California Children Services: CCS

Diagnostic Program

What is the CCS Diagnostic Program?
The CCS Diagnostic Program refers and pays for evaluations by medical specialists and diagnostic tests when a child (birth to 21 years of age) may have a serious medical condition. This program is available to families who have no health insurance, families who have Healthy Families or Medi-Cal insurance and all families whose health insurance denies in writing a CCS covered diagnostic service. Not all medical conditions or diseases are eligible, only the very serious.

What are medical eligibility criteria?
In one sentence, a child who may have serious, potentially life-threatening or physically disabling illness or condition is most likely medically eligible. To review the medical eligibility guidelines, click on Medical Eligibility. These are just the guidelines and the final decision rests with the CCS Office. CCS encourages referrals even when there is a doubt regarding medical eligibility.

Are there other restrictions on eligibility?
A child must be less than 21 years old. Also, a child must be a resident of Santa Barbara County; usually, this is demonstrated by attendance at school or work history.

To whom does CCS refer children?
CCS will refer a child to a CCS Paneled Specialist only. These are health professionals who have demonstrated special training and skills in the diagnosis and treatment of childhood conditions and diseases. CCS will help the child's physician and family through the process of application, referral, appointment authorization and follow up.

What is the process to obtain a CCS Diagnostic Program service?

• Initial referral by hospital, physician, community organization or family (Click on CCS Referral Form).
• Family submits application (Click on CCS Family Application).
• Medical records are sent from hospital and/or physician to CCS.
• CCS reviews and determines medical eligibility.
• CCS contacts physician with a letter regarding eligibility.
• CCS communicates by phone or letter with the family to complete the application.
• CCS works with the family and doctor to confirm and authorize the diagnostic service.

What if a serious medical problem is discovered?
The child is automatically referred to the CCS Treatment Program. This program provides case management and payment for treating the child's condition. This program has the same medical eligibility and residential criteria as the Diagnostic Program. However, it does have an eligibility criterion based on the family's financial status. Please click on Treatment Program to learn more.

What else is important to know about the CCS Diagnostic Program?

• CCS always tries to help a child; so, CCS encourages referrals. If CCS cannot help, it may be able to give advice to the doctor or family on other resources.
• This is a medical program and requires the collaboration of CCS with the child's doctor and family. CCS must receive medical reports and prescriptions for medical care from the child's doctors.