Financing and Funding

Healthcare Financing for Healthy Homes
This resource library created by NCHH provides a detailed overview of key financing strategies and links to resources for healthy home programs financed through healthcare sources such as nonprofit hospitals and public or private insurance. It offers a “Where to Start” feature that provides a range of options, depending on whether you’re new to healthcare financing of healthy homes or looking for ways to secure reimbursement for healthy home improvements or renovations. [url; NCHH]

Financing Healthy Housing
This brief, created by the National Safe and Healthy Housing Coalition, focuses on potential healthy housing finance avenues. It’s based on findings from a 2008 CDC/NCHH convening that addressed healthy housing interventions known to improve health and reduce risks associated with environmental hazards in the home.
[url; NCHH, 2009]

Sustainable Solutions: Devoting More Resources to Making Housing Healthy
A 2014 Chicago-area summit yielded this document that concisely describes several potential funding streams and resources to support healthy housing improvements. [url, Loyola University-Chicago, 2014]

Federal Funding of Healthy Housing

Following is a listing of various federal, state, and local funding resources available for construction and/or rehabilitation of healthy homes. Some of the federal funding programs (such as HOME) are allocated to the states and administered by state or local housing agencies.

State and Federal Healthy Housing Financing Initiatives
The Association of State and Territorial Health Officials (ASTHO) identified and compiled this concise, informative list of specific funding initiatives, mostly federal. (ASTHO). [url; ASTHO]

U.S. Department of Housing and Urban Development (HUD)
As the nation’s housing and community development agency, HUD funds and administers numerous programs to promote affordable, healthy housing. This link takes the user to HUD’s full listing of competitive grant opportunities. Some key funding opportunities and offices specifically targeted to affordable healthy, energy-efficient, sustainable housing and communities include:

  • National Housing Trust Fund (HTF)
    Annually allocated funds from HUD to states and state-designated entities. At least 80% must be used for rental housing; up to 10% for homeownership; and up to 10% for reasonable administrative and planning costs. HTF funds may be used for affordable housing production or preservation through acquisition, new construction, reconstruction, and/or rehabilitation. All HTF-assisted units are required to have a minimum affordability period of 30 years. [url; HUDExchange]
  • Office of Economic Resilience (OER)
    Manages a portfolio organized under three primary topic areas: Resilience, Place-Based, and Energy Efficiency and Green Building. Many of the programs span more than one issue and support inter-agency collaboration. Offers community grants under its Place Based and Energy Efficiency and Green Building Initiatives [url; HUD]
    • Placed Based Initiatives
      Offers numerous grants and technical assistance to support the integration of housing, transportation, and environmental standards that support regional planning goals; Grants are available as part of the Sustainable Communities Initiative (SCI), which includes, HUD, EPA and DOT. [url; HUD]
    • Energy Efficiency and Green Building
      Coordinates and supports energy-efficiency and green building goals and initiatives. Includes the following programs: Renew300 to increase the use of renewable energy in federally-assisted affordable housing; Multifamily Better Buildings Challenge, a partnership with DOE to increase the energy efficiency of multifamily rental housing; and Energy Efficient, Healthy Homes. [url; HUD]
  • HUD Exchange
    Provides contact information, reports, award, jurisdiction, and location data for all organizations that receive HUD funding under any program. State and local administrators of HUD formula grant programs may be found here. [url; HUD]
  • HUD’s Healthcare and Housing (H2) Systems Integration Initiative
    Offers technical assistance (TA) to states and communities undertaking systems changes needed to build integration and collaboration between housing and healthcare systems. Targeted to homeless population and low-income people living with HIV/AIDS, the goal is to maximize healthcare coverage and increase access to comprehensive healthcare and supportive services coordinated with housing. [url; HUD]
  • USDA Rural Development
    Listing of a range of financial assistance programs available for use in rural areas. Target audiences include nonprofit organizations, individuals, and businesses as well as lenders and utility companies. [url; U.S. Department of Agriculture]
  • Rural Housing: Repair Loans and Grants (Section 504 Home Repair Program)
    Provides loans to very-low-income homeowners to repair, improve or modernize their homes and grants to elderly (62 years and older), very-low-income homeowners to remove health and safety hazards. Maximum loans amount is $20,000 and the maximum grant is $7,500; the two may be combined for up to $27,500.

