Introduction
Despite resiliency through decades, Black older adults face a lifetime of structural racism and discriminatory policies that limit their access to housing, health care, employment, and economic security. Many came of age during legally sanctioned segregation and lived through the Civil Rights Movement, mass incarceration, and the weakening of social safety nets.
Black older adults perspectives are shaped by experience with policies that defined where they could live, learn, work, and receive care. The combination of aging and trauma, much of which stems from cumulative experiences of structural racism and lifelong discrimination, creates unique challenges for Black older adults as they age and navigate a patchwork of services and programs. This issue brief examines how public benefits programs support Black older adults and related legal and policy issues that Black older adults experience.
Throughout this brief, we feature quotes from Cooper, a religious Black trans woman in her late 60s residing in San Francisco. Cooper shared her experiences with The People Say, a project showcasing candid interviews with older adults discussing their lives and the policy issues that impact them. She is dually eligible for traditional Medicare and Medicaid, identifies as disabled, and is HIV positive.
Black Generation Timeline[1]
Birth Year Range | Age Range (as of Jan 2026) | Cohort Experiences | Mainstream Generation Name |
1934 and earlier | 92 + | National Association for the Advancement of Colored People (NAACP) Founded, 1909; Marcus Garvey and the Universal Negro Improvement Association, 1916; Harlem Renaissance, 1920 | Greatest Generation (born 1901–1924) |
1935-1949 | 77–91 | African Americans in WWII, 1941 | Silent Generation (born 1925–1945) |
1950-1964 | 62–76 | Brown v. Board of Education, May 17, 1954; Emmett Till, August, 1955; Rosa Parks and the Montgomery Bus Boycott, December, 1955; Loving v. Virginia, 1958; Birmingham Church Bombed, 1963; ‘I Have a Dream,’ Speech 1963; Civil Rights Act of 1964 | Baby Boomer Generation (born 1946–1964) |
1965-1979 | 47–61 | Selma to Montgomery March, March, 1965; Malcolm X Shot to Death, February, 1965; Voting Rights Act, August 1965; Fair Housing Act, April 1968; MLK Assassinated, April 4, 1968; The Bakke Decision and Affirmative Action, 1978 | Generation X |
1980-1996 | 30–46 | Los Angeles Riots, 1992; Million Man March, 1995 | Millennials |
1997-2013 | 13–29 | Barack Obama Becomes 44th US President, 2008; Passage of the Affordable Care Act (ACA), 2010; The Black Lives Matter Movement; George Floyd Protests; Kamala Harris Becomes the First Woman and First Black US Vice President, 2021 | Generation Z |
Anti-Discrimination and Civil Rights Protections
As explained throughout the brief, Black older adults face significant discrimination when accessing programs and services needed to age in the community. Deeply entrenched institutional bias and individual prejudices on the basis of age, race, and more continue to erect barriers, so leveraging civil rights and anti-discrimination protections is key to ensuring that Black older adults can age with dignity.
A patchwork of federal laws protects Black older adults and others from discrimination, including the Civil Rights Act of 1964, the Fair Housing Act of 1974 (and the Fair Housing Amendments Act of 1988), the Age Discrimination Act of 1975, the Americans with Disabilities Act of 1990, and Section 1557 of the Affordable Care Act.[2]
In addition to the protections that exist under federal law, states have their own framework of civil rights protections, which can mirror federal law but often serve as an important supplement by offering additional protections.
Current efforts to weaken protections at both the federal and state level, like curtailing disparate impact theory – the idea that discrimination includes facially neutral policies and practices that disproportionately impact a group – and limiting intersectional discrimination, will make it harder for Black older adults to access critical programs and services free from discrimination and bias.
Issues Black Older Adults Face in Accessing Programs and Services
I remember back in the day, white people [were] always telling Black people how we should live, telling us how we should maneuver through the system. I need you to be there to help guide me through the system, to what I need and to what I’m afforded, and to stop [inhibiting] services.
