Domestic Food Assistance: Complex System Benefits Millions, but Additional Efforts Could Address Potential Inefficiency and Overlap among Smaller Programs
Published: 2010-04-15T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: The federal government spends billions of dollars every year on domestic food assistance programs. The U.S. Department of Agriculture administers most of these programs and monitors the prevalence of food insecurity--that is, the percentage of U.S. households that were unable to afford enough food sometime during the year. Other federal agencies also fund food assistance programs; however, comprehensive and consolidated information on the multiple programs is not readily available. Congress asked GAO to examine: 1) the prevalence of food insecurity in the United States, 2) spending on food assistance programs, 3) what is known about the effectiveness of these programs in meeting program goals, and 4) the implications of providing food assistance through multiple programs and agencies. GAO's steps included analyzing food security and program spending data, analyzing studies on program effectiveness, analyzing relevant federal laws and regulations, conducting site visits, and interviewing relevant experts and officials.
section_title: What GAO Found
paragraphs: The prevalence of food insecurity hovered between 10 and 12 percent over the past decade until it rose to nearly 15 percent (or about 17 million households) in 2008. Households with incomes below the poverty line, households headed by single parents, minority households, and those with children had higher than average rates of food insecurity. These households were more likely to report, for example, that they had been hungry, but didn't eat, because there wasn't enough money for food. While some households were able to protect children from the effects of food insecurity, many could not. In more than 4.3 million households, children--as well as adults--were affected by food insecurity sometime during the year. The federal government spent more than $62.5 billion on 18 domestic food and nutrition assistance programs in fiscal year 2008. The five largest food assistance programs--Supplemental Nutrition Assistance Program (SNAP); the National School Lunch Program; the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); the Child and Adult Care Food Program; and the School Breakfast Program--accounted for 95 percent of total spending on the 18 programs. Since 1995 SNAP spending has fluctuated while spending on the other large programs has remained relatively stable. Economic conditions--such as unemployment or poverty--and other factors can affect spending on some programs, particularly SNAP. Research suggests that participation in 7 of the programs we reviewed--including WIC, the National School Lunch Program, the School Breakfast Program, and SNAP--is associated with positive health and nutrition outcomes consistent with programs' goals, such as raising the level of nutrition among low-income households, safeguarding the health and wellbeing of the nation's children, and strengthening the agricultural economy. However, little is known about the effectiveness of the remaining 11 programs because they have not been well studied. Federal food assistance is provided through a decentralized system that involves multiple federal, state, and local organizations. The complex network of 18 food assistance programs emerged piecemeal over the past several decades to meet various needs. Agency officials and local providers told us that the multiple food assistance programs help to increase access to food for vulnerable or target populations. However, the 18 food assistance programs show signs of program overlap, which can create unnecessary work and lead to inefficient use of resources. For example, some of the programs provide comparable benefits to similar target populations. Further, overlapping eligibility requirements create duplicative work for both service providers and applicants. Consolidating programs, however, entails difficult trade-offs. Such actions could improve efficiency and save administrative dollars but could also make it more difficult to achieve the goals of targeting service to specific populations, such as pregnant women, children, and the elderly.

section_title: Letter
paragraphs: The federal government spends billions of dollars every year on food and  nutrition assistance programs, and millions of Americans turn to these  federal programs when they lack the money to get enough to eat. The  nation’s largest food assistance program—the Supplemental Nutrition  Assistance Program (SNAP)—provided more than $34.6 billion in benefits  in fiscal year 2008. The recent economic crisis has increased demand for  such assistance, with participation in SNAP increasing by 22 percent  between June 2008 and June 2009.
U.S. Department of Agriculture’s (USDA) Food and Nutrition Service has  responsibility for administering most of the federal domestic food and  nutrition programs, including the five largest: SNAP; the National School  Lunch Program; the Special Supplemental Nutrition Program for Women,  Infants, and Children (WIC); the Child and Adult Care Food Program; and  the School Breakfast Program. As the federal government’s primary  domestic food assistance agency, USDA aims to help households achieve  food security—that is, to have consistent, dependable access to enough  food for an active, healthy life—and monitors the extent and severity of  food insecurity. The Department of Health and Human Services (HHS) and  the Department of Homeland Security (DHS) also fund programs that  provide food and nutrition assistance. However, consolidated and  comprehensive information on how much federal agencies spend to  support these multiple food assistance programs and information on their  effectiveness in meeting program goals is not readily available.
To shed light on these issues, we addressed the following: (1) what is the  prevalence of food insecurity among U.S. households; (2) how much did  the federal government spend on food and nutrition assistance programs  in fiscal year 2008, and how has spending on the five largest programs  changed over time; (3) what is known about the effectiveness of federal  food and nutrition programs in meeting program goals; and (4) what are  the implications of providing food assistance through multiple programs  and agencies?
To address these research objectives, we collected information on all  federal programs that focus primarily on providing or supporting food and  nutrition assistance. We identified these programs by reviewing the  Catalog of Federal Domestic Assistance, relevant federal laws and  regulations, and other relevant documents, and by interviewing federal  officials and experts. To show the prevalence of food insecurity among  U.S. households from 1995 (when this information was first collected) to  2008 (the most current data available), we present USDA’s food security  estimates based on the Current Population Survey (CPS) annual food  security supplement. Many of these estimates are obtained from the  USDA publication Household Food Security in the United States, 2008.  While the food security data have some limitations, these data provide a  nationally representative measure of hunger over time, and we consider  these data reliable for this engagement. To determine how much money  federal agencies spent on food and nutrition programs, we analyzed data  from the Consolidated Federal Funds Report (CFFR)—a database that  compiles expenditures or obligations from federal agencies—as well as  additional spending data provided by agencies. We confirmed the  reliability and accuracy of these data with federal officials. To determine  what is known about the impacts these programs have on outcomes  related to their goals, we analyzed the Economic Research Service’s  comprehensive review of studies published between 1973 and 2002. We  also conducted our own literature review that examined studies, published  between January 1995 and July 2009, of programs administered by  agencies other than USDA, as well as studies of USDA programs that were  conducted between 2002 and July 2009. These literature reviews included  peer-reviewed journal articles, agency documents, and other research  determined to be methodologically rigorous and reliable. To understand  the implications of providing food assistance through multiple programs  and agencies, we reviewed previous reports and interviewed federal, state,  and local officials, as well as local providers and other groups in five  states. We conducted site visits in California, Illinois, and Maryland, where  we met with local providers, including food banks, local health  departments, and other public and nonprofit entities that administer  federal food and nutrition assistance programs. We also conducted phone  interviews with officials and providers in Oregon and Texas. The states  and localities that we met with were selected to take into account  geographic distribution and to include both urban and rural areas, as well  as a diverse group of local agencies providing program services. We also  considered recommendations from federal officials and relevant experts.  (See appendix I for more information on our scope and methodology.) We  conducted this performance audit from February 2009 to March 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  we obtained provides a reasonable basis for our findings and conclusions.
subsections: section_title: Background
subsections: section_title: Hunger and Food Insecurity
paragraphs: The word hunger has several meanings—it can describe, for example,  one’s desire for food; the painful sensation or state of weakness caused by  the need for food; or famine. While severe hunger—manifesting as clinical  malnutrition—is uncommon in this country, millions of children and  adults who lack resources go without food and many are undernourished.  The mental and physical changes that accompany inadequate food intake  and even minor nutrient deficiencies can have negative effects on learning,  development, productivity, physical and psychological health, and family  life.
In 1995 USDA’s Economic Research Service—through the nationally  representative CPS Food Security Supplement—began tracking the  number of households that are uncertain of having or unable to acquire  enough food because they lack resources, and uses the term low food  security or very low food security, not hunger, to describe these  households. USDA adopted these terms in response to recommendations  by a National Academies panel, which found the term hunger to be  inappropriate when describing low-income households that lack enough  food both because of the difficulties in measuring hunger and because  hunger has physiological definitions that do not necessarily correspond to  nutritional insufficiency. USDA monitors the food security status of U.S.  households as part of its responsibility for administering most of the  federal government’s food and nutrition assistance programs, many of  which are intended to alleviate food insecurity and prevent the physical  and psychological outcomes—such as low birth weights, chronic illnesses,  and anxiety—associated with being undernourished. To be consistent with  USDA, this report uses the terms low food security, very low food security,  and food insecure. (See table 1 for definitions of these terms.)
