Program Performance and Measurement: Recent Work

1. Program Performance and Measurement: Recent Work 34th 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

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 GAO-14-343SP

4. Duplication, Overlap, Fragmentation, and Cost Savings – Definitions, Examples GAO-14-343SP

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) 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 GAO-14-343SP

7. Sequestration-Across the Board Reductions of $80.5 Billion in FY 2013 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 GAO-14-244 – 2013 Sequestration: Agencies Reduced Some Services and Investments, While Taking Certain Actions to Mitigate Effects

9. GAO-14-244

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 GAO-14-737T

11. Most Recent Improper Payment Estimates for Selected Programs 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 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)

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 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