United States Government Accountability Office

GAO Report to Congressional Committees

HEALTH CAREERS 

OPPORTUNITY 

PROGRAM 

Process for Awarding 

Competitive Grants 

Included Independent 

Review 

February 2007 

 

GAO-07-137 
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

February 2007

HEALTH CAREERS OPPORTUNITY 

PROGRAM 

Process for Awarding Competitive Grants 

Included Independent Review 

Highlights of GAO-07-137, a report to 

congressional committees 

To support the education and 

training of health professionals, the

Health Resources and Services

Administration (HRSA), in the 

Department of Health and Human

Services (HHS), administers health 

professions education programs 

authorized under title VII of the 

Public Health Service Act. One of

these programs, the Health Careers 

Opportunity Program (HCOP),

provides grants to health

professions schools and other

entities to help students from

disadvantaged backgrounds 

prepare for health professions 

education and training. Funding 

preference is given to grant 

applications that demonstrate a

comprehensive approach involving 

other educational or health-related

partners. 

Congressional committees have 

encouraged HRSA to give priority

to applications from schools with a 

historic mission of educating 

minority students for health 

professions. In 2004, the 

appropriations conference

committee asked GAO to review 

HRSA’s process for awarding 

grants. This report addresses, for

fiscal years 2002 through 2005, 

(1) HRSA’s process for awarding 

HCOP grants and (2) the number

and characteristics of HCOP 

applicants and grantees. 

GAO reviewed data from HRSA, 

interviewed HRSA officials, and

reviewed relevant federal laws and 

agency documents from HHS and 

the Department of Education. 

HRSA followed a standard process to award HCOP grants, distributing funds 

on a noncompetitive basis to continue funding existing HCOP grants within 

their approved project periods, and then awarding the remaining funds on a 

competitive basis. For each of fiscal years 2002–05, HRSA competitively 

awarded between $4 million and $15 million from the approximately 

$34 million annually available for HCOP. To award competitive grants, HRSA 

used independent reviewers who assessed applications against published 

criteria, scored applications that met minimum criteria, and determined if 

they qualified for the funding preference. HRSA ranked the applications from 

highest to lowest score—putting those with the funding preference first—

and awarded grants in decreasing rank order until the available funds were 

exhausted. Although HRSA had discretion to award grants out of rank order, 

the agency did not do so for fiscal years 2002–05. 

For fiscal years 2002–05, HRSA awarded a total of 99 competitive HCOP 

grants from 439 grant applications reviewed. Overall, minority-serving 

institutions submitted about 25 percent of the applications reviewed and 

received about 30 percent of the competitive grants; historically black 

colleges and universities were the most numerous grantees among minorityserving institutions, followed by Hispanic-serving institutions. 

HRSA commented that a draft of this report met the goals of describing the 

award process and outlining the number and characteristics of HCOP 

applicants and grantees. 

Results of Competitive HCOP Process, Fiscal Years 2002–05 

Source: GAO analysis of HRSA data.

Applications not scored Applications scored,

without funding preference

Applications scored,

with funding preference

0

20

40

60

80

100

120

140

31 applications 

funded, with scores 

ranging from 93 

through 80

10 applications 

funded, with scores 

ranging from 94 

through 87

24 applications 

funded, with scores 

ranging from 94 

through 83

34 applications 

funded, with scores 

ranging from 98 

through 89

Number of applications

2002 2003 2004 2005

Year

Note: The reviewers did not score applications they found were not responsive to the review criteria.

www.gao.gov/cgi-bin/getrpt?GAO-07-137.

To view the full product, including the scope 

and methodology, click on the link above. 

For more information, contact Leslie G. 

Aronovitz at (312) 220-7600 or 

aronovitzl@gao.gov. 
Contents 

Letter 1

Results in Brief 4 

Background 5

HRSA Followed a Standard Process to Award HCOP Grants 7 

Applications from Minority-Serving Institutions Generally Received 

Grants in Greater Proportion Than All Applications 15 

Agency Comments 19 

Appendix I Identification of Minority-Serving Institutions 21 

Appendix II HCOP Competitive Applications and Grants, 

by Location of Grant Applicant, Fiscal Years 2002 

through 2005 25 

Appendix III Comments from the Health Resources and Services 

Administration 27 

Appendix IV Contact and Acknowledgments 29 

Related GAO Products 30 

Tables 

Table 1: Review Criteria for HCOP Applications, Fiscal Year 2005 10 

Table 2: Number of Applications for Competitive HCOP Grants and 

Competitive Grants Awarded, Fiscal Years 2002–05 16 

Table 3: Applications and Awards for Competitive HCOP Grants, 

by Minority-Serving Status, Fiscal Years 2002–05 18 

Table 4: Numbers of HCOP Applications from, and Competitive 

Awards to, Designated Minority-Serving Institutions, Fiscal 

Years 2002–05 19 

Table 5: Minority-Serving Institution Designations, Criteria, and 

Approximate Number as of Fiscal Year 2005 24 

Page i GAO-07-137 Health Careers Opportunity Program 
Table 6: Entities Applying for and Receiving Competitive HCOP 

Grants, by Location, Fiscal Years 2002–05 25 

Figures 

Figure 1: Funds Awarded through the Health Careers Opportunity 

Program as Noncompetitive Continuations and 

Competitive Grants, Fiscal Years 2002–05 8 

Figure 2: Process for Awarding Competitive HCOP Grants 14 

Figure 3: Scores and Funding Preference for Competitive HCOP 

Applications and Grants, Fiscal Years 2002–05 17 

Abbreviations 

HCOP Health Careers Opportunity Program 

HHS Department of Health and Human Services 

HRSA Health Resources and Services Administration 

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Page ii GAO-07-137 Health Careers Opportunity Program 
United States Government Accountability Office

Washington, DC 20548 

February 2, 2007 

The Honorable Tom Harkin 

Chairman 

The Honorable Arlen Specter 

Ranking Minority Member 

Subcommittee on Labor, Health and Human 

 Services, Education, and Related Agencies 

Committee on Appropriations 

United States Senate 

The Honorable David R. Obey 

Chairman 

The Honorable James T. Walsh 

Ranking Minority Member 

Subcommittee on Labor, Health and Human 

 Services, Education, and Related Agencies 

Committee on Appropriations 

House of Representatives 

An appropriate supply of health professionals is vital to ensuring that all 

Americans have adequate access to health care. To support the education 

and training of health professionals, the Health Resources and Services 

Administration (HRSA), an agency within the Department of Health and 

Human Services (HHS), administers numerous health professions 

education and training programs authorized under title VII of the Public 

Health Service Act. One such program, the Health Careers Opportunity 

Program (HCOP), provides grants to health professions schools—such as 

medical or dental schools—and other entities to help students from 

disadvantaged backgrounds prepare for, and succeed in, education and

training for the health professions.1

 HCOP grants are generally approved

for a period of 3 years and support activities such as training to help 

students prepare for health professions education as well as counseling 

and mentoring for those already enrolled. Preference in funding HCOP 

grants is given to applications for projects with a comprehensive 

approach, including partnerships among health or educational entities to 

develop a pool of individuals from disadvantaged backgrounds interested 

 1

See Public Health Service Act, title VII, § 739 (codified, as amended, at 42 U.S.C. § 293c). 

