Foa_Content_of_HHS-2023-ACF-OCS-EMP-0085.pdf

Administration for Children and Families

Office of Community Services

Medical-Legal Partnerships Plus (+)

HHS-2023-ACF-OCS-EMP-0085

Application Due Date: 08/28/2023

Table of Contents Executive Summary

I. Program Description

II. Federal Award Information

III. Eligibility Information

III.1. Eligible Applicants

III.2. Cost Sharing or Matching

III.3. Other

IV. Application and Submission Information

IV.1. Address to Request Application Package

IV.2. Content and Form of Application Submission

Required Forms, Assurances, and Certifications

The Project Description

The Project Budget and Budget Justification

Application Submission Options

IV.3. Unique Entity Identifier (UEI) and System for Award Management (SAM)

IV.4. Submission Dates and Times

Explanation of Due Dates

Acknowledgement of Received Application

IV.5. Intergovernmental Review

IV.6. Funding Restrictions

IV.7. Other Submission Requirements

V. Application Review Information

V.1. Criteria

V.2. Review and Selection Process

V.3. Anticipated Announcement and Federal Award Dates

VI. Federal Award Administration Information

VI.1. Federal Award Notices

VI.2. Administrative and National Policy Requirements

VI.3. Reporting

VII. HHS Award Agency Contact(s)

VIII. Other Information

Reference Websites

Application Checklist

Appendix

Funding Opportunity Title:

Medical-Legal Partnerships Plus (+) Announcement Type:

Initial Funding Opportunity Number:

HHS-2023-ACF-OCS-EMP-0085

Primary CFDA Number:

93.647 Due Date for Applications:

08/28/2023 Executive Summary

Notice:

Applicants are strongly encouraged to read the entire notice of funding opportunity (NOFO) carefully and observe the application formatting requirements listed in Section IV.2. Content and Form of Application Submission. For more information on applying for grants, please visit "How to Apply for a Grant" on the ACF Grants & Funding Page at https://www.acf.hhs.gov/grants/how-apply-grant.

The Administration for Children and Families (ACF), Office of Community Services (OCS) announces the availability of funds for Medical-Legal Partnerships Plus (MLP+). OCS will make approximately $1.6 million available through a competitive process. OCS expects to make approximately four to eight awards to long-standing medical-legal partnerships (MLPs).

The objective of this funding opportunity is to provide support for MLPs to build, expand, and strengthen their capacity to provide comprehensive legal services and wraparound social services to families with low incomes. MLPs will use this funding to increase their capacity to serve vulnerable families, including enhancing and/or increasing legal services and building and/or strengthening partnerships with social service providers, community-based organizations, and other nonprofits that work to address the causes and consequences of poverty, address social determinants of health (SDoH), and increase the wellbeing of children and families. Recipients will participate fully in a federal evaluation and follow all evaluation protocols established by ACF and/or its designee contractor(s). Fully participating in a federal evaluation may include supporting and complying with data collection requirements, providing administrative data on program participation, and other activities. In addition, the federal evaluation may include an evaluation of MLP+ implementation.

OCS will award bonus points to applicants that successfully demonstrate their designation as a child-focused MLP or as a MLP that is affiliated with or designated as either a safety-net nonprofit hospital or a Native and/or Minority Serving Institution. See Section IV.2. The Project Description, Approach for more information.

I. Program Description https://www.acf.hhs.gov/grants/how-apply-grant

Statutory Authority This program is funded under the authority of section 1110 of the Social Security Act, 42 U.S.C.

1310.

Description Purpose / Statement of Need

Over 25 million Americans live in poverty[1], including more than 3.8 million children.[2] Recent analysis shows that 42 percent of children—more than 4 in 10 children—live in households that reported it was somewhat or very difficult to cover basic necessities, such as food, rent and medical expenses.[3]The relationship between poverty and one’s health and wellbeing overtime, particularly for children, is well documented.[4] In particular, deep and persistent poverty can disrupt children’s cognitive and physical development; educational attainment; and mental, physical, behavioral, and emotional health. These impacts have been found to extend into adulthood, reduce wellbeing across the lifespan, and ultimately shorten life expectancy. [5]

In order to address the dynamic and multifaceted nature of poverty—which is at the heart of SDoH—several hundred institutions have turned to multidisciplinary medical, legal, and social service teams, often referred to as medical-legal partnerships, to accelerate access to concrete supports, address systemic inequities, ensure proper legal representation and access to the justice system, and mitigate barriers that preclude families from living healthy lives.

The purpose of this funding opportunity is to provide funding support to long-standing MLPs to build, expand, and strengthen capacity to serve vulnerable families. This includes enhancing and/or increasing legal services and building and/or strengthening partnerships with social service providers, community-based organizations and other nonprofits that work to address the causes and consequences of poverty, address SDoH, and increase the wellbeing of children and families, especially families experiencing challenges with housing stability, income support, family stability, civil rights, immigration, and environmental health. An evaluation study accompanying this program will assess the implementation of capacity building efforts by the MLPs.

