What GAO Found In 2016, Congress strengthened the role of an existing office within the Department of Defense (DOD) to oversee and advocate for training and equipping special operations forces assigned to the Special Operations Command (SOCOM). That office, the Assistant Secretary of Defense for Special Operations and Low-Intensity Conflict known as ASD(SO/LIC), is also responsible for determining whether acquisition programs are within budget. ASD(SO/LIC) cannot effectively conduct program oversight, in part, because DOD policy has not fully enabled it to perform its acquisition-related responsibilities. For example, GAO found disagreement between ASD(SO/LIC) and SOCOM officials regarding the former’s access to some programs’ information and meetings. This resulted in ASD(SO/LIC) not getting information to help perform its responsibilities. Collaboration between ASD(SO/LIC) and SOCOM to document clear protocols for the former’s access to this information could enhance its ability to monitor acquisitions and fulfill its statutory role. Example of a Special Operations Forces Acquisition: AC-130J SOCOM reported mixed success meeting cost and schedule goals for its costliest acquisition programs. GAO found that, while one of nine selected programs reported cost growth, most reported delays, which can, over time, result in increased costs. SOCOM’s acquisition policy requires programs to report, in an online portal, current information—including cost estimates—relative to program goals. GAO found that officials for eight selected programs that must maintain such information did not do so, in part, because the command’s acquisition policy did not specify how frequently they needed to. Having ready access to current cost estimates in the portal could help support officials’ efforts to identify potential cost growth risks or opportunities to reallocate resources. Most SOCOM programs GAO reviewed that experienced delays reported using fewer leading practices for iterative product development than programs not experiencing delays. Opportunities exist for programs to more consistently adopt these practices. By updating acquisition policy to reflect and encourage adoption of the practices, SOCOM could further improve its programs’ ability to achieve the speed and innovation needed to meet the needs of special operations forces. Why GAO Did This Study SOCOM is a relatively small organization within DOD, accounting for under 2 percent of the defense budget. SOCOM is responsible for preparing and equipping special operations forces. A congressional committee report includes a provision for GAO to review ASD(SO/LIC)’s oversight of SOCOM acquisitions. This report examines (1) how ASD(SO/LIC) performs its acquisition oversight responsibilities and related challenges it faces, (2) the extent to which the costliest SOCOM weapons acquisition programs met cost and schedule goals, among other things, and (3) the extent to which these programs have taken steps to facilitate speed and innovation in product development. GAO reviewed ASD(SO/LIC) responsibilities in statute and policy; analyzed documentation for nine, of over 80, of SOCOM’s costliest weapons acquisition programs, including cost and schedule data; assessed program efforts to adopt leading product development practices; and interviewed relevant officials.

What GAO Found The Department of Veterans Affairs’ (VA) Veterans Health Administration (VHA) offers menopause care—treatments to manage symptoms of menopause—at its medical facilities through a wide array of treatment options, including medications and medical services. Primary care and gynecology providers are the key clinicians for veterans seeking to address menopause symptoms and can refer to other specialists such as mental health and physical therapy as needed. Common Menopause Symptoms To assist those providing menopause care, VHA is developing a clinical practice guideline. It is intended to provide evidence-based recommendations for providers on how to assess, diagnose, and treat menopause. However, the guideline was not complete at the time of GAO’s review. As part of the guideline development process, VHA plans to identify related performance measures. However, officials from the Office of Women’s Health, the sponsoring office for the guideline, could not confirm whether or how they plan to monitor the performance measures. Officials said it is difficult to make plans for monitoring before the recommendations and measures have been identified. Using performance measures to monitor implementation of the guideline’s recommendations could help VHA better achieve the objective of providing equitable, high-quality, and comprehensive health care services at all VHA facilities. VHA has developed patient education about menopause care, which include brochures and a website to help educate women veterans on menopause care. However, this information may not be reaching many women veterans. More than half (60 percent) of the 348 women veterans who responded to GAO’s questionnaire reported that they had not encountered any VHA menopause resources. VHA facility officials reported challenges finding time to discuss menopause education and print brochures. VHA does not have a strategy to ensure that menopause education is regularly communicated to veterans. This information would help women become more knowledgeable about the changes occurring in their bodies and would help them be more empowered to approach their providers about their symptoms. Furthermore, this could help VHA better meet its goal of providing women veterans with comprehensive health care. Why GAO Did This Study Almost half of women veterans served by VHA are aged 45-64, the age range most likely to experience menopause, or the permanent cessation of menstruation. According to VHA research, veterans may experience worse menopause symptoms compared to non-veterans due to aspects of their service. GAO was asked to review VA’s provision of menopause care. This report examines how VHA offers menopause care and educates veterans about menopause, among other topics. GAO analyzed VHA data on menopause care from fiscal years 2019 through 2024. GAO interviewed VHA officials with roles related to menopause care and officials from six VHA medical facilities, selected to represent variation in geographic area, among other criteria. GAO also administered an online questionnaire and conducted discussion groups with women veterans about their experiences with VHA menopause care. Their responses are not generalizable to all women veterans but provide perspectives about VHA’s menopause education efforts and care offerings.

