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entitled 'Means-Tested Programs: Information on Program Access Can Be 
an Important Management Tool' which was released on April 8, 2005. 

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Report to the Ranking Minority Member, Committee on the Budget, House 
of Representatives: 

United States Government Accountability Office: 

GAO: 

March 2005: 

Means-Tested Programs: 

Information on Program Access Can Be an Important Management Tool: 

GAO-05-221: 

GAO Highlights: 

Highlights of GAO-05-221, a report to the Ranking Minority Member, 
Committee on the Budget, House of Representatives: 

Why GAO Did This Study: 

Federal agencies that administer means-tested programs are responsible 
for both ensuring that people have appropriate access to assistance and 
ensuring the integrity of the programs they oversee. To balance these 
two priorities appropriately, it is important for agencies to have 
information on program integrity and program access. Knowing the 
proportion of the population that qualifies for these programs relative 
to the numbers who actually participate can help ensure that agencies 
can monitor and communicate key information on program access. 

To better understand participation in low-income programs, this report 
provides information on: (1) the proportion of those eligible who are 
participating in 12 selected low-income programs; (2) factors that 
influence participation in those programs; and (3) strategies used by 
federal, state, and local administrators to improve both access and 
integrity, and whether agencies monitor access by measuring 
participation rates. 

What GAO Found: 

For 12 federal programs supporting low-income people, we found that the 
proportion of those eligible who are enrolled varies substantially both 
between and within programs. Among entitlement programs—those programs 
that provide benefits to all applicants that meet program eligibility 
criteria—these rates range from about 50 to more than 70 percent. Among 
non-entitlement programs—those with limited funding—these rates ranged 
from less than 10 percent to more than 50 percent. While it may be 
neither feasible nor desirable for programs to serve 100 percent of 
those eligible for benefits, information on the share of those eligible 
who are enrolled in means-tested programs and on particular recipient 
groups such as the elderly or families with children, can help program 
managers more effectively address issues related to program access. 
However, participation rate estimates must be interpreted carefully 
because of limitations in the data sources and estimation methodologies 
used to calculate the estimates. 

Many factors influence access to low-income programs—including the type 
of benefits, ease of access, misperceptions about program requirements, 
and application and eligibility verification procedures. These factors 
can impact not only the share of eligible people who participate in low-
income programs, but other aspects of program access as well, including 
the composition of the program caseload and how programs work together 
to serve low-income individuals and families. 

Federal, state, and local administrators have implemented many 
strategies to achieve the goals of access and integrity, but federal 
agencies generally put more emphasis on tracking information and 
outcomes related to program integrity than program access. To better 
ensure that program administrators achieve program integrity goals, 
agencies have begun to develop measures to track and report on program 
integrity. Federal agencies have developed participation rate estimates 
for several low-income programs, but only four—CCDF, food stamps, WIC, 
and EITC—either currently collect and report information on the extent 
to which they are reaching their target populations or plan to do so. 
Such information can guide administrators in setting priorities and 
targeting scarce resources, even among programs that were not intended 
to serve everyone eligible for program benefits. 

The 12 Federal Means Tested Programs Reviewed: 

[See PDF for image]

[End of figure]

What GAO Recommends: 

GAO recommends that the Secretaries and Commissioners whose programs do 
not currently use participation rate information to consider using this 
information in managing their programs. GAO makes technical 
recommendations on how the usefulness of these measures could be 
improved. The agencies generally agreed with our recommendations. 

www.gao.gov/cgi-bin/getrpt?GAO-05-221. 

To view the full product, including the scope and methodology, click on 
the link above. For more information, contact David Bellis (415) 904-
2272 or bellisd@gao.gov. 

[End of section]

Contents: 

Letter: 

Results in Brief: 

Background: 

Use of Federal Low-Income Assistance Varies Greatly by Program and by 
Subgroup: 

Many Factors Influence Participation but Their Impact on Entitlement 
and Non-Entitlement Programs Differs: 

Program Administrators Have Strategies That Improve Both Access and 
Integrity, but Federal Agencies Have Generally Focused More on 
Measuring Program Integrity Outcomes: 

Conclusion: 

Recommendations to Executive Agencies: 

Agency Comments: 

Appendix I: Objectives, Scope, and Methodology: 

Appendix II: Limitations Affecting Use of Participation and Coverage 
Rates: 

Appendix III Estimates of Improper Payments for Programs Reviewed: 

Appendix IV: Comments from the Department of Education: 

Appendix V: Comments from the Department of Health and Human Services: 

Appendix VI: Comments from the Department of the Treasury: 

Appendix VII: Comments from the Social Security Administration: 

Appendix VIII: GAO Contacts and Staff Acknowledgments: 

GAO Contacts: 

Staff Acknowledgments: 

Related GAO Products: 

Tables: 

Table 1: Fiscal Year 2003 Annual Expenditures and Agencies Responsible 
for Administering 12 Selected Low--Income Programs: 

Table 2: Descriptions of 12 Low-Income Programs: 

Table 3. Level of Government Responsible for Funding and Design of 12 
Low-Income Programs: 

Table 4: Estimated Participation Rates for Entitlement Programs for the 
Most Recent Year Data Were Available: 

Table 5: Available Subgroup Participation Rate Estimates for 
Entitlement Programs for the Most Recent Year Data Were Available: 

Table 6: Estimated Coverage Rates for Non-Entitlement Programs for the 
Most Recent Year Data Were Available: 

Table 7: Coverage Rate Estimates for TANF Cash Assistance and WIC 
Subgroups for the Most Recent Year Data Were Available: 

Table 8: Potential Cost of Providing Benefits to Eligible Non-
participants for the Most Recent Year Data Were Available: 

Table 9: Status of Agencies Identification of and Reporting on the 
Amounts of Improper Payments by Program: 

Table 10: Status of Agencies Efforts to Use Information on 
Participation or Coverage Rates in Managing Their Programs: 

Table 11: Summary of Participation and Coverage Rate Methodologies: 

Table 12: Improper Payment Estimates Reported in Agency Fiscal Year 
2003 Performance and Accountability Reports: 

Figures: 

Figure 1: Food Stamp Participation Rate Estimates for Fiscal Years 1999 
to 2002: 

Figure 2: Head Start Coverage Rate Estimates for 1997 to 2003: 

Abbreviations: 

ACF: Administration for Children and Families: 

CCDF: Child Care and Development Fund: 

CMS: Centers for Medicare & Medicaid Services: 

CPS: Annual Social and Economic Supplement to the Current Population 
Survey: 

ED: Department of Education: 

EITC: Earned Income Tax Credit: 

FNS: Food and Nutrition Service: 

FRED: Fraud Early Detection: 

FY: fiscal year: 

HCV: Housing Choice Vouchers: 

HHS: Department of Health and Human Services: 

HIPAA: Health Insurance Portability and Accountability Act: 

HUD: Department of Housing and Urban Development: 

IPIA: Improper Payments Information Act: 

IRS: Internal Revenue Service: 

NRC: National Research Council: 

OMB: Office of Management and Budget: 

PRWORA: Personal Responsibility and Work Opportunity Reconciliation 
Act: 

SCHIP: State Children's Health Insurance Program: 

SIPP: Survey of Income and Program Participation: 

SSA: Social Security Administration: 

SSBG: Social Security Block Grant: 

SSI: Supplemental Security Income program: 

TANF: Temporary Assistance for Needy Families: 

TRIM3: Transfer Income Microsimulation Model, version 3: 

USDA: Department of Agriculture: 

WIC: Special Supplemental Nutrition Program for Women Infants, and 
Children: 

United States Government Accountability Office: 

Washington, DC 20548: 

March 11, 2005: 

The Honorable John M. Spratt, Jr.: 
Ranking Minority Member: 
Committee on the Budget: 
House of Representatives: 

Dear Mr. Spratt: 

Each year through more than 80 means-tested programs, the federal 
government provides benefits and services to individuals and families 
with low incomes--just 12 of which account for as much as $330 billion 
in annual federal expenditures. As stewards of these funds, federal 
agencies have many roles, among them: to ensure that people have 
appropriate access to this assistance and to ensure the integrity of 
these programs by guarding against improper payments and unqualified 
participation. These responsibilities can be complementary, but they 
can also be practiced in ways that work at cross purposes. Outreach 
without appropriate screening, for example, can result in service to 
the wrong recipients, but cumbersome enrollment procedures can 
discourage those who qualify from applying. To meet requirements 
related to the Improper Payments Information Act of 2002, federal 
agencies administering these programs will be required to institute new 
steps to assure integrity by annually measuring and reporting improper 
payments. As they step-up efforts to ensure integrity, they will be 
challenged, as well, to ensure appropriate access. Without a sense of 
the proportion of the population that qualifies for these programs 
relative to the numbers who actually participate, however, it may be 
difficult for most agencies to know whether they have struck an 
appropriate balance in the weight of their strategies and whether they 
need to pursue methods that better serve both access and integrity. 

To better understand participation in low-income programs, we have 
agreed to provide you information on: (1) the proportion of those 
eligible who are participating in 12 selected low-income programs; (2) 
the factors that influence participation in those programs; and (3) 
strategies used by federal, state, and local administrators to improve 
both access and integrity, and whether agencies monitor access by 
measuring participation rates. The 12 programs included in this review 
are among the largest and were selected to cover a range of benefits 
and services aimed at supporting needy families and individuals. They 
include: the Child Care and Development Fund (CCDF), the Earned Income 
Tax Credit (EITC), the Special Supplemental Nutrition Program for 
Women, Infants, and Children (WIC), the Food Stamp Program, the 
Supplemental Security Income program (SSI), the Head Start program, the 
Pell Grant program, the Medicaid program, the State Children's Health 
Insurance Program (SCHIP), the Temporary Assistance for Needy Families 
(TANF) program, the Housing Choice Voucher (HCV) program, and the 
public housing program. 

To address our research objectives, we compiled estimates of the 
proportion of those eligible who participate in each of the programs 
for the most recent year for which data were available[Footnote 1] 
using different methodologies. We refer to this proportion as a 
participation rate when discussing entitlement programs and other 
programs that provide program benefits to all eligible applicants: 
EITC, food stamps, Medicaid, Pell Grants, and SSI. We refer to it as a 
coverage rate when discussing non-entitlement programs that do not 
necessarily provide benefits to all eligible individuals who apply for 
the program: CCDF, Head Start, Housing Choice Vouchers, Public Housing, 
SCHIP, TANF, and WIC. For seven programs, we contracted with the Urban 
Institute to provide us with information about their microsimulation 
model estimates of participation rates.[Footnote 2] These model 
estimates are also used to calculate estimates of the potential cost of 
serving eligible nonparticipants in a subset of programs. For the 
remaining programs, we provide participation or coverage rate estimates 
based on administrative and national survey data. We held discussions 
with federal agency officials to discuss the reliability of program 
data used in our estimates, reviewed related documentation, and ensured 
that the agencies conducted tests of the data for omissions and errors. 
In addition, we reviewed literature on factors that influence 
participation in the 12 programs covered by the review and strategies 
to improve program access and program integrity. We surveyed and 
interviewed the federal agencies that administer the 12 programs on 
factors they have identified that influence program participation and 
on strategies they have implemented to improve program access and 
program integrity. In addition, we interviewed federal, state, and 
local program administrators of various programs in California, 
Connecticut, Georgia, Maryland, and Minnesota, on factors that affect 
participation and strategies they have employed to address the goals of 
program access and program integrity. These states were chosen on the 
basis of innovative programs and initiatives related to program 
integrity and program access and demographic and geographic diversity. 
We performed this work between November 2003 and January 2005 in 
accordance with generally accepted government auditing standards. See 
appendix I for additional information on scope and methodology. 

Results in Brief: 

For 12 federal programs supporting low-income people, we found that the 
proportion of those eligible who are actually enrolled varies 
substantially both between programs and among subgroups enrolled in a 
single program. Given the differences in the goals, design, 
administration, and funding of the 12 programs, it is not surprising 
that we found substantial variation in these proportions. For 
entitlement programs--those designed to support all those who qualify-
-the estimated proportion of eligible people who were enrolled ranged 
from about 50 percent to more than 70 percent. For example, 
approximately three-quarters of those who were eligible took advantage 
of the Earned Income Tax Credit program in 1999, the most recent year 
for which data were available. For non-entitlement programs--those with 
limited funding and not necessarily intended to cover all eligible 
persons--the estimated proportion of the eligible who were enrolled 
ranged from less than 10 percent to more than 50 percent. In the Head 
Start program, for example, funded enrollment was sufficient to cover 
half of all potentially eligible children in 2003. Within some 
programs, we found that some subpopulations were enrolled in different 
proportions than other groups. For example, in the Food Stamp Program, 
the participation rate for families with children was higher than the 
participation rate for other groups. Some evidence shows that enrollees 
tended to be those among the eligible who had greater needs--as 
indicated by the levels of assistance for which they qualified. While 
information on participation rates can help program managers more 
effectively address issues related to program access, several factors 
must be taken into consideration when interpreting this information. 
For example, because of limitations of the data and methodologies used 
to measure rates of participation, we could not make statistically 
reliable comparisons across programs nor could we describe fluctuations 
over time for most programs. 