Health Care and Coverage
As a group, Black older adults experience worse health conditions due to factors like unequal access to education, health care, nutritious food, safe housing, and economic opportunities. The life expectancy gap among racial and ethnic groups reflects these not-so-subtle inequities.
In 2023, the life expectancy for Black people was 74 years, compared to 78.4 years for white people.[3] Black adults had an average biological age nearly 12 years older than their chronological age, while white adults had an average biological age that was 10 years younger.[4]
Black older adults often face racial discrimination, economic strain, neighborhood stress, and interpersonal and family stress, and are more likely to experience the death of an immediate family member before midlife.[5] These consistent physical and psychological stressors contribute to the chronic stress that accumulates in the body and exacerbates numerous health issues.[6]
Meanwhile, many Black older adults in the United States believe that health care systems discriminate against them due to their race or ethnicity.[7]
Medicare and Medicaid
Medicare and Medicaid are especially important for Black older adults because they help address long-standing gaps in access to care, income, and health outcomes. Medicare and Medicaid help remove financial and structural barriers that would otherwise prevent people from receiving care. However, affordability remains a concern.
For Medicare beneficiaries, a larger share of Black versus white enrollees report problems with paying medical bills (21% and 9%, respectively) and delaying care due to cost (14% and 10%, respectively).[8] Medicaid can fill coverage gaps for individuals under 65, who otherwise would not have access to medical coverage, and help with Medicare cost-sharing for Medicare-eligible older adults.
Black older adults are less likely to have private health insurance and more likely than other demographics to require both Medicare and Medicaid. Approximately 87% of Medicare-Medicaid enrollees had an annual income below $20,000.[9] Significant income inequities are not isolated and coincide with a broader picture of inequities across the community.
Despite Black older adults making up 9% of the U.S. older adult population in 2022, a disproportionate amount (19%) of Black older adults was dually eligible for Medicare and Medicaid benefits.[10]
Home and Community-Based Services (HCBS)
Most older adults and people with disabilities will require assistance to remain living in their homes and communities at some point over their lifetime. In-home supports can potentially improve health outcomes and reduce reliance on more costly institutional care.[11]
Medicaid is the largest payer of a wide range of home and community-based services (HCBS), that enable many people with disabilities of all ages to live independently and fully participate in their communities as they choose.[12]
This is especially important for Black older adults, who often prefer to remain in their homes and maintain social ties.[13] Cooper believes she needs a trustworthy social worker or case manager who stays in regular contact, visits the home, provides personalized care, and offers holistic support.[14]
Despite the importance of HCBS in meeting the needs of Black older adults, gaps remain. Research shows that Black older adults enrolled in HCBS report higher rates of unmet needs compared to white older adults when receiving personal care, delivered meals, adult day services, and caregiver support.[15]
Medicaid Estate Recovery
In 2023, over 1.5 million Black adults aged 65 or older depended on Medicaid.[16] Medicaid rules generally allow recipients to keep their primary home during their lifetime, but federal law requires state Medicaid programs to recover costs from estates of deceased recipients, a policy known as Medicaid estate recovery.
This policy worsens existing inequities by causing people to avoid using essential services because of fear of losing their family home, hinders building intergenerational wealth, and increases financial and housing instability for surviving family members.
Estate claims often force heirs to sell a family home that otherwise would have been passed down, a critical source of intergenerational wealth. Medicaid estate recovery places a disproportionate burden on economically oppressed families and marginalized communities, including Black families, and [17] deepens housing and wealth inequities.
While homeownership comes with years of payments and sacrifices, Medicaid estate recovery can force many Black families to start over and further increase their risk of housing instability.
