Meeting the Health-Related Social Needs of Low-Income Persons: Funding Sources Available to States

The Accountable Health Communities initiative recently announced by the Center for Medicare & Medicaid Innovation (CMMI) holds promise for helping communities bridge the gap between health care and social services. This important work has the potential to improve health in communities by addressing food insecurity, housing instability, and other social determinants of health.  Although the CMMI initiative is focused at the local level, states themselves have the capacity and the resources to scale up local innovation for the benefit of all state residents, regardless of where they live.

States control an array of resources that can be used to provide health care and address the social determinants of health. To assist state policymakers seeking to maximize their leverage by working across state agencies to promote health, NASHP has compiled a chart of funding sources that state agencies use to address social determinants, such as stable housing, safe and prosperous neighborhoods and communities, access to healthy food, physical and mental health care, income support, and transportation. While many documents show states how Medicaid resources can be used for social services or housing needs, this chart aims to bring attention to other funding sources that states use specifically to help adult high-cost/high-need residents live healthy and prosperous lives. Is your state breaking down silos to promote health across agencies and funding streams? Please share your examples with us at aclary@nashp.org . Watch for additional NASHP resources for states on coordinating, braiding, and blending funding streams to improve health.

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State Agency/ Entity

Housing

National Housing Trust Fund (HTF) (U. S. Department of Housing and Urban Development [HUD]) State housing departments or housing finance agencies
HOME Investment Partnerships Program Block Grants (U. S. Department of Housing and Urban Development) Localities or State Housing and/or Community Development Authorities
Emergency Solutions Grants (U. S. Department of Housing and Urban Development) State housing and/or community development authorities; localities
Continuum of Care Program (U. S. Department of Housing and Urban Development) Applicants generally apply collectively by geographic area; state participants include State Housing and Finance Agencies. State and local governments and nonprofit organizations can apply.
Low Income Home Energy Assistance Program (LIHEAP) Block Grant (U. S. Department of Health and Human Services Administration for Children and Families) State housing, health and human services, community and economic development agencies
Low Income Housing Tax Credit (U. S. Department of Housing and Urban Development) State housing finance agencies
Mortgage Revenue Bonds(Issued by states and localities, subject to Internal Revenue Service requirements) State housing finance agencies

Health

Medicaid (U. S. Centers for Medicare & Medicaid Services) Medicaid agencies
Title V Maternal and Child Health Services Block Grant (U. S. Department of Health and Human Services Maternal & Child Health Bureau) State health departments
Community Mental Health Services Block Grant (U. S. Substance Abuse and Mental Health Services Administration) State health departments
Substance Abuse Prevention and Treatment Block Grant (U. S. Substance Abuse and Mental Health Services Administration) State health departments
Preventive Health and Health Services Block Grant (U. S. Centers for Disease Control and Prevention)[1] State health departments
State and Local Public Health Actions to Prevent Obesity, Diabetes, Heart Disease, and Stroke (U. S. Centers for Disease Control and Prevention) State and local health departments award
Ryan White HIV/AIDS Program (Part B) (U. S. Health Resources and Services Administration) State departments of health

Community and Economic Development

Community Development Block Grant (CDBG)(U. S. Department of Housing and Urban Development) State community and economic development agencies generally administer grants for smaller cities and counties which do not receive funds directly from HUD
Community Services Block Grant (CSBG) (U. S. Department of Health and Human Services Administration for Children and Families) State community and economic development agencies
Child Care and Development Block Grant (U. S. Department of Health and Human Services Administration for Children and Families) State human and social services agencies

Income Support and Food Security

Social Services Block Grant (SSBG)(U. S. Department of Health and Human Services Administration for Children and Families) State community and economic development agencies, and state human services agencies
Temporary Assistance for Needy Families (TANF) Block Grant (U. S. Department of Health and Human Services Administration for Children and Families) State departments of health and human services or social services
Supplemental Nutrition Assistance Program (SNAP) (U. S. Department of Agriculture Food and Nutrition Service) State departments of health and human services
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (U. S. Department of Agriculture Food and Nutrition Service) State health departments
Child and Adult Care Food Program (U. S. Department of Agriculture Food and Nutrition Service) State departments of education or departments of health or human services

Transportation

Surface Transportation Program (U. S. Department of Transportation; from the Highway Trust Fund) State Departments of Transportation

