FAQ: Healthy Start Initiative: Eliminating Disparities in Perinatal Health (HS)

Funding Opportunity Numbers: HRSA-24-033 (Competing Continuation, New)

Eligibility

What types of organizations are eligible to apply to this NOFO?

Eligible applicants include any domestic public or private entity. As noted on page 5 of the NOFO, domestic community-based organizations, tribes, and tribal organizations are also eligible to apply. Please note, if funded, for-profit organizations are prohibited from earning profit from the federal award (45 CFR § 75.216(b)).

Are current Healthy Start Initiative – Enhanced (HSE) recipients eligible to apply to the HS NOFO?

Yes, as noted on page 5 of the NOFO, current HSE recipients are eligible to apply if a new project area, not currently served by your existing award is proposed. If you are an HSE recipient and you propose a project area that fully overlaps within your own or another HSE award, you will be deemed ineligible.

If I am not an HSE recipient but I propose the same project area as an existing HSE recipient will my application be reviewed?

As noted on page 5 of the NOFO, if your proposed project area is the same as an HSE recipient, your application will be deemed ineligible.

If the target population within the project area does not meet the criteria outlined under Factors Demonstrating Need for the Target Population is my organization still eligible to apply to HRSA-24-033?

Yes. An organization’s eligibility to apply to this NOFO is not related to the rate of infant death, low birthweight or preterm birth for the target population within the project area. Eligible applicants include domestic public and private entities, community-based organizations, tribes and tribal organizations.

Data under Factors Demonstrating Need for the Target Population (infant mortality, low birthweight and preterm birth) are scored in the Need section. Please note that this is a change from the HRSA-19-049 competition. In the HRSA-19-049 competition applicants had to demonstrate that they met 1.5 times the national average for infant mortality, low birthweight or preterm birth to meet the eligibility requirements.

Multiple applicants from a single state

How many HS and HSE awards will HRSA make per state?

As noted on page 37 of the NOFO, HRSA will make no more than 6 Healthy Start awards per state (that is, awardees of HSE [HRSA-23-130] and HS [HRSA-24-033] projects combined).

Project area

Will HRSA fund more than one applicant proposing to serve the same project area?

No, pages 8-9 of the NOFO indicate that if two applications receiving a fundable score propose to serve the same project area, HRSA will only consider the highest scoring application.

What happens if two applicants propose overlapping project areas?

If part of your project area overlaps with a project area proposed by another applicant and you both receive fundable scores, HRSA will notify you and request that within a specified period of time, you establish an agreement with the other applicant outlining amended project areas. Please see pages 8-10 of the NOFO for more details where this is addressed.

Are there any exceptions to when two recipients would be funded to serve the same project area?

Two applicants in the fundable range may propose to serve the same project area if one, but not both of the applicants is a tribe, tribal organization or health organization serving tribes. Please see pages 9-10 of the NOFO for more details where this is addressed.

Can I apply for a project area funded through HRSA-19-049?

Yes, the HRSA-19-049 grant cycle ends on March 31, 2024. You may apply for any project area or part of a project area that was funded through the HRSA-19-049 NOFO. You are highly encouraged to review the list of the 101 HRSA-19-049 HS recipients (project period April 1, 2019 - March 31, 2024). We are including this link for your awareness/background information only. Many of the HRSA-19-049 awardees may re-apply for the same or similar project areas; you may wish to contact them for coordination purposes to avoid overlap in proposed project areas.

How do I find organizations in our region that have received Healthy Start Initiative-Enhanced (HSE) (HRSA-23-130) funds?

Appendix H of the NOFO has a list of all HSE recipients and the counties and zip codes in their project areas. Please note if you are an HSE recipient and you propose to serve a project area that fully overlaps with your own award or another HSE award, your application will be deemed ineligible and will not be considered. For all other applicants, if your proposed project area is the same as an HSE recipient, your application will be deemed ineligible.

If my proposed project area includes both rural and urban communities, how should I identify our project area?

