Homelessness: Improving Program Coordination and Client Access to Programs
Published: 2002-03-06T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: Many people are homeless for only a short time and get back on their feet with minimal assistance, but others are chronically homeless and need intensive and ongoing assistance. Fifty federal programs exist to help the homeless with housing. Sixteen of these are targeted exclusively to the homeless, and the others are mainstream programs. Targeted programs were funded at $1.7 billion in fiscal year 2001.
section_title: What GAO Found
paragraphs: GAO found that the Department of Housing and Urban Development (HUD) has been unable to ensure that adequate coordination occurs among the programs without creating undue administrative burdens for the states and communities. Steps have been taken to improve the coordination of homeless assistance programs within communities and to reduce some of the administrative burdens caused by separate programs. Although low-income populations face barriers to obtaining services provided by mainstream programs, these barriers are compounded by homelessness. In addition, the underlying structure and operations of federal mainstream programs do not ensure that the special needs of homeless people are met. Consolidating HUD's McKinney-Vento programs could help reduce the administrative burden. However, to end chronic homelessness in 10 years, federal agencies must strive to eliminate the barriers that homeless people encounter as they seek services from mainstream programs.

section_title: Letter
paragraphs: We are here today at your request to discuss federal assistance for  homeless people. As you know, homelessness in America is a complex  issue. Many people are homeless for only a short time and get back on  their feet with minimal assistance, but others are chronically homeless and  need a range of intensive and ongoing assistance in addition to housing. In  the late 1980s, Congress recognized that existing programs were not  effectively meeting the needs of homeless people. Consequently, Congress  passed the Steward B. McKinney Homeless Assistance Act (now known as  the McKinney-Vento Homeless Assistance Act) in 1987 as a comprehensive  federal response to homelessness. As part its fiscal year 2003 budget  submission, the Administration announced that it has made ending  chronic homelessness in the next decade a top objective. The Department  of Housing and Urban Development (HUD) is responsible for helping the  homeless toward self-sufficiency, in part, through four key McKinney- Vento Act programs, the Emergency Shelter Grants program, the  Supportive Housing Program, the Shelter Plus Care program, and the  Section 8 Single-Room Occupancy program. Low-income people,  including those who are homeless, can also receive a wide range of  assistance—such as housing, food, health care, transportation, and job  training—through an array of mainstream federal programs, such as the  Food Stamp Program and Medicaid.
Our testimony today is based primarily on issued reports and testimony  over the past 4 years. We will focus on the (1) federal approach to  assisting homeless people, (2) actions HUD has taken to overcome the  coordination and administrative challenges posed by its homelessness  programs, (3) inability of homeless people to access and use federal  mainstream programs that are available to low-income people generally,  and (4) issues that should be addressed in considering future  homelessness policies.
The federal approach to assisting homeless people includes 50 programs  administered by 8 federal agencies. Sixteen of these programs are  targeted, or reserved for the homeless, and the rest are mainstream  programs. In part because of the difficulties that homeless people have  accessing mainstream programs, much of the assistance provided under  the targeted programs mirrors the assistance provided under the  mainstream programs. Targeted programs were funded at about $1.7  billion in fiscal year 2001.
Under the varying eligibility and funding requirements of HUD’s four  McKinney-Vento Act programs, it has been a challenge for HUD to ensure  that adequate coordination occurs among the programs without creating  undue administrative burdens for the states and communities. HUD has  taken actions that have improved the coordination of homeless assistance  programs within communities and have helped reduce some of the  administrative burdens that separate programs cause.
Homeless people are often unable to access and use federal mainstream  programs because of the inherent conditions of homelessness as well as  the structure and operations of the programs themselves. All low-income  populations face barriers to applying for, retaining, and using the services  provided by mainstream programs; however, these barriers are  compounded by the inherent conditions of homelessness, such lack of a  permanent address or a phone number. In addition, the underlying  structure and operations of federal mainstream programs are often not  conducive to ensuring that the special needs of homeless people are met.
