United States General Accounting Office

GAO Report to the Chairman, Subcommittee

on Department Operations, Nutrition

and Foreign Agriculture, Committee on

Agriculture, House of Representatives

May 1995 WELFARE

PROGRAMS

Opportunities to

Consolidate and

Increase Program

Efficiencies

GAO/HEHS-95-139

GAO United States

General Accounting Office

Washington, D.C. 20548

Health, Education, and

Human Services Division

B-261056 

May 31, 1995

The Honorable Bill Emerson

Chairman, Subcommittee on Department Operations,

 Nutrition and Foreign Agriculture

Committee on Agriculture

House of Representatives

Dear Mr. Chairman:

Since the passage of the Social Security Act in 1935, nearly 80 programs

have been enacted to help meet the needs of low-income individuals and

families. Authorized by different congressional committees at different

points in time, these programs were created to help meet the specific

needs of various groups of low-income people. The numbers of programs

in this system, and the costs involved, have raised concerns, however, that

the system is too costly and complex and should be overhauled. In fiscal

year 1993 alone, the federal government spent about $223 billion to assist

low-income Americans of all ages.1

 These federal expenditures accounted

for approximately 16 percent of the fiscal year 1993 federal budget.

Rising program costs, growing caseloads, and dissatisfaction with current

program designs have prompted states to initiate major reforms.

Escalating costs for Medicaid—the single largest means-tested2

program—have prompted some states to move most or all of their

Medicaid population into managed care delivery systems3

 to control future

cost growth. Several states are simultaneously seeking to expand Medicaid

coverage to previously uninsured low-income individuals; states anticipate

that savings from managed care systems will help finance this expanded

coverage.

In response to caseload growth in the Aid to Families With Dependent

Children (AFDC) program, states have acted to change welfare recipients’

behavior and enhance family responsibility. For example, several states no

longer increase the amount of a family’s AFDC benefit for an additional

1

Program expenditures and numbers of recipients cited in this report are for fiscal year 1993, the most

recent year for which complete program expenditure and participation information was available.

2

Means-tested programs are restricted to individuals or families whose incomes fall below defined

levels and who meet certain other eligibility criteria established for each program.

3

Managed care in Medicaid is not a single health care delivery plan, but rather a continuum of models

that share a common approach. Common to all managed care models in the Medicaid program is the

use of a primary care physician to control and coordinate the delivery of health services in a

cost-conscious manner.

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B-261056 

child born while the mother is receiving welfare. State Medicaid and AFDC

reform efforts are taking place under specific federal waivers; the

Congress is currently considering restructuring these and other

means-tested programs to increase states’ flexibility to design and manage

these programs, increase program efficiency, and constrain spending

growth.

On February 7, 1995, we provided an overview of means-tested programs

in testimony before the Subcommittee;4

 this report expands on the issues

presented in our testimony. More specifically, we (1) describe low-income

families’ participation in multiple welfare programs; (2) examine program

inefficiencies, such as program overlap and fragmentation; and (3) identify

issues to consider in deciding whether, and to what extent, to consolidate

welfare programs.

To address these issues, we drew from our past work and other reports on

the issues related to the programs within the welfare system. (See app. II.)

In deciding which programs to include in our report, we followed the

Subcommittee’s request that we discuss the programs addressed in the

Congressional Research Service’s (CRS) September 1993 report on cash

and noncash benefits for persons with limited income.5

 Our analysis of

low-income families’ participation in means-tested programs is based on

data from a national household survey, the Bureau of the Census’

March 1994 Current Population Survey (CPS).

Results in Brief About 80 welfare programs provide assistance to low-income individuals

and families; federal expenditures for these programs totaled $223 billion

in 1993. Federal expenditures for the largest five programs—Medicaid,

Food Stamps, AFDC, Supplemental Security Income (SSI), and Section 8

Housing Assistance—alone composed about 65 percent of total 1993

welfare expenditures, about $145 billion. Many low-income families are

eligible for and receive assistance from multiple programs. Most families

receiving AFDC, for example, are also eligible for and receive Medicaid and

food stamps.

These myriad welfare programs—each with its own rules and

requirements—are difficult for families in need to access and cumbersome

4

Means-Tested Programs: An Overview, Problems, and Issues (GAO/T-HEHS-95-76, Feb. 7, 1995).

5

Cash and Noncash Benefits for Persons With Limited Income: Eligibility Rules, Recipient and

Expenditure Data, FY 1990-92 (EPW-93-832), Congressional Research Service, Library of Congress,

(Washington, D.C.: 1993).

Page 2 GAO/HEHS-95-139 Welfare Reform
B-261056 

for program administrators to operate. For example, the AFDC, Food

Stamp, and Medicaid programs all determine need differently and set

different household maximum resource limits. Moreover, interactions

among programs may send mixed signals to recipients. AFDC recipients

whose benefits are reduced because they failed to attend required

employment training activities, for example, qualify for increased food

stamps, thus undermining efforts to move AFDC recipients from welfare to

work.

We have identified several program areas—including employment training,

food assistance, and early childhood programs—where numerous

programs target the same clients, share the same goals, and provide

similar services. Such program overlaps add unnecessary administrative

costs and make service delivery more complicated. For example, 163

separate employment training programs are scattered across 15 federal

departments and agencies and 40 interdepartmental offices, which in turn

channel funds to state and local program administrators. Given their size

and complex structure, welfare programs are also inherently vulnerable to

fraud, waste, and abuse. Moreover, little is known about the effectiveness

of many of these programs. Most agencies that administer employment

training programs, for example, do not know if their programs are helping

people find jobs.

Confronted with this complex system, state governments and local

providers have sought to streamline program operations and service

delivery. However, such efforts are hindered by the patchwork of federal

programs and funding streams. To streamline this system, the Congress

and the administration are considering consolidating specific federal

programs, including employment training, child care subsidy, and housing

programs. Regardless of how welfare programs are ultimately

restructured, ensuring that federal funds are used efficiently and that

programs are focused on outcomes remains important.

Background Over the years, the Congress has established about 80 separate programs

to provide cash and noncash assistance to low-income individuals and

families. Taken together, these programs constitute the nation’s welfare

system of means-tested programs. Means-tested programs are restricted to

individuals or families whose income falls below defined levels and who

meet certain other eligibility criteria established for each program. To

qualify for assistance, applicants generally must show proof of income and

other documentation, which administering agencies must then verify.

Page 3 GAO/HEHS-95-139 Welfare Reform
B-261056 

Means-tested programs target low-income individuals and families to meet

two broad objectives: (1) to provide basic support and health care for

those who are often unable to support themselves—the aged, blind,

disabled, and children—and (2) to provide transitional assistance to

able-bodied adults and their families while promoting self-sufficiency.

These programs provide benefits in six areas of need: (1) cash assistance;

(2) medical benefits; (3) food and nutrition; (4) housing; (5) education and

training; and (6) other services, such as child care.

Federal expenditures for these welfare programs totalled about

$223 billion in fiscal year 1993. Many of these programs are also partially

funded by the states; when state dollars are included, the total amount of

spending reached $311 billion. Federal spending for these programs grew

from $80 billion in fiscal year 1980; in inflation-adjusted dollars, this

represents a 58-percent increase. Table 1 highlights the federal spending

levels in some of the largest programs in each of the six areas of need.

(See app. I for a complete listing of the 80 programs and their

expenditures.)

Page 4 GAO/HEHS-95-139 Welfare Reform
B-261056 

Table 1: Selected Means-Tested

Programs, by Type of Assistance

(Fiscal Year 1993) 

Dollars in billions

Type of assistance/program

Estimated

expenditures

Income support

Aid to Families With Dependent Children $13.8

Supplemental Security Income 21.8

Earned Income Credit (EIC) 10.9

Medical care

Medicaid 75.0

Medical Care for Certain Veterans 8.3

Food and nutrition

Food Stamps 23.7

School Lunch 3.8

Special Supplemental Food Program for Women, Infants. and Children

(WIC) 2.9

School Breakfast 0.9

Housing

Section 8 Housing Assistance 11.2

Low-Rent Public Housing 6.2

Education and training

Stafford Loans and Pell Grants 11.6

Job Training Partnership Act (JTPA) 3.5

Head Start 2.8

Job Opportunities and Basic Skills (JOBS) Training Program 0.7

Other services

Social Services Block Grant (SSBG) 2.8

Child Care and Development Block Grant (CCDBG) 0.9

Child Care—AFDC, Transitional, and At-Risk 0.8

Community Services Block Grant 0.4

Source: Congressional Research Service (CRS); the Joint Tax Committee; and the Departments of

Health and Human Services (HHS), Education, Agriculture, and Housing and Urban Development

(HUD).

