Transportation-disadvantaged populations, including those that cannot provide their own transportation due to age, disability, or income constraints, may face challenges in accessing transportation, such as lack of access to public transportation or a private vehicle. For example, according to a 2011 report by the National Council on Disability, people with disabilities are more likely than people without disabilities to report that they have inadequate transportation (34 percent versus 16 percent, respectively). We have previously reported that people in need of transportation often benefit from greater and higher quality services when transportation providers coordinate their operations. In addition, we have reported that coordination has the potential to reduce federal transportation program costs by clustering passengers; using fewer one- way trips; and sharing the use of personnel, equipment, and facilities. Federal agencies, including USDA, Education, HHS, HUD, Interior, DOL, DOT, and VA, play an important role in helping transportation- disadvantaged populations access federal programs by providing funds to state and local grantees. Federal programs that provide funding for transportation cover a variety of services, including education, job training, employment, nutrition, health, medical care, or other human services. As we have previously reported, many federally funded programs purchase transportation services from existing private or public providers. This includes contracting for services with private transportation providers or providing transit passes, taxi vouchers, or mileage reimbursement to program participants, or some combination of these methods. Some programs may use federal funds to purchase and operate their own vehicles. DOT and HHS formed the Coordinating Council on Human Services Transportation (Coordinating Council) in 1986 to improve the efficiency and effectiveness of human service transportation by coordinating related programs at the federal level and promoting the maximum feasible coordination at the state and local levels. In 2003, we reported that coordination efforts at the federal, state, and local levels varied greatly, and while some coordination efforts showed promising results, obstacles continued to impede coordination. As a result, we recommended that, among other things, the Coordinating Council be expanded to include additional federal agencies. The Coordinating Council was expanded to 11 federal agencies in 2004 by Executive Order 13330 and renamed the Interagency Transportation Coordinating Council on Access and Mobility. The expanded Coordinating Council was charged with, among other things, promoting interagency cooperation and establishing appropriate mechanisms to minimize duplication and overlap of federal programs and services so that transportation-disadvantaged persons have access to improved transportation services. More recently, in 2011, we reported that reducing or eliminating duplication, overlap, and fragmentation among government programs and activities could save tax dollars and help agencies to provide more efficient and effective services. With regard to transportation services for the transportation disadvantaged, we found that, while some federal agencies were developing guidance and technical assistance for transportation coordination, federal departments still had more work to do in identifying and assessing their transportation programs, working with other departments to identify opportunities for additional coordination, and developing and disseminating policies and grantee guidance for coordinating transportation services. As we have previously reported, many federal efforts transcend more than one agency, yet agencies face a range of challenges and barriers when they attempt to work collaboratively. Both Congress and the executive branch have recognized this, and in January 2011, the GPRA Modernization Act of 2010 was enacted, updating the almost two-decades-old Government Performance and Results Act (GPRA). This act establishes a new framework aimed at taking a more crosscutting and integrated approach to focusing on results and improving government performance. As we reported in February 2012, effective implementation of this act could play an important role in clarifying desired outcomes; addressing program performance spanning multiple organizations; and facilitating future actions to reduce unnecessary duplication, overlap, and fragmentation. In recent years, Congress has supported increased transportation coordination, as reflected in the Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users (SAFETEA-LU). Enacted in 2005, SAFETEA-LU amended several human services transportation coordination provisions sharpening the focus on transportation services for persons with disabilities, older adults, and individuals with lower incomes. Currently, the law requires the establishment of a locally developed, coordinated, public transit-human services transportation plan for all of DOT’s human service transportation programs administered by the Federal Transit Administration (FTA). Further, it requires the plan to be developed by a process that includes representatives of public, private, and nonprofit transportation and human services communities, including the public. Federal law also has promoted coordinated funding for non-DOT programs to be used as matching funds for specific transportation programs. More recently, FTA’s fiscal year 2013 budget request proposed consolidating some existing programs to give communities more flexibility in designing and coordinating FTA-sponsored human service programs. We identified 80 federal programs that fund a variety of transportation services for transportation-disadvantaged populations (see fig. 1). Thirty- one of these programs are administered by HHS. The Departments of Education and HUD each administer 12 programs; DOT administers 7 programs; and DOL, VA, Interior, and USDA administer 18 programs combined. Out of the 80 federal programs identified, 4 programs focus expressly on supporting transportation services for transportation- disadvantaged populations, including DOT’s Capital Assistance Program for Elderly Persons and Persons with Disabilities, Job Access and Reverse Commute Program, Capital and Training Assistance Program for Over-the-Road Bus Accessibility, and the New Freedom Program. A full list of programs is in appendix II. Transportation is not the primary mission for the vast majority of the programs we identified. Except for