Home » Blog Articles » Medicaid Waiver programs » OhioRISE: New Ohio Program for Behavioral & Community Health

The state of Ohio has a new managed care program called OhioRISE (Resilience through Integrated Systems and Excellence). The specialized program is focused on improving the state’s ability to provide supports for youth with complex behavioral health needs including children in foster care.

As a company, ABCS RCM has delivered billing, insurance credentialing and marketing services to behavioral health and other healthcare agencies for many years. This includes delivering account management, EVV software and billing services to Ohio Medicaid Waiver Provider Agencies. We understand the challenges that healthcare professionals face when providing services to these populations.

We are grateful for the recent update from the state of Ohio about the expanding of access to in-home and community-based services. People in this population are in need of supports, so it is good that the state is directing more attention and resources to the individuals who need it.

If children are in need of emergency medical treatments, they can often receive healthcare services through their family’s private commercial insurance, Medicaid, or CHIP (Children’s Health Insurance Program). However, finding treatment for behavioral health disorders is more of a challenge. Just like adults, children can struggle with the symptoms of depression as well as other mood disorders. In these situations, finding adequate and locally accessible behavioral health treatment services and placements is difficult.

Some current numbers for children with multi-system needs:

  • 38% of youth have family members with a history of substance use disorder or mood disorder.
  • 140 children per day are receiving care from out of state which has tripled since 2016.
  • In the child welfare system, over 40% of children over the age of 15 live in group homes or residential treatment facilities.

The goal is for the OhioRISE program to create better coordination of care for children who need behavioral health, community-based treatment services.

Officials at the Ohio Department of Medicaid have stated that: “Though multiple state agencies serve a majority of these children, the current absence of accountable, focused coordination to integrate these programs leaves parents facing an overly complex system of care during times of family crisis.”

Ohio’s Medicaid-managed care programs will grant children with mental health disorders expanded access to services and treatments. This should alleviate insurance coverage concerns for many children and their families. The program will focus on helping families prevent custody relinquishment due to lack of sufficient insurance coverage.

The OhioRISE program is in cooperation with Aetna healthcare. Aetna has successfully operated other programs in Ohio like the MyCare Ohio plan for over seven years. The Aetna MyCare plan is a complex dual eligibility state and federal benefits managed care plan.

The key components and of new program are:

  1. OhioRISE
  2. Medicaid Managed Care Organizations (MCOs)
  3. Service Providers
  4. Department of Medicaid
  5. Network of Care Management Entities (CMEs)

Aetna will serve as the central point of contact for over 26,000 people in Ohio. The launch of OhioRISE MCO is seen as Medicaid’s next generation of managed care organization. In cooperation with the Ohio Department of Medicaid (ODM), as well as other stakeholders, the program will implement upgraded and new support services. This includes a new 1915(c) Medicaid waiver that is focused on improvements in cross-system results for the beneficiaries.

As of the publication date of this article, eligibility for the OhioRISE program are:

  • The individual meets a functional needs threshold for behavioral health care, as identified by the Child and Adolescent Needs and Strengths (CANS) tool.
  • The individual is under the age of 21 years of age.
  • The individual is enrolled in Ohio Medicaid – either managed care or fee for service

The new OhioRISE program is scheduled to launch in January 2022.

About ABCS RCM:

Advanced Billing & Consulting Services provides a variety of back-office solutions for healthcare practitioners. Their professional services include medical billing, insurance enrollment and credentialing monitoring services and digital marketing for healthcare professionals.

As an Ohio-based company, they also provide software tools, EVV and billing services for agencies that provide supports for the Ohio I-DD community.

To learn more, email or call them at 614-890-9822.

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