Means-Tested Programs: Information on Program Access Can Be an Important Management Tool
Published: 2005-04-08T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: Federal agencies that administer means-tested programs are responsible for both ensuring that people have appropriate access to assistance and ensuring the integrity of the programs they oversee. To balance these two priorities appropriately, it is important for agencies to have information on program integrity and program access. Knowing the proportion of the population that qualifies for these programs relative to the numbers who actually participate can help ensure that agencies can monitor and communicate key information on program access. To better understand participation in low-income programs, this report provides information on: (1) the proportion of those eligible who are participating in 12 selected low-income programs; (2) factors that influence participation in those programs; and (3) strategies used by federal, state, and local administrators to improve both access and integrity, and whether agencies monitor access by measuring participation rates.
section_title: What GAO Found
paragraphs: For 12 federal programs supporting low-income people, we found that the proportion of those eligible who are enrolled varies substantially both between and within programs. Among entitlement programs--those programs that provide benefits to all applicants that meet program eligibility criteria--these rates range from about 50 to more than 70 percent. Among non-entitlement programs--those with limited funding--these rates ranged from less than 10 percent to more than 50 percent. While it may be neither feasible nor desirable for programs to serve 100 percent of those eligible for benefits, information on the share of those eligible who are enrolled in means-tested programs and on particular recipient groups such as the elderly or families with children, can help program managers more effectively address issues related to program access. However, participation rate estimates must be interpreted carefully because of limitations in the data sources and estimation methodologies used to calculate the estimates. Many factors influence access to low-income programs--including the type of benefits, ease of access, misperceptions about program requirements, and application and eligibility verification procedures. These factors can impact not only the share of eligible people who participate in low-income programs, but other aspects of program access as well, including the composition of the program caseload and how programs work together to serve low-income individuals and families. Federal, state, and local administrators have implemented many strategies to achieve the goals of access and integrity, but federal agencies generally put more emphasis on tracking information and outcomes related to program integrity than program access. To better ensure that program administrators achieve program integrity goals, agencies have begun to develop measures to track and report on program integrity. Federal agencies have developed participation rate estimates for several low-income programs, but only four--CCDF, food stamps, WIC, and EITC--either currently collect and report information on the extent to which they are reaching their target populations or plan to do so. Such information can guide administrators in setting priorities and targeting scarce resources, even among programs that were not intended to serve everyone eligible for program benefits.

section_title: Letter
paragraphs: Each year through more than 80 means-tested programs, the federal  government provides benefits and services to individuals and families with  low incomes—just 12 of which account for as much as $330 billion in  annual federal expenditures. As stewards of these funds, federal agencies  have many roles, among them: to ensure that people have appropriate  access to this assistance and to ensure the integrity of these programs by  guarding against improper payments and unqualified participation. These  responsibilities can be complementary, but they can also be practiced in  ways that work at cross purposes. Outreach without appropriate  screening, for example, can result in service to the wrong recipients, but  cumbersome enrollment procedures can discourage those who qualify  from applying. To meet requirements related to the Improper Payments  Information Act of 2002, federal agencies administering these programs  will be required to institute new steps to assure integrity by annually  measuring and reporting improper payments. As they step-up efforts to  ensure integrity, they will be challenged, as well, to ensure appropriate  access. Without a sense of the proportion of the population that qualifies  for these programs relative to the numbers who actually participate,  however, it may be difficult for most agencies to know whether they have  struck an appropriate balance in the weight of their strategies and whether  they need to pursue methods that better serve both access and integrity.
To better understand participation in low-income programs, we have  agreed to provide you information on: (1) the proportion of those eligible  who are participating in 12 selected low-income programs; (2) the factors  that influence participation in those programs; and (3) strategies used by  federal, state, and local administrators to improve both access and  integrity, and whether agencies monitor access by measuring participation  rates. The 12 programs included in this review are among the largest and  were selected to cover a range of benefits and services aimed at  supporting needy families and individuals. They include: the Child Care  and Development Fund (CCDF), the Earned Income Tax Credit (EITC),  the Special Supplemental Nutrition Program for Women, Infants, and  Children (WIC), the Food Stamp Program, the Supplemental Security  Income program (SSI), the Head Start program, the Pell Grant program,  the Medicaid program, the State Children’s Health Insurance Program  (SCHIP), the Temporary Assistance for Needy Families (TANF) program,  the Housing Choice Voucher (HCV) program, and the public housing  program.
To address our research objectives, we compiled estimates of the  proportion of those eligible who participate in each of the programs for  the most recent year for which data were available using different  methodologies. We refer to this proportion as a participation rate when  discussing entitlement programs and other programs that provide program  benefits to all eligible applicants: EITC, food stamps, Medicaid, Pell  Grants, and SSI. We refer to it as a coverage rate when discussing non- entitlement programs that do not necessarily provide benefits to all  eligible individuals who apply for the program: CCDF, Head Start, Housing  Choice Vouchers, Public Housing, SCHIP, TANF, and WIC. For seven  programs, we contracted with the Urban Institute to provide us with  information about their microsimulation model estimates of participation  rates. These model estimates are also used to calculate estimates of the  potential cost of serving eligible nonparticipants in a subset of programs.  For the remaining programs, we provide participation or coverage rate  estimates based on administrative and national survey data. We held  discussions with federal agency officials to discuss the reliability of  program data used in our estimates, reviewed related documentation, and  ensured that the agencies conducted tests of the data for omissions and  errors. In addition, we reviewed literature on factors that influence  participation in the 12 programs covered by the review and strategies to  improve program access and program integrity. We surveyed and  interviewed the federal agencies that administer the 12 programs on  factors they have identified that influence program participation and on  strategies they have implemented to improve program access and program  integrity. In addition, we interviewed federal, state, and local program  administrators of various programs in California, Connecticut, Georgia,  Maryland, and Minnesota, on factors that affect participation and  strategies they have employed to address the goals of program access and  program integrity. These states were chosen on the basis of innovative  programs and initiatives related to program integrity and program access  and demographic and geographic diversity. We performed this work  between November 2003 and January 2005 in accordance with generally  accepted government auditing standards. See appendix I for additional  information on scope and methodology.
subsections: section_title: Background
paragraphs: The federal government funds a wide array of programs intended to  provide benefits or services to low-income individuals, families, and  households. The 12 programs included in this review include the largest of  these programs, Medicaid, as well as some relatively small programs such  as WIC. The 12 programs are administered by seven different federal  agencies. Table 1 shows the agencies responsible for each program and  federal expenditures for fiscal year 2003, the most current year available.
These programs provide different benefits and services to different target  populations. Some of the programs provide benefits that phase out  gradually, so some people may be eligible for a very low benefit. For  example, in fiscal year 2005, monthly food stamp benefits for a three- person household can be as low as $1 per month. Other programs, such as  Medicaid, generally offer comparable benefits to every resident of a state  who meets eligibility requirements. Table 2 provides a brief description of  each of the programs covered in this report and the types of benefits  offered by each program.
The programs covered by this review represent both entitlement and non- entitlement programs; programs that are administered entirely by federal  agencies and those that are administered through federal partnerships  with state and/or local agencies; programs that allow substantial state and  local variation and those that provide uniform benefits throughout the  country. Table 3 summarizes the level of government with whom  responsibility for funding and design resides for each of the   12 programs.
subsections: section_title: Program Performance Management
paragraphs: Although state and local agencies responsible for administering several of  the programs have some control over program design and implementation,  primary responsibility for setting priorities, guiding policy, and measuring  performance rests with the federal agencies that oversee the programs.  The programs covered by this review may have many different goals and  objectives of varying degrees of importance, but all of these programs— regardless of size, target population, funding structure, or types of benefits  offered—were established to assist persons with limited income, and as  such, all were tasked with the overarching goal of reaching and serving  those eligible for program benefits or services. Likewise, all means-tested  programs share the common goal of ensuring that the funds allocated for  program benefits are provided only to those eligible.
A key factor in achieving desired program outcomes, including program  access and program integrity, is the implementation of appropriate  internal control. As discussed in our prior work on this topic, internal  control is an integral component of an organization’s management that  provides reasonable assurance that agencies are achieving outcomes  related to the effectiveness and efficiency of operations and compliance  with laws and regulations, among other things.
Federal agencies have several key management tools and program reports  that they use to provide information about the programs they administer,  develop policy, help with management decision-making, and help focus  program administrators at all levels of government on achieving the  federal agency’s highest priorities. For example, through their strategic  and annual performance plans and accountability reports, federal agencies  set program goals, measure program performance against those goals, and  report publicly on their progress. Some programs also issue annual or  biennial reports to Congress on specific programs they administer; these  generally include important program information.
A number of governmentwide initiatives have resulted in increased  emphasis by program managers on program integrity issues, including  OMB guidance, the President’s Management Agenda, GAO’s High-Risk  series and the Improper Payments Information Act of 2002 (IPIA). The  IPIA requires the head of each federal agency to annually review all  programs and activities that the agency administers and to identify all such  programs and activities that may be susceptible to significant improper  payments. For each program and activity identified, the agency is required  to estimate the annual amount of improper payments and submit those  estimates to Congress before March 31 of the following applicable year.  OMB guidance then directs federal agencies to include a measure of  improper payments in their annual Performance and Accountability  Reports. All 12 programs we reviewed are subject to these requirements.
section_title: Use of Federal Low- Income Assistance Varies Greatly by Program and by Subgroup
paragraphs: The proportion of those eligible who are actually enrolled in 12 selected  low-income programs varies substantially both between and within  programs, but several factors must be considered to understand the  implications of this information for program access. The estimated  proportion of eligible people who were enrolled in entitlement programs— those designed to support all those who apply and qualify—ranged from  about 50 percent to more than 70 percent. In contrast, the estimated  proportion of the eligible who were enrolled in non-entitlement  programs—those with limited funding and not necessarily intended to  cover all eligible persons—ranged from less than 10 percent to about   50 percent. Within programs, we found that subpopulations were enrolled  in different proportions. Some evidence also suggests that enrollees in  some programs, such as the Food Stamp Program, tend to be those who  are eligible for larger benefit amounts.
subsections: section_title: For Entitlement Programs, the Proportion of Those Eligible Who Were Enrolled Ranged from about 50 Percent to More Than 70 Percent, but Participation Rates Are Higher among Some Groups
paragraphs: For four of the five entitlement programs we examined, the proportion of  eligible people who were enrolled varied from around 50 percent in the  Food Stamp Program to more than 70 percent in the EITC and SSI  programs; and within programs, different types of participants, such as  children or the elderly, were enrolled in varying proportions.   Table 4 provides estimated participation rates for each of these programs,  expressed in ranges to reflect potential errors in sample survey data. The  actual participation rates may be outside the range of estimates shown  because some types of uncertainty in the estimation of participation rates  cannot be quantified. Estimates for the Food Stamp, Medicaid and SSI  programs were developed by the Urban Institute under contract with HHS  and Food Stamp Program estimates were developed by Mathematica  Policy Research, Inc., under contract with USDA. HHS and USDA are the  only two agencies to regularly estimate participation rates in low-income  programs. We estimated the EITC participation rate for 1999. However, we  were unable to estimate an enrollment rate for the Pell Grant program  because of concerns about the reliability of some of the data needed to  estimate the rate.
