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                              The Office of Climate Change and Health Equity (OCCHE) Quickfinder for Leveraging the Inflation Reduction Act for the Health Sector
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The Office of Climate Change and Health Equity (OCCHE) Quickfinder for Leveraging the Inflation Reduction Act for the Health Sector








  
  
    

  
      



The Quickfinder for Leveraging the Inflation Reduction Act (IRA) for the Health Sector is meant to help health stakeholders take advantage of the opportunities for resilience and emissions reduction in this historic legislation. It is divided into the following sections:

Background
	Overview of Investments and Actions Potentially Facilitated by the IRA
	Relevant IRA Programs for the Health Sector
	Tax Incentives and Direct Pay Provisions
		Grants and Incentives for Lowering Emissions
		Grants and Incentives for Climate ResilienceAppendix A: Example Use Cases
Appendix B: General Advice for Grant Applicants

The Quickfinder will be updated as needed to reflect new announcements and additional relevant programs. Major updates will also be shared through OCCHE Alerts. For a more comprehensive list of federal programs that can assist the American health sector with emissions reduction and climate resilience (both IRA and non-IRA), please visit the Health Sector Resource Hub. OCCHE’s recorded webinar series explores these opportunities in greater detail with experts from across the government and a new “catalytic program” to support safety net providers in utilizing the IRA will begin January 25, 2024. Learn more about this new series by watching our recorded information session and sign up for sessions here.

**Have you leveraged the IRA?** OCCHE would love to hear about your experience and, if you’re comfortable, share what you learned with other health stakeholders. Please email OCCHE@HHS.GOV. OCCHE also welcomes any questions or suggestions.

**1. Background**

Climate change is the most significant threat to human health in the 21st century according to more than 200 medical journals. It creates both acute and chronic risks, particularly to vulnerable populations, and already costs the American economy billions of dollars a year due to the harm it creates, significantly burdening the nation’s healthcare system. The health care sector also contributes to the problem itself, accounting for 8.5% of the country’s carbon emissions.

Health effects related to climate change range from heat stroke to asthma exacerbation to vector-borne diseases. In general, historically underserved groups and regions tend to be the hardest hit by climate events. For instance, lack of health insurance has been associated with greater risk of hospital admission after exposure to certain weather events. As climate change accelerates, so do these inequities. If the world warms by 2 degrees Celsius, Black and African American individuals are 34% more likely to live in areas with the highest projected increases in childhood asthma. In addition, climate change presents acute threats and disruptions to facility operations, with the majority of hospital evacuations coming as a result of climate-sensitive events.

Importantly, health sector organizations can actively reduce the potential for harm by anticipating these challenges, investing in resilient infrastructure, and reducing contributions to climate change through improvements in sustainability and efficiency. Such actions are not only broadly beneficial to society but can lead to direct savings. The Harvard Business Review, for example, shared how when the Cleveland Clinic switched from fluorescent lights to lower-energy LEDs, they ultimately saved $2.5 million a year with a short 4-year payback on energy costs. America’s Essential Hospitals reports that some hospitals have cited a cost savings of about $1 million a year thanks to efficiency projects and, more broadly, the Commonwealth Fund suggests that U.S. hospitals could save roughly $15 billion over 10 years by adopting basic energy efficiency, waste-reduction and smart purchasing measures.

At the Department of Health and Human Services (HHS) Office of Climate Change and Health Equity (OCCHE), we envision an American health sector that both: (1) adapts to increased crises and chronic stressors in service of its most vulnerable populations and (2) uses the best available evidence and technology to mitigate its own emissions. However, despite a growing recognition of the health problems associated with climate change and the need for action, many organizations – and particularly those serving the most at-risk communities – struggle to make investments in sustainability and resilience because of insufficient funding.

The landmark Inflation Reduction Act (IRA), signed into law by President Biden in August 2022, provides billions of dollars in grants, loan programs, and tax credits that can help transform the industry by significantly increasing access to funds that will create resilient and renewable infrastructure. Many of these investments have the potential to improve care, deepen resilience, and reduce costs. For example, enhancing building heating, ventilation, and air conditioning (HVAC) systems can reduce energy use and save money while also better filtering out air-borne illnesses like COVID-19 and pollution from hazards like wildfire smoke. Similarly, investments in renewable energy allow facilities to save money that would previously have gone to their local utility, opening the possibility for increased investments in patient-centered activities. If that renewable energy is stored onsite in a microgrid, it can also help the provider stay open in emergencies when the grid loses power.

