Nearly 26 million people in the United States rely on federally funded health centers for care, much of which is supported by grants from the Health Resources and Services Administration (HRSA).
The centers are prohibited from using federal funds for abortions unless the pregnancy is the result of rape or incest, or the woman's life is endangered.
We reviewed how HRSA helps to ensure federal funds are not used for prohibited abortions at the centers. Among other actions, HRSA emphasizes abortion restrictions when offering and awarding funding, and it reviews the centers’ annual independent audits to help ensure compliance.
A picture of a person signing a document in front of a clinician
What GAO Found
The Health Resources and Services Administration (HRSA) is responsible for overseeing health centers—which receive grant funds from HRSA—including helping to ensure that no federal funds are used for prohibited abortions, in accordance with federal laws. Federal law prohibits the use of federal funds from HRSA for abortions, unless the pregnancy is the result of rape or incest, or the life of the pregnant woman would be endangered unless an abortion is performed.
In carrying out its responsibility, HRSA emphasizes the restrictions on the use of federal funds for prohibited abortions in its funding opportunity notices and its notices of awards for health center grants. Additionally, according to agency officials, HRSA makes project officers and grant management specialists available to health centers for questions about unallowable costs or activities, including prohibited abortions. To oversee health centers' compliance with restrictions on the use of federal funds for prohibited abortions, HRSA relies on health centers' annual single audit reports conducted by independent auditors, which check that federal funds were not used for prohibited abortions, as well as financial management reviews it is starting to conduct, which check health centers' policies and procedures regarding prohibited abortions. HRSA also relies on site visits, which, according to HRSA officials, generally happen in the middle of the project period—the period of time approved for a given health center grant—which is typically 3 years.
HRSA has also awarded funding to the National Association of Community Health Centers (NACHC) to provide training and technical assistance to health centers on topics such as leadership development and health center governance. HRSA obligated over $51.3 million to NACHC for this training and technical assistance between fiscal years 2010 and 2017. Although HRSA awarded federal funds to NACHC to provide training on topics such as leadership and governance, training to health centers on prohibited activities is conducted by HRSA. HRSA oversees NACHC's performance under the cooperative agreement by, for example, reviewing required financial and progress reports. Like all organizations receiving federal funding from HRSA, NACHC may not use these funds for prohibited abortions.
Why GAO Did This Study
Nearly 26 million people in the United States rely on federally funded health centers for their health care. These health centers provide care for underserved individuals and families, including people experiencing homelessness, agricultural workers, residents of public housing, and veterans. Much of this care is supported through grants from HRSA, an agency within the Department of Health and Human Services. HRSA has also provided funding through cooperative agreements to NACHC, the national health care advocacy organization for health centers.
GAO was asked to review issues related to HRSA's funding of health centers and NACHC. Specifically, this report describes how HRSA (1) helps ensure that health center grantees do not use federal funds for prohibited abortions, and (2) supports NACHC and oversees the cooperative agreements with the association.
GAO examined federal laws and regulations related to abortion funding prohibitions at health centers; grant-related documentation, including funding opportunity notices and award notices; and compliance documents. GAO also examined data on funding obligated to NACHC for fiscal years 2010 through 2017, reviewed agency documents, and interviewed knowledgeable agency officials.
GAO is not making any recommendations. The Department of Health and Human Services reviewed a draft of this report and provided technical comments, which GAO incorporated as appropriate.