Recent economic, medical, technological, and social changes have increased opportunities for individuals with disabilities to live with greater independence and more fully participate in the workforce. For example, over the past several decades, the economy has shifted towards service- and knowledge-based jobs that may allow greater participation for some persons with physical limitations. Also, advances in medicine and assistive technologies—such as improved treatments for mental illnesses and advanced wheelchair design—afford greater opportunities for some people with disabilities. In addition, social and legal changes have promoted the goal of greater inclusion of people with disabilities in the mainstream of society, including adults at work. For example, the Americans with Disabilities Act supports the full participation of people with disabilities in society and fosters the expectation that people with disabilities can work and have the right to work. More recently, the President announced the New Freedom Initiative, a set of guiding principles and initiatives aimed at improving the integration of people with disabilities in all aspects of society, including employment. Public concern and congressional action have produced a broad array of federal programs designed to help people with disabilities. However, our prior reviews of the largest federal disability programs indicate that such programs have not evolved in line with these larger societal changes and therefore, are poorly positioned to provide meaningful and timely support for people with disabilities. Furthermore, program enrollment and costs for the largest federal disability programs have been growing and are poised to grow even more rapidly in the future, further contributing to the federal government’s large and growing long-term structural deficit. For example, from 1982 to 2002, the number of disabled workers receiving benefits under SSA’s Disability Insurance (DI) program doubled from 2.6 million to 5.5 million, while payments quadrupled from about $14.8 billion to $60 billion. Moreover, these disability programs are poised to grow even more as baby boomers reach their disability-prone years. This program growth is exacerbated by the low rate of return to work for individuals with disabilities receiving cash and medical benefits. In addition, the projected slowdown in the growth of the nation’s labor force has made it more imperative that those who can work are supported in their efforts to do so. We identified over 20 federal agencies and almost 200 federal programs that are either wholly or partially targeted to serving people with disabilities. These programs provide a wide range of assistance such as employment-related services, medical care, and monetary support. Multiple agencies run programs that provide similar types of assistance, but these programs often serve different populations of people with disabilities because of varying eligibility criteria. About 59 percent of the programs we identified provide indirect support to people with disabilities through means such as grants to states, while the rest provide support directly to people with disabilities. In fiscal year 2003, over $120 billion in federal funds were spent on programs that serve only people with disabilities. Although there were insufficient data available to estimate the total additional funds spent on people with disabilities by programs that also serve people without disabilities, benefit payments for people with disabilities for two such programs alone—Medicare and Medicaid— amounted to about $132 billion in fiscal year 2002. Twenty-one federal agencies—under the jurisdiction of more than 10 Congressional committees—administer 192 programs that target or give priority to people with disabilities (see table 1). However, four agencies— the departments of Health and Human Services (HHS), Education, Veterans Affairs, and Labor—are responsible for over 65 percent of these programs. About half of the programs that we identified are wholly targeted (targeted exclusively) to people with disabilities. The rest of the programs are partially targeted to people with disabilities—they serve people with and without disabilities. Specifically, of the 192 programs we identified, 95 reported being wholly targeted, and 97 reported being partially targeted. The wholly targeted programs reported that they served over 34 million beneficiaries or clients in fiscal year 2003, with the largest among these—SSA’s DI program and VA’s Veterans Compensation for Service-Connected Disability program—serving about 10 million of these beneficiaries. Although some of the partially targeted programs we surveyed could not provide data on the number of people with disabilities they serve, our survey data indicate that these programs served at least 15 million beneficiaries or clients with disabilities in fiscal year 2003, with the largest of these programs—SSA’s Supplemental Security Income Program—serving about 5.7 million of these beneficiaries. Federal programs provide a wide range of assistance to people with disabilities (see fig. 1). The most common primary types of assistance provided are employment-related services and medical care, although a number of programs provide civil protections or legal services, education, and monetary support as well as other benefits or services (see fig. 2). Most of the