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Other Federal Programs Affecting the Elderly

By Amal Trivedi, MD, MPH, Associate Professor, Department of Health Services, Policy and Practice and Department of Medicine, Brown University

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Patient Education

In the US, health care services for the elderly are funded mainly by Medicare, Medicaid, the Veterans Health Administration, private insurance, and out-of-pocket payments. In addition, many states offer health-related benefits and programs, such as subsidies for transportation, housing, utilities, telephone, and food expenses, as well as help at home and nutrition services. Health care workers should help elderly patients learn about health benefits and programs they are entitled to.

Veterans Health Administration

This Department of Veterans Affairs (VA) program provides health care to eligible veterans. Determining eligibility for VA benefits can be complex, and care is not always free. The VA operates > 160 hospitals, 43 domiciliary facilities, and > 130 nursing homes. It also contracts to provide care in community hospitals and nursing homes. Several innovative geriatric programs (including geriatric assessment units; Geriatric Research, Education, and Clinical Centers; and hospital-based home health care programs) have been developed within the VA system.


Tricare provides health coverage for active duty and retired service members, their families, and survivors.

Older Americans Act (OAA)

Enacted in 1965, the OAA has evolved from a program of small grants and research projects into a network of 57 state, territorial, and Indian tribal units on aging; 670 area agencies on aging; and thousands of community agencies. The primary purpose of the OAA is to develop, coordinate, and deliver a comprehensive system of services for elderly people at the community level; services include information and referral, outreach, transportation, senior centers, nutritional programs, advocacy, protective services, senior employment, ombudsman programs, and supportive services. The OAA also funds research and training. People> 60 are eligible for services funded by the OAA regardless of income level.

Social Security

Although not usually considered a health program, Social Security provides basic pension payments that the elderly use for health care services. The elderly receive 2 types of payments:

  • Old Age and Survivors Insurance, which is financed by Social Security trust funds and provides payments to retirees, surviving spouses, or qualified dependents

  • Supplementary Security Income, which is financed from general revenues and provides a guaranteed minimum income to aged, blind, and disabled people

Title XX of the Social Security Act

Title XX of the Social Security Act authorizes reimbursements to states for social services, including various home health services and homemaker services (eg, meal preparation, laundry, light housekeeping, grocery shopping) for the frail elderly. These funds have shifted to the Social Services Block Grant Program, which was designed to prevent or reduce inappropriate institutional care by providing for community-based care and other assistance that enables the elderly to maintain autonomy in the community. The program is defined, administered, and implemented by states; it does not support institutional care or any service covered by Medicare or Medicaid. The program covers health services only when they are an “integral but subordinate” component of an overall social service program.