What GAO Found All states that receive funding under Title I of the Elementary and Secondary Education Act of 1965, as amended (ESEA) are required to develop statewide accountability systems. Thirty-six states have chosen to include indicators related to chronic absenteeism in their statewide accountability systems. ESEA also has certain chronic absenteeism reporting requirements for all states, regardless of whether a state includes chronic absenteeism in its accountability system. In 2026, the Department of Education discontinued its most comprehensive monitoring of ESEA’s programmatic and fiscal requirements. The ESEA provision intended to improve oversight of funds does not explicitly direct Education to monitor grantees, nor does it include specific requirements regarding the method or frequency of monitoring and oversight activities. Suspending its most comprehensive monitoring has broad oversight implications that extend beyond chronic absenteeism. Given that Education is not currently assessing ESEA compliance with Title I fiscal requirements, there is higher risk that these federal funds—comprising about two-thirds of the nearly $27 billion in ESEA funding in 2025—could be subject to undetected fraud, waste, or abuse. While Education requires states to report data on chronically absent students using a standard method, the way Education uses those data to calculate chronic absenteeism rates can be unreliable. For example, Education directs states to report the number of chronically absent students over a school year, but to report total enrollment based on a single date. Calculating rates using mismatched timeframes has resulted in unreliable and implausible chronic absenteeism rates (e.g., rates over 100 percent), according to GAO’s analysis. GAO calculated rates at the school level and found this was especially true in low-performing schools where enrollment fluctuates more often, and shared-time schools which students attend for partial days, such as those housing career and technical education programs. Specifically, over 30 percent of these schools had implausible rates compared to under 2 percent for other schools. Methods of Calculating the Chronic Absenteeism Rates Missing school means missing valuable instructional time and poses serious implications for students' overall academic success and wellbeing. Absent quality chronic absenteeism data, this nationwide data source cannot be used to reliably track trends or evaluate the effectiveness of accountability efforts and interventions to address chronic absenteeism. Why GAO Did This Study Chronic absenteeism, which Education defines as missing 10 percent or more school days, is associated with decreased academic performance. As recently as February 2026, Education cited chronic absenteeism as a key challenge. Education has also noted that chronic absenteeism remains elevated following the COVID-19 pandemic. At least one-quarter of K-12 students were estimated to be chronically absent in recent years. GAO was asked to examine federal oversight related to chronic absenteeism. This report examines (1) how states have incorporated chronic absenteeism into their statewide accountability systems and the extent to which Education’s monitoring addresses relevant federal requirements and (2) the extent to which Education has leveraged its data to help address chronic absenteeism. GAO reviewed relevant federal laws and analyzed Education’s guidance and relevant monitoring reports since 2019, when Education fully implemented its main ESEA monitoring strategy. GAO also analyzed Education’s school year 2022–2023 chronic absenteeism data (the most recent available).

What GAO Found Under the Controlled Substances Act, substances that pose a risk of abuse and dependence are placed in categories—referred to as schedules. To carry out certain scheduling actions, the Drug Enforcement Administration (DEA) is required to obtain a scheduling recommendation from the Department of Health and Human Services (HHS) based on a scientific and medical evaluation from the Food and Drug Administration (FDA). Evaluations and recommendations from HHS or DEA are not required for substances scheduled through legislation. Of the 208 substances for which DEA took scheduling actions from 2020 through 2025, DEA considered HHS evaluations and recommendations for all 95 substances for which they were required. Of those 95 substances, DEA’s final scheduling decision aligned with HHS’s recommendation for all 84 substances for which DEA had published a final rule as of December 31, 2025. The remaining 11 substances were still under extended temporary scheduling orders. We selected this timeframe to assess DEA scheduling actions during the most recent 6 calendar years. DEA and FDA have policies that address aspects of the scheduling process, including a memorandum of understanding (MOU) for sharing information; however, these policies have gaps. For example, DEA does not have policies that identify roles, responsibilities, and procedures related to scheduling. FDA does not have policies or procedures specifying how its staff are to conduct evaluations or develop recommendations. Developing such policies and procedures could help ensure operational consistency, especially if key personnel with longstanding subject matter expertise depart. The below figure shows DEA and FDA methods for coordinating regarding evaluations and recommendations for substances. Figure: DEA and FDA Methods for Coordinating Regarding Evaluations and Recommendations for Substances FDA has another MOU with the National Institutes of Health’s (NIH) National Institute on Drug Abuse (NIDA) that describes procedures for FDA to consult NIDA when developing recommendations, but the MOU is over 40 years old and does not reflect the current entities involved or procedures. Without updating and regularly reviewing the MOU, FDA and NIDA staff may not know the entities and procedures to follow to ensure that NIDA’s expertise about drug abuse informs scheduling recommendations. According to DEA and FDA officials, differences of scientific opinion between the two agencies about a substance’s schedule have occurred rule but are rare. In such cases, they usually discuss their differences, share information, and resolve differences prior to soliciting public comments. Why GAO Did This Study The use of illicit drugs and misuse of prescription drugs has been a long-standing public health issue in the U.S. DEA, in consultation with HHS, may schedule such substances. Scheduling and quantity of a controlled substance control the extent to which criminal penalties under the Controlled Substances Act may be levied. Members of Congress have raised questions about how DEA considers HHS evaluations and recommendations. This report identifies when DEA is required to request and consider HHS evaluations and recommendations, the extent to which DEA requested and considered HHS evaluations and recommendations for scheduling actions from 2020 through 2025, and the extent to which the agencies have related policies. GAO analyzed relevant statutes and regulations, available agency policies, and DEA and FDA data on substances for which DEA took scheduling actions. GAO analyzed regulatory dockets to validate and supplement data. GAO also interviewed officials from DEA and HHS, including FDA and NIH.

What GAO Found The Vocational Rehabilitation (VR) and Medicaid home- and community-based services (HCBS) programs are the primary sources of federal funds supporting employment services for individuals with intellectual or developmental disabilities (I/DD), according to officials. The VR and I/DD agencies that administer these programs within three selected states—Georgia, Pennsylvania, and Washington—generally compensated employment service providers based on either units of services rendered, such as billed time, or when supported individuals achieved milestones, such as job placement. These compensation models can present different drawbacks. For example, according to one employment service provider, compensation based on units of services rendered does not incentivize providers to reduce the services they provide as an individual develops job skills. In contrast, milestone-based compensation may not cover a provider’s actual costs, which can vary in unforeseen ways, according to employment service providers that GAO interviewed. The VR and I/DD agencies within the selected states established procedures for funding employment services and collaborating with service providers to jointly support individuals with I/DD. In these states, VR and I/DD agencies generally funded employment services sequentially with the VR agency funding them before the I/DD agency followed through Medicaid HCBS. According to state VR and I/DD officials, such sequencing of services was more common than braiding, which uses multiple funding streams separately and simultaneously to provide services to an individual. Strategies for Using Different Funds to Increase Employment for Individuals with Disabilities Employment service providers that GAO interviewed in these states identified challenges in using funds from the VR and Medicaid HCBS programs in combination to support individuals. They described the administrative burden of navigating two state agencies as a challenge that contributed to service gaps. For instance, according to a service provider in Pennsylvania, I/DD service coordinators experienced confusion about whether a closure letter from the state’s VR agency was necessary before employment services through Medicaid HCBS were allowed, creating unnecessary service gaps for some individuals. The federal Departments of Education, Health and Human Services, and Labor have issued guidance and provided some technical assistance on using different program funds to increase employment for individuals with disabilities that could address these challenges. For example, a letter issued jointly in 2022 encouraged state agencies and others to coordinate different funding streams to support individuals with disabilities seeking employment. The guidance cited specific strategies for using different funds in combination, such as sequencing and braiding, to increase such employment. Why GAO Did This Study An estimated 2 million adults in the United States have I/DD, such as Down syndrome and cerebral palsy. Although many want to and can work, they are less likely to be employed than those without disabilities. Given concerns that employment service providers for individuals with I/DD often struggle to secure funding, GAO was asked to review how the federal government supports individuals with I/DD in employment and the degree to which separate federally funded programs could lead to inefficiencies. This report provides information about how VR and I/DD agencies in selected states compensated employment service providers and coordinated funding from VR and Medicaid HCBS programs, challenges the employment service providers experienced in using these program funds, and related federal guidance. GAO examined how the state VR and Medicaid HCBS programs operated in a nongeneralizable sample of three states selected based on variation in programmatic factors and geography. In each state, GAO reviewed VR and I/DD agency documents and interviewed state officials and employment service providers. GAO also reviewed relevant federal guidance and spoke with representatives of professional associations supporting individuals with I/DD. For more information, contact Elizabeth H. Curda at CurdaE@gao.gov.

