Community Access Program

Published on AidPage by IDILOGIC on Jun 24, 2005

Purpose of this program:

To provide assistance to communities and consortia of health care providers and others to develop or strengthen integrated community health care delivery systems that coordinate health care services for individuals who are uninsured or underinsured, and to develop or strengthen activities related to providing coordinated care for individuals with chronic conditions who are uninsured or underinsured.

Possible uses and use restrictions...

Funds received under the Healthy Communities Access Program (HCAP) are not intended to be used to supplant/replace existing Federal categorical programs that support entities providing services to low-income populations. Grant funds may support justified direct expenses associated with achieving the greater integration of and/or to fill identified or documented gaps in the health care delivery system, so that the proposed integrated delivery system either directly provides or ensures the provision of a broad range of culturally competent services, as appropriate, including primary, secondary, and tertiary services, as well as substance abuse treatment and mental health services. No more than 15 percent of funds provided under the award may be used to provide direct patient care and services. Direct patient care and services include: the provision of patient care services or supplies that are ordinarily reimbursable (e.g., exams, therapy sessions, pharmaceuticals); primary care site development or service expansions (e.g., extended clinic hours); capital equipment used for reimbursable patient care and services (e.g., radiology equipment, ambulances). Grant funds may NOT be used for construction, reserve requirements for state insurance licensure or support for lobbying/advocacy efforts.

Who is eligible to apply...

Applications may be submitted by entities, including tribal, faith-based and community-based organizations, that represent a consortium whose principal purpose is to provide a broad range of coordinated health care services to their defined community's uninsured and underinsured populations. For an entity to be eligible to receive a new HCAP award, the following requirements must be met: 1. The applicant entity must represent a consortium whose principal purpose is to provide a broad range of coordinated health care services to their defined community's uninsured and underinsured populations. 2. The community-wide consortium represented by the applicant entity must include at least one of each of the following providers that serve the stated community, unless such provider does not exist, declines or refuses to participate, or places unreasonable conditions on its participation: ? A Federally qualified health center (as defined in section 1861(aa) of the Social Security Act (42 U.S.C. 1395x(aa))); ? A hospital with a low-income utilization rate (as defined in section 1923(b)(3) of the Social Security Act (42 U.S.C. 1396r-4(b)(3)), that is greater than 25 percent; ? A public health department; and ? An interested public or private sector health care provider or an organization that has traditionally served the medically uninsured and underserved. In addition to the required consortium members listed above, the community-wide consortium should seek partners from all levels of care who provide a range of services (e.g., preventive and primary care, specialty medical care, mental health and substance abuse services, oral health, HIV/AIDS care, social services, transportation, health education, etc.), as appropriate for the needs of the community's uninsured and underinsured populations. 3. The applicant entity is neither a current HCAP grantee nor former HCAP or Community Access Program (CAP) grantee and is proposing to serve a service area or target population of uninsured and underinsured individuals that has never been served by a CAP or HCAP grant 4. The entity must submit an application in the form and manner prescribed in the application guidance.

Eligible Applicant Categories:
Eligible Functional Categories:

Preapplication Coordination is not required. This program is eligible for coverage under E.O. 12372, "Intergovernmental Review of Federal Programs." An applicant should consult the office or official designated as the single point of contact in his or her State for more information on the process the State requires to be followed in applying for assistance, if the State has selected the program for review. Informal inquiries regarding the program and intent to submit an application should be directed to the Director, Division of Health Center Development (DHCD) Bureau of Primary Health Care for Health Resources and Services Administration.

Note:This is a brief description of the credentials or documentation required prior to, or along with, an application for assistance.

About this section:

This section indicates who can apply to the Federal government for assistance and the criteria the potential applicant must satisfy. For example, individuals may be eligible for research grants, and the criteria to be satisfied may be that they have a professional or scientific degree, 3 years of research experience, and be a citizen of the United States. Universities, medical schools, hospitals, or State and local governments may also be eligible. Where State governments are eligible, the type of State agency will be indicated (State welfare agency or State agency on aging) and the criteria that they must satisfy.

Certain federal programs (e.g., the Pell Grant program which provides grants to students) involve intermediate levels of application processing, i.e., applications are transmitted through colleges or universities that are neither the direct applicant nor the ultimate beneficiary. For these programs, the criteria that the intermediaries must satisfy are also indicated, along with intermediaries who are not eligible.

How to apply...

