CCS Eligible Conditions

California Children's Services (CCS) applicants with at least one of the following conditions are medically eligible for participation in the CCS program:

• Injuries to organ systems or organs that, if left untreated, are likely to result in permanent physical disability, permanent loss of function, severe disfigurement, or death.
• Fractures of the spine, pelvis or femur.
• Skull fractures that, if left untreated, would result in central nervous system complications or severe disfigurement.
• All other fractures that require open reduction or internal fixation or that involve the joints or growth plates.
• Burns, when at least one of the following is present:
  • Second- and third-degree burns to more than 10 percent of the body surface area in children younger than age 10.
  • Second- and third-degree burns to more than 20 percent of the body surface area in children older than age 10.
  • Third-degree burns to more than five percent of the body surface area for any age group.
  • Burns involving signs or symptoms of inhalation injury or causing respiratory distress
  • Second- or third-degree burns to the face, ear, mouth and throat, genitalia, perineum, major joints, hands, or feet.
  • Electrical injury or burns, including burns caused by lightning.
• Presence of a foreign body when the object, if not surgically removed, would result in death or a permanent limitation or compromise of a body function.
• Ingestion of drugs or poisons that result in life-threatening events and require inpatient hospital treatment.
• Lead poisoning, defined as a confirmed blood level of 20 micrograms per deciliter or above.
• Poisonous snake bites that require complex medical management and that may result in severe disfigurement, permanent disability or death.
• Other envenomation, such spider bites, that require complex medical management and that may result in severe disfigurement, permanent disability or death.
• Severe adverse reactions to an immunization requiring extensive medical care.

California Children's Services (CCS) applicants with congenital anomalies are medically eligible for participation in the CCS program when the congenital anomaly is amenable to cure, correction or amelioration and one of the following:

• Anomaly limits or compromises a body function based on a combination of factors, such as its size, type and location.
• Anomaly is severely disfiguring.

The following conditions are not medically eligible for the CCS program when the application for eligibility is based solely on their presence:

• Inguinal and umbilical hernia.
• Hydrocele.
• Unilateral undescended testicle.

California Children's Services (CCS) applicants with at least one of the following conditions are medically eligible for participation in the CCS program:

• Anemias due to abnormal production of red cells or hemoglobin.
• Anemias resulting solely from a nutritional deficiency, such as inadequate intake of iron, folic acid or Vitamin B-12 are eligible only when they present life-threatening complications.
• Hemolytic anemia, such as congenital spherocytosis, sickle cell disease, thalassemia, and erythroblastosis fetalis.
• Hemolytic anemias resulting from infection are eligible only when they present with life-threatening complications.
• Pancytopenia, such as congenital and acquired aplastic anemia.
• Disorders of leukocytes, such as acquired and congenital neutropenia and chronic granulomatous disease.
• Hemorrhagic diseases due to:
  • Coagulation disorders, such as hemophilia and von Willebrand disease.
  • Disorders of platelets that are life-threatening.
• Other disorders of blood and blood-forming organs that are life-threatening, such as polycythemia, hypersplenism and hypercoagulable states.

California Children's Services (CCS) applicants with at least one of the following conditions are medically eligible for participation in the CCS program:

• Diseases of the endocardium, myocardium or pericardium.
• Cardiac dysrhythmias requiring medical or surgical intervention.
• Diseases of blood vessels, such as embolism, thrombosis, aneurysms, and periarteritis.
• Cerebral and subarachnoid hemorrhage.
• Chronic diseases of the lymphatic system.
• Primary hypertension that requires medication to control.
• Congenital anomalies of the circulatory system that meet the criteria of Congenital Anomalies. 

California Children's Services (CCS) applicants with at least one of the following conditions are medically eligible for participation in the CCS program:

• Diseases of the liver, including:
  • Acute liver failure.
  • Chronic liver disease.
• Disorders of the gastrointestinal tract, including:
  • Chronic inflammatory diseases requiring complex ongoing medical management or surgical intervention, such as pancreatitis, peptic ulcer, ulcerative colitis, regional enteritis, diverticulitis, and cholecystitis.
  • Chronic intestinal failure.
• Gastroesophageal reflux when:
  • It is part of or complicates the management of a CCS-eligible condition.
  • It is an isolated condition with complications such as esophageal stricture or chronic aspiration pneumonia.
• Congenital anomalies of the digestive system that meet the criteria under Congenital Anomalies.

