---
kind: "section"
citation: "42 U.S.C. § 256"
title: "42"
title_heading: "The Public Health and Welfare"
number: "256"
heading: "Grants to strengthen the effectiveness, efficiency, and coordination of services for the uninsured and underinsured"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/256"
units:
  - "Chapter 6A — Public Health Service"
  - "Subchapter II — General Powers and Duties"
  - "Part D — Primary Health Care"
  - "Subpart v — healthy communities access program"
---

# §256. Grants to strengthen the effectiveness, efficiency, and coordination of services for the uninsured and underinsured

- (a) **In general—** The [Secretary](/usc/42/201.md?p=c) may award grants to eligible entities to assist in the development of integrated health care delivery systems to serve communities of individuals who are uninsured and individuals who are underinsured—
  - (1) to improve the efficiency of, and coordination among, the [providers](/usc/42/299b–21.md?p=8) providing [services](/usc/42/201.md?p=a) through such systems;
  - (2) to assist communities in developing [programs](/usc/42/274l–1.md?p=4) targeted toward preventing and managing chronic diseases; and
  - (3) to expand and enhance the [services](/usc/42/201.md?p=a) provided through such systems.
- (b) **Eligible entities—** To be eligible to receive a grant under this section, an entity shall be an entity that—
  - (1) represents a [consortium](/usc/42/17061.md?p=4)—
    - (A) whose principal purpose is to provide a broad range of coordinated health [care services](/usc/42/300z–1.md?p=a-7) for a community defined in the entity’s grant application as described in [paragraph (2)](#b-2); and
    - (B) that includes at least one of each of the following [providers](/usc/42/299b–21.md?p=8) that serve the community (unless such [provider](/usc/42/299b–21.md?p=8) does not exist within the community, declines or refuses to participate, or places unreasonable conditions on their participation)—
      - (i) a Federally qualified health center (as defined in [section 1395x(aa) of this title](/usc/42/1395x.md?p=aa));
      - (ii) a [hospital](/usc/42/300s–3.md?p=1) with a low-income utilization rate (as defined in [section 1396r–4(b)(3) of this title](/usc/42/1396r–4.md?p=b-3)), that is greater than 25 percent;
      - (iii) a public health department; and
      - (iv) an interested public or private sector [health care provider](/usc/42/300aa–33.md?p=1) or an organization that has traditionally served the medically uninsured and underserved; and
  - (2) submits to the [Secretary](/usc/42/201.md?p=c) an application, in such form and manner as the [Secretary](/usc/42/201.md?p=c) shall prescribe, that—
    - (A) defines a community or geographic area of uninsured and underinsured individuals;
    - (B) identifies the [providers](/usc/42/299b–21.md?p=8) who will participate in the [consortium](/usc/42/17061.md?p=4)’s [program](/usc/42/274l–1.md?p=4) under the grant, and specifies each [provider](/usc/42/299b–21.md?p=8)’s contribution to the care of uninsured and underinsured individuals in the community, including the volume of care the [provider](/usc/42/299b–21.md?p=8) provides to [beneficiaries](/usc/42/300gg–91.md?p=d-2) under the medicare, medicaid, and [State](/usc/42/201.md?p=f) child health insurance [programs](/usc/42/274l–1.md?p=4) and to patients who pay privately for [services](/usc/42/201.md?p=a);
    - (C) describes the activities that the applicant and the [consortium](/usc/42/17061.md?p=4) propose to perform under the grant to further the objectives of this section;
    - (D) demonstrates the [consortium](/usc/42/17061.md?p=4)’s ability to build on the current system (as of the date of submission of the application) for serving a community or geographic area of uninsured and underinsured individuals by involving [providers](/usc/42/299b–21.md?p=8) who have traditionally provided a significant volume of care for that community;
    - (E) demonstrates the [consortium](/usc/42/17061.md?p=4)’s ability to develop coordinated systems of care that either directly provide or ensure the prompt provision of a broad range of high-quality, accessible [services](/usc/42/201.md?p=a), including, as appropriate, primary, secondary, and tertiary [services](/usc/42/201.md?p=a), as well as substance abuse [treatment](/usc/42/11851.md?p=11) and mental health [services](/usc/42/201.md?p=a) in a manner that assures continuity of care in the community or geographic area;
