This is the accessible text file for GAO report number GAO-11-782T entitled 'Nutrition Assistance: Additional Efficiencies Could Improve Services to Older Adults' which was released on June 21, 2011. This text file was formatted by the U.S. Government Accountability Office (GAO) to be accessible to users with visual impairments, as part of a longer term project to improve GAO products' accessibility. Every attempt has been made to maintain the structural and data integrity of the original printed product. Accessibility features, such as text descriptions of tables, consecutively numbered footnotes placed at the end of the file, and the text of agency comment letters, are provided but may not exactly duplicate the presentation or format of the printed version. The portable document format (PDF) file is an exact electronic replica of the printed version. We welcome your feedback. Please E-mail your comments regarding the contents or accessibility features of this document to Webmaster@gao.gov. This is a work of the U.S. government and is not subject to copyright protection in the United States. It may be reproduced and distributed in its entirety without further permission from GAO. Because this work may contain copyrighted images or other material, permission from the copyright holder may be necessary if you wish to reproduce this material separately. United States Government Accountability Office: GAO: Testimony: Before the Subcommittee on Primary Health and Aging, Committee on Health, Education, Labor, and Pensions U.S. Senate: For Release on Delivery: Expected at 10:00 a.m. EDT: Tuesday, June 21, 2011: Nutrition Assistance: Additional Efficiencies Could Improve Services to Older Adults: Statement of Kay E. Brown, Director: Education, Workforce, and Income Security Issues: GAO-11-782T: Mr. Chairman, Ranking Member Paul, and Members of the Subcommittee: We appreciate the opportunity to discuss our recent work on food insecurity among older adults and the nutrition assistance programs available to assist them, including nutrition assistance programs authorized under the Older Americans Act of 1965 (OAA).[Footnote 1] This work can help inform government policymakers as they address the needs of one of our nation's most vulnerable populations while ensuring the efficiency and effectiveness of federal programs given rapidly building fiscal pressures facing our national government. While the economy is still recovering and in need of careful attention, widespread agreement exists on the need to look not only at the near term but also at steps that begin to change the long-term fiscal path as soon as possible without slowing the recovery. Our recent work can help with this by identifying potential inefficiency and overlap among programs. At the same time, there is recognition that the services provided by the OAA can play an important role in helping older adults remain in their homes and communities. As the Congress takes steps to address the fiscal challenge, it will be important that these steps are balanced with efforts to ensure the health and well-being of older adults. My testimony today is based on two recent reports, our April 2010 report on domestic food assistance[Footnote 2] and our February 2011 report on the unmet need for services under the OAA.[Footnote 3] My testimony highlights key findings from each of these reports related to (1) the prevalence of food insecurity and the receipt of nutrition services among older adults; and (2) the extent to which nutrition assistance programs show signs of inefficiency or overlap. This statement will discuss some of the challenges related to ensuring the most efficient provision of services, and suggest how better information could help policymakers address overlap and duplication among programs while ensuring those most in need have access to services. To address the objectives, we drew upon our April 2010 report and our February 2011 report. In this work, we employed an array of methodologies including analysis of administrative data on program expenditures and participation and national self-reported data on food security status; a nationally representative survey of local agencies that administer nutrition assistance programs funded by OAA;[Footnote 4] an analysis of studies on program effectiveness; a review of relevant federal laws and regulations and agency documents; and interviews with relevant experts, federal officials, and staff of local agencies. We conducted our work in accordance with generally accepted government auditing standards. Those standards require that we plan and perform the audit to obtain sufficient, appropriate evidence to provide a reasonable basis for our findings and conclusions based on our audit objectives. We believe that the evidence we obtained provides a reasonable basis for our findings and conclusions. On March 1, 2011, we issued a report outlining opportunities to reduce duplication across a wide range of federal programs raising attention to these issues.