In Selected States, 67 of 100 Health Centers Did Not Use Their HRSA Access Increases in Mental Health and Substance Abuse Services Grant Funding in Accordance With Federal Requirements

Why OIG Did This Audit

In 2017, HHS declared the opioid epidemic in the United States a public health emergency. As part of its efforts to combat the opioid crisis, the Health Resources and Services Administration (HRSA) awarded $200.5 million in Access Increases in Mental Health and Substance Abuse Services (AIMS) grants to health centers nationwide. OIG audited AIMS grant funds awarded to health centers as part of our oversight of the integrity and proper stewardship of Federal funds used to combat the opioid crisis.

Our objective was to determine whether health centers in selected States used their AIMS grant funding in accordance with Federal requirements and grant terms.

How OIG Did This Audit

Our audit covered AIMS grant funds totaling $112.9 million awarded to 665 health centers in the 30 States with the highest opioid overdose death rates in calendar year (CY) 2016. Depending on a health center's budget period, these funds could be spent during the period

September 1, 2017, through May 31, 2019. We reviewed a statistical sample of 100 health centers from the 30 States to determine whether the health centers: (1) met AIMS grant requirements for mental health and substance use disorder (SUD) service expansion and (2) claimed allowable costs.

What OIG Found

Most health centers in the 30 States did not use their AIMS grant funding in accordance with Federal requirements and grant terms. Sixty-seven of the 100 health centers in our sample did not meet mental health and SUD service expansion requirements (30), claimed unallowable costs (34), and did not properly allocate salaries and other expenditures to their AIMS grants (34). These deficiencies occurred because health centers faced issues with hiring qualified staff, and their financial management systems did not ensure that only allowable, allocable, and documented costs were charged to their AIMS grants. In addition, HRSA did not effectively monitor health centers' progress toward meeting service expansion requirements and did not ensure that health centers spent their AIMS grant funds in accordance with grant requirements.

On the basis of our sample results, we estimated that 454 of 665 health centers did not use their AIMS grant funding in accordance with Federal requirements and grant terms. We also estimated that 125 health centers did not increase the total number of mental health and SUD services patients from CY 2017 to CY 2018, and that 99 health centers did not hire new staff or increase hours of existing staff within 120 days of their AIMS grant award. As a result, patients may not have received the needed mental health or SUD services. In addition, we estimated that the health centers charged unallowable costs totaling nearly $6 million and improperly allocated costs totaling $10.9 million to their AIMS grants that could have been spent on AIMS-related purposes.

What OIG Recommends and HRSA Comments

We made a series of recommendations to HRSA, including that it improve its monitoring of how health centers meet targets for future grant funding opportunities and charge expenditures to their HRSA grants. We also recommend that HRSA require the health centers to refund unallowable and improperly allocated costs to the Federal Government.

HRSA concurred with our recommendation that it improve its monitoring, partially concurred with our other recommendations, and described actions that it has taken or plans to take to address them. We maintain that our findings and recommendations are valid.