Corporation for Enterprise Development Integrating Financial Capability Services into Community Health Centers
November 2016
As health practitioners know, staying healthy takes more than just health care. Only 50% of health outcomes are
determined by health behaviors, genetic factors and access to quality clinical care. The other 50% is determined by social
and economic factors, along with elements of one’s physical environment.
2
These factors, otherwise known as “social
determinants of health,” include low household income, poor housing conditions and limited support systems. In recent
years, more and more people across a variety of sectors have come to realize that addressing these socioeconomic factors
will have the highest potential impact on public health outcomes.
3
Relatedly, poor nancial well-being, or the level of
satisfaction and control one feels around their nances both currently and in the future, can lead to toxic stress and other
conditions that contribute to poor health outcomes.
4
Providing nancial capability services—such as nancial coaching,
access to benets, or credit-building products and services—to low- and moderate-income individuals can improve their
nancial well-being and may therefore enhance health outcomes through mechanisms such as stress reduction. While
more research is needed to beer understand these
relationships, it is critical to explore opportunities to
leverage nancial capability services to boost health
outcomes. Community health centers (CHCs), which
serve low-income clients with poor social determinants
of health, are an ideal seing for exploring these
relationships and helping patients improve both
nancial and health outcomes.
There is compelling evidence demonstrating the
close ties between nancial well-being and physical
and mental health. Individuals with low incomes
are signicantly more likely to experience serious
and expensive health challenges, such as high blood
pressure, compromised immune systems and cancer.
5
Integrating Financial Capability Services
into Community Health Centers
Good Health Requires More Than Just Good Health Care
This brief is the fourth of a ve-part series that highlights the need and opportunity for integrating nancial capability services
into social service programs. The goal of this integration is to improve overall nancial outcomes that lead to nancial security for
low- and moderate-income households. This brief concentrates on why providers of health care services should focus on the multiple
dimensions of individuals’ nancial lives and how the government can encourage the integration of nancial capability services
into the community health care system.
The rst brief in this series describes the need for integrating nancial capability into social services, the second focuses on
integrating nancial capability into career pathway services and the third discusses the integration of nancial capability into the
housing system.
1
1
INCREASING FINANCIAL WELL-BEING
THROUGH INTEGRATION
Joanna Ain, Senior Policy Manager
[email protected] | 202.595.2619
David Newville, Director of Government Aairs
[email protected] | 202.207.0147
Alicia Atkinson, Independent Consultant
Parker Cohen, Associate Director
Savings & Financial Capability
[email protected] | 202.207.0159
$10,000
or less are
$100,000
or more
3X
more likely to
die by 65 than
those with
HOUSEHOLDS WITH ANNUAL INCOMES OF
Source: Reaching for a Healthier Life, 2007.
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INCREASING FINANCIAL WELL-BEING THROUGH INTEGRATION
In fact, research nds that people whose annual household incomes are below $10,000 are three times more likely to
die before turning 65 than those with annual household incomes of $100,000 or more.
6
However, nancial well-being
is about more than just income; it includes other critical factors, like saving for emergencies, not feeling stressed out by
bills and being able to reach nancial goals. Forty-four percent of households in the United States live in liquid asset
poverty, meaning they lack the savings needed to survive at the poverty level for three months in the event of a job loss or
other income disruption.
7
For these households living on the nancial edge, building nancial capability and assets could
potentially open the door not only to greater economic security but also to a longer, healthier life.
Given the relationship between nancial health and physical and mental health, investing in the nancial well-being of
low- and moderate-income individuals through community health centers may help improve health outcomes. CHCs
are community-based organizations whose primary goal is to provide underserved populations with access to critical
primary and preventive health care services. CHCs represent a crucial opportunity to change the unequal nature of health
outcomes today, which will require that we build upon the strong foundation laid by the Aordable Care Act (ACA).
While increased access to health care is an important rst step, simply spending more on access to health care is insucient
for improving health outcomes. The ACA was founded on the recognition that improving health care and community
health requires that we also aend to the social determinants of health.
