary grants to eligible nonprofit organizations to 

assist 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. 

In addition to funding P&As through formula grants, ACL annually reserves 7 percent of the funds 

appropriated for the Help America Vote Act P&A program, as required by authorizing statute, to 

provide training and technical assistance. 

Funding History:

Funding over the past five years is as follows:

FY 2018.................................. $6,946,000

FY 2019.................................. $6,963,000

FY 2020.................................. $7,463,000

FY 2021 Enacted........................ $7,963,000

FY 2022 President’s Budget.......... $9,963,000

Budget Request:

The FY 2022 request for Voting Access for Individuals with Disabilities is $9,963,000 an increase 

of +$2,000,000 above the FY 2021 Enacted level of $7,963,000. These additional funds are 

requested to buttress the ability of all people with disabilities to be able to vote by further 

expanding 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. Living within the community means more than just living but 

also participating in the community; there is no more quintessentially American activity than 

voting. As stated on day one of the Biden-Harris Administration:

“Equal opportunity is the bedrock of American democracy, and our diversity is one of our 

country’s greatest strengths. But for too many, the American Dream remains out of 

reach. Entrenched disparities in our laws and public policies, and in our public and 
CONSUMER INFORMATION, OUTREACH AND ACCESS

241 

private institutions, have often denied that equal opportunity to individuals and 

communities.” 

Examples of grantees working to ensure voting access include the creation and staffing of a hotline 

and training of 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.

Grant Awards Table:

Voting Access for Individuals with Disabilities Grant Awards

 FY 2020 

Final 

FY 2021 

Enacted 

FY 2022 

President's 

Budget

Number of 

Awards 56 56 56

Average Award $123,252 $130,821 $163,678 

Range of Awards $52,630-

$514,880

$56,156-

$539,638

$70,260 -

$675,230
FY 2020 FY 2021 FY 2022 FY 2022 +/-

STATE/TERRITORY Final Enacted President's Budget FY 2021 

Alabama $105,261 $112,313 $140,522 $28,209 

Alaska 105,261 112,313 140,522 $28,209 

Arizona 105,261 112,313 140,522 $28,209 

Arkansas 105,261 112,313 140,522 $28,209 

California 514,880 539,683 675,230 $135,547 

Colorado 105,261 112,313 140,522 $28,209 

Connecticut 105,261 112,313 140,522 $28,209 

Delaware 105,261 112,313 140,522 $28,209 

District of Columbia 105,261 112,313 140,522 $28,209 

Florida 277,236 293,357 367,036 $73,679 

Georgia 136,923 145,020 181,442 $36,422 

Hawaii 105,261 112,313 140,522 $28,209 

Idaho 105,261 112,313 140,522 $28,209 

Illinois 165,840 173,080 216,550 $43,470 

Indiana 105,261 112,313 140,522 $28,209 

Iowa 105,261 112,313 140,522 $28,209 

Kansas 105,261 112,313 140,522 $28,209 

Kentucky 105,261 112,313 140,522 $28,209 

Louisiana 105,261 112,313 140,522 $28,209 

Maine 105,261 112,313 140,522 $28,209 

Maryland 105,261 112,313 140,522 $28,209 

Massachusetts 105,261 112,313 140,522 $28,209 

Michigan 130,108 136,407 170,667 $34,260 

Minnesota 105,261 112,313 140,522 $28,209 

Mississippi 105,261 112,313 140,522 $28,209 

Missouri 105,261 112,313 140,522 $28,209 

Montana 105,261 112,313 140,522 $28,209 

Nebraska 105,261 112,313 140,522 $28,209 

Nevada 105,261 112,313 140,522 $28,209 

New Hampshire 105,261 112,313 140,522 $28,209 

New Jersey 115,955 121,319 151,789 $30,470 

New Mexico 105,261 112,313 140,522 $28,209 

New York 254,365 265,709 332,444 $66,735 

North Carolina 135,155 143,253 179,232 $35,979 

North Dakota 105,261 112,313 140,522 $28,209 

CONSUMER INFORMATION, OUTREACH AND ACCESS 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

ADMINISTRATION ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 

FY 2022 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: Voting Access for Individuals with Disabilities (CFDA 93.618) 

242 
FY 2020 FY 2021 FY 2022 FY 2022 +/-

STATE/TERRITORY Final Enacted President's Budget FY 2021 

Ohio 152,152 159,657 199,756 $40,099 

Oklahoma 105,261 112,313 140,522 $28,209 

Oregon 105,261 112,313 140,522 $28,209 

Pennsylvania 166,699 174,858 218,775 $43,917 

Rhode Island 105,261 112,313 140,522 $28,209 

South Carolina 105,261 112,313 140,522 $28,209 

South Dakota 105,261 112,313 140,522 $28,209 

Tennessee 105,261 112,313 140,522 $28,209 

Texas 373,588 396,045 495,514 $99,469 

Utah 105,261 112,313 140,522 $28,209 

Vermont 105,261 112,313 140,522 $28,209 

Virginia 110,868 116,584 145,865 $29,281 

Washington 105,261 112,313 140,522 $28,209 

West Virginia 105,261 112,313 140,522 $28,209 

Wisconsin 105,261 112,313 140,522 $28,209 

Wyoming 105,261 112,313 140,522 28,209 

 Subtotal 6,638,948 7,045,179 8,814,658 1,769,479 

American Samoa 52,630 56,156 70,260 $14,104 

Guam 52,630 56,156 70,260 $14,104 

Puerto Rico 105,261 112,313 140,522 $28,209 

Virgin Islands 52,630 56,156 70,260 14,104 

 Subtotal 263,151 280,781 351,302 70,521 

Total States/Territories 6,902,099 7,325,960 9,165,960 1,840,000 

Contingency Fund 560,901 637,040 797,040 $160,000 

 Subtotal Adjustments 560,901 637,040 797,040 160,000 

TOTAL RESOURCES 7,463,000 7,963,000 9,963,000 2,000,000 

CONSUMER INFORMATION, OUTREACH AND ACCESS 

PROGRAM/CFDA NUMBER: Voting Access for Individuals with Disabilities (CFDA 93.618) 

1/ Program Support- includes funds for statutory technical assistance and/or minority set-asides; grant systems and review, and 

program reporting systems costs. 

243 
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244 

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CONSUMER INFORMATION, ACCESS AND OUTREACH

245 

Assistive Technology

Services FY 2020 Final FY 2021 Enacted FY 2022 

President’s Budget

FY 2022 +/- 

FY 2021

Assistive Technology – 

Budget Authority $37.000 $37.500 $44.000 +$6.500

Alternative Financing 

Grant Competition

(non-add) 

$2.000 $2.000 --- -$2.000

*BA is in millions 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 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 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 increase the: 

• Availability, funding, access, provision, and training for AT devices and services; 
CONSUMER INFORMATION, OUTREACH AND ACCESS

246 

• 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 

application of AT; and the integration of AT devices and services in plans required to be developed 

under other federal laws. 
CONSUMER INFORMATION, OUTREACH AND ACCESS

247 

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. 

• Section 4 AT Act 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. Section 4 State AT 

Program data continues to show increased program use and performance. In fiscal year 

2019, the 56 State AT Program Section 4 grantees, achieved the following: 

• 4,668 individuals participated in assistive technology device demonstrations exploring 

devices to support decision-making about consumer-AT match.

• 54,018 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.\ 

• 78,412 AT devices were reutilized, saving consumers $30,448,542 by obtaining a gently 

used or refurbished AT device rather than a new one. 

• 945 financial loans totaling $8,532,521 at an average interest rate of 4.3% were made to 

enable consumers to purchase needed AT. 

• 6,224 AT devices at a value of $3,860,279 were provided to consumers through 

externally funded programs administered by State AT Programs. 

• 8,009 AT devices were acquired by consumers at a savings of $880,567 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. 

• 103,182 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, OUTREACH AND ACCESS

248 

Protection and Advocacy for Assistive Technology Grants 

Formula grants to 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.145

Alternative Financing Program

The Assistive Technology Alternative Financing Program (AFP) provides grantees 

one-year grant awards to assist individuals with disabilities of any age to obtain 

financial assistance for AT devices and services.

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 2018................................ $33,911,000

FY 2019................................ $34,000,000

FY 2020................................ $37,000,000

FY 2021 Enacted...................... $37,500,000

FY 2022 President’s Budget......... $44,000,000

Budget Request:

The FY 2022 request for Assistive Technology is $44,000,000, an increase of $6,500,000 over the 

FY 2021 Enacted level of $37,500,000. Consistent with past requests, no funding is included for 

145https://at3center.net/ and https://catada.info/
CONSUMER INFORMATION, OUTREACH AND ACCESS

249 

the redundant Alternative Financing Program since the AT State grant program already includes 

financing activities that allow States to make decisions to best meet specific needs. 

People with disabilities have been significantly impacted by the pandemic. Loss of crucial 

community-based services, social isolation, and in some cases the after effects of COVID-19 

significantly increased the need for access to assistive technology since it allowed individuals to 

maintain contact with and to participate in their communities while in their homes. The request 

for the State AT program is $37,000,000, an increase of $7,296,000. As recovery from the 

pandemic proceeds, the State AT programs need this additional funding to address backlogged 

requests while simultaneously expanding services to continue to meet the heightened demand 

created by the pandemic. 

The request would also increase funding for the Protection and Advocacy for Assistive Technology 

(PAAT) program to $6,000,000. Funds assist individuals with disabilities of all ages in the 

acquisition, use, or maintenance of AT services or devices. During the pandemic, there was an 

increased demand analogous to that of the State AT grants. 