Background

Social Determinants of Health

SDoH refers to a broad range of economic, social, and environmental conditions that affect individuals’ health and well-being, including access to safe and affordable housing and healthy foods, employment and educational opportunities, appropriate and adequate healthcare services, and neighborhoods where families can live without environmental pollutants and fear of violence or discrimination.[6] SDoH provide a framework for understanding the compounding and intersecting health-related social needs of individuals and families with low incomes.

According to a review of evidence-based strategies and current federal efforts by the U.S.

Department of Health and Human Services’ (HHS) Assistant Secretary for Planning and Education (ASPE), studies estimate that clinical care impacts only about 20 percent of county variation in health outcomes, while SDoH affect as much as 50 percent. [7] Despite investments to improve access to high quality healthcare, health inequities and poor health outcomes persist by race, ethnicity, sexual orientation, gender identity, disability, geographical location, poverty status, and employment status. Black, Latino, American Indian and Alaskan Native, Asian American, Native Hawaiian, and Pacific Islanders; lesbian, gay, bisexual, transgender, queer, and/or questioning (LGBTQ+) individuals; people in urban areas, and people with disabilities fare worse than their White, heterosexual, and urban counterparts and people without disabilities.

Health disparities exist across several outcomes, including infant mortality, heart disease, hypertension, chronic illness, disability, cancer, mental illness, substance use, and overall life expectancy. [8] Social and structural factors play a crucial role in health outcomes. According to a study conducted by the American Journal of Preventative Medicine, socioeconomic factors alone account for 47 percent of overall health outcomes, while health behaviors, clinical care, and physical environment account for 34 percent, 16 percent, and 3 percent of health outcomes, respectively. [9] To reduce the impact of poverty on health, in the last two decades, many health care institutions have begun to focus more on addressing SDoH in clinical settings. The SDoH framework, particularly as it relates to children and their families, have led healthcare providers to translate developmental science into lifelong health and work across public service sectors to build policies and practices that target the root causes of health disparities and inequities. [10]

According to ASPE’s report, there are several service models grounded in the SDOH that have produced compelling evidence of improvement in the health and wellbeing of vulnerable individuals and families. For example, the Housing First model has demonstrated that consistent access to safe and stable housing is associated with improved health and wellbeing for individuals and families with low incomes. Housing instability leads to several poor health outcomes ranging from distress in caregiver mental health to increased hospitalization to acute material hardship. [11] Within the Housing First framework, Permanent Supportive Housing (PSH) programs pair affordable housing with wraparound support services for individuals who are chronically homeless and have extremely low incomes and a documented disability. PSH programs have yielded demonstrable improvements in the health outcomes of participants, including reduced reliance on emergency public services and improvements in physical and mental well-being, as well as long-term cost savings due to the reduced reliance on costly public services. [12]

Medical-Legal Partnerships

MLPs have been at the forefront of innovation in policy and practice, leveraging medical, legal, and social service experts to address issues that contribute to poor health outcomes and combat persistent health inequities in various populations. Through an integrated healthcare system, MLPs provide comprehensive services that address various SDoH for patients and sometimes their families.

The Value of the MLP Service Model

The MLP model holds inherent value because it acknowledges the need for a multidisciplinary response to complex needs. Through the lens of the SDoH, it is well known and documented that the health of a person is comprised of a myriad of factors. Typically, the medical system is identified to address the overall health of a person. However, the medical system alone cannot fully address the causes and consequences of patient health outcomes. Health care has worked to integrate some social service navigation and individualized case management into the care of patients. However, many patients encounter challenges related to complicated local, state, and federal policies that require legal expertise to successfully navigate. [13] MLPs work to integrate https://endhomelessness.org/resource/housing-first/ this valued legal perspective in the healthcare setting, with the goal of preventing future poor health outcomes. Legal services are well positioned to advocate for patient rights both in and out of the clinical setting, particularly when it comes to issues such as safe and stable housing, assistance with utilities, and access to public benefits. MLPs help medical institutions work toward broad policy change and lift barriers to patient wellness.

The Impact of MLPs

Grounded in the SDoH, the interdisciplinary MLP model has yielded compelling results for patients and healthcare centers alike.

On the patient level, there are a variety of significant findings on the impact of leveraging legal professionals in tandem with medical professionals to address multi-faceted patient need. The Journal of Asthma conducted a study on the impact of MLPs on the home environments of inner-city adults with severe asthma. Home contaminants and mold were consistently exacerbating symptoms in a group of adult asthmatic individuals. Through the intervention of an MLP, lawyers were able to work with landlords to rectify the living conditions, ultimately improving the symptoms of the asthmatic patients. [14] Additionally, a study by the Journal of Behavioral Medicine found that families experiencing poverty and living in economic hardship who participated in MLPs felt reduction in stress and improvements in their overall wellbeing.[15] Moreover, the Journal of Health Care for the Poor and Underserved found that MLPs were an effective vehicle for providing certifications of medical needs to ultimately prevent utility shut-offs. [16]

In terms of impact on health care centers, clinicians and medical providers find value in the MLP model. According to a 2016 study conducted by the National Center for Medical-Legal Partnerships, one third of health care organizations include funding for MLPs, and, in 2016 alone, MLP partners trained nearly 11,000 medical service providers on MLP services and health-harming needs, in accordance with the SDoH.[17] Additionally, health care providers reported improved patient health outcomes and greater compliance with medical treatments as a result of MLPs.