First, use the Rural Health Grants Eligibility Analyzer to determine if part or all of your project area is rural. If your project area includes both rural and urban communities, use the Introduction and Need sections of the Project Narrative to describe the geography of your project area, provide an overview of the project area and describe the social determinants of health impacting the target population within the project area (for a full description of what is required in the Introduction and Need sections please see pages 22-24 of the NOFO). Describe differences in your approach to delivering direct and enabling services and meeting the requirements for the Community Consortium within the Approach section of your project narrative.

As noted in the NOFO you are encouraged to use the template in Appendix F on pages 54-56 of the NOFO to organize the information requested in Attachment 1. If you choose to use this template you may answer “yes” to the question, “Based on the results of the Rural Health Grants Eligibility Analyzer, is your project area classified as rural?” even if your project area includes both rural and urban areas.

Target population

How should the target population be defined?

As indicated on pages 10-11 of the NOFO, your target population should be the population with the highest rate of infant deaths, low birthweight or preterm birth.

Can an applicant propose more than one target population for the project area?

No, the target population is the population that you will serve within your project area. It should be the population with the highest rate of infant deaths, low birthweight or preterm birth.

Can an organization apply for this grant if its target population includes non-Hispanic whites and/or Hispanics?

Yes, as noted on page 10 of the NOFO, your target population should be the group with the highest rate of infant deaths, low birthweight or preterm birth living in the project area.

Current grantees (recipients of HRSA-19-049)

Can current grantees (recipients of HRSA-19-049) propose the same project area and target population for the HRSA-24-033 application that they are currently serving through their HRSA-19-049 grant?

Yes. However, as noted on pages 10-11 of the NOFO under Factors Demonstrating Need for the target population, applicants should propose a target population within the project area that has the highest rate of infant deaths, low birthweight or preterm birth (please carefully review the criteria outlined on page 11, number 1, 2a and 2b). Be advised, that if the target population within your current project area no longer meets this requirement, you may need to alter your current project area in order to target services to the communities with the greatest need.

Should current grantees include all data for Calendar Year 2022 Healthy Start Benchmarks in their application?

Yes, as noted on page 35-36 of the NOFO, Resources and Capabilities will be assessed based on the degree to which the applicant organization has the needed experience to achieve the program goals and objectives of this NOFO. In your application, please indicate your status as a HRSA-19-049 recipient and provide your Healthy Start benchmark data for Calendar Year 2022. This data should be the same as what was submitted through the Discretionary Grants Information System (DGIS).

Data demonstrating need

Where do I find the data requested under “Factors Demonstrating Need for the Target Population” on pages 10-11 of the NOFO?

As noted on page 10 of the NOFO, you should use verifiable, vital statistics data. CDC Wonder may be used to obtain infant mortality statistics (for counties with a 250,000+ population only). Otherwise, please contact your state or local vital statistics department. Please contact MCHBHealthyStart@HRSA.gov if you have any additional questions.

What if I can’t access 2019-2021 data for the target population in my proposed project area, can I submit data for a different 3-year period?

No, as noted on page 11 of the NOFO, you must submit 2019-2021 data. If you are unable to access 2019-2021 data for the target population in your project area from vital records, we recommend you contact your state Title V Director for assistance. Please also contact MCHBHealthyStart@HRSA.gov for questions and additional technical assistance.

My proposed project area is a combinations of zip codes (i.e., a portion of a county), can I use county-level data for the target population?

No, you must provide data for the target population in your specific project area. Please review pages 7-8 and 10-11 of the NOFO for details on defining your project area and the specific data requested for the target population. Data is available through vital statistics. CDC wonder may also be used to obtain infant mortality statistics (for counties with a 250,000+ population only): https://wonder.cdc.gov/lbd.html. If you are unable to access 2019-2021 data for the target population in your project area from vital records or CDC Wonder, we recommend you contact your state Title V Director for assistance.

What is the best way to organize the information requested under Need?

You are encouraged to use the template located in Appendix F on page 54 of the NOFO to organize the information requested in Attachment 1. Include information requested under “Factors Demonstrating Need for the Target Population” (on pages 10-11 of the NOFO) and “Project Area Proposed to be Funded” (on pages 7-8 of the NOFO).

Does the population of the entire project area AND the target population need to meet the criteria outlined under Factors Demonstrating Need for the Target Population on pages 10-11 of the NOFO?

