Alameda County Ryan White Emergency Financial Assistance (EFA) Program

2022-23 EFHA Application Submission Process for Funded Sites

(Updated 7-15-2022)

Cardea receives funds from the Alameda County Department of Public Health Department (ACDPH), Office of HIV Care to provide emergency financial assistance to clients living in Alameda County who are Ryan White eligible. This program is funded by the Health Resources and Services Administration’s (HRSA) Ryan White HIV/AIDS Program. Download an information flyer about the program for your clients.

The PRINCIPAL PURPOSE of this assistance program is to provide limited one-time or short-term payments to stabilize Ryan White eligible beneficiaries in their current home and to help them with funds to purchase food, transportation vouchers to get to medical and case management appointments and provide support with late rent and essential utilities during times of emergency need. These funds are not intended to provide continuous or long-term assistance or to support clients to secure housing. The goal of EFA is to move the client towards self-sufficiency.

ELIGIBILITY PROCESS for Ryan White. Primary intent of these funds is to provide services to low income, underinsured people living with HIV in Alameda County. Ryan White is always the payer of last resort. Eligibility for Ryan White is based on (see Table 1):

  • HIV status with proof of diagnosis
  • Residency — must live in Alameda County & receive medical or case management services in Alameda County
  • Health insurance status
  • Income — Less than or equal to 500% of the Federal Poverty Limit (see Table 2).

Alameda Table1

Alameda Table2

+RW eligibility needs to be verified every 12 months.

+Services are provided regardless of current or past health condition (no denial for pre-existing conditions).

RWHAP funds may only be used for HIV-related needs of eligible individuals. All clients are eligible beneficiaries of Ryan White funds regardless of age, gender, sexual orientation, race, ethnicity, disability, income, geographical location of residence with Alameda County or other factors unrelated to qualifications of service. Clients with Department of Veteran’s Affairs benefits are also eligible for Ryan White services. Ryan white program funds are used as the payer of last resort.

In Alameda County, Ryan White clients may request emergency financial assistance (EFA) via their case managers from Ryan White funded sites. Upon receipt and review of application and case manager’s case notes, Cardea staff will review eligibility and client’s emergency need to be able to provide financial assistance.

Approximate limits per person per year but subject to change based on availability and spending:

These funds are for one-time emergency need and not for ongoing support.

HOUSING: $500-1,500 towards late rent support per client/year

When calculating rent we will base it on client’s out of pocket rent after any subsidized housing support and roommate’s share if applicable.

UTILITIES: $300 towards late essential utilities support per client/year

FOOD & TRANSPORTATION CARDS: Based on case manager’s evaluation and allocated funds available to your agency.

Cardea will closely monitor spending throughout the year. If funds are depleting faster than anticipated, modifications will be made and case managers will be notified of the changes:

  • to annual limits
  • clients who have already received EFA once during that grant cycle will not be able to receive funds again until the next grant cycle
  • +Please note that funds are always based on availability and prioritized for clients with high needs. It is also possible that we may run out of funds before the end of the contract year

Below are the step-by-step instructions for Housing and Utilities:

STEP 1) Case manager needs to verify client’s eligibility for Ryan White every 12 months by using the RW Program Eligibility Verification Form

Eligibility is based on:

  • HIV status with proof of diagnosis
  • Income (see limits above)
  • Residency — must live in Alameda County and get medical and/or case management care in Alameda County
  • Health insurance status

STEP 2) Case managers should have client read and sign:
Consent to Enroll in EFA Program and Release of Information Form

and

ARIES Client Share/Non-Share Consent Form

STEP 3) Case manager should provide case notes from their last visit with the client to help support client’s application for emergency financial assistance. Case notes are very important, and we have may deny applications if the case notes do not indicate applicants are having an urgent need. Please provide details on the notes indicating why client is having an urgent need that is resulting in their inability to pay their utility bills or rent and how this financial assistance is necessary to improve health outcomes. Some urgent need situation examples:

  • A significant increase in bills
  • A recent decrease in income
  • High unexpected expenses on essential items
  • Recent medical situation
  • A failure to provide EFA will result in danger to the physical health of client or dependent children

It is also helpful for us to know that a plan is being developed with client to support them in the future and other resources pursued prior to using EFA funding for assistance.

You may use your own case notes or you may utilize this form: Ryan White EFA Program Client Case Notes.

STEP 4) Gather supporting documents for housing or utility assistance.