What GAO Found More than 9 million enrolled veterans are eligible to receive health care services through the Department of Veterans Affairs’ (VA) Veterans Health Administration (VHA) each year. Veterans who meet certain requirements (such as having a 100 percent service-connected disability or being former prisoners of war) are also eligible to receive VA dental benefits. According to VA, about 26 percent of VHA-enrolled veterans were eligible to receive dental benefits as of February 2026. According to VHA data, the number of veterans eligible for VA dental benefits increased from fiscal years 2020 through 2025, resulting in an overall increase of approximately 70 percent from fiscal year 2020 through fiscal year 2025. Number of VHA-Enrolled Veterans Eligible for VA Dental Benefits, Fiscal Years 2020–2025 The increase in the number of veterans eligible for dental benefits was largely driven by increases in veterans eligible because of a 100 percent service-connected disability rating or a 100 percent service-connection compensation rate due to the inability to work, according to VHA data. GAO’s review of VHA data regarding demographic characteristics of veterans eligible for VA dental benefits (age, sex, race and ethnicity, and rurality of residence) from 2020 through 2025 found that the largest increase in veterans eligible for VA dental benefits occurred among younger veterans (under age 50). Specifically, younger veterans composed 21 percent of eligible veterans in 2020 compared to 36 percent in 2025. Other demographic characteristics of veterans remained relatively constant. Using VHA data for 2025, GAO estimated that if all veterans with heart disease were eligible for dental benefits, the number of veterans eligible for VA dental benefits could increase by 25 percent from about 2.45 million to about 3.07 million. VHA officials and dental providers from selected facilities reported that if such an expansion were to occur, VA may need to consider hiring additional dental providers and increasing dental clinic space to accommodate it. Why GAO Did This Study According to VA, poor oral health can affect veterans’ overall health. Additionally, the American Heart Association and others have reported a link between poor oral health and other serious health conditions, such as heart disease. Congress has considered expanding eligibility for VA dental benefits to veterans with a diagnosis of heart disease. For example, the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act required VA to begin a pilot program in 2026 in which VA provides dental benefits to certain veterans with heart disease. The act also includes a provision for GAO to examine VA dental services and benefits. This report describes (1) the population of veterans eligible for VA dental benefits and (2) the potential effect of including all veterans with heart disease in the population eligible for VA dental benefits. GAO interviewed VHA officials and reviewed VHA documentation and data for calendar and fiscal years 2020 through 2025, the most recent full years of data available. GAO interviewed dental providers and staff from three VHA facilities, selected because they participated in a pilot program through which veterans without VA dental benefits could receive free or reduced-cost dental care. GAO also collected information from VA lead dentists and interviewed representatives from four relevant national organizations and three veterans service organizations, selected because they represent dental providers or could provide information about veterans’ dental care experiences. For more information, contact Sharon M. Silas at silass@gao.gov.

What GAO Found The U.S. Agency for International Development (USAID) allocated $624 million in Economic Support Fund (ESF) assistance for the West Bank and Gaza for fiscal years (FY) 2022-2024. This assistance funded 37 prime awards for sectors including water infrastructure and education, as well as debt relief payments to a Palestinian Authority creditor. With a few exceptions, USAID complied with its anti-terrorism policies and procedures. State took over administration of this ESF funding from USAID in July 2025. All 37 awards have ended except for support to the East Jerusalem Hospital Network. U.S.-Funded Neonatal Intensive Care Training for East Jerusalem Hospital Network State’s Bureau of Near Eastern Affairs (NEA) is managing the remaining USAID activities in the West Bank and Gaza. Congress appropriated ESF funding in FY 2025 and National Security Investment Programs (NSIP) funding in FY 2026 that State can use for the West Bank and Gaza if oversight requirements are met. Officials told GAO that State’s planning had identified potential early recovery and economic development programming for West Bank and Gaza, but State has not yet determined responsibility for managing such programs. According to State officials, ongoing regional conflict has delayed NEA’s initial efforts to replace USAID’s anti-terrorism policies and procedures for West Bank and Gaza. Once developed, these policies and procedures would not necessarily apply to State components other than NEA, such as the U.S. Embassy in Jerusalem, if they become responsible for future programming. State guidance says that risks should be identified, evaluated, and mitigated. Determining and documenting how relevant components will mitigate terrorism risk could help State ensure that such assistance is not diverted to terrorist ends. As State determines its risk mitigation measures, it could incorporate leading practices and lessons learned. GAO has identified mandatory provisions in award agreements as a leading oversight practice. This practice, formerly used by USAID, could help State ensure awardees understand their anti-terrorism obligations and associated penalties. Additionally, State could directly leverage USAID lessons learned by adopting timelines for any future compliance audits. As GAO has previously reported, these timelines could help ensure that appropriate corrective actions can be taken to address any noncompliance before awards expire. Incorporating these leading practices and lessons learned would strengthen State’s oversight of future funding to the West Bank and Gaza. Why GAO Did This Study Since 1993, the U.S. has provided more than $7.8 billion in assistance to Palestinians in the West Bank and Gaza primarily through ESF assistance. Appropriations acts for FY 2022-2024 include provisions for GAO to review the treatment, handling, and uses of ESF funds provided for assistance to the West Bank and Gaza. This report examines (1) the status of USAID’s West Bank and Gaza program supported by FY 2022-2024 ESF assistance, (2) the extent to which USAID complied with its anti-terrorism policies and procedures, and (3) U.S. plans for oversight of future ESF or NSIP assistance in the West Bank and Gaza. GAO reviewed relevant policies and data from USAID and State, as well as compliance reports and financial audits conducted by third parties. GAO also analyzed prime awards and a random generalizable sample of subaward actions for compliance with USAID’s anti-terrorism policies and procedures. Finally, GAO conducted fieldwork in Israel and the West Bank and interviewed USAID and State officials.

What GAO Found The National Nuclear Security Administration (NNSA) has traditionally used a single, all-encompassing management and operating (M&O) contract at each of its sites to acquire work performed, including to subcontract for construction services. Beginning in 2014, NNSA introduced individual contract line item numbers (line items) to some contracts to increase the visibility of specific efforts. Line items capture information about separately identifiable goods and services that the government seeks to acquire within the scope of the overall contract. Since introducing individual contract line items in 2014, NNSA has minimally used line items to separate contract deliverables, especially for construction projects. Specifically, five of NNSA’s 21 capital asset projects that had approved performance baselines as of June 2026 are covered by separate line items in the M&O contracts (see table). One smaller project and two projects under a former contract were completed as separate contract line items. NNSA officials told GAO they are considering adding at least two other construction projects at one site as separate line items. Ongoing Construction Projects with Separate Contract Line Items in the National Nuclear Security Administration’s Management and Operating Contracts Line item Contract Uranium Processing Facility (2 projects) Y-12 National Security Complex Savannah River Plutonium Processing Facility (2 projects) Savannah River Site Power Sources Capability Sandia National Laboratories Source: GAO analysis of National Nuclear Security Administration data. | GAO-26-108409 According to NNSA officials and M&O contractor representatives GAO interviewed, contract line items can enhance transparency of procurement data and allow NNSA to develop separate contractor fee plans and performance evaluations for high-risk, high-value projects. However, officials said these separate fee plans and performance evaluations require additional administrative resources to implement. Because line items can have both benefits and drawbacks, NNSA officials stated that they decide which deliverables are most appropriate to oversee through contract line items based on several considerations, such as the total project cost, complexity, and whether there are dedicated appropriations. However, NNSA has not documented the criteria for determining how and when officials should decide to use separate line items. Without doing so, NNSA lacks reasonable assurance that contracting officers are using consistent and appropriate criteria when determining separate line items. This could result in missed opportunities to improve accountability and contractor performance. NNSA also has not fully assessed and documented lessons learned from its use of line items, which could be used to inform its future use of line items. By documenting lessons learned, NNSA can ensure it retains information that could help it to most effectively and appropriately use line items and avoid expending administrative resources on ineffective acquisition approaches. Why GAO Did This Study Over the next decade, NNSA plans to spend almost $200 billion modernizing the nation’s nuclear weapons production and research infrastructure. In fiscal year 2025, NNSA spent close to $24 billion on multi-year, multi-billion-dollar M&O contracts to run the government-owned, contractor-operated sites of the nuclear security enterprise. Senate Report 118-188, accompanying S. 4638, the National Defense Authorization Act for Fiscal Year 2025, includes a provision for GAO to review NNSA’s use of line items in its M&O contracts and how line items can improve contract oversight. This report examines (1) the extent to which NNSA has used line items in its M&O contracts; (2) the benefits and drawbacks of using line items, according to officials and contractors; and (3) how NNSA determines when to use line items in M&O contracts. GAO reviewed NNSA’s M&O contracts and compared NNSA’s use of line items to Department of Energy (DOE) acquisition policy and relevant standards for internal control. GAO also interviewed DOE and NNSA headquarters and field office officials and M&O contractor representatives.

