Low-Income Workers: Millions of Full-Time Workers in the Private Sector Rely on Federal Health Care and Food Assistance Programs

What GAO Found

The 12 million wage-earning adults (ages 19 to 64) enrolled in Medicaid—a joint federal-state program that finances health care for low-income individuals—and the 9 million wage-earning adults in households receiving food assistance from the federal Supplemental Nutrition Assistance Program (SNAP) shared a range of common labor characteristics. For example, approximately 70 percent of adult wage earners in both programs worked full-time hours (i.e., 35 hours or more) on a weekly basis and about one-half of them worked full-time hours annually (see figure). In addition, 90 percent of wage-earning adults participating in each program worked in the private sector (compared to 81 percent of nonparticipants) and 72 percent worked in one of five industries, according to GAO’s analysis of program participation data included in the Census Bureau’s 2019 Current Population Survey. When compared to adult wage earners not participating in the programs, wage-earning adult Medicaid enrollees and SNAP recipients in the private sector were more likely to work in the leisure and hospitality industry and in food service and food preparation occupations.

Estimated Percentage of Wage-Earning Adult Medicaid Enrollees and Supplemental Nutrition Assistance Program (SNAP) Recipients Working at Least 35 Hours per Week, by Number of Weeks Worked in 2018

GAO’s analysis of February 2020 program data from 15 agencies—six Medicaid agencies and nine SNAP agencies—across 11 states shows that a majority of working adult Medicaid enrollees and SNAP recipients in these states worked for private sector employers. GAO’s analysis also shows that the percentage of working adult Medicaid enrollees and SNAP recipients working for any one employer did not exceed 4 percent in any state that provided data. Most working adults in the programs worked for private sector employers concentrated in certain industries, including restaurants, department stores, and grocery stores. Smaller percentages of working adults in each program in these states worked outside the private sector. For example, less than 10 percent worked for public sector employers, such as state governments, the U.S. Postal Service, or public universities; others worked for nonprofit organizations, such as charities, hospitals, and health care networks, or were self-employed.

Why GAO Did This Study

In October 2020, GAO issued a report entitled Federal Social Safety Net Programs Millions of Full-Time Workers Rely on Federal Health Care and Food Assistance Programs (GAO-20-45.) This testimony summarizes the findings of that report, which examined (1) what is known about the labor characteristics of wage-earning adult Medicaid enrollees and SNAP recipients, and (2) what is known about where wage-earning adult Medicaid enrollees and SNAP recipients work.

To answer these questions, GAO analyzed recent Census Bureau data on the labor characteristics of working adults in the two programs. GAO also analyzed recent (Feb. 2020) non-generalizable data on the employers of working adult Medicaid enrollees and SNAP recipients obtained from 15 state agencies across 11 states. GAO selected state agencies that (1) collected, verified, and updated the names of Medicaid enrollees’ and SNAP recipients’ employers; and (2) could extract reliable data.

What GAO Recommends

GAO made no recommendations.

For more information, contact Cindy S. Brown Barnes at (202) 512-7215 or brownbarnesc@gao.gov.
 

