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California Children’s Services (CCS) Whole Child Model Program

What is California Children’s Services (CCS)?

The CCS program provides services to children under 21 years old with eligible medical conditions. CCS services include:

Diagnostic and treatment services.
Medical case management.
Physical and occupational therapy services.
Medical therapy services at public schools.

What is the CCS Whole Child Model program?

Under the Whole Child Model program, CCS children get care from their Medi-Cal managed care health plan (health plan) instead of their county CCS program. This helps children get all of their care through one system. This model helps prevent confusion about where children get care. It can lead to better care management and health results.

As part of CCS WCM, you will get services in the language you speak. You will also get services in places that meet your child’s needs.

When CCS WCM children turn 21, they do not have to change where they get their services.

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How does the CCS Whole Child Model help families?

The Alliance helps with case management and care coordination to support and improve overall care for children who are part of the WCM program. Alliance staff can help families enrolled in CCS by:

Showing them how to use and pay for medical treatment and services through the Whole Child Model.
Explaining their child’s medical condition(s) and recommending specialists who can treat it.
Helping families apply for social services like Supplemental Security Income (SSI), food stamps, housing services and other medical programs.
Helping families resolve concerns or complaints about their child’s medical care.
Helping families use services and file appeals if their child is not approved for care.

Who is eligible for the CCS Whole Child Model?

Children who are under the age of 21 with special health care needs that need to be treated with medicines, surgery or rehabilitation. The county’s CCS program decides who is eligible for CCS.

Examples of CCS-eligible conditions include chronic medical conditions like:

Cystic fibrosis.
Hemophilia.
Cerebral palsy.
Heart disease.
Cancer.
Traumatic injuries.
Infectious diseases producing major sequelae. Sequelae is the effect of a disease, condition or injury after it happens.

If you think your child might be eligible, contact the Alliance’s Care Management team at 800-700-3874, ext. 5512. Our team is made up of nurses, social workers and care coordinators to help your child with case management and care coordination.

You can also ask your doctor to refer you to the CCS program in your county, or you can check your county’s website to learn how to make your own referral:

If your child is eligible for the CCS Whole Child Model program, your child’s doctor will treat them for their special health care needs. You will also be assigned a dedicated care coordination team to make sure your child receives the care they need.

What is covered in the CCS Whole Child Model program?

The CCS Whole Child Model program can help pay for services and treatments if they are medically necessary. Some examples include:

Doctor and specialist visits.
Hospital stays.
In-Home Supportive Services (IHSS).
Incontinence supplies.
Lab tests and x-rays.
Medical equipment, like wheelchairs and hearing aids.
Medicine.
Medical supplies.
Mental health services.
Orthopedic appliances.
Physical, occupational and speech therapy.
Surgeries.

Is there a cost?

Accessing Alliance Services

SERVICE	HOW TO ACCESS
Mental Health Services Provided through Carelon Behavioral Health. Carelon can provide a referral for: individual, group and family therapy; visits with a psychiatrist; psychological testing; and treatment for autism and other developmental conditions.	855-765-9700 (24 hours day, 7 days a week) The Alliance can help children, teens and families improve their quality of life. Carelon staff will explain mental health benefits, help find a mental health provider in your area and make an appointment for you.
Nurse Advice Line When you have health questions, the Alliance Nurse Advice Line is a good place to start. A registered nurse will answer your health questions and help you decide what to do next.	844-971-8907 (24 hours a day,7 days a week) It is fast, easy and at no cost to you. You won’t spend hours waiting in the emergency room.
Transportation The Alliance can provide transportation if your child has a medical appointment or you need to pick up a prescription or supplies.	800-700-3874, 5577 Prior approval is required. Call at least 5 business days before the appointment or service date.
Language Assistance If you speak a language other than English, language assistance services are available to you at no cost.	800-700-3874 We can get an interpreter who speaks your language. For the Hearing or Speech Assistance Line, call 800-735-2929 (TTY: Dial 7-1-1).

SERVICE

HOW TO ACCESS

Mental Health Services

Provided through Carelon Behavioral Health. Carelon can provide a referral for: individual, group and family therapy; visits with a psychiatrist; psychological testing; and treatment for autism and other developmental conditions.

855-765-9700

(24 hours day, 7 days a week)

The Alliance can help children, teens and families improve their quality of life. Carelon staff will explain mental health benefits, help find a mental health provider in your area and make an appointment for you.

Nurse Advice Line

When you have health questions, the Alliance Nurse Advice Line is a good place to start. A registered nurse will answer your health questions and help you decide what to do next.

844-971-8907

(24 hours a day,7 days a week)

It is fast, easy and at no cost to you. You won’t spend hours waiting in the emergency room.

Transportation

The Alliance can provide transportation if your child has a medical appointment or you need to pick up a prescription or supplies.

800-700-3874, 5577

Prior approval is required. Call at least 5 business days before the appointment or service date.

Language Assistance

If you speak a language other than English, language assistance services are available to you at no cost.

800-700-3874

We can get an interpreter who speaks your language. For the Hearing or Speech Assistance Line, call 800-735-2929 (TTY: Dial 7-1-1).

Transition Planning for Youths and Families

When children in the CCS Whole Child Model program turn 21, they are no longer covered by CCS. Instead, they get their health coverage through the Alliance’s Medi-Cal plan. This change is called transition planning. Transition planning helps youths ages 18-21 to:

Learn the life and social skills needed to live independently.
Create a plan with family and other trusted people.
Focus on their interests and plan for the future.
Transition from pediatric health care to adult health care.

Transition planning can help youths with setting and reaching goals around:

Health care.
Post-high school education.
Career or vocational training.
Finding a job.
Taking part in community activities.
Living as an adult.
Other support services based on needs.

For help with transition planning, contact our Care Management team at 800-700-3874, ext. 5512.

Whole Child Model Family Advisory Committee (WCMFAC)

The Whole Child Model Family Advisory Committee (WCMFAC) represents the needs and concerns of families of CCS-eligible children. This committee works to build family-centered care and makes suggestions on how to meet the Whole Child Model goals.

The group is made up of families with children who have special health care needs, Alliance staff, county CCS staff, Alliance Board members and representatives from community-based organizations.

The WCMFAC provides feedback to the Alliance’s Santa Cruz-Monterey-Merced-San Benito-Mariposa Managed Medical Care Commission, also known as the Alliance Board, on services provided by the health plan and health care coordination. WCMFAC’s goal is to hear from families of children with special health care needs and provide support.

WCMFAC members will:

Advise the Alliance Board on issues and concerns of members and their families as they relate to the Whole Child Model program.
Serve as voices of Alliance members who might not be heard otherwise.
Educate families about the services provided for children with special health care needs.
Help improve services for current and future CCS Alliance members.

WCMFAC meetings meet through video conference. Meetings last 90 minutes.

If you are interested in being on the committee, complete the online application or email [email protected] for more information.