Funding Sources Not Awarded Directly to States

Federal Reserve Banks: Pay for Success Programs and Social Impact Bonds State community development, housing finance agencies, or other agencies could be involved
Hospital Community Benefit Requirements Hospitals must comply with both federal and state (if any) community benefit requirements in order to maintain their tax exemptions.
Community Development Financial Institutions (CDFIs) Can include credit unions and non-regulated private-sector financial institutions
Community Development Financial Institutions Fund (Treasury) Funds credit unions, CDFIs, and other “mission-driven financial institutions,” not states
New Markets Tax Credit Programs (Treasury; Community Development Financial Institutions [CDFI] Fund)* *Federal funds are allocated to investment groups, not states, but many states operate their own NMTC programs. State NMTC programs are administered by state finance authorities or development agencies
Population Served

Housing

National Housing Trust Fund (HTF) (U. S. Department of Housing and Urban Development [HUD]) Very low and extremely low-income households, including homeless families
HOME Investment Partnerships Program Block Grants (U. S. Department of Housing and Urban Development) Very-low and low-income people 90% of occupants of HOME-supported rental units generally must have incomes at or below 60% of area median income. (Section 92.216 of final rule)
Emergency Solutions Grants (U. S. Department of Housing and Urban Development) The homeless and those at risk of homelessness (The definition of “homeless” for different purposes is codified in statute.)
Continuum of Care Program (U. S. Department of Housing and Urban Development) Homeless individuals and families
Low Income Home Energy Assistance Program (LIHEAP) Block Grant (U. S. Department of Health and Human Services Administration for Children and Families) Low-income households, including renters
Low Income Housing Tax Credit (U. S. Department of Housing and Urban Development) Low-income households
Mortgage Revenue Bonds(Issued by states and localities, subject to Internal Revenue Service requirements) Lower-income first-time homebuyers

Health

Medicaid (U. S. Centers for Medicare & Medicaid Services) Lower income individuals
Title V Maternal and Child Health Services Block Grant (U. S. Department of Health and Human Services Maternal & Child Health Bureau) Women and children, especially those with low income
Community Mental Health Services Block Grant (U. S. Substance Abuse and Mental Health Services Administration) Adults with serious mental illness and children with serious emotional disturbances
Substance Abuse Prevention and Treatment Block Grant (U. S. Substance Abuse and Mental Health Services Administration) Pregnant women, women with dependent children, IV drug users, those in need of TB and HIV services
Preventive Health and Health Services Block Grant (U. S. Centers for Disease Control and Prevention)[1] Varies by state
State and Local Public Health Actions to Prevent Obesity, Diabetes, Heart Disease, and Stroke (U. S. Centers for Disease Control and Prevention) Population-wide
Ryan White HIV/AIDS Program (Part B) (U. S. Health Resources and Services Administration) Those testing positive for HIV; generally lower-income or uninsured people. Some states establish additional criteria.

Community and Economic Development

Community Development Block Grant (CDBG)(U. S. Department of Housing and Urban Development) Low- and moderate-income people 70% of funds go to cities and communities; 30% to states for use in smaller communities
Community Services Block Grant (CSBG) (U. S. Department of Health and Human Services Administration for Children and Families) Low-income communities
Child Care and Development Block Grant (U. S. Department of Health and Human Services Administration for Children and Families) Lower-income (income not exceeding 85% of state median) working (or attending school or training) families with children younger than age 13.

Income Support and Food Security

Social Services Block Grant   (SSBG)(U. S. Department of Health and Human Services Administration for Children and Families) At state’s discretion. The program aims to promote economic self-sufficiency
Temporary Assistance for Needy Families (TANF) Block Grant (U. S. Department of Health and Human Services Administration for Children and Families) Needy families with children
Supplemental Nutrition Assistance Program (SNAP) (U. S. Department of Agriculture Food and Nutrition Service) Low-income households
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (U. S. Department of Agriculture Food and Nutrition Service) Low-income pregnant and postpartum women, and children up to age 5 at nutritional risk
Child and Adult Care Food Program (U. S. Department of Agriculture Food and Nutrition Service) Children in day care and adults in adult day care

Transportation

Surface Transportation Program (U. S. Department of Transportation; from the Highway Trust Fund) The general public
What It Pays For

