The document summarizes a presentation given at the 2018 NADO Annual Training Conference on current issues in aging. The presentation covered topics like the aging network and federal funding, the Older Americans Act reauthorization process, building connections to health care through programs like Medicare and Medicaid, and advocacy strategies. It provided data on trends in aging services and the needs of older adults, discussed the 2019 federal budget deal's impact on aging programs, and looked ahead to potential policy discussions in the coming years.
Finance strategies for adaptation. Presentation for CANCC
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Current Issues in Aging: Campell
1. National Association of Area Agencies on Aging
Current Issues in Aging
2018 NADO Annual Training Conference, Charlotte, NC
Autumn Campbell, n4a
October 16, 2018
4. National Association of Area Agencies on Aging
Agenda
โข Fast Facts About the Aging Network
โข Federal Budget and Funding for Aging Programs
โข Older Americans Act Reauthorization
โข Building the Bridge to Health Care
โข A Look Into the Crystal Ball
โข Questions?
9. National Association of Area Agencies on Aging
Growing Needs/Growing
Numbers of Older Adults
2016 Top 5 Purpose of Call to the
Eldercare Locator
Purpose Percentage
Transportation 21%
Home and Community Based Services (HCBS) (In-Home Svcs
11%, Nutrition Svcs, 4%, Senior Center Programs 3%, LTC 2%, Case Management 1%,
Employment 1%) 20%
Housing 9%
Medical Services and Supplies (Medical Services 6% and Medical Supplies
and Equipment 3%) 9%
Health Insurance
6%
13. National Association of Area Agencies on Aging
Responding to the Needs:
AAA Trends and Directions
โข Increasing Demand for Services with Limited Budgets
โข Serving Broader Population
โข Expansion of Health-related Services
โข Expansion of Work in Integrated Care
โข Increased Interest and Activity in Business Acumen and
Business Development to Meet Needs/Diversify $
15. National Association of Area Agencies on Aging
Outreach
A core role of AAAs is to create local information and
referral/assistance (I&R/A) hotlines to help consumers find
aging and other HCBS programs.
With these resources and a portfolio of other outreach tools
including public education, staff and volunteers, ADRCs and SHIPs,
AAAs are able to assist clients match services and solutions to their
individual needs, enabling consumers to age in place with increased
health, safety and independence.
16. National Association of Area Agencies on Aging
Nationwide Network with a
Local Flavor
โข In 2017, there are 622 AAAs serving older adults in virtually
every community in the nation.
โข In a few small or sparsely populated states, the state serves the
AAA function.
โข The OAA is foundational for all AAAs, but because the law calls
for local control and decision-making, AAAs adapt to the unique
demands of their communities to provide innovative programs
that support the health and independence of older adults.
18. National Association of Area Agencies on Aging
AAAs vary widely in size as
each state determines how
many service areas to
establish, which then
determines the number of
operating AAAs. For
example, Wisconsin has 3
AAAs, but New York has 59.
21. National Association of Area Agencies on Aging
Aging Services Offered by AAAs
Percent
n=412
Legal assistance 92%
Respite care 89%
Benefits/health insurance counseling 85%
Transportation (non-medical) 85%
Case management 82%
Homemaker 74%
Personal assistance/personal care 74%
Options counseling 72%
Assessment for care planning 70%
Ombudsman services 70%
22. National Association of Area Agencies on Aging
Aging Services Offered by AAAs
Percent
n=412
Enrollment assistance 64%
Home repair or modification 64%
Transportation (medical) 63%
Senior Center 61%
Emergency Response Systems 58%
Assessment for long-term care service eligibility 58%
Chore services 57%
Adult day service 55%
Evidence-based caregiver programs 51%
29. National Association of Area Agencies on Aging
Aging Policy Challenges
โข Lack of understanding, acceptance among lawmakers, public of
how huge this aging of the population is
โข Room to move on crafting good aging policy!
