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Health Related Social Needs (HRSN)

Members in Lane County: As of January 24, 2026, please do not request services through this form. Any requests for members in Lane County should be submitted to Trillium through their form: https://uniteus.com/networks/oregon/get-help/trilliumchphrsn (Please note, Trillium requests will not be processed before February 2, 2026).

 

This is a referral form to the Oregon Health Plan (OHP) Health-Related Social Needs (HRSN) program.

Oregon Health Plan (OHP) members facing certain life challenges will have services available to them. These services are to help members stay healthy during times of greater need. The services available as of January 1, 2025 are Climate Supports, Housing Supports, Nutrition Supports, and Outreach and Engagement.

Due to a high volume of HRSN requests, application processing time may be extensive. Please still apply, as your application will be reviewed in the order it was received. You’ll receive an email or text message when your application is under review. Thanks for your patience.

What are HRSN Climate Supports?

They are devices to help keep people safe during climate events. These include:

  • Air conditioners, heaters, and air filters to provide clean air and healthy temperatures
  • Mini fridges to keep medication cold during a power outage
  • Portable power supplies to operate medical devices like ventilators during a power outage

Who Qualifies for HRSN Climate Supports?

OHP covers devices for members who:

  • Have a living situation that qualifies them for HRSN services,
  • Have a health condition that makes climate events challenging or dangerous,
  • Live in a place with electricity, and
  • Can use the device safely.

Covered devices are only for use in the member’s home or primary residence.

What Are HRSN Housing Benefits?

  • Help paying rent for up to six months. This includes late payments.
  • Help paying for utilities like gas, electric and water. This includes set-up and late payments.
  • Up to six months of storage fees.
  • Tenancy support – help understanding your lease, speaking with your landlord and referrals to other services.
  • Home changes for health and safety, including pest control, heavy duty cleaning, and installation of ramps, grab bars, and drawer pulls.

Who Qualifies for HRSN Housing Benefits?

Each housing benefit has different requirements. They may include things like your income, your age or having a lease. But for all of them you must be an OHP member who:

  • Has a complex physical or behavioral health issue,
  • Has a developmental or intellectual disability,
  • Has difficulty with self-care and daily activities,
  • Is experiencing abuse or neglect,
  • Is 65 or older, with a clinical risk factor
  • Is under age 6, with a clinical risk factor
  • Is pregnant or gave birth in the past 12 months, with a clinical risk factor
  • Has repeated trips to the emergency room or crisis encounters.

What are HRSN Nutrition Supports?

Nutrition supports may include:

  • Links to community-based food resources (e.g., application support for Supplemental Nutrition Assistance Program (SNAP)/Special Supplemental Nutrition Program for Women, Infants and Children (WIC)
  • Nutrition and cooking education
  • Medically tailored meal delivery

Please get a referral from your primary care physician before submitting a request for medically tailored meals.  If you need help with connecting with your Primary Care Provider for a referral, please call our Care Management Team for assistance (541)-284-7964.

How to Complete this Form

Please fill out as much of the form below as possible. You or a parent or guardian can complete the form. Your health plan will review this form to connect with you and determine whether you are eligible for HRSN benefits.

Verify that the information entered on this form matches information on your OHP/Medicaid Card.

Please upload the following required documents with this application.

Housing Assistance: 

  • Rental lease that includes your name and address and is signed by the landlord  or property manager
  • Rental billing ledger (if available)
  • Proof of annual household income (pay stubs or tax documents that show any income) , if applicable  
  • W9 (if available from your property manager)
  • Utility bills (if requested in your application) with member’s name and address matching rental agreement
  • Storage bills (if requested in your application)  

Home Modifications:

  • Scope of Work completed by a landlord or property manager

Nutrition Assistance: 

  • Completed assessment by a Registered Dietician, if available 

Please note that missing documents will cause delays and possible cancellation for being incomplete.

Questions? 

For Questions, please call PacificSource at 541-749-3516 or send an email to pacificsource@211info.org