Housing

National Housing Trust Fund (HTF) (U. S. Department of Housing and Urban Development [HUD]) Primarily buying and developing affordable rental housing; some relocation costs, such as moving expenses. 10% can be used to promote homeownership.  
HOME Investment Partnerships Program Block Grants (U. S. Department of Housing and Urban Development) Tenant-based rental assistance, including rent and security deposits;Grants, loans or loan guarantees for construction or rehabilitation of rental housing, rehabilitation of owner-occupied housing, and assisting homebuyers and tenants. 60% to localities; 40% to states. (Section 92.20592.212)
Emergency Solutions Grants (U. S. Department of Housing and Urban Development) Emergency shelter, including costs associated with maintaining and operating an emergency shelter;Services associated with emergency shelter, including physical and mental health, employment, substance abuse and other services;Homelessness prevention and rapid re-housing, including rental assistance and utility and security deposits;Street outreach;Homeless Management Information Systems (HMIS)
Continuum of Care Program (U. S. Department of Housing and Urban Development) Permanent housing, transitional housing, permanent supportive housing, rapid rehousing, supportive services, outreach, homelessness prevention, and Homeless Management Information Systems.Covers property acquisition, rehabilitation, construction, leasing costs, and rental assistance (42 USC 11383).
Low Income Home Energy Assistance Program (LIHEAP) Block Grant (U. S. Department of Health and Human Services Administration for Children and Families) Home heating and cooling Weatherization: replacing or repairing furnaces or air conditioners; installing insulation; fixing leaks in doors and windowsEnergy needs resulting from a natural disaster or emergency(See the Low-Income Home Energy Assistance Act)
Low Income Housing Tax Credit (U. S. Department of Housing and Urban Development) Construction and rehabilitation of affordable rental housing that has a certain percentage of affordable units.
Mortgage Revenue Bonds(Issued by states and localities, subject to Internal Revenue Service requirements) Low-cost mortgages for first-time homebuyersThe federal government authorizes state or local governments, or their housing finance agencies, to sell Mortgage Revenue Bonds to investors. The proceeds of the sale finances mortgages to eligible homebuyers

Health

Medicaid (U. S. Centers for Medicare & Medicaid Services) For most beneficiaries, states must cover medically necessary services, including hospital, lab, physician, non-emergency medical transportation, and other services.   Services must generally be offered statewide, and adequate in amount, duration, and scope.
Title V Maternal and Child Health Services Block Grant (U. S. Department of Health and Human Services Maternal & Child Health Bureau) A wide range of health care and related activities, including preventive and primary health care services for children, some childcare services, and assistance applying for services.
Community Mental Health Services Block Grant (U. S. Substance Abuse and Mental Health Services Administration) Comprehensive community mental health services, including screening, outpatient, and emergency services
Substance Abuse Prevention and Treatment Block Grant (U. S. Substance Abuse and Mental Health Services Administration) A range of activities to prevent and treat substance abuse, including primary prevention services for those at high risk for substance abuse
Preventive Health and Health Services Block Grant (U. S. Centers for Disease Control and Prevention) A range of public health topics, including social determinants of health. The grant has funded walking trails, bicycle helmets, and water fluoridation, among other activities.The grant supports the priorities of Healthy People 2020
State and Local Public Health Actions to Prevent Obesity, Diabetes, Heart Disease, and Stroke (U. S. Centers for Disease Control and Prevention) Chronic disease prevention programs, focused in four areas: Epidemiology and surveillance; environmental strategies to promote healthy behaviors; health systems interventions, and community and clinical linkages.
Ryan White HIV/AIDS Program (Part B) (U. S. Health Resources and Services Administration) Medication to treat HIV/AIDS; medical and support services and services to support HIV/AIDS treatment

Community and Economic Development

Community Development Block Grant (CDBG)(U. S. Department of Housing and Urban Development) A variety of activities related to economic development, neighborhood revitalization, housing rehabilitation and blight prevention.At least 70% of funds must benefit low- and moderate- income people.
Community Services Block Grant (CSBG) (U. S. Department of Health and Human Services Administration for Children and Families) A range of poverty reduction and community development activities, based on community needs assessments. Examples can include emergency shelter and food programs, employment counseling, transportation programs, and activities for senior citizens and youth.
Child Care and Development Block Grant (U. S. Department of Health and Human Services Administration for Children and Families) Subsidies for child care; child care program improvements

