CCS Frequently Asked Questions

Q:        What is California Children’s Services?

• California Children’s Services (CCS) is a model for the nation and has been since it was established in 1927, in response to the polio epidemic.  Since that time, CCS has provided a lifeline for children and teens diagnosed with chronic or catastrophic health conditions.  When private insurance runs out or a parent has to quit work to care for a sick child, CCS ensures the child’s lifesaving care is not interrupted.

Q:        What is a pediatric specialist?

• Pediatric specialists are the only physicians uniquely qualified to treat children with complex, chronic conditions.  Pediatric specialists understand that children are not just small adults.  Children have key differences in their heart and respiratory systems, develop different diseases, and have special emotional and developmental needs that require individualized attention.

Q:        What children are eligible for CCS?

• California Children’s Services’ patients must meet strict eligibility requirements, ensuring that only the sickest and neediest children are enrolled.  Each young patient must:

1. Have an eligible medical condition; and,
2. Be eligible for Medi-Cal, OR enrolled in Healthy Families, OR have a family annual income of less than $40,000, OR have medical care costs that exceed 20% of the family’s annual income.

Q:        What kinds of medical conditions do children in CCS have?

• The California Children’s Services’ list of eligible conditions includes the most complex and catastrophic pediatric conditions, including: cancer, blood diseases, congenital heart disease, cleft lip/palate, AIDS, and rare genetic conditions.

Q:        Why can’t these children simply be served by Medi-Cal?

• California Children’s Services has successfully partnered with managed care providers for many years to provide quality care in the most efficient manner possible.  However, Medi-Cal managed care cannot adequately serve the special population that CCS has for almost 90 years.  Health plans are set up to help the greatest volume of people gain access to health care at the lowest cost.  They are not designed to meet the complex health care needs of sick children who require immediate access to pediatric sub-specialty inpatient and outpatient care.

Q:        How is CCS different from Medi-Cal or other state health care services?

• California Children’s Services care for only chronically or catastrophically ill children.  The CCS provider network includes only fully credentialed pediatric specialists who are dedicated to providing life-saving and life-enhancing treatment that is specially adapted to the needs of children.  Under CCS, young patients who have been diagnosed can go directly to their CCS-approved specialists to receive the care they need.  Other state health care services or plans route all services through a primary care provider, and specialists may not have the knowledge or training needed to care for a pediatric population.

Q:        Why does CCS need a special carve-out?

• California Children’s Services is carved-out to protect the sickest children.  The California State Legislature has supported the carve-out that has safeguarded CCS since 1994.  Lawmakers realize that, for the children’s sake, CCS must continue as a separate program, partnering with managed care providers, to target the needs of the sickest pediatric patients.  CCS is an organized system of care for children with catastrophic and chronic health conditions.  Dismantling this system would jeopardize children’s access to this critical health care system.