Health, Education, Employment, Social Security, Welfare, and Veterans
Reports (Letter Report, 06/01/95, GAO/HEHS-95-176W).

This booklet lists GAO documents on governments programs related to
health, education, employment, social security, welfare, and veterans
issues, which are administered primarily by the Departments of Health
and Human Services, Labor, Education, and Veterans Affairs.  One section
identifies reports and testimony issued during the past two months and
summarizes key products. Another section lists all documents published
during the past two years, organized chronologically by subject.  Order
forms are included.

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

 REPORTNUM:  HEHS-95-176W
     TITLE:  Health, Education, Employment, Social Security, Welfare, 
             and Veterans Reports
      DATE:  06/01/95
   SUBJECT:  Health care services
             Educational programs
             Welfare benefits
             Veterans benefits
             Retirement pensions
             Social security benefits
             Employment or training programs
IDENTIFIER:  Bibliographies
             Medicare Program
             Medicaid Program
             
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Cover
================================================================ COVER


Health, Education, and Human
Services Division Reports

June 1995

HEALTH
EDUCATION
EMPLOYMENT
SOCIAL SECURITY
WELFARE
VETERANS

GAO/HEHS-95-176W



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

  AFDC - Aid to Families With Dependent Children
  AIDS - acquired immunodeficiency syndrome
  BLS - Bureau of Labor Statistics
  CARE - Comprehensive AIDS Resources Emergency Act
  CDC - Centers for Disease Control and Prevention
  CDR - continuing disability review
  CHAMPUS - Civilian Health and Medical Program of the Uniformed
     Services
  DEA - Drug Enforcement Agency
  DC - District of Columbia
  DI - Disability Insurance
  DOD - Department of Defense
  DOE - Department of Energy
  EEO - Equal Employment Opportunity
  EEOC - Equal Employment Opportunity Commission
  EMA - eligible metropolitan area
  ERISA - Employee Retirement Income Security Act of 1974
  ESEA - Elementary and Secondary Education Act
  FDA - Food and Drug Administration
  FSA - Family Support Act
  GAO - General Accounting Office
  GPRA - Government Performance and Results Act
  HCFA - Health Care Financing Administration
  HEAF - Higher Education Assistance Foundation, Department of
     Education
  HEHS - Health, Education, and Human Services Division, GAO
  HHS - Department of Health and Human Services
  HMO - health maintenance organization
  HRD - Human Resources Division, GAO
  IFA - individualized functional assessment
  IHS - Indian Health Service
  INS - Immigration and Naturalization Service
  IRS - Internal Revenue Service
  JOBS - Job Opportunities and Basic Skills program
  JTPA - Job Training Partnership Act
  NAFTA - North American Free Trade Agreement
  NAGB - National Assessment Governing Board, Department of Education
  NPR - National Performance Review
  OBRA - Omnibus Budget Reconciliation Act of 1990
  PATH - Projects for Assistance in Transition from Homelessness
  PBGC - Pension Benefit Guarantee Corporation
  PPI - producer price index for prescription drugs
  SBA - Small Business Administration
  SSA - Social Security Administration
  SSI - Supplemental Security Income
  T&A - time and attendance
  UMWA - United Mine Workers of America Combined Benefit Fund
  VA - Department of Veterans Affairs
  WIC - Special Supplemental Food Program for Women, Infants, and
     Children

PREFACE
============================================================ Chapter 0

The General Accounting Office (GAO), an arm of the Congress, was
established to independently audit government agencies.  GAO's
Health, Education, and Human Services (HEHS) Division reviews the
government's health, education, employment, social security,
disability, welfare, and veterans programs administered in the
Departments of Health and Human Services, Labor, Education, Veterans
Affairs, and some other agencies. 

This file contains selected key reports and testimonies issued by GAO
on these programs in April and May 1995.  These summaries were taken
from Health, Education, and Human Services Division Reports, a
monthly booklet which contains the following information: 

  -- Most Recent GAO Products:  This section identifies reports and
     testimonies issued during the past 2 months and provides
     summaries for selected key products

  -- Comprehensive 2-Year Listings:  This section lists all products
     published in the last 2 years, organized chronologically by
     subject.  When appropriate, products may be included in more
     than one subject area. 

You may obtain single copies of the products free of charge, by
telephoning your request to (202) 512-6000 or faxing it to (301)
258-4066.  Additional ordering details, as well as instructions for
getting on our mailing list, appear at the end of this file.





