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ALN 93.224

Health Center Program Service Area Competition (SAC)

SAC is how HRSA recompetes every existing Section 330 health center service area. Current grantees compete to keep their federal funding, and new organizations or look-alikes can bid to take over an announced area. The application is judged on how well it documents need, delivers the full required service mix, and proves board governance and financial controls meet Health Center Program requirements.

Draft this applicationOfficial program page

Program facts

Agency
Health Resources and Services Administration (HRSA), Bureau of Primary Health Care, U.S. Department of Health and Human Services
Assistance Listing
93.224
Statutory authority
Section 330 of the Public Health Service Act (42 U.S.C. 254b), with funding under sections 330(e), (g), (h) and (i)
Award ceiling
Up to the Total Funding listed in the Service Area Announcement Table (SAAT) for the service area; the FY2026 NOFO averaged about $3.8 million per award
Awards
The FY2026 NOFO (HRSA-26-006) projected about $181 million across 48 grants, with further SAC NOFOs and SAC-Additional Area notices posted through the year
Period of performance
One or four 12-month budget periods; new applicants receive a one-year period of performance
Cost share
None required, but the budget must show all program income and other revenue supporting the total project on Form 3: Income Analysis
Cycle
HRSA typically posts several SAC NOFOs each summer, each covering service areas whose periods of performance end the following year. The FY2026 NOFO HRSA-26-006 posted July 24, 2025 with a Grants.gov Phase 1 deadline of November 10, 2025, an EHBs Phase 2 deadline of December 10, 2025 and a June 1, 2026 start.

Program goals

  • Keep comprehensive primary, dental, mental health and enabling services available in each announced service area
  • Serve at least 75% of the SAAT patient target without regard to ability to pay
  • Maintain compliance with Health Center Program requirements, including board composition and sliding fee discount rules
  • Improve clinical quality measures and reduce disparities reported in the Uniform Data System (UDS)

Scoring rubric

Criterion100 pts

  • Need10

    Access barriers, unmet need data tied to the service area map and Form 5B, a reasonable patient projection on Form 1A, and a plan to update the needs assessment with patient input. Continuation applicants must use UDS trends.

  • Response25

    Site locations that reduce access barriers, a plan for every required service on Form 5A across all age groups, continuity of expanded services funded since FY2023, a compliant sliding fee discount program and, for new applicants, a low-disruption transition plan.

  • Collaboration10

    Documented coordination with other providers in the area, letters or evidence of outreach in Attachment 9, and work with the state Primary Care Association and any Health Center Controlled Network.

  • Capacity20

    An appropriate organizational structure, a capable management team, a recruitment and retention plan for providers, sound internal controls and conflict of interest policies, emergency preparedness, and an explanation of any downward patient trend.

  • Impact/Evaluative measures15

    A QI/QA program covering standards of care, patient safety and UDS reporting, with concrete efforts to improve clinical outcomes in each specified measure area.

  • Governance10

    A board that reflects the community per Form 6A, exercises oversight of finances and quality, and, for public agencies, a clear co-applicant relationship.

  • Support requested10

    Budget figures that match across the SF-424A, budget narrative, Form 2 staffing and Form 3 income analysis, and a credible plan if projected patients fall below 95% of target.

Point values from the FY2026 SAC NOFO (HRSA-26-006). Competing continuation applicants can also earn up to 10 funding priority points (5 for a stable patient trend, 5 for PCMH recognition). Confirm against the current SAC posting.

Eligibility

  • Private nonprofit entities (with or without 501(c)(3) status) or public agencies in the U.S. or its territories and freely associated states
  • Native American tribal governments, tribal organizations and urban Indian organizations
  • Current H80 recipients applying to continue their service area (competing continuation) or to add an announced area (competing supplement)
  • New organizations and Health Center Program look-alikes proposing to serve a service area listed in the SAAT
  • Applicants must project at least 75% of the SAAT patient target and provide all required primary health services regardless of ability to pay

Required attachments

  • Attachment 1: Service Area Map and Table
  • Attachment 2: Bylaws
  • Attachment 3: Project Organizational Chart
  • Attachments 4 and 5: Position descriptions and biographical sketches for key management staff
  • Attachment 6: Co-Applicant Agreement (public agencies only)
  • Attachment 9: Collaboration Documentation
  • Attachment 10: Sliding Fee Discount Schedule
  • Attachment 12: Operational Plan (new and competing supplement applicants)
  • Program forms 1A, 1C, 2, 3, 5A, 5B, 5C, 6A, 8 and the Summary Page in EHBs

Formatting rules

  • 120-page limit for the overall application; the checklist marks which items count
  • Two-phase submission: SF-424 and abstract in Grants.gov, then narrative, budget and forms in HRSA EHBs
  • HRSA standard format: 12-point readable font, single spacing, 1-inch margins, 8.5 x 11 page size
  • Pages beyond the limit are not reviewed

Why applications lose points

  • Projecting fewer than 75% of the SAAT patient target, which makes the application ineligible
  • Omitting a required service type listed in the SAAT for the service area, or proposing a single age group or disease focus
  • Form 5A, Form 5B and the narrative describing different services or sites
  • Budget figures that do not reconcile across the SF-424A, budget narrative and Form 3
  • Bylaws that do not show the board authorities required by Chapters 19 and 20 of the Compliance Manual
  • No explanation for a declining UDS patient trend

How ELIXIR CONSUMERS helps with HRSA SAC

  1. 1.Pulls UDS tables, the prior SAC narrative and the current needs assessment from your vault so the Need section cites your own numbers
  2. 2.Cross-checks Form 5A services, Form 5B sites and narrative claims and flags mismatches before EHBs entry
  3. 3.Maps each bylaws clause to Compliance Manual board authority requirements and lists any gaps
  4. 4.Builds the budget narrative from your general ledger export and reconciles it to Form 3 income figures
  5. 5.Produces a Grants.gov Phase 1 package and EHBs-ready Word and PDF files that your team uploads
How the NOFO Parser works

More healthcare breakdowns

Questions, answered

Can a look-alike apply in a SAC?

Yes. A Health Center Program look-alike applies as a new applicant for an announced service area. If funded, it becomes an H80 recipient and stops being a look-alike.

What happens if we project fewer patients than the SAAT target?

Between 75% and 95% of target, HRSA reduces the funding request on a sliding scale from 1.25% to 5%. Below 75%, the application is not eligible.

Why would we get only a one-year period of performance?

All new applicants receive one year, and HRSA can also shorten the period for continuation applicants based on compliance status, such as unresolved conditions.

Does ELIXIR CONSUMERS submit into EHBs?

No. ELIXIR CONSUMERS prepares the narrative, attachments and form data as files. Your authorized official submits in Grants.gov and EHBs.

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