The IRA will facilitate many crucial investments of this kind. This “Quickfinder” document describes the general types of investments the legislation should make possible for healthcare stakeholders. An HHS supplement to the White House’s Building a Clean Energy Economy: A Guidebook to the Inflation Reduction Act’s Investments in Clean Energy and Climate Action (“Guidebook”), it zeros in on the most relevant IRA provisions for the sector. It also explores valuable investments and actions potentially facilitated by the IRA and closes with appendices that offer hypothetical use cases for different provider types and feature general advice on accessing government funds and programs.

**2. Overview of Investments and Actions Potentially Facilitated by the IRA**

The IRA created programs and opportunities with the potential to support provider organizations and other stakeholders seeking to increase resilience and sustainability. This is especially meaningful for institutions that serve the most vulnerable populations and may find accessing the significant financing required for some new infrastructure or equipment challenging.

We have listed particularly meaningful health sector actions to reduce emissions and invest in climate resilience below along with some IRA programs or initiatives that may be able to support them.
                        Investing in On-Site Renewable Energy Generation
    For crucial providers like rural emergency hospitals, federally qualified health centers, and nursing homes, on-site energy generation can save money and help ensure consistent power for the facility, even in an emergency. For example, the Kaiser Richmond Medical Center installed the first solar-powered microgrid with battery storage for a hospital in California in 2018. The microgrid can store 1 megawatt-hour of energy in batteries, and, if a power outage were to occur, the microgrid will furnish power, allowing the hospital to operate as an “island,” supporting critical systems for up to 3 hours (see the Agency for Healthcare Research and Quality (AHRQ) Reducing Healthcare Carbon Emissions Primer for more information). The Centers for Medicare & Medicaid Services (CMS) Categorical Waiver – Health Care Microgrid Systems (HCMSs) permits normal and emergency power to be supplied by sources other than a generator or battery system, including a health care microgrid system.1 IRA provisions that can help you invest in clean energy may include the*Energy Generation Incentives* (see section 3(a) below).
                        Energy Efficiency Building Improvements
    Providers and suppliers may also consider site improvements like HVAC and building envelope upgrades or retrofits. This may be particularly helpful for hospitals, the second most energy-intensive commercial buildings in the United States. For example, Oaks Healthcare LLC is using an investment from the Rural Energy for America Program to purchase and install a 350-ton chiller system for the nursing home/long term care campus of buildings. This project will save 560,923 kWh per year, which is enough electricity to power 52 homes (see USDA’s Awards as of August 30, 2023 for more information. Another example is from the Veterans Health Administration within the Department of Veterans Affairs (VA), one of the largest integrated healthcare systems in the United States. The VA upgrades its facility infrastructure and equipment while installing renewable power where feasible. From these efforts, VA has successfully reduced its energy intensity (kBtu/gross square foot) by over 26 percent since 2003. VA hospitals overall use 38 percent less energy per square foot than the national average for all hospitals (see the AHRQ Primer for more information). IRA provisions that can help you improve your building’s energy efficiency may include the *Energy Efficient Commercial Buildings Deduction* (see section 3(a)) and *Rural Energy for America Program* (REAP) (see section 3(b)).
                        Transportation
    Both fleet vehicles and employee travel can contribute to provider and supplier emissions across all scopes. The IRA gives providers and suppliers the opportunity to make discounted investments in low-emissions vehicles and on-site charging stations. For example, the VA has begun to transition its roughly 23,000 vehicle fleet to zero emission vehicles (ZEVs). Since October 2021, VA has confirmed 507 ZEV orders, which make up 34 percent of its light-duty vehicle acquisitions this annual cycle (see the AHRQ Primer for more information). IRA provisions that can support lowering transportation emissions may include the *Credit for Qualified Commercial Clean Vehicles* (see section 3(a)) and the *Alternative Fuel Vehicle Refueling Property Credit* (see section 3(a)).
                        Increased Building Resilience
    As access to care is increasingly threatened by storms and chronic hazards like extreme heat, providers can serve their communities better by improving their resilience. This will look different depending on the part of the country and climate your building(s) reside in. For example, the Nicklaus Children’s Hospital in Miami received a grant through FEMA’s Hazard Mitigation Grant Program (HMGP), administered by the Florida Department of Community Affairs, and was able to install a hurricane resistant shell, including a panel system designed to withstand winds of up to 200 miles per hour. Another example is the 175-bed Greenwich Hospital, which installed a combined heat and power (CHP) system. The power system enabled Greenwich Hospital to continue normal operations throughout Hurricane Sandy; they even admitted 20 additional patients during the outage period. In addition, 150 extra staff members stayed overnight at the hospital (for more information, visit the U.S. Climate Resilience Toolkit). IRA provisions that can support building resilience may include new *Robert T. Stafford Disaster Relief and Emergency Assistance Act authority* (see section 3(c)). Programs that offer Stafford Act assistance include HMGP, the program described above that helped Nicklaus Children’s Hospital in Miami.
                        Increased Community Resilience
    Certain provisions of the IRA offer unique opportunities for health stakeholders to join with their communities in addressing environmental justice and climate change adaptation. These projects can strengthen community ties and improve health outcomes in your area. For example, the Ben Archer Health Center used Environmental Justice Grant funding to provide pesticide training to farmworkers and their families. Another example is that the Health and Hospital Corporation of Marion County and Children's Mercy Hospital both used such funding to address unhealthy home air quality among at-risk populations in their respective communities (for more information, visit the Environmental Justice Grants). IRA provisions that can support building resilience include the *Environmental and Climate Justice Block Grants* (see section 3(c)) and *Investing in Coastal Communities and Climate Resilience* (see section 3(c)).
                        Decarbonizing the Health Supply Chain
    Pharmaceutical companies, medical device manufacturers, and other suppliers have an important role to play in decarbonizing the health sector. Scope 3 emissions -- which include the production and transportation of pharmaceuticals, chemicals, medical devices, and more -- account for 82 percent of U.S. national health sector greenhouse gas emissions and present the most significant opportunity for decarbonization. Suppliers may be able to access many of the tax incentives listed in section 3(a). Conversations are ongoing regarding other IRA policies and programs that health care suppliers may be able to take advantage of.
                        **3. Most Relevant IRA Programs for the Health Sector**

