Older Americans Act: Background and Overview

The Older Americans Act (OAA) is the major federal vehicle for the delivery of social and nutrition services for older persons. These include supportive services, congregate nutrition services (meals served at group sites such as senior 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. The OAA also supports grants to older Native Americans as well as research, training, and demonstration activities. The Administration on Aging (AOA)—a program office under the Administration for Community Living (ACL) within the U.S. Department of Health and Human Services (HHS)—administers most OAA programs. The exception is the Community Service Employment for Older Americans (CSEOA) program, also known as the Senior Community Service Employment Program (SCSEP), which is administered by the U.S. Department of Labor (DOL).

Title I of the OAA sets out broad social policy objectives oriented toward improving the lives of all older Americans. Title II establishes AOA within HHS as the chief federal agency advocating for older persons and sets out the responsibilities of AOA and the Assistant Secretary for Aging. It also establishes State and Territorial Units on Aging (SUAs) and Area Agencies on Aging (AAAs), which, along with local providers, comprise the Aging Network. Title III authorizes grants to SUAs and AAAs to act as advocates on behalf of, and to coordinate programs for, older persons, including nutrition services programs to seniors. Title IV authorizes the Assistant Secretary for Aging to award funds for training, research, and demonstration projects in the field of aging. Title V, CSEOA, has as its purpose the promotion of useful part-time opportunities in community service activities for unemployed low-income older individuals. 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. Title VII authorizes the Long-Term Care (LTC) Ombudsman Program as well as Elder Abuse, Neglect, and Exploitation Prevention Programs.

The OAA has been reauthorized and amended numerous times since it was first enacted in 1965. P.L. 114-144 (S. 192, 114th Congress), the Older Americans Act Reauthorization Act of 2016, was signed into law on April 19, 2016. The act authorizes appropriations for OAA programs through FY2019. The Consolidated Appropriations Act, 2017 (P.L. 115-31) 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 $1.888 billion for FY2017, which is $26.8 million (1.4%) less than FY2016 levels.

This report provides an overview of the Older Americans Act. It briefly describes the act’s titles, highlighting selected provisions followed by FY2017 appropriations and a funding history.

Older Americans Act: Background and Overview

June 19, 2017 (R43414)

Contents

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 114th 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 of appropriations for most OAA programs expired on September 30, 2011; however, OAA-authorized activities 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 FY2017 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 FY2017 appropriations and the act's funding history.2 Appendix A provides detailed OAA program budget authority for FY2007 through FY2017.

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 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 246 tribal and Native Hawaiian organizations, and almost 20,000 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.

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, is funded at $40.1 million in FY2017.

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, two territories, and the District of Columbia.5 Discretionary funding to ADRCs is $6.1 million in FY2017.6

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 fund SMP activities under discretionary appropriations from the Centers for Medicare and Medicaid Services (CMS) Health Care Fraud and Abuse Control (HCFAC) account. This account distributes funding to various antifraud 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 FY2017 SMP funding to be $18.0 million.7

OAA Title II: Aging Network and Elder Rights Support Activities

The following OAA programs and activities receive discretionary funding under OAA Title II:

Aging Network Support Activities

  • The National Eldercare Locator and Engagement program assists individuals, through a nationwide toll-free phone number and website, in identifying community resources for older persons (http://www.eldercare.gov, or 1-800-677-1116). It also supports model programs in senior civic engagement and volunteer engagement (FY2017 funding is $2.0 million).
  • The Pension Counseling and Information Program provides funds to six regional counseling projects that help older Americans learn about and receive the retirement benefits to which they are entitled. This program also supports the National Education and Resource Center on Women and Retirement Planning, which provides workshops and information on financial education and retirement planning for women (FY2017 funding is $1.9 million.)

Elder Rights Support Activities

  • The National Center on Elder Abuse provides information to the public and professionals regarding elder abuse prevention activities, and provides training and technical assistance to state elder abuse agencies and to community-based organizations (http://www.ncea.acl.gov/, FY2017 funding is $765,000).
  • The National Long-Term Care Ombudsman Resource Center provides training and technical assistance to state and local long-term care ombudsmen (http://www.ltcombudsman.org, FY2017 funding is $516,000).

Source: Personal communication with G. Steven Hagy, director, ACL Office of Budget and Finance, May 25, 2017; U.S. Department of Health and Human Services, Administration for Community Living, Fiscal Year 2018 Justification of Estimates for Appropriations Committees, pp. 73-79 and 131-137.

