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OhioRISE: Who is eligible and what are the benefits?

On Behalf of | Mar 30, 2023 | Children With Special Needs

On August 26, 2022, Ohio Gov. Mike DeWine officially announced the launch of OhioRise (Resilience through Integrated Systems and Excellence), a managed care plan to serve youth with complex needs.

In his announcement, DeWine said: “OhioRISE offers hope for thousands of Ohio families who have long struggled to find help for their children,” DeWine said. “It enables us to coordinate the care and services for at-risk kids, to better meet their emotional, behavioral, and physical needs.”

In a statement, The Ohio Department of Medicaid (ODM) said it has been concerned with the rise in use of congregate care settings for children with multiple needs, especially the increased use of out-of-state placements.

“Children with complex multisystem needs require a very different type of care coordination and different service array,” according to ODM. “Studies show that intensive community-based care coordination that is driven by kids and their families can have a significant impact on inpatient and emergency department use, moves between homes, family engagement and satisfaction, and life outcomes.”

OhioRISE enrollment began in July 2022. ODM estimated that 50,000-60,000 children would be enrolled within 12 months. See the Ohio Medicaid Managed Care web page on OhioRISE.

Who is eligible for OhioRISE?

To be eligible for OhioRISE, children and youth must be Medicaid eligible, age 0-20 and require significant and intensive Behavioral Health Treatment. Evidence of need is established through:

  • Child and Adolescent Needs and Strengths (CANS) assessment, or
  • Being an inpatient in a hospital for mental illness or substance abuse disorder
  • Being an inpatient in a Psychiatric Residential Treatment Facility

The CANS Assessment Tool: evaluates child and family needs and strengths; determines eligibility; and assists in care planning decisions. CANS Assessments must be done by people who have received training through ODM.

OhioRISE benefits

The OhioRISE program covers most existing behavioral health services for youth who are enrolled into the program. Benefits also can include:

  • Behavioral health respite for caregivers of OhioRISE enrollees
  • Flex funds for equipment or supplies that promote full inclusion in the community
  • Mobile Response and Stabilization Service (MRSS) for youth in crisis and their families, providing immediate behavioral health intervention to help them stay safe and receive necessary support and services.
  • Intensive and Moderate Care Coordination
  • Intensive Home-Based Treatment, which provides intensive behavioral health services for children, youth and families to stabilize and improve behavioral health functioning.

In 2023, OhioRISE will launch Psychiatric Residential Treatment Facilities. These facilities will provide inpatient-level behavioral health treatment services in a residential setting. The goals are twofold: quickly stabilize behaviors and treat symptoms of children and youth with acute behavioral health needs; and help children and youth prepare to return to a lower level of treatment or family-based setting.

If you have questions about OhioRISE, contact Hickman Lowder.