federal programs provide more than one type of assistance and over one-quarter of the programs provide three or more types of assistance to people with disabilities (see fig. 3). For example, the Developmental Disabilities Basic Support and Advocacy Grants program run by HHS provides multiple types of assistance to people with disabilities including housing, education, transportation, and information dissemination services. About 59 percent of the programs we identified provide support indirectly through other entities such as state agencies or private organizations, while the rest provide it directly to people with disabilities. For example, the Department of Education’s Preschool Grants program provides special education to preschool children with disabilities via funding to state education agencies, whereas the Department of Labor’s Coal Mine Workers’ Compensation program provides monetary support directly to eligible coal mine workers with disabilities. Of the programs that provide assistance indirectly to people with disabilities, the most common means is through nonfederal government entities (e.g., state or local agencies). Multiple federal agencies administer programs that provide similar types of assistance to people with disabilities (see table 2). For example, seven agencies—including the Social Security Administration, the Committee for the Purchase from People who are Blind or Severely Disabled, the Office of Personnel Management, and the departments of Agriculture, Education, Labor, and Veterans Affairs—administer 28 programs that primarily provide employment-related services to people with disabilities. Although programs from multiple agencies provide the same primary type of assistance, these programs often have varying eligibility criteria that may limit the populations served to distinct groups of people with disabilities. For example, the American Indian Vocational Rehabilitation Services program run by the Department of Education and the Department of Veterans Affairs’ Vocational Rehabilitation for Disabled Veterans program each provide employment-related assistance, but to distinct groups of people. Furthermore, the 28 programs that primarily provide employment-related services often have distinct eligibility criteria beyond the specific populations served. The programs that provide assistance only to people with disabilities spent over $120 billion in fiscal year 2003. SSA and VA accounted for about 88 percent of this amount (see fig. 4). In particular, SSA’s DI program accounted for about 64 percent of the total spending for wholly targeted programs, and the VA’s Veterans Compensation for Service-Connected Disability program accounted for approximately 17 percent of this total. Approximately 86 percent of the wholly targeted program spending was for programs that primarily provided monetary support to people with disabilities (see fig. 5). In addition to the billions of dollars spent on programs that serve only people with disabilities, additional amounts are spent on individuals with disabilities by partially targeted programs whose beneficiaries also include people without disabilities. While we were not provided with sufficient data to determine the total amount spent by all of these partially targeted programs on benefits or services for individuals with disabilities, these costs are certainly significant given that they include such programs as Supplemental Security Income (SSI), Medicaid, and Medicare. In 2002, SSI paid about $26 billion in cash benefits to people with disabilities and Medicaid and Medicare together paid about $132 billion in benefits for such individuals. Both our past work and our recent survey of federal programs supporting people with disabilities indicate that these programs face a number of challenges. Among these are challenges in ensuring timely and consistent processing of applications for assistance, ensuring timely provision of services and benefits, interpreting complex eligibility requirements, planning for growth in the demand for program benefits and services, making beneficiaries or clients aware of program services or benefits, and communicating or coordinating with other federal programs. Our past work examining disability programs administered by SSA and VA highlighted the challenges that federal programs face in ensuring timely and consistent processing of applications for assistance. Both SSA and VA have experienced lengthy processing times for disability claims over the past several years, with claimants waiting, on average, more than 4 months for an initial decision and for more than 1 year for a decision on appeal of a denied claim. In addition, we have also pointed out that inconsistencies in these agencies’ disability claim decisions across adjudicative levels and locations have raised questions about the fairness, integrity, and cost of these programs. Our survey provides further evidence of such challenges facing programs that provide monetary support. Almost half of these programs reported that ensuring timely processing of applications was a major or moderate challenge, and more than one-quarter of monetary support programs reported that consistent processing of applications was a major or moderate challenge. Our past work also identified the challenges encountered by federal programs in ensuring timely provision of services and benefits. For