The program started off with approximately 5,000 kids on day one, since growing to serve more than 22,000 children enrolled in OhioRISE.
Insurance companies cover some of the costs of inpatient psychiatric treatment or other care facilities, but those inpatient costs can quickly become expensive, said Maureen Corcoran, director of the Ohio Department of Medicaid. Corcoran has authorized payments upwards of $1,100 per day to send some children to very specialized programs states away.
“At that point, even middle- and upper-middle-class families are very challenged with those kinds of expenses, and insurance doesn’t pay for it,” Corcoran said. “So at that point, through absolutely no fault of the parents, the only alternative is that the child is sort of given over to the custody of the state, if you will — the child welfare system operated by the counties — and then because of that, Medicaid can then pay for that expensive treatment.”
Ohio Medicaid has heard countless stories of this happening to families, Corcoran said. One couple tried getting a second mortgage, selling their car, and using retirement savings to keep the family together.
“Then they had no other alternatives. In this case, they had to give over custody of their child to the child welfare agency in order for them to be able to have their child’s care paid for because regular insurance won’t pay for it,” Corcoran said.
OhioRISE coordinates wraparound services, such as counselors visiting the home or other evidence-based therapies, to try and divert some children from needing inpatient care. OhioRISE can also help keep families together in some cases even if the child does need inpatient care.
“One component of this program, of OhioRISE, is that we can cover young people on OhioRISE who are of a little bit higher income level, so that if it’s a lower or moderate income family, we can then cover the child on Medicaid without having the family have to give up custody,” Corcoran said.
Care management entities, which are usually local behavioral health providers, work as a network for intake and assistance for the OhioRISE program. Choices CCS (Coordinated Care Solutions), a national nonprofit, covers the area of Montgomery and Preble counties, working with approximately 400 children.
“For instance, we’ve been working with a young man in the Dayton area and he was described last school year as being combative, he was constantly being kicked out of school,” said Amanda Resler, executive director of Choices CCS. The boy was in the custody of his grandmother, who was feeling defeated, Resler said.
“She couldn’t even take him to the grocery store. He would run out and dart in front of traffic. He ended up getting into a stranger’s car,” Resler said.
Through OhioRISE, Choices CCS connected him to I Am Boundless, a local service provider.
“They were able to take a look at his medications that he was on and really look at ways to help assist with his behaviors,” Resler said. Since then, he has been able to join a basketball team and a drumming team, and he is also transitioning back into the public school system.
“That’s really the point of it is to help him stay stable in his home and in his community,” Resler said.
The OhioRISE program uses the Ohio Children’s Initiative Child and Adolescent Needs and Strengths (CANS) as an assessment tool to see if children qualify for the program, as well as to inform care planning.
“We’re going to continue to grow (these) kind of community services so that going to a residential placement or going to the hospital is not the first line of support for a family,” Corcoran said.
For those with questions about services or eligibility, OhioRISE can be contacted at 833-711-0773. They’re available from 7 a.m. to 8 p.m. Monday through Friday. Aetna Better Health of Ohio, the OhioRISE managed care entity, will coordinate a referral for a CANS Assessment to determine eligibility for the OhioRISE program.
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