8
Many of the social determinants of health can
be addressed through nancial capability services—services like nancial coaching, free tax ling assistance and credit
counseling—which work to alleviate many of the nancial stressors that contribute to poor physical and mental health.
CHCs are ideal places into which nancial capability services should be integrated because they are a proven model
for serving low- and moderate-income individuals who have already established trust in the integrated services CHCs
oer beyond clinical care. A number of dierent nancial capability services can be administered by CHCs through a
variety of models, depending on the needs of the population being served and the resources of the particular CHC. There
are also a variety of steps that policymakers can take to facilitate the integration of nancial capability services into the suite
of services already oered by CHCs. Each of these topics and more are explored in greater detail throughout this brief.
NEEDS
■ Quality diet
■ Routine exercise
■ Consistent medication
■ Regular medical
appointments
BARRIERS
FINANCIAL
OUTCOMES
■ Unemployment
■ Medical debt
■ Bankruptcy
■ Debt collection
■ Weakened
credit score
HEALTH
OUTCOMES
Health & Finances: A Reciprocal Relationship
AN ONGOING CYCLE
OF HEALTH & FINANCES
By looking at an individual example, we can
start to better understand the connection
between health care and nances and why
health care alone is not enough to prevent
or mitigate poor health outcomes. Imagine a
woman with diabetes working a low-wage job.
To manage the disease, she needs a quality
diet, routine exercise, consistent medication
and regular medical appointments. But
with obstacles such as inconsistent income,
low savings, unreliable transportation, little
access to fresh food and long work hours,
it is extremely difcult for her to manage
the disease effectively. Barriers to preventive
care can lead to surgery, forcing her to stop
working for a period of time, often without
pay. Even with health insurance, a high
deductible can lead to medical debt. Medical
debt can not only destabilize her nances but
is also the number one source of personal
bankruptcy.
9
That debt can then lead to
debt collection, the number one reported
consumer protection issue, further weakening
her credit score and ultimately wreaking havoc
on her nances.
10
This story is just one out of
countless examples of how health and nancial
outcomes affect each other.
Integrating Financial Capability Services into Community Health Centers
2
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■ Inconsistent income
■ Low savings
■ Unreliable
transportation
■ Little access to
fresh food
■ Long work hours
■ Surgery
■ Long-term
hospitalization
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INCREASING FINANCIAL WELL-BEING THROUGH INTEGRATION
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Integrating Financial Capability Services into Community Health Centers
Why Integrate Financial Capabilty Services into Community Health Centers?
Low- and moderate-income households face a multitude of barriers to
aaining the health care they need. Unreliable transportation, high medical
debt, lack of sick days, irregular work hours and volatile cash ow are all
barriers to accessing much-needed health interventions. CFED’s 2016 Assets &
Opportunity Scorecard indicates that 14.3% of adults surveyed in 2014 did not
see a doctor when they needed to due to the high cost. For African American
adults, this percentage rises to 18.9%, and for Latino/Hispanic adults, it goes
up to 23.7%.
11
Low- and moderate-income individuals can also have trouble
taking regular medication due to cost.
12
These issues may cause an illness to
worsen and increase the patient’s likelihood of needing a more costly health
intervention in the future. Medical expenses, often leading to medical debt,
pushed about 11 million people into poverty in 2014.
13
Financial insecurity creates barriers that make it dicult for people to
manage their lives, which leads to considerable nancial stress. This stress
can lead to health ramications. Without a nancial safety net, long-term
nancial stress can have negative eects on an individual’s health, employment, and ability to care for themselves and
their families. After the Great Recession, millions of households lost their jobs, saw their homes go into foreclosure
and watched their retirement savings disappear. With these nancial stressors, many individuals reported increased
anxiety, depression, blood pressure and headaches. Any one of these conditions can be disruptive and, over time,
constant physical, mental and nancial stressors can severely impact a household. For children, such toxic stress can
adversely impact learning, behavior and health throughout their lives. However, by building nancial capability, low-
and moderate-income households can more eectively deal with these stressors.
