The California Children’s Services (CCS) Program was established in 1927 and is one of the nation’s oldest public health programs. It was originally created to address the growing polio epidemic.
Today, CCS is a model program that provides children with the access to the best health care, regardless of family income. It provides diagnostic, treatment services, medical case management, and physical and occupational therapy services to children under age 21 years with CCS-eligible medical conditions.
Examples of CCS-eligible conditions include, but are not limited to, chronic medical conditions such as cystic fibrosis, hemophilia, cerebral palsy, muscular dystrophy, spina bifida, heart disease, cancer, traumatic injuries, and infectious diseases producing major sequelae. Families must satisfy specific financial and residential requirements, in addition to medical eligibility.
Approximately 200,000 children and youth under the age of 21 benefit from the program annually. CCS is financed by a combination of federal, state and county funds. CCS physicians and hospitals are carefully screened, credentialed, and held to rigorous standards to protect quality and ensure access to appropriate care. Program nurses provide intensive case management covering all aspects of a child’s care for their CCS condition.
Historically, specialty care for the majority of CCS patients has been carved out of Medi-Cal managed care and services are paid on a fee-for-service arrangement by the State. A CCS patient’s primary care has been provided by a Medi-Cal Managed Care plan.
CCS Modernization Act – SB 424 (Durazo)
CSCC and the California Children’s Hospital Association are co-sponsoring SB 424, authored by Senator Durazo to modernize the CCS Program.
The bill makes important updates and investments to the California Children’s Services (CCS) Program, which about 200,000 children and youth with medical complexity rely on each year.
The bill would do all of the following:
- Modify the CCS medical conditions that are now only in regulation, and require DHCS to consult with CCS providers to determine if new conditions should be added at least every five years.
- Modernize financial eligibility of the program to better align with the Affordable Care Act by providing cost-sharing assistance for families that exceed the income eligibility threshold for CCS;
- Make reimbursement more sustainable for the physicians, special care centers and hospitals providing CCS care by adjusting physician rates for inflation, and provide grants to hospitals and special care centers to the offset costs of providing care;
- Require high-cost, breakthrough drugs for CCS patients be reimbursed fully regardless of whether the drug is administered on an in-patient or outpatient basis;
- Maintain the status quo regarding Whole Child Model, with no further expansion;
A fact sheet for the bill is available: SB 424 (Durazo) CCS Modernization Fact Sheet.
CCS Redesign – Whole-Child Model
Beginning July 1, 2018, Medi-Cal eligible children and youth in the CCS program in five County Organized Health Systems (COHS) started receiving their specialty care through the same managed care plan that provides their primary care. This primary and specialty care integration is known as the Whole-Child Model, and affects 21 counties, and roughly 20 percent of the CCS population. The main goals of the Whole-Child Model are improved care coordination, reduced fragmentation and controlled costs.
There were three implementation phases, the last of which went into effect on July 1, 2019. A CCS Stakeholder Advisory Group, convened by the Department of Health Care Services has been a key stakeholder body throughout this transition, and continues to monitor and discuss the early phases of implementation.
SB 586 (Hernandez, 2016), enabled the Whole-Child Model, and includes safeguards to preserve the quality of care CCS-eligible children and youth receive, including continuity of care provisions, minimum rate requirements for providers to help maintain adequate networks, and a mandated program evaluation.
DHCS’s CCS Advisory Group Webpage
DHCS’s Whole-Child Model Webpage
Stanford Center for Policy Outcomes and Prevention – Reports and Policy Briefs
Department of Health Care Services California Children’s Services Program Site