Harvest Health Initiative

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Executive Summary

Harvest Health Initiative is a nonprofit in California that operates a mobile health clinic for migrant and seasonal farmworkers and their families in the San Joaquin Valley. A nurse practitioner and bilingual community health workers travel to farm labor camps, packing houses and rural gathering points on a weekly schedule, providing primary care screenings, chronic disease follow-up, Medi-Cal enrollment assistance and heat illness prevention education.

Farmworkers harvest the food and face some of the worst health outcomes of any population in California. Distance to a clinic, work schedules, language barriers and concerns about documentation keep most farmworkers from accessing the care they need until a problem becomes a crisis. With this grant we will pay our community health workers and keep the van on the road. We do not practice medicine in this proposal; the nurse practitioner's services are governed by her license and California law.

What we are asking for. Our program has a Year 1 budget of about $268,000. We are asking for $70,000 from a farmworker health foundation to pay a portion of community health worker salaries and mobile clinic operating costs. The rest of the budget comes from other grants, Medi-Cal billing and program income listed in the funding section. Every dollar amount in this plan is an estimate.

Company Description

Harvest Health Initiative is a nonprofit organization recognized under section 501(c)(3) of the tax code, governed by a volunteer board that includes two farmworkers, a public health nurse and a labor contractor. The board meets monthly, approves the budget and oversees the executive director. A new organization without its own determination letter can use a fiscal sponsor, explained in the funding section.

What we believe. Farmworkers deserve the same access to health care as anyone else in California. The clinic should go to them.

What we do:
- Mobile clinic route. The converted Ford Transit health van travels to 32 farm sites in Kings, Tulare and Fresno counties on a published weekly schedule from March through November.
- Primary care screenings. Blood pressure, blood glucose, BMI, vision and hearing at every visit.
- Chronic disease follow-up. Workers with identified hypertension or elevated blood glucose are seen again at the next site visit, given prescription navigation help and referred to the area FQHC with a warm handoff.
- Medi-Cal enrollment. Community health workers complete enrollment applications on a tablet connected to the state portal. Workers who qualify are enrolled before leaving the van.
- Heat illness prevention. A 10-minute education session at every summer visit covers California's heat illness regulations, hydration requirements and how to recognize heat stroke.
- Pesticide exposure education and referral to the county agricultural commissioner's reporting system.

What we do not do. We do not diagnose or prescribe on behalf of the grant; the NP does that under her license. We do not report immigration status to any authority. We do not promise that Medi-Cal enrollment will be approved.

Who we serve. Migrant and seasonal farmworkers and their family members in Kings, Tulare and Fresno counties, regardless of documentation status.

Our board has at least five members, including at least one person who has used our services or lives in the community we serve, and only a minority of board members may be related to each other or paid by the organization.

We keep a written conflict of interest policy, a whistleblower policy and a record retention policy, and the board reviews them every year.

Problem & Opportunity

Farmworkers in the San Joaquin Valley face some of the largest health care access gaps in California.

1. Distance. The nearest FQHC to many farm labor camps in Kings County is 18 to 25 miles away with no public transit and no appointment availability for weeks.
2. Work hours. Harvest season runs 10 to 14 hours a day, six days a week. A clinic appointment is not possible.
3. Chronic disease. Kings County has the highest rate of adult diabetes in California. Heat illness hospitalizations among California farmworkers have increased significantly over the past decade.
4. Documentation concerns. Fear of any system that might share information with immigration authorities keeps many farmworkers from seeking care until an emergency.
5. Language. Most farmworkers in our service area speak Spanish as a primary language. Some speak indigenous languages. Few clinics have bilingual staff available without an appointment.

Why it matters now. A survey of farmworkers in our target counties found that most had not seen any health care provider in the past 12 months. In our pilot, a large share of workers screened had blood glucose levels indicating undiagnosed pre-diabetes or diabetes, and many had undiagnosed hypertension.