[Footnote 5] That report was prepared in response to a new statutory requirement that GAO identify and report annually on federal programs, agencies, offices, and initiatives--either within departments or governmentwide--that have duplicative goals and activities.[Footnote 6] In that work, we also considered fragmentation and overlap among government programs or activities as these can be harbingers of unnecessary duplication. Fragmentation of programs exists when programs serve the same broad area of need but are administered across different federal agencies or offices. Program overlap exists when multiple agencies or programs share similar goals, engage in similar activities or strategies to achieve them, or target similar beneficiaries. Unnecessary duplication of program services can occur when two or more programs are engaged in the same activities or provide the same services to the same beneficiaries, and this can in turn result in inefficient service delivery and unnecessary program costs. Reducing or eliminating duplication, overlap, or fragmentation could potentially save billions of tax dollars annually and help agencies provide more efficient and effective services. These actions, however, will require some difficult decisions and sustained attention by the Administration and Congress. In Recent Years Nearly a Fifth of Low-Income Older Adults Were Food Insecure and Most Did Not Receive Assistance from Meals Programs Despite Increased Demand: Analysis of data from the Current Population Survey's (CPS) Food Security Supplement shows that in 2009, about 19 percent of households with adults ages 60 and over with low incomes--under 185 percent of the poverty line--were food insecure. These adults were uncertain of having or unable to acquire enough food because they lacked resources. In comparison, slightly less than 15 percent of all households were food insecure. A small but significant portion of households with older adults had very low food security in 2009--about 8 percent of those with households under 185 percent of poverty and about 14.5 percent of those with incomes under the poverty line. In these households, one or more household members' eating patterns were disrupted and their food intake reduced, at least some time during the year because they could not afford enough food. (See Figure 1.) Figure 1: Food insecurity among all households, low-income households, and elderly households (60 and older), 2009: [Refer to PDF for image: stacked horizontal bar graph] Percent of food insecurity: All households: Low food security: 9.0%; Very low food security: 5.7%; Total: 14.7%. All households less than 185 percent of poverty: Low food security: 20.4%; Very low food security: 14.4%; Total: 34.8%. All households less than 100 percent of poverty: Low food security: 24.4%; Very low food security: 18.5%; Total: 42.9%. Elderly households (60 and older): Low food security: 5.3%; Very low food security: 3.3%; Total: 8.6%. Elderly households less than 185 percent of poverty: Low food security: 11.6%; Very low food security: 7.7%; Total: 19.3%. Elderly households less than 100 percent of poverty: Low food security: 16.9%; Very low food security: 14.5%; Total: 31.4%. Source: GAO analysis of December 2009 Current Population Survey Food Security Supplement. [End of figure] Older adults can and do access a number of resources to help alleviate food insecurity; however, many low-income older adults likely to need assistance from meals programs did not receive it, according to 2008 data. Through our analysis of information from the CPS, we found that in 2008 approximately 9 percent of an estimated 17.6 million low- income older adults[Footnote 7] received home-delivered or congregate meals services including those provided by the OAA Elderly Nutrition Program: Home-Delivered and Congregate Meals Services (Elderly Nutrition Program)[Footnote 8] and other organizations such as churches or nonprofits.[Footnote 9] However, many more older adults did not receive these meals services, but likely needed them due to food insecurity, difficulties with daily activities, and/or limited social interaction, as shown in table 1.