Housing Services

Service Standard

Housing Services Service Standard print version

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

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 – 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 the development of an individualized housing plan, updated annually, to guide the client’s linkage to permanent housing. Housing may provide some type of core medical (e.g., mental health services) or support services (e.g., residential substance use disorder services).

Housing activities also include housing referral services, including assessment, search, placement, and housing advocacy services on behalf of the eligible client, and 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 in place to assess and document the housing status and housing service needs of new clients, and at least annually for existing clients. 

HRSA RWHAP strongly encourages recipients and subrecipients, along with local decision-making planning bodies, to institute duration limits to 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 or rental deposits. HUD Housing Opportunities for Persons with AIDS (HOPWA) grant awards may allow these costs.

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 provided by a housing case manager or other professional who possesses a comprehensive knowledge of local, state, and federal housing programs and how these programs can be accessed. These services may include assessment, search, placement, and advocacy services.
  • Emergency housing, 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 1 month of rental and utility assistance within a contract year.
  • Transitional housing, defined as housing support for a person experiencing homelessness that helps the client to 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. 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 6 continuous months of funding within a contract year. 
  • Short-term assistance, defined as support for a person currently in housing but needing financial support for rent, utilities, or both to gain or maintain medical care. 

Each HIV Service Delivery Area (HSDA) shall establish maximum amounts of emergency housing assistance, transitional housing assistance, and short-term housing assistance that are uniform throughout the HSDA. The HSDA should establish these through 1) planning councils (PCs) in areas where the PC determines recommended allocations for Ryan White Part B and State Services funds; or 2) by the Administrative Agency (AA) based on consumer input and planning processes in Ryan White Part B-only HSDAs.

Universal Standards

Service providers for Housing Services must follow HRSA and DSHS Universal Standards 1-52 and 159-164. 

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 3 business days of the onset of the emergency housing need. Staff must document assessment of client housing status and housing service needs. Reason(s) for emergency assistance may include but are not limited to: 

  • Client is unable to pay rent due to a recent job loss
  • Client is on an unpaid medical leave of absence or has exhausted all leave balances 
  • Client is unable to work due to recent hospitalization 
  • 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
  • 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 if the housing emergency has been resolved. If the emergency is not resolved 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 that occurred within 3 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 1 month to determine if the client is stably housed. (Pilot Measure)

Housing Plan for Transitional and Short-Term Housing: Agencies must develop a housing plan for all 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 on-going housing stability goal with a focus 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.

4. Percentage of client charts with a housing plan.

5. Percentage of client charts with housing plans updated at least monthly.

Housing Referral Services: Housing-related referrals provided by housing assistance/referral providers should 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 in the client’s primary record all activity to assist the client in securing housing and the outcome of the assistance, including whether the client has obtained secure and stable housing

6. Percentage of client charts with documentation of all elements of housing referral services provided. 

7. Percentage of clients with documentation of the outcome of referral services. (Pilot Measure)

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 2022.

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 2022.

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, 6 June 2017.

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

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