Key Takeaways
- HRSA's Section 330 Health Center Program is $6.6B annually — grants to Federally Qualified Health Centers (FQHCs) for primary care in medically underserved areas
- New Access Points (NAP) grants allow existing nonprofits to start new FQHCs — applications open competitively when HRSA releases the NAP NOFO, typically every 2–3 years
- The FQHC Look-Alike designation provides Medicare/Medicaid cost-based reimbursement without a federal grant — applications accepted year-round
- Existing FQHCs can apply for Expanded Services grants to add new services — behavioral health, dental, pharmacy, vision — through annual supplemental grant applications
- FQHC status unlocks 340B drug pricing, malpractice coverage under FTCA, and enhanced Medicare/Medicaid reimbursement — worth more than the grant itself in many cases
Why FQHC Status Matters Beyond the Grant
Becoming a Federally Qualified Health Center delivers benefits that dwarf the grant itself. FQHCs receive cost-based reimbursement from Medicare and Medicaid — unlike fee-for-service, this covers actual costs of serving uninsured and underinsured patients. Combined with 340B drug discounts (typically 25–50% below market), FTCA malpractice coverage (eliminating costly liability premiums), and enhanced HRSA support, FQHC status can transform a financially struggling community clinic into a sustainable organization.
Section 330 Health Center Program
Section 330 of the Public Health Service Act authorizes HRSA to fund health centers serving medically underserved areas and populations. There are four Section 330 program types — organizations can hold multiple designations:
- Community Health Centers (CHC): Serve populations in Health Professional Shortage Areas (HPSAs) or Medically Underserved Areas (MUAs)
- Migrant Health Centers (MHC): Serve migratory and seasonal agricultural workers and their families
- Healthcare for the Homeless (HCH): Serve individuals experiencing homelessness
- Public Housing Primary Care (PHPC): Serve residents of public housing
Base grant amounts range from $650K to $6M+ per year depending on patient volume, services offered, and location. Annual continuation applications allow existing FQHCs to request budget adjustments.
New Access Points (NAP) — Starting a New FQHC
The New Access Points program is how organizations without existing FQHC status apply to become FQHCs. HRSA releases the NAP NOFO on a competitive basis — not every year. When it opens, organizations must demonstrate:
- The proposed service area has a documented shortage of primary care (HPSA designation or MUA status — verify at hrsa.gov/shortage-areas)
- The organization is a nonprofit 501(c)(3) or public entity
- At least 51% of the board of directors are patients of the health center — this governance requirement is non-negotiable for FQHCs
- The organization has the capacity to provide comprehensive primary care: medical, behavioral health, dental, pharmacy (some services can be provided by referral)
- A strong financial management plan and evidence of organizational capacity
NAP awards: typically $650K–$1.5M/year. Competition is intense — HRSA typically receives 500–800 applications for 100–150 awards. Strong applications have prior experience running community health programs, demonstrated need with census data, and detailed implementation timelines.
FQHC Look-Alike: Designation Without a Grant
The Look-Alike designation grants all FQHC benefits except the Section 330 grant — specifically the Medicare/Medicaid cost-based reimbursement rates and 340B drug pricing. For organizations that don't need or don't qualify for the grant, Look-Alike status is often more valuable than the grant alone:
- No competitive application process — HRSA accepts Look-Alike applications year-round on a rolling basis
- Must meet all FQHC program requirements except the grant source
- Board composition requirement (51% patients) applies
- Enhanced reimbursement rates alone often offset millions in care delivery costs for busy clinics
Supplemental & Expanded Services Grants
Existing FQHCs can apply annually for supplemental funding to add new services or expand capacity. Common supplemental grant types include:
- Behavioral Health Integration: Funding to embed behavioral health clinicians in primary care settings — up to $250K/year
- Oral Health Expansion: Add or expand dental services — up to $250K/year
- COVID-19 Impact Relief: Post-pandemic workforce and infrastructure restoration
- Capital Improvement: Construction, renovation, and equipment through HRSA's Capital Development program
Action Checklist
- Verify your proposed service area is designated as a HPSA or MUA at hrsa.gov/shortage-areas — required for NAP eligibility
- Assess your board composition — do patients of your organization make up 51% of board seats? This is the most common NAP disqualifier
- Monitor HRSA's grant listings at hrsa.gov/grants for NAP NOFO release — sign up for HRSA grant alerts via grants.gov
- If your organization already runs community health programs and doesn't want to wait for NAP: apply for Look-Alike designation at hrsa.gov/opa/eligibility-and-registration
- Contact your state Primary Care Association (PCA) — PCAs provide free technical assistance to organizations seeking FQHC status and can guide you through the application process
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Frequently Asked Questions
What is Section 330 funding for health centers?
Section 330 of the Public Health Service Act funds Federally Qualified Health Centers (FQHCs) through HRSA. Base grants support primary care for underserved populations, and centers also receive enhanced Medicaid reimbursement, free malpractice coverage under FTCA, and 340B drug pricing.
How does a new organization become an FQHC?
New access point funding opportunities are announced by HRSA when Congress appropriates expansion money, posted on grants.gov. Organizations must serve a designated underserved area, offer sliding-fee discounts, and have a patient-majority governing board. FQHC Look-Alike status is an alternative path without grant funding.
What supplemental funding can existing health centers access?
HRSA regularly offers supplements for behavioral health integration, oral health expansion, capital improvements, and workforce. Health centers also compete for HRSA quality awards and can access separate federal streams like SAMHSA grants for substance use disorder treatment.
How much is a typical Section 330 grant?
Annual base awards commonly range from $650,000 to several million dollars depending on patient volume and service area. New access point awards have recently started around $650,000 per year, intended to cover a fraction of operating costs alongside patient revenue.