Aging Policy

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Missing Adults: Background, Federal Programs, and Issues for Congress

Adults may go missing due to personal choice, an abduction, foul play, a mental or physical disability, or a natural catastrophe, among other reasons. Although no accurate estimates exist of the number of missing adults, the Federal Bureau of Investigation (FBI) reported that as of December 31, 2016, approximately 54,000 cases of missing adults (age 18 and older) were pending in the National Crime Information Center (NCIC) system, a federal computerized index with data on crimes and locator files for missing and unidentified persons. Certain adults are particularly vulnerable to missing...

Comparison of the American Health Care Act (AHCA) and the Better Care Reconciliation Act (BCRA)

Per the reconciliation instructions in the budget resolution for FY2017 (S.Con.Res. 3), the House passed its reconciliation bill, H.R. 1628—the American Health Care Act (AHCA)—with amendments on May 4, 2017. The House bill was received in the Senate on June 7, 2017, and the next day the Senate majority leader had it placed on the calendar, making it available for floor consideration. The Senate Budget Committee published on its website a “discussion draft” titled, “The Better Care Reconciliation Act of 2017” (BCRA) on June 22, subsequently updated the discussion draft on June 26, again on...

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...

H.R. 1628: The American Health Care Act (AHCA)

In January 2017, the House and Senate adopted a budget resolution for FY2017 (S.Con.Res. 3), which reflects an agreement between the chambers on the budget for FY2017 and sets forth budgetary levels for FY2018-FY2026. S.Con.Res. 3 also includes reconciliation instructions directing specific committees to develop and report legislation that would change laws within their respective jurisdictions to reduce the deficit. These instructions trigger the budget reconciliation process, which may allow certain legislation to be considered under expedited procedures. The reconciliation instructions...

Medicaid Financial Eligibility for Long-Term Services and Supports

Medicaid is a means-tested entitlement program that finances the delivery of health care and long-term services and supports (LTSS) to certain eligible low-income individuals. Established under Title XIX of the Social Security Act (SSA), the Medicaid program is state-operated within broad federal guidelines, and is jointly funded by the federal government and states. To qualify for Medicaid, individuals must meet certain categorical and financial requirements. To qualify for Medicaid LTSS, individuals must also meet state-based functional eligibility criteria that determine need for...

Medicaid Coverage of Long-Term Services and Supports

Long-term services and supports (LTSS) refer to a broad range of health and health-related services and supports needed by individuals who lack the capacity for self-care due to a physical, cognitive, or mental disability or condition. Often the individual’s disability or condition results in the need for hands-on assistance or supervision over an extended period of time. Medicaid plays a key role in covering LTSS to aged and disabled individuals. As the largest single payer of LTSS in the United States, federal and state Medicaid spending accounted for $149.4 billion or 42.5% of all LTSS...

Health Care-Related Expiring Provisions of the 115th Congress, First Session

This report provides descriptions of selected health care-related provisions that are scheduled to expire during the 115th Congress, first session (i.e., during calendar year [CY] 2017). For purposes of this report, expiring provisions are defined as portions of law that are time limited and will lapse once a statutory deadline is reached absent further legislative action. The expiring provisions included in this report are those related to Medicare, Medicaid, State Children’s Health Insurance Program (CHIP), and private health insurance programs and activities. The report also includes...

Long-Term Care Services for Veterans

The Veterans Health Administration (VHA), an operating unit of the Department of Veterans Affairs (VA), is a direct service provider of health care, similar in many ways to a large private sector health care system. In addition to providing inpatient, outpatient, and a range of other medical care services, the VHA provides and purchases long-term care services. The VA is one of two federal payers of long-term care services (the other being Medicaid).

Since the 1960s, the VA has been authorized to provide nursing home care to eligible veterans in various settings, including VA facilities,...

Discretionary Spending Under the Affordable Care Act (ACA)

The Affordable Care Act (ACA) authorized many new discretionary grant programs and provided each one with an authorization of appropriations—typically through FY2014 or FY2015—to carry them out. The ACA also reauthorized funding for numerous existing programs with expired authorizations of appropriations, most of which were still receiving annual funding.

