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OhioRISE Plan

The Ohio Department of Medicaid (ODM) implemented OhioRISE (Resilience through Integrated Systems and Excellence). OhioRISE is a specialized managed care program for youth with complex behavioral health and multisystem needs.

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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 direct their interactions with multiple systems, including:
    • Child protection
    • Developmental disabilities
    • Education
    • Juvenile justice
    • Mental health and addiction

Even if you are enrolled in the OhioRISE program, you can be enrolled in a managed care plan like Humana Healthy Horizons™ in Ohio for your physical health benefits.

Eligibility

Ohio residents can enroll in OhioRISE if they:

  • Are already enrolled in Ohio Medicaid—either managed care or fee-for-service
  • Are under the age of 21
  • Meet a functional needs threshold for behavioral health care, as identified by the Child and Adolescent Needs and Strengths (CANS) tool

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 appropriate approaches to care and services
  • Helps providers make eligibility determinations and support care planning

A brief CANS is used as the initial assessment and includes core items to determine:

  • Eligibility
  • Tier of care coordination
  • Qualified residential treatment programs’ (QRTP) level of care (LOC)
  • Recommendations for care planning

A comprehensive CANS is used for ongoing assessments and expands items in the brief CANS to improve:

  • Care planning
  • Coordination

An assessor (e.g., provider) can use the comprehensive CANS during an initial assessment.

Get information about the process for referring children/families for a CANS assessment, PDF

Get a list of CANS providers, PDF

Review the general time frame for a CANS assessment and OhioRISE eligibility determination, PDF

Available services

New and enhanced services available through OhioRISE include:

  • Behavioral health respite: Short-term, temporary relief to the primary caregiver(s) of an OhioRISE plan enrolled youth, in order to support and preserve the primary caregiving relationship
  • Care coordination: Depending on the youth’s needs, he or she will receive 1 of 3 levels of care coordination
  • Flexible funds/Customized goods and services: Services, equipment, or supplies not otherwise provided through the Medicaid state plan that address an identified need in the service plan, including improving and maintaining the individual’s opportunities for full participation in the community
  • Intensive home-based treatment (IHBT): Intensive, time-limited behavioral health services for children, youth, and families that help stabilize and improve behavioral health functioning
  • Mobile response and stabilization service (MRSS): Youths in crisis and their families can get immediate behavioral health services to ensure they are safe and receive necessary supports and services
  • Psychiatric residential treatment facility (PRTF): This service is aimed at keeping youth with the most intensive behavioral health needs in-state and closer to their families and support systems

Humana Healthy Horizons in Ohio:

  • Covers the costs associated for services our members get
  • Connects members with services that can help them and/or their caregivers/families

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Value-added benefits

Learn about the extra benefits and services available to Humana Healthy Horizons in Ohio members.

Documents & forms

Find the documents and forms you need, including your Member Handbook.