the 7 DOT programs, where all funds are used to support public transportation, the remaining 73 programs we identified primarily provide a variety of human services, such as job training, employment, education, medical care, or other services, which incorporate transportation as an eligible program expense to ensure participants can access a service. In addition, the types of transportation services provided to the transportation-disadvantaged population through these federal programs vary, and may include capital investments (e.g., purchasing vehicles), reimbursement of transportation costs (e.g., transit fares, gas, bus passes), or direct provision of transportation service to program clients (e.g., operating vehicles). Examples of transportation services authorized for funding include the following: HHS’s Medicaid program reimburses states that provide Medicaid beneficiaries with bus passes to access eligible medical services, among other transportation options. DOL’s Workforce Investment Act-funded programs can provide funding for transportation services so that recipients can access employment and participate in required work activities. Types of transportation services include bus passes and cab fare. DOT’s Job Access and Reverse Commute Program allows for grantee agencies to purchase vehicles such as vans to improve access to transportation for employment-related services. VA’s Beneficiary Travel Program, as part of Veterans Medical Care Benefits, can provide mileage reimbursement to low-income or disabled veterans for travel to receive medical services at their VA hospital. Total spending on transportation services for the transportation disadvantaged remains unknown because, in many cases, federal departments do not separately track spending for these services. Of the 80 programs we identified, roughly two-thirds of the programs were unable to provide spending information for eligible transportation services. However, total expenditures and obligations for the 28 programs that do track or estimate transportation spending were at least $11.8 billion in fiscal year 2010 (see table 1). DOT’s 7 programs accounted for about $9.5 billion of this total amount. Of the non-DOT programs, HHS’s Medicaid program and VA’s Veterans Medical Care Benefits program each reported spending over $700 million in fiscal year 2010. Most of the programs we identified do not separately track transportation spending. According to federal officials, transportation spending may not be tracked for several reasons, including the following: Some programs allow for transportation spending as an optional service, but it is not required so they do not ask grantees to provide spending information. For example, HHS’s Head Start program, which provides comprehensive child development services to low-income children and their families, reported that many of its grantees may provide transportation, but the agency does not collect specific data on transportation spending. Some federal programs give states and localities broad flexibility to administer program funds, and the program structure may not lend itself to tracking transportation expenses. For example, Education provides grants to states under the Individuals with Disabilities Education Act (IDEA) for special education and related services to children with disabilities. State education agencies allocate most of these grant funds to local education agencies, usually school systems, to provide these services.on the amount of funds expended by local education agencies for specific services, including transportation services. Education does not collect data Some agencies may consider transportation services to be an administrative expense, and may include transportation spending with other eligible administrative expenses. As a result, transportation- specific spending is not fully known. For example, HHS’s Medicaid program has two allowable methods for states to report the costs of transportation services to the program—as expenditures for nonemergency medical transportation benefits or as an administrative expense, which is combined with other nontransportation expenses.As a result, HHS does not fully capture the total transportation costs provided under its Medicaid program. Resources necessary to track this information in some federal departments may outweigh the potential benefits, according to HUD officials who told us that for some HUD programs, requiring grantees to report transportation expenses would require a new reporting effort and that the resulting information may not be analyzed due to resource constraints. The interagency Coordinating Council, chaired by DOT, has been charged with leading governmentwide transportation coordination efforts since 2003. The Coordinating Council launched the “United We Ride” initiative in fall 2003, designed to establish an interagency forum for communication and help states and communities overcome obstacles to coordination. The Coordinating Council undertook a number of activities through its United We Ride initiative, largely between 2003 and 2007. Coordinating Council actions included issuing publications such as policy statements and progress reports on efforts taken, providing funding through FTA to help states and localities promote coordinated services and planning, and supporting technical assistance efforts (see table 2). For example, the Coordinating Council’s 2005 Report to the President outlined the council’s action plan for implementing the 2004 executive order, reported on the council’s accomplishments, and made specific recommendations to improve human services transportation coordination. The Coordinating Council is structured in several levels, including the Secretary-level members, an Executive Council consisting of senior-level appointees from each member agency, and interagency working groups (seven in fiscal year 2011) that cut across issue areas at the programmatic level. The Coordinating Council is staffed by officials from FTA. The Secretary-level members of the Coordinating Council last met in 2008.Council efforts have taken place at the working group level. However, according to DOT officials, more recent Coordinating identifies agency roles and responsibilities, measurable outcomes, or required follow-up. According to agency officials, the Coordinating Council is drafting a strategic plan, but officials were unable to provide an estimate for when the plan might be finalized. As previously discussed, the executive order contained reporting and recommendation