People With Disabilities

How efficient are federal efforts to help people with disabilities? In 1994, the government provided a range of services to people with disabilities through 130 different programs, 19 federal agencies, and a host of public and private agencies at the state and local levels. Although research groups and independent panels have stressed the need to simplify and streamline programs serving the disabled, creating a new service delivery system may prove difficult. GAO urged caution in 1992 when Congress was considering proposals that would have made fundamental changes in human service delivery systems at the federal, state, and local levels. GAO also urges caution with regard to programs serving people with disabilities. Although the potential benefits of creating a new system to deliver services more comprehensively to people with disabilities may be great, so are the barriers and the risks of failure. Obstacles preventing officials from reorganizing service agencies, creating new funding and service agreements, and divesting authority from their own agencies are hard to overcome. Mandates alone are unlikely to secure the major time and resource commitments needed from officials--whether they are charged with directing reforms or have responsibility for administering services. In the current fiscal environment, a renewed focus by federal agencies on improving coordination would be a useful step toward improving services and enhancing the customer orientation of their programs.

GAO found that: (1) 130 federal programs provide services to disabled persons; (2) in fiscal year 1994, federal agencies spent over $60 billion on 69 programs exclusively targeted to disabled persons and between $81 billion and $184 billion on 61 other programs targeted to a wider clientele that gave special consideration to disabled persons; (3) most program expenditures supported income maintenance and health care programs; (4) employment-oriented programs constituted only 26 of the 130 programs and received only 2.5 to 4 percent of total federal funding for such programs in 1994; (5) 57 other programs provided indirect employment assistance; (6) most programs provide services through states and local governments, and nonprofit and private organizations; (7) various program funding mechanisms affect the distribution of program funds among states; (8) the federal government funds a wide range of services to address major employment barriers; (9) disabled persons who need services from more than one program find the programs' differing eligibility criteria and numerous service providers burdensome; (10) the lack of program coordination and information sharing leads to service duplication and gaps, and past efforts to improve service coordination have only been marginally successful; (11) some state and local agencies have improved service delivery to disabled persons and reduced program costs; and (12) few programs have been evaluated for their effectiveness, since many agencies do not require or collect data on program outcomes.