As we recognize Rare Disease Week, I find myself reflecting on why I chose to pursue a career in health policy. For me, rare disease policy has never been abstract, it has always been deeply personal. My Dad and I Shortly before my first birthday, my dad was diagnosed with neurosarcoidosis, a rare inflammatory disease that left him permanently disabled. Growing up, I did not fully understand the medical complexity of his condition. What I understood was that our life included many medical complications, doctors appointments, and hospital visits. One of the things I noticed early on was how frequently doctors simply were not trained to care for patients with rare diseases. It was not a lack of compassion, it was the reality that rare conditions are, by definition, uncommon, and most medical training centers on the diagnoses providers are most likely to see in everyday practice. When you live with something rare, expertise can be limited. Patients and families often find themselves explaining the condition, repeating medical history, and connecting the dots between providers. I saw the gaps between specialists, between systems, and between what was known and what was not. I saw how much coordination fell on my father. But alongside those gaps, I saw resilience. My dad refused to let his disability define the kind of father he would be. He taught me tennis sitting in a lawn chair in the middle of the court. He played basketball with my brother and me while holding onto a cane. He adapted everything. He showed up fully. He taught me that strength is not about physical ability. It is about persistence, creativity, and love. Years later, rare disease entered our lives again when my niece was diagnosed with osteogenesis imperfecta, or OI, often referred to as brittle bone disease.. OI is a genetic disorder that affects collagen production and causes bones to fracture and break easily, requiring specialized and lifelong care. There is no cure. My beautiful neice and I Today, my niece is five years old. She is brilliant, witty, energetic, and just as curious and imaginative as any other five year old. She loves playing with her brother, her friends, and her mom. She sings at the top of her lungs and dances without hesitation. She is full of life. My sister, her mom, is the one who carries the weight of advocacy. She researches treatment options, asks hard questions in appointments, pushes for coordinated care, and ensures that my niece has access to the specialists she needs. Like so many parents of children with rare diseases, she has had to become an expert out of necessity, learning to navigate a system that often requires families to lead the way. While any single rare disease may affect a small population, rare disease as a whole is not rare. Approximately 25 to 30 million people in the United States are living with a rare disease.[i] That is nearly 1 in 10 Americans.[ii] And of the more than 10,000 known rare diseases, only about 5 percent have a United States Food and Drug Administration approved therapy.[iii] That reality should challenge all of us. The diseases may differ, but the barriers for people living with rare diseases are often similar. Delayed diagnoses. Limited provider awareness. Fragmented care. Difficulty accessing specialists. A need for more research and treatment development. And one of the most pressing issues is the transition from pediatric to adult care. As more children with rare diseases live longer, which is something to celebrate, we must ensure that adult systems are prepared to care for them. Pediatric settings are often coordinated and specialized, but many adult providers may have far less exposure to rare diseases, which often causes care to be fragmented. My personal experience shaped how I see the rare disease policy space. I do not see abstract legislative language. I see my dad and my niece. I see families doing everything they can to make sure their loved ones receive the care they deserve. Rare Disease Week is a celebration of the people living with these conditions and the families who stand beside them. It is also a reminder that we can and should continue to do more. I am deeply grateful that my work allows me to partner with incredible organizations that represent patients and families living with rare diseases. These groups are led by people with lived experience and an unwavering commitment to improving care for their patient groups. I feel privileged to come alongside them, to help translate patient priorities into policy conversations, to amplify their voices on Capitol Hill, and to support efforts that improve patient outcomes. Taylor Thomas, MPH Director of Government Affairs and Research [i] National Institutes of Health. (2025, January 21). Rare Diseases | National Institutes of Health.  NIH. Retrieved February 19, 2026, from https://www.nih.gov/about-nih/nih-turning-discovery-into-health/promise-precision-medicine/rare-diseases [ii] Wan, E. L., Elkaim, Y., Gao, W., & Yoon, R. (2023). Zebras Among Us: Advocating for the 30 Million Americans Living with Rare Disease. Medical science educator , 33 (5), 1239–1242. https://doi.org/10.1007/s40670-023-01856-2 [iii] U.S. Government Accountability Office. (2024, November 18). Rare Disease Drugs: FDA Has Steps Underway to Strengthen Coordination of Activities Supporting Drug Development . GAO|U.S. Government Accountability Office. Retrieved February 19, 2026, from https://www.gao.gov/products/gao-25-106774

We may be days into 2026, but Congress has yet to fully fund the federal government for the current fiscal year, which began on October 1, 2025. The longest shutdown in U.S. history concluded with the enactment of three appropriations bills covering part of Fiscal Year 2026, alongside a temporary continuing resolution funding the remaining federal agencies through January 30, 2026. As lawmakers returned from the holidays, appropriators faced mounting pressure to complete the remaining work. Senate leadership is expected to revisit a minibus package of five appropriations bills that stalled in December, while House Republican leadership, including Appropriations Committee Vice Chair Tom Cole (R-OK), has outlined an aggressive January schedule aimed at passing three bills per week to avoid another continuing resolution. Despite these plans, ongoing disagreements between House and Senate appropriators over topline spending levels make an extension beyond January 30 increasingly likely. While the procedural outcome remains uncertain, two realities are clear. Congressional leaders are highly motivated to avoid another shutdown in a politically sensitive midterm election year, and organizations that understand how to navigate appropriations during periods of uncertainty are best positioned to secure limited federal dollars. That is where Indigo Hill Strategies comes in. As we enter our second year of operation, Indigo Hill Strategies is expanding our federal offerings to include full-service appropriations support beginning with the Fiscal Year 2027 cycle. We will partner closely with clients to shape competitive Community Project Funding requests, identify the right congressional champions, manage submissions, and support follow-up with federal agencies. For healthcare, aging, and disability stakeholders facing growing financial strain, particularly in the wake of the One Big Beautiful Bill Act (P.L. 119-21), the federal appropriations process presents both a challenge and a critical opportunity. Appropriations are no longer a “nice to have.” They are increasingly essential to sustaining programs, piloting innovation, and offsetting reimbursement and regulatory pressures. To support this expanded work, we are proud to welcome Ebony Slaughter-Johnson to the Indigo Hill Strategies team. Ebony brings deep experience at the intersection of law, policy, and federal funding. A graduate of Princeton University and Harvard Law School, she began her career as a federal lobbyist in the Washington, DC office of a multinational law firm, advising clients across multiple appropriations cycles and funding bills. Her ability to translate complex policy landscapes into actionable strategy strengthens our commitment to delivering practical, results-oriented guidance to clients. With Ebony’s expertise and our firm’s integrated approach to policy, communications, and congressional engagement, Indigo Hill Strategies is uniquely positioned to help organizations pursue federal funding with intention and discipline. If your organization is considering federal appropriations as part of its 2027 strategy, or if you are reassessing how federal funding fits into your broader financial and policy goals, now is the time to start the conversation. Reach out to our team to learn how Indigo Hill Strategies can help you identify opportunities, avoid common missteps, and compete effectively in a constrained funding environment. We look forward to advising clients throughout the year and sharing timely appropriations insights as the FY 2026 and FY 2027 cycles continue to unfold.

