[Federal Register Volume 65, Number 63 (Friday, March 31, 2000)]
[Notices]
[Pages 17286-17289]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-8039]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


State Planning Grants

AGENCY: Health Resources and Services Administration.

ACTION: Notice of availability of funds.

-----------------------------------------------------------------------

SUMMARY: The Health Resources and Services Administration (HRSA) 
announces the availability of $15 million to support up to10 State 
grants for the development of plans to provide access to health 
insurance coverage for all State residents. This funding has been 
appropriated under the Fiscal Year (FY) 2000 HHS Appropriations Act.
    In FY 2000, HRSA, through its State Planning Grants Program (SPG), 
will accept applications from States for fiscal year (FY 2000) grants 
to conduct a one year, in-depth analysis and related activities 
necessary to develop the most effective methods for providing access to 
affordable health insurance coverage to all its citizens. States will 
be expected to design approaches that provide affordable health 
insurance benefits similar in scope to the Federal Employees Health 
Benefit Plan, Medicaid, coverage offered to State employees or other 
similar quality benchmarks. Each State receiving such grants must 
submit the study and analysis results in the form of a report to the 
Secretary that identifies the characteristics of the uninsured within 
the State and proposals for providing them with access to health 
insurance coverage. Together, these reports will provide additional 
data about the characteristics of the uninsured generally and potential 
models for other States seeking to provide comprehensive coverage.

DATES: The time line for application submission, review, and award is 
follows:
    April 10, 2000--Application kits (PHS 5161, OMB 0920-0528) and 
additional guidance will be available through the HRSA Grants 
Application Center (GAC). To receive a complete application kit, 
contact the GAC at 1-877-HRSA-123.
    April 26 and 28, 2000--Two pre-application workshops are 
anticipated at Denver, CO (April 26, 2000) and Philadelphia, PA (April 
28, 2000). For more information concerning these workshops, contact the 
State Planning Grant Program Office at 301-443-4619.
    July 10, 2000--Applications due.
    August 1-4, 2000--Applications reviewed.
    September 30, 2000--Grant awards announced.

ADDRESSES: To receive a complete application kit (i.e., application 
instructions, necessary forms, and application review criteria), 
contact the HRSA GAC at: HRSA, GAC, 1815 N. Fort Meyer Drive, Suite 
300, Arlington, VA 22209, Phone: 1-877-HRSA-123, Fax: 1-877-HRSA-345, 
E-Mail: [email protected]

FOR FURTHER INFORMATION CONTACT: For further information contact Dr. 
Marcia Brand, Health Resources and Services Administration, Parklawn 
Building, Room 11-25, 5600 Fishers Lane, Rockville, MD 20857, Phone: 
(301) 443-4619, Fax: (301) 443-0643.

SUPPLEMENTARY INFORMATION: In 1998, 44.5 million people in the United 
States did not have health insurance. This is roughly one out of every 
six non-elderly Americans. Of these, 24.6 million were employed--18.7 
million worked full time and 5.9 million worked part time. Nationally, 
over 11 million children (i.e., one in seven) are uninsured. Every 
year, approximately a million Americans lose their health coverage. A 
poll conducted for Health Coverage 2000 and released in October showed 
that seven out of ten Americans believe government must address the 
problem of the uninsured and state that they support $100 in new taxes 
to help provide additional health coverage. There is considerable 
public and private support for examining and implementing new models 
for providing access to affordable health coverage.
    Many States have expressed interest in expanding coverage for the 
uninsured. Every State has responded to the opportunity provided by the 
State Children's Health Insurance Program (SCHIP) to design a program 
that provides health insurance coverage for uninsured low-income 
children. Many States have also expanded Medicaid coverage to uninsured 
children and adults, using existing options, such as section 1115 
waiver authority, as well as increased flexibility under welfare reform 
to cover working parents. In addition, many States are assessing State 
policy in light of recent changes in Medicare. Some States are working 
towards enhancing coordination of publicly-funded health programs, such 
as health departments and community health centers. States have also 
undertaken activities that seek to expand insurance coverage through 
mechanisms other than Federally-

