A conversation with Stephen Halasnik and Dr. Adam Aponte, CEO of East Harlem Council for Human Services

How A Nonprofit Can Address Financial Challenges in an Era of Uncertainty

Nonprofit financial challenges are not new.

In today’s environment of funding delays, rising costs, and unpredictable reimbursement cycles, many organizations are facing more pressure than ever.

For nonprofit executive directors and CFOs, managing these financial challenges has become essential to protecting both operations and mission.

Stephen Halasnik, co-founder of Financing Solutions, a leading provider of lines of credit for nonprofits and host of The Nonprofit MBA Podcast, speaks with Dr. Adam Aponte about the real financial pressure facing community-based nonprofits today.

Tight margins, delayed reimbursements, restricted grants, rising costs, and unpredictable funding cycles have long been part of the job for nonprofit leadership.

But in the last year and a half, many organizations have faced a sharper and more urgent version of that pressure.

For Dr. Adam Aponte, CEO of East Harlem Council for Human Services, the challenge is not theoretical. His organization has served the East Harlem community for decades through a bilingual Head Start program, a federally qualified health center, school-based health programs, and a senior nutrition program. Together, those services reach some of New York City’s most vulnerable residents, including children, older adults, low-income families, Medicaid recipients, uninsured patients, and people who might otherwise struggle to access care.

But when funding becomes uncertain, the mission itself is put at risk.

“We operate on very, very tight margins already, and this added impact on revenue is not going to make things easier for us.”

Quick Answer

These nonprofit financial challenges often stem from timing gaps between expenses and incoming funding.

Funding delays are one of the most common causes of nonprofit cash flow disruption, especially for organizations relying on reimbursements or government contracts. Nonprofits can address financial challenges by combining advocacy, stronger board communication, collaboration, new revenue strategies, and disciplined working capital management. When funding delays create timing gaps between expenses and revenue, a nonprofit line of credit can help stabilize cash flow without replacing long-term funding.

This article walks through the key nonprofit financial challenges leaders are facing today, along with practical ways to respond.

In This Episode

  • How funding delays and policy changes affect nonprofit cash flow
  • Why advocacy is part of financial strategy
  • How nonprofit boards can support leaders during uncertainty
  • Why collaboration can reduce costs and improve service delivery
  • How nonprofits can develop new revenue streams
  • Why working capital matters when reimbursement or grant funding is delayed

Why Nonprofit Financial Challenges Are Increasing

East Harlem Council for Human Services is facing challenges on multiple fronts. Its bilingual Head Start program, which has served the community for more than 50 years, experienced a serious funding threat that could have jeopardized the program’s future. While city and state support provided temporary relief, Dr. Aponte emphasized that short-term funding is not enough.

The organization’s federally qualified health center, or FQHC, faces another set of financial pressures tied to Medicaid changes. More than 65% of the patients served by the health center are Medicaid recipients, and another 10% are uninsured.

If more people lose Medicaid coverage, the center will continue to care for them. But those visits may come with little or no revenue attached.

That creates a painful dilemma for nonprofit healthcare providers. Their mission requires them to serve people in need. Their financial reality requires revenue to keep the doors open, pay staff, and maintain programs.

Dr. Aponte estimates that East Harlem Council for Human Services could lose $700,000 to $800,000 in revenue as a result of the changes. That may not close the organization, he said, but it will force difficult decisions about staffing, services, and future priorities.

What Are Nonprofit Financial Challenges?

Nonprofit financial challenges refer to the ongoing difficulty of balancing expenses with inconsistent or delayed revenue. These challenges often include funding delays, restricted grants, reimbursement timing gaps, and limited working capital, all of which can impact an organization’s ability to operate effectively.

Common Nonprofit Financial Challenges

  • Delayed grant or government reimbursements
  • Restricted funding that limits flexibility
  • Unpredictable donation cycles
  • Rising operating and staffing costs
  • Limited working capital reserves

Step One: Advocacy

When asked how nonprofits should respond to financial challenges, Dr. Aponte’s first answer was clear: fight back.

That does not mean being combative for the sake of it. It means refusing to quietly accept decisions that could damage the community. It means educating legislators, funders, partners, and the public about what the organization does and why it matters.

For Dr. Aponte, advocacy has become a central part of leadership. He has gone to Albany. He has gone to Washington, D.C. He has spoken with elected officials, staff members, community partners, patients, employees, and anyone willing to listen.

His message is simple: cutting primary and preventive care does not save money in the long run. It pushes people into more expensive settings, including emergency rooms, urgent care centers, and hospitals.

“Primary care in my facility is much cheaper than when individuals go to emergency rooms and get admitted to hospitals.”

The work of a community health center is often misunderstood. Many people do not realize that these centers provide far more than basic medical visits. They help with chronic disease management, preventive care, pediatric care, food insecurity, clothing needs, school-based health support, and connections to other social services.

