Summary

In response to a congressional request, GAO provided information on the Department of Health and Human Services' (HHS) funding and monitoring of integration demonstration projects in five states. The demonstration projects will develop ways to ensure that an applicant for services under one program has access to available services under other programs by eliminating programmatic fragmentation. GAO reported specifically on: (1) funding arrangements for the projects; (2) whether certain requirements HHS placed on the states exceeded statutory mandates; and (3) possible federal obstructions to the development of integrated service projects.

GAO found that: (1) since Congress appropriated no funds for the projects for fiscal years (FY) 1985 and 1986, HHS used discretionary funds totalling $553,771 for the first-year planning phase; (2) as of July 1986, HHS had awarded grants totalling $2.4 million to the five states for projects beyond the planning phase; (3) HHS was authorized to require that states receiving funding demonstrate how their integrated service delivery systems could increase clients' social and economic self-sufficiency; (4) four of the five states expressed concerns about identifying and measuring self-sufficiency changes in clients as a result of the projects; (5) HHS will award a contract in 1987 to assist states in developing evaluation designs and in evaluating the projects' results; (6) state officials said they had to make major changes to their plans in FY 1985 without sufficient time to adequately study client needs and identify all desired outcomes for client target groups because HHS did not clearly communicate and emphasize the self-sufficiency requirement until 4 months before the plans were considered for continued funding; and (7) although states may request federal program waivers, they believe it would be a difficult and time-consuming process.