GAO Reports: Food Issues

This page lists the most recent publications related to food issues organized into four categories: domestic food programs, international food assistance, food prices, and food safety. It includes publications issued since 2000.

Domestic Food Programs

 http://www.gao.gov/docsearch/featured/food_domestic.html Sun, 22 Nov 2009 18:42:54 -0500 GAO http://www.gao.gov/images/title_object.jpg GAO logo http://www.gao.gov/ Feed provided by GAO. Click to visit. School Meal Programs: Improved Reviews, Federal Guidance, and Data Collection Needed to Address Counting and Claiming Errors, September 9, 2009 http://www.gao.gov/new.items/d09814.pdf In fiscal year 2008, the National School Lunch Program and School Breakfast Program provided meals to 30.9 million and 10.5 million children, respectively. Recently, the U.S. Department of Agriculture (USDA) issued the first estimate of improper payments due to meal counting and claiming errors in these programs, which was approximately $860 million (8.6 percent of federal program reimbursements) in school year 2005-2006. These errors include: (1) cashier errors, such as those made in determining if a meal meets the federal menu planning and nutrition requirements (meal counting), and (2) aggregation errors made when officials count and total meals for federal reimbursement (meal claiming). GAO was asked to review (1) actions taken by states and school food authorities (SFA) to identify and address meal counting and claiming errors; and (2) actions taken by USDA to help states and SFAs identify and address meal counting and claiming errors. GAO's steps included analyzing data on state administrative reviews of SFAs; surveying all states; conducting site visits; and interviewing federal, state, and SFA officials. Although states and SFAs conduct program integrity reviews of the school meal programs, gaps in federal requirements for these reviews limit their effectiveness at identifying meal counting and claiming errors. States and SFAs are generally not required to review the School Breakfast Program, and 21 states reported through GAO's survey that they do not review the breakfast program. However, USDA estimates that the percentage of meal counting and claiming errors is higher in the breakfast program than the lunch program. Further, some states reported that SFA reviews of the meal programs are ineffective at identifying and reducing errors, which may be due, in part, to the self-assessment design of these reviews. When state and SFA reviews identify errors, meal counting and claiming errors persist. For example, in several SFAs that GAO visited, the same errors were identified during consecutive reviews. States and SFAs identified multiple factors that hinder efforts to address these errors, such as staff turnover, inadequate training, and school policies that complicate meal service. USDA has taken some actions to improve state reviews of SFAs, but it has not directly focused on oversight of meal counting and claiming. USDA recently provided new review forms and nationwide training to strengthen state reviews and also simplified the application process for state grants to conduct additional reviews of SFAs. However, USDA has not targeted its oversight efforts to identify or address meal counting and claiming errors. For example, USDA regional offices' reviews of state administration of the school meal programs do not focus on these errors, and some regional officials could not provide information on the extent of these errors in the states they oversee. USDA also has not updated its meal counting and claiming manual since it was first issued in 1991. Further, while USDA collects annual data on findings from state reviews of SFAs, the agency has not used these data for oversight purposes or to assess risks associated with meal counting and claiming errors. Wed, 09 Sep 2009 00:00:00 -0400 School Meal Programs: Changes to Federal Agencies' Procedures Could Reduce Risk of School Children Consuming Recalled Food, August 20, 2009 http://www.gao.gov/new.items/d09649.pdf Over the past few years, several food recalls, such as for beef and peanut products, have affected schools. It is especially important that recalls affecting schools be carried out efficiently and effectively because young children have a higher risk of complications from food-borne illnesses. GAO was asked to determine how federal agencies (1) notified states and schools about food recalls, (2) advised states and schools about disposal and reimbursement of recalled food, and (3) ensured that recalls were being carried out effectively. To do this, GAO reviewed and analyzed relevant documents and interviewed federal and state officials, as well as officials from 23 school districts that had experience with at least one of four recent cases involving the safety of food in the school lunch program. Despite its efforts, the U.S. Department of Agriculture's (USDA) Food and Nutrition Service (FNS), which oversees federal school meals programs, did not always ensure that states and schools received timely and complete notification about suspect food products provided to schools through the federal commodity program. The federal commodity program provides food to schools at no cost to the schools, and accounts for 15 to 20 percent of food served in school meals. During 3 recent recalls, FNS notified states, but in only one case did it inform schools to hold and not serve suspect foods prior to an official recall of commodity products. When a videotape aired by the media showed inhumane treatment of cattle at a plant that provided beef to the commodity program, FNS told states to have schools stop serving the company's beef weeks before the official recall of commodity beef was announced. However, when the U.S. Department of Health and Human Services' (HHS) Food and Drug Administration (FDA) recalled suspect peanut products and canned vegetables in two other cases, FNS did not inform states and schools to hold and not serve the companies' commodity products until the recalls were expanded to include the companies' commodity products--weeks later. FNS's initial notification to states regarding recalls did not provide complete information on the full range of products affected. Instead, states and schools continued to receive information on multiple other recalled products over time. It sometimes took states and schools a week or more to determine what additional products were subject to a recall, during which time they unknowingly served affected products. FNS provided instructions for disposal and reimbursement of recalled products to states who, in turn, provided instructions to schools but, nonetheless, some schools experienced problems. Some schools reported to GAO problems in finding landfills that would accept large quantities of recalled products. Some schools also reported that reimbursement instructions were not clear, reimbursement was delayed for months, and that all of their expenses related to the recalls were not reimbursed. Although both USDA's Food Safety Inspection Service (FSIS) and the FDA procedures direct them to conduct recall quality checks, neither included thousands of schools that had received recalled USDA-commodities products for the beef and peanut recalls because they thought FNS conducted these checks. As a result, they were unable to ensure that the recalls were being carried out effectively by schools. FNS officials said that they did not conduct any kind of systematic quality checks of schools receiving recalled commodities, because they relied on FSIS and FDA to conduct such checks. FDA did include schools in its canned vegetable recall audit checks, and some may have received recalled-commodity canned vegetables. However, because FDA does not systematically sample for schools or analyze results of the quality checks for the group, the agency cannot be assured that the recall was carried out effectively in schools. Thu, 20 Aug 2009 00:00:00 -0400 School Meal Programs: Experiences of the States and Districts That Eliminated Reduced-price Fees, July 17, 2009 http://www.gao.gov/new.items/d09584.pdf In fiscal year 2008, about 31 million children participated in the National School Lunch Program and more than 10 million children participated in the School Breakfast Program each school day. The U.S. Department of Agriculture's (USDA) Food and Nutrition Service (FNS) spent $11.7 billion on the school meal programs in that year. The majority of school meals are provided for free or at a reduced price to low-income students. Some states and school districts have chosen to implement programs that eliminate the reduced-price fee (known as ERP programs) and instead provide free meals to students eligible for the reduced fee. GAO was asked to provide information on (1) what is known about the states and districts that have eliminated the reduced-price fee for school meals, (2) the experiences of states and districts that have ERP programs with respect to participation, errors, and costs, and (3) the factors that may help or hinder the establishment or continuation of ERP programs. To obtain this information, GAO interviewed FNS officials, interviewed officials from state- and district-level programs, and conducted a Web-based survey of the 35 districts identified as having ERP programs. However, because the universe of ERP programs is unknown, survey results cannot be generalized to all districts with ERP programs. USDA did not provide formal written comments, but FNS provided technical comments, which were incorporated where appropriate. GAO identified 5 states and an additional 35 school districts in 19 other states that eliminated the reduced-price fee for school meals, primarily to increase participation or reduce hunger. States and districts eliminated reduced-price fees for either breakfast or lunch or, in some cases, for both meals. Further, some ERP programs included all grades, and some covered only the early school years. One state- and most district-level officials GAO interviewed or surveyed reported that ERP programs have increased the rate of participation among students who are eligible for reduced-price meals. Participation may increase for a number of reasons; however, for those districts that implemented ERP programs in the most recently completed school year (2007-2008) and provided participation data, their average increase in the participation rate among reduced-price-eligible students was greater than the national change in this rate over the same year. ERP programs involve additional costs to states and districts, as they bear the cost of the reduced-price fees that these students otherwise would have paid. For the state and district ERP programs that experienced increased participation, FNS reimbursements, and thus federal costs, also increased. While the increased reimbursements partially offset program costs, state ERP programs covered their remaining costs with state funds and districts used a variety of revenue sources. The majority of district-level officials reported that their districts experienced benefits from the ERP programs, such as a decrease in the burden on staff to collect unpaid meal fees from reduced-price-eligible students who received school meals but who charged these meals and built up a balance of unpaid meal fees. State officials GAO interviewed cited support from legislators and nonprofit organizations in establishing ERP programs in state law. Supportive school boards and superintendents were a major factor in establishing district-level programs. Most state officials indicated that a loss of state funding would threaten program continuation, while some district-level officials indicated they would try to raise additional revenue or reduce expenditures to cover program costs. As of late 2008, officials from all 5 states and most district-level ERP programs planned to continue their programs. Fri, 17 Jul 2009 00:00:00 -0400 Disaster Assistance: Federal Efforts to Assist Group Site Residents with Employment, Services for Families with Children, and Transportation, December 11, 2008 http://www.gao.gov/new.items/d0981.pdf In August 2005, Hurricane Katrina caused more damage than any other single natural disaster in U.S. history, with Hurricane Rita adding to the devastation. The hurricanes hit some of the most distressed areas in the country. Louisiana and Mississippi had the highest poverty rates in the United States, according to the 2000 U.S. Census. Hurricane Katrina destroyed or made uninhabitable an estimated 300,000 homes, many of which had families with children. In response to this destruction, the Federal Emergency Management Agency (FEMA) provided many affected households with trailers for temporary housing in Louisiana and Mississippi. Those trailers not placed on homeowners' property were located in group sites. Although FEMA's guidance suggests that group sites should be located near existing supermarkets, public transportation, schools, and health care facilities, FEMA officials said the agency was not always able to locate temporary housing in these settings because of the level of destruction and, sometimes, opposition from communities. As of May 2008, several thousand households remained in group sites. Given the number of people who remained in group sites more than 2 years after Hurricane Katrina, GAO was asked to address a range of disaster assistance services and is conducting work looking at case management, housing, health