    - (F) provides evidence of community involvement in the development, implementation, and direction of the [program](/usc/42/274l–1.md?p=4) that the entity proposes to operate;
    - (G) demonstrates the [consortium](/usc/42/17061.md?p=4)’s ability to ensure that individuals participating in the [program](/usc/42/274l–1.md?p=4) are enrolled in public insurance [programs](/usc/42/274l–1.md?p=4) for which the individuals are eligible or know of private insurance [programs](/usc/42/274l–1.md?p=4) where available;
    - (H) presents a plan for leveraging other sources of revenue, which may include [State](/usc/42/201.md?p=f) and local sources and private grant funds, and integrating current and proposed new funding sources in a way to assure long-term sustainability of the [program](/usc/42/274l–1.md?p=4);
    - (I) describes a plan for evaluation of the activities carried out under the grant, including measurement of progress toward the goals and objectives of the [program](/usc/42/274l–1.md?p=4) and the use of evaluation findings to improve [program](/usc/42/274l–1.md?p=4) performance;
    - (J) demonstrates fiscal responsibility through the use of appropriate accounting procedures and appropriate management systems;
    - (K) demonstrates the [consortium](/usc/42/17061.md?p=4)’s commitment to serve the community without regard to the ability of an individual or family to pay by arranging for or providing free or reduced charge care for the poor; and
    - (L) includes such other information as the [Secretary](/usc/42/201.md?p=c) may prescribe.
- (c) **Limitations—**
  - (1) **Number of awards—**
    - (A) **In general—** For each of fiscal years 2003, 2004, 2005, and 2006, the [Secretary](/usc/42/201.md?p=c) may not make more than 35 new awards under [subsection (a)](#a) (excluding renewals of such awards).
    - (B) **Rule of construction—** This paragraph shall not be construed to affect awards made before fiscal year 2003.
  - (2) **In general—** An eligible entity may not receive a grant under this section (including with respect to any such grant made before fiscal year 2003) for more than 3 consecutive fiscal years, except that such entity may receive such a grant award for not more than 1 additional fiscal year if—
    - (A) the eligible entity submits to the [Secretary](/usc/42/201.md?p=c) a request for a grant for such an additional fiscal year;
    - (B) the [Secretary](/usc/42/201.md?p=c) determines that extraordinary circumstances (as defined in [paragraph (3)](#c-3)) justify the granting of such request; and
    - (C) the [Secretary](/usc/42/201.md?p=c) determines that granting such request is necessary to further the objectives described in [subsection (a)](#a).
  - (3) **Extraordinary circumstances—**
    - (A) **In general—** In [paragraph (2)](#c-2), the term “extraordinary circumstances” means an event (or events) that is outside of the control of the eligible entity that has prevented the eligible entity from fulfilling the objectives described by such entity in the application submitted under [subsection (b)(2)](#b-2).
    - (B) **Examples—** Extraordinary circumstances include—
      - (i) natural [disasters](/usc/42/5204.md?p=2) or other major disruptions to the security or health of the community or geographic area served by the eligible entity; or
      - (ii) a significant economic deterioration in the community or geographic area served by such eligible entity, that directly and adversely affects the entity receiving an award under [subsection (a)](#a).
- (d) **Priorities—** In awarding grants under this section, the [Secretary](/usc/42/201.md?p=c)—
  - (1) shall accord priority to applicants that demonstrate the extent of unmet need in the community involved for a more coordinated system of care; and
  - (2) may accord priority to applicants that best promote the objectives of this section, taking into consideration the extent to which the application involved—
    - (A) identifies a community whose geographical area has a high or increasing percentage of individuals who are uninsured;
    - (B) demonstrates that the applicant has included in its [consortium](/usc/42/17061.md?p=4) [providers](/usc/42/299b–21.md?p=8), support systems, and [programs](/usc/42/274l–1.md?p=4) that have a tradition of serving uninsured individuals and underinsured individuals in the community;