This section describes in greater detail the specific IRA programs that make possible the actions described above. This is an initial list based on statutory language and existing guidance, and additional relevant policies may be highlighted in the future.
                        A. Tax Incentives and Direct Pay Provisions
    The IRA includes numerous changes to the tax code that will allow health sector stakeholders to receive tax credits and, in some cases, direct payments for clean energy projects. Eligible organizations will include certain providers and suppliers.

Using these credits, a provider or supplier could make investments in energy generation equipment, energy efficiency, commercial clean vehicles, and vehicle refueling. Importantly, tax-exempt organizations can still benefit from many of these opportunities through elective pay. With "elective pay" (often informally called "direct pay"), tax-exempt and governmental entities that do not owe Federal income taxes will, for the first time, be able to receive a payment equal to the full value of tax credits for building qualifying clean energy projects or making qualifying investments. Unlike competitive grant and loan programs, in which applicants may not receive an award, elective pay allows entities to get their payment if they meet the requirements for both elective pay and the underlying tax credit. A list of IRA tax credits that are eligible for elective pay can be found here. Final regulations on elective pay were announced on March 5, 2024, along with proposed regulations on elective pay applicability for partnerships. Tax exempt and government entities can also subscribe to receive relevant tax updates from the IRS e-News Subscriptions.

Relevant tax incentives include:

The *Energy Generation Incentives* (pages 13 – 19 of the Guidebook), including the:

