Children’s Special Health Care Services now covers individuals up to age 26.
Children’s Special Health Care Services (CSHCS) is part of the Michigan Department of Health and Human Services. It provides extended insurance coverage for children and adults (now up to age 26) who have special health care needs. It covers specialty services, durable medical equipment, and community-based services. They can also help with travel and lodging costs for medical care.
Prior to October 2023, CSHCS only covered individuals up to age 21. Now, it will cover until age 26. This program is not Medicaid, the individual uses it in addition to Medicaid or private insurance. It is not just for people with disabilities. Anyone with a qualifying medical condition can get coverage. It only covers services related to the covered diagnosis, it does not cover primary care.
Qualifying Medical Conditions:
CSHCS covers over 2,700 physical conditions. Click here for a list of these diagnoses. CSHCS doctors determine qualifying medical conditions and review medical reports to decide if the individual qualifies. NOTE: CSHCS does not cover developmental, behavioral, or intellectual conditions. If you have coverage up to age 21 and lost it due to age, you need to reapply to get coverage.
**Individuals diagnosed with cystic fibrosis, hemophilia, or sickle cell disease can receive coverage past age 26.
Cost:
Eligibility is not based on income. Anyone with a qualifying medical condition can apply. The fee for CSHCS is waived if the individual has Medicaid, MiChild, a court-appointed guardian, or lives in a foster home. Otherwise, the fee is based on family income.
Apply:
The first step is to ask one of your medical specialists to submit a medical record less than one year old to CSHCS. This form cannot come from the primary physician. The information can be a letter or report that fully describes the condition and treatment plan. Your specialist will need permission to send the medical information to CSHCS.
Click here for an Authorization to Disclose Protected Health Information form or the MSA-0838 form. You must send this form with the medical report. The individual fills it out and sends it to their specialist. The specialist then sends this form along with a report to CSHCS. All the instructions and fax numbers are on this form.
**If the individual has not seen a specialist in the past year, call 1.800.359.3722 so they can help you.
Next Steps:
You will receive a determination notice from CSHCS. If they approved the individual, the letter will contain information about the qualifying the diagnosis and the approved specialists. It is very easy to add more specialists once the individual is approved. You can send them the MSA-0838 form.
If they do not approve the individual, they can appeal the ruling. You need to ask for a Department Review. They will include the details on how to do this in the letter you receive.
If the individual already has Medicaid or MiChild, then they will not get an additional health care card. Both Medicaid and CSHCS will be tied to the individuals Medicaid number. If they do not have Medicaid or MiChild, they will receive an insurance card.
Important:
ALWAYS tell providers you have CSHCS coverage. If you want specialty equipment, the process goes a lot smoother once they know you have CSHCS. Hospitals, doctor’s offices, and DME suppliers know what CSHCS covers and they will help you get what you need.
Contacts:
CSHCS 1-800-359-3722
CSHCS (Oakland County) 248-858-0056
CSHCSFC@michigan.gov