[Footnote 10] Table 1: Percentages of Low-Income Older Adults with Each Characteristic of Likely Need and Percentages Who Did and Did Not Receive Meals Services: Characteristics of likely need: Food security: Food secure; Have each characteristic: 81.4%; Received home-delivered meals: 3.3%; Did not receive home-delivered meals: 96.7%; Received congregate meals: 5.7%; Did not receive congregate meals: 94.3%; Received either type of meal: 8.3%; Received neither type of meal: 91.7%. Characteristics of likely need: Food security: Food insecure; Have each characteristic: 18.6%; Received home-delivered meals: 7.4%; Did not receive home-delivered meals: 92.6%; Received congregate meals: 4.9%; Did not receive congregate meals: 95.1%; Received either type of meal: 11.1%; Received neither type of meal: 88.9%. Characteristics of likely need: Numbers of impairments[A]: None; Have each characteristic: 65.2%; Received home-delivered meals: 2.3%; Did not receive home-delivered meals: 97.7%; Received congregate meals: 5.1%; Did not receive congregate meals: 94.9%; Received either type of meal: 6.9%; Received neither type of meal: 93.1%. Characteristics of likely need: Numbers of impairments[A]: One; Have each characteristic: 18.0%; Received home-delivered meals: 3.6%; Did not receive home-delivered meals: 96.4%; Received congregate meals: 6.3%; Did not receive congregate meals: 93.7%; Received either type of meal: 8.8%; Received neither type of meal: 91.2%. Characteristics of likely need: Numbers of impairments[A]: Two or more; Have each characteristic: 16.8%; Received home-delivered meals: 11.5%; Did not receive home-delivered meals: 88.5%; Received congregate meals: 6.4%; Did not receive congregate meals: 93.6%; Received either type of meal: 16.7%; Received neither type of meal: 83.3%. Characteristics of likely need: Social isolation[B]: Less isolated; Have each characteristic: 31.8%; Received home-delivered meals: 2.5%; Did not receive home-delivered meals: 97.5%; Received congregate meals: 6.1%; Did not receive congregate meals: 93.9%; Received either type of meal: 7.9%; Received neither type of meal: 92.1%. Characteristics of likely need: Social isolation[B]: More isolated; Have each characteristic: 41.4%; Received home-delivered meals: 5.0%; Did not receive home-delivered meals: 95.0%; Received congregate meals: 5.0%; Did not receive congregate meals: 95.0%; Received either type of meal: 9.0%; Received neither type of meal: 91.0%. Characteristics of likely need: Social isolation[B]: Missing[C]; Have each characteristic: 26.8%; Received home-delivered meals: 4.5%; Did not receive home-delivered meals: 95.5%; Received congregate meals: 5.8%; Did not receive congregate meals: 94.2%; Received either type of meal: 9.7%; Received neither type of meal: 90.3%. Source: GAO analysis of 2008 CPS data. [A] To identify older adults likely to need meals programs based on potential difficulties preparing or obtaining food, we used four CPS questions that identified functional impairments, such as difficulty doing errands alone, serious difficulty walking or climbing stairs, or difficult dressing or bathing. [B] We defined likely need for more social interaction as answering "no" to all of the questions in the CPS civic engagement supplement that asked about the older adult's participation in social activities. However, such survey data do not capture more qualitative aspects of an individual older adults' likely need for social interaction such as personality and individual preference. The data also do not allow us to identify individuals who may interact socially outside of organized groups and activities. [C] CPS questions related to social isolation were asked at a different time in the survey cycle than questions about receipt of meals services. Therefore, approximately 27 percent of the older adults with low incomes in our sample provided information about participation in meals programs, but not about participation in social groups. As a result, we could not measure whether they were more or less socially isolated. [End of table] It should be noted that there are many reasons why older adults may not receive nutrition assistance through the Elderly Nutrition Program. They may not know about the available services, may not have access to services due to limited supply in their area, may receive informal assistance from family or neighbors, or may choose to remain self-sufficient rather than request government benefits. In addition, some older adults may choose to participate in a separate program instead, such as the Supplemental Nutrition Assistance Program (SNAP), formerly known as Food Stamps, where they can purchase their preferred foods. Requests for Elderly Nutrition Program services have increased and demand will likely continue to grow. Through our survey of area agencies on aging (local agencies) conducted during the summer of 2010, we found that an estimated 79 percent of agencies had seen increased requests for home-delivered meals, and 47 percent had seen increased requests for congregate meals since the start of the economic downturn. Further, requests for OAA services are increasing as more seniors stay in their homes longer rather than move to assisted living facilities or nursing homes, according to agency officials. According to U.S. Census data, more than 9 million more Americans were 60 years and older in 2009 than in 2000, and the Census Bureau projects that population group will continue to grow. Further, demand for Elderly Nutrition Program home-delivered meals is growing compared to congregate meals. In our 2010 survey, an estimated 22 percent of agencies reported they were generally or very unable to serve all clients who request home-delivered meals, compared to an estimated 5 percent of agencies who were generally or very unable to serve all clients who requested congregate meals. To adjust to these changes in requests for services, most state and some local agencies utilized the flexibility provided by the law to transfer OAA funds among Title III programs.