Healthy Start Initiative


To eliminate disparities in perinatal infant and maternal health by: enhancing a community's health care infrastructure and service system and a State's infrastructure; and directing resources and interventions to improve access to, utilization of, and full participation in comprehensive perinatal and women's health services, particularly for women and infants at higher risk for poor health outcomes.

General information about this opportunity
Last Known Status
Program Number
Federal Agency/Office
Agency: Department of Health and Human Services
Office: Health Resources and Services Administration
Type(s) of Assistance Offered
Program Accomplishments
Not Applicable.
Title III, Part D, Section 330H of the Public Health Service Act, (42 U.S.C.254c-8).
Who is eligible to apply/benefit from this assistance?
Applicant Eligibility
Eligible Project Area
All applicants applying for funding under this grant announcement must identify themselves as
serving an urban, rural, or border community project area. A project area is defined as a geographic community in which the proposed services are to be implemented. A project area must represent a reasonable and logical catchment area, but the defined areas do not have to be contiguous. A map of the proposed project area must be included in the application.

Urban – Territory, population, and housing units located within an urbanized area (UA) or an urban cluster (UC), which has:
o a population density of at least 1,000 people per square mile; and
o surrounding census blocks with an overall density of at least 500 people per square mile.

Rural – To determine whether the Census tract or County for your proposed project area is defined as a rural area (RA), visit the webpage Rural Health Grants Eligibility Analyzerr ( and enter the project area address.

US/Mexico Border – Border communities are those communities located within 62 miles/100 kilometers of the U.S./Mexico border. In order to be considered for Border Community funding, the project area and the target population to be served both have to reside within 62 miles/100 kilometers of the U.S./Mexico border.

Eligible Target Population
The target population is the population that the applicant will serve within their geographic project area and will determine their eligibility. The target population may range from a single racial/ethnic group to the entire project area population. The project area for which the applicant is applying and the proposed target population within that project area must be clearly identified to confirm eligibility.

Eligibility Factors Demonstrating Need
HRSA/MCHB must be able to verify submitted data with the appropriate state/local government agency responsible for vital statistics. Border community applicants that cannot provide this verifiable data may use the other indicators specified in the second section below. Project data for the eligibility factors for all applicants must be included in the application’s transmittal letter and in the needs assessment section of the submitted application. The existing racial/ethnic disparities in these or other perinatal indicators should also be described in the needs assessment section of the application.
Applications that do not provide this information, in the manner described within this Funding Opportunity Announcement (FOA), will be considered ineligible and the application will be returned without review.
An applicant’s target population within their proposed project area must meet the following verifiable criteria using the smallest statistical level of verifiable data available -- not to be any larger than a combination of counties (e.g. a city project should not report county-level data).HRSA-14-020, Urban and Rural Communities
Using verifiable three-year average data for calendar years 2007 through 2009, the proposed project area for communities which meet the urban or rural community definition must meet the following indicators from the list below.

The 2007-2009 combined three-year infant mortality rate (IMR, infant deaths per 1,000 live births over three years) must be equal to or more than 9.9 deaths per 1,000 live births (1.5 times the national average) AND there must be 20 or more infant deaths over the three years for the targeted population.

If the combined 2007-2009 number of infant deaths are less than (<)20, then to be eligible the following must be met: o The 2007-2009 three-year average low birthweight (LBW) is equal to or more than 12.3% (1.5 times the national average) AND there must be 100 or more LBW births in the targeted population for the three-year period, 2007 to 2009

The 2007-2009 preterm births (PTB) is equal to or more than 18.6% (1.5 times the national average) AND there must be 100 or more PTB births in the targeted population for the period, 2007 to 2009

For Levels 2 and 3, if the combined 2007-2009 IMR is less than 9.9 deaths per 1,000 live births, then to be eligible the following must be met: o The applicant must demonstrate a 20% decrease in IMR in their target population for 2005-2009 (five-year combined average) and discuss how they were a significant contributor to this reduction

AND meet at least one of the following criteria:
The 2007-2009 three-year average low birthweight (LBW) is equal to or more than 12.3% (1.5 times the national average) AND there must be 100 or more LBW births in the targeted population for the three-year period, 2007 to 2009

The 2007-2009 preterm births (PTB) is equal to or more than 18.6% (1.5 times the national average) AND there must be 100 or more PTB births in the targeted population for the period, 2007 to 2009

