The Children with Special Health Care Needs (CSHCN) Services Program is dedicated to enhancing 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. Operating within Texas, this program prioritizes family-centered and community-based approaches to deliver comprehensive support.
All services provided through the CSHCN Services Program are deemed medically necessary and encompass a broad spectrum of care including:
- Medical services, ensuring access to essential healthcare professionals and treatments.
- Mental health support, addressing the emotional and psychological well-being of individuals and families.
- Dental care, promoting oral health as an integral part of overall wellness.
- Vision services, safeguarding and improving eyesight through examinations and corrective measures.
- Special medical equipment and supplies, providing necessary tools for daily living and medical management.
- Family services, offering resources and assistance to support the entire family unit.
- Community services, connecting individuals and families with local support networks and resources.
- Case management, providing personalized guidance and coordination of care to navigate the healthcare system effectively.
For healthcare providers seeking detailed information, the CSHCN Services Program offers specific resources at the CSHCN Services Program for providers.
Who is Eligible for the Children with Special Needs Care Program?
Eligibility for the Children with Special Needs Care Program is carefully defined to ensure support reaches those who need it most. To qualify for services, an individual must meet the following criteria:
- Residency: The individual must be a resident of Texas.
- Age: Applicants must be 20 years of age or younger, with no age limit for individuals diagnosed with cystic fibrosis.
- Income Level: The household income must be at or below 200 percent of the federal poverty level, ensuring accessibility for families with financial need.
- Medical Condition: The applicant must have a medical condition that satisfies specific requirements:
- Duration: The condition is expected to last for at least one year or longer, indicating a chronic health need.
- Functional Limitation: The condition must result in the limitation of one or more major life activities, impacting daily living.
- Healthcare Intensity: The condition necessitates a higher level of healthcare services compared to general needs.
- Physical Symptoms: The condition must manifest in physical symptoms. It’s important to note that solely having a mental, behavioral, or emotional condition, or experiencing developmental delays, does not meet the medical condition criteria for this program.
How to Apply for the Children with Special Needs Care Program
Navigating the application process for the Children with Special Needs Care Program is made easier with the assistance of social workers available at public health offices throughout Texas. To locate the nearest public health office, consult the Public Health Regions list and visit your region’s website for a directory of local offices.
To formally apply for the program, the following documents must be completed and submitted:
- Form 3031, CSHCN Services Program Application: This is the primary application form for the CSHCN Services Program.
- Form 3034, CSHCN Services Program Physician or Dentist Assessment Form: This form requires assessment and completion by the applicant’s physician or dentist, providing medical verification of the condition.
- Required Documentation: Along with the application forms, certain documents are necessary to verify eligibility:
- Proof of birth: Documentation to confirm the applicant’s age.
- Proof of residency: Evidence of Texas residency.
- Proof of income: Documentation to verify household income levels.
- Proof of insurance: Information regarding any existing health insurance coverage.
Application documents can be submitted through various channels for convenience:
- Local Office Submission: Documents can be delivered to your local public health office.
- Fax or Email: Documents may be faxed or emailed to the CSHCN Services Program using the contact information provided in the “Contact Us” section below.
- Mail: Application documents can be mailed to the following address:
CSHCN Services Program
Eligibility Services
Mail Code 1938
P.O. Box 149030
Austin, TX 78714-9947
Parents or guardians applying on behalf of a child with special health care needs are also required to apply for Medicaid and CHIP benefits for their child, as these programs may offer additional support and resources.
Contact Information for the Children with Special Needs Care Program
For any inquiries or assistance related to the Children with Special Needs Care Program, please utilize the following contact details:
Texas Medicaid and Healthcare Partnership-CSHCN Services Program Client Line
877-888-2350
Operating Hours: 8 a.m. to 5 p.m. Central Time, Monday through Friday
Use this client line for questions regarding:
- Services offered or prior authorizations needed.
- Billing issues from providers for current clients.
- Requesting a copy of the Client Guide for current clients.
Program Helpline
800-222-3986
Operating Hours: 8 a.m. to 5 p.m. Central Time, Monday through Friday
Contact the Program Helpline if you are:
- An applicant with questions about eligibility, needing application assistance, or lacking a local case manager.
- Currently on the waiting list and require case management services.
- A current client with inquiries about application renewal or family services.
- A current client needing to update personal or household information.
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
