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If you are a member looking for information on how to make a flex request or find other health related services, please visit the member Social Needs Assistance page.
What are social needs?
Health-related social needs (HRSN) refer to social and economic needs that contribute to health and well-being. They include food security, transportation, interpersonal violence, education, income/employment, stable housing, social support, and utility assistance. When one or multiple of these needs are unmet, an individual can experience poor health outcomes.
How do we provide social needs assistance?
There are two ways members may be eligible to receive the social needs supports described above: Health Related Social Needs (HRSN) or Health Related Service Fund (HRSF).
When a request is submitted, CareOregon will review it to determine whether the request meets eligibility criteria for one of these two sources, based upon the information provided.
Requesting different types of social needs supports
What kind of climate devices are available?
- Air conditioners
- Air filtration units and/or filters
- Mini-refrigerators
- Heaters
- Portable power supplies
Members may be eligible for one of each device every three (3) years. They are allowed one replacement device in that time frame if their item stops working.
Eligibility
To be eligible for a climate device, all of the following must be true for a patient:
- They must be a current member
- They are not able to get the item/service through any other benefit or means
- The item or service must help with their medical need or life situation, and
- They provide all required documentation for the request
Not all requested items or services are granted/funded. Our team evaluates each request on a case-by-case basis and makes the final funding determination, including the amount(s) of funding rewarded if members meet eligibility criteria. Please review the following Social Needs Assistance Guidelines for more information about qualifying medical conditions and life situations and the commonly funded supports for each.
Social Needs Assistance Guidelines (PDF)Requesting a climate device
If the member meets the eligibility standards listed above and want to request a climate device, simply click the button below to fill out the digital Climate Device Request Form.
Digital Climate Device request formYou can also download and fill out the Climate Device request form (PDF) and submit it to 211 by email or fax.
- Fax number: 503-214-8909
- Email: hrsn@211info.org
If you have questions or would like help filling out the request form with a member, call 211's direct line at 503-468-5375.
Housing support options and limits
| Support | Limitations |
| Rent support | Three to six months (depending on eligibility), available once every three years, including back rent |
| Utilities | No more than six (6) months, including any arrears, available once every three years |
| Home modifications | Available as needed to help medical conditions such as ramps, grip bars, cabinet handles |
| Home remediations | Available once. For methods or actions taken to address and fix issues or problems in a home. |
| Hotel stays |
|
| Storage fees | Up to six (6) months every three years |
| Housing deposits | Available once |
| Moving fees | Available once |
Exclusions include mortgage payments and payments related to the construction of new physical structures.
Eligibility
To be eligible for a housing support, all of the following must be true for a patient:
- They must be a current member;
- They are not able to get the item/service through any other benefit or means,
- The item or service must help with their medical need or life situation, and;
- They provide all required documentation for the request.
Not all requested items or services are granted/funded. Our team evaluates each request on a case-by-case basis and makes the final funding determination. Please review the following Social Needs Assistance Guidelines for more information about qualifying medical conditions and life situations and the commonly funded supports for each.
Social Needs Assistance Guidelines (PDF)Requesting a housing support
If a member meets the eligibility standards listed above and want to request a housing support, simply click the button below to fill out the secure digital Housing Request Form.
Digital Housing Request FormYou can also download and fill out the Housing request form (PDF) and submit it to 211 by email or fax.
- Fax number: 503-214-8909
- Email: hrsn@211info.org
If you have questions or would like help filling out the request form with a member, call 211's direct line at 503-468-5375.
Examples of other supports covered
Here are some examples of common support for social needs. This list isn't comprehensive. If a member needs something for their health that isn't listed, just submit a form and we'll consider the request.
- Food assistance (grocery store gift cards, nutrition education, etc)
- Sensory support items/tools (Weighted blankets, sleep aids, vouchers for yoga classes, etc.)
- Exercise equipment and gym memberships
- Electronic devices such as laptops and communication devices
- Baby equipment
- Specific educational materials and/or classes
- Camp enrollment
Eligibility
To be eligible for other supports, all of the following must be true for a patient:
- They must be a current member;
- They are not able to get the item/service through any other benefit or means,
- The item or service must help with their medical need or life situation, and;
- They provide all required documentation for the request.
Not all requested items or services are granted/funded. Our team evaluates each request on a case-by-case basis and makes the final funding determination. Please review the following Social Needs Assistance Guidelines for more information about qualifying medical conditions and life situations and the commonly funded supports for each.
Social Needs Assistance Guidelines (PDF)Requesting a social needs support
If a member meets the eligibility standards listed above and wants to request a housing support, simply click the button below to fill out the secure digital social needs request form.
Digital social needs request formYou can also download and fill out the Health-related services Flex Form (PDF) and submit it to 211 by email or fax.
- Fax number: 503-214-8909
- Email: hrsn@211info.org
If you have questions or would like help filling out the request form with a member, call 211's direct line at 503-468-5375.
Bulk Purchasing Program
We recognize that providers frequently feel there is a small window of opportunity to provide some services for members, so we’ve made some of these items that are commonly needed and have a clear benefit available via our bulk purchasing programs. This allows providers to have them on hand and give them to members as needed.
