HHS FY 2018 Budget in Brief - ACL
Administration for Community Living (ACL)
The Administration for Community Living works to maximize the independence, well-being, and health of older adults, people with disabilities across the lifespan, and their families and caregivers.
ACL Budget Overview
(Dollars in millions)
|Health and Independence Services||2016||2017 /1||2018||2018
|Home & Community-Based Supportive Services||348||348||348||--|
|Native American Nutrition & Supportive Services||31||31||31||--|
|Preventive Health Services||20||20||20||--|
|Chronic Disease Self-Management||8||8||5||-3|
|Aging Network Support Activities||10||10||10||--|
|Subtotal, Health and Independence||1,257||1,255||1,252||-3|
|Caregiver Services||2016||2017 /1||2018||2018
|Family Caregiver Support Services||150||150||150||--|
|Native American Caregiver Support Services||8||8||8||--|
|Alzheimer’s Disease Program||19||19||19||--|
|Lifespan Respite Care||3||3||3||--|
|Subtotal, Caregiver Services||180||180||180||--|
|Protection of Vulnerable Older Adults||2016||2017 /1||2018||2018
|Long Term Care Ombudsman Program||16||16||16||--|
|Prevention of Elder Abuse & Neglect||5||5||5||--|
|Senior Medicare Patrol Program (HCFAC)||18||18||18||--|
|Elder Rights Support Activities||12||12||12||--|
|Subtotal, Protection of Vulnerable Older Adults||51||51||51||--|
|Disability Programs, Research and Services||2016||2017 /1||2018||2018
|Partnerships for Innovation, Inclusion, and Independence||0||0||45||+45|
|State Councils on Developmental Disabilities||73||73||0||-73|
|Developmental Disabilities Protection and Advocacy||39||39||39||--|
|Projects of National Significance||10||10||8||-2|
|University Centers for Excellence in Developmental Disabilities||39||39||39||--|
|Nat’l Institute on Disability, Independent Living, & Rehab. Research||104||104||95||-9|
|Traumatic Brain Injury||9||9||3||-6|
|Limb Loss Resource Center||3||3||0||-3|
|Paralysis Resource Center||8||8||0||-8|
|Subtotal, Disability Programs, Research and Services||386||386||307||-79|
|Consumer Information, Access and Outreach||2016||2017 /1||2018||2018
|Voting Access for People With Disabilities (HAVA)||5||5||5||--|
|Aging and Disability Resource Centers||6||6||6||--|
|State Health Insurance Assistance Program||52||52||0||-52|
|MIPPA Programs (Mandatory)||38||35||38||+2|
|Subtotal, Consumer Information, Access and Outreach||135||132||81||-52|
|Other Programs, Total, and Less Funds From Other Sources||2016||2017 /1||2018||2018
|Total, Program Level||2,048||2,042||1,907||-135|
|Less Funds from Other Sources||-83||-81||-56||-25|
|Total, Budget Authority||1,965||1,961||1,851||-110|
1/ Reflects the annualized level of the Continuing Resolution that ended April 28, 2017, including the across the board reduction, the 21st Century Cures Act, and directed transfers.
Since its creation in 2012, the Administration for Community Living (ACL) has helped increase access to community supports, while focusing attention and resources on the unique needs and strengths of the populations served.
The Fiscal Year (FY) 2018 Budget requests $1.9 billion for ACL, which is $135 million below the FY 2017 Continuing Resolution. The Budget prioritizes funding for critical programs that help support older Americans, individuals living with disabilities, and their caregivers and connect them with direct services across the United States. Consistent with the President’s priorities, the Budget also maximizes Federal investments by promoting efficiencies and supporting evidence-based approaches.
Maintaining Health and Independence for Older Adults
The United States population over age 60 is projected to increase by 20 percent between 2014 and 2020, from 64.8 million to 77.6 million people. The Budget preserves funding for essential community-based services and supports that assist efforts to help older Americans stay healthy, independent, and living in their communities.
Nutrition Services Programs
The Budget requests $833 million for Nutrition Services—the same level as the FY 2017 Continuing Resolution—which includes funding for Congregate Meals, Home-Delivered Meals, and the Nutrition Services Incentive Program. ACL’s nutrition programs help ensure that millions of older Americans have access to meals, nutrition screening and education, and the opportunity to engage socially with others in their communities. This funding represents the vast majority of Federal funding for nutrition services for seniors, and in combination with State and local contributions, the Budget will support 216 million congregate and home-delivered meals for approximately 2.3 million older adults nation-wide, as well as 5.8 million meals to over 100,000 Native American seniors.
Home and Community-Based Supports
The Budget also includes a total of $368 million for Home and Community-Based Supportive Services and Preventive Health Services, which maintains funding at the FY 2017 Continuing Resolution level. The Home and Community-Based Supportive Services Program provides formula grants to States and Territories to fund a broad array of services that enable seniors to remain in their homes. These services include—but are not limited to—transportation assistance, case management, adult day care, and in-home services. In the most recent fiscal year for which data is available, the program provided over 9.9 million hours of care for dependent adults in a group setting and 23.6 million rides to doctors’ offices, senior centers, meal sites, and other locations.
The Preventive Health Services Program also provides formula grants to States and Territories to fund evidence-based programs that educate older adults about the importance of healthy lifestyles to help prevent or delay chronic disease and disability.