While the nation’s welfare system consists of about 80 means-tested

programs, a handful of programs account for most of the federal spending

on these programs and have driven much of the spending growth. The five

largest programs—Medicaid, Food Stamps, AFDC, SSI, and Section 8

Housing Assistance—accounted for 65 percent of federal spending for

means-tested programs in fiscal year 1993, about $145 billion. Federal

Page 5 GAO/HEHS-95-139 Welfare Reform
B-261056 

spending on these programs has more than doubled since 1980 in

inflation-adjusted dollars, as shown in figure 1.

Figure 1: Growth in Federal Spending

for Five Largest Means-Tested

Programs, 1980-93

160

140

120

100

80

60

40

20

0

Billions

1980 1985 1990 1993

Year

Section 8 Housing

SSI

AFDC

Food Stamps

Medicaid

Note: Dollars are in constant 1993 dollars.

Sources: The 1980, 1985, and 1990 figures (except for housing) are from 1995 Budget

Perspectives: Federal Spending for Social Welfare Programs CRS, 94-215 EPW (Washington,

D.C.: 1994). The housing expenditures are from HUD. The 1993 expenditures are from CRS, and

the Departments of HHS, Agriculture, HUD, and Education.

Four of these programs—Medicaid, Food Stamps, SSI, and AFDC—are

entitlement programs. Entitlement programs guarantee assistance to

individuals or families as long as they meet the income and eligibility tests.

The Section 8 Housing Assistance program, as well as many other

Page 6 GAO/HEHS-95-139 Welfare Reform
B-261056 

means-tested programs, is a nonentitlement program. Nonentitlement

programs do not guarantee assistance to all those who qualify. Instead,

they provide qualified applicants support until funds are depleted.

Medicaid Is the Largest

Means-Tested Program

The Medicaid program is the single largest program and is jointly funded

by federal and state governments. Federal expenditures reached nearly

$75 billion in fiscal year 1993, and the states spent an additional $56 billion

in 1993 for a total of $131 billion in Medicaid expenditures (see fig. 2).

Federal law mandates coverage of certain medical services and population

groups. It also includes coverage options, allowing states to choose

whether to cover additional services or low-income population groups.

The program provided health coverage to 33 million low-income

individuals in 1993.

The Medicaid program is also one of the fastest growing components of

both federal and state budgets. In 1993, Medicaid cost almost $100 billion

more and served about 10 million more low-income recipients than it did a

decade ago. About three-fourths of Medicaid beneficiaries are poor

children and their parents; however, two-thirds of program expenditures

are for poor elderly, blind, and disabled individuals.

Page 7 GAO/HEHS-95-139 Welfare Reform
B-261056 

Figure 2: Federal and State

Expenditures for Five Largest Welfare

Programs, Fiscal Year 1993

Expenditures

0

10

20

30

40

50

60

70

80

90

100

110

120

130

140

Medicaid

Food Stamps

SSI

AFDC

Section 8 Housing

State

Federal

Source: CRS and the Departments of HHS, Agriculture, and HUD.

Medicaid programs vary considerably among the states, which

independently establish eligibility standards and decide on covered

services. States partly determine the extent of their Medicaid program

when they set eligibility requirements for receiving cash assistance,

primarily AFDC.

6

 States also determine program scope by selecting which

optional services or groups to include in their programs. With some

discretion to modify eligibility and benefit provisions, the proportion of

the poor (as defined by the federal poverty level) and near-poor served by

Medicaid varies greatly by state. For example, for every 1,000 people with

incomes under 150 percent of the federal poverty level, Rhode Island

6

In 1993, the qualifying level for AFDC varied across states from 17 to 93 percent of the federal poverty

level, which in 1993 income was $1,027 per month for a family of three.

Page 8 GAO/HEHS-95-139 Welfare Reform
B-261056 

serves 913 beneficiaries, while Nevada serves 284. Nationally, in 1994,

Medicaid covered medical services for 58 percent of people under age 65

living in poverty.

Medicaid provides noncash assistance—eligible individuals receive

services, rather than cash. The Food Stamp and Section 8 Housing

Assistance programs also provide noncash benefits. The Food Stamp

program generally provides low-income individuals and families with

monthly food stamps or coupons to help them purchase a nutritionally

adequate diet.7

 Unlike Medicaid, the Food Stamp program is almost totally

funded by federal dollars and has uniform program rules in the contiguous

48 states.8

 Food Stamp expenditures were over $25 billion in fiscal year

1993; the federal share was about $24 billion. About 27 million people

received food stamps each month in 1993; about 50 percent were children

and about 7 percent were elderly.

The Section 8 Housing Assistance program provides rental subsidies to

low-income individuals and families to help them obtain affordable

housing. Unlike Medicaid, the Section 8 program is fully federally funded.

The federal government provided about $11 billion in rental housing

assistance to almost 3 million low-income families in 1993.

AFDC and SSI Provide

Billions in Cash Assistance

The nation’s two largest means-tested cash assistance programs—SSI and

AFDC—together provided assistance to over 20 million low-income

individuals in 1993.9 AFDC provided cash assistance to about 70 percent of

these individuals; however, SSI total program costs nearly equalled those of

AFDC. SSI is mostly federally funded, while the federal government and the

states share the costs of the AFDC program.

SSI is a primary source of cash income to aged, blind, or disabled

individuals with low incomes and limited resources. The program follows

uniform nationwide eligibility requirements. In 1993, over 6 million people

received SSI benefits, and expenditures were almost $26 billion—nearly

$22 billion of that in federal dollars.

7

Some states are experimenting with alternative ways to provide food assistance by providing cash

instead of coupons or using electronic benefit transfers.

8

While Food Stamp program rules are uniform among the states, food stamp benefits are higher in

Alaska and Hawaii.

9

No recipient may receive both SSI and AFDC benefits; however, families receiving AFDC may have

one or more family members who receive SSI.

Page 9 GAO/HEHS-95-139 Welfare Reform
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The AFDC program provides cash benefits to economically needy families

with children who lack support from one or both of their parents because

of death, absence, incapacity, or unemployment. As with Medicaid, AFDC is

jointly funded by the federal government and the states. The states define

benefit need, set their own benefit levels, establish (within federal

limitations) income and resource limits, and administer the program. As a

result, AFDC monthly benefits vary widely among states—from Mississippi,

where a family of three received $120 as of January 1994, to Alaska, where

the monthly benefit totalled $923. In addition to these state variations in

benefit levels, AFDC benefits vary by family size, with larger families

generally receiving higher benefits.10

In fiscal year 1993, the federal government and the states spent about $25

billion to assist over 14 million AFDC recipients in nearly 5 million families.

The federal government’s share was almost $14 billion. The majority of

children receiving AFDC—nearly 90 percent—live with one parent, usually

their mother.

Many Low-Income

Families Receive

Assistance From

Multiple Programs

Low-income families are likely to be eligible for and participate in several

means-tested programs, depending on the programs’ specific eligibility

criteria and availability. We found that families receiving AFDC, for

example, were generally receiving other benefits, including Medicaid and

food stamps; however, the extent to which they received such noncash

assistance varied. Working poor non-AFDC families, on the other hand,

were less likely to receive multiple types of noncash assistance than

families receiving AFDC.

10As of July 1, 1994, eight states—Arkansas, California, Georgia, Kentucky, Oklahoma, Virginia,

Washington, and West Virginia—have set benefit ceilings at a particular family size. Georgia, for

example, has a maximum benefit of $568 for families of 11 or more; Kentucky has a maximum of $419

for families of 7 or more. In addition, six states—Arkansas, Georgia, Indiana, Nebraska, New Jersey,

and Wisconsin—have received permission from the U.S. Department of Health and Human Services

(HHS) to freeze family size at the number of children in the family when the family first applies for

AFDC benefits. This cap on family benefits is aimed at discouraging welfare recipients from having

additional children while on AFDC.

