GAO

United States General Accounting Office

Report to Congressional Requesters

August 2000 FOOD ASSISTANCE

Options for Improving 

Nutrition for Older 

Americans

GAO/RCED-00-238

Page 1 GAO/RCED-00-238 Nutrition Assistance for Older Americans

Contents

Letter 3

Appendixes Appendix I: Objectives, Scope, and Methodology 22

Appendix II: Results of Telephone Survey of State Food

Stamp Directors 24

Appendix III: Food Stamp Program 35

Appendix IV: Elderly Nutrition Program 40

Appendix V: Commodity Supplemental Food Program 42

Appendix VI: Child and Adult Care Food Program 45

Appendix VII: GAO Contacts and Staff Acknowledgments 47

Tables Table 1: Distribution of Elderly Food Stamp Households by State, 

Fiscal Year 1998 37

Table 2: Characteristics of Older Persons Who Are Eligible for Food 

Stamps 39

Table 3: Characteristics of ENP Participants Compared With the

General Elderly Population 41

Table 4: Maximum Monthly Distribution Rates for Older Persons

and Certain Other Participants 43

Table 5: Characteristics of CACFP Adult Participants 46

Figures Figure 1: Distribution of Food Stamp Benefits for Elderly

Households, Fiscal Year 1998 12

Figure 2: Participation Rates and Major Food Stamp Program 

Legislation 18

Figure 3: Sample Food Stamp Allotment Calculation 36
Contents

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Abbreviations

CACFP Child and Adult Care Food Program

CSFP Commodity Suppemental Food Program

ENP Elderly Nutrition Program

HHS U.S. Department of Health and Human Services

USDA U.S. Department of Agriculture

SSI Supplemental Security Income
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United States General Accounting Office

Washington, D.C. 20548

Resources, Community, and

Economic Development Division

B-285169 Letr

August 17, 2000

The Honorable Charles E. Grassley

Chairman

The Honorable John B. Breaux

Ranking Member

Special Committee on Aging

United States Senate

Many older persons cannot consistently obtain a nutritious diet, 

particularly if their income is near the poverty level. In 1998, about 1.6 

million to 2 million households with individuals age 60 and older (elderly 

households) reported that they did not have enough of the right types of 

food needed to maintain their health or simply did not have enough to eat.1

Lack of money was the underlying reason these households were unable to 

obtain a sufficient quantity of food or had to reduce the quality of their 

food. In some cases, older persons are forced to choose between buying 

food or paying for medicine, utilities, or other needed items.

To address these problems, the Congress has authorized a number of 

programs to help provide nutrition assistance to low-income households, 

including those with older persons. You asked us to look at four of these 

programs. The Food Stamp Program provides benefits that can be used to 

purchase food at participating retail food stores. The Child and Adult Care 

Food Program (CACFP) and the Elderly Nutrition Program (ENP) provide 

prepared meals in a number of different settings. The CACFP serves 

participating day care facilities, while the ENP serves senior persons in 

group settings, such as senior centers, and offers home-delivered meals. 

Finally, the Commodity Supplemental Food Program (CSFP) supplies 

federally donated foods to participants. However, many older persons do 

not take advantage of these programs, according to studies by government 

agencies and others. 

Concerned about limited participation, you asked us to (1) determine why 

some older persons do not use these programs and (2) identify strategies 

that could be used to increase participation in these programs. To address 

1

Food Security Supplement to the Current Population Survey, U.S. Bureau of the Census, 

August 1998.
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these questions, we examined, among other things, available documents 

and studies discussing nutrition assistance for older persons and met with 

officials from the federal agencies principally responsible for administering 

these programs—the U.S. Department of Health and Human Services’ 

(HHS) Administration on Aging and the U.S. Department of Agriculture’s 

(USDA) Food and Nutrition Service. For the largest of these programs, the 

Food Stamp Program, we conducted a telephone survey of the directors of 

the 51 state agencies responsible for administering the program at the state 

level.2

 Appendix I discusses our scope and methodology in detail, and 

appendix II presents the results of the survey of state food stamp directors. 

Results in Brief Older persons do not participate in federal food assistance programs for 

many reasons. Some of these reasons cut across programs. For example, 

older persons are often reluctant to accept food assistance because they 

believe such acceptance would compromise their independence. 

Additionally, some older persons associate accepting food assistance with 

welfare, which many older persons view negatively. Furthermore, funding 

constraints limit participation in several of the programs (for example, the 

Commodity Supplemental Food Program is available in only 22 states and 

the District of Columbia). Moreover, older persons’ lack of awareness of 

the availability of programs and problems with access to transportation 

hinder participation in several of the programs. Other problems, however, 

are more program-specific. For example, all state food stamp directors told 

us some eligible older persons believe the burden of applying for food 

stamps outweighs the expected low benefits. Finally, unlike the other 

programs, the Child and Adult Care Food Program is limited in the benefits 

it provides to senior citizens because a limited number of facilities 

participate in the program. 

Program officials, providers, and advocacy groups have identified a 

number of actions that might increase older persons’ participation in 

nutrition assistance programs. In some instances, the options suggested 

would likely require a large infusion of resources. For example, nearly all of 

the state food stamp directors endorsed increasing the minimum benefit 

level from $10 to $25 per month. We estimate that the annual cost of this 

increase in Food Stamp Program benefits would be about $102 million for 

older persons who currently participate and could increase participation 

2

Including the District of Columbia; does not include Guam and the U.S. Virgin Islands. 
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resulting in additional annual costs of about $26 million. Similarly, Elderly 

Nutrition Program providers and officials administering the Commodity 

Supplemental Food Program suggested that additional funding is needed to 

expand both programs to serve more people. At this time, neither the Food 

and Nutrition Service nor the Administration on Aging has estimated the 

additional cost that might result if more people were attracted to these 

programs. Other suggestions are not likely to be as costly. For example, 

state food stamp directors endorsed proposals to simplify the application 

process, such as automatically making older persons eligible for food 

stamps when they are approved for other means-tested programs, such as 

Medicaid. (Older persons receiving Supplemental Security Income are 

automatically eligible for food stamp benefits). Additionally, program 

providers in the Commodity Supplemental Food Program have suggested 

service improvements by, for example, providing a greater variety of foods 

and smaller packaging sizes. For the Child and Adult Care Food Program, 

officials noted that, in general, expanding participation depends on 

increasing the number of adult care facilities in the program. 

Background Individuals who are 60 years of age and older represent about 17 percent of 

the total U.S. population but are expected to increase to about 25 percent 

by the year 2025. Adequate nutritional intake is essential for optimal 

physical and mental activity and can help maintain the health and 

emotional independence of older persons. Conversely, poor nutrition can 

contribute to or exacerbate chronic and acute diseases, hasten the 

development of degenerative diseases associated with aging, and delay 

recovery from illness. Concerns have been raised about the nutrition of 

older persons and whether their households have enough of the right kinds 

of foods or have sufficient quantities of food to maintain their health and 

well-being. 

Of the approximately 1.6 million to 2 million elderly households that 

experienced problems in obtaining a sufficient amount or quality of food in 

1998, about 1 million to 1.2 million, or 60 percent of these households, were 

low-income, and approximately 500,000 to 660,000 reduced their food 

intake to the point that they experienced hunger.3

 A lack of financial 

3

Low-income households are those with average monthly income up to 130 percent of the 

Federal Poverty Income Guidelines, referred to as the poverty level. The Guidelines are 

updated annually.
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resources was the reason that all of these elderly households experienced 

problems in obtaining a sufficient amount or quality of food. 

Food Stamp Program The Food Stamp Program is by far the largest of the four programs serving 

older persons in both the numbers of participants and cost. It had an 

average monthly participation of 1.5 million elderly households in 1998, 

spending about $1 billion in benefits for these households. According to the 

Food and Nutrition Service, the average monthly benefit for elderly 

households is $59. The program provides participants with food coupons or 

electronic benefit transfer cards that can be used in authorized retail stores 

to purchase food items.4

 Older persons may also use these benefits, if they 

so choose, as a donation towards their meals at ENP sites. In some areas 

they may also use these benefits to purchase low-cost meals at authorized 

restaurants. ENP program officials told us that the use of food stamp 

benefits by older participants at sites serving group meals or for homedelivered meals, while never extensive, has decreased even more with the 

advent of electronic benefit transfer cards. This is because it is costly to 

install electronic benefit transfer equipment at sites serving group meals 

and administratively burdensome to use paper vouchers as an alternative 

to electronic benefits for home-delivered meals. 

The Food and Nutrition Service administers the Food Stamp Program 

through agreements with state agencies, which conduct day-to-day 

operations. The federal government pays all of the benefit costs and nearly 

one-half of the administrative costs for each state. 

See appendix III for more detailed information on the Food Stamp 

Program, including special provisions for older persons and the method 

used to calculate benefits.

