Federal Disability Assistance: Wide Array of Programs Needs to be
Examined in Light of 21st Century Challenges (02-JUN-05,
GAO-05-626).
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.
-------------------------Indexing Terms-------------------------
REPORTNUM: GAO-05-626
ACCNO: A25641
TITLE: Federal Disability Assistance: Wide Array of Programs
Needs to be Examined in Light of 21st Century Challenges
DATE: 06/02/2005
SUBJECT: Aid for the disabled
Disabilities
Disability benefits
Disability insurance
Eligibility criteria
Federal aid programs
Federal social security programs
Health care programs
Medicaid
Medicare
Persons with disabilities
Program evaluation
Program management
Surveys
SSA Disability Insurance Program
******************************************************************
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GAO-05-626
United States Government Accountability Office
GAO
Report to Congressional Committees
June 2005
FEDERAL DISABILITY ASSISTANCE
Wide Array of Programs Needs to be Examined in Light of 21st Century Challenges
GAO-05-626
[IMG]
June 2005
FEDERAL DISABILITY ASSISTANCE
Wide Array of Programs Needs to be Examined in Light of 21st Century Challenges
What GAO Found
More than 20 federal agencies and almost 200 programs provide a wide range
of assistance to people with disabilities, including employmentrelated
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 (see figure below). In addition, considerable funds are spent on
people with disabilities by programs that also serve people without
disabilities, like Medicare and Medicaid.
Federal Spending for Wholly Targeted Programs by Primary Type of
Assistance, Fiscal Year 2003
1%
Other
2%
Employment-related
2%
Medical care
Education
Monetary support
Source: GAO analysis of survey data.
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.
United States Government Accountability Office
Contents
Letter
Results in Brief
Background
Over 20 Different Agencies Administer Almost 200 Programs That
Provide a Wide Range of Assistance Federal Programs That Support People
with Disabilities Face An Array of Challenges Key Factors to Consider in
Transforming Programs for the 21st Century
1
2 4
5
17
21
Appendix I Scope and Methodology
Appendix II Federal Programs Serving People with Disabilities
Appendix III GAO Contact and Staff Acknowledgments
Tables
Table 1: Federal Agencies That Administer Programs Assisting People with
Disabilities 7 Table 2: Number of Programs Serving People with
Disabilities, by Federal Agency and Primary Type of Assistance 12
Figures
Figure 1: Primary Types of Assistance Provided by Federal Programs to
Individuals with Disabilities, Indicating Percentage of Programs Providing
Such Assistance and Examples of Programs
Figure 2: Number of Federal Programs Providing Various Primary Types of
Assistance to Individuals with Disabilities Figure 3: Percentage of
Federal Programs Providing Multiple Types of Assistance Figure 4: Federal
Spending for Wholly Targeted Programs by Agency, Fiscal Year 2003 Figure
5: Federal Spending for Wholly Targeted Programs by Primary Type of
Assistance, Fiscal Year 2003
8
9 10 15 16
Figure 6: Key Factors and Questions Concerning Transformation of Programs
Serving Individuals with Disabilities 22
Abbreviations
CFDA Catalog of Federal Domestic Assistance
CFFR Consolidated Federal Funds Report
DI Disability Insurance
GAO Government Accountability Office
HHS Department of Health and Human Services
SSA Social Security Administration
VA Department of Veterans Affairs
This is a work of the U.S. government and is not subject to copyright
protection in the United States. It may be reproduced and distributed in
its entirety without further permission from GAO. However, because this
work may contain copyrighted images or other material, permission from the
copyright holder may be necessary if you wish to reproduce this material
separately.
United States Government Accountability Office Washington, DC 20548
June 2, 2005
Congressional Committees
In 2003, GAO designated modernizing federal disability programs as a
high-risk area-one that requires urgent attention and organizational
transformation to ensure that programs function in the most economical,
efficient, and effective manner possible. This designation was based on
more than a decade of research focusing primarily on the nation's largest
disability programs, which are administered by the Social Security
Administration (SSA) and the Department of Veterans Affairs (VA). GAO's
work has found that these programs are neither well aligned with 21st
century realities nor are they well-positioned to provide meaningful and
timely support for Americans with disabilities. For example, despite
opportunities afforded by medical and technological advancements and the
growing expectations that people with disabilities can and want to work,
federal disability programs remain grounded in an approach that equates
medical conditions with the incapacity to work. Given the projected
slowdown in the growth of the nation's labor force, it is imperative that
those who can work are supported in their efforts to do so. Yet federal
disability programs are not well-positioned to provide this support.
Solutions to these problems are likely to require fundamental changes,
including regulatory and legislative action.
In addition to disability programs operated within SSA and VA, there are a
number of other federal programs that provide various levels of support to
individuals with disabilities. We have prepared this report under the
Comptroller General's authority as part of a continued effort to help
policy makers better understand the extent of support provided by federal
programs to people with disabilities and to assist them in determining how
these programs could more effectively meet the needs of individuals with
disabilities in the 21st century. In this report, we (1) identify the many
federal programs that play a role in supporting people with disabilities
and (2) identify some of the major challenges that federal programs face
in supporting people with disabilities in the 21st century. We also
present factors that we believe are important for programs to consider in
assessing whether, and how, they could be transformed to better meet 21st
century challenges. As this report may prove helpful in the deliberations
of committees with oversight responsibilities or jurisdiction over
disability issues, we have addressed this report to each of these
committees.
Results in Brief
To obtain information on federal disability programs and the challenges
they face, we (1) reviewed the Catalog of Federal Domestic Assistance1
(CFDA) and agency Web sites to identify federal programs that provide
assistance to people with disabilities; (2) conducted a Web-based survey
of the programs we identified to obtain descriptive information on these
programs and the challenges they face; (3) interviewed selected agency
officials and officials from disability advocacy organizations to obtain
additional information on the challenges federal programs face; and (4)
reviewed pertinent agency documents, GAO reports, and academic research on
disability issues. We conducted our work between March 2004 and March 2005
in accordance with generally accepted government auditing standards. For
more details about our scope and methodology, see appendix I.