Page 1 GAO-07-137 Health Careers Opportunity Program 
in pursuing health careers.2

 Applications that receive this funding 

preference are considered for funding ahead of applications that do not. 

For each of fiscal years 2002 through 2005, HRSA awarded about 

$34 million for HCOP grants, including grants awarded on a competitive 

basis as well as funds distributed on a noncompetitive basis to continue 

funding existing HCOP grant projects within their approved project 

periods.3

 For fiscal year 2006, in response to direction received during the 

appropriations process,4

 funding made available for HCOP by HRSA from

its appropriations was reduced significantly. As a result, HRSA cancelled 

the competition for grants and distributed all funds available for HCOP for 

fiscal year 2006—about $4 million—on a noncompetitive basis to continue 

funding 4 of 58 existing HCOP grant projects within their approved project 

periods.5

 In response to guidance in an appropriations committee report, 

which strongly urged HRSA to give priority to those institutions with a 

historic mission of training minorities in the health professions,6

 the 

agency distributed the $4 million for fiscal year 2006 to continue funding 

existing HCOP grant projects at four institutions that met that criterion.7

 2

42 U.S.C. § 293c(b). 

3

All recipients of noncompetitive continuation grants initially competed for their HCOP 

grants and must compete for additional funding following the end of their approved project 

periods; for awards made for fiscal years 2002 through 2005, this period was 3 years. 

Funding after the initial year of each project period is awarded noncompetitively, subject 

to the availability of funds and HRSA’s review of each grantee’s annual progress report. 

4

H.R. Rep. No. 109-337, at 135 (2005) (accompanying the Departments of Labor, Health and

Human Services, and Education, and Related Agencies Appropriations Act, 2006). 

5

According to officials with HRSA’s grants management office, about $26 million would 

have been required for fiscal year 2006 to fund all 58 HCOP grants that would otherwise 

have been considered for noncompetitive continuation grants for that year. 

6

S. Rep. No. 109-103, at 38 (2005). 

7

On January 27, 2006, HRSA notified the 54 remaining HCOP grantees that, because of 

reductions in the funding available for HCOP, they would not receive noncompetitive 

continuation grants. 

Page 2 GAO-07-137 Health Careers Opportunity Program 
All projects supported by HCOP grants focus on individuals who are either 

educationally or economically disadvantaged.

8

 In reports accompanying 

HHS appropriations bills for fiscal years 2002 through 2004, congressional 

appropriations committees with responsibility for HHS programs noted 

with approval that HRSA had given “priority consideration for HCOP 

grants to minority health professions institutions.”9

 In the conference 

report accompanying the fiscal year 2005 appropriations act, however, the 

conference committee expressed concern that several applications for 

new or competitive continuation grants from historically minority health 

professions schools had not been funded for fiscal year 2004.10 In this 

report, the conference committee also directed us to study the HCOP grant 

award process.11 As discussed with the appropriations subcommittees with

responsibility for HHS programs, this report addresses, for fiscal years 

2002 through 2005, (1) HRSA’s process for awarding HCOP grants and 

(2) the number and characteristics of HCOP applicants and grantees. 

To conduct our work, we analyzed HRSA’s data on HCOP applications, 

including the scores and funding preference determinations made during 

the application review process, and HCOP grant award decisions for fiscal 

years 2002 through 2005.

12 We assessed the reliability of HRSA’s data on 

HCOP grant awards by discussing with agency officials the validation and 

internal controls applied to HRSA’s grant data and by comparing the data 

with HRSA documents, such as records of HCOP grant award decisions. 

We determined that the HCOP data were sufficiently reliable for our 

purposes. In addition, we interviewed HRSA officials and reviewed 

 8

For HCOP, HRSA has defined educationally disadvantaged individuals as those from an 

environment that has inhibited their obtaining the knowledge, skills, and abilities to enroll 

in and graduate from a health professions school or allied health program; it has defined 

economically disadvantaged individuals as those from families with annual incomes at or 

below the low-income thresholds published by the U.S. Bureau of the Census. See, for 

example, U.S. Department of Health and Human Services, Health Resources and Services

Administration, Health Careers Opportunity Program (HCOP): New Competition, 

Program Guidance, Fiscal Year 2005, HRSA 05-098 (Rockville, Md.: Oct. 28, 2004). 

9

See, for example, S. Rep. No. 107-84, at 55–56 (2001); H.R. Rep. 107-229, at 25 (2001); 

S. Rep. No. 107-216, at 48 (2002); H.R. Rep. 108-188, at 24 (2003); and S. Rep. No. 108-81, at 

49 (2003). 

10H.R. Conf. Rep. No. 108-792, at 1156 (2004). 

11Id. 

12Some entities applied for more than one HCOP grant or operated more than one HCOPsupported project. The numbers of HCOP applications presented in this report represent

the applications and not the individual entities that applied for, or received, HCOP grants. 

Page 3 GAO-07-137 Health Careers Opportunity Program 
relevant federal laws, congressional committee reports, and agency

documents. In reviewing the characteristics of entities submitting HCOP 

applications and of HCOP grantees, we included only those applications 

that HRSA officials determined met the initial screening requirements to 

be considered for awards. To determine whether applicants and grantees 

that were institutions of higher education met criteria for designation as 

minority-serving institutions,13 we used Department of Education 

documents and other sources. We conducted our work from October 2005 

through January 2007 in accordance with generally accepted government 

auditing standards. 

HRSA followed a standard process to award HCOP grants each year, 

distributing available funds on a noncompetitive basis to continue funding 

existing grant projects (subject to HRSA officials’ review of each grantee’s 

progress report), then awarding the remaining funds on a competitive 

basis. For each of fiscal years 2002 through 2005, HRSA awarded as 

competitive grants between $4 million and $15 million from the 

approximately $34 million annually available for HCOP. The competitive 

process relied on independent reviewers: individuals with experience in

fields related to health and education and who were unaffiliated with 

either HRSA or current HCOP grant applicants. These reviewers first 

scored applications in accordance with HRSA’s review criteria, then 

determined if the applications qualified for the funding preference for 

projects with a comprehensive approach. HRSA ranked the applications 

according to the results of this review—those with the funding preference 

first, from highest to lowest score, followed by those without the funding 

preference. HRSA then awarded grants in rank order, starting with the 

highest-ranked application and proceeding in order of decreasing rank 

until the funds available for competitive grants that year were exhausted. 

Although HRSA officials have discretion to award grants in an order that 

Results in Brief 

 13These minority-serving institutions include historically black colleges and universities, 

American Indian tribally-controlled (or “tribal”) colleges and universities, Hispanic-serving 

institutions, Native Hawaiian–serving institutions, and Alaska Native–serving institutions. 