The size and type of program benefits, ease of access, misperceptions 
about program requirements and eligibility verification requirements 
put in place to ensure program integrity can affect program access in 
both entitlement and non-entitlement programs. For example, agency 
officials told us that participation in the WIC program is highest 
among infants in part because infants are eligible for the highest 
benefits, but that factors such as extended office hours can also 
impact participation. The factors we identified can affect several 
aspects of program access, including not only the number of program 
participants, but also the extent to which programs reach the total 
population eligible for benefits and services, how well agencies are 
allocating resources among targeted subpopulations, and, from an 
agencywide or even governmentwide perspective, how well specific means-
tested programs complement and interact with programs that serve 
similar populations or provide for similar needs. While concerns about 
the allocation of scarce resources and interactions with other programs 
apply to all low-income programs, they may be of particular importance 
to non-entitlement programs whose participation is limited by funding 
constraints. Participation or coverage rate information can guide 
program administrators in setting priorities and targeting scarce 
resources, even among programs that were not intended to serve everyone 
eligible for program benefits. 

Federal, state, and local administrators have implemented a variety of 
strategies to achieve both program access and program integrity, but 
federal agencies generally put more emphasis on tracking information 
and outcomes related to program integrity than program access. Through 
federal agency surveys and site visits, we identified several 
strategies currently being used that have the potential to achieve two 
of the fundamental goals common to all means-tested programs--program 
access and program integrity. These strategies ranged from innovative 
use of information technology to special outreach programs; some were 
in use nationwide and others were state or local efforts. The 
initiation and control of these strategies is often beyond the direct 
control of the federal agencies managing the programs. However, federal 
managers do play a role in that they encourage and facilitate such 
strategies, even in the most decentralized program, by emphasizing the 
importance of program access and program integrity--even absent 
specific related laws or regulations related to these issues. The 
Improper Payments Information Act of 2002 has built upon existing 
governmentwide efforts to emphasize to federal agencies the importance 
of having an internal control framework to address program integrity 
issues. At the same time, internal controls are important management 
tools to ensure that agencies meet their basic goals of reaching 
eligible families. The federal agencies that oversee these entitlement 
and non-entitlement programs can benefit from having up-to-date 
information on the extent to which their programs reach eligible 
individuals. However, while all of the programs we reviewed have begun 
to take steps to measure the extent of improper payments and all make 
efforts to assess how well their programs are working, only four of the 
programs we covered in this review--CCDF, food stamps, WIC, and EITC--
either currently collect and report information on the extent to which 
they are reaching their target populations in key performance and 
program reports or plan to do so. 

To better ensure that agencies have information on program access, we 
recommend to the Secretaries and Commissioners whose programs do not 
currently use participation rate information to consider the use of 
participation rate information in managing their programs. We also make 
some technical recommendations on how the usefulness of these measures 
could be improved. The agencies generally agreed with these 
recommendations. 

Background: 

The federal government funds a wide array of programs intended to 
provide benefits or services to low-income individuals, families, and 
households. The 12 programs included in this review include the largest 
of these programs, Medicaid, as well as some relatively small programs 
such as WIC. The 12 programs are administered by seven different 
federal agencies.[Footnote 3] Table 1 shows the agencies responsible 
for each program and federal expenditures for fiscal year 2003, the 
most current year available. 

Table 1: Fiscal Year 2003 Annual Expenditures and Agencies Responsible 
for Administering 12 Selected Low--Income Programs: 

Program: CCDF; 
Agency: Department of Health and Human Services (HHS), Administration 
for Children and Families (ACF); 
FY 2003 federal expenditures (dollars in billions)[A]: $7.3. 

Program: EITC; 
Agency: Department of Treasury, Internal Revenue Service (IRS); 
FY 2003 federal expenditures (dollars in billions)[A]: 37.9[B]. 

Program: Food Stamp Program; 
Agency: Department of Agriculture (USDA), Food and Nutrition Service 
(FNS); 
FY 2003 federal expenditures (dollars in billions)[A]: 23.9. 

Program: Head Start; 
Agency: HHS/ACF; 
FY 2003 federal expenditures (dollars in billions)[A]: 6.6. 

Program: Housing Choice Voucher Program; 
Agency: Department of Housing and Urban Development (HUD), Office of 
Public and Indian Housing; 
FY 2003 federal expenditures (dollars in billions)[A]: 13.4[C]. 

Program: Medicaid; 
Agency: HHS, Centers for Medicare & Medicaid Services (CMS); 
FY 2003 federal expenditures (dollars in billions)[A]: 160.7. 

Program: Federal Pell Grant Program; 
Agency: Department of Education (ED), Office of Federal Student Aid; 
FY 2003 federal expenditures (dollars in billions)[A]: 12.1. 

Program: Public Housing Program; 
Agency: HUD, Office of Public and Indian Housing; 
FY 2003 federal expenditures (dollars in billions)[A]: 7.6[D]. 

Program: SCHIP; 
Agency: HHS/CMS; 
FY 2003 federal expenditures (dollars in billions)[A]: 4.3. 

Program: WIC; 
Agency: USDA/FNS; 
FY 2003 federal expenditures (dollars in billions)[A]: 4.5. 

Program: SSI; 
Agency: Social Security Administration (SSA); 
FY 2003 federal expenditures (dollars in billions)[A]: 35.2. 

Program: TANF; 
Agency: HHS/ACF; 
FY 2003 federal expenditures (dollars in billions)[A]: $16.3. 

[End of table]

Source: Federal agency officials. 

[A] This includes the total amount of federal expenditures in fiscal 
year 2003, which is the most recent year for which these data were 
available. It includes current and prior year federal funds expended in 
fiscal year 2003; it does not include state expenditures. 

[B] This includes both credits paid out in refunds and reduced tax 
liabilities. 

[C] This includes funding for the housing choice voucher and moderate 
rehabilitation programs. 

[D] This includes expenditures for the public housing capital fund, the 
public housing operating fund, and revitalization of severely 
distressed public housing (HOPE VI). 

These programs provide different benefits and services to different 
target populations. Some of the programs provide benefits that phase 
out gradually, so some people may be eligible for a very low benefit. 
For example, in fiscal year 2005, monthly food stamp benefits for a 
three-person household can be as low as $1 per month. Other programs, 
such as Medicaid, generally offer comparable benefits to every resident 
of a state who meets eligibility requirements. Table 2 provides a brief 
description of each of the programs covered in this report and the 
types of benefits offered by each program. 

Table 2: Descriptions of 12 Low-Income Programs: 

Program: CCDF; 
Description: The Personal Responsibility and Work Opportunity 
Reconciliation Act of 1996 (PRWORA) authorized CCDF to help provide 
child care to low-income families and to give states more flexibility 
to design child care policies. CCDF is funded through an annual block 
grant to states and required state funds and may also include transfers 
from TANF. States are permitted to transfer up to 30 percent of their 
TANF block grant to CCDF. Under CCDF, child care services are available 
to eligible families through certificates or contracts with providers, 
and parents may select any legally operating child care provider, 
including home-based or center-based providers. 

Program: EITC; 
Description: EITC is a refundable federal tax credit available to 
eligible workers earning relatively low incomes. Because the credit is 
refundable, a person does not need to owe taxes to receive benefits. 
EITC is based on earned income, adjusted gross income, and the presence 
of qualifying children, if any. Under current law, there are three 
categories of EITC recipients: childless adults, adults with one child, 
and adults with two or more children. 

Program: Food Stamps; 
Description: The Food Stamp Program is the primary source of nutrition 
assistance for many low-income households. It enables eligible low-
income households to buy nutritious food with electronic benefit cards 
at authorized retail food stores across the country. State and local 
welfare offices operate the program, and the federal government 
oversees the state operation of the program. Participants must meet 
income and resource standards and be U.S. citizens or eligible non-
citizens, and all able-bodied individuals between 16 and 60 without 
dependents must register for work, take part in an employment and 
training program, or accept or continue suitable employment. Households 
with incomes are expected to spend about 30 percent of their income, 
after certain deductions, on food. 

Program: Head Start; 
Description: Head Start provides comprehensive developmental services 
for low-income, pre-school children ages 3 to 5, and social services 
for their families. Services can be provided through either a half-day 
or a full-day program. Head Start provides diverse services in four 
components: education, health, parent involvement, and social services. 
Grants are awarded to about 1,400 local public or private non-profit 
agencies, and the community must contribute about 20 percent of the 
total cost of a Head Start program. 

Program: Housing Choice Vouchers; 
Description: The Housing Choice Voucher program is the federal 
government's major program for assisting very low-income families, the 
elderly, and the disabled with their housing needs. HUD gives public 
housing agencies the funds to administer the program. Participants use 
vouchers to find their own housing, including single-family homes, 
townhouses and apartments. The voucher recipient pays the difference 
between the actual rent charged by the landlord and the amount 
subsidized by the program. Generally, the subsidy allows the tenant to 
pay no more than 30 percent of adjusted monthly income towards the rent 
and utilities. 

Program: Medicaid; 
Description: Medicaid (title XIX of the Social Security Act) is a 
federal/state entitlement program that generally provides health 
insurance coverage for low-income families and individuals who are aged 
or disabled. Medicaid is the largest source of funding for medical and 
health-related services for America's poorest people. Within broad 
federal guidelines, each state can (1) establish its own eligibility 
standards; (2) determine the type, amount, duration, and scope of 
services; (3) set the rate of payment for services; and (4) administer 
its own program. Medicaid policies for eligibility, services, and 
payment are complex and vary considerably, even among states of similar 
size or geographic proximity. 

Program: Pell Grant; 
Description: The Pell Grant program provides grants (i.e., aid that 
does not have to be repaid) to needy undergraduates. It is the largest 
source of grant aid for postsecondary education attendance funded by 
the federal government and provided an estimated $13.1 billion to 
students in fiscal year 2004. Pell Grants are intended to be the 
foundation for all federal aid awarded to undergraduates and 
constituted an estimated 19 percent of all federally supported aid in 
fiscal year 2004 that benefited postsecondary education students. For 
fiscal year 2004-2005, grants ranged from $400 to $4,050. 

Program: Public Housing; 
Description: Public housing was established to provide decent and safe 
rental housing for eligible low-income families, the elderly, and 
persons with disabilities. Public housing comes in all sizes and types, 
from scattered single family houses to high-rise apartments for elderly 
families. HUD contributes both capital and operating funds to local 
housing agencies that manage the housing for low-income residents at 
rents they can afford. HUD also furnishes technical and professional 
assistance in planning, developing, and managing these developments. 

Program: SCHIP; 
Description: As part of the Balanced Budget Act of 1997, Congress 
created SCHIP as a federal/state partnership, similar to Medicaid, with 
the goal of expanding health insurance to low-income children--i.e., 
those children whose families earn too much money to be eligible for 
Medicaid, but not enough money to purchase private insurance. States 
can (1) use SCHIP funds to expand Medicaid eligibility to children who 
previously did not qualify for the program; (2) design a children's 
health insurance program entirely separate from Medicaid; or (3) 
combine both the Medicaid and separate program options. 

Program: WIC; 
Description: WIC provides supplemental foods to low-income women, 
infants, & children up to age 5 who are at nutritional risk. The WIC 
target population consists of low-income, nutritionally at risk: 
pregnant and breastfeeding women; nonbreastfeeding postpartum women; 
infants (up to 1st birthday), and children up to their 5th birthday. It 
provides supplemental nutritious foods, including infant formula; 
nutrition education and counseling at WIC clinics; and screening and 
referrals to other health, welfare and social services. 

Program: SSI; 
Description: The SSI program, title XVI of the Social Security Act, was 
enacted in 1972 and implemented in 1974 to ensure a minimum cash income 
to all aged, blind, or disabled persons. SSI is provided to eligible 
individuals or couples who have limited income and resources (the 
countable resource limit is $2,000 for an individual and $3,000 for a 
couple). Federal SSI benefits are paid from federal general revenues, 
but many states also supplement payments. 

Program: TANF; 
Description: The Personal Responsibility and Work Opportunity 
Reconciliation Act of 1996 (PRWORA) replaced Aid to Families with 
Dependent Children (AFDC) with TANF, which marked the end of federal 
entitlement to assistance. TANF ended unlimited matching funding for 
family cash welfare and created fixed-block grants to states. The block 
grant covers benefits, administrative expenses, and services targeted 
to needy families and gives states great flexibility to design their 
own TANF programs. PRWORA imposed a 5-year limit on TANF cash 
assistance paid with federal funds and required states to achieve 
minimum participation rates in federally recognized work activities. In 
addition, they must spend a specified amount of state funds on eligible 
low-income families--at least 75 percent of the state funds they spent 
in fiscal year 1994, known as the maintenance-of-effort requirement. 
States may use these funds to pay for separate state programs. 

Source: Federal agency documents. 

