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 Senior Opportunities Act
• Title VI. Grants for Services for Native Americans
• Title VII. Vulnerable Elder Rights Protection Activities
• FY2019FY2020 Appropriations Overview
• Annual Discretionary Appropriations
• Supplemental Appropriations Related to COVID-19 Response
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 114^116th Congress, both the House and the Senate considered bipartisanpassed legislation that would reauthorize the OAA for a threefive-year period. On April 19, 2016March 25, 2020, President Barack ObamaDonald J. Trump signed P.L. 114-144 (S. 192), the 116-131 (H.R. 4334), the Supporting Older Americans Act of 2020, which authorizes appropriations for OAA programs through FY2024.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 116-131, the last OAA reauthorization occurred in 20062016, when the Older Americans Act Amendments of 2006 (P.L. 109-365Reauthorization Act of 2016 (P.L. 114-144) was enacted, extending the act's authorizations of appropriations through FY2011. Authorizations of appropriations for most OAA programs expired on September 30, 2011; however, OAA-authorized activities continued to receive funding for FY2012 through FY2016FY2019.¹ In response to the Coronavirus Disease 2019 (COVID-19) pandemic, supplemental appropriations laws providing additional funding for OAA programs have been enacted. On March 18, 2020, the President signed P.L. 116-127, the Families First Coronavirus Response Act, which provides a total of $250 million in supplemental funding for expanded food assistance for OAA nutrition services to states and tribal organizations. On March 27, 2020, the President signed P.L. 116-136, the Coronavirus Aid, Relief, and Economic Security (CARES) Act, which provides a total of $870 million in supplemental funding for OAA nutrition services, supportive services, family caregiver services, Aging and Disability Resource Centers (ADRCs), and elder rights protection activities.

The following provides an overview of the Older Americans Act. It briefly describes the act's titles, highlighting selected provisions followed by FY2019 appropriations and aFY2020 appropriations, including supplemental appropriations in response to the COVID-19 pandemic, and 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 FY2019FY2020 appropriations and the act's funding history.² Appendix A provides detailed OAA program budget authority for FY2010FY2012 through FY2019FY2020.

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 operate within a planning and service area (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 a 2016 survey of AAAs across the country, the majority of AAAs were public organizations (55% public versus 39% private nonprofit, and 5% other).³ Collectively, these 56 SUAs, 622 AAAs and over 250 tribal and Native Hawaiian organizations, and tens of thousands of aging and social service providers in local communities comprise the Aging Network (see Figure 1).⁴ 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.

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, is funded at $41.1 million in FY2019FY2020.

Figure 1. The Aging Network

Source: Prepared by the Congressional Research Service.

Aging and Disability Resource Centers

The aim of Aging and Disability Resource Centers (ADRCs) is to create "one-stop shop" single entry points forCenter (ADRC)/No Wrong Door System (NWD) assists with state efforts to streamline access to and provide information about the range of public and private long-term services and supports (LTSS) options available to consumers. The NWD initiative is a collaborative effort among ACL, the Centers for Medicare & Medicaid Services (CMS), and the Department of Veterans Affairs (VA). ACL has provided planning grants to states to deliver person-centered options counseling and to provide access and information about programs that provide LTSS such as Medicaid, the Older Americans Act, and Department of Veterans Affairs programs, as well as state-funded programs. There are over 1,222 access points nationwide, operating across 56 states, territories, and the District of Columbia.⁵ These sites include local AAAs and ADRCs; Centers for Independent Living; Statewide Independent Living Councils; University Centers for Excellence in Developmental Disabilities Education, Research, and Services; and tribal organizations. Discretionary funding to ADRCs is $8.1 million in FY2020.⁶ In addition, P.L. 116-136, the CARES Act, provides $50.0 million in supplemental funding to ADRCs to prevent, prepare for, and respond to coronavirus.⁷available 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, two territories, and the District of Columbia.⁵ Discretionary funding to ADRCs is $8.1 million in FY2019.⁶

