Rural Homelessness: Better Collaboration by HHS and HUD Could Improve Delivery of Services in Rural Areas
Published: 2010-07-20T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: The Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act of 2009 directed GAO to conduct a broad study of homelessness in rural areas. In this report, we provide information about rural homelessness issues, based in significant part on our work in rural areas within six selected states. Specifically, the report addresses the following questions: (1) What are the characteristics of homelessness in rural areas? (2) What assistance is available to individuals or families experiencing homelessness and what amount of funding have the federal departments and agencies awarded to organizations that assist persons experiencing homelessness in rural areas? (3) What barriers do persons experiencing homelessness and homeless service providers encounter when seeking assistance or funding to provide assistance? To address these issues, GAO reviewed relevant literature, conducted site visits, and interviewed agency officials.
section_title: What GAO Found
paragraphs: Rural homelessness involves a range of living situations but comparing the extent of homelessness in rural and nonrural areas is difficult primarily due to data limitations. Based on GAO visits to six states, persons experiencing homelessness in rural areas could be living in one of a limited number of shelters, in extremely overcrowded situations, in severely substandard housing, or outdoors. While HUD and other agencies collect some data on homeless populations, several challenges exist in using these data to compare the extent of homelessness in rural and nonrural areas. They include difficulties in counting transient populations, limited reporting by service providers in federal data systems, inconsistent reporting across programs, and focusing on the segments of the homeless population that the agency serves. Definitional differences also make comparisons difficult. For instance, the three most common federal definitions of rural use differing criteria such as population or proximity to urban areas. Even within one measure such as population, different agencies can use different parameters and therefore identify different areas as rural. A number of federal programs exist to support those experiencing homelessness in rural areas. Targeted and nontargeted programs fund permanent and emergency housing and supportive services such as mental health services, case management, and job training. However, federal agencies maintain limited data on the amount of homeless assistance awarded to rural areas, making comparisons with assistance awarded to nonrural areas difficult. For instance, HUD maintains some data on the amount of homeless assistance awarded to rural areas through its targeted programs, but the data are based on providers' identification of locations as rural or not. Nontargeted programs can serve persons experiencing homelessness but do not track how much funding is used for homeless assistance. As a result of data limitations such as these, comparisons of funding levels offer limited insight into the relationship between the size of the homeless population in an area and the amount of funding received. Barriers to accessing and providing homeless services in rural areas include limited access to services, large service areas, dispersed populations, and a lack of transportation and affordable housing according to state and local officials and persons experiencing homelessness in the states we visited. For instance, many rural areas have few shelters or shelters with few beds serving very large areas. A program in which HUD provides housing vouchers to homeless veterans and the Department of Veterans Affairs provides clinical and case management services to these same veterans is one of a limited number of examples of formal collaboration and leveraging of federal resources that link housing and supportive services. The effects of limited collaboration may be particularly acute in rural areas because of the barriers cited above. Without a more formal linking of housing and supportive services by HUD and HHS, two of the key agencies for funding these activities, the effectiveness of federal efforts to address homelessness may be diminished.
section_title: What GAO Recommends
paragraphs: GAO recommends that the Departments of Housing and Urban Development (HUD) and Health and Human Services (HHS) explore further opportunities to strengthen formal collaboration on linking housing and supportive services to address homelessness, with specific consideration for how such collaboration can minimize barriers to service provision in rural areas. HHS and HUD generally agreed with the recommendation.

section_title: Letter
paragraphs: Homelessness has sometimes been characterized as the “extreme end of  poverty.” In rural areas of the United States, homelessness has not  attracted the same level of attention as in urban areas, although research  has shown that the highest poverty rates occur in rural areas as well as  center cities. Although some studies have examined the issue of  homelessness in rural areas, little comprehensive data exist on the extent  of homelessness in these areas or the extent to which various federal  programs meet the needs of those experiencing homelessness in rural  areas or support providers that serve this population. The Homeless  Emergency Assistance and Rapid Transition to Housing (HEARTH) Act of  2009 created the Rural Housing Stability Grant Program. This grant  program is seen as to allow rural areas more flexibility to identify and  address the needs of persons experiencing homelessness or those in the  worst housing situations and reserves Department of Housing and Urban  Development (HUD) funding for which rural communities may apply  separately.
The HEARTH Act also directed GAO to conduct a broad study of  homelessness in rural areas, including tribal lands and colonias. In this  report, we provide information about rural homelessness issues, based in  significant part on our work in rural areas within six states. Specifically,  the report addresses the following questions:  1.  What are the characteristics of homelessness in rural areas?  2.  What assistance is available to individuals or families experiencing  homelessness and what amount of funding have the federal  departments and agencies awarded to organizations that assist persons  experiencing homelessness in rural areas? 3.  What barriers do persons experiencing homelessness and homeless  service providers encounter when seeking assistance or funding to  provide assistance?
To address these questions, we conducted a review of relevant reports,  studies, and our prior research. We also conducted site visits in Arizona,  Kentucky, Maine, Minnesota, New Mexico, and Texas. During these visits,  we interviewed federal, state, and local housing and homelessness officials  and nonprofit homelessness organizations, and toured rural areas in which  homelessness was present. We selected the site visit locations based on  several factors, including (1) discussions with knowledgeable individuals  in the field of homelessness, (2) a review of studies and reports on local  and state efforts to serve the homeless in rural areas, (3) the presence of  tribal lands and colonias, and (4) geographical diversity. We also reviewed  relevant laws, regulations, and program documentation and interviewed  officials from various federal agencies as well as national stakeholder  organizations. For purposes of this report, we did not limit ourselves to  any one federal definition of homelessness and did not specify a specific  definition when speaking with researchers, providers, and relevant  government officials, but they did clarify on how they defined  homelessness in the context of their comments.
We conducted this performance audit from July 2009 to July 2010 in  accordance with generally accepted government auditing standards. Those  standards require that we plan and perform the audit to obtain sufficient,  appropriate evidence to provide a reasonable basis for our findings and  conclusions based on our audit objectives. We believe that the evidence  obtained provides a reasonable basis for our findings and conclusions  based on our audit objectives.
subsections: section_title: Background
paragraphs: Several federal programs—mainstream and targeted—may be available to  assist those experiencing homelessness in rural and nonrural areas.  Mainstream programs—such as Temporary Assistance for Needy Families,  public housing, the Supplemental Nutrition Assistance Program, Medicaid,  and the Workforce Investment Act—provide a wide range of assistance,  such as cash assistance, housing, food, health care, and job training, for  low-income people including those experiencing homelessness. Targeted  programs—such as the Emergency Shelter Grant and Runaway and  Homeless Youth programs—also provide a range of services but are  designed specifically for individuals or families experiencing  homelessness.
The McKinney-Vento Homeless Assistance Act (McKinney-Vento) is the  principal federal legislation designed to provide funding for shelter and  services to persons experiencing homelessness.  McKinney-Vento  originally consisted of 15 programs providing, among other things,  resources for emergency shelter, transitional housing, job training,  primary health care, education, and permanent housing. The current act  has been amended several times and was most recently reauthorized by  the HEARTH Act. For the most part, these amendments have expanded  the scope and strengthened the provisions of the original legislation by  expanding eligible activities and creating new programs. This legislation  continues to represent the primary source of funding for targeted  programs serving persons experiencing homelessness. HUD administers  both competitive and formula-based McKinney-Vento programs that fund  activities to address homelessness in rural and nonrural areas. HUD’s  competitively awarded homeless programs comprise the “Continuum of  Care” (CoC) system. According to HUD, the program is based on the  understanding that homelessness is not caused solely by a lack of shelter,  but also involves other physical, social, and economic needs. Through the  CoC system HUD allocates homeless assistance grants to organizations  that participate in homeless assistance program planning networks. The  planning network or CoC refers to a group of providers and key  stakeholders in a geographical area—a city, a county, a metropolitan area,  or an entire state—that join to plan for the homeless housing and service  system within that geographic area and apply for HUD’s competitive  homeless program funding. Rural areas typically organize into regional or  balance-of-state (areas in the state not already covered by other  continuums) CoC systems which may include a mixture of rural and  nonrural areas. Areas in 37 states or territories are organized as balance- of-state CoCs, while other states such as Minnesota and Nebraska have  organized into regional CoC systems. Several other federal agencies also  have programs targeting homelessness that primarily provide supportive  services—including the Departments of Education (Education), Homeland  Security (DHS), Labor (Labor), Justice (DOJ), Health and Human Services  (HHS), and Veterans Affairs (VA).
