Children's Medical Services Program - FAQ
What services does Children’s Medical Services cover?CMS can pay for many different kinds of services, such as visits to a specialist, hospitalizations, surgeries, medications, therapies, lab work, x-rays, and medical equipment. CMS does not cover routine check-ups or immunizations, sick visits, emergency services, routine dental care, or mental health services. To see a list of commonly covered services please click here.
For CMS to pay for a service the following conditions must be met:
The service must be approved by CMS before the service is provided;
The service must be provided through a provider that is approved by CMS;
All other sources of payment must be used first. For instance, if you have health insurance, the company must be billed first.
Who is Eligible for the Children’s Medical Services Program?
To become eligible for CMS Program, the applicant:
Must have a diagnosed (or suspected) chronic illness or disability that needs medical evaluation and/or treatment;
Must be a child or young adult ages 0-21 years;
Must be a Maryland resident;
Must not qualify for any other source of health insurance, or must have health insurance that does not meet all of the child’s special medical needs
How can I get a CMS application?
You can call our office at 410-767-5588 or 1-800-638-8864 and an application will be mailed to you, or visit links below to download a CMS application. Mail the original application and all requested information to the Children’s Medical Services Program, 201 W. Preston Street, Room 423 A, Baltimore, Maryland 21201. Faxed application will not be accepted
Who do I call for more information, or to get help with an application?
Staff in the local health department or hospital may help you. You can also call CMS, located in the Office for Genetics and People with Special Health Care Needs at 1(800)638-8864 for help.
How long does it take to find out if a child or young adult is eligible for the CMS program?
Each applicant will receive a program eligibility letter within 30 days after the office receives the completed application. This letter will indicate if the applicant is eligible for the CMS program.
What happens if a child or young adult is eligible for the CMS program?
If the child is eligible for the CMS program, an eligibility letter will be sent to the applicant within 30 days. You will be contacted by the care coordinator listed on the eligibility letter regarding authorization for services.
What happens if a child or young adult is not eligible for the CMS program?
If a child or young adult is not eligible for the CMS program, staff will try to help you find other ways to get the medical care that the child or young adult needs.
If a child or young adult is not able to get CMS services and you are not satisfied, you may request an informal meeting or conference. Call or write the CMS program within 14 days after receiving the letter stating that the child or young adult cannot get services through CMS at this time. The application will be reviewed again. If you are not satisfied after the informal conference, you have a right to request a hearing before a Departmental Hearing Officer.