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Does Ohio Medicaid Cover Alcohol Rehab?
The OhioRISE program provides additional behavioral health coverage beyond that offered by Ohio Medicaid. Care under OhioRISE must be provided by an OhioRISE plan, such as Aetna Better Health of Ohio.
Ohio Medicaid is the state's program that provides health coverage for low-income individuals. It is funded by both the federal government and the state. There are several different types of Ohio Medicaid programs available to eligible residents:
- Traditional Fee-for-Service (FFS) – covers medical services provided directly by a doctor or other healthcare provider.
Managed Care (MCO) – allows members to choose from multiple health plans that provide coordinated care through networks of doctors and hospitals.
Outpatient treatment options vary from one facility to another depending on what services they offer. These include traditional counseling sessions where patients can talk about their problems without having to leave work or school while receiving support from professionals who understand how difficult it can be living with alcohol addiction.
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Behavioral Health Services Inside Medicaid
Ohio Medicaid behavioral health benefits sit beside and complement OhioRISE services. OhioRISE is not a replacement for other mental health or substance use disorder treatment. OhioRISE complements it and fills gaps in care that are not covered by the regular Medicaid benefit.
Base Ohio Medicaid behavioral health coverage differs from those covered by OhioRISE.
Inside Ohio Medicaid, behavioral health care coordination services and case management are available to members who need help managing their mental health care.
Care Coordination is a service that helps with the management of mental health conditions, including:
- helping the member find providers for care
- working with other agencies or community resources on behalf of the member
- coordinating and arranging care as needed
Care Coordination and case management are available to all OhioRISE members who need this help.
Care coordination in Ohio Medicaid managed care helps members stay healthy by providing access to services at the right time and in the right place, with a goal of improving outcomes.
In OhioRISE, Aetna Better Health of Ohio is the MCO. They work with the youth and family to ensure they get all of their behavioral health services.
Behavioral health services, including substance use disorder treatment, are an essential part of a person's overall healthcare. Rehab centers that specialize in substance use disorder treatment can also help people with mental illness who are also struggling with addiction. This type of treatment is often called co-occurring disorder treatment.
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Next Generation Managed Care Plans
Next Generation managed care plans in Ohio began operating on February 1, 2023, and offer enhanced benefits to the Medicaid population and the state.
OhioRISE is a behavioral health plan administered by Aetna Better Health that serves the entire state and offers enhanced benefits beyond traditional Medicaid. It provides individualized care management and behavioral healthcare services for youth enrolled in Ohio's Medicaid managed care plans.
The OhioRISE plan covers the following:
- Mental health services (including crisis care).
- Substance use disorder treatment.
- Care coordination and care management supports.
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OhioRISE for Children and Youth
OhioRISE is a special Medicaid program for children and youth aged 0-20 years who have complex health and behavioral health needs. OhioRISE brings together care coordination from various systems to make sure these kids get the help they need from one system instead of several different ones. This includes:
- Juvenile justice
- Child protection services
- Schools
- Developmental disabilities services
- Mental health or addiction services
These children and youth often require the support of multiple systems, which can be confusing and difficult to coordinate.
For a child already on Ohio Medicaid, OhioRISE adds additional supports such as care coordination and mobile response and stabilization services. If the child has a behavioral health diagnosis, they may also qualify for other OhioRISE services.
Care Coordination – Care coordinators are assigned to each child and youth in OhioRISE based on their needs and preferences. These individuals will help families identify and access appropriate medical, mental health, and social supports. The care coordinator will provide ongoing support for children or youth and their families who may benefit from additional coordination of services.
Mobile Response and Stabilization Services (MRSS) – When there is a need for behavioral health crisis stabilization, this service will be provided by a mobile crisis response team.
Intensive Home-Based Treatment (IHBT) – When an OhioRISE youth needs more support than what can be provided through care coordination, mobile response services, or behavioral health respite, they may qualify for intensive home-based treatment.
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Who Qualifies for Ohio Medicaid
Eligibility for OhioRISE starts with Ohio Medicaid eligibility.
Ohio Medicaid membership is required before a child or youth can join OhioRISE. You must first be an Ohio Medicaid member in order to enroll in OhioRISE.
Children and youth can receive Medicaid coverage through fee-for-service or managed care.
Youth aged 0-20 at the time of enrollment who need help with behavioral health treatment are eligible. A CANS assessment must show a need for behavioral health services to qualify.
OhioRISE eligibility is limited to children and youth who have an unmet need for behavioral health services based on their assessment. The CANS tool will be used to identify youth and family needs.
To be eligible for OhioRISE, the youth must be enrolled in an Ohio Medicaid health insurance plan: Medicaid managed care or traditional Medicaid (fee-for-service).
OhioRISE eligibility is limited to children and youth, who must first be enrolled in Medicaid to participate in OhioRISE.
OhioRISE is a new program for children and youth ages 0-20 who have unmet needs for behavioral health services.
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Applying for Ohio Medicaid Coverage
County Departments of Job and Family Services accept applications for coverage through Ohio Medicaid. Apply at your local CDJFS office.
The Ohio Benefits Self-Service Portal and county offices offer a variety of ways to apply for Medicaid coverage.
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Finding a Provider That Takes Medicaid
County boards inform residents about continuum services and facilitate referral to appropriate services.
Local ADAMH boards contract with providers.
A provider that takes Medicaid is not the same as finding a rehab center that takes Medicare or private insurance. While there are many similarities between the two types of insurance, they are also quite different in many ways.
Medicaid is a government-funded program that provides healthcare coverage to low-income individuals and families. This includes children, pregnant women, people with disabilities, and elderly adults.
On the other hand, Medicare is an insurance program run by the federal government. It provides health care coverage for retired workers and their spouses, people with certain disabilities, and people with end-stage renal disease (ESRD).
While both Medicaid and Medicare offer important benefits to those who qualify, there are some key differences between the two programs.
The Ohio CareLine and 988 can connect someone with behavioral health concerns to a local crisis counselor.
The continuum is an array of community-based prevention, treatment, recovery support, and other services for individuals with substance use disorders and/or co-occurring mental illness.
The board contracts with providers for prevention, treatment, recovery supports, and other services to be provided within the county or counties it serves.