Presentation before the CSVAR (February 14, 2006)
Today I will focus my comments on the over-arching question: “What is the future of the Vocational Rehabilitation Program?” To answer this question, I think we first need to figure out the future of the federal disability program as a whole and then how VR will fit into it. The federal disability program is comprised of a collection of programs that were established at various points of time over decades to address the needs of people with disabilities. However, based on research we conducted of some of the largest disability programs—those run by SSA and VA—we have reason to believe that federal disability programs have evolved in line with societal changes and therefore, require urgent attention and possibly transformation to effectively serve people with disabilities in the 21st century. For this reason, in 2003, GAO designated modernizing federal disability programs as a “high risk” area.
In a continued effort to better understand the extent of support provided by federal programs to individuals with disabilities and to assist policy makers in determining whether these programs are aligned most effectively, we conducted a study to identify:
- the many federal programs that serve people with disabilities beyond those administered by SSA and VA
- some of the major challenges these programs face in the 21st century, and
- factors that are important for programs to consider in assessing how best to serve people with disabilities in the 21st century.
On the basis of that study, in June 2005, we reported that there are almost 200 federal programs run by about 20 federal agencies that support people with disabilities [excluding research programs]
About ½ of these programs serve only people with disabilities and the other half give some type of special consideration to people with disabilities like Medicare, Medicaid, SSI
These programs provide a wide array of assistance (employment-related, medical care, civil protections/legal assistance, education, monetary support, information dissemination. housing, transportation, loans)
Multiple federal agencies provide similar types of assistance, for example more than 25 programs reported providing employment-related assistance; more than reported providing healthcare-related assistance, and 19 provided monetary support. However, they often served different populations and used different eligibility criteria.
In addition, most of the programs provided more than 1 type of assistance; more than 1/4 provide 3 or more types of assistance.
We also reported that the federal programs spend a considerable amount of funds to support people with disabilities. In 2003, the programs that serve only people with disabilities spent over $120 billion. The bulk of the funds—about 85%--was spent on monetary support, 8% on education, 2% each on medical care and employment-related assistance.
We were not able to estimate the amount spent by programs that give special consideration to people with disabilities. However, in 2002, it was estimated that a combined total of over $150 billion was spent by three of the largest programs-- Medicare & Medicaid & SSI.
We also reported that challenges programs cited were largely consistent with those we had identified in prior GAO reports (varied based on the types of assistance provided)
- Timely and consistent processing of applications
- Timely provision of benefits and services
- Interpreting complex eligibility requirements
- Planning for growth in the demand for benefits and services
- Making beneficiaries/clients aware of services
- Communication and coordination among programs
Given the number of programs supporting people with disabilities, we need to make sure they are structured in a manner that collectively allows them to provide coherent and seamless support to people with disabilities. Also, in light of the nation’s large and growing structural deficit, we need to determine whether programs currently represent the most cost-effective approaches to serving people with disabilities.
Thus we believe it is time to assess whether federal disability programs as a whole have evolved to effectively serve people with disabilities in the 21st century. Doing so would help to determine how individual programs need to be transformed.
GAO has identified several factors that we believe are important to consider when assessing the need for transforming federal disability programs. These factors relate to program design, feasibility, and fiscal implications.
Program design
Do programs have up-to-date criteria for who they serve?
Do programs provide services at the most appropriate time?
Do the programs provide effective supports to enter or remain in the workforce?
Are programs designed to provide financial support for those unable to work?
Do programs require potential beneficiaries to receive assistance to enhance work as a precondition for benefits?
Are programs coordinated or integrated with related programs?
Are programs flexible enough to meet beneficiaries’ changing needs?
Feasibility/Implementation
Do the programs have clear standards that can be applied accurately and consistently?
Do the programs have qualified personnel?
Do the programs have internal controls to ensure the programs operate as intended?
Do the programs have the information technology to operate effectively?
Fiscal Implications
For example, are federal disability programs affordable and sustainable?
Is responsibility for payment of benefits and services appropriately assigned?
If an assessment of our current approach to serving people with disabilities suggests change or transformation is warranted, some of these same questions can be used along with others to guide that transformation.
- For example, before embarking upon major changes we would want to consider:
- ·What will be the short & long-term costs of changing the way we currently do business?
- What will be the benefits of changing?
- What would the financial impact on other federal, state, local and non-profit organizations?
We recognize determining how federal programs should be aligned to best serve people with disabilities in the 21st century will be an overwhelming and difficult task. However, we believe it is a necessary one. It is a task that will require all stakeholders, including customers, researchers, policymakers, and programs that serve people with disabilities to really work together; as they all hold pieces of the disability puzzle and answers to the questions you asked us to consider today. Customers can tell you what they need and want; disability programs that serve people with disabilities and researchers have information that can help identify trends of the people served, services provided, and hopefully, what works and what doesn’t; and Policymakers can provide some insight into what will be expected and what we will likely have to work with in the future.
Disability programs play a vital role in the lives of people with disabilities. Therefore, it is important that we design an effective disability system that will allow us to maximize benefits and services.