Application Procedure:

Each applicant will receive written notification of the outcome of the objective review process, including summary of the expert committee's assessment of the application's merits and weaknesses, and whether the application was selected for funding. Applicants who are selected for funding may be required to respond in a satisfactory manner to Conditions placed on their application before funding can proceed. Letters of notification do not provide authorization to begin performance. The Notice of Grant Award, which is signed by the Grants Management Officer and is sent to the applicant agency's Authorized Representative, is the authorizing document.

Note: Each program will indicate whether applications are to be submitted to the Federal headquarters, regional or local office, or to a State or local government office.

Award Procedure:

Please see HRSA Preview for further information at

Note: Grant payments may be made by a letter of credit, advance by Treasury check, or reimbursement by Treasury check. Awards may be made by the headquarters office directly to the applicant, an agency field office, a regional office, or by an authorized county office. The assistance may pass through the initial applicant for further distribution by intermediate level applicants to groups or individuals in the private sector.

Deadlines and process...


From 90 to 120 days.

Note: When available, this section indicates the deadlines for applications to the funding agency which will be stated in terms of the date(s) or between what dates the application should be received. When not available, applicants should contact the funding agency for deadline information.

Range of Approval/Disapproval Time


Preapplication Coordination

To receive a complete application kit, contact the HRSA Grants Application Center at 1-877-HRSA-123 and reference program 93.252. Or download the application from the HRSA Grants Policy website at

Note: This section indicates whether any prior coordination or approval is required with governmental or nongovernmental units prior to the submission of a formal application to the federal funding agency.


Same as application procedure.

Note: In some cases, there are no provisions for appeal. Where applicable, this section discusses appeal procedures or allowable rework time for resubmission of applications to be processed by the funding agency. Appeal procedures vary with individual programs and are either listed in this section or applicants are referred to appeal procedures documented in the relevant Code of Federal Regulations (CFR).



Note: In some instances, renewal procedures may be the same as for the application procedure, e.g., for projects of a non-continuing nature renewals will be treated as new, competing applications; for projects of an ongoing nature, renewals may be given annually.

Who can benefit...

Examples of eligible applicants that may apply on behalf of or participate as members of the community-wide consortium include but are not limited to: Community Health Center (CHC), Migrant Health Center (MHC), Health Care for the Homeless (HCH), Public Housing Primary Care (PHPC) and School-Based Health Centers Programs; Rural Health Clinics; Free and partial pay clinics; FQHC Look-alikes; local public health departments and other local government agencies; Tribal governments; Primary Care Associations; public and private hospitals; private provider or group practices; foundations; medical and dental societies and community-based non-profit organizations.

About this section:

This section lists the ultimate beneficiaries of a program, the criteria they must satisfy and who specifically is not eligible. The applicant and beneficiary will generally be the same for programs that provide assistance directly from a Federal agency. However, financial assistance that passes through State or local governments will have different applicants and beneficiaries since the assistance is transmitted to private sector beneficiaries who are not obligated to request or apply for the assistance.

What types of assistance...

Project Grants

The funding, for fixed or known periods, of specific projects. Project grants can include fellowships, scholarships, research grants, training grants, traineeships, experimental and demonstration grants, evaluation grants, planning grants, technical assistance grants, survey grants, and construction grants.

How much financial aid...

Range and Average of Financial Assistance

$162,087 to $1,925,089; $900,000.

Note: This section lists the representative range (smallest to largest) of the amount of financial assistance available. These figures are based upon funds awarded in the past fiscal year and the current fiscal year to date. Also indicated is an approximate average amount of awards which were made in the past and current fiscal years.


(CAP and HCAP Grants) FY 03 $105,000,000; FY est 04 $105,000,000; and FY 05 est $0.

Note: The dollar amounts listed in this section represent obligations for the past fiscal year (PY), estimates for the current fiscal year (CY), and estimates for the budget fiscal year (BY) as reported by the Federal agencies. Obligations for non-financial assistance programs indicate the administrative expenses involved in the operation of a program.

Account Identification


Note: Note: This 11-digit budget account identification code represents the account which funds a particular program. This code should be consistent with the code given for the program area as specified in Appendix III of the Budget of the United States Government.

Examples of funded projects...

Please refer to the CAP website ( for information on current HCAP grantees.

About this section

This section indicates the different types of projects which have been funded in the past. Only projects funded under Project Grants or Direct Payments for Specified Use should be listed here. The examples give potential applicants an idea of the types of projects that may be accepted for funding. The agency should list at least five examples of the most recently funded projects.