The Congressional Budget Office (CBO) estimated that fully funding the discretionary grant programs authorized (or reauthorized) by the ACA, based on the amounts specified in the authorizations of appropriations, would result in...

The Elder Justice Act: Background and Issues for Congress

Elder abuse is a complex issue that often requires a multifaceted policy response that combines public health interventions, social services programs, and criminal law enforcement for abusive behavior. To address this complexity, the Elder Justice Act was enacted on March 23, 2010 as part of the Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended). The act attempts to provide a coordinated federal response by emphasizing various public health and social service approaches to the prevention, detection, and treatment of elder abuse. The Elder Justice Act also represents...

Domestic Food Assistance: Summary of Programs

Over the years, Congress has authorized and the federal government has administered programs to provide food to the hungry and to other vulnerable populations in this country. This report offers a brief overview of hunger and food insecurity along with the related network of programs. The report is structured around three main tables that contain information about each program, including its authorizing language, administering agency, eligibility, services provided, participation data, and funding information. In between the tables, contextual information about this policy area and program...

The 21st Century Cures Act (Division A of P.L. 114-255)

The 21st Century Cures Act (P.L. 114-255) was signed into law on December 13, 2016, by President Barack Obama. On November 30, 2016, the House passed the House amendment to the Senate amendment to H.R. 34, the 21st Century Cures Act, on a vote of 392 to 26. The bill was then sent to the Senate where it was considered and passed, with only minor technical modification, on December 7, 2016, on a vote of 94 to 5. The law consists of three divisions: Division A—21st Century Cures Act; Division B—Helping Families in Mental Health Crisis; and Division C—Increasing Choice, Access, and Quality...

The Helping Families in Mental Health Crisis Reform Act of 2016 (Division B of P.L. 114-255)

This report summarizes the Helping Families in Mental Health Crisis Reform Act of 2016, enacted on December 13, 2016, as Division B of the 21st Century Cures Act (P.L. 114-255). Division B comprises Title VI through Title XIV. The first five titles in Division B (Title VI – Title X) deal primarily with the Substance Abuse and Mental Health Services Administration (SAMHSA) within the Department of Health and Human Services (HHS). SAMHSA is the federal agency with primary responsibility for increasing access to community-based services to prevent and treat mental disorders and substance use...

Older Americans Act: 2016 Reauthorization

First enacted in 1965, the Older Americans Act (OAA) was created in response to concern by policymakers about a lack of community social services for older individuals. Since then, the OAA has been reauthorized and amended numerous times. The last OAA reauthorization occurred in 2006, when the Older Americans Act Amendments of 2006 (P.L. 109-365) was enacted, which extended the act’s authorizations of appropriations through FY2011 (authorizations of appropriations for most OAA programs expired on September 30, 2011). OAA-authorized activities have continued to receive funding for FY2012...

Older Americans Act: Funding Formulas

The Older Americans Act (OAA) is the major vehicle for the delivery of social and nutrition services for older persons. The act’s statutory funding formulas determine allotments to states and other entities under the following OAA Titles: Title III, Grants for State and Community Programs; Title V, the Community Service Senior Opportunities Act; Title VI, Grants for Older Native Americans; and Title VII, Vulnerable Elder Rights Protection Activities.

Title III accounts for 71% of the act’s total FY2016 discretionary appropriations ($1.353 billion out of $1.915 billion). States receive...

President’s FY2017 Budget for the Centers for Medicare & Medicaid Services (CMS): CRS Experts

Federal law requires the President to submit an annual budget request to Congress no later than the first Monday in February. The budget informs Congress of the President’s overall federal fiscal policy based on proposed spending levels, revenues, and deficit (or surplus) levels. The budget request lays out the President’s relative priorities for federal programs, such as how much should be spent on defense, education, health, and other federal programs. The President’s budget also may include legislative proposals for spending and tax policy changes. Although the President is not required...