The term “minority-serving institution” includes institutions of higher education eligible for 

federal funding under title III or title V of the Higher Education Act of 1965, Pub. L. No. 89-

329, title III, §§ 301–305 et seq., 79 Stat. 1229–1231 (1965), as amended (codified, as 

amended, at 20 U.S.C. §§ 1051 et seq.); Pub. L. No. 89-329, title V, §§ 501–528, 79 Stat. 1254–

1260 (1965), as amended (codified, as amended at 20 U.S.C. § 1101 et seq.). See app. I for a 

detailed description of our methodology for determining an entity’s status as a minorityserving institution for the analyses in this report. 

Page 4 GAO-07-137 Health Careers Opportunity Program 
departs from the recommendation of the independent reviewers, the 

agency did not do so for fiscal years 2002 through 2005. 

Overall, less than one-fourth of all applications for competitive HCOP 

grants were funded; minority-serving institutions submitted about 

25 percent of the applications and received about 30 percent of the 

competitive grants. For fiscal years 2002 through 2005, HRSA reviewed a 

total of 439 applications for competitive HCOP grants and awarded 99 

grants. The number of HCOP grants awarded on a competitive basis 

ranged from a low of 10 (for fiscal year 2003) to a high of 34 (for fiscal year 

2005). HRSA awarded the fewest competitive grants for fiscal year 2003 

because that year the agency distributed almost 90 percent of available 

funds to continue funding existing HCOP grant projects on a 

noncompetitive basis. HCOP grantees consisted primarily of 

postsecondary educational institutions, such as community colleges, 

medical schools, and state university systems. Of the 30 grants awarded to 

minority-serving institutions for fiscal years 2002 through 2005, grants to 

historically black colleges and universities were the most numerous (18), 

followed by grants to Hispanic-serving institutions (10) and tribal colleges

and universities (2). 

In commenting on a draft of this report, HRSA stated that the report met 

the goals of describing the award process and outlining the number and 

characteristics of HCOP applicants and grantees.

First authorized in 1971,14 the program currently known as HCOP was last 

reauthorized in 1998.15 The Secretary of Health and Human Services is 

authorized to make HCOP grants “for the purpose of assisting individuals 

Background 

 14This program was authorized as Health Manpower Education Initiative Awards. See

Comprehensive Health Manpower Training Act of 1971, Pub. L. No. 92-157, § 774(b), 85 

Stat. 446–448 (1971). 

15Health Professions Education Partnerships Act of 1998, Pub. L. No. 105-392, 112 Stat. 

3534-3536 (1998) (codified, as amended, at 42 U.S.C §293c). The 1998 reauthorization 

resulted in the grouping of the more than 40 health professions education and training 

programs, including HCOP, in existence at the time into seven clusters. The Senate report

accompanying the reauthorization legislation stated that the purposes of the cluster that

included HCOP were to (1) provide for the training of minority and disadvantaged health 

professionals to improve health care access in underserved areas, (2) improve 

representation in the health professions, and (3) provide administrative flexibility and 

simplification. See S. Rep. No. 105-220, at 2 (1998). See also “Related GAO Products” at the 

end of this report.

Page 5 GAO-07-137 Health Careers Opportunity Program 
from disadvantaged backgrounds . . . to undertake education to enter a 

health profession.”16 A wide range of entities are eligible to receive HCOP 

grants, including, for example, schools of medicine, dentistry, and 

pharmacy; schools with graduate programs in behavioral and mental 

health; programs to train physician assistants; and other public or private 

nonprofit health or educational entities.17 HCOP grant funds may be used 

for a variety of activities, such as recruiting individuals from 

disadvantaged backgrounds interested in health careers; facilitating their

entry into health professions schools; providing counseling, mentoring, 

and other support activities designed to assist them to complete this 

education; providing information on financial aid; and providing 

experience in primary health care settings. 

The 1998 reauthorization of HCOP emphasized the importance of outreach 

activities by adding a funding preference for HCOP applications for 

projects that “involve a comprehensive approach by several public or 

private nonprofit health or educational entities to establish, enhance and 

expand educational programs that will result in the development of a 

competitive applicant pool of individuals from disadvantaged backgrounds 

who desire to pursue health professions careers.”18 Applications qualifying

for this funding preference have an advantage because they must be 

considered for funding ahead of applications that do not. 

Projects supported by HCOP grants focus on individuals from 

disadvantaged backgrounds, and Congress has recognized that such 

individuals may be members of minority groups. The Public Health Service 

Act directs the Secretary of Health and Human Services “to the extent 

practicable, [to] ensure that services and activities [funded by HCOP] are 

adequately allocated among the various racial and ethnic populations who 

are from disadvantaged backgrounds.”19 Section 739 of the Public Health 

 1642 U.S.C. § 293c(a)(1). These provisions also authorize the Secretary of Health and

Human Services to enter into contracts with eligible entities. A HRSA official responsible 

for administering HCOP informed us that, for fiscal years 2002 through 2005, the agency

entered into such contracts for administrative and logistical services, such as arranging

meetings for HCOP project directors. 

17Schools of nursing are not eligible for HCOP grants; nursing education programs are 

supported under title VIII of the Public Health Service Act. 

18See Health Professions Education Partnerships Act of 1998, Pub. L. No. 105-392, title I, 

§ 739(b), 112 Stat. 3534–3536 (1998)(codified, as amended, at 42 U.S.C. § 293c(b)). 

1942 U.S.C. § 293c(c). 

Page 6 GAO-07-137 Health Careers Opportunity Program 
Service Act does not specify any particular populations or methods that 

HRSA must use to ensure this allocation, leaving these decisions to the 

agency’s discretion. According to HRSA officials, in the 1990s, the agency 

allocated additional points to the scores of applications from historically 

black colleges and universities, Hispanic-serving institutions, and tribal 

colleges and universities to improve their chances of receiving an HCOP 

grant. HRSA reported that for 1997 this practice resulted in its awarding 

eight more HCOP grants to historically black colleges and universities than 

it had awarded for the previous year.20

For fiscal years 2002 through 2005, HRSA followed a standard process to 

award HCOP grant funds, distributing the program’s available funds on a 

noncompetitive basis to continue funding existing grant projects, then 

awarding the remaining funds on a competitive basis. For competitive 

HCOP grants, HRSA published criteria and relied on the assessment of 

independent reviewers. Grants were awarded in accordance with the 

applications’ rank order as determined by the independent reviewers. 

The amount of HCOP funds HRSA distributed each year on a 

noncompetitive basis to continue funding existing grant projects 

determined the amount that remained available for competitive grants and,

consequently, the number of competitive grants HRSA awarded. For fiscal 

years 2002 through 2005, the amounts HRSA made available for HCOP 

grants from its annual appropriations remained relatively stable, with an 

average of about $34 million a year over the 4 fiscal years. Before making 

competitive awards, HRSA distributed funds each year on a 

noncompetitive basis to support existing HCOP grant projects in their 

second or subsequent years.21 These noncompetitive continuation awards 

were subject to HRSA officials’ approval after the agency reviewed each

HRSA Followed a 

Standard Process to 

Award HCOP Grants 

HRSA Funded Existing 

HCOP Projects Before 

Awarding Competitive 

Grants 

 20U.S. Department of Health and Human Services, Health Resources and Services

Administration, Fiscal Year 1999 Justification of Estimates for Appropriations

Committees, vol. 1, Budget (Washington, D.C.). The Federal Register notifications 

describing the factors to be considered in awarding HCOP grants for fiscal years 1996 

through 1998 did not specify that additional points would be allocated to minority-serving 

institutions, and the HRSA official responsible for administering HCOP informed us that 

additional points were not allocated to applications from these institutions after fiscal year 

1998. 