The annual CPS Food Security Supplement collects data on the prevalence  and severity of food insecurity by asking one adult in each household a  series of questions about experiences and behaviors of household  members that indicate food insecurity. The food security status of the  household is assessed based on the number of food-insecure conditions  reported, such as being unable to afford balanced meals and being hungry  because there was too little money for food. Food-insecure households  are classified as having either low food security or very low food security  (see table 1). In addition, the survey assesses the food security status of  households with children.
section_title: Food and Nutrition Assistance Programs
paragraphs: The federal government has been helping needy individuals and families  access food for more than 60 years. The National School Lunch Program,  for example, was authorized in 1946 and became one of the first large- scale food and nutrition assistance programs. Other federal programs  followed, including the School Breakfast Program (founded by the Child  Nutrition Act of 1966) and WIC, authorized in 1972. Over time, some  programs have changed. For example, according to USDA, an early  version of SNAP (formerly the Food Stamp Program) required eligible  individuals to pay for a portion of their orange-colored stamps, which they  could use for any kind of food. In addition, this early version provided  eligible individuals with free blue stamps, equal to half the amount of the  orange stamps, to buy designated surplus foods. Today, SNAP recipients  now receive their benefits on electronic benefit transfer cards and no  longer use actual stamps to purchase food.
The federal government currently funds close to 70 programs that are  permitted to provide at least some support for domestic food assistance.  In our study, we identified the 18 programs that focus primarily on  providing food and nutrition assistance to low-income individuals and  households. (See table 2.)
The 18 programs we studied vary by target population, size, types of  benefits, and where these benefits are provided:    Target population. While the 18 programs serve four broad populations— individuals and households, children, the elderly, and special groups—the  specific target populations vary across programs. For example, SNAP  helps low-income individuals and families; the National School Lunch  Program assists school-aged children; the Elderly Nutrition Program  serves individuals 60 years of age and older; and WIC provides assistance  to low-income, nutritionally at-risk children up to age 5 and pregnant and  postpartum women.
Program size. The 18 programs also vary in size, ranging from the Food  Distribution Program on Indian Reservations, which serves approximately  90,000 individuals per month, to SNAP, which serves more than 28 million  people per month.
Benefit type. In addition, the programs differ by the types of benefits they  provide. Some programs—such as SNAP—were designed to help low- income individuals and families obtain a nutritious diet by supplementing  their income with cash-like benefits to purchase food, such as meat, dairy  products, fruits, and vegetables, but not items such as certain hot foods,  tobacco, or alcohol. Other programs provide food directly to program  participants. The Emergency Food Assistance Program supplies large  quantities of food to governmental or nonprofit organizations to prepare  meals for or distribute food to individuals and families. The National  School Lunch Program reimburses school districts for the meals served  and provides some commodities from USDA to offset the cost of food  service. Other programs do not directly provide benefits to individuals.  For example, the Community Food Projects Competitive Grants Program  provides grants to organizations to plan or implement projects to improve  access to food for low-income individuals and families.
Program administration. USDA, DHS, and HHS fund all of the 18  programs through a decentralized service delivery structure of state and  local agencies and nonprofit organizations. For example, WIC benefits are  typically delivered through state agencies to state and county health  departments; the Child and Adult Care Food Program works through state  agencies to subsidize child care providers, day care homes, and adult day  care facilities; and the Commodity Supplemental Food Program provides  food to state agencies, which then distribute the food to local nonprofit  organizations that provide it to recipients.
section_title: Program Goals
paragraphs: Each federal food and nutrition assistance program has its own set of  program goals that were generally established through legislation or  regulation. These goals have a mix of underlying purposes, including: (1)  raising the level of nutrition among low-income households, (2)  safeguarding the health and wellbeing of the nation’s children, (3)  improving the health of Americans, and (4) strengthening the agricultural  economy. (See appendix III for a summary of program goals.) While few  have specific goals to reduce or alleviate hunger, most of these programs  share an overarching goal of providing individuals access to a nutritionally  adequate diet to ensure the health of vulnerable Americans.  In addition,  the current administration set a national goal to end childhood hunger in  the United States by 2015 and the American Recovery and Reinvestment  Act of 2009 (Recovery Act) expanded eligibility guidelines and increased  benefits for SNAP, which may help the administration reach that goal.
section_title: Nearly Fifteen Percent of U.S. Households Were Food Insecure Sometime in 2008, According to USDA
paragraphs: The prevalence of food insecurity (the percentage of households with low  or very low food security) hovered between 10 and 12 percent from 1998  to 2007, before rising to 14.6 percent in 2008, according to USDA’s analysis  of CPS data. Following a similar pattern, very low food security stayed  between 3 and just more than 4 percent from 1998 to 2007, and reached 5.7  percent in 2008. (See figure 1.)
USDA recently reported that about 17 million households in the United  States (or 14.6 percent of all U.S. households) were food insecure at some  point in 2008. Of these food-insecure households, USDA reported that 6.7  million (or 5.7 percent of all U.S. households) had very low food security.  (See figure 2.) This increase in food insecurity coincided with the recent  economic recession, which began in late 2007 and continued throughout  2008.
Among households with incomes below the poverty line, those headed by  single parents, and those headed by minorities, prevalence rates for food  insecurity were higher than the national average rate of 14.6 percent.  (See figure 3.) According to USDA’s analysis of the food security data,  about 42 percent of households with incomes below the poverty line we food insecure in 2008. High levels of food insecurity were also found  among single-parent households with children; for example, about 37  percent of households with children headed by single women were food  re  insecure, and about 28 percent of households with children headed by  single men were food insecure. In contrast, among married couples with rried couples with children, 14.3 percent of households were food insecure. High levels of  children, 14.3 percent of households were food insecure. High levels of  food insecurity were also found among households headed by minorities food insecurity were also found among households headed by minorities for example, among households headed by Hispanics, nearly 27 percent  for example, among households headed by Hispanics, nearly 27 percent  were food insecure.  were food insecure.
Regardless of adults’ marital status, the prevalence of food insecurity was  almost twice as high among households with children (21 percent) as  among households without children (11.3 percent). In many families—just  under half of the roughly 8.3 million food-insecure households with  children—parents were able to maintain normal or near-normal diets and  meal schedules for their children, limiting the effects of food insecurity to  only the adults. However, in more than 4.3 million of these households,  children—as well as adults—experienced food insecurity sometime during  the year. Among households where children experienced food insecurity,  most indicated low (but not very low) food security among children,  reporting mainly reductions in the quality and variety of children’s meals.  Of the households with children just more than 1 percent (about 506,000  households) had very low food security among children—food insecurity  that was so severe that children’s eating patterns were disrupted and food  intake was reduced below levels that caregivers considered sufficient.
section_title: The Federal Government Spent More Than $62.5 Billion on 18 Food Assistance Programs in Fiscal Year 2008
subsections: section_title: Spending on the 18 Food Assistance Programs Totaled more than $62.5 Billion in Fiscal Year 2008
paragraphs: The federal government spent approximately $62.7 billion on 18 domestic  food and nutrition assistance programs in fiscal year 2008, with the 5  largest programs accounting for 95 percent of total spending. Programs’  spending amounts ranged from approximately $4 million on the  Community Food Projects Competitive Grants Program to more than $37  billion on SNAP. (See table 3.) Spending on food assistance programs is  often determined by both the value of the benefits and the number of  program participants. In 2008, for example, approximately 28.4 million  people (12.7 million households) participated in SNAP per month, with  each individual receiving an average of about $101.50 per month. In  contrast, approximately 2.2 million individuals participated in the WIC  Farmers’ Market Nutrition Program, with each participant receiving a  benefit between $10 and $30 for the year.
In fiscal year 2008, the five largest food assistance programs—SNAP, the  National School Lunch Program, WIC, the Child and Adult Care Food  Program, and the School Breakfast Program—accounted for 95 percent of  total spending on the 18 programs. SNAP, the largest program, accounted  for more than 60 percent of the overall spending total. (See figure 4.)  Compared to the other 13 programs, the largest five food assistance  programs have relatively high numbers of participants, and all but WIC are  entitlement programs—meaning that, by law, they must provide benefits  to all individuals or households that meet eligibility requirements and  apply for the program. This means that participation and benefits for  these programs are not capped, unlike programs that are appropriated  specific spending amounts, such as the Commodity Supplemental Food  Program or the Elderly Nutrition Program.
section_title: Spending on Most of the Large Programs— Excluding SNAP—Has Remained Stable
paragraphs: Since 1995 SNAP spending has fluctuated, while spending on the other  large programs—the National School Lunch Program, WIC, the School  Breakfast Program, and the Child and Adult Care Food Program— remained relatively stable. Between 1995 and 2000 the amount the federal  government spent on SNAP declined by 37.4 percent from $34.9 billion to  $21.8 billion. However, between fiscal years 2001 and 2007, SNAP  spending rose to $34.5 billion, nearly matching its previous 1995 level. In  fiscal year 2008, spending on SNAP totaled $37.6 billion—a sharp increase  of 9 percent in one year. In contrast, spending on the other large programs  was relatively stable from 1995 through 2000, and most increased slightly  between 2001 and 2008; however, WIC had an increase of 11 percent  between 2007 and 2008. Overall, when adjusted for inflation the federal  government spent 14 percent more on the largest five programs in fiscal  year 2008 than it did on those five programs in fiscal year 1995. (See  figure 5.)  figure 5.)