Page 10 GAO/HEHS-95-139 Welfare Reform
B-261056 

Benefit Receipt Varied

Among Families

To illustrate what the package of cash and noncash benefits for

low-income families might look like, we analyzed families’ receipt of five

types of benefits—AFDC, Medicaid, food stamps, housing,11 and school

lunches.12 We compared the benefits that AFDC families—consisting of a

female head of household and two children—received in 1993 with those

working poor female-headed families received.13

We found that most AFDC families received at least one type of noncash

benefit; however, the extent to which they receive each benefit varied. For

example, AFDC families are automatically eligible for Medicaid and most

also qualify for food stamps. Because both are entitlement programs, every

AFDC family that qualifies and applies will receive benefits. In contrast,

housing assistance is not an entitlement program, and its availability is

limited. As a result, all AFDC families participate in Medicaid, while only

about 37 percent of AFDC families reported receiving housing assistance in

1993, as shown in figure 3.

11Our analysis includes both Low Rent Public Housing and Section 8 Housing Assistance.

12We did not include SSI in our analysis because AFDC recipients are not eligible for SSI.

13For this analysis, we defined working poor as non-AFDC female-headed families of three in which the

family head worked full time for a full year and earned up to 1-1/4 times the minimum wage.

Page 11 GAO/HEHS-95-139 Welfare Reform
B-261056 

Figure 3: Percentage of AFDC Families

Receiving Noncash Assistance (1993) Percent

0

10

20

30

40

50

60

70

80

90

100

Medicaid

Food Stamps

School Lunch

Housing Subsidya

Noncash Benefit Program

100

81

55

37

aIncludes Low Rent Public Housing and Section 8 Housing Assistance.

Note: All families are shown as participating in Medicaid because of their automatic eligibility,

although not all may receive medical care in a given month.

Source: CPS, March 1994.

Working poor families may also be eligible for and receive noncash

assistance; however, they are less likely to receive such assistance than

AFDC families. An eligible family of three could have a gross monthly

income over $1,200 and be eligible for a small food stamp benefit. The

same family of three could receive as little as $2 and as much as $80 per

month. It also could have a monthly income as high as $3,000 and still

receive housing assistance. Of the working poor families we studied, about

22 percent received food stamps, and about 12 percent received housing

assistance in 1993.14

14Sampling errors at the 95-percent confidence level are about plus or minus 12 percentage points for

food stamps and about plus or minus 9 percentage points for housing assistance.

Page 12 GAO/HEHS-95-139 Welfare Reform
B-261056 

AFDC families are also much more likely to be receiving more than one type

of noncash assistance than are working poor families. For example, over

85 percent of the AFDC families received three or more types of assistance,

as shown in figure 4.15 In contrast, only about 6 percent of working poor

families participated in three or more noncash programs.

Figure 4: Comparison of AFDC and

Working Poor Families’ Benefit

Receipt (1993)

Percent

0

10

20

30

40

50

60

70

80

90

Not Receiving

Assistance

Receiving One

Type of

Assistancea

Receiving Two

Types of

Assistance

Receiving Three

or More Types of

Assistance

21.3

51.4

20.9

14.5

6.4

85.5

Working Poor Families Not Receiving AFDC

Families Receiving AFDC

aAll families receiving AFDC were receiving at least one other type of assistance.

Source: CPS, March 1994.

Our analysis depicts the set of benefits that low-income families received

at a particular point in time. However, these families’ economic status may

vary considerably over time. The families we examined—AFDC families and

working poor non-AFDC families—are frequently the same families

15At the 95 percent confidence level, sampling errors for estimates shown in figure 4 range from

3 percentage points (AFDC family estimates) to 12 percentage points (percent of working poor

receiving one type of assistance).

Page 13 GAO/HEHS-95-139 Welfare Reform
B-261056 

observed at particular points in time. Many low-income families go on and

off AFDC because of events that affect their ability to go to work at a

particular time—for example, changes in availability of a job, child care

arrangements, health of children, and access to affordable transportation.16

 As these families’ economic circumstances change, their need for

different types of assistance may also change.

Complex System of

Welfare Programs Is

Inefficient

Low-income families often rely on multiple assistance programs to meet

their needs; moreover, these needs may change over time. However, the

sheer numbers of programs, and their complex set of rules and

regulations, can make it difficult for a family to piece together the package

of benefits that it needs. This complex system is also administratively

burdensome and inefficient for the officials who deliver program services

and benefits. Some programs overlap, while others are so narrowly

focused that service gaps occur. Moreover, little is known about the

effectiveness of many welfare programs.

Multiple Programs Create

Difficulties for

Low-Income Families With

Many Needs

The programs that make up the nation’s welfare system have developed

incrementally over time as the Congress addressed specific needs of

low-income individuals and families. Considered individually, these

programs make sense. However, no overarching goal was ever developed

to unify the programs and help ensure that families’ needs were being met

as efficiently and effectively as possible.

Instead, each program has its own rules for eligibility and income

requirements, verification standards, and processing time frames. For

example, Food Stamps, AFDC, and Medicaid use different standards to

determine a family’s need for assistance. The Food Stamp program

determines need on the basis of the relationship of a household’s total

income to the federal poverty level, whereas in the AFDC program, need is

based on the relationship of a family’s income to the state’s need standard.

Medicaid bases its income limits on the maximum state AFDC payment

made to a family of the same size.

These three programs also treat assets differently. The AFDC program

allows a family to possess assets of up to $1,000, whereas the Food Stamp

program sets its maximum resource limit at $2,000 per household. Under

16According to a recent study, nearly 64 percent of welfare recipients leave AFDC within 2 years;

however, between two-thirds and three-fourths of those who leave AFDC return within a 5-year period;

see LaDonna A. Pavetti, The Dynamics of Welfare and Work: Exploring the Process by Which Women

Work Their Way Off Welfare (Cambridge, Mass.: Harvard University, 1993).

Page 14 GAO/HEHS-95-139 Welfare Reform
B-261056 

Medicaid, the resource limit is $2,000 for individuals and $3,000 for

couples and households with an elderly member. Income is verified in

similar ways by Food Stamps, AFDC, and Medicaid programs. However,

food stamp regulations also mandate verification of utility and medical

expenses, identity, residency, disability, and household composition. For

both AFDC and Medicaid, states may establish other additional verification

requirements. Moreover, for a family that owns a car, each program has

different rules governing the extent to which the car’s value is excluded in

valuing the family’s financial resources.

Time limits on eligibility determinations also vary among the programs.

Decisions on AFDC and Medicaid benefits must be reached within state-set

standards, not to exceed 45 days. States must provide AFDC benefits from

either the date of authorization or 30 days from application, whichever

occurs earlier. Food stamp recipients must receive benefits retroactive to

the date of application within 30 days of application under normal

processing and within 5 days for expedited service. Under Medicaid, states

may provide eligibility either from the date of application or the first day

of the month of the application.

From the low-income family’s perspective, navigating this complex system

of programs can be confusing and time-consuming. A low-income mother

with two children, for example, may need to visit several different offices

to obtain benefits from 17 different programs, as shown in figure 5. To

obtain benefits, a family will likely have to fill out separate applications for

each type of assistance. These applications are complicated and lengthy

and, in most cases, cannot be processed without documents, such as rent

receipts, birth certificates, and pay stubs. Such documentation

requirements may result in families’ having to return to the same office

more than once, and they may face the same scenario at each office they

must visit to obtain benefits.

Page 15 GAO/HEHS-95-139 Welfare Reform
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Figure 5: Multiple Offices May Provide Low-Income Assistance

Medical Services

– County Medical

Services

– Child Health &

Disability Prevention

& Treatment Program

64

Social Services

– AFDC

– Food Stamps

– Medicaid

Housing

Authority

– Section 8 Housing

– Public Housing

Child Care Programs

– AFDC/JOBS

Child Care

– At-Risk Child Care

– Child Care

Development Block

Grant

Employment &

Training Center

– JOBS

– JTPA

Internal Revenue

Service

– EIC

Social Security

Administration

– SSI

School

– School Lunch

– Individuals With

Disabilities

Education Act

Other Services

– WIC

Page 16 GAO/HEHS-95-139 Welfare Reform
B-261056 

The variations in eligibility rules and income requirements across

programs can also make it difficult for applicants to provide the

information needed for accurate eligibility and benefit determinations.

Such complexities may also make it difficult for eligibility workers to

correctly assess an individual’s or a family’s eligibility and calculate

benefit amounts.

Program Interactions Send

Mixed Messages to

Recipients

Interactions among the programs for which a family may be eligible may

send mixed messages to program recipients and undermine program goals.