McKinney-Vento also authorized the creation of the U.S. Interagency  Council on Homelessness (Interagency Council), which currently includes  19 member agencies. McKinney-Vento mandated that the Interagency  Council identify duplication in federal programs and provide assistance to  states, local governments, and other public and private nonprofit  organizations to enable them to serve those experiencing homelessness  more effectively. The HEARTH Act revises the Interagency Council’s  mission to coordinate the federal response to homelessness and create a  national partnership at every level of government and with the private  sector to reduce and end homelessness. HEARTH also mandates that the  Interagency Council develop and annually update a national strategic plan  to end homelessness. The Interagency Council’s plan, which was released  in June 2010, aims to align federal resources effectively and appropriately  with four key goals: (1) prevent and end homelessness for families, youth,  and children; (2) prevent and end homelessness among veterans; (3) end  chronic homelessness; and (4) “set a path” to end all types of  homelessness.
As described in our June 2010 report, federal programs define  homelessness differently. HUD administers programs under McKinney- Vento that specifically target persons experiencing “literal” homelessness  (that is, living in shelters or in places not meant for human habitation, but  not in precarious housing situations). According to HUD officials,  Congress directs federal agencies as to which definition of homelessness  shall be used within each program; furthermore, as HUD’s housing  resources are not an entitlement, funding must be targeted to those most  in need. The statutory definition of homelessness for Education, DOJ,  and some HHS targeted programs is broader than that for HUD programs.  For example, under McKinney-Vento, the Education for Homeless  Children and Youth program’s definition of homelessness includes  children and youth who are living in substandard housing, while the  Healthcare for the Homeless program’s definition includes those who are  “doubled up,” or living temporarily with another household because they  cannot afford housing of their own. Table 1 categorizes definitions of  homelessness across federal agencies with targeted homeless assistance  programs. In our June 2010 report, we recommended that Education, HHS,  and HUD develop a common vocabulary for homelessness and determine  if the benefits of collecting data on housing status in targeted and  mainstream programs would exceed the costs.
The HEARTH Act broadens the McKinney-Vento definition of “homeless  individual,” and also defined the terms “homeless,” “homeless person,” and  “homeless individual with a disability.”
Federal agencies also do not employ a single definition of “rural” and the  definitions generally are not comparable across agencies. In a prior GAO  report, we discussed the three most common federal definitions of rural— from the Bureau of the Census, the Department of Agriculture’s (USDA)  Economic Research Service, and the Office of Management and Budget— which have differing criteria, such as population threshold or proximity to  urban areas. However, even within one measure such as population  threshold, different agencies can use different parameters and therefore  identify different areas as rural.
The mandate for this report in the HEARTH Act identifies two distinct  communities to be included in this review of homelessness in rural  areas—tribal lands and colonias. Because the federal government has a  unique legal and political relationship with Native American tribes and  Alaska Native entities, the administration of housing, homeless assistance,  and supportive service programs on tribal lands differs. Federal agencies  that have distinct roles and responsiblities to these groups include the  Bureau of Indian Affairs (BIA), HUD, and HHS. BIA-administered  programs include social services, economic development, housing  improvement, and disaster relief. HUD’s Office of Native American  Programs is responsible for the implementation and administration of  programs, such as housing and community development, that are specific  to Native Americans and Alaska Natives. The Indian Health Service within  HHS is responsible for providing federal health services to Native  Americans and Alaska Natives.
Unlike Native Americans and Alaska Natives, the federal government does  not have a unique legal and political relationship with colonias. However,  the Cranston-Gonzalez Act of 1990 recognized colonias within U.S. borders  as distressed communities and designated set-aside funding to advance  opportunities for homeownership and economic self-sufficiency in these  areas. Individuals and families in colonias may lack safe, sanitary, and  sound housing and be without basic services such as potable water,  adequate sewage systems, utilities, and paved roads.
subsections: section_title: Forms of Rural Homelessness Encompass Situations Ranging from the More Visible, Such as Living in Shelters, to the Less Visible, Such as Living in Overcrowded Housing or Outdoors
paragraphs: The characteristics or forms of homelessness in the rural areas we visited  ranged from the more visible, such as living in shelters, to the less visible,  such as living in overcrowded or substandard housing. The range of living  situations of persons experiencing homelessness in rural areas may  overlap with the living situations of those experiencing homelessness in  nonrural areas. Some persons experiencing homelessness lived in shelters  or transitional housing. Shelters, where they existed, provided one of the  visible entry points to receiving both housing assistance and supportive  services. Some shelters we visited conduct initial assessments of  individuals and families experiencing homelessness to determine their  needs. The shelters may provide case management or mental health  services or provide referrals to services within the area. We also observed  various shelter types—some served specific groups, such as domestic  violence victims or youth, while others were multipurpose. Some shelters  were traditional, small communal shelters; some organizations used  scattered site housing as shelters; and some shelters had no fixed location.  For example, some service providers issued hotel vouchers, while others  had moving shelters in which churches or other organizations would offer  space. The shelter would be located in one organization’s donated space  for a set period of time before moving to another organization. Services  available to clients also varied greatly among shelters. Some shelters  offered a full range of on-site services such as mental health services,  substance abuse treatment, case management, and job training. Other  shelters offered limited services or lacked the funding to pay for 24-hour  staff. Some areas without shelters relied on volunteers for homeless  services because of limited or nonexistent funding.
Other forms of homelessness we observed or heard about in rural areas  we visited included persons who owned or rented substandard housing or  had established temporary alternative living arrangements such as  doubling-up (short stays with persons who offer space). In some rural  areas, infrastructure challenges contributed to substandard housing. For  example, we observed some houses built in floodplains in colonias we  visited in Texas. Additionally, building codes may not exist or may not be  enforced in some rural areas. We also observed houses with boarded-up  windows, caved-in floors or ceilings, and dangerous alternative heating  sources in rural areas in several states. Persons living in similar housing in  urban areas may more easily be identified as literally homeless as such  structures could be condemned. Some individuals and families in rural  areas lived in overcrowded homes, sometimes with multiple generations  living together. In some places we visited, we heard that doubling-up or  multigenerational living was a cultural norm or an accepted practice  because people “take care of their own.” Some people had very few  options. For example, on tribal lands many families have lived for long  periods in overcrowded housing because waiting lists for housing are  extremely long and private financing is rare due to legal issues with land  ownership. Tribal officials from the Pueblo of Acoma reservation recently  conducted a housing inventory and found approximately 155 overcrowded  units on the reservation out of approximately 700 occupied units.  Providers told us that severely overcrowded situations often were  associated with domestic violence and child abuse. Providers said youth  experiencing homelessness often “couch surfed,” trading goods or services  such as drugs, sex, money, or child care for a temporary stay in someone’s  home. Not all federal programs include such living conditions in their  definitions of homelessness, and persons living in these situations may not  be eligible for some federal assistance.
Finally, some individuals and families experiencing homelessness in the  rural areas we visited were sleeping in areas not meant for human  habitation, including outdoor locations, vehicles, and abandoned  buildings. For example:    On tribal lands in Arizona, we heard of persons living in dry river beds or  in outbuildings such as barns or backyard sheds.
In Maine, we were informed of year-round encampments in the woods. In  one case, the local fire department inspected and sanctioned a large fire  pit for an encampment with the intent of minimizing the number of smaller  pits.
In Minnesota, we observed abandoned buses and ice houses that were  used by persons without regular shelter and heard from a previously  homeless woman about how she built a structure using a pallet, a large  cardboard box, and a tarp to keep out the rain. She told us that she placed  the structure in an old mining pit to avoid detection.