How we know the need is real. We surveyed 80 farmworkers at five farm sites, reviewed county chronic disease data from the California Department of Public Health and talked with labor contractors and the area FQHC. The full data is in the appendix. We update these facts annually and change the program if the data changes.

Products & Services

What the funded project will do. With this grant we will pay a portion of community health worker salaries and mobile clinic operating costs for a full year.

How a farmworker takes part:
1. Site visit. The van arrives at the farm site on the published schedule, usually Tuesday or Thursday morning before the shift starts or at the lunch break.
2. Screening. A community health worker takes blood pressure and blood glucose and records findings. Consent is verbal, explained in Spanish.
3. Education. A 10-minute session on heat illness prevention or the current seasonal health topic.
4. Medi-Cal enrollment. The CHW opens the state portal on a tablet for any worker who wants to apply.
5. Referral. Workers with identified conditions receive a written referral to the FQHC and, when the schedule allows, the CHW calls ahead to make the appointment while the worker is still at the van.
6. Follow-up. The CHW records the worker's preferred name and which farm site they work at to follow up at the next visit.

What the grant pays for. This request covers a portion of CHW salaries and van fuel, maintenance and insurance.

What we do not promise. We do not promise that Medi-Cal will approve every application or that every referred worker will reach the FQHC. We track site visits, workers screened, Medi-Cal enrollments completed and referrals made, and we report honestly.

Safety and privacy. We do not collect or share immigration status. Personal health information is stored on an encrypted device. We call 911 in an emergency. The NP's clinical work follows her California license requirements.

Market Analysis

Who benefits from this project are farmworkers and their family members in Kings, Tulare and Fresno counties.

Who we serve. Migrant and seasonal farmworkers ages 18 and older and their family members, most Spanish-speaking, most uninsured or newly eligible for Medi-Cal, most working on row crops and tree fruits in the central San Joaquin Valley.

How many people we plan to serve. In Year 1 we plan to complete 32 farm site visits and screen about 800 individuals. By Year 5 we plan to complete 50 site visits and screen about 1,300 individuals. We chose those numbers from the van's schedule capacity and the NP's availability.

Where we serve. Kings, Tulare and Fresno counties, with sites at labor camps, packing houses and farm supply staging areas.

Who else benefits. Employers whose workers stay healthier and more productive during harvest. The county and state health systems that avoid costly emergency department visits for untreated chronic disease.

We choose how many site visits to schedule from the van's maintenance calendar, fuel budget and NP availability, not from the size of the need. If we complete fewer visits than planned, we will report it and explain why.

Competitive Landscape

Other organizations in our area.

1. Clinica Sierra Vista FQHC. Provides primary care but has a six-week appointment waitlist and no mobile capacity to reach labor camps. We refer workers to them and serve as an upstream screening partner.
2. County public health mobile units. Deployed during declared heat emergencies. We operate on a weekly scheduled route year-round.
3. Hospital emergency departments. The most common point of care for uninsured farmworkers with untreated chronic disease. We reduce preventable ER use.
4. State farmworker health programs. Fund mobile clinics but do not directly operate them in our counties.

What makes us different. We go to the farm site on a fixed weekly schedule, we enroll Medi-Cal on the van the same day and our community health workers are bilingual farmworkers or former farmworkers who the workers already trust. We coordinate with the FQHC rather than competing with it.

How we avoid duplication. We meet quarterly with Clinica Sierra Vista and the county public health department to share referral data and site scheduling.

Marketing & Sales Strategy

How we will reach farmworkers once the project is funded.

Labor contractor partnerships. We work with three labor contractors who have given us access to their farm sites. Site access depends on trust built over time with contractors and farm managers.

Word of mouth. Once a van is known and trusted at one camp, workers tell people at nearby camps. This is our most effective channel.

Farm postings. Flyers in Spanish on the bulletin boards at packing houses and labor camps list the weekly schedule.

FQHC referrals. Clinica Sierra Vista refers workers who mention they cannot make it to the clinic.

Funding outreach. The California Endowment, CDPH Farmworker Health Program and HRSA MSFW grant programs are the primary funding channels we cultivate each year.