For housing:

  1. Statement of Delinquent Rent Notice.
    • Notice/invoice from landlord dated in the last 30 days may suffice if it includes:
      • Landlord’s name and address
      • Client’s name and address indicating they are the tenant
      • Amount overdue
  2. W9 from landlord with their name, address, social security number or employer identification number and signed and dated within the last 1-year.
    • W9 is a Federal and State requirement that must be adhered to in order for Cardea to make rent payments to the landlord. Landlords will receive a Form 1099 from Cardea reporting the rental income they received that year.
    • Landlords can be provided with this Letter to request supporting documents and W9. If client is subleasing or paying rent to a relative or friend, they must also fill out delinquency notice and fill out W9 with their social security number.
    • If landlord are wanting to send us the documents directly, they can do so via secure email, fax or mail as indicated on the letter.

For utilities: Copy of past due bill from utility company (electric, gas, water). On occasion, we may consider late cell phone bill but priority is for water, gas and electric bills.

Utility bill or statement must show:

  1. Client’s name and an Alameda County address. If client is not listed on the bill, attach lease showing they live at that address.
  2. Account number
  3. Mailing address for check
  4. Past due date and bill must be dated within the last 30-days
  5. Clients should also be enrolled in the cost-saving programs offered by the utility company for example CARE program for PGE

STEP 5) If application is for housing, case manager must call the landlord to verify:

  • amount delinquent in rent and a completed rent delinquency notice,
  • mailing address for check if different than address on W9
  • who the check needs to be payable to and this should match information on W9
  • notify landlord that if application for rental assistance is approved, the check will be mailed directly to landlord from Cardea (within the next 2-4 weeks)

STEP 6) Complete the EFA Application Form at the following link https://forms.office.com/r/R5vffEwwVY.

STEP 7) After online submission of the EFA Application Form, case manager should send all the required supporting materials to Cardea via secured fax to (510) 338-4411 or via encrypted secure email to [email protected]

Download: Packet of all the forms mentioned above: EFA Application Forms

Clients receiving care at Kaiser or other non-Ryan White funded agencies must also provide:

    1. Proof of income
    2. Diagnosis letter

Approval or Denial of Application

  • Case managers will be contacted via email if documents are missing or if application was tentatively approved or denied by EFA staff. Please allow 3-5 business days for the application to be reviewed. After the application is tentatively approved, the check request is submitted to our finance team. On occasion, finance team will request additional documentation to support the application. If you do not hear from us after the tentative approval, you can assume checks will be mailed out within the next week.
  • If housing request is approved, please notify the landlord of approval. If check has not reached landlord within 3-4 weeks of having been mailed out, contact us to check status of check and if needed to reissue check. To reissue check, we will first have you sign a form insuring your agency will pay the $35 check reissue fee.

Step by Step Instructions for Food Cards

Immediately upon distribution of the food card(s), case managers will need to enter information into this online form.

For Cards from the 2021-22, enter the client data here: https://forms.office.com/r/WKBFLe0BLL

For Cards from the 2022-23, enter the client data here: https://forms.office.com/r/4dEyQ1M65Y

The form will ask for Client information, card batch number and the last 4 digits of the card(s) distributed to that particular client.

+Agencies are responsible for the safety of the cards. If cards are lost, agency will be responsible for reimbursing Cardea for the equivalent amount.


Step by Step Instructions for Transportation Voucher Cards

  • To request transportation voucher cards please email us with your needs and set up a time to pick up the from our office. We can support with
    • Day bus pass
    • BART card
    • Paratransit
  • Agencies are responsible for entering into ARIES client data for the transportation vouchers distributed. Please note transportation vouchers can be used for nonemergency transportation needs that enables an eligible client to access or be retained in core medical and support services.
  • To Cardea on the 1st of every month you will complete and send via secure email the EFA Transportation Voucher Distribution Log with the data from the previous month.

Grievance Process

If your organization or client do not feel good about the services provided, please fill out this form and email it to [email protected]. Please allow 10 business days for us to respond. A written response advising of the final decision with regard to the grievance and the basis for the decision will be sent. If we are unable to resolve your grievance we will put you in touch with ACPHD for further support:

Judy Caballeros
Office of HIV Care
1100 San Leandro Blvd, 3rd floor, San Leandro, CA 94577


Program Feedback

We want Case Manager’s feedback about the EFA program. Provide anonymous feedback here: https://forms.office.com/r/0kJdGizshg

Client can provide feedback here: https://tinyurl.com/RWEFA


Cardea Contact Information:

Shailey Klinedinst, EFA Program Director & Jiselle Soss, EFA Client Eligibility Coordinator 
[email protected] (best way to contact us) 
510-291-8266 to leave a message for Jiselle

Secured Fax (510) 338-4411

+please do not give out this website or email or phone to clients. Clients must go through your agency to access EFA services.