These estimates indicate that between half and three quarters of those  eligible are participating in four of the entitlement programs. Although  differences in years, data sources, and estimation methodologies make it  inappropriate to compare participation rates across programs, these  estimates provide a general sense of the extent to which programs are  reaching those eligible for benefits. Specifically, we found:    For the EITC program, we estimated in prior work that about   75 percent of eligible households took advantage of this credit in   1999. This estimate was adjusted to account for tax dollars that were  distributed in error that year. However, Congress has enacted new tax  laws and the IRS has taken steps to improve EITC program  compliance.
Two organizations, the Urban Institute and Mathematica Policy  Research, Inc., have estimated food stamp participation rates using  different methodologies but both found that about 48 percent of  eligible households participated in this program in 2001 and 2002,  respectively. In addition, Mathematica found that 54 percent of eligible  individuals were enrolled in 2002.
An estimated 66 to 70 percent of eligible, noninstitutionalized people  were enrolled in Medicaid in 2000. This estimate does not include  institutionalized people, such as those in nursing homes.
We were unable to estimate Pell Grant participation rates because we  were unable to assess the reliability of available data on the family  income of enrolled students who did not apply for federal financial aid.
For SSI, an estimated 66 to 73 percent of eligible adult individuals and  married couples received benefits in 2001. This estimate also does not  include institutionalized people or disabled children.
Participation rates also can vary substantially even within a single  program.  Disaggregating program participation rates by targeted  subpopulations can help us to better understand the implications of  overall program participation rates. In table 5, we provide participation  rate estimates for selected subgroups within the four entitlement  programs for which we have participation rate estimates. As in table 4,  these estimates are expressed in ranges to reflect potential errors that  result from using sample survey data. (See the footnotes to table 5 for  more details.)
As shown, participation in low-income programs varies markedly across  subgroups. For example, a smaller share of elderly people eligible for low  income programs tend to participate in the Food Stamps and Medicaid  programs than among the total eligible population. The elderly may  participate in the Food Stamp Program at a lower rate than other  households because most elderly households receive Social Security and  are eligible for relatively small food stamp benefits. For example, in 2000,  44 percent of all households with elderly members eligible for food stamps  were eligible for a monthly benefit of only $10 or less, the minimum  benefit for households of one or two persons. In comparison, 12 percent of  households without elderly members eligible for food stamps receive  benefits that low. Similarly, Medicaid participation among the elderly may  be low because Medicare also covers many elderly people who are eligible  for Medicaid. In contrast, families with children tend to participate in food  stamps, Medicaid, and the EITC at higher than average rates than those  households without children.  Although we were unable to disaggregate  participation rates by geographic area, program participation rates can  also vary by state or locality.
Information on trends in program participation rates over time can also  help in interpreting participation rate estimates, but we were only able to  provide information on trends in participation for one program.  Mathematica Policy Research, Inc., estimates food stamp participation  rates annually under contract with USDA and has taken steps to ensure  that estimates are comparable over time. As shown in figure 1, food stamp  participation rates remained fairly stable between fiscal years 1999 and  2002, declining slightly from 52 percent in fiscal year 1999 to 48 percent in  fiscal year 2002 among eligible households and 56 percent in fiscal 1999 to  54 percent in fiscal year 2002 among eligible individuals.
We were not able to provide information on trends in participation rates  for the Medicaid and SSI programs because the most recent participation  rate data available for these programs is not comparable to prior year  estimates. While prior year estimates are available, because of changes  from 1 year to the next in the methodology used to estimate participation  rates, estimates for prior years are not perfectly comparable with the most  recent estimates and are therefore not shown in this report. The  participation rate estimate for the EITC was available for only 1 year.
section_title: For Non-Entitlement Programs, the Proportion of Those Eligible Who Were Enrolled Ranged from Less Than 10 Percent to about 50 Percent
paragraphs: Among the seven non-entitlement programs we reviewed, the share of  those eligible who participate ranges from less than 10 percent to about   50 percent. These programs are generally not funded to serve all eligible  applicants, and many have other design features, such as the prioritization  of certain subgroups and eligibility criteria specific to a state or locality,  that would not necessarily allow for all eligible people who apply to  receive benefits. Consequently, we refer to these estimates as coverage  rates rather than participation rates. Table 6 provides estimated coverage  rates for each of these programs, expressed in ranges to reflect potential  errors in survey data. The actual coverage rates may be within a broader  range of estimates than shown because other errors that may have  resulted from calculating these estimates could not be quantified.  Estimates for the CCDF, SCHIP, and TANF cash assistance programs were  developed by the Urban Institute under contract with HHS. We also  include a WIC estimate developed by the National Research Council, and  another WIC estimate developed by the Urban Institute under contract  with us. We estimated the Head Start and housing programs using  administrative and national survey data.
Generally less than half of those eligible participate in the seven non- entitlement programs. Coverage rates also have limitations such as data  sources, and estimation methodologies that make it inappropriate to  compare the estimates across programs. However, they provide a general  sense of the extent to which these programs are reaching eligible people.  Specifically, we found:    Almost 20 percent of children who meet state-defined eligibility criteria  are receiving child care services through CCDF. This estimate does  not reflect participation in child care funded by other federal sources.  HHS estimates that about 26 percent of CCDF-eligible children are  receiving child care services through either CCDF (including the Child  Care and Development Block Grant, state CCDF funds or TANF  transfers to CCDF), or child care services funded directly through the  Social Services Block Grant (SSBG), TANF, or TANF state funds.    The Head Start program funded enough slots to serve about 44 to   54 percent of eligible 3- to 4-year-old low-income children in 2003.
An estimated 13 to 15 percent of households eligible for Housing  Choice Vouchers on the basis of income both received a voucher and  were able to successfully lease a housing unit in 1999, the most recent  year for which these data were available. In addition, less than   10 percent of households eligible on the basis of income were served  through the Public Housing program in 1999. While HCV and public  housing are the two largest federal housing programs, there are other  federal, state, and local housing programs from which eligible  households could receive assistance. HUD estimated that in 1999 about  a quarter of all households eligible for any kind of housing assistance  received assistance.  In 2000, about 44 to 51 percent of eligible children participated in  SCHIP. Since 2000, SCHIP enrollment has increased by nearly 3 million  children, but the impact this has had on the coverage rate is not known  because information on how the eligible population may have changed  over this time period is not available.  In addition, because states’  implementation of their programs varied, awareness of SCHIP may lag  in states that created their programs more recently.
About half of all eligible households receive cash assistance through  TANF. This estimate does not account for families that receive other  services, such as transportation and child care, that are offered through  this program, but who do not receive cash assistance.
WIC participation rates were available from two sources. The National  Research Council using the Survey of Income and Program  Participation found that 51 percent of eligible infants, children ages 1 to  4 and pregnant women were enrolled in WIC in 1998. The Urban  Institute, using the Current Population Survey, found that about 51 to   55 percent of eligible infants and children participated in 2001.
Coverage rates for these programs can also vary substantially by  subgroup, and they do vary within the TANF and WIC programs, the only  non-entitlement programs for which we have this information.  Understanding the extent to which different subgroups are covered by  non-entitlement programs can be particularly important precisely because  these programs are not necessarily funded to cover all those eligible. Table  7 provides coverage rates for groups of people eligible for TANF cash  assistance and WIC.
As shown, families with no income earners tend to receive TANF cash  assistance at a higher rate in the TANF program than families with earners  or two-parent families. The data also suggest that families with immigrants  have a lower coverage rate than families without immigrants. As noted  earlier, some families within these subpopulations may be receiving other  services funded by TANF, although data are not available on this. The  participation rate among infants eligible for WIC is higher than among  children ages 1 to 4.
We were unable to provide estimates of changes in coverage rates over  time for most of the non-entitlement programs covered in this review, but  we did find an increase in the coverage rate for the Head Start program  over the past several years. Since 1997, Head Start coverage rates have  increased from about 40 percent to 50 percent. However during this time  period, the coverage rate increased between 2000 and 2001 from about   50 percent to 58 percent and then gradually declined. The coverage rate  increased by this amount within 1 year because slots increased by nearly  40,000 for the Head Start program while the number of children eligible  decreased by about nearly 130,000. Since 2001 the number of funded Head  Start slots has increased, but the coverage rate fell because the child  poverty rate, and thus the number of eligible children, increased.  Figure 2  shows Head Start coverage rate estimates for 1997 to 2003.
Because of changes in the methodology used to estimate coverage rates  from 1 year to the next, we cannot reliably compare the most recent  coverage rate estimates for SCHIP and TANF to those of prior years, but  there is compelling evidence that coverage rates for these two programs  changed significantly over time. SCHIP was first implemented in 1997 and  the number of children in the program grew from 660,351 in fiscal year  1998 to over 3 million in fiscal year 2000. As states continued to reach out  to eligible children in subsequent years, participation continued to  increase to nearly 6 million in fiscal year 2003. This eightfold increase in  the number of children enrolled in SCHIP since fiscal year 1998 almost  certainly had a significant impact on the coverage rate. Meanwhile, as  states implemented welfare reforms during the strong economy of the late  1990s and other changes occurred in programs serving low-income  families, the number of families receiving TANF cash assistance declined,  falling by about 50 percent between fiscal years 1997 and 2003. This also  likely had a significant impact on the program coverage rate. HHS has  reported that about 70 percent of families eligible for TANF cash  assistance were enrolled in the program in 1997, compared to less than   50 percent in 2001, but we were unable to quantify how much of this  change was caused by changes in estimation methodology. It is also  important to note that states’ TANF programs have changed over this time.  States have more flexibility in the types of non-cash assistance they may  provide families, and some families eligible for cash assistance may be  receiving other forms of aid instead. In addition, some families or  individuals that may appear eligible according to the model may not be  participating because they have not complied with program requirements,  such as being involved in work activities.
section_title: The Estimated Costs of Serving Eligible Non- participants Show That in Some Programs, Those Eligible for the Largest Benefits Are More Likely to be Enrolled
paragraphs: Our estimates of the costs of providing benefits to eligible non-participants  show that for some programs, those currently participating in the  programs are generally eligible for a greater benefit amount than those not  participating. For these programs, the estimated costs of serving those  eligible but not currently receiving benefits may be less than one might  expect based on the participation or coverage rates we estimated. This is  not surprising, as it makes sense that, for example, a person eligible for a  $10 food stamp benefit might be more likely to forgo that benefit than a  person eligible for a $150 benefit. More specifically, Mathematica found  that the 48 percent of households participating in the Food Stamp Program  in fiscal year 2001 received about 62 percent of the total amount of  benefits that would be paid out if all eligible households received benefits.