	*Investment Tax Credit for Energy Property* (26 U.S. Code § 48) for projects beginning construction before January 1, 2025.  This tax credit is for investment in renewable energy projects including fuel cell, solar, geothermal, small wind, energy storage, biogas, microgrid controllers, and combined heat and power properties. A technology-neutral tax credit for investment in facilities that generate clean electricity and qualified energy storage technologies will replace § 48 for facilities that begin construction and are placed in service after 2024. Updated guidance on the investment tax credit with added clarifications was released through a Notice of Proposed Rulemaking here on November 17, 2023. * +
		*Production Tax Credit for Electricity from Renewables* (§ 45) for projects beginning construction before January 1, 2025. This tax credit is for production of electricity from eligible renewable sources, including wind, biomass, geothermal, solar, small irrigation, landfill and trash, hydropower, marine and hydrokinetic energy. A technology-neutral tax credit for production of clean electricity will replace § 45 for facilities that begin construction and are placed in service after 2024. Instructions on how to claim § 45 are available on the IRS website. * +
		*Increase in Energy Credit for Solar and Wind Facilities Placed in Service in Connection with Low-Income Communities* (§ 48(e) and § 48E(h)). Eligible applicants can now apply to receive a 10 or 20-percentage point boost to the energy investment tax credit for qualified solar or wind facilities that are in low-income communities or on Indian land, are part of affordable housing developments, or benefit low-income households. To allow the public time to prepare competitive applications, all applications received within the first 30 days (October 19th-November 18th) will be treated as having been received at the same time. DOE will no longer accept applications for the 2023 program year of the Low-Income Communities Bonus Credit Program after February 29, 2024, at 11:59 PM ET. Additional information can be found on the DOE landing page for the program and a map of eligible census tracts can be found here. * +Generally speaking, investment tax credits refer to a one-time credit based on the dollar amount of the investment and the credit is earned when the equipment is placed into service. In contrast, production tax credits refer to tax credits on every kilowatt-hour of electricity sold to an unrelated party for a period after a facility is placed into service.

The energy community bonus credit under §§ 45, 45Y, 48, and 48E of the Internal Revenue Code applies to projects located in historical energy communities, including areas with closed coal mines or coal-fired power plants. The bonus is also available to brownfield sites and to areas that have significant employment or local tax revenues from fossil fuels and higher than average unemployment. More information on eligibility is available here and a mapping tool is available here.

The Treasury Department and IRS also intend to propose regulations addressing the application of the rules that taxpayers must satisfy to qualify for the domestic content bonus credit amounts under §§ 45, 45Y, 48, and 48E of the Internal Revenue Code. It applies to facilities or projects built using the required amounts of domestically produced steel or iron, and manufactured products. When the domestic content requirements are met, Production Tax Credit facilities receive a 10 percent bonus, and Investment Tax Credit projects receive up to a 10-percentage point bonus. Initial guidance is available.

The *Energy Efficient Commercial Buildings Deduction* (§ 179D) (page 115 of the Guidebook) is a tax deduction for energy efficiency improvements to commercial buildings, such as improvements to interior lighting; heating, cooling, ventilation, and hot water; and building envelope. It is applicable starting in 2023 and has no expiration date. This deduction is available to owners of energy efficient commercial building properties (EECBP) or energy efficient building retrofit properties (EEBRP) and designers of EECBP/EEBRP installed in buildings owned by tax-exempt entities, including certain government entities, Indian tribal governments, Alaska Native Corporations, and other tax-exempt organizations. Initial guidance is available. +
	The *Credit for Qualified Commercial Clean Vehicles* (§ 45W) (page 52 of the Guidebook) is a tax credit for purchasers of qualified commercial clean vehicles, including passenger vehicles, buses, and ambulances. It is available for vehicles from 2023 to 2032. To qualify for the tax credit, a vehicle must meet certain requirements, including that it be made by a qualified manufacturer; be for use in your business, not for resale; and be for use primarily in the United States. The IRS is finalizing a form for you to claim the credit. Please check the IRS website for updates. *
	The *Alternative Fuel Vehicle Refueling Property* *Credit* (§ 30C) (page 53 of the Guidebook) is available from 2023 through 2032 and provides a tax credit for alternative fuel vehicle refueling and charging property in low-income and non-urban areas. Alternative fuels include electricity, ethanol, natural gas, hydrogen, biodiesel, and others. A map of eligible census tracts can be found here. Visit the IRS website for guidance on how to claim this credit. For organizations that are considering investing in electric vehicle charging stations, the Joint Office of Energy and Transportation hosts a series of recorded webinars on electric vehicle capacity building and implementing vehicle charging infrastructure, and they will also be holding office hours on March 20, 2024 at 3pm eastern. * +* All items listed above except § 179D are eligible for elective payment when used by organizations including States, certain tax-exempt organizations, and Indian Tribal governments. The IRS launched the IRA/CHIPS Pre-filing Registration Tool for qualifying businesses, tax-exempt organizations or entities such as state, local and tribal governments to take advantage of elective payment even if they don't have taxable income. The IRS created permission management guidance with more information on using the IRA/CHIPS Prefiling Registration Tool. Elective pay is only available after an applicable credit is earned and able to be claimed on the relevant annual tax return. In general, a tax credit is earned during the taxable year the applicable credit property is placed in service (investment tax credits) or eligible production occurs (production tax credits). Visit the IRS website and the IRS FAQ for more information on elective pay.