Economic conditions—such as unemployment or poverty—affect  spending on food assistance programs. Because the five largest programs  serve all or nearly all eligible individuals who apply, increases in poverty  that occur during economic downturns can lead to increases in program  participation, and consequently, increases in program spending. Of the five  large programs, SNAP, which serves the largest population, is particularly  responsive to economic changes. For example, changes in SNAP spending  between 1995 and 2008 generally tracked the percentage of people who  were unemployed, and spending changes were significantly correlated  with the percentage of people living in poverty during those times (see  figure 6). Consequently, the recent economic recession contributed to  the demand for and spending on SNAP. USDA reported that SNAP  participation nationwide increased in almost every month between  December 2007, when the recession began, and September 2009, the last  month for which information is available. Between June 2008 and 2009,  SNAP participation increased by just over 22 percent nationwide.  Spending on SNAP during the same time period increased by nearly 49  percent, due in part to increases in both participation and benefit rates.  Congress anticipates a continued expansion in SNAP spending: USDA’s  2010 appropriation includes approximately $58.3 billion for SNAP, a 55  percent increase compared to fiscal year 2008 spending.
State officials and local providers we spoke with also reported significant  increases in the demand for federal food assistance during challenging  economic conditions, and some found the recent influx of federal funds  crucial in meeting that demand. Oregon state officials told us in June 2009  that SNAP applications statewide had increased by more than 40 percent  during the previous year. Also, food bank officials in Texas told us that in  June 2008 demand for services at their member food banks—supported by  The Emergency Food Assistance Program—increased by 30 percent in the  previous year. According to these officials, the additional funding that the  program received from the Food, Conservation, and Energy Act of 2008  (2008 Farm Bill) and the Recovery Act  was critical in keeping up with  this demand. The Recovery Act alone provided more than $21 billion for  food assistance programs. These funds included a USDA estimated $20.1  billion for SNAP, in the form of increased benefits and state administrative  expenses; $500 million for WIC; $100 million for equipment assistance for  child nutrition programs; $150 million for The Emergency Food Assistance  Program; $100 million for the Emergency Food and Shelter National Board  Program; and $100 million for the Elderly Nutrition Program and Grants to  American Indian, Alaska Native, and Native Hawaiian Organizations for  Nutrition and Supportive Services.
In addition to economic conditions, other factors—such as natural  disasters, food costs, and outreach—can affect changes in program  spending over time. According to USDA, SNAP showed an increase in  spending in the fall of 2005 because of the additional assistance this  program provided to hurricane victims mostly in the Gulf Coast states.  Similarly, USDA attributed some of the increase in SNAP participation  during 2008 to the effects of Hurricane Gustav. Rising food costs can be  another driver of increased spending on some federal food assistance  programs, particularly for the WIC program, which provides specific foods  to women and their infants and young children. USDA’s Economic  Research Service reported an increase of 12 percent in per person food  costs for WIC between fiscal years 2007 and 2008, noting rising food costs  as a major factor in increased WIC spending during that time. SNAP and  the National School Lunch Program also make periodic adjustments in  their benefit or reimbursement amounts based on the cost of food. Also,  federal efforts beginning in 2001 to expand the proportion of eligible  households participating in SNAP likely contributed to increases in  participation and spending. These efforts included simplifying state SNAP  eligibility and application processes and improving access to SNAP for  eligible applicants.
section_title: Research Shows 7 Programs Have Positive Outcomes Related to Their Goals but Little Is Known about the Remaining 11 Programs
subsections: section_title: Seven Programs— Including Four of the Five Largest—Generally Show Positive Outcomes Consistent with Many of Their Program Goals
paragraphs: Research suggests that participation in seven of the programs we  reviewed, including four of the five largest—WIC, the National School  Lunch Program, the School Breakfast Program, and SNAP—is associated  with positive health and nutrition outcomes consistent with most of these  programs’ goals, including raising the level of nutrition among low-income  households, safeguarding the health and wellbeing of the nation’s children,  improving the health of Americans, and strengthening the agricultural  economy (see appendix III for summary of program goals).
WIC. Research generally suggests that participation in the WIC program is  associated with positive outcomes related to all three of its program   goals. For example, studies indicate that WIC has had several positive  effects related to its goal of improving the mental and physical health of  low-income pregnant, postpartum, and breastfeeding women, infants, and  young children. Specifically, research suggests that WIC has some positive  effects on individual dietary and nutrient intake, mean birth weight,  general health status of infants and children, and the likelihood that  children will receive complete and timely immunization, among other  outcomes. One study also found that WIC participation was associated  with reduced rates of child abuse and neglect. With regard to WIC’s goal of  preventing the occurrence of health problems and improving the health  status of the target population, some research suggests that WIC reduces  anemia and other nutritional deficiencies, improves the diet quality and  food use of households, and may even slightly increase the rates at which  pregnant women quit smoking.  Research on some of the other outcomes  related to WIC’s goals is less conclusive. For example, findings are mixed  on whether participation in the program increases the initiation or  duration of breastfeeding or improves cognitive development and behavior  of participants—outcomes that are related to WIC’s goals of improving the  mental and physical health of recipients and preventing the occurrence of  health problems and improving the health status of recipients.
The National School Lunch and School Breakfast programs.  Research  suggests that both the National School Lunch and the School Breakfast  programs have had some positive effects on health and nutrition outcomes  related to their goals of (1) safeguarding the health and wellbeing of  children and (2) encouraging the domestic consumption of agricultural  and other foods. Related to the goal of safeguarding the health and  wellbeing of children, research shows that both programs increase the  dietary and nutrient intakes of participating students. For example,  research finds that the School Breakfast Program improves students’  scores on a Healthy Eating Index and reduces the probability that  students will have low fiber, iron, and potassium intake and low serum  levels of vitamins C and E and folate. Also, research suggests that the  National School Lunch Program increases the frequency of eating lunch  among participants. However, research produced conflicting results on the  School Breakfast Program’s effects on other outcomes related to this goal,  such as whether the program increases the frequency that students eat  breakfast. An evaluation of the School Breakfast Pilot Program, which  unlike the traditional School Breakfast Program, provided universal free  meals, found no effect on general measures of health or cognitive  development.  The same study examining the School Breakfast Pilot  Program found that the program had a small negative effect on student  behavior (as rated by teachers). Similarly, there is conflicting and  inconclusive evidence on the National School Lunch Program’s effects on  other outcomes related to the goal of safeguarding the health and  wellbeing of children, such as childhood obesity. In addition, research  finds that the National School Lunch Program has no effect on children’s  cognitive development or behavior or iron status. Related to their other  similar goal, some evidence suggests that the School Breakfast and the  National School Lunch programs encourage the domestic consumption of  agricultural and other foods. A 2003 report by USDA’s Economic  Research Service found that through additional food consumption, school  nutrition programs—of which the National School Lunch and School  Breakfast programs are the largest—increased food expenditures by an  additional $1.9 billion, increased farm production by just more than $1  billion, increased labor earnings and returns to farm ownership by $318  million, and supported approximately an additional 9,200 farm jobs.
SNAP.  Literature also suggests that participation in SNAP, the largest of  the federal food and nutrition programs, is associated with positive effects  on outcomes related to many of its goals. According to the research,  participation in SNAP has several positive outcomes related to the  program’s goals of raising the level of nutrition and increasing the food  purchasing power of low-income households. For example, participation  in SNAP has been found to increase household food expenditures,   increase the availability of nutrients to the household, and, as some  research has found, reduce anemia and other nutritional deficiencies. In  addition, increasing household food expenditures is also related to SNAP’s  goal of strengthening the U.S. agricultural economy. However, the  literature is inconclusive regarding whether SNAP alleviates hunger and  malnutrition in low-income households, another program goal. While  studies show the program increases household food expenditures and the  nutrients available to the household, research finds little or no effect on  the dietary or nutrient intake of individuals. The Economic Research  Service cites several reasons why, despite increasing household nutrient  availability, SNAP may not affect individual dietary and nutrient intakes.  For example, all household members might not share equally in the  consumption of additional nutrients made available by SNAP benefits,  some food may be wasted or consumed by guests, and some household  members might consume food from other “nonhome” sources. In addition,  the availability of more food in the house does not guarantee individuals  eat a healthier diet.