care, and the role of not-for-profit organizations in disaster recovery. This report focuses on the federal government's efforts to assist group site residents with employment, services for families with children, and transportation. Specifically, this report addresses the following key questions: (1) What is known about the number and location of the group sites and their residents? (2) What did the federal government do to assist group site residents with employment, services for families with children, and transportation? (3) What challenges did federal and state agencies face in providing this assistance to group site residents? FEMA located more than 500 group sites, housing over 20,000 households over time, throughout counties in Louisiana and Mississippi. About another 106,000 households received trailers that were placed on their property while repairs were being made to their homes. The majority of group sites had less than 50 households, although some group sites had several hundred households residing in them. Most of the households who were placed in group sites reported that they were renters before the storm. While the majority of individuals who received a FEMA trailer reported being employed, about 65 percent reported less than $20,000 in income. About one-fifth reported no source of income, in some cases, they were unemployed and disabled. While FEMA does not update data on group site residents to reflect current employment status or income levels, some state and FEMA officials we spoke with in early 2008 stated that those who remained in the sites the longest were the hardest to serve people including the elderly, persons with disabilities, and unemployed people. Federal agencies provided assistance to hurricane victims through a variety of programs; group site residents may have received services, but data generally do not distinguish group site residents from other recipients. Federal agencies offered flexibilities within existing programs, distributed additional funding, and created new programs to assist states in providing employment services, services to families with children, and transportation for all eligible hurricane victims. Many of these federal actions were time-limited and available in 2005 and 2006. While federal agencies took actions to help all eligible hurricane victims, we identified only one federal program--LA Moves, a bus service--that specifically targeted group site residents, but services were limited and underutilized. This program started in January 2007, but the retirement of routes began immediately, with only two group sites receiving services as of June 2007. Some state agencies and not-for-profit organizations did provide outreach for other services to group sites. The largest group site, Renaissance Village, had several services offered on-site, including early childhood education programs, after-school programs, employment services, and transit for persons with disabilities, but was unique in this regard, according to some service providers. Federal and state agencies faced challenges obtaining information about group sites and group site residents and having available guidance to determine the type and scope of emergency transportation to fund. Regarding the first challenge, state agencies said they faced challenges in obtaining information from FEMA about group sites or their residents. However, these state officials may not have been aware of or understood FEMA's information sharing guidelines or procedural requirements for requesting data. Regarding the second challenge, FEMA did not have clear guidance or criteria to assist with emergency transportation planning including guidance that defined the types or scope of transit it would fund or criteria for determining the duration of that funding. In the absence of such guidance, FEMA had to make difficult decisions about the extent of its authority to fund transit operations. Thu, 11 Dec 2008 00:00:00 -0500 Food Stamp Program: Options for Delivering Financial Incentives to Participants for Purchasing Targeted Foods, July 30, 2008 http://www.gao.gov/new.items/d08415.pdf In fiscal year 2007, the Food Stamp Program provided about $30.4 billion in nutrition assistance benefits to 26.5 million individuals. Benefits are issued through Electronic Benefit Transfer (EBT) cards, similar to debit cards, to purchase eligible foods at authorized retail stores. The diets of many low-income individuals, like the U.S. population overall, do not meet federal dietary guidelines. One potential strategy for increasing the purchases of targeted foods that contribute to a healthy diet is to incorporate into the program financial incentives for purchasing these foods. GAO was asked to identify (1) what is known about the effectiveness of financial incentives and other approaches intended to increase the purchase of targeted foods, (2) the key factors to consider in designing a financial incentive program, and (3) options available to the U.S. Department of Agriculture's Food and Nutrition Service (FNS) for implementing financial incentives. GAO interviewed agency and state officials, retailers and associations, private EBT contractors, and other stakeholders; convened a panel of 17 experts; and conducted a literature review. In commenting on this report, FNS generally agreed with GAO's findings and concluding observations. A variety of approaches, including financial incentives and nutrition education, can increase the consumption of targeted foods, but little is known about the effectiveness of efforts to increase access to targeted foods. A few studies examining the effectiveness of financial incentives have demonstrated short-term positive effects on purchases, consumption, or weight loss. A study that reviewed 92 nutrition education studies found that most studies reported significant positive effects on consumption. Because of a lack of reported research, little is known about the effectiveness of approaches intended to improve access to targeted foods. Factors to consider in designing a program that delivers financial incentives through an additional food stamp allotment tied to the purchase of targeted foods include the following: (1) Selection of foods: Selecting which foods to promote could be a controversial and challenging part of designing an incentive program. (2) Incentive amount: The amount of the incentive will affect participant response and program costs. (3) Informing participants: Participants must be informed of the availability of incentives to take full advantage of a new incentive program. (4) Program monitoring and evaluation: Monitoring and evaluating the incentive program is critical to maintaining program integrity and determining the effects of the program. An incentive program could be implemented through either electronic or paper methods, and the different options would have implications for ease of implementation, program integrity, and cost. Electronic options include adding food benefits to the EBT cards currently used or to a separate card on the basis of the amount that participants spend on targeted foods. Providing incentives using existing EBT cards would build on the current checkout technology and process, and could require less time to complete transactions compared with using a separate card. However, delivering financial incentives to participants' EBT accounts on the basis of their purchases of certain foods would require several changes to the EBT system, such as modifications to retailer and EBT contractor software to separately track the amount spent on the targeted food items. Administering incentives using a separate card, such as an additional EBT card, may be more costly and complicated to implement. Alternatively, providing participants with paper vouchers for the purchase of targeted foods would not require changes to the EBT system, but could be more burdensome to use, increase fraud risk, and increase state administrative costs. With the new authority provided as part of the Food, Conservation, and Energy Act of 2008, FNS will have the opportunity to develop and administer a pilot incentive program and to determine both its effects on participant purchasing and consumption patterns and the costs associated with such a program. Wed, 30 Jul 2008 00:00:00 -0400 Food Stamp Program: Use of Alternative Methods to Apply for and Maintain Benefits Could Be Enhanced by Additional Evaluation and Information on Promising Practices, May 3, 2007 http://www.gao.gov/new.items/d07573.pdf One in 12 Americans participates in the federal Food Stamp Program, administered by the Food and Nutrition Service (FNS). States have begun offering individuals alternatives to visiting the local assistance office to apply for and maintain benefits, such as mail-in procedures, call centers, and on-line services. GAO was asked to examine: (1) what alternative methods states are using to increase program access; (2) what is known about the results of these methods, particularly on program access for target groups, decision accuracy, and administrative costs; and (3) what actions states have taken to maintain program integrity while implementing alternative methods. GAO surveyed state food stamp administrators, reviewed five states in depth, analyzed FNS data and reports, and interviewed program officials and stakeholders. All states use mail and about half of states use or have begun developing on-line services and call centers to provide access to the food stamp program. Almost all states allow households to submit applications, report changes, and submit recertifications through the mail, and 26 states have implemented or are developing systems for households to perform these tasks on-line. Almost half of the states are using or developing call centers and states also are allowing households to participate in telephone interviews instead of an in-office interview. States have taken a variety of actions to help households use on-line services and call centers, such as sending informational mailings, holding community meetings, and using community partners. Insufficient information is available to determine the results of using alternative methods. Few evaluations have been conducted identifying the effect of alternative methods on program access, decision accuracy, or administrative costs. Evaluating the effectiveness of alternative methods is challenging in part because limited data are available, states are using a combination of methods, and studies can be costly to conduct. Federal and state officials reported that while they believe alternative methods can help households in several ways, such as increasing flexibility and efficiency in the application process, certain types of households may have difficulty using or accessing alternative methods. In addition, technology and staffing challenges may hinder the use of alternative methods. To maintain program integrity while implementing alternative methods, the states GAO reviewed used a variety of strategies, such as using software to verify the information households submit, communicating with other states to detect fraud, or using finger imaging. Although there has been some concern that without frequent in-person interaction with caseworkers, households may not submit required documents on time and thus be denied benefits on procedural grounds ("procedural denials"), GAO's limited analysis of FNS data found no considerable fluctuations in the rate of procedural denials in the five states between fiscal years 2000 and 2005. The states GAO reviewed have instituted several approaches to prevent procedural denials. Thu, 03 May 2007 00:00:00 -0400 Food Stamp Program: FNS Could Improve Guidance and Monitoring to Help Ensure Appropriate Use of Noncash Categorical Eligibility, March 28, 2007 http://www.gao.gov/new.items/d07465.pdf In fiscal year 2005, the Department of Agriculture's (USDA) Food Stamp Program served over 25 million individuals per month, on average, providing over $28 billion in benefits for the year. To reduce the administrative burden on state agencies, current food stamp regulations allow households that receive or are authorized to receive Temporary Assistance for Needy Families (TANF) noncash services to obtain automatic eligibility for food stamps, known as categorical eligibility. TANF noncash services include any TANF noncash or in-kind benefits, such as child care and transportation aid. Under categorical eligibility, households must apply to determine if they will receive any food stamp benefits. The application process for categorically eligible food stamps is the same as for regular food stamps, except that caseworkers apply the different income and asset limits for the TANF noncash services, or those imposed by the state. Under current food stamp regulations, states must confer categorical eligibility for individuals receiving, or authorized to receive, TANF noncash services that are funded with more than 50 percent federal or state maintenance of effort (MOE) funds and serve certain TANF purposes. In addition, states have the option to confer categorical eligibility using TANF noncash services funded with less than 50 percent federal or state funds. States are required to determine that individuals are eligible for a TANF noncash service and notify them of this determination before conferring categorical eligibility, but individuals are not required to receive these services. USDA's Food and Nutrition Service (FNS), which administers the Food Stamp Program, is not required to track how states are implementing categorical eligibility, but it does sporadically collect information from the states on the nature and funding of the services used to confer categorical eligibility. The Administration has proposed eliminating TANF noncash categorical eligibility for food stamps, and the Congressional Budget Office has estimated that about 280,000 participants would no longer be eligible for food stamps in fiscal year 2008 if the proposal is implemented. Also, because food stamp eligibility confers automatic eligibility for other nutrition programs, such as the National School Lunch Program, there is some question as to how the elimination of TANF noncash categorical eligibility would affect the recipients of other nutrition programs. In this context, Congress asked us to review the implementation of TANF noncash categorical eligibility and examine the potential effect of its proposed elimination. Specifically, Congress asked us to answer the following questions: (1) How have states implemented categorical eligibility for TANF noncash recipients? (2) How do the income and asset levels of TANF noncash food stamp recipients compare to those of TANF cash food stamp recipients? (3) What is the potential effect of eliminating TANF noncash categorical eligibility on Food Stamp Program participation, administration, and state administrative costs? In summary, we reported the following findings: The 29 states that confer TANF noncash categorical eligibility use a variety of noncash services to qualify participants for food stamp benefits under categorical eligibility, such as services that provide employment support, family support, and self-sufficiency support. Some states use brochures or information referral services that could allow for a large segment of the state's food stamp population to be categorically eligible, while some states use services designed to serve more narrowly defined populations. Six states may not be following program regulations, however, which require them to use certain federally or state-funded noncash services to confer categorical eligibility. Additionally, some states reported that they do not specifically determine if an individual needs a certain TANF noncash service before conferring food stamp eligibility. TANF noncash categorically eligible food stamp households appear to have slightly higher incomes as compared to those of TANF cash categorically eligible households. We do not have asset data for the TANF cash categorically eligible households, so we cannot compare the assets of TANF cash and TANF noncash households. Our analysis showed that a vast majority of TANF noncash households may remain eligible for food stamps without TANF noncash categorical eligibility because their income and/or asset levels are within the regular food stamp limits. Other households may lose eligibility for food stamps because their income and/or asset levels are too high. However, the degree to which participation may decrease varies across the states. In addition, our analysis showed that few noncash households may lose eligibility for other nutrition programs because their incomes are sufficiently low to qualify them for these programs. Similarly, many of the states' food stamp officials believed eliminating noncash categorical eligibility would decrease participation in food stamps and other nutrition programs. Many of the states' food stamp officials also believed that the proposed elimination of noncash categorical eligibility would increase the Food Stamp Program administrative workload and state administrative costs, for example, due to the need to verify assets, change data systems, and train staff. Wed, 28 Mar 2007 00:00:00 -0400 Food Stamp Program: Payment Errors and Trafficking Have Declined despite Increased Program Participation, January 31, 2007 http://www.gao.gov/new.items/d07422t.pdf The U.S. Department of Agriculture's (USDA) Food Stamp Program is intended to help low-income individuals and families obtain a better diet by supplementing their income with benefits to purchase food. USDA's Food and Nutrition Service (FNS) and the states jointly implement the Food Stamp Program, which is to be reauthorized when it expires in fiscal year 2007. This testimony discusses our past work on two issues related to ensuring integrity of the program: (1) improper payments to food stamp participants, and (2) trafficking in food stamp benefits. This testimony is based on a May 2005 report on payment errors (GAO-05-245) and an October 2006 report on trafficking (GAO-07-53). For the payment error report, GAO analyzed program quality control data and interviewed program stakeholders, including state and local officials. For the trafficking report, GAO interviewed agency officials, visited field offices, conducted case file reviews, and analyzed data from the FNS retailer database. The national payment error rate for the Food Stamp Program combines states' overpayments and underpayments to program participants and has declined by about 40 percent between 1999 and 2005, from 9.86 percent to a record low of 5.84 percent, due in part to options made available to states that simplified program reporting rules. In 2005, the program made payment errors totaling about $1.7 billion. However, if the 1999 error rate was in effect in 2005, program payment errors would have been $1.1 billion higher. FNS and the states we reviewed have taken several steps to improve food stamp payment accuracy, most of which are consistent with internal control practices known to reduce improper payments. These include practices to improve accountability, perform risk assessments, implement changes based on such assessments, and monitor program performance. FNS estimates indicate that the national rate of food stamp trafficking declined from about 3.8 cents per dollar of benefits redeemed in 1993 to about 1.0 cent per dollar during the years 2002 to 2005 and that trafficking occurs more frequently in smaller stores. FNS has taken advantage of electronic benefit transfer and other new technology to improve its ability to detect trafficking and disqualify retailers who traffic. Law enforcement agencies have investigated and referred for prosecution a decreasing number of traffickers; they are instead focusing their efforts on fewer high-impact investigations. Despite the progress FNS has made in combating retailer trafficking, the Food Stamp Program remains vulnerable because retailers can enter the program intending to traffic and do so, often without fear of severe criminal penalties, as the declining number of investigations referred for prosecution suggests. While both payment errors and trafficking of benefits have declined in a time of rising participation, ensuring program integrity remains a fundamental challenge facing the Food Stamp Program. To reduce program vulnerabilities and ensure limited compliance-monitoring resources are used efficiently, GAO recommended in its October 2006 trafficking report that FNS take additional steps to target and provide early oversight of stores most likely to traffic; develop a strategy to increase penalties for trafficking, working with the Inspector General as needed; and promote state efforts to pursue recipients suspected of trafficking. FNS generally agreed with GAO's findings, conclusions, and recommendations. However, FNS believes it does have a strategy for targeting resources through their use of food stamp transaction data to identify suspicious transaction patterns. GAO believes that FNS has made good progress in its use of these transaction data; however, it is now at a point where it can begin to formulate more sophisticated analyses. Wed, 31 Jan 2007 00:00:00 -0500 WIC Program: More Detailed Price and Quantity Data Could Enhance Agriculture's Assessment of WIC Program Expenditures, July 28, 2006 http://www.gao.gov/new.items/d06664.pdf The Special Supplemental Nutrition Program for Women, Infants and Children (WIC), authorizes retail grocers, called regular WIC vendors, to provide the food benefit. Recently, some states have seen an increase in vendors called WIC-only vendors, who stock only WIC food and accept only WIC vouchers. Both vendor types accept WIC vouchers in exchange for a cash payment, or redemption, from WIC state agencies with U.S. Department of Agriculture (USDA) grant funds. To determine what effect WIC-only vendors' growth would have on program expenditures, in the absence of recent cost containment legislation, Congress asked GAO (1) what is known about WIC-only vendors' growth and their share of the WIC market in recent years, (2) to what extent do WIC-only and regular WIC vendors differ, and (3) what would WIC-only vendors' contribution to WIC program expenditures have been, if their market share increased. GAO analyzed national WIC vendor data, interviewed WIC state officials about vendors' business practices, and analyzed redemption data from California, Texas and Florida. The number of WIC-only vendors has tripled since 1999, with growth concentrated in a few states. However, WIC-only vendors' share of the national WIC market was relatively small compared to that of regular WIC vendors in 2004. Nationally, WIC-only vendors increased in number from 394 in 1999 to 1,180 in 2004, but 84 percent of these vendors are in California, Texas, and Florida. Despite their growth, WIC-only vendors accounted for 3 percent of all WIC vendors nationwide, and their market share, that is, their percentage of all WIC redemptions nationally, was on average 6 percent in 2004. Because of limitations in the data, we were unable to calculate annual growth rates or analyze changes in market share over time. WIC-only and regular WIC vendors generally employed different business and marketing practices, largely in response to the two different customer groups they served, according to WIC state agency officials. Because WIC participants are not required to consider retail prices, WIC-only vendors competed for participants' business by emphasizing customer service, which participants seemed to value. On the other hand, regular WIC vendors served non-WIC consumers as well as WIC participants. Because these non-WIC consumers are price sensitive, regular WIC vendors competed for their business based on price and competitors' behavior. An important difference in these approaches was that because WIC participants were not price sensitive, they might choose the service offered by WIC-only vendors, regardless of price. Finally, WIC-only and regular WIC vendors used similar food purchasing practices, because the cost of food purchased for resale is related more to the volume purchased than to the type of vendor purchasing the food. Both WIC-only and regular WIC vendors were able to lower the average cost of food purchased for resale when they bought in volume, according to WIC state agency officials. If WIC-only vendors' market share in 2004 had doubled in California, Texas, and Florida, either about 3 percent--about 136,000--fewer participants could have been served in each state, or program food expenditures would have increased about 3 percent--about $50 million--according to our scenario estimates. The average value of all vouchers redeemed by WIC-only vendors in 2004 was higher than the average value of all vouchers redeemed at regular WIC vendors. Thus, if the number of vouchers redeemed by WIC-only vendors had increased and state food expenditures remained at 2004 levels, fewer vouchers could have been issued, and fewer participants served. Conversely, if the number of vouchers issued remained at 2004 levels, the higher average value of vouchers redeemed at WIC-only vendors would have resulted in increased program expenditures. However, the price and quantity of the individual food items that make up the vouchers were not available to us; therefore we could not determine if the higher average value of vouchers meant that prices for individual food items were higher at WIC-only vendors. Making price comparisons would require food item price and quantity data for both WIC-only and regular WIC vendors, at a minimum. Fri, 28 Jul 2006 00:00:00 -0400 Food Assistance: FNS Could Take Additional Steps to Contain WIC Infant Formula Costs, March 28, 2006 http://www.gao.gov/new.items/d06380.pdf The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provides food, nutrition education, and health care referrals to close to 8 million low-income pregnant and postpartum women, infants, and young children each year. About a quarter of these participants are served using rebate savings from contracts with infant formula manufacturers. WIC is administered by the Department of Agriculture's Food and Nutrition Service (FNS). To better understand infant formula cost containment, this report provides information on: (1) factors that influence program spending on infant formula, (2) how the level of savings resulting from infant formula cost containment has changed and the implications of these changes for the number of participants served; and (3) steps federal and state agencies have taken to contain state spending on infant formula. Rebates drive state spending on infant formula but use of non-rebated formula increases state costs. In fiscal year 2004, states paid an average of $0.20 per can for milk-based concentrate formula, a savings of 93 percent off the wholesale price. However, states also allow some use of non-rebated