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What Happens If You Have a Party and No Girls Show Up? HRSA’s Healthy Start Initiative (HSI) FOA Tries Again

We just finished working on proposals for HRSA’s Healthy Start Initiative (HSI); we’ve written funded HSIs before, so we’re very familiar with the program. HSI, however, just reappeared as a Valentine’s Day Present, with a new deadline of March 31 and almost $40 million available. That link goes to the RFP.

What gives?

The RFP answers:

The number of applications received. . . was much less than expected. As a result, HRSA anticipates that funds will be available to support additional applicants after completing reviews and funding decisions of applications submitted for [HSI].

HRSA didn’t get enough applications—they threw a party and no girls showed up, which is strange because HRSA is trying to give away money. We can speculate on why HRSA didn’t get enough applications, or technically correct applications, starting with: The RFP was difficult. We worked on HSI over the holidays; a lot of people probably gave up and went back to the celebrations, or turned in technically incorrect proposals.

In honor of HRSA and drinking over the holidays, we’ll offer a 10% discount to anyone who wants to apply for HSI this time around. Call us at 800.540.8906 for a free quote.

We know that programs have been re-released one after another before, though we can’t think of any examples right now. Those other ones must have taken place before we started the blog, because we can’t find any posts on this particular topic. Chalk it up to the inherent weirdness of Federal grant making. As Winston Churchill is said to have said of the Russians, “It is a a riddle wrapped in a mystery inside an enigma.”

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More RFP Looney Tunes, This Time from the Centers for Medicare & Medicaid Services Health Care Innovation Award Program

Having been a grant writer since before the flood, I should not be flummoxed by a hopelessly inept RFP. I wasn’t flummoxed by the recently completed Centers for Medicare & Medicaid Services (CMS) Health Care Innovation (HCI) Awards Round Two process, but I was impressed by the sheer madness of it.

This Funding Opportunity Announcement (FOA, which is CMS-speak for “RFP”) was exceptionally obtuse and convoluted. I should expect this from an agency that uses 140,000 treatment reimbursement codes, apparently including nine codes for injuries caused by turkeys.

The HCI FOA was 41 single-spaced pages, which is fairly svelte by federal standards—but, in addition to the usual requirements for an abstract, project narrative, budget and budget narrative, it also includes links to templates for a Financial Plan, Operational Plan, Actuarial Certification and—my personal favorite—the Executive Overview. The Financial Plan was a fiendishly complex Excel workbook, while the Operational Plan and Executive Overview were locked Word files.

Since the Word documents were locked, spell check and find/replace didn’t work in the text input boxes. Every change had to be made manually. Charmingly, the Operational Plan template had no place to insert the applicant’s name or contact info. So when the file is printed for review, which I’m sure it will be, and gets dropped on the floor with several other proposals, which is possible, there’ll be no way to tell which Operational Plan is which.

This could be a problem in an Operational Plan.

My vote for the most fabulously miss-titled form is the “Executive Overview.” Remember: a one-page abstract was also required, so an Executive Overview seemed redundant until I realized it was 13 single-spaced pages, with tons of inscrutable drop-down menus and fixed-length text input boxes. It seems that CMS is confused as to the meaning of “overview.”

The Executive Overview was really another project narrative, disguised as a form. If one double-spaced the Executive Overview, it would be about 26 pages long. Although the FOA nominally allowed a 50-page project narrative, the length of the project narrative was effectively much shorter because of convoluted instructions that required the project narrative file to include other documents. Our project narrative ended up at 35 double-spaced pages—not all that much longer than the so-called Executive Overview.

This FOA also included four “innovation categories” that were obtuse and mostly interchangeable. The FOA required that the selected innovation category be listed four times, once in the abstract, twice in the project narrative and again in the Overview. Since the categories were confusing at best, our client changed their selection a couple of times during the drafting process, which meant it had to be changed in four different places each time.

The grant request amount had the same problem, except that it is also included in the Financial Plan, budget narrative, cover letter and Actuarial Certification, as well as the abstract, project narrative, and Overview. So when the budget changed—which it inevitably did—each change had to occur in seven places to maintain internal consistency.

CMS, of course, never thought to link the various templates so that global changes could be made. But then again, why would they? After all, the authors of this FOA don’t write proposals and aren’t concerned with simplifying the process, which brings me back to the nine categories of turkey injury treatment. I wonder who keeps stats on turkey injuries. I would like to meet the GS-13 in charge of domestic fowl attacks at the Department of Agriculture.

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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.

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The Health Resources and Services Administration (HRSA) Finally Issues a New Access Points (NAP) FOA: $250,000,000 and 350 Grants! (Plus Some Important History)

The Health Resources and Services Administration (HRSA) just issued a Funding Opportunity Announcement (FOA, which is HRSA-speak for RFP) for the New Access Points (NAP) program. There is $250,000,000 available and 350 grants up to $650/000/year for five years! The deadline is November 17. This the first NAP FOA in over three years, and the NAP program is the best way to fund primary health care and prevention for medically indigent folks. In other words, this is a great opportunity. The real question is, where has the NAP program been for the last three years?

