California Children Services - Frequently Asked Questions

What is California Children's Services?

California's medical program for treating children with physically handicapping conditions was started by California Legislature in 1927. Most handicapping conditions are eligible for benefits under the CCS program. This tax supported program provides specialized medical care and rehabilitation for children whose families cannot provide all or part of the care.

What are the CCS program goals?

• To locate California children who may need CCS specialized medical care.
• To encourage California families with physically handicapped children to obtain the medical services necessary to bring about maximum development of their children.
• To help these California families obtain medical treatment of the child's condition at the time care will be most effective.

Who is eligible for the CCS program?

The program is available to anyone who is under 21 years of age; is a California resident; has a handicapping medical condition that is eligible for care under CCS; and whose family income is less than $40,000 a year (State adjusted gross income). An individual whose family has a higher income may receive services if the estimated cost of medical care in one year is expected to exceed 20 percent of income.

What services does the CCS program provide?

Diagnostic evaluations. Children under 21 years of age suspected of having one of the CCS eligible medical conditions are eligible for free diagnostic services.

Treatment services for the handicapping condition, including: medical and surgical care, pharmaceuticals, physical and occupational therapy, laboratory tests, X-ray, appliances, equipment, and other needed services.

Complete Orthodontia Services.

Physical and occupational therapy is provided in medical therapy units located in public schools to children with physical handicaps who have a medical need for these treatment services. (These CCS services do not require financial eligibility).

Medical case management is provided by the CCS program. It includes: referrals to medical specialists and centers; follow-up with others involved with the care of the child such as schools, public health/school nurses, social workers and other agencies; transferring medical records; locating new facilities and services when families move; and assisting the family to cope with the child's condition.

How do I find out if my child has an approved CCS medically eligible condition?

Anyone may refer a child to CCS - public health/school nurses, other agencies, or the family itself - to determine if the child has an approved CCS medically eligible condition.

Most children are referred by the family physician, specialist or hospital. The physician or hospital can supply important medical information necessary in making the CCS medical eligibility determination and may also participate in the child's CCS treatment program.

Where do I apply for the CCS program?

You should apply for the CCS program at your local CCS office in the county where you reside. This office can be contacted by phone for assistance. Requests for CCS coverage must be made within 1 to 10 days that services are rendered, except for emergencies. Your county CCS office can tell you if your child may be eligible for the CCS program. CCS eligibility must be determined before services can be covered by CCS.

How will I know if my child is eligible for CCS program benefits?

Your county CCS office or the appropriate State Regional Office will consider your child's medical condition as well as the family's residential and financial status to determine CCS eligibility. This is accomplished by completing the necessary application forms and providing the required documentation. Based on this information and completed paperwork the CCS program will approve or deny your application. If your application is denied you have the right to appeal the decision.

What if I have private health insurance coverage for my child?

Your child can be eligible for the CCS program even though you have private health insurance coverage. If your child is a CCS applicant/client and has individual or group private health insurance coverage, you must report it to the county CCS office and to the child's health care provider. Private health insurance entitlement is used to help reduce CCS program costs.

What if my child is Medi-Cal eligible?

Children who are Medi-Cal eligible and have approved CCS medical conditions are usually eligible for CCS case management and other services not covered by Medi-cal. This assures that all California children with complex, disabling conditions will receive appropriate specialized care.

Will there be any cost to the family of a CCS client?

Some families may be required to pay an annual assessment fee and/or annual enrollment fee. These fees are used to help cover the cost of treatment, processing applications, telephoning hospitals, physicians and other caregivers, mailing authorizations to these caregivers, and coordinating care with the CCS agencies. All these services are provided by the CCS program to ensure that clients receive the best care possible from physicians and specialists who provide medical care to children. The annual assessment fee is $20 and the annual enrollment fee is calculated based on family and income size.

Which applicants/clients or families are required to pay the annual assessment fee?

Applicants/clients or families applying for the CCS program whose incomes exceed 100 percent of the federal poverty level are required to pay the annual assessment fee unless they are determined by the county CCS office to be exempt from paying the fee.

Which applicants/clients or families are not required to pay the annual assessment fee?

Applicants/client or families with full Medi-Cal benefits without a monthly share of cost. Applicants/clients receiving Medical Therapy Unit therapy services are part of an individualized education plan. Families with incomes less than 100 percent of the federal poverty level.

Which applicants/clients or families are required to pay the annual enrollment fee?

Applicants/clients or families applying for treatment services of a CCS medically eligible condition and whose incomes exceed 200 percent of the federal poverty level are required to pay the fee unless they are determined by the county CCS office to be exempt from paying the fee.

Which applicants/clients or families are not required to pay the annual enrollment fee?

Applicants/clients or families with full Medi-Cal benefits without a monthly share of cost. Families with incomes less than 200 percent of the federal poverty level. Applicants/clients or families applying for services to diagnose a child's medical condition which may be eligible for CCS. Applicants/clients or families applying only for physical therapy or occupational therapy in the medical therapy units in public schools. Families who, at the time of adoption, knew their child had a eligible CCS condition.

What if the family cannot pay the enrollment fee?

If a family is unable to pay the full fee because of undue hardship, the family may ask for reconsideration. Undue hardship means, for example, the family now has either less income due to unemployment or change in job; or, unavoidable expenses that reduce the ability to pay. The county may then reduce or waive the fee. The family may formally appeal a county's decision and should ask the county how to file and appeal under CCS regulations.