Children’s Special Health Care Services (CSHCS) is a program within the Michigan Department of Health and Human Services and provided by the Ionia County Health Department. It is for children and some adults with special health care needs and their families.
What the Program Offers
We help persons with chronic health care problems by providing:
- Coverage and referral for specialty services based on your child’s health problems.
- Family-centered services to support you in your role as the primary caretaker of your child.
- Community-based services to help you care for your child at home and maintain normal routines.
- Culturally competent services that demonstrate an awareness of cultural differences.
- Coordinated services to pull together the services of many providers who work within different agencies.
Who can join CSHCS?
Several factors determine if a person is eligible for CSHCS:
- Qualifying Medical condition: CSHCS covers more than 2,700 physical conditions when certain criteria are met. NOTE: CSHCS does not cover developmental, behavioral, or intellectual conditions. Severity, chronicity of the condition and the need for treatment by a specialist as evaluated by a MDHHS medical consultant.
- Age: Clients must be under the age of 26. The age limit is waived for individuals with certain blood clotting disorders, cystic fibrosis, or sickle cell disease (diagnosis of these conditions will result in lifelong CSHCS coverage eligibility).
- Citizenship: The client, or a parent of the minor client, or court appointed guardian must be one of the following:
- A US citizen, or
- A documented non-citizen who has been admitted for permanent residence, or
- A non-citizen legally admitted migrant farm worker (i.e., seasonal agricultural worker).
- Residency: Must be a Michigan resident
- Eligibility: Is not based on income.
- Families with any income are eligible as long as the previous criteria are met.
- There is a fee to join CSHCS. This fee is waived if the client has Medicaid, MIChild, a court-appointed guardian or lives in a foster home. The fee is determined on a sliding scale based upon family income and family size.
- Please call the Ionia County Health Department CSHCS office at 616-527-5341 or the Family Phone line at 1-800-359-3722 if you have specific questions about this fee.
Why Join CSHCS?
We work with you to ensure that you or your child receive the very best care. We help you with:
- Paying specialty medical bills.
- Coordinating services from multiple providers.
- Learning about specialty providers, such as Doctors, hospitals and clinics.
- Coordinating health insurance benefits.
- Covering co-pays or deductibles.
How to Join CSHCS?
The first step is to ask your specialist to submit a medical record less than one year old. This information can be in the form of a letter or report that fully describes the condition and treatment plan. Your specialist will need permission to send the medical information to CSHCS. Your child’s medical condition, not your income, determines if you qualify for this program. If your child qualifies, he or she will be invited to join the program. An application will be mailed to you. A review of this application will determine if we ask you to share in the cost of services.
If the child with special needs has not seen a specialist or you have questions, please contact your CSHCS Rep at ICHD at (616) 527-5341. Call our CSHCS Family Phone Line at 1 (800) 359-3722 or www.michigan.gov/cshcs
CSHCS Family Rights & Responsibilities
Your CSHCS Rights
It is important that you know your rights and responsibilities. In CSHCS, you have the right to:
- Receive quality health care
- Be treated with respect
- Choose your specialist from participating providers within your insurance guidelines
- Be seen by a medical specialist who will arrange the care you need
- Get all the facts from your specialist about the CSHCS-eligible diagnosis and treatment
- Say “no” to any medical treatment
- Tell the specialist how to treat you or your child if you become too ill to decide for yourself
- Get a second opinion from a specialist
- Be told what services CSHCS covers
- Know the names and backgrounds of your health care providers
- Get help with special disability needs you may have
- Get help with special language needs you may have
- Have your medical records kept confidential
- Get a copy of your medical records (there may be a cost)
- Voice your concern about the service or care you receive
- Be told in writing when and why benefits are being reduced or stopped
- Contact the Michigan Department of Health & Human Services with any questions or complaints
- Appeal any denial or reduction of CSHCS eligibility or service
Your Responsibilities
- Show all your insurance cards including your mihealth card and Client Eligibility Notice (CEN) to all providers before receiving services
- Call your local CSHCS office or Medicaid Health Plan if enrolled before your appointment when you need help to cover medical travel expenses
- Never let anyone who is not covered use your CSHCS coverage
- Choose a specialist from the participating providers within your insurance guidelines; then contact and build a relationship with the provider you have chosen
- Follow your provider’s medical advice
- Keep your scheduled appointments
- Provide complete information about past medical history
- Provide complete information about current medical problems
- Update medical and financial information as CSHCS requires
- Ask questions about the care your child is receiving
- Respect the rights of other patients and health care employees.
- Use emergency room services only when you believe an injury or illness could result in lasting injury or death
- Notify a CSHCS representative in your local health department or Medicaid Health Plan if enrolled if emergency room treatment related to the CSHCS-eligible diagnosis is given
- Make prompt payment for services not covered by CSHCS or your Medicaid Health Plan if enrolled
- Report changes that may affect your coverage to a CSHCS representative in your local health department or Medicaid Health Plan if enrolled. This could be an address change, birth of a child, death, marriage, divorce or change in insurance coverage
- Promptly apply for Medicaid, Medicare, or other insurance when you are eligible
- Report on Medicare, Medicaid, or other insurance benefits you have
Complaints and Appeals
If you have complaints or concern with your CSHCS health care or your CSHCS provider, there are things you can do:
- Call the Family Phone Line at (800) 359-3722. CSHCS will always try to solve problems before an appeal.
- Call or write to the Michigan Administrative Hearing System (MAHS) for the Michigan Department of Health & Human Services about your complaint:
Michigan Administrative Hearing System
for the Michigan Department of Health & Human Services
PO Box 30763
Lansing MI 48909
(877) 833-0870 - Call your Medicaid Health Plan if enrolled
Appealing an Action if CSHCS Denies Coverage or Services
You can appeal a negative action, such as CSHCS or Medicaid Health Plan if enrolled 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:
Michigan Administrative Hearing System
for the Michigan Department of Health & Human Services
PO Box 30763
Lansing MI 48909
OR
The address on the denial form you received
Questions? You can call either your local health department or the Family Phone Line, Ionia County Health Department at (616) 527-5341, or the Family Phone Line at (800) 359-3722