Income Support and Food Security

Social Services Block Grant   (SSBG)(U. S. Department of Health and Human Services Administration for Children and Families) A wide range of activities in 29 service categories that promote self-sufficiency, prevent child abuse, and support “community-based care for the elderly and disabled (CRS).” Examples:·   Child care, home maintenance, home-delivered meals, health support services, family planning, employment services, adoption and foster care, transportation, services for substance abuse
Temporary Assistance for Needy Families (TANF) Block Grant (U. S. Department of Health and Human Services Administration for Children and Families) Cash assistanceWork programsChild care & transportation aid for nonworking parentsPrograms, activities, and services “reasonably calculated” to achieve TANF’s four-fold purpose, per HHS ACF:(1) provide assistance to needy families so children can be cared for in their own homes; (2) Reduce the dependency of needy parents by promoting job preparation, work and marriage; (3) Prevent and reduce the incidence of out-of-wedlock pregnancies; and (4) encourage the formation and maintenance of two-parent families.
Supplemental Nutrition Assistance Program (SNAP) (U. S. Department of Agriculture Food and Nutrition Service) Food for home preparation and consumption; seeds and plants to grow food at home
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (U. S. Department of Agriculture Food and Nutrition Service) Food, nutrition education, breastfeeding support, health and social service screening and referrals
Child and Adult Care Food Program (U. S. Department of Agriculture Food and Nutrition Service) Meals meeting nutritional guidelines served to participants meeting income requirements for free or reduced-price meals

Transportation

Surface Transportation Program (U. S. Department of Transportation; from the Highway Trust Fund) Highways, transit infrastructure, bicycle transportation and pedestrian walkways
What It Cannot Pay For

Housing

National Housing Trust Fund (HTF) (U. S. Department of Housing and Urban Development [HUD]) Transitional housing; counseling services (except for housing counseling paid for as an administrative cost); some costs for projects already underway when the HTF is implemented; (See p. 5208 of the Federal Register, Section 92.730 of the Preamble to the Interim Rule) 
HOME Investment Partnerships Program Block Grants (U. S. Department of Housing and Urban Development) Modernizing public housing, providing tenant-based rental assistance under theSection 8 program, supporting ongoing operational costs of rental housing, paying back taxes or fees on properties that are or will be assisted with HOME funds, and providing non-federal matching funds for any other federal program. (Section 92.214)
Emergency Solutions Grants (U. S. Department of Housing and Urban Development) Services unrelated to street outreach emergency shelter, homelessness prevention, rapid re-housing assistance, HMIS, and administrative activities. (See Section 576.100 of Interim Rule)
Continuum of Care Program (U. S. Department of Housing and Urban Development) Services not meeting the required criteria for reducing homelessness
Low Income Home Energy Assistance Program (LIHEAP) Block Grant (U. S. Department of Health and Human Services Administration for Children and Families) Water bills (unless used for air conditioning) or energy for other uses such as lightingPurchase of real estate
Low Income Housing Tax Credit (U. S. Department of Housing and Urban Development)
Mortgage Revenue Bonds(Issued by states and localities, subject to Internal Revenue Service requirements) Mortgages for those who are not first-time home buyers, or who earn more than the area median income (with an adjustment for large families)

Health

Medicaid (U. S. Centers for Medicare & Medicaid Services) Expenditures not allowable under federal rules.Waivers and state plan amendments can provide states with some flexibility.
Title V Maternal and Child Health Services Block Grant (U. S. Department of Health and Human Services Maternal & Child Health Bureau) Cash payments to beneficiaries; purchase of medical equipment or real estate; most inpatient services (See 42 USC 704)
Community Mental Health Services Block Grant (U. S. Substance Abuse and Mental Health Services Administration) Financial assistance to private for-profit entities
Substance Abuse Prevention and Treatment Block Grant (U. S. Substance Abuse and Mental Health Services Administration) Financial assistance to private for-profit entities
Preventive Health and Health Services Block Grant (U. S. Centers for Disease Control and Prevention)[1] Prohibited uses include inpatient care, cash payments to beneficiaries, real estate or construction, as a source of non-federal matching funds, and financial assistance to a private for-profit entity.
State and Local Public Health Actions to Prevent Obesity, Diabetes, Heart Disease, and Stroke (U. S. Centers for Disease Control and Prevention) Prohibited uses include gun control promotion, needle exchange programs, dealings with corporations with felonies or tax debts,
Ryan White HIV/AIDS Program (Part B) (U. S. Health Resources and Services Administration) Prohibited uses include real estate, construction, or cash payments to recipients of services