Additional programs. The literature also suggests that participation in  three of the smaller programs—the Elderly Nutrition Program: Home  Delivered and Congregate Nutrition Services; Nutrition Assistance for  Puerto Rico; and the Special Milk Program—is associated with positive  outcomes related to their program goals. The research on the Elderly  Nutrition Program: Home Delivered and Congregate Nutrition Services  directly addresses two of the program’s goals. Studies found that the  program increases socialization and may have a positive effect on food  security. In addition, research suggests the program improves  participants’ dietary and nutrient intake—an outcome related to the  program’s goal of promoting the health and wellbeing of older individuals  by assisting such individuals to gain access to nutrition and other disease  prevention and health promotion services to delay the onset of adverse  health conditions resulting from poor nutritional health or sedentary  behavior. However, the research does not provide enough evidence to  assess the program’s effects on other goal-related outcomes, such as  nutritional status. Research on the Nutrition Assistance for Puerto Rico  and the Special Milk Program is somewhat limited and dated. However,  studies on Nutrition Assistance for Puerto Rico suggests that participation  in the program increases household access to a variety of nutrients—an  outcome related to its goal of funding nutrition assistance programs for  needy people. Research also shows that participation in the Special Milk  Program has positive effects, including increasing children’s intake of  vitamins and minerals found in milk.
In addition to the programs’ individual goals, USDA has a broad outcome  measure to reduce and prevent hunger by improving access to federal  nutrition programs but studies show that programs’ effectiveness in  achieving this outcome are mixed. Some research found that the National  School Lunch Program has a positive effect on the food security status of  families with children who participate in the program. For example, one  study found that for households with children that experienced hunger  during the previous year, those that participated in the National School  Lunch Program were more likely to be food secure during the month  before they were surveyed than those that didn’t participate. Some studies  also found that SNAP positively impacts food security. A recent paper  released by USDA’s Economic Research Service found that households’  food security deteriorated during the seven to eight months before  entering SNAP and improved after the households’ began receiving SNAP  benefits, suggesting that SNAP reduced the prevalence of very low food  security. A second study found that while simply participating in SNAP  did not reduce the odds of being food insecure, the level of benefits  received did—every additional $10 in SNAP benefits was associated with a  12 percent reduction in the odds of a household being food insecure.  However, other research findings differ on whether SNAP and other  programs increase food security. For example, one study found that food  security more often worsened than improved for households that began  receiving SNAP benefits in 2001 and 2002 and conversely, as households  left the program, their food security status more often improved than  worsened. Similarly, research is not conclusive regarding WIC’s success  in increasing food security for participants, and research did not produce  clear results on whether the School Breakfast Program improved  participants’ food security.
According to USDA and academic researchers, there are several reasons  why participation in food assistance programs may not be clearly  associated with improvements in food security. While some programs  focus more on improving or safeguarding the health of participants, the  approaches used by these programs may not be as effective in reducing  food insecurity. For example, the WIC program provides a relatively small,  but highly targeted, food package consisting of high nutrient foods to  address common nutritional deficiencies, an approach that may have only  a small impact on the food security of recipients. Other programs may  improve food security, but their impact may be difficult to measure  because economic trends—such as changes in poverty and unemployment  rates and changes in other assistance received by households—also affect  food security. In addition, those who choose to participate in food  assistance programs generally have greater difficulty meeting their food  needs and tend to be more food insecure compared to others that are  eligible for programs but do not participate.
section_title: Little Is Known about the Health and Nutrition Outcomes of the Remaining 11 Programs
paragraphs: Little is known about the effectiveness of the remaining 11 programs  because they have not been well studied. We found only one study that  measured the impact of the Summer Food Services Program on outcomes  related to its goals. Similarly, only one study of the Child and Adult Care  Food Program compared facilities that participate in the program with  those that did not.
While these studies had generally positive results, more research would be  needed to draw conclusions about the outcomes of the programs they  studied. For other programs, no academic literature was identified that  addressed outcomes related to their goals. For example, only one study we  reviewed evaluated the effects of the Commodity Supplemental Food  Program, but the findings from this study were not directly related to the  program’s goal of providing food to help meet the nutritional needs of the  target population. Table 4 summarizes the level of research we found on  each program.
One government evaluation—the Program Assessment Rating Tool  (PART) developed by the Office of Management and Budget—provides  some additional information on the effectiveness of 7 of the 11 less studied  programs. Four of these seven programs—the WIC Farmers’ Market  Nutrition Program, the Seniors Farmers’ Market Nutrition Program, The  Emergency Food Assistance Program, and the Commodity Supplemental  Food Program—received ratings of “results not demonstrated.” The  Summer Food Service Program was rated as “moderately effective.” Both  the Child and Adult Care Food Program and the Food Distribution  Program on Indian Reservations received ratings of “adequate.” The other  four programs for which limited academic research was identified have  not been evaluated. (See table 5.) It is important to note that PART rates  programs on their purpose and design, strategic planning, program  management, and program results and accountability rather than looking  at specific outcomes as the academic literature generally does. Therefore,  PART’s ratings do not provide the same type of assessment of program  effectiveness as, and are not directly comparable to, the findings from  academic research.
Additionally, agency data show that the 11 less-studied programs provide  food and nutrition assistance to millions of individuals and households  each year—an outcome related to their goals—however, this alone does  not demonstrate the overall effectiveness of these programs. One of the  goals of the Summer Food Service Program is to provide food to children  from needy areas during periods when schools are closed. USDA data  show that this program served an average of more than 2.1 million  children a day during July of 2008 and provided almost 130 million meals  to children during the course of that fiscal year. In addition, a goal of the  Child and Adult Care Food Program is to enable nonresidential institutions  to provide nutritious food service to program participants. According to  USDA, approximately 3.1 million children received free meals or snacks  each day in fiscal year 2008 in child care centers or day care homes  through this program. Smaller programs also provide benefits to millions  of individuals and households. For example, in fiscal year 2008, the WIC  Farmers’ Market Nutrition Program provided coupons to assist about 2.2  million participants purchase fresh produce—an outcome related to the  program’s goal of providing fresh nutritious unprepared foods from  farmers’ markets to women, infants, and children at nutritional risk. In that  same year, The Emergency Food Assistance Program distributed  approximately 337 million pounds of food to hunger relief organizations,  such as food banks and soup kitchens, and the Federal Emergency  Management Agency’s Emergency Food and Shelter National Board  Program served more than 73 million meals to needy individuals and  families. Both of these programs have goals related to providing food  assistance to needy individuals through eligible organizations. Although  these programs provide food to their target populations, this alone is too  little information to assess the overall effectiveness of these programs.
section_title: The System of Multiple Programs and Agencies That Provide Food Assistance Helps Address a Variety of Needs but Can Result in Overlap and Inefficiency
subsections: section_title: The 18 Food Assistance Programs Are Designed to Meet a Variety of Needs
paragraphs: Federal food assistance is provided through a decentralized system that  involves multiple federal, state, and local providers and covers 18 different  programs. Three federal agencies, numerous state government agencies,  as well as many different types of local providers—including county  government agencies and private nonprofit organizations—play a role in  providing federal food assistance, but the decentralized network of  federal, state, and local entities can be complex. Figure 8 illustrates how  the federal food assistance programs are administered through a  decentralized network of state offices and local providers in Texas—an  organizational structure we found less complicated than some of the other  states we visited.
The federal response to food insecurity and the decentralized network of  programs developed to address it emerged piecemeal over many decades  to meet a variety of needs. For example, according to the USDA, an early  food stamp program created during the Great Depression was designed to  help relieve agricultural surpluses by providing food to needy individuals  and households. This early food stamp program, like SNAP, was generally  available to most needy households with limited income and assets and  not targeted to a specific subgroup, but also like SNAP, it was not intended  to meet a household’s full nutritional needs. Over time, when it became  evident that despite the availability of food stamps, certain vulnerable  populations continued to experience nutritional risk, additional programs  were developed to meet those needs. The origin of WIC, for example,  dates back to the 1960s when a White House Conference on Food,  Nutrition, and Health recommended that special attention be given to the  nutritional needs of low-income pregnant women and preschool children  based on the premise that early nutrition intervention can improve the  health of children and prevent health problems later in life. The  Emergency Food Assistance Program—authorized in 1983—was created  to utilize excess federal food inventories and assist states with storage  costs while assisting the needy, while the Emergency Food and Shelter  National Board Program—administered by Federal Emergency  Management Agency—was established in the 1980s to provide assistance  to the homeless.
