This is the accessible text file for GAO report number GAO-11-369 entitled 'Refugee Assistance: Little Is Known about the Effectiveness of Different Approaches for Improving Refugees' Employment Outcomes' which was released on March 31, 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: Report to Congressional Committees: March 2011: Refugee Assistance: Little Is Known about the Effectiveness of Different Approaches for Improving Refugees' Employment Outcomes: GAO-11-369: GAO Highlights: Highlights of GAO-11-369, a report to congressional committees. Why GAO Did This Study: In fiscal year 2009, the United States resettled close to 70,000 refugees fleeing persecution in their homelands. To assist in their transition to the United States and help them attain employment, the Department of Health and Human Services Office of Refugee Resettlement (ORR) provides temporary cash, medical, and other assistance through four different assistance programs. The economic downturn and an increase in refugee arrivals posed challenges to ORR’s efforts to assist refugees and estimate program costs, resulting in fluctuating unobligated balances. Congress required GAO to examine (1) differences in ORR’s refugee assistance programs and factors program providers consider when placing refugees in a particular program; (2) refugee employment outcomes and the effectiveness of different approaches to providing assistance; and (3) how ORR estimates program costs and how its estimates have affected the agency’s unobligated balances. GAO met with federal and state officials, voluntary agency staff, and refugees; reviewed selected case files; analyzed ORR performance data for fiscal years 2007 through 2009; and reviewed and analyzed relevant federal laws, regulations, and budget documents. What GAO Found: ORR supports several approaches to providing cash, medical assistance, and social services to refugees through its Matching Grant, Publicly Administered, Wilson/Fish, and Public Private Partnership programs. The Matching Grant program, which is administered and partially funded by private voluntary organizations, features several design elements that set it apart from ORR’s other programs. For example, voluntary organizations select refugees for the Matching Grant program and those who participate have 4 to 6 months to find employment before their cash assistance ends. Most states also offer one of ORR’s other programs: these programs enroll any eligible refugee, and participants have up to 8 months to find a job before their assistance ends. Three of ORR’s programs—-the Wilson/Fish, Public Private Partnership, and Matching Grant-—were designed to give providers flexibility in developing innovative approaches to help refugees find employment and become self-sufficient. GAO observed providers using a number of different approaches, including offering refugees cash incentives for early employment, and these approaches varied within and among programs. Voluntary agencies told GAO that they consider several factors, such as the refugee’s English language and employability skills, in deciding whether to enroll a refugee in the Matching Grant program or another ORR assistance program. ORR’s four assistance programs showed some success in helping refugees obtain employment in fiscal year 2009, but the percentage of program participants who obtained employment declined in recent years and little is known about which approaches are most effective in improving the economic status of refugees. In fiscal year 2007, between 59 percent and 65 percent of refugees receiving cash assistance from ORR programs entered employment within 4 to 8 months. By fiscal year 2009, these rates decreased to between 31 percent and 52 percent, depending on the program. Little is known about the effectiveness of the different approaches providers use to improve employment outcomes for refugees, such as intensive case management and employment incentives, in part because of differences in the way programs are structured and the populations they serve and in part because of differences in the way program performance is measured. ORR’s estimates of program costs have generally tracked actual obligations but challenges in estimating specific variables such as the number of eligible refugees and the cost of serving them have contributed to fluctuations in unobligated balances between fiscal years 1999 and 2009. ORR has a 3-year period in which to obligate its annual appropriations. From fiscal years 1999 to 2005, ORR used unexpired and unobligated prior year funds to obligate more than it was appropriated for those years, in part because of higher-than- expected increases in refugee arrivals and medical costs. As a result, its unobligated balances were reduced in most of these years and were gone by fiscal year 2005. However, from fiscal years 2006 to 2009, ORR obligated less than it was appropriated, which allowed the agency to carry over funds from one year to the next. As a result, its unobligated balances grew from $17 million in fiscal year 2006 to over $83 million in fiscal year 2009. What GAO Recommends: GAO recommends that the Secretary of Health and Human Services identify effective approaches that state and voluntary agencies can use to help refugees become employed and self-sufficient. View [hyperlink, http://www.gao.gov/products/GAO-11-369] or key components. For more information, contact Kay E. Brown at (202) 512- 7215 or brownke@gao.gov. [End of section] Contents: Letter: Background: Design Elements Differentiate ORR's Programs, and Program Placement Depends on Refugees' Readiness to Work and Other Factors: Refugees' Employment Outcomes Have Declined Recently, and Little Is Known about the Effectiveness of Programs' Approaches: Difficulties in Projecting Certain Program Costs Have Contributed to Fluctuations in ORR's Unobligated Balances: Conclusion: Recommendation for Executive Action: Agency Comments and Our Evaluation: Appendix I: Scope and Methodology: Appendix II: Profiles of States Visited: Appendix III: ORR Employment Outcomes: Appendix IV: Refugee Vignettes from Discussion Groups: Appendix V: Comments from the Department of Health and Human Services: Appendix VI: GAO Contact and Staff Acknowledgments: Related GAO Products: Tables: Table 1: Performance Outcome Measures for Refugee Assistance Programs: Table 2: ORR's Budget Activities: Table 3: Characteristics of ORR's Refugee Assistance Programs: Table 4: Employment Outcomes of Refugees Receiving Cash Assistance through the Publicly Administered, Wilson/Fish, and Public Private Partnership Programs in Fiscal Year 2009: Table 5: Matching Grant Employment Outcome Measures in Fiscal Year 2009: Table 6: State Profiles: Table 7: Employment Outcome Definitions of the Publicly Administered, Public Private Partnership, and Wilson/Fish Programs: Table 8: Employment Outcome Definitions of the Matching Grant Program: Table 9: Employment Outcomes for Refugees Receiving Cash Assistance from ORR's Publicly Administered, Public Private Partnership, or Wilson/Fish Program from Fiscal Years 2007 to 2009: Table 10: Matching Grant Performance Rates from Fiscal Years 2007 to 2009: Figures: Figure 1: Geographical Distribution of Refugee Assistance Programs in 2009: Figure 2: Distribution of Refugees Receiving Cash Assistance from ORR Programs in Fiscal Year 2009: Figure 3: Services Available to Refugees Participating in ORR-Funded Programs: Figure 4: General Path of Refugee Resettlement in the United States: Figure 5: Distribution of ORR's Appropriation by Budget Activity in Fiscal Year 2009: Figure 6: Percentage of Refugees Receiving Cash Assistance from ORR's Programs Who Entered Employment in Fiscal Years 2007, 2008, and 2009: Figure 7: ORR Projected Obligations Compared with Actual Obligations, Fiscal Years 1999-2009: Figure 8: Refugee Arrivals Compared to the Presidential Ceiling, Fiscal Years 1999-2009: Figure 9: ORR Appropriations, Obligations, and Unobligated Balances Fiscal Years 1999-2009: Abbreviations: ACF: Administration for Children and Families: DHS: Department of Homeland Security: HHS: Department of Health and Human Services: ORR: Office of Refugee Resettlement: SNAP: Supplemental Nutrition Assistance Program: SSI: Supplemental Security Income: State: Department of State: TANF: Temporary Assistance for Needy Families: volag: Voluntary Agency: [End of section] United States Government Accountability Office: Washington, DC 20548: March 31, 2011: The Honorable Tom Harkin: Chairman: The Honorable Richard Shelby: Ranking Member: Subcommittee on Labor, Health and Human Services, Education and Related Agencies: Committee on Appropriations: United States Senate: The Honorable Dennis Rehberg: Chairman: The Honorable Rosa DeLauro: Ranking Member: Subcommittee on Labor, Health and Human Services, Education and Related Agencies: Committee on Appropriations: House of Representatives: Millions of individuals worldwide have fled their countries for fear of being persecuted for their race, religion, nationality, political opinions, or belonging to a particular social group. The United States has a long-standing tradition of providing refuge to people fleeing persecution in their homelands. Each year the United States resettles at least half of all refugees referred worldwide by the United Nations High Commissioner for Refugees for resettlement; the remaining refugees are resettled by other countries. In fiscal year 2009, the United States admitted more than 70,000 refugees. According to the Department of Health and Human Services (HHS), refugees often lack the basic foundation to rebuild their lives when they first arrive in the United States, and many newly arrived refugees are eligible for temporary cash, medical, and other assistance from one of four programs funded in full or in part by Office of Refugee Resettlement (ORR), located within the Administration for Children and Families (ACF) at HHS. The primary goal of ORR’s refugee assistance programs is to help refugees achieve self-sufficiency-—that is, rely on their earnings, rather than government-provided cash assistance, for their needs.[Footnote 1] In fiscal year 2009, Congress appropriated over $400 million to support ORR’s resettlement programs. According to ORR officials, fiscal year 2009 posed several challenges to ORR and its budget. During 2009, more refugees entered the country than in any year since the events of September 11, 2001, requiring ORR and many state and voluntary agencies to provide assistance to more refugees than expected. Furthermore, as a result of difficult economic conditions and high unemployment rates in many communities, many refugees were not able to find employment as quickly as they had prior to the recession. Additionally, ORR officials stated that because the United States has admitted an increased number of refugees who have spent many years living in difficult conditions, such as refugee camps, a larger proportion of recently arrived refugees have health and other issues that make it difficult for them to work and achieve self-sufficiency. Because of these changes in refugee populations, ORR faced difficulties in estimating the costs of serving newly arrived refugees, which, in turn, has affected the agency's unobligated balances. The House Report accompanying the Departments of Labor, Health and Human Services, Education, and Related Agencies Appropriations Act for fiscal year 2010 mandated that we conduct an evaluation of the Office of Refugee Resettlement's administration of the refugee assistance programs.[Footnote 2] We examined: (1) differences in ORR's refugee assistance programs and factors program providers consider when placing refugees in a particular program; (2) refugee employment outcomes and the effectiveness of different approaches to providing assistance; and (3) how ORR estimates program costs and how its estimates have affected the agency's unobligated balances.[Footnote 3] To gather this information, we conducted site visits in five states (California, Florida, Massachusetts, Minnesota, and Texas); interviewed state, county, and refugee resettlement agencies; led four discussion groups with refugees selected by voluntary agency staff; [Footnote 4] and collected and reviewed eight refugee case files that were provided by local government officials and voluntary agency staff. We selected states with both large and small refugee caseloads, with both high and low unemployment rates relative to the national average, and representing different geographic regions. The information we collected from these states provided insights into providers' efforts to provide ORR-funded services, but this information cannot be generalized. In addition, we interviewed federal program officials and national voluntary agency staff; reviewed relevant federal laws, regulations, and agency reports; and examined ORR budget documentation. We also aggregated and analyzed ORR's performance data, which provide information on refugee employment outcomes for each of ORR's programs. While they have some limitations, [Footnote 5] we consider ORR's performance data reliable and appropriate for this engagement. We focused our study on ORR's refugee assistance offered through the Publicly Administered, Public Private Partnership, Wilson/Fish, and Matching Grant programs. We chose these four programs because they are the ones through which ORR provides most of its cash and medical assistance to refugees. For more information on our scope and methodology, see appendix I. For information on the states we visited, see appendix II. We conducted this performance audit from December 2009 to March 2011 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. Background: A refugee is generally defined as a person who is outside his or her country and who is unable or unwilling to return because of persecution or a well-founded fear of persecution on account of race, religion, nationality, membership in a particular social group, or political opinion.[Footnote 6] Each year the President, after appropriate consultation with Congress and certain Cabinet members, determines the maximum number of refugees the United States will admit for resettlement in a given year.[Footnote 7] The presidential ceiling has decreased from about 90,000 in fiscal year 1999 to 80,000 in fiscal year 2009. However, the number of refugees actually entering the United States has increased in recent years compared to the relatively low numbers entering after the terrorist attacks of September 11, 2001. In the aftermath of those attacks, a review of refugee-related security procedures was undertaken, refugee admissions were briefly suspended, and enhanced security measures were implemented. As a result of these and other factors, refugee admissions declined from 68,393 in fiscal year 2001 to 26,383 in fiscal year 2002 and 28,348 in fiscal year 2003. Admissions have rebounded since, gradually increasing to 74,652 in fiscal year 2009. Refugee Resettlement and Assistance Programs: The Refugee Act of 1980[Footnote 8] provided a systematic and permanent procedure for admitting refugees to the United States and established comprehensive and uniform provisions to resettle refugees as quickly as possible and to encourage them to become self- sufficient.