These individuals meet both the existing McKinney-Vento and HEARTH  Act definitions of homeless and could be eligible for federal assistance.  However with a limited number of shelters or other outreach, they may  not be accessing services. Providers and persons experiencing  homelessness emphasized that some persons experiencing homelessness  wanted to remain hidden as they often were sought by abusive partners,  parents, creditors, or the police. In the case of some families, parents were  afraid that their children would be taken from them by social services.
section_title: Challenges in Collecting Comprehensive Data Make Understanding the Extent of Homelessness in Rural and Nonrural Areas Difficult
paragraphs: Due to limited comprehensive data and challenges in combining data from  different federal sources, understanding the extent of homelessness in  rural and nonrural areas is difficult. Several agencies are required to  collect data on segments of the homeless population, but as described in  our June 2010 report, these data have shortcomings and do not fully  describe the incidence and prevalence of homelessness in rural or  nonrural areas. HUD developed two sources of data—the Homelessness  Management Information System (HMIS) and the biennial Point-in-Time  (PIT) count—for understanding the extent of homelessness. These data  are reported to Congress annually for the Annual Homeless Assessment  Report (AHAR) on the extent and nature of homelessness in the United  States. Under the direction of Congress, HUD created a set of technical  data collection standards for local HMIS, instructed programs receiving  HUD McKinney-Vento funding to report to those local systems, and  encouraged all programs for homeless people, regardless of their funding  source, to report data to HMIS. HMIS records and stores client-level  information on the characteristics (on an ongoing basis throughout the  year) and service needs of homeless persons and the data are used to  produce counts of the sheltered homeless population over a full year. In  addition to HMIS, the PIT counts of both sheltered and unsheltered  homeless populations are based on the number of persons experiencing  homelessness on a single night during the last week in January (every  other year), and the data are included as part of the CoC applications,  which are submitted to HUD annually. CoCs conduct a PIT count every  other year with 452 CoCs completing a count in 2009. PIT counts include  the “street counts” that estimate the number of unsheltered homeless  people in each community, as well as estimates of sheltered homeless  people based on a census of shelter and transitional housing occupants on  a particular night.
Although other programs are encouraged to report data to HMIS, agencies  such as HHS, Education, and VA have their own systems for collecting  data. For example, HHS’s Runaway and Homeless Youth Management  Information System (RHYMIS) collects demographic and service data on  runaway and homeless youth being served by HHS’s Family and Youth  Services Bureau’s programs. To demonstrate compliance with the  Elementary and Secondary Education Act of 1965 (ESEA), as amended,  Education collects data on homeless children and youth served by ESEA  programs and the Education of Homeless Children and Youth program  through the Consolidated State Performance Report. The McKinney-Vento  Act requires local school districts to have Homelessness Liaisons, provide  appropriate services and support, and collect and report data to Education  annually. Additionally, through VA’s Northeast Program Evaluation  Center, VA collects data on each individual veteran that enters one of VA’s  specialized homeless veterans programs. And, through the Community  Homelessness Assessment Local Education and Networking Groups  (CHALENG) process, VA collects population-based data by conducting  local community group surveys with VA staff and community participants.  CHALENG data is nationally compiled in an annual report to provide  prevalence estimates of veteran homelessness and to assess the needs of  the population as well as gaps in local services. Lastly, the Census  Bureau’s decennial population and housing census collects data on places  in which the homeless population receive services as well as targeted  nonshelter outdoor locations. While the Census makes an effort to count  all residents, including those experiencing homelessness, the 2010 Census  does not plan to report a separate count of the population experiencing  homelessness or a count of the population who use homelessness  services, and the Census Bureau advises against using its data on  homelessness from the 2000 Census.
Because of different statutory requirements for each federal agency— including data collection requirements and differences in definitions— these data do not reflect the full extent of homelessness in rural or  nonrural areas. Each agency focuses on the segments of the homeless  population that the agency serves, resulting in incompatible data for  comparison and analysis. For example, HHS’s Runaway and Homeless  Youth Program, for which data is collected in RHYMIS, focuses on the  runaway and homeless youth being served by the Basic Center Program,  the Transitional Living Program for Older Homeless Youth, and contacts  made by the Street Outreach Program grantees. HHS provides homeless  assistance to adult individuals and families through programs such as  Health Care for the Homeless, Projects for Assistance in Transition from  Homelessness (PATH), Grants for the Benefits of Homeless Individuals,  and Service in Supportive Housing. All of these programs collect data on  their relevant populations based on statutory requirements. VA collects  data on homeless veterans as part of its annual CHALENG survey, in  accordance with different statutory requirements. However, in December  2009, HHS established an agreement with HUD for PATH providers to  move towards reporting under the HMIS. Also, according to HUD officials,  there has been an initial evaluation of aligning some of VA’s homelessness  data with HUD’s homelessness data.
The varying definitions of “homelessness” and “rural”—as well as the  extent to which “rural” is reported—also limit the ability to understand the  incidence and prevalence of homelessness in rural areas. For example,  according to officials, doubled-up persons are included in some VA and  HHS program definitions but excluded from HUD’s definition. Thus, data  on homelessness are captured differently across federal agencies.  Similarly, although our work did not focus on potential reasons for the  different definitions, these differences across federal programs make  comparing the extent of homelessness in rural and nonrural areas difficult.  For instance, HUD’s AHAR formally classifies locations into two groups— principal cities and suburban or rural areas. Specifically, HUD estimates  that about 1.56 million people were homeless in emergency shelters or  transitional housing at some point during fiscal year 2009. More than two- thirds (or about 1.1 million) of them were located in principal cities, while  one-third (or about 0.5 million) were in suburban or rural jurisdictions.  HHS’s RHYMIS and VA’s CHALENG do not break out the counts of  homelessness between rural and nonrural areas.
HUD’s PIT count is the only data collection effort designed to obtain a  national count of those experiencing homelessness, and while a more in- depth discussion of the difficulties associated with collecting the data can  be found in our June 2010 report, there are some additional challenges  particular to rural areas.
Persons experiencing homelessness are inherently difficult to count. They  are mobile, can seek shelter in secluded areas, and may not wish to attract  the notice of local government officials. Moreover, rural areas are often  large and have widely dispersed populations and difficult-to-reach  locations, exacerbating the difficulties of finding and counting persons  experiencing homelessness, including those who do not necessarily want  to be found.
Count methodologies vary by CoCs and might not be well implemented.
Service providers who conduct the PIT counts are meeting their mandated  requirements under McKinney-Vento. However, with no funding to pay for  the count, service providers often rely on volunteers to meet an unfunded  mandate. Particularly in areas of the United States where average  temperatures are below freezing in January, finding unsheltered persons  and recruiting volunteers to count them becomes difficult. Although HUD  officials told us that the benefit of a January count relates to the increased  demand for shelters at the coldest time of year, homeless shelters and  services are limited in rural areas, and in some counties, nonexistent. In a  few of the states we visited, commitments from state and local officials  and advocates have enhanced the process, resulting in an ability to recruit  volunteers and local organizations who have built a trusting relationship  with homeless populations.
According to officials and service providers in the states we visited, HUD’s  PIT count likely has undercounted the rural homeless population, but to  what extent is unknown. While HUD officials acknowledge the  shortcomings of their counts, they believe significant progress has been  made in recent years in collecting homelessness data, particularly their  estimate annually since 2005 of the extent of homelessness and their  efforts to ensure data quality through providing technical assistance.
Another factor associated with the completeness of federal agency data is  the lack of migration data. According to federal agency officials and  service providers, very little is known about the migration between rural  and nonrural areas of those experiencing homelessness because there is  no requirement or formal system for tracking migration patterns. Although  no federal programs formally track or are required to track migration  information, some local service providers maintain that information for  their own purposes. For example, the Kentucky Housing Corporation,  beginning in 2009, included questionnaires to track migration within and  across states. Those experiencing homelessness may migrate to and from  nonrural areas for many reasons. For example, service providers told us  that persons experiencing homelessness in rural areas have migrated to  nonrural areas following a job loss, to reconnect with families, and to  obtain supportive services. Conversely, people have migrated from  nonrural areas to rural areas to connect with families and, in the case of  tribal lands, to receive services. Furthermore, because persons  experiencing homelessness are more mobile, and formal migration data do  not exist, the potential exists for duplicated counts—complicating any  comparison of the extent of homelessness between rural and nonrural  areas.
section_title: Several Federal Agencies Fund Programs through State Intermediaries or Local Homeless Providers That Assist Persons Experiencing Homelessness in Rural Areas
paragraphs: Several federal agencies fund programs, through state intermediaries or  local homeless providers, which are targeted to the homelessness  population or which assist low income persons and families including  those experiencing homelessness. Some federal programs specifically  target homelessness, while others assist low income persons and families,  including those experiencing homelessness, or include assistance for  persons experiencing homelessness among eligible uses. In total, these  programs fund permanent and short term housing and a variety of  supportive services such as mental health services, substance abuse  treatment, case management, and job training. Targeted homeless funding  is often further targeted to segments of the population such as youth or  veterans. See figure 1 for examples of targeted and mainstream or  nontargeted programs that may benefit persons experiencing  homelessness and the types of assistance available under each program.