California Children's Services (CCS) applicants are eligible for participation in the CCS program for diagnostic services to determine the presence of a hearing loss when one of the following occurs:

• The applicant fails two pure tone audiometric hearing screening tests performed at least six weeks apart at levels not to exceed 25 decibels and at the minimum number of frequencies of 1,000, 2,000 and 4,000 hertz.
  • If this test is performed by an audiologist or otolaryngologist, only one exam is required for eligibility for diagnostic testing.
• The applicant fails to have normal auditory brain stem-evoked response.
• The applicant fails to have otoacoustic emission or behavioral responses to auditory stimuli as determined by two tests performed at least six weeks apart.
  • If this test is performed by an audiologist or otolaryngologist, only one exam is required for eligibility for diagnostic testing.
• The applicant fails to pass hearing screening provided through the Newborn and Infant Hearing Screening, Tracking and Intervention Program.
• The applicant exhibits symptoms that may indicate a hearing loss, such as poor speech for age or delay in age-specific behavioral milestones.
• The applicant has documentation of one of the risk factors associated with a sensorineural hearing or conductive hearing loss, such as:
  • A family history of congenital or childhood onset of hearing impairment.
  • Congenital infection known or suspected to be associated with hearing loss.
  • Craniofacial anomalies.
  • Hyperbilirubinemia at a level exceeding the indication for an exchange transfusion.
  • Ototoxic medications used for more than five days.
  • Bacterial meningitis.
• The applicant has severe depression at birth, defined as one of the following:
  • Apgar score of three or less.
  • Failure to initiate spontaneous respirations by ten minutes of age.
  • Hypotonia persisting to two hours of age.
• The applicant fails prolonged mechanical ventilation for the duration of at least 10 days.
• There is a finding of a syndrome known to be associated with hearing loss.

CCS applicants are eligible for participating in the CCS program for treatment services when one of the following is present:

• There is a hearing loss present, as defined by the following criteria:
  • Children over age five, a pure tone audiometric loss of 30 decibels or greater at two or more frequencies in the same ear tested at 500,1,000, 2,000, 3,000, 4,000, 6,000, and 8,000 hertz or a loss of 40 decibels or greater at any one frequency between and including 500 through 8,000 hertz.
  • Children ages three to five, a pure tone audiometric loss of 30 decibels or greater at any frequency tested at 500, 1,000, 2,000, 3,000, 4,000, 6,000, and 8,000 hertz.
  • In children unable to complete a pure tone audiometric test and whose auditory brain stem evoked response, or otoacoustic emission, or behavioral responses to auditory stimuli indicate hearing loss of 30 decibels or greater.
• Perforation of the tympanic membrane that requires tympanoplasty.
• Mastoiditis.
• Cholesteatoma.
• Congenital infection known or suspected to be associated with hearing loss.
• Craniofacial anomalies.
• Congenital anomalies of the ear and mastoid process that meet the criteria for Congenital Anomalies.

California Children's Services (CCS) applicants with at least one of the following eye conditions are medically eligible for participation in the CCS program:

• Strabismus, when surgery is required, and either until fusion is obtained or a visibly abnormal deformity is corrected.
• Infections that produce permanent visual impairment or blindness, such as keratitis and choroditis.
• Infections that require repeated ophthalmological treatment or surgery, such as chronic dacryocystitis.
• Other diseases that can lead to permanent visual impairment, such as:
  • Cataract.
  • Glaucoma.
  • Retinal detachment.
  • Optic atrophy or hypoplasia.
  • Optic neuritis.
  • Lens dislocation.
  • Retinopathy of prematurity.
  • Persistent hyperplastic primary vitreous.
  • Ptosis.
• Congenital anomalies of the eye that meet the criteria under Congenital Anomalies.

California Children's Services (CCS) applicants with at least one of the following conditions are medically eligible for participation in the CCS program:

• Acute glomerulonephritis in the presence of acute renal failure, malignant hypertension or congestive heart failure.
• Chronic glomerulonephritis, chronic nephrosis or chronic nephrotic syndrome.
• Chronic renal insufficiency.
• Obstructive uropathies.
• Vesicoureteral reflux, grade II or higher.
• Renal calculus.
• Congenital anomalies of the genitourinary tract that meet the criteria under Congenital Anomalies.

California Children's Services (CCS) applicants with at least one of the following conditions are medically eligible for participation in the CCS program:

• Acute and chronic suppurative infections of the joint.
• Chronic, progressive or recurrent inflammatory disease of the connective tissue or joints, such as rheumatoid arthritis, inflammatory polyarthropathy, lupus erythematosus, dermatomyositis, and scleroderma.
• Chronic, progressive or degenerative diseases of the muscles and fascia, such as myasthenias, myotonias, dystrophies, and atrophies that lead to atrophy, weakness, contracture and deformity, and motor disability.
• Intervertebral disc herniation.
• Scoliosis with a curvature of 20 degrees or greater.
• Other diseases of the bones and joints, except fractures, resulting in limitation of normal function and requiring surgery, complex customized bracing, or more than two castings.
• Congenital anomalies of the musculoskeletal system or connective tissue that meet the criteria under Congenital Anomalies.