[End of table]

Program Administration: 

The programs covered by this review represent both entitlement and non-
entitlement programs; programs that are administered entirely by 
federal agencies and those that are administered through federal 
partnerships with state and/or local agencies; programs that allow 
substantial state and local variation and those that provide uniform 
benefits throughout the country. Table 3 summarizes the level of 
government with whom responsibility for funding and design resides for 
each of the 12 programs. 

Table 3: Level of Government Responsible for Funding and Design of 12 
Low-Income Programs: 

Program: EITC; 
Funding[A]: Federal; 
Design[B]: Federal; 
Entitlement: Yes. 

Program: Food Stamp Program; 
Funding[A]: Federal; 
Design[B]: Federal; 
Entitlement: Yes. 

Program: Medicaid; 
Funding[A]: Federal/state; 
Design[B]: Federal/state; 
Entitlement: Yes. 

Program: SSI; 
Funding[A]: Federal[C]; 
Design[B]: Federal; 
Entitlement: Yes. 

Program: Pell Grants; 
Funding[A]: Federal; 
Design[B]: Federal; 
Entitlement: No. 

Program: CCDF; 
Funding[A]: Federal/state; 
Design[B]: Federal/state; 
Entitlement: No. 

Program: Head Start; 
Funding[A]: Federal; 
Design[B]: Federal/local; 
Entitlement: No. 

Program: Housing Choice Voucher; 
Funding[A]: Federal; 
Design[B]: Federal; 
Entitlement: No. 

Program: Public Housing; 
Funding[A]: Federal; 
Design[B]: Federal; 
Entitlement: No. 

Program: SCHIP; 
Funding[A]: Federal/state; 
Design[B]: Federal/state; 
Entitlement: No. 

Program: TANF cash assistance; 
Funding[A]: Federal/state; 
Design[B]: Federal/state; 
Entitlement: No. 

Program: WIC; 
Funding[A]: Federal; 
Design[B]: Federal; 
Entitlement: No. 

Source: GAO. 

[A] Defined as the level of government that supplies the primary source 
of funding for the support. If substantial funding comes from more than 
one source, we list both sources. Some additional funding may come from 
sources not listed in the table. 

[B] Defined as the level of government that is primarily responsible 
for availability, eligibility, and benefit amount determination. 

[C] Some states contribute to the SSI program, but state funding is not 
required and is not provided in all states. 

[End of table]

Program Performance Management: 

Although state and local agencies responsible for administering several 
of the programs have some control over program design and 
implementation, primary responsibility for setting priorities, guiding 
policy, and measuring performance rests with the federal agencies that 
oversee the programs. The programs covered by this review may have many 
different goals and objectives of varying degrees of importance, but 
all of these programs--regardless of size, target population, funding 
structure, or types of benefits offered--were established to assist 
persons with limited income, and as such, all were tasked with the 
overarching goal of reaching and serving those eligible for program 
benefits or services. Likewise, all means-tested programs share the 
common goal of ensuring that the funds allocated for program benefits 
are provided only to those eligible. 

A key factor in achieving desired program outcomes, including program 
access and program integrity, is the implementation of appropriate 
internal control. As discussed in our prior work on this topic, 
internal control is an integral component of an organization's 
management that provides reasonable assurance that agencies are 
achieving outcomes related to the effectiveness and efficiency of 
operations and compliance with laws and regulations, among other 
things.[Footnote 4]

Federal agencies have several key management tools and program reports 
that they use to provide information about the programs they 
administer, develop policy, help with management decision-making, and 
help focus program administrators at all levels of government on 
achieving the federal agency's highest priorities. For example, through 
their strategic and annual performance plans and accountability 
reports, federal agencies set program goals, measure program 
performance against those goals, and report publicly on their progress. 
Some programs also issue annual or biennial reports to Congress on 
specific programs they administer; these generally include important 
program information. 

A number of governmentwide initiatives have resulted in increased 
emphasis by program managers on program integrity issues, including OMB 
guidance, the President's Management Agenda, GAO's High-Risk series and 
the Improper Payments Information Act of 2002 (IPIA). The IPIA requires 
the head of each federal agency to annually review all programs and 
activities that the agency administers and to identify all such 
programs and activities that may be susceptible to significant improper 
payments.[Footnote 5] For each program and activity identified, the 
agency is required to estimate the annual amount of improper payments 
and submit those estimates to Congress before March 31 of the following 
applicable year. OMB guidance then directs federal agencies to include 
a measure of improper payments in their annual Performance and 
Accountability Reports. All 12 programs we reviewed are subject to 
these requirements. 

Use of Federal Low-Income Assistance Varies Greatly by Program and by 
Subgroup: 

The proportion of those eligible who are actually enrolled in 12 
selected low-income programs varies substantially both between and 
within programs, but several factors must be considered to understand 
the implications of this information for program access. The estimated 
proportion of eligible people who were enrolled in entitlement 
programs--those designed to support all those who apply and qualify--
ranged from about 50 percent to more than 70 percent. In contrast, the 
estimated proportion of the eligible who were enrolled in non-
entitlement programs--those with limited funding and not necessarily 
intended to cover all eligible persons--ranged from less than 10 
percent to about 50 percent. Within programs, we found that 
subpopulations were enrolled in different proportions. Some evidence 
also suggests that enrollees in some programs, such as the Food Stamp 
Program, tend to be those who are eligible for larger benefit amounts. 

For Entitlement Programs, the Proportion of Those Eligible Who Were 
Enrolled Ranged from about 50 Percent to More Than 70 Percent, but 
Participation Rates Are Higher among Some Groups: 

For four of the five entitlement programs we examined, the proportion 
of eligible people who were enrolled varied from around 50 percent in 
the Food Stamp Program to more than 70 percent in the EITC and SSI 
programs; and within programs, different types of participants, such as 
children or the elderly, were enrolled in varying proportions.[Footnote 
6] Table 4 provides estimated participation rates for each of these 
programs, expressed in ranges to reflect potential errors in sample 
survey data. The actual participation rates may be outside the range of 
estimates shown because some types of uncertainty in the estimation of 
participation rates cannot be quantified. Estimates for the Food Stamp, 
Medicaid and SSI programs were developed by the Urban Institute under 
contract with HHS and Food Stamp Program estimates were developed by 
Mathematica Policy Research, Inc., under contract with USDA. HHS and 
USDA are the only two agencies to regularly estimate participation 
rates in low-income programs. We estimated the EITC participation rate 
for 1999. However, we were unable to estimate an enrollment rate for 
the Pell Grant program because of concerns about the reliability of 
some of the data needed to estimate the rate. 

Table 4: Estimated Participation Rates for Entitlement Programs for the 
Most Recent Year Data Were Available: 

Program (year)[A]: EITC (1999); 
Eligibility unit: Households; 
Participation rate estimates (in percent)[B]: 75%[C]. 

Program (year)[A]: Food Stamp Program (2001): HHS/Urban Institute; 
Eligibility unit: Households; 
Participation rate estimates (in percent)[B]: 46-48%[E]

Program (year)[A]: (2002): USDA/Mathematica Policy Research, Inc; 
Eligibility unit: Households; Individuals; 
Participation rate estimates (in percent)[B]: 54%[F]. 

Program (year)[A]: Medicaid (2000); 
Eligibility unit: Individuals[G]; 
Participation rate estimates (in percent)[B]: 66-70%. 

Program (year)[A]: Pell Grants; 
Eligibility unit: Not available; 
Participation rate estimates (in percent)[B]: Not available[H]. 

Program (year)[A]: SSI (2001); 
Eligibility unit: Individuals and married couples[I]; 
Participation rate estimates (in percent)[B]: 66-73%. 

Sources: GAO's analysis of CPS and IRS survey data and data from the 
Urban Institute's TRIM3 model and Mathematica Policy Research, Inc. 

[A] All estimates are for the calendar year indicated in the table, 
except the food stamp estimates created by Mathematica, which are for 
fiscal year 2002. 

[B] This range represents a 95 percent confidence interval based on 
estimated sampling error in the national survey data. This interval 
does not take into account errors introduced by the modeling process or 
by administrative data. We assessed but did not quantify these errors. 

[C] The EITC participation rate shown has a sampling error that does 
not exceed plus or minus 2.7 percentage points. The number of eligible 
tax filers used in this estimate was adjusted to exclude those who 
received EITC benefits in error. The participation rate is a 
conservative estimate based on 32 percent of EITC dollars being claimed 
in error; the IRS estimated between 27 and 32 percent of these tax 
dollars were paid in error in 1999. Because more recent information 
about EITC payment errors is not available, we were unable to provide a 
more recent estimate. However, Congress has enacted new tax laws and 
the IRS has taken steps to improve compliance. For more details, see 
GAO, Earned Income Tax Credit Participation, GAO-02-290R (Washington, 
D.C.: Dec. 14, 2001). 

[D] While the Urban Institute and Mathematica each generate food stamp 
participation rate estimates using data from the CPS, their estimates 
differ slightly. The differences arise primarily from differences in 
imputation methodology for data missing from the CPS--such as assets, 
immigration/refugee status, and information on which household members 
buy and prepare food together. 

[E,F] Confidence intervals are not available. These estimates are from 
Mathematica Policy Research, Inc., Trends in Food Stamp Program 
Participation Rates: 1999 to 2002. (Washington, D.C.: Sept. 2004). 

[G] Estimates do not include individuals who are institutionalized. 
Estimates do account for variation in state eligibility rules and for 
people who may be eligible for only part of the year. 

[H] We were unable to estimate a participate rate for the Pell Grant 
program because we were unable to assess the reliability of data on the 
family income of students that did not apply for federal financial 
assistance. 

[I] No reliable national survey data exist on individuals who meet the 
SSI disability criteria. Therefore, researchers made assumptions about 
a person's disability based on self-reported information on inability 
to work due to illness or other disability, lack of work activity in 
the prior year, and receipt of disability income. Some of those assumed 
eligible for SSI based on disability may not meet the criteria and vice 
versa. As a result, the models may overestimate or underestimate the 
number of eligible people. This estimate also does not include 
institutionalized individuals and disabled children. 

[End of table]

These estimates indicate that between half and three quarters of those 
eligible are participating in four of the entitlement programs. 
Although differences in years, data sources, and estimation 
methodologies make it inappropriate to compare participation rates 
across programs, these estimates provide a general sense of the extent 
to which programs are reaching those eligible for benefits. 
Specifically, we found: 

* For the EITC program, we estimated in prior work that about 75 
percent of eligible households took advantage of this credit in 1999. 
This estimate was adjusted to account for tax dollars that were 
distributed in error that year.[Footnote 7] However, Congress has 
enacted new tax laws and the IRS has taken steps to improve EITC 
program compliance. 

* Two organizations, the Urban Institute and Mathematica Policy 
Research, Inc., have estimated food stamp participation rates using 
different methodologies but both found that about 48 percent of 
eligible households participated in this program in 2001 and 2002, 
respectively. In addition, Mathematica found that 54 percent of 
eligible individuals were enrolled in 2002. 

* An estimated 66 to 70 percent of eligible, noninstitutionalized 
people were enrolled in Medicaid in 2000. This estimate does not 
include institutionalized people, such as those in nursing homes. 

* We were unable to estimate Pell Grant participation rates because we 
were unable to assess the reliability of available data on the family 
income of enrolled students who did not apply for federal financial 
aid. 

* For SSI, an estimated 66 to 73 percent of eligible adult individuals 
and married couples received benefits in 2001. This estimate also does 
not include institutionalized people or disabled children. 

* Participation rates also can vary substantially even within a single 
program. Disaggregating program participation rates by targeted 
subpopulations can help us to better understand the implications of 
overall program participation rates. In table 5, we provide 
participation rate estimates for selected subgroups within the four 
entitlement programs for which we have participation rate estimates. As 
in table 4, these estimates are expressed in ranges to reflect 
potential errors that result from using sample survey data. (See the 
footnotes to table 5 for more details.) 

Table 5: Available Subgroup Participation Rate Estimates for 
Entitlement Programs for the Most Recent Year Data Were Available: 

Program (year)[A]: EITC (1999); 
Subgroup: All Households[C]; 
Participation rate estimates (percent)[B]: 75%[D]. 

Program (year)[A]: EITC (1999); 
Subgroup: Households with No children; 
Participation rate estimates (percent)[B]: 45%[E]. 

Program (year)[A]: EITC (1999); 
Subgroup: Households with 1 Child; 
Participation rate estimates (percent)[B]: 96%[R]. 

Program (year)[A]: EITC (1999); 
Subgroup: Households with 2 Children; 
Participation rate estimates (percent)[B]: 93%[G]. 

Program (year)[A]: EITC (1999); 
Subgroup: Households with 3 or More Children; 
Participation rate estimates (percent)[B]: 63%[H]. 

Program (year)[A]: Food Stamps (2001); 
Subgroup: All Households[I]; 
Participation rate estimates (percent)[B]: 46-48%. 