Health Insurance Expiring Provisions of the 114th Congress, Second Session

This report provides a list of expiring health insurance provisions. Specifically, it lists Medicare, Medicaid, State Children’s Health Insurance Program (CHIP), and private health insurance programs and activities under Chapter 7 of the United States Code (U.S.C.)—Social Security—and Chapter 157 of the U.S.C.—Quality, Affordable Health Care for All Americans, as created by the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended)—that are scheduled to expire between the date of this report and after the end of the 114th Congress (i.e., December 31, 2016). Health...

H.R. 6: The 21st Century Cures Act

On July 10, 2015, the House passed H.R. 6, the 21st Century Cures Act, on a vote of 344 to 77. Eight amendments were offered; five were approved by voice vote, two failed by recorded vote, and one was withdrawn. The House Energy and Commerce Committee, on May 21, 2015, unanimously ordered to be reported H.R. 6 and the House Committee on Rules published a committee print of the bill on July 2, 2015. On July 7, 2015, H.R. 6 was reported by the Committee on Energy and Commerce (H.Rept. 114-190), and the House Committee on Ways and Means was discharged from further consideration of the bill....

Older Americans Act: Long-Term Care Ombudsman Program

Quality of care in long-term care settings has been, and continues to be, a concern for federal policymakers. The Long-Term Care (LTC) Ombudsman Program is a consumer advocacy program that aims to improve the quality of care, as well as the quality of life, for residents in LTC settings by investigating and resolving complaints made by, or on behalf of, such residents. Established under Title VII of the Older Americans Act (OAA), the Administration on Aging (AoA) within the Administration for Community Living in the Department of Health and Human Services (HHS) administers the nationwide...

Health Care-Related Expiring Provisions, First Session of the 114th Congress

This report provides a list of selected health-related programs and activities under specified titles of the Social Security Act (SSA), including the Maternal and Child Health Services Block Grant (Title V), General Provisions, Peer Review, and Administrative Simplification (Title XI), Medicare (Title XVIII), Medicaid (Title XIX), and the State Children’s Health Insurance Program (CHIP; Title XXI); the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended); as well as selected provisions from the Public Health Service Act (PHSA) that are scheduled to terminate during...

President’s FY2016 Budget: Centers for Medicare & Medicaid Services (CMS) Legislative Proposals

Federal law requires the President to submit an annual budget request to Congress no later than the first Monday in February. The budget informs Congress of the President’s overall federal fiscal policy based on proposed spending levels, revenues, and deficit (or surplus) levels. The budget request lays out the President’s relative priorities for federal programs, such as how much should be spent on defense, education, health, and other federal programs. The President’s budget also may include legislative proposals for spending and tax policy changes. While the President is not required to...

Centers for Medicare & Medicaid Services: President’s FY2015 Budget

Federal law requires the President to submit an annual budget to Congress no later than the first Monday in February. The budget informs Congress of the President’s overall federal fiscal policy based on proposed spending levels, revenues, and deficit (or surplus) levels. The budget request lays out the President’s relative priorities for federal programs, such as how much should be spent on defense, education, health, and other federal programs. The President’s budget may also include legislative proposals for spending and tax policy changes. While the President is not required to propose...

Public Health, Workforce, Quality, and Related Provisions in ACA: Summary and Timeline

In March 2010, President Obama signed into law a comprehensive health reform bill, the Patient Protection and Affordable Care Act (ACA; P.L. 111-148), and a package of amendments to ACA, the Health Care and Education Reconciliation Act of 2010 (HCERA; P.L. 111-152). Health reform was one of President Obama’s top domestic policy priorities during his first term, driven by concerns about the growing ranks of the uninsured and the unsustainable growth in spending on health care and health insurance. Improving access to care and controlling rising costs were seen to require changes to both the...

Long-Term Services and Supports: Overview and Financing

This report provides an overview of Long-term services and supports (LTSS), including who needs LTSS, how need for LTSS is determined, and how much LTSS costs. The report also provides information on who the primary LTSS payers are, how much they spend, and what types of services are purchased.

