The HRSA Health Infrastructure Investment Program (HIIP) Illustrates Why It’s Hard to Handicap Chances of Getting a Grant

Anyone who’s been to a race track or Vegas knows that the odds of a given race or sporting event are being constantly updated by pros who seem to know how to handicap future events. Prospective clients often ask me to handicap their chances of winning a grant competition (and we’ve written before about why grant writing is not like the Olympics). Trying to handicap a particular grant competition is like trying to handicap a horse race in which you don’t know the horses, riders, or venue until after the race is completed. If grant writing was really like a horse race, you’d just pick the cutest horse or jockey with the best colors and hope for the best.*

A prospective client raised the odds issue on Friday, regarding the recently issued Health Resources and Services Administration (HRSA) Health Infrastructure Investment Program (HIIP) FOA. HIIP has $150,000,000 available, with about 175 grants up to $1,000,000, for Federally Qualified Health Centers (FQHCs). FQHCs are sometimes called “Section 330 grantees” and provide primary health care to publicly (Medicaid) and uninsured patients. HIIP is a great opportunity for FQHCs: there’s a lot of money up for grabs, the grants are large, and the money is for facility improvements (facility improvements are always hard to fund).

Not surprisingly, we’ve received a number of inquiries from FQHCs. On Friday, a FQHC CEO in rural Montana called. I learned a bit about his agency and provided a fee quote. Then he popped the question: “So, what are my chances of being funded?” As I was starting my standard reply to this standard question, he interrupted. He said he didn’t think his chances were very good, because “thousands of FQHCs would apply.”

I said that’s not true, since there aren’t that many FQHCs. We got into a bit of a tiff over this, so I double checked after the call. The Henry J. Kaiser Family Foundation says there were only 1,202 FQHCs as of 2013. I would’ve guessed closer to 1,000, but the numbers are in the same ballpark. While new FQHCs are created every year, there are likely less than 1,300 today. Thousands of FQHCs can’t apply for HIIP because not that many exist. My caller was trying to talk himself out of applying.

Let’s try estimating the likely competition.

For various reasons, not every FQHC will want to apply for a HIIP grant. Some are already happy with their current facilities, while others are undergoing leadership changes. Let’s assume that 1,000 FQHCs want to apply and that HRSA will ultimately make about 175 grants. This would mean around a 20% chance of any given application being funded, which is pretty good odds in submitting a grant proposal or buying a lotto ticket.

But, of the hypothetical 1,000 or so applicants, many will not finish their applications, so perhaps 700 applications will actually be submitted. Of these, a fair number, say 100, will be technically incorrect and will not even be scored. Now the pool is down to 600. Many of these will be poorly written, fail to demonstrate need, etc., and will not score high enough to be funded. Let’s assume that 350 – 400 score high enough to be funded.

Now the odds are close to one in two!

Still, grant handicapping is more complex than this simple analysis. Of my theoretical 400 potential grantees, some will be urban, some rural, some will serve special populations (e.g., homeless, Native Americans, etc.). Some will serve African Americans, some Hispanics and so on. Since, like all governmental funders, HRSA is a semi-political entity, the organization wants to spread the sugar. Even if the top 200 applications, based on points alone, were somehow clustered in the Northeast, applicants in other areas would still be funded.

My 400 possible grantees are actually competing against similar applicants, rather than all applicants, because not all applicants are equal in the eyes of HRSA administrators. If your FQHC is the only highly scored applicant that serves rural Native Americans, your chances of being funded could be 100%. If your FQHC serves a general population in a large city like New York or LA, you might be one of ten possible grantees in that city. HRSA will likely make multiple awards in a given big city, but not ten. Now your odds could be one in three. This particular exercise can be played ad infinitum, but it doesn’t mean much because no one outside of HRSA knows the organization’s subjective priorities in advance and because you don’t know who else is going to apply.

Not knowing who else is going to apply really counts. If four other FQHCs similar to yours operate in a given region, they may all say they’re going to apply—just to scare you, or intimidate you, or impress you, or for any number of other reasons. Will they? Maybe, maybe not. You can’t control them, and we recommend that you not be dissuaded by their rhetoric. They may claim to have juice with power players in Washington, or any number of other advantages. You don’t know and can’t know if they’re telling the truth.

My advice to all callers is the same: if your agency is eligible and you want to provide the service, you should disregard real or imagined odds and apply. The logic is similar to seeking a new job. In most cases, you don’t know the other job applicants. Most people apply for jobs they want to do in places they want to live. Say you’re a highly qualified lion tamer and there is a great job open at a circus in Seattle. You should only apply if you like rain, coffee, and tech / nerd culture. If you like sunshine, Cubano sandwiches, and salsa dancing instead, wait for a circus opening in Miami.

The same is true for HIIP: FQHCs who need facility improvements should complete technically correct and compelling proposals that are submitted on time. Worrying about the odds is an interesting but pointless enterprise.


* This is actually the way I bet at horse races, which is why I’m not much of a gambling man.

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