Children's Special Health Care Services Program of Indiana

The Children’s Special Health Care Services (CSHCS) program helps families of children with serious chronic medical conditions get treatment related to their child’s condition. CSHCS serves as a type of supplemental insurance. The program is federally and state funded, and features care coordination services that help children and their families get medical care.

There are four conditions that must be met to be eligible for the Children’s Special Health Care Services program. The individual must be between 0-21 years of age, a resident of Indiana, and meet certain medical eligibility criteria. The family also must meet certain financial eligibility criteria. There is one exception to these four conditions being met. If a person has cystic fibrosis, is a resident of Indiana and continues to be financially eligible, then they are covered for life.

New financial eligibility guidelines are effective each March when the federal poverty level guidelines are established. A family with a gross income (before taxes) no greater than 250% of the poverty level may be eligible for the program. As of March 2002, for example, a family of four could qualify with a gross annual income of up to $45,250 or monthly income of $3,771.

All services processed and paid by this program are based on Indiana Medicaid allowed rates. This means the program may not pay in full the amount your provider bills to CSHCS. If CSHCS approves the charge for services, you will not be billed for any balance.

Conditions that meet medical eligibility are listed below. Additionally, the eligible condition must last, or be expected to last, at least two years and require more health care services than would usually be required for a child of the same age. The severity of the condition must have caused, or be expected to cause, disability disfigurement, limitation of function, or require a special diet or dependence on an assistive device. Also the condition, without treatment, would need to lead to a chronic, disabling physical condition.

The twenty-three medical conditions that are eligible include:

Arthritis
Autism
Profound Hearing Loss; +40db both ears
Apnea
Hemophilia; Severe
Hydrocephalus
Asthma; Severe and requires two medications daily
Inflammatory Bowel Disease
Cerebral Palsy
Inborn Errors of Metabolism
Chronic Anemia
Neuromuscular Dysfunction
Cleft Lip and/or Palate
Myelodysplasia or Spinal Cord Dysfunction
Congenital Heart Disease or Arrhythmias
Chromosomal Disorders
Developmental Deformities
Oncologic Disorders
Chronic Pulmonary Disease
Renal Disease
Cystic Fibrosis
Seizure Disorder
Endocrine Deficiencies

Depending on the child’s needs and medical condition, the CSHCS program services available can include:

Community Referrals and Information
Diagnostic Evaluation
Comprehensive Primary and Secondary Care Visits
Immunizations
Prescription Drugs
Routine Dental Care
Other services related to the eligible medical conditions, such as therapies, durable medical equipment, and inpatient hospitalization may also be accessed.

Applying for the Children’s Special Health Care Services (CSHCS) program can be done at three locations. If your child is under 3 years of age, you can contact the local First Steps office for your county. The Office of Family and Children (also known as the Welfare Office) for your county, or Riley Hospital in Indianapolis also are sites for applying to the program. CSHCS shares a combined enrollment form with Hoosier Healthwise.

When completing an application, you are required to have your child’s birth certificate and social security number, proof of residency (e.g., utility bills, federal tax records, driver’s license, rental or property payment receipts), proof of household income (e.g., recent tax form, three consecutive check stubs), and other health insurance information. This program requires that families also access any private health insurance and/or the Hoosier Healthwise/Medicaid Program. The Children’s Special Health Care Services program is set up as a supplemental insurance company and is always the payer of last resort. Primary insurance or Hoosier Healthwise/Medicaid must be billed first.

Once enrolled, all services must receive prior authorization, must be delivered by a provider enrolled in the CSHCS program and must be related to eligible medical conditions covered by the CSHCS program. Prior authorization is needed even for basic health and dental care, since these may not necessarily be related to the eligible medical condition. Before making your first appointment with a healthcare provider or when changing your primary or specialty care physician, you must contact the CSHCS Prior Authorization (PA) Unit at 1-800-475-1355 or TTY at 1-866-275-1274 to be sure your provider is enrolled in the CSHCS program. If you do not obtain a prior authorization, your bills may not be paid. If you are unsure about whether a specific service is covered by the CSHCS program, call the 1-800 numbers listed above.

For more information about the CSHCS program, call the Indiana State Department of Health at the CSHCS Division number. If you live in the Indianapolis area, the number is 1-317-233-1274. The toll-free statewide phone number is 1-800-475-1355, the TTY number is 1-866-275-1274, or in Espanola at 1-800-433-0746.

Wheeler, M. (2002). Children’s Special Health Care Services Program of Indiana. The Reporter, 7(2), 8-9, 11.