The interaction between AFDC and SSI illustrates such a conflict. As of

January 1994, SSI benefits per person were higher than AFDC benefits for a

family of three in 36 states. SSI benefits increase a family’s total income,

because a family member’s SSI benefits are not included in the family’s

income when determining eligibility and calculating benefits for AFDC.

Given this, SSI may create an incentive for families to coach their children

to fake mental impairments by misbehaving or doing poorly in school so

that they can qualify for SSI.

17 This disparity between AFDC and SSI benefits

thus makes the SSI program susceptible to fraud and undermines a key

goal of the AFDC program—to help adult recipients reduce welfare

dependency.

Interactions between the AFDC and Food Stamp programs may also

undermine states’ efforts to reduce welfare dependency. For example,

some states sanction certain AFDC recipients for failing to attend job

training activities by reducing their AFDC benefits. These job training

activities are designed to help adult AFDC recipients obtain the skills they

need to obtain work. However, this reduction in AFDC benefits results in

recipients’ qualifying for increased food stamps. Therefore, the impact of

the AFDC sanction may have little real effect on recipients’ total income

and, thus, may not provide the intended incentive for the recipient to

continue in training activities.

Program Overlaps and

Service Gaps Create

Administrative

Inefficiencies and Service

Delivery Problems

The growth in welfare programs over time and the lack of overarching

goals have also contributed to overlapping and conflicting programs.

Program overlap adds unnecessary administrative costs at each level of

government and makes service delivery more complicated. At the federal

level, the myriad of assistance programs are administered by different

agencies, each with its own goals. In response to program complexities at

17Social Security: New Functional Assessments for Children Raise Eligibility Questions

(GAO/HEHS-95-66, Mar. 10, 1995).

Page 17 GAO/HEHS-95-139 Welfare Reform
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the federal level, states have established and maintained elaborate

organizational, programmatic, and financial structures for each program.

We have previously reported on several areas of program overlap,

including employment training, food assistance, and early childhood

programs. In each of these areas, at least some of the overlapping

programs are means-tested.18 The extent and nature of program overlaps

in each of these areas is summarized below.

Employment Training We have identified 163 federal programs scattered across 15 federal

agencies providing employment training assistance. The Departments of

Education and Labor administer the most programs—61 and 37,

respectively—while the remaining reside in departments not generally

expected to provide employment training assistance, such as the

Departments of Agriculture, Defense, Housing and Urban Development,

and Justice. Because of the many federal agencies administering

employment training programs, these programs frequently target the same

clients, share the same goals, and provide similar services. For example,

nine of these programs target economically disadvantaged individuals.

These agencies maintain separate administrative structures that devote

staff and other resources to administer, monitor, and review program

implementation. For example, within the 15 departments and agencies, 40

interdepartmental offices channel funds to state and local program

administrators. Each office provides staff and incurs costs—often at both

headquarters and regional locations—to plan and monitor the

implementation of its programs.

Food Assistance The Department of Agriculture administers 14 food assistance programs

for low-income individuals. These programs vary considerably in the type

of benefits provided and in the manner of providing them. The current

food assistance approach, which has evolved over the past 46 years, is

largely focused on the goals of the individual 14 programs rather than a

broader view of federal food assistance needs. For example, these

programs have a mix of purposes, including (1) supporting U.S.

agriculture, (2) enhancing children’s learning and growth processes,

(3) improving the health of Americans, and (4) improving the nutritional

content of diets. No overarching federal food assistance policy exists to

guide these programs or to explain how each program contributes to the

federal food assistance effort.

18GAO’s efforts to identify program overlap have been focused on program areas and were not limited

to means-tested programs. In a number of cases, multiple programs that GAO identified as overlapping

were cited as a single program in CRS’ 1993 report on means-tested programs.

Page 18 GAO/HEHS-95-139 Welfare Reform
B-261056 

Early Childhood More than 90 federal programs administered by 11 separate federal

agencies provide education, child care, and other services to very young

children. Of these, we identified 34 key programs that provided services to

children below age 5. Key programs include the Head Start program,

which provides education and developmental services to young children

and is administered by the Department of Health and Human Services. The

Department of Education’s Chapter 1 program also provides preschool

education to young children. Although these programs have some

similarities, they may target different populations, use different eligibility

criteria, and provide a different mix of services to children and their

families.

In contrast, other programs are so fragmented and narrowly focused that

service gaps result. For example, between 1988 and 1990, the Congress

created four child care programs for low-income families, and in fiscal

year 1994 nearly $2 billion in federal funds was made available for these

programs. The categorical nature of these child care subsidy programs

creates service gaps that diminish the likelihood that low-income mothers

will work.

For example, the current system of child care assistance guarantees

subsidies to AFDC recipients participating in employment or state-approved

education and training activities as well as to employed former AFDC

recipients, but not to working poor families outside the AFDC system. Yet

our analysis of low-income families showed that an AFDC recipient’s

economic status may differ little from a low-income, working non-AFDC

recipient’s. In fact, working non-AFDC recipients may be economically

worse off because they face work-related expenses that may include child

care. Moreover, because many AFDC recipients cycle on and off welfare,

the separate assistance programs may be distinguishing between the same

individuals at different points in their journey from welfare to

self-sufficiency.

Program Barriers Hinder

States’ Efforts to Develop

Streamlined Automated

Systems

The complexity of the welfare system has also made it difficult for states

to develop integrated, streamlined automated information systems.

Advances in technology have made greater systems integration, data

sharing, and consolidation more feasible, but program barriers have

hindered states’ ability to reengineer their welfare information systems.

Faced with diverse and sometimes contradictory program requirements,

separate funding provisions, statutory deadlines, and inadequate federal

monitoring, states have developed essentially separate automated systems

Page 19 GAO/HEHS-95-139 Welfare Reform
B-261056 

for each program. For example, in a recent survey of the status of state

automated welfare systems, we found that virtually all the states were

operating multiple systems (ranging from 2 to 12) to provide welfare

program support.19

Federal agencies are undertaking initiatives to help states develop more

efficient and effective automated welfare systems. Examples include

funding the consolidation of separate AFDC, Medicaid, and Food Stamp

eligibility systems into integrated Family Assistance Management

Information Systems and developing model systems for the Child Welfare

program. And some states—including Connecticut, Minnesota, Rhode

Island, and Texas—have focused on integrating their automated welfare

systems. However, the difficulties in surmounting program barriers such

as contradictory program requirements and separate funding provisions

leave many states with little opportunity or incentive to reexamine and, if

necessary, reengineer their existing automated processes.

Programs Susceptible to

Fraud, Waste, and Abuse

In addition to the challenges involved in efficiently running the programs

and delivering their services, welfare programs are inherently vulnerable

to fraud and abuse. Given their size and structure, these programs are

subject to billions of dollars in incorrect payments and services annually

as a result of fraudulent or erroneous eligibility and benefit claims. In

fiscal year 1993, nearly $1.8 billion in overpayments was estimated to have

been made in the Food Stamp program alone.

For example, we reported in 1993 that prescription drug diversion and

other fraudulent billings had been an ongoing problem in the Medicaid

program for at least the previous decade.20 We found that physicians,

clinic owners, and pharmacists collude to defraud Medicaid by billing for

services not rendered or needed and by prescribing and distributing drugs

mainly to obtain reimbursement. Patients are often willing participants in

these schemes, allowing the use of their Medicaid recipient numbers for

billing purposes in exchange for cash, drugs, or other inducements.

In January 1994, California estimated that hundreds of millions of dollars

were being wasted through fraud in its public assistance programs. In its

AFDC program alone, about 4 percent of cases randomly selected for quality

control review in 1992 and 1993 were estimated to involve fraud. In the

19Automated Welfare Systems: Historical Costs and Projections (GAO/AIMD-94-52FS, Feb. 25, 1994).

20Medicaid Drug Fraud: Federal Leadership Needed to Reduce Program Vulnerabilities

(GAO/HRD-93-118, Aug. 2, 1993.)

Page 20 GAO/HEHS-95-139 Welfare Reform
B-261056 

Food Stamp program, we found four problems that exist with the current

coupon-based system. In addition to benefit overpayments that occur

during the eligibility and benefit determination process, we identified the

illegal use of benefits after they are issued, counterfeiting of food stamps,

and theft of coupons from the mail as common problems.