[Footnote 11] Agencies most commonly transferred funds from congregate meals to home-delivered meals or other Title III services. Nationally, from fiscal year 2000 through fiscal year 2008, states collectively transferred an average of $67 million out of the congregate meal program each year (see Figure 2). Figure 2: Average Yearly Fund Transfers among Title III Programs, Fiscal Years 2000 through 2008: [Refer to PDF for image: illustration] Congregate meals to Home delivered meals: $34.4 million; Home delivered meals to Congregate meals: $87,000. Congregate meals to Support Services: $32.6 million; Support Services to Congregate meals: $139,000. Home delivered meals to Support Services: $3.5 million; Support Services to Home delivered meals: $983,000. Source: GAO analysis of AoA Fiscal Year 2000-2008 State Program Reports. [End of figure] Actions Needed to Reduce Administrative Overlap among Domestic Food Assistance Programs: In part because food insecurity is a national problem that affects not only older adults but also many other vulnerable groups, the federal government spent more than $90 billion on domestic food assistance programs in 2010. This represents an increase of approximately 44 percent over 2008 spending, driven largely by increased spending on the SNAP. We identified 18 different federal programs that provide nutrition assistance, programs that emerged piecemeal over the past several decades to address a variety of needs. Agency officials and local providers have indicated that the multiple food assistance programs work together and provide various points of entry to the system to help increase access to food for vulnerable or target populations at high risk of malnutrition or hunger. Those officials and providers told us that, since no one program alone is intended to meet a household's full nutritional needs, the variety of food assistance programs can help households fill gaps and address the specific needs of individual members. However, we have previously reported signs of overlap and inefficient use of resources in the delivery of benefits through these programs. In addition to the Departments of Agriculture (USDA), Health and Human Services (HHS), and Homeland Security (DHS) multiple state and local government and nonprofit organizations work together to administer a complex network of programs and providers. We have found that some of these programs, including those serving older adults, provide comparable benefits to similar or overlapping populations. For example, the Elderly Nutrition Program administered by the Administration on Aging (AoA), provides home-delivered and congregate meals primarily to individuals 60 years and older. Separately, other programs administered by USDA, including the Commodity Supplemental Food Program, targets a similar population, providing food to older adults, as well as women, infants and children who are also served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). program. In addition, individuals eligible for groceries through the Commodity Supplemental Food Program or services through the Elderly Nutrition Program may also be eligible for groceries through the Emergency Food Assistance Program and for targeted benefits that are redeemed in authorized stores through the largest program, SNAP. In fact, a recent AoA report conducted by Mathematica[Footnote 12] found that seven percent of congregate meal recipients and 16 percent of home-delivered meal recipients were also receiving SNAP benefits. The availability of multiple programs with similar benefits helps ensure that those in need have access to nutritious food, but can also increase administrative costs, which account for approximately a tenth to more than a quarter of total costs among the largest of these programs. In addition, our previous work has shown that overlap among programs can lead to inefficient use of federal funds, duplication of effort, and confusion among those seeking services. We have found in previous work that despite the potential benefits of varied points of entry, program rules related to determining eligibility often require the collection of similar information by multiple entities.