What GAO Found Veterans Health Administration (VHA) medical facility officials are responsible for reviewing the clinical care delivered by their providers when concerns arise. GAO identified 104 providers with clinical care concerns (such as practicing in a manner that is unsafe or inconsistent with industry standards of care) at five selected VHA medical facilities between January 2020 and July 2024. GAO found these facilities did not consistently adhere to VHA policy when conducting quality reviews, or reporting providers to state licensing boards or the National Practitioner Data Bank. All five facilities also had missing or incomplete review documentation. As of March 2026, VHA has developed some mandatory training for facility staff related to credentialing providers, but not any on quality review and reporting processes. By failing to follow VHA policy, facilities increase the risk that these processes are conducted incorrectly and that these providers may continue to provide unsafe care to veterans. State Licensing Board Reporting Process for VHA Providers, as of July 2024 Related to reporting, GAO also found these five facilities did not initiate processes to determine whether seven providers should have been reported to state licensing boards or the National Practitioner Data Bank. Completing the review process for these providers will provide VHA assurance that any identified quality concerns will be properly assessed and that the providers who should be reported are reported. Timely reporting helps reduce the risk that other VHA facilities or community hospitals and clinics hire providers with unreported clinical care issues, thereby potentially putting patients at risk. In addition, GAO found that VHA oversight of review and reporting processes at medical facilities was limited in ensuring adherence to VHA policy requirements. Specifically, VHA’s oversight methods—which include a tracking tool and an annual facility self-assessment and audit—are not designed to assess adherence with all timeliness and documentation requirements. These limitations prevent VHA from comprehensively and consistently overseeing processes for monitoring provider clinical performance and ensuring safe, quality health care for veterans. Why GAO Did This Study VHA is responsible for ensuring providers deliver safe care to veterans at its more than 170 medical facilities. However, VHA has faced challenges ensuring providers with clinical care concerns undergo timely and documented reviews, and are reported to external entities when appropriate. GAO was asked to examine VHA processes for reviewing concerns about providers’ clinical care. This report assesses (1) selected VHA medical facilities’ adherence to VHA policies for reviewing and reporting providers with clinical care concerns; and (2) VHA’s oversight of quality review and reporting processes for providers with clinical care concerns. GAO reviewed VHA policy documents and interviewed VHA officials. GAO also selected a non-generalizable sample of five VHA medical facilities (based on factors such as facility complexity) and identified providers with clinical care concerns from January 2020 through July 2024. This time frame included the most recent facility meeting minutes and allowed for reviews and reporting to be completed. For each provider, GAO reviewed available documentation and interviewed local and regional VHA officials.

What GAO Found The National Guard Bureau (NGB) collects and tracks Freedom of Information Act (FOIA) data from all three National Guard components—NGB, Army National Guard, and Air National Guard. NGB reports FOIA data to the Department of Defense (DOD). NGB officials stated they provide Army National Guard and Air National Guard FOIA data to the Army and the Air Force, respectively. The National Guard tracks data on FOIA requests received, processed, and backlogged through various systems (see figure). Freedom of Information Act Tracking Systems GAO found discrepancies in the accuracy of reported data that officials responsible for reporting National Guard FOIA data were unable to explain. Specifically, GAO found that the numbers of FOIA requests received, processed, and backlogged by the Army National Guard differed between Army National Guard and NGB data for fiscal years 2016 through 2024, in part because there is no single, standardized process across the National Guard components for verifying the accuracy of FOIA data. Moreover, FOIA managers that improperly log FOIA requests and the absence of tools to verify data entries have affected the accuracy of reported data. Without a standardized process to verify the accuracy of National Guard FOIA data, such as the number of FOIA requests received and processed or the extent of backlogs, NGB may continue to inaccurately report FOIA data and hinder transparency for Congress and the public. National Guard FOIA officials identified challenges with insufficient staffing and inconsistent communication that have affected the timely processing of FOIA requests. However, NGB has not fully addressed these challenges. For example, NGB has not analyzed its headquarters workforce needs to know how many full-time equivalent staff are currently needed to process FOIA requests in a timely manner and address backlogs. NGB has not developed a plan to improve communication between NGB and officials responsible for processing FOIA requests in the field through a shared online environment. Addressing data discrepancies and identified challenges can help DOD and the NGB report data more accurately and process FOIA requests more efficiently. Why GAO Did This Study FOIA enables the public to request access to government records and information from any federal executive branch agency. Each year, hundreds of thousands of FOIA requests are filed. For example, NGB continues to face challenges processing such requests within the 20-day time frame that FOIA requires. House Report 118-529 includes a provision for GAO to review the National Guard’s FOIA program. This report evaluates the extent to which (1) NGB and DOD have taken steps to ensure the accuracy of reported FOIA data, including request backlogs; and (2) NGB has identified and addressed challenges associated with the processing of FOIA requests. GAO reviewed NGB and DOD policies on FOIA processing. It also analyzed National Guard FOIA data for fiscal years 2016 through 2024 and distributed a survey to Army and Air National Guard FOIA officials asking about policies and factors that affect timely processing of requests, among other issues. GAO also interviewed NGB and military service officials.

What GAO Found Given the trauma survivors of human trafficking have experienced, they may need behavioral health services, including mental health care services, such as therapy, or substance use disorder treatment. The Department of Health and Human Services (HHS) and the Department of Justice (DOJ) fund grant programs that help provide access to such services. In fiscal year 2025, HHS awarded approximately $7.5 million for two key trafficking survivor services programs and DOJ awarded approximately $45 million for two key programs. The programs assisted approximately 2,600 survivors and 11,300 survivors in that year, respectively, helping them access services. GAO’s review of HHS’s two key grant programs found that the agency followed leading practices in assessing how programs perform. HHS did this by, for instance, setting long-term and measurable near-term goals with targets and time frames that communicated what the agency expected the programs to achieve. For example, to assess its long-term goal to provide services for survivors, HHS set a near-term goal for a grantee to deliver services to 50 survivors in a given fiscal year. DOJ also followed leading practices for its minor survivor assistance program, but did not do so for its adult program. Specifically, DOJ did not set measurable near-term goals for what it expects its adult program to achieve. By setting such near-term goals with targets and time frames, DOJ would be better positioned to assess the effectiveness of its adult program and the progress it makes toward supporting the needs of adult human trafficking survivors. GAO’s analysis of literature and interviews with selected HHS and DOJ grantees and selected stakeholders identified factors that can affect human trafficking survivors’ access to behavioral health services. Such factors included shortages of providers specializing in treating survivors of human trafficking. These are longstanding and complex issues, some of which are beyond federal control. HHS and DOJ officials said they are aware of the factors and have taken actions—such as increasing human trafficking training for behavioral health providers—to help improve survivors’ access to services. Factors That Can Affect Access to Behavioral Health Services for Survivors of Human Trafficking Why GAO Did This Study Human trafficking is a crime that involves compelling or coercing a person to provide labor or engage in commercial sex acts. In 2024, the National Human Trafficking Hotline identified nearly 12,000 human trafficking cases in the United States. The Trafficking Victims Prevention and Protection Reauthorization Act of 2022 includes a provision for GAO to study the accessibility of behavioral health services for survivors of human trafficking in the United States. This report (1) describes the key HHS and DOJ programs that fund behavioral health services for trafficking survivors, (2) evaluates how HHS and DOJ assessed the performance of key programs, and (3) describes factors that can affect survivors’ access to services and federal efforts to improve access. GAO reviewed HHS and DOJ documentation and interviewed agency officials. GAO selected four key programs whose grantees reported providing the largest amount of behavioral health services in recent years and interviewed 15 grantees selected to obtain variation in the amount of services provided and location. GAO analyzed fiscal year 2025 grantee performance data for the four programs, the most recent available. GAO evaluated HHS and DOJ steps for assessing the performance of the programs. GAO also conducted a literature search and interviewed six selected stakeholders, including representatives from survivor organizations and a researcher.

