Flexible Services

Flexible Services provide extra help for health needs that are not covered by OHP benefits.  

Some examples: 

• Assist 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).
• Visit this flexible services webpage to find information in your language.
• If your request is not approved, you cannot appeal, but you can file a complaint. 

Health-Related Social Needs Benefits

Some members can get extra benefits to help with big life changes for housing, food or weather-related needs. These benefits are called Health Related Social Needs (HRSN). Not all members qualify. There are specific federal rules. You need to meet certain health, housing and financial conditions. 

Learn more about these benefits and who can qualify at Health Share of Oregon: Health-Related Social Needs.

Home Changes for Health 

Eligible members with medical needs can get things like: 

• Air conditioners
• Air filtration units and/or filters
• Mini refrigerators
• Heaters
• Portable power supplies 

 To apply for Home Changes for Health: 

• Send a request online
• Call customer service: 844-827-6572
• Email: ohsuhshrs@ohsu.edu

Connect with a Traditional Health Worker

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

Working with a Traditional Health Worker is free to you as an OHP member. To begin, 

• Talk with your primary care provider team or your behavioral health provider.
• Email ohsuhscareteam@ohsu.edu or call 844-827-6572. 

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

• Birth doula (see below): A birth companion who provides personal, nonmedical support during pregnancy and childbirth.
• 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 also 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 health care choices.
• Community health worker: A trusted member of a community working in public health to connect people with social and medical resources.  

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

Birth doula services  

Birth doulas are trained birth companions. You may choose to use services from a certified doula, along with your prenatal provider. Doulas offer personal support to pregnant members and families during pregnancy, delivery and beyond. Doulas aren’t medical providers, but can be a great addition to your health care team. Research shows that doulas improve the likelihood of a healthier birth for both baby and mother. 

Choose or change your primary care provider (PCP)

Every family member can choose their own PCP.  

• Need help choosing a primary care provider? Call 844-827-6572.
• To choose or change PCPs, fill out the PCP selection form. 
• Mail it to: 

OHSU Health Services 
Attn: Membership Accounting 
P.O. Box 40384 
Portland, Oregon 97240

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. Instructions for Advance Directives.

Children in foster care

Children must have these health exams in the first 60 days (2 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. 

Extreme weather

Stay informed

• 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 coolest times of day.

Cold weather resources

Bookmark these links for resources for extreme cold.  If you have other questions, please call us at 503-418-3010. 

• 211info: Dial 211 to find a warm space nearest you and to learn about transportation options.
  • 211 shelter resources by county
• Oregon Health Authority preparing for winter storms
• Clackamas County: Warming centers list
• Multnomah County:
  • Care for when it's cold (multco.us/cold)
  • Severe weather and homelessness resources
• Washington County:
  • Emergency shelter programs
  • Day shelters and homelessness resources

Hot weather resources

Bookmark these links for resources for extreme heat.  If you have other questions, please call us at 503-418-3010. 

• 211info: Dial 211 to find a cool space nearest you and to learn about transportation options.
• Oregon Health Authority Extreme Heat: Heat-related illness warning signs
• Multnomah County: Find cool spaces in Multnomah County
• Clackamas County: Find cool spaces in Clackamas County.
• Washington County: Find cool spaces in Washington County
• Heat Risk Map: The National Weather Service forecasts heat risk for vulnerable populations.
• Video: How to protect yourself during extreme heat 

Wildfire smoke and air quality resources

Breathing in smoke can cause health problems. Stay safe and healthy when air quality is poor. Find tips and resources below under Extreme Weather. 

• OHA wildfires and smoke website: Find videos and fact sheets in other languages
• Oregon Smoke Information 
• Air quality index colors explained
• Stay healthy when the air is smoky video

What is the Oregon Health Plan?

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

• Families
• Children
• Pregnant women
• Single adults

For more information, visit the Oregon Health Plan website. If you already have OHP, visit Health Share of Oregon's member benefits page to download a member handbook.

What is Health Share of Oregon?

Your medical, mental and dental benefits from OHP are coordinated through Health Share of Oregon. OHSU Health Services works with Health Share to deliver the medical care you deserve 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. View the back or inside of your Health Share ID card to locate the plan you have been assigned to. To contact Health Share for more information, call 503-416-8090 or visit www.healthshareoregon.org.

You can use OHSU Health Services if your Health Share ID card lists OHSU Health Services as your physical health plan. Your physical health plan is listed on the back or inside of your Health Share ID card.

What is OHSU Health Services?

OHSU Health Services provides access to a system of health care resources, including three adult hospitals - OHSU Hospital, Adventist Health Portland and Hillsboro Medical Center - and OHSU Doernbecher Children’s Hospital. There are also dozens of patient care locations throughout the Portland metro area. Our goal is to serve OHP members with outstanding patient care informed by cutting-edge research.

Renewing coverage

It is very important to keep a current address with the Oregon Health Plan. There is a schedule for OHP members to confirm their eligibility for Medicaid coverage. You will be notified, so keep your contact information current to help keep your benefits.  

Update your information or renew your OHP benefits:  

• Call OHP customer service 800-699-9075
• OHP One Portal
• Learn how you can update your contact information. 

Member rights

• Nondiscrimination notice

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 the 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.

See something wrong? Tell someone.

Fraud, waste and abuse in health care 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 health care that isn't needed or used well.
• Abuse is when someone accidentally gives wrong information causing unneeded cost.

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

• 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.

Here is how you can report:

• Call the OHSU Anonymous Compliance Hotline at 1-877-733-8313.
• Fill out a form online at www.ohsu.edu/hotline.

• Call or write to: 

  DHS Fraud Investigation Unit
  P.O. Box 14150
  Salem, OR 97309
  Hotline: 1-888-FRAUD01 (888-372-8301) (TTY/OREGON RELAY users, please call 711)
  Fax: 503-373-1525 Attn: Hotline 
  Website: www.oregon.gov/oha/FOD/PIAU/Pages/Report-Fraud.aspx

Privacy policy

We keep your health information safe. Read the privacy policy.

Filing a complaint or appeal

For assistance, call 844-827-6572.

Have you been denied a medical service or benefit? You have a right to ask for a review of the decision. This is called asking for a hearing. Use this form to help you ask for a hearing. Asking for a hearing doesn't change your OHP.

Oregon Health Authority Request to Review a Health Plan Decision

• English
  • Regular print
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• Spanish (Español)
  • Regular: Cómo solicitar una apelación
  • Grande: Cómo solicitar una apelación
• Russian (Pусский)
  • обычный: Порядок подачи запроса об апелляционном пересмотре решения
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  • 常规的: 如何要求提出申诉
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  • Joogto ah: Sida loo codsado rafcaan qaadashada
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  • Thường xuyên: Quy trình khiếu nại
  • Lớn: Quy trình khiếu nại

Oregon Health Plan Complaint Form

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