Contents

• Introduction
• Older Americans Act: Current Law
• Title I. Declaration of Objectives; Definitions
• Title II. Administration on Aging
• Aging and Disability Resource Centers
• Senior Medicare Patrol Program
• Title III. Grants for State and Community Programs on Aging
• Title IV. Activities for Health, Independence, and Longevity
• Title V. Community Service Employment for Older Americans
Senior Opportunities Act
• Title VI. Grants for Services for Native Americans
• Title VII. Vulnerable Elder Rights Protection Activities
• FY2016FY2017 Appropriations Overview
• OAA Funding History

Introduction

The Older Americans Act (OAA) supports a wide range of social services and programs for individuals aged 60 years or older. These include supportive services, congregate nutrition services (i.e., meals served at group sites such as senior centers, community centers, schools, churches, or senior housing complexes), home-delivered nutrition services, family caregiver support, community service employment, the Long-Term Care Ombudsman Program, and services to prevent the abuse, neglect, and exploitation of older persons. Except for Title V, Community Service Employment for Older Americans (CSEOA), all programs are administered by the Administration on Aging (AOA) in the Administration for Community Living (ACL) within the Department of Health and Human Services (HHS). Title V is administered by the Department of Labor's (DOL's) Employment and Training Administration.

The OAA has been reauthorized and amended numerous times since it was first enacted in 1965. In the 114^th Congress, both the House and the Senate considered bipartisan legislation that would reauthorize the OAA for a three-year period. On April 19, 2016, President Barack Obama signed P.L. 114-144 (S. 192), the Older Americans Act Reauthorization Act of 2016. P.L. 114-144 authorizes appropriations for OAA programs for FY2017 to FY2019.¹ Prior to enactment of P.L. 114-144, the Older Americans Act Reauthorization of 2016, the last OAA reauthorization occurred in 2006, when the Older Americans Act Amendments of 2006 (P.L. 109-365) was enacted, extending the act's authorizations of appropriations through FY2011 (authorizations. Authorizations of appropriations for most OAA programs, expired on September 30, 2011).; however, OAA-authorized activities have continued to receive funding for FY2012 through FY2016.

The following provides an overview of the Older Americans Act. It briefly describes the act's titles, highlighting selected provisions followed by FY2016FY2017 appropriations and a funding history.

Older Americans Act: Current Law

The OAA statutory language contains seven titles, which are summarized in this section, highlighting selected activities. Funding for most OAA programs is provided in annual HHS appropriations; OAA Title V is part of annual DOL appropriations. The next section provides information on FY2016FY2017 appropriations and the act's funding history.² Appendix A provides detailed OAA program budget authority for FY2007 through FY2016FY2017.

Title I. Declaration of Objectives; Definitions

Title I of the OAA sets out broad social policy objectives oriented toward improving the lives of all older Americans, including adequate income in retirement, the best possible physical and mental health, opportunity for employment, and comprehensive long-term care services, among other things. Also, Title I provides definitions for various terms under the act. Title I does not authorize appropriations.

Title II. Administration on Aging

Title II establishes the Administration on Aging (AOA) as the chief federal agency advocating for older persons and sets out the responsibilities of AOA and the Assistant Secretary for Aging. The Assistant Secretary is appointed by the President with the advice and consent of the Senate. Title II also establishes State Units on Aging (SUAs), who serve as the state agency primarily responsible for planning and policy development as well as administration of OAA activities. In addition, the act authorizes the Assistant Secretary to make grants to eligible tribal organizations for social and nutrition services to older Native Americans.