Janet L.  Shikles
Assistant Comptroller General


MOST RECENT GAO PRODUCTS
(APRIL - MAY 1995)
============================================================ Chapter 1


   HEALTH
---------------------------------------------------------- Chapter 1:1


      SELECTED SUMMARIES
-------------------------------------------------------- Chapter 1:1.1

Medicare:  Reducing Fraud and Abuse Can Save Billions (Testimony,
5/16/95, GAO/T-HEHS-95-157). 

Medicare is highly vulnerable to fraud and abuse.  The program is
overwhelmed in its efforts to keep pace with, much less stay ahead
of, those bent on cheating the system.  Various factors converge to
create a particularly rich environment for profiteers, including (1)
weak fraud and abuse controls to detect questionable billing
practices, (2) few limits on those who can bill, and (3) overpaying
for services.  These problems are exacerbated by a combination of
factors involving the program's budget, management, and leadership. 
Despite some recent Health Care Financing Administration (HCFA)
initiatives, solving these problems will require both greater
investment in the people and technology needed to manage efforts to
ensure that federal dollars are spent appropriately and more
demanding standards for providers seeking authority to bill Medicare. 

Medicare Managed Care:  Program Growth Highlights Need to Fix HMO
Payment Problems (Testimony, 5/24/95, GAO/T-HEHS-95-174). 

GAO found that recent enrollment growth in Medicare health
maintenance organizations (HMO) has been rapid, increasing the
urgency of correcting rate-setting flaws that result in unnecessary
Medicare spending.  Because it does not tailor its HMO capitation
payment to how healthy or sick HMO enrollees are, HCFA cannot realize
the savings that private-sector payers are able to capture from HMOs. 
Although HCFA is planning demonstration projects to study ways to
correct its HMO rate-setting method, results are likely to be years
away.  GAO believes that, in the short term, HCFA can mitigate its
capitation rate problem by introducing a better health status risk
adjuster.  HCFA also should proceed promptly to test competitive
bidding and other promising approaches to setting HMO rates that
reduce Medicare costs.  Given the recent acceleration in Medicare's
HMO enrollment growth, GAO believes that correcting Medicare's HMO
payment rate problems should become a HCFA priority. 


Community Health Centers:  Challenges in Transitioning to Prepaid
Managed Care (Report, 5/4/95, GAO/HEHS-95-138).  Testimony on same
topic (5/4/95, GAO/T-HEHS-95- 143). 

In response to the changing health care environment, an increasing
number of community health centers are participating in Medicaid
prepaid managed care arrangements.  While centers continue to serve
vulnerable populations, prepaid managed care exposes the centers to
significant financial risks.  By 1993, almost one-half million
community health center patients were covered by prepaid Medicaid
managed care arrangements, an increase of 55 percent from 1991. 
Despite initial concerns that the centers' ability to provide
services to vulnerable populations would be diminished, GAO found
this was not the case in the 10 centers it visited, in part because
the centers receive other revenues.  While maintaining or expanding
their medical and enabling services, all 10 health centers also
improved their overall financial positions to some degree.  However,
even with improved overall financial positions, some health centers
may be still vulnerable to financial difficulties. 

Prescription Drug Prices:  Official Index Overstates Producer Price
Inflation (Report, 4/28/95, GAO/HEHS-95-90). 

Recent research indicates that the producer price index for
prescription drugs (PPI- Drugs) published by the Bureau of Labor
Statistics (BLS), the official wholesale level index of U.S.  drug
prices, has overstated drug price increases substantially since at
least 1984.  This overstatement has three causes.  First, before
1994, BLS used a market basket (sample) of drugs that
underrepresented new and recently introduced drugs in the market. 
This sampling problem alone led PPI-Drugs to overstate drug inflation
between 1984 and 1991 by an estimated 23 to 36 percent.  Second, the
index does not account for the cost savings incurred when consumers
switch to lower priced substitutes, such as generics.  Third,
PPI-Drugs does not adequately separate pure price changes, which
constitute inflation, from price changes that reflect different
product characteristics, such as fewer side effects.  Some progress
has been made in addressing the causes of the overstatement. 

Medicaid Managed Care:  More Competition and Oversight Would Improve
California's Expansion Plan (Report, 4/28/95, GAO/HEHS-95-87). 