[Footnote 9],[Footnote 10] The Departments of State and Homeland Security handle the first part of the resettlement process by approving and processing refugees overseas. The Department of State then partners with 10 national voluntary agencies to determine where in the United States refugees will live. The national voluntary agencies consider a variety of factors when determining where refugees will live, including placing refugees where they may already have relatives and where the national agencies have offices to meet the needs of the refugees. Voluntary agencies use their network of some 350 affiliates to provide refugees with initial placement services, including meeting refugees at the airport when they first arrive in the United States and providing housing, food, clothing, and other necessities for the first 30 to 90 days. [Footnote 11],[Footnote 12] Also, during this time, staff from local voluntary agencies help refugees apply for federal assistance. After their initial month in the United States, many refugees are eligible for temporary resettlement assistance from ORR. All states, except Wyoming, administer an ORR-funded assistance program that provides up to 8 months of cash and medical assistance,[Footnote 13] as well as other social services, and states have the flexibility to choose among three program delivery models[Footnote 14]--the Publicly Administered, Wilson/Fish, or Public Private Partnership programs. [Footnote 15] These three delivery models were established over a 20- year period and give states options in how they provide refugee assistance: * Publicly Administered: Refugee resettlement assistance is provided primarily through the Publicly Administered program. States are not required to administer this program, but those that do generally model the program after their Temporary Assistance for Needy Families (TANF) programs. * Wilson/Fish: In 1984, Congress authorized ORR to implement the Wilson/Fish program,[Footnote 15] which gave states flexibility in how they provide assistance to refugees, including whether to administer assistance primarily through local voluntary agencies. One of the goals in developing this program was to expand the number of states that offered a refugee program so that an ORR-funded program could exist in every state that resettles refugees. * Public Private Partnership: In 2000, ORR established the Public Private Partnership program, which promotes states' partnerships with voluntary agencies to provide assistance, and gives states the flexibility to set refugees' cash grants at levels higher than those authorized for the Publicly Administered program. (See figure 1 for the geographical distribution of refugee assistance programs.) Figure 1: Geographical Distribution of Refugee Assistance Programs in 2009: [Refer to PDF for image: illustrated U.S. map] Not reported: Wyoming[A]: Publicly Administered: Arizona: Arkansas: California (except San Diego County): Connecticut: Delaware: District of Columbia: Florida: Georgia: Hawaii: Illinois: Indiana: Iowa: Kansas: Maine: Michigan: Mississippi: Missouri: Montana: Nebraska: New Hampshire: New Jersey: New Mexico: New York: North Carolina: Ohio: Pennsylvania: Rhode Island: South Carolina: Tennessee: Utah: Virginia: Washington: West Virginia: Wisconsin. Public Private Partnership: Maryland: Minnesota: Oklahoma: Oregon: Texas. Wilson/Fish: Alabama: Alaska: Colorado: Idaho: Kentucky: Louisiana: Massachusetts: Nevada: North Dakota: San Diego County, California: South Dakota: Vermont. Source: ORR. [A] At the time of this report, Wyoming did not provide a Publicly Administered, Wilson/Fish, or Public Private Partnership program. [End of figure] In addition, some refugees participate in the Matching Grant program, which is only partially funded by ORR. According to ORR, this program is administered by a network of national voluntary agencies, and is offered in 42 states and the District of Columbia.[Footnote 17] The Matching Grant program provides refugees with cash and other assistance for 4 to 6 months[Footnote 18] with the goal of helping them become self-sufficient without receiving cash benefits from a public assistance program.[Footnote 19] Of the refugees who received cash assistance from ORR in fiscal year 2009, just over 30 percent of them participated in the privately administered Matching Grant program, while most of the remaining percent participated in ORR's other assistance programs. (See figure 2.) Figure 2: Distribution of Refugees Receiving Cash Assistance from ORR Programs in Fiscal Year 2009: [Refer to PDF for image: pie-chart] Publicly Administered: 41%; Public Private Partnership: 10%; Wilson/Fish: 18%; Matching Grant: 31%. Source: GAO analysis of ORR's Annual Outcome Goal Plans and Matching Grant annual report data. Note: We combined the Annual Outcome Goal Plans and Matching Grant annual report data sources to calculate the percentages above. The numerators for the Publicly Administered, Public Private Partnership, and Wilson/Fish programs represent the number of refugees who received cash assistance and employment services in each of the three programs in fiscal year 2009. The numerator for the Matching Grant program is the number of employable adults who participated in the Matching Grant program in fiscal year 2009. The denominator represents the combined total of refugees who received cash assistance and employment services in the Publicly Administered, Public Private Partnership, and Wilson/ Fish programs as well as the employable adults participating in the Matching Grant program in fiscal year 2009. [End of figure] All four programs fund cash and medical assistance[Footnote 20] as well as a broad range of social services, including employment services, English language instruction, case management, citizenship and naturalization preparation services, and social adjustment services.[Footnote 21] Eligible refugees may also receive other federal benefits, such as food assistance offered through the United States Department of Agriculture's Supplemental Nutrition Assistance Program (SNAP, formerly the Food Stamp Program). Figure 3 shows the assistance offered to refugees who participate in one of ORR's resettlement programs. Figure 3: Services Available to Refugees Participating in ORR-Funded Programs: [Refer to PDF for image: illustrated table] Service: Cash assistance; Matching Grant: 4 to 6 months; Publicly Administered, Wilson/Fish, and Public Private Partnership: up to 8 months. Service: Medical assistance; Matching Grant: up to 8 months; Publicly Administered, Wilson/Fish, and Public Private Partnership: up to 8 months. Service: Employment services; Matching Grant: up to 180 days; Publicly Administered, Wilson/Fish, and Public Private Partnership: up to 5 years. Service: Citizenship preparation education/training other services; Matching Grant: up to 5 years; Publicly Administered, Wilson/Fish, and Public Private Partnership: up to 5 years. Service: Food assistance (through SNAP); Matching Grant: as long as eligible; Publicly Administered, Wilson/Fish, and Public Private Partnership: as long as eligible. Source: GAO. Note: Cash assistance amounts among ORR programs vary and are described in the following section of this report. [End of figure] Not all refugees receive assistance through ORR-funded programs. Refugees who are eligible for or receiving cash assistance from programs outside of ORR, such as TANF or Supplemental Security Income (SSI), are generally not eligible to receive cash assistance from ORR's Publicly Administered, Wilson/Fish, or Public Private Partnership programs.[Footnote 22] Refugees who are eligible for TANF but who are not receiving TANF benefits may, however, receive cash assistance and other services offered by the Matching Grant program. See figure 4 for the general path of refugee resettlement in the United States. Figure 4: General Path of Refugee Resettlement in the United States: [Refer to PDF for image: illustration] Refugee overseas: Overseas processing: Refugees are approved and processed by the Department of State (State) and the Department of Homeland Security (DHS). Refugee in United States: Voluntary Agency (volag) assignment: Refugees are matched to one of 10 national-level volags that have multiple local affiliates. Initial Reception and Placement: Representatives from volags greet refugees upon arrival. Volags provide housing and other basic needs for 30-90 days with funding from State. Program placement: Volags help refugees apply for the assistance they are likely eligible to receive: * ORR Assistance programs[A]: - Eight months of cash and medical assistance; - Administered by volags or by a government agency; - Totally funded by ORR; - Includes Publicly Administered, Public Private Partnership, and Wilson/Fish; * Privately administered Matching Grant program[A]: - Four to six months of cash assistance; - Administered by volags; - Funded in part by ORR; - Limited slots available; * Other public assistance: - Type and duration of assistance varies; - Administered by various government agencies; - Includes programs such as Temporary Assistance for Needy Families (TANF) and Supplemental Security Income (SSI). Source: GAO. [A] Fully or partially funded and administered by Department of Health and Human Services Office of Refugee Resettlement. [End of figure] Performance Management: In addition to helping newly arrived refugees adjust to their surroundings and settle in the United States, the overall goal of ORR's assistance programs is to help refugees attain self-sufficiency. Self-sufficiency is defined in ORR's regulations as the refugee earning a total family income at a level that enables a family unit to support itself without receiving a cash assistance grant.[Footnote 23] ORR collects data on several employment-related outcomes to assess program performance. As part of the Government Performance and Results Act's requirement for agencies to produce performance measures used to assess their progress toward meeting performance goals, the Publicly Administered, Public Private Partnership, and Wilson/Fish programs have six shared outcome measures. The Matching Grant program has its own measures--three of which are directly related to the program's goal of helping refugees become economically self-sufficient.[Footnote 24] Table 1 lists the performance measures for the different types of refugee assistance programs. (For a description of these measures, see appendix III.) Table 1: Performance Outcome Measures for Refugee Assistance Programs: Publicly Administered, Public Private Partnership, and Wilson/Fish Programs: 1. Entered Employment; Matching Grant Program: 1. Entered Employment. Publicly Administered, Public Private Partnership, and Wilson/Fish Programs: 2. Average Wage at Employment; Matching Grant Program: 2. Average Wage at Employment. Publicly Administered, Public Private Partnership, and Wilson/Fish Programs: 3. Employment with Health Benefits; Matching Grant Program: 3. Employment with Health Benefits. Publicly Administered, Public Private Partnership, and Wilson/Fish Programs: 4. Job Retention for 90 days; Matching Grant Program: 4. Self-Sufficient at 120th day. Publicly Administered, Public Private Partnership, and Wilson/Fish Programs: 5. Cash Assistance Reductions due to Earnings; Matching Grant Program: 5. Economic Self-Sufficiency Retention at the 180th day. Publicly Administered, Public Private Partnership, and Wilson/Fish Programs: 6. Cash Assistance Termination due to Earnings; Matching Grant Program: 6. Economic Self-Sufficiency Overall. Source: ORR Program Guidelines. [End of table] Program Funding: Congress appropriates a fixed amount of funding each year to fund refugee assistance programs. ORR distributes this funding among seven budget activities--each with a specific purpose. (See table 2.) Table 2: ORR's Budget Activities: Activities: Transitional and Medical Services; Purpose: Provides cash and medical assistance to refugees, asylees, entrants, and trafficking victims who participate in the Publicly Administered, Public Private Partnership, Wilson/Fish, and Matching Grant programs, and supports other activities, such as services provided by the Matching Grant program and the Unaccompanied Refugee Minor program; FY 2009 actual funding level[A]: ($282.3 million. Activities: Social Services; Purpose: Supports employment and other services such as social adjustment, translation, child care, and citizenship services as well as case management; FY 2009 actual funding level[A]: $154.0 million. Activities: Unaccompanied Alien Children; Purpose: Provides for the care and placement of unaccompanied alien minors who are apprehended in the United States and taken into care pending resolution of their claims for relief under U.S. immigration law or released to a family member or guardian; FY 2009 actual funding level[A]: $205.1 million. Activities: Targeted Assistance; Purpose: Primarily provides services designed to secure employment for refugees within 1 year or less in areas that are impacted by high arrival numbers and high concentrations of refugees; FY 2009 actual funding level[A]: $48.6 million. Activities: Victims of Torture; Purpose: Provides services and rehabilitation for victims of torture; FY 2009 actual funding level[A]: $10.8 million. Activities: Victims of Trafficking; Purpose: Certifies adults as trafficking victims and provides benefits, such as case management, housing assistance, and counseling; FY 2009 actual funding level[A]: $9.8 million. Activities: Preventive Health; Purpose: Promotes refugee access to health screening, assessment, treatment, and follow-up services; FY 2009 actual funding level[A]: $4.7 million. Source: ORR and ACF Budget Justification fiscal year 2011. [A] These fiscal year 2009 funding levels include unobligated balances from the previous year. [End of table] ORR's largest budget activity, Transitional and Medical Services, primarily supports refugees' cash and medical assistance offered through the Publicly Administered, Wilson/Fish, and Public Private Partnership programs as well as the federal contribution to the Matching Grant program. ORR is authorized to fully reimburse program providers[Footnote 25] for the cash and medical assistance[Footnote 26] they provide to refugees enrolled in the Publicly Administered, Wilson/Fish, and Public Private Partnership programs,[Footnote 27] even if the costs of serving all eligible refugees exceed ORR's annual appropriation in a given fiscal year.[Footnote 28] The social services that state and voluntary agencies provide to refugees enrolled in these programs, such as employment services and case management, are primarily funded through ORR's Social Services budget activity. [Footnote 29] ORR receives a fixed amount of Social Services funds each fiscal year and allocates these funds to states based on estimates of arriving refugees. These Social Services funds do not increase within a given year if the number of refugees served is greater than anticipated. Together Transitional and Medical Services and Social Services funding accounted for more than half of ORR's total appropriations in fiscal year 2009 (about $436 million, including unobligated funds). Figure 5 shows the distribution of appropriations across ORR's budget activities in fiscal year 2009. Figure 5: Distribution of ORR's Appropriation by Budget Activity in Fiscal Year 2009: [Refer to PDF for image: pie-chart] Transitional and Medical Services: 39%; Unaccompanied Alien Children: 29%; Social Services: 22%; Targeted Assistance: 7%; Victims of Torture: 2%; Victims of Trafficking: 1%; Preventive Health: 1%. Source: ACF Fiscal Year 2011 Budget Justification. [End of figure] Design Elements Differentiate ORR's Programs, and Program Placement Depends on Refugees' Readiness to Work and Other Factors: Several Design Elements Differentiate ORR's Four Assistance Programs: The Matching Grant program features several design elements that distinguish it from assistance offered through the Publicly Administered, Wilson/Fish, and Public Private Partnership programs. According to state officials and voluntary agency staff, Matching Grant providers select the refugees they want to participate in the program, and these refugees can opt to participate in the Matching Grant program or may choose to apply for and receive benefits from other programs if eligible. In contrast, providers of the Publicly Administered, Wilson/Fish, or Public Private Partnership programs enroll any eligible refugee. In interviews with providers, we learned that refugees who find employment while participating in the Matching Grant program may keep their earnings in addition to their cash grant. However, refugees enrolled in ORR's other programs have their cash assistance reduced or terminated as a result of their employment earnings. In addition, according to ORR and providers, funding for the Matching Grant program is tied to refugees' success in finding employment while enrolled in the program--that is, providers of the Matching Grant program who do not demonstrate that refugees have achieved specific employment-related outcomes may have their