Elderly Nutrition Program ENP provides grants and meal subsidies to state agencies on aging to 

support meals for older persons in group settings and delivered to 

participants’ homes. Administered by the Administration on Aging, the 

program is designed to address problems of dietary inadequacy and social 

4

 As of May 2000, 41 states, including the District of Columbia, have operational on-line food 

stamp electronic benefit transfer systems (37 statewide). The Personal Responsibility and 

Work Opportunity Reconciliation Act of 1996 requires that all states switch to electronic 

benefit issuance for food stamps by October 2002.
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isolation among older persons. Meals served in ENP must meet nutrition 

standards, including one-third of the recommended dietary allowances 

established by the Food and Nutrition Board of the National Academy of 

Sciences, as well as the dietary guidelines for Americans. While the 

program does not include means testing, it targets its services to older 

people having the greatest economic or social need, with special attention 

given to low-income minorities. For example, 16 percent of home-delivered 

meal participants were low-income minorities, while 4 percent of the 

overall U.S. population aged 60 and over were low-income minorities. In 

administering the group meal program, state agencies must ensure that 

sites are in close proximity to areas where most participants reside. 

The Administration on Aging estimated that ENP served about 244 million 

meals in fiscal year 1998. An estimated 130 million, or 53 percent, of these 

meals were home-delivered. This represents an approximate 11 percent 

increase in home-delivered meals as a percentage of total ENP meals since 

1990. During this same period, the number of meals served in group 

settings decreased by about 20 percent. Organizations providing these 

meals, such as senior centers and religious facilities, provide nutrition 

education in addition to meals. They can also receive support from other 

sources, such as local governments, as well as donated food and supplies, 

private donations, and voluntary contributions from participants.

In addition to providing meals, the program has as a goal increasing 

socialization opportunities for its participants. For participants receiving 

meals in a group setting, such contacts usually involve considerable social 

interaction. In contrast, for persons receiving home-delivered meals, social 

interactions tend to be much shorter, but volunteers who deliver meals to 

older persons are encouraged to spend some time with the recipients and 

to check on their welfare. 

See appendix IV for more detailed information on ENP.

Commodity Supplemental 

Food Program

CSFP provides free boxed and canned food (such as juice, canned 

vegetables and meat, and powdered milk) and nutrition education to lowincome participants, including older persons. Older participants must have 

a household income at or below 130 percent of the poverty level. The state 

may also impose residency requirements. 

CSFP participants pick up their food, generally once a month, from 

distribution centers, which are in locations accessible to low-income 
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people, such as community centers or churches. Older participants who 

cannot pick up their food can designate a representative to do so; in some 

locations volunteers deliver food to older participants who are unable to 

get to the distribution center. Currently, the program operates in 22 states, 

including 5 that joined the program in January 2000, as well as in the 

District of Columbia and on the Red Lake (Minnesota) and Pine Ridge 

(South Dakota) Indian Reservations. According to the Food and Nutrition 

Service, with the exception of Nebraska, none of the participating states 

provides CSFP coverage statewide. In most of the participating states, the 

program operates in parts of the state; for example, in Illinois, the program 

operates in only one county. For fiscal year 2000, $88.3 million was 

appropriated for CSFP. In fiscal year 1999, about 71 percent of those 

enrolled in this program were older (about 270,000 of the total enrollment 

of almost 382,000 people). 

See appendix V for more detailed information on CSFP.

Child and Adult Care Food 

Program

Any person 60 years of age or older, and any person 18 years of age or older 

who has a functional impairment, such as a mental disability, and attends a 

nonresidential day care facility can qualify to participate in CACFP.5

 The 

participating care facility must be licensed or approved by the state. The 

program provides meal reimbursements to the day care facility according 

to the number of meals served and the income level of program 

participants. For example, during the period from July 1, 1999, to June 30, 

2000, for participants from families with incomes at or below 130 percent 

of the poverty level, the day care facility received a reimbursement of $1.09 

for breakfast, $1.98 for lunch or supper, and $0.54 for a snack. Participating 

CACFP facilities cannot receive reimbursement for more than two meals 

and one snack or one meal and two snacks for each adult in a single day. 

The Food and Nutrition Service does not maintain statistics only for 

participants aged 60 or older in this program. However, according to the 

Service, in fiscal year 1999, average daily participation by all adults aged 18 

or over was about 62,500. The number of adult day care facilities 

participating in CACFP grew from 1,222 in fiscal year 1993 to 1,855 in fiscal 

year 1999, an increase of almost 52 percent. In fiscal year 1999, the Child 

5

Adults aged 60 and over can live in a group setting outside of their homes or in a group 

living arrangement on less than a 24-hour basis.
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and Adult Care Food Program received $1.6 billion in federal funds for both 

the child and adult care components of the program. 

See appendix VI for more detailed information on the CACFP.

Multiple Reasons for 

Older Persons 

Nonparticipation in 

Nutrition Assistance 

Programs

A number of reasons account for older persons’ nonparticipation in federal 

nutrition assistance programs, according to program officials, providers, 

and advocacy groups. Some reasons cut across programs, such as the belief 

that accepting food assistance would compromise their independence and 

the constraints on funding, which contribute to waiting lists for ENP homedelivered meals or limit the range of CSFP services. Other reasons are 

associated with a particular program, such as the perceived burdensome 

application procedure for food stamps or a shortage of licensed adult care 

facilities participating in CACFP. 

Some Reasons for 

Nonparticipation Are 

Common to the Food 

Assistance Programs 

According to the Food and Nutrition Service, the Administration on Aging 

and our interviews with state officials and local providers, a number of 

factors inhibit older persons’ participation in food assistance programs. 

Reluctance to Accept Food 

Assistance

Chief among many older persons’ reasons for not participating in food 

assistance programs is their reluctance to accept food assistance because 

they take pride in their independence and believe that such assistance 

would compromise that independence. For example, according to a 1996 

Urban Institute evaluation of ENP, 86 percent of older Americans eligible 

for, but not participating in, the ENP home meal program said that they did 

not believe they needed the program, even though about 35 percent of 

these people had shown one or more signs of inadequate food intake in the 

previous 6 months. In addition, some older persons associate the 

acceptance of food assistance with welfare, which many older persons 

view negatively.

Funding Limitations Constrain 

Increased Participation in 

Programs

Funding limitations also constrain participation in several of the food 

assistance programs. For example, according to the Urban Institute study, 

many older people who would like to participate in ENP cannot because 

the providers have reached their capacity to serve or deliver meals. Fortyone percent of the providers delivering meals to recipients at home and 9 

percent of group meal providers reported having waiting lists. One provider 
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told us that it currently has a waiting list of 400 for ENP meals, while 

another provider has a list of 100. According to the Urban Institute study, 

the size of these waiting lists suggests a considerable unmet need among 

older persons for ENP nutrition assistance. Furthermore, officials believe 

that the degree of unmet need may be understated because many nutrition 

programs with unmet needs for services do not maintain waiting lists. 

Additionally, according to a 1999 HHS-sponsored study, the unmet need will 

grow as the number of older persons increases, particularly the group aged 

85 and over, which is the fastest growing part of the older population. The 

study concludes that more older persons are likely to receive long-term 

care in their homes, thereby increasing future demand for home-delivered 

meals. 

According to the president of one of the organizations representing ENP 

providers, some providers have transferred funds for group meals to 

supplement funding for program services and home deliveries. The 

president said the net result has been a “severe erosion of the congregate 

meal program.” Even though they are transferring funds from the 

congregate program, providers continue to face unmet needs in the home 

delivery program, according to the ENP providers we contacted. 

Further expansion of CSFP to more counties in participating states or into 

additional states is also constrained by funding limitations, according to 

USDA. Federal funding for fiscal year 1999 represented an increase of less 

than 2 percent from the level in fiscal year 1995. During the same period, 

participation by older persons in CSFP increased from about 200,000 in 

1995 to about 270,000 in 1999, a 35-percent increase. During this same 

period, the number of women, infants, and children in CSFP decreased 

from about 164,000 to about 112,000, a 32-percent decrease, which was 

primarily due to increased participation in the Special Supplemental 

Nutrition Program for Women, Infants, and Children.

Several of the state food stamp directors we surveyed cited the lack of 

available state resources as constraining them from expanding outreach 

efforts. For example, they lack resources for developing and distributing 

literature about the Food Stamp Program targeted to older persons or 

locating food stamp employees to certify eligibility in places that would be 

more accessible to older persons. 

Lack of Awareness of Programs 

Deters Older Persons’ 

Participation

Studies of ENP and other nutrition assistance programs indicate that while 

older persons are vaguely aware that programs are available to meet their 

needs, their understanding of the program services provided, as well as 
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where and how to apply, may be unclear. For example, according to the 

president of an ENP provider organization, lack of program awareness is a 

primary reason older persons do not participate. Similarly, for CSFP, the 

providers we contacted told us that this lack of program awareness, as well 

as the perceptions of a burdensome application process, limit program 

participation. Furthermore, some older persons mistakenly believe that if 

they enroll in the Food Stamp Program, they will not be eligible to 

participate in other nutrition assistance programs. Many are also reluctant 

to apply for food stamps because they believe they will only receive a small 

monthly benefit. 