Community and Economic Development

Community Development Block Grant (CDBG)(U. S. Department of Housing and Urban Development) Ineligible activities generally include construction of new housing (with exceptions), some income payments, political activities, buildings to house “the general conduct of government”
Community Services Block Grant (CSBG) (U. S. Department of Health and Human Services Administration for Children and Families) Real estate or construction; political activities
Child Care and Development Block Grant (U. S. Department of Health and Human Services Administration for Children and Families) Prohibited uses include:Administrative costs exceeding 5% of a year’s allocationMost real estate purchases or constructionSectarian worship or instruction

Income Support and Food Security

Social Services Block Grant   (SSBG)(U. S. Department of Health and Human Services Administration for Children and Families) Prohibited uses include:Land or capital improvements (may be waived)Room and board (with certain exceptions)WagesMost medical care (with some exceptions for family planning, rehab/detox, and medical care provided as an “integral but subordinate component of a social service”),Social services for people in institutionsEducational services available in public schools
Temporary Assistance for Needy Families (TANF) Block Grant (U. S. Department of Health and Human Services Administration for Children and Families) TANF block grant “assistance” has some limitations, such as a prohibition on payment for medical services in most cases.However, non-assistance aid can fund a broad range of services related to TANF’s four-fold purpose
Supplemental Nutrition Assistance Program (SNAP) (U. S. Department of Agriculture Food and Nutrition Service) Hot food ready to eat (with some exceptions), alcohol, tobacco
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (U. S. Department of Agriculture Food and Nutrition Service) Food items that are not WIC-eligible
Child and Adult Care Food Program (U. S. Department of Agriculture Food and Nutrition Service) The program will not approve reimbursement to   state agencies for:Food served to someone not enrolled for adult or child careMeals not approved in the agreement or out of compliance with the approved meal pattern

Transportation

Surface Transportation Program (U. S. Department of Transportation; from the Highway Trust Fund) Some projects on non-federal, local or rural minor roads
Strings Attached

Housing

National Housing Trust Fund (HTF) (U. S. Department of Housing and Urban Development [HUD]) Cannot require tenant to accept supportive services.All HTF-assisted units will be required to have a minimum affordability period of 30 years. (See Section 93.304 of the interim rule)Aligned with the HOME Investment Partnerships program regulationsNo state match is required, although the state allocation plan must consider the availability of non-federal funding as a priority factor for determining allocations. (See Section 92.220 of the interim rule)
HOME Investment Partnerships Program Block Grants (U. S. Department of Housing and Urban Development) Most HOME grantees must match 25% of their grant with non-federal funds (Section 92.218 of Final Rule)Participating jurisdictions must reserve part of their HOME funding for Community Development Housing Organizations. (Section 92.300 of Final Rule)
Emergency Solutions Grants (U. S. Department of Housing and Urban Development) States are required to match grant funds awards above a certain threshold
Continuum of Care Program (U. S. Department of Housing and Urban Development) Grantees must match 25% of funds, except for leasing funds.Housing units acquired, built, or rehabilitated must be operated for the specified purpose for 15 years
Low Income Home Energy Assistance Program (LIHEAP) Block Grant (U. S. Department of Health and Human Services Administration for Children and Families)
Low Income Housing Tax Credit (U. S. Department of Housing and Urban Development) Credits are allocated to states, who allocate them to developers, who sell them to investors, who finance low-income housing developments
Mortgage Revenue Bonds(Issued by states and localities, subject to Internal Revenue Service requirements) There is an annual cap on the amount of bonds a state can issue

Health

Medicaid (U. S. Centers for Medicare & Medicaid Services) States pay for a portion of their Medicaid expenses. The state share varies from state to state based on per capita income and other factors.
Title V Maternal and Child Health Services Block Grant (U. S. Department of Health and Human Services Maternal & Child Health Bureau) States must match every $4 of Title V funding with at least $3 in non-federal funds
Community Mental Health Services Block Grant (U. S. Substance Abuse and Mental Health Services Administration) Grantee states must have a mental health planning councilState maintenance of effort requirement
Substance Abuse Prevention and Treatment Block Grant (U. S. Substance Abuse and Mental Health Services Administration) State maintenance of effort requirementSpecified percentages of grant funds must be used for primary prevention; early HIV intervention; administration; and a SAMHSA “set-aside” for data collection, evaluation, and TA
Preventive Health and Health Services Block Grant (U. S. Centers for Disease Control and Prevention) Maintenance of effort requirement
State and Local Public Health Actions to Prevent Obesity, Diabetes, Heart Disease, and Stroke (U. S. Centers for Disease Control and Prevention) States sub-award half of the funds to 4-8 local communities
Ryan White HIV/AIDS Program (Part B) (U. S. Health Resources and Services Administration) Some state must provide non-federal matching funds