Program accomplishments...

The HCAP program began in 2000 as a demonstration project with 23 grantees, called the Community Access Program (CAP). In 2002, it received its own legislative authority and in fiscal year 2003, 35 new communities in 20 states received HCAP awards. Currently, the program has a total of 193 grantees located in 44 states and the District of Columbia (all but Hawaii, Nevada, New Jersey, South Dakota, Vermont and Wyoming). Up to 35 new funding awards may be made in fiscal year 2004.

Criteria for selecting proposals...

Each new award HCAP application submitted by the deadline will be screened for eligibility. An application will be considered eligible if it meets all of the specific eligibility requirements listed above. Applications that do not meet the eligibility requirements will not be accepted for processing and will be returned. An Objective Review Committee (ORC) will review all eligible applications. The review criteria used by the ORC to assess each application (out of 100 points) will include: Community Health Care Delivery System Needs Assessment (maximum 10 points): Extent to which the applicant clearly defines the service area and target population of uninsured and underinsured individuals for the project and provides a detailed assessment of the current delivery system for the applicant's uninsured and underinsured populations so as to describe the extent of unmet need for a more coordinated system of care. Consortium Organizational and Functional Structure (Maximum 15 Points): Extent to which the applicant describes the history, membership, functional structure, accountability and strategies of the applicant's HCAP consortium in terms of its capacity to implement an efficient, higher quality, comprehensive system of care for the stated target population of uninsured and underinsured individuals. Project Work Plan (Maximum 35 Points): Extent to which the applicant's work plan demonstrates the clarity, feasibility and scope of proposed activities, goals and measurable objectives which are consistent and aligned with stated needs and will develop or strengthen an integrated community health care delivery system that provides more efficient, effective, coordinated and quality care at a lower cost for the stated population of uninsured or underinsured individuals. Program Performance Plan (Maximum 15 Points): Extent to which the applicant provides an appropriate plan for evaluation of the activities carried out under the grant that ensures monitoring and measurement of progress towards the corresponding goals and objectives as well as the use of evaluation findings to improve program performance and support sustainability. Sustainability Plan (Maximum 15 Points): Extent to which the applicant provides an appropriate plan for long-term project sustainability and community-reinvestment for HCAP activities through decreasing dependence on Federal funds. Budget (Maximum 10 Points): Extent to which the applicant presents a detailed, clear and comprehensive budget that is appropriate and reasonable for the scope of proposed activities described in the Project Work Plan and which adequately documents and demonstrate the use of nonfederal contributions to the greatest extent possible for the proposed HCAP project.

Assistance considerations...

Length and Time Phasing of Assistance

Up to a 3-year Project period with a 12-month budget period for new HCAP grantees. Receipt of continuation funding is contingent on reasonable and demonstrable progress in meeting the goals and measurable objectives set forth in the entity's grant application for the budget period (September 1-August 31) for the preceding fiscal year, annual fund availability and a determination by the awarding office that continued funding of the grant is in the best interest of the Government. No eligible entity funded under HCAP may receive funds for more than three consecutive fiscal years except that entities may request a grant award for not more than one additional fiscal year (a 4th year of funding) under demonstrated extraordinary circumstances. Extraordinary circumstances are an event (or events) outside of the control of the eligible entity that has prevented the eligible entity from fulfilling the objectives described by such entity in their approved grant application for the budget period (September 1-August 31) for the preceding fiscal year. Granting of 4th year funding under extraordinary circumstances is contingent on demonstrated extraordinary circumstances whose event(s) and impact, or impact alone, occurred during the previous budget period and directly prevented the completion of goals and measurable objectives set forth in the entity's approved grant application for the budget period (September 1-August 31) for the preceding fiscal year. In order to justify such a request, there must be available funds and a determination by the awarding office that continued funding of the grant is in the best interest of the Government and necessary to further the objectives of the HCAP program.

Formula and Matching Requirements

No match or cost-sharing required.

A formula may be based on population, per capita income, and other statistical factors. Applicants are informed whether there are any matching requirements to be met when participating in the cost of a project. In general, the matching share represents that portion of the project costs not borne by the Federal government. Attachment F of OMB Circular No. A-102 (Office of Management and Budget) sets forth the criteria and procedures for the evaluation of matching share requirements which may be cash or in-kind contributions made by State and local governments or other agencies, institutions, private organizations, or individuals to satisfy matching requirements of Federal grants or loans.

