Web Content Viewer
Actions

About OhioRISE

OhioRISE is governed by ODM, the Governor’s Office of Children’s Initiatives, and Ohio’s Family and Children First Cabinet Council. Council members include:

Ohio Medicaid holds the contract with the OhioRISE plan.

OhioRISE aims to shift the system of care and keep more kids and families together by creating new access to in-home and community-based services for children with the most complex behavioral health challenges. The OhioRISE program’s child and family-centric delivery system recognizes the need to specialize services and support for this unique group of children and families. Aetna will partner with ODM, sister state agencies, providers, families, and other stakeholders to develop and implement new and enhanced services, including those listed under the "OhioRISE services" tab below. You can learn more about the OhioRISE program's services and delivery system by watching the video below.

OhioRISE will also feature a new 1915(c) Medicaid waiver that will drive toward improving cross-system outcomes for its enrollees. OhioRISE will feature intensive care coordination and both new and enhanced behavioral health services targeted toward this population and will offer a new Medicaid waiver program that will focus on mitigating risks and preventing negative health and life outcomes for youth who have complex behavioral needs, with the goal to prevent institutionalization.

OhioRISE Eligibility

  • Enrolled in Ohio Medicaid – either managed care or fee for service
  • Aged 0-20 at the time of enrollment 
  • In need of significant behavioral health services 
  • Meet a functional needs threshold for behavioral health care, as identified by the Child and Adolescent Needs and Strengths (CANS) tool

OhioRISE Services

New and enhanced services available through OhioRISE include:

  • Intensive and Moderate Care Coordination: two levels of this service (intensive and moderate) will be consistent with principles of High-Fidelity Wraparound and be delivered by a Care Management Entity-qualified agency.
  • Intensive Home-Based Treatment (IHBT): OhioRISE will make changes to existing IHBT services and align with the Family First Prevention Services Act (FFPSA).
  • Psychiatric Residential Treatment Facility (PRTF): this service is aimed at keeping youth with the most intensive behavioral health needs in-state and closer to their families and support systems.
  • Mobile Response and Stabilization Service (MRSS): provide youth in crisis and their families with immediate behavioral health services to ensure they are safe and receive necessary supports and services (this new service will also be available to children who are not enrolled in OhioRISE).
  • Behavioral Health Respite: provide short-term, temporary relief to the primary caregiver(s) of an OhioRISE plan enrolled youth, in order to support and preserve the primary caregiving relationship.
  • Primary Flex Funds: services, equipment, or supplies not otherwise provided through the Medicaid state plan that address an identified need in the service plan, including improving and maintaining the individual’s opportunities for full participation in the community.

OhioRISE Delivery System

OhioRISE services will be provided through a collaborative delivery system, as illustrated in the image below.

OhioRISE Delivery System

For Ohio Medicaid managed care youth members who are not enrolled in the OhioRISE plan, Ohio Medicaid MCOs and the fee for service program will continue coverage for the Medicaid’s existing behavioral health services and MRSS. MCOs will manage also administrative care coordination, utilization management, and quality improvement efforts. The Ohio Medicaid MCOs also will be responsible for assuring access to the Child and Adolescent Needs and Strengths (CANS) assessment to determine when a child needs the enhanced services of the OhioRISE plan.

ODM presented highlights of the OhioRISE program to stakeholders via webinar:

View the OhioRISE highlights webinar

View the OhioRISE highlights presentation

Member Care FAQs

To learn about the OhioRISE program, please click here to view the OhioRISE Member Care FAQs. You will find answers to common questions including: 

  • How is OhioRISE different from Ohio Medicaid’s typical coverage for behavioral health?
  • Who may benefit from OhioRISE?
  • Who is eligible for OhioRISE?
  • When can a child or youth start receiving OhioRISE services?

Please send your additional questions to the OhioRISE mailbox.