Strategy 2: Leverage partnerships with intermediaries such as nonprofit organizations or foundations
State agencies may not be best-positioned to directly partner with and assist CBOs due to a variety of factors, including a lack of internal capacity, prohibitions on providing assistance or engaging with applicants in competitive grant processes, or power dynamics that can make CBOs hesitant to engage with state agencies.
What Does an Intermediary Organization Do?
Intermediary organizations (generally nonprofits or foundations) are contracted partners that administer community grant programs and support networks of CBOs. Examples of state partnerships with intermediary organizations across state health programs include accountable communities for health, regional health hubs, health equity zones, and community care hubs.
While they may operate under different names, common functions of intermediary organizations include:
- Acting as fiscal agents of the state to administer community-level grant programs
- Assuming liability and providing support for grant applications and management, compliance, reporting, and other administrative tasks
- Having additional flexibility to provide upfront resources to grantees that would otherwise need to be reimbursed at a later date under traditional contracting mechanisms
- Providing capacity-building support, learning opportunities, and networking
- Serving as trusted convener and resource within the community.
Policy Levers: Leveraging Partnerships for Added Flexibility and Support
To address some of these limitations, and better engage potential CBO grant applicants, state agencies may identify community-based third-party organization partners to help administer opioid settlement or federal opioid funding.
These contracting mechanisms may help level the playing field for under-resourced CBOs in several respects. First, many state procurement rules prevent state agencies from providing assistance to applicants that might offer an unfair advantage within competitive processes (although abatement or settlement funding is not subject to these rules). Funds allocated to CBOs as subgrantees through intermediaries may not be subject to these restrictions, which allows these organizations to provide technical assistance and support from the beginning of the grant cycle, which can include assisting with grant writing and budgeting.
Second, intermediary organizations can reduce administrative burden on CBOs by assuming liability for compliance with grant requirements, providing support for administrative functions, and providing technical assistance, networking, continuous quality improvement, and capacity-building support to help CBOs achieve program goals. Lastly, foundations or nonprofits with cash reserves may have additional flexibility to provide upfront resources to grantees for services that would otherwise be reimbursed at a later date under traditional contracting mechanisms. This can help support organizations with hiring, staffing, and planning needed to administer grants.
Specific examples include:
The Sunflower Foundation and Kansas Fights Addiction Grant Review Board partnership
Strategy in Action: Since partnership with the Kansas Fights Addiction Grant Review Board, the foundation has completed four rounds of grants with opioid settlement funding
The Foundation for a Healthy Kentucky and Kentucky Opioid Response Effort (KORE) partnership
Strategy in Action: With KORE’s funding from the Substance Abuse and Mental Health Services Administration, the foundation has supported the Funding for Recovery Equity and Expansion (FREE) program, which awards nonprofits that offer substance use services across the continuum of care.
The Mosaic Opioid Recovery Partnership – RIZE Massachusetts Foundation and the Massachusetts Department of Public Health
Strategy in Action: Through this partnership, a series of three grant rounds have been conducted or planned from 2024 through 2026 that have focused on helping organizations further develop their internal infrastructure, partnership, and resource development at the local level.
The Rhode Island Foundation and Rhode Island Executive Office of Health and Human Services partnership
Strategy in Action: Supported by settlement funding, the foundation has awarded grants in 2023 and 2024(with an upcoming grant cycle in 2025) to nonprofits pursuing projects within the categories of community prevention services, nonprofit capacity support, basics needs support (food, clothing, transportation), family support, and trauma support for individuals or families affected by opioid or substance use.
Considerations for Implementation
- Success of this strategy is often tied to the level of trust that the intermediary partner has in its community, as well as its ability to convene key partners to respond to community needs.
- Some states may have limitations on the use of settlement funds for administration purpose, which can prohibit contracting with intermediary organizations.
- Staff turnover — within state agencies and intermediary organizations — can complicate building and maintaining working relationships. State agencies can continue evaluate the “health” of the intermediary organization and its role in the community to ensure it continues to support CBO infrastructure and development