Note: ACL reported combined program funding for the National Eldercare Locator and civic engagement under National Eldercare Locator and Engagement; however, civic engagement activities are authorized under OAA Title IV, Section 417, and included under Title II activities for simplicity.

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 accounts for 72.0% of the OAA's total FY2017 funding ($1.358 billion out of $1.888 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.8 The OAA allows states some flexibility to transfer funds among Title III programs. For example, in FY2015, states collectively transferred a net total of $97.4 million from congregate nutrition to either supportive services or home-delivered nutrition.9

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 FY2015, the most recent year for which data are available, 11.6 million older persons were served by Title III programs.10 Title III services included the provision of 142.6 million home-delivered meals; 79.4 million congregate meals; 23.6 million rides to medical appointments, grocery stores, and other activities; 38.9 million hours of personal care, homemaker, and chore services; and 9.9 million hours of adult day care/adult day health services in FY2015.11

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 $18.7 million in discretionary funding for 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").12

OAA Title IV: Activities for Health, Independence, and Longevity

The following OAA programs and activities receive discretionary funding under Title IV authorities:

Aging Network Support Activities

  • The National Alzheimer's Call Center is staffed by customer service workers and social workers; it provides free information, referrals, and counseling for persons with Alzheimer's disease, their families, and caregivers (FY2017 funding is $946,000).
  • National Resource Centers on Native American Elders provide research and technical information on health, long-term services and supports, elder abuse, mental health, and other issues relevant to older Native Americans (FY2017 funding is $655,000).
  • National Minority Aging Organizations Technical Assistance Centers provide culturally and linguistically appropriate information on health promotion and disease prevention for Asian-Pacific American, Native American, Hispanic, and African-American older individuals, and older lesbian, gay, bisexual, and transgender (LGBT) persons (FY2017 funding is $1.2 million).
  • Program Performance and Technical Assistance supports the development of outcome measures and performance measurement tools to assess the results of OAA programs (FY2017 funding is $799,000).
  • Holocaust Survivor's Assistance provides supportive services for aging Holocaust survivors living in the United States (FY2017 funding is $2.5 million).

Elder Rights Support Activities

  • Legal Assistance and Supports funds two different activities. First, Model Approaches help states integrate Adult Protective Services into broader state legal service delivery networks. Second, Legal Assistance and Support grants fund services to professionals and advocates working in legal, elder rights, and aging and disability services to further develop resources available to older individuals with social or economic needs (FY2017 funding is $2.6 million).
  • Elder Justice/Adult Protective Services (APS) provides funding for demonstration grants to states to enhance their APS Systems, technical assistance to states with regard to the national APS data collection effort, and research in the areas of elder abuse, neglect, and exploitation (FY2017 funding is $10.0 million).

Source: Personal communication with G. Steven Hagy, director, ACL Office of Budget and Finance, May 25, 2017; U.S. Department of Health and Human Services, Administration for Community Living, Fiscal Year 2018 Justification of Estimates for Appropriations Committees, pp. 73-79 and 131-137.

Note: FY2017 funding for the Elder Justice Initiative may also be used for activities authorized under OAA Sections 751 and the Elder Justice Act (§2042(a) of the Social Security Act).

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-income13 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 FY2017, Title V represents 21.2% of OAA discretionary funding ($400.0 million out of $1.888 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.14 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 30.15 For PY2015 (ending June 30, 2016), the CSEOA program supported 44,790 job slots, serving 65,170 participants, at a cost of $6,702 per participant.16 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 PY2015, 50.7% of participants who exited the program found employment in the following quarter; of those, 73.6% remained employed through the next two quarters.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 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 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 FY2017, these programs receive $38.8 million ($31.2 million for supportive and nutrition services, and $7.6 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 FY2017, these programs are funded at a total of $20.7 million.19 The majority of Title VII funding ($15.9 million, or 77%, in FY2017) 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 FY2015, ombudsmen handled more than 199,000 resident complaints and provided almost 520,000 consultations to individuals and long-term care facilities.20

FY2017 Appropriations Overview

The Consolidated Appropriations Act, 2017 (P.L. 115-31) 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 $1.888 billion, which is $26.8 million (1.4%) less than FY2016 levels.21 Figure 2 shows the distribution of FY2017 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 72.0% of funding appropriated to nutrition, supportive services, family caregivers, and health promotion activities. More than one-fifth of OAA funding (21.2%) is allocated to Title V, the CSEOA Program. The remaining funds are allocated to AOA-administered activities under Titles II (2.7%) and IV (1.0%), grants to Native Americans under Title VI (2.1%), and vulnerable elder rights protection activities under Title VII (1.1%).