California plans a major expansion of its Medi-Cal managed care
program in selected counties.  Problems identified to date in a
primarily voluntary enrollment program could be significantly
magnified in a much larger program with mandatory enrollment.  GAO is
concerned about whether the state will monitor managed care plans
effectively enough to minimize any adverse effects on the
availability and quality of health care provided to Medicaid
enrollees placed in mandatory managed care.  A vital factor in the
success of the program will be the capabilities of the state's
contract management staff.  GAO is also concerned that the state does
not give enough attention to the magnitude of financial incentives
for providers to limit needed care and that the state has difficulty
verifying whether services it pays for are actually provided,
including preventive care for children.  GAO believes that any
benefits of competitive managed care will be lessened by the state's
decision to limit beneficiaries in selected areas to choosing between
two health plans. 

Indian Health Service:  Improvements Needed in Credentialing
Temporary Physicians (Report, 4/21/95, GAO/HEHS-95-46). 

The Indian Health Service (IHS) has unknowingly allowed temporary
physicians with disciplinary actions taken against their licenses to
treat patients.  As a result, these patients may have been placed at
risk of receiving substandard care.  IHS' credentials and privileges
policy does not explicitly require verifying all active and inactive
state medical licenses that a physician may have.  Rather, the policy
requires that a physician have a current medical license with no
restrictions against it to practice medicine.  Furthermore, most IHS
facilities that have contracts with private companies that supply
temporary physicians do not require the companies to inform IHS of
the status of all medical licenses a physician may hold.  IHS
facilities do not have a formal network to share information on the
performance of temporary physicians who have worked with the IHS
medical system.  Therefore, IHS facilities are not always aware of
temporary physicians who have had performance or disciplinary
problems. 

Long-Term Care:  Current Issues and Future Directions (Report,
4/13/95, GAO/HEHS-95-109). 

Long-term care consists of many different services aimed at helping
people with chronic conditions compensate for limitations in their
ability to function independently.  More than 12 million
Americans--young and old--report some long-term care need, and more
than 5 million are estimated to be severely disabled.  Expenditures
for long-term care, particularly institutional care, are high.  In
1993, of nearly $108 billion spent, about 70 percent paid for
institutional care.  Both federal and state governments provide most
of the money for long-term care through dozens of categorical funding
streams.  The financial burden on families, who pay over a third of
the long-term care bill out of pocket, is also high.  To guard
against financial loss, a small but growing number of individuals are
purchasing private long-term care insurance policies.  Families also
bear a considerable nonmonetary burden by caring for relatives. 
Recognizing this, some employers have begun to offer more flexible
schedules and other assistance to help employees balance work and
caregiving. 

Ryan White Care Act of 1990:  Opportunities Are Available to Improve
Funding Equity (Testimony, 4/5/95, GAO/T-HEHS-95-126).  Testimony on
same topic (2/22/95, GAO/T-HEHS-95-91).  Correspondence on same topic
(2/14/95, GAO/HEHS-95-79R, and 3/31/95, GAO/HEHS-95-119R). 

GAO found that the Ryan White Comprehensive AIDS Resources Emergency
(CARE) Act of 1990 funding formulas result in per case funding
disparities that are, to a large extent, unrelated to service costs
or to the ability of states and eligible metropolitan areas (EMA) to
fund services from local sources.  These funding disparities result
from the fact that (1) EMA cases are inappropriately double counted
in both the formula for EMAs and the title II formula for states, (2)
the formulas contain no indicator that reflects differences in the
cost of providing services in both states and EMAs, and (3) formula
factors inappropriately measure caseloads and funding capacity.  GAO
believes that greater funding equity could be achieved by changing
the structure of the two titles to correct the bias introduced by
double counting EMA AIDS cases and by using more appropriate measures
of EMA and state funding needs. 

Medicaid:  Spending Pressures Drive States Toward Program Reinvention
(Report, 4/4/95, GAO/HEHS-95-122).  Testimony on same topic
(GAO/T-HEHS-95-129). 

Medicaid costs are projected to increase from about $131 billion to
$260 billion by the year 2000, according to the Congressional Budget
Office.  Between 1985 and 1993, federal Medicaid expenditures grew
each year, on average, by 16 percent.  In the mid-1980s, some states
began using creative financing mechanisms to leverage additional
federal dollars.  More recently, states began seeking section 1115
waivers designed to contain the cost of their Medicaid programs
through the use of capitated managed care delivery systems and expand
coverage to uninsured individuals who would not normally qualify for
Medicaid benefits.  GAO's analysis of four states with approved
waivers shows that Florida, Hawaii, and Oregon may obtain more
federal funding than they would have likely received under their
original Medicaid programs.  While these expansions will extend
health care benefits to more low-income individuals, the result could
also be a heavier burden on the federal budget. 

