October 2, 2026
FSM — Veterans living in the Federated States of Micronesia continue to face costly travel and limited access to health care while the U.S. Department of Veterans Affairs pursues a partial expansion of services without a timetable for implementation, according to a new U.S. Government Accountability Office report.
Released September 25, the report documents VA’s decision in April 2025 not to use new authorities granted under the Compact of Free Association Amendments Act of 2024, followed by a change in direction toward implementing some of those authorities in 2026.
The proposed expansion would provide telehealth, delivery of medications and medical supplies, reimbursements for care, and travel benefits for eligible veterans with service-connected disabilities living in the FSM, the Marshall Islands, and Palau. However, those plans remained subject to further U.S. government procedures and negotiations with the three countries when GAO completed its review.
The FSM government welcomed the renewed engagement but argued in its written response that the proposed approach remains too narrow. It urged VA to provide comprehensive care for all eligible veterans, including treatment for conditions unrelated to military service.
The 2024 law gave VA discretionary authority to provide hospital care, medical services, and travel payments in the three freely associated states. That authority permits care for conditions regardless of whether they relate to a veteran’s military service. Before delivering hospital care or medical services under the new provisions, VA must establish agreements with the countries.
GAO found that VA assessed implementation options between March 2024 and March 2025. Nevertheless, an April 2025 memorandum to the U.S. Congress said the agency would not exercise the new authorities, citing a desire “to ensure equity with all U.S. veterans.”
VA and freely associated state officials confirmed to GAO in June 2026 that communication on implementation had stopped following that decision.
In July, VA officials told auditors they intended to renew engagement. By August, the agency had submitted a draft memorandum to the U.S. Department of State to begin the process necessary to authorize formal international negotiations. Officials from the freely associated states confirmed that communication with VA resumed that month.
As of September, however, VA could not provide estimated implementation dates. It also did not provide GAO with updated budget plans or anticipated changes to internal regulations.
The report describes substantial barriers under existing arrangements. There are no Veterans Health Administration facilities or providers in the three countries, and veterans there cannot access VA telehealth services.
The Foreign Medical Program provides a limited avenue for reimbursement of local care, generally for service-connected disabilities or conditions that aggravate those disabilities. But shortages of local services reduce the program’s usefulness.
Veterans who need care at VA facilities must travel to U.S. states or territories. Under the regulations and policies described in the report, veterans residing in the freely associated states cannot receive reimbursement for travel between their home countries and the United States, although eligible travel within U.S. areas may qualify.
GAO’s July 2026 search of United Airlines fares found that the lowest round-trip seat price exceeded $1,000 on every route examined between the three countries’ capitals and VA facilities in Guam or Honolulu. Those figures were a snapshot of available fares, rather than a measure of every veteran’s travel costs.
The obstacles extend beyond transportation. VA’s assessment found that specialty services such as oncology, cardiology, and advanced imaging remain largely unavailable locally and usually require off-island referrals. Mental health services are also limited, with insufficient providers to address veterans’ particular needs.
Officials estimated that up to approximately 1,100 veterans live across the three freely associated states, but the population remains difficult to measure. Veterans sometimes leave their home countries for extended periods to obtain care, complicating data collection.
VA identified 462 known veterans residing in the three countries as of March 2025. Of those, 144 had enrolled in Veterans Health Administration services during fiscal year 2024.
According to the report, officials said some veterans see little incentive to register or attend outreach events because enrollment does not necessarily provide practical access to care where they live.
VA’s earlier analysis estimated that full implementation would cost approximately $26 million annually for currently enrolled veterans, rising to a projected $200 million if all 1,100 potentially eligible veterans fully participated. These were planning estimates for full implementation across all three countries, not approved funding or estimates for the narrower approach now under consideration.
In a September 18 response included with the report, FSM Secretary of Foreign Affairs Ricky Cantero supported broader implementation. The FSM urged VA to establish a delivery model covering all medically necessary care for eligible veterans, regardless of service connection.
The response also called for bilateral agreements, clear milestones, implementation timelines, and dedicated funding. It described continuing gaps between the benefits veterans understood they would receive through military service and their ability to obtain those benefits after returning home.
GAO’s report records renewed movement toward expanded services, but it does not establish that the proposed benefits are available. For veterans in the FSM and the other freely associated states, the scope of future care and the date it will begin remain unresolved.
The full report, GAO-26-109152, is available at https://www.gao.gov/products/gao-26-109152.
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