	Background

Recent economic, medical, technological, and social changes have  increased opportunities for individuals with disabilities to live with greater  independence and more fully participate in the workforce. These programs provide a wide range of assistance such as  employment-related services, medical care, and monetary support. In fiscal year 2003, over $120 billion in  federal funds were spent on programs that serve only people with  disabilities. Although there were insufficient data available to estimate the  total additional funds spent on people with disabilities by programs that  also serve people without disabilities, benefit payments for people with  disabilities for two such programs alone—Medicare and Medicaid— amounted to about $132 billion in fiscal year 2002. The rest of the  programs are partially targeted to people with disabilities—they serve  people with and without disabilities. Federal Programs Provide a Wide Range of Assistance to People with Disabilities

Federal programs provide a wide range of assistance to people with  disabilities (see fig. 1). 2). 3). 4). 5). In addition to the billions of dollars spent on programs that serve only  people with disabilities, additional amounts are spent on individuals with  disabilities by partially targeted programs whose beneficiaries also include  people without disabilities. Federal Programs That Support People with Disabilities Face an Array of Challenges

Both our past work and our recent survey of federal programs supporting  people with disabilities indicate that these programs face a number of  challenges. Among these are challenges in ensuring timely and consistent  processing of applications for assistance, ensuring timely provision of  services and benefits, interpreting complex eligibility requirements,  planning for growth in the demand for program benefits and services,  making beneficiaries or clients aware of program services or benefits, and  communicating or coordinating with other federal programs. Key Factors to Consider in Transforming Programs for the 21st Century

Over the past several years, GAO, in reporting that the largest federal  disability programs were mired in outdated concepts of disability, has  identified the need to reexamine and transform these programs to better  position the government to meet the challenges and expectations of the  21st century. On the basis of more than a decade of research focusing on the nation’s  largest disability programs and our review of prior GAO reports examining  efforts to reform federal programs and transform agencies, we have  identified several key factors that are important to consider in assessing  the need for, and nature of, program transformations. In particular, our  prior work identifying shortcomings in the work incentives and supports  provided by the largest federal disability programs indicates that these  basic program design issues need to be addressed.
Why GAO Did This Study

In 2003, GAO designated modernizing federal disability programs as a high-risk area requiring urgent attention and organizational transformation to ensure that programs function as efficiently and effectively as possible. GAO found that although social attitudes have changed and medical advancements afford greater opportunities for people with disabilities to work, the Social Security Administration and the Department of Veterans Affairs have maintained an outmoded approach that equated disability with inability to work. We have prepared this report under the Comptroller General's authority as part of a continued effort to help policymakers better understand the extent of support provided by federal programs to people with disabilities and to assist them in determining how these programs could be better aligned to more effectively meet the needs of individuals with disabilities in the 21st century. This report identifies (1) the wide array of federal programs that serve people with disabilities, and (2) the major challenges these federal programs face in the 21st century. In addition, GAO presents factors policy makers and program administrators should address in assessing whether, and how, they could be transformed to better meet 21st century challenges.

What GAO Found

More than 20 federal agencies and almost 200 programs provide a wide range of assistance to people with disabilities, including employment-related services, medical care, and monetary support. About half of these programs serve only people with disabilities while the rest serve people both with and without disabilities. In fiscal year 2003, more than $120 billion in federal funds was spent on programs that only serve people with disabilities, with over 80 percent of these funds spent on monetary support. In addition, considerable funds are spent on people with disabilities by programs that also serve people without disabilities, like Medicare and Medicaid. The program challenges cited most frequently in our recent survey of nearly 200 programs serving people with disabilities are largely consistent with several of the key findings from past reports that led GAO to place federal programs supporting people with disabilities on its high-risk list. Both our recent survey and our past work have identified challenges in (1) ensuring timely and consistent processing of applications; (2) ensuring timely provision of services and benefits; (3) interpreting complex eligibility requirements;( 4) planning for growth in the demand for benefits and services; (5) making beneficiaries or clients aware of benefits and services; and (6) communicating or coordinating with other federal disability programs. In light of the vital role federal programs play in providing assistance to people with disabilities and in helping to ensure an adequate national labor force, we have identified a number of factors that are important to consider in assessing the need for, and nature of, program transformations including (1) program design issues; (2) fiscal implications of proposed program changes; and (3) feasibility of implementing program changes.