On Friday, July 1, 2022, the OhioRISE (Resilience through Integrated Systems and Excellence) Medicaid program for youth with complex behavioral health and multi-system needs launched after years of development.
OhioRISE seeks to bring comprehensive, coordinated care and new and enhanced services to children and youth with the most complex needs.
OhioRISE seeks to bring comprehensive, coordinated care and new and enhanced services to children and youth with the most complex needs that have, to date, not been able to be served by any one system of care in Ohio. In April, 2022, Aetna Better Health was selected as the managed care plan to operate OhioRISE. On day one of the program, OhioRISE is expected to have enrolled around 5,500 children and youth across 20 care management entities (CME) coordinating care across the state that fall into 20 catchment areas.
Who is eligible for OhioRISE?[1]
- Enrolled in Ohio Medicaid – either managed care or fee for service
- Children and youth aged 0 to 20
- Needs significant behavioral health services
- Meets a functional needs threshold for behavioral health care, as identified by the Child and Adolescent Needs and Strengths (CANS) tool
- In addition, if a child or youth have an inpatient stay in a hospital for mental illness or substance use disorder (SUD); or an inpatient in a psychiatric residential treatment facility (PRTF).
Ultimately enrollment is expected to build to 50,000-60,000 children and youth. The Center for Community Solutions has been active in the policy development leading to this program for many years and will continue to examine how OhioRISE serves youth in Ohio. Community Solutions will also release additional pieces exploring different facets of the program—including one focused on CMEs—to be released later this month.
For now, as OhioRISE launches, we want to ensure Ohio families across the state have access to the information that they need to learn more about the program and explore options that may be available to children in their lives. Linked below are many resources on OhioRISE.
Ohio Department of Medicaid, OhioRISE Frequently Asked Questions
How will OhioRISE operate on Day 1? (slides 5-8)
OhioRISE Brochure for Families and Children
OhioRISE Brochure for Families and Children available in different languages
OhioRISE Information for Community Partners
CANS Assessment Information for Assessors and Members
To learn more about Care Management Entities
[1] Ohio Department of Medicaid, OhioRISE Frequently Asked Questions