example, we noted that structural weaknesses in SSA’s DI and SSI programs have prevented the agency from offering return-to-work services when it may help most—soon after a person becomes disabled. Our survey indicates that some other federal programs also face the challenge of providing services in a timely fashion. For example, 38 percent of the programs that provide employment-related assistance to people with disabilities reported that ensuring timely provision of services and benefits was a challenge. Officials from the Department of Education, for instance, told us that of the 80 Vocational Rehabilitation (VR) agencies they are responsible for overseeing, about half of these agencies operate under a special procedure for prioritizing services because the demand for VR services outweighs the available resources. Our past work indicated that SSA and VA’s eligibility requirements are complex and difficult to interpret. For example, we have reported that the high costs of administering SSA’s DI program reflects the complex and demanding nature of making disability decisions. Our survey provides further evidence of such challenges for federal disability programs. For example, 53 percent of programs providing monetary support to people with disabilities reported that interpreting complex eligibility requirements was a challenge. Our past work noted that federal disability programs are facing challenges in planning for the anticipated increase in demand for their benefits and services. For example, by the year 2010, SSA expects the number of Social Security DI beneficiaries to increase by more than one-third over 2001 levels. However, our past work found that most of the state Disability Determination Services agencies responsible for processing DI claims face significant challenges in ensuring there are enough trained staff to handle DI as well as SSI claims. Similarly, in our prior work we reported that despite VA’s recent progress in reducing its disability claims workload, it will be difficult for the agency to cope with future workload increases due to several factors, including increased demand for services as a result of military conflicts and legislative mandates. Our survey of federal disability programs indicates that planning for growth in the demand for benefits or services is also a challenge for other programs that support people with disabilities. For example, 54 percent of the programs that provide medical care and almost half of the programs that provide employment-related assistance reported that planning for growth in the demand for assistance was a challenge. Our discussions with responsible agency officials reinforced the challenges posed by potential growth in demand for program services or benefits. For example, officials from the Department of Labor’s one-stop center program told us they are not sure if the program has sufficient resources to meet any increased demand for services that might result from the outreach they are conducting to people with disabilities. Our past work highlighted challenges in making beneficiaries aware of services offered under federal disability programs. For example, we reported that SSA’s work incentives are ineffective in motivating people to work, in part, because many beneficiaries are unaware that the work incentives even exist. Our survey indicated that 69 percent of programs that disseminate information to people with disabilities reported that making beneficiaries or clients aware of their programs’ services was a challenge. The need to make people more aware of disability program services has also been noted by other entities. For example, in 1999, the Presidential Task Force on Employment of Adults with Disabilities suggested that the White House take more action to make people aware of programs that support people with disabilities. Both our work and the work of others suggests some weaknesses in communication and coordination among various federal disability programs. In a 1996 report, we noted that programs helping people with disabilities do not work together as efficiently as they could to share information about their programs and to overcome obstacles posed by differing eligibility criteria and numerous service providers. We said that the lack of coordination among programs could result in duplication or gaps in services provided to people with disabilities. Others have also identified the need for greater coordination among federal disability programs. For example, in announcing the New Freedom Initiative—a federal effort to remove barriers and promote community integration for people with disabilities—the President identified policy areas, such as the provision of assistive technology, where better federal coordination was needed. Also, in a review of programs for low-income adults with disabilities, Urban Institute researchers described the safety net supporting such individuals as “a tangled web of conflicting goals and gaps in needed services.” In addition, officials at the National Council on Disability told us that although various interagency commissions exist to address issues faced by people with disabilities, most of these commissions have weak authority or have never met as a group. Our survey provides further evidence of the coordination and communication challenges facing federal programs serving individuals with disabilities. About one-third