Nearly three years after the scandal first broke that hundreds of veterans had died waiting for medical treatment at Department of Veterans Affairs medical centers, the VA continues to operate under a cloud of doubt.

Despite numerous reforms and improvements and tens of billions of dollars in new funding to upgrade medical treatment and eliminate long waiting lists, the VA remains on the Government Accountability Office’s notorious “High Risk List” of agencies prone to mismanagement, waste and even fraud.

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The VA – one of only a handful of federal departments that received a funding increase under President Trump’s fiscal 2018 budget plan released on Thursday, will be undergoing yet another round of reforms and improvements under the new administration.

“We're going to straighten out the VA for our veterans,” Trump said in January, in announcing his choice of Dr. David Shulkin as the new VA secretary. “I've promised that for a long time, and it's something I feel very, very strongly.

The VA operates one of the largest health care delivery systems in the country, including 168 medical centers and more than 1,000 outpatient facilities organized in regional networks. The number of people who have enrolled in the VA health care system has mushroomed from 7.9 million in fiscal year 2006 to nearly nine million last year.

Throughout that same period, VA’s Veterans Health Administration’s total budget increased substantially, from $37.8 billion in FY 2006 to $91.2 billion in FY 2016. In response to the many serious and long-festering problems with access to VA health care, a $10 billion “Veterans Access” law was enacted in 2014 to provide temporary authority for veterans to obtain health care services from non-VA providers if they have to wait too long.

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But despite these and some other notable improvements during the final years of the Obama administration and the leadership of former secretary Robert A. McDonald, the GAO added the troubled agency to its high-risk list in 2015 out of concern about the VA’s inability to ensure the “timeliness, cost-effectiveness, quality and safety” of veterans’ health care.

Debra A. Draper, GAO’s director of health care, told the Senate Veterans’ Affairs Committee this week that VA officials had met only two of five crucial criteria for successful operation – including demonstrating leadership ability through the creation of task forces and other positive action and properly developing an action plan to address continued inadequacies in the agency’s health care system.

However, the VA has fallen well short of meeting three other criteria for escaping the list: demonstrating the capacity to address the major areas of concern, closely monitoring implementation of corrective actions, and demonstrating that progress is being made.

Since the VA was added to the list in 2015, the GAO has conducted two follow-up reports examining mental health and primary care access at VA medical facilities. Both studies found “wide variation in the time that veterans waited for primary and mental health care,” Draper said.

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She said those problems partly stemmed from “a lack of clear, updated policies for appointment scheduling,” which led to “inconsistent and unreliable wait-time data.” In short, for all its efforts and reforms, VA health care facilities continue to leave patients waiting too long to receive needed treatment.

Indeed, last year there were reports that the wait time at VA facilities had gotten worse. Compared to the situation in 2015 levels, there were 70,000 more appointments that took veterans at least a month to be seen. The VA blamed the problem on a huge surge in demand for care, but it was apparent the problem had more to do with the confusing and complicated way Veterans Choice was set up.

VA has implemented about 50 percent of the recommendations GAO has made to the agency. However, there continue to be more than 100 open recommendations related to VA health care. Nearly a quarter of those recommendations have remained open for three or more years.

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The GAO’s high risk list dates to the early 1990s, and more than 60 different agencies and areas of government have been on the list at one time or another. Trump no doubt would like to see the VA come off the list as a sign of improved service and management. But Draper said that on average it has taken agencies nine years to get off the black list.