As shown in table 8, we were able to estimate the additional cost of  providing benefits to eligible nonparticipants for 6 of the 12 programs we  reviewed. These cost estimates take into consideration the characteristics  of non-participants and the benefits for which they would be eligible but  do not account for increases in administrative costs that could result from  participation increases. We were unable to estimate the cost of providing  benefits to eligible, non-participants in the six other programs—CCDF,  HCV, Medicaid, Pell Grants, Public Housing, and SCHIP—because we did  not have enough information to determine how the characteristics of the  non-participants would have affected the benefit amounts they could have  received.
Although Medicaid is by far the largest program we reviewed, developing  reliable estimates of the costs of serving those eligible but not enrolled in  the Medicaid program is difficult for a number of reasons. These reasons  include a lack of information about the health status of eligible non- participants, the many variables that affect health care costs, and the  open-ended nature of health care benefits.
The costs included in the table do not reflect the total costs that would be  incurred if all eligible people enrolled in these programs. Probable  increases in administrative costs that would be incurred are not included,  and we did not estimate how the cost of goods and services offered  through the Food Stamp, Head Start, and WIC programs would change if  more participants were demanding them. However, the costs do include  some additional costs that would be incurred by states in programs where  states are required to cover some of the program costs.
Recognizing the differences in goals, design, administration, and funding  in the 12 programs, it may be neither feasible nor desirable to provide  program benefits to all those eligible. Because alternative programs could  offer the similar benefits and services as the programs we reviewed, some  of these programs, especially those with limited funding, may be best  administered by only serving a certain subgroup of their eligible  population. For example, in localities where school systems offer pre- kindergarten classes to 4-year-old children, Head Start programs may want  to focus more on enrolling 3-year-olds from low-income families. Also,  limited administrative resources may prevent federal, state, and local  agencies from serving all those eligible. Full participation among eligible  people also may not be feasible because some choose not to enroll in  means-tested programs. Given these constraints, some programs may  focus on targeting their resources to those most in need of program  services.
Finally, while participation and coverage rate estimates as well as  estimates of potential program costs provide important program  information that can be useful to both policymakers and program  administrators, these estimates must be interpreted carefully to take into  consideration such factors as survey data, research methodology,  timeliness of estimates, and the availability of alternative programs. These  factors limit our ability to compare rates across programs and would need  to be considered in efforts to define appropriate or desired participation or  coverage rate levels. For a detailed discussion of the factors that affect use  of these estimates, see appendix II.
section_title: Many Factors Influence Participation but Their Impact on Entitlement and Non- Entitlement Programs Differs
paragraphs: Many factors influence access to means-tested programs, including the  benefits provided by the program, ease of access, misperceptions about  program requirements, and eligibility verification procedures put in place  to ensure program integrity, based on our literature review and agency  interviews. These factors influence participation by affecting the number  of people who participate in a program as well as the type of people who  participate. Entitlement programs may focus on addressing factors that  affect access in order to increase program participation. However,  because coverage rates in non-entitlement programs are determined  primarily by funding levels, non-entitlement programs are more likely to  be concerned about the impact of these factors on other aspects of  program access, such as the composition of the program caseload and  how the program interacts with alternative programs that provide similar  benefits.
subsections: section_title: The Size and Type of Benefits Can Affect Participation
paragraphs: The size and type of program benefits can affect whether or not an  individual participates in a program. Numerous studies show that the size  or value of the benefit influences program participation, and this depends  largely on the structure of program benefits. Some programs, such as the  Food Stamp Program, determine benefit levels based on income, allowing  a three-person household to receive as little as $1 per month depending on  household income.  Other programs, such as Medicaid, generally offer  comparable benefits to every resident of a state who meets eligibility  requirements. A recent National Bureau of Economic Research study  showed that across a range of programs and within programs, larger  benefits were associated with higher participation and coverage rates. In  addition, our literature review, site visits, and analysis of participation  rates for selected programs showed that participation and coverage rates  tend to be higher among subgroups eligible for larger benefits. For  example:    Elderly individuals are generally eligible for small food stamp benefits;  their participation rate in the program is lower than for other groups.
Families with infants participate in WIC at higher rates than families  with older children, in part because the value of the WIC voucher is  greater for families with infants. WIC officials in Connecticut reported  to us that 10 percent of families stopped participating in the program  when their youngest child reached age 1.
On average, families with children who are eligible for the EITC receive  a higher EITC benefit than individuals and families without children,  and they participate at a higher rate.
The type of benefits offered can also influence whether someone eligible  for a program participates. Some programs—such as EITC and SSI—offer  cash benefits while other programs—such as Head Start and Medicaid— offer direct services, such as educational or health services. Our research  on participation in low-income programs generally shows that  participation and coverage rates are higher among programs that provide  cash benefits than among programs that provide direct services. One  reason for this difference is the flexibility cash benefits give to individuals.  Although the recipient may need the services provided by programs in  which they are enrolled, these types of benefits do not allow individuals to  shift resources away from program purposes toward what they might  consider more pressing needs. Our site visits confirmed that the type of  benefits influence participation and coverage rates. For example, we  found that:    SSI recipients who participated in a pilot project that allowed them to  receive their food stamp allotment in cash expressed a strong  preference for this over traditional food stamp coupons.
Some individuals who need subsidized housing may prefer the Housing  Choice Voucher program, which allows individuals to choose their  housing in neighborhoods that offer better educational and  employment opportunities or choose to remain in a place while paying  less rent, over the Public Housing program that does not give the  individuals flexibility to choose where they live.
section_title: Ease of Access to Program Benefits and Services Can Influence Participation
paragraphs: Factors that influence the ease with which potential participants can  access a program—including office hours, program location, and the  ability of program participants to redeem or use their benefits—can also  affect the number and groups of people who participate in the programs.  Several of the programs we reviewed require applicants to visit the  program office to establish and maintain eligibility. For instance, local  WIC, TANF, and Food Stamp Program offices typically require face-to-face  interviews before individuals can receive benefits. Those programs that  keep traditional office hours—8:00 a.m. to 5:00 p.m.—pose a barrier to  potential applicants who work and would have to take time away from  their job in order to apply. Studies on child care and WIC programs  identify traditional office hours as a barrier for working families. Similarly,  Medicaid officials in California told us that one of their barriers to  participation is office hours that do not accommodate working families.  Although many program officials suggested that having flexible office  hours is important to participants, some offices are challenged to extend  their operating hours. WIC officials in Connecticut told us that they have  attempted to promote extended hours and have made some progress;  however, instituting extended hours remains problematic due to limited  funding and contracts governing the workforce.
The location of the program office can also affect participation and  caseload composition. For many individuals—like the elderly, individuals  with disabilities, and families living in rural areas—traveling to a program  office that is outside the limits of their available mode of transportation  makes it difficult for them to receive needed benefits. The USDA published  in its National Survey of WIC Participants that one of the top barriers in  the WIC program is transportation with 30 percent of participants  reporting that they missed appointments because they lack transportation  to the office. Studies on the Housing Choice Voucher, child care, Head  Start, and Food Stamp programs reported similar findings. Many state and  local officials we visited agreed that transportation is a barrier to  participation. A TANF, Food Stamp, and Medicaid official in Washington  County, Maryland, told us that public transportation is limited and getting  to and from the program offices poses a barrier to participation for many  individuals, especially those in rural communities. According to officials,  participants without vehicles have to seek rides from family members or  acquaintances to access services. For many of these participants being  seen going to the welfare office is difficult and sometimes stigmatizing.
Some programs—including child care, Housing Choice Voucher, and  Medicaid—offer benefits that can be difficult for participants to use, as  some service providers—landlords, day care workers, or health care  providers—will not exchange their services for program benefits. For  example, our prior work found that the proportion of providers who will  accept child care subsidies varied widely by state, ranging from 23 to   90 percent. Even in cases where providers accepted subsidies, the number  of slots for children that used child care subsidies was limited.  Additionally, several state and local officials suggested that participants  are sometimes challenged to find health care providers that accept  Medicaid. According to officials in Chisago County, Minnesota,  participants have to drive up to 200 miles to visit a dentist that accepts  Medicaid.
section_title: Misperceptions about Program Requirements Discourage Some Individuals from Participating
paragraphs: From our literature review and interviews with program officials, we also  found that many individuals do not participate in low-income programs  because they do not know that they are potentially eligible for benefits.  Numerous studies have documented instances where participation was  compromised because individuals were unaware of program benefits or  had misconceptions about eligibility. For example, several EITC,  Medicaid, Food Stamp, Head Start, and SSI studies indicate that one of the  primary barriers to participation is that individuals do not know that they  are eligible for these benefits. For some individuals—like the elderly and  non-English speakers—this unfamiliarity with program benefits is even  more widespread, creating a larger barrier to participation and an under  representation of these individuals in the caseload. Many program officials  we visited agreed and explained that individuals also have misconceptions  about program eligibility. For example, some individuals do not believe  that they are eligible for benefits because they are employed while others  do not want to be attached to the perceived stigma associated with the  programs. In Los Angeles, Medicaid officials noted that rumors circulated  about the eligibility criteria for Medicaid prevent many potential recipients  from applying for the program. Particularly in non-English speaking  communities, information about social services is often received through  word of mouth; thus, when incorrect information circulates, it can have a  significant impact on participation.
section_title: Application Process and Eligibility Verification Requirements to Ensure Program Integrity Can Have an Effect on Participation
paragraphs: Eligibility verification requirements—rules put in place to improve  program integrity by ensuring that only those eligible for program benefits  receive them—can also affect the overall number and characteristics of  people who participate in the program. Each low-income program in this  study has a set of verification requirements that individuals must complete  to establish and maintain eligibility. Common requirements among the  programs include completing application forms and providing necessary  documentation. In addition, some programs require applicants to take  additional steps, such as attending face-to-face interviews, documenting  parental or spousal assets, or participating in orientation classes.  According to our literature review, the complexity of verification  requirements can impact the number of enrollees, especially for  individuals with mental disabilities or who are homeless. One WIC study  reviewed participation rate differences among states and found that states  that required applicants to provide proof of income (before it was  federally mandated) and had stricter program rules had lower program  participation than states that did not require income documentation.  Additionally, another study examined EITC participation rates across  states and found that differences in participation rates are due in part to  the applicant having help completing the complex tax forms. Many state  and local officials agree that strict and/or complicated verification  requirements can decrease participation, particularly among certain  groups of people. For example, we found:    According to officials, the Pell Grant application is very long and  complicated and can be difficult for students and their parents to  complete. Staff from an organization in St. Paul, Minnesota, dedicated  to assisting low-income students to access higher education told us  that many low-income students in the area would not be able to  complete the forms correctly without their assistance.
