OhioRISE Care Coordination & Care Management Entities (CME)

OhioRISE serves young people who are dealing with behavioral health challenges. These children/youth may need extra support and could be at risk for out-of-home placement or deeper system involvement due to:

• Mental health needs.
• Substance use challenges.
• Autism or other developmental disabilities.
• Juvenile court involvement.
• Situations that lead to child protective services involvement.
• Difficulty with peer and/or family relationships.
• Problems at school.

OhioRISE provides support for behavioral health concerns through “care coordination.” An OhioRISE enrollee and their caregiver/family are paired with a care coordinator who assists them by:

• Designing a care plan that builds on the young person and their caregiver/family’s strengths, needs, culture, and vision.
• Building a care team that collaborates to prioritize child/youth and caregiver/family voice and choice.
• Connecting a child/youth to treatment services and resources.
• Ensuring all needed services are received and barriers to care are removed.

The program provides new and improved behavioral health services including:

• Intensive in-home and crisis services.
• Outpatient services, such as individual and group counseling.
• Inpatient mental health and substance use care at hospitals.
• Behavioral health respite, which is temporary relief for a child/youth’s caregiver(s).
• Primary flex funds, which is funding for services or items to help address a need in a young person’s care plan.

More information about OhioRISE services can be found on the OhioRISE Services flyer.

Young people can be eligible for OhioRISE if they are:

• Between the ages of 0-20,
• Eligible for Medicaid, and
• Need significant behavioral health treatment, as measured by the Child and Adolescent Needs and Strengths Assessment (CANS).

Children/youth may also be eligible because of certain urgent conditions. For example, if a child/youth is in a hospital for behavioral health reasons.

The Ohio Child and Adolescent Needs and Strengths (CANS) assessment is a tool used to determine eligibility for OhioRISE. The CANS assessment also:

• Gathers the young person and their caregiver/family’s story.
• Helps understand the young person and their caregiver/family’s needs and strengths.
• Guides the best ways to provide support.
• Assists with ongoing care planning.

The CANS assessment is updated regularly to make sure the child/youth’s needs are being met.

A CME is an organization that is contracted by the OhioRISE plan (Aetna). In addition to completing CANS assessments, CMEs:

• Provide care coordination for many of the young people enrolled in OhioRISE.
• Have regular communication with OhioRISE enrollees and their caregivers/families.
• Work with community organizations to see what other services and supports are available for the enrollee and their family/caregiver.
• Offer 24/7 crisis support to OhioRISE enrollees and their caregivers/families so they are never alone.
• Advocate for enrollees and their caregivers/families with schools, juvenile courts, behavioral health providers, and others, to ensure their voices are heard and their needs are being met.

Unison Health completes CANS assessments. To request a CANS assessment, you can:

• Complete our online referral form
• Call (419)214-4673

Following a CANS assessment, eligible children and youth are enrolled in OhioRISE effective the date their assessment is submitted.

If a child or youth is determined to not be eligible, they will be sent a denial notice with hearing rights.