More than 20 federal agencies and almost 200 programs serve people with
disabilities in a multifaceted and complex manner. About half of these
programs serve only people with disabilities, while the rest serve people
both with and without disabilities. Together these programs provide a wide
range of assistance such as employment-related services, medical care,
civil protections or legal services, education, and monetary support.
Multiple agencies administer programs that provide similar types of
assistance, but these programs often serve different populations of people
with disabilities because of varying eligibility criteria. For example,
the Department of Education and the Department of Veterans Affairs have
separate programs that provide vocational rehabilitation services to
American Indians and veterans, respectively. In fiscal year 2003, over
$120 billion in federal funds were spent on programs that only serve
people with disabilities, with over 80 percent of these funds spent on
monetary support.2 Although insufficient data were available to estimate
the total additional funds spent on people with disabilities by programs
that also serve people without disabilities, this amount is significant
given that benefit payments in fiscal year 2002 for people with
disabilities for
1 The Catalog of Federal Domestic Assistance is a database of all federal
programs available to state and local governments (including the District
of Columbia); federallyrecognized Indian tribal governments; territories
(and possessions) of the United States; domestic public, quasi-public, and
private profit and nonprofit organizations and institutions; specialized
groups; and individuals.
2 The $120 billion estimate represents reported obligations for fiscal
year 2003 and includes administrative costs for some programs (i.e., those
that included these costs when reporting total program spending to us).
two such programs alone-Medicare and Medicaid-amounted to about $132
billion.
The 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 our past reports that led GAO to place
federal programs supporting people with disabilities on its high-risk
list. Our past work examining the federal government's disability
programs- particularly those administered by SSA and VA-revealed
challenges these programs face in a variety of areas including 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 and coordinating with other
federal programs serving individuals with disabilities. Our recent survey
of nearly 200 programs serving people with disabilities indicates that
many of these programs face challenges similar to those we have previously
identified. For example, in responding to our survey, 54 percent of the
programs that provide medical care and 46 percent of the programs that
provide employment-related assistance reported that planning for growth in
the demand for assistance was a major or moderate challenge. In addition,
53 percent of the programs that provide monetary support to people with
disabilities reported that interpreting complex eligibility requirements
was a major or moderate challenge.
Over the past several years, GAO has identified the need to reexamine and
transform federal disability programs to better position the government to
meet the new challenges and changing expectations of the 21st century. We
have identified several key factors that are important to consider in
assessing the need for, and nature of, program transformations including
(1) program design issues, particularly those affecting individual work
incentives and supports; (2) fiscal implications of proposed program
changes, such as their affordability and effects on federal and state
spending and tax revenues; and (3) feasibility of implementing program
changes, which would include considering whether appropriate processes and
systems are in place including those related to the planning and
management of human capital and information technology. In addition to
considering these factors, it is also important that some mechanism be
established for looking across programs to assess their overall
effectiveness and integration and whether they achieve similar or
complementary goals.
Background
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 serviceand
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.3 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.
3 Long-term budget simulations by GAO, the Congressional Budget Office,
and others show that, over the long term the U.S. faces a large and
growing structural deficit due primarily to known demographic trends and
rising health care costs.
Over 20 Different Agencies Administer Almost 200 Programs That Provide a
Wide Range of Assistance
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.
Multiple Federal Agencies Administer Programs Serving People with
Disabilities
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.4 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
4 We considered a program to be wholly or partially targeted to people
with disabilities if it met one or more of the following criteria: (1)
people with disabilities are specifically mentioned in 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.
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.5
5 The number of beneficiaries or clients served by these programs in any
given year is probably significantly higher than the numbers we report
here for fiscal year 2003 because many programs did not provide us with
estimates of the number of beneficiaries or clients they serve, or they
provided us with estimates for a different fiscal year. Wholly targeted
programs reported serving a total of about 44 million beneficiaries or
clients, 10 million of whom were for fiscal years other than 2003.
Similarly, partially targeted programs reported serving a total of about
22 million beneficiaries, 7 million of whom were for fiscal years other
than 2003.
Table 1: Federal Agencies That Administer Programs Assisting People with
Disabilities
Total number of
programs
Number of Number of supporting people
wholly partially with
Federal agencies targeted targeted disabilities
programs programs
Department of Health and Human 17 23
Services
Department of Education 27 6
Department of Veterans Affairs 20 12
Department of Labor 8 14
Department of Housing and Urban
Development 6 10
Social Security Administration 6 4
Department of Agriculture 1 8
Department of Transportation 2 4
Department of Justice 0 5
Equal Employment Opportunity
Commission 1 2
Office of Personnel Management 2 1
Department of Commerce 0 2
Department of Treasury 0 2
Library of Congress 1 1
Access Board 1 0
Committee for Purchase from People
Who
are Blind or Severely Disabled 1 0
Department of Defense 1 0
Department of Energy 0 1 1
Department of the Interior 1 0 1
Railroad Retirement Board 0 1 1
Small Business Administration 0 1 1
Total number of programs in our survey 95 97 192
Source: GAO analysis of survey data.
Federal Programs Provide Federal programs provide a wide range of
assistance to people with a Wide Range of disabilities (see fig. 1). The
most common primary types of assistance Assistance to People with provided
are employment-related services and medical care, although a Disabilities
number of programs provide civil protections or legal services, education,
and monetary support as well as other benefits or services (see fig. 2).
Figure 1: Primary Types of Assistance Provided by Federal Programs to
Individuals with Disabilities, Indicating Percentage of Programs Providing
Such Assistance and Examples of Programs
Source: GAO analysis of survey data.
Figure 2: Number of Federal Programs Providing Various Primary Types of
Assistance to Individuals with Disabilities
Number of programs Employment-related
Medical careCivil protectionsor legal services Education
ysuppor
Monetar
t
ormationInfdissemination
Housingsonal assistant
vicesser
ansportation rT
Loans
hnologyAssistivetec
Food Other
reP
Primary type of assistance
Partially targeted programs
Wholly targeted programs
Source: GAO analysis of survey data.
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.
Figure 3: Percentage of Federal Programs Providing Multiple Types of Assistance
Percentage of programs providing assistance 50
47
40
30
20
10 0
12 3456 or more
Number of types of assistance provided
Source: GAO analysis of survey data.
