Medically Tailored Meals

Medicaid members residing in a ToRCH county who screen positive for food insecurity and transportation insecurity who are pregnant, postpartum, and/or have a diagnosis of obesity or overweight, diabetes or pre diabetes, hypertension, or kidney disease.

Nutritional Counseling & Education

Medicaid members residing in a ToRCH county who screen positive for food insecurity and who are pregnant, postpartum, and/or have a diagnosis of obesity or overweight, diabetes or pre diabetes, hypertension, kidney disease or other diet related chronic conditions.

Non-Emergency Health Related Transportation

Medicaid members residing in a ToRCH county who screen positive for transportation insecurity.

Environmental Modifications to the Home

Medicaid members residing in a ToRCH county (with qualifying ME code verified in eMOMED) who screen positive for housing-related safety issues. Services may include ramp installs, grab bars, etc.

Environmental Goods & Services

Medicaid members residing in a ToRCH county (with qualifying ME code verified in eMOMED) who screen positive for housing problems and who have a diagnosis related to breathing difficulty, such as asthma, COPD, emphysema, etc. Services may include: mold removal, dehumidifier purchase, A/C window or wall unit installation.

How does Unite Us support ToRCH?

The ToRCH program is powered by Unite Us, a national leader in software enabling cross-sector collaboration to improve people’s health and well-being. Through Unite Us, partners will be able to manage eligibility and authorization, send referrals to contracted providers (i.e. close the loop), securely track outcomes and document services, efficiently manage reimbursement of social care services, and connect activities back to improved health outcomes.

What is the difference between a Priority Partner and B3 Contracted Partner?

A Priority Partner is a community based organization (typically a 501c3 nonprofit) that provides services in at least one of the six ToRCH counties (Dent, Polk, Pettis, Phelps, Henry and/or Ray County) that will use Unite Us closed-loop referral platform to send or receive electronic referrals. A B3 Contracted partner is a community based organization or vendor that provides services in at least one of the six ToRCH counties that fall under the B3 eligible services. These services include: non medical need transportation, medically tailored meals, nutritional counseling & education, environmental modifications to the home (ramp / grab bar installations), environmental goods and services (mold removal, pest control). A B3 Contracted Partner will use Unite Us to receive electronic referrals sent by the Hub for clients that are eligible for B3 ToRCH services. The B3 Contracted Partner will use Unite Us’ Payments Solution functionality to document the service in Unite Us and send an invoice to the Hub to receive reimbursement.

Is my organization eligible to be a ToRCH contracted partner?

If your organization provides non-emergency health related transportation, medically tailored meals, nutritional counseling & education, and/or is a licensed general contractor experienced with mold/pest removal, plumbing, heating & cooling, you may be eligible to be a ToRCH B3 contracted partner. Your organization must serve community members from at least one of the six ToRCH counties (Dent, Polk, Pettis, Phelps, Henry, Ray County).

Who can identify and enroll community members in ToRCH?

ToRCH eligibility requires verification of Medicaid enrollment and insurance as well as completion of a screening to determine non-clinical, but health-related needs. Lastly, a patient must have a medical diagnosis that is directly impacted by the HRSN. Due to these requirements, only clinical care organizations (hospital, clinic, FQHC, behavioral health, county health departments, etc) have the ability to enroll a community member in ToRCH social care coverage in Unite Us.

Which ToRCH B3 programs require an authorization to be approved by the Hub?

Authorization must be approved by the Hub for some of the ToRCH programs based on the ToRCH clients’ needs. ToRCH programs include: medically tailored meals, nutritional counseling & education, environmental modifications to the home, and environmental goods and services. The required authorization will be included in the referrals sent to the contracted partners. The authorization will inform the contracted partner of the amount of service approved by the Hub that the contracted partner can provide. The authorization will also include the service delivery dates that the contracted partner will provide services to the client.

Who are the ToRCH community hubs?

Dent County – Salem Memorial District Hospital – Salem, MO Henry County – Golden Valley Memorial Healthcare – Clinton, MO Pettis County – Bothwell Regional Health Center– Sedalia, MO Phelps County – Phelps Health – Rolla, MO Polk County – Citizens Memorial Hospital – Bolivar, MO Ray County – Ray County Hospital – Richmond, MO

Is there a cost for my community-based organization to participate in ToRCH?

No, there is no cost for community-based organizations providing social services to participate in ToRCH and use the Unite Us platform to send, receive and manage referrals.

How does Unite Us protect clients’ privacy and security?

Trust and transparency are the cornerstones of the Unite Us Platform. Unite Us is compliant with HIPAA and leading security frameworks including HITRUST. Read more about our security guidelines here and our privacy policy here.