Senior Medicare Patrol Program

Title III. Grants for State and Community Programs on Aging

Title III authorizes grants to 56 SUAs and 629 AAAs to act as advocates on behalf of, and to coordinate programs for, older persons.⁹ Title III accounts for 72.973.2% of the OAA's total FY2019FY2020 funding ($1.498538 billion out of $2.055 billion). 100 billion). In addition, a combined $1.020 billion in supplemental Title III funding is appropriated under the Families First Coronavirus Response Act (P.L. 116-127) and the CARES Act (P.L. 116-136) for response to the COVID-19 pandemic (see "Supplemental Appropriations Related to COVID-19 Response").¹⁰ 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.⁹11 The OAA allows states some flexibility to transfer funds among Title III programs. For example, in FY2015FY2016, the most recent year for which data are available, states collectively transferred a net total of $97.496.8 million from congregate nutrition to either supportive services or home-delivered nutrition.¹⁰

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, 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 20162018, the most recent year for which data are available, 11.3about 10.8 million older persons were served by Title III programs.¹¹13 Title III services included the provision of 145.2146.8 million home-delivered meals; 79.273.5 million congregate meals; 23.720.3 million rides to medical appointments, grocery stores, and other activities; 40.747.8 million hours of personal care, homemaker, and chore services; and 10.611.7 million hours of adult day care/adult day health services in 2016.¹²

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. 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 receive $3735.0 million in discretionary funding for FY2019FY2020. 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").¹³15 FY2018 appropriations language accepted ACL's proposal to consolidate the funding of four Alzheimer's programs into one single program, entitled the Alzheimer's Disease Program: (1) Alzheimer's Disease Initiative – Specialized Supportive Services, (2) the Alzheimer's Disease Initiative – Communications Campaign, (3) Alzheimer's Disease Supportive Services, and (4) the National Alzheimer's Call Center.¹⁴16 Total funding is $2326.5 million for FY2019FY2020, of which $811.8 million is discretionary budget authority included in this report and another $14.7 million is mandatory funding from the Prevention and Public Health Fund (PPHF).

Title V. Community Service Senior Opportunities Act

Title V, Community Service Senior Opportunities Act, also known as Community Service Employment for Older Americans (CSEOA) 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-income¹⁶17 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 FY2019FY2020, Title V represents 19.53% of OAA discretionary funding ($400405.0 million out of $2.055100 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 day care centers, senior centers, schools, and hospitals.¹⁷18 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 30.¹⁸19 For PY2016PY2019 (ending June 30, 20172020), the CSEOA program is supporting 41,126 positions), the CSEOA program supported 44,678 job slots, serving 60,002 participants.¹⁹ In FY2017, CSEOA had a cost of $7,339 per participant.²⁰ 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.

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 nonprofit groups representing Native Hawaiians. To be eligible for funding, a tribal organization must represent at least 50 Native Americans aged 60 and older. In FY2017FY2018, grants were awarded to 270 tribal organizations representing 400 Indian tribes and villages, including one organization serving Native Hawaiian elders.²⁴21 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 FY2019FY2020, these programs receive $44.345.0 million ($34.27 million for supportive and nutrition services, and $10.13 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 FY2019FY2020, these programs are funded at a total of $2122.7 million.²⁵22 The majority of Title VII funding ($1617.9 million, or 7879%, in FY2019FY2020) 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 FY2016, ombudsmen handled more than 199,000 resident complaints and provided almost 520addition, $20 million in funding for elder rights protection activities, including the long-term care ombudsman, has been provided under the CARES Act (P.L. 116-136) for response to the COVID-19 pandemic. In 2018, ombudsmen handled more than 194,000 resident complaints and provided more than 543,000 consultations to individuals and long-term care facilities.²⁶

