New Mexico program
Help organizing care and paying some costs (Children’s Medical Services)
Children’s Medical Services offers care coordination and can buy approved care for eligible children.
What it is
Children’s Medical Services offers care coordination and can buy approved care for eligible children.
Children’s Medical Services offers care coordination and help buying approved care. Coordination has no income test, but staffing and funding can limit availability. Purchased care and related travel have separate financial and medical rules.
Eligibility rules
- Purchased care requires household income below 200% of poverty and medical eligibility under the program’s medical index and medical director.
- The 2026 reference amounts at 200% of poverty are $4,554 monthly for three people and $5,500 for four. Purchased care requires income strictly below the applicable limit, which the program confirms.
- A child with two or more other payers does not meet the financial test for purchased care.
- Referrals can arrive by telephone, post, written referral or application. A clinic referral must come from a physician, physician assistant or pediatric nurse practitioner.
- The child must meet New Mexico residency and age rules, generally under 21, and purchased care requires the program’s medical review. The team should check the current medical index for the child’s exact cancer diagnosis. Purchased-care income must be below—not equal to—200% of poverty, and two or more other payers can block purchased-care payment without deciding whether care coordination is available.
What you get
- No charge for the program’s own clinic, though outside tests can cost money.
- Care coordination without an income test, as staffing and funding allow.
- Approved care, meals, lodging and travel can be included in a service plan.
What this includes
- The service plan identifies approved health care and travel costs, with other payers going first. Advance approval and available funds limit purchased care. The ordinary medical-management cap is $15,000 per client per year. The program manager and medical director can approve a good-cause increase when funds permit.
If you decide to apply
- Ask the oncology social worker about a referral to Children’s Medical Services.
- Have income information, insurance details and clinic notes ready. Ask about care coordination separately from help paying bills.
Children’s Medical Services, New Mexico Department of Health · Official page ↗
After you apply
- A decision usually comes within 20 working days of a complete application. If it is refused, you have 30 days to ask in writing for a review, and the committee answers within 60 days.
- Completing the application within 30 days can preserve coverage treatment based on the referral date. The program confirms the records and approvals needed for any out-of-state or emergency care.
Good to know
The program pays after other insurance. Two or more other payers can block purchased care.
Other details
- The purchased-care income test does not apply to care coordination. Availability of staff and program funding can still limit the coordination help offered.
“Could Children’s Medical Services help coordinate care or pay approved costs? What are the benefits and drawbacks, and could you help us request a referral if it fits?”
Why I’m asking: We want help keeping care organized and understanding any costs other insurance leaves.
More background and detailed requirements
Additional program information and published rules
Who does what
The three parts, side by side. The agency decides; nobody on this page does.
You
Ask for the referral and ask about care coordination separately from the money.
Your social worker
The oncology social worker makes the referral.
The care team
A physician, physician’s assistant or pediatric nurse practitioner has to refer for the clinic.
- Who decides
- The programme’s medical director decides the clinical side; the programme decides the financial side.
- Ask your social worker
- “Can you refer us to Children’s Medical Services, and can we get a care coordinator even if our income is over the line?”
How to apply
First step: Ask the oncology social worker to refer you, and ask for care coordination by name.
- Ask the oncology social worker to refer you to Children’s Medical Services.
- Ask for care coordination even if income is over the line.
- Ask whether leukemia is on the programme’s medical list before counting on it for bills.
Official application / program page ↗
Where it starts: Ask the oncology social worker to refer you, or contact the programme yourself by phone, post or letter.
What to gather
The diagnosis letter, the child’s insurance card, and the last two pay stubs cover most applications. The official page lists the rest.
How long: The posted rule generally gives 20 working days after a complete application. A written record-review request is due within 30 calendar days of the action notice, by postmark; the committee decision is due within 60 days.
What a yes looks like
A service plan naming what the programme will pay for.
What a no looks like, and the next move
A no on income or on other payers. Ask for care coordination anyway.
Watch out
- It pays last, after every insurance.
- Care coordination has no income test even when the money side does.
- Whether leukemia is on its medical list could not be checked. Ask before counting on it.
The numbers and the rules
The arcane layer, kept on purpose. Checked September 11, 2026.
What it is worth
Approved care, plus lodging, meals and transport in the service plan, for a household under twice the poverty guideline: $5,500 a month for four people.
- $5,500/month — Household of 4, twice the poverty guideline
- $4,554/month — Household of 3, twice the poverty guideline
- $0 — Charge for the programme’s own clinic
Covers: Purchase of approved health care services · Lodging, meals and transport related to medical care in the service plan · Care coordination regardless of income, as resources allow
What it costs the family: No charge for the programme’s own clinic; outside tests can cost money.
The eligibility facts, as published
- Income
- household income below 200 percent of the poverty guidelines for the part that buys care; no income test for care coordination
- Clinical
- medically eligible under the programme’s medical index and its medical director
- Other payers
- a child with two or more other payers does not meet the financial test for purchased care
- Referral
- by telephone, post, a written referral or an application; a clinic referral must come from a physician, physician’s assistant or pediatric nurse practitioner
The trap: This pays last, after every insurance. And whether leukemia is on the programme’s own medical list could not be checked, so ask before counting on it for treatment costs.
Where I read this
- 7.30.3 NMAC — Children's Medical Services — New Mexico State Records Center (NMAC), read September 10, 2026
- BeWell — Federal Poverty Level Chart — BeWellnm (New Mexico Health Insurance Exchange), read September 10, 2026