How Is It Funded?

Most programs assemble budgets from multiple sources — municipal grants, hospital institutional support, federal awards, state appropriations, philanthropic contributions, and in a growing number of jurisdictions, Medicaid reimbursement — while none of those sources covers the full operating cost.

The Capacity Gap: Why Funding is Harder Than It Looks

Before reviewing funding sources, the structural challenge is worth naming directly.

Police and fire departments are funded for the capacity to be available: officers and firefighters are on salary whether or not they respond to a call in any given hour. The funding covers their readiness. HVIPs, by contrast, have historically been funded primarily for active service delivery: grants tied to specific interventions, Medicaid reimbursements tied to billable clinical encounters, city investments tied to projected service volume.

The unfunded gap includes everything that makes the direct service possible: specialist training, clinical supervision, travel time to and from the hospital and follow-up locations, community relationship-building that takes months before it produces a patient referral, follow-up contacts that fall below billing thresholds, and staff availability during slow periods (the cost of having a specialist on duty at 3 a.m. when no trauma patient has arrived yet). when no trauma patient has arrived yet.

This structural mismatch between encounter-based revenue and capacity-based costs is the primary reason programs with documented outcomes still report persistent funding instability. A program cannot bill Medicaid for a violence specialist sitting at a desk at 2 a.m. waiting for a trauma notification page, even though that availability is what makes the next encounter possible.

Funding Source 1: Municipal and County Government

Chicago’s investment provides one of the most documented examples. Mayor Brandon Johnson’s community safety plan included a $3 million allocation to “deliver hospital-based violence intervention programming and wrap-around services to victims of violence,” administered through the Chicago Department of Public Health. The investment targets 15 neighborhoods that account for roughly half of the city’s gun violence, and supports programs with documented outcomes including “reduced recidivism rates, return to work and school, increased self-esteem, decreased retaliatory violence, decreased substance use, and decreased trauma.”¹

Louisville’s Office of Violence Prevention funds the hospital-based component of the city’s “Pivot to Peace” program as part of Mayor Craig Greenberg’s broader Safe Louisville public safety plan. Between 2024 and 2025, the program enrolled 85% of the 628 patients who arrived at University of Louisville Hospital with a gunshot wound or stabbing injury, a capture rate that reflects sustained institutional investment rather than a pilot-scale effort.²

Louisville’s program also illustrates the return-on-investment case that cities make when seeking appropriations. City data from the Office of Violence Prevention’s 2025 report documented a 62% decline in gun violence in the four target neighborhoods during the first half of 2025, compared to the same period over the prior four years.³ Homicides dropped 22% citywide in 2025. These figures do not isolate HVIP’s contribution from other Pivot to Peace components, but they represent the political argument mayors make when defending public health spending to skeptical councils.

Mobile, Alabama launched its program (called HALO) through a three-way municipal partnership between the city government, the Mobile County Health Department, and USA Health University Hospital, with former Mayor Sandy Stimpson as the program’s public champion.⁴ That multi-agency structure spread both the cost and the institutional risk across partners, a common approach in smaller cities where no single entity can absorb a new program’s startup costs alone.

What municipal funding covers: program staff salaries, case management operations, community partnership coordination, program administration. What it does not cover: clinical supervision infrastructure at most sites, capital costs for dedicated program space, research and evaluation, and the cost of reaching patients who are uninsured or who do not connect to follow-up services.

Funding Source 2: Hospital Institutional Support

Some of the most durable HVIPs operate because their host institution absorbed the program cost as a direct line item, not a grant or a pilot, but a sustained institutional decision to treat violence intervention as part of the hospital’s core mission.

The University of Chicago Medicine’s Violence Recovery Program is the clearest national example. The program launched in 2018 when UChicago opened its Level 1 adult trauma center, and has operated continuously since, now serving more than 11,000 patients. Institutional support from the University, combined with philanthropic contributions including a $9.1 million gift from the Block Hassenfeld Casdin Collaborative for Family Resilience, built the program to a scale that grant funding alone could not sustain: roughly 20 violence recovery specialists working around the clock, connected to more than 60 community agencies.⁵

Academic medical centers — UChicago, Yale, VCU Medical Center in Richmond, Emory at Grady in Atlanta, Prisma Health in Columbia — have developed programs with the most stable institutional backing. Dwayne Johnson, the VRP’s director, has described the model’s durability: “This wasn’t a one-off training” — the program has operated continuously since 2018.⁶

Virginia provides a state-level illustration of how institutional support can scale. The state’s Hospital and Healthcare Association oversees 12 HVIPs operating in hospitals across Virginia, and the programs collectively reported “a sharp decline in re-injury rates.” The national average stands at roughly 40%; Virginia HVIP patients are seeing 3%.⁷ The Virginia state government responded with an $8.5 million investment to continue and expand the programs. Since 2019, Virginia HVIPs have served more than 8,000 violence victims, with an estimated $82.5 million in healthcare costs avoided, nearly half representing direct state savings.⁸

What hospital funding covers: staff positions embedded in trauma department operations, hospital overhead, technology access (electronic health records, trauma pager systems), clinical supervision and compliance infrastructure. What it does not cover: community-based follow-up activities outside the hospital walls, partner organization costs, and in most cases, the patient social services (housing, food, legal) that HVIP specialists connect patients to but do not directly provide.

