Opportunity Information: Apply for HHS 2008 AOA CD 0814
Apply for HHS 2008 AOA CD 0814
- The Administration on Aging in the income security and social services sector is offering a public funding opportunity titled "Nursing Home Diversion Modernization Cooperative Agreement" and is now available to receive applicants.
- Interested and eligible applicants and submit their applications by referencing the CFDA number(s): 93.048 Special Programs for the AgingTitle IVand Title IIDiscretionary Projects.
- This funding opportunity was created on Aug 5, 2008 and posted on Jul 1, 2008.
- Applicants must submit their applications by Aug 14, 2008 See link to full announcement for details.. (Agency may still review applications by suitable applicants for the remaining/unused allocated funding in 2026.)
- The funding agency has allocated a total of $10,000,000.00 to eligible and selected applicants.
- Each selected applicant is eligible to receive up to $1,000,000.00 in funding.
- The number of recipients for this funding is limited to 15 candidate(s).
- Eligible applicants include: Others (see text field entitled Additional Information on Eligibility for clarification).
- Only a State Unit on Aging (SUA) may apply for a Nursing Home Diversion Modernization Grant. As State Units on Aging are both the State agency and Aging Services Network entity designated with directing the planning and provision of OAA funds and services within their State for the targeted population, they are the only organization positioned to collaborate with all the necessary partners in the State (including the State Medicaid agency, Area Agencies on Aging, and Aging Service Providers), and to coordinate the development of and implementation of State nursing home diversion programs. State Units on Aging are uniquely positioned in their states to manage and implement the primary goal of this grant to develop and implement, or expand an existing, nursing home diversion program that helps individuals and families avoid unnecessary institutionalization and spend down to Medicaid.
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Opportunity Summary:
The Nursing Home Diversion Modernization Cooperative Agreement is a discretionary cooperative agreement from the Administration on Aging (AoA) designed to help states update and strengthen how they keep older adults and other high-risk individuals out of nursing homes when those individuals are not yet eligible for Medicaid but are at imminent risk of entering a facility and then spending down to qualify. The opportunity is rooted in the long-term care modernization direction reflected in the 2006 Amendments to the Older Americans Act, with the practical goal of intervening earlier and more effectively so people can remain safely at home or in community settings, while also slowing growth in Medicaid long-term care costs tied to avoidable institutionalization.
Only State Units on Aging (SUAs) are eligible to apply, because they are positioned to coordinate Older Americans Act resources statewide and to align multiple partners that have to work together for diversion to function in real time. Applicants are expected to build projects in active partnership with Area Agencies on Aging (AAAs), aging services providers, Single Entry Point (SEP) programs, and other long-term care stakeholders, including the single state Medicaid agency. In other words, the grant is not just for adding services; it is aimed at changing how a state identifies, prioritizes, authorizes, delivers, and tracks services for people who are on the edge of nursing home placement.
Funding is expected to total up to $10,000,000, with AoA anticipating awards to roughly 10 to 15 states over an 18-month project period. Individual awards are expected to fall between $600,000 (floor) and $1,000,000 (ceiling), and cost sharing or matching is required. Applications are evaluated partly on how much progress the state proposes to make compared with the current statewide status quo and the current practices in the specific communities where the project will operate. The emphasis is on concrete modernization: faster pathways to services, better targeting of those at highest risk, and stronger accountability through outcomes and data.
The core program changes the grants are meant to drive include more effective use of Single Entry Point systems to find and triage people who are not Medicaid eligible but are likely to enter a nursing home soon; strengthening the network’s ability to rapidly authorize and deploy home and community-based services (HCBS) that can stabilize someone at home; expanding service delivery models so the network can offer a full menu of options and adjust supports as needs change; increasing the use of consumer-directed approaches so individuals can have more control over the services they receive and how they receive them; and improving outcome tracking so states can document whether the program actually diverted nursing home placement, prevented or delayed Medicaid spend down, and produced measurable Medicaid cost avoidance.
The announcement sets clear implementation milestones. By the end of month 9, a funded state must have at least one local project operating and serving the targeted high-risk population. That local project must (A) use a Single Entry Point program to identify the right individuals (those not on Medicaid but at imminent risk of placement and spend down), (B) rely on formal protocols and tools shared across key stakeholders for referral, prioritization, service authorization, and follow-up so services can start quickly and be adjusted as needs change, and (C) have formal SUA and AAA policies in effect (at least in the planning and service areas where the project runs) that support investing some Older Americans Act dollars to serve this high-risk group. By the end of month 15, the project must not only meet the earlier requirements, but also provide a full range of service options and offer consumer-directed models to participants.