To cite another example, we found that noncompliance in the Earned

Income Credit (EIC) program has been a continuing concern of the Internal

Revenue Service (IRS).21 EIC provides assistance to low-income working

taxpayers to offset the impact of Social Security taxes and to encourage

them to work. EIC expenditures were about $10.9 billion in fiscal year 1993.

An IRS study of noncompliance for returns filed electronically during 2

weeks in January 1994 found that an estimated 29 percent of the returns

claimed too much EIC and that for about 13 percent of these, taxpayers

may have intentionally claimed too much EIC. Judging by problems spotted

by IRS personnel, noncompliance on EIC paper returns is also a concern. In

1994, IRS withheld refunds of about $500 million from about 400,000 paper

return filers due to insufficient proof that they qualified.

Where benefit overpayments do occur, variations in programs’ authorizing

legislation may reduce the government’s ability to recover overpaid

amounts. For example, Food Stamp legislation authorizes states to

intercept individuals’ federal income tax refunds if they are delinquent in

repaying overpaid amounts; AFDC legislation provides no such authority.

AFDC rules generally allow administrators to reduce benefits in order to

collect overpayments on all types of errors; Food Stamp law allows

program administrators to reduce recipients’ benefits in order to recover

overpayments due to agency error only with the recipient’s consent. We

will be providing information on states’ efforts to collect overpayments

and examining options for increasing collections in an upcoming report.

Little Is Known About

Programs’ Effectiveness

With the growth in the size and numbers of welfare programs,

policymakers and the public have become increasingly concerned about

the effectiveness of individual programs as well as the system as a whole.

However, many programs do not articulate specific and measurable policy

goals that should be achieved; nor do they collect the data necessary to

determine how recipients fare. Instead, program monitoring generally

focuses on compliance with program requirements and procedures.

21Earned Income Credit: Targeting to the Working Poor (GAO/T-GGD-95-136, Apr. 4, 1995).

Page 21 GAO/HEHS-95-139 Welfare Reform
B-261056 

For example, most agencies that administer employment training

programs do not know if their programs are really helping people find

jobs. One such program is the Job Opportunities and Basic Skills program

(JOBS), the employment training program designed specifically to provide

parents receiving AFDC with the help they need to find jobs and avoid

long-term welfare dependence. Since 1989, nearly $8 billion in federal and

state funds has been spent on this program, yet JOBS is not well focused on

its primary goal, getting recipients employed.

The U.S. Department of Health and Human Services (HHS) does not know

whether JOBS is reducing welfare dependency because it does not gather

enough information on critical program outcomes, such as the number of

participants entering employment and leaving AFDC annually. In addition,

states are held accountable for the number and type of participants

enrolled in education and training but not for outcomes, such as the

number of participants finding employment. While the current approach to

monitoring performance provides important information on the activities

of JOBS participants, state JOBS directors are concerned that the approach

provides little incentive for states to focus on moving participants off AFDC

and into jobs.

Moreover, despite the JOBS program goal of helping move AFDC adult

recipients from welfare to work, most adult recipients do not participate

in the JOBS program due to allowable exemptions and minimum

participation rates established in the legislation that created the JOBS

program.22 While JOBS has grown at the gradual rate provided for by the

Family Support Act, the program still reached only about 13 percent of

single female-headed households receiving AFDC each month in 1992, with

about 60 percent exempt from participation. Most of the 1.95 million

exempt adults were excused from participation because they were caring

for a child less than 3 years old.23

Recognizing the need to better focus on program results, the Congress

enacted the Government Performance and Results Act of 1993 (GPRA). GPRA

seeks to shift the focus of federal management and accountability away

from a preoccupation with inputs, such as budget and staffing levels and

adherence to rigid processes, to a greater focus on outcomes and results.

GPRA requires every agency to establish indicators of performance, set

annual performance goals, and report on actual performance in

22The 1988 Family Support Act established the JOBS program.

23Welfare to Work: Participants’ Characteristics and Services Provided in JOBS (GAO/HEHS-95-93,

May 2, 1995).

Page 22 GAO/HEHS-95-139 Welfare Reform
B-261056 

comparison with these goals each March beginning in the year 2000.

However, given the current lack of data on program outcomes, much of

the work needed to comply with GPRA lies ahead.

Consolidation Could

Improve Program

Efficiency and

Effectiveness

Program consolidation is one possible approach to reducing program

overlaps and service gaps and improving the efficiency and effectiveness

of service delivery. The Congress and the administration have proposed

consolidating some of these programs to streamline service delivery,

reduce administrative costs, and enhance the states’ ability to deliver

services. However, deciding how and whether to consolidate specific

programs is a complex task because of differences in existing program

structures. Moreover, consolidation can be accomplished in a number of

different ways, such as using block grants. Regardless of how programs

are restructured, the Congress and the federal agencies will continue to

maintain an interest in the efficient and effective use of federal funds.

State and Local Efforts to

Consolidate Services

As we have noted, states are moving to reform specific programs such as

Medicaid and AFDC. In addition, state governments and local providers

have reform efforts underway that are designed to coordinate service

delivery and streamline operations across several programs. Connecticut,

for example, has a project to provide an integrated set of services in one

location, in conjunction with efforts to integrate its automated processes.

Under this initiative, the state’s Departments of Labor and Social Services

are jointly establishing one-stop shopping career centers located

throughout the state. These centers will provide individuals with

employment training and unemployment compensation benefits and

services.

Oregon has developed a multiyear demonstration to encourage

cooperation among federal, state, and local agencies. Known as the

Oregon Option, this demonstration is focused on redesigning and testing

an outcomes-oriented approach to intergovernmental service delivery. As

part of this effort, a Federal Interagency Action Team was organized to

work with state and local officials. This team includes officials from the

Domestic Policy Council, the Office of Management and Budget (OMB), and

seven federal departments—Agriculture, Commerce, Education, HHS,

Housing and Urban Development (HUD), Justice, and Labor. Together with

state and local agencies, this interagency team developed cross-cutting

initiatives for children and families and is using measurable outcomes to

determine how well the state is meeting long-range goals.

Page 23 GAO/HEHS-95-139 Welfare Reform
B-261056 

In another example, local providers in Baltimore are working

collaboratively to make needed services more accessible to families in

low-income neighborhoods. The city’s Lafayette Square Community

Center provides training, employment, and scholarship programs for

unemployed young adults seeking jobs and educational opportunities. As a

long-term community-based effort, the center currently works

collaboratively with the Sandtown-Winchester neighborhood to offer a

broad array of services for the local community.

State and local officials who seek innovative approaches for delivering

services and benefits are faced with the challenge of funding and

managing multiple programs. For example, the different funding sources

needed to support multiple programs create a strain on the financial

systems of community-based organizations because each program has a

different set of accounting standards and reporting requirements and,

therefore, has to be tracked separately. Other efforts, such as those in

Baltimore, have been hindered by the lack of coordination among the

many federal departments and agencies that have responsibility for

administering the programs that can be used to assist distressed

communities.

Past efforts to better coordinate at the federal level have generally been

unsuccessful, leaving community organizations to try to piece together

programs to serve their communities. For example, we found that the

federal government had set up a patchwork of parallel administrative

structures to deliver an estimated $25 billion annually in employment and

training services. Many of these programs target the same population, yet

despite decades of attempts to improve coordination, conflicting program

requirements continue to hamper administrators’ efforts to coordinate

activities and share resources.24

Federal Proposals to

Consolidate Programs

To provide states with greater flexibility and reduce administrative costs,

the Congress and the administration are considering proposals to

consolidate certain welfare programs. For example, the welfare reform bill

recently passed by the House—H.R. 4—would consolidate eight child care

programs into one Child Care Block Grant. Included in this proposal are

the four subsidy programs—Child Care and Development Block Grant,

AFDC-Child Care, Transitional Child Care, and At-Risk Child Care—where

we found service gaps. Congressional committees are also considering

24Community Development: Comprehensive Approaches Address Multiple Needs but Are Challenging

to Implement (GAO/RCED/HEHS-95-69, Feb. 8, 1995).

Page 24 GAO/HEHS-95-139 Welfare Reform
B-261056 

proposals to consolidate a number of the employment training programs

that we identified as overlapping. These committees also have proposed

consolidating three federal departments and agencies—the Departments

of Education and Labor and the Equal Employment Opportunities

Commission—to improve the quality of services provided.25 In the housing

area, HUD has proposed consolidating 60 programs into 3.