[Footnote 13] For example, an older adult might apply for congregate meals through the Elderly Nutrition Program at their local area agency on aging, electronic benefits through SNAP at the Health and Human Services office, and vouchers for fresh fruit and vegetables through the Senior Farmers' Market Nutrition Program at a local food bank. Most of the 18 programs have specific and often complex administrative procedures that federal, state, and local organizations follow to help manage each program's resources. According to our previous work and state and local officials, rules that govern these and other nutrition assistance programs often require applicants who seek assistance from multiple programs to submit separate applications for each program and provide similar information verifying, for example, household income. This can create unnecessary work for both providers and applicants and may result in the use of more administrative resources than needed. Moreover, not enough is known about the effectiveness of many of these programs. Research suggests that participation in 7 of the 18 programs--including the Elderly Nutrition Program and SNAP--is associated with positive health and nutrition outcomes consistent with programs' goals.[Footnote 14] For example, studies on the Elderly Nutrition Program found that the program increases socialization and may have a positive effect on food security. In addition, research suggests the program improves participants' dietary and nutrient intake--an outcome related to the program's goal of promoting the health and wellbeing of older individuals by assisting such individuals to gain access to nutrition and other disease prevention and health promotion services to delay the onset of adverse health conditions resulting from poor nutritional health or sedentary behavior. However, little is known about the effectiveness of the remaining 11 programs because they have not been well studied. Agencies do regularly collect performance and other data on nutrition assistance programs but these data are not sufficient to determine program effectiveness and do not always provide all the information needed to effectively and efficiently manage their programs. Agency data show that the 11 less-studied programs provide food and nutrition assistance to millions of individuals and households each year--an outcome related to their goals--however, this alone does not demonstrate the overall effectiveness of these programs. Other data-- such as on need and unmet need for services--could help agencies better target limited resources and more efficiently serve their target populations but agencies often do not have this information. For example, while the OAA requires AoA to design and implement uniform data collection procedures for states to assess the receipt, need, and unmet need for Title III services,[Footnote 15] AoA does not provide standardized definitions or measurement procedures for need and unmet need that all states are required to use. Instead, AoA provides states with non-binding guidance on these issues and an assortment of tools and resources that they can use to evaluate need and limited information about measuring unmet need. States use a variety of approaches to measure need and measure unmet need to varying extents, but no agencies that we spoke with fully estimate the number of older adults with need and unmet need in their service area. Such information could help providers make informed decisions about serving those most in need as the number of older adults increases and resource constraints are likely to continue. In April 2010, we recommended that USDA, as the principal administrator of the federal government's food assistance programs, identify and develop methods for addressing potential inefficiencies among food assistance programs and reducing unnecessary overlap among its smaller food assistance programs while ensuring that those who are eligible receive the assistance they need. These methods could include conducting a study as a first step; convening a group of experts; identifying which of the lesser-studied programs need further research and taking steps to fill the research gap; or identifying and piloting proposed changes. Further, in February 2011 we recommended that, to help ensure that agencies have adequate and consistent information about older adults' needs and the extent to which they are met, the Secretary of Health and Human Services partner with other government agencies that provide services to older adults and, as appropriate, convene a panel or work group of researchers, agency officials, and others to develop consistent definitions of need and unmet need and to propose interim and long-term uniform data collection procedures for obtaining information on older adults with unmet needs for services provided from sources like Title III. In addition to our specific recommendations to USDA and HHS, we have also noted in prior work that agencies can reduce program inefficiencies by broadening their efforts to simplify, streamline, or better align eligibility procedures and criteria