	Children's Special Health Care Services Program of Indiana Contributed by Marci Wheeler The Children’s Special Health Care Services (CSHCS) program helps families of children with serious chronic medical conditions get treatment related to their child’s condition. CSHCS serves as a type of supplemental insurance. The program is federally and state funded, and features care coordination services that help children and their families get medical care. There are four conditions that must be met to be eligible for the Children’s Special Health Care Services program. The individual must be between 0-21 years of age, a resident of Indiana, and meet certain medical eligibility criteria. The family also must meet certain financial eligibility criteria. There is one exception to these four conditions being met. If a person has cystic fibrosis, is a resident of Indiana and continues to be financially eligible, then they are covered for life. New financial eligibility guidelines are effective each March when the federal poverty level guidelines are established. A family with a gross income (before taxes) no greater than 250% of the poverty level may be eligible for the program. As of March 2002, for example, a family of four could qualify with a gross annual income of up to $45,250 or monthly income of $3,771. All services processed and paid by this program are based on Indiana Medicaid allowed rates. This means the program may not pay in full the amount your provider bills to CSHCS. If CSHCS approves the charge for services, you will not be billed for any balance. Conditions that meet medical eligibility are listed below. Additionally, the eligible condition must last, or be expected to last, at least two years and require more health care services than would usually be required for a child of the same age. The severity of the condition must have caused, or be expected to cause, disability disfigurement, limitation of function, or require a special diet or dependence on an assistive device. Also the condition, without treatment, would need to lead to a chronic, disabling physical condition. The twenty-three medical conditions that are eligible include: Arthritis Autism Profound Hearing Loss; +40db both ears Apnea Hemophilia; Severe Hydrocephalus Asthma; Severe and requires two medications daily Inflammatory Bowel Disease Cerebral Palsy Inborn Errors of Metabolism Chronic Anemia Neuromuscular Dysfunction Cleft Lip and/or Palate Myelodysplasia or Spinal Cord Dysfunction Congenital Heart Disease or Arrhythmias Chromosomal Disorders Developmental Deformities Oncologic Disorders Chronic Pulmonary Disease Renal Disease Cystic Fibrosis Seizure Disorder Endocrine Deficiencies Depending on the child’s needs and medical condition, the CSHCS program services available can include: Community Referrals and Information Diagnostic Evaluation Comprehensive Primary and Secondary Care Visits Immunizations Prescription Drugs Routine Dental Care Other services related to the eligible medical conditions, such as therapies, durable medical equipment, and inpatient hospitalization may also be accessed. Applying for the Children’s Special Health Care Services (CSHCS) program can be done at three locations. If your child is under 3 years of age, you can contact the local First Steps office for your county. The Office of Family and Children (also known as the Welfare Office) for your county, or Riley Hospital in Indianapolis also are sites for applying to the program. CSHCS shares a combined enrollment form with Hoosier Healthwise. When completing an application, you are required to have your child’s birth certificate and social security number, proof of residency (e.g., utility bills, federal tax records, driver’s license, rental or property payment receipts), proof of household income (e.g., recent tax form, three consecutive check stubs), and other health insurance information. This program requires that families also access any private health insurance and/or the Hoosier Healthwise/Medicaid Program. The Children’s Special Health Care Services program is set up as a supplemental insurance company and is always the payer of last resort. Primary insurance or Hoosier Healthwise/Medicaid must be billed first. Once enrolled, all services must receive prior authorization, must be delivered by a provider enrolled in the CSHCS program and must be related to eligible medical conditions covered by the CSHCS program. Prior authorization is needed even for basic health and dental care, since these may not necessarily be related to the eligible medical condition. Before making your first appointment with a healthcare provider or when changing your primary or specialty care physician, you must contact the CSHCS Prior Authorization (PA) Unit at 1-800-475-1355 or TTY at 1-866-275-1274 to be sure your provider is enrolled in the CSHCS program. If you do not obtain a prior authorization, your bills may not be paid. If you are unsure about whether a specific service is covered by the CSHCS program, call the 1-800 numbers listed above. For more information about the CSHCS program, call the Indiana State Department of Health at the CSHCS Division number. If you live in the Indianapolis area, the number is 1-317-233-1274. The toll-free statewide phone number is 1-800-475-1355, the TTY number is 1-866-275-1274, or in Espanola at 1-800-433-0746. Wheeler, M. (2002). Children’s Special Health Care Services Program of Indiana. The Reporter, 7(2), 8-9, 11.