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Information for Families

General Info

The Children with Medical Handicaps Program (CMH) provides assistance to children with special health care needs and their families who meet the medical and financial eligibility criteria.  Assistance is provided to children under the age of 21 who have special health care needs and are residents of the State of Ohio.

Although CMH covers a wide range of services, it is important to know CMH does not cover all the services a child with special health care needs may require, nor are all services available for every diagnosis. Services must be related to the child’s CMH-eligible condition.

If you have a specific question about a child/client on the program, please give the child’s/client’s name, date of birth and CMH case number to the customer service representative at 1-800-755-4769 (families only) or (614) 466-1700 or BCMH@odh.ohio.gov. This information will allow CMH staff to answer your questions in a prompt and accurate manner.

Frequently asked Questions can be found HERE

CMH Main Programs

The Children with Medical Handicaps Program (CMH) has three core programs for children with special health care needs:
· Diagnostic
· Treatment
· Service coordination

Each program requires medical and/or financial criteria to be met before a child/adult can be eligible to receive CMH services.

Additional Programs

· Adult Cystic Fibrosis Program:  This program provides limited treatment services for persons over age 21 with cystic fibrosis.  Financial eligibility is required.  The benefit package currently consists of prescription medications, medical supplies, special formula, and public health nursing visits upon request.

· Adult Hemophilia Insurance Premium Program (HIPP):  HIPP helps with payment of health insurance premiums for persons over 21 years of age, with hemophilia or a related bleeding disorder, who meet the eligibility criteria as defined in Ohio Administrative Code 3701-43-16.1

· Metabolic Formula Program:  This program provides metabolic formula to individuals with phenylketonuria (PKU), homocystinuria and other metabolic disorders.  Without special formula, individuals, especially infants and children, may develop brain damage and mental retardation. More information can be found HERE.

· Community Nutrition Services:  Children on the CMH diagnostic or treatment programs who have a nutrition-related concern may request to work with a CMH community dietitian.  Community dietitians are registered and licensed dietitians with additional training in pediatrics.  They work with the family during home visits to provide nutrition assessments and education.  Some examples of issues community dietitians can help with include evaluation of tube feedings, treatment for food allergies, strategies for gaining or losing weight, or any feeding behaviors that cause a caregiver concern.  To find a community dietitian in your area, contact (614) 466-1700.  More information can be found HERE.

· Premium Payment Assistance Program:   Families who are using a COBRA option or who are paying annual health insurance premiums that are equal to or greater than 2.5 percent of their adjusted gross annual income and whose child is enrolled in the CMH treatment program may be eligible for this program.  For CMH to enroll a family, it must prove to be cost effective for CMH.  Families often are referred to this program by public health nurses or hospital staff. If you are approved for the Premium Payment Assistance Program you MUST visit this website. http://www.supplier.obm.ohio.gov/ 

· Public Health Nursing Services:  Public health nursing services are approved for every child in the CMH diagnostic, treatment and service coordination programs.  A public health nurse is:  a registered nurse employed by the local health department; skilled in working with children, families and medical/dental providers; and an expert in accessing local community agencies to help families.

How To Enroll

The Children with Medical Handicaps Program (CMH) provides assistance to families who have children with special health care needs who meet the medical and financial eligibility criteria.  All criteria are for children under the age of 21 who have special health care needs and are residents of the State of Ohio.

In order to enroll in CMH, a Medical Application Form  must be submitted by a CMH-approved physician.  Local health department public health nurses can provide a referral to start the enrollment process.  Dependent upon the program, financial eligibility may or may not be a criteria. (See Enrollment Guidelines below for financial information)

Enrollment Guidelines

Medical Eligibility Criteria

For the CMH Diagnostic Program, a child must:

  • Be under the age of 21
  • Be a permanent resident of Ohio
  • Be under the care of a CMH-approved doctor (MD or DO)
  • Have a possible special health care need

For the CMH Treatment Program, a child must:

  • Be under the age of 21
  • Be a permanent resident of Ohio
  • Be under the care of a CMH approved doctor (MD or DO)
  • Be financially eligible
  • Have an eligible special health care need

For the Service Coordination Program, a child must:

  • Be under the age of 21
  • Be a permanent resident of Ohio
  • Be under the care of a CMH-approved hospital specialty team approved for service coordination
  • Have a diagnosis eligible for service coordination

Financial Eligibility Criteria

The CMH Treatment Program has a financial eligibility requirement.

Financial eligibility for CMH is determined case by case based on:

  • A percentage of the federal poverty income guidelines
  • The family’s taxable income
  • The medical care the child needs
  • A calculation of the family’s maximum ability to pay for health care
  • Amount spent on private health insurance
  • Amount spent on weekly child care

CMH does not count personal assets such as a home, car or savings account when determining financial eligibility. Also, income from child support, stepparent income or social security income (SSI) for the child is not counted.

When a child’s doctor applies to CMH for treatment services a child needs, CMH will send the parent or legal guardian a financial application packet unless the child is active on the Medicaid program. It is important that all the instructions in the packet are followed. A form called the CMH Financial Application will be in the packet.  It must be filled out and mailed to CMH along with 3 pay stubs from each parent/adult client who is employed and a copy of their most recent federal income tax form (1040) and verification of child care expenses. A child receiving benefits through Medicaid, SSI or WIC is automatically financially eligible for CMH treatment services, regardless of the parent’s income.

CMH and Medicaid

Families who meet the income standards for the Medicaid program of the Ohio Department of Medicaid (ODM) will be required to apply to that program for coverage of medical services for their child. The Medicaid Guidelines are in the CMH financial application packet, along with instructions on how to apply. If over-income for the Medicaid Program, the Financial Application, denial letter from Healthy Start and income verification must be sent to CMH to determine eligibility for CMH.

If a Family is Determined to be “Over Income” for the CMH Program

If CMH sends the family a denial letter, stating they are “over-income” for the Treatment Program, they will also receive information about the CMH’s cost share program. They will be given a cost share dollar amount and CMH Information Sheet: Steps to Meet your Cost Share on how they can meet that cost share amount. When the family provides proof to CMH that they have spent that amount of money on medical costs including dental, and/or vision bills for any member of their family, they will have met their cost share. On the date the cost share is met, the child will become eligible for the Treatment Program for one year.

Forms & Documents

Commonly used forms by parents and clients

Medical Application Form (MAF): Basic application filled out with help from a Physician

CMH Financial Application:  Financial application for all families that don't have Medicaid

Release and Consent: Must be signed by all parents

Release and Consent over 18 years old: Must be signed by all clients over the age of 18

Steps to meet your cost share: Used to help track your cost share

Parents with Secondary Insurance: Used if Client has Medicaid or Secondary Insurnace

Notification of Change in Family Status: Used to update address, insurance, custodial parent, etc.

Brochures

CMH Main Brochure

Standard of Care and Outcomes for Children With Cerebral Palsy

Standard of Care and Outcomes for Children With Chronic Pulmonary Disease

Standard of Care and Outcomes for Children With Craniofacial Deformities 

Standard of Care and Outcomes for Children With Spina Bifida

Handbook for Families of Children with Special Health Care Needs

Documents

CMH Rules (Ohio Administrative Code): Ohio Revised Code outlining rules for CMH program

Medicaid Guidelines 2018: Income guidelines for Medicaid