HUD funds programs targeted to the homeless populations through state  or local entities for the Emergency Shelter Grant (ESG) program and to  providers who participate in CoCs. The ESG program is dispersed by  formula, while three grant programs—the Single Room Occupancy,  Shelter Plus Care, and Supportive Housing programs—are awarded  competitively through the CoC process. HUD receives a single  appropriation for its targeted programs and administratively determines  the amount of funding for the ESG program. ESG funding is awarded  based on the Community Development Block Grant (CDBG) formula,  which designates that 70 percent of funding is awarded directly to  entitlement cities and counties and 30 percent is awarded to state entities  that determine the dispersion of funding for the more rural parts of the  state. Organizations located in areas or municipalities not receiving  direct ESG allocations compete for funding through the state entity. For  example in 2009 in Maine, only Portland received its own allocation of  about $94,000, while organizations from all other areas or municipalities  within the state competed for about $770,000.
HUD’s three competitive homeless assistance grants are awarded through  the CoC process using a scoring system where HUD scores the planning  document submitted by the CoCs as part of the application. Programs  that have previously received funding, referred to as renewals, receive a  higher funding priority and are funded before new programs are  considered for funding. In 2008, 86 percent of the competitive homeless  assistance grants were renewals. Although CoC funding is awarded  competitively, HUD determines a need factor called the pro rata need (also  based on the CDBG formula) for each CoC. According to a HUD official, in  calculating the preliminary pro rata need, HUD allocates 75 percent of  funding to entitlement cities and counties that qualify for direct ESG  allocations and 25 percent of funding to all other areas. All CoCs have an  identified need factor, but CoCs may not have funded programs as new  funding is awarded in order of CoC score, which is based on multiple  factors.
HHS and other federal agencies—including Education, Labor, VA, DHS,  and DOJ—largely operate their targeted programs through state entities or  by directly funding community-based public or nonprofit entities. HHS  provides funding for a number of programs, including Runaway and  Homeless Youth, Health Care for the Homeless, and PATH. Funding for  Health Care for the Homeless is distributed competitively, while PATH  funding is distributed to states, Washington, D.C. and U.S. territories that  distribute the funding. The PATH formula, which has remained unchanged  since 1990, primarily considers the urban population of the state or  territory and designates a minimum of $300,000 for states and $50,000 for  territories. In 2009, 18 states and the District of Columbia received the  state minimum. DHS, through the Federal Emergency Management  Agency, funds the Emergency Food and Shelter Program, which  distributes funding to local entities through the United Way of America or  similarly functioning organizations. Funding is formula-based and  considers poverty rate and unemployment. Some providers in very small  communities told us that they receive federal funding only through the  Emergency Food and Shelter Program.
Mainstream federal programs may assist persons experiencing  homelessness but the level of assistance directed towards homelessness is  generally unknown as some programs are not required to track if  participants have been or are experiencing homelessness. Mainstream  programs provide assistance to individuals and families and include HHS’  Temporary Assistance for Needy Families; USDA’s food programs such as  the Supplemental Nutrition Assistance Program and the Special  Supplemental Nutrition Program for Women, Infants, and Children; HUD’s  housing programs such as public housing and the Housing Choice Voucher  program; the Social Security Administration’s Supplemental Security  Income and disability insurance programs; and VA’s disability  compensation program.
Funding in other federal programs also may be used for homeless  assistance based on the decisions of state, local, or tribal governments.  Homeless programs are one of many eligible uses for funding in programs  such as HUD’s CDBG program and USDA’s Community Facilities Loan  program. CDBG is formula-based with state entities receiving and  dispersing the portion of funding intended for rural areas, while the  Community Facilities Loan program is awarded competitively through  USDA’s state offices. Some programs direct funding to areas that are in  particular need of housing infrastructure. For example, the Cranston- Gonzalez Act requires states that share a border with Mexico to set aside  CDBG funds for the colonias. This funding may be used to expand water  and sewer services and to provide housing assistance. USDA’s agency for  rural development also funds programs to improve infrastructure in the  colonias.
Tribes receive funding for housing, health care, and other services through  HUD’s Native American Housing Assistance and Self-Determination Act  (NAHASDA) programs and a variety of programs offered through HHS and  BIA. These programs, although not specifically targeted at homelessness,  may assist persons experiencing homelessness. They are available to  recognized tribes only and funding generally is formulaic, based on tribal  enrollment. Generally, NAHASDA money is distributed to tribal-designated  housing entities that use money to build or refurbish housing. BIA  programs are funded as contracts awarded to designated tribal entities to  provide a range of services. In both cases, tribal governments determine  priorities, usage, and eligibility. Housing funds are distributed to regional  BIA offices through a formula process and individuals receive assistance  based on priority until funds are exhausted.
section_title: Limited Data Are Available on the Amount of Targeted and Nontargeted Assistance to Rural Versus Nonrural Areas
paragraphs: The amount of federal funding for targeted homeless assistance programs  in rural areas is uncertain. According to the Congressional Research  Service, in fiscal year 2009 federal agencies spent more than $2.85 billion  on programs targeted to address the needs of individuals and families  experiencing homelessness. HUD’s targeted homeless programs  represent the largest funding source for federal targeted homeless  assistance, which for fiscal year 2009 totaled more than $1.7 billion or  more than 62 percent of total targeted funding. Figure 2 shows the  targeted funding by federal agency. We were unable to determine the total  portion of this funding that went to rural areas.
Determining what funding went to rural areas is difficult because some  federal agencies use self-reported data that may not be accurate, do not  distinguish between rural and nonrural areas, or do not track whether  funding went to such areas. As discussed earlier in this report, federal  agencies use multiple definitions of rural, complicating any determination  of what types of areas received funding. For instance, HUD’s CoC  programs maintain data on the amount of assistance for rural areas;  however, grant applicants could designate (self-identify)—based on a HUD  provided definition of rural area—whether they were in rural areas or not.  Table 2 shows the funding based on this designation for fiscal years 2006- 2008. In fiscal year 2008, according to the HUD data, 9.3 percent of CoC  funding went to rural areas, which represented about 15 percent of total  projects.
Similarly, VA can determine spending levels in rural areas for its grant and  per diem program using self-reported data. Table 3 shows funding and the  number of beds based on this designation for fiscal years 2007-2009. In  fiscal year 2009, according to VA data, 13.5 percent of capital grant awards  under the Grant and Per Diem program funding went to rural areas, which  represented 8.5 percent of the funded beds. HUD’s ESG program targets 30  percent of its funding toward nonentitlement cities or counties, which  represent more rural areas. However, according to HUD, ESG provides  discretion to the state entity to decide how to allocate ESG funds. A state  may limit funds to nonentitlement areas and metropolitan cities and urban  counties that did not receive individual allocations, or may choose to fund  entitlement cities and counties that received direct allocations from HUD.
Other agencies also maintain limited information on the amount of  targeted homeless funding that is allocated to rural or nonrural areas.  Depending on the program, HHS and Education do not track whether  funding is for providers or projects in rural or nonrural areas. Labor has  two size categories within its targeted Homeless Veterans’ Reintegration  program, one for urban areas and one for nonurban areas, with different  dollar amounts available. However, Labor officials said their definition of  nonurban was an area with less than 569,463 persons, which is at least 10  times the population limit specified in other agencies’ definitions of rural.