Our Founder and CEO, Ryann Hill, MPH, was recently featured in a Rise Health article exploring the key challenges health care organizations will face in 2026 and how leaders can prepare for what lies ahead. She shared perspective on how shifting federal priorities, regulatory uncertainty, and election year dynamics are reshaping the policy landscape for providers, advocates, and health systems. We are grateful to the Rise Health team for including her voice in this important conversation and for fostering thoughtful, forward looking dialogue on the future of health policy. You can read the full article here: https://www.risehealth.org/insights-articles/article/9-challenges-health-care-organizations-will-face-in-2026-and-how-to-overcome-them/

One of the things we are most proud of from 2025 is our commitment to growing the next generation of health policy leaders. At Indigo Hill Strategies, we believe that building a stronger, more equitable policy ecosystem requires intentional investment in people. That means creating space for emerging professionals to learn, contribute, and bring new perspectives to the table. It is not optional work. It is an obligation. From June through December 2025, we had the privilege of working with Dr. William Knight PT, DPT, SPH, CSCS . A practicing physical therapist pursuing his Masters of Public Health at The George Washington University's Milken Institute of Public Health, Will joined us with deep clinical experience and a clear desire to understand how policy decisions shape the care patients receive long before they ever enter a clinic. We are grateful to Dr. William Knight for sharing reflections on his time with Indigo Hill Strategies and his experience as a Health Policy Fellow. Dr. William Knight, PT, DPT, SPH, CSCS At Indigo Hill Strategies, the work starts from a simple premise. Public policy is one of the most powerful tools we have to improve the lives of people and communities that are often overlooked. The firm partners with organizations that serve those communities and helps them turn their goals into concrete policy strategies. I joined Indigo Hill Strategies as a full-time physical therapist who was also pursuing an MPH. My days in the clinic are spent helping people manage pain, recover function, and navigate complicated health systems. The fellowship invited me into a different part of that same story, where legislative language, regulatory decisions, and advocacy campaigns quietly shape what care is available in the first place. Over the past months, I have been able to see how a firm like Indigo Hill Strategies connects those dots. I watched how they help clients make sense of shifting federal and state landscapes, sharpen their message, and show up in the right rooms on behalf of the people they serve. What follows are a few reflections on what I worked on, what I learned, and how this experience has reshaped the way I see my role as both a clinician and an emerging policy professional. Why I pursued a health policy fellowship I pursued this fellowship because of what I see every day in the clinic. As a physical therapist, I work with people living with acute injuries, chronic pain, and long-term health conditions. Their progress is influenced not only by the quality of care they receive, but also by policies that determine coverage, prior authorization, medication access, and the availability of nonpharmacologic options. I wanted to understand the forces behind those decisions. Specifically, I hoped this fellowship would allow me to: See how policy advocacy actually unfolds, beyond what I learn in class Practice turning clinical experience and public health evidence into clear, persuasive messages Contribute to work that centers patients and caregivers who are often left out of policy conversations I was drawn to Indigo Hill Strategies because the firm sits alongside organizations that focus on aging, disability, chronic disease, and equity. It is a place where data, lived experience, and strategy are all treated as essential parts of the same conversation. Clinicians belong in policy conversations Before this experience, I sometimes saw policy as far removed from the clinic. Working with Indigo Hill Strategies showed me that clinical voices are not just helpful, they are essential. My background as a physical therapist helped me: Ask realistic questions about how a policy would work in practice Notice potential unintended consequences for patients and providers Keep attention on function, quality of life, and long-term outcomes, not only short-term costs Policy discussions can quickly become abstract. Bringing in clinical experience grounds those conversations in what happens when a person walks into a clinic, a hospital, or a community-based program. In public health and advocacy, there can sometimes be a split between those who focus on numbers and those who focus on narrative. This fellowship showed me how powerful they are when used together: Data clarifies the scale of the problem and who is most affected Stories show what that reality looks and feels like for real people The most compelling materials I helped with did both. They paired patient and caregiver stories with strong evidence and clear policy analysis so that decision makers could see both the human impact and the broader pattern. Systems can change, but only with intent Finally, this experience underscored that our health systems are not accidental. The way we pay for care, which services are covered, and how people with complex needs are supported all reflect choices. Those choices can be revisited. Watching the day to day work of advocacy made structural change feel less mysterious. It is not magic. It is the result of many small, deliberate steps taken by people who are willing to stay engaged over a long period of time. This fellowship confirmed something I felt when I first enrolled in my MPH program. There is real value in bringing clinical experience into policy spaces, especially when the focus is on aging, disability, pain, and chronic conditions. Indigo Hill Strategies made room for that perspective and encouraged me to translate it into concrete recommendations for clients and policymakers. Looking Ahead Looking ahead, I see my career unfolding in a way that