requirements, resulting in the 2005 Report to the President and the 2007 Progress Report. However, since those reports, no other guidance document has been created, or is required, to report on actions taken or to plan additional actions. We have previously reported that defining and articulating a common outcome, agreeing on agency roles and responsibilities, and reinforcing agency accountability through agency plans and reports are important elements for agencies to enhance and sustain collaborative efforts. Further, we have reported that federal agencies engaged in collaborative efforts need to create the means to monitor, evaluate, and report on their efforts to enable them to identify areas for improvement. There are several practices involved in strategic planning that could be useful to help the Council determine and communicate its long-term goals and objectives. However, without a plan to help reinforce agency goals and responsibilities, the Coordinating Council may be hampered in articulating a strategy to help strengthen interagency collaboration and lack the elements needed to remain a viable interagency effort. Cost-sharing policy: A joint cost-sharing policy has not been endorsed by all Coordinating Council members, even though development of a cost allocation policy was one of the recommendations of the Coordinating Council in its 2005 Report to the President. According to the 2005 report, a major obstacle to sharing transportation resources has been the difficulty of reaching agreements at the local level about the appropriate allocation of costs to each agency. Federal, state, and local agency officials that we spoke with noted that this continues to be a significant impediment. Further, as part of a discussion hosted by the National Academy of Public Administration in 2009, which brought together key stakeholders to discuss ways to improve access to reliable transportation for the transportation disadvantaged, explicit and clear guidance for cost sharing was said to be needed in order to address significant federal policy barriers to coordination. Coordinated transportation planning: Coordinating Council members pledged to take actions to accomplish federal program grantee participation in locally developed, coordinated planning processes as part of their 2006 Coordinated Human Service Transportation Planning Policy Statement, but it is unclear if the Coordinating Council’s members have consistently followed through on their 2006 pledge. According to the Coordinating Council’s 2006 policy statement, federal grantees’ participation in their local human services transportation planning process is necessary to reduce duplication of services, increase service efficiency, and expand access for transportation-disadvantaged populations. However, the discussion hosted by the National Academy of Public Administration in 2009 indicated that the process for creating coordinated transportation plans continues to need improvement and recommended that Coordinating Council members with grant programs create incentives for their grantees to participate in coordinated planning at the state and local levels. According to participants, while the Coordinating Council has issued a joint policy on coordinated planning, challenges remain to fully engage agencies that are not funded by DOT in the planning process at the local levels. DOT’s FTA is the only agency that has adopted a coordinated human services transportation planning requirement, which has resulted in broadened participation in the transportation planning processes. Coordination of services is also challenging due to differences in federal program requirements and perceived regulatory or statutory barriers, according to officials. For example, coordinated planning is generally only a requirement for FTA-funded human service transportation programs, and while a handful of programs may encourage coordination, other federal program rules are unclear about coordination of transportation services between programs. Also, programs may have perceived or actual statutory or regulatory barriers related to sharing costs, or have differences in service requirements and eligibility. For example, HHS’s Medicaid program is the largest source of federal funds for nonemergency medical transportation for qualified low-income beneficiaries; however, the Centers for Medicare & Medicaid Services (CMS) officials expressed concern about coordinating transportation services due to concerns about commingling federal program funds and the potential for fraud. CMS has issued rules that allow states to contract with one or more transportation brokers to manage their Medicaid transportation to, among other things, reduce costs. However, these rules could result in fragmented transportation services at the state and local levels because some brokers transport only Medicaid-eligible beneficiaries, and may not coordinate their transportation services with other programs. In another example, VA officials explained that VA only has the authority to provide transportation at the agency’s expense to certain qualifying veterans and nonveterans in relation to VA health care, but has no legal authority to transport nonbeneficiaries. State and local officials in the five states we selected used a variety of coordinated planning and service efforts to serve the transportation disadvantaged. One way that states facilitate coordination efforts is through statewide coordinating bodies—some created by legislative actions and others by executive order or initiative—to oversee the implementation of coordinated transportation for transportation- disadvantaged populations in their states. State coordinating bodies can help to facilitate collaboration between federal, state, and local agencies by providing a venue for agencies to discuss and resolve transportation issues to better coordinate transportation activities related to the provision of human services and enhance services for transportation- disadvantaged populations. Three of the five states we selected had state coordinating bodies in 2010. In addition to state coordinating councils, efforts include regional and local planning, one-call centers, mobility managers, and vehicle sharing (see table 3). Several state and local agency officials said that federal requirements for the establishment of locally developed, coordinated public transit-human services transportation plans for FTA’s human service transportation programs have had a positive impact on transportation coordination in their