Several OAA programs saw increases in funding for FY2017 compared with FY2016-enacted levels. Title III programs received an additional $2.5 million for supportive 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 $75,000 for supportive and nutrition and caregiver services. Under Title IV, Elder Rights Support Activities receive an additional $2.0 million for a total of $10.0 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.

Figure 2. Older Americans Act, FY2017 Discretionary Appropriations

(funding as a percentage of total OAA funding, $1.888 billion)

Source: "Explanatory Statement Submitted by Mr. Frelinghuysen of New Jersey, Chairman of the House Committee on Appropriations, Regarding the House Amendment to the Senate Amendments on H.R. 244," Congressional Record, vol. 163, no. 76 Book III (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.22

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 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 inflation.) 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-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-FY2017 Funding

Table A-1 shows the discretionary budget authority history for OAA programs for FY2007 through FY2017. Amounts are not adjusted for inflation. The table includes several nonadd 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.

Table A-1. Discretionary Budget Authority for the Older Americans Act (OAA) Programs: FY2007-FY2017

($ in millions)

OAA Programs

FY2007

FY2008

FY2009

FY2010a

FY2011

FY2012

FY2013

FY2014b

FY2015

FY2016

FY2017

Title II: Administration on Aging

$31.518

$49.653

$60.390

$64.252

$40.075

$43.160

$40.741

$50.007

$50.007

$51.359

$51.359

Program administration

18.385

18.064

18.696

19.976

19.939

23.063

21.771

30.035c

30.035

40.063

40.063

Aging network support activities

13.133

31.589d

41.694e

44.276

2.891f

2.886

2.274

3.661g

3.661

3.896h

3.896

Senior Medicare Patrol

9.420i

9.402

8.875

8.910

8.910

0j

0j

Aging and Disability Resource Centers

6.469i

6.457

6.095

6.119

6.119

6.119

6.119

Elder rights support activities

1.355k

1.352

1.277

1.282

1.282

1.281

1.281

Title III: Grants for State and Community Programs on Aging

$1,263.232

$1,283.816

$1,443.337

$1,362.866

$1,360.342

$1,357.770

$1,281.470

$1,327.815

$1,327.815

$1,352.911

$1,358.411

Supportive services and centers

350.595

351.348

361.348

368.290

367.611

366.916

347.724

347.724

347.724

347.724

350.224

Family caregiversl

156.167

153.439

154.220

154.197

153.912

153.621

145.586

145.586

145.586

150.586

150.586

Disease prevention/health promotion

21.400

21.026

21.026

21.026

20.984

20.944

19.849

19.848

19.848

19.848

19.848

Nutrition services

735.070

758.003

906.743

819.353

817.835

816.289

768.311

814.657

814.657

834.753

837.753

Congregate meals (nonadd)

(398.919)m

(410.716)

(499.269)

(440.718)

(439.901)

(439.070)

(416.104)

(438.191)

(438.191)

(448.342)

(450.342)

Home-delivered meals (nonadd)

(188.305)m

(193.858)

(246.459)

(217.644)

(217.241)

(216.830)

(205.489)

(216.397)

(216.397)

(226.342)

(227.342)

Nutrition services incentive grants (nonadd)

(147.846)

(153.429)

(161.015)

(160.991)

(160.693)

(160.389)

(146.718)

(160.069)

(160.069)

(160.069)

(160.069)

