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 .