What GAO Found The Governmentwide Treasury Account Symbol Adjusted Trial Balance System (GTAS) is the central platform federal agencies use to submit standardized data for government-wide financial reporting. GTAS collects budgetary and proprietary data; validates them; and interfaces with other federal systems to support transparency, accountability, and fiscal oversight. Federal laws, including the Chief Financial Officers Act of 1990, the Federal Financial Management Improvement Act of 1996, and the Digital Accountability and Transparency Act of 2014 (DATA Act), require agencies to report standardized financial data. These laws assign implementation responsibilities to the Office of Management and Budget (OMB) and the Department of the Treasury, which issue guidance on budget formulation, technical instructions on GTAS reporting procedures, U.S. Standard General Ledger crosswalks, and attribute requirements. Together, this guidance governs how agencies complete various accounting, validation, and reporting procedures. Through a combination of manual and automated interfaces, GTAS exchanges data with fiduciary authoritative source agencies and major government-wide accounting systems, including the following: Central Accounting Reporting System (CARS) DATA Act Broker Government Invoicing (G-Invoicing) OMB Max Simplified Overview of Selected Data Inflows to and Outflows from GTAS Why GAO Did This Study GTAS plays a central role in the financial management and transparency of the U.S. federal government. It supports a wide array of government financial operations, helping to ensure the accurate reporting of intragovernmental transactions, cash flow, and other financial activities. Federal entities use GTAS as a key system to report financial and budgetary execution information to Treasury. Treasury, in coordination with OMB, uses this information to prepare the annual financial report of the U.S. government. The financial report provides the President, Congress, and the public with a comprehensive view of the federal government’s finances—its revenue, debt, and expenditures. The Government Management Reform Act of 1994 includes a provision for GAO to annually audit the consolidated financial statements of the U.S. government. Because of the importance of GTAS in preparing these financial statements and ensuring the accuracy and completeness of the data, GAO conducted this review to provide a system overview. This report describes the (1) laws and guidance relevant to government-wide financial reporting requirements and the use of GTAS for that purpose, (2) major government-wide accounting systems that interface with GTAS, and (3) data flow and validation processes of GTAS. To address these objectives, GAO reviewed applicable laws, Treasury and OMB guidance, and GTAS system documentation. GAO also discussed GTAS data transmission and validation processes with Treasury officials. Treasury stated the agency did not have any comments on the report. For more information, contact Paula M. Rascona at RasconaP@gao.gov.

What GAO Found The federal government is on an unsustainable fiscal path that poses serious economic, national security, and societal challenges if not addressed. Nearly every year this century, the government has spent more than it collected in revenue. To finance these deficits, the government has had to borrow by issuing debt. If current spending and revenue policies continue, the nation’s fiscal outlook is projected to deteriorate further, as debt accumulates at a faster rate than the economy grows. GAO projects that under current revenue and spending policies, debt held by the public will reach its historical high of 106 percent of gross domestic product (GDP) by 2029 and grow to 251 percent of GDP in 2056. Debt Held by the Public Projected to Grow Faster than the Economy Projected deficits are driven by projected growth in program spending—largely from Social Security, Medicare, and other federal health care programs—and in interest costs. Under current policy, spending on net interest will be the fastest growing portion of the federal budget and represent an increasingly large share of total spending. The magnitude of policy changes needed to create a sustainable fiscal future for the federal government requires a coordinated strategy that includes fiscal rules to encourage fiscal discipline (and as an alternative to the debt limit); builds consensus about how to reduce annual deficits; addresses financing gaps in the Social Security and Medicare trust funds before they are depleted in 2032 and 2033, respectively; and considers other opportunities to improve fiscal responsibility. Congress and the administration will need to make difficult budgetary and policy decisions to address the key drivers of debt and improve the government’s fiscal outlook. The longer actions are delayed, the more dramatic they will need to be. Why GAO Did This Study GAO produces this annual fiscal health report to examine the current fiscal condition of the federal government and its future fiscal outlook, absent policy changes in revenue and program spending. The report is based on the results of GAO's fiscal simulation using information available as of February 2026. This report presents GAO’s projections—under current policy—of (1) federal debt; (2) primary deficits (the gap between program spending and revenue); (3) interest costs and (4) revenue and spending changes needed for a sustainable fiscal outlook.