What support can I expect for my organization?

Unite Us’ Technical Support team is ready to assist you. There are several ways to connect with our team: Email: Send your questions directly to our Technical Support team for prompt responses and consultations. Live Chat: Engage with a Technical Support team member in real-time via live chat, accessible in the bottom right corner of the Unite Us Platform, even if you’re not logged in. The chat window also provides access to Help Center articles and allows users to download the Unite Us consent form in over 50 languages. Phone: Call the Unite Us support line for assistance.

What kind of training does Unite Us offer?

Post-launch, all users have ongoing opportunities to enhance their Unite Us knowledge. Our team hosts live, regularly scheduled, standardized new and advanced user webinar training where participants can dive deeper into our platform’s features. In addition, the team manages a robust e-learning catalog where users can complete on-demand courses at their own pace. Users also have access to guides that describe the main features and workflows in our platform.

Do you integrate with other platforms?

We have implemented hundreds of integrations with EHRs, HIEs, and other systems of record, such as ZeOmega, Salesforce, NextGen, Epic, VirtualHealth, Cerner, Meditech, and eClinicalWorks, including the nation’s first native social care integration in Epic that incorporates structured outcomes. These integrations provide mechanisms for data exchange that leverage industry standards, including single sign-on (SSO), HL7, APIs, and file exchange.

Transformation of Rural Community Health

ToRCH, a rural health program supported by Missouri Medicaid, directs resources to rural communities addressing the root causes of poor health. By integrating social care into clinical care, ToRCH aims to improve outcomes, optimize existing funding, and create sustainable paths for rural hospitals while helping individuals manage chronic conditions.

Learn More

Unite Your Network with an Integrated Community Care Platform

The Unite Us platform brings together your existing network of community partners to facilitate referrals, track outcomes, and improve community health. By joining Unite Missouri, contracted partners gain access to the tools, partnerships, and resources to amplify impact and streamline care coordination.

Learn about Unite Missouri

Maximize Your ToRCH Impact with Unite Us

The ToRCH model is driving impact by connecting eligible clients to the service providers that can meet their needs. More than 400 programs are available through Unite Us across the six ToRCH counties, serving more than 1,750 clients since January 2024.

400+
Community-Based ToRCH Contracted Programs

A wide array of non-medical ToRCH contracted programs are available through Unite Us to support ToRCH community members.

100%
Case Acceptance Rate for Contracted Programs

ToRCH providers are meeting the needs of eligible clients, strengthening the ToRCH model.

1,750+
Clients Served since January 1, 2024

ToRCH partners are impacting the lives of their community members.

ToRCH Eligibility Requirements

In order for an individual to be referred to community providers delivering contracted programs, they must meet the following eligibility criteria.

Enrolled in Medicaid: Verification of active Medicaid enrollment with one of the Missouri Medicaid health plans (Healthy Blue MO, UnitedHealthcare MO, Home State Health, Show Me Healthy Kids, or MO HealthNet).
Hub County Resident: The member must be a resident of one of the six participating hub counties (Pettis, Polk, Henry, Phelps, Dent, & Ray Counties). This will be verified during enrollment in Social Care Coverage in the Unite Us platform.
Screen positive for a non-clinical, but health-related need: Each hub has its own screening process. Check in with your manager or ToRCH project lead if you have questions here.
Medical Diagnosis: The member should have a clinical diagnosis or relevant medical need that is impacted by the non-clinical concern.

Medicaid members residing in a ToRCH county who screen positive for food insecurity and transportation insecurity who are pregnant, postpartum, and/or have a diagnosis of obesity or overweight, diabetes or pre diabetes, hypertension, or kidney disease.
Medicaid members residing in a ToRCH county who screen positive for food insecurity and who are pregnant, postpartum, and/or have a diagnosis of obesity or overweight, diabetes or pre diabetes, hypertension, kidney disease or other diet related chronic conditions.
Medicaid members residing in a ToRCH county who screen positive for transportation insecurity.
Medicaid members residing in a ToRCH county (with qualifying ME code verified in eMOMED) who screen positive for housing-related safety issues. Services may include ramp installs, grab bars, etc.
Medicaid members residing in a ToRCH county (with qualifying ME code verified in eMOMED) who screen positive for housing problems and who have a diagnosis related to breathing difficulty, such as asthma, COPD, emphysema, etc. Services may include: mold removal, dehumidifier purchase, A/C window or wall unit installation.

Ready to Take the Next Step by Getting Involved with ToRCH?

Join as a ToRCH Contracted Partner

Learn more about becoming a ToRCH Contracted Partner and whether your organization’s services qualify.

Join as a Priority Partner

Community-based organizations that provide social services can join the Unite Missouri coordinated care network and access the Unite Us platform at no cost.

