1. Program Performance and Measurement: Recent Work 34 th Annual NAPIPM Conference August 20, 2014 Gale Harris, Assistant Director Education, Workforce, and Income Security U.S. Government Accountability Office harrisg@gao.gov (202-512-7235) GAO Reports Available at www.gao.gov

2. Overview Governmentwide efforts Annual Duplication, Overlap, Fragmentation, and Cost Savings Reports Sequestration Review Improper Payment Status Assessed Annually Recent and ongoing human services work SNAP Medicaid Cross-cutting Page 2

3. As the fiscal pressures facing government continue, so does the need to improve the efficiency and effectiveness of government programs and activities GAO is required by statute to identify and report annually to Congress on federal programs, agencies, offices, and initiatives, both within departments and government-wide, which have duplicative goals or activities. GAO has also identified additional opportunities to achieve greater efficiency and effectiveness by means of cost savings or enhanced revenue collection. Duplication, Overlap, Fragmentation, and Cost Savings - Overview Page 3 GAO-14-343SP

4. Duplication, Overlap, Fragmentation, and Cost Savings – Definitions, Examples Page 4 GAO-14-343SP DuplicationOverlapFragmentationCost Savings Activities that are essentially the same, but administered through different agencies or programs. Activities are similar enough in scope and action that the same people might benefit from all of them. Activities that are working toward different parts of the same goal inefficiently. Opportunities to cut costs or collecting additional revenue if the government took action to encourage payment. For example, at one Air Force base, Dept. of Defense maintains 8 separate satellite ground control systems operating 10 satellites. For example, some people receive disability pay from Social Security Administration plus unemployment benefits from Labor and states. For example, in 2013, Congress put restrictions on military development of separate combat uniforms, which will equal savings over time. For example, IRS could collect some delinquent federal taxes, by, for example, limiting passport issuance for individuals with tax debt.

5. Early Learning and Child Care: Education and HHS should extend coordination efforts to other agencies (2012) Employment and Training Programs: Providing information on colocating services and consolidating administrative structures could promote efficiencies (2011) Domestic Food Assistance: Actions needed to reduce administrative overlap with 18 different programs (2011) Page 5 GAO-14-343SP

6. Executive branch and Congress have made progress in addressing hundreds of actions across 162 areas that GAO identified in its past annual reports. As of March 2014, GAO found that nearly 20 percent of these areas were addressed, over 60 percent were partially addressed, and about 15 percent were not addressed GAO's 2014 annual report identifies 11 new areas where actions could be taken to improve efficiency and effectiveness Efforts to address these over the past 3 years have resulted in over $10 billion in cost savings with billions of dollars more in cost savings anticipated in future years. Duplication, Overlap, Fragmentation, and Cost Savings – Results So Far Page 6 GAO-14-343SP

7. Sequestration-Across the Board Reductions of $80.5 Billion in FY 2013 Page 7 GAO-14-244

8. Effects of FY2013 Sequestration – GAO Review of 23 Federal Agencies Sequestration reduced or delayed some services to the public, including benefit payments, and disrupted agency operations Agencies took many actions to minimize sequestration's effects, but many of these were short-term responses--not sustainable long- term budget reduction strategies Many effects will not be known until future years, if at all There is a limit to agencies' ability to achieve efficiencies and budget reductions by doing more with less. Implementing future budget reductions will likely require Congress and executive branch to reexamine federal agencies' missions— what they do and how they do it--for more than a single fiscal year Page 8 GAO-14-244 – 2013 Sequestration: Agencies Reduced Some Services and Investments,Agencies Reduced Some Services and Investments, While Taking Certain Actions to Mitigate Effects

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10. 10 years into the Improper Payments Act, More to Be Done Federal agencies reported an estimated $105.8 billion in improper payments in FY2013 (from 84 programs across 18 agencies) Still, GAO cited as material weakness inability of federal govt to determine full extent of improper payments and claim reasonable assurances that appropriate actions are taken to reduce them 4 risk-susceptible programs did not report estimates, including TANF. HHS cited a statutory barrier to estimating TANF improper payments Page 10 GAO-14-737T

11. Most Recent Improper Payment Estimates for Selected Programs Page 11 ProgramError rateImproper Payment Estimate Earned Income Tax Credit24.00%$14.5 billion Medicare Fee-for-Service10.10%$36 billion Unemployment Insurance 9.30%$6 billion Child Care Development Fund 5.90%$306 million Medicaid 5.80%$14.4 billion SNAP 3.42%$2.6 billion TANFNot available Reported by agencies in Annual Financial Reports or Performance Accountability Reports for FY2013

12. Forthcoming Report on Combating SNAP Fraud Large growth in SNAP benefits since FY 2009 could leave program more vulnerable to fraud like: Selling benefits to retailers Selling EBT cards to another person GAO looked at: How 11 states are combating fraud Effectiveness of certain fraud detection tools Food and Nutrition Service oversight of anti-fraud efforts Page 12 Forthcoming GAO-14-641

13. Medicaid: Recent Work Medicaid Program Integrity: Increased Oversight Needed to Ensure Integrity of Growing Managed Care Expenditures (GAO-14-341) Medicaid: CMS Should Ensure That States Clearly Report Overpayments (GAO-14-25) Medicaid: Alternative Measures Could Be Used to Allocate Funding More Equitably (GAO-13-434) Page 13

14. Rethinking Human Services Delivery The current multiplicity of programs is too fragmented, complex: For clients to navigate, for program operators to administer efficiently, and for assessing program performance. Efforts to address this could include: Simplifying policies to improve productivity and help staff focus more time on activities such as ensuring the accuracy of benefits. Facilitating technology enhancements to streamline eligibility processes and improve program integrity, and Fostering state innovation and evaluation to help the federal government and policymakers determine which approaches are the most cost-effective and limit investment in unproven strategies Page 14 GAO-11-531T

15. Data sharing and privacy in human services programs GAO-13-106 Focus on: - Eligibility and enrollment - Case management Recommendations: -HHS: timely completion of confidentiality toolkit -OMB: more active leadership role Page 15

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