Application Assistance

Agreement Administrator
OHA - Oregon Health Authority
635 Capitol St NE, Ste 350
Salem, Oregon
97301

ContactJewelee M BellPhone1 (503) 945-9869Fax EmailJ​E​W​E​L​E​E​.​M​.​B​E​L​L​@​d​h​s​o​h​a​.​s​t​a​t​e​.​o​r​.​u​s​



Agreement #
OHA-162109-19

Agreement Start Date
11/18/2019
Expiration Date
12/31/2022
Agency Number
C01105
All dates are mm/dd/yyyy


Subject Matter
The County agrees to provide Application assistance to Applicants as follows:
County Responsibilities (the Work):
a. County shall provide enrollment assistance, or provide an appropriate referral for
enrollment assistance, for anyone who requests assistance accessing health coverage
through OHA or HealthCare.gov.
b. County shall ensure that all individuals performing work under this Agreement receive
training from OHA on procedures for providing assistance to Applicants.
c. County

will require all Application Assisters to use and fill out the current OHAprovided
Consent Form with an Applicant, before any personal information is shared
with an Application Assister. Either a paper or electronic copy of the document must be
shared with the Applicant. The County is responsible for securely storing all consent
forms for six years.
d. County will provide information to potential Applicants. Information provided will
explain Public Medical Programs and Qualified Heath Plan options. County will give
the potential Applicant enough information to make informed choices. The information
shall, at a minimum, include an explanation of the role of an Application Assister.
County shall use information materials produced by OHA or receive approval prior to
using any other materials.
e. County will employ or engage Application Assisters to provide enrollment assistance to
potential eligible applicants through HealthCare.gov and OHA.
f. Potential Application Assisters must attend initial training and all required additional
training to become and maintain status as a certified Application Assister.
g. Application Assisters will provide information about accessing health coverage and
potential financial assistance through HealthCare.gov and OHA to potentially eligible
consumers.

Agreement Value
$0.00


Secondary Organization
Gilliam County Government (ORCPP)
221 S Oregon Street
Condon, Oregon
97823

ContactTeddy FennernPhone1 (541) 384-2399Fax Emailt​e​d​d​y​.​f​e​n​n​e​r​n​@​c​o​.​g​i​l​l​i​a​m​.​o​r​.​u​s​

Primary Organization
OHA - Director's Office
500 Summer Street NE
Salem, Oregon
97301

ContactPerry DeJoodePhone1 (503) 945-6525 334Fax1 (503) 945-6871Emailp​e​r​r​y​.​b​.​d​e​j​o​o​d​e​@​s​t​a​t​e​.​o​r​.​u​s​


ContactPerry DeJoodePhone1 (503) 945-6525Fax1 (503) 945-6871Emailp​e​r​r​y​.​b​.​d​e​j​o​o​d​e​@​s​t​a​t​e​.​o​r​.​u​s​