Title IV: Activities for Health, Independence, and Longevity

$24.058

$14.655

$18.172

$19.020

$27.102

$7.723

$7.291

$6.392

$12.892

$16.658

$18.658

Program Innovations

24.058

14.655

18.172

19.020

19.069

0

0

0

0

0

0

Elder rights support activities

2.741k

2.736

2.582

2.592

6.592n

10.593

12.593

Aging network support activities

5.292o

4.988

4.708

3.800g

6.300

6.065h

6.065

Title V: Community Service Senior Opportunities Act

$483.611m

$521.625

$691.925

$825.425p

$449.100

$448.251

$424.805

$434.371

$434.371

$434.371

$400.000

Title VI: Grants to Native Americans

$32.375

$33.214

$36.597

$34.092

$34.029

$33.965

$32.188

$32.189

$32.189

$38.689

$38.764

Supportive and nutrition services

26.134

26.898

30.208

27.704

27.653

27.601

26.157

26.158

26.158

31.158

31.208

Native American caregivers

6.241

6.316

6.389

6.388

6.376

6.364

6.031

6.031

6.031

7.531

7.556

Title VII: Allotments for Vulnerable Elder Rights Protection Activities

$20.156

$20.633

$21.383

$21.880

$21.839

$21.797

$20.658

$20.658

$20.658

$20.658

$20.658

Long-term care ombudsman program

15.010

15.577

16.327

16.825

16.793

16.761

15.885

15.885

15.885

15.885

15.885

Elder abuse prevention

5.146

5.056

5.056

5.055

5.046

5.036

4.773

4.773

4.773

4.773

4.773

TOTAL Older Americans Act Programs

$1,854.950

$1,923.596

$2,271.804

$2,327.535

$1,932.487

$1,912.666

$1,807.153

$1,871.432

$1,877.932

$1,914.646

$1,887.850

Source: FY2006 to FY2017 Labor-Health and Human Services (HHS)-Education Appropriations acts and accompanying report and explanatory statement language available at the CRS appropriations status table; various HHS, Administration on Aging (AOA), Administration for Community Living (ACL), and Department of Labor (DOL) budget documents, including budget justifications (FY2013 and FY2017), and operating plans for FY2010 through FY2013; personal communication with G. Steven Hagy, director, AOA/ACL Office of Budget and Finance, 2011 to 2017, and personal communication with Michael Bernier, HHS Budget Office, 2012.

a. FY2010 amounts reflect both appropriations and transferred funds, including the HHS Secretary's transfer of $224,298 from AOA to assist states with AIDS Drug Assistance Programs (ADAP). This was part of $25 million that the Secretary reallocated and transferred in total from various HHS agencies to assist state ADAP programs with wait lists and cost containment.

b. FY2014 numbers reflect appropriated amounts before transfers. Per P.L. 113-76, Division H, Title II §206, the Administration in FY2014 had limited authority to transfer funds among HHS accounts. Under this authority, $3.857 million was transferred out of OAA programs: $3.466 million from the Nutrition Services Incentives Program; $233,000 from ACL Program Administration; $55,000 from Aging network support activities; $52,000 from ADRCs; $29,000 from Elder Rights Support Activities; and $22,000 from Senior Medicare Patrol. (Personal communication with G. Steven Hagy, Director, Office of Budget and Finance, ACL, April 2, 2015).

c. Starting with FY2014, amounts reflect program administration costs for aging and disability services programs administered by ACL, not just aging services programs administered by AOA as in prior years. Prior to FY2014, amounts reflected under program administration included AOA administration of most OAA programs and several programs under non-OAA authorities, such as the Public Health Service Act (PHSA) and the Medicare Improvements for Patients and Providers Act (MIPPA).

d. The FY2008 Consolidated Appropriations Act (P.L. 110-161) provided $16.2 million in Title II funds under Aging network support activities for the Choices for Independence Initiative (after a 1.747% across-the-board reduction). This initiative included newly authorized provisions of the OAA Amendments of 2006 (P.L. 109-365) related to "aging and disability resource centers (ADRCs), evidence-based prevention programs, and consumer-directed services targeted at individuals who are at high risk of nursing home placement and spend-down to Medicaid" (H.Rept. 110-231, p. 207).

e. The Omnibus Appropriations Act, 2009 (P.L. 111-8) provided $28.0 million for the Choices for Independence Initiative under Title II Aging network support activities. Choices for Independence was subsequently renamed "Health and Long-Term Care Programs" in the Obama Administration's FY2010 budget request.

f. Several activities that were previously included under Aging network support activities are listed under separate line items starting in FY2011. These activities include the Senior Medicare Patrol Program, ADRCs, and the National Center on Elder Abuse and the National Long-Term Care Ombudsman Resource Center (both under Elder rights support activities). Starting in FY2011, Title II Aging network support activities include only the National Eldercare Locator and the Pension Counseling and Information Program.

g. Starting in FY2014, Budget documents provide funds for the National Eldercare Locator (authorized under Title II) and Multigenerational Civic Engagement (authorized under Title IV) together under a new "National Eldercare Locator and Engagement" line item. For simplicity, this table includes this funding under Title II Aging network support activities.

