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Health Related Social Needs (HRSN)

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 November 1, 2024 are Climate Supports, Housing Supports, and Outreach and Engagement.

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.

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.

If you are submitting a request for housing assistance, we require the following documents:

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

Please email these documents to HealthRelatedServices@PacificSource.com and title the email: HRSN Housing Documents.

 

Questions?

For questions, please call PacificSource at 541-749-3516 or send an email to HealthRelatedServices@PacificSource.com