Many Older Persons Lack 

Transportation

Finally, older persons may not be able to participate in food assistance 

programs because they either do not have access to transportation, 

particularly in rural areas, or because they are physically unable to leave 

their home to go to locations where assistance is available. For example, in 

rural areas, many older persons depend on others for transportation and 

may not want to impose on their families and friends for transportation to 

apply for benefits in government offices, which may involve multiple trips, 

and to receive food assistance benefits at, for example, distribution 

centers. 

Program-Specific Reasons 

for Nonparticipation by 

Older Persons

In addition to the reasons for nonparticipation that are common to several 

programs, we identified reasons that appear to be unique to some 

programs. 

Food Stamp Program According to a USDA estimate, only about 30 percent of elderly persons 

who were eligible for food stamps in 1997 participated in the program. In 

contrast, about 63 percent of all eligible persons participate in the program. 

Food stamp officials in the 51 states we surveyed said that some older 

persons believe the burden of applying for food stamps outweighs the 

expected benefits. For example, to calculate a food stamp applicant’s 

monthly allotment amount, using the available shelter and medical 

deductions, the applicant must provide documentation of income, 

rent/mortgage and utility expenses, and medical expenses. Applicants may 

also have to provide information on their assets.6

 Applicants must also 

6

Assets of households in which all members are receiving Supplemental Security Income 

(SSI), or of individuals receiving SSI are not counted for food stamp purposes.
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discuss with program officials details on their general living arrangements, 

including, for example, who in the household purchases food and prepares 

meals. In one state we examined, the application form for just the Food 

Stamp Program was 15 pages. Participants must go through much of this 

process at least once every 2 years to continue receiving benefits, and 

many may only be eligible for the minimum monthly benefit of $10. 

As shown in figure 1, in fiscal year 1998, about one-quarter of the elderly 

households participating in the Food Stamp Program received the 

minimum monthly benefit of $10 and another 16 percent received a 

monthly benefit ranging from $11 to $25. 

Figure 1: Distribution of Food Stamp Benefits for Elderly Households, Fiscal Year 

1998

Source: Food and Nutrition Service, “Characteristics of Food Stamp Households, Fiscal Year 1998,” 

Mathematica Policy Research, Inc., February 2000.

•21% $10

$11-$25

$26-$50

$51-$100

$101 or higher

26%

16%

16%

21%

21% •

•

•

•

•

Under $25 per month

Over $25 per month
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Additional reasons for the lack of participation in the Food Stamp Program 

that we identified through our survey are discussed in more detail in 

appendix II. 

Commodity Supplemental Food 

Program 

According to the president of a CSFP provider organization and several 

local service providers, older persons do not use CSFP for a number of 

reasons, including the following:

• the program provides a limited variety of foods,

• the food is packaged in sizes that are often too large for older persons 

living in one- to two-person households, 

• a number of the foods provided require too much preparation effort for 

many older persons who have difficulty cooking, and

• the food provided does not meet the needs of many older persons who 

are on restricted diets.

Child and Adult Care Food 

Program

Older persons do not use CACFP, principally because not enough adult day 

care facilities participate, according to program officials. The most recent 

major study of the adult segment of the program reported that these 

facilities do not participate for several reasons.7

 According to the 

Mathematica report, one-third of the directors of nonparticipating facilities 

did not know the program existed. Furthermore, 20 percent of these 

directors said they were not eligible for the program because they were not 

licensed or approved by the state, as required. Finally, 26 percent of the 

nonparticipating directors believed that CACFP requirements for program 

administration were too burdensome, and 12 percent reported that meal 

reimbursement rates were too low. While an insufficient number of these 

facilities participate, program officials noted that the number of 

participating facilities increased by almost 52 percent between fiscal years 

1993 and 1999. 

7

National Study of the Adult Component of the Child and Adult Care Food Program 

(CACFP): Final Report. Prepared by Mathematica Policy Research, Inc., for USDA. October 

15, 1993.
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Options for Increasing 

Older Persons’ 

Participation in 

Federal Nutrition 

Assistance Programs

Some options suggested by program officials, providers, and advocacy 

groups for increasing participation by older persons, would require a large 

infusion of resources, in some instances. Others would not likely require 

significant amounts of additional funding. However, increasing older 

persons’ participation in federal nutrition assistance programs could be 

difficult to achieve. 

Resource-Intensive Options More resources would be needed to increase the participation of eligible 

elderly persons in the Food Stamp Program, ENP, and CSFP, according to 

many state program officials and service providers. For example, for the 

Food Stamp Program, we estimate that the annual cost of increasing the 

minimum benefit from $10 to $25 per month for only elderly households 

currently participating in the program would be about $102 million. 

Moreover, higher benefits would likely increase participation by about 

89,000 elderly households, resulting in additional annual costs of about $26 

million. To arrive at these estimates, we used a model developed by 

Mathematica Policy Research, Inc. for the Food and Nutrition Service to, 

among other things, estimate changes in participation rates and changes in 

program costs.8

 Food Stamp Program officials noted that the $10 minimum 

benefit, which has been in place since 1979, is not always a sufficient 

incentive to overcome the perceived obstacles to participation. 

The Food Stamp Program’s application process could also be simplified by 

having a standard medical deduction. Although such a change could bring 

more older people into the program, it could also be quite costly. Currently, 

elderly persons may deduct medical expenses above $35 per month that are 

not paid by insurance or someone who is not a household member. These 

expenses must be documented, which many elderly persons find difficult 

to do. Instituting a standard medical deduction of $35 for older persons 

would eliminate the documentation now required for the first $35 of these 

expenses, thereby easing older persons’ record keeping burden somewhat 

and simplifying the application process. Eighty-eight percent of the state 

directors thought this was a strategy worth trying. Food and Nutrition 

Service officials told us that—while they have not made any formal 

estimates—implementing a standard medical deduction could significantly 

8

The model generated point estimates rather than ranges with confidence intervals. 

Mathematica verified through duplication the modeling results.
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increase the cost of the program. For example, according to these officials, 

implementing a standard medical deduction of $35, while retaining the 

current medical deduction for elderly households with out-of-pocket 

medical costs over the $35 threshold, could increase program costs by 

about $200 million annually. Using the Mathematica model, we estimate the 

total annual cost of a $35 standard medical deduction would be about $179 

million. Of the $179 million, about $145 million would derive from 

increased benefits to 931,000 elderly households already participating in 

the program. In addition, according to the Mathematica model, the 

standard medical deduction would likely entice another 83,000 elderly 

households into the program, further increasing costs by about $35 million. 

ENP, which operates at full capacity in some areas, would also require an 

infusion of resources to expand service. For example, according to the 

Urban Institute study, 41 percent of home-delivered and 9 percent of group 

meal providers reported having waiting lists for the program. According to 

HHS officials and service providers, additional funding would be needed to 

meet this demand but at this time HHS has not estimated how much 

additional funding would be needed. 

Similarly, additional funding would be needed to expand CSFP. Program 

officials and service providers told us that program expansion, both within 

participating states and into states where it has not yet been established, 

would require more funding but no estimates of this additional funding 

have been prepared. 

Options Not Requiring 

Substantially Higher 

Expenditures

Program officials, providers, and others suggested several improvements to 

program services that could help to increase older persons’ participation in 

the Food Stamp Program and CSFP, but that would not require significant 

amounts of additional funding. For the Food Stamp Program, for example, 

state directors suggested simplifying the application process by 

automatically making older persons eligible for food stamps when they are 

approved for other means-tested programs in addition to SSI, such as 

Medicaid. 

For CSFP, program providers have likewise suggested that in some parts of 

the country they cannot serve all who wish to participate. However, some 

CSFP providers suggested that services could be improved through such 

means as providing a greater variety of foods and smaller, more 

manageable, package sizes.
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Some states have received waivers from the Food and Nutrition Service to 

pilot other approaches to increase elderly participation in the Food Stamp 

Program. For example, in South Carolina, one-person SSI households 

automatically receive a standard food stamp benefit amount based on 

whether or not they receive other unearned income. If these households 

are entitled to a level of benefits higher than this standard amount because 

of high medical expenses or shelter costs, then they have the option of 

applying for food stamps under the standard rules for the Food Stamp 

Program. The Food and Nutrition Service estimates that food stamp 

participation rates among SSI recipients, many of whom are elderly, 

increased in South Carolina from 38 percent to 50 percent from 1994 (a 

year before the program began) to 1998. Other states, including Mississippi, 

New York, Tennessee, and Washington, are planning to start, or have 

expressed interest in starting, a similar program. The Food and Nutrition 

Service has approved waivers for other states to, among other things, 

simplify the application process by instituting a standard deduction for 

utilities and excluding one vehicle from the asset calculation (Montana) 

and reduce the stigma associated with receiving government assistance by 

depositing a cash benefit, instead of food stamp coupons or an electronic 

benefit transfer card, in the bank account of recipients age 65 or older 

(Vermont). 

Finally, Food Stamp Program officials noted that older persons might be 

encouraged to participate in the program if a public education campaign 

was targeted to that population. Such a campaign could emphasize the 

provisions that are in place to make the program more accessible to older 

persons through, for example, using an authorized representative or 

completing the application over the telephone. They added that such a 

campaign might be a relatively inexpensive way to increase participation 

by older persons.

