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 is dependent on family size and income There may be a waiting list to receive CMSP coverage.
CMSP-covered services include:
- Well-child visits and immunizations
- Office visits when the child is sick or hurt
- Laboratory tests, X-rays, hearing tests, eye exams
- Family-planning services
- Specialty consultations
- Outpatient surgery for tympanostomy 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
- Outpatient mental health and substance abuse visits up to 20 visits each state fiscal year
- Prescriptions, up to $200 per state fiscal year
- Dental services: exams, X-rays, cleanings, fluoride treatments, sealants, fillings, extractions, root canals, crowns, space maintainers (maximum dental benefit: $750 per state fiscal year)
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
- Over-the-counter drugs
- Diagnostic photographs
- Removal of wisdom teeth
Please contact CMSP Customer Service at 800-909-2677 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 1st and continues through June 30th.
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 Uncompensated Care Pool at Massachusetts acute hospitals for inpatient services not covered by CMSP. A deductible, based on family size and income, may apply.
Copayments and Premiums
Copayments may apply as follows:
- Nonpreventive medical services: $2, $5, or $8 depending on family size and income
- 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:
- Income less than or equal to 199.9% of the federal poverty level: no premium charge
- Income from 200% to 300.9% of the federal poverty level: $7.80 per child/$23.40 maximum per family
- Income 301% to 400% of the federal poverty level: $33.14 per family
- Income greater than or equal to 400.1% of the federal poverty level: $38.99 per child per month
Call MassHealth Customer Service at 800-841-2900 or 800-497-4648 (TTY) to request a Medical Benefit Request (MBR), or click to download a Medical Benefit Request:
Submit the completed application to:
MassHealth Enrollment Center
Central Processing Unit
P.O. Box 290794
Charlestown, MA 02129-0214
Other application sites: Application forms may also be requested from and submitted to hospitals, community health centers, and community agencies.
CMSP Customer Service: 800-909-2677
MassHealth Customer Service: 800-841-2900 or 800-497-4648 (TTY)
CMSP Office Hours: Monday through Friday, 8:30 AM to 5 PM
MassHealth Office Hours: Monday through Friday, 9 AM to 5 PM