โ E.g., many states still not rebalanced, few truly livable
communities, treatment vs. wellness/prevention
โข Uncertainty about long-term financial stability of key social
safety net and social insurance programs
โข Short-term instability on annual federal budget (appropriations)
30. National Association of Area Agencies on Aging
Federal Budget and Funding
for Aging Programs
32. National Association of Area Agencies on Aging
Most of the Federal Budget = Defense, Social Security and
Major Health Programs
Chart Courtesy of Center on Budget and Policy Priorities
33. National Association of Area Agencies on Aging
Federal Budget Snapshot
In FY 2017โฆ
โข Total Federal Spending = ~$4 Trillion
โข Total Non-Defense Discretionary Spending =
$610 Billion (~15.25 percent)
โข Total Older Americans Act Spending =
~$2 Billion
โข Total OAA Spending as percentage of
Federal Budget = .05 percent
34. National Association of Area Agencies on Aging
A Look Back:
Budget Battles, 2011-2018
โข Recession, changes in politics drove louder conversation
about federal debt (and deficit)
โข July 2011: Budget Control Act = caps, threat of
sequestration, Super Committee, debt ceiling relief
โข March 2013: Sequestration
โข October 2013: Shutdown
โข Series of two-year budget deals (FY14-15/FY16-17), partially
offset sequester/caps
โข Jan-Feb 2018: Two shutdowns
โข February 2018: Third two-year budget deal (FY 18-19),
partially offset sequester/caps
35. National Association of Area Agencies on Aging
Trump Administration Budget FY 2019
โข Deep cuts to Non-Defense Discretionary (domestic)
programs (>40 percent/10 years) overall
โข โFlatโ funds most core Older Americans Act programs
โข Cuts/eliminates critical domestic programs serving older
adults (SCSEP, SHIP, SSBG, CDBG, CSBG, LIHEAP, Housing,
Transportation)
โข Guts Medicaid (states will limit HCBS)
โข Repeals ACA (higher premiums, double uninsured rate
among pre-Medicare population)
โข Nutrition assistance eliminated for 1 million seniors
โข Cuts SSDI for 6 million people over 55
36. National Association of Area Agencies on Aging
โฆBUT Congress Is Where the
Action Is
Theory:
โ Budget resolutions passed by both chambers, agreed
to; sets high-level spending limits
โ Appropriators develop 12 bills, move through
committee and to floor
โ Everything done and signed by President by Sept. 30
Reality:
โ After five CRs, two shut-downs and significant
compromises, final FY 2018 funding passed in March
2018 (nearly six months into FY)
โ FY 2019โReturn to โRegular Orderโ
37. National Association of Area Agencies on Aging
Bipartisan Budget Agreement for
FY 2018-19 (February)
Highlights
โ Rejected major cuts to domestic programs
President requested in FY 18-19
โ Increased discretionary caps (for defense and
non-defense) by $300 billion over two years
โ Included the CHRONIC Care Act (more on that
later!)
โ Closed the Part D Donut Hole in 2019
โ Included $80 billion in disaster relief funding
โ 10-year reauthorization of CHIP
โ Funding for opioid response
38. National Association of Area Agencies on Aging
Older Americans Act BIG INCREASES!
โข + $35 million for Title III B Supportive Services
โข + $40 million for III C 1 Congregate Nutrition
โข + $19 million for III C 2 Home-Delivered Meals
โข + $5 million for III D Preventative Health
โข + $30 million for III E National Family Caregiver Support
Program
โข + $4 million for Title VI Native American
โข +$1 million for Title VII Ombudsman
[HUD Section 202 +$105 million, Service Coords +$90 mil]
What Happened in FY 2018? (March)
39. National Association of Area Agencies on Aging
Other Administration for Community Living
โข State Health Insurance Programs preserved with
$2 million increase to $49 million
โข Elder Justice (APS) Initiative, 20% boost to $12 million
โข Aging and Disability Resource Centers boosted 32% to
$8 million
โข CDSMP level at $8 million, Falls Prevention level at $5
million (Prevention and Public Health Fund)
โข Lifespan Respite up 22% to $4.1 million
โข Holocaust Survivors doubled to $5 million
FY 2018 Final Levels
40. National Association of Area Agencies on Aging
Other Agencies, Proposed for Elimination
โข OAA Title V Senior Community Services Employment
Program level funded at $400 million (Dept. of Labor)
โข Social Services Block Grant, $1.7 billion
โข Community Services Block Grant, $715 million
โข Low-Income Home Energy Asst, boosted $240 million to
$3.6 billion
โข Senior Corps, $202 million
โข Community Development Block Grant, $3.24 billion, a
boost of $235 million
FY 2018 Final Levels
41. National Association of Area Agencies on Aging
What About FY 2019?
Return to (roughly) Regular Order
โข Labor-HHS Funding signed into law on Sept. 28
โข Continuing Resolution (CR) for other agencies until
December 7
โข $855 billion funding bill contains $178 billion for Labor-
HHS (including OAA/other Aging Programs)
โข First time in 22 years!
โข 9 of 12 bills passed in Senate; 7 of 12 bills passed in
House
42. National Association of Area Agencies on Aging
What About FY 2019?
An FY 2018 Redux for OAA/Aging Programs
- Labor/HHS put with Defense bill
- Full-year funding!
- OAA programs mostly flat at FY 2018 levels
- Preserves 2018 increases
- $10 million increase for Title III C Nutrition Programs
- Make other small increases (OAA Title VI, RAISE, GRG,
Caregiver Corps)
- Avoids eliminations for key programs
- Increases funding for CSBG ($10 million) and LIHEAP ($50
million)
43. National Association of Area Agencies on Aging
Older Americans Act Reauthorization
Lyndon Johnson signing the OAA, July 14, 1965.