state. According to officials, these planning efforts help to bring relevant stakeholders to the table to discuss needs for the transportation disadvantaged and to resolve problems. For example, in Virginia, the Department of Rail and Public Transportation has taken the lead in implementing this requirement, assisting 21 planning district commissions to formulate human services transportation coordination plans for their districts, and formulating a statewide plan which draws from these local plans. According to officials of a regional planning commission in Virginia, transportation coordination in the state would not be at the same point it is currently without these requirements. These officials said that the federal requirements created one place for people to come together to learn what programs are available, raise awareness, and avoid duplication. Also, a Virginia Regional Transit official told us that the increased communication among agencies due to coordinated planning efforts made it possible for providers to transport more people, including those who were not currently being served, thus opening access to larger and broader groups of people. State and local entities’ efforts to coordinate services for the transportation disadvantaged are not without challenges. According to officials, challenges include insufficient federal leadership, changes to state legislation and policies, and limited financial resources in the face of growing unmet needs. Several state and local officials told us that there is not sufficient federal leadership and guidance on how to coordinate transportation services for the transportation disadvantaged and that varying federal program requirements may hinder coordination of transportation services. State and local officials in four out of the five states we selected said that with the exception of DOT, other federal agencies were not actively encouraging transportation coordination. For example, Texas Department of Transportation officials told us there is a disconnect between human services and transportation agencies and that the general perception is that other human services programs, such as some of those funded by HHS, are exempt from coordination. These officials also said that federal leadership is needed to promote buy-in for transportation coordination among human services agencies and transportation agencies at the state level. Officials in each of the five states that we selected said that the federal government could provide state and local entities with improved guidance on transportation coordination—especially as it relates to instructions on how to share costs across programs (i.e., determining what portion of a trip should be paid by whom). State and local officials in Virginia, Texas, and Washington identified a fear of losing federal funding if they improperly shared funding with other federal programs. These officials said that federal cost-sharing guidance would help facilitate transportation coordination between programs. Further, state Medicaid officials said that their main priority is to make sure they are following Medicaid requirements, and some officials expressed concerns about their ability to ensure Medicaid funds are being appropriately spent and properly accounted for if they coordinated with other programs. For example, Medicaid officials in one state said that they would need to obtain approval from CMS before adopting any cost-sharing strategies with other programs to ensure the appropriateness of their state program’s expenditures. When we spoke with CMS officials, they told us that CMS is not opposed to coordinating transportation services; however, the agency does have concerns that coordination would result in Medicaid funds being improperly commingled with other federal program funds. Several state and local officials said that varying federal government program requirements may hinder the provision of transportation services and act as barriers to coordination. A regional planning official in Washington told us that varying program requirements may discourage transportation coordination as one program’s requirements may not be suitable for another program’s clients. For example, if two different program clients were to share school vehicles for special needs populations, each program might have a separate set of rules and requirements. Determining whether drivers meet drug and alcohol testing requirements for both programs could be a challenge, according to this official. Similarly, an official from the Florida Department of Transportation told us that the federal government could do more to identify standards and requirements that act as barriers to coordination. In Wisconsin, a Department of Transportation study found that key challenges to coordinating transportation services in the state include program regulations or requirements that impede coordination, including different guidance and restrictions on how federal funding could be spent. Officials we interviewed in four states identified recent changes in state legislation or state policies as potential challenges to coordinating services for the transportation disadvantaged in their states. According to these officials, such changes have caused some uncertainty in their efforts to coordinate human services transportation in the future. For example, some state coordinating bodies’ authority has not been renewed or is about to expire: Executive order not renewed: In Wisconsin, the governor charged a group of individuals from a number of state agencies to form a state coordinating council in 2005—the Interagency Council on Transportation Coordination (ICTC). In addition to sponsoring a statewide coordination conference in 2007, ICTC contracted with a national consultant to develop a Wisconsin Model of Coordination with implementation strategies. Intended outcomes of this model included increasing the quantity and quality of existing transportation resources, supporting and encouraging local coordination efforts, and improving transportation service for users. However, due to a downturn in the economy and a change in the state’s administration after the model’s completion, its findings were not implemented. Because the new administration did not renew the executive order establishing ICTC’s authority, ICTC has been inactive since January 2011. Enabling legislation to expire: In Washington, the state legislature created the Agency Council on Coordinated Transportation (ACCT) in 1998 to coordinate with state and local agencies