+ Increased credit amounts are available under §§ 30C, 45, 45Y, 45Z, 48, and 48E, and an increased deduction is available under § 179D, for taxpayers satisfying certain prevailing wage and apprenticeship requirements.

In general, taxpayers that wish to take advantage of an enhanced clean energy tax benefits must ensure that all laborers and mechanics are paid the applicable prevailing wage, including fringe benefits, for all hours performing construction, and in some cases alteration or repair, on the site of the work of a qualified facility. A prevailing wage is the combination of the basic hourly wage rate and any fringe benefits rate, paid to workers in a specific classification of laborer or mechanic in the area where construction, alteration, or repair is performed, as determined by the Secretary of Labor.
	The inclusion of Registered Apprenticeship provisions also enables a talent pipeline for developing this critical workforce and ensures that it is an industry-driven approach with high-quality career pathway opportunities for all workers. By utilizing Registered Apprenticeships, employers can develop and prepare their future workforce, and individuals can obtain paid work experience, receive progressive wage increases, classroom instruction, and a portable, nationally-recognized credential.
                        B. Grants and Incentives for Lowering Emissions
    The IRA includes numerous grant programs and funding opportunities to invest in new clean energy and emissions reduction. Providers and suppliers can leverage these programs to invest in zero-emissions or low-emissions energy generation.
Relevant grants and assistance include:

The *Rural Energy for America Program* (REAP) (page 42 of the Guidebook) provides guaranteed loan financing and grant funding to agricultural producers and rural small businesses for renewable energy systems or to make energy efficiency improvements. Funds may be used for renewable energy systems as well as for the purchase, installation and construction of energy efficiency improvements, such as high efficiency heating, ventilation and air conditioning systems (HVAC); insulation; lighting; cooling or refrigeration units; doors and windows; and replacement of energy-inefficient equipment. Funds can also be used for underutilized renewable energy technologies. The IRA funding will remain available until September 30, 2031. Grant applications, guaranteed loan-only applications, and combined grant and guaranteed loan applications for financial assistance may be submitted at any time on an ongoing basis. Additional information is available in the Notice of Solicitation of Applications for the Rural Energy for America Program for Fiscal Years 2023 and 2024. Many health facilities have utilized REAP, including Centro de Diagnostico y Tratamiento San Sebastian, a health service clinic center located in San Sebastián. The investment will be used to purchase and install a 96.76 kilowatt (kW) photovoltaic solar system connected to a battery backup energy storage system to ensure the business never loses power. This project will realize $42,452.00 per year in savings and will replace 142,000 kilowatt hours (kWh) (100 percent) per year, which is enough electricity to power 13 homes.
	The *Greenhouse Gas Reduction Fund* (page 22 of the Guidebook) provides competitive grants to mobilize financing and leverage private capital for clean energy and climate projects that reduce greenhouse gas emissions, with an emphasis on projects that benefit low-income and disadvantaged communities. The EPA will implement the Fund in alignment with President Biden’s Justice40 Initiative, which directs that 40% of the overall benefits of certain Federal investments flow to disadvantaged communities. Much of the fund will be administered by lending nonprofits such as green banks, Community Development Financial Institutions, and credit unions. The eight National Clean Investment Fund and Clean Communities Investment Accelerator nonprofits were announced in April 2024. Health organizations may want to apply directly to these lending nonprofits.
	The *Climate Pollution Reduction Grants Program* (page 87 of the Guidebook) will provide grants to states, local governments, tribes, and territories to develop and implement plans for reducing greenhouse gas emissions and other harmful air pollution. Health stakeholders are not eligible for such grants, unless an organization is part of a municipality, tribe, or other eligible entity. However, subawards can be given to non-governmental organizations and academic institutions. On September 20, 2023, EPA announced two competitions for $4.6 billion in implementation grants under the Climate Pollution Reduction Grants program. Additional information is available on EPA’s website.
                        C. Grants and Incentives for Climate Resilience
    The IRA includes substantial investments in climate resilience from across a wide range of climate hazards, from extreme heat and wildfire (*Environmental and Climate Justice Program*) to hurricanes and flooding (*Stafford Act* assistance and *Coastal Communities and Climate Resilience*). Providers and suppliers should see this as an opportunity to seek federal support for investments that will help your facility stay functional and safe during an emergency and/or in the face of repeated stressors. It will be helpful to examine resilience at the local or regional level and have a clear explanation for how your facility or organization fits into local preparedness and response. If you have committed to the White House/HHS Health Sector Climate Pledge, you may already have a climate resilience plan for continuous operations in place that anticipates the needs of groups in your community that experience disproportionate risk of climate-related harm.

