• DSHS HIV/STD Program

    Post Office Box 149347, MC 1873
    Austin, Texas 78714

    Phone: (512) 533-3000

    E-mail the HIV/STD Program

    E-mail data requests to HIV/STD Program - This email can be used to request data and statistics on HIV, TB, and STDs in Texas. It cannot be used to get treatment or infection history for individuals, or to request information on programs and services. Please do not include any personal, identifying health information in your email such as HIV status, Date of Birth, Social Security Number, etc.

    For treatment/testing history, please contact your local Health Department.

    For information on HIV testing and services available to Persons Living with HIV and AIDS, please contact your local HIV services organization.

Emergency Financial Assistance

Service Standard

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HRSA Definition:

Emergency Financial Assistance provides limited one-time or short-term payments to assist the RWHAP client with an emergent need for paying for essential utilities, housing, food (including groceries, and food vouchers), transportation, and medication. Emergency financial assistance can occur as a direct payment to an agency or through a voucher program.

 

Limitations:

Direct cash payments to clients are not permitted. No funds may be used for any expenses associated with the ownership or maintenance of a privately owned motor vehicle.

 

Services:

Ryan White HIV/AIDS/State Services funds may be used to provide services in the following categories:

  1. ADAP eligibility determination period;
  2. Dispensing fee for ADAP medications; and/or
  3. 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/year cap.

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

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

  • Assistance is provided only for the following essential services/subcategories:
    • Utilities such as household utilities including gas, electricity, propane, water, and all required fees
    • Housing such as rent or temporary shelter. EFA can only be used if HOPWA assistance isn't available
    • Food such as groceries and food vouchers
    • 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)

 

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. Continuous provision of an allowable service to a client should not be funded through EFA.

 

Service Standard and Performance Measure

The following Standards and Performance Measures are guides to improving healthcare outcomes for PLWH throughout the State of Texas within the Ryan White Part B and State Services Program.

Standards
Standard Performance Measure

Assisting Clients during ADAP eligibility determination period: HIV+ clients with documented evidence of emergency need of HIV medications are able to receive short-term medication assistance (30-day supply) with limited use of EFA for no more than 60 days (2 months or less).

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

Percentage of clients that have documented evidence in the client primary record of short-term HIV medication assistance provided during ADAP application period.

Percentage of clients that have documented evidence in the client primary record of short-term HIV medication copay assistance provided during health insurance application period.

Client Determination for Emergency Financial Assistance: Applicants must demonstrate an emergent need resulting in their inability to pay their utility bills or prescriptions without assistance and risk disconnection of service due to one or more of 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 shelter
  • A failure to provide EFA will result in danger to the physical health of 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 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.

Client will be assessed for ongoing status and outcome of the emergency assistance. Referrals for services, as applicable, will be documented in the client file. 

Resolution of the emergency status will be documented in the client record.

Percentage of clients with documented evidence of determination of EFA need noted in client’s primary record.

Percentage of clients with documented service plan for EFA in the client’s primary record that indicates emergent need, other resources pursued, and outcome of EFA provided.

Percentage of clients with documented evidence of resolution of the emergency status and referrals made (as applicable) with outcome results in client’s primary record.

Emergency Financial Assistance Provided: Short-term assistance will only be provided for:

  • Utilities
  • Housing
  • Food (groceries and food vouchers)
  • Prescription medication assistance

All completed requests for assistance shall be approved or denied within three (3) business days.

Assistance shall be issued in response to an essential need (as identified by the staff person providing EFA) within three (3) business days of approval of request. 

Payment for assistance made to service providers will protect client confidentiality.

  • Use of checks and envelopes that de-identify agency as an HIV/AIDS provider to protect client confidentiality.

Percentage of clients with documented evidence of payments made by agency for resolution of emergency status. (copies of checks/vouchers available)

 

References

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

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

HRSA Policy Notice 16-02: Eligible Individuals & Allowable Uses of Funds, June 2017.

DSHS HIV/STD Program Policies Payer of Last Resort (Policy 590.001)


Last updated January 18, 2018