A large part of the money spent goes to pay the people required to run the system, which is why, though it is spent "on the poor", the poor never actually see it.
It's the same with schools. Public-school proponents here love to point out that Utah has the lowest per-pupil spending of any state in the US. Yet if we were to give a teacher thirty students and hand her $146,700 ($4890 per pupil) and say "Teach these kids", think of what she could accomplish!
It's the administration of the programs that sucks up all the money spent, and the people who actually need it get what's left over. But how can it be done differently?
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“Never do anything you can't take back.”
—Rocky Russo
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