California Children Services: CCS

Treatment Program

What is the CCS Treatment Program?
The CCS Treatment Program provides comprehensive case management for children (birth to 21 years) with serious, potentially life threatening or disabling physical conditions or diseases. A child who is eligible is assigned to a team consisting of a Nurse Case Manager and a Case Worker. The Case Management Team helps families, health professionals and community organizations access specialty care for children with special health care needs. The CCS Medical Director and Program Manager assist the Team as needed. Children and families must meet medical, financial and residential eligibility requirements. Children who qualify receive all services free of charge or with minimal fees. CCS may purchase medical services from physicians, nurses, audiologists or other health professionals and medical equipment and supplies that are needed by the child.

What are the medical eligibility criteria?
In one sentence, a child who has a 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.

What are the financial and residential eligibility criteria?
The child's family must be earning less than $40,000 per year at the time of application and annual renewal of eligibility (adjusted gross income on California tax return). There is one exception; when the medical expenses of the family for treatment of a CCS Medically Eligible condition exceed 20% of the family's adjusted annual income, a child may become financially eligible. The family must provide sufficient documentation to verify the cost of the planned treatment and their income. 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, (there are rare exceptions decided by the CCS Medical Director). 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, service authorization and follow up.

What is the process to participate in the CCS Treatment Program?

• 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, financial and residential eligibility. This may require the family to come to CCS for an interview and/or to apply for Medi-Cal insurance coverage.
• CCS contacts physician(s) with a letter(s) regarding eligibility.
• CCS sends a letter to the family regarding eligibility.
• Family completes and returns all CCS documents including a Parent Participation Agreement.
• Treating physician(s) submits prescriptions for care to CCS for authorization.
• CCS communicates with physicians and family to authorize treatment services.

What if it is uncertain if the child has a CCS Medically Eligible condition?
If there is a reasonable suspicion that the child has a CCS condition but confirmation is needed, then the child should be referred to the CCS Diagnostic Program.

What else is important to know about the CCS Treatment 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. Ongoing medical reports and prescriptions for treatment services are required from the treating physicians.

What happens after acceptance into the CCS Treatment Program?
Once a child is determined to be eligible, he or she can receive authorized services for that eligible medical condition for the next year. Eligibility must be renewed annually. The family, the child's health professionals and CCS become a team that works together to assure the child's optimal treatment. The CCS part of the team includes a Public Health Nurse, Case Worker, Program Manager and Medical Director.

What if CCS does not authorize a service requested by the family and health professionals?
There are services that CCS expressly does not cover. However, there are times when there are questions about the necessity or appropriateness of a request. If CCS denies a request, a family or prescribing health professional can appeal the decision through CCS Due Process. The family will receive a formal letter called a Notice of Action when a prescribed service is denied. The letter includes the steps a family must take to appeal the decision.