Program (year)[A]: Food Stamps (2001); 
Subgroup: Households with Children; 
Participation rate estimates (percent)[B]: 55-57%. 

Program (year)[A]: Food Stamps (2001); 
Subgroup: Households with Elderly Members; 
Participation rate estimates (percent)[B]: 27-28%. 

Program (year)[A]: Medicaid (2000); 
Subgroup: All Individuals[J]; 
Participation rate estimates (percent)[B]: 66-70%. 

Program (year)[A]: Medicaid (2000); 
Subgroup: Adults; 
Participation rate estimates (percent)[B]: 56-64%. 

Program (year)[A]: Medicaid (2000); 
Subgroup: Children; 
Participation rate estimates (percent)[B]: 74-79%. 

Program (year)[A]: Medicaid (2000); 
Subgroup: Elderly; 
Participation rate estimates (percent)[B]: 40-43%[K]. 

Program (year)[A]: SSI (2001); 
Subgroup: All Individuals and Married Couples[L]; 
Participation rate estimates (percent)[B]: 66-73%. 

Program (year)[A]: SSI (2001); 
Subgroup: Elderly; 
Participation rate estimates (percent)[B]: 61-68%[M]. 

Source: GAO's analysis of CPS and IRS survey data and the Urban 
Institute's TRIM3. 

[A] All estimates are for the calendar year mentioned. 

[B] This range represents a 95 percent confidence interval based on 
estimated sampling error in the national survey data. This interval 
does not take into account errors introduced by the modeling process or 
by administrative data. We assessed but did not quantify these errors. 

[C] The number of eligible tax filers used in these estimates were 
adjusted to exclude those who received EITC benefits in error. The 
participation rate is a conservative estimate based on 32 percent of 
EITC dollars being claimed in error; the IRS estimated between 27 and 
32 percent of EITC dollars claimed in 1999 were paid in error. Because 
more recent information about EITC payment errors is not available, we 
were unable to provide a more recent estimate. However, since 1999, 
Congress has enacted new tax laws and the IRS has taken steps to 
improve compliance. For more details, see GAO, Earned Income Tax Credit 
Participation, GAO-02-290R (Washington, D.C.: Dec. 14, 2001). 

[D] The EITC participation rate for all households has a sampling error 
that does not exceed plus or minus 2.7 percentage points. 

[E] The EITC participation rate for households with no children has a 
sampling error that does not exceed plus or minus 3.9 percentage 
points. 

[F] The EITC participation rate for households with one child has a 
sampling error that does not exceed plus or minus 7.7 percentage 
points. The actual participation rate cannot exceed 100 percent. 

[G] The EITC participation rate for households with 2 children has a 
sampling error that does not exceed plus or minus 8.3 percentage 
points. The actual participation rate cannot exceed 100 percent. 

[H] The EITC participation rate for households with 3 or more children 
has a sampling error that does not exceed plus or minus 8.3 percentage 
points. 

[I] Estimates in the table are from the Urban Institute. Mathematica 
has also estimated participation rates for these subgroups and found 
that about 66 percent of eligible households with children and 28 
percent of those with elderly members participated in fiscal year 2002. 
While the Urban Institute and Mathematica each generate food stamp 
participation rate estimates using data from the CPS, their estimates 
differ slightly. The differences arise primarily from differences in 
imputation methodology for data missing from the CPS--such as assets, 
immigration/refugee status, and information on which household members 
buy and prepare food together. 

[J] Estimates do not include individuals who are institutionalized. 
Estimates do account for variation in state eligibility rules and for 
people who may be eligible for only part of the year. 

[K] Estimates include those who are dually enrolled in Medicare and 
Medicaid who thus qualify for the full Medicaid benefit and those who 
only receive Medicaid assistance for their Medicare cost sharing. 
Estimates do not include eligible elderly people who are 
institutionalized. The participation rate may be lower for this group 
in part because those over the age of 65 may have Medicare coverage. 

[L] No reliable national survey data exist on individuals who meet the 
SSI disability criteria. Therefore, researchers made assumptions about 
a person's disability based on self-reported information on inability 
to work due to illness or other disability, lack of work activity in 
the prior year, and receipt of disability income. Some of those assumed 
eligible for SSI based on disability may not meet the criteria and vice 
versa. As a result, the models may overestimate or underestimate the 
number of eligible people. This estimate also does not include 
institutionalized individuals or disabled children. 

[M] Estimates do not include eligible elderly people who are 
institutionalized. 

[End of table]

As shown, participation in low-income programs varies markedly across 
subgroups. For example, a smaller share of elderly people eligible for 
low income programs tend to participate in the Food Stamps and Medicaid 
programs than among the total eligible population. The elderly may 
participate in the Food Stamp Program at a lower rate than other 
households because most elderly households receive Social Security and 
are eligible for relatively small food stamp benefits. For example, in 
2000, 44 percent of all households with elderly members eligible for 
food stamps were eligible for a monthly benefit of only $10 or less, 
the minimum benefit for households of one or two persons. In 
comparison, 12 percent of households without elderly members eligible 
for food stamps receive benefits that low. Similarly, Medicaid 
participation among the elderly may be low because Medicare also covers 
many elderly people who are eligible for Medicaid. In contrast, 
families with children tend to participate in food stamps, Medicaid, 
and the EITC at higher than average rates than those households without 
children.[Footnote 8] Although we were unable to disaggregate 
participation rates by geographic area, program participation rates can 
also vary by state or locality. 

Information on trends in program participation rates over time can also 
help in interpreting participation rate estimates, but we were only 
able to provide information on trends in participation for one program. 
Mathematica Policy Research, Inc., estimates food stamp participation 
rates annually under contract with USDA and has taken steps to ensure 
that estimates are comparable over time. As shown in figure 1, food 
stamp participation rates remained fairly stable between fiscal years 
1999 and 2002, declining slightly from 52 percent in fiscal year 1999 
to 48 percent in fiscal year 2002 among eligible households and 56 
percent in fiscal 1999 to 54 percent in fiscal year 2002 among eligible 
individuals. 

Figure 1: Food Stamp Participation Rate Estimates for Fiscal Years 1999 
to 2002: 

[See PDF for image]

[End of figure]

We were not able to provide information on trends in participation 
rates for the Medicaid and SSI programs because the most recent 
participation rate data available for these programs is not comparable 
to prior year estimates. While prior year estimates are available, 
because of changes from 1 year to the next in the methodology used to 
estimate participation rates, estimates for prior years are not 
perfectly comparable with the most recent estimates and are therefore 
not shown in this report. The participation rate estimate for the EITC 
was available for only 1 year. 

For Non-Entitlement Programs, the Proportion of Those Eligible Who Were 
Enrolled Ranged from Less Than 10 Percent to about 50 Percent: 

Among the seven non-entitlement programs we reviewed, the share of 
those eligible who participate ranges from less than 10 percent to 
about 50 percent. These programs are generally not funded to serve all 
eligible applicants, and many have other design features, such as the 
prioritization of certain subgroups and eligibility criteria specific 
to a state or locality, that would not necessarily allow for all 
eligible people who apply to receive benefits.[Footnote 9] 
Consequently, we refer to these estimates as coverage rates rather than 
participation rates. Table 6 provides estimated coverage rates for each 
of these programs, expressed in ranges to reflect potential errors in 
survey data. The actual coverage rates may be within a broader range of 
estimates than shown because other errors that may have resulted from 
calculating these estimates could not be quantified. Estimates for the 
CCDF, SCHIP, and TANF cash assistance programs were developed by the 
Urban Institute under contract with HHS. We also include a WIC estimate 
developed by the National Research Council, and another WIC estimate 
developed by the Urban Institute under contract with us. We estimated 
the Head Start and housing programs using administrative and national 
survey data. 

Table 6: Estimated Coverage Rates for Non-Entitlement Programs for the 
Most Recent Year Data Were Available: 

Program (year): CCDF (2001); 
Eligibility unit: Children[B]; 
Coverage rate estimates (percent)[A]: 18--19%[C]. 

Program (year): Head Start (2003); 
Eligibility unit: Children[D]; 
Coverage rate estimates (percent)[A]: 44--54%[E]. 

Program (year): Housing Choice Vouchers (1999); 
Eligibility unit: Households[F]; 
Coverage rate estimates (percent)[A]: 13--15%. 

Program (year): Public Housing (1999); 
Eligibility unit: Households[G]; 
Coverage rate estimates (percent)[A]: 7--9%. 

Program (year): SCHIP (2000)[H]; 
Eligibility unit: Children[I]; 
Coverage rate estimates (percent)[A]: 44--51%. 

Program (year): TANF-cash assistance (2001); 
Eligibility unit: Families[J]; 
Coverage rate estimates (percent)[A]: 46--50%. 

Program (year): WIC (1998): National Research Council; 
Eligibility unit: Infants and Children[K]; 
Coverage rate estimates (percent)[A]: 51%[L]. 

Program (year): (2001): Urban Institute; 
Eligibility unit: Individuals; 
Coverage rate estimates (percent)[A]: 51--55%[M].

Source: The Urban Institute's TRIM3 and GAO's analysis of data from the 
CPS and HUD. 

[A] This range represents a 95 percent confidence interval based on 
estimated sampling error in the national survey data. This interval 
does not take into account errors introduced by the modeling process or 
by administrative data. We assessed but did not quantify these errors. 

[B] The estimates account for variations in state eligibility criteria 
and are based on criteria as of October 2001. Estimates do not account 
for participation in other programs that provide similar services. 

[C] To increase the precision of these estimates, 3 years of CPS data 
were used to estimate the eligible population; other coverage rates and 
participation rates estimated using TRIM3 only use 1 year of data. As a 
result, the confidence interval based on the sampling error is smaller 
than for the other estimates. 

[D] Head Start participation is measured by the number of funded slots, 
not the number of children in the program. Therefore, this estimate may 
overstate or understate the actual coverage rate because more than one 
child may fill a slot in a year and some slots may go unfilled. 
Estimates do not account for participation in other programs that 
provide similar services. 

[E] The coverage rate does not include enrolled children living above 
the poverty threshold. Nonpoor children can comprise up to 10 percent 
of Head Start enrollment slots. 

[F] HUD's data on the number of eligible households was based on the 
American Housing Survey. This survey may overestimate household income 
and underestimate the number of households in poverty. These estimates 
also may include households who do not qualify for the voucher despite 
their low-income status. Coverage rates are based on the number of 
households who successfully leased units in 1999. A total of 1,649,645 
vouchers were authorized, but some of these were not used partially due 
to voucher-holders' inability to find housing. Rates reflect only those 
participating in the Housing Choice Voucher program; however, those 
eligible may also be served by a number of other federal, state, and 
local housing assistance programs. 

[G] HUD's data on the number of eligible households was based on the 
American Housing Survey. This survey may overestimate household income 
and underestimate the number of households in poverty. Income-eligible 
households may not be eligible for other reasons--for example, local 
public housing authorities may deny assistance to people with habits 
and practices that may be detrimental to other public housing tenants-
-and the estimate does not account for this. Coverage rates are based 
on the number of public housing units that were leased; a total of 
1,235,229 units were available but some were unleased for a variety of 
reasons, such as resident turnover. Rates reflect only those 
participating in the public housing program; however, those eligible 
may also be served by a number of other federal, state, and local 
housing assistance programs. GAO used an eligible population of those 
who earn less than 80 percent area median income as per the eligibility 
criteria; however, nationally the vast majority of those served by 
public housing make less than 50 percent of the area median income. 

[H] A new program established in 1997, SCHIP saw its enrollment 
increase 75 percent between fiscal years 2000 and 2003; a more recent 
estimate of the SCHIP coverage rate would likely be higher than the 
range shown. In addition, because states' implementation of their 
programs varied, awareness of SCHIP may lag in states that created 
their programs more recently. 

[I] Estimates account for variation in state eligibility rules, and the 
estimates are based on state eligibility rules in place in 2000. 
Children who are eligible for Medicaid expansion SCHIP programs and 
separate state SCHIP programs are included in the estimate. Children 
covered by private and other public health insurance such as Medicaid 
are generally not eligible for SCHIP and are, therefore, not included 
in the denominator for the calculation; to the extent that some are 
included in the actual caseload under "employer buy in" programs, the 
coverage rate will be slightly overestimated. 

[J] Estimates account for variation in state eligibility rules. All 
units receiving TANF cash assistance are included, even though a 
separate state program might fund their benefits. Families receiving 
non-cash benefits funded by TANF are not included, although an 
increasing proportion of TANF funds are being used to provide non-cash 
assistance to families. Some families or individuals that may appear 
eligible according to model may not be participating because they have 
not complied with program requirements, such as being involved in work 
activities. However, those who have reached their state or federal TANF 
time limit are appropriately excluded from eligibility in estimating 
the coverage rate. 

[K] Estimates only include eligible infants and children, even though 
pregnant, postpartum, and breastfeeding women are eligible for this 
program, because the CPS does not have data to determine a woman's 
pregnancy status or whether she is breastfeeding. According to the FNS, 
women account for a quarter of WIC participants. 

