Monthly Archives: May 2017

FQHCs, Reproductive Health/Family Planning Services, and Planned Parenthood: An Uneasy but Symbiotic Relationship, Centered on Title X Funding

We often write about Federally Qualified Health Centers (FQHCs), in part because we often work for them in part because FQHCs illustrate many challenges facing other nonprofits. This post discusses a service that FQHCs could provide but mostly choose not to—a common circumstance among certain classes of nonprofits, like foster family agencies and substance abuse treatment providers.

To understand the dilemma, you have to know that the Health Resources & Services Administration (HRSA) funds FQHCs under Section 330 of the Public Health Services Act and FQHCs are sometime referred to as “Section 330 providers.” While FQHCs do collect copays and most take insurance, a large chunk of their funding comes directly and indirectly (via Medicaid) from the feds. FQHCs are mandated to provide “integrated full life-cycle care” (HRSA-lingo here), including reproductive health/family planning services. Still, many of our FQHC clients are skittish about promoting these services and are consequently reluctant to seek other grants to support family planning.

Thus, FQHCs have effectively ceded the huge pot of Title X family planning grants ($288 billion in 2016) to specialized family planning clinics, which are mostly but not exclusively operated by local affiliates of Planned Parenthood. While Planned Parenthood provides great women’s reproductive and related preventative health care, with an emphasis on low-income women and girls, unlike FQHCs, their clinics do not provide full life-cycle care.

From what we can tell, FQHCs and Planned Parenthood clinics seem to operate in a symbiotic, but parallel manner, in which both stay out of each other’s turf (if you have even more specialized knowledge about this situation, feel free to leave a comment). There are about 650 Planned Parenthood clinics, which serve about 2.5 million women annually with family planning services (this does not include abortions). In contrast, there are about 1,400 FQHCs, which serve about 17 million patients annually, and these numbers are growing rapidly due to the expansion of Medicaid under the ACA. More than 50% of FQHC patients are women, so let’s call it 9 million. FQHCs serve many more women than Planned Parenthood, but readers would never know this from the media.

While I don’t know this for sure, one presumes this is because, bureaucratically speaking, there are at least two parts to Planned Parenthood that are structured separately: the family planning side, which is touted by progressives, and the abortion side, which is demonized by some conservatives. The nascent FY ’18 federal budget battle between the Trump administration/Republicans and Democrats is being fought partially over Title X funding. The media usually obfuscates the Tile X grant aspect, focussing instead on the much more sensational issue of Planned Parenthood funding.

I assume that, if Congress passed legislation making Planned Parenthood ineligible for Title X (unlikely but possible), other providers, like FQHCs, would start applying for Title X grants. In other words, no matter what happens, as far as I know, there are no proposed cuts to Title X (again, if you have specialized knowledge, leave a comment). It’s just a question of which agencies will provide Title X funded services and how those agencies will link with Planned Parenthood, which presumably would continue as the nation’s main abortion provider.

I know the potential competition between FQHCs and Planned Parenthood clinics is a big issue for Planned Parenthood, as Title X provides more or guaranteed funding to keep the lights on—a concern for all nonprofits. This basic issue was confirmed by several interesting pieces I found and that the Alan Guttmacher Institute published (it’s more or less the research affiliate of Planned Parenthood).* For example, this article makes the curious argument that FQHCs couldn’t expand to provide family planning service now being provided by Planned Parenthood:

FQHCs are an integral part of the publicly funded family planning effort in the United States, but it is unrealistic to expect these sites to serve the millions of women who currently rely on Planned Parenthood health centers for high-quality contraceptive care.

As a grant writer, I admire the carefully crafted but entirely specious reasoning, which reminds me of our needs assessments, I’m pretty confident that FQHCs would have no trouble picking up the slack and the Title X grants—if they wanted to. We have some FQHC clients with over 40,000 patients, and at that size they can begin to resemble something larger than a community clinics. At the moment, they’re mostly reluctant to tangle with Planned Parenthood—but, again, they could.

And they might.

* The Guttmacher Institute is a great source, albeit one with a point of view, for studies and data relating family planning, teen pregnancy, and the like. We sometimes use their citations in writing needs assessments. If you’re curious about research organizations with a point of view, Daniel Drezner’s book The Ideas Industry is good.

“Turning NATO’s Words into Action After the Brussels Meeting”

One advantage of reading the Federal Register every day while looking for RFPs is that I also get a first look at how bureaucrats are trolling the politicians who are supposed to be the bureaucrats’ masters. In today’s Federal Register, for example, there is a notice for the “Turning NATO’s Words into Action After the Brussels Meeting” (this is not a joke and that is a real link). Given the current words of the United States Executive Branch, which I will not belabor here (you’ve either been following that news or not or are on Mars), I can’t help but think that someone is having a good time with some dark humor at the “U.S. Mission to NATO,” which is the federal agency that issued this particular RFP.

There is $100,000 available for two awards, should you want to apply. I can only wish you good luck in attempting to achieve the program’s purpose, which at this juncture seems even less achievable than many of the projects we work on. The RFP invites applicants to “submit project proposals which encourage public discussions and creative public engagements in Europe.” I can think of at least one major way to encourage “creative public engagements in Europe,” but that way starts with the House of Representatives, not with the two nonprofits that might get this funding.

