Tag Archives: ACA

Partnerships to Improve Community Health (PICH)—Riding the CDC Grant Gravy Train

Even after a hundred years as a grant writer, the feds never cease to amaze me. Last week, it was the CDC issuing a Funding Opportunity Announcement (“FOA,” which is CDC-speak for RFP) for an entirely new program: Partnerships to Improve Community Health (PICH). The program is funded through the Affordable Care Act (ACA)—or ObamaCare as it is sometimes known to its many friends.

PICH is great news: as Pink Floyd put it in Have a Cigar: “And did we tell you the name of the game, boy? We call it riding the gravy train.” This post explains the game.

The game is walkin’ around money, as we explain at the link. In this case, there’s $150,000,000 up for grabs, with max grants ranging from $1,000,000 to $4,000,000, depending on the population of the service area.

What makes PICH nearly pitch-perfect walkin’ around money is that the program funds community collaboratives that meet to essentially talk about improving health, but not actually do anything, like deliver healthcare. It’s all process and no services. This means that the grantee only has to form the collaborative, hold meetings, conduct needs assessments and develop the ever popular action plans. Since there are no services, there’s nothing to evaluate, except process objectives like the “composition” of the collaborative, number of meetings held, plans drafted, long tons of donuts consumed during meetings, and the like.

This should make most public health officers and nonprofit executive directors swoon. Get a PICH grant and you’ll definitely be riding the gravy train. And, since you’ll be the one with the gravy ladle, other organizations in your service area will be sitting on their hind legs begging for the sub-grants that are required under PICH.

For example, say you’re Executive Director or Chairwoman of the Healthy Owatonna Collaborative. To make your pitch for a PICH grant, you’ll need to gather input from, and meet the needs of, all segments of the “community.” An easy way to accomplish this is to propose involvement of population-specific or advocacy groups in the planning and implementation process.

If cyclopes are an important population in Owatonna, propose a subcontract in your proposal with the Owatonna Cyclops Improvement Association, which has its eye, so to speak, on health issues confronting cyclopses in Owatonna. The ability to pass out big subcontracts to local advocacy organizations is going to make you very popular, as lots of organizations will try to get their snouts into the PICH trough. The applicant and lead agency is the Gatekeeper to this largesse.*

An interesting aspect of PICH is applicant eligibility:

  • Government Organizations: Local public health offices, American Indian tribes or Alaskan Native villages, local housing authorities, school districts, or local transportation authorities.
  • Non-government Organizations: Nonprofits with 501(c)3 IRS status (other than institution of higher education), or nonprofits without 501(c)3 IRS status (other than institution of higher education.

Two aspects of the listed eligible organizations are curious. First, essentially every kind of non-business entity is eligible to apply for PICH, except colleges and universities, for some arcane reason. Universities are unlikely to want to improve local health, but transportation authorities are? Welcome to the odd world of federal grantmaking.

Second, nonprofits with or without 501(c)3 status are eligible. Most people’s reaction to the eligibility of nonprofit, but not tax-exempt, organizations is probably “WTF?

Let me explain.

Many community collaboratives for various purposes (e.g., health improvement, substance abuse prevention, services to homeless cyclopses, etc.) are actually unincorporated associations composed of representatives of nonprofit and public agencies, who get together once a month or so to eat donuts, drink beer (if they’re lucky), and opine on the subject of interest. In most states, however, it’s very easy to get a charter for the collaborative as a nonprofit corporation. As we’ve written about before, the hard part is not incorporating—it’s getting a 501(c3) letter of determination out of the IRS. So the CDC is encouraging informal collaboratives, which are willing to incorporate, or incorporated nonprofits, to apply. Very sweet.

Now, don’t let the fact that your agency may not actually be part of an existing health collaborative prevent you from applying. Remember, this is the proposal world, not the real world. A good grant writer should be able to create a plausible collaborative out of polka dots and moonbeams. I know we can, as we’ve written many funded proposals like PICH over the years, including an $800,000 HRSA Community Access Program (CAP) grant for a rural public health department in Illinois, a $900,000 OCS CCF-CEY capacity building grant for a youth services collaborative in Wisconsin, a $2,000,000 CDC Capacity Building grant for a national HIV/AIDs coalition serving African Americans, and a $2,000,000 CDC REACH-US grant for a collaborative in Virginia to reduce the incidence of diabetes.


* Sigouney Weaver, as Dana, was possessed by the Gatekeeper demon, while Rick Moranis as the hapless Louis was possessed by the Keymaster demon in the 1984 classic Ghostbusters, which was Jake’s favorite movie as a kid.

Health Care Innovation Awards Round Two: ObamaCare, the Gift that Keeps Giving for Grant Seekers and Writers

Another week, another huge ACA / ObamaCare RFP announced. This time it’s Health Care Innovations Awards Round Two. There’s $900,000,000 up for grabs, with grants to $25,000,000. These eye popping numbers are big enough to seize the attention of even this grizzled grant writer.

The purpose of this very attractive RFP is to:

The second round of Health Care Innovation Awards will fund applicants who propose new payment and service delivery models that have the greatest likelihood of driving health care system transformation and delivering better outcomes for Medicare, Medicaid, and CHIP beneficiaries in four Innovation Categories.

