Federal and State Actions Needed To Overcome Problems in Administering the Title XX Program

HRD-81-8: Published: Oct 29, 1980. Publicly Released: Oct 29, 1980.

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The title XX program, authorized by Social Security Act amendments, enables States to tailor social services programs to fit the needs of people in local communities. The social services are provided directly by public social services agencies or purchased from other public agencies and private profit or nonprofit organizations. The States must fund about 25 percent of their title XX program costs.

Most of the contracts awarded to purchase social services in the five States which GAO visited did not adequately define the units of service purchased. The States did not know what contractors were committed to deliver and whether they met their commitments. The States reimbursed contractors for the costs they billed, up to the contract price, regardless of the units of service delivered. Most of the certified expenditures used in New Mexico for matching purposes were questionable project costs. The expenses were only incidentally related to the contractor's program on which they were used for matching purposes and would have been incurred regardless of whether the title XX contracts had been awarded. The Guide to Federal Financial Participation under title XX provides that expenditures of public agencies may be certified as matching under title XX if they are made on behalf of the title XX program, based on an approved cost allocation plan, and charged to the program. This guidance, coupled with indepth reviews of the State cost allocation plans, should help to preclude the improper charging of certified expenditures to the program. New Mexico needs to more clearly document that certified expenditures were authorized, beneficial, and covered by contract. GAO interviewed 100 clients of California's in-home services for the elderly program. They were generally satisfied with the services received. Only one of the two counties which GAO visited monitored the quality of the services provided, and neither had a formal method of recording the hours of service provided.

Recommendations for Executive Action

  1. Status:

    Comments: Please call 202/512-6100 for additional information.

    Recommendation: The Secretary of HHS should direct the HHS regional offices to give States technical assistance to develop reasonable units of measurement for various services.

    Agency Affected: Department of Health and Human Services

  2. Status:

    Comments: Please call 202/512-6100 for additional information.

    Recommendation: The Secretary of HHS should direct the HHS regional offices to encourage States that authorize persons to hire their own service providers to have a system that monitors the quality of services provided and assures that the required hours of service are delivered.

    Agency Affected: Department of Health and Human Services

  3. Status:

    Comments: Please call 202/512-6100 for additional information.

    Recommendation: The Secretary of Health and Human Services (HHS) should direct HHS regional offices to use contracts based on unit prices or specific levels of services in purchasing social services under the title XX program.

    Agency Affected: Department of Health and Human Services

 

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