California Children's Services

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The California Children's Services (CCS) Program, established in 1927, is a partnership between state and counties that provides medical case management for children in California diagnosed with serious chronic diseases. [1] [2] It provides services to more than 165,000 children in California. [2]

Contents

History

Title V of the Social Security Act was passed in an effort to support states who pledged to improve child and maternal health and welfare. [3] This act has been modified, but its goal of serving children and women has remained the same. [3] [4]

Medicaid United States social health care program for families and individuals with limited resources

Medicaid in the United States is a federal and state program that helps with medical costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and personal care services. The Health Insurance Association of America describes Medicaid as "a government insurance program for persons of all ages whose income and resources are insufficient to pay for health care." Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States, providing free health insurance to 74 million low-income and disabled people as of 2017. It is a means-tested program that is jointly funded by the state and federal governments and managed by the states, with each state currently having broad leeway to determine who is eligible for its implementation of the program. States are not required to participate in the program, although all have since 1982. Medicaid recipients must be U.S. citizens or qualified non-citizens, and may include low-income adults, their children, and people with certain disabilities. Poverty alone does not necessarily qualify someone for Medicaid.

About 15% of California's CSHCN receive specialty care through the CCS program. Nearly 150,000 children annually receive care through the CCS program and about 80% are Medi-Cal beneficiaries. [5] [6]

Program Description

CCS is administered by Children's Medical Services in the Department of Health Services (DHCS). For providers to see patients covered by CCS, they must be approved by the state CCS program to be considered a CCS paneled provider. [6]

CCS provides the following support services. [6]

  1. Assist in treatment costs related to the CCS condition. Such examples include doctor services, surgical costs, inpatient costs, medical equipment, physical therapy, and laboratory tests.
  2. Medical Case Management. Given that these patients have very complex healthcare condition CCS has the ability to ensure that physicians from various specialties can provide the services to the child.
  3. Medical Therapy Program (MTP) services that provide medically eligible children with physical therapy, occupational therapy or both. [6]

Funding for CCS

For a county CCS program the funding source is a combination of appropriations from the county, state general funds and the federal government. [1] California is required to spend 30% of funds from its Title V Maternal and Child Health Block Grant on children with special health care needs, thus a portion of these federal funds go to the CCS program. The amount of state money available for the program is determined every year through the Budget Act. AB 948 states that the state and county need to share the costs of providing services, such as these, to ill children. [1]

Funding differs among those with CCS and other sources of financial assistance. Seventy percent of children that are eligible for CCS are also eligible for Medi-Cal. [1] In this case, the Medi-Cal program reimburses their care. [1] The other 30 percent of children account for those children who are CCS only and those that have Healthy Families (considered CCS-Healthy families). Funding for individuals with both CCS and Healthy Families is mainly provided by the federal Title XXI, with state and county funds providing 30% of the costs. Costs for individuals with just CCS are paid between the state and counties. [6] [7]

Note that Insurance Code Sections 12693.62, 12693.64, and 12693.66—which address California's Healthy Families Programstate that services that CCS authorizes for dual-eligible individuals are not covered by the Healthy Families plan. [5] [6] Healthy Families continue to pay for primary care services not pertaining to the condition that made the child CCS medically eligible. [5] [6]

Program Structure

The way the program is administered is dependent on the size of the population in the county. For instance, in counties that are considered independent counties, those that have more than 200,000, individuals residing in that specific location, county staff are expected to play a vital role in evaluation, eligibility determination, and authorizations. [1] For those counties with less than 200,000 individuals, also referred to as dependent counties, the Children's Medical Services Branch provides assistance with these procedures through its regional offices. Dependent counties make decisions on financial and residential eligibility and have direct contact with families. Some dependent counties have participated in the Case Management Improvement Project (CMIP) to partner with regional offices in determining medical eligibility and authorization of services. Regional offices also provide assistance to independent counties, CCS paneled providers, and hospitals in their region. [1]

Eligibility

Children, from birth to the age of twenty-one, are eligible for CCS if the meet the following medical, residential and financial eligibility [1] [8]

Medical Requirements

Eligible conditions include, but are not limited to:

All conditions covered by CCS tend to produce major long-term effects. [1]