No, it is not necessary for both the population of the project area as a whole and the target population to meet the criteria outlined under Factors Demonstrating Need for the Target Population in order to demonstrate need. As indicated on pages 10-11 of the NOFO, it is required that the target population within the project area meets the criteria.

How will HRSA evaluate and score the data provided for infant mortality, low birthweight and preterm birth?

This NOFO has six review criteria to review and rank applications. The maximum score is 100 total points. Reviewers will evaluate and score the merit of your application based on the review criteria. Reviewers will score up to 85 of the 100 total points. The remaining 15 points will be scored by HRSA.

The Need section allows for applicants to receive a maximum of 20 points. The Objective Review Committee will score up to 5 points for Need. HRSA will score up to 15 points, based on the data provided by the applicant for infant mortality, preterm birth and low birthweight. HRSA will first look to see whether or not your target population within the project area has 30 or more infant deaths between 2019-2021. If it does, you should use the infant mortality rate and number of infant deaths to demonstrate need. If your application does not meet the infant mortality rate or provide all of the data completely and accurately, HRSA will give your application 0 points for this portion of the Need score. If you provide all of the data accurately (as requested in the NOFO) and it meets the criteria, HRSA will give your application 15 points.

If your target population within the project area has less than 30 infant deaths between 2019-2021, you may use either low birthweight or preterm births to demonstrate need. In this instance, you should have 90 or more low birthweight births or preterm births in the target population within the project area from 2019-2021 and meet the criteria for low birthweight or preterm birth outlined within the NOFO (pages 10-11). If your application does not meet the low birthweight or preterm birth rate and number of low birthweight or preterm births or provide all of the data requested in the NOFO completely and accurately, HRSA will give your application 0 points for this portion of the Need score. If you provide all of the data accurately (as requested in the NOFO) and it meets the criteria, HRSA will give your application 15 points.

If my target population in the project area has more than 30 infant deaths but the infant mortality rate is less than 8.2 can my application still receive the 15 points scored by HRSA in the Need section?

No, if the target population within your proposed project area has 30 or more infant deaths but has an infant mortality rate that is less than 8.2, the application will receive 0 out of 15 points that HRSA scores.

Direct and enabling services

How many participants will HS recipients serve annually?

Funded HS projects will serve 700 participants annually: 450 participants through case management/care coordination and 250 participants through group-based health and parenting education. Please reference pages 13-15 of the NOFO for additional information.

Can applicants propose to implement group prenatal care models to fulfill the requirement to provide group-based prenatal/postpartum health and parenting education?

Yes, page 14 of the NOFO indicates that group prenatal care models are acceptable.

Does a one-time workshop count as group-based prenatal/postpartum and parenting education?

No. Healthy Start projects are expected to implement group-based health and parenting education in groups or cohorts with successive sessions so that participants are able to engage in robust learning and form supportive connections with other group members.

For the group-based prenatal/postpartum and parenting education classes, how many sessions for each cohort are needed for it to “count”?

There is no guidance on the exact number of sessions for each cohort. HRSA allows applicants the flexibility to design an approach to group-based health and parenting education that meets the needs of their target population and project area, while reflecting the best findings from literature and practice. Healthy Start projects are expected to tailor models and strategies to meet the needs of the community and the stated goals and objectives of the program. HRSA asks Objective Review Committee members to assess the likely impact and success of the program design proposed by the applicant, which includes the proposed design of group-based educational activities, as it scores applicants’ proposals.

Do I need to use an evidence-based curriculum for the group-based prenatal/postpartum and parenting education?

No. Applicants are not required to use an evidence-based curriculum. However, applicants should design an approach that is based on a best practice or uses either evidence-based, evidence-informed or scientifically based information. This will be considered by the Objective Review Committee in its deliberations.

Do the group-based health and parenting education participants need to reside in the project area?

Yes, all participants served under HRSA-24-033 must reside in the project area. Please note that 50 percent of Healthy Start participants receiving direct and enabling services should be from the target population within the project area.

Does the population served through group-based health and parenting education have to be from the target population (population with the highest rate of infant death, low birthweight or preterm birth) within the project area?