Measuring outreach. We track how each new worker heard about the van and adjust if a channel stops working.

Operations Plan

How the project will be carried out.

Timeline for Year 1. Month 1: renew labor contractor site agreements, confirm van maintenance, stock supplies. Months 2 to 11: run weekly site visits March through November. Month 12: end-of-season data review, funder reports and site planning for Year 2.

The van. A 2019 Ford Transit converted health van with an exam table, blood pressure cuffs, glucometers, vision testing equipment and a tablet for Medi-Cal enrollment. The van is owned by the organization and maintained on a written preventive maintenance schedule.

Partners. Clinica Sierra Vista FQHC for warm referrals, three labor contractors for site access, the CDPH Farmworker Health Program for data sharing and the county health department for heat emergency coordination. Each has a written agreement.

Medi-Cal billing. Services provided by the NP that qualify for Medi-Cal reimbursement are billed through a contracted billing firm. Billing revenue is estimated conservatively.

Money controls. Van fuel and maintenance expenses require two approvals. Supply purchasing is done quarterly with board review.

Records and reporting. We track site visits, workers screened, screening findings, Medi-Cal applications completed and referrals made. We report to funders twice a year.

Management & Organization

The executive director manages operations and funder relationships. The nurse practitioner provides and supervises clinical services. Community health workers conduct screenings, education and enrollment.

The team. Pay figures include payroll taxes and workers' compensation insurance. The numbers in parentheses are how many people we plan to have in Years 1 through 5. A number with a half, such as 2.5, means a hire phased in during the year or one part-time person.
- Executive Director and Nurse Practitioner (combined role): 1, 1, 1, 1, 1 (Years 1 to 5), about $88,000 a year.
- Community Health Worker: 2, 2, 2, 3, 3 (Years 1 to 5), about $46,000 a year each.
- Program Coordinator (part-time): 1, 1, 1, 1, 1 (Years 1 to 5), about $22,000 a year.
- Program Associate (added as the budget grows): 0, 0.5, 1, 1, 1.5 (Years 1 to 5), about $38,000 a year each, hired as new grant money arrives.

Governance and money controls. The board reviews financial statements monthly and an outside accountant prepares the yearly tax return. Every grant is tracked in its own budget line. Medi-Cal billing revenue is tracked separately.

Feedback and complaints. Farmworkers can give feedback to any CHW verbally or in writing. We ask three questions after every visit and report findings to the board quarterly. No worker loses services for speaking up.

Milestones Narrative

Goals for each of the first five years. These are goals, not promises.
- Before the grant starts: renew site agreements with labor contractors, confirm van maintenance and stock supplies for the season.
- Year 1: complete 32 site visits, screen about 800 workers, complete about 150 Medi-Cal enrollments. Budget about $268,000.
- Year 2: expand to 40 site visits, begin HRSA MSFW grant application with Year 1 data. Budget about $310,000.
- Year 3: add dental screenings in partnership with a dental hygiene program. Budget about $345,000.
- Year 4: add a second CHW and expand to a fourth county. Budget about $385,000.
- Year 5: complete 50 site visits and screen about 1,300 workers. Budget about $422,000.

How we will measure results: site visits completed, workers screened, new diagnoses identified, Medi-Cal enrollments completed, referrals made and Medi-Cal billing revenue. We report to funders twice a year and say honestly when a goal was missed.

Funding Request

What we are asking for, and how the money will be used. Our request: $70,000 from a farmworker health foundation for a portion of community health worker salaries and mobile clinic operating costs, for January through December 2027.

The request is spread across these budget lines:
- Personnel: Community Health Worker salaries (part), $48,000.
- Other: Van fuel, maintenance and insurance, $22,000 (other funds add $0; this grant covers the full van operating cost).

Other money in the program. This request is about 30% of Year 1 grant income. Other grants and Medi-Cal billing pay for everything it does not cover.