Minor orthopedic conditions, such as tibial torsion, femoral anteversion, knock knees, pigeon toes, and flat feet that only require special shoes, splints or simple bracing, are not eligible.

California Children's Services (CCS) applicants with at least one of the following conditions are medically eligible for participation in the CCS program:

• Noninfectious diseases of the central and peripheral nervous system that produce a neurological impairment that is life threatening or disabling.
• Cerebral palsy, a non-progressive motor disorder with onset in early childhood resulting from a non-progressive lesion in the brain manifested by the presence of one or more of the following:
  • Rigidity or spasticity.
  • Hypotonia, with normal or increased deep tendon reflexes, and exaggeration of or persistence of primitive reflexes beyond the normal range.
  • Involuntary movements that are described as athetoid, choreoid or dystonic.
  • Ataxia, manifested incoordination of voluntary movement, dysdiadochokinesia, intention tremor, reeling or shaking of trunk and head, staggering or stumbling, and broad-based gait.
• Seizure disorder when either of the following occurs:
  • It is secondary to a CCS-eligible condition.
  • It is of unknown origin and one of the following exists:
    • The frequency or duration of the seizures requires more than four changes in dosage or type of medications in the 12 months preceding the initial or subsequent determination of medical eligibility.
    • The frequency or duration of the seizures requires three or more types of seizure medications each day.
    • The frequency or duration of the seizures requires at least monthly medical office visits for assessment of the applicant's clinical status and periodic blood tests for medication levels or presence of blood dyscrasia.
    • The applicant has an episode of status epilepticus, in which case medical eligibility extends for one year following that event.
• Congenital anomalies of the nervous system that meet the criteria under Congenital Anomalies.

When the eligibility criteria listed above have not been present for at least one year, eligibility ceases.

California Children's Services (CCS) applicants with at least one of the chronic conditions of the respiratory tract, such as the following conditions, are eligible for participation in the CCS program:

• Chronic pulmonary infections, such as abscess or bronchiectasis.
• Cystic fibrosis.
• Chronic lung disease (CLD) of infancy, such as bronchopulmonary dysplasia (BPD), when one or more of the following criteria are met:
  • History of care in a neonatal intensive care unit that includes all of the following:
    • Mechanical ventilation for more than six days.
    • Concentration of oxygen greater than 60 percent for more than four of the days of ventilation.
    • Need for supplemental oxygen for more than 30 days.
  • Presence of at least one of the following in an infant:
    • Radiographic changes characteristic of CLD, such as hyperinflation, areas of radiolucency, and areas of radio density due to peribronchial thickening or patchy atelectasis.
    • Impaired pulmonary function, as manifested by one or more of the following during a stable phase: increased airway resistance, increased residual capacity, decreased dynamic compliance, arterial CO₂ tension (PaCO₂) greater than 45, or arterial O₂ tension (PaO₂) less than 80.
    • Cardiovascular sequelae, such as pulmonary or systemic hypertension or right or left ventricular hypertrophy.
• Asthma, when it has produced CLD.
• Chronic disorders of the lung that are the result of chemical injury, metabolic disorders, genetic defects, or immunologic disorders other than asthma.
• Respiratory failure requiring ventilatory assistance.
• Hyaline membrane disease.
• Congenital anomalies of the respiratory system that meets the criteria under Congenital Anomalies.

California Children's Services (CCS) applicants with at least one of the following conditions are medically eligible for participation in the CCS program:

• Persistent or progressive diseases of the skin or subcutaneous tissue, such as pemphigus and epidermolysis bullosa, which:
  • Are disabling or life-threatening.
  • Require multidisciplinary management.
• Scars when surgery is required and at least one of the following criteria is met:
  • There is limitation of or loss of mobility of a major joint, such as the ankle, knee, hip, wrist, elbow, or shoulder.
  • They are disabling or severely disfiguring.
• Congenital anomalies of the skin or subcutaneous tissue that meet the criteria under Congenital Anomalies.

California Children's Services (CCS) applicants with at least one of the following conditions are medically eligible for participation in the CCS program:

• Diseases of the pituitary, thyroid, parathyroid, thymus, and adrenal glands.
• Growth hormone deficiency (eligible without qualifiers).
• Diseases of the ovaries or testicles in which there is delayed onset of puberty, primary amenorrhea after the age of 15, sexual development prior to the age of eight, feminization of a male, or virilization of a female.
• Diseases of the pancreas resulting in pancreatic dysfunction.
• Diabetes mellitus (eligible without qualifiers).
• Diseases due to congenital or acquired immunologic deficiency manifested by life-threatening infections, as determined from medical information about the applicant's clinical course and laboratory studies.
• Inborn errors of metabolism, such as phenylketonuria, homocystinuria, galactosemia, glycogen storage disease, and maple syrup urine disease.
• Cystic fibrosis.

