The Health Resources and Services Administration (HRSA) helps ensure that health center grantees do not use federal funds for prohibited abortions by emphasizing the restrictions in its funding opportunity notices and award notices and by making project officers and grant management specialists available for questions about unallowable costs or activities. In addition, while HRSA provides funding to the National Association of Community Health Centers (NACHC) to provide training and technical assistance to health centers, HRSA trains health centers on prohibited activities (GAO Report, GAO-18-508R, July 12, 2018).
HRSA administers the Health Center Program and awards grants to eligible health centers under sec. 330 of the Public Health Service Act (as amended by secs. 4206 and 5601(a) of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148)). Health centers are prohibited from using federal funds from HRSA for abortions, unless the pregnancy is the result of rape or incest or the life of the pregnant woman would be endangered unless an abortion is performed. Congress annually prohibits HHS from funding abortions through legislation, most recently the Consolidated Appropriations Act, 2018 (P.L. 115-141), division H, title V, secs. 506 and 507. In addition, Executive Order 13535 applies this prohibition to health centers through the Community Health Center Fund established by sec. 10503 of the ACA.
In addition to making grantees aware of the restriction through funding opportunity notices and award notices, HRSA relies on annual single audit reports conducted by independent auditors, financial management reviews, and site visits, generally in the middle of the three-year project period.
HRSA awards funding to NACHC through cooperative agreements to provide training and technical assistance to health centers on such topics as leadership development and health center governance. HRSA, however, conducts training on prohibited activities. The agency oversees NACHC’s performance under the cooperative agreement by requiring the association to submit financial and progress reports.
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