Homelessness: Appropriate Controls Implemented for 1990 McKinney
Amendments' PATH Program (Letter Report, 02/22/94, GAO/HEHS-94-82).

The Department of Health and Human Services' (HHS) Projects for
Assistance in Transition From Homelessness (PATH) program provides
states with funds to serve homeless persons with serious mental
illnesses and substance abuse problems.  HHS has implemented appropriate
program controls to ensure that PATH expenditures are consistent with
the 1990 McKinney Amendments, which require GAO to report on the PATH
program every three years.  In the five states GAO reviewed--California,
Florida, Illinois, New York, and Texas--state grant procedures,
financial oversight, and provider monitoring also helped guarantee that
PATH services reached the target population.  Local providers' mental
health assessments further ensured that PATH services reach the people
they were intended for.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  HEHS-94-82
     TITLE:  Homelessness: Appropriate Controls Implemented for 1990 
             McKinney Amendments' PATH Program
      DATE:  02/22/94
   SUBJECT:  Disadvantaged persons
             Program evaluation
             Monitoring
             Indigents
             Internal controls
             Homelessness
             Mental illnesses
             Funds management
             Reporting requirements
             Eligibility determinations
IDENTIFIER:  California
             Florida
             Illinois
             New York
             Texas
             Tennessee
             HHS Projects to Assist in Transition from Homelessness 
             Program
             Hurricane Andrew
             
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Cover
================================================================ COVER


Report to Congressional Committees

February 1994

HOMELESSNESS - APPROPRIATE
CONTROLS IMPLEMENTED FOR 1990
MCKINNEY AMENDMENTS' PATH PROGRAM

GAO/HEHS-94-82

Transition From Homelessness


Abbreviations
=============================================================== ABBREV

  CMHS - Center for Mental Health Services
  DSM-III-R - Diagnostic and Statistical Manual of Mental Disorders
  HHS - Department of Health and Human Services
  PATH - Projects for Assistance in Transition From Homelessness
  SAM-E - Systems Administrative Management Entity
  SAMHSA - Substance Abuse and Mental Health Services Administration

Letter
=============================================================== LETTER


B-255718

February 22, 1994

The Honorable Edward M.  Kennedy
Chairman
The Honorable Nancy L.  Kassebaum
Ranking Minority Member
Committee on Labor and Human Resources
United States Senate

The Honorable Henry A.  Waxman
Chairman
The Honorable Thomas J.  Bliley, Jr.
Ranking Minority Member
Subcommittee on Health and the Environment
Committee on Energy and Commerce
House of Representatives

On any given night, up to 600,000 Americans are homeless.\1

About one-third of the adults in this population have a serious
mental illness.  The Department of Health and Human Services' (HHS)
Projects for Assistance in Transition From Homelessness (PATH)
program provides the states and territories with funds to serve
homeless individuals who are seriously mentally ill or dually
diagnosed with serious mental illness and substance abuse disorders. 

The PATH program is authorized under the Stewart B.  McKinney
Homeless Assistance Amendments Act of 1990 (P.L.  101-645).  Section
528(c) of the act requires us to report on the PATH program every 3
years.  For this first report, we interviewed officials responsible
for the program, reviewed documents, and visited two local providers. 
We specifically reviewed documents describing PATH program
implementation in California, Florida, Illinois, New York, and Texas. 
(See app.  I for more details on our scope and methodology.)

This report provides information on (1) how HHS ensures that PATH
expenditures are consistent with the 1990 McKinney Amendments and (2)
how HHS and the states ensure that PATH funds reach the target
population.  As requested, it also provides information on how local
providers assess the appropriateness of homeless individuals for
receiving PATH services.  In September 1993, we briefed your offices
on the results of our work.  As agreed, this report completes our
initial work on the PATH program. 


--------------------
\1 M.R.  Burt and B.E.  Cohen, America's Homeless:  Numbers,
Characteristics, and Programs that Serve Them (Washington, D.C.:  The
Urban Institute Press, July 1989).  Many factors, such as states'
definitions of homelessness, and undomiciled and unstable living
conditions, prevent federal and state officials from obtaining an
accurate count on the number of homeless.  For example, see 1990
Census:  Limitations in Methods and Procedures to Include the
Homeless (GAO/GGD-92-1, Dec.  30, 1991). 