funding reduced the following program year. In contrast, funding for the Publicly Administered, Wilson/Fish, or Public Private Partnership programs is not affected by refugees' employment outcomes,[Footnote 30] according to ORR officials. (For more information on the Matching Grant program, see table 3.) The extent to which each of the four ORR programs allow state and voluntary agencies the flexibility to develop or use various service delivery approaches differs. In the two states we visited that offered the Publicly Administered program, refugee assistance was modeled after the states' TANF programs. In these states, refugees generally received their cash and medical benefits, employment assistance, and other social services from multiple public and private agencies, such as county social service offices and local community-based organizations, and typically met with several caseworkers to receive these services. In comparison, the Wilson/Fish, Public Private Partnership, and Matching Grant programs allow state and voluntary agencies flexibility in developing approaches that are different than those used in states' TANF programs and at the same time focus on helping the refugee become economically self-sufficient. These approaches varied within and among programs and examples we observed included providers integrating their refugee services, providing intensive case management, and offering employment incentives: Service integration: Some providers we visited used a single government or voluntary agency to provide cash assistance, employment counseling and case management to refugees, often in one location, while other providers referred refugees to multiple agencies for different services. For example, a Public Private Partnership program in Texas used a single agency to provide refugees with most services while a Public Private Partnership in Minnesota utilized multiple service providers. Refugees enrolled in Minnesota's Public Private Partnership program accessed their cash assistance and case management from a local voluntary agency but then often received other types of services, like employment counseling and English language instruction, from a combination of other private, nonprofit, and public agencies. Most of the Matching Grant and Wilson/Fish programs we visited used a single agency to provide most refugee services. Intensive case management: In some of the states we visited, ORR programs provided refugees with intensive case management using a single case manager to oversee most aspects of a refugee's case whereas in other states, officials told us that providers spread responsibility for managing a refugee's case between multiple case workers, often in different agencies. Guidelines state that refugees enrolled in the Matching Grant program be assigned a caseworker who provides intensive case management. Intensive case management can encompass a wide range of activities, including referring refugees to needed services, such as transportation, child care, English classes, employment-readiness training, and food and housing assistance; helping the refugee adapt to the new culture; and facilitating interactions between clients and employers or other service providers. In Florida, one voluntary agency case manager who provided intensive case management to his clients drove refugees enrolled in the Matching Grant program to and from work on their first day of employment and checked in with the employers to help resolve any employment-related issues that may have arisen. However, the extent to which refugees receive intensive case management can vary by program. The Public Private Partnership program does not receive dedicated funding from ORR to specifically support case management activities,[Footnote 31] and two providers of the Public Private Partnership program told us they could not always provide intensive case management services to refugees. Incentives for early employment: In addition to the Matching Grant program, the Wilson/Fish and Public Private Partnership programs allow states or voluntary agencies to offer financial incentives to encourage refugees to find employment quickly. While some providers may choose not to offer incentives, all the Wilson/Fish and Public Private Partnership providers we visited offered employment incentives to refugees. Providers of the Wilson/Fish program in Massachusetts and San Diego County, for example, offered refugees a cash bonus if they found full-time employment within the first 4 months of arrival. [Footnote 32] The four programs differ in others ways as well. Table 3 outlines some of the different characteristics of these programs. Table 3: Characteristics of ORR's Refugee Assistance Programs: Funding: Publicly Administered: ORR reimburses states for 100% of costs; Wilson/Fish: ORR reimburses states or voluntary agencies for 100% of costs; Public Private Partnership: ORR reimburses states for 100% of costs; Matching Grant: ORR provides national voluntary agencies $2 for every $1 they privately raise, up to $2,200 per person. Funding affected by refugees' employment outcomes: Publicly Administered: No; Wilson/Fish: No; Public Private Partnership: No; Matching Grant: Yes. Dedicated funding for case management services: Publicly Administered: No; Wilson/Fish: Yes; Public Private Partnership: No; Matching Grant: Yes. Duration of cash assistance: Publicly Administered: Up to 8 months; Wilson/Fish: Up to 8 months; Public Private Partnership: Up to 8 months; Matching Grant: 4-6 months. Cash assistance amount: Publicly Administered: Amount based on state's TANF formula; Wilson/Fish: Depending on the state, amounts may range from an amount based on the state's TANF formula to an amount set by ORR[A]; Public Private Partnership: Depending on the state, amounts may range from an amount based on the state's TANF formula to an amount set by ORR[A]; Matching Grant: A minimum of $200 a month per adult and $40 a month per minor in cash plus assistance with housing and transportation costs per adult refugee. Participation limits: Publicly Administered: All eligible refugees can enroll; Wilson/Fish: All eligible refugees can enroll; Public Private Partnership: All eligible refugees can enroll; Matching Grant: The number of refugees that can enroll is limited by available funding. Refugees selected by voluntary agencies may participate. Flexibility to states and voluntary agencies: Publicly Administered: In accordance with TANF regulations and policies; Wilson/Fish: States and voluntary agencies can partner with each other to provide cash assistance and services and develop early employment incentives; Public Private Partnership: States must partner with voluntary agencies to provide cash assistance and states have flexibility in how they provide other services and may offer early employment incentives; Matching Grant: Voluntary agencies have flexibility to design programs based on ORR guidelines. Agencies can offer early employment incentives. Source: ORR information compiled by GAO. [A] 45 C.F.R. § 400.60 provides a payment ceiling. [End of table] Providers Consider Several Factors when Placing Refugees in a Program, including the Refugee's Readiness to Work: According to staff at voluntary agencies in four of the five states we visited, enrollment in the Matching Grant program is based primarily, though not necessarily exclusively, on the refugee's readiness to work--including his or her level of motivation, English skills, education or previous work experience, and physical and mental health. Agency officials from one state we visited explained that because the program duration is shorter than the other three assistance programs, the Matching Grant program is best suited to those who are likely to obtain employment quickly. In addition, as funding for Matching Grant programs is based on the performance of voluntary agencies in helping refugees achieve employment-related outcomes, voluntary agency staff have an incentive to select refugees to participate in the program who they think are most likely to be successful in finding a job. Some voluntary agency officials we spoke with said that refugees with high motivation to work and high levels of English proficiency are more likely than those who do not have these qualities to find employment. In some instances, the amount of cash assistance provided by refugee assistance programs is another factor that can influence the placement of refugees in particular programs. Because cash assistance levels under the Publicly Administered, Public Private Partnership, and Wilson/Fish programs are based on the benefits provided under a state's TANF program,[Footnote 33] the amount of cash assistance provided to families can vary by state and can be either higher or lower than the amounts available under the Matching Grant program. Some voluntary agency officials in the states we visited told us they encourage refugees to participate in the assistance program that offers the greatest monetary benefit to the refugee. In two states we visited, Massachusetts and Texas, voluntary agencies told us they preferred to enroll refugee families with children in the Matching Grant program because, based on the number of eligible members, the family could receive a higher cash benefit in the first few months after their arrival compared to what the family would receive from other assistance programs.[Footnote 34] In those states, refugees without children would receive more cash assistance overall from the Public Private Partnership or Wilson/Fish programs than from the Matching Grant program.[Footnote 35] In addition, some voluntary agencies told us they select families who may face relatively more obstacles than other refugees to participate in programs that provide integrated services and intensive case management because these families can benefit from these approaches. According to a director at one voluntary agency, intensive case management and integrated services tend to benefit refugees who might otherwise fall through the cracks in a traditional assistance program [Footnote 36] that provides assistance through multiple agencies and different case managers. Voluntary agency staff in Minnesota told us that when possible, they enrolled single-parent families who are ready to work into the Matching Grant Program instead of the TANF program because they believe the family will benefit from intensive case management and integrated services.[Footnote 37] One voluntary agency manager explained that refugees enrolled in the TANF program in Minnesota often have several case workers and need to access multiple government and nonprofit agencies to receive the type of services that are mostly offered through one voluntary agency through the Matching Grant program. State policies can also determine whether refugee families with children are placed in ORR refugee assistance programs or the state's TANF program, which is generally available to eligible families with children. While refugees who are eligible for or receiving cash assistance from programs that are available to the general population-- such as SSI and TANF--are generally prohibited from receiving cash assistance from Publicly Administered, Public Private Partnership, or Wilson/Fish programs, some states determine TANF eligibility in a way that allows families with children--who in other states would likely be eligible for TANF--to participate in an ORR-funded refugee assistance program. For example, officials in Texas who administer the state's Public Private Partnership program explained to us that refugees with children who apply for TANF soon after they arrive in Texas are often ineligible due to the income they receive during the initial resettlement process. [Footnote 38] According to Texas officials, families who are ineligible for TANF may participate in the state's Public Private Partnership,[Footnote 39] which offers higher cash benefits than the state's TANF program.[Footnote 40] In contrast, officials in Minnesota who also administer the Public Private Partnership program told us that refugees' initial resettlement payments do not make families ineligible for TANF in their state. As a result, many families with children in Minnesota participate in TANF, not the state's Public Private Partnership program. In addition, some states administering the Wilson/Fish program have the flexibility to allow families who would otherwise be eligible for TANF to participate in the Wilson/Fish program. [Footnote 41] According to ORR, four out of 13 Wilson/Fish programs provided cash assistance to TANF-eligible refugees in fiscal year 2010. [Footnote 42],[Footnote 43] Refugees' Employment Outcomes Have Declined Recently, and Little Is Known about the Effectiveness of Programs' Approaches: Refugees' Employment Declined in Recent Years: Overall, fewer refugees found jobs within their first months in the United States in fiscal year 2009 than they did in fiscal year 2007. Before the economic recession, in fiscal year 2007, ORR's performance data show that between 59 percent and 65 percent of all refugees receiving cash assistance from ORR's four assistance programs entered employment within 4 to 8 months of coming to the United States. By fiscal year 2009, however, these employment rates decreased, ranging from 31 percent to 52 percent, depending on the program. (See figure 6.) Figure 6: Percentage of Refugees Receiving Cash Assistance from ORR's Programs Who Entered Employment in Fiscal Years 2007, 2008, and 2009: [Refer to PDF for image: vertical bar graph] Percentage who entered employment: Publicly Administered: Fiscal year 2007: 65%; Fiscal year 2008: 50%; Fiscal year 2009: 34%. Public Private Partnership: Fiscal year 2007: 64%; Fiscal year 2008: 75%; Fiscal year 2009: 52%. Wilson/Fish: Fiscal year 2007: 59%; Fiscal year 2008: 44%; Fiscal year 2009: 31%. Matching Grant: Fiscal year 2007: 64%; Fiscal year 2008: 57%; Fiscal year 2009: 47%. Source: ORR's Annual Outcome Goal Plans and Matching Grant annual report data compiled and analyzed by GAO. Notes: The differences in entered employment rates among programs do not necessarily reflect program effectiveness due to differences in populations served and other factors. These entered employment rates include only those refugees who received cash assistance from the Publicly Administered, Wilson/Fish, Public Private Partnership, or Matching Grant program. These rates do not include refugees who did not receive ORR-funded cash assistance but may have received other types of ORR-funded services, such as employment assistance. Refugees who do not receive ORR-funded cash assistance but receive other types of ORR assistance may include (1) those who are participating in the TANF program and receiving ORR- funded employment services or (2) refugees who have exhausted their ORR-provided cash assistance but continue to receive ORR-funded employment services. ORR told us it typically includes all refugees who received some type of ORR-funded services when it reports employment outcomes for the Publicly Administered, Wilson/Fish, and Public Private Partnership programs. The Entered Employment rate for the Public Private Partnership in fiscal year 2008 is substantially higher than the rates for the other programs. We asked ORR if the performance data had any abnormalities that would cause rates to be particularly high or low for a given year. Officials said they believed the performance data to be accurate and were not aware of any abnormalities. [End of figure] Several state officials and voluntary agency staff told us that refugees have struggled to find and keep full-time jobs during the economic downturn. Some explained that refugees today compared to 3 years ago have fewer employment options because jobs that used to be relatively easy for refugees to find, such as those in hospitality and construction sectors, are now being filled by non-refugees who have more training or experience. We also heard that of the refugees who do find work, an increasing number have only part-time or temporary jobs. For example, in reviewing the case file of a single Somali man who resettled in Minneapolis, we learned that he had found a part-time job, only to