formula that can cost states more than 10 times as much as contract formulas. For example, in 2004, 8 percent of infant formula provided to WIC participants was non-rebated. Rebate savings from infant formula cost-containment contracts have allowed WIC to serve an additional 2 million participants per year, but recent increases in the cost per can of formula could lead to reductions in the number of participants served with rebates. Rebate savings have remained near $1.6 billion per year since 1997 after adjusting for inflation, but the amount states pay per can of infant formula has increased since 2002. We estimated that in 2004, if the cost per can of formula increased in every state by as much as it did in two states, approximately 400,000 fewer participants would have been able to enroll in WIC nationwide. State and federal agencies have both taken steps to contain WIC infant formula costs, but FNS also focuses on sustaining the cost-containment system. States have sought to increase their costs savings through their infant formula contracts--for example, by joining coalitions to leverage greater discounts. Some also try to restrict the use of the more expensive non-contract formulas. FNS, in turn, helps states to contain costs through its review of contracts and through policy and guidance. For example, FNS reduced--but did not eliminate--the price increases that can result from the introduction of new, more costly formulas. FNS has also used its oversight authority to ensure that all interested manufacturers can compete for state infant formula contracts in an effort to maintain the long-run sustainability of the infant formula cost-containment system. Tue, 28 Mar 2006 00:00:00 -0500 Breastfeeding: Some Strategies Used to Market Infant Formula May Discourage Breastfeeding; State Contracts Should Better Protect Against Misuse of WIC Name, February 8, 2006 http://www.gao.gov/new.items/d06282.pdf Millions of U.S. mothers and infants each year forgo the health benefits of breastfeeding and rely on infant formula. Infants who are breastfed are less likely to develop infectious diseases and chronic health problems, such as diabetes and asthma, while breastfeeding mothers are less likely to develop certain types of cancer. Recognizing the health benefits of breastfeeding for infants and mothers, the U.S. Department of Health and Human Services' Healthy People 2010 campaign has recommended that more U.S. infants be breastfed and that babies be breastfed for longer periods of time. According to the U.S. Department of Agriculture (USDA), the U.S. would save a minimum of $3.6 billion in health care costs and indirect costs, such as parents' lost wages, if breastfeeding increased to meet these Healthy People goals. Breastfeeding rates are particularly low among infants who participate in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). WIC is administered by the USDA's Food and Nutrition Service (FNS) in cooperation with state and local agencies. The program provides free food and infant formula to improve the health and nutritional well-being of low-income women, infants, and young children. Nearly half of infants born in the U.S. receive benefits through WIC. Although formula manufacturers agree that breastfeeding is best, they market infant formula as an alternative for mothers who do not exclusively breastfeed. A congressional committee asked us to review the potential impact of infant formula marketing on breastfeeding rates, especially for infants in the WIC program. We answered the following questions: 1) What are the estimated breastfeeding rates for infants in the general population and for infants on WIC, and how do these rates compare to recommended breastfeeding rates? 2) How is infant formula marketed to women in general and to women on WIC in particular? 3) What is known about the impact of infant formula marketing on the breastfeeding rates of women in the general population and women on WIC? On December 14, 2005, we briefed interested congressional staff on the results of our analysis. This report formally conveys information provided during that briefing. In summary, WIC and non-WIC breastfeeding rates fell short of most national goals, but rates were substantially lower for WIC infants. Infant formula marketing targets non-WIC mothers and also reaches WIC mothers. Some of these marketing efforts use the trademarked WIC acronym in promotional materials. Although FNS requires states to restrict this practice in their WIC contracts, most states do not. A majority of studies we reviewed that examine giving free formula samples to mothers at hospital discharge found lower breastfeeding rates among both WIC and non-WIC mothers. However, little is known about the impact of most types of marketing. Wed, 08 Feb 2006 00:00:00 -0500 School Meal Programs: Competitive Foods Are Widely Available and Generate Substantial Revenues for Schools, August 8, 2005 http://www.gao.gov/new.items/d05563.pdf Recent increases in child obesity have sparked concerns about competitive foods--foods sold to students at school that are not part of federally reimbursable school meals. The nutritional value of these foods is largely unregulated, and students can often purchase these foods in addition to or instead of school meals. In our April 2004 report on competitive foods (GAO-04-673), we reported that several states had enacted competitive food policies that were more restrictive than federal regulations. However, these policies differed widely in the type and extent of restrictions. In addition, it was unclear how and to what extent states were monitoring compliance with these policies. GAO was also asked to provide a national picture of competitive foods in schools, as well as strategies that districts and schools themselves are taking to limit the availability of less nutritious competitive foods. This report provides information from two nationally representative surveys about the prevalence of competitive foods in schools, competitive foods restrictions and groups involved in their sale, and the amounts and uses of revenue generated from the sale of competitive foods. It also provides information about strategies schools have used to limit the availability of less nutritious competitive foods, based on visits to a total of six school districts in California, Connecticut, Mississippi, Missouri, and South Carolina. Nearly 9 out of 10 schools sold competitive foods to students in school year 2003-2004, and the availability of competitive foods sold in middle schools and through a la carte lines has increased over the last 5 years. Schools often sold these foods in or near the cafeteria and during lunch, and the competitive foods available ranged from nutritious items such as fruit and milk to less nutritious items such as soda and candy. High and middle schools were more likely to sell competitive foods than elementary schools. Many different people made decisions about competitive food sales, but no one person commonly had responsibility for all sales in a school. In a majority of schools, district officials made competitive food policies, while school food authority directors and principals made decisions about specific sales. Other groups, such as student clubs and booster groups, also made competitive food decisions through their direct involvement in sales. Many schools, particularly high schools and middle schools, generated substantial revenues through competitive food sales in 2003-2004. Specifically, the nearly 30 percent of high schools generating the most revenue from these sales raised more than $125,000 per school. Food services, responsible for providing federal school meals, generally spent the revenue they generated through a la carte sales on food service operations. Other school groups often used revenues for student activities. The six school districts visited all recently took steps to substitute healthy items for less nutritious competitive foods. In each district, committed individuals took actions to initiate and lead change while also involving those affected. However, districts faced several barriers to change, including opposition due to concerns about revenue losses. In the districts visited, the effects of changes on revenues were often unclear because of limited data. Mon, 08 Aug 2005 00:00:00 -0400 Food Stamp Program: States Have Made Progress Reducing Payment Errors, and Further Challenges Remain, May 5, 2005 http://www.gao.gov/new.items/d05245.pdf In fiscal year 2003, the federal Food Stamp Program made payment errors totaling about $1.4 billion in benefits, or about 7 percent of the total $21.4 billion in benefits provided to a monthly average of 21 million low-income participants. Because payment errors are a misuse of public funds and can undermine public support of the program, it is important that the government minimize them. Because of concerns about ensuring payment accuracy GAO examined: (1) what is included in the national food stamp payment error rate and how it has changed over time, (2) what is known about the causes of food stamp payment errors, and (3) what actions the Food and Nutrition Service (FNS) and states have taken to reduce these payment errors. To answer these questions, GAO analyzed program quality control data for fiscal years 1999 through 2003 and interviewed program stakeholders, including state and local officials from nine states. The national dollar payment error rate for the Food Stamp Program, which combines states' overpayments and underpayments to program participants in all states, has declined by almost one-third over the last 5 years to a record low of 6.63 percent. This decline has been widespread; the rate fell in 41 states and the District of Columbia, and rates in 18 of these states fell by at least one-third. However, despite this decrease, some states continue to have relatively high payment error rates. For example, in 2003, 7 states had payment error rates of more than 10 percent. Almost two-thirds of food stamp payment errors are caused by caseworkers, usually when they fail to keep up with reported changes or make mistakes applying program rules, and one-third are caused by participant failure to report required, complete, or correct information, such as household income and composition. State officials said program complexity and other factors, such as the lack of resources and staff turnover, can contribute to these errors. In fiscal year 2003, states referred about 5 percent of all cases identified with errors for suspected participant fraud investigation. To increase food stamp payment accuracy, FNS and the 9 states GAO reviewed took many approaches that parallel good internal control practices. These efforts include increasing the leadership and accountability in the program, performing risk assessments to identify problem areas, implementing various program and process changes in response to the findings from risk assessments, and monitoring and promoting improved performance. The states are using a combination of approaches to improve payment accuracy, making it difficult to tie error rate improvements to specific practices. However, state officials point to their improved state error rates as evidence of a collective impact. Thu, 05 May 2005 00:00:00 -0400 Means-Tested Programs: Information on Program Access Can Be an Important Management Tool, April 11, 2005 http://www.gao.gov/new.items/d05221.pdf 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. 