Tyler Cowen’s “The Complacent Class,” 25 Years After the Rodney King Uprising and Grant Writing

Tyler Cowen’s exceptional The Complacent Class: The Self-Defeating Quest for the American Dream is another must-read for grant writers, like Sam Quinones’s Dreamland: The True Tale of America’s Opiate Epidemic. Jake and I like Cowen not only because he’s a terrific writer, but also because he often points out when “conventional wisdom” isn’t supported by data or logic.

While this is not a full book review (see Jake’s review here), I want to focus on one of Cowen’s key findings: America is by some metrics actually more segregated today than it was when I was a budding community organizer and grant writer in 1972. In describing what “segregated” means, Cowen not only cites compelling studies for racial segregation in housing, but also for education, economic, and political metrics. Anyone who lived through the recent election and has seen the startling red/blue county election map should realize that some obvious political divides exist. Still, the increasing racial and educational segregation of America most trouble me.

If I could travel backwards in time to interview my 20-year-old, idealistic self in 1972, I know that my 1972 self would believe two things about America in 2017: we’d be using flying cars powered by dilithium crystals or something exotic, and racial segregation in housing and education would be a distant memory. I was wrong on both counts. While electric cars are slowly gaining ground and articles about the coming autonomous car revolution are rampant, my 21-year-old self would have no trouble either driving or understanding most 2017 cars, which still have gasoline engines (primarily), a steering wheel, gas pedal, brake pedal, and so on.

As Cowen points out, and as we grant writers daily see in Census data, racial segregation is worse today, by some metrics, than it was in 1972, both in terms of housing and education. As Cowen says, “If we look at school systems, racial segregation is also getting worse in some ways.” Despite the perfectly rational explanations Cowen provides, I still find this almost incomprehensible. After five decades of the “War on Poverty,” endless speechifying from politicians, religious leaders, and virtue signalers on the left and right, and the racial divide is not only still here, but seems to be increasing.

Data that supports this doesn’t just come from The Complacent Class. The New York Times just published “Family by Family, How School Segregation Still Happens.” Although Jim Crow laws are long gone, the vast majority of American public school students attend highly segregated schools. For example, 73% of Los Angeles Unified School District (LAUSD) students are Latino, even though only 47% of LA residents are Latino (of any race; note this is Census lingo). Only 8.8% of LAUSD students are white, while 49.8% of LA City residents are white. It’s obvious that LA has re-segregated from both residential and school attendance perspectives. The vast majority of white LA residents, regardless of income, have simply abandoned LAUSD (or, depending on one’s point of view, LAUSD has abandoned them). Thus, no matter what ethnicity a LAUSD student is, they likely attend a very segregated school, and, unless they’re Latino, that student is going to be on the extreme narrow end of the segregation stick.

Re-segregation in America presents an interesting problem for grant writers, as we frequently must gently massage the data to fit within the prevailing notions of clients, and grant reviewers. For example, when writing a proposal for Watts or South Central LA, we still present the mythology that this area is largely African American—though it isn’t and hasn’t been for at least two decades. Even the LA Times revealed in 2015 that Watts is over 70% Latino.

We’ve also reached the 25th anniversary of the Civil Disturbances* following the acquittal of the cops involved in the Rodney King beating. I watched a Showtime documentary about this big brother to the 1965 Watts Rebellion, “Burn Motherfucker, Burn”.

In 1992, I was living in the Bay Area, but on April 29th I happened to be in Hollywood visiting a hospitalized relative. We were watching on TV in his room. When the not-guilty decision was announced, the station switched to live feeds of gathering angry crowds at the LAPD’s Parker Center Downtown, which is pretty close to the hospital. I quickly decided to “get out of Dodge” (or Hollywood in this case), as I knew what was going to happen.

I was staying in the San Fernando Valley, which was largely untouched, but as I drove to LAX the next afternoon, I could see the smoke billowing over much of the basin. To quote a prophetic James Baldwin story, it’ll be “The Fire Next Time.”

Around April 29, 1992, I first thought of leaving my public sector career as a Community Development Director to start a consulting business, as I watched LA burn. This idea eventually became Seliger + Associates in 1993. I reasoned correctly that the federal response to the unrest would be massive grant programs aimed at South Central. Since I had worked for the Cities of Lynwood and Inglewood for years, I knew many public agency managers and nonprofit executive directors in LA. Consequently, our first clients were mostly from LA, with many being in South Central. In this way, Seliger + Associates is linked to the Rodney King decision.

While the Showtime documentary is reasonably well made and should be viewed by those too young to remember 1992, I was struck by how the film maker perpetuated the same mythology about South Central and similar areas we still use in proposals to describe target areas. In reality, the disturbances extended way beyond South Central to Hollywood, Mid-Wilshire and Koreatown, none of which were even close to being majority African American. Many of the looters and arsonists were Latino. Even the area around the infamous live TV broadcast beating of the unfortunate Reginald Denny at Normandy and Florence was probably not majority African American in 1992. But this doesn’t fit the narrative of the Civil Disturbance in the documentary, just like Census data doesn’t always fit the narrative of our proposals. As we’ve written about before, grant writers, like documentarians, are at our most basic level story tellers. As Jimmy Stewart’s Ransom Stoddard is told by a newspaper editor at the end of John Ford’s classic western, The Man Who Shot Liberty Valance, “when the legend becomes fact, print the legend.”

* Note that I use “Civil Disturbance” and “Rebellion,” both capitalized, not the more descriptive term, “riots.” Avoid words like “riot” or similarly loaded terms in your grant proposals. Remember who’s going to read the proposal and use language that fits their worldview.