and organizations to provide affordable and accessible transportation choices for the transportation disadvantaged. Over the years, ACCT has facilitated coordination by helping to form transportation coalitions that include human services representatives, transit services, and community transportation providers. These coalitions plan regional public transportation, evaluate and prioritize project proposals, and implement local coordination strategies. However, enabling legislation for ACCT expires in June 2012 and officials do not expect the legislation to be renewed. In some states, officials were uncertain about how recent developments may affect their state Medicaid program’s participation in state and local efforts to coordinate transportation services for the transportation disadvantaged. For example, in an effort to control program costs, state legislation was signed into law in Florida in June 2011 that moves the responsibility for Medicaid nonemergency medical transportation from the coordinated transportation system run by the Florida Commission for the Transportation Disadvantaged to a private managed care system. An official with the Florida Commission for the Transportation Disadvantaged said that it is not known whether the managed care system will choose to operate within the state’s coordinated transportation system or contract with private transportation brokers outside of the coordinated system, which could result in duplication of transportation services. Similarly, officials in Texas and Wisconsin told us that, in an effort to control costs, their state Medicaid program is moving to a transportation brokerage system. According to some state and local officials, these brokers typically only transport Medicaid-eligible clients and do not often coordinate their transportation services with other federally funded programs. CMS maintains that their brokerage rule does not preclude state Medicaid agencies from coordinating transportation services, as long as they comply with all applicable Medicaid policies and rules and ensure that Medicaid funds are only used for Medicaid services provided to eligible beneficiaries. A number of state and local officials in our five selected states told us that limited financial resources and growing unmet needs were challenges for them. In Texas, state and local officials told us that although it is believed that coordination will save costs in the mid- to long-term, state budgets are being reduced in transit and social services agencies, as well as in municipal programs and nonprofit organizations. According to these officials, some agencies and their potential partners find it difficult to come up with funding, even when it is a modest local match for grants. Similarly, state and local officials in Virginia told us that state and local match requirements may preclude some entities from applying for federal funds. State and local officials also mentioned that limited financial resources often promote turf battles—or a mistrust and unwillingness to share resources for fear of losing control of them. Conversely, some officials told us that limited resources were an incentive to coordinate because coordination made the best use of limited resources. In the face of limited financial resources, state and local officials are also concerned about growing disadvantaged populations and unmet needs— both now and in the future. As part of the discussion hosted by the National Academy of Public Administration in 2009, participants identified continuing transportation gaps in programs across the federal government. Several state and local officials that we spoke with also expressed concern about their ability to adequately address expected growth in elderly, disabled, low-income, and rural populations. A local transit agency official in Virginia, for example, told us that there is a great need for transportation services for the elderly and disabled and that the need is increasing. This agency official questioned whether transportation providers will have adequate funding and resources to meet this growing demand. In a presentation before the state Senate in 2011, Florida’s Commission for the Transportation Disadvantaged reported that, statewide, 3.75 million trips had been denied to passengers in the coordinated transportation system during the past 5 years due to a lack of funding or for other reasons. Nevertheless, the commission expects the state’s transportation-disadvantaged population to undergo steady growth over the next decade. In addition, a number of state and local entities were concerned about populations in rural areas—primarily because public transportation availability was limited in these areas. The Coordinating Council was created to, among other things, promote interagency cooperation and minimize duplication and overlap of federal programs providing transportation services to transportation- disadvantaged populations. While some member agencies, including DOT, have remained active in pursuing these goals, sustained interagency activity through the Coordinating Council has lost momentum in recent years. The 11 Coordinating Council members have not met since 2008 and the Executive Council designees have not met since 2007. According to some federal officials, this lack of leadership at the Coordinating Council poses challenges to federal-, state-, and local-level coordination efforts. Further, the Coordinating Council has been operating without a strategic plan to help determine and communicate its long-term goals and objectives. While Executive Order 13330 spurred Coordinating Council activity beginning in 2004, sustained agency commitment has proved challenging. We have previously reported that articulating a common outcome, agreeing on agency roles and responsibilities, and reinforcing agency accountability through agency plans and reports are important elements for agencies to sustain and improve collaborative efforts. A collaborative interagency strategic planning effort could help to provide the direction and momentum the Coordinating Council needs at this time. Finally, we have previously reported that federal agencies engaged in collaborative efforts need to create the means to monitor, evaluate, and report on their efforts to enable them to identify areas for improvement. It is difficult to fully assess activities of the Coordinating Council, in part, because the council has not reported on its activities or reported on progress implementing its own recommendations since 2007. At that