of these programs indicated that, in their efforts to support people with disabilities, they experienced challenges in obtaining information from or coordinating with other federal or nonfederal programs. Over the past several years, GAO, in reporting that the largest federal disability programs were mired in outdated concepts of disability, has identified the need to reexamine and transform these programs to better position the government to meet the challenges and expectations of the 21st century. In identifying the wide range of federal programs serving individuals with disabilities and some of the major challenges these programs face, this report raises several questions about whether other federal disability programs may also need to be reoriented and transformed. In particular, are the nearly two hundred programs that provide assistance to people with disabilities well-suited to address these challenges, and are they structured in a manner that collectively allows them to provide coherent and seamless support to people with disabilities? Also, in light of the nation’s large and growing structural deficit, do these programs represent the most cost-effective approaches to serving individuals with disabilities? On the basis of more than a decade of research focusing on the nation’s largest disability programs and our review of prior GAO reports examining efforts to reform federal programs and transform agencies, we have identified several key factors that are important to consider in assessing the need for, and nature of, program transformations. In particular, our prior work identifying shortcomings in the work incentives and supports provided by the largest federal disability programs indicates that these basic program design issues need to be addressed. Second, given the tight fiscal constraints facing both federal and state governments, programs will need to carefully consider the sustainability of current costs and the potential costs associated with transformation initiatives. Finally, programs will need to evaluate the feasibility of any transformation efforts, considering whether appropriate processes and systems— including those related to the planning and management of human capital and information technology—are in place to effectively carry out current operations or proposed changes. Figure 6 presents a list of questions that may serve as a guide for addressing these factors. In addition to addressing these questions, which will provide a basic framework for individually assessing existing programs and proposals for transforming them, it is also important that some mechanism be established for looking across programs to assess their overall effectiveness and integration and whether they are designed to achieve similar or complimentary goals. The diffusion of responsibility for federal programs serving people with disabilities across multiple agencies and the absence of any clear central authority for guiding a fundamental reassessment of federal disability policy will likely pose significant impediments to such action. However, a reexamination could serve to identify programs and policies that are outdated or ineffective while improving the targeting and efficiency of remaining programs through such actions as redesigning allocation and cost-sharing provisions and consolidating facilities and programs. Our recently issued report concerning “21st Century Challenges” identifies approaches—such as the use of special temporary commissions to develop policy proposals and the exercise of congressional oversight through hearings on the activities of federal agencies—that may be used for such a reexamination should the Congress choose to pursue this course of action. Addressing the individual program transformation questions we identify above in conjunction with a reexamination of how these programs work collectively represent key steps in efforts to meet 21st century social and economic expectations of individuals with disabilities and the general public. Copies of this report are being sent to: the Secretaries of Agriculture, Commerce, Defense, Education, Energy, Health and Human Services, Housing and Urban Development, Interior, Justice, Labor, Transportation, Treasury, and Veterans Affairs; the Commissioner of SSA; the Director of the Office of Personnel Management; the Administrator of the Small Business Administration; the Chairman of the Railroad Retirement Board; the Chairperson of the Committee for Purchase from People who are Blind or Severely Disabled; the Chair of the Access Board; the Chair of the Equal Employment Opportunity Commission; the Librarian of Congress; appropriate congressional committees; and other interested parties. The report is also available at no charge on GAO’s 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 RobertsonR@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 III. For our review, we defined a federal program as a function of a federal agency that provides assistance or benefits to a state or states, territorial possession, county, city, other political subdivision, or grouping or instrumentality thereof; or to any domestic profit or nonprofit corporation, institution, or individual, other than an agency of the federal government. We defined the scope of our review to include those federal programs meeting one of more of the following criteria: (1) people with