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County offices closed June 19th

Macomb County offices will be closed on Wednesday, June 19th in observance of Juneteenth. Online services are available 24/7.

Cooling Centers

Looking for a place to escape the extreme heat? Cooling centers are available across Macomb County.

FAQs

Whether you're new to Children's Special Health Care Services (CSHCS) or need a refresher, we have answers to your questions here!

FAQs (Frequently Asked Questions)

Residents of Macomb must meet certain guidelines for Children's Special Health Care Services (CSHCS) Programming.

Medical conditions that qualify:

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. List of diagnoses

Age:

Children must be under the age of 26. Persons age 26 and above with cystic fibrosis, hereditary coagulation defects commonly known as hemophilia, or hereditary red blood cell disorders commonly known as sickle cell disease may also qualify.

Citizenship:

The client, or a parent of the minor client, or court appointed guardian must be one of the following:

  • A U.S. 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:

  • CSHCS is available to families with any income level as long as the previous criteria are met.

Children’s Special Health Care Services (CSHCS) works alongside a primary insurance plan. The primary insurance is billed first and CSHCS is billed last for services related to the approved diagnosis(es). It is important to have a primary insurance plan to cover office visits to your primary care doctor, vaccines, physicals and other health needs outside of what CSHCS covers.

CSHCS pays the copays for specialist office visits and offsets the cost of medical equipment, therapies and medication. CSHCS can also assist with transportation and mileage reimbursement to specialist visits and therapies. With prior authorization, CSHCS can offset lodging and mileage costs for out-of-state appointments.

Providers need to be added to the CSHCS database to ensure they are approved providers for the service(s) you receive. Once added, you will see your providers on your Client Eligibility Notice (CEN). To avoid billing problems if your provider changes, call CSHCS at 586-466-6855.

CSHCS is a fee-for-service program. The fee is based on family size and income. People with any income level may apply. The fee ranges from $120 - 2964 annually, based on your household income. It can be paid monthly, quarterly, or all at once.

The fee is waived if the client has Medicaid, MIChild, a court-appointed guardian or lives in a foster home. 

The renewal process for annual coverage begins 45 days before your coverage ends. 

Medical review reports are required based on to the timeframe established based on the insured person’s primary diagnosis. Depending on your primary insurance status, an Income Review Payment Agreement (IRPA) may also be required. If you continue to meet all of the criteria, a new Children’s Special Health Care Services (CSHCS) coverage period is normally issued in 12-month increments. 

The Client Eligibility Notice (CEN) works like an insurance card. Show it at the time of your appointments to ensure you are billed correctly. 

If you have commercial primary insurance, most providers must be listed on your CEN to receive payment from Children’s Special Health Care Services (CSHCS).

These providers are exceptions and do not need to be added:

  • Anesthesiologists
  • Hearing aid dealers / Audiologists
  • Durable Medical Equipment (DME) suppliers
  • Pharmacies
  • Nurse Practitioners / Physician Assistants
  • Radiologists
  • Medical groups

To add a new provider, contact the CSHCS office and provide the following:

  • Your child’s name and date of birth
  • CSHCS identification number
  • First and last name of new provider
  • Beginning date of coverage

An updated Client Eligibility Notice listing the new provider will be mailed to you once approved.

If you have a Medicaid insurance plan or straight Medicaid, contact Modivcare for mileage reimbursement or to arrange transportation to an appointment. Find your health plan on the list below and call for assistance.

Aetna Better Health of Michigan: 1-866-316-3784

Blue Cross Complete: 1-800-228-8554

Trusted Health Plan Michigan, Inc.: 1-844-427-2671

McLaren Health Plan of Michigan, Inc.: 1-888-327-0671

Meridian Health Plan: 1-888-437-0606

Molina Healthcare of Michigan: 1-888-898-7969

Michigan Medicaid: 1-866-569-1902

Total Health Care: 1-800-826-2862

UnitedHealthcare Community Plan: 1-800-903-5253

Children’s Special Health Care Services (CSHCS) provides transportation and lodging assistance to all Non-Medicaid enrolled clients. You can also get help with out-of-state transportation costs, including driving mileage, flight and hotel fees.

You must be pre-approved to receive assistance before you travel. Contact CSHCS representative Susan Craik at 586-466-6855 for more information.

Additional Questions

Review the document below or call us at 586-466-6855

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Frequently asked questions about Macomb County CSHCS coverage
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