Anne de Biasi
Trust for America’s Health
Director of Policy Development
Vinu Ilakkuvan
Trust for America’s Health
Policy Development Consultant

Making braiding easier: what can federal agencies do?

September 20, 2018 - 1:32pm

This blog series “Uniting funding streams for health and social innovation” is a collaboration between the Urban Institute’s Pay for Success Initiative (PFSI) and The Brookings Institution-hosted Braiding and Blending Working Group. Though not every post is focused on pay for success, the working group and this blog series aligns with the PFSI mission of researching and supporting innovative financing solutions to today’s most pressing challenges. This series highlights the research of experts in healthcare financing focused on creative approaches.

Physical and mental health, education, housing, and a range of other health and social factors are irrevocably interlinked. As a result, meaningful and sustained improvements to outcomes in any of these areas requires the involvement of multiple sectors. Over the past several years, Trust for America’s Health has convened experts, highlighted model programs, and generated policy recommendations with the goal of improving health and social outcomes through multi-sector collaboration. One theme that has repeatedly emerged is that financial sustainability is key to the long-term success of such multi-sector efforts.

Given the challenges of securing sustainable public and private support for multi-sector initiatives, finding ways to better coordinate two or more funding streams toward a unified set of programs, services or benefits to a group of people – also known as braiding – is essential. Unlike blending, braiding keeps funding streams in distinguishable strands, so expenses can be tracked and attributed to specific funding streams – often a necessity when it comes to federal funds.

Federal agencies – which fund a substantial portion of initiatives designed to improve health and social outcomes – can play a key role in enabling braiding to enhance health and social impact.

In a brief released today, we recommend specific ways federal agencies can facilitate braiding of funding streams under current authorities.  These options allow agencies to promote integration across programs while still meeting individual requirements of each funding stream. 

Federal agencies can:

 Streamline application processes

If requirements for multiple programs are closely aligned, federal agencies can create a single announcement, application, and grant award, simplifying the application process. They can also:

    • coordinate the timing of grant cycles for related programs across agencies;
    • require recipients of two or more related federal grants to submit coordination and implementation plans;
    • jointly award grants;
    • recommend peer reviewers across agencies; and
    • allow applicants to partner to meet eligibility for multiple awards.

Use proposal requirements and preferences to encourage braiding of multiple awards

When federal agencies are partnering in an initiative, they can require applicants to apply for grants from each of the funding agencies involved, restrict eligibility to applicants that are already receiving the other grant(s), and/or require proof of partnership with an entity that applied to the other grant(s).

Another way federal agencies can create this synergy is by giving priority to designated applicants within relevant grant programs.

Create interagency teams

During the program design or redesign phase, federal agencies can create interagency teams that work with communities to allow funding proposals to stem from local need, rather than siloed funding opportunities.

Coordinate planning, monitoring, and reporting processes

Federal agencies implementing programs with similar goals can:

    • permit or require a single planning process;
    • conduct integrated data development, auditing, monitoring and improvement efforts;
    • align reporting requirements – including creating joint evaluation metrics – and permit joint reports;
    • require applicants to track cross-program outcomes and interim indicators; and
    • conduct or fund evaluations on the impact of programs funded by one agency that impact the goals of a different agency.

For example, HUD’s Section 202 Supportive Housing for the Elderly Program includes evaluation of the programmatic impact on Medicare costs for elderly individuals living in Section 202 housing.

Provide and coordinate technical assistance to facilitate and enhance the impact of braiding

Federal agencies partnering on an initiative can fund coordinated national training and technical assistance and hold integrated grantee meetings and conferences.

They can also issue guidance on best practices for coordinating braided funding based on specific programmatic knowledge. For example, in 2015, the Center for Medicaid and CHIP Services (CMCS) issued an informational bulletin on housing and service integration that highlighted effective practices in coordinating funding between Medicaid and state and local housing organizations.

At each stage of the funding cycle, there are steps federal agencies can take to make it easier for communities and programs to braid funds, sustaining services at the community level and ultimately improving the health and well-being of communities.

Braiding funds is difficult, creating an administrative burden and lack of flexibility that can hamper outcomes.  Federal requirements can inadvertently complicate state and local efforts to comprehensively address health and social issues. By taking these steps, federal agencies can make braiding easier, meaningfully benefiting local communities and grantees.

It is important that agencies using these options put safeguards in place to ensure funds are not reduced or cut, or those served adversely affected. With such safeguards in place, federal agencies that take these steps can maximize the effectiveness of existing funding streams, putting government dollars to better use and improving the lives of residents in communities across the nation.

Stay tuned for next week’s piece in this blog series, focused on braiding and blending possibilities in local communities to fund services involved in Social Determinants of Health.

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The views expressed in the series are those of the authors; as an organization, the Urban Institute does not take positions on issues. Experts are independent and empowered to share their evidence-based views and recommendations shaped by research. Photo via Shutterstock.