DEPARTMENT
               of HEALTH
              and HUMAN
                SERVICES
                   Fiscal Year
                   2023
               Administration for 
               Community Living
                  Justification of
                  Estimates for
            Appropriations Committees
                   DEPARTMENT OF HEALTH AND HUMAN SERVICES                                     Administration for  
          Community Living  
                                                                                                      Washington, DC 20201
          I am pleased to present the Administration for Community Living (ACL) FY 2023 Budget, which includes a discretionary
          request for $2.986 billion in budget authority. The request reflects ACL’s prioritization of direct services for people with
          disabilities and older adults; innovation and collaboration to improve program effectiveness and sustainability; protecting
          rights and preventing abuse; and advancing the President’s priorities of expanding home and community-based services,
          supporting family caregivers and advancing equity. It also continues ACL’s focus on bolstering the infrastructure that supports
          program administration and oversight, as well as ACL’s increasing leadership responsibilities as an advocate for older adults
          and people with disabilities.
          The populations served by ACL’s programs are growing, and the need for the services and supports that make community
          living possible is growing along with them. In addition, the pandemic created a spike in demand for services that has
          stabilized at a level below the peak, but well above pre-pandemic levels. To help meet the needs of this “new normal,” the
          request includes funding increases across a number of programs that collectively expand our country’s overall capacity to
          support community living, with a particular focus on programs that provide services directly to people with disabilities and
          older adults. 
          For example, increases are requested for Protection and Advocacy (P&A) programs and Centers for Independent Living,
          which play critical roles in protecting the rights of people with disabilities. The services they provide are key to ensuring that
          people with disabilities have equal access and opportunity to fully participate in their communities. They are also at the
          forefront of helping people with disabilities move back to the community from nursing homes and other institutions. Increases
          also are requested for ACL’s Nutrition and Home and Community-Based Supportive Services, which similarly provide the
          core services that make it possible for millions of older adults to age in place.  
          ACL’s request also includes funding to continue programs that address abuse and neglect, which rob people of their
          fundamental human rights, erode equal opportunity, harm health and well-being, and pose a significant barrier to equity and
          inclusion. In addition to the increased funding for P&A programs, which also investigate and address abuse, ACL’s request
          includes funding for grants to support state adult protective services programs and increased funding for state Long-Term Care
          Ombudsman programs. 
          While increased funding for direct services is necessary, it is not sufficient to meet growing needs. Ongoing innovation,
          coordination of efforts across programs and partnerships between networks, and alignment of resources to meet greatest needs,
          also are needed to continually improve the capacity, effectiveness and sustainability of interventions and service delivery.
          Therefore, ACL is requesting authority to fund cross-program demonstrations to address issues and needs that are common to
          both older people and disabled people of all ages. In addition, with many programs returning to in-person service delivery, the
          request restores the traditional balance of funding between home-delivered and congregate meals for older adults. The request
          also includes modest investments in innovation, including a cross-cutting initiative to better meet the needs of older adults and
          people with disabilities during disasters. 
          Finally, the request reflects ACL’s need to establish adequate infrastructure to properly administer programs and carry out the
          agency’s advocacy responsibilities. ACL has faced staffing challenges almost from its creation; with the significant increase in
          its scope of responsibilities in recent years, addressing staffing gaps and other administrative needs has become critically
          important. 
           
          In closing, our communities are stronger when everyone is included, everyone is valued, and everyone can contribute. This
          requires equitable access to health care, education, transportation, recreation, and other systems, resources and opportunities.
          ACL and I remain committed to making community living an option for every American, regardless of age or disability, race
          or ethnicity, gender identity or sexual orientation, income or any other factor, and this budget aligns with that commitment.
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          DEPARTMENT OF HEALTH AND HUMAN SERVICES                                     Administration for  
     Community Living  
                                             Washington, DC 20201
                                            Alison Barkoff
                          Acting Administrator and Assistant Secretary for Aging
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                      Table of Contents
        Table of Contents.........................................................................................................................ii
        Organization Chart......................................................................................................................iv
        Introduction and Mission.............................................................................................................1
        Overview of the Budget Request.................................................................................................3
        Overview of Performance..........................................................................................................11
        All Purpose Table.......................................................................................................................18
        Mandatory Proposals Summary Table.......................................................................................21
        Appropriations Language..........................................................................................................22
        Appropriations Language Analysis............................................................................................26
        Amounts Available for Obligation.............................................................................................30
        Summary of Changes.................................................................................................................31
        Budget Authority by Activity.....................................................................................................33
        Authorizing Legislation.............................................................................................................34
        Appropriations History..............................................................................................................37
        Appropriations Not Authorized by Law....................................................................................39
        Health and Independence for Older Adults...............................................................................40
        Home and Community-Based Supportive Services..................................................................45
        Nutrition Services......................................................................................................................56
        Preventive Health Services........................................................................................................74
        Chronic Disease Self-Management Education..........................................................................81
        Falls Prevention.........................................................................................................................85
        Native American Nutrition and Supportive Services.................................................................88
        Aging Network Support Activities............................................................................................93
        Caregiver and Family Support Services..................................................................................102
        Family Caregiver Support........................................................................................................106
        Native American Caregiver Support Services.........................................................................115
        Alzheimer’s Disease Program..................................................................................................119
        Lifespan Respite Care..............................................................................................................122
        Protection of Vulnerable Adults...............................................................................................128
        Long-Term Care Ombudsman Program..................................................................................131
        Prevention of Elder Abuse and Neglect...................................................................................138
        Health Care Fraud and Abuse Control/Senior Medicare Patrol Program................................143
        Elder Rights Support Activities...............................................................................................147
        Elder Justice/Adult Protective Services...................................................................................152
        Disability Programs, Research and Services...........................................................................161
        State Councils on Developmental Disabilities........................................................................164
        Developmental Disabilities – Protection and Advocacy.........................................................171
        University Centers for Excellence in Developmental Disabilities..........................................180
        Developmental Disabilities – Projects of National Significance.............................................185
        Independent Living..................................................................................................................190
        Limb Loss Resource Center.....................................................................................................202
        Paralysis Resource Center.......................................................................................................205
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