Centers for Disease Control (CDC) Healthy Homes and Lead Poisoning Prevention Program
This CDC program provides lead poisoning prevention funding on three-year cycles to state and local health agencies. Grantees conduct surveillance to determine the extent of childhood lead poisoning at the state and county levels, educate the public and healthcare providers about lead poisoning, and ensure that lead-exposed children receive necessary medical and environmental follow-up services. Information about grant applications is available from the program’s website; the application announcements and forms are available at Grants.gov. [url; CDC]

CDC Funding
The CDC Funding site provides information about CDC grants contracts, financial reporting and the CDC’s budget cycle. The site also provides information and links to help determine an organization’s eligibility for funding from the CDC, and resources about how the CDC funds research and non-research public health programs. It also provides access to the CDC grants application page to learn more about applying for a grant from the CDC. The CDC posts all of its grant opportunities on grants.gov. [url; CDC]

Grants.gov
This e-government initiative, managed by the U.S. Department of Health and Human Services, is a centralized location for organizations to find and apply for federal funding opportunities. The system provides information on more than 1000 grant programs and evaluates grant applications for federal grant-making agencies. Grants offered through the CDC for their Healthy Homes and Lead Poisoning Prevention program, as well as opportunities from several other federally-sponsored programs can be found here. Filters on the site allow users to search for specific types of grants using key words and funding instrument types. Users can also create an online “Workspace” to receive alerts about funding opportunity announcements (FOAs) as well as to complete grant applications. Organizations can also set up a Workspace to allow multiple members of their staff to work on the same application. [url; Grants.gov]

Guide to Federal Financing for Energy Efficiency and Clean Energy Deployment
The Guide to Federal Funding for Energy Efficiency is a listing of federal funding programs that support energy efficiency upgrades and clean energy projects. Some resources specifically fund energy-related projects; energy efficiency and clean energy are just part of the overall potential use of the funding for others. The guide is organized by market segment and includes a matrix showing the various financial instruments aligned with the federal agency that administers it. [url, pdf; DOE, 2014]

For information specifically on tax credits or state-specific incentives, please see DSIRE. [link]

Weatherization Plus Health
This program is funded by the Department of Energy and administered at the state and local levels. Although funding is limited, weatherization, combined with healthy housing repairs, is an important step in ensuring healthier housing for low-income individuals and families. It ensures that homes being weatherized and made more energy efficient are also healthy.

Federal Tax Credits

Low Income Housing Tax Credit (LIHTC) Program
Tax credit for affordable housing development, renovation and preservation. Allows Investors to claim federal income tax credits based on costs incurred to develop affordable housing. Federal government establishes minimal thresholds, but the program is administered by the states. States develop annual Qualified Allocation Plans (QAPs) that dictate criteria used to award LIHTCs. Many state QAPs require specific provisions, such as green building practices or transportation-oriented development, targeted to state development goals and objectives. LIHTC State administering agencies. Access State QAPs. [url; Novogradac Affordable Housing Resource Center]

Low-Income Housing Tax Credits: Affordable Housing Investment Opportunities for Banks
Discusses how LIHTCs are used to finance affordable housing development and how banks and financial institutions participate as investors and lenders. Outlines risks and regulatory considerations of LIHTC
investments, including impact they have on Community Reinvestment Act (CRA) examinations. Includes LIHTC-related financing case studies. [url, pdf; U.S. Office of the Comptroller of the Currency (OCC), 2014]

Energy Efficiency Tax Credits
Provides detailed information about what energy efficiency upgrades are eligible for federal income tax credits. [url; Energy Star]

Community Reinvestment Act (CRA)
Not a funding source per se. Data collected on financial institutions to fulfill CRA requirements could be used by housing and health practitioners to identify noncompliant lending institutions such as banks and credit unions. Non-compliant Institutions may be willing to work with local nonprofits to create a funding source to support healthy housing repair loans and grants as a means of coming into compliance with CRA. [url; Federal Financial Institutions Examination Council (FFIEC)]

State and Local Funding Opportunities

Low Income Housing Energy Assistance Program (LIHEAP)
Although LIHEAP funds are allocated to the states by the federal government, states administer the Funds. LIHEAP funds used for weatherization is limited to 15% of the available funding (or up to 25% with a waiver from HHS). Beyond this requirement, states have much discretion in designing and implementing their respective LIHEAP programs. [url; U.S. Department of Health and Human Services]