Examples of items available:
- Cell phones with 1-year data plans
- Transit passes
- Sleeping bags
- Shelter materials (tents and tarps)
- City Team shelter vouchers
- Personal hygiene products
Requesting bulk purchases
If your clinic or organization is interested in using the Bulk Purchasing Program, please reach out to socialhealth@careoregon.org to get information about signing up. Here are some highlights of the program:
- Items should only be requested that are anticipated to be distributed over a one-month period.
- Once CareOregon receives your request, it will be reviewed and verified for accuracy before order fulfillment. Requests must be submitted using the link below with the PIN Code assigned to your clinic.
- Required member level reporting on bulk purchases can be provided by using the Bulk request tracker below.
- It is a requirement that reporting be current before new items may be requested.
Helpful resources
Health Related Social Needs (HRSN)
As part of the state’s recent 1115 waiver, Oregon was approved to offer the new health-related social needs (HRSN) benefit. The health-related social needs (HRSN) benefit was developed to provide social support to OHP members who are experiencing certain life transitions, to improve their health during this specific time. The HRSN benefit will provide three types of support; housing, nutrition, and climate-related devices. Some examples of life transitions include:
- Involvement with the child welfare system
- Recently became eligible for both Medicaid and Medicare (within the past 9 months)
- Experiencing homelessness
- At risk for homelessness
- Released from jail, detention center, Oregon Youth Authority facility, prison, or the Oregon State Hospital within the past 12 months
What is an HRSN Service Provider?
As an integral part of the community, HRSN Service Providers help connect members with the HRSN benefit. These can be public or private social service organizations or clinics who work with Jackson Care Connect to identify eligible members, help them complete requests for support and directly provide HRSN services for the member.
- Be accessible to OHP members in your region.
- Demonstrate the ability and/or experience of effectively serving at least 1 of OHA’s Priority Populations.
- Demonstrate qualified services and administrative staff.
- Provide culturally and linguistically appropriate, responsive and trauma-informed services.
- Demonstrate a history of responsible financial administration.
- Meet readiness standards defined above.
- Demonstrate readiness to send and receive closed loop referrals.
- Comply with reporting and oversight requirements and applicable laws relating to privacy and security.
JCC will utilize OHA’s HRSN fee schedule to reimburse HRSN Service Providers. During the contracting process, we will work together to establish reporting and invoicing processes, which may look different depending on the type of services or financial needs of the HRSN Service Provider. Those who want to participate as HRSN Service Providers will get proper training on reporting and invoicing prior to any deadlines.
Listed below are the types of information that HRSN Service Providers may be required to submit. This list is subject to change:
- Member identifying information (name, date of birth, Medicaid ID)
- Date(s) of service
- Location where services were provided (e.g., home, in office, in the community)
- A description of HRSN Services
HRSN Devices Fee Schedule:
Climate-Related Supports
Climate Devices Fee Schedule (Version 7, January 17, 2024)
Procedure Code
Modifiers
Service Description
Unit
OHA Expected Unit Costs
Rate1,2
Procedure Code
Modifiers
Service Description
Unit
OHA Expected Unit Costs
Rate1,2
S5165 – Home modifications; per service
U1 – HRSN Waiver Program
V1 – Air conditioner
Medically necessary – Air conditioner, including delivery
Per Item
660
Actual cost, subject to maximum allowable
Procedure Code
Modifiers
Service Description
Unit
OHA Expected Unit Costs
Rate1,2
T2029 – Specialized medical equipment, NOS, waiver
U1 – HRSN Waiver Program
Medically necessary – Air filtration device, including delivery
Per Item
500
Actual cost, subject to maximum allowable
Procedure Code
Modifiers
Service Description
Unit
OHA Expected Unit Costs
Rate1,2
S5165 – Home modifications; per service
U1 – HRSN Waiver Program
TS – Follow up service
Medically necessary – Air filter replacement, including delivery
Per Item
70
Actual cost, subject to maximum allowable
Procedure Code
Modifiers
Service Description
Unit
OHA Expected Unit Costs
Rate1,2
S5165 – Home modifications; per service
U1 – HRSN Waiver Program
V3 - Generator
Medically necessary – Portable power supply, including delivery
Per Item
1590
Actual cost, subject to maximum allowable
Procedure Code
Modifiers
Service Description
Unit
OHA Expected Unit Costs
Rate1,2
S5165 – Home modifications; per service
U1 – HRSN Waiver Program
V4 – Heater
Medically necessary – Heater, including delivery
Per Item
290
Actual cost, subject to maximum allowable
Procedure Code
Modifiers
Service Description
Unit
OHA Expected Unit Costs
Rate1,2
S5165 – Home modifications; per service
U1 – HRSN Waiver Program
V2 – Refrigeration
Medically necessary – Mini refrigerator, including delivery
Per Item
170
Actual cost, subject to maximum allowable
Procedure Code
Modifiers
Service Description
Unit
OHA Expected Unit Costs
Rate1,2
S5165 – Home modifications; per service
U1 – HRSN Waiver Program
NU – New Equipment
Medically necessary climate device installation
Per Service
28
Actual cost, subject to maximum allowable
Procedure Code
Modifiers
Service Description
Unit
OHA Expected Unit Costs
Rate1,2
T1017 – Targeted case management, each 15 minutes
U1 – HRSN Waiver Program
UD – Outreach and engagement
Outreach and Engagement by CBO or HRSN provider3
Per 15 minutes
20
20
Procedure Code
Modifiers
Service Description
Unit
OHA Expected Unit Costs
Rate1,2
N/A
N/A
CCO variable administrative load4
Per Device
NA
78
Footer:
- Rates listed as “Actual cost, subject to maximum allowable” will have an upper payment limit of 150% of the OHA Expected Unit Costs. The 150% factor is to allow for variation in device and shipping costs over time and across geographies.