   BACKGROUND
------------------------------------------------------------ Letter :1

Assistance programs for the homeless under the McKinney Act, as
amended, provide homeless people with emergency food and shelter,
transitional and permanent housing, primary health care services,
mental health care, alcohol and drug abuse treatment, education, and
job training.  From fiscal year 1991 through fiscal year 1993,
Congress appropriated about $92.5 million for PATH, of which HHS
granted about $90.7 million to the 56 states and territories to
support specific services for the target population.\2 These services
include outreach, screening and diagnosis, training and retraining of
independent living skills, community mental health care, alcohol or
drug treatment, staff training, client case management, client
supportive and supervisory services in a residential setting,
referrals for primary health care, job training, and educational
services.  In addition, a state may allocate up to 20 percent of its
PATH grant for housing services and up to 4 percent of the grant for
administrative expenses.  The 1990 McKinney Amendments do not require
each state to provide all of the eligible services.  They also do not
permit expenditures for emergency shelters, housing construction,
inpatient psychiatric or substance abuse treatment, or cash payments
to recipients of mental health services. 

States and territories must apply annually to HHS for PATH grants and
provide year-end annual reports on clients and services delivered.\3
The PATH application asks the states for comprehensive budgetary and
programmatic information on the states' planned local provider
activities, as well as state-level implementation and oversight.  As
part of the application, states also must describe how they have
coordinated planned PATH activities with the states' plans for
comprehensive community mental health services.\4 The states must
submit their year-end annual reports by January 31 to receive
subsequent years' PATH grants.  The annual reports include narrative
and statistical reports on client services delivered. 

HHS awards PATH grants to the states according to a statutory formula
based on a state's urban population.  The 1990 McKinney Amendments
require that HHS allocate to each state, the District of Columbia,
and Puerto Rico no less than $300,000 and to each of the four
territories--Guam, the Virgin Islands, American Samoa, and the
Northern Marianas--no less than $50,000.  Appendix II shows the funds
allocated to states and territories for fiscal years 1992 and 1993. 
The amendments also require that states match PATH funds by providing
$1 for every $3 of federal funds.\5 States award PATH grants to local
providers that can be political subdivisions and/or nonprofit
entities. 

Nationally, from fiscal year 1991 to fiscal year 1992, states
reported an increase in the number of local PATH providers from 167
to 382 and the number of clients served from about 53,000 to about
98,000.\6 (See app.  III for information on the number of clients
served by states and territories for fiscal year 1992.) According to
the states' annual reports, PATH funds accounted for 1.3 percent of
the local providers' total budgets in fiscal year 1991 and 0.7
percent in fiscal year 1992.  Similarly, PATH clients constituted a
small percent of the local providers' client enrollments--11 percent
in fiscal year 1991 and 8.4 percent in fiscal year 1992.  Although
PATH is a small portion of providers' budgets, it is important
because it allows them to target services for a difficult-to-reach
population. 


--------------------
\2 The remaining $1.8 million was used to fund the PATH program's
technical assistance contracts. 

\3 Organizationally, the PATH program is administered by the
Substance Abuse and Mental Health Services Administration's Center
for Mental Health Services. 

\4 Among other activities, this federally financed planning process
requires states to develop community-based outreach and support
services for chronically mentally ill individuals who are homeless. 

\5 Under HHS regulations, Guam, the Virgin Islands, American Samoa,
and the Northern Marianas are not required to meet HHS' cash or
in-kind matching requirements for grants and cooperative agreements
requiring $200,000 or less as a match. 

\6 HHS' PATH Director estimates that the states' fiscal year 1993
data will closely resemble those from fiscal year 1992. 


   RESULTS IN BRIEF
------------------------------------------------------------ Letter :2

HHS implemented appropriate program controls to help ensure that PATH
expenditures are consistent with the 1990 McKinney Amendments.  In
the five states we reviewed, state grant procedures, financial
oversight, and provider monitoring also help ensure that PATH
services reach the target population.  Local providers' mental health
assessments further ensure that PATH services reach the target
population. 


