HRSA's FY2027 Health Center Competitions Were Reshuffled: $1.49 Billion, 410 Awards, December 30 and January 8 Deadlines, and a One-Year Leash for Every Challenger

A month ago we previewed HRSA's FY2027 Health Center Program Service Area Competition based on the Grants.gov forecasts as they stood then. Those forecasts showed two NOFOs, HRSA-27-006 and HRSA-27-007, posting September 18 and closing October 19. The schedule changed after that.

On September 18, HRSA posted a different notice, HRSA-27-005. Its Grants.gov deadline passed yesterday, October 19. On September 23, HRSA revised every remaining SAC forecast, and the dollar figures moved to different NOFO numbers. Here is the FY2027 SAC as of today, from the Grants.gov records:

The five notices total $1.49 billion across 410 expected awards. Compare the earlier version: the $422.4 million, 109-award figures we reported for HRSA-27-006 now belong to HRSA-27-007, and the $288.9 million, 80-award figures we reported for HRSA-27-007 now belong to HRSA-27-008. HRSA-27-006 is now the largest notice, at $461 million. If you're tracking a specific service area, confirm which NOFO its Service Area Announcement Table (SAAT) appears in. Don't rely on the number you wrote down in August.

HRSA-27-009 stands out. It has 75 awards and $49.6 million, an average of about $661,000, with a floor of $650,000. Nearly every award in that notice will be close to the minimum, which suggests small service areas. Its forecast also lists an archive date of February 7, 2027, far earlier than the others. That may be a data-entry error, so watch for a correction.

HRSA-27-005 shows what the remaining notices will likely require

Since HRSA-27-005 is the only FY2027 SAC notice published in full, it's the best guide to what HRSA-27-006 through -009 will say. SAC NOFOs in a given year are usually built from one template, though HRSA can change the later ones. Here is what the template contains.

Two possible award lengths: one year or four

The FY27 SAC "anticipates funding awards in one or four 12-month budget periods." Under HRSA-27-005, a four-year award runs April 1, 2027 to March 31, 2031, and funding requests for years two through four "cannot exceed your year one funding request." A one-year award runs April 1, 2027 to March 31, 2028.

Who gets which:

• Every new applicant gets one year. HRSA "will award all new applicants a one-year period of performance" and will conduct an operational site visit within two to four months of the start date. That includes look-alikes, which must apply as new applicants and become H80 recipients if funded.
• Incumbents with compliance conditions get one year. A competing continuation applicant with unresolved Section 330(k)(3) conditions when award decisions are made receives a one-year period.
• Incumbents with two straight one-year periods lose the award. "We will NOT issue an FY 2027 SAC award if you had two consecutive one-year periods of performance in FY 2025 and FY 2026, and you are still not compliant." If no fundable application comes in, the area is recompeted.
• Any one-year recipient must file a Compliance Achievement Plan within 120 days. Applicants attest to this on the Summary Page. Missing the deadline without good cause means HRSA "will terminate your award," citing Section 330(e)(1)(B).

The SAAT shows which service areas have an incumbent in a first or second consecutive one-year period. For a challenger, that column is the most useful information in the notice.

Funding priority points mostly go to incumbents

On top of the 100-point merit review, HRSA-27-005 offers up to 13 priority points:

• Patient Trend, 5 points: for competing continuation applicants with no active conditions, if the four-year patient trend, calculated as (2025 UDS total patients minus 2022 UDS total patients) divided by 2022, doesn't fall more than 5 percent.
• PCMH Recognition, 5 points: for competing continuation applicants with no active conditions, if one or more sites hold Patient-Centered Medical Home recognition.
• Not currently funded, 3 points: for organizations with no active Health Center Program award that propose to serve an area "in need of a new award recipient to ensure continuity of care."

A compliant incumbent with stable patient numbers and one PCMH-recognized site starts 10 points ahead. A challenger can get 3 at most. Any condition on the incumbent's award removes both of its 5-point priorities, which turns 10 points ahead into 3 points behind.

The merit criteria themselves: Need 10, Response 15, Collaboration 10, Impact 15, Capacity 15, Governance 10, Continuity of Care 15, Support Requested 10.

The patient floor and funding reductions

Applicants must propose to serve at least 75 percent of the SAAT Patient Target. Below 95 percent, the funding request is cut on a sliding scale:

• 90% to under 95%: 1.25% reduction
• 85% to under 90%: 2.5%
• 80% to under 85%: 3.75%
• 75% to under 80%: 5%
• Under 75%: not eligible

HRSA monitors progress against the target through budget period progress reports, site visits, and UDS. Proposing to serve 100 percent of the patients and then serving 70 percent is a compliance problem later.