To meet the data reporting requirements, out of the 700 participants you are expected to serve annually at least 450 should be through case management/care coordination and at least 250 should be through group-based health and parenting education. A minimum of 50 percent of these participants should be from the target population (i.e., the group with the highest infant mortality rate in your project area or, if there were less than 30 infant deaths in your target population from 2019 through 2021, the group with the highest low birthweight rate or preterm birth rate).

Can HRSA provide technical assistance on designing my approach for implementing direct and enabling services?

No. Please do not contact the Supporting Healthy Start Performance Project for specific technical assistance questions and requests. However, you may visit the website for the Supporting Healthy Start Performance Project’s Healthy Start EPIC Center. This website provides publicly available resources on training, technical assistance and other materials for communities, including current Healthy Start grantees that are working to improve perinatal health outcomes. Resources on this website may help to inform your program design. For questions about the HRSA-24-033 application please contact MCHBHealthyStart@HRSA.gov.

Community Consortia

Will an existing network be considered as a Community Consortium?

Yes, an existing network may be considered a Community Consortium if it meets the expectations outlined on pages 17-19 of the NOFO. Community Consortia (formerly known as Community Action Networks or “CANs”) are intended to bring together various representatives across the community to address pressing issues and needs that may lead to adverse perinatal health outcomes.

If my organization is an HSE recipient or a recipient of HRSA-19-049, can our existing Community Consortium/CAN serve as the Community Consortium for the proposed project area?

Yes, an existing Community Consortium/CAN may act as the Community Consortium for this program. However, it must act on behalf of the proposed target population in the project area proposed for this HS application.

Is there a minimum or maximum number of partners required in the Community Consortium?

No, it is expected that the Community Consortium will have representation from enrolled HS participants, women of reproductive age, mothers, fathers, or partners, other people with lived experience living in the project area; and Title V, public health departments, hospitals, health centers under section 254b, State substance abuse agencies, and other significant sources of health care services. Other categories of partners can include community leaders, representatives from service agencies, community-based organizations; state/non-profit organizations/faith-based organizations addressing housing, employment, education, transportation, and health care. For additional details on the composition of the Community Consortium see pages 17 - 20 of the NOFO.

Is compensation to Community Consortium participants an allowable expense?

Yes, page 26 of the NOFO asks that you state whether community members and/or HS participants on the Community Consortium will be compensated for services provided.

The Community Consortium plan

Our community has a plan to address perinatal outcomes and reduce infant deaths. Is a new plan required for HS?

No, recipients of HS are to develop and submit a Community Consortium plan to address social determinants of health (SDOH) by October 30, 2024. If the recipient has an existing plan that meets the requirements in the NOFO, it can be submitted for review to your HRSA Project Officer. Plans should go beyond solely addressing barriers to clinical care and improving the local system of care. The plan should address the environmental, social, and economic conditions that contribute to disparities in perinatal outcomes. Plans are expected to be based upon the results of a community needs assessment and environmental scan that identifies and prioritizes SDOH causes of disparities in perinatal outcomes for the target population in the project area.

Could we use a community needs assessment that was conducted by another organization to inform the Community Consortium Plan?

Yes. There are no specific guidelines pertaining to the organization who performs the needs assessment. The information included in the needs assessment should provide Healthy Start project recipients with sufficient information to inform the plan to address social determinants of health within project area.

Is there a required format/template for the Community Consortia plan?

No, HRSA does not require a specific format for the Community Consortia plan.

Program monitoring and evaluation

Will my application be penalized if the proposed project does not intend to use CAREWare?

No. CAREWare is not mandatory to use as a data management system for Healthy Start’s data reporting requirements.

However, as noted on page 42 of the NOFO, HRSA strongly encourages recipients to consider using the CAREWare database for their data collection, management, and reporting needs. CAREWare provides recipients with a client-level data collection system at no cost to them with reporting and case management features; customization capabilities; dedicated technical assistance; a quick-start option for new and inexperienced recipient; and an adaptable system that is directly informed by/linked to Healthy Start’s data reporting requirements.

As described in the evaluation section on page 21 of the NOFO, what is the difference between "impact” and “progress toward goals and objectives"?

