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Ohio Medicaid opens bid for specialized, kids-focused managed care plan


Kevin R. Walter, Press Secretary, Ohio Department of Medicaid
614-752-3688 ǀ kevin.walter@medicaid.ohio.gov

Lisa Lawless, Communications Director, Ohio Department of Medicaid
614-813-5358 ǀ lisa.lawless@medicaid.ohio.gov

Ohio Medicaid opens bid for specialized, kids-focused managed care plan

Program will coordinate comprehensive care services and support for youth with complex behavioral health and multi-system needs

COLUMBUS, Ohio – The Ohio Department of Medicaid (ODM) today released its request for applications (RFA) inviting bidders to submit proposals for OhioRISE (Ohio Resilience through Integrated Systems and Excellence), a specialized managed care program serving Ohio’s kids with the most complex behavioral health and multisystem needs.

OhioRISE will introduce a child- and family-centric plan covering targeted behavioral health services. The model will consist of a network of behavior health providers and care management entities that work together to deliver intensive, coordinated services and reach more children and families statewide. OhioRISE will fill a void that leaves many children and families without access to the care they need.

“Too many times parents wrestle with a heart-wrenching choice: relinquishing custody of their child in exchange for access to life-saving services or face insurmountable health care bills and financial insolvency by seeking care on their own,” said Maureen Corcoran, director of Ohio Medicaid. “The current approach is not good for the child or their family and costs the state and county more money for custody or court involvement. We can do better for the children we serve.”

OhioRISE will drive toward aligning care coordination, expanding the availability of in-home and community-based services, reducing the use of out-of-home care, and leveraging the state’s resources across all agencies to support this unique population of kids. OhioRISE’s governance will be shared by Ohio Medicaid and Governor DeWine’s Family and Children First Cabinet Council, though ODM will hold the program contract.

“For too many Ohio families, especially families with children in crisis, navigating services and supports across Ohio’s state agencies can be a challenge,” said LeeAnne Cornyn, director of Governor DeWine’s Children’s Initiative. “OhioRISE will help to eliminate the barriers that families face, replacing them with a highly engaged, integrated support structure that begins and ends with the child’s needs.”

Children eligible for OhioRISE often face multiple adverse and traumatic experiences, including foster care placement, severe learning and developmental disabilities, struggles with substance use disorders (SUD), or 2 poorly managed mental health diagnoses. Lack of coordinated care results in families using services inefficiently, often seeking costly emergency and inpatient crisis care. The statistics speak for themselves:

  • More than 40% of kids over age 15 in the child welfare system live in congregate care settings.
  • Youth out-of-state placements have grown 200% since 2016, with 140 Ohio kids living in out-of-state mental health treatment facilities on any given day.
  • 38% of youth in the Medicaid program have family members with a history of opioid use disorder, or a serious emotional disorder.

Medicaid anticipates approximately 60,000 eligible children (up to age 21) with significant behavioral health needs will be enrolled in the program. OhioRISE intends to keep families together by meeting defined goals:

  • Expand early interventions to reduce hospitalization and emergency department use.
  • Increase access to community and in-home support.
  • Increase school attendance and participation.
  • Reduce recidivism rates in the juvenile justice system.
  • Provide families with training and support to stabilize their home environment.

OhioRISE is a cornerstone of Governor DeWine’s Children’s Initiative, which helps to advance policies that improve the lives of Ohio's children and families, so every child has a chance for a bright future.

The RFA will be posted until Dec. 16. Bidders can learn more about the OhioRISE procurement process and goals at https://medicaid.ohio.gov/RESOURCES/Legal-and-Contracts/RFPs.