Community and Economic Development

Community Development Block Grant (CDBG)(U. S. Department of Housing and Urban Development) States generally may not use the funds to directly undertake community development activities. States are pass-through agents that distribute funds to communities.
Community Services Block Grant (CSBG) (U. S. Department of Health and Human Services Administration for Children and Families) States must pass at least 90% of CSBG funds to local entities.
Child Care and Development Block Grant (U. S. Department of Health and Human Services Administration for Children and Families) Health and safety requirements for providersMost families contribute child care co-payments on a sliding scale.

Income Support and Food Security

Social Services Block Grant   (SSBG)(U. S. Department of Health and Human Services Administration for Children and Families) No matching requirement for states
Temporary Assistance for Needy Families (TANF) Block Grant (U. S. Department of Health and Human Services Administration for Children and Families) States contribute their own funds in a maintenance-of-effort (MOE) requirementWork requirements for some adult recipients60-month time limit for adults
Supplemental Nutrition Assistance Program (SNAP) (U. S. Department of Agriculture Food and Nutrition Service) SNAP benefits may only be used at certain retailersMost able-bodied recipients must meet work or training requirements
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (U. S. Department of Agriculture Food and Nutrition Service) States participating in the Farmers Market Nutrition Program must pay for at least 30% of the program’s administrative costs
Child and Adult Care Food Program (U. S. Department of Agriculture Food and Nutrition Service)

Transportation

Surface Transportation Program (U. S. Department of Transportation; from the Highway Trust Fund) States and localities generally pay for the 20% of a project not covered by the federal share. States and localities generally pay 10% of interstate projectsNote: states also contribute significantly to transportation funding through gas and vehicle taxes and other sources.
Accountability

Housing

National Housing Trust Fund (HTF) (U. S. Department of Housing and Urban Development [HUD]) States prepare an annual allocation plan (See Section 91.220 of the interim rule)Annual audits
HOME Investment Partnerships Program Block Grants (U. S. Department of Housing and Urban Development) To be awarded funds, submit a Consolidated Plan covering a 3- to 5-year period describing housing needs and how HOME funds will be used to meet those needs and attract non-federal funds for affordable housing.Annually, submit a performance report describing the year’s activities, progress to date, and use of funds.
Emergency Solutions Grants (U. S. Department of Housing and Urban Development) Grant recipients submit a Consolidated Plan and annual performance reports
Continuum of Care Program (U. S. Department of Housing and Urban Development) Annual Report to Congress
Low Income Home Energy Assistance Program (LIHEAP) Block Grant (U. S. Department of Health and Human Services Administration for Children and Families) Grantees report annually
Low Income Housing Tax Credit (U. S. Department of Housing and Urban Development) Tax credit documents are filed with the IRS
Mortgage Revenue Bonds(Issued by states and localities, subject to Internal Revenue Service requirements) Subject to IRS requirements

Health

Medicaid (U. S. Centers for Medicare & Medicaid Services) States report budget and expenditure data
Title V Maternal and Child Health Services Block Grant (U. S. Department of Health and Human Services Maternal & Child Health Bureau) Annual reporting on outcome and performance measures, and narrative of program impact.
Community Mental Health Services Block Grant (U. S. Substance Abuse and Mental Health Services Administration) Annual reporting; federal monitoring visits to some states
Substance Abuse Prevention and Treatment Block Grant (U. S. Substance Abuse and Mental Health Services Administration) Annual reporting, including reporting on national outcome measures
Preventive Health and Health Services Block Grant (U. S. Centers for Disease Control and Prevention)[1] Annual reporting requirements
State and Local Public Health Actions to Prevent Obesity, Diabetes, Heart Disease, and Stroke (U. S. Centers for Disease Control and Prevention) Annual reporting, including the Prevention and Public Health Fund reporting requirements
Ryan White HIV/AIDS Program (Part B) (U. S. Health Resources and Services Administration) Annual reporting requirements

