Flexible services

Flexible services provide extra help for health needs that are not covered by OHP benefits. Examples: 

• Assistance with utilities payments when medically needed 
• Cell phones for medical needs coordination 
• Safety items like car seats  
• ID cards when needed to access resources or apply for employment  

To ask for a service:  

• Talk to your doctor. 
• Call 844-827-6572 (TTY 711). 
• Learn how to request flexible services and find information in your language. 
• If your request is not approved, you can’t appeal but you can file a complaint.  

Health Related Social Needs benefits

Some members can get extra benefits for housing, food and weather-related needs to help with big life changes. These Health Share of Oregon benefits are called Health Related Social Needs (HRSN). You may qualify based on your health needs, housing situation and income. 

Connect with a Traditional Health Worker

A Traditional Health Worker is trained to walk alongside you in your healthcare journey. They may share similar life experiences, language and/or ethnicity with you. They can answer health questions, connect you with services and help you find a provider.   

Traditional Health Workers are often based in primary care and behavioral health clinics as well as community organizations.  

Working with a Traditional Health Worker is free for OHP members. Talk with your primary care provider or behavioral health provider about options that are right for you. Contact us with questions: 

• ohsuhscareteam@ohsu.edu  
• 844-827-6572

There are five types of licensed traditional health workers in Oregon:  

Birth doula: A trained birth companion who provides nonmedical support for you and your family before, during, and after birth. Doulas work alongside your healthcare team and can help improve health outcomes for both parents and baby.

Peer support specialist: A person who gives support services to people who are or have been in mental health or substance use treatment.

Peer wellness specialist: A trained person who has lived experience with psychiatric conditions. They support you as part of a health team that combines mental health with primary care. 

Personal health navigator: A person who provides tools and information to help you make the best healthcare choices.

Community health worker: A trusted member of a community working in public health to connect people with social and medical resources.

End-of-life planning

Choose who can speak for you if you cannot. We can help you make an official document called an advance directive to let your wishes be known.  

• Fill out an advanced directive (multiple languages) 

Children in foster care

Children must have these health exams in the first 60 days (two months) of entering foster care:     

• Physical exam 
• Mental health screening (ages 3 and older) 
• Dental exam (ages 1 and older)  

A care coordinator can help you schedule these visits. Contact ohsuhscareteam@ohsu.edu or 844-827-6572 to learn more. 

Extreme weather resources

Stay informed during severe weather events. If you need help finding resources, call 503-418-3010.

• Public Alerts: Sign up to receive health and safety alerts in your area. 
• National Weather Service: Check the forecast and plan outdoor activities for the safest times of day. 
• 211info: Dial 211 to find a warm or cool space near you and learn about transportation options. 
• Health Share of Oregon extreme weather and homelessness resources 

Cold weather resources

• 211info winter and severe weather resources by county 
• Oregon Health Authority preparing for winter storms 
• Clackamas County warming centers  
• Multnomah County: Care for when it's cold (multco.us/cold) and severe weather and homelessness resources 
• Washington County: Emergency shelter programs and day shelters and homelessness resources 

Hot weather resources

• 211info summer and heat-related resources by county 
• Oregon Health Authority heat-related illness warning signs  
• Multnomah County cool spaces  
• Clackamas County cooling centers   
• Washington County cool spaces 
• Heat Risk Map: The National Weather Service forecasts heat risk for vulnerable populations 
• Video: How to protect yourself during extreme heat  

What is the Oregon Health Plan?

The Oregon Health Plan (OHP) is the Medicaid program for the state of Oregon. It provides healthcare coverage for low-income residents of Oregon. The plan serves: 

• Families 
• Children 
• Pregnant women 
• Single adults 

If you already have OHP, explore Health Share of Oregon's member benefits and download the member handbook. 

What is Health Share of Oregon?

Your medical, mental and dental benefits from the Oregon Health Plan (OHP) are coordinated through Health Share of Oregon. OHSU Health Services works with Health Share to deliver your medical care and to give you information about healthy living.  

Health Share organizes your care into three categories to help with all your health needs: physical, mental and dental.  

Check your Health Share ID card to find your plan, primary care provider and primary care clinic. You can use OHSU Health Services if your Health Share ID card lists OHSU Health Services as your health plan.  