I have no idea why HRSA has not issued any NAP FOAs lately, but it may have something to do with the change in administrations and the extended health care reform debate. The NAP program was greatly expanded during the Bush administration, and HRSA issued NAP FOAs frequently during the early and mid years of the decade. We wrote many funded NAP grants and became very familiar with the program in the process. Then funding for NAP was either not included in HRSA appropriations or HRSA slowed down the grant making process, causing NAP to disappear beneath the waves a year or so before President Obama assumed office. But NAP funding was included in the recently passed Health Reform Act of 2010. This Act authorizes dozens of new competitive federal grant programs, as well as some old friends like NAP, and voila, HRSA issues this enormous FOA, so it seems that the NAP program is once again in favor.

For those not in the know, to be eligible for a NAP grant, the applicant has to be, or agree to set-up, a nonprofit “Health Center” under Section 330 of the Public Health Service Act (42 USCS § 254b), or, as they are termed in the trade, a Section 330 provider. Older terms that are sometimes used, like Federal Qualified Health Centers (FQHC) or FQHC Look-Alikes. Without getting too far inside baseball, the intent of such health centers is to provide access to patients who are eligible for public insurance programs, such as Medicaid, Medicare and SCHIP, or have no insurance. Although services are nominally provided on a sliding scale and no one is supposed to be turned away, Section 330 providers have to keep the doors open and, like all health care providers, they prefer patients with third party payers.

The entire Section 330/FQHC/FQHC Look-Alike system grew up to replace the chaotic but never dull “free clinic” model of the late 1960s and 1970s, which was pioneered to serve assorted hippies, druggies, runaways and other youth by the Haight Ashbury Free Clinic and LA Free Clinic. When I moved to LA in 1974, I almost went to work for the LA Free Clinic’s founding Executive Director, Lenny Somberg, who was a very interesting guy but was unfortunately killed by an intruder a few months after I met him.

While I didn’t get the job, I eventually volunteered and served on the board of the Harbor Free Clinic in San Pedro*, another one of the original free clinics. The basic idea of free clinics was to use volunteer docs and allied health professionals to provide free health care while not accepting Medicaid or any other insurance. Although some organizations retain “Free Clinic” in their name, I don’t think any still use this model, having shifted long ago to some version of the Section 330/FQHC paradigm—in other words, they are primarily Medicaid/Medicare providers and use paid medical staff.

These days, if an organization wants to provide primary health care for the uninsured, publicly insured or underinsured, they become a Section 330 provider, and a NAP grant is the organization’s ticket into the Medicaid reimbursement world. This is the first opportunity to compete for a NAP grant in three years, so start writing f you’re eligible. Who knows when the next NAP FOA will pop up in the federal trough?


*Pronounced “Peedro” by residents, not “Paydro,” and often affectionately termed, “The city where the sewer meets the sea.” I lived in Pedro for a few years and can attest to its many charms. Among other things, Pedro often turns up as a locale in movies and TV, including the most recent episode of my favorite TV show, Mad Men, “The Good News.”

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No Experience, No Problem: Why Writing a Department of Energy (DOE) Proposal Is Not Hard For A Good Grant Writer

The Stimulus Bill deluge has begun, and we’ve been getting lots of calls from for-profit companies interested in Department of Energy “Funding Opportunity Announcements” (FOA is DOE-speak for RFP). Usually the caller will say something along the lines of, “So, how many funded proposals for Dilithium Crystal research have you written?” This leads me to launch into my standard response, which is more less as follows:

We’ve never written funded proposals for this particular unusual topic—but so what? There are lots of things we haven’t written about. Looking for qualified grant writers is about the same as looking for unicorns: don’t make a hard problem insolvable by looking for a unicorn with a horn of a certain length or one that has purple spots. Be happy to find one at all. And, of course, keep in mind that most creatures you’ll find in the forest that look like unicorns are actually just ponies with party hats taped to their heads.

We’re also transparent to funding sources, so it’s not like the DOE Program Officer is going to say, “Great, another proposal from Seliger + Associates, we love these guys” (or the reverse). The funding source won’t even know we exist, so the proposal is going to rise or fall based on the believability of the applicant, the competition, the technical correctness of the proposal and the story it tells. We take care of and are experts in the last two aspects. The first one is up to the client, and the second is unknowable. To hire us, you have to be like Demi Moore responding to Patrick Swayze’s question in Ghost: “Do you believe?” If you believe we can write the proposal, hire us. Otherwise, crack your knuckles and start writing the proposal yourself.

