What GAO Found In June 2024, GAO identified 20 priority recommendations for the Department of Transportation (DOT). Since then, DOT has implemented four of those recommendations, including taking actions to improve vehicle and pedestrian safety. In addition, GAO removed the priority status from one recommendation related to DOT oversight of the air ambulance industry due to actions taken by Congress to enhance the information DOT has to conduct oversight. In June 2025, GAO identified six new priority recommendations for DOT, bringing the total number to 21. These recommendations involve managing cybersecurity risks and information technology, improving transparency and communication, developing plans to address safety risks, and reducing fraud and abuse risks. DOT's continued attention to these issues could lead to significant improvements in government operations. Why GAO Did This Study Priority open recommendations are the GAO recommendations that warrant priority attention from heads of key departments or agencies because their implementation could save large amounts of money; improve congressional and/or executive branch decision-making on major issues; eliminate mismanagement, fraud, and abuse; or ensure that programs comply with laws and funds are legally spent, among other benefits. Since 2015, GAO has sent letters to selected agencies to highlight the importance of implementing such recommendations. For more information, contact Heather Krause at KrauseH@gao.gov.

What GAO Found Some key technologies currently used in wildfire management include: Satellites, which provide data that are integrated into models for wildfire forecasting, including data on terrain, vegetation, and weather. They are also used for detection and monitoring, although some satellites face resolution issues, data lags, and other limitations. Aircraft and drones, which can deploy to the scene to collect information on a fire’s location and its potential to spread. Aircraft and drones with thermal cameras can see through smoke and dense trees, helping to locate fires and determine their intensity. Challenges include safety issues for aircraft pilots and limited drone lifespan (3 to 5 years, or less in harsh conditions). Cameras and air sensors, whichare used in several states for wildfire detection, sometimes in extensive networked systems. For example, in 2024, Hawaiian Electric stated that it began deploying high-resolution cameras with artificial intelligence (AI) for early fire detection. For both cameras and sensors, installation, data transmission, and fire verification may be challenging in remote areas. Sensors may require dense networks to operate accurately. AI tools have the potential to improve modeling for wildfire forecasting and response. AI may help address key limitations of the traditional mathematical models used for wildfire. For example, AI can: Allow models to use more data by speeding up data assimilation, the process of updating forecasts with the most current observations. Rapidly flag potential inaccuracies for human review. Potentially reduce uncertainty in some situations when data do not exist or are insufficient, by using prior information to create plausible synthetic data. However, use of AI in this field faces challenges. For example, AI requires extensive up-front work to ensure the data are readily usable by AI tools, which can be costly. AI also presents a risk of conveying inaccurate information, which can put lives and property at risk. In addition, historical data are limited for rare events, which may limit the utility of AI for forecasting extreme wildfires. Why GAO Did This Study Annually, wildfires in the U.S. cause an average of 12 deaths and cost at least $3.2 billion. Wildfire severity has increased across much of the country, a trend that is expected to continue. Current and emerging technologies have the potential to save lives and property by improving forecasting, detection, mitigation, and response. This testimony provides information on selected technologies and on the benefits and limitations of AI tools to enhance use of these technologies. This statement is based on prior GAO work, including a 2023 report on the use of AI to model wildfires and other natural hazards; a 2025 report on wildfire detection technologies such as satellites, aircraft, drones, cameras, and sensors; and prior GAO reports on forest management, wildfire staffing, and interagency coordination on wildfire response.