Program Goals and Desired Outcomes

MLP+ provides an opportunity for ACF to learn more about the following:

1. How award recipients use increased funding to build or expand legal services offered to children and families through MLPs.

2. How MLPs connect children and families to wraparound social services to address concrete needs.

3. Perceived efficiencies of strengthening and enhancing relationships between medical, legal, and social service professionals to address the SDoH.

4. How strengthened and expanded MLP services and supports shape the experiences of individuals, families, and communities.

Below are both the child-, family-, and community-level outcomes as well as the institutional outcomes expected from the MLP+ pilot program. Award recipients will work to achieve these outcomes in their projects.

Child, family, and community outcomes:

Increased awareness of the availability of MLP services for eligible children and families Increased number of children and families receiving services through MLPs Increased access to specific services related to housing stability, income support, family stability, immigration, and environmental health through the MLP Decreased stress/strain on individuals and families due to medical, legal, or social service challenges Increased knowledge of and access to health care and/or community-based economic, social, and legal supports Increase in resolved legal and social service issues affecting the health of children and families Improved physical, mental, and emotional health for participating children and families Increased knowledge about medical, legal, and social service providers in the community

Institutional outcomes:

Increased capacity to enhance services/serve a greater number of individuals through MLPs

Increased/expanded relationships with social service providers and other community partners

Increased capacity to provide specific services related to housing stability, income support, family stability, immigration, and environmental health

Increased cost savings due to additional capacity for prevention within the MLP model Increase in resolved legal and social service issues affecting health Increase in positive health outcomes for patients

NOTE: Consistent with the Paperwork Reduction Act (PRA) of 1995, (44 U.S.C. 3501-3521), under this NOFO, OCS will not conduct or sponsor – and a person is not required to respond to a collection of information covered by such Act, unless it displays a currently valid Office of Management and Budget (OMB) control number.

Major Activities

Areas of activity: There are four areas of activity for the MLP+. Funds from this award may be used within these four areas to help address health-harming legal and social needs in underserved communities. Recipients will be required to implement projects that have a thorough plan for value-added activities in each of the following areas:

1. Building, expanding, and/or strengthening the capacity of the MLP to deliver legal services

2. Intentionally including, or expanding the role of, social service workers/case managers /navigators in the MLP context

3. Building, expanding, and/or strengthening capacity of the MLP to connect children and families with needed wraparound social services that help address health-harming legal and social needs

4. Actively supporting the federal evaluation

As a reminder, funds for this program may only be used for expenses associated with addressing health-harming legal and social needs for individuals and families with low incomes in underserved communities. Funding cannot be used to provide social services, such as housing and employment services; however, funding can be used to connect and/or refer individuals and families to these services/the entities that provide these services.

Principles: Recipients will be required to design and implement their MLP+ program so that it reflects the following principles:

Recipients will prioritize equity in the design and implementation of their programs Recipients will center services related to housing stability, income supports, family stability, civil rights, immigration, and environmental health in their program design and implementation

1. Building and/or strengthening capacity of MLPs to deliver legal services: Award recipients will work to strengthen and expand the capacity to provide legal services through the MLP. Potential activities related to this requirement include but are not limited to funding additional legal partners; increasing the size and scope of legal partner activities; obtaining specialized legal support; scaling up current MLP operations to include additional legal outreach and hours of operations; investing in stronger data sharing and infrastructure within the MLP structure, and working to institutionalize efforts at the individual and policy levels to a range of health-related economic, social, and legal needs.

2. Including social service navigators in the MLP context: Award recipients without an embedded social service navigator will integrate this role within their MLP. Social service navigator includes titles such as case manager, community health navigator, family specialist, social worker, family navigator, service navigator, patient navigator, etc. and their main role is to provide case management services, build relationships with community-based social service providers, maintain and increase knowledge of community resources, connect participating families to social services, and help them navigate through legal and social systems and policies.

Award recipients with an established case manager or navigator will utilize a portion of this funding to enhance the capacity of this role, including the ability to increase and enhance partnerships and relationships with local social service providers.

3. Building and/or strengthening the capacity of MLPs to connect children and families with wraparound social services that help address health-harming legal and social needs:

Award recipients will establish and/or strengthen partnerships with a variety of local service organizations, such as Community Action Agencies (CAAs), social service providers, and/or other non-profit community organizations with relevant social service expertise and capacity.

The purpose of the partnerships is to increase the organizations’ collective capacity to provide comprehensive social services and outreach to families with low incomes. These partner organizations will work together with the recipient to expand and/or strengthen services provided as part of the MLP and this award. Award recipients will seek out social service partners that provide services in the following areas: housing stability, income supports, family stability, civil rights, immigration, and environmental health.

4. Actively supporting the federal evaluation: Award recipients will work closely with ACF to facilitate an evaluation of the federal MLP+ pilot. The federal evaluation may include gathering implementation data from recipients. It may also include, but is not limited to, data gathering from recipients, partners, and/or program beneficiaries through surveys, small focus groups, and/or qualitative interviews. Recipients will fully and actively support the federal evaluation.