As we testified previously, consolidating HUD’s McKinney-Vento programs  is a step that could help reduce the administrative burden on HUD.  However, to meet the goal of ending chronic homelessness in 10 years,  another important step for the Administration and the Congress is to  alleviate the barriers that homeless people encounter as they seek services  from mainstream programs. A number of long-standing and complex  issues such as improving the integration and coordination of federal  programs, ensuring an appropriate system of incentives for serving  homeless people, and holding mainstream programs more accountable for  serving homeless people will need to be addressed in order to alleviate the  barriers to accessing mainstream programs.
subsections: section_title: Background
paragraphs: Homelessness in America is a significant and complex problem. According  to a survey conducted for the federal Interagency Council on the Homeless  in 1996, 85 percent of homeless clients were single, predominately male  and nonwhite, and almost 40 percent had less than a high school diploma.
About one quarter of those who used the programs were veterans. About  15 percent of homeless clients were families that had on average, two  children. Forty-two percent of homeless clients reported that finding a job  was their top need followed by a need for help in finding affordable  housing. Almost 60 percent reported at least one problem with getting  enough food to eat during the 30 days before being interviewed. About 40  percent reported alcohol problems in the past month, 26 percent reported  drug problems, and 39 percent reported mental health problems during  that period. As the survey demonstrates, the homeless population is far  from homogenous. For many homeless people, particularly those in  homeless families, homelessness is a short-term or episodic event. These  individuals may require little more than emergency shelter to help them  through a difficult situation. For other homeless people, particularly those  with severe substance abuse or mental health disorders, homelessness is a  chronic condition; these individuals may require intensive and ongoing  supportive services in addition to housing. As a result, the types of  assistance that different homeless people and families require vary greatly.
HUD has responsibility for administering a homeless assistance grant  account funded at about $1 billion in fiscal year 2002. The homeless  assistance grant account was created to provide funding for HUD’s four  key homeless assistance programs:  Emergency Shelter Grants: This program is intended to improve the  quality of existing emergency shelters for homeless people and makes  additional shelters available for this population. In addition, the program is  designed to help grantees meet the costs of operating shelters, provide  essential social services to homeless people, and prevent homelessness.  This program provides formula grants to states, metropolitan cities, urban  counties, and territories in accordance with the distribution formula used  for HUD’s Community Development Block Grant program. According to  HUD, grantees are generally notified of their annual Emergency Shelter  Grant allocation before the start of each calendar year.
Supportive Housing Program: This program is intended to promote the  development of supportive housing and services, including innovative  approaches to help homeless people make the transition from  homelessness and enable them to live as independently as possible. States,  local governments, other governmental entities (such as public housing  authorities), private nonprofit organizations, and community mental health  associations that are public nonprofit organizations can annually compete  for supportive housing grants through a national competition. These  grants may be used to provide (1) transitional housing for up to 24 months  and up to 6 months of follow-up services for residents who move to  permanent housing; (2) permanent housing with appropriate supportive  services for homeless people with disabilities to enable them to live as  independently as possible; (3) supportive services only, with no housing;  (4) safe havens for homeless individuals with serious mental illness; and  (5) innovative approaches to help develop supportive housing that will  meet the long-term needs of homeless people. The term for initial grants  made under this program is up to 3 years.
Shelter Plus Care: This program provides rental assistance for hard-to- serve homeless people with disabilities along with supportive services that  are funded from other sources. States, units of general government, and  public housing authorities are eligible to apply for project grants through a  national competition. Grants can be used to provide rental assistance  payments for either 5 or 10 years depending on the type of rental  assistance requested and whether the grantee meets other program  requirements.