Consolidating overlapping programs or groups of programs that create

service gaps could improve program efficiency and effectiveness.

Consolidating the child care subsidies, for example, could be a remedy for

the service gaps that trouble mothers, child care providers, and program

administrators alike. Consolidation could also offer states the flexibility to

tailor their child care assistance programs to their particular mix of

low-income families. Consolidating overlapping employment training

programs could reduce administrative costs by eliminating duplicative

bureaucracies.

Issues to Consider in

Consolidating Programs

Although consolidating overlapping programs or programs that create

service gaps can improve program effectiveness and efficiency, decisions

on program consolidation are complex. Officials from OMB and public

policy researchers believe that program consolidation has historically

been difficult to achieve because of the congressional subcommittee

structure, the protectiveness of agencies toward their programs, and the

strong program support of constituent groups. In addition, overlapping

programs may have different managerial and financial requirements that

may make it difficult to combine program resources.

For example, the nine employment training programs that target the

economically disadvantaged are administered by five different federal

departments and have three different operating cycles—starting either

October 1, July 1, or September 1. Moreover, these programs use separate,

parallel structures to administer the delivery of services. The Job Training

Partnership Act program (JTPA), for example, funds about 630 service

delivery areas to administer local services. In contrast, the JOBS and Food

Stamp Education and Training programs frequently use the network of

over 3,000 state- or county-run welfare offices to administer the delivery of

program services. These differences could serve as barriers to program

consolidation and should be considered in deciding which programs to

consolidate.

25In an upcoming report, we address issues related to this proposed consolidation.

Page 25 GAO/HEHS-95-139 Welfare Reform
B-261056 

In addition to determining which programs to consolidate, decisions as to

what the federal government’s role will be in overseeing and managing a

consolidated set of programs are critical. A major goal of current program

consolidation proposals—especially those that would provide block grants

to the states—is to provide the states with more flexibility to set priorities

and manage programs and funds.

In previous reports, we have recommended a shift in program focus from

federal management and accountability toward program results and

outcomes, with less emphasis on rigid adherence to rules. This focus on

outcomes—lacking in many of the individual welfare programs—will be

especially important if states are provided greater flexibility in

determining specific problems to address and strategies for addressing

them. Decisions will need to be reached as to the kinds and nature of

information needed to assess program results. Given its focus on program

outcomes and results, GPRA may provide a useful accountability

framework.

Conclusions The federal government provides billions of dollars annually in public

assistance through an inefficient welfare system that is increasingly

cumbersome for program administrators to manage and difficult for

eligible clients to access. Program consolidation may be one strategy to

reduce the inefficiency of the current system of overlapping and

fragmented programs. Regardless of how the welfare system is

restructured, ensuring that federal funds are used efficiently and that

programs are focused on outcomes remains important. Without a focus on

outcomes, concerns about the effectiveness of welfare programs will not

be adequately addressed.

Page 26 GAO/HEHS-95-139 Welfare Reform
B-261056 

Because this report is based on information contained in published GAO

reports and testimonies, we did not obtain official agency comments. We

are sending copies of this report to the appropriate congressional

committees and federal agencies. Copies also will be available to others on

request.

If you or your staff have any questions concerning this report, please call

me on (202) 512-7215. Other GAO contacts and staff acknowledgments are

listed in appendix I.

Sincerely yours,

Jane L. Ross

Director, Income Security Issues

Page 27 GAO/HEHS-95-139 Welfare Reform
Contents

Letter 1

Appendix I 

Estimated

Expenditures for

Means-Tested

Assistance Programs

(Fiscal Year 1993)

30

Appendix II 

GAO Reports and

Testimonies on

Welfare Programs and

Issues

37

Income Support 37

Medical Care 37

Food and Nutrition 38

Housing 38

Education and Training 39

Services 40

Management Issues 40

Appendix III 

GAO Contact and

Acknowledgments

42

Tables Table 1: Selected Means-Tested Programs, by Type of Assistance 5

Table I.1: Summary of Welfare Programs 30

Table I.2: Income Support Programs 31

Table I.3: Medical Care Programs 32

Table I.4: Food and Nutrition Programs 33

Table I.5: Housing Programs 34

Table I.6: Education Programs 35

Table I.7: Training Programs 36

Table I.8: Services 36

Figures Figure 1: Growth in Federal Spending For Five Largest

Means-Tested Programs, 1980-93

6

Figure 2: Federal and State Expenditures for Five Largest Welfare

Programs, Fiscal Year 1993

8

Page 28 GAO/HEHS-95-139 Welfare Reform
Contents

Figure 3: Percentage of AFDC Families Receiving Noncash

Assistance

12

Figure 4: Comparison of AFDC and Working Poor Families’

Benefit Receipt

13

Figure 5: Multiple Offices May Provide Low-Income Assistance 16

Abbreviations

AFDC Aid to Families With Dependent Children

CCDBG Child Care and Development Block Grant

CPS Current Population Survey

CRS Congressional Research Service

EIC Earned Income Credit

GPRA Government Performance and Results Act of 1993

HHS Health and Human Services

HUD Housing and Urban Development

IRS Internal Revenue Service

JOBS Job Opportunities and Basic Skills

JTPA Job Training Partnership Act

OMB Office of Management and Budget

SSBG Social Services Block Grant

SSI Supplemental Security Income

WIC Special Supplemental Food Program for Women, Infants and

Children

Page 29 GAO/HEHS-95-139 Welfare Reform
Appendix I 

Estimated Expenditures for Means-Tested

Assistance Programs (Fiscal Year 1993)

Table I.1: Summary of Welfare

Programs (Fiscal Year 1993) Estimated expenditures (in millions)

Benefit category Federal State Total

Income support $53,325 $20,356 $73,681

Medical care 86,293 61,493 147,786

Food and nutrition 33,185 1,544 34,729

Housing 22,757 64 22,821

Education 16,690 632 17,322

Training 4,733 562 5,295

Services 5,536 3,866 9,402

Total $222,519 $88,517 $311,036

Page 30 GAO/HEHS-95-139 Welfare Reform
Appendix I 

Estimated Expenditures for Means-Tested

Assistance Programs (Fiscal Year 1993)

Table I.2: Income Support Programs (Fiscal Year 1993) 

Estimated expenditures (in millions)

Program Federal State Total

Average monthly

recipients (in

thousands)

Aid to Families With Dependent Childrena $13,757 $11,302 $25,059 14,144b

Supplemental Security Incomea 21,801 3,908 25,709 6,021c

Earned Income Credita,d 10,883 e 10,883 14,004

Pensions for Needy Veterans, their Dependents, and Survivorsa 3,477 0 3,477 896

Foster Carea 2,524 1,171 3,695 233

General Assistance (nonmedical care component)a 0 3,350 3,350 1,168

Adoption Assistancef 272 231 503 78

Assistance to Refugees and Cuban/Haitian Entrants (cash components)f 74 0 74 26

Emergency Assistancea 394 394 788 165g

Dependency and Indemnity Compensation and Death Compensation for

Parents of Veteransa 60 0 60 30

General Assistance to Indiansa 83 0 83 56

Total $53,325 $20,356 $73,681 h

aCongressional Research Service.

bChildren and/or parents.

cAnnual number.

dData are from the Joint Tax Committee and refer to the calendar year in which the credit was

received. Benefits exclude tax expenditures (reductions in taxes owed), which totalled $2.3 billion

in 1993.

eNot available.

f

Department of Health and Human Services.

gFamilies or households.

hBecause of overlap, and in some cases because of mixture of monthly and annual numbers and

mixture of dwelling units, loans, grants, children, families, and households, recipient totals are not

shown.

Page 31 GAO/HEHS-95-139 Welfare Reform
Appendix I 

Estimated Expenditures for Means-Tested

Assistance Programs (Fiscal Year 1993)

Table I.3: Medical Care Programs (Fiscal Year 1993) 

Estimated expenditures (in millions)

Program Federal State Total

Average monthly

recipients (in

thousands)

Medicaida $74,953 $55,886 $130,839 33,432b

Medical Care for Veterans Without Service-Connected Disabilityc 8,349 0 8,349 601d

General Assistance (medical care component)c 0 5,189 5,189 e

Indian Health Servicesc 1,525 0 1,525 1,300b

Maternal and Child Health Services Block Grantc 558 418 976 11,600

Community Health Centersc 559 e 559 6,200b

Title X Family Planning Servicesc 173 0 173 4,000b

Migrant Health Centersc 57 e 57 550b

Medical Assistance to Refugees and Cuban/Haitian Entrantsa 119 0 119 37

Total $86,293 $61,493 $147,786 f

aDepartment of Health and Human Services.

bAnnual number.

cCongressional Research Service.

dAnnual number of episodes.

eNot available.

f

Because of overlap, and in some cases because of mixture of monthly and annual numbers and

mixture of dwelling units, loans, grants, children, families, and households, recipient totals are not

shown.

