What is the California Kids Care plan?

It is often difficult for CCS families to know where to go and what to do to make sure their child or young adult gets everything they need. This project is focused on finding and removing roadblocks to families getting the care they need for their child or young adult. It focuses on what we can do better within Medi-Cal and CCS to get the child what they need. It is NOT about changing providers or benefits.

I currently have CCS, am I losing benefits or are they changing?

You are not losing benefits. This program is focused on helping families get better coordination of care. Hopefully, any changes you notice should mean that getting care is easier for you. If not, we want to hear about your experience. We are here to fix problems with getting care.

How will California Kids Care help my child get what they need?

A Care Navigator, which is a nurse that has experience working with children with special healthcare needs, will be assigned to help your family. This nurse will help set up appointments with your doctors, help you understand the treatment given to your child, and will help you find other services such as behavioral health, vision and dental. If you have questions about your child’s treatment or need help getting care, you can always call your Care Navigator or CKC Member Services at 1-844-225-5430 (TTY 711).

What is it like to participate in California Kids Care?

Once you have selected your child’s PCP, who will be the team leader of your child’s medical home,  here is what to expect:

  • The Care Navigator assigned to your child will reach out to you to schedule an appointment (Initial Health Assessment) and develop a Care Plan. In addition to welcoming your child to the Medical Home and providing program information, the Care Navigator will ask for basic information about your child’s current and overall health status so that goals can be set to support your child’s care needs.
  • The Care Navigator will also communicate important information, how you can communicate with your Care Navigator anytime regarding your child’s care or accessing urgent care, and important contact information for California Kids Care Members.

What is a Medical Home Team?

The Medical Home Teams are made up of your PCP, Care Navigator, Patient Care Coordinator, any specialists providing care, and your family. The Medical Home Team will set up your child’s Care Plan, the guide for determining the goals, actions, and treatment for achieving optimal health and successful condition management.

As a parent, what is my role on the Medical Home Team?

Parents/Caregivers are an important part of the Team! Parents can help with bringing information to appointments.

I keep hearing that California Kids Care uses the “Family Centered Care” model. What does that mean?

California Kids Care believes that it is important to involve families in decisions about their child’s healthcare. We promise to always treat your family with respect and dignity. This means that we will talk with you about your child’s treatment, listen to your thoughts, and answer your questions. We will work with your family to help your child get better.

I have also heard that California Kids Care treats the “Whole Child”. What does that mean?

This means that we will not only treat the immediate problem that your child is having. We will coordinate all of your child’s’ CCS and non-CCS needs.

Do I need to designate a primary care provider?

Yes. Once you have been enrolled in California Kids Care the first step is to select a PCP to provide primary care services for your child. If you do not select a PCP, then California Kids Care will select a PCP for your child based on such criteria as geographic proximity to your home, language preference, and the provider’s capacity to take on new patients.

Does my child need to receive all his/her care from the Medical Home Team?

To maximize the benefits of being a California Kids Care Member and to ensure that your child receives the best coordinated care, most of your child’s care should be provided by the medical home. The Medical Home model succeeds because it allows the patient and providers furnishing regular care to develop a solid working relationship and it affords the provider an opportunity to follow-up on the patient’s success in adhering to Care Plan recommendations.

Do I need to get a referral to see a specialist?

One of the roles of your medical home team, particularly the Care Navigator, is to help coordinate your child’s care with specialists. Care Navigators and PCP will be responsible for coordinating all of your child’s specialty care and ensuring that access is not an issue. When your child needs specialty care, the Medical Home Team will ensure that appointments are readily available to meet your care needs. Specialists in the program will maintain appointment availability to handle urgent requests for care, particularly those related to your child’s CCS condition.

How can I maximize the benefits of my child’s participation in California Kids Care?

To get the most from your California Kids Care Membership and the patient-centered medical home experience, it is essential to embrace all of the California Kids Care features, including using preventive care benefits, following through with actions outlined in the Care Plan, getting to know your team of health care professionals, and using the tools and resources available to Members for promoting health and wellness. Parents can also participate in the Family Advisory Committee and participate in program initiatives, promote meaningful dialogue, and advocate for program improvements.

My child has a chronic condition but is stable and healthy. What will my child’s experience be like as a CKC Member?

If you find that you don’t need to schedule an immediate appointment with a specialist, you will still gain important information as a result of contact with your child’s Care Navigator and the PCP as part of the Initial Health Assessment. You’ll collaborate on building a Care Plan to ensure that your child continues to maintain high levels of general health and functionality and you will learn how to access care when your child needs it.

My child’s condition is stable, but I think he/she could improve some lifestyle behaviors. How can CKC help?

If lifestyle support needs are discovered during the outreach (e.g., tobacco use, diet issues, exercise support needs, poor sleep habits) contact your Care Navigator. Together you, your child, the Care Navigator, and the PCP can explore and determine what the best next steps are to make appropriate lifestyle changes. These interventions will be added to the Care Plan.

What happens if I miss appointments?

California Kids Care understands that parents or caregivers lead hectic stressful lives trying to manage their child’s healthcare needs. However, successful implementation of the Care Plan requires follow-through and attending scheduled appointments. If there is a regular pattern of missed appointments, the Care Navigator will connect with you to resolve the issues that are making access and follow-through difficult. California Kids Care wants to help address any issues that make it difficult for you to get to an appointment or follow the Care Plan. CKC can provide transportation (see Member Handbook).

How long do I have to wait for appointments for my child?

Type of Care and Service California Kids Care Standards
Emergency Care Immediately
Routine or Non-Urgent Primary Care Appointments Within ten (10) working days of the request
Routine or Non-Urgent Care Appointments with a Specialist Within fifteen (15) working days of the request
 Urgent Care Appointments For services that do not require prior authorization: within  forty-eight (48) hours of the request.
For services that do require prior authorization: within ninety-six (96) hours of request.
Routine or Non-Urgent Care Appointment for Ancillary Services Within fifteen (15) working days of the request
Routine or Non-Urgent Care Appointment with a Non-Physician Mental Health Provider Within ten (10) working days of the request
Initial Health Assessment Within sixty (60) calendar days of enrollment