Year 1 budget: about $268,000, planned to balance with a small surplus (about $5,400 after the yearly wear on equipment). Year 1 money coming in: Grant Revenue $233,000; Medi-Cal Billing Revenue $35,000. Year 1 costs: executive director and nurse practitioner (combined role) $88,000; community health worker $92,000; program coordinator (part-time) $22,000; van fuel, maintenance and insurance $19,700; medical supplies and health kits $14,300; medi-Cal billing contractor $7,200; office and reporting $10,700; annual data report and outreach $7,200.

One-time startup costs. Startup costs of $13,800 are paid once from startup money: $4,200 for van conversion upgrades and equipment refresh, $3,400 for a secure case management system and encrypted tablets, $2,600 for Spanish-language outreach materials design and printing, $2,000 for staff training in Medi-Cal enrollment and trauma-informed practice, and $1,600 for legal setup and policy review.

How we got our startup number. The Funding Need Calculator in this plan adds the startup costs ($13,800), the cash the program uses before it balances (about $3,800) and a cash cushion of about $65,300, which is about 3 months of Year 1 costs. In all, that comes to $83,000. We start with $18,000 of our own savings and $65,000 from the CDPH Farmworker Health Program startup allowance and board contributions, $83,000 in all, which covers that amount.

The next five years. Our budget grows from about $268,000 in Year 1 to about $422,000 in Year 5. Grant revenue is planned at $233,000, $228,000, $258,000, $294,000 and $287,000 in Years 1 to 5. Other income grows as sponsors and donors join. The program plans to end each year with a surplus, about $5,400, $20,000, $26,500, $9,500 and $15,000 in Years 1 to 5, which we put into savings. Some years are larger because new grant money arrives before the added staff are hired. The lowest year-end cash in the plan is about $71,600.

After the grant. Medi-Cal billing revenue grows as more workers are enrolled, reducing grant dependence over time. HRSA MSFW grants become the primary federal funding stream in Year 2.

Risks:
- Van breakdown can cancel a week of visits. We maintain a preventive schedule and a repair reserve.
- A labor contractor may withdraw site access. We cultivate relationships with five contractors so any one loss does not cancel operations.
- Medi-Cal billing revenue may be lower than projected. We budget conservatively and adjust.
- A heat emergency may create demand that exceeds the van's capacity. We coordinate with county public health and can add a second site visit day during declared emergencies.

Appendix Notes

Documents to attach before you send this proposal:

- Your IRS determination letter showing 501(c)(3) status, or your fiscal sponsor agreement.
- Your board list and board minutes approving the application.
- Your most recent budget and financial statements.
- A list of other funders and what each has given or been asked to give.
- NP license and van health clinic operating permit.
- CHW certificates for both community health workers.
- Labor contractor site access agreements.
- Clinica Sierra Vista referral agreement.
- Pilot data summary from the first season.
If you don't have any of this yet, no worries - let's continue.

The assumptions behind our numbers:
- Grant Revenue: $233,000 in Year 1, growing to $287,000 in Year 5.
- Medi-Cal Billing Revenue: $35,000 in Year 1, growing to $80,000 in Year 5 as enrollment improves.
- Staff pay includes payroll taxes and workers' compensation.
- Van operating costs ($22,000) include fuel at approximately $4.20/gallon for about 18,000 miles, scheduled maintenance and commercial auto insurance.
- Medical supplies ($16,000) include blood pressure cuffs, glucometer strips, vision charts, heat kits and printed outreach materials.
- Every dollar amount is an estimate.

Plain words used in this proposal:
- FQHC: federally qualified health center, a community clinic that receives federal funding to serve uninsured and low-income patients.
- Medi-Cal: California's Medicaid program, available to low-income residents regardless of immigration status in many cases.
- CHW: community health worker, a trained health educator and navigator from the community being served.
- MSFW: migrant and seasonal farmworkers, the population designation used by HRSA grant programs.
- NP: nurse practitioner, an advanced practice registered nurse licensed to diagnose and prescribe.

Startup Costs