Program “impact” assess the degree to which a project meets the desired outcomes. “Progress towards goals and objectives” is the incremental progress that a program will make throughout the implementation of a program which includes assessment of both process and outcome measures. As noted on page 21, recipients should monitor impact, ongoing processes and the progress toward the goals and objectives of the project throughout the grant cycle.

Budget

Can HS funds be used to address participant needs such groceries, utility and rental assistance payments or income supplements?

No, as noted on page 31 of the NOFO, funds awarded under the HS Initiative NOFO cannot be used to provide in-kind benefits or cash payments (for example, rental assistance payments, housing vouchers, income supplements, and other.).

Will HS recipients be allowed to sub-contract with organizations that are providing in-kind benefits?

Yes, recipients may sub-contract with organizations that provide in-kind benefits. Recipients who plan to make sub-awards must describe how their organization will ensure proper use and documentation of funds.

Are applicants to submit a budget for the 5th year of the project only?

No. Applicants are to provide a complete 5-year budget for the proposed project. The NOFO directs applicants to include the 5th year budget as attachment 8 (see pages 29 and 46 of the NOFO).

Is the 5-year budget attachment just the SF-424 form, or is a justification also included?

The 5th year budget is to be included as Attachment 8 in the application. Use SF-424A to document the budget. The budget justification, sometimes called the budget narrative, is a companion to the budget. It explains how the costs were estimated, and it justifies the need for the cost. For additional guidance, review the budget guidance on page 20 of HRSA SF-424 Application Guide.

Can HS funds be used to purchase a vehicle?

Proposed costs for a vehicle purchase may be included in the budget but are closely reviewed on a case-by-case basis to assess for allowability and necessity.

Will funded organizations be allowed to combine HS funding with non-federal sources of funding to implement planned activities?

There are no restrictions on the use of non-federal funding to support implementation of HS activities. HS recipients may accept and use external funds to support implementation of their program components. However, HS funding cannot be blended with non-federal funding. Blending involves combining funding sources where the individual identity of the funding source is lost and cannot be allocated and tracked separately. HS funding must be allocated and tracked in a way that it maintains its own identify.

Can HS funds be used to support doulas?

Yes, HRSA understands the vital role doulas play in reducing disparities in infant mortality, maternal mortality, and other adverse perinatal outcomes. HS recipients are strongly encouraged to consider community-based doulas as members of HS participant care teams and to connect participants to doula services during pregnancy, birth, and for at least 3 months post-partum.

Can I allocate more than 10 percent of the budget for clinical services?

As page 16 of the NOFO notes, all recipients are expected to provide clinical services and allocate 10 percent of their award to provide clinical services to HS participants. Applicants may elect to dedicate more than 10 percent of their award to clinical services, providing the proposed budget and budget narrative are aligned with the NOFO’s requirements and objectives, and the recipient’s proposed activities/technical approach.

Can doulas be included in the 10% of funds used to support clinical services?

No, as indicated in footnote 27 on page 16, doulas should not be included in the 10% of funds used to support clinical services. HRSA understands the vital role doulas play in reducing disparities in infant mortality, maternal mortality, and other adverse perinatal outcomes. HS recipients are strongly encouraged to consider community-based doulas as members of HS participant care teams and to connect participants to doula services during pregnancy, birth, and for at least 3 months post-partum.

Priority points

The Appendix E: Attachment 1 Checklist indicates that the application should include the following percentages for each county in your project area: pregnant women with pre-pregnancy or gestational diabetes, pregnant women with pre-pregnancy or gestational hypertension, pregnant women with pre-pregnancy obesity, pregnant women entering prenatal care in the first trimester. If none of the counties in my project area are listed in Appendix G, do I need to provide this data in my application?

No, you do not need to provide the data in your application. If none of the counties in your project area are listed in Appendix G, you are not eligible for priority points under Priority 2: Other Perinatal Indicators for the Total Pregnant Population.

None of the counties in my project area listed in Appendix G, can my application still qualify for priority points under Priority 2: Other Perinatal Indicators for the Total Pregnant Population if I provide my own data?

No, the data in Appendix G has been analyzed and refined for accuracy and reliability for all counties in the U.S. HRSA will not accept data from sources other than Appendix G.