By targeting various needs, the 18 food assistance programs help increase  access to food for vulnerable populations, according to several agency  officials and local providers we spoke with. Some officials and providers  told us that individuals in need of food assistance have different comfort  levels with different types of assistance and delivery mechanisms and the  diversity of food assistance programs can help ensure that low-income  individuals and households who need assistance have access to at least  one program. For example, some individuals in need of assistance prefer  to pick up a bag of groceries from a food bank rather than having to  complete the application and eligibility procedures necessary to receive  SNAP benefits. Others, such as those in rural areas, may find it easier to  receive food assistance through commodities from the Commodity  Supplemental Food Program or other programs, as a lack of local grocery  stores can make it difficult to use SNAP benefits. Several officials said that  the availability of multiple programs provided at different locations within  a community can also increase the likelihood that eligible individuals  seeking benefits from one program will be referred to other appropriate  programs. In addition, several officials and providers told us that since no  one program alone is intended to meet a household’s full nutritional needs,  the variety of food assistance programs offers eligible individuals and  households different types of assistance and can help households fill the  gaps and address the specific needs of individual members. For example, a  single parent with a low-paying job may rely on SNAP for her basic  groceries, the National School Lunch Program to feed her child at school,  and WIC to provide high-nutrient supplemental foods for herself and her  infant.
While the federal government’s food assistance structure allows  households to receive assistance from more than one program at a time,  USDA data indicate that a small portion of food insecure households  received assistance from more than one of the primary food assistance  programs. According to USDA, of the food insecure, low-income  households, only about 3 percent participated in all of the three largest  programs—SNAP, the National School Lunch Program, and WIC.  Additionally, 12 percent participated in both SNAP and the National  School Lunch program, about 15 percent participated in only SNAP, and  another 15 percent participated in only the National School Lunch  Program (see figure 7). USDA reported that some food insecure  households also received other types of food assistance, such as through  food pantries and soup kitchens.
section_title: The Multiple Food Assistance Programs Show Signs of Program Overlap, Which Can Result in Inefficient Use of Resources, and USDA Has Taken Some Steps to Address This
paragraphs: The federal food assistance structure—with its 18 programs—shows signs  of program overlap, which can create unnecessary work and waste  administrative resources, creating inefficiency. Program overlap occurs  when multiple programs have comparable benefits going to similar target  populations—not uncommon within programs that are administered by  multiple agencies and local providers. GAO’s previous work has shown  that overlap among programs can create an environment in which  participants are not served as efficiently and effectively as possible.  Additionally, program overlap can create the potential for unnecessary  duplication of efforts for administering agencies, local providers, and  individuals seeking assistance. Such duplication can waste administrative  resources and confuse those seeking services.
During our site visits, we found ways in which overlap among the 18 food  assistance programs may be creating unnecessary work for providers and  applicants and may be using more administrative resources than needed.  The following examples came from selected states and the degree of  overlap across programs may vary from state to state. However, the scope  of this report did not allow us to gather enough information to discuss the  level of overlap or extent of administrative efficiencies among food  assistance programs on a national level.
Some programs provide comparable benefits to similar population and  are managed separately—a potentially inefficient use of federal funds.  While the programs in this study do not exactly duplicate each others’  services, some provide comparable benefits to similar target  populations—this may be in part because they were created separately to  meet various needs. For example, six programs—the National School  Lunch Program, the School Breakfast Program, the Fresh Fruit and  Vegetable Program, the Summer Food Service Program, the Special Milk  Program, and the Child and Adult Care Food Program—all provide food to  eligible children in settings outside the home, such as at school, day care,  or summer day camps. Also, the Commodity Supplemental Food Program  provides food to the elderly and to women, infants, and children up to age  six. These populations are targeted by other programs as well. The Elderly  Nutrition Program primarily serves individuals 60 years and older and WIC  serves pregnant and postpartum women and children up to age five. In  addition, individuals eligible for groceries through the Commodity  Supplemental Food Program are generally eligible for groceries through  The Emergency Food Assistance Program and for SNAP.  The Federal  Emergency Management Agency’s Emergency Food and Shelter National  Board Program and USDA’s Emergency Food Assistance Program both  provide groceries and prepared meals to needy individuals through local  government and nonprofit entities. As another example, the Summer Food  Service Program has similarities to the Summer Seamless Option of the  National School Lunch Program. However, the two programs have  different reporting requirements and reimbursement rates and, as an  official explained, this difference made his school choose between the  Summer Food Service Program’s higher reimbursement rate and the  Seamless Summer Option’s fewer reporting requirements.
GAO has found that program overlap—having multiple programs provide  comparable benefits to similar target populations—is an inefficient use of  federal funds. Like other social service programs, most food assistance  programs have specific and often complex administrative procedures that  federal, state, and local organizations follow to help manage each  program’s resources and provide assistance. Government agencies and  local organizations dedicate staff time and resources to separately manage  the programs even when a number of the programs are providing  comparable benefits to similar groups and could potentially be  consolidated. Previous GAO work indicates that combining programs  could reduce administrative expenses by eliminating duplicative efforts,  such as eligibility determination and data reporting. However, some  officials and providers express concern that such consolidation would  make it more difficult to serve people in need and easier to reduce funds  specifically dedicated to providing food assistance.
Consolidating to improve program efficiency presents other tradeoffs as  well. Most of the 18 programs, including the small programs, were  designed to target assistance to specific populations or meet the specific  needs of certain populations. Efforts to reduce overlap could detract from  the goals of some of the programs. For example, programs focused on  improving the nutritional status of participants may use a different  approach than programs focused on reducing food insecurity even if both  programs are available to the same or similar target groups, and efforts to  reduce overlap could make it difficult to achieve both goals.
Overlapping eligibility requirements create duplicative work for  providers and applicants. According to previous GAO work and the  officials we spoke with, overlapping program rules related to determining  eligibility often require local providers to collect similar information— such as an applicant’s income and household size—multiple times because  this information is difficult to share, partly due to concerns for  safeguarding individuals’ confidentiality but also due to incompatible data  systems across programs. In addition, some of these rules often require  applicants who seek assistance from multiple programs to submit separate  applications for each program and provide similar information verifying,  for example, household income. Some local providers and state officials  told us families with the greatest needs often access multiple programs in  an attempt to ensure they have enough food to eat. The application  process is made even more challenging for families when the programs are  physically housed in a wide range of government agencies or nonprofit  organizations within the community.
USDA has taken steps to address some of these inefficiencies. To align  eligibility procedures and encourage participation, especially among its  largest programs, USDA has policies in place that often make it simpler for  recipients of one program to receive benefits in another. For example,  evidence of SNAP participation is one way for a mother to show that her  income is low enough to qualify for WIC. USDA also has instituted direct  certification for its child nutrition programs, including the National School  Lunch Program, the School Breakfast Program, and the Child and Adult  Care Food Program. Direct certification allows state SNAP offices to share  their local enrollment lists with school districts so that children in  households receiving SNAP can automatically be determined eligible to  receive free school meals without having to complete a separate  application. Education officials we talked with who have established  direct certification with SNAP believe that it reduces work for both the  school districts and the families. However, the process to directly certify  eligible school-aged children is not always effective. USDA has estimated  that 10 million children were eligible for direct certification at the start of  the 2008-2009 school year, but only 6.5 million were directly certified.  Consequently, the families of approximately 2 million children completed  and submitted two similar applications: one for SNAP and one for free or  reduced-priced school meals. Further, as many as 1.5 million children may  not be receiving free school meals because they were not automatically  enrolled through direct certification and their parents or guardians did not  apply.
USDA has also taken steps to coordinate programs—including those  related to nutrition education—within the Food and Nutrition Service as  well as across state agencies and local providers. In 2003 USDA initiated  State Nutrition Action Plans in part to advance cross-program integration  among the nutrition education component of the federal food assistance  programs at the state level. Through this process, state teams identify a  common goal and formulate a plan for working together across programs  to achieve that goal. In 2004, soon after USDA initiated efforts to integrate  its nutrition education programs, GAO reviewed USDA’s nutrition  education programs and identified challenges related to program  overlap. For example, GAO found that while nutrition educations  programs share similar target populations and nutrition education goals,  they lacked strong coordination, which can result in, among other things,  inefficient use of resources. In addition, GAO found that the programs’  different administrative structures hindered coordination among nutrition  education efforts. In response to this 2004 report, USDA made a number of  efforts to improve coordination among its nutrition education programs  and strength linkages among them. For example, USDA established  Nutrition.gov, a Web site which provides a variety of information on  nutrition education and describes USDA’s food assistance programs.  USDA has also taken a number of steps to systematically collect reliable  data and identify and disseminate lessons-learned for its nutrition  education efforts.