Financial capability supports nancial well-being, and nancial well-being can help produce positive health
outcomes. A household’s nancial knowledge, skills and behaviors, as well as their access to nancial products, all
contribute to the family’s overall nancial capability and lead to nancial well-being. A range of entities, from national
nonprots like CFED to government commissions like the U.S. Department of the Treasury’s Financial Literacy and
Education Commission (FLEC), are engaged in how best to connect those in need of nancial capability services.
Connecting individuals to resources, such as public benets, incentivized savings programs, Volunteer Income Tax
Assistance (VITA) sites and personal nancial coaching, can mitigate nancial challenges. Financial capability services
can also help boost the overall performance of CHCs. While more research is needed, improved nancial capability
may help lead to beer access to transportation for individuals to get to health care, stricter adherence to medication
regimens, higher rates of on-time medical bill payments and lower overall stress levels—with obvious health benets.
Also known as federally qualied health centers (FQHCs), CHCs target low- and moderate-income communities
that are medically underserved and are funded in part by the Health Resource and Service Administration (HRSA).
20
Incorporating nancial capability services into CHCs is an eective use of resources for a number of reasons:
OVERLAP IN POPULATION
Financial capability service providers and CHCs are already serving overlapping populations. For
example, almost half of the patients who used CHCs in 2014 were enrolled in Medicaid and over a
quarter were uninsured.
21
This focus on low-income populations makes these centers ideal sites for
integrating nancial capability services with substantial results.
MULTI-GENERATION APPROACH
CHCs’ holistic approach to care provides an opportunity to address the nancial drivers of poor health
outcomes at every life stage. CHCs serve all ages and are in a position to have impacts over multiple
generations, including where toxic stress often rst manifests—in children.
DOCTOR
1 IN 4
1 IN 5
LATINO/HISPANIC ADULTS
AFRICAN AMERICAN ADULTS
DID NOT VISIT A
DUE TO
COST
&
Source: Assets & Opportunity Scorecard, 2016
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Integrating Financial Capability Services into Community Health Centers
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INCREASING FINANCIAL WELL-BEING THROUGH INTEGRATION
OPPORTUNITIES FOR SCALE
CHCs’ reach is vast—they provide services to more than seven percent of the U.S. population.
22
Implementing nancial capability services into these centers will give tens of millions of individuals each
year the opportunity to build their nancial well-being.
ACCESSIBILITY
CHCs are legislatively required to provide services in a way that best serves their target constituents in
a focused and consistent manner.
24
As a result, these centers often have hours that are conducive to low-
and moderate-income clients’ schedules, which may be irregular or inexible. Many are also located in
neighborhoods with low-income populations. Therefore, CHCs are commonly more accessible than other
social service providers.
FLEXIBILITY
CHCs can deliver nancial capability services through models targeted to the specic needs of the local
community. For example, in a community with a strong network of free tax preparation providers, CHC
sta wouldn’t need to become tax experts. Instead, they could partner to host a tax-preparation site in
the waiting room or simply refer clients to a nearby VITA site. This integration, delivered through direct
service or referrals during times when nancial topics are already being discussed, can help vulnerable
populations quickly and eciently get the resources they need for a host of nancial issues.
How Community Health Centers Can Structure Financial Capability Integration
Community health centers have begun to see the value in oering services that address nancial challenges, because
they know that health inequities cannot be fully solved by clinical care alone. Patient nancial issues already come
up during the service delivery process, so increasing the capacity of CHC sta to address these issues by delivering or
referring clients to nancial capability services can help patients address issues more eectively. While clinicians often
do not have the time to work with patients on the nancial challenges that contribute to their health, there are many
points in a clients’ interaction with the CHC at which nancial capability services can be oered. For example, the
intake process serves as a promising point of integration because it is often when individuals enroll in health insurance,
are oered other enabling services or are connected with other public benets with the help of a Health Navigator.