Finally, the request would maintain approximately the same funding level, $1,000,000, 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 2022, 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.
CONSUMER INFORMATION, OUTREACH AND ACCESS

250 

Outcomes and Outputs Table:

Measure Year and Most Recent 

Result /

Target for Recent Result /

(Summary of Result)

FY 2021

Target

FY 2022

Target

FY 2022

Target

+/-FY 2021

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 2019: 95%

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 2019: 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 2019: 99%

Target:

95%

(Target Exceeded)

95% 95% Maintain

Indicator Year and Most Recent 

Result /

FY 2021

Projection

FY 2022

Projection

FY 2022

Projection

+/-FY 2021

Projection

Output ATi: Device 

Demonstrations Provided 

(Output)

FY 2019: 33,799 35,000 38,500 +3,500

Output ATii: Short-Term 

Device Loans Made 

(Output)

FY 2019: 36,198 38,000 38,350 +350
CONSUMER INFORMATION, OUTREACH AND ACCESS

251 

Indicator Year and Most Recent 

Result /

FY 2021

Projection

FY 2022

Projection

FY 2022

Projection

+/-FY 2021

Projection

Output ATiii: Recipients 

of Reused Devices 

(Output) 

FY 2019: 57,588 58,250 64,075 +5,825

Output ATiv: State 

Financing Device 

Recipients (Output)

FY 2019: 10,307 7,000 7,700 +700

Grant Awards Tables:

Assistive Technology Act - State Grants

 FY 2020 

Enacted 

FY 2021 

President's 

Budget 

FY 2022 

Requested 

Number of Awards 56 56 56

Average Award $519,480 $525,124 $654,107 

Range of Awards $126,424-

$1,267,323

$125,692-

$1,286,889

$127,626-

$1,786,405

Assistive Technology Act - Protection and Advocacy Grants 

 FY 2020 

Enacted

FY 2021 

President's 

Budget 

FY 2022 

Requested 

Number of 

Awards 57 57 57

Average Award $83,703 $83,368 $104,211 

Range of Awards $30,000-

$472,346

$30,000 -

$467,579

$30,000 -

$630,192
CONSUMER INFORMATION, ACCESS AND OUTREACH

252 

 Assistive Technology Act – National Grant Activities

 

 FY 2020 

Final

FY 2021 

Enacted 

FY 2022 

President's 

Budget 

Number of 

Awards 2 2 6 

Average Award $445,345 $445,345 $665,345 

Range of Awards $317,942 - 

$572,748

$317,942 - 

$572,748

$317,942 - 

$572,748

Alternative Financing Grant Competition for Assistive Technology 

 FY 2020

Final 

FY 2021 

Enacted 

FY 2022 

President ‘s 

Budget 

Number of 

Awards 7 7 - 

Average Award $284,336 $284,336 - 

Range of Awards $31,468 -

$625,754

$31,468 -

$625,754 - 
CONSUMER INFORMATION, OUTREACH AND ACCESS

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

FY 2022 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Assistive Technology State Grants (CFDA 84.224A)

FY 2020 FY 2021 FY 2022 FY 2022 +/-

STATE/TERRITORY Final Enacted President's Budget FY 2021

Alabama 492,455 497,823 620,643 122,820

Alaska 458,722 462,000 539,414 77,414

Arizona 669,110 676,728 825,405 148,677

Arkansas 509,681 514,081 616,380 102,299

California 1,267,323 1,286,889 1,786,405 499,516

Colorado 519,910 526,285 658,417 132,132

Connecticut 445,611 450,096 558,354 108,258

Delaware 443,884 447,433 527,484 80,051

District of Columbia 400,520 403,908 481,042 77,134

Florida 816,871 831,592 1,134,815 303,223

Georgia 667,494 676,438 861,453 185,015

Hawaii 479,481 483,072 567,934 84,862

Idaho 455,683 459,934 548,837 88,903

Illinois 679,978 687,587 894,963 207,376

Indiana 527,588 534,081 676,809 142,728

Iowa 484,290 488,682 592,475 103,793

Kansas 443,831 448,157 549,319 101,162

Kentucky 512,837 517,803 635,882 118,079

Louisiana 540,848 545,753 665,804 120,051

Maine 492,014 495,713 579,796 84,083

Maryland 545,358 551,056 686,311 135,255

Massachusetts 569,743 575,641 720,113 144,472

Michigan 722,379 729,625 907,778 178,153

Minnesota 537,301 543,163 673,999 130,836

Mississippi 428,542 432,732 534,578 101,846

Missouri 603,736 609,581 745,835 136,254

Montana 473,440 477,028 558,113 81,085

Nebraska 488,306 492,252 582,758 90,506

Nevada 454,921 459,904 562,881 102,977

New Hampshire 460,058 463,730 547,982 84,252

New Jersey 546,122 552,660 718,789 166,129

New Mexico 477,118 481,084 573,359 92,275

New York 801,852 812,142 1,093,333 281,191

North Carolina 619,808 628,782 812,390 183,608

North Dakota 399,052 402,448 480,195 77,747

253 
CONSUMER INFORMATION, OUTREACH AND ACCESS

PROGRAM/CFDA NUMBER: Assistive Technology State Grants (CFDA 84.224A)

FY2020 FY2021 FY2022 FY2022 +/-

STATE/TERRITORY Final Enacted President's Budget FY2021

Ohio 635,782 643,882 840,562 196,680

Oklahoma 472,476 477,414 589,935 112,521

Oregon 467,972 473,198 588,558 115,360

Pennsylvania 767,598 776,117 984,911 208,794

Rhode Island 398,690 402,215 483,197 80,982

South Carolina 565,523 571,652 697,145 125,493

South Dakota 448,176 451,631 530,712 79,081

Tennessee 499,981 506,767 650,550 143,783

Texas 1,038,080 1,057,598 1,442,651 385,053

Utah 495,441 500,466 604,813 104,347

Vermont 434,426 437,705 513,949 76,244

Virginia 560,265 567,240 729,596 162,356

Washington 542,482 549,877 702,212 152,335

West Virginia 454,450 458,084 547,042 88,958

Wisconsin 517,338 523,019 655,844 132,825

Wyoming 390,325 393,628 469,380 75,752

Subtotal 28,124,872 28,436,376 35,551,102 7,114,726

American Samoa 125,676 125,689 126,235 546

Guam 127,233 127,310 129,141 1,831

Northern Mariana Islands 125,692 125,711 126,274 563

Puerto Rico 461,005 465,409 569,622 104,213

Virgin Islands 126,424 126,465 127,626 1,161

Subtotal 966,030 970,584 1,078,898 108,314

Total States/Territories 29,090,902 29,406,960 36,630,000 7,223,040

Contingency Fund 7,909,098 8,093,040 7,370,000 (723,040)

Subtotal Adjustments 7,909,098 8,093,040 7,370,000 (723,040)

TOTAL RESOURCES 37,000,000 37,500,000 44,000,000 6,500,000

1/ Contingency Fund-- includes funds for grant systems and review, and program reporting systems costs.

254 
CONSUMER INFORMATION, OUTREACH AND ACCESS

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

FY 2022 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM/CFDA NUMBER: Assistive Technology Protection and Advocacy (CFDA 84.343) 

FY 2020

Final

FY 2021

Enacted

FY 2022

President's Budget

FY 2022 +/-

STATE/TERRITORY FY 2021

Alabama 58,365 58,023 78,202 20,179

Alaska 50,000 50,000 50,000 -

Arizona 85,636 86,135 116,090 29,955

Arkansas 50,000 50,000 50,000 -

California 472,346 467,579 630,192 162,613

Colorado 68,010 68,148 91,848 23,700

Connecticut 50,000 50,000 56,864 6,864

Delaware 50,000 50,000 50,000 -

District of Columbia 50,000 50,000 50,000 -

Florida 254,332 254,162 342,555 88,393

Georgia 125,611 125,644 169,340 43,696

Hawaii 50,000 50,000 50,000 -

Idaho 50,000 50,000 50,000 -

Illinois 152,139 149,955 202,107 52,152

Indiana 79,907 79,667 107,374 27,707

Iowa 50,000 50,000 50,321 321

Kansas 50,000 50,000 50,000 -

Kentucky 53,356 52,869 71,256 18,387

Louisiana 55,644 55,013 74,145 19,132

Maine 50,000 50,000 50,000 -

Maryland 72,155 71,543 96,424 24,881

Massachusetts 82,417 81,564 109,931 28,367

Michigan 119,360 118,182 159,283 41,101

Minnesota 67,002 66,738 89,948 23,210

Mississippi 50,000 50,000 50,000 -

Missouri 73,155 72,629 97,888 25,259

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 -

New Jersey 106,375 105,110 141,665 36,555

New Mexico 50,000 50,000 50,000 -

New York 233,350 230,209 310,270 80,061

North Carolina 123,989 124,113 167,277 43,164

North Dakota 50,000 50,000 50,000 -

255 
CONSUMER INFORMATION, OUTREACH AND ACCESS

PROGRAM/CFDA NUMBER: Assistive Technology Protection and Advocacy (CFDA 84.343) 

FY 2020 FY 2021 FY 2022 FY 2022 +/-

STATE/TERRITORY Final Enacted President's Budget FY 2021 

Ohio 139,582 138,326 186,433 48,107

Oklahoma 50,000 50,000 63,111 13,111

Oregon 50,041 50,000 67,270 17,270

Pennsylvania 152,927 151,496 204,183 52,687

Rhode Island 50,000 50,000 50,000 -

South Carolina 60,709 60,929 82,118 21,189

South Dakota 50,000 50,000 50,000 -

Tennessee 80,840 80,815 108,920 28,105

Texas 342,724 343,130 462,464 119,334

Utah 50,000 50,000 51,133 1,133

Vermont 50,000 50,000 50,000 -

Virginia 101,708 101,007 136,135 35,128

Washington 89,981 90,113 121,452 31,339

West Virginia 50,000 50,000 50,000 -

Wisconsin 69,419 68,901 92,864 23,963

Wyoming 50,000 50,000 50,000 -

Subtotal 4,571,080 4,552,000 5,739,063 1,187,063

Indian Tribes 30,000 30,000 30,000 -

American Samoa 30,000 30,000 30,000 -

Guam 30,000 30,000 30,000 -

Northern Mariana Islands 30,000 30,000 30,000 -

Puerto Rico 50,000 50,000 50,937 937

Virgin Islands 30,000 30,000 30,000 -

 Subtotal 200,000 200,000 200,937 937

Total States/Territories 4,771,080 4,752,000 5,940,000 1,188,000

Contingency Fund 1,920 21,000 (881,000) (902,000)

Subtotal Adjustments 1,920 21,000 (881,000) (902,000)

TOTAL RESOURCES 4,773,000 4,773,000 5,059,000 286,000

256 
CONSUMER INFORMATION, OUTREACH AND ACCESS

257 

National Technical Assistance Center on Kinship and Grandfamilies

Services FY 2020 Final FY 2021 Enacted FY 2022 

President’s Budget

FY 2022 +/- 

FY 2021

National Technical 

Assistance Center on 

Kinship and 

Grandfamilies - 

Supplemental 

Funding 

--- $10.000 --- -$10.000

1/ The American Rescue Plan Act, P.L. 117-2 provides $10 million to establish this technical assistance center, with the funding 

available for five years, from FY 2021 through FY 2025.