CCDF Officials in Connecticut and Georgia told us that the application  process can be complex and difficult for applicants and, as a result,  many applicants submit their applications late or incomplete. Because  there is very high demand for child care subsidies, these families are  often denied benefits or removed from the waiting list.
Local SSI officials told us that participants face many life changes such  as frequent hospitalization and institutionalization, moving into  different family households, and changes in the hours that they work.  To remain eligible for program benefits, SSI recipients must report  these types of changes within 10 days from the end of the month of the  change.
Finally, while each program has its own set of verification requirements,  these requirements become even more challenging when participants are  applying or maintaining eligibility for multiple programs. Program officials  in Maryland told us that one of the biggest barriers to accessing multiple  means-tested programs is the many different eligibility criteria and  reporting requirements of the various programs. According to state  officials in Maryland, the TANF and Food Stamp Programs are relatively  well aligned, but Medicaid has not coordinated as much with the other  programs. According to officials, this can be problematic because a  participant who is turned down for one program might assume that he or  she is ineligible for other low-income programs and may fail to apply for  benefits for which they are eligible.
section_title: Factors That Influence Participation Rates Can also Impact Other Aspects of Program Access Such As Targeting and Program Interactions
paragraphs: Factors that influence participation also impact other aspects of program  access such as targeting and program interactions among all low-income  programs, but particularly among non-entitlement programs whose  enrollment levels are determined largely by funding levels. The non- entitlement programs covered in this review—CCDF, Head Start, Housing  Choice Vouchers, Public Housing, SCHIP, and TANF—have funding  limitations that could restrict the total number of people who could  potentially participate in the programs and, as a result, coverage rates for  these programs may be determined, at least in part, by funding. However,  among programs that allow states substantial flexibility in determining  program eligibility and implementation such as CCDF, SCHIP, and TANF,  funding constraints contribute to, but do not determine coverage rates to  the extent that they do for programs that allow less state and local  flexibility. Given funding constraints for non-entitlement programs,  agencies are challenged to allocate scarce resources appropriately by  targeting their benefits to specific groups of people and planning  strategically to ensure that the program complements a broader range of  programs administered by the same agency or that provide similar services  or benefits to the program’s eligible population.
Because factors that influence participation often affect the composition  of a program’s caseload, some agencies that administer programs with  limited funding have put measures in place to ensure that their caseloads  reflect program priorities—whether that involves targeting certain groups  or ensuring that benefits do not disproportionately favor or exclude  certain subpopulations. For example, although the public housing program  generally does not target benefits to households with the lowest incomes,  it allows priority to be given to elderly and disabled recipients. Agency  officials reported that they track participation of these groups to ensure  that their share of the total caseload does not change dramatically from   1 year to the next. Similarly, state child care officials told us that funds are  generally provided to recipients based on priority groups that favor  families receiving public assistance and those with the greatest financial  need.
Additionally, many agencies are cognizant of how their programs interact  with and complement other programs that serve the same population. For  example, some child care programs pair with half-day Head Start  programs to provide continuous care to children of working parents;  Medicaid and SCHIP programs within some states coordinate their  enrollment processes to facilitate access to health insurance for  individuals in the state; and between 1998 and 2003, HUD responded to a  decrease in the number of public housing units available for low-income  households by increasing resources available through its voucher program  to maintain coverage for families. Likewise, in allocating TANF resources,  programs often coordinate with local workforce development agencies,  child care programs, and other programs that provide similar services to  best meet the needs of their clients without duplicating an existing effort.  In these ways, programs acknowledge and respond to access issues and  ways in which factors affect access other than participation levels and  rates.
section_title: Program Administrators Have Strategies That Improve Both Access and Integrity, but Federal Agencies Have Generally Focused More on Measuring Program Integrity Outcomes
paragraphs: Program administrators have implemented many strategies to achieve  desired program outcomes, including those related to program access and  program integrity, but while agencies have generally taken steps to  monitor and disseminate information on program integrity, few track and  report on the extent to which they are serving their eligible populations.  The programs we reviewed have many goals and objectives of varying  degrees of importance to the agencies that administer them, among them  program access and program integrity. Strategies implemented at the  federal, state, and local level to address these two issues include  information systems, data sharing, and technological innovation, changes  to the application and eligibility verification process, and outreach and  coordination with other programs. Although federal agencies do not have  direct control over many of the strategies we identified—including those  mandated by law and those initiated at the state and local level—federal  managers can play a role in encouraging and facilitating such strategies by  emphasizing program access and program integrity as federal agency  priorities. In response to the Improper Payments Information Act of 2002,  all of the federal agencies we reviewed have taken at least some steps to  identify and begin reporting information to Congress and others on the  extent of improper payments. We also found, however, that for several of  the programs we reviewed, federal agencies have not taken steps to  identify and use participation or coverage rate information in managing  their programs. Having up-to-date information on the extent to which their  programs reach eligible individuals can help agencies plan strategically,  set priorities, and ensure that agencies are reaching eligible families.
subsections: section_title: Programs Have Found Ways to Improve Access by Reducing the Burden on Applicants While at the Same Time Improving Program Integrity
paragraphs: The state, local and federal program officials we spoke with identified  several strategies that they believe may improve either of the two  objectives—program access or program integrity—without harming, and  in many cases improving, the other. As mentioned, some efforts to  increase program integrity and prevent fraud, such as increasing the  amount of eligibility verification required, may actually hurt access to the  program by deterring even those eligible from applying. However, program  administrators told us of several strategies that increase access while  maintaining and even improving integrity. The complementary strategies  we identified are enabled by information systems, data sharing, and  technological innovations, changes in the application and eligibility  verification process, and outreach and coordination with other programs.
subsections: section_title: Information Systems, Data Sharing, and Technological Innovation
paragraphs: Improved information systems, sharing of data between programs, and use  of new technologies can help programs to better verify eligibility and make  the application process more efficient and less error prone. These  strategies can improve integrity not only by preventing outright abuse of  programs, but also by reducing chances for client or caseworker error or  misunderstanding. They can also help programs reach out to populations  who may face barriers. One strategy involves sharing verified eligibility  information about applicants across programs. Data sharing prevents  applicants from having to submit identical verification to multiple  programs for which they may be eligible, and it can also speed up the  sometimes-lengthy application process. In addition, data sharing allows  programs to check the veracity of information they receive from  applicants with other databases.
In Minnesota, WIC caseworkers are able at the time of application to  determine participant eligibility by accessing basic eligibility information  via technology systems from other means-tested programs, such as  Medicaid, food stamps and TANF. SSI administrators told us that during  the application interview, income data is entered in their computer system.  This information is then checked with a number of other databases  including those of the IRS, the Department of Veterans Affairs, and the  state Civil Service Administration to quickly verify earnings and other  eligibility requirements and inconsistencies are flagged. Similarly, Georgia  has an interactive computer system that aggregates client information for  TANF, Medicaid, and the Food Stamp Program and calculates benefits for  all three programs. Additionally, when clients need to make a change in  their eligibility information, these data are automatically changed for all  three programs, so that clients can receive the appropriate level of benefits  based on their most current eligibility information. Furthermore, the data  reliability matches may include information from the Department of Labor  wage match, SSI benefits, prison information, and information on a  person’s death. If any of the matched information conflicts with the  information provided by the client, a caseworker is to ask additional  questions of the client. In all these ways, caseworkers can accelerate the  application process while capitalizing on verified eligibility information  already provided to other programs.
Some administrators told us that such data sharing, however, can be  complicated by concerns over ensuring privacy and by insufficient  technological capacity. Local program administrators told us that  eligibility data for Medicaid and SCHIP is tightly controlled because of  Health Insurance Portability and Accountability Act (HIPAA)—a law that  limits access to an individual’s health information—but that its data might  be shared, if warranted, with proper consent. Data sharing can be impeded  by technological limitations, such as computer systems that cannot  communicate directly with other systems over the Internet or some other  network, or a lack of software needed to translate information into  formats that other computers can understand. Our prior work on data  sharing identifies strategies agencies have implemented to address  concerns about privacy and technological capacity issues.
Some agency officials told us of ways in which on-line applications can  improve both access and integrity. As stated, program integrity is  compromised not only by willful misrepresentation, but also by applicant  and caseworker error. Web-based or partially web-based applications can  automatically check that all required fields are completed before an  application is submitted for review and automatically calculate benefits  thereby reducing error. Moreover, having the option of an on-line  application can increase access to those who are eligible for benefits but  who may have difficulty physically getting to program offices. Minnesota  has instituted an on-line interactive application for Medicaid that program  administrators believe will make the application process easier for both  participants and caseworkers. In addition to making the process easier,  the system will also check verification information with a variety of other  data sources and thus reduce the likelihood of errors as well. In this way, a  potentially burdensome application process becomes simpler, more  accessible, and less error prone. Similarly, eight states accept food stamp  applications through the Internet.  Of course, this strategy is less viable or  effective where access to computers is limited or where the on-line  environment cannot be adequately secured.
section_title: Application and Eligibility Verification Process Changes
paragraphs: Program administrators told us about several changes in the application  and eligibility verification process that have improved their ability to  promote access and ensure integrity. Efforts to increase the accuracy of  eligibility and benefit determination can increase access by reducing the  number of applicants who were incorrectly denied benefits or whose  benefit determinations resulted in underpayments. For example,  streamlining or simplifying the application and providing applications in  other languages can increase access, but also promote program integrity  by reducing errors or misunderstanding in the application process.  Simplifying applications by clarifying confusing wording and removing  redundant questions as well as providing applications in an applicant’s  native language can reduce the possibility of these types of errors.  According to federal officials, most states use a simplified application  form for the SCHIP program to remove application barriers for families.   For example, the SCHIP program applications in both Connecticut and  California have been reduced from 17 and 27 pages respectively to only   4 pages each without sacrificing required information, according to state  officials.  In many cases, the SCHIP streamlined application forms caused  corresponding changes in state Medicaid applications as well. In addition,  many of the program administrators with whom we spoke told us that  their applications and forms were available in many languages. For  example, the Minnesota Department of Revenue now has state EITC tax  forms and fact sheets directing them to the federal EITC in eleven  languages.
