The Children with Special Health Care Needs (CSHCN) Services Program is dedicated to improving the health, well-being, and overall quality of life for individuals aged 20 and younger with special health care needs, as well as people of any age diagnosed with cystic fibrosis. This vital program operates with a strong emphasis on family-centered and community-based strategies, ensuring that support is accessible and tailored to the unique needs of each individual and their family.
A cornerstone of the CSHCN Services Program is the principle that all services provided must be medically necessary. This encompasses a broad spectrum of essential care areas, designed to provide comprehensive support. These services include:
- Medical Care: Access to a range of medical services to address specific health conditions.
- Mental Health Support: Crucial mental health services to support emotional and psychological well-being.
- Dental Services: Essential dental care to maintain oral health.
- Vision Services: Vision care to ensure optimal eyesight and address vision impairments.
- Special Medical Equipment and Supplies: Provision of necessary medical equipment and supplies tailored to individual needs.
- Family Services: Support services designed to assist families in caring for their children with special needs.
- Community Services: Connecting families with community-based resources and support networks.
- Case Management: Personalized case management to help navigate and coordinate services effectively.
For healthcare providers seeking detailed information about program participation and guidelines, resources are available at the CSHCN Services Program for providers.
Who is Eligible for the Children with Special Needs Care Program Services?
Eligibility for the Children with Special Needs Care Program is carefully defined to ensure services reach those who need them most. To qualify, individuals must meet specific criteria:
- Residency: Applicants must be residents of Texas.
- Age: Eligibility extends to individuals 20 years of age or younger, and people of any age with a confirmed diagnosis of cystic fibrosis.
- Income Level: The program is designed to support families with financial needs, requiring an income level at or below 200 percent of the federal poverty level.
- Medical Condition: Applicants must have a medical condition that meets specific criteria, including:
- The condition is expected to last for at least one year or longer, indicating a chronic or long-term health need.
- The condition results in substantial limitations in one or more major life activities, impacting daily functioning.
- The condition necessitates a higher level of health care than typically required for children without special needs.
- The condition is characterized by physical symptoms. It’s important to note that while mental, behavioral, or emotional conditions are significant, having only these conditions or a developmental delay without physical symptoms does not meet the medical condition criteria for this specific program.
How to Apply for the Children with Special Needs Care Program
Navigating the application process for the CSHCN Services Program can be made easier with support. Social workers at local public health offices are available to assist families through each step of the application. To locate the nearest public health office, refer to the Public Health Regions list and visit the website for your specific region to find a directory of local offices.
To formally apply, the following documents must be completed and submitted:
- Application Form: Form 3031, CSHCN Services Program Application is the primary application document.
- Physician or Dentist Assessment Form: Form 3034, CSHCN Services Program Physician or Dentist Assessment Form requires a medical professional to assess and document the applicant’s health needs.
- Required Supporting Documentation: Several documents are needed to verify eligibility:
- Proof of Birth: Documentation to verify the applicant’s age.
- Proof of Residency: Documents confirming the applicant’s Texas residency.
- Proof of Income: Financial documentation to verify income level.
- Proof of Insurance: Information about any existing health insurance coverage.
Application documents can be submitted through several channels for convenience. You can submit them to your local public health office, or directly to the CSHCN Services Program via fax or email using the contact information provided in the “Contact Us” section below. Alternatively, applications can be mailed to:
CSHCN Services Program
Eligibility Services
Mail Code 1938
P.O. Box 149030
Austin, TX 78714-9947
Parents of children with special health care needs applying for the CSHCN Services Program are also required to apply for Medicaid and CHIP benefits for their child, as these programs may offer complementary or primary coverage.
Contact Us for More Information
For questions or assistance, the CSHCN Services Program offers multiple contact points to ensure you can get the help you need.
Texas Medicaid and Healthcare Partnership-CSHCN Services Program Client Line
877-888-2350
Hours: 8 a.m. to 5 p.m. Central Time, Monday through Friday
Contact this client line for inquiries regarding:
- Questions about available services or prior authorizations for care.
- Assistance if you are a current client and have received a bill from your provider.
- Requesting a copy of the Client Guide for current program participants.
Program Helpline
800-222-3986
Hours: 8 a.m. to 5 p.m. Central Time, Monday through Friday
Reach out to the Program Helpline if you are:
- An applicant with questions about eligibility criteria, in need of an application, or unable to locate a case manager in your area.
- Currently on the waiting list for the program and require case management services.
- A current client with questions about application renewal or family services support.
- A current client who needs to report changes to your personal or household information.
Local Austin Area Phone
512-776-7150
Fax Number
512-206-3988
Email Address
[email protected]
Mailing Address
CSHCN Services Program
Mail Code 1938
P.O. Box 149030
Austin, TX 78714-9947
