In my many years working in community health development, I’ve learned that developing a federally funded community health center is a process wrought with complications. Time and again, I’ve heard stories of inexperienced but well-intentioned folks stumbling over the same impediments, of which start-up funding is only one. Obviously, it is possible to get a federally funded health center up and running, but before you jump in, you should be ready for what could be a long and drawn out process.
First, we need to understand that the term “Federally Qualified Health Center” includes those funded by HRSA (FQHC) and FQHC Look-alikes. A Look-alike is generally either the first or the fall back option when pursuing federal funding for a health center. While having a Look-alike is not as advantageous as having a fully-funded FQHC, the process of getting one is not competitive. That’s not to say, however, that the process isn’t detailed and demanding. In fact, in recent years, requirements for getting an FQHC Look-alike have stiffened. A site survey may now be required as part of the evaluation and a full range of compliance is expected. Also, receiving enhanced reimbursement can take some time. For example, the last look-alike that we did was submitted on 1 April and expeditiously approved (there was no survey requirement at that time), but the first check with enhanced reimbursement did not arrive until mid-October.
When you submit a Look-alike you must “look like” a fully-funded FQHC, only without the benefit of the grant funding and Federal Torts Claims Act coverage. Also, the application for a Look-alike differs from that for an FQHC. In a Look-alike application, you tell the story of what you are currently doing (and show evidence that you are in compliance with guidelines), while in an FQHC New Access Point funding application you state what you are going to do if you are funded. Obviously, what you would do with your health center given an additional $650,000 in federal funding is a rather different story than the one you would present in your Look-alike application.
However, a major benefit of attaining Look-alike status is that an organization undoubtedly has a competitive edge when applying for full FQHC funding status. This doesn’t necessarily guarantee funding as the organization must still submit a well-developed and competitive application. What is key here is that in recent years federal funding has been widely available for FQHC development, while in the past funding was limited or nonexistent. In times of scarce funding, the Look-alike option may be the only mechanism available to support a health center operation in many communities.
New Access Point Funding
At the moment, everyone in community health is waiting to see if the upcoming federal budget is going to support New Access Point grant funding for additional health center sites. In some senses, the FQHC grant application process is like a beauty contest, often favoring experienced grant writers. Thus, established health centers applying for New Access Point satellite sites and centers with extensive grant writing experience have a distinct advantage. However, FQHC look-alikes also have an advantage because there is an assumption that that they could be up and running as an FQHC and in compliance with operational guidelines in short order. Likewise, the process of applying for Look-alike status presumes some level of community energy, governance, planning, and organization, lending force to a decision to jump at the opportunity to submit an FQHC New Access Point application when a funding cycle is announced.
Given the seemingly subjective nature of the grant-making process (universally and not unfairly described as a “crapshoot”), objective criteria have been established and refined to focus on community need. Guidelines have been revised and re-revised over time to focus on criteria and scoring that best describe the need for health services in applicant communities. These changes have helped to level the playing field somewhat, but many successful applicants have taken additional steps to present the best statistical picture of their communities. By researching beyond the criteria in the guidelines, digging deep into a variety of sources, and presenting additional relevant and reinforcing data in the project narrative, these organizations have been able to develop stronger applications than their competitors.
Our view is that the work undertaken to apply for a Look-alike, or in becoming a Look-alike, can move an organization into a posture of readiness, preparing it to take advantage of New Access Point funding cycles. With that said, the long-range planning involved in the Look-alike process should include a focus on planning for a successful New Access Point application.
For additional info on the differences between FQHCs and Look-alikes, check out our comparison page.