NOTE: Consistent with the Paperwork Reduction Act (PRA) of 1995, (44 U.S.C. 3501-3521), under this NOFO, OCS will not conduct or sponsor – and a person is not required to respond to a collection of information covered by such Act, unless it displays a currently valid Office of Management and Budget (OMB) control number.

Subawards

Recipients under this program may opt to transfer a portion of substantive programmatic work to other organizations through subaward(s). The prime recipient must maintain a substantive role in the project. ACF defines a substantive role as conducting activities and/or providing services funded under the award that are necessary and integral to the completion of the project.

Subrecipient monitoring activities alone, as specified in 45 CFR § 75.352, do not constitute a substantive role. Furthermore, ACF does not fund awards where the role of the applicant is primarily to serve as a conduit for passing funds to other organizations unless that arrangement is authorized by statute. Additionally, all subrecipient(s) must obtain a Unique Entity Identifier (UEI) number assigned by the System for Award Management (SAM), if they do not already have one. Prime recipients are required to check SAM to verify that the subrecipient(s) is/are not debarred, suspended, or ineligible.

Please reference the Award Term and Condition on Subawards on the ACF Administrative and National Policy Requirements website for further requirements involving subawards.

OCS Response to a Nationally Declared Emergency If, during the project period, OCS and/or recipients are required to adjust program and/or cooperative agreement requirements due to a nationally declared emergency, OCS will exercise maximum flexibility as needed. Requirements may be conducted virtually, or timelines may be modified in consultation with OCS.

Pre-Application Webinar

A pre-application webinar will be available for viewing no later than 10 days after publication at https://www.acf.hhs.gov/ocs/grants until the closing of this NOFO. The goal of the pre-recorded webinar is to outline MLP+’s program’s purpose and strategies; provide key dates for submitting an application for MLP+; and review key application criteria and requirements, as outlined in the NOFO. Viewing the pre-recorded webinar is voluntary. Only the information provided in this NOFO will be presented. No question-and-answer portion will be conducted during the session. Participants will remain anonymous. Opting not to view the webinar will not affect eligibility, application scoring, or the selection process. Applicants will be able to access the recording and transcript on the program office website at https://www.acf.hhs.gov/ocs/grants.

OCS Equity Action Statement

OCS is committed to advancing equity across all programs as called for in the Executive Order On Advancing Racial Equity and Support for Underserved Communities Through the Federal Government and the Executive Order on Further Advancing Racial Equity and Support for Underserved Communities Through The Federal Government. OCS focused on https://www.acf.hhs.gov/administrative-and-national-policy-requirements#book_content_14 https://www.acf.hhs.gov/administrative-and-national-policy-requirements https://www.acf.hhs.gov/administrative-and-national-policy-requirements https://www.acf.hhs.gov/ocs/grants https://www.acf.hhs.gov/ocs/grants https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/20/executive-order-advancing-racial-equity-and-support-for-underserved-communities-through-the-federal-government/ https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/20/executive-order-advancing-racial-equity-and-support-for-underserved-communities-through-the-federal-government/ https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/20/executive-order-advancing-racial-equity-and-support-for-underserved-communities-through-the-federal-government/ https://www.whitehouse.gov/briefing-room/presidential-actions/2023/02/16/executive-order-on-further-advancing-racial-equity-and-support-for-underserved-communities-through-the-federal-government/ https://www.whitehouse.gov/briefing-room/presidential-actions/2023/02/16/executive-order-on-further-advancing-racial-equity-and-support-for-underserved-communities-through-the-federal-government/ the following areas to guide the creation of a comprehensive strategy: addressing the root causes of inequity in underserved communities; elevating the voices of individuals, families, award recipients, and stakeholders in strategic planning; revising policies that perpetuate systemic barriers to opportunities; and promoting integrated service delivery using an equity lens. OCS has made steps to advance equity by implementing demographic data collection in programs across OCS to ensure programs are equitably serving individuals and households across the country. In FY 2023, recipients of the Low Income Home Energy Assistance Program and the Low Income Household Water Assistance Program will begin reporting demographic data on race, ethnicity, and gender. Learn more about OCS's equity activities here.

Definitions

The following definitions apply to this funding opportunity. Applicants are strongly encouraged to review these carefully prior to applying.

Community Action Agencies (CAAs) – Public and private non-profits that work to implement community-based anti-poverty programs and provide support services to vulnerable households, including education and employment services and assistance with basic needs. CAAs were established to carry out the Community Action Program, which was founded by the 1964 Economic Opportunity Act to fight poverty by empowering the poor as part of the War on Poverty.

Child focused MLP – an MLP with a mission statement or bylaws that is focused primarily on addressing the health, legal, and/or social needs of children and their families.

Children’s hospital – hospitals with inpatients predominantly aged 18 or younger.

Civil rights – includes but is not limited to legal services related to the protection of individual and family civil rights, which prohibit discrimination on the basis of race, color, national origin, disability, age, religion, and sex.

