OhioRISE (Resilience through Integrated Systems and Excellence) is a specialized managed care program for youth with complex behavioral health and multisystem needs. Behavioral health relates to how a person’s behavior impacts the health of their mind and body. The program is offered to our members in partnership with the Ohio Department of Medicaid (ODM).
The OhioRISE Plan
OhioRISE aims to:
- Expand access to in-home and community-based services.
- Ensure OhioRISE members and families have the tools they need to manage all aspects of their child’s behavioral health care, including:
- Child protection
- Developmental disabilities
- Juvenile justice
- Mental health and substance use disorders
Your child can be enrolled in OhioRISE as an extra level of care on top of regular benefits received through Molina Healthcare.
Ohio residents can seek to enroll their child in OhioRISE if the child:
- Is an Ohio Medicaid member—either managed care or fee-for-service.
- Is under the age of 21.
- Meets a functional needs threshold (certain level of need) for behavioral health care, as identified by the Child and Adolescent Needs and Strengths (CANS) assessment.
Children may also be eligible for OhioRISE due to certain urgent conditions, such as a stay in the hospital for behavioral health conditions.
What is a CANS assessment?
Child and Adolescent Needs and Strengths (CANS) is a functional assessment tool that:
- Assesses the child and family’s needs and strengths.
- Provides decision support to identify good plans for care and services.
- Helps providers make eligibility decisions and support care planning.
A brief CANS is used to determine:
- Level of care coordination
- Qualified residential treatment programs’ (QRTP) level of care (LOC)
- Recommendations for care planning
A comprehensive CANS is used for ongoing reviews. It expands on items in the brief CANS to improve:
- Care planning
You can learn more about the process for referring children/families for a CANS assessment here.
Find a CANS provider in our Provider Online Directory.
OhioRISE services include:
- Intensive and moderate care coordination: Your child will receive one of three levels or "tiers" of care coordination based on the needs of the child and family.
- Mobile Response and Stabilization Services (MRSS): Children in crisis and their families can get immediate behavioral health services to make sure they are safe. They will receive necessary supports and services.
- MRSS is different from 911 emergency services. MRSS responders are trained to handle behavioral health crises.
- Intensive home-based treatment (IHBT): Thorough, time-limited behavioral health services for children, youth and families that help stabilize and improve behavioral health functioning. This helps meet the needs of youth with serious emotional disturbances who are at risk of out-of-home placement or who are returning home from inpatient hospitalization or residential treatment.
- Behavioral health respite: Short-term, temporary relief to the primary caregiver(s) of the child in OhioRISE. This short respite period helps support and preserve the primary caregiving relationship.
- Flexible funds/Customized goods and services: Services, equipment or supplies that may not be provided through Molina that address a need in the service plan. This includes improving and maintaining the child’s opportunities for full involvement in the community.
- Psychiatric residential treatment facility (PRTF): New in January 2023. A service to help keep youth with the most intensive behavioral health needs in-state and closer to their families and support systems.
Coordination between Molina and the OhioRISE Plan
- Molina covers the costs for services our members receive.
- Molina connects members with services that can help them, their caregivers and families.
- Molina works with OhioRISE to provide support for all covered services.
Visit the OhioRISE website to learn more about the program. Parents or guardians whose child is enrolled in OhioRISE can contact OhioRISE Member Services at (833) 711-0773 from 7 a.m. to 8 p.m., Monday through Friday. Parents or guardians who would like to enroll their child in OhioRISE can call their child’s Care Manager or Molina Member Services at (800) 642-4168 (TTY 711) Monday to Friday, 7 a.m. to 7 p.m.