Nutrition Assistance Programs: Federal Agencies Should Improve Oversight and Better Collaborate on Efforts to Support Veterans with Food Insecurity

Fast Facts

What happens when veterans can't get enough food or aren’t sure when they'll get their next meal? In 2016, the Department of Veterans Affairs started trying to find these veterans and refer them for assistance.

VA uses a screening tool to identify such veterans and refer them to food banks and other services and resources. In 2020, VA began collaborating with the Department of Agriculture to help veterans obtain Supplemental Nutrition Assistance Program benefits—formerly known as food stamps.

But VA hasn't fully monitored or evaluated the effectiveness of its efforts. We recommended that VA do so, and that USDA improve its collaboration with VA.

Veterans Affairs application for health benefits on a clipboard

Highlights

What GAO Found

The Department of Veterans Affairs (VA) has taken several actions to identify veterans who may be experiencing food insecurity—which the United States Department of Agriculture (USDA) defines as the condition of limited or uncertain access to adequate food—and refer them for assistance, but has not fully monitored or evaluated the effectiveness of these efforts. In 2016, VA established its Ensuring Veteran Food Security Workgroup (Workgroup), which is led by the Veterans Health Administration (VHA). VHA has taken several actions through the Workgroup to address food insecurity among veterans. For example, VHA is using a two-question screening tool to identify and refer veterans who may be food insecure to a social worker, dietitian, or other VA medical center staff (see figure). Veterans who screen “positive” are referred to support and resources they need, which could include a referral to a local food bank. In addition, VHA has trained VA medical center staff on the use of the tool and how to enroll veterans in the Supplemental Nutrition Assistance Program. However, VA has not fully monitored the implementation or evaluated the effectiveness of these efforts, which is inconsistent with federal internal control standards and may hinder VHA's ability to achieve its defined outcomes and result in fewer veterans receiving the support they need.

Example of VHA Food Insecurity Screening Tool Record

USDA began leading an informal interagency workgroup (workgroup) with VA in 2020 to help address food insecurity among veterans, but it has not fully addressed leading practices for collaboration and cannot fully assess its progress in accomplishing related goals. USDA established the workgroup to, among other things, enhance support for veterans experiencing food insecurity. USDA has taken steps to collaborate with VA through this workgroup, for example, by developing nutritional resources that include common definitions of food insecurity. Developing such resources is consistent with one of GAO's leading collaboration practices. However, USDA did not follow other collaboration practices, including those related to outcomes and accountability. By taking steps to address other leading practices in its workgroup, such as through identifying clear goals that establish organizational outcomes and developing mechanisms for accountability, USDA could enhance collaboration with VA to better support veterans' food insecurity.

Why GAO Did This Study

Recent USDA data indicate that veterans experience high rates of food insecurity, which can contribute to many negative health outcomes. GAO was asked to review VA's efforts to support veterans who may be experiencing food insecurity and the extent to which USDA coordinates with VA to support these veterans.

This report examines (1) how VA identifies and assists veterans who may be experiencing food insecurity and the extent to which it monitors and assesses the effectiveness of these efforts, and (2) the extent to which USDA coordinates with VA to support those veterans. GAO reviewed relevant VA and USDA initiatives and interviewed key officials responsible for administering these initiatives in addition to veterans' service organizations, among others. GAO assessed VA's process for monitoring and evaluating its efforts in accordance with federal standards for internal control and the extent to which USDA is coordinating with VA in accordance with leading collaboration practices, based on prior work. GAO also conducted virtual site visits to three VA medical centers that were selected to represent a range of criteria including a large number of positive screenings for food insecurity.

Recommendations

GAO is making four recommendations including that VA monitor and evaluate the effectiveness of its Workgroup's efforts and that USDA take steps to enhance collaboration in its workgroup with VA. VA concurred and said it would monitor and evaluate its workgroup. USDA also concurred.

