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Trillium Health Related Social Needs (HRSN)

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

Trillium Oregon Health Plan (OHP) members facing certain life challenges will have services available to help stay healthy during times of greater need. The services currently available are Home Changes for Health (formerly known as Climate Supports), Housing Supports, select Nutrition Supports, and Outreach and Engagement.

For housing support requests, please note that OHA HRSN housing benefits are not intended for emergency situations, as some requests may take 28 days or more to complete. These benefits are designed to help individuals stabilize before they receive an eviction notice.

If you are facing imminent eviction, please contact 211info (dial 2-1-1 on your phone) or your regional Community Action Agency. 

What are HRSN Home Changes for Health Supports?

They are items to help keep people safe and healthy in their homes. 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 Homes Changes for Health Supports?

Trillium 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.

If you are submitting a request for housing assistance, it is helpful to have the following documents available:

Rent: Signed Lease or Written Lease Agreement, W9
Utilities: Most recent utility bill
Storage: Most recent storage bill
Home Modifications/Remediation: Scope of Work signed by your landlord, you, and the servicing provider

 

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 a Trillium OHP member who:

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


Who Qualifies for HRSN Nutrition Benefits?

Each nutrition 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 physical or behavioral health issue that requires extra support,
  • Has a developmental or intellectual disability,
  • Has difficulty with self-care and daily activities,
  • Is experiencing abuse or neglect,
  • Is 65 or older,
  • Is under age 6,
  • Is pregnant or gave birth in the past 12 months, or 
  • 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

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.

Questions?
View Trillium HRSN Member information at Trillium Community Health Plan or call Trillium Member Services at 1-877-600-5472 or email Trillium’s Community Health Workers to apply. We will help you find out if you can get HRSN services or other support.