   PRINCIPAL FINDINGS
------------------------------------------------------------ Letter :3


      HHS IMPLEMENTED PROGRAM
      CONTROLS
---------------------------------------------------------- Letter :3.1

HHS' PATH program controls help ensure that the states use PATH
grants to fund eligible services for the target population.  The
program controls include the annual grant application review process
and the annual state reports.  In 1993, the PATH program added
on-site monitoring to its program control measures. 


         APPLICATION REVIEW
         PROCESS
-------------------------------------------------------- Letter :3.1.1

The PATH program has a three-step application review/follow-up
process.  First, grants management specialists use a checklist to
review state budgets to ensure that they comply with the 1990
McKinney Amendments' 25-percent matching requirement and that PATH
expenditures are within the housing and administrative cost limits. 
Second, a PATH program review panel of federal officials uses another
checklist to identify unclear, incomplete, and inconsistent
information in the states' applications. 

The Director selects review panel members based on their familiarity
with the PATH program or the target population.  Experts serving on
the 1993 review panel represented the Department of Housing and Urban
Development and HHS' National Institute of Mental Health, Center for
Substance Abuse Treatment, and Health Resources and Services
Administration, as well as the Center for Mental Health Services
(CMHS) and the Substance Abuse and Mental Health Services
Administration (SAMHSA).  After the panel members complete and
discuss their application review findings, the PATH Director contacts
the states' PATH coordinators to follow up on all unresolved issues
identified by the grants specialist and program review panel. 

The Director contacted the five states included in our review to
follow up on their fiscal year 1993 applications.  For example, the
Director asked Florida officials to report on the impact of Hurricane
Andrew on available PATH services and to define items included in the
state's administrative costs.  Florida officials reported that the
hurricane disrupted PATH activities in three counties, including the
cities of Miami, Key West, and Fort Lauderdale.  State officials also
revised the budget estimates to comply with the 1990 McKinney
Amendments' administrative cost limit. 

The Director also asked New York officials to clarify the state's
planned use of PATH funds to support holding and housing beds.  The
New York officials explained that local providers would use PATH
funds to hold a resident's bed in community housing programs in the
event a resident is hospitalized for more than 15 days.  New York
officials further explained that supportive housing is a rental
assistance program and that funds would be used for eligible services
such as minor repairs and security deposits. 

The Director also asked California, Illinois, and Texas officials,
respectively, to submit intended use plans, identify the number of
persons served, and define clinical terms.  The PATH program has not
denied states their allotments; however, PATH has delayed allotments
until the states resolved open application issues. 


         ANNUAL STATE REPORTING
-------------------------------------------------------- Letter :3.1.2

The 1990 McKinney Amendments require PATH grantees (the states and
territories) to annually report the prior fiscal year's program
activities and expenditures by January 31.  The PATH Director, as
well as other CMHS officials, wanted to use the year-end annual
reports to compile statistics, to evaluate program effectiveness such
as the number of homeless individuals reached, and to ensure that
states and territories provided the services listed in their grant
applications.  However, HHS officials acknowledge that the early data
collection format for the report was difficult for states to use and
resulted in inaccurate or inconsistent information across the states,
in some cases. 

HHS allowed states to defer reporting of fiscal year 1991 activities
until January 1993.\7 PATH officials also modified fiscal year 1993's
reporting format to make the instrument easier for states to use and
made more comprehensive revisions for fiscal year 1994 data.  For
example, the fiscal year 1994 annual report requires the states to
report on the number of dually diagnosed persons served and
demographics information for PATH clients; these statistics were
optional information in prior years' reports. 

In addition to requiring further statistical data, the PATH program
is working to develop outcome or person-centered data.  Such data
would measure the impact of services on the homeless individual's
life.  In August 1992, the PATH Reporting and Evaluation
Group--comprised of 23 representatives of state mental health
agencies, local providers, mental health consumers, researchers,
members of the National Association of State Mental Health Program
Directors, and HHS--developed data collection and analysis principles
on the type of person-centered information needed.  A partial list of
desirable outcome data includes information on client satisfaction
and the impact of prevention efforts such as onetime rental payments
or clinical crisis intervention.  The group also recognized that the
data should be relatively inexpensive to collect and should be useful
for monitoring programs. 


