CareSource joins bid for state contract to care for high needs kids

Nov. 29--CareSource announced it joining with another Ohio nonprofit to bid for a state contract to manage the health care of high-needs children.

The Dayton-based insurance company is working with Ohio Children's Alliance, a statewide network of community agencies who serve children and families, to form a new venture called Kids' Care Alliance, which is a stand alone organization that will submit a bid seeking a contract with the recently announced OhioRISE program.

The two organizations have a new venture called Kids' Care Alliance, which is a stand alone organization that will submit a bid seeking a contract with the recently announced OhioRISE program.

Ohio Medicaid is spinning off a separate Medicaid program called OhioRISE, which will coordinate the care of children with complex behavioral health needs. The department is accepting bids and will select which insurers it trusts to manage the claims and care for these children.

Insurers have until Dec. 16 to submit their bids.

"While CareSource has collaborated closely with the Ohio Children's Alliance to care for multi-system youth for nearly a decade, we are now creating a separate organization dedicated to breaking down silos and getting to the heart of family-centered care," Steve Ringel, CareSource Ohio Market president, said in a statement. "Often, children with complex behavioral health needs engage with multiple providers and services at the same time. Kids' CareAlliance's focused approach will significantly improve this coordination."

The separate Medicaid program will coordinate care for an estimated 60,000 children and young adults. The program is intended to cover mental and behavioral health care that in the past might not have been covered and also will provide coordination to help navigate what can be a maze of different systems and programs, such as juvenile justice and corrections, child protection, developmental disabilities, mental health and addiction, education, and others.

Children eligible for OhioRISE often face multiple adverse and traumatic experiences, including foster care placement, severe learning and developmental disabilities, struggles with substance use disorders, or poorly managed mental health diagnoses. Lack of coordinated care results in families using services inefficiently, often seeking costly emergency and inpatient crisis care.

The new program is part of a sweeping health care overhaul being led by Ohio Department of Medicaid and Gov. Mike DeWine's administration. The DeWine administration is creating a new set of conditions for how the 3 million Ohioans covered by Medicaid get their care and will reselect which insurance companies it trusts to manage their benefits.

The story so far: OhioRISE

Previously: Ohio Medicaid announced Oct. 28 that it is carving off a separate program called OhioRISE specifically designed to coordinate the health care of kids who have complex behavioral health needs and get care from multiple complicated systems.

What's new: CareSource and Ohio Children's Alliance announced they are forming a separate entity called Kids' Care Alliance that will bid on getting a contract to manage the health care of the kids in the program.

What's next: Insurers have until Dec. 16 to submit their bids.

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