Sustainability of Funding Toolkit for Childhood Lead Poisoning Prevention Programs Disclaimer: The findings and conclusions in this document have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy. Table of Contents Introduction .......................................................................................................................... 1 Essential Childhood Lead Poisoning Prevention Program Activities ........................................ 5 Category 1: Outreach and Education .......................................................................................... 5 Category 2: Surveillance .............................................................................................................. 5 Category 3: Follow-up to Elevated Blood Lead Levels ................................................................ 6 3.1: Case Management ......................................................................................................................... 6 3.2 Environmental Investigations.......................................................................................................... 7 3.3: Linkages to Services ....................................................................................................................... 7 Category 4: Abatement of Lead Hazards .................................................................................... 7 4.1: Lead-Based Paint Hazard Control .................................................................................................. 7 4.2: Community-based Environmental Contamination ......................................................................... 8 4.3: Lead-Safe Childcare Facilities and Schools ..................................................................................... 8 Tool: Essential CLPPP Activities Checklist.................................................................................... 9 Sources of Funding and Revenue for Childhood Lead Poisoning Prevention Programs .......... 10 Federal Sources of Funding and Revenue ................................................................................. 10 Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR) ............................................................................................................................................... 10 Childhood Lead Poisoning Prevention Cooperative Agreement ................................................ 10 Enhancing Innovation and Capabilities of the Environmental Public Health Tracking Network 11 Public Health Associate Program ................................................................................................ 11 ATSDR’s Partnership to Promote Local Efforts to Reduce Environmental Exposure.................. 12 U.S. Department of Housing and Urban Development (HUD) ............................................................ 13 Lead-Based Paint Hazard Reduction Grant Program .................................................................. 13 Lead and Healthy Homes Technical Studies Program ................................................................. 14 Community Development Block Grant Program ........................................................................ 15 Lead-Based Paint Capital Fund Program ..................................................................................... 17 Housing Choice Voucher Program .............................................................................................. 17 Home Investment Partnership Program ..................................................................................... 18 Authority to Accept Unsolicited Proposals for Research Partnerships ....................................... 19 U.S. Environmental Protection Agency (EPA) ...................................................................................... 20 Superfund Program ..................................................................................................................... 20 Brownfields Program .................................................................................................................. 22 The Water Infrastructure Improvements for the Nation Act Grants .......................................... 23 Drinking Water State Revolving Fund ......................................................................................... 25 Water Infrastructure Finance and Innovation Act Program ....................................................... 26 State Environmental Justice Cooperative Agreements Program ................................................ 27 Environmental Justice Collaborative Problem-Solving Cooperative Agreement Program ......... 28 Environmental Justice Small Grants Program ............................................................................. 28 U.S. Department of Health and Human Services (HHS) – Other ......................................................... 29 Head Start ................................................................................................................................... 29 Title V Maternal and Child Health Services Block Grant Program .............................................. 31 Healthy Start ............................................................................................................................... 33 United States Department of Agriculture (USDA) ............................................................................... 34 Supplemental Nutrition Assistance Program and SNAP Education ............................................ 34 Special Supplemental Nutrition Program for Women, Infants, and Children ............................ 35 State Sources of Funding and Revenue ..................................................................................... 36 State General Funds .................................................................................................................... 36 State Lead Service Line Replacement Programs ......................................................................... 37 Medicaid ..................................................................................................................................... 39 Fees and Taxes ............................................................................................................................ 42 Penalties and Fines ..................................................................................................................... 43 Tax Credits ................................................................................................................................... 44 Lawsuits and Settlements ........................................................................................................... 45 Nongovernmental Sources of Funding and Revenue ............................................................... 45 Nonprofit Hospitals ..................................................................................................................... 45 Hospital Community Benefits ..................................................................................................... 47 Banks and Financial Institutions .................................................................................................. 48 Pay for Success Programs ........................................................................................................... 49 Table 1: Sources of Funding and Revenue for Essential CLPPP Activities ................................. 50 Blending and Braiding Models for Childhood Lead Poisoning Prevention Programs .............. 52 Blending ..................................................................................................................................... 53 Braiding ..................................................................................................................................... 56 Tool: Blank Sources of Funding and Revenue for Essential CLPPP Activities Table .................. 58 Limitations and Challenges .................................................................................................. 60 Conclusion ........................................................................................................................... 61 References .......................................................................................................................... 62 Introduction Public health services in the United States are largely delivered and regulated by state and local health departments. Successful implementation of these services by health departments is reliant on adequate and sustained sources of funding across all levels of the public health system. However, consistent underfunding of these services has required health departments to creatively diversify funding streams from several sources to maintain their commitment to promote health and protect the lives of people in their communities. A 2012 report from the Institute of Medicine stated that “the U.S. public health financing structure is broken.”1 As it currently exists, there are large expenditures for individual care paired with a significant underfunding for public health and prevention efforts, especially in certain programs areas, such as environmental health.1 Over the past two decades, inflation-adjusted public health spending in the United States