US/Mexico Border Communities
Using verifiable three-year average data for 2007 through 2009, the proposed target population for project areas which meet the border community definition (i.e., within 62 miles of the U.S./Mexico border) must have at least 1,000 births for the three year period and meet at least three (3) indicators from the list below. If vital statistics are not available from state/local government agencies, border community applicants can use other verifiable data.
• Percentage of women of childbearing age with diabetes is 3.1% or more;
• Percentage of women of childbearing age who are obese is 31.8% or more;
• Percentage of pregnant women entering prenatal care in the first trimester is less than 80%;
• Percentage of births to women who had no prenatal care is greater than 2%;
• Percentage of births to women who smoke is greater than 20%;
• Percentage of children 0-2 years old with a completed schedule of immunization is less than 60%;
• Percentage of children under 18 years of age with family incomes below the Federal Poverty Level exceeded 25% for 2010. If more recent verifiable poverty data is available, please provide this data and identify year and source;
• Percent of infants born large for gestational age (LGA) is 9.4 or greater.
Beneficiary Eligibility
Service area residents, particularly women and infants in areas with significant perinatal health disparities.
Applicants should review the individual HRSA funding opportunity announcement issued under this CFDA program for any required proof or certifications which must be submitted prior to or simultaneous with submission of an application package. 2 CFR 200, Subpart E - Cost Principles applies to this program.
What is the process for applying and being award this assistance?
Pre-Application Procedure
Preapplication coordination is required. Environmental impact information is not required for this program. This program is eligible for coverage under E.O. 12372, "Intergovernmental Review of Federal Programs." An applicant should consult the office or official designated as the single point of contact in his or her State for more information on the process the State requires to be followed in applying for assistance, if the State has selected the program for review.
Application Procedure
2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards applies to this program. HRSA requires all applicants to apply electronically through
Award Procedure
All qualified applications will be forwarded to an objective review committee. Based on the advice of the objective review committee, the HRSA program official with delegated authority is responsible for final selection and funding decisions.
Notification is made in writing by a Notice of Award.
Contact the headquarters or regional office, as appropriate, for application deadlines.
Approval/Disapproval Decision Time
Final decisions are made approximately 166 days after receipt of applications.
Not Applicable.
After initial award, projects may be renewed annually up to the limit of the project period upon the submission and approval of a satisfactory progress report .
How are proposals selected?
See the funding opportunity announcement to obtain specific program grant guidance.
How may assistance be used?
Every Healthy Start project implements community-driven approaches to address infant mortality rates by reducing maternal behavioral and medical risk factors and promoting healthy outcomes for women and their families. Beginning with prenatal care and continuing through the infant's second year of life, each community awarded funds assures the availability of a core set of services and activities for the perinatal population in their project area. These services include case management, home visiting and links to health care and other needed services for mothers and their infants; direct outreach and peer mentoring by trained community members; screening and referral for perinatal/postpartum depression; and strong coordination with and access to substance abuse, domestic violence, mental health, early intervention, parenting and other critical services for high-risk women and families. In addition, each Healthy Start project is required to have a community-based consortium composed of individuals and organizations and that includes women and families served by their project, to collaborate with their State Title V (MCH) Agency, and to implement a local health system action plan to improve the quality, cultural competence of and access to services and/or to address other problems in the local system of care. Funds may not be used to supplant currently funded activities/services.
What are the requirements after being awarded this opportunity?
The awardee will be required to submit performance and progress reports as well as status-federal financial reports (see the program announcement and notice of award for details for each required report). The awardee must submit a quarterly electronic Federal Financial Report (FFR) Cash Transaction Report via the Payment Management System within 30 days of the end of each calendar quarter. A Federal Financial Report (SF-425) according to the following schedule: A final report is due within 90 days after the project period ends. If applicable, the awardee must submit a Tangible Personal Property Report (SF-428) and any related forms within 90 days after the project period ends. New awards (“Type 1”) issued under this funding opportunity announcement are subject to the reporting requirements of the Federal Funding Accountability and Transparency Act (FFATA) of 2006 (Pub. L. 109–282), as amended by section 6202 of Public Law 110–252, and implemented by 2 CFR Part 170. Grant and cooperative agreement recipients must report information for each first-tier subaward of $25,000 or more in federal funds and executive total compensation for the recipient’s and subrecipient’s five most highly compensated executives as outlined in Appendix A to 2 CFR Part 170 (FFATA details are available online at Competing continuation awardees, etc. may be subject to this requirement and will be so notified in the Notice of Award. No cash reports are required. Progress reports are not applicable. No expenditure reports are required. No performance monitoring is required.
In accordance with the provisions of 2 CFR 200, Subpart F - Audit Requirements, non-Federal entities that expend financial assistance of $750,000 or more in Federal awards will have a single or a program-specific audit conducted for that year. Non-Federal entities that expend less than $750,000 a year in Federal awards are exempt from Federal audit requirements for that year, except as noted in 2 CFR 200.503.
Grantees are required to maintain grant accounting records 3 years after the date they submit the Federal Financial Report (FFR). If any litigation, claim, negotiation, audit or other action involving the award has been started before the expiration of the 3-year period, the records shall be retained until completion of the action and resolution of all issues which arise from it, or until the end of the regular 3-year period, whichever is later.
Other Assistance Considerations
Formula and Matching Requirements
This program has no statutory formula.
This program has no matching requirements.
This program does not have MOE requirements.
Length and Time Phasing of Assistance
Project periods vary depending on specific grant announcement with non-competing continuation awards made on an annual basis for up to 5 years depending on satisfactory progress and subject to the availability of funds. See the following for information on how assistance is awarded/released: Grantees drawdown funds, as necessary, from the Payment Management System (PMS). PMS is the centralized web based payment system for HHS awards.
Who do I contact about this opportunity?
Regional or Local Office
See Regional Agency Offices. Director, Division of Healthy Start and Perinatal Services, Maternal and Child Health Bureau, Health Resources and Services Administration, Department of Health and Human Services, Room 13-91, Parklawn Building, 5600 Fishers Lane, Rockville, MD 20857. Telephone: (301) 443-0543.
Headquarters Office
Director, Division of Healthy Start and Perinatal Services 5600 Fishers Lane, Room 13-91, Rockville, Maryland 20857 Phone: (301) 443-0543
Website Address
Financial Information
Account Identification
(Project Grants) FY 14 $100,746,000; FY 15 est $93,382,488; and FY 16 est $102,000
Range and Average of Financial Assistance
Based on FY 14 $750,000-$2,000,000.
Regulations, Guidelines and Literature
HRSA awards are subject to the requirements of the HHS Grants Policy Statement (HHS GPS) that are applicable based on recipient type and purpose of award. The HHS GPS is available at
Examples of Funded Projects
Not Applicable.