weaves together clinical practice and policy engagement. I plan to continue working as a physical therapist, particularly with people managing musculoskeletal pain and other complex conditions, while also staying involved in advocacy that improves access to evidence-based care, advances equity, and supports people across the lifespan. I am deeply grateful to Ryann Hill and the entire Indigo Hill Strategies team for investing in my growth as a Health Policy Fellow and for modeling what it looks like to do this work with integrity, creativity, and purpose. Their mentorship has given me a clearer picture of the kind of advocate and clinician I hope to be. For other clinicians and students who are curious about advocacy, my invitation is simple. There is a place for you at the policy table, especially if you are willing to pair your lived and professional experience with strategy and persistence. My time with Indigo Hill Strategies showed me that when patient stories, strong evidence, and thoughtful strategy come together, policy stops being an abstract process. It becomes a practical way to deliver meaningful change for the people we serve. Dr. William Knight, PT, DPT, SPH, CSCS

Welcome to the Q4 2025 edition of the Indigo Hill Strategies Quarterly Newsletter, The Indigo Insider . As we wrap up 2025, this update is your window into the conversations, milestones, and policy shifts shaping the healthcare, aging, and disability landscape. A Note From Ryann Team Indigo Hill Strategies at Women in Government Relations’ Annual End of Year Party. Niyahnee Thomas (Left), Taylor Thomas (Middle), Ryann Hill (Right) As we close out 2025, I have been reflecting on how much can shift in a relatively short period of time, and how powerful this work can be when it is guided by clarity, purpose, and strong partnerships.   Since our September newsletter, Indigo Hill Strategies has continued to grow in both impact and visibility. This fall, we launched Mic’d Up with Ryann Hill , releasing five episodes that explore timely issues ranging from aging and state policy to Medicare Advantage. We have also partnered with organizations across the country to engage in thoughtful conversations shaping the future of healthcare, aging, and disability.   From moderating the inaugural Sick Cells Therapeutics Conference to speaking at national forums focused on quality improvement and the future of aging, the past few months have been full, energizing, and deeply meaningful.   As we look ahead to 2026, we are excited to meet the moment. The year ahead will bring expanded offerings at Indigo Hill Strategies, including deeper policy analysis, research support, and appropriations strategy, allowing us to support clients more comprehensively across the federal policy landscape. While our work continues to evolve, one thing remains constant: our commitment to showing up with expertise, thoughtfulness, and purpose in every space we enter.   Thank you for being part of this community. Your partnership and trust continue to make this work possible, and we look forward to what we will build together in the year ahead.   With Gratitude,   Ryann Hill, MPH Founder and CEO, Indigo Hill Strategies   Indigo In Action   This fall, Indigo Hill Strategies had the opportunity to contribute to national conversations shaping the future of healthcare, aging, and disability. Highlights from the quarter include:   Sick Cells Therapeutics Conference Ryann Hill, Founder and CEO of Indigo Hill Strategies, served as Master of Ceremonies for the 2025 Sick Cells Therapeutics Conference, which convened patients, advocates, researchers, policymakers, and industry leaders to examine advances in sickle cell therapeutics and access to care. In addition to guiding the overall program, Ryann moderated a panel on therapeutics innovation and policy featuring Sara Davis, Vice President of Patient Advocacy and Policy at Fulcrum Therapeutics, Josh Trent, Chief Executive Officer of Leavitt Partners, and Annie Kennedy, Chief of Policy, Advocacy, and Patient Engagement at EveryLife Foundation for Rare Diseases. The discussion explored the evolving policy landscape, innovation challenges, and opportunities to accelerate access to emerging treatments for people living with sickle cell disease.   Future of Aging Summit As a panelist at the inaugural Future of Aging Summit in Boston, Ryann joined students, young professionals, researchers, faculty, and community leaders for a full day of discussion on aging and its intersection with whole person care, intergenerational connection, biology, and public policy. The summit convened more than 100 attendees and was held in partnership with the Gerontological Society of America, creating a space for thoughtful dialogue and collaboration across disciplines focused on the future of aging.   RISE HEDIS® and Quality Improvement Summit At the RISE HEDIS® and Quality Improvement Summit, Ryann presented Advocacy Unlocked: Shaping the Future of Medicare Advantage Policy , offering health plans a clear framework for understanding the broader regulatory and political context shaping quality and performance requirements. The session focused on how plans can interpret proposed and final rules, anticipate congressional oversight and legislative activity, and engage more strategically in advocacy efforts that align regulatory compliance with long term program sustainability.   RISE Stars Masterclass At the RISE Stars Masterclass in Dallas, Ryann led a deep dive on proposed Medicare Advantage rules, helping plans connect regulatory changes to the broader policy and congressional landscape. The discussion emphasized how and when Congress influences Medicare Advantage policy, how plans can track and respond to evolving priorities, and how to craft effective, policy informed comment letters that reflect both operational realities and legislative considerations.   Leadership and Field Building Taylor Thomas joined the Board of Directors of the Society of Health Policy Young Professionals, a Washington, DC based organization focused on educating, connecting, and supporting emerging health policy leaders. Ryann serves as an advisory board member, helping guide the organization’s strategic direction and programming.   