Who Can Request a Service
To receive a flexible service, you must be an Umpqua Health member. You must also meet the rules for approval. These requests require documentation (proof) to support your request. Please see the criteria (rules) and documentation (proof) requirements below.
Both clinical and non-clinical staff—including, but not limited to, those listed below—may submit a flexible services request for a member at any time.
- Providers
- Primary care teams
- Specialists
- Health care providers
- Care coordinators
- Traditional Health Workers (i.e. patient navigators, community health workers, peer support specialists, doulas, etc.)
- Community partners
- Members
- Family members or representatives
How To Request a Service
To request a service or item to be covered, you can send us your request. To do this, complete the electronic Assistance Request Form. You can also complete a printable or fillable form and send it to us by mail, email, or fax. You can also deliver it in-person. You can call us if you need help.
Assistance Request Form
Timelines
Please keep in mind that your application may take a minimum of 30 days to be reviewed, and if approved, more time to receive the service. Incomplete requests or requests submitted without documentation will not be accepted. Urgent requests will only be allowed for inpatient discharges. Care coordination will determine if the need meets the criteria for urgent review.
What is Changing
- Pharmacy rides are limited to one trip each month.
- Rides to the Oregon Department of Human Services office are covered only if you have an appointment. You must show proof of the appointment.
- Rides to WIC (Women, Infants, and Children) visits need proof of your appointment.
- Rides to court for your own mental health hearings need proof of your court date.
- Grocery stops are allowed only if planned before the ride is given and can be either on the way to or from another approved appointment, and do not add extra travel time.
- Rides to gyms, Lamaze classes, equine therapy, and weight loss programs will no longer be covered. Online weight loss programs are still available.
- Rides to self-help groups like NA or AA may be limited. If you go to these meetings and also have other regular covered visits, you may be able to get a monthly bus pass instead.
- Rides to UHA Community Advisory Council (CAC) meetings or other UHA community health meetings are covered if you are a member or invited guest. Proof of the meeting is required.
- Rides to Chadwick House are no longer covered.
New Support Options
- Monthly bus passes are available through BCB. These can be used if you need to get to grocery stores, self-help groups, or other places not covered for rides.
- Online programs, like weight loss or support groups, may also help.
- Grocery stops can still be planned as part of another approved ride.
What You Should Do
- Always plan your rides ahead of time.
- Keep proof of your appointments.
- Use your monthly bus pass for trips not covered.
- Call us if you are not sure if a ride is covered.
Effective 10/1/2025
Supporting Documentation Requirements
All services require documentation to support the request. Required documentation often includes, but is not limited to:
- A recent W9 for the vendor or landlord receiving payment
- A bill, invoice and/or ledger indicating how much is due and/or past due
- Proof of income (most recent 60 days for all adults living in the household)
- Three (3) bids or estimated cost of the repair (as applicable)
- Lease agreement or proof of ownership (as applicable)
- Medical records or notes to support your qualifying health condition.
- A care or treatment plan from your provider or case manager.
- Evidence-based criteria, medical justification, or any additional documentation that the service or item will help your health outcomes.
- Additional documentation or supporting information may be needed to determine the appropriateness of the service.
- All requests must have a signed attestation by the member, or submitter signature if attestation was received verbally, to share your personal health information for referrals and payment of services.
Incomplete applications or applications submitted without complete documentation will result in your request being dismissed. A new request will need to be submitted with all documentation attached.
For questions or for more information, please reach out to flexspending@umpquahealth.com.
Helpful resources
General Criteria
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:
- No alternative community resources are available for the member.
- 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.
Request Specific Criteria
- 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 and speak with our Care Coordination team 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 members 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