Chapter 10. Financing and Funding Opportunities and Strategies

Chapter Description

This chapter provides an overview of potential financing and funding opportunities for community-based oral health coalitions and programs and then links to specific funders and examples of funded programs. Tips and worksheets on grantwriting and other methods of fundraising are included. Issues around creating sustainable programs are addressed.

Chapter Overview

A common mistake that groups make when trying to solve an oral health problem is to think that money, usually in the form of a grant, will solve the problem and magically create a program. A second mistake is to think you're saving time by hiring a grantwriter who knows little about the problem, proposed project or the local community. A third mistake is to expect to secure funding based on a grant application that includes a great deal of rhetoric about the need for a program, but only vague descriptions about what the proposed program is, what it will cost, and what the anticipated outcomes will be. A fourth mistake is to express outrage when your grant application is not funded, and then send the same grant application to three more foundations!

Want to avoid these mistakes? Use the tools and tips in this chapter and in previous chapters to plan a cohesive approach to program planning and fundraising.

Self-Assessment: Financing and Funding

Chapter 2 provided an overview of several types of resources you might need. In the assessment process, you probably identified what resources can be obtained within the community through creative partnering, and what will require outside funding. How much do you already know about sources for funding or financing community-based programs? Do you know which organizations/agencies provide grant opportunities? What are other fundraising strategies? How can you take advantage of reimbursement for clinical services, education or administrative functions? Use the Financing and Funding Self-Assessment to determine what knowledge and resources you already have.

Creating a Funding Plan

Fundraising requires good networking, personal relationships, communication, marketing, investing, perseverance, patience and planning. To be successful, people need to be passionate about the cause, persuasive, proactive, assertive and persistent. Fundraising efforts can easily bog down in the daily realities of running an organization or conducting oral health activities. Fundraising requires a great deal of time and effort on a daily basis and a team of people, not just one person acting as a fundraiser.

The key to sustainability is to not put all your eggs in one basket. Programs that rely solely on one grant source are at major risk of dying when that funding dries up. Try to create a mix of funding that will sustain basic operations, allow expansion of activities, and generate sufficient cash flow to maintain smooth program operations. Relying solely on grants or on contracts based on completion of deliverables may result in periods of zero cash flow. Some funders may take months before making a decision to fund your program, and then there may be a delay in dispersing funds or a reduction in funding levels. Organizations can't afford to just "sit, hope and wait" for these funds to appear. Funders also want to be assured that they are contributing to an organization that is fiscally responsible and has a financial plan that is followed.

When putting together a funding plan, think about how your fundraising efforts are tied together. Are they for one-time expenditures or recurring needs? Do you all of a sudden have brand new dental equipment but no clinic space? A new mobile van with staff but no dental providers? Providers but an inadequate system for billing and collecting payments? Not enough cash flow to purchase disposable products or repair dental equipment? Fragmented attempts at grantwriting will create such situations.

Once funding is received, review your plan periodically and create reports to show the mix of resources and how you are maximizing those resources. Show how the funding has made a difference in the lives of people in the community. Reports are a form of marketing and are important not just to funders but also to individual donors and others who support your programs.

Locating Potential Funding Opportunities

Who are the grantmakers? (The link provides a description of 5 categories: government, private foundations, corporate grantmakers, community foundations and public charities.) Today the most timely and efficient way to research funding opportunities is through Internet search engines. Try to be fairly specific in your search, e.g., "health funding," but not overly restrictive-"funding for dental sealants"-as most funders will not be this specific in their funding descriptions. You might want to search by geographic location such as "community foundations in Northern California" or "funding for rural health programs."

Some agencies regularly post a list of new and continuing funding opportunities, usually with brief descriptions and links to the funding source's website if it is different from their own. Examples include:

• The Foundation Center: http://www.fdncnter.org/grantmakers (search by state or type of funding source).
  
• Rural Assistance Center: http://www.raconline.org/ provides resources for health and human services, including funding opportunities.
  
• California Rural Health Policy Council: http://www.ruralhealth.ca.gov lists local, state, regional and national funding opportunities.
  
• The Rural Health Advocate: http://www.csrha.org/advocate, an online newsletter, lists grant and research opportunities.
  
• Rural Health Services Funding: A Resources Guide: http://www.nal.usda.gov/ric/richs.
  
• Check in your community to see if any groups regularly monitor the Federal Register (http://www.gpoaccess.gov/fr); they might be willing to alert you to potential opportunities if they know your interests.
  
• Some listservs will alert members to funding opportunities, e.g., the dental public health listserv (subscription information at http://www.aaphd.org, click on "links").
  
• Foundations and government agencies regularly post new grant opportunities on their websites. Bookmark the ones that are most likely to match your needs and check them at least once a month.
  