California Children's Services (CCS) applicants diagnosed with at least one of the following are medically eligible for participation in the CCS program:

• Infections of the bone, such as osteomyelitis and periostitis.
• Infections of the eye when the infection, if left untreated, may result in permanent visual impairment or blindness.
• Infections of the central nervous system producing a neurological impairment that results in physical disability requiring surgery or rehabilitation services to regain or improve function, such as movement or speech, which was limited or lost as a result of the infection.
• Infections acquired in utero and for which medically necessary postnatal treatment is required, such as toxoplasmosis, cytomegalovirus infection, rubella, herpes simplex, and syphilis.
• HIV, when confirmed by laboratory tests.

The following criteria are used to determine California Children's Services (CCS) medical eligibility for admission into a CCS-approved neonatal intensive care unit (NICU).

An infant is medically eligible for care in a CCS-approved NICU when one of the following conditions are met:

• There is the presence of a CCS-eligible medical condition.
• One of the following services is required (medical eligibility continues only for the duration needed to deliver the service):
  • Positive pressure ventilatory assistance that is invasive or non-invasive; the latter includes, but is not limited to, continuous positive airway pressure (CPAP) by nasal prongs, nasal cannula or face mask.
  • Supplemental oxygen concentration by hood of greater than or equal to 40 percent.
  • Maintenance of an umbilical arterial catheter or peripheral arterial catheter for medically necessary indications including, but not limited to, monitoring blood pressure, sampling of blood for monitoring blood gases, and exchange transfusions.
  • Maintenance of an umbilical venous catheter or other central venous catheter for medically necessary indications including, but not limited to, pressure monitoring, cardiovascular drug infusions, hypertonic solutions, and exchange transfusions.
  • Maintenance of a peripheral line for intravenous pharmacologic support of the cardiovascular system.
  • Central or peripheral hyperalimentation.
  • Chest tube.
• Two of the following services are required (medical eligibility continues only for the duration needed to deliver the services):
  • Supplemental inspired oxygen.
  • Maintenance of a peripheral intravenous line for administration of fluids, blood, blood products, or medications other than those agents used in support of the cardiovascular system.
  • Pharmacologic treatment for apnea or bradycardia episodes.
  • Tube feedings.

  Medical eligibility for CCS ceases when the infant does not have a CCS-eligible condition or no longer meets the criteria defined above.

There are two separate groups of children served in the California Children's Services (CCS) Medical Therapy Program.

CCS applicants with one of the following conditions are medically eligible for participation in the Medical Therapy Program:

• Cerebral palsy as specified in Diseases of the Nervous System section above.
• Neuromuscular conditions that produce muscle weakness and atrophy, such as poliomyelitus, myasthenias and muscular dystrophies.
• Chronic musculoskeletal and connective tissue diseases or deformities, such as osteogenesis imperfecta, arthrogryposis, rheumatoid arthritis, amputations, and contractures resulting from burns.
• Other conditions manifesting the findings listed in Diseases of the Nervous System, such as ataxias, degenerative neurological disease or other intracranial processes.

CCS applicants under age three are eligible when two or more of the following neurological findings are present:

• Exaggerations of or persistence of primitive reflexes beyond the normal age (corrected for prematurity).
• Increased deep tendon reflexes that are 3+ or greater.
• Abnormal posturing as characterized by the arms, legs, head, or trunk turned or twisted into abnormal position.
• Hypotonicity, with normal or increased deep tendon reflexes, in infants under one year of age (infants one year of age or older must meet criteria described in Diseases of the Nervous System).
• Asymmetry of neurological motor findings of trunk or extremities.

California Children's Services (CCS) applicants with a mental disorder, whose application is based on that disorder, are not medically eligible for the CCS program. CCS applicants with mental retardation, whose application is based on that condition, are not medically eligible for the CCS program.

CCS applicants with a mental disorder or mental retardation may be eligible only when the mental disorder is associated with or complicates an existing CCS-eligible condition.

California Children's Services (CCS) applicants with at least one of the following conditions are medically eligible for participation in the CCS program:

• All malignant neoplasms, including leukemia.
• A benign neoplasm when either of the following is present:
  • The neoplasm is physically disabling or severely disfiguring.
  • The neoplasm is located contiguous to or within a vital organ or body part, and its continued growth or lack of treatment would limit or eliminate the function of the organ or body part or lead to the death of the applicant.