This string of policy buzz words doesn’t really say anything other than that applicants are supposed to do something that will somehow lower undefined health care costs born by public insurance programs, while at the same time magically improving undefined outcomes. This is great news for applicants because almost anything can be proposed. It’s even better news for grant writers, as we can wax eloquently in health policy mumbo jumbo while spinning grant Tales of Brave Ulysses (I used this quote before, as well, but it just seems so damn perfect here). Speaking of quotes, I’ve cited the late, lamented Senator Everett Disksen before, but it applies here too: “A billion here, a billion there, and pretty soon you’re talking about real money.” This program is another example of the talk about sequestration and budget deficits having little effect on actual federal grant funding: the grant spigot is on at ObamaCare and it’s a gusher.

Every type of applicant is eligible: nonprofits, IHEs (Institutions of Higher Education, otherwise known as “colleges or university” but in bureaucrat-speak), Indian tribes, businesses and your Aunt Martha, as individuals are eligible applicants. Think of it as another Oklahoma Land Rush of grant opportunities.

As faithful readers know, I’ve been writing grant proposals since dinosaurs walked the earth and I can’t remember another grant program that has had so much money available, so little direction, and so broad an eligible applicant pool.

If your organization or your Aunt Martha have any bright ideas on improving Medicare, Medicaid and/or CHIP service delivery and costs, you should not let this opportunity pass. The deadline is August 15, so, for a change, there’s plenty of time to plan the project concept and write the proposal. A word of caution, however: a mandatory letter of intent to apply must be submitted by June 28. LOIs are easy to draft, so you should work most di di mau on the letter to reserve your place at this incredibly tasty grant trough.

Another New Federal Grant Program Emerges: PPHF – 2013 – Cooperative Agreement to Support Navigators in Federally-facilitated and State Partnership Exchanges

Despite sequestration and budget worries, the Feds are churning out a new grant program every month or so; today, let’s consider this tasty if poorly named treat from the Centers for Medicare and Medicaid Service: “PPHF – 2013 – Cooperative Agreement to Support Navigators in Federally-facilitated and State Partnership Exchanges.” The trade name for this FOA is “Health Navigators,” and it is the first of what should be a tsunami of federal and state FOAs designed to help clueless Americans understand how to access the cornucopia of subsidies and benefits glittering like tiny jewels in the 25,000 pages (so far) of the byzantine Affordable Health Care Act (“ObamaCare”) regulations.

ObamaCare is roaring at us from the distance and is supposed to arrive at the station on January 1, 2014. Without getting too far inside baseball, the subsidies and Medicaid expansion at the heart of ObamaCare are supposed to provide health insurance for millions of uninsured Americans. These programs are structured as a series of state-run Health Insurance Exchanges. Somewhere along the way, however, only 16 states actually opted to set up their own exchanges, with the balance deciding to join the Federally-facilitated and State Partnership Exchanges.

The new Health Navigators program has $54,000,000 up for grabs for nonprofits in the 34 states without Exchanges. If you’re in a state with a proto-Exchange, like California or New York, don’t worry—they’ll issue their Health Navigator FOAs.

In the federal program, however, here’s a section that should warm the cockles of the stone-like heart of even the most jaded nonprofit Executive or, in my case, grizzled grant writer:

Section 1311(i) of the Affordable Care Act requires each Exchange to develop and implement Navigator grant programs. This funding opportunity announcement (FOA) is open to . . . serve consumers in States with an FFE or State Partnership Exchange. As health reform implementation continues, consumers will need to understand new programs, take advantage of consumer protections, and navigate the health insurance system to find the most affordable coverage that meets their needs. Exchange Navigators are intended to assist consumers in those areas.

Health Navigator grantees will be responsible for ObamaCare outreach and education to uninformed populations—which is just about anybody in America, since nobody understands it. Maybe a few health policy wonks do.

If there is any nonprofit Executive Director reading this post who doesn’t think their agency could run a Health Navigator program, call me, because you’ve missed one essential aspect of human service providers: virtually all nonprofits do some kind of outreach and education. This makes the Health Navigator program an exceptionally great opportunity, and perhaps the best in recent memory, for getting “walkin’ around money“—a grant concept we’ve written about before.

Although the Health Navigator FOA clearly presents a very attractive grant opportunity on the street, with its promise of walking around money for vaguely defined and impossible-to-measure activities (just the kind we love to write proposals about and our clients love to operate), the real reason to apply now is to be on the ground floor of this emerging class of grants. As I noted in my recent blog about another new grant program, Face Forward, it is always a good idea to apply for the first funding round of any new grant program.

In the case of the Health Navigators FOA, this general principle is even more important because ObamaCare has created an entirely new class of service delivery organizations—”Health Navigators”—which is presumably going to provide never-ending grant competitions.

This reminds me of about 20 years ago, when the HIV/AIDS crisis was in the full bloom of its first major publicity salvo and a mounting public outcry. The Feds responded with Ryan White Act grants. The agencies that originally received Ryan White and similar HIV/AIDS grants formed what we termed an “AIDS Mafia” that slurped up all the available HIV/AIDS grant funds.

If your agency was not in the local AIDS Mafia, your chances of getting grants was very low. The same thing happened about 18 years ago with HUD McKinney Act Homeless Assistance Grants (and we’ve written about the knock-on effects in “HUD’s Confusing Continuum of Care (CoC) Program Explained“). As with Ryan White, it soon became obvious that if you weren’t part of the Homeless Mafia, your agency would not be likely to get HUD homeless grants.

I think the same will be true for Health Navigator grants: if you want to get your organization’s snout into the ObamaCare trough, make sure you apply for this first Health Navigator funding round. When you get funded, your agency will instantly become an expert! In grant writing, I sometimes refer to programs like this as grant herpes: it’s the gift that keeps on giving.