One of the largest federal investments to strengthen local health care safety nets through community coalitions was the Community Access Program (CAP) and its successor, the Healthy Communities Access Program (HCAP). From 2000 through 2005, HCAP provided grants to local communities to strengthen the health care safety net that serves the uninsured and underinsured. Congressional funding for CAP began with a $25 million appropriation in the fiscal year (FY) 2000 budget that was used to make grants to 23 coalitions of community organizations and safety net providers. Additional funding provided to the Health Resources and Services Administration (HRSA) for the program included approximately $500 million from FY 2001 through FY 2005. In total, HRSA awarded 260 grants in 45 states plus the District of Columbia and the U.S. Virgin Islands. Funding for the program was ended in FY 2006.
One of the ways in which CAP/HCAP distinguished itself from other federal safety net programs was by requiring collaboration. Namely, grants were given to consortia of local providers, rather than individual institutions. The program sought to overcome the fragmented nature of safety net care by bringing together the major players of a community and providing funds to address problems that could not be adequately addressed by individual providers or organizations. The CAP/HCAP-funded coalitions focused on activities such as service integration, expansion of the delivery system, cultural competency, provider education, community and patient education, disease detection and prevention, service integration, and new coverage plans for the uninsured, among others.
Understanding the sustainability of community coalitions is particularly important today given new federal investments in clinical and community-based strategies through the American Recovery and Reinvestment Act (ARRA) of 2009 and the Patient Protection and Affordable Care Act of 2010. For example, $373 million of ARRA money will fund community consortia to address the leading causes of preventable death and disability under the Communities Putting Prevention to Work initiative. A more complete understanding of the factors that impede and facilitate coalition sustainability will assist successful coalitions to continue this important work after their initial federal funding ends.