What is the purpose of the program?
Children's Medical Services (CMS)
is a collection of programs that serve eligible children with special health care needs using a family-centered model of care. Additionally, CMS provides a continuum of medical and supportive services to eligible high-risk pregnant women enrolled in Medicaid.
What medical services does the program provide?
The collection of programs provide medical and support services to eligible children including prevention and early intervention programs, primary and specialty care, and long-term care.
- CMS Managed Care Plan is a statewide managed system of care for children with special health care needs who are Medicaid eligible or eligible for Florida KidCare. The CMS Network provides children with special health care needs a family-centered, culturally competent, comprehensive and coordinated statewide managed system of care that links community-based care with multidisciplinary, regional, and tertiary pediatric care. Care coordinators, nurses and social workers who assist families with organizing their child's care, are located at 20 local CMS area offices across the state. The care coordinators receive referrals and complete the clinical screening process with the child's family using a multi-tiered tool.
- Early Steps is Florida's early intervention system that offers services to eligible infants and toddlers (birth to 36 months) with significant delays or a condition likely to result in a developmental delay. Early intervention is provided to support families and caregivers in developing the competence and confidence to help their child learn and develop. These services include occupational and physical therapy, speech language pathology, nutrition services, and other medical services.
- Florida's Newborn Screening Program tests all babies born in Florida for more than 50 different primary and secondary disorders. The screening process helps find and treat conditions early, which can prevent serious problems and death.
- The Division of Prevention and Intervention offers services associated with child abuse and neglect to children with special health care needs and their families. Services include Child Protection Teams, Sexual Abuse Treatment Programs, and other child abuse and neglect prevention initiatives aimed at preventing child abuse before it begins and promoting nurturing relationships between the whole family.
- Poison Control Centers provide emergency services and information regarding poison exposure to the public through the hotline and educational information provided to communities. The Poison Centers, staffed by physicians, nurses, physician assistants, and pharmacists who specialize in poison information, provide real-time data on poisons through the Poison Information System.
- Regional Perinatal Intensive Care Centers (RPICC) provide obstetrical services to women with high-risk pregnancy and care services for newborns with special health needs, including critical illness and low birth weight, to improve the outcomes of pregnancy and quality of life from birth. Services are provided by a medical team of nurses, a doctor specializing in high-risk obstetrical care, a genetic counselor, and an ultrasound technician at 11 RPICC hospitals and 2 Obstetrical Satellite Clinics around the state.
How are primary and specialty health care services delivered?
CMS partners with WellCare of Florida to deliver and coordinate primary and specialty care for CMS Health Plan members. Each child within the program has access to a personal primary care physician who provides or authorizes all medically necessary services for the child. The child and family are also assigned a care manager who helps the child and family figure out what services are needed, provides assistance with accessing services, and works with providers to coordinate services.
Who is eligible for CMS primary and specialty health care?
Eligibility, as well as benefits and services, differ for the two versions of the CMS Health Plan.
CMS Health Plan for Medicaid is designed for children under age 21 who meet Medicaid financial requirements and CMS clinical screening requirements. CMS Health Plan for KidCare
is designed for children under age 19 who are eligible for Florida KidCare
and meet CMS clinical screening requirements. To meet clinical eligibility requirements, as defined by Title V of the Social Security Act, children must have, or are at an increased risk for, chronic and serious physical, developmental, behavioral, or emotional conditions and require health care and related services of a type or amount beyond that which is generally required by children.
Children who are clinically eligible can choose the CMS Health Plan as a benefit plan option if they meet eligibility requirements for Title 19 (Medicaid) or Title 21 ((Florida's Children's Health Insurance Program (CHIP)). Title 19 Medicaid and Title 21 CHIP eligibility are determined by the child's age and the family income. Additionally, Medicaid eligible pregnant women who are considered to be high risk are also eligible.
Subject to the availability of funds, other individuals may also receive services through CMS, including
- children, up to age 21,with special health care needs who do not qualify for Medicaid or Title XXI, and who meet other criteria;
- children, up to age 21, with special health care needs who are eligible under Title V of the Social Security Act;
- infants who are compensated for a birth related neurological injury by the Florida Birth-Related Neurological Injury Compensation Association; and
- children with serious and chronic special health needs who had medical or surgical treatment under CMS prior to adoption shall continue to be eligible for treatment after adoption.
How do families evaluate the care their children receive through CMS?
For Fiscal Year 2018-19, 87% of families served reported a positive evaluation of care. This is below the state approved performance standard of 96.60%.
What percentage of enrollees met the schedule for well child visits?
For Fiscal Year 2018-19, 74.2% of enrollees met the schedule for well child visits. This is an increase from 73.8% reported in the prior fiscal year, but less than the state approved performance standard of 91% for Fiscal Year 2018-19.
How are these activities funded?
Where can I find related OPPAGA reports?
A complete list of related OPPAGA reports is available on our website
Where can I get more information?
What are the applicable statutes?
, and III
, and ss. 383.011
, and 409.813
, Florida Statutes.
Whom do I contact for help?
Children's Medical Services Central Office, 850-245-4201