3.3 CSHCN Services Program Eligibility FormThe CSHCN Services Program Eligibility Form gives clients, parents, and providers a quick way to verify CSHCN Services Program eligibility. The form is designed to convey all of the information necessary to document identification information. Medicaid or other insurance information (including CHIP) listed on the form at the time of application is valid and must be verified independently. CSHCN Services Program Eligibility Forms are valid for a 6-month coverage period. Clients must reapply for CSHCN Services Program health-care benefits every 6 months. A new application and all proofs of financial eligibility must be submitted each time a client reapplies for the CSHCN Services Program. The CSHCN Services Program Eligibility Form provides the reapplication deadlines specific to each client. It tells clients the earliest day that they can start the reapplication and lets them know that they must submit a renewal application before their eligibility ends. Refer to: Section 3.3.2, "CSHCN Services Program Eligibility Form Sample". Approximately 60 days before the eligibility renewal date, the CSHCN Services Program mails a letter and a reapplication packet containing the CSHCN Services Program Application Booklet (T-3) to clients and their families. If a client or family has not received the packet within 30 days prior to their renewal date, they should obtain a copy of the CSHCN Services Program Application Booklet, either by requesting one from their local CSHCN Services Program Regional Office (refer to the listing at Section 1.2.2, "Regional Offices" of this manual), by calling the CSHCN Services Program Central Office at 1-800-252-8023, or by downloading the booklet from the CSHCN Services Program website at www.dshs.state.tx.us/cshcn/clapplforms.shtm. The CSHCN Services Program Eligibility Form gives eligibility information. Providers should ask for the form when scheduling a client for an appointment. Under certain circumstances, the form may not be valid at the time the provider sees the client. Providers should verify client eligibility before providing services by using the following options:
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• If the client is not eligible when they arrive for an appointment, the provider must advise the client that they are being accepted as a private-pay client at the time the service is provided. The client will be responsible for paying for all services received. Providers are encouraged to ensure that the client signs written notification indicating that the client is being accepted as a private-pay client. |
CSHCN Services Program Automated Inquiry System (AIS) at 1-800-568-2413