--------------------
\7 HHS offered the states the option of postponing fiscal year 1991
reports until January 31, 1993--the due date for the fiscal year 1992
reports--because the Department did not distribute the fiscal year
1991 grants until the last quarter of fiscal year 1991. 


         ON-SITE MONITORING
-------------------------------------------------------- Letter :3.1.3

HHS' on-site monitoring protocol includes observing selected local
provider activities and meetings between the PATH Director and the
state's PATH Coordinator concerning the state's organizational
structure for delivering mental health services; techniques the state
uses to ensure that local providers deliver services; and the state's
working definitions of "homelessness," "serious mental illness," and
"co-occurring mental illness and substance abuse disorders."

The PATH Director first tested the protocol in Tennessee in August
1993.  She reported that on-site monitoring will augment her
understanding of the states' and territories' PATH programs.  The
Director plans to visit six to eight additional states during fiscal
year 1994; she is the only full-time PATH employee.  The Director
will address statutory and regulatory issues she identifies and will
refer program implementation matters to a technical assistance
contractor.\8


--------------------
\8 Under contract with HHS, the National Association of State Mental
Health Program Directors provides PATH-related technical assistance
to the states.  The technical assistance contractor staffs a hotline
to answer the states' programmatic and implementation questions,
issues newsletters, conducts six 2-day workshops and training
sessions annually, and plans and hosts periodic national meetings
bringing all 56 PATH Coordinators together.  Issues addressed in the
newsletter include how to effectively deliver PATH services to
homeless women and children, how to achieve state and local provider
accountability, and how to provide client job training.  The
technical assistance contractor is most often asked to conduct
workshops on delivering services to the dually diagnosed and
developing and accessing housing for the homeless mentally ill. 


      STATE-LEVEL CONTROLS ARE
      DESIGNED TO HELP ENSURE
      PROGRAM INTEGRITY
---------------------------------------------------------- Letter :3.2

State-level program controls that are designed to ensure program
integrity include conducting a needs assessment and maintaining
oversight of local providers' finances and programs.  States are
required to identify geographical areas with the greatest need for
PATH services before selecting local providers.  States also must
develop their own methods for monitoring the financial and program
performance of local providers. 

The five states we reviewed identified high-need areas within their
states before selecting local providers.  Illinois distributed funds
to four urban areas based on the percentage of poverty in the urban
area, the number of persons in the urban area, and the percentage of
overcrowded housing.\9 Florida distributed funds to 7 of its 11
service districts based on the estimated number of homeless persons
in each district.  New York based the PATH fund distribution on
estimates of the number of homeless persons within the state and the
statewide distribution of the homeless mentally ill.  New York
awarded 75 percent of the grant to New York City and equally
distributed the balance among Long Island, the Hudson River area
(including Westchester County), and central and western New York. 
Texas chose to fund the state's seven largest urban areas, along with
three nonurban areas.  California distributed PATH funds to its
counties based on a formula that included the number of households
with incomes below 125 percent of the federal poverty level and the
number of unemployed persons. 


--------------------
\9 Illinois distributed PATH funds to providers located in Chicago,
East St.  Louis, Joliet, and Rockford. 


         FINANCIAL AND PROGRAM
         OVERSIGHT
-------------------------------------------------------- Letter :3.2.1

States hold local providers accountable for appropriately delivering
the agreed-to services by conducting periodic site visits and
requiring providers to report their anticipated outcomes.  For
example, California, Florida, and Texas PATH Coordinators conduct
site visits during the program year to validate local provider
adherence to program requirements and to provide technical
assistance.  These states' providers must also submit expenditure
reports documenting how they have used PATH funds.  New York
delegates oversight responsibilities to a local governmental unit or
to the state's mental health regional office. 

