Tag Archives: HIV

“Backbone” grants for nonprofits, illustrated by the HRSA SAC and RWHAP Part C EIS programs

Human-service nonprofits face two basic challenges: keeping the lights on and providing integrated, case-managed services to meet client needs. Meeting the first challenge is obvious—if the nonprofit can’t cover basic costs like rent and salaries, the need for their services is irrelevant. The latter is trickier, since it usually takes a layer cake of grants, donations, and contracts to provide comprehensive services that really meet client needs.* To do this over the long term, it’s helpful to have at least one ongoing grant source that I’ll term a “backbone grant” for purposes of this post.

Two HRSA programs, both of which have RFPs on the street now, illustrate what backbone grants look like. In both cases, new applicants are eligible to compete with current grantees.

The Service Area Competition (SAC) provides three-year grants (often called “Section 330” or “Health Center” program grants) to Federally Qualified Health Centers (FQHCs) to provide primary health care to low-income patients. SAC grants are tagged for designated geographies called “service areas.” Hence the term “Service Area Competition or SAC;” we’ve written about the SAC grant process.

There are about 1,400 FQHCs right now, and every year a few dozen nonprofit health care providers receive a new FQHC designation, usually by receiving a New Access Point (NAP) grant. These days, FQHCs derive most of their revenue from Medicaid and other third-party payer reimbursements. Still, The Kaiser Family Foundation—a great source for health-related data—reports that Section 330 grants account for 18% of FQHC revenue. At first glance this might not seem like a lot, but imagine that your income was suddenly reduced by 18%—there goes Netflix, vacations, your rainy-day fund; you’ll be buying yoga wear at Target, not Lululemon. The same is true for FQHCs, which, like most Medicaid providers, operate on thin margins.** Thus, disaster would follow loss of Section 330 funding.

The second, Ryan White HIV/AIDS Program Part C HIV Early Intervention Services Program (RWHAP Part C EIS), provides three-year grants for outpatient primary health care and support services for low income, uninsured, and underinsured people living with HIV/AIDS (PLWH) in specified service areas. A range of nonprofit types receive RWHAP Part C EIS grants, including many FQHCs.

Not surprisingly, PLWH have very complex heath care and supportive services needs in addition to primary health care, as many also face challenges like injection drug use (IDU), other substance abuse, severe mental illness, homelessness, and so on. This makes providing case-managed integrated care to PLWH complicated and expensive. While grantees use multiple funding streams (e.g., Medicaid, other RW grants, etc.) to serve this hard-to-serve population, RWHAP Part C EIS grants are often the glue that holds the Rube Goldberg PLWH care system together. They’re the backbone grant. Without those grants, many fewer people would receive comprehensive HIV services—and they’d be more likely to transmit HIV to others.

We write many SAC and RWHAP Part C EIS proposals and know that many current grantees alternate between being indifferent and hysterical when the new funding cycle is announced. CEOs of FQHCs and similar large grantees often come to take backbone grants like these for granted (pun intended) because they’ve had the funding for years and think they’re entitled to the grant. This is a mistake.

Both programs, as well as many other similar backbone grant programs, force current grant grantees to complete with new applicants. While it’s not easy for a new applicant to “take away” a backbone grant, it can be done. We know, as we’ve helped clients do just this. We’ve also helped clients defend against new entrants to the market.

The CEO indifference towards the grant turns to hysteria when the CEO realizes the deadline is approaching and also realize they can’t receive a new backbone grant unless a technically correct and compelling proposal is submitted on time. HRSA uses peer reviewers and, from the reviewer’s point of view, applications from existing and new applicants are the same—it’s as if HRSA has never heard of the applicant, even if they’ve received the same grant for years. Victory is never final. Proposals need to meet some minimum quality threshold to be fundable. If they don’t meet that threshold, they may be rejected even if there are no other plausible providers in a given area.

The moral of this tale is twofold. If you’re a current grantee for a backbone program, don’t take your grant for granted. If you’re a new applicant, who wants to provide the service, by all means, go after the current grantee’s grant—they might stay in indifference mode and either turn in a lousy proposal or miss the deadline. It happens.