21For fiscal years 2002 through 2005, HRSA authorized project periods of 3 years for HCOP. 

For fiscal year 2001, HRSA authorized project periods of up to 5 years. 

Page 7 GAO-07-137 Health Careers Opportunity Program 
grantee’s annual progress report. Once the noncompetitive continuation 

awards were made, HRSA awarded the remaining HCOP funds on a 

competitive basis, including new grants to entities that did not have an 

HCOP grant for a particular project and competitive continuation grants to

entities that applied for continued funding after the end of their authorized 

HCOP grant period. As shown in figure 1, the amounts distributed on a 

noncompetitive basis to continue funding existing grant projects varied, 

from a low of $18 million for fiscal year 2005 to a high of $30 million for 

fiscal year 2003, and the remaining funds awarded as competitive grants 

ranged from a low of $4 million for fiscal year 2003 to a high of $15 million 

for fiscal year 2005. 

Figure 1: Funds Awarded through the Health Careers Opportunity Program as 

Noncompetitive Continuations and Competitive Grants, Fiscal Years 2002–05 

0

5

10

15

20

25

30

35

Competitive grants (new and competitive continuation grants)

Noncompetitive continuations of existing grant projects

2002 2003 2004 2005

Fiscal year

Source: GAO analysis of HRSA data. 

Dollars in millions

10

23

4

30

11

23

15

18

Page 8 GAO-07-137 Health Careers Opportunity Program 
For each of fiscal years 2002 through 2005, HRSA published a notification 

of upcoming grant opportunities, including those for HCOP grants. This 

notification provided an overview of the HCOP program, including the 

entities eligible to receive HCOP grants and a description of the funding 

preference for projects with a comprehensive approach. For detailed 

review criteria, the annual notification referred prospective HCOP 

applicants to the HCOP program guidance available on request or, for 

fiscal year 2005, through HRSA’s Web site.22

HRSA’s Process for 

Awarding Competitive 

Grants Was Based on 

Published Criteria 

The review criteria HRSA published in its HCOP program guidance 

addressed different aspects of a successful HCOP project. Each criterion 

carried a specified number of potential points, for a maximum total score 

of 100. For some criteria, the point values differed according to whether 

the application was for a new grant or a competitive continuation grant.23

This difference reflected the fact that applications for competitive 

continuation grants were required to include a summary of the grantee’s 

management of its previous HCOP grant project and of progress toward 

meeting its objectives. For all applications for competitive grants—both 

new and competitive continuations—HRSA assigned the greatest number 

of potential points to the criterion that addressed plans to implement the 

HCOP activities authorized in the Public Health Service Act. Table 1 

summarizes the criteria used by reviewers to assess HCOP applications for 

fiscal year 2005.24

 22For fiscal years 2002 through 2004, these notifications, called “HRSA Preview,” were

published in the Federal Register along with announcements for other HRSA grant

opportunities. For fiscal year 2005, HRSA published a notice in the Federal Register that 

referred interested parties to the HRSA Preview available through the HRSA Web site. See

69 Fed. Reg. 61026 (Oct. 14, 2004). 

23Competitive grants consisted of both new grants to entities that did not have an HCOP 

grant for a particular project and competitive continuation grants to entities that applied 

for funding after the end of a previously authorized HCOP project period. 

24HRSA made minor revisions to the format and terminology of the published HCOP review

criteria each year, but they remained substantially similar for fiscal years 2002 through 

2005. For example, the fiscal year 2005 criterion titled “Resources and Capabilities” was 

called “Institutional Commitment” in the guidance from 2002 through 2004, although it 

required essentially the same documentation for all years.

Page 9 GAO-07-137 Health Careers Opportunity Program 
Table 1: Review Criteria for HCOP Applications, Fiscal Year 2005 

Weight in points

Criterion

Competitive 

continuation New

Response: An effective, well-delineated plan for carrying out the HCOP program activities

authorized by the Public Health Service Act;a

 identifying the targeted health disciplines; and 

providing measurable objectives linked to sections within the application’s methodology, 

evaluation, and budget sections. 35 50

Evaluative measures: A progress summary showing successful management of a previous 

grant and meeting of its objectives. 20 Not applicable

Cultural competence development: Clearly defined goals and objectives for teaching cultural 

competence, with activities appropriate to each educational level.b

15 10

Need: Well-established need for the project, supported by data on the targeted health disciplines 

and health professions workforce needs in the geographic area and on the academic and social 

needs of the individuals participating in proposed HCOP activities. 10 10

Support requested: A cost-effective, reasonable budget consistent with the project’s objectives 

and activities. 10 10

Resources and capabilities: A demonstrated commitment to disadvantaged students, 

underserved communities, or both, with experience using institutional resources and activities to 

develop, train, and strengthen the academic performance of disadvantaged students at all 

educational levels, including health professional schools. A well-delineated plan to meet the 

needs of underserved communities in the area. 5 15

Impact: A clearly designed plan to disseminate and implement HCOP project results to the 

regional or national education and health professions communities. 5 5

Source: U.S. Department of Health and Human Services, Health Resources and Services Administration, Health Careers Opportunity 

Program (HCOP): New Competition, Program Guidance, Fiscal Year 2005, HRSA 05-098 (Rockville, Md.: Oct. 28, 2004). 

Note: Reviewers did not approve for funding or assign scores to applications they determined were 

not responsive to these criteria. 

a

HRSA’s guidance for this criterion required that applications address all of the following HCOP 

activities listed in the Public Health Service Act: (1) identifying and recruiting individuals from 

disadvantaged backgrounds; (2) facilitating their entry into health professions education; (3) providing 

counseling, mentoring, and support services; (4) providing preparatory education and health research 

training; (5) disseminating information on financial aid; (6) supporting programs that provide 

experience in primary care settings; and (7) conducting activities to develop a competitive health 

professions applicant pool through community partnerships. In addition to the activities that all 

applications had to address in this criterion, the Public Health Service Act authorized grantees to use 

HCOP funds to pay for stipends or scholarships for health professions programs—subject to the 

approval of the Secretary of Health and Human Services, 42 U.S.C. § 293c(a)(2). The program 

guidance for fiscal year 2005 stated that grantees could provide stipends, with justification and 

approval by the Secretary, but that grantees could not use funding to pay for scholarships. 

b

For purposes of the HCOP program, HRSA defines cultural competence as the skills required to 

provide effective clinical care to patients from diverse racial or ethnic groups. 

