Opportunity Information: Apply for CA CAP 12 001
Apply for CA CAP 12 001
- The CMS Consumer Information Insurance Oversight in the health sector is offering a public funding opportunity titled "Limited Competition for Affordable Care Act Consumer Assistance Program Grants" and is now available to receive applicants.
- Interested and eligible applicants and submit their applications by referencing the CFDA number(s): 93.519 Affordable Care Act (ACA) Consumer Assistance Program Grants.
- This funding opportunity was created on Apr 20, 2012 and posted on Apr 20, 2012.
- Applicants must submit their applications by May 21, 2012 No Explanation. (Agency may still review applications by suitable applicants for the remaining/unused allocated funding in 2026.)
- Each selected applicant is eligible to receive up to $127,967.00 in funding.
- The number of recipients for this funding is limited to 38 candidate(s).
- Eligible applicants include: State governments.
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Opportunity Summary:
This grant opportunity, titled "Limited Competition for Affordable Care Act Consumer Assistance Program Grants" (Funding Opportunity Number CA-CAP-12-001), is a discretionary federal grant program administered through HHS/CMS (Consumer Information and Insurance Oversight) under CFDA 93.519. It was created to support state governments in carrying out key consumer help functions required by the Affordable Care Act (ACA), the combined set of reforms enacted through the Patient Protection and Affordable Care Act (signed March 23, 2010) and the Health Care and Education Reconciliation Act of 2010 (signed March 30, 2010). The basic idea behind the funding is that as health reform changes the private insurance market and expands coverage options, consumers need a trustworthy, independent place to go for practical help with coverage questions, enrollment, and disputes.
The statutory basis for the grants comes from Section 1002 of the ACA, which added Section 2793 to the Public Health Service (PHS) Act. That provision authorizes federal grants to states to establish, expand, or support independent offices of health insurance consumer assistance or ombudsman programs. The emphasis is on independence and hands-on assistance: these programs are expected to be consumer-facing operations that can explain coverage, troubleshoot problems, and help people navigate complicated insurance processes at times when they may be stressed, sick, or financially strained.
To receive funding, a state-supported consumer assistance or ombudsman program must meet specific functional requirements. First, it must help consumers file complaints and pursue appeals related to group health plans and health insurance coverage. That includes guiding people through dispute resolution steps when claims are denied, when coverage is rescinded, or when plan rules are applied incorrectly. Second, programs must assist with enrollment into health coverage, meaning they should help individuals understand options and complete steps necessary to get covered. Third, they must educate consumers about their rights and responsibilities under group health plans and health insurance coverage, which can include explaining new protections created by the ACA and helping consumers understand how to use their coverage appropriately.
A major component of the program is data collection and reporting. Grantees are expected to collect data on consumer inquiries and complaints so that the Secretary of HHS can identify recurring problems in the insurance marketplace and strengthen oversight and enforcement. The opportunity description makes clear that the data collection is not limited to private insurance issues alone; it also anticipates that programs will capture information on consumer problems and questions tied to public coverage and related programs. Specifically, it notes that programs may encounter and collect data involving Medicaid, the Children’s Health Insurance Program (CHIP), state high-risk pools, and the Pre-Existing Condition Insurance Plan (PCIP), reflecting the reality that consumers often move between coverage sources or have questions spanning multiple systems.
The notice also describes additional responsibilities tied to the ACA’s Exchange-era implementation. Starting in 2014, consumer assistance or ombudsman programs are expected to help resolve problems consumers have obtaining premium tax credits for coverage purchased through a State Exchange established under ACA Section 1311. They also must be able to receive referrals from navigator entities when an enrollee has a grievance, complaint, or question about their health plan, their coverage, or a plan determination. In practical terms, this sets up a workflow where navigators who focus on enrollment and plan selection can hand off more complex complaint or dispute issues to a dedicated consumer assistance office.
Eligibility for this limited competition was restricted to state governments. The grant did not require cost sharing or matching funds. CMS anticipated making 38 awards, with an award ceiling listed as $127,967 and an award floor of $0 (which typically signals that award sizes could vary and that not every applicant is guaranteed funding). The opportunity was posted on April 20, 2012, with an application closing date of May 21, 2012, and it was later archived on June 20, 2012. The overall purpose behind the funding was to strengthen states’ capacity to provide direct, independent consumer help at a time of major insurance reforms, while also creating a structured feedback loop to the federal government through standardized tracking of the problems consumers actually experience in the field.
For applicants or members of the public who had trouble accessing the full announcement electronically, the notice directed them to the Grants.gov Contact Center, including the standard phone number (1-800-518-4726) and email (support@grants.gov), with support hours listed as weekdays from 7:00 a.m. to 9:00 p.m. Eastern.
FAQs: Limited Competition for Affordable Care Act Consumer Assistance Program Grants (CA-CAP-12-001)
What is this funding opportunity?