have his schedule reduced to 1 day per week. As a result, he continues to look for other work. Our analysis of ORR's performance data shows that fewer refugees have been able to keep their jobs for at least 90 days in fiscal year 2009 than in fiscal year 2007. [Footnote 44] Specifically, in fiscal year 2007, the percentage of refugees in the Publicly Administered, Wilson/Fish, and Public Private Partnership programs who found work and kept their jobs for at least 90 days ranged from 77 percent to 84 percent, depending on the program. By fiscal year 2009, these rates decreased somewhat to between 67 percent and 80 percent. For more information, see appendix III. ORR's Programs Helped Some Refugees Achieve Positive Outcomes, but No Single Program Consistently Outperformed the Others: Performance data indicate that some refugees obtained employment while enrolled in an ORR assistance program, but no single refugee assistance program consistently outperformed the others across the various performance measures in fiscal year 2009. In comparing the three ORR programs that provide assistance for 8 months, we found, for example, that the Public Private Partnership program performed relatively well at helping refugees find jobs while the Wilson/Fish program had the most positive outcomes related to job retention. Table 4 below shows the actual measures for ORR's 8-month programs in fiscal year 2009. For more information on ORR's performance measures, see appendix III. Table 4: Employment Outcomes of Refugees Receiving Cash Assistance through the Publicly Administered, Wilson/Fish, and Public Private Partnership Programs in Fiscal Year 2009: Employment outcome: Entered Employment within 8 Months after Refugee's Arrival; Fiscal year 2009[A]: Publicly Administered: 34%; Fiscal year 2009[A]: Wilson/Fish: 31%; Fiscal year 2009[A]: Public Private Partnership: 52%. Employment outcome: Employment with Health Benefits[B] Obtained within 8 Months of Arrival; Fiscal year 2009[A]: Publicly Administered: 67%; Fiscal year 2009[A]: Wilson/Fish: 64%; Fiscal year 2009[A]: Public Private Partnership: 71%. Employment outcome: Cash Assistance Termination because of Employment; Fiscal year 2009[A]: Publicly Administered: 65%; Fiscal year 2009[A]: Wilson/Fish: 64%; Fiscal year 2009[A]: Public Private Partnership: 24%[C]. Employment outcome: Job Retention at 90th day of Employment; Fiscal year 2009[A]: Publicly Administered: 73%; Fiscal year 2009[A]: Wilson/Fish: 80%; Fiscal year 2009[A]: Public Private Partnership: 67%. Employment outcome: Cash Assistance Reductions due to Employment; Fiscal year 2009[A]: Publicly Administered: 4%; Fiscal year 2009[A]: Wilson/Fish: 16%; Fiscal year 2009[A]: Public Private Partnership: 1%. Employment outcome: Average Wage per Hour; Fiscal year 2009[A]: Publicly Administered: $8.87; Fiscal year 2009[A]: Wilson/Fish: $9.33; Fiscal year 2009[A]: Public Private Partnership: $8.90. Source: ORR's Annual Outcome Goal Plans data compiled by GAO. [A] These employment outcome rates include only those refugees who received cash assistance from the Publicly Administered, Wilson/Fish, or Public Private Partnership program. These rates do not include refugees who did not receive ORR-funded cash assistance but may have received other types of ORR-funded services, such as employment assistance. Refugees who do not receive ORR-funded cash assistance but receive other types of ORR assistance may include (1) those who are participating in the TANF program and receiving ORR-funded employment services or (2) refugees who have exhausted their ORR-provided cash assistance but continue to receive ORR-funded employment services. ORR told us it typically includes all refugees who received some type of ORR-funded services when it reports employment outcomes for the Publicly Administered, Wilson/Fish, and Public Private Partnership programs. [B] Employment with Health Benefits, Cash Assistance Termination because of Employment, and Cash Assistance Reductions due to Employment include the outcomes of those refugees who are captured under the Entered Employment measure. [C] According to ORR, the measure for Cash Assistance Termination because of Employment for the Public Private Partnership program is approximately 40 percentage points lower than the same measure for Publicly Administered and Wilson/Fish programs primarily because of the unique program design in Texas, one of the Public Private Partnership states. ORR officials explained that the Public Private Partnership programs in Texas collect data for this measure at the 120th day, and these data represent the percent of refugees whose cash assistance was terminated because of incomes over 165 percent of the federal poverty income limit. In contrast, other Public Private Partnership states collect data for the same measure at 8 months, and in these states, the data represent the percentage of refugees whose cash assistance was terminated based on states' TANF provisions. [End of table] The Matching Grant 4-to-6-month assistance program, with its own set of employment measures, performed well on some but not all of its measures in fiscal year 2009. (See table 5.) Table 5: Matching Grant Employment Outcome Measures in Fiscal Year 2009: Matching Grant employment outcome: Entered Employment by 120th Day of Refugee's Arrival; Fiscal year 2009: 47%. Matching Grant employment outcome: Employment with Health Benefits[A] within 120th Day of Arrival; Fiscal year 2009: 51%. Matching Grant employment outcome: Economic Self-Sufficiency at 120 Days[B]; Fiscal year 2009: 52%. Matching Grant employment outcome: Economic Self-Sufficiency Retention at 180 Days[C]; Fiscal year 2009: 93%. Matching Grant employment outcome: Economic Self-Sufficiency Overall[D]; Fiscal year 2009: 67%. Matching Grant employment outcome: Average Wage per Hour at Employment (full-time) Obtained by 120th Day of Refugee's Arrival; Fiscal year 2009: $8.67. Source: ORR's Matching Grant annual report data compiled by GAO. [A] Employment with Health Benefits includes refugees who are captured under the Entered Employment measure. [B] Economic Self-Sufficiency at 120 days refers to those individuals who reached the 120th day after the date of eligibility who were self- sufficient--that is, earned a total family income at a level that enables a family unit to support itself without receipt of cash assistance per 45 C.F.R. 400.2. [C] Economic Self-Sufficiency Retention refers to the individuals who were reported to be self-sufficient at a 120th day and continued to be self-sufficient 60 days later. [D] Economic Self Sufficiency Overall is the percent of individuals who participated in the program for 180 days and reached self- sufficiency, including those individuals who did not report being self- sufficient at 120 days. [End of table] Little Is Known about the Relative Effectiveness of Approaches Used by ORR Assistance Programs in Improving Refugees' Economic Status: ORR performance data cannot be used to compare Matching Grant program outcomes with the outcomes from the other three programs because they do not share the same performance measures. While all four refugee assistance programs have three measures in common, the programs collect information for their common measures at different points in time. For example, the Matching Grant program reports the number of refugees who enter employment 4 months after the refugee arrives in the United States, while providers of the other three programs report entered employment rates for refugees receiving ORR-funded cash assistance within 8 months of their arrival in the United States. [Footnote 45] Because the approaches states and voluntary agencies use to provide assistance vary both within and between programs, ORR's performance data provide little information on the relative effectiveness of specific approaches. The Wilson/Fish, Public Private Partnership, and Matching Grant programs were designed to allow providers to develop innovative approaches that are different than those used in states' TANF programs, including integrated services, intensive case management, and employment incentives. Several providers we spoke with believe that the approaches they use to provide assistance play an important role in helping refugees find employment. One study published in 1999 (based on data from 1992 through 1994) compared a Wilson/Fish and a Publicly Administered program in San Diego and concluded that the Wilson/Fish program with integrated services, personal and flexible system of service delivery, and intensive support services helped refugees find employment more quickly than the Publicly Administered program that provided services through multiple agencies and case workers,[Footnote 46] but we found no other studies that were published recently and have reliably assessed the effectiveness of the various approaches used by refugee assistance programs. In addition, the way these approaches are implemented varies significantly both within and across programs. For example, in Texas, the voluntary agencies that administer both the Matching Grant and the Public Private Partnership programs told us that the way employment related services are provided under the two programs is virtually indistinguishable, whereas in Minnesota, the Matching Grant and Public Private Partnership programs use two very different service delivery approaches, according to voluntary agency staff. Because providers consider different factors when placing refugees in assistance programs, it can be difficult to determine whether differences in program performance are attributed to program approaches or to differences in the populations served. For example, because refugee families with children may face different challenges to employment than refugees without children, a program that serves more families with children could have different employment outcomes than one that serves fewer. In one of our discussion groups, a single mother from Rwanda told us that she was unable to find work when she first arrived in the United States because she had to care for her children, the youngest being 6 weeks old at the time. Eventually, she found child care for her children and found her first job after being in the United States for almost 4 years. Additionally, several Matching Grant program administrators told us they were more likely to enroll refugees who speak English fluently, as the ability to speak English can greatly facilitate a refugee's chances of finding employment. One provider in Florida explained that in Miami, despite the fact that most refugees can get by outside the workplace speaking only Spanish, most employers require that job applicants also speak English. A refugee from Belarus told us that in his home country he was an economist and a construction manager, but since arriving in Los Angeles over a year ago with his wife and child he has been unable to find work. He told us that he did not speak English when he arrived and believes that this has been a significant barrier to employment. According to the results of ORR's annual survey of refugees published in the agency's 2007 report to Congress[Footnote 47] (the most recent published report), English proficiency was one of the most important factors influencing the economic status of refugees, with close to 90 percent of those who lacked earnings and received cash assistance living in a household where no one could speak English. Difficulties in Projecting Certain Program Costs Have Contributed to Fluctuations in ORR's Unobligated Balances: ORR considers a broad range of factors when estimating its program costs, and these estimates for fiscal years 1999 through 2009 have generally tracked actual program obligations in most but not all years. When estimating program costs, ORR officials told us they consider several factors, such as the projected inflation rate; participation rates; costs for cash and medical assistance; administrative costs; and monitoring, data collection, and evaluation costs, as well as the projected number of specific refugee groups such as unaccompanied refugee minors. According to our analysis, ORR's estimates of program costs have generally tracked what the agency actually obligated. Between fiscal years 1999 and 2009, ORR's estimates were, on average, within 6 percent of the agency's actual obligations. (See figure 7.) Figure 7: ORR Projected Obligations Compared with Actual Obligations, Fiscal Years 1999-2009: [Refer to PDF for image: multiple line graph] Year: 1999; Total obligations: $464 million; Total projected obligations: $415 million. Year: 2000; Total obligations: $450 million; Total projected obligations: $443 million. Year: 2001; Total obligations: $473 million; Total projected obligations: $433 million. Year: 2002; Total obligations: $511 million; Total projected obligations: $445 million. Year: 2003; Total obligations: $491 million; Total projected obligations: $465 million. Year: 2004; Total obligations: $474 million; Total projected obligations: $472 million. Year: 2005; Total obligations: $534 million; Total projected obligations: $488 million. Year: 2006; Total obligations: $553 million; Total projected obligations: $552 million. Year: 2007; Total obligations: $564 million; Total projected obligations: $615 million. Year: 2008; Total obligations: $623 million; Total projected obligations: $656 million. Year: 2009; Total obligations: $704 million; Total projected obligations: $667 million. Source: ORR and ACF Budget Justifications from fiscal years 2001 through 2011. [End of figure] Despite its efforts to consider various factors when estimating program costs, ORR has faced difficulties in estimating specific variables, such as the number of refugees that will enter the country in a given year and the share of those refugees who will be eligible for ORR assistance programs, according to officials. ORR officials told us they use the presidential ceiling of refugees that may enter the United States in a given year when estimating the number of refugees they must serve. In fiscal year 2009, the number of refugees that arrived in the United States was more than 90 percent of the maximum number of refugees the United States set as the ceiling that year. However, this ceiling has not always been a good proxy of the actual number of incoming refugees. For fiscal years 2002 through 2007, the number of refugees that arrived was, on average, about 40 percent lower than the presidential ceiling. (See figure 8.) In addition to using the refugee ceiling, ORR projects the number of refugee arrivals by using historical arrival patterns,[Footnote 48] and in its fiscal year 2004 budget estimate, ORR requested less than it did in the previous year because of the decreasing number of refugee arrivals since September 11, 2001. Figure 8: Refugee Arrivals Compared to the Presidential Ceiling, Fiscal Years 1999-2009: [Refer to PDF for image: multiple line graph] Year: 1999; Arriving refugees: 85,019; Presidential ceiling: 91,000. Year: 2000 Arriving refugees: 72,519; Presidential ceiling: 90,000. Year: 2001; Arriving refugees: 68,393; Presidential ceiling: 80,000. Year: 2002; Arriving refugees: 26,383; Presidential ceiling: 70,000. Year: 2003; Arriving refugees: 28,348; Presidential ceiling: 70,000. Year: 2004; Arriving refugees: 52,869; Presidential ceiling: 70,000. Year: 2005; Arriving refugees: 53,813; Presidential ceiling: 70,000. Year: 2006; Arriving refugees: 41,279; Presidential ceiling: 70,000. Year: 2007; Arriving refugees: 48,281; Presidential ceiling: 70,000. Year: 2008; Arriving refugees: 60,193; Presidential ceiling: 80,000. Year: 2009; Arriving refugees: 74,652; Presidential ceiling: 80,000. Source: ACF Budget Justifications fiscal years 2005 and 2011. [End of figure] Once ORR has refugee arrival estimates, the agency projects the number of refugees who will likely participate in ORR-funded programs. The share of refugees who are eligible for ORR-funded services varies from year to year. For example, between fiscal years 2007 and 2009, the percentage of all refugees who received cash assistance through ORR's assistance programs fluctuated between 26 percent and 38 percent. [Footnote 49] ORR must also estimate the average cost of providing cash assistance to refugees participating in its assistance programs, which can vary significantly depending on the distribution of refugees across the country. A refugee living in Texas participating in the Public Private Partnership program, for example, receives a cash assistance grant of about $200 per month, whereas a refugee living in Massachusetts participating in the Wilson/Fish program receives a cash assistance grant of about $428 per month. Consequently, the amount ORR reimburses state and voluntary agencies for the costs of providing cash assistance may change as refugee arrival patterns shift. For example, in fiscal year 2009, 3,082 more refugees were settled in Texas--a low benefit state--than in fiscal year 2008,[Footnote 50] while Minnesota and Connecticut--both high benefit states--saw decreases in their numbers of arrivals. ORR officials also told us that because they do not play a role in deciding where refugees are geographically placed, the agency is limited in its ability to estimate costs associated with refugee arrival patterns. Uncertainty regarding the costs for medical expenses incurred by refugees also affects ORR's ability to accurately estimate funding for the amount of services it must provide. Since an increasing proportion of arriving refugees need intensive medical care, refugees' medical costs on average have increased over time, creating uncertainty for ORR in estimating these expenses from year to year, according to officials. ORR officials indicated that refugees admitted in recent years have more diverse medical backgrounds than in the past, and that the number of refugees with chronic mental and medical conditions has grown, due in part to increases in refugee groups that have spent years living in refugee camps with limited access to medical care and proper nutrition. Burmese refugees in particular have lived for decades in refugee camps, according to ORR, and have grown from 128 refugee arrivals in fiscal year 2002 to 18,275 arrivals in fiscal year 2009, an increase from less than 1 percent to 24 percent of the total population of arriving refugees. Partly because of this demographic shift in the refugee arrival population, according to ORR officials, the agency's cost for medical assistance more than doubled from fiscal year 1999 through fiscal year 2009.