Children & Families with Special Needs

Children's Special Health Care Services (CSHCS)

Eligibility | Applying | Newsletters | Turning 18 or 21 | FAQs | Resources | Forms

Children's Special Health Care Services (CSHCS) offers medical care and treatment assistance for children with chronic, severe, disabling health problems; and provides service coordination to meet child and family needs.

Contact Us

616-632-7066
CSHCS@kentcountymi.gov

Eligibility is based on the child's diagnosis, severity, and treatment plan—NOT income. Many families with CSHCS coverage have private insurance. CSHCS provides additional help to these families. There is a cost for the program determined by a sliding fee scale. (In other words, the fee is determined by your income and household size.) This fee is waived if the individual applying is enrolled in Medicaid or MI Child.

What Does Enrollment in CSHCS Offer?

  • Helps pay for visits to specialists.
  • May help pay for specialized equipment such as wheelchairs when they relate to the CSHCS qualifying medical condition.
  • May help pay for medications when they relate to the CSHCS qualifying medical condition.
  • Coordination of services and assistance with finding community resources.
  • May assist with travel and lodging expenses relating to treatment and care for the CSHCS qualifying medical diagnosis.
  • May help to pay medical bills for a child who has recently died.

What Does CSHCS NOT Pay For?

  • CSHCS does not cover primary care, well-child checks, mental health needs, or experimental health care.
  • CSHCS does not provide assistance with diapers or incontinence supplies. Incontinence supplies may be a benefit of Medicaid coverage for children 3 and older who meet the medical criteria.

Eligibility for CSHCS

  1. Medical Diagnosis - Severity, chronicity of the condition, and the need for treatment by a specialist is evaluated by a MDHHS medical consultant. This does not include developmental, behavioral, or intellectual conditions.
    • There are more than 2,700 medical diagnoses that CSHCS may cover.
    • These include (but are not limited to):
  2. Age - Children under 21. Adults with sickle cell disease, cystic fibrosis and certain blood clotting disorders over the age of 21 may be eligible for the program.
  3. Residency - A person must be a Michigan resident to receive CSHCS.
  4. Citizenship - U.S. citizens, a non-citizen lawfully admitted for permanent residence, or a lawfully admitted migrant farm worker. CSHCS may request additional documentation.
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Applying for CSHCS

Newsletters

CSHCS and FIMR Quarterly Newsletter - Winter 2022 Back to Top

Turning 18 or 21 Years Old

Children's Special Health Care Services covers eligible individuals until the day before their 21st birthday. Certain diagnoses such as sickle cell disease, cystic fibrosis, and hemophilia may qualify someone for the program over the age of 21. When children reach age 18, the financial payment agreement is filled out with respect to the 18-year old's income; it must also be signed by them unless someone else has legal guardianship at that time. Please contact us if you have any questions or concerns regarding these transitions.

If you are 19 or older, you may qualify for the Healthy Michigan Plan. Please click here to apply online. If you need assistance with the application, the health department has a Medicaid Outreach Worker. Please call 616-632-7062 to schedule an appointment.

Transition to Adulthood Back to Top

Frequently Asked Questions

  • Where can I pay my payment agreement?

    You can pay your payment agreement online here, or you can call the Family Center at 1-800-359- 3722. If you would like to mail a check and no longer have the coupons that were mailed to you, please contact our office for another copy.

  • Does CSHCS cover autism and other behavioral health services?

    CSHCS does not cover autism, behavioral health, or mental health services. However, your child may be eligible for services through Network180. You can contact their access line at 616-336-3909 and ask to speak with their Children's Intellectual & Developmental Disabilities team for further assistance.

  • I lost my green MiHealth insurance card, where can I get a new one?

    You can call the Medicaid Beneficiary Helpline at 1-800-642-3195 and request a new one.

    If you would like to have a virtual copy, you can register for myHealthPortal/myHealthButton and have a copy within the app for convenience.

  • Are incontinence supplies covered by CSHCS?

    CSHCS does not provide assistance with incontinence supplies. Incontinence supplies may be a benefit of Medicaid coverage.

  • Is travel and lodging a benefit of CSHCS?

    Yes, CSHCS may provide travel assistance to clients who do not have active Medicaid. Please contact our office, 616-632-7066, for further assistance.

    If you have FFS MA, you will need to reach out to the local MDHHS office and ask for assistance. Please call the Kent County MDHHS office at 616-248-1941 and leave a voicemail.

    If you have a Medicaid Managed Health Plan, you will need to reach out to your case manager and ask for assistance.

  • Why did my provider list (CEN) change?

    The medical consultants at CSHCS in Lansing periodically review the medical services being received by clients. This review sometimes results in finding that a service being covered was no longer necessary for treatment of or was not relevant to the child's CSHCS covered condition. Or it might be determined that the condition your child has no longer meets the severity criteria established by CSHCS.