What GAO Found Since 2021, F-35 sustainment costs have continued to increase, but the F-35 has not met performance goals and performance has trended down. Across the fleet from fiscal year 2021 through fiscal year 2025: The mission capable rate (percentage of time the aircraft can perform one of its tasked missions) declined from 67 percent to 44 percent. The full mission capable rate (percentage of time the aircraft can perform all of its missions) declined from 38 percent to 25 percent. In response, the F-35 Joint Program Office (JPO) updated its sustainment strategy, which it refers to as the Global Support Solution (GSS) Reset. The GSS Reset requires an estimated $13.7 billion more than previously planned through fiscal year 2031 and seeks to address challenges GAO previously identified, including a lack of spare parts and heavy reliance on contractors. GAO found that multiple risks threaten JPO’s ability to achieve GSS Reset goals. For example, JPO will be reliant on the private sector to deliver more than $7 billion in additional parts and other material. But capacity constraints persist for key parts. Estimated costs for the F-35 also continue to increase. As a result, the U.S. military services will annually face a more than $1 billion gap between the projected costs to sustain their F-35s and their affordability goals by the mid-2030s. GSS Reset is a positive step toward addressing sustainment challenges, but risk mitigation plans would better position JPO to attain GSS Reset goals. Further, JPO’s use of contract incentives did not achieve F-35 readiness goals, due in part to JPO paying incentive fees for performance that did not align with service requirements (see figure). Until JPO ensures the future use of incentives better achieves desired performance, it risks rewarding contractor performance that does not help meet program goals. Minimum Full Mission Capable Rate (FMC) Requirements for Contractors to Receive a Portion of Incentive Fees Compared with Service Requirements, 2020–2023 Why GAO Did This Study The F-35 aircraft is the Department of Defense’s (DOD) most costly weapon system, with lifetime sustainment costs for the United States alone estimated at $1.6 trillion, as of 2024. DOD operates and sustains over 800 U.S. F-35s and plans to buy about 1,700 more aircraft by the mid-2040s. DOD uses the F-35 to perform a wide range of missions. It is vital to the success of U.S. combat operations and homeland defense, according to DOD. The National Defense Authorization Act for Fiscal Year 2022, as amended, includes a provision for GAO to conduct an annual review of F-35 sustainment efforts. This report assesses the extent to which JPO has evaluated the performance of its sustainment strategy and managed sustainment responsibilities with contractors to achieve goals, among other objectives. GAO analyzed performance metrics, cost information, and sustainment contract incentive fee data for, among other things, full mission capable-related goals from 2020 through 2023, the last contract in which that metric was incentivized. GAO also reviewed relevant program documentation and interviewed DOD officials and contractor representatives.

What GAO Found The Department of Veterans Affairs (VA) uses dozens of systems to schedule appointments, manage referrals, and monitor wait times for veterans. The department is also in the process of replacing its primary health information system—the Veterans Health Information Systems and Technology Architecture (VistA)—by deploying a new electronic health record system with Oracle Health. However, the rollout of the new system has been delayed due to technical and performance issues. Some of those scheduling systems and tools are commonly used across the department by many VistA facilities. Schedulers at the handful of facilities that have the new Oracle Health system also have an additional set of scheduling systems and tools available. For example: VistA facilities. Almost allVA medical facilities use the VistA health information system, which is over 30 years old. These facilities use multiple VistA applications, in addition to other systems, for scheduling health care appointments and managing referrals for specialty care. Both schedulers and veterans must navigate a complex environment when using VA’s systems to schedule appointments. VA facility staff are required to open multiple applications to schedule a single appointment. They must also run reports in different systems to identify veteran self-scheduled and self-canceled appointments and appointment requests. Oracle Health facilities. Due to difficulties in rollout, very few facilities have begun to use the new Oracle Health system. These facilities have another set of scheduling systems, as well as some of the same systems VistA facilities use for scheduling appointments and managing referrals. In addition, veterans have experienced issues requesting an appointment online, getting confirmation once an appointment is scheduled, and receiving duplicative appointment reminders. This complex systems environment presents challenges for VA and for veterans scheduling appointments. VA officials acknowledge that some challenges are the result of operating multiple platforms (VistA and Oracle Health) as well as having multiple versions of VistA. VA is taking steps to address these challenges. VA initiated efforts to modernize its scheduling systems, which included several concurrent efforts to improve scheduling-related systems across VA’s medical facilities. For example, one of these efforts is intended to allow provider-based scheduling, which is the ability for VA schedulers to see a provider’s schedule across multiple modalities (in-person, telephone, telehealth) in a single scheduling application. According to VA officials, the department is also working to standardize veteran appointment self-scheduling at VistA and Oracle Health sites. GAO has reported for many years on VA’s challenges concerning its scheduling systems and their impact on delivering care to veterans. Although VA has generally agreed with GAO’s recommendations, it has not yet fully implemented them. Doing so would aid VA’s progress toward providing timely, quality care to veterans. Why GAO Did This Study The VA schedules tens of millions of health care appointments for veterans each year. To do so, it uses a patchwork of systems that have been developed in ways that make scheduling—with both Veterans Health Administration (VHA) and non-VHA providers—difficult for veterans and staff. In addition, VA has experienced information technology (IT) challenges related to the outdated, inefficient nature of systems and its efforts to modernize its health information system. VA health care was added to GAO’s High Risk List in 2015, where it remains today. GAO was asked to testify on its key prior work on VA scheduling and the systems involved, as well as the related challenges for VA providers, staff, and veterans, and how VA plans to address those challenges. GAO summarized the results of five prior reports.

What GAO Found In May 2025, GAO identified 14 priority recommendations for the Department of the Interior. Since then, Interior has implemented one of those recommendations. In May 2026, GAO identified an additional 2 priority recommendations and removed the priority status from one recommendation, bringing the total to 14. GAO is highlighting the following two areas that warrant timely and focused attention: Improving oversight of oil and gas activities, and Conducting strategic workforce planning and oversight. Addressing GAO's recommendations in these areas would enhance Interior's ability to oversee oil and gas development—which provides billions of dollars of revenue—and help Interior develop strategies to close skill gaps and better understand the resources it needs to improve its overall capacity and fulfill its trust responsibility. Taking action to implement all of GAO's open priority recommendations would help enhance the efficiency and effectiveness of operations across Interior. 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 make progress toward addressing a high risk or duplication issue, among other benefits. Since 2015, GAO has sent letters to selected agencies to highlight the importance of implementing such recommendations. For more information, please contact Allison Bawden at BawdenA@gao.gov.