This is a discretionary federal grant opportunity titled "Limited Competition for Affordable Care Act Consumer Assistance Program Grants." The Funding Opportunity Number is CA-CAP-12-001.
Which federal agency administers this grant?
The program is administered by HHS/CMS (Consumer Information and Insurance Oversight).
What is the CFDA number for this program?
The CFDA number listed for this opportunity is 93.519.
What is the main purpose of these grants?
The purpose is to support state governments in carrying out key consumer help functions required by the Affordable Care Act (ACA), including providing practical, independent assistance to consumers with coverage questions, enrollment issues, and disputes in a changing insurance marketplace.
What laws created the Affordable Care Act reforms referenced in this opportunity?
The ACA reforms referenced include the Patient Protection and Affordable Care Act (signed March 23, 2010) and the Health Care and Education Reconciliation Act of 2010 (signed March 30, 2010).
What is the statutory authority for this grant program?
The statutory basis is Section 1002 of the ACA, which added Section 2793 to the Public Health Service (PHS) Act. This authorizes federal grants to states to establish, expand, or support independent offices of health insurance consumer assistance or ombudsman programs.
Who was eligible to apply?
Eligibility for this limited competition was restricted to state governments.
Was this a limited competition?
Yes. The opportunity is explicitly described as a limited competition, and eligibility was restricted to state governments.
Did the grant require cost sharing or matching funds?
No. The opportunity did not require cost sharing or matching funds.
How many awards were anticipated?
CMS anticipated making 38 awards.
What were the award amounts (ceiling and floor)?
The award ceiling was listed as $127,967. The award floor was listed as $0, indicating award sizes could vary and that not every applicant was guaranteed funding.
What types of programs did the grant support?
The grants were intended to establish, expand, or support independent offices of health insurance consumer assistance or ombudsman programs that provide consumer-facing help with insurance questions, enrollment, and disputes.
What does "independent" mean in the context of these consumer assistance or ombudsman programs?
The opportunity emphasizes independence and hands-on assistance, describing these programs as trustworthy, independent places where consumers can go for practical help navigating complicated insurance processes.
What core functions must a state-supported consumer assistance or ombudsman program perform to receive funding?
Programs must meet specific functional requirements, including: (1) helping consumers file complaints and pursue appeals related to group health plans and health insurance coverage; (2) assisting with enrollment into health coverage; and (3) educating consumers about their rights and responsibilities under group health plans and health insurance coverage.
What kinds of complaints and appeals were programs expected to help with?
The opportunity notes that assistance should include guiding consumers through dispute resolution steps when claims are denied, when coverage is rescinded, or when plan rules are applied incorrectly, as part of complaints and appeals related to group health plans and health insurance coverage.
What does "assist with enrollment into health coverage" involve?
Based on the description, it involves helping individuals understand coverage options and complete the steps necessary to get covered.
What types of consumer education were programs expected to provide?
Programs were expected to educate consumers about their rights and responsibilities under group health plans and health insurance coverage, including explaining protections created by the ACA and helping consumers understand how to use their coverage appropriately.
What data collection and reporting expectations were included?
Grantees were expected to collect data on consumer inquiries and complaints so the Secretary of HHS could identify recurring problems in the insurance marketplace and strengthen oversight and enforcement.
Was data collection limited only to private insurance issues?
No. The opportunity indicates that data collection was expected to capture consumer problems and questions tied to public coverage and related programs as well.
Which public coverage programs were specifically mentioned as possible sources of consumer issues and data?
The notice specifically mentions Medicaid, the Children’s Health Insurance Program (CHIP), state high-risk pools, and the Pre-Existing Condition Insurance Plan (PCIP).
How did the opportunity connect consumer assistance programs to ACA Exchange implementation?
The notice describes additional responsibilities starting in 2014, including helping resolve consumer problems obtaining premium tax credits for coverage purchased through a State Exchange established under ACA Section 1311.
What role did navigators play in relation to these consumer assistance programs?
Starting in 2014, programs were expected to be able to receive referrals from navigator entities when an enrollee has a grievance, complaint, or question about their health plan, coverage, or a plan determination.
What is the overall policy goal behind requiring data tracking of inquiries and complaints?
The goal was to create a structured feedback loop to the federal government through standardized tracking of real consumer problems, enabling HHS to identify recurring marketplace issues and strengthen oversight and enforcement.
When was the opportunity posted and when did it close?
The opportunity was posted on April 20, 2012, and the application closing date was May 21, 2012.
When was the opportunity archived?
The opportunity was later archived on June 20, 2012.
Where could applicants get help if they had trouble accessing the full announcement electronically?
The notice directed applicants to the Grants.gov Contact Center for assistance.
What contact information was provided for the Grants.gov Contact Center?
The notice listed the Grants.gov Contact Center phone number as 1-800-518-4726 and the email as support@grants.gov.
What were the stated support hours for the Grants.gov Contact Center?
Support hours were listed as weekdays from 7:00 a.m. to 9:00 p.m. Eastern.
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