California Children’s Services (CCS) 101

Services funded via CCS include:

• Hospital and surgical treatment
• Medical case management
• Physical and occupational therapies
• Labs and imaging
• Medical equipment

CCS can also help provide coordination between different members of a child's care team. Dr. Shafali Jeste explains in this clip:

CCS-eligible medical conditions, include, among others:

• Congenital heart defects
• Hearing and vision impairments
• Chronic lung disease
• Diabetes
• Muscular dystrophy
• Blood disorders
• Cerebral palsy
• Epilepsy (with specific qualifying factors)

You can find a complete list of eligible conditions at the Department of Health Care Services CCS eligibility website.

In addition to having a CCS-eligible medical disability, your child also needs to meet the following criteria in order to access services:

• Your child must be a California resident under age 21.

• Your family adjusted gross income (AGI) must be less than $40,000 OR your out-of-pocket medical expenses for your child must be expected to exceed 20 percent of your family’s income.

• Family income is NOT a factor for children who:

  • Need diagnostic services to confirm they have a CCS-eligible medical condition.

  • Were adopted with a known CCS-eligible medical condition.

  • Are applying only for services through the Medical Therapy Program. Children with certain neuromusculoskeletal conditions may be eligible for physical and occupational therapy services in conjunction with local education agencies regardless of household income or Medi-Cal status.

  • Have full-scope Medi-Cal with no share of cost — meaning that you never pay for some of the costs of services provided to your child each month. (For families of children who are Regional Center eligible, it may be worthwhile to investigate Medi-Cal enrollment under the institutional deeming waiver so that income will not be a factor for CCS.)

As with most public programs, private insurance is treated as the primary avenue of funding. If your child has private insurance, CCS will require a written denial from your private insurance before it agrees to fund services or equipment.

If a child has full-scope Medi-Cal, they automatically meet CCS financial eligibility criteria. CCS then acts as a case manager, reviewing and authorizing service requests to be funded by Medi-Cal. If a service is not covered by Medi-Cal, the request is returned to CCS for further review and potential funding.

If your family exceeds the income limit and your child is not enrolled in Medi-Cal, your child may still be eligible for occupational and physical therapy services provided free of charge through CCS’s Medical Therapy Program. This program provides PT, OT, and Medical Therapy Conference services (essentially multidisciplinary case planning) to children with specific musculoskeletal and neurological disabilities. In cases of financial need, the CCS Medical Therapy Program can also help fund durable medical equipment.

The Department of Health Care Services lists some examples of eligible conditions, including “cerebral palsy, neuromuscular disease (e.g., muscular dystrophy), musculoskeletal diseases (e.g., arthrogryposis), juvenile rheumatoid arthritis, spina bifida, brachial plexus injury, and acquired injury and illnesses such as burns and traumatic brain injuries.”

Medical Therapy Units are housed at designated public schools, and providers are often part of the IEP team, although services may be available from birth if medically necessary. Because orthopedic impairment is a designated low-incidence disability for special education in California, the school district or Special Education Local Plan Area (SELPA) may be involved even for infants and toddlers.

1. Find your local CCS office based on your county.
2. Complete the forms found on the DHCS website.
3. Apply for Medi-Cal if CCS asks that you do.

You can also ask potential pediatricians if they are “paneled providers” with California Children’s Services (CCS). CCS can pay for prescription drugs, medical equipment, and supplies, but only if the order is written by a physician who has gone through their approval process.

You can find step-by-step guides to applying for CCS and enrolling in Medi-Cal on the Undivided platform. Get started →

If CCS denies your child eligibility or a service, make sure you know your appeal rights.

1. CCS must send you written notice within seven to ten days. The written notice will have information about how to submit your appeal.
2. CCS has a separate appeal process from Medi-Cal, but if your child qualifies for both, you can choose to go through the Medi-Cal appeal process instead.
3. If your child is currently receiving CCS services and you're appealing a denial or reduction, you can request aid pending appeal so that your child's coverage continues at the same level until the appeal is resolved.

For more information, see this fact sheet from Family Voices of California.