That is why controlling the narrative is so important.

“Make sure people know the value. Don’t be complacent and think that people know what a community health center does.”

Step Two: Staff and Board Engagement

Financial challenges cannot be handled by the CEO alone.

At East Harlem Council for Human Services, Dr. Aponte has made transparency a priority. His staff of more than 200 people understands the threats facing the organization. Many have become advocates themselves, sharing information on social media, participating in public conversations, and even traveling to Albany to speak directly with decision-makers.

That matters because elected officials hear something different when the message comes from frontline staff and patients.

A CEO can explain the numbers. But staff and patients can explain the human impact.

The board has also become more engaged. Like many community health centers, East Harlem Council’s board includes consumer members, meaning people who are patients of the health center. Dr. Aponte sees part of his job as educating the board so members understand the financial issues, the policy environment, and the strategic choices facing the organization.

Board meetings have changed as a result. There are more questions, deeper conversations, and greater transparency.

That is a healthy development. In times of financial stress, nonprofit boards should not simply receive reports. They should understand the risks, ask hard questions, help open doors, and support leadership in making difficult decisions.

Step Three: From Shock to Action

At this stage, nonprofit financial challenges shift from theoretical concerns to immediate operational decisions.

When nonprofits receive bad financial news, the first reaction is often shock. During COVID, many organizations experienced what Stephen Halasnik described as a “deer in the headlights” moment before moving toward acceptance and action.

During periods of uncertainty, nonprofit cash flow becomes the central financial concern, as leaders must balance immediate expenses with unpredictable revenue timing.

Dr. Aponte said his organization went through similar stages, but quickly.

Community-based organizations do not always have the luxury of long deliberation. They have to be agile. When funding is threatened, leaders must understand what is happening, assess the financial impact, communicate with the board, identify immediate risks, and begin looking for solutions.

That includes asking practical questions:

  • What funding is at risk?
  • How much revenue could be lost?
  • Which programs are most vulnerable?
  • What costs can be reduced without damaging the mission?
  • What new revenue streams can be developed?
  • What advocacy efforts could influence the outcome?
  • What partnerships could help the organization become more efficient?

This kind of disciplined response can prevent fear from becoming paralysis.

Step Four: Collaboration Over Competition

One of Dr. Aponte’s strongest recommendations is that nonprofits, especially healthcare providers, stop seeing nearby organizations as competitors and start seeing them as collaborators.

In healthcare, he said, organizations often talk about “my patient” or “your patient.” But from his perspective, that mindset misses the point.

“No patient belongs to me. Our role is to serve this community.”

That shift in thinking can have major financial implications.

Organizations may be able to share services, reduce duplicate expenses, coordinate referrals, and create economies of scale. For example, multiple health centers may each be paying separately for legal support, credentialing, administrative systems, or other services. By working together, they may be able to lower costs while improving care.

Dr. Aponte is working with other FQHCs in East Harlem to build a more collaborative model, one he describes as a “no wrong door” approach. Wherever a patient enters the system, the goal is to connect that person with the care and support they need, even if another organization is better suited to provide it.

That requires trust. It also requires a willingness to put mission ahead of institutional ego.

Step Five: Developing New Revenue Streams

Advocacy matters, but nonprofits cannot rely on advocacy alone. They also need to think creatively about revenue.

For East Harlem Council for Human Services, one strategic focus is Medicare. The organization serves a large Medicaid population but has a smaller Medicare base. Growing Medicare services could help offset some of the revenue pressure tied to Medicaid changes.

Dr. Aponte is also exploring healthcare revenue opportunities tied to care management, including transitional care management, chronic care management, and remote patient monitoring.

Transitional care management helps patients move safely from a hospital or nursing home back into the community. Without that support, patients with chronic conditions may quickly end up back in the hospital.

Chronic care management allows providers to stay connected with patients who have conditions such as diabetes or hypertension, helping them manage medications, appointments, and follow-up care.

Remote patient monitoring uses technology to track health indicators outside the clinic. If a patient’s blood pressure rises, for example, the care team can intervene before the issue becomes an emergency.

These services can create revenue while also improving patient outcomes and reducing the total cost of care.

That is the best kind of nonprofit revenue strategy: one that supports the mission rather than distracting from it.

Step Six: The Role of Philanthropy

Restricted funding is often necessary, but it can limit innovation. Many grants must be used for very specific purposes, leaving little room for experimentation or emerging needs.

That is why unrestricted philanthropy is so valuable.

Dr. Aponte said philanthropic support allows organizations like his to be more creative. It can help fill gaps, test new ideas, support urgent needs, and respond to community challenges that do not fit neatly into a grant category.

Fundraising events, donor cultivation, partnerships, and community storytelling all become more important during financially unstable times.