Community and Economic Development

Community Development Block Grant (CDBG)(U. S. Department of Housing and Urban Development) Uses the HUD consolidated planning process. Annual action plan and a performance evaluation report detailing its progress toward the goals identified in the action plan. The evaluation report must include information on the racial, ethnic, and income status of people benefiting from the funds.
Community Services Block Grant (CSBG) (U. S. Department of Health and Human Services Administration for Children and Families) Annual state assessments; monitoring visits to some states
Child Care and Development Block Grant (U. S. Department of Health and Human Services Administration for Children and Families) States must make electronically available the results of monitoring and inspection results for child care providersQuarterly, annual, and biennial reporting requirements

Income Support and Food Security

Social Services Block Grant   (SSBG)(U. S. Department of Health and Human Services Administration for Children and Families) States submit an annual intended use plan and post-expenditure report
Temporary Assistance for Needy Families (TANF) Block Grant (U. S. Department of Health and Human Services Administration for Children and Families) ·  States submit three quarterly reports and an annual report
Supplemental Nutrition Assistance Program (SNAP) (U. S. Department of Agriculture Food and Nutrition Service) Included in annual Schedule of Expenditures of Federal Awards (SEFA)
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (U. S. Department of Agriculture Food and Nutrition Service) Annual reporting and evaluation requirements
Child and Adult Care Food Program (U. S. Department of Agriculture Food and Nutrition Service) Annual reportingUnannounced site visits at least once every three years

Funding Sources Not Awarded Directly to States

Federal Reserve Banks: Pay for Success Programs and Social Impact Bonds Based on the terms of the program
Hospital Community Benefit Requirements Annual reporting to IRS on Schedule H of Form 990 to maintain tax-exempt status
Community Development Financial Institutions (CDFIs)
Community Development Financial Institutions Fund (Treasury)
New Markets Tax Credit Programs (Treasury; Community Development Financial Institutions [CDFI] Fund)* *Federal funds are allocated to investment groups, not states, but many states operate their own NMTC programs. Community Development Entities certify their status with Treasury’s CDFI fundNMTC grantees report to IRS

[1] States spending $500,000 or more of federal awards per year must file a single audit reporting on federal programs.

Magnitude

Housing

National Housing Trust Fund (HTF) (U. S. Department of Housing and Urban Development [HUD]) HUD expects to award funds by summer 2016. HUD is required to grant each state and DC a minimum allocation.
HOME Investment Partnerships Program Block Grants (U. S. Department of Housing and Urban Development) $1 billion appropriated nationwide in FY2014, according to the Congressional Research Services (CRS).According to HUD, “HOME is the largest Federal block grant to state and local governments designed exclusively to create affordable housing for low-income households.”
Emergency Solutions Grants (U. S. Department of Housing and Urban Development) $250 million nationwide appropriated for FY2014, according to CRS
Continuum of Care Program (U. S. Department of Housing and Urban Development) Total allocation for 2014 nationwide: $1.8 billion
Low Income Home Energy Assistance Program (LIHEAP) Block Grant (U. S. Department of Health and Human Services Administration for Children and Families) $3.4 billion appropriated for the block grant nationwide in FY2014; $3.36 billion for FY2015
Low Income Housing Tax Credit (U. S. Department of Housing and Urban Development) It gives the equivalent of $8 billion in tax credits annually. According to HUD, “The Low-Income Housing Tax Credit (LIHTC) is the most important resource for creating affordable housing in the United States today.”
Mortgage Revenue Bonds(Issued by states and localities, subject to Internal Revenue Service requirements) The National Council of State Housing Agencies estimates that Mortgage Revenue Bonds make first-time homeownership possible for approximately 100,000 families each year