In Illinois, state officials visit local providers biannually.  In
addition, the state links Chicago-area local providers into a
homeless mental health network.  An Illinois PATH contractor, Systems
Administrative Management Entity (SAM-E), oversees the network's
activities.  SAM-E visits a network provider weekly to identify
problems, monitor and coordinate network services, and train network
staff as needed.  For example, SAM-E found that one local provider
had not fully staffed the program in accordance with its PATH
agreement and was not delivering the agreed-to services.  When the
provider did not correct the problem, the state did not renew its
PATH contract. 


         MENTAL HEALTH ASSESSMENTS
-------------------------------------------------------- Letter :3.2.2

The PATH program targets homeless individuals and at-risk populations
with serious mental illnesses and those with co-occurring serious
mental illnesses and substance abuse disorders.  To ensure that the
program serves the target population, many local providers perform
mental health assessments.  Typically, providers performing such
assessments include nonprofit community-based mental health
organizations and county departments of health.  We visited two
Chicago local providers to observe their assessment processes and
determine how their assessments ensured the appropriateness of
homeless individuals for receiving PATH services. 

The Bobby E.  Wright Comprehensive Community Mental Health Center,
Inc., gets client referrals from three sources:  hospitals,
community-based agencies, and the public.  The type of referral is
the primary factor triggering the extent of mental assessment the
Wright center will perform on potential clients.  Hospital referrals
are the most comprehensive and typically include psychiatric and
psychological test results and diagnoses.  These diagnoses are based
on the American Psychiatric Association's Diagnostic and Statistical
Manual of Mental Disorders (DSM-III-R).\10 Community-based referrals
are less comprehensive and have limited psychiatric information about
the potential client.  Usually the PATH screener reviews the
available information on the potential client and can accept the
information, request more data from the referring agency, or schedule
the potential client for in-house diagnostic tests.  Public referrals
from the police, relatives, friends, and others are the least
comprehensive of the three and usually require Wright staff to
conduct a comprehensive mental health assessment on the potential
client. 

The Wright center's comprehensive assessment is a 30-day, three-step
process leading to a DSM-III-R diagnosis.  The caseworkers initially
screen a potential client to determine whether he or she is homeless
and whether the client appears to have a mental health disorder.  If
a client appears to meet the program criteria, he or she is provided
with temporary housing.  Caseworkers then collect data to develop a
psychosocial history that could include historical information on the
client's problems, illegal and legal drug use, medical
recommendations, a tentative diagnosis, and other pertinent
information.  A psychiatrist also tests and observes client
activities and gives the potential client a clinical diagnosis.  At
the end of 30 days, the caseworker, psychiatrist, and others review
the case, confirm or revise the client's initial diagnosis, and then
develop and help implement the client's individual treatment plan. 
An individual treatment plan is a customized strategy that outlines a
client's needs and goals with a view toward helping the client become
self-sufficient. 

Thresholds Bridge Program-Mobile Assessment Unit receives referrals
from the same sources as the Wright center.  In addition, Thresholds
identifies clients through street outreach.  Two-person teams,
consisting of a qualified examiner who is a licensed clinical social
worker and an outreach worker, drive, bike, and walk around
metropolitan Chicago to locate and identify potential clients.\11
Once the team identifies homeless individuals, the assessment process
begins.  The team talks with each homeless individual to assess his
or her mental functioning and to obtain historical information on the
person's medical and psychological condition, familial structure, and
illegal and legal drug use.  With this information, the team begins
developing a DSM-III-R diagnosis. 

If a potential client is in the midst of a medical or psychiatric
crisis, the team calls for immediate services.  When there is no
crisis, the assessment process can take days or months depending on
the potential client's willingness to receive services.  According to
the Mobile Assessment Unit's Director, it may take several visits
with a homeless individual before the person develops enough trust to
accept Thresholds' services. 


--------------------
\10 Diagnostic and Statistical Manual of Mental Disorders: 
DSM-III-R, Third Edition, Revised (Washington, D.C., 1987).  The
manual includes more than 200 mental disorders and diagnostic
criteria for each disorder. 

