COLUMBUS, Ohio – The Ohio Department of Medicaid (ODM) selected Aetna to serve as the specialized managed care organization for the state’s children with the most complex behavioral health needs under the new OhioRISE (Ohio Resilience through Integrated Systems and Excellence) program. Aetna will work with ODM and Governor DeWine’s Family and Children First Cabinet Council to implement a child and family-centric model featuring new targeted services and intensive care coordination delivered by community partners. Aetna also will coordinate with the state’s Medicaid managed care organizations and the new single pharmacy benefit manager to ensure medical and pharmaceutical services and supports are integrated in the child’s comprehensive health plan.
The OhioRISE program addresses gaps in Ohio’s health care system that currently result in 140 Ohio kids living out of state on any given day in order to access the behavioral health services they need. Other families voluntarily relinquish custody of their children to local child welfare agencies solely to access needed behavioral health care for their children. The OhioRISE managed care plan will fill in these gaps by developing a network of care management entities and by working with Ohio’s behavioral health providers to offer new intensive, coordinated services for children and families statewide.
“Too often, parents wrestle with a heart-wrenching choice to either relinquish custody of their child in exchange for life-saving services or face insurmountable health care bills and financial insolvency by seeking care alone,” said Maureen Corcoran, director of Ohio Medicaid. “The current system is at a breaking point. We spend up to $1,100 per day to send children out of state to receive supports needed, and we can do better.”
Ohio aims to enroll 55,000-60,000 Medicaid-eligible children, up to age 21, in the OhioRISE program. Though multiple state agencies serve a majority of these children, the current absence of accountable, focused coordination to integrate these programs leaves parents facing an overly complex system of care during times of family crisis.
Aetna earned the highest total evaluation score among the four proposals received and brings more than 25 years of experience designing and developing similar programs for children and families across the country. In fact, within the first seven months of launching its Mountain Health Promise plan in West Virginia, Aetna reduced the number of children sent out-of-state by 9.6%, decreased the rate of in-state group home placements by 7.4%, and lowered the number of children residing in shelters by 14.5%. Additionally, Aetna recently implemented the new Supporting Kentucky Youth (SKY) Medicaid managed care program.
Aetna serves as the sole statewide coordinator of physical and behavioral health, dental care, and social services for approximately 28,000 children and youth in Kentucky’s child welfare and juvenile justice systems. Today, more than 225,000 children in 13 states receive high-intensity behavioral health programming and wraparound care coordination through Aetna.
Aetna’s Ohio experience also is strong. For more than seven years, Aetna has successfully managed care in for MyCare Ohio -- one of the state’s most complex dual eligibility state/federal benefits programs. Aetna’s MyCare Ohio offering aligns benefits administration for Ohioans eligible for both Medicare and Medicaid benefits. In this role, Aetna serves as the single point of contact to more than 26,000 Ohioans, helping them navigate health care services and supports offered through each.
As the OhioRISE MCO, Aetna will be responsible for:
- Building capacity for new intensive, community-based services by developing and strengthening partnerships with community providers.
- Designing outcomes-based payment innovations and identifying strategies to leverage individual practitioners' unique strengths and support services.
- Serving as a single point of accountability to assist families, health care providers, and other system partners in accessing services and supports when needed.
- Collaborating with Medicaid’s next generation managed care organizations to develop agreements and operating relationships responsive to systemic and individual member issues.
Partnering with Governor DeWine’s Family and Children First Cabinet Council on key initiatives, and cross-agency work to better serve children who have co-occurring intellectual or developmental disabilities and behavioral health challenges.
OhioRISE is an integral cornerstone of Governor DeWine’s Children’s Initiative and is governed by ODM and Governor DeWine’s Family and Children First Cabinet Council. The program supports Ohio’s response to the Family First Prevention Services Act (FFPSA) of 2018 – the nation’s most significant change in child protection and Title IV-E funding in decades.
OhioRISE launches in January 2022 and is a core component of ODM’s next generation managed care overhaul.
# # #