MY GUIDE Age 1 Up to Age 3 > DSHS Children with Special Health Care Needs Program (CSHCN)

KEYWORDS: age 1 up to age 3age 3 through 5agenciesnewborn up to age 1state agency

Medical services and financial assistance

The Children with Special Health Care Needs (CSHCN) program provides services to children with extraordinary medical needs, disabilities, and chronic health conditions. The program pays for medical care, family support services, and related services not covered by Medicaid, CHIP, private insurance, or another party.

Eligibility for CSHCN

To qualify for CSHCN, applicants must:

  • Live in Texas

  • Be under 21 years old (or any age with cystic fibrosis)

  • Have a certain level of family income

  • Have a medical problem that

    • is expected to last at least 12 months

    • will limit one or more major life activities

    • needs more health care than children usually need

    • has physical symptoms (This means that the program does not cover clients with only a mental, behavioral or emotional condition, or a delay in development.)

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List of program benefits

The CSHCN program administers program benefits which helps clients with:

  • Medical, dental and mental health care
  • Drugs
  • Special therapies
  • Case management
  • Travel to health care visits
  • Insurance Premium Payment Assistance (IPPA)

And much more

CSHCN Family Support Services

Family Support Services (FSS) help families take care of CSHCN Services Program clients at home. Learn more about FSS.

 

HOT TIPS

Have your child’s physician or dentist complete the Physician/Dentist Assessment Form. An important part of the form is the section, “Determination of Urgent Need for Service.” This form helps determine eligibility and level of need and may influence wait time on the list. There are times when the program is able to provide services to clients on the waiting list that are time limited such as for a few months. Your child’s physician or dentist can download the form here

Applying for services

In order to receive services you must first apply for Medicaid and CHIP. This is because CSHCN is a “payer of last resort.” It will not pay for any services that would be covered under Medicaid, CHIP, or your family’s health insurance.

If you have already applied for Medicaid and CHIP, you can apply for CSHCN by mail using this form (PDF). The application form is also available in Spanish.

There may be a waiting list for services. Renewal of eligibility happens every twelve months. If you miss the renewal while receiving services you will be placed back on the waiting list.

CSHCN may provide support for a family whose child is not on a Medicaid Waiver.

Families may receive case management services while they are on the waiting list.