across programs to the extent that it is permitted by law. Consolidating or eliminating overlapping programs also have the potential to reduce administrative costs but may not reduce spending on benefits unless fewer individuals are served as a result. More broadly, essential to all these efforts is collaboration among many entities. Achieving meaningful results in many policy and program areas, including food and nutrition services, requires some combination of coordinated efforts among various actors across federal agencies with other governments at state and local levels and nongovernmental organizations. Conclusion: In conclusion, as I have outlined in my testimony, opportunities exist to streamline and more efficiently carry out these important domestic food assistance programs. Specifically, addressing duplication, overlap, and fragmentation could help to minimize the administrative burdens faced by those entities--including states and localities as well as nonprofit organizations--that are delivering these programs' services. Such administrative burdens range from eligibility requirements and the application process to costs associated with carrying out the program and reporting requirements. Improving consistency among these various requirements and processes as well as considering how multiple agencies could better coordinate their delivery of programs could result in benefits both for those providing and those receiving the services. In addition, collection of adequate and consistent information about older adults' needs and the extent to which they are met could help providers make informed decisions about serving those most in need. It is particularly important to use resources efficiently given that the need for meals programs among low- income older adults will likely continue to outpace available services given the growing older population and continued economic constraints. Careful, thoughtful actions will be needed to address issues involving potential duplication, overlap, and fragmentation among federal programs and activities. These are difficult issues to address because they may require agencies and Congress to re-examine within and across various mission areas the fundamental structure, operation, funding, and performance of a number of long-standing federal programs or activities. Continued oversight will be critical to ensuring that unnecessary duplication, overlap, and fragmentation are addressed. Thank you, Mr. Chairman, Ranking Member Paul, and Members of the Subcommittee. This concludes my prepared statement. I would be pleased to answer any questions you may have. For further information on this testimony, please contact Kay Brown, Director, Education, Workforce, and Income Security, who may be reached at (202) 512-7215, or BrownKE@gao.gov. [End of section] Appendix I: Selected Federal Food and Nutrition Assistance Programs, by Agency: USDA: Item number: 1. Program name: Child and Adult Care Food Program. Item number: 2. Program name: Commodity Supplemental Food Program. Item number: 3. Program name: Community Food Projects Competitive Grant Program[A]. Item number: 4. Program name: Food Distribution Program on Indian Reservations. Item number: 5. Program name: Fresh Fruit and Vegetable Program. Item number: 6. Program name: National School Lunch Program. Item number: 7. Program name: Nutrition Assistance for Puerto Rico. Item number: 8. Program name: School Breakfast Program. Item number: 9. Program name: Senior Farmers' Market Nutrition Program. Item number: 10. Program name: Special Milk Program. Item number: 11. Program name: Summer Food Service Program. Item number: 12. Program name: Supplemental Nutrition Assistance Program (SNAP). Item number: 13. Program name: The Emergency Food Assistance Program. Item number: 14. Program name: WIC. Item number: 15. Program name: WIC Farmers' Market Nutrition Program. DHS Federal Emergency Management Agency: Item number: 16. Program name: Emergency Food and Shelter National Board Program. HHS Administration on Aging: Item number: 17. Program name: Elderly Nutrition Program: Home-Delivered and Congregate Nutrition Services. Item number: 18. Program name: Grants to American Indian, Alaska Native, and Native Hawaiian Organizations for Nutrition and Supportive Services. Source: GAO, Domestic Food Assistance: Complex System Benefits Millions, but Additional Efforts Could Address Potential Inefficiency and Overlap among Smaller Programs, GAO-10-346 (Washington, D.C.: Apr. 15, 2010). [A] The Community Food Projects Competitive Grants Program is administered by the National Institute of Food and Agriculture (formerly the Cooperative State Research, Education, and Extension Service, CSREES) of USDA. All other USDA programs listed above are administered by the Food and Nutrition Service. Community Food Projects Competitive Grants Program participation information is from CSREES