What GAO Found In May 2025, GAO identified 35 priority recommendations for the Department of Health and Human Services (HHS). Since then, HHS has implemented four of those recommendations. In May 2026, GAO identified an additional seven priority recommendations, bringing the total to 38. GAO is highlighting the following two areas that warrant timely and focused attention: Strengthen Medicare and Medicaid program integrity and oversight; and Improve public health program oversight and coordination. Taking action to implement GAO's open recommendations in these areas would help increase the efficiency and effectiveness of key federal health care programs and funding. It would also help officials understand how prepared jurisdictions are to respond to public health emergencies. Addressing all of GAO's open priority recommendations could significantly improve HHS's 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 make progress toward addressing a high risk or duplication issue, among other benefits. Since 2015, GAO has sent letters to selected agencies to highlight the importance of implementing such recommendations. For more information, please contact Jessica Farb at farbj@gao.gov.

What GAO Found The Air Force’s metrics for aircraft availability and mission capability do not provide a complete picture of the KC-135 and KC-46A tanker fleet’s ability to meet its primary refueling mission. The tanker fleet did not meet the Air Force’s availability and capability standards from fiscal year 2019 through fiscal year 2025, but these metrics do not specifically account for the aircraft’s ability to meet the primary refueling mission. The Air Force also calculates a “fully mission capable” (FMC) rate to measure the fleet’s ability to meet all its missions, which decreased substantially during that 7-year period. According to Air Force officials, while FMC is a clear indicator of an aircraft’s ability to meet its primary refueling mission, it excludes non-FMC aircraft that may be able to meet the refueling mission but not other missions. Without metrics and standards focused on the aerial refueling mission specifically, the Air Force risks not having a clear understanding of the fleet’s ability to meet key operational requirements. Air Force officials identified sustainment risks for the KC-135 and KC-46A fleets, but the Air Force has not comprehensively assessed these risks or developed a plan to mitigate them. The sustainment risks included shortages of critical parts and skilled maintainers and infrastructure limitations. The Air Force has taken some actions to address these risks, including identifying alternative sources for parts and upgrading infrastructure. However, conducting a comprehensive assessment of risks associated with sustaining the fleet and developing a mitigation plan to address these risks based on their likelihood or impact would help the Air Force target scarce resources to areas of greatest risk and enhance the health of the aerial refueling tanker fleet. Aerial Refueling Tanker Sustainment Risks Why GAO Did This Study The Air Force’s aerial refueling tanker fleet—capable of transferring fuel from airborne tankers to aircraft while in flight—is the largest in the world and plays a critical role in air mobility operations. House Report 118-529, accompanying a bill for the National Defense Authorization Act for Fiscal Year 2025, included a provision for GAO to assess the Air Force’s refueling capabilities and sustainment of the aerial refueling fleet. Among other objectives, this GAO report addresses the extent to which the fleet meets the Air Force’s current and future needs, and the extent to which the Air Force has assessed risks and developed mitigation plans associated with sustaining the KC-135 and KC-46A aerial refueling aircraft. GAO reviewed Air Force data on the composition and performance of the aerial refueling fleet, reviewed agency documentation, contacted 16 units across 11 bases, and interviewed relevant Department of Defense and Air Force officials. This is a public version of a sensitive report GAO issued in May 2026. This version omits information DOD deemed to be Controlled Unclassified Information.

What GAO Found In weapon systems acquisition, waste is not merely about individual overpriced parts; it is the systemic loss of billions of dollars and decades of time. Since 1990, the Department of Defense’s (DOD) costliest weapon programs have wasted billions while often failing to deliver a usable capability to the field. For example, the Army’s Integrated Visual Augmentation program—intended to provide augmented-reality headgear for soldiers for close combat—has yet to deliver operational capability after three different acquisition efforts over the last 8 years. Though the program produced nearly 10,000 units of the first two versions, they do not meet soldiers’ needs and will go into storage, with some potentially used for testing, rather than into the field. Thousands of Integrated Visual Augmentation System Headsets Head for Storage GAO's decades-long body of work on DOD acquisition consistently shows that waste in these programs occurs when they are structured to “fail slow” as DOD pours time and money into efforts that stagnate while global technology accelerates. DOD is incentivized to award massive development contracts and obligate funds quickly to ensure the budget is not “lost” to another program. Success is often measured by money spent, not capability delivered. As a result, the expected time frame for major programs to deliver an initial capability now exceeds 12 years. Every month of delay in a weapon system acquisition program causes a warfighter to rely on aging, less-capable equipment for longer. In contrast, leading commercial companies iteratively develop business cases to respond to users’ needs and finish fast, helping them stay on budget. They reassess business cases regularly to avert problems sooner. They also ramp up investments as products demonstrate progress. (See GAO-25-107130.) However, DOD has yet to fully adopt these leading practices because acquisition policies do not treat iterative development as a founding principle for all weapon system acquisitions programs. As noted in its November 2025 policy memorandum aimed at revamping the defense acquisition system, DOD now plans to maximize acquisition flexibility, among other changes. GAO will continue to assess DOD’s efforts. Why GAO Did This Study DOD plans to invest over $2.4 trillion to develop and acquire its costliest weapon systems. The need for smart spending and increased urgency and innovation for these acquisitions are national imperatives to help DOD maintain a competitive edge over adversaries. But DOD continues to struggle with delivering timely, cost-effective solutions to the warfighter, and slow, linear development approaches persist. GAO has reported for decades on the persistent issues that plague these weapon programs and on leading practices that commercial companies use to avoid these issues. GAO was asked to discuss issues related to waste in DOD weapon systems acquisition. This report, which GAO prepared for a subcommittee roundtable, addresses (1) the wasteful DOD practices that lead to undesirable weapon system acquisition program outcomes and (2) leading commercial practices that, if thoughtfully applied, could reduce waste and improve outcomes. GAO based this report predominantly on prior work, including recent reports on leading practices for product development and prior GAO reports on weapon systems acquisitions.