Medicaid:  Restructuring Approaches Leave Many Questions (Report,
4/4/95, GAO/HEHS-95-103). 

Different advantages and disadvantages for each of the three basic
approaches to restructuring Medicaid--federal block grants,
federalizing the program, or splitting responsibility between federal
and state governments--have been cited by observers and proponents. 
GAO found that all discussions identified to restructure Medicaid
have focused on the altered financing arrangements and lacked
information on how elements of program design would be structured. 
Further, little quantitative analysis has been done to determine any
of the potential effects of restructuring.  GAO's statistical
analysis demonstrates the important influence of the business cycle
on Medicaid spending.  A rainy day fund could be one way to assist
states during economic downturns if strong limits are placed on
federal contributions.  GAO found that in at least 22 states,
including 8 of the 10 largest states, Medicaid spending is sensitive
to state economic conditions.  On average, Medicaid spending rises by
6 percent for every 1 percentage point increase in the unemployment
rate. 


      OTHER HEALTH PRODUCTS
-------------------------------------------------------- Chapter 1:1.2

Medicare Claims:  Commercial Technology Could Save Billions Lost to
Billing Abuse (Report, 5/5/95, GAO/AIMD-95-135). 

Vaccines for Children:  Barriers to Immunization (Testimony, 5/4/95,
GAO/T- PEMD-95-21). 

Financial Audit:  U.S.  Senate Health Promotion Revolving Fund for
the Periods Ended 9/30/93 and 12/31/92 (Report, 5/3/95,
GAO/AIMD-95-105). 

Maine Practice Guidelines (Letter, 4/4/95, GAO/HEHS-95-118R). 


   EDUCATION
---------------------------------------------------------- Chapter 1:2


      SELECTED SUMMARIES
-------------------------------------------------------- Chapter 1:2.1

School Safety:  Promising Initiatives for Addressing School Violence
(Report, 4/25/95, GAO/HEHS-95-106). 

The four school-based violence-prevention programs--in Anaheim and
Paramount, California; Dayton, Ohio; and New York City--that we
visited all show initial signs of success.  Violence-prevention
literature and experts consistently associate at least seven
characteristics with promising school-based violence-prevention
programs.  These characteristics are (1) a comprehensive approach,
(2) an early start and long-term commitment, (3) strong leadership
and disciplinary policies, (4) staff development, (5) parental
involvement, (6) interagency partnerships and community linkages, and
(7) a culturally sensitive and developmentally appropriate approach. 
Although few violence-prevention programs have been evaluated,
efforts are under way to identify successful approaches for curbing
school violence.  For example, for fiscal years 1993 and 1994, GAO
identified 26 federal grants (approximately $28 million) that help to
evaluate the effectiveness of various school-based violence
prevention programs. 

School Facilities:  America's Schools Not Designed or Equipped for
21st Century (Report, 4/4/95, GAO/HEHS-95-95).  Testimony on same
topic (4/4/95, GAO/T-HEHS-95- 127). 

School officials in a national sample of schools reported that
although most schools meet many key facilities requirements and
environmental conditions for education reform and improvement, most
are unprepared for the 21st century in critical areas.  Most schools
do not fully use modern technology.  Over 14 million students attend
about 40 percent of schools that reported that their facilities
cannot meet the functional requirements of laboratory science or
large-group instruction even moderately well.  Although education
reform requires facilities to meet the functional requirements of key
support services, about two-thirds of schools reported that they
cannot meet the functional requirements of before- or after- school
care or day care.  Moreover, not all students have equal access to
facilities that can support education into the 21st century, even
those attending school in the same district. 

Department of Education:  Information on Consolidation Opportunities
and Student Aid (Testimony, 4/6/95, GAO/T-HEHS-95-130). 

The Department of Education's budget, in fiscal year 1995, accounts
for about $33 billion of the estimated $70 billion in federal
education assistance.  The Department administers 244 education
programs, and 30 other federal agencies administer another 308.  The
Department has already proposed several programs as candidates for
consolidation.  Some portion of an additional 151 programs
administered by both the Department and other federal agencies may
also present an opportunity to streamline federal education spending. 
Additional factors need to be considered in determining maximum
efficiency from consolidation.  For example, determining how to
achieve a coordinated delivery of services at the local level needs
to be considered.  Concerning student aid, the Department's budget
proposal may overstate the cost savings associated with fully
implementing direct lending under credit reform rules, but
substantial savings could still accrue.  In addition, it is too early
to evaluate the effectiveness of recent Department initiatives to
improve its oversight of student aid programs. 