LIHEAP Clearing Housing
Provides information about individual state programs, including administrative and delivery practices, and links directly to the state and local administering agency. Also provides “Snapshots” of key LIHEAP characteristics found in each program, along with details of its non-federal low-income energy programs (state- and utility-funded, and charitable) are also available. [url; U.S. Department of Health and Human Services]

County Health Rankings and Roadmaps Funding Guide
Helps communities identify and access funding resources for community health initiatives. [url; County Health Rankings]

State and Local Housing Trust Funds
Funds established by state and local governments which receive dedicated public monies to support preservation and production of affordable housing. Although access to funds varies, housing renovation and repair is an essential eligible use in nearly every state and local housing trust fund. List of state and local housing trust funds. If your jurisdiction does not have an existing housing trust fund, the Housing Trust Fund Project offers more information and technical assistance to help establish local housing trust funds. [url; Center for Community Change Housing Trust Fund Project]

  • Example: Polk County Housing Trust Fund
    The Polk County Housing Trust Fund created the Healthy Homes East Bank (HHEB) (Healthy Homes Des Moines) intervention to reduce clinic and hospital visits tied to pediatric asthma in three low-income neighborhoods. The program uses health education and community health workers to raise families’ awareness, and home repairs to improve indoor air quality. [url; Polk County Housing Trust Fund]

Talking Housing and Health in Washington, DC

  • Example: Washington State Housing Trust Fund
    Supports weatherization and home repair programs to reduce energy dependence, while decreasing energy costs for low-income families and improving the health and safety of their homes.
    [url; Housing Consortium]

Housing Bonds

States and local jurisdictions have the authority to issue bonds, including general obligation and private activity bonds, to support specific goals and objectives or projects. Private Activity Bonds (PAB) are issued by the state in conjunction with 4% low-income housing tax credits for specific development projects, while General Obligation (GO) Bonds may be issued by either a state or a locality for a variety of purposes, including development, renovation, and preservation of affordable housing. GO Bonds are subject to voter approval. Novogradac maintains a resource guide and links to state allocating agencies.

  • Example: Austin Affordable Housing Bond
    Austin voters approved a bond proposition that provides $65 million to support repair, construction, renovation of affordable housing for low-income people and families. [url; City of Austin, 2013]

Local Funding/Incentive Programs

Several state and local jurisdictions offer “incentive” funding to assist with housing repairs and energy efficient upgrades. Lacking the upfront money to make the repairs, low-income households are often eligible for forgivable low-interest loans or grants. Although many programs are geared to low- and moderate-income homeowners, there are models with no income limits. For example, in the case of loans, eligibility can be based on a tiered system in which households pay varying rates of interest based on income, so that higher-income households pay higher interest rates than moderate- and low-income households. Programs are often launched through seed money from the local jurisdiction or other funder(s) to support the work on low-income housing, while a pool of ongoing funding is created from the interest on higher-income loans.

Home Repair Program Examples

  • City of Dallas Home Repair Program
    Offers deferred loans to low-income homeowners for major systems repairs (MSRP) such as roof replacement, replacement or upgrades to plumbing, electrical and HVAC. The program also offers no-interest, deferred payment loans for reconstruction of homes referred from the MSRP program. A percentage of the MSRP loans are reduced annually as long as the owner remains in the home.
    [url, City of Dallas]
  • Boulder, CO, Low-Interest Home Repair Loan Fund
    A low-interest loan fund, based on financial need, in which the owner-occupant can defer repayment of the loan for 15 years or until they sell the house, whichever comes first. [url; City of Boulder, CO]
  • Milwaukee, WI Low-Interest Home Repair Loans
    A loan fund somewhat similar to Boulder’s (although not as flexible) which offers lower loan amounts and provides a clear listing of eligible repairs. [pdf; City of Milwaukee]

Property Tax Abatement or Exemptions
Exempts or defers (i.e., “abates”) property taxes on the value of the improved portion of a property for a prescribed period of time. Most programs do not cover improvements that could be considered routine maintenance such as roof or window replacement.

