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HRSA Helped Health Centers With Elevated Risks and Can Continue To Take Additional Steps


The Health Center Program provides Federal funds to support health centers' operations with the goal of ensuring access to primary health care services for medically underserved populations. HRSA is tasked with administering and overseeing the program, which serves 1 in 12 people in the United States. Effective oversight of the program is essential to HRSA's ability to protect health center patients and Federal funds from the potential negative impacts of health centers that have elevated risks—i.e., health centers that are out of compliance with multiple program requirements or that are not financially stable.


We analyzed HRSA data from 2013 through 2015 related to the 309 health centers that received Service Area Competition (SAC) grants for FY 2014. We used HRSA's risk assessments to identify health centers with elevated risk. For these health centers, we reviewed 2 years of HRSA actions to help the health centers improve.


Twenty-five percent of the health centers to which HRSA awarded SAC grants in FY 2014 had elevated programmatic or financial risks. Included among these health centers were two that did not meet HRSA's funding criteria. HRSA took steps to help health centers improve, and many health centers were able to do so. However, HRSA missed opportunities to further help health centers because it did not use certain risk management interventions when it should have, exposing Federal funds to unnecessary risk. In addition, HRSA was not always able to help health centers, particularly those with elevated financial risks, to improve before awarding them additional years of funding.


During this study, OIG provided technical assistance to HRSA as it improved its oversight and worked to update its risk management process to implement new HHS guidance. According to HRSA, it made changes in its risk management process based on this early information from OIG. In this report, we provide two additional recommendations to help HRSA in its ongoing efforts to strengthen oversight of the Health Center Program. Specifically, we recommend that HRSA (1) use risk management interventions in accordance with its policies to help health centers reduce elevated risks and (2) explore additional steps it could take to help health centers reduce elevated risks. HRSA did not concur or nonconcur with our recommendations, but it noted actions it took that are responsive to them.