What GAO Found Funding for Commerce’s Bureau of Industry and Security (BIS) grew by $97 million and roughly doubled from fiscal years 2013 through 2024. During this timeframe, the number of funded positions in BIS went from 403 to 585—an overall increase of 182 positions. About $58 million (60 percent) of BIS’s 12-year funding increase was appropriated in fiscal years 2022 and 2023. BIS primarily used these recent increases in two areas. First, to bolster implementation and enforcement of export controls in response to Russia’s 2022 invasion of Ukraine. Second, to create a new office focused on securing the U.S. information and communications technology and services supply chain. However, BIS does not have a long-term workforce plan to determine its resource needs. Instead, BIS assesses its staffing needs on an annual basis as part of the budget request process. BIS last conducted a bureau-wide workforce planning effort in 2016. Comprehensive, long-term workforce planning would help BIS leadership determine the size and composition of its workforce needed to meet its expanding workload and better position it to reduce the risk of exporting sensitive, dual-use items to an adversary. BIS oversees an interagency export license review process which includes reviews by the Departments of Defense (DOD), Energy (DOE), and State. However, challenges to information-sharing and limited consultation compromise the integrity of these reviews. For example, BIS does not provide the agencies ready access to all relevant information about export license applications, which is housed in multiple classified and unclassified systems. Providing reviewing agencies with easy access to all information relevant to license applications would help ensure reviews are well informed. In addition, officials from reviewing agencies told us that BIS has sometimes removed agreed upon license conditions without consultation. According to BIS, it removed conditions that were redundant or inconsistent with standard licensing provisions. Consulting with reviewing agencies prior to changing or removing conditions would help ensure that licensing decisions fully reflect national security risks and other concerns. Key Steps in Interagency Review Process for Commerce’s Bureau of Industry and Security Export License Applications, as of April 2025   Why GAO Did This Study To address varied foreign policy and national security concerns, the U.S. government has increasingly used export controls. For example, the U.S. has imposed export controls to restrict access to advanced semiconductors that could aid the People’s Republic of China in developing military systems powered by artificial intelligence. BIS is primarily responsible for reviewing applications and issuing licenses to exporters of dual-use technologies that could be used for both civilian and military purposes. DOD, DOE, and State also play roles in reviewing export license applications. GAO was asked to review BIS’s resources and processes for export licensing. This report examines (1) BIS's resources from fiscal years 2013 through 2024, (2) the extent to which BIS has conducted workforce planning, and (3) the extent to which BIS shares information and consults with reviewing agencies. GAO reviewed legislation and agency documents; interviewed Commerce, DOD, DOE, and State officials; and analyzed agency funding, staffing, and workload data.

What GAO Found State Medicaid programs predominantly rely on managed care to provide coverage. In 2022, just over 75 percent of Medicaid beneficiaries (about 74 million beneficiaries) received coverage through managed care. Under Medicaid managed care, states contract with managed care plans and generally pay them a fixed monthly amount per beneficiary (i.e., a capitation payment) to provide a set of covered services. The Centers for Medicare & Medicaid Services (CMS), the federal agency that oversees Medicaid, develops an improper payment estimate for Medicaid. This estimate consists of three components: managed care, fee-for-service, and eligibility. For the managed care component, CMS reviews a sample of the payments that states made to their Medicaid managed care plans. CMS checks to see if those payments were made correctly based on the information in the state’s Medicaid information system and managed care plan contract. In recent years, including 2024, the improper payment estimate for Medicaid managed care has been at or near 0 percent. This means CMS found few to no errors in states’ payments to their Medicaid managed care plans. Components of the Improper Payment Estimate for Medicaid and Estimates Reported in 2024 Note: These components are part of the Payment Error Rate Measurement program, which identifies improper payments in Medicaid. For more information, see figure 2 in GAO-25-107770. CMS’s estimate of improper payments in Medicaid managed care does not include a review of payments from managed care plans to providers. GAO and others, including the Department of Health and Human Services’ Office of Inspector General (HHS-OIG) and some state auditors, have identified program integrity risks related to Medicaid managed care payments that are not accounted for in the improper payment estimate. These include, for example, payments from managed care plans to providers for services that were not delivered or lacked necessary documentation, and capitation payments made by the state for the same beneficiary with multiple identification numbers. CMS conducts audits related to managed care, which can identify program integrity risks not captured in the improper payment estimate. For example, CMS audits can determine if managed care plans paid providers for services that were not delivered. CMS increased the number of audits it conducts, in part, in response to a GAO recommendation. As a result, between October 2021 and February 2025, CMS completed 899 audits of managed care providers