To illustrate the kind of modernization expected, the announcement highlights examples such as shifting from fixed-sum contracts with a single provider toward fee-for-service or unit-rate arrangements where funding and service hours can follow the consumer, which can expand provider choice and sharpen attention to quality. Another example is moving away from first-come, first-served enrollment toward validated screening, assessment, care planning, and case management approaches that prioritize individuals most likely to enter nursing homes soon. Across these changes, the expectation is that funded projects will actively monitor participants, confirm services are actually being delivered and meeting needs, and make timely adjustments as conditions change.
Data and accountability are central requirements, not add-ons. Grantees must be able to report client-level data, track outcomes, and document effectiveness in diverting long-term nursing home placement and delaying or preventing Medicaid spend down, including any associated cost avoidance. AoA and the Nursing Home Diversion Technical Assistance Center are expected to work with awardees to define the specific data elements that must be collected, reinforcing that the program is meant to produce evidence of impact and not just activity counts.
States are allowed to braid multiple funding sources to support service delivery for the targeted population. In addition to the grant funds provided under this announcement, projects may use Older Americans Act resources, Alzheimer’s Disease Demonstration Grants to States (ADDGS), and other public programs or sources that can legally serve individuals who are not Medicaid eligible. This flexibility is meant to help states build sustainable diversion pathways that can continue beyond the 18-month award window.
A notable feature of this announcement is a special, connected funding opportunity for veterans. The Veterans Health Administration (VHA) planned to invest about $3,000,000 to support home and community-based services for veterans and their family caregivers through the Veterans Directed Home and Community Based Service Program (VDHCBS). That veterans funding was structured to flow to successful AoA Nursing Home Diversion Modernization grantees that also submit a complete VDHCBS application, with VHA intending to support up to 12 Veterans Integrated Service Networks (VISNs). This creates a strong incentive for states to design diversion systems that explicitly coordinate with veterans’ health and caregiving supports where relevant.
Key administrative details from the posting include Funding Opportunity Number HHS-2008-AOA-CD-0814, CFDA 93.048 (Special Programs for the Aging, Title IV and Title II Discretionary Projects), activity category Income Security and Social Services, and instrument type Cooperative Agreement. The opportunity was posted July 1, 2008, with an application closing date of August 14, 2008, and an archive date of September 13, 2008. The contact listed for access issues was Richard Nicholls (Richard.nicholls@aoa.hhs.gov).
Frequently Asked Questions (FAQs): Nursing Home Diversion Modernization Cooperative Agreement
What is the Nursing Home Diversion Modernization Cooperative Agreement?
It is a discretionary cooperative agreement from the Administration on Aging (AoA) intended to help states modernize and strengthen how they divert older adults and other high-risk individuals from nursing home placement when they are not yet eligible for Medicaid but are at imminent risk of entering a facility and then spending down to qualify.
What problem is this funding trying to address?
The opportunity targets avoidable institutionalization by intervening earlier, helping people remain safely at home or in community settings, and slowing the growth of Medicaid long-term care costs associated with nursing home entry and subsequent Medicaid spend down.
What is the main goal of the project work (beyond adding services)?
The focus is on changing how a state identifies, prioritizes, authorizes, delivers, and tracks services for individuals on the edge of nursing home placement, with an emphasis on faster access to services, better targeting of those at highest risk, and stronger accountability through outcomes and data.
Who is eligible to apply?
Only State Units on Aging (SUAs) are eligible to apply.
Why are only State Units on Aging (SUAs) eligible?
The announcement emphasizes that SUAs are positioned to coordinate Older Americans Act resources statewide and align the multiple partners that must work together for diversion to function in real time.
What partners are applicants expected to work with?
Projects are expected to be built in active partnership with Area Agencies on Aging (AAAs), aging services providers, Single Entry Point (SEP) programs, and other long-term care stakeholders, including the single state Medicaid agency.
Who is the target population for the diversion effort?
The target population is people who are not Medicaid eligible but are at imminent risk of nursing home placement and likely to spend down to qualify for Medicaid if they enter a facility.
How much total funding is expected to be available?
Funding is expected to total up to $10,000,000.
How many awards does AoA anticipate making?
AoA anticipated awarding to roughly 10 to 15 states.
What is the expected award size per state?
Individual awards are expected to range from $600,000 (floor) to $1,000,000 (ceiling).