Page 10 GAO-07-137 Health Careers Opportunity Program 
The HCOP program guidance also included information on how to apply 

for, and receive, the funding preference for projects involving a 

comprehensive approach. To receive the funding preference, applicants 

were required to meet all four of the following statutory requirements: 

• Demonstrate a commitment to a comprehensive approach through formal 

signed agreements that specify common objectives and establish 

partnerships with institutions of higher education, school districts, and 

other community-based entities. 

• Enter into formal signed agreements reflecting the coordination of 

educational activities and support services and the consolidation of 

resources within a specific area. 

• Design activities that establish a competitive health professions applicant 

pool of individuals from disadvantaged backgrounds by focusing on both 

academic and social preparation for health careers. 

• Describe educational activities that focus on developing a culturally 

competent health care workforce to serve needy populations in the 

geographic area.25

HRSA’s HCOP program guidance for fiscal years 2002 through 2005 

specified that, to receive the funding preference, copies of formal 

agreements between applicants and community-based partners must be 

included with the application. 

For fiscal years 2002 through 2005, HRSA’s standard process for awarding 

competitive HCOP grants relied on independent reviewers to assess 

applications against the agency’s published review criteria. HRSA officials 

generally limited their own review of applications for competitive HCOP 

grants to screening for applicant eligibility and compliance with technical 

requirements such as format and length. 

HRSA’s Process for 

Awarding Competitive 

Grants Relied on 

Assessment by 

Independent Reviewers 

 25U.S. Department of Health and Human Services, Health Resources and Services

Administration, Health Careers Opportunity Program (HCOP): New Competition, 

Program Guidance, Fiscal Year 2005, HRSA 05-098 (Rockville, Md.: Oct. 28, 2004); 42

U.S.C. 

§ 293c(b). 

Page 11 GAO-07-137 Health Careers Opportunity Program 
After determining which applications met basic eligibility requirements, 

HRSA officials forwarded all eligible HCOP applications to the agency’s 

Division of Independent Review to arrange for assessment and scoring.26

To assess HCOP applications, the division selected reviewers with healthrelated educational, counseling, academic, or project management 

experience who were not employed by HRSA and who were free from 

conflicts of interest, including employment or consulting arrangements 

with any entity that was applying for an HCOP grant for that fiscal year.27

The division sent each reviewer about eight applications to read in 

advance, then convened multiple panels in which reviewers met to discuss 

the merits of those applications. The reviewers were instructed to apply 

the published HCOP review criteria and reach consensus within each

panel on their funding recommendations. The reviewers did not 

recommend for approval those applications they determined were not 

responsive to the review criteria. For each application recommended for 

approval, the reviewers assigned a score and determined whether the 

application qualified for the funding preference. The reviewers also had 

the opportunity to comment on applications’ proposed budgets and to 

recommend adjustments for reasonableness.28

After the independent reviewers completed their assessments, HRSA 

officials used a statistical method to standardize the results from all HCOP 

review panels for a given year into a single ranked list, placing all 

applications receiving the funding preference ahead as a group, from 

 26HRSA’s Division of Independent Review selected independent reviewers and organized 

reviews of applications for competitive grants for HRSA-administered grant programs.

Division officials briefed reviewers on the review process and sent reviewers a manual with 

detailed instructions on their responsibilities, along with the applications they were 

assigned to read. The division then convened panels of reviewers and facilitated their 

discussions. 

27The Division of Independent Review obtained a conflict-of-interest certification from each 

reviewer. Reviewers needed to be free from biases and to certify that they did not have a

conflict of interest, including employment or consulting arrangements, with an entity 

applying for an HCOP grant during that fiscal year. According to the Director of the

Division of Independent Review, employment information supplied by potential reviewers

was compared to applicant organization entities to identify obviously excludable reviewer 

candidates. Otherwise, the division accepted the conflict-of-interest certifications at face 

value unless the prospective reviewers declared either a potential conflict of interest or the 

potential perception of a conflict of interest. In such cases, the division determined 

whether to disqualify the prospective reviewers after contacting them directly and 

discussing the nature of the potential conflict. 

28For each application, the reviewers also prepared a summary statement of its strengths 

and weaknesses.

Page 12 GAO-07-137 Health Careers Opportunity Program 
highest to lowest score, followed by applications without the funding 

preference, from highest to lowest score. HRSA officials used this rankorder list as their basis for recommending which applications should 

receive grants for a given fiscal year and the amount of each award. The 

HRSA officials’ recommendations were included in memorandums to the 

HRSA Administrator, who made the final award decisions for fiscal years

2002 through 2005.29 Figure 2 provides an overview of the process for 

awarding competitive HCOP grants. 

 29For fiscal years 2002 through 2005, the HRSA Administrator’s award decisions were 

consistent with these recommendations. 

Page 13 GAO-07-137 Health Careers Opportunity Program 
Figure 2: Process for Awarding Competitive HCOP Grants 

a

HRSA has discretion to award grants to applications out of rank order for documented policy 

reasons, such as ensuring geographic distribution, targeting high-priority health professions, or

allocating HCOP services and activities among disadvantaged minority populations. 

When awarding HCOP grants, HRSA had the discretion to consider 

additional factors, such as geographic diversity, targeted health

professions, and the allocation of HCOP-funded services and activities 

among minority populations who are disadvantaged. According to a HRSA 

Source: GAO and HRSA.

HRSA determines if applications meet basic eligibility requirements

Applicant

notified

If not eligible

If approved 

and scored

If eligible

HRSA notifies

grantees of awards

If funded

Applicants submit applications

If not approved

and not scored

Applicant

notified

Independent reviewers assess applications against published criteria to:

 ● Determine whether to approve applications for funding and assign

 approved applications a score (0 to 100 points)

 ● Determine if approved and scored applications qualify for 

 funding preference

HRSA creates ranked list and decides

which applications to fund:

 ● Combines results from independent 

 review into single list ranked by 

 preference and then score

 ● Allocates funding available for 

 competitive grants to highest-ranked

 applications or uses agency discretiona

If not funded

Applicant

notified

Page 14 GAO-07-137 Health Careers Opportunity Program 
official responsible for administering the HCOP program, the agency could 

have used this discretion to depart from the rank-order list resulting from 

the independent review process but did not do so for fiscal years 2002

through 2005. This official said that 80 percent of HCOP program 

participants in fiscal year 2004 came from disadvantaged minority groups, 

regardless of the entity that received the HCOP grants, and that HRSA had 

concluded that no divergence from the rank-order list was required since 

the allocation of HCOP-funded activities among minority populations was 

consistent with the Public Health Service Act.30 For fiscal year 2004, 

however, HRSA reduced all competitive HCOP grant budgets by 

10 percent—an action that enabled the agency to fund five additional 

grants, including three at historically black colleges and universities that 

would not otherwise have been funded. 

For fiscal years 2002 through 2005, HRSA reviewed a total of 439 

applications for competitive HCOP grants and awarded 99 HCOP grants.31

The number of competitive HCOP grants awarded depended on the 

availability of funds each year, and HRSA was unable to fund many highscoring applications that received the funding preference. Over the 4 fiscal 

years, minority-serving institutions submitted 25 percent of the 

applications for competitive HCOP grants and received 30 percent of the 

awards. 

