Supporting Health for All through REinvestment (SHARE)

SHARE overview

SHARE comes from a legislative requirement for coordinated care organizations (CCOs) to invest some of their profits back into their communities. After meeting minimum financial standards, CCOs must spend a portion of their net income or reserves on services to address health inequities and the social determinants of health and equity (SDOH-E).

SHARE is just one way that CCOs respond to SDOH-E, health inequities and the social needs of their members. CCOs may also use their global budgets to address members’ social needs and community SDOH-E through health-related services (HRS). See this SHARE, HRS and ILOS comparison for an overview of CCO spending programs to meet member and community needs.

SHARE is defined by the following state law and Oregon Administrative Rule:

2018 legislative requirement: House Bill 4018, Section 3, 1(b)(C)
2019 legislation that modified minimum financial standards for CCOs, over which a portion must be dedicated to SHARE: Senate Bill 1041, Section 57, 1(b)
SHARE definitions and requirements: Oregon Administrative Rule 141-414-3735

2025 changes

See this CCO memo about 2025 SHARE changes (12/13/24).

2025 SHARE updates webinar

CCO convening

For CCO staff working in HRS, SHARE, ILOS and SDOH-E
Convening materials (10/9/24)

SHARE requirements

According to requirements in OAR 410-141-3735, a CCO’s SHARE dollars must:

Align with community priorities in the CCO's current community health improvement plan;
Include any statewide priorities for SHARE spending that are identified in the contract between CCOs and OHA (currently housing-related services and supports);
Include a role for the CCO’s community advisory council in spending decisions;
Involve community partnerships, with a portion of dollars going to SDOH-E partners; and
Fit into one of four SHARE Initiative domains related to the social determinants of health and equity (SDOH-E): economic stability, neighborhood and built environment, education, and social and community health.

CCO reports and summaries

CCO spending plans and reports are posted on the SHARE reports page.
SHARE spending plan summaries

2023: English / Spanish

Webinar: Slides (English / Spanish) / Recording

2022: English / Spanish

Webinar: Slides (English / Spanish) / Recording

2025 guidance and reporting templates

OHA has released draft 2025 SHARE guidance for CCO feedback. We want to make sure the updated requirements and flexibilities are clear before releasing final guidance in September. CCOs may share feedback during the July 29 Contracts and Compliance meeting or send written feedback by August 1 to Transformation.Center@odhsoha.oregon.gov.

2024 guidance and reporting templates

Guidance

Reporting templates

2024 SHARE Spending Plan Template

2024 SHARE Spending Plan Evaluation Tool

SHARE Designation and Spend-down Reports in Exhibit L (Report L6.7 and L6.71): Due June 30

CCO memo about changes to SHARE spending reporting (1/12/24)

Supplemental resources

SHARE, HRS and ILOS comparison document (updated March 2024)
HRS, SHARE and ILOS Program Essentials for CCO Staff (July 2024) – Crosswalk of Medicaid spending program implementation guidance
HRS, SHARE and ILOS Overview for Community Partners (November 2024) – Basic information on CCO spending programs.
HRS, SHARE and ILOS Basics for OHA Staff (November 2024)
Housing and Medicaid Spending Programs (November 2024)
Oregon's SUD 1115 demonstration waiver (see Attachment F: Community Integration Services and Eligibility)

Community integration services fact sheet for OHP members

Oregon's 1115 Medicaid waiver, 2022-2027 (see Section 9: Health-related Social Needs)
Health and Housing: Introduction to Cross-Sector Collaboration (National Academy for State Health Policy, 2021)
Health System Investments in Housing: A Development Guide (Corporation for Supportive Housing, 2020)

Webinars

Integrated funding case studies

Slides / Recording (4/17/25)

2025 SHARE program changes – A summary of anticipated changes to SHARE, based on this CCO memo (12/13/24).

Slides / Recording (1/28/25)

Medicaid spending programs braided funding example scenarios

Slides / Recording (4/15/24)
Resource: Braided funding scenarios

Spending programs 101 for community partners (communicating with community partners about HRS, SHARE and ILOS)

Slides / Recording (1/8/24)
Overview handout (for CCOs to edit and share with community partners)
Audience: CCO staff who oversee HRS, SHARE and related programmatic work with community partners.

Collaboration and sustainability through SHARE: Impactful CCO processes and investments: Slides / Recording (6/7/23)
Nuts and bolts of grantmaking: Slides / Recording (2/15/23)
SMARTIE goals: Slides / Recording / Handout (12/2/22)
Partnering to provide supportive housing services: an introduction for CCOs: Slides / Recording (6/2/22)

Collaborating within your region to address housing and homelessness: an overview for CCOs from one Oregon region’s experience: Slides / Recording (4/13/22)
Learning collaborative session: Identifying ROI for investments that address SDOH-E: Slides (3/28/22)

SHARE spending areas: examples

Income/poverty
Employment
Food security/insecurity
Diaper security/insecurity
Access to quality childcare
Housing stability/instability (including houselessness)
Access to banking/credit

Early childhood education and development
Language and literacy
High school graduation
Enrollment in higher education

Access to healthy foods
Access to transportation (non-medical)
Quality, availability and affordability of housing
Crime and violence (including intimate partner violence)
Environmental conditions, such as clean air and water
Access to outdoors, parks

Social integration
Civic participation/community engagement
Meaningful social role
Citizenship/immigration status
Corrections
Discrimination (for example, race, ethnicity, culture, gender, sexual orientation, disability)
Trauma (for example, adverse childhood experiences)

Contact

If you have questions about SHARE, please contact Transformation.Center@odhsoha.oregon.gov.