CAP was originally funded by Congress and implemented by the Health Resources and Services Administration (HRSA) in September 2000. In 2002, Congress passed authorizing legislation creating HCAP, which began in fiscal year 2003. Congressional funding for CAP began with a $25 million appropriation in the Fiscal Year (FY) 2000 budget, used to make grants to 23 coalitions of community organizations and safety net providers. Additional funding provided to HRSA for the program comprised approximately $500 million from FY 2001 through FY 2005. The program was unfunded for FY 2006. Between 2000 and 2006, HCAP provided grants to local communities to strengthen the health care safety net that served the uninsured and underinsured. In total, HRSA awarded 260 grants in 45 states and the District of Columbia and the Virgin Islands. Most grantees received an initial grant of $750,000 to $1 million in the first year, with additional, but reduced, funding for two additional years. Many grantees within the initial cohorts of the HCAP program had a track record of building partnerships, having been recipients of earlier national foundation funding from the W.K. Kellogg and Robert Wood Johnson Foundations, or having received support from other contributors such as health systems, corporations, or non-profit organizations.
Although federal and foundation grants have long supported safety net providers’ efforts to increase access to care and the quality of care for underserved populations, the HCAP program distinguished itself on three fronts: first, by requiring collaboration—grants were given only to consortia of local providers, not to individual institutions; second, the funds were to be directed to infrastructure development, rather than direct service provision; and, third, the program afforded grantees wide latitude to formulate programs based on their communities’ specific needs (e.g. care coordination, patient education, disease prevention, service integration). Through these design features, the program sought to overcome the fragmented nature of safety net care by bringing the major players together and providing funds to address problems that cannot adequately be addressed by individual providers or organizations.