Supporting the Continuum of Care Building Ryan White Program Grantee Capacity to Enroll Eligible Clients in Affordable Care Act Health Coverage Programs | Apply Online

Opportunity Summary:

The HRSA funding opportunity "Supporting the Continuum of Care: Building Ryan White Program Grantee Capacity to Enroll Eligible Clients in Affordable Care Act Health Coverage Programs" (HRSA-13-281) was a nationwide cooperative agreement designed to help Ryan White HIV/AIDS Program (RWHAP) grantees and their provider networks prepare for major Affordable Care Act (ACA) coverage expansions beginning in 2014. The core idea behind the opportunity is that, as the ACA broadened access to health coverage through Medicaid expansion and the creation of Health Insurance Marketplaces (Exchanges), many people living with HIV (PLWH) who had historically been shut out of private coverage due to pre-existing condition exclusions would now have realistic paths into insurance. HRSA sought to ensure that RWHAP-funded systems could actively support clients in navigating these new options, especially during the first open enrollment period starting in October 2013, while preserving RWHAP resources for services that insurance would not cover.

A central policy driver for this grant is the Ryan White Program's "payer of last resort" requirement in the Public Health Service Act. RWHAP dollars generally cannot pay for items or services when another payer has paid, or can reasonably be expected to pay, for those services. In practice, that means grantees and subgrantees are expected to make serious, ongoing efforts to connect clients to other funding sources whenever possible, including Medicaid, Medicare, CHIP, state HIV/AIDS programs, employer-sponsored coverage, and private insurance. This opportunity reflects that statutory expectation by investing in capacity building so that programs can better screen for eligibility, help clients enroll, and explain the financial and coverage implications if clients decide not to enroll (particularly relevant given the ACA's individual responsibility expectations at the time). Importantly, HRSA emphasized that RWHAP would continue to play an essential role even in a more insured environment, covering comprehensive HIV care and supportive services that are not covered by insurance or are limited by insurance.

The award was structured to fund a single national-level cooperative agreement recipient (Expected Awards: 1) to deliver technical assistance that strengthens outreach and enrollment capability across the Ryan White continuum of care, with a particular focus on racial and ethnic minority PLWH served by RWHAP. The cooperative agreement mechanism signals that the recipient would not just operate independently but would work closely with the federal government, coordinating with HRSA and key federal partners like CDC, SAMHSA, and CMS. The work was meant to support grantees and provider organizations across the country rather than serving one state or region, so a national scope of work was a must.

The project had three main objectives. First, the recipient would assess the technical assistance needs of RWHAP grantees related to building outreach and enrollment capacity for minority PLWH. This included conducting a needs assessment very early in the project, within the first two months of the cooperative agreement, and then sharing those findings with HHS federal partners and other stakeholders so the broader federal response could be aligned with what was happening on the ground. Second, the recipient would help identify and synthesize best practices for minority outreach and enrollment that could improve access to Medicaid expansion coverage and Marketplace plans. The announcement specifically pointed to learning from earlier coverage expansions and enrollment efforts, such as Massachusetts health reform, CHIP expansions, and Medicare Part D implementation, and then translating those lessons into practical approaches RWHAP organizations could use. A key deliverable here was a matrix of best practices for minority client outreach and enrollment activities, essentially a structured, usable reference rather than a high-level literature review. Third, the recipient would collaborate with HHS agencies and national partners to develop and disseminate strategies, tools, and trainings that RWHAP grantees could implement. This deliverable was intentionally time-sensitive: tools and trainings were expected to begin rolling out from October 2013 (in sync with open enrollment) and continue on an ongoing basis into 2015, with materials maintained on a website to support broad sharing and future reuse.

The funding opportunity set an early timeline for foundational work, noting that the assessment phase would occur in the first six months of the project. That front-loaded schedule reflects the urgency of preparing Ryan White providers, case managers, and other front-line staff for immediate enrollment demands as coverage expansions took effect. It also reinforces that the grant was not primarily about providing direct services to clients; it was about enabling RWHAP systems nationwide to more effectively do outreach, eligibility screening, enrollment assistance, and client education at scale, with special attention to minority communities that often face added barriers such as language access needs, distrust of systems, complex documentation requirements, and uneven access to enrollment help.

In terms of basic grant mechanics, the opportunity was posted June 28, 2013, and closed July 29, 2013 (archived September 27, 2013). It was a discretionary grant using a cooperative agreement instrument under the health activity category, associated with CFDA 93.145 (AIDS Education and Training Centers). There was no cost sharing or matching requirement. Eligible applicants were broadly defined but focused on entities able to operate at a national level on HIV-related issues, including public and private organizations, nonprofits (including 501(c)(3) organizations), faith-based and community-based organizations, state and county governments, and school and academic health science centers. HRSA indicated a preference for applicants with demonstrated experience developing and disseminating informational materials and providing national-level capacity-building assistance to HIV/AIDS organizations and constituencies, reflecting the expectation that the recipient would rapidly produce high-quality training and technical assistance products and distribute them widely.

Overall, this grant opportunity was essentially a national technical assistance and capacity-building investment meant to help RWHAP grantees adapt to the ACA era. By strengthening outreach, screening, and enrollment support for Medicaid and Marketplace coverage, especially for racial and ethnic minority PLWH, the project aimed to increase insurance uptake, reduce reliance on limited Ryan White funds for services that other payers could cover, and preserve RWHAP's ability to fill gaps in coverage and provide HIV-related services that remain uncovered or insufficiently covered by insurance.

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