Plan to keep kids with behavioral issues with parents
COLUMBUS — Five years ago, Jerry and Karen Freewalt faced a gut-wrenching choice: Should they give up custody of their 17-year-old daughter so she could get the health care she desperately needs?
Their health insurance would no longer cover the extensive behavioral treatments to alleviate her frequent urges to kill herself, and they were far too expensive for the couple to pay on their own.
“That was at her darkest moment when they told us that. She was in a very dire situation when they told us the bad news,” Jerry Freewalt said.
So they were forced to go through the same process as parents suspected of abusing or neglecting their children — complete with a Children Services inspection of their home and interview with Hannah’s two younger brothers — before they would voluntarily relinquish custody and have her placed in an out-of-state facility where she would get the necessary help.
Freewalt made a pact with another Ohio father who suffered through the same agonizing procedure: This should never happen to any other Ohio parent again.
Monday, Gov. Mike DeWine rolled out a $1 billion program designed to go a long way toward achieving that goal. It’s called OhioRISE, which stands for Resilience through Integrated Systems and Excellence.
“Far too many families in Ohio struggle to stay together,” he said.
It doubles about $18 million in seed money added to the biennial state budget two years ago that enabled parents of 469 children to avoid relinquishing custody, and provided technical assistance to 82 additional families.
‘At a breaking point’
But the new setup covers a much broader scope. The ultimate goal of OhioRISE is shifting how care is delivered — creating new access to in-home and community-based services — so more children and parents can stay together instead of giving up custody because their personal insurance won’t cover the cost of needed treatment.
“The current system is at a breaking point,” said Medicaid Director Maureen Corcoran. “We spend up to $1,100 per day to send children out of state to receive supports needed, and we can do better.”
Under the new system, Ohio children showing signs of complex behavioral needs can be given the Child and Adolescent Needs and Strengths evaluation. Once their needs are determined, interventions will be put in place ranging from basic counseling to assigning a caseworker around-the-clock to monitor a juvenile threatening self-harm.
Hubs will be set up so that children in rural areas are served as well. In all, the goal is to serve as many as 60,000 Ohio children within the first couple of years. The state has awarded the contract to manage the new program to Aetna Better Health of Ohio.
Calling the revamped system “a transformational step,” Freewalt said, “I’ve got to tell you, Gov. DeWine cares about this issue a lot. This is a priority for him.”
Revamping care
OhioRISE, set to get off the ground in January 2022, is labeled a “core component of the Ohio Department of Medicaid’s next generation managed care overhaul.”
“This is the crown jewel,” Corcoran said, “because it is central to the governor’s commitment to children. It is new. It is a different approach, a bold approach.”
OhioRISE will assume responsibilities currently handled by five Medicaid managed care organizations hired by the Medicaid agency to operate the federal-state health insurance program for the poor and disabled.
An all-encompassing new managed care contract — a multibillion-dollar pact forecast as the largest in the history of Ohio government — was due for unveiling Jan. 25. Corcoran
says the agreement will be awarded soon. The “go-live” date is Jan. 5, 2022.
Ohio currently has contracts with Buckeye Health Plan; CareSource; Molina Health Care; Paramount Advantage; and United Health Care Community Plan. Eleven companies are in the running to get a piece of the new contract.
Medicaid provides health insurance for almost half of Ohio children, pays for 50% of Ohio births and covers most residents of long-term-care facilities. The state expanded Medicaid coverage in 2014 to individuals making up to 138% — now $30,305 for a three-person family — of the federal poverty level.
Overall, the entire massive restructuring should wind up roughly budget neutral, per Corcoran. The potential cost of $35 million to $58 million represents a small percentage of the multibillion-dollar program, she said.
The new OhioRISE plan was formulated by cabinet directors of agencies that deal with children working with parents and other advocates. Freewalt, director of the Catholic Diocese of Columbus Office for Social Concerns, was one of those advisers.
Life-threatening issues
He’s still motivated by what his family faced as his daughter battled a life-threatening diagnosis of untreatable major depressive disorder, anxiety and acute suicidal ideation.
“She spent 70 days of intensive, inpatient, psychiatric treatment, while the typical stay is three to five days. After a couple weeks at the hospital, during our darkest hour, we learned our private insurance stopped coverage of her stay,” he said.
“We’re a good family and just wanted what was best for our daughter. To us, relinquishing custody is breaking the sacred bond of the family. Facing untold medical costs, our deliberations were heartbreaking. ... We just hoped and prayed.”
But Hannah’s story has a happy ending. With the hospital warning that her 15th electroconvulsive therapy would have to be her last if she didn’t show improvement, she began a rapid recovery that had her merely getting outpatient treatment less than two weeks later.
Hannah now lives on her own and has a job as she remains on medication and receives treatment.
But Freewalt presses on. “We’re doing this because it’s like a personal mission to us to do it.”