After the release of California’s Master Plan for Aging (“MPA” or “Plan”) in January 2021, the California Department of Aging (CDA) appointed and convened the Implementing the Master Plan for Aging in California Together (IMPACT) Stakeholder Committee to provide guidance on implementation of the Plan. With diverse representation and expertise, the IMPACT Committee focuses on accountability, outcomes, and continued improvement toward the realization of the five bold goals of the MPA.
- Goal 1: Housing for All Ages and Stages
- Goal 2: Health Reimagined
- Goal 3: Inclusion & Equity, Not Isolation
- Goal 4: Caregiving that Works
- Goal 5: Affording Aging
Now, four years into the implementation of the Plan, the IMPACT Committee has prepared this report to provide feedback on MPA implementation and recommendations for the considerable work ahead. While investments in aging and disability services have been made since the release of the MPA, the state now faces a challenge on three fronts: instability at the federal level, a state budget deficit, and a growing aging and disability population in need of vital services that need to be strengthened.
This is a critical juncture in the MPA implementation, and the state should be focused on identifying the path forward, including revenue streams, to meet the home care needs of Californians, as well as end older adult homelessness in California. Importantly, advancing equity for older adults and people with disabilities continues to be a fundamental tenet of MPA implementation, and must remain a priority for the Administration.
The report is divided into two sections. The first section outlines the committee’s response to the most recent MPA annual report as well as the new initiatives for 2025-2026. The second section delves into the areas of focus that the IMPACT committee has identified in the past that should be maintained and preserved in a more difficult federal and economic climate. Those areas are:
- Building a home care system that works for all Californians
- Preventing and ending older adult homelessness in California
Section 1: Response to Annual Report and 2025-2026 MPA Initiatives
The IMPACT Committee commends CDA for its work preparing this year’s annual report, as well as developing the new 2025-2026 initiatives following the CA For All Ages and Abilities Day of Action. The annual report shows the breadth and depth of how the MPA is being implemented across state government. The annual report also highlights the importance of engaging stakeholders in the implementation process, and how future implementation of the MPA will, in part, be guided by those with lived experience.
While the annual report does a good job of laying out achievements of the MPA, one of the recommendations from the Committee in last year’s report was that the annual report include a summary of completed initiatives and an update on incomplete initiatives. Especially given the rollout of the new initiatives, from this annual report – it is difficult to track where we stand on our progress. In addition, the annual report highlights achievements that were not necessarily MPA initiatives in the past, compounding the difficulty in parsing out achievements on specific initiatives. As we enter this next phase of MPA implementation, and the uncertain federal and state budget climate, keeping track of our progress is critical.
We appreciate that leading up to the development of the 2025-2026 initiatives, there was significant stakeholder engagement from the six MPA implementation committees, and that many of the updated initiatives reflect that stakeholder feedback. However, we are disappointed that significant recommendations from the stakeholder committees were not included in the new round of MPA initiatives, and in some cases, some initiatives feel watered down compared to previous years. For example, a focus on rental subsidies is no longer a standalone initiative, despite being a key stakeholder priority and recommended by multiple committees, including IMPACT.
Additionally, reforming the Medi-Cal Share of Cost program is no longer an explicit MPA initiative, which is disappointing, given that reforming that program is one of the ways to almost instantly increase access to affordable LTSS for those just outside of Medi-Cal eligibility, a key MPA priority. Finally, the IMPACT committee feels that in some instances, the new initiatives cover implementation of ongoing work, rather than the bold visioning that the MPA started with. We understand that there have been significant shifts on the state and federal front since the initial release of the MPA, however, the need for a transformation in our aging and disability systems has not changed – and the MPA should remain responsive to that urgent need.
Finally, since release of the annual report and new initiatives, the IMPACT committee would like to recognize the departure of Kim McCoy Wade, the Governor’s Senior Advisor on Aging, Disability and Alzheimer’s. This Senior Advisor role is critical in being a bridge between the Administration and stakeholders, and also helping to promote the MPA, aging, and disability across state government. The IMPACT committee recommends that this position be filled so this important work can continue.