Section 8 Single-Room Occupancy Moderate Rehabilitation: The Single- Room Occupancy program brings more standard single-room occupancy  units into the local housing supply and makes them available to homeless  individuals. These housing units are intended for occupancy by a single  person and may or may not contain either food preparation or sanitary  facilities. Under this program, HUD enters into annual contracts with  public housing authorities for the moderate rehabilitation of residential  properties so that when the work is done, the properties will contain  multiple single-room units. The public housing authority is responsible for  selecting properties that are suitable for rehabilitation and for identifying  landlords who would like to participate in the program. Under this  program, public housing authorities and private nonprofit organizations  are eligible to compete for rental subsidies through an annual national  competition. Rental assistance payments are provided for a period of 10  years.
section_title: A Wide Range of Federal Assistance is Available for Homeless People
paragraphs: As we reported in February 1999, 50 federal programs administered by 8  federal agencies can provide services to homeless people. Of the 50  programs, 16 are targeted, or reserved for the homeless; and 34 are  mainstream programs. Although all the mainstream programs may serve  homeless people, the extent to which they do so is generally unknown  because the primary purpose of these programs is to serve low-income—  not homeless—people; therefore, most of the programs do not track the  number of homeless people served. In fiscal year 2001, the targeted  programs were funded at roughly $1.7 billion.
Both targeted and mainstream programs provide an array of services, such  as housing, health care, job training, and transportation. In some cases,  programs operated by more than one agency offer the same type of  service. As shown in table 1, 23 programs operated by 4 agencies offer  housing, such as emergency shelter, transitional housing, and other  housing assistance. Twenty-six programs administered by 6 agencies offer  food and nutrition services, including food stamps, school lunch subsidies,  and supplements for food banks.
In addition, some of the programs are available to the general homeless or  low-income population; others are reserved for specific groups within  these populations. As shown in table 2, only 4 of the 16 targeted programs,  including HUD’s Supportive Housing Program and FEMA’s Emergency  Food and Shelter Program, serve the homeless population as a whole. The  remainder serve specific subgroups of homeless people. For example, five  of the targeted programs serve only homeless children and youth; and four  other targeted programs serve only homeless veterans. Similarly, of the 36  mainstream programs, 14 programs, such as Medicaid, are available to all  low-income persons who meet eligibility criteria. Eight programs, such as  Head Start, are available only to low-income children and youth.
section_title: HUD Has Taken Some Actions to Address Coordination and Administrative Challenges in its Targeted Homeless Programs
paragraphs: Collectively, HUD’s McKinney-Vento programs provide a wide variety of  housing and services to meet the diverse needs of several segments of the  homeless population. However, as we testified in May 2000, although the  differences in these programs are meant to serve the diverse needs of a  broad spectrum of homeless people, they also create coordination and  administrative challenges because each program must be implemented  according to differing legislative requirements. For example, state  governments can receive Emergency Shelter, Supportive Housing  Program, and Shelter Plus Care grants but not Single-Room Occupancy  grants. Similarly, private nonprofit organizations can apply for Supportive  Housing Program and Single-Room Occupancy grants but not Emergency  Shelter and Shelter Plus Care grants. Coordination can be further  complicated by the differences in eligible activities. For example, although  Emergency Shelter and Supportive Housing Program grants can be used to  provide supportive services, Shelter Plus Care and Single-Room  Occupancy grants cannot be used for supportive services. Table 3  compares some of the requirements among HUD’s four McKinney-Vento  programs, including (1) the type of grant, (2) the organizations eligible to  apply for funding, (3), the types of services that can be provided, (4) the  types of activities eligible for funding, (5) the types of homeless people  each program can serve, (6) the initial time period for which funds are  available, and (7) the amount of matching funds required.
HUD has taken steps to improve coordination among its McKinney-Vento  programs and reduce the administrative burden caused by different  program requirements. First, in 1993 HUD implemented a process called  the “Continuum of Care” to encourage and enable localities to develop a  coordinated and comprehensive community-based approach for program  and service delivery to homeless people. The Continuum of Care process  is designed to build partnerships among localities, states, nonprofit  organizations, and the federal government. Funding for the housing and  service needs identified by communities within their Continuum of Care  plans is available through HUD’s McKinney-Vento programs. HUD also  requires that the planning and implementation of the Continuum of Care  process take place within the broader context of the community’s 5-year  Consolidated Plan. The Consolidated Plan describes how resources from  HUD’s key community development programs, such as the Community  Development Block Grant, will be used to create long-term development  within a community.
