Children's Medical Services

California Children's Services

• CCS - What are Eligible Medical Conditions?

  Answer:  

  Conditions involving the heart (congenital heart disease, rheumatic heart disease)

  Neoplasms (cancers, tumors)

  Diseases of the blood (hemophilia, sickle cell anemia)

  Diseases of the respiratory system (cystic fibrosis, chronic lung disease)

  Endocrine, nutritional, and metabolic diseases (thyroid problems, PKU, or diabetes that is hard to control)

  Diseases of the genito-urinary system (serious kidney problems)

  Diseases of the gastrointestinal system (liver problems such as biliary atresia)

  Serious birth defects (cleft lip/palate, spina bifida)

  Diseases of the sense organs (eye problems leading to loss of vision such as glaucoma and cataracts, and hearing loss)

  Diseases of the nervous system (cerebral palsy, uncontrolled epilepsy/seizures)

  Diseases of the musculoskeletal system and connective tissue (rheumatoid arthritis, muscular dystrophy)

  Severe disorders of the immune system (HIV infection)

  Disabling injuries and poisonings requiring intensive care or rehabilitation (severe head, brain, or spinal cord injuries, and severe burns)

  Complications of premature birth requiring an intensive level of care

  Diseases of the skin and subcutaneous tissue (severe hemangioma)

  Medically handicapping malocclusion (severely crooked teeth)

• CCS - What services does CCS provide?

  Answer:   Diagnostic Services If there is a good chance that your child has a CCS-eligible condition but we need more information, we can pay for more doctor's visits and testing. The Nurse Case Manager can help you if you have questions about this.
  You do not need to go through financial eligibility to receive this service!
  Treatment Services
  The most common medical treatment services for your child's CCS-eligible condition include:
  
  Emergency room care
  Hospital stays
  Surgery
  Medicines
  Special Equipment
  
  CCS pays for many different services that are not included on this list. Please call your child's Nurse Case Manager to find out everything that is available for your child's condition.
  
  If you have private insurance, and/or Medi-Cal or Healthy Families, your Nurse Case Manager will help you figure out when to use your private insurance, Medi-Cal, Healthy Families, or CCS, so that CCS is the "payor of last resort." That means we will pay after everyone else pays.
  
  Special Care Centers
  
  A Special Care Center is a place where a team of doctors and other professionals (like nurses, therapists and social workers) work together with the family to help a child diagnosed with one general type of illness. Special Care Centers have been reviewed by the State to make sure the care they give a child meets CCS standards.
  
  This is a list of CCS Special Care Centers by type:
  
  

  Bone Marrow Transplant Center	Heart and Lung Transplant Center	Pediatric Intensive Care Units (PICU)
  Burn Center	Hematology/Oncology Center	Prosthetic/Orthotic Center
  Cardiology (heart) Center	Hemophilia Center	Rehabilitation Center
  Cleft Palate Center	Immunology/Infectious Disease (including AIDS) Center	Renal (kidney) Dialysis and Transplant Center
  Craniofacial Center	Liver Transplant Center	Rheumatology Center
  Cystic Fibrosis & Lung	Metabolic and Endocrine Center	Sickle Cell Center
  Communication Disorders Center	Metabolic (including PKU) Center	Speech and Hearing Center
  Endocrine Center	Musculoskeletal/Neuromusculoskeletal Center	Spina Bifida Center
  Extracorporeal Membrane Oxygenator Center (ECMO)	Neonatal Intensive Care Units (NICU)
  Gastrointestinal Center	Neurological Diseases Center
  Heart Surgery Center

  
  
  Your child's Nurse Case Manager will tell you if your child needs the services of a Special Care Center.
  
  Medical Therapy Unit (MTU) Services
  
  Medical eligibility for MTU services is different than for the general CCS program. Not all children covered by CCS are eligible for MTU services!
  
  Children with physical disabilities may get help through the CCS Medical Therapy Program. Medical Therapy Units (MTUs) provide physical and occupational therapy, and may include pediatric and orthopedic clinics, depending on your insurance situation. MTUs are located in public schools but are part of CCS.
  
  This is the only CCS program where we provide direct care, working one-on-one with your child. (All other care is provided by doctors, hospitals, and other professionals outside the CCS program.)
  
  Your child's Nurse Case Manager can help you figure out if you should apply to the MTU for these services. If your child has an MTU-eligible condition, your Nurse Case Manager will continue to help you with CCS services through the MTU.
  
  The Medical Therapy Program has its own parent handbook. A child receives a copy of the MTU parent handbook at the first meeting with the CCS MTU therapist. If you are interested, you can ask your Nurse Case Manager for a copy.
  