and opened 155 managed care plan audits. Through these audits, CMS has identified over $33 million in overpayments; nearly $23 million of these overpayments are the federal share, which the agency is working to recover. Why GAO Did This Study Improper payments are payments that should not have been made, that were made in an incorrect amount, or whose appropriateness cannot be determined due to lacking or insufficient documentation. They have been a long-standing and significant problem in the federal government. Consistent with the Payment Integrity Information Act of 2019, CMS develops an improper payment estimate for Medicaid, a federal-state health financing program for certain low-income and medically needy individuals. House Report 117-389, which accompanied the Legislative Branch Appropriations Act, 2023, includes a provision for GAO to provide quarterly reports on improper payments. In this 10th quarterly report, GAO describes how CMS develops the improper payment estimate for Medicaid managed care and its other oversight efforts to identify program integrity risks related to managed care. GAO reviewed relevant federal statutes and regulations, as well as documentation of CMS’s methodology for the improper payment estimate. In addition, GAO reviewed reports by the HHS-OIG and state auditors in five states selected for variation in geographic location and size of the Medicaid managed care population. GAO also interviewed officials from CMS, the HHS-OIG, and an organization that represents state auditors.

What GAO Found Crisis line data show it had about 3.8 million customer interactions from fiscal year 2021 through 2024, with the number increasing each year. GAO found the crisis line faces challenges in several areas: Customers with complex needs. The crisis line provides specialized training to responders in a unit that addresses complex callers. However, these callers are increasingly being routed to responders who may not have received the training, raising service quality and staffing concerns that could put customers at risk. Chat and text. Procedures for staff in this unit—such as responding to more than one customer at once—as well as how the unit is staffed may have adverse effects. These include increased responder burnout, which could also put customers at risk. Chat routing process. The chat platform did not automatically change the status of responders who were not available to respond timely to a chat (e.g., responders who were on a break or experiencing internet outages). As a result, chat customers could be redirected between two unavailable responders, or the chats could be abandoned. Further, in July 2024, the Department of Veterans Affairs (VA) determined that, as a non-clinical service, the procedure the crisis line used to disclose incidents to customers or their representatives in cases when actions or inactions created a significant risk of harm to the customer was not applicable. The crisis line withdrew the procedure and a new one has not been established. This runs counter to VA's goal of building trust with stakeholders through transparency and accountability. Why GAO Did This Study An average of 17.6 U.S. veterans died by suicide per day in 2022—the most recent data available. Preventing suicide is a top stated priority of the VA. VA runs the Veterans Crisis Line: a 24/7 phone, chat, and text service, staffed by crisis responders who support veterans and their family and friends (i.e., customers). This testimony is based on GAO's report publicly released today on the Veterans Crisis Line (GAO-25-107182). In preparing that report, GAO obtained, reviewed, and analyzed crisis line documents as well as data from fiscal years 2021 through 2024; interviewed crisis line and VA officials; surveyed all crisis line responders; and conducted interviews with a non-generalizable sample of eight responders.

Why This Matters An average of 17.6 U.S. veterans died by suicide per day in 2022—the most recent data available. This was more than double the rate for nonveterans. Preventing suicide is a top stated priority of the Department of Veterans Affairs (VA). VA runs the Veterans Crisis Line: a 24/7 phone, chat, and text service, staffed by crisis responders who support veterans and their family and friends (i.e., customers). GAO Key Takeaways Crisis line data show it had about 3.8 million customer interactions from fiscal year 2021 through 2024, with the number increasing each year (see figure). We found the crisis line faces challenges: Customers with complex needs. The crisis line provides specialized training to responders in a unit that addresses complex callers. However, these callers are increasingly being routed to responders who may not have received the training, raising service quality and staffing concerns that could put customers at risk. Chat and text. Procedures for staff in this unit—such as responding to more than one customer at once—as well as how the unit is staffed may have adverse effects, including increased customer wait times and responder burnout, which could also put customers at risk. Further, in July 2024, VA determined that, as a non-clinical service, the procedure the crisis line was using to disclose incidents to customers or their representatives in cases when actions or inactions created a significant risk of harm to the customer was not applicable. The crisis line withdrew the procedure and a new one has not been established. This runs counter to VA’s goal of building trust with stakeholders through transparency and accountability. Number of Veterans Crisis Line Customer Interactions, Fiscal Years 2021-2024 How GAO Did This Study We obtained, reviewed, and analyzed crisis line documents as well as data from fiscal years 2021 through 2024; interviewed crisis line officials; surveyed all crisis line responders and conducted interviews with a non-generalizable sample of eight responders.