    - (C) shows evidence that the [program](/usc/42/274l–1.md?p=4) would expand utilization of preventive and primary [care services](/usc/42/300z–1.md?p=a-7) for uninsured and underinsured individuals and families in the community, including behavioral and mental health [services](/usc/42/201.md?p=a), oral health [services](/usc/42/201.md?p=a), or [substance abuse services](/usc/42/290cc–34.md?p=4);
    - (D) proposes a [program](/usc/42/274l–1.md?p=4) that would improve coordination between [health care providers](/usc/42/300aa–33.md?p=1) and appropriate social [service](/usc/42/201.md?p=a) [providers](/usc/42/299b–21.md?p=8);
    - (E) demonstrates collaboration with [State](/usc/42/201.md?p=f) and local governments;
    - (F) demonstrates that the applicant makes use of non-Federal contributions to the greatest extent possible; or
    - (G) demonstrates a likelihood that the proposed [program](/usc/42/274l–1.md?p=4) will continue after support under this section ceases.
- (e) **Use of funds—**
  - (1) **Use by grantees—**
    - (A) **In general—** Except as provided in paragraphs [(2)](#e-2) and [(3)](#e-3), a grantee may use amounts provided under this section only for—
      - (i) direct expenses associated with achieving the greater integration of a health care delivery system so that the system either directly provides or ensures the provision of a broad range of culturally competent [services](/usc/42/201.md?p=a), as appropriate, including primary, secondary, and tertiary [services](/usc/42/201.md?p=a), as well as substance abuse [treatment](/usc/42/11851.md?p=11) and mental health [services](/usc/42/201.md?p=a); and
      - (ii) direct patient care and [service](/usc/42/201.md?p=a) expansions to fill identified or documented gaps within an integrated delivery system.
    - (B) **Specific uses—** The following are examples of purposes for which a grantee may use grant funds under this section, when such use meets the conditions stated in [subparagraph (A)](#e-1-A):
      - (i) Increases in outreach activities and closing gaps in health care [service](/usc/42/201.md?p=a).
      - (ii) Improvements to case management.
      - (iii) Improvements to coordination of transportation to health care facilities.
      - (iv) Development of [provider](/usc/42/299b–21.md?p=8) networks and other innovative models to engage physicians in voluntary efforts to serve the medically underserved within a community.
      - (v) Recruitment, training, and compensation of necessary personnel.
      - (vi) Acquisition of technology for the purpose of coordinating care.
      - (vii) Improvements to [provider](/usc/42/299b–21.md?p=8) communication, including implementation of shared information systems or shared clinical systems.
      - (viii) Development of common processes for determining eligibility for the [programs](/usc/42/274l–1.md?p=4) provided through the system, including creating common identification cards and single sliding scale discounts.
      - (ix) Development of specific prevention and disease management tools and processes.
      - (x) Translation [services](/usc/42/201.md?p=a).
      - (xi) Carrying out other activities that may be appropriate to a community and that would increase access by the uninsured to health care, such as access initiatives for which private entities provide non-Federal contributions to supplement the Federal funds provided through the grants for the initiatives.
  - (2) **Direct patient care limitation—** Not more than 15 percent of the funds provided under a grant awarded under this section may be used for providing direct patient care and [services](/usc/42/201.md?p=a).
  - (3) **Reservation of funds for national program purposes—** The [Secretary](/usc/42/201.md?p=c) may use not more than 3 percent of funds appropriated to carry out this section for providing technical assistance to grantees, obtaining assistance of experts and consultants, holding meetings, developing of tools, disseminating of information, evaluation, and carrying out activities that will extend the benefits of [programs](/usc/42/274l–1.md?p=4) funded under this section to communities other than the community served by the [program](/usc/42/274l–1.md?p=4) funded.
- (f) **Grantee requirements—**
