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IHN-CCO Health Related Social Needs Form

Health Related Social Needs (HRSN) benefits are for members with life changes listed by Oregon Health Plan.  

The life changes covered for HRSN benefits are one of the following:

  • Young Adults with Special Health Care Needs (YSHCN) ages 19-20 (starting 1/1/25) with a complex health care condition;
  • A member with current or past involvement in the Oregon child welfare system;
  • A member who is discharged from an IMD, residential mental health and substance use disorder facility, or inpatient psychiatric unit in the past 12 months;
  • A member who is new to having both Medicaid and Medicare health plans in the upcoming 3 months or past 9 months;
  • A member who has been released from incarceration; including prison and jail in the last 12 months;
  • Members who are at risk of homelessness;

Clinical Risk Factors:

  • Members must have a qualifying health condition to get this benefit.
    • Examples:
      • Complex Behavioral Health Needs
      • Complex Medical Health Needs
      • Needs help with Activities of Daily Living

Social Risk Factors:

  • The member who live in their own home or apartment, live with friends or family, or live in a camper or trailer. (A camper or trailer will need a constant power source, can be a generator);
  • The member did not get the same or similar service in the last 1-3 years;
  • The member can safely use the device in their home;
  • There are rules for services that will have additional service rules. For example:
    • Only members who need support paying for current housing may qualify for rent and utilities support, storage;        
    • Only members who are approved for rent support can have HRSN benefits to help pay utilities;           
    • Only members who have a health condition for which there is a medically tailored meal plan can access Medically Tailored Meals.

Covered Population + Clinical Risk Factor + Social Risk Factor = HRSN Services

After submitting this form, IHN-CCO or 211Info will reach out to you for more information and to complete a full eligibility screening for the services requested on this form. You may be contacted by one of our community partners as well.

All HRSN eligibility will require income verification.  Depending on what services you are requesting, you may need to provide additional documentation, such as rental/lease agreements, utility bills, storage fees, etc.

 

Contact info for questions: