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Learn About the Whole-Child Model

COVID-19 Updates

In light of the COVID-19 public health emergency, the Department of Health Care Services (DHCS) has issued temporary guidance and direction for the administration of the Whole-Child Model (WCM) program and California Children’s Services (CCS). The guidance ensures that WCM members (CalOptima members who are CCS-eligible) can access medically necessary services without any delay.

Below are DHCS memorandums that provide COVID-19-related guidance:

April 30, 2020

DHCS California Children’s Services (CCS) Guidance Relative to 2019-Novel Coronavirus (COVID-19) Public Health Emergency

Guidance that provides temporary direction to California Children’s Services (CCS)

April 24, 2020

DHCS CCS MTP Guidance Relative to COVID-19 Public Health Emergency

Guidance that provides temporary direction to California Children’s Services (CCS) Medical Therapy Programs (MTPs)

WCM Program Updates

CalOptima is committed to keeping our stakeholders informed and providing opportunities for feedback. Our most recent efforts for the Whole-Child Model (WCM) include:

WCM Program Launch

The Whole-Child Model is live! As of July 1, 2019, CalOptima members who are California Children’s Services (CCS) -eligible will receive their CCS services and non-CCS services under CalOptima’s Whole-Child Model program. This means these members will be receiving the majority of their health care needs through CalOptima from now on.

Under the WCM program, CalOptima members will have the ability to be more involved with their care and have access to additional resources to help navigate the health system. A Personal Care Coordinator (PCC) is assigned to every CalOptima WCM member and may be reached for questions regarding their health care.

If you have any questions regarding the WCM program, contact CalOptima Customer Service at 888-587-8088.

Member Notices and Outreach

The transition from California Children’s Services (CCS) to the Whole-Child Model (WCM) will occur on July 1, 2019. Members and their families currently enrolled in CCS will receive notices on April 1 (90-day notice) and May 1 (60-day notice) informing them about the transition. The notices will include information about the transition, next steps and answers to frequently asked questions. The 60-day notice will also contain a WCM member guide with further details about CalOptima’s WCM program. Additionally, CalOptima will conduct outreach calls to members regarding the transition in mid-May.

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About the Whole-Child Model

California Children’s Services (CCS) is a statewide program for children with certain medical conditions. CCS provides medical care, case management, physical/occupational therapy and financial assistance. Prior to July 1, 2019, CCS services were carved out (separated) from most Medi-Cal managed care plans, including CalOptima.

The Orange County Health Care Agency (OC HCA) managed the local CCS program. It provided case management, eligibility determination, service authorization and direct therapy under the Medical Therapy Program.

CCS became a Medi-Cal managed care plan benefit in select California counties starting July of 2018. The goal is to improve health care coordination for the whole child, rather than handle CCS conditions separately. This approach is known as the Whole-Child Model.

As of July 1, 2019, CalOptima members’ needs related to CCS services became a part of CalOptima’s Medi-Cal plan. Under this model, OC HCA will continue to determine eligibility and manage the Medical Therapy Program.

CalOptima and OC HCA continue to work diligently on a seamless transition for the CalOptima children and families involved.

Whole-Child Model Family Advisory Committee

CalOptima created a Whole-Child Model Family Advisory Committee (WCM FAC). Committee members include CCS family representatives/members, community-based organizations, and/or consumer advocates.

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Learn More About The Whole-Child Model Family Advisory Committee
Guiding the transition of California Children’s Services

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