Another example of USDA’s efforts to increase coordination across  program services is by permitting their regional offices to retain a small  percentage of WIC funds—also known as WIC operational adjustment  funds—to support regional priorities including, for example, coordinating  food assistance programs at the state and local levels. One such  coordination effort at the local level made possible through WIC  operational adjustment funds, was in Alameda County, California, where a  group of local providers meets regularly to discuss ways to coordinate  their food assistance programs. Among this group’s accomplishments is a  pamphlet that provides information in both English and Spanish on how to  access services through the several federal food assistance programs in  their community, such as SNAP benefits, WIC services, school meals for  children, and emergency food services offered through the local food bank  (see figure 9). This group is also actively pursuing funding for piloting a  universal application so that individuals interested in applying for multiple  food assistance programs can complete one application instead of several.  During our visits to rural areas of California and Maryland, we learned that  local coordination efforts were less structured and based more on  personal connections among program officials and between service  providers.
Throughout our site visits, some state officials and local providers told us  they would like to see the federal government do more to coordinate its  food and nutrition assistance programs. For example, a director of a  nongovernmental organization (NGO) that provides food assistance  through the Elderly Nutrition Program and the Emergency Food and  Shelter National Board Program explained that he is not always clear  about what federal food assistance programs are available to NGOs or  which ones are best suited for his organization’s mission and resources.  The NGO director suggested that federal agencies work together to build a  Web site that identifies the various food assistance programs and provides  information—such as programs’ eligibility, administrative, and funding  requirements—to help local providers determine if their NGOs have the  right type of mission and sufficient personnel and funding to provide  assistance funded by certain federal programs. According to this local  provider, having consolidated information on all the food assistance  programs would help organizations determine what federal food  assistance program best matches their mission and resource capacity.
section_title: Conclusion
paragraphs: The federal government spends billions of dollars every year to support a  food assistance structure that, while critical to addressing some of the  most basic needs facing the nation’s most vulnerable individuals, shows  signs of potential overlap and inefficiency among its programs. With the  growing rate of food insecurity among U.S. households and significant  pressures on the federal budget, it is important to understand not only the  extent to which food assistance programs complement one another to  better meet program goals but also the extent to which program services  and administrative requirements may overlap and create duplication that  adversely impacts program effectiveness and efficiency. While research  indicates that the largest programs have positive outcomes consistent with  their program goals, limited research on most of the smaller programs  makes it difficult to determine whether these are filling an important gap  or whether they are unnecessarily duplicating functions and services of  other programs. It is only by looking more closely at the goals, benefits,  and target populations of the many smaller programs that the federal  government can begin to develop methods to help reduce inefficiencies  and save administrative resources while at the same time ensuring that  those who are eligible receive the assistance they need. Furthermore, for  the programs that have complementary goals, functions, and services,  there may be ways to more efficiently fulfill administrative requirements  and processes. Small changes to increase administrative efficiencies, such  as additional efforts to align application procedures, could be made in the  near-term; however, larger changes involving program duplication will  require careful attention to the potential effects on those currently  receiving assistance. Without such efforts, resources may be wasted or  those in need may not be able to access enough food for a healthy,  productive life.
section_title: Recommendation for Executive Action
paragraphs: We recommend that the Secretary of Agriculture, as the principal  administrator of the federal government’s food assistance programs,  identify and develop methods for addressing potential inefficiencies  among food assistance programs and reducing unnecessary overlap  among the smaller programs while ensuring that those who are eligible  receive the assistance they need. Approaches may include conducting a  study; convening a group of experts (consistent with the Federal Advisory  Committee Act), including, for example, representatives of the 18 food  assistance programs, state representatives, and local providers;  considering which of the lesser-studied programs need further research; or  piloting proposed changes. Recommendations from further study could be  used by administering agencies or, if appropriate, by Congress to improve  the federal government’s food assistance system.
section_title: Agency Comments and Our Evaluation
paragraphs: We shared a draft of this report with USDA, HHS, and DHS for review and  comment. The following summarizes the response from each agency.
On March 10, 2010, USDA provided informal comments via e-mail. USDA  stated that our analysis was thoughtful and objective. However, the agency  expressed concern that our discussion of the overlap and duplication of  nutrition assistance programs in the body of the report may be overlooked  by readers who focus on the summary and conclusion. USDA emphasized  that no single nutrition assistance program is designed to meet all of a  family’s nutrition needs, and that participation in one or more of the  largest nutrition assistance programs does not guarantee food security.  Additionally, while they may appear similar in terms of the general  demographic characteristics of their target populations, USDA noted that  programs vary with respect to how well they fit the needs of different  subgroups and no single program attracts or serves everyone in its  respective target audience. For example, some individuals—like the  homeless or elderly—may find it difficult to prepare their own meals and  instead need already prepared meals, such as those provided by The  Emergency Food Assistance Program and the Child and Adult Care Food  Program. The agency also emphasized that fundamental change to  improve program efficiency requires legislation that facilitates program  integration. USDA concluded by stating that it will consider the value of a  study to examine potential inefficiencies and overlap among smaller  programs. However, the agency explained that it has generally focused  research efforts on large programs as the most cost-effective use of the  limited dollars available. We should note that our recommendation  includes the need to address unnecessary overlap and duplication among  smaller programs but also refers to the need to identify and develop  methods for addressing potential inefficiencies among food assistance  programs overall, which would include the larger programs that have  complementary goals but often have separate administrative systems and  eligibility requirements. USDA also expressed concern that in the absence  of a specific appropriation for such a study, any allocation of resources to  this effort would shift resources away from other projects and priorities.  We believe that conducting study is one possible method for addressing  potential inefficiencies and reducing overlap among smaller programs.  Other approaches—such as convening a group of experts—may be as  effective and require fewer resources.
HHS agreed with the report’s finding that the Elderly Nutrition programs  directly address program goals. In addition, HHS agreed that federal  programs should aim to achieve the greatest efficiency, effectiveness, and  reduction of duplication and overlap. The agency stated its view that the  Older Americans Act Nutrition Services programs complement, not  duplicate, USDA’s food and nutrition assistance programs. HHS’s written  comments appear in appendix IV.
DHS Federal Emergency Management Agency provided technical  comments, most of which provided clarification and were incorporated in  the report where appropriate.
We are sending copies of this report to relevant congressional committees;  the Secretaries of Agriculture, Health and Human Services, and Homeland  Security; and other interested parties. The report also will be available at  no charge on the GAO Web site at http://www.gao.gov.
If you or your staff have any questions about this report, please contact me  at (202) 512-7215 or brownke@gao.gov. Contact points for our Offices of  Congressional Relations and Public Affairs may be found on the last page  of this report. Key contributors to this report are listed in appendix V.
section_title: Appendix I: Objectives, Scope, and Methodology
subsections: section_title: Program Selection
paragraphs: In selecting programs for this review, we defined the scope to include only  federal programs that focus primarily on providing or supporting food and  nutrition assistance in the United States. We identified these programs by  reviewing the Catalog of Federal Domestic Assistance (CFDA),  relevant  federal laws and regulations, and relevant documents. We also met with  federal officials and relevant experts. Using key words related to food and  nutrition assistance and other social services, we conducted a systematic  search in the CFDA to identify programs that have some role in providing  food and nutrition assistance and the respective agencies responsible for  administering each of these programs. We also interviewed federal  officials and reviewed agencies’ Web sites. In addition, we reviewed  related federal legislation—such as the Food, Conservation, and Energy  Act of 2008 (2008 Farm Bill) and Child Nutrition and WIC Reauthorization  Act of 2004—to search for new grant programs or pilot projects that  provide or support food and nutrition assistance. From this search, we  identified 70 potential food and nutrition-related programs.
Using our initial collection of 70 programs, we limited the list to programs  that (1) mentioned food or nutrition assistance in their CFDA profile or on  the agency’s Web site or (2) allowed funds to be used to build the  infrastructure within or the coordination across food and nutrition  assistance programs. We then excluded any programs that met one or  more of the following:    Food and nutrition assistance is not the primary objective of the program,  but is one of multiple social support services.