The Budget maintains funding at a total of $51 million for other health and independence services, which provide a range of services designed to ensure the safety and well-being of seniors who are in danger of being mistreated, neglected, or exploited in both at-home and institutional settings.
The Budget also maintains mandatory funding for the State Health Insurance Assistance Program, Aging and Disability Resource Centers, Area Agencies on Aging, and the National Center for Benefits Outreach and Enrollment. These programs provide funding for targeted one-on-one counseling and outreach to low-income and rural populations to assist with Medicare enrollment. The National Center for Benefits Outreach and Enrollment supports an online enrollment benefit tool as well as a nation-wide network of 59 Benefits Enrollment Centers that help connect low-income populations to public benefits.
The Budget includes $161 million to fund three programs designed to support and provide services to family and other informal caregivers, the same as the FY 2017 Continuing Resolution. Research has shown that these caregivers make an important economic contribution to the care of people needing long-term services and supports. Without them, the cost and burden to the Nation’s long-term care system would be substantial.
The National Family Caregiver Support Program and the Native American Caregiver Support Services Program provide caregivers with a range of support services such as counseling, respite care, and training. In FY 2018, the Family Caregiver Support program will support approximately 850,000 family caregivers with respite care services, access assistance services, counseling and training. The Lifespan Respite Care program focuses on easing the burdens of caregiving by helping States develop more efficient, evidence-based, and cost-effective methods to improve quality and access to respite care. These caregiver programs enable individuals across the lifespan to stay at home longer and enjoy greater independence, which can translate into lower costs when institutional care is avoided.
In FY 2018, the Budget maintains funding for Alzheimer’s Disease activities at $19 million, consolidating all related Alzheimer’s Disease activities across ACL into a single grant program. An estimated 5.2 million individuals in the United States are living with Alzheimer’s Disease and related dementias; that number is expected to increase by about 40 percent by 2025. Consolidating similar Alzheimer’s Disease activities into a single grant program will provide greater flexibility to States, Territories, Tribes, and localities to meet the needs of their communities.
Improving the Lives of Individuals with Disabilities
ACL is dedicated to ensuring that individuals with disabilities and their families are able to fully participate in and contribute to all aspects of community life. Through partnerships with States, Territories, communities, and non-profit organizations, ACL works to improve opportunities for people with disabilities to access quality services and supports, achieve economic self-sufficiency, and experience equality and inclusion in all facets of community life.
Protection and Advocacy
The Budget requests $39 million to maintain funding for the Developmental Disabilities Protection and Advocacy Program. Protection and Advocacy Systems work at the State level to protect individuals with developmental disabilities by investigating incidents of abuse and neglect, and pursuing legal, administrative, or other appropriate remedies.
Most participants reported that the ACL Nutrition Services programs had helped them to eat healthier foods, and up to 86 percent indicated the program had improved their health. Additionally, 63 percent of congregate and 93 percent of home-delivered meal participants reported that the program had helped them to live independently and remain in their own home.
University Centers for Excellence
The Budget also requests $39 million—the same funding level as the FY 2017 Continuing Resolution—to continue funding for University Centers for Excellence in Developmental Disabilities, a nationwide network that provides an array of interdisciplinary programs to improve the quality of services and supports for individuals with developmental disabilities and training for professionals. The Centers also advise Federal, State, and community policymakers about opportunities that can advance research related to the needs of individuals with developmental disabilities and their families as well as emerging issues in the field.
Partnerships for Innovation, Inclusion, and Independence
Finally, the Budget restructures activities carried out by the State Councils on Developmental Disabilities, Independent Living and Traumatic Brain Injury programs into a single state grant program. The Budget requests $45 million for the Partnerships for Innovation, Inclusion, and Independence program, which will combine these activities into a single statewide, cross-disability entity, promoting evidence-based approaches, efficiencies, and a more cohesive approach to disability partnerships. This restructuring of State council activities into a single grant program achieves $57 million in savings in FY 2018, while ensuring that States have the tools they need to coordinate care for individuals with disabilities.
Other Disability Programs
The FY 2018 Budget reduces funding for Projects of National Significance and the National Institute on Disability, Independent Living, and Rehabilitation Research to prioritize funding for direct service programs. The Budget requests $8 million for Projects of National Significance, which is $2 million below the funding level provided by the FY 2017 Continuing Resolution. The Budget includes $95 million—$9 million below the FY 2017 Continuing Resolution—for the National Institute on Disability, Independent Living, and Rehabilitation Research.
Streamlining Programs and Delivery of Services
The Budget proposes to discontinue funding for programs whose activities could be carried out with existing funding streams to deliver services more efficiently.
The FY 2018 Budget request achieves $63 million in savings by discontinuing discretionary funding for the Limb Loss Resource Center, the Paralysis Resource Center, and the State Health Insurance Assistance Program. The activities carried out by these programs are duplicative of other Federal efforts. Activities carried out by the Limb Loss and Paralysis Resource Centers will be merged into the National Institute on Disability, Independent Living and Rehabilitation Research and Aging and Disability Resource Centers. The Budget discontinues discretionary funding for the State Health Insurance Assistance Program leveraging alternative sources for Medicare beneficiaries to obtain access to reliable information to better understand and manage benefits.
The Budget includes $38 million for program management and support activities. This funding supports rent, staff, and other administrative costs.