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    What GAO Found In fiscal year 2020, the Missile Defense Agency (MDA) made progress toward achieving its delivery and testing goals for some of the individual systems—known as elements—that combine and integrate to create the Missile Defense System (also known as the Ballistic Missile Defense System). However, MDA did not complete its overall planned deliveries or annual testing. The figure below shows MDA's progress delivering assets and conducting flight tests against its fiscal year 2020 plans. Percentage of Missile Defense Agency Planned Deliveries and Flight Tests Completed for Fiscal Year 2020 Deliveries— In fiscal year 2020, MDA delivered many assets it had planned. Specifically, MDA was able to deliver 82 missile interceptors for 3 elements. However, MDA was not able to deliver all planned interceptors, including one originally planned for 2018 for the Ground-based Midcourse Defense program, as the program experienced delays related to qualifying parts from a new supplier. Flight testing— MDA conducted two planned flight tests, but neither was successful. The issues were due to problems with non-MDA assets, but the agency was able to collect important data. In addition, COVID-19 restrictions also affected the planned schedule. However, the delays continue a trend of MDA's inability to conduct planned annual flight testing, resulting in assets and capabilities that are subsequently delayed or delivered with less data than planned. Ground testing— In fiscal year 2020, MDA continued to implement a new ground testing approach that the agency began in fiscal year 2019. In addition, MDA successfully completed three planned ground tests demonstrating defense capabilities for the U.S., U.S. forces and regional allies. However, MDA delayed two other ground tests to future fiscal years and expects disruptions in fiscal year 2021, in part due to ongoing COVID-19 disruptions. Cyber— Despite failing to meet annual operational cybersecurity assessments since 2017, MDA canceled its planned fiscal year 2020 operational assessments, instead taking steps to implement a new approach designed to improve cyber system requirements while streamlining cyber test planning. It is premature to assess whether this new approach will achieve its intended goals. Why GAO Did This Study For over half a century, the Department of Defense has funded efforts to defend the U.S. from ballistic missile attacks. This effort consists of diverse and highly complex land-, sea-, and space-based systems and assets located across the globe. From 2002 through 2019, MDA—the agency charged with developing, testing, integrating, and fielding this system of systems—received about $162.5 billion. The agency also requested about $45 billion from fiscal year 2020 through fiscal year 2024. In fiscal year 2020, MDA's mission broadened to include evolving threats beyond ballistic missiles such as defending against hypersonic missile attacks. With the inclusion of non-ballistic missile threats, the Ballistic Missile Defense System is in the process of transitioning to the Missile Defense System. Congress included a provision in statute that GAO annually assess and report on MDA's progress. This, our 18th annual review, addresses the progress MDA made in achieving fiscal year 2020 delivery and testing goals. GAO reviewed planned fiscal year 2020 baselines, along with program changes due to COVID-19 restrictions, and other program documentation and assessed them against responses to GAO detailed question sets and program and baseline reviews. GAO also interviewed officials from MDA and various Department of Defense Combatant Commands. We do not make any new recommendations in this report but continue to track the status of prior recommendations. For more information, contact John D. Sawyer at (202) 512-4841 or SawyerJ@gao.gov.
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  • VA Disability Benefits: VA Should Continue to Improve Access to Quality Disability Medical Exams for Veterans Living Abroad
    In U.S GAO News
    The number of disability claims for veterans living abroad—in foreign countries or U.S. territories—increased 14 percent from fiscal years 2014 to 2019. During this time period, claims processing time frames improved. In fiscal year 2019, the Veterans Benefits Administration (VBA) of the Department of Veterans Affairs (VA) approved comparable percentages of disability claims for veterans living abroad and domestically—63 percent and 64 percent respectively. However, for a subset of these claims—those where veterans likely received a disability medical exam scheduled by Department of State (State) embassy staff—approval rates were often lower. Veterans' access to disability medical exams abroad improved as VBA has increasingly relied on contracted examiners, rather than embassy-referred examiners, to conduct these exams. According to VBA, this shift expanded the pool of trained examiners abroad and increased the frequency and depth of VBA's quality reviews for contract exams. These quality reviews help VBA and its contractor identify and address common errors, according to VBA and contractor officials. However, several factors continue to limit some veterans' ability to access quality disability medical exams (see figure). Factors That Impair the Access of Veterans Living Abroad to Quality Disability Medical Exams Unknown quality of certain exams: A subset of veterans living abroad receive disability medical exams from an embassy-referred provider. VBA does not systematically assess the quality of these exams. Without doing so, VBA cannot determine if such exams affect the approval rates of veterans who