[L] A confidence interval is not available. This estimate is based on 
data from National Research Council of the National Academies, 
Estimating Eligibility and Participation for the WIC Program 
(Washington, D.C.: Sept. 2003). Estimates include pregnant women, 
infants, and children. It does not include postpartum and breastfeeding 
women. 

[M] Estimates are preliminary because they are partially based on the 
numbers used to create Medicaid participation rates and SCHIP coverage 
rates. The Medicaid participation rate and SCHIP coverage rate for 2001 
had not been completed in time to include in this report. 

[End of table]

Generally less than half of those eligible participate in the seven non-
entitlement programs. Coverage rates also have limitations such as data 
sources, and estimation methodologies that make it inappropriate to 
compare the estimates across programs. However, they provide a general 
sense of the extent to which these programs are reaching eligible 
people. Specifically, we found: 

* Almost 20 percent of children who meet state-defined eligibility 
criteria are receiving child care services through CCDF.[Footnote 10] 
This estimate does not reflect participation in child care funded by 
other federal sources. HHS estimates that about 26 percent of CCDF-
eligible children are receiving child care services through either CCDF 
(including the Child Care and Development Block Grant, state CCDF funds 
or TANF transfers to CCDF), or child care services funded directly 
through the Social Services Block Grant (SSBG), TANF, or TANF state 
funds.[Footnote 11]

* The Head Start program funded enough slots to serve about 44 to 54 
percent of eligible 3-to 4-year-old low-income children in 
2003.[Footnote 12]

* An estimated 13 to 15 percent of households eligible for Housing 
Choice Vouchers on the basis of income both received a voucher and were 
able to successfully lease a housing unit in 1999, the most recent year 
for which these data were available. In addition, less than 10 percent 
of households eligible on the basis of income were served through the 
Public Housing program in 1999. While HCV and public housing are the 
two largest federal housing programs, there are other federal, state, 
and local housing programs from which eligible households could receive 
assistance. HUD estimated that in 1999 about a quarter of all 
households eligible for any kind of housing assistance received 
assistance. 

* In 2000, about 44 to 51 percent of eligible children participated in 
SCHIP. Since 2000, SCHIP enrollment has increased by nearly 3 million 
children, but the impact this has had on the coverage rate is not known 
because information on how the eligible population may have changed 
over this time period is not available. In addition, because states' 
implementation of their programs varied, awareness of SCHIP may lag in 
states that created their programs more recently. 

* About half of all eligible households receive cash assistance through 
TANF. This estimate does not account for families that receive other 
services, such as transportation and child care, that are offered 
through this program, but who do not receive cash assistance.[Footnote 
13]

* WIC participation rates were available from two sources. The National 
Research Council using the Survey of Income and Program Participation 
found that 51 percent of eligible infants, children ages 1 to 4 and 
pregnant women were enrolled in WIC in 1998. The Urban Institute, using 
the Current Population Survey, found that about 51 to 55 percent of 
eligible infants and children participated in 2001. 

Coverage rates for these programs can also vary substantially by 
subgroup, and they do vary within the TANF and WIC programs, the only 
non-entitlement programs for which we have this information. 
Understanding the extent to which different subgroups are covered by 
non-entitlement programs can be particularly important precisely 
because these programs are not necessarily funded to cover all those 
eligible. Table 7 provides coverage rates for groups of people eligible 
for TANF cash assistance and WIC. 

Table 7: Coverage Rate Estimates for TANF Cash Assistance and WIC 
Subgroups for the Most Recent Year Data Were Available: 

Program (year): TANF-cash assistance (2001)[A]; 
Eligibility units: All Families; 
Coverage rate estimates (percent): 46--50%. 

Program (year): TANF-cash assistance (2001)[A]; 
Eligibility units: Families with Earners[B]; 
Coverage rate estimates (percent): 37--44%. 

Program (year): TANF-cash assistance (2001)[A]; 
Eligibility units: Families with No Earners[C]; 
Coverage rate estimates (percent): 51--56%. 

Program (year): TANF-cash assistance (2001)[A]; 
Eligibility units: Two-Parent Families; 
Coverage rate estimates (percent): 31--36%. 

Program (year): TANF-cash assistance (2001)[A]; 
Eligibility units: Families with Immigrants; 
Coverage rate estimates (percent): 34--43%. 

Program (year): WIC (2001)[D]; 
Eligibility units: All Individuals[E]; 
Coverage rate estimates (percent): 51--55%. 

Program (year): WIC (2001)[D]; 
Eligibility units: Infants; 
Coverage rate estimates (percent): 79--93%. 

Program (year): WIC (2001)[D]; 
Eligibility units: Children Ages 1-4; 
Coverage rate estimates (percent): 41--45%. 

Source: GAO analysis of estimates from the Urban Institute's TRIM3. 

[A] Estimates account for variation in state eligibility rules. All 
units receiving TANF cash assistance are included, even though a 
separate state program might fund their benefits. Some families or 
individuals that may appear eligible according to the model may not be 
participating because they have not complied with program requirements, 
such as being in involved in work activities. However, those who have 
reached their state or federal TANF time limit are ineligible and are 
not included, unless receiving assistance through a separate state 
program. 

[B,C] Estimates only include families with one parent or no parents 
present. 

[D] Estimates are preliminary because they are partially based on the 
numbers used to create Medicaid participation rates and SCHIP coverage 
rates. The Medicaid participation rate and SCHIP coverage rate for 2001 
had not been finalized during the time frames of this report. 

[E] Estimates only include eligible infants and children, even though 
pregnant, postpartum, and breastfeeding women are eligible for this 
program, because the CPS does not have data to determine a woman's 
pregnancy status or whether she is breastfeeding. According to the FNS, 
women account for a quarter of WIC participants. 

[End of table]

As shown, families with no income earners tend to receive TANF cash 
assistance at a higher rate in the TANF program than families with 
earners or two-parent families. The data also suggest that families 
with immigrants have a lower coverage rate than families without 
immigrants. As noted earlier, some families within these subpopulations 
may be receiving other services funded by TANF, although data are not 
available on this. The participation rate among infants eligible for 
WIC is higher than among children ages 1 to 4. 

We were unable to provide estimates of changes in coverage rates over 
time for most of the non-entitlement programs covered in this review, 
but we did find an increase in the coverage rate for the Head Start 
program over the past several years. Since 1997, Head Start coverage 
rates have increased from about 40 percent to 50 percent. However 
during this time period, the coverage rate increased between 2000 and 
2001 from about 50 percent to 58 percent and then gradually declined. 
The coverage rate increased by this amount within 1 year because slots 
increased by nearly 40,000 for the Head Start program while the number 
of children eligible decreased by about nearly 130,000. Since 2001 the 
number of funded Head Start slots has increased, but the coverage rate 
fell because the child poverty rate, and thus the number of eligible 
children, increased. Figure 2 shows Head Start coverage rate estimates 
for 1997 to 2003. 

Figure 2: Head Start Coverage Rate Estimates for 1997 to 2003: 

[See PDF for image]

[End of figure]

Because of changes in the methodology used to estimate coverage rates 
from 1 year to the next, we cannot reliably compare the most recent 
coverage rate estimates for SCHIP and TANF to those of prior years, but 
there is compelling evidence that coverage rates for these two programs 
changed significantly over time. SCHIP was first implemented in 1997 
and the number of children in the program grew from 660,351 in fiscal 
year 1998 to over 3 million in fiscal year 2000. As states continued to 
reach out to eligible children in subsequent years, participation 
continued to increase to nearly 6 million in fiscal year 2003. This 
eightfold increase in the number of children enrolled in SCHIP since 
fiscal year 1998 almost certainly had a significant impact on the 
coverage rate. Meanwhile, as states implemented welfare reforms during 
the strong economy of the late 1990s and other changes occurred in 
programs serving low-income families, the number of families receiving 
TANF cash assistance declined, falling by about 50 percent between 
fiscal years 1997 and 2003.[Footnote 14] This also likely had a 
significant impact on the program coverage rate. HHS has reported that 
about 70 percent of families eligible for TANF cash assistance were 
enrolled in the program in 1997, compared to less than 50 percent in 
2001, but we were unable to quantify how much of this change was caused 
by changes in estimation methodology.[Footnote 15] It is also important 
to note that states' TANF programs have changed over this time. States 
have more flexibility in the types of non-cash assistance they may 
provide families, and some families eligible for cash assistance may be 
receiving other forms of aid instead. In addition, some families or 
individuals that may appear eligible according to the model may not be 
participating because they have not complied with program requirements, 
such as being involved in work activities. 

The Estimated Costs of Serving Eligible Non-participants Show That in 
Some Programs, Those Eligible for the Largest Benefits Are More Likely 
to be Enrolled: 

Our estimates of the costs of providing benefits to eligible non-
participants show that for some programs, those currently participating 
in the programs are generally eligible for a greater benefit amount 
than those not participating. For these programs, the estimated costs 
of serving those eligible but not currently receiving benefits may be 
less than one might expect based on the participation or coverage rates 
we estimated. This is not surprising, as it makes sense that, for 
example, a person eligible for a $10 food stamp benefit might be more 
likely to forgo that benefit than a person eligible for a $150 benefit. 
More specifically, Mathematica found that the 48 percent of households 
participating in the Food Stamp Program in fiscal year 2001 received 
about 62 percent of the total amount of benefits that would be paid out 
if all eligible households received benefits. 

As shown in table 8, we were able to estimate the additional cost of 
providing benefits to eligible nonparticipants for 6 of the 12 programs 
we reviewed. These cost estimates take into consideration the 
characteristics of non-participants and the benefits for which they 
would be eligible but do not account for increases in administrative 
costs that could result from participation increases. We were unable to 
estimate the cost of providing benefits to eligible, non-participants 
in the six other programs--CCDF, HCV, Medicaid, Pell Grants, Public 
Housing, and SCHIP--because we did not have enough information to 
determine how the characteristics of the non-participants would have 
affected the benefit amounts they could have received. 

Table 8: Potential Cost of Providing Benefits to Eligible Non-
participants for the Most Recent Year Data Were Available: 

Program (year): EITC (1999); 
Potential annual cost of serving eligible non-participants[A,B]: $2-
3.4[C]. 

Program (year): Food Stamp Program (2001); 
Potential annual cost of serving eligible non-participants[A,B]: 8.8-
11.5. 

Program (year): Head Start (2003); 
Potential annual cost of serving eligible non-participants[A,B]: 3.8-
5.6[D]. 

Program (year): SSI (2001); 
Potential annual cost of serving eligible non-participants[A,B]: 8-9.8. 

Program (year): TANF-cash assistance (2001)[E]; 
Potential annual cost of serving eligible non-participants[A,B]: 8-9. 

Program (year): WIC (2001)[F]; 
Potential annual cost of serving eligible non-participants[A,B]: 1.9-
2.1. 

Source: The Urban Institute's TRIM3 and GAO's analysis of data from 
CPS, HHS, and IRS. 

Note: Cost estimates do not include increases in administrative costs 
associated with greater program participation. 

[A] This range represents a 95 percent confidence interval based on 
estimated sampling error in the national survey data. This interval 
does not take into account errors introduced by the modeling process or 
by administrative data. We assessed but did not quantify these errors. 
Estimates are based on most of the same data used to estimate 
participation and coverage rate estimates for the related programs and, 
therefore, many of the same data and model limitations apply. 

[B] Estimates do not account for policy or economic changes that would 
occur if participation in these programs increased. All estimates are 
based on the assumption that participation in other programs remains 
constant. 

[C] Estimates are from GAO, Earned Income Tax Credit Participation, GAO-
02-290R (Washington, D.C.: Dec. 14, 2001). 

[D] Estimate is based on an average cost per slot multiplied by the 
number of non-participating eligible children. This estimate does not 
account for local variation in the cost of services, and does not 
account for the possibility of more than one child filling a slot. 

[E] Estimates are only for the additional cost of providing TANF cash 
assistance. The program provides other supports, such as child care and 
transportation, to needy families, and the cost of these services would 
increase the estimate if they were included. 

[F] Estimates are only for the additional cost of providing food 
benefits to infants and children who are not enrolled. 

[End of table]

Although Medicaid is by far the largest program we reviewed, developing 
reliable estimates of the costs of serving those eligible but not 
enrolled in the Medicaid program is difficult for a number of reasons. 
These reasons include a lack of information about the health status of 
eligible non-participants, the many variables that affect health care 
costs, and the open-ended nature of health care benefits. 

The costs included in the table do not reflect the total costs that 
would be incurred if all eligible people enrolled in these programs. 
Probable increases in administrative costs that would be incurred are 
not included, and we did not estimate how the cost of goods and 
services offered through the Food Stamp, Head Start, and WIC programs 
would change if more participants were demanding them. However, the 
costs do include some additional costs that would be incurred by states 
in programs where states are required to cover some of the program 
costs. 