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. Mon, 11 Apr 2005 00:00:00 -0400 Food Stamp Program: Farm Bill Options Ease Administrative Burden, but Opportunities Exist to Streamline Participant Reporting Rules among Programs, September 16, 2004 http://www.gao.gov/new.items/d04916.pdf Many individuals familiar with the Food Stamp Program view its rules as unnecessarily complex, creating an administrative burden for participants and caseworkers. In addition many participants receive benefits from other programs that have different program rules, adding to the complexity of accurately determining program benefits and eligibility. The 2002 Farm Bill introduced new options to help simplify the program. This report examines (1) which options states have chosen to implement and why, and (2) what changes local officials reported as a result of using these options. Selected results from GAO's web-based survey of food stamp administrators are provided in an e-supplement to this report, GAO-04-1058SP. Another e-supplement, GAO-04-1059SP, contains results from the local food stamp office surveys. As of January 2004, states chose four of the eight Farm Bill options with greater frequency than the others. These options provided states with more flexibility in requiring participants to report changes and in determining eligibility. The most common reasons state officials gave for choosing the eight options were to simplify program rules for participants and caseworkers. Local food stamp officials reported mixed results from implementing the Farm Bill options. Although they reported some improvements for both caseworkers and participants from some options, no option received consistent positive reports in all the areas where state officials expected improvements. In fact, in many cases, officials were as likely to report that an option resulted in no change as they were to report improvements. Moreover, many local officials reported that three options introduced complications in program rules. One option that offered the most promise because it was selected by most states and affects a large number of participants resulted in food stamp participant reporting rules that differed from Medicaid and TANF. These differences resulted in confusion for food stamp participants and caseworkers, and some changes were made that undermined the intended advantages of the option. These problems reflect the challenge of trying to simplify rules for one program without making the rules of other related programs the same. Concerns about whether there are costs associated with aligning reporting rules may hinder a state's decision to pursue alignment; yet the extent to which program costs might increase as a result of making reporting rules the same is unclear. Thu, 16 Sep 2004 00:00:00 -0400 Nutrition Education: USDA Provides Services through Multiple Programs, but Stronger Linkages among Efforts Are Needed, April 27, 2004 http://www.gao.gov/new.items/d04528.pdf The Centers for Disease Control and Prevention recently reported that poor nutrition and lack of physical activity are catching up to tobacco use as the leading cause of death in the United States. In addition to having negative health outcomes, children with poor nutrition may have a harder time succeeding in school than other children. To help improve nutrition, the U.S. Department of Agriculture (USDA) provides nutrition education through five of its programs. The department spent $472 million on these efforts in fiscal year 2002. GAO was asked: (1) What key actions can officials take to increase the likelihood of success in nutrition education? (2) Do USDA and state and local officials take these actions during program design, service delivery, and program monitoring and evaluation? GAO identified several key actions, based on research and performance-based management principles, that increase the likelihood that programs providing nutrition education will achieve their goals. Examples of these actions include identifying program goals, tailoring services to meet the needs of participants, and collecting data on program results. The actions can be taken during program design, service delivery, and program monitoring and evaluation. USDA programs providing nutrition education that we reviewed--the Food Stamps Program; the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); the National School Lunch Program; the Child and Adult Care Food Program; and the Expanded Food and Nutrition Education Program--generally incorporated the key program design actions likely to contribute to success. For example, the USDA programs identified nutrition education goals and target populations. However, the programs' administrative structures hinder coordination among the USDA nutrition education efforts. We found that the USDA programs incorporated the service delivery actions likely to contribute to successful nutrition education in different ways and to varying extents, but they faced similar challenges that affected their ability to fully incorporate these actions. The challenges included limited resources and systems for providing nutrition education and competing program requirements that took time or resources away from nutrition education. For example, WIC officials said they had limited time for nutrition education because of competing requirements, such as providing information on drug and alcohol counseling. USDA's nutrition education efforts did not fully incorporate the monitoring and evaluation actions that contribute to success, such as collecting data on the types of nutrition education provided and the outcomes of the efforts. As a result, little is known about what nutrition education is provided and whether these programs have met their nutrition education goals. Tue, 27 Apr 2004 00:00:00 -0400 School Meal Programs: Competitive Foods Are Available in Many Schools; Actions Taken to Restrict Them Differ by State and Locality, April 23, 2004 http://www.gao.gov/new.items/d04673.pdf The nation faces a complex challenge in addressing recent trends in children's health and eating habits. To address these trends, in 2001, the U.S. Surgeon General issued a call to action to prevent and decrease overweight and obesity among all Americans, especially children. In this statement, schools were identified as one of the key settings for public health strategies to address these issues. The National School Lunch and School Breakfast Programs provide millions of children with nutritious meals each school day. The United States Department of Agriculture's (USDA) Food and Nutrition Service (FNS) administers these programs at the federal level, and FNS subsidizes the meals served through these programs in local schools as long as the meals meet certain nutritional guidelines. In the last decade, these nutritional guidelines were amended to require schools to serve meals that adhere to the Dietary Guidelines for Americans, which limit total and saturated fat and provide specific minimum levels of vitamins and nutrients. Despite these efforts to improve the nutritional quality of meals offered through the school meal programs, other foods not provided through these programs are often available to children at school through a la carte lines in the cafeteria where individual foods and beverages can be purchased, snack shops, school stores, vending machines, and other venues. The nutritional value of these foods, often referred to as competitive foods, is largely unregulated by the federal government. Because of its concern about the trends in children's health and eating habits and interest in further understanding issues related to competitive foods in schools, Congress asked us to answer the following questions: (1) Which foods and school food practices fall under the term competitive foods, and what federal restrictions exist on their sale? (2) What is currently known about the types of competitive foods and their availability and prevalence in schools? (3) What is currently known about additional steps that are being taken on the state and local levels to curtail the sale of competitive foods? On April 12, 2004, we briefed interested Senate staff on the results of our analysis. This report formally conveys the information provided during that briefing. In summary, we reported that competitive foods include all foods and beverages sold in schools except for meals provided through the School Lunch and School Breakfast Programs. Current federal regulations restrict only a subset of competitive foods, foods of minimal nutritional value, from being sold during mealtimes in food service areas. Competitive foods are sold in a variety of locations on a majority of school campuses nationwide. The types of competitive foods available often differ by location where they are sold, with healthy foods more often sold in a la carte lines in the cafeteria and less healthy foods more often sold through vending machines, school stores, canteens, and snack bars. Several states, school districts, and individual schools have enacted competitive foods policies that are more restrictive than federal regulations. These policies differ widely in the types of restrictions they apply. Fri, 23 Apr 2004 00:00:00 -0400 Food Stamp Program: Steps Have Been Taken to Increase Participation of Working Families, but Better Tracking of Efforts Is Needed, March 5, 2004 http://www.gao.gov/new.items/d04346.pdf Eligible working families are believed to participate in the Food Stamp Program at a lower rate than the eligible population as a whole. As a result, many federal, state, and local officials believe the program is not living up to its potential as a component of the nation's work support system. This report examines: (1) what proportion of eligible working families participate in the program and what family characteristics are associated with a family's participation; (2) what factors may be acting as impediments to a working family's decision to participate in the program; and (3) what steps are being taken, or have been suggested, to help eligible low-income working families participate in the program while ensuring program integrity. In 2001, an estimated 52 percent of eligible individuals in working families participated in the Food Stamp Program compared with about 70 percent of eligible members of nonworking families. Participating working families are more likely to receive greater food stamp benefit amounts than those eligible working families that do not participate. Also, participating working families were more likely to participate in other government assistance programs and to rent rather than own their home. Factors that can impede an eligible working family's participation in the program include whether the family is aware of the program's existence and eligibility criteria and whether a family considers the program's administrative process--including having to make frequent trips to a food stamp office during working hours and providing documentation of income--overly burdensome. However, there are some potentially significant benefits, including error and fraud prevention, to some of the administrative requirements. Evidence also suggests that some families weigh the perceived burdens of participation against the benefits of doing so and perceive a stigma attached to receiving food stamps. The Food and Nutrition Service (FNS) and several states and localities have taken or suggested steps to address the impediments to participation in the program for working families, while also considering ways to balance easier participation with program integrity. These efforts include increasing food stamp outreach, adopting new administrative processes to ease participation and reduce program error, developing tools to help families estimate food stamp benefit amount, and re-naming the program to reduce the stigma associated with food stamps. Compiling a complete picture of these steps was not possible, however, because FNS does not systematically track these efforts, and the outcomes of their use are still largely unknown. Fri, 05 Mar 2004 00:00:00 -0500 School Lunch Program: Efforts Needed to Improve Nutrition and Encourage Healthy Eating, May 9, 2003 http://www.gao.gov/new.items/d03506.pdf Recent trends in children's health and eating habits are alarming. Over 15 percent of children are overweight--double the rate in 1980. Children's diets are high in fat but low in fruits, vegetables, and other nutritious foods. The National School Lunch Program has had a continuing role in providing students with nutritious meals. However, serving the meals is only the first step. Students must choose to eat the nutritious food and limit the less healthful choices. GAO was asked to report on the extent to which school lunches, nationwide, were meeting nutrition standards, and schools were encouraging healthy eating, what barriers selected schools faced in accomplishing this, and what innovative steps they had taken to overcome the barriers. Schools are moving toward meeting school lunch nutrition requirements, but more improvements are needed. According to national studies, lunches meet requirements for nutrients such as protein, vitamins, calcium, and iron, but do not meet the required 30 percent limit for calories from fat. Also, efforts to encourage healthy eating could be increased. Students may need more exposure to nutrition education to effect positive changes in their behavior, and most students have access to foods of little nutritional value, such as soft drinks and candy, at school. In schools we visited, barriers to providing nutritious meals and encouraging healthy eating included budget pressures and competing time demands. Regarding providing nutritious food, officials said when they introduce healthier foods, they take the risk that students will buy fewer school lunches resulting in loss of needed revenue. Regarding encouraging healthy eating, officials said the focus on meeting state academic standards limited time to teach nutrition. Also, schools paid for special activities or other items not covered in the school's budget with profits from vending machines and snack bar sales. Schools had taken a variety of innovative steps to overcome barriers. With respect to providing nutritious food, while minimizing the risk students might reject healthier choices, schools modified recipes to lower the fat content of popular foods such as pizza and conducted taste tests before adding healthier choices. To encourage healthy eating, schools found time to teach nutrition by integrating nutrition lessons into reading and math classes, and some established school food policies to restrict unhealthy choices. Some schools enlisted help from parents, community organizations, and businesses. Officials noted that overcoming barriers required strong and persevering leadership. Fri, 09 May 2003 00:00:00 -0400 School Meal Programs: Revenue and Expense Information from Selected States, May 9, 2003 http://www.gao.gov/new.items/d03569.pdf The National School Lunch and Breakfast Programs provide millions of children with low-cost or free nutritious meals each school day. In school year 1996-97, the Department of Agriculture instituted more stringent requirements for the nutritional content of school meals. GAO was asked to study the school food service revenues and expenses and how they have changed since the requirements went into effect. This report includes information on the sources of revenues available for