Health

Medicaid (U. S. Centers for Medicare & Medicaid Services) The federal government’s share of Medicaid expenditures totaled $299 billion in FY2014, according to CRS.
Title V Maternal and Child Health Services Block Grant (U. S. Department of Health and Human Services Maternal & Child Health Bureau) $630 million appropriated nationwide in FY2014, according to CRS
Community Mental Health Services Block Grant (U. S. Substance Abuse and Mental Health Services Administration) FY2014 appropriation was $480 million nationwide, per CRS
Substance Abuse Prevention and Treatment Block Grant (U. S. Substance Abuse and Mental Health Services Administration) FY2014 appropriation was $1.8 billion, per CRS. SAMHSA writes that this block grant accounts for roughly 29% of public funds spent on substance abuse services.
Preventive Health and Health Services Block Grant (U. S. Centers for Disease Control and Prevention)[1] $160 million appropriated for FY2014
State and Local Public Health Actions to Prevent Obesity, Diabetes, Heart Disease, and Stroke (U. S. Centers for Disease Control and Prevention) $33 million in new funds for 2014. Financed by the Affordable Care Act’s Prevention and Public Health Fund
Ryan White HIV/AIDS Program (Part B) (U. S. Health Resources and Services Administration) Funded at $2.32 billion as of October 2014

Community and Economic Development

Community Development Block Grant (CDBG)(U. S. Department of Housing and Urban Development) According to CRS, over $3 billion was allocated nationwide in FY 2013. In that year, the CDBG was the largest source of federal funding for community development, and the 20th largest source of federal assistance to state and local governments.
Community Services Block Grant (CSBG) (U. S. Department of Health and Human Services Administration for Children and Families) According to CRS, $709 million was appropriated for FY2014. TheFY 2015 White House budget proposed $350 million for CSBG nationwide
Child Care and Development Block Grant (U. S. Department of Health and Human Services Administration for Children and Families) $2.36 billion discretionary funding appropriation and $2.9 billion in mandatory appropriation for FY2014, per CRS.

Income Support and Food Security

Social Services Block Grant   (SSBG)(U. S. Department of Health and Human Services Administration for Children and Families) $1.57 billion appropriated for FY2014, according to CRS
Temporary Assistance for Needy Families (TANF) Block Grant (U. S. Department of Health and Human Services Administration for Children and Families) FY2014 appropriation was $17.3 billion nationwide, according to CRS
Supplemental Nutrition Assistance Program (SNAP) (U. S. Department of Agriculture Food and Nutrition Service) According to CRS, in 2014, more than 46 million individuals participated in SNAP, and the federal government spent more than $70 million on benefits nationwide
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (U. S. Department of Agriculture Food and Nutrition Service) $6.6 billion as of September 2015
Child and Adult Care Food Program (U. S. Department of Agriculture Food and Nutrition Service) $3 billion obligated for FY2014, according to CRS

Transportation

Surface Transportation Program (U. S. Department of Transportation; from the Highway Trust Fund) $10 billion appropriated nationwide in FY2014, according to CRS

Funding Sources Not Awarded Directly to States

Federal Reserve Banks: Pay for Success Programs and Social Impact Bonds Social Impact Bonds address social services or social issues. The specific project and criteria for success are outlined in the contract between parties.Government contracts with an entity to provide services, and pays the entity based on their performance. The entity raises private and philanthropic capital for operations. Investors are paid back with the entity’s pay for performance funds, if any.
Hospital Community Benefit Requirements Services and activities to support the health or safety of the communities served by the hospitals. “Community building activities” can include child care services; housing rehabilitation; the provision of housing for certain patients after discharge; construction or maintenance of parks and playgrounds; economic development activities; public health emergency readiness activities; environmental improvements, such as addressing pollution and garbage.The ACA also requires tax-exempt hospitals to conduct a community health needs assessment once every three years and plan a strategy to implement it.IRS requirements for tax-exempt hospitals describe the activities and services that satisfy the hospital community benefit requirements.Hospitals can count the uncompensated and charity care as community benefit activities.
Community Development Financial Institutions (CDFIs) Mortgage financing, bond funding and commercial loans in low-income communities
Community Development Financial Institutions Fund (Treasury) Financing for affordable housing services, economic development services, consumer credit counseling and financial education
New Markets Tax Credit Programs (Treasury; Community Development Financial Institutions [CDFI] Fund)* *Federal funds are allocated to investment groups, not states, but many states operate their own NMTC programs. Permits individual and corporate taxpayers to receive a federal income tax credit for making Qualified Equity Investments (QEIs) in qualified community development entities (CDEs).Cannot pay for things outside the scope of the Treasury programLegislation is pending to indefinitely extend the federal NMTC program.$3.5 billion in NMTCs allocated for CY2014

Note: Other CDC support is available to states and localities, often targeted at specific conditions. Such support includes state-based tobacco control programs, the National Asthma Control Program, and a number of HIV–related demonstrations.