Administration's Block Grant Proposals for Health Services and Preventive Health

GAO endorses the concepts of: (1) consolidating separate categorical programs having related objectives and serving similar target populations; (2) placing management responsibility for similar programs in the same agency; (3) giving the States greater flexibility to match resources with needs and priorities; and (4) resolving the problems frequently created when Federal project grants are awarded directly to local organizations, bypassing relevant State agencies. Some of the items which Congress should consider in its deliberations on the block grant proposals are: (1) the relationship between programs designated for health block grants and other related programs; (2) the possible need to make special provisions for certain activities and groups, such as migrant farmworkers; (3) the possibility that the funding allocation formula may not accurately reflect the need or demand for services; (4) the fact that the States will need time to prepare for administering funds for some project grants; (5) the desirability of using a uniform definition of low-income persons among the health and social service blocks; (6) the likelihood that all expected benefits may not materialize; and (7) the need for adequate accountability provisions. The categorical grant system has diminished the most basic form of accountability in State Government, the legislative oversight of executive actions. The aspects of grant programs that discourage State legislative involvement should be removed. Congress should ensure that the provisions of the block grant proposals do not interfere with the States' own mechanisms for assigning functions to the legislative and executive branches of governments.