Title II also establishes Area Agencies on Aging (AAAs), which are designated by SUAs to operate within specifieda planning and service areasarea (PSA) designated by the SUA. AAAs serve as local entities who, either directly or through contract with local service providers (LSPs), oversee a comprehensive and coordinated service system for the delivery of social, nutrition, and long-term services and supports to older individuals. AAAs are required to be public or private nonprofit organizations. According to 2015 research on program structure and administration, the majority of AAAs were public organizations (62% public versus 38% private nonprofit).³ Collectively, these 56 SUAs, over 600 AAAs and 260246 tribal and Native Hawaiian organizations, and almost 20,000 aging and social service providers in local communities comprise the Aging Network (see Figure 1).³4 With respect to the distribution of federal funding, AOA allocates federal funds authorized under OAA statutory funding formulas to SUAs and tribal organizations. SUAs, in turn, award these funds to AAAs based on an intrastate funding formula developed in accordance with AOA guidelines and approved by the Assistant Secretary.

Figure 1. The Aging Network

Source: Prepared by the Congressional Research Service.

Discretionary funding authorized under Title II goes toward program administration and Aging and Disability Resource Centers (ADRCs), described in greater detail below, as well as other authorized activities that support the Aging Network and Elder Rights activities (see textbox entitled "OAA Title II: Aging Network and Elder Rights Support Activities"). Program administration funding for all Administration for Community Living (ACL) programs, which includes those authorized by the OAA, wereis funded at $40.1 million in FY2016FY2017.

Aging and Disability Resource Centers

The aim of Aging and Disability Resource Centers (ADRCs) is to create "one-stop shop" single entry points for information about the range of public and private long-term services and supports (LTSS) available to consumers. ADRCs may provide options counseling regarding public and private LTSS, and provide access to public programs such as Medicaid and Department of Veterans Affairs programs. ADRCs may also provide discharge planning and care transition services to help individuals remain in their own homes after a hospitalization, rehabilitation, or skilled nursing facility visit. There are over 500 ADRC sites nationwide, operating in 50 states, threetwo territories, and the District of Columbia.⁴ Funding5 Discretionary funding to ADRCs wasis $6.1 million in FY2016.

Senior Medicare Patrol Program

Also authorized under Titles II and IV (Sections 201, 201, and 411) of the OAA is the Senior Medicare Patrol (SMP) Program, which funds projects that educate older Americans and their families to recognize and report Medicare and Medicaid fraud. Beginning in FY2016, discretionary funding under ACL's budget authority is no longer provided for SMP. Instead, FY2016 and FY2017 appropriations language fully fundsfund SMP activities under discretionary appropriations from the Center'sCenters for Medicare &and Medicaid Services (CMS) Health Care Fraud and Abuse Control (HCFAC) account. This account distributes funding to various anti-fraudantifraud activities from the Medicare Trust Fund at the joint discretion of the HHS Secretary and Attorney General, and distributes certain discretionary appropriations at the discretion of Congress. Total SMP funding for the program was $17.6 million in FY2015. For FY2016 SMP funding was $18.0 million. ACL estimates FY2017ACL estimates FY2016 SMP funding at the same level.⁵

Title III. Grants for State and Community Programs on Aging

Title III authorizes grants to 56 SUAs and over 600 AAAs to act as advocates on behalf of, and to coordinate programs for, older persons. Title III accounted for 70.7accounts for 72.0% of the OAA's total FY2016FY2017 funding ($1.353358 billion out of $1.915888 billion). States receive separate allotments of funds based on a statutory funding formula for supportive services and centers, family caregiver support, congregate nutrition, home-delivered nutrition, the nutrition services incentive grant program, and disease prevention and health promotion services.⁶8 The OAA allows states some flexibility to transfer funds among Title III programs. For example, in FY2014FY2015, states collectively transferred a net total of $77.397.4 million from congregate nutrition to either supportive services or home-delivered nutrition.⁷

Title III services are available to all persons aged 60 and older, but are targeted at those with the greatest economic or social need, particularly low-income and minority persons, older individuals with limited English proficiency, and older persons residing in rural areas. Means testing is prohibited. Participants are encouraged to make voluntary contributions for services they receive. States are allowed to implement cost-sharing policies for certain services based on a sliding-scale fee basis, but older persons must not be denied services due to failure to make cost-sharing payments. State, local, and private funding sources also supplement federal OAA funds for these services.