What gets an application rejected before review

HRSA-27-005 screens out applications that miss either the Grants.gov Phase 1 deadline or the EHBs Phase 2 deadline, request more than the SAAT Total Funding for year one, or leave out Attachment 13: Health Center Program Compliance. SAC funds can't pay for construction or alteration/renovation, trailers or modular units, land or facility purchases, new paving, or an EHR without ONC certification. The salary cap is $228,000.

Policy terms in the 2026 NOFO

HRSA-27-005 is issued under 2 CFR Part 200 as HHS adopted it on October 1, 2025. It says an award "may be terminated in part or in its entirety… if an award no longer meets the program goals or agency priorities." It also includes administration priorities that prior SAC notices didn't have. HRSA says it will deprioritize organizations with "harm reduction" models and housing-first approaches. It lists "reserving benefits for eligible individuals" and "discouraging illegal immigration" among the ways it will align funding. It says it will not support "medical interventions for gender dysphoria in minors that lack a strong evidence base," and it calls for school-based health centers "that respect parental rights." Recipients "must demonstrate ongoing compliance with these priorities."

For Health Care for the Homeless (330(h)) grantees, these terms matter in the narrative. A program description built around harm reduction or housing first now goes against stated HRSA priorities. The applicant still has to meet the statutory homeless-services requirements, and the conflict between the two is the applicant's to manage. Describe outcomes, such as treatment engagement, chronic disease control, and transitions to stable housing, in evidence-based terms, and don't use labels the NOFO names as disfavored.

What incumbents should do in the next 70 days

If your service area is in HRSA-27-006 or -007, you have about ten weeks to a December 30 deadline that falls in the middle of the holidays, and the NOFO won't post until about November 30.

1. Resolve every open condition now. Conditions cost you the 10 priority points and limit you to a one-year award. If you were on one-year periods in both FY2025 and FY2026, an unresolved condition when HRSA decides means no award.
2. Calculate your 2022-to-2025 UDS patient trend today. If it is worse than −5 percent, you don't get the 5 points, and your Need and Continuity of Care narratives should explain why.
3. Get PCMH recognition at one site if you don't have it. Recognition only has to be in place "at the time HRSA reviews applications."
4. Draft against HRSA-27-005's structure now. The project narrative sections, the 100-point rubric, and the attachment list are already published. Waiting until November 30 leaves a holiday month to write a multi-million-dollar renewal.
5. Register both deadlines. HRSA-27-005 gave about 30 days between the Grants.gov deadline and the EHBs deadline. Expect a similar gap for the later notices, but treat the earlier deadline as the real one.

What challengers and look-alikes should consider

For a new applicant, the SAC is a one-year trial. You give up the incumbent's 10 priority points, have about 120 days to open every proposed site (with up to 180 more under a condition), and face an operational site visit within four months. The incumbent's sites don't transfer to you unless both organizations agree, and HRSA may give the outgoing grantee up to 120 days of extended funding to phase out. You would be building an operating network in a community where the incumbent is still present.

That works best in two situations:

• The incumbent is on its second consecutive one-year period (check the SAAT). If it is still noncompliant at decision time, HRSA can't fund it, and a ready, compliant challenger may be the only fundable applicant.
• You are a look-alike already serving the area. You already have sites, a sliding fee schedule, a compliant board, and UDS history. Winning converts that existing operation to H80 funding without building new infrastructure. Look-alikes can also cite collaboration with "other HRSA-supported health centers, including look-alikes" in the Collaboration criterion.

Our earlier piece on how the Service Area Competition works explains the incumbent-versus-challenger dynamics, but its dates and NOFO numbers are superseded by the table above. If your organization is trying to add sites rather than take over a service area, the August 2026 New Access Points round is the relevant comparison.

Timeline

• November 18, 2026, 5 p.m. ET: HRSA-27-005 EHBs Phase 2 deadline (Phase 1 closed Oct 19)
• About November 30: HRSA-27-006 and -007 post
• About December 9: HRSA-27-008 and -009 post
• About December 30: HRSA-27-006 and -007 due
• About January 8, 2027: HRSA-27-008 and -009 due
• April 1 / July 1 / August 1, 2027: project starts for 005 / 006–007 / 008–009

These dates come from forecasts revised on September 23, and they have changed before. Check Grants.gov opportunities 363419 through 363421 and 363777 weekly, and email bphcfunding@hrsa.gov with questions about a specific service area.

A December 30 deadline means the work happens in November. Granted can help you draft the Need, Continuity of Care, and Compliance sections against the published HRSA-27-005 rubric now.