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Questions?
Call Member Services at 1-833-711-0773 (TTY: 711). We’re here for you 24 hours a day, 7 days a week.
Experts on your benefits
Experts on your benefits
Care coordinators have experience working with children and families. They also know what services you can receive from your:
- OhioRISE plan for specialized behavioral health (Aetna Better Health of Ohio).
- Other Medicaid health benefits.
- Community providers.
Your first visit with a care coordinator
Your first visit with a care coordinator
A lot happens during the first visit with your care coordinator. First, you’ll complete an assessment. This helps us learn more about your needs and goals. We’ll get information about past healthcare and what services you use now. We will also:
- Review and talk about current behavioral health concerns.
- Help you learn more about conditions that affect you.
- Talk about what level (tier) of care coordination you may need and whether you agree or disagree with that level.
- Understand who is, or should be, on your child and family team so we can connect with them.
- Start to work together on a child- and family-centered care plan that makes sure your behavioral health needs are met.
- Explain how to get services for crisis situations and start to create a crisis plan.
- Set up times for regular contacts through visits and calls.
- Decide what services you need help to set up and how we can help.
- Help you with referrals to specialist care.
- Connect you with healthcare providers, state child-serving agencies and other groups.
- Share how to contact your care coordinator.
- Explain what to do if you want to change your care coordinator or Care Management Entity (CME).
- Help you decide who you want to take part in your child and family team (CFT).
Understanding tiers
Understanding tiers
After you are enrolled, we contact you and share the care coordination tier recommended from the Ohio Children's Initiative (OCI) and the CANS assessment you completed.
Tier 1: Limited Care Coordination
You receive help from an Aetna® care coordinator. Your care coordinator will schedule a visit to your home or a place that you choose.
Tiers 2: Moderate Care Coordination and 3: Intensive Care Coordination
You receive help from Care Management Entity (CME) care coordinators. Your CME care coordinator will schedule a visit to your home or a place you choose.
Care Management Entities (CMEs) are local organizations that know all about:
- The area where you live and what local services your community offers.
- How to work with state systems that serve children and youth.
- How to help you make decisions that improve your health.
- Building systems of care to support you and your community.
Your child and family team (CFT)
Your child and family team (CFT)
This group of people includes:
- The child
- The family or caregivers
- A behavioral health provider
Your team can also include:
- Teachers
- Extended family members
- Friends
- Family support partners
- Healthcare providers
- Coaches
- Community resource providers
- Representatives from religious affiliations
- Representatives from other service systems like juvenile justice
- Anyone in your life that you invite to take part
The size, scope and intensity of involvement of your child and family team members depends on:
- Your goals
- Your needs
- Your preferences
- Resources to make an effective child- and family-centered care plan
People can join or leave your team to make sure you get the best care. Learn more about our system of care.
CMEs are OhioRISE plan’s collaborative partner — a “go-to” place to help families/caregivers, providers and other community partners navigate a complex and often confusing multi-system environment. There are 18 CME catchment areas in the state.
System partners can request information about their member’s care coordinator by:
- Calling Member Services at 1-833-711-0773, the select the Care Coordination queue
- Email us
You can learn more about the CMEs and their catchment areas (PDF) at these links:
Choices® Coordinated Care Solutions (PDF)
Cincinatti Children’s HealthVine (PDF)
ColemanSM Health Services S (PDF)
ColemanSM Health Services O (PDF)
Integrated Services for Behavioral Health — catchment area H (PDF)
Integrated Services for Behavioral Health — catchment area I (PDF)
Jefferson Country Educational Services Center (PDF)
Lighthouse Youth & Family Services (PDF)
National Youth Advocate Program (PDF)
Positive Education Program (PDF)