Note: Numbers in this figure do not add up to 100 percent due to rounding.
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 Multiple federal agencies administer programs
that provide similar types Provide Similar Types of of assistance to
people with disabilities (see table 2). For example, seven Assistance
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.
Table 2: Number of Programs Serving Individuals with Disabilities, by
Federal Agency and Primary Type of Assistance
Monetary Medical Personal Employment-
assistant
Federal agency support care services Housing Food Education related
Access Board 0 0 0 0 0 0
Committee for
Purchase From
People Who Are
Blind or
Severely 0 0 0 0 0 0
Disabled
Department of 0 0 0 3 3 0
Agriculture
Department of 0 0 0 0 0 0
Commerce
Department of 0 0 0 0 0 0
Defense
Department of 0 0 3 0 0 12
Education
Department of 0 0 0 0 0 0
Energy
Department of
Health and
Human Services 2 13 0 0 2 1
Department of
Housing and
Urban 0 0 0 8 0 0
Development
Department of 1 0 0 0 0 1
Justice
Department of 4 0 0 0 0 0
Labor
Department of 0 0 0 0 0 1
Interior
Department of 0 0 0 0 0 0
Transportation
Department of 0 0 0 0 0 0
Treasury
Department of
Veterans 7 15 0 1 0 3
Affairs
Equal
Employment
Opportunity
Commission 0 0 0 0 0 0
Library of 0 0 0 0 0 0
Congress
Office of
Personnel
Management 0 0 0 0 0 0 2
Railroad
Retirement 1 0 0 0 0 0 0
Board
Small Business 0 0 0 0 0 0 0
Administration
Social
Security 4 0 0 0 0 0 4
Administration
Total 19 28 3 12 5 18 28
Civil protections Information Assistive Other
or legal services Loans Transportation dissemination technology assistance
Totals
0 0 0001
0 0 0 0 0 0
0 0 0 0 2 0
0 0 0 0 0 2
0 0 0 0 1 0
3 2 0 2 0 4
0 0 0 0 0 1
4 0 0 3 0 15
3 1 0 2 0 2
3 0 0 0 0 0
2 0 1 5 0 0
0 0 0 0 0 0
0 0 5 1 0 0
0 0 0 0 0 2
0 2 1 0 0 0
3 0 0000
0 0 0002
0 0 0100
0 0 0000 1 0 0 0001 1 0 0 0200 10 18 5 716 330192
Source: GAO analysis of survey data.
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.6 Furthermore, the 28 programs that primarily provide
employment-related services often have distinct eligibility criteria
beyond the specific populations served.
Billions Are Spent on Programs for People with Disabilities
The programs that provide assistance only to people with disabilities
spent over $120 billion in fiscal year 2003.7 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).
6 Approximately 77 percent of the wholly targeted programs we identified
limit eligibility to a specific population of people who have a disability
(e.g., to a certain age group, disability type, or population group).
7 Of the 95 wholly targeted programs in our analysis, we were able to
obtain some type of spending data for 85 programs (either from federal
government data on program spending or from our web-based survey). The
$120 billion estimate represents reported obligations for fiscal year 2003
and includes administrative costs for some programs (i.e., those that
included these costs when reporting total program spending to us).
However, data on fiscal year 2003 obligations were not available or
reported for some programs. In those instances, some programs instead
provided data on outlays or appropriations, and these data, in some cases,
pertained to a fiscal year other than 2003. For example, in addition to
the more than $120 billion in fiscal year 2003 obligations that we report,
other wholly targeted programs reported outlays of over $7 billion in
fiscal year 2003. (See appendix I for a more detailed discussion of our
methodology and see appendix II for a more detailed listing of spending by
individual programs.)
Figure 4: Federal Spending for Wholly Targeted Programs by Agency, Fiscal
Year 2003
1%
Other agencies
2%
HHS
Education
VA
SSA
Source: GAO analysis of survey data.
Note: The percentages in this figure are calculated based on fiscal year
2003 program obligations that we were able to identify. Therefore, it does
not reflect the spending of a number of programs (and agencies) for which
we were unable to obtain any fiscal year 2003 spending data or which
provided data representing program outlays rather than obligations. For
example, the Department of Labor's reported outlays of almost $3 billion
for wholly targeted programs are not reflected in this figure. For a more
comprehensive listing of program spending, see appendix II. Numbers in
this figure do not add up to 100 percent due to rounding.
Figure 5: Federal Spending for Wholly Targeted Programs by Primary Type of
Assistance, Fiscal Year 2003
1%
Other assistance
2%
Employment-related
2%
Medical care
Education
Monetary support
Note: The percentages in this figure are calculated based on fiscal year
2003 program obligations that we were able to identify. Therefore, it does
not reflect the spending of a number of programs for which we were unable
to obtain any fiscal year 2003 spending data or which provided data
representing program outlays rather than obligations. For a more
comprehensive listing of program spending, see appendix II. Numbers in
this figure do not add up to 100 percent due to rounding.
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,8 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
8 Some of these programs were unable to provide us with information
pertaining to their programs' spending on people with disabilities because
they do not separately track or collect spending data for individuals with
disabilities.
Federal Programs That Support People with Disabilities Face an Array of
Challenges
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.
Timely and Consistent Processing of Applications for Assistance
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,9 and more
than one-quarter of monetary support programs reported that consistent
processing of applications was a major or moderate challenge.10
9 In discussing our survey results throughout the remainder of this
section, our figures regarding the percentage of programs that considered
particular issues to be a "challenge" includes programs that identified an
issue as either a "major" or "moderate" challenge in their responses to
our survey. Also, the survey results presented in this section combine
responses from both grant-making and non-grant-making programs. The
responses of grant-making programs reflect these programs' views of the
challenges their grantees face. 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.
10 Of all 192 federal programs included in our analysis, including
programs providing monetary support, 21 percent reported that ensuring
timely processing of applications for assistance was a challenge and 15
percent reported that ensuring consistent processing of applications for
assistance was a challenge.
Timely Provision of Services and Benefits
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.11
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 services12 because the demand for VR services outweighs
the available resources.