In 2014FY2015, the most recent year for which data are available, 10.911.6 million older persons were served by Title III programs.⁸10 Title III services included the provision of 138.0142.6 million home-delivered meals; 80.379.4 million congregate meals; 22.223.6 million rides to medical appointments, grocery stores, and other activities; 36.538.9 million hours of personal care, homemaker, and chore services; and 8.59.9 million hours of adult day care/adult day health services in FY2014.

Title IV. Activities for Health, Independence, and Longevity

Title IV of the OAA authorizes the Assistant Secretary for Aging to award funds for training, research, and demonstration projects in the field of aging.⁹ Over the years, Title IV has supported a wide range of research and demonstration projects, including those related to income, health, housing, retirement, and long-term services and supports, as well as projects on career preparation and continuing education for personnel in the field of aging. Title IV activities received $16receive $18.7 million in discretionary funding FY2016for FY2017. Funding provided under Title IV goes toward various activities that are designed to support health, independence, and longevity of older individuals (see textbox entitled "OAA Title IV: Activities for Health, Independence, and Longevity").¹⁰

Title V. Community Service Employment for Older Americans

Title V, Community Service Senior Opportunities Act, also known as Community Service Employment for Older Americans (CSEOA), also known as or the Senior Community Service Employment Program (SCSEP), has as its purpose the promotion of useful part-time opportunities in community service activities for unemployed low-income¹¹13 persons who are 55 years or older and who have poor employment prospects. The Title V program is administered by DOL's Employment and Training Administration; it is the only OAA program not administered by HHS under ACL. For FY2016FY2017, Title V represented 22.7represents 21.2% of OAA discretionary funding ($434.4400.0 million out of $1.915888 billion). DOL allocates Title V funds for grants based on a statutory funding formula to state agencies in all 50 states, the District of Columbia, Puerto Rico, and the U.S. territories, and to national organizations. There is a 10% nonfederal match requirement for Title V grant activities.

SCSEP participants are placed in part-time positions working in a variety of community service activities, such as in day care centers, senior centers, schools, and hospitals.¹²14 Participants work part-time and receive on-the-job experience and skills. The program operates on a program year (PY) basis from July 1 through June 30.¹³15 For PY2014PY2015 (ending June 30, 20152016), the CSEOA program supported 44,790 job slots, serving 67,35665,170 participants, at a cost of $6,449702 per participant.¹⁴16 Enrollees are paid no less than the highest of the federal minimum wage, the state or local minimum wage, or the prevailing wage paid by the same employer for similar public occupations. In addition to wages, enrollees receive training, physical examinations, personal and job-related counseling, transportation for employment purposes (under certain circumstances), and placement assistance into unsubsidized jobs. In PY2014, 46PY2015, 50.7% of participants who exited the program found employment in the following quarter; of those, 7473.6% remained employed through the next two quarters.% remained employed through the next two quarters.¹⁵

On September 1, 2010, DOL promulgated a final rule implementing changes made by the 2006 OAA amendments.¹⁶ These changes include a 48-month limit on individual participation, increases in funds available for training and supportive services, and a requirement that national grants recompete every four years, among other changes. A competition for national grantees is being conducted for PY2016.¹⁷

Title VI. Grants for Services for Native Americans

Title VI authorizes funds for supportive and nutrition services to older Native Americans. Funds are awarded directly by ACL to Indian tribal organizations, Native Alaskan organizations, and non-profitnonprofit groups representing Native Hawaiians. To be eligible for funding, a tribal organization must represent at least 50 Native Americans aged 60 and older. In FY2015, grants were awarded to 264 tribal organizations representing 400 Indian tribes, including one organization serving Native Hawaiian elders.¹⁸ The program provides services such as transportation, home-delivered and congregate nutrition services, information and referral, and a wide range of home care services. Title VI also authorizes caregiver support services to Native American elders. Respite, caregiver training, information and outreach, counseling, and support groups are among the services provided. For FY2016FY2017, these programs receivedreceive $38.78 million ($31.2 million for supportive and nutrition services, and $7.56 million for Native American family caregivers).