What GAO Found Spacecraft and space systems are operating in a cyber threat environment with increased risks of attack and mission disruption. To help protect systems at federal agencies such as National Aeronautics and Space Administration (NASA), the National Institute of Standards and Technology developed cybersecurity risk management guidelines. The guidelines include seven key risk management steps: prepare , categorize systems, select controls, implement controls, assess control implementation, authorize the system, and continuously monitor security control effectiveness. NASA fully or partially implemented all steps of its cybersecurity risk management program for selected systems. However, partial determinations indicate that NASA did not perform key activities within the steps. For example: For the prepare step, NASA did not have an approved organization-wide risk assessment. Such an assessment is essential to identifying and mitigating the highest priority cyber threats across the enterprise. Regarding the monitor step, selected systems did not document system-level continuous monitoring strategies due in large part to the lack of guidance on how to do so. Without documented strategies that are fully understood by key cyber personnel, organizations face increased risks of data breaches, delayed detection of threats, and slower responses to attacks. The following table summarizes the extent to which NASA implemented each risk management step for the four selected systems. Extent to Which National Aeronautics and Space Administration (NASA) and Selected Systems Implemented Risk Management Steps Risk management step Implementation by NASA organization Preparea ◐   Implementation across selected systems Categorize ◐ Select ◐ Implement ● Assess ◐ Authorize ◐ Monitor ◐ Legend: ●—implemented; ◐—partially implemented; ○—not implemented Source: GAO analysis of NASA documentation. | GAO-25-108138 aFor the review of the Prepare step, GAO evaluated the organizational-level activities and not the system-level activities. Developing, implementing, and maintaining a comprehensive cybersecurity risk management program is critical to protecting NASA's systems and information, detecting suspicious activity, and responding to incidents. Without a strong risk management program covering the selected systems, NASA faces increased risks that cyber incidents could result in loss of mission data, or decreased lifespan or capability of space systems. Why GAO Did This Study NASA's space development project portfolio includes 36 major projects. Over the lifecycle of these projects, NASA plans to invest about $80 billion in them. GAO was asked to review cybersecurity risk management at NASA. This report assesses the extent to which NASA implemented cybersecurity risk management for selected major projects. GAO reviewed NASA policies and guidance regarding cybersecurity risk management. GAO selected a nongeneralizable sample of two major projects and two associated systems for each project. For the four selected systems, GAO analyzed system authorization documentation and compared it to seven key cybersecurity risk management steps and associated activities. GAO also interviewed project and cybersecurity officials. This report is a public version of a sensitive report issued in March 2025. Information that NASA deemed sensitive has been omitted.