[[Page 17287]]

financed programs (e.g., high risk pools and insurance market changes).
    The private sector has expressed an interest in supporting States' 
efforts to expand coverage for the uninsured. The Robert Wood Johnson 
Foundation has implemented the State Coverage Initiatives (SCI), a 
major new technical assistance endeavor that will build on the 
successes and lessons learned in its earlier States Initiatives in 
Health Care Reform. The new program seeks to improve the practical 
capacity of State governments in their quest to decrease the number of 
uninsured Americans and has an emphasis on policy development and 
technical assistance. The SCI Program provides resources for technical 
assistance that States can use to analyze data, diagnose problems, 
identify solutions, and develop new strategies and policies. It offers 
small policy planning grants and for a few States, larger scale 
demonstration grants.
    In January 2000, the Robert Wood Johnson Foundation, with the 
Health Insurance Association of America and Families USA, announced its 
Health Coverage 2000--Meeting the Challenge of the Uninsured 
initiative. Through this effort, eight of the nation's leading trade, 
professional and consumer organizations joined representatives of 
business, labor, physicians, nurses, hospitals, insurance companies and 
consumers to propose specific solutions for expanding access to health 
coverage. During this national conference, these organizations agreed 
that it is critically important for the health insurance industry to 
join with other organizations to find ways to promote health coverage 
for uninsured individuals. Of the eight proposals to expand health 
insurance coverage to low-income individuals developed at the 
conference, seven would expand Medicaid, SCHIP, or other government 
programs to increase coverage.
    At the Federal level, the DHHS is committed to assisting States as 
they examine their options for expanding health insurance benefits. By 
providing State planning grants, the HRSA State Planning Grants Program 
intends to encourage States to provide access to affordable health 
insurance overage for all its citizens. Each grantee State will receive 
resources for necessary planning and a coordinated DHHS policy 
environment. Together, the results of each State's analysis of its 
uninsured population and its proposals for providing these individuals 
with access to health insurance coverage will provide additional data 
about the characteristics of the uninsured generally and present models 
for other States seeking to provide such comprehensive coverage.
    SPG shares some of the same goals as and focus of the Robert Wood 
Johnson Foundation's State Coverage Initiatives and the Health Policy 
Studies Division of the National Governors' Association Center for Best 
Practices. Thus, whenever possible, SPG will coordinate its efforts 
with activities of these programs to share information about insurance 
trends, best practices, data and analyses, and technical assistance.

State Planning Grants

Program Purpose

    The purpose of SPG is to have each grantee State develop a plan or 
propose options that would ensure every citizen in that State access to 
affordable health insurance benefits similar in scope to the Federal 
Employees Health Benefit Plan, Medicaid, benefits offered to State 
employees or other similar quality benchmarks. Not only will the 
grantee State benefit from its analysis, but by submitting a summary of 
this analysis and proposed plan at the end of the grant period in a 
report to the Secretary, other States may learn about successful or 
innovative ways to provide access to coverage. In addition, DHHS will 
have the opportunity to review these reports and gain insight into 
effective methods of supporting such endeavors.

Program Goal

    The overarching SPG goal is to encourage States to provide access 
to health insurance coverage to all citizens by providing the resources 
needed to develop successful plans and to provide a number of data 
collection and planning strategies, along with viable insurance 
expansion options to consider. The immediate goal of SPG is to assist 
States as they collect and analyze data, develop coverage options or 
design programs that provide health insurance coverage to all uninsured 
citizens in the State through expanded State, Federal, and private 
partnerships.

