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Health-Related Social Needs (HRSN) Request Form

Health-Related Social Needs (HRSN) Request Form

OHP members of the following Coordinated Care Organizations (CCOs) can use this form to request HRSN Housing, Nutrition, and Climate benefits:

  • Health Share of Oregon (CareOregon, Providence, Kaiser Permanente, OHSU Health)
  • Jackson Care Connect (JCC)
  • Columbia Pacific CCO (CPCCO)

*Important note about climate requests for Health Share of Oregon members:

  • Health Share of Oregon members assigned to CareOregon can use this form to request HRSN climate supports.
  • Health Share of Oregon  members assigned to other plans (Kaiser Permanente, OHSU Health, or Providence Health Assurance) should request HRSN climate supports directly through their assigned plan. See here for more information.

Please DO NOT use this form to request Flexible Services. Instead, follow the instructions below based on your CCO.

  • Health Share of Oregon members can request Flexible Services through their assigned health plan. See here for details.
  • JCC and CPCCO members can request Flexible Services through CareOregon. See here for details.

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

  • You must be a current Oregon Health Plan member
  • You must have a verified qualifying medical condition*
  • You cannot 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 qualifying medical condition must be verified by your health plan before your request can be approved (for example, records of a hospital or doctor visit).

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

There are multiple steps involved in reviewing requests for the HRSN benefit:

  1. Initial screening: After you submit a request, CareOregon will review it and contact you if additional information is needed. Please allow up to 28 days for review before following up.
  2. Getting a decision letter : You will receive a letter in the mail with the decision on your request. If approved, the letter will list what services or items you will get.
    Note: This letter does NOT mean services start right away. Additional steps are required.
  3. Making a care plan:  If you receive an approval letter, CareOregon will contact you to create your Care Plan and discuss your service preferences and needs.
  4. Getting help:
    • Climate support for CareOregon members (About 2 weeks): If your request for climate help, such as an air conditioner, is approved, CareOregon will order your device(s) to be delivered to you.
    • Nutrition support (Up to 4 weeks): If your request for nutrition support is approved, you’ll be sent to a nutrition service provider. They will contact you to coordinate your services.
    • Housing support (Up to 4 weeks): If your housing request is approved, you will be connected with a housing provider. Please keep paying your rent and utilities if you can. It may take up to 4 weeks after approval before rent assistance is paid.

For HRSN Housing supports

OHP Housing benefits are designed to help before you get an eviction notice and keep you housed. They are not for housing emergencies.

The following documentation must be provided before processing your housing supports request:

  • 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 (if you have one)
  • Storage unit bill (if you have one)
  • Income Verification/Budget worksheet
  • Proof of income (most recent two months’ pay stubs, unemployment letter, Social Security Statement, etc.)

Documents related to your housing request should be uploaded in advance. Documentation can be emailed to hrsncx@careoregon.org or uploaded to your member portal. If you already have an account go here to login or you can find registration information here to set up an account. Once logged in, upload your documents by doing the following:

  1. Go to the message center and click “new message”
  2. Click “add recipients” and select “Health Related Services Requests”
  3. Add HRSN in the subject line and attach the file(s) to the message using the attach file feature
  4. Add any other context and click “send”

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