  • Example: Cleveland, OH Residential Tax Abatement Program
    Offers tax rebates for both single-family homes and multifamily properties for renovations and conversion of nonresidential buildings to residential units. The tax abatement and period of abate is determined by the County Auditor’s Office based on the type of improvements. [url; City of Cleveland, OH]
  • Energy Efficiency Example: Cambridge Energy Alliance
    Nonprofit established by Cambridge (MA) to promote energy efficiency and renewable energy. Offers no-cost energy assessments for any building in Cambridge; no-cost weatherization for low-income residents; financing for solar energy and energy efficient upgrades; and educational resources on energy efficiency and renewables. Available to residents, businesses, and institutions, with specific services targeted to low-income residents and landlords of low-income properties. Pooled resources help ongoing funding of projects targeted to low-income population. [url; Cambridge Energy Alliance]

State Tax Credits
Many state offer tax credits to help homeowners make specific repair or renovation upgrades such as lead or asbestos abatement, or to promote other state goals such as energy efficiency. DSIRE provides the most comprehensive list of energy efficiency and renewable tax credits available at the state or local level.

  • Example: Massachusetts Lead Paint Removal Credit
    State tax credit to help residents offset costs associated with abating lead hazards. Residential property owners can claim a tax credit equal to the lesser of the cost of containment or abatement of lead hazards or $1,500 if they are fully compliant with lead abatement regulations. The state also offers a lower tax credit for interim control measures. [url; State of Massachusetts]
  • Example: New York Asbestos Removal Tax Credit
    State tax credit for eligible individuals and developers to cover a percent of the costs associated with removal of asbestos from residential or commercial property. Provides a 20% credit of all eligible costs incurred from asbestos remediation from building 25 years or older, not to exceed $1 million over a three-year period. [url; New York State Senate]

Database of State Incentives for Renewables and Efficiency (DSIRE)
Most comprehensive source of information on incentives and policies supporting renewables and energy efficiency in the United States. Includes resources for developers, policymakers, researchers, and the general public. [url; DSIRE]

Green Affordable Housing Preservation Loan Fund
Reduced interest loans to affordable housing developers for energy efficient improvements and to ensure properties are environmentally sustainable. Funding supports: integrated plan and design, energy efficiency measures, use of materials beneficial to the environment, water conservation, healthy living environment, location and smart growth, site improvements, resident and management education and information.
[url; National Housing Trust]

Utility Rebate Programs
Provides a listing of state, local government and utility rebate programs to promote installation of renewal energy sources and energy efficiency measures. Matrix indicates where the rebate program is located, the type of incentive, program eligibility and eligible technologies covered under the program. [url; Open Energy Information]

Philanthropic

Numerous foundations, both national and community, fund healthy housing and community development efforts, from a healthcare, affordable housing, or sustainable, smart growth perspective. Funding cycles may vary, as may focus areas, from one year to the next.

The Foundation Center
Resource for information about philanthropic organizations; maintains the most comprehensive database on U.S. grantmakers and their grants. The site provides a robust library of research, education, and training programs about philanthropic opportunities. Health Fund Watch is the Foundation Center’s newsletter on health-related topics. It provides links to health-related news and resources, as well as highlights funding opportunities for individuals and organizations. [url; Foundation Center]

Community Foundations
Council on Foundations (COF) provides a map and listing of community foundations across the country. Community Foundations generally only fund efforts within a specific community and/or region. You can click on the site map to see a listing of COF Community Foundations for each state. Listings provide contact information and links to Foundations’ sites, which offer more specific information about the types of support they offer. [url; COF]

  • Example: Episcopal Health Foundation
    Based in Houston, Texas, the Foundation was established through a transfer of the St. Luke’s Episcopal Health System by the Episcopal Diocese of Texas to Catholic Health Initiatives. The Foundation operates as a supporting organization of the Episcopal Diocese of Texas, working to improve the health and well-being of the 10 million people living in the 57 counties of the Diocese. [url; Episcopal Health Foundation]

Healthy Futures Fund
Uses LIHTCs and New Market Tax Credits to expand low-income residents’ access to healthcare and affordable housing. Funding supports construction of affordable housing units with integrated health services and federally qualified health centers. The fund also attempts to expand collaboration between affordable housing developers and healthcare providers. [url; Healthy Futures Fund]