Increasing Elderly 

Participation Will Be 

Difficult

Although program officials agreed that more can be done to increase older 

persons’ participation in food assistance programs, they noted that 

increasing participation will be difficult. For example, in an attempt to 

encourage elderly persons to participate in the Food Stamp Program, the 

Congress has relaxed program requirements over the years in the following 

ways:

• The Food Stamp Amendments of 1979 allowed elderly and disabled 

households to deduct medical expenses over $35 per month from their 

gross income for eligibility purposes and for determining benefits. 
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• The Food Security Act of 1985 raised the asset limit for all elderly 

households to $3,000, while keeping the limit at $2,000 for any 

nonelderly household.

• The Personal Responsibility and Work Opportunity Reconciliation Act 

of 1996 extended the maximum certification period for elderly 

households to 24 months. 

However, as shown in figure 2, despite these and other actions, older 

persons’ participation rates have remained fairly stable since 1977, in 

contrast to the participation rates for all food stamp participants during 

this period. 
B-285169

Page 18 GAO/RCED-00-238 Nutrition Assistance for Older Americans

Figure 2: Participation Rates and Major Food Stamp Program Legislation

In an attempt to increase older persons’ participation, USDA recently 

developed a handbook for state agencies and others on ways to increase 

Participation rates

0%

10%

20%

30%

40%

50%

60%

70%

100%

1976 1978 1980 1982 1984 1986 1988 1990 1991 1992 1993 1994 1995 1996 1997

Year

All persons

Change in the Food and Nutrition Service's methodology for calculating participation rates

Elderly persons

Omnibus Budget 

Reconciliation Act 

of 1981 and Food 

Stamp Amendments 

and Reauthorization 

Act of 1981 

Food Stamp 

Amendments of 

1979 and 1980 

Food Stamp 

Amendments 

of 1982

1985 Food 

Security Act

Farm, Agriculture, 

Conservation, and 

Trade Act of 1990

Amendments to 

Farm, Agriculture, 

Conservation, and 

Trade Act of 1991 

Food Stamp 

Act of 1977

Personal 

Responsibility 

and Work 

Opportunity 

Reconciliation 

Act of 1996 
B-285169

Page 19 GAO/RCED-00-238 Nutrition Assistance for Older Americans

access to the Food Stamp Program.9 Many of the strategies suggested in 

this access guide, while considered worthwhile, had previously been 

attempted, according to state food stamp directors. State directors’ views 

on the access handbook and other strategies are included in appendix II.

Agency Comments and 

Our Response

We provided a draft copy of this report to the Department of Health and 

Human Services’ Administration on Aging and to the U.S. Department of 

Agriculture’s Food and Nutrition Service for review and comment. We met 

with Food and Nutrition Service officials, including the Director, Program 

Development Division, Food Stamp Program, and with Administration on 

Aging officials, including the Director of the Office of State and Community 

Programs. Overall, both the Food and Nutrition Service and Administration 

on Aging generally concur with the information in the report. The Food and 

Nutrition Service, however, expressed concern that establishing a standard 

medical deduction for older persons could result in considerable cost to 

the Food Stamp Program and therefore probably should not be included in 

the section entitled “Options Not Requiring Substantially Higher 

Expenditures.” We agreed and moved this discussion to the section entitled 

“Resource-Intensive Options.” In addition, the agencies provided technical 

suggestions, which we incorporated as appropriate.

As agreed with your offices, unless you publicly announce its contents 

earlier, we plan no further distribution of this report until 30 days from the 

date of this letter. At that time, we will send copies to congressional 

committees with jurisdiction over nutrition assistance programs; the 

Honorable Dan Glickman, Secretary of Agriculture; the Honorable Donna 

E. Shalala, Secretary of Health and Human Services; the Honorable Jacob J. 

Lew, Director, Office of Management and Budget; and other interested 

parties. We will also make copies available to others upon request.

9

The Nutrition Safety Net—Help for the Elderly and Disabled: A Primer for Enhancing the 

Nutrition Safety Net for the Elderly and Disabled. Spring, 2000.
B-285169

Page 20 GAO/RCED-00-238 Nutrition Assistance for Older Americans

If you or your staff have any questions about this report, please contact me 

at (202) 512-5138. The key contributors to this report are listed in appendix 

VII. 

Robert E. Robertson, 

Associate Director, Food and 

Agriculture Issues
Page 21 GAO/RCED-00-238 Nutrition Assistance for Older Americans
Page 22 GAO/RCED-00-238 Nutrition Assistance for Older Americans

Appendix I

Objectives, Scope, and Methodology ApApenednxidexiIs

We were asked to (1) determine the reasons some older citizens do not use 

the Food Stamp, Elderly Nutrition, Commodity Supplemental Food, and 

Child and Adult Care Food programs and (2) identify strategies for 

increasing older persons’ participation in these programs. To address these 

objectives, we examined laws and program regulations and reviewed 

studies by, among others, Mathematica Policy Research, Inc. and the Urban 

Institute. We also met with officials from the U.S. Department of 

Agriculture’s (USDA) Food and Nutrition Service and the Department of 

Health and Human Services’ (HHS) Administration on Aging. We also 

contacted representatives of associations of nutrition providers, including 

the National Association of Nutrition and Aging Services Programs, the 

Meals on Wheels Association of America and the National Commodity 

Supplemental Food Program Association. We also contacted organizations 

that directly provide food assistance to older persons, including the 

Community Food Resource Center (New York), Catholic Charities 

(Archdiocese of New Orleans), Focus: Hope (Detroit), and Project Bread 

(Massachusetts). We also contacted human services advocacy groups, 

including the American Association of Retired Persons, American Public 

Human Services Association, the Center on Budget and Policy Priorities, 

and the Food Research and Action Center. 

For the largest of these programs, the Food Stamp Program, we conducted 

a telephone survey of the directors of the 51 state agencies responsible for 

administering the program at the state level.1

 For the Elderly Nutrition 

Program, we contacted the president and several members of the National 

Association of Nutrition and Aging Services Programs and the executive 

director of the Meals on Wheels Association of America, which are 

organizations representing nutrition service providers. For the Commodity 

Supplemental Food Program (CSFP), we contacted the president and 

several members of the National Commodity Supplemental Food Program 

Association, an organization representing CSFP providers.

To determine the number of elderly households that have experienced 

problems in obtaining a sufficient amount or quality of food, we analyzed 

data collected by the U.S. Bureau of the Census and reported in the 1998 

Food Security Supplement to the Current Population Survey; these 

numbers are presented at the 95-percent confidence level. 

1

Our response rate was 100 percent, including the District of Columbia.
Appendix I

Objectives, Scope, and Methodology

Page 23 GAO/RCED-00-238 Nutrition Assistance for Older Americans

To estimate the increase in program cost if the minimum food stamp 

benefit was increased from $10 to $25, we consulted with representatives 

of Mathematica Policy Research, Inc. and used their model—known as 

MATH (Micro-Analysis of Transfers to Households)—which utilizes data 

from the Bureau of the Census’ Current Population Survey. We also used 

this model to estimate costs from implementing a standard medical 

deduction. Mathematica verified our estimates by duplicating the modeling 

results of both analyses. 

We conducted our work between February and July 2000 in accordance 

with generally accepted government auditing standards. 
Page 24 GAO/RCED-00-238 Nutrition Assistance for Older Americans

Appendix II

Results of Telephone Survey of State Food 

Stamp Directors ApendxiI

This appendix presents a copy of the telephone questionnaire used to 

survey 51 state food stamp directors or their designees (including the 

District of Columbia), and the results of that survey.1

Telephone Survey

Hello, my name is _______________ with the U.S. General Accounting 

Office. GAO is a nonpartisan agency of the U.S. Congress. As part of a study 

we are conducting on food stamps for the elderly, we are calling the states 

to ask about their experiences in targeting elderly participation. Are you 

the right person to talk with? (If caller answers no, obtain the name and 

phone number of a better contact.) Did you receive the letter we sent?

It will probably take between 45 minutes and an hour to answer our 

questions. Is now a good time to talk or would you rather schedule another 

time? During this interview I may ask you some questions that you cannot 

answer because someone else in your state government handles that. 

Whenever this happens, just tell me and we'll skip on to the next question, 

OK? 

In this survey, we'll be using the word elderly. As we understand, the Food 

Stamp Program considers the elderly to be adults 60 years and older. 

1

Percentages do not add up to 100% for all questions due to rounding. 
Appendix II

Results of Telephone Survey of State Food 

Stamp Directors

Page 25 GAO/RCED-00-238 Nutrition Assistance for Older Americans

1. To start our interview, I'd like to ask you some background 

questions about how your state operates the Food Stamp Program. 

First, we'd like to ask whether your state has integrated or 

consolidated procedures that cover food stamp applications. Which 

of the following choices best describes your state's procedures. 