Section 2: Maintaining and Protecting Existing MPA Investments
The IMPACT Committee recognizes the difficult fiscal condition that the state is currently experiencing, as well as the significant uncertainty regarding funding and programs from the federal government. The MPA was created as a roadmap to guide state investments during surplus and fiscal downturns, and the IMPACT committee urges the Governor and the Legislature to maintain their commitment to services for older adults and people with disabilities. It is critical that the Governor and Legislature reaffirm their support to recent expansions of programs and services under the MPA and refuse to look to older adults, people with disabilities, and their families to bear the brunt of any budget shortfall the state is facing.
In addition, cuts to federal funding for programs will put further strain on state aging and disability services that are already underfunded. We cannot afford to lose these critical programs, and the state must work to find ways to maintain these critical services that older adults and people with disabilities rely on. This year’s MPA annual report shows how successful many of the new investments in aging and disability have been. Reversing those investments will only set us back further in creating a state where older adults and people with disabilities can age with dignity.
The IMPACT committee has previously identified creating a home care system for all Californians and preventing and ending older adult homelessness as the two key priorities for investment and focus for MPA implementation. Despite challenges at the federal level, and state budget uncertainty – these two key areas remain priorities for the IMPACT committee. By 2030, 30% of our state will be age 60 or older, and with the aging of the state will come a pressing need for improved home and community-based support. And older adults are the fastest growing group of people experiencing homelessness in California, with many of these individuals facing homelessness for the very first time. It is the IMPACT Committee’s continued recommendation that the state maintain investments related to LTSS and older adult homelessness, and not pull back from the commitment to the key structural reforms in the MPA in order to support California’s growing population of older and disabled adults.
Delaying or cutting critical investments in California’s aging and disability services will ultimately cost the state more. We know that home and community-based services (HCBS) are more cost effective for the state than institutional care. And we know that preventing homelessness is more cost effective for the state than helping to rehouse someone experiencing homelessness.
Building a home care system that works for all Californians
The majority of older adults and people with disabilities want to live at home, even as their needs for care change – but California lacks an affordable, inclusive, and equitable system to support them. Aging in place, or in one’s home, can be of great benefit to one’s mental health, connection to social support networks, and support the role of older adults and people with disabilities within their communities. Right now, too many Californians cannot afford in-home care. Many people – especially those with complex needs, and people of color, due to structural discrimination and systemic health inequities – are forced to ultimately receive their care in more expensive institutional settings, like nursing facilities.
Our current system of care for older and disabled Californians is inequitable. The ultra-wealthy are able to pay out-of-pocket for care. Very low-income individuals have coverage, but struggle to access services. The IMPACT Committee also recognizes that those in the middle – an increasingly racially diverse group of older adults, often referred to as the “forgotten middle” – struggle to both afford and access services. By 2033, 89% of Californians aged 75 and older will not have enough financial resources to pay privately for care. A subset of the forgotten middle population, Medicare beneficiaries just over income eligibility for Medi-Cal, known as “near-duals,” are feeling the impact now.
Increasing affordability and access to long-term services and supports (LTSS) has been a key tenet of the MPA, and significant investments have been made in recent years: expanding Medi-Cal to all income-eligible Californians regardless of immigration status, increasing the Medi-Cal Aged, Blind, and Disabled income limit to 138% FPL, eliminating the Medi-Cal asset limit for older adults and people with disabilities, investments around caregiver training, increasing slots for HCBS programs, and much more.
These investments have been critical in making progress on creating a more equitable and accessible home care system for all Californians. These investments in HCBS are also a smart fiscal decision for the state, because without these HCBS we know that the only option for older adults and people with disabilities is institutionalized care – which is significantly more expensive for the state.
By maintaining and improving investments in at-home care and support, California can lead the nation in ensuring everyone can get the help they need to live with dignity as they age and prevent aging into poverty. Maintaining economic security is a critical piece of this work. Many older Californians and their families are severely burdened by the cost of long-term care. In order to maintain older adults’ economic security, and also not threaten their families’ financial circumstances, the state needs to be focused on addressing the affordability crisis in California. Despite uncertainty at the federal and state level, the demographic trends in California are not changing. The need for investment in an affordable, accessible home care system for all Californians remains urgent.