Both the number of applications and the number of competitive grants 

awarded varied from year to year (see table 2).32 Overall, for fiscal years 

2002 through 2005, applications for new HCOP grants outnumbered 

applications for competitive continuations by nearly three to one, but 

applications for new grants received about the same number of awards as 

applications for competitive continuation grants.

Applications from 

Minority-Serving 

Institutions Generally 

Received Grants in 

Greater Proportion 

Than All Applications 

Number of Competitive 

Grants Awarded Depended 

on Availability of Funds 

 30The Public Health Service Act’s provision requiring that HCOP services and activities be 

adequately allocated among racial and ethnic populations from disadvantaged backgrounds 

refers to populations served by grantees and not to the grantee institutions. See 42 U.S.C.

§ 293c(c). 

31The total number of applications included only those that passed HRSA’s initial screening 

and were sent to the independent reviewers.

32For information on the number of applications and grants by location, see app. II. 

Page 15 GAO-07-137 Health Careers Opportunity Program 
Table 2: Number of Applications for Competitive HCOP Grants and Competitive 

Grants Awarded, Fiscal Years 2002–05 

Applications for competitive grants Competitive grants awarded

Fiscal 

year Total New

Competitive 

continuations Total New

Competitive 

continuations

2002 107 77 30 31 18 13

2003 93 84 9 10 7 3

2004 116 91 25 24 12 12

2005 123 78 45 34 15 19

Total 439 330 109 99 52 47

Source: GAO analysis of HRSA data. 

The number of competitive grants awarded in a given year depended more 

on the availability of funds for competitive HCOP grants than on the 

applications’ scores. Each year, the score of the lowest-scoring application 

receiving a grant differed little from the score of the next application on 

the list, which did not receive a grant. While all applications that received

grants for fiscal years 2002 through 2005 qualified for the funding 

preference for comprehensive projects, the preference did not guarantee

that an application would be funded. In some years, applications that 

received the funding preference and scored in the 80s (out of 100 possible 

points) were not funded. As shown in figure 3, the majority of applications

that were approved for funding by the independent reviewers received the 

funding preference, but not all were funded. 

Page 16 GAO-07-137 Health Careers Opportunity Program 
Figure 3: Scores and Funding Preference for Competitive HCOP Applications and Grants, Fiscal Years 2002–05 

Source: GAO analysis of HRSA data.

Applications not scored

Applications scored, without funding preference

Applications scored, with funding preference

0

20

40

60

80

100

120

140

31 applications

funded, with 

scores ranging 

from 93 through 80

10 applications

funded, with 

scores ranging 

from 94 through 87

24 applications

funded, with 

scores ranging 

from 94 through 83

34 applications

funded, with 

scores ranging 

from 98 through 89

Number of applications

2002 2003 2004 2005

Year

Note: Reviewers did not approve for funding or score applications that they determined were not 

responsive to the review criteria for HCOP applications. 

About One-Third of 

Competitive HCOP Grants 

Were Awarded to MinorityServing Institutions 

For fiscal years 2002 through 2005, minority-serving institutions submitted 

a total of 25 percent of all applications for competitive HCOP grants and 

received about 30 percent of awards.33 Although minority-serving 

institutions received awards in greater proportion than their 

representation among all applications for HCOP grants over the 4 fiscal

years, the proportions varied from year to year. For fiscal years 2002, 2004, 

and 2005, minority-serving institutions were represented among grantees 

in the same, or in greater, proportion than they were among applications, 

 33The designation of a minority-serving institution applies only to institutions of higher

education that may be eligible for federal funding under title III or title V of the Higher

Education Act of 1965, as amended. 

Page 17 GAO-07-137 Health Careers Opportunity Program 
submitting 25–28 percent of applications and receiving 25–35 percent of 

grants. Fiscal year 2003 stands out because of the smaller number of 

competitive grants awarded; that year, 10 competitive HCOP grants were 

awarded, 1 of which was awarded to a minority-serving institution (see 

table 3). The smaller number of competitive grants was mainly due to the 

relatively high number of noncompetitive continuation grants that 

received funding for that fiscal year. 

Table 3: Applications and Awards for Competitive HCOP Grants, by MinorityServing Status, Fiscal Years 2002–05 

Applications Awards 

Total

Number 

from 

minorityserving

institutions

Percentage

from 

minorityserving

institutions Total

Number to 

minorityserving

institutions

Percentage

to minorityserving

institutions

2002 107 30 28 31 11 35

2003 93 20 22 10 1 10

2004 116 29 25 24 6 25

2005 123 32 26 34 12 35

Total 439 111 25 99 30 30

Source: GAO analysis of HRSA data. 

Note: Total applications and total awards include entities other than institutions of higher education, 

such as health care providers, to which formal designation as a minority-serving institution does not 

apply. For grant competitions for fiscal years 2002 through 2005, such entities submitted less than 

25 percent of all applications and received less than 12 percent of all competitive awards for any one 

fiscal year. 

Among minority-serving institutions, historically black colleges and 

universities submitted the most applications and received the most 

awards, followed by Hispanic-serving institutions (see table 4). 

Page 18 GAO-07-137 Health Careers Opportunity Program 
Table 4: Numbers of HCOP Applications from, and Competitive Awards to, Designated Minority-Serving Institutions, Fiscal 

Years 2002–05

Historically black 

colleges and universities 

Hispanic-serving

institutions

Tribal colleges and

universities 

Native Hawaiian– and Alaska 

Native–serving institutions

Applications Awards Applications Awards Applications Awards Applications Awards

2002 17 6 10 4 3 1 0 0

2003 11 1 7 0 2 0 0 0

2004 21 5 6 0 2 1 0 0

2005 18 6 11 6 2 0 1 0

Total 67 18 34 10 9 2 1 0

Source: GAO analysis of HRSA data. 

Some entities submitted more than one application over the 4 fiscal years 

of our review, and a given entity may have received more than one grant.

For example, an entity may have applied for an HCOP grant for fiscal year 

2002 and failed to receive a grant, then tried again in subsequent years. A 

new fiscal year 2002 grantee would have had to apply for a competitive 

continuation grant for fiscal year 2005 after the end of its 3-year project 

period. It is also possible for the same entity to have had more than one 

HCOP grant at the same time, provided that each grant had a distinct 

purpose and budget. 

In written comments on a draft of this report (see app. III), HRSA stated 

that the report met the goals of describing the award process and outlining 

the number and characteristics of HCOP applicants and grantees. HRSA 

suggested that, due to the small number of grantees, the summary of 

findings on our Highlights page present the numbers, rather than 

percentages, of minority institutions that were awarded grants between 

2005 and 2006. For the summary, we believe it is appropriate to use 

percentages to convey that applications from minority-serving institutions 

generally received grants in greater proportion than all applications. As 

noted in the draft report, the percentages we present are for the 4-year 

period of fiscal years 2002 through 2005. HRSA provided two other 

comments suggesting revisions to clarify our discussion, which we 

generally incorporated. In addition, HRSA provided technical comments 

which we incorporated as appropriate. 

