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| 1. | Age -- Your child must be under 21 years of age. | |
| 2. | Residence -- Your child must be a permanent resident of the California county where you apply. (Your child's residence is usually where you live.) | |
| 3. | Income -- Your family income must be less than $40,000 per year, according to the adjusted gross income on your California income taxes. A child may be eligible when the family income is more than $40,000 if medical care for the child's CCS condition is expected to cost the family more than 20% of the family's income. If your child is adopted, your income will not matter. There is no financial eligibility requirement for diagnostic or therapy services. | |
| 4. | Medical conditions -- Only certain conditions are eligible for CCS. In general, CCS covers medical conditions that are physically disabling or require medical, surgical or rehabilitative services. There may be certain criteria that determine if your child's medical condition is eligible. Ask CCS if you have questions. | |
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What are the steps to CCS services?
STEPS TO CCS SERVICES Child's condition found Referral made / Medical report sent to CCS Application completed
(If your child does not have Medi-Cal, you must apply for it.
If your child has Medi-Cal, he or she may be assigned to a "Managed Care" plan.)Eligibility determined
• age • residency • financial • medicalServices given
• medically necessary • prior authorization
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Benefits of CCS are medical services that the CCS program provides directly to eligible children or arranges to pay for their cost. The following explains some of those services.
CASE MANAGEMENT
Case management is determining medical eligibility, deciding what your child needs, and helping you get special doctors and services to meet your child's special needs. This includes help to coordinate your child's medical care and referral to other agencies, such as the county health department, schools, and agencies that serve children and adults with disabilities. Every CCS client receives case management.
DIAGNOSTIC SERVICES
If CCS thinks that your child might have an eligible condition, CCS will pay for diagnostic services. These include examinations, laboratory tests, and X-rays. Diagnostic services will be provided only until CCS finds out that your child has a condition that is eligible for CCS.
TREATMENT SERVICES Treatment services include medical services, medicines, equipment, or supplies that are necessary to treat your child's CCS- eligible condition. Treatment services are provided when they are a benefit of the CCS program, prescribed by a CCS-approved doctor, and authorized by CCS. Most of the time, these services can be provided in doctor's offices close to your home, but sometimes CCS might refer your child to a special care center if your child is eligible. Hospital stay can be authorized by CCS only if the doctor and hospital are approved by CCS, and the child's condition requires in-patient care.
SPECIAL CARE CENTERS
A special care center is where CCS can send your child to get the best medical care, using a team of specialists, such as doctors, social workers, nurses, therapists, and nutritionists. The team members will help you and your child manage your child's medical condition, and you are expected to bring your child in at least once a year. There will be evaluations to measure your child's progress and team meetings, which include you and your child (if your child is old enough) to discuss and/or change the treatments as your child's needs change. CCS special care centers are not for every child enrolled in CCS. Ask CCS about eligibility requirements.
MEDICAL THERAPY PROGRAM (MTP) IN SCHOOLS
The Medical Therapy Program (MTP) is a coordinated program of medically necessary PT and OT services provided to medically eligible children. These services are provided in Medical Therapy Units (MTUs) located at certain public schools. PT and OT may help your child to be independent in such areas as getting around, getting in and out of a wheelchair, walking, feeding, dressing, staying clean and neat, and home skills. There is a separate evaluation by the Medical therapy team (the doctors and therapists who specialize in treating children with physical disabilities). The team decides if your child would benefit from MTU services and meets with you to discuss which services would best meet your child's needs.
Benefits may be authorized only from CCS-approved doctors, hospitals, OTs, PTs, etc. These people or groups are called "providers". Only services determined by CCS to be medically necessary to treat the CCS-eligible condition will be authorized.
| Office Hours: |
8:00
am to 5:00 pm |
| Location/ Mailing Address: |
10769
Hole Ave., Suite 220 Riverside, CA 92505 |
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Telephone: |
909.358.5401 |
| FAX: | 909.358.5198 |
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Treatment, such as doctor services, hospital and surgical care,
physical therapy (PT) and occupational therapy (OT), laboratory
tests, X-rays, orthopedic appliances, and medical equipment;