h. For FY2016, Budget documents provide funds for the Resource Center on Women and Retirement Planning (authorized under Title IV) and the Pension Counseling and Information Program (authorized under Title II) together under a new "Pension Counseling and Retirement Information" line item. For simplicity, this table includes this funding under Title II Aging network support activities.

i. Prior to FY2011, Title II funds to Senior Medicare Patrol and ADRCs were included in the total for Aging network support activities. In addition to discretionary funding, the Senior Medicare Patrol Program receives mandatory Health Care Fraud and Abuse Control (HCFAC) account funds under the Centers for Medicare and Medicaid Services (CMS). In addition to ADRC discretionary funding under Title II, §2405 of the Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) provided mandatory appropriations for ADRCs of $10.0 million for each year from FY2010 to FY2014.

j. In FY2016, The Consolidated Appropriations Act, 2016 (P.L. 114-113) changed the source of discretionary funding for the Senior Medicare Patrol program from that funded under ACL appropriations to CMS HCFAC appropriations. However, no specific amount was specified for these activities.

k. Elder rights support activities include the National Center on Elder Abuse and the National Long-Term Care Ombudsman Resource Center (both authorized under Title II), and Model Approaches to Statewide Legal Assistance and National Legal Assistance and Support Projects (both authorized under Title IV). Prior to FY2011, funding for these programs was included in totals for Aging network support activities and Program Innovations.

l. Funding for Native American family caregiving is shown in Title VI.

m. Funding level was specified in P.L. 110-5, Revised Continuing Appropriations Resolution, 2007.

n. Starting in FY2015, Elder rights support activities also include Elder Justice/Adult Protective Services (APS) funding. For simplicity, this table counts FY2015 and FY2016 funding for Elder Justice/APS under Title IV elder rights support activities; however, these funds may also be used for activities authorized under OAA Section 751 and the Elder Justice Act (§2042(a) of the Social Security Act).

o. Title IV Aging network support activities include the National Alzheimer's Call Center; the National Education and Resource Center on Women and Retirement Planning; National Resource Centers on Native Americans; National Minority Aging Organizations and National Technical Assistance Resource Center; Multigenerational Civic Engagement; and Program Performance and Technical Assistance. In AOA budget documents prior to FY2012, funding for these programs was provided under Program Innovations. (In this report, for comparability, the FY2011-FY2013 columns reflect the categorizations in FY2012 and FY2013 appropriations documents.) Starting in FY2015, Title IV Aging network support activities also includes Holocaust Survivors Assistance.

p. 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 B. Older Americans Act: Authorizations of Appropriations

Table B-1 provides authorizations of appropriations under the Older Americans Act, as amended by P.L. 114-144. 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 (FY2017 through FY2019) 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. 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. 114-144. The last three columns show the authorizations of appropriations amounts for each program or activity for FY2017, FY2018, and FY2019 with a total amount summed below for each fiscal year.

Table B-1. Authorizations of Appropriations for Older Americans Act (OAA) Programs

(as amended by P.L. 114-144)

 

Change to OAA

Authorizations of Appropriations

 

 

For FY2017

For FY2018

For FY2019

Title II, Administration on Aging (AOA)

Administration, Salaries, and Expenses of AOA

Amends §216(a) to authorize to be appropriated

$40,063,000

$40,063,000

$40,063,000

Eldercare Locator

Strikes §216(b) and replaces with §216(b)(1)-(4); in §216(b)(1), relating to the National Eldercare Locator Services, authorizes to be appropriated

$2,088,758

$2,132,440

$2,176,121

Pension Counseling and Information Program

Strikes §216(c) and replaces with §216(b)(2), relating to Pension Counseling and Information Programs, it authorizes to be appropriated

$1,904,275

$1,944,099

$1,983,922

Elder Rights Support Activities (Title II)