Economic Support Programs – Social Security and Supplemental Security Income
While no one should age into economic insecurity, nearly five million older adults live on less than $1,000 a month, and over eight million older adults are in poverty.[18] Due to systemic racial inequities in income, wealth, and employment opportunities, Black older adults are less likely than white older adults to have financial assets, retirement accounts, or home equity, and are twice as likely as white older adults to live in poverty.[19]
Even when Black older adults have assets, their net worth is substantially lower than white older adults, due to generations of discriminatory policies that limited wealth-building opportunities. As a result, they face higher rates of financial insecurity in retirement.[20]
Social Security
As of February 2026, 70.8 million people, including retirees, people with disabilities, and their spouses, children, and survivors receive Social Security benefits.[21] The program lifted over 1.6 million Black older adults 65 or older out of poverty in 2024, cutting the poverty rate for that group by nearly two-thirds.[22] For example, in 2020, Black older adults received 92.9 % or more of their income from Social Security.[23]
The heavy reliance is more pronounced among Black older adults with lower lifetime earnings and fewer pension benefits. The structure of the Social Security formula, however, reflects existing inequities, largely stemming from discrimination in employment and education, since benefits are tied to wages while working, causing Black older adults, who are more likely to work in lower-paying jobs, to receive less in benefits in their older age and experience higher rates of poverty as a result.
Supplemental Security Income
Supplemental Security Income (SSI), also administered by the Social Security Administration, is a critical program for low-income older adults and people with disabilities. For those without significant income from work, and little to no Social Security or pension benefits, SSI is a lifeline that keeps people out of deep poverty, even though the average monthly benefit is well below the official poverty line.
Over seven million people currently receive SSI, including approximately 2.5 million older adults.[24] People who are Black are more than twice as likely to receive SSI compared to white individuals.[25] SSI provides a critical safety net for Black older adults, by offering a source of stable income to those with significant needs.
Housing/Food and Other Support Programs
Federal Rental Assistance
“I have Section 8, thank God. Matter of fact, I was the first Black trans woman in San Francisco. It’s Section 8, [that pays] 70% of my rent.”[28]
Housing inequities and systemic impediments contribute to housing insecurity and the need for federal rental assistance, such as public housing and Housing Choice (“Section 8”) Vouchers. Federal rental assistance provides subsidized rent, which allows older adults with limited resources to maintain stable shelter. Between 2002 and 2022, households using federal rental assistance grew more diverse, as the share of white households fell from 41% to 29% while Black households increased from 40% to 49%.[26]
Black older adults are more likely to be low-income renters because of systemic discrimination and predatory lending and other practices that threaten home ownership and destabilize Black communities. They often face higher housing cost and have a greater need for rental assistance. The Black community – across age groups – represents 44% of public housing residents, with Black older adults likely to constitute a significant portion.[27]
Black older adults on fixed incomes often depend on affordable housing to maintain independence and quality of life. Systemic barriers are a key factor in subsidized housing and housing market inequities for Black older adults. The legacy of redlining and disinvestment in Black neighborhoods has limited wealth accumulation, resulting in many Black older adults having fewer resources and facing increased barriers to securing subsidized or private housing. Such barriers can often lead to loss of basic shelter, and lack of rental assistance directly contributes to older adult homelessness.[29]
Expanding tenant-based voucher programs specifically for older adults could stabilize housing and reduce homelessness. Even when Black older adults are housed and own a home, maintaining a property is difficult when there are complications with a family’s estate upon death. Estate complications can occur when a home is passed down informally without a will, creating unclear ownership and barriers to repairs, selling, or refinancing.
Guardianship & Advanced Planning
Elder justice advocates have consistently pushed for the use of less restrictive alternatives to guardianship to preserve autonomy and provide individualized support to older adults. Unfortunately, while many alternatives to guardianship exist, Black older adults have historically faced barriers and lack of access to the legal and financial tools needed to preserve their autonomy as they age.
The vast majority of Black people (67%) do not have a will, and low-income Black households are significantly more likely to be unbanked compared to their white counterparts.[30] Without access to these systems, alternatives like advanced directives, powers of attorney, and trusts are not available, and guardianship may become the only option.[31]
Nutrition Supports
Inequities in access to nutrition and nutritional supports are prevalent for Black older adults. The Supplemental Nutrition Assistance Program (SNAP) provides food benefits to low-income families to help them afford nutritious food that is essential to health and well-being.