Original Authorizing Legislation: American Rescue Plan Act of 2021, Subtitle L, Section 2922, 

P.L. 117-2. 

Most Recent Authorizing Legislation: American Rescue Act of 2021, Subtitle L, Section 2922, 

P.L. 117-2. 

Current FY Authorization of Funds..........................................................$10,000,000 

Authorization Expiration Date..................................................................... FY 2025 

Allocation Method.................................Competitive Grants/ Formula Grants or Contracts 

Program Description and Accomplishments:

The National Technical Assistance Center on Kinship and Grandfamilies, first funded in FY 2021, 

provides, at a national level, training, technical assistance, and resources for government programs, 

nonprofit and other community-based organizations, and Indian Tribes, Tribal organizations, and 

urban Indian organizations that serve grandfamilies and kinship families. The Center supports the 

health and well-being of members of grandfamilies and kinship families, including caregivers,

children, and their parents. The Center in intended to focus primarily on serving grandfamilies and 

kinship families in which the primary caregiver is an adult age 55 or older, or the child has one or 

more disabilities. 

The Center provides support for the following key activities: 
CONSUMER INFORMATION, OUTREACH AND ACCESS

258 

• engage experts to stimulate the development of new, and identify existing evidence-based, 

evidence-informed, and exemplary practices or programs related to health promotion 

(including mental health and substance use disorder treatment), education, nutrition, 

housing, financial needs, legal issues, disability self-determination, caregiver support, and 

other issues to help serve caregivers, children, and their parents in grandfamilies and 

kinship families;

 

• encourage and support the implementation of the evidence-based, evidence-informed, and 

exemplary practices to support grandfamilies and kinship families and to promote 

coordination of services for them across the systems that support them; 

• facilitate learning and provide technical assistance, resources, and training to individuals 

and entities across systems that directly work with grandfamilies and kinship families;

• promote collaboration and coordination of OAA services in conjunction with programs 

that ACL already provides, including Family Caregivers, the Long-term Care Ombudsman 

program, Elder Justice, and Nutrition. 

• plan and coordinate disaster response to assist grandfamilies and kinship families during 

emergencies and disasters by supporting coordination and collaboration across 

grandfamily-serving government programs, nonprofit and community-based 

organizations, and Indian tribes, Tribal organizations, and urban Indian organizations; and, 

• assist government programs, and nonprofit and other community-based organizations, to 

promote racial equity, enhance services, and implement culturally and linguistically 

appropriate approaches as the programs and organizations serve grandfamilies and kinship 

families.

Funding History

The National Technical Assistance Center on Kinship and Grandfamilies received $10 million in 

initial funding available for five years (FY 2021-FY 2025). 

FY 2018..................................... $0

FY 2019..................................... $0

FY 2020..................................... $0

FY 2021 Supplemental Funding ........ $10,000,000

FY 2022 President’s Budget.............. $0
CONSUMER INFORMATION, ACCESS AND OUTREACH

259 

Budget Request

 

No FY 2022 funding is requested for this activity. Initial funding provided by the American 

Rescue Plan Act, 2021, P.L. 117-2, is available through FY 2025. 
CONSUMER INFORMATION, OUTREACH AND ACCESS

260 

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CONSUMER INFORMATION, OUTREACH AND ACCESS

261 

Medicare Improvements for Patients and Providers Act Programs (MIPPA)

Services FY 2020 Final FY 2021 Enacted FY 2022 

President’s Budget

FY 2022 +/- 

FY 2021

ADRCs $5.000 $5.000 $5.000 ----

AAAs $7.500 $15.000 $15.000 ----

NCOBE $12.000 $15.000 $15.000 ----

SHIP146 $13.000 $15.000 $15.000 ----

Program Total $37.500 $50.000 $50.000 ----

FTE 3.3 3.0 4.0 ----

*BA is in millions of dollars. FTE is a whole number, 4.0 FTE for this activity are supported by program dollars.

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 2021, Public Law 116-

68. 

Current FY Authorization of Funds ...............................................................................$35,000,000 

Authorization Expiration Date ............................................................................................ FY 2024 

146 MIPPA-SHIP funding is currently appropriated to CMS and transferred to ACL.
CONSUMER INFORMATION, OUTREACH AND ACCESS

262 

 

 

Allocation Method ............................................ Competitive Grants/Formula Grants and Contracts

Program Description and Accomplishments:

The Medicare Improvements for Patients and Providers Act (MIPPA) programs provide additional 

funding to key segments of ACL’s network of community-based service providers – including 

Area Agencies on Aging (AAA), Aging and Disability Resource Centers (ADRCs), and State 

Health Insurance Assistance Programs (SHIPs). This funding is provided so that these providers 

can undertake more in-depth activities, above and beyond the basic information and referral that 

they normally provide, specifically for the benefit of hard to reach low-income and rural Medicare 

beneficiaries who qualify for either Medicare Savings Plans (MSP) or a Low Income Subsidy 

(LIS). 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. MIPPA funds also 

support the National Center for Benefits Outreach and Enrollment. 

MIPPA 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 2019, MIPPA State 

Grantees conducted over 41,000 group outreach events, serving 1.2 million people, and conducted 

almost 943,000 one-on-one contacts with Medicare beneficiaries, their families, or caregivers.

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. To date in FY 2021 (9/1/2020-

4/30/2021) the NCBOE Benefit Enrollment Centers assisted 64,363 individuals and submitted 

104,564 applications for LIS, MSP and other low income benefits worth an estimated $190 million.
CONSUMER INFORMATION, ACCESS AND OUTREACH

263 

Funding History:

MIPPA is funded through mandatory appropriations and is currently funded through FY 2023. 

Funding for MIPPA over the past five years is as follows:

FTE 

FY 2018.............................. $37,500,000 4.0

FY 2019.............................. $37,500,000 3.4

FY 2020.............................. $37,500,000 3.3

FY 2021 Enacted..................... $50,000,000 3.0

FY 2022 Budget....................... $50,000,000 4.0

__________________

1/ Reflects request for mandatory funding in FY 2020 and FY 2021. 

2/The program most recently was funded in FY 2021, through FY 2023, in the Coronavirus Response and Relief Supplemental 

Appropriations Act, P.L. 116-260, at $50 million per year.

Budget Request:

MIPPA is currently funded at $50 million annually for fiscal years FY 2021 through FY 2023 out 

of mandatory appropriations. Appropriations were most recently provided by the Coronavirus 

Response and Relief Supplemental Appropriations Act, 2021, P.L. 116-260. 

Grant Awards Tables:

 

MIPPA – Aging Disability and Resource Centers 

 FY 2020 

Final 

FY 2021 

Enacted 

FY 2022 

President's 

Budget 

Number of Awards 53 53 53

Average Award $88,172 $89,522 $89,522

Range of Awards $1,456 - 

$388,635

$694- 

$37,6342

$221,986 - 

$609,927
CONSUMER INFORMATION, ACCESS AND OUTREACH

264 

MIPPA – Area Agencies on Aging147

 FY 2020 

Final 

FY 2021 

Enacted 

FY 2022 

President's 

Budget 

Number of Awards 54 54 54

Average Award $126,713 $259,121 $259,121 

Range of Awards $2,644- 

$557,337

$8,670- 

$1,141492

$8,670- 

$1,141492

 

 

 

MIPPA – National Center for Benefits Outreach and Enrollment 

 FY 2020 

Final 

FY 2021 

Requested 

FY 2022 

President's 

Budget 

Number of Awards 1 1 1 

Average Award $11,281,282 $11,500,000 $13,500,000 

Range of Awards $11,281,282 $11,500,000 $13,500,000 

MIPPA – State Health Insurance Assistance Programs

 FY 2020 

Final

FY 2021 

Enacted 

FY 2022 

President's 

Budget 

Number of Awards 54 54 54

Average Award $229,853 $266,930 $266,930 

Range of Awards $4,796-

$1,010,968

$8,931-

$1,175,892

$8,931-

$1,175,892

147 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.
 

265 

FY 2020 FY 2021 FY 2022 FY 2022 +/-

STATE/TERRITORY Final Enacted President's Budget FY 2021 

Alabama 86,327 82,308 82,308 -

Alaska 8,466 8,072 8,072 -

Arizona 112,704 107,457 107,457 -

Arkansas 53,587 51,093 51,093 -

California 178,939 376,342 376,342 -

Colorado 79,832 76,116 76,116 -

Connecticut 55,932 53,328 53,328 -

Delaware 17,174 16,374 16,374 -

District of Columbia 7,815 7,451 7,451 -

Florida 388,635 370,543 370,543 -

Georgia 148,767 141,841 141,841 -

Hawaii 22,195 21,161 21,161 -

Idaho 28,442 27,118 27,118 -

Illinois 184,085 175,515 175,515 -

Indiana 104,375 99,516 99,516 -

Iowa 51,506 49,109 49,109 -

Kansas 44,379 42,313 42,313 -

Kentucky 77,058 73,471 73,471 -

Louisiana 72,179 68,819 68,819 -

Maine 28,228 26,914 26,914 -

Maryland 86,673 82,638 82,638 -

Massachusetts 109,648 104,543 104,543 -

Michigan 170,611 162,668 162,668 -

Minnesota 86,260 82,245 82,245 -

Mississippi 50,430 48,082 48,082 -

Missouri 103,824 98,991 98,991 -

Montana 19,418 18,514 18,514 -

Nebraska 28,736 27,399 27,399 -

Nevada 45,103 43,003 43,003 -

New Hampshire 25,226 24,052 24,052 -

New Jersey 134,971 128,688 128,688 -

New Mexico 35,388 33,740 33,740 -

New York 299,554 285,608 285,608 -

North Carolina 167,479 159,682 159,682 -

North Dakota 10,923 10,415 10,415 -

 

 

 

 

 

 

 

 

 

 

 

 

 