Program did not exist or was not funded in fiscal year 2008.
Programs provide fungible funds to states or individuals that may be used  for, but are not required to be spent on, the purchase of food.
Program supports infrastructure costs that support a range of programs or  a facility, which can include, but are not limited to, food and nutrition  assistance-related functions.
Dedicated funding stream that supports a program or a component of a  food assistance program already included in our review. For example, the  Nutrition Services Incentive Program (NSIP) provides funds and  commodities to support two Department of Health and Human Services  (HHS) programs: the Elderly Nutrition Program: Home-Delivered and  Congregate Nutrition Services, and Grants to American Indian, Alaska  Native, and Native Hawaiian Organizations for Nutrition and Supportive  Services; therefore, we did not consider NSIP as a separate program in this  review).
Federal efforts that process or deliver food to organizations that  administer food and nutrition assistance programs, such as the food  distribution and price support functions of the U.S. Department of  Agriculture’s (USDA) Farm Service Agency.
Program funds that are directed toward research or nutritional education  or outreach only.
We excluded programs that focus solely on nutrition education because of  previous GAO work in this area. Examples of nutrition education  programs include Team Nutrition Initiative and Expanded Food and  Nutrition Education Program. Other programs that have nutrition  education components but primarily provide food assistance—such as the  Supplemental Nutrition Assistance Program (SNAP), Special Supplemental  Nutrition Program for Women, Infants, and Children (WIC), the National  School Lunch Program, and the Child and Adult Care Food Program—are  included in this review.
Once initial program determinations were made, we sent e-mails to the  agencies that had only programs excluded from our program list. These  agencies included the Corporation for National and Community Service  (CNCS), Department of Defense (DOD), Department of Housing and  Urban Development (HUD), Department of Veterans Affairs (VA), and the  following offices within HHS: Administration for Children and Families;  Health, Resources, and Services Administration; Indian Health Services;  Centers for Medicare and Medicaid Services (CMS); and Centers for  Disease Control and Prevention (CDC). All liaisons confirmed our  exclusion decisions, with the exception of officials from CMS.
For the agencies with programs that met our inclusion criteria, we held  follow-up meetings or corresponded with agency liaisons from three  agencies—USDA, HHS, and the Department of Homeland Security  (DHS)—to confirm or offer feedback on our decisions. This process  resulted in the 18 programs included in our engagement. See table 6 for a  full list of included and excluded programs.
section_title: Food Security Data
paragraphs: To show the prevalence of food insecurity among U.S. households from  1995 to 2008, we presented data from the Current Population Survey  (CPS), a nationally representative survey with comparable measures  across years. Food insecurity is measured each year by the USDA  Economic Research Service using the Food Security Supplement of the  CPS. The survey asks individuals 10 questions (18 questions are asked if  the household contains children 18 years of age or younger) about  behaviors or conditions known to characterize households having  difficulty meeting basic food needs. The answers to the survey questions  determine the food security status of each household and, collectively,  allow USDA to monitor and track changes in food insecurity among U.S.  households.
The food insecurity prevalence rates are sample-based estimates. All food  security rates presented in this report are statistically significant (different  than zero) at the 90 percent confidence level, and rates for different  subpopulations are presented only where there are statistically significant  differences between these populations. More information on the  confidence intervals around the food insecurity estimates is presented in  appendix II.
While the food security data have some limitations, we consider these data  reliable and appropriate for this engagement. See appendix II for more  information on the food security data.
section_title: Program Spending
paragraphs: To determine how much money federal agencies spent on food and  nutrition programs, we analyzed data from the Consolidated Federal  Funds Report (CFFR)—a database that compiles expenditures or  obligations from federal agencies. These data are not entirely consistent  across programs. For example, USDA agency officials reported  obligations, while the Administration on Aging reported the amounts in the  CFFR are comparable to the amount of federal funds that states and tribes  spent in fiscal year 2008 to support the agency’s nutrition assistance  programs. Programs also differ in whether and how they report funds  dedicated to administrative efforts to the CFFR. In addition, agency  officials told us that some spending amounts were not included in the  CFFR, and for those programs, we contacted agencies directly to obtain  spending amounts. Once we compiled the spending amounts for each  program, we contacted budget officials at each agency to confirm the  amounts. In several cases, we combined the CFFR totals with additional  spending information provided by agency officials, to ensure an accurate  reporting of spending (see notes in table 2). After speaking with agency  officials and interviewing a federal Census Bureau official with detailed  knowledge of the CFFR database, we determined the data are reliable and  appropriate for our engagement.
section_title: Program Participation
paragraphs: In order to determine the number of individuals and households  participating in USDA, HHS, and DHS food and nutrition assistance  programs and the quantity of benefits distributed, the team relied on  publicly available data from these agencies. Because these data are being  used for background purposes only, we did not conduct a reliability  assessment of these data.
section_title: Program Effectiveness
paragraphs: To determine what is known about the effects food and nutrition  assistance programs have on outcomes related to their program goals, we  began by compiling a list of program goals based on our review of federal  statutes, regulations, or discussions with agency officials. We then used a  large scale literature review conducted by the Economic Research Service  of USDA and conducted our own, smaller-scale literature review of studies  that addressed the impacts of food and nutrition assistance programs. The  Economic Research Service literature review—Effects of Food Assistance  and Nutrition Programs on Nutrition and Health—evaluated available  research on the effectiveness of USDA food and nutrition assistance  programs produced or published between 1973 and 2002. Our literature  review was designed to capture research on USDA programs published  between January 2002 and March 2009, as well as programs administered  by HHS and DHS between January 1995 and March 2009. Our initial  literature searches returned hundreds of studies. We then narrowed the  results using criteria that included research that examined (1) program  participation effects on nutrition or health related outcomes and (2) the  effects of the programs on the agricultural economy, which contained a  comparison between a participant and nonparticipant group or was  longitudinal in nature. These criteria allowed us to reduce the number of  potential studies to fewer than 125. From this list we selected a sample of  35 studies to review. To ensure our sample did not inadvertently omit any  seminal research we consulted experts at USDA and HHS. Due to the  limited available research on smaller programs, identified studies of these  programs were automatically included. Each of the 35 studies chosen was  systematically reviewed and information on the study’s design,  methodology, limitations, and findings was compiled and analyzed. Of the  35 studies, we deemed five to be too methodologically flawed or limited  for our purposes.
Although the Economic Research Service literature review and the  research selected for our literature review were considered to be  methodologically sound, it is important to understand that certain  limitations may prevent firm conclusions regarding the effects of the  programs. For example, the data used in some of the studies is dated and  programs may have changed substantially since the data was collected or  the research was completed. In addition, some of the research examined  pilot or demonstration projects and thus only provide suggestive evidence  for actual program impacts. The samples used in some studies may  prevent generalizing their findings to wider populations. Furthermore,  selection bias is a concern in much of the literature as few randomized  controlled experiments exist. Selection bias can occur for many reasons— for example, in voluntary programs, those who chose to participate (or  stop participating) may be systematically different from those who chose  not to participate and its consequence can be to make a program appear  more (or less) effective than it actually is.
With few exceptions, the academic literature related to programs’  effectiveness did not directly examine whether programs were meeting  their legislative and program goals. Therefore, we were required to assess  which program outcomes addressed in the literature were related to these  goals. To do this, we first identified the goals of each program by  reviewing relevant federal statues and regulations, as well as consulting  agency officials. Second we reviewed the impacts addressed in the  literature reviewed and assessed which program goals, if any, they were  related to. We then assessed the relevance of each impact to each program  goal. A GAO economist independently performed a similar assessment.  Last the assessments were reconciled with the help of the methodologist  assisting on the engagement. The methodology for our determinations  regarding which program outcomes were related to which program goals  was shared with agency officials who expressed no concerns about its  validity.
section_title: Site Visits
paragraphs: We visited California, Illinois, and Maryland. We also conducted phone  interviews with officials and providers in Oregon and Texas. The states  that we selected represent a combination of urban and rural demographics  and geographic distribution. We also selected states and local areas based  on recommendations from federal and state officials and relevant experts.  The information we collected from our site visits helped inform our  understanding of the complex issues related to food assistance. These site  visits also helped us better understand the implications of providing food  assistance through multiple programs and agencies.
We conducted this performance audit from February 2009 to March 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 we obtained provides a reasonable basis for our findings and  conclusions.
section_title: Appendix II: The Prevalence of Food Insecurity among U.S. Households from 1995 to 2008 and the Issues Affecting Food Insecurity Data
section_title: Appendix III: Selected Program Goals
paragraphs: Appendix III: Selected Program Goals Summary of selected program goals   Assist states to initiate, maintain, and expand nonprofit food service programs for  children or adults in nonresidential institutions which provide care.