Black people represent 22.7% of participants, a share nearly twice their proportion of the general population in fiscal year 2024.[32] In 2022, approximately 17.2% of Black older adults (age 60+) experienced food insecurity, compared to roughly 6.3% of white older adults.[33]
Food insecurity is defined by the United States Department of Agriculture (USDA) as the lack of access to enough food for an active, healthy life, due to limited financial resources.[34] For Black older adults 65 and older in 2022, the rate of food insecurity increased to 19.5%.[35] Strengthening and expanding the SNAP program and continuing outreach are critical to ensure that Black older adults have access to the nutrition supports they need to age with dignity.
OAA Programs
The Older Americans Act (OAA) is a key federal statute that addresses the needs of people age 60 and over.[36] The law funds a number of important services for older adults, such as nutrition supports (e.g., home-delivered meals, congregate meal sites), support for caregivers, long-term care ombudsmen, and legal support.[37]
The OAA requires states and agencies to prioritize services for individuals with the greatest economic or social needs, with an emphasis on low-income individuals, cultural factors, and social and geographic isolation, including isolation caused by language, race, or ethnic status.[38]
As discussed throughout the brief, historical and systemic factors disadvantage Black older adults such that states can consider them as a community under the definition of greatest social and economic needs. A comprehensive definition of greatest social and economic need, coupled with robust implementation, helps ensure that Black older adults and other marginalized communities are equitably served under the OAA.
Conclusion
Safety net programs and services, though imperfect, are vital for Black older adults. Safety net programs help lessen the harmful effects of long-standing discrimination and the resulting economic and health inequities that impact Black older adults in later life.
Programs like Social Security, Medicare, Medicaid, housing assistance programs and services under the Older Americans Act are essential. Policymakers, advocates, and service providers must prioritize advancing comprehensive supports equitably to meet the needs of Black older adults.
Endnotes
History, Black History Milestones: Timeline (Last Updated Jan. 13, 2026). ↑
Kevin Prindiville & Denny Chan, Navigating the Patchwork of Civil Rights Protections for Older Adults, 43 Generations: Journal of the American Society on Aging, 59, 59-66 (2019). ↑
Elizabeth Arias et al., Centers for Disease Control and Prevention, National Vital Statistics Reports (Jul 15, 2025). ↑
Jazmin Goodwin et al., KIRO 7, Older Black people die at higher rates than their white peers. Here’s why aging is a greater risk for Black Americans (Feb 27, 2025). ↑
Debra Umberson et al., PNAS, Death of family members as an overlooked source of racial disadvantage in the United States (Jan 23, 2017). ↑
Jazmin Goodwin et al., KIRO 7, Older Black people die at higher rates than their white peers. Here’s why aging is a greater risk for Black Americans (Feb 27, 2025). ↑
Michelle M. Doty et al., The Commonwealth Fund, How Discrimination in Health Care Affects Older Americans, and What Health Systems and Providers Can Do (Apr. 21, 2022); Celli Horstmanet et al., The Commonwealth Fund, What an Ideal Health Care System Might Look Like Perspectives from Older Black and Latinx Adults (Jul. 21, 2022). ↑
Nancy Ochieng et al., KFF, Racial and Ethnic Health Inequities and Medicare (Feb 16, 2021). ↑
Maria T. Peña et al., KFF, A Profile of Medicare-Medicaid Enrollees (Dual Eligibles) (Jan 31, 2023). ↑