But again, the organization must tell its story well. Donors need to understand not only what the nonprofit does, but why it matters now.

Step Seven: Protecting Leadership Capacity

At the end of the conversation, Stephen Halasnik offered a reminder that nonprofit leaders often forget: you have to put your own oxygen mask on first.

Executive directors, CEOs, and nonprofit staff are often deeply mission-driven. That commitment is admirable, but it can also lead to burnout. When funding is threatened and communities are in need, leaders may feel pressure to keep pushing without rest.

But exhausted leaders cannot make clear decisions. Burned-out staff cannot sustain high-quality service. A depleted organization cannot fully serve its mission.

Taking care of yourself is not selfish. It is part of the work.

Whether that means exercise, prayer, meditation, calling a friend, taking a quiet cup of coffee, or simply stepping away long enough to breathe, nonprofit leaders need daily practices that keep them grounded.

Because communities need them.

How to Respond to Nonprofit Financial Challenges

Many nonprofit financial challenges are not caused by a lack of approved funding. They are caused by timing. A grant may be awarded, a reimbursement may be pending, or a contract payment may be expected, but payroll, rent, benefits, vendors, and program costs still need to be paid now. Without sufficient working capital, even financially stable nonprofits can struggle to maintain consistent operations during funding gaps.

That is where nonprofit cash flow planning becomes essential. Leaders should regularly review expected inflows, upcoming expenses, reimbursement timelines, and available working capital. The goal is to identify shortfalls early, before they become urgent.

A nonprofit line of credit can be useful when an organization has reliable funding coming in but needs help bridging the timing gap. It should not be viewed as a substitute for revenue or a solution to long-term structural deficits. Used appropriately, however, it can help nonprofits manage funding delays, protect operations, and avoid disruption to essential services.

FAQ

How can nonprofits address financial challenges?

Nonprofits can address financial challenges by advocating for funding, educating board members, improving financial transparency, collaborating with peer organizations, reducing duplicated costs, developing new revenue streams, and building stronger donor relationships.

What causes nonprofit cash flow problems?

Nonprofit cash flow problems are often caused by delayed reimbursements, restricted grants, slow government payments, rising expenses, and timing gaps between when services are delivered and when funding is received.

How can a nonprofit line of credit help with funding delays?

A nonprofit line of credit can help bridge short-term timing gaps between expenses and incoming funding. It can support payroll, operating costs, and program continuity while the organization waits for expected revenue.

What is working capital for a nonprofit?

Working capital is the money available to cover short-term operating needs. For nonprofits, this often includes payroll, rent, program expenses, vendor payments, and other costs that must be paid before grant funds, reimbursements, or donations arrive.

Why is advocacy important for nonprofit financial stability?

Advocacy helps funders, legislators, and the public understand the real impact of funding cuts. It allows nonprofits to explain how their services save money, support communities, and prevent larger social problems.

How can nonprofit boards help during financial uncertainty?

Boards can help by asking better financial questions, understanding funding risks, supporting advocacy, opening doors to donors or partners, and helping leadership evaluate difficult strategic decisions.

Why should nonprofits collaborate instead of compete?

Collaboration allows nonprofits to share resources, reduce costs, improve service delivery, and avoid duplication. In healthcare and social services, collaboration can also help clients receive the right support faster.

What are examples of new revenue streams for nonprofit health centers?

Examples include Medicare growth, transitional care management, chronic care management, remote patient monitoring, fundraising events, unrestricted philanthropy, and strategic partnerships.

Why is unrestricted funding valuable for nonprofits?

Unrestricted funding gives nonprofits flexibility to respond to urgent needs, test new ideas, cover operational gaps, and invest in programs that restricted grants may not support.

How can nonprofit leaders avoid burnout during financial stress?

Leaders should protect their energy through rest, exercise, peer support, reflection, prayer, meditation, or other grounding routines. A burned-out leader cannot effectively support staff, clients, or the mission.

Ultimately, nonprofit financial challenges require both strategic planning and day-to-day financial discipline.

The Bottom Line

Nonprofit financial challenges are not going away. Funding will shift. Government priorities will change. Costs will rise. Reimbursement delays will happen. Programs will face pressure.

But organizations are not powerless.

They can advocate. They can educate. They can activate their staff and board. They can collaborate instead of compete. They can seek new revenue streams. They can pursue unrestricted support. And they can build financial tools and partnerships that help them weather uncertainty.

As Dr. Aponte’s leadership shows, the strongest nonprofits do not simply react to financial challenges. They use those challenges as a reason to become louder, smarter, more collaborative, and more determined.

For mission-driven organizations, financial stability is not just about money. It is about protecting the people, programs, and communities that depend on them.

For organizations navigating funding delays, understanding how tools like a nonprofit line of credit work can help you evaluate your options while continuing to focus on your mission.

