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Questions?
Call 1-833-711-0773 (TTY: 711). We're here for you 7 a.m. to 8 p.m. Eastern Time, Monday through Friday.
You can also find local resources and services to help you.
What is OhioRISE?
What is OhioRISE?
We're a team in a system of care that provides support to children and youth, families/caregivers and their circles of support. It’s a whole-family approach to care for Ohio that aims to keep kids and families together. We’ll help you find your way to specialized behavioral health services and supports close to home and in your community. We can help coordinate care with local:
- Groups
- Resources
- Providers
Who can enroll in OhioRISE?
Who can enroll in OhioRISE?
Youth who may qualify for OhioRISE meet these requirements:
- Are under age 21,
- Are determined eligible for Ohio Medicaid,
- Are not enrolled in a MyCare Ohio plan, and
- Have one of the following:
- Certain needs for behavioral healthcare, identified by the Ohio Children's Initiative (OCI) and the Child and Adolescent Needs and Strengths (CANS) assessment, or
- A recent inpatient hospital stay for mental illness or substance use disorder, or
- A recent inpatient stay in a Psychiatric Residential Treatment Facility (PRTF).
If you’re enrolled in a MyCare Ohio plan and have qualifying needs for OhioRISE services, you can still get access to the care you need. Please contact the Medicaid Consumer Hotline if you’d like to talk about your options. Just call 1-800-324-8680 (TTY: 711), Monday through Friday 7 a.m. to 8 p.m. and Saturday 8 a.m. to 5 p.m.
You can learn more about the CANS assessment, which helps:
- Support decision-making for things like level of care and service planning.
- Improve program quality.
- Check on service results.
All 50 states use a form of the CANS assessment in areas like:
- Child welfare
- Mental health
- Juvenile justice
- Early intervention
Call Member Services at 1-833-711-0773 (TTY: 711) for more information on the CANS assessment.
OhioRISE 1915(c) Home and Community-Based Services Medicaid Waiver
OhioRISE 1915(c) Home and Community-Based Services Medicaid Waiver
The OhioRISE program includes a 1915(c) home and community-based services waiver. The waiver aims to reduce risks and prevent negative health and life outcomes for children with serious emotional disturbances and functional impairments.
Youth who may qualify for the OhioRISE 1915(c) waiver meet these requirements:
- Are under age 21,
- Are determined eligible for Ohio Medicaid,
- Are not enrolled in a MyCare Ohio plan, and
- Are determined to meet the following level of care (LOC) criteria for inpatient psychiatric (IP) services:
- Have certain needs for behavioral healthcare, identified by the Ohio Children's Initiative (OCI) and the Child and Adolescent Needs and Strengths (CANS) assessment,
- Have a diagnosis of serious emotional disturbance (SED), and
- Have documented functional impairment and behaviors.
Youth are considered for enrollment up through age 20 but may continue to remain enrolled in the OhioRISE 1915(c) waiver program through the age of twenty-two (22), if the youth continue to meet the eligibility criteria of the 1915(c) waiver program.
If you’re enrolled in a MyCare Ohio plan and have qualifying needs for OhioRISE services, you can still get access to the care you need. Please contact the Medicaid Consumer Hotline if you’d like to talk about your options. Just call 1-800-324-8680 (TTY: 711), Monday through Friday 7 a.m. to 8 p.m. and Saturday 8 a.m. to 5 p.m.
Some covered services include:
These short-term services, as identified in the Child and Family-Centered Care Plan, are for youth who can't care for themselves due to the:
- Absence of their caregiver.
- Caregiver’s need for relief.
These services and supports, as identified in the Child and Family-Centered Care Plan, help youth and families going through changing conditions or transitions in care.
These supports, as identified in the Child and Family-Centered Care Plan, are designed to meet a need of the youth to address behaviors. They include more services, equipment or supplies that aren’t already provided by the Medicaid state plan.
How your benefits work
We all work together to provide your benefits and help support your family:
Your specialized behavioral health benefits
This is Aetna Better Health of Ohio. We provide your OhioRISE behavioral health benefits. We’ll also assign you a care coordinator or care management entity (CME) to support you and help build your child and family team (CFT).
Your pharmacy benefits
OhioRISE covers medications your doctor gives you in the office to treat mental health and substance use disorders. Gainwell Technologies covers all your other pharmacy services and benefits.
Questions?
You can call Gainwell at 1-833-491-0344 (TTY: 1-833-655-2437) 24 hours a day, except on the Christmas and Thanksgiving holidays. You can also visit Gainwell’s website to learn more.
Your other Medicaid health benefits
If you are a member of a managed care organization (MCO), your other health benefits are covered under that plan. This includes things like rides to healthcare visits and other general health benefits. Contact your MCO for questions about this coverage.
If you are not a member of an MCO, contact the Ohio Medicaid Consumer Hotline for information on your other health benefits. Just call 1-800-324-8680. You can get help Monday through Friday from 7 a.m. to 8 p.m. and Saturday from 8 a.m. to 5 p.m.
Community partners
Community partners
We’re here to provide direct support and resources not only to youth, families and caregivers, but also to:
- Providers
- Community organizations and service providers
- State agencies
You can learn more about OhioRISE:
OhioRISE frequently asked questions
Get involved
Joining a member committee or advisory council allows you to take part, share your voice and help improve our services.
Member committee and advisory councils
You can also stay up to date with local news and events.