Form Dhcs 4480 - California Application To Determine Ccs Program Eligibility - Health And Human Services Agency
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5State of California—Health and Human Services Agency
Department of Health Care Service
California Children’s Services CCS)
INFORMATION ABOUT CALIFORNIA CHILDREN’S SERVICES (CCS)
What is California Children’s Services?
CCS is a statewide program that treats children with certain physical limitations and chronic health conditions or diseases. CCS
can authorize and pay for specific medical services and equipment provided by CCS-approved specialists. The California
Department of Health Care Services manages the CCS program. Larger counties operate their own CCS programs, while smaller
counties share the operation of their program with state CCS regional offices in Sacramento, San Francisco, and Los Angeles.
The program is funded with state, county, and federal tax monies, along with some fees paid by parents.
What does CCS offer children?
If you or your child’s doctor think that your child might ha ve a CCS-eligible medical condition, CCS may pay for or provide a
medical evaluation to find out if your child’s condition is covered.
If your child is eligible, CCS may pay for or provide:
• Treatment, such as doctor services, hospital and surgical care, physical therapy and occupational therapy, laboratory tests, X-
rays, orthopedic appliances and medical equipment.
• Medical case management to help get special doctors and care for your child when medically necessary, and referral to other
agencies, including public health nursing and regional centers; or a
• Medical Therapy Program (MTP), which can provide physical therapy and/or occupational therapy in public schools for children
who are medically eligible.
Who qualifies for CCS?
The program is open to anyone who:
• is under 21 years old;
• has or may have a medical condition that is covered by CCS;
• is a resident of California; and
• has a family income of less than $40,000 as reported on the adjusted gross income on the state tax form or whose out-of
pocket medical expenses for a child who qualifies are expected to be more than 20 percent of family income.
Family income is not a factor for children who:
• need diagnostic services to confirm a CCS eligible medical condition; or
• were adopted with a known CCS eligible medical condition; or
• are applying only for services through the Medical Therapy Program; or
• have Medi-Cal full scope, no share of cost.
What medical conditions does CCS cover?
Only certain conditions are covered by CCS. In general, CCS covers medical conditions that are physically disabling or require
medical, surgical, or rehabilitative services. There also may be certain criteria that determine if your child’s medical condition is
eligible. Listed below are categories of medical conditions that may be covered and some examples of each:
• Conditions involving the heart (congenital heart disease)
• Neoplasms (cancers, tumors)
• Disorders of the blood (hemophilia, sickle cell anemia)
• Endocrine, nutritional, and metabolic diseases (thyroid problems, PKU, diabetes)
• Disorders of the genito-urinary system (serious chronic kidney problems)
• Disorders of the gastrointestinal system (chronic inflammatory disease, diseases of the liver)
• Serious birth defects (cleft lip/palate, spina bifida)
• Disorders of the sense organs (hearing loss, glaucoma, cataracts)
• Disorders of the nervous system (cerebral palsy, uncontrolled seizures)
• Disorders of the musculoskeletal system and connective tissues (rheumatoid arthritis, muscular dystrophy)
• Severe disorders of the immune system (HIV infection)
• Disabling conditions or poisonings requiring intensive care or rehabilitation (severe head, brain, or spinal cord injuries, severe
burns)
• Complications of premature birth requiring an intensive level of care
DHCS 4480 (04/17)
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