Why This Matters Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment requirements provide a range of preventive and medically necessary health care services to eligible children. Services include well-child screenings to identify potential medical issues, and treatment to improve or maintain the child’s health. The Centers for Medicare & Medicaid Services (CMS) oversees states’ provision of Medicaid. GAO Key Takeaways State Medicaid programs often contract with managed care plans to deliver health care services, including well-child screenings and treatment. In fiscal year 2022, the most recent data available, about 85 percent of the 33 million children covered by Medicaid were enrolled in managed care plans. Three states we reviewed had programs that withheld a small portion of managed care plans’ funding. The funding was then used to reward plans that improved performance on well-child screening and treatment quality measures. Medicaid officials in Ohio and Washington said their programs were effective tools to encourage plans to improve performance, such as the extent to which eligible children receive well-child screenings. Results from North Carolina are not yet available, but officials said they may add more quality measures. Selected managed care plans developed incentives for children, their caregivers, and providers to improve the extent to which children receive screenings and treatment. For example, Rhode Island offered children a teddy bear for completing a blood lead screening. Some plans offered providers support with coordinating care. Also, some plans increased payment rates for certain services to encourage improved access to screenings, including behavioral health screenings. Example of a Medicaid Periodic Well-Child Screening and Identification for Treatment How GAO Did This Study We reviewed documentation and interviewed Medicaid officials from a non-generalizable sample of four states with large child Medicaid managed care populations. We also reviewed CMS guidance, and interviewed CMS, two managed care plans per state, and seven stakeholder organizations, including those representing children. For more information, contact Michelle B. Rosenberg at rosenbergm@gao.gov.

What GAO Found The U.S. Coast Guard faces increasing challenges operating and maintaining its fleet of 241 cutters—vessels 65 feet or greater in length with accommodations for crew to live on board. Since fiscal year 2019, the cutter fleet's availability to conduct missions generally declined due, in part, to increasing equipment failures. Across the cutter fleet, the number of instances of serious cutter maintenance issues increased by 21 percent from 3,134 in fiscal year 2018 to 3,782 in fiscal year 2023. As a result, more cutters are operating in a degraded state and at an increased risk of further maintenance issues. Coast Guard Cutter Penobscot Bay at a Major Repair Facility in Baltimore, Maryland Two maintenance challenges that are particularly impactful are increasing deferred maintenance and delays in obtaining obsolete parts. In fiscal year 2024, the Coast Guard deferred $179 million in cutter maintenance, almost nine times the amount deferred in 2019 (based on inflation-adjusted values). Due to delays in receiving critical parts needed for repairs, the Coast Guard cannibalizes cutters by moving working parts between cutters. The Coast Guard lacks complete information to address the impacts of these challenges. Systematically collecting data on, and assessing, deferred maintenance and parts obsolescence could enable the Coast Guard to better prioritize projects and funding. The Coast Guard has not fully addressed the impacts of personnel shortages that are a major challenge to operating and maintaining the cutter fleet. Cutter crew and support positions are short staffed, with vacancy rates increasing from about 5 percent in fiscal year 2017 to about 13 percent in fiscal year 2024. Cutter personnel workload has increased to meet mission demands and cutters often deploy without a full crew, which the Coast Guard does not account for in its staffing data. Regularly collecting and assessing data on staff availability could help ensure the Coast Guard is fully considering the workload faced by cutter crews and support personnel when making decisions on personnel assignments. Why GAO Did This Study The Coast Guard, a multi-mission military service within the Department of Homeland Security (DHS), is responsible for ensuring the safety, security, and stewardship of more than 100,000 miles of U.S. coastline and inland waterways. It relies heavily on its cutter fleet to meet these mission demands. In 2012, GAO reported that the Coast Guard's legacy cutters were approaching, or had exceeded, their expected service lives and that their physical condition was generally poor. GAO was asked to review how the cutter fleet has changed since 2012. This report examines, among other things, the Coast Guard's (1) challenges in operating and maintaining its cutter fleet, and (2) the extent it has determined its cutter-related workforce needs. GAO analyzed available Coast Guard documentation and data for the period 2012-2024 on types of cutters, cutter availability, and cutter usage time. GAO also conducted site visits to observe facility operations and interviewed Coast Guard officials, including maintenance officials and cutter crews representing a mix of cutter types and geographic locations.

