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type of health promotion and disease prevention activity which
States and communities might wish to pursue on behalf of older
persons. Section 321 of the Act delineates a variety of activities
related to promotion/prevention which are authorized under Title
III, Part B. Similarly, Title III, Part C, authorizes providers to
offer nutrition education programs, which can play a vital role in
health promotion, at congregate meal sites.

We believe that the best strategy is to allow States and communities to use the the broad-ranging authorities In Title III, Parts B and C, to fund health promotion and disease prevention activities tailored to their individual needs. Use of the Title III, Part F, authority could well lead to fragmentation of program efforts at the local level. Therefore, we believe that the policy Congress has followed since Part F was enacted in 1987, i.e., of not appropriating funds for III-F, is well- advised.


Question: When does the Administration expect to submit its bill on the reauthorization of the Older Americans Act to Congress?

Answer: The Administration's proposals are currently under development within the Executive Branch. While a particular target date cannot be specified at this point, we are committed to submitting our proposals to Congress within the very near future.

Question: Will this proposal include mandatory contributions for Older Americans Act nutrition programs? Inasmuch as there is a good track record for voluntary contributions at nutrition sites, what analysis has been done on the impact of mandatory contributions on the voluntary program?

Answer: As indicated in the previous answer, the specific provisions of the Administration's proposals for amending the Older Americans Act are still under development. Therefore it would be premature to comment at this point on what the final provisions might include. The formulation of any proposals related to costsharing would take into account the experiences which States and communities have had with other programs which provide services based on the recipient's ability to pay. The possible effects which cost-sharing arrangements might have on various aspects of the Title III program, e.g., participation rates, program administration, maintenance of contribution levels, etc., would be carefully considered in light of available data.

Question. What is the estimate of the cost of administering a mandatory cost-sharing program?

Answer. No estimate has been made of the cost of administering a mandatory cost-sharing program. The General Accounting Office (GAO) study of this proposal did not estimate administrative costs. However State program administrators with cost-sharing programs interviewed by GAO usually indicated that their experiences with cost-sharing have been favorable. A majority of States also indicated to GAO that cost sharing allowed them to serve greater numbers of elderly clients and has broadened the range of services offered. This is a strong indication that the administrative costs are substantialy less than funds received from cost-sharing clients.

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In our opinion, it would take a great deal of time and money to estimate the cost/benefits of this program change and considerable uncertainty would remain about any such estimate.

Question: What are the budgetary implications associated with the Administration's proposal?

Answer: As indicated above, the Administration's proposals for amending the Older Americans Act are still under development. Therefore it would be premature to comment at this point on what the final provisions might include and what their implications might be.

Question. Current law permits older persons to make voluntary contributions toward the costs of services. The amount collected in 1989 was $179 million, which was equal to 21 percent of the federal funds appropriated for Title services that year. What estimates, if any, can you provide as to increased revenues that might be generated through expanded voluntary or mandatory cost-sharing programs?

Answer. No estimates have been made of the effects of expanded voluntary or mandatory cost-sharing programs.

Our experience with voluntary cost-sharing programs would lead us to expect that the level of voluntary contributions will continue to grow at their current rate, particularly for Title III-C (meals), if the encouragement to contribute is maintained at its current high level.

Question. Has the Department conducted an analysis, study, or survey on which these estimates are based?

Answer. The Department has not conducted any studies on the issue. However, based on a GAO study of cost-sharing, we are convinced that the administrative overhead related to cost-sharing would be small compared to the program income raised to expand services. Many States already collect the needed information and/or have a mechanism for cost-sharing. The existing systems for collecting voluntary contributions are a natural foundation for administering cost-sharing.


Question. Congress has consistently tried to increase funding for nutrition programs. However, each year, monies provided for congregate meals are transfered at the State and local level to home delivered meals or supportive services. Does this suggest that the need for congregate nutrition services are not as great? Given the fact that these monies for congregate meals are being used for other purposes, why doesn't the 92 budget request increases for home-delivered meals and supportive services?

Answer. Although the Congress has consistently increased funds for nutrition programs, the Congress has also, provided authority in the Older Americans Act for States to make limited transfers between program categories. This enables States, based on their particular circumstances, to reallocate limited amounts between program categories. This is critical flexibility for States enhances their ability to manage the program to best meet the needs of the elderly

in their jurisdictions. We would point out that in spite of these
transfers, the overall number of meals served in congregate and home
settings each year continues to increase. We encourage the Congress
to leave this important, but limited, flexibility to reallocate
funds in the Act.

Question: Indications are that instances of elder abuse continue to increase. However, nothing in this budget reflects any recognition of this problem. Did the Administration on Aging propose an initiative in its original budget to deal with elder abuse? How much did the Administration on Aging request?

Answer: The Administration on Aging and the Department of Health and Human Services determined that the most effective approach to funding programs to combat elder abuse was to base the FY 1992 request for Title III-G activities on the level established by Congress for FY 1991. Please note that States and localities are free to supplement their Title III-G allocations by using Title III-B (Supportive Services and Senior Centers) funds for programs and activities to combat elder abuse.


Question: What implications does the most recent report completed for AoA on the role of the ombudsman program in board and care facilities have for funding of the ombudsman program?