National Academy of Social Insurance Ryann accepted a nomination to join the incoming class of the National Academy of Social Insurance, a distinguished community of experts dedicated to strengthening social insurance policy through research, education, and informed dialogue. Membership in the Academy recognizes individuals who have made significant contributions to social insurance policy and practice across programs such as Medicare, Social Security, and disability insurance. Ryann looks forward to contributing to the Academy’s work by bringing a practical, policy grounded perspective informed by direct engagement with federal policymakers, stakeholders, and affected communities. Sick Cells Therapeutics Conference with Emerald Adeyemi, Sickle Cell Caregiver and Advocate   Mic’d Up with Ryann Hill   Our podcast is officially underway, and the momentum is just beginning. This fall marked the launch of Mic’d Up with Ryann Hill , a platform for thoughtful, accessible conversations about the policies shaping healthcare, aging, and disability, and the leaders working at the intersection of policy and impact.   To date, we have released five episodes exploring a range of timely topics, including: Why Mic’d Up with Ryann Hill Hard Work and Heart Work: Building a Better Future for Aging , featuring Dr. Leanne Clark Shirley, President and CEO of the American Society on Aging More Than Federal: Why State Policy Matters , with Davion Percy, Vice President of Community Relations and Public Policy at Luminis Health Dollars Defended, Not Donated: The New ROI of Social Impact , with Christina Rodriguez, Founder of The Pull Stars, Scrutiny, and Survival: A Year End Look at Medicare Advantage , with Rex Wallace of Rex Wallace Consulting   The debut episode, Why This Podcast, Why Now , set the tone for honest, policy grounded conversations that connect complex issues to real world impact. Each episode highlights experts, advocates, and leaders who are shaping the future of care, access, and accountability.   Listen to the first five episodes on YouTube: https://www.youtube.com/@IndigoHillStrategies   New Services in ‘26!   As we look toward 2026, Indigo Hill Strategies is preparing to meet a rapidly evolving policy environment with expanded capabilities and renewed focus. In the year ahead, we will broaden our service offerings to include enhanced policy analysis, research, and appropriations , allowing us to support clients more comprehensively across the full federal policymaking lifecycle.   These additions reflect both the growing complexity of the issues our clients face and the increasing demand for thoughtful, data informed advocacy. We are energized by the opportunity to meet this moment and to continue helping mission driven organizations translate policy goals into meaningful outcomes.   We look forward to sharing more in the months ahead and to continuing this work alongside our partners.     Let’s Connect!     At Indigo Hill Strategies, we support mission driven organizations as they navigate the complexities of federal policy and advocacy. If you are looking for a trusted partner in Washington, DC, we welcome the opportunity to connect.   If you know an organization or colleague who could benefit from stronger, more strategic engagement in DC, please feel free to share this newsletter. We are always open to building new partnerships with organizations committed to meaningful, lasting impact.

By Ryann Hill, MPH This week marks two milestones in my life. My oldest son started kindergarten, and Indigo Hill Strategies turned one. Lots of happy tears over here. Both milestones reminded me that growth is as emotional as it is exciting. Launching Indigo Hill Strategies was a leap of faith. One year later, I’m still pinching myself that this little dream of mine has grown into a real business making real impact. The Vision When I launched Indigo Hill, my goal was clear: to use policy as a tool to improve lives. I wanted to build a firm that paired deep expertise in healthcare, aging, and disability with a people-first approach that makes clients not just heard, but truly influential. And honestly, I also wanted to prove to myself (and maybe a few others) that I could build something of my own. That I could step away from the big title roles, start fresh, and still thrive. The Work We’ve Done In just twelve months, we’ve had the privilege of: Supporting national coalitions and nonprofits in shaping federal policy. Helping advocates prepare for Hill Days, hearings, and key meetings. Drafting comment letters, policy roadmaps, and strategic analyses that drive impact. Launching newsletters and tools to keep clients ahead of fast-moving developments. Building new champions on Capitol Hill and strengthening the voices of communities that deserve to be heard. Sometimes I still laugh when I think back to the early days: just me, my laptop, and a vision board. That feels both surreal and deeply gratifying. Lessons from Year One Faith and risk are worth it.  Walking away from certainty to bet on myself was terrifying. Without my faith, I never would have taken the leap. Trusting that God had placed this vision on my heart gave me the courage to move forward when the safer choice would have been to stay put. It has been a reminder that faith and risk often go hand in hand, and that is where the magic happens. Community matters.   This journey has not been a solo act. From clients to mentors to my ride-or-die friends who let me talk policy over dinner, it is the people who have carried Indigo Hill forward. I am especially grateful to my team, who trusted me, trusted my vision, and chose to build with me in this first year. Balance is a practice.  Running a firm while raising two little boys means some days I feel like Superwoman and other days like a hot mess. The trick is giving myself grace and remembering that balance is not about perfection, it is about showing up, trying again, and savoring the moments that matter. Looking Ahead Year two is about growth with intention. Expanding our client base, deepening partnerships, and continuing to shape policy in healthcare, aging, and disability. And also making sure I keep space for the things that matter most: family dinners, morning walks, and the occasional self-care splurge (because your girl has earned it).