Page 32 GAO/HEHS-95-139 Welfare Reform
Appendix I 

Estimated Expenditures for Means-Tested

Assistance Programs (Fiscal Year 1993)

Table I.4: Food and Nutrition Programs (Fiscal Year 1993) 

Estimated expenditures (in millions)

Program Federal State Total

Average monthly

recipients (in

thousands)

Food Stampsa $23,698 $1,544 $25,242 26,983

School Lunch Program (free and reduced-price segments)a 3,791 b 3,791 4,800

Special Supplemental Food Program for Women, Infants, and Childrena 2,928 b 2,928 5,921

School Breakfast Program (free and reduced-price segments)a 877 b 877 4,844

Child and Adult Care Food Programa 697 b 697 2,119

Nutrition Program for the Elderly (no income test, but preferences for

those with greatest economic or social needs)c 607 b 607 3,200d

The Emergency Food Assistance Programa 207 b 207 7,759e

Summer Food Service Program for Childrena 228 b 228 2,057

Commodity Supplemental Food Programa 82 b 82 371

Food Distribution Program on Indian Reservationsa 68 b 68 116

Special Milk Program (free segment)a 2 b 2 61

Total $33,185 $1,544 $34,729 f

aDepartment of Agriculture.

bNot available.

cCongressional Research Service.

dAnnual number.

eFamilies or households.

f

Because of overlap, and in some cases because of mixture of monthly and annual numbers and

mixture of dwelling units, loans, grants, children, families, and households, recipient totals are not

shown.

Page 33 GAO/HEHS-95-139 Welfare Reform
Appendix I 

Estimated Expenditures for Means-Tested

Assistance Programs (Fiscal Year 1993)

Table I.5: Housing Programs

Estimated expenditures (in millions)

Program Federal State Total

Families or units

during the year (in

thousands)

Section 8 Low-Income Housing Assistancea $11,158 $0 $11,158 2,812b

Low-Rent Public Housinga 6,180 0 6,180 1,408b

Low-Income Home Energy Assistancec 1,346 64 1,410 5,600

Rural Housing Loansd 1,831 0 1,831 31

Section 236 Interest Reduction Paymentsa 635 0 635 510b

Rural Rental Housing Loansd 574 0 574 15

Rural Rental Assistanced 404 0 404 34b

Weatherization Assistancec 186 0 186 107

Section 101 Rent Supplementsa 55 0 55 19b

Section 235 Homeownership Assistancea 62 0 62 95b

Farm Labor Housing Loans and Grantsd 32 0 32 1

Rural Housing Repair Loans and Grantsd 26 0 26 6e

Rural Housing Preservation Grantsd 23 0 23 6

Indian Housing Improvement Grantsc 20 0 20 1b

Rural Self-Help Technical Assistance Grants and Site Loansd 19 0 19 f

Home Investment Partnershipsa 206 f 206 f

Total $22,757 $64 $22,821 g

aDepartment of Housing and Urban Development.

bUnits.

cCongressional Research Service.

dDepartment of Agriculture.

eLoans or grants.

f

Not available.

gBecause of overlap, and in some cases because of mixture of monthly and annual numbers and

mixture of dwelling units, loans, grants, children, families, and households, recipient totals are not

shown.

Page 34 GAO/HEHS-95-139 Welfare Reform
Appendix I 

Estimated Expenditures for Means-Tested

Assistance Programs (Fiscal Year 1993)

Table I.6: Education Programs (Fiscal Year 1993) 

Estimated expenditures (in millions)

Program Federal State Total

Annual number of

recipients (in

thousands)

Stafford Loansa $5,825 $0 $5,825 5,300

Pell Grantsa 5,788 0 5,788 3,808

Head Startb 2,800 560 3,360 714

College Work-Study Programa 617 0 617 713

Supplemental Educational Opportunity Grantsa 583 0 583 991

Federal TRIO Programsb 385 0 385 648

Chapter 1 Migrant Education Programb 303 0 303 402

Perkins Loansa 181 0 181 697

State Student Incentive Grant Programsa 72 72 144 241

Fellowships for Graduate and Professional Studyb 63 0 63 6

Health Professions Student Loans and Scholarshipsa 49 0 49 36

Follow Throughb 9 0 9 c

Migrant High School Equivalency Programb 8 0 8 3

Ellender Fellowshipsb 4 0 4 6

College Assistance Migrant Programb 2 0 2 0

Child Development Associate Scholarshipsb 1 0 1 c

Total $16,690 $632 $17,322 d

aDepartment of Education.

bCongressional Research Service.

cNot available.

dBecause of overlap, and in some cases because of mixture of monthly and annual numbers and

mixture of dwelling units, loans, grants, children, families, and households, recipient totals are not

shown.

Page 35 GAO/HEHS-95-139 Welfare Reform
Appendix I 

Estimated Expenditures for Means-Tested

Assistance Programs (Fiscal Year 1993)

Table I.7: Training Programs (Fiscal Year 1993) 

Estimated expenditures (in millions)

Program Federal State Total

Average monthly

recipients (in

thousands)

JTPA (Training Services for Disadvantaged Adults)a $1,015 $0 $1,015 358

JTPA (Training Services for Disadvantaged Youth)a 677 0 677 281

JTPA (Summer Youth Employment and Training Program)a 849 0 849 569

JTPA (Job Corps)a 966 0 966 102

Job Opportunities and Basic Skills Training Programa 735 471 1,206 542

Senior Community Service Employment Programa 396 44 440 65

Foster Grandparentsa 65 30 95 22

Senior Companionsa 30 17 47 13

Total $4,733 $562 $5,295 b

aCongressional Research Service.

bBecause of overlap, and in some cases because of mixture of monthly and annual numbers and

mixture of dwelling units, loans, grants, children, families, and households, recipient totals are not

shown.

Table I.8: Services (Fiscal Year 1993) 

Estimated expenditures (in millions)

Program Federal State Total

Annual number of

recipients (in

thousands)

Social Services Block Grant (Title XX)a $2,800 $3,332 $6,132 b

Child Care and Development Block Granta 893 b 893 b

AFDC and Transitional Child Carea 583 420 1,003 474c

At Risk Child Carea 264 114 378 219c

Community Services Block Granta 441 0 441 b

Legal Servicesa 357 0 357 b

Emergency Food and Shelter programa 129 0 129 b

Social Services for Refugees and Cuban/Haitian Entrantsd 69 0 69 114

Total $5,536 $3,866 $9,402 e

aCongressional Research Service.

bNot available.

cChildren and/or parents.

dDepartment of Health and Human Services.

eBecause of overlap, and in some cases because of mixture of monthly and annual numbers and

mixture of dwelling units, loans, grants, children, families, and households, recipient totals are not

shown.

Page 36 GAO/HEHS-95-139 Welfare Reform
Appendix II 

GAO Reports and Testimonies on Welfare

Programs and Issues

Income Support Earned Income Credit: Targeting to the Working Poor (GAO/T-GGD-95-136,

Apr. 4, 1995).

Social Security: New Functional Assessments for Children Raise Eligibility

Questions (GAO/HEHS-95-66, Mar. 10, 1995).

Means-Tested Programs: An Overview, Problems, and Issues

(GAO/T-HEHS-95-76, Feb. 7, 1995).

Low-Income Families: Comparison of Incomes of AFDC and Working Poor

Families (GAO/T-HEHS-95-63, Jan. 25, 1995).

Welfare to Work: Current AFDC Program Not Sufficiently Focused on

Employment (GAO/HEHS-95-28, Dec. 19, 1994).

Child Welfare: HHS Begins to Assume Leadership to Implement National

and State Systems (GAO/AIMD-94-37, June 8, 1994).

Tax Administration: Earned Income Credit-Data on Noncompliance and

Illegal Alien Recipients (GAO/GGD-95-27, Oct. 25, 1994).

Welfare to Work: JOBS Participation Rate Data Unreliable for Assessing

States’ Performance (GAO/HRD-93-73, May 5, 1993).

Earned Income Tax Credit: Effectiveness of Design and Administration

(GAO/T-GGD-93-20, Mar. 30, 1993).

Medical Care Medicaid: Restructuring Approaches Leave Many Questions

(GAO/HEHS-95-103, Apr. 4, 1995).

Medicaid: Spending Pressures Drive States Toward Program Reinvention

(GAO/HEHS-95-122, Apr. 4, 1995).

Medicaid: Experience With State Waivers to Promote Cost Control and

Access to Care (GAO/T-HEHS-95-115, Mar. 23, 1995).

Medicaid: A Program Highly Vulnerable to Fraud (GAO/T-HEHS-94-106, Feb. 25,

1994).

Medicaid: Alternatives for Improving the Distribution of Funds to States

(GAO/HRD-93-112FS, Aug. 20, 1993).

Page 37 GAO/HEHS-95-139 Welfare Reform
Appendix II 

GAO Reports and Testimonies on Welfare

Programs and Issues

Medicaid Drug Fraud: Federal Leadership Needed to Reduce Program

Vulnerabilities (GAO/HRD-93-118, Aug. 2, 1993); testimony on same topic

(GAO/T-HRD-93-28, Aug. 2, 1993).

Medicaid: Data Improvements Needed to Help Manage Health Care

Program (GAO/IMTEC-93-18, May 13, 1993).

Medicaid: States Turn to Managed Care to Improve Access and Control

Costs (GAO/HRD-93-46, Mar. 17, 1993); testimony on same topic

(GAO/T-HRD-93-10, Mar. 17, 1993).

Food and Nutrition Food Assistance: Potential Impacts of Alternative Systems for Delivering

Food Stamp Program Benefits (GAO/RCED-95-13, Dec. 16, 1994).

Food Assistance: Information on Meal Costs in the National School Lunch

Program (GAO/RCED-94-32BR, Dec. 1, 1993).

Food Assistance: USDA’s Multiprogram Approach (GAO/RCED-94-33, Nov. 24,

1993).

Food Stamp Program Provisions (GAO/RCED-93-70R, Nov. 25, 1992).

Housing Housing and Urban Development: Reinvention and Budget Issues

(GAO/T-RCED-95-112, Feb. 22, 1995).

Housing and Urban Development: Reforms at HUD and Issues for Its Future

(GAO/T-RCED-95-108, Feb. 22, 1995).

Housing and Urban Development: Major Management and Budget Issues

(GAO/T-RCED-95-89, Jan. 24, 1995).

Federally Assisted Housing: Conditions of Some Properties Receiving

Section 8 Project-Based Assistance Is Below Housing Quality Standards

(GAO/T-RCED-94-273, July 26, 1994).

Public Housing: Information on Backlogged Modernization Funds

(GAO/RCED-94-217FS, July 15, 1994).

Section 8 Rental Housing: Merging Assistance Programs Has Benefits but

Raises Implementation Issues (GAO/RCED-94-85, May 27, 1994).

Page 38 GAO/HEHS-95-139 Welfare Reform
Appendix II 

GAO Reports and Testimonies on Welfare

Programs and Issues

Multifamily Housing: Status of HUD’s Multifamily Loan Portfolio

(GAO/RCED-94-173FS, Apr. 12, 1994).

Public Housing: Low-Income Housing Tax Credit as an Alternative

Development Method (GAO/RCED-93-31, July 16, 1993).

Education and

Training

Welfare to Work: Participants’ Characteristics and Services Provided in

JOBS (GAO/HEHS-95-93, May 2, 1995).

Welfare to Work: Measuring Outcomes for JOBS Participants (GAO/HEHS-95-86,

Apr. 17, 1995).

Multiple Employment Training Programs: Major Overhaul Needed to

Create a More Efficient, Customer-Driven System (GAO/T-HEHS-95-70, Feb. 6,

1995).

Welfare to Work: AFDC Training Program Spends Billions, but Not Well

Focused on Employment (GAO/T-HEHS-95-51, Jan. 10, 1995).

Multiple Employment Training Programs: Major Overhaul Needed to

Reduce Costs, Streamline the Bureaucracy, and Improve Results

(GAO/T-HEHS-95-53, Jan. 10, 1995).

JOBS and JTPA: Tracking Spending Outcomes and Program Performance

(GAO/HEHS-94-177, July 15, 1994).

Multiple Employment Training Programs: Overlap Among Programs Raises

Questions About Efficiency (GAO/HEHS-94-193, July 11, 1994).

Multiple Employment Training Programs: Conflicting Requirements

Underscore Need for Change (GAO/T-HEHS-94-120, May 10, 1994).

Multiple Employment Training Programs: Major Overhaul Is Needed

(GAO/T-HEHS-94-109, Mar. 3, 1994).

Multiple Employment Training Programs: Most Federal Agencies Do Not

Know If Their Programs Are Working Effectively (GAO/HEHS-94-88, Mar. 2,

1994).

Multiple Employment Training Programs: Overlapping Programs Can Add

Unnecessary Administrative Costs (GAO/HEHS-94-80, Jan. 28, 1994).

Page 39 GAO/HEHS-95-139 Welfare Reform
Appendix II 

GAO Reports and Testimonies on Welfare

Programs and Issues

Multiple Employment Training Programs: Conflicting Requirements

Hamper Delivery of Services (GAO/HEHS-94-78, Jan. 28, 1994).

Services Child Care: Recipients Face Service Gaps and Supply Shortage

(GAO/T-HEHS-95-96, Mar. 1, 1995).

Child Care: Narrow Subsidy Programs Create Problems for Mothers Trying

to Work (GAO/T-HEHS-95-69, Jan. 31, 1995).

Child Care: Child Care Subsidies Increase Likelihood That Low-Income

Mothers Will Work (GAO/HEHS-95-20, Dec. 30, 1994).

Child Care: Promoting Quality in Family Child Care (GAO/HEHS-95-36, Dec. 7,

1994).

Child Care: Current System Could Undermine Goals of Welfare Reform

(GAO/T-HEHS-94-238, Sept. 20, 1994).

Child Care: Working Poor and Welfare Recipients Face Service Gaps

(GAO/HEHS-94-87, May 13, 1994).

Management Issues Department of Education: Information on Consolidation Opportunities

and Student Aid (GAO/T-HEHS-95-130, Apr. 6, 1995).

Tax Administration: IRS’ Fiscal Year 1996 Budget and the 1995 Filing

Season (GAO/T-GGD-95-97, Feb. 27, 1995).

Block Grants: Characteristics, Experience, and Lessons Learned

(GAO/HEHS-95-74, Feb. 9, 1995).

Community Development: Comprehensive Approaches Address Multiple

Needs but Are Challenging to Implement (GAO/RCED/HEHS-95-69, Feb. 8, 1995).

Health and Human Services: Opportunities to Realize Savings

(GAO/T-HEHS-95-57, Jan. 12, 1995).

Early Childhood Programs: Multiple Programs and Overlapping Target

Groups (GAO/HEHS-95-4FS, Oct. 31, 1994).

Page 40 GAO/HEHS-95-139 Welfare Reform
Appendix II 

GAO Reports and Testimonies on Welfare

Programs and Issues

Automated Welfare Systems: Historical Costs and Projections

(GAO/AIMD-94-52FS, Feb. 25, 1994).

Management Reform: GAO’s Comments on the National Performance

Review’s Recommendations (GAO/OGC-94-1, Dec. 3, 1993).

Integrating Human Services: Linking At-Risk Families with Services More

Successful Than System Reform Efforts (GAO/HRD-92-108, Sept. 24, 1992).

Page 41 GAO/HEHS-95-139 Welfare Reform
Appendix III 

GAO Contact and Acknowledgments

Contact Cynthia M. Fagnoni, Assistant Director, (202) 512-7202

Acknowledgments In addition to the contact named above, the following individuals made

important contributions to this report: Paula A. Bonin, Senior Computer

Specialist; Karen A. Brown, Evaluator; Annette Graziani Lozen, Evaluator;

Ronald Vieregge, Senior Evaluator; and Mark E. Ward, Senior Evaluator.

(105924) Page 42 GAO/HEHS-95-139 Welfare Reform
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