Another way in which programs can streamline the application process is  through categorical eligibility with other programs, which can be set at the  federal or state level depending on the program. Categorical eligibility,  also known as adjunctive eligibility, allows an individual who has been  found eligible for one program to be automatically granted eligibility for  another program, typically one with less stringent eligibility criteria. For  example, if an individual is receiving SSI, federal legislation generally  requires that that person be automatically eligible for Medicaid. Similarly,  if a pregnant woman is receiving Food Stamps, Medicaid, or TANF, then  she automatically qualifies for WIC benefits—and thus does not need to  provide income verification once again when applying for the program.  States also have flexibility to grant automatic eligibility for other  programs. A state WIC program, for example, may grant automatic  eligibility for families receiving Free and Reduced Price School lunches.  These adjunctive or automatic eligibility policies allow ultimately for  simpler applications, which may enhance access and reduce error. In fact,  federal administrators at USDA noted that adjunctive eligibility is one of  the most important tools now used to address program integrity and  access issues in a way that cuts across programs.
The provision of more comprehensive in-person assistance in filling out  applications can encourage a candidate eligible for benefits to complete an  otherwise lengthy, complicated, or intimidating application process. Such  personal assistance can also prevent errors that result from  misunderstanding of application questions or requirements or even fraud  by reminding applicants in person that fraudulent claims are punishable by  law. For example, to increase access to the program, California program  officials told us that the SCHIP program developed a training process that  certified staff from other entities, such as schools and community-based  organizations, as “application assistants.” These “application assistants”  are also trained to recognize when applicants seem to be submitting false  information and are prohibited from assisting families who have  previously been found to have committed fraud. In a Maryland SSA office,  SSI program administrators told us that they had abbreviated their  application form so that most information is now collected in an interview.  This process helps improve access for those with limited literacy or those  who may be discouraged by a long paper application. Officials also noted  that this process helps program integrity because the interviews allow  caseworkers the opportunity to remind clients that fraudulent claims are  punishable by law. Similarly, EITC officials in Minnesota told us that free  tax preparation assistance could make the process less complicated for  filers and could also cut down on fraud from tax preparers. As one official  explained, many low-income families live near a high concentration of  paid tax preparers, who have incentives to fraudulently file for a high  credit. While more in depth application assistance has these benefits, it  can pose challenges to programs in ensuring the quality of the assistance  offered and it can be costly. According to California SCHIP officials,  funding to train “application assistants” for the SCHIP program in  California was ended in May 2002 due to budget constraints.
Lastly, some policies put in place to prevent fraud at the time of  application can also help with program access. Connecticut Department of  Social Services has begun a fraud prevention program, termed FRED  (Fraud Early Detection), which was instituted to address an increase in  the amount of fraud and error detected in the program. The purpose of  FRED is to identify potential fraud cases before benefits are paid out to  prevent improper payments rather than identifying fraud after the  payments have been made. Under FRED, cases that meet 1 of 12 risk  criteria are to be referred to a fraud investigator who is to visit the home  within 10 days of the referral. While the investigator is visiting the home,  he/she is to interview the client about aspects of the risk criteria, and  make a recommendation regarding eligibility. While the primary purpose  of the visit is to prevent fraud, in practice investigators have found that  their role is also to explain the eligibility criteria more clearly to applicants  and to explain what steps they need to take in order to be eligible for  program benefits. In addition, investigators are trained to provide  additional information to the family on other resources available to them  and to assist them with referrals, thereby increasing access to an array of  related social services.
section_title: Outreach and Coordination with Other Programs
paragraphs: Targeted outreach to populations that might have more barriers to  accessing the program has the potential to increase access without  necessarily compromising integrity. Many program officials we spoke with  told us that they had outreach strategies to reach out to populations—such  as rural-dwellers, the elderly, or those with limited English proficiency— that have had trouble accessing the program. Such strategies include  information sessions or pamphlets in ethnic community centers or  partnering with advocacy groups. In addition, cross agency referrals for  applicants already found to be eligible and more overall agency  coordination can improve access without sacrificing integrity.
Many agency officials with whom we spoke told us that they coordinated  with other programs to reach potential clients. In Maryland, the  Department of Social Services invites the Volunteer Income Tax  Assistance program to work out of its office, so that those low-income  earners already in contact with social services can have better access to  the EITC. Some offices in California participate in an open door policy  program in which clients can access any social service program through  referrals at any state government office they walk in to. Some program  administrators told us that program co-location can help increase access.  This happens when an individual applying for one program in an office is  referred to and immediately serviced by another program in that same  location. Some examples we found had Food Stamps located in TANF  offices and a WIC clinic collocated with the state Children’s Health  Insurance Program.
section_title: Federal Agencies Have Taken Steps to Track Improper Payments, but Few Estimate Program Participation or Coverage Rates to Monitor Program Access
paragraphs: All of the programs we reviewed emphasize both program access and  program integrity, and as we have described, many federal, state, and local  program administrators have implemented strategies intended to achieve  access and integrity goals. However, not all agencies responsible for  administering these programs have established management practices, in  keeping with standards of internal control, that will consistently guide  them in achieving these outcomes. Among the standards that are  particularly relevant for agencies responsible for administering means- tested programs are:    establishing and maintaining a control environment, a culture of  accountability that sets a positive and supportive attitude toward  achieving management objectives;    monitoring program performance over time; and  recording and communicating relevant, reliable, and useful information  to management and others who need it to carry out their internal  control and operational responsibilities.
To achieve desired program outcomes and safeguard federal funds, these  standards should be part of an agency’s operational and management  practices. While the agencies we reviewed have taken steps to establish  internal controls for improper payments and program integrity, not all  have established similar controls for achieving desired program access  outcomes.
There are many ways in which federal agencies can establish a culture of  accountability, one that “sets the tone” for program administrators at all  levels of government to emphasize certain priorities. One way to do this is  to monitor progress toward achieving desired program outcomes, and  another is to effectively communicate program information in a broad  sense, with information flowing down, across, and up the organization.  Depending on the program, some aspects of an achievement-oriented  environment are codified in laws, regulations, and federal policies. For  example, the Improper Payments Information Act of 2002 requires those  programs and activities susceptible to significant erroneous payments to  calculate annual improper payment estimates and sets statistical sampling  confidence and precision levels for estimating those payments.
As shown in table 9, some of the federal agencies covered by this review  have already begun to monitor improper payments for the programs they  administer and, as directed by OMB guidance, communicate this  information by including a measure of improper payments in their annual  Performance and Accountability Reports. Including measures of  improper payments in agency annual performance plans and  accountability reports is one way to provide officials with important  information on areas of success and areas that need improvement and to  send a signal to all working on agency programs that the measured goal is  a priority. (For information on the amounts of improper payments  reported by agencies, see app.III.) To varying degrees, the other agencies  included in this review have begun taking steps to identify and report on  improper payments as well. While agencies are taking steps, much remains  to be accomplished before a comprehensive picture is available of the  amount of improper payments for these programs.
While an internal control framework is emerging for addressing financial  program integrity issues, few of the agencies responsible for administering  the programs we reviewed have established a similar framework for  achieving desired program access outcomes, although they have  implemented numerous strategies to increase program participation. The  12 programs we reviewed have numerous program goals and objectives of  varying degrees of importance to the agencies that administer them.  Because the most fundamental purpose of these programs is to serve low- income individuals and families, all track measures that provide some  information about program participation and access. For example:    All of agencies responsible for administering the programs we  reviewed track the number of people participating in their programs.    Some federal agencies—such as HUD—measure the extent to which  program participants redeem or use benefits provided to them.
Others use other measures related to access. CMS tracks the number of  individuals who are uninsured each year.
Many agencies track participants and participant outcomes through  program effectiveness studies.
Through these efforts, agencies have demonstrated their concern about  program access, yet, the ways in which most of these agencies measure  program participation do not inform administrators about the extent to  which they are meeting overall need and therefore do not provide all the  information they need to monitor access. As discussed above, access  encompasses not only the number of program participants, but also the  extent to which programs reach the total population eligible for benefits  and services, how well agencies are allocating resources among targeted  subpopulations, and, from an agencywide or even governmentwide  perspective, how well specific means-tested programs complement and  interact with programs that serve similar populations or provide for  similar needs. While concerns about the allocation of scarce resources and  interactions with other programs apply to all low-income programs, they  may be of particular importance to non-entitlement programs whose  participation is limited by funding constraints. Participation or coverage  rate information can guide program administrators in setting priorities and  targeting scarce resources, even among programs that were not intended  to serve everyone eligible for program benefits.
As shown in table 10, only one of the agencies we reviewed, USDA,  regularly estimates participation rates for the programs it administers and  communicates and disseminates information on these rates in a way that  promotes a culture of accountability supportive of achieving program  access outcomes. USDA has been estimating participation rates annually  for the Food Stamp Program since 1975. The agency uses this information  to get a better understanding of how well they are reaching certain priority  subpopulations such as the working poor, single-parent families with  children, and SSI recipients; and to identify states in need of outreach  assistance. In addition, USDA has established a performance goal to  increase participation rates in the Food Stamp Program and reports food  stamp participation rates in its annual performance report.  In these  ways, the agency uses this information for program management  purposes.
USDA has taken steps to develop a reliable participation rate measure for  the WIC program and plans to estimate the WIC participation rate  annually. Because the WIC program is not an entitlement and participation  is determined by the appropriated funds, FNS officials told us they do not  plan to establish a performance goal related to the WIC participation rate.  However, officials told us that they do think it is important to monitor and  report on the WIC participation rate for policy, planning, and budgeting  purposes, and the agency plans to use these data in managing the program  by highlighting the measure in the program’s budget reports and its annual  report to Congress.
HHS plays a key role in estimating participation rates for several means- tested programs. Since 1973, HHS’s Office of the Assistant Secretary for  Planning and Evaluation has funded TRIM3 for the purposes of policy  development, analysis, and research on such topics as the interactive  effects of programs serving low-income families. The Welfare Indicators  Act of 1994, requires HHS to submit annual reports to Congress on  welfare receipt in the United States and key indicators and predictors of  welfare dependence. These reports, produced annually since 1997, include  participation and coverage rates from TRIM3 for TANF (and its  predecessor program, Aid to Families With Dependent Children), SSI, and  food stamps.
HHS includes CCDF coverage rates in the biennial congressional report  and plans to include a performance measure related to participation rates  in its annual performance reports starting in fiscal year 2006. However,    HHS generally does not use participation rate estimates it has available  from TRIM3 in managing its other programs by highlighting the  information in its annual performance plans or congressionally mandated  program reports. For example, TANF participation rates are not included  in the agency’s TANF Annual Report to Congress and Medicaid and SCHIP  participation and coverage rates are not included in any of the other  congressionally mandated reports disseminated by CMS, the agency that  administers these programs.