   EMPLOYMENT
---------------------------------------------------------- Chapter 1:3


      SELECTED SUMMARIES
-------------------------------------------------------- Chapter 1:3.1

EEOC:  Burgeoning Workload Calls for New Approaches (Testimony,
5/23/95, GAO/T- HEHS-95-170). 

The Equal Employment Opportunity Commission's (EEOC) world has
changed drastically since EEOC was established by the Civil Rights
Act of 1964.  By law, EEOC must accept for possible investigation
every charge of employment discrimination.  It is burdened with a
growing and aging inventory of pending charges.  In addition, because
of employees' increased awareness of their rights and the number of
nondiscrimination laws, EEOC faces a large and growing inflow of new
charges.  To continue to approach its mission as it has in the past
and reduce the current inventory of pending charges, EEOC would
require large numbers of new staff.  In the current economic climate,
however, substantial increases in staff to handle EEOC's burgeoning
workload are unlikely.  EEOC recognizes its dilemma.  It has
discontinued its long-standing policy of fully investigating every
charge in favor of a policy that targets investigative resources on
the basis of the strength of a charge's evidence of discrimination. 
Beginning October 1, 1995, EEOC will attempt to settle selected cases
through mediation before using the traditional charge process. 

Department of Labor:  Rethinking the Federal Role in Worker
Protection and Workforce Development (Testimony, 4/4/95,
GAO/T-HEHS-95-125). 

GAO's work suggests that although the Department of Labor has
accomplished much over its history, its current approaches to worker
protection are dated and frustrate both workers and employers.  What
is needed, according to the employers and employees GAO spoke with,
is a greater service orientation:  improved communication, increased
employers' and workers' accessibility to compliance information, and
expanded meaningful input into the standard-setting and enforcement
processes.  By developing alternative regulatory strategies that
supplement and in some instances might replace its current
labor-intensive compliance and enforcement approach, Labor can carry
out its statutory responsibilities in a less costly, more effective
manner.  Similarly, in the workforce development area, the nation's
job training programs have become increasingly fragmented and
unclear.  What exists today, spread across many federal agencies, is
a patchwork of federal programs with similar goals, conflicting
requirements, overlapping populations, and questionable outcomes. 


      OTHER EMPLOYMENT PRODUCTS
-------------------------------------------------------- Chapter 1:3.2

Personnel Practices:  Selected Characteristics of Recent Ramspeck Act
Appointments (Testimony, 5/24/95, GAO/T-GGD-95-173). 

Title 6 T&A Data (NASA) (Letter, 5/23/95, GAO/AIMD-95-140R). 

Title 6 T&A Data (NRC) (Letter, 5/23/95, GAO/AIMD-95-139R). 

Sunday Premium Pay:  Millions of Dollars in Sunday Premium Pay Are
Paid to Employees on Leave (Report, 5/19/95, GAO/GGD-95-144). 

Employees' Travel Claims (USIA) (Letter, 5/19/95.  GAO/AIMD-95-138R). 

Federal Affirmative Employment:  Progress of Women and Minority
Criminal Investigators at Selected Agencies (Report, 4/25/95,
GAO/GGD-95-85). 

Federal Quality Management:  Strategies for Involving Employees
(Report, 4/18/95, GAO/GGD-95-79). 

Administratively Uncontrollable Overtime (Letter, 4/14/95,
GAO/GGD-95-129R). 

Equal Opportunity:  DOD Studies on Discrimination in the Military
(Report, 4/7/95, GAO/NSIAD-95-103). 


   SOCIAL SECURITY, DISABILITY,
   AND WELFARE
---------------------------------------------------------- Chapter 1:4


      SELECTED SUMMARIES
-------------------------------------------------------- Chapter 1:4.1

Welfare Programs:  Opportunities to Consolidate and Increase Program
Efficiencies (Report, 5/31/95, GAO/HEHS-95-139). 