Interpreting Complex Eligibility Requirements
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.13
Planning for Growth in the Our past work noted that federal disability
programs are facing challenges Demand for Services and in planning for the
anticipated increase in demand for their benefits and Benefits 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
11 Of all 192 federal programs included in our analysis, including
programs providing employment-related assistance, 24 percent reported that
ensuring timely provision of services and benefits was a challenge.
12 Under the Rehabilitation Act of 1973, states that cannot provide
vocational rehabilitation services to all eligible applicants must provide
assurances that those with the most severe disabilities will be selected
first under "order of selection" criteria.
13 Of all 192 federal programs included in our analysis, including
programs providing monetary support, 30 percent reported that interpreting
complex eligibility requirements was a challenge.
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.14 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 program15 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.
Making Beneficiaries or Clients Aware of Program Services and Benefits
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.16 The need to make people more aware of disability program
services has also been noted by other entities. For example, in 1999, the
14 Of all 192 federal programs included in our analysis, including
programs providing medical care and employment-related assistance, 36
percent reported that planning for growth in the demand for assistance was
a challenge.
15 The Workforce Investment Act of 1998 (WIA) requires states and
localities to bring together a number of federally funded employment and
training services into a single system-the one-stop system. Funded through
different federal agencies, these programs are to provide services through
a statewide network of one-stop career centers to adults, dislocated
workers, and youth.
16 Of all 192 federal programs included in our analysis, including
information dissemination programs, 38 percent reported that making
beneficiaries or clients aware of their programs' services and benefits
was a challenge.
Presidential Task Force on Employment of Adults with Disabilities17
suggested that the White House take more action to make people aware of
programs that support people with disabilities.
Communication and Coordination among Programs Serving Individuals 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."18 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
17 The Presidential Task Force on the Employment of People with
Disabilities was established to create a coordinated and aggressive
national policy to bring adults with disabilities into gainful employment
at a rate that is as close to the employment rate of the general adult
population. The Task Force published a series of reports over the course
of four years entitled Re-charting the Course.
18 David Wittenburg and Melissa Favreault, "Safety Net or Tangled Web? An
Overview of Programs and Services for Adults with Disabilities,"
Occasional Paper Number 68, The Urban Institute, p. 23 (Washington, D.C.;
November 2003).
information from or coordinating with other federal or nonfederal
19
programs.
Key Factors to Consider in Transforming Programs for the 21st Century
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.
19 Although our survey asked programs to report information sharing or
coordination challenges with both federal and nonfederal programs, most of
the respondents who reported having such challenges indicated that these
challenges related to their interactions with other federal programs,
either within or outside of their own agency.
Figure 6: Key Factors and Questions Concerning Transformation of Programs
Serving Individuals with Disabilities
Program Design-Individual incentives and supports:
o Are the program's eligibility criteria up to date, taking into
consideration (1) medical and technological advances; (2) changes in
the labor market (e.g., shift toward more service and knowledge-based
work); (3) social changes (e.g., altered expectations focusing on work
and self-sufficiency and legal protections for workers with
disabilities); and (4) changing demographics (i.e., aging of the Baby
Boom generation)? o Does the program appropriately identify those who
can't work and provide them with financial support? o Does the
program provide effective work supports to individuals to enhance their
chances of entering, returning to, or staying in the workforce? o
Does the program provide return to work assistance at the optimal time
(i.e., soon after a person incurs a disability, when they may be more
motivated to return to work)? o Should some beneficiaries be required
to accept assistance to enhance work capacities as a precondition for
benefits? o Is the program sufficiently coordinated with related
programs to provide coherent and integrated assistance to individuals
with disabilities as well as incentives promoting work? o Is the
program flexible enough to support the changing needs of people with
disabilities?
Fiscal implications:
o What would be the program costs (both short and long term) of
specific efforts to streamline and modernize disability programs and
what are the implications of these costs for the nation's fiscal
outlook? o What would be the financial benefits (e.g., increased tax
revenues from individuals who return to work) of such efforts? o Who
will pay for program benefits and services (e.g., medical and assistive
technologies) and will beneficiaries be required to defray some portion
of the costs? o What are the fiscal implications for states and
localities and for nongovernmental organizations?
Feasibility of Implementation and Transformation:
o Has the program established clear standards, and are these standards
applied accurately and consistently? o Does the program have
personnel who are capable of carrying out eligibility determinations
and assessments? o Are eligibility determinations and assessments
completed in a timely manner? o Does the program have appropriate
controls in place to ensure program integrity? o Does the program
make use of information systems which not only facilitate day-to-day
processing needs but also provide sufficient information for longer
term performance evaluation and policy assessment?
Source: GAO.
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.20 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.
20 GAO, 21st Century Challenges: Reexamining the Base of the Federal
Government, GAO-05-325SP (Washington, D.C.: February 2005).
If you or your staff have any questions about this report, please contact
me at (202) 512-7215 or [email protected]. 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.