Administration on Aging, Administration for Community Living, 2023 PROFILE OF OLDER AMERICANS (May 2024). Medicaid and CHIP Payment and Access Commission, Data Book Beneficiaries Dually Eligible for Medicare and Medicaid (Dec 2025). ↑
Margae J Knox et al., Association of Hospital-Based Social Needs Interventions with Potentially Preventable Admissions 40 J Gen Intern Med. 2198, 2198-2206 (2025). Rita Hamad et al., JAMA, The Role of Health Care Systems in Bolstering the Social Safety Net to Address Health Inequities in the Wake of the COVID-19 Pandemic (Jun 15, 2022). ↑
Natalie Kean & Gelila Selassie, Justice in Aging, How Medicaid Supports Older Adults (February 12, 2026). ↑
BLK + GRN, Culturally Rooted Care: Rethinking Safety for Black Seniors at Home (Jul 23, 2025). ↑
The People Say, Cooper #19 (Feb 2025-Jul 2025). ↑
Chanee D Fabius et al., Racial and ethnic differences in unmet needs among older adults receiving publicly-funded home and community-based services 72 J Am Geriatr Soc. 3520, 3520-3529 (2024). ↑
Unidos US, Medicaid Cuts Would Rip Away Health Coverage from Millions of Americans, Disproportionately Harming People of Color (Mar 2025). ↑
Justice in Aging, California Advocates for Nursing Home Reform, National Academy of Elder Law Attorneys, National Health Law Program, and Western Center on Law and Poverty, How Medicaid Estate Recovery Perpetuates Poverty (April 13, 2021). ↑
Justice in Aging, Advocating for Older Adults in 2025—Economic Security & Housing (December 4, 2024). ↑
Center on Budget and Policy Priorities, Social Security: A Vital Protection for African American People of All Ages (Jul 24, 2019). ↑
Center on Budget and Policy Priorities, Social Security Lifts More People Above the Poverty Line Than Any Other Program (Feb 25, 2026). ↑
Social Security Administration, Research, Statistics & Policy Analysis (Mar 2026). ↑
Center on Budget and Policy Priorities, Social Security Lifts More People Above the Poverty Line Than Any Other Program (Feb 25, 2026). ↑
Congress.gov, Income for the Population Ages 65 and Older: Evidence from the Health Retirement Study (HRS) (Aug 5, 2025). ↑
Justice in Aging, FAQ: Supplemental Security Income (SSI) (Mar 4, 2026). ↑
MaryBeth Musumeci et al., KFF, Supplemental Security Income for People with Disabilities: Implications for Medicaid (Jun 23, 2021). ↑
National Low Income Housing Coalition, Households Receiving Rental Assistance Are Becoming Older and More Diverse (Aug 12, 2024). ↑
National Caucus and Center on Black Aging, Inc., Black and Aging in America (2021). ↑
The People Say, Cooper #21 (Feb 2025-Jul 2025). ↑
UCSF Benioff Homelessness and Housing Initiative, Toward Dignity Understanding Older Adult Homelessness (May 2024). ↑
Consumer Reports, American Experiences Survey: A Nationally Representative Multi-Mode Survey, CR, 6 (2022). ↑
Lesli Skolarus, Devin L Brown, Casey L Corches, Evan Reynolds, Sarah Bailey, Maria Mansour, Maria Cielito Robles, et al. Extending Advance Care Planning to Black Americans in the Community: A Pilot Study of the PREPARE Program, Journal of Pain and Symptom Management 62, no. 1 (July 2021): e4–9. ↑
Federico Fontanella, Traceone, Which States Depend Most on Food Assistance? (Nov 11, 2025). ↑
Feeding America, Food Insecurity Among Seniors and Older Adults in 2022, 2 (2022). ↑
Id at 1. ↑
Id at 2. ↑
Administration for Community Living, Older Americans Act (last visited Mar 23, 2026); Older Americans Act of 1965, Pub. L. No. 89-73, 79 Stat. 218, 42 U.S.C. §§ 3001–3058ff. ↑
Id. ↑
United States Government Accountability Office, Older Americans Act: Options to Better Target Need and Improve Equity (last visited Mar 23, 2026). ↑