Agency Comments 

Page 19 GAO-07-137 Health Careers Opportunity Program 
We are sending copies of this report to the Administrator of HRSA and 

appropriate congressional committees. We will also provide copies to 

others upon request. In addition, the report is available at no charge on the 

GAO Web site at http://www.gao.gov. 

If you or your staff members have any questions about this report, please 

contact me at (312) 220-7600 or aronovitzl@gao.gov. Contact points for our 

Offices of Congressional Relations and Public Affairs may be found on the 

last page of this report. GAO staff who made major contributions to this 

report are listed in appendix IV. 

Leslie G. Aronovitz 

Director, Health Care 

Page 20 GAO-07-137 Health Careers Opportunity Program 
Appendix I: Identification of Minority-Serving 

Institutions 

Page 21 GAO-07-137 Health Careers Opportunity Program 

Appendix I: Identification of Minority-Serving 

Institutions 

We determined whether Health Careers Opportunity Program (HCOP) 

applicants and grantees were minority-serving institutions by using 

statutory definitions, lists of institutions that fall under these statutory 

definitions, and data from the Department of Education. The term 

“minority-serving institution” refers to an accredited institution of higher 

education eligible for federal support under title III or title V of the Higher 

Education Act of 1965;1

 this support is administered by the Department of 

Education. These institutions include historically black colleges and 

universities, American Indian tribally controlled (or tribal) colleges and 

universities, Hispanic-serving institutions, Native Hawaiian–serving 

institutions, and Alaska Native–serving institutions.2

For our review, we defined historically black colleges and universities and

tribal colleges and universities as institutions that met certain statutory 

definitions for institutions eligible to receive federal support under title III 

of the Higher Education Act of 1965.3

 To identify an HCOP applicant or 

grantee as a historically black college or university, we compared a list of

historically black colleges and universities published by the White House 

Initiative on Historically Black Colleges and Universities4

 with the data we 

obtained from the Health Resources and Services Administration (HRSA) 

on HCOP grant applicants and recipients. To identify HCOP applicants and 

grantees that were designated as a tribal college or university, we 

compared a list published by the White House Initiative on Tribal Colleges

 1

Higher Education Act of 1965, Pub. L. No. 89-329, title III, §§ 301–305 et seq., 79 Stat. 1229–

1231 (1965), as amended (codified, as amended, at 20 U.S.C. §§ 1051 et seq.); Pub. L. No. 89-

329, title V, §§ 501–528, 79 Stat. 1254–1260 (1965), as amended (codified, as amended, at 20

U.S.C. §§ 1101 et seq.). For the remainder of this appendix, we will refer to the U.S. Code

when referencing provisions of the Higher Education Act of 1965. 

2

We included only educational institutions in our counts of applications from, and HCOP

grants to, minority-serving institutions. We did not categorize applications from other 

entities, such as area health education centers (academic-community partnerships that

train health care providers in rural or underserved areas), even if they served a minority 

population. Consequently, the non-minority-serving institution categories of HCOP 

grantees include institutions of higher education as well as entities that are not colleges or 

universities, which do not fall under the definition of minority-serving institutions as used

in this report. 

3

20 U.S.C. §§ 1059c, 1061. 

4

U.S. Department of Education, “List of HBCUs—White House Initiative on Historically 

Black Colleges and Universities,” http://www.ed.gov/about/inits/list/whhbcu/edlite-list.html 

(downloaded November 21, 2005). This list represents entities that met certain criteria for 

Historically Black Colleges and Universities, regardless of whether the institutions had or 

were currently receiving federal funding under title III of the Higher Education Act of 1965. 
Appendix I: Identification of Minority-Serving 

Institutions 

and Universities5 with the data we obtained from HRSA on HCOP grant 

applicants and recipients. 

Hispanic-serving institutions, Native Hawaiian–serving institutions, and 

Alaska Native–serving institutions are eligible for federal funding under 

title III or title V of the Higher Education Act of 1965.6

 Unlike historically 

black colleges and universities and tribal colleges and universities, 

however, eligibility of these institutions for funding is based on the 

percentage of enrolled minority students.7

 As a result, the number of 

institutions that qualify as Hispanic-serving institutions, Native Hawaiian–

serving institutions, and Alaska Native–serving institutions can vary from 

year to year. For our review, we defined Hispanic-serving institutions as 

those that received grants through the Developing Hispanic-Serving 

Institutions Program under title V of the Higher Education Act of 19658

 for 

fiscal years 2002 through 2005. That is, we determined an institution’s 

status as a Hispanic-serving institution for a particular fiscal year on the 

basis of whether the institution had a title V grant that year. To identify 

HCOP applicants and grantees that were Hispanic-serving institutions at 

the time of our review, we obtained lists of title V grantees for the 

Developing Hispanic-Serving Institutions Program from the Department of 

Education’s Web site for fiscal years 1999 through 2005.9

 We cross-checked

the title V grantee lists with the membership of the Hispanic Association of 

Colleges and Universities10 and with lists of schools with significant 

 5

U.S. Department of Education, “White House Initiative on Tribal Colleges and Universities: 

Tribal Colleges and Universities Address List,” 

http://www.ed.gov/about/inits/list/whtc/edlite-tclist.html (downloaded Nov. 30, 2005). This 

list represents entities that met certain criteria for tribal colleges and universities, 

regardless of whether the institutions had or were currently receiving federal funding

under title III of the Higher Education Act of 1965. 

6

20 U.S.C. §§ 1051 et seq.; 20 U.S.C. §§ 1101 et seq. 

7

For example, title V of the Higher Education Act of 1965, as amended, defines a “Hispanicserving institution” as an institution of higher education that has an enrollment of full-timeequivalent undergraduate students consisting of at least 25 percent Hispanic students, and 

provides assurances that not less than 50 percent of its Hispanic students are low-income 

(at or below 150 percent of the federal poverty level). 20 U.S.C. § 1101a. 

8

20 U.S.C. §§ 1101 et seq. 

9

Department of Education, “Developing Hispanic-Serving Institutions Program—Title V,” 

http://www.ed.gov/programs/idueshsi/awards.html (downloaded Mar. 28, 2006). 

10Hispanic Association of Colleges and Universities, “HACU Member Hispanic-Serving 

Institutions,” 

http://www.hacu.net/assnfe/CompanyDirectory.asp?STYLE=2&COMPANY_TYPE=1,5&SEA

RCH_TYPE=0 (downloaded Apr. 28, 2006). 

Page 22 GAO-07-137 Health Careers Opportunity Program 
Appendix I: Identification of Minority-Serving 

Institutions 

Hispanic enrollment from the Department of Education’s Office of Civil 

Rights.11 We compared these lists with the data we obtained from HRSA on 

HCOP grant applicants and recipients. In addition, we counted all HCOP 

applicants and grantees located in Puerto Rico as Hispanic-serving 

institutions. Because not all institutions that could be eligible for grants 

under title V of the Higher Education Act of 1965 apply for or receive title 

V grants, our counts of Hispanic-serving institutions at a given time are 

likely to be conservative. Likewise, we defined Native Hawaiian–serving 

institutions and Alaska Native–serving institutions as those that were 

eligible to receive grants under title III of the Higher Education Act of 

196512 and that received such grants for fiscal years 2002 through 2005. 

