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.