How we build this, in order, without pretending.
Every phase has a gate. We do not start the next until the last is genuinely done — and we will say publicly when a gate fails.
The build sequence
Ask 30 neighbors why they don’t go
We have built this entire plan on one belief: that people stay away from a clinic that would see them because they think they cannot go. We have not proven that. Nobody has. So before we ask for a dollar or hire a soul, we are going to knock on thirty doors and ask.
We will also ask the clinic what outreach they already do, and ask Canal Alliance whether they already walk people over. If they have this covered, this company should not exist — and we would rather find that out in week two than year two.
Gate: is there a real gap? We publish the answer either way, including the answer that ends this. Cost: roughly nothing.
Legal foundation
Complete the 501(c)(3). Register with the California Attorney General’s Registry. Seat an independent majority board. Counsel on governance, affiliate transactions, health privacy, employment classification, and the rules on paying for referrals.
Gate: exemption granted + registry active. Not one dollar solicited before this.
Renewal help, on foot
Volunteers and clipboards against the renewal deadline that is quietly taking people’s coverage for good. No funding, no software, no permission. Saves people this month; teaches us the real workflow.
Gate: renewals assisted, counted, documented.
Partners, in writing
The clinic, for the clinical home and discounted medication. Canal Alliance, for trust. The health plan, for care-management contracting and rates. Nothing about our economics is knowable until these are written down.
Gate: written rates and a partnership that is signed, not assumed.
Sponsorship pilot
Two canvassers, four weeks, one question: how many sponsors does a person sign per day? That number decides whether sponsorship funds this or whether we need grants.
Gate: measured conversion. Above the line we scale; below it we say so and change course.
First navigators — employed and insured
Canal residents hired W-2 with health coverage from day one. Formation of the worker cooperative, so the people doing the work own the enterprise doing it.
Gate: emergency room visits avoided — measured, not asserted.
Publish and hand it away
Outcomes published, including failures. The model goes out free to any neighborhood that wants it. The Canal is the pilot, not the product.
Gate: published, replicable, honest.
What it costs, and who pays
We will not publish a number we cannot substantiate. These blanks fill in after Phase 2, and not one minute earlier.
| Source | What it funds | Share |
|---|---|---|
| Medi-Cal CHW billing | Navigator wages for enrolled neighbors; reinvestment margin | [pending Phase 2] |
| Philanthropy & grants | Neighbors with no payer — unbillable to anyone | [pending] |
| Health plan / FQHC contracts | Contracted navigation, enhanced care management | [pending] |
| Individual donors | Direct aid, emergency needs | [pending] |
Cohort cost
[pending]
Fully loaded annual cost to field and supervise one cohort.
Break-even
[pending]
Billable units per navigator per day to cover loaded cost.
Philanthropy gap
[pending]
Driven by the share of neighbors with no coverage pathway. Rising since the freeze.
Every bracketed figure resolves once we have written rates from Partnership HealthPlan and an FQHC partner. We would rather publish blanks than a number we made up. Our Form 990 will be posted permanently once we have one.
What could sink this
If we are wrong, it will probably be one of these.
Community health work may not pay inside an FQHC
Federally qualified health centers are reimbursed a bundled rate per visit, and a community health worker is generally not a billable provider type. If our work is absorbed into that bundle rather than paid separately, the engine stalls and we need a managed-care contract instead. The single biggest open question in the model.
Realization may be brutal early
First-year billing programs commonly under-collect. If denials run high, the margin meant to fund cohort two does not appear and we stay grant-dependent longer.
The unbillable share may swamp us
The freeze grows the population we cannot bill for. If that share climbs faster than our billable base, philanthropy carries more each year, not less.
We may not be needed
If existing clinics and community organizations already reach everyone we would reach, the honest answer is to hand them our findings and stop. Our research arm exists partly to tell us that.