First, an integrated or consolidated application includes food 

stamps, or second, the food stamp application is separate. N=51

80% Integrated/consolidated application includes food stamps

6% Food stamp application is separate

14% Depends on the situation

2. How often does your state generally require recertification for the 

elderly households for food stamps? Is it quarterly, annually, every 

two years, or some other time period? N=51

61% Annually

33% Every 2 years

6% Other 

3. Is that recertification period different for elderly and nonelderly 

food stamp households? N=51

78% Yes 

20% No 

2% Other

4. Does your state currently use electronic benefit transfer cards, 

EBT for food stamp participants? N=51

69% Yes, currently use EBT

10% Yes, but not yet in all parts of state

12% No, no implementation date planned 

8% No, but plan to implement

2% Other 

[If state has already implemented EBT:] 

5. We're interested in your opinion about these electronic benefits 

and whether you think they affect food stamp participation by the 

elderly. You might think the EBT cards increase participation, 

decrease it, or maybe you think they have no impact. Let me read 

the categories, and tell me which one best describes the effect that 

electronic benefits have on elderly participation in your state. 

Would you say electronic benefits have increased participation, 

decreased participation, had no effect on participation, or would 

you say you have no opinion? N=41

12% Increased moderately

24% No effect

27% Decreased moderately

32% Can't say

5% Other 
Appendix II

Results of Telephone Survey of State Food 

Stamp Directors

Page 26 GAO/RCED-00-238 Nutrition Assistance for Older Americans

Even though the Access Guide covers disabled participation, our survey 

questions today are limited to food stamp participation by the elderly. We'd 

like to read you a list of suggestions that FNS makes in that guide and ask 

Major

Reason

(1)

Minor

Reason

(2)

Not a

reason

(3)

No opinion

(4)

6. USDA has stated that 65 percent of the elderly who are 

eligible for food stamps do not receive them. We've made a list 

of reasons to explain why many of the elderly do not participate 

and we'd like to get your state's perspective on this list. For each 

one I read, I'll ask whether your state experienced this as a 

major reason, a minor reason, or not a reason to explain why 

many of the elderly who are eligible do not participate in the 

Food Stamp Program.

a. The first one is ... Some elderly don't like the intrusive 

questions in the eligibility certification. How does that explain 

why some elderly in your state do not participate in the Food 

Stamp Program? Would you say that is a major reason, a minor 

reason, not a reason, or would you say you don't have an 

opinion on that one? N=51

41% 51% 2% 6%

b. Some elderly think the effort needed to apply is not worth the 

food stamp benefit received. N=51

86% 14% 0% 0%

c. Some elderly cannot afford the transportation costs to make 

the necessary trips to the food stamp office. N=51

8% 51% 31% 10%

d. Some elderly cannot deal with the difficulty of filling out the 

application form. N=51

24% 43% 29% 4%

e. Some elderly do not realize that they are eligible for food 

stamps. N=51

31% 53% 10% 6%

f. Some elderly feel that others need the food stamps more than 

they do, so they do not apply. N=51

12% 39% 35% 14%

g. Some elderly feel embarrassed to be a food stamp recipient 

because of the stigma associated with it. N=51

67% 28% 2% 4%

h. Are there any other reasons why elderly in your state do not 

participate in the Food Stamp Program when they are eligible? 43% gave comments

7. The next set of questions concerns the Access Guide that the 

Food and Nutrition Service, FNS, distributed to the states in 

March 2000. It is called, “Help for the Elderly and Disabled.” It 

shows how to increase food stamp participation for those two 

groups. Are you familiar with that guide?

92% Yes

8% No
Appendix II

Results of Telephone Survey of State Food 

Stamp Directors

Page 27 GAO/RCED-00-238 Nutrition Assistance for Older Americans

your opinion on each one. These suggestions are made to improve elderly 

participation in the Food Stamp Program. As I read each one, I'll ask you to 

rate the suggestion as excellent, good, fair, or poor. If you haven't tried the 

suggestion yet, please rate the suggestion considering how well you think it 

would work in your state to increase elderly participation. Please consider 

the practical issues of implementing each suggestion such as quality 

control and available resources. OK? 

After you rate a suggestion, I'll ask you whether or not your state has 

actually tried that suggestion in the last 3 years. You might have sponsored 

a pilot project, you might have implemented the suggestion statewide, or 

maybe one of your counties tried it.

Excellent

(1)

Good

(2)

Fair

(3)

Poor

(4)

No

opinion

(5)

Yes

(1)

No

(2)

Uncertain

(3)

8. Our first set of suggestions is about marketing 

the Food Stamp Program to the elderly.

a. Let's try the first one... Design materials that 

advertise the Food Stamp Program as nutrition 

assistance rather than “welfare.” How would you 

rate that for increasing elderly participation in your 

state? Would you say it's excellent, good, fair, 

poor, or would you say you have no opinion? 

Has your state tried that in the last 3 years? N=51

26% 51% 16% 4% 4% 43% 55% 2%

b. Target nutrition education programs to the 

elderly. 

Has your state tried that in the last 3 years? N=51

33% 51% 10% 6% 0% 53% 45% 2%

c. Design promotional materials on food stamps 

that are targeted to the elderly. 

Has your state tried that in the last 3 years? N=51

28% 53% 18% 2% 0% 41% 57% 2%

d. Distribute flyers to locations where the elderly 

are likely to go such as grocery stores. 

Has your state tried that in the last 3 years? N=51

35% 45% 18% 2% 0% 57% 39% 4%

e. Promote the minimum benefit of $10 a month 

as an annual value of $120. 

Has your state tried that in the last 3 years? N=51

10% 14% 31% 43% 2% 20% 77% 4%

f. Emphasize to elderly persons that many will be 

eligible for more than the minimum benefit of $10 

a month. 

Has your state tried that in the last 3 years? N=51

12% 24% 41% 20% 4% 10% 84% 6%
Appendix II

Results of Telephone Survey of State Food 

Stamp Directors

Page 28 GAO/RCED-00-238 Nutrition Assistance for Older Americans

Excellent

(1)

Good

(2)

Fair

(3)

Poor

(4)

No

opinion

(5)

Yes

(1)

No

(2)

Uncertain

(3)

9. The next set of suggestions from the FNS Access 

Guide is about your Food Stamp Program staff.

a. The first one is. . . Give staff special training to assist 

elderly applicants. Would you say it's excellent, good, 

fair, poor, or would you say you have no opinion?

Has your state tried that in the last 3 years? N=51

16% 43% 28% 8% 6% 31% 65% 4%

b. Provide training on how the medical deduction works 

for the elderly. 

Has your state tried that in the last 3 years? N=51

28% 33% 22% 14% 4% 69% 31% 0%

c. Train workers to be more personal with the elderly 

such as giving them the worker's business card. 

Has your state tried that in the last 3 years? N=51

16% 41% 29% 8% 6% 43% 51% 6%

d. Encourage staff to provide timely, courteous and 

dignified service. 

Has your state tried that in the last 3 years? N=51

69% 18% 8% 6% 0% 96% 4% 0%

e. Place food stamp workers in locations that serve the 

elderly such as hospitals, community centers, and 

congregate feeding sites. 

Has your state tried that in the last 3 years? N=51

28% 53% 16% 4% 0% 49% 45% 6%

f. Encourage workers to spend extra time with the 

elderly such as making speeches at senior centers. 

Has your state tried that in the last 3 years? N=51

22% 59% 14% 4% 2% 65% 29% 6%

g. Set up a separate unit that focuses on the needs of 

elderly participants. 

Has your state tried that in the last 3 years? N=51

12% 45% 22% 16% 6% 31% 65% 4%
Appendix II

Results of Telephone Survey of State Food 

Stamp Directors

Page 29 GAO/RCED-00-238 Nutrition Assistance for Older Americans

Excellent

(1)

Good

(2)

Fair

(3)

Poor

(4)

No

opinion

(5)

Yes

(1)

No

(2)

Uncertain

(3)

10. The next set of suggestions from the FNS Access 

Guide is about certifying participants. Let me remind 

you that our categories are excellent, good, fair, poor, 

and no opinion.

a. The first one is. . .Lengthen the certification period 

to 24 months for the elderly. 

Has your state tried that in the last 3 years? N=51

33% 29% 18% 12% 8% 45% 55% 0%

b. Promote the use of authorized representatives who 

can apply for food stamps or purchase food on behalf 

of the elderly. 

Has your state tried that in the last 3 years? N=51

35% 47% 10% 6% 2% 78% 20% 2%

c. Promote the use of collateral contacts such as 

neighbors to reduce the documentation required for 

food stamp applications.

Has your state tried that in the last 3 years? N=51

14% 20% 24% 41% 2% 33% 63% 4%

d. Waive some or all fraud prevention procedures for 

elderly applicants. For example, waive finger printing 

for the elderly.

Has your state tried that in the last 3 years? N=50

18% 26% 14% 28% 14% 12% 86% 2%

e. Waive face-to-face interview for all food stamp 

applicants over 60 years of age.