  - (1) **Evaluation of effectiveness—** A grantee under this section shall—
    - (A) report to the [Secretary](/usc/42/201.md?p=c) annually regarding—
      - (i) progress in meeting the goals and measurable objectives set forth in the grant application submitted by the grantee under [subsection (b)](#b); and
      - (ii) the extent to which activities conducted by such grantee have—
        - (I) improved the effectiveness, efficiency, and coordination of [services](/usc/42/201.md?p=a) for uninsured and underinsured individuals in the communities or geographic areas served by such grantee;
        - (II) resulted in the provision of better quality health care for such individuals; and
        - (III) resulted in the provision of health care to such individuals at lower cost than would have been possible in the absence of the activities conducted by such grantee; and
    - (B) provide for an independent annual financial audit of all records that relate to the disposition of funds received through the grant.
  - (2) **Progress—** The [Secretary](/usc/42/201.md?p=c) may not renew an annual grant under this section for an entity for a fiscal year unless the [Secretary](/usc/42/201.md?p=c) is satisfied that the [consortium](/usc/42/17061.md?p=4) represented by the entity has made reasonable and demonstrable progress in meeting the goals and measurable objectives set forth in the entity’s grant application for the preceding fiscal year.
- (g) **Maintenance of effort—** With respect to activities for which a grant under this section is authorized, the [Secretary](/usc/42/201.md?p=c) may award such a grant only if the applicant for the grant, and each of the participating [providers](/usc/42/299b–21.md?p=8), agree that the grantee and each such [provider](/usc/42/299b–21.md?p=8) will maintain its expenditures of non-Federal funds for such activities at a level that is not less than the level of such expenditures during the fiscal year immediately preceding the fiscal year for which the applicant is applying to receive such grant.
- (h) **Technical assistance—** The [Secretary](/usc/42/201.md?p=c) may, either directly or by grant or contract, provide any entity that receives a grant under this section with technical and other nonfinancial assistance necessary to meet the requirements of this section.
- (i) **Evaluation of program—** Not later than September 30, 2005, the [Secretary](/usc/42/201.md?p=c) shall prepare and submit to the appropriate committees of Congress a report that describes the extent to which [projects](/usc/42/13641.md?p=2) funded under this section have been successful in improving the effectiveness, efficiency, and coordination of [services](/usc/42/201.md?p=a) for uninsured and underinsured individuals in the communities or geographic areas served by such [projects](/usc/42/13641.md?p=2), including whether the [projects](/usc/42/13641.md?p=2) resulted in the provision of better quality health care for such individuals, and whether such care was provided at lower costs, than would have been provided in the absence of such [projects](/usc/42/13641.md?p=2).
- (j) **Demonstration authority—** The [Secretary](/usc/42/201.md?p=c) may make demonstration awards under this section to historically black health professions [schools](/usc/42/300j–21.md?p=6) for the purposes of—
  - (1) developing patient-based research infrastructure at historically black health professions [schools](/usc/42/300j–21.md?p=6), which have an affiliation, or affiliations, with any of the [providers](/usc/42/299b–21.md?p=8) identified in [subsection (b)(1)(B)](#b-1-B);
  - (2) establishment of joint and collaborative [programs](/usc/42/274l–1.md?p=4) of medical research and data collection between historically black health professions [schools](/usc/42/300j–21.md?p=6) and such [providers](/usc/42/299b–21.md?p=8), whose goal is to improve the health status of [medically underserved populations](/usc/42/300s–3.md?p=14); or
  - (3) supporting the research-related costs of patient care, data collection, and academic training resulting from such affiliations.
- (k) **Authorization of appropriations—** There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2002 through 2006.
- (l) **Date certain for termination of program—** Funds may not be appropriated to carry out this section after September 30, 2006.

