Ohio Medicaid chooses Aetna to manage care of kids with complex mental health needs

MM Curator summary

Aetna has won the OH children’s mental health contract.


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Habeebah Rasheed Grimes is CEO of the Positive Education Program in the Cleveland area. It’s one of Ohio’s largest non-profit agencies committed to children with severe mental health and behavioral challenges, their families and the professionals who support them. (Screen shot)

COLUMBUS, Ohio – The Ohio Department of Medicaid chose Aetna Better Health to manage the care of children with complex behavioral health needs in a new program called OhioRISE, Gov. Mike DeWine announced Monday.

When fully implemented, Aetna will get $900 million a year to manage the care of around 60,000 children in OhioRISE from a combination of state and federal money, an Ohio Medicaid spokeswoman said.

DeWine, when announcing the program during a Monday briefing, said the kids tend to need services among many programs administered by the state and federal governments.

He provided some examples of children who would qualify for OhioRISE, such as a child with a developmental disability and a mental illness, or a child with a substance abuse disorder and a chronic health issue.

On an average day, 140 Ohio children receive services outside the state for complex behavioral problems. Parents often have to relinquish custody of their children to ensure they get the care they need. Under OhioRISE, those situations are expected to end. Children are expected to get services in their communities.

“Far too many families in Ohio struggle to stay together, and in many cases that’s not because of abuse or neglect, which is what we normally think of what breaks families up,” DeWine said. “But in this case it’s because their children have very complex needs.”

The contract with Aetna goes begins Jan. 1.

In the first fiscal year, which will last until June 30, 2022, it will cost the state $130 million in new money. In the second year, it will cost Ohio $265 million in new money, with the balance of the roughly $900 million coming from federal government, as well as funds from Ohio Medicaid and other state agencies that had already been used to pay for services for the kids, the Medicaid spokeswoman said.

Habeebah Rasheed Grimes, CEO of the Positive Education Program in the Cleveland area — one of the state’s largest nonprofits that serve these children — said children can have challenges at school and home, contact with the police and county job and family services agencies, as well as hospitalizations. Some children experience suicidal urges.

“We are seeing that the hospital systems are eager to have partners who can support the needs of these young people without them having to be placed into psychiatric beds, or stay in hospital beds for a long period of time,” she said. “They are in need of support from their community and there are financial barriers to the families being able to access some of these sources of support in the community where the child is living.”

Rasheed Grimes said that the coordinated, holistic approach under OhioRISE will give families some assurance that things will work out for the best, with providers, families, patients and others on the same page for treatment.

In 2013, Central Ohio father Mark Butler had to surrender custody of his son after violent outbursts at school and home. Andrew has autism, a severe intellectual disability, several mental illnesses and is nonverbal. Neither Andrew’s Medicaid waiver nor the family’s private health insurance could pay for the health care he needed.

Butler described the sorrow his family felt when Andrew moved to a treatment facility two hours from home.

“That sorrow turned to frustration when I attended meetings and I watched multiple agencies behave almost like you’re playing Hot Potato with my son’s health care,” he said.

These days, Andrew is a happy adult who lives in a supportive living environment. The family has a great relationship with him, Butler said.

Yet Butler said that he doesn’t want other families to suffer as his did.

“My family, like many in our situation, struggled for so long in silence, isolated and afraid of what would happen to Andrew,” he said.


Clipped from: https://www.cleveland.com/open/2021/04/ohio-medicaid-chooses-aetna-to-manage-care-of-kids-with-complex-mental-health-needs.html