Community-based organization – public or private not-for-profit resource hubs that provide specific services to the community or targeted population within the community.

CBOs include but are not limited to aging and disability networks, community health centers, child care providers, home visiting programs, state domestic violence coalitions and local domestic violence shelters and programs, adult protective services programs, homeless services providers, and food banks that work to address the health and social needs of populations.

Equity – The consistent and systematic fair, just, and impartial treatment of all individuals, including individuals who belong to underserved communities that have been denied such treatment, such as Black Latino, Indigenous and Native American persons, Asian Americans and Pacific Islanders and other persons of color, members of religious minorities; lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons; persons with disabilities; persons who live in rural areas; and person otherwise adversely affected by persistent poverty or inequality.

Environmental health – includes, but is not limited to, legal and health issues related to air quality, water and sanitation, extreme weather, and chemical exposures.

Family stability – includes, but is not limited to, support for families who have been involved in the child welfare system or who might be at risk of being involved in the child welfare system.

https://www.acf.hhs.gov/ocs/ocs-equity-action-statement-fy2022

Immigration – includes, but is not limited to, resources for individuals and families in need of legal assistance for immigration-related issues.

Low Income – ACF defines “low income,” for purposes of this grant, as an individual whose household income level does not exceed 200 percent of the official poverty guidelines, as found in the most recent revision of the HHS Poverty Guidelines published by HHS, available at https://aspe.hhs.gov/poverty-guidelines.

Long standing MLP – for the purposes of this NOFO, a long standing MLP is defined as an MLP that has been established and in operation for at least five years.

Housing instability – includes, but is not limited to, individuals who are unhoused and experiencing housing related challenges such as having trouble paying rent, overcrowding, moving frequently, or spending the bulk of household income on housing.

Income supports – includes programs that allow families and individuals to have enough income to meet an individual or family’s basic/concrete needs.

Medical-legal partnership (MLP) – integrates civil legal aid services alongside health care services to mitigate complex social conditions that may disadvantage individuals, families, and communities.

Native and/or minority-serving institution – an accredited academic institution whose enrollment of a single minority or a combination of minorities exceeds 50 percent of the total enrollment, including graduate and undergraduate and full- and part-time students.

Pediatric department – department with the specialty of medical science concerned with the physical, mental, and social health of children from birth to young adulthood.

Pediatric department care encompasses a broad spectrum of health services ranging from preventive health care to the diagnosis and treatment of acute and chronic diseases.

Safety-net, non-profit hospital – defined broadly as a non-profit hospital with a mission or mandate of serving low-income individuals, regardless of patients’ insurance coverage, ability to pay, or immigration status.

Social Determinants of Health (SDoH) – the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

Social Service navigator – for the purposes of this NOFO, a social service navigator includes but is not limited to a case manager, community health navigator, family specialist, social worker, family navigator, service navigator, patient navigator, etc. The main roles of a social service navigator include providing case management services, building relationships with community-based social service providers, maintaining and increasing knowledge of community resources, connecting participating families to social services, and helping families navigate through legal and social systems and policies.

Social service providers – Social service providers promote the health and well-being of individuals by helping them to become more self-sufficient; by strengthening family relationships; and by restoring individuals, families, groups, or communities to successful social functioning.

University affiliated hospital – a hospital that is affiliated with a university. University hospitals provide clinical education and training to future and current doctors, nurses, and other health professionals, in addition to delivering medical care to patients.

Wraparound social services – Wraparound social services encompass any services that individuals or families with low incomes may need to become more financially stable and https://aspe.hhs.gov/poverty-guidelines self-sufficient. Wraparound social services may include, but are not limited to, financial literacy services, child care services, transportation, substance-use disorder treatment, English language education, job training, social service referrals, basic needs support, housing services, etc.

[1] US Census Bureau. (2022, September 13). Poverty in the United States: 2021. Census.gov.

https://www.census.gov/library/publications/2022/demo/p60- 277.html#:~:text=The%20official%20poverty%20rate%20in,37.9%20million%20people%20in %20poverty.

[2] Baldari, C. (2022, December 14). U.S. Child Poverty in 2021 – First Focus on Children. First Focus on Children – Making Children and Families the Priority.

https://firstfocus.org/resources/fact-sheet/u-s-child-poverty-in- 2021#:~:text=On%20September%2013%2C%202022%2C%20the,the%20poverty%20line%20i n%202021.