Full Transcript

Stephen Halasnik: Welcome everyone. My name is Stephen Halasnik. I will be your host for today’s Nonprofit MBA Podcast. For those of you who don’t know me, I am co-founder of Financing Solutions.

Stephen Halasnik: For the last 15 years, we have been the leading and largest provider of lines of credit to small nonprofits in the United States. It is a great product. If you’re interested in learning more about it, please feel free to visit our website at nonprofitmbapodcast.com.

Stephen Halasnik: Today, I am very excited to be speaking with Dr. Adam Aponte from East Harlem Council for Human Services. Today we are going to be talking about how to address your nonprofit’s financial challenges, which is a great conversation, especially now. It is always an issue, but certainly in the last year and a half, it has been more of an issue.

Stephen Halasnik: A little bit about Dr. Aponte. He is the CEO of East Harlem Council for Human Services, a leading nonprofit organization dedicated to delivering high-quality, community-based health care and social services. A lifelong advocate for health equity, Dr. Aponte has spent his career improving access to care for underserved populations across New York City. His leadership in East Harlem continues to shape how nonprofit, community-driven health initiatives can create lasting, meaningful impact. We are honored to welcome Dr. Aponte to today’s show. Welcome.

Dr. Adam Aponte: Thank you, Stephen, and thank you for inviting me to join you and your audience and take part in this conversation.

Stephen Halasnik: So, I guess the big elephant in the room has been, have things been any different in the last year and a half in regard to financial stability than they were prior to a year and a half ago?

Dr. Adam Aponte: Yeah, absolutely. That is a very loaded question. Just to give context to your listeners, our organization, the East Harlem Council for Human Services, runs several programs under our umbrella. We have a bilingual Head Start program that is funded through the Department of Education here in New York.

Dr. Adam Aponte: We have a federally qualified health center, or FQHC, which is a HRSA-funded health center that we have been operating for over 52 years in our community. It provides primary preventive care services to any individual who crosses our threshold, regardless of insurance, regardless of immigration status, you name it. We take care of them to ensure access. We also have some school health programs where we embed our health services inside elementary and middle schools, and we have a senior nutrition program for older adults. That is what older adults like to call themselves now, Stephen. Instead of seniors, they want to be called older adults. Or if you go to my center, they like to be called recycled teenagers.

Stephen Halasnik: Haha.

Dr. Adam Aponte: Anyway, those are the four programs. To focus on two of those first programs, Bilingual Head Start and the federally qualified health center, the FQHC, we have seen significant threats to our funding. This is a big challenge that we have been facing over the last year and a half.

Dr. Adam Aponte: For our bilingual Head Start program, which is funded through the federal government, we saw a pause in funding this last year. So much so that we thought we were going to close our program after 57 years of serving the community. Fortunately, here in New York City, we got a reprieve from our mayor and governor, who are investing in early childhood care. We are fortunate that we do have some funding at least through next year, but we need long-term funding.

Dr. Adam Aponte: That is one of the issues coming down from the federal government that normally supports these programs. Then with our FQHC, the biggest issue has been H.R. 1 and the changes in terms of Medicaid and how that is going to impact us. We serve a very large Medicaid population. Over 65% of the individuals who receive services at our health center are Medicaid recipients. Another 10% or so are uninsured individuals.

Dr. Adam Aponte: With H.R. 1 and the changes that are coming through H.R. 1, we are going to see a significant drop of individuals from the Medicaid rosters, which means more individuals will be uninsured. As I mentioned, our health center will continue to see these individuals, but there will be no revenue tied to these visits. That is creating a gap in what is already a challenge as far as revenue for FQHCs and health centers like ours.

Dr. Adam Aponte: That is a significant challenge we have been facing, and we have been trying to advocate at the city, state, and federal levels to address it. Otherwise, these gaps are going to create pauses in our programs, limiting the programs and services we offer. Some FQHCs may actually close. That will even further the gap as far as access to care for primary preventive care services. That is a big headwind we are facing today.

Stephen Halasnik: Wow, it is unbelievable. Maybe we could give some context. What was the annual revenue of your organization prior to a year and a half ago on a yearly basis?

Dr. Adam Aponte: The way I would look at this, Stephen, is what revenue we anticipate we will lose as a result of H.R. 1. When you look in New York State, there are 80 FQHCs with over 900 locations. We take care of 2.5 million New Yorkers. That means one in eight New Yorkers gets their care in an FQHC. As a result of H.R. 1, we anticipate that collectively we are going to lose $300 million in revenue.

Dr. Adam Aponte: That is a very conservative figure. It may be greater than that, but we anticipate a loss of $300 million. Added to that, in New York State, FQHC reimbursement rates are based upon 1999 cost factors. Imagine a quart of milk in 1999 and what a quart of milk costs today. Today, we basically get 70 cents on the dollar. These two things, additively, are going to create significant funding gaps for us.