In our July 2000 review of HUD’s funding for these programs, we found  that most projects that communities ranked as high priority were awarded  funding. We also reported that although most communities that applied  for funds during the 1999 competition had few, if any, problems in  understanding HUD’s application requirements and completing their  paperwork, more than one-third had significant problems. Community  representatives we spoke with suggested a number of actions that HUD  could take to alleviate the problems they experienced, such as better  training for applicants and field office staff, more use of technology to  provide access to information, and a simpler application format.
Second, to support the coordination and planning inherent in the  Continuum of Care process and streamline and simplify the administration  of the McKinney-Vento competitive grant programs, HUD combined the  separate competitions for the Supportive Housing Program, Shelter Plus  Care, and Single-Room Occupancy programs into one competitive process  in 1998. Before HUD combined the application process, these three  competitive grant programs had different time frames, application  processes, and selection criteria. Under the current application process,  communities are required to provide a Continuum of Care plan and an  individual application for each project in that plan for which funds are  being requested from any of the three programs. In addition, HUD now  uses the same core rating criteria for making award decisions for all three  programs. By streamlining the application process, HUD’s goal was to  lower the costs and problems of program administration for service and  housing providers, with the expectation that this would enable providers  to spend more of their resources on implementing the programs.
For several years, HUD proposed legislation to consolidate its McKinney  programs into a single homeless assistance grant program and deliver  these funds to communities through block grants. HUD requested this  legislation because it believed that consolidation would create a simpler,  less paper-intensive system through which localities could develop  coordinated community-based efforts to address and prevent  homelessness. Although subsequent congressional action resulted in a  single appropriation for HUD’s four McKinney-Vento homeless assistance  programs, consolidating legislation has not yet been enacted. As we  testified in May 2000, HUD has made a considerable effort in trying to  improve coordination and streamline the programs within the existing  legislative framework. However, there is little more that HUD can do  within the existing legislative framework. Recognizing the need to move  further, both your bill and the Administration’s budget propose  consolidating HUD’s McKinney-Vento programs.
section_title: Homeless People Encounter Barriers to Using Mainstream Programs
paragraphs: Despite the availability of a wide array of programs, we reported in July  2000 that homeless people are often unable to access and use federal  mainstream programs because of the inherent conditions of homelessness  as well as the structure and operations of the programs themselves. All  low-income populations face barriers to applying for, retaining, and using  the services provided by mainstream programs; however, these barriers  are compounded by the inherent conditions of homelessness, such as  transience, instability, and a lack of basic resources. For example,  complying with mainstream programs’ paperwork requirements and  regularly communicating with agencies and service providers can be more  difficult for a person who does not have a permanent address or a phone  number.
Furthermore, as we reported in July 2000, the underlying structure and  operations of federal mainstream programs are often not conducive to  ensuring that the special needs of homeless people are met. Federal  programs do not always include service providers with expertise and  experience in addressing the needs of homeless people. These providers  may not be organized or equipped to serve homeless people, may not be  knowledgeable about their special needs, or may not have the sensitivity  or experience to treat homeless clients with respect. For example, many  providers delivering Medicaid services for states are not adept at dealing  with homeless patients’ special needs and characteristics, such as their  inability to store medicines or their lack of adequate shelter, nutrition, and  hygiene.
In addition, we noted that federal mainstream programs may not provide  adequate incentives for service providers to serve the homeless  population. Homeless people often have multiple needs, more severe  problems, and fewer resources than other segments of the low-income  population. Therefore, they can be a comparatively more expensive and  difficult population to serve. States, localities, and service providers who  receive federal funds but face resource constraints may therefore be  deterred from making the special efforts that are needed to reach out to  and serve the homeless population. Also, the federal government’s  performance-based approach to measuring program outcomes, although  beneficial in many respects, can inadvertently create disincentives for  states, local areas, or individual providers to serve the most challenging  populations, such as homeless people. This is because programs that focus  on hard-to-serve populations, such as homeless people, may not have  outcomes that are as successful as programs that focus on more  mainstream and easier-to-serve populations.