In saying the above, which I’ve been doing endlessly for the past two months, I’m trying to get across the concept that qualified grant writers like Seliger + Associates could presumably write anything, just as journalists are trained to cover anything. When I started this business 16 years ago, my immediate background was mostly in economic development and redevelopment. I quickly decided that what the world needed was general purpose grant writing firms, and we took on any proposal writing assignment for which the client was eligible and able to afford our fees. We began writing all kinds of human services proposals about which we knew essentially nothing.

For example, in late 1993, we wrote a proposal for a small nonprofit in South Central Los Angeles for the then-new HUD version of the YouthBuild program. The NOFA was fantastically complex and disjointed, demonstrating how some things don’t change. After studying the NOFA like a Talmudist using the “pilpul” approach, I quickly discerned that it was really just another job training program and not an affordable housing program, despite being issued by HUD and being wrapped up in housing ribbons. We wrote the proposal, which was the only YouthBuild grant awarded in Southern California for that first funding cycle, even though competing applicants included the LA County Housing Authority and lots of other heavy hitters. It was probably funded because we were the only grant writers who could cobble together a compelling story in the face of the incoherent and obtuse NOFA.*

As this first YouthBuild (and eventually dozens of other proposals) were funded for a cacophony of organizations and programs, we could have proclaimed ourselves “experts” in numerous areas. No matter how many funded proposals on any particular topic we’ve churned out over the years, however, we still call ourselves generalists and never represent the company any other way. I often describe our knowledge base as being like an oil slick: a few molecules thick and very wide. Whenever someone hires us to write for a program or project concept we know nothing about—which is quite often—the slick becomes a bit wider, but not much thicker. So, while we’re pretty familiar with, say, SAMHSA or HRSA from writing endless proposals to them, we still don’t claim special knowledge about substance abuse treatment or primary health care. As we like to say, “we just write ’em.”

I am old enough to have been a busy, busy grant writer during the energy crisis of the late 1970s and actually wrote a funded proposal for the long-forgotten DOE Electric Vehicle Demonstration Grant Program and other state and federal alternative energy programs. When working as the Grants Coordinator for the City of Lynwood, I was detailed to find companies and grants to recycle the approximately 6,000,000 old tires that had been stored on about 20 acres of land in Lynwood since World War II. I put out the word that the City was looking for would-be tire recyclers and was soon inundated with lots of folks who wanted to use someone else’s money to try out their tire recycling schemes.

These ranged from the somewhat plausible, like turning the tires back into oil, to my personal favorite, turning them into margarine. I am not making this up: “Steel-belted Blue Bonnet, anyone?” None of these panned out, although I had a lot of fun flying around the country to look at prototype plants. As luck would have it, none of those prototypes were actually operating when I got there (“you should have been here yesterday!”) and all seemed to be fronted by two guys: a fast talking promoter type in white shoes and a white belt—this is the ’70s, remember—and a “scientist” with a vague German/Eastern European accent (“Vie vill take ze tires und cook zem until ze molecules crack. Zen vie vill make zem into ze margarine!”).

Flash forward to 2009. The Stimulus Bill gusher is roaring and bringing out lots of folks who want their piece of the DOE pie. Guess what? For every seemingly legit potential applicant (e.g. utility company, car battery manufacturer, etc.), I’m getting about two calls from the “white shoes and mad scientist” crowd. We’re happy to work for anyone as long as they are eligible applicants. But it helps if they also can provide us with technical content about their research design, proposed products, etc. We’re now writing a fair number of DOE proposals and, sooner or later, one or more will be funded. Will this make us “experts” at DOE grants? No: we’ll still just be general purpose grant writers, but the slick will be wider and perhaps even a nanometer (a little tech talk to get myself in the mood for DOE) or two thicker.

The real point of this post is that a good grant writer should be able to write anything, just as I was able to write the Electric Vehicle proposal in the ’70s. As Randy Jackson likes to say on American Idol, “The theory is that Mariah Carey can sing anything. You hear that expression, ‘She can sing the phone book.’ So if you can really sing, you should be able to sing anything, so we’re testing them. That’s the whole competition.” It pains me to admit it, but over the last two years I’ve finally succumbed to the many charms of Idol (or, as Jake calls it, American Idle). While I’ve yet to bring myself to vote, I finally grok the show, and it’s obvious that Randy is right. Some contestants, like this year’s Adam Lambert and Danny Gokey and last year’s winner, David Cook, really could sing the phone book, while others, like this year’s just kicked off Megan Joy or last year’s dreadlocked wonder Jason Castro, are really mediocre singers. In picking a grant writer, make sure they really can “sing the phone book, Dawg.”


* A fun anecdote: when HUD issued the YouthBuild NOFA for the next funding round the following year, the NOFA had been changed to model the proposal we had written. In other words, we had explained the YouthBuild program to HUD by writing a simple, declarative proposal in the face of extraordinary obfuscation.