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HIV/STD Program

HIV/STD Program

HIV Medical and Support Service Categories

Housing Services

Service Standard

Housing Services Service Standard print version

Texas Department of State Health Services, HIV Care Services Group – HIV/STD Program

Subcategories Service Units
Care Services Housing Referral Services Per 15 minutes
Housing Opportunities for Persons with AIDS (HOPWA) Housing Referral Services Per 15 minutes
Housing Assistance – Emergency Per day
Housing Assistance – Transitional Monthly
Housing Assistance – Short-term Per day

Health Resources and Services Administration (HRSA) Description

Housing provides transitional, short-term, or emergency housing assistance to enable a client or family to gain or maintain outpatient/ambulatory health services and treatment, including temporary assistance necessary to prevent experiencing homelessness and to gain or maintain access to medical care. Activities within the Housing category must also include developing an individualized housing plan, updated annually, to guide the client’s linkage to permanent housing. Housing may provide some core medical (e.g., mental health services) or support services (e.g., residential substance use disorder services).

Housing activities include housing referral services, assessment, search, placement, and advocacy services on behalf of the eligible client, as well as fees associated with these activities.

Program Guidance

HRSA Ryan White HIV/AIDS Program (RWHAP) recipients and subrecipients that use funds to provide Housing must have mechanisms to assess and document new clients' housing status and housing service needs, and at least annually for existing clients. HRSA RWHAP strongly encourages recipients, subrecipients, and local decision-making planning bodies to institute duration limits for housing activities. HRSA HIV/AIDS Bureau (HAB) recommends recipients and subrecipients align duration limits with those definitions used by other housing programs, such as those administered by the Department of Housing and Urban Development (HUD), which currently uses 24 months for transitional housing.

Agencies should report housing referral activities performed by Ryan White-funded medical or non-medical case managers under the respective case management service category. Agencies should report referral services provided by Ryan White-funded housing specialists under the Housing service category.

Limitations

Housing services cannot provide direct cash payments to clients and cannot fund mortgage payments.

Housing services cannot provide cash security deposits that landlords will return directly to clients because this violates the RWHAP statutory prohibition on cash payments to clients. However, to address this barrier to getting clients into stable and permanent housing, RWHAP funding may be used to pay for an RWHAP client’s security deposit if the subrecipient has policies and procedures in place to ensure that the security deposit is returned to the RWHAP subrecipient and not to the RWHAP client.

Subrecipients interested in using RWHAP funds to pay for a RWHAP client’s security deposit must maintain policies and procedures that demonstrate programmatic and legislative compliance, including that there is no violation of RWHAP’s prohibition on cash payment to the RWHAP client. The procedures should also include how the agency will address the return of less than the full security deposit with the client. RWHAP subrecipients must also track returned security deposits as a refund, which agencies will use for program purposes and expend before grant funds.

Agencies may use various funding sources to pay for an RWHAP client’s security deposits, including HUD Housing Opportunities for Persons with AIDS (HOPWA) grant awards, Ending the HIV Epidemic (EHE) funds, program income generated through the 340B program, braided funding, and non-RWHAP grant awards.

Services

Eligible housing may include housing that:

  • Provides some type of core medical or support services (such as mental health services, residential substance use disorder services, residential foster care, or assisted living residential services).
  • Does not provide direct core medical or support services but is essential for a client or family to gain or maintain access to and adherence to HIV-related medical care and treatment.

Agencies may use funds under this category for the following housing-related expenditures:

  • Housing referral services- a housing case manager or other professional who possesses a comprehensive knowledge of local, state, and federal housing programs and how to access them provides housing referral services. These services may include assessment, search, placement, and advocacy services.
  • Emergency housing assistance- defined as housing services provided in response to an unforeseen event that jeopardizes a household’s ability to pay housing costs. Assistance is limited to one month of rental and utility assistance within a contract year.
  • Transitional housing assistance- Housing support for a person experiencing homelessness that helps the client gain or maintain access to medical care. Agencies may use funds for rental fees, application fees, or both; however, they may not use funds for rental deposits unless they have policies and procedures in place to ensure that the security deposit is returned to the RWHAP subrecipient and not to the RWHAP client (see details in Limitations section above). Agencies may also use funds for transitional residential housing that provides core medical or support services. Transitional housing assistance is based on need and available resources, and agencies should provide no more than six continuous months of funding within a contract year.
  • Short-term housing assistance- support for a person currently in housing but needing financial support for rent, utilities, or both to gain or maintain medical care.