Recognizing the differences in goals, design, administration, and 
funding in the 12 programs, it may be neither feasible nor desirable to 
provide program benefits to all those eligible. Because alternative 
programs could offer the similar benefits and services as the programs 
we reviewed, some of these programs, especially those with limited 
funding, may be best administered by only serving a certain subgroup of 
their eligible population. For example, in localities where school 
systems offer pre-kindergarten classes to 4-year-old children, Head 
Start programs may want to focus more on enrolling 3-year-olds from low-
income families. Also, limited administrative resources may prevent 
federal, state, and local agencies from serving all those eligible. 
Full participation among eligible people also may not be feasible 
because some choose not to enroll in means-tested programs. Given these 
constraints, some programs may focus on targeting their resources to 
those most in need of program services. 

Finally, while participation and coverage rate estimates as well as 
estimates of potential program costs provide important program 
information that can be useful to both policymakers and program 
administrators, these estimates must be interpreted carefully to take 
into consideration such factors as survey data, research methodology, 
timeliness of estimates, and the availability of alternative programs. 
These factors limit our ability to compare rates across programs and 
would need to be considered in efforts to define appropriate or desired 
participation or coverage rate levels. For a detailed discussion of the 
factors that affect use of these estimates, see appendix II. 

Many Factors Influence Participation but Their Impact on Entitlement 
and Non-Entitlement Programs Differs: 

Many factors influence access to means-tested programs, including the 
benefits provided by the program, ease of access, misperceptions about 
program requirements, and eligibility verification procedures put in 
place to ensure program integrity, based on our literature review and 
agency interviews. These factors influence participation by affecting 
the number of people who participate in a program as well as the type 
of people who participate. Entitlement programs may focus on addressing 
factors that affect access in order to increase program participation. 
However, because coverage rates in non-entitlement programs are 
determined primarily by funding levels, non-entitlement programs are 
more likely to be concerned about the impact of these factors on other 
aspects of program access, such as the composition of the program 
caseload and how the program interacts with alternative programs that 
provide similar benefits. 

The Size and Type of Benefits Can Affect Participation: 

The size and type of program benefits can affect whether or not an 
individual participates in a program. Numerous studies show that the 
size or value of the benefit influences program participation, and this 
depends largely on the structure of program benefits. Some programs, 
such as the Food Stamp Program, determine benefit levels based on 
income, allowing a three-person household to receive as little as $1 
per month depending on household income. Other programs, such as 
Medicaid, generally offer comparable benefits to every resident of a 
state who meets eligibility requirements. A recent National Bureau of 
Economic Research study showed that across a range of programs and 
within programs, larger benefits were associated with higher 
participation and coverage rates.[Footnote 16] In addition, our 
literature review, site visits, and analysis of participation rates for 
selected programs showed that participation and coverage rates tend to 
be higher among subgroups eligible for larger benefits. For example: 

* Elderly individuals are generally eligible for small food stamp 
benefits; their participation rate in the program is lower than for 
other groups. 

* Families with infants participate in WIC at higher rates than 
families with older children, in part because the value of the WIC 
voucher is greater for families with infants. WIC officials in 
Connecticut reported to us that 10 percent of families stopped 
participating in the program when their youngest child reached age 
1.[Footnote 17]

* On average, families with children who are eligible for the EITC 
receive a higher EITC benefit than individuals and families without 
children, and they participate at a higher rate. 

The type of benefits offered can also influence whether someone 
eligible for a program participates. Some programs--such as EITC and 
SSI--offer cash benefits while other programs--such as Head Start and 
Medicaid--offer direct services, such as educational or health 
services. Our research on participation in low-income programs 
generally shows that participation and coverage rates are higher among 
programs that provide cash benefits than among programs that provide 
direct services. One reason for this difference is the flexibility cash 
benefits give to individuals. Although the recipient may need the 
services provided by programs in which they are enrolled, these types 
of benefits do not allow individuals to shift resources away from 
program purposes toward what they might consider more pressing needs. 
Our site visits confirmed that the type of benefits influence 
participation and coverage rates. For example, we found that: 

* SSI recipients who participated in a pilot project that allowed them 
to receive their food stamp allotment in cash expressed a strong 
preference for this over traditional food stamp coupons. 

* Some individuals who need subsidized housing may prefer the Housing 
Choice Voucher program, which allows individuals to choose their 
housing in neighborhoods that offer better educational and employment 
opportunities or choose to remain in a place while paying less rent, 
over the Public Housing program that does not give the individuals 
flexibility to choose where they live. 

Ease of Access to Program Benefits and Services Can Influence 
Participation: 

Factors that influence the ease with which potential participants can 
access a program--including office hours, program location, and the 
ability of program participants to redeem or use their benefits--can 
also affect the number and groups of people who participate in the 
programs. Several of the programs we reviewed require applicants to 
visit the program office to establish and maintain eligibility. For 
instance, local WIC, TANF, and Food Stamp Program offices typically 
require face-to-face interviews before individuals can receive 
benefits.[Footnote 18] Those programs that keep traditional office 
hours--8:00 a.m. to 5:00 p.m.--pose a barrier to potential applicants 
who work and would have to take time away from their job in order to 
apply. Studies on child care and WIC programs identify traditional 
office hours as a barrier for working families. Similarly, Medicaid 
officials in California told us that one of their barriers to 
participation is office hours that do not accommodate working families. 
Although many program officials suggested that having flexible office 
hours is important to participants, some offices are challenged to 
extend their operating hours. WIC officials in Connecticut told us that 
they have attempted to promote extended hours and have made some 
progress; however, instituting extended hours remains problematic due 
to limited funding and contracts governing the workforce. 

The location of the program office can also affect participation and 
caseload composition. For many individuals--like the elderly, 
individuals with disabilities, and families living in rural areas--
traveling to a program office that is outside the limits of their 
available mode of transportation makes it difficult for them to receive 
needed benefits. The USDA published in its National Survey of WIC 
Participants that one of the top barriers in the WIC program is 
transportation with 30 percent of participants reporting that they 
missed appointments because they lack transportation to the office. 
Studies on the Housing Choice Voucher, child care, Head Start, and Food 
Stamp programs reported similar findings. Many state and local 
officials we visited agreed that transportation is a barrier to 
participation. A TANF, Food Stamp, and Medicaid official in Washington 
County, Maryland, told us that public transportation is limited and 
getting to and from the program offices poses a barrier to 
participation for many individuals, especially those in rural 
communities. According to officials, participants without vehicles have 
to seek rides from family members or acquaintances to access services. 
For many of these participants being seen going to the welfare office 
is difficult and sometimes stigmatizing. 

Some programs--including child care, Housing Choice Voucher, and 
Medicaid--offer benefits that can be difficult for participants to use, 
as some service providers--landlords, day care workers, or health care 
providers--will not exchange their services for program benefits. For 
example, our prior work found that the proportion of providers who will 
accept child care subsidies varied widely by state, ranging from 23 to 
90 percent. Even in cases where providers accepted subsidies, the 
number of slots for children that used child care subsidies was 
limited.[Footnote 19] Additionally, several state and local officials 
suggested that participants are sometimes challenged to find health 
care providers that accept Medicaid. According to officials in Chisago 
County, Minnesota, participants have to drive up to 200 miles to visit 
a dentist that accepts Medicaid. 

Misperceptions about Program Requirements Discourage Some Individuals 
from Participating: 

From our literature review and interviews with program officials, we 
also found that many individuals do not participate in low-income 
programs because they do not know that they are potentially eligible 
for benefits. Numerous studies have documented instances where 
participation was compromised because individuals were unaware of 
program benefits or had misconceptions about eligibility. For example, 
several EITC, Medicaid, Food Stamp, Head Start, and SSI studies 
indicate that one of the primary barriers to participation is that 
individuals do not know that they are eligible for these benefits. For 
some individuals--like the elderly and non-English speakers--this 
unfamiliarity with program benefits is even more widespread, creating a 
larger barrier to participation and an under representation of these 
individuals in the caseload. Many program officials we visited agreed 
and explained that individuals also have misconceptions about program 
eligibility. For example, some individuals do not believe that they are 
eligible for benefits because they are employed while others do not 
want to be attached to the perceived stigma associated with the 
programs. In Los Angeles, Medicaid officials noted that rumors 
circulated about the eligibility criteria for Medicaid prevent many 
potential recipients from applying for the program. Particularly in non-
English speaking communities, information about social services is 
often received through word of mouth; thus, when incorrect information 
circulates, it can have a significant impact on participation. 

Application Process and Eligibility Verification Requirements to Ensure 
Program Integrity Can Have an Effect on Participation: 

Eligibility verification requirements--rules put in place to improve 
program integrity by ensuring that only those eligible for program 
benefits receive them--can also affect the overall number and 
characteristics of people who participate in the program. Each low-
income program in this study has a set of verification requirements 
that individuals must complete to establish and maintain eligibility. 
Common requirements among the programs include completing application 
forms and providing necessary documentation. In addition, some programs 
require applicants to take additional steps, such as attending face-to-
face interviews, documenting parental or spousal assets, or 
participating in orientation classes. According to our literature 
review, the complexity of verification requirements can impact the 
number of enrollees, especially for individuals with mental 
disabilities or who are homeless. One WIC study reviewed participation 
rate differences among states and found that states that required 
applicants to provide proof of income (before it was federally 
mandated) and had stricter program rules had lower program 
participation than states that did not require income 
documentation.[Footnote 20] Additionally, another study examined EITC 
participation rates across states and found that differences in 
participation rates are due in part to the applicant having help 
completing the complex tax forms.[Footnote 21] Many state and local 
officials agree that strict and/or complicated verification 
requirements can decrease participation, particularly among certain 
groups of people. For example, we found: 

* According to officials, the Pell Grant application is very long and 
complicated and can be difficult for students and their parents to 
complete. Staff from an organization in St. Paul, Minnesota, dedicated 
to assisting low-income students to access higher education told us 
that many low-income students in the area would not be able to complete 
the forms correctly without their assistance. 

* CCDF Officials in Connecticut and Georgia told us that the 
application process can be complex and difficult for applicants and, as 
a result, many applicants submit their applications late or incomplete. 
Because there is very high demand for child care subsidies, these 
families are often denied benefits or removed from the waiting list. 

* Local SSI officials told us that participants face many life changes 
such as frequent hospitalization and institutionalization, moving into 
different family households, and changes in the hours that they work. 
To remain eligible for program benefits, SSI recipients must report 
these types of changes within 10 days from the end of the month of the 
change. 

Finally, while each program has its own set of verification 
requirements, these requirements become even more challenging when 
participants are applying or maintaining eligibility for multiple 
programs. Program officials in Maryland told us that one of the biggest 
barriers to accessing multiple means-tested programs is the many 
different eligibility criteria and reporting requirements of the 
various programs. According to state officials in Maryland, the TANF 
and Food Stamp Programs are relatively well aligned, but Medicaid has 
not coordinated as much with the other programs. According to 
officials, this can be problematic because a participant who is turned 
down for one program might assume that he or she is ineligible for 
other low-income programs and may fail to apply for benefits for which 
they are eligible. 

Factors That Influence Participation Rates Can also Impact Other 
Aspects of Program Access Such As Targeting and Program Interactions: 

Factors that influence participation also impact other aspects of 
program access such as targeting and program interactions among all low-
income programs, but particularly among non-entitlement programs whose 
enrollment levels are determined largely by funding levels. The non-
entitlement programs covered in this review--CCDF, Head Start, Housing 
Choice Vouchers, Public Housing, SCHIP, and TANF--have funding 
limitations that could restrict the total number of people who could 
potentially participate in the programs and, as a result, coverage 
rates for these programs may be determined, at least in part, by 
funding. However, among programs that allow states substantial 
flexibility in determining program eligibility and implementation such 
as CCDF, SCHIP, and TANF, funding constraints contribute to, but do not 
determine coverage rates to the extent that they do for programs that 
allow less state and local flexibility. Given funding constraints for 
non-entitlement programs, agencies are challenged to allocate scarce 
resources appropriately by targeting their benefits to specific groups 
of people and planning strategically to ensure that the program 
complements a broader range of programs administered by the same agency 
or that provide similar services or benefits to the program's eligible 
population. 

Because factors that influence participation often affect the 
composition of a program's caseload, some agencies that administer 
programs with limited funding have put measures in place to ensure that 
their caseloads reflect program priorities--whether that involves 
targeting certain groups or ensuring that benefits do not 
disproportionately favor or exclude certain subpopulations. For 
example, although the public housing program generally does not target 
benefits to households with the lowest incomes, it allows priority to 
be given to elderly and disabled recipients. Agency officials reported 
that they track participation of these groups to ensure that their 
share of the total caseload does not change dramatically from 1 year to 
the next. Similarly, state child care officials told us that funds are 
generally provided to recipients based on priority groups that favor 
families receiving public assistance and those with the greatest 
financial need. 