Has your state tried that in the last 3 years? N=51

26% 33% 24% 12% 6% 28% 73% 0%

f. Promote the use of scheduled home visits to reduce 

the documentation required for food stamp 

applications.

Has your state tried that in the last 3 years? N=51

12% 29% 26% 33% 0% 24% 77% 0%

g. Promote the use of medical deductions for elderly 

applicants for food stamps. 

Has your state tried that in the last 3 years? N=51

29% 41% 18% 10% 2% 55% 41% 4%

h. Create special forms for the elderly such as large 

type versions. 

Has your state tried that in the last 3 years? N=50

24% 56% 12% 6% 2% 14% 86% 0%
Appendix II

Results of Telephone Survey of State Food 

Stamp Directors

Page 30 GAO/RCED-00-238 Nutrition Assistance for Older Americans

Excellent

(1)

Good

(2)

Fair

(3)

Poor

(4)

No

opinion

(5)

Yes

(1)

No

(2)

Uncertain

(3)

11. [Skip if state not fully EBT implemented:] The 

next set of suggestions from the FNS Access Guide 

is about electronic benefits. Again, I'll remind you 

that our categories are excellent, good, fair, poor, 

and no opinion.

a. The first one is. . .Give qualified elderly 

households 6 months rather than 3 months to use 

electronic benefits. How would you rate that for 

increasing elderly participation in your state?

Has your state tried that in the last 3 years?

N=46, 40

39% 24% 9% 9% 20% 20% 80% 0%

b. Provide training on the use of Automatic Teller 

Machines, with EBT cards. 

Has your state tried that in the last 3 years?

N=46, 40

50% 39% 4% 4% 2% 93% 5% 3%

c. Follow up on non-users of EBT cards to find out if 

they need help accessing the benefits.

Has your state tried that in the last 3 years? 

N=46, 40

39% 46% 11% 2% 2% 58% 35% 8%

Excellent

(1)

Good

(2)

Fair

(3)

Poor

(4)

No

opinion

(5)

Yes

(1)

No

(2)

Uncertain

(3)

12. The last group of suggestions from the FNS 

Access Guide is about partnerships with other 

agencies and organizations. Again, our categories 

are excellent, good, fair, poor, and no opinion.

a. The first one is. . .Locate food stamp staff at the 

Social Security Administration who accept 

applications from the elderly even if they are not 

applying for SSI. 

Has your state tried that in the last 3 years?

N=51

12% 33% 22% 29% 4% 8% 88% 4%

b. Work with staff at the Social Security 

Administration to increase elderly participation in 

the Food Stamp Program. 

Has your state tried that in the last 3 years?

N=51

24% 47% 16% 10% 4% 37% 57% 6%

c. Work with companies and community 

organizations to promote elderly participation in 

the Food Stamp Program. 

Has your state tried that in the last 3 years? N=50

38% 54% 4% 4% 0% 67% 29% 4%
Appendix II

Results of Telephone Survey of State Food 

Stamp Directors

Page 31 GAO/RCED-00-238 Nutrition Assistance for Older Americans

[If respondent answered “poor” to any of 

Access Guide questions (Q8 to Q12 above):]

You mentioned that one or more suggestions in the 

Access Guide were “poor.” We'd like to know more 

about your thinking on that. 80% gave additional comments

Excellent

(1)

Good

(2)

Fair

(3)

Poor

(4)

No

opinion

(5)

Yes

(1)

No

(2)

Uncertain

(3)

13. Based on your reading of the Access Guide and the things 

you've learned about it in our interview today, we want to know 

how useful you think it is. We want you to consider its usefulness 

for helping your state increase food stamp participation among 

the elderly. Our categories are very useful, moderately useful, 

somewhat useful, and not useful. Which of those categories best 

describes how your state feels about the Access Guide. Would 

you say... it is very useful, moderately useful, somewhat useful, 

not useful or don't you have an opinion on that?

16% Very useful 

35% Moderately useful 

37% Somewhat useful 

10% Not useful 

2% No opinion 

0% Other

14. Considering the suggestions in the Access Guide that we 

covered, we'd like to know how many of them are new ideas for 

your state. Please tell me which of the following categories best 

answers that question. Would you say all of the ideas are new, 

more than half, about half, less than half, few, if any are new, or 

can't you say?

0% All or almost all 

0% More than half 

12% About half 

29% Less than half

53% Few, if any

6% None

0% Can't say

15. Before we go on to the next series of questions, would 

you like to add any comments about your reaction to the 

Access Guide? 69% gave additional comments
Appendix II

Results of Telephone Survey of State Food 

Stamp Directors

Page 32 GAO/RCED-00-238 Nutrition Assistance for Older Americans

Greatly

increases

(1)

Increases

somewhat

(2)

Does not

affect

(3)

No opinion

6)

16. The next series of questions asks about elements of 

food stamp participation rules that the federal government 

designed to increase elderly participation. Some have 

been made over the last few years; others have been in 

place for a while. We'd like to ask you about the effect of 

each of these rules on the elderly in your state. That is, 

whether the rule increases, decreases, or does not affect 

food stamp participation by the elderly. 

a. The first one is... Eligibility is relaxed for elderly 

households by allowing $3,000 in resources. Would you 

say it increases, decreases, does not affect participation, 

or would you say no opinion? N=51

6% 55% 31% 8%

b. Elderly persons in institutions are eligible for food 

stamps under certain conditions. N=51

4% 41% 43% 12%

c. Medical costs over $35 a month are deductible from 

income. N=51

12% 45% 39% 4%

d. Excess shelter costs are deductible from income for 

elderly households. N=51

14% 63% 24% 0%

e. An authorized representative can be designated by the 

household for food stamp application and using benefits. 

N=51

16% 53% 31% 0%

f. The face-to-face interview must be waived, if requested, 

in situations where an elderly household can neither 

appoint an authorized representative nor come to the food 

stamp office. N=51

16% 57% 27% 0%

g. The Social Security office must help SSI applicants 

apply for food stamps. N=51

8% 29% 60% 4%

h. The elderly are allowed to qualify by meeting only a net 

income standard. N=51 

14% 63% 20% 4%

i. Households that receive public assistance or SSI 

benefits are categorically eligible for food stamps. N=51

22% 55% 22% 2%

j. A 24-month certification period is allowed for elderly 

households. N=50

14% 32% 36% 18%

17. [Ask as necessary:] Does your state use the 24-month 

certification period statewide for elderly households? N=48

46% Yes

48% No

6% Other
Appendix II

Results of Telephone Survey of State Food 

Stamp Directors

Page 33 GAO/RCED-00-238 Nutrition Assistance for Older Americans

High

Priority

(1)

Medium

priority

(2)

Low

priority

(3)

No change

needed

(4)

No opinion

(5)

18. Finally, we'd like to ask you about a list of possible 

changes to improve participation in the food stamp 

program by the elderly. We'd like for you to think 

about the priority that you think the federal 

government should place on these changes. As I 

read each one, please tell me if the change should be 

a high priority, a medium priority, a low priority, or if 

you think the change is not needed.

a. The first one is ... Adjust minimum benefit level 

from $10 to $25. What is your opinion about that 

change? Would you say that it should be a high 

priority, a medium priority, a low priority, no change is 

needed, or would you say you don't have an opinion? 

N=50

94% 4% 0% 0% 2%

b. Set a standard deduction for medical costs for the 

elderly. N=50

68% 20% 6% 4% 2%

c. Use adjunct eligibility so that the elderly 

automatically receive food stamps if they are eligible 

for related benefits. N=50

56% 16% 12% 10% 6%

d. Mandate passive certification for the elderly for 

periods of two years and adjust quality control 

procedures to account for it. N=50

44% 34% 12% 6% 4%

e. Increase a recipient's SSI check to include the 

value of any food stamp benefit. 

[As necessary:] Some states call this “cash out.” 

N=50

34% 26% 16% 16% 8%

f. Increase a recipient's Social Security payment to 

include the value of any food stamp benefit. N=50

30% 22% 18% 16% 14%

g. Give the elderly a cash benefit in place of food 

stamp coupons or EBT cards. N=50

26% 12% 38% 18% 6%

h. Adjust resource eligibility for household size. N=50 20% 42% 12% 16% 10%

i. Provide more flexibility to states for elderly eligibility. 

N=51

55% 28% 14% 2% 2%
Appendix II

Results of Telephone Survey of State Food 

Stamp Directors

Page 34 GAO/RCED-00-238 Nutrition Assistance for Older Americans

18a. [Probe answer to “i”:] Just to follow-up on that answer, could 

you tell me what you have in mind for more flexibility? N=51

80% gave additional comments

18b. Are there any other suggestions that you have for changes that 

the federal government should consider? N=51

55% gave comments

18c. Do you have any ideas for simplifying the application 

procedures? N=51

61% gave comments

19. I also wanted to ask you whether your state has done any 

research to find out why some elderly do not participate in the Food 

Stamp Program. Have you done anything like that? N=51

8% Yes 

88% No

4% Other

20. Another thing I wanted to ask is whether your state has tried 

any other ideas that you would recommend to other states to 

improve elderly participation in the Food Stamp Program? N=51

63% gave comments

21. That's all the questions I have for our telephone survey. Before 

we finish today, would you like to add anything else? N=51

43% gave comments
Page 35 GAO/RCED-00-238 Nutrition Assistance for Older Americans

Appendix III

Food Stamp Program ApendxiI

This appendix contains information on the Food Stamp Program and 

characteristics of participating and nonparticipating eligible households.