• County First 5 commissions and the state First 5 Commission post Requests for Proposals (RFPs) on a periodic basis for minigrants, statewide initiatives, insurance demonstrations or other funding opportunities (access the county websites through the state commission website at http://www.ccfc.ca.gov). An April 2004 survey of 17 county oral health initiatives of $100,000 or more (not counting fluoridation) showed the following types of health health projects: 76% for direct dental services, 58% for consumer education, 41% for provider education, and 29% other (e.g., case management, home visits, screenings.) More than half of these programs were in rural counties.
  
• The US government has established a website for information and applications for all Federal grant programs (http://www.grants.gov)
  
• Other funding resources are listed in the Resources section.
  
  

The foundations listed in the box target a fairly wide geographic area or comprise a group of philanthropists. In addition, a number of community foundations provide grants to a specific area such as a city or county. A descriptive list of community foundations with website links can be accessed through the Foundation Center website. Community foundations are more willing to provide funding for small rural community-based projects. Check their individual websites to view lists of projects they have funded.

The following organizations or agencies have already funded oral health projects for stand-alone or collaborative oral health projects. Funding may not be available every year as priorities shift, but reviewing lists of previously funded projects may give you ideas for types of projects you might want to undertake.

Federal Opportunities

The application process for federal grants is usually more formal and complex than for most foundation grants. Most use the PHS 5161-1 grant application form, so become very familiar with the correct way to complete it; download from http://www.hrsa.gov/grants/forms.htm.

• The HRSA Bureau of Primary Health Care (http://bphc.hrsa.gov) provides funding for community/migrant/homeless health center clinics, the Community Access Program (CAP), and Healthy Schools/Healthy Communities Program.

• HRSA's Office of Rural Health provides funding to counties through a Rural Health Outreach Grant Program to "encourage the development of new and innovative health care delivery systems in rural communities that lack essential health care services." They require a focus on direct services through networks of at least two partners. Check their website for eligibility and a list of funded projects (http://ruralhealth.hrsa.gov/funding/outreach.htm.)

• HRSA's Maternal and Child Health Bureau offers a number of funding opportunities to states and communities for oral health programs through the state Title V Block Grant, Healthy Tomorrows grants and other initiatives. Check their website at http://mchb.hrsa.gov.

• The Administration for Children and Families (ACF) provides discretionary grants through an RFP process. ACF recently funded three oral health projects and also support minigrants to states for Head Start oral health forums through the Association of State and Territorial Dental Directors. View the ACF website at http://www.acf.hhs.gov/grants/index.html.

California and National Foundations

These are only selected examples of recent initiatives (some of the websites are listed on pg 3).

• The California Endowment has at least two mechanisms that may be used for oral health projects. Communities First focuses on access, health and well being, and multicultural health; there are no specific proposal deadlines, and multi-year funding is available. The Local Opportunities Fund provides grants of up to $50,000 for a maximum of 18 months that address a locally defined need. Grants can provide support for pilot projects, start-up or expansion of programs, core operating support, capacity-building or planning. Funds can be used for direct services, community organizing, education and information dissemination, using technology or media, and training. Check their website for specific funding cycle deadlines.

• The California Wellness Foundation provides funds for projects and for core operating support for health promotion/disease prevention activities in eight priority areas, as well as a special projects fund. Funding can be used for salaries, operating expenses, strategic planning or board development. Funding has been used in the past for community water fluoridation infrastructure.

• Sierra Health Foundation has a brightSmiles initiative, with 15 grantees receiving funding for projects in 1999 and 2000, and some funding being given for community water fluoridation. Check their website for a list of funded projects and current updates at http://www.sierrahealth.org/programs/bright.html.

• Through their Local Initiative Funding Partners program, the Robert Wood Johnson Foundation partners with local grantmakers to support innovative, community-based projects to improve health and health care for vulnerable populations. Grants are $100,000-$500,000 per project over a 3-4 year period, which must be matched dollar-for- dollar by local grantmakers. See http://www.lifp.org.

• The California Dental Association Foundation, in cooperation with the Henry Schein Cares Program, provides funding once a year to non-profit organizations for dental equipment and supplies. Funding is $5,000-$25,000 per year for two years. Recipients pay shipping costs. In 2003, four organizations received funding out of 72 applications. In addition, The Healthy Californians Grant Program provides financial grants of up to $25,000 to nonprofit organizations and clinics that address one or more of the following objectives:
  
  

  Access to care: programs that increase access to oral health care, particularly for the underserved, including children, their caregivers, and the elderly Prevention education/intervention: programs that promote oral health, disease prevention and risk assessment Treatment programs: nonprofit organizations and clinics providing direct oral health treatment services.

  View their website at http://www.cdafoundation.org/grants.htm.