Cash contributions represent the grantees' cash outlay, including the outlay of money contributed to the grantee by other public agencies, institutions, private organizations, or individuals. When authorized by Federal regulation, Federal funds received from other grants may be considered as the grantees' cash contribution.

In-kind contributions represent the value of noncash contributions provided by the grantee, other public agencies and institutions, private organizations or individuals. In-kind contributions may consist of charges for real property and equipment, and value of goods and services directly benefiting and specifically identifiable to the grant program. When authorized by Federal legislation, property purchased with Federal funds may be considered as grantees' in-kind contribution.

Maintenance of effort (MOE) is a requirement contained in certain legislation, regulations, or administrative policies stating that a grantee must maintain a specified level of financial effort in a specific area in order to receive Federal grant funds, and that the Federal grant funds may be used only to supplement, not supplant, the level of grantee funds.

Post assistance requirements...


Grantees are required to submit an annual report that describes the utilization costs of services provided under the grant, and provide such other information as the Secretary determines appropriate. Financial status reports are required no later than 90 days after the end of each budget period. Final financial status and progress reports are due 90 days after the end of a project period.

Note: This section indicates whether program reports, expenditure reports, cash reports or performance monitoring are required by the Federal funding agency, and specifies at what time intervals (monthly, annually, etc.) this must be accomplished.


Audits: An independent annual financial audit that meets OMB A-133 requirements and includes all records that relate to the disposition of funds received through this and any other Federal grant is required. The audits are due within 30 days or receipt from the auditor or within 9 months of the end of the fiscal year, whichever occurs first.

Note: This section discusses audits required by the Federal agency. The procedures and requirements for State and local governments and nonprofit entities are set forth in OMB Circular No. A-133. These requirements pertain to awards made within the respective State's fiscal year - not the Federal fiscal year, as some State and local governments may use the calendar year or other variation of time span designated as the fiscal year period, rather than that commonly known as the Federal fiscal year (from October 1st through September 30th).



Note: This section indicates the record retention requirements and the type of records the Federal agency may require. Not included are the normally imposed requirements of the General Accounting Office. For programs falling under the purview of OMB Circular No. A-102, record retention is set forth in Attachment C. For other programs, record retention is governed by the funding agency's requirements.



Public Health Service Act(42 U.S.C 256), Title 111, Subpart V, Section 340.

Note: This section lists the legal authority upon which a program is based (acts, amendments to acts, Public Law numbers, titles, sections, Statute Codes, citations to the U.S. Code, Executive Orders, Presidential Reorganization Plans, and Memoranda from an agency head).

Regulations, Guidelines, And Literature

Federal Register Notice Volume 66, Number 27.

Contact information...

Web Sites
Regional Or Local Office

Program contact: Division of Health Center Development, Health Center Infrastructure Branch, Bureau of Primary Health Care, Health Resources and Services Administration, 4350 East-West Highway, Bethesda, MD 20814. Telephone: (301) 594-4300. Grants Management Contact: Division of Grants Management Operations, Health Resources and Services Administration, 5600 Fishers Lane, Rockville, MD 20857.

Note: This section lists the agency contact person, address and telephone number of the Federal Regional or Local Office(s) to be contacted for detailed information regarding a program such as: (1) current availability of funds and the likelihood of receiving assistance within a given period; (2) pre-application and application forms required; (3) whether a pre-application conference is recommended; (4) assistance available in preparation of applications; (5) whether funding decisions are made at the headquarters, regional or local level; (6) application renewal procedures (including continuations and supplementals) or appeal procedures for rejected applications; and (7) recently published program guidelines and material. However, for most federal programs, this section will instruct the reader to consult the so-called Appendix IV of the Catalog due to the large volume of Regional and Local Office Contacts for most agencies. This information is provided in Additional Contact Information (see below).

Headquarters Office

Division of Health Center Development, Health Center Infrastructure Branch, Bureau of Primary Health Care, Health Resources and Services Administration, 4350 East-West Highway, Bethesda, MD 20814. Telephone: (301) 594-4300.

Note: This section lists names and addresses of the office at the headquarters level with direct operational responsibility for managing a program. A telephone number is provided in cases where a Regional or Local Office is not normally able to answer detailed inquiries concerning a program. Also listed are the name(s) and telephone number(s) of the information contact person(s) who can provide additional program information to applicants.

Additional Contact Information (Appendix IV)

Due to the large volume of regional and local office contacts for most agencies, full contact information is also provided separately here in a PDF format: