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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 Service Administration (HRSA) Description:

Emergency Financial Assistance (EFA) provides limited one-time or short-term payments to assist a Health Resources and Services Administration (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 the Texas HIV Medication Program (the AIDS Drug Assistance Program for the State of Texas) or Local 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 should use other sources of funding in the community effectively, and any allocation of RWHAP funds for these purposes is the payer-of-last resort. RWHAP provides EFA to individual clients with a limited frequency and for a limited period of time, with a specified frequency and duration of assistance. Staff must document the emergent need each time agencies use EFA funds.

Limitations:

HRSA does not permit direct cash payments to clients. Agencies cannot fund the continuous provision of an allowable service to a client 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 Texas HIV Medication Program (THMP) eligibility determination period; and
  • Administrative agencies may approve a one-time waiver for a service exceeding the $800 per client per calendar year cap.

Agencies may only use EFA for short-term assistance with medications not covered by medical insurance:

Services:

Agencies may use EFA funds on the following essential items or services:

  • Medication not covered by THMP or LPAP, such as temporary access to THMP-eligible medications during the eligibility determination period
    • Agencies must assist clients with applications for pharmaceutical company patient assistance programs, when applicable, to reduce the need or length of time for EFA assistance.
  • Utilities (including gas, electricity, propane, water, internet, telephone services, and all required fees)
    • Agencies must demonstrate that other private, local, and state utility assistance programs cannot meet the urgent need.
  • Housing (which may include rent or temporary shelter)
    • Agencies may only use EFA if comparable Housing Opportunities for Persons with AIDS (HOPWA) or Ryan White Housing Services assistance is not available or if the client is not eligible for HOPWA or Housing Services.
  • Food (groceries or food vouchers) 
    • Agencies must demonstrate a lack of available food assistance programs or food bank services available to clients.
  • Transportation
    • Agencies may not use Ryan White funds for direct maintenance expenses, or other costs associated with privately owned vehicles, such as lease or loan payments, insurance, or license and registration fees.
  • Prescription medication assistance such as:
    • Short-term, 30-day assistance for medication (clients can request an additional 30-day supply for a total of 60 days)
    • Medication administered on a one-time or occasional basis during a primary medical visit 
    • Medication dispensing fees associated with purchased medications1
  • 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

Client Determination for Emergency Financial Assistance:
Agencies must maintain documentation of an urgent need for essential items or services necessary to improve health outcomes.
Clients may demonstrate need by, but not limited to, the following:

  • A recent decrease in income or significant increase in bills; 
  • High unexpected expenses on essential items;
  • The client cannot provide for basic needs or shelter;
  • A failure to provide EFA results in danger to the physical health of the client or dependent children; or
  • Other emergency needs as deemed appropriate by the agency.

Agencies must document other resources pursued prior to using EFA funding for assistance. If no other resources are available for the client’s needs (e.g., a generic medication with no available patient assistance program), staff should note this in the client file.

1.    Percentage of clients with documentation of urgent needs. 
2.    Percentage of clients with documentation of other resources pursued. 

Assisting Client with Short-Term Medication:
Agencies may provide short-term medication assistance (up to a 30-day supply at a time) with limited use of EFA for no more than 60 days total (two months or less) for RWHAP-eligible clients with documentation of an urgent need for HIV medications. 

  • Agencies may assist clients with medications on the THMP formulary during the THMP eligibility determination period. The $800 per client per calendar year cap does not include medications purchased during the THMP eligibility determination period. 
     
  • Agencies may provide other short-term medication assistance through EFA for RWHAP-eligible clients, including those with documentation of pending health insurance medication plan approval. 

3.    Percentage of clients with documentation of short-term medication assistance provided by amount, frequency, duration of assistance, and method. 

Assisting Clients with Other Essential Services:
Agencies may assist clients with utilities, housing, food (including groceries and food vouchers), transportation, or other allowable healthcare costs. 

 4.    Percentage of clients with documentation of non-medication related essential services by amount, frequency, duration of assistance, and method.
 

EFA Cap Waivers:
In cases of emergency needs exceeding $800 per client per calendar year, providers must document the reason for exceeding the yearly maximum amount and must have documented approval of a one-time waiver from the local administrative agency (AA).


This cap does not include medications purchased during the Texas HIV Medication Program (THMP) eligibility determination period.

 5.    Not including medications purchased during the THMP eligibility determination period, percentage of clients with documentation of a waiver approved by the AA, 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 and Services Administration, 22 Oct. 2018.
Texas Department of State Health Services. Texas HIV Medication Program Participating Pharmacy Guidelines, Last Updated: May 1, 2019.

1 Pharmacies under the 2017 or later Memorandum of Agreement do not collect a dispensing fee from clients. The pharmacy invoices the THMP directly each month for dispensed THMP medications, not to exceed $5.00 per medication. This includes Medicaid-eligible and non-eligible clients. See Texas HIV Medication Program Participating Pharmacy Guidelines.

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