• Delta Dental Plan of California has signed contracts with California's Managed Risk Medical Insurance Board (MRMIB) to fund more than 35 dental projects. One contract is for the 3-year Oral Health Demonstration Project, which funds projects for 0-5-year-olds in 16 counties. The second project is a Rural Health Demonstration Project that funds 20 community-based clinics and non-profits serving rural areas and special populations (children of migrant and seasonal farmworkers, fishing and forestry workers, and Native Americans.) Download descriptions of all projects at
  http://www.deltadentalca.org/news/index.html.

Other Funding Opportunities

• The American Academy of Pediatrics provides CATCH Planning Fund grants for pediatricians to plan "innovative, community-based child health initiatives that will ensure that all children, especially underserved children, have medical homes and access to health care services." This includes access to oral health services and dental homes. Annual grants are for a maximum of $10,000. Extensive technical assistance can be received from the chapter AAP CATCH facilitator prior to submission of the proposal (http://www.aap.org/catch/RosterChapterFac.pdf).

• Some faith-based groups (e.g., United Ministries in Missouri) and service organizations (e.g., Grottos of North America) provide funding for dental programs or dental care.

• The American Dental Association Foundation offers small grants of up to $5,000 for community-based non-profit oral health promotion programs through their Samuel Harris Fund for Children's Dental Health (http://www.ada.org/ada/charitable/adahf/).
  
• The Hospital Community Benefit Program (HCBP) resulted from legislation passed in 1994 (SB 697). Private not-for-profit hospitals "assume a social obligation to provide community benefits in the public interest in exchange for their tax-exempt status." They are required to 1) conduct a community needs assessment every three years, 2) develop a community benefit plan in consultation with the community, and 3) annually submit a copy of its plan to the Office of Statewide Health Planning and Development (OSHPD) http://www.oshpd.cahwnet.gov/hid/HID/hospital/hcbp/index.htm. Funding may be given to various local projects or programs to meet these obligations.
  
• The California Children's Dental Disease Prevention Program http://www.dhs.ca.gov/ps/cdic/cdcb/Medicine/OralHealth/Children's_Dental/index.htm provides funding to local agencies for school-based oral health programs that can include preschool-age children. New three-year grants were just awarded. Check the website for updates, lists of grantee and funding opportunities for new programs.
  
• Through the Child Health and Disability Prevention Program (http://www.dhs.ca.gov/pcfh/cms/chdp) or the Maternal and Child Health Branch (http://www.mch.dhs.ca.gov/programs/lhdmchp/lhdmchpfacts.htm), local health department MCH or CHDP programs or others can have local funds matched by the State at a 2:1 or 3:1 ratio (depending on the type of personnel) for dental-related activities, including case management for Medi-Cal clients.

• Two options are available through California Dept of Health Services, Medical Care Services:
  1. Local Educational Agency (LEA) Medi-Cal Billing Options allow LEAs to become Medi-Cal providers and bill the Medi-Cal program for health services provided by the health care professionals they employ, and by the schools to get reimbursed for case management and dental screening for Medi-Cal children.
  2. Targeted Case Management (TCM) Programs allow Local Governmental Agencies (LGAs) to provide case management services to Medi-Cal eligible individuals in a defined target population to gain access to needed medical/dental, social, educational and other services. TCM services include needs assessment, consultation, and assistance in obtaining needed services. See http://www.dhs.ca.gov/mcs/mcpd/MBB/ACSS/MAAdescription.htm .
  3. Other opportunities for using Medicaid funding can be found at http://www.hrsa.gov/Medicaidprimer.

Securing Funding Through Grants

When should you join with others to raise funds versus trying to do it yourself? In rural areas where populations are scarce and there may be limited resources to actively pursue grantwriting or fundraising, it might be advantageous to work collaboratively with others in a joint proposal or ask to be included in a broader grant application. Applications from individual organizations are best when trying to start local coalitions or projects, especially when doing pilot projects to generate more community support and address local needs, e.g., trying to involve local dental providers in a project, or local case management for dental care. A regional approach is good if 1) there are limited numbers of children in a community and larger numbers are needed to show an impact, 2) communities can agree on regional goals and activities that also meet local needs, 3) there is an organization that can serve as a fiscal agent, 4) communities are willing to commit and share resources in a collaborative manner.

Including oral health projects as part of a broader initiative may be advantageous when funds for oral health programs are limited, and when additional resources are available through other project components. Examples of potential areas for oral health involvement are provided for those areas that are listed in the box.

Is Grantwriting Worth the Effort?

It is important to estimate how much effort and what resources are needed to write and administer a grant versus how much funding the grant will generate. Is it worth writing a grant for $5,000 for some small part of a pilot project or portable equipment, or do you really need $100,000 over a three-year period of time to accomplish your goals? Review the following tips on grantwriting.

Tips for Writing Successful Grants