Administration Spending Reduction Proposals and Repeal of Title V of the Social Security Act

GAO offered observations on the Administration's proposals to consolidate several categorical health programs into block grants to States, and presented the views of GAO on the Administration's proposal to limit Federal contributions to State operated Medicaid programs and to modify Federal requirements to provide States with more flexible managing programs. GAO is developing an inventory of instances where States have attempted to introduce cost-saving initiatives which were blocked as being inconsistent with Federal requirements. GAO made some recommendations for improving Federal and State health care programs to achieve: (1) more coordination at Federal, State, and local levels; (2) greater flexibility at the State and local levels to match resource needs; (3) better cooperation between public and private health care sectors; (4) more accountability for use of Federal funds; and (5) better program monitoring and evaluation. A comprehensive, multiyear, statewide maternal and child health plan is needed to stimulate the development of a working document that could be used to allocate funds and measure progress. The States should be more aggressive in promoting the concept of regionalized perinatal care. Maternal and Child Health Program funds have enabled States to promote, better manage, and extend their health services to women and children. However, the funds have not been sufficient to enable States to extend services to all those in need or to extend services to the extent envisioned in the authorizing legislation or program regulations. State agencies have had only limited effectiveness in their role. Use of the funding needs reassessment. State projects serve relatively few communities. Program management needs improvement. Grants are often awarded directly to private organizations, bypassing State agencies. Separate categorical programs having related objectives and serving similar target populations should be consolidated. States need time to gear-up for block grants. Congress should specify a uniform definitiion of low-income persons applicable to the block grants.