OhioRISE (Resilience through Integrated Systems and Excellence)
OhioRISE (Resilience through Integrated Systems and Excellence) is a specialized Statewide Managed Care Program for youth with complex behavioral health and multisystem needs. OhioRISE aims to build a system of care and keep more kids and families together by creating access to new and improved home and community-based services. The program’s child and family-centered model recognizes the need to specialize services and supports that honor the voice and choice of children, youth and their caregivers. OhioRISE offers specialized Managed Care Programs, shared governance, coordinated and integrated care and services, and preventing custody relinquishment, including, but not limited to:
Intensive and Moderate Care Coordination- Improved Intensive Home-Based Treatment (IHBT)
- In-state Psychiatric Residential Treatment Facilities (PRTFs)
- Behavioral Health Respite
- Primary Flex Funds
- Mobile Response and Stabilization Services (MRSS)
Populations Served: The individuals served through this Program are children and youth, who have multiple needs which 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. Young people with multisystem needs often require help and services from community systems, which may include juvenile justice, child protection, developmental disabilities, schools, mental health and addiction, as well as other systems in the community.
Children and youth who may be eligible for OhioRISE:
- Are eligible for Ohio Medicaid (either managed care or fee-for-service).
- Are age 0-20.
- Require significant behavioral health treatment needs, measured using the Ohio Child and Adolescent Needs and Strengths (CANS) assessment.
Children and youth may also be eligible for OhioRISE due to certain urgent conditions. For example, if a child or youth is in a hospital for behavioral health reasons.
Location: CareStar has partnered with Ohio Medicaid and Aetna Better Health of Ohio in serving Butler, Warren and Clinton Counties for this Program.
Application Process: To make a direct referral for an individual who could benefit from these services, please utilize the below channels:
- Contact OhioRISE Member Services at 1-833-711-0773 (TTY: 711) from 7 a.m. to 8 p.m. Monday through Friday and Aetna Better Health of Ohio will work with the youth and their Managed Care Organization (MCO) to coordinate a referral for a CANS Assessment to determine eligibility for the Program.
- Contact the youth’s MCO, or if they are in fee-for-service Medicaid, the Medicaid Consumer hotline at 1-800-324-8680 (TTY: 1-800-292-3572) to initiate a referral for a CANS Assessment to determine eligibility for the Program. Below are the websites youth and families/caregivers can use to reach out directly to their MCO:
Managed Care Organization Phone Number Website Anthem BCBS* 1-800-462-3589 www.anthem.com/oh Buckeye 1-866-246-4358 http://www.buckeyehealthplan.com/ CareSource 1-800-488-0134 www.caresource.com/ Molina 1-855-665-4623 http://www.molinahealthcare.com/ United 1-800-895-2017 http://www.uhccommunityplan.com *Administered by Paramount Advantage in West and Northeast Region until later in 2022.
Additional Ohio Medicaid Managed Care Organizations (available in late 2022):
Managed Care Organization Phone Number Website AmeriHealth Caritas 1-833-764-7700 www.amerihealthcaritasoh.com Anthem BCBS* 1-844-912-0938 www.anthem.com/oh Humana 1-877-856-5702 Humana.com/HealthyOhio *Administered by Anthem BCBS Statewide.
External Resources: You can learn more about the OhioRISE Program and eligibility by contacting CareStar through one of the avenues provided here (CareStar OhioRISE Contact Information), or by visiting the OhioRISE Webpage.
Ohio Home Care Waiver Program (OHCW)
The Ohio Home Care Waiver (OHCW) Program is a part of the Ohio Department of Medicaid’s (ODM) waiver services designed to allow individuals with chronic conditions and disabilities receive care in their homes and 
communities, rather than in long-term or intermediate care facilities or hospital
settings. In 1998, CareStar obtained a contract to provide Intake and Case Management services for the OHCW Program in half the State of Ohio and in 2004, CareStar became the sole Statewide provider for this contract. We are proud to maintain our 22-year history of serving fellow Ohioans.
Through this Program, CareStar offers Assessment and Case Management Services in all 88 counties of Ohio to enroll and assist individuals in receiving waiver services that include:
- Skilled nursing care.
