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Health-Related Services


Health-related services are non-covered services that are offered as a supplement to covered benefits under Oregon’s Medicaid State Plan to improve care delivery and overall member and community health and well-being. Health-related services include: ​​​
  • Flexible services, which are cost-effective services offered to an individual member to supplement covered benefits, and
  • Community benefit initiatives, which are community-level interventions focused on improving population health and health care quality. These initiatives include members, but are not necessarily limited to members.
Health-related services must meet requirements for:

a) Activities that improve health care quality (45 CFR 158.150);
- or -
b) Expenditures related to health information technology and meaningful use requirements to improve health care quality (45 CFR 158.151).

Health-related services are defined by Oregon Administrative Rules (OAR 410-141-3500 and 410-141-3845), the 1115 waiver special terms and conditions, and federal regulations. See the OHA brief below for more details.



Sources to support a health-related service

In addition to other resources a CCO may identify, OHA has identified the following resources as acceptable sources for published studies or evidence to support a health-related service:
  • Centers for Disease Control and Prevention (CDC):
    • CDC Community Health Improvement Navigator: Expert-vetted tools and resources for health system, hospital, public health agency and other community organization staff leading community health improvement efforts.
    • CDC Health Impact in 5 Years (HI-5): Highlights non-clinical, community-wide approaches that have evidence reporting 1) positive health impacts, 2) results within five years, and 3) cost effectiveness or cost savings over population lifetime.
    • CDC Social Determinants of Health: Resources for social determinants of health data, tools for action, programs and policy.
  • Community Preventive Services Task Force Findings: What works to promote healthy communities.
  • Healthy People 2020: Resources, organized by domain, to help learn how communities across the country are addressing the social determinants of health.
  • Leveraging the Social Determinants of Health: The Massachusetts Foundation’s report on what works for interventions addressing social determinants of health.
  • Social Interventions Research & Evaluation Network (SIREN): University of California, San Francisco’s SIREN works to improve health and health equity by advancing high quality research on health care sector strategies to improve social conditions.
    • SIREN Evidence & Resource Library: Includes both peer-reviewed and other types of resources, such as webinars and screening tools/toolkits on medical and social care integration.
  • OHA Health Evidence Review Commission: Multisector intervention reports on population-based health interventions or other types of interventions that happen outside of clinical settings.
  • OHA has also identified the following resources to support CCOs in calculating return on investment (ROI) for health-related service expenditures. Note: Calculating an ROI is not required for reporting HRS expenditures to OHA, but may support CCOs’ long-term HRS expenditure planning: Commonwealth Fund ROI Calculator: This calculator is designed to help health systems and their community-based organization partners plan sustainable financial arrangements to fund the delivery of social services to high-need, high-cost patients. To help users of this ROI calculator, the Commonwealth Fund has provided a summary assessment of available evidence of health care impact for interventions related to addressing health-related social needs for high-need adults. Center for Health Care Strategies ROI Forecasting Calculator: This web-based tool is designed to help state Medicaid agencies, health plans, and other stakeholders assess and demonstrate the cost-savings potential of efforts to improve quality.


If you have questions, please email the OHA health-related services team at ​​​​​​​​​​​​​

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