Relevant grants and assistance include:

The *Environmental and Climate Justice Program* (page 86 of the Guidebook) provide grants and technical assistance to community-based organizations, alone or in partnerships, to reduce indoor and outdoor air pollution, including greenhouse gases; monitor for pollution; improve community resilience to the impacts of climate change, including extreme heat and wildfire; and build the capacity of these organizations to engage with state and federal decision-making processes. Eligible recipients include (1) a community-based nonprofit organization; (2) a partnership of community-based nonprofit organizations; or (3) a partnership between a community-based nonprofit organization and an Indian Tribe, local government, or an institution of higher education. Funds will remain available through September 30, 2026. EPA has announced several competitions as part of this program:

	*The Environmental and Climate Justice Community Change Grants Program (Community Change Grants)* will invest approximately $2 billion dollars in environmental and climate justice activities to benefit disadvantaged communities through projects that reduce pollution, increase community climate resilience, and build community capacity to respond to environmental and climate justice challenges. These place-based investments will be focused on community-driven initiatives to be responsive to community and stakeholder input. They are designed to deliver on the transformative potential of the IRA for communities most adversely and disproportionately impacted by climate change, legacy pollution, and historical disinvestments. Requests for grant application technical assistance are being accepted until May 5, 2024, and grant applications are being acceptedon a rolling basis until November 21, 2024.
		*The**Environmental Justice Thriving Communities Grantmaking Program* is a competition to select multiple Grantmakers around the nation to reduce barriers to the federal grants application process communities face and increase the efficiency of the awards process for environmental justice grants. Grantmakers will design competitive application and submission processes, award environmental justice subgrants, implement a tracking and reporting system, provide resources and support to communities, all in collaboration with EPA’s Office of Environmental Justice and External Civil Rights. 11 Grantmakers were selected in December 2023 and subgrants are expected to become available by Summer 2024.
		*The**Environmental Justice Government-to-Government Program* provides funding at the state, local, territorial, and tribal level to support government activities that lead to measurable environmental or public health impacts in communities disproportionately burdened by environmental harms.  Applications are not open at this time.
		*The**Environmental Justice Collaborative Problem-Solving Cooperative Agreement Program*, which provides financial assistance to eligible organizations working to address local environmental or public health issues in their communities. Applications are not open at this time.A similar program –EPA’s Environmental Justice Grants – has funded health organizations in the past. Examples of previous grantees include the Health and Hospital Corporation of Marion County, Children's Mercy Hospital, and Ben Archer Health Center.

The *Robert T. Stafford Disaster Relief and Emergency Assistance Act* constitutes the statutory authority for most Federal disaster response activities especially as they pertain to Federal Emergency Management Agency (FEMA) and FEMA programs. The IRA authorizes the Stafford Act to provide financial assistance for costs associated with low-carbon building or construction materials and incentives that encourage low-carbon and net-zero energy projects. These clean, climate-resilient considerations are applicable to materials and projects through FEMA’s Hazard Mitigation Grant Program (HMGP), Building Resilient Infrastructure and Communities (BRIC) Program, and Public Assistance (PA).