Robert E. Robertson Director, Education, Workforce, and Income Security
Issues
List of Committees
The Honorable Thad Cochran
Chairman
The Honorable Robert C. Byrd
Ranking Minority Member
Committee on Appropriations
United States Senate
The Honorable Charles E. Grassley
Chairman
The Honorable Max Baucus
Ranking Minority Member
Committee on Finance
United States Senate
The Honorable Michael B. Enzi
Chairman
The Honorable Edward M. Kennedy
Ranking Minority Member
Committee on Health, Education, Labor,
and Pensions United States Senate
The Honorable Susan Collins
Chairman
The Honorable Joseph Lieberman
Ranking Minority Member
Committee on Homeland Security
and Governmental Affairs
United States Senate
The Honorable Larry Craig
Chairman
The Honorable Daniel Akaka
Ranking Minority Member
Committee on Veterans' Affairs
United States Senate
The Honorable Jerry Lewis
Chairman
The Honorable David R. Obey
Ranking Minority Member
Committee on Appropriations
House of Representatives
The Honorable John A. Boehner
Chairman
The Honorable George Miller
Ranking Minority Member
Committee on Education and
the Workforce
House of Representatives
The Honorable Joe Barton
Chairman
The Honorable John D. Dingell
Ranking Minority Member
Committee on Energy and Commerce
House of Representatives
The Honorable Tom Davis
Chairman
The Honorable Henry A. Waxman
Ranking Minority Member
Committee on Government Reform
House of Representatives
The Honorable Steve Buyer
Chairman
The Honorable Lane Evans
Ranking Minority Member
Committee on Veterans' Affairs
House of Representatives
The Honorable William M. Thomas
Chairman
The Honorable Charles B. Rangel
Ranking Minority Member
Committee on Ways and Means
House of Representatives
Appendix I: Scope and Methodology
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.1 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,
1 Our definition of a program is derived from the Catalog for Federal
Domestic Assistance (CFDA), a database of all federal programs available
to state and local governments (including the District of Columbia);
federally-recognized Indian tribal governments; territories (and
possessions) of the United States; domestic public, quasi-public, and
private profit and nonprofit organizations and institutions; specialized
groups; and individuals. The CFDA states that "A `Federal domestic
assistance program' may in practice be called a program, an activity, a
service, a project, a process, or some other name, regardless of whether
it is identified as a separate program by statute or regulation." The CFDA
further notes that " `Assistance' or `benefits' refers to the transfer of
money, property, services, or anything of value, the principal purpose of
which is to accomplish a public purpose of support or stimulation
authorized by federal statute."
Appendix I: Scope and Methodology
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
Appendix I: Scope and Methodology
Census-for all of the relevant programs listed in this database.2 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.3 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
2 The CFFR reports federal government expenditures or obligations in
state, county, and subcounty areas of the United States as well as the
District of Columbia and U.S. outlying areas. Various federal government
agencies provide the data for this report from their existing reporting
systems.
3 In addition, several programs provided us with data on their
appropriations, rather than either obligations or outlays.
Appendix I: Scope and Methodology
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.
Appendix II: Federal Programs Serving People with Disabilities
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.)
Federal Programs Serving People with Disabilities
Direct or
indirect Wholly or
Spending (for assistance partially
fiscal year 2003 to targeted to
unless individuals individuals
Primary area of otherwise with with
Program assistance indicated) disabilities disabilities
Access Board
Access Board Other: Guidelines $4,000,000a,b,c Indirect Wholly on
accessibility
Committee for Purchase From People Who Are Blind or Severely Disabled
Javits-Wagner-O Day Program (Committee for Purchase From
Employment-$4,629,000a,b,c Indirect Wholly People Who Are Blind or
Severely Disabled) related
Department of Agriculture
Assistive & Ergonomic Technology Assistive Direct Partially
(Target Center, USDA,
Washington, D.C.) technology
Assistive and Ergonomic Technology Assistive Direct
(Midwest Target Center, Partially
St. Louis, Missouri) technology
Assistive Technology Program for $4,002,000a,c
Farmers with Disabilities: Employment- Indirect Wholly
AgrAbility Project related
Child and Adult Care Food Program Food Indirect Partially
Food Stamps Food Direct Partially
Rural Rental Assistance Payments Housing Indirect Partially
Appendix II: Federal Programs Serving People with Disabilities
Direct or
indirect Wholly or
Spending (for partially
assistance
fiscal year 2003 to targeted to
unless individuals individuals
Primary area of otherwise with with
Program assistance indicated) disabilities
disabilities
Rural Rental Housing Housing Indirect Partially
Loans
Section 538 Rural Rental Housing Indirect Partially
Housing Guaranteed Loans
Summer Food Service Food Indirect
Program for Children Partially
Department of Commerce Department of Defense
Public Telecommunications Facilities Other: Indirect Partially
Program
Telecommunication
and information
technology
Technology Opportunities Program Other: Indirect Partially
Telecommunication
and information
technology
Computer/Electronic Accommodations Program Assistive $4,662,000a,b,c
Direct Wholly technology
Department of Education
Access to Telework Loans $20,000,000a,c Wholly
Indirect
Adult Education and Family Education Indirect Partially
Literacy Act State Grants
American Indian Vocational $28,399,000d,e
Rehabilitation Services Employment- Direct Wholly
related
American Printing House for the Other: $15,399,000d,e
Blind Educational Indirect Wholly
materials
Information $22,289,000a,c
Assistive Technology Act Indirect Wholly
dissemination
Assistive Technology Loans $13,001,000a,f,c Wholly
Alternative Financing Program Indirect
Assistive Technology State $4,573,000d,e
Grants for Protection and Civil Indirect
Advocacy protections or Wholly
legal services
Carl D. Perkins Vocational and Education Indirect
Technical Education State Partially
Grants
Civil $12,068,000a,g