What GAO Found Quantum computers and their capabilities have the potential to revolutionize modern computing but could also introduce new risks. In October 2021, GAO identified options that policymakers (e.g., legislative bodies, government agencies, and industry) could consider to help address key factors affecting the development of quantum computers. Specifically, the report noted that policymakers could encourage further collaboration; consider ways to expand the workforce; incentivize or support continued investment in development; and encourage the development of a robust, secure supply chain. In November 2024, GAO reported that various documents developed over the past 8 years had contributed to an emerging U.S. national strategy for addressing the threat of quantum computing to cryptography. Based on review of these documents, GAO identified three central goals in the strategy: (1) standardize post-quantum cryptography that is resistant to attacks from conventional and quantum computers, (2) migrate federal systems to this cryptography, and (3) encourage all sectors of the economy to prepare for the threat of quantum computers to their cryptography (see figure). Figure: The Three Central Goals of the U.S. National Quantum Computing Cybersecurity Strategy However, GAO reported the strategy documents had not fully defined a strategy to counter the threat of quantum computers to the nation’s cryptography. Specifically, the documents did not fully address the key characteristics of a national strategy that GAO had identified in prior work. For example, the documents did not identify objectives for the third goal to encourage all sectors to prepare and did not identify performance measures for any of the three goals. GAO noted that these shortcomings occurred, in part, because no single federal organization was responsible for coordination and oversight of a comprehensive national strategy. However, in January 2021 Congress established an organization that is well-positioned to lead these efforts: the Office of the National Cyber Director. If the office embraces this role and ensures that the strategy fully addresses key characteristics, the nation will have a better-defined roadmap for allocating resources and holding participants accountable. Why GAO Did This Study Quantum computers could address some critical problems that are not possible to solve with conventional computers within the span of a human lifetime. However, GAO has reported that the emergence of quantum computers could undermine the security of widely used cryptographic methods (e.g., encryption) that federal agencies and critical infrastructure owners and operators rely on to protect sensitive systems and data. Some experts predict that a quantum computer capable of breaking certain cryptography may be developed in the next 10 to 20 years, putting agency and critical infrastructure systems that rely on cryptography at risk. GAO was asked to testify on its 2021 and 2024 quantum computing reports. GAO summarized these prior reports that discuss (1) factors that affect the development of quantum computers and (2) the federal government’s strategy to address the threat that quantum computers pose to cryptography on unclassified systems.

Why This Matters The Waste Isolation Pilot Plant (WIPP) is the nation’s only geologic repository for disposing of certain nuclear waste from defense-related activities, such as contaminated soil. The Department of Energy (DOE) expects the site to operate until the 2080s. However, much of the infrastructure is in degraded condition, increasing risks of failure and impacting WIPP’s waste disposal mission. GAO Key Takeaways DOE commissioned a survey in 2016 that identified over $37 million in deferred maintenance costs for WIPP’s site infrastructure—including buildings, electrical substations, hoists, and other assets. Some infrastructure has been refurbished or replaced since then. However, our analysis shows 29 of 56 assets that are essential to the mission were in substandard or inadequate condition in 2023 (the most recent data at the time of our review). WIPP’s contractor handles daily maintenance, refurbishment, and replacement of infrastructure. The contractor also maintains data about the condition and deficiencies of site infrastructure. DOE uses the data to make decisions about assets. DOE has repeatedly identified issues with the data, including unreliable values, but has not ensured that the contractor develops timelines to correct those issues. DOE evaluates the contractor’s performance annually and approves long-term plans for infrastructure management. However, DOE has not consistently incentivized the contractor to develop and execute long-term plans. Accurate data and clear long-term management plans would help DOE plan, prioritize, and fund critical maintenance for WIPP’s infrastructure and reduce costly emergency refurbishment of assets critical to nuclear waste disposal. The Waste Isolation Pilot Plant in Carlsbad, New Mexico How GAO Did This Study We visited WIPP in 2024. We analyzed data and documents and interviewed officials from DOE and from the contractor. We compared this information against DOE’s requirements for data maintenance and reporting and for contractor oversight.