providing meals, the expenses of producing meals, the revenues compared to expenses, and the approaches that local school food authorities have adopted to manage their school food service finances. It uses data from six selected states. This report does not provide specific information on the expense of producing a reimbursable school lunch or breakfast. Revenue from federal reimbursements and the sale of food were the principal sources of revenue for school food services in the six states GAO reviewed for school years 1996-97 through 2000-01. Federal reimbursements decreased slightly in proportion to the total, while revenues from food sales increased slightly. Funds from state governments and other sources represented a relatively small portion of total revenues and remained relatively stable as a share of total revenues. Labor and food purchases were the principal expenses for the six states, sharing nearly equal proportions and changing only slightly. Labor expenses, which included salaries and benefits for food service employees, grew slightly while food expenses decreased slightly. Other expenses, such as contract services, made up a smaller portion of expenses, and this portion remained constant. The six states had a small though increasing shortfall in total revenue compared to expenses over the 5-year period, as shown below. Their total expenses increased by about 22 percent, while their total revenues increased by about 20 percent. The portion of total school food service expenses covered by federal reimbursements declined from 54 to 51 percent, and the portion of expenses paid by state funds was small and declined slightly. To limit their expenses and maximize their revenues, local school food authority officials reported buying food in bulk, hiring more part-time staff, expanding a la carte food sales and catering programs, and other strategies. Fri, 09 May 2003 00:00:00 -0400 School Meal Program: Few Instances of Foodborne Outbreaks Reported, but Opportunities Exist to Enhance Outbreak Data and Food Safety Practices, May 9, 2003 http://www.gao.gov/new.items/d03530.pdf More than 28 million children receive meals daily through the federal school meal programs. Providing meals that are safe is especially important because young children have a higher risk of complications from some foodborne illnesses. GAO examined (1) the frequency and causes of reported foodborne illness outbreaks associated with the federal school meal programs and (2) the practices that federal, state, and local governments as well as other food providers find useful for safeguarding meals. GAO found that 195, or about 3 percent, of the total of 7,390 foodborne outbreaks that were reported nationwide, between 1990 and 1999, occurred in schools. Specific national data on whether these outbreaks were related to the federal school meal programs do not exist; however, GAO's survey of state health officials provided information on 40 large outbreaks involving these programs. Nearly half of these large outbreaks resulted from improper food preparation and handling practices in school kitchens. Most commonly, foods involved in the outbreaks were contaminated with Norwalk-like viruses, which cause a mild gastrointestinal illness. However, data limitations make comprehensive assessment of the safety of school meal programs difficult. In particular, the reporting mechanism that states use to voluntarily report outbreaks to the Centers for Disease Control and Prevention (CDC) does not distinguish between outbreaks in schools involving the school meal programs and those involving food from other sources, such as brought from students' homes. Federal, state, and local governments, as well as other food providers use a variety of practices to safeguard meals. Some of them may have national applicability to the federal school meal programs. For example, having key food service personnel trained and certified in food safety would address the improper food preparation and handling practices that caused most of the outbreaks reported in GAO's survey. Purchasing precooked or irradiated meat and poultry products could reduce the risk of foodborne illness in schools. Furthermore, the U.S. Department of Agriculture requires that some of the commodities it donates to schools be purchased under more stringent safety standards than the agency's regulatory requirements for meat and poultry processors. Currently, these more stringent procurement requirements are not readily accessible for school districts' use. While the practicality of applying these food preparation/handling and purchasing practices to the nation's schools has not been assessed, several food safety experts believe that applying these practices in all schools would enhance the safety of federal school meals. Some of these practices would likely lead to increased food costs for schools. Fri, 09 May 2003 00:00:00 -0400 Food Stamp Employment and Training Program: Better Data Needed to Understand Who Is Served and What the Program Achieves, March 12, 2003 http://www.gao.gov/new.items/d03388.pdf Since the late 1990s, many funding changes have been made to the Food Stamp E&T Program. In 1997, legislation required states to spend 80 percent of their funds on participants who lose their food stamp benefits if they do not meet work requirements within a limited time frame. The legislation also increased funds by $131 million to help states serve these participants. But spending rates for the program declined until, in 2001, states spent only about 30 percent of the federal allocation. In 2002, the Congress reduced federal funds to $110 million a year. While it is too soon to know the impact of these changes, GAO was asked to determine whom the program serves, what services are provided, and what is known about program outcomes and effectiveness. Food Stamp Employment and Training (E&T) participants are a small proportion of the food stamp population and do not usually receive cash assistance from other programs. While the U.S. Department of Agriculture (USDA) does not collect nationwide data on the number and characteristics of Food Stamp E&T participants, program officials in the 15 states GAO contacted described the population as generally hard to employ because they have little education and a limited work history. States may provide program participants with a range of employment and training activities that qualify them for food stamp benefits. USDA data show that, in fiscal year 2001, job search accounted for about half of all participant activities. Work experience--whereby participants receive food stamp benefits in exchange for work--accounted for about 25 percent. Food Stamp E&T services are delivered through a variety of local entities, such as welfare offices or one-stop centers--sites designed to streamline the services of many federal employment and training programs. While all but 1 of the 15 states delivered at least some of their Food Stamp E&T services at the one-stops, Food Stamp E&T participants do not usually engage in intensive services provided by other programs at the one-stops. Program officials from most of the 15 states noted that Food Stamp E&T participants generally lack basic skills that allow them to use other program services successfully. No nationwide data exist on whether the Food Stamp E&T Program helps participants get a job. While some outcome data exist at the state level, it is not clear the outcomes were the result of program participation. USDA has no plans to evaluate the effectiveness of the program nor have the Departments of Labor or Health and Human Services included Food Stamp E&T participants in their studies of the hardest-to-employ. Wed, 12 Mar 2003 00:00:00 -0500 Food Assistance: Potential to Serve More WIC Infants by Reducing Formula Cost, February 12, 2003 http://www.gao.gov/new.items/d03331.pdf The Department of Agriculture's Food and Nutrition Service (FNS) provided about $3 billion to state agencies in fiscal year 2001 for food assistance, including infant formula, through its Special Supplemental Nutrition Program for Women, Infants and Children (WIC). Most infants receiving formula are given a milk- or soy-based standard formula. To stretch program dollars, each state WIC agency contracts with a single company for purchases of that company's standard formula for which they receive rebates. These rebates totaled $1.4 billion in fiscal year 2001. Rebates do not apply to other companies' brands of standard formula (noncontract standard formula) or to nonstandard formulas designed to meet special medical or dietary conditions. GAO was directed to examine the extent that WIC agencies have restricted the use of noncontract standard formula to lower cost of the WIC program. As of February 2002, all 51 of the state WIC agencies included in our survey had policies to restrict the use of noncontract standard formula. Three of the 51 agencies prohibited the use of this formula entirely. The other 48 agencies restricted its use to specific situations, such as if medically prescribed or if needed for religious reasons. Seven of these 48 agencies also set percentage limits, such as 4 percent of all standard formula issued, on the use of noncontract standard formula. In fiscal year 2002, 3.3 percent of the infants using formula in the WIC program received a noncontract standard formula, while 90.3 percent received the contract brand. The remaining 6.4 percent received a medically prescribed nonstandard formula for special medical or dietary needs. There were wide variations between WIC agencies in the percentage of infants who received noncontract standard formula, ranging from a low of zero, for the 3 agencies that prohibited its use, to 10.5 percent. Likewise, the percentage of infants receiving medically prescribed nonstandard formula ranged from 0.2 percent to 27.7 percent. FNS has not routinely collected from WIC agencies the data that would allow it to monitor the effectiveness of these agencies in restricting the use of either noncontract standard or nonstandard infant formula. Buying noncontract standard formula brands cost the WIC program an estimated $50.9 million in foregone rebates in fiscal year 2002. Although it may be neither feasible nor desirable to prohibit all purchases of noncontract standard formula, rebates would have increased by $13.8 million if every state had a noncontract standard formula usage rate no higher than the average of 3.3 percent reported across all agencies. Wed, 12 Feb 2003 00:00:00 -0500 Major Management Challenges and Program Risks: Department of Agriculture, January 1, 2003 http://www.gao.gov/pas/2003/d0396.pdf In its 2001 performance and accountability report on the U.S. Department of Agriculture (USDA), GAO identified important security, modernization, food safety, food assistance, and other issues facing the department. The information GAO presents in this report is intended to help to sustain congressional attention and departmental focus on continuing to make progress in addressing these challenges and ultimately overcoming them. This report is part of a special series of reports on governmentwide and agency-specific issues. USDA has taken steps to address some of the specific performance and management challenges that GAO previously identified. However, a variety of challenges continue, including a significant expansion of the one involving security. Ensuring adequate security: USDA has taken actions when security problems are brought to its attention. However, it needs to be proactive in identifying and correcting an expanding array of weaknesses, such as a recently identified one involving biological agents at its laboratories as well as in correcting a long-standing one involving information security. Improving the delivery of services to farmers: USDA is progressing with its field office modernization effort to improve efficiency and customer service. However, it needs to complete this task on a number of fronts, including the automation of its application processes and the integration of field operations across its various agencies. Enhancing the safety of the nation's food supply: USDA and other federal agencies responsible for food safety have implemented an inspection program intended to enhance food safety. However, because of the millions of instances of foodborne illnesses and 5,000 related deaths that occur annually, we believe the responsibilities of USDA and other agencies for ensuring the safety of the nation's food supply need to be brought together in a single food safety agency. Providing food assistance and improving program integrity: USDA has actions underway to minimize fraud, waste, and abuse in its food assistance programs. However, it needs to reduce further the errors that occur in these programs, which, among other things, lead to significant overpayments and underpayments to benefit recipients. Enhancing financial management: USDA has achieved an unqualified opinion on its financial statements for the first time in 9 years. However, more needs to be done, especially in the Forest Service, which continues to be "high risk" due to serious financial and accounting weaknesses. Improving performance accountability at the Forest Service: The Forest Service has initiated or planned actions to address how it accounts for and reports on its operations, accomplishments, and expenditures. However, the agency has a continuing need to make significant improvements in its performance