Recommendations for Executive Action

Agency Affected	Recommendation	Status
Department of Veterans Affairs	The Under Secretary for Health should ensure that VHA monitors and evaluates the effectiveness of the Ensuring Veteran Food Security Workgroup's activities, including at the VA medical center level. (Recommendation 1)	Closed – Implemented VA agreed with this recommendation and has implemented it. In September 2022, VHA rechartered the Workgroup and among other things made the Workgroup responsible for monitoring and evaluating its activities. In addition, in January 2023, VA established a Food Security Office within VHA that will assist the Workgroup with monitoring and evaluating its activities including at the VA medical center level. For example, the Social Worker Program Manager, within the Food Security Office, will be responsible for evaluating VA's food security program to enhance the quality of service veterans receive from social workers. In addition, the National Director of the Food Security Office will be responsible for the development and implementation of a data dashboard that will help assess the quality, efficiency, and effectiveness of VA's food security program. This data dashboard includes the number of veterans who screen "positive" for food insecurity across VA's medical centers and the number of veterans referred to social workers for assistance.
Department of Veterans Affairs	The Under Secretary for Benefits should direct VBA to assess the extent to which proactively providing information about nutrition assistance and making related referrals through the Solid Start Program would be beneficial to veterans. (Recommendation 2)	Closed – Implemented VA agreed with this recommendation and has implemented it. VBA assessed the extent to which proactively providing information about nutrition assistance and making related referrals through the VA Solid Start Program would be beneficial to veterans. In December 2021, VBA began proactively emailing veterans with information about nutrition assistance through the VA Solid Start Program. In addition, VBA began tracking veterans who requested additional support after receiving this information through its scheduled follow-up phone calls with veterans. VBA also developed a script for its VA Solid Start Program representatives that would help them identify and assist veterans who may be experiencing food insecurity. Further, in February 2022, VA Solid Start Program representatives received specialized training on available resources and referral options for veterans who requested additional assistance. This training will help representatives better identify and address food insecurity by ensuring veterans are referred to the Veterans Health Administration, United States Department of Agriculture, and state/local resources for assistance. Finally, to ensure follow-up occurs through subsequent scheduled phone calls, VBA added an identifier to each veteran's record that is experiencing food insecurity.
Department of Agriculture	The Secretary of Agriculture should take steps to enhance collaboration within USDA's workgroup with VA including through a written agreement that specifically clarifies agency roles and responsibilities, articulates common outcomes, and establishes a mechanism to monitor progress, and routinely monitor and update this written agreement. (Recommendation 3)	Closed – Implemented USDA agreed with this recommendation. As of September 2023, USDA signed a memorandum of agreement (MOA) that would help enhance its collaboration with VA. Among other things, the MOA clarifies roles and responsibilities for both agencies, defines objectives of the collaboration, identifies performance metrics to monitor progress including the number of new food security initiatives developed, and includes a provision for amendments. The MOA will also be reviewed annually to determine if the goals of the collaboration are being achieved and if roles and responsibilities are being fulfilled.
Department of Agriculture	The Administrator of USDA's Food and Nutrition Service should consider recommending that state SNAP agencies that target veterans for SNAP benefits share their SNAP outreach plans with local VHA facilities. (Recommendation 4)	Closed – Implemented USDA agreed with this recommendation, noting that sharing these plans will help the two agencies collaborate on providing SNAP information resources and targeted enrollment assistance to veterans. In July 2022, USDA identified veterans as an outreach priority area and encouraged state SNAP agencies that identified veterans as a target population to share their fiscal year 2023 SNAP outreach plans with local VHA facilities through its annual outreach priorities memorandum. USDA also encouraged state SNAP agencies to form partnerships with these facilities and incorporate any related outreach activities with VHA in their SNAP outreach plans. In addition, in February 2023, USDA continued to identify veterans as an outreach priority area and encouraged state SNAP agencies that identified veterans as a target population to share their fiscal year 2024 SNAP outreach plans with local VHA facilities through its annual outreach priorities memorandum.