Resources to Help States Fund Health-Related Social and Economic Needs

Federal funding can help states improve housing, employment, and other life conditions for their vulnerable residents. This table highlights new programs, including public-private investment opportunities from the US Treasury, integrated care models from the Center for Medicare & Medicaid Innovation, and recent federal initiatives to combat the opioid crisis. It also features key longstanding sources, such as tax-exempt hospitals’ community benefits dollars, Medicaid investments, and health promotion funds from the US Centers for Disease Control and Prevention. This table updates and complements NASHP’s chart, Meeting the Health-Related Social Needs of Low-Income Persons: Funding Sources Available to States.

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US Treasury
Initiatives
Funding Sources Agency or Entity Awarded to: Needs Addressed Notes and Sources
Social Impact Partnerships to Pay for Results Act Treasury States and localities

 

 

A goal of this act is to “facilitate the creation of public-private partnerships that bundle philanthropic or other private resources with existing public spending.”

Social benefits that could be funded include:

–  Increasing employment and earnings, increasing financial stability for a range of populations, improving birth outcomes;
– Reducing teen pregnancy and preventable diseases, such as asthma and diabetes among low-income people;
– Increasing the proportion of children living in two-parent families;
– Reducing child abuse and kids in foster
– Reducing recidivism; and
– Improving educational outcomes among vulnerable populations.

Half the funding goes to programs that benefit children

Most of the fund’s $100 million is allocated for outcomes payments, awarded to projects that are considered feasible and have an implementation plan.

A Notice of Funding Availability (NOFA) was published in the Feb. 21, 2019 Federal Register. Award announcements are expected by November 2019.

A separate NOFA for feasibility study grants for projects in the early stages is expected later in 2019.

Legislation: Title VIII of the Bipartisan Budget Act of 2018

Projects are funded for up to 10 years

Urban Institute explainer

Opportunity Zones Treasury/ Internal Revenue Service (IRS)

 

Created by the Tax Cuts and Jobs Act of Dec. 22, 2017

Private investors defer taxes on capital gains by investing in Opportunity Funds, which invest in businesses located in an Opportunity Zone.

State departments of economic development, commerce, housing development, and others can also be involved.

The “CEOs” or leaders of each state nominates census tracts to be designated as opportunity zones.

Economic development and job creation in certain low-income communities

The proposed FY 2020 White House budget prioritizes the development of affordable housing in opportunity zones.

The Kresge Foundation is partnering with two impact fund managers on Opportunity Zone investments, guided by community advisory boards that prioritize affordable housing without displacement and jobs that pay living wages.

Proposed rules on investments in qualified opportunity zones were issued in October 2018 and April 2019.

The first set of opportunity zones were designated in April 2018.

IRS FAQs, Jan. 2019

State legislation enacted to support opportunity zones is available here

This Executive Order established the White House Opportunity and Revitalization Council to support opportunity zone investment.

The National Opportunity Zones’ Ranking Report from Smart Growth America ranks designated opportunity zones on their potential to improve social equity and foster walkable communities.

Center on Budget and Policy Priorities’  blog, Potential Flaws of Opportunity Zones Loom, as Do Risks of Large-Scale Tax Avoidance

Integrated
Care Models
Funding Sources Agency or Entity Awarded to: Needs Addressed Notes and Sources
Integrated Care for Kids (InCK) Center for Medicare & Medicaid Innovation (CMMI) State Medicaid agency or lead organization Children’s health-related needs, including adverse childhood experiences NASHP Issue Hub: Resources to Help States Improve Integrated Care for Children
Maternal Opioid Misuse (MOM) model CMMI State Medicaid agencies The model will include referrals to community services, such as housing and supported employment. NASHP Issue Hub: Resources to Help States Improve Integrated Care for Children (includes MOM information)
Selected Opioid Funding Sources
(See NASHP’s Snapshot of Major Federal Opioid Funding by State, December 2018)

Funding Sources Agency or Entity Awarded to: Needs Addressed Notes and Sources
Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act US Department of Health and Urban Development (HUD) States are to distribute housing pilot funds “giving priority to entities with the greatest need and ability to deliver effective assistance in a timely manner.” Housing: The act establishes a pilot program for states to provide temporary housing (for no more than two years) to people recovering from substance use disorder (SUD). Section 8071 of the act, enacted in October 2018, authorizes funds for housing pilots to be appropriated FY 2019 through FY 2023.

Funds will be allocated according to a needs-based funding formula established by HUD.

Funds are to be treated as though they were Community Development Block grants (CDBG) funds.

Read NASHP’s blog, New Funding and Flexibility for States to Address Substance Use Disorder.

State Opioid Response (SOR) Grants Substance Abuse and Mental Health Services Administration (SAMHSA) States and territories; single-state agencies delivering substance abuse services (generally departments of health, human services, or social services)  States can use it for:

– Recovery housing
– Services to individuals who are incarcerated

 

No match required

Each state gets at least $4 million

Applications were due August 2018

Programs funded for up to two years

See NASHP’s chart of federal opioid funding by state

Pennsylvania is using SOR funds for pilot projects to help people with opioid use disorder become and remain housed.

Opioid State Targeted Response to the Opioid Crisis (STR) Grants

 

SAMHSA, created by the 21st Century Cures Act Single-state agencies based on unmet need for opioid use disorder treatment and drug poisoning deaths.

 

 

States are using it for:

– Recovery housing
– Services to individuals who are incarcerated
– Child care
– Transportation

 

Example: Colorado and Pennsylvania are using it to fund co-location pilots and bi-directional referrals for women and children.

