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.
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. Children with medically eligible conditions for CCS with full scope Medi-Cal with no Share of Cost are automatically financially eligible regardless of family income.
State regulations require families to apply for Medi-Cal when they are requesting medical coverage to pay for hospitalizations, medical provider appointments for treatment, medications, durable medical equipment and supplies from the CCS program.
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 the Medical Therapy Units to children with physical handicaps that meet medical eligibility criteria for the Medical Therapy Program. (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.
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.
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.
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.
Your child may be eligible for the CCS program even though you have private health insurance if there are out of pocket costs that your insurance does not cover and the family meets the CCS financial eligibility requirements. Private health insurance must be reported to the CCS program and is used to help reduce CCS program costs. It is considered the first payer on the CCS eligible condition.
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.
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.
Families or clients 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. Families or clients who are not required to pay the $20 assessment fee include those clients who have full scope Medi-Cal with no Share of Cost, clients receiving Medical Therapy Unit Services and have an Individualized Education Plan and clients/families whose incomes are less than 100 percent of the federal poverty level.
Families or clients applying for treatment services of a CCS medically eligible condition who do not have full scope Medi-Cal with no Share of Cost 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. The annual enrollment fee can be paid in monthly installments for the eligibility period for which the client is receiving services. 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.
Families or clients who are not required to pay the annual enrollment fee include those clients with full scope Medi-Cal with no Share of Cost, clients receiving physical or occupational therapy services only (through the CCS Medical Therapy Units), clients receiving Diagnostic only services to determine if an eligible CCS condition exists, or families who adopted a child with a known CCS medically eligible condition.