California Children’s Services Transition to the
Whole-Child Model


What is The Whole-Child Model?

The Whole-Child Model (WCM) is based on integration between California Children’s Services (CCS) – a statewide program for children with special health care needs; and Medi-Cal – free or low-cost health coverage for children and adults with limited income and resources. CCS provides medical care, case management, physical/occupational therapy and financial assistance for these children. At this time, CCS services are “carved-out” (not a covered benefit) under most Medi-Cal Managed Care Plans, including the Central California Alliance for Health (the Alliance).


The purpose of this “CCS Redesign” is to provide integrated care for children who need it most. The goals of the redesign are:

• Implement Family Centered Approach;
• Improve Care Coordination through a Managed Care System;
• Maintain and Improve Quality;
• Streamline Care Delivery; and
• Improve Family and Provider Satisfaction.


The approach is consistent with the primary goals of providing comprehensive treatment and focusing on the whole-child, including the child’s full range of needs rather than only on the CCS health condition. The anticipated result is improved care coordination for primary, specialty, and behavioral health services for the child's CCS and non-CCS conditions.


How Will It Work?

The integration of CCS services in the Whole Child Model (WCM) will be accomplished through County Organized Health Systems (COHS) that manage Medi-Cal by way of a contract with state governments. Senate Bill (SB) 586 authorizes the Department of Health Care Services (DHCS) to establish the WCM in designated COHS counties to incorporate CCS covered services for Medi-Cal-eligible CCS children and youth into a Medi-Cal managed care plan (MCP) contract. DHCS developed the WCM to meet this need, and plans to implement it in 21 specified counties.


What does this mean for the Alliance, our members, our providers and our stakeholders?

Under the WCM pilot, COHS plans such as the Alliance will assume responsibility for payment, authorization, and care coordination of primary and specialty care services, including inpatient hospitalizations, prescriptions, durable medical equipment, early and periodic screening, diagnostic and treatment benefit, ancillary services and palliative care, for children with CCS-eligible conditions. County Health Departments will continue to provide financial, residential, and medical eligibility services for CCS members.


DHCS proposed a phase-in methodology for the transition of responsibility for current CCS services between counties and Medi-Cal managed care health plans (health plans) participating in the Whole-Child Model. The Alliance is under Phase 1 of the CCS integration, which is set to be implemented no sooner than July 1, 2018.


Whole-Child Model Phase 1 Population:
Central California Alliance for Health

County

CCS Transitioning Population**

Merced 2,458
Monterey 2,983
Santa Cruz 1,150

**Source: Department of Health Care Services April 5, 2017 eligibility report


The Alliance formed a CCS Integration/WCM project in preparation for these changes, and is working with the county CCS offices in each of our three counties, Santa Cruz, Monterey, and Merced. We will partner with our provider network in each county to ensure our network is prepared to serve the CCS population under the WCM. We are dedicated to providing the most up-to-date information to our partners in preparation for the July 1, 2018 implementation.


Please visit the links below for additional information, and return to this page for updates on the WCM and how together we can best support the children in our communities who need it most.

Resources

Alliance Resources

•  April 2017 Alliance Board Packet (see PDF, CEO Report, page 32)


County-Specific Information

•  Santa Cruz County Health Services Agency CCS Program
•  Monterey County Health Department CCS Program
•  Merced County Human Services Agency CCS Program


Resources for Members and Providers

•  Beneficiary Flyer (English)(Spanish) (Updated February 2017)
•  Grievance, Appeal, and Fair Hearing Processes


General Resources and Information

•  DHCS California Children’s Services (CCS) Program Overview
•  DHCS CCS Whole-Child Model (WCM)
•  Whole-Child Model and SB 586 PowerPoint
•  DHCS CCS Advisory Group
— On April 12, 2017, Alan McKay, Alliance CEO, attended the DHCS CCS Advisory Group meeting in Sacramento. Read more here (see PDF, CEO Report, page 32).
•  Frequently Asked Questions (FAQs) (Updated February 2017)
•  Implementation Timeline (Updated January 13, 2017)






















 

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