OhioRISE is a specialized Medicaid managed care program serving children and youth who have complex behavioral health and multisystem needs. The RISE in the program’s name stands for Resilience through Integrated Systems and Excellence, highlighting its mission to provide comprehensive care that meets the needs of each unique individual. Coleman Health Services is proud to partner with OhioRISE as a Care Management Entity, helping connect kids and families in our service areas with the wraparound care they need.
What is OhioRISE?
OhioRISE differs from the regular Ohio Medicaid plan’s coverage for behavioral health by bringing together multiple providers and organizations to ensure children and youth have their needs met through a care plan that values kids’ and families’ voices.
Children and youth with multisystem needs are often involved in multiple community systems such as juvenile justice, child protection, developmental disabilities, education, addiction and mental health. OhioRISE connects those systems to create a care plan tailored to an individual’s needs at every step of their behavioral health journey.
Who Can Receive Help?
Children and youth may be eligible for OhioRISE if they are eligible for Ohio Medicaid, are 20 years old or younger and require significant behavioral health treatment.
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
- Are at risk of out-of-home placement or are returning to their families from out-of-home placement.
A Child and Adolescent Needs and Strengths (CANS) assessment is used to determine eligibility for OhioRISE. It gathers the young person and family’s story, strengths and needs, to determine the best ways to provide help. An individual’s assessment is updated regularly to aid with ongoing care planning.
CANS assessments are available from:
- Child or youth’s managed care organization
- Aetna Better Health of Ohio
- Coleman Health Services
- Medicaid Consumer Hotline
- Behavioral health providers
- Family and Children first councils
What Happens After Your CANS Assessment?
Following a CANS assessment, eligible children and youth are enrolled in OhioRISE effective the date their assessment is submitted.
In urgent cases, enrollment into OhioRISE will be:
The date of admission for an inpatient hospital stay for a mental illness or substance use disorder.
– OR –
The date of admission into a Psychiatric Residential Treatment Facility (PRTF).
Enrollment for OhioRISE is mandatory for children and youth who are eligible. Parents or guardians will receive a notice of denial if their child or youth is not eligible. If a parent or guardian does not want their eligible child or youth enrolled in the program, they can submit a disenrollment request to the Ohio Department of Medicare.
What Does OhioRISE Cover?
The program provides the following 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)
OhioRISE enrollees will also be offered new and improved behavioral health services. They 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.
State and Federal Civil Rights Laws Compliance
Ohio Medicaid and OhioRISE follow state and federal civil rights laws that protect against discrimination or unfair treatment. To help you understand this page, language assistance, interpretation services, auxiliary aids and services are available upon request at no cost to you, connect with the Coleman Health Services team. More information is also available at the OhioRISE website.
Connect with a Care Coordinator
Coleman is ready to answer your questions about OhioRISE – get connected with our team today.