Children's Medical Services for Providers
The Federal Maternal & Child Health Bureau defines CYSHCN as “children and youth with special health care needs are those who have or are at increased risk for chronic, physical, developmental, behavioral, or emotional conditions and who also require health and related services of a type or amount beyond that required by children generally.”
Brochure
Please see our brochure available in both English and Spanish below.
Who is Eligible?
Children from birth to 21 are eligible if diagnosed with chronic medical conditions or disabilities that require surgical or medical treatment or limit activities.
These conditions are automatically qualifying:
- Cancer
- Cardiac Disease
- Cerebral Palsy
- Cleft Lip & Palate
- Cystic Fibrosis
- Diabetes
- Epilepsy with Seizure Medications
- Juvenile Rheumatoid Arthritis
- Lupus
- Renal Failure
- Spina Bifida
The Children’s Medical Services Medical Director will review all other medical conditions to determine eligibility based on established guidelines.
Adults
Adults are eligible if they have genetic/metabolic or cystic fibrosis who are eligible for lifelong services.
Treatment Services
For treatment services, those who are within financial guidelines (for more information contact your local office) and meet medical eligibility and have no other pay source.
Residents of New Mexico
To be eligible for Medicaid applicants/recipients must be living in New Mexico on the date of application or final determination of eligibility and have demonstrated an intention to remain in the state.
Establishing Residence
Residence in New Mexico is established by living in the state and carrying out the types of activities associated with normal living, such as occupying a home, enrolling child(ren) in school, getting a state driver’s license, or renting a post office box. An applicant/recipient who is homeless is considered to have met the residence requirements if he/she intends to remain in the state.
Recipients Receiving Benefits Out-of-State
Applicants/recipients who receive financial or medical assistance in another state which makes residence in that state a condition of eligibility are considered residents of that state until the ISD office receives verification from the other state agency indicating that it has been notified by an applicant/recipient of the abandonment of residence in that state.
Abandonment
Residence is not abandoned by temporary absences. Temporary absences occur when recipients leave New Mexico for specific purposes with time-limited goals. Residence is considered abandoned when any of the following occurs;
- Applicant/recipient leaves New Mexico and indicates that he/she intends to establish residence in another state;
- Applicant/recipient leaves New Mexico for no specific purpose with no clear intention of returning;
- Applicant/recipient leaves New Mexico and applies for financial, food or medical assistance in another state which makes residence in that state a condition of eligibility; or
- Applicant/recipient has been absent from New Mexico for more than thirty (30) days without notifying HSD of his/her departure or intention of returning.
Please see our CMS Income Guidelines document to learn more.
Making a Referral
Initial referrals may come from a variety of sources including Physicians, Hospitals/Clinics, DD Programs, Local Health Offices, Social Services, Indian Health Service, Schools (including Preschool, Headstart, Day Care Centers, Boarding Schools, Public Schools), staff/clinics, Child Find, WIC, Public Health and others. Families may also self-refer to the program.
Referrals for children and youth attending specialty clinics and seeing specialists must have a referral from their Primary Care Provider in order to attend clinics or see Pediatric Specialists.
Please see our CMS Telephone Referral Form to learn more about making a referral.
What is a Medical Home?
A medical home is not a building or a place. It is an approach to providing comprehensive primary care that facilitates partnerships between patients, clinicians, medical staff, and families. Care within a medical home should be accessible, continuous, comprehensive, patient- and family-centered, coordinated, compassionate, and culturally effective.
A medical home consists of:
- Committed primary care leadership.
- Addition of financial resources.
- A formal ongoing relationship with an academic medical center for training, consultation, and hospital.
- Cultural and language expertise.
- Family buy-in.
Family-Centered Care
A family-centered approach to health care and related services must be central to our thinking and to our efforts. The following are the basic elements of family-centered care:
- Recognizing that the family is the constant in a child’s life, while the service systems and personnel within those systems fluctuate.
- Facilitating family/professional collaboration at all levels of health care.
- Honoring the racial, ethnic, cultural and socioeconomic diversity of families.
- Recognizing family strengths and individuality and respecting different methods of coping.
- Sharing with parents, on a continuing basis and in a supportive manner, complete and unbiased information
- Encouraging and facilitating family-to-family support and networking.
- Understanding and incorporating the developmental needs of infants, children, and adolescents and their families into health care systems.
- Implementing comprehensive policies and programs that provide emotional and financial support to meet the needs of families.
- Designing accessible health care systems that are flexible, culturally competent, and responsive to family-identified needs.
Community-Based Care
Children and youth with special health care needs should live with their families in their own communities, and share in the everyday experiences most of us take for granted. We must commit to providing the kinds of health care children and youth require, in ways that allow them to participate as fully as possible in all aspects of family and community life.
Services should be in or near the home communities of families of children and youth with special health care needs.
The geographic area involved in developing a service delivery system can vary widely within the State. Services in or near their home communities facilitate the ability of families to care for their children at home and promote normal patterns of living. The geographic area covered by a service delivery system will depend on a number of factors including population density, political subdivisions, existing arrangements for provision of services, and availability of resources.
Cultural Competence
Many terms have been used to relate cultural issues to practice. The National MCH Bureau Work Group chose to discuss “culturalcompetence” because competence implies more than beliefs, attitudes and tolerance, though it does include them. Competence implies skills which help to translate beliefs, attitudes and orientation into action and behavior within the context of daily interaction with children and families.
Cultural Competence refers to a program’s ability to honor and respect beliefs, interpersonal styles, attitudes, and behaviors of families who are clients as well as the multi-cultural staff who are providing services. It incorporates these values at the levels of policy, administration, and practice.
Coordinated Care
Children and youth with special health care needs and their families generally require multiple services from different providers associated with different agencies, institutions and organizations. This calls for a service delivery system that provides services that are coordinated. Often, these services are highly fragmented.
Coordination between programs serving infants and young children, school age children and adolescents and young adults are lacking. Because of this fragmentation, children and youth with special health care needs and their families are likely to encounter significant difficulties in obtaining needed comprehensive services.
Many public and private programs serving children, youth and their families have different mandates, eligibility requirements and inconsistent policies. This leads to gaps and/or duplications in services, and may serve only particular age groups.
Community-based services must be integrated, consistent and timely to be responsive to the needs of families. MCH/CYSHCN programs should facilitate access to care within their community by coordinating health services and creating linkages between providers of health services and providers of other services. In an ideal system there would be coordination and cooperation among health care professionals at the primary, secondary and tertiary levels of care; there would be cooperation among all sectors - public, private and voluntary; all departments and levels of government would work together across agency lines and among community, State, regional and national levels to ensure effective and efficient services.
Learn More
Please visit the following websites to learn more.