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The Next Generation mailbox remains open as a way for individuals, providers, and advocates to communicate with ODM about the current Medicaid managed care program.

For information on OhioRISE, including information on new and improved covered services:  

  • Visit managedcare.medicaid.ohio.gov/OhioRISE
  • Visit AetnaBetterHealth.com/OhioRISE.
  • Call OhioRISE Member Services at 1-833-711-0773 (TTY: 711) Monday through Friday from 7:00 a.m. to 8:00 p.m. 
  • Call the Medicaid Consumer Hotline at 1-800-324-8680 (TTY: 711) Monday through Friday from 7:00 a.m. to 8:00 p.m. and Saturday from 8:00 a.m. to 5:00 p.m.
  • Contact a care management entity (CME). Contact information can be located here

Ohio Medicaid managed care members will remain with their current managed care plan until Ohio Medicaid's Next Generation managed care plans begin providing healthcare coverage on December 1, 2022. 

  • Intensive and Moderate Care Coordination
  • Improved Intensive Home-Based Treatment (IHBT)
  • In-state Psychiatric Residential Treatment Facilities (PRTFs) – Available January 2023
  • Behavioral Health Respite
  • Primary Flex Funds
  • Mobile Response and Stabilization Services (MRSS) – Also covered by MCOs or FFS Medicaid

Children and youth who may be eligible for OhioRISE are:

  • Eligible for Ohio Medicaid (either managed care or fee-for-service),
  • Are age 0-20 at the time of enrollment, and
  • Require significant behavioral health treatment, measured using the Ohio Child and Adolescent Needs and Strengths (CANS) assessment.
  • Young people may also be eligible for OhioRISE due to certain urgent conditions. For example, if a child or youth is  in a hospital for behavioral health reasons.

In early 2019, Ohio Governor Mike DeWine called on Ohio Medicaid to ensure Ohioans get the best value in providing quality care.

In response, we conducted a series of listening sessions to hear from Ohio Medicaid members and providers across Ohio. We also gathered input through email, phone calls and mail. We received more than 1,000 comments including many suggestions for improving the current program.

Ohio Medicaid is “upgrading” our managed care program in order to address the issues we heard and meet the Governor’s and our goal.

This refers to the innovative changes Ohio Medicaid is making to upgrade the managed care program to align with our mission – to focus on the individual rather than the business of managed care. ODM wants to do better for the people it serves.

Ohio Medicaid encourages all managed care members to review and select the Next Generation plan that best fits their healthcare needs. Current Ohio Medicaid managed care members who do not select a plan will stay with their current plan, with the exception of Paramount members. 

Unless a current Paramount member chooses another plan, they will be enrolled with Anthem Blue Cross and Blue Shield during the implementation process. Members can review and select the Next Generation plan that best fits their healthcare needs at any time through open enrollment ending November 30, 2022. 

A CANS assessment is a tool used to determine eligibility for OhioRISE. It gathers the young person and family’s story to understand their needs and strengths, and to help determine the best ways to provide help. The CANS assessment is updated regularly to aid with ongoing care planning. 

To ask for a CANS assessment, contact: 

  • A child or youth’s managed care organization, 
  • Aetna Better Health of Ohio,
  • A local care management entity,  
  • The Medicaid Consumer Hotline, or
  • Behavioral health providers or Family and Children First Councils, which may have a CANS assessor onsite or be able to link to one.

Beginning March 1, 2022 individuals who are newly eligible for managed care, those who are currently in Medicaid fee-for-service BUT not enrolled with a managed care plan, and those with a gap in eligibility of 91+ days will receive care paid for through Medicaid fee-for-service until December 1, 2022 when they will be transitioned to an Ohio Medicaid Next Generation plan.

ODM will notify impacted members which plan they have been transitioned to. Members can review and select the next generation plan that best fits their healthcare needs at any time through open enrollment ending November 30, 2022. Newborns and case additions will continue to be added to managed care plans as they become Medicaid eligible during this time. 