By Ryann Hill, MPH On August 14, 1935, President Franklin D. Roosevelt signed the Social Security Act into law, transforming the way America supports its people. What began as a bold response to the economic devastation of the Great Depression has grown into one of the most impactful social programs in our nation’s history. Ryann Hill with Jim Roosevelt JR (FDR's Grandson) Last month, I had the privilege of celebrating this milestone with James Roosevelt Jr., FDR’s grandson. As someone who deeply admires FDR’s vision for a more secure and equitable America, it was an unforgettable moment. I’ll admit, I was fangirling a little (okay, a lot — and my smile in the photo says it all). Why Social Security Matters For 90 years, Social Security has served as a lifeline for millions of Americans. It provides critical income to older adults, people with disabilities, and surviving family members, helping keep countless households from falling into poverty. More than just a financial benefit, Social Security embodies a core national value: that we take care of one another. Today, nearly 70 million people receive Social Security benefits. These payments help cover basic needs like housing, food, and healthcare. For many, Social Security is the difference between living in dignity or facing financial hardship. Challenges Ahead As we mark this anniversary, the Social Security program faces significant political and fiscal challenges. Conversations about its solvency and sustainability have already begun to take center stage in policy debates. For those of us who work in public policy, the task is clear: protect and strengthen this program so it continues to serve future generations. A Legacy Worth Defending The Social Security Act Social Security’s legacy is one of foresight, compassion, and commitment to the American people. The 90th anniversary is not just a time to look back, but also to reaffirm our dedication to the principles it represents. Here’s to honoring its legacy and protecting its promise for generations to come.

By: Taylor Turner, MPH Last month, I attended the Alliance for Health Policy’s Signature Series Summit on Aging in America—an event that could not have been more timely. As the U.S. faces a dramatic demographic shift, with the population of adults aged 65 and older expected to grow by nearly 50% by 2050, the policy landscape is at a turning point. The event offered a valuable forum to explore emerging policy priorities, hear diverse perspectives, and reflect on how we, as a society, can better support older Americans today and in the decades ahead. Dr. William Knight (Health Policy Fellow) and Taylor Turner, MPH As the aging population expands, so does the need for coordinated, forward-thinking policies that can meet the evolving needs of older adults. Aging is not a siloed issue, it intersects with many other issues including disability, caregiving, and long-term care. The longer we live, the more likely we are to experience disability, rely on support systems, and engage with complex care networks. This reality presents an opportunity for policymakers and stakeholders to build systems that are interconnected, efficient, and rooted in dignity. This gathering came on the heels of two significant developments in federal aging policy: the restructuring of the Administration for Community Living (ACL) and the reauthorization of the Older Americans Act. Earlier this year, the U.S. Department of Health and Human Services (HHS) announced plans to dissolve the functions of the ACL into the newly created Administration for Children, Families, and Communities, the Office of the Assistant Secretary for Planning and Evaluation (ASPE), and the Centers for Medicare & Medicaid Services (CMS).  The OAA has been reauthorized several times to reflect the evolving landscape of aging in America. Most recently reauthorized in 2020, the bill was slated to be reauthorized in 2024, but was not included in the end of year Continuing Resolution (CR) in December 2024; therefore,  it is again under consideration by the 119th Congress. On June 18, 2025, Senator Bill Cassidy (R-LA) introduced S.2120 – Older Americans Act Reauthorization Act of 2025, with strong bipartisan backing, which proposes reauthorizing the OAA through fiscal year 2030 and includes key provisions to strengthen health outcomes, expand support for caregivers, improve services for Native elders, and bolster the long-term care ombudsman program Reflections from the Alliance for Health Policy’s Aging in America Summit The Aging in America Summit underscored the urgent need to align policy innovation with real-world service delivery. While advances in technology and care models are helping older adults live more independently, policy and funding structures, particularly the disconnect between Medicare and Medicaid, often lag behind. Improving coordination between these systems could significantly reduce care gaps, improve outcomes, and lower costs for the growing number of dually eligible older adults. A clear takeaway from the summit was the widespread desire among older adults to age in place, remaining in their homes and communities rather than transitioning into institutional settings. Yet, this vision requires far more than just intent. It demands investment in housing, transportation, home and community-based services (HCBS), technology, and a well-supported care workforce. Ensuring aging in place is an option for everyone, not just those with personal resources, will require meaningful federal and state policy shifts and stronger cross-sector collaboration. Long-term care was another focal point. As demand grows, states like Washington are exploring new models, such as the Long-Term Care Trust Act, which uses a payroll tax to fund future care services. Programs like this show how states can proactively address long-term care affordability and planning, challenges that will only intensify as our population ages. The summit also highlighted the essential role of caregivers, both paid and unpaid. Many family caregivers juggle work, financial pressures, and their own health needs, often with limited support. Expanding training, financial assistance, and mental health resources for caregivers is not just supportive, it is foundational to an aging system that works. With more older adults also stepping into caregiving roles themselves, policies must reflect the full spectrum of caregiving experiences. Ultimately, the summit reinforced that aging intersects with nearly every sector of society. It is not just a policy issue, it is a shared opportunity to create systems that promote dignity, autonomy, and equity in aging. The conversations sparked at this event laid a strong foundation, and I am hopeful about the momentum they will build.