\11 In Illinois, a licensed clinical social worker holds a license
authorizing the independent practice of clinical social work under
the auspices of an employer or in private practice.  The licensed
clinical social worker must apply for licensure with the State
Department of Professional Regulations and must have either a
master's degree in social work and at least 3,000 hours of supervised
clinical professional experience or a doctorate degree in social work
and at least 2,000 hours of supervised clinical professional
experience subsequent to earning the degree. 


---------------------------------------------------------- Letter :3.3

We discussed a draft of this report with HHS' SAMHSA, CMHS, and PATH
officials.  They generally agreed with the information presented.  We
have incorporated their comments where appropriate. 

We are sending copies of this report to other interested
congressional committees, the Secretary of Health and Human Services,
the PATH Director, and other interested parties.  We also will make
copies available to others on request. 

Please call me on (202) 512-7119 if you or your staff have any
questions concerning this report.  Major contributors to this report
are listed in appendix IV. 

Mark V.  Nadel
Associate Director
National and Public Health Issues


SCOPE AND METHODOLOGY
=========================================================== Appendix I

To gather PATH program information, we interviewed HHS' Substance
Abuse and Mental Health Services Administration and Center for Mental
Health Service officials responsible for policy and program
oversight, and the PATH program Director.  We also interviewed
officials from the National Association of State Mental Health
Program Directors--the PATH program's technical assistance
contractor, Illinois' PATH Coordinator and two Chicago-area
providers:  the Bobby E.  Wright Comprehensive Community Mental
Health Center, Inc., and the Thresholds Bridge Program-Mobile
Assessment Unit.  We reviewed HHS' program application, monitoring,
and reporting guidance. 

We also reviewed fiscal year 1991-93 grant applications from
California, Florida, Illinois, New York, and Texas and follow-up on
the states' applications.  Further, we reviewed the five states'
fiscal year 1991 and 1992 annual reports.  These five states received
over 34 percent of fiscal years 1991-93 PATH allotments and accounted
for 62, or 16 percent, of the nation's fiscal year 1992 local PATH
providers.  We did not test the adequacy of the five states'
financial controls, nor are the results of our work projectable to
other states.  In addition, we contacted state PATH officials in
Florida, Nevada, and New Hampshire to obtain information on PATH
local providers and clients in fiscal years 1991 and 1992 missing
from HHS' data.  Our review concerned use of federal funds and
program monitoring only; we did not assess the effectiveness of the
programs. 

We performed our work from May to November 1993, except where noted,
in accordance with generally accepted government auditing standards. 


FISCAL YEARS 1992 AND 1993 STATE
AND TERRITORY ALLOTMENTS FOR PATH
PROGRAM
========================================================== Appendix II


State                                       1992        1993
------------------------------------  ----------  ----------
Alabama                                 $300,000    $300,000
Alaska                                   300,000     300,000
American Samoa                            50,000      50,000
Arizona                                  396,000     386,000
Arkansas                                 300,000     300,000
California                             3,800,000   3,705,000
Colorado                                 355,000     346,000
Connecticut                              366,000     357,000
Delaware                                 300,000     300,000
District of Columbia                     300,000     300,000
Florida                                1,519,000   1,481,000
Georgia                                  487,000     474,000
Guam                                      50,000      50,000
Hawaii                                   300,000     300,000
Idaho                                    300,000     300,000
Illinois                               1,265,000   1,233,000
Indiana                                  402,000     392,000
Iowa                                     300,000     300,000
Kansas                                   300,000     300,000
Kentucky                                 300,000     300,000
Louisiana                                332,000     324,000
Maine                                    300,000     300,000
Maryland                                 534,000     521,000
Massachusetts                            706,000     688,000
Michigan                                 867,000     846,000
Minnesota                                354,000     345,000
Mississippi                              300,000     300,000
Missouri                                 415,000     405,000
Montana                                  300,000     300,000
Nebraska                                 300,000     300,000
Nevada                                   300,000     300,000
New Hampshire                            300,000     300,000
New Jersey                               989,000     964,000
New Mexico                               300,000     300,000
New York                               2,106,000   2,054,000
North Carolina                           375,000     366,000
North Dakota                             300,000     300,000
N. Mariana Islands                        50,000      50,000
Ohio                                     993,000     968,000
Oklahoma                                 300,000     300,000
Oregon                                   300,000     300,000
Pennsylvania                           1,075,000   1,049,000
Puerto Rico                              317,000     309,000
Rhode Island                             300,000     300,000
South Carolina                           300,000     300,000
South Dakota                             300,000     300,000
Tennessee                                331,000     323,000
Texas                                  1,697,000   1,654,000
Utah                                     300,000     300,000
Vermont                                  300,000     300,000
Virgin Islands                            50,000      50,000
Virginia                                 571,000     557,000
Washington                               480,000     468,000
West Virginia                            300,000     300,000
Wisconsin                                368,000     359,000
Wyoming                                  300,000     300,000
============================================================
Total                                 $29,400,00  $28,874,00
                                               0           0
------------------------------------------------------------
Source:  HHS. 


