What GAO Found Medicaid programs that choose to cover outpatient prescription drugs are required to cover all Food and Drug Administration (FDA) approved drugs for their medically accepted indications when those drugs are made by a manufacturer that participates in the Medicaid Drug Rebate Program (MDRP), except as outlined in federal law. The FDA has approved two drugs—Mifeprex in 2000 and its generic equivalent in 2019, referred to as Mifepristone Tablets, 200 mg—for the medical termination of an intrauterine pregnancy, known as a medical abortion. Danco Laboratories and GenBioPro are the exclusive manufacturers of Mifeprex and Mifepristone Tablets, 200 mg, respectively, and both manufacturers participate in the MDRP. Medicaid programs in all 50 states, the District of Columbia, and Puerto Rico cover prescription drugs and participate in the MDRP. According to officials from the Centers for Medicare & Medicaid Services (CMS)—the federal agency within the Department of Health and Human Services (HHS) responsible for ensuring Medicaid programs’ compliance—none of the MDRP’s statutory exceptions apply to Mifeprex or Mifepristone Tablets, 200 mg. Thus, these 52 Medicaid programs must cover these drugs when prescribed for medical abortion in circumstances eligible for federal funding, such as when the pregnancy is the result of rape or incest. GAO identified gaps in Medicaid programs’ coverage of Mifeprex and Mifepristone Tablets, 200 mg. Officials from 35 of the 49 programs who responded to GAO questions said their programs covered Mifeprex and Mifepristone Tablets, 200 mg for medical abortion, as of December 31, 2024. In contrast, officials from 13 programs told GAO their programs did not cover either drug for medical abortion. An official from the remaining program did not specify the medical indications for which its program covered the drugs. Medicaid Programs’ Coverage of Danco Laboratories’ Mifeprex and GenBioPro’s Mifepristone Tablets, 200 mg, as of December 31, 2024 Note: For more details, see fig. 1 in GAO-25-107911. State officials’ responses to GAO’s questions indicated that some states may not be complying with the MDRP requirements for covering Mifeprex and Mifepristone Tablets, 200 mg. However, CMS has not determined the extent to which states comply with the MDRP requirements for these drugs. CMS officials told GAO they were not aware of the following: Nine programs did not cover Mifeprex and Mifepristone Tablets, 200 mg for any medical indication, as of December 31, 2024; GAO reported four of these programs did not cover Mifeprex in 2019. Mifepristone Tablets, 200 mg was not available at the time of GAO’s 2019 report. Four additional Medicaid programs did not cover either drug when prescribed for medical abortion, as of December 31, 2024. CMS was not aware of these coverage gaps, in part, because it had not implemented GAO’s 2019 recommendation to take actions to ensure Medicaid programs comply with MDRP requirements to cover Mifeprex. CMS also has not taken actions related to the coverage of Mifepristone Tablets, 200 mg, as of August 2025. Without such actions, CMS lacks assurance that Medicaid programs comply with MDRP requirements and Medicaid beneficiaries may lack access to these drugs when appropriate. Why GAO Did This Study GAO was asked to describe Medicaid programs’ coverage of mifepristone. This report examines Medicaid programs’ coverage of Mifeprex and Mifepristone Tablets, 200 mg, among other things. GAO reviewed laws and CMS guidance on the MDRP, and coverage of Mifeprex and Mifepristone Tablets, 200 mg. GAO also sent written questions to officials from the 52 Medicaid programs that participate in the MDRP regarding their coverage of these drugs, and reviewed officials’ responses from the 49 programs that provided GAO information.