Title VII. Vulnerable Elder Rights Protection Activities

Title VII authorizes the Long-Term Care (LTC) Ombudsman Program as well as Elder Abuse, Neglect, and Exploitation Prevention Programs. For FY2016FY2017, these programs receivedare funded at a total of $20.7 million.¹⁹ The majority of Title VII funding ($15.9 million, or 77%, in FY2016FY2017) is directed at the LTC Ombudsman Program, which investigates and resolves complaints of residents in nursing facilities, board and care facilities, and other adult care homes. In FY2014FY2015, ombudsmen handled more than 191199,000 resident complaints and provided almost 491520,000 consultations to individuals and long-term care facilities.²⁰

FY2016FY2017 Appropriations Overview

The Consolidated Appropriations Act, 20162017 (P.L. 114-113115-31) provided discretionary appropriations for OAA programs, projects, and activities under ACL's Aging and Disability Services Programs budget authority and the Department of Labor budget authority at an estimated total of $1.915888 billion, which is $36.726.8 million (2.0%) more than FY20151.4%) less than FY2016 levels.^21,22 Figure 2 shows the distribution of FY2016FY2017 OAA discretionary amounts by title, with program -level detail for Title III State and Community Programs on Aging. Title III programs received the largest proportion of OAA funding, with 70.772.0% of funding appropriated to nutrition, supportive services, family caregivers, and health promotion activities. Almost one-fourthMore than one-fifth of OAA funding (22.7%) was21.2%) is allocated to Title V, the CSEOA Program. The remaining funds wereare allocated to AOA-administered activities under Titles II (2.7%) and IV (0.91.0%), grants to Native Americans under Title VI (2.01%), and vulnerable elder rights protection activities under Title VII (1.1%).

Several OAA programs saw increases in funding for FY2016FY2017 compared with FY2015FY2016-enacted levels. Title III programs received an additional $5.02.5 million for family caregivers and about $10.0supportive services and senior centers and $3 million in additional funding for congregate and home-delivered nutrition services, respectively. Title VI grants to Native Americans received an additional $6.5 million for75,000 for supportive and nutrition and caregiver services. Under Title IV, Elder Rights Support Activities receivedreceive an additional $42.0 million for a total of $810.0 million for Elder Justice and Adult Protective Services program activities. Title V, the CSEOA program, saw a decrease in funding of $34.4 million, 7.9% less than the FY2016 level.0 million for Elder Justice.

P.L. 114-113 also changed the source of funding for the Senior Medicare Patrol Program from discretionary appropriations provided directly to ACL to discretionary appropriations under the Center's for Medicare & Medicaid Services (CMS) Health Care Fraud and Abuse Control (HCFAC) account. ACL will continue to administer the program.

Figure 2. Older Americans Act, FY2016FY2017 Discretionary Appropriations (funding in millions of dollars and as a percentage of total OAA funding, $1.915888 billion)

Source: Division H of the "Explanatory Statement Submitted by Mr. Rogers of KentuckyFrelinghuysen of New Jersey, Chairman of the House Committee on Appropriations, Regarding the House Amendment No. 1 to the Senate AmendmentAmendments on H.R. 244,"H.R. 2029, Consolidated Appropriations Act, 2016," House of Representatives, Congressional Record, vol. 161163, no. 18476 Book III (December 17, 2015), pp. H10289, H10296, H10331-H10334; and U.S. Department of Health and Human Services, Administration for Community Living, Fiscal Year 2017 Justification of Estimates for Appropriations Committees. May 3, 2017), pp. H3997-H4000; and Personal communication with G. Steven Hagy, director, ACL Office of Budget and Finance, May 25, 2017. Note: Sums may not total due to rounding.