FY2019FY2020 Appropriations Overview

The Department of Defense and Labor, Health and Human Services, and Education Appropriations Act, 2019 and Continuing Appropriations Act, 2019 (P.L. 115-245),following provides information on FY2020 discretionary appropriations provided in annual HHS and DOL appropriations, as well as supplemental appropriations in response to the COVID-19 pandemic. Annual Discretionary Appropriations The Further Consolidated Appropriations Act, 2020 (P.L. 116-94) 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 $2.055100 billion for FY2019FY2020, which is $17.144.5 million (0.82.2%) more than FY2018 levels.²⁷the FY2019 level.²⁴ Figure 2 shows the distribution of FY2019FY2020 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 72.973.2% of funding appropriated to nutrition, supportive services, family caregivers, and health promotion activities. About one-fifth of OAA funding (19.53%) is allocated to Title V, the CSEOA Program. The remaining funds are allocated to AOA-administered activities under Titles II (2.6%) and IV (1.87%), grants to Native Americans under Title VI (2.21%), and vulnerable elder rights protection activities under Title VII (1.1%).

Several OAA programs saw increases in funding for FY2019FY2020 compared with FY2018FY2019-enacted levels. Title III programs received a $515.0 million increase in funding for congregate nutrition services and home-delivered nutrition services each, and an additional $0.604.8 million was appropriated for the National Family Caregiver Support Program. An additional $5.0 million was provided for Title IV Aging Network Support Activities for new Care Corps Demonstration Grants and $5.0 million for Supportive Services and Senior Centers. Title VI grants to Native Americans received an increase of $1.5 million750,000 for supportive and nutrition andservices, as well as caregiver services.

Title V, the CSEOA program, saw no changean increase of $5.0 million in funding compared to the FY2018 level of $400.0 millionFY2019 level.

Figure 2. Older Americans Act, FY2019FY2020 Discretionary Appropriations (funding as a percentage of total OAA funding, $2.055100 billion)

Source: H.Rept. 115-952, pp. 71, 107-108, 540-541, 551, 587-590Explanatory statement submitted by Rep. Lowey, Chairwoman of the House Committee on Appropriations regarding H.R. 1865, Further Consolidated Appropriations Act, 2020, Congressional Record, December 17, 2019, pp. H11079, H11089, H11127-H11130; personal communication with G. Steven Hagy, director, ACL Office of Budget and Finance, October 22, 2018January 10, 2020. Note: Sums may not total due to rounding. Supplemental Appropriations Related to COVID-19 Response In response to the Coronavirus Disease 2019 (COVID-19) pandemic, supplemental appropriations have provided an additional $1.120 billion in funding for OAA programs and activities to prevent, prepare for, and respond to coronavirus.25 On March 18, 2020, the President signed P.L. 116-127, the Families First Coronavirus Response Act, which provides a total of $250.0 million in supplemental funding for expanded food assistance for OAA nutrition services to states and tribal organizations. Funding is to remain available until September 30, 2021. Specifically, P.L. 116-127 provided $80.0 million for congregate nutrition and $160.0 million for home-delivered nutrition, and $10.0 million for nutrition services to Native Americans.26 On March 27, 2020, the President signed P.L. 116-136, the Coronavirus Aid, Relief, and Economic Security (CARES) Act, which provides a total of $870.0 million in supplemental funding for OAA nutrition services, supportive services, family caregiver services, ADRCs, and elder rights protection activities.27 Funding is to remain available until September 30, 2021. Specifically, P.L. 116-136 provides an additional $480.0 million for nutrition services to states and U.S. territories, $20.0 million for nutrition services to Native Americans, $200.0 million for supportive services, $100.0 for family caregiver services, $50.0 million for ADRCs, and $20.0 million for elder rights protection activities, including the long-term care ombudsman program.28 For all activities funded by OAA title under these supplemental appropriations for COVID-19 response, see Table A-1. . Note: Sums may not total due to rounding.