Only one of the other agencies we reviewed, the IRS, has plans to estimate  and report on participation rates for the programs they administer. IRS  plans to begin estimating the participation rate in the EITC program on an  annual basis starting in fiscal year 2005 and to use the EITC participation  rate as a performance measure in its annual performance report. However,  the other agencies we reviewed, including SSA, HUD, and ED, do not  estimate participation or coverage rates for the SSI, Housing Choice  Voucher, Public housing, or Pell Grant programs and reported no plans to  do so.
There are several reasons agency officials cited for not collecting  participation rate information. For some programs, information on certain  eligibility criteria can be difficult or costly to obtain. For example, reliable  data on the disability status of children who do not receive SSI is not  readily available from national survey data. We were unable to provide a  participation rate estimate for this group for this reason. Absent a  legislative or other mandate to estimate participation and coverage rates,  agency officials may not consider conducting such estimates a priority.  However, some agency officials that do not regularly estimate  participation or coverage rates indicated they would find such estimates  useful. For example, HUD officials indicated that the agency finds its  estimates of worst case housing needs, which include some coverage rate  measures for all housing programs, useful for policy and planning  purposes. Similarly, while Head Start officials do not publish or report  coverage rate estimates in any agency documents, they indicated that they  occasionally estimate participation rates informally for internal use in  policy, planning, and budgeting.
section_title: Conclusion
paragraphs: Federal agencies responsible for administering means-tested programs are  charged with ensuring that those eligible for program benefits and services  are able to access them and with ensuring prudent oversight of taxpayer  dollars by maintaining program integrity, including preventing improper  payments. Program administrators may find it challenging to achieve these  goals in part because they may conflict—ensuring program integrity can  potentially come at the expense of program access. While we identified a  number of strategies that have been implemented by federal, state, and  local agencies that could potentially achieve both of these goals, unless  agencies track progress toward meeting these goals in a way that signals  to program administrators at all levels of government that both access and  integrity are federal priorities, there is a risk that one of the goals may be  compromised. Estimating participation rates for means-tested programs is  difficult—and more difficult for some than for others—and cannot be  considered “an exact science.” Nevertheless, when done rigorously—in a  way that ensures that estimates are comparable over time and quantifies  the errors that result from the estimation methodology—these estimates  can provide a basic understanding of the extent to which needy  populations are being served by federal programs and can be a key  component of a federal agency’s efforts to establish a culture of  accountability that emphasizes the importance of program access. Federal  agencies responsible for administering only four of the programs we  covered in this review—CCDF, food stamps, WIC, and EITC—either  currently collect and report information on the extent to which they are  reaching their target populations in key performance and program reports  or plan to do so. As a result, the federal agencies that administer the other  nine programs covered by this review may lack data that could inform  their budgetary and programmatic decisions, assist them in ensuring that  their programs are coordinated with and appropriately complement other  programs available to their target populations, help them to manage their  programs effectively, and enable them to provide policymakers with the  information they need to make decisions.
section_title: Recommendations to Executive Agencies
subsections: section_title: Recommendations to the Secretary of the Department of Agriculture
paragraphs: As the department moves forward with participation rate estimates for the  WIC program, we recommend that the Secretary: 1.  take steps to clarify to users the limitations of the estimates; and  2.  comparability between estimates by reanalyzing data as estimation  methodologies change, so that consistent methods are applied over  time.
section_title: Recommendation to the Secretaries of the Department of Education and the Department of Housing and Urban Development
paragraphs: To help ensure that agencies have information on program access, we  recommend that the Secretaries of Education and HUD study the  feasibility of calculating participation or coverage rates and including  them in key program management reports.
section_title: Recommendations to the Secretary of the Department of Health and Human Services
paragraphs: We recommend that the Secretary of HHS consider making some  improvements to the participation and coverage rate information  produced for the CCDF, Medicaid, SCHIP, and TANF programs, such as:  1.  quantifying errors that result from calculating these estimates to help  users better understand the accuracy of the data; and  2.  ensuring, to the extent possible, that estimates are comparable over  time.
We also recommend that the Secretary include participation and coverage  rate estimates in key program reports for these four programs.
We also recommend that the Secretary study the feasibility of estimating  the coverage rate for the Head Start program on a regular basis and to  include these estimates in key Head Start program reports.
section_title: Recommendation to the Commissioner of the Internal Revenue Service
paragraphs: As the IRS moves forward on developing participation rate estimates to  use as a program performance measure for the Earned Income Tax Credit,  we recommend that the Commissioner of the Internal Revenue Service  take steps to quantify errors that may result from estimating these  participation rates to help users better understand the accuracy of the data  and ensure that estimates will be comparable over time.
section_title: Recommendation to the Commissioner of the Social Security Administration
paragraphs: To help ensure that the agency has information on program access, we  recommend that the Commissioner consider the feasibility of providing  participation rate information (from the existing source or another source)  in SSA program management reports.
section_title: Agency Comments
paragraphs: We provided drafts of this report to and received comments from the  Departments of Agriculture, Education, Health and Human Services, and  Housing and Urban Development; the Internal Revenue Service; and the  Social Security Administration.  They generally agreed with our  conclusions and recommendations.  Agency written comments appear in  appendixes IV through VII.
On February 3, 2005, we met with FNS officials to discuss their comments.  The officials said they agreed with our conclusions and recommendations.  They stated that they recognize the importance of tracking both program  access and program integrity and their ongoing efforts to estimate  participation rates in the food stamp program reflect their commitment to  balancing the goals of access and integrity. They stated that as they move  forward in developing a participation rate estimate for the WIC program,  they plan to take steps to clarify to users the limitations of the estimates  and to ensure that the estimates will be comparable over time. Agency  officials also provided technical comments, which we incorporated in the  report where appropriate.
The Department of Education agreed that data sources now available  would not provide sufficient information to develop a reliable  participation rate estimate for the Pell Grant program. However, the  department cited a study currently being conducted by the National  Center for Education Statistics that will determine the feasibility of  implementing a system of collecting data on all postsecondary students.  This study will also provide information that could be used to examine the  feasibility of estimating participation rates for the Pell Grant program.
The Department of Health and Human Services provided comments  related to each of the five programs under its jurisdiction. The department  noted that it has taken steps to measure program access in the TANF,  CCDF, Medicaid, and SCHIP programs through their funding of TRIM3,  although they do not always report these estimates in key program  reports. With regard to CCDF, HHS recognized the importance of coupling  efforts to control improper payments with efforts to provide effective  service delivery, and therefore access. The department noted that it has  recently established a performance measure related to coverage rates for  the CCDF program. We incorporated this information into the report. HHS  also thought that we overstated the differences between CCDF and TANF  in the impact of state flexibility on coverage rates so we changed that  section of the report. With regard to TANF, HHS raised the concern that  increasing coverage rates may conflict with other TANF program goals  and consequently, coverage rates are not an appropriate performance  measure for the TANF program. We recognize that increasing the coverage  rate is not an explicit goal of TANF and believe this concern is consistent  with the report’s conclusion that increasing program access may not be  feasible or desirable for some programs.  Nevertheless, we continue to  believe that including program participation and coverage rates in key  program reports can help inform policymakers and program  administrators at all levels of government and assist them making  budgetary and programmatic decisions. In its discussion of SCHIP and  Medicaid, HHS indicated that the report reinforced the agency’s approach  to promoting both access and integrity.  The department noted that CMS is  working to improve its coverage rate estimates for SCHIP and meanwhile,  it continues to measure progress toward increasing coverage among  children under 200 percent of poverty, a proxy for the program coverage  rate.
HHS also highlighted several other issues that we believe are already  sufficiently discussed in the report. These include the fact that not all  those eligible and not participating need program services; that some  programs allow states considerable flexibility in implementing programs  and determining eligibility; that participation or coverage rates can be  challenging to estimate accurately; and that uncertainties and limitations  surrounding participation and coverage rate estimates should be made  clear to users of this information.  HHS also reiterated some of the  limitations of our cost estimates and our Head Start coverage rate  estimates.  Agency officials also provided technical comments, which we  incorporated in the report where appropriate.
Department of Housing and Urban Development officials provided us with  technical comments, which we incorporated in the report where  appropriate.
The Internal Revenue Service agreed with our conclusions and  recommendation. The IRS recognizes the interactions between efforts to  improve program access and those intended to improve program integrity,  and as part of their efforts to utilize a balanced approach that emphasizes  both goals, the IRS has recently established the EITC participation rate as  a GPRA measure. As it moves forward in developing the EITC  participation rate, the IRS plans to take steps to quantify errors that may  result from estimating these participation rates to help users better  understand the accuracy of the data and ensure that estimates will be  comparable over time. Agency officials also provided technical comments,  which we incorporated in the report where appropriate.
The Social Security Administration agreed with our conclusions and  recommendation. The agency noted that it has considered the feasibility of  estimating participation rates in the past and has calculated participation  rates among the elderly. However, the agency also noted that limitations of  the national survey data make such estimates challenging for the SSI  program. The agency agreed that estimating participation rates on a  regular basis could provide an important management tool.
As agreed with your office, unless you publicly announce its contents  earlier, we plan no further distribution of this report until 30 days after its  issue date. At that time we will send copies of this report to the Secretaries  of the Departments of Agriculture, Education, Health and Human Services,  and Housing and Urban Development; the Commissioners of the Internal  Revenue Service and the Social Security Administration; relevant  congressional committees; and others who are interested. Copies will be  made available to others upon request, and this report will also be  available on GAO’s Web site at http://www.gao.gov.
If you or your staff have any questions about this report, please contact me  on (415) 904-2272. Additional GAO contacts and acknowledgments are  listed in appendix VIII.
section_title: Appendix I: Objectives, Scope, and Methodology
paragraphs: We designed our study to provide information on (1) the proportion of  those eligible who are participating in 12 selected low-income programs;  (2) the factors that influence participation in those programs; and   (3) strategies used by federal, state, and local administrators to improve  both access and integrity, and whether agencies monitor access by  measuring participation rates. To obtain information on these issues, we  compiled estimates of participation and coverage rates for each of the  programs covered by the review for the most recent year for which data  were available, we reviewed literature on participation in programs for  low-income people, and we gathered information directly from both  federal program officials and state and local administrators. To determine  the completeness and accuracy of data obtained from various sources, we  took several steps, described below, to assess the data and determined  that the data were sufficiently reliable for use in this report.
