What is California Children's Services (CCS)?

CCS is a statewide program that treats children with certain physical limitations and chronic health conditions or diseases.  CCS can authorize and pay for specific medical services and equipment provided by CCS-approved specialists.  The California Department of Health Services manages the CCS program.  Larger counties operate with their own CCS programs, while smaller counties share the operation of their program with state CCS regional offices in Sacramento, San Francisco, and Los Angeles.  The program is funded with state, county, and federal tax monies, along with some fees paid by parents.

What Does CCS Offer?

If you think your patient might have a CCS-eligible medical condition, CCS may pay for or provide a medical evaluation to find out if your patient's condition is covered.

If your patient is eligible, CCS may pay for or provide:

• Treatment, such as doctor services, hospital and surgical care, physical therapy and occupational therapy, laboratory tests, X-rays, orthopedic appliances and medical equipment
• Medical case management to help get speical doctors and care for your patient when medically necessary, and referral to other agencies, including public health nursing and regional centers; or a Medical Therapy Program (MTP), which can provide physical therapy in public schools for children who are medically eligible.

Who Qualifies for CCS?

The program is open to anyone who:

• is under 21 years old;
• has or may have a medical condition that is covered by CCS;
• is a resident of California; and
• has a family income of less than $40,000 as reported as the adjusted gross income on the state tax form; or
• the out-of-pocket medical expenses for a child who qualifies are expected to be more than 20 percent of family income; or
• the child has Healthy Families or Healthy Kids coverage.

Family income is not a factor for children who:

• need diagnostic services to confirm a CCS eligible medical condition; or
• were adopted with a known CCS eligible medical condition; or
• are applying only for services through the Medical Therapy Program; or
• are Medi-Cal beneficiaries, full scope, no share of cost; or
• are Healthy Families subscribers

What Medical Conditions Does CCS Cover?

Only certain conditions are covered by CCS.  In general, CCS covers medical conditions that are physically disabling or require medical, surgical, or rehabilitative services.  There also may be certain criteria that determine if your child's medical condition is eligible.  Listed below are categories of medical conditions that may be covered and some examples of each:

• Conditions involving the heart (congenital heart disease)
• Neoplasms (cancers, tumors)
• Disorders of the blood (hemophilia, sickle cell anemia)
• Endocrine, nutritional, and metabolic diseases (thyroid problems, PKU, diabetes)
• Disorders of the genito-urinary system (serious chronic kidney problems)
• Disorders of the gastrointestinal system (chronic inflammatory disease, diseases of the liver)
• Serious birth defects (cleft lip/palate, spina bifida)
• Disorders of the sense organs (hearing loss, glaucoma, cataracts)
• Disorders of the nervous system (cerebral palsy, uncontrolled seizures)
• Disorders of the musculoskeletal system (rheumatoid arthritis, muscular dystrophy)
• Severe disorders of the immune system (HIV infection)
• Disabling conditions or poisonings requiring intensive care or rehabilitation (severe head, brain, or spina cord injuries, severe burns)
• Complications of premature birth requiring an intensive level of care
• Disorders of the skin and subcutaneous tissue (severe hemangioma)
• Medically handicapping malocclusions (severely crooked teeth)

For more information on medical eligibility, please contact your county CCS office at 1-800-288-4584 or visit the LA County Children's Medical Services website at http://www.lapublichealth.org/cms/ccs/ .

Families (or applicants age 18 and older, or an emancipated minor) must:

• complete an application (in English or Spanish) and return it to their county CCS office;
• give CCS all of the information requests so CCS can determine if the family qualifies;
• apply to Medi-Cal if CCS believes that a family's income qualifies them for the Medi-Cal program.  (If a family qualifies for Medi-Cal, the child is also covered by CCS.  CCS approves the services; payment is made through Medi-Cal.)

Where Can I Get More Information About CCS?

For more information, please contact your contracted Participating Provider Group or L.A. Care UM Department at 1-877-431-2273 or your county CCS office at 1-800-288-4584 .  You may also visit the State of California's CCS homepage website at http://www.dhs.ca.gov/pcfh/cms/ccs/