Similarly, funding information on the mainstream and other nontargeted  programs that can provide support to individuals or families experiencing  homelessness is limited. Individuals and families who meet the  qualifications for services under mainstream programs are eligible  regardless of whether they live in rural, tribal, or nonrural areas. Some  mainstream programs, such as Temporary Assistance for Needy Families,  that may offer assistance to individuals or families experiencing  homelessness are not required to track housing status, which prevents a  determination of how much funding went to persons in rural and nonrural  areas. For other nontargeted programs, funding for homelessness is often  difficult to disaggregate from other spending. For example, HUD’s CDBG  funds have many eligible uses as well as usage clauses that required a  certain percentage of funding to be used for projects that benefit low- income persons. The building of shelters and transitional housing are  among several eligible uses that would assist persons experiencing  homelessness; however, the total amount of assistance to specific types of  projects is unknown. A certain percentage of CDBG funds for states  bordering Mexico are targeted to the colonias, but the amount of funding  that specifically addresses homelessness is unknown. For NAHASDA and  other programs that fund assistance to tribal entities, individual tribal  governments determine usage and disaggregating funds used for persons  experiencing homelessness would need to be done at the tribal level.  However, USDA, which has nonfood programs that primarily serve rural  areas, was able to disaggregate funding within its Community Facilities  Loan Program. Eligible uses under this program include homeless and  domestic violence shelters, community centers, and fire stations. For fiscal  years 2004-2009, the program financed a total of 7 homeless shelters and  76 domestic violence shelters for a total of about $29.7 million of the  program’s $4.5 billion total for those years.
We were unable to determine whether the distribution of federal funding  for supporting persons experiencing homelessness was proportional to  need in rural and nonrural areas. Such a determination would require  complete data on the total number of persons experiencing homelessness  in both rural and nonrural areas, as well as reliable information on the  funding available in both rural and nonrural areas. We found that the  counts of homelessness are not complete for this purpose, and as stated  above, funding levels are nondeterminable for a variety of reasons.
section_title: Barriers to the Rural Homeless Population Seeking Assistance Include Limited Availability of Services, Lack of Transportation, and Lack of Affordable Housing
paragraphs: According to state and local officials, as well as individuals experiencing  homelessness we interviewed in the states we visited, limited availability  of services, lack of transportation, and lack of affordable housing have  been some common barriers that the rural homeless population  encounters when seeking assistance. Factors such as geography,  population density, and socio-economic conditions also can make access  to services challenging in rural areas—particularly when considered in  combination with the barriers cited above.
Providers we spoke to in the states we visited said homeless shelters and  transitional housing in rural areas are scarce and serve a wide  geographical area, and in some instances, counties do not have shelters. A  shelter we visited in Maine with 63 beds is the only multi-purpose shelter  that serves the entire homeless population in a county of nearly 1,000  square miles. In addition, 4 of the 16 counties in Maine are without  emergency shelters, with 1 of those 4 counties using hotels as an  alternative in the winter. Some shelters may dedicate services to a specific  subpopulation such as youth, domestic violence, and substance abuse  clients, which could narrow the availability of assistance for some  individuals or populations. Many of the providers with whom we spoke  have had to turn away individuals and families because their shelters were  full and backlogged. According to officials in Maine, between June and  August 2009, shelters across the state turned away 500 families, including  a total of 200 children. Because shelters are one of the visible points of  entry to a network of services such as health care, alcohol and drug  treatment, job training, and case managers, those experiencing  homelessness in rural areas who are without shelters may be more likely  to be disconnected from caseworkers who can provide referrals to these  supportive services. However, community action agencies, faith-based  organizations, and other nongovernmental entities may offer assistance to  networks of services. Similarly, supportive services, such as medical and  dental, mental health, food, and job training, are also limited in rural areas.  For example, one service provider in rural Kentucky stated that the closest  mental health center was 50 minutes away, while another service provider  in rural Maine told us that the closest psychiatrist was about an hour and a  half away. Also in Maine, rural service providers told us that there is no  funding to support job training. Furthermore, officials said that domestic  violence is associated with homelessness in rural communities and tribal  areas, and those individuals have limited resources or services.
According to those we interviewed, the lack of transportation in rural  areas has hindered the homeless population in accessing services. Rural  areas can be isolating due to the combination of expansive land size and  sparse population. Persons experiencing homelessness might be  geographically cut-off from the limited homeless service providers  available in their area, and would need to travel long distances to receive  needed services. Many of the state and local officials, service providers,  and individuals experiencing homelessness interviewed told us that public  transportation either was nonexistent or limited (i.e., infrequent service  and limited coverage areas). If homeless individuals missed their  appointments, they have to reschedule for another appointment at a later  time thereby delaying services, or their services could be denied according  to one service provider in Minnesota. Individuals experiencing  homelessness in some of the areas we visited with no public  transportation reported that they utilized dial-a-ride services provided by  community action agencies or relied on friends or caseworkers. The cost  of public transportation can also be an issue for those with very little  income, although some local service providers with whom we spoke were  able to give bus passes to their clients. Alternatively, some local nonprofits  provided automobiles or buses to connect individuals and families to  services, but coverage areas also were limited.
According to many of the people we interviewed, persons experiencing  homelessness and seeking assistance also may encounter the barrier of  limited safe and affordable housing in rural areas. Providers in certain  areas of the states we visited raised concerns about the shortage of  affordable housing and, in some cases, quality of housing available in the  areas, noting that they were aware of some properties that lacked  complete plumbing or heat. In some of the rural areas we visited,  deteriorating housing conditions for private market units may be more  severe due to the absence of building code enforcement. According to a  service provider in eastern Kentucky, many homes in the areas are heated  with wood or coal (a potential fire hazard), and others lacked complete  plumbing. Moreover, because market rents in eastern Kentucky have been  so low compared to nonrural areas due to high poverty rates, programs,  such as the Low- Income Housing Tax Credits (LIHTC) are examples of  financial incentives to attract investors who have shied away from  supporting low-income housing development in the area. Furthermore,  according to providers we spoke with in Kentucky and Texas, topographic  conditions, such as limited flat land in eastern Kentucky and flood plains  in the colonias in Webb and Hidalgo counties in Texas, have discouraged  investors and developers from investing in these rural areas. According to  a service provider in Arizona, development on tribal lands is restricted by  legal issues relating to sovereign land, which reduces banks’ willingness to  finance projects. Resistance in local communities also has presented  obstacles to building new housing as described by those we interviewed.  For example, Minnesota state officials noted that some local communities  have resisted the building of shelters and other housing for the homeless  or low-income populations because they believe that undesirable persons  will move to their communities. For similar reasons, a local government in  Texas has not sought funds from state or other sources to fund homeless  programs, according to a local shelter provider. Compounding the issue of  lack of affordable housing, service providers in some of the states we  visited have experienced long waiting lists (about 2 years) for the Housing  Choice Voucher Program (tenant-based Section 8). For example, service  providers in Maine told us that they have not been able to obtain tenant- based Section 8 vouchers since December 2008.
Based on those with whom we spoke and relevant research, individual  barriers such as mental health issues, felony records, and no proof of  identification have hindered those seeking assistance. According to the  1996 National Survey of Homeless Assistance Providers and Clients, two- thirds of the rural homeless population report having a mental health or  substance abuse problem and may require specialized services such as  psychiatric referral and treatment. Several individuals with whom we  spoke in a shelter indicated that they felt more mentally and emotionally  stable after being put on medication received under public health care  coverage through the help of shelter staff. Also, program eligibility and  rules may exclude some felons from federal housing assistance, including  tenant-based and project-based Section 8 programs. Without federal  housing assistance, these individuals could remain homeless because the  ability to find a job that would pay for market rent could also be affected  by their criminal records. Another individual barrier is the lack of  documentation to prove identity. Without birth certificates, driver’s  licenses, and Social Security cards which, according to some providers  with whom we spoke, some persons experiencing homelessness lack,  individuals and families might not be able to apply for and obtain services.  Table 4 illustrates some examples of barriers for persons experiencing  homelessness, as discussed above and further identified in our interviews  with local service providers and homeless individuals in the states we  visited.