What GAO Found As part of the federal government’s efforts to support Tribes and tribal members’ health and to help prevent disease, an Indian Health Service (IHS) program provides Tribes with technical and financial assistance to build drinking water and wastewater infrastructure in tribal communities. Through this program, IHS staff work closely with Tribes to identify their needs and design and build water projects. Several U.S. Environmental Protection Agency (EPA) and U.S. Department of Agriculture (USDA) programs also provide assistance for tribal water projects, and the three agencies often work together and with Tribes. Selected Agencies’ Funding for Tribal Water Projects, Fiscal Year 2025 IHS has determined that only certain homes are eligible for funding as part of a community tribal water project based on its interpretation of its statutory authority to build water infrastructure for “Indian homes, communities, and lands.” This excludes various homes that tribal members live in, such as those owned by a spouse or grandparent who is not a tribal member—something tribal officials said is common in tribal communities. It also excludes homes owned by Tribes or tribal members that are rented to other tribal members with fewer than 5 years on the lease or to community service providers (e.g., teachers or law enforcement) who are not tribal members. Examples of Water Infrastructure in Underserved Tribal Communities When an IHS-funded project includes ineligible properties, such as nontribal homes or community buildings, Tribes and the IHS staff helping them must provide or obtain other funding for these properties’ costs. This can lead to high administrative costs, such as to help Tribes navigate other federal agencies’ differing application processes. This can be expensive and inefficient for IHS when such activities cost as much or more than the project costs of these properties. For example, IHS officials reported spending over 80 hours helping one Tribe obtain a $8,000 grant, plus more hours helping the Tribe report on how it spent the grant. Congress could help IHS more efficiently fund projects and expedite delivering safe water to more tribal members by (1) defining in law “Indian homes, communities, and lands” to clarify which homes and buildings in a tribal community should be eligible for IHS funding, and (2) authorizing IHS to create an exception to allow it to fund ineligible properties when administrative costs would exceed the costs to serve them. These changes would enable IHS to focus more of its limited resources on projects when Tribes do not need to pursue other funding for IHS-ineligible properties. EPA, USDA, and IHS have opportunities to streamline processes and requirements to reduce administrative burdens for Tribes and IHS staff, help Tribes more easily access funding, and make agency collaboration efforts more cost effective. For example: USDA requires additional financial information from Tribes for underwriting to help ensure project sustainability, which can be burdensome for Tribes. IHS and EPA do not require such information or underwriting for their programs. Further streamlining the standard interagency agreements that EPA and IHS use in part to facilitate joint funding of water projects, changing how IHS can distribute EPA funding for projects to Tribes, and streamlining EPA’s application process for certain projects in IHS’s project database could minimize the additional time IHS staff spend helping Tribes pursue EPA funding and administering that funding, which can be significant. Maintenance of a Tribal Water Tank After water infrastructure construction is complete, Tribes’ limited financial capacity can contribute to challenges with operating and maintaining their infrastructure, which can lead to it deteriorating and failing early. For example, Tribes face difficulties with hiring and retaining certified water operators who keep systems in working order, according to an agency study. This can create risks to tribal health and increase costs to the federal government from needing to repair or replace infrastructure. IHS generally does not provide funding to Tribes for routine operations and maintenance (O&M). While IHS has assessed tribal capacity to fund O&M, it has not assessed whether funding O&M could result in federal cost savings and better tribal health. Since Tribes’ needs can vary, more information on the effects of funding O&M on federal costs could help Congress make decisions on how to cost effectively meet those needs. However, IHS officials have said IHS does not have the authority or funding to pay O&M costs. By establishing an IHS pilot program for routine O&M assistance for tribal water infrastructure, Congress would enable IHS to provide direct, on-the-ground assistance to participating Tribes while collecting data that could inform decision-making on whether it is cost-effective to provide that assistance to Tribes on a broader scale. Why GAO Did This Study Safe drinking water and wastewater disposal are critical to public health, but many Tribes have limited resources to build, operate, and maintain water infrastructure. Tribes often do not have access to the same financing options and traditional tax bases as other communities. Tribal water systems have been underdeveloped, and many have fallen into disrepair because of chronic underfunding, according to the U.S. Commission on Civil Rights. IHS estimated that as of November 2025, $6 billion was needed to ensure all tribal communities have access to safe water. GAO has previously reported that Tribes face systemic barriers to accessing federal assistance, including for tribal water infrastructure. IHS, within the Department of Health and Human Services, EPA, and USDA have taken steps to better collaborate with each other, including through a tribal infrastructure task force, but Tribes may continue to experience barriers. Many Tribes also have limited capacity to operate and maintain their water infrastructure, according to agency studies. GAO was asked to review federal tribal water infrastructure assistance. This report examines the extent to which (1) IHS can fund water infrastructure for various properties in a tribal community, (2) opportunities exist to address differing agency processes and requirements when IHS collaborates with other agencies, and (3) IHS funds the operations and maintenance of tribal water infrastructure. GAO reviewed agency data and program documents, including interagency and task force documents; conducted site visits to Alaska and Arizona; and interviewed Tribes, tribal organizations, and headquarters and regional agency officials.

What GAO Found Section 889 of the John S. McCain National Defense Authorization Act for Fiscal Year 2019 prohibits federal agencies from procuring covered telecommunications and surveillance equipment and services from five specific Chinese companies (and their affiliates or subsidiaries) or awarding contracts to companies that use such equipment and services. Following implementation in fiscal year 2019, agencies reduced spending with the five companies through fiscal year 2025 with no spending in three of those fiscal years. As of March 2026, GAO found that nearly 90 percent of companies with active government contracts in fiscal year 2025 represented publicly that they do not use equipment from these companies. Federal Obligations to Five Identified Companies in Section 889 Prohibitions, Fiscal Years 2016-2025   Note: Agencies could have used a waiver to make awards after 2019, which the statute permitted for a certain time. The General Services Administration (GSA) and Department of Defense (DOD) have processes to help ensure they do not buy the prohibited equipment and services or contract with vendors that use such equipment and services. For example, GSA has automated processes to remove prohibited equipment and services on its Multiple Award Schedule contracts used by other agencies. DOD and GSA have search tools that contracting officers and purchase cardholders can use to determine how contractors represent their compliance with the prohibitions in the System for Award Management. However, GSA and DOD do not broadly share their insights from implementing Section 889 prohibitions with other government agencies. This would include information about the five companies’ subsidiaries and affiliates and methods the two agencies have used to enhance insight into the supply chain. For example, based on its experience with Section 889 prohibitions, GSA has plans to expand its use of customs data to identify the origin of goods, which GAO previously reported is difficult to do. By sharing information about their experience with current prohibitions, GSA and DOD could help other agencies address additional upcoming statutory prohibitions, such as on semiconductors. Sharing information could also help improve compliance. Why GAO Did This Study Concerns about the U.S. government’s reliance on Chinese companies for telecommunications and information technology have existed for more than a decade. Government agencies have reported concerns that government procurement of certain foreign-made items could facilitate cyberattacks, espionage, and threats to U.S. national security. A House report asked GAO to report on implementation of Section 889 prohibitions. GAO’s report assesses, among other objectives, how selected agencies have taken actions to ensure compliance with the prohibitions and the extent to which these agencies are sharing information to improve their ability to implement prohibition efforts. GAO identified GSA and DOD processes for ensuring compliance with prohibitions and analyzed federal procurement and System for Award Management data. GAO focused on DOD and GSA as they together account for nearly two-thirds of fiscal year 2025 contract obligations and GSA supports procurements across government agencies. GAO also interviewed GSA and DOD officials to obtain their perspectives on government efforts to comply with prohibitions.