Update: September 17, 2009, Office of the Administrator, CSREES, USDA. [End of table] [End of section] Footnotes: [1] Pub. L. No. 89-73, 79 Stat. 218 (codified as amended at 42 U.S.C. §§ 3001-3058ff). [2] GAO, Domestic Food Assistance: Complex System Benefits Millions, but Additional Efforts Could Address Potential Inefficiency and Overlap among Smaller Programs, [hyperlink, http://www.gao.gov/products/GAO-10-346], (Washington, D.C.: April 15, 2010). [3] GAO, Older Americas Act: More Should Be Done to Measure the Extent of Unmet Need for Services, [hyperlink, http://www.gao.gov/products/GAO-11-237], (Washington, D.C.: February 28, 2011). [4] We conducted a survey of 125 local agencies, with 99 agencies (79 percent) responding, The percentages cited from this survey are subject to margins of error no more than plus or minus 12 percentage points at the 95 percent confidence level. [5] GAO, Opportunities to Reduce Potential Duplication in Government Programs, Save Tax Dollars, and Enhance Revenue, [hyperlink, http://www.gao.gov/products/GAO-11-318SP], (Washington, D.C.: March 1, 2011). [6] Statutory Pay-As-You-Go Act of 2010, Pub. L. No. 111-139, § 21, 124 Stat. 8, 29-30 (codified at 31 U.S.C. § 712 note). [7] Our analysis of meal program recipients and non-recipients was limited to those living in households below 185 percent of the poverty threshold because the CPS did not collect generalizable information for individuals with higher incomes. In addition to people age 60 and over, younger spouses living with people age 60 and over and people with disabilities of all ages in housing facilities occupied primarily by older people where congregate meals are served or who live with someone age 60 and over are also eligible for meals services through Title III. 42 U.S.C § 3030g-21(2)(I). Our estimates of older adults who are likely to need meals services also include these additional individuals. An estimated 31 percent of people age 60 and over were below 185 percent of the poverty threshold. [8] 42 U.S.C. §§ 3030e and 3030f. Nutrition services authorized under Title III Part C of the OAA are designed to provide balanced and nutritious meals at home or in a congregate setting. Home-delivered meals, commonly referred to as "Meals on Wheels," are typically provided to individuals who have health difficulties that limit their ability to obtain or prepare food. Congregate meals are served at a variety of sites, such as schools and adult day care centers, and serve older adults' social interaction needs, in addition to nutrition. [9] The CPS asked seniors whether they received home-delivered or congregate meals, but did not specify the source of the meals. [10] We aligned our definition of likely need with two of the three key purposes of the Elderly Nutrition Program as described in the OAA: (1) reducing hunger and food insecurity and (2) promoting socialization. 42 U.S.C. § 3030d-21. Given available data, we could not estimate the number of older adults likely to need services based on the third purpose of promoting health and well-being. Unless otherwise noted, our estimates of low-income older adults likely to need or receive meals services have a maximum confidence interval of +/-3.2 percentage points of the estimate. [11] OAA Title III authorizes a supportive services and senior centers program that covers, for example, health, transportation, ombudsman, nutrition, and education services, as well as home-delivered and congregate meals programs. 42 U.S.C. § 3030d. The OAA provides states with some authority to transfer federal funding allocations among programs. A state may transfer up to 40 percent of allocated funds for the home-delivered meals programs to the congregate meals program, or vice versa, and the Assistant Secretary of Aging can grant a waiver for a state to transfer an additional 10 percent.42 U.S.C. § 3028(b)(4). In addition, a state may transfer up to 30 percent of allotted funds for Part B support services (such as transportation and home-based care) to the meal programs and vice versa, and the Assistant Secretary may grant a waiver of the 30 percent limit. 42 U.S.C. § § 3028(b)(5) and 3030c-3(b)(4). [12] Allison Barrett and Jody Schimmel, Mathematica Policy Research, "Multiple Service Use Among OAA Title III Program Participants," September 2010 (Research Brief). [13] GAO, Domestic Food Assistance: Complex System Benefits Millions, but Additional Efforts Could Address Potential Inefficiency and Overlap Among Smaller Programs, [hyperlink, http://www.gao.gov/products/GAO-10-346], (Washington, D.C.: April 15, 2010). [14] The other programs that show outcomes consistent with many of their program goals include: WIC, the National School Lunch Program, the School Breakfast Program, Nutrition Assistance for Puerto Rico, and the Special Milk Program. [15] 42 U.S.C. § 3012(a)(26). 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