Choosing the best service delivery model (who provides the service), case management structure (is the service high-
touch or low-touch) and specic nancial capability services for the CHC and its targeted population is key.
MEETING PEOPLE WHERE THEY ARE
CHCs already provide “enabling services”—services that aren’t clinical in nature but help support
patients in accessing clinical health interventions, such as medicine and medical treatments.
25
Unlike
hospitals that focus on clinical care, CHCs address the numerous barriers that come between patients
and the care they need. Provided by case managers and other CHC sta, these services can include
translation services, transportation, public health education, general case management, and youth and
family services, depending on the needs of the people served by the CHC.
26
While nancial capability
services are not explicitly listed in the enabling services denition, some CHCs are using these funds
towards nancial capability integration.
27
ESTABLISHED TRUST
Integrating nancial capability into CHCs builds on existing relationships between CHC sta and
patients. While an individual’s nances is a sensitive topic, so too is an individual’s health, and CHC
sta are trained to discuss sensitive issues. For example, patients often discuss and look for guidance
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INCREASING FINANCIAL WELL-BEING THROUGH INTEGRATION
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Integrating Financial Capability Services into Community Health Centers
DotHouse Health is a CHC located in the Dorchester
neighborhood of Boston and offers a range of services to
help improve their patients’ nancial lives. Services include
hosting free tax preparation during tax season, offering nancial
education classes to individuals in their primary language,
partnering with a law rm that provides pro bono bankruptcy
assistance to patients and holding a weekly farmers’ market
that accepts Electronic Benet Transfer (EBT) cards. In addition,
DotHouse Health assists patients in the process of applying
for insurance and other benets. These services exist outside
of DotHouse Health’s main clinical service offerings, but are
provided onsite and play a key role in their patients’ lives.
31
FROM THE FIELD
THREE OPTIONS FOR SERVICE DELIVERY
CHCs can boost clients’ nancial health by oering
nancial capability services in-house, referring patients
to other organizations’ services, or partnering with other
organizations to “co-locate” these services. The chosen
method(s) depend on the capacity of the CHC, as well
as the local availability of existing nancial capability
services and the capacity of other organizations to partner
with the CHC.
CASE MANAGEMENT STRUCTURES
Regardless of the chosen service delivery method, there
are several possible case management structures CHCs
can employ. These include ongoing case management
meetings focusing on a range of topics, regular meetings
focusing on a single area of need, and/or one-time
meetings focusing on a single area of need. In many cases,
this structure will already be in place within the CHC, and
existing structures typically dictate how CHCs approach
nancial capability integration.
EXAMPLES OF FINANCIAL CAPABILITY SERVICES
By optimizing their service delivery method and case management structure with the population’s most needed
nancial capability services, CHCs can impact the nancial and medical lives of their patients. Some examples
of the nancial capability services that may be provided by case managers through direct service, referral or
partnering include:
28
■ Helping patients enroll in public benets programs, such as Temporary Assistance for Needy Families
(TANF), Supplemental Nutrition Assistance Program (SNAP), Women, Infants and Children Special
Nutrition Program (WIC), and/or state or federal health insurance plans, to improve access to nutritional
food and increase net income to aord monthly medications.
■ Referring patients to Bank On programs that assist “unbanked” or “underbanked” individuals in accessing
safe and aordable banking products.
29
■ Linking patients to credit counseling and debt management services to assist them in building their credit
scores and paying down their debt.
■ Connecting patients with local VITA programs, hosted onsite or osite, to ensure they receive the proper tax
credits and refunds for their income bracket, such
as the Earned Income Tax Credit and the Child Tax
Credit.
■ Helping patients access Individual Development
Account (IDA) programs, which match the savings
of low- and moderate-income individuals working
toward the goal of going to school, buying a house
or starting a business.
30
■ Facilitating one-on-one nancial coaching sessions
that help individuals work toward personal
nancial goals.
■ Connecting individuals to products focused on
longer-term nancial stability, such as myRA, a
retirement account designed for people who don’t
have the option to participate in an employer-
sponsored retirement savings program.