By Ryann Hill MPH Last month, I had the pleasure of speaking at the Black Health Connect  Annual Conference here in DC. The panel, titled “What in the Health Policy?!” , brought together policy professionals for a real, grounded conversation about how federal health strategy is shifting and what that means for our work on the ground. I opened by walking through a few key Executive Orders and the broader context behind them. Since taking office, President Trump has signed over 160 executive actions, including several that directly impact health programs and infrastructure. Recent orders have eliminated DEIA offices across federal agencies, instructed departments to shrink or sunset equity programs under the name of efficiency, and paused race-based data collection, limiting agencies’ ability to track disparities. These decisions have been layered on top of deep staffing cuts at HHS, the effects of DOGE, and funding rollbacks across public health and global health programs. At Indigo Hill Strategies, we have been helping clients unpack these shifts, understand the implications, and recalibrate their strategies in real time. During the discussion, I was asked how organizations should engage this administration. My guidance was simple: be specific, be strategic, and stay steady. Broad messaging won’t move policy right now. Instead, focus on aligning your message with current agency or congressional priorities. Use the language that resonates with decision-makers. Point out problems, but always offer a solution that fits within the current policy framework. And bring partners to the table. We also talked about what resilience looks like in a moment like this. I shared that for me, it’s about relationships, relevance, and repetition. Who are your trusted partners? Is your message still timely? Are you showing up consistently? Advocacy work isn’t always headline-grabbing. Sometimes the most important work happens quietly, in the rooms where decisions are made, with people who refuse to back down. Indigo Hill Strategies helps clients build that kind of presence—long-term, consistent, and grounded in real impact. On coalition building, I shared a reminder that strong coalitions don’t require uniformity. They require clarity and alignment. The most effective coalitions are the ones that agree on a clear goal, use a mix of tactics inside and outside government, and know who is responsible for what. Whether we’re supporting a national nonprofit, a grassroots movement, or a cross-sector alliance, Indigo Hill Strategies focuses on getting our clients into position to lead, contribute, and win. Whether you are responding to new policy, building a coalition, or preparing for a critical meeting on the Hill, our team is here to help you lead with strategy and purpose. The landscape may be evolving, but your work still matters—and the right strategy can make it count. Ryann D. Hill, MPH Founder and CEO Indigo Hill Strategies

By Dr. William Knight, PT, DPT, SPH, CSCS and Niyahnee Thomas On July 30, 1965, President Lyndon B. Johnson signed into law the Social Security Amendments of 1965, establishing two groundbreaking federal programs: Medicare and Medicaid. The legislation created the first broad-based public health insurance programs in U.S. history, dramatically expanding access to care for older adults, people with disabilities, and individuals with low incomes. Today, Medicare and Medicaid remain foundational pillars of the American healthcare system. A Landmark in Health Policy History President Johnson signed the Medicare and Medicaid Act in Independence, Missouri, with former President Harry Truman by his side. The moment was both symbolic and transformative. At the time, fewer than half of Americans aged 65 or older had health insurance, leaving them to shoulder the cost of prescriptions and other care services alone. Medical expenses often placed care out of reach for older adults and low-income individuals, making basic medical necessities inaccessible to the people who needed them most. The law was created: Medicare , a federal health insurance program for people aged 65 and older, was later expanded to include those under 65 with qualifying disabilities and end-stage renal disease Medicaid , a joint federal and state program that historically only provided health insurance to individuals eligible for Aid to Families with Dependent Children (AFDC) or federal Supplemental Security Income (SSI) and has evolved to provide health coverage for eligible low-income individuals and families, children, and people with disabilities Decades of Program Expansion and Innovation Over the past six decades, Medicare and Medicaid have grown to cover more than 150 million Americans. Key milestones include: Medicare Advantage (Part C), created in 1997 to offer beneficiaries health insurance through private insurance companies approved by Medicare Children's Health Insurance Program (CHIP), signed into law in 1997 to provide health insurance to children in families with incomes too high to qualify for Medicaid, but can’t afford health insurance Medicare Part D, introduced in 2003 to provide prescription drug coverage Medicaid Expansion, enabled by the Affordable Care Act in 2010, which allowed states to cover more low-income adults, improving access to care, especially in underserved communities Both programs have also become central to long-term services and supports, behavioral health care, maternal health services, and coverage for people living with disabilities. How the “One Big Beautiful Bill” Is Affecting Medicare and Medicaid In July 2025, President Donald Trump signed into law the “ One Big Beautiful Bill ,” a budget and tax package passed through the reconciliation process. Among its many provisions are significant changes to Medicare, Medicaid, and other health and safety net programs. The Act introduces several modifications to Medicare, Medicaid, and various other health safety net initiatives. Key components of the bill include: Reductions in Medicaid spending by over $900 billion over ten years, with new work requirements for certain adults, shortened eligibility review timelines, and reduced funding for providers such as Planned Parenthood. Experts have projected that these changes may result in loss of coverage for up to 11 million Medicaid enrollees, with higher loss of eligibility in states that have not expanded Medicaid Automatic cuts to Medicare under pay-as-you-go rules, potentially totaling 500 billion dollars over the next decade, unless Congress intervenes Creation of a 50 billion dollar emergency fund to support rural hospitals Supporters of the bill praise the bill’s