Friday, September 11, 2015

Accessing health care financing programs for children with special health care needs

Children with special health care needs are those with medical or developmental needs who require more services than that required by typical children. Such an extraordinary level of services can quickly drain the budget of any family without adequate supports. Fortunately, any professional working with these families can help them find a path to paying for the services they need. What follows is a “cheat sheet” about how to direct a family to help with information about, and applications for, four key health care financing programs.

Indiana Medicaid
            Indiana has many different forms of Medicaid that offers good insurance coverage for children. The types most typically available to children include Hoosier Healthwise Package A or C, and Medicaid Disability. Eligibility for these programs depend on income. The first step to applying for Medicaid is to apply online at or to visit the regional Division of Family Resources (DFR) office (local offices information available by clicking on the family’s county at Families can find help for applying by contacting their nearest Covering Kids & Families office ( or an Indiana navigator near them (

Children’s Special Health Care Services (CSHCS)
            Children’s Special Health Care Services (CSHCS) is a program of the Indiana State Department of Health to provide coverage for health care expenses related to a child’s special health care needs. Eligibility depends on the child’s diagnosis and income. It requires children to have applied for Medicaid, but its income limit is higher than Medicaid at 250% of the federal poverty line ($60,625 or less for a family of four). Information about the CSHCS program, including how to apply, is at . A convenient place to apply in Indianapolis is at the CSHCS in Riley Hospital for Children (contact at 317-944-4603), and families should be able to apply at their local DFR offices (

The ACA and children’s coverage
            Families can apply for health insurance for themselves and/or their children from the federal insurance marketplace at or by calling 1-800-318-2596 (TTY: 1-855-889-4325). If a child qualifies for a state Medicaid program, the marketplace application will identify that and, if not, identify marketplace plans that would be available to them. Families who need help understanding marketplace plan options can call this number as well, visit, or receive one-on-one help from an Indiana navigator (

Medicaid waivers
Children with qualifying developmental disabilities, including autism, may be eligible for an Indiana Medicaid waiver. Waivers offer Medicaid health coverage and other services without counting parental income and resources. Families can apply for a waiver for their CSHCN at any age. Because they typically have a waiting list, families should apply as soon as possible.

·         Children with an intellectual/developmental disability are most likely to qualify for a Family Supports waiver through the Bureau of Developmental Disabilities (BDDS), with 8 local offices throughout Indiana ( ). 

·         Children with significant medical needs or a traumatic brain injury are most likely to qualify for an Aged & Disabled waiver through their Area Agency on Aging (AAA). Families can apply for this waiver by contacting their local AAA, with locations and contacts available at .

·         Children who may qualify for both waivers can apply for both; however, they can only receive services from one waiver at a time.

For general information

            For help understanding any of these children’s health insurance programs, contact Covering Kids & Families ( ; (574) 968-1645) or Family Voices Indiana ( ; 317-944-8982).

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