Dr. Adam Aponte: Again, we are going to have to curtail services. We cannot continue to deliver all the services that we feel our communities need because we just will not have the funding to support it. For us at the East Harlem Council, we anticipate a loss of about $700,000 to $800,000 in revenue as a result of H.R. 1, which is pretty significant. It is not going to close our doors, but it is definitely going to make us pivot and think about what programs we offer and what staffing we can bring on board as a result, because every penny is tight in the not-for-profit world.

Dr. Adam Aponte: We operate on very, very tight margins already, and this added impact on revenue is not going to make things easier for us.

Stephen Halasnik: How has this impacted you personally?

Dr. Adam Aponte: Interesting question. To me, this has made me be a little bit more, excuse my French, but badass. I grew up in the community of East Harlem myself and faced significant challenges. I work and serve the community that I grew up in. I faced significant challenges as a young kid growing up poor in this community, and I faced the challenge of people thinking I would not become a doctor.

Dr. Adam Aponte: That has created a certain defiance within me that says, I am going to prove people wrong. I am going to show people that we can make a difference. When I see cuts like this that continue to impact the community that I love, I become even more determined to make a difference. I have become extremely vocal on every platform, including your platform, which we really appreciate having this opportunity to talk about our narrative, to talk about the work that we do, the importance of the work that we do to the communities that we serve, and why it is fundamentally flawed to be cutting services to communities like East Harlem.

Dr. Adam Aponte: When we talk about fraud, waste, and abuse in the healthcare system, yes, some of that does exist. I do not doubt that exists, but this is not the place to be looking for that. That is not where it exists. What you are going to further do is really hamper our efforts and drive people into more expensive care.

Dr. Adam Aponte: Primary care in my facility is much cheaper than when individuals go to emergency rooms and get admitted to hospitals. That drives up the cost. Urgent care, those things drive up the cost of medicine.

Dr. Adam Aponte: We are focusing and putting the emphasis on the wrong part of the healthcare system, where we should be bolstering organizations like ours. I will talk to anybody who will listen. I have gone up to Albany. I have gone up to Washington, D.C. I talk to as many individuals as I can to make sure they understand the true impact of the work that we do and why we need to be supported. We are not looking for a handout.

Dr. Adam Aponte: We want to continue to serve these individuals who otherwise would not have access to care were it not for us. We need the assistance of our legislators and elected officials to continue to fulfill our mission.

Stephen Halasnik: How has it affected your staff? What have you noticed? How have they changed?

Dr. Adam Aponte: They certainly are concerned. I keep my staff very well informed, and I have activated them as well. We have a staff of over 200 individuals who work throughout our programs, and they see how active I am in fighting these issues or raising these issues. We have activated them and created forums to have discussions around the work that we do.

Dr. Adam Aponte: Many of them have been on similar podcasts. They post on their social media. We have had them come up to Albany with us because as a CEO, people hear me and say, okay, you are saying this because you are a CEO. But when you hear directly from my staff and from my patients as well, whom we take up to Albany, it makes a big difference.

Dr. Adam Aponte: They have expressed concerns, but they also want to know what they can do to help make sure we have a viable organization that continues to serve in the important way that we serve. They are in the same fight with me.

Stephen Halasnik: From a realistic standpoint, when you have gone to talk to people at the state or federal government and talked to them about your organization, the cuts, and how it is going to affect everybody, what has been the reaction?

Dr. Adam Aponte: It is interesting because one thing I will say about community health centers nationally, and to give context to your listeners, community health centers, FQHCs, have close to 1,600 locations in the United States, with many more sites than that. So 1,600 FQHCs, but they have about 9,000 locations serving over 35 million U.S. residents.

Dr. Adam Aponte: There has always been bipartisan support for community health centers, just not at the level that it needs to be. What we find is that we are continually educating our legislators about the work that we do. They do not fully understand our work or the impact that we have. It has been our responsibility, and I think it is our responsibility, to make sure that we control our narrative and help them understand.

Dr. Adam Aponte: Admittedly, these legislators get a lot of issues thrown at them, so it is hard for them to become steeped in the issues that we face. It is our responsibility to share with them. Once we do share with them, there is obvious support for the work that we do among many of the legislators across the aisles.

Dr. Adam Aponte: Some still have misconceptions about fraud, waste, and abuse and things that could be changed, so we have to further educate them around that. There has been bipartisan support at the state level, the federal level, and the local city level. But the appetite to take action is what is missing among many of them. They say they want to support, but when it comes down to pen to paper, they are not giving us the support we need. That is something we need to really work on. That is why the constituents and our staff need to start pushing these legislators to push it further.

