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Chapter 6
Funding Your Health Center
Grant Application Overview
Securing a federal grant to fund a health center can be a
competitive and time-intensive task; it demands careful attention to
detail and a well-planned presentation of project goals and methods.
With the establishment of the President’s New Access Point
Initiative more federal dollars are available than ever before. At
the same time, those seeking FQHC status have multiplied so it is
imperative to present a solid grant application when seeking
funding. A thorough business plan and project outline along with the
demonstration of how the new center will increase primary care
access is among the most important ingredients in the grant
application. By clearly illustrating the presence of need and the
detailed methods by which the health center will increase access to
primary care, the application can gain a competitive edge. Though
there is no simple way of completing the grant process, here are
some Insider Tips for FQHC Grant Applications (from the TACHC). The
grant application itself can be found through the HRSA field office
or at: Application And for BPHC-issued advisories on the 330
application process see the PINs and PALs section below Renewing
health center applications can be just as demanding a process as
obtaining initial funding, but is accomplishable by presenting how
the CHC has addressed the needs of the community, increased access
to primary care, met the BPHC service requirements and is keeping
ahead of the changing market elements. The renewal application can
be found at:
Alternative Funding
Sources
Although federal funds offer health centers a considerable sum of
money, alternative sources of funding are still needed to help
defray the cost of providing services to underserved and uninsured
populations. CHCs already receiving the general 330 (e) Community
Health Centers funding may be eligible to receive additional 330
funds designated for special populations such as Migrant Health and
Health Care for the Homeless. Additional Government Grant Sources:
- Ryan White Comprehensive AIDS Resources Emergency Act
- Title X Family Planning Services
- WIC Program
- Maternal and Child Health Program
- Community Access Program (CAP)
Another large area of resources is non-governmental grant makers
which can include independent, community and operating foundations
or corporate and employee giving programs. Many of the funds that
come from these alternate foundations can be competitive and must be
sought out by each individual health center. Often the state PCA or
PCO can assist in locating the proper funding sources for a
particular CHC and two great web resources are:
- The Foundation Center offers resource guides that cross
reference foundations, grant recipients, and specific grant awards
by subject area and state
- Grant-Makers in Health provides information on grants specific
to health care
Obtaining Federal
Designations
Before any funding decisions can be made, FQHC applicants must
obtain the proper federal designations to make them eligible for
government grants. Securing federal designation is an advantageous
exercise because it can allow for benefits even if FQHC status is
not achieved. The following is a summary of various designations
provided by NACHC.*
Medically Underserved Area or Population: Required for those
seeking FQHC status or 330 funding. HPSA status can be used in lieu
of MUA for rural health centers.
- Apply to: Division of Shortage Designation, BPHC, HRSA in
cooperation with state PCO
- Requirements: based on composite score from four indicators
– physician-to-population ratio, infant mortality rate, % of
pop. below poverty level, % of pop. over 65 years of age. Areas
that meet these requirements and have already been designated
may not include recent shifts in population so petition for
designation where appropriate
- For more information: Contact the Division of Shortage
Designation, HRSA Field Office, State PCO or PCA. Listings of
current MUAs can be found on the HRSA website
- Health Professionals Shortage Area: Required for those who
wish to employ NHSA providers; can also be used for obtaining
Rural Health Clinic status and is important for 330 funding
criteria
- Apply to: Division of Shortage Designation, BPHC, HRSA in
cooperation with state PCO
- Requirements: a geographic HPSA is an area with a
physician-to-population ratio of 1:3500 or greater or 1:3000 in
areas of unusually high primary care need. Health care providers
must be considered to have insufficient capacity or be
inaccessible. Population HPSA is a sub-population with a ratio
of 1:3000 or greater.
- Dental: geographic Dental Health HPSA determined by 1:4500
ratio, 1:4000 in areas of high need
- Mental Health: these ratios can vary based on the method
used to determine mental health professionals, so contact the
state PCO for further assistance
- For more Information: Contact the Division of Shortage
Designation, HRSA Field Office, State PCO or PCA. Listings of
current HPSA designations can be found on the HRSA website
- Federally Qualified Health Status (FQHC): Allows prospective
Medicaid payments and cost-based Medicare reimbursement and
eligibility for Section 340B PHS Drug Pricing Program
- Apply through: HRSA field office and find guidance through
PIN/PAL documents at the BPHC site
- Requirements: 330-funded CHCs are automatically designated
as FQHC status. For those not receiving funding they can be
eligible for FQHC “look-alike” status by meeting regulatory and
statutory requirements and program expectations for CHCs
- For more information: Contact the HRSA Field Office, state
PCA or NACHC
- National Health Service Corps: status allows organizations to
hire health care professionals seeking assistance with educational
expenses through govt. loan forgiveness programs
- Apply to: HRSA Filed Office/NHSC Office
- Requirements: The Clinic must be in an HPSA, must agree to
serve Medicaid/Medicaid patients without billing them in excess
of what the programs pay, and must have a sliding-fee schedule
of discounts for people who are living below 22% of the FPL
without insurance. Many states also have supplemental state loan
repayment programs for health care provider programs so check
with the state PCO or PCA
- For more information: request a site application from your
HRSA field office
- Rural Health Clinic: Allows Medicare and Medicaid cost-based
reimbursement eligibility for public and private non-profit and
for-profit providers
- Apply through: State Health Department
- Requirements: The organization must be located in a rural,
non-urbanized area that is currently designated as an MUA or
HPSA and have a nurse, midwife, or physician assistant present
at least 50% of the time it is open for services
- For more information: Contact the State Health Licensing
Dept., State Office of Rural Health, the Field CMS Office or the
DHHS Office of Rural Health Policy
*reference and contact PCO,
HRSA, PCA for most current program information
PINs
and PALs
Policy Information Notices
(PIN) and Program Assistance Letters (PAL) are documents issued
periodically by the Bureau of Primary Health Care that outline
specific requirements, procedures and practices relating to the
establishment and operation of Federally Qualified Health Centers.
They are an excellent resource for new-starts as well as existing or
expanding health centers and often outline the precise steps needed
to create a successful FQHC. Among the most important PINs to be
aware of are:
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Scope of Project Policy: describes
the health center project by the five core elements of services,
sites, providers, target population, and service area
-
Affiliations PIN: provides guidance
on creating affiliations with other health providers in an effort
to improve access to primary care for the underserved
-
Governance PIN: describes the
implementation of governance requirements for all 330-funded
programs
-
Requirements for FY Funding for New
Access Point Grants: clearly states all the necessary steps in
pursuing funding for the establishment of a new community health
center
For a full and updated list of
all such documents issued by the BPHC, visit the website PINs PALs
PIN Archives
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