Emergency Financial Assistance

Service Standard

EFA Service Standard print version

Texas Department of State Health Services, HIV Care Services Group — HIV/STD Program | Texas DSHS

Subcategories Service Units
Food     Per visit
Housing Per transaction
Medication Per transaction
Other Allowable Healthcare Cost Per transaction
Utilities     Per transaction

Health Resources and Services Administration (HRSA) Description:

Emergency Financial Assistance (EFA) provides limited one-time or short-term payments to assist a HRSA Ryan White HIV/AIDS Program (RWHAP) client with an urgent need for essential items or services necessary to improve health outcomes, including: utilities, housing, food (including groceries and food vouchers), transportation, medication not covered by an AIDS Drug Assistance Program (ADAP) or Local AIDS Pharmaceutical Assistance Program (LPAP), or another HRSA RWHAP-allowable cost needed to improve health outcomes. Emergency financial assistance must occur as a direct payment to an agency or through a voucher program. 

Program Guidance:

Agencies must use all other sources of funding in the community effectively and any allocation of RWHAP funds for these purposes will be as the payer-of-last-resort, and for limited amounts, uses, and periods of time. Agencies must account for EFA funds used to pay for otherwise allowable HRSA RWHAP under the EFA category. 

Agencies must set priorities, delineate, and monitor what part of the overall allocation for emergency assistance is obligated for each subcategory. Agencies must carefully monitor expenditures within a subcategory of EFA to ensure that spending adheres to planned amounts for specific services and to determine when reallocations are necessary.

EFA to individual clients is provided with limited frequency and for a limited period of time, with specified frequency and duration of assistance. Staff must document emergent need each time funds are used.

Limitations:

Direct cash payments to clients are not permitted. Continuous provision of an allowable service to a client must not be funded through EFA. 

EFA services have an $800 per client per calendar year cap, with the following exceptions:

  • The $800 per client per calendar year cap does not include medications purchased during the ADAP eligibility determination period.
  • The $800 per client per calendar year cap does not include medication dispensing fees.
  • Administrative Agencies may approve a one-time waiver for a service that exceeds the $800 per client per calendar year cap.

Services:

EFA funds may be used on the following essential items or services: 

  • Temporary access to ADAP-eligible medications during the ADAP eligibility determination period
  • Utilities (may include household utilities such as gas, electricity, propane, water, and all required fees) 
  • Housing (may include as rent or temporary shelter) 
    • Agencies can only use EFA if comparable HOPWA (Housing Opportunities for Persons With AIDS) or Ryan White (RW) housing assistance is not available or if the client is not eligible for HOPWA or RW housing services
  • Food (groceries or food vouchers) 
  • Transportation
  • Prescription medication assistance such as short-term, one-time assistance for any medication as a result or component of a primary medical visit (not to exceed a 30-day supply) 
  • Medication dispensing fees associated with purchased medications
  • Other RWHAP allowable costs needed to improve health outcomes

Universal Standards:

Service providers for Emergency Financial Assistance must follow HRSA and DSHS Universal Standards 1-52 and 143-145.

Service Standards and Measures:

The following standards and measures are guides to improving healthcare outcomes for people living with HIV throughout the State of Texas within the Ryan White Part B and State Services Program. 

Standard Measure

Assisting Clients during ADAP Eligibility Determination Period: Agencies may provide short-term medication assistance (30-day supply) with limited use of EFA for no more than 60 days (two months or less) for  RWHAP-eligible clients with documentation of an emergency need for HIV medications.

Assisting Clients with Short-Term Medications: Agencies may provide short-term HIV medication assistance through EFA for RWHAP-eligible clients with documentation of pending health insurance medication plan approval. 

1. Percentage of clients with documentation of short-term HIV medication assistance provided during the ADAP application period.

2. Percentage of clients with documentation of short-term HIV medication assistance provided during the health insurance application period. 

Client Determination for Emergency Financial Assistance: Applicants must demonstrate an urgent need resulting in their inability to pay their utility bills or prescriptions without financial assistance for essential items or services necessary to improve health outcomes. For example, need may be demonstrated by, but not limited to, the following: 

  • A significant increase in bills 
  • A recent decrease in income 
  • High unexpected expenses on essential items 
  • They are unable to provide for basic needs or shelter 
  • A failure to provide EFA will result in danger to the physical health of the client or dependent children 
  • Other emergency needs as deemed appropriate by the agency 

Agency staff will conduct an assessment of the presenting needs of the client with the emergency financial issue. 

A service plan will be developed documenting the client’s emergent need resulting in their inability to pay bills or prescriptions without assistance, and other resources pursued noted prior to using EFA funding for assistance. 

3. Percentage of clients with documentation of determination of EFA needs. 

4. Percentage of clients with documentation of a service plan for EFA that indicates the emergent need, other resources pursued, and outcome of EFA provided. 

5. Percentage of clients with documentation of resolution of the emergency status and referrals made (as applicable) with outcome results. 

6. Percentage of clients with documentation of a waiver approved by the Administrative Agency, if the total amount of EFA exceeds the $800 per client per calendar year cap. (Pilot Measure 2024-2025)

References:

Division of Metropolitan HIV/AIDS Programs, HIV/AIDS Bureau (HAB). Ryan White HIV/AIDS Program (RWHAP) National Monitoring Standards for RWHAP Part A Recipients. Health Resources and Services Administration, June 2023.

Division of State HIV/AIDS Programs, HIV/AIDS Bureau (HAB). Ryan White HIV/AIDS Program (RWHAP) National Monitoring Standards for RWHAP Part B Recipients. Health Resources and Services Administration, June 2023.

Ryan White HIV/AIDS Program. Policy Notice 16-02: Eligible Individuals & Allowable Uses of Funds. Health Resources & Services Administration, 22 Oct. 2018.