* Many grants and contracts don’t actually provide sufficient funding to do all the activities and accomplish all the goals funders require. Everyone knows this but no one talks about it. Except us.

** According to this analysis by FiveThirtyEight, state funding for colleges is down to the 8 – 20% range—which explains most of the cost of public-college tuition hikes over the last decade. For some reason, most state residents are demanding that colleges be better funded.

NIH opioid research grants are here; expect opioid treatment RFPs to come soon

In his review of Dreamland: The True Tale of America’s Opiate Epidemic” and in his post on the “New grant wave for Medication Assisted Treatment (MAT),” Isaac noted that the heroin and prescription drug addiction epidemic crisis is likely to generate new grant programs. Since then, the crisis has in some ways been getting worse, not better, especially in politically sensitive parts of the country. The federal response has so far been slower than we expected, but the NIH just released a trio of research grant RFPs focusing on “Marijuana, Prescription Opioid, or Prescription Benzodiazepine Drug Use Among Older Adults.” Those grants are under the NIH R01, R03, and R21 categories.

The only surprising thing about these RFPs is how long they’ve taken to hit the street. Every time you see a news article or watch a TV exposé about the opioid epidemic, the likelihood of federal action rises. And every time you see such an article or video, you should be thinking about how it will affect your own proposals.

For example, SAMHSA just released a new RFP for a very old program: “Targeted Capacity Expansion-HIV Program: Substance Use Disorder Treatment for Racial/Ethnic Minority Populations at High Risk for HIV/AIDS (Short Title: TCE-HIV: High Risk Populations).” Someone ought to tell SAMHSA that brevity is a virtue in program titles, but apart from that I’ll note that, if I were writing a TCE-HIV proposal, the needs assessment would be filled with data about opioid use. We have collectively known about the dangers of sharing needles for decades, but the present opioid issue gives new urgency to old problems.

Links for 8-13-08

* Imagine our surprise at seeing a client on the front page of CNN:

“AIDS in America today is a black disease,” says Phill Wilson, founder and CEO of the institute and himself HIV-positive for 20 years. “2006 CDC data tell us that about half of the just over 1 million Americans living with HIV or AIDS are black.”

We wrote a two-million dollar funded CDC Capacity Building Assistance to Improve the Delivery and Effectiveness of Human Immunodeficiency Virus (HIV) Prevention Services for Racial/Ethnic Minority Populations grant for the Black Aids Institute in 2004.

* I discussed how to attract and retain grant writers by relying on Joel Spolsky’s Joel on Software for guidance. He also wrote a short book, Smart and Gets Things Done: Joel Spolsky’s Concise Guide to Finding the Best Technical Talent on the subject. To reiterate my earlier point: although Spolsky is writing about programmers, much of what he says is equally applicable to any intellectual worker—including grant writers. Buy a copy and put it on your bookshelf next to Write Right!.

(37signals has a good article on environment and productivity echoing Spolsky’s points.)

* The L.A. Times ran an article attempting something unusual—fresh perspectives on teen pregnancy:

Teenage motherhood may actually make economic sense for poorer young women, some research suggests. For instance, long-term studies by Duke economist V. Joseph Hotz and colleagues, published in 2005, found that by age 35, former teen moms had earned more in income, paid more in taxes, were substantially less likely to live in poverty and collected less in public assistance than similarly poor women who waited until their 20s to have babies. Women who became mothers in their teens — freed from child-raising duties by their late 20s and early 30s to pursue employment while poorer women who waited to become moms were still stuck at home watching their young children — wound up paying more in taxes than they had collected in welfare.

Eight years earlier, the federally commissioned report “Kids Having Kids” also contained a similar finding, though it was buried: “Adolescent childbearers fare slightly better than later-childbearing counterparts in terms of their overall economic welfare.”

To evade the set of angry e-mails and comments likely to follow, I’ll point out that the thrust of the article isn’t that teen pregnancy is a great idea—it’s those involved, rhetorically and otherwise, in the issue might want to consider alternate viewpoints and explanations rather than go back to the usual birth control and sex ed versus abstinence debate.

