Ohio Department of Medicaid

ODM 2022 Periodical

November 17, 2022

The ODM 2022 Periodical is a short, periodic email update on the progress of the ODM strategic initiatives for individuals who receive services through Ohio Medicaid’s managed care program.

Important Updates on Next Generation Launch

Over the past year, Ohio Department of Medicaid (ODM) has prepared for and successfully launched many components of the Next Generation Ohio Medicaid program. Our implementation has consistently followed our key Next Generation commitment – to focus on the individual. To meet these commitments, on July 1, ODM implemented OhioRISE (Resilience through Integrated Systems and Excellence) and on October 1, we implemented the Single Pharmacy Benefit Manager (SPBM). The feedback has been clear about the significant benefits members have experienced because of these new program changes.

Our focus has been and continues to be on implementing new components and improvements as they are fully ready to support achieving our mission. ODM remains committed to listening to members and we have taken a hands-on approach to resolving implementation issues that have been experienced. ​

What is changing?

Based on the feedback we have received and our commitment to carefully transitioning, we will not implement the new Next Generation managed care plans launch on December 1.  ODM will launch the Next Generation managed care plans and program requirements on February 1, 2023, including exciting improvements that will support members in accessing the healthcare services and supports they need.

What does this mean for members?

There will be no disruption in services for members. The timeline during which a member’s Next Generation managed care plan will be effective varies based on which plan they selected.

• Managed care members that have not made an active plan selection will continue receiving healthcare coverage through their current managed care plan. 
• Paramount Advantage members will continue receiving healthcare coverage through Paramount Advantage until February 1. At that time Anthem will be their Next Generation managed care plan, unless they selected a different plan.
• Managed care members that selected a new Next Generation managed care plan will begin receiving services from that plan February 1.
• Managed care members that selected a different continuing plan, such as CareSource Ohio, Inc., Buckeye Health Plan, Molina Healthcare of Ohio, Inc., or United Healthcare Community Plan of Ohio, Inc., from their current plan will begin receiving services from that plan on December 1.
• Individuals who are newly eligible for managed care, those who are currently in Medicaid fee-for-service but not enrolled with a managed care plan, and those with a gap in eligibility of 91+ days will receive care paid for through Medicaid fee-for-service until February 1, 2023 when they are transitioned to an Ohio Medicaid Next Generation plan.

What's next?

ODM will provide more information about the upcoming implementation for members in the coming weeks. In the meantime, please reach out to This email address is being protected from spambots. You need JavaScript enabled to view it. with questions.

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OhioRISE can benefit you and your family

OhioRISE (Resilience through Integrated Systems and Excellence) is Ohio’s first-ever highly specialized behavioral health program for children and youth with the most complex behavioral health needs who are served by Medicaid. Since its July 1 launch, OhioRISE has enrolled over 12,000 children and youth into the program!

What are the goals and benefits of OhioRISE?

The goal of OhioRISE is to provide new and improved behavioral health services and support to give more children and youth the opportunities they deserve at home, in school, and in their communities. The program helps to prevent custody relinquishment by better serving youth and families who need additional services. To accomplish this, OhioRISE uses evidence-based approaches that help children, youth, and families navigate multiple systems using care coordination. Learn more about OhioRISE care coordination on Aetna Better Health of Ohio’s (the OhioRISE plan) website.

A child or youth may benefit from OhioRISE if they:

• Have multiple needs that result from behavioral health challenges,
• Have multisystem needs or are at risk for deeper system involvement, and/or
• Are at risk of out-of-home placement or are returning to their families from out-of-home placement.

Would you and your family benefit from OhioRISE?

To be eligible for OhioRISE enrollment, a child or youth must be eligible for Ohio Medicaid (either managed care or fee-for-service), age 0-20, and require significant behavioral health treatment needs, indicated by the results of the Ohio Child and Adolescent Needs and Strengths (CANS) assessment. Children and youth may also be eligible for OhioRISE due to certain urgent conditions, like a hospitalization for behavioral health reasons.

If you believe you and your family would benefit from OhioRISE, obtain a CANS assessment referral to help determine eligibility for the program. This assessment gathers a young person and family’s story to understand their needs and strengths and helps determine the best ways to provide help. The CANS assessment is updated regularly to support ongoing care planning. Guidance on obtaining a referral for a CANS assessment is available.

How is OhioRISE impacting Ohio families?

In October, I Am Boundless hosted a podcast episode with Lisa Clark (State Director of Care Coordination and Management at I Am Boundless), Shannon Hunter (Family Engagement Director at Aetna), Marisa Weisel (Deputy Director of Strategic Initiatives at ODM), and Shirley Grey-Nine (OhioRISE parent). I Am Boundless is an OhioRISE CME serving counties in central Ohio. The group engaged in a meaningful discussion about how OhioRISE is impacting Ohio families, while answering questions like:

• How would you describe OhioRISE to a family?
• What does state-wide and local collaboration look like in the program?
• How can OhioRISE support a family as their child’s/youth’s healthcare needs evolve?
• How does OhioRISE customize healthcare and treatment plans for children and youth with complex behavioral health needs?

We encourage you to listen to the podcast on I Am Boundless’ website, on Spotify, or on Apple Podcasts!

Questions?

We are here to help you! To learn more, visit the Resources for Members and Families page of the OhioRISE webpage. If you have questions, reach out to our member help desks who have representatives available to assist you. Please also feel free to direct your questions to the This email address is being protected from spambots. You need JavaScript enabled to view it.

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