Ohio Medicaid encourages all managed care members to review and select the Next Generation plan that best fits their healthcare needs. Current Ohio Medicaid managed care members who do not select a plan will stay with their current plan, with the exception of Paramount members. 

Unless a current Paramount member chooses another plan, they will be enrolled with Anthem Blue Cross and Blue Shield during the implementation process. Members can review and select the Next Generation plan that best fits their healthcare needs at any time through open enrollment ending November 30, 2022. 

If you are currently enrolled with a plan that will be participating as part of our Next Generation managed care program and you wish to stay with this plan, no action is required.

Ohio Medicaid encourages all members to review the Next Generation plans available and select the plan that best meets their healthcare needs. Members can review and select the Next Generation plan that best fits their healthcare needs at any time through open enrollment ending November 30, 2022.

The child or youth will be enrolled into managed care effective the first day of the month that agency custody begins. Your local Title IV-E Agency (Public Children Services Agency or IV-E Court) that holds custody of the youth may work with you to review the current managed care plans available and will select from these plans when making an enrollment decision. You can begin coordinating with the Title IV-E Agency that holds custody to review and select a Next Generation managed care plan 1-2 months prior to the plan start date of December 1, 2022.

OhioRISE focuses on young people who need specialized care. While all children and youth with Ohio Medicaid can access mental health and substance use disorder care, OhioRISE enrollees will also be offered new and improved behavioral health services. OhioRISE enrollees will receive their behavioral health benefits through Aetna (the OhioRISE plan) and their physical health services through a separate managed care organization or fee-for-service Medicaid.

Following a CANS assessment, children and youth found to be eligible are enrolled in OhioRISE effective the date their CANS assessment is submitted. In urgent cases, enrollment into OhioRISE will be:

  • The date of admission for an inpatient hospital stay for mental illness or substance use disorder or
  • The date of admission into a Psychiatric Residential Treatment Facility (PRTF).

Young people with complex behavioral health needs benefit from more intensive services and a coordinated approach to planning their care. OhioRISE works with multiple providers and organizations to make sure a child or youth has their needs met through a care plan that values kids’ and families’ voices and choices.

Young people would be considered eligible for this waiver if they meet all of the following eligibility criteria:

  • Live in a family home or other private residence.
    •  Please note: Children and youth who do not currently live in a home or private residence, but plan on transitioning to this setting soon, may still apply for the OhioRISE Waiver. If they meet all other eligibility criteria, the child or youth will be enrolled on the waiver when they move to a home or other private residence.
  • Need at least one of the OhioRISE Waiver services mentioned above.
  • Meet the OhioRISE Waiver Level of Care, which means they must have:
    • A serious emotional disturbance (SED) diagnosis, and 
    • Documented functional impairment and behaviors that substantially interfere with, or limit, the child or youth’s role or functioning in family, school, or community activities which result in recommended institutionalization and potential relinquishment of custody to the child protection system, and
    • An Inpatient Psychiatric Level of Care.
  • Are already enrolled in Ohio Medicaid or are determined to be eligible for, and enroll in, Ohio Medicaid after they are determined to meet the OhioRISE Waiver Level of Care.

Ohio Resilience through Integrated Systems and Excellence (OhioRISE) is a specialized managed care program that focuses on providing services to children and youth who have complex behavioral health and multisystem needs. Young people with multi-system needs require support from community systems such as schools, developmental disabilities, child protection, juvenile justice, and mental health and addiction.


As part of OhioRISE, the Ohio Department of Medicaid (ODM) also created a new 1915(c) Home and Community Based Services (HCBS) Medicaid waiver to offer additional services for qualifying children and youth who have some of the greatest needs within the program. These services include:

  • Out-of-Home Respite – Respite care provided to a child or youth outside of their home to help their caregiver(s) get temporary relief. 
  • Transitional Services and Supports – A short-term intensive service that assists the young person and their caregiver(s) in their home and community after they go through changes in circumstances – for example, at the time the young person comes home from a mental health hospital stay or residential mental health treatment. 
  • Secondary Flex Funds – Services, equipment, or supplies that help a young person with their behavioral needs. Funds must be used to decrease the need for other Ohio Medicaid services, promote the child or youth’s opportunities for full inclusion in the community, or increase their safety in the home.
  • If a child or youth is eligible for, and enrolled on, the OhioRISE Waiver, they will also get:
  • Mental health and substance use disorder care through the OhioRISE managed care program, and
  •  Physical health services and pharmacy coverage through an Ohio Medicaid managed care organization. If they are not eligible for managed care, they will get physical health services and pharmacy coverage through Medicaid’s fee-for-service program. 