## Source credit

(July 1, 1944, ch. 373, title III, § 340, as added Pub. L. 107–251, title IV, § 402, Oct. 26, 2002, 116 Stat. 1655.)

## Notes

### Editorial Notes

### Prior Provisions

A prior section 256, act July 1, 1944, ch. 373, title III, § 340, as added July 22, 1987, Pub. L. 100–77, title VI, § 601, 101 Stat. 511; amended Nov. 4, 1988, Pub. L. 100–607, title VIII, §§ 801(a), (c), 802(a), (b)(1), 803, 804, 102 Stat. 3168, 3169; Nov. 7, 1988, Pub. L. 100–628, title VI, §§ 601(a), (c), 602(a), (b)(1), 603, 604, 102 Stat. 3241, 3242; Aug. 16, 1989, Pub. L. 101–93, § 5(t)(1), (3), 103 Stat. 615; Nov. 29, 1990, Pub. L. 101–645, title V, §§ 501–503, 104 Stat. 4724; Oct. 27, 1992, Pub. L. 102–531, title III, § 309(c), 106 Stat. 3501, related to grant program for certain health services for the homeless, prior to repeal by Pub. L. 104–299, § 4(a)(3), Oct. 11, 1996, 110 Stat. 3645, eff. Oct. 1, 1996.

Another prior section 256, act July 1, 1944, ch. 373, title III, § 340, as added Nov. 10, 1978, Pub. L. 95–626, title I, § 115(2), 92 Stat. 3567; amended Dec. 12, 1979, Pub. L. 96–142, title III, § 301(a), 93 Stat. 1073; Aug. 13, 1981, Pub. L. 97–35, title IX, § 903(b)(1), 95 Stat. 561; Jan. 4, 1983, Pub. L. 97–414, § 8(h), 96 Stat. 2061, related to primary care research and demonstration projects to serve medically underserved population, prior to repeal by Pub. L. 97–35, title IX, § 903(c), Aug. 13, 1981, 95 Stat. 561, eff. Oct. 1, 1982.

Another prior section 256, act July 1, 1944, ch. 373, title III, § 340, formerly § 332, 58 Stat. 698; renumbered § 340, Oct. 12, 1976, Pub. L. 94–484, title IV, § 407(b)(2), 90 Stat. 2268, related to apprehension, detention, treatment, and release of persons being treated for leprosy, prior to repeal by Pub. L. 95–626, title I, § 105(b), Nov. 10, 1978, 92 Stat. 3560.

### Statutory Notes and Related Subsidiaries

### Demonstration Project To Provide Access to Affordable Care

Pub. L. 111–148, title X, § 10504, Mar. 23, 2010, 124 Stat. 1004, provided that: In General.—Not later than 6 months after the date of enactment of this Act [Mar. 23, 2010], the Secretary of Health and Human Services (referred to in this section as the ‘Secretary’), acting through the Health Resources and Services Administration, shall establish a 3 year demonstration project in up to 10 States to provide access to comprehensive health care services to the uninsured at reduced fees. The Secretary shall evaluate the feasibility of expanding the project to additional States. Eligibility.—To be eligible to participate in the demonstration project, an entity shall be a State-based, nonprofit, public-private partnership that provides access to comprehensive health care services to the uninsured at reduced fees. Each State in which a participant selected by the Secretary is located shall receive not more than $2,000,000 to establish and carry out the project for the 3-year demonstration period. Authorization.—There is authorized to be appropriated such sums as may be necessary to carry out this section.”

### Purpose

Pub. L. 107–251, title IV, § 401, Oct. 26, 2002, 116 Stat. 1655, provided that: “The purpose of this title [enacting this subpart and subpart X (§ 256f et seq.) of this part and provisions set out as a note under section 1396a of this title] is to provide assistance to communities and consortia of health care providers and others, to develop or strengthen integrated community health care delivery systems that coordinate health care services for individuals who are uninsured or underinsured and to develop or strengthen activities related to providing coordinated care for individuals with chronic conditions who are uninsured or underinsured, through the— coordination of services to allow individuals to receive efficient and higher quality care and to gain entry into and receive services from a comprehensive system of care; development of the infrastructure for a health care delivery system characterized by effective collaboration, information sharing, and clinical and financial coordination among all providers of care in the community; and provision of new Federal resources that do not supplant funding for existing Federal categorical programs that support entities providing services to low-income populations.”