disabilities are specifically mentioned in a program’s authorizing legislation as a targeted group, (2) people are eligible for the program wholly because of a disability, (3) people are eligible for the program partially because of a disability, (4) people with disabilities are given special consideration in eligibility determinations, or (5) people with disabilities are given priority in being served. Programs that serve individuals without respect to disability (i.e., disability is not an explicit criteria for program eligibility) but that serve some individuals with disabilities (such as Temporary Assistance for Needy Families) are beyond the scope of our review. In addition, we excluded programs whose principal focus is research, demonstrations, training for professionals who work with people with disabilities, technical assistance, or special transportation, as well as disability retirement programs for federal workers. To develop a list of programs that met these criteria, we first conducted a systematic search in the Catalog of Federal Domestic Assistance (CFDA) to identify programs that have some role in serving people with disabilities and the respective agencies responsible for administering each of these programs. In addition, we reviewed federal agency Web sites to identify additional programs that were not included in the CFDA. We then submitted the list of programs administered by each agency to that agency for verification. (The final list of programs along with some descriptive information on each program can be found in app. II.) In developing our list, we included federal programs regardless of how the benefit, service, or assistance is ultimately delivered to the individual (e.g., directly by the federal agency or indirectly by another entity, such as a state agency). To obtain information on federal programs supporting people with disabilities and the challenges they face, we conducted a Web-based survey, which collected basic information on each program, including the types of assistance provided, whether the assistance is provided directly to beneficiaries or indirectly through other entities, whether the program is partially or wholly targeted to people with disabilities, the number of beneficiaries served, program spending, and the challenges faced by these programs (i.e., obstacles that hindered a program’s ability to effectively and efficiently support people with disabilities). (A more complete tabulation of the survey results related to program challenges is available on the GAO Web site at www.gao.gov/cgi-bin/getrpt?GAO-05-695SP.) To identify the appropriate program officials to respond to the survey, we submitted the list of programs that we compiled to liaisons at each agency. These liaisons then identified the appropriate respondents at their respective agencies. We pretested the content and format of our survey with officials from eight programs to determine if it was understandable and if the information was feasible to collect, and we refined the survey as appropriate. We then sent e-mail notifications to the identified officials of 299 programs beginning on June 15, 2004, asking them to complete the survey by June 28, 2004. To encourage respondents to complete the survey, we sent e-mail messages to prompt each nonrespondent 1 and 2 weeks after the initial e-mail message. We closed the survey on August 16, 2004. We obtained survey responses from 258 programs, for an overall response rate of 86 percent. In addition, for 11 of the 41 programs that did not submit survey responses, we obtained descriptive information from the CFDA to answer a limited number of survey questions to the extent that such information was available. Based on responses to survey questions asking programs to identify the criteria they apply in serving people with disabilities and the primary type of assistance they provide, we identified 192 programs (comprising 64 percent of all programs surveyed) that met our criteria for defining programs as either wholly or partially targeted towards serving individuals with disabilities. Although our survey asked programs to provide spending data, because of limitations or inconsistencies in the spending information reported by survey respondents, we obtained spending data from the Consolidated Federal Funds Report (CFFR)—a database compiled by the Bureau of the Census—for all of the relevant programs listed in this database. For programs that did not have data reported in the CFFR, we used spending information from the survey data. In a few cases where spending data was not available from either the CFFR or survey data, we obtained this information from the CFDA. To verify the spending data that we present in this report, we sent each program an e-mail message asking them to confirm the amounts we had identified. While many programs confirmed the spending amounts that we listed in our message, others identified different amounts. The spending data we present in this report are based on the final verified spending amounts identified by programs in their response to our e-mail. These data are not entirely consistent across programs. For example, while most of these data represent spending for fiscal year 2003, some programs instead provided data for other fiscal years. Also, some programs included administrative costs in their spending figures while others did not include such