About 80 welfare programs provide assistance to low-income
individuals and families; federal expenditures for these programs
totaled $223 billion in 1993.  These myriad welfare programs--each
with its own rules and requirements--are difficult for families in
need to access and cumbersome for program administrators to operate. 
GAO has identified several program areas--including employment
training, food assistance, and early childhood programs--where
numerous programs target the same clients, share the same goals, and
provide similar services.  Confronted with this complex system, state
governments and local providers have sought to streamline program
operations and service delivery.  However, such efforts are hindered
by the patchwork of federal programs and funding streams.  To
streamline this system, the Congress and the administration are
considering consolidating specific federal programs, including
employment training, child care subsidy, and housing programs. 

Foster Care:  Health Needs of Many Young Children Are Unknown and
Unmet (Report, 5/26/95, GAO/HEHS-95-114). 

GAO's work indicates that a significant proportion of young foster
children did not receive critical health-related services in the
three locations reviewed--Los Angeles County, New York City, and
Philadelphia County.  Despite state and county foster care agency
regulations requiring comprehensive routine health care, an estimated
12 percent of young foster children received no routine health care,
34 percent received no immunizations, and 32 percent had at least
some identified health needs that were not met.  GAO also found that
young foster children placed with relatives received fewer
health-related services of all kinds than children placed with
nonrelative foster parents.  Local foster care agencies continue to
grapple with designing programs to meet the health-related service
needs of children.  In the locations reviewed, agencies have revised
health-related foster care regulations and modified their programs in
efforts to improve the delivery of health care to foster children. 

Disability Insurance:  Broader Management Focus Needed to Better
Control Caseload (Testimony, 5/23/95, GAO/T-HEHS-95-164). 

At nearly $40 billion annually in cash payments to disabled workers,
plus $16 billion more for medical coverage, the Social Security
Disability Insurance program represents a significant investment of
public resources.  A program of this magnitude and importance needs
proper management and controls to ensure that funds are being spent
as the Congress intended.  GAO's work to date shows that the Social
Security Administration (SSA) has not paid enough attention to
controlling the program and managing caseload growth.  SSA has
devoted its management attention and resources to improving the
disability determination process to reduce huge backlogs created by
increases in applications and appeals.  However, SSA needs to ensure
that these efforts do not result in increased allowances and less
accurate decisions.  SSA also needs to focus more attention and
resources on determining whether beneficiaries already on the rolls
should still be there and whether more beneficiaries could be
encouraged to return to work. 

Welfare to Work:  Most AFDC Training Programs Not Emphasizing Job
Placement (Report, 5/19/95, GAO/HEHS-95-113). 

Programs that stress the goal of employment for their participants
and forge close links with employers show promise in promoting work
among welfare recipients.  The five programs that GAO visited all
share that emphasis, although they differ in their approaches.  A
majority of county Job Opportunities and Basic Skills (JOBS) programs
across the nation do not have a strong employment focus.  About
one-half of the county JOBS administrators nationwide stated that
they do not work enough with employers to find jobs for participants. 
Program administrators reported that many obstacles stood in their
way.  Most local administrators cited insufficient staffing and
resources as hindering their work with employers.  Many also stated
that more flexibility in federal rules governing employment subsidies
and work-experience programs could facilitate their use.  GAO also
noted that states are currently not required to track the number of
Aid to Families With Dependent Children (AFDC) recipients who get
jobs or earn their way off AFDC.  As a result, programs need not make
strong efforts to help them get jobs. 

Welfare Dependency:  Coordinated Community Efforts Can Better Serve
Young At-Risk Teen Girls (Report, 5/10/95, GAO/HEHS/RCED-95-108). 

The forces of poverty--eroding the foundations of individuals,
families, and communities--can show some of their most debilitating
effects on young at-risk teen girls.  Generally, community service
providers told GAO that services for at-risk girls aged 10 to 15 were
limited and the services that were available were often provided
after problems reached the crisis stage.  To better serve and reach
more area residents, including young girls, some neighborhoods are
organizing coalitions led by local providers, often with assistance
from private organizations and public agencies.  In some cases, these
efforts at integrating services have had a positive effect on
neighborhood children.  Some providers, often working in middle
schools, have expanded their role in the community to better
integrate services for at-risk teens and their families.  Providers
working in these coalitions told GAO they believed the emergence of
neighborhood leadership is critical to the long-term success of the
coalitions. 

Welfare to Work:  Participants' Characteristics and Services Provided
in JOBS (Report, 5/2/95, GAO/HEHS-95-93). 