What GAO Found The General Services Administration (GSA) owns and leases thousands of office buildings, which are used by federal employees and the public. The Architectural Barriers Act of 1968 (ABA) requires that certain GSA office buildings be accessible to individuals with physical disabilities. According to GSA officials and documentation, GSA reviews alteration, leasing, and construction projects throughout the design process for compliance with its ABA Accessibility Standard. The U.S. Access Board (Board), an independent federal agency, enforces the ABA by addressing complaints of potential violations of applicable ABA standards. The Board generally relies on complaints rather than inspections due to resource constraints, according to Board officials. Anyone may file complaints with the Board alleging ABA noncompliance of GSA buildings. From October 2022 to June 2026, the Board received 41 ABA complaints about GSA’s office buildings and closed 25; 16 are still in process. Some stakeholders who were aware of the process said it was effective in addressing ABA complaints. However, the public is generally unaware that it can file complaints on accessibility barriers in GSA office buildings, according to almost all the industry stakeholders, federal employee unions, and disability advocates GAO interviewed. Moreover, GSA has not publicized the ABA complaint process. The Board relies on complaints it receives through its complaint process to learn about potential ABA violations and enforce the ABA. Without public information from GSA on this process, such as in its buildings, people with disabilities may be unaware that they are able to file ABA complaints and barriers to the accessibility of GSA office buildings may go unremedied. Accessible Parking Spaces at the Eaglecrest Building in Memphis, TN, Leased by the General Services Administration Why GAO Did This Study Tens of millions of Americans live with disabilities. Those individuals may need to access federal office buildings to work or to obtain government services. GSA’s national accessibility program helps ensure that these individuals can access the more than 6,000 office buildings owned or leased by GSA. The Thomas R. Carper Water Resources Development Act of 2024 includes a provision for GAO related to GSA office buildings and the ABA. This report (1) describes GSA’s practices for ensuring compliance with the ABA during construction, alteration, and leasing of office buildings and recent changes to its ABA program; and (2) examines the extent to which ABA complaints about GSA office buildings are received and addressed, and the extent to which GSA makes individuals aware they can file complaints. GAO reviewed relevant statutes, regulations, and agency documents. GAO conducted site visits to six GSA office buildings with open and closed ABA complaints and with recent construction, alteration, and leasing projects. GAO analyzed October 2022 to June 2026 complaint data from the Access Board. GAO also interviewed nine stakeholders including from industry organizations, federal employee unions, and disability advocates, as well as GSA and Access Board officials.

What GAO Found Many countries, including the U.S., are experiencing an increase in both the number and the proportion of older adults in their populations. According to the World Health Organization, the share of the global population aged 60 and over is expected to more than double from one billion in 2020 to 2.1 billion by 2050. As countries experiencing population aging take steps to address the domestic effects, experts told GAO that global population aging may also affect the U.S. GAO identified three broad U.S. foreign policy interests that may be affected by aging abroad: national security, economic competitiveness, and global health and humanitarian assistance (see figure). Effects of Global Aging on U.S. Foreign Policy Interests GAO identified several key implications of global aging populations for the U.S. by interviewing experts and conducting a literature review. For example, U.S. national security interests may be affected as allies spend more on healthcare for their aging populations, likely resulting in fewer available resources for defense spending. U.S. economic interests may also be affected by shrinking labor pools abroad, which could affect labor force competition and worldwide migration patterns. Lastly, global health interests may be influenced by the prevalence of chronic disease in aging populations. As a result, U.S. global health priorities may have to be adapted to the health-related risks and vulnerabilities faced by aging populations. The Departments of Defense (DOD), Health and Human Services (HHS), and State have some efforts that indirectly address the implications of global aging. These agencies produce research and data, engage with partner nations, and provide health and humanitarian assistance. State’s regional bureaus train younger populations in other countries to replace skills lost when older individuals leave the workforce. Additionally, HHS researches the effects of aging and age-related conditions on populations both domestically and abroad. However, U.S. agencies do not provide foreign assistance that specifically addresses the needs of older populations, according to agency officials. Why GAO Did This Study According to the United Nations, population aging is occurring at an unprecedented pace and is poised to become one of the most significant social transformations of the twenty-first century. As the populations of partners and adversaries age, the U.S. may be affected by this trend. Stakeholders have increasingly identified global aging abroad as a potential strategic challenge for the U.S. Understanding the changes associated with global aging and their potential effects, including consequences for U.S. fiscal policy, may help inform U.S. strategic priorities and goals. GAO was asked to examine the U.S. foreign policy implications of global aging and how U.S. agencies are considering these implications in their programming. This report examines (1) the implications of aging populations worldwide on U.S. foreign policy interests; and (2) U.S. agencies’ efforts to identify and address the implications of aging populations worldwide on U.S. interests. To address these objectives, GAO interviewed experts and conducted a literature review to identify the implications of aging populations worldwide on U.S. foreign policy interests. GAO selected experts from academia and nongovernmental organizations to represent a balance of views. To identify agency efforts to address global aging, GAO reviewed relevant agency documents, policy guidance, and program documentation. GAO also spoke with officials at DOD, HHS, and State. GAO selected these agencies based on their roles in foreign assistance programming and policy development relevant to demographic change. For more information, contact Chelsa Kenney at kenneyc@gao.gov.

What GAO Found The Federal Assets Sale and Transfer Act of 2016 (FASTA) established a temporary process to reduce the inventory of federal civilian real property and the time it takes to dispose of such property. FASTA created the Public Buildings Reform Board (Board) to recommend properties for disposal for approval in each of several rounds. Once approved, the General Services Administration (GSA) takes a primary role in implementation. FASTA also established a fund to help with disposal costs. The last year of FASTA implementation is underway, with two approved rounds—2019 and 2025—and a final round expected to be released before the Board ceases operations in December 2026. As of August 2026, 14 properties (of 23 recommended and approved) have been disposed of for a total of about $576 million in sales proceeds. Most of these disposals were from the 2019 round. Timeframes for completing disposal on many 2025 round properties are not clear due to shifting cost and schedule estimates. Stakeholders said that FASTA’s main benefit is the potential for funding to offset disposal costs, but the uncertainty of accessing this funding has been a significant challenge. Proceeds from initial FASTA disposals are deposited into a fund—the Asset Proceeds and Space Management Fund—that can be accessed to cover the costs of future disposals, subject to congressional appropriation. While Congress appropriated $90 million from 2016 to 2022 for the fund, it did not provide additional FASTA appropriations from 2023 to 2025. Without this appropriation, GSA could not access the full amount of sales proceeds. Timeline of Cumulative Amounts Deposited into and Appropriated from the Asset Proceeds and Space Management Fund In 2026, Congress appropriated an additional about $143 million in FASTA proceeds. However, other longstanding disposal challenges remain. For example, stakeholders said relocating tenants is a challenge, particularly for the 2025 round, as most of these properties remain occupied by federal tenants. GSA and the Board suggested improvements to FASTA if it were extended beyond 2026, including greater access to FASTA sales proceeds. Why GAO Did This Study The federal government owns hundreds of thousands of buildings that cost billions of dollars annually to occupy, operate, and maintain. Disposing of real property that federal agencies no longer need—but continue to pay for—has been a longstanding challenge. The process for disposing of unneeded property may take years, with the federal government bearing the property costs until the disposal is completed. FASTA includes provisions for GAO to review the Board’s recommendations and selection process and annually review agencies’ efforts to implement the FASTA recommendations. This report describes (1) the status of the FASTA disposal process and (2) insights from FASTA implementation as of the Second Round (2025). GAO reviewed published reports, relevant federal laws and regulations. GAO interviewed officials from the Board, GSA, and four selected tenant agencies occupying properties recommended under FASTA. GAO also conducted site visits to four selected FASTA properties included in the 2025 round recommendations. In addition, GAO analyzed GSA real property disposal data from January 1, 2020, through August 5, 2025, to review the amount of time it takes to dispose of federal properties.

