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Strengthening the Health Care Safety Net

New Federal Resources


Eric Baumgartner, M.D., M.P.H., Director, Community Access and State Planning Programs, Office of the Administrator, Health Resources and Services Administration (HRSA), Rockville, MD.

Dr. Baumgartner described two new Federal grant programs administered through HRSA intended to support State and community-driven solutions to access-to-care problems.

The goal of HRSA's Community Access Program (CAP) is to "assist communities and consortia of health care providers to develop the infrastructure necessary for integrated health systems that coordinate health services for the uninsured and underinsured." The program involves establishing a strategic alliance of partnerships with funding for coordination.

Eligible applicants may include public, private, and nonprofit entities such as a consortium of:

  • Network providers.
  • Local government agencies.
  • Tribal governments.
  • Managed care plans.
  • Agencies of State governments.

Grant funds may be used for items such as:

  • Project staff salaries.
  • Consultant support.
  • Management information systems.
  • Project-related travel.
  • Other direct expenses.
  • Program evaluation activities.

In the program's first round of funding, HRSA received more than 200 CAP applications and announced 20 awards. Common elements in the applications included:

  • Community need.
  • Collaboration among safety net providers.
  • Rational referral of uninsured.
  • Comprehensive services.
  • Coordination with public insurance programs.
  • Community involvement.
  • Sustainability.

Dr. Baumgartner identified some key change agents with CAP such as integration, communities taking action, and leadership for change. He also described what he refers to as a "recipe for action":

  • Treat the uninsured as a population.
  • Enroll patients using a unified data system.
  • Develop a formal integrated panel of providers and link them through an electronic information system.
  • Maximize insurance enrollment.
  • Institute a regimen of demand management.
  • Report on performance and community and provider status.

HRSA has also recently established the State Planning Grants (SPG) program for the uninsured. The SPG program was created in fiscal year 2000 as part of the Labor-Department of Health & Human Services (HHS) Appropriations Act, providing $15 million for up to 10 awards.

The goal of the SPG program is to "encourage States to provide access to affordable health insurance coverage to all citizens, by providing resources needed to develop successful plans...and (in the aggregate) to provide a number of data collection and planning strategies, along with viable insurance expansion options for States to consider."

Eleven States were awarded in the first grant cycle, and another 9 are expected to receive funding in fiscal year 2001. Early observations include:

  • Most States are committed to planning for universal insurance coverage.
  • There are a broad range of starting points.
  • States will invoke multiple strategies.
  • There is a great interest in family coverage.

Dr. Baumgartner described the multiple strategies States are undertaking to increase access to affordable health insurance coverage. They include:

  • Optimize Medicaid, State Children's Health Insurance Program (SCHIP), employer-based, and State/locally funded plans.
  • Maximize effective enrollment strategies.
  • Challenge small group and individual markets.
  • Target sponsors/uninsured.
  • Address the growing complexity of publicly sponsored private insurance.

Future prospects for the SPG program include possible funding for new grants in fiscal year 2002, as well as national guidance from the Secretary's Report to Congress. The Secretary's Report will describe and analyze leading State activities and indicate ways Federal policy could provide better support. For further information on either of these two programs, visit


Community Access Program. Overview. Health Resources and Services Administration Web site.

State Planning Grant Program. Overview. Health Resources and Services Administration Web site.

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