CONSUMER INFORMATION, ACCESS AND OUTREACH 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

ADMINISTRATION ON AGING 

FY 2022 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: MIPPA - ADRC (CFDA 93.071) 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONSUMER INFORMATION, OUTREACH AND ACCESS 

PROGRAM/CFDA NUMBER: MIPPA – ADRC (CFDA 93.071) 

FY 2020 FY 2021 FY 2022 FY 2022 +/-

STATE/TERRITORY Final Enacted President's Budget FY 2021 

Ohio 190,916 182,029 182,029 -

Oklahoma 62,789 59,866 59,866 -

Oregon 73,258 69,847 69,847 -

Pennsylvania 222,810 212,438 212,438 -

Rhode Island 18,157 17,312 17,312 -

South Carolina 89,529 85,362 85,362 -

South Dakota 15,171 14,465 14,465 -

Tennessee 113,540 108,255 108,255 -

Texas 351,375 335,018 335,018 -

Utah 33,343 31,791 31,791 -

Vermont 12,433 11,854 11,854 -

Virginia 129,354 123,332 123,332 -

Washington 114,744 109,402 109,402 -

West Virginia 36,204 34,518 34,518 -

Wisconsin 97,029 92,512 92,512 -

Wyoming 9,279 8,847 8,847 -

Subtotal 4,694,800 4,681,977 4,681,977 -

Indian Tribes 

Migrant Program 

American Samoa 

Guam 1,456 694 694 -

Marshall Islands 

Micronesia 

Northern Mariana Islands 

Palau 

Puerto Rico 65,046 62,018 62,018 -

Virgin Islands - - - -

 Subtotal 66,502 62,712 62,712 -

Total States/Territories 4,761,302 4,744,689 4,744,689 -

Contingency Fund 1/ 238,698 255,311 255,311 

Subtotal Adjustments 238,698 255,311 255,311 -

TOTAL RESOURCES 5,000,000 5,000,000 5,000,000 -

1/ Contingency Fund- 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. 

266 
 

FY 2020 FY 2021 FY 2022 FY 2022 +/-

STATE/TERRITORY Final Enacted President's Budget FY 2021 

Alabama 147,104 306,652 306,652 -

Alaska 17,762 33,454 33,454 -

Arizona 120,242 219,312 219,312 -

Arkansas 135,794 277,122 277,122 -

California 557,337 1,141,492 1,141,492 -

Colorado 73,043 162,807 162,807 -

Connecticut 53,001 110,154 110,154 -

Delaware 23,854 27,372 27,372 -

District of Columbia 8,472 17,325 17,325 -

Florida 412,029 779,417 779,417 -

Georgia 228,432 436,191 436,191 -

Hawaii 38,639 77,442 77,442 -

Idaho 52,815 96,736 96,736 -

Illinois 230,842 473,488 473,488 -

Indiana 160,028 336,917 336,917 -

Iowa 98,940 208,657 208,657 -

Kansas 69,658 145,792 145,792 -

Kentucky 175,136 362,489 362,489 -

Louisiana 122,848 242,076 242,076 -

Maine 58,493 111,022 111,022 -

Maryland 77,997 144,310 144,310 -

Massachusetts 113,811 216,227 216,227 -

Michigan 208,224 471,685 471,685 -

Minnesota 122,508 259,704 259,704 -

Mississippi 125,030 269,395 269,395 -

Missouri 167,317 346,079 346,079 -

Montana 39,846 99,177 99,177 -

Nebraska 49,311 104,234 104,234 -

Nevada 47,296 105,444 105,444 -

New Hampshire 37,152 87,879 87,879 -

New Jersey 111,346 227,696 227,696 -

New Mexico 59,504 128,049 128,049 -

New York 398,979 840,915 840,915 -

North Carolina 289,174 581,825 581,825 -

North Dakota 19,378 45,613 45,613 -

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONSUMER INFORMATION, OUTREACH AND ACCESS 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

ADMINISTRATION ON AGING 

FY 2022 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: MIPPA - AAA (CFDA 93.071) 

267 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONSUMER INFORMATION, OUTREACH AND ACCESS 

PROGRAM/CFDA NUMBER: MIPPA – AAA (CFDA 93.071) 

FY 2020 FY 2021 FY 2022 FY 2022 +/-

STATE/TERRITORY Final Enacted President's Budget FY 2021 

Ohio 246,709 569,558 569,558 -

Oklahoma 105,803 232,370 232,370 -

Oregon 91,560 175,782 175,782 -

Pennsylvania 282,801 574,375 574,375 -

Rhode Island 17,003 34,771 34,771 -

South Carolina 147,280 274,325 274,325 -

South Dakota 27,724 60,318 60,318 -

Tennessee 202,397 406,396 406,396 -

Texas 451,059 959,247 959,247 -

Utah 42,207 72,554 72,554 -

Vermont 27,787 65,839 65,839 -

Virginia 170,872 330,723 330,723 -

Washington 114,418 225,358 225,358 -

West Virginia 82,395 156,092 156,092 -

Wisconsin 134,311 291,306 291,306 -

Wyoming 18,694 47,679 47,679 -

Subtotal 6,814,362 13,970,842 13,970,842 -

Guam 2,644 - - -

Puerto Rico 22,022 13,017 13,017 -

Virgin Islands 3,493 8,670 8,670 -

 Subtotal 28,159 21,687 21,687 -

Total States/Territories 6,842,521 13,992,529 13,992,529 -

Contingency Fund 1/ 657,479 1,007,471 1,007,471 -

Subtotal Adjustments 657,479 1,007,471 1,007,471 -

TOTAL RESOURCES 

7,500,000 15,000,000 15,000,000 -

1/ Contingency Fund- 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. 

268 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONSUMER INFORMATION, ACCESS, AND OUTREACH 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

ADMINISTRATION ON AGING 

FY 2022 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM/CFDA NUMBER: MIPPA - SHIP (CFDA 93.071) 

FY 2020 FY 2021 FY 2022 FY 2022 +/-

STATE/TERRITORY Final Enacted President's Budget FY 2021 

Alabama 266,840 315,895 315,895 -

Alaska 32,219 34,462 34,462 -

Arizona 218,114 225,922 225,922 -

Arkansas 246,325 285,473 285,473 -

California 1,010,986 1,175,892 1,175,892 -

Colorado 132,498 167,713 167,713 -

Connecticut 96,142 113,474 113,474 -

Delaware 43,270 28,197 28,197 -

District of Columbia 15,368 17,847 17,847 -

Florida 747,404 802,906 802,906 -

Georgia 414,367 449,336 449,336 -

Hawaii 70,090 79,776 79,776 -

Idaho 95,805 99,652 99,652 -

Illinois 418,738 487,756 487,756 -

Indiana 290,283 347,071 347,071 -

Iowa 179,472 214,945 214,945 -

Kansas 126,357 150,186 150,186 -

Kentucky 317,691 373,413 373,413 -

Louisiana 222,842 249,371 249,371 -

Maine 106,105 114,368 114,368 -

Maryland 141,483 148,659 148,659 -

Massachusetts 206,448 222,743 222,743 -

Michigan 377,710 485,900 485,900 -

Minnesota 222,225 267,529 267,529 -

Mississippi 226,797 277,513 277,513 -

Missouri 303,507 356,509 356,509 -

Montana 72,280 102,166 102,166 -

Nebraska 89,449 107,375 107,375 -

Nevada 85,792 108,622 108,622 -

New Hampshire 67,393 90,527 90,527 -

New Jersey 201,978 234,558 234,558 -

New Mexico 107,937 131,907 131,907 -

New York 723,731 866,257 866,257 -

North Carolina 524,549 599,358 599,358 -

North Dakota 35,151 46,988 46,988 -

269 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONSUMER INFORMATION, ACCESS, AND OUTREACH 

PROGRAM/CFDA NUMBER: MIPPA -SHIP (CFDA 93.071) 

FY 2020 FY 2021 FY 2022 FY 2022 +/-

STATE/TERRITORY Final Enacted President's Budget FY 2021 

Ohio 447,520 586,723 586,723 -

Oklahoma 191,921 239,373 239,373 -

Oregon 166,086 181,080 181,080 -

Pennsylvania 512,991 591,685 591,685 -

Rhode Island 30,844 35,819 35,819 -

South Carolina 267,161 282,592 282,592 -

South Dakota 50,291 62,135 62,135 -

Tennessee 367,140 418,643 418,643 -

Texas 818,203 988,155 988,155 -

Utah 76,561 74,740 74,740 -

Vermont 50,403 67,822 67,822 -

Virginia 309,954 340,690 340,690 -

Washington 207,551 232,150 232,150 -

West Virginia 149,461 160,796 160,796 -

Wisconsin 243,634 300,085 300,085 -

Wyoming 33,911 49,116 49,116 -

Subtotal 12,360,978 14,391,870 14,391,870 -

Guam 4,796 - - -

Puerto Rico 39,947 13,409 13,409 -

Virgin Islands 6,336 8,931 8,931 -

 Subtotal 51,079 22,340 22,340 -

Total States/Territories 12,412,057 14,414,210 14,414,210 -

Contingency Fund 1/ 587,943 585,790 585,790 -

Subtotal Adjustments 587,943 585,790 585,790 -

TOTAL RESOURCES 13,000,000 15,000,000 15,000,000 -

1/ Contingency Fund- 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. 

270 
PROGRAM ADMINISTRATION

271 

Program Administration

Services FY 2020 Final FY 2021 Enacted FY 2022 

President’s Budget

FY 2022 +/- 

FY 2021

Program Administration 

–Budget Authority $41.063 $41.063 $47.063 +$6.000

FTE 154 171 192 +21

*BA is in millions of dollars; FTE is a whole number. FTE numbers shown above for Program Administration include 5 

FTE paid for with evaluation set-aside funding. 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: Supporting Older Americans Act of 2020, Public Law 116-

131, 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

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 
PROGRAM ADMINISTRATION

272 

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, among others, 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 2020, evaluation funding supported 5 FTE and Program Administration funding another 

149 FTE for a total of 154 of the 170 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 2018......................... $40,063,000 170.1

FY 2019......................... $41,063,000 163.0

FY 2020......................... $41,063,000 154.0

FY 2021 Enacted................ $41,063,000 170.8

FY 2022 President’s Budget.. $47,063,000 191.8

ACL 

Budget Request:

The FY 2022 request for Program Administration is $47,063,000 and 192 FTE, an increase of 

+$6,000,000 and +21 FTE above the FY 2021 Enacted levels. The additional funding is needed 

to provide continued support for existing FTE, including projected to be hired in the last quarter 

of FY 2021, as well as to support seventeen (17) new FTE, related overhead and IT support 

contracts. Six of these additional FTE will support the President’s National COVID-19 Strategy 

will also enable ACL to carryout key activities that align with executive order directives.. Three 

staff are requested to allow ACL to fully serve the role of advisor on aging and disability policy 

across HHS and the Administration. Three staff are needed to build ACL’s technical assistance 

capacity–and especially its disability capacity—with its regional offices. The remaining five FTE 

and funding will provide additional contract support for vital IT services. 

For the last five years, funding for ACL Program Administration has been essentially flat, only 

growing from $40.063 million to $41.063 million during this period. At the same time, program 

requirements (particularly in information technology) and complexity have significantly increased. 
PROGRAM ADMINISTRATION

273 

Lack of funding led to significant staffing reductions and an inability to adequately invest in key 

areas—especially the IT realm, which has increased the Agency’s exposure to risk. Further, as a 

result of the pandemic and the significant additional funding that ACL’s programs received 

through various supplemental appropriations including the American Rescue Plan Act, ACL also 

needs to invest additional resources in program and fiscal monitoring and oversight. To this end, 

ACL also seeks to explore options for charging a limited number of additional program monitoring 

and fiscal operations staff to some of its program funding where doing so would allow it to better 

carry out full stewardship of the Acts that it is responsible for implementing. 

ACL is well aware of the difference that being fully staffed makes, having dealt with a range of 

issues in prior years related to under-staffing that resulted in delays, missed deadlines, and reduced 

ability to provide technical assistance and oversight, all of which had an impact on the ability of 

ACL grantees to do their work. Therefore, in FY 2022, ACL is requesting an increase of 

approximately +$1.4 million to cover the annualized costs of current baseline operations and the 

staff that are expected to be on-board at the beginning of fiscal year 2022. 

This increase, however, is not sufficient to address priorities of the new administration—in 

particular those related to the President’s National COVID-19 Strategy, executive orders and other 

Administration priorities—nor does it provide the level of investment in IT that ACL believes is 

critical to reducing its risk in this sphere. To address these gaps, ACL seeks an additional +$4.6 

million and 17 FTE, detailed below, for a total FY 2022 Program Administration request of 

$47.063 million. The additional funds include:

• Support for the Administration’s National COVID-19 Strategy and Executive 

Orders and other Administration Priorities. (+6 FTE). This portion of the request will 

support COVID-19 priorities in the President’s National COVID-19 Strategy and will also 

enable ACL to carryout key activities that align with executive order directives. It will 

support a total of 6 additional FTE and associated overhead costs to support ongoing 

COVID-19 priorities and several other Administration priorities. The request supports 

work on the President’s Caregiving Infrastructure Plan, Interagency work on the 

President’s priorities for expanding Community Living and Home and Community Based 

Services for individuals with disabilities and older adults, and the President’s Executive 

Order On Advancing Racial Equity and Support for Underserved Communities, in 

addition to the ongoing work to support the President’s Executive Orders on Ensuring 

Equitable Pandemic Response and Recovery and Improving and Expanding Access to 

Care and Treatment of COVID-19. 

 

The additional staff will provide leadership and subject matter expertise focused on 

accomplishing the following: ensuring the COVID-19 response addresses the unique needs 

and heightened risks faced by people with disabilities and older adults; exploring and 

implementing strategies to expand access and address systemic barriers for individuals with 

disabilities, older adults and their families, particularly those who are marginalized due to 

race or ethnicity, who are experiencing disproportionate economic or health effects. The 

additional staff will assist with increasing access to home and community based services, 
PROGRAM ADMINISTRATION

274 

with particular attention to people with disabilities and older adults and the direct care 

workforce crisis; and the implementation of community-based, multi-sector efforts to align 

health and social interventions. 

• Support for ACL to Fully Serve as the Advisor on Aging and Disability Across HHS 

and the Administration, (+3 FTE). ACL serves in the unique role of advising the 

Secretary of HHS and other federal agencies on issues and policies impacting people with 

disabilities and older adults. Until now ACL has not fully achieved this function. Since 

the Administration began, ACL has taken on additional leadership roles, for which 

additional FTEs are needed: 

o At the request of the Secretary’s office, ACL has begun leading an HHS 

disability policy workgroup and has taken a leadership role with the Domestic 

Policy Council on four workgroups – long term services and supports, children 

with disabilities, and COVID-19 – and anticipates extensive work on additional 

workgroups. 

o In support of these efforts, ACL is strengthening and broadening partnerships 

with CMS, HHS OCR, DOJ, HUD, DOL, ED and other federal agencies to 

address a range of disability and aging issues, with a particular focus on 

addressing the Nation’s institutional bias in public long-term care. 

o These efforts are in addition to ACL’s work on the President’s Caregiving 

Infrastructure Plan, the President’s Executive Order on Advancing Racial 

Equity and Support for Underserved Communities, and the President’s National 

COVID-19 Strategy and associated Executive Orders. 

An additional three (3) FTE will enable ACL to sufficiently staff this work and make 

significant progress on the Administration’s agenda with regards to disability, aging, 

caregiving, and equity and inclusion. 

• Support for Programmatic Technical Assistance and Oversight, (+3 FTE). The 

pandemic has highlighted the importance of providing technical assistance and oversight 

to programs especially through ACL’s regional offices. Significant gaps have been 

revealed in ACL’s capacity to provide a sufficient level of technical assistance and 

oversight to grantees, gaps that have been exacerbated by the pandemic. The impact of 

COVID-19 on programs is expected to last well beyond the immediate crisis, so ACL is 

requesting funding for three additional FTE to allow it to build its technical assistance 

capacity—and especially its disability capacity—with its regional offices. 

• Supporting IT Services (+5 FTE). This request would provide funding to expand IT 

services within ACL providing for 5 additional FTE and $400,000 for a new IT oversight 

contract, and $100,000 for additional funds for the existing IT support contract. The new 
PROGRAM ADMINISTRATION

275 

FTE and new and expanded contracts will provide support for program expansions (both 

existing and new) including additional cybersecurity specialists, product managers to 

support acquisition, development and operations efforts, and an enterprise architect. The 

architect is needed to help ensure that the business processes for which ACL develops and 

supports systems collecting data allow for effective decision making on the efficacy of 

ACL’s programs. 

 

 

ACL has historically underinvested in technology – both in terms of people, money, and 

engagement with our programs and our customers. This has prevented ACL from 

developing and operating systems that maximize interoperability with other HHS programs 

across Operating and Staff Divisions, and with our grantees, health care providers, and 

other community-based organizations providing services supporting the social 

determinants of health.

The additional resources will address longstanding concerns from ACL leadership, staff, 

and stakeholders regarding the risk and constraints that result from having a very limited 

team of Federal and contractor staff with which to address a multi-year backlog of requests 

for technology services. 

The addition of IT product managers will allow existing program office staff to return to 

their roles as subject matter experts, and will provide the ACL CIO better insight into the 

development and operation of ACL projects and systems, as required by the Federal 

Information Technology Acquisition Reform Act of 2014 and the Clinger Cohen Act of 

1996. 

ACL has worked diligently in FY 2021 to fill a variety of vacant positions, and going into FY 2022 

expects to have its full complement of 195 staff on board; requested funding will allow it to 

maintain and build from that staffing level in FY 2022 to address the current administration’s 

critical priorities. 
276 

Section Break
NONRECURRING EXPENSES FUND

277 

Nonrecurring Expenses Fund

Administration for Community Living

 *Dollars in millions.

Budget Summary

FY 20202 FY 20213/4 FY 20225

Notification #8148 $0 $9.826 TBD

Authorizing Legislation: 

Authorization.............Section 223 of Division G of the Consolidated Appropriations Act, 2008 

Allocation............................................................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.

ACL continues to work to augment, replace, or modernize its portfolio of IT systems. In FY 2020 

and FY 2021, 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 received $9.8 million in FY 2021 to continue system enhancements across the agency. ACL 

plans for the NEF funds included the following new and continuing projects: 

ACL Data

FY 2021: $2,000,000 

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 
NONRECURRING EXPENSES FUND

278 

ACL. In FY 2020, 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.” The project will 

continue with the award of a development and implementation contract in FY 2021 to replace the 

ACL Aging, Independence, and Disability Data Portal with a new portal offering streamlined user 

experience and a greatly increased ability to incorporate new program data sets. 

ACL Reporting Enhancements 

FY 2021: $500,000

Development and use of ACL Reporting was suspended in FY 2020 due to issues with 

performance of the system and a desire by the Administration on Disability to pursue a different 

approach to program performance reporting. Additional development to integrate the new 

performance reporting tools is anticipated in FY 2021 and FY 2022. In FY 2021 ACL will use 

NEF funds to develop tools to integrate data from three disparate systems into the ACL Data Lake 

for analysis, program oversight, and performance measurement. 

ACL.gov Enhancements 

FY 2021: $1,000,000 

In FY 2020 ACL and its contractor completed enhancements to ACL.gov that improved the 

security and functionality of the content management system supporting ACL.gov; expanded and 

enhanced 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. 

In FY 2021, ACL.gov will undergo a platform upgrade, and will continue to expand program 

content and enhance the functionality of the website. 

ACL Security Mitigation and Enhancements

FY 2021: $4,326,000 

In FY 2021 ACL received $1.8 million as a part of its total request to ensure that all of its systems 

have the appropriate security controls in place; have up-to-date secure code, design, and 

monitoring tools in place; have documentation required to meet Federal Information System 

Modernization Act guidelines and HHS policy; and that our accounts and systems are constantly 

monitored for unusual activity. To reach this goal, ACL has developed an approach which will 

allow the most important enterprise tools and platforms to be prioritized for attention, working our 

way through the entire portfolio of systems and applications. As the team works through assessing, 

mitigating, and documenting the portfolio, ACL will put in place policy and processes to ensure 

that any new services and systems are documented as they are developed, and that all systems 

maintain an ongoing assessment until they are decommissioned. 
NONRECURRING EXPENSES FUND

279 

ACL Using Available Data to Visually Represent the Aging and Disability Network 

FY 2021: $2,000,000 

ACL received $500,000 to create data sets and tools that allow visual representation of the aging 

and disability network and the services provided by our partners on a public facing map of the 

United States based on currently available data from ACL grantees and other community based 

organization that are part of community support agencies. Over time, additional data will be 

collected and available to visually represent other information about the Aging and Disability 

Networks, and to allow access to the data and visual representation to serve older adults and those 

with disabilities. This will allow both individuals and health care organizations looking for the 

services and capabilities offered by ACL’s networks to find providers offering the services, or to 

find opportunities to partner with service providers supporting the social determinants of health. 

