For Applicants & Members
The information on this page only pertains to the CMSP benefit program. If you’re looking for more information on the Path to Health or Connect to Care programs, click the buttons below:
Advanced Medical Management is responsible for CMSP medical and dental benefits administration. Further information on benefit administration is available at the Advanced Medical Management website at https://cmsp.amm.cc.
To download the Member Guide for CMSP Members (Aid Code 50 & 89) who are eligible for CMSP Benefits with a Share of Cost, click here
To download the Member Guide for CMSP Members (Aid Code 88 & 8F) who are eligible for CMSP Benefits without a Share of Cost, click here
Find a medical or dental provider.
A wide array of inpatient and outpatient benefits are provided through the CMSP Benefit. Covered services are subject to prior authorization requirements, medical necessity and clinical guidelines, provider network requirements, and/or benefit limits may apply. Please see sections below about emergency services, Share of Cost (SOC) requirements, coverage for undocumented members, and primary care benefit services.
- Acute inpatient hospital care
- Adult day health care services
- Audiology services
- Blood and blood derivatives
- Chronic hemodialysis services
- Limited dental services
- Durable medical equipment (DME)
- Emergency air and ground ambulance services
- Hearing aids
- Home health agency services
- Hospital outpatient services and outpatient clinic services
- Infusion therapy
- Laboratory and radiology services
- Medical supplies dispensed by physicians, licensed pharmacies or DME dealers
- Non-emergency medical transportation when medically necessary
- Occupational therapy services
- Inpatient and outpatient heroin detoxification services (excluding methadone maintenance)
- Pharmaceutical services provided by network pharmacies
- Physical therapy services
- Physician services
- Podiatry services
- Prosthetic and orthotic appliances
- Psychiatry services (inpatient and outpatient provided by a licensed, in-network psychiatrist)
- Speech therapy services
Emergency services are those health services that are provided by CMSP network or non-network providers for a medical condition manifesting itself by acute symptoms of recent onset and severity (including, without limitation, severe pain), such that a prudent layperson, possessing an average knowledge of health care and medicine, could reasonably believe that the absence of immediate medical attention could reasonably result in any of the following:
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- Placing your health in serious jeopardy
- Serious impairment of bodily function
- Other serious medical consequences
- Serious and/or permanent dysfunction to any bodily organ or part
CMSP members with a medical emergency should call 911 or go to the nearest emergency room. Emergency services within California and designated border state areas of Arizona, Oregon and Nevada provided by network and non-network providers to CMSP members are covered by CMSP. Emergency services do not require prior authorization by AMM. However, the provider may need to submit medical records to AMM documenting the emergency. CMSP members should call AMM at 1-877-589-6707 after the emergency so follow-up care can be planned.
CMSP will NOT pay for, or reimburse CMSP members for, non-emergency medical services provided by a non-contracting non-CMSP/AMM Network Provider. In addition, CMSP will NOT pay any providers who provide services, including emergency medical services, outside of California and the designated border state areas of Arizona, Nevada and Oregon.
Specific services that are NOT covered by the program include:
- Pregnancy-related services (contact your county eligibility office); infertility services (contact F-PACT); long-term care facility services (contact your county eligibility office); acupuncture services; optometry services (including eyeglasses and contact lenses); cosmetic services; sexual reassignment services; public transportation such as airplane, bus, car, or taxi rides; and, methadone maintenance services
- All services provided outside of the State of California and designated border state areas
- Services provided by providers that do not participate in the CMSP network administered by Advanced Medical Management (excluding emergency services) and the MedImpact Healthcare Systems pharmacy network
- Organ transplants for persons who are eligible for CMSP emergency services only under aid code 50
If a CMSP member needs or desires medical care which is not covered by CMSP, the member must pay for the care or make other arrangements with the provider.
Some CMSP members have a monthly Share of Cost (SOC) obligation, depending on income and family size. With this SOC obligation, a CMSP member must pay, or agree to pay, part of their monthly income towards medical and prescription drug expenses before CMSP will pay for certain CMSP Health Benefits. The CMSP member will be mailed a Notice of Action from the county which includes their SOC amount, if any.
A specific set of primary care benefits are excluded from the Share of Cost requirements. The added benefit provides the following coverage during the member’s CMSP eligibility period:
Primary care and/or specialty care services (with no SOC or copayment) at an in-network provider for:
- Medical office visits with a primary care doctor and/or specialist or for physical therapy services
- Preventive health screenings: annual physical, specific lab tests and cancer screenings
- Specific diagnostic tests and minor office procedures
Prescription drug coverage with a $5.00 copay for each prescription (maximum benefit limit of $1,500 in prescription costs)
Aid Code 50 (Undocumented) Members
For undocumented members, CMSP coverage is limited to services that are medically necessary to address an emergency medical condition as a specific set of primary care benefit services.
The added benefit provides the following coverage during the member’s CMSP eligibility period:
Primary care and/or specialty care services (with no SOC or copayment) at an in-network provider for:
- Medical office visits with a primary care doctor and/or specialist or for physical therapy services
- Preventive health screenings: annual physical, specific lab tests and cancer screenings
- Specific diagnostic tests and minor office procedures
Prescription drug coverage with a $5.00 copay for each prescription (maximum benefit limit of $1,500 in prescription costs)
Advanced Medical Management
(877) 589-6807
Types of Inquiries: Medical, Dental, Selecting a PCP, Grievances and Appeals
Hours of Availability: Monday through Friday, 8 a.m. to 5 p.m. PST
1545 River Park Drive, Suite 435
Sacramento, CA 95815