What GAO Found The Food and Drug Administration’s (FDA) Center for Devices and Radiological Health (CDRH) administers the Third Party Review Program, a voluntary alternative review process for selected low-to-moderate risk medical devices, such as diagnostic ultrasound systems and surgical lasers. Under this program, which is intended to facilitate faster reviews, device sponsors can contract with FDA-accredited entities. These entities, known as Third Party Review Organizations (third parties), conduct the initial review of certain premarket applications, known as 510(k) submissions. These third party reviews occur prior to agency officials making the final decision about whether the device can be marketed. According to FDA officials, the agency received approximately $8 million for Third Party Review Program operations in fiscal years 2023 through 2027. FDA’s administration of the program includes overseeing third parties’ accreditation and reaccreditation applications to ensure participation standards are met, and reviewing third parties’ recommendations on 510(k) submissions and making final decisions. From fiscal years 2018 through 2025, third parties provided FDA with 617 510(k) submission reviews and recommendations, which accounted for about 2 percent of CDRH’s 510(k) submission reviews annually. Center for Devices and Radiological Health (CDRH) and Third Party 510(k) Medical Device Submission Reviews, Fiscal Years 2018–2025, as of November 2025     Fiscal Year 2018 2019 2020 2021 2022 2023 2024 2025 Number of 510(k) submissions reviewed by CDRH only 3,276 3,464 3,504 3,731 3,554 3,684 3,461 3,476 Number of 510(k) submissions reviewed by Third Party Review Organizations and CDRH 75 78 85 90 77 77 68 67 Source: GAO analysis of Food and Drug Administration data. | GAO-26-108499 FDA is required to audit third parties periodically to ensure they remain in compliance with the standards for program participation. The agency conducted 25 periodic audits of third parties from 2000 to 2026, according to FDA officials. These audits were conducted in four phases: 13 audits from 2000 through 2003, five audits from 2011 through 2013, two audits in 2022, and five audits from 2025 to 2026. Results of these audits varied in terms of the deficiencies identified. GAO found that FDA’s audit policies have gaps and are missing key details. For example, FDA has not established time frames specifying how long it should take the agency to complete an audit and communicate results to third parties. As a result, GAO identified several recent audits with findings of deficiencies, such as language in standard operating procedures being too vague, that took FDA more than 6 months to close. Ensuring the agency has detailed policies, such as time frames for completing audits and communicating results, would strengthen FDA’s efforts to ensure third parties meet program requirements and are therefore eligible to continue reviewing 510(k) submissions, which provide recommendations to FDA as to whether devices should be allowed on the market and thus available for patient use. Why GAO Did This Study FDA, within the Department of Health and Human Services (HHS), is responsible for ensuring that medical devices sold in the U.S. are regulated to provide reasonable assurance of safety and effectiveness. The review process FDA uses to make this determination represents a substantial investment of time and resources for both the agency and the device sponsor. The Food and Drug Administration Modernization Act of 1997 created the Third Party Review Program, which FDA oversees. Since program inception, FDA said it accredited 32 third parties to participate in the program; as of May 2026, there were nine third parties with active accreditations. The Consolidated Appropriations Act, 2023, includes a provision for GAO to report on the Third Party Review Program. This report (1) describes FDA’s roles and responsibilities in administering the Third Party Review Program; and (2) examines the extent to which FDA audits third parties’ performance. GAO reviewed the statute authorizing the Third Party Review Program and FDA’s related policy and guidance documents. GAO analyzed FDA third party performance metrics from fiscal years 2018 through 2025. GAO also reviewed documentation and internal communications from completed third party audits. GAO interviewed FDA officials and representatives from six third parties.

What GAO Found The Federal Aviation Administration (FAA) has identified electromagnetic spectrum-related threats, including spoofing and jamming, to the National Airspace System (NAS) and international flight routes. However, FAA has not completed risk and mitigation assessments, and updated security documentation needed to address these threats. Additionally, FAA did not have a defined, real-time monitoring and detection capability for all spectrum-related threats. Without comprehensive risk and mitigation assessments, complete security documentation, and real-time monitoring capabilities, FAA may not have sufficient information to identify, prioritize, and respond to evolving spectrum-related threats. As a result, spoofing, jamming, and other attacks could disrupt aviation communications, degrade situational awareness, and increase the risk of operational disruptions. Potential Cyberattacks Impacting Aircraft Communications FAA participates in multiple collaborative efforts with other federal agencies as well as non-federal aviation industry stakeholders regarding cybersecurity. FAA's collaborative efforts fully addressed two of the eight leading practices and partially addressed six. While FAA has defined roles and responsibilities within interagency groups, it has not established policies or procedures for information sharing, reporting, and coordination with non-federal partners outside those groups. Fully implementing leading collaboration practices could strengthen FAA's ability to effectively coordinate with key partners to mitigate cybersecurity threats affecting the aviation sector and thereby avoid fragmented and inefficient responses to incidents. The communication applications that FAA, pilots, and aviation stakeholders use to exchange text-based information are vulnerable to cyber threats, including interception and spoofing, due to limitations related to authentication, encryption, and protocol design. For example, a malicious actor could transmit fraudulent clearance cancellations, possibly leading to flight delays or safety issues. Until FAA develops and implements a plan to strengthen authentication and data protection for these applications, malicious actors could exploit weaknesses and increase the risk of disrupted flight operations, aviation accidents, or safety incidents. Why GAO Did This Study Commercial flight operations rely on interconnected systems that reside onboard an aircraft and on the ground in the NAS. These systems use radio frequency signals transmitted through the electromagnetic spectrum to communicate. The Servicemember Quality of Life Improvement and National Defense Authorization Act for Fiscal Year 2025 includes a provision for GAO to review the vulnerability of the NAS to spectrum attacks and to assess efforts to prevent and prepare for such attacks. This report examines, among other objectives, the extent to which FAA has identified and mitigated spectrum-related cybersecurity threats; the extent to which FAA has collaborated with federal partners to defend against cybersecurity threats; and what specific cybersecurity vulnerabilities exist in key communication applications. To address these objectives, GAO analyzed FAA vulnerability assessments to identify spectrum-related threats to the NAS. GAO selected eight spectrum-dependent systems and assessed them against National Institute of Standards and Technology guidance. GAO also assessed key FAA collaboration mechanisms against leading practices. In addition, GAO reviewed FAA documentation to identify vulnerabilities with communication applications. GAO interviewed FAA officials and federal and non-federal stakeholders.

