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Oregon Health Authority

Case Managers

Resources for Community-Based Case Managers

Information and resources for community based case managers who are assisting people living with HIV.

Note:

Client Eligibility Review

Application and Supporting Documents

CAREAssist Application

Instructions

HIV Verification Form

A health care provider must sign this document and submit for a complete application

PDF iconResidency Verification Form

Word format

The Residency Verification form is only needed when no other verification documents can be obtained

Federal Poverty Levels for eligibility

PDF iconCER Forms and Instructions

Medication Therapy Management

MTM direct referral form

In partnership with Ramsell, CAREAssist offers MTM to eligible clients who are having difficulty adhering to medications. Any HIV Case Manager can refer a CAREAssist client to MTM.
Complaints and Grievances

CAREAssist Grievance Policy and Form - English

CAREAssist Grievance Policy and Form - Spanish

Pharmacy Information

CAREAssist clients have two ways for accessing their medications, 1) a store based pharmacy or 2) a mail order pharmacy. More information about the pharmacy system can be found on the Providers and Prescribers page.

Store Based Pharmacy

CAREAssist works with a number of pharmacies statewide that are considered to be in-network or out of network.

  • In-network pharmacy - Most clients are required to use an in-network pharmacy for their ongoing medication needs.
  • Out of network pharmacy - In some circumstances, a client may use an out-of network pharmacy for their medication needs. To find an out of network pharmacy, use the Pharmacy Locator feature on the Ramsell website.

Mail Order Pharmacy

CAREAssist clients can also conveniently receive medications at their home, or other destination of their choosing, through services provided by Credena and CVS Pharmacies. Enrollment information can be found above or on the Providers and Prescribers page.

Insurance Information

OHP Member Handbooks

Search for CCOs by County.

Uninsured Persons Program

For persons who are unable to secure health insurance outside of an open enrollment period, CAREAssist can assist with payments for a limited number of medical services and medications (indicated by a "C" in the left hand column) necessary to maintain engagement in HIV treatment through the Uninsured Persons Program. Persons enrolled in this program must also be enrolled in community based Ryan White HIV case management, and stay closely connected to the CAREAssist program to ensure that ongoing health insurance is secured as soon as it becomes available. To see if a client may be eligible, please contact the CAREAssist program.

Formulary Information

Download the current PDF iconCAREAssist program formulary. CAREAssist will pay a co-pay for almost any medication prescribed by a doctor as long as it is covered by insurance. Should a prescription not be covered by insurance, CAREAssist will pay full cost if it is on the CAREAssist formulary.

Training

The CAREAssist overview provides a brief overview of the CAREAssist program, and includes information about eligibilty, program services and client responsibilities. The module includes recorded audio so headsets are recommended. It is approximately 13 minutes in running time.

Insurance Information

Pharmacy Information

  • Ramsell is the Pharmacy Benefits Manager for CAREAssist. Ramsell coordinates pharmacy distribution and payment for most CAREAssist clients.
  • Credena Pharmacy and CVS Pharmacy administers the mail-order pharmacy for CAREAssist clients.

General ADAP information

  • HIV/AIDS Bureau (HAB) is the bureau within the Human Resources and Services Administration that administers Ryan White funding, including the ADAP Program.
  • The ADAP Glossary provides definitions for terms and acronyms commonly used in ADAP programs.
  • The ADAP Programs Fact Sheets provides answers to commonly asked questions about ADAP programs. This document is not specific to CAREAssist, but provides a good overview of ADAPs in general.

Other ADAPs

All states receive funding for ADAP. If a client is moving out of Oregon, you might consider referring them to services elsewhere.

What other resources or information would you like to see here?

Email your ideas to care.assist@odhsoha.oregon.gov