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

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