In Praise of Alphabet Soup

May is Older Americans Month. Most years, this is an opportunity to celebrate the contributions of older adults make in our communities, as volunteers and civic leaders.  2025 was the year to celebrate milestones of programs that recognized and affirmed the contributions of older Americans and secured a degree of comfort and dignity for them after a lifetime of work.

But this is not “most years.”

Recent changes in the Health and Human Services Administration along with massive reductions in funding for Medicaid and Older Americans Act programs proposed in budget resolutions in April present a threat to the social safety net that older American rely on for their health and wellbeing.

The federal bureaucracy and the budget process can be overwhelming. At times it appears to be an “alphabet soup” of programs and funding. The number of proposed changes at the federal level make it challenging to define their scope and impact on people affected by them. Later in this blog I’ll share information on these programs. But I’d like to begin with stories of real people.

Recently widowed, Alice described the time between dinner and going to bed as the “lonely hours.” The house felt empty and alone. Her first visit to the Rose Center for Aging Well in her neighborhood was out of curiosity – she had never gone to a senior center before. There was lunch, and activities. She took part in an exercise class. She recognized a neighbor. She made new friends. Before long she was a regular at the Rose Center. Some evenings, she picks up the phone to check in with someone who missed lunch that day. Alice knows other people also have “lonely hours.”

Many of our Meals on Wheels routes have “jumpers” and “drivers.” While the driver’s role may seem obvious, the “jumper” is a second person on the truck who helps deliver meals to the client’s door. Joe is one of those jumpers. A meal route in the City of Cleveland includes residents in high-rise buildings. There may be a dozen deliveries in a single building. The elevators are slow, so, Joe will carry a thermal bag of meals up the stairs, stopping at each floor to knock on a door (or two) and hand the meal to an elderly resident. Joe may be their only visitor that day.

Tim noticed his mother was becoming more and more confused, and worried about her living alone. His mother moved in with the family, which included his wife, Teresa, and three teenagers.  Teresa reached out to Benjamin Rose when she felt overwhelmed with the situation and her mother-in-law’s dementia. A WeCare counselor helped Tim and Teresa explore options for care, and how to address their needs and concerns as caregivers.

Alice, Joe, Tim and Teresa are part of the story of Benjamin Rose. But they are also examples of how the “alphabet soup” of federal programs and federal funding affect the daily lives of older adults and family caregivers.  

The Rose Centers are funded in part by the Older Americans Act (OAA). Title III B funds help cover counseling services, programming expenses and transportation costs. Title IIIC supports meals served at the Rose Centers, and the Meals on Wheels that Joe delivers.  The chair yoga class that Alice took her first day at Rose Center was funded in part by Title IIID that supports evidence-based health promotion programs. Tim and Teresa benefitted from a Title IIIE grant that ensures resources are available for family caregivers.

OAA also supports. . .

• The long-term care ombudsman to address the rights of residents in nursing homes and assisted living facilities (Title III B and Title VII A)
• Information and referral services, benefits enrolment and the Aging and Disability Resources Centers (ADRCs) that connect people with programs and resources
• Elder Justice and Adult Protective Services to assist victims of neglect or abuse (also funded by Social Services Block Grants (SSBG) and Title XX-A of Social Security)

The alphabet soup also includes Medicaid and Medicaid Waiver (MAW) services for home and community-based services (HCBS).

Low-income adults may be “dual-eligible” if they qualify both for Medicare (based on their age) and Medicaid (based on their income). Medicare covers medical care costs, while Medicaid protects low-income seniors from high out-of-pocket costs or co-pays. Medicaid also covers long-term care costs in nursing homes for poor older adults.  Medicaid Waivers (MAW) provide support for long-term care services in home or community setting (“waiving” the requirement for institutional care.) The incontinence supplies that Tim’s mother needs are covered by MAW, because she lives with her family instead of the memory care unit in a nursing home. Adoption of Medicaid Waiver programs helped expand options for home care and reduce the number of Ohioans living in institutional settings (with programs like Balancing Incentive Programs (BIP), Money Follows the Person (MFP) and HOME Choice.)

Funding for these programs is at risk. The budget resolution passed by the House of Representatives on April 10 calls for up to $1.5 trillion in spending cuts. Much of the discussion of spending cuts has focused on Medicaid. More than 72 million people rely on Medicaid for their healthcare. According to the Health Policy Institute of Ohio, Medicaid provides health coverage for 3 million residents. Federal funding accounted for 69 percent of Ohio’s Medicaid budget in 2024.

Elderly Ohioans, especially those living with chronic health conditions, including dementia, have greater health needs, and higher health costs, than the overall population. One-sixth of Ohio’s Medicaid enrollees are aged, blind and disabled adults. Almost half of the state’s Medicaid expenditures are for their care. Many residents in skilled nursing facilities, as well as those receiving long-term care services at home, rely on Medicaid.

Medicaid is also critical for family caregivers who support their loved ones. Services provided through Medicaid and Medicaid Waivers in Ohio include adult day programs, transportation, skilled care and home health aides. These supports are vital to families caring for older adults, people with disabilities and families managing dementia care and complex medical needs. Medicaid is a lifeline for working caregivers and those balancing additional responsibilities as parents, students, employees and other roles.

Like I said. Alphabet soup. But this soup, like all good soup, blends a variety of ingredients together. State and local resources, philanthropy and volunteers form the basis of an aging services network that support … people. Programs that meet the needs of older adults, as well as the people who care for them. You. Your family. Your friends. Your neighbors.

Congress is working toward passage of a Budget Reconciliation Bill that will determine funding many of these programs. Your advocacy can help ensure that older adults and their families will continue.  Advocating for the “alphabet soup” might be intimidating, but here are two, simple messages to share with legislators and public officials.  

Ask Congress to:

Reauthorize the Older Americans Act and support funding of OAA programs in communities across Ohio and the nation.

And,

Maintain full funding for Medicaid and protect the lives of older adults and the people who care about them.