Resources required including Federal staff to oversee and manage the work, and budget for 

contractors to establish a data taxonomy (including metadata) and business rules for the use of the 

data; plan for, implement, and operate the systems needed to collect and store the data to visually 

represent the aging and disability network; and to ensure the data collected is current and valid. 

ACL anticipates work on this project will begin in FY 2021 and will continue through FY 2022. 

ACL Knowledge Management

Following reorganization in FY 2019, ACL suspended development of initiatives under the 

Knowledge Management project pending decisions on how requests for technical assistance from 

Older Americans Act grantees would be received, assigned, processed, and closed. ACL 

anticipates resuming initiatives that are part of the Knowledge Management project in FY 2021 

with continuing development in FY 2021 and 2022. 

HHS Accessibility and Usability Shared Service Pilot 

In FY 2019, ACL received $350,000 in NEF funding to explore 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, though ACL anticipates resuming activities on the business case and pilot in FY 

2021. 

1 Pursuant to Section 223 of Division G of the Consolidated Appropriation Act, 2008, notification is required of planned use

2 Notification submitted to the Committees on Appropriations in the House of Representatives and the Senate on July 20, 2020. 

3 Notification submitted to the Committees on Appropriations in the House of Representatives and the Senate on October 22, 2020. 

4

4The projects described below are the current list of approved projects through FY 2021. Additional projects may be funded from the FY 2021 

notification letter upon approval from OMB.

5

HHS has not yet notified for FY 2022. 
280 

 

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SUPPLEMENTARY TABLES

281 

Supplementary Tables

Administration for Community Living 
SUPPLEMENTARY TABLES

282 

COVID-19 Impacts on Program Performance Reporting

Administration for Community Living 

The Key Outputs and Outcomes reported in the FY 2022 Congressional Budget justification are 

based on the most recent actual data. Those data are from 2019 and were unaffected by COVID19 and the COVID-19 supplemental funding. The projections and estimates for FY 2021 and 

FY2022 include the budget amounts from the columns entitled “FY 2021 Enacted” and “FY 2022 

President's Budget”. They do not include the FY 2020 or FY 2021 supplemental funding. ACL did 

not develop new measures based on the COVID-19 supplemental funding. 
SUPPLEMENTARY TABLES

283 

Object Classification Table - Direct

Administration for Community Living

(Dollars in Thousands) 

FY 2020 

Final

FY 2021 

Enacted

FY 2022 

President's 

Budget

FY 2022 +/- 

FY 2021

Personnel compensation:

Full-time permanent (11.1).................................. 19,942 21,680 25,151 3,472

Other than full-time permanent (11.3)................... 768 916 1,063 147

Other personnel compensation (11.5).................. 393 305 354 49

Military personnel (11.7).....................................

Special personnel services payments (11.8).........

Subtotal personnel compensation................ 21,103 22,901 26,568 3,667

Civilian benefits (12.1)........................................... 6,998 7,634 8,856 1,222

Military benefits (12.2)...........................................

Benefits to former personnel (13.0)........................

Total Pay Costs................................................... 

34 - - -

28,135 30,535 35,425 4,890

Travel and transportation of persons (21.0).............. 100 81 391 310

Transportation of things (22.0)................................ 2 2 3 1

Rental payments to GSA (23.1)............................. 3,245 3,295 3,327 32

Rental payments to Others (23.2)...........................

Communication, utilities, and misc. charges (23.3).. 159 180 268 87

Printing and reproduction (24.0).............................. 6 7 8 2

Other Contractual Services:

Advisory and assistance services (25.1)............... 39,469 40,105 47,905 7,800

Other services (25.2).......................................... 1,347 1,369 1,843 475

Purchase of goods and services from

government accounts (25.3)............................. 10,403 10,571 12,994 2,423

Operation and maintenance of facilities (25.4)....... 1 1 1 1

Research and Development Contracts (25.5)........

Medical care (25.6)............................................

Operation and maintenance of equipment (25.7)... 15 21 6

Subsistence and support of persons (25.8)...........

Subtotal Other Contractual Services............ 51,220 52,061 62,764 10,703

Supplies and materials (26.0)................................. 42 43 75 32

Equipment (31.0).................................................. 9 9 21 13

Land and Structures (32.0) ...................................

Investments and Loans (33.0)................................

Grants, subsidies, and contributions (41.0)............. 2,088,083 2,119,788 2,868,549 748,761

Interest and dividends (43.0)..................................

Refunds (44.0)......................................................

Total Non-Pay Costs........................................... 2,142,865 2,175,465 2,935,406 759,941

Total Budget Authority by Object Class.............. 2,171,000 2,206,000 2,970,831 764,831
SUPPLEMENTARY TABLES

284 

Budget Authority by Object Classification Table – Reimbursable 

Administration for Community Living

(Dollars in Thousands) 

FY 2020 

Final

FY 2021 

Enacted

FY 2022 

President's 

Budget

FY 2022 +/- 

FY 2021

Personnel compensation:

Full-time permanent (11.1).................................. 1,207 1,320 1,347 28

Other than full-time permanent (11.3)................... 17 18 18 0

Other personnel compensation (11.5).................. 24 27 27 1

Military personnel (11.7).....................................

Special personnel services payments (11.8).........

Subtotal personnel compensation................ 1,248 1,364 1,393 29

Civilian benefits (12.1)........................................... 421 460 470 10

Military benefits (12.2)...........................................

Benefits to former personnel (13.0)........................

Total Pay Costs................................................... 

- - - - 

1,669 1,825 1,863 38

Travel and transportation of persons (21.0).............. 5 6 71 65

Transportation of things (22.0)................................

Rental payments to GSA (23.1)............................. 905 919 928 9

Rental payments to Others (23.2)...........................

Communication, utilities, and misc. charges (23.3)..

Printing and reproduction (24.0)..............................

Other Contractual Services:

Advisory and assistance services (25.1)............... 3,475 3,799 3,828 29

Other services (25.2).......................................... 472 530 534 4

Purchase of goods and services from

government accounts (25.3)............................. 1,009 1,132 1,140 8

Operation and maintenance of facilities (25.4)....... - 

Research and Development Contracts (25.5)........

Medical care (25.6)............................................

Operation and maintenance of equipment (25.7)... - 

Subsistence and support of persons (25.8)...........

Subtotal Other Contractual Services............ 4,956 5,460 5,501 41

Supplies and materials (26.0)................................. -

Equipment (31.0).................................................. -

Land and Structures (32.0) ...................................

Investments and Loans (33.0)................................

Grants, subsidies, and contributions (41.0)............. 127,779 143,605 144,578 973

Interest and dividends (43.0)..................................

Refunds (44.0)......................................................

Total Non-Pay Costs........................................... 133,646 149,990 151,079 1,089

Total Budget Authority by Object Class.............. 135,315 151,815 152,942 1,127
SUPPLEMENTARY TABLES

285 

Salaries and Expenses – Direct

Administration for Community Living

(Dollars in Thousands) 

FY 2020 

Final

FY 2021 

Enacted

FY 2022 

President's 

Budget

FY 2022 +/- 

FY 2021

Personnel compensation:

Full-time permanent (11.1).................................................................. 19,942 21,680 25,151 3,472

Other than full-time permanent (11.3)............................................... 768 916 1,063 147

Other personnel compensation (11.5).............................................. 393 305 354 49

Military personnel (11.7)....................................................................

Special personnel services payments (11.8)....................................

Subtotal personnel compensation.................................................... 21,103 22,901 26,568 3,667

Civilian benefits (12.1)........................................................................ 6,998 7,634 8,856 1,222

Military benefits (12.2)........................................................................

Benefits to former personnel (13.0).................................................. 34 - - -

Total Pay Costs................................................................................... 28,135 30,535 35,425 4,890

Travel and transportation of persons (21.0).................................... 100 81 391 310

Transportation of things (22.0)......................................................... 2 2 3 1 

Rental payments to GSA (23.1)......................................................... 3,245 3,295 3,327 32

Rental payments to Others (23.2)......................................................

Communication, utilities, and misc. charges (23.3)......................... 159 180 268 87

Printing and reproduction (24.0)....................................................... 6 7 8 2 

Other Contractual Services:

Advisory and assistance services (25.1)......................................... 39,469 40,105 47,905 7,800

Other services (25.2)........................................................................... 1,347 1,369 1,843 475

Purchase of goods and services from

government accounts (25.3).............................................................. 10,403 10,571 12,994 2,423

Operation and maintenance of facilities (25.4)................................ 1 1 1 1 

Research and Development Contracts (25.5)..................................

Medical care (25.6)..............................................................................

Operation and maintenance of equipment (25.7)............................ 15 21 6 

Subsistence and support of persons (25.8).....................................