aims to reduce federal deficits, strengthen incentives for employment, and eliminate waste in government spending, while critics worry about the impact on vulnerable populations and the long-term viability of the health care safety net. The full impact of the legislation will depend on how states implement new federal guidance and whether additional changes are made in upcoming appropriations bills. The Rising Cost of Healthcare Beyond the new legislation, Medicare continues to face long-term financial pressures. According to the Hospital Insurance Trust Fund, Medicare Part A,  is projected to become insolvent in the next decade, prompting policy discussions around potential solutions such as drug pricing reform, adjustments to payroll tax caps, and changes to provider payment formulas. Similarly, states are actively reevaluating Medicaid eligibility in the face of rising healthcare costs, with millions of Americans at risk of losing coverage. Many states are pursuing delivery system reforms to improve outcomes and reduce costs, including value-based payment models, integrated care coordination, and expanded access to community-based services to ensure those insured remain covered. The Importance of Medicaid and Medicare Sixty years after their creation, Medicare and Medicaid continue to represent the nation’s commitment to protecting access to care for those most in need. The programs provide coverage to older adults, children, individuals with disabilities, and low income individuals. As health care costs rise, demographics shift, and political debates intensify, the importance of these programs has only grown. The 60th anniversary is not just a time to look back, but a moment to look forward to protecting and improving these vital programs for future generations. References Centers for Medicare & Medicaid Services. (n.d). Centers for Medicare & Medicaid Services Data. https://data.cms.gov/fact-sheet/cms-fast-facts Congressional Budget Office. (2024).  The budget and economic outlook: 2024 to  2034 .  https://www.cbo.gov/publication/59710 Kaiser Family Foundation. (2024).  10 things to know about  Medicaid .  https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid/ Kaiser Family Foundation. (2024, May 28). Medicaid 101 . https://www.kff.org/health-policy-101-medicaid/?entry=table-of-contents-how-has-medicaid-evolved-over-time National Archives. (n.d.).  Medicare and Medicaid Act  (1965) .  https://www.archives.gov/milestone-documents/medicare-and-medicaid-act Washington Post. (2025, July 1).  What Trump’s “Big Beautiful Bill” means for Medicaid,  Medicare, and the future of American health care .  https://www.washingtonpost.com/health/2025/07/01/trump-big-beautiful-bill-health-care-medicaid-impacts/

By Taylor Turner, MPH Director of Federal Affairs Today, July 14, 2025, marks the 60th anniversary of the Older Americans Act (OAA)—a landmark law signed by President Lyndon B. Johnson in 1965. At a time when there were few formal programs addressing the needs of older adults, the OAA was a significant step forward in recognizing and supporting the right of older Americans to age with dignity, health, and independence in their communities. [i] Background The Older Americans Act emerged in response to growing national concern about the lack of accessible social services and supports for the nation’s aging population. [ii]  As the number of older adults increased, it became clear that better infrastructure and resources were needed to support this group. The law created a framework for delivering services through grants to states, supporting community planning, social services, research and demonstration projects, and training in the field of aging. [iii]   From the onset, the OAA does not impose strict income eligibility requirements, unlike Medicaid. Instead, it was designed to serve individuals aged 60 and older, with a focus on those facing the greatest economic and social challenges. Instead, services are targeted to older adults living below the poverty line and those experiencing non-economic challenges such as disabilities, language barriers, or social, cultural, or geographic isolation that limits their ability to live independently. [iv] The law also created the Administration on Aging (AoA), which was charged with overseeing these programs and serving as the federal focal point for issues affecting older Americans. Over the decades, the OAA has been reauthorized multiple times, with updates that expanded and strengthened the services offered. [v]  The AoA’s mission and operations were housed under the Administration for Community Living (ACL), which oversaw the delivery of OAA services through a robust national network: 56 State Units on Aging (SUAs), more than 600 Area Agencies on Aging (AAAs), 281 tribal organizations, 1 Native Hawaiian organization representing 400 tribes, and nearly 20,000 community-based service providers. [vi] Programs and Services Under the OAA The majority of OAA funding falls under Title III of the Act, which supports a broad array of state and local programs, including transportation, case management, homemaker and personal care assistance, adult day care, and legal aid. Nutrition is a major focus: the OAA funds both home-delivered and congregate meals, including through well-known programs like Meals on Wheels. It also invests in evidence-based health promotion and disease prevention. [vii]   To respond to changing community needs, states have flexibility to transfer funds among its Title III programs to address local needs. State Units on Aging (SUAs) may transfer up to 40% of funds between congregate and home-delivered meal programs, with the possibility of an additional 10% transfer pending federal approval. Additionally, SUAs may move up to 30% of funds between these nutrition programs and supportive services. However, states must retain control over these transfers and cannot delegate authority to Area Agencies on Aging (AAAs) or other entities.  [viii] The law also played a critical role in supporting caregivers. Nearly half of all caregivers are over the age of 50 and face increased risks to their own health and well-being. The OAA addresses these needs though programs such as the National Family Caregiver Support Program and the Lifespan Respite Care Program, which provide counseling, respite care, training, and other vital supports. [ix] In fiscal year 2023 alone, OAA Title III programs provided over 180 million home-delivered meals, more than 2 million hours of case management, homemaker, and personal care services, and assisted nearly 800,000 caregivers. [x] The reach of these programs is particularly significant for underserved communities, as nearly 40% of those receiving select OAA services in 2023 were living in poverty, 33% were people of color, and 29% resided in rural areas.  [xi] Additionally, the OAA funds critical services such as elder abuse prevention and the Long-Term Care Ombudsman program, which advocates for residents in nursing homes and other long-term care settings. [xii] A Restructuring in Aging Policy In March 2025, the Department for Health and Human Services (HSS) announced a major departmental restructuring that could reshape the federal landscape foraging policy. Under the plan, the ACL is slated to be dissolved, with its functions integrated into the newly established Administration for Children, Families, and Communities [TT1]  , the Office of the Assistant Secretary for Planning and Evaluation (ASPE), and the Centers for Medicare and Medicaid Services (CMS). [xiii] While the goal is improved coordination across age groups and services, this [TT2]   proposed shift has raised concerns among stakeholders about how aging services will be prioritized and coordinated in the absence of a standalone agency focused exclusively on older adults. Reauthorization of the OAA The Older Americans Act (OAA) has been reauthorized multiple times to reflect the evolving needs of older adults, with the most recent reauthorization occurring in 2020. In the current 119th Congress, the OAA was reintroduced as S.2120 – Older Americans Act Reauthorization Act of 2025 on June 18, 2025, by Senator Bill Cassidy (R-LA). The bill has strong bipartisan support with cosponsors including Senators Bernie Sanders (I-VT), Rick Scott (R-FL), Kirsten Gillibrand (D-NY), Susan Collins (R-ME), Tim Kaine (D-VA), Markwayne Mullin (R-OK), Ed Markey (D-MA), Lisa Murkowski (R-AK), and Ben Ray Luján (D-NM). [xiv] S.2120 proposes reauthorization of the OAA through fiscal years 2026–2030, and includes provisions to enhance health outcomes, support family caregivers, improve services for Native elders, and strengthen the long-term care ombudsman program, among other reforms. It also proposes funding innovations like medically tailored meals and improvements to multipurpose senior centers. Looking Ahead As the U.S. population continues to age, with the U.S. Census Bureau predicting that older adults—ages 65 and older—are expected to outnumber children by 2029,  [xv] the relevance and importance of the OAA will only grow. Over the past 60 years, the Act has evolved from a pioneering idea into a cornerstone of American aging policy. Its continued reauthorization and modernization will be essential to ensuring that older adults and their caregivers can thrive in their communities with the dignity, support, and opportunity they deserve. At Indigo Hill Strategies, we are proud to partner with organizations working to advance the goals of the Older Americans Act—expanding access to essential services, supporting family caregivers, and ensuring that aging policies reflect the realities and dignity of today’s older adults. As the aging landscape evolves, we remain committed to helping our clients shape and strengthen the systems that support aging well. [i]  USAging. Older Americans Act. N.d. Accessed July 12, 2025. https://www.usaging.org/olderamericansact [ii]  Meals on Wheels America. The Older Americans Act. Updated January 2023. Accessed July 12, 2025. https://www.mealsonwheelsamerica.org/wp-content/uploads/2023/01/the-older-americans-act-overview_jan2023_final-1.pdf [iii]  Administration for Community Living. Older Americans Act. Updated on February 13,2025. Accessed July 12, 2025. https://acl.gov/about-acl/authorizing-statutes/older-americans-act [iv]  Colello, K.J.  & Napili, A. Congress.gov . Older Americans Act: Overview and Funding. May 6, 2024. Accessed July 12, 2025. https://www.congress.gov/crs-product/R43414 [v]  USAging. Old Americans Act Reauthorization Toolkit. 2016. Accessed July 12, 2025. https://www.usaging.org/files/Key%20Milestones%20through%202016%20final%20text%20FINAL.pdf [vi]  Administration for Community Living. Older Americans Act. Updated on February 13,2025. Accessed July 12, 2025. https://acl.gov/about-acl/authorizing-statutes/older-americans-act [vii]  Freed, M, Cubanski J, & Neumann T. Kaiser Family Foundation. What to Know About the Older Americans Act and the Services it Provides to Older Adults. June 3, 2025. Accessed July 12, 2025. https://www.kff.org/medicare/issue-brief/what-to-know-about-the-older-americans-act-and-the-services-it-provides-to-older-adults/ [viii]  Colello, K.J.  & Napili, A. Congress.gov . Older Americans Act: Overview and Funding. May 6, 2024. Accessed July 12, 2025. https://www.congress.gov/crs-product/R43414 [ix] Administration for Community Living. Support to Caregivers. Modified November 21, 2024. Accessed July 12, 2025. https://acl.gov/programs/support-caregivers [x]  Freed, M, Cubanski J, & Neumann T. Kaiser Family Foundation. What to Know About the Older Americans Act and the Services it Provides to Older Adults. June 3, 2025. Accessed July 12, 2025. https://www.kff.org/medicare/issue-brief/what-to-know-about-the-older-americans-act-and-the-services-it-provides-to-older-adults/ [xi]  Freed, M, Cubanski J, & Neumann T. Kaiser Family Foundation. What to Know About the Older Americans Act and the Services it Provides to Older Adults. June 3, 2025. Accessed July 12, 2025. https://www.kff.org/medicare/issue-brief/what-to-know-about-the-older-americans-act-and-the-services-it-provides-to-older-adults/ [xii]  Freed, M, Cubanski J, & Neumann T. Kaiser Family Foundation. What to Know About the Older Americans Act and the Services it Provides to Older Adults. June 3, 2025. Accessed July 12, 2025. https://www.kff.org/medicare/issue-brief/what-to-know-about-the-older-americans-act-and-the-services-it-provides-to-older-adults/ [xiii] U.S. Department of Health and Human Services. HHS Announces Transformation to Make America Healthy Again. March 27, 2025. Accessed Just 12, 2025. https://www.hhs.gov/press-room/hhs-restructuring-doge.html#:~:text=Reorganization%20of%20the%20Administration%20for,and%20Medicaid%20Services%20(CMS) . [xiv]   Congress.gov . S.2120 - Older Americans Act Reauthorization Act of 2025. June 18, 2025. Accessed July 12, 2025. https://www.congress.gov/bill/119th-congress/senate-bill/2120/text [xv]  Vespa J, Armstrong D.M., & Medina L. United States Census Bureau. Demographic Turning Points for the United States: Population Projections for 2020 to 2060. February 202. Accessed July 12, 2025. https://www.census.gov/library/publications/2020/demo/p25-1144.html#:~:text=Beginning%20that%20year%2C%20all%20baby,population%20from%202020%20to%202060 .