Coast Guard personnel who work near vacation destinations or in remote areas experience challenges accessing private sector housing. Implementing our prior recommendations can better position the military services to manage military housing and support service members and their families. The Big Picture Due to rising costs, Coast Guard service members, 40 percent of whom rotate to new duty stations annually, and their families find it increasingly difficult to access adequate housing. The Department of Defense (DOD) and the Coast Guard (within the Department of Homeland Security) rely on the private sector to house the majority of service members; other service members may reside in government-owned housing. The basic allowance for housing (housing allowance) is often one of the largest components of cash compensation for military personnel. Around 41 percent of Coast Guard units are in remote or high vacation rental areas, where there is limited housing supply and high cost-of-living relative to the housing allowance. Coast Guard service members and spouses in these areas report challenges with affordability and availability of private-sector housing, which 76 percent of Coast Guard service members rely upon. However, while the Coast Guard and DOD seek to ensure that all members and their families have access to adequate housing, they are not fully aware of the challenges experienced by some service members. As a result, it may be difficult for these service members and their families to find adequate housing, which can affect morale and retention. What GAO’s Work Shows Our prior work highlighted key challenges that the Coast Guard has faced in managing its housing program and DOD actions that affect the Coast Guard. These include Coast Guard and DOD data collection and monitoring processes that inform housing guidance, such as collecting service member feedback, calculating housing allowance rates, and assessing priority housing types and locations. As of July 2026, there were nine open GAO recommendations focused on improving access to affordable housing for DOD and Coast Guard service members and their families. Location of Coast Guard Units and Classification as Remote or Majority Vacation Rental Areas, as of 2023 While the Coast Guard manages its housing program, DOD is responsible for calculating housing allowance rates for all eligible active-duty military service members, including the Coast Guard, by their pay grade, dependency status, and geographic location. These rates are based on rental costs data of “anchor points” or types of housing in approved market areas. However, DOD has not always used complete information to set housing allowances. DOD policy states that remote and isolated areas may pose particular challenges. Yet, DOD does not routinely assess or maintain comprehensive information on its housing supply or home affordability in relation to service members. We previously reported on steps DOD could take to make improvements, as well as how military services, such as the Coast Guard, may pursue changes to the allowance boundaries. By implementing our recommendations, Coast Guard and DOD could improve the management of military service housing affordability, availability, and costs while better supporting service members and their families. Quality of Life Tradeoffs Service members we spoke to across the armed forces, including the Coast Guard, cited key quality-of-life tradeoffs of living in remote and vacation destinations. These included increased commuting costs and distances, lower school quality, and limited access to health care services. Additionally, Coast Guard officials acknowledged that disparities in the housing allowance can exist, particularly in regions where multiple military housing areas cover large military service member populations, such as the San Francisco and Cape Cod areas. While Coast Guard officials identified beneficial practices they developed to manage their housing programs, in 2024, we found that the Coast Guard could improve its collection and sharing of such practices. For example, Coast Guard officials said they could hold regular calls with housing field units. These actions can help mitigate the loss of knowledge on local housing issues as personnel change duty stations. Similarly, we found that coordination between DOD and local communities on issues like housing varies across military installations. In March 2026, DOD issued guidance for military departments to define related responsibilities and requirements. Service-Wide Survey While the Coast Guard has collected some information on housing-related issues, such as analyses of housing market data, it had not conducted a service-wide feedback survey since 2012. In response to our 2024 recommendation, the Coast Guard developed the Nationwide Housing Satisfaction Survey. The goal of the survey is to enable the Coast Guard to make data-driven decisions and ensure that resources are allocated effectively to areas with the most pressing housing needs. The Coast Guard launched the annual survey in Fall 2025. However, the Coast Guard has yet to inform its housing policies with related current or complete information. Critical Housing Area Classification Currently, DOD has limited information regarding which military housing areas, such as Coast Guard specific areas, have the most significant housing availability and affordability challenges, known as critical housing areas. Thus, there may be additional areas where service members are experiencing significant housing challenges that the Coast Guard and DOD are not aware of. In 2024, we recommended DOD develop a comprehensive list of critical housing areas and consider local characteristics, such as vacation rentals, in its analysis. DOD officials shared interim guidance on this in March 2026 and told us it plans to publish a list of such areas by May 2027. In the absence of DOD information, the Coast Guard has taken some actions to designate critical housing areas. The Coast Guard considers this designation when it makes decisions to alter, acquire, or build new housing. As of 2026, the Coast Guard designated 46 areas affecting 400 out of 2,490 of the Coast Guard’s family housing units across the United States. Statutory Housing Authorities While the Coast Guard uses various statutory housing authorities to manage its housing program, DOD has additional authorities available to it that could potentially lower Coast Guard housing-related costs. For example, DOD has the authority to enter into multiyear utility service contracts. Coast Guard officials told us that having similar statutory authorities could be beneficial and may result in cost savings for the service. Other authorities, such as the use of public-private partnerships, would not be beneficial to the service and could result in large amounts of new direct spending, according to Coast Guard officials. We recommended the Coast Guard assess the extent to which 10 DOD statutory housing authorities could be beneficial to the service. As of June 2026, Coast Guard had submitted one legislative proposal to obtain one of these authorities and plans three additional proposals by the end of 2026. For more information, contact Triana McNeil at McNeilT@gao.gov.

Sexual misconduct in the U.S. Coast Guard is a longstanding problem. Implementing our recommendations can help the Coast Guard instill a culture intolerant of sexual misconduct and communicate progress to Congress and the public. The Big Picture Sexual misconduct has been a challenge within the U.S. Coast Guard for decades. For example, in a 2020 internal investigation called “Operation Fouled Anchor,” the Coast Guard examined more than 100 allegations of sexual assault from 1990 to 2006 at the Coast Guard Academy. The investigation concluded that the academy often mishandled these cases and failed to take sufficient action to ensure a safe environment for cadets. Sexual misconduct negatively affects victims and cadet retention, and it disrupts mission readiness. Cadets at Coast Guard Academy Practicing Drills In June 2023, after media reporting on the mishandling of sexual assault cases, the Coast Guard committed to reforming its culture, including addressing sexual misconduct. It also committed to better communicate its progress on these efforts to Congress and the public. A November 2023 Coast Guard report developed in response to Operation Fouled Anchor concluded that drastic improvement was needed to address harmful behaviors, including sexual misconduct. The report highlighted that about 18 percent of current Coast Guard women and 4 percent of men who responded to the Coast Guard’s 2022 Workforce and Gender Relations survey reported having experienced sexual harassment. What GAO’s Work Shows The National Defense Authorization Act for Fiscal Year 2026 includes a provision for GAO to report on Coast Guard efforts to mitigate sexual misconduct in the service. Pub. L. No. 119-60, div. G, tit. LXXV, subtit. A, § 7501, 139 Stat. 718, 1788-89 (2025). Our prior work has highlighted challenges that the Coast Guard has faced in addressing and reporting sexual misconduct. The Coast Guard has begun to implement our recommendations to address these concerns, but as of August 2026, its actions were incomplete. Implementing Reforms to Address Key Gaps The Coast Guard has taken some actions to implement reforms, but gaps in key areas may affect the Coast Guard’s ability to maintain progress and achieve lasting results. Specifically, we reported that in November 2023 the Coast Guard identified 33 actions to implement as part of its reform effort to address sexual misconduct. Subsequently, the Coast Guard identified 16 additional actions. These actions include revising policy and filling new positions to address sexual misconduct, among others. As of August 2026, the Coast Guard reported completing 36 of the 49 actions. We found that the Coast Guard had not updated timelines or outlined clear next steps for implementing the incomplete reform actions. In addition, Coast Guard did not have a way to collect feedback from personnel to determine whether the reforms were working. In light of these findings, we recommended in January 2026 that the Coast Guard develop an implementation plan for its reform effort, reconstitute its implementation team, and establish a two-way communications strategy with employees regarding the status and effects of its reform efforts, among other items. The Coast Guard is taking steps to implement these recommendations. For example, in June 2026 it developed a feedback tool to engage the workforce on reform efforts. The Coast Guard also provided an updated implementation plan in August 2026. Assessing the Effectiveness of the Reforms The Coast Guard has not yet developed a performance plan to assess its progress over time—a deficiency we highlighted more than two years ago in our testimony before Congress in March 2024. Since that time, the Coast Guard has begun to develop a tool to leverage relevant metrics from its current surveys and other reports to establish a baseline for assessing the cumulative impact of its reform actions. However, as of June 2026, the service has yet to develop goals and measures for its tool, and effort remains incomplete. Assessing the effectiveness of its actions would better ensure that the Coast Guard has the information it needs to evaluate whether the actions are helping personnel have an experience free from sexual misconduct. Improving Reporting to Congress The service did not notify Congress of Operation Fouled Anchor until media reporting was imminent, potentially impairing congressional oversight. In April 2025 we reported that the Coast Guard's policy provides limited guidance on notifying Congress of its investigations into sexual misconduct. Additionally, the Coast Guard is statutorily required to inform Congress annually about sexual misconduct. However, we reviewed the Coast Guard’s report issued in 2022 under 14 U.S.C. § 5112 and it did not include all statutorily required information and was nearly a year late. In our January 2026 report, we recommended the Coast Guard ensure that future reports address all required elements and issue on time. However, the Coast Guard issued its 2023, 2024, and 2025 reports late and still did not include all required information. Coast Guard officials stated that the 2025 report is complete. We found that required elements are still missing As we also recommended, documenting its guidance for determining the investigations that warrant proactive congressional notification and issuing complete and on time reports would provide Congress with information it can use for oversight. Challenges and Opportunities Addressing sexual misconduct in the Coast Guard requires a cultural transformation. Our previous work shows that fully implementing major transformations can take years and requires focused, full-time attention to ensure that initiatives are implemented in a coherent and integrated way. But gaps in leadership, monitoring, and employee engagement have hindered progress. Absent implementation of our recommendations related to sexual misconduct, the service risks not being able to make the types of long-term cultural and procedural changes that are necessary to address sexual misconduct. It also risks missed opportunities for the Coast Guard to assess the effectiveness of its reform efforts and accurately communicate results to Congress and the public. Coast Guard Personnel on Patrol For more information, contact Triana McNeil at McNeilT@gao.gov.