Home Depot Foundation
The Home Depot Foundation offers Community Impact Grants of up to $5,000 to registered nonprofit organizations to help fund community projects. [url; Home Depot Foundation]
Robert Wood Johnson Foundation (RWJF)

Supports multiyear research and innovative programs designed to move the needle on community health. Most grants are awarded via calls for proposals (CFPs). RWJF also accepts brief proposals for projects to solving health and health care problems. Health Beyond Healthcare: Housing addresses RWJF’s interest in building the integration of housing with health initiatives. List of recent grant awards. [url; RWJF]

Funder Affinity Groups

Several funder collaboratives, or “affinity” groups, have formed to share information, build awareness, and in some cases pool funding to support healthy housing and community efforts. Although not all of the organizations listed provide funding, they may provide information on the foundations and corporate giving programs working in the healthy housing and community arena. The Grantseeker’s Guide to Foundation Affinity Groups provides a broader list of Affinity Groups, information about their focus areas, and strategies to help non-profits work with them. [url; Blue Avocado]

Health and Housing Funders’ Forum
Created to align philanthropic funding plans and priorities in the housing and health space. Fosters collaboration between philanthropic organizations to make a significant impact in the areas of healthy housing and healthy communities for vulnerable populations. Members help create a multidisciplinary impact in areas such as health equity, sustainability, housing and community development, and public health. [url; NCHH]

BUILD Health Challenge
Funder collective supporting integrative health interventions created through collaborations between health systems, community-based organizations and leaders, and local health departments. Challenge goal is to identify, support, and put a spotlight on best practice models and innovative approaches which focus on upstream factors such as the built environment, transportation and housing that influence health. [url; BUILD Health Challenge]

Grantmakers-in-Health (GIH)
Educational organization focused on helping foundations and corporate giving programs improve the health of all people. Generates and disseminates information about health issues and grantmaking strategies that work in health by offering issue-focused forums, workshops, and large annual meetings; publications; continuing education and training; technical assistance; consultation on programmatic and operational issues; and by conducting studies of health philanthropy. [url; Grantmakers-in-Health]

Funders’ Network for Smart Growth and Livable Communities
The Funders’ Network is a membership organization that helps grantmakers advance strategies to create fair, prosperous, and sustainable regions and communities. Several working or “affinity” groups of funders, focused on issues related to healthy housing and communities, have evolved from the Funders’ Network including:
[url; Funders’ Network]

  • Partners for Places A matching grant program that helps improve communities by building partnerships between local government sustainability offices and place-based foundations. National funders invest in local projects to promote a healthy environment, a strong economy, and well-being of all residents.
  • Restoring Prosperity in Older Industrial Cities A working group focused on neighborhood revitalization, transportation and land issues, and economic development in older industrial cities that have been significantly impacted by the recession and sprawling development patterns. The group works to bolster federal and state policy, foster capacity building, and promote best local/regional models and practices.

Enterprise Community Partners
National nonprofit intermediary supporting preservation and development of affordable housing. In addition to the Enterprise Green Communities (EGC) program, which is specifically geared toward affordable green housing development and rehabilitation, Enterprise’s Health and Housing Initiative helps link low-income housing and healthcare. Enterprise Community Investment offers low-income housing funding via LIHTC, New Market Tax Credits, and a Community Loan Fund. [url; Enterprise Community Partners]

Crowdsourcing for Affordable Housing and Community Development

Crowdsourcing leverages social networking tools to create funding, build support, and gather input into specific projects. Although not the standard method currently used by many healthcare, affordable housing or community development practitioners, Crowdsourcing provides a novel option to funding healthy housing projects through loans, grants, and other common tools.The Complete Idiot’s Guide to Crowdsourcing
The Complete Idiot’s Guide to Crowdsourcing documents how Bristol, CT, crowdsourced its downtown redevelopment and provides step-by-step instructions to help other communities use crowdsourcing for their revitalization efforts. [url; Cool Town Studios].