  The therapy that CCS provides is usually different than what the school provides. That is because CCS provides therapy for your child's eligible medical condition, while the school provides therapy for your child's educational needs and goals.
  
  The physical and occupational therapy CCS gives through the MTU is free, no matter what your family's income is. There is no financial eligibility requirement for occupational and physical therapy services.
  
  If you have questions about Medical Therapy Unit services, your Nurse Case Manager or your child's MTU occupational or physical therapist can help.
  
  Other Services
  
  Families caring for a child with a CCS eligible condition sometimes need other kinds of help. For instance:
  
  Counseling Support Services: Your child or someone in your family might want to talk with a counselor or therapist about how your child's condition is
  affecting your lives. Ask your child's Nurse Case Manager about counseling
  support services. Families find this helps more than they thought it would. For
  more information, ask your Nurse Case Manager or for a referral to the Social Work Unit
  
  Transportation: If it is hard for you to get your child to medical care provided
  by CCS, your Nurse Case Manager can help. In some cases, we may be able to
  arrange the ride you need.
  
  Finding a Pharmacy/Supplier: Your child's Nurse Case Manager can help you
  find a pharmacy and/or supplier that meets your needs.
  
  Maintenance and Transportation (for parents when their child in the
  hospital): CCS knows that families want to be together, even in the hospital.
  Sometimes we can help families in need with rides, parking, food, and/or lodging nearby.
  
  Ask your child's Nurse Case Manager if you need any of these services!
  

• CCS - How is my privacy protected?

  Answer:  
  1. California law requires that families applying for services be given information or how CCS protects their privacy:
  
  To protect your privacy:
  - We must keep this information confidential
  - We may share information on the form with authorized staff from other health and welfare programs only when you have signed a consent form.
  - You have the right to see your application and CCS records concerning you or your child. If you wish to see these records contact us. By law, the information you give CCS is kept by the program.
  
  What if you do not agree with a CCS decision?
  If you disagree with a decision we make in a letter called a Notice of Action (NOA), you have the right to appeal. We must have an application signed by you in our files for you to appeal our decision.
  
  The Appeal Process
  To appeal:
  Send your appeal to us in writing. Include:
  - what it is you are appealing
  - what you would like CCS to do
  - any other information that you would like us to consider
  - If CCS is changing or ending services and you want the services to continue during the appeal process, you need to ask for this in your appeal.
  
  You can get help and information about how to appeal from your Nurse Case Manager or Nurse Supervisor at CCS.
  
  Send your appeal within 30 days of the date on the Notice of Action letter to:
  
  Program Director
  California Children's Services
  9320 Telstar Avenue, Suite 226
  El Monte, CA 91731
  
  We will respond to your appeal within 21 calendar days from the date of received.
  MTU service appeals are different! Ask your Therapy Unit supervisor for help.
  The right to appeal and the description of the "First Level of Appeal" is in the California Code of Regulations, Title 22, Division 2, Part 2, Subdivision 7, Chapter 13, Article 2, Sections 42702 and 42703

• CCS - How does a child get CCS?

  Answer:  A child gets CCS services if the child meets all four CCS eligibility rules:
  
  1. Age eligible: the child is under 21 years old.
  
  2. Medically eligible: the child has a physical disability or medical condition that is covered by CCS. This is called having a "CCS eligible condition." CCS covers many serious health and physical conditions. After careful study of the information we receive from your child's doctors, we decide if your child has an eligible condition. Ask us if you have questions.
  
  3. Residentially eligible: the child lives with a parent or guardian who lives in Los Angeles County. Each county in California has a CCS program, and if you move to another county, we will help you transfer to that county's CCS program.
  
  4. Financially eligible:
  The child has
        - Medi-Cal or
              - The family's adjusted gross income is less than
  $40,000 (if a family earns less than $40,000 but
  200% above the federal poverty level, they will
        - The family earns more than $40,000, but would
  spend 20% or more on medical services for the
  child's CCS eligible condition without CCS.
  
  FEES
  
  Some families may pay:
  An annual assessment fee of $20 AND
  An enrollment fee, using a sliding scale based on
  family income and size.
  
  The amount of the enrollment fee depends on how much money a family makes and how big the family is. For example, a family of three earning $40,000 will pay an enrollment fee of $300 plus the $20 assessment fee each year.
  A family in need can ask us to lower or "waive" these fees if there is financial hardship.
  
  A family will not pay these fees if the child has one of the following:
  
  "Full-scope Medi-Cal with no Share Of Cost," which
  can be:
  1. Medi-Cal Managed Care or
  2. Fee-for-Service Medi-Cal
  
  - Diagnostic services
  - CCS Medical Therapy Program (MTU) services only.
  