Program Information Food stamp benefit allotments vary with the type and amount of income, 

household size and some nonfood expenses (such as high shelter costs or 

medical costs). Benefits are provided monthly, and recipients are expected 

to contribute a portion of their net income to their food expenses. The 

program has also established some special rules for households with older 

persons (elderly households). For example, while the general population 

must meet both gross and net income limits, elderly households need to 

meet only the net income limit. Therefore, they could have a higher gross 

income than other food stamp households and still be eligible once their 

allowable deductions are calculated. These deductions include a standard 

deduction of $134 for all food stamp households; a medical expenses 

deduction for elderly or disabled members if these expenses are more than 

$35 for the month, after insurance or government reimbursement or 

payment by someone who is not a household member; and a deduction for 

shelter costs that exceed one-half of household income after all other 

deductions. 1

 Households with elderly members also have a higher limit on 

allowable assets ($3,000) than other households ($2,000). Additionally, 

applicants who have difficulty getting to the Food Stamp Program office or 

food retailer may appoint an authorized representative to apply for and use 

their food stamp benefits. 

The maximum food stamp allotment is set annually at the cost of the U.S. 

Department of Agriculture’s “Thrifty Food Plan” for the household’s size, 

and indexed annually for food price inflation. Food stamp allotments are 

based on the maximum allotment, adjusted for household size, less 30 

percent of monthly net income. Figure 3 shows a sample benefit 

calculation, using the most common deductions for elderly households. 

The calculation is for a one-person, elderly household with income of $750, 

monthly medical expenses of $175 and monthly shelter costs of $350. 

1

These are the deductions most commonly used by elderly households. Deductions for child 

support and dependent care are also available if applicable. The standard deduction is 

adjusted annually and is higher in Alaska and Hawaii.
Appendix III

Food Stamp Program

Page 36 GAO/RCED-00-238 Nutrition Assistance for Older Americans

Figure 3: Sample Food Stamp Allotment Calculation

Benefit Computation A one-person, elderly household with $750 gross monthly 

income, monthly medical expenses of $175, and monthly 

shelter costs of $350.

Determine gross monthly income Earned and nonearned income.

Standard deduction $134 in the continental U.S.

Medical costs over $35 a month that are 

not paid by insurance or someone else

$750

$750 gross income

− $134 standard deduction

Apply the net income test Since the net monthly income ($364) is less than the 

$687 allowed for a household of 1, the household has 

met the net income test.

Example

Calculate the benefits · Multiply net income by 30% (round up)

· Subtract 30% of net income from the 

maximum allotment for the household size

Maximum 

Household size monthly allotment

1 $127

2 $234

3 $335

4 $426

5 $506

6 $607

7 $671

8 $767

each additional

person... + $96

$364 x 0.30 = $110

Subtract deductions to determine net income

· Determine half of adjusted income

· Determine if shelter costs are more 

than half of adjusted income

· Subtract excess amount

Net monthly

Household size income limits

1 $687

2 $922

3 $1,157

4 $1,392

5 $1,627

6 $1,862

7 $2,097

8 $2,332

each additional 

person... + $235

Medical deductions

Excess shelter cost deduction for

shelter costs that exceed half of 

household income after all other 

deductions.

$127 maximum allotment for 1 person

− $110 30% of net income

$ 17 Food stamp allotment for a full month

$616

− $140 medical deduction ($175-$35)

$476

$476 x 1⁄2 = $238

$350 − $238 = $112

− $112

$364 Net income after deductions have been met
Appendix III

Food Stamp Program

Page 37 GAO/RCED-00-238 Nutrition Assistance for Older Americans

Table 1 presents information, by state, on the number and percentage of 

elderly households receiving food stamps in fiscal year 1998—the most 

recent year for which complete data are available.

Table 1: Distribution of Elderly Food Stamp Households by State, Fiscal Year 1998

State

Number of elderly

households

 (in thousands)

Percent of food stamp

households with elderly

members

Total 1,500 18.2

Alabama 37 21.9

Alaska 1 8.8

Arizona 13 11.8

Arkansas 25 24.9

California 30 3.4

Colorado 16 19.1

Connecticut 15 16.4

Delaware 2 11.6

District of Columbia 6 15.0

Florida 120 27.9

Georgia 58 22.5

Hawaii 10 19.0

Idaho 4 16.0

Illinois 71 18.1

Indiana 23 18.1

Iowa 11 19.4

Kansas 11 20.5

Kentucky 29 17.7

Louisiana 40 19.7

Maine 16 28.4

Maryland 18 13.2

Massachusetts 18 13.3

Michigan 44 13.5

Minnesota 17 17.4

Mississippi 39 30.2

Missouri 34 19.6

Montana 4 17.4

Nebraska 7 18.7
Appendix III

Food Stamp Program

Page 38 GAO/RCED-00-238 Nutrition Assistance for Older Americans

Notes: The data in this table are from the Food and Nutrition Service’s fiscal year 1998 food stamp 

quality control database. This database contains detailed demographic, economic, and food stamp 

eligibility information for a nationally representative sample of 47,145 food stamp households. The 

national sample is stratified by month and by the 50 states, the District of Columbia, Guam, and the 

U.S. Virgin Islands. The Food and Nutrition Service weights the file so that the data replicate, by state, 

the monthly number of Food Stamp Program households as reflected in the program operations data.

Characteristics of Older 

Participants in the Food 

Stamp Program

Table 2 lists some of the demographic characteristics of older participants 

in the Food Stamp Program, and shows how they compare with those who 

are eligible but do not participate. USDA has only limited information on 

eligible elderly households that did not participate.

Nevada 7 22.0

New Hampshire 3 19.1

New Jersey 40 21.5

New Mexico 10 15.2

New York 147 19.4

North Carolina 60 26.8

North Dakota 3 21.2

Ohio 74 22.2

Oklahoma 28 23.2

Oregon 21 18.5

Pennsylvania 76 19.0

Rhode Island 5 15.0

South Carolina 31 22.7

South Dakota 3 15.4

Tennessee 62 26.8

Texas 103 17.2

Utah 4 12.8

Vermont 5 21.2

Virginia 41 24.1

Washington 18 11.5

West Virginia 22 20.0

Wisconsin 15 19.7

Wyoming 1 12.5

(Continued From Previous Page)

State

Number of elderly

households

 (in thousands)

Percent of food stamp

households with elderly

members
Appendix III

Food Stamp Program

Page 39 GAO/RCED-00-238 Nutrition Assistance for Older Americans

Table 2: Characteristics of Older Persons Who Are Eligible for Food Stamps

a

Food and Nutrition Service’s quality control data, 1998.

b

1999 pre-test survey by Mathematica Policy Research, Inc. The limitations of these data include (1) 

small sample size, which made results not nationally representative, and (2) some nonparticipants who 

are probably ineligible for benefits.

Eligible population

Characteristic Participantsa Nonparticipantsb

Average age 66 67

Gender 73% female 73% female

Average gross monthly income $589 Not available

Average net monthly income $334 Not available

Live alone 79% 52%

Average household size 1.3 1.9

Urban/rural 69% urban Not available

Race

53% Caucasian 65% Caucasian

29% African American 27% African American

13% Hispanic 5% Hispanic
Page 40 GAO/RCED-00-238 Nutrition Assistance for Older Americans

Appendix IV

Elderly Nutrition Program ApendxiIV

This appendix contains information on the Elderly Nutrition Program’s 

(ENP) resources and on the characteristics of the population served by the 

program. 

Program Information and 

Resources

The number of older persons, particularly those with impairments, has 

increased during a time in which funding for programs authorized by the 

Older Americans Act of 1965 has remained relatively flat. There are waiting 

lists for ENP services in various parts of the country, especially for homedelivered meals. 

The Administration on Aging provides grants under title III of the Older 

Americans Act to state agencies that are based on a state’s relative share of 

the population aged 60 and over. In fiscal year 1999, the Administration on 

Aging provided about $486 million for meal programs and support services, 

including the nutrition education required by the Older Americans Act. In 

addition, the Food and Nutrition Service provided state agencies with $140 

million in meal subsidies for ENP, at a rate of about 55 cents per meal. 

States may opt to receive the Food and Nutrition Service reimbursement in 

the form of cash or commodities; most states opt for cash. 

About 41 percent of the providers that arrange or provide home-delivered 

meals reported waiting lists in the home-delivered meal program, 

according to a 1996 study. For providers maintaining waiting lists, the 

average number of older persons on the list is 85, and the median is 35—

about one-third of the average daily number of homebound recipients 

served. The average length of time spent on a home meal waiting list is 2 to 

3 months. Roughly 9 percent of the group meal programs reported waiting 

lists for elderly participants. The average size of these waiting lists is 52 

persons, while the median is 47—about 20 percent of the average number 

of participants served. The average stay on such waiting lists is 2 months. 