What GAO Found The routine home care that makes up the bulk of Medicare hospice care for its beneficiaries is primarily delivered through visits made by nurses, aides and social workers. GAO found that in 2024 for selected beneficiaries and hospices, low-visit hospices—the 20 percent of hospices that delivered the fewest visits per week per beneficiary—averaged about half as many visits per week as high-visit hospices—the 20 percent that delivered the most visits per week. Low-visit hospices delivered a total of 2.5 visits per week on average, compared to a total of 5.5 visits per week on average for high-visit hospices. Because Medicare’s hospice daily payment rates are the same regardless of the number of visits delivered, Medicare effectively paid low-visit hospices twice as much per visit as high-visit hospices, on average. Also, Medicare effectively paid more per visit under hospice payment rates than it would have under rates for comparable home health visits. (See figure.) (GAO adjusted home health rates to account for, among other things, differences between services covered under the payment rates for each program.) Hospice routine home care visits and home health visits are comparable because they involve similar services provided by the same types of health care professionals. GAO’s analysis of claims from 2022 through 2024 showed that Medicare paid about $16.7 billion for the hospice routine home care but estimated Medicare would have paid about $9.1 billion if the care had been reimbursed under the home health per-visit payment rates for comparable services—a $7.6 billion difference. Average Per-Visit Hospice Payment and Home Health Per-Visit Rates for Low- and High-Visit Hospices for Selected Beneficiaries Discharged from Hospice in 2024 Note: GAO made several adjustments to account for differences between hospice payment rates and home health per-visit payment rates, including services that are covered by hospice, but not home health. Though GAO found Medicare spending for routine home care is higher than what it would be under home health per-visit rates, Centers for Medicare & Medicaid Services (CMS) officials said the statute requires daily hospice payment rates and does not provide flexibility for further refinements to the payment structure beyond those made in 2016 and 2020. Officials also said CMS will continue to monitor hospice utilization to determine if there is a need for further refinements consistent with their statutory authority. Any excess hospice spending may have negative implications for the sustainability of the Medicare program and is inconsistent with Medicare’s responsibility to be an efficient purchaser of health care services. Why GAO Did This Study Medicare beneficiaries who are terminally ill may be able to enroll in Medicare’s hospice benefit, and the number who have done so has increased. Medicare’s spending on hospice care nearly doubled from $15.5 billion in fiscal year 2015 to $27.5 billion in fiscal year 2024. For routine home care provided through its hospice benefit, Medicare generally pays a set amount per day regardless of the number and type of visits delivered. A daily rate may create financial incentives for hospices to provide a limited number of visits, which could affect the quality of hospice care. GAO was asked to review Medicare hospice services and payments for those services. In this report, GAO (1) describes the frequency of hospice routine home care visits provided by selected hospices; and (2) examines how estimated per-visit payment rates for hospice routine home care compare across selected hospices as well as to home health per-visit payment rates. GAO analyzed Medicare claims for routine home care from 2022 through 2024 for a selection of 1,225,049 beneficiaries discharged from hospice in 2024 and a selection of 4,340 hospices that served more than 30 beneficiaries. GAO also reviewed documents and interviewed researchers and national organizations and CMS officials on hospice payment reform.

What GAO Found Since January 2025, in response to presidential directives and accompanying Office of Personnel Management (OPM) guidance, many federal agencies have taken steps to reduce their probationary and trial employee staffing levels. These are employees who have not yet completed the service requirements necessary to finalize their appointments, either after being newly hired or after being appointed as a supervisor or manager. Probationary periods are generally 1 or 2 years during which probationary and trial employees have limited job protections. An executive order and OPM guidance directed agencies to identify their probationary employees and determine who should be retained. When making termination decisions about probationary employees, federal agencies could now consider—in addition to employee performance and conduct—whether the individual’s continued employment would advance organizational goals. In December 2025, OPM proposed a rule that would make it the adjudicator of all appeals, replacing the U.S. Merit Systems Protection Board. This proposed probationary and trial period appeals regulation provides for appeals of such terminations to claims alleging discrimination based on partisan politics, marital status, or the agency’s failure to follow termination procedures. According to OPM, until a final rule is issued, there is no right to appeal. GAO’s analysis of OPM’s Federal Workforce Data (FWD) found that, in 2025, probationary employees separated from 11 selected agencies at a slightly higher rate (19 percent) compared to all employees who separated from these agencies (15 percent). Over two-thirds of these separating probationary employees did so voluntarily (see figure) as did all employees who separated from these agencies. Number and Percent of Personnel Actions by Type of Separation for Probationary Employees at Selected Agencies, 2025 Across most selected agencies in 2025, a greater proportion of probationary employees separated compared to all employees who separated. At the Department of Energy, for instance, about 34 percent of probationary employees separated, compared with 19 percent of all employees. The Department of Defense recorded the largest number of probationary separations—about 20,000 employees—but separation rates for probationary employees and the overall Defense workforce were nearly identical, at about 14 percent. Why GAO Did This Study Since January 2025, several executive orders directed changes to the federal workforce including probationary employees. As a result, federal agencies, including those with health and safety missions, took steps to reduce their probationary and trial employee staffing levels. GAO was asked to examine workforce changes affecting federal probationary and trial employees at agencies that focus on health or safety. This report describes (1) regulations and policies related to probationary and trial periods for federal employees, including updates since January 2025; and (2) trends in these employee separations at selected agencies from January through December 2025. GAO analyzed workforce data on OPM’s FWD website from the following selection of 11 agencies, including 12 subcomponents, with health or safety missions: the Departments of Agriculture and Forest Service; Commerce and National Oceanic and Atmospheric Administration; Defense; Energy; Health and Human Services, Centers for Disease Control and Prevention, Food and Drug Administration, and National Institutes of Health; Homeland Security, Federal Emergency Management Agency, and Transportation Security Administration; the Interior, Bureau of Land Management, and National Park Service; Transportation and Federal Aviation Administration; Veterans Affairs, Veterans Health Administration, and Veterans Benefits Administration; the Environmental Protection Agency; and the Nuclear Regulatory Commission. For more information, contact Dawn G. Locke at locked@gao.gov.