What GAO Found The Centers for Medicare & Medicaid Services (CMS) oversees the accuracy of Medicaid eligibility determinations through the Payment Error Rate Measurement (PERM) and the Medicaid Eligibility Quality Control (MEQC) programs. CMS estimates improper payments due to eligibility errors through its PERM program, and both the PERM and MEQC programs identify the root and specific causes of Medicaid eligibility errors and require states to develop corrective action plans (CAP) to address them. Root causes describe the source of the error and specific causes describe the exact action taken or not taken that led to the error. Caseworkers (staff who process Medicaid applications) were generally identified as the most prevalent root cause of errors in the PERM and MEQC reports GAO reviewed. The specific causes of errors generally fell into four categories. Causes of Medicaid Eligibility Errors Identified in Payment Error Rate Measurement (PERM) Reports from Reporting Years 2019–2025 Note: Error totals may not match as some causes are not listed. See report for more information. The selected states GAO reviewed took a variety of corrective actions—such as providing caseworkers with training, guidance, and making updates to eligibility systems—to reduce eligibility errors identified in the PERM and MEQC. Although CMS provides feedback on states’ CAPs, the agency’s inconsistent enforcement of required evaluations and limited analysis of state CAPs impair its oversight: Incomplete CAPs. CMS accepted PERM CAPs that were missing elements required by federal regulations. For example, states are required to evaluate the effectiveness of their prior corrective actions across five elements, but many CAPs GAO reviewed were missing required elements. Limited analyses of CAPs. CMS does not systematically analyze eligibility errors and CAPs across states and years to determine the effectiveness of corrective actions and whether they could be effective in multiple states. Collecting required elements and conducting these analyses would help CMS better support states in reducing eligibility errors and improper payments. Why GAO Did This Study Determining Medicaid eligibility is a complex process that is vulnerable to errors and can lead to improper payments. CMS oversees Medicaid eligibility determinations through its PERM program, which is conducted across all states on a 17-state, 3-year rotational cycle. CMS also requires states to conduct reviews of both eligibility approvals and denials through the MEQC program. The PERM national estimate of improper payments due to eligibility errors has fluctuated in recent years, in part due to temporary changes in Medicaid eligibility requirements implemented in response to the COVID-19 pandemic, but has recently begun to increase. GAO was asked to review Medicaid eligibility errors. This report describes the causes of Medicaid eligibility errors and corrective actions selected states took to address them, and assesses CMS’s oversight of state corrective actions. GAO reviewed state-specific PERM reports and other documentation from CMS for reporting years 2019 through 2025, as well as MEQC results and CAPs from seven states selected to obtain variation in Medicaid expenditures, enrollment, and eligibility error rates. GAO also interviewed officials from CMS and those states.

What GAO Found Federal support for economic development is fragmented. GAO identified 140 federal economic development programs administered by 13 agencies. GAO surveyed these programs, 131 of which reported total obligations of about $60 billion in fiscal year 2024. Further, these programs overlap. To assess overlap, GAO reviewed four selected Economic Development Administration (EDA) programs and 29 selected economic development programs administered by other federal agencies. All 29 programs overlapped with at least one of the EDA programs in at least one of three aspects—activities, beneficiaries, or purpose. Further, 20 programs overlapped with at least one of the EDA programs in all three aspects. Selected EDA and Other Federal Economic Development Programs with Overlap in Activities, Beneficiaries, and Purpose, as of May 2026 Note: Using survey responses from federal officials, GAO compared the four selected EDA programs with 29 selected federal economic development grant programs to determine whether they reported funding one or more of the same activities, serving similar beneficiaries, or having similar purposes. Overlap can create both benefits and challenges. For example, communities can use similar programs in different phases of projects but may find it difficult to navigate requirements across multiple agencies. Agencies can share expertise in overlapping programs but may find it challenging to avoid duplicative funding. EDA’s actions to manage the effects of overlap between programs have been limited. Of the 29 programs noted above, five reported collaborating with EDA in fiscal year 2024, the last full year at the time the survey was developed. In addition, EDA asks applicants to report funding from other federal agencies, but it does not verify the accuracy of this information prior to awarding funding. The Public Works and Economic Development Act of 1965, as amended, requires EDA to coordinate with other federal agencies carrying out economic development activities. EDA officials said their current approaches meet this requirement. But most of EDA’s efforts to collaborate with other agencies are inactive and EDA does not have plans to resume them. Coordinating with other agencies on programs that overlap with EDA programs would help EDA limit the risk of duplicating efforts and avoid wasting resources. Further, incorporating GAO’s leading practices for interagency collaboration would help EDA better leverage the benefits of overlap, such as shared resources and information, with other agencies. Why GAO Did This Study The federal government supports economic development grant programs to help regional and local communities improve job opportunities and promote economic growth. EDA is the only federal agency focused solely on economic development. The Senate Appropriations Committee report accompanying the Departments of Commerce and Justice, Science, and Related Agencies Appropriations Bill, 2024, includes a provision for GAO to evaluate potential overlap and duplication among EDA grants and other federal grant programs. This report examines (1) fragmentation of federal economic development programs across agencies and overlap in activities and beneficiaries; (2) overlap and duplication among selected EDA grant programs and other selected federal grant programs; and (3) EDA actions to manage the effects of overlap among selected grant programs. GAO identified federal economic development programs using assistance listing data from SAM.gov. GAO reviewed the four EDA programs that received the most funding in fiscal years 2023 and 2024 and selected and surveyed 30 other programs with similar purposes to the EDA programs. Among the 29 programs that responded, GAO evaluated overlap and duplication with the four EDA programs. GAO also interviewed organizations representing grantees and economic developers and officials from EDA and eight other agencies.

