You can learn about which services the OhioRISE program delivers to Ohio's youth and families with complex behavioral health needs by watching the video below. Click on each question underneath the video to learn more about how the OhioRISE program's services are accessible to and may benefit you and your family.
Who may benefit from OhioRISE?
- Children and youth who may benefit from OhioRISE:
- Have multiple needs that result from behavioral health challenges,
- Have multisystem needs or are at risk for deeper system involvement, and/or
- Are at risk of out-of-home placement or are returning to their families from out-of-home placement.
Young people with multisystem needs often require help and services from community systems which may include juvenile justice, child protection, developmental disabilities, schools, mental health and addiction, and others.
Who is eligible for OhioRISE?
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, and
- Require significant behavioral health treatment needs, measured using the Ohio Child and Adolescent Needs and Strengths (CANS) assessment.
Children and youth 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.
What special services does OhioRISE provide to members?
OhioRISE will provide the following new and improved behavioral health services:
- Intensive and Moderate Care Coordination
- Improved Intensive Home-Based Treatment (IHBT)
- In-state Psychiatric Residential Treatment Facilities (PRTFs)
- Behavioral Health Respite
- Primary Flex Funds
- Mobile Response and Stabilization Services (MRSS)
Why are these services being provided by OhioRISE and not the “regular” Ohio Medicaid plan?
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.
How is OhioRISE different from Ohio Medicaid’s (ODM) typical coverage for behavioral health?
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.
What are the services children and youth will have access to through the OhioRISE 1915(c) Waiver?
- Out-of-Home Respite: A service provided to individuals unable to care for themselves that is furnished on a short-term basis because of the absence or need for relief of those persons who normally provide care for the individual.
- Transitional Services and Supports (TSS): Shorter-term supports for individuals and their families to help them understand, mitigate, and provide connections to long-term solutions that address behavior challenges.
- Secondary Flex Funds: Services, equipment, or supplies not otherwise provided through the waiver or through Medicaid that address an identified need in the service plan, including improving and maintaining the individual’s opportunities for full participation in the community.
How can children and youth access the OhioRISE 1915(c) Waiver?
A child or youth can be referred for the waiver through their local care management entity (CME). Youth and families interested in receiving a waiver referral for the OhioRISE Waiver can do so through a number of different “access points.” It is anticipated that behavioral health providers that a youth is connected with can help make the appropriate referral for a CANS assessment to determine waiver eligibility to a CME in the child’s or youth’s local area.
It is important to remember that a waiver referral is the first step in accessing the OhioRISE Waiver. In addition to meeting Medicaid and OhioRISE program eligibility, a child or youth must also meet the following requirements to be eligible for the waiver:
- Have an Inpatient Psychiatric Level of Care.
- Have a diagnosis of a Serious Emotional Disturbance (also known as SED).
- Have documented functional limitations.
- Need at least one of the OhioRISE Waiver services.
- Have waiver needs that are less than or equal to the waiver service cost limit of $15,000.
What is a CANS assessment?
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.
Where can a child or youth go to receive a CANS assessment?
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.
When can a child or youth start receiving OhioRISE services?
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).
Is enrollment in OhioRISE mandatory?
Yes. If a child or youth is eligible for OhioRISE, enrollment into OhioRISE is mandatory. If a child or youth is not eligible, a notice of denial and hearing rights will be mailed to them. If a child or youth or their parent/guardian does not want them to be enrolled in OhioRISE, they can ask to be disenrolled. ODM will review the request and decide if disenrollment is appropriate. A child or youth who is disenrolled from OhioRISE will not be able to get the new and improved services because these services are only available through OhioRISE.
Where can I direct my questions about OhioRISE?
You can email us with questions at OhioRISE@medicaid.ohio.gov