Call Health Share at 503-416-8090 to learn more. 

What is OHSU Health Services?

OHSU Health Services is a system of providers, clinics and services for Oregon Health Plan (OHP) members. We provide advanced care informed by the latest research across the Portland area. Our locations include: 

• OHSU Hospital
• OHSU Doernbecher Children’s Hospital
• Adventist Health Portland
• Hillsboro Medical Center
• Dozens of patient care clinics

Renewing coverage

OHP members need to confirm eligibility for Medicaid coverage each year. Keep your contact information up to date with Oregon Health Plan so you don't miss Medicaid renewal notices and benefit updates. Explore these resources to learn more: 

• OHP customer service 800-699-9075 
• OHP One Portal 
• Report changes to the Oregon Health Authority 

Your rights and responsibilities

You have the right to exercise your member rights without a bad response or discrimination.

You can make a complaint if you feel your rights have not been respected. You can call an Oregon Health Authority ombudsperson at 877-642-0450 (TTY 711). You can send them a secure email.

For people under age 18, visit Health Share of Oregon to get a member handbook and refer to minor rights and access to care.

Your rights as an OHP member

• You have the right to:
• Be treated with dignity, respect and consideration for your privacy. 
• Be treated by providers the same as other people seeking health care. 
• Have a stable relationship with a care team that manages your overall care. 
• Not be held down or kept away from people because it would be easier to care for you, punish you or get you to do something you do not want to do.

You have the right to get this information:

• Materials explained in a language and format you can understand. 
• Materials that tell you about CCOs and how to use the health care system. 
• Written materials that tell you your rights, responsibilities, benefits, how to get services and what to do in an emergency.
• Information about your condition, treatments and alternatives, what is covered and what is not covered. This information will help you make good decisions about your care. 
• A health record that keeps track of your conditions, the services you get and referrals. You can have access to your health records and share them with a provider. 
• Written notice mailed to you of a denial or change in a benefit before it happens, when required by federal or state rules.
• Written notice mailed to you about providers who are no longer in-network. In-network means providers or specialists that work with OHSU Health Services. 
• Timely notice if an appointment is canceled.

You have the right to get:

• Care and services that put you at the center. Get care that gives you choice, independence and dignity. This care will be based on your health needs and will meet standards of practice. 
• Services that consider your cultural and language needs and are close to where you live. If available, you can get services in non-traditional settings such as online. 
• Care coordination, community-based care and help with care transitions in a way that works with your culture and language. This will help keep you out of a hospital or facility. 
• Services that are needed to know what health conditions you have.
• Help to use the health care system, including cultural and language support: 
  • Certified or qualified health care interpreters
  • Written translations of pharmacy materials and prescriptions
  • Certified traditional health workers
  • Community health workers
  • Peer wellness specialists
  • Peer support specialists
  • Doulas
  • Personal health navigators
• Help from OHSU Health Services staff who are fully trained in CCO policies and procedures.
• Covered preventive services. 
• Urgent and emergency services 24 hours a day, seven days a week without approval or permission. 
• Referrals to specialty providers for covered coordinated services that are needed based on your health. 
• Extra support from an OHP Ombudsperson.

You have the right to do these things:

• Choose your providers and change those choices. To change PCPs, call 844-827-6572 or fill out the form to change your PCP.
• Get a second opinion.
• Have a friend, family member or helper come to your appointments.
• Be actively involved in making your treatment plan.
• Agree to or refuse services. Know what might happen based on your decision (a court-ordered service cannot be refused).
• Refer yourself to behavioral health or family planning services without permission from a provider.
• Make a statement of wishes for treatment. This means your wishes to accept or refuse medical, surgical or behavioral health treatment. It also means the right to make directives and give powers of attorney for health care, listed in ORS 127.
• Make a complaint or ask for an appeal.
• Ask the state to review if you do not agree with our decision. This is called a hearing.
• Get free certified or qualified health care interpreters for all non-English languages and sign language. Call OHSU Customer Service at 844-827-6572 (TTY 711).