In spite of the Family Support Act (FSA) aim of making AFDC a
transitional program by providing the education, training, and
supportive services that AFDC recipients need to move from welfare to
work, most adult AFDC recipients do not participate in JOBS programs
because of the act's allowable exemptions and minimum participation
standards.  JOBS programs offer participants a range of services that
are drawn from existing community programs to avoid duplication of
services.  JOBS programs obtain many services at no cost to their
programs, consistent with FSA's emphasis on using such services
whenever possible.  However, most programs also purchase at least
some of the education and training services JOBS participants need. 
Despite the low percentage of adult AFDC recipients being served by
JOBS, many JOBS programs lack the capacity to ensure that all
participants receive the specific services they need when they need
them. 


Welfare to Work:  Measuring Outcomes for JOBS Participants (Report,
4/17/95, GAO/HEHS-95-86). 

HHS does not know whether the JOBS program is reducing welfare
dependency because it does not gather enough information on critical
program outcomes, such as the number of participants entering
employment and leaving AFDC annually.  While little progress has been
made in monitoring JOBS outcomes at the federal level, the picture is
better at the state level.  Nearly all states use some information on
participant outcomes to manage their individual programs, although
the extent to which states monitor outcomes varies widely.  The
current national interest in making welfare more employment focused,
as well as requirements in the Government Performance and Results Act
(GPRA) that performance monitoring become more outcome oriented
governmentwide, indicate a need for HHS to move decisively to ensure
that it meets its current schedule for developing outcome measures
and goals for JOBS. 


      OTHER SOCIAL SECURITY,
      DISABILITY, AND WELFARE
      PRODUCTS
-------------------------------------------------------- Chapter 1:4.2

Combined Fund Update (Letter, 5/25/95, GAO/HEHS-95-166R). 

Overview of Federal Retirement Programs (Testimony, 5/22/95,
GAO/T-GGD-95- 172). 

Federal Retirement:  Benefits for Members of Congress, Congressional
Staff, and Other Employees (Report, 5/15/95, GAO/GGD-95-78). 
Testimony on same topic (5/15/95, GAO/T-GGD-95-165). 

SSI Disability Issues (Letter, 5/11/95, GAO/HEHS-95-154R). 


   VETERANS AFFAIRS AND MILITARY
   HEALTH
---------------------------------------------------------- Chapter 1:5


      SELECTED SUMMARIES
-------------------------------------------------------- Chapter 1:5.1

Operation Desert Storm:  Health Concerns of Selected Indiana Persian
Gulf War Veterans (Report, 5/16/95, GAO/HEHS-95-102). 

Despite Department of Defense (DOD) and Department of Veterans
Affairs (VA) efforts to address the concerns of Persian Gulf
veterans, the Indiana veterans GAO surveyed still expressed concerns
about their health and dissatisfaction with services from DOD and VA. 
Most respondents were still in the reserves and almost all reported
that they had health problems they believed were caused by their
service in the Persian Gulf.  Most also reported that these problems
limited their physical and social activities to some extent.  Over
half of the respondents had taken advantage of medical services,
either the special examinations or other health care, available to
them through VA or DOD.  Many, however, were dissatisfied with the
medical care they received or were unaware of available services. 
DOD and VA have undertaken a variety of efforts to address the
concerns raised by Persian Gulf veterans, including expanding the
health examinations available to them.  Also, in response to recent
legislation, both agencies are expanding outreach efforts to better
ensure that veterans are aware of available services. 

VA Health Care:  Challenges and Options for the Future (Testimony,
5/9/95, GAO/T-HEHS-95-147). 

VA, with a $16 billion health care budget, faces increasing pressures
to contain or reduce health care spending as part of governmentwide
efforts to reduce the budget deficit.  It also faces increasing
challenges from a rapidly changing health care marketplace.  GAO's
work clearly demonstrates that VA lags far behind the private sector
in improving the efficiency of its hospitals.  VA is at a crossroad
in the evolution of its health care system.  The average daily
workload in its hospitals dropped about 56 percent during the last 25
years, and further decreases are likely.  At the same time, however,
demand for outpatient care, nursing home care, and certain
specialized services is expanding, taxing VA's ability to meet
veterans' needs.  Decisions made over the next few years about VA's
role will have significant implications for veterans, taxpayers, and
private health care providers.  A complete reevaluation of the VA
health care system appears to be needed.  Absent such an effort, use
of VA hospitals will likely continue to decline to a point where VA's
ability to provide quality care and support its secondary missions
will be jeopardized. 