Additionally, many agencies are cognizant of how their programs 
interact with and complement other programs that serve the same 
population. For example, some child care programs pair with half-day 
Head Start programs to provide continuous care to children of working 
parents; Medicaid and SCHIP programs within some states coordinate 
their enrollment processes to facilitate access to health insurance for 
individuals in the state; and between 1998 and 2003, HUD responded to a 
decrease in the number of public housing units available for low-income 
households by increasing resources available through its voucher 
program to maintain coverage for families. Likewise, in allocating TANF 
resources, programs often coordinate with local workforce development 
agencies, child care programs, and other programs that provide similar 
services to best meet the needs of their clients without duplicating an 
existing effort. In these ways, programs acknowledge and respond to 
access issues and ways in which factors affect access other than 
participation levels and rates. 

Program Administrators Have Strategies That Improve Both Access and 
Integrity, but Federal Agencies Have Generally Focused More on 
Measuring Program Integrity Outcomes: 

Program administrators have implemented many strategies to achieve 
desired program outcomes, including those related to program access and 
program integrity, but while agencies have generally taken steps to 
monitor and disseminate information on program integrity, few track and 
report on the extent to which they are serving their eligible 
populations. The programs we reviewed have many goals and objectives of 
varying degrees of importance to the agencies that administer them, 
among them program access and program integrity. Strategies implemented 
at the federal, state, and local level to address these two issues 
include information systems, data sharing, and technological 
innovation, changes to the application and eligibility verification 
process, and outreach and coordination with other programs. Although 
federal agencies do not have direct control over many of the strategies 
we identified--including those mandated by law and those initiated at 
the state and local level--federal managers can play a role in 
encouraging and facilitating such strategies by emphasizing program 
access and program integrity as federal agency priorities. In response 
to the Improper Payments Information Act of 2002, all of the federal 
agencies we reviewed have taken at least some steps to identify and 
begin reporting information to Congress and others on the extent of 
improper payments. We also found, however, that for several of the 
programs we reviewed, federal agencies have not taken steps to identify 
and use participation or coverage rate information in managing their 
programs. Having up-to-date information on the extent to which their 
programs reach eligible individuals can help agencies plan 
strategically, set priorities, and ensure that agencies are reaching 
eligible families. 

Programs Have Found Ways to Improve Access by Reducing the Burden on 
Applicants While at the Same Time Improving Program Integrity: 

The state, local and federal program officials we spoke with identified 
several strategies that they believe may improve either of the two 
objectives--program access or program integrity--without harming, and 
in many cases improving, the other. As mentioned, some efforts to 
increase program integrity and prevent fraud, such as increasing the 
amount of eligibility verification required, may actually hurt access 
to the program by deterring even those eligible from applying. However, 
program administrators told us of several strategies that increase 
access while maintaining and even improving integrity. The 
complementary strategies we identified are enabled by information 
systems, data sharing, and technological innovations, changes in the 
application and eligibility verification process, and outreach and 
coordination with other programs. 

Information Systems, Data Sharing, and Technological Innovation: 

Improved information systems, sharing of data between programs, and use 
of new technologies can help programs to better verify eligibility and 
make the application process more efficient and less error prone. These 
strategies can improve integrity not only by preventing outright abuse 
of programs, but also by reducing chances for client or caseworker 
error or misunderstanding. They can also help programs reach out to 
populations who may face barriers. One strategy involves sharing 
verified eligibility information about applicants across programs. Data 
sharing prevents applicants from having to submit identical 
verification to multiple programs for which they may be eligible, and 
it can also speed up the sometimes-lengthy application process. In 
addition, data sharing allows programs to check the veracity of 
information they receive from applicants with other databases. 

In Minnesota, WIC caseworkers are able at the time of application to 
determine participant eligibility by accessing basic eligibility 
information via technology systems from other means-tested programs, 
such as Medicaid, food stamps and TANF. SSI administrators told us that 
during the application interview, income data is entered in their 
computer system. This information is then checked with a number of 
other databases including those of the IRS, the Department of Veterans 
Affairs, and the state Civil Service Administration to quickly verify 
earnings and other eligibility requirements and inconsistencies are 
flagged. Similarly, Georgia has an interactive computer system that 
aggregates client information for TANF, Medicaid, and the Food Stamp 
Program and calculates benefits for all three programs. Additionally, 
when clients need to make a change in their eligibility information, 
these data are automatically changed for all three programs, so that 
clients can receive the appropriate level of benefits based on their 
most current eligibility information. Furthermore, the data reliability 
matches may include information from the Department of Labor wage 
match, SSI benefits, prison information, and information on a person's 
death. If any of the matched information conflicts with the information 
provided by the client, a caseworker is to ask additional questions of 
the client. In all these ways, caseworkers can accelerate the 
application process while capitalizing on verified eligibility 
information already provided to other programs. 

Some administrators told us that such data sharing, however, can be 
complicated by concerns over ensuring privacy and by insufficient 
technological capacity. Local program administrators told us that 
eligibility data for Medicaid and SCHIP is tightly controlled because 
of Health Insurance Portability and Accountability Act (HIPAA)--a law 
that limits access to an individual's health information--but that its 
data might be shared, if warranted, with proper consent. Data sharing 
can be impeded by technological limitations, such as computer systems 
that cannot communicate directly with other systems over the Internet 
or some other network, or a lack of software needed to translate 
information into formats that other computers can understand. Our prior 
work on data sharing identifies strategies agencies have implemented to 
address concerns about privacy and technological capacity 
issues.[Footnote 22]

Some agency officials told us of ways in which on-line applications can 
improve both access and integrity. As stated, program integrity is 
compromised not only by willful misrepresentation, but also by 
applicant and caseworker error. Web-based or partially web-based 
applications can automatically check that all required fields are 
completed before an application is submitted for review and 
automatically calculate benefits thereby reducing error. Moreover, 
having the option of an on-line application can increase access to 
those who are eligible for benefits but who may have difficulty 
physically getting to program offices. Minnesota has instituted an on-
line interactive application for Medicaid that program administrators 
believe will make the application process easier for both participants 
and caseworkers. In addition to making the process easier, the system 
will also check verification information with a variety of other data 
sources and thus reduce the likelihood of errors as well. In this way, 
a potentially burdensome application process becomes simpler, more 
accessible, and less error prone. Similarly, eight states accept food 
stamp applications through the Internet. Of course, this strategy is 
less viable or effective where access to computers is limited or where 
the on-line environment cannot be adequately secured. 

Application and Eligibility Verification Process Changes: 

Program administrators told us about several changes in the application 
and eligibility verification process that have improved their ability 
to promote access and ensure integrity. Efforts to increase the 
accuracy of eligibility and benefit determination can increase access 
by reducing the number of applicants who were incorrectly denied 
benefits or whose benefit determinations resulted in underpayments. For 
example, streamlining or simplifying the application and providing 
applications in other languages can increase access, but also promote 
program integrity by reducing errors or misunderstanding in the 
application process. Simplifying applications by clarifying confusing 
wording and removing redundant questions as well as providing 
applications in an applicant's native language can reduce the 
possibility of these types of errors. According to federal officials, 
most states use a simplified application form for the SCHIP program to 
remove application barriers for families. For example, the SCHIP 
program applications in both Connecticut and California have been 
reduced from 17 and 27 pages respectively to only 4 pages each without 
sacrificing required information, according to state officials. In many 
cases, the SCHIP streamlined application forms caused corresponding 
changes in state Medicaid applications as well. In addition, many of 
the program administrators with whom we spoke told us that their 
applications and forms were available in many languages. For example, 
the Minnesota Department of Revenue now has state EITC tax forms and 
fact sheets directing them to the federal EITC in eleven languages. 

Another way in which programs can streamline the application process is 
through categorical eligibility with other programs, which can be set 
at the federal or state level depending on the program. Categorical 
eligibility, also known as adjunctive eligibility, allows an individual 
who has been found eligible for one program to be automatically granted 
eligibility for another program, typically one with less stringent 
eligibility criteria. For example, if an individual is receiving SSI, 
federal legislation generally requires that that person be 
automatically eligible for Medicaid.[Footnote 23] Similarly, if a 
pregnant woman is receiving Food Stamps, Medicaid, or TANF, then she 
automatically qualifies for WIC benefits--and thus does not need to 
provide income verification once again when applying for the program. 
States also have flexibility to grant automatic eligibility for other 
programs. A state WIC program, for example, may grant automatic 
eligibility for families receiving Free and Reduced Price School 
lunches. These adjunctive or automatic eligibility policies allow 
ultimately for simpler applications, which may enhance access and 
reduce error. In fact, federal administrators at USDA noted that 
adjunctive eligibility is one of the most important tools now used to 
address program integrity and access issues in a way that cuts across 
programs. 

The provision of more comprehensive in-person assistance in filling out 
applications can encourage a candidate eligible for benefits to 
complete an otherwise lengthy, complicated, or intimidating application 
process. Such personal assistance can also prevent errors that result 
from misunderstanding of application questions or requirements or even 
fraud by reminding applicants in person that fraudulent claims are 
punishable by law. For example, to increase access to the program, 
California program officials told us that the SCHIP program developed a 
training process that certified staff from other entities, such as 
schools and community-based organizations, as "application assistants." 
These "application assistants" are also trained to recognize when 
applicants seem to be submitting false information and are prohibited 
from assisting families who have previously been found to have 
committed fraud. In a Maryland SSA office, SSI program administrators 
told us that they had abbreviated their application form so that most 
information is now collected in an interview. This process helps 
improve access for those with limited literacy or those who may be 
discouraged by a long paper application. Officials also noted that this 
process helps program integrity because the interviews allow 
caseworkers the opportunity to remind clients that fraudulent claims 
are punishable by law. Similarly, EITC officials in Minnesota told us 
that free tax preparation assistance could make the process less 
complicated for filers and could also cut down on fraud from tax 
preparers. As one official explained, many low-income families live 
near a high concentration of paid tax preparers, who have incentives to 
fraudulently file for a high credit. While more in depth application 
assistance has these benefits, it can pose challenges to programs in 
ensuring the quality of the assistance offered and it can be costly. 
According to California SCHIP officials, funding to train "application 
assistants" for the SCHIP program in California was ended in May 2002 
due to budget constraints. 

Lastly, some policies put in place to prevent fraud at the time of 
application can also help with program access. Connecticut Department 
of Social Services has begun a fraud prevention program, termed FRED 
(Fraud Early Detection), which was instituted to address an increase in 
the amount of fraud and error detected in the program. The purpose of 
FRED is to identify potential fraud cases before benefits are paid out 
to prevent improper payments rather than identifying fraud after the 
payments have been made. Under FRED, cases that meet 1 of 12 risk 
criteria are to be referred to a fraud investigator who is to visit the 
home within 10 days of the referral. While the investigator is visiting 
the home, he/she is to interview the client about aspects of the risk 
criteria, and make a recommendation regarding eligibility. While the 
primary purpose of the visit is to prevent fraud, in practice 
investigators have found that their role is also to explain the 
eligibility criteria more clearly to applicants and to explain what 
steps they need to take in order to be eligible for program benefits. 
In addition, investigators are trained to provide additional 
information to the family on other resources available to them and to 
assist them with referrals, thereby increasing access to an array of 
related social services. 

Outreach and Coordination with Other Programs: 

Targeted outreach to populations that might have more barriers to 
accessing the program has the potential to increase access without 
necessarily compromising integrity. Many program officials we spoke 
with told us that they had outreach strategies to reach out to 
populations--such as rural-dwellers, the elderly, or those with limited 
English proficiency--that have had trouble accessing the program. Such 
strategies include information sessions or pamphlets in ethnic 
community centers or partnering with advocacy groups. In addition, 
cross agency referrals for applicants already found to be eligible and 
more overall agency coordination can improve access without sacrificing 
integrity. 

Many agency officials with whom we spoke told us that they coordinated 
with other programs to reach potential clients. In Maryland, the 
Department of Social Services invites the Volunteer Income Tax 
Assistance program to work out of its office, so that those low-income 
earners already in contact with social services can have better access 
to the EITC. Some offices in California participate in an open door 
policy program in which clients can access any social service program 
through referrals at any state government office they walk in to. Some 
program administrators told us that program co-location can help 
increase access. This happens when an individual applying for one 
program in an office is referred to and immediately serviced by another 
program in that same location. Some examples we found had Food Stamps 
located in TANF offices and a WIC clinic collocated with the state 
Children's Health Insurance Program. 

Federal Agencies Have Taken Steps to Track Improper Payments, but Few 
Estimate Program Participation or Coverage Rates to Monitor Program 
Access: 

All of the programs we reviewed emphasize both program access and 
program integrity, and as we have described, many federal, state, and 
local program administrators have implemented strategies intended to 
achieve access and integrity goals. However, not all agencies 
responsible for administering these programs have established 
management practices, in keeping with standards of internal control, 
that will consistently guide them in achieving these outcomes. Among 
the standards that are particularly relevant for agencies responsible 
for administering means-tested programs are:[Footnote 24]

* establishing and maintaining a control environment, a culture of 
accountability that sets a positive and supportive attitude toward 
achieving management objectives;

* monitoring program performance over time; and: 

* recording and communicating relevant, reliable, and useful 
information to management and others who need it to carry out their 
internal control and operational responsibilities. 

