Children's Medical Services Program (CMS)

What is the Children’s Medical Services Program (CMS)?

Children’s Medical Services, also called CMS, is a program of the Maryland Department of Health and Mental Hygiene. CMS can help low-income, uninsured or underinsured Marylanders ages 0-21 years get specialty care for a chronic illness or disability by paying for needed services.

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 be a child or young adult ages 0-21 years;
• Must have a diagnosed (or suspected) chronic illness or disability that needs medical evaluation and/or treatment;
• Must be a Maryland resident;
• Must meet the CMS Program’s income requirements (see Financial eligibility scale)
• 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 or bring the completed application to the Children’s Medical Services Program, 201 W. Preston Street, Room 423 A, Baltimore, Maryland 21201.

Application Form   Instructions 

Solicitud para Servicios Médicos de Niños (CMS)  Instrucciones

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. After you receive the eligibility for service letter, call the CMS program office on 410-767-5585 or 1-800-638-8864 and give the physician and/or specialist contact information, appointment date and time, and office location.

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.

Brochures

Children’s Medical Services (English)

Children’s Medical Services (Spanish)

Forms

Form 4510 - Request for Pre-Authorization of Services and Instructions