About the Program
The Children's Medical Security Plan (CMSP) is a program that provides certain uninsured children and adolescents with primary and preventive medical and dental coverage.
CMSP is for children under the age of 19 who are Massachusetts residents at any income level, who do not qualify for MassHealth (except MassHealth Limited), and who are uninsured. The amount a family pays for CMSP coverage depends on family size and income. There may be a waiting list to receive CMSP coverage.
CMSP-covered services include
- preventive pediatric care (well-child visits and immunizations)
- office visits (sick visits and follow-up care)
- urgent care visits not including emergency care in a hospital outpatient or emergency department
- diagnostic laboratory tests and X rays
- hearing tests
- annual and medically necessary eye exams
- outpatient surgery and anesthesia for tympanostomy (ear) tube placement and for inguinal hernias
- durable medical equipment, up to $200 per state fiscal year, with an additional $300 per state fiscal year for equipment and supplies related to asthma, diabetes, and seizure disorders only
- outpatient mental health services including substance abuse treatment not to exceed 20 visits per state fiscal year
- prescriptions, up to $200 per state fiscal year
- dental services, up to $750 per state fiscal year, including preventive dental care
Some examples of services not covered by CMSP include
- early intervention
- inpatient hospital care and any charges related to inpatient hospital care
- ambulance and other medical transportation services
- emergency room services
- cosmetic or surgical dentistry
Please contact MassHealth Customer Service at 1-800-841-2900 for more information about services that are not covered.
CMSP benefits are calculated on a state fiscal-year basis. The state fiscal year starts on July 1 and continues through June 30.
Some children are also eligible for MassHealth Limited, which covers emergency services and care.
Children covered by CMSP with family incomes up to 400% of the federal poverty level are eligible for the Health Safety Net (HSN) at Massachusetts acute hospitals and community health centers for medically necessary services not covered by CMSP. A deductible, based on family size and income, may apply.
Premiums and Copayments
Copayments may apply as follows.
- prescriptions: $3 for generic drugs and $4 for brand-name drugs
- dental services: $2, $4, or $6 depending on family size and income
CMSP premium amounts are as follows.
- income is less than or equal to 199.9% of the federal poverty level : no premium charge
- income is 200% to 300.9% of the federal poverty level : $7.80 per child/$23.40 maximum per family
- income is 301% to 400% of the federal poverty level: $33.14 per family
- income is greater than or equal to 400.1% of the federal poverty level: $64 per child per month
Download the CMSP Premium and Copayment Chart (PDF) to help you determine your premiums and copayments.
Call MassHealth Customer Service at 1-800-841-2900 (TTY: 1-800-497-4648 for people who are deaf, hard of hearing, or speech disabled) to request a Massachusetts Application for Health and Dental Coverage and Help Paying Costs (ACA-3), or download an application:
Submit the completed application to:
Health Insurance Processing Center
P.O. Box 4405
Taunton, MA 02780
Application forms may also be requested from and submitted to hospitals, community health centers, and community agencies.
MassHealth Customer Service: 1-800-841-2900 (TTY: 1-800-497-4648 for people who are deaf, hard of hearing, or speech disabled)
Office Hours: Monday through Friday, 8:00 A.M. to 5:00 P.M.
This information is provided by MassHealth.