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Indiana State Department of Health
The Children's Special Health Care Services (CSHCS) Program provides travel reimbursement to the parent or guardian of the underage participant or to the participant of age for trips to approved health care providers for covered services. The trip must be 50 miles or more one-way or round trip, and payment is in accordance with state travel policies and procedures established by the Indiana State Department of Administration and approved by the Indiana State Budget Agency.
Effective July 1, 2010, the CSHCS Program has discontinued travel reimbursement for participants dually enrolled in both CSHCS and Medicaid/Hoosier Healthwise (HHW). Dually enrolled participants will need to contact their Medicaid/HHW assigned health plan to arrange transportation.
The cost of traveling to and from a network provider for approved services may be reimbursed to the parent, foster parent or legal guardian of a participant if the following conditions are met:
State law now requires any person and/or entity who submit claims for payment by the State to be reimbursed by electronic funds transfer. This means that if you wish to be reimbursed for family travel by the CSHCS Program, you must submit information to set up direct deposit. Information on the direct deposit process and copies of the forms required - the W-9 and Direct Deposit forms - can be found below.
Vouchers must be submitted within one (1) year of the date of travel. For example, if you traveled to the doctor on May 1 of 2013, we must have received your travel vouchers in our office prior to May 1 of 2014. Blank travel vouchers and the W-9 and Direct Deposit forms can be obtained below or by contacting us directly at 1-317-233-1351 or 1-800-475-1355 (Option 4).
Properly signed and completed travel vouchers must be mailed to the CSHCS office:
- Reimbursement (money paid back to you) will be made at 50 percent of the rate established by the Department of Administration and approved by the State Budget Agency.
- Effective July 1, 2009, the first 49 miles one-way or round trip will not be reimbursed. Only mileage that exceeds 49 miles one-way or round trip will be reimbursed.
- Mileage will not be approved for trips in excess of 2,500 miles round trip.
- All mileage is based on the city-to-city calculation from the Indiana State Mileage Chart and not the odometer reading from your vehicle.
- All signatures submitted on the Travel Voucher must be original.
- All sections of the Travel Voucher must be completed legibly.
- A Maximum of three (3) travel dates may be submitted per one Travel Voucher.
- Anyone requesting Travel Reimbursement must have filed (one time only) completed W-9 and Direct Deposit forms.
- The CSHCS Program will not reimburse for transportation to visit a hospitalized participant, parking, meals or lodging.
Forms and Instructions
Travel Claim Form
Direct Deposit Form
Travel Reimbursement Bulletins:
Bulletin 1: Travel Reimbursement Change Effective 7/1/2010
Children's Special Health Care Services
2 North Meridian Street, Section 5C
Indianapolis, IN 46204