- Personal care.
- Homemaking assistance.
- Home delivered meals.
- Personal emergency response systems.
- Accessible home modifications.
- Home maintenance services for minor home repairs and pest control.
- Specialized medical equipment and vehicle modifications.
- Out of home respite care.
- Adult Day Care.
- Supplemental transportation.
Individuals who qualify and are enrolled in the Program will have a CareStar Case Manager assist in the development of a Person-Centered Service Plan to identify services specific to their individual needs. CareStar Case Managers are Registered Nurses and Licensed Social Workers, who work directly with individuals in their home and are dedicated to ensuring the health and safety of individuals in their home and communities.
Through our nine-year span of operations, from 2004-2013, CareStar worked collaboratively with the Ohio Department of Medicaid and the Ohio Attorney General’s Office to establish and build a highly regarded Provider Oversight Program. Our track record of success in educating new providers, reviewing provider compliance and managing incidents helped protect individuals from harm and allowed the State of Ohio to maintain quality providers. At the peak of its operations, CareStar’s Provider Management Services activities covered 8,000 Agency and Independent Providers across the State of Ohio. The three (3) primary service lines within the Provider Oversight Program were Provider Enrollment, Provider Monitoring and Incident Management. As part of Ohio’s HCBS waiver redesign, the State sought to separate Case Management and provider oversight contractors to avoid the appearance of any conflict of interest. As a result, another entity assumed responsibility for Provider Oversight as CareStar was asked to continue case management services due to our outstanding results.
Populations Served: OHCW enrolls Medicaid-eligible individuals from birth to age 60, with diagnoses and medical care needs that meet an Intermediate or Nursing Facility Level of Care. The OHCW makes it possible for these individuals with chronic disabilities or medically fragile conditions to receive care in their home and communities, rather than requiring long-term placement in a nursing facility.
Location: The OHCW is available in all 88 counties of the state of Ohio. Individuals can find additional information at Medicaid.ohio.gov/FOR-OHIOANS/PROGRAMS/Ohio-Home-Care-Waiver.
Application Process: Individuals can request an assessment to determine eligibility for the Ohio Home Care Waiver by contacting their County Department of Job and Family Services, or by calling 1-833-496-1288 to work with a Single-Entry Point (SEP) Support Navigator, who can direct them to the appropriate community resource. CareStar is also a proud provider of SEP and Ohio Benefits Long-Term Services and Supports through the Ohio Department of Medicaid.
External Resources: The Ohio Administrative Code Policy for the Ohio Home Care Waiver Program can be found at https://codes.ohio.gov/oac/5160-46-06 and the waiver handbook can be accessed at Waiver Participant’s Handbook.
Specialized Recovery Services Program (SRSP)
The Specialized Recovery Services Program (SRSP) began in Ohio in 2016 providing Medicaid healthcare insurance for Ohio residents with qualifying medical or mental health diagnoses, who may not otherwise qualify for Medicaid healthcare insurance. In 2017, individuals with Diagnosed Chronic Conditions (DCC) were added to the populations served under this program. The Program provides assessments, ongoing case management and navigation services, as well as some Peer Support and Supported Employment services, to those enrolled in the Program. CareStar has been a Statewide provider in this Program since its inception and has seen it grow to currently serve more than 8,000 individuals.
Populations Served: The individuals served through this program are adults, aged 21 and older, who are diagnosed with severe and persistent mental illness or diagnosed chronic conditions (e.g., end stage renal disease, cystic fibrosis, certain cancer diagnoses, HIV-AIDs, sickle cell anemia and organ transplants). Individuals may receive their insurance through the State Medicaid system or through one of the Medicaid Managed Care Providers (e.g., Buckeye, Molina, Aetna, United Healthcare or CareSource).
Location: CareStar provides Recovery Management Services to individuals in all 88 counties of the state of Ohio.
Application Process: The Ohio Department of Medicaid receives referrals for this Program from mental health providers, medical providers, and County Departments of Jobs and Family Services. These referrals are then sent to CareStar, who conducts an assessment to determine if the individual possesses a qualifying diagnosis from a medical or mental health provider. CareStar’s recommendation for enrollment is sent to the County Department of Jobs and Family Services where income and other requirements are verified. The applicant then receives a letter from the Department of Jobs and Family Services informing them of their eligibility status.
