Office of Program Policy Analysis and Government Accountability
Office of Program Policy Analysis and Government Accountability

Department of Health

Children's Medical Services (CMS)

What is the purpose of the program?

Children's Medical Services (CMS) is a collection of programs that provides a statewide managed system of care for children with special health care needs and essential preventive, evaluative, and early intervention services for at-risk children.

What medical services does the program provide?

Children's Medical Services Managed Care Plan (CMS Plan) is a statewide managed system of care for children and youth with special health care needs who are Medicaid eligible up to age 21 or eligible for Florida's Children's Health Insurance Program (CHIP) up to age 19. The CMS Plan provides its members comprehensive health care that aligns with the State of Florida's Medicaid managed medical assistance program benefit coverage. In addition to standard benefits, the plan offers an array of expanded benefits to address needs of the member population. Each CMS Plan member is assigned a care manager to assist with care coordination and provide linkages to community-based resources.

Early Steps is Florida's early intervention system that offers services to eligible infants and toddlers, age birth to 36 months, who have or are at risk for developmental disabilities or delays. Early intervention is provided to support families and caregivers in developing the competence and confidence to help their child learn and develop. These services may include  screening and evaluation; individualized family support planning; professional support and service coordination; therapies such as occupational, speech, and physical; assistive technologies; and hearing and vision services.

Florida's Newborn Screening Program tests all babies born in Florida for more than 55 different primary and secondary disorders. The screening process helps find and treat conditions early, which can prevent serious problems and death.

The Bureau of Child Protection and Special Technology offers services associated with child abuse and neglect to children who have been alleged to have been victims or abuse, abandonment, or neglect. Services include Child Protection Teams and Sexual Abuse Treatment Programs. In addition, the Child Abuse Death Review System eliminates preventable child fatalities through understanding the complexities of child maltreatment, utilizing evidence-based knowledge to support prevention strategies.

Poison Control Centers provide emergency services and information regarding poison exposure to the public through the hotline and educational information provided to communities. The 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 hospitals and obstetrical satellite clinic around the state.

Safety Net Program serves children with chronic and serious health conditions who do not qualify for Florida Medicaid or KidCare or are unable to access services. Safety Net helps families pay for health services on a first-come, first-served basis, until the funds have been allocated. Families may also have to pay some of the cost for services, based on a sliding scale. 

How are primary and specialty health care services delivered?

CMS, through its many programs, utilizes public and private provider contracts and partnerships to deliver services. For example, the CMS Plan partners with Sunshine Health to deliver and coordinate primary and specialty care for CMS Plan members. Each member is assigned a primary care physician who provides or authorizes all medically necessary services for the member.

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 21 who meet Medicaid financial requirements and CMS clinical screening requirements. Children under age 19 who are eligible for CHIP and meet CMS clinical screening requirements may enroll in CMS Plan.

To meet clinical eligibility requirements for the CMS Health Plan, as defined in s. 391.029, Florida Statutes, 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. 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. Additionally, Medicaid eligible pregnant women who are considered to be high risk are also eligible.

Through the Safety Net Program, subject to the availability of funds, other individuals may also receive specialty 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; and
  • children, up to age 21, with special health care needs who are eligible under Title V of the Social Security Act.

How do families evaluate the care their children receive through CMS?

For Fiscal Year2022-23, 85.4% of families served reported a positive evaluation of care. This is below the state approved performance standard of 96.6%.

What percentage of enrollees met the schedule for well child visits?

For state Fiscal Year 2022-23, 65.45% of enrollees met the schedule for well child visits, less than the state approved performance standard of 91%.

How are these activities funded?

Fiscal Year: 2023-24
Fund Dollars Positions
PROGRAM: CHILDREN'S MEDICAL SERVICES
CHILDREN'S SPECIAL HEALTH CARE
1,461,213,202
335.50
TOTAL
1,461,213,202
335.50

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?

Other Reports
Publications, Children's Medical Services
The Auditor General reports on department operations are located on the Auditor General website

Websites of Interest
Association of Maternal & Child Health Programs
CMS Managed Care Plan
Healthfinder
Institute for Patient- and Family-Centered Care
Institute for Child Health Policy
U.S. Department of Health and Human Services, Maternal and Child Health Bureau
Zero to Three National Center for Infants

Performance Information


Performance measures and standards for the department may be found in its Long Range Program Plan.

What are the applicable statutes?

Chapters 391 and 411 Parts I, II, and III, and ss. 383.011, 383.14, 383.145, 383.402, 385.203, 395.1027, 395.401, and 409.813, Florida Statutes

Whom do I contact for help?

Children's Medical Services Central Office, 850-245-4201
Website