We performed this work between November 2003 and January 2005 in  accordance with generally accepted government auditing standards.
subsections: section_title: Participation and Coverage Rates
paragraphs: To obtain information on the proportion of those eligible who are  participating in 12 selected low-income programs, we used information  developed by the Urban Institute under contract with HHS about the  participation and coverage rates they estimated for 7 programs—CCDF,  Medicaid, TANF, food stamps, SCHIP, SSI, and WIC. Also, we estimated  the coverage rates for the Head Start program using administrative data  and CPS data and for the Housing Choice Voucher and Public Housing  programs using data from a HUD report on worst case housing needs in  1999. The participation rate estimate for the EITC program was from our  previous work. In addition, we performed a literature review to obtain  information about program participation and coverage rates that were  estimated by other organizations. When possible, we obtained rates from  1997 to the most recent year available, but as mentioned in the report, we  did not present many estimates of rates prior to the most recent year  available because changes in methodologies did not allow us to determine  whether changes in the rates over time were actual changes in  participation rates or resulted from changes to the estimation  methodology. We were unable to provide a Pell Grant program  participation rate because we were unable to assess the reliability of  available data on the family income of students who did not apply for  federal financial assistance, which is necessary for determining program  eligibility. Table 11 summarizes the methodologies used to calculate  participation and coverage rates for the 12 programs covered in this  review.
The Urban Institute estimated participation and coverage rates for CCDF,  Medicaid, TANF, food stamps, SCHIP, SSI, and WIC under a contract with  the Department of Health and Human Services (HHS). In order to evaluate  the reliability of these data and to determine whether it met our standards  for reporting quantitative information, we contracted with the Urban  Institute to obtain additional information about these estimates and the  methodologies used to calculate them, including the Transfer Income  Model, version 3 (TRIM3).
The TRIM3 microsimulation model was used to determine the number of  people who would be eligible for a program if they applied. This model  simulates the process that a caseworker would undergo to determine  eligibility by reviewing individual or household characteristics such as  household composition, income, disability, and other factors as  appropriate for the programs. TRIM3 primarily relies on the Census  Bureau’s Annual Social and Economic Supplement to the Current  Population Survey to estimate the eligible population. For some programs,  this data source does not include all information needed to determine a  person’s or household’s eligibility. For example, the data do not include  information on the value of certain assets that might be considered during  eligibility determination for some programs. In these instances, the Urban  Institute researchers used TRIM3 to assign eligibility-related  characteristics to individuals included in the CPS who they believed were  likely to have them, a process referred to as imputation. The estimates of  the eligible population were used as the denominators of the participation  and coverage rates, and administrative data on the number of participants  were generally used as the numerator. In general, groups excluded from  the TRIM3 eligibility estimate used for the denominator (such as those  who are institutionalized) were also excluded from the administrative data  used for the numerator.
The CPS data limitations and the process of assigning characteristics may  have resulted in errors in the estimates of the eligible population and,  therefore, the participation and coverage rates for seven programs. These  include sampling error, non-sampling error, error related to the imputation  process, and error related to program implementation. GAO statisticians  and social science analysts reviewed the Urban Institute’s TRIM3 technical  documentation, interviewed the Urban Institute researchers, requested  additional TRIM3 calculations from the Urban Institute, and reviewed  available academic and government literature on the sources of error in  microsimulation models of low-income program participation to  determine what errors existed. Although there are several types of  potential errors, not all the errors could be quantified.
The CPS, like all sample surveys, is subject to sampling error. This  error reflects the difference between (1) the results that are obtained  from the members of the sample that are actually surveyed and (2) the  results that would be obtained if each member of the population were  surveyed. We contracted with the Urban Institute to calculate the  sampling error of CPS data used in TRIM3, and we verified that they  used the appropriate procedures to make these calculations. We used  the estimates of sampling error provided by the Urban Institute to  calculate a range for the most recent TRIM3 estimates at the   95 percent confidence level, and these ranges are presented in the  report. However, the ranges underestimate the total error in   TRIM3 estimates.
The CPS data used in TRIM3 are also subject to non-sampling error that  has not been quantified. These errors can occur if survey respondents  have difficulty interpreting a particular question, lack information  necessary to answer a question, are uncomfortable with accurately  reporting certain sensitive information, or do not answer certain  questions, among other factors that affect data collection and  measurement. Such non-sampling errors are likely to have affected  variables that are used by TRIM3, such as labor force participation for  example. According to a 2002 Census Bureau report, the 1996 CPS  covers a smaller proportion of the Black population (84 percent) than it  does of the White population (94 percent). The Census Bureau reported  that this low coverage rate biases labor force estimates, because those  who are left out of the sampling frame are quite different from those  who are included in it. Yet, the full extent of non-sampling error in the  CPS is unknown.
The process of assigning characteristics when CPS data are not  available—the imputation process—also can produce error. In most  instances, efforts were not made to quantify the error associated with  these imputed data. However, a National Research Council (NRC)  panel attempted to quantify such error when reviewing methods for  estimating participation rates for WIC and found that estimates can  vary noticeably depending on whether imputed or reported monthly  income data are used to determine eligibility. During this review, the  NRC panel compared TRIM-adjusted CPS data, in which monthly  income is imputed on the basis of annual income, and Survey of  Income and Program Participation (SIPP) data, in which monthly  income is collected directly from survey respondents.
Specification error can result when the variables in a microsimulation  model incorrectly represent the process for determining program  eligibility that actually occurs between caseworkers and applicants.  For example, in its TANF module, TRIM3 does not consider certain  aspects of program eligibility, including specific work requirements,  behavioral requirements such as school attendance and immunizations,  and sanctions from failing to comply with work rules or child support  rules. These exclusions could cause TRIM3 to overestimate eligibility  and therefore underestimate participation and coverage rates.   Similarly, while several means-tested programs base their eligibility on  the federal poverty guidelines, there is no universal administrative  definition of “family,” or “household” that is valid for all programs that  use the poverty guidelines.  To the extent that federal programs use  administrative definitions that differ somewhat from the statistical  definitions used by the CPS, estimates of the eligible population could  be affected.
subsections: section_title: Participation and Coverage Rates We Estimated
paragraphs: We estimated the participation and coverage rates for the Head Start,  Housing Choice Vouchers, Public Housing, and EITC (in prior work).  These estimates are also limited by the data sources and assumptions of  who may be eligible for these programs. The EITC and Head Start rates  were estimated using the CPS and, therefore, estimates are subject to  sampling and non-sampling errors mentioned earlier. In addition, because  the CPS did not have complete information to determine who may be  eligible for the EITC, we made assumptions about whether children were  in a household long enough for them to be counted as a member for tax  purposes. We also assumed that the lack of data on certain assets would  not significantly affect participation rate estimates. For Head Start, the  administrative data did not allow us to determine the number of children  who are actually served in the program. The data were only on the number  of program slots funded, and more than one child can be served with each  slot over the course of a program year if there is turnover in participation.  However, for the purposes of calculating Head Start coverage rates, we  assumed that only one child filled a slot.
We used a HUD report on the households with worst case housing needs  in 1999 and administrative data to estimate the Housing Choice Vouchers  and Public Housing coverage rates. HUD used data from the American  Housing Survey in this report. We assessed the reliability of the survey  data and determined that the data were sufficiently reliable for use in this  report. In conducting this assessment, we reviewed Bureau of the Census  studies on the survey. Census reported that the American Housing Survey  underestimates income and overestimates poverty for households,  variables used to determine the number of people with housing needs. We  were unable to quantify the error this may have produced in the estimates.
section_title: Reliability of Administrative Data
paragraphs: We determined that the administrative data used to estimate participation  and coverage rates were reasonably reliable for this purpose. As a part of  this assessment, we reviewed the data on the number of participants and  we discussed this information with federal agency officials. However, with  the exception of the EITC data, we did not adjust the number of  participants to account for those who may have received program benefits  and/or services in error. As a result, the administrative data could have  produced errors in the estimates due to potential inaccuracies in reporting  the number of eligible participants.
section_title: Cost Estimates
paragraphs: To obtain the estimated cost of providing benefits to those eligible and not  participating in the Food Stamp Program, SSI, TANF cash assistance and  WIC, we contracted with the Urban Institute to provide us with these  estimates. The organization used the TRIM3 model to estimate the total  benefit amount for eligible non-participants, and these estimates were  based on the amount that each individual or household would receive  based on their characteristics. These estimates have similar limitations as  their related participation and coverage rates, and not all of their errors  could be quantified.
The EITC cost estimate was based on our prior work, but the Head Start  cost estimates were done during the course of this project. We estimated  the potential costs for Head Start using administrative data on the average  cost per slot and the number of eligible non-participating children we  estimated using the CPS. We assume that only one child would be served  with a slot, even though in actuality more one than can. We also did not  account for variation in program cost at the local level, and we did not  account for variation in local eligibility criteria.
All of the estimates have two major limitations. We did not include the  administrative costs of serving the non-participants; this would increase  the cost estimates for all programs. For some programs, federal, state, and  local governments would share these administrative costs. We also did not  factor in policy or economic changes that may occur if participation  increased in these programs. In addition, for all programs, we calculated  the estimates for each program individually and we did not account for  how changes in the participation for one program could influence benefit  amounts in another.
We were unable to estimate the cost of serving eligible, non-participants in  the five other programs—CCDF, HCV, Medicaid, Pell Grants, Public  Housing, and SCHIP—because we did not have enough information to  determine how the characteristics of the non-participants would have  affected the benefit amounts they could have received.
section_title: Factors That Affect Participation and Strategies to Improve Access and Integrity
paragraphs: To obtain information about factors that affect participation and strategies  to improve access and integrity for the 12 selected programs, we  conducted a literature review, obtained documentation from federal  officials, interviewed federal officials and interviewed state and local  officials in California, Connecticut, Georgia, Maryland, and Minnesota. The  literature review consisted of studies on factors that affect participation  and program integrity issues that we found through searches of the  Internet and social science research databases and recommendations from  federal agency officials. Among the documentation we reviewed for this  objective were the available fiscal year 2004 and 2005 annual plans for  each program and agency reports to Congress to determine whether the  relevant agencies had stated measures for program integrity and access  outcomes. We selected states to visit primarily based on their innovative  practices to address barriers to participation for multiple programs we  reviewed. We obtained information on innovative practices from federal  officials, federal agency publications and a database on state and local  initiatives complied by the Administration for Children and Families and  several non-profit, non-partisan agencies. We also considered state efforts  to ensure program integrity, program aspects that may create barriers to  access and demographic and geographic diversity in making our selection.  We were not able to address all the programs we reviewed during every  site visit, and information from these site visits cannot be generalized to all  states and localities and to all programs we reviewed. In addition, we did  not assess the effectiveness of the strategies we presented.
section_title: Appendix II: Limitations Affecting Use of Participation and Coverage Rates
paragraphs: While participation and coverage rate estimates provide important  program information that can be useful to both policymakers and program  administrators, these estimates must be interpreted carefully to take into  consideration such factors as survey data, research methodology,  timeliness of estimates and the availability of alternative programs. These  factors limit our ability to compare rates across programs and must be  considered in efforts to define appropriate or desired participation or  coverage rate levels.
subsections: section_title: Limitations of National Survey Data
paragraphs: There are two national household level surveys conducted by the Census  Bureau that can be used to estimate the total number of people eligible for  low-income programs, the Annual Social and Economic Supplement to the  Current Population Survey (CPS) and the Survey of Income and Program  Participation (SIPP) and each has advantages and disadvantages. The CPS  is the larger of the two surveys and data from this survey are available  annually for the prior year. In addition, it has detailed information about  income, household composition, labor force participation, and receipt of  many federal benefits, but it does not include all the information that may  be needed to determine program eligibility. For example:    Although the value of assets such as automobiles and savings accounts  are considered when determining financial eligibility for some of  programs we reviewed, the CPS does not collect some of these data.