For more information, also see:

Crowdsourcing for a Common Good: A Community Development Approach
Highlights various ways and places crowdsourcing has been utilized in a community development context, either to raise funds for specific projects, gain community input and support, or to help respond to disasters.
[url; Federal Reserve Bank of Atlanta]

Hospital Community Benefits

Hospital Community Benefits
According to federal tax law, nonprofit hospital organizations must allocate some of their surplus funding to “community benefits.” Provides information about how hospitals and healthcare providers are implementing community benefits requirements. [url; NCHH

]IRS Confirms Hospital Community Benefits Can Be Used for Safe and Healthy Housing
On December 18, 2015, the IRS confirmed that hospitals are permitted to report expenditures for healthy housing as community benefit expenditures on page 1 of Schedule H: “[S]ome housing improvements and other spending on social determinants of health that meet a documented community need may qualify as community benefit for the purposes of meeting the community benefit standard,” the agency’s December 18 EO Update (Issue Number 2015-9) states.

Hospital Community Benefit: How Partnerships Can Support Healthy Communities
Provides specific examples of how Hospital Community Benefits are promoting healthy affordable housing and community initiatives. [url; Health Affairs]

Developer Community Benefits

Legally binding contract negotiated between various community entities. In community development, a community benefit agreement (CBA) is generally between a developer and coalition representing community members impacted by the development. The developer agrees to provide certain benefits in exchange for community support for a specific project. Benefits often include provisions such as funding for affordable housing repair programs or workforce development agreements.

Summary and Index of Community Benefit Agreements
List of CBAs implemented across the country. [url, pdf; Tulane Public Law Center, 2011]

Community Benefits Law Center
Provides legal assistance to community-based organizations and government entities to help navigate the legal and policy related to development of community benefit agreements. [url; For Working Families]

Information on Healthcare Savings Due to Affordable Housing and Connecting Affordable Housing and Health

Numerous reports illustrating how funding for affordable housing and affordable housing renovations helps reduce healthcare costs by taking an “upstream” approach to health issues. Integrating funds previously reserved for “health” with housing interventions designed to promote healthier homes can help reduce asthma triggers, prevent home injuries and falls, and reduce healthcare costs associated with repeat hospitalization and emergency care treatments.

Health and Housing Reports: Center for Housing Policy, National Housing Conference (NHC)
A series of housing and health reports from the National Housing Conference (NHC) providing innovative ideas and insights about how to integrate affordable housing and healthcare. Cites some potential funding sources; provides evidence-based arguments for integration of housing and healthcare funding [url, pdf; National Housing Conference, Center for Policy Studies]

  • Addressing Housing as a Healthcare Treatment
    Examines accountable care organizations (ACOs), a new system of delivering Medicare health care, coverage of the costs of medical care, similar to a health insurance company, as well as coordinate health and social services. ACOs focus on preventive care and healthcare coordination to reduce costs related to expensive acute care. [2015]

Health in Housing: Exploring the Intersection between Housing and Health Care
Oregon Health in Housing study which explores the link between affordable housing and health care. Using national health reform metrics, the study found that integrating housing and healthcare led to better primary care, fewer emergency department visits, improved access to and quality of care, and lower costs. Read the full report. [url; Enterprise Community Partners, 2016] [link]

To Reduce Health Costs, Insurer Pays for Housing
September 2015 article in The Texas Tribune about United Healthcare’s innovative approach to supportive housing to lower healthcare costs. [url; Texas Tribune]

Hospitals Must Address Housing in Treating the Homeless
November 2015 article in the Journal of Modern Healthcare, written by an Emergency Room physician, exploring the need for healthcare providers (e.g., hospitals) to support supportive housing to reduce overall healthcare costs. [url; Modern Healthcare News]

Housing as Health Care — New York’s Boundary-Crossing Experiment
Discusses New York State’s investment in supportive housing to address growing Medicaid costs. Study shows supportive housing costs are largely offset by savings resulting from a reduced use of the healthcare system. Funding for capital, operating expenses, rent subsidies, and services are integrated to finance supportive housing units targeted to high-need, high-cost Medicaid recipients. [url; New England Journal of Medicine]

Potential for Energy Savings in Multifamily Affordable Housing
Documents the economic and energy savings potential by making multifamily affordable housing more energy-efficient. Uses data gathered from a sample of states to show estimated savings in electricity and natural gas usage generate by adoption of energy efficiency programs in multifamily affordable housing. Includes specific findings (and fact sheets) for Georgia, Illinois, Maryland, Michigan, Missouri, New York, Pennsylvania, and Virginia. Read the full report. [url; Energy Efficiency for All, 2015]