External Resources: The Ohio Department of Medicaid receives referrals at BHCP@medicaid.ohio.gov Interested individuals can also receive assistance by contacting the Ohio Benefits Long Term Services and Supports toll-free number at 833-496-1288.
Single-Entry Point (SEP)
CareStar partnered with the Ohio Benefits Long-Term Services and Supports (OBLTSS) Department in 2015, and later with all 12 Statewide Area Agencies on Aging (AAAs), to manage the SEP Program and assist Ohioans navigate the complex healthcare and service system with a person-centered 
approach. Individuals seeking long-term services and supports sometimes struggle with where and how to find resources. The SEP Program creates a one-stop shop for finding these resources. CareStar’s trained navigators guide Ohioans through the eligibility process for State funded services, including the completion of a standardized long-term service and supports questionnaire (LTSSQ) and Support Navigation. As a SEP Agency, CareStar completes referrals to appropriate Ohio programs and provides community resources for identified needs based on the LTSSQ determination. CareStar provides continued support navigation and follow-up to the individuals until they have been linked to the appropriate services or provided the needed resources to make an informed decision on their care.
Populations Served: The SEP Program helps individuals requiring long-term services and supports, such as those with disabling or chronic conditions, who are in need of assistance with multiple Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) and qualify for Medicaid.
Location: The SEP Program is available in all 88 counties in the State of Ohio.
Application Process: Individuals can contact their local County Department of Job and Family Services, or contact 1-833-496-1288, to complete the LTSSQ and work with a SEP Agency who can link them to the appropriate programs and community resources.
External Resources: Additional information regarding the Single Entry Point Program can be found at https://www.ohiohelps.org/.
Transitional Services
HOME Choice, which was originally designed as Ohio’s “Money Follows the Person” (MFP) federal grant program, is an acronym for “Helping Ohioans Move, Expanding Choice” and is administered by the Ohio Department of 
Medicaid (ODM). HOME Choice Case Management (HCCM) provides Transition Coordination and Community Transition Services to children, older adults, and persons with disabilities participating in the HOME Choice Demonstration Program, who are living in institutions, such as hospitals and nursing facilities, interested in moving from these facilities to home and community-based settings. Through these services, the HOME Choice Program offers support with discharge planning, housing navigation and obtaining goods necessary to establish a basic household, acquired through connections to community resources and the use of program funding. Ultimately, the goal of HOME Choice is to increase an individual’s independence and quality of life by facilitating a successful, sustainable transition to the community. Since CareStar began providing these services, we have helped transition more than 10,000 Ohioans from institutions to home and community-based settings, where they receive long-term services and supports at home and in their communities. Many of these individuals ultimately transitioned to another Medicaid waiver program, such as the Ohio Home Care Waiver Program. With CareStar’s hard work and dedication to this program and these individuals the State of Ohio has been recognized nationally as the leader in Transitional Services!
Populations Served: This Program serves Medicaid eligible individuals who are 18 years of age and older and who have lived in an institutional setting, such as a nursing facility or hospital, for at least 90 consecutive days. To be eligible, individuals must be receiving Medicaid, have enough income or means to sustain community living at the time of application and during the enrollment period, must agree to move to an approved home and community-based services setting, and, finally, must have healthcare needs that can safely be met in the community.
Location: The HOME Choice program is available in all of Ohio’s 88 counties.
Application Process: Individuals may visit the HOME Choice Website to apply for services. Applications are processed by the Ohio Department of Medicaid and a HOME Choice Needs Assessment is completed. If eligible, individuals are assigned a Transition Coordinator within approximately one (1) month from the date the application was submitted.
Community Living Services (CLS)
When a nursing facility resident has expressed an interest in receiving more information about the possibility of returning to a home and community-based setting, a referral is made for Community Living Services (CLS). CareStar receives referrals from the Ohio Department of Medicaid to meet with individuals 
residing in nursing facilities to provide information and community resources to help residents make informed decisions about transition planning. In a face-to-face interview, CareStar’s experienced Specialists obtain information about an individual’s needs and preferences for community living and provide education about what services from which the individual may benefit, making referrals to various services or assisting with program applications, as appropriate.