[Footnote 51] ORR officials and voluntary agency staff explained that detailed information about refugees' health conditions are often not known prior to their arrival in the United States, which contributes to uncertainty in medical costs.[Footnote 52] For example, one voluntary agency director in Texas stated that medical information provided on refugees prior to their arrival is minimal, and only describes whether the client has a "Class A" condition, such as active tuberculosis, or a "Class B" condition, such as hypertension, without specifying the illness. Estimating the number of children ORR will likely serve as a result of the William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008 also created uncertainty in ORR's budget formulation in recent years, according to ORR. Officials said they were uncertain about the impact this Act would have on their budget due to a provision stipulating that victims of trafficking and undocumented youths who are granted Special Immigrant Juvenile status may receive care and placement services funded by ORR instead of being returned to their home country.[Footnote 53] The Department of Homeland Security provides ORR with estimates about asylees and unaccompanied alien children who do not enter the United States through the traditional resettlement channels. According to ORR officials, the Department of Homeland Security estimated that the number of minors receiving services from ORR in fiscal year 2009 would be approximately 12,000 to 14,000, but the overall number of Unaccompanied Alien Children declined from 7,211 in fiscal year 2008 to 6,622 in fiscal year 2009. Difficulties in accurately estimating program costs have contributed to fluctuations in ORR's unobligated balances at the end of each fiscal year. For example, ORR officials said that they used the presidential ceiling of 70,000 to estimate the number of refugees they would likely serve during fiscal years 2006 through 2007. However, refugee arrivals were significantly lower those years, and consequently the agency's costs to support newly arrived refugees were less than the amount it received in appropriations. Additionally, in anticipation of the potential influx of 4,000 to 6,200 additional unaccompanied alien children as a result of the William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008, ORR requested supplemental funding, which was appropriated in fiscal year 2009. According to ORR, the Act requires that youth entering the United States from neighboring countries be screened to determine if they are victims of trafficking. ORR anticipated that these youth would be cared for under the Unaccompanied Alien Children program while being screened. However, ORR's Unaccompanied Alien Children program served fewer children than anticipated, and at the end of fiscal year 2009, officials said they carried over about $31 million of unobligated Unaccompanied Alien Children funds and $52 million of unobligated supplementary funds. In total, from fiscal years 2006 to 2009, ORR's unobligated balances grew from $17 million to over $83 million. (See figure 9.) Figure 9: ORR Appropriations, Obligations, and Unobligated Balances Fiscal Years 1999-2009: [Refer to PDF for image: horizontal bar graph] Year: 1999; Total obligations: $465 million; End of year unobligated balances: $2 million; Appropriations: $435 million. Year: 2000; Total obligations: $450 million; End of year unobligated balances: $50 million; Appropriations: $426 million. Year: 2001; Total obligations: $473 million; End of year unobligated balances: $22 million; Appropriations: $433 million. Year: 2002; Total obligations: $511 million; End of year unobligated balances: $24 million; Appropriations: $460 million. Year: 2003; Total obligations: $491 million; End of year unobligated balances: $15 million; Appropriations: $478 million. Year: 2004; Total obligations: $474 million; End of year unobligated balances: $7 million; Appropriations: $445 million. Year: 2005; Total obligations: $534 million; End of year unobligated balances: $0 million; Appropriations: $481 million. Year: 2006; Total obligations: $553 million; End of year unobligated balances: $17 million; Appropriations: $569 million. Year: 2007; Total obligations: $564 million; End of year unobligated balances: $41 million; Appropriations: $588 million. Year: 2008; Total obligations: $623 million; End of year unobligated balances: $73 million; Appropriations: $656 million. Year: 2009; Total obligations: $704 million; End of year unobligated balances: $83 million; Appropriations: $715 million. Source: ORR’s Budget Justifications fiscal years 2001-2011 compiled and analyzed by GAO. Note: These unobligated balances are at the end of fiscal years 1999 to 2009. Since ORR's funds are available for 3 fiscal years, ORR's total obligations and unobligated balances in a particular fiscal year may not equal the appropriation amount enacted for that fiscal year, an amount which also remains available for obligation during the 2 subsequent fiscal years. [End of figure] Congress appropriates a certain amount of money to ORR each year to fund its activities, and ORR has a 3-year period in which to obligate funding for most of its budget activities[Footnote 54]--so funds that have not expired and are not yet obligated for a specific activity at the end of a fiscal year can be used during the following 2 fiscal years. From fiscal years 1999 to 2005, ORR used prior years' unexpired and unobligated funds to allow it to obligate more than it was appropriated in those years.[Footnote 55] For example, in fiscal year 2005, ORR allocated $205 million of its appropriation to its Transitional and Medical Services budget activity to reimburse states for the costs of providing cash and medical assistance to refugees. When states' costs exceeded this amount, ORR was able to cover the difference between its expenses and its allocation by using funds from its unobligated balances from prior years. By the end of fiscal year 2005, ORR did not have any remaining unobligated balances. From fiscal years 2006 to 2009, however, ORR obligated less than it was appropriated and thus was able to accumulate balances again. ORR officials told us they prioritize their unobligated balances to supplement the program costs of refugees who participate in the agency's Publicly Administered and Public Private Partnership programs because they place an emphasis on these programs in their funding decisions. Officials explained they do not typically use the agency's unobligated balances to supplement funding for other activities, such as funds dedicated to Social Services or the Wilson/Fish program. ORR's reimbursements to state and voluntary agencies for activities other than cash and medical assistance generally do not increase as the number of newly arrived refugees increase. Officials told us, for example, that the amount appropriated for Social Services has remained at approximately $154 million from fiscal years 2006 to 2009, even though the number of refugee arrivals increased by 81 percent. As a result, program providers have strategies to prioritize the use of limited funds in serving refugees. To ensure that new arrivals continued to receive needed services, refugee coordinators from Texas and Los Angeles told us they provided employment services to refugees for only about 1 year rather than the 5 years allowed in regulation. Similarly, ORR does not generally increase funding for Wilson/Fish services during a given year. In fiscal years 2008 and 2009, the San Diego Wilson/Fish program experienced an unexpected increase in refugees from 3,309 to 5,178. In fiscal year 2010, ORR directed providers to begin transferring refugee families with children, who were otherwise eligible for TANF but had been allowed to enroll in the Wilson/Fish program, off of their Wilson/Fish program and into the TANF program thereby transferring the costs of resettling these refugee families to other programs.[Footnote 56] Conclusion: ORR spends millions of dollars every year on assistance that is critical to addressing the basic needs of refugees who are new to the United States. State and voluntary agencies that administer ORR's programs vary in how they provide assistance, and little is known about the effectiveness of the approaches they use to help refugees become self-sufficient--an overall goal of all of ORR's programs. With refugees' employment outcomes declining because of the recession and significant pressures on the federal budget, it is important that program providers use approaches that have been shown to be effective in helping refugees find employment that enables them to live without cash assistance. ORR tracks the success of its programs using performance measures, but these measures alone provide little information about the relative effectiveness of the various approaches providers use. It is only by looking more closely at the individual approaches and controlling for other factors that may influence employment outcomes that ORR can begin to identify and promote the most successful strategies while at the same time make more effective and efficient use of its resources. Recommendation for Executive Action: We recommend that the Secretary of Health and Human Services identify effective approaches that state and voluntary agencies can use to help refugees become employed and self-sufficient. To identify these approaches, the Secretary may consider, for example, conducting a series of rigorous evaluations of the programs and their approaches or expanding information collected on the annual survey. Recommendations from further study could be used by HHS or, if appropriate, by Congress, to improve ORR's refugee resettlement programs. Agency Comments and Our Evaluation: We shared a draft of this report with HHS for review and comment. On March 16, 2011, HHS provided written comments, which may be found in appendix V, and technical comments, which we incorporated in the report where appropriate. In its written comments, HHS confirmed several of our findings and agreed with our recommendation to identify effective approaches to help refugees become employed and self-sufficient. HHS indicated that it seeks to highlight promising practices related to effective employment approaches and cited two recently published studies that it sponsored as examples of its efforts. While the two studies cited described different services states and voluntary agencies use to assist refugees and one study even compared employment outcomes of refugees living in two cities, neither of the studies evaluated the effectiveness of the programs or the approaches providers use in helping refugees become self-sufficient. In fact, as HHS indicated, one study suggested future research should include such an evaluation. The agency also emphasized that refugee resettlement in the United States is intended to be a rescue and restore program, which not only provides refugees with temporary cash, medical, and employment assistance, but also promotes cultural orientation, civic engagement, and other activities. GAO acknowledges that HHS has a broad mission to provide refugees with critical resources to assist them in becoming integrated members of society. Nonetheless, we focused our report on the temporary assistance and employment services refugees receive within the first 4 to 8 months after arriving in the United States because it is within this amount of time that refugees are expected to find employment and become self-sufficient. We are sending copies of this report to relevant congressional committees; the Secretary of Health and Human Services, and other interested parties. The report will also be available at no charge on the GAO Web site at [hyperlink, http://www.gao.gov]. If you or your staff have any questions about this report, please contact me at (202) 512-7215 or brownke@gao.gov. Contact points for our Offices of Congressional Relations and Public Affairs may be found on the last page of this report. Key contributors to this report are listed in appendix VI. Sincerely Yours, Signed by: Kay E. Brown: Director, Education, Workforce, and Income Security Issues: [End of section] Appendix I: Scope and Methodology: To describe how the Office of Refugee Resettlement (ORR) refugee assistance programs differ and the factors used to place refugees in a program, we interviewed ORR officials and National Voluntary Agency officials from all nine National Voluntary Agencies who help administer ORR programs.[Footnote 57] We also interviewed state, county, and local voluntary agency officials in five states, including California, Florida, Massachusetts, Minnesota, and Texas and conducted discussion groups with refugees in all but Massachusetts. We selected four states with a high concentration of ORR refugee caseloads and one state with a relatively low concentration of refugee cases. We also selected states with a range of average 2009 unemployment rates. States we selected were geographically diverse and all offered Matching Grant programs. We also collected and reviewed refugee case files from the government and voluntary agencies we visited, so that we would have case files representing refugees with different experiences. From the states we visited except California, we collected copies of two complete case files chosen by the voluntary agency--one case file representing a refugee who participated in either the Publicly Administered, Wilson/Fish, or Public Private Partnership; and one case file representing a refugee who participated in a Matching Grant program.