Client Assistance Program protections or Direct Wholly
legal services
Congressionally-Directed Other: $3,517,000a,c
Projects Disability- Indirect Wholly
related
earmarks
Gallaudet University Education Direct Partially
Helen Keller National Center $8,660,000a,c
Employment- Direct Wholly
related
Personal $68,820,000a,g
Independent Living Services assistant Direct Wholly
services
Appendix II: Federal Programs Serving People with Disabilities
Direct or
indirect Wholly or
Spending (for assistance partially
fiscal year 2003 to targeted to
unless individuals individuals
Primary area of otherwise with with
Program assistance indicated) disabilities disabilities
Independent Living Services Personal
for Older Individuals Who assistant $27,538,000a,g Direct Wholly
are Blind
services
Independent Living State Personal
Grants assistant $21,930,000a,g Direct Wholly
services
Migrants and Seasonal $2,306,000a,c
Farmworkers Employment- Indirect Wholly
related
National Technical Education $53,699,000a,g Direct Wholly
Institute for the Deaf
Native Hawaiian Special Education $3,100,000d,e Wholly
Education Indirect
Payments for Children with Education $50,669,000a,g Wholly
Disabilities Indirect
Program of Protection and
Advocacy of Individual Civil protections
Rights or $16,585,000a,g Direct Wholly
legal services
Projects with Industry Employment- $21,708,000a,g Direct Wholly
related
Randolph-Sheppard Vending $31,400,000a,f,c
Facilities Program Employment- Indirect Wholly
related
Other: $2,354,000a,g
Recreational Programs Recreational Indirect Wholly
programs
Rehabilitation Services $2,480,000,000a,g
Vocational Rehabilitation Employment- Direct Wholly
Grants to
States related
Special Education-Pre-School Education $384,223,000a,g Wholly
Grant Program Direct
Special Education-Grants for $429,307,000a,g
Infants and Families with Other: Early Direct Wholly
Disabilities intervention
services
Special Education-Grants to Education $8,858,398,000a,g Wholly
States Direct
Special Education-Parent Information
Information Centers $26,327,000a,g Direct Wholly
dissemination
Special Education-Technology Education $37,962,000a,g
and Media Services for Indirect Wholly
Individuals with
Disabilities
Star Schools Education Indirect Partially
Supported Employment
Services for Individuals $37,525,000a,g Direct
with Severe Employment- Wholly
Disabilities related
Tech Prep Education State Education Indirect Partially
Grants
TRIO Student Support Education Indirect Partially
Services
Department of Energy
Weatherization Assistance Indirect
for Low-Income Persons Other: Energy Partially
efficiency
Appendix II: Federal Programs Serving People with Disabilities
Direct or
indirect Wholly or
Spending (for assistance partially
fiscal year 2003 to targeted to
unless individuals individuals
Primary area of otherwise with with
Program assistance indicated) disabilities disabilities
Department of Health and Human Services
Adoption Assistance Monetary support Indirect Partially
Aging and Disability Resource Information Indirect
Center Partially
dissemination
Alzheimer's Disease Demonstration Other: Respite Indirect Partially
Grants to States
Attention Deficit Hyperactivity Information Indirect
Disorder Partially
dissemination
$5,563,000d,e
Black Lung Clinics Program Medical care Indirect Wholly
Block Grants for
Community Mental Health Other: $437,140,000a,b,c Indirect Wholly
Services
Development of
comprehensive
systems of care
Child Care Mandatory and Matching Funds Indirect Partially
of the Child Care Other: Child care
and Development Fund subsidies
Civil Rights and Privacy Rule
Compliance Activities Civil protections Direct
or Partially
legal services
Comprehensive Community Mental Health $80,078,000d,e Indirect
Services for Children Medical care Wholly
with Serious Emotional Disturbances
Developmental Disabilities Basic
Support and Advocacy Grants Other:
Systems $133,236,000d,e Indirect Wholly
change and
capacity building
Developmental Disabilities Projects of
National Significance Other: $12,403,000h,g Indirect
Independent Wholly
living support
Disabilities Prevention (Disability Other: Capacity $25,551,000d,e Wholly
and Health) Indirect
building and
information
dissemination
Early Hearing Detection & Other: Early Indirect Partially
Identification
hearing
detection
Family Support Payments to Monetary Indirect
States Assistance Payments support Partially
(Adult Programs in the
Territories)
Grants to Provide Outpatient
Early Intervention Services Medical care $19,000d,e Indirect
with Wholly
Respect to HIV Disease
Hansen's Disease National Medical care Indirect Partially
Ambulatory Care Program
Head Start Education Indirect Partially
HIV Care Formula Grants Medical care $1,022,337,000d,e Wholly
Indirect
HIV Emergency Relief Project Medical care $600,673,000d,e
Grants Indirect Wholly
Appendix II: Federal Programs Serving People with Disabilities
Direct or
indirect Wholly or
Spending (for assistance partially
fiscal year 2003 to targeted to
unless individuals individuals
Primary area of otherwise with with
Program assistance indicated) disabilities disabilities
Maternal and Child Health Federal Medical care Indirect Partially
Consolidated Programs-
Special Projects of Regional and National
Significance/Awareness and Access to Care
for Children and
Youth with Epilepsy
Maternal and Child Health $1,873,000a,b,c
Federal Consolidated Other: Systems Indirect Wholly
Programs-
Special Projects of Regional building
and National
Significance/CISS/Community
Systems for CSHCN
Maternal and Child Health
Federal Consolidated Other: Direct
Programs- Partially
Special Projects of Regional Infrastructure
and National and
Significance/Early
Detection and Intervention support systems
for Children with Autism
Maternal and Child Health
Services Block Grant to the Other: Systems Indirect
States of Partially
(Title V) care
Medicaid Infrastructure $35,000,000a,i
Grants To Support the Other: Indirect
Competitive Wholly
Employment of People with Infrastructure
Disabilities and
coordination
Medical Assistance Medical care Indirect Partially
Program-Medicaid
Medicare Hospital Insurance Medical care Direct Partially
Medicare Supplementary Medical care Direct Partially
Medical Insurance
National Family Caregiver Other: Indirect
Support Multifaceted Partially
support systems
Nutrition Services Incentive Food Indirect Partially
Program
PATH Formula Grant-Homeless Other: Outreach $41,306,000d,e
Direct Wholly
and case
management.