What GAO Found During the COVID-19 public health emergency, Congress provided temporary additional federal funding to states to keep Medicaid and most Children's Health Insurance Program (CHIP) enrollees continuously enrolled. In April 2023, states began resuming full eligibility redeterminations for the millions of enrollees who had been continuously enrolled, including disenrolling those no longer eligible or who did not submit all required information—a process known as “unwinding.” States are to complete unwinding redeterminations by the end of 2025. The Centers for Medicare & Medicaid Services (CMS) found that, of the 89 million completed redeterminations by states, about 27 million individuals were disenrolled during the first year and a half of unwinding. Enrollment nationwide was around 79 million as of October 2024, about 10 percent higher than prior to the pandemic. CMS also found significant variation across states in the percentage of individuals disenrolled during unwinding, with a number of factors potentially contributing to those differences. Percentage of Completed Redeterminations That Resulted in Disenrollments, by State, March 2023-September 2024 Note: For more details, see fig. 4 in GAO-25-107413. CMS and selected states identified certain populations that may have been disenrolled more frequently than others. For example, CMS and two states found that certain young adults were the most likely to be disenrolled when compared to other groups. CMS officials said young adults could have become ineligible because they aged out of child-specific eligibility groups, which generally allow for higher income than eligibility groups for adults who are under the age of 65 and who do not have a disability. Why GAO Did This Study Continuous enrollment during the COVID-19 public health emergency, which largely paused disenrollments, contributed to Medicaid and CHIP growing from 71 million enrollees in February 2020 to 94 million enrollees in March 2023—an increase of more than 30 percent. During unwinding, some people were expected to be disenrolled either because they were no longer eligible or because of procedural reasons, such as not returning information necessary to determine their eligibility. States are required to report data on redetermination outcomes during unwinding to CMS. CMS has used the data to monitor, for example, how many people were disenrolled or had their coverage renewed. The CARES Act includes a provision for GAO to report on the federal response to the COVID-19 pandemic. This report describes (1) the results of CMS's analyses of unwinding outcomes, and (2) the extent to which selected states identified differences in unwinding outcomes across population characteristics. GAO reviewed CMS analyses, such as analyses of state-reported data on eligibility redeterminations scheduled for completion from March 2023 through June 2024, some of which were completed through September 2024. GAO also interviewed CMS officials. GAO also reviewed information from five states—Arizona, Maryland, Montana, New York, and Wisconsin—selected to capture a mix of program size and geographic diversity. For more information, contact Michelle B. Rosenberg at RosenbergM@gao.gov.

What GAO Found Studies GAO reviewed showed that abortion restrictions can have negative economic effects for women seeking an abortion, as well as for women who are unable to obtain an abortion and instead carry their pregnancies to term. Studies also found laws restricting abortion access can have broader effects, for example, by influencing women's decisions about where to live, lowering educational attainment for certain sub-groups of women and men, and influencing birth and maternal mortality rates. The Centers for Disease Control and Prevention (CDC) collected some abortion data from states to document the number and characteristics of women obtaining abortions and the number of abortion-related deaths, but reporting was voluntary and not all states provided the agency with this information. In May 2025, agency officials said the future of this data collection is uncertain, given ongoing realignment efforts at the agency. The Social Security Administration (SSA) reported plans to incorporate changes to state abortion laws in its future analyses of the financial condition of the Social Security Trust Funds, but its analyses will be limited to any potential changes to fertility rates. SSA's ability to use federal data to inform this analysis depends on whether CDC continues to collect abortion data from states. Why GAO Did This Study In June 2022, the U.S. Supreme Court held that the Constitution does not confer a right to abortion in its decision in Dobbs v. Jackson Women's Health Organization. Following the 2022 decision, several states have taken actions to protect or restrict access to abortion. GAO was asked to examine what is known about the potential economic and household effects of state-level restrictions on abortion, as well as efforts of federal agencies to assess these effects. This report provides information on the potential economic effects of state-level abortion restrictions on individuals and households across different demographic groups and on aspects of the economy more broadly, as well as the role federal agencies play in collecting abortion-related data and assessing the economic effects of state restrictions. GAO conducted an extensive, multi-step review of academic and government literature. To identify relevant studies, GAO searched multiple databases to compile research published within the last 7 years that focused on abortion restrictions and related outcomes. These searches yielded 611 studies whose abstracts GAO reviewed for relevance. We considered studies relevant if they (1) included original research or data analysis; (2) were U.S. focused; and (3) examined the effects of abortion restrictions on abortion rates; travel times and costs to obtain an abortion; socioeconomic outcomes such as educational attainment, financial distress or career trajectories; and population demographics including fertility rates, maternal morbidity and mortality. A subsequent review examined the remaining articles using a standardized list of questions on the study population, outcomes, and time frames. As a final step, GAO assessed the methodological quality of the studies to determine whether they were sufficiently rigorous, including data quality, research design, and analytic techniques, as well as a summary of major findings and conclusions. This process resulted in the 55 studies used in this report. GAO also interviewed academic researchers and officials from national organizations with subject matter expertise and reviewed information from the Centers for Disease Control and Prevention and the Social Security Administration. In addition, we analyzed abortion data from the Guttmacher Institute, which we determined were reliable for the purposes of describing changes in the number of abortions before and after the Dobbs decision. For more information, contact Tom Costa at CostaT@gao.gov.