time, the Coordinating Council reported that it was working to establish cost-sharing principles for transportation coordination that federal human service and transportation agencies could endorse; however, we found that the council had not accomplished this goal as of June 2012. Also in 2007, the council reported it had issued a policy statement encouraging federally assisted grantees involved in human services transportation to participate in local coordination planning processes. As part of that policy statement, members of the Coordinating Council agreed to take action to implement the policy within 6 months of council adoption; however, it is unclear what implementation actions agencies have taken to date. Despite recent actions that some agencies have taken to encourage coordination and provide technical assistance, without any means to monitor, evaluate, or report on interagency efforts, the Coordinating Council may face barriers to identifying areas for improvement and pursuing its goal of improving transportation services for transportation- disadvantaged populations. To promote and enhance federal, state, and local coordination activities, we recommend that the Secretary of Transportation, as the chair of the Coordinating Council on Access and Mobility, and the Secretaries of the Departments of Agriculture, Education, Health and Human Services, Housing and Urban Development, Interior, Labor, and Veterans Affairs, as member agencies of the Coordinating Council, should meet and take the following actions: Complete and publish a strategic plan for the Coordinating Council, which should, among other things, clearly outline agency roles and responsibilities and articulate a strategy to help strengthen interagency collaboration and communication. Report on the progress of Coordinating Council recommendations made as part of its 2005 Report to the President on Implementation of Executive Order 13330 and develop a plan to address any outstanding recommendations, including the development of a cost- sharing policy endorsed by the Coordinating Council and the actions taken by member agencies to increase federal program grantee participation in locally developed, coordinated planning processes. We provided USDA, Education, HHS, HUD, Interior, DOL, DOT, and VA with a draft of this report for their review and comment. In commenting on a draft of this report, Education and VA generally agreed with our conclusions and recommendations. Education also provided technical and written comments, which appear in appendix III. HHS, HUD, and DOT neither agreed nor disagreed with the report and provided technical comments. In their technical comments, DOT officials stated that, as chair of the Coordinating Council, they have been working with the council to refocus its efforts away from policy discussions to the coordination of on- the-ground services, such as through the Veterans Transportation and Community Living Initiative Grant Program, which is discussed in this report. USDA, Interior, and DOL did not comment on our report. We incorporated the technical and clarifying comments that we received from the agencies, as appropriate. We are sending copies of this report to interested congressional committees and the Secretaries of Agriculture, Education, Health and Human Services, Housing and Urban Development, Interior, Labor, Transportation, and Veterans Affairs. We also will make copies available to others upon request. In addition, this report will be available at no charge on GAO’s website at http://www.gao.gov. If you or your staff have any questions about this report, please contact David Wise at 202-512-2834 or WiseD@gao.gov. Contact points for our Offices of Congressional Relations and Public Affairs may be found on the last page of this report. GAO staff who made major contributions to this report are listed in appendix IV. To identify federal programs that provide funding for transportation services for the transportation disadvantaged, we examined prior GAO work on the topic, conducted an online search of the Catalog of Federal Domestic Assistance, and requested program information from federal agency officials for the programs identified. We included only federal programs that provide nonemergency, nonmilitary, surface transportation services of any kind, targeted to transportation-disadvantaged populations. We then asked program administrators to review and verify the programs identified and the program information collected, including the general target population, types of transportation services and trips typically provided, and program spending on transportation services in fiscal year 2010. We supplemented and modified the inventory based on this information. In addition, we reviewed the relevant federal laws governing these programs including their popular title or original source of program legislation and U.S. Code or other provision cited as authorizing transportation. To determine what federal coordination efforts have taken place since we last fully reported on this issue in 2003 and what challenges remain, we conducted interviews with program officials from eight federal agencies— the Departments of Agriculture, Education, Health and Human Services, Housing and Urban Development, Interior, Labor, Transportation, and Veterans Affairs—and reviewed relevant documentation provided by agency officials. We chose these agencies because they administered programs that were authorized to provide funding for transportation services for the transportation disadvantaged in fiscal year 2010 and were identified by executive order to participate in coordination. We also interviewed officials from the National Resource Center for Human Service Transportation Coordination and interviewed or corresponded with transportation researchers and representatives from relevant industry and advocacy groups, including the following: American Public Transportation Association Association of Metropolitan Planning Organizations Easter Seals Project ACTION National Conference of State Legislatures To identify the types of coordination that have occurred at the state and local levels, we conducted interviews with state and local officials from five states—Florida, Texas, Virginia, Washington, and Wisconsin. We based our selection of these states on a variety of characteristics, including size of target populations per state, geographic diversity, existence of a state coordinating body, and states deemed notable for their transportation coordination efforts. As part of our state