Protection and Advocacy for $34,620,000a,b,j,i
Individuals with Mental Civil Indirect
Illness protections or Wholly
legal services
Real Choice Systems Grants Other: Indirect
for Community Living Partially
Infrastructure
and
support
services
Ryan White CARE Act - Title $69,936,000d,e
IV: Grants for Coordinated Medical care Indirect
HIV Wholly
Services and Access to
Research for Women
Ryan White HIV/AIDS Dental Medical care $9,843,000a,c Wholly
Reimbursements Indirect
Special Programs for the Other:
Aging Title III, Part B, Multifaceted Indirect
Grants for Partially
Supportive Services & Senior support systems
Centers
Special Programs for the
Aging Title III, Part C Food Indirect
Nutrition Partially
Services
Special Projects of National Medical care Indirect
Significance (Ryan White CARE Partially
Act)
Appendix II: Federal Programs Serving People with Disabilities
Direct or
indirect Wholly or
Spending (for partially
assistance
fiscal year 2003 targeted to
to
unless individuals
individuals
Primary area of otherwise with with
Program assistance indicated) disabilities
disabilities
Traumatic Brain Injury Information Indirect Partially
dissemination
Voting Access for
Individuals with Civil protections $2,000,000d,e
Disabilities-Grants for or Indirect Wholly
Protection and Advocacy
Systems legal services
Voting Access for Individuals with Disabilities-Grants to States Civil
protections or $12,849,000d,e Indirect Wholly and Local Governments legal
services
Department of Housing and Urban Development
Architectural Barriers Act Civil protections NA Direct Wholly
Enforcement or
legal services
Assisted Living Conversion for Indirect
Eligible Multifamily Housing Housing Partially
Projects
Elderly/Disabled Service Other: Service Indirect
Coordinator Program Partially
coordination
Fair Housing Initiatives Other: Fair Indirect
Program housing Partially
assistance
Housing Opportunities for Housing $252,200,000a,g Wholly
Persons with AIDS Indirect
Lower Income Housing Indirect
Assistance Program Section 8 Housing Partially
Moderate Rehabilitation
Mortgage Insurance Rental Loans Indirect Partially
Housing for the Elderly
Multifamily Housing Service Information Direct
Coordinators Partially
dissemination
Non-Discrimination in
Federally Assisted and Civil protections NA Direct
Conducted or Wholly
Programs (on the Basis of legal services
Disability)
Non-Discrimination on the
Basis of Disability by Public Civil protections NA Direct
Entities or Wholly
legal services
Public and Indian Housing Housing Indirect Partially
Resident Opportunity and Information Indirect
Self-Sufficiency Partially
dissemination
Section 202 Housing Housing Indirect Partially
Shelter Plus Care Housing $76,822,000d,e Wholly
Indirect
Supportive Housing for Persons Housing $286,652,000a,g Wholly
with Disabilities Indirect
Supportive Housing Program Housing Indirect Partially
Department of Justice
Civil Rights of Civil protections Indirect
Institutionalized Persons or Partially
legal services
Civil protections Indirect
Equal Employment Opportunity or Partially
legal services
Appendix II: Federal Programs Serving People with Disabilities
Direct or
indirect Wholly or
Spending (for assistance
partially
fiscal year 2003 to
targeted to
unless individuals
individuals
Primary area of otherwise with with
Program assistance indicated) disabilities
disabilities
Protection of Voting Rights Civil protections or Indirect Partially
legal services
Public Safety Officers' Monetary support Direct Partially
Benefits Program
Public Safety Officers' Education
Educational Assistance Direct Partially
Department of Labor
Coal Mine Workers' Monetary support $370,389,000a,c Wholly
Compensation Direct
Disability Info.gov Information Direct Partially
dissemination
$3,000,000a,b,c
Disability Navigator Employment- Indirect Wholly
related
Disabled Veterans' Outreach Indirect
Program Employment- Partially
related
Employer Assistance Referral Indirect
Network Employment- Partially
related
Employment Service Information Indirect Partially
dissemination
Energy Employees'
Occupational Illness Direct
Compensation Monetary support Partially
Program
Federal Employees' Monetary support $2,345,471,000a,c Wholly
Compensation Program Direct
Job Accommodation Network Information Indirect Partially
dissemination
Job Corps Employment- Direct Partially
related
Longshore and Harbor Monetary support $2,817,000a,c Wholly
Workers' Compensation Indirect
O*Net Information Indirect Partially
dissemination
Office of Federal Contract Civil protections Direct
Compliance Programs or Partially
legal services
One-Stop Career Center Indirect
System Employment- Partially
related
Small Business and
Self-Employment for People Information Indirect
with Partially
Disabilities dissemination
United We Ride Transportation Indirect Partially
Veteran's Preference in NA Direct
Federal Employment Employment- Wholly
related
Veterans Workforce Indirect
Investment Programs Employment- Partially
related
Appendix II: Federal Programs Serving People with Disabilities
Direct or
indirect Wholly or
Spending (for assistance
partially
fiscal year 2003 to targeted
to
unless individuals
individuals
Primary area of otherwise with with
Program assistance indicated) disabilities
disabilities
Wage and Hour Division Civil protections or NA Indirect Wholly
legal services
WIA Youth Program
(formula grants) Employment- Direct Partially
related
Work Incentives Grant $20,000,000a,i Indirect
Employment- Wholly
related
Workforce Recruitment
Program Employment- $500,000a,b,c Indirect Wholly
related
Department of the Interior
Assistance for Indian Children with Severe Disabilities Education $60,000d,k
Direct Wholly Department of Transportation
Capital and Training Assistance Transportation $6,905,000a,i Wholly
Program for Over-the-Road Indirect
Bus Accessibility
Capital Assistance Program for Indirect
Elderly Persons and Persons Transportation Partially
with Disabilities
Capital Investment Grants Transportation Indirect Partially
FTA general activities and Information $3,000,000a,c
technical assistance related to Indirect Wholly
disability issues dissemination
Nonurbanized Area Formula Program Transportation Indirect Partially
Urbanized Area Formula Program Transportation Indirect Partially
Department of Treasury
Tax Deduction to remove barriers for the Elderly and Disabled Other: Tax
Indirect Partially deduction
Work Opportunity Tax Credit Other: Tax credit Indirect Partially
Department of Veterans Affairs
Automobiles and Adaptive $30,013,000d,k
Equipment for Certain Transportation Direct Wholly
Disabled
Veterans and Members of the
Armed Forces
Blind Rehabilitation Centers Medical care $59,569,000a,b,c Wholly
Indirect
Compensation for
Service-Connected Deaths for Direct
Veterans' Monetary support Partially
Dependents
Life Insurance for Veterans Monetary support Direct Partially
Montgomery GI Bill
Educational Assistance Education Direct Partially
(Chapter 30)
Monthly Allowance for $13,900,000d,l