Two-year program

Funding was awarded for Year One and Two

2017 Funding Opportunity Announcement

An FY18 supplement was available for 10 states with highest overdose rates

See NASHP chart

Hospital
Investments
Funding Sources Agency or Entity Awarded to: Needs Addressed Notes and Sources
Tax-Exempt Hospital Community Benefits Tax-exempt hospitals, pursuant to Treasury/IRS requirements Community organizations or programs.

Policies overseen by state attorneys general and/or public health agencies

A range of community health improvement services and community benefit activities, guided by the hospital’s community health needs assessment. They can include community building activities, such as housing, economic development, child care, and mentoring programs for vulnerable populations or neighborhoods. Hospitals report this information on Form 990 Schedule H. States can create reporting and investment requirements that go beyond those established by the federal government. See NASHP’s infographic How 10 States Keep the ‘Community’ in Hospitals’ Community Health Needs Assessments, and blog States Work to Hold Hospitals Accountable for Community Benefits Spending.

Sara Rosenbaum, et al., Improving Community Health through Hospital Community Benefit Spending: Charting a Path to Reform, December 2016

Robert Wood Johnson Foundation’s Community Benefit Insight tool

The Hilltop Institute, Community Benefit State Law Profiles Comparison

Hospital Certificate of Need (CoN) requirements Tax-exempt hospitals in states with a CoN requirement Community organizations or programs

Policies overseen by state attorneys general and/or public health agencies

Community health needs, often identified by the hospital’s community health needs assessment State CoN requirements are generally triggered by hospital projects and expansions, such as capital improvements.

NASHP’s State Strategies to Address Rising Prices Caused by Health Care Consolidations

Health Promotion and Disease Prevention
Funding Sources Agency or Entity Awarded to: Needs Addressed Notes and Sources
US Centers for Disease Control and Prevention (CDC) Chronic Disease Prevention and Health Promotion funding CDC State and local public health agencies CDC funding supports a range of state chronic disease and violence prevention activities, as well as condition-specific funding. CDC FY 2018 grant funding by state
Medicaid
Supports
Funding Sources Agency or Entity Awarded to: Needs Addressed Notes and Sources
Medicaid Section 1115 Demonstrations

 

 

Centers for Medicare & Medicaid Services (CMS) State Medicaid agencies

 

Agencies involved could include State Innovation Model (SIM) or transformation offices.

Housing services, transportation, education, social isolation, employment, investment in community partnerships, and other issues NASHP’s State Delivery System and Payment Reform Map (Delivery System Reform and Incentive Payment tab)

NASHP’s State Strategies to Improve Health Through Housing Services

Center for Health Care Strategies (CHCS), Addressing Social Determinants of Health via Medicaid Managed Care Contracts and Section 1115 Demonstrations

Medicaid managed care contracting CMS State Medicaid agencies States can encourage or require managed care organizations to invest in a range of non-clinical needs, including nutrition, physical activity, and housing. NASHP’s How States Address Social Determinants of Health in their Medicaid Contracts and Contract Guidance Documents

Sara Rosenbaum, et al., How Are States Addressing Primary Care Quality in Medicaid Managed Care?

Medicaid Section 1915(c) Home and Community Based Services waivers and 1915(i) state plan amendments CMS State Medicaid agencies Housing and employment supports and others NASHP’s Housing-Related Service Definitions in 1915(i) State Plan Amendments, 1915(c) Waivers, and Section 1115 Demonstrations

NASHP’s Tenancy Supports in Three States’ Medicaid Waivers

NASHP’s State Housing and Services Options in 1915(c) Waivers for People with Developmental Disabilities

Additional resources to help states meet health-related needs, by authoring organization:

NASHP Resources

Meeting the Health-Related Social Needs of Low-Income Persons: Funding Sources Available to States, 2016. Table provides an overview of funding sources.

State Strategies to Improve Health through Housing Services, 2016. Chart contains funding mechanisms.

Financing Prevention, 2014

Blending, Braiding, and Block-Granting Funds for Public Health and Prevention: Implications for States, December 2017. Two tables: featuring block grants and state examples of Medicaid authorities to address non-clinical needs.

For New Governors: Snapshot of Major Federal Opioid Funding by State, December 2018:

Toolkit: Upstream Health Priorities for New Governors, December 2018.

*For additional information on funding health-related services, explore NASHP’s Population and Public Health resource list.

Academy Health/Nemours

Innovative Medicaid Payment Strategies for Upstream Prevention and Population Health, May 2018.

Implementing Social Determinants of Health Interventions in Medicaid Managed Care: How to Leverage Existing Authorities and Shift to Value Based Purchasing, February 2018.

Center for Health Care Strategies

Addressing Social Determinants of Health via Medicaid Managed Care Contracts and Section 1115 Demonstrations, December 2018.

Addressing Social Determinants of Health through Medicaid Accountable Care Organizations, April 2018.

Commonwealth Fund

Enabling Sustainable Investment in Social Interventions: A Review of Medicaid Managed Care Rate-Setting Tools, January 2018.

Addressing the Social Determinants of Health through Medicaid Managed Care, November 2017.

Georgia Health Policy Center

Bridging for Health: Improving Community Health through Innovations in Financing, February 2019.

Kaiser Family Foundation

Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity, May 2018.

National Academy of Social Insurance

Strengthening Medicaid as a Critical Lever in Building a Culture of Health, January 2017.


Support for this work was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the foundation.