[3] Sherman, A. (2020, October 21). 4 in 10 Children Live in a Household Struggling to Afford Basics. Center on Budget and Policy Priorities. https://www.cbpp.org/blog/4-in-10-children-live-in-a-household-struggling-to-afford-basics

[4] The Annie E. Casey Foundation. (2022, September 19). New Data Show That the Child Tax Credit Fueled a Substantial Reduction in Child Poverty. https://www.aecf.org/blog/new-data-show-that-the-child-tax-credit-fueled-a-substantial-reduction-in-child-poverty#:~:text=Newly%20released%20data%20from%20the,a%20historic%20low%20of%205 %25

[5] Murphey, D. (2020, July 8). 5 Ways Poverty Harms Children - Child Trends. Child Trends.

https://www.childtrends.org/publications/5-ways-poverty-harms-children#:~:text=Particularly%20at%20its%20extremes%2C%20poverty,for%20a%20shortened %20life%20expectancy

[6]Francis, L., DePriest, K., Wilson, M., & Gross, D. (2018). Child Poverty, Toxic Stress, and Social Determinants of Health: Screening and Care Coordination. Online Journal of Issues in Nursing, 23(3). https://doi.org/10.3912/ojin.vol23no03man02

[7] SDOH-Evidence-Review.pdf (hhs.gov)

[8] SDOH-Evidence-Review.pdf (hhs.gov)

[9]Hood CM, Gennuso KP, Swain GR, et al. County Health Rankings: Relationships Between Determinant Factors and Health Outcomes. American Journal of Preventive Medicine. February 2016; 50(2):129- 135. doi:10.1016/j.amepre.2015.08.024

[10] Care, D., Developmental, S. O., Garner, A. J. P., Shonkoff, J. P., Siegel, B., Dobbins, M. I., Earls, M. F., McGuinn, L., Pascoe, J., & Wood, D. A. (2012). Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science Into Lifelong Health. Pediatrics, 129(1), e224–e231. https://doi.org/10.1542/peds.2011-2662

[11] SDOH-Evidence-Review.pdf (hhs.gov) https://www.census.gov/library/publications/2022/demo/p60-277.html#:~:text=The%20official%20poverty%20rate%20in,37.9%20million%20people%20in%20poverty https://www.census.gov/library/publications/2022/demo/p60-277.html#:~:text=The%20official%20poverty%20rate%20in,37.9%20million%20people%20in%20poverty https://www.census.gov/library/publications/2022/demo/p60-277.html#:~:text=The%20official%20poverty%20rate%20in,37.9%20million%20people%20in%20poverty https://firstfocus.org/resources/fact-sheet/u-s-child-poverty-in-2021#:~:text=On%20September%2013%2C%202022%2C%20the,the%20poverty%20line%20in%202021 https://firstfocus.org/resources/fact-sheet/u-s-child-poverty-in-2021#:~:text=On%20September%2013%2C%202022%2C%20the,the%20poverty%20line%20in%202021 https://firstfocus.org/resources/fact-sheet/u-s-child-poverty-in-2021#:~:text=On%20September%2013%2C%202022%2C%20the,the%20poverty%20line%20in%202021 https://www.cbpp.org/blog/4-in-10-children-live-in-a-household-struggling-to-afford-basics https://www.cbpp.org/blog/4-in-10-children-live-in-a-household-struggling-to-afford-basics https://www.aecf.org/blog/new-data-show-that-the-child-tax-credit-fueled-a-substantial-reduction-in-child-poverty#:~:text=Newly%20released%20data%20from%20the,a%20historic%20low%20of%205%25 https://www.aecf.org/blog/new-data-show-that-the-child-tax-credit-fueled-a-substantial-reduction-in-child-poverty#:~:text=Newly%20released%20data%20from%20the,a%20historic%20low%20of%205%25 https://www.aecf.org/blog/new-data-show-that-the-child-tax-credit-fueled-a-substantial-reduction-in-child-poverty#:~:text=Newly%20released%20data%20from%20the,a%20historic%20low%20of%205%25 https://www.aecf.org/blog/new-data-show-that-the-child-tax-credit-fueled-a-substantial-reduction-in-child-poverty#:~:text=Newly%20released%20data%20from%20the,a%20historic%20low%20of%205%25 https://www.childtrends.org/publications/5-ways-poverty-harms-children#:~:text=Particularly%20at%20its%20extremes%2C%20poverty,for%20a%20shortened%20life%20expectancy https://www.childtrends.org/publications/5-ways-poverty-harms-children#:~:text=Particularly%20at%20its%20extremes%2C%20poverty,for%20a%20shortened%20life%20expectancy https://www.childtrends.org/publications/5-ways-poverty-harms-children#:~:text=Particularly%20at%20its%20extremes%2C%20poverty,for%20a%20shortened%20life%20expectancy https://doi.org/10.3912/ojin.vol23no03man02 https://aspe.hhs.gov/sites/default/files/documents/e2b650cd64cf84aae8ff0fae7474af82/SDOH-Evidence-Review.pdf https://aspe.hhs.gov/sites/default/files/documents/e2b650cd64cf84aae8ff0fae7474af82/SDOH-Evidence-Review.pdf https://doi.org/10.1542/peds.2011-2662 https://aspe.hhs.gov/sites/default/files/documents/e2b650cd64cf84aae8ff0fae7474af82/SDOH-Evidence-Review.pdf

[12] U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. Building the Evidence Base for Social Determinants of Health Interventions. May 2021. Microsoft Word - PR-A1010-1_final_mw.docx (hhs.gov)

[13] The Need for Medical-Legal Partnership. (2020, October 8). Medical-Legal Partnership.

https://medical-legalpartnership.org/need/

[14] Pardalos, P. M., Brandfield, J., Hoskote, S. S., Segal, S. N., Chug, L., Modrykamien, A., & Eden, E. (2012). Environmental improvements brought by the legal interventions in the homes of poorly controlled inner-city adult asthmatic patients: a proof-of-concept study. Journal of Asthma, 49(9), 911–917. https://doi.org/10.3109/02770903.2012.724131

[15] Valverde, J. N. R., Backstrand, J. R., Hills, L., & Tanuos, H. (2019). Medical-Legal Partnership Impact on Parents’ Perceived Stress: A Pilot Study. Behavioral Medicine, 45(1), 70–

77. https://doi.org/10.1080/08964289.2018.1481011

[16] Taylor, D. J., Bernstein, B., Carroll, E., Oquendo, E. J. C., Peyton, L., & Pachter, L. M.

