Build Back Better Invests in Crucial Services for Older Adults & People with Disabilities

US National Capitol

California Health Advocates submitted the letter below as part of the California Collaborative for Long Term Services and Supports in support of the Build Back Better Act (H.R. 5376), which makes critical investments to supportive services for older adults and disabled individuals nationwide. 

December 17, 2021

Senator Dianne Feinstein
331 Hart Senate Office Building
Washington, DC 20510
Fax: 202-228-3954

Senator Alex Padilla
112 Hart Senate Office Building
Washington, DC 20510
Fax: 202-224-2200

Re: H.R. 5376 Build Back Better: Support for Provisions Impacting Older Adults and People with Disabilities  

Dear Senators Feinstein and Padilla, 

The California Collaborative for Long-Term Services and Supports (CCLTSS) is comprised of nearly 60 statewide aging and disability organizations that promote dignity, health, and independence in community living. Our members include advocates, providers, labor, and health insurers, and collectively we represent millions of California seniors and people with disabilities, their caregivers, and those who provide health, human services, and housing. On behalf of our members, we respectively urge you to support the Build Back Better Act (H.R. 5376), which makes critical investments to supportive services for older adults and disabled individuals nationwide. 

Over the next 10 years, California’s over-60 population is projected to diversify and grow faster than any other age group, increasing from 16 percent in 2010 to one quarter of the population by 2030, when there will be 10.8 million older adults in California1. In addition, California is home to over 7 million adults living with a disability2. These vulnerable populations have an increased risk for life threatening outcomes when exposed to the COVID virus, and therefore    

have been disproportionately impacted as a result of system inequities, fragmentation, and over-reliance on nursing homes. COVID has also brought to light the plight of the caregivers who are serving these populations, who are underpaid and undervalued, resulting in high staff turnover at care facilities and to families who have experienced isolation, higher stress, and compromised resources as a result of the impact of COVID. 

We are grateful that the Build Back Better Act is making critical investments in programs that support California’s older adults and people with disabilities, and their caregivers, including: 

  • $10 mil to carry out the Assistive Technology Act of 1998, which improves access to assistive technology that enables people with disabilities to live and work in their communities. 
  • $1.2 billion for Older Americans Act (OAA) programs, including:
    • $75 million for the Research, Demonstration, and Evaluation Center for the Aging Network; 
    • $655 million to support home-and community-based supportive services;
    • $140 million to support nutrition programs for older Americans; 
    • $150 million to support the National Family Caregiver Support Program. 
    • $50 million for services, including nutrition, for Native American older adults; 
    • $50 million for the long-term care ombudsman program; 
    • $75 million for technical assistance centers or national resource centers for culturally appropriate care management and services for older individuals with greatest social need, including racial and ethnic minority individuals and older individuals who are underserved due to sexual orientation or gender identity; and 
    • $5 million for multigenerational civic engagement projects. 
  • $20 million to fund a national technical assistance center through the Administration for Community Living which will develop and disseminate evidence-based strategies for recruitment, education and training, retention, and career advancement of direct care workers and provide recommendations for activities to further support paid and unpaid family caregivers.
  • $40 million to establish, enhance, or expand programs to address behavioral health needs of unpaid caregivers of older individuals and older relative caregivers. 
  • $25 million to fund initiatives to address the behavioral health needs of individuals with intellectual and developmental disabilities. 
  • Provides states with a permanent 6%-point increase to the FMAP if the state implements an HCBS improvement program to strengthen and expand HCBS. 
  • Requires HHS to develop and publicize HCBS quality measures for state Medicaid programs.
  • Permanently extends the protections against spousal impoverishment for individuals whose partners receive Medicaid HCBS. 
  • Provides permanent funding for the Money Follows the Person Rebalancing Demonstration to help states transition folks out of institutions into HCBS. 

All of these provisions are critical to ensuring appropriate care for the nation’s older adults and people with disabilities, and the availability of resources needed by our caregivers. On behalf of the California Collaborative, we respectfully ask for your support and urge you to reject any amendments that would weaken vital safety and support programs for this population. We thank you in advance for your consideration.


Eric Dowdy, Chair 
Board of Directors
California Collaborative for Long-Term Services and Supports

Karen Joy Fletcher

Our blogger Karen Joy Fletcher is CHA’s Communications Director. With a Masters in Public Health from UC Berkeley, she is the online “public face” of the organization, provides technical expertise, writing and research on Medicare and other health care issues. She is responsible for digital content creation, management of CHA’s editorial calendar, and managing all aspects of CHA’s social media presence. She loves being a “communicator” and enjoys networking and collaborating with the passionate people and agencies in the health advocacy field. See her current articles.