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.
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.)
The CSHCN program administers program benefits which helps clients with:
- Medical, dental and mental health care
- Special therapies
- Case management
- Travel to health care visits
- Insurance Premium Payment Assistance (IPPA)
And much more
Family Support Services (FSS) help families take care of CSHCN Services Program clients at home. Learn more about FSS.
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.
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.
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.