Funding for the Older Americans Act and Other Aging Services Programs

Medicare, Medicaid, and Other Health Provisions in the American Taxpayer Relief Act of 2012

Several policies that would have reduced spending and increased revenues were poised to take effect at the end of 2012; collectively, these were referred to by some as the “fiscal cliff.” Had these policies taken effect, CBO projected that the ensuing fiscal contraction would have resulted in a recession in 2013. On January 2, 2013, the President signed H.R. 8, the American Taxpayer Relief Act of 2012 (ATRA, P.L. 112-240), which prevented most—but not all—of the fiscal cliff policies from going into effect. This Act was passed by the Senate on January 1, 2013 by a vote of 89-8, and by the...

Withholding of Income Taxes and the Making Work Pay Tax Credit

The Making Work Pay (MWP) tax credit provided a refundable tax credit of up to $400 for individuals and up to $800 for married taxpayers filing joint returns in 2009 and 2010. The MWP tax credit expired on December 31, 2010. As a result of the expiration of the MWP tax credit, some taxpayers are finding that the amount of their income tax withholding had increased in 2011. In 2009 and 2010, as a result of the implementation of the MWP tax credit, some taxpayers may have found that their 2009 and 2010 income tax refunds were lower than they anticipated or that they owed taxes when they were...

CRS Issue Statement on Health Care Reform

Public Health, Workforce, Quality, and Related Provisions in the Patient Protection and Affordable Care Act (P.L. 111-148)

On March 23, 2010, President Obama signed into law a comprehensive health care reform bill, the Patient Protection and Affordable Care Act (PPACA; P.L. 111-148). Health care reform has been the Obama Administration’s top domestic priority, driven by concerns about the growing ranks of the uninsured and the unsustainable growth in spending on health care and health insurance. Improving access to care and controlling rising costs are seen to require changes to both the financing and delivery of health care.

Both the House and the Senate passed comprehensive health care reform bills last...

Public Health, Workforce, Quality, and Related Provisions in H.R. 3962

Health care reform is at the top of the domestic policy agenda for the 111th Congress, driven by concerns about the growing ranks of the uninsured and the unsustainable growth in spending on health care and health insurance. Improving access to care and controlling rising costs are seen to require changes to both the financing and delivery of health care. Experts point to a growing body of evidence of the health care system’s failure to consistently provide high-quality care to all Americans.

The health reform debate has encompassed a number of proposals to address these challenges and...

Jobs for Main Street Act: Education, Training and Direct Assistance Provisions

The Obama Administration and Congress continue to grapple with high rates of unemployment despite some tentative signs of economic recovery. On December 8, 2009, President Obama outlined a series of proposals intended to accelerate job growth, focusing on incentives to small businesses, spending on infrastructure projects, and job creation through energy initiatives. The President also signaled support for the extension of some of the direct assistance provisions included in the American Recovery and Reinvestment Act (ARRA, P.L. 111-5), including Unemployment Compensation (UC) benefits and...

Private Health Insurance Provisions of S. 1796, America’s Healthy Future Act of 2009

This report summarizes key provisions affecting private health insurance in S. 1796, America’s Healthy Future Act of 2009, as ordered reported by the Senate Committee on Finance on October 19, 2009.

Title I of the bill imposes new requirements on individuals, employers, and health plans; restructures the private health insurance market; sets minimum standards for health benefits; and provides financial assistance to certain individuals and, in some cases, small employers. Title VI of the bill include a number of new provisions to raise revenues to pay for health care reform. These...

Overview of Provisions in the Amendment in the Nature of a Substitute to H.R. 3962 Offered by Mr. Boehner of Ohio

Health care reform is at the top of the domestic policy agenda for the 111th Congress, driven by concerns about the growing ranks of the uninsured and the unsustainable growth in spending on health care and health insurance. Improving access to care and controlling rising costs are seen to require changes to both the financing and delivery of health care. Experts point to a growing body of evidence of the health care system’s failure to consistently provide high-quality care to all Americans.

Several comprehensive bills have been introduced on the topic of health reform in the 111th...