Veterans' Benefits:  VA Can Prevent Millions in Compensation and
Pension Overpayments (Report, 4/28/95, GAO/HEHS-95-88). 

Despite its responsibility to ensure accurate benefits payments, VA
continues to overpay veterans and their survivors hundreds of
millions of dollars in compensation and pension benefits each year. 
For example, in 1994, VA detected about $372 million in overpayments
to its beneficiaries.  Based on our analysis of a survey of
overpayments in May 1994, changes in income accounted for a large
portion of overpayments, and receipt of Social Security benefits
accounted for a significant share of income-related overpayments.  VA
has the capability to prevent millions of dollars in overpayments,
but has not done so because it has not focused on prevention.  For
example, VA does not use available information, such as when
beneficiaries will become eligible for Social Security benefits, to
prevent the overpayments from occurring.  VA does not systematically
collect, analyze, and use information on the specific causes of
overpayments that will help it target prevention efforts. 

VA Health Care:  Retargeting Needed to Better Meet Veterans' Changing
Needs (Report, 4/21/95, GAO/HEHS-95-39). 

Many veterans have health care needs that are not adequately
addressed through current health care programs, including the VA
health care system.  VA cannot adequately address many of these
health care needs because (1) it relies primarily on direct delivery
of health care services in VA-owned and operated facilities, (2) its
complex eligibility and entitlement provisions limit the services
veterans can get from VA facilities, and (3) space and resource
limitations prevent eligible veterans from obtaining covered
services.  In GAO's view, changes need to be made in the veterans'
health care system to enable it to better meet veterans' needs.  To
make optimum use of limited health care resources, such changes would
need to be designed to complement rather than duplicate coverage
provided through other public and private health benefits programs. 
VA's plans for restructuring the VA health care system, however,
focus primarily on preserving and expanding VA's acute care mission
rather than retargeting VA programs and resources to enable VA to
fill the gaps in veterans' coverage under other public and private
health benefits programs. 


      OTHER VETERANS AFFAIRS AND
      MILITARY HEALTH PRODUCTS
-------------------------------------------------------- Chapter 1:5.2

Concurrent Receipt (Letter, 4/27/95, GAO/HEHS-95-136R). 

Barriers to VA Managed Care (Letter, 4/20/95, GAO/HEHS-95-84R). 

Veterans Compensation:  Offset of DOD Separation Pay and VA
Disability Compensation (Report, 4/3/95, GAO/NSIAD-95-123). 


MAJOR CONTRIBUTORS
============================================================ Chapter 2

Jessie L.  Battle
David W.  Bieritz
Susan Y.  Higgins
James L.  Kirkman
Stephen F.  Palincsar



MAILING LIST REQUEST FORM
============================================================ Chapter 3


         ADDRESS INFORMATION
------------------------------------------------------ Chapter 3:0.0.1

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         AREAS OF INTEREST
------------------------------------------------------ Chapter 3:0.0.2

To receive future reports and testimonies, check your area(s) of
interest. 

HEALTH EMPLOYMENT
Access and Infrastructure Equal Employment Opportunities
Employee and Retiree Benefits High Performance Workplaces
Financing Labor and Management Relations
Health Care Reform Training and Employment
HHS Public Health Service Assistance
Long-Term Care and Aging Workplace Quality
Malpractice Other Employment Issues
Managed Care
Medicare and Medicaid SOCIAL SECURITY, DISABILITY,
Prescription Drugs & WELFARE
Provider Issues Children's Issues
Public Health and Education Pensions
Quality and Practice Standards Social Security & Disability
Substance Abuse and Treatment Welfare
Other Health Issues Other Social Security, Disability,
& Welfare Issues
EDUCATION
Department of Education
Early Childhood Development VETERANS AFFAIRS & MILITARY
Armed Forces HEALTH
Elementary and Secondary Military Health
Higher Education Veterans' Benefits
School-to-Work Transition Veterans' Health Care


         MAIL OR FAX TO: 
------------------------------------------------------ Chapter 3:0.0.3

Janet Shikles, Assistant Comptroller General
Health, Education, and Human Services Division, NGB/ACG
U.S.  General Accounting Office
441 G Street, N.W., Washington, D.C., 20548


         (6/95)(GPO)
------------------------------------------------------ Chapter 3:0.0.4

Fax Number (202) 512-5806. 


*** End of document. ***