Source: Building Financial Capability: A Planning
Guide for Integrated Services, 2015
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INCREASING FINANCIAL WELL-BEING THROUGH INTEGRATION
Barriers to Integrating Financial Capability Services into the Health System
Policy Recommendations for Integrating Financial Capability Services into CHCs
Despite the potential impact of integrating nancial capability services into CHCs, there are some barriers that CHCs
face when bringing these services into their scope of work:
1. A general lack of communication between the health system and the existing network of nancial capability
providers. In many cases, CHCs operate separately from other social service providers. Therefore, community
organizations may overlook CHCs as potential partners. Beer communication and stronger outreach strategies
for building bridges between systems can result in improved programs and service delivery for all parties.
2. A lack of funding for enabling services in a stretched health care market, forcing CHCs to absorb the cost of
this vital work.
32
Financial capability services fall under enabling services in CHCs that can be billed to Medicaid
or HRSA funding. However, these funds are fragmented and inconsistent, thereby hindering programmatic
innovation and the robust evaluation needed to identify best practices. By raising awareness about the promise
of nancial capability service integration, CHCs and nancial capability service providers can help advocate
for increased funding.
3. The lack of capacity of health system sta who may not be familiar or comfortable with nancial topics.
Similar to other social service providers, many CHC case managers and frontline sta are unfamiliar with
nancial capability services and need training and increased capacity in order to oer such services eectively.
An important step to determining whether case managers should provide nancial capability services is
measuring their level of comfort in providing services. To address these issues, health centers can conduct sta
assessments to determine how case managers feel about discussing various topics (e.g., budgeting, credit/debt,
benet enrollment, etc.) with patients. Using tools, such as the Consumer Financial Protection Bureau’s “Your
Money, Your Goals” curriculum, can help CHC sta think about how best to approach nancial topics with
patients. As previously mentioned, CHCs with lile capacity for nancial capability services have the option
of referring patients to or partnering with outside nancial capability service providers who have expertise in
these topics.
The federal government must prioritize the integration of financial capability services into the CHC system by
improving the funding landscape, encouraging cross-sector collaboration, and fostering innovation and evaluation
and disseminating best practices. These investments will pay off by improving physical and financial health outcomes for
low- and moderate-income households, which in turns helps create stronger communities. The federal government should
take these steps to support integration efforts throughout the country.
To increase awareness of and funding for these services:
■ The U.S. Department of Health and Human Services’ (HHS) Health Resource and Service Administration (HRSA)
should specically call out nancial capability services in its denition of “enabling services” to raise awareness
among CHCs about the possibility of including nancial capability services in their oerings. As an agency focused
on medically vulnerable populations, HRSA can expand the denition of “enabling services” to denitively include
nancial capability services. In so doing, HRSA should list examples of qualifying services, such as benet enrollment,
nancial coaching, free tax preparation and credit building.
33
Listing nancial capability services explicitly in the
denition of enabling services will allow CHCs to identify the best services to meet their patients’ needs and garner
support for building out a more comprehensive, integrated physical and nancial health program.
■ HRSA should release another Health Center Expanded Services funding opportunity. In FY 2015, HRSA released a
supplemental funding opportunity of $350 million for Health Center Expanded Services. This opportunity
increased
access to primary health services for underserved populations. CHCs were able to use up to 20% of this
funding towards enabling services, including hiring enabling sta, such as case managers, and increasing
services on site or through partnerships with other agencies.
34
Continuing this funding practice in future years
and increasing the percentage of funding that can go towards enabling services would help CHCs create or
scale up their nancial capability services to beer match their patients’ needs.
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INCREASING FINANCIAL WELL-BEING THROUGH INTEGRATION
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To encourage cross-sector collaboration:
■ HHS should provide guidance to local CHCs that encourage partnering with Assets for Independence
(AFI) grant recipients. This guidance can break down the siloes that exist between nancial capability service
providers and CHCs and should list resources that will help CHCs identify opportunities to partner with
nancial capability service providers. Because AFI grantees already oer nancial capability services through
Individual Development Account (IDA) programs, partnering with them would allow CHCs to connect patients
with opportunities for homeownership, postsecondary education or small business ownership.
