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California Children's Services (CCS: state care for children under 21 with serious medical conditions): who qualifies, what you get, how to apply, and what happens next

California Children's Services pays for diagnosis, treatment, case management and therapy for children under 21 with serious medical conditions such as cancer, cystic fibrosis, heart disease or cerebral palsy. A child qualifies with a covered condition, California residence and one of several financial routes, including family income of $40,000 or less or high medical costs; the Medical Therapy Program has no income limit. Referrals go to the county CCS office.

What California Children's Services is, in one paragraph

California Children's Services (CCS) is a state program, run with the counties, that pays for diagnosis, treatment, medical case management and physical and occupational therapy for children under 21 with serious medical conditions: examples are cystic fibrosis, hemophilia, cerebral palsy, heart disease, cancer and traumatic injuries (rule:definition, rule:medical_eligibility). Its Medical Therapy Program provides therapy at units in public schools with no income limit and no charge to the family (rule:mtp_no_income). For children who also have Medi-Cal, CCS acts as Medi-Cal's agent for the eligible condition (rule:medi_cal_link).

$40,000
family adjusted gross income at or below which a child with a CCS-eligible condition meets CCS financial eligibility; higher incomes can qualify through high medical costs (DHCS, rule:financial_40k)

Who may qualify

Three tests decide it: a CCS-eligible condition, residence in California, and financial eligibility, for a child under 21 (rule:three_tests, rule:age_under_21).

The condition must be in one of the categories in Title 22 of the California Code of Regulations, which run from cancer and blood disorders to heart, lung, nervous system, eye and ear conditions, congenital anomalies and serious injuries (rule:medical_eligibility). A newborn who needs a CCS-approved NICU for an eligible condition is covered for the stay (rule:nicu).

Financial eligibility is met by any one of (rule:financial_40k):

RouteTest
IncomeFamily adjusted gross income of $40,000 or less
High costsExpected out-of-pocket medical costs over 20% of family adjusted gross income
Medi-CalThe child has full-benefit Medi-Cal
EvaluationThe child needs an evaluation to find out whether a covered condition exists
AdoptionAdopted with a known covered condition
TherapyThe child needs the Medical Therapy Program (no income limit)

DHCS states plainly that eligibility is not limited to families earning $40,000 or less (rule:not_capped_40k).

How to apply, and what happens after

Send a referral or application to the local county CCS office; doctors and hospitals usually refer (rule:apply_county). In counties over 200,000 people the county decides everything; in smaller counties DHCS regional offices decide medical eligibility and the county decides financial and residential eligibility. In Whole Child Model counties the Medi-Cal plan provides the services (rule:county_administration). A child who may qualify for Medi-Cal must also apply for Medi-Cal (rule:medi_cal_link).

The county sends a Notice of Action on eligibility and on each service. Renewals restarted in April 2023; the interval is not stated on the pages read (rule:renewals).

Disagree with a decision? Three paths (rule:grievance, rule:first_level_appeal_30, rule:state_hearing_90):

  • First Level Appeal to the county within 30 days of the Notice of Action, verbally, in person, by phone or in writing.
  • State Hearing within 90 days, counted from the day after the notice is sent; a First Level Appeal is not required first.
  • Grievance any time about service or care quality; it does not restore services.

A child already receiving a service keeps it while the appeal or hearing is pending (rule:aid_paid_pending).

The procedure, stage by stage, as data
JSONThe procedure, stage by stage, as data
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"id""stage:complete_application"
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"id""stage:interview_verification"
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"id""stage:issuance_use"
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"id""stage:report_changes"
"order"8
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"what_happens""Report changes in income, residence or insurance to the county CCS office"
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"evidence""New information"
"failure_mode""Unreported moves between counties"
"model_role""Prompt a county transfer after a move"
"automation_class""A"
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"id""stage:renew_recertify"
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"id""stage:appeal_fair_hearing"
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"model_role""State both deadlines"
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The same facts open other programs

The child's diagnosis, age, county and family income are the facts CCS runs on; the same facts open Medi-Cal and the other supports for children with disabilities.

What this article shares with the graph
JSONWhat this article shares with the graph
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Official addresses

References (6)
Related pages
References (16)
  1. California Children's Services — California Department of Health Care Services“To qualify for the CCS program, a child must have a CCS-eligible condition, reside in California and meet financial eligibility.”
  2. California Children's Services: income — California Department of Health Care Services“CCS financial eligibility is not limited to families earning $40,000 or less.”
  3. California Children's Services: where to apply — California Department of Health Care Services“Please send any referrals or applications to the LOCAL COUNTY CCS OFFICE for processing.”
  4. California Children's Services: renewals — California Department of Health Care Services“Important News – CCS Program Renewals have Restarted as of April 2023”
  5. Find Out if I Qualify — California Department of Health Care Services“out-of-pocket medical expenses expected to be more than 20 percent of family’s adjusted gross income”
  6. Overview of CCS Medical Eligibility — California Department of Health Care Services“CCS applicants diagnosed with at least one of the following shall be medically eligible for participating in the CCS program:”
  7. Overview of CCS Medical Eligibility: NICU — California Department of Health Care Services“Infants who require a threshold level of specialized care services meet CCS eligibility for the duration of the NICU stay.”
  8. Program Overview — California Department of Health Care Services“The CCS program provides diagnostic and treatment services, medical case management, and physical and occupational therapy services to children under age 21 with CCS-eligible medical conditions.”
  9. Program Overview: Medi-Cal — California Department of Health Care Services“Currently, approximately 70 percent of CCS-eligible children are also Medi-Cal eligible.”
  10. Program Overview: administration — California Department of Health Care Services“In counties with populations greater than 200,000 (independent counties), county staff perform all case management activities for eligible children residing within their county.”
  11. Medical Therapy Program — California Department of Health Care Services“There is never a charge to a family for therapy services under the MTP.”
  12. CCS Grievances, Appeals, and State Hearings: First Level Appeal — California Department of Health Care Services“must be filed within 30-days from the date of the NOA”
  13. CCS Grievances, Appeals, and State Hearings: State Hearing — California Department of Health Care Services“The 90* days starts the day after you are sent a notice.”
  14. CCS Grievances, Appeals, and State Hearings: continuation — California Department of Health Care Services“This is also known as Aid Paid Pending (APP).”
  15. CCS Grievances, Appeals, and State Hearings: grievance — California Department of Health Care Services“Submitting a grievance will not reinstate CCS benefits.”
  16. CCS Grievances, Appeals, and State Hearings: contact — California Department of Health Care Services“Please direct any CCS State Hearing questions to DHCS Hearings and Appeals unit at ISCDHAU@dhcs.ca.gov.”