Answer: AOA will continue to evaluate the needs of the ombudsman program on a regular basis to assure that State and community-level ombudsman service providers have adequate resources to meet their responsibilities under the Older Americans Act. Reports such as the assessment of the board and care issue will obviously be considered in making these judgements, as will relevant information from other sources. For FY 1992, the Administration on Aging and the Department of Health and Human Services have determined that the funding level established by Congress for FY 1991 was appropriate for the ombudsman program for FY 1992.

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Question. At the request of the Office of Human Development Services, the Inspector General is currently undertaking a needs survey to determine the availability of training, staffing, etc., an expanded Head Start program. When will the results of this survey


Answer. It is expected that the survey will be completed by May


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Question. What is the timetable for awarding FY 1991 funds to

Answer. A Program Instruction was mailed to all grantees on March 19 explaining how the FY 1991 increase will be implemented. The grantees' requests for quality improvement funds are due on May 3; the expansion requests are due on June 3. The PCC increase will be awarded through a competitive process this summer as will be the

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funds for Head Start transition grants. The increase in training and technical assistance funds are being awarded throughout the year.

Question. What is the amount of FY 1991 quality improvement funds and how will those funds be distributed?

Answer. The amount of 1991 quality improvement funds is $195,180,000. Of that amount, $180,180,000 will be directly allocated to grantees using the allocation formula contained in the Head Start Act. Grantees that have already received their FY 1991 refunding will receive a supplemental award. Grantees funded later this fiscal year will have the quality improvement increase included in their FY 1991 refunding. The remaining quality improvement funds, $15,000,000, will be awarded competitively to Head Start grantees and will be for three purposes: to fund projects that deal with the various problems associated with substance abuse; to fund projects that address the special needs of families with severe or multiple problems; and to fund projects to address the issue of how Head Start families can better achieve self-sufficiency. These projects will be funded in the latter part of FY 1991.

Question. How many new counties were served with FY 1990 expansion funds, and how many new grantees were established in that year? Please provide the same information for FY 1991.

Answer. In FY 1990 179 new counties were served. Services were initiated in these counties by a combination of the existing grantees that expanded their service areas and 41 newly funded grantees. The expansion planned for FY 1991 has not been completed and, therefore, data are not yet available.

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Question. What progress has the Department made in addressing various concerns regarding quality? For example, what progress will be made this year in meeting the recommendation of the Commissioner's Task Force on Social Services that every Head Start program have a social service coordinator and that the family caseload ratio be no more than 35 families for each social services staff person?

Answer. At this time, we are considering the recommendations of the Task Force as they affect all aspects of the Head Start Program. The Head Start Bureau has several initiatives to promote quality within the Social Services Component of the program. For example, in FY 1990, 13 competitive grants were awarded for Head Start grantees to improve their capacity to reduce and prevent substance abuse in Head Start families, to improve the literacy skills of family members and to increase the employability of Head Start parents. In FY 1991, $195,180,000 will be awarded to maintain or improve the quality of services to current enrolles in Head Start programs. These funds allow salary increases plus a wide variety of other improvements that local Head Start programs may decide upon, including hiring Social Services staff to reduce family caseload ratios and providing training to Social Services staff. of the $198,180,000, $15,000,000 will be awarded to Head Start grantees through a competitive process for special family support initiatives. These initiatives will address substance abuse issues

and strengthening the capacity of social services staff meet the needs of families with special needs.

In addition, during FY 1990 and FY 1991 all Head Start Social Services staff are being trained in a new social services manual which provides the entry level skills needed to work with families.

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Question. Please explain how the Department intends to use the funding increase in FY 1991 and why the Department has chosen not to use part of the increase to adjust for inflation when the law requires precisely that.

Answer. The FY 1991 increase for Head Start is $399,800,000. This increase will be used for five purposes: 1) To award Head Start grantees quality improvement funds $195,180,000; 2) To increase funding for Parent Child Centers $14,229,000; 3) To increase Head Start training and technical assistance $11,436,000; 4) To fund Head Start Transition Projects - $19,518,000 and; 5) To increase enrollment by up to 51,000 children and maintain current service levels $159,447,000.

Funds from the FY 1991 budget increase will be available for grantees to maintain the current levels of service. Section 105 of PL 101-501 does not mandate a standard cost-of-living increase for all Head Start programs. Instead, it requires that the Secretary shall not increase enrollment in FY 1991 without first assuring that grantees have sufficient funds to maintain FY 1990 service levels. This will be accomplished by allowing grantees to use funds from their FY 1991 allotment for expansion to maintain services before they add new children to their programs. Such decisions will be made on a case-by-case basis, since the amount of funds that will needed to maintain service levels will vary depending on each program's particular circumstances. The increase in enrollment that we have projected should be viewed a goal that will be achieved to the extent that funds are available after current services are maintained.



Question. Is it the Department's intent that the quality funds that every grantee will receive this year should substitute for an adjustment to cover inflation's effects on operating costs? If this is the case, then how will the programs ever upgrade their quality if they have to spend their quality funds to pay for heat and rent?

Answer. The quality improvement funds which will be allocated to grantees this year will provide the average grantee a funding increase of 11.5 percent. In addition to quality improvement funds, grantees will also be able to use other increased funds to help maintain current services.

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Question. What funding level does the Department believe would be required to increase Head Start enrollment by the 29,500 you propose and meet the requirements for inflation and allow for the funding of the quality reserve?

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