New OhioRISE program enrolls more than 8,000 kids with behavioral health needs

Before July, Shirley Grey-Nine and Eugene Nine were exhausted trying to contact all the doctors, mental health workers and others providing care for their 16-year-old autistic son. In some cases, important information was missed amid the chaos.

Then, the Delaware County couple heard about OhioRISE, a new program providing coordinated care for Ohio children with severe behavioral health needs that launched this summer. They enrolled at I Am Boundless and say it's been a blessing.

"It's just overwhelming to try to take care of our home, our family, our jobs and our son's regular needs without trying to run down and track people down and get all these people together. So it's been very helpful," said Grey-Nine.

OhioRISE, short for Resilience through Integrated Systems and Excellence, is the first of several reforms to the state's Medicaid program. It improves past situations where parents had to give up custody of their children to the state in order to get the required, expensive mental health and residential care needed by a child with severe behavioral problems.

Not only will it make care for intensive needs cheaper, but it also keeps families together, advocates said.

Enrollment is expected to grow to 50,000 children by the end of the first year.

What services does OhioRISE provide?

Families covered by Medicaid, government-paid health insurance for nearly 3 million low-income or disabled Ohioans, have access to OhioRISE services.

A care management entity, which is typically a local behavioral health organization, is responsible for the coordination, bringing together schools, behavioral health providers, juvenile services and other systems to provide help tailored to an individual child with severe needs.

"Prior to OhioRISE, kids would get care coordination only when they were at the point that they were going to be sent into placement or into residential care," said Hattie Tracy, CEO of Coleman Health Services, the entity for Summit and Portage counties. "Now, we have the ability to intervene much earlier on."

OhioRISE emphasizes in-home treatment, sending in therapists and others multiple times a week for sessions in a community setting. Emergency mental health assistance is also provided, where a team is dispatched when a crisis occurs.

Respite care allows for caregivers to take a break when needed, substituting in short-term help and serving as a bridge to longer-term solutions. Other services can be provided in addition to mental health care one can access through Medicaid.

There will also be in-state psychiatric residential treatment facilities beginning next year. Those address past issues when out-of-state facilities were sometimes the only option for families.

OhioRISE services are covered by a single insurance provider, Aetna, under a $1 billion contract. Physical health services would be covered separately by other Medicaid insurance.

How can you enroll in OhioRISE?

To be eligible, a child must be 20 years old or younger and already receive Medicaid as his or her health insurance.

Families must take the Ohio Child and Adolescent Needs and Strengths assessment to prove their children require significant behavioral health treatment. Extreme circumstances, such as hospitalization due to a mental health crisis, may also qualify.

To take the assessment, which gathers details on behaviors, needs and trauma, reach out to Aetna, your Medicaid health plan, the Ohio Medicaid Consumer Hotline, a behavioral health professional or the local care management entity. There are 20 regions each served by an entity, which can be found on the Ohio Medicaid website.

If eligible, a care coordinator will reach out to the family to conduct an at-home assessment or have a conversation, said Margrit Springer, vice president of integrated care at Buckeye Ranch, which offers OhioRISE for east Franklin County. From there, a team will be formed to work toward a care plan for the child.

Getting a hold of a family can take some time if no one's picking up the phone or contact information is incorrect, said Springer. It's important to be prepared for your local care management entity reaching out to you to avoid any delay.

Enrollment is mandatory, and to be disenrolled, a request for review is required. Any questions can be directed to OhioRISE@medicaid.ohio.gov.

How is OhioRISE doing?

Almost two months in, up to 8,266 youth are enrolled as of Aug. 18. Upwards of 1,100 people have been trained in care coordination and at least 2,000 have been trained in using the Ohio Child and Adolescent Needs and Strengths assessment.

Most care management entities are in the phase of reaching out and educating families and the community. Understanding of OhioRISE has been mixed among families.

"It's not just families. But there are providers who don't know and still are learning the nuances," said Dr. Jessica McClure, who oversees behavioral health at Cincinnati Children's Healthvine, which offers OhioRISE. "We had pediatricians calling us or saying in those meetings, 'We need more information.' They're going to be in the frontline identifying a lot of these families."

As awareness increases, there's the underlying worry on whether staffing will be able to accommodate more families enrolling into the system. The behavioral health care field is facing a COVID-exacerbated workforce crisis, though right now, the staffing situation is manageable, entities said.

"OhioRISE offers things other than care coordination, like in-home behavioral therapy or mobile crisis services," said Lisa Clark, care coordination director at I Am Boundless. "The problem is, especially in the rural counties, to be able to find the staffing levels to staff those teams is very difficult. I've already heard from providers that they're not going to try to implement those programs, because they know they can't staff them. "

Another thing that still needs to be tested is whether these services will be paid for properly by insurance. Right now, many OhioRISE entities are relying on $19.5 million of grant money to pay for costs until October. The hope is by then, much of the billing and claims process will be figured out.

OhioRISE is still being built out, said Ohio Medicaid Director Maureen Corcoran. But for the Nines parents, having a centralized place for their child's care is already lifting a burden for them.

"It was a lot emotionally to handle and having to tell the story over and over and over and over; it's like reliving the trauma," said Grey-Nine. "So having somebody besides us do that helps take away that emotional overwhelming-ness."

Titus Wu is a reporter for the USA TODAY Network Ohio Bureau, which serves the Columbus Dispatch, Cincinnati Enquirer, Akron Beacon Journal and 18 other affiliated news organizations across Ohio.