Funding Source 3: Federal Grants

Federal funding for HVIPs flows primarily through the Department of Justice’s Office of Justice Programs, specifically the Community Violence Intervention and Prevention Initiative (CVIPI), and through the Department of Health and Human Services, including the Health Resources and Services Administration (HRSA).

The DOJ CVIPI has been a significant source. Dr. Randi N. Smith, founder and medical director of Atlanta’s IVYY Project at Grady Memorial Hospital, was awarded a $2 million DOJ grant through CVIPI in 2023 for the program’s violence intervention work.⁹ In November 2024, the University of Chicago Medicine’s Violence Recovery Program and Recovery Legal Care received a $4.92 million National Institutes of Health grant to study the impact of free legal help on recovery and violence prevention, an example of how federal research funding can support both program operations and the evidence base simultaneously.¹⁰

The federal funding environment carries a structural risk that program leaders consistently name: grant cycles end. Programs that build capacity during a federal funding period (hiring specialists, expanding eligibility, building community partnerships) face a contraction decision when the grant expires. The American Rescue Plan Act (ARPA) allocated significant resources to community violence intervention between 2021 and 2024, and a number of HVIP programs expanded during that period. As ARPA funds expire, programs are navigating the transition from temporary federal investment to sustainable local and state revenue.

What federal funding covers: program expansion capacity, research and evaluation, training and technical assistance, capital improvements in some programs. What it does not cover: ongoing operations after grant expiration, which is the sustained institutional cost that grant funding cannot structurally address.

Funding Source 4: Medicaid Reimbursement

Connecticut became the first state in the nation to authorize Medicaid reimbursement for community services to perform violence intervention outreach.¹¹

The Medicaid model reclassifies certain HVIP services (peer support, psychological services, case management) as reimbursable healthcare services, enabling programs to bill for clinical encounters with eligible patients. For programs serving predominantly Medicaid-eligible populations (which describes most HVIPs operating in urban trauma centers), this creates a sustainable revenue stream that scales with patient volume.

As of early 2023, five states (California, Connecticut, Illinois, Maryland, and Oregon) authorized Medicaid to support community violence intervention programming under federal guidance issued by the Biden administration, which confirmed that CVI models providing long-term health services are eligible for reimbursement.¹² The number has grown, but the majority of states have not acted. Programs in non-Medicaid states must fund services that Medicaid-participating programs can bill.

Yale School of Medicine’s HVIP in New Haven, which focuses on children admitted with firearm injuries and provides psychiatric care, substance use treatment, and victim compensation assistance, operates in Connecticut — giving it access to Medicaid reimbursement that programs in most other states lack.¹³

The Medicaid reimbursement pathway addresses the capacity gap only partially. It covers billable clinical encounters with enrolled patients. It does not cover: time spent on calls with patients who are not currently in crisis and thus not generating a billable encounter; relationship maintenance between formal appointments; community-based outreach that precedes patient contact; or services for patients who are uninsured or whose conditions fall outside billable categories. Programs relying on Medicaid as their primary revenue still need supplemental funding to maintain the capacity infrastructure that makes those billable encounters possible.

Funding Source 5: Philanthropy and Private Sources

Private philanthropy has played an unusually significant role in building the national HVIP field, particularly in funding the research, training, and model-development work that precedes and supports government investment.

The Health Alliance for Violence Intervention (HAVI) and the Everytown for Gun Safety Support Fund jointly developed a customizable cost calculator, based on a report examining existing hospital-based programs, to help cities and funders understand the key implementation costs of HVIPs and tailor estimates to their own circumstances.¹⁴ This type of infrastructure investment (field-building rather than direct service delivery) typically comes from philanthropic sources because government funding structures are not designed for it.

The UChicago VRP’s Block Hassenfeld Casdin Collaborative for Family Resilience represents what institutional-scale private philanthropy looks like in this space: a $9.1 million gift that funded not just program operations but trauma-focused programs across the health system, community partner grants, and vicarious trauma support for program staff.¹⁵

The Return on Investment Case

The most documented cost-benefit analysis comes from Virginia, where 12 HVIPs collectively produced an estimated $82.5 million in healthcare cost avoidance since 2019, with nearly half representing direct state savings.¹⁶ The Virginia Hospital and Healthcare Association has noted this represents a return on the state’s $8.5 million investment, though the figures are estimates based on re-injury reduction rather than a prospective cost-benefit trial.¹⁷

A broader framework from a review of HVIP programs nationally estimated cost savings from reduced injury recidivism ranging from $82,765 to $4 million across a five-year model per program, depending on scale and population served.¹⁸

The American Hospital Association estimated the total cost of violence to U.S. hospitals at roughly $18 billion annually, an upstream figure that contextualizes the case for hospital institutional investment in prevention.¹⁹

None of these figures represent standalone evidence of HVIP cost-effectiveness in the way a randomized cost-benefit trial would. They are reasonable frameworks for budget arguments, not proof. Program leaders and city officials should use them as approximations, not as precise projections.

What Sustainable Funding Looks Like

Angela Kimball, of Inseparable, has described the structural challenge the field has not yet resolved: police and fire departments are funded for the capacity to be ready — officers are paid whether or not they take a call in a given hour. Violence recovery specialists funded through encounter-based mechanisms are paid only for active patient contact. The supervision, training, community relationship maintenance, and staff availability during slow periods are not covered by encounter-based billing.²⁰ HAVI’s primary advocacy focus has been closing this gap through Medicaid reform and dedicated prevention funding streams.²¹