What GAO Found In August 2025, U.S. Immigration and Customs Enforcement (ICE)’s largest immigration detention facility to date (known as Camp East Montana) opened on U.S. Army Fort Bliss in El Paso, Texas. GAO found that the Army—which awarded and administered the $1.3 billion facility contract—and ICE expedited the award and construction schedule for the facility. This negatively affected their planning and acquisition. Army and ICE officials indicated that the expedited time frames directed by senior leadership dictated several decisions related to their acquisition approach, such as using a contracting vehicle not previously used for detention services. They also selected a contractor that did not have prior experience providing detention services. The Army transferred contract administration responsibilities to ICE in October 2025. U.S. Immigration and Customs Enforcement’s Camp East Montana GAO found that the Army did not incorporate flexibilities in the contract to account for occupancy levels below the maximum, resulting in millions of dollars in waste. For example, the Army paid the full cost for meals and services from August 1 to August 15, 2025, when there were no detained noncitizens at the facility. GAO also found that ICE could save tens of millions of dollars through September 2026 by incorporating cost saving measures in the contract, such as tiered pricing for meals. In April 2026, ICE terminated the contract for convenience and chose a new contractor to operate the facility. However, ICE had not yet incorporated these cost saving measures into the new contract and continued to pay for meals that it did not need. GAO also identified serious performance and oversight challenges at Camp East Montana. The facility opened without meeting key detention standards. For example, the facility initially did not have perimeter security cameras, outdoor recreation space, or space for attorney and family visitation. ICE did not identify these issues because it did not inspect the facility prior to housing detained noncitizens there, as required by ICE policy. After the facility opened, ICE reported additional problems, including gaps in medical services, the loss of a loaded firearm, and unsanitary conditions, among other issues. These issues posed serious risks to the safety and security of both detained noncitizens and staff in the facility. Why GAO Did This Study ICE increased its enforcement efforts and expanded its detention capacity in response to a January 2025 Executive Order. ICE’s average daily population of detained noncitizens increased 71 percent from January 20, 2025 to April 1, 2026, according to ICE data. This report provides observations from our ongoing review of ICE’s expansion of immigration detention operations and focuses on (1) how the Army and ICE planned for and acquired Camp East Montana and (2) oversight of the facility. We are issuing this report given the need for ICE to take immediate corrective actions to save taxpayer dollars and improve detention operations. To conduct this audit, GAO visited Camp East Montana and observed facility operations in September 2025. GAO reviewed relevant statutes and regulations, agency policies, contract documentation, and Army and ICE reports on Camp East Montana operations. GAO also analyzed facility population data and invoices to calculate waste and potential cost savings. GAO interviewed Army and ICE officials and contractors to discuss operations and oversight.

What GAO Found When communities are hit by a major disaster—such as a flood, hurricane, or wildfire—a key first step is removing large quantities of debris so that they can begin to recover. The Federal Emergency Management Agency (FEMA), a component within the Department of Homeland Security (DHS), and the U.S. Army Corps of Engineers can help them respond quickly by awarding contracts before disasters strike. Tribes, states, and localities may also award their own advance contracts for debris removal. GAO found that six of 16 selected governments had awarded advance contracts for debris removal and identified benefits of having them, such as speed of debris removal. GAO also found confusion among FEMA’s procurement training group and its regional offices about roles and responsibilities for encouraging governments to award advance debris removal contracts. Clarifying roles and responsibilities would improve information sharing to encourage advance contract use. Uncleared Fire Debris in Pacific Palisades, California (May 2025) GAO found that the Army Corps’s processes for reporting debris removal data to those affected by the Los Angeles wildfires (January 2025) and Hurricane Helene in North Carolina (September 2024) differed. In Los Angeles, the Army Corps publicly shared an online interactive map with real-time debris removal data within about 6 weeks after the wildfires began. In contrast, it did not share county-specific infographics for those in North Carolina affected by the hurricane until 4 months after the disaster. Because the Army Corps has not completed an analysis of the reasons for the differences in data sharing, it may miss opportunities to improve its approach to providing timely and consistent data, including real-time debris removal data, during future disasters. FEMA put controls in place to mitigate the risks of fraud, waste, and abuse in its debris removal program. For example, it requires that grant applicants ensure that debris removal quantities are accurate to avoid incurring unnecessary costs. But, FEMA is not well positioned to obtain and evaluate information about new or evolving fraud, waste, and abuse risks in its debris removal program because its efforts do not align with fraud risk management leading practices. Conducting regular risk assessments and developing a process to address risks would help FEMA more strategically manage risks across its entire debris removal program. Why GAO Did This Study FEMA and the Army Corps spend billions of dollars annually to respond to major disasters. Using advance contracts can help quickly start the recovery because contractors may be able to start work soon after a disaster. The Disaster Contract Improvement Act includes a provision for GAO to review several areas related to debris removal. This report, among other objectives, examines (1) selected governments’ perspectives on the use of advance contracts for debris removal, and the extent to which FEMA encouraged the use of advance contracts; and the extent to which (2) the Army Corps developed processes for reporting advance contract debris removal efforts during the responses to two disasters, and (3) FEMA mitigated risks in its debris removal program. To conduct this review, GAO reviewed FEMA and Army Corps policies, data, and other documents and conducted site visits to observe ongoing debris removal in Los Angeles and North Carolina. GAO also interviewed FEMA and Army Corps officials, and officials from 16 governments, selected based on obligation amounts and geographic variation, among other factors.

