Inside EHF: Beyond Health Care is a new series from our team exploring how non-medical factors shape health across Texas. From transportation to food access to public policy, we’ll take a closer look at forces outside the doctor’s office that influence whether people can live long, healthy lives.
In this edition: Shao-Chee Sim, EHF’s Executive VP for Health Policy, Research & Strategic Partnerships, writes that with Texas evaluating Medicaid coverage for diabetes prevention and new rural health investments beginning to flow, a unique window is emerging to move from managing diabetes to preventing it.
In 2025, EHF made a deliberate and responsive shift to include general operating support (GOS) as a grantmaking strategy, departing from its historically predominant focus on project-based grants. The rapidly evolving external environment — including federal funding uncertainty, shifting regulatory landscapes, and sector-wide instability — prompted this notable transition away from project-based grantmaking, which involved intentional outreach to grantees in the latter half of 2025 pertaining to GOS. In response, EHF deployed GOS through two distinct channels: conversion grants and intentional, unrestricted awards. This report reflects the early outcomes, key learnings, and implications of that work, with the goal of informing EHF’s future grantmaking approach.
General Operating Support Grantee Breakdown
Conversion Grants
EHF proactively converted a significant portion of its active project-specific grants to general operating support across two rounds, prioritizing responsiveness over process.
- Round 1 (Early 2025): 76 active grants totaling $10,473,440 were converted to GOS. This round was driven by the need to increase financial flexibility for grantees whose federal funds had been eliminated, frozen or delayed. EHF reviewed existing reports and engaged grantees directly to identify unspent amounts.
- Round 2 (Mid-April 2025): 44 active grants totaling $7,935,398 were converted to GOS. This round responded to emerging compliance pressures related to executive orders and new DEI-related regulations, ensuring grantees had additional flexibility to navigate operational and legal uncertainty.
Explicit GOS Grants
For its May and December 2025 grant cycles, EHF made an intentional decision to offer unrestricted funding in direct response to the challenges facing the nonprofit sector because of federal policy and funding changes. These GOS grants were directed toward advancing each organization’s overall mission and long-term sustainability.
- May 2025: 59 grantees received explicit GOS awards totaling $10,591,500.
- December 2025: 23 grantees received explicit GOS awards totaling $16,100,000.
Key Learnings
GOS as a Strategic Grantmaking Tool
General Operating Support is a versatile grantmaking tool that can be deployed in multiple ways, including funding innovation, stepping down grants that no longer align with strategic priorities, and sustaining the core operations that make programmatic work possible. Unlike program-specific grants, GOS offers flexibility not just for grantees, but for funders as well — allowing investments to support a range of goals, whether seeding new ideas, maintaining trusted partnerships, or shifting resources as priorities evolve. This flexibility makes GOS a powerful lever for driving impact that is both responsive and intentional.
GOS Produces Tangible Organizational Benefits
In October 2025, EHF facilitated mid-year check-ins with May 2025 grantees awarded GOS funds. This interim check-in was conducted via a combination of written submissions and oral interviews, and participation was optional. Across interviews and written reflections, no negative outcomes of GOS were reported. Every respondent identified concrete organizational benefits, including:
- Improved operational stability
- Strengthened staff morale and retention
- Greater creativity and innovation in programming
- Enhanced organizational performance overall
These findings suggest that flexible funding can strengthen organizational stability, responsiveness, and effectiveness during times of uncertainty.
Proactive Action: Responsiveness Is a Form of Partnership
EHF’s decision to convert grants, particularly in Round 1, was not driven by formal grantee requests or survey data, but by EHF’s own read of the landscape and a commitment to act before being asked. Later in the year, particularly for the December grant cycle, grantee experience and direct feedback for flexibility informed the explicit GOS offering. Across both approaches, grantees consistently praised EHF’s speed and decisiveness, contrasting it favorably with funders who adopted a “wait and see” position. Grantees described this responsiveness as a form of partnership.
GOS Is Experienced as Trust, Not Just Flexibility
Grantees did not describe GOS primarily in financial terms. Instead, they characterized it as a trust-based investment, an affirmation of EHF’s confidence in grantee leadership and local expertise. This shift from a prescriptive, project-based orientation to a genuine partnership model had meaningful relational effects, fostering open communication and deeper collaboration between grantees and EHF.
| Theme | Key Learnings |
|---|---|
| Flexibility and Adaptibility | Enabled rapid response to crises and emerging community needs that fell outside the scope of existing project grants |
| Sustainability and Resilience | Supported stable staffing and reinforced long-term organizational health during a period of significant external disruption |
| Trust and Partnership | Deepened the EHF-grantee relationship; experienced as an affirmation of confidence in grantee leadership and local expertise |
| Health Equity Alignment | Advanced community health and health equity priorities at both the EHF portfolio level and within individual grantee organizations |
| Resilience Against Policy Instability | Provided a critical operational buffer against unpredictable policy shifts and funding landscape changes |
Challenges
While GOS outcomes were broadly positive, grantees continued to face significant external pressures that GOS alone could not fully address:
- Unstable and declining public funding streams
- Workforce strain driven by sector-wide talent and compensation pressures
- Rising operational costs that outpaced available resources
These challenges underscore the importance of pairing GOS with complementary support, such as capacity building and technical assistance.
Conclusion
The 2025 GOS experience offers a compelling case for rethinking the relationship between funders and grantees. When EHF introduced greater flexibility into its grantmaking approach, grantees described greater stability, creativity, and impact — not less accountability. The evidence from 2025 points toward GOS not as an exception to EHF’s grantmaking model, but as a deliberate and ongoing opportunity to deepen trust with grantees, strengthen the partnerships that drive lasting impact, and reaffirm EHF’s commitment to showing up as a true partner when it matters most.