Your responsibilities as an OHP member

You must:

• Treat healthcare staff, providers and others with respect
• Be honest with your providers so they can give you the best care

You must report some information to OHP:

• If you get OHP, you must report certain changes about you and your household. Your OHP approval letter tells you what you must report and when.
• You can report changes in one of these ways:
• If you get OHP, you must report certain changes about you and your household. Your OHP approval letter tells you what you must report and when.

You can report changes in one of these ways:

• Use your ONE online account.
• Visit any Oregon Department of Human Services office in Oregon. Find a list of offices.
• Contact a local OHP-certified community partner. Find a community partner.
• Call OHP Customer Service on weekdays at 800-699-9075.
• Fax to 503-378-5628.
• Mail to ONE Customer Service Center, P.O. Box 14015, Salem, OR 97309.

There are other rights and responsibilities you have as an OHP member. OHP shared these when you applied. You can find a copy under the “Rights and Responsibilities” link.

You must help with your care in these ways:

• Choose or help choose your primary care provider or clinic. 
• Get yearly checkups, wellness visits and preventive care to keep you healthy. 
• Be on time for appointments. If you will be late, call ahead or cancel your appointment if you can’t make it. 
• Bring your medical ID cards to appointments. Tell the office that you have OHP and any other health insurance. Let them know if you were hurt in an accident. 
• Help your provider make your treatment plan. Follow the treatment plan and actively take part in your care. 
• Follow directions from your providers or ask for another option. 
• If you don’t understand, ask questions about conditions, treatments and other issues related to care. 
• Use information you get from providers and care teams to help you make informed decisions about your treatment. 
• Use your primary care provider for tests and other care needs unless it’s an emergency. 
• Use in-network specialists or work with your provider for approval if you want or need to see someone who doesn’t work with OHSU Health Services. 
• Use urgent or emergency services appropriately. Tell your primary care provider within 72 hours if you do use these services. 
• Help providers get your health record. You may have to sign a form called a Release of Information. 
• Tell OHSU Health Services if you have any issues or complaints, or if you need help. 
• If you want services not covered by OHP, fill out an Agreement to Pay form. 
• If you get money because of an injury, help OHSU Health Services get paid for services we gave you because of that injury.

American Indian and Alaska Native members

American Indian and Alaska Native members have a right to choose where they get care. They can use primary care providers and other providers that are not part of our CCO, such as:

• Tribal wellness centers
• Indian Health Services clinics
• Native American Rehabilitation Association of the Northwest (NARA)

You can use other clinics that are not in our network. American Indians and Alaska Natives do not need a referral or permission to get care from these providers. These providers must bill OHSU Health Services. We will only pay for covered benefits. If a service needs approval, the provider must request it first.

American Indians and Alaska Natives have the right to leave OHSU Health Services at any time and have OHP fee-for-service (FFS) pay for their care.

If you want OHSU Health Services to know you are an American Indian or Alaska Native, contact OHP Customer Service at 800-699-9075 (TTY 711) or log in to your online account to report this.

• You may be assigned a qualifying tribal status if any one of the following is true. These questions are also asked on the OHP application:
• You are an enrolled member of a federally recognized tribe or a shareholder in an Alaska Native Regional Corporation.
• You get services from Indian Health Services, tribal health clinics or urban Indian clinics.

You have a parent or grandparent who is an enrolled member of a federally recognized tribe or a shareholder in an Alaska Native Regional Corporation or village.

File a complaint

You can make a complaint orally or in writing.

• Call: 503-416-8090 or 888-519-3845 (TTY 711)

If you’re not happy with how your plan or Health Share handled your complaint, you can also contact:

• OHP Client Services: 1-800-273-0557
• Ombuds Program: 1-877-642-0450 or email OHA.OmbudsOffice@odhsoha.oregon.gov

Below are links to the forms that you can use to file your complaint:

• OHP Complaint Form – English
• OHP Complaint Form – Spanish
• OHP Complaint Form – Russian
• OHP Complaint Form – Vietnamese

Appeal a health decision

If OHSU Health Services says “no” to a service your doctor or dental provider asked for, or stops or reduces a service, you can ask us to take a second look at the decision. This is called an appeal.

You can ask for an appeal orally or in writing.

