CCS is a Medi-Cal program that treats children under 21 years of age with certain health conditions, diseases or chronic health problems and who meet the CCS program rules.
If L.A. Care or your PCP believes your child has a CCS eligible condition, they will be referred to the CCS county program to check if they qualify.
County CCS program staff will decide if you or your child qualifies for CCS services. L.A. Care does not decide CCS eligibility.
If your child qualifies to get this type of care, CCS providers will treat them for the CCS-eligible condition. L.A. Care will continue to cover the types of service that do not have to do with the CCS condition such as physicals, vaccines and well-child checkups.
L.A. Care does not cover services that the CCS program covers.
For CCS to cover these services, CCS must approve the provider, services and equipment.
CCS covers most health conditions.
Examples of CCS-eligible conditions include but are not limited to:
- Congenital heart disease
- Cancers
- Tumors
- Hemophilia
- Sickle cell anemia
- Thyroid problems
- Diabetes
- Serious chronic kidney problems
- Liver disease
- Intestinal disease
- Cleft lip/palate
- Spina bifida
- Hearing loss
- Cataracts
- Cerebral palsy
- Seizures under certain circumstances
- Rheumatoid arthritis
- Muscular dystrophy
- AIDS
- Severe head, brain or spinal cord injuries
- Severe burns
- Severely crooked teeth
Medi-Cal pays for CCS services. If your child does not qualify for CCS program services, they will keep getting medically necessary care from L.A. Care.
To learn more about CCS, you can visit the CCS website or call L.A. Care Member Services at 1-888-839-9909 (TTY: 711).
Transportation and travel expenses for CCS
You may be able to get transportation, meals, lodging, and other costs such as parking, tolls, etc. if you or your family needs help to get to a medical appointment related to a CCS-eligible condition and there is no other available resource.
Call L.A. Care and request pre-approval (prior authorization) before you pay out of pocket for transportation, meals, and lodging.
L.A. Care does provide non-medical and non-emergency medical transportation as noted in the Medical Transportion and Non-Medical Transportation sections of this online handbook.
If your transportation or travel expenses that you paid for yourself are found necessary and L.A. Care verifies that you tried to get transportation through L.A. Care, L.A. Care will pay you back.
We must pay you back within 60 calendar days of the date you submit the required receipts and proof of transportation expenses.
Home and community-based services (HCBS) outside of CCS services
If you qualify to enroll in a 1915(c) waiver, you may be able to get home and community-based services that are not related to a CCS-eligible condition but are necessary for you to stay in a community setting instead of an institution.
For example, if you require home modifications to meet your needs in a community-based setting, L.A. Care cannot pay those costs as a CCS-related condition. But if you are enrolled in a 1915(c) waiver, home modifications may be covered if they are medically necessary to prevent institutionalization.