Adds a new §216(b)(3); it authorizes to be appropriated

$1,312,904

$1,340,361

$1,367,817

Aging and Disability Resource Centers

Adds a new §216(b)(4); it authorizes to be appropriated

$6,271,399

$6,402,551

$6,533,703

Title III, State and Community Programs on Aging

Supportive Services and Centers

Amends §303(a) to authorize to be appropriated

$356,717,276

$364,456,847

$372,196,069

Congregate Nutrition Services

Amends §303(b)(1) to authorize to be appropriated

$459,937,586

$469,916,692

$479,895,348

Home-Delivered Nutrition Services

Amends §303(b)(2) to authorize to be appropriated

$232,195,942

$237,233,817

$242,271,465

Disease Prevention and Health Promotion

Amends §303(d) to authorize to be appropriated

$20,361,334

$20,803,107

$21,244,860

Family Caregiver Support

Amends §303(e) to authorize to be appropriated

$154,336,482

$157,564,066

$160,791,658

Nutrition Services Incentive Program

Amends §311(e) to authorize to be appropriated

$164,055,664

$167,486,502

$170,917,349

Title IV, Activities for Health, Independence, and Longevity

Aging Network Support Activities

Amends §411(b) to authorize to be appropriated for aging network support activities

$6,216,054

$6,346,048

$6,476,043

Elder Rights Support Activities (Title IV)

Amends §411(b) to authorize to be appropriated for elder rights support activities

$10,856,828

$11,083,873

$11,310,919

Title V, Community Service Senior Opportunities Act

Community Service Employment for Older Americans

Amends §517(a) to authorize to be appropriated

$445,189,405

$454,499,494

$463,809,605

Title VI, Grants for Native Americans

Indian and Native Hawaiian Programs

Amends §643(1) to authorize to be appropriated

$31,934,018

$32,601,843

$33,269,670

Native American Caregiver Support Program

Amends §643(2) to authorize to be appropriated

$7,718,566

$7,879,982

$8,041,398

Title VII, Vulnerable Elder Rights Protection Activities

Subtitle A—State Programs

Long-Term Care Ombudsman Program (Chapter 2)

Amends §702(a) to authorize to be appropriated

$16,280,630

$16,621,101

$16,961,573

Elder Abuse, Neglect, and Exploitation Prevention Program (Chapter 3) and Legal Assistance Development Program (Chapter 4)

Amends §702(b) to authorize to be appropriated to carry out Chapters 3 and 4

$4,891,876

$4,994,178

$5,096,480

Subtitle B—Native American Organization and Elder Justice Provisions

Native American Elder Rights Program and Grants for State Elder Justice Systems

No change to current law; §751(d) authorizes to be appropriated such sums as may be necessary (SSAN) for FY2007 and subsequent fiscal years

SSAN

SSAN

SSAN

Total Authorization of Appropriationsa

$1,962,331,997

$2,003,370,001

$2,044,407,000

Sources: The Older Americans Act, as amended by The Older Americans Act Reauthorization Act of 2016 (P.L. 114-144).

Notes:

a. The "Total Authorization of Appropriations" do not include an amount for OAA §751(d) under Subtitle B, Native American Organizations and Elder Justice Provisions.

Author Contact Information

[author name scrubbed], Specialist in Health and Aging Policy ([email address scrubbed], [phone number scrubbed])
[author name scrubbed], Information Research Specialist ([email address scrubbed], [phone number scrubbed])

Footnotes

1.

For more information on the OAA 2016 reauthorization see CRS Report R44485, Older Americans Act: 2016 Reauthorization, by [author name scrubbed].

2.

The funding amounts described in this report are in budget authority.

3.

J. Mabli, N. Redel, R. Cohen. et. al., Final Report, Process Evaluation of Older Americans Act Title III-C Nutrition Services Program, Mathematica Policy Research, September 30, 2015, p. ix, https://www.acl.gov/sites/default/files/programs/2016-11/NSP-Process-Evaluation-Report_0.pdf.

4.

The 56 State Units on Aging include the 50 states, 5 U.S. territories, and the District of Columbia. U.S. Department of Health and Human Services, Administration for Community Living, Older Americans Act, https://www.acl.gov/about-acl/authorizing-statutes/older-americans-act.

5.

U.S. Department of Health and Human Services, Administration for Community Living, Administration on Aging, FY2015 Report to Congress: Older Americans Act, January 12, 2017, p. 7, https://www.acl.gov/sites/default/files/about-acl/2017-03/FY15OAAReportCongress_2017-1-24.docx. U.S. Department of Health and Human Services, Administration for Community Living, Administration on Aging, Aging and Disability Resource Centers in a No Wrong Door System, https://www.acl.gov/sites/default/files/news%202017-03/ADRC_NWD2014.pdf. ADRCs may be located through the Eldercare Locator directory http://www.eldercare.gov.

6.