  NOTE: A signed application form gives the family legal rights to appeal.

• CCS - Does CCS provide Counseling or Support Services?

  Answer:  
  Having a child with Special Health Care Needs can impact the entire family - and can add to emotional, financial, and social difficulties. The Social Work Unit is available to help families cope with their child's medical condition. We provide multiple services, including emotional support, community resources, family/individual counseling, advocacy, and interagency collaboration. The goal of the Social Work Unit is to support the emotional and social well-being of our clients and their families.
  
  We encourage all our clients and families to use our social work services when they need psychosocial and emotional support or community referrals. For Social Work Unit assistance, please first contact for a referral:
  
  Your Nurse Case Manager (NCM)
  Your Medical Therapy Unit (MTU)
  Social Work (800-972-1707)
  

  We can also authorize for psychiatric mental health support, if it is related to the CCS-eligible condition. Here are some other mental health resources:
  Links: Mental Health Resources for Los Angeles County
  Links: CCS Social Work Resource Guide

• CCS - What does CCS offer children?

  Answer:   If you or your child's doctor think that your child might have a CCS-eligible medical condition, CCS may pay for or provide a medical evaluation to find out if your child's condition is covered.
  
  If your child 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 special doctors and care for your child 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 and/or occupational therapy in public schools for children who are medically eligible.

• CCS - Where do I get CCS services?

  Answer:  
  CCS will give you an authorization to go to a doctor, hospital or therapist that is "CCS-Paneled." That means they met the State's standard of quality care. These people are called "CCS Providers."
  

  
  Many doctors, therapists and hospitals that treat children with special healthcare needs are already CCS-Paneled. You may ask your child's providers if they are "CCS Paneled", or you can contact us to find out if you need to change to another doctor.

  
  
  We will give you an authorization to see a CCS-paneled doctor. When possible, we will try to authorize the doctor of your choice.
  
  What is an authorization?
  An authorization is our way to agree to pay for a service for your child's CCS-eligible condition as "payor of last resort." That means, if you have private insurance, Medi-Cal or Healthy Families, we will find out if they can pay before we do.
  

  When your child needs:
  Doctor visits or
  A stay in the hospital or
  Treatment (like medicine, an x-ray, or surgery) or
  Supplies (like tracheotomy supplies or feeding pumps) or
  Equipment (like wheelchairs or braces or hearing aids)
  

  Your child's CCS-authorized doctor, therapist or medical supplier sends us a request describing the service and why it is needed for your child's special healthcare needs.
  

  If we agree that the service is medically necessary, we can authorize the treatment, and you will get a copy of an authorization letter from us in the mail.
  

  It is important for you to keep the authorization letter! You may need to show it to your doctor or pharmacist.
  

  How long does an authorization take?
  

  An authorization from us should take about a week once we get the request. Please call your child's Nurse Case Manager if you have not received one after a week has passed by.
  

  Urgent or emergency care can be approved very quickly with a telephone call to your Nurse Case Manager from your child's doctor - even if it is a day later! We can work with the provider at the time of need. The phone number given below can get you to a Nurse Case Manager, if yours is not available.
  

  1 (800) 288-4584

• CCS - Are there any costs to me?

  Answer:   There are some fees for CCS clients who do not have Medi-Cal or who have Medi-Cal with a share of cost. The amount of fees is based on family income and size.

• CCS - How do I apply for CCS?

  Answer:  
  1. Anyone can refer a child to CCS, including parents.
  2. Families (or the applicant if age 18 or older, or an emancipated minor) must: Complete the application form and return it to LA County CCS office; give CCS all of the information requested 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.
  3. Your child's doctor will have a general idea whether or not your child is medically eligible, so asking your doctor is the first step. You and your child's doctor can work together to provide your child's medically history to CCS so we can decide it your child is medically eligible.
  4. If your child becomes eligible, CCS can pay for bills all the way back to the day the family signed the application. So it is important to sign & return the application to us as quickly as possible.
  5. Remember CCS only covers the eligible condition.

• CCS - What papers should I bring?

  Answer:   You may need papers that show your child's age, where you live, and how much income you had in the past year. Examples of papers you may need are your social security card, driver's license, rent and utility receipts, paycheck stubs, birth or baptismal certificates, school enrollment forms, military ID, health insurance information or Medi-Cal card, and recent income tax forms.

• CCS - What are the steps to CCS services?

