Overview

The Children’s Medical Security Plan provides primary health and dental coverage to uninsured children and adolescents (under age 19). Families contribute through premiums and co-payment, depending on income. Note: Families with income levels up to 400% of the Federal Poverty Guidelines may be eligible for subsidized coverage through ConnectorCare. They also might be eligible for the Health Safety Net (previously known as Free Care) for wrap-around coverage such as inpatient services not covered by CMSP.

Member Booklet   (Large Print version)

• Combined member booklet for MassHealth, the Children’s Medical Security Plan (CMSP), ConnectorCare Plans and Premium Tax Credits, and the Health Safety Net. To get this booklet in Cambodian, Chinese, Haitian Creole, Laotian, Brazilian Portuguese, Russian, Vietnamese, or in Braille please call MassHealth Customer Service at 1-800-841-2900 (TTY: 1-800-497-4648)

Eligibility

To be eligible for the CMSP, an individual must be:

• under nineteen years of age
• a resident of Massachusetts
• not eligible for MassHealth (except MassHealth Limited)
• uninsured

NOTE: MassHealth may limit the number of children who can be enrolled in CMSP. When MassHealth sets such a limit, applicants will be placed on a waiting list.

Copays

Copayments are as follows:

• $3 for generic drugs;
• $4 for brand name drugs

The CMSP will pay for services such as:

• Outpatient services including preventive and sick visits
• Outpatient mental health services and substance abuse treatment services up to 20 visits per fiscal year
• Outpatient surgery and anesthesia that is medically necessary for the treatment of inguinal hernia and ear tubes
• Prescription drugs up to $200 per state fiscal year with co-payments of $3 for each generic drug and $4 for each brand name drug
• Eye exams and hearing tests
• Durable medical equipment up to $200 per fiscal year. Asthma-, diabetes-, and epilepsy-related durable medical equipment may be available up to an additional $300 per state fiscal year
• Dental services – maximum $750 per fiscal year (This includes exams, X rays, cleanings, fluoride treatment, sealants, fillings, extractions, full or partial root canals, crowns, and space maintainers.) (Frequency limits apply to certain dental services.)

The CMSP will NOT cover:

• inpatient hospital care
• ER services
• medical transportation services
• wisdom teeth extraction
• over-the-counter drugs
• orthodontia
• diagnostic photographs
• early intervention services

How To Apply

To apply for the CMSP MGH patients should contact Patient Financial Services. Or call: 1-800-841-2900 or visit: Massachusetts Health Connector. Families may also apply at their local community health centers.