costs. In addition, while the majority of the spending data we report represent program obligations, some of the data instead represent outlays. Of the 95 wholly targeted programs in our analysis, we were able to obtain some type of spending data for 85 programs. However, many partially targeted programs were unable to provide us with data pertaining to their programs’ spending on people with disabilities because they do not separately track or collect such data for these individuals. As a result, we do not present spending data in this report for partially targeted programs except for three programs (Supplemental Security Income, Medicare, and Medicaid) for which we were able to obtain a breakdown of spending on people with disabilities from agency documents. Because we relied extensively on program spending data derived from the 2003 CFFR data that are available on-line from the CFFR Web site (http://www.census.gov/govs/www/cffr.html), we conducted limited tests of the reliability of these data, including frequency analyses of critical data fields. We restricted our reliability assessment to the specific variables that were pertinent to our analysis. These tests indicated that the critical data fields were sufficiently complete and accurate for the purposes of our analysis. To obtain additional information on the challenges faced by programs, we conducted interviews with federal agency officials and officials from disability advocacy organizations, and reviewed pertinent agency documents, GAO reports, and academic research on disability issues. To identify questions that should be addressed in transforming federal disability programs, we reviewed the major findings and recommendations that have resulted from the substantial body of GAO research on federal disability programs over the past decade. We also examined past GAO reports on program reform and organizational transformation throughout the federal government. Because our questionnaire was not a sample survey, there are no sampling errors. However, the practical difficulties of conducting any survey may introduce errors, commonly referred to as nonsampling errors. For example, difficulties in how a particular question is interpreted, in the sources of information that are available to respondents, or in how the data are entered into a database or were analyzed, can introduce unwanted variability into the survey results. We took steps in the development of the questionnaire, the data collection, and the data analysis to minimize these nonsampling errors. For example, social science survey specialists designed the questionnaire in collaboration with GAO staff with subject matter expertise. Then, as mentioned earlier, the draft questionnaire was pretested with program officials to ensure that the questions were relevant, clearly stated, and easy to comprehend. When the data were analyzed, a second, independent analyst checked all computer programs. Since this was a Web-based survey, respondents entered their answers directly into the electronic questionnaire. This eliminated the need to have the data keyed into a database, thus removing an additional source of error. We performed our work at various locations in Washington, D.C. We conducted our work between March 2004 and March 2005 in accordance with generally accepted government auditing standards. The following table presents an overview of the 192 federal programs that we identified as targeted to people with disabilities. The information presented in this table is based mostly on the programs’ survey responses, although it also presents data obtained from other sources. In particular, the spending information is derived from multiple sources, including programs’ survey responses and federal government reports on program spending. The spending data we present below represent either obligations, expenditures, or appropriations, as indicated by the table notes accompanying each reported amount. Due to the various sources that we used to identify program spending and possible inconsistencies in these data (e.g., differences in the fiscal years for which spending was reported by programs), we advise caution in efforts to compare or sum spending figures across programs. Also, given the significant limitations in the spending data available for partially targeted programs, we do not present such data in this table. (See app. 1 for a more detailed discussion of our methodology for collecting spending data and other information on these programs.) Spending (for fiscal year 2003 unless otherwise indicated) Committee for Purchase From People Who Are Blind or Severely Disabled Javits-Wagner-O Day Program (Committee for Purchase From People Who Are Blind or Severely Disabled) Assistive & Ergonomic Technology (Target Center, USDA, Washington, D.C.) Assistive and Ergonomic Technology (Midwest Target Center, St. Louis, Missouri) Spending (for fiscal year 2003 unless otherwise indicated) Spending (for fiscal year 2003 unless otherwise indicated) Spending (for fiscal year 2003 unless otherwise indicated) Disabilities Prevention (Disability and Health) Family Support Payments to States Assistance Payments (Adult Programs in the Territories) Spending (for fiscal year 2003 unless otherwise indicated) Maternal and Child Health Services Block Grant to the States (Title V) Other: Infrastructure and coordination Other: Multifaceted