What GAO Found Authorizations are statutory provisions that establish and provide for the continuing operation of federal programs or activities. Some authorizations also include an authorization of appropriations, which authorizes Congress to enact appropriations to fund the programs or activities. However, there is no general requirement, either constitutional or statutory, that an appropriations act be preceded by a specific authorization of appropriations. In general, an authorizing statute imposing substantive functions upon an agency is itself sufficient authorization for any subsequent appropriations. GAO identified a permanent agency-level authorization for 17 selected agencies. Table: Agency-Level Statutory Authorizations for Selected Cabinet-Level Agencies Agency Public Law Citation Date of Enactment U.S. Code Citation Department of Agriculture Ch. 72, § 1, 12 Stat. 387, 387 (1862) 5/15/1862 7 U.S.C. § 2201 Department of Commerce Ch. 552, § 1, 32 Stat. 825, 825 (1903) 2/14/1903 15 U.S.C. § 1501 Department of Defense Pub. L. No. 80-325, § 201, 61 Stat. 496, 499–500 (1947) 7/26/1947 10 U.S.C. § 111 Department of Education Pub. L. No. 96-88, § 201, 93 Stat. 668, 671 (1979) 10/17/1979 20 U.S.C. § 3411 Department of Energy Pub. L. No. 95-91, § 201, 91 Stat. 565, 569 (1977) 8/4/1977 42 U.S.C. § 7131 Department of Health and Human Services Pub. L. No. 83-13, 67 Stat. 18, 18–19 (1953) 4/1/1953 42 U.S.C. § 3501 Department of Homeland Security Pub. L. No. 107-296, § 101, 116 Stat. 2135, 2142 (2002) 11/25/2002 6 U.S.C. § 111 Department of Housing and Urban Development Pub. L. No. 89-174, § 3, 79 Stat. 667, 667 (1965) 9/9/1965 42 U.S.C. § 3532   Department of the Interior Ch. 108, § 1, 9 Stat. 395, 395 (1849) 3/3/1849 43 U.S.C. § 1451 Department of Justice Pub. L. No. 41-97, § 1, 16 Stat. 162, 162 (1870) 6/22/1870 28 U.S.C. § 501 Department of Labor Ch. 141, § 1, 37 Stat. 736, 736 (1914) 3/4/1914 29 U.S.C. § 551 Department of State Ch. 1, § 1, 1 Stat. 28, 28–29 (1789) 7/27/1789 22 U.S.C. § 2651 Department of Transportation Pub. L. No. 89-670, § 3(a), 80 Stat. 931, 931 (1966) 10/15/1966 49 U.S.C. § 102 Department of the Treasury Ch. 12, § 1, 1 Stat. 65, 65 (1789) 10/2/1789 31 U.S.C. § 301 Department of Veterans Affairs Pub. L. No. 100-527, § 2, 102 Stat. 2635, 2635 (1988) 10/25/1988 38 U.S.C. § 301 Environmental Protection Agency Reorganization Plan No. 3 of 1970, 84 Stat. 2086, 2086 (1970) 12/2/1970 42 U.S.C. § 4321 note Small Business Administration Pub. L. No. 83-163, § 204(a), 67 Stat. 230, 233 (1953) 7/30/1953 15 U.S.C. § 633 Source: GAO analysis of public laws and the U.S. Code. | GAO-25-107294 Additionally, for each selected agency, GAO identified relevant authorizations and authorizations of appropriations by appropriation account in the Consolidated Appropriations Act, 2023. Congress has established varying structures for the appropriations, authorizations, and authorizations of appropriations that apply to federal agencies. Therefore, this information is not comparable across agencies. This page includes a link to a downloadable data set for each selected agency that contains information about appropriations, authorizations, and authorizations of appropriations for each appropriations account funded in the act. GAO also identified seven appropriations accounts—across six of the 17 selected agencies—that were provided budget authority in the Consolidated Appropriations Act, 2023 that did not previously receive budget authority, according to Office of Management and Budget data. Why GAO Did This Study GAO was asked to review authorizations and authorizations of appropriations for federal agencies. This report provides information for selected agencies about: agency-level authorizations; authorizations and authorizations of appropriations by appropriations account in the Consolidated Appropriations Act, 2023; and new appropriations accounts in fiscal year 2023, specifically accounts that were provided budget authority in the Consolidated Appropriations Act, 2023 that had not been provided budget authority previously. GAO selected 17 agencies that 1) were in the Cabinet at the start of this review and 2) are subject to the Chief Financial Officers Act of 1990. They were the Departments of Agriculture, Commerce, Defense, Education, Energy, Health and Human Services, Homeland Security, Housing and Urban Development, the Interior, Justice, Labor, State, Transportation, the Treasury, and Veterans Affairs; the Environmental Protection Agency; and the Small Business Administration. These agencies accounted for approximately two-thirds of the accounts funded in the Consolidated Appropriations Act, 2023 and approximately 90 percent of appropriations provided for federal agencies for fiscal year 2023. GAO reviewed U.S. Code to identify agency-level authorizations and any related authorizations of appropriations. GAO then reviewed the Consolidated Appropriations Act, 2023 and, as necessary, Congressional Budget Justifications for fiscal year 2023 to identify authorizations relevant to each selected agency’s appropriations accounts. GAO used common legal databases to locate key information about each authorizing law, such as dates of enactment, public law numbers, locations of authorization provisions in U.S. Code, and any authorizations of appropriations the authorizing laws contain. GAO requested each selected agency to review this material it compiled. In some cases, GAO’s methodology did not identify relevant authorizing laws or key information about them. GAO reviewed data from the Public Budget Database included with the Budget of the U.S. Government to identify appropriations accounts across the selected agencies that were provided budget authority in the Consolidated Appropriations Act, 2023 that had not been provided budget authority previously. For more information, contact Jeff Arkin at (202) 512-6806 or arkinj@gao.gov.

