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Health Share of Oregon — Social Needs Request Form

Health Share of Oregon members can use this form to request climate, housing, or nutrition supports. Please note, we are currently experiencing a high volume of requests and calls that may delay initial response time. 

Please wait at least 28 days before you follow up or expect a call back about your request. 

If you are requesting housing support, please note that OHP housing benefits are not set up to address housing emergencies. These benefits are designed to support people before they have an eviction notice, and help them stabilize.

To be eligible to receive assistance, all of the following must be true: 

  • You must be a current Health Share of Oregon, Jackson Care Connect CCO, or Columbia Pacific CCO member (this includes members of CareOregon, Kaiser Permanente, Legacy Health PacificSource, OHSU Health, and Providence Health Assurance)
  • You must have a verified qualifying medical condition*
  • You are not able to get the item/service through any other benefit or means
  • The item or service must help with your medical condition 
  • You must provide all required documentation for the request

*Your health plan will need to verify your qualifying medical condition (for example, records of a hospital or doctor visit) before approving your request. Please review the Social Needs Assistance Guidelines for more information about qualifying medical conditions, life situations, benefit/program limitations and the commonly funded supports for each.

For members who meet all eligibility criteria and are approved, CareOregon also decides the amount(s) of funding provided as defined by OHA guidance. 

There are multiple steps involved in reviewing requests for the HRSN benefit:
Health Share Oregon Steps

If you are requesting:

  • Move-in fees or deposits (with or without utilities)
  • First month’s rent (with or without utilities)
  • Utilities only
  • Storage unit fees only

The following documentation must be provided in advance before the processing of your request, as relevant:  

  • Rental or lease agreement (must be signed)
  • Utility bill (such as electricity, natural gas, internet, water, sewer, garbage, cell phone, landline)
  • Shut-off notice for utilities
  • Storage unit bill
  • Budget worksheet

If you are requesting moving expenses or vehicle repairs, you must provide an invoice from the service provider that details the cost estimate. This must be sent in advance before the processing of your request.

Not all requested items or services are granted or funded. CareOregon evaluates each request on a case-by-case basis and makes the final decision, including the amount(s) of funding applied if members meet eligibility criteria. 

For more information, visit: 

https://careoregon.org/members/more-careoregon-services/social-needs-assistance 

To download the Social Needs Assistance Guidelines, go to: 

https://careoregon.org/docs/default-source/members/hrs/hrsn/social-needs-assistance-guidelines.pdf