All Flex requests must meet one of the following criteria:

• Improve health outcomes compared to a baseline and reduce health disparities among specified populations.
• Prevent avoidable hospital readmissions through a comprehensive program for hospital discharge.
• Improve patient safety, reduce medical errors, and lower infection and mortality rates.
• Implement, promote, and increase wellness and health activities.
• Support expenditures related to health information technology and meaningful use requirements necessary to accomplish the activities above that are set for the in 45 CFR 158.151 that promote clinic, community linkage and referral processes or support other activities as defined in 45 CFR 158.150.
• Social Determinates of Health and Equity (SDOH-E)

They must also meet all of the following:

• Likely improve health outcomes.
• Lack billing and encounter codes.
• Be health related.
• Be consistent with a care/treatment plan.
• Likely to be a cost-effective alternative.
• Have no other community resources are available.

• Please be sure to complete the gym membership section of the request form
• If the request is for a facility other than the YMCA, please provide rationale explaining the need for the alternative facility
• Initial request must be sent in by the provider/community partner and have medical notes to support the request
• Initial requests will only be approved in 3 month increments to ensure member is utilizing services
• For members to be approved for ongoing membership, they must utilize services at least 8 times/month

• Please be sure to complete the specific AC/Heating unit section of the request form
• These requests are primarily for members who are:
  • 55 or older, or age 4 or younger, AND
  • Living alone or socially isolated and has a condition that increases risk of a heat related illness (age 65 or older, morbid obesity, heart disease, diabetes, alcohol use disorder, Parkinson’s, disease, multiple sclerosis, history of certain brain injuries/tumors or spinal cord injuries, hyperthyroidism, asthma or COPD, use of a medication that cause temperature regulation interruption), OR
  • Has a history of heat-related illness requiring treatment or hospitalization that home cooling/heating could have prevented

• Please be sure to complete the specific Temporary Housing section of the request form
• Submission must include a signed Temporary Housing Member Agreement by the member for hotel/motel requests
• The member must be engaged/speak with our Care Coordination team with before a request will be considered (this is to ensure that care plans are offered to ensure long-term support beyond the temporary placement is made)
• Stays will be approved for the shortest time necessary and will not exceed 3 months
• These services are prioritized for member who:
  • Experiencing homelessness or a disruption in their housing
  • Short-term housing needed for recovery after hospital discharge or a medical procedure
  • Enrolled in the New Day or New Beginning programs
  • Receiving a Direct Acting Antiviral (DAA) medication for the treatment of Hepatitis C
    • The member must have already received their medication
  • Has a valid ID (hotel requirement)
  • Not previously broken rules outlined in the temporary housing agreement

60 day financial proof of income. Qualifying examples:

• • DHS printout with current TANF benefits
  • Pay stubs
  • SSA/SSI award letters
  • Child support print out
  • Unemployment benefits print out
  • Bank statements checking/savings
• A copy of the rental agreement (as applicable)
• Eviction notice/72 Hour Notice (as applicable)
• Property management/Landlord information (as applicable)
  • W9
  • Name
  • Address
  • Email address
  • Phone number