Stephen Halasnik: Today’s topic is how to address your nonprofit’s financial challenges. If I understand you correctly, the first step is to fight back, right? Not to just take it, but to fight back. Not to let things steamroll you. Is that fair to say?

Dr. Adam Aponte: Absolutely. Advocacy, raising our voice, making sure people know the work that we do, what we are doing, the impact that we have, and the return on investment that we represent. We represent less than 1% of the total core healthcare expenditures in this country, yet we care for 10% of the population. I mentioned 35 million-plus U.S. residents get care in FQHCs, so we are doing something right to control the cost of healthcare expenditure.

Dr. Adam Aponte: This is not a time to pivot away from that. That is part of what we need to do. Be very, very vocal around it. But it is not all, because we also need to pivot ourselves and think about how we do business.

Dr. Adam Aponte: To further expand on your question and how we bridge those gaps, we are also a very siloed healthcare delivery system. We tend to work as competitors and not collaborators. The health center down the block from me, instead of looking at them as a potential collaborator and asking how we can work together and work on economies of scale, we look at each other as competition.

Dr. Adam Aponte: This is my patient. That is nonsense. No patient belongs to me. Our role is to serve this community. What we need health centers like us to do is start to work as collaborators, share services so we can decrease some of the individual costs. We all retain lawyers. We all have credentialing people who help us with credentialing, and a whole host of services that we purchase. If we came together as a collective, we could decrease that cost and save some dollars while being more efficient.

Dr. Adam Aponte: To me, what I am trying to do here in East Harlem, and scale it quite frankly, is to get my fellow FQHCs in East Harlem, of which there are about five of us, to work more as a clinically integrated network and share expenses and resources. We want to create this process that I call no wrong door. Wherever a patient goes, they get the care they need. If I know that a patient is better served at another health center, then it is my responsibility and my duty to get that patient there and not worry about that patient coming to my health center particularly.

Dr. Adam Aponte: That is a paradigm shift in healthcare delivery that does not exist. Then we need to bring in other partners, community-based organizations that have expertise we do not. I do not do housing. I know how to refer people to housing facilities. I do not have a food pantry. I have a small food pantry, but people have food insecurity, transportation issues. All those things collectively are what we need to focus on to improve healthcare delivery and focus on what I call whole-person care.

Dr. Adam Aponte: If we do these things in collaboration and not competition, we are going to be able to decrease some of that cost. That gap that I described in terms of revenue can be decreased by decreasing some of the costs that we incur as functioning health centers.

Stephen Halasnik: Take me back to the time when you found out that your funding was going to be cut. How did you and the board respond? What happened?

Dr. Adam Aponte: There have been a couple of instances. The very first attack on us, I believe, was January 27, 2024, when we got a grant from the government. FQHCs get a 330 grant from the Community Health Center budget, which in the most recent budget for FQHCs in the country was about $4.7 billion. By the way, that represented a $100 million increase from the past 10 years, but it falls short of what we think we need collectively and nationally at $5.7 billion, although it is a step in the right direction.

Dr. Adam Aponte: On that date, there was an executive order issued to pause all funding allocations for 330 grants immediately. I was in a conference and got this text or email notification, and I was like, holy crap, what is going on? That funding represents about 15% to 20% of my annual operating budget.

Dr. Adam Aponte: That is not insignificant, and that would have really caused some significant issues as far as programming. Fortunately, there was an immediate stay a day later on that executive order, and it has not been issued. That was the first sort of glancing blow, or shot across the bow, that we looked at.

Dr. Adam Aponte: Then H.R. 1 came through. Leading up to H.R. 1, we had a lot of issues in terms of what the language was, the misunderstandings around Medicaid, the new requirements as far as Medicaid reenrollment, doing it twice a year versus once a year, which is how it currently exists.

Dr. Adam Aponte: It also eliminated the continuous coverage of children. I am a pediatrician, right? When a child is born into Medicaid, they have continuous coverage until six years old because we want to make sure that children in early development get everything they need, including immunizations, height and weight monitoring, and developmental assessments. These are critical because if we address them early in life, we can curtail the long-term impact. Medicaid in New York State allowed these children to stay continuously enrolled. That was impacted.

Dr. Adam Aponte: The work requirement now for Medicaid recipients, able-bodied individuals between the ages of 18 and 64, means they have to either work, go to school, or volunteer up to 80 hours a month. That is a part-time job.

Dr. Adam Aponte: All of those things were a real punch to the gut for us as far as how we are going to continue to make sure our patients stay enrolled in Medicaid, since they have to do this twice a year. It is not the most complicated application, but for individuals who are facing many challenges, it is not easy.

Dr. Adam Aponte: We often have people help folks with those applications. Now they have to do it twice a year instead of once a year. If you miss that, by the way, you can go months before you get reenrolled in Medicaid.

