Tag Archives: Affordable Care Act

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.

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.

The Affordable Care Act (“Obamacare”) Is Legal — For Now — And Its Implications for Grants

Subscribers to the Seliger Funding Report (our e-mail newsletter) have seen the numerous RFPs related to the Affordable Care Act, and loyal blog readers have probably noticed our numerous posts on the issue. Unless you’ve been living in a media-free environment for the last couple of days, you’re also aware that the Supreme Court found the Act to be Constitutional. If it had not, the fate of the numerous discretionary grant programs authorized by the Act would be as uncertain as the fate of the peripheral characters in a horror movie.

But that’s not the end of the story.

It’s plausible that Mitt Romney will win in November, and it’s probable that Republicans will take the Senate, with the House a possibility; if that happens, it’s also plausible that Obamacare will be repealed, replaced, or significantly modified. Such changes would likely impact the dozens of discretionary, competitive grant programs that are larded throughout the Affordable Care Act. Even if these new grant programs are left more or less intact, many could face rescission anyway. Rescissions are rare, but certainly not impossible, and the Affordable Care Act will present a juicy target rescission-minded members of Congress.

Still, it will be more tempting to ax future spending without taking already allocated money away, and Federal grant making agencies know this. So we should see a gaggle of Affordable Care Act RFPs issued between now and November, as Federal agencies work to make sure they have as many grantees on the ground as possible, who will squawk if their grants are rescinded. Last week’s Funding Report included the Personal Responsibility Education Program; this week, DHHS released the Establishment of the Affordable Care Act’s Health Insurance Exchanges program (for which only states are eligible)—and next week we might see even more.

Making it Easy to Understand Who’s Eligible for HRSA’s School-Based Health Center Capital Program

The Affordable Care Act has made it especially hard to figure out who’s eligible for a program. This week, the “Affordable Care Act: Grants for School-Based Health Center Capital Program” is our star. The announcement says that eligible applicants must “Be a school-based health center or a sponsoring facility of a school-based health center as defined in 4101(a)(6) of the Affordable Care Act [. . .]”

Once you track that section down, however, you find this: “(6) DEFINITIONS- In this subsection, the terms ‘school-based health center’ and ‘sponsoring facility’ have the meanings given those terms in section 2110(c)(9) of the Social Security Act (42 U.S.C. 1397jj(c)(9)).” So it’s off to find the Social Security Act. Eventually you’ll find:

In general.—The term “school-based health center” means a health clinic that—

(i) is located in or near a school facility of a school district or board or of an Indian tribe or tribal organization;

(ii) is organized through school, community, and health provider relationships;

(iii) is administered by a sponsoring facility;

(iv) provides through health professionals primary health services to children in accordance with State and local law, including laws relating to licensure and certification; and

(v) satisfies such other requirements as a State may establish for the operation of such a clinic.

Note that these five subsections describe only what school-based health center means “In general.” What would a specific definition be? Notice too that the act doesn’t mention whether this program applies only to K-12 schools, or if universities count. We’re choosing to interpret Local Education Agencies (LEAs) and their subsidiaries as eligible, since IHEs aren’t mentioned and “school district” generally implies LEAs. If you have any reason to think otherwise, let us know in the comments.

This isn’t the first time we’ve investigated curious, obfuscatory eligibility requirements, and I doubt it will be the last.