What are 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. Administration of the Mendocino County CCS Program is provided by the Public Health Department in Ukiah. The program is funded with state, county, and federal tax monies, along with some fees paid by parents.

What Does CCS Offer Children?

• Diagnostic Program: If a potential CCS client is suspected of having a CCS-eligible medical condition, but additional tests or studies are needed to confirm the medically eligible condition, the case may be opened for just those studies or tests needed to confirm the presence or absence of the suspected CCS medical condition.
• Treatment Program: If a child is found to be medically and financially 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 access specialty care when medically necessary, and referral to other agencies, including public health nursing and regional centers; or a
  • The Medical Therapy Program (MTP) is a special program within California Children's Services that provides physical therapy (PT), occupational therapy (OT) and medical therapy conference (MTC) services for children who have handicapping conditions, generally due to neurological or musculoskeletal disorders.

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 coverage*;
• the child has full scope, no share of cost, Medi-Cal.

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.

_{*Healthy Families Insurance Plans will NOT reimburse for care related to any CCS-eligible condition. Care for a CCS-eligible condition must be provided by a CCS-approved provider and can only be billed to the CCS Program.}

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 a 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 and connective tissues (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 spinal 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 malocclusion (severely crooked teeth)

What is the CCS Referral Process?

Referrals to the CCS Program can be made by anyone including the family, school, public health nurse, family doctor, or physician specialist. It is important that referral be made to CCS as early as possible because CCS does not pay for any medical care that is provided before the date of referral. The family must also apply for CCS. Once the family applies, CCS determines whether the child meets the medical, residential and financial eligibility requirements.

A referral to the CCS Program may be received through written or verbal communication, though the preferred method is by faxing a completed "New Referral CCS/GHPP Client Service Authorization Request (SAR)" form. To expedite the process, it is important that providers also fax medical reports documenting the suspicion or confirmation of a CCS eligible medical condition.

Where Can You Get More Information About CCS?

California Children’s Services
Mendocino County Department of Public Health
1120 South Dora Street
Ukiah, CA 95482

Phone: (707) 472-2600
Fax: (707) 472-2735