What GAO Found The Department of Veterans Affairs (VA) has dozens of systems to support appointment scheduling for veterans. It has acquired these systems over time to address needs, such as for online scheduling and virtual appointments. VA schedulers experience challenges navigating VA's complex systems environment, while veterans experience challenges with online scheduling. To address these, VA's Veteran Health Administration (VHA) and Office of Information and Technology (OIT) are collaborating to modernize systems. VA has partially met key practices in the areas of project scheduling and requirements management. Specifically, VA's project schedule substantially met two elements of a reliable schedule and partially met two others. For example, it does not include all IT work needed for the effort, which limits VA's ability to ensure VHA and OIT agree on what work needs to be completed and when. GAO Assessment of VA's Schedule for its Enterprise Scheduling Modernization Program against Characteristics of a Reliable Schedule Characteristic Assessment Comprehensive Partially Met Well-Constructed Substantially Met Credible Partially Met Controlled Substantially Met Legend: Substantially Met = VA provided evidence that satisfies a large portion of the criteria. Partially Met = VA provided evidence that satisfies about half of the criteria. Source: GAO analysis of VA's enterprise scheduling modernization program documentation as of May 2024. | GAO-25-106851 VA implemented three of six key practices for effectively managing requirements, and partially implemented three. For example, VA has not fully developed a requirements management plan and does not fully monitor and control requirements by maintaining bi-directional traceability between them and the deliverables. Developing a plan agreed to by VHA and OIT would reduce the risk of failing to support the work needing to be done. Tracing requirements forward and backward would help VA demonstrate that the solution meets requirements and that veterans' online scheduling challenges are addressed. GAO Assessment of VA's Implementation of Key Requirements Development and Management Practices on its Scheduling Systems Modernization Effort Practice Assessment Needs Assessment Implemented Requirements Management Planning Partially Implemented Requirements Elicitation Implemented Requirements Analysis Implemented Requirements Monitoring and Controlling Partially Implemented Solution Evaluation Partially Implemented Legend: Implemented = VA provided complete evidence that satisfies the criteria. Partially Implemented = VA provided some but not all evidence that satisfies the criteria. Source: GAO assessment of VA documentation and information. | GAO-25-106851 Why GAO Did This Study VA schedules tens of millions of health care appointments for veterans each year. However, it has faced challenges related to appointment scheduling systems, which have contributed to delays in providing health care. The department has initiated efforts to modernize these systems. GAO was asked to examine the systems VA uses to schedule appointments and its plans to modernize them. This report (1) describes the systems VA uses to schedule appointments and monitor wait times, (2) describes the challenges VA facilities and veterans experience using these systems, and (3) evaluates the extent to which VA has met key planning practices for its scheduling systems modernization. GAO reviewed VA documents that identified scheduling systems and challenges with them and interviewed a select non-generalizable sample of schedulers and veteran organization officials regarding challenges. GAO also interviewed relevant VA officials and assessed VA's schedule and requirements management for its scheduling system modernization against practices developed by GAO and the Project Management Institute.