	*HMGP* provides funding to state, local, tribal and territorial governments so they can develop hazard mitigation plans and rebuild in a way that reduces, or mitigates, future disaster losses in their communities. In this program, homeowners and businesses cannot apply for a grant. However, a local community may apply for funding on their behalf. In the example discussed in section 2, Nicklaus Children’s Hospital in Miami received a grant through HMGP, administered by the Florida Department of Community Affairs, and was able to install a hurricane resistant shell, including a panel system designed to withstand winds of up to 200 miles per hour.
		The *BRIC Program* will support states, local communities, tribes and territories as they undertake hazard mitigation projects. For the BRIC Program, business operators and nonprofit organizations cannot apply directly to FEMA but can be included in a subapplication submitted by an eligible subapplicant.
		The *Public Assistance Program* provides supplemental grants to state, tribal, territorial, and local governments, and certain types of private non-profits so communities can quickly respond to and recover from major disasters or emergencies.
	*Investing in Coastal Communities and Climate Resilience* (page 164 of the Guidebook) supports coastal resilience, coastal communities, and conservation, restoration, and protection of coastal and marine habitat and resources. Eligible recipients include Coastal states (states bordering the Atlantic, Pacific, or Arctic Ocean, the Gulf of Mexico, Long Island Sound, or one or more of the Great Lakes), the District of Columbia, Tribal governments, nonprofit organizations, local governments, and institutions of higher education. An initial framework is available and includes a Climate Resilience Regional Challenge, Tribal Priorities, Climate-Ready Fisheries, Ocean-Based Climate Resilience Accelerators, and Climate-Ready Workforce. NOAA has opened the application for the Climate Resilience Regional Challenge. The letter of intent is due on August 28, 2023 and the full application is due on Feb 13, 2024.
	The *Native Hawaiian Climate Resilience Program* (page 176 of the Guidebook) will help the Native Hawaiian Community cope with the effects of climate change by taking actions that maintain the integrity and identity of the Native Hawaiian Community while also building the capacity for adaptation, learning, and transformation. Applications are currently being accepted until February 29, 2024, and additional information can be found on the DOI landing page for the program.
	*Climate Change Technical Assistance for Territories* (page 173 of the Guidebook) will provide grants for climate change planning, mitigation, adaptation, and resilience to American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the U.S. Virgin Islands, and Puerto Rico. Health stakeholders may be able to receive assistance through these projects from the awardees, and OCCHE will continue to share relevant information. Information on the selected projects is available.
	*Tribal Climate Resilience* (page 174 of the Guidebook) supports climate resilience planning to help sustain Tribal ecosystems and natural and cultural resources, economies, infrastructure, human health, and safety. Funds will remain available until September 30, 2031. Eligible applicants include Federally Recognized Indian Tribal Governments, Native American Organizations authorized by Indian tribal governments and Native American non-profit organizations, federally/tribally chartered tribal colleges and universities. In the past, the Bureau of Indian Affairs Branch of Tribal Climate Resilience has awarded funding to climate health projects including the Sophie Trettevick Indian Health Center (STIHC) Relocation Project, an effort to relocate the STIHC to higher elevation to protect it from flooding, landslides, coastal inundation, and erosion. For the FY 2023 Tribal Climate Annual Awards Program, applications can be submitted online via the TCR Annual Awards Program Application Portal. More information is available here.Note: The White House has released a Guidebook on Funding for Tribes in the Inflation Reduction Act. This guidebook provides an overview of the clean energy, climate mitigation and resilience, agriculture, and conservation-related funding programs in the Inflation Reduction Act for which Tribes are eligible. The guidebook also provides information on how Tribes can leverage new and expanded clean energy tax credits to reduce pollution and energy costs on Tribal lands.
                        Appendix A: Example Use Cases
    In Section 2, we gave examples of ways providers have already leveraged programs like FEMA’s Hazard Mitigation Grant Program and Environmental Justice Grant funding to invest in emissions reduction and resilience. However, numerous new programs and policies have been created by the IRA.

We hope the following use cases featuring key safety-net providers can help providers envision what leveraging these opportunities might look like. In no way does this imply that these are the only important programs or the only provider types that can benefit from them. These hypothetical use cases also should not be read as guidance or an official indication of how these provisions will be implemented.

