FAQ

Members who have CareOregon Medicaid health insurance and members who have both CareOregon Medicaid and CareOregon Advantage Medicare plans are eligible. Additionally, CareOregon Medicaid plans include the following networks:

• Jackson Care Connect
• Columbia Pacific CCO
• Health Share of Oregon with CareOregon physical health coverage
• Health Share of Oregon with CareOregon dental health coverage
• Health Share of Oregon behavioral health coverage

To check a member’s eligibility, access MMIS first or call CareOregon's Provider Customer Service at 503-416-4100 or 800-224-4840. Press option 3 for help to determine eligibility.

Yes, as long as the requested item supports the member’s overall treatment plan. 

No. Billable items or services are not eligible for flexible services funding. 

Please see the appropriate provider manual for more details about how to request a billable item or service:

• Physical Health Provider Manual
• Behavioral Health Provider Manual 

There is no list of diagnoses. However, the requested items or services must show support of the member’s overall treatment plan. 

For example, it may be easy to see how an AC unit or air purifier would be supported by a physical health diagnosis, but that doesn’t mean it’s not applicable for someone with a behavioral health diagnosis — we just may need more justification to showcase that alignment. We’re looking for a correlation between the request and the diagnosis, clinical documentation and the sustainability plan. If you want examples of items, please click here for examples from Oregon Health Authority (OHA).

There is no monetary cap or specified duration per member, as flexible service funding requests are based on the needs required for the intended outcome and support. However, flex services are not intended for long-term support. Longer-term requests can be approved with sufficient justification at CareOregon’s discretion. A sustainability plan for reasonable long-term support must be outlined at the time of request.  

Multiple quotes are not required. A cost estimate and/or a website link to the item for purchase will suffice. 

All the information requested on the hotel form is required to avoid any additional need for communication and delays in processing. This includes the individual flex request form, the code of conduct (Liability form) and the hotel checklist (or the hotel request form that combines these documents). Please see the hotel section on our flex request page for more details.  

The NEMT benefit includes some funding for hotel stays and meals when medical appointments require four or more hours of travel. If additional support beyond the NEMT benefit is needed, a flex request for a hotel can be made to help with additional costs.  Please let us know if you are working with NEMT. More information about NEMT can be found here: 

Health Share of Oregon members
Ride to Care – 503-416-3955 or 855-321-4899

Columbia Pacific CCO members
NW Rides – 503-861-0657 or 888-793-0439

Jackson Care Connect members
TransLink – 541-842-2060 or 888-518-8160

Health-related services cannot fund trips to OHP covered services (emergent or non-emergent) as these types of trips are covered by the members’ OHP transportation benefit. Non-Emergency Medical Transportation (NEMT) includes mileage reimbursement, public transportation or vehicle-provided rides. For more information about NEMT, visit the website or contact the call center for the applicable NEMT brokerage:

Health Share of Oregon members
Ride to Care – 503-416-3955 or 855-321-4899

Columbia Pacific CCO members
NW Rides – 503-861-0657 or 888-793-0439

Jackson Care Connect members
TransLink – 541-842-2060 or 888-518-8160

Yes, a request can be submitted for things like insurance, car payments, vehicle registration, back payments, or car repairs if it would increase a member’s access to resources with the use of their own transportation. Requests for funding for fuel would fall under the member’s NEMT benefit (mileage reimbursement) if it is for medical appointments. 

Currently, CareOregon does not have a preferred list of vendors, but we do encourage providers to utilize specific partners when possible:

• Hotels: Our payment processing vendor (PANOW) has contracted hotels and we encourage requesters to use them when possible, as non-contracted hotels require a third-party authorization process. 
• Furniture or household goods: For members in the Portland metro area, we encourage requesters to use our local furniture bank, Community Warehouse, when possible.
• Specific items vs. gift cards: Specify the vendor, vendor contact information and type of item (e.g., food, clothing), and the dollar amount being requested for the gift card, if applicable.  

We need:

• An itemized receipt that includes the item type(s), quantities and price per item.
• The name of the organization to which the check should be made out.
• The address where the check should be sent.
• Please note that the check will be sent from CareOregon for bulk reimbursements. Please include any information needed in the memo field to ensure that the proper account or vendor gets credited. 
• In most instances a W-9 for the landlord or property management company is required for rental supported payments 

Please submit all relevant documents that identify the plan of care in the last six months, including chart notes, or care coordination notes that show your justification for the request.

CareOregon does not have access to members’ health records. Therefore, we require recent records to determine the connection between the item/service and the plan of care.

Due to the need to process a high volume of requests in a timely manner, we can start processing requests once they are complete. Incomplete requests are closed after five business days. You may resubmit a new request with all the required materials once you have gathered the required documents. Because our team is not member-facing, we ask that the requestor communicates with the member as needed. Completed requests are then triaged and assigned to a team member for processing.

A letter is sent by fax or email to the requester and another letter is sent to the address provided for the member by OHA. We strongly encourage requesters to follow up and notify the member about the determination since the requester will know the outcome before the member. 

