Port Jarvis in New York State. PHOTO: Sam Aronov/SHUTTERSTOCK

Port Jarvis in New York State. PHOTO: Sam Aronov/SHUTTERSTOCK

In today’s fast-changing philanthropy landscape, big new pots of grant money are appearing all the time. But most of this funding is coming from a billionaire class that’s been ramping up its giving—like the $10 billion that Jeff Bezos recently committed for climate change. What’s less common is to see a major new institutional foundation emerge, although that’s exactly what happened in 2018, when the Mother Cabrini Health Foundation (MCHF) became one of the largest philanthropies in New York State, where all its funding will be focused.

This grantmaker is a health conversion foundation, created after the Fidelis Care, a nonprofit health insurer created by the Catholic bishops of New York State. Starting with $3.2 billion in assets, it is pretty big, even for a national funder—and nonprofits in the state have been watching to see how that money would be deployed.

MCHF’s giving came into sharper focus with the recent announcement of its first round of grants—nearly $150 million to more than 500 health and human services programs statewide. The grants included:

  • $57 million toward general services for low-income individuals and families, including grants to programs serving people in Harlem and in rural communities in the Adirondack North Country region

  • $25 million toward youth and young adults, including grants addressing opioid use in Oneida County and elsewhere

  • $18 million toward programming nursing, and caregiving services for older adults

  • $18 million toward housing and services for persons with special needs

  • $10 million toward initiatives for immigrants and refugees

The remainder of the grants went to programs for new and pregnant mothers and young children, opportunities for formerly incarcerated people, federally qualified health centers throughout the state, and services for veterans.  

MCHF says its mission is to improve the health and wellness of New York State’s poor, disadvantaged, elderly and underserved populations. “In reviewing grant applications during this first round, our priority was to serve as many people as possible all across New York State,” said Bob Varettoni, director of communications for the foundation. “We’re proud that this first batch of grantees is working in every corner across New York—from upstate to downstate, western New York to Long Island, and everywhere in between.”

Finally, a Focus on Needs in Rural Areas?

As a state, New York’s demographics are about as varied as they come, from the hyper-urban New York City and the dense suburbs downstate to the smaller cities and extremely rural areas in the western and northern counties. But when it comes to philanthropic giving in New York, it is no surprise that the lion’s share has gone to the more densely populated portions of the state, leaving needs in rural areas unmet.

This is partly a matter of allocation of resources: Funders typically want to see their dollars help as many people as possible. A program in a city or dense suburb can address more clients in a day than one working in a rural area, where clients are spread widely. Another reason for the lack of funders is the drop in population in rural areas over recent decades.

The paucity of grants going to rural communities is a topic that Inside Philanthropy has discussed a lot, as it affects not just New York State, but the whole country. “A fair number of foundations have cities as their focus, but almost no foundations care about rural communities as a whole,” said Aaron Dorfman, president and CEO of the National Committee for Responsive Philanthropy (NCRP).

One bright spot in this picture, though, has been the rise of several hundred health conversion foundations across the U.S. in recent decades. As we’ve reported, these grantmakers typically have strong geographic mandates that determine where funding can flow. Some big ones, like the Colorado Health Foundation, engage in grantmaking across an entire state. But according to the Rural Health Information Hub, “Over 80% of these foundations primarily serve one local community or county, which can provide consistent sources of funding for rural health programs.”

Because MCHF has a statewide mandate, the deployment of its resources in rural areas has been an open question. When the foundation was created in 2018—the same year that two other big new health conversion foundations were created—rural philanthropy expert Allen Smart wrote a guest post on IP in which he asked, “How well will these three funders engage the rural portions of their service areas? How well and how deeply will they partner with rural communities to create innovative strategies? Those of us who care deeply about rural America are watching closely.”

Crossing Divides

For its part, MCHF says it wants to address needs in rural areas. “We also recognize that many of New York’s rural communities experience significant healthcare access challenges, including health professional workforce shortages and lack of transportation resources,” said Varettoni. “We will continue to encourage potential grantees to propose innovative approaches and effective collaborations to address health barriers in New York’s rural areas.”

But there’s another force at work, one that has less to do with calculations of returns on investments and more to do with the social and economic separation between marginalized communities and the wealthier urban and business leaders that traditionally populate boards of directors and staffs of foundations. This results in a lack of access and relationships that has a chilling effect on grantmaking for rural nonprofits.

At the time of MCHF’s formation, NCRP criticized the makeup of the funder’s board of directors as insufficiently diverse, consisting primarily of white, wealthy individuals from large hospital systems and corporations. “At the time it was formed, it was going to be the second-largest health conversion foundation in the country, but it did not have a board representative of the community they hope to serve,” said Dorfman. NCRP urged the New York attorney general to mandate that the board be reshaped to include representation from more diverse communities, but no such orders were given.

While MCHF’s first round of funding does include programs to benefit the state’s rural areas, observers we spoke to say they’d like to see that focus intensify, particularly on programs that address social determinants of health. Obviously, the proof will be in future funding cycles. But as one of the largest funders now operating in New York, MCHF has the power to correct a too-old tradition of neglect for more sparsely populated parts of the state.

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