[Footnote 58] The information we collected at these selected states does not allow us to generalize to other states, refugees, or local voluntary agencies. We also reviewed relevant federal laws and regulations. To describe refugee employment outcomes and the effectiveness of different approaches to providing assistance, we collected, aggregated, and analyzed performance data across all states for fiscal years 2007, 2008, and 2009 by program--Publicly Administered, Public Private Partnership, and Wilson/Fish. To assess the reliability of the performance data, we interviewed knowledgeable agency officials and reviewed official documents. We compiled these data into a spreadsheet and only included the performance outcomes of refugees who received cash assistance from one of ORR's programs. Because this study focused primarily on the refugees who received cash assistance from ORR's four assistance programs, we did not include refugees who participated in the Temporary Assistance for Needy Families (TANF) program. We also did not include any data that represented refugees who were receiving ORR services but not receiving refugee cash assistance. We also collected and analyzed performance data for the Matching Grant program from the nine national voluntary agencies for fiscal years 2007 through 2009. We analyzed these 3 years of performance data to gain insight on how refugee assistance programs were performing most recently. While the performance data have some limitations, we consider these data reliable and appropriate for this engagement. We also conducted a literature review and found one study that reliably addressed the effectiveness of approaches used by providers to provide refugee assistance. To describe how ORR estimates program costs and how estimates affect its unobligated balances, we interviewed officials from the Department of Health and Human Services (HHS), Administration for Children and Families (ACF), and ORR to determine how ORR formulates its budget. We also reviewed and analyzed budget documents from fiscal years 1999 through 2009, including ORR budget justifications and annual reports to Congress. We interviewed knowledgeable agency officials and reviewed official documents to assess the data that ORR uses to estimate program costs, and found the data to be sufficiently reliable. Analyzing budget information from fiscal years 1999 to 2009 allowed us to identify trends in ORR's obligations and unobligated balances. In addition, we spoke with officials from the Departments of State and Homeland Security to obtain information on how they develop budgets for their refugee programs and what, if any, coordination occurs between these agencies and ORR to help ORR formulate its budget. We conducted this performance audit from December 2009 to March 2011 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. [End of section] Appendix II: Profiles of States Visited: Table 6: State Profiles: State: California; Program: Wilson/Fish in San Diego County; Benefit level per month (1 adult/2 adults): $359/$584; Caseloads[A]: 2007: 801; Caseloads[A]: 2008: 2,182; Caseloads[A]: 2009: 4,046; [Empty]; 2009 average state unemployment rates[B]: 11.4%. State: California; Program:Publicly Administered in all other counties; Benefit level per month (1 adult/2 adults): $382/$627 and $363/ $598[C]; Caseloads[A]: 2007: 2,208; Caseloads[A]: 2008: 757; Caseloads[A]: 2009: 2,721; 2009 average state unemployment rates[B]: 11.4%. State: Florida; Program: Publicly Administered; Benefit level per month (1 adult/2 adults): Ranges from $95/$158 to $180/$241[D]; Caseloads[A]: 2007: 5,448; Caseloads[A]: 2008: 7,779; Caseloads[A]: 2009: 10,048; 2009 average state unemployment rates[B]: 10.5%. State: Massachusetts; Program: Wilson/Fish; Benefit level per month (1 adult/2 adults): $428/$531; Caseloads[A]: 2007: 431; Caseloads[A]: 2008: 464; Caseloads[A]: 2009: 696; 2009 average state unemployment rates[B]: 8.4%. State: Minnesota; Program: Public Private Partnership; Benefit level per month (1 adult/2 adults): $250/$437; Caseloads[A]: 2007: 1369; Caseloads[A]: 2008: 803; Caseloads[A]: 2009: 438; 2009 average state unemployment rates[B]: 8.0%. State: Texas; Program: Public Private Partnership; Benefit level per month (1 adult/2 adults): $200/$300[E] for months 1-4 $187.50/$252 for months 5-8; Caseloads[A]: 2007: 1,021; Caseloads[A]: 2008: 2,122; Caseloads[A]: 2009: 3,340; 2009 average state unemployment rates[B]: 7.6%. Source: Information compiled by GAO. [A] Caseloads represent refugees who received cash assistance and employment services from the Publicly Administered, Wilson/Fish, or Public Private Partnership program. [B] As reported by the Bureau of Labor Statistics, U.S. Department of Labor in a March 3, 2010, News Release, Report Number USDL-10-0231. [C] Based on the state's TANF payment standards, California's Publicly Administered program has two benefit levels: one for high-cost counties and one for all other counties, according to state officials. [D] The range in Florida depends on the amount of rent the refugee pays. For a single adult who does not pay rent, the lowest benefit payment applies. For a single adult who pays more than $50 in rent, the highest benefit payment applies. [E] For one adult, $200 per month for months 1-4 and $187.50 per month for months 5-8. For two adults, $300 per month for months 1-4 and $252 per month for months 5-8. [End of table] [End of section] Appendix III: ORR Employment Outcomes: Table 7: Employment Outcome Definitions of the Publicly Administered, Public Private Partnership, and Wilson/Fish Programs: Outcome measure: Entered Employment; Definition: The unduplicated number of refugees who entered employment. Outcome measure: Employment with Health Benefits; Definition: The unduplicated number of refugees who entered full-time employment where health benefits are offered within the first 6 months of employment. Outcome measure: Average Wage per hour; Definition: The average wage at placement for all refugees who entered full-time employment. Outcome measure: Cash Assistance Terminations because of Employment; Definition: The unduplicated number of refugees terminating cash assistance due to earnings from employment. Outcome measure: Job Retention at 90th Day of Employment; Definition: The unduplicated number of refugees who entered employment between July of the previous calendar year through June of the current calendar year. This rate is a measure of refugee's retention of employment--not retention of a specific job. As long as the refugee is employed in a job a quarter after the date he or she entered employment, it is considered retention. Outcome measure: Cash Assistance Reductions Due to Employment; Definition: The unduplicated number of refugees reducing cash assistance due to earnings from employment. Source: ORR. [End of table] Table 8: Employment Outcome Definitions of the Matching Grant Program: Outcome measure: Entered Employment; Definition: The unduplicated number of refugees who entered employment. Outcome measure: Employment with Health Benefits; Definition: The unduplicated number of refugees who entered full time employment where health benefits are offered within the first 6 months of employment. Outcome measure: Average Hourly Wage; Definition: The sum of the hourly wages for the unduplicated number of full-time job placements divided by the total unduplicated number of individuals placed in full-time employment. Outcome measure: Economic Self-Sufficiency (120); Definition: This rate measures the self-sufficiency of refugees enrolled in the Matching Grant program at the 120th day. Self- sufficiency means that the refugee or refugee family is earning a total family income at a level that enables the family unit to support itself without receipt of cash assistance. Refugees who receive non- cash assistance, such as Supplemental Nutrition Assistance Program (SNAP) benefits or housing subsidies, are considered to be self- sufficient by ORR if they have earnings and do not receive cash assistance. Outcome measure: Economic Self-Sufficiency Retention (180); Definition: This refers to the individuals who were reported to be self-sufficient at the 120th day and continued to be self-sufficient 60 days later. Refugees who receive non-cash assistance, such as SNAP benefits or housing subsidies, are considered to be self-sufficient by ORR if they have earnings and do not receive cash assistance. Outcome measure: Economic Self-Sufficiency Overall; Definition: This rate measures the self-sufficiency of all refugees enrolled in the Matching Grant program, including the status at 120 days and 180 days. Source: ORR. [End of table] Table 9: Employment Outcomes for Refugees Receiving Cash Assistance from ORR's Publicly Administered, Public Private Partnership, or Wilson/Fish Program from Fiscal Years 2007 to 2009: Employment outcomes: Entered Employment; 2007; Publicly Administered: 65%; Public Private Partnership: 64%; Wilson/Fish: 59%. Employment outcomes: Entered Employment; 2008; Publicly Administered: Employment outcomes 50%; Public Private Partnership: Employment outcomes 75%; Wilson/Fish: Employment outcomes 44%. Employment outcomes: Entered Employment; 2009; Publicly Administered: 34%; Public Private Partnership: 52%; Wilson/Fish: 31%. Employment outcomes: Employment with Health Benefits; 2007; Publicly Administered: 54%; Public Private Partnership: 67%; Wilson/Fish: 81%. Employment outcomes: Employment with Health Benefits; 2008; Publicly Administered: 76%; Public Private Partnership: 62%; Wilson/Fish: 77%. Employment outcomes: Employment with Health Benefits; 2009; Publicly Administered: 67%; Public Private Partnership: 71%; Wilson/Fish: Employment outcomes 64%. Employment outcomes: Cash Assistance Termination because of Employment; 2007; Publicly Administered: 69%; Public Private Partnership: 37%; Wilson/Fish: 80%. Employment outcomes: Cash Assistance Termination because of Employment; 2008; Publicly Administered: 51%; Public Private Partnership: 26%; Wilson/Fish: 68%. Employment outcomes: Cash Assistance Termination because of Employment; 2009; Publicly Administered: 65%; Public Private Partnership: 24%; Wilson/Fish: 64%. Employment outcomes: Job Retention at 90th day of Employment; 2007; Publicly Administered: 77%; Public Private Partnership: 81%; Wilson/Fish: 84%. Employment outcomes: Job Retention at 90th day of Employment; 2008; Publicly Administered: 58%; Public Private Partnership: 80%; Wilson/Fish: 85%. Employment outcomes: Job Retention at 90th day of Employment; 2009; Publicly Administered: 73%; Public Private Partnership: 67%; Wilson/Fish: 80%. Employment outcomes: Cash Assistance Reductions due to Employment; 2007; Publicly Administered: 1%; Public Private Partnership: 6%; Wilson/Fish: 5%. Employment outcomes: Cash Assistance Reductions due to Employment; 2008; Publicly Administered: 3%; Public Private Partnership: 3%; Wilson/Fish: 9%. Employment outcomes: Cash Assistance Reductions due to Employment; 2009; Publicly Administered: 4%; Public Private Partnership: 1%; Wilson/Fish: 16%. Employment outcomes: Average Wage per Hour; 2007; Publicly Administered: $8.72; Public Private Partnership: $8.96; Wilson/Fish: $8.98. Employment outcomes: Average Wage per Hour; 2008; Publicly Administered: $8.86; Public Private Partnership: $9.09; Wilson/Fish: $9.31. Employment outcomes: Average Wage per Hour; 2009; Publicly Administered: $8.87; Public Private Partnership: $8.90; Wilson/Fish: $9.33. Source: ORR's Annual Outcome Goal Plans compiled by GAO. Notes: The Entered Employment rate for the Public Private Partnership in fiscal year 2008 is substantially higher than the rates for the other programs. We asked ORR if the performance data had any abnormalities that would cause rates to be particularly high or low for a given year. Officials said they believed the performance data to be accurate and were not aware of any abnormalities. These rates include only those refugees who received cash assistance from the Publicly Administered, Wilson/Fish, or Public Private Partnership program. These rates do not include refugees who did not receive ORR-funded cash assistance but may have received other types of ORR-funded services, such as employment assistance. Refugees who do not receive ORR-funded cash assistance but receive other types of ORR assistance may include (1) those who are participating in the Temporary Assistance for Needy Families (TANF) program and receiving ORR-funded employment services or (2) refugees who have exhausted their ORR-provided cash assistance but continue to receive ORR-funded employment services. ORR told us it typically includes all refugees who received some type of ORR-funded services when it reports employment outcomes for the Publicly Administered, Wilson/Fish, and Public Private Partnership programs. [End of table] Table 10: Matching Grant Performance Rates from Fiscal Years 2007 to 2009: Employment outcomes: Entered Employment; Matching Grant: 2007: 64%; Matching Grant: 2008: 57%; Matching Grant: 2009: 47%. Employment outcomes: Employment with Health Benefits; Matching Grant: 2007: 58%; Matching Grant: 2008: 55%; Matching Grant: 2009: 51%. Employment outcomes: Economic Self-Sufficiency (120); Matching Grant: 2007: 69%; Matching Grant: 2008: 62%; Matching Grant: 2009: 52%. Employment outcomes: Economic Self-Sufficiency Retention (180); Matching Grant: 2007: 95%; Matching Grant: 2008: 95%; Matching Grant: 2009: 93%. Employment outcomes: Economic Self-Sufficiency (Overall); Matching Grant: 2007: 80%; Matching Grant: 2008: 78%; Matching Grant: 2009: 67%. Employment outcomes: Average Wage per Hour at Employment (full-time); Matching Grant: 2007: $8.58; Matching Grant: 2008: $8.68; Matching Grant: 2009: $8.67. Source: ORR's Matching Grant annual report data compiled by GAO. [End of table] [End of section] Appendix IV: Refugee Vignettes from Discussion Groups: The following examples are from our four discussion groups held in various parts of the country. Voluntary agencies convened the discussion groups, selected the participants, and provided translators when necessary. These examples are illustrations of refugees' experiences, and are not indicative of any success or failure of ORR's programs. * A single male from Iraq had job experiences as a shop owner, translator, and sports trainer prior to arriving in the United States. His voluntary agency provided him with assistance in finding an apartment and a job. He currently works two jobs and makes enough money to make ends meet. He hopes to begin a new career by taking training in massage therapy in the near future. * A married couple from Burma with two teenagers lived an agrarian life in their native land, farming rice and vegetables for their own subsistence and selling the rest. Caseworkers from a voluntary agency enabled them to obtain medical care and Social Security cards, and fill out job applications. Neither husband nor wife was literate in their native Burmese dialect and found learning English difficult. He has found work in a factory and his wife has qualified for SSI. With these sources of income they are able to pay their bills and save some money. * A man from Eritrea was a plant scientist in his native country and knew some English. A voluntary agency helped him with enrolling in a nursing assistant certification program and applying for a job. He aspires to become a doctor. * Married with two children, an Iranian physician with 15 years of medical experience in his native land arrived in the United States wanting to practice medicine. However, because of his limited English, he said it was difficult to study for the U.S. Medical Licensing exam. A voluntary agency helped him find a job as a medical assistant, but he did not keep that job. In the future, he hopes to enhance his English skills so he can enter and complete a physician's assistant program. [End of section] Appendix V: Comments from the Department of Health and Human Services: Department Of Health & Human Services: Office Of The Secretary: Assistant Secretary for Legislation: Washington, DC 20201: March 16 2011: Kay E. Brown, Director: Education, Workforce, and Income Security Issues: U.S. Government Accountability Office: 441 G Street N.W. Washington, DC 20548: Dear Ms. Brown: Attached are comments on the U.S. Government Accountability Office's (GAO) draft report entitled, "Refugee Assistance: Little is Known about the Effectiveness of Different Approaches for Improving Refugees' Employment