and local interviews, we spoke with officials from state and local human services and transportation agencies, metropolitan planning organizations, transportation providers, interest and advocacy groups, and others and reviewed relevant documentation. Because we used a nongeneralizable sample of states, our findings cannot be used to make inferences about other states. However, we determined that the selection of these states was appropriate for our design and objectives and that the selection would generate valid and reliable evidence to support our work. Table 4 provides more detailed information about the state and local entities we interviewed. We also interviewed the appropriate United We Ride Regional Ambassadors for each state. In addition, we reviewed relevant literature and prior GAO and Congressional Research Service reports, as appropriate. We conducted this performance audit from June 2011 to June 2012 in accordance with generally accepted government auditing standards. Those standards require that we plan and perform the audit to obtain sufficient, appropriate evidence to provide a reasonable basis for our findings and conclusions based on our audit objectives. We believe that the evidence obtained provides a reasonable basis for our findings and conclusions based on our audit objectives. Food Stamp Act of 1977 7 U.S.C. § 2015(d)(4)(I)(i) (I) Routine medical appointments, shopping, entertainment, etc. Individuals with Disabilities Education Act 20 U.S.C. §§ 1411(a)(1) and 1401(26) No actual data or estimate available from the federal agency 29 U.S.C. § 723(a)(8) To access vocational rehabilitation services $81,000,000(estimate) 29 U.S.C. §§ 796f-4(b)(2) and 705(18)(xi) Fiscal year 2010 federal spending on transportation 29 U.S.C. §§ 796e-2(1) and 705(18)(xi) Individuals with Disabilities Education Act 20 U.S.C. §§1419(a) and 1401(26) No actual data or estimate available from the federal agency 29 U.S.C. § 796k(e)(5) Individuals with Disabilities Education Act 20 U.S.C. §§1433 and 1432(4)(E)(xiv) No actual data or estimate available from the federal agency 29 U.S.C. §§ 795g and 705(36) No actual data or estimate available from the federal agency 42 U.S.C. § 11433(d)(5) Fiscal year 2010 federal spending on transportation 29 U.S.C. §§ 741(a) and (b)(1)(B) and 723(a)(8) Elementary and Secondary Education Act of 1965 20 U.S.C. § 7173(a)(10) Elementary and Secondary Education Act of 1965 20 U.S.C. § 7225a(a) Department of Health and Human Services Older Americans Act of 1965 42 U.S.C. § 3030d(a)(2) Adults age 60 and older $73,585,717(expended) Older Americans Act of 1965 42 U.S.C. §§ 3057, 3030d(a)(2) Public transportation, mileage reimbursement, GSA lease, etc. $7,318 (estimate) To access health care services $26,300,000(expended) Indian Health Care Improvement Act: Balanced Budget Act of 1997 42 U.S.C. § 254c-3 Public transportation, mileage reimbursement, etc. To access diabetes prevention and cardiovascular disease services $419,247 (estimate) Persons with substance use or mental disorders $3,800 (estimate) Personal Responsibility and Work Opportunity Reconciliation Act of 1996 42 U.S.C. § 604(a), (k) To access work, employment training, and child care providers $445,118,725 (expended) 8 U.S.C. §§ 1522(b)(7)(D), 1522(c) Fiscal year 2010 federal spending on transportation 8 U.S.C. §§ 1522(b)(7)(D), 1522(c) No actual data or estimate available from the federal agency 8 U.S.C. §§ 1522(b)(7)(D), 1522(c) No actual data or estimate available from the federal agency 8 U.S.C. §§ 1522(b)(7)(D), 1522(c) Fiscal year 2010 federal spending on transportation No actual data or estimate available from the federal agency 42 USCA § 9835(a)(5)(B) No actual data or estimate available from the federal agency 42 U.S.C. § 1397a(a)(2)(A) Access services, or obtain medical care or employment $22,863,512(estimate) No actual data or estimate available from the federal agency 42 U.S.C. § 1397jj(a)(26), (27) (partial) Target population as defined by program officials 42 U.S.C. §§ 1396a, 1396n(e)(1)(A) Fiscal year 2010 federal spending on transportation $786,966,682(partial) Persons with HIV or AIDS $10,750,025(estimate) Ryan White Comprehensive AIDS Resources Emergency Act of 1990 42 U.S.C. §§ 300ff-21, 300ff- 23(a)(2)(B) Persons with HIV or AIDS $5,598,234(estimate) ADAMHA Reorganization Act of 1992 42 U.S.C. § 300x-1(b)(1) No actual data or estimate available from the federal agency 42 U.S.C. § 701(a) Department of Housing and Urban Development 12 U.S.C. 1701g(g)(1) To access supportive services, such as medical treatment, employment, or job training, etc. Accessible taxis, local transportation programs, buses, etc. Housing and Community Development Act of 1974 42 U.S.C. § 5305(a)(8) social services, medical services, jobs, etc. Low- and moderate-income persons, mobility-impaired persons, and jobseekers (expended) Housing and Community Development Act of 1974 42 U.S.C. § 5305(a)(8) social services, medical services, jobs, etc. Low- and moderate-income persons, mobility-impaired persons, and jobseekers $0 (expended) Housing and Community Development Act of 1974 42 U.S.C. § 5305(a)(8) social services, medical services, jobs, etc. Low- and moderate-income persons, mobility-impaired persons, and jobseekers $19,211 (expended) No actual data or estimate available from the federal agency 42 U.S.C. § 12907(a)(3) To access supportive services, such as medical treatment, employment, job training, etc. Low to extremely low- income persons living with HIV/AIDS $1,530,187 (expended) No actual data or estimate available from the federal agency 42 U.S.C. § 1437v(d)(1)(L), (i)(3) Native American Housing Assistance and Self Determination Act of 1996 25 U.S.C. § 4132(3) No actual data or estimate available from the federal agency 42 U.S.C. § 1437v(d)(1)(L), (i)(3) No Child Left Behind Act of 2001 25 U.S.C. § 2001(b)(8)(C)(v) To access school and educational activities $373,368 (estimate) No Child Left Behind Act of 2001 25 U.S.C. § 2001(b)(8)(C)(v) To access school, educational activities, and for use in emergency situations $52,637,635 (obligated) Workforce Investment Act of 1998 29 U.S.C. § 2864(d)(2) At-risk youth, ages 16-24, who meet low- income criteria $24,100,000 (estimate) Older Americans Act of 1965 42 U.S.C. § 3056(c)(6)(A) (iv) Fiscal year 2010 federal spending on transportation 19 U.S.C. § 2296(b) Workforce Investment Act of 1998 29 U.S.C. § 2864(d)(2) Workforce Investment Act of 1998 29 U.S.C. § 2854(a)(4) Workforce Investment Act of 1998 29 U.S.C. § 774 (3)(A), 29 U.S.C. § 