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TGI​ WELLNESS & EQUITY UNIT​

Request for Application (RFA)

Transgender, Gender Nonconforming and Intersex Wellness and Equity Fund

​​Gender Aff​irming Care Clinical Services​ Grants


​Questions & Answers​

*Updated July 24, 2023

​Q1:
​What is the difference between mental health and behavioral health services? One is allowable and the other isn’t.
​A1:
​The forthcoming addendum addresses this issue. Behavioral health services for TGI individuals are allowable activities. Please specify in your application how these services will relate to gender affirming care.

​Q2:
​Is case management an allowable activity?
​A2:
​The forthcoming addendum addresses this issue. Case management for TGI individuals is an allowable activity.

​Q3:​
​If patient navigators are allowable under this RFA, then what activities are to be performed by the patient navigators if wraparound care is not allowable?
​A3:
​Patient navigator activities focused on referrals to gender affirming health care services and advocacy for individuals in a clinical setting are allowable activities. The forthcoming addendum clarifies allowable activities include, but are not limited to, the following:
  1. Continuing gender affirming health care services
  2. Expanding gender affirming health care services
  3. Establishing a program that offers gender affirming health care services
  4. Continuing or establishing Patient Navigators who will provide referrals to and/or case management for gender affirming health care services and advocacy for TGI individuals in a clinical setting.
  5. Uncompensated care in clinical settings
  6. Creating educational materials about gender affirming health care services
  7. Training for clinical and support staff to provide culturally responsive care
  8. Services related to substance use disorder or substance abuse for TGI individuals
The forthcoming addendum clarifies unallowable activities include the following:
  1. Supplantation (replacement) of funds
  2. Compensated care in clinical settings
  3. Research 
  4. Use of funds towards legal aid for name changes, supportive housing, therapeutic arts programs, and financial assistance

​Q4:
​What is the ceiling amount that applicants can apply for? We have been assuming the $350,000 mentioned on p.25 is a typo and the correct amount is $500,000.
​A4:
​Correct, applicants may apply for a maximum of $500,000.

​Q5:
​Would contracting with state reimbursement programs cause any type of conflict?
​A5:
​Grantees cannot seek reimbursement for activities for which they already receive reimbursement, regardless of the source.

​Q6:
​Is a city or county considered a “public agency” and can they serve as prime contractor?
​A6:
​Yes.

​Q7:
​It seems that there is overlap between the goals of RFA 1 and 2. Would both support training and education for health providers? And if so, do you have information to help decide if one RFA may be a better fit than the other.
​A7:
​RFA 1 is limited to training in specific clinics or clinical situations in relation to the provision of gender-affirming care. RFA 2 allows for training and education more broadly to effectively provide TGI health care and institute TGI-inclusive best practices.

​Q8:
​If the primary applicant is a medical provider and the secondary applicant is a TGI-serving organization, can the TGI-serving organization’s role be providing LGBTQ+ cultural humility training for the medical professionals at the primary, or is training strictly not allowed under RFQ #1?
​A8:
Proposals that include training and education for providers in a clinical setting are allowable but should be narrowly focused on medical staff and other who interact with clients.
Proposals for medical professional training should center issues impacting TGI persons, not LGBTQ+ communities broadly.
As described, if providing cultural humility training for medical professionals was the only role for the TGI-serving organization, that role would not satisfy the partnership requirements as described in this RFA and in Health and Safety Code §150900(d). Specifically:

i. If the applicant is a medical provider and proposing to fund an existing or newly established program to provide gender-affirming ​care services, the medical provider must apply in partnership with the TGI-serving organization and consult with them throughout the process of the program’s creation and implementation (Health and Safety Code §150900(d).

ii. If the applicant is a medical provider proposing to establish a new program, they have the additional requirement of having an established relationship with a TGI-serving organization that will lead in the program’s establishment (HSC §150900(c)(4).

​Q9:
​Can you speak to what is meant by 'uncompensated care in clinical settings' which is listed in allowable activities?
​A9:
​This refers to care that is not covered by insurance or another third-party payer. For example, hair removal services that support gender affirming care but is not billable to a third-party payer is an allowable activity.

​Q10:
​If the lead is a TGI-serving organization and they partner with a medical provider, I assume the required licensure would be from the medical provider? For example, a CA state community clinic license should cover multiple clinical care services under this grant, but a behavioral health provider may need a specific license.
​A10:
​If the grant agreement funds direct medical services, the applicant is responsible for ensuring that the medical provider meets all licensure requirements for those specific services. In this scenario, if the grant agreement funds services to be provided by the medical provider, that medical provider is considered a subcontractor and it is the responsibility of the applicant (the TGI-serving organization) to verify and provide evidence of all necessary licensure for services funded as part of a finalized grant agreement.  
If the grant agreement only funds ancillary services such as case management or patient navigation, all required licensure must be obtained by the applicant.

​Q11:
​What about an LGBTQIA2S+ Federally Qualified Healthcare Clinic (FQHC) that is both a medical provider and has grant programming? What category do they fit under and do they need a partnering CBO?
​A11:
​At least one partner must meet the definition of a TGI-serving organization as defined in stature, and all applicants must meet all minimum requirements specified in Section 3.1 in the RFA. Also please reference the response to question 8.

​Q12:
​What if a TGI focused program applies within a large health system/university?
​A12:
​A TGI-focused program of a large health system does not qualify as a TGI-serving organization as defined in HSC §150900(f)(2). However, a hospital, health care clinic or other medical provider can apply in partnership with a TGI-serving organization. 

​Q13:
​It isn’t clear where in the Organization Capacity section (if at all) the partner/sub-applicants will be described. If an applicant is applying under Scenario 2, for instance, would the Medical Provider organization provide similar information regarding Organization Capacity questions 1a-d and be included within the org chart described in e? Or would just describing the nature of the partnership (f) be sufficient?
​A13:
​The applicant's narrative should include information about the entirety of the program, including the applicant and any partners’ organizational capacity. If you are applying with partners, then they are also considered key personnel and should be reflected in organization capacity questions a-d and in the organization chart, in addition to describing the nature of the partnership in f.

​Q14:
​As the community is pretty small, how will you ensure that there are no conflicts of interest or bias when scoring?
​A14:
​CDPH takes seriously our obligation to ensure that the funds we administer are done so in an equitable and fair manner that are free from conflicts of interest. Every person providing scores will be state employees and are required to file an annual Statement of Economic Interests (Form 700) with the California Fair Political Practices Commission (FPPC). Every public employee who makes or influences governmental decisions is required to submit this report to ensure transparency and ensure accountability. The FPPC posts on its website all statements of economic interests.

​Q15:
​Can a TGI-serving organization apply to provide ONLY gender-affirming mental health services to the TGI population and nothing else, i.e. no other type of clinical services?
​A15:
​Yes, a TGI-serving organization may apply to only provide one type of gender-affirming health care services. An addendum will be posted to provide further clarification on the unallowable activities.

​Q16:
​Can a TGI-serving organization apply to provide patient navigation services to the TGI population and have a partnership with a clinic that provides gender affirming health care?
​A16:
​As stated in Section 2.6 of the RFA, Applicant Structure, a TGI-serving organization may apply to this funding in partnership with a medical provider (hospital, health care clinic, or other medical pro​vider).​

Contact :

Malina Keaton (they/them):

TGIUnit@cdph.ca.gov

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