- A 2% MCO tax load will be added to all payments included in the fee schedule.
- Outreach and Engagement applies to activities performed by CBOs and HRSN providers. This activity is only billable for HRSN-eligible members.
- Must be billed in conjunction with a climate device.
Closed loop referrals refer to the process of exchanging information between and among the CCO and HRSN Service Providers to make referrals and communicate about the status of referrals for a member. This can occur through multiple different avenues including email, community information exchange (CIE), direct mail, and/or phone calls. This process with our network and in the community is still under development. More concrete workflows and procedures will be available later this year.
Health Related Service Fund (HRSF), or “Flex”
Health-related services (HRS) are non-covered services under Oregon’s Medicaid plan that are not administrative requirements and are intended to improve care delivery and overall member and community health and well-being. One of the purposes of HRS is to allow coordinated care organizations (CCOs) an opportunity to address the social determinants of health and equity (SDOH-E), including the health-related social needs, of their members. For CCOs to use Oregon’s Medicaid funds to pay for HRS, they must comply with state and federal criteria.
The HRS section on the Oregon Health Authority (OHA) website has the most up-to-date information, including more information on using HRS to address SDOH-E.
Questions? Email us at social.determinants@careoregon.org.
Providing additional documentation for HRSF requests
Budget worksheet
Often evaluating requests involves asking for more information about the member, which may include the member's budget information. If more details about the budget are indicated, this form can be used to provide that information.
Flex FAQ
Flexible services are cost-effective items and/or services delivered to an individual OHP member to supplement covered benefits and improve their health and well-being. Flexible services are intended to meet immediate social needs, stabilize crisis situations and support a sustainable plan for ongoing needs. These are commonly referred to as flex requests.
The Oregon Administrative Rules restrict health-related services to items not paid for with grant money, funding separate from CCO contract revenue, normal clinical service billing, and is the payor of last resort. In other words, health-related services may be used only if other funding is not available.
CareOregon evaluates all completed request forms based on:
- The member’s eligibility
- How the request matches their treatment plan
- Which other community resources or safety net funds (besides HRS) were pursued before the request was made
We will provide members with a written outcome (mailed to the address on file with the CCO) and copy the requesting provider (and the member’s representatives, if applicable).
Any primary care or behavioral health provider or care team, care coordination staff member working directly with members, or other subcontractors of CareOregon’s network, may make a flex request for a member. CareOregon encourages our community-based organization (CBO) partners to help our shared members access flexible services. CBOs can work with members and their treatment providers to identify the need, and the provider can submit a request. Members can also now submit requests themselves on our member-facing Social Needs Assistance page.
If you are a CBO and need help connecting a member to a provider, please complete the Care Coordination referral form.
HRSF Standard requests now have a minimum TAT of 4+ weeks
HRSF Urgent requests now have a minimum TAT of 2+ weeks
Please note this does include fulfillment time for approved requests.
To ensure timely review of a request, please ensure the following items are met and included in the request submission:
- Please ensure the form is completed in its entirety and efforts to access other sources of funding and support are adequately described in detail
- Medical documentation. This could include a care plan, treatment plan or chart notes that address the specific diagnosis listed on the request form.
- We may also need other types of documentation such as lease agreements, a budget/ledger or copies of utility bills in order to process requests.
Submitting requests with incomplete forms or missing required documentation will significantly delay the processing of requests.
In addition to CareOregon’s Health Related Services, there are other local resources that offer social needs assistance in our community. If a member finds that they do not qualify for our program, they may be able to access what they need from one of the links below.
- Medical transportation: Non-emergency Medical Transportation (NEMT)
- Discounted car repairs: Oregon's Car Care Program or Self-Sufficiency Grants
- Car Assistance: How to Get a Donated Car From Goodwill or Salvation Army
- Pet assistance: Multnomah County Animal Services
- Discounted phone or internet: Oregon Lifeline program
- Utility assistance: Oregon Energy Assistance Program or call 211
- Furniture: Community Warehouse
- Home repairs: Home Repair and Home Ownership Retention Services
- Bikes: Bike Farm or Bikes for Humanity PDX