support systems Other: Outreach and case management. Special Programs for the Aging Title III, Part C Nutrition Services Special Projects of National Significance (Ryan White CARE Act) Spending (for fiscal year 2003 unless otherwise indicated) Housing Opportunities for Persons with AIDS Lower Income Housing Assistance Program Section 8 Moderate Rehabilitation Mortgage Insurance Rental Housing for the Elderly Non-Discrimination in Federally Assisted and Conducted Programs (on the Basis of Disability) Spending (for fiscal year 2003 unless otherwise indicated) Spending (for fiscal year 2003 unless otherwise indicated) Assistance for Indian Children with Severe Disabilities Capital and Training Assistance Program for Over-the-Road Bus Accessibility Capital Assistance Program for Elderly Persons and Persons with Disabilities FTA general activities and technical assistance related to disability issues Tax Deduction to remove barriers for the Elderly and Disabled Other: Tax Automobiles and Adaptive Equipment for Certain Disabled Veterans and Members of the Armed Forces Compensation for Service-Connected Deaths for Veterans’ Dependents Montgomery GI Bill Educational Assistance (Chapter 30) Spending (for fiscal year 2003 unless otherwise indicated) Pension to Veterans Surviving Spouses, and Children Post-Vietnam Era Veterans’ Educational Assistance Specially Adapted Housing for Disabled Veterans Survivors and Dependents Educational Assistance Veterans Compensation for Service-Connected Disability Veterans Dependency and Indemnity Compensation for Service-Connected Death; Compensation for Service Veterans Housing—Guaranteed and Insured Loans Vocational and Educational Counseling for Separating Service Members (Chapter 36) Vocational Rehabilitation for Disabled Veterans Vocational Training and Rehabilitation for Vietnam Veterans’ Children with Spina Bifida or Other Covered Birth Defects Employment Discrimination Section 501 of the Rehabilitation Act (federal employees) Spending (for fiscal year 2003 unless otherwise indicated) Other: Library service. The following individuals made important contributions to this report: Shelia D. Drake, Erin M. Godtland, Joel A. Green, Mark de la Rosa, David J. Forgosh, Mark Trapani, Stuart M. Kaufman, and Daniel A. Schwimer.

Summary: In 2003, GAO designated modernizing federal disability programs as a high-risk area requiring urgent attention and organizational transformation to ensure that programs function as efficiently and effectively as possible. GAO found that although social attitudes have changed and medical advancements afford greater opportunities for people with disabilities to work, the Social Security Administration and the Department of Veterans Affairs have maintained an outmoded approach that equated disability with inability to work. We have prepared this report under the Comptroller General's authority as part of a continued effort to help policymakers better understand the extent of support provided by federal programs to people with disabilities and to assist them in determining how these programs could be better aligned to more effectively meet the needs of individuals with disabilities in the 21st century. This report identifies (1) the wide array of federal programs that serve people with disabilities, and (2) the major challenges these federal programs face in the 21st century. In addition, GAO presents factors policy makers and program administrators should address in assessing whether, and how, they could be transformed to better meet 21st century challenges. More than 20 federal agencies and almost 200 programs provide a wide range of assistance to people with disabilities, including employment-related services, medical care, and monetary support. About half of these programs serve only people with disabilities while the rest serve people both with and without disabilities. In fiscal year 2003, more than $120 billion in federal funds was spent on programs that only serve people with disabilities, with over 80 percent of these funds spent on monetary support. In addition, considerable funds are spent on people with disabilities by programs that also serve people without disabilities, like Medicare and Medicaid. The program challenges cited most frequently in our recent survey of nearly 200 programs serving people with disabilities are largely consistent with several of the key findings from past reports that led GAO to place federal programs supporting people with disabilities on its high-risk list. Both our recent survey and our past work have identified challenges in (1) ensuring timely and consistent processing of applications; (2) ensuring timely provision of services and benefits; (3) interpreting complex eligibility requirements;( 4) planning for growth in the demand for benefits and services; (5) making beneficiaries or clients aware of benefits and services; and (6) communicating or coordinating with other federal disability programs. In light of the vital role federal programs play in providing assistance to people with disabilities and in helping to ensure an adequate national labor force, we have identified a number of factors that are important to consider in assessing the need for, and nature of, program transformations including (1) program design issues; (2) fiscal implications of proposed program changes; and (3) feasibility of implementing program changes.