“Teenage Childbearing and Its Life Cycle Consequences: Exploiting a Natural Experiment” uses a very clever method to get around the correlation-is-not-causation problem in research areas like this, and it’s one of the academic papers underlying the article. You can read it at Duke economist V. Joseph Hotz’s website (warning: .pdf link).

EDIT: In addition, compare these pieces to our later post, What to do When Research Indicates Your Approach is Unlikely to Succeed: Part I of a Case Study on the Community-Based Abstinence Education Program RFP.

* The Wall Street Journal has done excellent reporting on the housing perhaps-crisis, as Isaac mentioned previously. Now comes “Philadelphia’s Housing Woes May Provide Lesson for Lawmakers:”

One point is being missed in this squabble: No matter what Congress does, some cities will end up owning more crumbling houses as owners fail to pay taxes and do their maintenance. Taxpayers will foot the bill. The bigger question is: How can cities quickly get this property back into productive use?

For perspective on this debate, it helps to stroll through Philadelphia’s Ludlow neighborhood, about a mile north of the city center. In this neighborhood and others like it, the Philadelphia Housing Authority became one of the main property owners in the 1970s and 1980s, acquiring homes through foreclosures after owners failed to pay their mortgages or taxes.

One thing you can be sure the solution will involve: grants.

* Well-run career programs that incorporate college counseling and prep classes help low-income students according to a study cited by the New York Times. This is at least a somewhat better study than most, as the New York Times says:

To compare similar students, all those who volunteered to join a career academy at each school were randomly assigned either to participate in the academy or to serve as part of a control group outside the academy.

Nonetheless, it still suffers from the cherry-picking flaw most grant-funded programs do, and it’s encapsulated in one word: volunteered. Those who are at least smart and willing enough to seek help are be definition more likely to do better than those who don’t. Nonetheless, that the group receiving services did better still than the control group is encouraging.

* Freakonomics discusses advice to young and ludicrously rich philanthropists who don’t know much about the world:

They believed that poverty was largely a result of resource deficiencies and organizational inefficiencies: if the poor had more money and their service providers could simply manage their giving more efficiently, change would happen. None placed much emphasis on feelings of self worth, the long-term nature of behavioral change or, most important, that staying above water is itself an accomplishment for a poor household. Everyone modeled their expectations after their family business or other corporate workplaces where they saw the “bottom line” motivate people to meet certain standards of achievement.

* For those of you interested in the academic and systematic aspects of philanthropy more generally, check out the heavy hitters at Creative Capitalism, including Bill Gates, Richard Posner, Gary Becker, Clive Crook, Larry Summers, Ed Glaeser, and Gregory Clark. Alternately, if you want to wait, a book based on the discussions is supposed to be released in 2009. Conor Clarke explains why you might pay for something you can get free online.

* What’s mystery ingredient X for improving school outcomes? Marginal Revolution considers.

* More on parsing RFPs: The Partnerships for Innovation program wants you to:

1) stimulate the transformation of knowledge created by the research and education enterprise into innovations that create new wealth; build strong local, regional and national economies; and improve the national well-being; 2) broaden the participation of all types of academic institutions and all citizens in activities to meet the diverse workforce needs of the national innovation enterprise; and 3) catalyze or enhance enabling infrastructure that is necessary to foster and sustain innovation in the long-term.

That’s not easily understood and doesn’t answer the essential “what” question that an RFP should: what does the program demand that an Institute for Higher Education (IHE) do? The answer is probably “nothing,” and the National Science Foundation (NSF) probably could’ve just said, “We’re giving walking around money to universities so they can use it to fund research or donut eating. Enjoy!”

* An unintentionally funny RFP called the Sexually Transmitted Infections Cooperative Research Centers says:

The purpose of this Funding Opportunity Announcement (FOA) is to stimulate multidisciplinary, collaborative research that is focused on control and prevention of sexually transmitted infections (STIs) […]

Surely I can’t be the only one to read a certain double meaning into “stimulate” in this context, given its juxtaposition with the program title.

* Slate points to a study that found TV watching among the very young might cause or contribute to autism.