receive them or contribute to longer processing times and are unable to make informed decisions about their use. Travel reimbursement: Under current VA regulations, VA is not authorized to reimburse veterans for travel expenses for certain services incurred in foreign countries as it is for those incurred within the United States, including U.S. territories. Consequently, some veterans living in foreign countries may be unable to afford to travel to exams. Examiner reimbursement: The Veterans Health Administration's (VHA) Foreign Medical Program reimburses examiners referred by embassy staff via paper checks in U.S. currency. These checks may be slow to arrive and not accepted by foreign banks, according to State and other officials and staff we interviewed. Such payment issues can deter examiners from being willing to conduct disability medical exams and thus limit veterans' access to these exams in foreign countries. Of the roughly 1 million disability claims VBA processed in fiscal year 2019, 18,287 were for veterans living abroad. Veterans living abroad are entitled to the same disability benefits as those living domestically, but GAO previously reported that veterans living abroad may not be able to access disability medical exams as readily as their domestic counterparts. VBA uses medical exam reports to help determine if a veteran should receive disability benefits. GAO was asked to review the disability claims and exam processes for veterans living abroad. Among other things, this report examines disability claims trends for veterans living abroad and these veterans' ability to access quality disability medical exams. GAO analyzed VBA claims data for fiscal years 2014 to 2019; assessed data reliability; reviewed relevant federal laws, regulations, policies, and contract documents; and interviewed employees of VBA, State, and other stakeholders. GAO is making five recommendations, including that VBA assess the quality of embassy-referred exams, VBA and VHA assess whether to reimburse beneficiaries for travel to disability medical exams in foreign countries, and that VBA and VHA pay examiners located by embassy staff electronically. The Department of Veterans Affairs concurred with GAO's recommendations. For more information, contact Elizabeth Curda at (202) 512-7215 or curdae@gao.gov.
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  • Substance Use Disorder: Medicaid Coverage of Peer Support Services for Adults
    In U.S GAO News
    Substance use disorders (SUD)—the recurrent use of alcohol or illicit drugs causing significant impairment—affected about 19.3 million adults in the United States in 2018, according to the Substance Abuse and Mental Health Services Administration. State Medicaid programs have the option to cover services offered by peer providers—individuals who use their own lived experience recovering from SUD to support others in recovery. GAO's review of Medicaid and CHIP Payment and Access Commission data found that, in 2018, 37 states covered peer support services for adults with SUDs in their Medicaid programs. Medicaid Coverage of Peer Support Services for Adults with Substance Use Disorders, 2018 Officials from the three states GAO reviewed—Colorado, Missouri, and Oregon—reported that their Medicaid programs offered peer support services as a complement, rather than as an alternative, to clinical treatment for SUD. Missouri officials said that peer providers did not maintain separate caseloads and were part of treatment teams, working in conjunction with doctors and other clinical staff. Similarly, officials in Colorado and Oregon said peer support services were only offered as part of a treatment plan. State officials reported that peer support services could be offered as an alternative to clinical treatment outside of Medicaid using state or grant funding. SUD treatment can help individuals reduce or stop substance use and improve their quality of life. In 2007, the Centers for Medicare & Medicaid Services recognized that peer providers could be an important component of effective SUD treatment, and provided guidance to states on how to cover peer support services in their Medicaid programs. However, states have flexibility in how they design and implement their Medicaid programs, and coverage for peer support services is an optional benefit. The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act included a provision for GAO to report on peer support services under Medicaid. This report describes, among other objectives, the extent to which state Medicaid programs covered peer support services for adult beneficiaries with SUDs nationwide, and how selected state Medicaid programs offered peer support services for adult beneficiaries with SUDs. GAO obtained state-by-state data from the Medicaid and CHIP Payment and Access Commission on 2018 Medicaid coverage of peer support services. GAO also reviewed information and interviewed officials from a nongeneralizable sample of three states, which GAO selected for a number of reasons, including to obtain variation in delivery systems used. The Department of Health and Human Services provided technical comments on a draft of this report, which GAO incorporated as appropriate. For more information, contact Carolyn L. Yocom at (202) 512-7114 or yocomc@gao.gov.
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  • Former Owner of Aquarium Business Sentenced to Prison for Illicit Trafficking of Protected Reef Creatures
    In Crime News
    The Justice Department announced today that a Puerto Rico man was sentenced to a year and a day in federal prison for felony violations of the Lacey Act that involved the trafficking and false labeling of protected reef creatures as part of an effort to subvert Puerto Rican laws designed to protect coral reef organisms.