Some of the common reasons include:

• A member may not be actively covered by CareOregon, OHP plan or
• An item/service may be billable
• The form is incomplete, and no response was received within 5 business days
• The direct connection to the members’ care plan is not clear
• There is no sustainability plan or indication that this request can be supported in the future (if applicable)
• Funding may be limited to a “share of cost” to be coupled with member contribution and/or alternative sources of community funding.

HRSF is not a benefit, so there is no appeal process. That said, we can and will allow requesters to re-submit the same request with additional information speaking to any questions we may have raised in initial review.

Due to the high volume of requests, follow-up questions about specific requests can be sent to our HRSF processing department by email at: social.determinants@careoregon.org. You may contact CareOregon Provider Customer Service at 503-416-4100 or 800-224-4840 by phone for general questions about HRSF.  

Since the requester is not included in the review process, we welcome the requester, provider, and treatment team to include all pertinent information in the actual request. Please include as many attachments or addendums to support the request as you deem necessary. 

Emergent requests: CCO health-related services are not available as an emergency or crisis funding option. Any request submitted within less than one business day of the date needed will be processed on the urgent timeline described below.

Urgent requests: All urgent requests must be submitted two to five business days before the date the requested item/service is needed. Any request submitted less than two business days prior may not be reviewed by the date the item/service is needed. Our team will prioritize the following urgent requests: eviction prevention shut-off notices and hotels.

Non-urgent requests: All non-urgent requests must be submitted 10 to 14 business days before the date the requested item/service is needed.

Requested items will be purchased and sent to the address requested on the flex form (this can be any safe place for the member to receive the item, including a provider’s office). If there are any difficulties in getting an item delivered to the original delivery address provided, either the requestor or CareOregon may ask for an alternate address to ensure safe delivery.

Requested services will be arranged directly with the merchant. If any additional information is needed for the service, we will reach out to the requester to coordinate.

We need:

• An itemized receipt if it’s a reimbursement.
• The name of the person or organization the check should be made out to.
• The address where the check should be sent.
  • Please note that the check will be sent via our payment processing vendor (Project Access NOW) except for bulk reimbursements. Please include any information needed in the memo field of the check to ensure that the proper account or vendor gets credited. 

Please also make sure whoever receives the check knows that the check will come from our vendor, Project Access Now, not CareOregon (except for bulk reimbursements).

Please contact our team. We will consult with the necessary parties to determine next steps. Most of the time for bigger purchases the merchant will ask that the item be shipped back and once they’ve confirmed that they’ve received the original item either they will send a replacement or CareOregon will order one if applicable.

CareOregon receives many requests daily and we appreciate your patience. We understand the urgency of some of these requests and work towards reviewing and responding in a timely way. Our current process involves several steps to ensure the requests are tracked, reviewed, communicated and monitored to support meeting regulatory requirements. Additionally, external factors such as issues with supply chains and product scarcity may result in delays.

Yes. Please see our instruction form for more details about this type of request. You may also see the next question about what documentation is needed for checks.

Our partner payment vendor program has been growing swiftly. The team is experiencing higher numbers of requests than normal, resulting in turnaround times that are longer than we would all hope for.

A temporary hold on bulk ordering – other than items on the approved list –  allows the team to focus on and process urgent requests. Urgent requests include hotel/motel stays, utilities, rental assistance and essential services. 

Our vendor expects the pause to last until the end of 2023. We’ll send out additional information when it is available.  

The vendor is taking a few steps.  

• Recruiting and training additional staff 
• Delaying taking on additional business 
• Improving internal efficiencies  

Yes, you may still order items on the approved list. To request reimbursement during this pause, submit your tracking sheet and receipts directly to CareOregon. See the info below about the reimbursement process. 

The current list of approved bulk purchase items is on the CareOregon, Columbia Pacific CCO and Jackson Care Connect bulk request section of the Flex requests pages.

You can ask if the item can be added to the approved list. Send an email to social.determinants@careoregon.org, explaining the need for the item. Due to the high number of incoming requests, it may take us about two business days to get back to you. 

Forms and other information are available on the CareOregon, Columbia Pacific CCO and Jackson Care Connect websites under Health-related services.  

1. As the requestor, you purchase items that are on the approved bulk items list. On or before the 15th of the month following your purchase, you’ll need to submit this documentation: 
   1. Flexible Services bulk request form
   2. HRSF Bulk Purchase Tracker indicating the members who received the items you purchased
   3. Itemized invoice and receipt
2. CareOregon will review this documentation. We will reimburse you, as the requester, for all eligible members and items.
   1. We will not approve reimbursement for any items distributed to ineligible members.
   2. Before we reimburse for new orders, we must have complete documentation from your previous orders.
   3. A Supply Request ID (field on Part B of the tracker) is not needed  for this purchase type.
3. Each reimbursement request must reconcile the relevant invoices and receipts.
   1. The dollar values for the invoice, the member tracker and the sum of the submitted receipts must all be in alignment.
   2. We reimburse for bulk purchases only when these all align.

Send them to us by fax or U.S. mail. 

Fax:

• ATTN: HRS Flex at 503-416-4728

Mail:

• ATTN: HRSF Clinical Operations Team
  CareOregon
  315 SW Fifth Ave
  Portland, OR 97204

You may email, call or fax us.

Email: social.determinants@careoregon.org

Voicemail: 503-488-2808

Fax: 503-416-4728

Thank you!