I think the best approach for things like welfare would be a checklist with basic things like:
1. Is this person clean?
2. Are they improving their job skills?
3. Are they improving their job finding skills?
4. Is this person literate?
Many people who are on welfare rolls do not have even basic skills like those I defined and are borderline dysfunctional, so an effort should be made to teach them those skills and even trade skills like plumbing or carpentry. If the person does not improve, assign them a job with some agency digging ditches or some other basic labor and if they fail at that, the welfare checks should either be reduced or stop until they improve.
For the medical social programs, there should audit upon audit. A significant percentage of expenses should be proven and it should be compensated at cost + 3% to the medical facility.