Residential Requirements

To be covered by CCS children must be residents of California. [7]

Financial Requirements

Children are eligible if they are:

  1. Enrolled in Medi-Cal or Healthy Families program;
  2. Uninsured and annual family income less than $40,000; or
  3. The child's condition requires expenditures projected to exceed 20% of the family's annual adjusted gross income. [1] [2]

Note that children with neuromuscular or orthopedic problems like cerebral palsy need not meet financial eligibility requirements to access services under the MTP. [6]

Impact

Analysis of CCS claims of 2009 showed that about 16% of children enrolled in CCS are less than one year of age and the majority of children at 28% were ages 1 to 4. [9] For children under the age of one the leading diagnoses were heart conditions. For children greater than 1 year of age the most common condition was neurological disorders. [9]

The Future of CCS

For California to change the way it delivers Medi-Cal services, the federal government must grant permission in the form of a waiver. A 1115 Waiver approved on November 2010 affects children eligible to receive CCS health care needs through demonstration pilots. [10] Demonstration pilots under the Department of Health Care Services test new models for healthcare delivery among this population of CCS children. [10]

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References

  1. 1 2 3 4 5 6 7 8 9 10 Department of HealthCare Services. California Children’s Services Program Overview. Retrieved from http://www.dhcs.ca.gov/services/ccs/Pages/ProgramOverview.aspx
  2. 1 2 3 Lewis V. Assessing the California Children Services Program. California Healthcare Foundation. 2009. Retrieved from http://www.chcf.org/publications/2009/08/assessing-the-california-childrens-services-program
  3. 1 2 3 4 Association of Maternal and Child Health Programs. About Title V. Retrieved from http://www.amchp.org/abouttitlev/Pages/default.aspx
  4. 1 2 California Department of Health Services. California Five Year Needs Assessment for the Maternal and Child Health Services Title V Block Grant Program. Retrieved from http://www.cdph.ca.gov/programs/mcah/Documents/MO-TitleV-NeedsAssessment.pdf Archived 2010-08-25 at the Wayback Machine
  5. 1 2 3 Inkelas M, Ahn P, Larson K. Access to Health Care for California’s Children with Special Health Care Needs. UCLA Center for Healthier Children, Families, and Communities (2001). Retrieved from http://www.healthychild.ucla.edu/PUBLICATIONS/Documents/Chartbook.pdf Archived 2006-12-08 at the Wayback Machine
  6. 1 2 3 4 5 6 7 8 Inkelas M, Samson K. Specialty Health Care for Children in the Los Angeles California Children’s Services Program (CCS). 2005. UCLA Center for Healthier Children, Families and Communities. Retrieved from http://www.healthychild.ucla.edu/CCS%20Survey%20report%20final%20revised%20(2).pdf
  7. 1 2 Seidman RL, Wolf JC. Evaluation of Expenditures by California children’s Services (CCS) Beneficiaries: 2001-2005. Institute for Public Health Graduate School of Public Health (2007). Retrieved from http://www.dhcs.ca.gov/provgovpart/Documents/CCS%20Revised%20Final%20Report%20-%20Final%2010-19-07.pdf
  8. ↑ Belfiori J, Oliva G, Rienks J, Gass B, Thind N. Title V Children with Special Health Care Needs (CSHCN) Needs Assessment Report: California Children’s Services (CCS) Program Systems Issues and Priority Action Objectives. Family Health Outcomes Project.2005.Retrieved from http://www.lpfch.org/californiaservicesystem/servicesystemapp11.pdf Archived 2014-10-11 at the Wayback Machine
  9. 1 2 Wise PH, Sundaram V, Chamberlain L, Wang E, Saynina O, Chan J, Chan K, Danielsen B, Gould J. California Children’s Services Program Analysis. Stanford Center for Policy, Outcomes and Prevention, Stanford University (2011). Retrieved from http://www.dhcs.ca.gov/services/ccs/Documents/CCSFinalReport06_30_11.pdf
  10. 1 2 Family Voices of California. Changes in Medi-Cal and California Children’s Services: The 1115 Waiver. Retrieved from http://www.familyvoicesofca.org/files/1115%20waiver%20fact%20sheet%20FINAL.pdf
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