OhioRISE Realigned Service Delivery
Next Generation of Ohio Medicaid Managed Care
Consistent with Governor DeWine’s priority and the Ohio General Assembly’s commitment to prevent custody relinquishment, the OhioRISE managed care program realigns spending and invests in a package of intensive, specialized services for a targeted group of eligible youth.1
As a part of the next generation of managed care, ODM will implement OhioRISE (Resilience through Integrated Systems and Excellence)2, a specialized managed care program for youth with complex behavioral health and multi-system needs. OhioRISE aims to shift the system of care and keep more youth and families together by creating new access to in-home and community-based services for children with the most complex behavioral health challenges. The OhioRISE program’s child and family-centric delivery system recognizes the need to specialize services and support for this unique group of children and families.
Building Provider and Service Capacity While Controlling Costs
Now, more than ever, OhioRISE and the intensive community services it envisions are desperately needed by Ohio children with complex needs and the local systems that serve them. Ohio’s experience illustrates the proof over the last few years:
- The General Assembly issued the “Joint Legislative Committee on Multi-System Youth Recommendations”3 report in June of 2016, including recommendations to ensure MSY safety-net funding, access to peer support services, Medicaid-reimbursable high-fidelity wraparound services, and facilitation of data collection that enables the state to track uniform metrics for the MSY population.
- H.B. 166 created the multi-system youth (MSY) custody relinquishment prevention program. To date, the program has served nearly 600 children, with Medicaid managed care organizations covering 75% of expenses. Of the funding requests submitted, 64% sought financial assistance to cover the costliest type of care to prevent custody relinquishment: residential treatment services.
- Even with the MSY program support, children are put on lengthy waiting lists for residential
treatment and the state continues to fund out-of-state services for an average of 140
children at any given time. Cost for these services run as high as $1,100 per day, per kid.”4
- Our Children’s Hospital partners report that their inpatient psychiatric beds are full, with
kids waiting in emergency rooms for days to access behavioral health care – a problem
solved through intensive community services that will be a part of the OhioRISE program.
- Public Children’s Services Association of Ohio (PCSAO) reports a 31% increase in the
number of children in state custody.
Federal Child Protection Laws Emphasize Prevention Services and Community-
Focused, Family-Centric Supports
The Family First Prevention Services Act (FFPSA) of 2018 is the most significant change in child
protection and Title IV-E funding in decades. It requires investing in prevention-focused services,
adds requirements and additional oversight of group residential treatment for children, and
enables children who are foster care candidates to remain in their communities with additional
OhioRISE supports the Family First requirements and more. Enhanced OhioRISE services and the
FFPSA services are being developed collaboratively; with MSY families, stakeholders, providers,
sister state agencies and children’s hospital clinicians. These efforts leverage the support of local
public systems, expand access to less costly community services, avoid the high costs of sending
children out-of-state to receive care and constrain the use of prolonged, expensive congregate
residential services to the greatest extent possible.
Additionally, OhioRISE is consistent with Governor DeWine’s priority and the Ohio General
Assembly's commitment to prevent custody relinquishment. Custody relinquishment is a
heartbreaking, last resort that far too many Ohio parents face. The cost of custody relinquishment
to local public children services agencies (PCSAs) depends on the level of care needed by the child
and includes the cost of case management and placement.5 Examples include:
- $82,192.80 per year for a child who needs congregate residential treatment care.
- $16,777.00 per year for a child who needs foster care.
Compare these figures to cases requiring PCSA involvement in which a child can be cared for at
home, in which the average cost to PCSAs is $651 per year.
Absent OhioRISE, implementation of FFPSA in Ohio would be significantly more costly and
challenging for our state and local child protection system. Figure 1, on the following page,
illustrates critical FFPSA requirements and Ohio Medicaid’s response to support FFPSA compliance
through the OhioRISE managed care program.
Specialized services for OhioRISE will cost an additional $130M in SFY 2022 and $265M in SFY
2023. This realignment and investment in an appropriate service delivery model will drive better
long-term outcomes for children and youth, prevent custody relinquishment, facilitate compliance
with the federally mandated FFPSA and Medicaid requirements, and reduce financial burden for
state and local programs and services such as county developmental disability boards, children
services enforcement agencies, and the department of rehabilitation and corrections.
For a complete analysis of the administrative costs and savings of OhioRISE and other components
of the Next Generation of Medicaid Managed Care, ODM has prepared a white paper which can be
Experience has shown us that kids with the most complex, multisystem needs require a very different type of care coordination and specialized services. Both the DeWine Administration and the General Assembly have acknowledged the need by adopting several recommendations from “The Joint Legislative Committee on Multi-System Youth” and creating the Multi-System Youth Custody Relinquishment Fund.
The growing evidence of need combined with requirements to meet federal FFPSA criteria support the call for a specialized managed care organization (MCO) that brings expertise in serving the most complex, multi-system youth. OhioRISE is the state’s best tool to meet the needs of Ohio’s children and families, to ensure access to transformative health services and to control costs. Building the required provider workforce and service capacity is the key! Working together across agencies, local entities, schools, providers, and health plans, OhioRISE can help families avert the trauma of custody relinquishment and provide the next generation of Ohio’s children with the opportunity to thrive.
2OhioRISE (Resilience through Integrated Systems and Excellence) | Ohio Medicaid Managed Care
4 Absent OhioRISE management of psychiatric residential treatment facility beds and the intensive community
alternatives, Ohio might look like Pennsylvania, which would require Medicaid funding for over 1,250 psychiatric
residential treatment facility beds.
5 The cost indicated is the net cost for a year to the county public children services agency after subtracting federal IVE
reimbursement. Cost estimates provided by PCSAO.