How long is the project period?
The project period is 18 months.
Is cost sharing or matching required?
Yes. The announcement states that cost sharing or matching is required.
How are applications evaluated?
Applications are evaluated in part on the amount of progress the state proposes to make compared with the current statewide status quo and current practices in the specific communities where the project will operate. The emphasis is on concrete modernization, including faster pathways to services, better targeting, and stronger accountability using outcomes and data.
What kinds of system changes are the grants meant to drive?
The announcement highlights modernization such as: using Single Entry Point (SEP) systems to find and triage people who are not Medicaid eligible but are likely to enter a nursing home soon; strengthening the ability to rapidly authorize and deploy home and community-based services (HCBS); expanding service delivery models so the network can offer a full menu of options and adjust supports as needs change; increasing consumer-directed approaches; and improving outcome tracking to document diversion, delayed/prevented spend down, and Medicaid cost avoidance.
What role does a Single Entry Point (SEP) system play in the project?
SEP systems are expected to be used to identify and triage the right individuals (those not on Medicaid but at imminent risk of placement and spend down) and to support timely referrals and service initiation.
What are the required milestones by the end of month 9?
By the end of month 9, a funded state must have at least one local project operating and serving the targeted high-risk population. That local project must:
- (A) Use a Single Entry Point (SEP) program to identify the appropriate individuals.
- (B) Rely on formal protocols and tools shared across key stakeholders for referral, prioritization, service authorization, and follow-up so services can start quickly and be adjusted as needs change.
- (C) Have formal SUA and AAA policies in effect (at least in the relevant planning and service areas) that support investing some Older Americans Act dollars to serve this high-risk group.
What additional requirements must be met by the end of month 15?
By the end of month 15, the project must meet the earlier requirements and also provide a full range of service options and offer consumer-directed models to participants.
What are examples of the "modernization" changes AoA expects to see?
Examples highlighted include shifting from fixed-sum contracts with a single provider toward fee-for-service or unit-rate arrangements where funding and service hours can follow the consumer (supporting provider choice and attention to quality). Another example is moving away from first-come, first-served enrollment toward validated screening, assessment, care planning, and case management approaches that prioritize individuals most likely to enter nursing homes soon.
What does the announcement say about monitoring and follow-up?
Funded projects are expected to actively monitor participants, confirm services are actually being delivered and meeting needs, and make timely adjustments as conditions change.
What are the data and reporting expectations?
Data and accountability are described as central requirements. Grantees must be able to report client-level data, track outcomes, and document effectiveness in diverting long-term nursing home placement and delaying or preventing Medicaid spend down, including any associated cost avoidance.
Who helps define the specific data elements that must be collected?
AoA and the Nursing Home Diversion Technical Assistance Center are expected to work with awardees to define the specific data elements to be collected.
Can states combine (braid) multiple funding sources to support services?
Yes. States are allowed to braid multiple funding sources to support service delivery for the targeted population, as long as those sources can legally serve individuals who are not Medicaid eligible.
What funding sources are mentioned as potentially usable alongside the grant?
In addition to the grant funds, projects may use Older Americans Act resources, Alzheimer’s Disease Demonstration Grants to States (ADDGS), and other public programs or sources that can legally serve individuals who are not Medicaid eligible.
Is there a related funding opportunity connected to veterans?
Yes. The announcement describes a connected opportunity where the Veterans Health Administration (VHA) planned to invest about $3,000,000 to support home and community-based services for veterans and their family caregivers through the Veterans Directed Home and Community Based Service Program (VDHCBS).
How would a state access the veterans-related VDHCBS funding described?
The veterans funding was structured to flow to successful AoA Nursing Home Diversion Modernization grantees that also submit a complete VDHCBS application, with VHA intending to support up to 12 Veterans Integrated Service Networks (VISNs).
What is the Funding Opportunity Number (FON) for this posting?
HHS-2008-AOA-CD-0814.
What CFDA number is associated with this opportunity?
CFDA 93.048 (Special Programs for the Aging, Title IV and Title II Discretionary Projects).
What is the instrument type?
Cooperative Agreement.
When was the opportunity posted and when did it close?
It was posted on July 1, 2008, and the application closing date was August 14, 2008.
What are the archive details listed in the posting?
The archive date listed is September 13, 2008.
Who is listed as the contact for access issues?
Richard Nicholls (Richard.nicholls@aoa.hhs.gov).
What activity category is associated with this opportunity?
Income Security and Social Services.
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