Dr. Adam Aponte: How are we going to ensure our children do not fall off the Medicaid roster and continue to get the care they need? How are we going to help an individual identify volunteer work, vocational services, or schooling for 80 hours a month? I think most people, if they can work that amount of time, they would. But they are finding challenges in the workforce and finding these opportunities. All those things really represent a significant impact to us and are causing us to think about how we are going to bridge that divide.

Stephen Halasnik: How would you say the stages that you and the board went through from that first announcement to the way it is now? Usually, from what I had seen, going back to the COVID days, it was like a deer in the headlights first, then a little bit more realization of what is happening. Then came a little bit more acceptance, and then came action. Are those the same stages that you and your board went through?

Dr. Adam Aponte: Yeah, I think we went through those, but at a high rate of speed because we could not stay thinking about this too long. One of the things about community health centers like ours is that we have to be very, very agile and pivot on a dime when these sorts of issues face us. We try to figure out immediately what we can do differently.

Dr. Adam Aponte: First it was, okay, this is the reality. Let’s make sure we understand what this bill is doing and what it is not doing, and how to educate my board. My board, by the way, for your listeners, are consumers. They are actually patients of my health center, 51%. Many of them are not very aware of these issues until we bring them to their attention. My job as CEO is to make sure my board is aware of these issues and how they impact us.

Dr. Adam Aponte: Number two was, okay, financial impacts. Is there anything immediate we need to do? That is another reaction. What are the levers we can pull to try to impact this? Are there any opportunities around advocacy? What are the business decisions we need to make differently to sustain ourselves during this time?

Dr. Adam Aponte: One of the things we are doing, for example, is what I talked about earlier: partnership, working with other FQHCs on economies of scale and decreasing our costs. That is something we have, and we are moving forward. It is going to be a model that other people are going to see and, we hope, replicate.

Dr. Adam Aponte: The other one is looking at our lines of business. As I mentioned, we are a big Medicaid provider. We are not such a big Medicare provider. How do we intentionally grow another line of business that can help augment that revenue loss in Medicaid? We are strategically focused on Medicare now. Most FQHCs, unless they are in what is called a NORC, a naturally occurring retirement community, do not have a great percentage of Medicare. Not that we cannot take care of these patients. So how do we attract those patients to our health center, which for a health center is a good payer? That is a good financial model for us.

Dr. Adam Aponte: Those are some of the things that we have worked on. Fundraising, right? We try to do as much as possible. We embark on galas and try to get our partners to lean in with us and understand the work we are doing. As a matter of fact, May 20 in 2026, if you are in New York City and want to attend our gala, come on through and join us. See the work that we do, the impact that we have, the vision we have for the future, and how you can partner with us.

Dr. Adam Aponte: Philanthropy can help us deliver on our mission, and in many ways it is actually a little better for us because it is unrestricted. We can be a little more creative. Many of the dollars that we get are very restricted and have to be used for very specific types of things. When we get unrestricted funding, we can be a little more innovative.

Dr. Adam Aponte: That is the process that we have gone through today. I am happy to report that we are on stable ground at this point in time, but anything can happen at any given time. We continue to be ready to pivot whenever we have to pivot.

Stephen Halasnik: Have you found new revenue streams?

Dr. Adam Aponte: Yeah. The big one right now is Medicare, increasing that. Then there are a couple of other services under the Medicaid and Medicare program that we have not fully developed that can represent revenue streams for us.

Dr. Adam Aponte: Transition of care means patients who leave a certain care setting, like an inpatient setting or nursing home, making sure they transition smoothly back into the community and into primary care. Patients who get discharged from a hospital with a chronic condition, if there is not a warm handoff after that, can get readmitted into the hospital fairly quickly if they do not have the right support when they leave the hospital. During that transition of care time, there is an opportunity for us to provide additional services to patients and generate some revenue from that.

Dr. Adam Aponte: Another is additional care management, managing chronic conditions on a more regular basis, not only at the health center but also talking to patients who have diabetes and hypertension. It is called the Chronic Care Management Program. That is a revenue stream we can also tap into that allows us to work with patients, not necessarily in the health center, but even at home.

Dr. Adam Aponte: We can call you, your relative, or someone who is dealing with these conditions and say, hey, Stephen, make sure you are taking your medications correctly. Hey, Stephen, you have a follow-up with the specialist as a result of your diabetes. All these sorts of things. We do some intense care management. That is a revenue stream that we are able to work into.

Dr. Adam Aponte: The last one is what we call remote patient monitoring, where we can actually monitor conditions remotely for patients who have hypertension, diabetes, COPD, and other conditions, so that we know how well they are doing when they are not in the health center. Through wearable devices, we can get an alert and say, okay, Stephen’s blood pressure is pretty high today. Let me have the nurse call him and find out what is going on because I might need to bring him in and adjust his medications.