Outcomes" (GAO 11-369). The Department appreciates the opportunity to review this report prior to publication. Sincerely, Signed by: Jim R. Esquea: Assistant Secretary for Legislation: Attachment: [End of letter] General Comments Of The Department Of Health And Human Services (HHS) On The Government Accountability Office's (GAO) Draft Report Entitled, "Refugee Assistance: Little Is Known About The Effectiveness Of Different Approaches For Improving Refugees' Employment Outcomes" (GA0- 11-369): The Department appreciates the opportunity to comment on this draft report. GAO Recommendations: We recommend that the Secretary of Health and Human Services identify effective approaches that state and voluntary agencies can use to help refugees become employed and self-sufficient. To identify these approaches, the Secretary may consider, for example, conducting a series of rigorous evaluations of the programs and their approaches or expanding information collected on the annual survey. Recommendations from further study could be used by HHS or, if appropriate, by Congress to improve ORR's refugee resettlement programs. HHS Response: The Department agrees with GAO's recommendation concerning the importance of identifying effective approaches that state and voluntary agencies can use to help refugees become employed and self- sufficient. HUB' Office of Refugee Resettlement is engaged in ongoing efforts to do so, including activities to share information about effective approaches with grantees and providers. We also agree that important insights could be gained through rigorous evaluations of alternative approaches, and that it may be possible to expand information collected in the annual survey of refugees to learn more about their employment experiences through the direct input of refugees. HHS wishes to emphasize that the goals of refugee assistance include but are not limited to employment; that the U.S. refugee resettlement program is a Federal/state partnership in which states are given certain discretion to utilize program approaches that best address the self-sufficiency needs of refugees being resettled in their communities; that the flexibility in program design presents challenges for comparing program outcomes; that current activities seek to highlight promising practices about effective employment approaches within a very flexible framework; and that while program budgeting projections have been within 6 percent of actual obligations, we continue to seek to improve those projections. The draft report examines differences in three assistance programs and the Voluntary Matching Grant program. The different program models were developed over time in response to local conditions and state preferences in implementation. While each of these programs provides services to promote employment, it is important to appreciate that the goals of refugee assistance include but are not limited to employment. The U.S. refugee resettlement program is rooted in humanitarian concern, foreign affairs and national security considerations. Refugees are admitted to the United States for resettlement based on each individual's persecution or well-founded fear of persecution on account of race, religion, nationality, membership in a particular social group or political opinion. An individual's employability is not a determining factor for admission to the United States Similarly, resettlement services go beyond the temporary assistance and employment services discussed in this draft report to include health and mental health care, civic engagement, English language instruction, cultural orientation, case management and other social services. Taken together, the refugee resettlement program is intended to be a rescue and restore program, of which employment services is one component. States have discretion in determining whether or not to participate in refugee resettlement, and in how to structure their participation. Thirty-two states and the District of Columbia operate publicly administered resettlement assistance and services. Oregon, Texas, Oklahoma, Minnesota and Maryland operate a variation of the publicly administered program with an emphasis on public and private partnerships. Twelve states and San Diego County, California, provide resettlement services through an alternative known as the Wilson-Fish program. Wyoming does not provide resettlement services. These programs and the Matching Grant program were not created as competing options, but as solutions to particular needs and conditions. As such, refugees can receive refugee cash assistance or Temporary Assistance for Needy Families and participate in the Wilson-Fish and Matching Grant programs. The type of assistance program a refugee participates in is determined by the program that exists in the state of the refugee's initial resettlement. The Department of State's (State) Bureau of Population, Refugees and Migration determines the initial placement of refugees. [Footnote 1] HHS is working closely with states to enhance placement decisions by linking newly arriving refugees and the receiving communities with refugee resettlement resources. This level of flexibility and variation across programs makes it difficult to directly compare program outcomes. As the report notes, the Matching Grant program uses different performance outcomes for employment from those used by the three assistance programs. One reason for this difference is that the Matching Grant program design focuses on early employment; consequently employment outcomes are measured at 120 days and 180 days instead of eight months or 0 to 60 months as in the assistance programs. In addition, because the Matching Grant program is not an assistance program, it does not measure termination or reduction of Federal cash assistance. Even if the same outcome measures were used, there would still be limitations in the ability to compare effectiveness of alternative approaches through outcome measures alone, because there are significant differences in program designs across states, in the characteristics of refugee populations across states, and because the characteristics of individuals served through voluntary matching grants may differ from the characteristics of those served in other programs. Nevertheless, HHS believes that having and reporting annual outcome measures provides important information to states and policymakers about the employment-related goals of the program and allows measurement of progress over time within and across states. At the same time, we appreciate that outcome measures are not measures of program impact, and that additional research could benefit the program. In the interest of identifying effective approaches across states, the Department sponsored two studies in 2008 and 2009.[Footnote 2] These studies identified promising approaches (e.g., English language instruction where refugees live and work; professional recertification and career laddering for refugees who were professionals in their native countries; leveraging mainstream social service resources; and partnering with ethnic community based organizations for culturally competent service-delivery). The 2009 report also suggested a follow- up study to evaluate whether employment and self-sufficiency programs are more effective when administered by a Voluntary Agency (i.e., generally Wilson-Fish or Matching Grant programs) or by state or county agencies. It also recommended examining whether refugees fare better when they quickly enter the workforce or when they focus on English language instruction before entering the workforce. HHS will consider incorporating these recommendations in future studies as funding for program evaluation becomes available. In addition to these studies, HHS administers a training and technical assistance grant dedicated to refugee employment. The training and technical assistance provider assists refugees, the nationwide refugee resettlement network, employers and policymakers with employment and self-sufficiency efforts by promoting promising practices and providing trainings. The Department provides cash and medical assistance to refugees through the Transitional and Medical Services (TAMS) budget. This budget also supports state administration costs, monitoring, data collection, and evaluation costs, as well as the Matching Grant program, the Wilson-Fish program, the Anti-Trafficking In Persons program and the Unaccompanied Refugee Minors program (URM). The program develops budget projections after considering many factors, some of which are unpredictable (e.g., arrival numbers, participation rates). On average, projections for the TAMS budget have tracked within 6 percent of the program's actual obligations for fiscal years 1999 through 2009. We are reviewing our process for projecting the TAMS budget in an effort to track even more closely with actual obligations for each fiscal year. An emerging consideration is the increasingly large impact that the URM program has on the TAMS budget. The URM program and associated costs are growing due to recent legislation, the Trafficking Victims Protection Act and subsequent reauthorizations, which authorizes certain unaccompanied alien children and victims of trafficking to be eligible for services. Appendix V Footnotes: [1] The Immigration and Nationality Act (INA) states, "[Ole Director... shall consult regularly (not less than quarterly) with State and local governments and private nonprofit voluntary agencies concerning the sponsorship process and the intended distribution of refugees among the States and localities before their placement in those State and localities." See INA §412(a)(2)(A), 8 U.S.C. §1522(a)(2)(A). In addition. "[t]he director shall develop and implement, in consultation with representatives of voluntary agencies and State and local governments, policies and strategies for the placement and resettlement of refugees within the United States." See INA §412(a)(2)(B), 8 U.S.C. § 1522(a)(2)(B). "Such policies and strategies... shall — (i) insure that a refugee is not initially placed or resettled in an area highly impacted (as determined under regulations prescribed by the Director after consultation with such agencies and governments) by the presence of refugees... (ii) provide for a mechanism whereby representatives of governments to plan and coordinate in advance of their arrival the appropriate placement of refugees among the various States and localities, and (iii) take into account — (I) the proportion of refugees and comparable entrants in the population in the area. (ii) the availability of employment opportunities, affordable housing, and public and private resources (including education, health care, and mental health services) for refugees in the area, UM the likelihood of refugees placed in the area becoming self-sufficient and free from long-term dependence on public assistance, and (IV) the secondary migration of refugees to and from the area that is likely to occur. The Office of Refugee Resettlement (ORR) Director is responsible for the care of unaccompanied refugee children. Under section 412(d) of the INA, the ORR Director "shall attempt to arrange for the placement under the laws of the States of such unaccompanied refugee children..." See INA §412(d)(2)(B)(ii), It U.S.C. § 1522(d)(2)(B)(ii). [2] The HHS-sponsored studies, Building an Integrated Refugee Program and The Evaluation of the Refugee Social Services (RSS) and Targeted Assistance Formula Grant (TAG) Programs were published in 2008 and 2009 respectively. The 2008 study focused on four sites (i.e., Northern Virginia; Fort Wayne, Indiana; Seattle, Washington: Metropolitan Detroit, Michigan) and the 2009 study focused on three sites (i.e., Houston, Texas; Miami, Florida; and Sacramento, California). [End of section] Appendix VI: GAO Contact and Staff Acknowledgments: GAO Contact: Kay E. Brown (202) 512-7215 or brownke@gao.gov: Staff Acknowledgments: In addition to the contact named above, Kathryn Larin, Assistant Director; Danielle Giese and Cheri Harrington, Analysts-in-Charge; Richard Burkard; David Chrisinger; Erin Cohen; Rajiv D'Cruz; Mitchell Karpman; Carol Henn; Brittni Milam; James Rebbe; Cynthia Saunders; Kathleen van Gelder; Shana Wallace; and Daniel Webb made key contributions to this report. [End of section] Related GAO Products: Displaced Iraqis: Integrated International Strategy Needed to Reintegrate Iraq's Internally Displaced and Returning Refugees. [hyperlink, http://www.gao.gov/products/GAO-11-124]. Washington, D.C.: December 2, 2010. Humanitarian Assistance: Status of North Korean Refugee Resettlement and Asylum in the United States. [hyperlink, http://www.gao.gov/products/GAO-10-691]. Washington, D.C.: June 24, 2010. Iraq: Iraqi Refugees and Special Immigrant Visa Holders Face Challenges Resettling in the United States and Obtaining U.S. Government Employment. [hyperlink, http://www.gao.gov/products/GAO-10-274]. Washington, D.C.: March 9, 2010. Iraqi Refugee Assistance: Improvements Needed in Measuring Progress, Assessing Needs, Tracking Funds, and Developing an International Strategic Plan. [hyperlink, http://www.gao.gov/products/GAO-09-120]. Washington, D.C.: April 21, 2009. Refugee Resettlement: Unused Federal Funds in 1991 and 1992. [hyperlink, http://www.gao.gov/products/GAO/HRD-94-44]. Washington, D.C.: December 7, 1993. Refugee Resettlement: Initial Reception and Placement Assistance. [hyperlink, http://www.gao.gov/products/GAO/NSIAD-93-193BR]. Washington, D.C.: June 18, 1993. Refugee Resettlement: Federal Support to the States Has Declined. [hyperlink, http://www.gao.gov/products/GAO/HRD-91-51]. Washington, D.C.: December 21, 1990. Soviet Refugees: Issues Affecting Domestic Resettlement. [hyperlink, http://www.gao.gov/products/GAO/HRD-90-106BR]. Washington, D.C.: June 26, 1990. Refugee Program: Financial Accountability for Refugee Resettlement Can Be Improved. [hyperlink, http://www.gao.gov/products/GAO/NSIAD-89-92]. Washington, D.C.: March 17, 1989. Refugee Programs: Status of Early Employment Demonstration Projects. [hyperlink, http://www.gao.gov/products/GAO/NSIAD-88-91]. Washington, D.C.: February 3, 1988. Refugee Program: Initial Reception and Placement of New Arrivals Should Be Improved. [hyperlink, http://www.gao.gov/products/GAO/NSIAD-86-69]. Washington, D.C.: April 7, 1986. Greater Emphasis on Early Employment and Better Monitoring Needed in Indochinese Refugee Resettlement Program. [hyperlink, http://www.gao.gov/products/GAO/HRD-83-15]. Washington, D.C.: March 1, 1983. [End of section] Footnotes: [1] ORR considers refugees to be self-sufficient if they have earnings and do not receive cash assistance, even if they receive other types of public assistance, such as Supplemental Nutrition Assistance Program (SNAP) benefits or Medicaid. [2] H.R. Rept. No. 111-220 at 162 (2009). [3] An unobligated balance represents the portion of the unexpended balance of an appropriation unencumbered by recorded obligations. [4] The discussion groups focused primarily on the refugees' experiences before coming to the United States and the assistance they received from the voluntary agencies. [5] Data limitations stem from the fact that performance data are reported by multiple agencies. [6] 8 U.S.C. § 1101(a)(42)(A). In special circumstances, a refugee also may be a person who is within his or her country and who is persecuted or has a well-founded fear of persecution on account of race, religion, nationality, membership in a particular social group, or political opinion. Excluded from the definition of a refugee is any person who participated in the persecution of another. [7] The Department of State submits a report to Congress with its recommendations on how many refugees should be admitted, which according to Department of State officials, takes into account government agencies' refugee processing capabilities. [8] Pub. L. No. 96-212, 94 Stat. 102. [9] The intent of the legislation was, among other things, to end an ad hoc approach to refugee admissions and resettlement that had characterized U.S. refugee policy since World War II. [10] In addition to refugees, other groups are eligible for the same benefits and services for which refugees are eligible, including asylees (persons physically present in the United States who, in order to be granted asylum, must establish that they are refugees), Cuban/ Haitian Entrants, Amerasians, victims of severe forms of trafficking, and Iraqi and Afghan Special Immigrants. This study generally uses the term "refugees" to refer to all groups that qualify for ORR services. [11] Before the Refugee Act of 1980, voluntary agencies assumed the primary responsibility for resettling refugees in the United States, usually by using their own resources. [12] The Department of State helps fund the services provided to refugees within their first 30 to 90 days in the United States. [13] According to ORR, over the years, the eligibility period for a refugee to receive cash assistance through ORR programs has been shortened. In April 1981, assistance was limited to the first 36 months after a refugee entered the country. The duration of cash and medical assistance available to refugees was reduced to 18 months in 1982, to 12 months in 1988, and to 8 months in 1991, which is the eligibility period that exists today. [14] A state will typically adopt either the Publicly Administered, Wilson/Fish, or Public Private Partnership program on a state-wide basis; however, California has two programs: the Wilson/Fish Program is offered in the County of San Diego, and the Publicly Administered program is offered throughout the rest of the state. [15] While ORR does not consider the Publicly Administered, Public Private Partnership, and Wilson/Fish as three separate programs, we refer to each as a separate program in this report. [16] According to HHS, the Wilson/Fish program was named after Senator Pete Wilson (from California) and Representative Hamilton Fish (from New York), both of whom collaborated to enact the legislation that established the program (8 U.S.C. § 1522(e)(7)). [17] The Matching Grant program is not provided in the following states: Alaska, Arkansas, Delaware, Mississippi, Montana, Oregon, West Virginia, and Wyoming. [18] A refugee does, however, continue to receive medical assistance until he or she reaches the end of his or her time-eligibility period for refugee medical assistance, which may not correspond to the refugee's eligibility period for cash assistance. 45 C.F.R § 400.104(c) [19] According to ORR, refugees who receive assistance from the Matching Grant program may not receive assistance or funding from any of ORR's other three assistance programs at the same time. If a refugee does not find employment after participating in the Matching Grant program for 4 to 6 months, he or she may receive services, including cash and medical assistance, from one of ORR's other assistance programs. [20] Refugee medical assistance is provided through state and local health departments or their proxies, according to ORR. [21] Refugees eligible for ORR-funded social services may include those who are receiving ORR-funded cash assistance and those who are not receiving ORR-funded cash assistance, including refugees participating in the TANF program. [22] Under 45 C.F.R. § 400.53(a)(2), refugees who are eligible for TANF and SSI cannot receive ORR cash assistance under the Publicly Administered or Public Private Partnership program. Refugees receiving cash assistance under the Wilson/Fish program are prohibited from receiving TANF payments pursuant to 8 U.S.C. § 1522(e)(7)(B). [23] 45 C.F.R. § 400.2. The regulations use the term "economic self- sufficiency." [24] According to ORR, it is not authorized to collect similar information related to self-sufficiency for the other three programs-- Publicly Administered, Wilson/Fish, and Public Private Partnership-- without permission from the Office of Management and Budget. The Paperwork Reduction Act requires agencies to get the Office of Management and Budget's approval for information collected from 10 or more nonfederal entities. 44 U.S.C. § § 3502(3) and 3507. ORR officials also said the agency is allowed to collect information related to economic self-sufficiency without the Office of Management and Budget's approval for the Matching Grant program because it is collecting it from less than 10 entities. Nine national voluntary agencies administer the Matching Grant program in 42 states with the help of their affiliates. [25] In this report, we refer to providers as the government and local voluntary agencies who offer ORR-funded services to refugees. [26] The term medical assistance used in this report refers to the assistance provided through ORR-funded programs. [27] ORR does not reimburse providers of the Matching Grant program for all eligible refugees. Voluntary agencies are given a set amount of funds each fiscal year, and must determine the number of refugees they can serve with the set amount. [28] When states' cash and medical assistance expenses exceed the agency's appropriation in a given year, ORR may use its unexpired and unobligated balances to cover costs. [29] The Social Services budget activity does not fund social services for the Matching Grant program. Funding for services for the Matching Grant program comes from the Transitional and Medical Services budget activity. [30] In this report, we use the terms refugees' employment outcomes and programs' performance measures interchangeably. [31] The Publicly Administered program also does not receive dedicated funding from ORR to provide case management activities. Providers of the Publicly Administered, Wilson/Fish, and Public Private Partnership programs may use Refugee Social Service funding to support case management activities as well as other services, such as employment services, immigration assistance, and social adjustment services for up to 5 years, based on available funding. [32] In Massachusetts a state official told us they offer refugees a cash bonus of $600 for finding employment within 4 months and retaining employment for 90 days. In San Diego, a refugee who has 90 days or more of employment within 120 days of his or her arrival to the United States, will receive a cash bonus that is equal to the amount of cash assistance he or she would have received during the second and third months (31 to 90 days) of continuous employment. [33] For the Wilson/Fish and Public Private Partnership programs, cash assistance amounts may range from an amount based on the state's TANF formula to an amount set by ORR within a payment ceiling set by 45 C.F.R. § 400.60. [34] A refugee family consisting of two adults and three children may receive an average monthly amount of $1,220 in cash, rental, and utility assistance from a Matching Grant program in Texas. The same family living in Texas would receive an average of $712 per month in cash, rental, and utility assistance from another assistance program. Compared to the Public Private Partnership program, the Matching Grant program may initially offer higher cash, rental, and utility benefits; however, assistance from the Matching Grant program is provided for up to four months, unless the family needs additional months of rental assistance, according to voluntary agency staff we spoke with. In contrast, a refugee family participating in another assistance program may receive rental and utility assistance for 4 months and cash assistance for up to 8 months. [35] An adult refugee without children would receive an average monthly amount of $367 in cash, rental, and utility assistance over a four-month period from a Matching Grant program in Texas. The same refugee would receive an average monthly amount of $316 in cash, rental, and utility assistance for up to 8 months from the Texas Public Private Partnership program. Overall, a single refugee without children participating in the Public Private Partnership for 8 months could receive about $2,500 whereas a refugee participating in a Matching Grant program for 4 months would receive approximately $1,450. [36] In addition to the Matching Grant program, both the Wilson/Fish and Public Private Partnership programs allow states the flexibility to design their programs in ways that offer intensive case management and integrated services to refugees. [37] According to ORR, refugee families who are enrolled in the Matching Grant program and do not find employment within 4 to 6 months may apply and receive benefits from their states' TANF programs. [38] Refugees receive an initial resettlement grant from the Department of State's Reception and Placement program (through one of the voluntary agencies participating in the program) for their first 30 to 90 days in the United States. [39] Officials in Texas told us that while refugee families with children may be eligible for their Public Private Partnership program, their data show that most families with children are in the Matching Grant program. [40] Families who do not find employment within the 8-month benefit period of Texas's Public Private Partnership program may reapply for the state's TANF program. [41] ORR allows some states to enroll refugees who would otherwise be eligible for TANF under the stipulation that states provide the full amount of TANF funding to the eligible refugee and ORR provides the differential between the TANF payment rate and the Wilson/Fish payment rate. [42] Wilson/Fish programs that accepted TANF-eligible refugees were located in Idaho, North Dakota, South Dakota, and Vermont. [43] Until October of 2009, ORR allowed providers in San Diego County and Colorado to allow TANF-eligible refugees to participate in the Wilson/Fish program. One of the states we visited, Massachusetts, does not allow TANF-eligible refugees to participate in the Wilson/Fish program. [44] The Matching Grant program does not have a job retention performance measure, but it does measure self-sufficiency retention. [45] ORR officials told us that states also collect and report employment outcome information on refugees who have been in the United States for up to 60 months and do not receive ORR-funded cash assistance but receive other types of ORR-funded services. Refugees who do not receive ORR-funded cash assistance but receive other types of ORR assistance may include (1) those who are participating in the TANF program and receiving ORR-funded employment services or (2) refugees who have exhausted their ORR-provided cash assistance but continue to receive ORR-funded employment services. [46] This 1999 study, A Quantitative Comparison of the Effectiveness of Public and Private Refugee Resettlement Programs: An Evaluation of the San Diego Wilson/Fish Demonstration Project (Hohm et al), compared the effectiveness of a privately administered Wilson/Fish program with a Publicly Administered program managed by a county social service agency. The study described the Wilson/Fish program as one agency providing concurrent refugee services in a way that was flexible, outcome oriented, performance based, and budget neutral. In contrast, the Publicly Administered program consisted of multiple agencies that provided consecutive and sequential services in a way that was, for example, bureaucratic and process oriented. The study's results indicated that the average number of cash assistance dollars received, the average number of days the refugee received cash assistance, and the average number of days it took a refugee to find employment were less in the Wilson/Fish program compared to the Publicly Administered program. In addition, the proportion of refugees who participated in the Wilson/Fish program who found employment was higher than the proportion of refugees who participated in the Publicly Administered program. The researchers concluded that the following qualities of the Wilson/Fish program contributed to the differences in performance: integrated services in a single agency, personal and flexible system of service delivery, and intensive support services, such as transportation and assistance with job searches. Two samples of 800 refugees from each of these programs were drawn at random for the period of January 1992 to August 1994. However, subjects were not randomly assigned to these programs. Both samples consisted only of adults without children who were predominately Vietnamese, male, and less than 30 years of age. [47] This report publishes the survey results of refugees who arrived in the United States from 2002 to 2007. For the 2007 survey, a total of 1,205 households were contacted and interviewed. The overall response rate for this survey was 36.6 percent. [48] ORR also uses historical arrival patterns to estimate the numbers of other eligible populations who do not enter the United States through the traditional resettlement process, such as asylees and Cuban Haitian entrants, according to officials. [49] The portion of refugees who did not receive ORR-funded cash assistance may have received benefits from TANF, SSI, or other ORR- funded assistance, such as employment services or language instruction. [50] In fiscal year 2008, 5,130 refugees were resettled in Texas. The 8,212 refugees that were resettled in fiscal year 2009 represent a 60 percent increase. [51] The estimated average cost of providing medical assistance to an estimated number of refugees participating in ORR programs increased significantly over the years from $1,717 per recipient of medical services in fiscal year 1999 to $3,324 in fiscal year 2004 to $4,338 in fiscal year 2009. It is important to note that these average medical costs per refugee are only estimates. We were unable to calculate actual costs in part because ORR does not have an unduplicated count of refugees who have received medical assistance during this time period. In addition, not all states reported their refugee medical expenses in two of the years we examined--fiscal years 1999 and 2004. [52] According to officials at the Department of State Bureau of Population, Refugees, and Migration, the Department of State typically does not provide a refugee's detailed medical information prior to a voluntary agency agreeing to accept a refugee case. Officials believe that providing the refugee's detailed medical information may result in the voluntary agency selecting one refugee case over another. Department of State officials told us they believe that the initial medical information they provide is enough for the national voluntary agency staff to know if the affiliate offices can resettle the refugee. [53] See Pub. L. No. 110-457, § 212, 122 Stat. 5044, 5063. Funds dedicated to the Unaccompanied Alien Children budget activity provide for the care and placement of immigrant children who arrive in the United States without a parent or guardian--a relatively new responsibility for ORR. In March 2003, functions under U.S. immigration law with respect to the care of unaccompanied alien children the presidential ceiling and the accompanying appropriations connected to those functions were transferred to ORR from the Immigration and Naturalization Service in accordance with the Homeland Security Act of 2002. Pub. L. No. 107-296, § 462, 116 Stat. 2135. [54] Funding for the Victims of Torture budget activity cannot be obligated beyond the year in which they are appropriated. [55] In fiscal year 2000, in addition to its unobligated balances, ORR also had approximately $72 million in other unexpended balances, the majority of which were deobligated from states. [56] While refugees participating in the TANF program may not receive cash assistance from ORR's assistance programs, these refugees may receive some resettlement services, such as employment services, from ORR's programs. [57] Ten voluntary agencies administer the Department of State's Reception and Placement Program. Of these, nine administer ORR's Matching Grant Program. [58] In California we did not collect any case files because the agencies were not comfortable with GAO taking the case files off of the premises. [End of section] GAO's Mission: The Government Accountability Office, the audit, evaluation and investigative arm of Congress, exists to support Congress in meeting its constitutional responsibilities and to help improve the performance and accountability of the federal government for the American people. 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