OhioRISE is a specialized managed care program in Ohio’s Medicaid Department for youth with complex behavioral health and multi-system needs. Basically, OhioRISE is Medicaid for youth with behavioral health needs.

The ultimate goal of OhioRISE is to keep youth in their homes, communities, and schools by assessing for and delivering the appropriate intensity of services needed, thus reducing unnecessary out-of-home placement and potential custody relinquishment. State and local level partnering across the juvenile justice, behavioral health, developmental disabilities, child welfare, and education systems, will further this goal.

You can learn more about the OhioRISE program's services and delivery system by watching the video below or by viewing this one-pager.

The Ohio Department of Medicaid has stated, “We want to do better for the people we serve.” This includes an estimated 50-60,000 of Ohio’s most vulnerable children, youth and their families. To accomplish this, a new managed-care approach, OhioRISE, will focus on a population of children and youth with serious behavioral health needs, who are often involved in multiple public youth-serving systems, and their families. Many of these children and youth are often referred to as “multisystem” youth or MSY. These are youth and families for whom more traditional approaches to treatment have not been adequate to meet their multiple and complex needs. Their treatment and support requirements transcend any one public system, including behavioral health, child protection services, juvenile justice, health, developmental disabilities and education.

OhioRISE will support the development of a single managed-care plan for the OhioRISE youth population and their families. The plan will ensure the following: appropriate assessments as to intensity of need; individualized plans of care that draw on an array of in-home and community services; and coordination of these services across various community providers, agencies and systems. Both qualitative and quantitative data reveal there is an ‘intersection’ of youth who need a greater array of services and care coordination than the current Medicaid plan provides. OhioRISE is designed to address the behavioral health treatment and support needs of this group of Ohio’s children, youth and their families, irrespective of any prior or concurrent involvement in any of the public child-serving systems.

• Enrolled in Ohio Medicaid – either managed care or fee for service
• Ages 0 – 20
• In need of significant behavioral health services

• Meet a functional needs threshold for behavioral health care, as identified by the Child and Adolescent Needs and Strengths (CANS) tool
• A child or youth who has an inpatient stay in a hospital for mental illness or substance use disorder (SUD); or an inpatient in a psychiatric residential treatment facility (PRTF)

Families interested in learning about eligibility should contact Aetna OhioRISE Member Hotline at 833-711-0773.

Click here to view a brochure for youth and their families. The brochure provides high-level information regarding OhioRISE to help youth and their families understand the program and its major components. Youth and their families will find information about eligibility, covered services, CANS assessments, how to get more information on OhioRISE, contact information for questions, and more.

Learn more about OhioRise eligibility, services, delivery system and frequently asked questions on the OhioRise website.

Click here to learn more about Care Management Entities (CMEs) providing the services covered by OhioRise.