Beginning in FY2009, Congress provided mandatory funding under the Medicare Improvements for Patients and Providers Act (MIPPA, P.L. 110-275; 42 U.S.C. 1395b-3 note) for Medicare enrollment assistance to Aging Disability Resource Centers (ADRCs), as well as Area Agencies on Aging (AAAs), State Health Insurance and Assistance Programs (SHIPs), and the National Center for Benefits Outreach and Enrollment. ADRCs received $5 million in mandatory funding for FY2017.

7.

U.S. Department of Health and Human Services, Administration for Community Living, Fiscal Year 2018 Justification of Estimates for Appropriations Committees, pp. 126-127, https://www.acl.gov/sites/default/files/about-acl/2017-05/FY%202018%20ACL%20Budget%20Congressional%20Justification%20v2.pdf.

8.

State allotments for Title III programs are listed at HHS, ACL, State and Tribal Funding Allocations, https://www.acl.gov/node/124.

9.

U.S. Department of Health and Human Services, Administration for Community Living, Administration on Aging, FY2015 Report to Congress: Older Americans Act, pp. 17-18, https://www.acl.gov/sites/default/files/about-acl/2017-03/FY15OAAReportCongress_2017-1-24.docx.

10.

Ibid., p. 12. Data are preliminary.

11.

U.S. Department of Health and Human Services, Administration for Community Living, Fiscal Year 2018 Justification of Estimates for Appropriations Committees, p. 30.

12.

Also authorized under Title IV, Section 411, are Falls Prevention activities and the Alzheimer's Disease Initiative – Specialized Supportive Services. Funding for these programs and activities for FY2017 were provided under mandatory funding for the Prevention and Public Health Fund.

13.

Participants' incomes must be no greater than 125% of the federal poverty guidelines, 20 C.F.R. §641.500.

14.

U.S. Department of Labor, Senior Community Service Employment Program, http://www.doleta.gov/Seniors/.

15.

Program Year 2016 allotments were announced in a series of letters and change documents available at U.S. Department of Labor, Training and Employment Guidance Letter No. 18-15, http://wdr.doleta.gov/directives/corr_doc.cfm?DOCN=7959. Per OAA Section 517(b), CSEOA is forward funded; for example, dollars appropriated in FY2016 (October 1, 2015 to September 30, 2016) are used for PY2016 (July 1, 2016 to June 30, 2017).

16.

There are more participants than job slots in a given program year; as participants leave the program their job slots can be filled by new participants. U.S. Department of Labor, Fiscal Year 2018 Congressional Budget Justification, Employment and Training Administration, Community Service Employment for Older Americans, p. CSEOA-11, https://www.dol.gov/sites/default/files/CBJ-2018-V1-05.pdf.

17.

Ibid., p. CSEOA-12.

18.

U.S. Department of Health and Human Services, Administration for Community Living, Fiscal Year 2018 Justification of Estimates for Appropriations Committees, p. 69.

19.

State allocation tables are at ACL, State and Tribal Funding Allocations, https://www.acl.gov/node/124.

20.

U.S. Department of Health and Human Services, Administration for Community Living, Fiscal Year 2018 Justification of Estimates for Appropriations Committees, p. 115.

21.

Program Administration funding reflects administration costs for ACL-administered programs authorized under OAA as well as 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), the Elder Justice Act (EJA), and the Medicare Improvements for Patients and Providers Act (MIPPA). (U.S. Department of Health and Human Services, Administration for Community Living, Fiscal Year 2018 Justification of Estimates for Appropriations Committees, p. 229). In addition, the Falls Prevention Program and Alzheimer's Disease Initiative Programs, both authorized under OAA Title IV, receive mandatory funding under the Public Health Prevention Fund (PPHF). The Senior Medicare Patrol Program also receives mandatory HCFAC account funding. These mandatory amounts are not reflected in the estimated OAA total.

22.

The Budget Control Act of 2011 (BCA; P.L. 112-25) tasked a Joint Select Committee on Deficit Reduction with developing a deficit reduction plan for Congress and the President to enact by January 15, 2012. The failure of Congress and the President to enact deficit reduction legislation by that date triggered an automatic spending reduction process that included sequestration. This sequestration affected OAA programs through a 5% reduction in nonexempt nondefense discretionary funding in FY2013. In addition, the Consolidated and Further Continuing Appropriations Act, 2013 (P.L. 113-6), which generally funded discretionary HHS and Department of Labor (DOL) programs for FY2013 at their FY2012 levels, also included an across-the-board rescission of 0.2% per Section 3004.