By phone:

Ways you can ask for an appeal by phone:

• Call the number on your ID card
• Call the medical plan, dental plan or mental health plan that sent you the Letter of Adverse Benefit Determination
• Call the number on your Letter of Adverse Benefit Determination

In writing:

You can ask for an appeal in writing in 2 ways:

• Send in the form that came with your Letter of Adverse Benefit Determination.
• You or your provider can write us a letter. Make sure to sign the letter.

For help filling out the request form: 

• Find an Oregon Department of Human Services (ODHS) office 
• Call OHP Client Services at 800-273-0557 (TTY 711) 

Fraud, waste and abuse

If you see something wrong, tell someone. Fraud, waste and abuse in healthcare hurt everyone. When money is misused, it can't help those who need it. 

• Fraud is when someone tricks others on purpose for their own benefit. 
• Waste is spending money on healthcare that isn't needed or used well. 
• Abuse is when someone accidentally gives wrong information, causing unneeded costs. 

Some examples of fraud, waste and abuse by a provider: 

• Faking reports of services that didn't happen or products that weren't given 
• Reporting more services than were provided 
• Charging too much to people who don't have Medicaid or other insurance 
• Not giving the right services that are supposed to be given 
• Charging people more than they should pay 
• Doing things that cost too much, aren't needed or don't follow good healthcare practices 

Some examples of fraud, waste and abuse by a member are: 

• Cheating in the process of enrolling or disenrolling people 
• Going to multiple doctors for prescriptions for a drug already prescribed 
• Using another person’s ID to get benefits 

You can report fraud, waste or abuse if you think you've seen it. You don't have to give your name, and you're protected by law. OHSU Health Services tells the authorities about any fraud they find.

How to report it: 

• Call the OHSU Anonymous Compliance Hotline at 1-877-733-8313
• Fill out a form to report a concern or ask a question  
• Contact the Oregon Health Authority

Interoperability and Patient Access

Patient access

• You have a right to see your health information and medical records.
  • You have a right to see your health information because of a law called the Health Insurance Portability and Accountability Act of 1996, or HIPAA.
• Your medical records help you know more about your health.
• You decide who gets to see your health information.
• Getting your Oregon Health Plan medical records on your phone:
  • You can get the following information: 
    • Services you received (Adjudicated claims)
    • Description of costs (Provider remittances)
    • Clinical data (labs, vitals and other data)
    • Medication prescribed (Formulary data)
    • Information about your provider or doctor, including their specialty and how to contact them. (Provider names, addresses, phone numbers, specialties)
• You can get your OHSU Health medical records from 1/1/2020 to now using an app or website.  
   

Tips for privacy and security 

• Use a trusted app or website to get your health information.
• Read the fine print. Check the terms and conditions before you sign up to make sure the app or website does not share or sell your information.
• Use strong passwords. Change them often to keep your information safe.
• Don’t share your health information or ID numbers on social media.
• Use encryption apps or software for extra security. 
   

HIPAA and privacy violations

• Your health information is private and should be protected.
• Clinics, providers, health plans and the State of Oregon have to follow HIPAA rules to keep your health information safe.
• Be careful when sending your health information to an app or website. Apps and websites do not have to follow the same health privacy rules as OHP or your doctor.
• If you believe your health information was not protected, you can file a complaint. 
   

Complaints about providers, clinics, health plans and other medical organizations

• File a health information protection complaint with the Office for Civil Rights in the U.S. Department of Health and Human Services.
• The Office for Civil Rights (OCR) investigates complaints against people and organizations that follow HIPAA rules, like providers and health plans.

Complaints about apps, websites and other businesses 

• File a privacy and online security complaint with the Federal Trade Commission.
• The Federal Trade Commission (FTC) investigates violations of online security, fraud, and bad business practices.

Key resources for you 

• Member homepage: OHP.Oregon.gov
  • Dedicated page for Interoperability and Patient Access info 
• OHP Notice of Privacy Practices: Your information, your rights, our responsibilities 
  HealthIT.gov infographic: Your health information, your rights 
  HealthIT.gov fact sheet: How to keep your information private and secure

OHSU Health Service’s Customer Service 
Need help? Call 844-827-6572. TTY users, please call 711. Customer Service is 
open Monday through Friday, 7:30 a.m to 5:30 p.m. PST.