■ The Internal Revenue Service should provide information to VITA programs about partnering with CHCs
to provide tax assistance and health benet enrollment to CHC patients onsite. Because patients at CHCs
often have very low incomes and are thus eligible for multiple tax credits, having VITA programs operate at the
CHC facility is a smart partnership strategy. Considering the synergy between VITA and the impact on health
enrollment, tax ling and credits, this natural partnership should be encouraged by the federal government,
especially as the ACA tax penalty for not having health insurance increases. As CFED has proposed, Congress
should also create a VITA Innovation Fund “to develop, test and scale up best practices,” as doing so would
facilitate partnerships between VITA sites and CHCs.
35
How IDAs Work
2015 Volunteer Income Tax Assistance Program
Source: Strengthening VITA to Boost Financial Security at Tax Time & Beyond, 2015
Source: Asset Building Strategy: Individual Development Accounts, 2014
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INCREASING FINANCIAL WELL-BEING THROUGH INTEGRATION
Acknowledgements
Conclusion
■ The Financial Literacy and Education Commission (FLEC) should facilitate a partnership between CHCs
and nancial capability service providers to increase cooperation and foster deeper understanding about
opportunities to work together. FLEC has previously featured panels at their public meetings about nancial
capability integration in education and legal service seings. By highlighting CHCs on the cuing edge of
nancial capability service integration, FLEC can promote the benets of integration to a wider audience of
policymakers and practitioners.
To foster innovation and evaluation and disseminate best practices:
■ Congress should appropriate funds for HRSA to issue innovation grants to help CHCs test, implement
and evaluate nancial capability services. If HRSA explicitly calls out that nancial capability services
qualify as enabling services, Congress should appropriate sucient funding to support the expansion of
enabling services. Congress can provide innovation grants to CHCs through HRSA to help centers interested
in implementing or expanding a nancial capability program. Grant recipients could then utilize Building
Financial Capability: A Planning Guide for Integrated Services to plan and implement nancial capability services.
The innovation grant should also include a research and evaluation component to identify best practices that
can be used by other CHCs.
■ HHS should create a pilot training program to build the capacity of Health Navigators to connect patients
with nancial capability services. With some targeted nancial capability training, Health Navigators could
expand their focus to include nancial capability services.
36
HHS should train Navigators to discuss nancial
topics with low- and moderate-income patients and refer them to nancial capability providers. Navigators
can be educated through the “Your Money, Your Goals” curriculum or through the Federal Deposit Insurance
Corporation’s “Money Smart” workshops.
37
In this new role, Navigators can become a vital resource for
vulnerable populations.
As they go through the doors of their local CHC, low-income patients face innumerable challenges—many involving
their nancial insecurity—that are intertwined with their health issues. But CHCs, along with other social services
in the US, continue to be too disconnected from other services. While research into the relationship between nancial
health and physical and mental health is ongoing, the likelihood that improving the nancial well-being of households
improves health outcomes is high. CHCs that only focus on health care are missing important opportunities to help
patients stabilize their nancial lives.
Community health centers reach millions of nancially insecure households each year. In order to decrease the
impact that nancial insecurity has on health outcomes, CHCs should integrate nancial capability services into their
programs to mitigate the challenges facing low- and moderate-income populations. Although more research is needed,
nancial capability services have the potential to play a major role in improving health outcomes for underserved
populations who are entering the health system in increasing numbers thanks to the implementation of the ACA.
If adopted, the policy recommendations highlighted in the preceding pages will enable the health system to focus on
more than just treating clinical issues. By accounting for the social determinants of health, CHCs can help households
beer navigate the path to long-term nancial well-being. In turn, families will not only be more nancially secure—
they’ll enjoy beer health and longer lives.
