WELCOME TO THE CHILDREN WITH SPECIAL HEALTH CARE NEEDS (CSHCN) PROGRAM

The Children with Special Health Care Needs (CSHCN) Program, in the Office of Maternal, Child and Family Health (OMCFH) advances the health and well-being of children and youth with certain chronic, debilitating conditions by providing specialized medical care and care coordination services to children under 21 years of age who meet financial and medical eligibility criteria.

Medical services provided by the CSHCN Program are financed by the client’s primary coverage source(s) which include Title XIX (Medicaid), Title XXI (CHIP), and private health insurance. Program participants who are not eligible for other coverage sources for CSHCN eligible medical diagnoses will have program-approved services paid for by Title V funds.

CSHCN is not an entitlement program and the extent of services provided is contingent upon the amount of monies available for the delivery of services and the policy and procedures established by the OMCFH and CSHCN Administration. Program participants covered by Title V are eligible only for services offered through the CSHCN Program. Program participants with Medicaid, CHIP or private insurance should review their benefit plan to learn about non-CSHCN Program services for which they may be eligible.

The following pages of the Policy Manual describe details of the eligibility requirements, patient and program rights and responsibilities, and the specific medical conditions and services provided by the CSHCN Program. An appendix also includes:

• Allowable Family Income Scale

• Covered Medical Conditions by Category

• Glossary of Terms and Abbreviations

• Hospitals with Border Status for Medicaid

Questions about the CSHCN Program policies should be directed to:

West Virginia Department of Health and Human Resources

Bureau for Public Health

Office of Maternal, Child and Family Health

Children with Special Health Care Needs Program

350 Capitol Street, Room 427

Charleston, WV 25301 – 3714

Phone: 1-800-642-8522 or (304) 558-5388

Last Updated:    July 23, 2008

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