section_title: Barriers to the Rural Homeless Service Providers Include Administrative Burden, Lack of Affordable Housing, and Challenges Related to Geography and Population Density
paragraphs: According to state and local officials and local service providers in the  states we visited, administrative burden, lack of affordable housing, and  challenges related to geography and population density were barriers for  rural homeless service providers. Some of the local service providers with  whom we spoke indicated that they operated with limited staff and, due to  capacity issues, assumed a wide variety of responsibilities from providing  direct service to clients to applying for federal and other grants. In  particular, service providers in rural areas with whom we spoke have  responded to limited resources by applying to, and assembling multiple  funding sources from both state and federal programs. As a result, the time  consumed in grant writing and meeting the various compliance and review  requirements set by statute represented an administrative and workload  burden, according to service providers and state officials with whom we  spoke. For example, providers in Maine expressed frustration with the  duplicative review for the Supportive Housing Grant Program and tenant- based Section 8 Program, both of which HUD administers but under  separate authorities. According to some service providers with whom we  spoke, many grant applications also require data to demonstrate resource  needs. Especially in rural areas with no shelters or visible points of entry  for services, counts of the homeless are not documented, and without data  it is hard to prove that the services are needed. Because of the  administrative burden and challenges in meeting application requirements,  some providers with whom we spoke were discouraged from applying for  funds from certain programs. A coalition we spoke to in Maine said that  many of its members were discouraged by the requirements of programs  that received stimulus funds and therefore considered not applying for  them. Also, as described in our June 2010 report, issues related to multiple  federal definitions of homelessness have posed challenges for service  providers. Moreover, according to Minnesota state officials and service  providers we spoke with, Minnesota’s definition of homelessness is  different from some federal programs, creating another level of complexity  in understanding the definition and determining client eligibility.  According to state officials, Minnesota’s definition of homelessness  includes those who, as long as the person or family’s situation is not stable  are doubling up and “couch surfing” for at least a year or four separate  occasions over a 3 year period. While this is consistent with a broader  definition of homelessness used by Education under the McKinney-Vento  Act, it has not been consistent with HUD’s definition of chronic  homelessness.
State and local officials and rural service providers cited a lack of  affordable housing as another challenge for service providers when  addressing homelessness in rural areas. Specifically, some of the local  service providers with whom we spoke have been unable to move people  from emergency shelters, homeless shelters, or transitional housing  programs to permanent housing due to shortages of tenant-based Section  8 vouchers and a shortage of affordable housing. According to service  providers in multiple locations, due to the shortage in tenant-based  Section 8 vouchers, the shelters they work with are full and stays at  shelters have lengthened. Without financial assistance, those experiencing  homelessness may find it challenging to move out of short-term housing.  Furthermore, to the extent that tenant-based Section 8 vouchers have been  available, some providers told us in their communities that the current  housing stock has been deteriorating and limited new housing units have  been built, so there is nowhere for that voucher to be used. According to  HUD, between 1995 and 2007, LIHTC—the principal federal subsidy  mechanism for supporting the production of new and rehabilitated rental  housing for low-income households—were used predominately for new  construction. With that said, the number of new construction units has  declined since 2005. Moreover, according to HUD regional office  officials, the lack of affordable housing also is attributable to the  significant reduction in size of the housing projects being built. As a result,  some providers told us long waiting lists for tenant-based Section 8  vouchers exist. According to a rural service provider in Kentucky, the  tenant-based Section 8 voucher waiting list had 3,000 names on it.
The persons with whom we spoke also consistently said the size of service  areas and low population densities in rural areas presented obstacles to  service provision. The combination of expansive service areas and sparse  populations require many service providers to drive long distances to  serve their clients. For example, several rural service providers,  particularly case workers, described their vehicles as their offices because  of the amount of time they spent traveling between meetings with other  service providers and serving clients. Furthermore, according to HUD,  because funding is limited, many rural service providers cannot afford  large staffs and often wear many hats. In an urban area, separate staff or  separate agencies might be responsible for assessing different needs such  as housing, nutrition, education, job-search, mental and physical health,  and substance abuse needs. However, in a rural area, one individual may  be the client’s primary point of contact and may have to consider the  whole range of issues. Furthermore, some rural areas do not have  broadband services and some providers we spoke with said that they are  excluded from some of the communications and resources available over  the Internet. For instance, HUD regional office officials acknowledged that  some rural service providers have been unable to connect to some of their  technical assistance workshops and learn about application preparation,  project administration, and management.
Local officials and service providers have cited other barriers such as  variability of local commitments and diminishing purchasing power. In  some of the states we visited, some service providers mentioned  variability in local and state commitment, which can influence the  homeless assistance programs. For example, 10 years ago Minnesota  invested in an intensive case management pilot program which provides  housing and supportive services to assist people with long histories of  homelessness. Because of the success of the pilot, the Minnesota  legislature has continued to appropriate funding to finance supportive  housing for five long-term homeless projects in areas that include  approximately 80 percent of Minnesota’s population, according to a  service provider in Minnesota. In contrast, other communities have been  resistant to supporting homeless programs, such as one community  organization in Texas described that their local government resisted  acquiring additional funds in fear of attracting more homeless individuals  and families to the community. Diminishing purchasing power also affects  the ability of local service providers to address needs in their  communities. According to CoC participants, Maine receives PATH funds,  but the amount has remained steady at $300,000 per year for the last 17  years. According to officials, the buying power of the program has  diminished to $158,000 (in real dollars) today compared to 17 years ago.  Similarly, the per diem rate, funded through HUD’s ESG program, has  diminished from $12.41 in 2008 to $11.21 in 2009, nearly a 10 percent  decrease, although service providers in Maine have increased services  such as adding more beds in the shelter.
section_title: Limited Effective Collaboration among Federal Homelessness Programs Has Hindered Opportunities to Integrate Services
paragraphs: While a few examples of federal collaboration regarding homelessness  have demonstrated aspects of effective collaboration, effective  collaboration has been limited between HUD and HHS, two of the key  federal agencies funding housing and supportive services that include  programs for more than one subpopulation. In an October 2005 report, we  identified key collaborative practices among federal agencies that include  agreeing on roles and responsibilities, defining and articulating a common  outcome, establishing mutually reinforcing or joint strategies, and  identifying and addressing needs by leveraging resources. Collaboration  to link supportive services and housing is particularly significant for rural  areas because of the complex system of barriers in rural areas, such as  limited bed capacity in shelters, distance to services, and lack of  transportation. Such linkage can enhance strategies to address challenges  that limited resources and the other barriers pose. One study regarding the  linking of affordable housing with supportive services— supportive  housing—indicated that over the long term, it could save public resources  by reducing the cycle of homelessness through improved housing stability  and behavioral health outcomes. Moreover, some studies indicated that  offering housing with supportive services resulted in fewer hospital days  and emergency room visits, which are publicly provided.
Two completed demonstration projects—Collaborative Initiative to Help  End Chronic Homelessness (CICH) and Ending Chronic Homelessness  through Employment and Housing—and the existing HUD-VASH program  demonstrated key collaboration practices identified in our October 2005  report, such as defining roles and responsibilities and leveraging  resources. Under the CICH, HUD, HHS, and VA agreed on roles and  responsibilities and leveraged resources by allotting 3-year grants from  HHS and VA and up to 5-year grants from HUD to 11 communities.  Similarly, Ending Chronic Homelessness through Employment and  Housing was a partnership between Labor and HUD in which, through a  cooperative agreement, HUD and Labor defined roles and responsibilities  and leveraged resources, also consistent with key collaboration  practices. Since 2008, under the HUD VASH program, HUD has  designated more than 30,000 tenant-based Section 8 vouchers to public  housing authorities for veterans who are homeless and VA provided  funding for supportive services, including case management and clinical  services. Particularly, VA identified a number of Veterans Affairs Medical  Centers to participate in the program and provide case management  resources. While these efforts demonstrated practices that enhanced and  sustained collaboration, particularly linking housing assistance and  supportive services, HUD-VASH has not demonstrated collaborative  strategies that could benefit rural areas specifically, according to officials  and rural service providers in some of the states we visited. Because the  HUD vouchers must be linked to VA facilities, the recipients of the  vouchers have been mostly in nonrural areas in which most VA medical  centers are located. However, according to HUD officials, innovative  approaches, such as using a mobile clinic, are now being used to serve  rural areas. Furthermore, according to VA officials, HUD and VA have  discussed opportunities to improve voucher allocation in rural areas.
Additionally, the Interagency Council has developed the first-ever Federal  Strategic Plan to Prevent and End Homelessness. The plan, which was  presented to Congress on June 22, 2010, reflects interagency agreements  on a set of priorities and strategies agencies will pursue over 5 and 10-year  timeframes according to population. Also, according to HUD and HHS  officials, the two departments, as part of the President’s fiscal year 2011  budget, are proposing two demonstration initiatives, one involving 4,000  housing vouchers with health, behavioral health, and other supportive  services for chronically homeless persons, and another involving 6,000  housing vouchers linked with mainstream services like job training and  income assistance through TANF for homeless and at-risk families with  children. Additionally, according to HUD and HHS officials, the two  departments established working groups to identify collaboration  opportunities related to homelessness. However, given that the Council’s  strategic plan has only recently been released and that the proposal in the  President’s fiscal year 2011 budget has yet to be approved, the impact of  both of these efforts is uncertain.
