California Children's Services (CCS)

California Children's Services (CCS) is a program for kids and youth with certain diseases. CCS selects the best services and pays for the care.

CCS may provide

Treatment, such as doctor's services
Hospital care
Surgical care
Physical therapy
Occupational therapy
Testing
Medical equipment

CCS program has two parts

CCS eligibility

A child or youth can get CCS services if they meet these four requirements:

Birth to age 21
Lives in Santa Clara County
Has a chronic, disabling, or life-threatening medical condition that is a CCS eligible medical condition
Has one of the following:

Family income (AGI-Adjusted Gross Income) of $40,000 or less
Family income (AGI-Adjusted Gross Income) over $40,000 and out-of-pocket medical expenses are expected to be more than 20 percent of the family income (AGI-Adjusted Gross Income)
A need for an evaluation to find out if there is a health problem covered by CCS
Was adopted with a known health problem that is covered by CCS
A need for the Medical Therapy Program (children and youth can get Medical Therapy Program services no matter what their family income is)
Medi-Cal, with full benefits (Full-Scope or Shared-Of-Cost)

Steps to receiving CCS services

Referral

Anyone can refer a child or youth to CCS (i.e. doctor, parent, teacher, etc.)

Diagnosis

A doctor identifies that the child or youth may have a CCS eligible medical condition. The doctor sends a report to CCS for review by the Nurse Case Manager

Application

Family or youth fills out and signs an application for CCS services

Case management and care coordination

The CCS Nurse Case Manager assists the child or youth with getting the right care at the right place

Treatment

CCS approves health care services to treat the child's or youth's CCS eligible medical condition. A copy of the approval is mailed to the home of the child or youth. The family/ client can then schedule an appointment for the care that was approved
Each time the child or youth needs to see a new doctor, get a new medication or equipment, a Service Authorization Request form needs to be completed. The medical provider will fill out the Service Authorization Request form and send it to CCS. You will be notified by mail when the services have been approved. You can contact CCS to find out the status of a Service Authorization Request

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How are children referred to CCS?

Anyone can refer your child or youth to CCS (i.e. parent, teacher, social worker). Most of the time a doctor or health insurance plan will refer your child or youth to CCS.

What are the income guidelines?

You must meet one of the following:

Have a family income of $40,000 or less;
Your child already has full-scope Medi-Cal;
Your medical fees are more than 20% of your family income; or
You adopted a child with a known CCS eligible medical condition.

If my child already has Medi-Cal, why does she/he need CCS?

CCS works with Medi-Cal to help manage children and youths with special health needs. CCS may pay for services that Medi-Cal alone does not.

What if my child has an HMO?

Children that has an HMO may be eligible for CCS, if the requested services are not a benefit of their HMO. Children with HMOs are eligible for MTU services.

How do I know if my child is eligible?

Your child may be eligible for CCS if they are 21 years old or younger, and have a serious medical condition.

Overview of CCS Medical Eligibility.

How does CCS help my child?

CCS can help you find and pay for medical services that may include the following: hospital and physician care; x-ray and laboratory services; medical supplies and equipment; medications; home health care; physical and occupational therapy; orthodontic care; confidential HIV testing and monitoring (All services except emergencies need CCS approval before the services are given).

Are there any fees for CCS services?

There are no fees for children who have full-scope Medi-Cal insurance. Other families may need to pay a small fee based on family size and income.

Can my child have CCS and Regional Center services?

Yes, some children are eligible for both CCS and Regional Center services.

Is treatment for autism covered by CCS?

No, autism is not a CCS-covered diagnosis. Current, detailed information on medical eligibility and conditions that are covered can be found on the state medical eligibility web page.

Where can I find medical eligibility conditions?

You can find eligibility information on the California Sate Website.

California Children's Services (CCS) Administration
720 Empey Way
San Jose, CA 95128

Phone: (408) 793-6200
Fax: (408) 793-6250

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