OAA Funding History

Overall, total annual OAA discretionary funding has declinedincreased over the 10-year period from FY2010 to FY2019 (not adjusted for inflation). Since FY2010, total OAA funding levels have remained below the FY2010 level when discretionary funding was at its highest amount of $2.328 billion (see Figure 3). For FY2010, a one-time special appropriation provided additional funding to 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 of $1.855 (FY2011 to FY2020, with the largest one-year increase of 56.7% in funding for FY2020 due to the COVID-19 pandemic (not adjusted for inflation; see Figure 3). For FY2020, total OAA funding, including supplemental funding to respond to the needs of seniors during the COVID-19 pandemic, is at its highest level ($3.220 billion) in the act's 55-year history. Prior to FY2020, total OAA funding levels had remained below the FY2010 level, when funding was at its previously highest level of $2.328 billion (not shown) due to supplemental funding provided to the CSEOA Program to serve low-income seniors affected by the Great Recession. Total OAA funding declined in FY2011 through FY2013, when funding was at $1.807 billion, its lowest level over the 10-year period (this amount was also below the FY2007 level of $1.855, not shown). Most of the 5.5% reduction from FY2012 to FY2013 is attributable to sequestration.²⁸

29 For FY2014 through FY2016, total OAA funding increased slightly each year from the FY2013 level, which was the lowest level of OAA funding over the 10-year period. . FY2017 saw a slight 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. In FY2018, total OAA funding increased by $150.2 million, or 8.0%, which is the largest increase in funding over the same 10-year period. For FY2019, total OAA funding increased by $17.1 million, or 0.8Total OAA funding increased by 8.0% in FY2018 and 1.0% in FY2019. Total OAA funding for FY2020, including supplemental funding in response to the COVID-19 pandemic, increased by $1.165 billion, 56.7%. (Amounts in this discussion are not adjusted for inflation.) For programs and activities funded by OAA title over this time period, see Appendix ATable A-1.

Figure 3. Total Discretionary Funding for Older Americans Act Programs, FY2010-FY2019 ($ billions) FY2011-FY2020

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: The FY2010 Title V funding level included $225 million that, according to the DOL, "was intended as a one-time provision related to current economic conditions. The additional funding was provided as a short-term program expansion to support temporary job opportunities for low-income elderly individuals while the nation recovers from the economic downturn." (DOL, FY2011 Congressional Budget Justification, Employment and Training Administration, Community Service Employment for Older Americans (CSEOA), p. CSEOA-2).

Appendix A. Older Americans Act Programs: FY2010-FY2019FY2012-FY2020 Funding

Table A-1 shows the discretionary budget authority history for OAA programs for FY2010FY2012 through FY2019FY2020. Amounts are not adjusted for inflation. The table includes several nonaddnon add 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:
• 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 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.

Appendix B. Older Americans Act: Authorizations of Appropriations

p. P.L. 116-136, Coronavirus Aid, Relief, and Economic Security Act (CARES Act) provides $20.0 million for OAA Title VII services that ACL allocated to the Long-Term Care Ombudsman Program. Appendix B. Authorizations of Appropriations for Older Americans Act (OAA) ProgramsTable B-1 provides authorizations of appropriations under the Older Americans Act, as amended by P.L. 114-144116-131. Authorizations of appropriations are shown by OAA title and program or activity (Titles II through VII). No authorizations of appropriations are under Title I of the act.

Authorizations of appropriations for each fiscal year (FY2017FY2020 through FY2019FY2024) have been summed to show a total amount for each year (bottom of Table B-1). However, this total amount includes only those OAA authorizations of appropriations with a discrete amount specified in statute, which applies to almost all authorizations of appropriations. The one exception is under OAA Title VII, Subtitle B, Native American Organization and Elder Justice Provisions. OAA Section 751 authorizes to be appropriated "such sums as may be necessary" for Native American elder rights program and grants for state elder justice systems.

Table B-1 shows the authorizations of appropriations by OAA title and program or activity (first column). The second column describes any amendments or changes to statutory language under P.L. 114-144116-131. The last threefive columns show the authorizations of appropriations amounts for each program or activity for FY2017, FY2018, and FY2019 FY2020 through FY2024 with a total amount summed below for each fiscal year.

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Footnotes