44. National Association of Area Agencies on Aging
Timeline of Major Amendments
1972 โ Nutrition program
1978 โ Home โdelivered
meals authorized and
ombudsman services
required
1992 โ Elder
rights recognized
1973 โ AAAs created;
multipurpose senior centers
and community service
employment authorized
2006 โ HCBS systems thru
ADRCs; evidence-based
health promotion services
2000 โ National family
caregiver support program
1965
Present (Preparing for 2019
OAA Reauthorization)
2016 โ Small changes to definitions,
specific authorization levels
45. National Association of Area Agencies on Aging
Topics included:
Rising Demand
Eligibility
Flexibility
Transfer Authority
Targeting
Cost-Sharing
Data Collection
Private Pay
ADRCs
46. National Association of Area Agencies on Aging
Older Americans Act Reauthorization
(current law expires Sept. 30, 2019)
n4a Process on OAA
โข June-August: Preparatory phaseโhearing
from the field; developing high-level
approach
โข July-August: Comprehensive survey of n4a
members
โข Currently: Review survey results, develop
initial priorities.
โข November 6: Election will inform specific
advocacy strategy
โข Early 2019: Release n4a OAA
reauthorization priorities to new Congress
and start advocating!
Coalition Process on OAA
โข May-August: Leadership Council of Aging
Organizations (LCAO) reviewing 2011 coalition
priorities
โข September-October: n4a taking a leading role
in negotiations to determine and elevate priorities
among the 72-member coalition
โข November-January: Approve comprehensive
list of LCAO priorities and identify top few to
highlight for the Hill. Determine coalition
advocacy strategy.
โข Early 2019: Release LCAO OAA reauthorization
priorities to new Congress and start advocating!
49. National Association of Area Agencies on Aging
Social Needs Affect Health
In a survey of 1,000 physicians:
๏ง 85% say unmet social needs directly leading to worse health
๏ง 85% say social needs as important to address as medical
conditions
๏ง 80% not confident in their ability to address social needs
Source: Robert Wood Johnson Foundation,
http://www.rwjf.org/content/dam/farm/reports/surveys_and_polls/2011/rwjf71795
51. National Association of Area Agencies on Aging
Medicare: New Opportunities Abound?
โข Medicare largest federal
health care program
โข Health happens at home: 80
percent of health care costs
are attributed to SDOH
โข Traditionally, Medicare has
not touched these
factors
52. National Association of Area Agencies on Aging
Medicare: New Opportunities Abound?
Emerging Opportunities for CBOs in Medicare
โข CHRONIC Care Act (passed Feb. 2018)
โข Medicare Advantage Call Letter for 2019
โข Legislative proposals to add LTSS to Medicare
Challenges
โข Not available for all beneficiaries
โข Late notice for Medicare Advantage plans to implement
this year
โข Cost
53. National Association of Area Agencies on Aging
But What About Medicaid?
โข 6 million low-income seniors and 10 million people with
disabilities receive services and supports through
Medicaid (=62% of Medicaid spending)
โข Two-thirds of seniors in nursing homes rely on Medicaid
โข 39% of American children are covered by Medicaid
(=21% of Medicaid spending)
โข Overall, Medicaid covers nearly 80 million low-income
Americans
โข 15% Medicaid spending covers non-disabled low-
income adults
55. National Association of Area Agencies on Aging
Another Medicaid Issue: MFP
Money Follows the Person
โข Medicaid rebalancing program, transitioned over 88k people from
institutional settings back to the community
โข Bipartisan program with 12+ years of success; expired at the end of
FY 2016
โข States running out of MFP moneyโramping down programs; losing
infrastructure
โข Bipartisan House/Senate bills to reauthorize: EMPOWER Care Act
(H.R. 5306 & S. 2227)
โข House marked up its bill last month!
โข See n4a.org/advocacy for what you can do to support MFP
reauthorization
56. National Association of Area Agencies on Aging
Funding for OAA/Aging Programs
โข FY 2019 stability for OAA/Aging programs
โข Fights over budget caps will start again next year
Health Care Proposals
โข Limited legislative traction due to election
โข Administrative action will continue
โข Potential: MFP
OAA Reauthorization
โข Education is important through the end of the year
โข Potentially high priority in early 2019โelection will determine strategy
A Look Into the Crystal Ball
58. National Association of Area Agencies on Aging
Key Advocacy Reminders
โข Educate, educate, educate your elected officials
about the importance of OAA programs and delivering
aging services in the home and community!
โข Build relationships with Members/staff
โข Engage candidates in your work (site visits!)
โข THANK your elected officials for advocacy wins
โข Keep them informed about what is going on in your
community
โข Engage with the media, too