| || |
|Frequently Asked Questions|
|What Does CCS Offer Children? |
|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 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.
|Who Qualifies for CCS? |
|The program is open to any child 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
- has Healthy Families coverage.
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.
|What Medical Conditions Does CCS Cover? |
|Only certain conditions are covered by CCS. In general, CCS covers medical conditions that are physically disabiling or require medical, surgical, or rehabilitative services. There also my be certain criteria that determine if your 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 (congeital 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 (cerebal 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)
For more information on medical eligibility, please read this overview or contact our office.
|How Do You Refer and Apply for CCS? |
|Children and young adults can be referred to us by anyone. Referrals and applications are accepted by phone, mail, or fax. Please be sure to submit both the referral and the application form. |
The CCS referral form can be completed by anyone. The CCS application for services must be completed by the parents or legal guardians.
|How Do We Assist Providers? |
- assistance with becoming a CCS approved provider
- help with navigating the CCS/Medi-Cal system
- expedite authorizations, claims approval and processing
- provide information on client eligibility status
- provide outreach and education