What GAO Found Unpaid household work includes domestic tasks, such as cooking and cleaning, as well as caregiving. Studies show that supplementing Gross Domestic Product (GDP) with the value of unpaid household work can provide a better understanding of the U.S. economy than GDP alone. For example, the decline in economic output during the COVID-19 recession was smaller when this value was included. Unpaid household work is not included in GDP because it takes place outside of formal market transactions and requires additional resources to calculate. According to economists GAO interviewed, valuing unpaid work can help inform policies that affect caregivers, such as policies intended to improve caregivers’ financial security in retirement. In a typical day, most individuals (87.3 percent) spent at least some time on household work—an average of about 3.72 hours, according to GAO’s analysis of 2021–2024 American Time Use Survey (ATUS) data. In addition, GAO estimated that the national market value of unpaid household work was at least $5.6 to 6.0 trillion in 2024 (which was equivalent to at least 19.2 to 20.2 percent of 2024 GDP). This estimated national market value includes the values of various types of unpaid household work, such as: Domestic tasks: $4.3 to $4.4 trillion (which was equivalent to 14.7 to 15.1 percent of 2024 GDP); and Caregiving (caring for adults or caring for children as a primary activity): $1.1 to $1.4 trillion (which was equivalent to 3.9 to 4.9 percent of 2024 GDP). These estimated values do not include secondary child care, which is keeping an eye on children while engaged in other activities. Including secondary child care increases the estimated values of caregiving and of all unpaid household work. GAO found certain groups were overrepresented among those engaged in unpaid household work from 2021-2024. For example, women made up about 53.9 percent of those engaged in this work, but 51.2 percent of the U.S. population. Also, women and married individuals spent more time on child care than men and unmarried individuals. However, women and men who cared for adults spent similar amounts of time doing so, as did married and unmarried individuals. Time Spent on Unpaid Caregiving by Selected Characteristics, 2021–2024 Notes: Primary child care is when the caregiver’s primary focus is helping or caring for a child (e.g., reading to a child), according to ATUS. GAO defined married individuals as living with their spouse or partner and unmarried individuals as not married or not living with their spouse or partner. Why GAO Did This Study Millions of people spend time on unpaid household work each day. Unpaid household work is work someone does for their household that someone else could do for pay. GAO was asked to examine how unpaid household work contributes to the economy and whether a better understanding of this work could help inform policy. This report (1) describes how estimating the time and monetary value of unpaid household work can supplement economic data and inform caregiving policy; (2) estimates the time spent on this work and its monetary value; and (3) determines the characteristics of individuals who do this work. To inform all objectives, GAO reviewed studies on unpaid household work in the U.S. that had strong research methods; and interviewed economists knowledgeable about estimating the time and value of this work. To estimate the time spent on unpaid household work, GAO analyzed nationally representative ATUS data from 2021–2024, which were the most recent data available at the time of GAO’s review. GAO estimated the monetary value of this work by multiplying hours from the ATUS by median hourly wages from the 2024 Current Population Survey (CPS). For most types of unpaid work, GAO selected both lower and higher wages to show how the value changes based on the wages used. GAO also analyzed 2021–2024 ATUS and CPS data to describe the characteristics of individuals engaged in this work. Both ATUS and CPS are federally funded surveys. For more information, contact Thomas Costa at CostaT@gao.gov or Michael Hoffman at HoffmanME@gao.gov.

What GAO Found In 2021, the U.S. Postal Service (USPS) published a 10-year strategic plan, which it has periodically updated, that aims to achieve financial sustainability and service excellence. Since that time, USPS has lengthened the expected delivery times of some First-Class Mail to align with strategic plan initiatives intended to cut costs. Effective October 2021, USPS added 1 to 2 days to its expected delivery times for certain products to accommodate its transportation change from air to ground. In April 2025, USPS further changed expected delivery times by eliminating end-of-day or afternoon collection at the over 24,000 post offices that are more than 50 miles from a Regional Processing and Delivery Center. Additionally, USPS lowered its service performance targets—the percentage of mail it expects to meet service standards—in fiscal year 2021 and has not met most targets since then. While intended to achieve cost savings, USPS’s strategic plan initiatives have slowed service for some mail and had a disproportionate impact on rural customers, according to oversight entities and industry stakeholders. U.S. Postal Service’s (USPS) Service Performance for Selected First-Class Mail Products, Fiscal Years 2021–2025 USPS has tried to address service performance in several ways, including using diagnostic tools and regular operational meetings. However, ongoing service performance issues indicate that USPS’s actions have not been sufficient. Moreover, broader challenges—such as USPS’s poor financial condition—may contribute to the difficulty in doing so. Given persistent concerns about service performance, it is important that USPS clearly communicate about its ongoing and planned actions to address this issue, even as it seeks to cut costs, as well as about the challenges it faces. The upcoming update to USPS’s strategic plan, which is planned for 2027, presents an opportunity for USPS to communicate this information to Congress, the public, and relevant stakeholders. Why GAO Did This Study USPS has long faced challenges meeting its mission in a financially self-sufficient manner. Under its current strategic plan, USPS has sought to improve its finances and service performance. Balancing service performance with financial viability poses a significant ongoing challenge for USPS. GAO was asked to review USPS service performance issues. This report examines (1) changes USPS has made to service standards for market-dominant products and to related operations since 2021; (2) how the cost-cutting initiatives in USPS’s strategic plan have affected service performance and customers; and (3) the extent to which USPS’s actions have addressed service performance issues, and how USPS has communicated ongoing and planned actions to Congress and the public. GAO reviewed USPS documents, including its annual reports to Congress for fiscal years 2020 through 2025. GAO also reviewed USPS Office of Inspector General reports, as well as Postal Regulatory Commission (PRC) reports and relevant advisory opinions. GAO selected First-Class Mail for this review, because it is one of the market-dominant products USPS uses to assess its service performance. GAO also interviewed USPS officials, PRC commissioners and staff, and five stakeholders that included commercial mailers and mailer organizations on topics related to USPS service performance.

What GAO Found The Department of Homeland Security (DHS) Office of Inspector General (OIG) has not ensured timely investigations of whistleblower retaliation complaints. OIG took over 3 years to investigate the majority (39 of 73) of the cases it opened and closed in fiscal years 2018 through 2025. OIG officials told GAO that case complexity and limited staff affected some case time frames, and that they have focused more on investigation quality and thoroughness than timeliness. While OIG policy requires timely review of whistleblower retaliation complaints, OIG has not defined this objective in specific, measurable terms; evaluated timeliness; or implemented other mechanisms to help enhance accountability and ensure more timely investigations. Improving timeliness could lessen the personal, financial, and professional hardships on complainants and help convey that protecting whistleblowers is a priority. DHS OIG Time Frames for Closing Whistleblower Retaliation Investigations, Cases Opened and Closed, Fiscal Years 2018–2025 From fiscal years 2018 through 2025, OIG substantiated 11 of the 73 whistleblower retaliation cases noted above. The Secretary of Homeland Security did not decide whether to take corrective action for any of these cases within 30 days of receiving OIG’s report, as required by law. As of May 2026, the Secretary decided to take corrective action for five cases and had not decided whether to take corrective action for the remaining six. These 11 cases had awaited the Secretary’s decision for 4 months to over 2 years. DHS officials told GAO there is no process or designated official responsible for ensuring cases are reviewed in a timely manner. Until the Secretary decides on corrective action for the six pending cases and takes steps to ensure timely decisions on future substantiated cases, whistleblowers with substantiated cases will not receive timely restorative personnel actions. This could decrease confidence in DHS whistleblower protections and discourage other whistleblowers from coming forward. Why GAO Did This Study Federal employees who report wrongdoing play a crucial role in improving government operations but risk retaliation, such as removal from their duties. Whistleblower retaliation can damage careers and have a chilling effect on others’ willingness to report wrongdoing. Federal statutes protect whistleblowers, including DHS employees, from such retaliation. Within DHS, OIG is responsible for receiving and investigating retaliation complaints and the Secretary of Homeland Security is responsible for deciding whether to take corrective action on substantiated complaints. GAO was asked to review OIG’s processes for receiving and investigating whistleblower retaliation complaints. This report addresses the extent to which OIG has ensured timely investigations of retaliation complaints and DHS has made timely corrective action decisions in response to substantiated retaliation allegations, among other objectives. To conduct this review, GAO analyzed OIG policies, procedures, reports to Congress, and retaliation complaint and investigations data from fiscal years 2018 through 2025. GAO also interviewed officials from DHS and OIG. To obtain whistleblower perspectives, GAO interviewed nongeneralizable samples of three whistleblower advocacy groups, selected based on their work in this area, and current and former DHS personnel with closed whistleblower retaliation complaints.