Services covered under the Children's Medical Security Plan

This section identifies services covered by CMSP, and identifies examples of services not covered by CMSP.

• primary and preventive health care services (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
• outpatient surgery and anesthesia for tympanostomy (ear) tube placement and for inguinal hernia
• diagnostic laboratory and x-rays
• auditory screenings
• annual and medically necessary eye exams
• dental health care, including preventative dental services, up to $750 per state fiscal year, and provided that no funds be expended for cosmetic dentistry and orthodontic services
• mental health outpatient services including substance abuse services, limited to 20 visits per year
• pharmacy services limited to $200 per state fiscal year with co-payments of $3 for each generic drug and $4 for each brand name drug
• 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 disorder only

Some examples of services not covered by CMSP

• emergency room services
• ambulance or other medical transportation
• inpatient hospital care
• cosmetic or orthodontic dentistry