Enable nonresidential institutions to provide nutritious food service to participants.
Improve the quality of meals or level of services provided or increase participation in  the program at adult day care centers.
Provide food to help meet the nutritional needs of the target population.
Meet the food needs of low-income individuals.
Increase the self-reliance of communities in providing for the food needs of the  communities.
Promote comprehensive responses to local food, farm, and nutrition issues.
Meet specific state, local, or neighborhood food and agricultural needs, including  needs relating to infrastructure improvement and development, planning for long-term  solutions, or the creation of innovative marketing activities that mutually benefit  agricultural producers and low-income consumers.
Reduce hunger and food insecurity.
Promote socialization of older individuals.
Promote the health and well-being of older individuals by assisting such individuals to  gain access to nutrition and other disease prevention and health promotion services  to delay the onset of adverse health conditions resulting from poor nutritional health  or sedentary behavior.
Provide shelter, food, and supportive services to homeless individuals and to help  them access other services.
Provide funding to help create more effective and innovative local programs.
Do minor rehabilitation to mass shelter and mass feeding facilities to make them safe,  sanitary, and to bring them into compliance with local building codes.
Provide emergency food and shelter to needy individuals through private  organizations and local governments.
Raise the level of nutrition among low-income households.
Alleviate hunger and malnutrition in low-income households.
Increase food purchasing power for eligible households.
Strengthen the U.S. agricultural sector.
More orderly marketing and distribution of food.
Permit low-income households to obtain a more nutritious diet through normal  channels of trade.
Make fresh fruits and vegetables available in elementary schools.
Promote the delivery of supportive services, including nutrition services to American  Indians, Alaskan Natives, and Native Hawaiians.
Safeguard the health and well-being of the nation’s children.
Encourage the domestic consumption of nutritious agricultural commodities and other  foods.
Fund nutrition assistance programs for needy people.
Summary of selected program goals   Safeguard the health and well-being of the nation’s children.
Encourage the domestic consumption of agricultural and other foods by assisting  states to more effectively meet the nutritional needs of children.
Assist the states and the Department of Defense to initiate, maintain, or expand  nonprofit breakfast programs in all schools that apply for assistance and agree to  carry out a nonprofit breakfast program.
Provide fresh, nutritious, unprepared produce to low-income seniors from farmers’  markets and roadside stands, and community supported agriculture.
Increase the consumption of agricultural commodities.
Expand or aid the expansion of farmers’ markets, roadside stands, and community  supported agriculture programs.
Develop or aid in the development of new farmers’ markets, roadside stands, and  community supported agriculture programs.
Encourage consumption of fluid milk by U.S. children in nonprofit schools, high school  grade and under, that don’t participate in federal meal service programs.
Encourage consumption of fluid milk by U.S. children in nonprofit institutions devoted  to the care and training of children, such as nursery schools and child care centers,  that don’t participate in federal meal service programs.
Safeguard the health and well-being of the nation’s children.
Encourage the domestic consumption of agricultural and other foods by assisting  states to more effectively meet the nutritional needs of children.
Provide food service to children from needy areas during periods when area schools  are closed for vacation.
Assist states to initiate and maintain nonprofit food service programs for children in  service institutions.
Raise the level of nutrition among low-income households.
Alleviate hunger and malnutrition in low-income households.
Increase food purchasing power for eligible households.
Strengthen the U.S. agricultural sector.
More orderly marketing and distribution of food.
Permit low-income households to obtain a more nutritious diet through normal  channels of trade.
Make maximum use of the nation’s agricultural abundance.
Expand and improve the domestic distribution of price-supported commodities.
Make excess agricultural commodities available without charge, for use by eligible  recipient agencies for food assistance.
Improve the mental and physical health of low-income pregnant, postpartum, and  breastfeeding women, infants, and young children.
Prevent the occurrence of health problems, including drug abuse, and improve the  health status of the target population.
Provide supplemental foods and nutrition education to target population.
Provide fresh nutritious unprepared foods from farmers’ markets to women, infants,  and children at nutritional risk.
Increase awareness and use of farmers’ markets and sales at such markets.
section_title: Appendix IV: Comments from the Department of Health and Human Services
section_title: Appendix V: GAO Contact and Staff Acknowledgments
subsections: section_title: Staff Acknowledgments
paragraphs: In addition to the contact named above, Kathryn Larin, Assistant Director;  Cheri Harrington, Analyst-in-Charge; Jacques Arsenault; David Barish;  Nancy Cosentino; Sara Edmondson; Alex Galuten; Charlene Johnson;  Kirsten Lauber; Jean McSween; Mimi Nguyen; Susan Offutt; Jessica Orr;  Rhiannon Patterson; Catherine Roark; Nyree Ryder Tee; Gregory Whitney;  and Charles Willson made significant contributions to this report.
section_title: Related Products
paragraphs: School Meal Programs: Experiences of the States and Districts That  Eliminated Reduced-price Fees. GAO-09-584. Washington, D.C.: July 17,  2009.
Food Stamp Program: Options for Delivering Financial Incentives to  Participants for Purchasing Targeted Foods. GAO-08-415. Washington,  D.C.: July 30, 2008.
Department of Agriculture, Food and Nutrition Service: Special  Supplemental Nutrition Program for Women, Infants and Children  (WIC): Revisions in the WIC Food Packages. GAO-08-358R. Washington,  D.C.: December 17, 2007.
Nutrition Education: USDA Provides Services through Multiple  Programs, but Stronger Linkages among Efforts Are Needed. GAO-04-528.  Washington, D.C.: April 27, 2004.
Federal Food Safety and Security System: Fundamental Restructuring Is  Needed to Address Fragmentation and Overlap. GAO-04-588T.  Washington, D.C.: March 30, 2004.
Food Stamp Program: Steps Have Been Taken to Increase Participation  of Working Families, but Better Tracking of Efforts Is Needed.  GAO-04-346. Washington, D.C.: March 5, 2004.
School Lunch Program: Efforts Needed to Improve Nutrition and  Encourage Healthy Eating. GAO-03-506. Washington, D.C.: May 9, 2003.
Fruits and Vegetables: Enhanced Federal Efforts to Increase  Consumption Could Yield Health Benefits for Americans. GAO-02-657.  Washington, D.C.: July 25, 2002.
Food Stamp Program: States’ Use of Options and Waivers to Improve  Program Administration and Promote Access. GAO-02-409. Washington,  D.C.: February 22, 2002.
Means-Tested Programs: Determining Financial Eligibility Is  Cumbersome and Can be Simplified. GAO-02-58. Washington, D.C.:  November 2, 2001.
Food Assistance: Research Provides Limited Information on the  Effectiveness of Specific WIC Nutrition Services. GAO-01-442.  Washington, D.C.: March 30, 2001.
Food Assistance: Performance Measures for Assessing Three WIC  Services. GAO-01-339. Washington, D.C.: February 28, 2001.
Title III, Older Americans Act: Carryover Funds Are Not Creating a  Serious Meal Service Problem Nationwide. GAO-01-211. Washington,  D.C.: January 9, 2001.
Food Assistance: Options for Improving Nutrition for Older Americans.  GAO/RCED-00-238. Washington, D.C.: August 17, 2000.
Early Education and Care: Overlap Indicates Need to Assess  Crosscutting Programs. GAO/HEHS-00-78. Washington, D.C.: April 28,  2000.
Managing for Results: Barriers to Interagency Coordination.   GAO/GGD-00-106. Washington, D.C.: March 29, 2000.
Welfare Programs: Opportunities to Consolidate and Increase Program  Efficiencies, GAO/HEHS-95-139. Washington, D.C.: May 31, 1995.
Food Assistance Programs. GAO/RCED-95-115R. Washington, D.C.:  February 28, 1995.
Food Assistance: USDA’s Multiprogram Approach. GAO/RCED-94-33.  Washington, D.C.: November 24, 1993.
Early Intervention: Federal Investments Like WIC Can Produce Savings.  GAO/HRD-92-18. Washington, D.C.: April 7, 1992 Food Assistance Programs: Recipient and Expert Views on Food  Assistance at Four Indian Reservations. GAO/RCED-90-152. Washington,  D.C.: June 18, 1990.
Food Assistance Programs: Nutritional Adequacy of Primary Food  Programs on Four Indian Reservations. GAO/RCED-89-177. Washington,  D.C.: September 29, 1989.