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.