(2015). Keeping the Heat on for Children’s Health: A Successful Medical–Legal Partnership Initiative to Prevent Utility Shutoffs in Vulnerable Children. Journal of Health Care for the Poor and Underserved, 26(3), 676–685. https://doi.org/10.1353/hpu.2015.0074

[17] Findings from the 2016 NCMLP national survey. (2017, December 20). Medical-Legal Partnership. https://medical-legalpartnership.org/mlp-resources/2016-ncmlp-survey-report/

II. Federal Award Information

Funding Instrument Type:

CA (Cooperative Agreement) Estimated Total Funding:

$1,600,000 Expected Number of Awards:

Award Ceiling:

$250,000 Per Project Period

Award Floor:

$100,000 Per Project Period

Average Projected Award Amount:

$175,000 Per Project Period

Anticipated Project Start Date:

09/29/2023 Length of Project Periods:

18-month project period and budget period

Additional Information on Project Periods and Explanation of 'Other' https://aspe.hhs.gov/sites/default/files/documents/e400d2ae6a6790287c5176e36fe47040/PR-A1010-1_final.pdf https://medical-legalpartnership.org/need/ https://doi.org/10.3109/02770903.2012.724131 https://doi.org/10.1080/08964289.2018.1481011 https://doi.org/10.1353/hpu.2015.0074 https://medical-legalpartnership.org/mlp-resources/2016-ncmlp-survey-report/

Additional Information on Awards:

Awards made under this funding opportunity are subject to the availability of federal funds.

Applications requesting an award amount that exceeds the Award Ceiling per budget period, or per project period, as stated in this section, will be disqualified from competitive review and funding under this funding opportunity. This disqualification applies only to the Award Ceiling listed for the first 12-month budget period for projects with multiple budget periods. If the project and budget period are the same, the disqualification applies to the Award Ceiling listed for the project period. Please see Section III.3. Other, Application Disqualification Factors.

Note: For those programs that require matching or cost sharing, recipients will be held accountable for projected commitments of non-federal resources in their application budgets and budget justifications by budget period or by project period for fully funded awards, even if the projected commitment exceeds the required amount of match or cost share. A recipient's failure to provide the required matching amount may result in the disallowance of federal funds.

For more information on these requirements, see Section III.2. Cost Sharing or Matching.

Description of ACF's Anticipated Substantial Involvement Under the Cooperative Agreement Award

The responsibility for the management, control, direction, or performance of the project will be shared by OCS and the recipient. OCS will have the right to intervene (including interruption or modification) in the conduct or performance of project activities if the recipient does not adhere to the goals and objectives as outlined in the NOFO and a signed cooperative agreement.

OCS program involvement will include the following:

Providing program guidance and input, as appropriate;

Approving all work plans and schedules;

Reviewing and providing feedback on the activities, documentation, procedures, measures, and tools established and implemented for accomplishing the goals of the cooperative agreement throughout the duration of the initiative;

Reviewing, providing feedback, and concurring with activities, procedures, tools, measures, products, and written materials prior to external communication and dissemination on an ongoing basis;

Providing support for the federal evaluation contractor and recipients in meeting the requirements of the federal evaluation; and

Participating in the presentation of results in publications.

III. Eligibility Information

III.1. Eligible Applicants

Long-standing MLPs.

To be eligible for this award, applicants must submit signed documentation on letterhead (i.e., a contract, MOU, or other declaration of partnership) demonstrating the MLP partnership and attesting to at least 5 years of experience operating as an MLP. Documentation must be titled

“Evidence of Medical-Legal Partnership Operation" in the application. Documentation must be added to the Appendix section of the application.

IMPORTANT: Documentation must be on official letterhead and must be signed by all parties involved in the MLP.

Applications from individuals (including sole proprietorships) and foreign entities are not eligible and will be disqualified from competitive review and funding under this funding opportunity. See Section III.3. Other, Application Disqualification Factors.

III.2. Cost Sharing or Matching

Cost Sharing / Matching Requirement:

Yes Recipients are required to meet a non-federal share of the project cost, in accordance with in accordance with Social Security Act Section 1110(a)(1)(A), which states that the funding is to be used for making grants to States and public and other organizations and agencies for paying part of the cost of research or demonstration projects.

For all federal awards, any shared costs or matching funds and all contributions, including cash and third-party in-kind contributions, must be accepted as part of the recipient’s cost sharing or matching when such contributions meet all criteria listed in 45 CFR § 75.306.