OCCHE intends to populate this document with additional use cases from the field in the coming months. The use cases offered below are based on the structure of IRA programs and the known needs of certain provider-types; they are not based on the experience of any specific facility.

***Health Center Uses Investment Tax Credit for Electricity from Renewables***

A community health center is located at the heart of an energy community that is also at major risk for damaging storms and extreme heat. The center realizes that it could improve its bottom line and resilience in crisis situations by installing solar power and battery storage. The nonprofit center applies for and receives direct payment for the *Investment Tax Credit for Electricity from Renewables*in 2023 and starts generating energy in 2024.

Over the course of several years, the center realizes significant savings and is able to store excess energy for use in emergency situations. When a hurricane knocks out power to the surrounding area in 2025, the center stays open and serves its community thanks to its reliable backup power.

***Nursing Home Uses Energy Efficient Commercial Buildings Deduction***

A nursing home sometimes struggles to maintain its indoor air quality during increasingly frequent wildfire events. Using the *Energy Efficient Commercial Buildings Deduction*, the nursing home is able to improve its heating, ventilation, and air conditioning (HVAC) system and building envelope.

The site improvements lead to the nursing home reducing its use intensity by 27% in 2024 compared to 2023. These improvements also help the facility improve its indoor air quality, protecting residents and staff from wildfire smoke.

***Rural Emergency Hospital Uses Rural Energy for America Program***

A rural emergency hospital provides essential services for its community, which faces disproportionately high adverse health and environmental impacts. The hospital meets the eligibility requirements for the *Rural Energy for America Program (REAP),* including being a small business in a rural area with a population of 50,000 residents or less. The hospital is able to use REAP funding for the purchase and installation of wind generation equipment.

By the end of 2024, the hospital is generating its own energy through wind power. The hospital previously emitted 1.2 metric tons of carbon dioxide equivalent gases per year through indirect emissions. The hospital is now generating more energy than it uses and is ultimately able to invest in other minor site improvements that save money by improving energy efficiency (for example, switching to lower-energy LEDs lights).

***Community Mental Health Center Uses Environmental and Climate Justice Block Grants***

A nonprofit community mental health center and nearby federally-recognized tribe are concerned about how increasing extreme heat – including a recent heat dome – have affected their community. Using an *Environmental and Climate Justice Block Grant*, they are able to partner on a program to study local urban heat islands and mitigate their effects through increasing tree cover and installing cool reflective roofs.

The grantees were able to hire staff to map urban heat islands, identifying areas of risk. They developed informational materials for providers and citizens regarding the risks of extreme heat in their community and how to stay cool. They are also able to use HHS resources like the Climate and Health Outlook to publicize resilience resources like the availability of home energy assistance through the Low-Income Home Energy Assistance Program.
                        Appendix B: Advice for Grant Applications
    Some of the opportunities listed above are grants that will require applications. Each opportunity will have its own application requirements and process. General advice for first-time applicants that may be applicable to many types of applications is included below:

**Include a Unique Entity Identifier (UEI).** A UEI must be provided for an application to be submitted and reviewed. A UEI can be obtained by accessing SAM.gov.

**Keep the audience in mind.** Reviewers will use only the information contained in the application to assess the application. Therefore, the applicant should be sure the application and responses to the program requirements and expectations are complete and clearly written. Do not assume that reviewers are familiar with the applicant's organization. Keep the review criteria in mind when writing the application.

**Start preparing the application early.** If applying electronically through Grants.gov please ensure that adequate time is allotted to register and download applicable software and forms. Grants.gov offers several grants-related YouTube videos , we encourage you to begin with "Intro to Grants.gov – Applying for a Federal Grant on Grants.gov " which provides startup requirements and tips.

**Formatting tips.**  Be sure pages are numbered (including appendices) and that page limits are followed. Limit the use of abbreviations and acronyms, and define each one at its first use and periodically throughout the application.



**Learn how to navigate Grants.gov to file electronically:** Applicant Resources on Grants.gov
                        Endnotes

1  The categorical waiver excludes long-term care (LTC) facilities that provide life support as the LTC requirements at 42 CFR 483.90(c)(2) requires these facilities to have an emergency generator without exception.

                    
  


Content created by Office of the Assistant Secretary for Health (OASH) Content last reviewed April 8, 2024 Back to top
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