accountability. Resolving discrimination complaints: USDA has made modest process in processing discrimination complaints. However, it has a continuing need to resolve complaints in a more timely manner. Wed, 01 Jan 2003 00:00:00 -0500 Welfare Reform: Implementation of Fugitive Felon Provisions Should Be Strengthened, September 25, 2002 http://www.gao.gov/new.items/d02716.pdf In response to concerns that individuals wanted in connection with a felony or violating terms of their parole or probation could receive benefits from programs for the needy, Congress added provisions to the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 that prohibit these individuals from receiving Supplemental Security Income (SSI), Food Stamp benefits, and Temporary Assistance to Needy Families (TANF) and make fugitive felon status ground for the termination of tenancy in federal housing assistance programs. In addition, the act directs these programs to provide law enforcement officers with information about program recipients for whom there are outstanding warrants to assist in their apprehension. Actions taken to implement the act's fugitive felon provisions have varied substantially by program. In implementing provisions to prohibit benefits to fugitive felons, all but housing assistance programs include, at a minimum, a question about fugitive felon status in their applications. SSI and some state Food Stamp and TANF programs also seek independent verification of fugitive felon status by using computer matching to compare arrest warrant and program recipient files. To date, 110,000 beneficiaries have been identified as fugitive felons and dropped from the SSI, Food Stamp, and TANF rolls, and many have been apprehended. Computerized file matching has been responsible for the identification of most of these fugitive felons. Aggressive implementation of the act's fugitive felon provisions poses a number of challenges for programs. First, centralized and complete national and statewide arrest warrant data for computer matching are not readily available. Second, because direct access to arrest warrants and criminal records is limited to law enforcement personnel, computer matching requires what many state TANF and Food Stamp officials view as a burdensome and complex negotiation process to obtain these records. Third, the absence of information and guidance about how to conduct file matching and overcome its logistical challenges has also hindered aggressive implementation of the law. Finally, there is evidence that individuals with outstanding warrants for felonies, or probation or parole violations, may continue to collect benefits because there may be differences in the interpretation of what constitutes a fugitive felon within the Food Stamp and TANF programs. Wed, 25 Sep 2002 00:00:00 -0400 School Meal Programs: Estimated Costs for Three Administrative Processes at Selected Locations, September 25, 2002 http://www.gao.gov/new.items/d02944.pdf Each school day, millions of children receive meals and snacks provided through the National School Lunch and National School Breakfast Programs. Any child at a participating school may purchase a meal through these school meal programs, and children from households that apply and meet established income guidelines can receive these meals free or at a reduced price. The federal government reimburses the states, which in turn reimburse school food authorities for each meal served. During fiscal year 2001, the federal government spent $8 billion in reimbursements for school meals. The Department of Agriculture's Food and Nutrition Service, state agencies, and school food authorities all play a role in these school meal programs. GAO reported that costs for the application, verification, and meal counting and reimbursement processes for the school meal programs were incurred mainly at the local level. Estimated federal and state-level costs during school year 2000-2001 for these three processes were generally much less than 1 cent per program dollar administered. At the local level--selected schools and the related school food authorities--the median estimated cost for these processes was 8 cents per program dollar and ranged from 3 cents to 16 cents per program dollar. The largest costs at the local level were for counting meals and submitting claims for reimbursement. Estimated costs related to the application process were the next largest, and estimated verification process costs were the lowest of the three. Wed, 25 Sep 2002 00:00:00 -0400 Fruits and Vegetables: Enhanced Federal Efforts to Increase Consumption Could Yield Health Benefits for Americans, July 25, 2002 http://www.gao.gov/new.items/d02657.pdf Fruits and vegetables are a critical source of nutrients and other substances that help protect against chronic diseases. Yet fewer than one in four Americans consumes the 5 to 9 daily servings of fruits and vegetables recommended by the federal Dietary Guidelines for Americans. Fruit and vegetable consumption by the general public as a whole has increased by about half a serving under key federal nutritional policy, guidance, and educational programs, as shown by the national consumption data compiled by federal agencies. But key federal food assistance programs have had mixed effects on fruit and vegetables consumption, as shown by national consumption data. However, increasing fruit and vegetable consumption is not a primary focus of these programs, which are intended to reduce hunger and support agriculture. A number of actions the federal government could take to encourage more Americans to consume the recommended daily servings have been identified. These include expanding nutrition education efforts, such as the 5 A Day Program; modifying the special supplemental Nutrition Program for Women, Infants, and Children to allow participants to choose from more of those fruits and vegetables; expanding the use of the Department of Defense Fresh Fruit and Vegetable Project in schools; and expanding farmers' market programs for food assistance participants. These options could require additional resources or redirecting resources from other programs. Thu, 25 Jul 2002 00:00:00 -0400 Food Safety: Continued Vigilance Needed to Ensure Safety of School Meals, April 30, 2002 http://www.gao.gov/new.items/d02669t.pdf The national school lunch and breakfast programs provide inexpensive or free meals to more than 27 million children each day. During the 1990s, nearly 300 outbreaks of foodborne illness at the nation's schools sickened 16,000 students. The rise in the number of school outbreaks mirrors a rise in the number of outbreaks in the overall population, according to the Centers for Disease Control and Prevention (CDC). Because the CDC data include outbreaks attributable to food brought from home or other sources, GAO could not determine the extent to which food served in the school meal programs caused reported outbreaks. Data from 1998 and 1999 do show, however, that most of the outbreaks during those years were caused by foods served through the school meal program. Foods contaminated with salmonella and Norwalk-like viruses were the most common causes of outbreaks. GAO found that the Department of Agriculture has not developed security measures to protect foods served at schools from deliberate contamination. The existing food safety system is a patchwork of protections that fall short in addressing existing and emerging food safety threats. Tue, 30 Apr 2002 00:00:00 -0400 Food Stamp Program: States' Use of Options and Waivers to Improve Program Administration and Promote Access, February 22, 2002 http://www.gao.gov/new.items/d02409.pdf To help states administer their Food Stamp Programs, the Food and Nutrition Service (FNS) offers options and waivers to their program rules and regulations. Almost all states used options or waivers in their food stamp eligibility determination process. More than half of the states chose to make households receiving Temporary Assistance for Needy Families (TANF) services automatically eligible for food stamps. Thirty-three states exempted some or all vehicles in the determination of food stamp eligibility. Although most states used these options and waivers, they considered them a cumbersome way to increase access to the program for families owning a vehicle. Almost all states used at least one option or waiver to change the reporting methods required of food stamp household earnings. The most frequently used reporting waivers exempted recipients from reporting changes in earned income of $25 or more per month. States used these options and waivers to simplify paperwork requirements for both the food stamp recipient and eligibility worker. Although few states were using the new option to provide food stamp benefits to families leaving TANF, 20 other states planned to implement the option. No state was implementing or planning to implement all aspects of the simplified program option, which allows states to merge their TANF and Food Stamp Program for families receiving both types of assistance. States told GAO that the simplified program option would make administering the programs more difficult because it creates a separate program, covering only a subset of food stamp recipients. However, nine states were using a portion of the simplified program to align their food stamp and TANF work or reporting requirements. Fri, 22 Feb 2002 00:00:00 -0500 Food Stamp Program: Implementation of Electronic Benefit Transfer Systems, January 16, 2002 http://www.gao.gov/new.items/d02332.pdf The Department of Agriculture provided $15 billion in food stamp benefits to 17 million recipients in 2000. Until the mid-1990s, most recipients received paper coupons that they could use to buy food; today, 80 percent of all benefits are provided electronically. Recipients use cards, much like debit cards, to pay for their groceries at the checkout counter, and the costs are deducted from the recipients' monthly allocation. GAO found that 42 of the 53 jurisdictions it studied will likely meet the October 1, 2002, deadline for implementing a statewide electronic benefit transfer (EBT) system. Thirty-nine states and the District of Columbia had already implemented a statewide EBT system by October 2001, and six other states had signed EBT contracts and were on track to meet the October 2002 deadline for statewide implementation. GAO did not identify any technical barriers to statewide implementation of EBT systems that are interoperable and portable. Wed, 16 Jan 2002 00:00:00 -0500 Food Assistance: WIC Faces Challenges in Providing Nutrition Services, December 7, 2001 http://www.gao.gov/new.items/d02142.pdf The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) serves almost half of all infants and about one-quarter of all children between one and four years of age in the United States. The WIC program faces the following challenges: (1) coordinating its nutrition services with health and welfare programs undergoing considerable change, (2) responding to health and demographic changes in the low-income population, (3) recruiting and keeping a skilled staff, (4) improving the use of information technology to enhance service delivery and program management, (5) assessing the effect of nutrition services, and (6) meeting increased program requirements without a corresponding increase in funding. This report identifies 16 approaches to address these challenges. Each of the approaches has advantages and disadvantages that policymakers should consider. Fri, 07 Dec 2001 00:00:00 -0500 Means-Tested Programs: Determining Financial Eligibility Is Cumbersome and Can Be Simplified, November 2, 2001 http://www.gao.gov/new.items/d0258.pdf About 80 means-tested federal programs assisted low-income people in 1998. GAO reviewed 11 programs that assisted families and individuals with income, food, medical assistance, and housing. Despite substantial overlap in the populations they serve, the 11 programs varied significantly in their financial eligibility rules. At the most basic level, the dollar levels of the income limits--the maximum amounts of income an applicant can have and still be eligible for a program--vary across programs. Beyond this, differences exist in the income rules, such as whose income and what types of income are counted. The variations and complexity of the federal financial eligibility rules, along with other factors, have led to processes that are often duplicative and cumbersome for both caseworkers and applicants. Overall, federal, state, and local entities have made little progress in simplifying or coordinating eligibility determination processes. States realigned some of the financial rules, but only to a limited extent. Another approach uses computer systems to establish joint eligibility determination processes that a single caseworker can administer. Efforts to simplify or better coordinate eligibility determination processes confront many obstacles, including restrictive federal program statutes and regulations. In addition, program costs may rise if financial eligibility rules are changed. Fri, 02 Nov 2001 00:00:00 -0500 Food Stamp Program: Program Integrity and Participation Challenges, June 27, 2001 http://www.gao.gov/new.items/d01881t.pdf The Food and Nutrition Service (FNS) and the states have taken steps to reduce fraud, waste, and abuse in the Food Stamp Program. GAO's past work has found that FNS and the states need to make better use of electronic data to track