The authors would like to thank their colleagues at CFED who provided helpful edits, comments and guidance
throughout this process, including Jeremie Greer, Kate Grin, Melissa Grober-Morrow, David Meni and Kasey
Wiedrich. We are also thankful to Roberto Arjona, Sandiel Grant, Merrit Gillard and Sean Luechtefeld on CFED’s
Communications team for their eorts in producing this publication.
We are also grateful to Craig Nolte of the Federal Reserve Bank of San Francisco for his helpful feedback on earlier
drafts of this paper.
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Endnotes
1 Alicia Atkinson, Meeting People Where They Are (Washington, DC: CFED, 2014), http://cfed.org/assets/pdfs/Meeting_People_Where_They_Are.pdf; Alicia Atkinson
and Jeremie Greer, Gaining and Retaining Employment (Washington, DC: CFED, 2015), http://cfed.org/assets/pdfs/Gaining_and_Retaining_Employment.pdf; Alicia Atkinson
and Jeremie Greer, Gaining and Sustaining Housing Stability (Washington, DC: CFED, 2015), http://cfed.org/assets/pdfs/Gaining_and_Sustaining_Housing_Stability.pdf.
2 2016 County Health Rankings: Key Findings Report (Madison, WI: Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, 2016),
1, http://www.countyhealthrankings.org/le/11360/download?token=3-NFTTES.
3 Financial Well-being: What It Means and How to Help (Washington, DC: Consumer Financial Protection Bureau, 2015), http://les.consumernance.gov/f/201501_cfpb_
digest_nancial-well-being.pdf.
4 Harry Heiman and Samantha Artiga, Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity (Menlo Park, CA: Henry J. Kaiser Family
Foundation, 2015), 2, http://les.kff.org/attachment/issue-brief-beyond-health-care.
5 Nancy Adler and Judith Stewart, Reaching for a Healthier Life (San Francisco, CA: The John D. and Catherine T. MacArthur Foundation Research Network on
Socioeconomic Status and Health, 2007), 7, http://www.macses.ucsf.edu/downloads/reaching_for_a_healthier_life.pdf.
6 Ibid., 6.
7 “Liquid Asset Poverty,” Assets & Opportunity Scorecard, January 25, 2016, http://scorecard.assetsandopportunity.org/latest/measure/liquid-asset-poverty-rate. Data
Source: “Survey of Income and Program Participation, 2008 Panel, Wave 10,” U.S. Department of Commerce, Census Bureau, 2013, Data calculated by Haveman Economic
Consulting.
8 Heiman and Artiga, “Beyond Health Care.”
9 Christina LaMontagne, “NerdWallet Health Finds Medical Bankruptcy Accounts for Majority of Personal Bankruptcies,” NerdWallet, March 26, 2014, https://www.
nerdwallet.com/blog/health/medical-bankruptcy/.
10 Semi-Annual Report of the Consumer Financial Protection Bureau (Washington, DC: Consumer Financial Protection Bureau, 2016), 21-22, http://www.consumernance.
gov/documents/535/Report.Spring_2016_SAR.06.28.16.Final.pdf.
11“Liquid Asset Poverty,” Assets & Opportunity Scorecard.
12 Alyssa Brown, “With Poverty Comes Depression, More Than Other Illnesses,” Gallup, October 30, 2012, http://www.gallup.com/poll/158417/poverty-comes-
depression-illness.aspx?utm_source=alert&utm_medium=email&utm_campaign=syndication&utm_content=morelink&utm_term=All%20Gallup%20Headlines.
13 Kathleen Short, The Supplemental Poverty Measure: 2014 (Washington, DC: U.S. Census Bureau, 2015), https://www.census.gov/content/dam/Census/library/
publications/2015/demo/p60-254.pdf.
14 Laura Choi, “Financial Stress and Its Physical Effects on Individuals and Communities,” Community Development Investment Review 5, no. 3 (2009): 120-122.
15 Jack Shonkoff and Andrew Garner, “The Lifelong Effects of Early Childhood Adversity and Toxic Stress,” American Academy of Pediatrics 129, no. 1 (2012), 232-246.