For awards that require matching by statute, recipients will be held accountable for projected commitments of non-federal resources in their application budgets and budget justifications by budget period, or by project period for fully funded awards, even if the projected commitment exceeds the amount required by the statutory match. A recipient’s failure to provide the statutorily required matching amount may result in the disallowance of federal funds.

Recipients will be required to report these funds in the Federal Financial Reports.

For awards that do not require matching or cost sharing by statute, where “cost sharing” refers to any situation in which the recipient voluntarily shares in the costs of a project other than as statutorily required matching, recipients will be held accountable for projected commitments of non-federal resources in their application budgets and budget justifications by budget period, or by project period for fully funded awards. These include situations in which contributions are voluntarily proposed by a recipient or subrecipient and are accepted by ACF. Non-federal cost sharing will be included in the approved project budget so that the recipient will be held accountable for proposed non-federal cost sharing funds as shown in the Notice of Award (NoA). A recipient’s failure to provide voluntary cost sharing of non-federal resources that have been accepted by ACF as part of the approved project costs and that have been shown as part of the approved project budget in the NoA, may result in the disallowance of federal funds. Recipients will be required to report these funds in the Federal Financial Reports.

Recipients must provide at least 10 percent of the total approved cost of the project. The total approved cost of the project is the sum of the ACF (federal) share and the non-federal share. The non-federal share may be met by cash or in-kind contributions, although recipients are encouraged to meet their match requirements through cash contributions. For example, if the total approved project cost is $277,778, in order to meet the match requirements, a project requesting $250,000 in ACF (federal) funds must provide a non-federal share of the approved total project cost of at least $ 27,778, which is 10 percent of the total approved project cost.

Non-federal resources will be evaluated under criteria found in Section V.1. of this funding opportunity.

III.3. Other

Application Disqualification Factors Applications from individuals (including sole proprietorships) and foreign entities are not eligible and will be disqualified from competitive review and funding under this funding opportunity.

Award Ceiling Disqualification

Applications that request an award amount that exceeds the Award Ceiling per budget period or per project period ("per project period" refers only to fully funded awards), as stated in Section II. Federal Award Information, will be disqualified from competitive review and funding under this funding opportunity. This disqualification applies only to the Award Ceiling listed for the first 12-month budget period for projects with multiple budget periods. If the project and budget period are the same, the disqualification applies to the Award Ceiling listed for the project period.

Required Electronic Application Submission

ACF requires electronic submission of applications at Grants.gov. Paper applications received from applicants that have not been approved for an exemption from required electronic submission will be disqualified from competitive review and funding under this funding opportunity.

Applicants that do not have an internet connection or sufficient computing capacity to upload large documents to the internet may contact ACF for an exemption that will allow the applicant to submit applications in paper format. Information and the requirements for requesting an exemption from required electronic application submission are found in "ACF Policy for Requesting an Exemption from Electronic Application Submission."

Missing the Application Deadline (Late Applications)

The deadline for electronic application submission is 11:59 pm ET on the due date listed in the Overview and in Section IV.4. Submission Dates and Times. Electronic applications submitted to Grants.gov after 11:59 pm ET on the due date, as indicated by a dated and time-stamped email from Grants.gov, will be disqualified from competitive review and funding under this funding opportunity. That is, applications submitted to Grants.gov, on or after 12:00 am ET on the day after the due date will be disqualified from competitive review and funding under this funding opportunity.

https://www.acf.hhs.gov/sites/default/files/documents/ACF_Policy_for_Requesting_an_Exemption_from_Required_Electronic_FINAL_0.pdf https://www.acf.hhs.gov/sites/default/files/documents/ACF_Policy_for_Requesting_an_Exemption_from_Required_Electronic_FINAL_0.pdf

Applications submitted to Grants.gov at any time during the open application period, and prior to the due date and time, which fail the Grants.gov validation check, will not be received at, or acknowledged by ACF.

Each time an application is submitted via Grants.gov, the submission will generate a new date and time-stamp email notification. Only those applications with on-time date and time stamps that result in a validated application, which is transmitted to ACF will be acknowledged.

The deadline for receipt of paper applications is 4:30 pm ET on the due date listed in the Overview and in Section IV.4. Submission Dates and Times. Paper applications received after 4:30 pm ET on the due date will be disqualified from competitive review and funding under this funding opportunity. Paper applications received from applicants that have not received approval of an exemption from required electronic submission will be disqualified from competitive review and funding under this funding opportunity.

Additional Disqualification Factors

Applications that do not provide the required documentation outlined in Section IV.2. The Project Description, Additional Eligibility Documentation will be disqualified from competitive review and funding under this NOFO.

Notification of Application Disqualification Applicants will be notified of a disqualification determination by email or by USPS postal mail within 30 federal business days from the closing date of this NOFO.

IV. Application and Submission Information

IV.1. Address to Request Application Package

Thom Campbell Department of Health and Human Services Administration for Children and Families Office of Community Services 1401 Mercantile Lane, Suite 401 Largo

MD

20774 1-855-792-6551

HHS-2023-ACF-OCS-EMP-0085

ocstech@reviewops.org…