The CPS also omits institutionalized individuals, some of whom may be  eligible for Medicaid and SSI.
Researchers at the Urban Institute and Mathematica told us that, while  they were aware of these disadvantages, they continue to use CPS data in  their calculations because of the relatively large sample size and because  the CPS is conducted annually, which makes it a good source for yearly  snapshots of participation. To compensate for the limitations in the data,  researchers either make assumptions and assign information needed to  determine eligibility, such as asset values, to individuals in order to  determine their program eligibility or they omit certain subpopulations  such as institutionalized individuals or pregnant and postpartum women  from their participation rate estimates.
The SIPP is a smaller survey than the CPS, but because it was designed  specifically to better measure low-income program participation, it has  some advantages over the CPS. Specifically, it includes more detailed  information about individual characteristics, monthly labor force activity,  monthly income, and household assets that factor in program eligibility  determinations. However, the SIPP is designed as a panel study (following  the same individuals for 2½ to 4 years) and thus may be more suited for  use in examining detailed characteristics of participants and reasons for  movement into and out of social programs. In addition, the sample faces  attrition over the survey period, and some data needed to determine  eligibility are available only for a limited number of years. The National  Research Council used the SIPP to estimate WIC participation rates. This  estimate included pregnant women in addition to infants and children, but  by 2003 when this estimate was published, the most recent estimate they  could create using SIPP was for 1998.
There are some low-income programs for which neither the CPS nor the  SIPP provide sufficient information to estimate participation rates. For  example, to estimate the proportion of enrolled students eligible for a Pell  Grant would require information on student enrollment status in addition  to family income information. The National Center for Education Statistics  within the Department of Education conducts a survey, the National  Postsecondary Student Aid Study, that includes both student enrollment  and family income information. However, concerns have been raised  about the reliability of the family income data for students who did not  apply for federal financial assistance. We were unable to assess the  reliability of this data element and thus were unable to determine whether  the data were sufficiently reliable for our purposes. As a result, we did not  estimate a participation rate for this program.
section_title: Errors from Research Methodology
paragraphs: Because no existing national data provide every piece of information  needed to determine the exact size of the eligible population for low- income programs, all participation rate estimates involve certain  assumptions and generalizations. These assumptions can create errors  that are difficult or impossible to quantify. Consequently, the margins of  error we present, which only capture errors that result from sampling,  could understate the true range within which participation rate estimates  are most likely to fall.
One way to better understand how these estimates are affected by the  research methodology is to compare them to alternative participation rate  estimates that have been calculated using different assumptions. While the  Urban Institute and Mathematica Policy Research, Inc., both estimate food  stamp participation rates based on CPS data, they use slightly different  assumptions to estimate the eligible population. For example, because the  CPS does not include information on which household members purchase  and prepare food together, model estimates had to make assumptions  about household food preparation habits. Despite differences in  assumptions, the participation rates estimated by the Urban Institute and  Mathematica were very similar.
section_title: Years for Which Estimates Are Available
paragraphs: The most recent participation rate data available varies by program, and  all estimates are at least 3 years old. As a result, changes in legislation,  state policy, program administration, the national economy, and other  factors that may have influenced the participation rate over the past few  years are not reflected in these estimates.
The EITC participation rate estimate is based, in part, on an estimated  32 percent of EITC claims being made in error in 1999. Since that time,  Congress has enacted new tax laws and the IRS has taken steps to  improve compliance.
The total number of people receiving food stamps and Medicaid fell  after passage of the Personal Responsibility and Work Opportunity  Reconciliation Act of 1996 when participation in these programs was  “de-linked” from participation in TANF. Since 2000, however, states  have implemented policies to ensure that those eligible for food stamps  and Medicaid continue to receive benefits when they leave TANF.
Since 2000, the national economy has emerged from a recession, but  economic growth, until recently, has been slow and uneven and  marked by slow job growth. Economic conditions have historically  been correlated with low-income program participation.
None of these factors are reflected in the numbers we presented in this  report.
section_title: Availability of Alternative Programs
paragraphs: When interpreting the participation and coverage rate estimates we  provided, it is important to keep in mind that those eligible but not  participating in the programs we reviewed may not be living without  assistance; many could be receiving assistance from alternative programs.  In some cases, people could be eligible for more than one program we  reviewed and able to receive similar services from these programs. Those  eligible could also have access to state and local programs that address  similar needs. This is particularly relevant for the non-entitlement  programs covered by our review.
The coverage rates we provide for the two housing programs in this  review are calculated in isolation, and as a result, some of the households  that appear eligible but not participating in the Public Housing program  are receiving Housing Choice Vouchers (HCV), and vice versa. In addition,  while HCV and public housing are two of the largest federal housing  programs, there are several other federal, state, and local housing  programs from which eligible households could receive assistance. HUD  estimated that in 1999 about a quarter of all households eligible for any  kind of housing assistance received assistance.
The availability of alternative programs could also affect coverage rates  for CCDF and Head Start. For example, state-financed pre-school  programs provide child care and educational development services for  many 4-year-olds who appear eligible but are not enrolled in Head Start.  Children could be eligible for both programs but only receiving services in  one, but this would not be reflected in program coverage rate estimates.  HHS officials have recognized that other federal programs, such as TANF  and Social Services Block Grant (SSBG), also provide child care to  children eligible for CCDF. Because the CCDF participation rate does not  reflect these additional sources of federal child care funds, HHS has  produced a different coverage rate, estimating that about 26 percent of  CCDF-eligible children were receiving child care services through one of  four federal funding streams—CCDF, SSBG, TANF, and TANF state funds  in 2001.
section_title: Cost Considerations
paragraphs: State and localities are able to set the eligibility criteria for some of these  programs, and the cost estimates do not account for the policy changes  agencies may make if the current criteria resulted in increased  participation. For example, if states found that current eligibility limits  may result in increased TANF participation, they may change eligibility  criteria or benefit levels to ensure state costs do not increase. Either of  these changes may reduce the total additional costs.
All cost estimates were calculated individually and, therefore, do not  account for how participation changes in one program may influence  benefit amounts in another. For example, Food Stamp Program costs may  not be as high if participation in the SSI program increased because some  eligible non-participants would qualify for lower food stamp benefits due  to the cash assistance. Also, as mentioned earlier, other federal, state, and  local programs may provide similar benefits that non-participants could be  receiving, and, therefore, they may not need or want the benefits from the  programs we covered. For example, food stamp eligible non-participants  with short-term nutritional needs may decide to receive assistance through  food banks. In addition, the TANF estimate we provide is only the cost of  providing cash assistance to eligible people who are not participating; this  program offers other supports to needy families, such as transportation to  work and child care, that is funded by the federal and state government.
section_title: Appendix III: Agency Estimates of Improper Payments for Programs Reviewed
section_title: Appendix IV: Comments from the Department of Education
section_title: Appendix V: Comments from the Department of Health and Human Services
section_title: Appendix VI: Comments from the Department of the Treasury
section_title: Appendix VII: Comments from the Social Security Administration
section_title: Appendix VIII: GAO Contacts and Staff Acknowledgments
subsections: section_title: GAO Contacts
section_title: Staff Acknowledgments
paragraphs: Carolyn Blocker, Cheri Harrington, Danielle Giese, Amanda Mackison, and  Kim Siegal also made significant contributions to this report. Jay Smale,  Mark Braza, Doug Sloane, Ed Nannenhorn, and Beverly Ross provided  technical assistance in developing and evaluating the reliability of  participation rate and potential program cost estimates; Lise Levie  provided key technical assistance; and Johnnie Barnes, Carrie Watkins,  and Charles Wilson provided information on the two housing programs  covered in the report.
section_title: Related GAO Products
paragraphs: Food Stamp Program: Farm Bill Options Ease Administrative Burden,  but Opportunities Exist to Streamline Participant Reporting Rules  among Programs. GAO-04-916. Washington, D.C.: September 16, 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.
SSA Disability Decision Making: Additional Steps Needed to Ensure  Accuracy and Fairness of Decisions at the Hearing Level. GAO-04-14.  Washington, D.C.: November 12, 2003.
Federal Student Aid: Expanding Eligibility for Less Than Halftime  Students Could Increase Program Costs, but Benefits Uncertain.   GAO-03-905. Washington, D.C.: September 10, 2003.
Social Security Disability: Reviews of Beneficiaries’ Disability Status  Require Continued Attention to Improve Service Delivery. GAO-03-1027T.  Washington, D.C.: July 24, 2003.
Welfare Reform: States Provide TANF-Funded Work Support Services to  Many Low-Income Families Who Do Not Receive Cash Assistance.  GAO-02-615T. Washington, D.C.: April 10, 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.
Medicaid and SCHIP: States’ Enrollment and Payment Policies Can  Affect Children’s Access to Care. GAO-01-883. Washington, D.C.:  September 10, 2001.
Food Stamp Program: Program Integrity and Participation Challenges.  GAO-01-881T. Washington, D.C.: June 27, 2001.
Medicaid and SCHIP: Comparisons of Outreach, Enrollment Practices,  and Benefits. HEHS-00-86. Washington, D.C.: April 14, 2000.
Medicaid Enrollment: Amid Declines, State Efforts to Ensure Coverage  after Welfare Reform Vary. HEHS-99-163. Washington, D.C.: September 10,  1999.
Food Stamp Program: Various Factors Have Led to Declining  Participation. RCED-99-185. Washington, D.C.: July 2, 1999.
Medicaid: Demographics of Nonenrolled Children Suggest State Outreach  Strategies. HEHS-98-93. Washington, D.C.: March 20, 1998.