FISCAL YEAR 1992 NUMBER OF PATH
CLIENTS SERVED, BY STATE/TERRITORY
========================================================= Appendix III

                                              Number of PATH
State                                              clients\a
--------------------------------------------  --------------
Alabama                                                1,091
Alaska                                                    79
American Samoa                                           200
Arizona                                                  493
Arkansas                                                 915
California                                            47,723
Colorado                                                 776
Connecticut                                              667
Delaware                                                 199
District of Columbia                                     105
Florida                                                2,157
Georgia                                                1,027
Guam                                                      37
Hawaii                                                   518
Idaho                                                    357
Illinois                                               1,442
Indiana                                                1,171
Iowa                                                     697
Kansas                                                   635
Kentucky                                                 653
Louisiana                                                211
Maine                                                    845
Maryland                                                 452
Massachusetts                                          1,302
Michigan                                               1,527
Minnesota                                                803
Mississippi                                              166
Missouri                                               2,417
Montana                                                1,338
Nebraska                                                 260
Nevada                                                 1,003
New Hampshire                                          1,976
New Jersey                                             2,630
New Mexico                                               231
New York                                               2,570
North Carolina                                           594
North Dakota                                             642
N. Mariana Islands                                        45
Ohio                                                   2,407
Oklahoma                                                 584
Oregon                                                   194
Pennsylvania                                           2,068
Puerto Rico                                              457
Rhode Island                                             603
South Carolina                                           791
South Dakota                                             355
Tennessee                                                635
Texas                                                  3,362
Utah                                                     486
Vermont                                                  893
Virgin Islands                                            26
Virginia                                               1,978
Washington                                               762
West Virginia                                            762
Wisconsin                                              1,833
Wyoming                                                  213
============================================================
Total                                                 98,363
------------------------------------------------------------
\a The 1990 McKinney Amendments do not require the states to provide
clients with all eligible PATH services nor do they require states to
emphasize all eligible services equally. 

Source:  HHS. 


MAJOR CONTRIBUTORS TO THIS REPORT
========================================================== Appendix IV

HEALTH, EDUCATION, AND HUMAN
SERVICES DIVISION,
WASHINGTON, D.C. 

Sarah F.  Jaggar, Director, Health Financing and Policy Issues,
 (202) 512-7119
Bruce D.  Layton, Assistant Director

CHICAGO REGIONAL OFFICE

Enchelle D.  Bolden, Evaluator-in-Charge
Shaunessye D.  Curry, Evaluator
Leslie F.  Fautsch, Intern

RELATED GAO PRODUCTS

Homelessness:  McKinney Act Programs and Funding Through Fiscal Year
1991 (GAO/RCED-93-39, Dec.  21, 1992). 

Homelessness:  Single Room Occupancy Program Achieves Goals, but HUD
Can Increase Impact (GAO/RCED-92-215, Aug.  27, 1992). 

1990 Census:  Limitations in Methods and Procedures to Include the
Homeless (GAO/GGD-92-1, Dec.  30, 1991). 

Homelessness:  Transitional Housing Shows Initial Success but
Long-Term Effects Unknown (GAO/RCED-91-200, Sept.  9, 1991). 

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