On May 28, the Government Accountability Office (GAO) issued a report on the impacts of sequestration in 2013.  The report looked at several agencies that provide funding to state and local governments and deliver services directly to individuals.  The GAO found that many of these agencies reduced or delayed services to account for the across the board cuts. The report notes that in some cases, it is difficult to quantify the immediate and longer term effects of sequestration on CMS' operations and services because of the difficulty isolating the effects of sequestration from other factors.