CSHCN Services Program: Health Benefits

ATTENTION: Medicaid Managed Care for CSHCN Services Program Clients

On March 1, 2012, the managed care model for Medicaid in Texas expanded statewide. DSHS is working with the Texas Health and Human Services Commission (HHSC) to make sure you know about the changes. Note: The changes only apply to you if you have Texas Medicaid coverage. Here is more important information:

You need a medical plan. If you did not have a medical plan, HHSC should have sent a packet in the mail encouraging you to pick one. The packet described the medical plans and how to enroll. If you did not pick a medical plan by February 10, 2012, HHSC picked one for you. You can check the provider directories of the medical plans offered in your service area to find out which doctors are in which medical plan. If you have questions, call 1-800-964-2777. You also can call that number if you need help finding a provider. You can learn more about the medical plans and services by going to a meeting in your area. To see a list of these meetings, go to the Community Outreach Meeting Calendar.
Your prescription drug benefit may change. Your medical plan has network pharmacies where you can fill your prescriptions. Contact information for your medical plan is on Your Texas Benefits Medicaid card and the member ID card that your medical plan sent to you. If you have both Medicare and Medicaid, you will continue to get your prescription benefit through Medicare.

Since 1933, Texas has worked to improve the lives of children with special health care needs. Through state and federal funds, the Children with Special Health Care Needs (CSHCN) Services Program provides health benefits to qualified children with special health care needs and their families, and individuals of all ages with cystic fibrosis. Under Title V of the Social Security Act, the state receives a block grant to provide direct services (e.g., health benefits), as well as enabling services (e.g., case management) and population-based services (e.g., newborn screening). Title V programs, including the CSHCN Services Program Health Benefits, provide and promote family-centered, community based, culturally competent, and coordinated health care and family support services. The CSHCN Services Program recognizes the importance of the family as the focus of planning and service delivery, and promotes family choice and collaboration between parents and professionals. The CSHCN Services Program strives to deliver services that honor and respect cultural beliefs, traditions, values, interpersonal styles, attitudes and behaviors.

Program Services

The CSHCN Services Program offers many kinds of services, including:

Ambulance
Ambulatory surgery
Care by medical specialists
Dental health services
Equipment and medical supplies
Family support services
Home health nursing
Hospice care
Hospital care
Inpatient rehabilitation
Insurance Premium Payment Assistance (IPPA)
Laboratory and radiology
Meals, Lodging, and Transportation when needed to obtain medical care updated 12/9/2010
Medicines
Mental health services
Orthotics and prosthetics
Outpatient care (including kidney dialysis)
Physical and occupational therapy
Primary and preventive care
Special nutritional products and services
Speech and hearing services
Transportation of Deceased Clients updated 8/11/2010
Vision services

How to Get Benefits from the Program

To qualify for the CSHCN Services Program health benefits, an applicant must be:
A person younger than 21 years of age who has a chronic physical or developmental condition:

That will last or is expected to last for at least 12 months; and
That results or, if not treated, may result in limits to one or more major life activities; and
That requires health and related services of a type or amount beyond those required by children generally; and
That must have a physical (body, bodily tissue or organ) manifestation; and
That may exist with accompanying developmental, mental, behavioral, or emotional conditions; but
That is not solely a delay in intellectual development or solely a mental, behavioral, and/or emotional condition.

OR
A person of any age who has cystic fibrosis.

All CSHCN Services Program Health Benefits must be medically necessary for the care and treatment of a person with a chronic physical or developmental condition who is eligible. Medicaid, CHIP, and commercial health insurance benefits, if any, must be used before using the CSHCN Services Program health benefits. For specific questions regarding types of benefits and eligibility, contact the CSHCN Services Program through the CSHCN Inquiry Line at 1-800-252-8023.

Send comments or report broken links by e-mail to CSHCN Services Program.