According to officials and providers we interviewed, HUD and HHS are the  key agencies serving the general population of those experiencing  homeless. For instance, HUD officials noted that the agency was the only  federal provider of permanent supportive housing for the homeless. While  several agencies provide supportive services, including HUD, the health- related services on which HHS focuses correspond to needs often  associated with persons experiencing homelessness, particularly mental  health and substance abuse treatment (see table 5). Service providers  with whom we spoke consistently cited HHS as the appropriate agency for  supportive services.
However, according to officials and rural providers we interviewed (and  nonrural providers interviewed for our June 2010 report), there is little  evidence that HUD and HHS have formally agreed on their respective roles  and responsibilities, or identified ways to leverage resources to support  the delivery of coordinated housing and supportive services. According  to HUD officials, beginning in 2002, in response to a requirement in the  2001 HUD Appropriations Act, HUD shifted its emphasis towards funding  housing for persons experiencing homelessness. This reduced the  proportion of the total CoC funding which went to supportive services  from 50 percent in 2002 to 34 percent in 2008, as illustrated in figure 3. In  subsequent years, CoCs submitted new and renewal projects with mostly  housing activities (such as operation and leasing), and according to HUD  officials, this resulted in more than 40,000 newly constructed housing  units. During this shift towards housing assistance, HUD required new  and renewal applicants to provide information on how those projects  planned to coordinate and integrate with other mainstream health, social  services, and employment programs. Even though HUD officials noted that  it relied on other federal agencies to fill the supportive services gap,  providers we visited told us they are challenged to secure supportive  services funding from agencies other than HUD. A requirement that HUD  applicants provide information on plans to coordinate with other agencies  does not directly address this concern of these service providers.
HUD and HHS, which both have missions to address homelessness, have  not adopted some of the key practices that could be used to enhance  collaborative efforts, particularly during the period when HUD shifted its  resources and responsibilities. HUD officials said that they consulted with  HHS prior to their shift in resources and responsibilities. HHS officials told  us that there was no formal discussion or agreement between them and  HUD about how HHS might fill the gap in supportive services created by  HUD’s shift toward housing. We previously have recommended that  federal agencies adopt a formal approach—including practices such as a  memorandum of agreement or formal incentives focused on collaboration,  signed by senior officials—to encourage further collaboration. However,  while HUD and HHS have not previously done this, they reported that they  have started discussions as part of their demonstration initiatives for fiscal  year 2011.
Without formally linking housing and supportive services across federal  agencies, federal efforts to address homelessness may not be as effective  as they could be. According to HUD officials, from 2001 to 2007, HUD and  several partners—HHS, VA, Labor, Education, and the Interagency  Council—held a series of Policy Academies which focused on fostering  collaboration, enhancing partnerships, and building capacity. Additionally,  HHS and HUD collaborated to create FirstStep to encourage use of  mainstream services. However, the impact of this collaboration is not  clear, as evidenced by numerous rural providers who were not aware of  the collaboration. In addition, service providers with whom we spoke in  both rural and nonrural areas consistently raised concerns about the lack  of coordination between HUD and HHS. In spite of HUD’s housing  emphasis, which encouraged local communities to coordinate with other  mainstream supportive services programs, and HUD’s efforts in issuing  guidance to rural areas on ways to collaborate with other organizations,  some service providers we spoke with mentioned that they did not  observe coordination across federal agencies. They cited the  administrative challenges they faced in developing programs for the  homeless that incorporated both housing and services. Particular to  Kentucky, state officials and service providers told us that HHS’s PATH  program, due to state stipulations, limits resources for serving rural  clients, many of whom suffer from mental health or substance abuse  problems. The lack of service dollars also affects organizations that could  access HHS funding. Officials who administer several shelter and  transitional housing programs in rural Maine told us they sought  nongovernmental funding to fill the gaps in services. For example, HHS’s  Transitional Living Program provided $200,000 for supportive services  over 5 years, but the officials had to seek additional supportive services  funds through foundations and private donors. Development by HUD and  HHS of formal efforts to link housing and services, which may include  their proposed collaboration in the President’s fiscal year 2011 budget,  could enhance the effectiveness of federal efforts to address  homelessness.
section_title: Conclusions
paragraphs: The issue of rural homelessness presents a number of challenges for  federal agencies, not the least of which is determining its extent. Data  limitations and the array of federal programs, some of which are not  specifically targeted toward homelessness and some of which do not track  if their services or dollars have been expended in rural areas or on persons  experiencing homelessness, have resulted in multiple data sets that do not  allow for an overall assessment of the characteristics and extent of rural  homelessness or a comparison with nonrural homelessness. The data  issues are enormously challenging, but they also highlight the importance  of coordinating within existing programs to mitigate some of the impact of  the information gaps and to effectively deliver services.
As HUD and HHS consider collaborative efforts to address homelessness,  formal coordination across these agencies that links supportive services  and housing—a model that has shown to be effective—needs to include  tangible and accessible opportunities for providers to bridge the gap in  funding for supportive services that can be joined with housing for  persons experiencing homelessness. Providers with whom we met in rural  areas were generally unaware of any collaborative efforts between HUD  and HHS that would assist them in linking housing and supportive  services. Particularly during HUD’s shift in its resources and  responsibilities in 2002, HHS and HUD, the primary agencies for  supportive services and housing, did not implement some of the key  practices for effective collaboration that could have limited gaps in  services. More effective collaboration can create incentives and  opportunities for homeless housing and supportive services to be linked,  which is considered to be important for the effective delivery of assistance  to persons experiencing homelessness, and to further reduce  administrative challenges for local service providers. By more formally  linking housing and supportive services, HUD and HHS could increase  their ability and opportunities to address gaps in efforts to effectively  address homelessness and decrease challenges to service providers and  persons experiencing homelessness.
section_title: Recommendation for Executive Action
paragraphs: To strengthen formal collaboration efforts, we recommend that the  Secretary of Housing and Urban Development and the Secretary of Health  and Human Services direct the appropriate program offices to further  explore opportunities to more formally link housing and supportive  services—in the most appropriate forms and combinations of mainstream  and targeted programs identified by both agencies—with specific  consideration for how such collaboration could minimize barriers to  service provision in rural areas.
section_title: Agency Comments and Our Evaluation
paragraphs: We provided draft copies of this report to the Departments of Agriculture,  Education, Health and Human Services, Housing and Urban Development,  Interior, Labor, and Veterans Affairs and the Executive Director of the U.S.  Interagency Council on Homelessness for their review and comment. Both  HHS and HUD generally agreed with our recommendation and provided  technical comments which we incorporated, as appropriate. Letters from  the Deputy Assistant Secretary for Legislation at the Department and  Health and Human Services, and the Assistant Secretary of Community  Planning and Development at the Department of Housing and Urban  Development, are reprinted in appendixes II and III of this report,  respectively. The Departments of Labor and Veterans Affairs and the staff  of the U.S. Interagency Council on Homelessness did not provide formal  comments but provided technical comments which we also incorporated,  as appropriate. The Departments of Agriculture and Interior did not  provide any comments.
HUD’s Assistant Secretary of Community Planning and Development  stated in written comments that HUD agrees that increased collaboration  among federal agencies would improve the delivery of services in rural  areas. In addition, HUD stated that due to statutory requirements, federal  agencies do not employ a single definition of “rural” and it may not be  reasonable for all agencies to utilize the same definition of rural as the  purposes of the programs may be vastly different. We do not recommend  that agencies utilize a single definition of rural but rather recognize that  the varying definitions limit the ability to understand the incidence and  prevalence of homelessness in rural areas. HUD also commented that this  report presents a limited review of HUD’s data collection and reporting  efforts and does not acknowledge the progress that HUD has been making  in this area or the value of the data currently being collected, or that their  Annual Homeless Assessment Report is the only national estimate of  homelessness to use longitudinal data. Since we recently issued a report  that provides a detailed review of HUD’s data collection and reporting  efforts and discusses the efforts HUD has taken to improve the data, we  did not provide this same level of detail in this report. We have added a  reference to our June 2010 report for additional information on these  topics. In addition, as noted in our June 2010 report, HUD’s data in their  Annual Homeless Assessment Report are not longitudinal in that they do  not follow specific individuals over time; rather HUD collects aggregated  data that track numbers of homeless over time.