Public Health, Workforce, Quality, and Other Provisions in the America’s Healthy Future Act (S. 1796)

Health care reform is at the top of the domestic policy agenda for the 111th Congress, driven by concerns about the growing ranks of the uninsured and the unsustainable growth in spending on health care and health insurance. But efforts to improve access to care and control rising health care costs also will require changes to the health care delivery system. Experts point to a growing body of evidence of the health care system’s failure to consistently provide high-quality care to all Americans. Major challenges to the delivery of high-quality care include improving patient safety by...

Public Health, Workforce, Quality, and Other Provisions in the Affordable Health Choices Act (S. 1679)

Health care reform is at the top of the domestic policy agenda for the 111th Congress, driven by concerns about the growing ranks of the uninsured and the unsustainable growth in spending on health care and health insurance. But efforts to improve access to care and control rising health care costs also will require changes to the health care delivery system. Experts point to a growing body of evidence of the health care system’s failure to consistently provide high-quality care to all Americans. Major challenges to the delivery of high-quality care include improving patient safety by...

Public Health, Workforce, Quality, and Other Provisions in H.R. 3200

Health care reform is at the top of the domestic policy agenda for the 111th Congress, driven by concerns about the growing ranks of the uninsured and the unsustainable growth in spending on health care and health insurance. But efforts to improve access to care and control rising health care costs also will require changes to the health care delivery system. Experts point to a growing body of evidence of the health care system’s failure to consistently provide high-quality care to all Americans. Major challenges to the delivery of high-quality care include improving patient safety by...

U.S. Motor Vehicle Industry: Federal Financial Assistance and Restructuring

This report focuses on the current situation faced by the Detroit 3, key aspects of their current crisis, including possible consequences of a failure of one or more companies, and some aspects of legislative actions that have been considered to bridge their financial conditions to a more stable situation.

End-of-Life Care: Services, Costs, Ethics, and Quality of Care

End-of-life care can be broadly defined as health care provided to persons who are very ill, have a prognosis that is likely to worsen, and most likely will die in the near term from their illness. End-of-life care may be in the form of acute care provided in the days or months prior to death or palliative care, which focuses on relieving the patient’s suffering and reducing the severity of disease symptoms as well as improving quality of life. Hospice care is a form of palliative care that delivers comfort care to those who forgo curative treatment and have a life expectancy that can be...

Converting Retirement Savings into Income: Annuities and Periodic Withdrawals

To a worker contemplating retirement, there is perhaps no more important question than "How long will my money last?" Congress has a strong interest in the income security of older Americans because much of their income is either provided directly from public programs like Social Security, or in the case of pensions and retirement accounts, is subsidized through tax deductions and deferrals. This report looks at strategies to help deal with the following risks: longevity, investment, inflation, and unexpected events.

Retiring Baby-Boomers = A Labor Shortage?

The unemployment rate in 2007 averaged just 4.6%, which is low by historic standards and suggests the presence of tight labor market conditions that are related to long-running demographic trends. The oldest members of the baby-boom generation turned age 60 at the end of 2006, and every year thereafter, more of this large birth-cohort will move into the ages when workers traditionally have retired. Consequently, the business community in particular has asserted that the future supply of labor will fall short of employer demand and that U.S. economic growth and competitiveness would be put...

“Clear Incompatibility” Between Antitrust and Securities Laws Implies Antitrust Immunity: Credit Suisse Securities v. Billing

In Credit Suisse Securities v. Billing, the Supreme Court examined whether entities in a heavily regulated industry are necessarily entitled to immunity from prosecution under the federal antitrust laws simply by virtue of their regulated status. The Court had previously ruled that, absent a specific congressional mandate, such immunity may be granted only by findings either of “clear repugnance” between the regulatory scheme and enforcement of the antitrust laws, or sufficiently pervasive regulation of an industry as would be disrupted by application of the antitrust laws; the Credit...

Beneficiary Information and Decision Supports for the Medicare-Endorsed Prescription Drug Discount Card

On December 8, 2003 the President signed into law the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA, P.L. 108-173). This legislation establishes a Medicare prescription drug benefit, effective January 1, 2006. In the interim, the legislation requires the Department of Health and Human Services (HHS) to establish a temporary program of Medicare-endorsed prescription drug discount cards. This report discusses the objectives and benefits of this legislation.