Program Description

    The $15 million in available funding has been appropriated under 
the FY 2000 Labor-HHS Appropriations Act. The HRSA, Office of the 
Administrator, State Planning Grants Program, will oversee the program. 
Up to 10 awards are anticipated and will vary in size, with a typical 
grant not to exceed $1.3 million. Preference will be given to States 
with lower rates of uninsured, unless the applicant shows a potential 
for a significant decrease in its uninsured population. Grant awards 
will reflect diverse State characteristics (e.g., rural/frontier/urban 
areas and high/low penetration of managed care) and represent a variety 
of geographic areas of the country.
    During FY 2000, SPG will support one-year planning grants to States 
to (1) collect and analyze data that describe the characteristics of 
their uninsured and assist in the design of approaches to provide 
access to affordable coverage, (2) design a program that would provide 
all uninsured with access to insurance benefits similar in care to 
State employee coverage, Federal Employees Health Benefit Plan, 
Medicaid or other similar quality benchmarks, through a State, Federal, 
and private partnership, (3) prepare a report to the Secretary 
describing these findings, and (4) by September 30, 2001, provide the 
report to the Secretary describing proposals for an expanded State, 
Federal, and private partnership to cover all of their uninsured.
    The successful State applicant will have a demonstrated commitment 
to reducing its uninsured population; will demonstrate commitment by 
its Governor and Executive Branch to studying the possibilities for 
providing health insurance coverage to all uninsured; and will present 
a comprehensive proposal for the kinds of data to be collected, 
analysis of that data, use of the analyses to create an approach for 
covering all uninsured, and a strategy for implementing and funding 
that approach. The successful applicant will work with all appropriate 
health-related State agencies, including the Medicaid agency, the 
budget office, and other relevant departments (e.g., insurance, public 
health, human services, mental health and substance abuse, and aging). 
If possible, the applicant should demonstrate communication with the 
health committees in the State legislature about the proposal. Formal 
collaboration must exist with private sector organizations (including 
both business and the health care provider communities), consumer 
groups, and researchers.
    We are looking for applicants with a clear commitment to the goal 
of providing coverage to all uninsured and an operational plan for 
using these planning grants to help achieve that goal. As such, funded 
State planning grants will contain these common elements:
    A goal of providing access to affordable health insurance coverage 
to all citizens in the State--Access to affordable coverage for this 
grant program means that individuals or families have the opportunity 
to purchase health insurance coverage or participate in a program that 
provides

[[Page 17288]]

adequate benefits at an affordable cost. States may ensure 
``affordability'' by determining cost-sharing based on the 
beneficiary's income level and applying a sliding scale related to 
income, or implementing other cost-sharing protections such as spending 
caps. For example, in non-Medicaid SCHIP programs, for children in 
families with income levels above 150 percent of the Federal poverty 
line, cost-sharing may be imposed on a sliding scale related to income, 
but the total annual aggregate cost-sharing for all targeted low-income 
children in the family cannot exceed 5 percent of the family's annual 
income.
    Citizens of the State--If Federal funds are proposed to be used, 
States should plan their coverage options based on existing Federal 
eligibility criteria for participation in the Medicaid, SCHIP, and 
Medicare programs. States may use State funds or other resources to 
cover non-citizen residents.
    Commitment to eliminating the number of uninsured--Grantee States 
must demonstrate prior efforts, whether or not approved by their State 
Legislatures, to reduce their number of uninsured through program 
expansions, data collection activities to support further expansions 
and/or other activities demonstrating a commitment to providing 
increased access to health insurance.
    Low rates of uninsured--Grantee States should have low rates of 
uninsured at the time of application submission or the potential for a 
significant decrease in their uninsured population.
    Collaboration among State, Federal, and private partners--Grantee 
States should build upon current collaborations among State, Federal, 
and private partners for expanding health insurance coverage to all 
citizens within the State. States are encouraged to consult with Tribal 
governments, where appropriate. These collaborations should be formal 
and should include the leadership of public and private partners.
    Capacity for data collection and analysis--Grantee States should 
demonstrate data collection and analytical capacity or a detailed plan 
for acquiring this technical assistance, including a commitment from 
the agency/organization to provide this technical assistance. States 
are encouraged to work with the many existing Federal and State data 
collection activities, as well as ongoing efforts in the private, non-
profit sector.

