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Children’s Medical Services

Children’s Medical Services (CMS) is the go-to program for families with children with special health care needs. CMS offers multidisciplinary pediatric specialty clinics, information, referral, care coordination, and limited medical coverage to qualifying families. Children and youth are medically eligible based on a diagnosis from a doctor or primary care provider.

Who is Eligible

Children and youth with special health care needs are defined as individuals younger than 21 years old, experiencing a medical condition:

With significant potential or actual impact on long-term health and ability to function.
• Which requires specialized health care services and/or a variety of services from multiple diverse systems.

Examples of covered conditions:

Asthma
Blood Disorders
Cancer
Cardiomyopathy
Chronic ear/throat/sinus infections
Chronic liver, gallbladder, pancreas, or gastrointestinal disorders
Chronic Rheumatic conditions
Chronic, severe skin disorders
Cleft lip and palate
Congenital Anomalies
Cystic Fibrosis
Diabetes
Epilepsy
Hearing Loss
Hydrocephalus and other brain anomalies
Long-term effects of severe burns
Most eye disorders
Neurological disorders (cerebral palsy, transverse myelitis, spina bifida)
Renal Disease
Thyroid Disorders

CMS licensed medical social workers assist clients to coordinate health, medical, and community resources as they grow and can help families communicate with the child’s primary care physician and obtain the medical and educational services needed.

Families participate with their child in the decision-making process regarding their child’s medical care and other services. These services are coordinated in partnership with the child’s local primary care provider/medical home.

How We Can Help

We offer the following services for children or youth with special health care needs up to 21 years old:

Care coordination for children and their families including a range of medical, educational, and support services.
Transition (pediatric to adult) service planning.
Access to multidisciplinary pediatric specialty clinics.
Care for children with genetic conditions.
Facilitate transportation to medical appointments.
Follow-up care for children who are deaf or hard of hearing.

Medical Coverage

For those who meet financial and medical eligibility guidelines we can also help with:

Payment for medical services, procedures, medications, and supplies.
Payment of premiums, deductibles and co-pays for the New Mexico Medical Insurance Pool.
Payment for diagnostic services and care coordination.

Services covered are specific to the child’s diagnosis but may include payment for diagnostic services, hospitalizations, physician services, and some therapies. Children must be both medically and financially eligible (except for diagnostic services). For more information, call your local CMS office.

Pediatric Specialty Clinics

CMS sponsors community-based clinics throughout New Mexico. Specialties include:

Asthma
Cardiology
Cleft Palate
Cystic Fibrosis
Endocrine
Gastrointestinal
Genetics
Metabolic
Nephrology
Neurology

Check with your local CMS office to see which clinics are available in your area. There are no financial requirements for these services, but insurers of clients not financially covered by CMS are billed for clinic services.

Apply to the CMS Program

Have questions or are looking to apply? Call us toll free at 1-877-890-4692. Or find a public health office near you that offers CMS services here at Public Health Offices.