CCS program Overview

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California Child Services

 

Information Overview

The CCS program provides diagnosis and treatment services, medical case management and physical and occupational therapy services to children under age 21 with CCS-eligible medical conditions, such as cystic fibrosis, hemophilia, cerebral palsy, heart disease, cancer and traumatic injuries. CCS pays only for health care services related to the CCS eligible medical condition. CCS also provides medically necessary physical and occupational therapy to special education students.

The CCS program has been in existence for decades and pre-dates Medi-Cal and Healthy Families. ut” and continue to be provided by the CCS program. 

As these children’s health coverage programs were created and expanded, services to children for CCS eligible medical conditions have generally been “carved out” and continue to be provided by the CCS program. This means that children receive treatment directly related to their CCS medical condition through the CCS program and primary care and other medical services through their Medi-Cal or Healthy Families health plan.

Counties have historically been responsible for eligibility determination and case management services. Small counties (under 200,000 population) may elect to have the state provide case management services (referred to as “dependent” counties). Counties have also had a long standing share of cost for the non-Medi-Cal portion of the CCS program, which was increased in Realignment.



CCS Program Eligibility

Medi-Cal/CCS: Any Medi-Cal eligible child with a CCS identified condition.

Healthy Families/CCS: Any Healthy Families eligible child with a CCS identified condition.

Straight CCS: Any child who has a CCS medical condition and has a family Adjusted Gross Income (AGI) of $40,000 or less. Children in families with higher incomes may still be eligible for CCS if the estimated cost of care to the family in one year is expected to exceed 20 percent of the family’s AGI. Please note that many children in this program have private health insurance and CCS pays for services and/or durable medical equipment that are not covered by their primary health insurance.

Special Education Students: Any special education student whose Individualized Education Program (IEP) includes medically necessary occupational or physical therapy is entitled to receive CCS Medical Therapy services. There is no means test for these children. Counties are the providers of care for these services through their Medical Therapy Programs (MTP), with services generally provided at school sites by county employed physical therapists. Counties are required to have MOU’s with their local school districts detailing how these services are to be delivered.
 

Program Financing (Diagnosis/Treatment and Therapy)

Medi-Cal/CCS: 50% Federal Medicaid funds and 50% State General Funds

Straight CCS: 50% State General Funds and 50% County funds

Healthy Families/CCS: For family incomes under $40,000 AGI: 65% Federal SCHIP funds, 17.5% State General Funds and 17.5% County funds

For family incomes over $40,000 AGI: 65% Federal SCHIP funds and 35% State General Funds

Special Education Students: Billed to Medi-Cal when child has been identified as
Medi-Cal eligible; otherwise 50% State General Fund and 50% County funds

Program Financing (County Administration/case management)

Medi-Cal/CCS: 50% Federal Medicaid Funds and 50% State General Funds

Straight CCS: 50% State General Funds and 50% County funds

Healthy Families/CCS: 65% Federal SCHIP funds, 17.5% State General Funds and 17.5% County Funds 
 

Realignment (1990/91) Changes to CCS

Straight CCS Diagnosis/Treatment and Therapy:
Prior to Realignment: The state paid for 75% and counties paid for 25%.
After Realignment: The sharing ratio was changed to 50% state and 50% county in Realignment. Of the 50% county share, half is funded through the Realignment Social
Services Account and half (the original 25%) is a general county obligation.

Straight CCS County Administration (case management):
Prior to Realignment: The state reimbursed counties for administration/case management up to 4.1% of the gross total expenditure for diagnosis, treatment and therapy services.
After Realignment: For the Straight CCS program, counties are reimbursed for 50% of the total amount required to meet state administrative standards. Statute does not designate the source of the county funds.

Maintenance of Effort: Realignment requires counties to provide contributions to fund Diagnosis, Treatment and Therapy up to the level of their actual expenditures for FY 90/91, unless the State CCS program certifies that a lower level of funding is sufficient. The state made a commitment to match one dollar for each dollar a county appropriates for CCS services expenditures above its MOE level and in the past has provided additional state matching funds if a county appropriated additional funds to meet the demands of their local program.

Program Statutes

Health and Safety Code §123800-123995: Statute governing the CCS program.

Insurance Code §12693.62 and 12693.69: Statute governing the CCS carve-out in Healthy Families.

Government Code § 7575(a)(1): Statute requiring CCS to pay for therapy services for Special Education children. 

Program Regulations

The CCS program is administered through both regulation (Title 22, Division 2, Subdivision 7) and Policy Letters. The Policy Letters are not subject to the public review process that is required for regulations.

Although statute governing CCS is riddled with “to the extent funds are available” language, the state generally administers the program as an entitlement with no guidance regarding adjustments to program eligibility or services if there are insufficient state or county funds.