OhioRISE Brings New Hope to Families of Multi-system Youth

July 1 began a new era in Ohio: one in which some of Ohio’s children and youth — those with significant behavioral health needs who are also involved with other social service systems — no longer have to navigate a maze of systems and bureaucracies. And they have access to more specialized behavioral health resources than ever before.

For children and youth with the most complex and challenging behavioral health needs, this means their families might be spared a devastating choice that others have been forced to make: relinquish custody of their children to the county so their child can access costly and desperately needed behavioral health services.

This opportunity is a result of Governor DeWine’s OhioRISE (Resilience through Integrated Systems and Excellence) program, the first installment of the Next Generation of Ohio Medicaid Managed Care, launching in stages throughout this year. I’m proud Aetna was chosen to be the health plan partner for this program.

The idea behind OhioRISE is kids and families involved with multiple systems need greater coordination of care and, often, more-intensive services. For example, a child or youth involved with the juvenile justice system may also have a behavioral health issue, such as mental illness or addiction. Another young adult with addiction or mental illness may also qualify for developmental disability services. And those same children and youth could be in foster care.

Without OhioRISE care coordination services, each system might have a different plan for the child or youth, and those plans might have conflicting goals and approaches. Enrollment in OhioRISE means a single care coordinator will interact with the family and oversee the child’s care in all involved systems. It also entitles families to new and enhanced Medicaid services, including intensive home-based treatment; in-state psychiatric residential treatment facilities; behavioral health respite care; and flexible funding opportunities, which allows for non-Medicaid purchases such as tutoring, summer camps and other medically necessary resources for the member.

Many states have had the difficult challenge of ensuring all systems understand the totality of the child’s needs. With OhioRISE, the State of Ohio is at the forefront of solving this problem and eyes are on all of us as we work together to bring the program to life.

At the start of July, over 5,500 children were automatically enrolled in OhioRISE based on what the state already knew about their needs. Our challenge is to reach all of those “day one” members to make sure they’re utilizing their benefits and services under this new program.

I wish every case was like the one in which a dad, after receiving a notification postcard, called our office at around 6:30 p.m. on July 1, saying, essentially, “Really? We get what?”.  We found another family after a dad, desperate to help his child, wrote a letter to a legislator who passed it on to us. We were at the family’s home and activated services the same day.

Since July 1, we’ve also enrolled over 3,000 more new members — families who were referred by a health care provider, teacher, insurance plan, social worker or community partner. Some have heard of OhioRISE and inquired on their own.

There is no wrong door for enrolling in the program, with multiple pathways for families to seek and find care. A child or youth age 0 to 20 can be enrolled if he or she meets these criteria:

• Qualifies for Ohio Medicaid (either managed care or fee-for-service)
• Requires significant behavioral health treatment, measured using the Ohio Child and Adolescent Needs and Strengths (CANS) assessment
• Is eligible for OhioRISE due to certain urgent conditions. For example, if a child or youth is in a hospital for behavioral health reasons

As soon as a child or youth is enrolled, an OhioRISE care coordinator reaches out and convenes a child and family care team for that member, creating a coordinated, ongoing care plan that “wraps around” the whole family. OhioRISE care coordinators will consider questions such as how is the child doing academically? Do they need social supports, after school programs or would belonging to a sports team or taking art classes benefit the youth? Does the family need referral to a food bank?

To date, our Care Plan Review Team has completed over 1,000 care plan reviews. There is a lot of work ahead and eventually we expect full program capacity to have 50,000 to 60,000 children enrolled.

I spent many years as a mental health clinician in a variety of provider settings, such as children’s residential, foster care, even the prison system, and was CEO of a mental health center before moving to managed care to assist with the carve in of behavioral health services. I joined Aetna when it was chosen to be the provider of OhioRISE — truly the most exciting thing happening in children’s mental health, and I am thrilled to be a part of it.

The best part is seeing hope dawn in the eyes of families who see a path to help for their child for the first time. Before OhioRISE I saw many families, caught in the swirl of not knowing where to go for help, give up before they got started.

We’re still in the infancy phase with OhioRISE, and all who are helping built it are working together. It’s tremendously exciting to be in on the ground floor of solving a problem families have struggled with for decades.

Find more information about OhioRISE here.