Dr. Adam Aponte: Those are a couple of revenue streams that we are looking to tap into that are very beneficial and ultimately, by the way, will decrease the total cost of care. Again, keeping people out of the emergency room, keeping people from being admitted to the hospital, and keeping people out of urgent care is really going to have a significant impact and decrease the cost of care.

Stephen Halasnik: When you have your board meetings now versus the way it was two years ago, are they different?

Dr. Adam Aponte: They have evolved. I have been the CEO for this organization for about two and a half years. We have developed a good relationship, my executive team and the board, to really help them understand how they can help us do our job. As I mentioned earlier, many of them are not steeped in the work that we do, but they are lending their time and efforts to try to help us achieve that work.

Dr. Adam Aponte: The difference has been that there is a greater deal of transparency with us and the board, and a greater deal of in-depth conversations about the work that we do so there is a better understanding. When they offer opinions, there are a lot more questions being asked by our board members, and we like that. We do not want board members just to sit there and accept our board reports and have no questions.

Dr. Adam Aponte: There are a lot more suggestions. In that sense, it has changed. They have allowed me to really get ourselves out there and increase the exposure of the health center so that people know more about us, and to continue to find opportunities for us to share our narrative with new individuals who may become supporters. That is the way it has changed over the last two and a half years, and in a good way.

Stephen Halasnik: Cool. We are running out of time. In regard to how to address your nonprofit financial challenges, what would your last recommendation be?

Dr. Adam Aponte: Don’t do it alone. We cannot do this alone. We really have to collaborate, and we do not do a good job of that in the not-for-profit world. I think we put our blinders on and we do not look to partners. There are so many ways that we can help one another. To me, that is what has failed our communities, this siloed approach to healthcare delivery, and it has also impacted our finances.

Dr. Adam Aponte: Let’s collaborate. Let’s share ideas. Let’s think about ways that we can work together. Those things will be very, very beneficial to all of us at the end of the day. There is enough margin out there for all of us that we can share patients and work in this fashion without taking anything away from one another.

Dr. Adam Aponte: I think that is really, really important. Control your narrative. Make sure people know the value, and do not be complacent and think that people know what a community health center does. Share the stories of your patients and the impact that you have. Look, we deliver healthcare, but I told you I have a food pantry for 50 families every two weeks. I give away clothing from the health center as well.

Dr. Adam Aponte: Those are other things that we are doing that we do not do a good job of sharing with folks so they can understand the full impact of the work that we do. That is when people will lean in and lend their support, when they do know that.

Dr. Adam Aponte: For those who are in a position to support FQHCs, visit your local FQHC. Go see the work that they are doing and see how you can lend a hand. It does not always have to be monetarily. There is expertise that we lack in FQHCs because we cannot afford certain expertise, but having that expertise would be very beneficial to helping us deliver on our mission. Volunteering your time and efforts is equally as important as writing a check.

Stephen Halasnik: Great. Well, I would like to thank you so very much, Dr. Adam Aponte from East Harlem Council for Human Services, for coming on today’s podcast. If you like today’s podcast, please feel free to share it with a friend and also subscribe on your favorite podcasting app for The Nonprofit MBA Podcast.

Stephen Halasnik: Again, if you are looking for a line of credit for your organization, please feel free to visit our website at nonprofitmbapodcast.com. Dr. Aponte, if anybody wants to get a hold of you, how would they go about doing that?

Dr. Adam Aponte: Sure. You can visit our website. By the way, the name Boriken is the original name of the island of Puerto Rico before the Spanish took over. We are very steeped in Puerto Rican culture here in East Harlem.

Dr. Adam Aponte: You can follow me on LinkedIn. Just look up Adam Aponte, MD. I am very active on LinkedIn. I am trying to get my Instagram game going a little bit as well, so A. Aponte, MD. You can find me on Instagram, posting there as well. Those are the three ways that your listeners can get in touch with us. If you visit our website and you are in New York City and want to come to our gala on May 20, you will see information about that as well.

Stephen Halasnik: Thanks for coming on today.

Dr. Adam Aponte: Thank you, Stephen.

Stephen Halasnik: Everyone knows this adage, but when times are in trouble, you put your own air mask on first in the plane, and then you help others.

Stephen Halasnik: Many of the nonprofits out there are going through a lot of rough stuff. I just want to remind all the executive directors and listeners out there that you have to take good care of yourself first because you cannot help your family, you cannot help your employees, and you cannot help your cause if you are burnt out.

Stephen Halasnik: Make sure every day you are doing what you need to do first for yourself, whether that is taking some time for a cup of coffee, calling a friend, meditating, praying, exercising, or whatever keeps you sane. We need you, and we appreciate the work that everybody is doing to make this world a better place.

Stephen Halasnik: Other than that, I want to thank you for listening to The Nonprofit MBA Podcast, and everybody have a fantastic day. I will see you later.