Administrative Agencies (AAs) must establish maximum amounts of emergency housing assistance, transitional housing assistance, and short-term housing assistance for each HIV Service Delivery Area (HSDA). AAs should determine allocations through Planning Councils (PCs) in areas where the PC sets allocations for Ryan White Part B and State Services funds. In areas that receive Ryan White Part B funds only, the AA should base allocations on consumer input and planning processes.

Universal Standards

Service providers for Housing Services must follow HRSA and DSHS Universal Standards 1-63 and 170-174.

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

Emergency Housing Assistance: Agency staff will initiate an intake within three business days of the onset of the emergency housing need. Staff must document an assessment of the client's housing status and housing service needs.

The reason(s) for emergency assistance may include but are not limited to:

  • The client is unable to pay rent due to a recent job loss
  • The client is on an unpaid medical leave of absence or has exhausted all leave balances
  • The client is unable to work due to recent hospitalization
  • The client had to purchase unexpected costly HIV medications or pay for unexpected HIV-related medical expenses out-of-pocket

The housing assessment must document the following:

  • The actual costs to avoid eviction
  • Other resources are not reasonably available to address the unmet housing need
  • The client will maintain or achieve stable housing as a result of housing assistance

Staff will contact the client at the end of the month to determine the resolution to the housing emergency. If the emergency remains unresolved and the client needs
additional assistance, staff may assess the client for short-term housing assistance.
  1. Percentage of client charts with documentation of an intake within three business days of emergency need.
     
  2. Percentage of client charts with an emergency housing needs assessment.
     
  3. Percentage of client charts with documentation of follow-up conducted after one month to determine if the client has stable housing.

Housing Plan for Transitional and Short-Term Housing: Agencies must develop a housing plan for clients receiving assistance for transitional or short-term housing that includes:

  • Housing status
  • Reason for housing service need
  • Other resources screened for housing assistance

Plans must detail the ongoing housing stability goal, focusing on access to medical treatment and supportive services. The plan must include:

  • Sustainable short-term and long-term goals for alleviating risks of a lack of housing, establishing affordable permanent housing stability, and improving access to health care and supportive services
  • Identification of barriers to sustainable housing
  • Steps to address housing needs
  • Referral(s) to available housing support services
  • Budget and money management skills building, if indicated

Staff must review the housing plan at least monthly and update the plan with progress toward housing goals.
  1. Percentage of client charts with a housing plan.
     
  2. Percentage of client charts with housing plans updated at least monthly.

Housing Referral Services: Housing-related referrals provided by housing assistance or referral providers must include a housing assessment, housing search, placement, and advocacy services to seek housing. This may include applications to other funding sources or housing-related visits to court systems.

Staff will document all activity to assist the client in securing housing and the outcome of the assistance in the client’s primary record, including whether the client has obtained secure and stable housing.
  1. Percentage of client charts documenting all housing referral services provided.
     
  2. Percentage of clients with documentation of the outcome of referral services.

References

HIV/AIDS Bureau Ryan White HIV/AIDS Program. Housing Security Deposit Guidance Program Letter. June 26, 2024.

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, October 22, 2018.

HIV/AIDS Bureau Ryan White HIV/AIDS Program. HIV/AIDS Bureau (HAB) Ryan White HIV/AIDS Program (RWHAP) Policy Clarification Notice 16-02: Eligible Individuals and Allowable Uses of Funds Housing Services Frequently Asked Questions. Health Resources & Services Administration, June 6, 2017.