What GAO Found Criminal investigators at military criminal investigative organizations (MCIO) must complete federal and service-specific criminal investigative training (see figure). MCIOs include the Department of the Army Criminal Investigation Division, Naval Criminal Investigative Service, and Air Force Office of Special Investigations—within the Department of Defense (DOD)—as well as the Coast Guard Investigative Service within the Department of Homeland Security (DHS). Training for Military Criminal Investigative Organizations' Criminal Investigators MCIOs track the completion of some service-specific and advanced criminal investigative training to determine investigators' progress through training. However, MCIOs do not have guidance with requirements or procedures to track completion of criminal investigative training. As a result, MCIOs may not have full information on investigators' completed training. Tracking training completion ensures compliance with requirements and allows organizations to track progress consistent with identified goals and objectives. Without such information, MCIOs may not have complete information on the qualifications met or retained by their criminal investigators. MCIOs evaluate their service-specific basic training courses through periodic course reviews and feedback collected from participants and their supervisors. However, MCIOs do not conduct program-wide evaluations to determine the effectiveness of their criminal investigative training. Plans for regular program-wide evaluation with time frames for review, measures of effectiveness, and documented results would provide MCIOs with the ability to demonstrate how their criminal investigative training programs develop criminal investigators and contribute to MCIOs' missions. DOD has multiple offices with responsibilities for law enforcement and criminal investigative programs. However, DOD does not regularly monitor and evaluate criminal investigative training programs because responsibility for oversight remains unclear. Without final guidance designating DOD offices' responsibilities for criminal investigative training programs, DOD oversight of the MCIOs' investigative training programs may be incomplete, unclear, or delayed. This could limit DOD's ability to support MCIOs as they develop their programs to ensure criminal investigators are fully qualified to carry out their investigative missions. Why GAO Did This Study Criminal investigators at MCIOs investigate serious and complex crimes involving military service members and civilian personnel. An independent committee, established by the Army in response to the disappearance and murder of a Fort Hood, Texas, soldier, identified deficiencies in criminal investigators' experience and training to handle complex cases and accomplish investigative missions. Senate Report 118-58, accompanying a bill for the National Defense Authorization Act for Fiscal Year 2024, includes a provision for GAO to review criminal investigators' training. This report assesses the extent to which (1) MCIOs provide and track the completion of investigative training, (2) MCIOs evaluate investigative training effectiveness, and (3) DOD oversees criminal investigative training. GAO reviewed relevant policies, analyzed data and documents on MCIO training, and interviewed cognizant MCIO, DOD, and DHS officials.

What GAO Found Airport service workers support the U.S. commercial air transportation industry by loading cargo and baggage, cleaning aircraft and terminals, assisting passengers with disabilities, driving shuttle buses, and providing food and beverages, among other functions. The revenue generated by businesses associated with these workers can provide insight into their economic contributions. For example, Federal Aviation Administration (FAA) data show that in 2023, the nation’s busiest 138 commercial service airports earned approximately $5.9 billion in revenue from ground transportation and parking services, and $2.3 billion from terminal concessions. These earnings accounted for nearly 30 percent of those airports’ annual operating revenue. GAO’s analysis of airport service workers’ economic characteristics found that they are generally better off than service workers in all industries and worse off than air transportation workers overall (a population that includes workers like flight attendants and mechanics). For example, the median wage for airport service workers paid hourly was estimated to be $19.74 (in 2024 dollars), according to 2018 through 2024 Current Population Survey data. This wage was higher than that of service workers in all industries and lower than that of air transportation workers overall. Median Wages for Selected Hourly Workers, 2018-2024 (in 2024 dollars) Notes: For the purposes of this report, airport service workers are private sector employees in 36 selected occupations within the air transportation industry. Air transportation workers overall include all private sector employees in the air transportation industry, such as flight attendants and mechanics. Service workers in all industries are private sector employees—in all industries combined—working in the same 36 selected occupations as airport service workers. GAO’s wage analysis only includes workers who reported that they were paid hourly. GAO’s analysis also found that approximately 7 percent of airport service workers lived at or below the poverty line when they responded to the U.S. Census Bureau’s American Community Survey from 2018 through 2022. The same analysis found 15 percent of service workers in all industries lived at or below the poverty line, as did 4 percent of air transportation workers overall. Why GAO Did This Study The U.S. air transportation industry is a key component of the nation’s economy, enabling the movement of goods and passengers throughout the nation and the world. The FAA Reauthorization Act of 2024 included a provision for GAO to conduct a comprehensive review of domestic airport service workers, including their role in, importance to, and impact on the aviation economy. This report provides information about selected airport service workers’ economic contributions to airports and their economic characteristics, among other topics. To describe airport service workers’ economic contributions to airports, GAO analyzed 2023 data from FAA’s Certification Activity Tracking System. GAO also reviewed economic impact reports representing 26 large hub airports (defined as airports that have 1 percent or more of the annual national passenger boardings). In addition, GAO interviewed FAA officials and representatives from 12 organizations, including airports, airlines and other employers, and labor unions. To describe the workers’ economic characteristics, GAO analyzed the U.S. Census Bureau’s American Community Survey 5-year data from 2018 through 2022. GAO also analyzed 2018 through 2024 data from the Current Population Survey, which is sponsored jointly by the U.S. Census Bureau and the Bureau of Labor Statistics. For each of these data sources, GAO analyzed the most recently finalized data available at the time of its analysis. For more information, contact Danielle Giese at giesed@gao.gov.