When my kids were young, they watched, Where in the World is Carmen Sandiego? Now I must ask, where in the world are the 2027 HRSA SAC NOFOs? There was a time not that long ago when HRSA was a predicable funding agency—annual and periodic NOFOs appeared on a fairly regular basis. This was especially true for most Bureau of Primary Care programs of interest to FQHCs. For example, the first annual Service Areas Competition (SAC) NOFO would be published on grants.gov in May, with the remaining ones appearing in the next few months. The deadlines were from July to December. Not true anymore. As Bob Dylan put it, Things have changed. But, what has changed?
So far, only one FY ’27 NOFO, HRSA-27-005, has been published. Four more SAC NOFOs are forecasted, but forecasts of future NOFO releases by any federal agency are about as reliable as the beater cars I drove in high school. While I have no secret knowledge of why this is, I imagine it has something to do the policy changes since the advent of the Trump Part Deux administration. The combination of DOGE, the ongoing attempt to root out obvious corruption in certain programs, forced and voluntary staff reductions, funding delays, and the like seem to have scrambled the grant-making system at HRSA and many federal agencies. Still, this is not unprecedented, as the federal grant-making system often gets disrupted when the administration shifts from on the party to the other, as we wrote about in 2010 during the early years of the Obama Administration, “Where have all the RFPs Gone?“
Since we work for many FQHCs, I talk to many FQHC CEOs. None of the CEOs I’ve talked to recently have any idea of what is going on but they’re all unhappy about the chaos in the funding system. I tell them to contact their HRSA program officer for clarification, which makes them even more unhappy. At one time, each FQHC had an assigned program officer, which meant that CEOs developed relationships with them and could often glean insights into the byzantine internal workings of HRSA. No longer. During the Biden administration, HRSA changed this system, so that when an FQHC CEO contacts HRSA, they get a random program officer who they don’t necessarily know. Supposedly this was intended to prevent some sort of corruption that might develop from too friendly relationships between CEOs and program officers. Perhaps, but it also goes against human nature which thrives on interpersonal connections.
There is another possibility. Perhaps HRSA is heading toward changing the Section 330 Program from one that is competitive to one that is entitlement in nature. If I went into the Time Tunnel 25 years, there were tons of HUD competitive grant programs for public housing authorities (PHAs).* I know because at the time, PHAs were among S + A’s most significant client types. Now, we rarely get inquiries from PHAs. What changed? HUD shifted most of these from competitive to entitlement, so PHAs got the grants on a formula basis. Although each grant was smaller, there was no competition. This kind of metamorphosis would not be great for the SAC program because the possibility of losing their Section 330 grant to a competing applicant helps keep FQHCs focused on quality service delivery. We wrote about this possibility in 2014, “HRSA Service Area Competition (SAC) Grants: How to Defend Your Turf or Deftly Lift a HRSA Grant from an Unsuspecting Grantee.”
If any FQHC CEOs or HRSA program officers know what’s really going on at HRSA regarding SAC and other NOFOs, email or call me and I’ll post an update. Or, we’d be happy to put up a guest post, anonymously if requested, explaining the situation from the inside. Guest posts from insiders are always popular.