As we and others have reported in the past, the federal government’s  system for providing assistance to low-income people is highly  fragmented. Each federal assistance program usually has its own eligibility  criteria, application, documentation requirements, and time frames;  moreover, applicants may need to travel to many locations and interact  with many caseworkers to receive assistance. Among other things, this  fragmentation can make it difficult to develop an integrated approach to  helping homeless people, who often have multiple needs. Numerous  studies have demonstrated that the multiple and complex needs of  homeless people—which may include medical care, mental health care,  substance abuse treatment, housing, income support, and employment  services—should not be addressed in isolation but rather through  programs that are integrated and coordinated.
As we reported in July 2000, alleviating these barriers would require the  federal government to address a number of long-standing and complex  issues. An expert panel we convened during the course of our work on the  July 2000 report presented a variety of strategies that the federal  government could pursue to improve homeless people’s access to, and use  of, mainstream federal programs. These included (1) improving the  integration and coordination of federal programs, (2) making the process  of applying for federal assistance easier, (3) improving outreach to  homeless people, (4) ensuring an appropriate system of incentives for  serving homeless people, and (5) holding mainstream programs more  accountable for serving homeless people.
The issues the panel members identified are not new to the federal  agencies responsible for administering mainstream programs, and federal  agencies have tried to address them for years with varied degrees of  success. For example, as we reported in July 2000, with regard to  improving coordination and simplifying the application process, the  Department of Health and Human Services (HHS) developed an  information system design in the 1980s that facilitated state efforts to  combine the eligibility determination process for Medicaid, the Food  Stamp Program, and Aid to Families With Dependent Children. In  addition, several states are planning or implementing their own automated  systems to coordinate the delivery of services provided by multiple federal  programs. However, these projects have faced several serious challenges,  owing, in part, to the complexity of the system of aid for low-income  people and the difficulties inherent in managing any large information  technology project.
Another mechanism for coordination of targeted and mainstream  programs is the Interagency Council on the Homeless, which was  established by Congress in 1987 to help streamline the governments  approach to homelessness by bringing together representatives of federal  agencies that administer programs or resources that can be used to  alleviate homelessness. In 1994, however, because of congressional  concern that the Council was not effectively coordinating a streamlined  federal approach to homelessness, funds were not appropriated for the  Council and it became a voluntary working group. In fiscal year 2001, the  Congress funded the Council again.  The conference report to the fiscal  year 2002 HUD appropriations directed that the Council be placed under  the President’s Domestic Policy Office, that meetings be held at least semi- annually, and that the chairmanship of the Council be rotated among the  Secretaries of HUD, Health and Human Services, Labor, and Veterans  Affairs.
In terms of increasing accountability, the Government Performance and  Results Act of 1993 requires federal agencies to collect performance data  and use these data to hold programs accountable for their performance.  However, we reported in 1999, the extent to which federal agencies were  using this process to hold mainstream service providers more accountable  for serving homeless people was not yet clear. Nevertheless, we reported  in 1999 that communities were increasingly using outcome measures to  manage their homeless assistance programs, focusing less on the types  and numbers of activities performed and more on the results achieved. In  Minnesota, for example, the state-funded Family Homeless Prevention and  Assistance Program is an outcome-based program that provides agencies  with flexible grants but holds them accountable for achieving certain  measurable outcomes related to preventing homelessness among families.  One outcome measure used by the program is the number of at-risk  families who maintain stable housing.
Federal agencies have developed a large body of knowledge about serving  homeless people effectively through the McKinney-Vento Act programs  and various demonstration and research projects targeted to homeless  people. These programs and demonstration projects clearly show there  are strategies mainstream programs can adopt to better serve the  homeless population in such areas as mental health, substance abuse  treatment, primary health care, housing, and job training. In 1994, we  recommended that the secretaries of HUD, HHS, Veterans Affairs, Labor,  and Education incorporate the successful strategies for working with  homeless people from the McKinney-Vento Act demonstration and  research projects into their mainstream programs. Although the federal  agencies have taken some steps to implement our recommendation,  members of the expert panel we convened during our review of barriers to  access to mainstream programs emphasized that these efforts could go  further. They said that federal agencies could do more to incorporate into  mainstream programs the “best practices” for serving the homeless  population that have been learned from past demonstration and research  projects.