  Answer:  
  STEP 1. Child's condition found
  STEP 2. Referral made / Medical report sent to CCS
  STEP 3. Application completed (if your child does not have Medi-Cal or Healthy Families you must apply for it. If your child has Medi-Cal, he or she may be assigned to a "Managed Care" plan:)
  STEP 4. Eligibility checked for: age, residency, financial, and medical
  STEP 5. Authorizations provided for services requested by your child's doctor for CCS -eligible condition - before the service is provided.

Child Health & Disability Prevention

• CHDP - What is the CHDP referral network?

  Answer:  The CHDP Referral Directory was created to make it easier for CHDP providers to refer children who have fee-for-service Medi-Cal through the CHDP Program to a Medi-Cal specialist, dentist or vision care provider.

• CHDP - Who is eligible for CHDP Exam?

  Answer:  Medi-Cal recipients who are enrolled in Medi-Cal Managed Care Plans are eligible for health exams from birth to age 21 years.
  CHDP provides free periodic preventive health services to non-Medi-Cal eligible children and youth from birth to age 19 whose family income is equal to or less than 200 percent of the federal income guidelines. They are eligible for health exams based on the same schedule as Medi-Cal eligible children and youth.
  Children in Head Start and State Preschool programs.
  Children in Foster Care.
  

• CHDP - Are CHDP Examinations the same as the regular check a child receives?

  Answer:   Yes is the simple answer. However, the CHDP Examination requires the health professional to include all the items mentioned above.

• CHDP - Is CCS related to CHDP and part of the referral system?

  Answer:   California Children's Services (CCS) is the other half to Children's Medical Services (CMS). CMS administers the CHDP and CCS programs. CCS is a program for children who have serious medical conditions. This Program helps children receive care from pediatric specialists. This website has many pages related to CCS.

• CHDP - How does the referral process work?

  Answer:   When a problem has been found during a CHDP examination, the health professional and the family discuss and decide what to do. If possible, the provider may treat the problem; for example, a prescription for a medication may be given to the family. If the child needs specialty care, such as an optometrist or a dentist, the CHDP health professional may then make the necessary referral.

• CHDP - Who pays for the specialty care?

  Answer:   CHDP does not pay for specialty care. Children who have full scope Medi-Cal or Healthy Families can use their insurance to pay for specialized care. For families without insurance, there are many resources that depend on the type of problem and family situation. The family can contact the CHDP office and our staff will be happy to assist the family to obtain resources.

• CHDP - What are CHDP Referrals?

  Answer:   One of the goals of the CHDP Program is to find any medical, dental, nutritional and developmental problems that a child may have before the problems become too severe for treatment. If a problem is found during a CHDP exam, a child may need a referral for diagnosis and/or treatment for that problem. The CHDP health professional must assist families obtain the care their children need.

• CHDP - Does a child receive the same service at every CHDP Examination check?

  Answer:   No. There is an established schedule based on a child's age and health status. Please click on CHDP Periodicity Schedule for a table listing the dates of exams and the items that are required for each age. The CHDP Immunization Schedule lists all the required vaccinations and the dates for receiving them.

• CHDP - How to get a CHDP Exam?

  Answer:  Call your physician or clinic and ask for a CHDP exam appointment.
  Ask at a county health center if you are eligible for a CHDP exam
  Ask the school nurse.
  Call 1-800-993-2437
  

• CHDP - What if a problem is found during the CHDP Examination?

  Answer:   If the health professional finds a problem in any part of the examination, the child and family may receive advice, a specific treatment (such as a prescription) or a referral for additional examinations, diagnosis and treatment.

• CHDP - What services does CHDP provide?

  Answer:  In L.A. County, the CHDP Program began in 1975. The main purpose of the Program is to make sure that children from low/moderate income families and children with Medi-Cal have access to complete preventive exams. CHDP offers scheduled health checkups at NO COST to the eligible family. The health checkup includes:
  
  A complete medical and developmental history
  An unclothed examination
  A dental screening assessment
  A nutritional assessment
  Visions and hearing screening
  Immunizations (shots)
  Urine, blood, and TB screening tests
  Certain lab tests as needed
  Tobacco avoidance and cessation counseling for patients and caregivers
  Health education
  
  CHDP exams are available at 1,000 provider offices (approximately 1,900 health assessors) in the Los Angeles area including private doctors, clinics, and county facilities providing CHDP exams.

• CHDP - Who provides CHDP exams?

  Answer:  
  The CHDP health exams are provided by CHDP approved:
  Private medical doctors, clinics, medical groups and HMO's.
  County public health centers, comprehensive health centers and some county hospital pediatric clinics, e.g. MLK, Harbor UCLA.
  Some school districts.