16 “Amended Charter: President’s Advisory Council on Financial Capability,” U.S. Department of the Treasury, September 2, 2010, https://www.treasury.gov/resource-
center/nancial-education/Documents/PACFC%202010%20Amended%20Charter.pdf.
17 Tasked with the responsibility of creating the national strategy on nancial education, FLEC manages MyMoney.gov and facilitates public meetings highlighting new
research and practices in areas of nancial literacy and education.
18 VITA programs are community-based programs that provide free tax preparation assistance and other nancial capability services.
19 Rita Bowen, Kori Hattemer and Kate Grifn, Building Financial Capability: A Planning Guide for Integrated Services (Washington, DC: U.S. Department of Health and
Human Services, 2015), 6, http://www.acf.hhs.gov/sites/default/les/ocs/a_resource_guide_building_nancial_capability_nal.pdf.
20 “Program Requirements,” U.S. Department of Health and Human Services, July 27, 2016, http://bphc.hrsa.gov/programrequirements/index.html.
21 “Health Center Program Grantee Data,” U.S. Department of Health and Human Services, 2014, http://bphc.hrsa.gov/uds/datacenter.aspx.
22 “About Our Health Centers,” National Association of Community Health Centers, July 27, 2016, http://nachc.org/about-our-health-centers/.
23 Since the passage of the Affordable Care Act, certied Health Navigators have worked with individuals and businesses to help them nd appropriate healthcare in
health exchanges, many within CHCs.
24 “Program Requirements,” U.S. Department of Health and Human Services.
25 Rachel Talley, Susan Baade and Hui Song, Highlighting the Role of Enabling Services at Community Health Centers: Collecting Data to Support Service Expansion & Enhanced
Funding (San Leandro, CA: Association of Asian Pacic Community Health Organizations and National Association of Community Health Centers, 2010), 3, http://nachc.
org/wp-content/uploads/2015/06/EnablingServicesReport.pdf.
Corporation for Enterprise Development
Integrating Financial Capability Services into Community Health Centers
10
INCREASING FINANCIAL WELL-BEING THROUGH INTEGRATION
26 Ibid., 4.
27 “Service Descriptors for Form 5A: Services Provided,” U.S. Department of Health and Human Services, August 15, 2016, 23, http://bphc.hrsa.gov/programrequirements/
scope/form5aservicedescriptors.pdf.
28 For more information about nancial capability services, see Bowen, Hattemer and Grifn, Building Financial Capability, Appendix A.
29 For more information about Bank On programs, visit joinbankon.org.
30 Operated by the Ofce of Community Services, an ofce of the Administration for Children and Families, the Assets for Independence program helps low-income
households build assets using matched savings accounts, otherwise known as Individual Development Accounts (IDAs), and other nancial capability services. IDAs are
dedicated to one of three objectives: buying a home, getting an education or starting a business.
31 DotHouse Health, http://www.dothousehealth.org/.
32 Talley, Baade and Song, Highlighting the Role of Enabling Services, 3.
33 For other nancial capability services, see Bowen, Hattemer and Grifn, Building Financial Capability, Appendix A.
34 “FY 2015 Health Center Expanded Services (ES) Supplemental Funding Opportunity HRSA-15-153 Frequently Asked Questions (FAQs),” U.S. Department of Health
and Human Services, August 31, 2016, http://bphc.hrsa.gov/programopportunities/fundingopportunities/ExpandedServices/esappfaqs.pdf.
35 Shervan Sebastian, Ezra Levin and David Newville, Strengthening VITA to Boost Financial Security at Tax Time & Beyond (Washington, DC: CFED, 2016), 11, http://cfed.
org/assets/pdfs/06-2016_strengthening_VITA_to_boost_nancial_security_at_tax_time_beyond.pdf.
36 Please see endnote 23 for Health Navigator denition.
37 “Money Smart: A Financial Education Program,” Federal Deposit Insurance Corporation, https://www.fdic.gov/consumers/consumer/moneysmart/trainthetrainer.html.
