Overview

OhioRISE Medicaid Managed Care Program

OhioRISE (Resilience through Integrated Systems and Excellence), is a specialized Medicaid managed care program for children and youth with complex behavioral health needs (mental health/substance use disorder) and multisystem needs. Aetna Better Health of Ohio (Aetna) is the managed care partner for the program.

Children and youth with multisystem needs are often involved in multiple community systems such as juvenile justice, child protection, developmental disabilities, education, mental health and addiction, and others.

The OhioRISE Program uses a “system of care” approach and the guiding principles of a wraparound philosophy. These techniques focus on “wrapping around” a child or youth through care coordination to provide services and supports through a coordinated network in their community. This helps ensure the child or youth functions better at home, in school, in the community, and throughout life.

OhioRISE care coordination uses a Child and Family Team (CFT) approach. Children or youth and their caregivers select members of their CFT. The CFT meets regularly to assist with care planning that focuses on the child or youth’s and family’s strengths, beliefs, culture, community/natural supports, and their voice and choice. OhioRISE care coordination is provided at three levels of intensity:

• Limited Care Coordination (Tier 1) - delivered by Aetna and is the least intensive level.
• Moderate Care Coordination (Tier 2) - delivered by Care Management Entities (CMEs) and uses wraparound-informed strategies.
• Intensive Care Coordination (Tier 3) - delivered by CMEs and adheres to the High- Fidelity Wraparound model.

Additional information on OhioRise can be found on AETNA’s website at https://www.aetnabetterhealth.com/ohiorise/index.html.

You can also learn more about additional services covered in the OhioRise program by visiting the OhioRISE web page at https://www.managedcare.medicaid.ohio.gov/ohiorise.

Who We Serve

Children or youth who are eligible for OhioRISE:

• Are eligible for Ohio Medicaid (either managed care or fee-for-service),
• Are age 0-20,
• Are not enrolled in a MyCare Ohio plan, 
• Require significant behavioral health treatment needs, measured using the Ohio Child.

Services

• Payments for Goods and Services - We process payments for goods and services purchased or provided by for the participant using their allocated budget funds.
• Enrollment support - We help the Aetna Care Coordinators with participant enrollment.
• Customer service - Our professional Customer Service Representatives are available 5 days a week to assist the Aetna Care Coordinators and Vendors.