Children's Medical Services (CMS)

Children’s Medical Services is part of the Family Health Bureau in the Public Health Division of the Department of Health, and is federally funded through Title V and State General Funds to serve as a safety net for medical management, payment for medical services, diagnostic studies and service coordination for Children and Youth with Special Health Care Needs (CYSHCN).

CMS is committed to accessible, available and appropriate health care for all children living in New Mexico, regardless of race, ethnicity, socioeconomic status or culture. The program creates a system of care that is family centered, community-based, culturally competent and coordinated.

Children’s Medical Services is comprised of several programs, including the Family-Infant-Toddler Program, the Newborn Metabolic Screening Program, the Newborn Hearing Screening Program, and Children and Youth with Special Health Care Needs (CYSHCN).

I. Children and Youth with Special Health Care Needs (CYSHCN):

This program provides comprehensive medical care and care coordination for children with chronic medical conditions, birth to 21 years of age, who are uninsured or underinsured and are not eligible for Medicaid. Clients must have an eligible medical diagnosis (“medical eligibility”) and also meet income guidelines of family income under 200% of poverty level (“financial eligibility”). CMS has almost 60 medical social workers housed in 32 health offices throughout the state.

Financial Eligibility: General financial eligibility is based on a family’s gross income and assets. In general, family income must be less than 200% of the Federal Poverty Level. Other factors taken into account include family size and the number of children in the family with special health care needs.

Families whose income exceeds the financial eligibility criteria may still attend specialty outreach clinics, are still eligible for care coordination provided by social workers throughout the state, and are also eligible for diagnostic services to rule out eligible medical conditions.

CMS serves as the last payer after insurance and does not provide financial coverage for Medicaid clients.

Medical Eligibility

• Covered Conditions: CMS provides payment for medical care, up to $15,000 per year, for clients with a wide range of chronic conditions, including, but not limited to, cleft lip and/or palate, congenital heart conditions, asthma, cerebral palsy, diabetes, immune deficiencies, cystic fibrosis, childhood cancer, epilepsy, renal disease, endocrine disorders and rheumatic disease. In addition to specialty care related to their diagnosis, clients with eligible conditions also receive primary care visits, general dental care, general vision care, medications and nutrition counseling.


• Diagnostics: Children who may have an eligible medical diagnosis are provided with diagnostic services for that condition, regardless of financial status.


• Not covered: Acute injuries or disease processes, breast or cervical cancer, experimental treatment or medication, psychiatric disorders (unless related to underlying eligible medical diagnosis). Most orthopedic conditions are not covered by CMS, as care for these may be provided by the University of New Mexico through Carrie Tingley Hospital.


• High Risk Insurance: For children who meet income guidelines and have certain high-cost conditions such as cancer, cerebral palsy, renal failure, heart failure, or cystic fibrosis, CMS will cover the cost of the premium for the New Mexico Medical Insurance Pool to ensure comprehensive insurance coverage.


• Care Coordination: Licensed medical social workers around the state provide care coordination to children with eligible medical conditions and assist the family in obtaining needed services and accessing community resources. Care coordination also plays a critical role in providing transition services to adolescents ages 15-21 with chronic illnesses, assisting the youth in transitioning from pediatric to adult health care and in obtaining educational support and community services.


• Multidisciplinary Pediatric Specialty Clinics: CMS provides approximately 128 community-based pediatric specialty clinics around the state, in conjunction with UNM and community providers. These clinics provide multidisciplinary, coordinated diagnostic services and/or ongoing medical care to children and youth with special health care needs. Current specialty clinics include: asthma, endocrine, genetic, metabolic, nephrology, neurology, and cleft lip and palate. Clinics are held in each region of the state, in order to ensure access to care for families who may find it difficult to travel to Albuquerque. There is no financial eligibility requirement for the clinics. Payer sources include private insurance, Medicaid, and CMS.


• Cystic Fibrosis and Metabolic Disease: CMS provides lifelong care coordination for these diseases, regardless of financial status.

II. Family-Infant-Toddler Program

This family-centered program provides care coordination and social work services for children ages 0-3 who have a developmental delay or are at risk for developmental delay. The FIT program promotes the capacity of parents and other caregivers in the child’s life to support the child’s development.

A developmental delay is a term used to describe what is observed in a child who develops at a slower rate than other children his age. Some children are “at risk” for a developmental delay based on factors such as premature birth, genetic conditions or serious medical problems, or children who have been exposed to substances such as drugs or alcohol prior to birth.

Parents can choose whether or not they and their children participate in the program. CMS-FIT Service Coordinators assist families through the intake process and coordinate the comprehensive multidisciplinary evaluation that determines eligibility. If the child is eligible, the family can choose to continue to receive service coordination through CMS or through their local early intervention program.

CMS-FIT Service Coordinators have particular knowledge of medical resources and are especially helpful to families of children with complex medical, developmental or social needs. The FIT program provides information to families and also provides training to early intervention professionals.

There is no income eligibility requirement for the FIT program. Early Intervention services are provided in the home or wherever the child typically spends their day. Early Intervention workers help families find opportunities for the child to learn and develop within the child’s daily routines, such as playtime, mealtime, bedtime, etc.

III. Newborn Hearing Screening

The Newborn Hearing Screening program administered by CMS began in January 1996. This partnership between public and private physicians, hospitals, audiologists, and the Department of Health was implemented to ensure that newborns would be screened before they leave the hospitals, and that a system of follow-up would be developed and put in place for those children who are referred for further hearing testing.

Mandated newborn hearing screening is now in effect for all children born in New Mexico. All birthing hospitals in NM are required to screen newborns for hearing loss prior to discharge from the hospital. Any infant who does not pass the newborn hearing screening is referred to CMS and followed by a CMS worker. The CMS worker provides resources to the family and ensures that the child has access to a follow-up hearing exam.

IV. Newborn Metabolic Screening Program

The New Mexico Newborn Screening Program (NMNBSP)screens all babies born in NM for certain genetic, metabolic, hematologic and endocrine disorders. In 2006 the NM Legislature mandated expanded screening, which was rolled out in January 2007 and now includes testing for 27 different conditions. The NMNBSP provides services to over 29,000 babies annually, with each baby receiving two newborn screens, one done in the first 48 hours of life (before leaving the hospital) and the second within the first two weeks of life.

CMS has partnered with Mountain States Genetic Network, Oregon State Public Health Laboratory, and UNM to provide expanded screening and follow-up services for children with identified metabolic and genetic disorders. CMS provides follow-up of all children identified on newborn screening as having a genetic, metabolic, endocrine or hemoglobin disorder, including cystic fibrosis. Children are followed to age 21, and those diagnosed with cystic fibrosis and certain metabolic disorders are given lifelong follow-up and care coordination.