Subtotal Other Contractual Services............................................. 51,220 52,061 62,764 10,703

Supplies and materials (26.0)............................................................. 42 43 75 32

Total Non-Pay Costs........................................................................... 54,773 55,669 66,836 11,167

Total Salary and Expense.................................................................. 82,908 86,203 102,260 16,057

Direct FTE............................................................................................ 159 176 200 24
SUPPLEMENTARY TABLES

286 

Detail of Full Time Equivalents (FTE)

Administration for Community Living

 Total:...................................................................... 15.0 0 15 15.0 0 15 0.0 0 0.0

Administration on Aging

 Direct: 32 32 35 35 0

 Reimbursable: 4.5 4.5 4.5 4.5 0

 Total:...................................................................... 36.5 0 36.5 39.5 0 39.5 0.0 0 0.0

Administration on Disabilities

 Direct: 26 26 26 26 0

 Reimbursable: 1.6 1.6 1.6 1.6 0

 Total:...................................................................... 27.6 0 27.6 27.6 0 27.6 0.0 0 0.0

Center for Policy and Evaluation

 Direct: 13 13 13 13 0

 Reimbursable: 4.2 4.2 4.2 4.2 0

 Total:...................................................................... 17.2 0 17.2 17.2 0 17.2 0.0 0 0.0

Center for Management and Budget

 Direct: 39 39 42 42 0

 Reimbursable: 0 0 0 0 0

 Total:...................................................................... 39.0 0 39.0 42.0 0 42.0 0.0 0 0.0

Center for Innovation and Partnerships

 Direct: 8 8 8 8 0

 Reimbursable: 12.0 12 12.0 12 0

 Total:...................................................................... 20.0 0 20 20.0 0 20 0.0 0 0.0

Center for Regional Operations

 Direct: 10.0 10.0 10.0 10 0

 Reimbursable: 0 0 0 0 0

 Total:...................................................................... 10.0 0 10.0 10.0 0 10 0.0 0 0.0

National Institute on Disability, Independent Living, 

and Rehabilitation Research

 Direct: 24 24 24 24 0

 Reimbursable: 0 0 0 0 0

 Total:...................................................................... 24.0 0 24 24.0 0 24 0.0 0 0.0

ACL FTE Total........................................................ 189.3 0.00 189.3 195.3 0.00 195.3 0 0 0

Appropriation Account Title

Detail of Full Time Equivalents (FTE)

2020 2020 2020 2021 2021 2021 2022 2022 2022 

Est. Est. Est. Est. Est. Est. Est. Est. Est. 

Civilian Military Total Civilian Military Total Civilian Military Total

Immediate Office of the Administrator

 Direct: 15 15 15 15 0

 Reimbursable: 0 0 0 0 0
SUPPLEMENTARY TABLES

287 

Detail of Positions

Administration for Community Living

2020 

Est. 

Civilian

2020 

Est. 

Military

2020 Est. 2021 Est. 

Total Civilian

2021 

Est. 

Military

2021 Est. 

Total

2022 

Est. 

Civilian

2022 

Est. 

Military

2022 Est. 

Total

Immediate Office of the Administrator

 Direct: 16 16 17 17 21 21

 Reimbursable: 0 0 0 0 0 0

 Total:........................................................ 16 0 16 17 0 17 21 0 21

Administration on Aging

 Direct: 22 22 27 27 31 31

 Reimbursable: 2 2 4 4 3 3

 Total:........................................................ 25 0 25 31 0 31 34 0 34

Administration on Disabilities

 Direct: 21 21 21 21 24 24

 Reimbursable: 2 2 2 2 2 2

 Total:........................................................ 23 0 23 24 0 24 26 0 26

Center for Policy and Evaluation

 Direct: 6 6 7 7 10 10

 Reimbursable: 5 5 5 5 5 5

 Total:........................................................ 11 0 11 13 0 13 15 0 15

Center for Management and Budget

 Direct: 35 35 42 42 50 50

 Reimbursable: 0 0 0 0 0 0

 Total:........................................................ 35 0 35 42 0 42 50 0 50

Center for Innovation and Partnerships

 Direct: 10 10 11 11 13 13

 Reimbursable: 12 12 12 12 12 12

 Total:........................................................ 21 0 21 23 0 23 25 0 25

Center for Regional Operations

 Direct: 11 11 11 11 11 11

 Reimbursable: 0 0 0 0 0 0

 Total:........................................................ 11 0 11 11 0 11 11 0 11

National Institute on Disability, Independent Living, 

and Rehabilitation Research

 Direct: 27 27 27 27 30 30

 Reimbursable: 0 0 0 0 0 0

 Total:........................................................ 27 0 27 27 0 27 30 0 30

ACL FTE Total............................................. 170 0 170 188 0 188 212 0 212

Average GS Grade

FY 2018 13.1

FY 2019 13.3

FY 2020 13.2

FY 2021 13.1

FY 2022 13.1
SUPPLEMENTARY TABLES

288 

Programs Proposed for Elimination

Administration for Community Living

ACL has no programs proposed for elimination. 
SUPPLEMENTARY TABLES

289 

FTE Funded by P.L. 111-148 and Any Supplementals

Administration for Community Living

FY 2012 FY 2013 FY 2014

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 $ 3,000 1 0 $ 86 0 0 $ - 0 0

 Medicare Improvements for Patients & Providers Act Programs Section 3306 $ - 0 0 $ 25,000 0 0 $ - 0 0

New programs authorized and funded by ACA (Mandatory)

 Aging and Disability Resource Centers Section 2405 $ 10,000 4 0 $ 9,490 4 0 $ 9,280 3 0

New programs funded from the PPHF under ACA (Discretionary)

 Adult Protective Services (Prevention & Public Health Fund) Section 4002 $ 6,000 0 0 $ 2,000 0 0 $ - 0 0

 Chronic Disease Self-Management Education (PPHF) Section 4002 $ 10,000 0 0 $ 7,086 1 0 $ 8,000 0 0

 Alzheimer's Disease Initiative--Supportive Services (PPHF) Section 4002 $ - 0 0 $ - 0 0 $ 10,500 0 0

 Alzheimer's Disease Initiative--Communications (PPHF) Section 4002 $ 4,000 0 0 $ 150 0 0 $ 4,200 0 0

 Falls Prevention--(PPHF) Section 4002 $ - 0 0 $ - 0 0 $ 5,000 0 0

Programs authorized by ACA but funded by other sources (Discretionary)

 Elder Justice Initiative/Adult Protective Services Subtitle H, Sections 

6701-6703 $ - 0 0 $ - 0 0 $ - 0 0

FY 2015 FY 2016 FY 2017

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 $ 10,500 0 0

 Alzheimer's Disease Initiative--Communications (PPHF) Section 4002 $ 4,200 0 0 $ 4,200 0 0 $ 4,200 0 0

 Alzheimer's Disease Program--(PPHF Allocation) Section 4002 $ - 0 0 $ - 0 0 $ - 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 $ 4,000 2 0 $ 8,000 1 0 $ 10,000 2.5 0

FY 2018 FY 2019 FY 2020

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 $ - 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 $ 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 $ 12,000 2.1 0 $ 12,000 2.35 0 $ 12,000 1.7 0
SUPPLEMENTARY TABLES

290 

 

 

Funded by P.L. 111-148 and Any Supplementals - Continued

Administration for Community Living

FY 2021 FY 2022

Program Section Total FTEs CEs Total FTEs CEs

Pre-existing programs funded by ACA (Mandatory)

 National Clearinghouse for Long-Term Care Information Title VIII

 , 

$ - 0 0 $ - 0 0

 Medicare Improvements for Patients & Providers Act Programs Section 3306 $ - 0 0 $ - 0 0

New programs authorized and funded by ACA (Mandatory)

 Aging and Disability Resource Centers Section 2405 $ - 0 0 $ - 0 0

New programs funded from the PPHF under ACA (Discretionary)

 Adult Protective Services (Prevention & Public Health Fund) Section 4002 $ - 0 0 $ - 0 0

 Chronic Disease Self-Management Education (PPHF) Section 4002 $ - 0 0 $ - 0 0

 Alzheimer's Disease Initiative--Supportive Services (PPHF) Section 4002 $ - 0 0 $ - 0 0

 Alzheimer's Disease Initiative--Communications (PPHF) Section 4002 $ - 0 0 $ - 0 0

 Alzheimer's Disease Program--(PPHF Allocation) Section 4002 $ - 0 0 $ - 0 0

 Falls Prevention--(PPHF) Section 4002 $ - 0 0 $ - 0 0

Programs authorized by ACA but funded by other sources (Discretionary)

 Elder Justice Initiative/Adult Protective Services 6701-6703 , $ 14,000 2.6 0 $ 15,000 2.6 0

 Elder Justice Initiative/Adult Protective Services (American Rescue Plan Act) 6701-6703 $ 88,000 0 0 $ 188,000 1.0 0
SUPPLEMENTARY TABLES

291 

Physicians’ Comparability Allowance 

Administration for Community Living 

ACL does not have anything to submit for this section. 
SUPPLEMENTARY TABLES

292 

Performance Measures Proposed Changes

Administration for Community Living 

ACL does not have anything to submit for this section. 
GOOD ACCOUNTING OBLIGATIONS IN GOVERNMENT ACT

293 

 

 

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

Administration for Community Living 

This request has been moved externally. ACL reports have been sent separate from this 

submission. 
294 

This page intentionally left blank. 
LEGISLATIVE PROPOSALS

295 

 

 

Legislative Proposals

FISCAL YEAR 2022 HHS 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 2021, if full authority was utilized:

• 1⁄2% -- $7,783,816 

• 1% -- $15,567,633 

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

296 

FISCAL YEAR 2022 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 2021, there are 352 CIL

grants, requiring 53 annual onsite compliance reviews. Historically, the program has not met the 

requirement. As demonstrated by pilot desktop reviews conducted in FY2019 and 6 reviews 

conducted in FY2020 whole or in part remotley due to the need to maintain social distancing during 

the pandemic, 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. 

Budget Impact: None 

Personnel Requirements: No change 

Effective Date: Upon enactment
SIGNIFICANT ITEMS

297 

 

 

Significant Items

Administration for Community Living 

1-National Technical Assistance Center on Grand families. The Committee encourages ACL 

to work with the Advisory Council to Support Grandparents Raising Grandchildren and with ACF, 

to coordinate the establishment of a Technical Assistance Center on Grandfamilies to provide 

information, resources and individualized technical assistance and support to help State, tribal, and 

local agencies and non-profit organizations use model practices and programs for serving children, 

parents and caregivers in grandfamilies, including those impacted by parental substance use. 

Action to be Taken: ACL continues its work to implement the Supporting Grandparents Raising 

Grandchildren Act and leads the work of the Advisory Council to Support Grandparents Raising 

Grandchildren. ACL and the council (of which ACF is an active participant), are identifying and 

compiling a range of resources and information that will be included in the Council’s initial Report 

to Congress. We expect to submit a report in FY 2021, and then update it on a regular basis. ACL 

will use $10 million in resources (available from FY 2021 through FY 2024) provided in the 

American Rescue Plan Act, P.L. 117-2, to coordinate the establishment of a Technical Assistance 

Center on Grandfamilies to help State, tribal, and local agencies and non-profit organizations to 

use model practices and programs to serve children, parents and caregivers in grandfamilies.