Population Served: Residents of Ohio nursing facilities, who are at least 18 years of age and older, are eligible to apply for and receive these services.
Location: Interested individuals can reside in any of Ohio’s 88 counties.
Application Process: CareStar receives referrals for Community Living Services on a weekly basis. Referrals are made based on individuals’ responses to the Minimum Data Set (MDS) and the level of assistance required by the resident. Individuals who wish to be referred can contact CareStar at 1-800-616-3718.
Population Health – Health Risk Assessments (HRA)
CareStar has partnered with Managed Care Plans to complete telephonic and in-person Health Risk Assessments, Health Needs Assessments and care planning for eligible members. CareStar completes the assessments to gather updated health 
history and to determine if there are any identified health or social service needs. Risks identified for the individual during the assessment are reported for additional care management follow-up. CareStar is committed to helping identify an individual’s needs and providing resources when necessary.
Population Served: Members of a managed care plan or other medical insurance provider.
Location: CareStar can perform these services where members reside or telephonically.
Population Health Management – Diabetic HEDIS
CareStar assists individuals diagnosed with Diabetes, to obtain maximum health. The goal of this program is to assist in removing barriers to healthcare and decreasing their HbA1c levels to below nine (9). By focusing on all conditions surrounding the individual and providing interventions that address the social determinants of health, CareStar can improve the health of the diabetic population.
Population Served: Members of a managed care plan or other medical insurance provider, who have been diagnosed with Diabetes, currently possess an HbA1c greater than nine (9) and have been hospitalized in the last 12 months with diabetic ketoacidosis (DKA).
Location: CareStar can performs these services where members reside or telephonically.
Multiple Sclerosis Society Case Management
Since 2016, CareStar has partnered with the National Multiple Sclerosis Society to provide Case Management and Assessment services to eligible individuals. The goal of the partnership is to help individuals living with and managing their Multiple Sclerosis, set goals for and receive appropriate care, support, and safety to improve their independence and quality of life. For each individual, CareStar will perform an initial assessment, develop a person-centered care plan, link the individual with caregivers and resources, and follow-up to ensure the plan is being executed and accomplished.
Populations Served: CareStar serves individuals of all ages, who have been diagnosed with Multiple Sclerosis and who the MS Society’s Case Management Program deem eligible.
Location: CareStar can perform services, both telephonically and in-person, across the United States.
Application Process: If you, or a family member, has been diagnosed with MS and believe could benefit from CareStar’s Case Management services, please contact an MS Navigator by calling 1-800-344-4867 and request to work with CareStar. If the Case Management Program eligibility and criteria has been met, the MS Society will refer the applicant to an authorized Case Management Agency (CMA). The CMA will contact the applicant to schedule and complete the assessment, develop goals, and develop a person-centered care plan.
Quality and Utilization Review
CareStar is proud to be Quality Improvement Organization-like (QIO-like) certified by the Centers for Medicare and Medicaid Services (CMS). As a leader in Case Management, Assessment, Technology and Software Development, CareStar uses this Certification to assist our customers with quality assurance, improved healthcare outcomes and reduced costs. Additionally, CareStar engages physicians in specialty areas including, but not limited to, Family Medicine, Cardiology, Pulmonology, Gastroenterology, Neurology, Vascular Surgery, Internal Medicine, and Cardiovascular and Thoracic Surgery, to expand our expertise and capabilities and ensure efficiency and accuracy of our QIO-like activities.
Administered by CMS, a QIO-like Organization is made up of a group of expert healthcare clinicians and professionals contracted to complete utilization reviews and analyze patterns of care related to medical necessity and quality review. State Medicaid Agencies and organizations contracting with CareStar for QIO-like services are eligible for an enhanced Federal match of funds up to 75 percent. The QIO-like Certification is one of CMS’s most significant programs to improve quality and efficiency of healthcare delivery. As of March 2020, CareStar is one of 76 organizations to hold this certification nationally.