2912 (d) Workforce Investment Act of 1998 29 U.S.C. § 2911(d)(2) Workforce Investment Act of 1998 29 U.S.C. §§ 2801(46) Funding for bus and bus facilities, new fixed guideway and modernization, and other capital expenses $3,566,689,946(obligated) General public in urbanized areas $4,849,410,834 (obligated) General public and federally recognized tribes $624,837,418(obligated) Elderly individuals and persons with disabilities $176,237,261 (obligated) Low-income individuals and reverse commuters $163,976,876 (obligated) General public and individuals with disabilities $544,261 (obligated) To enhance transportation systems and access to those systems $90,140,813 (obligated) Mileage reimbursement; special mode (ambulance, wheelchair van); common carrier (air, bus, train, boat, taxi) To access VA or VA- authorized non-VA health care $745,315,000(obligated) Homeless Veterans Comprehensive Service Programs Act of 1992 38 U.S.C. §§ 2011(b)(1)(B), 7721 Note and transportation of homeless veterans by community- based providers (obligated) No actual data or estimate available from the federal agency Spending was reported by program officials, and we did not verify the information. Amounts obligated or expended on transportation are given, depending upon the information available. When actual information was not available, agency officials provided estimates. Figure was amount obligated in fiscal year 2010 for 32 van grants, and grantees have 5 years to spend these funds, according to program officials. In addition to the individual named above, other key contributors to this report were Heather MacLeod, Assistant Director; Rebekah Boone; Brian Chung; Jennifer Clayborne; Jean Cook; Bert Japikse; Delwen Jones; and Sara Ann Moessbauer.

Summary: Millions of Americans are unable to provide their own transportation or have difficulty accessing public transportation. Such transportation-disadvantaged individuals may include those who are elderly, have disabilities, or have low incomes. The Departments of Education, Health and Human Services (HHS), Labor (DOL), Transportation (DOT), Veterans Affairs (VA), and other federal agencies may provide funds to state and local entities to help these individuals access human service programs. As requested, GAO examined (1) federal programs that may fund transportation services for the transportation disadvantaged; (2) federal coordination efforts undertaken since 2003; and (3) coordination at the state and local levels. GAO analyzed information from the Catalog of Federal Domestic Assistance; interviewed federal officials; and interviewed state and local officials in five states, chosen based on a variety of characteristics, including geographic diversity. Eighty federal programs are authorized to fund transportation services for the transportation disadvantaged, but transportation is not the primary mission of most of the programs GAO identified. Of these, the Department of Transportation administers 7 programs that support public transportation. The remaining 73 programs are administered by 7 other federal agencies and provide a variety of human services, such as job training, education, or medical care, which incorporate transportation as an eligible expense in support of program goals. Total federal spending on transportation services for the transportation disadvantaged remains unknown because, in many cases, federal departments do not separately track spending for these services. However, total funding for the 28 programs that do track or estimate transportation spending, including obligations and expenditures, was at least $11.8 billion in fiscal year 2010. The interagency Coordinating Council on Access and Mobility, which the Secretary of Transportation chairs, has led governmentwide transportation coordination efforts since 2003. The Coordinating Council has undertaken a number of activities through its United We Ride initiative aimed at improving coordination at the federal level and providing assistance for state and local coordination. For example, its 2005 Report to the President on Human Service Transportation Coordination outlined collective and individual department actions and recommendations to decrease duplication, enhance efficiencies, and simplify access for consumers. Key challenges to federal interagency coordination efforts include a lack of activity at the leadership level of the Coordinating Council in recent yearsthe Coordinating Council leadership has not met since 2008and the absence of key guidance documents for furthering agency coordination efforts. For example, the Coordinating Council lacks a strategic plan that contains agency roles and responsibilities, measurable outcomes, or required follow-up. GAO has previously reported that defining and articulating a common outcome and reinforcing agency accountability through agency plans and reports are important elements for agencies to enhance and sustain collaborative efforts. State and local officials GAO interviewed use a variety of planning and service coordination efforts to serve the transportation disadvantaged. Efforts include state coordinating councils, regional and local planning, one-call centers, mobility managers, and vehicle sharing. For example, state coordinating councils provide a forum for federal, state, and local agencies to discuss and resolve problems related to the provision of transportation services to the transportation disadvantaged. In other examples, one-call centers can provide clients with transportation program information and referrals for appropriate service providers and mobility managers may serve many functionsas policy coordinators, operations service brokers, and customer travel navigators. However, state and local governments face several challenges in coordinating these servicesincluding insufficient federal leadership, changes to state legislation and policies that may hamper coordination efforts, and limited financial resources in the face of growing disadvantaged populations. To promote and enhance federal, state, and local coordination activities, the Secretary of Transportation and the Coordinating Council should meet to (1) complete and publish a strategic plan; and (2) report on progress of recommendations made by the Council in its 2005 Report to the President and develop a plan to address outstanding recommendations. Education and VA agreed with GAOs recommendations. HHS, DOL, DOT, and other federal agencies neither agreed nor disagreed with the report. Technical comments were incorporated as appropriate.