Ohio Medicaid managed care members are encouraged to review and select the Next Generation plan that best fits their healthcare needs now. 

You will remain with your current managed care plan until Ohio Medicaid's Next Generation managed care plans begin providing healthcare benefits on December 1, 2022. You can review and select the Next Generation plan that best fits your healthcare needs at any time through open enrollment ending November 30, 2022.

Yes, you can still use your current Medicaid / managed care plan ID card.

  • Starting July 1, 2022, if you or a child in your family is in the OhioRISE program, a new ID card indicating OhioRISE enrollment, and more information will be sent to you.
  • Starting October 1, 2022, every managed care enrollee (including OhioRISE members) will be sent a new ID card with new pharmacy information. If you or a child in your family is in the OhioRISE program, this ID card will also indicate OhioRISE enrollment, making this your only card.
  • If you have selected a new managed care plan during open enrollment, in November 2022, or are in fee-for-service enrolling in managed care for the first time, you will be sent a new Next Generation ID card. If you or a child in your family is in the OhioRISE program, this ID card will also indicate OhioRISE enrollment, making this your only card.

If you have questions about what member ID card you should be using, please contact the Ohio Medicaid Consumer Hotline at (800) 324-8680.

The Next Generation managed care plans changes do not apply to MyCare Ohio plans, which will continue to provide benefits to Ohioans who receive both Medicaid and Medicare benefits, with enhanced coordination of medical, behavioral, and long-term care services.

OhioRISE enrollees will receive their behavioral health benefits through Aetna (the OhioRISE plan) and their physical health services through a separate managed care organization or fee-for-service Medicaid.

ODM is implementing the Next Generation of Ohio Medicaid program in stages to avoid unnecessary disruption and confusion for members and to reduce burdens on our service providers. The staggered approach remains true to our Next Generation vision – to ensure that we keep our focus on the individual, honor members' choice, and provide continuity in the provision of members’ care.

Member transition is the process to introduce members to new services and benefits of the next generation of Ohio Medicaid. ODM has made a lot of changes including better coordination of care among healthcare providers, improved transportation options for unexpected medical needs, and more. 

Enrollment is the way members can sign up with a managed care plan. To give members the time needed to get to know the next generation plans, ODM is kicking off member enrollment on March 1 and keeping it open through November 30. 

ODM's goal is ensuring members understand the changes ahead and how to take advantage of them to serve members better. 

No. Your child must be determined to be eligible for OhioRISE services through the Ohio Child and Adolescent Needs and Strengths (CANS) assessment or meet the criteria for urgent OhioRISE enrollment.

OhioRISE may not be your child's only Medicaid plan. While enrolled in OhioRISE, your child will still receive their physical health services through a managed care plan or fee-for-service Medicaid.

Visit our website at managedcare.medicaid.ohio.gov

You can email us with questions at ODMNextGen@medicaid.ohio.gov

Yes, Ohio Medicaid’s contract with the managed care plans (both current and future) includes requirements – referred to as continuity of care – that ensure you continue receiving the same services from the same providers during and after the transition.

The feedback being provided by individuals as well as providers, advocacy groups and community organizations was shared with Ohio Department of Medicaid (ODM) staff for consideration as we improve our Medicaid Managed Care program. Feedback is not being attributed to any specific individual and any personally identifiable information (PII) was removed.

Overarching feedback themes are being shared publicly during presentations and meetings. In addition, all the responses to RFI #1, with PII removed, have been posted to the RFI #1 Responses page on medicaid.ohio.gov

Visit the What We’ve Heard From the Individuals We Serve page for more information about high-level themes of the responses.

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