{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T04:24:20Z","timestamp":1777782260667,"version":"3.51.4"},"reference-count":28,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2024,11,9]],"date-time":"2024-11-09T00:00:00Z","timestamp":1731110400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"The Ohio Long-Term Care Research Project","award":["This is a line-item in the State of Ohio budget."],"award-info":[{"award-number":["This is a line-item in the State of Ohio budget."]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Appl Gerontol"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:p>Most older Americans do not financially qualify for Medicaid and support provided through the Older Americans Act is quite limited. In response, Ohio has generated funds for services for older adults through the use of local county tax levy programs. Ohio currently leads the nation in the utilization and support of local levy funding, generating more than US$200 million annually. This study conducted qualitative descriptive interviews with 15 locally funded programs across the state. Thematic analysis revealed that local programs encounter an array of implementation barriers, including increased state and federal eligibility requirements, staffing issues, lack of access to services in rural locations, and low reimbursement rates. These barriers are coupled with added pressure from county officials to move individuals onto state-funded programs, rather than locally funded programs. This paper also provides recommendations for how these programs can be better supported to ensure their sustainability for the future.<\/jats:p>","DOI":"10.1177\/07334648241298108","type":"journal-article","created":{"date-parts":[[2024,11,9]],"date-time":"2024-11-09T06:28:58Z","timestamp":1731133738000},"page":"1030-1038","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cWe\u2019re Preventing People From Going Into the Most Expensive Level of Care in Every Way that We Can\u201d: Barriers and Recommendations for Use of Local Funds"],"prefix":"10.1177","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6886-126X","authenticated-orcid":false,"given":"Bailee","family":"Brekke","sequence":"first","affiliation":[{"name":"Department of Sociology and Gerontology, Miami University, Oxford, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4075-9615","authenticated-orcid":false,"given":"Leah M.","family":"Janssen","sequence":"additional","affiliation":[{"name":"Scripps Gerontology Center, Miami University, Oxford, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oksana","family":"Dikhtyar","sequence":"additional","affiliation":[{"name":"Scripps Gerontology Center, Miami University, Oxford, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian","family":"Nelson","sequence":"additional","affiliation":[{"name":"Scripps Gerontology Center, Miami University, Oxford, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Applebaum","sequence":"additional","affiliation":[{"name":"Scripps Gerontology Center, Miami University, Oxford, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,11,9]]},"reference":[{"key":"e_1_3_5_2_1","unstructured":"Administration for Children & Families. (2022). Social services block grant (SSBG). https:\/\/www.acf.hhs.gov\/sites\/default\/files\/documents\/ocs\/COMM_OCS_SSBG_FactSheet_FY2022.pdf"},{"key":"e_1_3_5_3_1","unstructured":"American Association for Retired People (AARP). (2021). Where we live where we age: Trends in home and community preferences. https:\/\/livablecommunities.aarpinternational.org"},{"key":"e_1_3_5_4_1","volume-title":"Local initiatives to fund services for older people: Building on an Ohio area of strength","author":"Applebaum R.","year":"2023","unstructured":"Applebaum R., Bowblis J. R., Janssen L. M., Nelson M., Dikhtyar O., Brekke B. (2023). Local initiatives to fund services for older people: Building on an Ohio area of strength. Scripps Gerontology Center."},{"issue":"4","key":"e_1_3_5_5_1","first-page":"20","article-title":"Local support for aging services: An island of progress in a sea of uncertainty","volume":"42","author":"Applebaum R.","year":"2019","unstructured":"Applebaum R., Goldstein C. (2019). Local support for aging services: An island of progress in a sea of uncertainty. Generations, 42(4), 20\u201325. https:\/\/www.jstor.org\/stable\/26608425","journal-title":"Generations"},{"key":"e_1_3_5_6_1","volume-title":"Local initiatives to fund services for older Americans: A growing option for states","author":"Applebaum R.","year":"2020","unstructured":"Applebaum R., Heston-Mullins J. (2020). Local initiatives to fund services for older Americans: A growing option for states. AARP Public Policy Institute: Promising Practices and Emerging Innovations."},{"key":"e_1_3_5_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/1744987107081254"},{"key":"e_1_3_5_8_1","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"e_1_3_5_9_1","unstructured":"Centers for Medicare & Medicaid Services (CMS). (2023). Nhe fact sheet. https:\/\/www.cms.gov\/data-research\/statistics-trends-and-reports\/national-health-expenditure-data\/nhe-fact-sheet#:\u223c:text=Medicare_spending_grew_5.9%25_to 29_percent_of_total_NHE"},{"key":"e_1_3_5_10_1","unstructured":"Congressional Research Service. (2018). Older Americans act: COVID-19 response [CRS report prepared for members and committees of congress]. Congressional Research Service."},{"key":"e_1_3_5_11_1","unstructured":"Congressional Research Service. (2023). Older Americans act: Overview and funding [CRS report prepared for members and committees of congress]. Congressional Research Service."},{"key":"e_1_3_5_12_1","unstructured":"Eiken S. Sredl K. Burwell B. Amos A. (2018). Medicaid expenditures for long-term services and supports in FY 2016. https:\/\/www.medicaid.gov\/medicaid\/long-term-services-supports\/reports-evaluations\/index.html"},{"key":"e_1_3_5_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/08959420.2023.2197563"},{"issue":"1","key":"e_1_3_5_14_1","first-page":"1","article-title":"Straight from the source: Consumers\u2019 take on care management","volume":"45","author":"Heston-Mullins J.","year":"2021","unstructured":"Heston-Mullins J. (2021). Straight from the source: Consumers\u2019 take on care management. 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