Children of Vietnam Veterans Direct
Born with Monetary support Wholly
Spina Bifida
Native American Veteran Loans Direct Partially
Direct Loan Program
Pension for
Non-Service-Connected $2,489,932,000d,l
Disability for Veterans Monetary support Direct Wholly
Appendix II: Federal Programs Serving People with Disabilities
Direct or
indirect Wholly or
Spending (for partially
assistance
fiscal year 2003 to targeted to
unless individuals individuals
Primary area otherwise with with
of
Program assistance indicated) disabilities
disabilities
Pension to Veterans Monetary
Surviving Spouses, and support Direct Partially
Children
Post-Vietnam Era
Veterans' Educational Education Direct Partially
Assistance
SMI: Psychotic Disorders Medical care $1,655,076,000a,b,c Wholly
Direct
SMI: PTSD Medical care $139,873,000a,b,m,c Wholly
Direct
SMI: Substance Abuse Medical care $44,083,000a,b,c Wholly
Direct
Specially Adapted
Housing for Disabled Housing $17,324,000d,k Direct Wholly
Veterans
Spinal Cord Injury Medical care $301,666,000a,b,c Wholly
Direct
Survivors and Dependents Education $275,123,000d,k Direct Wholly
Educational Assistance
Traumatic Brain Injury Medical care $12,668,000a,c Direct Wholly
Veterans Compensation Monetary $20,622,189,000d,l
for Service-Connected support Direct Wholly
Disability
Veterans Dental Care Medical care Direct Partially
Veterans Dependency and $3,773,937,000d,l
Indemnity Compensation Monetary Direct
for support Wholly
Service-Connected Death;
Compensation for Service
Veterans Domiciliary Medical care $295,505,000a,b,c Wholly
Care Direct
Veterans Home-Based Medical care Direct Partially
Primary Care
Veterans
Housing-Guaranteed and Loans Direct Partially
Insured Loans
Veterans Medical Care Medical care Direct Partially
Benefits
Veterans Nursing Home Medical care $1,684,725,000a,b,c
Care Direct Wholly
Veterans Prosthetic Medical care $523,366,000h,g Wholly
Appliances Direct
Veterans State Domiciliary Medical care Indirect Partially
Care
Veterans State Hospital Medical care $41,937,000d,e Wholly
Care Indirect
Veterans State Nursing Home Medical care $327,524,000d,e Wholly
Care Indirect
Vocational and Educational
Counseling for Separating Direct
Service Employment- Partially
Members (Chapter 36) related
Vocational Rehabilitation $376,622,000d,k
for Disabled Veterans Employment- Direct Wholly
related
Vocational Training and
Rehabilitation for Vietnam
Veterans' Employment- $26,000a,b,c Direct Wholly
Children with Spina Bifida
or Other Covered Birth related
Defects
Equal Opportunity
Employment Commission
Employment Discrimination
Section 501 of the Civil Direct
Rehabilitation protections or Partially
Act (federal employees) legal services
Employment Discrimination
State and Local Fair Civil Indirect
Employment protections or Partially
Practices Agency Contracts legal services
Employment Discrimination
Title I of The Americans Civil NA Direct
with protections or Wholly
Disabilities Act legal services
Appendix II: Federal Programs Serving People with Disabilities
Direct or
indirect Wholly or
Spending (for assistance partially
fiscal year 2003 to targeted to
unless individuals individuals
Primary area of otherwise with with
Program assistance indicated) disabilities disabilities
Library of Congress Office of Personnel Management Railroad Retirement Board
Access Programs Other: Direct Partially
Accessibility
of facilities and
services
Library Services for the
Blind and Physically $50,632,000a,b,c
Handicapped Other: Library Direct Wholly
service.
Federal Employment Assistance for Employment- NA Indirect Wholly
Veterans
related
Federal Employment for Individuals NA Indirect
with Disabilities Employment- Wholly
related
Government Telework Program Guide Information Indirect Partially
dissemination
Social Insurance for Railroad Workers Monetary support Direct Partially
Small Business Administration
Veterans Entrepreneurial Training and Counseling Other: Multi-Direct
Partially faceted services for small businesses
Social Security Administration
AeDib - Electronic
Disability Claims Employment- Indirect Partially
Imaging and Processing
Project related
Social Security
Benefits Planning, Information $23,000,000a,b,c
Assistance, and Indirect
Outreach Wholly
Program dissemination
Social Security Monetary support $77,146,763,000d,l Wholly
Disability Insurance Direct
Social Security Monetary support Direct Partially
Retirement Insurance
Social Security State
Grants for Work $7,000,000h,g Indirect
Incentives Assistance
to Employment- Wholly
Disabled Beneficiaries related
Social Security Monetary support Direct Partially
Survivors Insurance
State Vocational
Rehabilitation Cost NA Indirect
Reimbursement Program Employment- Wholly
related
Supplemental Security Monetary support Direct Partially
Income
Ticket to Hire Information $140,000a,c Indirect Wholly
dissemination
Ticket to Work and Work NA Indirect
Incentives Program Employment- Wholly
related
Source: GAO analysis of survey data and of program information presented
in federal government reports (see table notes below).
Appendix II: Federal Programs Serving People with Disabilities
Note: "NA" means Not Available.
aData source: Program-reported data (e.g., through our survey or agency
correspondence).
bSurvey respondent indicated that this figure includes administrative
costs.
cExpenditure.
dData source: Consolidated Federal Funds Report.
eThe data sources used for the CFFR vary by major category of federal
government expenditure or obligation. The spending data for this program
are included in CFFR's "Grant" category, which includes formula grants,
project grants, block grants, and cooperative agreements. The data for
about 98 percent of all grants reported in the CFFR come from the Federal
Assistance Award Data System, which represent the federal obligations
incurred at the time the grant is awarded.
fData for FY 2001.
gObligation.
hData source: Catalog of Federal Domestic Assistance.
iAppropriation.
jData for FY 2004.
kThe data sources used for the CFFR vary by major category of federal
government expenditure or obligation. The spending data for this program
are included in CFFR's "Other Direct Payments" category. The data for this
category come from the Federal Assistance Award Data System. These amounts
generally represent obligations incurred during the fiscal year.
lThe data sources used for the CFFR vary by major category of federal
government expenditure or obligation. The spending data for this program
are included in CFFR's "Retirement and disability payments to individuals"
category. The data for this category are compiled by federal agencies for
the Federal Assistance Award Data System. Reported amounts represent
obligations of federal funds during the fiscal year.
mData for FY 2002.
Appendix III: GAO Contact and Staff Acknowledgments
GAO Contact
Staff Acknowledgments
(130360)
Robert E. Robertson, (202) 512-7215
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.
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