Eligible Applicants

    Eligibility is limited to States with only one application per 
State permitted. The Governor of each State is invited to apply. Each 
Governor is asked to designate an individual or agency responsible for 
preparing the State's grant application. A letter from the Governor 
authorizing this individual or agency to prepare the State's 
application should accompany the application.

Funding Criteria

    Review criteria that will be used to evaluate applications 
includes:
    Evidence that the State has a low rate of uninsured or a 
justification for its ability to significantly decrease a relatively 
high level of uninsured.
    Evidence of commitment by the Governor, State agencies, and public 
and private health care providers to provide coverage to all uninsured.
    Evidence of prior data collection and analysis resulting in efforts 
to expand coverage to the uninsured.
    Evidence of meaningful collaboration between the agencies and 
constituencies in the public and private sectors necessary to 
successfully complete the analysis and submit the required report to 
the Secretary.
    A demonstrated understanding of the technical capacity, resources, 
and collaboration necessary to successfully carry out the proposed 
analysis and provide the required report to the Secretary.
    An accountable management and budget plan with time lines, 
demonstrating readiness of the State government to conduct the data 
collection, analyze the data, develop approaches to providing access to 
coverage, and determine strategies for implementing and funding such 
approaches. States should provide an explanation of how they will 
contract for needed technical assistance, if necessary.

Report Contents

    This grant funding will assist States to develop models for 
providing access to health insurance coverage for all citizens of the 
State. As a result, each grantee State will prepare a report to the 
Secretary that provides:
    A detailed plan for data collection and analysis, upon which the 
State will base its design for covering its uninsured.
    Its strategy for gaining collaboration and consensus among State, 
Federal, and private partners on options to expand health insurance 
coverage to all citizens.
    Options for expanding health insurance coverage through State, 
Federal, and private partnerships. For each option, the grantee State 
will describe how it proposes to address these issues: (1) targeting 
expansion groups such as parents of SCHIP children, young adults ages 
19-20, and early retirees; (2) delivery systems; (3) administration; 
(4) outreach; (5) eligibility levels; (6) eligibility determination 
process; (7) enrollment process; (8) marketing plan; (9) coverage and 
benefits (similar to State, Federal employees, Medicaid, and other 
credible coverage); (10) portability; (11) cost-sharing (co-pays, 
premiums); (12) integration with existing public and private programs 
(e.g., Medicaid, Medicare, and SCHIP coverage, State programs, projects 
proposed through the Community Access Program, See Federal Register 
notice, February 4, 2000); (13) plans for studying or avoiding crowd-
out-interaction with employer-sponsored insurance; (14) cost-
containment; (15) ensuring quality; (16) ensuring access; (17) data 
collection; (18) audits; (19) program budget; (20) program evaluations; 
(21) funding; (22) maintenance of effort; (23) necessary waivers (under 
existing program authority); (24) necessary State or Federal 
legislative changes (not under current authority); and (25) private 
sector options (e.g., high risk pools, employer options, market 
reforms). States that propose or prepare waivers or State plan 
amendments (e.g., Medicaid waivers, SCHIP amendments) as a result of 
their grant activities must submit their requests through existing 
review processes established by the Health Care Financing 
Administration.

Use of Grant Funds

    Funding provided through this program may not be used to substitute 
for or duplicate funds currently supporting similar activities. In 
addition, grant funds may not be used to support construction, 
renovation or modernization costs. However, grant funds may support 
costs such as project staff salaries, consultants, project-related 
travel, project evaluation, limited equipment and software purchases or 
leases and coordinating project-related meetings.

Expected Results

    The implementation of State Planning grants is expected to result 
in the development of a plan that the State might subsequently 
implement to provide health insurance coverage to all citizens of the 
State. In addition, the grantee States will provide information about 
data collection activities, partnerships, and options that other States 
may draw from in their efforts to expand health insurance coverage.


[[Page 17289]]


    Dated: March 27, 2000.
Claude Earl Fox,
Administrator, Health Resources and Services Administration.
[FR Doc. 00-8039 Filed 3-30-00; 8:45 am]
BILLING CODE 4160-15-P