What GAO Found The U.S. Department of Homeland Security (DHS) and its components spend billions annually on programs to acquire systems and capabilities that support national security. In fiscal year (FY) 2025, GAO reviewed 27 DHS major acquisition programs—generally, those with total costs over $300 million. To support timely delivery of capabilities and minimize cost growth, DHS policy requires programs to get DHS approval for their baseline cost, schedule, and performance goals. Of the 27 programs reviewed, 19 had received this approval while the other 8 had not yet reached the stage where this was required. As of September 30, 2025, 15 of the 19 programs had revised their baseline goals since initially setting them, some of them multiple times. Most programs with revised baselines delayed their plans to deliver full capabilities. Baselined costs collectively increased a projected $11.4 billion, or 26 percent, since they were first set. Of those 19 programs, 18 were meeting their most recent baseline goals. One program—the Coast Guard’s Offshore Patrol Cutter—has ongoing efforts to revise its baseline to reflect recent schedule delays and cost increases. DHS’s programs face a continually changing environment, which affects their ability to manage cost and schedule risks. For example: Staff. Uncertainties around staff could risk programs’ ability to achieve future milestones. Specifically, in FY 2025, eight programs experienced at least a 20 percent or more reduction in staff, resulting in lost subject matter expertise and technical skills. Acquisition oversight. In October 2025, DHS decided to dissolve the office responsible for department-level oversight of major acquisition programs. DHS officials stated some of the oversight responsibilities had been moved to other parts of DHS. However, as of January 2026, DHS officials were unsure what level of oversight DHS would continue to provide. In May 2026, at least one part of that office was reconstituted, according to DHS officials. Funding. Twelve of the 27 programs expect to receive at least $14 billion in funding from the 2025 Budget Reconciliation Act. GAO will continue to monitor DHS’s updated acquisition oversight structure as well as DHS’s portfolio of major acquisition programs. Why GAO Did This Study DHS plans to invest over $55 billion to acquire systems for its current portfolio of major acquisition programs—over $11 billion more than DHS had initially planned. The Explanatory Statement accompanying a bill for the DHS Appropriations Act, 2015 includes a provision for GAO to review DHS’s major acquisitions on an ongoing basis. This report assesses (1) how DHS major acquisition programs have performed since establishing their baseline cost, schedule, and performance goals; and (2) the status of DHS’s acquisition portfolio, including any cost and schedule risks. GAO selected 27 of DHS’s largest acquisition programs to determine program status as of the end of FY 2025. Of these, GAO identified 19 with DHS-approved acquisition baselines for further analysis. GAO reviewed key documents; collected cost, schedule, and performance information; and interviewed DHS officials. For more information, contact Travis J. Masters at masterst@gao.gov.

What GAO Found The General Services Administration (GSA) maintains an inventory of the federal government’s real property assets in a database called the Federal Real Property Profile (FRPP) Management System. Over time, data elements have been added to the FRPP for various reasons, including in response to laws. GSA has taken steps to improve FRPP data’s completeness and accuracy, such as updating guidance for agencies that submit data to FRPP. GAO assessed the accuracy of location data for fiscal year 2024 and found the data were generally accurate at the country and state level—data that GSA validates. However, the data were less accurate at a more granular level. In particular, about 20 percent of buildings listed in the FRPP had latitude and longitude coordinates that did not match their reported zip codes. As a result, FRPP’s building location data is less useful than it could be in providing accurate information on federal property. Examples of Significant Mismatches Between the Federal Real Property Profile’s Latitude and Longitude Data and Zip Code Data for Two Buildings Officials from all five selected agencies and all nine federal real property stakeholders GAO interviewed said they make limited use of the FRPP. Officials from three agencies said they use the data for illustrative purposes, such as making comparisons with other agencies. Officials from all five agencies said they relied on their agencies’ own more comprehensive systems to manage their real property. Real property stakeholders said they use other data to inform their decisions and cited concerns about FRPP’s data reliability, presentation, and timeliness. Six noted that the FRPP is difficult to use, with five tying this to the size and formatting of the FRPP. GSA officials said they have not identified which of the FRPP’s more than 100 data fields are most useful to agencies and stakeholders because they typically add or remove elements in response to requirements from Congress or the administration. Internal control standards note the importance of communicating useful information and the need to develop a plan to respond to change (such as changes in user needs) within available resources. Developing a plan to streamline and improve the FRPP would help GSA provide a more useful and cost effective FRPP product that could better support the real property data needs of the administration, Congress, and other stakeholders. Why GAO Did This Study Congress and the administration have directed agencies to identify and dispose of underused real property, and reliable data can help inform efforts to more efficiently use federal space. GAO has previously identified problems with the reliability of FRPP location data, most recently in 2020. GAO was asked to study the reliability of FRPP data and its usefulness for different purposes and audiences. This report assesses (1) the steps GSA has taken to improve the accuracy and completeness of FRPP and the extent to which selected data elements for buildings are complete and accurate, and (2) the extent to which selected agencies and stakeholders use FRPP data. GAO reviewed federal laws, documents, and data, including GSA’s FRPP data for fiscal years 2023 and 2024. GAO interviewed officials at GSA and from a non-generalizable sample of five federal agencies (military and civilian) selected based on their number of federal buildings. GAO also interviewed a non-generalizable sample of nine real property stakeholders selected based on GAO’s prior work, GAO’s research, and stakeholder recommendations. GAO also compared GSA’s efforts to provide FRPP data against OMB guidance and Standards for Internal Control in the Federal Government.