    If you have questions or concerns about the decision made, you may start by contacting your child's local CSHCS.

  • What should I do if I have a grievance or complaint regarding CSHCS?

    If you have complaints or concerns with your CSHCS health care or your CSHCS provider call or write the Department of Community Health (DCH) about your complaint.

    OR

    To appeal a negative action, such as CSHCS not paying a bill or not approving a service, complete the form you received when you were notified of the decision. Your request must explain the problem in writing. Mail the form to:

    Department of Community Health
    Administrative, Tribunal and Appeals Division
    PO Box 30763
    Lansing MI 48909-7695
    1-877-833-0870

    If you have questions, call the CSHCS Family Phone Line at 1-800-359-3722.

  • What should I do if I want to go to a provider not on the Eligibility Notice?

    Contact us at 616-632-7066 to see if the provider can be authorized. Without authorization, you may be responsible for the bill.

    NOTE: Pharmacies, medical equipment and supply companies, hearing and speech centers, hearing aid dealers, and home health agencies do not need to be listed on the Eligibility Notice.

  • How does CSHCS work with other insurance?

    CSHCS cannot pay for providers that your insurance will not cover. If you see a provider that your other insurance provider does not cover, CSHCS will not be able to assist you in paying for the visit either. If your insurance has "in-network" providers, you must utilize those providers rather than "out-of- network" providers.

    When you have additional insurance, present both insurance cards to the providers upon receiving services. The provider will bill your primary insurance first and then bill CSHCS for the remainder. For services or prescriptions relating to the CSHCS qualifying diagnoses, you will not need to pay a co-pay when CSHCS is billed.

    If you have further questions about how your insurance works with CSHCS, call us!

  • Why did I receive this letter about needing to apply for MI Child/Healthy Kids?

    Clients renewing or enrolling in CSHCS whose reported income indicates they may be eligible for MI Child/Healthy Kids are required to apply. Once notified, if you do not apply, CSHCS coverage will expire in 90 days. When the application is received and processed, coverage will be extended through the remainder of your coverage year.

    It is in your best interest to apply online! This will speed processing, which allows your coverage for CSHCS to be extended sooner.

    MI Child is a program for children less than 19 years old who have no comprehensive health insurance, including Medicaid. MI Child services include ambulance, dental services, doctor visits and health check-ups, family planning, hearing and speech therapy, hospital care, medicine, and many other se rvices. MI Child costs only $10/month regardless of how many children in your family are covered by MI Child. The Healthy Kids program is for those under age 19 or pregnant. This service also provides health and dental services. There is no monthly premium for Healthy Kids.

  • What if I do not want to receive MI Child/Healthy Kids services?

    You may disenroll from MI Child/ Healthy Kids once you have received notice of eligibility. You are not required to receive MI Child/ Healthy Kids in order to continue receiving coverage through CSHCS even if you are determined to be eligible.

  • What should I do if I receive a bill that I thought CSHCS would cover?

    DO NOT IGNORE THE BILL!

    If the bill is from a provider not listed on your eligibility notice, contact us to see if they can be added. If the provider is already listed or does not need to be listed (see note below), contact the provider and ask them to bill CSHCS.

    NOTE: Pharmacies, medical equipment and supply companies, hearing and speech centers, hearing aid dealers, and home health agencies do not have to listed on the Eligibility Notice.

  • Can I be reimbursed by CSHCS for bills I have already paid?

    CSHCS does not provide reimbursement for bills that have already been paid. However, sometimes the provider or pharmacy is willing to submit the bill to CSHCS and pay you back once they receive payment. Call our office for assistance.

  • What if my provider recommends a provider out of state?

    Out-of-state care always requires special approval. Please contact us for assistance in obtaining approval for out-of-state care.

  • How are Medicaid and CSHCS different?

    One major difference is in terms of eligibility. Eligibility for Medicaid is based on income whereas CSHCS eligibility is based on a qualifying medical condition.

    Another big difference is services covered. CSHCS covers only those providers and services related to the qualifying medical condition, Medicaid covers general health care expenses.

  • My child is about to turn 18 and is unable to make medical decisions. How do I pursue guardianship?

    The Kent County Probate Court handles requests for guardianship. Please call the probate court at 632- 5440 or email them at probatecourt@kentcountymi.gov with your questions.

    For help filling out forms, contact the Legal Assistance Center located on the 5th floor of County Court Building 180 Ottawa Ave NW #5, Grand Rapids, MI 49503. You can also call them at 616-632-6000.

    Guardianship paperwork can be filed on the individual's 18th birthday.

Resources

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Forms