Children’s Special Health Care Services is a state-wide program that serves children with chronic health problems and their families. The program can save families money and at the same time make sure that sick kids get what they need! The program's aim is to provide patients and caregivers with the knowledge and resources to receive the best quality care for their individual needs. In Washtenaw County we currently have about 940 children enrolled!
How Does it Work?
The program works as secondary insurance to help cover the cost of the child’s diagnosis. Which means the family’s primary insurance – such as employer insurance or Medicaid – pays first and then CSHCS picks-up the co-pays, deductible, and out-of-pocket costs related to the qualifying diagnosis.
Here is an example:
Max is enrolled is CSHCS because he has Type 1 Diabetes. One day, he loses consciousness during gym class. His school calls an ambulance. The paramedic finds that his blood sugar was too low. CSHCS will cover the cost of the ambulance ride, the ER visit, any medicine prescribed or tests run, and hospital admission if necessary. The out of pocket medical expense for Max's family is $0.
But even during a good month where Max doesn't have to go to the hospital or to see a doctor, he still needs medication and supplies to help manage his Type 1 Diabetes. Look at the charts below to see how CSHCS helps Max's family cover those costs.
It's important to note that CSHCS doesn't help cover all medical costs, only the costs related to the child's qualifying diagnosis. The program will not pay for visits to the primary care physician or any other unrelated medical costs.
Who Can Enroll?
CSHCS covers children from birth to age 21 with one or more of the qualifying diagnoses. These diagnoses are any of 2,700 physical conditions like severe Asthma, Type 1 Diabetes, Cerebral Palsy, and different types of cancer. Click here for a list of these diagnoses.
A lot of times, if a child is diagnosed with one of the diseases on the list, a nurse or social worker will recommend the child for the program and a designated pediatrician decides whether or not the child is approved. But sometimes, the program receives calls from parents who believe their child is a good fit for the program and then our public health nurses will investigate those cases further. The program may even help pay for the costs of diagnostic tests if needed.
Is CSHCS Only For Low-Income Families?
A lot of families don't know that they can enroll in CSHCS even if they have private or employer insurance! CSHCS is based on the child’s diagnosis, not income. So anyone with a child who has one or more of the qualifying diagnoses can enroll. There is a sliding annual fee which is based on the family’s income, but in certain cases--for foster children or kids already on Medicaid--the fee can be waived. For almost all current enrollees, the annually fee is significantly less than what the cost of healthcare would be without CSHCS.
For more information you can visit the Children's Special Health Care Services website.
If you live in Washtenaw County you can contact one of our RNs with questions:
- Last names starting with A through J: Colleen Warner at 734-544-3080 or by email at firstname.lastname@example.org.
- Last names starting with K through Z: Muhammad Saifudin at 734-544-9750 or by email at email@example.com
If you are a service provider or community partner, please contact our program supervisor, Christina Katka at 734-544-2984 or firstname.lastname@example.org.
If you live outside of Washtenaw County you can find contacts here.
Editor's Note: This blog post was written by Kayla Okarski, a Washtenaw County Public Health and Washtenaw Health Plan summer intern who is a senior at Grand Valley State University. Thanks Kayla for all of your work!