Emergency Financial Assistance

Service Standard

EFA Service Standard print version

Subcategories Service Units
Emergency Assistance - Prescription Per prescription
Emergency Assistance – Utilities Per transaction
Emergency Assistance – Food Per visit

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 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

It is expected that all other sources of funding in the community for EFA will be effectively used and that 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. EFA funds used to pay for otherwise allowable HRSA RWHAP services must be accounted for under the EFA category.

Limitations

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

Services

RWHAP Part B/State Services funds may be used to provide services in the following categories:

  1. ADAP eligibility determination period; and
  2. Emergency Financial Assistance (EFA).

EFA can be used during the ADAP eligibility determination period. Initial medications purchased for this use are not subject to the $800/client/calendar year cap.

EFA can be used to reimburse dispensing fees associated with purchased medications. Dispensing fees are not subject to the $800/client/calendar year cap.

EFA is an allowable support service with an $800/client/calendar year cap.

  • The agency must set priorities, delineate and monitor what part of the overall allocation for emergency assistance is obligated for each subcategory. Careful monitoring of expenditures within a subcategory of "emergency assistance" is necessary to assure that planned amounts for specific services are being implemented, and to determine when reallocations may be necessary.
  • Limitations on the provision of emergency assistance to eligible individuals/households should be delineated and consistently applied to all clients. It is expected that all other sources of funding in the community for emergency assistance will be effectively used and that any allocation of EFA funding for these purposes will be the payer-of-last-resort, and for limited amounts, limited use, and limited periods of time.

EFA provides funding through:

  • Short-term payments to agencies
  • Establishment of voucher programs

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

EFA funds used to pay for otherwise allowable RWHAP services must be accounted for under the EFA category.

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

  • Utilities (may include household utilities such as gas, electricity, propane, water, and all required fees)
  • Housing (may include as rent or temporary shelter. EFA can only be used if HOPWA assistance is not available or if client is not eligible for HOPWA services)
  • Food (groceries or food vouchers)
  • Transportation
  • Prescription medication assistance such as short term, one-time assistance for any medication and associated dispensing fee as a result or component of a primary medical visit (not to exceed a 30-day supply)
  • Other RWHAP allowable costs needed to improve health outcomes

Universal Standards

Service providers for Emergency Financial Assistance must follow HRSA/DSHS Universal Standards 1-46 and 137-139.

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: RWHAP-eligible clients with documentation of an emergency need for HIV medications are able to receive short-term medication assistance (30-day supply) with limited use of EFA for no more than 60 days (two months or less).

Assisting Clients with Short-Term Medications: RWHAP-eligible clients with documentation of pending health insurance medication plan approval are able to receive short-term HIV medication assistance through EFA.

  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 and/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 problems/needs of the client with the emergency financial issue.

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

  1. Percentage of clients with documentation of determination of EFA needs.
     
  2. Percentage of clients with documentation of a service plan for EFA that indicates the emergent need, other resources pursued, and outcome of EFA provided.
     
  3. Percentage of clients with documentation of resolution of the emergency status and referrals made (as applicable) with outcome results.

References

HRSA/HAB Division of Service Systems Program Monitoring Standards – Part A April, 2013, page 29-30. Accessed on June 2022.

HRSA/HAB Division of State HIV/AIDS Programs National Monitoring Standards – Program Part B April, 2013, page 29-30. Accessed on June 2022.

HRSA Ryan White HIV/AIDS Program Services: Eligible Individuals & Allowable Uses of Funds Policy Clarification Notice (PCN) #16-02 (Revised 10/22/2018)