What happened?
A draft budget for the Department of Health and Human Services (DHHS) was leaked to reporters on Wednesday, April 16 that proposes massive budget cuts to social safety net services. The leaked memo has been authenticated by The Washington Post and reported in multiple sources. The full memo can be downloaded here.
What’s in the memo?
The leaked 64-page budget proposal contains details about programs that will continue to be funded under the other divisions of Centers for Medicare and Medicaid Services (CMS) and the Administration for Children and Families (ACF) and those that are eliminated. This provides more detail than previously disclosed by the HHS restructuring news. The memo also includes a grainy organizational chart outlining the proposed structure of the re-organized DHHS.
For ACL programs, we’ve collected the proposed amounts, as well as the previous line items according to past years’ Congressional budgets. Link to spreadsheet here.
The Good News for ACL Programs
Plenty of ACL programs will continue to be funded, amounting to $2.3B in the DHHS budget. Note that the budget requested in 2025 was $2.6B. These programs are now dispersed among other divisions, namely CMS and ACF. For these programs that remain, in many cases the new budget proposal matches what was originally requested for FY 2025. In addition, there is a new budget line item introduced for “ACL Program Administration Shift to CMS,” indicating that the transition will at least be partially funded and perhaps some level of thought has been put into a transition plan.
Home and Community Based Supportive Services programs continue at their current level of funding, which has been in place since at least FY 2023. The Family Caregiver Support Services also received a modest increase versus the request. While the Senior Nutrition Programs like Congregate Meals, Home Delivered Meals, and NSIP are getting a haircut vs. the 2025 Budget Request, they are still mostly whole versus the FY2024 CR.
Interestingly, while many of the Disability-focused programs have been cut, such as State Councils on Developmental Disabilities, DD Protection and Advocacy, and other Resource Centers, it appears that the line item for Independent Living, now within ACF, has grown dramatically from $132M in previous year’s request to $453M in the memo. The $325M above the 2024 enacted will go towards Independent Living State Grants to provide flexibility for states to use the funding to provide services eliminated by the Budget.
Which ACL Programs are in Danger?
A number of programs are proposed to be eliminated in their entirety, amounting to $326M in eliminated budget. Here are all the programs mentioned in the memo:
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ACL Programs Eliminated:- Preventive Health Services
- Elder Falls Prevention
- Lifespan Respite Care
- Long-Term Care Ombudsman
- Chronic Disease Self-Management Education
- Elder Rights Support Activities
- Elder Justice/Adult Protective Services
- ACL Aging Programs Discretionary Funding Eliminated
- Aging & Disability Resource Centers
- State Health Insurance Assistance Programs
- Nutrition and Disability Services Programs Eliminated
- State Councils on Developmental Disabilities
- Developmental Disabilities Protection and Advocacy
- Developmental Disabilities Projects of National Significance
- Paralysis Resource Center
- Limb Loss Resource Center
- Voting Access for People with Disabilities
Agencies are allowed to request changes to HHS but have been told they cannot change the bottom line, according to an anonymous official.
What Comes Next?
This is a draft budget. It has not yet been formally submitted to Congress for approval. From the memo, it seems that agencies are granted some forum to request changes, but an anonymous insider has also said that any changes must maintain the bottom line. It is expected that the formal budget proposal for FY 2026 may be submitted to Congress in the coming weeks. Once submitted, Congress will review the proposal, and the appropriations process will commence. The goal would be to pass the necessary appropriations bills before the start of the new fiscal year on October 1, 2025.
It's important to note that the administration's proposal is subject to change during the congressional review process. Stakeholders and the public will have opportunities to provide input and express concerns as the budget undergoes scrutiny and potential modifications.
There is also language in the memo that allows states to “use grant funding they receive from funded formula grant programs to provide or invest in services provided by programs that the Budget eliminates.” Agencies are advised to work with the Office of Management and Budget (OMB).
For ACL programs, many open questions remain. What happens to program management now that III-B, III-C, and other programs are split under different divisions? What will Independent Living look like with the potential for its expanded budget and scope? How will states respond to the elimination of Elder Justice, Adult Protection, and LTC Ombudsman programs?
What Can We Do?
While the cuts do not represent a large percentage of the ACL’s budget, it’s imperative the broader aging & disability networks continue to make it known how vital all these programs are to the fabric of our communities.
- As individuals, call your congressman and governor and compel them to reauthorize the Older Americans Act and the Elder Justice Act.
- Connect with larger advocacy efforts, such as those led by the National Consumer Voice for Long Term Care and the Elder Justice Coalition.
- Make sure clients who rely on these services are informed about how to reach out to the new administering agencies (ACF, ASPE, or CMS) to understand how specific programs will be transitioned.
- Stay informed about the budget approval process and make your voice heard during public comment periods.
Have more to share?
We encourage folks in this network to review the leaked document (be wary of the low resolution) and chime in. If you have additional information that would be useful to those in the aging & disability networks, please write to us at hello@monami.io or come speak to us in person at the ASA conference in Orlando next week.