Characteristics of the ENP 

Population

Table 3 identifies some of the demographic characteristics of ENP 

participants, and compares them with the general population, aged 60 and 

over.
Appendix IV

Elderly Nutrition Program

Page 41 GAO/RCED-00-238 Nutrition Assistance for Older Americans

Table 3: Characteristics of ENP Participants Compared With the General Elderly 

Population

Source: HHS, Administration on Aging, Serving Elders at Risk: The Older Americans Act Nutrition 

Programs—National Evaluation of the Elderly Nutrition Program 1993-1995, July 1996.

Characteristics

 Participants in

group meals

Home-delivery

participants

General elderly

population, 60+

Average age (years) 76 78 72

Percent living alone 57 60 25

Percent with income 

below 100% of the 

federal poverty level

34 48 15

Percent female 69 70 58

Percent in rural areas 28 16 25

Percent racial/ethnic 

minorities

27 25 14
Page 42 GAO/RCED-00-238 Nutrition Assistance for Older Americans

Appendix V

Commodity Supplemental Food Program ApendxiV

This appendix contains information on the Commodity Supplemental Food 

Program (CSFP) and on the characteristics of the population served by the 

program. 

Program Information and 

Resources

CSFP provides food and nutrition education to low-income participants; it 

is authorized under section 4(a) of the Agriculture and Consumer 

Protection Act of 1973. The program is available to low-income infants; 

children up to age 6; pregnant, postpartum, or breastfeeding women; and 

persons aged 60 and older. Older persons participating in CSFP must have 

household income at or below 130 percent of the federal poverty level and 

meet state residency requirements. The program gives preference to 

women, infants and children at each site; eligible low-income elderly 

persons can participate in CSFP if there are resources available after all 

eligible women, infants and children have been served. While women, 

infants, and children have preference under the program, their 

participation has been declining since 1993, principally because of the 

expansion of the Special Supplemental Nutrition Program for Women, 

Infants, and Children, which also provides benefits to these groups. 

CSFP participants receive, at no cost, boxed and canned goods, which are 

generally distributed once a month. In some locations, participants who are 

unable to pick up their food at the distribution centers can have it delivered 

to their homes, generally by volunteers. Participants also receive nutrition 

education provided by the local CSFP agency. USDA provides guidance to 

participating states on the type and amount of food that should be provided 

to older CSFP recipients. The maximum monthly distribution rates for 

older persons and certain other participants are shown in table 4.
Appendix V

Commodity Supplemental Food Program

Page 43 GAO/RCED-00-238 Nutrition Assistance for Older Americans

Table 4: Maximum Monthly Distribution Rates for Older Persons and Certain Other Participants

Note: Participants may choose to select one package of cereal and one package of farina, rather than 

two packages of either cereal or farina. Participants may also choose to select one can of tuna fish and 

one can of meatball stew, for example, rather than two cans of the same meat item.

Source: Food and Nutrition Service.

Food Item Package size Packages per month

Total maximum

amount per month

Cereal (one of the following)

Dry, ready-to-eat cereal 18-ounce package 2 packages 36 ounces

Farina 14-ounce package 2 packages 28 ounces

Rolled oats 3-pound package 1 package 48 ounces

Grits 5-pound package 1 package every other month 2.5 pounds

Fruit juice 46-ounce can 3 cans 138 ounces

Meat/poultry (one of the 

following) 

Meat/poultry 29-ounce can 1 can 29 ounces

Meatball stew 15-ounce can 2 cans 30 ounces

Tuna fish 12.5-ounce can 2 cans 25 ounces

Salmon 14.75-ounce can 2 cans 29.5 ounces

Egg mix, dry 6-ounce package 2 packages 12 ounces

Milk (both types)

Evaporated milk 12-ounce can 3 cans 36 ounces

Instant nonfat dry milk 25.6-ounce package 1 package every other month 12.8 ounces

Peanut butter or dry 

peas/beans (one of the 

following)

Peanut butter 18-ounce package 1 package 18 ounces

Dry peas/beans 2-pound package 1 package 2 pounds

Pasta, etc. (one of the 

following)

Dehydrated potatoes 1-pound package 1 package 1 pound

Macaroni 1-pound package 2 packages 2 pounds

Spaghetti 2-pound package 1 package 2 pounds

Rice 2-pound package 1 package 2 pounds

Grits 5-pound package 1 package every other month 2.5 pounds

Process American cheese 2-pound package 1 package 2 pounds

Fruits 15- or 16-ounce can 2 cans 2 pounds

Vegetables 15- or 16-ounce can 4 cans 4 pounds
Appendix V

Commodity Supplemental Food Program

Page 44 GAO/RCED-00-238 Nutrition Assistance for Older Americans

Federal funding for CSFP has varied somewhat over the past several fiscal 

years. Appropriations for fiscal years 1997 through 2000 were $76 million, 

$96 million, $86 million, and $88.3 million, respectively. In addition to 

appropriations, unused food funds can be carried over from one fiscal year 

to the next. For example, in fiscal year 1999, because of carryover funding, 

$96.1 million was available for program expenditures, while in fiscal year 

2000, a total of $97 million was available. By law, no more than 20 percent 

of the total appropriation and carryover funds can be used to cover state 

and local administrative costs.

Characteristics of Older 

CSFP Participants

USDA does not maintain a comprehensive database describing the 

characteristics of older persons served by CSFP. According to Food and 

Nutrition Service officials, since CSFP is relatively small compared with 

other federal food assistance programs and is not nationwide in scope, the 

program has not been subjected to as much study as some of the larger 

food assistance programs. Our discussions with the National Commodity 

Supplemental Food Program Association and CSFP service providers in 

several states suggest that a large number of older persons participating in 

CSFP are female and live alone. 
Page 45 GAO/RCED-00-238 Nutrition Assistance for Older Americans

Appendix VI

Child and Adult Care Food Program ApendxiVI

This appendix contains information on the Child and Adult Care Food 

Program (CACFP) and on the characteristics of the population served by 

the program.

Program Information and 

Resources

The adult segment of CACFP was initially authorized under the Older 

Americans Act Amendments of 1987. The Child Nutrition and WIC 

Reauthorization Act of 1989 changed the name to reflect the addition of the 

adult component. Any adult, aged 60 or older and any person aged 18 and 

over who has a functional impairment and attends a nonresidential day 

care facility can qualify to participate in CACFP. Participants from families 

with incomes at or below 130 percent of the poverty level qualify for free 

meals, while those with incomes between 130 and 185 percent of the 

poverty level qualify for reduced-price meals. Meals served to those with 

incomes above 185 percent of the poverty level are reimbursed at a lower 

rate. 

CACFP services are provided by licensed adult day care centers 

(nonresidential) operated by public agencies, or private nonprofit and forprofit organizations meeting certain criteria. Participants do not pay for 

individual meals; instead the fee participants pay to attend the center 

includes meals and snacks, along with other program services. Meals 

served must meet minimum nutrition criteria as set forth in program 

regulations; participants cannot receive more than two meals and one 

supplement (snack) or one meal and two snacks in a single day. USDA 

reimburses the day care center for a portion of the cost of all meals and 

snacks served to adult participants.

Adult participation in CACFP has increased every year since fiscal year 

1993. For example, average daily attendance has increased from about 

36,000 in fiscal year 1993 to about 63,000 in fiscal year 1999, a 75-percent 

increase. During the same period, federal reimbursement to adult day care 

centers for meals more than doubled to approximately $36.5 million in 

fiscal year 1999 and the number of participating facilities has increased 

from 1,222 to 1,855. 

Characteristics of CACFP 

Participants

The most recent information describing the characteristics of adult CACFP 

participants is from an October 1993 Mathematica study done for the Food 

and Nutrition Service. Table 5 provides information from the study.
Appendix VI

Child and Adult Care Food Program

Page 46 GAO/RCED-00-238 Nutrition Assistance for Older Americans

Table 5: Characteristics of CACFP Adult Participants

Source: National Study of the Adult Component of the Child and Adult Care Food Program (CACFP): 

Final Report, Mathematica Policy Research, Inc., for USDA, October 15, 1993.

Characteristics CACFP participants

Average age 59

Not married, living alone 19%

Not married, living alone in a group setting 21%

Income below 130% of the federal poverty level 84%

Female 62%

Participating in other federal programs:

SSI 57%

Medicaid 68%

Food stamps 18%

Percent racial/ethnic minorities 43%
Page 47 GAO/RCED-00-238 Nutrition Assistance for Older Americans

Appendix VII

GAO Contacts and Staff Acknowledgments ApendxiVI

Contacts Robert E. Robertson, (202) 512-5138

Robert C. Summers, (404) 679-1839

Acknowledgments In addition to those named above, Eugene W. Wisnoski, Clifford J. Diehl, 

Kerry D. Hawranek, Fran A. Featherston, Carol E. Bray, and Carol 

Herrnstadt Shulman made key contributions to this report. 

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