Preventing and ending older adult homelessness
Older adults are the fastest growing age group within California’s homeless population. Older adults (age 50+) now make up almost half (48%) of homeless individuals, and, of those older adults, almost half (41%) had their first incident of homelessness after age 50. Since 2017, the number of unhoused older adults over the age of 65 has increased by more than 166%. The primary drivers of the surge in older adult homelessness in California are unsustainable rent burdens and an inadequate supply of affordable, accessible, and stable housing. According to a recent Justice in Aging analysis, Black older Californians face a substantially higher risk of homelessness, and 36% of people experiencing homelessness of all ages report disabling conditions, and that percentage is much higher for older adults experiencing homelessness.
We appreciate that there have been significant budget investments in addressing homelessness over the last several years including Homelessness Housing, Assistance and Prevention (HHAP) grant, HomeSafe, and the Housing and Disability Advocacy Program (HDAP). CDA’s annual report this year highlights how successful HomeSafe and HDAP have been at preventing older adult homelessness – and these two programs are the only programs across state government targeted at homelessness prevention for older adults. These two programs are some of the most successful housing programs the state has, yet funding is running out. And while these programs have been very successful, their scope has been limited, and the issue of older adult homelessness is still getting worse.
Now is not the time to be cutting cost-effective programs that prevent homelessness. Research shows that preventing homelessness is more cost-effective for the state, rather than paying for shelter beds and services to rehouse people. And, for older adults and people with disabilities, the rehousing process can be more difficult due to their unique needs.
Another key driver of homelessness, especially amongst older adults, is inadequate income benefits. During the recession, the SSP grant was dramatically cut, which pushed older adults and individuals with disabilities who rely on SSI/SSP into deep poverty. In the ten years after that, rents dramatically increased, and other costs of living continued to rise due to inflation, contributing to the high rates of homelessness we see today. We appreciate that the state made significant investments in 2021-2023 to start bringing the SSP grants to their pre-recession level. However, older adults receiving SSI/SSP still have less income relative to the poverty line than they had pre-recession. It is critical that the state maintain the level of the SSP grant. Cutting it will only worsen our poverty and homelessness issues, and make it harder to recover from in a better economic climate.
The consistently rising trend of older adult homelessness indicates that the state must maintain the commitment to preserving programs, despite federal and state uncertainty, and continue to explore investments in other proven solutions – like a targeted rental subsidy program for older adults. Once older adults become homeless, it is much more difficult and expensive to rehouse and stabilize them. The Committee continues to urge CDA and the Administration to focus on homeless prevention as a key strategy to meeting the goal of ending older adult homelessness.
Conclusion
The IMPACT Committee is grateful for the Governor’s leadership to date and for the work of CDA and other agencies and departments to implement the MPA over the past four years. We appreciate the opportunity to provide feedback and recommendations via this report and our continued meetings. When we began the MPA process over five years ago, we could not have imagined the situation we would be in today. We’ve made immense progress in the goals, but now facing significant challenges in continuing to implement the bold goals. However, the underlying need and the impetus for creating the MPA has not changed. And despite significant uncertainty regarding federal and state programs, older adults and people with disabilities will continue to need services.
The IMPACT committee urges the Administration to use the MPA and the goals of the MPA as a guiding frame to navigate this current climate. Lessons from the last recession show us that making cuts to safety-net programs are a short-term solution that lead to long-term negative outcomes. Maintaining MPA investments around LTSS and homelessness are not only equitable decisions, they are also the most financially prudent in the long-term. The IMPACT committee looks forward to continuing to work with the Administration and provide feedback and partnership on ongoing MPA implementation.
Endnotes
https://www.norc.org/content/dam/norc-org/documents/standard-projects-pdf/NORC%20Forgotten%20Middle%20CA%20-%20Findings%20(1).pdf ↑
https://justiceinaging.org/california-older-renters-unaffordability-homelessness/ ↑
https://news.nd.edu/news/targeted-prevention-helps-stop-homelessness-before-it-starts/ ↑