To achieve desired program outcomes and safeguard federal funds, these 
standards should be part of an agency's operational and management 
practices. While the agencies we reviewed have taken steps to establish 
internal controls for improper payments and program integrity, not all 
have established similar controls for achieving desired program access 
outcomes. 

There are many ways in which federal agencies can establish a culture 
of accountability, one that "sets the tone" for program administrators 
at all levels of government to emphasize certain priorities. One way to 
do this is to monitor progress toward achieving desired program 
outcomes, and another is to effectively communicate program information 
in a broad sense, with information flowing down, across, and up the 
organization. Depending on the program, some aspects of an achievement-
oriented environment are codified in laws, regulations, and federal 
policies. For example, the Improper Payments Information Act of 2002 
requires those programs and activities susceptible to significant 
erroneous payments to calculate annual improper payment estimates and 
sets statistical sampling confidence and precision levels for 
estimating those payments. 

As shown in table 9, some of the federal agencies covered by this 
review have already begun to monitor improper payments for the programs 
they administer and, as directed by OMB guidance, communicate this 
information by including a measure of improper payments in their annual 
Performance and Accountability Reports.[Footnote 25] Including measures 
of improper payments in agency annual performance plans and 
accountability reports is one way to provide officials with important 
information on areas of success and areas that need improvement and to 
send a signal to all working on agency programs that the measured goal 
is a priority. (For information on the amounts of improper payments 
reported by agencies, see app.III.) To varying degrees, the other 
agencies included in this review have begun taking steps to identify 
and report on improper payments as well. While agencies are taking 
steps, much remains to be accomplished before a comprehensive picture 
is available of the amount of improper payments for these 
programs.[Footnote 26]

Table 9: Status of Agencies Identification of and Reporting on the 
Amounts of Improper Payments by Program: 

Agency: USDA; 
Program: Food Stamps; 
Subject to the IPIA? Yes; 
Agency included improper payment information in fiscal year 2004 annual 
performance and accountability report: Yes. 

Agency: USDA; 
Program: WIC; 
Subject to the IPIA? Yes; 
Agency included improper payment information in fiscal year 2004 annual 
performance and accountability report: No; 
If not, has the agency reported taking some steps to identify and 
monitor the amount of improper payments? Yes. 

Agency: HHS/ACF; 
Program: TANF; 
Subject to the IPIA? Yes; 
Agency included improper payment information in fiscal year 2004 annual 
performance and accountability report: No; 
If not, has the agency reported taking some steps to identify and 
monitor the amount of improper payments? Yes. 

Agency: HHS/ACF; 
Program: CCDF; 
Subject to the IPIA? Yes; 
Agency included improper payment information in fiscal year 2004 annual 
performance and accountability report: No; 
If not, has the agency reported taking some steps to identify and 
monitor the amount of improper payments? Yes. 

Agency: HHS/ACF; 
Program: Head Start; 
Subject to the IPIA? Yes; 
Agency included improper payment information in fiscal year 2004 annual 
performance and accountability report: No[A]; 
If not, has the agency reported taking some steps to identify and 
monitor the amount of improper payments? Yes. 

Agency: IRS; 
Program: EITC; 
Subject to the IPIA? Yes; 
Agency included improper payment information in fiscal year 2004 annual 
performance and accountability report: Yes. 

Agency: HHS/CMS[B]; 
Program: Medicaid; 
Subject to the IPIA? Yes; 
Agency included improper payment information in fiscal year 2004 annual 
performance and accountability report: No; 
If not, has the agency reported taking some steps to identify and 
monitor the amount of improper payments? Yes. 

Program: SCHIP; 
Subject to the IPIA? Yes; 
Agency included improper payment information in fiscal year 2004 annual 
performance and accountability report: No; 
If not, has the agency reported taking some steps to identify and 
monitor the amount of improper payments? Yes. 

Agency: SSA; 
Program: SSI; 
Subject to the IPIA? Yes; 
Agency included improper payment information in fiscal year 2004 annual 
performance and accountability report: Yes. 

Agency: ED; 
Program: Pell Grant; 
Subject to the IPIA? Yes; 
Agency included improper payment information in fiscal year 2004 annual 
performance and accountability report: Yes. 

Agency: HUD; 
Program: Public Housing; 
Subject to the IPIA? Yes; 
Agency included improper payment information in fiscal year 2004 annual 
performance and accountability report: Yes. 

Agency: HHS/CMS[B]; 
Program: Housing Choice Voucher; 
Subject to the IPIA? Yes; 
Agency included improper payment information in fiscal year 2004 annual 
performance and accountability report: Yes. 

Source: GAO survey of federal agencies and interviews with agency 
officials and agency performance and accountability reports. 

[A] ACF has estimated the percentage of "over-income" families served 
by Head Start in excess of the 10 percent allowed by regulation. 

[B] CMS has a performance goal in its annual performance plan related 
to a pilot project to develop payment error rates for both SCHIP and 
Medicaid. 

[End of table]

While an internal control framework is emerging for addressing 
financial program integrity issues, few of the agencies responsible for 
administering the programs we reviewed have established a similar 
framework for achieving desired program access outcomes, although they 
have implemented numerous strategies to increase program participation. 
The 12 programs we reviewed have numerous program goals and objectives 
of varying degrees of importance to the agencies that administer them. 
Because the most fundamental purpose of these programs is to serve low-
income individuals and families, all track measures that provide some 
information about program participation and access. For example: 

* All of agencies responsible for administering the programs we 
reviewed track the number of people participating in their programs. 

* Some federal agencies--such as HUD--measure the extent to which 
program participants redeem or use benefits provided to them. 

* Others use other measures related to access. CMS tracks the number of 
individuals who are uninsured each year. 

* Many agencies track participants and participant outcomes through 
program effectiveness studies.[Footnote 27]

Through these efforts, agencies have demonstrated their concern about 
program access, yet, the ways in which most of these agencies measure 
program participation do not inform administrators about the extent to 
which they are meeting overall need and therefore do not provide all 
the information they need to monitor access. As discussed above, access 
encompasses not only the number of program participants, but also the 
extent to which programs reach the total population eligible for 
benefits and services, how well agencies are allocating resources among 
targeted subpopulations, and, from an agencywide or even governmentwide 
perspective, how well specific means-tested programs complement and 
interact with programs that serve similar populations or provide for 
similar needs. While concerns about the allocation of scarce resources 
and interactions with other programs apply to all low-income programs, 
they may be of particular importance to non-entitlement programs whose 
participation is limited by funding constraints. Participation or 
coverage rate information can guide program administrators in setting 
priorities and targeting scarce resources, even among programs that 
were not intended to serve everyone eligible for program benefits. 

As shown in table 10, only one of the agencies we reviewed, USDA, 
regularly estimates participation rates for the programs it administers 
and communicates and disseminates information on these rates in a way 
that promotes a culture of accountability supportive of achieving 
program access outcomes. USDA has been estimating participation rates 
annually for the Food Stamp Program since 1975. The agency uses this 
information to get a better understanding of how well they are reaching 
certain priority subpopulations such as the working poor, single-parent 
families with children, and SSI recipients; 
and to identify states in need of outreach assistance. In addition, 
USDA has established a performance goal to increase participation rates 
in the Food Stamp Program and reports food stamp participation rates in 
its annual performance report.[Footnote 28] In these ways, the agency 
uses this information for program management purposes. 

Table 10: Status of Agencies Efforts to Use Information on 
Participation or Coverage Rates in Managing Their Programs: 

Agency: USDA; 
Program: Food Stamps; 
Does the agency estimate a participation or coverage rate? Yes; 
If so, does the agency use this rate information as a performance 
measure? Yes; 
If the agency estimates a participation or coverage rate, does it 
include rate information in their performance report or other key 
program report[A]? Yes. 

Agency: USDA; 
Program: WIC; 
Does the agency estimate a participation or coverage rate? Yes; 
If so, does the agency use this rate information as a performance 
measure? No; 
If the agency estimates a participation or coverage rate, does it 
include rate information in their performance report or other key 
program report[A]? Yes[B]. 

Agency: HHS/ACF; 
Program: TANF; 
Does the agency estimate a participation or coverage rate? Yes; 
If so, does the agency use this rate information as a performance 
measure? No; 
If the agency estimates a participation or coverage rate, does it 
include rate information in their performance report or other key 
program report[A]? No[C]. 

Agency: HHS/ACF; 
Program: CCDF; 
Does the agency estimate a participation or coverage rate? Yes; 
If so, does the agency use this rate information as a performance 
measure? No; 
If the agency estimates a participation or coverage rate, does it 
include rate information in their performance report or other key 
program report[A]? Yes[D]. 

Agency: HHS/ACF; 
Program: Head Start; 
Does the agency estimate a participation or coverage rate? Yes; 
If so, does the agency use this rate information as a performance 
measure? No; 
If the agency estimates a participation or coverage rate, does it 
include rate information in their performance report or other key 
program report[A]? No. 

Agency: IRS; 
Program: EITC; 
Does the agency estimate a participation or coverage rate? Yes[E]; 
If so, does the agency use this rate information as a performance 
measure? No; 
If the agency estimates a participation or coverage rate, does it 
include rate information in their performance report or other key 
program report[A]? No[F]. 

Agency: HHS/CMS; 
Program: Medicaid; 
Does the agency estimate a participation or coverage rate? No. 

Agency: HHS/CMS; 
Program: S-CHIP; 
Does the agency estimate a participation or coverage rate? No. 

Agency: SSA; 
Program: SSI; 
Does the agency estimate a participation or coverage rate? No[G]. 

Agency: ED; 
Program: Pell Grant; 
Does the agency estimate a participation or coverage rate? No[H]. 

Agency: HUD; 
Program: Public Housing; 
Does the agency estimate a participation or coverage rate? No[I]. 

Agency: HUD; 
Program: Housing Choice Voucher; 
Does the agency estimate a participation or coverage rate? No. 

Source: GAO survey of federal agencies, agency annual performance 
plans. 

[A] Key program reports include routine reports that agencies must 
prepare for Congress for the purpose of providing updated information 
on the status of the programs they administer. 

[B] USDA's methodology for calculating the WIC coverage rate is being 
revised. The agency has not yet started reporting in its annual program 
reports but it has plans to do so. 

[C] HHS includes a TANF coverage rate as part of their Indicators of 
Welfare Dependence report. 

[D] CCDF has published a coverage rate for child care in their Biennial 
Report to the Congress, which includes SSBG and TANF funds. 

[E] IRS has calculated a participation rate for the EITC, but only for 
selected years. 

[F] IRS has plans to use a participation rate as part of their 
Strategic Plan. 

[G] SSA has calculated a participation rate for the years 1991-1996, 
but only for a subpopulation of those participating in SSI. 

[H] ED has calculated a take-up rate, which is the share of those who 
applied and were found eligible for a Pell Grant who actually received 
a grant. 

[I] HUD has calculated a voucher utilization rate for the housing 
choice voucher program, and tracks the occupancy rates of public 
housing authorities. 

[End of table]

USDA has taken steps to develop a reliable participation rate measure 
for the WIC program and plans to estimate the WIC participation rate 
annually. Because the WIC program is not an entitlement and 
participation is determined by the appropriated funds, FNS officials 
told us they do not plan to establish a performance goal related to the 
WIC participation rate. However, officials told us that they do think 
it is important to monitor and report on the WIC participation rate for 
policy, planning, and budgeting purposes, and the agency plans to use 
these data in managing the program by highlighting the measure in the 
program's budget reports and its annual report to Congress. 

HHS plays a key role in estimating participation rates for several 
means-tested programs. Since 1973, HHS's Office of the Assistant 
Secretary for Planning and Evaluation has funded TRIM3 for the purposes 
of policy development, analysis, and research on such topics as the 
interactive effects of programs serving low-income families. The 
Welfare Indicators Act of 1994,[Footnote 29] requires HHS to submit 
annual reports to Congress on welfare receipt in the United States and 
key indicators and predictors of welfare dependence. These reports, 
produced annually since 1997, include participation and coverage rates 
from TRIM3 for TANF (and its predecessor program, Aid to Families With 
Dependent Children), SSI, and food stamps. 

HHS includes CCDF coverage rates[Footnote 30] in the biennial 
congressional report and plans to include a performance measure related 
to participation rates in its annual performance reports starting in 
fiscal year 2006. However, HHS generally does not use participation 
rate estimates it has available from TRIM3 in managing its other 
programs by highlighting the information in its annual performance 
plans or congressionally mandated program reports. For example, TANF 
participation rates are not included in the agency's TANF Annual Report 
to Congress and Medicaid and SCHIP participation and coverage rates are 
not included in any of the other congressionally mandated reports 
disseminated by CMS, the agency that administers these programs. 

Only one of the other agencies we reviewed, the IRS, has plans to 
estimate and report on participation rates for the programs they 
administer. IRS plans to begin estimating the participation rate in the 
EITC program on an annual basis starting in fiscal year 2005 and to use 
the EITC participatio