On the first Monday in February, the President issues his budget requests for the next fiscal year, which begins October 1.  But they are only requests.

Over the next seven months the administration and Congress will go through a serpentine process to try to reach spending levels they can both live with.

But a budget is a philosophy and illustrates the Chief Executive's priorities.  So here is a lengthy description of items from the FY2016 Presidential budget that relate to aging in place:

Administration for Community Living
The Department of Health and Human Services provides federal funding for programs and services that support “aging in place” through the Administration for Community Living (ACL).

The FY 2016 Budget requests $2.1 billion for the ACL, an increase of $177 million over FY 2015. ACL focuses on ensuring that older adults and people with disabilities are able to live independently with the support they need while participating in communities that value their contributions. In FY 2016, the Budget prioritizes efforts to bolster nutrition assistance and other key services that help seniors remain independent, assist and support family caregivers, and increase ACL’s capacity to empower and support individuals with disabilities to live independent lives, fully integrated into all aspects of society.
 
The Budget includes $386 million, $38 million more than in FY 2015, to fund in-home and community-based services to help older Americans live independently and with dignity. These services include transportation; case management; information and referral; help with personal care, including eating, dressing, and bathing; and adult day care and physical fitness programs. In combination with state and local funding, the Budget will support over 28 million hours of assistance to seniors unable to perform daily activities; more than 23 million rides for critical activities such as visiting the doctor, pharmacy, or grocery stores; and nearly 8 million hours of adult day care. These direct services assist older individuals as well as the caregiving friends and family members of these seniors by providing caregivers with relief and flexibility to attend to other demands in their lives, while also continuing to support their friends or loved ones.
The Budget also includes $10 million for Aging Network Support Activities that help older Americans access resources and services they need to remain in the community, including $2.5 million that is specifically targeted to assist nonprofit service providers that work with the Holocaust survivor community.
 
Another $20 million is being requested for Preventive Health Services, a program that provides grants to states and territories that help educate older adults about the importance of healthy lifestyles and promote healthy behaviors, which can help to prevent or delay chronic disease and disability, thereby reducing the need for more costly medical interventions. The Budget also includes $8 million for Chronic Disease Self-Management Education and $5 million for Falls Prevention, which both support programs designed to help seniors improve their health status, with the ultimate goal of reducing hospital stays and emergency room visits.

Protecting Older Americans from Abuse
Fighting the rising scourge of adult abuse, neglect, and exploitation in America remains one of ACL’s top priorities. The Budget, as part of the $29 million request for Elder Rights Support Activities, continues to request $25 million—an increase of $21 million—for ACL’s Elder Justice initiative to address the damaging impact of abuse, neglect, and exploitation on the health and independence of seniors by making strategic investments in Adult Protective Services, research, and evaluation activities.
With this funding, ACL will continue to develop a national Adult Protective Services data system, including grants to states to test and develop infrastructure, while also providing funding for key research. Research in the area of Adult Protective Services is essential to the future development of evidence-based interventions that will effectively prevent, identify, report, and respond to abuse of adults of all ages. ACL will become the federal home for Adult Protective Services and will develop national standards to assist all states in improving the quality and consistency of their Adult Protective Services programs.

Assisting Americans and Promoting Efficiency in Community Based Service Delivery
The Budget requests $20 million in new discretionary funding for the Aging and Disability Resource Centers program, which has a proven track record of success in supporting state efforts to develop more efficient, cost-effective, and consumer-responsive systems of information and integrated access by creating consumer-friendly entry points into long-term care at the community level. Aging and Disability Resource Centers make it easier for Americans nationwide to learn about and access their health and long-term services and support options.
The Budget also requests $52 million to fund the State Health Insurance Assistance Program, which supports 12,000 counselors in more than 1,300 community-based organizations across the country. These individuals and organizations provide Medicare beneficiaries who have a disability and/or are elderly, as well as those nearing Medicare eligibility, with one-on-one outreach and counseling on the health insurance options available to them.
The FY 2016 request also includes $31 million for the Assistive Technology programs, which were transferred to ACL under the Workforce Innovation and Opportunity Act. Assistive Technology programs support state efforts to improve opportunities for individuals with disabilities of all ages to obtain assistive technology that fosters greater independence, productivity, as well as integration and inclusion within the community and workforce.

Supporting Family Caregivers
The FY 2016 Budget provides $15 million for a new Family Support Initiative focused on ensuring the optimal deployment of public and private resources at the state and community level to support family members caring for older adults and/or people with disabilities across the lifespan. Research suggests that informal family care for the elderly is valued at over $500 billion annually, an amount that exceeded total Medicaid expenditures in 2013. Additionally, over 75 percent of people with developmental disabilities rely primarily on family caregivers. The Family Support Initiative will complement the $151 million in funding included in the FY 2016 Budget for Family Caregiver Support Services and spur innovation to support and sustain the largest provider of our nation’s long-term care: families.


In addition, the Budget includes $5 million for Lifespan Respite Care, $3 million more than FY2015, to provide resources that will allow caregivers to continue care for their loved ones for longer, and thereby allow more care recipients.

Providing Nutrition Assistance for Older Americans
Nutrition Services are a vital support for older Americans nationwide, many of whom are low-income, as meals provided through home delivery or in senior centers allow many older Americans to remain independent and living at home for as long as possible, delaying or preventing the need for more costly institutional services.
 
The FY 2016 Budget includes over $875 million in funding for the ACL’s Nutrition Services programs, $60 million more than was provided for these programs in FY 2015. Leveraged further by state and local funding, $40 million of this increase will allow states to continue to provide 208 million meals to over 2 million older Americans nationwide, helping to halt the decline in service levels for the first time since 2010. In addition to these core investments in Nutrition Services, the FY2016 Budget invests the remaining $20 million in evidence-based innovations to help ensure that future funding for Nutrition Services programs is spent as efficiently as possible to maximize the impact of these funds.

Protecting Seniors from Identity Theft
Protecting seniors from identity theft is a top priority for the Administration. This Budget requests $50 million to support the removal of Social Security Numbers from Medicare cards, so that millions of beneficiaries will no longer have to fear that their personal identification numbers could be used against them due to a lost, stolen or misused Medicare card.
 
Advancing Comprehensive Medicaid Long-Term Care
The Budget proposes an eight-year pilot program to create a Medicaid comprehensive long-term care state plan option for up to five states. Participating states would be authorized to provide long-term care services across the continuum of care under one authority, creating equal access to home and community-based care and nursing facility care. The Secretary of HHS would have the discretion to make these pilots permanent at the end of the eight years. This proposal works to end the institutional bias in long-term care and simplify state administration.
 
Part D ($108.0 billion gross spending in 2016)
In 2016, the number of beneficiaries enrolled in Medicare Part D is expected to increase by about 3.5 percent to 43.7 million, including about 12.6 million beneficiaries who receive the low-income subsidy. The Affordable Care Act closes the Medicare Part D coverage gap, or “donut hole,” through a combination of manufacturer discounts and gradually increasing federal subsidies. Beneficiaries fall into the coverage gap once their total drug spending exceeds an initial coverage limit ($2,960 in 2015), until they reach the threshold for qualified out-of-pocket spending ($4,700 in 2015), at which point they are generally responsible for five percent of their drug costs.
To view a copy of the Administration’s “Budget in Brief” for HHS, click. The section pertaining to the Administration for Community Living begins in page 132.