HUD commented that they have undertaken efforts to better align their  homelessness data with homelessness data from HHS and VA. We  acknowledged these efforts in the report. HUD also commented that the  report indicates that effective collaboration hinges predominately on the  use of a common vocabulary and offered barriers it considers more  significant to effective collaboration. Discussions of issues related to a  common vocabulary are not described in this report but are included in  our June 2010 report. Additionally, while HUD agrees with our discussion  about the proportion of CoC dollars awarded for supportive services  activities having decreased, they commented that the total dollar amount  associated with those service remains significant. We do not suggest that  the total dollar amount of HUD funded supportive services is insignificant,  but rather that the decrease in the proportion of dollars for supportive  services has contributed to a gap in funding for providers. Further, HUD  commented that it has worked with HHS to improve access by homeless  persons to their programs and that federal coordination and collaboration  are evident in the U.S. Interagency Council on Homelessness’s Federal  Strategic Plan to Prevent and End Homelessness. We recognize in our  report actions that HUD and HHS have taken to collaborate; however, we  believe that we correctly assess the opportunities for further progress by  the agencies in linking housing and supportive services across their  programs.
HUD also commented that it agreed that a common vocabulary among  federal agencies and increased collaboration would improve the delivery  of services in rural areas, but that the existence of both of these elements  does not equate to a seamless integration of various streams of funding to  create a project to serve homeless persons. We are not suggesting that a  common vocabulary and increased collaboration by themselves will  equate to a seamless integration of funding streams, but we believe that it  could help to improve the delivery of services. Finally, HUD commented  that it believes our report’s focus on the anecdotal experiences of local  providers does not provide a complete picture of efforts made by HUD  regarding data collection, interagency collaboration, and the funding of  supportive services. As noted earlier, we did not seek to repeat the level of  detail on HUD’s efforts regarding data collection as had already been  included in our June 2010 report and we refer readers to this report for  additional information. Also, while our report provides the perspectives  of local providers as gathered from six site visits, we also conducted  numerous interviews with national stakeholder groups and federal agency  officials, and reviewed relevant reports and federal agency documents.  Based on all of the information we gathered and reviewed, we believe we  have correctly assessed the data collection, interagency collaboration, and  funding of supportive service issues referred to by HUD in their comment.
HHS’s Deputy Assistant Secretary for Legislation stated in written  comments that HHS strongly agrees with the importance of collaboration  with HUD to effectively address homelessness. In addition, HHS  commented that GAO’s reference to the demonstration initiative—around  housing vouchers for homeless people—included in the Fiscal Year 2011  President’s Budget was incomplete. We added an expanded description of  this initiative. HHS commented that the Patient Protection and Affordable  Care Act will contribute to filling gaps in supportive services for homeless  people. We did not examine the Patient Protection and Affordable Care  Act as part of our review. HHS also commented that the discussion of  funding and services in the report needs to distinguish between linking  homeless individuals with the services that they need and aligning services  with housing programs that target specific homeless populations. We  acknowledge that collaboration between HHS and HUD related to housing  and supportive services could take different forms. As we state in our  recommendation, the two agencies should explore opportunities to link  housing and supportive services while considering the most appropriate  forms and combinations for this collaboration.
We will send copies of this report to interested congressional committees,  the United States Interagency Council for the Homeless, and to the  Departments of Agriculture, Education, Health and Human Services,  Housing and Urban Development, Interior, Labor, and Veterans Affairs.  This report will also be available on our home page at no charge at  http://www.gao.gov.
If you have any question about this report, please contact me at   (202) 512-8678 or cackleya@gao.gov. Contact points for our Offices of  Congressional Relations and Public Affairs may be found on the last page  of this report. GAO staff who made key contributions to this report are  listed in appendix IV.
section_title: Appendix I: Scope and Methodology
paragraphs: To address all of our objectives, we conducted site visits to six states— Arizona, Kentucky, Maine, Minnesota, New Mexico, and Texas. During  these visits, we interviewed federal, state, and local housing and  homelessness officials and nonprofit homelessness organizations, and  toured rural areas in which homelessness was present. We selected the  site visit locations based on several factors, including (1) discussions with  advocates and researchers in the field of homelessness—including the  Housing Assistance Council, the National Alliance to End Homelessness,  the National Law Center on Homelessness and Poverty, and the Urban  Institute—to learn about rural homelessness issues and the outcomes  across different states; (2) a review of studies and reports on local and  state efforts to serve the homeless in rural areas, including papers  prepared for the 2007 National Symposium on Homelessness Research  that highlighted issues related to rural homelessness; (3) the presence of  tribal lands and colonias; and (4) geographical diversity. While on site  visits we interviewed federal field office officials, state officials, local  providers, and local advocates, and in Minnesota panels of homeless  individuals. We also toured service areas and providers facilities, and in  Texas we toured several colonias. On the site visits to Arizona and New  Mexico we visited the tribal lands of the San Carlos Apache Tribe of the  San Carlos Reservation, Arizona; the Tohono O’odham Nation of Arizona;  the Pueblo of Acoma, New Mexico; and the Pueblo of San Felipe, New  Mexico. We interviewed tribal officials from the tribal designated housing  entities, service providers on and off tribal lands, and advocates. We  reviewed relevant laws, regulations, and program documentation and  interviewed officials from various federal agencies, including Departments  of Agriculture, Education, Health and Human Services, Housing and Urban  Development, Interior, Labor, Veterans Affairs, and the U.S. Interagency  Council on Homelessness (Interagency Council). We also conducted  interviews with a variety of stakeholders, including advocates and  researchers.
To describe the characteristics of homelessness in rural areas, we  reviewed existing research and studies on homelessness issues,  particularly those that are related to rural homelessness. We conducted  interviews with relevant federal and state officials, service providers,  national homeless and poverty organizations, and to the extent possible,  homeless individuals and families to obtain their perspectives on the  conditions of homeless in rural areas and the extent of migration to  nonrural areas for assistance. Specifically, we interviewed federal officials  to understand the extent data is available in estimating the incidence and  prevalence of homelessness in rural areas and how it compares to  nonrural areas.
To identify the federal homeless assistance and amount of funding  awarded, we reviewed statutes, regulations, and reports, including our  prior work, on federal homeless assistance for both targeted and  mainstream programs. We interviewed federal, state, and local officials, to  understand the range of assistance that is available to assist homeless  individuals or families in rural areas, how those assistance programs are  delivered, and the amount of funding that has been awarded. To the extent  that data were available for comparison, we interviewed selected federal  officials to understand funding differences between rural and nonrural  areas. Specific data from some programs funded by the Departments of  Agriculture, Housing and Urban Development, and Veterans Affairs were  determined to be reliable enough to use in this report.
To identify the barriers persons experiencing homelessness and homeless  service providers encounter, we interviewed state and local officials,  homeless service providers, and to the extent possible, homeless  individuals and families for information on barriers encountered when  seeking assistance, barriers encountered when providing assistance, and  any challenges related to federal coordination and efforts. We also  interviewed select federal officials, including officials from the  Interagency Council, to understand the extent of federal collaboration in  providing services to persons or families experiencing homelessness in  rural areas.
We conducted this performance audit from September 2009 to July 2010 in  accordance with generally accepted government auditing standards. Those  standards require that we plan and perform the audit to obtain sufficient,  appropriate evidence to provide a reasonable basis for our findings and  conclusions based on our audit objectives. We believe that the evidence  obtained provides a reasonable basis for our findings and conclusions  based on our audit objectives.
section_title: Appendix II: Comments from the Department of Health and Human Services
section_title: Appendix III: Comments from the Department of Housing and Urban Development
section_title: Appendix IV: GAO Contact and Staff Acknowledgments
subsections: section_title: Staff Acknowledgments
paragraphs: In addition to the individual named above, Marshall Hamlett, Assistant  Director; Aglae Cantave; Chir-Jen Huang; Karen Jarzynka; John Lord; Paul  Thompson; Marc Molino; LuAnn Moy; Andrew Pauline; and Barbara  Roesmann made key contributions to this report.