individuals and storeowners who may be trafficking in food stamps. GAO also found that financial sanctions and enhanced funding have been at least partially successful in focusing states' attention on minimizing payment errors. However this "carrot and stick" approach can accomplish only so much. Food stamp regulations for determining eligibility and benefits are extremely complex and their application is inherently error-prone and costly to administer. Furthermore, this approach, carried to extremes, can create incentives for states to take actions that may inhibit achievement of one of the agency's basic missions--providing food assistance to needy persons. For example, requiring recipients to report income changes more frequently could decrease errors, but it could also have the unintended effect of discouraging participation by the eligible working poor. This would run counter not only to FNS' basic mission but also to an overall objective of welfare reform--helping people move successfully from public assistance into the workforce. Simplifying the Food Stamp Program's rules and regulations could reduce payment error rates and promote program participation by eligible recipients. FNS has begun to look at ways to simplify requirements for determining benefits. However, in view of the upcoming reauthorization, it is critical that FNS follow through with this process and develop options that strike an appropriate balance between the sometimes competing objectives of ensuring program integrity and encouraging eligible individuals to participate. To be successful, this process must include a continuing dialogue with all appropriate stakeholders, including Congress and state officials, and must ensure that steps are taken to streamline the program while at the same time improving program integrity. Wed, 27 Jun 2001 00:00:00 -0400 Food Assistance: Research Provides Limited Information on the Effectiveness of Specific WIC Nutrition Services, March 30, 2001 http://www.gao.gov/new.items/d01442.pdf Despite methodological limitations, demonstration studies provide program managers and policymakers with some useful information on the types of Special Supplemental Program for Women, Infants and Children (WIC) nutrition service interventions that can have positive results for participants. However, only one recent demonstration study provides any information on the costs associated with implementing various interventions. Given the limited resources available to provide WIC nutrition services, information on the costs to provide effective services could play a critical role in managers' decisions to implement the intervention and policymakers' decisions on funding the intervention. Fri, 30 Mar 2001 00:00:00 -0500 Food Assistance: Performance Measures for Assessing Three WIC Services, February 28, 2001 http://www.gao.gov/new.items/d01339.pdf GAO examined the performance measures that the Food and Nutrition Service (FNS) uses to assess the nutrition education, breastfeeding promotion and support, and health referral services provided to participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program. GAO found that FNS has an outcome-based measure for one of the three nutrition services--breastfeeding promotion and support. However, the measure, breastfeeding initiation rate, examines only one of several important aspects of the service's possible impact on WIC participants. In addition, several obstacles have hindered FNS' efforts to develop and implement outcome-based measures for nutrition education and health referral services for the WIC program. These include difficulties in identifying measures that would allow the agency to appropriately link a particular service's activity to a desired outcome and resource constraints affecting FNS' ability to collect data needed to implement a proposed measure. Wed, 28 Feb 2001 00:00:00 -0500 Food Stamp Program: States Seek to Reduce Payment Errors and Program Complexity, January 19, 2001 http://www.gao.gov/new.items/d01272.pdf In fiscal year 2000, the Department of Agriculture's Food Stamp Program, administered jointly by the Food and Nutrition Service (FNS) and the states, provided $15 billion in benefits to an average of 17.2 million low-income persons each month. FNS, which pays the full cost of food stamp benefits and half of the states' administrative costs, promulgates program regulations and oversees program implementation. The states run the program, determining whether households meet eligibility requirements, calculating monthly benefits the households should receive, and issuing benefits to participants. FNS assesses the accuracy of states' efforts to determine eligibility and benefits levels. Because of concerns about the integrity of Food Stamp Program payments, GAO examined the states' efforts to minimize food stamp payment errors and what FNS has done and could do to encourage and assist the states reduce such errors. GAO found that all 28 states it examined had taken steps to reduce payment errors. These steps included verifying the accuracy of benefit payments calculated through supervisory and other types of casefile reviews, providing specialized training for food stamp workers, analyzing quality control data to determine causes of errors and developing corrective actions, matching food stamp rolls with other federal and state computer databases to identify ineligible participants, and using computer software to assist caseworkers in determining benefits. To reduce payment errors, FNS has imposed financial sanctions on states with high error rates and has waived some reporting requirements. Fri, 19 Jan 2001 00:00:00 -0500 Title III, Older Americans Act: Carryover Funds Are Not Creating a Serious Meal Service Problem Nationwide, January 9, 2001 http://www.gao.gov/new.items/d01211.pdf Under Title III of the Older Americans Act, the Administration on Aging (AoA) distributes grants to states on the basis of their proportional share of the total elderly population in the United States. These grants are then disbursed to more than 600 area agencies nationwide, and are used to fund group and in-home meals, as well as support services, including transportation and housekeeping. The grants are further subdivided by these agencies to more than 4,000 local service providers. AoA requires that states obligate these funds by September 30 of the fiscal year in which they are awarded. Also, states must spend this money within two years after the fiscal year in which it is awarded. During this time AoA does not limit or monitor the amount of unspent funds that states may carry over to the succeeding fiscal year. GAO examined whether states were using Title III carryover funds to expand their meal service programs for the elderly beyond a level sustainable by their annual allotments alone. GAO found that the buildup and use of Title III carryover funds to support elderly nutrition services does not appear to be a widespread problem. However, AoA does not monitor the states' buildup of carryover funds. As a result, the agency has little assurance that it could identify meal service problems that could emerge in the future. Tue, 09 Jan 2001 00:00:00 -0500 Food Assistance: Activities and Use of Nonprogram Resources at Six WIC Agencies, September 29, 2000 http://www.gao.gov/archive/2000/rc00202.pdf The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federally funded nutrition assistance program run by the Department of Agriculture's Food and Nutrition Service (FNS). This program provides supplemental foods and nutrition services to lower-income pregnant, breastfeeding, and postpartum women; infants; and children up to age 5 who are at nutritional risk. In fiscal year 1999, WIC benefits and services were provided to about 7.3 million individuals each month. To help Congress better understand the cost of administering WIC and delivering nutritional services, GAO is mandated by law to assess various costs associated with WIC nutrition services and administration. This report, the second in a series of such assessments, provides information on: (1) the ways in which WIC agencies deliver nutrition services and administer the program; (2) the ways in WIC which WIC agency staff allocate their time delivering the services and administering the program; and (3) the types of nonprogram resources used and the extent to which such resources cover costs of delivering the nutrition services. GAO's first report was issued in March 2000. (See GAO/RCED-00-66.) Fri, 29 Sep 2000 00:00:00 -0400 Food Assistance: Options for Improving Nutrition for Older Americans, August 17, 2000 http://www.gao.gov/archive/2000/rc00238.pdf In 1998, about 1.6 to 2 million households with individuals age 60 and older reported that they did not have enough of the right types of food to maintain nutrition or simply did not have enough to eat, despite programs like the Food Stamp Program, Child and Adult Care Food Program, the Elderly Nutrition Program, and the Commodity Supplemental Food Program. Nevertheless, many are reluctant to accept nutrition assistance. Some older persons believe that accepting food assistance will compromise their independence. Others equate it with welfare; still others lack transportation to the programs' locations or believe that the burden of applying for food stamps outweighs the expected low benefit. Program officials, providers, and advocacy groups have identified several actions that might increase older persons' participation in nutrition assistance programs. These actions include simplifying the application process, increasing the minimum benefit level from $10 to $25 per month, expanding programs to serve more people, and making older persons automatically eligible for food stamps when they are approved for programs like Medicaid. Thu, 17 Aug 2000 00:00:00 -0400 Food Assistance: Reducing the Trafficking of Food Stamp Benefits, July 19, 2000 http://www.gao.gov/archive/2000/rc00250t.pdf The Food Stamp Program provided $16 billion in benefits to about 18 million recipients in 1999. As one of the nation's largest assistance programs, it is vulnerable to a type of fraud and abuse know as "trafficking" exchanging food stamps for cash or nonfood items. About 70 percent of all food stamp benefits are now provided electronically through a card used like a debit card at the grocery checkout counter. Under federal law, agencies may use electronic benefits transfer (EBT) data to act against traffickers who violate the Food Stamp Program. This testimony suggests that (1) EBT data be used alone, without the added expense of an undercover investigation, to take action against traffickers; (2) better debt collection activities be developed by the Department of Agriculture's Food and Nutrition Service to improve its collection of financial penalties imposed on traffickers; and (3) all states delivering benefits electronically analyze EBT data to identify recipients who may have been trafficking food stamp benefits. Wed, 19 Jul 2000 00:00:00 -0400 Food Stamp Program: Better Use of Electronic Data Could Result in Disqualifying More Recipients Who Traffic Benefits, March 7, 2000 http://www.gao.gov/archive/2000/rc00061.pdf The U.S. Department of Agriculture provided about $16 billion in food stamp benefits to about 18 million recipients in 1999. Until the mid-1990s, most recipients bought food using coupons. Today, however, about 70 percent of all benefits are provided electronically. The government saves time and money by providing benefits electronically because there is no need to print, safeguard, distribute, account for, or destroy the coupons. This report determines the (1) extent to which the states with electronic transfer systems are identifying and disqualifying recipients who engage in trafficking and (2) steps the Food and Nutrition Service has taken to encourage states to take these actions. Of the 29 states with statewide electronic benefit systems, only four--Florida, Missouri, South Carolina, and Texas--independently and actively analyze their electronic databases to identify suspect recipients. Tue, 07 Mar 2000 00:00:00 -0500 Food Assistance: Financial Information on WIC Nutrition Services and Administrative Costs, March 6, 2000 http://www.gao.gov/new.items/rc00066.pdf The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provides supplemental foods, nutrition services, and health care referrals to lower-income pregnant, breastfeeding, and postpartum women; infants; and children up to age 5. To help Congress better understand the costs associated with the program, GAO reviewed various cost aspects of WIC's nutrition services and administration. This is the first in a series of reports on this subject. Mon, 06 Mar 2000 00:00:00 -0500 School Meal Programs: Few Outbreaks of Foodborne Illness Reported, February 22, 2000 http://www.gao.gov/archive/2000/rc00053.pdf More than 33 million meals are served daily to children through two federally assisted meal programs run by the Department of Agriculture (USDA): the National School Lunch and School Breakfast programs. This report provides information on the safety of foods served in the two programs. GAO discusses the extent (1) of foodborne illness outbreaks related to meals served in schools; (2) to which USDA-donated foods in schools were removed, replaced, or disposed of; and (3) to which USDA has established procurement policies and procedures for ensuring the safety of foods it donates to the programs. Tue, 22 Feb 2000 00:00:00 -0500