Are you a community member who needs help?

Residents of Dent, Pettis, Polk, or Ray County can fill out their county-specific form to be contacted by the local hospital partner.

Frequently Asked Questions:

The ToRCH program is powered by Unite Us, a national leader in software enabling cross-sector collaboration to improve people’s health and well-being. Through Unite Us, partners will be able to manage eligibility and authorization, send referrals to contracted providers (i.e. close the loop), securely track outcomes and document services, efficiently manage reimbursement of social care services, and connect activities back to improved health outcomes.
- A Priority Partner is a community based organization (typically a 501c3 nonprofit) that provides services in at least one of the six ToRCH counties (Dent, Polk, Pettis, Phelps, Henry and/or Ray County) that will use Unite Us closed-loop referral platform to send or receive electronic referrals.
- A B3 Contracted partner is a community based organization or vendor that provides services in at least one of the six ToRCH counties that fall under the B3 eligible services. These services include: non medical need transportation, medically tailored meals, nutritional counseling & education, environmental modifications to the home (ramp / grab bar installations), environmental goods and services (mold removal, pest control). A B3 Contracted Partner will use Unite Us to receive electronic referrals sent by the Hub for clients that are eligible for B3 ToRCH services. The B3 Contracted Partner will use Unite Us’ Payments Solution functionality to document the service in Unite Us and send an invoice to the Hub to receive reimbursement.
- If your organization provides non-emergency health related transportation, medically tailored meals, nutritional counseling & education, and/or is a licensed general contractor experienced with mold/pest removal, plumbing, heating & cooling, you may be eligible to be a ToRCH B3 contracted partner.
- Your organization must serve community members from at least one of the six ToRCH counties (Dent, Polk, Pettis, Phelps, Henry, Ray County).
ToRCH eligibility requires verification of Medicaid enrollment and insurance as well as completion of a screening to determine non-clinical, but health-related needs. Lastly, a patient must have a medical diagnosis that is directly impacted by the HRSN. Due to these requirements, only clinical care organizations (hospital, clinic, FQHC, behavioral health, county health departments, etc) have the ability to enroll a community member in ToRCH social care coverage in Unite Us.
- Authorization must be approved by the Hub for some of the ToRCH programs based on the ToRCH clients’ needs.
- ToRCH programs include: medically tailored meals, nutritional counseling & education, environmental modifications to the home, and environmental goods and services. The required authorization will be included in the referrals sent to the contracted partners.
- The authorization will inform the contracted partner of the amount of service approved by the Hub that the contracted partner can provide. The authorization will also include the service delivery dates that the contracted partner will provide services to the client.
- Dent County – Salem Memorial District Hospital – Salem, MO
- Henry County – Golden Valley Memorial Healthcare – Clinton, MO
- Pettis County – Bothwell Regional Health Center– Sedalia, MO
- Phelps County – Phelps Health – Rolla, MO
- Polk County – Citizens Memorial Hospital – Bolivar, MO
- Ray County – Ray County Hospital – Richmond, MO
No, there is no cost for community-based organizations providing social services to participate in ToRCH and use the Unite Us platform to send, receive and manage referrals.
Trust and transparency are the cornerstones of the Unite Us Platform. Unite Us is compliant with HIPAA and leading security frameworks including HITRUST. Read more about our security guidelines here and our privacy policy here.
Unite Us’ Technical Support team is ready to assist you. There are several ways to connect with our team:
- Email: Send your questions directly to our Technical Support team for prompt responses and consultations.
- Live Chat: Engage with a Technical Support team member in real-time via live chat, accessible in the bottom right corner of the Unite Us Platform, even if you’re not logged in. The chat window also provides access to Help Center articles and allows users to download the Unite Us consent form in over 50 languages.
- Phone: Call the Unite Us support line for assistance.
Post-launch, all users have ongoing opportunities to enhance their Unite Us knowledge. Our team hosts live, regularly scheduled, standardized new and advanced user webinar training where participants can dive deeper into our platform’s features. In addition, the team manages a robust e-learning catalog where users can complete on-demand courses at their own pace. Users also have access to guides that describe the main features and workflows in our platform.
We have implemented hundreds of integrations with EHRs, HIEs, and other systems of record, such as ZeOmega, Salesforce, NextGen, Epic, VirtualHealth, Cerner, Meditech, and eClinicalWorks, including the nation’s first native social care integration in Epic that incorporates structured outcomes. These integrations provide mechanisms for data exchange that leverage industry standards, including single sign-on (SSO), HL7, APIs, and file exchange.

For additional Frequently Asked Questions, visit the Missouri Department of Social Services ToRCH webpage.