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  • Michigan Man Pleads Guilty to Conspiring to Defraud the IRS and to Steal Crash Reports from the Detroit Police Department
    In Crime News
    A Birmingham, Michigan, resident pleaded guilty today to conspiring to defraud the IRS and to steal from an organization receiving federal funds, announced Acting Deputy Assistant Attorney General Stuart M. Goldberg of the Justice Department’s Tax Division.
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    In Crime Control and Security News
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    In Crime Control and Security News
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    In Crime Control and Security News
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    In Crime Control and Security News
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    In Space
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  • Leon DeKalb: U.S. Probation’s First Black Officer
    In U.S Courts
    Leon Elmer DeKalb made history nearly 80 years ago when he became the first African American probation officer in the federal court system.
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  • DRL Promoting Transparent and Accountable Governance in the Indo-Pacific Region
    In Human Health, Resources and Services
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  • Federal Justice Statistics, 2017-2018
    In Justice News
    (Publication)
    This report is the 32nd in an annual series based on data from BJS's Federal Justice Statistics Program, which began in 1979.
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    In Crime Control and Security News
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    In Crime Control and Security News
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  • Three Individuals Charged with Arranging Adoptions from Uganda and Poland Through Bribery and Fraud
    In Crime News
    Three women were charged in a 13-count indictment filed on Aug. 14 in the Northern District of Ohio for their alleged roles in schemes to corruptly and fraudulently procure adoptions of Ugandan and Polish children through bribing Ugandan officials and defrauding U.S. adoptive parents, U.S. authorities, and a Polish regulatory authority.
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  • The International Visitor Leadership Program: Celebrating 80 Years
    In Crime Control and Security News
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  • On Transparency and Foreign Funding of U.S. Think Tanks
    In Crime Control and Security News
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  • Return to Election Negotiations
    In Crime Control and Security News
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    In Crime Control and Security News
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  • Mississippi Tax Preparer Sentenced to Prison for False IRS Returns
    In Crime News
    A Moss Point, Mississippi, resident was sentenced to 22 months in prison for preparing false tax returns, announced Principal Deputy Assistant Attorney General Richard Zuckerman of the Justice Department’s Tax Division and U.S. Attorney Mike Hurst for the Southern District of Mississippi.
    [Read More…]
  • Utah Man Posing As Medical Doctor To Sell Baseless Coronavirus Cure Indicted On Fraud Charges
    In Crime News
    Utah resident Gordon H. Pedersen has been indicted for posing as a medical doctor to sell a baseless treatment for coronavirus (COVID-19). According to the indictment returned by a federal grand jury in Salt Lake City late last week, Pedersen fraudulently promoted and sold ingestible silver-based products as a cure for COVID-19 despite having no evidence that his products could treat or cure the disease. Pedersen is also alleged to have claimed to be a physician and worn a stethoscope and white lab coat in videos and photos posted on the Internet to further his alleged fraud scheme.
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  • Remarks by Attorney General William P. Barr at the Major Cities Chiefs Association Conference
    In Crime News
    I appreciate the invitation to address this group.  I want to start by thanking you, and the men and women you lead, for serving in what I think is the most noble profession in our country – enforcing the law and keeping our communities safe. 
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  • Attacks by the Terrorist PKK Organization in the IKR
    In Crime Control and Security News
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    In Crime Control and Security News
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    In Crime Control and Security News
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  • The Scripps Research Institute To Pay $10 Million To Settle False Claims Act Allegations Related To Mischarging NIH-Sponsored Research Grants
    In Crime News
    The Scripps Research Institute (TSRI) has agreed to pay the U.S. $10 million to settle claims that it improperly charged NIH-funded research grants for time spent by researchers on non-grant related activities such as developing, preparing, and writing new grant applications, teaching, and engaging in other administrative activities, the Department of Justice announced today. 
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  • Secretary Blinken’s Call with Pakistani Foreign Minister Qureshi
    In Crime Control and Security News
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    In Travel
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