OAA Funding History

Annual increases in OAA discretionary funding occurred from FY2007 to FY2010. Since then, overall OAA funding levels have remained below the FY2010 level (see Figure 3). OAA funding increased steadily from $1.855 billion in FY2007 to $2.328 billion in FY2010, an overall increase of 25.5% over this time period (not adjusted for inflation). Additional funding was provided in FY2009 under the American Recovery and Reinvestment Act (ARRA; P.L. 111-5). For FY2010, a one-time special appropriation funded the CSEOA Program to serve low-income seniors affected by the recession.

Total discretionary funding for OAA programs declined in FY2011 through FY2013, with FY2013 funding of $1.807 billion falling below the FY2007 level. Most of the 5.5% reduction from FY2012 to FY2013 is attributable to sequestration.²³22

For FY2014 through FY2016, total OAA funding has increased slightly each year from the FY2013 level, which was the lowest level of OAA funding over the 10-year period from FY2007 to FY2016. FY2017 saw a funding decrease, with total OAA funding at 1.4% less than FY2016; most of the decrease is due to a 7.9% reduction to Title V CSEOA funding in FY2017. (Amounts in this discussion are not adjusted for inflationinflation.) For programs and activities funded by OAA title over this time period, see Appendix A, Table A-1.

Figure 3. Total Discretionary Funding for Older Americans Act Programs, FY2007-FY2016 FY2017 ($ billions)

Source: Prepared by CRS based on appropriations legislation, committee reports, explanatory statements, and agency operating plans. Amounts are nominal dollars (not adjusted for inflation). Note: ARRA = American Recovery and Reinvestment Act (P.L. 111-5).

Appendix A. Older Americans Act Programs: FY2007-FY2016FY2017 Funding

Table A-1 shows the discretionary budget authority history for OAA programs for FY2007 through FY2016FY2017. Amounts are not adjusted for inflation. The table includes several non-addnonadd lines—in italicized font with funding amounts in parentheses—for specific programs within a larger budget account (i.e., Nutrition Services).

Amounts shown in Table A-1 also account for the following:

• Across-the-board reductions though rescissions and the discretionary spending sequestration in FY2013. These include the following:
• The FY2008 Consolidated Appropriations Act (P.L. 110-161) which applied an across-the-board reduction of 1.747% to figures in the bill text and Explanatory Statement narrative (Division G, Title V, §528).
• FY2011 amounts reflect the 0.2% across-the-board rescission required by §1119.
• The FY2012 Consolidated Appropriations Act (P.L. 112-74), Division F, §527, applied a 0.189% across-the-board rescission to most Labor-HHS-Education accounts, including OAA accounts.
• FY2013 amounts reflect sequestration pursuant to the Budget Control Act of 2011 (P.L. 112-25) and the American Taxpayer Relief Act of 2012 (ATRA; P.L. 112-240) and the across-the-board rescission of 0.2% required by the Consolidated and Further Continuing Appropriations Act, 2013 (P.L. 113-6, §3004), and transfers.
• For FY2007 and FY2011, funding for OAA programs was provided through full-year continuing appropriations. This gave the agency some flexibility in allocating funds across programs for these years. To the extent feasible, CRS determined the amounts in these years for each program based on agency budget documents and operating plans.
• For FY2009, budgetary figures include budget authority from both the FY2009 Omnibus Appropriations Act (P.L. 111-8) and the American Recovery and Reinvestment Act (ARRA, P.L. 111-5). OAA Programs received $220 million in total from ARRA as follows:
• $120 million for OAA Title V, CSEOA,
• $65 million for congregate meals,
• $32 million for home-delivered meals, and
• $3 million for Native Americans supportive and nutrition services.

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Footnotes