As noted above, the exact number of entities designated as minorityserving institutions may vary from year to year. While we were able to 

classify the HCOP applicants and grantees for fiscal years 2002 through 

2005, table 5 summarizes the different minority-serving institution 

designations and provides approximate counts for fiscal year 2005, the 

most recent year for which total counts were available. 

 11Department of Education, Office of Civil Rights, “United States Department of Education 

Accredited Postsecondary Minority Institutions: Institutions with High Hispanic 

Enrollment,” http://www.ed.gov/about/offices/list/ocr/edlite-minorityinst-list-hisp-tab.html 

(downloaded Mar. 28, 2006).

1220 U.S.C. § 1059d. 

Page 23 GAO-07-137 Health Careers Opportunity Program 
Appendix I: Identification of Minority-Serving 

Institutions 

Table 5: Minority-Serving Institution Designations, Criteria, and Approximate Number as of Fiscal Year 2005 

Designation Designation criteria

Approximate number

as of fiscal year 2005

Historically black colleges and universities Defined under title III of the Higher Education Act of 1965 as

“any [accredited] historically Black college or university that 

was established prior to 1964, whose principal mission was,

and is, the education of Black Americans.”a

104

Tribal colleges and universities Defined under title III of the Higher Education Act of 1965 as an 

accredited institution of higher education that is formally 

controlled, or has been formally sanctioned or chartered, by the 

governing body of an Indian tribe.b

 

35

Hispanic-serving institutions Defined under title V of the Higher Education Act of 1965 as an 

accredited institution of higher education with at least a 

25 percent full-time-equivalent undergraduate enrollment of 

Hispanic students, of whom at least 50 percent must be low 

income (at or below 150 percent of the federal poverty level).c

179

Native Hawaiian–serving institutions Defined under title III of the Higher Education Act of 1965 as an 

accredited institution of higher education with a student body

consisting of at least 10 percent Native Hawaiian students.d

9

Alaska Native–serving institutions Defined under title III of the Higher Education Act as an 

accredited institution of higher education with a student body

consisting of at least of 20 percent Alaska Native students.e

10

Source: GAO, HRSA, the Department of Education, the White House Initiative on Historically Black Colleges and Universities, the

White House Initiative on Tribal Colleges and Universities, and the Hispanic Association of Colleges and Universities. 

a

20 U.S.C. § 1061. 

b

20 U.S.C. § 1059c; 25 U.S.C. § 1801(a)(4). 

c

20 U.S.C. § 1101a. 

d

20 U.S.C. § 1059d. 

e

20 U.S.C. § 1059d. 

Page 24 GAO-07-137 Health Careers Opportunity Program 
Appendix II: HCOP Competitive Applications

and Grants, by Location of Grant Applicant,

Fiscal Years 2002 through 2005

Page 25 GAO-07-137 Health Careers Opportunity Program 

Table 6 shows, by location, applications and awards for competitive HCOP 

grants for fiscal years 2002 through 2005. The numbers represent 

applications, rather than individual applicant entities. An entity may have

applied for a competitive HCOP grant more than once, and a single entity

may have had more than one HCOP grant for separate and distinct HCOP 

projects. The locations are those of the grant applicants, although 

partnerships may cross state lines and result in HCOP-funded activities 

and services in more than one state.

Table 6: Entities Applying for and Receiving Competitive HCOP Grants, by

Location, Fiscal Years 2002–05 

State or territory of grant applicant HCOP applications HCOP awards

Alabama 17 5

Alaska 2 2

American Samoa 0 0

Arizona 4 0

Arkansas 6 2

California 30 7

Colorado 3 0

Commonwealth of the Northern Mariana Islands 0 0

Connecticut 2 1

Delaware 1 0

District of Columbia 13 3

Federated States of Micronesia 0 0

Florida 20 6

Georgia 13 3

Guam 2 0

Hawaii 3 0

Idaho 0 0

Illinois 7 1

Indiana 2 0

Iowa 3 0

Kansas 2 1

Kentucky 11 2

Louisiana 9 2

Maine 1 0

Maryland 7 1

Massachusetts 17 1

Appendix II: HCOP Competitive Applications 

and Grants, by Location of Grant Applicant, 

Fiscal Years 2002 through 2005 
Appendix II: HCOP Competitive Applications

and Grants, by Location of Grant Applicant,

Fiscal Years 2002 through 2005

State or territory of grant applicant HCOP applications HCOP awards

Michigan 15 5

Minnesota 6 1

Mississippi 2 0

Missouri 4 2

Montana 5 2

Nebraska 8 1

Nevada 5 0

New Hampshire 2 0

New Jersey 8 3

New Mexico 8 2

New York 34 7

North Carolina 15 4

North Dakota 11 3

Ohio 13 5

Oklahoma 5 3

Oregon 4 3

Pennsylvania 11 3

Puerto Rico 4 0

Republic of the Marshall Islands 0 0

Republic of Palau 1 0

Rhode Island 1 0

South Carolina 12 0

South Dakota 3 0

Tennessee 10 3

Texas 42 6

United States Virgin Islands 2 2

Utah 8 2

Vermont 1 0

Virginia 4 1

Washington 9 1

West Virginia 2 1

Wisconsin 9 2

Wyoming 0 0

Total 439 99

Source: GAO analysis of HRSA data. 

Page 26 GAO-07-137 Health Careers Opportunity Program 
Appendix III: Comments from the Health 

Resources and Services Administration 

Page 27 GAO-07-137 Health Careers Opportunity Program 

Appendix III: Comments from the Health 

Resources and Services Administration 
Appendix III: Comments from the Health 

Resources and Services Administration 

Page 28 GAO-07-137 Health Careers Opportunity Program 
Appendix IV: Contact and Acknowledgments 

Page 29 GAO-07-137 Health Careers Opportunity Program 

Appendix IV: Contact and Acknowledgments 

GAO Contact Leslie G. Aronovitz at (312) 220-7600 or aronovitzl@gao.gov 

In addition to the contact named above, Kim Yamane, Assistant Director; 

Matt Byer; Ellen W. Chu; Karlin Richardson; Suzanne Rubins; and 

Hemi Tewarson made key contributions to this report. 

Acknowledgments 
Related GAO Products 

Page 30 GAO-07-137 Health Careers Opportunity Program 

Related GAO Products 

Health Professions Education Programs: Action Still Needed to Measure 

Impact. GAO-06-55. Washington, D.C.: February 28, 2006. 

Low-Income and Minority-Serving Institutions: Department of 

Education Could Improve its Monitoring and Assistance. GAO-04-961. 

Washington, D.C.: September 21, 2004. 

Health Professions Education: Clarifying the Role of Title VII and VIII 

Programs Could Improve Accountability. GAO/T-HEHS-97-117. 

Washington, D.C.: April 25, 1997. 

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