2 -Alzheimer’s Disease Program. The Committee continues to support efforts to increase respite 

care services for family members and caregivers supporting individuals living with Alzheimer’s 

Disease and Related Dementias.

Action to be Taken: ACL will continue to make competitive grants available to states and 

communities through the Alzheimer’s Disease Program Initiative (ADPI), the primary focus of 

which is building dementia capable systems of services and supports for persons living with 

Alzheimer’s disease and related dementias (ADRD) and their family caregivers. The ADPI 

focuses on the provision of direct services to persons living with ADRD and their caregivers--

50% of total programs funds must be dedicated to direct services. Respite for caregivers plays a 

significant role in many ADPI grants. ACL program funds are used by grantees to pilot 

innovations in respite care in their communities. ADPI projects have brought and are bringing 

dementia-capable adult day services (ADS) to communities that did not previously have them, as 

well as voucher programs to support ADS attendance for those who would otherwise not be able 

to attend. Programs have also funded volunteer respite initiatives, including bringing companion 

care in to homes, offering weekend respite programs, hosting Memory Cafes and cultural outings 

at museums and other community-based venues. 

During the COVID-19 pandemic respite has become more challenging and much more important 

for caregivers. In response to the pandemic, ACL ADPI grantees have pivoted to on-line activities, 

and offer outdoor programs when possible. All of ACL’s ADPI program activities are evaluated 
SIGNIFICANT ITEMS

298 

to demonstrate their impact on the communities they serve. The evaluation data is expected to aid 

grantees in securing program support beyond the federal funding of their pilots. 

In addition to funding under its Alzheimer’s Disease Program Initiative, ACL also works to expand 

respite services through its Lifespan Respite Services program. These efforts include further 

integrating, sustaining, and advancing Lifespan Respite activities into broader long-term services 

and supports in the State and/or providing additional respite services to family caregivers across 

the age and disability spectrum. By investing in the Lifespan Respite 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.

3 - Elder Rights Support Activities. The Committee encourages ACL to lead efforts to develop 

a coordinated and consistent approach to Adult Protective Services (APS) through development of 

an APS National Data System. The Committee recognizes that the opioid crisis is affecting adult 

protective services, but believes this work should be done as part of increased screening efforts, 

which should be prioritized in order to reduce elder abuse, neglect and exploitation. 

Action to be Taken: ACL launched and runs the National Adult Maltreatment Reporting System 

(NAMRS), which receives voluntarily submitted Adult Protective Services (APS) data from all 50 

States, the District of Columbia, and territories. All data reports for FY 2016-2019 are posted on 

the Adult Maltreatment Reports page (https://namrs.acl.gov/Learning-Resources/AdultMaltreatment-Reports.aspx). ACL is currently updating the NAMRS to capture information on 

APS cases that involve opioids. It is expected that the earliest this information will be reflected 

will be the FY 2021 NAMRS Report. 

ACL further encourages a coordinated and consistent approach to adult protective services 

through the “National Voluntary Consensus Guidelines for State APS Systems” (or APS 

Guidelines). From 2018-2019, ACL facilitated updates of the APS Guidelines. The APS 

Guidelines incorporate information from research and input from the field about effective APS 

practices and policies. Overall, the APS Guidelines are designed to provide APS Administrators 

with recommendations from the field about quality practice, including in responses to abuse that 

originates in opioid misuse. For more information on the APS Guidelines and how states are using 

them, please visit the Voluntary Consensus Guidelines for State APS Systems webpage

(https://acl.gov/programs/elder-justice/final-voluntary-consensus-guidelines-state-aps-systems).

ACL is also supporting Elder Justice State Grants to two State APS programs that will contribute 

to better understanding and responding to the opioid crisis. 

4- Guardianship Systems. The agreement supports continued investment, as established by 

Senate Report 115-289, in research by universities and other eligible entities that seek to develop 

technologies that allow for independent living, address the disabled aging populations, and target 

rural, frontier, and tribal communities. 
SIGNIFICANT ITEMS

299 

Action to be Taken: ACL has long-supported Working Interdisciplinary Networks of 

Guardianships (WINGS) initiatives and will continue to use all appropriate means of facilitating 

information-sharing among existing and emerging State WINGS as an effective approach to 

collective action for guardianship reform. Because WINGS are predominantly chaired and hosted 

by the highest state courts, we anticipate continued national support for WINGS initiatives through 

these grants and other opportunities. Additionally, ACL has received a $2 million appropriation 

pursuant to the “Departments of Labor, Health and Human Services, and Education, and Related 

Agencies Appropriations Act, 2021” to award up to 16 demonstration grants under the authority 

of the Elder Justice Act Section 2042(c)(2)(E) to the highest courts of States. In accordance with 

the statutory authority, these grants will assess the fairness, effectiveness, timeliness, safety, 

integrity, and accessibility of adult guardianship and conservatorship proceedings, including the 

appointment, monitoring, and performance of court-appointed guardians and conservators. 

Grantees will implement changes deemed necessary as a result of the assessments. The 

assessments will focus on identifying discrepancies, and fraud that lead to the exploitation of 

protected persons. Changes may include mandating background checks for all potential guardians 

and conservators, implementing systems to enable the annual accountings and other required 

conservatorship and guardianship filings to be completed, filed, and reviewed electronically in 

order to simplify the filing process for conservators and guardians and better enable courts to 

identify discrepancies and detect fraud and the exploitation of protected persons. 

5 – Traumatic Brain Injury. The Committee encourages ACL to expand efforts to better 

understand the impacts of TBI on young people. 

Action to be Taken: The Traumatic Brain Injury ((TBI) State Partnership Program grantees work 

within their respective states to create and strengthen person-centered systems of services and 

supports that maximize the independence, health, and well-being of people with TBI. Grantees 

develop state plans that focus their efforts on building and expanding infrastructure that supports 

the state’s priorities and makes use of the state’s unique resources and partnerships. ACL requires 

that these state plans include goals for closing the gap of unmet or insufficiently met needs of 

children and youth with TBI in the state.

Specifically, many grantees leverage TBI grant funds to develop and strengthen infrastructures 

within their state Departments of Education in order to better serve students with TBI, particularly 

with respect to strengthening concussion management within school systems and ensuring 

sufficient protocols for students returning to activities after a concussion. Other areas of significant 

infrastructure development involve increasing Workforce Innovation and Opportunity Act 

(WIOA) services for transition-aged youth with TBI across Vocational Rehabilitation and other 

workforce systems and supporting young people involved within states’ justice systems. The 

grantees’ work in these areas continually leads to protocols, tools, and resources that ACL then 

shares with other states to encourage and facilitate expanded work on behalf of and in support of 

children and youth with TBI. 

ACL anticipates that these activities addressing the impact of TBI on children and youth with TBI 

will continue as part of the TBI State Partnership Program. 
SIGNIFICANT ITEMS

300 

6- Developmental Disabilities Protection and Advocacy. The Committee supports efforts that 

ensure programs properly account for the needs and desires of patients, their families, and 

caregivers and the importance of affording patients the proper setting for their care. 

Action to be Taken: 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. 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 2018, 36,654 people with disabilities received rights training and 29,514 received advocacy 

training by P&As. In addition, 17,771 people with disabilities received information and referral 

services. 

ACL understands that many people with developmental disabilities need specialized, 

individualized services and supports to live independently, and that for some individuals with 

developmental disabilities, families and caregivers are an integral part of their support system. 

ACL recognizes the important role family members and caregivers can play in ensuring that 

individual preferences are honored and needs are met. ACL will continue to support P&As in 

ensuring they account for the needs and desires of individuals with developmental disabilities, 

their families, and caregivers and in understanding the importance of affording individuals the 

proper setting of their choosing. 

7- Developmental Disabilities Programs. The agreement encourages ACL to consult with the 

appropriate Developmental Disabilities Act stakeholders prior to announcing opportunities for 

new technical assistance projects and to notify the Committees prior to releasing new funding 

opportunity announcements, grants, or contract awards with technical assistance funding. Note: 

The agreement includes not less than $700,000 for technical assistance and training for the State 

Councils on Developmental Disabilities. 

Action to be Taken: ACL gathers information from multiple sources, including the 

Developmental Disabilities Act grantees, training and technical assistance providers and other 

stakeholders with a vested interest in developmental disabilities, as part of our planning process 

for new activities, including technical assistance projects. ACL will communicate with the 

Committees as appropriate prior to releasing new funding opportunity announcements, grants, or 

contract awards with technical assistance funding. 

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. 
SIGNIFICANT ITEMS

301 

Action to be Taken: ACL continues 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 

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- National Institute on Disability, Independent Living, and Rehabilitation Research. The 

agreement supports continued investment, as established by Senate Report 115-289, in research 

by universities and other eligible entities that seek to develop technologies that allow for 

independent living, address the disabled aging populations, and target rural, frontier, and tribal 

communities. 

Action to be Taken: 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.

10- Youth Caregivers. The Committee recognizes the significant barriers and lack of support 

youth caregivers face, and urges ACL and its Family Caregiving Advisory Council to consider 

the needs of youth caregivers in the development and execution of its national family caregiving 

strategy. 

Action to be Taken: Youth caregivers are an ongoing focus of ACL and the Family Caregiving 

Advisory Council (FCAC) currently: 

• The FCAC’s initial Report to Congress is well under development and includes a section 

on the specific needs and challenges of younger caregivers. 

• ACL fully expects that the National Family Caregiving Strategy will include specific 

actions that can be taken on behalf of youth caregivers to improve the recognition and 

support of their particular circumstances. 

• The National Academy for State Health Policy, under a grant from The John A. Hartford 

Foundation, established a resource, technical assistance and dissemination center to 

support the work of the Family Caregiving Advisory Council (FCAC). As part of this 

grant, NASHP has convened a faculty of advisors to their work. The faculty includes 

representation of the Association of Caregiving Youth. 
SIGNIFICANT ITEMS

302 

As part of its grant, NASHP convened a series of caregiver focus groups to delve into the key 

issues and challenges faced by family caregivers. A focus group of young caregivers was 

convened and the findings are being included in the FCAC’s initial Report to Congress.
303 

 

 

ACL Specific Requirements 

Administration for Community Living 

See individual chapters for the ACL specific requests. 
310

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
311

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.